Relationship between Traumatic Spinal Canal Stenosis and Neurologic Deficits in Thoracolumbar Burst Fractures / 대한정형외과학회잡지

In the assessment of thoracolumbar burst fractures, computed tomography(CT) is superior to other imaging modalities, especially when a more definitive assessment of the posterior elements of the spine or the nueral canal is desired. A few authors have reported the relationship between traumatic spinal canal stenosis and neurologic deficits. Authors analysed 64 patients with thoracolumbar burst fractures about the relationship between traumatic spinal canal stenosis and neurologic deficits using plane x-ray findings and CT scans. The results were as follows; 1. There was no difference of kyphotic angle and anterior vertebral height loss between neurologic deficit group on lateral plane x-ray findings. 2. The incidence of injury of the superior endplate was 100%(64/64); of the inferior endplate 53%(36/64); of the posterior element 45.3%(29/64). 3. Twenty(69.0%) of 29 patients with disruption of posterior element had neurologic deficits, while fourteen(40.0%) of 35 patients without disruption had neurologic deficits. 4. Spinal canal ratio of 35.3% or more at the epiconus level, 56.0% or more at the conus medullaris level, and 65.3% or more at the cauda equine level were significant factors for neurologic deficits in thoracolumbar burst fractures. Spinal canal ratio of 22.0% or less at the epiconus level, 34.5% or less at the conus medullaris level, and 43.1% or less at the cauda equine level were not accompanied with neurologic dieficit in thoracolumbar burst fractures. 5. Fifteen(68%) of 22 patients with neurologic deficit in epiconus and conus medullarsis level had the horsehoe or crescent shape of patient spinal canal, eight (66.7%) of 12 patients with neurologic deficit in cauda equine level had the horsehoe or crescent shape of spinal canal.

Treatment of Bone Defect with Ilizarov Apparatus in the Tibia / 대한정형외과학회잡지

Bone defect of the long bone continues to challenge orthopedic surgeons. It is usually very difficult to obtain union. Ilizarov ext. fixation has recently gained popularity as a multifactorial approach to the management of tibial bone defect because nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. From February 1992 to May 1993 at the department of orthopedic surgery, Inje University Pusan Paik Hospital, 9 patients aged from 8 to 37 years were treated for tibial bone defect. The causes were open comminuted fractures with initial bone loss and bone defect after removal of infected necrotic bone. Bony defect size was ranged from 2cm to 14cm, averaging 7.2cm. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length discrepancy was achieved by means of external lengthening technique. Soft tissue defects were treated with secondary closure, split thickness skin graft, and muscle flap. The average healing index was 42.8 days/cm. According to Paley's classification the complications were developed as follows; The problem included pin tract infection(9), knee flexion contracture(4), and intractable pain(1), the obstacles included delayed union(3) and premature consolidation(1), the complication included nonunion(9) and equinus ankle(1). At an average 1 years follow up, according to Paley and Catagnl's classification, body and functional results were either excellent or good in 7 cases. So, we recommend that Ilizarov technique is very useful treatment for open fracture with bone loss, bone defect after removal of infected necrotic bone and limb shortening.

Treatment of the Humerus shaft Fracture with Closed Interlocking medullary Nail / 대한정형외과학회잡지

The interlocking nail is used as a valuable method in treating humerus shaft fracture because of the merit, including relatively simple procedure, one of the most stable fixation methods, and allowing early ROM excericise and low complication. Fourteen pateints with humerus shaft fractures were treated using interlocking nail at the Department of Orthopaedic Surgery Paik Hospital from Jan.1993 to Oct.1994. l. Among the 14 pateints, average age was 34.8 years and 9 cases were male and the most common cause of injury was traffic accident. 2. Associated injury including 3 cases of ipsilateral scapular fracture, I case of ipsilateral clavicle fracture, and 1 case of brachial plexus injury, and 1 case of radial nerve injury. 3. The mean duration of the radiologic bone union was 8.6 weeks. 4. There was no serious post operative complication such as non-union, infection, bending or rotational deformity at fracture site, impingement syndrome, metal failure of the nail or interlocking screws. 5. To prevent the impingement syndrom and rotator cuff injury, we countersinked the proximal end of the nail into the humeral head and minimized skin incision.

