Effect of aging on the production and the action of nitric oxide in articular cartilage / 대한정형외과학회잡지

PURPOSE: We investigate the age-related changes in the production of nitiric oxide (NO) in the articular cartilage and its effects on cell proliferation. MATERIALS AND METHODS: Forty New Zealand white rabbits of four different age groups were used. There were 10 rabbits in each group and the age groups were 1 month, 6 months, 1 year and 3 years of age. We measured the basal and induced production of NO in cultured articular chondrocytes that were obtained from distal femur by using a nitrite assay. We observed the changes in the proliferative activity of the chondrocytes after exogenous NO administration using a nonradioisotopic proliferation assay. In addition, we also detected endothelial nitric oxide synthase (eNOS) in articular cartilage using immunohistochemical staining. RESULTS: The basal and induced levels of NO were lower in the cultured chondrocytes from older rabbits. Exogenous NO administration suppressed the proliferative activity of chondrocytes to a greater degree in the younger rabbits than in the older ones. Immunohistochemistry showed a predominance of eNOS positive chondrocytes in the superficial layer. The number of eNOS positive chondrocytes decreased in older rabbits. CONCLUSION: The production of NO decreased with aging in normal articular cartilage. The suppression of proliferative activity in chondrocytes by exogenous NO declined with aging.

Suture Technique in Treatment of Displaced Proximal Humeral Fractures / 대한정형외과학회잡지

PURPOSE: To find out the advantages and disadvantages of the suture technique and improve the method of operation. MATERIALS AND METHODS: Postoperative follow-up of at least one year was possible in thirteen cases including 7 surgical neck fractures and 6 three-part fractures. The results were analysed radiographically and clinically using a modified UCLA scale. RESULTS: There was one non-union and except for that case, the average union time was 10.2 weeks. Active forward flexion averaged 140 degrees, external rotation 50 degrees and internal rotation between T12 and L1 vertebra. The clinical results were 3 excellent, 5 good and 4 fair. There was no significant corelation (P=0.538) between fracture type and clinical results statistically. But for above 65 years, the UCLA scale averaged 25.8 points and for under 65 years, 31.6 points (P=0.006 ) . CONCLUSION: The use of a suture technique for these displaced fracture without the use of metals achieved a high percentage of acceptable results. But in order to achieve good stability and early exercise, the neck fragment had to be impacted into the humeral head and the medial and lateral part of the neck fracture should be fixed together. Therefore, it is difficult to use this method for severely comminuted neck fractures.

Interaction of cytokines in osteolysis / 대한정형외과연구학회지

PURPOSE: Osteolysis has become a major cause of aseptic loosening in total hip arthroplasty. Macrophages phagocytose wear debris from implants and release the pro-inflammatory mediators such as IL-1beta, IL-6, TNF-alpha and nitric oxide. We evaluated the effects of metal patricles on the release of bone-associated cytokines and nitric oxide from J774 mouse macrophage cell line. MATERIALS AND METHODS: Titanium-Aluminum-Vanadium (Ti6Al4V) and Cobalt-Chrome-Aluminium (CoCr) particles were loaded and nitric oxide production was measured indirectly by the nitrite assay. The effect on cell proliferation, and apoptosis were also investigated with non-isotopic proliferation assay, and ELISA to DNA and histone. The levels of two proinflammatory cytokines, IL-6 and TNF-alpha, were measured with ELISA. The modulatory effect of anti-inflammatory cytokine on the nitrite, IL-6 and TNF-alpha production was additionally investigated. RESULTS: Nitrite levels increased after administration of Ti6Al4V and CoCr particle. IL-10 and IL-4 inhibited the production of nitrite with TiAl4V particle, but not in significant amount with CoCr particles. Cellular proliferative activity decreased and apoptosis increased after administration of Ti6Al4V and CoCr particle. Levels of IL-6 and TNF-a increased with both particles. IL-10 and IL-4 inhibited the production of IL-6 and TNF-alpha in varying degrees. CONCLUSION: Our data confirmed the increased production of pro-inflammatory cytokines and nitric oxide with metal particles and the inhibitory effect of IL-10 and IL-4 on the production of these substances, and suggest differences in the specific action between different metal particles.

