Remodeling of Traumatic Sternal Segment Dislocation in a 13-Year-Old Boy / 대한정형외과학회잡지

A traumatic sternal segment dislocation in children is very rare. Of the few cases reported, some recommended surgical treatment, while others reported good results by conservative treatment. Therefore, the treatment remains unclear. This paper reports a case of completely remodeled traumatic sternal segment dislocation in a 13-year-old boy treated by the restriction of activity and periodic observations.

Coronoid view: A New Radiograph for the Evaluation of the Coronoid Fractures

PURPOSE: It is very important to evaluate and fix coronoid process fractures because they are a critical element for a stable, effective elbow function. The lateral view of the elbow joint is used for a radiographic evaluation of the coronoid but an understanding of the fracture pattern is often difficult because of overlap of the radial head and obliquity of the fracture line. We developed the coronoid view, which is a new radiograph for an evaluation of the coronoid process fracture, and discuss its advantages for a postoperative follow-up. MATERIALS AND METHODS: The coronoid view was designed for an evaluation of the anteromedial fragment of the coronoid process. After the patient sat on his side, the shoulder was abducted 45degrees and the elbow was flexed 90degrees The X-ray beam was shot perpendicular to the table. Since shoulder was abducted 45degrees the fracture line of the coronoid process can be parallel to the X-ray beam, and the radial head can be cleared. CONCLUSION: The coronoid view can be a good alternative radiograph for an evaluation of a coronoid process fracture because the beam is parallel to the fracture line. The coronoid view can be particularly useful in postoperative patient follow-up where computed tomography is impractical due to metal implants and cost.

Antibacterial Effects of Controlled Antibiotic Release Using Antibiotic-LDH Hybrids / 대한정형외과연구학회지

PURPOSE: To evaluate an effect of controlled antibiotic release of the layered double hydroxides (LDH) as a new drug delivery system, and to observe a histological changes of the LDH in vivo and the differences of antibacterial effects among the several antibiotic-LDH hybrids. MATERIALS AND METHODS: Staphylococcus aureus (ATCC 23235) and Escherchia coli (ATCC 10536) were used as a bacterial specimens. Antibiotic-LDH hybrids were gentamicin-LDH (GM-LDH), cefaclor-LDH (CCLO-LDH), cefuroxime axetil-LDH (CRXMA-LDH) and ceftazidime-LDH (CAZ-LDH). In vitro study, two methods were used. One was dilution method, used to determine the minimum inhibitory concentrations (MICs) of the antibiotic-LDH hybrids. The other one was disk diffusion method, to observe the zones of bacterial inhibition of them. In vivo forty New Zealand White rabbits (2.5~3.0 kg) were divided into 10 groups. Animals were anesthetized and a 3 mm-diameter hole was drilled 2 cm proximal to the distal end of the left femur. The antibiotic-LDH hybrids was put into the drilled hole and then 0.1 ml (105 CFU/ml) of S. aureus and E. coli were inoculated into the drilled hole in each group. Histological examination was done at postoperative 1, 2, 3, and 4 weeks respectively. RESULTS: The MICs for S. aureus were more than 400 microgram/ml in GM-LDH, 25 microgram/ml in CRXMA-LDH, 25 microgram/ml in CCLO-LDH, and 100 microgram/ml in CAZ-LDH. The MICs for E. coli were 12.5 microgram/ml in GM-LDH, 25 microgram/ml in CRXMA-LDH, 25 microgram/ml in CCLO-LDH, and 1.56 microgram/ml in CAZ-LDH. CCLO-LDH was effective on both S. aureus and E. coli and CRXMA-LDH on E. coli in disk diffusion method. In contrast, GM-LDH and CAZ-LDH were not effective on neither S. aureus nor E. coli. Histologically, LDH was shown as large masses at the postoperative 1~2 weeks and changed to several small masses or fragments at the postoperative 3~4 weeks. CONCLUSION: There was much difference of the extent of controlled antibiotic release among antibiotic-LDH hybrids. The size and volume of LDH in vivo was reduced gradually. CCLO-LDH, and CRXMA-LDH seemed to have an effect of the bacterial growth inhibition.