The Relatuonship betweeh Clinical Carrying Angle and Baumann's Angle in Treatment of Supracondylar Fracture of the Huerus / 대한정형외과학회잡지

Supracondylar fracfture of the humerus is the most common fracture about the elbow joint in children. Early accurate reduction is very important to obtain good results. The authors reviewed 44 cases of supracondylar fractures treated at Inje Universsity Pusan Paik Hospital from January 1986 to December 1990. Average follow-up time was 1 year 6 months. The results were as follows; 1. Thirty cases were treated with closed reduction and percutaneous pinning, ten with manipulation and cast immobilization, three with skeletal traction and the rest one with open reduction and internal fixation. 2. If there was a difference of the angle within 10-degree in post-reduction X-ray, deformity did not follow at the last follow-up. 3. The common formula was that a change of 5-degree in Baumann's angle corresponded to a 2- degree change in the clinical carrying angle. 4. Baumann's angle did not change between that of initially accepted and that of the final follow up X-ray. So, the authors recommend post-reduction measurements of the Baumann's angle as the adequancy of reduction of supracondylar fractures in children.

A Clinical Study of Anterior Interbody Fusion for Low Back Pain: Using an Effective Device , Reduction Spreader / 대한정형외과학회잡지

There are many experiences and principles about posterior approach in the spine as surgical procedure in the treatment of the patients with low back pain. And the anterior approach to the disc with its excision and bone graft, less known to others, has become a relatively safe procedure with the increasing experience. The greatest advantage of anterior lumbar interbody fusion is that the reduction of lumbar vertebral slipping is possible, the distance between the involved bodies is well maintained and the rate of fusion increases by spreading the vertebral bodies and putting into the measured bone bloc especially in the patients with severe segmental instability or spondylolisthesis. We analysed 48 patients having anterior interbody fusion by using a specially designed reduction-spreader during eight years, from January 1.978 to December 1985. The results were as follows: 1. Among 48 cases, 20 cases were male and 28 cases were female; 12 cases were in the fourth decade and 19 cases were in the fifth decade-most common in the fifth decade. 2. 28 cases were at the level of L4–L5, 16 cases were L5–S1, and 4 cases were two levels(L3–L4 L4–L5 and L4–L5 LS–Sl). 3. Retroperitoneal approach was used for the L3–L4 and L4–L5, and transperitoneal approach was used for the L5–S1. 4. After distraction between the involved vertebral bodies using an effective device, reduction-sprea-der, a pair of full thickness iliac bone grafts were impacted into the interspace, maintaining the reduction after removal of the reduction-spreader. 5. Fusion was achieved between 3 months and 6 months in 46 cases except 2 cases. 6. Overall clinical results were as follows: good in 42 cases, fair in 6 cases. 7. The anterior interbody fusion using the reduction-spreader is found to be useful method in the treatment of low back pain with spinal instability diagnosed by lumbar flexion-extension lateral roentgenograms.

Radiographic Measurement of Normal Adult Cervical Spinal Region in the Korean Population / 대한정형외과학회잡지

Radiographic measurement of cervical spine is very important in cervical spine injury especially those without fracture. Authors measured the retropharyngeal space, retrotracheal space, lordortic curve and sagittal diameter of cervical spinal canal in 148 cases of normal adult male. The results are as follows: 1 . In normal Korean adult male maximum retropharyngeal space is 7mm in C, level and Smm in Cs level. Maximum retrotracheal space is 16mm in C, level. 3. Loss of normal lordotic curve is shown in 21 cases(14.2%), 4. Average sagittal diameter of C, level is 21.27mm-it's the largest of all the cervical spinal cana1s, and that of C, level is 16.15mm-it's the smallest.