Clinical use of Ender Flexible Intramedullary Nail for the Proximal or Distal third Fracture of Tibia / 대한정형외과학회잡지

Authors reviewed 39 cases of proximal or distal fracture which had been managed with Ender flexible intramedullary nails to identify the proper region of tibial fracture for the nail and acceptable indication of retrograde nailing relevant to our clinical experiences. The results were as followings; l. Incidence of malunion with more than 10° of angulation was higher in the fracture of proximal 1/3 tibia than that of distal 1/3. Especially this phenomenon was more significant in case of combination with segmental fracture. 2. As all segmental fractures combined with proximal tibial fracture within 9cm from the plateau were malunited with angulation of 10° or more, another method of internal fixation should be considered. 3. Although degree of angulation was relatively larger in distal tibial fracture within 10cm from the plafond than that beyond 10cm and 2 cases of malunion with angulation of 10° or more were also found within 10cm from tibial plafond, there was no statistically significant difference. 4. Retrograde nailings were performed for 5 cases of proximal 1/3 fractures and 1 case of poor skin condition on the proximal entry. Clinical relevance: Suitable region of tivial fracture managed with Ender-flexible intreamedullary nail was fracture which occurred from 9cm distal to tibial plateau to 10cm proximal to tibial plafond.

Immediate internal fixation in open fractures of the long bones / 대한정형외과학회잡지

No abstract available.

The Clinical Study on Ipsilateral Fracture of the Femur and Tibia / 대한정형외과학회잡지

The "flosting knee" is the term applied to the flail knee joint segment resulting from a fracture of the shaft of adiacent metanhysis of the ipsilateralfemur and tibia. The various methods of treatment of the "floating knee" were adapted by many authors according to degree of the comminution, degree of the soft tissue injury, general condition state of the fracture. Authors experienced the floating knee in 52 cases on 51 patients who were treated at Soon Chun Hyang University Hospital in the period of 4 years and 5 months from January 1985 to June 1989 and among them, 45 cases were treated by operative method and 7 cases by conservative methods at least one of the femur and tibia, The results were as follews;1. Floating Knee occured six times more in male and the peak age was third and fourth decades. 2. The most common cause of fractures was traffie aecident and there was difficulty in diagnosis of ligamentous disruption of the ipsilateral knee. 3. The common fracture site were middle one third and the most common fracture shape was comminuted in both femur and tibia. 4. A good or excellent functional result was aohieved in treated with open reduction and rigid fixation of both fracture and there were no significant difference in group of the internal fixation of both femur and tibia. 5. Intramedullary nailing on the femur and plate fixation on the tibia provided rigid fixation of fracture and the it made possible early joint motion exercise and ambulation and the average healing time of fracuture was much shortened. 6. The most common concomitant injury were soft tissue injury and delayed or nonuion and osteomyelitis were developed more frequently in the plate and screw fixation group of the open fracture.

Traumatic Rupture of the Medial Ligament of the Knee in a 2-Year and 1-Month-Old Boy: Case Report / 대한정형외과학회잡지

Significant traumatic disruption of the ligaments about the knee can occur in a child. Recently several reports have described knee ligament, injuries with open growth plates. And these reports contradict the notion that complete tears of knee ligaments occur only after growth plates have closed. The youngest patient with medial collateral ligament injury reported before was a 4-year-old boy by Joseph and Pogrund in 1978. But authors experienced a case of ruptured medial collateral ligament of the knee in a 2-year and 1-month old boy, who seemed to be youngest with the ligament injury.

Clinical Evaluation of Cementless Total Hip Arthroplasty in Avascular Necrosis of the Femoral Head in Adult / 대한정형외과학회잡지

Recently, Prosthetic replacement of hip was recognized as a reliable technique for the treatment of avascular necrosis of femoral head in adult. There were many reports about post-operative evaluation of functional difference between hemiarthroplasty and total hip arthroplasty and which revealed that the revision rate for the total hip arthroplasty was less compared with the femoral endoprosthesis. Also, controversy was existed between the porous coating system and bone cement fixation. In order to evaluate the functional difference among each prosthetic replacement, authors reviewed the result of 10 cases of cementless unipolar endoprosthesis (abbreviated as UE), 10 cases of cementless bipolar endoprosthesis (abbreviated as BE), and 25 cases of cementless total hip replacement arthroplasy (abbreviated as THRA), performed at Department of Orthopaedic Surgery, Soon Chun Hyang University Hospital, during the period from September, 1985 to August, 1988. The following results were obtained: 1. The incidence was higher in 6th decade in UE, THRA groups, 4th decade in BE group. 2. The average follow up of UE, BE, and THRA groups were 30.7, 15.2, and 16.9 months, respectively. 3. By radiological classification of Marcus et al., the average stages of UE, BE, and THRA were 4.9, 4.0, and 5.3respectively. 4. According to Harris hip rating system, post-op. Harris scores were increased as much as 33.1, 37.2, and 43.4 in UE, BE, and THRA groups respectivelycompared with pre-op. score. 5. In this study, the last follow up results of hip function in BE, and THRA groups were better than that evaluated at 6 months after surgery in most cases. 6. External rotation, which was one of needed motion in cross leg sitting position, was significantly influenced by the degree of excision of joint capsule, the type of replacement prosthesis, the regimen of post-op. starting exercise, and a history of previous surgical treatment. 7. Because serious complications were not developed at recent follow up, the UE, BE, and THRA groups showed insignificant difference in functional difference in prosthetic replacement.

