Congenital Vertical Talus Treated with Kumar Operation / 대한정형외과학회잡지

Congenital vertical talus is dufficult to correct and tends to recur. Reduction of the deformed talon-avicular joint is rarely possible by conservative means alone and consequently surgical reduction is usually necessary. The technique of Kumar, Cowell and Ramsey(TAL, capsular release, open reduction of navicular, and K-wire fixation) was combined with or without tendon transfer using Tibialis anterior(Grice operation) in 11 feet of seven children(bilateral in four) under the age of four(2 girls and 5 boys), and followed them for average 41 months. Three of them were combined with cerebral palsy, syringomyelia, and multiple joint stiffness with camptodactyly. In preoperative radiograms, all of their tali are so distorted plantarward and medially as to be almost vertical. The talus was in an equinus position also but to a lesser degrees. The forefoot was dorsiflexed at the midtarsal joint and the navicular lay on the dorsal aspect of the talar head. Seven feet are corrected normally after operation, but four feet were recurred and soft tissue releasing techniques combined with extraarticular subtalar arthrodesis or triple arthrodesis were planned after their skeletal maturity.

Simultaneous Fractures of the Vertebral End Plates of Fifth Lumbar and First Sacral Vertebrae: A Case Report / 대한정형외과학회잡지

Fracture of the vertebral end plate in the lumbar and sacral spine has been reported as a rare lesion. Especially it is very rare that fractures are found at two levels simultaneously. To our knowledge, there has been only one reported case of this type of fracture in Korea3). We report a case of fractures of the vertebral end plates at two levels in adolescent patient.

Treatment of Symmetrical Thumb Polydactyly by Bilhaut-Cloquet Operation / 대한정형외과학회잡지

Since 1985, 7 symmetrical thumb polydactylies were treated with Bilhaut-Cloquet operation (V-shaped wedge out). As for Wassel's classification, two cases were type I (duplicated distal phalanx but not epiphysis) and two type IV (duplicated proximal and distal phalanx), and three type II (duplicated distal phalanx and epiphysis). Preoperatively, thumb polydactylies must be symetric and cut articular surfaces be accurately approximated. As for Wassel's type IV polydactyly, preoperative angiogram was done for detection of any vascular anomalies and tried not to damage the anomalous digital arteries of thumb. There was no postoperative complications. All patients and their parents were much satisfied with the postoperative results, but somewhat limited thumb motions were remained. In type I (2 cases) the average IP joint range of motion was 39°, in type II (3 cases) the average IP joint range of motion was 22°, and in type IV (2 cases) the average range of motion of IP joint was 21° and MP joint was 26°.

The Causes of Metallic Failure and Loosening of MOSS Transpedicular Spinal Instrumentation / 대한정형외과학회잡지

With the increasing use of pedicular system to fix the spine, many complications are being reported. Recently many systems are available to fix the spine. However, each system has own advantages and disadvantages. The causes of metallic failure of Modular Segmental Spinal (MOSS) instrumentation on 42 consecutive patients undergone in Kang-Nam St. Mary's hospital since 1989 were reviewed. The specific aim of this investigation was to assess causes of metallic failure and loosening of this system on various spinal disorders. Of these, 8 cases had metallic failure and loosening. Breakage of screw and rod developed in 6 cases and dislodgement of rod from screw in 2 cases. In case of degenerative spondylolisthesis (unstable phase) with stenosis, however, the complications were closely correlated to expansile decompressive laminectomy to widen the narrowed spinal canal and the instrumental distraction to gain normal intervertebral disc space at the operation. Bony union and back pain were not correlated to metallic failure and loosening. Therefore, the main causes of metallic failure and loosening were (1) preoperative instability undergone expansile decompressive laminectomy including total bilateral facetectomy that aggravated preoperative instability, and (2) forceful instrumental dis traction. In cases needed these requirements, combined anterior interbody fusion or posterior interbody fusion should be added, heavier rods and screws larger than 3.5mm, 4.0mm in diameter, respectively, should be used. In addition to postoperatively sufficient bed rest and immobilization using rigid braces should be recommended to reduce these complications.

Surgical Correction of Neglected Clubfeet in the elder Child and Adult / 대한정형외과학회잡지

Clubfoot or talipes equinovarus is the most common congenital anomaly of the foot observed in children as well as in adults. This deformity should be treated immediately after birth, and so the cases of old neglected clubfeet are quite rare now. Moreover, in the cases of old neglected clubfoot, it is very difficult to get satisfactory results because there will be secondary adaptive changes in the tarsal bones and surrounding soft tissues. Therefore, clubfeet are considered to be one of many things requiring on or more of the many different types of treatment. The authors have experienced to treat nine cases of old neglected clubfoot from May, 1978 to April, 1988 at the Department of Orthopedic Surgery, St. Mary's Hospital, and reported herewith. 1. Their average age was 14.8 years old (3 to 25 yesrs old). There were one bilateral clubfeet, left foot in 5 cases and right foot in 4 cases. 2. According to the age of the patients and severity of deformities, two patients from three to ten years old were treated with soft-tissue release and serial casting, and seven patients after ten years old were treated by soft-tissue release, various osteotomies and triple arthrodesis. Postoperative management consisted of long leg cast for first four weeks and short leg walking cast for another four to eight weeks. 3. The results were estimated by the talo-calcaneal index according to Beatson et al(3)radiologically and their external appearance of corrected foot subjectively. The talo-calcaneal index was improved from 17.8° to 37° after operation and all of patients satisfied with the results of their operation.

Panclavicular Dislocation: A Case Report / 대한정형외과학회잡지

Dislocation of both ends of a clavicle in a 49-yesr-old man during an auto-accident is presented. The medial end of the right clavicle was severely displaced antero-inferiorly while the 1ateral end displaced posteriorly. And the clavicle was rotated along its long axis. Sever al attempts of manual and a surgical reduction through separate incision on both ends of the clavicle failed to have anatomical reduction. It was presumed that the cause of failure in reduction were delayed reduction due to combined chest injury, blockade by first rib that was broken and was anteriorly displaced as well as the complexity of the dislocation. It is speculsted that anatomic reduction in this rare injury require wider surgical exposure. Though authors failed to have anatomic reduction in present case, stabilization of the medial end of the clavicle with a strip of fascia lata after medial clavicular resection and ligament repair at the lateral end resulted in satisfactory regain of shoulder motion and cosmetic improvement.