Interaction of cytokines in osteolysis / 대한정형외과연구학회지

PURPOSE: Osteolysis has become a major cause of aseptic loosening in total hip arthroplasty. Macrophages phagocytose wear debris from implants and release the pro-inflammatory mediators such as IL-1beta, IL-6, TNF-alpha and nitric oxide. We evaluated the effects of metal patricles on the release of bone-associated cytokines and nitric oxide from J774 mouse macrophage cell line. MATERIALS AND METHODS: Titanium-Aluminum-Vanadium (Ti6Al4V) and Cobalt-Chrome-Aluminium (CoCr) particles were loaded and nitric oxide production was measured indirectly by the nitrite assay. The effect on cell proliferation, and apoptosis were also investigated with non-isotopic proliferation assay, and ELISA to DNA and histone. The levels of two proinflammatory cytokines, IL-6 and TNF-alpha, were measured with ELISA. The modulatory effect of anti-inflammatory cytokine on the nitrite, IL-6 and TNF-alpha production was additionally investigated. RESULTS: Nitrite levels increased after administration of Ti6Al4V and CoCr particle. IL-10 and IL-4 inhibited the production of nitrite with TiAl4V particle, but not in significant amount with CoCr particles. Cellular proliferative activity decreased and apoptosis increased after administration of Ti6Al4V and CoCr particle. Levels of IL-6 and TNF-a increased with both particles. IL-10 and IL-4 inhibited the production of IL-6 and TNF-alpha in varying degrees. CONCLUSION: Our data confirmed the increased production of pro-inflammatory cytokines and nitric oxide with metal particles and the inhibitory effect of IL-10 and IL-4 on the production of these substances, and suggest differences in the specific action between different metal particles.

Cellular Proliferation and Apoptosis during Endochondral Fracture Healing / 대한정형외과학회잡지

PURPOSE: The authors investigated the process of endochondral ossification quantitatively and objectively in respect to proliferation and apoptosis. MATERIALS AND METHODS: Fractures were made on the left tibiae of 72 male Sprague-Dawley rats. The fracture callus was harvested at the 5th, 7th, 9th, 11th, 14th, and the 21st day after fracture. Cellular DNA content was analyzed with image cytometry, and proliferative index was determined from the data. The Ki-67 antigen expression was semiquantitatively measured by the immunohisto-chemical method. TUNEL was used for in situ localization of apoptotic cells. The expression of cell cycle inhibitors, P21 and P27, was investigated with Northern blotting. RESULTS: The proliferation index was highest on the 5th day, then gradually decreased until the 11th day. The expression of Ki-67 antigen gradually decreased with time. Apoptotic cells increased in accordance with enhanced bone formation within chondroid callus. The expression of p21 and p27 was highest on the 11th and the 14th day. CONCLUSIONS: These findings show that proliferative activity decreased with the reduction of mesenchymal tissue and the appearance of mature chondroid tissue. The apoptosis of hypertrophic chondrocytes occurred in accordance with enhanced bone formation. P21 and P27 had a certain role in the differentiation of chondrocytes.

Treatment of Acute Acromioclavicular Dislocation by a Modified Bosworth Method / 대한정형외과학회잡지

PURPOSE: To find out the problem of modified Bosworth method and improve the method of operation. MATERIALS AND METHODS: 21patients treated with modified Bosworth method were evaluated after a minium follow-up period of two years. The results were analysed clinically and reontgenographically. RESULTS: In postoperative X-ray evaluation, the coracoclavicular interval of the operated side was decreased by an average of 0.8 mm compared with that of the normal side. There was no significant difference in coracoclavicular interval between after screw removal and last follow-up. Loosening of the screw was seen in 3 of the 5 cases overcorrected by more than 2 mm and the result was fair in two of them. A satisfactory result was obtained in 17 (81.1%) of the 21 cases. CONCLUSION: Modified Bosworth method for acute complete acromioclavicular dislocation yields better results provided the overcorrection and anterior displacement of the clavicle are appropriately protected.

