The Thai Journal of Orthopaedic Surgery

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Rotational Alignment of Femoral Fractures : Does Fluoroscopic Assessment of the Lesser Trochanter be Helpful?
(The Thai Journal of Orthopaedic Surgery, 2010-02-09) Rangson Chiawsirikajorn, MD Banchong Mahaisavariya, MD
The simulation study was performed on 15 pairs of adult cadaveric femora to determine whether the size or width of the apparent lesser trochanter (ALT) from the image screen of different projection of the C-arm image intensifier will be useful or not for the prediction of rotational profile of the proximal femur. From the study, the width of ALT is smallest at the position of internal rotation and gradually increase with the decreasing degree of internal rotation to neutral AP projection. The width of ALT is gradually increase with increasing degree of external rotation projection. However from the pairs study, it wasfound that the apparent width of ALT from right femur is larger than that of the left side in almost all projection between 30 degree internal rotation to 30 degree external rotation of the C-arm. The difference of the width of ALT at internal rotation 30 degree averaged 1.9 mm and the difference at external rotation 30 degree averaged 6.2 mm. The range of difference of the width of ALT in the pairs study ranged from 0 to 24 mm. No any relationship of the difference of the width of ALT and the degree of internal or external rotation was found. There was no tendency that width of ALT can be used as a reference to each other to any degree of femoral rotation.
The Effect of Total Lymphocyte Count on Postoperative Complications in Elderly Patients with Hip Fractures
(The Thai Journal of Orthopaedic Surgery, 2010-10-27) Opas Chaiyamahapruek, MD
Objective: To evaluate the effect of total lymphocyte count on postoperative complications in elderly patients with hip fractures.Methods: In-patient medical records of elderly patients with hip fracture surgery including patient demographic, site of fracture, comorbidities, postoperative complications, operative technique, length of stay, hematocrit, total lymphocyte count and albumin were reviewed then evaluated the effect of total lymphocyte count on postoperative complicationsResults: 16 males and 52 females with mean age 73.81±8.17 years were included in this study. 37 patients had postoperative complications. There were 4 postoperative deaths. Patients with low total lymphocyte count had a higher prevalence of postoperative complications as compared with patients with normal total lymphocyte count but the difference was not statistically significant.Conclusions: From this study, total lymphocyte count had no statistically significant affect on postoperative complications in elderly patients with hip fractures. However, patients with low total lymphocyte count had a higher prevalence of postoperative complications than patients with normal total lymphocyte count. Keywords: total lymphocyte count, comorbidities, postoperative complications, elderly, hip fractures
The H-Index
(The Thai Journal of Orthopaedic Surgery, 2010-02-09) Banchong Mahaisavariya, M.D.
The h-index was suggested by Jorge E. Hirsch as a tool for determining theoretical physicists’ relative quality and is sometimes called the Hirsch index.1The h-index is defined as follows :A scientist has index h if h of his/her Np papers have at least h citations each and the other (Np-h) papers have no more than h citations each.In other words, a scholar with an index of h has published h papers each of which has been cited by others at least h times. Thus, the h-index reflects both the number of publications and the number of citations per publication. The index is designed to improve upon simpler measures such as the total number of citations or publications. The index works properly only for comparing scientists working in the same field ; citation conventions differ widely among different fields.
The Simple Distraction Device for Bone Transport Combined with Minimally Invasive Plate Osteosynthesis (MIPO) in the Treatment of Segmental Bone Defect
(The Thai Journal of Orthopaedic Surgery, 2010-02-09) Theerachai Apivatthakakul, MD
The authors present two cases of segmental bone defect of the femur and tibia treated with bone transport using the simple distraction device which has been designed and adapted from Chiang Mai University (CMU) external fixator combine with MIPO technique. It can be applied for the femur and tibia with the distraction length of 7.5 cm. The device is simple, effective, cheap and reproducible.
Reliability and accuracy of roentgenographic measures in determining the degree of comminution of femoral shaft fractures
(The Thai Journal of Orthopaedic Surgery, 2011-01-31) Weera Chaimongkol, MD Boonsin Tangtrakulwanich, MD, Ph.D.
