Analysis of the Wrist Motion Using 3 / 대한정형외과학회잡지

The wrist joint is composed of midcarpal, radiocarpal and distal radioulnar joints. It is difficult to analyze the motion of these joints by the simple roentgenogram. We reconstructed three dimensional images of the wrist and distal radius from computerized tomogram using a new interactive graphics software written in Pascal and Turbo Graphic. There were 10 normal wrists in neutral position, and two normal and one abnormal wrists in ulnar-radial deviation and one normal wrist in flexion-extension were analyzed in this study. For simplification, the images were reformatted for the scaphoid, the proximal carpal row, the distal carpal row and the distal radius. We established the three dimensional references for wrist by defining the Z axis as the long axis of radius, the X axis as a line which is in horizontal plane and parallel to the anterior cortex of distal radius about 2 cm proximal to the articular surface and the Y axis as the automatically defined line perpendicular to both X and Z axes. We measured the angles between the X-axis and the reference lines of scaphoid and each carpal rows. The scaphoid was internally rotated by 60,0 degrees from X axis, the proximal carpal row by 7.0 degrees and the distal carpal row by 25.6 degrees each. There was only minimal change in the angles during the ulnar and radial deviation. The pattern of angles in abnormal wrist was different from those in normal wrists. In flexion-extension, the angle of distal carpal row was changed significantly, which means there was some error in selecting the reference line of distal carpal row as an axis of motion, or in measuring the angles, or it can be suggested that there is some rotational motion of distal carpal row on the Z axis. The proximal poles of the scaphoid and the triquetrum were displaced ventrally during flexion and dorsally during extension.

Comparative Functional Evaluation of Cementless Bipolar Endoprosthesis and Cementless Total Hip Replacement Arthroplasty in Avascular Necrosis of the Femoral Head in Adult / 대한정형외과학회잡지

In these days, there are two main ways in the treatment of the avascular necrosis of the femoral head in adult by prosthetic replscement; total hip replacement and bipolar endoprosthesis. So far, no study has been performed on the post-operative functional evaluation of them. Therefore it is difficult to decide which one is preferred to the other in the treatment of avascular necrosis of the femoral head in adult. In order to evaluate the functions of the prosthetic joints, the authors reviewed the results of 18 cases of cementless bipolar endoprosthesis(abbreviated as CBE) and 22 csses of cementless total hip replscement arthroplasty(abbreviated as CTHRA), performed at the Department of Orthopedic Surgery, Seoul National University Hospital, during the period from February, 1984 to May, 1986. The following results were obtained. 1. The average ages of CBE and CTHRA groups at the time of operation were 48.5 years and 37.5 years, respectively. 2. The average follow-ups of CBE and CTHRA were 15.7 months and 30.5 months, respectively. 3. By Meyer's modification of Marcus and Enneking classification, the sverage stages of CBE and CTHRA groups were 3.7 and 4.4 respectively. 4. According to Harris hip rating score system, Harris scores were increased as much as 30.5 in CBE group and 30.6 in CTHRA group. 5. In the aspects of functional improvement and relief of pain, the two groups showed no significant difference. However, the operation was essier, and the damage to the acetabular bone was less in CBE group. For these reasons, CBE was believed to be the preferred choice of treatment of avascular necrosis of femoral head in adult.

Reconstruction of the Paralytic Hand / 대한정형외과학회잡지

Paralytic hand is the ultimate result of permsnent damage of the central nervous system, failure of the functional repair of peripheral nerve injuries and extensive muscular or tendinous defect resulting in the impairment of hand function. There are a lot of controversies in the side of treatment methods in the paralytic hand, and it is very difficult to formulate the most adequate surgical reconstruction for a given pstient. At Depsrtment of Orthopedic Surgery, Seoul National University Hospital, 66 cases oi paralytic hands in 62 patients have been treated surgically with tendon transfers for 7 years from Jan, 1980 to Dec, 1986. 49 case in 46 patients were followed up for more than one year, and surgical method and its results were anslysed. They consist of CNS lesion (17), peripheral nerve lesion(23) and musulotenidinous defect(9). The methods of surgical reconstruction were opponenesplasty(12), standard set extensor reconstruction(9), Green and Bsnks FCU transfer(11), intrinsic reconstruction(7), pronator rerouting(7), adductorplasty (5) and so on. The mean follow-up was 2.2 years, and in 38 cases good or excellent results were obtained.

