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Intervertebral discs are fibrocartilage structures, which play a role in buffering the compression applied to the vertebral bodies evenly while permitting limited movements. According to several previous studies, degenerative changes in the intervertebral disc could be accelerated by factors, such as aging, the female sex, obesity, and smoking. As degenerative change progresses, the disc height could be reduced due to the dehydration of the nucleus pulposus. This study aimed to quantitatively analyze the pressure that each structure of the spine receives according to the change in the disc height and predict the physiological effect of disc height on the spine. We analyzed the biomechanical effect on spinal structures when the disc height was decreased using a finite-element method investigation of the lumbar spine. Using a 3D FE model, the degree and distribution of von-Mises stress according to the disc height change were measured by applying the load of four different motions to the lumbar spine. The height was changed by dividing the anterior and posterior parts of the disc, and analysis was performed in the following four motions: flexion, extension, lateral bending, and axial rotation. Except for a few circumstances, the stress applied to the structure generally increased as the disc height decreased. Such a phenomenon was more pronounced when the direction in which the force was concentrated coincided with the portion where the disc height decreased. This study demonstrated that the degree of stress applied to the spinal structure generally increases as the disc height decreases. The increase in stress was more prominent when the part where the disc height was decreased and the part where the moment was additionally applied coincided. Disc height reduction could accelerate degenerative changes in the spine. Therefore, eliminating the controllable risk factors that cause disc height reduction may be beneficial for spinal health.

Background Despite widely use of femoral neck system system (FNS®), there is little evidence for mechanical property according to type of femoral neck fracture. This study is to assess the structural/mechanical stability of fixation constructs with a femur neck system by using the finite-element (FE) analysis after simulating the femur neck fractures and to introduce the clinical implications. Methods We simulated the fracture models of subcapital, transcervical, basicervical, and vertical types by using the right femur model (SAWBONES®) and imported the implant model of FNS® to ANSYS® to place the implant in the optimal position. The distal end of the femur model was completely fixed and was abducted 7°. The force vector was set laterally at an angle of 3° and posteriorly 15° in the vertical ground. We did the analysis using Ansys® software with the von Mises stress (VMS) in megapascal (MPa). Results The max VMS of the fracture site was 67.01 MPa for a subcapital fracture, 68.56 MPa for a transcervical fracture, 344.54 MPa for a basicervical fracture, and 130.59 MPa for a vertical fracture. The max VMS of FNS® was 840.34 MPa for a subcapital fracture, 637.37 MPa for a transcervical fracture, 464.07 MPa for a basicervical fracture, and 421.01 MPa for a vertical fracture. The max VMS of the implant corresponded to the value of the entire fixation construct and thus, FNS® mainly functions as a load-bearing implant. When we compared the basicervical and vertical fractures, the stress distribution between the implant and the fracture sites differed significantly, and the basicervical fracture had higher VMS in the bone, implant, and fracture sites. Conclusion Considering the stress distribution of the assembly model, FNS® fixation should consider the osseous anchorage between the proximal bolt and cancellous bone of femoral head and might be appropriate for vertical fractures. Regarding the VMS of fracture site, FNS® might be applied cautiously just in the basicervical fracture of anatomical reduction without gap and comminution.

Background: To determine the optimal direction of the syndesmotic screw and introduce a consistent landmark for practical application by analyzing three-dimensional (3D) modeling and virtual implantation.Methods: A total of 102 cadaveric lower legs (50 males and 55 females, average height of 160.6 ± 7.1cm) were used to reconstruct a 3D model by using the Mimics® software and the joint morphology was evaluated. Syndesmotic cylinders (Ø3.5 mm/Length 100 mm) were transversely placed in the proximal end of the incisura fibularis for simulating screw fixation. The tibial proximal cylinder, which was tangent to the posterior tibial condyles, was traced and the angle between the two cylinders was measured as the tibial torsion angle (TTA). After rotating the syndesmotic cylinder parallel to the ground, the overlapping degree between the proximal fibula and tibia were assessed as a radiologic indicator. Results: Concerning tibial torsion, the TTA was an average of 36.7° (range, 17.2°–54.4°, SD 8.78) When the syndesmotic cylinder was rotated to be parallel to the ground, the proximal fibula had non- or linear overlap with the lateral border of the tibia, regardless of the joint morphology. In this nonoverlapping view, compared to the mortise view, the three criteria for normal fibular length could be better visualized. Conclusion: The syndesmotic cylinder in the proximal end of the incisura fibularis could be consistently placed parallel to the ground by internally rotating the tibia until there was a non- or linear overlap between the proximal fibula and the tibia, regardless of the joint morphology.

