Treatment of Comminuted - Intraarticular Fracture of Distal Radius using External Fixator: Comparative Study of Treatment by External Fixation with or Without bone Graft / 대한정형외과학회잡지

Distal radial fractures are recognized as very complex injuries with a variable prognosis that depends upon the fracture type and the treatment method. The purpose of this study is to compare radiological and clinical result between external fixation and external fixation with primary bone graft in intraarticular comminuted fracture of distal radius. From January 1993 to December 1995, 32 patients with comminuted intraarticular fractures of the distal radius were treated using a external fixation. 15 cases were treated with ligamentotaxis without bone graft and 17 cases were treated with additional primary bone graft. In last follow-up examination, the mean loss of radial length, radial inclination and volar tilt were less in with bone graft group than without bone graft group. According to Demerit point system Excellent to good results were obtained in 88.2% in cases of external fixation and bone graft group, 66.6% in cases of only extemal fixation group. External fixation combined with primary bone graft is more useful method for the reconstruction and treatment of comminuted intraarticular fractures of the distal radius than closed reduction and external fixation because cancellous bone graft not only provides early mechanical stability but also helps to reduce and supports the depressed intraarticular fragments. Furthermore, this method not only prevents late collapse of fracture but also enhance fracture healing.

Cementless Bipolar Hemiarthroplasty for the Management of Fracture of the Femoral Neck / 대한정형외과학회잡지

Various methods for the treatment of fracture of the femur neck including total hip arthroplasty have been developed and performed, but it is still called the ""unsolved fracture"" in certain situations. The role of bipolar hemiarthroplasty as primary treatment of fracture of the femur neck, however, continues to be controversial. The authors reviewed and analysed 38 cases of cementless bipolar hemiarthroplasty in patients between the ages of 51 and 69 at the Department of Orthopaedic Surgery, Chosun University, during the period from January, 1989 to December, 1994. The purposes of the study were to analyse the clinical and radiological results and to detect the motions of bipolar cup. At the average 38 months follow up, 31 (81.6%) of the patients were satisfied by Lunceford methods. But, 24 (63.2%) of the patients suffered from inguinal area pain and discomfort while they resumed their normal Korean life-styles. As time elapsed, the amount of the outer bearing motion was more than that of the inner bearing motion. the acetabular erosion were present in 2 patients.

Treatment of chronic osteomyelitis by using antibiotic: containing bone cement beads / 대한정형외과학회잡지

Since Klemm introduced the concept of antibiotic-containing bone cement for the treatment of chronic osteomyelitis, a number of studies have demonstrated the positive results of this therapy. It has been proved that antibiotic-containing bone cement continuously releases high levels of atibiotics locally into the infected and avascular wound environment. Antibiotic-containing bone cement provides several distinct advantages over irrigation-suction drainage. The major objective of this study is to analyze the results of therapy using antibiotic-containing bone cement beads for chronic osteomyelitis. The authors analyzed 21 cases of chronic osteomyelitis in patients who had been treated by saucerization and antibiotic-containing bone cement beads at Chosun University Hospital, between February 1990 and January 1993. Each patient's case was followed for at least thirteen months after operation. The results are as follows: 1. The causes of osteomyelitis were postoperative complications(10 patients), open fracture(8 patients), and hematogenous osteomyelitis(3 patients). 2. Staphylococcus aureus was the most common organism causing osteomyelitis, followed by Pseudomonas. 3. The femur was the most common location of lesion(11 patients) followed by the tibia(7 patients), the humerus(2 patients) and the ulna (1 patients). 4. Pus drainage was stopped in 13 cases with one insertion of the beads, in 2 cases with two insertions and in 2 cases with three insertions. 5. Therapy using antibiotic-containing bone cement beads can be regraded as an effective method of increasing local antibacterial activity by releasing the antibiotic into surrounding tissue over a continuous period in the treatment of chronic osteomyelitis. Antibiotic-containing bone cement beads are useful in the treatment of chronic osteomyelitis.

