Operative Treatment of Tibial Plateau Fractures / 영남의대학술지

BACKGROUND: The purpose of this study was to evaluate the relationship between variable factors and clinical results following the operative treatment of the tibial plateau fractures. MATERIALS AND METHODS: The clinical and radiological analysis was performed on 29 cases of the tibial plateau fractures who had been treated with operative treatment and followed up for more than 1 year from January 1991 to December 1997. The analysis of clinical results was performed dividing into age, cause of injury, fracture type of Schatzker classification, associated soft tissue injury and method of operative treatment. RESULTS: According to Schatzker classification, 2 cases(6.9%) were type I, 11 cases(37.9%) were type II, 1 case(3.5%) was type III, 5 cases(17.2%) were type IV, 4 cases(13.8%) were type V, and 6 cases(20.7%) were type VI. In all cases, bony unions were obtained. According to Blokker evaluation, 23 cases(79.3%) of 29 cases were acceptable. CONCLUSION: We could expect good clinical results if early knee joint mobilization following minimal invasive open reduction and internal fixation could be obtained. Bad clinical results were related with young age group under 30, more than Schatzker classification type IV of high energy trauma and associated injury of anterior cruciated ligment or meniscus.

Lumbar Spinal Epidural Lipomatosis: Two Cases Report / 대한척추외과학회지

STUDY DESIGN: We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication OBJECTIVES: The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. SUMMARY OF LITERATURE REVIEW: Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. MATERIALS AND METHODS: Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination, postmyelography CT and MRI. RESULTS: Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. CONCLUSION: The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.

Result of Pedicle Screw Fixation in Lumbar Stenosis with: A Comparison of Degenerative Type Lumbar Stenosis with Spondylolisthetic type Lumbar Stenosis / 대한정형외과학회잡지

Concurrent use of instrumentation has been shown to increase fusion rates and satisfactory results for surgical treatment of the lumbar stenosis. The objectives of the present study were to evaluate clinically and radiologically two groups of lumbar stenosis who were surgically treated with pedicular screw fixation system and posterior lumbar interbody or posterolateral autogenous bone graft following complete posterior decompression. One group was degenerative type and the other group was spondylolisthetic type spinal stenosis. We analyzed the results of 39 cases of lumbar stenosis who underwent pedicular screw and rod fixation system and posterior lumbar interbody or posterolateral autogenous iliac bone fusion following complete posterior decompressive operation during the period from May 1988 to December 1992. There were 27cases of degenerative type and 12 cases of spondylolisthetic type lumbar stenosis. The were 25 women and 14 men. Their age was ranged 20 to 76 years old with an average of 51.7 years old. The follow up period was the interval from 18 months to 6 years with an average of 3.2 years. The radiologic union rate was average 94.9% and 96.3%(26cases) in degenerative spinal stenosis and 91.7%(11 cases) in spondylolisthetic spinal stenosis. The clinical success rate was average 92.3%(36 cases), 88.9%(24 cases) in degenerative spinal stenosis and 100%(12 cases) in spondylolisthetic spinal stenosis. The patients with spondylolytic spinal stenosis showed better result in their life than the patient with degenerative spinal stenosis.

Traumatic Spondylolisthesis of Cervical Spine Treated by Contoured Loop Fixation and Sublaminar Wiring / 대한정형외과학회잡지

Rigid posterior fixation of the atlas to the third and fourth cervical spine was achieved in a patient in whom axis pedicle fracture and dislocation of axis on the third cervical spine. Althouth there was no evidence of neurologic disorder, marked instability of axis on the third cervical spine should inevitably be fused in any procedures. An anatomically contoured loop was secured to the posterior arch of the atlas and the laminae of the third and the fourth cervical spine by sublaminar wirings. The technique has the advantage over bone graft, either alone or with cement, in that it affords rigid stabilization, allows early mobilization and some flexion movement of atlanto-occipital joint.

Malignant Granular Cell Tumor: Report of One Case / 대한정형외과학회잡지

Granular cell tumor is one of the rare tumorous condition. At present there are estimated 600 reported examples of the tumor in the medical literature. Malignant granular cell tumor is a well established but extremely rare entity that is found in appr- oximately 2 % of all granular cell tumor. Diagnosis should be restricted to neoplasms that are similar in their histological appearance to benign granular cell tumors but can be seperated on the basis of cellular pleomorphism, mitotic activity, and, most importantly, their capacity to produce metastases. The authors had experienced that a 55 years old male patient had two large malignant granular cell tumors at the left thigh and left inguinal area with metastatic lesion.

