Hematogenous Osteomyelitis Occurred in Adult Long Bones / 대한정형외과학회잡지

The adult long bone is known to be very rarely infected by the hematogenous route because of the different vascular pattern from the children and the clinical pattern of the primary hematogenous pyogenic osteomyelitis occurred in adult long bones is very different from the well known acute osteomyelitis of the children. The authors studied 16 cases of the hematogenous pyogenic osteomyelitis occurred in the adult long bones without previous history of the bone infection and the diagnosis was confirmed by histological and/or bacteriological examinations. The cases were 8 males and 8 females having ages between 19 years to 50 years old. The involved bones were 6 femurs, 5 tibias, 2 humeri and fibulas and a ulna and the involved sites were 10 in shafts and 6 in ends of long hones. All the cases had insidious onset without acute symptoms and the course was rather subacute form. There were three different types based on x-ray findings and operative findings. 5 cases were cortical type having localized cortical thickening in the shaft around one or several small intracortical ahscesses, 7 cases were medullary localized type having well circumscribed bone abscess and 4 cases were medullary diffuse type having extensive irregular destruction with occasional small sequestrum. The problems of these cases were differential diagnosis because there were no typical symptoms or signs of the infection and the x-ray findings were very confusing, but most of the cases healed well hy simple surgery and antibiotics.

Sacral Agenesis: Report of Two Cases in A Family / 대한정형외과학회잡지

Four families having identical sacral agenesis were reported in the literatures and an another family is added here. This family has an eleven year old boy and a seven year old girl who have identical complete sacral agenesis without spincter disturbance but with some anomalies in the other spines, rib and progressive club feet. These cases are followed for six years and the foot deformity was corrected by surgery.

A Clinical Study on Chronic Osteomyelitis of Adult Long Bones / 대한정형외과학회잡지

The chronic osteomyeltis of the adult long bones has different problems from the acute osteomyelitis and osteomyelitis of the children. The ischemic scar tissues and infected bones of the chronic csteomyelitis in the adult are resistant to the antibiotic therapy and their healing mechanisms are delayed. The chronic osteomyelitis has no single effective method of treatment since every case reveals different conditions and the treatment should be individualized case by case. 87 cases of chronic osteomyelitis of the adult long bones were studied in the department of orthcpaedic surgery, Fatima Hospital for 7 years during the years between 1973 to 1979. The cases were 65 male and 22 female having ages 35 years in average and the duration of the osteomyelitis was 14 years and 4 months in average ranging from 3 months to 50 years. The cau ative organisms were mostly staphylococcus but Gram (−) bacilli were found in 28% and the adjacent joint problems were found in 38% The cases were analysed in 5 different groups according to x-ray findings as follows; I. Group with sequestrum: 23 cases having sequestra with varying degree of bone sclerosis and destruction. Most cases had draining sinus but the soft tissue involvement was not severe. II. Sclerotic group: 32 cases having significant bone sclerosis with minimal destructicn if any. The soft tissue involvement and scarring were severe but involvement of the bone marrow was not significant. The duration of osteomyelitis was longest having recurrent episodes of the painful swelling in most cases. III. Destructive group: 17 cases with significant bone destruction with varying degree cf sclerosis. The involvement of the bone marrow was significant and soft tissue involvement was not marked The duration of osteomyelitis was short mostly. IV. Group with skin problem: 9 cases having scar problems overlying tibia. V. Group with complication: There were 2 pathologic fractures of the femurs, 3 quamous cell carcinomas on the lower legs and a severe deformity of a leg. Treatment was mostly surgical including 4 amputations. The surgical method was focused on saucerization of the bone and extensive excision of the infected soft tissues and the scar tissues. 23 cases having small or no dead cavity after mobilization and suture of the adjacent healthy soft tissue closed primarily. Otherwise the cavity was packed open for econdary healing in other 23 cases including several cases having big cavity which was unable to close the skin. The cases having big cavity were prepared for continueus irrigation in 14 caes which were able to closed skin. The transposition of muscles to fill the dead cavity was performed in 4 cases that had big cavity and was unable to close skin. The results were healing in 10 weeks in 54% and after 10 weeks in 38% and 8% failed to heal with the first trials. The recurrence of the ostecmyelitis was found in 9 cases among the 42 cases followed for I year and 3 months in average mostly in group II and in cases of primary closure and open packing.

