Change of AST & ALT in Patients with Multiple Trauma / 대한정형외과학회잡지

Increase of AST and ALT is a common biochemical finding in patients with multiple trauma. So it is difficult to make a decision for appropriate operation timing and to predict prognosis with consideration of parenchymal liver disease. We studied patients with multiple trauma who admitted to orthopedic department with increased AST & ALT and patients who had hepatitis from Jan. 1993 to Dec. 1993. The patients were checked AST & ALT on admission day and followed by the 3rd, 5th, 9th day, second and third week. We checked the relation of changed level of these enzymes and severity of injury, combined abdominal trauma, head trauma and the presence of HBs Ag/Ab. We concluded as followed: 1) Traumatized patients had high AST than ALT during first 3 days but hepatitis patients had higher ALT than AST during throughout admission days. High ALT in hepatitis patients had statistically significance compare to traumatized patients. 2) Traumatized patients with high AST were decreased more rapidly than ALT and showed normalized enzymatic level by 3rd week. 3) The AST level was higher in severely injured patients and it was statistically significant within first 3 days. But ALT was not correlated with the severity of injury. 4) In patients with abdominal injury, AST was higher than ALT and AST had significance but ALT had none. 5) There is no specific correlation between these enzyme level in neurosurgical problem and the presence of HBsAg/Ab.

CT Classification and Surgical Treatment of Intra-Articular Fractures of the Calcaneus / 대한정형외과학회잡지

Computed tomography was used in the evaluation of intra-articular fractures of the calcaneus to develop and reasonable treatment program and predict prognosis. Twenty-four fractures of the calcaneus in the twenty-two patients were shown to involve the posterior facet and classified by the images of coronal CT scan; Type 1(non-displaced), Type 2(displaced) and Type 3(comminuted). There were one Type 1, fourteen Type 2, and nine type 3 fractures, all of which were treated with open reduction, internal fixation, with or without bone graft. The length of follow-up ranged from eighteen to thirty-six months(mean, 23 months). the results were fraded by a predetermined point system. The one Type 1 had an excellent result. Of the fourteen Type 2 fractures, four had and excellent result; seven good result; two fair; and one poor. Of the nine Type 3 fractures, two had good; three fair; and four poor result. On the basis of our study, we believed that open reduction and internal fixation was a good method of treatment for the displacce or mildly comminuted intra-articular fractures of the cal-caneus.

Treatment of the Acromioclavicular Dislocation with the Modified Weaver and Dunn Procedure / 대한정형외과학회잡지

We treated 27 cases of the complete dislocation of the acromioclavicular joint with the modified Weaver and Dunn procedure described by Shoji et al, which is resection of the lateral end of the clavicle and bone block transfer of the coracoacromial ligament, from July 1987 to December 1989. Twenty-one patients were followed for an average of fourteen months and the brief summary of the observations are as follows: 1. The peak incidence was in 3rd and 4th decades and much more prevalent in male (76%). 2. The most common cause of the injury was traffic accident and followed by fall down. 3. In functional evaluation by the Weitzmann criteria, an excellent result was seen in fourteen cases; a good result, in five; a fair result, in two. 4. The comparision of the coracoclavicular interval ratio before surgery with that after surgery facilitated the evaluation of the effectiveness of the coracoclavicular ligament reconstruction. 5. There were no major complications that could affect to end result.

Separation of the Symphysis Pubis: Report of 5 Cases / 대한정형외과학회잡지

The symphysis pubis is a nonsynovial amphiarthrosis in which the bodies of the two pubic bones are united by a fibrocartilaginous disk. This forms subsidiary tie arches that augment femorsacral arch in the erect position, ischiosacral arch in the sitting position. In normal state the symphysis is strong enough not to be separated. We experienced 5 cases of separated symphysis pubis developed during labor at the Catholic Hospital from January 1987 to December 1988. The duration of follow-up was between 12 and 19 months without any residual symptom after conservative treatment.

The Inyo Nailing for the Lateral Malleolus Fracture of the Ankle / 대한정형외과학회잡지

The Inyo nail is a new intramedullary device for the treatment of the lateral malleolus. fracture of the ankle with the advantage of rigid fixation. The authors have experieced 16 cases of the Inyo nailing for the ankle fracture and fallowed more than 1 year in the 11 of them. Two groups of patients were evaluated; Group I was treated with the Inyo nail and Group II was treated by conventional technique. The following results were obtained; 1. The Inyo nail was suitable for treatment of type A & B fractures of the ankle. 2. Group I patients resumed their preinjury ROM of the ankles and activity earlier than Group II. 3. The results in the radiographic rating and fuctional criteria were excellent in those cases of Group I than those of Group II.