Bacterial Contamination of Allografts from Living Donors / 대한정형외과학회잡지

PURPOSE: To analyze the rate of allograft contamination from living donors using a swab culture method and to determine the necessity of antibacterial processing. MATERIALS AND METHODS: From September 2001 to June 2004, 334 allografts were obtained from living donors undergoing total joint arthroplasty. Two hundred and fourteen allografts were obtained from the femoral heads, 86 from the knee joint, and 34 from other sources. All allografts from donors with inflammatory diseases were discarded. After retrieving the graft, the entire surface of the allograft was carefully swabbed, and the specimen was inoculated and cultured on blood agar for 48 hours. A bacterial culture with the entire tissue was also carried out on discarded allografts, and the rate of contamination was compared with that of used allografts. RESULTS: Of the 334 allografts, 20 (6%) allografts were culture positive using swab method. 132 allografts were discarded. The reasons for discarding were a prior medical history in 26, no informed consent in 54 and a positive blood test in 10. The rate of contamination of the discarded allografts was 15% (20/132) using the swab method, and 19% (25/132) using entire tissue culture method. The sensitivity of the swab culture technique was only 44%. CONCLUSION: The low sensitivity implies that the swab method is unsuitable for detecting bacterial contamination. Unprocessed swab-culture-negative grafts may be contaminated with organisms that can cause infections. Therefore, additional antibiotic processing such as gamma-irradiation will be required.

Epidemiologic Study and Analysis of Serum Markers for Osteonecrosis of Professional Divers

Purpose: To evaluate the risk factors for the development of osteonecrosis in civilian professional divers by an epidemiologic study and to determine the correlation between osteonecrosis in divers and coagulopathy by analysis of serologic markers that are related to thrombophilia and hypofibrinolysis. Materials and Methods: Forty-two divers, who collected pen shells (Atrina pinnata), and among whom 10 had osteonecrosis (group 1), were compared with 32 divers without osteonecrosis (group 2). Both groups were evaluated based on the number of years of diving experience, number of dives per year, mean number of dives per day, mean diving time and depth, and diving methods. We determined any statistically significant differences among these variables. We measured the levels of serologic markers that were related to hyperlipidemia, thrombophilia, and hypofibrinolysis from the divers and a control group of 20 physicians (group 3). The levels of the serologic markers were compared between groups 1 and 2 and between the divers and the control group, in order to determine the relationship between the serologic markers and the development of dysbaric osteonecrosis. Results: None of the variables demonstrated any statistically significant differences, except for the mean diving time, in which group 1 had a mean diving time of 124 minutes and group 2 had a mean diving time of 62.1 minutes (P<0.05). In the analysis of the serologic markers, there were no statistically significant differences between groups 1 and 2; however, in comparison with the group 3, the divers demonstrated significantly decreased activity levels of proteins C and S (Protein C: P<0.05; Protein S: P<0.05), and an increase in the levels of plasminogen activator inhibitor-1 (PAI-1) (P<0.05). Conclusion: The divers with osteonecrosis had a longer mean diving time than did those divers without osteonecrosis. In the serologic marker analysis, the divers with osteonecrosis demonstrated significantly decreased activity levels of Proteins C, S and a significant increase in the levels of PAI-1, compared with the control group.

Epiphyseal Fracture-Separation of the Distal Humerus Suspected Brachial Plexus Injury : A case report

The epiphyseal fracture-separation of the distal humerus is extremely rare injury in neonates. It is frequently misdiagnosed as a elbow dislocation owing to the invisible cartilagenous portion of the distal humerus in roentgenograms. We described a case, 9-day-old neonate with finally diagnosed the Salter-Harris type 1 injury of the distal humeral epiphysis. He was referred for further evaluation of 'refusal to use the left arm' from a local clinic. The injury had initially misdiagnosed as normal roentgenograms by a locaorthopedic specialist, so we preferentially give an impression of the brachial plexus injury or the hemiplegic cerebral palsy. But electromyography and brain magnetic resonance imaging were negative findings. A neonate was referred to the pediatric orthopedic subspecialist and properly diagnosed. He was treated with the closed reduction and the percutaneous pinning. No complication has occurred.