Objective: This present study was conducted to determine the structural-mechanical stability of various fixation constructs through finite element (FE) analysis following simulation of a basicervical fracture and to introduce the clinical implications.Materials and Methods: We simulated fracture models by using a right synthetic femur (SAWBONES®). We imported the implant models into ANSYS® for placement in an optimal position. Five assembly models were constructed: (1) multiple cancellous screws (MCS), (2) FNS (femoral neck system®), (3) dynamic hip screw (DHS), (4) DHS with anti-rotation 7.0 screw (DHS + screw), and PFNA-II (Proximal Femoral Nail Antirotation-II®). The femur model’s distal end was completely fixed and 7° abducted. We set the force vector at a 3° angle laterally and 15° posteriorly from the vertical ground. Analysis was done using Ansys® software with von Mises stress (VMS) in megapascals (MPa) and displacement (mm)Results: The displacements of the proximal femur were 10.25 mm for MCS, 9.66 mm for DHS, 9.44 mm for DHS + screw, 9.86 mm for FNS, and 9.31 mm for PFNA-II. The maximum implant VMS was 148.94 MPa for MCS, 414.66 MPa for DHS, 385.59 MPa for DSH + screw, 464.07 MPa for FNS, and 505.07 MPa for PFNA-II. The maximum VMS at the fracture site was 621.13 MPa for MCS, 464.14 MPa for DHS, 64.51 MPa for DHS + screw, 344.54 MPa for FNS, and 647.49 MPa for PFNA-II. The maximum VMS at the fracture site was in the superior area with the high point around the posterior screw in the MCS, anterosuperior corner in the DHS, the posteroinferior site of the FNS, and posterosuperior site around the entry point in the PFNA-II. In the DHS + screw, the stresses were distributed evenly and disappeared at the maximum VMS fracture site. Conclusion: Based on the fracture site and implant's stress distribution, the model receiving the optimal load was a DHS + screw construct, and the FNS implant could be applied to anatomically reduced fractures without comminution. Considering the high-stress concentration around the entry point, a PFNA-II fixation has a high probability of head-neck fragment rotational instability.

Background Transiliac–transsacral (TITS) screw fixation might be necessary in some cases involving the vertical shearing injuries with transforaminal fracture and bilateral posterior ring injuries. However, the possibility of S1 TITS screw should be preoperatively assessed because the pelvic ring injuries with sacral dysmorphism had the insufficient osseous corridors. Hypothesis AxWS2 may predict the possibility of TITS screw fixation and be used as the new indicator to discriminate the sacral dysmorphism. Materials & methods The conventional CT images of eighty-two cadaveric pelvis imported into Mimics® software to reconstruct three-dimensional (3D) models. A 7.0 mm-sized screw was processed into a 3D model using a 3D-sensor at actual size and virtually implanted as S1 and S2 TITS screw using Mimics® software. The cortical violation around screw path was evaluated using 3D biplanar and conventional CT images. The osseous corridor widths around TITS screws were measured in the axial plane images and defined as AxWS1 and AxWS2, respectively. Results Despite no cortical violation in S2 of all models, cortical violation of S1 TITS screw was found in 20 models. Of them, 14 models (impossible models) were identified in the 3D biplanar images, and all 20 models (CT-violation models) were identified only in CT axial plane images. AxWS1 was Discussion By using AxWS2, the possibility of S1 TITS screw fixation could be predicted and safely placed without cortical violation, if AxWS2 was less than 13 mm. Considering the negative relationship with AxWS1, AxWS2 should be used as a new indicator to predict safe S1 TITS screw fixation. Level of evidence III, controlled laboratory study.