Objective: The aim of this study was to evaluate both the reliability and accuracy of plain and high resolution radiographs in determining the degree of comminution of femoral fractures. Methods: Eighteen patients were selected for evaluation of femoral fracture using plain and high resolution radiography, followed by computerized tomography (CT) with reconstruction. Three groups of assessors included four orthopedic members of staff, four senior residents, and four junior residents (first and second year). Consensus agreement of the staff reading the CT scans was considered as “the gold standard”. Results: The accuracy in determining the degree of comminution of plain radiography was 45.8%, 70.8% and 70.8% for junior resident, senior resident and staff, respectively. Those for high resolution radiography were 50.0%, 68.0% and 73.6%. Interobserver reliability in both plain and high resolution radiography was moderate in both the senior resident and staff groups, but only fair among the junior residents. The intraobserver reliability in the staff group was substantial in both types of x-rays. Conclusion: The difference in accuracy and reliability between plain and high resolution radiographs is marginal when used to define the degree of comminution of femoral shaft fracture, except when interpreted by assessors with less experience. Key words: Reliability, accuracy, comminution, femoral fracture The Thai Journal of Orthopaedic Surgery: 35 No.1: P1-5Full text. e journal: https://www.rcost.or.th/journal, https://thailand.digitaljournals.org/index.php/JRCOST
Migratory Intrathecal Bullet: a case report detailing the technique
(The Thai Journal of Orthopaedic Surgery, 2011-01-31) Chalermpong Sermkiettipong, MD
The literature contains few reports of migratory intrathecal bullets. Treatment of this kind of injury remains controversial. This paper presents one case of a migratory intrathecal bullet at the lumbar level. A Foley catheter was used to effect its removal. This alternative technique demonstrated a safe and simple method of treatment. Keywords: gunshot injury, migratory bullet, intrathecal
Early Functional Result of Arthroscopic Bankart Repair: The Rajavithi Hospital’s Experience
(The Thai Journal of Orthopaedic Surgery, 2010-10-27) Pinij Srisuwanporn, MD, Sukrom Cheecharern, MD, Porntham Choosakde, MD, Sittiporn Kamchatphai, MD
Objective: To study functional result and redislocation rate of the shoulder after arthroscopic Bankart repair using suture anchors.Methods: Sixteen patients who underwent arthroscopic Bankart repair at Rajavithi Hospital between Jan 2007 and Dec 2008 were enrolled in this study. Demographic data and functional score were collected using the methods of UCLA (University of California, Los Angeles) and ASES (American Shoulder and Elbow Surgeons). Preoperative and postoperative scores were compared using statistical analysis.Results: Postoperative functional scores were statistically better than preoperative scores in all patients. No redislocation was observed. There was no correlation between preoperative number of dislocations and functional result one year after surgery.Conclusion: The functional result after arthroscopic Bankart repair using suture anchors is excellent with proper selection and technique. There was no correlation between preoperative number of dislocations and functional result. Keywords: Anterior shoulder dislocation, Bankart, Suture anchor, functional score, UCLA, ASES
The Effect of Sequencial Insertion of Tibial Polyethelene to the Stability of Total Knee Arthroplasty
(The Thai Journal of Orthopaedic Surgery, 2010-02-09) Wallop Adulkasem, MD
Stability of the knee after total knee arthroplasty(TKA) is very important. Good alignment may not be maintained in case with unstable knee. Furthermore, knee instability may result in abnormal motions of femoral condyle on tibial surface (slipping) in all direction such as ; anteroposterior, rotation, varus and valgus tilting. This will result to the rapid wear and tear on polyethelene surface and lead to implant failure in later stage. This paper present the investigation to show that the sequencial tibial polyethelene insertion can effect the knee stability after TKA. The experimental model of TKA was performed on saw bone with three difference tibial polyethelene inserting techniques; group I, tibial polyethelene is inserted before femoral part, group II tibia polyethelene is inserted after femoral part with push and pull and group III tibia polyethelene is inserted after femoral part with subluxated tibia.Varus and valgus stress test, drawer tests were done on saw bone after saw bone operation. The study was also performed in 70 knees from 65 patients. The stability test after TKA at ; immediate, 3, 6 months and 1 year after operation was performed. There were 50 knees in group I, 16 knees in group II and 4 knees in group III. Varus and valgus stress, drawer tests were positive grade1 or more in all knees in group II \& III but none in group I both in saw bone and in the studied patients. From the study both in experimental model and in the study patients it was found that the sequential of tibial inserting may have important effect in knee stability for TKA. This effect has not been reported and is not recognized by most surgeons.
