ABSTRACT
Free vascularized fibula is often used in orthopaedic reconstructive surgery because the fibula is a straight cortical bone, long enough, and has a long vascular pedicle. But morbidity is occurred at the donor site which may cause problems at the ankle in children. We reviewed 10 causes who had free vascularized fibula transfer at the Department of Orthopaedic Surgery, Yonsei University College of Medicine from January 1984 to June 1989. This study is attempted to evaluat the effects of fibular defect on the ankle in children and the results of treatment. Free vascularized fibula transfer was done in 5 cases due to ossifying fibroma, 3 cases due to nonunion of fracture and 2 cases due to congenital pseudoarthrosis. The average valgus deformity was 3 degrees in 2 cases in which distal tibiofibular fixation was done with one screw and 6 degrees in 8 cases in in which distal tibiofibular fixation was not done. Three cases had severe valgus deformity and secondary operation was done. The attended type of operation was distal tibiofibular fusion in 3 cases. The valgus deformity was changed after distal tibiofibular fusion from 4 degrees to 3 degrees in 3 cases. The size of fibular defect did not effect on the degree of valgus deformity of the ankle. In conclusion, fibular defect can cause valgus deformity of the ankle in children and early distal tibiofibular fusion is recommended to prevent valgus deformity of the ankle in growing child who as defect on fibular.
Subject(s)
Child , Humans , Ankle , Congenital Abnormalities , Fibroma, Ossifying , Fibula , Pseudarthrosis , Tissue DonorsABSTRACT
Various methods have been described for surgical treatment of recurrent shoulder dislocation. Arthroscopic techniques for stabilizing the shoulder have the theoretical advantage of reduced complication, decreased discomfort, and improved motion. The arthroscopic Bankart procedure was performed in 23 cases at Department of Orthopaedic Surgery, Yonsei University College of Medicine, from January, 1991 to December, 1993. This study is an attempt to evaluate results of arthroscopic Bankart procedure by Caspari's technique. Results of this study were as follows: l. According to the clinical evaluation of Rowe, results were excellent in 18 cases, good in 2 cases, fair in 1 cases and poor in 2 case. The prognosis was related to the size of Hill-Sachs lesion. 2. Complication after treatment included 5 cases of knot problem, 1 case of subluxation, and 2 cases of redislocation. Redislocation was developed in one patient who played ice hockey at 2 months after operation and in one patient who played soccer at 8 months after operation. Subluxation was developed in one patient who had psychologic problem. Among 5 patients who had knot prob- lem, two patients had a operation of removal. In conclusion, Caspari's suture technique in arthroscopic Bankart procedure needs some modification on the insertion point of the guide pin and suturing technique. And arthroscopic Bankart procedure by Caspari's technique offers good cosmetic results, low perioperative morbidity, low complications except knot irritation, and excellent results by the Rowe's criteria for patients with anterior shoulder instability.
Subject(s)
Humans , Arthroscopy , Hockey , Prognosis , Shoulder , Shoulder Dislocation , Soccer , Suture TechniquesABSTRACT
Ossifying fibroma is a benign tumor which arises typically within the jaw bone and rarely affect the long bone. The usual affected site in the long bone is tibia and fibula. Ossifying fibroma has a moderate tendency to progress during childhood and ceases to progress after puberty. So, surgery should be delayed as long as possible. But if the lesion is wide, which may cause pathologic fracture or severe deformity, it would be necessary to resect the lesion and restore the alignment. We have experienced 10 cases of ossifying fibroma which were treated at Department of Orthopaedic Surgery, Yonsei University College of Medicine, from Jan. 1984 to Nov. 1992. Results were.as follows: l. Among 10 cases, female was 5 cases and male was 5 cases. Age at operation was 9 years 1 month in average ranging from 1 year 7 months to 18 years 6 months. 2. The lesion site was 9 cases in the tibia, 1 case in the fibula. 3. Attended type of treatment was 3 cases of bone biopsy and observation, 1 case of curettage and bone graft, 1 case of curettage, external fixation with Ilizarov apparatus and internal transportation, 1 case of resection with curettage and free vascularized fibular graft, and 4 cases of wide resection and free vascularized fibula graft. 4. Second operation was needed in 2 cases due to recurrence which were performed incomplete wide resection. In conclusion, continuous observation is needed until puberty when the lesion ceases to progress in ossifying fibroma but radical surgery like wide resection and free vascularized fibula transfer is needed if there is a risk of pathologic fracture or severe bowing deformity due to its large size.