A Clinical Obserfation of the Unstable Thoracolumbar Spine Fracture and Fracture-Dislocation / 대한정형외과학회잡지

Clinical observation was made on 131 cases of the unstable spine injury treated at the Orthopedic Surgery Department of Busan National University Hospital during the period from January 1974 to December 1981. The results obtained were as follows: 1. More than two-thirds of patients were between the age of 20 and 40, and the proportion of males to females showed a ratio of 5.9 to 1. The most common cause of injury was falling at an industrial area, rating 64.1% of all cases. 2. Fracture level was observed 31.3% in the first lumbar level, 24.4% in the twelfth thoracic vertebra, and 67.9% between the twelfth thoracic vertebra and the second lumbar vertebra. 3. Mechanisms of injury were 44.3% by pure flexion, 26.7% by flexion and rotation, 15.3% by direct shearing force, and 13.7% by vertical compression. 4. The fracture with lower extremity paralysis was due to the rotational fracture dislocation, which comprised 66% of all. 5. Kyphosis increased to the average of 10.6 degree in the case of decompressive laminectomy and of 3.4 degree in the case of spinal fusion. 6. The anatomical alignment and a definite stability could be obtained by the use of Harringtons rod in the cases of the unstable thoracolumbar fracture and fracture-dislocation. In 3 cases of all, we could get satisfactory results 1 month after the day injury occured. 7. In case of complete paralysis of lower extremity, it was found only 9.4% showed partial recovery, neurologically, and 61.9% of the patients with incomplete paralysis were also partly recovered. 8. The most common complication was urinary tract infection, which comprised 83% of the cases. With the use of intermittent urinary catheterization, the voiding reflex recovered within 4 months in most cases.

Metallic Failures after Compression Plate Fixation Clinical Analysis of 12 Cases / 대한정형외과학회잡지

The twelve cases of metallic failure after compression plate fixation which were observed and treated at Department of Orthopedic Surgery, Busan National University Hospital were clinically analysed. The results were summerized as follows; 1. Age and sex of the patients was male in his active age in life. 2. The causes of fracture were traffic accidents and industrial accidents. The sites of fracture were femur in 11 cases and tibia 1 case. 3. The types of fracture were comminuted in 11 cases and short oblique in 1 case. 4. The 6 patients were not cooperative and began walking at their will after postoperative 4 weeks despite doctors order of nonweight bearing. Average duration of immobilization was 6 weeks. 5. Metallic failure occurred as screw failure in 1 case, plate failures through empty hole in 4 cases and plate failures through hole filled with screw nearest to the sites of fracture in 7 cases. 6. Interval between operation and metallic failure was 6.25 months average. The 75% of the metallic failure occurred between 4 to 7 months. 7. Treatments of metallic failures were cast immobilization with bone grafting in 1 case at tibia, intramedullary nailing with bone grafting in 1 case at femur and compression plate fixation with bone grafting in 10 cases at femur. 8. Causes of failure after internal fixation 1). Insufficient bone support Inadequate inter-fragmentary compression 9 cases Absence of cancellous bone graft 8 cases Empty plate hole 4 cases Remaining defects 3 cases 2). Inadequate postoperative treatment 6 cases.

Osteochondritis of the Both Patella: One Case Report / 대한정형외과학회잡지

Osteochondritis usually occurs in the epiphyseal center of children. Common sites of involvement of osteochondritis are the femoral head, tarsal navicular, talus, lunate, but the patellar involvement is rare. The exact cause of osteochondritis is unknown but it is believed to be traumatic or nontraumatic (idiopathic) in origin. This disease was first described by Kohler in 1908 and characterized by radiographic finding of increased density in the patella We have experienced here one case which is believed to be osteochondritis of the patella.

