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There has been no prior study to demonstrate the relationship between the occurrence of fragility fractures of the pelvis and its morphology. The aim of this study was to investigate the effect of pelvic morphology on fragility fractures of the pelvis caused by low-energy trauma in elderly female patients. As a normal pelvis group, 643 female patients over 65 years of age who underwent pelvic CT were collected. Using three-dimensional multiplanar reconstruction (3D-MPR) function of RadiAnt software, the DT (diameter of transverse true pelvis)/DS (diameter of sagittal true pelvis) values of normal pelvis were measured. Sorted in ascending order, the mean DT/DS value of normal pelvis was 1.13 ± 0.09. The values corresponding to the 25th percentile and the 75th percentile were 1.06 and 1.18, respectively. We arbitrarily named DT/DS values of 1.06 or less corresponding to lower than 25th percentile as ‘Circle types’, and DT/DS values of 1.18 or higher corresponding to higher than 75th percentile as ‘Ellipse types’. Total of 76 female patients over 65 years of age who underwent 3D reconstructions of pelvic CT scans with fragility fractures of the pelvis, who fell into the criteria corresponding to FFP classification type II, were studied separately. Of the 76 female FFPs, two were FFP type IIa, 32 were FFP type IIb, and 42 were FFP type IIc. Their DT/DS was measured. Based on the above mentioned criteria, we classified the pelvis shape of 76 patients with fragility fracture of the pelvis type II. 33 patients (43.4%) were classified as circle types and eight patients (10.5%) were classified as ellipse types. The odds ratio of “circle type” for fragility fractures of pelvis type II was 4.1. With digital reconstruction and 3D measurement of normal adult pelvic CT scans, this study obtained a series of DT/DS values describing the shape of true pelvises. Circle-type true pelvis was found to be more common in patients with fragility fracture of the pelvis type II.

Unicondylar femoral fractures are uncommon injuries, known to occur primarily in young people, with high energy trauma. However, according to our experiences, unicondylar femoral fractures in geriatric patients generally involved the medial femoral condyle, unlike previously reported. In addition, the fractures of medial femoral condyle (FMFC) showed a characteristic fracture pattern. To date, there has been no published article focusing on the FMFC in geriatric patients. Thus, the aim of this study was to determine the characteristics of FMFC in geriatric patients and to present their outcomes. We retrospectively reviewed the medical records of 13 patients over age of 65 who underwent surgery for FMFC (AO-OTA 33B2). Of the 13, 10 patients were treated with Tomofix medial distal femoral plate (MDF) (Synthes GmbH, Switzerland) and additional screws fixation; the other three were treated with screw fixation and cast application. The mean age of patients was 76.8 years, and 10 patients were females. The fracture was due to low-energy trauma in all of the cases. Eight patients had medial knee osteoarthritis, and 2 patients were on osteoporosis treatment. A characteristic fracture pattern was observed. The fracture line extended from the lateral aspect of the intercondylar notch to the posteromedial column of the distal femur, with a characteristic medial beak. All fractures belonged to AO classification 33B2.1; there were no cases of AO classification 33B2.2 or 33B2.3. The postoperative joint function was graded according to the Kolmert functional criteria: ten cases were excellent, one case was good, one case was fair, and one case was poor. FMFC caused by low-energy trauma in geriatric patients tend to have a characteristic pattern. We believe that anatomic reduction and firm fixation with Tomofix MDF plate and cannulated screw for low-energy trauma FMFC in geriatric patients would yield good outcomes.

