Surgical Treatment of the Distal Radius Fracture / 대한정형외과학회잡지

Fractures of the distal radius are one of the most common injuries met in the orthopedic field. Once it was thought that good function comes despite of poor anatomic restoration in the distal radius fractures. But now there are wide consensus that more aggressive surgical treatments are needed in such complex fractures to fulfill the better clinical results. We reviewed 56 consecutive distal radius fractures of 54 patients treated surgically in Orthopedic Department of Asan Medical Center between October 1989 and July 1994. The mean length of follow-up was 29.2 months. Clinical end results were statistically analyzed according to each anatomi- cal variables and state of distal ulna, and anatomies and results were analyzed according to different surgical modalities in each fracture classes. Radial length and radial inclination was significantly correlated with clinical results. The clinical results were significantly worse when dorsal tilt exceeded 10. In intraarticular type of fractures, residual articular incongruency seems to be the significantly affecting factor of development of arthritis and the clinical result. The associated fracture of distal end of the ulna did not significantly affect the result. In same type of fracture class, achievement and loss of reduction, arthritis, and Demerit score show no significant differences between groups of different surgical modalities. Probably this is due to proper choice of modalities in each different situations.

Reconstruction of the Tissue Defects in Extremity by Microvascular Surgery: Analysis of 138 cases / 대한정형외과학회잡지

From 1981 to 1993, one hundred and thirty eight patients had been treated by free flap or island flap, for the tissue defects of the extremities. Among these 138 patients, vascularized bone graft was 29 cases, soft tissue free flap 40, replantation 22, local island flap 45, and lymphovenous shunt 2. Average age at the time of operation was 27 years(1-66 years), and men were 110, women 28. Average duration of follow-up was 2 years and 8 months(4 months-11 years and 8 months). Twenty nine cases of vascularized bone graft was consisted of fibular graft in 15 patients, ilium 8, joint transplantation 4, thumb reconstruction using big toe 1, and rib 1. Four of them were failed. Among 40 patients of soft tissue free flap, latissimus dorsi flap was 12 cases, dorsalis pedis flap 11, scapular flap 8, wraparound procedure 7 and gracilis flap 2. Seven of them were failed. The levels of replantations were both lower extremities in one patient, leg 1, arm 2, distal forearm 2, and finger(s) 16. In six patients, replantation was nor successful. Among 45 patients of local island flap, lateral supramalleolar island flap was performed in 8 patients, dorsalis pedis flap 2, Chinese flap 10, reverse ulnar artery flap 4, reverse posterior interosseous artery flap 3, neurovascular island flaps for fingers 14, and others 4. Two of them were failed. Two cases of lymphovenous shunt for the treatment of lymphedema were successful. As a whole, 119 cases were successful(86%) among 138 cases including local island flap 45 cases.

Hyperextension Overload Syndrome of the Elbow in Baseball Pichers / 대한정형외과학회잡지

Some baseball pichers have the symptom-complex of the elbow joint due to repetitive throwing. The Hyperextension overload syndrome is symptom-complex caused by impingement between olecranon tip and fossa during hyperextension of the elbow. The patients of hyperextension overload syndrome is have some pathology of his elbow such as bony spur on olecranon tip, intra-articular loose body or degenerative arthritis. And they complaint of pain or limitation of extension. The authors diagnosed and treated five cases of hyperextension overload syndrome. All of them had flexion contracture. Three cases of them had cubitus valgus. But no had medial instability of the elbow. Three cases of them had tenderness on the olecranon tip. Four patients treated by excision of osteophyte or loose body with arthroscopic or open operative technique.

Periosteal chondroma arising in the Phalangeal Bone: Report of Three Cases / 대한정형외과학회잡지

Periosteal chondroma is a slowly growing cartilage tumor of limited size, which develops within and beneath the periosteal connective tissue and characteristically erodes and induces sclerosis of the contiguous cortical bone. The typical morphology of this tumor consists of an area of outer cortex scalloping involving the metaphyseal lesion of a long bone with slightly overhanging edges and a small amount of cartilage calcified matrix adjacent to the scalloping. Histologically this benign tumor can mimic chondrosarcoma. Awareness of this fact is important in order to avoid overdiagnosis and resultant overtreatment of the benign lesion. We report three cases of periosteal chondromas arising in the phalangeal bones of the hand. All were treated by curettage. No local recurrence was seen following this treatment.

Wrist Tuberculosis / 대한정형외과학회잡지

Twenty nine cases of wrist tuberculosis were reviewed(19 joint involvement cases and 4 tendon involvement cases) and twenty three cases were followed up more than one and half years. The mean follow up period was 26.7 months. Synovectomies were not satisfactory in cases of joint involvement and they were useful only in cases of tendon involvement. Arthrodesises were used for 16 cases of joint involvement and were satisfactory in 87,5 percent by Robin's criteria. Finger stiffness was most serious complication(initially, 8.7 percent and finally, 34.8 percent) and it is suggested that early motion of fingers after arthrodesis can prevent this complication.