The Journal of the Korean bone and joint tumor society
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v.9
no.1
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pp.38-44
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2003
Purpose: To suggest an appropriate treatment modality regarding analyze outcomes of treatment for pathologic fracture to simple bone cyst of the long bone. Materials and Methods: We selected 12 cases with pathologic fracture of the long bone among the 31 cases treated for simple bone cyst from December. 1993 to May. 2001. The mean age was 9 years ranged from 2 years to 19 years, male was 11 cases and female was 1 cases, and the mean follow up interval was 32.9 month ranged from 12 month to 69 month. The principle of treatment for pathologic fracture of the long bone was conservative treatment except operative treatment for fracture with displacement of the femur. After fracture was united, the residual lesion was treated by local steroid injection, cortical drilling, curettage & bone graft. But we observed without specific treatment in cases that had healing process of simple bone cyst followed by bony union. The clinical results were evaluated as exellent if simple bone cyst was completely healed, as good if that had process of healing, as poor if that was no change or more increased in size. Results: The pathologic fracture was united in all cases treated with conservative treatment in 9cases and by open reduction with internal fixation in 3 cases. After fracture was united, the 6 cases were observed without specific treatment, because they had healing process of cyst, and had outcomes as good and excellent. Conclusion: We suggest to need observation when simple bone cyst has healing process after pathologic fracture was united, otherwise secondary treatment will be needed when residual lesion is persisted.
Statement of problem: The clinical use of electric and electomagnetic fields for fracture healing applications began in the early 1970s. Since then, several technologies have been developed and shown to promote healing of fractures. Developments of these devices have been aided in recent years by basic research and several well controlled clinical trials not only in the medical field but in dentistry. Purpose: The purpose of this study was to compare alveolar bone reduction following immediate implantation using implants onto which magnets were attached in fresh extracted sockets. Material and methods: Four mongrel dogs were involved. Full buccal and lingual mucoperiosteal flaps were elevated and third and fourth premolars of the mandible were removed. Implants with magnets and implants without magnets were installed in the fresh extracted sockets and after 3 months of healing the animals were sacrificed. The mandibles were dissected and each implant sites were sampled and processed for histological examination. Results: The marginal gaps that were present between the implant and walls of the sockets at the implantation stage disappeared in both groups as a result of bone fill and resorption of the bone crest. The buccal bone crests were located apical of its lingual counterparts. At the 12 week interval the mean of marginal bone resorption in the control group was significantly higher than that of the magnet group. The majority of specimens in magnet group presented early bone formation and less resorption of the buccal marginal bone compared to the control group. Conclusion: Within the limitations of this study, it could be concluded that implants with magnets attached in the early stages of implantation may provide more favorable conditions for early bone formation and reduce resorption and remodeling of marginal bone.
Purpose: This study was performed to evaluate the clinical outcomes of operative treatment using porous hydroxyapatite for intraarticular calcaneal fracture of joint depression type. Materials and Methods: Twenty patients with intraarticular calcaneal fracture were followed up for more than 1 year. The period to union was calculated to evaluate the osteoconductivity of porous hydroxyapatite used as bone graft substitute. The measurement of Bohler angle, Gissane angle and the degree of articular surface depression was performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). Results: Bohler angle and Gissane angle had improved significantly from preoperative average $10.4^{\circ}$, $117.8^{\circ}$ to average $22.6^{\circ}$, $113.5^{\circ}$ immediate postoperatively, and had maintained to average $21.2^{\circ}$ and $114.4^{\circ}$ at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 4.8 mm to 1.5 mm at the last follow-up. All cases achieved bone union, and the interval to union was average 12.8 weeks. AOFAS score was average 85.2 points at last follow-up. There were 7 excellent, 10 good, and 3 fair results according to the CNHF scale. Therefore, 17 cases (85%) achieved satisfactory results. Conclusion: Plate fixation using porous hydroxyapatite seems to be one of effective treatment methods for intraarticular calcaneal fracture of joint depression type, because of supporting the reduction of subtalar articulation by augmenting bony defect and facilitating bone formation. Further evaluation about long-term radiological changes and histological analysis on hydroxyapatite implantation site should be required.
