Kneeedylad augmentation of posterior cruciate ligament reconstruction

No abstract available.

Arthroscopic finding of synovial plica within Korean knees / 대한정형외과학회잡지

No abstract available.

The role of the hamstrings as antagonists of quaadriceps inmaintaining knee joint stability / 대한정형외과학회잡지

No abstract available.

The Assessment of Bone Mineral Density in Postmenopausal and Senile Osteoporosis Using Quantitative Computed Tomography / 대한정형외과학회잡지

Osteoporosis is a skeletal condition that is characterized by reduction in bone volume and an increased vulnerability to fracture, practically of the proximal femur and vertebrae. Unfortunately, osteoporosis does not usually become obvious until a patient presents with a fracture. For this reason, it has been referred to as the silent epidemic. While radiological examination remains the mainstay of diagnosis, there are certain disadvantages associated with this technique. Almost one third of the skeletal mass must be lost before osteoporosis becomes apparent on a plain radiograph and radiological artifacts are not uncommon. Many methods have been developed for quantitative assessment. of the skeleton. So osteoporosis can be detected early and its progression and response to therapy can be carefully monitored. Recently, quantitative computed tomography(QCT) has been investigated as a means for non-invasive quantitative determination of bone mineral density of the spine. Highly signifcant correlation have been found between vertebral trabecular mineral amount and quantity determined by QCT. Furthermore vertebral strength and failure load have been found to correlate well with trabecular density determined by QCT. Authors has analysed bone mineral density(BMD) of 213 patients who visited Severance Hospital, Yonsei University College of Medicine from Jan. 1988 to Sept. 1989. The aims of this study is to compare BMD of osteoporosis group with that of mormal group, to investigate correlation between BMD and age distribution, and to estimate fracture threshold in osteoporosis group. Following results were obtained:l. After 20 years of age, men lose an average of 0.83 per cent of bone per year, and women lose an average of 0.96 per cent per year. Such lost in women seems to be accelerated during and after menopause. 2. The bone mineral densities for the osteoporosis group are lower than those for the normal group by 28.4% for male and 29.7% for female. There was little difference between sex. 3. It is suggested that 90mg/cm3 of BMD is the fracture threshold for the osteoporosis group. 4. The compression fracture rate among post-menopausal women is 38.8%.

The Limited Experiences in the Management of the Difficult Fractures of Tibia Using the Ilizarov External Fixator / 대한정형외과학회잡지

Since 1952, Ilizarov external fixator has been developed and used for more than 30 years in Russia and world-wide interest on it has been prevalent during last 2-3 years. The fixation of the tension applied thin wires to the metal frame resist flexional and translational deformity just like other extenal fixators. But, it allows cyclic axial micro-motion at the fracture site without loss of reduction so that it can provide good environment for the fracture healing biologically and biomechanically. Another advantage of Ilizarov external fixator is that it permits mobilization of the adjacent joints and weight bearing of the fractured limb during the application of it and shortens the duration of administration. Since 1988, We applied the Ilizarov external fixator for the treatment of diffcult tibial fractures (open comminuted, segmented and comminuted fractures, nonunion, maunion) and obtained good results in 7 cases. So we report our results even if we had limited cases and experiences.

A Study of Plain X / 대한정형외과학회잡지

Treatment modalities for herniated lumbar intervertebral disc are the conservative method, chemonucleolysis, percutaneous diskectomy and operation. Conservative treatment is effective in 70–80% of the acute stage and the other 20% requires chemonucleolysis, percutaneous diskectomy or operation. Indications for operation are cases not improved after conservative treatment, recurrent cases and cauda equina syndrome. Mixter and Barr(1934) demonstrated that laminectomy and surgical removal of disc material could relieve symptoms, but spinal segmental instability, incomplete removal of the disc and postoperative adhesion of the nerve root caused low back pain after long-term follow up. Thus, the authors evaluated the plain X-ray and computed tomographic findings in 21 cases of failed laminectomy to determine the cause of failure. The results were as follows ; 1. Among 21 cases, 18 cases complained of low back pain with sciatica and 3 cases complained of low back pain. 2. In all cases, disc space narrowing was detected on plain X-ray. Total laminectomy and diskectomy promote insufficiency and instability of the lumbar and lumbosacral spine. Whenever one attempts to do total laminectomy and diskectomy, it is recommended that spine fusion be performed in same operating field. 3. Several findings were detected on CT scan : 8 disc protrusions in the operation site, 6 disc protrusions in the operation site and spinal stenosis, 4 extradural scars, 1 extradural scar and other site disc protrusion and 2 cases of spinal stenosis and spondyloisthesis. 4. Computed tomography in cases of failed laminectomy offers more information than has been available by any other imaging method.

