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Motor-sparing regional anesthesia modalities, such as periarticular infiltration (PAI) and pericapsular nerve group (PENG) block, have become the mainstay of multimodal approaches used during total hip arthroplasty (THA). We hypothesized that the postoperative analgesia of the PENG block was non-inferior to that of the PAI.Sixty patients were randomly allocated into two groups. The PAI group were injected with 100 mL of cocktail solution (ropivacaine 20 mL, ketorolac 2 mL, and epinephrine 1 mL mixed with normal saline) in periarticular tissues directly by the surgeon. The PENG group were injected with 30 mL of 0.5% ropivacaine in the iliopubic eminence plane by ultrasound. The primary outcome was the resting pain score 12 h after surgery, and the prespecified non-inferiority was 1. Additionally, the cumulative opioid consumption and quality of recovery were evaluated.The mean difference in pain score 12 h postoperatively between the PENG and PAI groups was 0.6 [95% confidence interval (CI): -0.8 to 2.0]. The upper 95% CI exceeded the non-inferiority margin of 1 at all postoperative time points. There was no difference in opioid consumptions and quality of recovery scores.PENG block provided comparable analgesia with PAI following THA. It is not conclusive that PENG is inferior or non-inferior to PAI based on our study.Clinical Research information Service (CRIS, https://cris.nih.go.kr, KCT0006049).

We aimed to compare clinical and radiologic outcomes in patients with cam-type femoroacetabular impingement (FAI), with and without a partial ligamentum teres (LT) tear, who underwent hip arthroscopy (HA) with ≥10 years of follow-up. Among the patients who underwent HA for a cam-type FAI diagnosis with a labral tear, 28 patients (28 hips) with a partial LT tear and 87 patients (99 hips) with an intact LT were assigned to Groups A and B, respectively. All patients underwent partial labral debridement and femoroplasty. Debridement and thermal shrinkage were performed for LT tears. The grade of chondral damage was measured intraoperatively. Clinical items were assessed preoperatively and at the last follow-up. Patients’ satisfaction with the surgery and changes in postoperative sports ability in those who had previously been active in sports were assessed at the last follow-up. The Tönnis grade was assessed preoperatively and at the last follow-up for radiologic evaluation. Chondral damage to the acetabular and femoral head detected intraoperatively was significantly different between the groups (P = 0.005 and P

A 48-year-old man visited the emergency room with right hip pain that started abruptly while walking out of the bathroom. Computed tomography showed an intraosseous mass in the femoral neck. The patient had a 15-year history of gout and had numerous bilateral tophi in his hands, feet, knees, and elbows. After operation, we diagnosed a pathological fracture due to intraosseous tophi. Patients with hip pain who have many subcutaneous tophi and long-standing gout should be diagnosed carefully. Peri-hip joint pain caused by gout is uncommon, however, if a patient complains of pain, a simple X-ray may be required. If intraosseous tophi are present, appropriate treatment (e.g., strict hyperuricemia control with or without prophylactic internal fixation), may be required before fracture occurs.

Background The purpose of this study is to report the long-term follow-up results of arthroscopic repair of acetabular labral tears with femoroacetabular impingement (FAI). Methods Of 45 patients who underwent arthroscopic labral repair under the diagnosis of acetabular labral tears with FAI from January 2008 to December 2010 and met our inclusion criteria, 41 patients who were available for a long-term follow-up were included in the analysis. We compared the long-term follow-up results with the previously reported short-term follow-up results of the same patients. The mean follow-up period was 92.4 months (range, 85 to 117 months). There were 21 males and 20 females, and their mean age at surgery was 34.6 years (range, 16 to 54 years). A modified Harris hip score (mHHS), visual analog scale (VAS), hip outcome score-activity of daily living (HOS-ADL), hip outcome score-activity-sport-specific subscale (HOS-SSS), and patient satisfaction were used for evaluation of the clinical results and Tonnis grade for detection of early osteoarthritis (OA). Results The mean VAS score decreased from 6.4 points to 1.8 points (p < 0.001), the mean mHHS increased from 59.5 points to 86.8 points (p < 0.001), and the mean HOS-ADL and HOS-SSS increased from 58.3 and 51.2, respectively, to 85.2 and 82.4, respectively (p < 0.001), between the preoperative and last follow-up assessment. The mean patient satisfaction score was 7.6 of 10. The average Tonnis grade at the last follow-up (0.67; range, 0 to 3) was not significantly different from the preoperative average (0.51; range, 0 to 1). Only one case was converted to total hip arthroplasty because of progression of OA at 8 years after surgery. Five cases of secondary arthroscopic surgery were performed before maximum 5 years postoperatively because of labro-synovial adhesion (three cases), pullout of the suture anchor (one case) or symptomatic heterotrophic ossification (one case). Conclusions The clinical and radiological long-term follow-up revealed that improvement after arthroscopic labral repair and osteoplasty for FAI were maintained in most cases without significant progression of arthritis. Anatomical recovery of the acetabular labrum was associated with the improvement of clinical symptoms.