Human Bite Injuries of the Hand at Sawanpracharak Hospital: 10 years of experience
(The Thai Journal of Orthopaedic Surgery, 2010-10-27) Prathan Oprasertsawat, MD
Objective: To study patient characteristics, nature of injury, time to receive treatment, treatment procedure, and final outcome in patients with human bite injuries on the hand.Methods: Retrospective, descriptive study in 45 patients with hand wounds from bites who were treated in Sawanpracharak Hospital from January 1st, 2000 to December 31st, 2009. Data was collected from medical records and presented by descriptive statistics. Patient characteristics and outcomes were compared between patients who received treatment within 48 hours and after 48 hours by Exact test and t-test.Results: All patients were males, mean age 29.2±9.0 years. 84.4% of the lesions were on the right hand and 57.8% of lesions were at the MCP joint of the middle finger. Radiology found nine fractured metacarpal heads and one narrowing joint space. 55.5% had cellulitis, 37.8% had open joint injury, and 22.2% had tendon injury. 33.3% of wound cultures had Streptococcus spp. and 22.2% had Staphylococcus spp. Of the 21 patients who completed follow-up, 71.4% showed a good final function outcome. Patients who received treatment within 48 hours revealed fewer cellulitis (45.7% vs. 90.0%, p= 0.027), a lower average length of hospital stay (2.3±1.5 vs 11.8 ± 8.7, p= 0.007), and less joint stiffness (6.3% vs 100.0%, p = 0.001) than those who did not.Conclusion: Time from injury to treatment and appropriate treatment were important factors in reducing complications. Key words: Human bite injury, fight bite, clenched fist injury
Comparison of Treatment Time Index for Management of Bone Defects between Distraction Osteogenesis and External Fixator with Cancellous Bone Graft
(The Thai Journal of Orthopaedic Surgery, 2010-10-27) Wanchai Jarusombat, MD
Objective: To compare the durations of treatment in management of bone defects between distraction osteogenesis and external fixator with cancellous bone graft.Method: This retrospective study was conducted from October 2000 to August 2010. There were 32 cases of bone loss at the femur and tibia. They were divided into 2 groups: group 1 (15 patients were treated using distraction osteogenesis) and group 2 (17 patients were treated using an external fixator with cancellous bone graft). Both groups were compared based on the duration of treatment and clinical results.Results: The first group, which was treated with the distraction osteogenesis method, had a duration of treatment of 33.99 days per 1cm of bone defect. The second group, which underwent an external fixator along with a cancellous bone graft, had a duration of treatment of 77.75 days per 1cm of bone defect.Conclusion: Distraction osteogenesis method had a shorter duration of treatment than the external fixator with bone graft method in managing bone defects. Keywords: bone defect, distraction osteogenesis, external fixator, cancellous bone graft
Image-based Navigation in Orthopaedic Surgery
(The Thai Journal of Orthopaedic Surgery, 2010-02-09) Kongkhet Riansuwan, MD Banchong Mahaisavariya, MD
Image-based navigation is recently accepted as one of the most profitable devices utilized to improve the accuracy of many procedures in orthopaedic surgery. Actually, navigation-assisted surgery systems were initially used in neurosurgery in the late 1980s. The interactive computer system is able to match the co-ordinate pre-or intraoperative images, patient’s anatomy and the surgical instruments by using tracking and registration process. The initial image-based navigation system has based upon preoperative computer tomography (CT) images and clinical application has been successfully introduced in spinal instrumentation since 1994.1-2 However, time consuming, comsplicated techniques and error in the registration process known as a pair-point matching remain the major concern and may cause CT-based navigation less popularity with time.