Introduction Ilio-sacral screw fixation has been used for sacral fractures and sacroiliac joint dislocations. However, it is associated with significant complications including screw loosening with backing-out and loss of reduction. Trans-sacral screw fixation is indicated for rigid fixation in specific circumstances including bilateral posterior ring injuries, osteoporotic bone, or to supplement other types of posterior ring fixation. Hypothesis The reformatting the CT scanning plane may distinguish sacral dysmorphism and predict the possibility of trans-sacral screw fixation by introducing the new indicator. Material and methods The CT data of 112 adult cadavers (61 males and 51 females) were imported into Mimics® software and a 7.0 mm-sized trans-sacral screw was virtually placed in the ideal position of S1. The osseous widths around screw in the axial images (AxWS1) were measured. By reformatting the CT scanning plane parallel to the superior endplate of S1, the AxWRS1 was measured and the height of elevated segment in the upper sacrum (elevated height) was assessed as a new preoperative indicator. Results Cortical violation around screw was detected in 26 models and was considered as sacral dysmorphism. The average AxWS1 was measured as 13.70 ± 2.76 mm in the non-dysmorphism group, and 5.81 ± 2.19 mm in the dysmorphism group, with statistical difference (p Discussion By reformatting the CT scanning plane, the osseous width around screw was widened, and the new preoperative indicator of elevated height could be introduced to predict the possibility of trans-sacral screw fixation into S1. If the elevated height exceeded 13 mm, the pelvis was assigned to sacral dysmorphism and thus, could not apply the trans-sacral screw fixation into S1. Level of evidence III, controlled laboratory study.

Purpose: This study aims to investigate the difference in physiological loading on the spine in three different motions (flexion-extension, lateral bending, and axial rotation) between osteoporotic and normal spines, using finite element modelling.Methods: A three-dimensional finite element (FE) model centered on the lumbar spine was constructed. We applied two different material properties of osteoporotic and normal spines. For the FE analysis, three loading conditions (flexion-extension, lateral bending, and axial rotation) were applied.Results: The load was higher on the nucleus pulposus at all vertebral levels in all movements, in the osteoporosis group than in the normal group. On the annulus fibrosus, the load increased at the level of L3-L4, L4-L5, and L5-S in the flexion-extension group and at L4-L5 and L5-S levels in the lateral bending group. The values of flexion-extension and lateral bending increased in two motions in the L4 and L5 cortical bones and in axial rotation at the level of L5. Additionally, the load increased in the lower endplate of L5-S and L4-L5 in all movements, especially lateral bending. Even in the group with no increase, there was a part that received increased load locally for each element in the three-dimensional reconstructed view of the pressure distribution in color.Conclusion: The load on the lumbar region in the three loading conditions, was greater in most components of osteoporotic vertebrae than in normal vertebrae and the value was highest in the nucleus pulposus. Considering the increase in the measured load and the local increase in the pressure distribution, we believe that these results can contribute to explaining discogenic pain and degeneration.

Purpose: The objective of this study was to improve the three-dimensional (3D) understanding of optimal lateral cortical hinge in medial open-wedge high tibial osteotomy (MOWHTO) via a computational cadaveric simulation of actual size. Methods: The computed tomography data of 117 adult cadavers were imported into Mimics® software to design 3D models of tibia and fibula. To simulate the MOWTHO, a virtual cutting plane was developed inside the safe zone based on established landmarks. After splitting and distracting through the cutting plane, the 10-mm cylinder (Ø 30 mm; height 10 mm) was placed vertically to be occupied properly in the nonosteotomized lateral cortex. The cross points between the round cylinder and cutting plane represented the anterior and posterior hinge points, which were used to validate the 3D position and direction of cortical hinge. Results: A 10-mm cylinder did not violate the proximal tibiofibular joint (PTFJ) and the protruding segment of the condylar area was less than 2 mm in 115 models. The connecting line between anterior and posterior hinge points was an average of 12.1° (range 0–24.1°, SD 4.64) to the lateral side. In the nonoverlapping anteroposterior projection between proximal fibula and tibia, the posterior hinge point was laid over the PTFJ as close as possible. Based on free 360° rotation and magnification without any tilt, no posterior cortical disruption of PTFJ was observed while securing a minimum width of 10 mm. Conclusion: If the posterior hinge point was placed immediately above the PTFJ without involvement, the nonosteotomized portion carried sufficient width greater than 10 mm, despite lateral rotation at an average hinge direction of 12.1°.