Case report An 83-year-old woman presented with a high-energy tibial fracture. We treated her with temporary external fixation and delayed flexible intramedullary nailing because of extensive soft-tissue damage and interference from the hardware retained from a previous total knee arthroplasty. Conclusions In our opinion, flexible intramedullary nailing is an effective procedure and provides good functional and radiological results in high-energy tibial fractures with extensive soft-tissue loss.

Background and Objectives: The effect of supra-inguinal fascia iliaca compartment block (SI-FICB) in hip arthroscopy is not apparent. It is also controversial whether SI-FICB can block the obturator nerve, which may affect postoperative analgesia after hip arthroscopy. We compared analgesic effects before and after the implementation of obturator nerve block into SI-FICB for hip arthroscopy. Materials and Methods: We retrospectively reviewed medical records of 90 consecutive patients who underwent hip arthroscopy from January 2017 to August 2019. Since August 2018, the analgesic protocol was changed from SI-FICB to SI-FICB with obturator nerve block. According to the analgesic regimen, patients were categorized as group N (no blockade), group F (SI-FICB only), and group FO (SI-FICB with obturator nerve block). Primary outcome was the cumulative opioid consumption at 24 hours after surgery. Additionally, cumulative opioid consumption at 6 and 12 hours after surgery, pain score, additional analgesic requests, intraoperative opioid consumption and hemodynamic stability, and postoperative nausea and vomiting were assessed. Results: Among 87 patients, there were 47 patients in group N, 21 in group F, and 19 in group FO. The cumulative opioid (fentanyl) consumption at 24 hours after surgery was significantly lower in the group FO compared with the group N (N: 678.5 (444.0&ndash, 890.0) &micro, g, FO: 482.8 (305.8&ndash, 635.0) &micro, p = 0.014), whereas the group F did not show a significant difference (F: 636.0 (426.8&ndash, 803.0) &micro, g). Conclusion: Our findings suggest that implementing obturator nerve block into SI-FICB can reduce postoperative opioid consumption in hip arthroscopy.

BackgroundWe investigated the incidence and location of heterotopic ossification (HO) following hip arthroscopy.MethodsThis retrospective study enrolled 327 patients who underwent hip arthroscopy from January 2010 to December 2015. From this cohort, we extracted an HO group with simple radiographs or three-dimensional computed tomography (3D CT). Findings consistent with HO were classified according to the Brooker classification aided with 3D CT for the location of HO. The indication for revision arthroscopic excision of HO was painful, functional impairment of the hip. Patient clinical outcomes were assessed pre- and postoperatively, with modified Harris Hip Scores (mHHS), a visual analogue scale (VAS) for pain, and the Hip Outcome Score-Activity of Daily Living (HOS-ADL) and Sport Specific Subscales (HOS-SSS).ResultsIn all, 14 (4.28%) of the 327 patients had confirmed HO radiographically. The mean follow-up was 39 months. In 13 patients, HO formed in the central area of the arthroscopic portals or capsulotomy. Ten patients had Brooker Grade 1 and four had Grade 2. At the last follow-up, 12 asymptomatic patients had significant (P ConclusionsHO is a minor complication of hip arthroscopy, but sometimes induces severe pain and functional impairment. Usually, HO forms in the arthroscopic portal or capsulotomy area.