Repair of Cartilage Defect by Cultured Mesenchymal Stem Cells from Bone Marrow / 대한정형외과연구학회지

We investigated the feasibility of repairing cartilage defect with cultured mesenchymal stem cell from bone marrow. Mesenchyaml stem cells were aspirated from bone marrow of mature rabbits, and cultured in monolayer. Osteochondral defect was artificially made on the patellar groove of distal femur of the same rabbit, and fascia overlying quadriceps was harvested and sutured around the defect, then cultured mesenchymal cells were injected to the defects. Sixteen mature New Zealand white rabbits were used as experimental group and 13 rabbits were used as control. The rabbits were killed at after 14 weeks. Healing of defect was investigated histologically with H-E and toluidine blue staining, biochemically with immunohistochemical staining for Type II collagen, and also at molecular level through RT-PCR for mRNA of type II collagen. Semiquantitative histological scores were significantly higher in experimental group than thoese in control(P<0.05). Immunohistochemical staining showed high signal thor type II collagen on newly formed cartilage in the defect. RT-PCR detected mRNA for type II collagen from mature chondrocytes. Our data suggest that repair of cartilage defect can be enhanced with transplantation of cultured mesenchymal stem cell.

Bosworth Fracture Treated by the Anti: Glide Plate Technique: A Case Report / 대한정형외과학회잡지

Bosworth fracture, fracture-dislocation of ankle with entrapment of fibula behind the tibia, is a rare condition. Diagnosis of this fracture-dislocation may not he easy, and closed reduction of this injury is difficult because of entrapment of fibula by the tieht interosseous membrane. We report a case of Bosworth fracture treated with the anti-glide plate technique.

Intraosseous Ganglion of Femoral Head: A Case Report / 대한정형외과학회잡지

Intraosseous ganglion is an uncommon benign tumor thought to be caused by an intramedullary metaplastic event. We recently experienced a case of intraosseous ganglion that occurred on the femoral head of a 65-year old man who complained of intermittent hip pain. Complete evaluation including bone scan, CT, MRI was done. His pain disappeared after curettage and bone graft was done on the lesion.

Repair of Cartilage Defect by Transplantation of Cultured Chondrocyte in the Rabbit: Difference related to Size of Defect / 대한정형외과연구학회지

Chondrocytes were harvested from knee joints of immature rabbits and cultured as monolayer until confluence, then split, and grown in collgen gel. The cells were transplanted into osteochondral defect of two different sizes (Group I : 16.1mm2, Group II : 7.1mm2) made on the patellar groove of distal femur in 21 mature rabbits. Left legs were used as experimental group and right leg as control. After 7 weeks, 1 out of 5 in experimental side and none out of 5 in the control side showed cartilaginous repair in Group I and 3 out of 8 in experimental side and 2 out of 8 in control side showed cartilaginous repair in Group II. After 14 weeks, 1 out of 4 in experimental side and none out of 4 in control side showed cartilaginous repair in Group I and 2 out of 4 in experimental side and 2 out of 4 in control side showed cartilaginous repair in Group II.

Assessment of Bone Mineral Density by Dual energy X-ray Absorptiometry in Korean Postemenopausal Women / 대한정형외과학회잡지

Osteoporosis represents reduced amount of bone mass per unit volume as compared with controls of the same age and sex. The purpose of this study was to show how bone mineral densities of spine and intertrochanteric area decrease with aging, to investigate the relationship between the bone mineral densities (BMD) of the two areas, and to obtain fracture threshold values. We measured BMD of lumbar vertebrae and intertrochanteric areas by Dual Energy X-ray Absorptiometry (DEXA) from 241 postmenopausal women. 190 normal postmenopausal women comprised non-fracture group and there were 50 fresh thoracolumbar fracture patient and 31 intertrochanteric fracture patients in whom the fractures were not caused by high energy trauma. The mean bone mineral density values of non-fracture group were significantly higher than those of fracture groups and significant correlation held between bone density of spine and that of intertrochanteric area in non-fracture group and fracture groups. The fracture threshold was 0.837 g/cm3 in spine fracture group and 0.792 g/cm3 in the intertrochanteric fracture group.