Clinical Results of Segmental spinal instrumentation in Unstable Fracture and Fracture / 대한정형외과학회잡지

Segmental Spinal Instrumentation (S.S.I.) is considered to the effective operative procedure in unstable fracture and fracture-dislocation of the thoracolumbar spine, providing improved correction effect, high rate of fusion and immediate rigid fixation which obviates the need for postoperative immobilization. Retrospective study was carried out of 24 cases of fracture or fracture-dislication of the thoracolumbar spine, There were treated with Harrington rod instrumentation and sublaminar wiring (8 cases) and Luque rod instrumentatiom and sublaminar wiring (16 cases) in Soonchnhyang University, from January 1986 to June 1988. We have analyzed the results of treatment, which were as follows ; 1. Thoracolumbar junction (T12 Ll) was most commomly involved segment (63%) and falling from a height was most common cause of injuries. 2. The most common type by Denis classification was burst fracture (38%). 3. About improvement of neurologic status by injury site and type of instrumentation, thoracolumbar junction (38.5%) and lumbar spine (35%) were better prognosis than thoracic spine (8.75%). 4. In commparison with kyphotic deformity and displacement, Harrington rod (66.4%) was better than Luque rod (58.9%) in postoperative correction. Also in total correction, Harrington rod was better than Luque rod in spite of more or less large amount of loss of correction. words : Thoracolumbar spine, Unstable fracture-dislocation, Segmental spinal instrumentation (S.S.I.)

Traumatic Spondylolisthesis of Cervical Spine Treated by Contoured Loop Fixation and Sublaminar Wiring / 대한정형외과학회잡지

Rigid posterior fixation of the atlas to the third and fourth cervical spine was achieved in a patient in whom axis pedicle fracture and dislocation of axis on the third cervical spine. Althouth there was no evidence of neurologic disorder, marked instability of axis on the third cervical spine should inevitably be fused in any procedures. An anatomically contoured loop was secured to the posterior arch of the atlas and the laminae of the third and the fourth cervical spine by sublaminar wirings. The technique has the advantage over bone graft, either alone or with cement, in that it affords rigid stabilization, allows early mobilization and some flexion movement of atlanto-occipital joint.

Malignant Granular Cell Tumor: Report of One Case / 대한정형외과학회잡지

Granular cell tumor is one of the rare tumorous condition. At present there are estimated 600 reported examples of the tumor in the medical literature. Malignant granular cell tumor is a well established but extremely rare entity that is found in appr- oximately 2 % of all granular cell tumor. Diagnosis should be restricted to neoplasms that are similar in their histological appearance to benign granular cell tumors but can be seperated on the basis of cellular pleomorphism, mitotic activity, and, most importantly, their capacity to produce metastases. The authors had experienced that a 55 years old male patient had two large malignant granular cell tumors at the left thigh and left inguinal area with metastatic lesion.

A Clinical Result of the Fracture of the Forearm Bone Shaft in Adult / 대한정형외과학회잡지

Thirty-seven patient who had forearm bone fracture were treated by four different methods at the Department of Orthopedic Surgery, Soonchunhyang University Hospital from Jan. 1979 to March 1982. The obtained results are as follow; 1. Nineteen cases out of 37 cases of the forearm bone fracture were both forearm bones, 10 cases were ulna and 8 were radius fracture. 2. Twenty-three cases out of 37 were closed and 13 cases were open fracture, respectably. 3. The applied treatment were manual reduction with cast immobilization, intramedullary naliing, plate and screw fixation and combined. 4. Mean duration of primary bone union of the forerm bone fracture which were treated by plate and screw was 12. 4 weeks, combined fixation was 12.8 weeks, intramedullary nailing was 15.3 weeks and that of manual reduction and cast was 16 weeks in order. 5. Functional result was classified according to the rating system of Smith and Sage. The best method was plate and screw and the worst was manual reduction and cast immobilization. 6. D.C.P. fixation seems to be one of the best method in this series. Combined method, in a way of D.C.P. for radius and I–M nailing for ulna, is a method when shortening of operation time is inevitable.