A Clinical Study of the Unstable Thoracolumbar Vertebral Fractures or Fracture-dislocations: 10 Cases Report / 대한정형외과학회잡지

In accidents, the spines are generally subjected to one of five types of violence; pure flexion, flexion and rotation, extention, vertical compression, or direct shearing force by Holdsworth's report. Flexion and rotational violence, so-called, unstable rotational fracture-dislocation results in paraplegia commonly. The treatment of the fracture-dislocations of the thoracic and lumbar spine had varied widely during the past 100 years, including conservative and operative treatment, but there is no definitive study that convincingly show the superiority of either operative or nonoperative treatment till now. Ten cases of the unstable thoracolumbar vertebral fracture or fracture-dislocations during the past two years were reported in this paper. In unstable types on the thoracolumbar vertebral fracture or fracture-dislocations, direct blow was the most common cause of injury and the thoracolumbar junction extending from T10 to L1 was the most common location of injury in this report. Three among four paraplegic patients were received flexion and rotational violence and the remaining one, direct shearing force. All four paraplegic parients were operated. Among them two cases, the one who was performed open reduction and simple wire fixation and the other open reduction and Harrington instrumentation, recovered almost completely except mild motor weakness of lower extremities. All cases complained of remaining back pain more or less without relation to the method of treatment.

Clinical Study of Spinal Tuberculosis / 대한정형외과학회잡지

A clinical study of spinal tuberculosis was made on 81 patients, who had been treated at the Department of Orthopedic Surgery, Seoul Red Crose Hoapital, during the 4 years period from January 1974 to December 1977. The results obtained were as follows; 1) The patients have been increased since 1977. 2) The ratio of male to female was not significant, but the age distribution showed a peak incidence in the third decade. 3) The lumbar spine was most commonly involved, being in 43.4% of the cases, while the dorsal spine occupied 27.7%. Considering the age, however, the dorsal spine was most commonly involved in the children as compared to the lumbar spine in the adults 4) In 84.2% of the patients, chemotheraphy was begun prior to operation and in 57.8% for a period less than 4 weeks. 5) The major associated tuberculous lesions elsewhere and complications were pulmonary tuberculosis in 28.4% paraplegia in 27.2% and draining sinus or buldging mass over body surface in 21.0%. 6) The number of involved vertebral bodies was higher in children than in adults. 7) Paraplegia presented a peak incidence in the second decade (42.9%). The number of vertebral bodies involved and the extent of destruction and kyphotic angulation were more severe in the paraplegic group than in the nonparaplegic group. 8) In the paraplegic group, thoracic, cervico-thoracic, and thoraco-lumbal spines comprised 71.8% of the cases. In our experience, the paraplegic group of early onset was better than that of late onset in regard to prognosis for recovery. 9) 22 patients who had complete or incomplete paraplegia had a variety of pathological lesions in or near the spinal canal. The most, common lesion was a sequestrum or a sequestrated disc.

A Clinical Study on Acromioclavicular Separation / 대한정형외과학회잡지

The Acromioclavicular joint is classified as a diarthrodial joint. Its stability is maintained by articular capsule, acromioclavicular ligament, articular disc, coraco clavicularligament(trapezoid and conoid ligament) and attached muscles. 17 cases of acromioclavicular dislocation which had been seen at Seoul Red Cross Hospital during the period of January 1975 through December 1977 were studied. The following observations were made. 1. This injury is more prevalent in male (82%) with the peak incidence in the 3rd and 4 th decades (53%). 2. Conservative treatment was given in 11 cases by adhersive strapping around the elbow and lateral one third of the clavicle reinforced by Velpeau dressing for 3 weeks, then followed by active exercise. 3. Operative treatment consist of modified Phemister technique in 3 cases, Mumford technique in 2 cases, and Dewar and Barington's technique in 1 case. 4. Results were evaluated in 4 groups as excellent, good, fair, and poor according to Gerald weitzman's classification(1975). 5. Overall results of more than good (satisfactory) was obtained in 72.7% of the 11 cases with conservative treatment and in 50% of the 6 cases with operative treatment.