A Clinical Study on Osteoprosis and Back Pain / 대한정형외과학회잡지

The back pain is increasingly becoming a major problem in the elderly people. The cause of back pain in the elderly patient is quite different from in the young subject. And relationship of the occurrence of osteoporosis with the incidence of fractures in general is currently regarded as a major factor. The authors performed clinical observation on 194 elderly patients who were treated for back pain during 5 years period from April, 1983 to April, 1988 at the Department of Orthopaedic Surgery, Severance Hospital and relationship between osteoporosis and compression fracture of spine was reviewed. The results were as follows : l. Among the 194 cases of back pain(28.3% of total admission cases), whose age were over 50: 142 cases were female and 52 cases were male, being more common in female. 2. Most common cause of back pain was the compression fracture of spine : 86 cases(44.3 %). Osteoporosis was associated with 66 cases(76.7%) out of 86 cases. 3. The number of compression fracture in same patient was more frequent in osteoporotic patient and thoracolumber junction (T12, Ll) was the major site of fracture (45.6%). Compression fracture of spine caused by osteoporosis occured at multiple level in 60.6%. 4. Twenty three cases(34.8%) of compression fracture of spine with osteoporosis were found to have previous history of fractures of spine and/or extremities by radiological examination. Regarding this results, compression fractures of spine was not infrequent cause of back pain in the elderly. It was thought that re-fracture of spine should be prevented by vigorous approach against osteoporosis along with the treatment of presenting fracture in these patients.

A Clinical Study of Soft Tissue Tumors in Extremities / 대한정형외과학회잡지

Soft tissues, which are widespread in body, are derived from a common primitive mesenchyme and the tumors arising from them tend to closely resemble the prototype tissue in varying degree. Some soft tissue tumors have benign course, which can be cured by local excision and the other have malignant course being resistant to therapy and resulting in recurrence to other organ of tissues. The authors reviewed 279cases of soft tissue tumors which had been treated at Department of Orthopedic Surgery in Severance Hospital, Yonsei University College of Medicine from January 1983 to December 1987. 1. Among 279cases of soft tissue tumors, 257(92.1%) were benign and 22(7.9%) were malignant. 2. Benign soft tissue tumors were common two times in female, and malignant tumors were relatively common in male. 3. Common sites of soft tissue tumors were 92 csses about the knee, 69 csses in the hand and wrist, 44 cases in the foot, 26 cases in the leg, 15 cases in the thigh, 14 cases about the elbow, 10 cases in the arm and foresrm. 4. The most common benign tumors was ganglion which was followed by Baker's cyst, hemangioma, fibromatosis, lipoma, epidermal cyst in decreasing order of incidence. Among malignant tumors, fibrosarcoma, malignant fibrous histiocytoma, malignant schwannoma, synovial sarcoma, leiomyosarcoma were common. 5. Most of the benign tumors was taken by locsl excision, and malignant tumors were were trested by wide resection with combination of chemotherapy. 6. Local recurrences of benign tumors were developed in 26(10.1%) out of 257cases, especially in fibromatosis and hemangioma.

Birth Trauma / 대한정형외과학회잡지

Birth injury is defined as any condition that affects the fetus adversely during the labor or delivery. These traumatic injuries are subdivided further into those that from hypoxia and mechanical factors. We analyzed 57 patients of birth trauma including fractures, nerve injuries and head injuries during the delivery at Severance Hospital from Jan. 1980. to Dec. 1985 and 24 patients which were transfered from other hospital after delivery and the following results were obtained. 1. The rates of birth trauma in our hospital were 0.36% including clavicle fractures 0.27%,femoral fractures 0.006%, brachial plexus injuries 0.031%, skull fractures 0.025% and intracranial hemorrhage 0.025%. 2. The site of clavicle fractures were all middle one third, and 71.4% of cases were displaced. 3. Five cases of brachial plexus injuries were found, and each type was Erb's palsy 3 cases, Klumpke's palsy 1 case and whole arm palsy 1 case. Three cases were recovered completely and 2 cases were recovered partially. 4. Methods of delivery were as followed; normal delivery 50.6%, breech delivery 3.7%, forcep 7.5%, vacuum 21.0%, and Cesarian section 17.2%. 5. The primipara was 65.4% of the patients of birth trauma. 6. There was no statistical significances in the birth weight, head circumferences, and chest circumferences of the patients comparing to the normal infants.