Prosthetic Replacement for Severe Proximal Humeral Fractures / 대한정형외과학회잡지

The authors have reviewed 11 cases of prosthetic replacement for severe proximal humeral fractures which were treated from March 1989 to December 1993, paying particular attention to the range of motion attained after surgery and the factors which influence the limitation of shoulder motion. The results of this study were as follows: l. Among the 11 cases, 10 cases showed sttisfactory pain relief. 2. Active motion of the shoulder averaged 91° of forward flexion, 72.8° of abduction and 35° of external rotation. 3. The humeral offset averaged 30.9mm in normal shoulder and 18.9mm in affected shoulder. 4. In 6 cases which the humeral offset measured over 20mm, active motion averaged 104° of forward flexion and 83° of abduction and 5 cases showed satisfactory results. 5. In 5 cases which the humeral offset measured under 20mm, active motion averaged 104° of forward flexion and 83 of abduction and 5 cases showed unsatisfactory results. 6. Prosthetic replacements were performed within 1 week after injury in 7 cases and among these 5 cases showed satisfactory results. The range of motion after prosthetic replacement for severe proximal humeral fracture was disappointing. We concluded that limited range of motion is mainly due to reduced humeral offset and restoration of humeral offset by appropriate reattachment of greater tuberosity will allow better clinical result.

A Comparison of using Interlocking IM Nail versus Plate Fixation in Humeral shaft fractures / 대한정형외과학회잡지

The tibial pilon fracture has been described as difficult fracture to manage. We have reviewed 23 cases of tibial pilon fractures from Mar. 1987 to Feb. 1993 at our hospital. 1. The fractures were classified into five types according to the system of Ovadia and Beals and the methods of treatment were divided into two groups; 9 cases were treated with Ilizarov device(Group I). 6 cases out of Group I were type 3, 4 and 5. Other methods were performed in 14 cases(Group II). 8 cases out of Group II were type 3, 4, and 5. 2. In type 3, 4 and 5 fractures, there were 86 per cent good and fair radiographic results in Group I and 63 per cent good and fair results in Group II. 3. Satisfactory results were obtained by the treatment of Ilizarov method especially in type 3, 4 and 5 fractures. The advantages of Ilizarov device were its primary reduction with ligamentotaxis, easy open reduction due to proximal and distal stabilization, minimal soft tissue injury and minimal internal fixation.

Changes of rotator Cuff using Ultrasonography in Frozen Shoulder / 대한정형외과학회잡지

Although several histopathological changes have been developed in frozen shoulder, frozen shoulder is mostly accompanied by the changes of the rotator cuff which has the most important function in movement and has a role in stabilizing the shoulder joint. The changes of the rotator cuff in frozen shoulder have not been reported in Korea yet, but Simon reported that there was an attenuation of the rotator cuff in frozn shoulder. Accordingly, we observed the changes of the rotator cuff in frozen shoulder by ultrasonography, which has no rsdiation exposure and is non-invasive. The authors practiced the shoulder ultrasonography on 36 patients with a pain and limitation of motion in shoulder at the Dept. of Orthopedic Surgery, Hangang Sacred Heart Hospital, Hallym University, from March in 1988 to August in 1988. The results are as follows ;1) Ultrasonography is thought to contribute a great deal in detection of the changes of the rotator cuff, especially of the thickness of the rotstor cuff. 2) Among 36 patients, the thickness of the rotator cuff of 35 patients was 6.494+1.008 mm (M+SD) in the affected shoulder and 6.475+1.052 mm(M+SD) in the unaffected shoulder. In only one pstient, the thickness of the rotator cuff was 1.68+0.58 mm(M+SD) in the affected shoulder and 553+1.16mm(M+SD) in the unaffected shoulder. Theres no significant change in the thickness of the rotator cuff measured by ultrasonography in frozen shoulder. 3) Ultrasonography is an excellent diagnostic method in detecting the rupture of the rotator cuff in frozen shoulder.