An Epidemiologic Study of the Osteonecrosis In Adult Femoral Head / 대한정형외과학회잡지

Authors analylsed 384 hips of 269 patients with osteonecrosis of the femoral head in adult, who were diagnosed and treated between August 1976 and March 1986 at the Department of ()rthopaedic Surgery, Kyung Hee University Hospital. These are investigated in terms of history, clinical data and reontgenogram, retrospectively. In 269 patients, nontraumatic femoral head necrosis (NTFHN) were 199 patients (74.0%) and traumatic femoral head necrosis (TFHN) were 70 patients (26.0%). The male was more affected in ratioof 3.1: 1, especially higher in NTFHN about 4: l. In alcohol-induced necrosis all were male patients, but in polyvinyl pyrrolidone(PVP)-storaged cases 63% were female patients. The peak incidence of age distribution was at 6th decade(average 53.9 years) in the TFHN ahd 5th decade(average 44.2 years) in NTFHN). The most frequent probable etiologic frctor in NTFHN was idiopathic (71 patients, 35.8%), followed by alcohol-induced (68 patients, 34.2%), steroid-induced (27 patients, 13.6%) and PVP-storaged (19 patients, 9.5%). The bilateral involvement in NTFHN was 112 patients (53.6%). The idiopathic cases (42.0%) were lower than steriod-induced (81.9%), alcohol-induced (76.5%) or PVP-storaged (63.2%) in the bilaterality. The associated diseases in NTFHN were hepatopathy (12 patients), diabetes (7 patients), pulmonary tuberculosis (6 patients) and dermatopathy (5 patients). And the underlying diseases in steroid-induced were nephrotic syndrome (4 patients), arthralgia (4 patiehts), rhematiod arthritis (3 patients), dermatopathy (4 patients) and systemic lupus erythematosus (1 patient). 61.4% of TFHN was diagnosed within 2 years after trauma, 56.7% of NTFHN had the duration of symptom over one year. The initial reontgenogram stage according to Ennekings classification was average stage 1V. In NTFHN cases, there were no significant relationship between etiologic factors and initial reotgenographic stage or duration of symptom. But there were significant corelation between Enneking's reontgengraphic stage and clinical findings (range of movement of joint, Harris hip score, duration of symptom). In more severe cases than Enneking's radiologic stage IV, Harris hip score not provide any information to select a proper treatment.

Replantations of Amputated Limbs and Digits: An analysis of 200 replantations / 대한정형외과학회잡지

We studied two hundread cases of replantations-61 cases of major limb replantation and 139 cases of finger replantation. 53 of 179 patients had multiple amputation. The most common cause of amputation was cutting-machine injury and the next one was belt and roller injury. The patients were followed than 6 months, ranging 6 months to 5 years and 10 months, averaging 36 months. The success rate of replantation is 86.9%(53/61) in the amputated limbs and 80.6%(112/139) in the amputated digits. Main causes of failure were tissue crushing, vessel thrombosis, long ischemic time, and amputation wound infection. Common complications were infection (25 cases), delayed union(7 cases), nonunion(2 cases), bleeding tendency and hematoma formation due to systemic heparinization(5 cases). We used Seddon's classification to assess the recovery of the nerve function of the replanted limbs and digits. 84.6 % of success cases of limb replantation presented the excellent result in the motor fuction recovery and 89.1% also presented the excellent sensory recovery. 89.8% of the success cases of the digit replantation showed the excellent result in the sensory recovery. The factors influencing the functional recovery of the replantation surgery were mechanism of injury, ischemic time, surgical technique, numbers of anastomosed vessels, ratio between anastomosed artery and vein, and wound infection. This analysis demonstrated that strict selection of the indication or the replantation is the first step in the limb and digit replantation surgery.

Vascularized Fibula Graft for Restoration of the Large Bone Defect / 대한정형외과학회잡지

We analyzed 34 cases of large bone defect caused by trauma, infection and tumor resection from July, 1979 to June, 1985. The bony defect were restored by vascularized fibular graft or vascularized fibular transposition. 22 cases were the traumatic segmental loss and 7 cases were infected ones and 5 cases were the loss following tumor resection. Vascularized fibular graft was performed in 19 cases and vascularized fibular transposition was performed in 15 cases. The 33 cases(97%) of 34 cases had obtained sound bony union and average union time had been 18.6 weeks. Even local infection in the bone, vascularized fibular graft or transposition can be performed. Grafted or transposed fibula had been hypertrophied about 1.2 times in anteroposterior and lateral film which had been measured in the center of the fibula. The most common complication was the clawing of first or second toe. If the ipsilateral fibula is intact, the vascularized fibular transposition is better and if not, vascularized fibular graft is preferred. Operation using the vascularized fibula is a excellent method for the restoration of large bone defect in long bone.