There have been no prior case series of isolated iliac wing fracture (IIWF) due to low-energy trauma in geriatric patients in the literature. The aim of this study was to describe the characteristics of IIWF in geriatric patients, and to present a case series of IIWF in geriatric patients who underwent our minimally invasive screw fixation technique named ‘iliac pillar screw fixation’. We retrospectively reviewed six geriatric patients over 65 years old who had isolated iliac wing fracture treated with minimally invasive screw fixation technique between January 2006 and April 2016. Six geriatric patients received iliac pillar screw fixation for acute IIWFs. The incidence of IIWFs was approximately 3.5% of geriatric patients with any pelvic bone fractures. The main fracture line exists in common; it extends from a point between the anterosuperior iliac spine and the anteroinferior iliac spine to a point located at the dorsal 1/3 of the iliac crest whether fracture was comminuted or not. Regarding the Koval walking ability, patients who underwent iliac pillar screw fixation technique tended to regain their pre-injury walking including one patient in a previously bedridden state. The visual analog scale score for pain at the last follow-up was quite satisfactory. Union was achieved in all patients at the last follow-up. Geriatric patients can have a form of IIWF caused by low-energy trauma that is a type of fragility fracture of the pelvis. Because subsequent deterioration of their walking status followed by a long period of non-weight bearing in geriatric patients could be as threatening as the fracture itself, the treatment paradigm for IIWF due to low-energy trauma in geriatric patients should differ from that due to high-energy trauma in most patients. In these types of fractures, minimally invasive surgical management that includes iliac pillar screw fixation can lead to good outcomes.

To control such a hemorrhage, a displaced pelvic ring must be rapidly reduced and stabilized with a pelvic binder, an external fixator, or a pelvic clamp. Among them, pelvic clamps can be life-saving but pin malposition may cause vascular complications. We present a case of superior gluteal artery pseudoaneurysm caused by AO pelvic C-clamp pin malposition.

Periprosthetic bone loss may lead to major complications in hip arthroplasty, including aseptic loosening, implant migration, and even periprosthetic fracture. Such a complication leads to revision surgeries, which are expensive, technically demanding, and result in a low satisfaction rate. Therefore, a study was conducted of the factors affecting the periprosthetic bone loss around the stem that caused these complications. Factors influencing periprosthetic bone loss include demographic factors such as age, sex, obesity, smoking, and comorbidity including diabetes and osteoporosis. The implant design and fixation method are also factors that are determined before surgery. In addition, there are surgical factors, such as surgical approach and surgical technique, and we wish to investigate the factors affecting periprosthetic bone loss around the stem by comparing the effects of postoperative rehabilitation protocols and osteoporosis drugs.

Introduction The quadratus femoris muscle has not attracted attention as a structure for surgical exposure during posterior hip approaches. We sought to introduce a modified posterior approach through the quadratus femoris muscle area only, by flap osteotomy, which we have named the quadratus femoris osteotomy (QFO) approach. We compare this with the conventional posterior approach to determine the effectiveness of the new technique. Methods We retrospectively reviewed the medical records of 329 patients (383 hips) who had undergone primary total hip arthroplasty (THA) between March 2006 and January 2013 by a single hip surgeon. The conventional group consisted of consecutive 118 patients (138 hips) who had undergone THA using the conventional posterior approach. The QFO group consisted of consecutive 101 patients (120 hips) who were treated with THA using the QFO approach. Results The 2-year postoperative average Harris hip score were 88.8 ± 6.6 in the conventional group and 93.1 ± 6.9 in the QFO group. The 2-year postoperative average WOMAC scores were 20.8 ± 6.7 in the conventional group and 14.1 ± 6.6 in the QFO group. Complications in the conventional group were 2 deep vein thrombosis (DVT)s, 1 intraoperative fracture, and 6 posterior dislocations; the QFO group experienced 1 DVT and 3 intraoperative fracture. No dislocation was noted within 2 years after surgery. Conclusions Although further studies are needed to confirm the validity of our findings, a modified posterior approach using a quadratus femoris flap osteotomy could be an option worth considering among the variants of posterior approaches in THA.

