Ender Nailing of the Tibial Shaft Fractures under the Local Anesthesia

PURPOSE: To evaluate the clinical result of ender nailing under local anesthesis was done to patient with tibia shaft fracture who had high risk for general anesthesia or spinal anesthesia. MATERIALS AND METHODS: 10 cases with ender nailing procedure under local anesthesia due to high anesthetic risk were selected from total of 20 cases with tibia shaft fracture operated with ender nailing. In each patient, hepatic, diabetic, cadiopulmonary complication and thromboembolism which can be initiated or aggravated by general or spinal anesthesia, were evaluated. Radiologic and clinical evaluation were used to check bone union. RESULTS: There were no complication of local anesthesia. Bone union were acquired in all cases with average bone union period of 18 weeks. There were no evidence of flexion deformity, limb shortening or joint contracture. CONCLUSION: Ender nail fixations under local anesthesia enable close reduction and intramedullary nailing and is effective in patient care but has no problem with bone union. For this reason, ender nail fixation under local anesthesia seem to be effective method if general of spinal anesthesia is difficult.

Treatment of Nonunion of Proximal Scaphoid Fractures Using Vascularized Bone Graft / 대한정형외과학회잡지

PURPOSE: To evaluate the radiographic and clinical results of the treatment of nonunion of scaphoid proximal fractures using vascularized bone graft and internal fixation, and to present the surgical procedures in detail. MATERIALS AND METHODS: Six patients with established nonunion of scaphoid proximal fractures who had been treated by vascularized bone graft and internal fixation from the year of 2000 to 2003 were analyzed retrospectively. The mean ages were 27.8 years old (18-45) and all the patients were male. The average follow up period was 13 months (8-18), and the causes of injuries were fall down in 4 cases, and motor vehicle accident in 2 cases. The 1, 2-intercomparmental supraretinacular artery was used as a vascular pedicle for the bone graft and fixed with a Herbert screw. RESULTS: All the non-unions had united at a mean period of 8.7 weeks (7-11). According to the Maudsley and Chen's criteria, 4 and 2 cases showed excellent and good results, respectively. There was one case of dysesthesia on the superficial branch of the radial nerve after surgery, which was resolved in 2 months. CONCLUSION: A vascularized bone graft is an useful method for treating a nonunion of scaphoid proximal fractures without severe arthritic changes, and can achieve a shorter immobilization and improved bone healing.

Kinematic Gait Analysis in Children with Hemiplegic Spastic Cerebral Palsy

OBJECTIVE: The purpose of this study is to evaluate gait characteristics using kinematic analysis in children with hemiplegic spastic cerebral palsy. METHOD: Fifty-seven non-operated spastic hemiplegic children who were able to walk independently without any walking aid were recruited as subjects. Three-dimensional kinematic gait analysis using a motion analyzer (Vicon 370 M. A. with 6 infrared cameras) were performed in all patients. Changes in joint angle of hip, knee and ankle in sagittal plane were evaluated to classify gait pattern and also the temporospatial values were measured to determine any differences between groups. RESULTS: Gait patterns were able to be classified into 6 groups. Group I had a minimal gait disturbance, a drop foot pattern. Group II showed hip and knee flexed, with normal ankle range. Group III showed hip, knee, and ankle flexed. Group IV showed genu recurvatum with tibia progression, Group V showed genu recurvatum with tibia arrest. Group VI showed stiff crouch gait. However, the temporospatial values between groups were not significantly different. CONCLUSION: This classification system would be useful for converting the vast quantitative information of gait analysis into descriptive and clinically relevant patterns. Therefore, it would be helpful for the clinician to understand underlying pathology and plan appropriate treatment.

Assessment of Autonomic Nervous Function with Power Spectral Analysis of Heart Rate Variability in Spinal Cord Injured Patients

OBJECTIVE: To investigate the autonomic activities in spinal cord injured patients, and to compare their activities according to the level and completeness of spinal cord lesions. METHOD: Thirty-five spinal cord injured patients and thirty healthy adults participated in this study. The ECG signals were recorded at the tilt angle of 0o and 70o for 5 minutes, and power spectral analysis of Heart Rate Variability (HRV) was done at each angle. RESULTS: The data reveals two major components such as a low-frequency (LF) component (0.05~0.15 Hz) reflecting primarily sympathetic activities with orthostatic stress, and a high- frequency (HF) component (0.2~0.3 Hz) reflecting parasympathetic activity. In supine position, all frequency components were not significantly different regardless the level and completeness of spinal cord lesion. At 70o head-up tilt position, the LF power and heart rate didn't increase in complete tetraplegia but significantly increased in paraplegia and healthy adults (p<0.05). However, the HF power didn't reveal any differences in four groups by decreasing significantly in all groups. CONCLUSION: We concluded that there is an abnormal control of autonomic activities especially the sympathetic function in complete tetraiplegia, compared with paraplegia and healthy adults.