Treatment of Pediatric Displaced Supracondylar Fractures of the Humerus by Pin Leverage Technique

PURPOSE: To evaluate a new treatment method by pin leverage technique in Gartland type III fractures to avoid forceful manipulation or open reduction. MATERIALS AND METHODS: 99 cases were included in this study and divided into 3 groups (I;open reduction, II; closed reduction and percutaneous pin fixation, III; pin leverage technique), and we analyzed timing to operation, length of operation, associated neurovascular injuries, complications, and clinical and radiological outcomes at final follow-up. RESULTS: The average length of operation 119, 57, and 68 minutes respectively. The associated nerve injuries were 8, 2, and 2 cases respectively. There were a case of superficial pin tract infection in group I, three cases of superficial pin tract infection and a case of iatrogenic ulnar nerve injury in group II. At final follow-up, clinical results were excellent or good in all cases and there were 5 cases (8.3%) of fair results in group II radiologically. Closed reduction with pin leverage technique were failed in 5 cases. CONCLUSION: In treatment of Gartland type III fractures, pin leverage reduction technique is considered to be a good alternative prior to open reduction, because it provides shortened length of operation, avoidance of forceful manipulation and open reduction.

Surgical Treatment for Lumbar Spinal Stenosis with Fracture in Multiple Osteoporotic Compression Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the outcome of the surgical treatment for lumbar spinal stenosis with fracture in multiple osteoporotic vertebral body compression fractures. SUMMARY OF LITERATURE REVIEW: An osteoporotic vertebral compression fracture, without neurological symptom, has mainly been treated with conservative care. Sometimes, vertebroplasty or kyphoplasty has been used as a surgical treatment. In the case of a single thoracolumbar fracture with neurological symptoms, not improved by conservative care, decompression, fusion and instrumentation through an anterior or a posterior approach has been attempted. MATERIALS AND METHODS: 10 patients, who had received surgical treatment for symptomatic lumbar spinal stenosis with fracture out of those with multiple osteoporotic vertebral body compression fractures, and over the age of 60, were assessed. The surgical treatment was performed on the patient with all of the following five criteria; (1) severe back pain caused by fractures, (2) neurological symptoms of lumbar spinal stenosis, (3) radiological evidences of stenosis by lumbar fracture, (4) no response to conservative treatment for over 3 months, and (5) adequate physical ability for daily living without a severe medical condition. The surgical procedure included: decompressive laminectomy, posterior instrumentation using pedicle screw fixation, and fusion in situ. The pedicle screws were located 2-3 above and below the most cephalad and caudad fractured vertebral bodies. RESULTS: Clinically, favorable results were obtained in 8 of the 10 patients. In the roentgenographic assessment, the operated states were well maintained, without the metallic failure or instability. Halos around the pedicle screws were seen in 4 patients, but there was no significant evidence of loosening. There were no serious medical and systemic complications in the peri- and postoperative periods. Additional vertebral body fractures and pain were seen in 5 patients, but they had been well managed, conservatively. CONCLUSION: Favorable clinical results could be expected for the surgical treatment of lumbar spinal stenosis, with fracture, in the patients with multiple osteoporotic vertebral fractures, as long as the surgical treatment was indicated exactly and carefully.