An Effect of Fibular Fracture in Healing of Tibial Shaft Fracture / 대한정형외과학회잡지

Three hundred and fourty two patients with a fracture of tibial shaft were treated and managed in the Department of Orthopaedic Surgery, Soon Chun Hyang University Hospital from January 1981 to December 1985. In 147 cases, 62 cases had only tibial shaft fracture and 85 tibial and fibular shaft fracture. All of these were treated conservatively by manipulation and cast immibilization. We analyzed the initial fracture characteristics, the treatment employed, and the subsequent complications in fracture healing in a series of patients who had sustained a tibial shaft fracture with and without a fibular fracture. The results were as follows; 1. Duration of average bone healing was more slowly in the patients more than twenty years old who were treated for a tibial shaft fracture with and without a concomitant fibular fracture than in the patients less than twenty years old. 2. Duration of average bone healing was more slowly by one or two weeks in the the group of tibial shaft fracture without fibular fracture than in than in those with fibular fracture. 3. The frequency of delayed union, nonunion, varus malunion and pain in the ipsilateral ankle joint were more increased in the group of the tibial shaft fractures without fibular fracture in than those with fibular fracture. 4. The frequency of valgus malunion was more increased in the group of the tibial shaft fractures with fibular fracture than in those without fibular fracture.

Myotonia Dystrophica: A Case Report / 대한정형외과학회잡지

Myotonia dystrophica(Synonym: Myotonia atrophica, Dystrophia myotonia, Steinert's disease) is a autosomal dominant hereditary multisystemic disorder involving several organs besides skeletal muscle, and commonly called with myotonia congenita, paramyotonia congenita as myotonia. Although most cases are of adult onset, where a mother has the disease, neonatal dystrophia myotonia can occur in her offspring. The main feature is a steadily progressive muscle dystrophy, complicated by myotonia, which is a failure of muscles to relax normally after a forceful contraction. Steinert in 1909 was the first to report the finding of atrophic testes and baldness in patients with myotonia dystrophica, and the other clinical feature of myotonia dystrophica were reported by many authors after that time. We are reporting a case of myotonia dystrophica, which showing familial history with brief review of literature.

Poymyositis; A Case Report / 대한정형외과학회잡지

Polymyositis is uncommon, nonsuppurative Connective tissue disorder. We have experienced a case of polymyositis. Patient was a 20-y.ear old female in good healthy appearance with history of mild, progressive muscle weakness of lower extremities and inability to walk up and down of stairs in recent 3 weeks. Her symptoms were mainly subjective and individual muscle test revealed no abnormalities, but evidences of primary myopathy were easily obtained by muscle biopsy, electromyogram and several enzyme values. We are reporting a case of polymyositis with brief review of literature.

An Experimental Study on the Immune Complex Induced Chronic Arthritis in Rabbits: Reference to Macrophophages and M-type Cells of Synovium / 대한정형외과학회잡지

No abstract available in English.

Etiologic Factors of Delayed and Non / 대한정형외과학회잡지

Delayed and non-union of the femur shaft fractures in adult have been increased in spite of improvement of method of treatment. In geheral, the principal factors predisposing to delayed and non-union have been known as infection, disturbances of the blood supply, poor immobilization (inadequate rigid fixation), distraction of fracture site. 43 cases of the femur shaft fractures in adult over 18 years old examined at the department of orthopedic surgery, Korea General Hosipital, during the period of January 1973 to January 1982, were divided into two Groups; Group A was 31 cases, which had been taken solid bony union as control group and Group B was 12 cases, which had been developed delayed and non-union. Group A and B were analysed to find out other etiologic factors such as liver function which were suspicious to result in delayed or non-union of the fracture except above mentioned principal factors. The results were as follows, l. In delayed and non-union group (Group B), the interval of age was 20 to 40 years of age, open fracture was 33.4% comparing to control(6.5%), comminuted fracture was 83%, comparing to control (42%), the time interval to operation was delayed over 2 weeks(18%) comparing to control(8%g), and gap between fractured ends after internal fixation was more than 2mm in 33% comparing to control(absent), and liver function, especially, SGOT, and SGPT was bad in 46% comparing to control(13.4%). 2. All 3 cases ot infection in fracture site were in delayed and non-union group, tracture level, associated injury and postoperative immobilization were not concerned with delayed and non-union between two groups.

Tuberculous Tenosynovitis Affecting the Tendons of Wrist: Report of 3 Cases / 대한정형외과학회잡지

No abstract available in English.

A Clinical Study of Trochanteric Fractures / 대한정형외과학회잡지

No abstract available in English.

Progressive Muscular Dystrophy (Report of 32 cases) / 대한정형외과학회잡지

Progressive muscular dystrophy is a genetically determined myopathy of unknown etiology and is a primary degenerative disease of skeletal muscle fibers. The authors reviewed 32 cases of progressive muscular dystrophy and made following observations. 1. The types among the 32 cases were as follows. 1) Duchenne type ; 16 2) Limb-Girdle type ;12 3) Facioscapulohumeral type ;3 4) Distal myopathy ;1 5) Ocular myopathy ;0 2. 13 of the 32 patients had relevant family history. 3. In general, creatinine excretion was decreased in 24-hour urine and creatine was increased. 4. 6 of the 10 patients tested had increased serum C.P.K. level.

