The intramedullary nailing is one of the most available method in the treatment of femoral shaft fracture. Since the development of Küntscher nail in 1940, new designs such as the Grosse-Kempf interlocking femoral nail, Ressell-Taylor Femoral nial, AO/ASIF universal nail, ACE titanium nail became widely used by more applicable level of femoral shaft fracture. But complication of intramedullary nailing was rarely seen. The authors analyzed the clinical and mechanical factors predisposing to failures of intramedullary interlocking nails in 6 cases whom treated the comminuted fracture of the femoral shaft, at the department of orthopaedic surgery, Sun General Hospital from 1991 to 1995 and the following results are obtained. 1. Initial fracture patterns were comminuted in all 6 cases. 2. The implant nails were AO nail in 4 cases, Grosse-Kempf nail in 1 case, Russell-Taylor nail in 1 case(nail diameter was 10mm to 12mm). 3. The failure sites of the interlocking nail were the initial bone fracture site in 2 cases, distal to the proximal screw hole in 1 case, proximal to the distal screw hole in 2 cases, fracture site and distal to the proximal screw hole in 1 case. 4. The average time to failure of implants were 11.5 months. 5. The average times to partical weight bearing were 6.3 weeks. In the analy of above results, by using diameter of nail more than 13mm and delaying weight bearing on the injured limb until there is clear radiographic evidence of early union of the femur fracture, we may reduce the metal failures of intramedullary interlocking nail in comminuted femoral shaft fractures.
Extremities ; Femur ; Fracture Fixation, Intramedullary ; Fractures, Bone ; Fractures, Comminuted ; Hospitals, General ; Methods ; Solar System ; Titanium ; Weight-Bearing

Fibular fractures that begin proximal to the tibial plafond are assumed to include an injury of the syndesmosis. Many surgeons have treated this injuries by rigidly repairing the medial and lateral malleoli with trans-syndesmotic fixation. However, recently, some demonstrated that a trans-syndesmotic screw places biomechanical restrictions on the tibiotalar joint and is not required to maintain the integrity of the distal tibiofibular joint in cadava models. Thirty eight patients of ankle fracture with syndesmotic injury treated at Sun General Hospital from January 1989 to June 1994 week analyzed in clinical and radiologic aspect. The results obtained from this study were as followings. 1. If rigid anatomic medial and lateral joint fixation was obtained, syndesmotic screw fixation was not required to maintain the integrity of the syndesmotic. 2. Repairting the deltoid ligament did not enhance treatment results when fibular fracture and syndesmotic had been fixed anatomically. Therefore, we believe that syndesmotic screw fixation was indicated only when medial and lateral stabilization could not be achieved adequately.
Ankle Fractures ; Ankle Injuries ; Ankle ; Hospitals, General ; Humans ; Joints ; Ligaments ; Solar System ; Surgeons

Irreducible knee dislocation among acute knee dislocations is very rare. If reduction and treatment are not performed early, serious complications such as skin necrosis, vascular and nerve injury, compartment syndrome, and instability can occur. So far, treatment options, such as two-staged operation with early open reduction and delayed ligaments reconstruction or repair, one-staged arthroscopic reduction without ligaments reconstruction or repair, one-staged operation with open reduction and ligaments reconstruction have been reported for the irreducible knee dislocation. In this case, the authors have found satisfactory results following one-staged operation with open reduction and primary ligament suture after diagnosing the exact injury site using magnetic resonance imaging preoperatively.

PURPOSE: We have performed total knee arthroplasty for treating valgus and varus in the knees of one person. We investigated the clinical characteristics of these patients and the relationship between the kind of deformity and the postoperative result. MATERIALS AND METHODS: From March 2002 to May 2005, fourteen patients who had simultaneous varus and valgus knee deformities underwent total knee arthroplasties and they were followed for more than 12 months, and these were the subjects of our study. The average age was 64.6.years and the average follow-up period was 18.4 months. Follow-up imaging assessments were done and the clinical outcomes were evaluated using the HSS score at the last follow-up. RESULTS: Nine cases had more pain in the varus knee preoperatively and two cases had more pain in the valgus knee preoperatively. In 8 cases, degenerative scoliosises were associated with the knee deformity and among these cases, seven cases had vlagus deformities in the right knees. In two cases, hip deformities were noted in the ipsilateral side of the valgus deformity. The preoperative mean valgus angle and varus angle was 10.5 degrees and 7.8 degrees, respectively. The postoperative valgus and varus angle improved to 6.8 and 6.0 degree, respectively. The HSS score improved from 64.7 to 86.0 points for the valgus deformities and from 61.5 to 86.9 points for the varus deformities. Postoperative patellar clunk syndrome was identified in one valgus knee and arthroscopic resection was then performed. The knee had completely recovered on the last follow-up. CONCLUSION: Simultaneous or staged total knee arthroplasties in patients with simultaneous varus and contralateral valgus knee deformities achieved satisfactory outcomes with regard to the objective orthopedic criteria as well as the overall patient satisfaction in terms of pain relief and function. We found that scoliosis and ipsilateral hip deformities concurred with knee deformities, and this indicated that hip deformity and scoliosis are related with knee deformities. We found no significant difference between the kind of deformity and the postoperative result, yet a prospective study with more cases and longer follow-up is recommended in the future to reaffirm our findings.
Arthroplasty ; Congenital Abnormalities ; Follow-Up Studies ; Hip ; Humans ; Knee ; Orthopedics ; Patient Satisfaction ; Scoliosis