Insufficiency Fractures of the Femoral Shaft Associated with Osteoporosis

PURPOSE: To present a clinical experience of the insufficiency fractures of the femoral shaft associated with osteoporosis MATERIALS AND METHODS: From January 1995 to December 2002, four patients (8 cases, four females) more than 1-year follow up were reviewed retrospectively. The mean age was 61 years (range, 55 to 73). Medical records and roentgenograms were reviewed. RESULTS: The fractures were bilateral. Plain film revealed fracture line in six among seven cases excluding 1 displaced fracture at initial presentation. All cases presented osteoporosis, anterolateral bowing of the femur, and hot spot in bone scan. Five cases (four displaced, one impending displaced fracture) underwent interlocking intramedullary nailing and all five of them manifested no evidence of delayed union. The preoperative thigh and knee joint pain improved postoperatively. CONCLUSION: Femoral shaft insufficiency fracture could occur rarely in patients with anterolateral bowing of the femur and postmenopausal osteoporosis. Careful history taking, radiography and bone scan are necessary, and bone scan is helpful for early diagnosis. Once diagnosed as the insufficiency fracture with fracture-related symptoms, prophylactic nailing may be necessary lest complete displaced fracture should occur.

Ring-Shaped Lateral Meniscus

PURPOSE: To investigate the clinical characteristics and the results of treatment of ring-shaped lateral meniscus. MATERIALS AND METHODS: From 1984 to 2003, We treated 6 patients with ring-shaped lateral meniscus who were diagnosed during surgery. Among them, five cases were symptomatic. The follow-up period ranged from 12 to 60 months (average 31). All patients were assessed by Lysholm score. RESULTS: There were 5 men and 1 women. Mean age was 27 years. The mean interval from onset of symptoms to surgery was 22 months. Absent or minimal trauma appeared responsible in 5 cases. All patients had excellent results at last follow-up. CONCLUSION: Ring-shaped lateral meniscus was a very rare congenital anomaly which occurred mostly in the lateral meniscus and could present with symptomatic case due to tear.

Evaluation of Porosity in Cylindrical Bone Cement Specimen Using Image Analysis System / 대한정형외과연구학회지

PURPOSE: The porosity of the bone cement is the most important cause of fatigue failure, the most common mode of failure of bone cement using widely in arthroplasty. It is important to evaluate the porosity of bone cement for improvement or development of bone cement, but the conventional 'stain, 'cut, and 'polish, manual method takes long time and efforts. So it is necessary to develop a new technique for evaluation of porosity of bone cement. We tried a technique using computer image analysis system to evaluate the porosity of bone cement specimen and assess efficacy of the method. Simultaneously we evaluated the relationship between the porosity of bone cement and fatigue failure. MATERIAL AND METHODS: We made 59, 2.5inch-length bone cement specimens(30 Simplex P, 29 Palacos R) using Simplex P and Palaces R which are widely using in clinical situation and checked radiogram using mammography film. After scanning the mammography film, we measured the porosity of the bone cement specimens using NIH(National Institute for Health) Image 1.6 version image analysis program. We also, measured the porosity of the bone cement specimens with conventional 'stain','cut' and 'polish' method, after then compared the results of two methods. Simultaneously, we evaluated the relationship between porosity & fatigue failure by loading 9.0, 10.0, 12.5 and 15.0 MPa load with frequency of 10Hz to the bone cement specimens under the physiologic condition. RESULTS: The coefficient of relation of simplex P and palaces R was 0.729 and 0.713 respectively, so there was high relationship between the image analysis system method and conventional one. It was easy and took shorter time to measure the porosity of bone cement specimens with image analysis system. There was high correlation between cement porosity and fatigue failure, regardless of level of load. CONCLUSION: It was very easy and fast to measure the porosity of the bone cement specimens with image analysis system and there was high correlation between cement porosity and fatigue failure.