Segmental Fractures of the Femur Treated by Intramedullary Nailing / 대한정형외과학회잡지

Since the segmental fractures of the femur are resulted by violent force, they are frequently associated with severe soft tissue damage and multiple skelectal injuries and they necessitated careful emergency care. Occasionally, they combined with severe communition, so their ultimate fixation of the fractures are very difficult. Authors analysed sixteen fractures of the segmental fracture of the femur which were treated by intramedullary nailing with or without interlocking at the Kyung Hee University, medical college, from the December, 1975 to May, 1985. In eight of sixteen cases the nailing was done by closed technique, one case was semiclosed. In the seven fractures the traditional retrograde nailing technique with open reduction of fracture was used. The pin & plaster, cast brace, side bone plate, wiring or interlocking screws were used as additional stabilization to intramedullary nailing. The diameter of the nails were 9–12 mm in 5 cases, 13–15 mm in 11 cases. There were no need the cancellous bone graft to promote the bony union. The results were as follows; 1. The closed intramedullary nailing with interlocking screw offers an ideal anatomical, functional and physiological treatment for the segmental fracture of the femur. 2. When the segmental fracture of the femur involves the neck or supra- or intercondylar fractures, the intramedullary nailing can be used with Knowles pin or tibial bolt fixation. 3. In the cases of infected nonunion, we obtained solid bony union by means of extensive and meticulous debridement and rigid intramedullary nailing using additional devices without cancellous bone graft.

Follow / 대한정형외과학회잡지

From May, 1971 to June, 1984, we performed extensive saucerization on the chronic osteomyelitis of long bones eradicating all pathologic foci; not only sequestra but sclerotic involocurum and necrotic original cortex embeded by new bone, which was different from the conventional methods such as sequestrectomy or guttering in its extensiveness. Clinical analysis on the base of radiologic evaluation after saucerization was done on the 16 patients; for average 5 years of follow-up. The results obtained were as follows; 1. The angulatory deformity of the long bones after pathologic fracture complicated by the chronic osteomyelitis was not corrected satisfactorily due to the bony sclerosis or hyperostosis at the fracture site, especially in cases of posterior or medial angulation. 2. The recurrence was closely related to the persisting non-sequestered original cortical lesion after incomplete saucerization, which was embeded by the new bone. So to prevent the recurrence the non-sequestered original cortical lesion must be removed completely. 3. The cortical defect after saucerization was restored completely in patients under the age of 14, but which was not the way in patients over the age of 16.

Popliteal Artery Injury Associated with Severe Knee Trauma / 대한정형외과학회잡지

Fracture dislocation or dislocation of the knee can produce a popliteal artery injury that may be difficult to evaluate clinically. Diagnosis of disruption or thrombosis of the popliteal artery is frequently delayed until the opportunity to salvage the extremity is lost. 22 cases of popliteal artery injury were reviewed from July 1978 to December 1983, associated with severe knee trauma at the Orthopaedic department of Kyung Hee University Hospital, of whom average follow-up for about 52 months. The results obtained were as follows; 1. In all 22 cases, 14 cases (63. 6%) were amputated. The amputation rate was correlated with ischemic time after injury. 2. Resection of all injuried vessels with reconstitution of continuity by the use of an interposed saphenous vein graft is often warrented to avoid tension. 3. All 8 patients, which was managed conservatively, were amputated in all cases(100%). In cases of suspicious popliteal artery injury, early aggressive exploration and obvious microvascular reconstruction should be mandatory. 4. Subperiosteal fibulectomy-fasciotomy should be done routinely immediately after vascular injury. 5. Diagnosis of popliteal artery injury was based on the clinical findings but the capillary filling was not contributary. 6. The use of Doppler flowmeter and emergency arteriography was recognizedtobeanexcellent methods in determination of arterial injury.

