The Effect of Femoral Lengthening on Mechanoreceptors of Anterior Cruciate Ligament in the Rabbit / 대한정형외과학회잡지

PURPOSE: This study aimed to observe the effect of femoral lengthening on proprioceptive nerve endings of the anterior cruciate ligament in rabbits and to evaluate the relationship between changes in the number of mechanoreceptors and electrophysiologic abnormalities, and histomorphological changes in the ligament, according to the length gain. MATERIAL AND METHODS: Forty rabbits were divided into two groups, such as 10% and 20% lengthening. Each ipsilateral femur was distracted by gradual method and the contralateral side was used for the sham group. Distraction at a rate of 1 mm per day was started on the 5th day postoperatively. The frequency of distraction was 2 steps per day. At the end of the experiment, nerve conduction studies including amplitude, latency and area of compound muscle action potential (CMAP) were measured. Modified gold-chloride stain was used for detection of proprioceptive nerve endings of the anterior cruciate ligament and hematoxylin-eosin stain was used for light microscopic examinations of the anterior cruciate ligament. Among 40 animals, 7 were excluded in our study due to experimental faults which were 3 inadequate osteotomy, 2 premature consolidation and 2 sepsis. Three types of mechanoreceptors were identified by Freeman and Wyke criteria. RESULT: There was a statistically significant reduced number of three morphological kinds of corpuscles in anterior cruciate ligaments in the 20% lengthening group than in the sham group (p<0.03) . Morphological changes of synovium on the anterior cruciate ligaments were more evident in the lengthened groups rather than in the ligament itself. However, there was little relationship between abnormalities of nerve conduction velocity and the change in number of proprioceptive nerve endings. CONCLUSION: This study provided morphological evidence of the harmful effects on proprioceptive function of adjacent joints due to lengthening, and that femoral lengthening may alter the neurophysiological function of the knee joint by decreasing the number of mechanoreceptors in the anterior cruciate ligament. As well, this morphological change by limb lengthening did not seem to be related to distraction neuropathy.

Antibiotic cement-coated Unreamed nailing for Treatment of Infected Nonunion of Long bone / 대한정형외과학회잡지

PURPOSE: Our study was aim to evaluate the results of treatment by antibiotic cement-coated unreamed nailing for infected nonunion of long bone shaft. MATERIALS AND METHODS: Ten cases of nonunion, 6 femurs and 4 tibias were included in this study. Average age of patients was 38.5 and men were eight. Average follow-up period was 16.4 months (12-35) . Etiologies of infection were open fractures (6 cases) and iatrogenic (4 cases) . Eight cases which had positive antimicrobial sensitivity test preoperatively were used a sensitive, heatstable, and powderform antibiotics. Primary autogenous bone grafting with nailing was perfomed in five cases. Delayed bone grafting after curettage and nailing was done in another five cases in infected by S. aures organism. RESULTS: All of ten cases had bony union. Union time was average 31.5 in femur and 26.4 in tibia. Early weight bearing ambulation and motion of adjacent joint were beneficial. But average 8 mm of shortening was developed and angulation more than 5 degrees occured in one case. CONCLUSION: Antibiotic cement coated-unreamed intramedullay nailing is the recommended treatment of method in infected nonunion of long bone shaft with minimal shortening.

Fixation of Infected Nonunion of Femur by a Kuntscher Nail Stuffed with Antibiotic Laden Bone Cement: A Case Report / 대한정형외과학회잡지

A case of established infected nonunion of femur after open reduction and internal fixation of proximal femoral fracture with plate and screws in a 20-year-old man has been satisfactorily treated with a conventional Kiintscher nail filled with antibiotic laden bone cement in its hollow cavity. Though the removal of plate and screws, wound debridement, insertion of antibiotic laden bone cement bead at the nonunion site with temporary external skeletal fixation and skeletal traction preceded, a rigid fixation by the nail and vancomycin elution from the cement are believed to have contributed for bony union without troublesome complication of infection in this case.