Purpose The aim of this study is to conduct clinical and radiographic evaluations of the use of percutaneous bridge plating for distal fibular fractures combined with distal tibia type III open fractures. Methods Thirty-four patients with acute distal third fibular shaft fractures (4F2A(c) and 4F2B(c) according to the AO/OTA classification) combined with distal tibia type III open fractures were enrolled. Concurrent fibular fractures were fixed with the percutaneous bridge plating simultaneously, while distal tibia open fractures were temporally stabilized with a spanning external fixator. Clinical and radiographic outcomes were evaluated using the Lower Extremity Functional Scale (LEFS), the proportional length difference of the fibula, the talocrural angle, the union rate of the fibula and tibia, the operation time, and complications at the final follow-up. Results All fibular fractures healed with an average bone healing time of 20.7 ± 6.3 weeks (range, 16–35). The mean proportional length difference was 0.492 ± 0.732% compared with that in the uninjured fibula. The functional assessment result according to the LEFS was 74.0 ± 3.70 points (range, 57–80). No cases of fibula fracture infection developed throughout the follow-up period in any of the patients. Iatrogenic postoperative superficial peroneal nerve injury was not found in any of the patients. Conclusion With the perspective of minimizing soft tissue problems due to high-energy trauma, the application of percutaneous bridge plating for the treatment of distal fibular fractures can be an alternative to conventional treatment methods.

Objectives The aim for the present study was to determine whether projection error of measuring Pauwels’ angle in young femur neck fracture could be eliminated by CT plane manipulation. Methods Clinical data of displaced femur neck fractures in young adults aged 20 to 64 years old (13 females and 17 males) were retrospectively analyzed. Their average age was 47.9 years (range: 22–64 years; SD: 11.3). Using modified measurement method for Pauwels’ angle using central line of the shaft as a guideline, the angle of a conventional coronal CT image was measured. CT images were imported into Mimics® software. The scanning plane was then reformatted parallel to the neck axis to eliminate projection error of injured limb. Measured angles were classified into three types (I 50°) and differences were analyzed. Results Average Pauwels’ angle was 52.9° (range: 28.6–68.3°; SD: 9.9; type II, 17 cases; type III, 13 cases) for conventional CT images and 68.7° (range: 29.8–91.2°; SD: 13.4; type II, 1 cases; type III, 29 cases) for reformatted CT images. Difference between these two measurements on average was 15.7° (range: 1.2–34.9°; SD: 7.3). Conclusions Reformatting CT scanning plane by manipulating the proximal fragment to be parallel with the neck axis of the distal neck-shaft fragment is a convenient and reliable technique for eliminating the projection error of measuring Pauwels’ angle in the femur neck fractures. Level of evidence IV, cohort study.

This study aimed to investigate the association between osteoporosis and comorbidity, which are very common in Korea, and develop a treatment strategy to improve bone health based on the findings of the Korean National Health and Nutritional Examination Surveys (KNHANES). This study was based on data obtained from 4060 subjects (1755 males, 2305 females) aged above 60 years in the KNHANES (2016&ndash, 2017). Well-trained medical staff performed the standard procedures and measured several variables including height, weight, and waist circumference. Interviews and laboratory tests were based on the diagnosis of hyperuricemia, dyslipidemia, type 2 diabetes mellitus (T2DM), osteoporosis, and depression. Comorbidities were defined as a self-reported physician diagnosis. The association of osteoporosis with depression and metabolic disease was assessed statistically using the complex sample analysis method of SPSS. The presence of osteoporosis, dyslipidemia, T2DM, hyperuricemia, obesity, abdominal obesity, and depression was 6.1 &plusmn, 0.5%, 15.2 &plusmn, 0.7%, 6.5 &plusmn, 0.4%, 13.4 &plusmn, 0.7%, 30.8 &plusmn, 0.8%, 19.4 &plusmn, 0.9%, 4.0 &plusmn, 0.2%, respectively. After adjusted by age, osteoporotic subjects were significance in the presence of abdominal obesity (p = 0.024, OR 0.80), hyperuricemia (p = 0.013, OR 0.68), dyslipidemia (p &lt, 0.001, OR 1.84), and depression (p &lt, 0.001, OR 2.56), respectively. Subgroup analyses showed dyslipidemia (female subjects, p &lt, 0.001, OR 1.04, male subjects, p = 0.94, OR 1.09) and depression (female subjects, p &lt, 0.001, OR 1.76, male subjects, p = 0.51, OR 0.62) were associated with osteoporotic female subjects but not in male subjects. The comorbidity of dyslipidemia and depression in female subjects was associated with osteoporosis and an odds ratio was 13.33 (95% CI: 8.58&ndash, 20.71) (p &lt, 0.001). The comorbidity of abdominal obesity (female subjects, p = 0.75, OR 0.97, male subjects, p = 0.94, OR 1.02) and hyperuricemia (female subjects, p = 0.27, OR 0.81, male subjects p = 0.07, OR 0.35) was not associated with osteoporosis in both Subgroup. The result of this study shows a strong dependency of comorbidity with dyslipidemia and depression in elderly women with osteoporosis. Therefore, efforts to improve dyslipidemia and depression might prevent compromised bone health.