To evaluate the clinical and radiological outcomes of unstable proximal humeral fractures (PHFs) treated with a locking plate and fibular strut allograft. This study included 36 patients [7 men, 29 women; mean age, 68 years (range, 22–94 years)] with unstable PHFs with medial column disruption. All patients were treated with open reduction and internal fixation using a locking plate and fibular strut allograft. Post-operative assessment included clinical outcomes, shoulder range of motion, radiographic examination, and any complications. Post-operative radiological assessment including the humerus neck-shaft angle (NSA) and the humeral head height was performed. At the mean two year follow-up visit, the mean American Shoulder and Elbow Society (ASES) and University of California, Los Angeles (UCLA) scores were 77 and 28, respectively. According to the UCLA rating scale, the result was excellent in six, good in 20, fair in six, and poor in four cases. According to the Paavolainen method, 31 patients had good results with an NSA of 130 ± 10°; three patients showed fair results with an NSA of 100–120°, and two patients experienced a poor result with an NSA of

The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the sacroiliac joint. This fracture represents a subset of lateral compression injury. The strong posterior ligaments of sacroiliac joint remain intact and a fracture fragment (crescent shape) involving the posterior superior iliac spines remains firmly attached to the sacrum. We report a patient with atypical pelvic crescent fracture that is mainly influenced by vertical shear injury and is characterized by posterior fracture-dislocations of the sacroiliac joint. In this case report, we review the literature on classification and treatment of atypical type of crescent fracture.

The intrapelvic migration of cervicocephalic lag screws is a rare complication after intertrochanteric fracture synthesis with an intramedullary nail. Only 15 cases of intrapelvic penetration by three different instrument systems have been described in the literature. However, to our knowledge, there is no report of intrapelvic migration of the lag screw with wedge wing designed to increase fixation power using the Dyna locking trochanteric (DLT) nail. We present a case of intrapelvic migration of the lag screw with wedge wing from DLT nail. The patient described herein underwent a two-staged operation of implant removal without intrapelvic approach followed by bipolar hemiarthroplasty. With intrapelvic migration conditions, although it is not uncommon to require an additional intrapelvic approach, this modification can lead to lethal consequences. For this reason, it is recommended to coordinate with the vascular surgery department due to the close proximity of the major vessels.

We present two patients with open pilon fractures with large bone defects treated successfully with fibular strut allografts. The patients were initially treated by massive irrigation, wound debridement, and temporary external fixation. After complete wound healing, the bone defects were managed. Because autologous iliac crest or fibular bone grafts were impossible to be harvested due to multiple fractures, the bone defects were reconstructed with fibular strut allografts. Fixation was performed with a periarticular distal tibia locking plate. At 2 months postoperatively, the patients ambulated with partial weight-bearing; at 6 months, they had full range of motion of the ankle joint and full weight-bearing.

Background: There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears. Materials and Methods: 22 patients of arthroscopic single row repair (group I) and 25 patients who underwent double row repair (group II) from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA) rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES). Results: In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method. Conclusions: Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.

Purpose This study characterizes the short-term outcomes of ceramic coated metal-on-metal (MoM) large head total hip arthroplasty (THA) in prospectively selected patients aged 70 to 75 years. Materials and methods Eighteen patients (18 hips) between the ages of 70 and 75-years old with THA using ceramic-coated MoM large heads between June 2014 and December 2014 were evaluated. We prospectively selected patients younger than 70 years for bipolar hemiarthroplasty and older than 75 years for conventional THA. There were one case of osteoarthritis, 8 cases of femur neck fracture, and 9 cases of intertrochanteric fracture. All patients underwent clinical and radiological follow-up at 6 weeks, 6 and 12 months, and every year postoperatively. The mean duration of follow-up was 24.2 months (range, 18-34 months). Results The average Harris hip score at the final follow-up was 81.0, except one case which was ultimately converted to conventional THA due to acetabular cup loosening. Radiographically, mean acetabular cup inclination was 45.8°(range, 38-56°) and anteversion was 20.1° (range, 11-25°). The average femoral head size was 48.7 mm. All stems were neutral-positioned except 1 varus-positioned stem. There was 1 case of a soft tissue infection, 3 patients complained of persistent groin pain, and no dislocations occurred. Conclusion Ceramic coated large MOM articulation (ACCIS) have many complications: cup loosening, groin pain, which can lead to fatal outcomes in the elderly patients. Especially in patients with communicated intertrochanter fracture (AO 31-A22, 23), careful attention should be paid to the choice of surgical option.