Symptomatic Os Subfibulare: Two Cases Reports / 대한정형외과학회잡지

Os subfibulare is a accessory bone arround the lateral maleolus, but it is different from many other accessory bones in foot and ankle in its development related to trauma and frequent symptoms of ankle instability. Accessory bone is a developmental anomaly which fails to unite to main secondary ossification center and usually asymptomatic. But os subfibulare is developed by recurrent ankle sprains in younger age or non-union of avulsion fracture of anterior talofibular ligament and causes instability of ankle. We experienced two cases of symptomatic os subfibulare in adolecents and report them with review of literatures.

Lipoma Arborescens in the Knee Joint: A Case Report

Lipoma arborescens is a rare intra articular lesion consisting of a villous lipomatous proliferation of the synovial lining and occurs mainly in the knee joint. It is mostly found in older patients with joint trauma, meniscal lesions or chronic synovitis. The authors describe one case of a 29-year-old male with multiple lipomas in the right knee joint who has a history of joint trauma. He had joint effusion, pain, giving way and restricted terminal extension of the right knee. Histology and gross findings are consistent with the lipoma arborescens. After arthroscopic excision of the masses, symptom was relieved completely and the patient had gained full range of motion of the right knee joint.

Symtomatic Discoid Medial Meniscus: Five Cases Report

Discoid medial meniscus was first reported in l930 by Watson-Jones. Discoid medial menisci are very rarely reported although the presence of discoid lateral menisci are not uncommon. From Jan. 1989 to Dec. 1994, we have experienced five cases who had discoid medial menisci with pain due to substance tear following knee injury in arthroscopy. There were three complete type anct two incomplete type. Out of flve cases, longitudinal tea1 and bucket-handle type tear were two, respectively. The remained one was a compound tear.

Effect of Diabetes Mellitus and Recombinant Bovine Basic-Fibroblast Growth Factor on Healing of Sciatic Nerve Defect in Rat / 대한정형외과학회잡지

The purpose of this study was to assess the impact of diabetes mellitus and fibroblast growth factor(FGF) on healing process of nerve defect in rat. Sixty-three adult female Wistar rats weighing between 200 and 250g were divided into a control group(32) and a diabetic group(31). To make diabetic rats, Streptozotocin(50mg/kg) was injected into tail vein after dissolution in saline solution. Each group was further divided into two subgroups respectively, FGF and non-FGF, according to the filling material of the silicone tube. A 5mm segmental defect was made at right sciatic nerve. Both proximal and distal nerve ends were connected with 9mm long silicone tube with internal diameter of 1.57mm. The defect was filled with 10ul FGF(recombinant bovine basic-fibroblast growth factor: final concentration 400ng/ml)-collagen solution(FGF group) or 10ul collagen(Vitrogen 100: final concentration 2.4mg/ml) solution(non-FGF group). After 2 and 4 weeks, electromyographic studies including the latency and the amplitude of action potentials in soleus muscle of the operated limb were checked. After the sacrifice, the regenerated nerves were examined histologically after toluidine blue staining. Cross-sectional area, the number of myelinated axons, non-neuronal cells and vessels were recorded at mid-chamber cross section. Statistical analysis was carried out with the results. From these results, it would be suggested that diabetes mellitus retarded the healing process of sciatic nerve defect in rat, however FGF prompted and accelerated the healing process both in control and diabetic groups so as to overcome the adverse effect of diabetes mellitus.

