Unipolar Versub Bipolar Hip Hemiarthroplasty for Fractures of Femoral Neck in the Dlderly / 대한정형외과학회잡지

Among the 85 cases of prosthetic replacement of femoral neck fracture which had been operated at Department of Orthopaedic Surgery, Korea Veterans Hospital from January, 1982 to May, 1990, 32 cases (15 unipolar hemiarthroplasty and 17 bipolar hemiarthroplasty) were examined clinically and radiologically at an average 7.7 years postoperatively. And the results were as follows; 1. The group I (Unipolar hip hemiarthroplasty without cement) had Harris hip score - average 79.4. The group II (Unipolar hip hemiarthroplasty with cement) had Harris hip score average 87.3. The group III (Bipolar hip hemiarthroplasty without cement) had Harris hip score average 80.5. The group IV (Bipolar hip hemiarthroplasty with cement) had Harris hip score average 86. 2. There were 2 cases of stem loosening (13%) among 15 cases in unipolar hip hemiarthroplasty and 1 case (6%) among 17 cases in bipolar hip hemiarthroplasty. 3. The movement of two components in bipolar hip hemiarthroplasty was noted in all cases and the movement of the outer bearing joint was more active than that of the inner. And the movement of the two components was not correlated with the use of cement. But Harris hip score was superior cement stem group to noncement stem group. 4. Unipolar hip hemiarthroplasty showed the similar clinical and radiological results with bipolar hip hemiarthroplasty of femoral neck fracture in the elderly. As a result, unipolar and bipolar hip hemiarthroplasty were considered the proper treatment method of the femoral neck fracture in the elderly.

Ankle Arthrodesis by Chevron Osteotomy: Report of 16 cases / 대한정형외과학회잡지

The Marcus ankle arthrodesis was carried out in 16 patients at department of orthopaedic surgery of Korea Veterans Hospital from January 1989 to December 1993. All of patients were reviewed and evaluated with subjective and functional rating scales according to the Mazur scoring system. The average follow up was 23 months, ranging from 12 months to 60 months. The Marcus ankle arthrodesis involves a chevron osteotomy, tibial onlay graft medially, internal fixation with staples and screws. According to the Mazur score, the results were 6 cases of Excellent, 7 cases of Good. The average Mazur score was 75.1. There were 4 cases of complication, a non-union, a superficial wound infection, a bursitis, and a tendon injury. In summary the Marcus ankle arthrodesis by chevron osteotomy seems to be a good procedure, which gives solid bony union with short duration, relief of pain, normal looking ankle configuration without leg length discrepancy and good function with few complications.

The Treatment of Infected Total Hip Arthroplasty: Report of 12 Cases / 대한정형외과학회잡지

Deep infection is the most serious complication of total hip arthroplasty with difficulty to treat and occasionally results into catastrophic consequences. The treatment methods are antibiotics, incision & drainage of the hip, debridement & modified Girdlestone resection arthroplasty, one stage revision to total hip arthroplasty, two stage revision and hip disarticulation. The purpose of this report is to consider the treatment of the infected total hip arthroplasty. Since 1979, we have treated 12 cases of infected arthroplasty including 6 cases from other hopital. Duration of interval between primary hip arthroplasty and diagnosis of infection were average 42,4 months(minimum 2 months to maximum 16 years). The results were as follows; 1. The incidence rate of the infected total hip arthroplasty was 1.3%. 2. By Fitzgerald classification, 2 cases were in acute stage, 6 cases in delayed stage and 4 cases in late stage. 3. The causative organisms were coagulase negative Staphylococcus aureus in 6 cases, Staphylococcus hemolyticus in 2 cases, Pseudomonas in 1 case and negative culture in 3 cases. 4. Increased uptake on Bone Scan in all 12 cases and increased ESR ranged from 28mm/hr to 82mm/hr. 5. Our treatment methods were secondary revision to total hip arthroplasty with cement bead insertion in 4 cases, primary revision in 1 case, incision & drainage of hip in 1 case, debridement & modified Girdlestone resection arthroplasty in 2 cases and hip disarticulation in 2 cases. And the rest 2 cases have been followed up after modified Girdlestone resection arthroplasty because of the remained infection. In our experience, two stage revision to total hip arthroplasty with antibiotics mixed cement bead was more useful in the treatment of the infected total hip arthroplasty.

Spinal Stenosis in Paget's Disease: 1 Case Report / 대한정형외과학회잡지

In the paget's disease involving the vertebra, the symptom and sign of compression come from encroachment on the spinal cord due to the enlarging vertebral bodies, pedicles and laminae. The cord compression appears to be preceded by a long insidious period of noncharacteristic clinical symptoms with minor neurologic dysfunction. The lumbar syndrome of Paget's disease is classified according to its severity, clinical findings, biochemical factors and radiologic patterns. The severity of neurologic complication in Paget's disease involving the vertebra varies according to the level involved. The outcome depends on the suddeness of symptom onset and the effectiveness of decompression. We have experienced a case of Paget's disease involving long bones and lumbar spine in 56 year old male patient, in which surgical decompression produced improvement. We report a case of spinal stenosis in paget's disease with brief review of literature.

Surgical Decompression for the Impingement Syndrome of the Shoulder / 대한정형외과학회잡지

The impingement syndrome has an anatomical character that occur against the anterior edge and the undersurface of anterior third of the acromion, coracoacromial ligament and acromioclavicular joint. The treatment consists of conservative and surgical things. We consider the surgical intervention only in cases fail to control pain by conservative treatment over 3 months(from Feb. 1990 to Jan. 1994). The author experienced 15 cases (14 pts) in positive impingement sign & test and evaluated by shoulder arthrography in all cases. 1. The mean age was 60 years ranged from 48 to 68 years and the average symptom duration was 23 months. 2. There were all positive impingement sign & test clinically. 3. There were partial tear of rotator cuff in 3 cases and complete tear in 12 cases radiologically. 4. The anterior acromioplasty with division of coracoacromial ligament was performed in all cases, additional rotator cuff repair in 3 cases and bicipital tenodesis in 2 cases. 5. At the follow up based on UCLA shoulder rating scale, results were excellent & good in 13(86%) and unsatisfactory in 2(14%) cases.

A Clinical comparison between One Plane Unilateral and One Plane bilateral Frame of External Fixation in the Treatment of Tibial Open Fractures / 대한정형외과학회잡지

External fixation was improved in its material, design and techniques as a specific method of open fracture treatment. Seventy-three, tibial open fracture, patients were treated with external fixator in Korea Veterans Hospital from January 1983 to April 1988. Each fixation method was divided into two types;one-plane unilateral frame and one-plane bilateral frame. 1. The duration of external fixation was 14.3 weeks in averge, 15.4 weeks in one plane unilateral frame and 13.2 weeks in one plane bilateral frame. 2. Secondary operation for bony union was performed 19 cases in one plane unilateral frame and 8 cases in one plane bilateral frame. 3. The union time was 23.6 weeks in average, 26.8 weeks in one plane unilateral frame and 21.4 weeks in one plane bilateral frame. 4. The common complications were delayed union and nonunion (7 cases) and pin tract infection (5 cases) in one plane unilateral frame, and pin tract infection ( 9 cases), joint stiffness (4 cases) and delayed union and nonunion (3 cases) in one plane bilateral frame. 5. External fixation gave rigid fixation and easy wound access, but did not give excellent bony union. 6. One plane bilateral frame showed more or less better result than one plane unilateral frame except some complications.