Total Knee Replacement Report of Three Cases / 대한정형외과학회잡지

Stability, mobility, and freedom from pain are the requirements of a normal knee. Arthrodesis of a knee damaged by disease or injury will satisfy two of the three requirenents. The current status of knee replacement surgery suggests that high density polyethylene and chrome cobalt alloy or stainless steel are acceptable materials for use in the intra-articular environment of knee. These prosthetic components of artificial knees can be firmly cemented into bone and provide acceptable slinical results if used within their design limits. We have had 3 total knee replacements in the chronic rheumatoid patients. The results of 2 Geometric knee replacements and 1 Guepar knee replacement were assessed from 5 months to 2 years after operation. Total knee replacement improved mobility and reduced pain in these patients.

A Correlative Study in the Clinical and Pathological Aspects of Rheumatoid Arthritis / 대한정형외과학회잡지

It has been thought the histological features of rheumatoid arthritis do not reliably indicate the degree of activity or prognosis of the disease and that they are not specific for that condition (Hemerman, 1963). Recently, however, Muirden and Mills (1971) found in rheumatoid joints submitted for synovectomy a direct correlation between the degree of lymphocytic infiltration and joind damage. Lymphocytes might play a helpful role in protection of the rheumatoid joint. Muirden (1970) has also reported a significant relationship between histological estimates of the extent of the iron deposits nd the grades of roentgenographic changes in biopsied joints. The present study directed to confirm and analyze the changes in the clinical and pathological aspects, with the cases synovectomized at Korea and Severance Hospital, Seoul, Korea. Resuits: Clinical and histological studies were made on 21 cases of “classical” and “definite” rheumatoid arthritis submitted to the Department of Orthopaedic, Korea General Horsital and the Department of Pathology, Yonsei University College of Medicine, during the period from 1966 to 1975, and results were as follows. 1 In age distribution, 16 cases (76.2%) were in the interval between 21 and 51 years old: the mean age was 33.5 years old. The sex distribution showed approximately a three fold female predominance with 16 females (76.2%) to 5 male cases (23.8%). 2. The most common chief complaint recorded were morning stiffness and multiple joint pain. Other symptoms, in descending order of occurrence were tenderness, synovial swelling, flexion deformity, joint swelling and subcutaneous nodules. The interval from initial complaint to admission varied from 7 months to 15 years, with a mean interval of 5.9 years. 3. Serological studies for rheumatoid factor were done on 15 cases and eight (53.3%) were found to be positive while seven cases (46.7%) were negative. The positive cases had longer histories and were in older age groups than the negatives. 4. Histologic findings were characterized by proliferation of suface lining cells of synovium, infiltration of lymphocytes, proliferation and thickeness of the vessels, and synovial villi, deposition of fibrins and hemosiderins and infiltration of acute inflammtory celIs. Each of the characteristics studied was ratect on a scaled score ranging from 0 to 3 from 1 to 3. For each patient the scaled scores were totaled and the totals ranged between 6 and 18 with a mean score of 10.5 5. Roentgenographic findings were characterized by swelling of the soft tissues swelling of the joints,. narrowed space of the joint cavity, and destruction of bone. Each of the characteristics studied was rated. on a scaled score ranging from 0 to 3 or from 1 to 3. For each patient the scaled scores were totaled and the totals ranged between 3 and 11 with a mean score of 7.1. 6. There was no significant correlation between histologic findings such as synovial hyperplasia or infiltration of lymphocytes, and clinical findings such as age, duration of histories, presence of rheumatoid factor, roentgenographic findings or surgicaI findings.

A Climical Study of Unequal Leg Length following Femoral Shaft Fracture in Children / 대한정형외과학회잡지

The managements of fractures of shaft of the femur in children differ in manyways from those in adults. The union occurs rapidly and the remodelling of bone assists in realignment as the child grows. However, the greatest difference observed in the two groups is that in children the growing bone tends to respond to fracture and other influences with growth acceleration. Among the many kinds of methods in the treatment of femoral shaft fractures in children, we have used the method of skeletal traction with Charnleys balanced traction unit due to 1) Fixed traction that introduces the length remaining constant, 2) Weight traction, the tension remaining constant, 3) Eaay control of alignment, that is controlled by the splint not by the traction force, especially in correcting the deformity of retroflexion angulation. Twenty-two cases of fracture of the femoral shaft in children treated with skeletal traction in that method at Korea General Hospital during 4 years, were analyzed. The purpose of this study was, through a series of follow up examination, to elucidate to what extent fracture of the femoral shaft in children gives us increased longitudinal growth of the fractured bone as compared with the healthy limb. The result revealed that in about 72.7% of children with fracture of the frmoral shaft, the leg length discrepancy was within the range of 0+1 cm. The period of accelerated growth was between 6 months and g months after the fracture. Corrected angle at fracture site was noted 3.2 from 10.7 that had been measured as good callus formation.