The Results of Treatment in Femoral Neck Fractures / 대한정형외과학회잡지

We clinically analyzed 53 patients of fresh femoral neck fractures who were treated in Daegu Catholic Hospital from Aug. 1980 to Apr. 1987: The end results of the surgical methods, i.e. internal fixation, endoprosthesis and total hip replacement, were compared in the 45 patients who were followed for more than 2 years. The results were as follows. 1. The most frequent age occurrence was different in sexes ; male was in the 8th decade (29%) and female was in the 6th decade(31%). 2. The most frequent cause of fracture was “fell from height” in male(43%) and slip down in female(47%).3. Mid cervical fracture was the most frequent in anatomical classification(49%) and 83% of fractures were displaced(Garden stage III & IV). 4. The results were evaluated by the modified Lunceford criteria which included the degree of patient's own satisfaction. The combined result of “excellent” and “good” were obtained in 75% of 20 internal fixation cases, 80% of 15 endoprosthesis cases and 71% of total hip replacement cases. It was concluded that we could get similar results by 3 surgical methods if reasonable criteria of indication were applied for each method: rehabilitation of patient can more important than osteosynthesis itself in the determination of indication of operative methods.

Rupture of Peroneus Brevis Combined with Bimaileolar Fracture: A case Report / 대한정형외과학회잡지

Combined injury of peroneus brevis rupture and bimalleolar fracture is very rare. The avulsion of peroneus brevis tendon from insertion maybe neglected and may prevent anatomic reduction of lateral malleolar fracture. We have treated open bimalleolar fracture with avulsion of peroneus brevis tendon from its insertion.

Assesment of the Prognosis of Femoral Neck Fractures: Preoperative and Postoperative Tc / 대한정형외과학회잡지

In 38 patients with femorsl neck fracture trested at Cstholic Hospital from Aug. 1980 to Jun. 1985, 24 patients were followed for more thsn 2 years. Preoperative bone scanning with 99m Tc MDP was performed in those 24 patients and postoperative follow-up bone scan assesment of the femorsl vascularity was done in 9 patients of them. Following results were obtained. 1 . Tc 99m methylenediphosphonate bone scanning was effective in assesing the femoral head vascularity in the femoral neck fracture patients. 2. The femoral head activity could be changed in the postoperative scanning : there could be further injury to the blood supply during operation or femoral head revascularization after operation 3. Some information about the possibility of future avascular necrosis could be obtained by comparing preoperative and postoperative bone scan in order that early preventive measures might be applied against the late head collapse. 4. It was conculuded that internal fixation should be considered first in the treatment of fresh femoral neck fracture : the indication of head replaement surgery could not be rnade by preoperative bone scan only.

A Clinical Study on Surgical Treatment of Clavicular Nonunions / 대한정형외과학회잡지

Six. patients with clavicular nonunion were treated at the Daegu Catholic Hospital from Aug. 1980 to Jun, 1986. Five patients were male and one was female, and their ages ranged from 35 to 52 years. There were hypertrophic nonunion in four patients and atrophic nonunion in two patients; all six patients had symptoms due to nonunion. Factors that might have influenced the development of nonunion in our cases seem to be inadequate operative treatment, severe trauma and inadequate external fixation due to combined injuries. Five patients were treated with semitubular plating and iliac graft, and one was treated with intramedullary K-wire fixation and iliac graft. All patients achieved good union by average 10 weeks postoperatively and symptoms disappeared. It was concluded that symptomatic nonunion of the mid-clavicle could be treated by operation, and the procedure of choice seemed to be rigid internal fixation with plating applied in compression and bone graft.

Clinical Study of Acute Osteomyelitis in Children / 대한정형외과학회잡지

The treatment of acute osteomyelitis has been much improved with the development of better antibiotics, but still a number of problems have remained unsolved. To find out possible problems in our method of management and to help resolve these problems, a clinical study was done of 34 cases of acute childhood osteomyelitis treated from August 1980 to January 1985. The results were as follows: 1. Bone scan helps diagnosis and localization of this disease; blood culture is significant in the selection of relevant antibiotics by sensitivity test. 2. All the causative organisms cultured were staphylococcus aureus which showed 100% sensitivity to cephalosporin and 100% resistant to penicillin: methicillin was not much effective compared with other reports. 3. 22 cases were trcated with decompression operation and 12 cases with conservative method: surgery is considered to be better method of treatment in the viewpoints of clinical process and complications.

