A treatment methods of segmental fracture according to AO classification / 대한정형외과학회잡지

No abstract available.

Screening tests in early detection of proximal deep venous thrombosis(DVT): prospective study / 대한정형외과학회잡지

No abstract available.

A Study of Influencing Factors Causing Peripheral Vascular Occlusions in Diabetes Mellitus Patients by Doppler Flow Meter / 대한정형외과학회잡지

The peripheral vascular occlusion in the diabetes was studied in fifty-nine male and forty-six female diabetic patients by means of doppler flow meter performed on the dorsalis pedis arteries & post. tibial arteries of the both lower limbs. Patients were divided into two groups, one with occlusion and the other without occlusion. Various predisposing factors causing peripheral vascular occlusions were examined. The results are summerized as follows: 1. Peripheral vascular occlusions were more prevalent in male than in female (male: 25.4%, female: 17.4%). 2. In male patients age, plasma cholesterol level & smoking were statically significant among the various predisposing factors between occlusion & nonocclusion groups. 3. In female patients, duration of diabetes mellitus and the sugar levels of fasting blood and post prandial 2 hours were statiscally significant.

Clinical Results of Bipolar Endoprosthesis / 대한정형외과학회잡지

In 1974, bipolar endoprosthesis was first introduced by Bateman & Giliberty. It has theoretical advantages including minimizing acetabular wear, possible reduction of incidence of stem loosening, lessening of dislocation and easy revision procedure. Various methods for the treatment of fracture of the femur neck have been developed & performed, but it is still called “the unsolved fracture” in certain situation. But the role of it as primary treatment of fracture of the femur neck continues to be controversial. Current clinical results encourage its continued use and expansion of indication. Authors reviewed and analysed 21 cases of bicentric endoprosthesis and 1 case of Giliberty endoprosthesis those have been operated at the Department of Orthopaedic Surgery, National Medical Center from 1981 to 1983. Following results were obtained, l. According to disorder distribution, 14 cases were neglected fracture of femur neck, 2 old fracture, 1 idiopathic femoral head necrosis and 2 avascular necrosis & 1 non-union complicated by femoral neck fracture. 2. Among 20 cases, 8 cases were operated within 1/2 1 month after injury and 6 cases within 1 3months 3. Harris lateral appmach was used in 16 cases (80%) and Modified Gibson approach in 4 cases (20%). There were no significant differences in morbidity during operation and postoperative complication. 4. We used femoral stems those head diameter was 22 and 32mm(Charnley & Miiller type) and head pieces those diameter was 48-51 mm in male and 44–48 mm in Ifemale. 5. 3 cases were stiff in inner bearing without acetabular erosion. 6. In 6 cases more than 2 years followup 1 degree CE angle of Wiberg was increased in 2 cases of youngage respectively without associated hip joint pain. 7. Although inclination of head piece was vertical in 8 cases, fracture and dislocation were not found. 8. The circumference of head piece and opposite femoral head was measured and compared. There were 12 cases (mean 12.6 mm) that of head piece larger than opposite femoral head and 3 cases smaller than opposite femoral head. 9. There was 4 cases of complication (3 patients) and still no reoperation and revision converted to T.H.R. 10. With regard to average 18 months of follow-up, 7 cases of 81–90 Harris hip-rating score, 6 of 91–100, 4 of 71–80 and 3 of 61–70.

Partial Fibulectomy for Non / 대한정형외과학회잡지

One may sometimes complicated with non-union of the tibia with intact fibula or comparatively early united fibular fracture during the cause of treatment of crural fractures. So that the fibula is to strut the tibial fragment preventing effective contact. Several authors have sporadically reported the removal of a portion of fibula may increase potential compression force across the tibial fracture site and promote bony union of non-delayed union of the tibia. Partial fibulectomy was performed in 9 patients with established nonunion of the tibia at National Medical Center from 1975 to 1982. The results were as follows: 1. Healing occurred in 8 of the 9 cases, and average time to union was 7.4months after fibulectomy. 2. In one case performed B-K amputation due to intractable infection after partial fibulectomy. 3. The average shortening of the involved lower limb was about 1.9cm. 4. All cases did not have significant symptoms at the fibulectomy site after union. 5. Partial fibulectomy proved to be a relatively effective method for the treatment of nonunion of the tibia.

