Prognostic Indices in Surgical Treatments of Legg - Calve - Perthes Disease / 대한정형외과학회잡지

Methods of management of Legg-Calve-Perthes Disease (LCPD) are at present controversial. Some practical prognostic indices were imperative for proper management of the disease. .We followed up on twenty LCPD patients-14 who underwent varization osteotomy of proximal femur and 6 who underwent pelvic innominate osteotomy or shelf procedure-for more than 3 years and analyzed the results using the Stulberg classification. There were three requirements for the hip to be included in this study: follow-up until residual stage occurred, Catterall group III or IV and complete clinical and radiological data. The purpose of this study-was to determine the validity of radiological and clinical factors in predicting prognosis in surgical treatments. Results of the evaluation were as follows; 1.Age was found to be an important prognostic index. Older children aged > 9 years tended to do worse than younger children (P<0.05). Other prognostic indices were not found to be statistically significant. 2. When Stulberg classification IV atients were considered, there were common factors in the children who were more than 9 years old, were of Catterall group IV, and late fragmentation stage disease with more than 1.5 of the lateral subluxation index, regardless of treatment. 3. Although Catterall's classification had been widely accepted, Catterall group III or IV seemed to be difficult to be distinguished. Many cases that had been regarded as Catterall group IV were proved to have intact posteromedial portion of femoral head later in residual stage. 4. Even though well-known prognostic indices were important in anticipating the results, we considered additional unknown biomechanical factors. In some cases continuous deformation of femoral head would not be prevented even though necrotic portion of femoral head was well contained by surgical treatment.

Island Falp in the Hand / 대한정형외과학회잡지

Soft tissue reconstruction of the hand remains a challenge for the hand surgeon, who must choose whether to use a local flap, a distant flap or a free flap. Local flaps, derived from tissue immediately adjacent to the primary defect, are the first choice. But there is a shortage of skin in the hand and there are regions of the hand that should not be used as donor sites since cover of the resultant secondary defect with a skin graft would be inappropriate. We used island flaps for the small soft tissue defects in the hand which were difficult to cover with a conventional skin graft or local flap. The results were as follows; 1. The causes of the soft tissue defects were traumatic amputation in 4 cases, camptodactyly in 4 cases, replantation in 3 cases, infection in 3 cases and tumor in 1 case. 2. The sites of the soft tissue defects were thumb tip in 6 cases, fifth finger PIP joint volar aspect in 3 cases, index tip in 2 cases, thumb volar and dorsal surface in 2 cases, third and fourth MP joint dorsal surface in 1 case, fourth finger PIP joint volar aspect in 1 case and first interdigital web space in 1 case. 3. The donor flaps were fourth finger neurovascular island flap in 8 cases, reverse dorsal matacarpal flap in 5 cases and first dorsal metacarpal artery flap in 4 cases. 4. The sizes of the flap were from 1. 0×1. 5cm to 2.0×4.0cm and and average of 1.5×2.0cm. 5. The flaps were survive completely with a touch sensat,ion except 2 cases which were covered by reverse 5th dorsal metacarpal flap.

A clinical study of tibial condylar fracture / 대한정형외과학회잡지

No abstract available.

Comparative Study of the Clinically Diagnosed Herniated Nucleus Pulposus with the Computed Tomographic and Myelographic Finding / 대한정형외과학회잡지

79 patients with suspected H.N.P. of lumbar vertebrae were studied from June 1983 to June 1986 who had had both metrizamide myelography and computed tomography. Comparative study of the findings from clinical examination, CT and myelography of them are as follows. l. In physical examination, S.L.R.T. was most common sign, 58 patient(73.4% of study group) showed positive in S.L.R.T.(30~70 range). Of these positive patients in S.L.R.T. 41.4% was the patients who were younger than 30 years of age and also had pressure sign of nerve root on CT and myelography. These group showed highest positive rate in S.L.R.T. 2. In CT and myelographic study, the most frequent occurence of H.N.P. were seen in L4–5, L5–S1, L3–4 in order and myelography showed higher positive rate in L4–5 intervertebral space while CT showed higher positive rate in LS–S1. 3. On CT, facet joint arthritis or stenosis were seen in 49.4% of the study group and 53.7% of computed tomographic positive patients of H.N.P. 4. Corresponding rate of positive sign of H.N.P. between CT and myelographic findings were seen 71 intervertebral spaces, which means 84.5% of 84 positive spaces on CT and 88.8% of 80 positive spaces on myelography. 5. In 49 intervertebral spaces clinical sign, CT and myelographic findings were all positive. In another words 58.3% of 84 positive intervertebral spaces on CT and 61.3% of 80 positive spaces on myelography showed all positive sign on clinical examentation, CT and myelography. 6. L5–Sl intervertebral spaces showed most controversial results in comparative study of CT and myelography. 7. 25 of 26 positive spaces on CT(96.2%) and 23 of 26 positive spaces of myelography(88.5%) were confirmed by operation and all 3 false-negative on myelography were found in L5–Sl intervertebral space. 8. Most diagnostic differences were seen in L5–S1, which has wider epidural space. CT showed higher sensitivity than myelography in this study. For its higher sensitivity and non-invasiveness CT is thought to be first recommendable method for diagnosis of H.N.P. and myelography is recommended as second best choice where diagnostic differences are seen.