A Clinical Study on Trochanteric Fractures of the Femur / 대한정형외과학회잡지

A clinical study was done for 103 cases of the trochanteric fractures which were admitted and treated at the department of orthopedic surgery, Kyungpook National University Hospital during the period of 9 yeras from January 1972 to December 1980. Following results were obtained: 1. Of the 103 cases of the trochanteric fractures, 73 cases were in man, with peak age at 6th decade and 21 out of 30 in woman were over 50 years of age. 2. Causes of the fracture were ear accidents in 67 cases and “slip or fall down” in 36 cases. 3. According to the classification of the trochanteric fractures by Boyd and Griffin, most common type was type 11 in 40 cases and followed by type 111 in 27, type 1 in 24 and type 1V in 12. 4. Upon the treatment, 53 out of 103 cases were conservatively treated with Thomas splint and skeletal tractior. Those cases were mostly combined injury on other organs. Open reduction and internal fixation was done on 50 cases with Jewett nail in 48, Zickel nail in 1 and Judet plate with screw in 1. Most of unstable fractures were reduced by Dimon-Hughston method and fixed with Jewett nail. 3. Union of thef ractures ranged from 10 to 16 weeks, average 13 weeks, by open reduction with internal fixation and from 12 to 24 weeks, average 17. 5 weeks, by conservative treatment. 6. Complications were encountered 31% of those cases with conservative treatment and 16% of those cases with operative treatment. Major complicationss after the conservative treatment were decubitus ulcer in 14 cases (27%), coxa vara deformity in 8(16%) and urinary tract infections in 5(10%).

Clinical Study on Fractures of Femoral Neck / 대한정형외과학회잡지

A clinical analysis was done on forty-five patients with fracture of the femoral neck, who have been admitted and treated at our orthopedic department during the period of 6 years, from January 1975 to December 1980. The following results were obtained: Age over 60 comprised 60% of the patients. Male to female ratio revealed no significant difference, being 21 to 24. However, with advancing age, female was affected more frequently than male. The major cause of injuries were “fall or slip down” occuring in 33 patients (73.3%) and “hit by car” in 12 patients (26.7%). Of the 39 patients in whom Garden's calssification of fracture could be applied. Stage II was the most common type occuring in 29 patients (75%), followed by Stage N in 6(15.4%), and Stage 5 in 4 (10%). Of the total 45 cases, forty patients were reduced and fixed with multiple Knowles pins and two patients with Jewett nail. Three patients with neglected treatment of the fracture for over 1 to 4 months were treated with primary replacement arthroplasty of the femur in two and total hip replacement in one. Fractures were united within 3 months in 10 patients (23%), 4 to 6 months in 19 patients (45.2%), and non-union in 2 patients. Relationship between accuracy of reduction using Gardens alignment index and develepment of avascular necrosis was evaluated. Of the 27 patients with reduction in the range of 155 180 in both frontal and lateral views, 3 patients were developed avascular necrosis, and of the 9 patients with reduction of less than 155 in frontal view or greater than 180 in lateral view, 4 patients were developed avascular necrosis.

Anatomical Study Designed to Clarify the Mechanism of the Pivot Shift / 대한정형외과학회잡지

There has been much dispute about the pathomechanics and the significance of the test even among the most competent surgeons in this field. Some have claimed that the posterolateral capsule must be torn to initiate the pivot shift. Some have even gone as far as to deny the importance of the anterior cruciate ligament as a main stabilizing structure of the knee. We evaluated the concept of MacIntosh in anatomical studies which were carried out at the both Pathology and Orthopedic department of Kyungpook National University, School of Medicine, Taegu Korea. Experiments have been carried out to study the etiology of anterolateral instability and the production of a pivot shift sign. In the cadaver knees and A/K amputation knees, which did not have any sign of instability or osteoarthritis, the anterior cruciate was severed by a short medial incision. We could immediately detect a pivot shift. No pivot shift resulted however when the posterolateral capsule was completely divided first and the anterior cruciate left intact, or when the medial collateral ligament and medial capsule were cut. If both the anterior cruciate and posterolateral capsule were divided the pivot shift became more prominent than after cutting the anterior cruciate alone. When the medial collateral ligament including the capsular structures was completely severed, however, the pivot shift disappeared. In summary the experiments show the following: 1. An isolated rupture of the anterior cruciate ligament or its combination with a partial tear of the medial collateral ligament may be detected with the pivot shift sign. 2. If the rupture of the medial collateral ligament is complete the pivot shift test can be negative in spite of a tear of the anterior cruciate ligament.

