A Case of Partial Trisomy 9 by Balanced Maternal Translocation

Trisomy 9p syndrome was first described by Rethore et al in 1970 and about 100 cases have been reported since. The phenotypic spectrum of this syndrome is characterized by craniofacial malformation, facial deformity, skeletal and dermatoglyphic anomalies with variable degrees of mental retardation. We experienced a case of partial trisomy 9 syndrome in a 15-month-old female who had multiple congenital anomalies of frontal bossing, oblique antimongoloid palpebral fissures, enophthalmos, hypertelorism, globular prominent nose, down-turned mouth, prominent low-set ears, simian creases of both hands, clinodactyly and single crease of 5th finger, congenital dislocation of both knees and mental retardation. In cytogenetic studies using G banding technique and fluorescent in situ hybridization(FISH), she presented with an extra derivative chromosome No. 9. The karyotype of the patient was confirmed as 47,XX,+der (9),t (6:9) (q27;q21.2) mat. We report the case with the review of the associated literatures.

Operative Treatment of Acromioclavicular Dilocation: Comparative Study Between Two Operative Methods / 대한정형외과학회잡지

Acromioclavicular joint dislocations are frequently seen with industrial accident, sports activity and traffic accident. Various operative treatment modalities have been suggested. The purpose of this study is to compare the clinical results of two operative methods in young patients with acromioclavicular dislocation. The authors analyzed the clinical and radiological results of 30 patients with acromioclavicular dislocation, in whom 15 patients were treated by acromioclavicular reduction & fixation with K-wire(Phemister procedure) and 15 patients by acromioclavicular reduction & coracoclavicular fixation by cancellous screw with coracoclavicular ligament repair(Bosworth procedure) from March 1989 to September 1993 at Ansan Hospital, Korea University. They were followed up more than 12 months. The results obtained were as follows: 1. The difference of coracoclavicular distance compared with normal side after operation was 2.6mm in Phemister operations and 1.6 mm in Bosworth operations. And these differences were not changed at follow up significantly. 2. The complications were two K-wire migrations, one superficial infection, and one recurred gross deformity after pin removal in Phemister operations and two mild upward migrations of screw after Bosworth operations. 3. We obtained similar good results after Phemister and Bosworth operations. But less complications were visible, and anatomical reduction and early ROM exercise were possible after Bosworth operations.

Mechanical Failure of Internal Fixation in Femoral Fractures / 대한정형외과학회잡지

Operative internal fixation of femoral fractures is widely accepted as the best method of treatment but the techniques are by no means devoid of complications, nor are they simple to execute. A method of treatment must be based on the analysis of the :"personality of the fracture", that is, the nature of the fracture and of patient. Mechanical failure such as metal failure, loosening of screw or nail after internal fixation, residual deformity, and nonunion, may impose serious problems on the surgeon and patient unless treatment is appropriate. The authors analyzed 14 mechanical failures of internal fixation in 12 femoral fractures from Dec. 1987 to Aug. 1992 in the department of orthopedic surgery, Ansan Hospital Korea University to study the possible cause of mechanical failure of internal fixation and pursue the way of reducing that complications and obtained the following results. 1. Eleven were males and one was female, most of them were in age of active life. 2. The level of fractures in 12 femorals were subtrochanteric in two, shaft in nine and supracondylar in one. 3. The time interval between internal fixation and failure in 10 failures was 5.5 months on average(range, 3month to 11months). It was uncertain in 4 failures. 4. Mechanical failure were presented as breakage in five plates, loosening of screw in five plates, loosening of screw in two DCP fixation, loosening of nail in one interlocking nail, bending of nail in one Kuntscher nail, one breakage and one bending in two condylar buttres plates, and cutting-out of hip screw in three compression hip screw. 5. The causes of failure were presumed to be improper surgical technique in 7 failures, inadequate selection of internal fixatives in 5 failures, and inadequate postoperative care in 1 case.