Ganglion cysts of the shoulder are rare, and the pathogenesis is similar to that of meniscal cysts. We present details of two cases of isolated ganglion cyst of shoulder which were treated arthroscopically. Both patients following 1 year after the surgery, complained of nonspecific shoulder pain and magnetic resonance imaging revealed new SLAP lesion which was treated arthroscopically.

Pigmented villonodular synovitis (PVNS) rarely affects the shoulder. We describe two cases of PVNS arising from the shoulder joint, which caused rotator cuff tears and sub-acromial bony erosion, and which were treated arthroscopically. Sub-acromial erosion is frequently associated with various glenohumeral joint disorders, but it has not been reported in association with PVNS. We believe PVNS should also be considered in the differential diagnosis of patients who present with sub-acromial erosion.

Purpose: The aim of this study is to analyze the clinical results of using the technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff. Material and Methods: Form January 2005 to January 2007, we performed the arthroscopic biceps repair with incorporating suture to the rotator cuff for 21 patients with large or massive rotator cuff tear. The mean follow up period was 23 months (range: 6-48months). The number of males and females was 9 and 13, respectively. The age distribution ranged from 47 to 73 years with a mean age of 60.3 years. We compared the preoperative score with the postoperative scores using the University of California Los Angeles (UCLA) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES) and a simple shoulder test (SST). Results: The improvement in the VAS, ASES and the UCLA and SST scores was statistically significant at the final follow up (average follow-up 23 months) (p>0.05). Two of nine cases were found to have partial tear with continuity but seven cases were found to have complete tear according to the ultrasonography and MRI. Conclusion: The technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff is considered to be recommendable.

Os acromiale is the rare shoulder disease and its treatment is controversial. Despite conservative treat-ments for 6 months include medication, exercise, physical therapy and subacromial steroid injections,operative treatment for uncontrolled symptomatic Os acromiale is considered the treatment of choice.Operative treatment includes excision, arthroscopic or open reduction and internal fixation with a bonegraft. Open reduction with tension band wiring and a bone graft is now the preferred treatment.We experienced 8 patients with symptomatic Os acromiale from March, 2001 to March, 2006. The aver-age patient’s age was 45 years and the man and women ratio were 2: 6. All 8 cases of symptomatic Osacromiale of the mesoacromion were treated with open reduction and internal fixation using tension-bandwiring. The preoperative ASES(47.3 ±24.4) and UCLA (16.65.8)scores were improved to 88.87.3 and 31.5±1.9,respectively, at the 2 year follow up. The overall UCLA score showed 1 excellent result and 7 good results. Wethink that symptomatic Os acromiale is a specific disease entity, and open reduction and internal fixation usingtension-band wiring with K-wire is a good treatment modality.

However, no cases of secondaryinstability have been reported so far. We report acase of anterior dislocation of shoulder joint afterarthroscopic pancapsular release and subscapularistenotomy which was treated successfully withclosed reduction using K-wires and showed noinstability during 2 years of follow up.

We report a case of Baker's cyst that induced compression of both the tibial and common peroneal nerves. The patient presented with calf atrophy and foot drop over a 6-month period. These signs and symptoms could have been mistaken for those of spinal origin. Based on an electrodiagnostic study and magnetic resonance imaging, compression of nerves by an asymptomatic Baker's cyst measuring 6x4 cm was confirmed. This cyst communicated with the articular joint which was also associated with a medial meniscal lesion. We treated the patient arthroscopically by performing partial medial meniscectomy, and through the posterolateral and the posteromedial portal, decompression of the Baker's cyst was performed. Approximately 6 weeks after the arthroscopic decompression, the cyst recurred. Therefore open resection was performed. At 1-year follow-up, the patient had considerable improvement in motor as well as sensory function and showed no evidence of recurrence. Although the electrodiagnostic studies showed an improvement in symptoms, the patient continued to complain of lower leg weakness owing to delayed diagnosis and cyst decompression. We believe that Baker's cysts should also be considered in the differential diagnoses of patients who present with neuromuscular dysfunction in the calf and leg.