Background: The management of lateral clavicle fractures is often challenging because of difficulties in identifying displacement patterns that indicate an unstable fracture. Hypothesis: The aim of this study was to evaluate displacement patterns through analysis using 3-dimensional (3D) rendering software for displaced lateral clavicle fractures. We hypothesized that most displaced lateral clavicle fractures would have posterior displacement and angulation as well as superior displacement of the medial fragment. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Radiographs of 37 displaced lateral clavicle fractures were imported into the 3D rendering software to reconstruct the fracture model. For the computational simulation of fracture reduction, the medial fragment was manipulated and returned into place using the software’s moving tools. Two corresponding points were marked between the medial and lateral fragments to measure 3D spatial location in the x-axis (shortening), y-axis (horizontal displacement), and z-axis (vertical displacement). The displacement angle on the cranial view was also measured based on the medial end of the clavicle. Results: There were 32 cases (86.5%) of superior displacement of the medial fragment (mean, 5.8 mm; range, –6.5 to 19.0 mm), 35 cases (94.6%) of posterior displacement of the medial fracture fragment (mean, 8.8 mm; range, –3.2 to 18.3 mm), and 23 cases (62.2%) of distraction of the fracture site (mean, 2.1 mm; range, –9.2 to 12.2 mm). All 37 patients revealed posterior angulation of the fracture site (mean, 8.9°; range, 2.2°-39.4°). Conclusion: Most displaced lateral clavicle fractures have posterior displacement and angulation as well as superior displacement of the medial fragment. Our results revealed that 3D evaluation of lateral clavicle fracture displacement patterns is useful for assessing fracture stability and making treatment decisions.

Purpose: The purpose of this study was to introduce practical landmarks for the successful use of the fluoroscopic inlet and outlet views to verify safe screw trajectories when placing percutaneous iliosacral (IS) screws. Materials and Methods: A total of 10 sacra (19 hemi-sacra) from cadavers without gross deformity or previous injury were included in this study. The upper boundaries and S1 were marked with 1 mm lead wire. The marked sacra were positioned on a radiolucent operative table similar to the operative supine position and projected into the pelvic inlet and outlet views and the true lateral view of the pelvis via an image intensifier. Using image editing software, fluoroscopic images were analyzed to identify the fluoroscopic landmarks and ideal entry points. Results: The posterior-superior corner of the lateral articular surface was constantly projected as a curve point in the pelvic inlet view, and the imaginary connecting line between two points did not violate the posterior walls of S1 in any of the sacra with a little space. Based on the curve points, screws had to be directed either straight or anteriorly (range: 18.3°-29.6°) on inlet view. On outlet view, the ideal screw trajectory was the imaginary oblique line from the height of the S1 foramen to the opposite upper corner of S1 (range: 15.5°-24.4°) and the sacral ala was not violated. Conclusion: For successful fluoroscopy, two simple landmarks could be utilized, the imaginary connecting line between the two curve points in the pelvic inlet view and the oblique screw trajectory toward the opposite corner of S1 in the pelvic outlet view, using the standard technique and irrespective of sacral dysplasia.