Purpose: Although the number of hip arthroscopies is rapidly increasing in non-elderly patients, outcomes of this procedure in middle-aged patients are not well documented or clearly understood. The purpose of this study was to evaluate the clinical and radiological outcomes after hip arthroscopy in middle-aged patients with early osteoarthritis. Materials and Methods: This retrospective study analyzed 189 patients with early osteoarthritis of various diagnoses aged 40 years or older who underwent hip arthroscopy between January 2010 and December 2015. Clinical (e.g., modified Harris hip score [mHHS], hip outcome score-activities of daily living [HOS-ADL], visual analogue scale [VAS] for pain, range of motion) and radiological (change of Tonnis grade) outcomes were assessed at a minimum of 3-year follow-up. Results: The mean preoperative and final mHHS and HOS-ADL improved from 61.2 and 60.6 to 79.5 and 81.8, respectively, while the VAS pain score decreased from 6.3 to 3.2 (P

Although postoperative pain is inevitable after bone surgery, there is no general consensus regarding its ideal management. We hypothesized that the combination of ultrasound-guided peripheral nerve block (PNB) and patient-controlled analgesia (PCA) with ketorolac would be useful for pain control and reducing opioid usage. This prospective study aimed to evaluate the effectiveness of this method. This study included 95 patients aged >18 years who underwent bone surgery in the ankle area from June to December 2018. All operations were performed under anesthetic PNB, and additional PNB was given for pain control ∼11 hours after preoperative PNB. An additional PCA with ketorolac, started before rebound pain was experienced, was used for pain control in group A (49 patients) but not group B (46 patients). We used intramuscular injection with pethidine or ketorolac as rescue analgesics if pain persisted. A visual analogue scale (VAS) for pain was used to quantify pain at 6, 12, 18, 24, 36, 48, and 72 hours postoperatively. Patient satisfaction was assessed, along with side effects in both groups. VAS pain scores differed significantly between the groups at 24 hours after the operation (p = .013). All patients in group A were satisfied with the pain control method; however, 5 patients in group B were dissatisfied (p = .001), 3 owing to severe postoperative pain and 2 owing to postoperative nausea and vomiting. An average of 0.75 and 11.40 mg pethidine per patient was used in groups A and B, respectively, for 3 days. We concluded that the combined use of ultrasound-guided PNB and PCA with ketorolac can be an effective postoperative method of pain control that can reduce opioid usage.

Background Patients with extraspinal diffuse idiopathic skeletal hyperostosis (DISH) involving the hip joint have symptoms like femoroacetabular impingement (FAI). To date, no reported study has determined the clinical outcomes of arthroscopic treatment in extraspinal DISH involving the hip joint. Methods A total of 421 hips with FAI that underwent arthroscopic treatment were reviewed retrospectively. We determined the extraspinal involvement of DISH with three-dimensional computed tomography (3D-CT) and simple radiography of the pelvis and hip joint. Clinical outcomes were evaluated at a minimum of 2 years postoperatively. The visual analog scale score (VAS), modified Harris hip score (MHHS), and hip outcome score-activity of daily living scale (HOS-ADL) were used, and hip range of motion (ROM) was evaluated pre- and postoperatively and at the time of the final follow-up. Results Among the 421 hips (372 patients) with FAI that underwent arthroscopic treatment, 17 hips (12 patients, 4.04%) had extraspinal DISH on the hip joints. The mean age of the patients was 51.5 years. The 3D-CT scans and simple radiographs showed extraspinal DISH on multiple points around the pelvis and hip joint. Nine of the 17 hips (seven of 12 patients) had spinal DISH. At the final follow-up, VAS, MHHS, and HOS-ADL improved significantly from 6.5, 65.3, and 66.6, respectively, to 1.2, 87.8, and 89.5, respectively, and hip flexion and internal rotation improved significantly from 97.7° and 7.9°, respectively, to 117.1° and 18.2°, respectively. Conclusions This study has demonstrated that extraspinal DISH involving the hip joint could lead to FAI, and arthroscopic treatment could result in relief of symptoms, including pain and ROM limitation, in extraspinal DISH patients.