Effect of Buttress Graft in Anterior Fusion for Spinal Tuberculosis / 대한정형외과학회잡지

Long term follow-up study was done on 38 cases of anterior fusion for spinal tuberculosis especially about effect of buttress graft. The average follow-up period was 16 months. 14 cases of effective buttress group were appeared' to achieve more rapid bony union and prevent further kyphosis or lateral wedging of the involved vertebral body than inadequate buttress group of 7 cases.

Prebent Intramedullary Nailing of the Shaft Fracture of the Femur / 대한정형외과학회잡지

No abstract available in English.

Early Detection of Viability of the Femoral Head by 99mTc-MDP Bone Scan in Femoral Neck Fracture / 대한정형외과학회잡지

After femur neck fracture, many techniques have been known for early detection of the viability of the femoral head which is very important to decide method of treatment. At the present time, bone scan with 99mTc-MDP is the best available radioistope for use in scanning, because it is very sensitive, non-invasive and simple, minimal radiation dose, easily reproducible. Bone scanning was carried out in 18 cases of femur neck fractures from July, 1981 to October, 1982 in Kyung Hee University Hospital. The results were as follows: l. In twelve cases in which radiological confirmation of viability of the femoral head was difficult to make, we could confirm the presence or absence of vascularity of femoral head using bone scan. 2. Six cases which were considered to have vascular impairment to the femoral head radiologically, were identified to have vascular impairment to the femoral head by bone scan and these were evidenced by operative findings and by histology of biopsy specimen. 3. In fresh fractures, we identified the vascular impairment by the bone scan minimally 5 days after injury. 4. In old fractures, we could confirm the viability of the femoral heads by bone scan. 5. Bone scan is considered to be the excellent technique for early detection of the vascular impairment to the femoral head after femur neck fractures.

A Study of Normal Korean Adult Femur Length and Configuration / 대한정형외과학회잡지

The preoperative measurement of adequate nail length is very important for femoral shaft fracture naiTing Operation. To reduce the disadvantages of scanography which are the fracture site pain, motion and radiation hazard, the simple external measurement method of intramedullary nail length was designated through this study. The fifty normal Korean whose bone growth v:as ceased were chosen for this study. And the lengths with the simple external measurement of thigh and scanogram of femur were compared at both side. The lateral roentgenographic view of femur was checked to analysis of anterior angulation at the proximal one third of femur was checked to analysis of anterior angulation at the proximal one third of femur. The following results were: 1. Femoral length was about 24% body height on an average. 2. The distance between the lower margin of the anterior superior iliac spine and the patellar upper pole (SPD) was equal to the distance between the tip of the greater trochanter and the cented of distal subchondral line. 3. Straight intramedullary nail length was 40 to 45 mm shorter than SPD. 4. The roentgenogram revealed that the femur took its anterior bowing by 9 degrees.

Subtalar Dislocation: A Case Report / 대한정형외과학회잡지

Subtalar dislocation of the foot is one in which there is simultaneous dislocation of the talonavicular joint and talocalcaneal joint while the tibiotalar relationship is unchanged. It was described first by Judey and Defourest in 1811. It incidence was 1% to 1.3% of all dislocations and 15% of injuries of the talus. We have experienced one case of a medial subtalar dislocation without fracture. In our case which was followed for 14 months, the head of the talus was palpable on the dorsum of the foot and the heel was displaced medially in relation to the leg. Radiographically, on the lateral view, the head of the talus was shown superior to the navicular and on the A-P view, the normal talonavicular relationship was disturbed with the calcaneus being displaced medially. The closed reduction was carried out successfully.

“V” Shape Corrective Osteotomy of the Long Bone / 대한정형외과학회잡지

French method of wedge osteotomy has been widely used to correct the cubitus varus deformity, but it is difficult to correct the rotational deformity, gunstock deformity effectively and to fix the distal fragment rigidly because the supracondylar area of the humerus has an anatomical characteristic of short distance in A-P plane. We can design a new method of “V” shape osteotomy to correct the cubitus varus and apply this method to the deformities of the tibia and femur. Ten cases of “V” shape corrective osteotomy were performed in the Department of orthopedic Surgery, Kyung Hee University. Of these, 5 cases were cubitus varus deformities, 3 cases were deformities of tibia and 2 cases were deformities of femur. The results were obtained as follows. 1. The cubitus varus and gunstock deformities are corrected effectively without unnecessary bony loss. 2. The rotational deformity can be corrected in stable position due to the “V” shape contact surface. 3. The contact area is so wide and oblique that it may be ease to manage the distal fragment and we may expect good union process with early ROM exercise due to rigid fixation. 4. Additional change of the corrective angle can be possible. 5. This method is also effective for the correction of the deformity caused by partial epiphyseal closure of the long boen, using partial open wedge osteotomy.

