The Anatomical Relationship of the Aortic Bifurcation and the Iliocaval Junction to the Lumbar Vertebrae in a Korean Population

PURPOSE: The objective of this study was to determine the anatomic significance and the level of the abdominal aortic bifurcation and the iliocaval junction in relation to the lumbar spine. METHOD: We conducted a retrospective study of 79 patients who underwent prosthetic replacement of an intervertebral disc by the anterior approach. The location of the aortic bifurcation and iliocaval junction and the size of the aorta and IVC were evaluated using CT angiography. The levels of the aortic bifurcation and iliocaval junction were recorded in relation to the upper or lower half of the adjacent vertebral body or intervertebral disc. RESULT: The aorta was bifurcated at the lower half of the L4 vertebral body in 35.4% of the cases. The iliocaval junction was between L4 and L5, and it was most often at the upper half of L5 (43.0%). CONCLUSION: The variability of the aortic bifurcation and iliocaval junction is high and an accurate description may be useful for using the various retroperitoneal approaches for not only aortic and venacaval surgery, but also for the anterior approach for spinal surgery.

A Clinical Analysis of the Diver's Osteonecrosis / 대한정형외과학회잡지

Diver's bone lesion was described for the first time by Grutzmacher in 1941. Ten cases of osteonecrosis of the femoral head in divers were analysed on the basis of clinical and pathologic feature. The pathologic feature of the osteonecrosis in divers was not reported in Korea previously. The cases were observed from March, 1985 to June, 1988. The authors treated the cases with total hip replacement and obtained good results. The results were as follows:1. The average ate age at the time of operation was 41.5 years. 2. The average follow-up was 20.4 months. 3. The specimens were confirmed as osteonecrosis mieroscopically. 4. By Meyer's modification of Marcus and Enneking classification the average stage was 3.7. 5. Divers bone lesion was increased with the length of diving experiences:diving depth, diving time, age and with bends. 6. The pathologic feature of osteonecrosis in divers differ from that of idiopathic avascular or aseptic osteonecrosis and could be differentiated easily. 7. After total hip replacement, according to Harris hip rading score system, all results were good.

Metallic Failure in Treatment of Comminuted Fracture of Femur: Clinical Analysis / 대한정형외과학회잡지

The authors clinically analysed the causes of metallic failure in 21 cases after treatment of comminuted fracture of femur at Department of Orthopaedic Surgery, Kang-Nam St. Marys Hospital during 5 year period from May 1981 to December 1986. In this series, the nature of metallic property was not studied which may influence the result of failure. 1. Metallic failure occurred in seventeen self-compression plates, one Kuntscher nail, one I-beam nail, one Ender nail, and one Angle blade-plate. 2. Seventeen patients had fractures in the middle or distal one third of femur. 3. Metallic failure occurred from 3 to 19 months following open reduction and internal fixation. The time interval between internal fixation and failure was 9.6 months on an average. 4. Metallic failure of the self-compression plate was observe in the empty hole over the fracture site in 14 out of 17 patients. In the Kiintscher, failure developed at the interlocking hole corresponding with the fracture level. In the Ender nail and Angle blade-plate, failure developed at the fracture site, and in the I-beam nail plating, failure developed at the neck of the fixation screw, and not at the plate. 5. The cause of metallic failure in 17 self-compression plate-treated cases was improper plating such as varus plating in 4, absence of medial buttress due to cortical comminution in 10. Above mentioned two conditions were combined in 4 cases, in which one case of Angle blade-plate was included. Incorrect position of I-beam nail, inadequate postoperative management following Ender nailing and incorrect selection of implant in one case of Kiintscher nailing were the other possible causes of metallic failure.