— Surgical Treatment of Neglected Adult Monteggia Fracture - 2 Cases Report - Hyun-Chul Shon, M.D. � , Weon-Yoo Kim, M.D., Sang-Eun Park, M.D., Young-Yul Kim, M.D., Jong-Seoung Yoon, M.D., Jong-Hun Ji, M.D.* Department of Orthopedic Surgery, Chungbuk National University College of Medicine � ,Daejon St. Mary ’ s Hospital, The Catholic University of Korea College of Medicine, Korea Neglected adult Monteggia fracture could induce the pain, instability and malformation of elbow. Especially, com-pared with the chronic Monteggia fracture of child, that of adult is difficult to treat and could concur with valgusinstability and deformity, limitation of range of motion and tardy ulnar nerve palsy. But recently, the chronic Mon-teggia fracture of adult could be treated by the 3.5 mm compression plate (DCP) or 3.5 mm pelvic reconstructionplate, so that the result improved more and more. The treatment of choice of the chronic Monteggia fracture of adultis the corrective osteotomy and reduction of radial head or resection of radial head. We experienced two patients whohad neglected Monteggia fracture over 1 year 6 months and 25 years respectively and we want to report the result ofsurgical treatment of chronic Monteggia fracture of adult.

Failure of total hip arthroplasty with central migration of prosthetic components is uncommon. Various pelvis and visceral complications have been reported from intrapelvic migration of the acetabular cup or the cement or from the heat generated by methylmethacrylate polymerization. To our knowledge, we are the first to report intrapelvic migration of a femoral stem causing ipsilateral lower-extremity swelling, pressure sores, and severe bowel symptoms after the removal of the acetabular component.

Most pigmented villonodular synovitis (PVNS) is occurred in knee joint and finger of hand. PVNS is rarely occurred in shoulder joint. In English and French literatures, less than 30 cases were reported. We report 3 PVNS cases with rotator cuff tears, which was treated by arthroscoic extensive synovectomy, debridement and rotator cuff repair. The PVNS with rotator cuff tear in shoulder joint was rarely reported in the Korean literature.

Spontaneous bilateral rupture of the quadriceps tendons without a significant history of trauma is an uncommon disease. It is generally associated with chronic metabolic disorders such as chronic renal failure and secondary hyperparathyroidism. Here, we report a case of spontaneous bilateral tendon rupture in a patient on chronic hemodialysis for the past 5 years. We performed a preoperative MRI to confirm the diagnosis; then we repaired the ruptured quadriceps tendons and reviewed the patient both clinically and by performing MRI postoperatively 4 yrs later. The patient attained the full function of the quadriceps tendon.

Olecranon bursitis rarely Progresses to septic arthritis. In our case, the 24 year old woman was visited due to progressing right elbow pain, despite antibiotic treatment of chronic olecranon bursitis caused by elbow laceration 2 months ago. Pus draining sinus, localized heating and swelling could be seen on physical examination. Septic arthritis and pathologic fracture was diagnosed under arthroscopic examination. Arthroscopic irrigation and synovectomy for elbow joint, olecranon bursectomy and curettage of olecranon bone was done. In the operation field, the elbow and draining sinus over olecranon was communicated each other on saline irrigation test. The patient was treated for 3 weeks with intravenous antibiotics. At postoperative 4 weeks, bone graft was done. The possibility of chronic osteomyelitis and septic arthritis must be considered in a patient with chronic olecranon bursitis.

As more of the patients with traumatic pelvic injuries survive, they desire an optimal quality of life, including normal sexual function, even after the most severe injuries. We present the case of a 31-year-old woman who had dyspareunia due to impaired vaginal penetration after severe pelvic injury. After excision of a disunited fragment of pelvic bone and an adhesion band at the vaginal wall, dyspareunia was considerably resolved and the patient resumed sexual function. In cases of severe pelvic injury, physicians used to be satisfied with the patient's survival alone, and tended to regard sexual dysfunction as a trivial outcome. However, restoration of sexual function is an important part of management of these patients. In selected cases, obstructive dyspareunia resulting from traumatic pelvic injury can be managed by planned surgical intervention.