A Clinical Study of Conservative Treatment on the Tibial Shaft Fracture / 대한정형외과학회잡지

One hundred and two patients with fracture of the tibial shaft were treated conservatively at the Department of Orthopaedic Surgery, National Medical Center from 1977 to 1982. In this article, we have analyzed early and late influencing factors upon healing process of the tibial shaft fractures treated with conservative methods. Early factors: Age, fracture type, initial displacement, comminution, open fracture, ipsilateral fibular fracture and associated injuries. Late factors: Interval between accident & final manipulation, distraction of fracture site after skeletal traction, and condition of final apposition. Also, we had the result that the mean healing time of tibial shaft fx. was 17.9 weeks by conservative treatment.

Clinical Analysis of Diabetic Gangrene / 대한정형외과학회잡지

No abstract available in English.

Fractures of the Distal End of the Femur / 대한정형외과학회잡지

No abstract available in English.

Total Hip Replacement in the Treatment of Steroid-induced Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

Since 1957, multiple possible mechanisms have been suggested to explain the production of the osteonecrosis of the femoral head and it is now accepted that steroid medication is one of the etiologic factors producing osteonecrosis of the femoral head. Among the surgical procedures in ischemic osteonercrosis of the femoral head are bone grafting, core decom-pression, rotational osteotomy, angulation osteotomy, hemiarthroplasty and total hip replacement. The choice of surgical procedures in the management of idiopathic osteonecrosis of the femoral head is dependent on several factors. Most important are the etiology and stage of the lesion. Other considerations are the patients age, lifestyle, and demands on his hip, and the surgeons preference and expertise. We reviewed 32 total hip replacements in 22 patients, which had been performed to treat steroid-induced osteonecrosis of the femoral head at Department of Orthopaedic Surgery, National Medical Center from Jan. 1975 to Dec. 1981. The longest follow-up was 7 years and 6 months and the shortest, 1 year, the average being 2 years and 6 months. The results were as follows: 1. There were 13 males and 9 females and more than half were in 5th decade. 2. Principal causes to use oral corticosteroids were rheumatoid arthritis, arthralgia, and low back pain in the order of frequency. 3. Duration of corticosteroid medication was between 2 months and 12 years and 18 patients took more than 12 months. 4. Of 18 patients who had the bilateral involvement, the two also had osteonecrosis of the humeral head. 5. Roentgenographically, 30 hips were in stage IV and 2, in stage III according to the classification of Arlet and Ficat. 6. Types of the implants used were Charnely (28 cases), MQller (2 cases) and Trapezoidal-28 (3 cases). 7. The function of the each hip was evaluated preoperatively and postoperatively by the method of Wilson and Salvati and all improved from average poor to average good.

Compression Hip Screw for Fracture of the Neck of the Femur: 22 Cases / 대한정형외과학회잡지

The displaced femoral neck fracture continues to be a difficult problems such as high percentage of avascular necrosis and non-union. Compression hip screw was designed to aliow firm impaction at the time of operation and secondarily, for continued impaction if resorption occurs at the fracture line during healing. 22 cases of femoral neck fracture treated by compression hip screw in the department of orthopaedic surgery at National Medical Center were analyzed, and results were as follow. 1. The average of patient was fifty-three years, and man was predominant. 2. Average 8.9 days was elapsed from initial injury to hospital, and good results were observed in the cases of operation within 3 days. 3. The end results were good when the fragment was reduced within 165°–180° of Garden's angle in A-P film and 20° of anterior and posterior angulation in lateral film. 4. The good results were observed in the position of the screw center and low in A-P film, and center and posterior in lateral film. 5. The positive findings of the intraosseous-venogram was observed in 6 weeks from operation and apparent in all cases done after 6 months. 6. Bony union was obtained within 5.9 months, and avascular necrosis was established in 29 months. 7. Developed 3 avascular necrosis, 1 non-union, and 2 degenerative arthritis of 22 cases.