When do Soft Tissue Injuries of Extremities without Obvious Deformity Require Radiography?
(The Thai Journal of Orthopaedic Surgery, 2010-10-27) Theerasak Mongkol, MD
Background: Emergency departments commonly treat soft tissue injuries to extremities. When to use radiography in cases without obvious deformity is unclear.Objectives: To establish appropriate criteria for radiography in patients having soft tissue injuries of extremities without obvious deformity.Methods: A cross-sectional study of 400 patients over 15 years old who presented with acute extremity injuries without obvious deformity from January 2007 – December 2009. Patients with polytrauma, neurosis, psychosis, alcoholism, gross fractures, neurological deficits, open injuries, inability to bear weight on injured lower extremities, and doubtful radiographs were excluded. Diagnosis for fracture by physical examination included swelling, ecchymosis, axial percussion test, generalized tenderness, bony point tenderness, and range of motion. Radiographs were obtained for all patients without knowing physical examination results.Results: Fractures were present in 17.25% of soft tissue injuries without obvious deformity. The most accurate predictors of fracture were axial percussion test (88.50%) and bony point tenderness (73.50%). Positive and negative predictive values of physical diagnosis were 51.88% and 95.24%.Conclusions: Axial percussion test and/or bony point tenderness should be followed by radiography due to their high accuracy. Other clinical signs such as swelling, generalized tenderness, and decreased range of motion were less than 32.50% accurate. Keywords: soft tissue injury, radiography
Intermediate Screws in Short Segment Pedicular Fixation for Thoracolumbar and Lumbar Burst Fractures
(The Thai Journal of Orthopaedic Surgery, 2010-02-09) Suwit Ekapichon, MD
Purpose: To evaluate the clinical relevance of short segment pedicular fixation with intermediate screws. Methods: Retro- and prospective studies were done of 29 patients with thoracolumbar or lumbar burst fractures who were treated with posterior short segment pedicular fixation. Anterior vertebral body height compression percentage (AVBCP) and local kyphosis were measured and analyzed pre-operatively, post-operatively, and at last follow-up period. All patients were followed up for a minimum of 6 months. Results: The mean immediate post-operative corrections of AVBCP and kyphosis were 24±15% and 14±8° respectively. The mean losses of correction at the last follow-up period were 0% and 2.2° for AVBCP and kyphosis respectively. At last follow-up, there was significant loss of correction of kyphosis (p
New Technique to Improve Subchondral Bone Mechanics in Core Drilling and Bone Graft for Osteonecrosis in Swine Hip Model
(The Thai Journal of Orthopaedic Surgery, 2010-02-09) Cholawish Chanlalit, MD
The mechanical compressive strength of the femoral head after core tract drilling and debridement of subcondral bone to simulate the post-treatment condition of avascular necrosis of the femoral head was studied using the swine hip model. Compressive strength after other treatment methodwas also investigated. This includes ; the group with the use of strut graft only and the group with interference screw supplementation. Twelve swine hips model were use for the study by creating a large void beneath the superior part of femoral head by core tract drilling and subchondral bone debridement technique in area that will usually a common site of subchondral bone destruction from osteonecrosis. The specimens were then randomized into 3 groups, 4 hips for control group (bone debridement alone), 4 hips for strut graft group (with strut graft placed beneath subchondral plate) and the rest 4 hips for experimental interference screw supplementation group. Compressive strength were measured using round indenter compress at the upper mostof femoral head that can collapse subchondral plate to 2 mm. The result show that experimental group have significant higher compressive strengh than the contol and the strut graft group
Comparison of cast-associated pruritus prevention using calamine lotion and talcum powder: A randomized trial
(The Thai Journal of Orthopaedic Surgery, 2010-10-27) Chanin Boontangjai, MD, Boonsin Tangtrakulwanich, MD, Ph.D.