Pelvic fractures are classified according to the stability of the pelvic ring. Unlike stable pelvic fractures, which heal without complications, unstable fractures may lead to pelvic ring deformities, which cause severe complications. An orthopedic surgeon must determine the stability of the pelvic ring by radiography and physical examination of the patient in order to ensure early, prompt treatment. This article includes anatomy of the pelvic ring, classification of pelvic ring injuries, its treatment algorithm, and corresponding cases involving unstable pelvic ring injury.

The classification of anteroposterior compression (APC) injury type is based on using static radiographs, stress radiographs are known as a useful adjunct in classifying type of APC pelvic injuries. According to a recent article, the intraoperative stress examination has led to a change in the treatment plan in more than 25% of patients on 22 patients presumed APC type I (symphyseal diastasis

The authors describe a patient with small bowel herniation after traumatic symphysis disruption. Although gastrointestinal problems occur rarely with pelvic fractures, in a patient with a pubic diastasis and paralytic ileus, the development of abdominal hernia through torn peritoneum should be considered. Treatment of the patient with a pubic diastasis and a bowel problem should include early careful exploration and management of the gastrointestinal tract during pelvic surgery.

We have reviewed 178 intertrochanteric fractures treated by dynamic hip screw (DHS) fixation between March 1995 and December 1999 and followed for a minimum of 1 year. We used Singh's classification of the trabecular bone structure in the proximal femur as a measure of osteoporosis and also classified the fractures according to three different systems (Boyd-Griffin, Evans, AO). The postoperative radiographs were examined for loss of reduction, i.e. varus angulation >100, perforation of the femoral head, more than 20-mm extrusion of a lag screw or metal failure. We found 49 cases which showed radiographic failures. Two were stable fractures and 47 unstable fractures (Evans' classification). Unstable fractures with osteoporosis had a failure rate of more than 50%. In such cases DHS should not be the first choice for treatment.

Calcific tendinitis most commonly affects the rotator cuff and has not been previously reported affecting the biceps-labral complex. We report a case of calcific tendinitis of the biceps-labral complex attachment, a rare cause of acute, severe shoulder pain. Clinically, it can be misdiagnosed as supraspinatus tendinitis or septic arthritis of the shoulder joint. Non-operative treatment failed to resolve the symptoms. Arthroscopic debridement of the calcific deposit resulted in resolution of symptoms. Knowledge of this clinical condition and its imaging features is crucial for a correct diagnosis of this uncommon cause of shoulder pain.

Unicompartmental knee arthroplasty (UKA) with extrusion of cement into the posterior compartment of the knee is uncommon. Various problems after a UKA procedure, such as aseptic loosening, polyethylene wear and progressive arthritis have been reported. This study will report on a patient with extrusion of cement fragments into the posteromedial compartment of the knee after a UKA procedure. This complication was treated successfully with the direct posterior–posterior triangulation arthroscopic visualization method. In cementing the prosthesis, it is of paramount importance to take caution to completely remove extruded cement remnants in order to prevent this complication during UKA.

Nonunion of an unstable pelvic fracture with cranial displacement pelvic surgery is technically difficult due to a large amount of bleeding and the risk of nerve damage. In addition, surgical correction of leg length discrepancy by reduction of a dislocated sacroiliac joint is in high demand. Nevertheless, when a patient is strongly disabled by a pelvic deformity, surgical correction may be necessary. Two patients with pelvic deformity were treated successfully by surgical correction and osteosynthesis.