Intraosseous Venography for the Early Union Detection of the Femoral Neck Fracture / 대한정형외과학회잡지

In spite of highly advanced technology in orthopaedic field, management of femoral neck fracture presents difficult problems due to frequent non-union or avascular necrosis of femoral head even with adequate treatments. Intracapsular fracture of the femoral neck heals in the same way as other intra-articular fractures only by endosteal and not by periosteal repair. Avascular necrosis occurred in one-third of displaced fractures with more than a two-year follow-up and is the most serious remaining factor affecting the result. Many attempts have been made to achieve early diagnosis of nonunion and avascular necrosis of the femoral head. Yet, there is still no reliable clinical method of early detection of the union of femoral neck fracture and the viability of the femoral head. For the early detection of union and viability of femoral head, we performed femoral trochanteric intra-osseous venographic technique. Intraosseous venography was performed in 19 cases of femoral neck fractures in the orthopaedic department of National Medical Center during the period from Jan. 1979 to Dec. 1981. The results were as follows: l. 19 patients of femoral neck fracture were performed osteomedullography. Intra-osseous venous flow across the fracture line was seen in 11 cases from 19 patients. 2. Intra-osseous venous flow across the fracture line was seen between the 6th and 12th week following fracture treatment in rigid fixation and adequate reduction. 3. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing and non-union.

The Result of Anterior Interbody Fusion in Spondyloysis and Spondylolisthesis / 대한정형외과학회잡지

Spondylolisthesis and spondylolysis is one of the major causes of the low back pain and orthopaedic surgeons frequently encounter this problems with increasing tendency. In 19th century, spondylolisthesis had been studied by the European obstetrician as the main cause of dystocia. Advancement of the radiological techniques enabled us to know more precise degree of slipping. Therefore, many surgical techniques have been used. Spondylolysis has been also studied as the precursor of the spondylolisthesis. This report is based upon the analysis of the records of 26 patients who had operated at the Department of Orthopaedic Surgery of National Medical Center from 1972 to 1981. The results were as follows. 1. Most common age group was 30–50 age group and theres no sexual difference. 2. Most common symptoms were lumbago and radiating pain and the most common sign was Lasegue sign. 3. Most common type was isthmic type and location was 5th lumbar vertebra, and degree of slipping was grade I by Meyerding's method. 4. The fusion of the grafted bone were observed in 24 cases among 26 cases: of which the duration were 3 months in 16 cases and remaining 8 cases had duration between 3 and 6 months. 5. Postoperative analysis under the basis of the functional recovery was satisfactory in 93% of cases by Gill's criteria.

The Treatment of Non-union of Humeral Shaft / 대한정형외과학회잡지

The non-surgical treatment for the fresh humeral shaft fracture would appeared to be not sufficient in respect of immobilization and maintenance of the contact surface of the fracture ends, which have had stimulated surgeons to perform internal fixation. This might be one of the reasons to produce non-union of humeral shaft fracture, supplemented by increasing incidence of fractures due to car and machinary accident. Authors have experienced 18 cases of non-union of humeral shaft fracture and accomplished solid union in all cases by osteosynthesis accompanied by autogenous bone graft. In detail: 1. Non-union was prevalent in the agr group of 20 to 40 and mostly in male. Site of non-union was found mostly at the lower 2/3. 2. The cause of the fracture was mainly due to the car and machinary accident. Initial treatments were surgical in 14 out of 18 cases, and 12 cases of this surgically treated group were treated within 2 days after the injury. 3. On retrospective analysis of medical records and X-ray films, probable cause of the non-union were supposed to be too early performed inadequate internal fixation and post-operative infection in the operated cases, whereas distraction of fracture ends due to poor external fixation and infection in the cases treated conservatively. 4. 16 cases of established non-union were treated by authors with rigid internal fixation and additional bone graft, and 1 case with bone graft only. 5. Authors have utilized shoulder spica or long arm cast post-operatively for 1 to 4 months. 6. Union was obtained in all cases. Developed transient radial nerve palsy in 4 cases; and neighbouring joints contracture in 2 cases, which required considerable time of physical therapy.