Peripheral Nerve Injuries of the Upper Extremity / 대한정형외과학회잡지

Ninety-one nerve injuries (median; 36, ulnar; 43, radial; 12) involving the upper extremity in 66 patients were studied over a twelve-month period. The results for the median, ulnar and radial nerves after nerve repair were analyzed with respect to the suture method, the age, the level of injury and the time interval from injury. The results were obtained as follows: 1. Sympathetic nerve function returned from 6 weeks (average) after operation. 2. There are better results in perineurial suture than in epineurial suture. 3. There are better results in under 16 years old than over 16 years. 4. There are better results in high level injury than in low level. 5. There are the best results in the delayed primary suture, the next in the primary suture and the last in the secondary suture. 6. Good recovery in motor function was observed in radial, median and ulnar nerve in order.

An Experimental Microvascular Grafting on Rabbits Using the Microsurgical Technique / 대한정형외과학회잡지

The vascular graft used for the reconstruction of certain types of vascular occlusive diseases and traumatic damages of the vessel, is very important, especially for the reconstruction of microvascular damages as occuring in hand injuries. Until recently microvascular graft done by microsurgical techniques was rare compared to the many- numbered large vessel grafts. But their biologic fate is currently uncertain. We studied the histologic changes occuring in the microvesseles of 1.5cm in length and 2mm in diameter, which were grafted to the femoral artery of rabbits by recently developed microsurgical techniques. Histologic changes were observed between different donor materials with different time intervals. For 60 rabbits which were used as experimental material, 15 cases received autogenous venous graft (group I). 15 cases autogenous arterial graft (group II) and 15 cases homogenous arterial graft (group I). The observd post-operative dates were 3,7,14.60 and 90 days for each respective group. The results were summerized as follows: 1. The patency rate of grafted vessels using microsurgical technique was 91.2%. 2. The histological changes observed were: a. On the 3rd and 7th day post-operatively, mainly inflammation, formation of thrombus, increased population of endothelium and formation of suture granuloma around the suture site were observed. b. On the 14th day, decreased numbers of inflammatory cells, progressed organization of thrombus, disorganization of the medial muscle layer of the grafted vessels and degeneration of endothelium were observed. c. On the 60th day, inflammatory cells and previously formed thrombi were no longer found and increased amount of fibrosis was prominent instead. 3. The autogenous venous graft group showed less histological changes in every aspect compared to the other two groups. 4. The autogenous arterial graft group showed considerable histological changes, but endothelial lining cells were well preserved. 5. In the homogenous arterial graft group, good patency rate of grafted vessel were observed despite of severe inflammatory change initially. 6. It can be concluded from the above observation that the micrcvascular graft thought to be most useful in recstablishing circulation of injured vessels was the autcgenous venous graft. Homogenous vessel graft and autogenous graft artery were also found to be applicable when autogenous vencous graft is not available.

Treatment of Femoral Neck Fracture (Twenty-nine Cases Treated by Multiple Knowles Pinning and Compression Hip Screw) / 대한정형외과학회잡지

It has been emphasized that treatment of hemoral neck fracture is early anatomical reduction and rigid internal fixation to reduce severe complications such as avascular necrosis or non-union.Operative treatment were developed recently with development of radiological technique. This study reviewed twenty-nine patients of femoral neck fracture treated by internal fixation between December 1973 and December 1979. There are eleven casesof Garden's stage I or II fracture with multiple Knowles pinning and eighteen cases (All Gardens stage) treated with compression hip screw, and followed for a minimum of nine months with an average eighteen months. The results were as follows; 1. Eleven cases with minimal displaced fracture (Garden's stage I or II) treated by multiple Knowles pinning were revealed good results. 2. In total eighteen cases treated by compression hip screw, nine cases (Garden's stage I or II) were revealed good results and other nine cases (Garden's stage I or II) were revealed fair or poor results. 3. Eleven cases of mlutiple Knowles pinning and nine case of compressian hip screw used for undisplaced fracture (Garden's stage I or II) were revealed good results without regard to internal fixation devices. 4. Avascular necrosis were four cases in nine cases(44%) of displaced fracture. 5. Non-union were not found in this aeries.