불안정성 골반환 손상은 불안정성이 전후방에 함께 존재하는 경우에는 전방 고정과 후방 고정을 함께 사용하여 안정시켜야 한다. 전방과 후방 모두 안정시켜야 할 불안정성 골반환 골절 여성 환자에서 전방 고정만을 실시하여, 추시상 골반골 부정 유합으로 형성된 골 가교가 질벽을 기계적으로 압박하여 성교통을 호소하였다. 저자들은 골편과 질내 반흔 조직 및 유착밴드를 제거하여 이를 성공적으로 치료한 증례를 경험하였기에 문헌 고찰과 함께 보고하고자 한다.

Pelvic external fixators allow two locations of pin purchase: anterosuperior (into the iliac crest) and anteroinferior (into the supraacetabular dense bone, between the anterior superior and anterior inferior iliac spine). The purpose of this study was to compare the stability of these two methods of fixation on Tile Type B1 (open book) and C (unstable) pelvic injuries. Five unembalmed cadaveric pelves (mean age, 68 years; four males and one female) were loaded vertically in a servohydraulic testing machine in a standing posture. The AO tubular system and Orthofix were used. On each pelvis, a Type B1 injury was simulated. Each external fixator was applied in each location in random order. Cyclic loads were applied through the sacral body to a maximum of approximately 200 N while force and displacement of the pelvic ring were recorded digitally. Sacroiliac joint motion was quantified tridimensionally with displacement transducers, mounted on the sacrum and contacting a target fixed to the posterior superior iliac spine. A Type C injury was created and augmented with two iliosacral lag screws, and the tests were repeated. For the Type B1 injuries with anteroinferior pin purchase, the mean stiffness was 201.2 N/mm for the AO frame and 203.2 N/mm for the Orthofix. For the anterosuperior frames the mean stiffness was 143.9 N/mm for the AO frame and 163.3 N/mm for the Orthofix. For Type B1 and Type C injuries, the anteroinferior location of pin purchase resulted in significantly reduced sacroiliac joint separation. There were no significant differences between the frame types. Dissection of the preinserted anatomic specimen revealed no evidence of injury to the lateral femoral cutaneous nerve after blunt dissection and drilling with protective drill sleeves. It is concluded that the anteroinferior location of external fixation pins is a safe technique with the potential for increased stability of fixation.

대퇴골 전자간 골절, 특히 불안정성 분쇄 골절은 점차 그 발생 빈도가 증가하고 있으며, 대퇴골 근위부 골절의 약 50% 정도를 차지하고 있다. 전자간 골절은 대퇴 경부 골절보다 발생 빈도가 4배 정도 많고 노령층에서 주로 발생된다. 따 라서 고령 환자의 불안정성 분쇄 골절에 있어서 골 유합술 대신 인공 고관절 반치환술을 일차적으로 사용하는 것에 대한 관심이 늘고 있으며, 여러 연구에서 골 유합술에 비해 조기 체중 부하 가능으로 인한 여러 전신적인 합병증의 발 생을 감소시키고, 골절부 불유합 및 대퇴 골두 무혈성 괴사 등의 위험성을 제거할 수 있는 장점을 가진다. 전자간 골절 시에 인공 고관절 반치환술을 시행하는 경우 EvansFixation of Greater Trochanter Using an AO Trochanteric Reattachment Device (AO TRD) in Arthroplasty for Intertrochanteric Femur Fracture of Elderly Patients