Incarcerated Patella Synovial Plica Syndrome 4 Cases / 대한정형외과학회잡지

Over twenty per cent of adult knees have a synovial plica which always has possibility of changes into pathologic synovial plica symptomes and signs resembling those of other common internal derangement of the knee joint. Especially the young active patient who has a history of trauma to the knee should once be suspected incarcerated synovial plica not only the possibility of internal derangement. Four cases of symptomatic synovial plica experienced by authors are reported with available references.

The Result of Compression-Plate Fixation in Forearm Fractures / 대한정형외과학회잡지

We meet much difficult problem to solve in the treatment of the forearm fractures which are not encountered in the treatment of fractures of the other long bone and there are many reports on the results of treatment of forearm fractures and many methods have been introduced. In the late 1950's ASIF compression plate was invented and developed by Muller, Allgower, and Willenegger and it has shown excellent union rate and functional results in the treatment of forearm fractures. From Jan. 1971 to Dec. 1979, we have experienced 71 cases of fresh or old forearm fractures treated by different methods and devices and among them, 53 patients, those were treated with compression plate and other various internal fixation devices, were possible to trace for more than 3 months. The Author divided the traceable patients into two groups, the one was the group treated with compression plate and the othtr one was the group treated with other various internal fixations, and compared the results in the aspect of healing time and functional results. The results were as follows; 1. Among 71 patients, 45 patients (36.6%) were fresh and 26 were old cases. Of 61 adult patients 21 cases (34.4%) exhibited severe soft tissue injury due to crushing machinary injury. 2. There was 24 (33.8%) cases of open fractures and the most common fracture site was middle one-third of both radius and ulna. 3. The period between operation and exercise was 7.3 weeks in fresh cases which were treated with compression-plate fixation and 10.3 weeks in old cases with other fixation devices. 4. The time of radlological union was comparatively rapid in compression-plate fixation group, acute cases and radial fractures when compared it with those treated with other fixation devices, old cases and ulnar fractures, respectively. Radiological union time in average was as follows; Radius, compression-plate fixation: 12.1 weeks ulna, compression-plate fixation: 12.4 weeks redius, other fixation devices 14.9 weeks ulna, other fixation devices 15.5 weeks 5. By Anderson's functional criteria, the ratio of excellent or good results was as follows, Acute compression-plate fixation: 87% Acute, other fixation devices 67% Old, Compression-plate flxation: 67% Old, Other fixation devices 23% 6. Achieved bony union in all cases in compression-plate fixation group and experienced 3 cases of non-union in the group treated with other fixation devices. Among 3, two cases of non-union were due to post-operative infection and technical failure and the other one was a solitary ulnar fracture which was treated with rush pin.

The correction of spinal deformities due to Tuberculous Spondylitis: 6 cases Report / 대한정형외과학회잡지

The Halo-pelvic traction has been considered as a powerful and strong method for correction of the severely deformed rigid spine whether it is kyphotic or scoliotic. It also affords firm stabilization during the operation and postoperative management with immobilization for a long time. Ambulation with this instrument enhances the usefulness. We have succeeded in treating and correcting 6 cases of Tuberculous Kyphosis, and 3 of which accompanied paraplegia. Especially one case of severe kyphosis, 78 was corrected to 20 and anterior strut graft was accomplished with vascuiarized free fibular graft with aid of microvascular technique. The correction rate was 38% in average. No significant complications have developed except osteoporosis of the spine.

Correlative Study on Abnormal Roentgenological Findings of the Spine and the Incidence of Low Back Pain / 대한정형외과학회잡지