Arthrographic Measurement of the Normal Knee Joint in Adult / 대한정형외과학회잡지

Several measurements were performed about 105 cases of normal stress A-P arthrographic findings in adult knee including discoid without tearing or osteoarthritis, those were selected from 166 cases examined arthrographicaliy under same technical condition due to suspicious internal derangement of the knee from October 1976 to March 1980. After stastistical analysis and comparative study about chondrai thickness, chondral index, meniscal size, meniscal index, intermeniscal distance, type of meniscus, communication between knee and proximal tibiofibular joint, following results were obtained. 1. Chondral thickness of normal articular cartilage was not related to joint size, but almost same value individually. Mean chondral thickness In P and P points was 2.90±0.63mm, 2.90±0.62mm, 2.93±0.64mm, 2.92±0.65mm in lateral, medial femoral condyle and lateral, medial tibial condyle in order. Age change was not seen statistically. 2. The size of meniscus was correlated nearly proportional with that of the joint. Mean lateral meniscus size (transverse meniscal length × meniscal thickness) was 12.55±2.50mm × 6.53±0.7mm in male and 10.13±2.25mm × 6.02±0.52mm in female. That of medial meniscus was 9.79+1.54mm × 5.85+ 0.45mm in male, and 7.72±1.64mm × 5.36±0.92mm in female. Age change was not seen statistically either. 3. Mean intermeniscal distance was 60.21x2.74mm in male, 53.34±3.31mm in female and occupied 83% in male, 82% in female of joint size each other. 4. In types of meniscus, normal type was 8.10%, infantile type dlscoid 12.4%, intermediate type 2.9%, primitive type 3.7% each other. 5. Communications between knee joint and proximal tibiofibular joint were seen in 24%.

A Clinical Study of Tarsometatarsal Joint Injuries / 대한정형외과학회잡지

Authors reviewed and clinically analysed 34 cases of trasometatarsal joint injury treated at the Orthopedic department of Pusan National University Hospital during the period from January 1975 to December 1979, and following results were obtained. 1. The incidence was higher in male and the active age group of 20-40. 2. Among the causes, traffic accidents were 22 cases (64.7%) and crushing injuries in the industrial field were 6 cases (17.6%). 3. Fracure-dislocations were higher than simple dislocation. 4. According to the Wilsons Classifications, the injuries were classified as follows. First stage of supination (51), 11 cases (32.4%): First stage of pronation (P1), 8 cases (23.5%): Plantar-flexion alone (PF), 4 cases (11.8%): Second stage of supination (S2), 3 cases (8.8%): Second stage of pronation (P2), 2 casese (5.9%): And finally direct crushing injuries,were 6 cases (17.6%): 5. Associated injuries were fracture of the metatarsal bone in 15 cases (44.1%), fractures of the tarsal bone in 7 cases (20.6%) and severe soft tissue injuries in 6 cases (17.6%), 6. The operative treatments with early anatomical reduction were obtained better results than conservative treatment. 7. As complications, pain in 31 cases (91.2%), bony deformity in 26 cases (76.5%), motion limitation in 32 cases (94.1%), skin necrosis in 3 cases (8.8%) and traumatic arthritis in 23 cases (67.6%) were observed.

Vascular Injuries Associated with the Fractures About the Knee / 대한정형외과학회잡지

Fractures about the knee including the distal femur and the proximal tibia not infrequently result in vaseular injuries of the popliteal artery and the distal part of the femoral artery. This is often followed by circulatory disturbance and jeopadizes the viability of the lower extremity. During the three and a half year period, from January 1973 to June 1976, 20 cases of vascular injuries complicated by fractures about the knee were treated at the Orthopedic Department of Busan National University Hospital. Review of the cases resulted in the following observations. 1. The lower extremity escaped amputation in 45% the cases (9 of the 20 cases) 2. Femoral arteriography showed that the site of injury was proximal to the Soleus insertion. in 17 cases. 3. Types of vascular injury were contusion in 9 cases, laceration in 7 and total disruption in 4. 4. 5 of the 6 extremities that were treated within 12 hours after injury survived, while only 2 out of t he 9 extremities treated after 24 hours following injury escaped amputation. 5. 6 of the 13 extermities (46%) tredted by interval fixation survived, while 1 out of 5 extremities (20%) treated by traction escaped amputation.