Distribution of Lengths of the Normal Femur and Tibia in Korean Children from Three to Sixteen Years of Age

To develop a standard growth curve of the lower extremity in Korean children from 3 to 16 yr of age, the lengths from a total of 2087 normal long bone segments (582 femurs and 645 tibias in boys, and 417 femurs and 443 tibias in girls) were measured. Children were grouped by years of bone age, which was determined by using the Korean specific bone age standard; TW2-20 method. The growth spurt occurred in girls from eight to eleven years by bone age, and in boys from eleven to thirteen years. The mean tibial length relative to the mean femoral length was 0.78 in boys and 0.79 in girls. The overall growth pattern was similar to that observed in American children in the 1960s. Korean children and adolescents appear to have a different tempo of skeletal maturation during pubertal growth from that of English and American children and adolescents. The Korean standard growth curve and the Korean bone age chart allow determination of the presence of any existent growth abnormalities and prediction of future remaining growth in lower extremities. These normative growth standards can be used for leg-length equalization purposes in children with anisomelia.

Meniscal Cysts of the Knee

PURPOSE: To investigate the clinical characteristics and the results of arthroscopic treatment of meniscal cysts. MATERIALS AND METHODS: From 1995 to 2002, 16 patients with meniscal cysts were treated by arthroscopic partial meniscectomy and cyst decompression. Five men and eleven women comprised the study group and had an average age of 31.9 years. The follow-up period ranged from 12 to 52 months (average 27). All patients were assessed by modified Ryu and Ting's method. RESULTS: The mean interval from onset of symptoms to surgery was 30 months. Minimal or absent trauma appeared responsible in 87.5% of all case. Eight of the cysts were lateral and eight were medial. It was difficult to palpate the cyst in three cases. All were noted to have a meniscal tear with horizontal tear at the time of surgery. There have been no recurrences, and all patients returned to their previous level of activity and were satisfied to their results. CONCLUSIONS: Meniscal cysts occur predominantly in women and almost same as often in the medial compartment as in the lateral compartment. Parameniscal cysts may result from synovial fluid tracking through a cyst tract of horizontal cleavage component. Satisfactory results can be expected from only arthroscopic partial meniscectomy and decompression of meniscal cysts without repair.

Medication and Flying: A Pilot's guide

No abstract available.

The Surgical Treatment of Ossification of Ligamentum Flavum of Thoracic and Thoracolumbar Spine / 대한척추외과학회지

STUDY DESIGN: The authors reviewed 14 patients with neurologic deficits caused by ossification of ligamentum flavum(OLF) of thoracic and thoracolumbar spine. OBJECTIVE: To evaluate the clinical and roentgenographic characteristics and suggest the treatment method of the OLF in the thoracic and thoracolumbar spine. SUMMARY OF LITERATURE REVIEW: The reported OLF mainly developed at the thoracolumbar area. It compressed the spinal cord and resulted to the symptoms of thoracic myelopathy. The methods of treatment were posterior decompression including laminectomy or laminoplasty, and sometimes anterior and posterior decompression, with or without fusion. The OLF was not common disease yet and many surgeons have met a problem in making the decision of the extent of posterior decompression multiple or selective. METHODS: The authors reviewed 14 patients with the OLF using clinical reports and roentgenographic studies. We checked the plain roentgenograms, computed tomograms, and magnetic resonance imagings. We performed the posterior decompression using total laminectomy without fusion. We divided three groups according to the operative methods. Group I included the patients with one or two levels of OLF treated with posterior extensive laminectomy. Group II included the patients with OLF in three or more levels, or combined other cord-compressing diseases. They had been treated with multiple posterior or anterior decompression for the entire cord-compressing levels. Group III included the patients with same conditions as group II but they had been treated with selective decompression for the mainly symptomatic levels of OLF. RESULTS: We found the OLF at 54 segments of 14 patients. The involvement of OLF was 29 segments(53.7%) in thoracolumbar and 25 segments(46.3%) in thoracic area. The most commonly involved segment was T10-11(16.7%) and the second was T11-12(14.8%). Clinically the most common neurologic deficit was motor weakness and sensory deficit. The most symptomatic level of OLF was T10-11 and T12-Ll segment(28.6% at each) and the next was T11-12 segment(21.4%). We got the favorable results in group I and group III. But the final results of group II were not good. CONCLUSION: The OLF was most common at the thoracolumbar area and the symptoms and signs were revealed same as those of the thoracic myelopathy. We obtained favorable clinical results after posterior laminectomy without fusion in cases with the OLF in 1-2 segments. In the cases with multiple OLF in three or more segments, or the cases with other cord-compressing diseases, we could get more favorable results in the patients with the selective decompression than the patients with multiple decompression for the entire cord-compressing diseases.