Open Reduction of Calcaneal Fracture / 대한정형외과학회잡지

Calcaneal fractures involving subtalar joint can be associated with prolonged and severe disability. Many different methods have been tried for the treatment in order to search for better results. From March 1983 to December 1985, 8 cases of calcaneal fractures involving subtalar joint were treated by open rcduction and internal fixation. and the results were as follows: 1. Satisfactory results were obtained from 7 cases out of 8. 2. Anatomic reduction was obtained by open reduction and internal fixation. 3. When medial approach failed, combined lateral and medial approaches gave better visualization of articular fecets and ensured anatomic reduction.

A Clinical Study of Lumbar Spinal Stenosis / 대한정형외과학회잡지

Lumbar spinal stenosis may be defined as any type of narrowing of the spinal canal, nerve root canals or intervertebral foramina. It may be local, segmental or generalized and may be caused by the encroachment of bone or soft tissue. The narrowing may involve the bony canal alone or the dural sac or both. Routine conventional radiographs or sagittal tomographs cannot accurately assess the midsagittal diameters of the lumbar canal or detect encroachment on the canal by osteoarthritis articular facets. However, myelography and computed tomography provide a means for distinguishing between herniation of a disc and bony encroachment on the spinal cord. The goals of surgical treatment in lumbar spinal stenosis are the relief of pain and the preservation or restoration of neurological functi ions. The surgical strategy is based on the patients symptoms and roentgenographic findings. Eighty-two operative cases of lumbar spinal stenosis were analyzed who were admitted in the Department of Orthopedic Surgery at Yonsei University College of Medicine from January, 1979, to July, 1984. The male female ratio was 1.3:1 and 66 cases (80.5%) included in their 50's and 60's. The results of the study are as follows: 1. Clinical symptoms included aggravation of pain during back extension (28.0%); back pain with radiating pain (22.0%); paresthesia of extremities (18.3%); back pain only (13.4%); and claudication (12.2%). 2. On physical examination, the straight leg raising test showed positive results in 25.6%, motor changes occurred in 24.4%, sensory changes in 20.7%, and DTR changes in 11.0%. 3. The most frequent level of spinal stenosis, L5-Sl invertebral space, was found in 68.3%(56cases) followed by L4-L5 intervertebral space found in 61.0% (50 cases). 4. Operative findings induded 31 lesions (46.3%) identified as herniated or ruptured discs,20 lesions (29.9%) identified as thickening of lamina and ligamentum flavum, and 5 lesions (7.5%) as compression of a nerve root by scar adhesion. 5. Of the 67 patients (81.7%) operated through the posterior surgical approach, 52 cases (77.6%) were effective; and of the 15 patients operated on by the anterior surgical approach, 9 cases (60.0%) were effective. 6. When the duration of symptoms was less than 1 year and the involved level of spinal stenosis was less than 2, operative results were satisfactory. 7. When there was a degenerative type of stenosis without a herniated or ruptured disc, operative results were excellent. 8. For post operative external support, 32 cases (39.0%) wore body jacket cast and 38 cases (46.3%) wore back braces.

Clinical Effects of Diadynamic Currant for Patients with Pain in the Back and Extremities / 대한정형외과학회잡지

The treatment of pain in the back and extremities remains empirical. The application of surface electrodes to the dorsal columns of the spinal cord has been used by Shealy. The rationale. for dorsal column stimulation has been the “gate control theory” of pain proposed by Melzack and Wall. Transcutaneous electrical nerve stimulation is well recognized for its effectiveness in pain relief. The authors studied 48 cases of group A (physiotherapy, medication) and compared them with 43 cases of group B(physiotherapy, medication 'and diadynamic current), in the Department of Orthopedic Surgery, Yonsei University Hospital, from April, 1983, to June, 1984. The results were as follows: 1. Significant relief of pain was noted in group B in long term follow up of acute pain in the back and extremities. 2. In long term follow-up of group B, there was more improvement than in group A, especially when there was radiating pain in the extermities with or without back pain. 3. In long term follow-up according to the causes of the pain, there was more improvement in group B than in group A in cases of herniated nucleus pulposus and low back syndrome. From a consideration of these studies, it was concluded that satisfactory results were obtained from diadynamic current treatment for the patient with pain in the back and extremities.