Operative Treatment in Fractures of the Humeral Shaft: Comparison of the Clinical Results of Flexible Intramedullary Nailing Versus Interlocking Intramedullary Nailing / 대한정형외과학회잡지

The purpose of this paper is to compare the results, complications, advantages and disadvantages of treatment by flexible intramedullary nail with those by interlocked intramedullary nail in humeral shaft fractures. The authors analyzed 42 cases of humeral shaft fractures in patients who were treated by intramedullary nailing. Nineteen patients were treated with flexible I-M nail and twenty three patients were treated with interlocked I-M nail. Fourteen cases(74%) treated with flexible I-M nail were obtained primary bone union, and twenty one cases(91%) treated with interlocked I-M nail were obtained primary bone union. Five cases treated with flexible I-M nail and 2 cases treated with interlocked I-M nail failed union and the most common cause of nonunion was distraction. Flexible I-M nailing does not solve rotational deformity and could't obtain a high union rate due to distraction. Therefore, we recommend that adequate external support is considered to prevent distraction using the flexible I-M nail. Although we obtained a satisfactory union rate using by Seidel interlocked I-M nail, we must observe the distal spreading screw loosening during the follow up period. In bones with small diameter, sufficient reaming may be necessary, because the distal spreading screw can't spread well.

Migration of Kirschner-wires from the Acromioclavicular joint into the Neck: Report of 2 cases / 대한정형외과학회잡지

Kirschner-wires and pins are used for the intenal fixation of the acromioclavicular joint. Many surgeons are aware of the tendency of these appliances to migrate, however, few reports of this complication have appeared in literature. This report concerns two instances of migration K-wires from the acromioclavicular joint into the neck, The potential for K-wires to migrate must be recogniged, and more frequent postoperative radiographic studies performed after the insertion of such pins to permit earlier detection of bony resorption and migration. Thereby permitting earlier removal. In cases of young adult, the wires must be removed as soon as the desired theurapeutic results have been obtained.

Percutaneous Pinning for Intra-articular Calcaneal Fracture / 대한정형외과학회잡지

Calcaneus was the most commonly involved bone among the tarsal bone fracture. Many different methods have been tried for the treatment of fractures of the calcaneus in order to search for better results. But there is no general agreement on the treatment of the fracture of the calcaneus, especially involving the subtalar joint. From Jan. 1986 to Jan. 1990, 25 feet in 20 patients of calcaneal fractures involving the subtalar joint were treated by closed reduction & percutaneous pinning at the Dept. of Orthopedic Surgery, Chosun University Hospital and the results were as follows; 1. Of these intra-articular fractures, 15 fractures were tongue type and 10 fractures were joint depression type by Essex-Lopresti classification. 2. According to the Salama unit system, the results of treatment were excellent or good in 11 cases of 15 tongue types and 6 cases of 10 joint depression types. 3. The results were excellent in which reduction is achieved near anatomical reduction. 4. Even if the joint depression type fracture which is not severely comminuted, the treatment with closed reduction & percutaneous pinning is thought to be good method.

Supracondlylar Osteotomy for Cubitus Varus / 대한정형외과학회잡지

Cubitus varus deformity is the most common angular deformity resulted by supracondylar fractures in children. Although, this deformity rarely limit elbow function, the correction is frequently requested due to cosmetic problem. The normal carrying angle can be restored by supracondylar osteotomy. Previous reports controversy over the cause of the deformity, the necessity and timing of operative correction, the operative technique itself, and the attendant risks. We performed 18 lateral closing wedge osteotomies with French technique(10 cases), and Sherman plate fixation(8 cases) by posterolateral approach from January 1978 to December 1988 at Chosun University Hospital. The results were as follows: 1. The most common cause of cubitus varus was suprcondylar fracture of the humerus(88.9%). 2. The results of supracondylar osteotomies were excellent is 8 cases(44.8%), good in 7 cases (38.9%), poor in 3 cases(16.7%). 3. The varus and rotational deformities were corrected by modified French method and Sherman plate fixation after lateral closing osteotomy. 4. In case of plate fixation, good results were obtained even older cases because of reducing time of extermal immobilization and promotion early joint exercise.

Osteogenesis Imperfecta: Case Report / 대한정형외과학회잡지

Osteogenesis imperfecta is a hereditary condition characterized by fragility of bone, deafness, blue sclera, laxity of joints and a tendency to improvement with age. Authors experienced osteogenesis imperfecta that develped over 3 generations in one pedigree. A 28 years old female exhibited severe anterior bowing deformity of left tibia. She has a past history of many times of bone fractures. She was treated with corrective osteotomy, plate fixation for correction of bowing deformity of left tibia and medullary nailing with fibular graft for paeudarthrosis of Rt. forearm bone.