Background Open total extrusion of the talus without concomitant fracture is an extremely rare injury. We present 6-year follow-up data of a patient treated using a temporary spanning external fixator and less invasive single K-wire fixation. Case presentation A 55-year-old Asian man who had a totally extruded talus without fracture underwent immediate reimplantation surgery. A spanning external fixator with single antegrade K-wire fixation was applied to maintain the reimplanted talus. During 6 years of follow-up, he could walk without aids and could squat, corresponding to an American Orthopaedic Foot and Ankle Society score of 85. We found that the suspect lesion that was evident at 6 months after surgery had disappeared at 12 months postoperatively on the basis of sequential follow-up magnetic resonance imaging. There was no evidence of osteonecrosis of the dislocated talus at the final follow-up. Conclusions In patients with a totally extruded talus, a surgical strategy including immediate reimplantation of the talus and a temporary spanning fixator with single K-wire fixation might be useful to allow early mobilization around the ankle joint and to prevent additional damage of the foot without significant complications.

Benign bone tumor is a typical disease encountered in the field of orthopedic surgery. As one of the palliative treatments, invasive curettage of the lesion has been widely used.1) It is unavoidable, however, that palliative curettage is extremely invasive to soft tissue and the cortical bone in the lesions depending on the size of lesions. It is thus disadvantageous in that it may lead to various complications such as delayed union or bleeding, postoperative fracture due to a loss of the cortical bone and delayed wound healing and recovery at the operated sites.2-4) To reduce these undesirable side effects, Stricker5) first reported on endoscopic curettage in 1995. In 1999, Bonnel et al.6) reported that endoscopic curettage and bone graft were performed for simple bone cyst of the calcaneus. Thereafter, several authors have confirmed an excellent profile of efficacy for endoscopic curettage. In Korea, however, there is a dearth of studies evaluating the treatment. Most reports have been made regarding clinical cases (case studies). A comparative analysis of other types of bone tumor has been performed only in a limited scope. Based on the above background, we examined the clinical usefulness of endoscopic curettage, one of the non-invasive treatment modalities, and assessed which benign bone tumors could be effectively treated with endoscopic curettage.

Purpose: The purpose of this study was to evaluate the radiologic and clinical outcomes after operative treatment using endobuttons for unstable distal clavicle fractures. Materials and Methods: Between October 2007 and September 2009, 9 consecutive patients who were followed up for at least more than 12 months after operative treatment using a TightRope were studied. The radiologic results on the serial plain radiographs and the clinical results according to the American Shoulder Elbow Surgeons (ASES) score were analyzed. Result: Bony union was shown in 8 cases (88.9%) and the average time to union was 12.9 (range: 9~16) weeks. The average coracoclavicular distances at the postoperative and final follow-up were 5.6 mm and 6.2 mm, respectively, with no statistically significant difference (p>0.05). The average ASES score was 90.3 (range: 78~96) and the clinical outcomes were 6 excellent, 2 good and one fair. There were no complications such as implant failure or infection except for one case of nonunion due to loss of the initial reduction. Conclusion: A major advantage of TightRope fixation for unstable distal clavicle fractures is that no further surgery is needed to remove the implant. We suggest that this technique provides an alternative for fracture with a distal fragment, which is difficult to fix.

This study was undertaken to introduce an anterolateral approach for mini-open rotator cuff repair and evaluate its clinical outcome and effectiveness.We evaluated 128 consecutive cases that were repaired by mini-open repair using an anterolateral approach. There were 80 men and 48 women, with an average age of 56.2 years. Average follow-up was 25.7 months. There were eight partial-thickness, 26 small, 40 medium, 39 large and 15 massive tears. After arthroscopic glenohumeral examination and subacromial decompression, we made a 3- to 4-cm skin incision from anterolateral edge of the acromion and dissected to the raphe between the anterior and middle deltoid. The torn tendon was repaired with single- or double-row technique using suture anchors. To prevent avulsion of the deltoid from the acromion, additional suturing within the bone tunnel was performed. We retrospectively evaluated clinical outcomes using the American Shoulder and Elbow Surgeon (ASES) scoring system.The average visual analogue scale (VAS), activity of daily living (ADL) and ASES scores improved, respectively, from 6.6, 12.0 and 36.7 preoperatively to 1.2, 26.6 and 88.2 postoperatively. There were 71 excellent, 39 good, ten fair and eight poor results. There were no statistically significant difference between final ASES scores and age, symptom duration, tear size or preoperative stiffness, but men had significantly higher final ASES scores than women (P = 0.014).Anterolateral approach for mini-open rotator cuff repair produces satisfactory results. It may also provide better visualisation for rotator cuff tears of all sizes.