Dural Tears in the Thoracolumbar Fractures / 대한척추외과학회지

STUDY DESIGN: The authors reviewed the dural tears in the thoracolumbar fractures treated surgically. OBJECTIVES: To evaluate the incidence and the predictive values for the presence of dural tears in the thoracolumbar fractures. SUMMARY OF LITERATURE REVIEW: Many authors reported that the dural tear was usually related to the thoracolumbar fractures especially with laminar fracture and neurologic deficit. The dural tears may lead complications such as the entrapment of spinal nerve root, delayed wound healing, cerebrospinal fluid fistula, and myelomeningocele. Previous reports emphasized posterior approach to confirm and treat the dural tears using laminectomy. So it is very important that surgeons should identify the presence of dural tear preoperatiyely to determine the surgical approach and treatment options. MATERIALS AND METHODS: The authors reviewed 22 patients of thoracolumbar fractures treated with posterior laminectomy, posterior decompression, posterolateral fusion, and instntmentation from August 1993 to August 1996. The follow-up period was minimally 12 months. We checked the canal compromise, the injury of the posterior column including laminar fracture and ligamental injury, and neurologic deficits as the predictive values. The statistical analysis was done to evaluate the relationship between the dural tear and the predictive values. RESULTS: The incidence of dural tear was 54.4% of the thoracolumbar fractures. The canal encroachment, the injury of the posterior column, and the neurologic deficits were not significantly related with the dural tears in statistical analysis. But we could find the tendency that is related to the dural tear and posterior column injury. CONCLUSION: The authors concluded that we could find the possible presence of dural tears in the severe thoracoiumbar which were needed the surgical treatment and we could suggest the injury of posterior column was a possible value that could predict the presence of dural tear.

Correlation between Subluxation of Calcaneocuboid Joint and Residual Forefoot Adduction in Congenital Clubfoot / 대한정형외과학회잡지

Residual adduction of the forefoot is recognized as common sequelae of treated clubfoot. The causes of residual forefoot adduction may be metatarsus varus, talonavicular subluxation and subluxation of the calcaneocuboid joint. But, less attention has been given to subluxation of the calcaneocuboid joint. The purpose of this study was to assess the correlation between subluxation of calcaneocuboid joint and residual forefoot adduction, and to suggest the guideline of treatment for subluxation of the calcaneocuboid joint. A retrospective analysis was done by the medical records and radiographs of 48 clubfeet (thirty-four patients) that had been treated with an operation (thirty-three feet) or conservative methods (fifteen feet) at the Kang-Nam St. Mary's Hospital, between 1990 and 1995. The severity of adduction of the forefoot was determined by the angle of talo-first metatarsal. Subluxation of the calcaneocuboid joint was measured by using a grading system. And then, the forefoot adduction was categorized to mild, moderate, and severe degree according to the talo-first metatarsal angle. The average length of follow-up was eighteen months. Of the 48 feet, seventeen had no subluxation of the calcaneocuboid joint (35.4%), twenty-seven Grade I subluxation (56.3%), and four Grade 3 subluxation (8.3%) on initial radiograph. On the final radiograph, twenty-five feet had a residual adduction of the forefoot. In reviewing the distribution of the residual forefoot adduction according to the initial grade of the calcaneocuboid joint subluxation, Grade 0 subluxation had 6 forefoot adduction (35.3%), Grade I subluxation had 15 forefoot adduction (55.6%), and Grade 3 subluxation had 4 forefoot adduction (100%). Grade II calcaneocuboid joint subluxation had two severe residual forefoot adduction deformities (2 out of 4 cases) and Grade I calcaneocuboid joint subluxation had one severe residual forefoot adduction deformity (1 out of 15 cases). But, there was no severe forefoot adduction deformity in Grade 0 calcaneocuboid joint subluxation. The average angle of talo-first metatarsal was decreased in Grade 0 and Grade I subluxation, whereas it was increased in Grade II subluxation. Conclusively, we believe that there is significant correlation between the severity of subluxation of calcaneocuboid joint and residual forefoot adduction, and that the patients who have a Grade II subluxation of calcaneocuboid joint need operative correction of the subluxation of the calcaneocuboid joint.