Objective: To compare the efficacy between calamine lotion and talcum powder in reducing pruritus in patients having distal radius fractures treated with short arm casts.Materials and methods: Patients having a closed distal radius fracture without associated injuries aged 15-80 years visiting our emergency unit were randomized into talcum powder and calamine groups. All patients were treated by closed reduction and a short arm cast for four weeks. Atarax and paracetamol were prescribed for rescue medication. Patients were requested to report their pruritus score (0-10) daily in a supplied diary. The patients were followed up at one week for cast changing and then every week until cast removal. After cast removal, the skin condition was inspected for skin problems and the patients rated their satisfaction with the overall treatment.Result: Thirty-four patients with distal radius fractures were randomized into talcum powder (19) and calamine (15) groups. The most common causes of fracture were fall and motor vehicle accident. No patient was lost to follow-up during the study period. Patients in the calamine group reported a significantly lower mean pruritus scores than those in the talcum powder group at the end of treatment period. There were no significant differences in the mean usage of rescue medication, complications, and satisfaction with treatment between the two groups.Conclusion: Calamine lotion showed a better efficacy in reducing pruritus associated with casts than talcum powder in patients having distal radius fracture treated with short arm cast.
Mortality and ambulatory status after intertrochanteric fracture treated at Maharat Nakhon Ratchasima Hospital, Thailand
(The Thai Journal of Orthopaedic Surgery, 2010-10-27) Supphamard Lewsirirat, MD, Pachin Thanomsingh, MD
Purpose: 1. To assess elderly intertrochanteric fracture patients for overall one-year mortality rate and for ambulatory ability two years after treatment. 2. To analyze factors that may affect one-year mortality and independent walking. 3. To compare one-year mortality, survival function, and independent walking between operative and home skin traction treatment.Methods: A retrospective cohort study of 496 intertrochanteric fracture patients at least 60 years of age, treated at Maharat Nakhon Ratchasima Hospital between October 2002 and September 2006, assessed one-year mortality rate and two-year ambulatory ability. The factors studied were treatment methods (251 operation, 245 home skin traction), gender (337 female, 159 male), age (mean 78 years, SD8.7), numbers of comorbidities (57% had one or more comorbidities), and ASA classification (ASA I, II, III, and IV were 55%, 36.7%, 7.5%, and 0.8% respectively).Results: The overall one-year mortality rate was 23.6%. The median survival time was 4.18 years after fracture. Of patients who were still alive two years later, 55.2% could walk independently, 27.7% needed assistance or gait aids, and 17.1% were confined to bed or wheelchair. Factors that significantly affected one-year mortality were nonoperative treatment, being male, and each additional year of age. The home traction group had a higher one-year mortality rate than the operative group (odds ratio 3.01; 95 % CI 1.8634, 4.8997 P 0.000). Independent walking depended on type of treatment only. The operative group had more independent walking (odds ratio 2.19; 95% CI 1.3009, 3.6917 P 0.003). Gender, age, numbers of comorbidities, and ASA class did not affect independent walking.Conclusion: Intertrochanteric fracture in the elderly is a terrible condition with a very high risk of one-year mortality and later dependence. Operative internal fixation is the treatment of choice, with a lower one-year mortality rate and more independent walking. Keywords: Elderly intertrochanteric fracture, one-year mortality, ambulatory ability, independent walking, home skin traction
Comparison of Prosthesis Position in Total Hip Arthroplasty by Lateral and Posterior Approach in Pathum Thani Hospital
(The Thai Journal of Orthopaedic Surgery, 2010-10-27) Chatchawal Kaewkun, MD
Purpose: To compare differences in prosthetic position in total hip arthroplasty between the lateral and posterior approaches.Methods: Retrospective analytical study reviewed the X-ray films and medical records of every patient treated with total hip arthroplasty from 2002 to 2010. There were 107 hips in 93 patients.Results: There was no statistically significant difference in sex, age, or diagnosis between the two approaches. Acetabular inclination, vertical height, horizontal distance, and anteversion were also not significantly different between the two groups, yet the femoral stem alignment significantly tended to be varus in the posterior approach and valgus in the lateral approach. This also made the posterior approach group have longer offset with statistically significance. This might be the influence of the position of the femur when inserting the femoral stem. Limb length discrepancy was similar in both groups.Conclusion: The femoral stem alignment significantly tended to be varus in the posterior approach and valgus in the lateral approach. This data can be used to prevent prosthetic malalignment following the selected approach in total hip arthroplasty. Keywords: Hip arthroplasty, comparison of prosthesis, stem, malalignment, misalignment