The analgesic effects of preoperative ultrasound-guided nerve blocks wear off after about 12 hours, leaving some patients in substantial pain. Transdermal fentanyl concentrations peak at 12 to 24 hours after application and maintain this concentration for approximately 72 hours. We sought to determine whether combining the use of a transdermal fentanyl patch with either a sciatic or femoral-sciatic nerve block would improve pain control in patients undergoing foot and/or ankle surgery. Consecutive patients in the no-patch control group (n = 104) were enrolled from July 2011 to October 2011, and those in the treatment group (n = 232) were enrolled from November 2011 to May 2012 and received a transdermal patch (4.125 mg/7.5 cm(2) releasing 25 μg of fentanyl per hour) applied to their chest postoperatively. Pain was assessed using a visual analog scale at 6, 12, 24, and 48 hours after surgery. The primary outcome measure was the number of requests for additional postoperative pain medication. Additional postoperative analgesia was requested by 49 of the 104 control patients (47.1%) and 63 of the 232 treated patients (27.1%; p = .002). The mean pain scores were also lower in the treatment group, with a statistically significant difference (p < .05) at 12, 24, and 48 hours. Thus, patients receiving a fentanyl patch combined with an ultrasound-guided nerve block required less supplemental analgesia to maintain adequate pain control than did those receiving a nerve block alone. In conclusion, a fentanyl patch is a useful adjunct to an ultrasound-guided nerve block in foot and ankle surgery.

Purpose:We measured the width of the acetabular labra in, and the clinical outcomes of, patients with borderline hip dysplasia (HD) who underwent arthroscopy.Methods:A total of 1436 patients who underwent hip arthroscopy to treat symptomatic, acetabular labral tears were enrolled. From this cohort, we extracted a borderline HD group (162 cases). Lateral labral widths were evaluated using preoperative magnetic resonance imaging scans. Clinical data including the modified Harris hip score (mHHS), non-arthritic hip score (NAHS), hip outcome score–activity of daily living (HOS-ADL) score, visual analog scale (VAS) pain score, and Tönnis grade were collected. In addition, patient satisfaction with arthroscopy outcomes was rated. All complications and reoperations were noted.Results:The mean follow-up time was 87.4 months. The lateral labral width was 7.64 mm in those with normal hips and 7.73 mm in borderline HD patients, respectively ( p = 0.870). The Tönnis grade progressed mildly from 0.46 to 0.76 ( p = 0.227). At the last follow-up, clinical outcome scores (mHHS, NAHS, and HOS-ADL scores) and the VAS score were improved ( p < 0.001). The mean patient satisfaction was scored at 8.2. The reoperation rate was higher in those who underwent labral debridement (25.6%) than labral repair (4.1%).Conclusions:The lateral labral width did not differ significantly between the borderline HD group and the nondysplastic control group. Arthroscopy relieved the symptoms of painful borderline HD and did not accelerate osteoarthritis. Therefore, if such patients do not respond to conservative treatment, hip arthroscopy can be considered for further treatment.

Purpose:There is no definitive consensus on the optimal treatment of Achilles tendon rupture. We comparatively analyzed the clinical outcomes of two types of repair surgeries in treating Achilles tendon rupture.Methods:This retrospective study included 12 patients of Achilles tendon rupture (group A) treated with ultrasound-guided percutaneous repair and 18 patients (group B) treated with open repair. Clinical evaluation was performed using the Arner–Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, Achilles Tendon Total Rupture score (ATRS), visual analog scale, time to single heel raise, bilateral calf circumferences, recovery of athletic ability, and other complications.Results:While the Arner–Lindholm scale, AOFAS ankle–hindfoot score, ATRS, time point when single heel raise was possible, differences in bilateral calf circumference, and recovery of athletic ability compared to pre-rupture level were not significantly different between the two groups (p = 0.999, 0.235, 0.357, 0.645, 0.497, and 0.881, respectively), overall and aesthetic satisfaction levels were higher in the group treated with percutaneous repair under ultrasonography guidance (p = 0.035 and 0.001, respectively). Overall, there were no cases involving sural nerve injury in either group.Conclusion:Innovative percutaneous repair provides not only similar clinical outcomes but also greater overall and aesthetic satisfaction levels of operative outcomes and minimal complications (i.e. sural nerve injury) compared to open repair surgeries. Therefore, percutaneous repair may be a useful technique in the treatment of Achilles tendon rupture.

