Femur Shaft Fracture in Children Treated by Charnley's Traction Unit / 대한정형외과학회잡지

The treatment and results of 6 cases of the femoral shaft fracture in children are prensented and the method of Charnleys traction unit used most frequently at Korea General Hospital is described. Many Kinds of traction for the femoral shaft fracture in children was introduced. But nearly all methods which depend on heavy traction are open to the following criticism; 1) It is impossible to diminish the traction force alone without jeopardising the stablity of the reduction. 2) Gravity is not used to help in correcting the deformity of backward angulation. 3) Backward angulation of the distal fragment can never be corrected by traction in the axis of the femur. To do this the direction of the traction must be delfected away from the axis of the femur. Charnleys traction offers the following features: 1 The foot is supported at right angles to the tibia. 2. The external popliteal nerve and calf muscles are protected from pressure against the slings of the splint. The tibia is suspendcd from the Steinmann pin inside the plaster so that an air space develops under the tibia as the calf muscles lose their bulk. 3. External rotation of the foot and distal fragment of the femur is controlled. 4. The tendo Achillis is protected from pressure sores. 5. Comfort; the patient is unaware of the traction when applied through the medium of the nail. Age distribution of the patients was from 2 years to 13 years. Initial angulation after the manual reduction was from 0 to 25 degree posteriorly and from 5 to 9 degree laterally. Angulation after radiological union was from 0 to 15 degree posteriorly and from 0 to 8 degree laterally. Overriding before reduction was from 0.9 to 3.2cm and after reduction from 0.3 to 1.2cm. The duration of the inmobilization in Charnleys traction unit was from 15 days to 57 days. The duration of radiological union was from 51 days to 94 days.

A Case of Unusual Lung Abscess Induced by Psoas Abscess in Tuberculosis of the Spine / 대한정형외과학회잡지

A case of unusual lung abscess induced by psoas abscess in tuberculosis of the thoracolumbar spine complicated with complete spastic paraplegia is reported. Usually the tuberculous psoas abscess drains out along the fascia and ligament by it's own gravity. The common site of drainage of the tuberculous psoas abscess are the Petit triangle, the femoral triangle, the sciatic notch, the adductor region of the thigh and the lumbar region. In the reported case the left psoas abscess penetrated into the diaphragm and induced a lung abscess. This was confirmed by operation as no communication was inspected between the paravertebral abscess. The abscess was completely evacuated through thoracotomy and the tuberculous lesion in T-11,12 was operated by complete removal of focus and simultaneous anterior spinal fusion, another lesion in the lumbar spine was operated by radical operation three weeks after first operation. The paraplegia was recovered three months after first operation with satisfactory bony union and the patient was allowed to be up and about. A satisfactory result was obtained by radical ressection and anterior interbody fusiao of T-11,12 of the diseased vertebrae through the left extrapleural approach. This was followed by focal deberidement of right psoas abscess.