Overlap Connecting Plate for Treating Facture
(The Thai Journal of Orthopaedic Surgery, 2010-02-19) Wallop Adulkasem , MD
Short segmented and comminuted fractures usually require special implants such as the special long plate or interlocking nailing system for the fixation. These implants or instruments may not be available in most hospital in Thailand or in the developing countries. This paper presents an improvise technique of using the overlap connecting plate to overcome this problem. The method have been successfully applied in fifteen patients who had segmented or comminuted fractures. Seven cases were treated by using condylar plate with broad dynamic compression plate (DCP) for femoral fractures, four were fixed bysmall T-plate with small DCP for distal radius fractures and another four were fixed by using T-plate with narrow DCP for tibial fractures. The operation time and blood loss were not exceed the average of ordinary operating procedure. All fractures were united in 4 months post operation. All patients could have early ambulation or mobilization program post operation and the injured limbs had returned to normal function at the time of final visits.The overlap connecting plate is an alternative method for treating complicated fractures. Special considerations of the method include; minimum of six cortices in each fragment fixation is required, plate must seat well on the bone, the thinner plate should be placed underneath the thicker one, the blade plate should be placed over the normal DCP. The overlap connection plate has been found simple and effective. The instrument and implants are familiar to the surgeon and are available in most hospitals.
Six Months Postoperative Outcomes of Carpal Tunnel Release Using a Short Palmar Incision in Lampang Hospital
(The Thai Journal of Orthopaedic Surgery, 2010-02-18) Nutthapong Wongwiwat, MD
Carpal tunnel release is one of the most commonly performed procedures of outpatient surgery in Lampang Hospital. The author studied 42 consecutive patients who underwent a short palmar incision for carpal tunnel release between January and June 2006 in Lampang Hospital. Only 35 patients (40 hands) were included. All operations were carried out under local anesthesia and without tourniquet. The patients were evaluated before and 6 months after surgery using subjective symptoms, physical examination findings and the Boston carpal tunnel questionnaires(BCTQ). The results showed that all symptoms and BCTQ scores decreased significantly (p \< 0.001). Night pain and day pain disappeared in all patients. Numbness was improved with a less score than other symptoms. Tinel’s sign and Phalen’s test were decreased postoperatively(p \< 0.001). The thenar wasting was improved in some patients but no statistical significance was found (p = 0.25). The scar tenderness was found in 3 patients at 6 months follow-up. However, pillar pain occurred in the early postoperative period and completely resolved in 6 months. The average operation time was 10.8 minutes. The average incision length was 15.4 mm. There were no serious complications. In conclusion, carpal tunnel release with a short palmar incision is a simple procedure with no need for specialized instrument. It can be effectively and safely used for the treatment of carpal tunnel syndrome.
Urinary Crosslinked N-telopeptides of type I collagen (NTx) among Reproductive and Post-menopausal Thai women
(The Thai Journal of Orthopaedic Surgery, 2010-04-01) Phutorn Sangkarak, MD
Purpose: To study the level of Urinary Crosslinked N-telopeptides of type I collagen (Urinary NTx) in reproductive and postmenopausal Thai women and their correlation with bone mineral density (BMD) and duration after menopause.Methods: Second or third void morning urine samples were collected in 48 reproductive women and 42 postmenopausal women. Urinary NTx was measured by competitive-inhibition ELISA and corrected with spot urine creatinine. BMD was measured in all postmenopausal participants.Results: The mean value of Urinary NTx in reproductive women was 36.19 nanomoles of bone collagen equivalents per millimole of Creatinine (nM BCE/mM Cr), standard deviation = 25.18 with 95% confidence interval = 28.88 to 43.50 nM BCE/mM Cr. The mean value of Urinary NTx in postmenopausal women was 58.89 nM BCE/mM Cr, standard deviation = 26.93 with 95% confidence interval = 50.50 to 67.28 nM BCE/mM Cr. Neither BMD nor duration after menopause is significantly correlated with Urinary NTx.Conclusion: Urinary NTx increased with age in Thai women (p

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