Traumatic Dislocation of the Knee / 대한정형외과학회잡지

Traumatic dislocation of the knee is an uncommon but serious injury associated with extensive soft tissue damage and the danger of neurological and vascular involvement. During the periods from September 1983 to September 1992, we had experienced 21 cases of the traumatic dislocation of knee at the Guro and Ansan Hospital, Korea University College of Medicine. The results obtained from this study were as follows ; 1. The age of initial dislocation varied from 11 to 79 years with the average of 32. 8 years and the ratio of male to female was 20: 1. 2. Dislocations were classified into 5 types which were anterior in 9, posterior in 4, medial in 1, lateral in 4 and rotatory in 2 cases and also unclassified in 1 case. 3. Causes of the injury were traffic accident in 9, sports injury in 7, fall down in 4 and industriai injury was 1 case. 4. Complications of traumatic dislocation of the knee included popliteal artery rupture in 3, compartment syndrome in 2 and peroneal nerve palsy in 4 cases. 5. All of ligamentous injuries were repaired and augmented except 2 cases which were treated conservating 10-14 days after trauma and all of the cases of arterial injuries were repaired with an autogenous vein graft. 6. Results were excellent 3, good 12, fair 4, and poor 2 cases by Marvin classification at the average 27 months after operation. 7. Prompt completion of vascular repair is critical to avoid amputation and also operative repair of injured ligaments seems to be good method to yield good results with the improved stability.

Operative Treatment of Femoral Shaft Fracture in Adult: Compression Plate Versus Intramedullary Nailing for Femoral Shaft Fracture / 대한정형외과학회잡지

The authors studied 54 patients (55 cases) of femoral shaft fractures treated by compression plate fixation and IM nailing from August 1986 to December 1991. The purpose of this study is to analyse comparatively the radiological and clinical results between the compression plate fixation and IM nailing in femoral shaft fracture of adult. The obtained results were as follows: 1. Among the 54 patients, the ratio of male and female was 44: 10, and the highest in cidence of age was between 3rd and 4th decades. 2. The main cause of injury was traffic accident in 38 cases. 3. The most common fracture type was B1-② in ten cases by AO-ASIF classification. 4. The mean duration of union was 13 weeks in compression plate fixation by the Koostra's criteria and the average 23 weeks in IM nailing by the Bjorens criteria. 5. The clinical result according to Margerl et al, was good in 25 cases (80.6%) with compression plate fixation and good in 20 cases (83.3%) with intramedullary fixation. 6. Complications of compression plate fixation were metal failure in 2 cases and deep wound infection in 1 case, and 1 case of femur neck fracture during operation and 1 case of metal failure in intramedullary fixation.

Intraneural Ganglion of the Peroneal Nerve: A Case of Report / 대한정형외과학회잡지

Intrsneural ganglion cysts of the peroneal nerve are rare. The precise etiology and pathological changes remain obscure. We have experienced recently a case of intraneural ganglion cyst developed in the sheath of the peroneal nerve. A 28 year old male had suffered from lump producing pain over the posterolateral aspect of the upper portion of the fibula, weakness of dorsiflexion of the ankle and of extension of the toes and diminution of sensation on the dorsum of the foot. He underwent excision of the ganglion and the prognosis for recovery of function is good.

Treatment of Unstable Intertrochanteric Fracture of the Femur: Cpmparision between Sliding Compression Hip Screw and Jewett nail Plate / 대한정형외과학회잡지

Commonly used internal devices to fix the stable and unstable intertrochanteric fractures are fixed nail plate (Jewett nail, Holt nail), sliding nail plate (compression hip screw) and intramedullary device (Ender, Harris nail). The choice of internal device is influenced by the general coditions of patients, the pattern of fracture and the personal preference of surgeon. There are many reports that sliding nail plate appears to give better result than fixed nail plate because the latter device leads to high failure rate. Twenty nine unstable intertrochanteric fractures treated with Jewett nail plate (group I) and sliding compression hip screw (group II) between 1981 and 1988 were reviewed after minimal twelve months follow up. Group I comprised of fourteen cases, Group II, of fifteen. There were seventeen males and twelve females. The ages ranged from thirty-two to seventy-eight years, the average age being 57.8 years. Eighteen cases were caused by slip down; eight, traffic accident; and three, fall down. The average operation time was 124 minutes in group I and 148 minutes in group II. The average amout of blood loss was 1024cc in group I and 1040cc in group II. The average time to union was 13 weeks in group I and 12.9 weeks in group II. In Jewett nail plate fixed group, there were three complication; one coxa vara, and superior migration of nail, and one subcapital fracture and one superficial wound infection. In sliding compression hip screw group, one was complicated with coxa vara. Above results suggest that the use of Jewett nail plate in unstable intertrochanteric fracture could be got good results with method using compression hip screw.