Vascularized Fibular Bone Graft for Tuberculous Spondylitis: Case Report / 대한정형외과학회잡지

The tuberculous infection of the skeletal system especially, tuberculous spondylitis is frequently encountered with orthopedic fields. Up to date, Various methods of the treatment are present but each method has problems. Recently, as a development of the microsurgical instrumentation and surgical technique, we had been tried to the two patients of tuberculous spondylitis by vascularized fibular bone graft and anterior fusion. The advantages were as follows; 1. Shortened the bony union times by this operative method. 2. Earlier returning to the social activities compared to the ordinary method. 3. The children involved tuberculous spondylitis with severe kyphosis, who can be corrected the severe kyphosis by this operative method. 4. We can be obtained the rigid graft bone fixation with adequate length of bone by this operative method.

Clinical Study of the Tibial shaft Fracture / 대한정형외과학회잡지

A clinical study of the Tibial Shaft fracture was made on 128 patients, who had been treated at the Department of Orthopedic Surgery, College of Medicine Kyung Hee Universlty from the October, 1971 to May, 1979. The results were as follows: 1. The rate of fracture union was accelerated under the age of 20 years but it was slow in aged group. 2. The poor prognosis of fracture union was shown in junction between middle and distal 1/3 than others. 3. The better prognosis of the fracture type was shown in oblique and spiral fracture than in the comminuted and segmental. 4. There was prolonged rate of union in case of associated fibula fracture. 5. The frequency of delayed and nonunion were more prevalent in open fracture. 6. Among the open comminuted tibial shaft fracture with skin and soft tissue loss, the good results was obtained by the Hoffmanns external skeletal fixation method.

Compression Plate Fixation in the Treatment of Diaphyseal Fractures of the Radius and Ulna / 대한정형외과학회잡지

From Oct. 1974 to Jun. 1979, 47 diaphyseal fractures of the forearm bones in 36 patients were treated with compression plates. Among them 36 diaphyseal fractures in 28 patients (23 with acute fractures. and 5 with non-union) followed for average 8.3 months from three months to thirty seven months were studied. 19 fractures of the radius and 17 fractures of the ulna were treated with compression plates. Fifteen fractures which were delayed for operation for more than 3 weeks or had severe comminution, had primary iliac bone grafts. The fracture unlon of the radius and ulna was obtained in all cases and average healing time for the radius was 11.9 weeks and for the ulna was 12.3 weeks. The final functional results were excellent, 16 and satisfactory,7. The over all rates of excellent and satisfactory results were 82.2 percent. Therefore compression plate is one of the excellent methods to treat diaphyseal fractures and non-union of the forearm bone.

A Study on Wound Infection of Open Fracture / 대한정형외과학회잡지

In 257 open fracture patients, treated from 1972 to 1979 at Kyung Hee University Hospital and analysed retrospectively, the infection rate was 35.8%. The factors thought to be associated with post-operative infection in open fracture were statistically analysed and discussed. The conclusions of this study were follows: 1. Open fractures require adequate debridement and irrigation. 2. Antibiotics should be administered as early as possible, especially before operation. 3. Early determination of local blood clrculation and its improvement are importent. 4. Contaminated open wound should be treated open, but if wound considered clean by adequate debridement may be closed primarlly. 5. If primary bone fixation is required, external flxation is recommended. Internal fixation should be avoided In grade I & II, but in grade III internal fixatlon is not contraindication for Improvement of blood circulation and open wound management.

CAT Guided Needle Biopsy of Spinal Lesions / 대한정형외과학회잡지

The utility of computed axial tomography(CAT) in the diagnosis of spinal disorders has been the subject of considerable interest since the introduction of CAT scanning. Computed tomographic guided needle biopsy of 12 consecutive patients with a variety of undermined spinal disorders resulted in a 100% yield of positive tissue diagnoses, without signlficant complications. The principal advantage of cat guidance is the continuous direct observation of the needle tip position in relation to the target volume. We think that the application of computed tomographic guided needle biopsy in the lesions of the spine is of great value, because it is the single most accurate method of obtaining diagnosis other than by open surgical biopsy.