Surgical Treatment of the Acute Anterior Cruciate Ligament Injuries / 대한정형외과학회잡지

The anterior cruciate ligament(ACL) is one of the major stabilizers of knee motion. The ACL does not heal once torn, unlike many other biological tissues. Its absence can lead to severe joint instability which can lead to disruptions of secondary restraints around the knee and then progress to degenerative joint disease. Thus many authors advocate surgical intervention for a torn ACL in order to restore stability to the joint. Yet, there is still controversy as to best treatment for the ACL injuries. It is desirable to be considered for the patients age, the severity of the injury, and the future activity level of the patient to decide treatment. We analyzed thirty ACL acute injuries of twenty seven patients who had an ACL injury and treated surgically between Apr. 1986 and Dec. 1991 at St. Pauls Hospital. The results were as follows: 1. There were twenty five males and two females. The mean age was 33.4 years ranged, 15 to 52 years. 2. The anterior cruciate ligaments were torn at proximal portion in twenty two cases, at midportion and distal portion in four, respectively. 3. Two knees had isolated ACL injuries and twenty eight had combined injuries. 4. Twenty one out of twenty six cases treated with primary repair, and three out of four cases treated with reconstruction had good-excellent results.

Treatment for posterior cruciate ligament injury / 대한정형외과학회잡지

No abstract available.

The treatment of neglected patellar fracture: report of 2 cases / 대한정형외과학회잡지

No abstract available.

Panclavicular Dislocation: A Case Report / 대한정형외과학회잡지

Dislocation of both ends of a clavicle in a 49-yesr-old man during an auto-accident is presented. The medial end of the right clavicle was severely displaced antero-inferiorly while the 1ateral end displaced posteriorly. And the clavicle was rotated along its long axis. Sever al attempts of manual and a surgical reduction through separate incision on both ends of the clavicle failed to have anatomical reduction. It was presumed that the cause of failure in reduction were delayed reduction due to combined chest injury, blockade by first rib that was broken and was anteriorly displaced as well as the complexity of the dislocation. It is speculsted that anatomic reduction in this rare injury require wider surgical exposure. Though authors failed to have anatomic reduction in present case, stabilization of the medial end of the clavicle with a strip of fascia lata after medial clavicular resection and ligament repair at the lateral end resulted in satisfactory regain of shoulder motion and cosmetic improvement.

The Fate of Demineralized Human Osteosarcoma in Rat's Muscle Pouch / 대한정형외과학회잡지

Demineralized homogenous bone matrix is reported to have no antigenic activity and its osteoinductive prcoess is faster than that of undemineralized homogenous bone. The present authors studied on the osteoinduction of demineralized human osteosarcoma in rat's muscle pouch. The results showed that demineralized human osteosarcoma tissue can induce new bone though there were inflammatory signs and giant. cell reaction. The osteoinductive process seemed to be delayed compared to that of demineralized homogenous bone matrix. The authors believed that further immunological investigations are needed to clarify the cause of these tissue response.

Subungal Exostosis / 대한정형외과학회잡지

Four cases of subungal exostosis are presented. All of them were young male and big toe was involved in 2 cases. Histological features of subungal exostosis was characteristic; the cancellous bony stalk was capped mainly fibrocartilage, although scattered areas of hyaline cartilage were also found where enchondal ossification occured. Superficial to this cartilaginous cap, there was fibrous tisse covering. When terminal phalax of a toe shows deformity of nail and skin changes due to hard mass, radiological examination is required for the proper diagnosis and treatment. Complete local excision is required but damage to the nail bed during excision should be avoided.

Comparison Study Between Rush Nailing and Ender Nailing in the Treatment of Fracture of the Tibial Shft / 대한정형외과학회잡지