A Clinical Study of Acute Pyogenic Osteomyelitis / 대한정형외과학회잡지

Acute pyogenic osteomyelitis is frequent in infants and children, usually hematogenous, and predominant in male. The etiology of acute osteomyelitis is of 3 types: hematogenous, direct innoculation, or postoperative. Acute pyogenic hematogenous osteomyelitis is the most frequent type in children. This study consisted of 119 cases of acute pyogenic osteomyelitis which were studied at the department of orthopedic surgery, Yonsei university, Severance hospital and Youngdong hospital for 10 years from Jan. 1974 to Dec. 1983. The result were as follows. 1. There were tendency to decrease the frequency of this disease graduaUy since 1973 except 1978. 2. 20 patient (16.8%) had the history of trauma and 43 patients (36.1%) had the entry site of infecting organism. 3. The most frequent involved sites were femur and tibia. 4. E.S.R. was definitely increased in 90.4% of male, in 100% of female. 5. 59.6% of patients revealed the definite bone change at admission on X-ray findings. 6. Staphylococcus coagulase positive was the most frequent organism isolated (95%). 7. The most sensitive antibiotics was cephalosporin and the most resistant was penicillin (90.2%). 8. The antibiotics treatment with immobilization of involved site was initially tried, if there was no symptomatic improvement, the various surgical process was performed with satisfactory result.

The Clinical Study of Pyogenic Arthritis: Pathogeny and Complication / 대한정형외과학회잡지

After developement of antimicrobial chemotherapy, morbidity and mortality from pyogenic arthritis has been reduced dramatically, but still this disease has remained as a serious and life threatening infectious disease of childhood or late sequelae in surviving patients. For the period of 6 years from January 1978 to December 1983, seventy nine patients, eigthy one cases who were treated as pyogenic arthritis at Severance Hospital and Yong Dong Hospital were studied retrospectively and the results are summerized as follows. 1. We thought that the main pathogeny of septic arthritis of knee joint are trauma and direct invasion of microorganism, because the frequency of pyogenic arthritis in knee joint are proportional to the age and history of accupuncture therapy and trauma are common. 2. In thirty three cases (40.7%) underlying causes were found, composed of infectious focus in eleven cases(13.6%) correspondent to hematologic transmission, osteomyelitis in seven cases(8.7%), trauma and accupuncture in six cases(7.4%) and eight cases(9.9%) corresponding to direct invasion. 3. In forty five cases(55.6%) microorganism are identified, among which coagulase positive staphylococci are in forty cases(88.9%) . 4. Tc-99m-MDP(Medronate) whole body bone scan were taken at twelve patients and positive findings were eleven cases. 5. In thirty eight cases(46.9%) the complications were appeared: Osteomyelitis of tibia in ankle joint and periarticular or subarticular bone defects in knee joints were common. 6. There were complications in every cases that the duration was more than eleven days, no exceptional.

Clinical Study on treatment of Diabetic Gangrene / 대한정형외과학회잡지

Diabetic gangrene is a common complication of diabetes mellitus, and its an incidence which has an increasing tendency. And its treatment is very difficult because of the high incidence of delayed wound healing. The diagnostic method to determine the level of amputation for treatment of ischemic limb was reported by many authors, but it still has many controversies. From January 1973 to December 1982, 60 cases in 55 patient of diabetic gangrene were treated at the Department of Orthopedic Surgery Severance Hospital. The result of treatment of diabetic gangrene according to the level of amputation, primary healing rates, and complication were studied. The results obtained are as follow; l. Among 55 patients, 34 male and 21 female, 50 patients(90.9%) were older than 51 years. 2. There was no correlation between primary healing and palpating arterial pulsation at the amputation level, also there was no correlation between primary healing and obstruction of proximal artery in arteriography. 3. It wasrecommended to correct hemoglobin level above 12.1gm% before treatment for primary healing at the operation site. 4. Debriment and skin graft were indicated with the grade I lesion. Whenever they amputate and attempt to do primary healing at the operation site, the ideal level is the site where the skin temperature is between 33.1℃ to 34℃. 5. High delayed healing rate(71.4%) was anticipated in below knee amputation with grade IV lesion with low skin temperature(below 32℃). 6. Among 12 patients who took Pylon prosthesis and started early weight bearing walking after major amputation, 10 patients(83.3%) were healed orimarily. 7. Operative mortality was 5.4% and 5 year mortality after operation due to diabetic gangrene was 16.9%.