Femoral Varus Osteotomy for Legg - Calve - Perthes Disease in Children Who Are Less Than 5 Years Old / 대한정형외과학회잡지

Because clinical course of the Legg-Calve'-Perthes disease (LCPD) is varied and unpredictable, it is important that pediatric orthopedists have to know prognostic factors of LCPD in order to choose proper method of treatment. The most universally accepted prognostic factor is the patient's age at the onset of the disease, and most patient's who are less than 5 years old have been treated non-operatively. However, we believe that the extent of involvement of the femoral head is more important in this age group and that operative treatment can get good results in cases of servere head involvement. The purpose of this study is to evaluate the efficacy of femoral varus osteotomy in patients before the age of 5 years with severe involvement. We reviewed 18 patients (23 hips) who were less than 5 years old with Catterall group III (5 patients, 7 hips) or IV (13 patients, 16 hips) involvement from June 1984 to June 1994. Femoral varus osteotomies were performed in all cases. We followed up more than 2 years (range, from 24 to 130 months) and analysed clinical and radiological results. The results were as follows: 1. The mean duration from onset of the disease to the stage of repair was 16 months (range, from 8 to 27 months). 2. 2 hips (28.6%) in group III and 12 hips (75%) in group IV showed radiographic head at-risk signs. 3. Clinically all hips in group III showed good result. However, among the 16 hips in group IV, 13 hips were rated good and 3 hips were fair. Overall, 20 hips (86.9%) showed good result. 4. Radiologically all hips in group III showed good result, whereas in group IV, 10 hips were rated good and 6 hips were fair. Overall, 17 hips (78.9%) showed good result. We concluded that femoral varus osteotomy in patients less than 5 years old with severe involvement might shorten the course of disease and might be effective method.

Dysplasia Epiphysealis Captitis Femoris (Meyer's Dysplasia) / 대한정형외과학회잡지

Dysplasia epiphysealis captitis femoris is a rare syndrome which after the hip joing in childhood. Pedersen(1960) was the first to differentiate dysplasia epiphysealis capitis femoris(DECF) from Perthes' disease. Scattered reports of this entity have appeared, and in 1964 Meyer defined the syndrome through explanation of its clinical and radiological characteristics. There is a clinical significance that DECF is clinical-radiologic syndrome which resemble Perthes' disease but has important differences, especially in its treatment and prognosis, We experienced two cases of DECF which are misdiagnosed as Perthes' disease. Therefore, pediatricians should keep in mind the possibility of the DECR among the Perthes' disease of younger children.

Osteoid Osteoma in Intra-articular Cancellous Bone: Report of Three Cases / 대한정형외과학회잡지

Osteoid osteoma is a relatively common benign tumor that most commonly affect the cortex of the long bone, Adolescent and young adult males are most frequently affected. It causes aching pain that worsens at night and commonly is relieved by aspirin. The typical radiographic appearance is a lucent nidus with surrounding dense cortical thickening. If the lesion is located in intra-articular cancellous bone, an osteoid osteoma may present with clinical findings that are more indicative of an inflammatory synovitis, and with atypical radiographic findings such as lack of both surrounding sclerosis and a lucent nidus. Therefore intra-articular osteoid osteoma may pose a diagnostic difficulty. Recently, we experienced 3 cases of intra-articular osteoid osteoma(2 humeral haed, 1 femoral head) and present them in detail.