BACKGROUND The purpose of this study is to evaluate the disease-free survival (DFS) and overall survival (OS) of patients with stage IIB osteosarcoma at a single institution for 20 years and to compare the results according to the chemotherapy protocols. METHODS From Jan 1988 to Nov 2008, 167 patients with osteosarcoma were treated at our hospital and among them, 117 patients (67 males and 50 females) with stage IIB osteosarcoma were evaluable. Their mean age was 22.6 years (range, 8 months to 71 years). Seventy-eight cases underwent the modified T10 (M-T10) protocol (group 1), 23 cases underwent the T20 protocol (group 2) and 16 cases underwent the T12 protocol (group 3). The DFS and OS were calculated and compared according to the chemotherapy protocols. RESULTS At a mean follow-up of 78.9 months, 63 patients were continuously disease-free (63/117), 6 patients were alive after having metastatic lesions, 7 patients died of other cause and 41 patients died of their disease. The 5- and 10-year OS rates were 60.2% and 44.8%, respectively and the 5- and 10-year DFS rates were 53.5% and 41.4%, respectively. There was no significant difference of the OS and DFS between the chemotherapy protocols (p = 0.692, p = 0.113). CONCLUSIONS At present, we achieved success rates close to the internationally accepted DFS and OS. We were able to achieve the higher survival rates using the M-T10 protocol over the 20 years. However, there was no significant difference of results between the chemotherapy protocols. We think the M-T10 protocol will achieve more favorable results in the near future.

Purpose: We wanted to evaluate the clinical outcomes after operative treatment using two suture anchors and Kirschner wire for treating acute Rockwood type V acromioclavicular joint dislocation Materials and Methods: Between May 2006 and May 2009, 10 patients underwent surgical treatment for acute Rockwood type V acromioclavicular joint dislocation using two suture anchors and Kirschner wire and they were followed for a mean of 12.0 (range: 7-31) months. We analyzed the functional results by the Korean shoulder score, the Constant-Murley score and the reduction state of the acromioclavicular joint at the last follow-up. Results: All the cases achieved a satisfactory outcome. The mean Korean shoulder score was 89.9 (range: 81-100) points and the mean Constant-Murley score was 87.8 (range: 82-93) points. According to the radiologic findings, 8 patients achieved anatomical reduction of the acromioclavicular joint: there was a slight loss of reduction in one patient and a partial loss of reduction in one patient. None of the patients had deep infection or re-dislocation. Conclusion: The operative treatment using two suture anchors and Kirschner wire may be used for acute Rockwood type V acromioclavicular joint dislocation, and it has an advantage in that it can prevent chondral injury of the joint.

증례138세남자환자로자전거에서넘어지면서발생한우측주관절골절로내원하였다. 단순방사선상전이된구상돌기골절을동반한주관절탈구및외측외상과골절을보였다. 주관절도수정복후시행된3차원전산화단층촬영상전외측방향에위치하는구상돌기골절을볼수있었다(Fig. 1A, B). 구상돌기및외측외상과골절에대해관혈적정복및내고정술이필요할것으로판단되어내외측이중절개를시행하기로하였다. 상완신경총마취하에서내상과에서하방으로8cm 정도의피부절개를가하고척골신경의주행을확인한후척골수근굴곡근양두사이로접근하여구상돌기를노출하였으며, 구상돌기골절편에대해K-강선으로일시적정복을시행한후구상돌기모양에맞게술전변형된2.4 mm 잠김압박금속판 (CompactHand set

Purpose: To introduce mini-open rotator cuff repair using the anterolateral approach and evaluate its clinical outcomes and effectiveness. Materials and Methods: 59 consecutive cases of rotator cuff tearing which were treated with mini-open repair utilizing the anterolateral approach were evaluated. The population comprised 39 men and 20 women, with an average age of 56.6 years. An average follow-up time period was 26 months. Clinical outcomes were analyzed based on VAS, ADL, and ASES scores. Results: The average respective VAS, ADL, and ASES scores improved from 7.04, 12.37, and 35.32 preoperatively to 1.02, 27.20, and 90.08 postoperatively (p=0.000). There were 41 excellent, 11 good, 2 fair, and 5 poor results. There were satisfactory results in 52 cases (88.1%). There were no statistically significant differences between the final ASES scores and age, sex, duration of symptoms, tear size, and preoperative stiffness (p>0.05). Conclusion: Mini-open rotator cuff repair using the anterolateral approach effective in providing better visualization.