Effects of Posterior Spine Fusion on Vertebral Growth in Children / 대한정형외과학회잡지

There is debatable opinions as to the nature and clinical significance of the changes that may occur in the spine after posterior spine fusion performed in growing children. Clinical survey is known to be difficult because X-ray films in children are not easy to interpret and measure in the presence of disease and accuracy is uncertain due to magnification on X-ray films. Authors selected 8 cases of tuberculous spondylitis which were managed with posterior spine fusion under the criterias that cases had surgery under 10 years old, no evidence of pseudoarthrosis clinically and roentgenologically on serial examinations at least once 1 year, follow-up more than 2 years since 3 months after surgery, enough spines are included on lateral X-ray films, and accurate measurement and correction of magnification are possible. The cases were surveyed for changes occured in fused spines after posterior spine fusion and the results were as follows: 1. There was actual lengthening of grafted bone mass after solid fusion in all cases although the amounts were minimal. 2. The fused spines grew 46% on an average less than adjacent normal unfused spines. 3. The vertebral bodies of fused spines grew nearly same as the adjacent normal vertebral bodies. 4, The intervertebral disc spaces of the fused spines were narrowed in all cases. 5. The intervertebral angles had tendency to increase and kyphosis angles to decrease.

Compression Arthrodesis of the Knee / 대한정형외과학회잡지

Twelve cases of compression arthrodesis of the knee, which was performed during the period 1973 to 1978, were reviewed. All of the cases had tuberculous arthritis of the knee and included 3 children. Post-operative management was carried out with compression in a long leg cast with crutch walking for an average of 6 weeks and successive cylinder casts without compression and permitting full weight bearing were applied on an average of every 7 weeks. All cases eventually revealed bony fusion and the tuberculosis subsided without signiflcant complications even in the children.

Intravenous Regional Anesthesia with Lidocaine under Double Tourniquet for Surgery in the Upper extremities / 대한정형외과학회잡지

During the past three years, 110 consecutive cases of intravenous lidocaine anesthesia under tourniquet for surgery in the upper extremities were observed. The cases were simple injuries or diseases which needed simple surgery or closed reduction requiring only a short period of time. A tourniquet with double cuff was utilized. After tourniquet inflation, 0.5% or 0.75% lidocaine was injected intravenously in the amount of 1.5 mg per Kg body weight. Satisfactory anesthesia was performed in all except 18 cases who had some discomfort of tourniquet origin and analgesics were necessary. No significant complication was noticed. The technic was very simple, safe and effective for simple procedures on hands or forearms.

Clinical Study of Salmonella Spondylitis / 대한정형외과학회잡지

13 cases of salmonella spondylitis were experienced for 4 years since 1973 and are reviewed with follow-up of 12 months period in average. All cases had febrile disease for 1 to 4 weaks and the symptoms of spondylitis started at febrile stage in 4 cases and at convalescent stage in 9 cases. The pathologic lesions found on x-rays involved 2 to 3 vertebral bodies mostly in middle lumbar spines ranging from thoracolumbar junction to lumbosacral junction. Needle aspirations for the spinal lesions were tried in 9 cases and salmonella typhi group “D” was identified in 5 cases. Needle aspiration was safe, simple, and valuable diagnostic method. Diagnosis of the other cases ware made clinically. It was difficult to differentiate from tuberculous spondylitis or pyogenic spondylitis, but there was some differential points in history, physical findings, laboratory and x-ray findings. All cases responded well to conservative treatments with antibiotics and immobilization and no case indicated surgery.