Background Bosworth described an unusual fracture-dislocation of the ankle with fixed posterior fracture-dislocation of the fibula. Previous epidemiological data on the prevalence and characteristics of patients with Bosworth ankle fractures have been limited. Bosworth fracture-dislocations are often missed in patients with ankle fractures. We investigated the outcomes of missed diagnosis and the prevalence of Bosworth fracture-dislocation in patients with ankle fractures. Methods We conducted a retrospective analysis of inpatients aged 15 years and older with an ankle fracture, who underwent surgery between 2007 and 2016 in 4 Korean hospitals. The patient demographics, risk factors, fracture characteristics, treatment data, outcomes, and complications were analyzed. Results We reviewed 3405 hospital admissions for ankle fractures. During the study period, Bosworth fracture-dislocations were diagnosed in 51 cases. The prevalence of Bosworth fracture-dislocations (n = 51) was 1.62% among patients with ankle fractures who were enrolled in this study (n = 3140). Emergency surgery was performed within 24 h of injury in 36 cases (group A) and delayed surgery was performed in 15 cases (group B). The mean patient age at admission was 35.97 (standard deviation [SD], 1.643) years in group A and 34.33 (SD, 2.296) years in group B. Men were more commonly affected than women, with a 32:19 ratio. Most of the patients with Bosworth fracture-dislocations were young adults with high-energy trauma. The most frequent mechanism of trauma was falling down stairs (n = 27, 52.94%), followed by traffic accidents. Patient outcomes were significantly better in group A than in group B. Conclusion The prevalence of Bosworth fracture-dislocations was higher than expected. If unrecognized, it can result in inappropriate treatment and permanent disability. With accurate diagnosis and prompt treatment, excellent results can usually be obtained. Level of clinical significance 4.

Background Arthroscopic iliopsoas tendon release was introduced in 2000. The purpose of this study was to evaluate clinical outcomes of arthroscopic iliopsoas tendon release for painful internal snapping hip with concomitant hip pathologies. Methods Between January 2009 and December 2011, we performed arthroscopic iliopsoas tendon release and related surgeries in 25 patients (20 men and 5 women; mean age, 32 years; range, 17 to 53 years) with combined intraarticular hip pathologies. The patients were followed for a minimum of 2 years postoperatively. Clinical and radiological evaluations were performed. Results Snapping sounds had disappeared by the 2-year follow-up in 24 of the 25 patients. All patients who had presented with loss of flexion strength postoperatively showed recovery at postoperative week 6 to 10. Harris hip score improved from 65 points (range, 46 to 86 points) preoperatively to 84 points (range, 67 to 98 points) postoperatively (p < 0.001). Seven hips (28%) had an excellent score, 15 hips (60%) a good score, 2 hips (8%) a fair score, and one hip (4%) a poor score (p < 0.001). The Tonnis grade of osteoarthritis did not change in any of the patients at the last follow-up. Conclusions Patients with painful internal snapping hip have combined hip pathologies. Therefore, the surgeon should keep in mind that painful internal snapping hips are frequently combined with concomitant intraarticular pathologies.

Purpose To evaluate the usefulness of separate vertical wirings for extra-articular fracture of distal pole of patella. Materials and methods We have analyzed the clinical results of 18 cases that underwent separate vertical wirings for extra-articular fracture of distal pole of the patella from March 2005 to March 2010, by using the range of motion and Bostman score. Occurrence of complication was also evaluated. Additionally, by taking simple radiographs, the correlation between the postoperative degree of anterior transposition of bone fragment and the time of bone fusion, preoperative length of bone fragment, and occurrence of comminuted fracture were investigated. Results It took an average of 13.8 weeks for radiological bone union after separate vertical wiring fixation. Flexion contracture was an average of 0.8 degrees and further flexion was an average of 127.6°, and Bostman score was an average of 27.5 points (excellent in 12 cases, and good in 6 cases). On the first postoperative year, average flexion contracture was 0.6 degrees and further flexion was an average of 136.3°, which exhibited increased joint motion and recovery to normal range of motion, and Bostman score was an average of 28.7 points (excellent in 16 cases, and good in 2 cases). There was no statistically significant difference between the preoperative bone fragment length and presence of comminution, and degree of anterior transposition of bone fragment after fracture union on simple radiograph (p=0.175, p=0.146). Conclusions We were able to obtain satisfactory clinical results, while preserving the bone fragment by separate vertical wiring fixation for extra-articular fracture of distal pole of patella. Moreover, the method is easy to perform, which is also considered as a useful surgical method for extra-articular fracture of distal pole of patella.