Isolated acromial fracture is not common and it frequently accompanies fractures to the coracoid process and glenoid bone and also injuries to the acromioclavicular joint. Furthermore, most of these combined acromial fractures have minimal displacement, which needs no additional treatment other than protection for a certain period of time. We have experienced a case of isolated fracture of the posterolateral angle of the acromion, which we reduced and fixated using K-wire and cannulated screws. We report on the technical aspects and clinical results of this reduction and fixation, along with a review of the literature.

For comminuted shaft fracture of clavicle, the operative goal, aside from sound bone healing without complications of direct reduction, is maintenance of the original length in order to maintain the normal biomechanics of adjacent joint. Our bridge plating technique utilizing distraction through a lumbar spreader was expected to be effective for restoring clavicular length with soft tissue preservation. However, there are two disadvantages. First, there is more exposure to radiation compared to conventional plating; and second, it is difficult to control the rotational alignment. Despite these disadvantages, our technique has important benefits, in particular, the ability to preserve clavicular length without soft tissue injury around the fracture site.

Bisphosphonate (BSP) therapy has been widely used for management of osteoporosis, and has been shown to reduce the risk of vertebral and femoral neck fractures in postmenopausal osteoporotic patients [1, 2]. BSPs inhibit osteoclast function and induce osteoclast apoptosis, and, thus, increase bone mineral density and suppress bone turnover. However, previous studies have suggested that chronic suppression of bone turnover may produce hypermineralized bone that is more brittle, and therefore more susceptible to low-energy or stress fractures [3, 4]. Longterm BSP therapy has recently been reported to be associated with low-energy subtrochanteric and diaphyseal femoral fractures, and a peculiar, consistent fracture configuration has been described for these insufficiency fractures [5]. Radiological findings of stress reactions before the fracture have also been described [6]. Therefore, to prevent fractures, patients on long-term BSP therapy may require close monitoring. In a recent study, prophylactic fixation was performed on the basis of symptoms and radiographic findings. However, radiographic findings alone may not be sufficient to support the decision to adopt a preventive procedure. To the best of our knowledge, no study has yet been undertaken to determine whether magnetic resonance imaging (MRI) can detect cortical damage or predict an impending fracture in patients on long-term BSP therapy. In this study we used MRI to identify evidence of impending fractures in patients on long-term BSP therapy with thigh pain and a suspicious radiographic femoral lesion.

261 Copyright c 2014 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received May 27, 2014 Revised June 12, 2014 Accepted September 18, 2014 Address reprint requests to: Gu-Hee Jung, M.D. Department of Orthopaedic Surgery, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea Tel: 82-51-990-6785ᆞFax: 82-51-243-0181 E-mail: jyujin2001@kosin.ac.kr

58 통신저자:정 구 희 부산시 서구 암남동 34번지 고신대학교 의과대학 복음병원 정형외과학교실 Tel:051-990-6785ᆞFax:051-243-0181 E-mail:jyujin2001@kosin.ac.kr 접수: 2011. 6. 21 심사 (수정): 2011. 7. 25 게재확정: 2011. 11. 15 Address reprint requests to:Gu-Hee Jung, M.D. Department of Orthopaedic Surgery, Gospel Hospital, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan 602-030, Korea Tel:82-51-990-6785ᆞFax:82-51-243-0181 E-mail:jyujin2001@kosin.ac.kr 정형외과 수술실에서 영상 증폭기에 의한 1년간의 방사선 노출량

237 통신저자:조 철 현 대구시 중구 달성로 56 계명대학교 의과대학 정형외과학교실 Tel:053-250-7729ᆞFax:053-250-7205 E-mail:oscho5362@dsmc.or.kr 접수: 2011. 5. 5 심사(수정): 2011. 5. 30 게재확정: 2011. 6. 24 Address reprint requests to:Chul-Hyun Cho, M.D., Ph.D. Department of Orthopedic Surgery, School of Medicine, Keimyung University, 56, Dalsung-ro, Joong-gu, Daegu 700-712, Korea Tel:82-53-250-7729ᆞFax:82-53-250-7205 E-mail:oscho5362@dsmc.or.kr 상완골 근위부와 간부를 침범한 복합 골절에서의 골수강내 금속정 고정술