Chun, Young Soo;Baek, Jong Hun;Lee, Seung Hyuk;Lee, Chung Hwan;Han, Chung Soo
The Journal of the Korean bone and joint tumor society
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v.20
no.1
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pp.7-13
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2014
Purpose: As well as patient survival, the restoration of postoperative function such as ambulation is important in limb salvage operations for treatment of malignant bone tumors involving the proximal femur. The authors analyzed clinical outcomes of limb salvage operations using tumor prostheses for metastatic or primary malignant bone tumors in the proximal femur. Materials and Methods: From February 2005 to January 2014, 20 cases (19 patients) with malignant bone tumor involving the proximal femur with pain or complicated pathologic fracture were treated with segmental resection and limb salvage operations with tumor prostheses. Mean age was 63.1 years (range 35-86). Fourteen patients were male and six ones were female. The mean follow-up period was 20 months (1-94 months). There were 15 cases of metastatic bone tumor, 4 cases of osteosarcoma, and 1 case of multiple myeloma. The primary tumors of the metastatic bone tumors included 4 lung cancers, 3 hepatocellular carcinomas, and 3 renal cell carcinomas. Other primary tumors were breast cancer, thyroid cancer, colon cancer, prostate cancer, and malignant spindle cell tumor, each in 1 case. Modular tumor prostheses were used in all cases; (Kotz's$^{(R)}$ Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey) in 3 cases, MUTARS$^{(R)}$ proximal femur system (Implantcast, Munster, Germany) in 17 cases). Perioperative pain was assessed with Visual Analogue Scales (VAS). Postoperative functional outcome was assessed with Musculoskeletal Tumor Society (MSTS) grading system. Results: Out of 20 cases (19 patients), 11 cases (10 patients) survived at the last follow-up. Average postoperative survival of the 9 deceased patients was 10.1 months (1-38 months). VAS score improved from pre-operative average of 8.40 (5-10) to 1.35 (0-3) after operation. Average postoperative MSTS function score was 19.65 (65.50%, 7-28). The associated complications were 2 local recurrences, 3 hematomas, 3 infections, 2 scrotal swellings, and 1 dislocation. There was no case of periprosthetic fracture or loosening. Conclusion: Limb salvage operation with tumor prosthesis is an appropriate treatment for early pain reduction and functional restoration in malignant bone tumors in the proximal femur with pain an/or complicated pathologic fractures.
Objective : Balloon kyphoplasty can effectively relieve the symptomatic pain and correct the segmental deformity of osteoporotic vertebral compression fractures. While many articles have reported on the effectiveness of the procedure, there has not been any research on the factors affecting the deformity correction. Here, we evaluated both the relationship between postoperative pain relief and restoration of the vertebral height, and segmental kyphosis, as well as the various factors affecting segmental deformity correction after balloon kyphoplasty. Methods : Between January 2004 and December 2006, 137 patients (158 vertebral levels) underwent balloon kyphoplasty. We analyzed various factors such as the age and sex of the patient, preoperative compression ratio, kyphotic angle of compressed segment, injected PMMA volume, configuration of compression, preoperative bone mineral density (BMD) score, time interval between onset of symptom and the procedure, visual analogue scale (VAS) score for pain rating and surgery-related complications. Results : The mean postoperative VAS score improvement was $4.93{\pm}0.17$. The mean postoperative height restoration rate was $17.8{\pm}1.57%$ and the kyphotic angle reduction was $1.94{\pm}0.38^{\circ}$. However, there were no significant statistical correlations among VAS score improvement, height restoration rate, and kyphotic angle reduction. Among the various factors, the configuration of the compressed vertebral body (p=0.002) was related to the height restoration rate and the direction of the compression (p=0.006) was related with the kyphotic angle reduction. The preoperative compression ratio (p=0.023, p=0.006) and injected PMMA volume (p<0.001, p=0.035) affected both the height restoration and kyphotic angle reduction. Only the preoperative compression ratio was found to be as an independent affecting factor (95% CI : 1.064-5.068). Conclusion : The two major benefits of balloon kyphoplasty are immediate pain relief and local deformity correction, but segmental deformity correction achieved by balloon kyphoplasty does not result in additional pain relief. Among the factors that were shown to affect the segmental deformity correction, configuration of the compressed vertebral body, direction of the most compressed area, and preoperative compression ratio were not modifiable. However, careful preoperative consideration about the modifiable factor, the PMMA volume to inject, may contribute to the dynamic correction of the segmental deformity.