Clinical Study of Clavicle Fractures / 대한정형외과학회잡지

A clinical study of 147 clavicle fracture patients (one patient had bilateral fractures) who were admitted and treated by the Department of orthopedic surgery of Wonju Christian Hospital, Wonju Medical College, Yon Sei University. The period covered was from September 1974 to August 1981, a total of seven years. The study focused on three fertors in relation to the pain and limitation of motion and these causes were comminution of fracture, shortening of the clavicle length and external deformity. The results were as followings; l. Of the 148 cases, 125 were male and 22 female (one with bilateral fractures). The majority were between 31 and 40 years of age. 2. The mid 1/3 fracture was most common and both sides showed no difference in incidence(left ; 73 cases, right; 75 cases). 3. The mean follow up ranged from 4 months to H3 months with a mean 49.5 months. 4. The complications resulting from comminution, shortening of clavicle length and malunion were shoulder joint pain-16 cases (10.8%), limitation of motion-17 cases(11.5%) and external deformity-18 cases(12.9%). 5. Using a rating scale of excellent(no apparent factors), good( one factor), fair(two factors), poor(more than three factors) the results showed, 106 excellent, 31 good, 9 fair and 2 poor. 6. On a percentage scale, the pain showed difference of 9 times with initial comminution, 7 times with shortening of clavicle length and 7 times with deformity. 8. On a percentage scale, the limitation of motion of shoulder joint showed difference of 6 times with initial comminution, 6 times with shortening of clavicle length and 17 times with deformity.

Treatment of Complete Acromioclavicular Joint Dislocation by Weaver and Dunn Method / 대한정형외과학회잡지

No abstract available in English.

Traumatic Complete Dislocation of the Knee Joint: Report of 3 Cases / 대한정형외과학회잡지

No abstract available in English.

A Clinical Observation of the Pelvic Bone Fracture / 대한정형외과학회잡지

62 cases of the fracture of the pelvis admitted to the orthpedic department of Wonju Christian Hospital during past 5 years from 1975 to 1979 were reviewed and clinical results were obtained as follows: 1. Males were frequent than females and almost 3rd to 4th decades of life. 2. The causes of injury were traffic accident, coal minor accident, and falling. 3. Stable type is the most common in this series and among the unstable types, lateral compression type is the most common and then straddle type and vertical shear type. 4. The most common complication is uro-genital injury. 5. The residual complications at the end of treatment remained in some cases, Arthritis of sacroiliac joint, Impotence, Urethral stricture, Low back pain, etc. 6. All of the cases were treated conservatively and their results were somewhat good except 4 cases. 7. Surgical treatment would be considered, if necessory, to decrease the complications and reduce hospital days.

Ankle Arthrodesis: A Clinical Review / 대한정형외과학회잡지

Injuries to the ankle or various disease in ankle are one of the most common musculoskeletal problem. The ankle is amazingly tolerant to at least minor anatomic disruption. But in situation of severed ankle it is the anxious problem to solve the pain, disability and so on. Since past time, ankle fusion can solve the pain problem, and there is little disabiiity from walking on standard surfaces, comparing the ankle arthroplasty. So we analyse 48 cases of the ankle fusion at Wonju Christian Hospital, Yonsei University College of Medicine for ten years. The results are summerized as follows: l. Applying method for fusion are distraction-compression bone graft arthrodesis, Charnley compression method, extraarticular arthrodesis, anterior sliding graft-21, 16, 2 and 9 cases respectively. 2. Post-operative complications are wound infection, loss of position of grafted bone, skin necrosis, fracture of the grafted bone and phlebitis