Background After calcaneal fracture surgery, a short leg splint and cast are typically applied. However, these restrict joint exercises, which is inconvenient for patients. In addition, there is a risk of complications, such as pressure ulcers or nerve paralysis with a short leg cast. In this study, we evaluated clinical and radiological outcomes of the use of a specially designed calcaneal brace after calcaneal fracture surgery. Methods From among patients who underwent open reduction and internal fixation for calcaneal fracture between July 9, 2013 and May 31, 2017, 102 patients who wore a calcaneal fracture brace (group A) and 82 patients who wore a postoperative short leg cast (group B) were randomly chosen for this study. Radiological changes and clinical factors were compared between the two groups. After swelling at the surgical site decreased, a special calcaneal brace was applied to patients in group A. They were allowed to perform early weight bearing and joint motion. Patients in group B were immobilized in a short leg cast and were told to avoid weight bearing for 6 weeks. In each group, the Bohler's angle and Gissane's angle were measured and compared using postoperative and final follow-up radiographs. Pain (measured using a visual analogue scale [VAS]) and ankle joint range of motion (dorsiflexion, plantar flexion, eversion, and inversion) were measured serially until the final follow-up visit. Results There were no significant differences in the Bohler's angle or Gissane's angle between the two groups as measured postoperatively and at the final follow-up (paired t-test). Differences in the VAS pain score and eversion were also statistically nonsignificant between the two groups. However, group A had a significantly higher range of dorsiflexion (p = 0.021), plantar flexion (p = 0.012), and inversion (p = 0.045) of the ankle than group B (independent t-test). Conclusions Application of the calcaneal fracture brace after open reduction and internal fixation of a calcaneal fracture not only maintained the fracture reduction but allowed for greater joint motion than the short leg cast. Thus, the calcaneal fracture brace can be considered an effective postoperative management option that enables early resumption of daily activities and facilitates postoperative joint motion.

The current conventional portals for hip arthroscopic surgery are the anterior, anterolateral, and posterolateral portals. For lesions in the medial anteroinferior or posteroinferior portion of the hip, these portals provide insufficient access to the lesion and consequently lead to incomplete treatment. Thus, in such a situation, a medial portal approach might be helpful. However, operators have avoided this procedure because of the risk of injury to the obturator, femoral neurovascular structures, and the medial femoral circumflex artery. Thus, to overcome the disadvantages of the conventional method for medial lesions of the hip, we performed a cadaveric study to evaluate the technique, usefulness, and risk of the medial portal technique.

Traumatic hip fracture-dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the hip joint. Incarceration, such as interposed labrum between acetabulum and femoral head that is not readily visualized preoperatively, is a rare but important cause of pain and can potentially be a source for early degeneration and progression to osteoarthritis. We present three cases, arthroscopic surgery of incarcerated acetabular osseo-labral fragment following reduction of traumatic hip fracture-dislocation.

To compare and analyse the relationship between horizontal tear and root ligament tear of the posterior horn of the medial meniscus (PHMM) and the degree of varus in the axis of lower limb and body weight. One hundred and nineteen patients underwent surgical treatment as they were diagnosed with medial meniscus tear in our hospital from May 2006 to December 2009. Of these, 19 cases (group 1), underwent partial meniscectomy as they were confirmed to solely have horizontal tear of the PHMM on arthroscopic examination and 27 cases (group 2), underwent subtotal meniscectomy as they were confirmed to solely have root ligament tear of the PHMM on arthroscopic examination, were chosen for retrospective study. Standing radiographs were taken of every case prior to arthroscopic surgery to measure varus angle. Also, we checked body mass index (BMI) of two groups. The difference of varus angle and BMI between two groups were statistically verified using the Levene’s test, paired t-test. Group 1 showed mean value of varus angle of 2.30 ± 0.54, and BMI of 25.32 ± 3.23. Group 2 showed mean value of varus angle of 5.64 ± 0.54, and BMI of 25.67 ± 3.12. The degree of varus of group 2 was statistically significantly higher than group 1 (p = 0.002). Comparison between the BMI of two groups showed no statistical significance (p = 0.053). Through a comparative study of sole horizontal tear and root ligament tear of the PHMM, the authors have found that sole root ligament tear of the PHMM is more relative to the genu varum than sole horizontal tear of the PHMM. However, body weight was statistically irrelevant to the incidence of the two lesions.