Purpose: To examine the relationship between total fat infiltration (TFI) rate, which quantifies the reduction of muscles around the spine and is an important factor for sarcopenia, and the factors affecting osteoporotic vertebral compression fracture. Materials and Methods: Patients treated for osteoporotic compression fractures of the lumber spine from January 2012 to December 2016 were analyzed retrospectively. Among them, this study included ninety-eight patients who were 1) diagnosed with osteoporosis with a bone mineral density (BMD) T score of less than 2.5 g/cm2, 2) received vertebroplasty or kyphoplasty for lumbar fractures, 3) involved one segment of the lumbar spine, and 4) were followed-up for more than one year. The TFI rate confirmed by analyzing magnetic resonance imagings with the Image J program was studied. Based on this, the relationship between the TFI of the multifidus and erector spinae muscles and the factors of osteoporosis were analyzed. Results: The mean TFI of the multifidus and erector spinae was 14.66±10.16. The spine BMD showed a positive correlation with the hip BMD, but a negative correlation with the TFI. A positive correlation was observed between the hip BMD and body mass index. In addition, vitamin D was positively correlated with both the hip and spine BMD but negatively correlated with the TFI rate. Conclusion: Muscle growth helps treat osteoporosis, and can prevent fractures that occur frequently in osteoporosis patients. Increasing the vitamin intake can also slow the progression of muscle atrophy.
Purpose: Nonunion of intra-articular fractures of calcaneus is rarely reported complication. We present our experiences with 4 patients (5 cases) treated operatively for nonunion after intra-articular fracture of calcaneus. Materials and Methods: 4 patients (5 cases) with nonunion of intra-articular fracture of calcaneus after operative treatment were followed for 4 years (from 2002 to 2006). For assessment, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Visual Analogue Scale (VAS) were assessed for clinical outcome and the union of fracture site, the talocalcaneal height and the angle of talar declination were determined for radiologic outcome. Results: The mean talocalcaneal height was 6.94 cm (range, 5.9${\sim}$7.6 cm) preoperatively and 7.34 cm (range, 6.0${\sim}$8.3 cm) at last follow-up. The mean angle of talar declination was 5.68 degrees (range, 4.6${\sim}$8 degrees) preoperatively and 13.1 degrees (range, 5.7${\sim}$21 degrees) at last follow-up. The mean preoperative AOFAS score and VAS were 20.4 (range, 14${\sim}$36) and 4 (range, 3${\sim}$6), respectively. At last follow-up, these scores improved to a mean of 59.6 (range, 54${\sim}$68) and 3 (range, 2${\sim}$4), respectively. Unions of previous nonunion site of intra-articular fracture of calcaneus were achieved in all 4 patients (5 cases). Conclusion: The reconstructive procedure for nonunion of intra-articular fracture of calcaneus showed good results in terms of bone union, radiologic results and functional improvement than preoperative state. Because the plantar pain for the inferior angular formation in nonunion site may happen, we will pay attention to reduction of fragment.