Normolipemic Tendinous and Tuberous Xanthomatosis: One Case Report / 대한정형외과학회잡지

A xanthoma is a localized collection of tissue histiocytes containing lipid and is usually associated with hyperlipidemia. Tendinous and tuberous xanthomatosis have been found in association with familial hypercholesterolemia, Type III hyperlipidemia, beta-sitosterolemia and cerebrotendinous xanthomatosis. Tendinous and tuberous xanthomatosis without hyperlipidemia have been reported very rarely. Especially tendinous xanthomatosis without hyperlipidemia have not been reported at all in korea. We are reporting a patient with tendinous and tuberous xanthomatosis accompanied by normal plasma lipids

The Carpal Angle, Metacarpal Sign and Sesamoid Index of the Healthy Koreans / 대한정형외과학회잡지

The authors estimated and analyzed the carpal angle, metacarpal sign and sesamoid index in the roentgenogram of both hands of healthy 180 male and 180 female Koreans. The results were as follows. 1. The mean value of carpal angle was 133.3°±5.8° in the right hand and 133.5°±5.1° in left hand. 2. The negative metacarpal sign were seen in 93.9 percent of normal subject. 3. The mean value of sesamoid index was 19.6±5.4 in male and 18.2±4.9 in female.

The Treatment of Open Tibial Fractures by Ender's Nailing / 대한정형외과학회잡지

The treatment of open tibial fracture has become one of the most controversial subjects in orthopedic surgery. Recently flexible intramedullary nails have been used successfully in treatment of Type I, II open fractures of the tibial shaft. In this paper we are reporting our experience with the method in 20 open fractures of the tibia in 18 patients. The results were ss follows. 1. The patients were predominantly more common in male(90%) and the average age was 42.7 years old and the most common cause of fracture was traffic accident. 2. The most common site and shape were at midshaft and comminuted fracture. 3. With early operation the incidence of infection was greatly reduced and wound healing was relatively rapid. 4. The patients were applied with long leg or P.T.B. cast for at least 4 weeks in order to the prevention of re-displacement. 5. The average healing time was 17.7 weeks in 14 cases and union was most rapid at upper third and Type I fractures. 6. The complication was developed in 14 cases, 3 cases of delayed union, nonunion and ankle stiffness was seen respectively. 7. Infection rate was greatly reduced because Ender's nailing procedure was easy to perform, operation time was shortened, good fixation and alignment of fracture fragment was done without periosteal stripping. 8. Ender's nailing is considered to be a good method in the treatment of open tibial fracture associated with soft tissue injurv and multiole iniuries.

Quantitative Analysis of Bone Density on Roentgenography in Korean / 대한정형외과학회잡지

The bone is the dynamic living tissue which is always maintained bone mineral content by bone resorption and formation. It has been well known that the bone mineral content is decreased very slowly with aging. It is very difficult to diagnose the osteopenia because it is almost subclinical. Another important problem in the osteopenia is the fracture occurring spontaneously. The quantitative method of bone mineral mass provide an information to diagnose the osteopenia and predict the risk of spontaneous fracture. Various methods have been used to access the degree of bone atrophy but have not been routinely available for clinical application in the hospital. The microdensitometric method is a noninvasive, easy, accurate, and objective one to monitor the degree of changes in the skeletal mass quantitatively. So, we measured the 7 indices at the middle site of the 2nd metacarpal bone with a microdensitometer and computer on an X-ray film of the hands and studied the correlations between the age and indices of those under 30 and over 30 yrs old in healthy and fracture groups. The results were obtained as follows : 1. There was a significant high correlation between age and indices in healthy and fracture groups. 2. The measurement of age by microdensitometric method was highly correlated with the chronological age. 3. Comparing both groups, There was a significant correlation of D (P<0.001), MCI(P<0.01), and d (P<0.01) over 30 yrs in male and GSmin (P<0.001) and ΣGS/D (P<0.01) over 30 yrs in female. 4. In fracture group, 1) The index of bone width(D) was slightly larger than in the healthy group. 2) The metacarpal index(MCI) was lower than in the healthy group. 3) The index of medulla width(d) was wider than in the healthy group. 4) The density index of cortex(GSmax) was smaller than in the healthy group. 5) The density index of cortex and medulla(GSmin) was smaller than in the healthy group. 6) There was no considerable difference in ΣGS/D between healthy and fracture groups. 7) The densitometric pattern was more aggrevated than in the healthy group.