Talar Tilt Angle(A Comparative Study with Sagittal Mobility of the Normal Ankle) / 대한정형외과학회잡지

The object of this study was to determine the physiological range of talar tilt angle of the Korean and to establish the basis for diagnosis and treatment of the lateral instability of the ankle. The anteroposterior inversion stress view of both ankles was taken in the 108 healthy Korean who had no history of ankle injury or disease. The sagittal stress films were also performed on 96 ankles (48 cases) of these to further define the physiological limits of the sagittal mobility of the normal talus. We compared these two values of normai mobility of talus to deterrnine the significance and relationship of the rwo. The results obtained were as follows: 1) Talar tilt over 10 degrees was seen in only 6 ankles (1.9%) and most of the ankles (279 ankles, 88.4%) showed a tilt less than 5 degrees. 2) Normal talar tilt angle was increased in 30 degrees plantarflexed position than in 90 degrees neutral position of ankle. In 12 cases the value was different between the right and the left; but there was no significant difference between the sexes. 3) The anterior displacement index over 200 was seen in only 5 ankles (5.2%). 4) There was gross positive inter-relationship between physiological. range of talar tilt angle and talar sagittal mobility.

A Case of glomor on the Thumb / 대한정형외과학회잡지

Authors have treated a case of glomus tumor which was occurred in the tip of the right thumb, 34 years old female. The patient has complained of pain, tenderness, and cold sensitivity on the lateral side of the tip of the right thumb for 10 years. Reddish purple discolorarion was noticed under the nail bed. On X-ray, erosion of the lateral cortex of the distal phalanx and increased soft tissue density around the erosion was noted. Grossly, the tumor was purple in color, more deeply colored than the surrounding tissue and tumor tissue will shell out of the surrounding bone and soft tissue. Glomus tumor was confirmed by the excisional biopsy.

Giant Cell Tumor(The Efficacy of Bone Cementing after Curettage) / 대한정형외과학회잡지

In the past 13 years period, authors experienced 14 cases of giant cell tumor, 3 of which were treated by bone cementing after curettage. The results of various methods of treatment applied were compared and literatures surveyed. The followings were noted: 1. The most efficient method of treatment for giant cell tumor is en bloc resection. 2. The method of bone graft after curettage has such disadvantages as high recurrence rate and sequelae due to long periods of immoblization, especially for the large lesion with severe bone destruction. 3. Bone cementing after curettage seemed to be a choice in the methods of primary treatment of long bone giant cell tumor, especially useful for the tumors near the knee joint; the main advantages over other methods of treatment were considered to be technical simplicity and lack of complications.

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

Twenty-six cases of fracture of the femur and tibia on the same leg in twenty-five patients were treated at the Dept. of Orthopedic Surgery, Kyungpook National University Hospital during the period of 1973 to 1979. Twenty-two patients were sustained by the motor vehicle accident. Open fractures of the femur and tibia were ten cases, and closed femur fracture and open tibia fracture were twelve cases. Concomitant Injuries were brain Injury in eight patients and hemorrhagic shock In seven patients. Eight patients were treated by internal fixation (Kuntschernall or Compression plate) on femur and by conservative treatment on tibia. Conservative treatment was done in eleven patients on both femur and tibia fracture. Five patients were amputated. Average healing time of fracture was: twenty-two weeks in femur and twenty-seven weeks in tibia. Functional end results were assessed and rated with satisfactory results In six patients and fair and poor in elght patients respectively.

Clinical analysis of the Traumatic Posterior Dislocation of the Hip / 대한정형외과학회잡지

Authors had analyzed 35 patients of traumatic posterior dislocation of the hip which was treated at Kyungpook National University Hospital during the period of 7 years from 1972 to 1978. 21 of the 35 dislocation of the hip had sustained the injury by automobile accidents. 33 patients were reduced by closed reduction under general anesthesia. Within one week following closed reduction, intra-articular bony fragments were removed in 4 patients and posterior fragments of acetabular fractures were reduced and fixed with screws in 8 patients. 17 of the 35 patients were followed for eight months to 91 months, average 38 months. The results were rated according to criteris of the Stewart and Milford. Satisfactory results were obtained in 11 patients and those of 9 patients were reduced within 12 hours after injury. As the complication, avascular necrosis, myositis ossificans and osteroarthritis were developed in two patients, four patients, and seven patients respectively.

Degloving Injuries / 대한정형외과학회잡지

No abstract available in English.

Subungual Melanoma of Left Thumb: A Case Report / 대한정형외과학회잡지

The following case report concerns a rare subungual melanoma of left thumb which metastasized into the ipsilateral axilla. Subungual melanoma, or melanotic whitlow, is a malignant lesion requiring early diagnosis and urgent treatment. Unlike melanomas located elsewhere on the skin of the body, subungual melanomas are shielded by the nails, which handicaps the securing of a biopsy by the clinician. We report a case of subungual melanoma in a 61 year-old man who had a 6 months history of painful axillary mass.