Kim, Jihyeung;Kim, Jang Woo;Lee, Jeong Ik;Kim, Sang Kil;Rhee, Seung Hwan
Journal of Korean Foot and Ankle Society
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v.18
no.1
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pp.24-28
/
2014
Purpose: The purpose of this study is to evaluate the clinical and radiographic results of internal fixation using multiple Kirschner wires (K-wires) for the fifth metatarsal base fracture. Materials and Methods: We retrospectively reviewed 14 patients with a displaced fifth metatarsal base fracture. We measured the distance of fracture displacement on the foot oblique radiograph pre- and post-operatively. We evaluated the clinical results using the visual analog pain scale at six weeks and three months postoperatively and the American Orthopaedic Foot and Ankle Society (AOFAS) mid-foot score at six months postoperatively. Results: In our series, 10 cases were zone I fracture and four cases were zone II fracture. We achieved anatomical reduction and bony union in all of our cases. The average time to bone union was 43 days. The degree of pain around the fifth metatarsal base was significantly decreased after surgery. The average AOFAS score was 95 at six months postoperatively. Conclusion: Multiple K-wire fixation is a relatively simple fixation method for displaced fifth metatarsal base fractures. If we place a K-wire into the medial cortex of the fifth metatarsal, we could prevent proximal migration of the K-wire.
Purpose: To evaluate the radiological and clinical results after open reduction and internal fixation with calcaneal F plate and locking calcaneal plate using lateral extensile approach in the treatment of intra-articular calcaneal fracture Materials and Methods: This study included 34 cases of 33 patients followed up for at least 6 months postoperatively. F plate was applied in 18 cases (Group 1), locking plate was used in 16 cases (Group 2) and compared radiological and clinical results between two groups. Results: Radiollogically, the mean Bohler angle was improved from $5.5^{\circ}$ preoperatively to $20.1^{\circ}$ postoperatively and $18.8^{\circ}$ at the last follow up in group 1 and $8.6^{\circ}$ preoperatively, $21.4^{\circ}$ postoperatively and $20.3^{\circ}$ at last follow up in group 2. Bone union was observed in all cases and 4 cases of screw loosening were noted in Group 1 with extended fracture to anterior process. At the last follow up, both groups showed clinical results in American orthopedic foot and ankle society ankle hindfoot score, 76(77 in Sanders type II and 75 in type III) in group 1 and 72(73 in type II and 70 in type III) in group 2. Conclusion: F plate and locking plate showed firm fixation and satisfactory clinical results in the treatment of intra-articular calcaneal fracture. We suggest applying locking plate in cases with extended fracture to anterior process, considering screw loosenings in those who were treated with F plate fixation.
Restorative procedures can lead to weakening tooth due to reduction and alteration of tooth structure. It is essential to prevent fractures to conserve tooth. Among the several parameters in cavity designs, cavity isthmus is very important. In this study, amalgam 0 cavity was prepared on maxillary first premolar. Two dimensional finite element models were made by serial photographic method and isthmus(1/4, 1/3, 1/2, 2/3 of intercuspal distance) were varied. Three or four-nodal mesh were used for the two dimensional finite element models. The periodontal ligament and alveolar bone surrounding the tooth were excluded in these models. 1S model was sound tooth with no amalgam cavity. B model was assumed perfect bonding between the restoration and cavity wall. Both compressive and tensile forces were distributed directly to the adjacent regions. A load of 500N was applied vertically at the first node from the lingual slope of the buccal cusp tip. This study analysed von Mises stress, 1 and 2 directional normal stress and Y and Z axis translation with FEM software Super SAPII Version 5.2 (Algor Interactive System Co.) and hardware 486 DX2 PC. The results were as :follows : 1. 1S model was slightly different with 1B model in stress distibution. 1S, 2B, 3B, 4B models showed similiar stress distribution. 2. 1S model and four B models showed similiar pattern in Y axis and Z axis translation. 3. 1S model and four B models showed the bending phenomenon in the translation. 4. As increasing of the width of the cavity, experimental group was similiar with the control group in stress distribution. 5. As increasing of the width of the cavity, experimental group was similiar with the control group in Y and Z axis tranlation.
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