Purpose: The purpose of this study is to report on the result of repairing Achilles tendon using absorbable suture under nerve block. Materials and Methods: We retrospectively reviewed 20 patients with acute Achilles tendon rupture who were followed up for at least six months after the operation. We repaired Achilles tendon using two absorbable sutures using the Krackow technique for the proximal stump and the Kessler technique for the distal stump. A programmed postoperative management including non-weight bearing with a short leg cast for four weeks after the operation was applied for all patients. We evaluated clinical results using American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) for satisfaction, range of motion of ankle, functional recovery rate, and the starting time of single heel raise. Results: The mean VAS score for satisfaction and AOFAS score was 9.2 and 93.0, respectively. The affected ankle showed a mean dorsiflexion rate of 90% and plantar-flexion rate of 94% compared to the uninjured side. The single heel raise could start at a mean of 3.5 months after the operation. Conclusion: Treatment of Achilles tendon rupture with absorbable suture material using the hybrid suture technique of proximal Krackow and distal Kessler showed sufficient stability and minimal chronic inflammatory reaction.

목적: 대퇴 비구 충돌 및 비구순 파열로 진단받고 관절경적 비구순 봉합술을 시행한 환자들의 단기 추시 후 결과를 보고하고자 한다. 대상 및 방법: 2008년부터 2010년까지 대퇴 비구 충돌 및 비구순 파열로 진단받고 관절경적 비구순 봉합술을 시행한 45명을 대상으로 하였다. 임상 결과는 modified Harris hip score (MHHS), 통증 점수(VAS), hip outcomes score (HOS) 및 환자 만족도를 이용하였다. 결과: 남자 22명, 여자 23명이었고, 평균 나이는 33.0세(16-54세), 평균 추시 기간은 26.7개월(24-56개월)이었다. 임상적 결과로 VAS는 수술 전 평균 6.4점에서 수술 후 평균 2.5점, MHHS는 수술전 평균 59.5점에서 수술 후 평균 85.4점으로 호전되었고, HOS의 일상 생활척도와 운동 척도가 각각 수술 전 평균 58.3%, 51.2%, 수술 후 평균 83.0%, 79.8%이었다. 재수술을 시행한 경우는 5예(12.1%)로 비구순 부위의 활액막 증식에 의한 유착이 3예, 봉합 나사못이 빠진 경우가 1예, 이소성 골화가 1예 관찰되었다. 결론: 관절경적 비구순 봉합술은 대퇴 비구 충돌과 동반된 비구순 파열의 치료로 효과적인 방법으로 생각된다.

� This is a report of 2 cases that showed dissociation of the acetabular cup liner by acetabular fixation screw among patients who underwent total hip replacement. Screws for fixation of the acetabular cup were used during the primary surgery in both cases. Each patient visited the out patient department complaining of pain and noise from the joint; radiologic finding revealed a collapse of the column shape bone graft area with dissociation of the acetabular cup liner. In both cases, during revision surgery, screw was extruded to the inner side of the acetabular cup, since it migrated superiorly. There has been no report of liner dissociation by extrusion of acetabular cup fixation screw after total hip replacement. Therefore, we report two cases of dissociation of the acetabular cup liner of hip arthroplasty, which occurred due to screw issues after total hip replacement with structural autogenous bone graft.

230 통신저자:강 찬 대전시 중구 대사동 640 충남대학교병원 정형외과 Tel:042-280-8381ᆞFax:042-252-7098 E-mail:-chan-@hanmail.net 접수: 2011. 1. 5 심사(수정): 2011. 2. 15 게재확정: 2011. 4. 26 Address reprint requests to:Chan Kang, M.D. Department of Orthopaedic Surgery, Chungnam National University Hospital, 640, Daesa-dong, Jung-gu, Daejeon 301-721, Korea Tel:82-42-280-8381ᆞFax:82-42-252-7098 E-mail:-chan-@hanmail.net 원위 경골 골절의 최소 침습적 금속판 치료에서 해부학적 경피적 강선 정복