Journal of Orthopaedic Surgery

From September 1996 to September 1997, 27 adult patients were diagnosed with chronic triangular fibrocartilage complex (TFCC) tears with distal radioulna joint (DRUJ) instability in our clinic. They all received the procedure of TFCC reconstruction with partial extensor carpi ulnaris (ECU) tendon combined with or without ulnar shortening. There were 26 males and one female in the study with a mean age of 22.4 years. The follow-up period ranged from 22 to 28 months with a mean of 26.2 months. 24 patients who had positive or zero ulnar variance received the procedure of ulnar shortening. Three patients who had minus ulnar variance only received TFCC reconstruction. After the operation, the DRUJ was fixed by a 2.0 mm K-wire for 4 weeks. All patients underwent a rehabilitation program and they were reexamined at our outpatient department (OPD). The results were graded according to the Mayo Modified Wrist Score. Five of the 27 patients rated their wrists ‘excellent’, 18 rated ‘good’, and 4 rated ‘fair’. Overall, a total of 23 patients (85%) rated satisfactorily and returned to work or sport activities. In the 4 patients rated ‘fair’, mild pain at work and/or exercise, and mildly limited supination were found; however their grip strength was improved at least by 65% compared to the opposite hand. Therefore, as suggested by this study, TFCC reconstruction with partial ECU tendon combined with the ulnar shortening procedure is an alternative method for chronic TFCC tears with DRUJ instability.

A review was carried out on 59 patients (10 males and 49 females) who had anterior interbody fusion performed with femoral ring allograft packed with autograft bone chips with a minimum follow up of 2 years. The average age at the time of surgery was 49.1 year old (26 to 75). The total number of levels grafted was 141. The diagnosis consisted of multiple degenerative disease in 6, degenerative change below the long segment of fusion for scoliosis in 9, osteoporosis with collapsed fracture in 3, pseudarthrosis after posterior laminectomy and fusion in 35, congenital scoliosis in 3, scoliosis in 2 and paralytic scoliosis due to multiple sclerosis in one. The distribution of levels fused was T12-L1 in 6, L1–2 in 12, L2–3 in 17, L3–4 in 22, L4–5 in 35 and L5-S1 in 39. The remaining 10 levels were in the lower thoracic areas (T7-T12). The operations were performed as anterior fusion alone in 13 patients, one-stage anterior and posterior fusion in 26 patients and two-stage surgery in 20 patients. Anterior instrumentation was used in all 141 levels. At average follow-up (33.7 months) there was no significant change in allograft angles (average = 1.6^o). Fusion of the allograft was classified by Bridwell's grading system. At 24 months of the follow up, 97 % of the allografts were in grade I (fully incorporated) and 3% were in grade II (partially incorporated). Compared to 12 months follow-up only 76.2% of the grafts were in grade I, 28 % were in grade II and 0.8% were in grade III. Two patients had deep posterior infections which required further surgery (without resorption of the allograft anteriorly). One patient had a screw migration anteriorly which required removal. Three patients had persistence of radiolucent line at one of the vertebral end plates – graft interfaces but no subsidence of the graft or pain. In conclusion, the femoral ring allograft appeared to benefit the anterior interbody fusion in complex spinal surgery.

The role of quantitative bacteriology is considered controversial for the prediction of infection in open fractures. A study was done in 20 patients with open fractures. Post debridement pieces of skin, muscle and periosteal tissue were obtained for quantitative bacterial counts. Among a total of 50 samples from all of the tissues, 29 showed positive bacterial counts (16 of 20 skin, 11 of 20 muscle and 2 of 10 periosteum samples). By quantitative estimation, the bacterial load was >10⁵ per gram in 10 skin and 3 muscle tissue samples. Infection developed in 9 of the 20 cases within one month, and eight of these patients had contamination of >10⁵ per gram in 8 of the skin but only 3 muscle samples. It was concluded that with tissue specific bacterial load estimation, prediction of subsequent infection can be made if skin tissue contains >10⁵ per gram, or if muscle tissue carries any level of bacterial presence.

We performed a comparative study of iliac bone graft (the iliac bone group) and carbon cage with local bone graft (the cage group) in PLIF to evaluate the clinical results of both methods. We examined both groups about the operating time, the estimated blood loss, the operative results using the score rating system of Japanese Orthopaedic Association (JOA score), and the presence of bone union on radiography. The operating time and the estimated blood loss of the cage group were statistically less than those of the iliac bone group. There were no significant differences between both groups about the operative results. The radiographic evaluation on bone union showed that half of the iliac bone group had collapsed union, but all cases of the cage group revealed union without collapse.

A prospective sequential MRI study was done to investigate the morphologic changes of the lumbar disc hernia (LDH). We also studied the relationship between the MRI changes and the type of LDH and the clinical outcome.

MRI was performed every 3 months from the onset for a maximum of 24 months in 42 patients with radicular leg pain and symptoms definitely diagnosed as caused by LDH. The size of the herniated mass was determined by the ratio of the anteroposterior diameter of the spinal canal to the maximum diameter of the LDH mass on T2-weighted axial images.

The clinical outcome was evaluated as excellent, good, or poor depending on leg pain and physical findings. The JOA (Japanese Orthopaedic Association) score for LDH was also used to assess the outcome. Thirty-seven (88%) of the 42 patients showed >50% reduction of the hernia on MRI 3–12 months after onset, and the morphologic changes of the herniated mass were well correlated with the clinical outcome.