Fracture of the tibial shaft is one of the most common fracture of the long bones and, due to its frequency and easy accessibility to traumatic insults, it is frequently complicated with malunion, delayed union and nonunion, and osteomyelitis. Recently, closed flexible intramedullary nailing of the fracture of the long bones has gained popularity. And its application to the tibial shaft fracture is reported to meet the object of fracture treatment by providing maintenance of reduction and by allowing early mobilization of the injured leg. There are other advantages such as stimulation of forming external callus by allowing some motion at fracture site, adequate fixation without exposure of the fracture site. Authors carried out retrospective study of the 56 tibial shaft fractures in 54 patients which were fixed with Rush nails (31 tibial fracture in 30 patients) or Ender nails (25 tibial fractures in 24patients). The results were analyzed to compare the effectiveness of these two methods. The results were as follows: 1. Tibial fracture treated with rush nailing united clinically at 15.7 weeks and united radiologically at 21.8 week on an average postoperatively. 2. There was a tendency of earlier healing of fracture of tibial shaft treated with Ender nailing:clinical union and radiological union were obtained at 12.8 weeks and 18.8 weeks on an average, respectively. 3. Ender nailing has advantage such fracture fragment during insertion. 4. Additional insertion of Ender nail as ease of nailing, low incidence of displacement of undisplaced provided greater stability at the fracture and it was attributable to earlier healing of tibial fracture treated with Ender nailing. 5. Rush and Ender nailings failed to maintain reduction of the fracture of proximal tibia shaft. As the advantages of Ender nailing surpass those of Rush nailing, authors have preference of Ender nailing in the treatment of the tibial shaft fracture.

Gold Sodium Thiomalate Therapy on Rheumatoid Arthritis: Clinical Experience / 대한정형외과학회잡지

Seventeen patients with classical rheumatoid arthritis have been treated with gold sodium thiomalate(G.S.T) injection and followed up for 1.7 years on average. The results obtained are as follows: 1. Clinical improvement was obtained in 12(70.3%) out of 17 cases, but only in 5 cases(29.3%) marked and persisting improvement was obtained. Such improvement was first noticed when the total dose of the gold sodium thiomalate reached 500mg or more, and also noticed about 10 weeks after initiation of G.S.T therapy. 2. Changes in laboratory parameters such as hemoglobin, hematocrit, eosinophilia, titers of rheumatoid factor and C-reactive protein, and proteinuria began to appear at the time of the clinical improvement. 3. Adverse reaction consisted mostly of mucocutaneous lesions. The main causes of drop-out during therapy also are severe skin rashes and pruritus. Most of the adverse reactions appeared when the total dose of G.S.T. administered reached over 500mg. In two severe cases skin rashes terminated the gold therapy. Our findings suggest, because of high incidence of adverse reaction during G.S.T therapy, repeated careful clinical and laboratory examination of the patient are mandatory especially when the total dose of G.S.T is reached 500mg. In spite of the well documented reports of the maintenance gold therapy for rheumatoid arthritis it is felt that the maintenance gold therapy should be studied further before it can be safely used as a routine in daily rheumatology practice because of its toxicity.

Subtrochanteric Fracture Treated with Bent Self / 대한정형외과학회잡지

Subtrochanteric fracture is well known for its difficulty in management, though various devices of rigid fixation have been developed. Each internal fixation device requires a lot of surgical instruments and the surgeon must be skillful in using them. Osteo self-compression plate which was preoperatively bent to fit the contour of the lateral surface of the subtrochanteric region was proved to be technically easy to fix these fractures without causing major complication. Present authors recommend to use this prebent Osteo self-compression device to treat this fracture when the surgical instruments are not fully equipped, and suitable fixation devices are not available, and/or the surgeon has no experience in handling the newly developed surgical instruments for the subtrochanteric fracture.

Sequela of Untreated Avulsion Fracutre of Ischial Tuberosity: Report of Two Cases / 대한정형외과학회잡지

Avulsion fracture of ischial tuberosity which usually occurs in a young athelete is often undiagnosed early, and therefore is treated after a considerable time elapsed. And it causes a lot of discomfort to the athelete because of subsequent tumorous enlargement of tuberosity with fibrous union, and hamstring dysfunction as a late sequela. Two cases of this sort that required excision of the ununited enlarged fragment are presented. The present authors feel that widely displaced avulsion fracture of ischial tuberosity should be treated operatively and that even minimally displaced one also has to be protected from another injury.