A Brodie's abscess is a localized form of subacute or chronic osteomyelitis that occurs most often in the long bones of the lower extremities of young adults. Before physeal closure, it most commonly occurs in the metaphysis. In adults, the metaphyseal-epiphyseal area is involved. Rarely Brodie's abscess traverses the open growth plate, affecting the epiphysis, although such extension does not commonly result in growth disturbance. We reported a subacute osteomyelitis that traversed the physis of the distal tibia in a child, which was treated by surgical curettage and intravenous antibiotics.
Abscess ; Adult ; Anti-Bacterial Agents ; Child* ; Curettage ; Epiphyses ; Growth Plate ; Humans ; Lower Extremity ; Osteomyelitis* ; Tibia* ; Young Adult

It is been known that the deltoid ligament of the ankle joint plays an important role in the stabiliy of the ankle joint. In cases of deltoid ligament rupture, associated with lateral malleolar fractures, cannot be maintained the integrity of the mortise and the stability of the talus. Controversy remains about the treatment of deltoid ligament injuries. Many authors advocate an operative repair for deltoid ligament ruptures for optimal reduction of lateral malleolar fracture. However, according to recent cadaveric studies and many satisfactory results of clinical studies, excellent results have been reported regarding the ankle joint stability by anatomical reduction of the lateral structure, but only without surgical repair of the medial structure. Fourteen patients with lateral malleolar fractures with associated deltoid ligament injuries treated at Sun General Hospital between January 1990 and June 1995. There were examined clinically and radiologically. We concluded that deltoid ligament repairs should be considered unnecessary as long as fibular fracture are stabilized anatomically with normal medial joint space. However, in cases with higher fracture levels of lateral malleolus, associated with syndesmotic injury, we recommend syndesmotic screw fixation or deltoid ligament repair.
Ankle ; Ankle Injuries ; Ankle Joint ; Cadaver ; Fibula* ; Hospitals, General ; Humans ; Joints ; Ligaments* ; Rupture ; Solar System ; Talus

Recurrent spontaneous hemarthrosis is a relatively rare complication of total knee arthroplasty. This paper reports a case of a patient treated with arterial embolization for recurrent spontaneous hemarthrosis even after undergoing arthroscopic surgery. The patient had several relapses after total knee arthroplasty.

The purpose of this study was to investigate the ultrasonographic features of flexor hallucis longus (FHL) tenosynovitis in sports players. High-resoluted ultrasound was used to measure the thickness and echogenicity of the flexor hallucis longus at the posteromedial ankle, especially the fibro-osseous tunnel, for 60 sports players (120 feet). They were compared with their asymptomatic feet. There were two group; group 1 was symptomatic feet, 2 was asymptomatic. The 36 males (72 feet) and 24 females (48 feet) had an average age of 21.3 years (range, 18.23 years). Thickness, echogenicity of the tendon on each group were evaluated by the ultrasonography and the results were statistically analyzed. The mean thickness of the FHL on group 1 was 3.4+/-1.2 mm, 2.1+/-1.3 mm on group 2. There was significant difference between two groups (p=0.002). The thickness of FHL based on gender and location was not significant different (p>0.05). For group 1, increased thickness of the FHL and reduced echogenicity, peritendious fluid collection were observed in ultrasonographic findings.Increased thickness (>3 mm) and hypoechoic lesion, peritendinous fluid collection of the tendon were sonographic findings at the posteromedial ankle in the FHL tenosynovitis. The authors suggested that Ultrasonography is a valuable and alternative tool for the evaluation of FHL tenosynovitis.
Ankle ; Athletes ; Female ; Foot ; Foot Diseases ; Humans ; Male ; Sports* ; Tendons ; Tenosynovitis* ; Ultrasonography

Authors report a case of cystic tuberculosis of left olecranon in a 44 year-old woman, which mimicked the bone tumor at initial presentation. She complained mild discomfort in the left elbow over a month. On examination there were no local redness, swelling, tenderness and deformity. There was no limitation of left elbow motion. After open curettage of the lesion, bone tuberculosis was confirmed by histological study. Postoperative triple chemotherapy of 12 months (Rifamcpicin, ethambutal, INH) could cure the disease.
Congenital Abnormalities ; Curettage ; Elbow ; Female ; Humans ; Olecranon Process ; Tuberculosis ; Tuberculosis, Osteoarticular

PURPOSE: This study aimed to evaluate the outcomes, including the complications, of open reduction and internal fixation using a headless cannulated compression screw for a fifth metatarsal base fracture. MATERIALS AND METHODS: We retrospectively investigated 11 patients with 5th metatarsal base fracture who were treated with a headless cannulated compression screw. The mean follow-up period was 13 months (8~15 months), and the mean age was 46.5 years (21~70 years). We analyzed the patients' sex, age, time to union, amount of fracture displacement, and complications. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score was used for clinical assessment. RESULTS: The average amount of displacement decreased significantly from 3.4 mm (2.1~5.2 mm), preoperatively, to 0.4 mm (0~1.3 mm), postoperatively (p<0.001). The average bone union time was 54.1 days (41~68 days). There were no complications, such as a metal failure, irritation, and loss of a reduction. The mean AOFAS midfoot score was 97.7 (90~100) at 6 months, postoperatively. CONCLUSION: We suggest that a headless cannulated compression screw for 5th metatarsal base fracture is a useful and alternative method for a firm fixation without complications.
Ankle ; Follow-Up Studies ; Foot ; Humans ; Metatarsal Bones* ; Methods ; Retrospective Studies