Purpose: In cases of patients who underwent bipolar hemiarthroplasty (BPHA) for treatment of a pertrochanteric fracture, we compared and analyzed the amount of blood loss and complications between a group using the cemented stem and a group using the cementless stem. Materials and Methods: A total of 104 patients who underwent BPHA for treatment of a pertrochanteric fracture in our hospital for three years and 10 months (From January 2008 to October 2011) were included in this study. Among the 104 patients, 64 patients with a cemented stem were categorized into group 1, and the other 40 patients with an uncemented stem were categorized into group 2. Before surgery, the type of stem was determined by the bone quality of the proximal femur, which had been evaluated with a simple X-ray. Then, after surgery, the amount of blood loss and complications were compared between the two groups. Results: Expected blood loss during the operation was 389.8 cc in group 1, and 395.3 cc in group 2(P=0.88). Postoperatively, average drained blood loss was 219.6 cc in group 1, and 338.1 cc in group 2. Cemented stem was associated with significantly less blood loss (P=0.004). The average operation time in group 1 and in group 2 was 96 minutes and 72 minutes. There was no significant difference in operating time (P=0.85). In addition, there was no difference in INR (International Normalized Ratio) and BMI (Body Mass Index) (P=0.28 and 0.08) regarding total amount of postoperatively drained blood loss. There was no occurrence of hypotensive shock or fatal pulmonary embolism in either group. Three cases of periprosthetic fracture occurred in group 2. Conclusion: Fewer occurrences of postoperative blood loss and fewer complications were observed in the cemented stem group than in the cementless stem group. Preoperative evaluation of bone quality and use of the cement stem for patients with poor bone quality may be a good treatment method that can help to reduce complications.

A sacrococcygeal dislocation is a rare occurrence, and the treatment options vary. Initial treatment is nonoperative, consisting of a manual reduction with a gloved finger and local rest. Acute operative treatment of a failed closed reduction is unusual. We report a case of an acute irreducible anteriorly dislocated coccyx successfully treated with a minimally invasive technique: joystick reduction and Steinman pin fixation.

The acetabulum is the socket of the hip joint and incongruence of the joint surface caused by fracture causes hip pain and posttraumatic arthritis. The usual choice of treatment for displaced acetabular fracture is operative treatment, which entails a challenging, stiff learning curve. The principle of treatment is restoring the stable and congruent hip joint for early mobilization to prevent local and systemic complications.

Purpose: A closed reduction of the posterior arch and percutaneous fixation with S1 and S2 iliosacral (IS) screw was performed on an unstable pelvis fracture with a disruption of the sacroiliac complex. The radiological and clinical results were analyzed according the number of screws and their position. Materials and Methods: Of 31 cases with an unstable pelvis fracture involving the sacral complex, classified as Tile type C (AO/OTA), 16 and 15 cases were treated with one S1 screw fixation and two screws fixation into S1 and S2, respectively, using a percutaneous fixation technique. The patients were followed up for a minimum of 12 months and the radiological and clinical outcomes were analyzed statistically using the Majeed score and SF-36. Results: Five cases of screw displacement occurred in the one screw fixation group. On the other hand, there was no screw displacement in the two screws fixation group after a mean follow-up of 40.2 months. In the case of a narrow safe zone (iliac cortical density, ICD), it is impossible to fix with two S1 screws. However, in these patients, good clinical results were achieved with S1 and S2 were achieved with S1 and S2 screw without complications. Conclusion: The technique of two screws fixation is an efficient and reliable method for reducing and fixing the unstable pelvic ring disruptions. Additional S2 screw fixation is recommended for patients with a narrow ICD.

In cases of displaced greater tuberosity fractures, treatments by arthroscopic-assisted reduction and percutaneous screw fixation have been reported. However, in cases in which there is a comminuted fracture or a minimally displaced fracture combined with concomitant lesions such as rotator cuff tear or labral pathology, it is difficult to reduce the fracture and to treat other pathologies by use of a percutaneous screw. Recently, many surgeons have used the double-row repair method in rotator cuff repair, which provides a tendon-bone interface better suited for biologic healing and restoring normal anatomy. In accordance with this method, we used the arthroscopic technique of double-row suture anchor fixation for a minimally displaced greater tuberosity fracture without additional incision. Initially, debridement was performed on the fracture surface by use of a shaver, and the medial-row anchor was inserted through the anterior portal or the intact cuff. Two lateral-row anchors were inserted just anterior and posterior to the lower margin of the fractured fragment under C-arm guidance. The medial-row sutures and lateral-row sutures were then placed. Arthroscopic double-row suture anchor fixation of a displaced greater tuberosity fracture restores the original footprint of the rotator cuff and normal tendon-bone interface of the displaced greater tuberosity fracture.