To explore the relationship in terms of time scale between pre-operative expectations and postoperative outcomes and satisfaction after Hallux valgus surgery. A patient derived questionnaire was developed and 30 patients aged 19 to 67 were included undergoing primary hallux valgus correction with a first metatarsal osteotomy and distal soft tissue release. Patients were asked pre-operatively to quantify their expected time scale for improvement in pain, ability to walk unaided, ability to drive, routine foot wear and foot feeling normal at 6 weeks, 3 and 6 months following surgery, and to indicate their confidence in achieving this result. Patients recorded postoperative outcomes achieved at number of weeks. Ordinal logistic regression multivariate modelling was used to examine predictors of postoperative satisfaction.Purpose
Methods
Olecranon plates used for the internal fixation of complex olecranon fractures are applied directly over the triceps tendon on the posterior aspect of the olecranon. The aim of the study is to describe the relationship of the plates and screws to the triceps tendon at the level of the olecranon. Eight cadaveric elbows were used. Dimensions of the triceps tendon at the insertion and 1cm proximal were measured. A long or a short olecranon plate was then applied over the olecranon and the most proximal screw applied. The length of the plate impinging on the tendon and the level of the screw tract on the tendon and bone were measured. The mean olecranon height was 24.3cm (22.4-26.9cm) with a tip-to-tendon distance of 14.5cm (11.9-16.2cm). The triceps tendon footprint averaged 13.3cm (11.7-14.9cm) and 8.8cm (7.6-10.2cm) in width and length, respectively. The mean width of the central tendon 1 cm proximal to the footprint was 6.8 cm. The long olecranon plate overlay over more movable tendon length than did the short plate and consequently the superior screw pierced the triceps tendon more proximally with the long plate. Using the Mann-Whitney U test, the differences were significant. The long olecranon plates encroach on more triceps tendon than short plates. This may be an important consideration for olecranon fractures with regards implant loosening or triceps tendon injury.
The incidence of atypical femoral fractures (AFFs) continues to increase. However, there are currently few long-term studies on the complications of AFFs and factors affecting them. Therefore, we attempted to investigate the outcomes, complications, and risk factors for complication through mid-term follow-up of more than three years. From January 2003 to January 2016, 305 patients who underwent surgery for AFFs at six hospitals were enrolled. After exclusion, a total of 147 patients were included with a mean age of 71.6 years (48 to 89) and 146 of whom were female. We retrospectively evaluated medical records, and reviewed radiographs to investigate the fracture site, femur bowing angle, presence of delayed union or nonunion, contralateral AFFs, and peri-implant fracture. A statistical analysis was performed to identify the significance of associated factors.Aims
Methods
Most surgeons that have performed kinematically aligned TKA have noticed an overall better clinical outcome, better motion, better patient satisfaction, and a quicker recovery than their patients treated with mechanically aligned TKA. We prospectively followed all 128 knees who underwent primary total knee arthroplasty. The Lysholm knee Introduction
Materials and Methods
The purpose of this study was to demonstrate postoperative improvement and high satisfaction rates after a surgical approach that includes arthroscopic labral repair only, in patients with borderline dysplasia, without instability. Between September 2009 and December 2011, patients less than 50 years old who underwent hip arthroscopy for symptomatic intra-articular hip disorders, with a lateral center-edge (CE) angle between 20 and 25, were included in this study. Patients with Tönnis grade 2 or greater, hip joint space narrowing, severe hip dysplasia, hip joint instability and Legg-Calve-Perthes disease were excluded. Patient-reported outcome scores, including the modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Arthritis index (WOMAC), and visual analog scale (VAS) for pain were obtained in all patients preoperatively and at 1, 2, and 3 years postoperatively.Purpose
Methods
The goal of total knee arthroplasty (TKA) is to relieve pain and restore the function of the knee joint. Recently the number of TKA cases in Korea has increased considerably with increase in elderly population and change in life style. Accordingly, demand for TKA design that is capable of better accommodating anatomical dimensions and life styles of Koreans is also on the rise. During the prototype design process for the Korean-TKA, different stem and keel designs of the tibial base plate have been attempted to improve fixation and longevity of the implant. In this study, we conducted a biomechanical analysis of the tibial base plate using finite element analysis (FEA). Specifically, biomechanical effects of insert positioning in the tibia were assessed to investigate the likelihood of tibial fracture and implant loosening due to mal-positioning of the implant. A 3-D finite element(FE) models of the left femur, patella, and tibia were developed from computed tomography (CT) scan data (a normal Korean male, 27 years of age, 70 kg). 2-D truss elements were chosen to represent ligamentous structures such as lateral &