A Functional Classification of the Congenital Anomalies of the Extremities and Spine / 대한정형외과학회잡지

Various classifications of congenital anomalies of the extremities and spine have been proposed and are in use. Some are based on anatomy, some on embryology, presumed etiology, or therapeutical approach. An ideal classification would help better understanding and treatment of various kinds of congenital anomalies. It should be simple, logical, and broad enough to include most of the congenital anomalies with minimal confusion. In this paper, we are proposing a functional classification of congenital anomalies of the extremities and spine based upon the concept that development of each organ is processed by differentiation and modulation according to the genetically determined information and by control mechanism at particular moment. We classified congenital anomalies into structural failure where quality of certain tissue is abnormal and functional failure where control mechanisms failed to regulate organogenesis. We divided structural failure into generalized and localized form while we divided functional failure into differentiation and modulation failures. Differentiation failure was subdivided as either forrnation failure or segmentation failure. Formation failure, segmentation failure, and modulation failure were specified according to the timing of failed inhibition and topography.

The Result of Surgical Tratment of Soft / 대한정형외과학회잡지

Soft-tissue sarcomas are derived from mesodermal tissues and with few exceptions are located in deeper planes of the musculoaponeurotic structures. Despite differences in histogenesis, the rate of locsl recurrence snd distant metastasis of these sarcomas reveals that their rstes are almost the same. These soft-fissue sarcomas do not respond well to chemotherpy or radiotheraphy. And soft-tissue sarcomas located on different anatomical sites, so the surgical approach to them located centrally is difficult than the approach to them located peripherally. The authors reviewed 75 cases of soft-tissue sarcoma, which were confirmed by pathological reports, and also analysed the results of some kinds of surgery on 60 cases of that tumor at the Department of Orthopedidic Surgery, Seoul National University Hospital during the period from January 1976 to Decomber 1985, and following results were obtained. 1. There were 54 males and 21 females, and the age incidence wss highest in 5th decade. There was no special age-peak. 2. Malignant fibrous histiocytomas accounted for 26.7% of the tumors in this study. Liposarcoma, rhabdomyosarcoma, and synovial sarcoma were the next common tumors. 3. The lower extremity was the most common anatomicsl site of malignant soft-tissue sarcomas, which acconted for 46.7% in this study. There showed low incidence below the wrist and ankle joints. 4. Enneking's stage II B was the most common tumor, which accounted for 41.7%. 5. When we decided the prognosis at 2 years postoperatively, in the inadequately treated group the local recurrence rate was 97.1%, distant metastasis rate was 80.0%, and 2 YSR was 28.6%. In the adequately treated group the local recurrence rate was 20.0%, distant metastasis rate was 24.0%, and 2 YSR was 84.0%. 6. The most common site of distant metastasis was the lungs, which accounted for 82.4%. So the significant factors affecting the prognosis of soft-tissued sarcomas were the location of sarcomas and the adequacy of sugical procedure.

A Clinical Study of Colles' Fracture Treated by Closed Reduction and Sugar Tong Splint / 대한정형외과학회잡지

We analyze ninty-seven cases of Colles fractures treated with closed reduction and sugar tong splint immobilization and followed for more than 1 year at Seoul National University from January 1981 to Decmber 1985. The results of this study were as follows; l. All of 97 cases were closed fractures and the incidence was high in females who aged over 6th decades. The main cause of this injury was slipping down accident comprising of 68.0%. 2. 63 cases (64.9%) were simple extra-articular fractures, and 34 cases (35.1%) were comminuted intra-articular fractures. 3. In a group of simple extra-articular fracture the functional end result was satisfactory in 88.9%, so closed reduction and sugar tong splint were thought to be a good procedure in this group. 4. In a group of comminuted intra-articular fracture the functional end result was satisfactory in 58.9% only. In the cases which show unacceptable loss of position during first two weeks of routine sugar tong splint immobilization we feel another technique is indicated, such as.pin and plaster immobilization or percutaneous pinning. 5. The main cause of unsatisfactory result was malunion, which was produced by loss of reduction position.

Distraction-motion Arthroplasty for the Management of Kienböck's Disease / 대한정형외과학회잡지

Many kinds of operations have been devised to treat Kienböck's disease with variable results. But no one have mentioned about the advantage of early motion in distraction to prevent the fibro-osseous ankylosis and carpal collapse. Two cases with Kienböck's disease were treated by the complete excision of the lunate and replacement of it with pronator quadratus muscle pedicled rectangular bone graft. Once these procedures were accomplished, the distraction-motion devices were used to maintain the joint surfaces separated at predetermined distances while kinematically normal joint motion was gradually restored. Although the experience is limited to two cases, the final results seem to be very promising.