The etiologic factors causing low back pain are numerous and variable. Orthopaedic sugreons tend to focus attention to any defects of structural and functional origins such as pine, discs and facet joints. Clinically, however, the fact remains that not all abnormal findings produce back pain and vice vera. Among the many modalities of investigation to determine the etiology of back pain, plain X-ray of the lumbosacral spine is the single most important acreening method. In addition to antero-posterior, lateral and oblique views, stress view of the spine gives certain clue to predict the disc degeneration. The X-ray findings of a total of 503 patients with low back pain (the study group). admitted during the year of 1977 to the Department of Orthopaedic Surgery, National Medical Center, were reviewed and compared with the control group of 100 patients without relevance to back pain (the control group). Our intention was to explore the relationship between the abnormal findings of plain X-rays and occurence of back pain. and to further entrance the diagnostic value of the spine. The study group of 503 patients (86 cases of which were operated on) were diagnosed not only by routine plain X-rays but also by contrast myelography and tomography in addition to detailed physical examination. Following observations were made: 1. The sex was nearly equally distributed in the atudy group of 503 patients. The age ranged from the second to the eighth decade, dominant group being the third to fifth decades. 2. The causes of the low back pain were herniated disc, spondylosis, spondylolysis, and infection, in that order. 119 patients (23.7%) out of the 503 showed no roentgenologicaI abnormal findings. 3. 384 cases out of the 503 revealed abnormal findings, mainly congenital or developmental and degenerative changes in that order. 4. In a comparative study with the control group, congenital or developmental anomalies and degenerative changes were not related to low back pain. Disc. space narrowing, supposed to be valuable in establishing the diagnosis of low back pain was present in 26% of the cases in study group and in 11% in the control group. 5. The age incidence of the low back pain with congenital or developmental anomalies was mainly in th second and third decades, while that of disc space narrowing was in the third to fifth decade. The degenerative changes of the spine appeared after the fourth decade. 6. Transitional vertebra and tropism are supposed to plsy a role on the degenerative change of the spine. 7. The stress study of the spine had some benifit it the diagnosis of disc degeneration. The mobility of the L4-5 lesion with low back pain was increased to mean 15.1 and standard deviation 3.7, in comparison to the mean 12.3 and standard deviation 3.7 in the control group.

The Result of the Tension Band Internal Fixation / 대한정형외과학회잡지

The principle of the tension band technique is to counteract the tensile forces acting across the fracture site and to convert them into compressive forces. We have experienced 37 fractures treated with tension band technique from 1975 to 1978 and the results are as followings; 1. 37 Cases of fracture were treated by tension band technique. Eight cases out of 37 were olecranon fractures. 16 cases were patellar fractures. 10 cases were malleclar fractures. and three cases were trochanteric fractures of the femur. 2. As post-operative immobilization, applied cast splint in almost of the cases except application of hip spica cast in trochanteric fracture. 3. The average duration of immobilization in each cases, 12 days in olecranon, two weeks in patella, four weeks in malleolus and six weeks in greater trochanter respectively. 4. The radiological union was obtained in seven weeks in olecranon, six weeks in patella, eight weeks in malleolus and six weeks in greater trochanter. 5. As complication, one case of nonunion in olecranon, one case of infection and, one case of wire breakage in patella and one case of traumatic arthritis in malleolus were noted, which needed further surgery. 6. In conclusion, tension band wiring is considered as a good method for the fractures involving joing, olecranon, patella, and malleolus because the technique has advantages such as rigid internal fixation, shortening the duration of immobilization and fracture healing and early mobilization of the neighboring joints.

A Case of Acquired Syphilitic Osteomyelitis of the Tibia / 대한정형외과학회잡지

Acquired syphilis rarely manifest itself in the skeleton, causing localised osteoscopic pain, commonly in the abscence of general systemic complaints. Diagnosis of bone syphilis can easily be made by clinical history, course of the disease, roentgeno-graphic findings, serological tests, therapeutic test of antiluetic treatment and, most reliably, by biopsy. We experienced a patient with syphilitic osteomyelitis of tbe tibia who had a history of sexual contact and the diagnosis was confirmed by serological tests and biopsy.

A Cases of Endodermal Sinus Tumor in Sacrococcygeal Region / 대한정형외과학회잡지

A endodermal sinus tumer (Teilum) is a highly malignant germ cell tumor showing a selective overgrowth of yalk sac endoderm intimately associated with the extraembryonic mesoblast. Several cases of the tumor originating from the ovaries have been reported in the literature. We present a case of the tumor with a rare origin from the sacrococcygeal region.