medial collateral ligament, posterior cruciate ligament, patella tendon and patella ligament. Nonlinear elastic materal properties for the soft-tissue structures were also adopted from literatures. The surgical model was then constructed after inserting Korean-TKA prototype in the intact model. Here, the implant was the posterior cruciate ligament retaining type (CR) with the fixed bearing system. To simulate loading on the knee joint in heel strike and toe off positions, 15° and 45° flexions of the femur orientation were simulated under the compressive load of 3.8 and 5.7 times of body weight (BW= 700N), respectively, in a uniform pressure at the horizontal section of the femur. The tibia was assumed to be completely constrained. The surgical position of the tibial insert was varied from the center either to the medial or to the lateral direction by 3-mm. The peak von mises stresses (PVMS) at the stem and the keel regions of the tibial insert were assessed. With respect to the central positioning the lateral shift of the tibial plate resulted in higher PVMS than the medial. Particularly, increases of 24.5 %, 29.8%, and 28.4% were observed at the stem, the lateral keel, and the medial keel, respectively, due to lateral mal-positioning of the implant. With the medial shift, on the other hand, PVMS increase remained at around 6% level at the stem and the lateral keel. A decrease of 4.5 % was noted at the medial keel region. In this study, a computational approach was used to evaluate biomechanical effect of tibial plate positioning on the stress distribution within the implant. The lateral mal-positioning showed more stress concentration than the medial. This may be due to the fact that body weight is transmitted more to the lateral portion of the tibia (5.5:4.5) that is smaller and thinner than its counterpart. These results suggest that the lateral deviation of the implant can be more likely cause TKR loosening and tibial fracture.
We carried out an MRI study of the lumbar spine in 15 patients with achondroplasia to evaluate the degree of stenosis of the canal. They were divided into asymptomatic and symptomatic groups. We measured the sagittal canal diameter, the sagittal cord diameter, the interpedicular distance at the mid-pedicle level and the cross-sectional area of the canal and spinal cord at mid-body and mid-disc levels. The MRI findings showed that in achondroplasia there was a significant difference between the groups in the cross-sectional area of the body canal at the upper lumbar levels. Patients with a narrower canal are more likely to develop symptoms of spinal stenosis than others.
Stable fixation after a corrective supracondylar osteotomy in adults is difficult because of the irregularity of the area of bony contact, displacement of the fragments, the predominance of cortical bone, and the need for early mobilisation. We have used the Ilizarov apparatus for fixation in 15 patients who were treated by complex osteotomies with displacement of fragments for cubitus varus or valgus. Most patients with cubitus varus required medial displacement with rotation of the distal fragment. Those with cubitus valgus required lateral shift of the distal fragment to reduce the medial prominence of the elbow that would otherwise result. All osteotomies united within the expected time without loss of correction, despite early mobilisation. Complications related to the fixation were few and had resolved at the long-term follow-up.
We performed a randomised trial on 37 hips (33 patients) with early-stage osteonecrosis (ON). After the initial clinical evaluation, including plain radiography and MRI, 18 hips were randomly assigned to a core-decompression group and 19 to a conservatively-treated group. All the patients were regularly followed up by clinical evaluation, plain radiography and MRI at intervals of three months. Hip pain was relieved in nine out of ten initially symptomatic hips in the core-decompression group but persisted in three out of four initially painful hips in the conservatively-treated group at the second assessment (p <
0.05). At a minimum follow-up of 24 months, 14 of the 18 core-decompressed hips (78%) and 15 of the 19 non-operated hips (79%) developed collapse of the femoral head. By survival analysis, there was no significant difference in the time to collapse between the two groups (log-rank test p = 0.79). Core decompression may be effective tin symptomatic relief, but is of no greater value than conservative management in preventing collapse in early osteonecrosis of the femoral head.
