Free Digital Sensory Nerve Graft in Degloving Injuries of the Finger / 대한정형외과학회잡지

Degloving injuries of the fingers receive digital sensory nerve damage as well as digital artery damage together with degloving of the finger skin at the time of injury. Although the finger is well covered with skin and the joint motion has completely recovered after the injury, if there is no sensation in the finger tip problems remain. From October, 1982 to December, 1985 Dong San Medical Center, Keimyung University did free digital sensory nerve grafts on 11 cases using the sural nerve. Follow up studies which lasted from 10 to 39 months showed good results. Therefore this free digital nerve graft operation is considered to be a favourable mothod in obtaining sensation for digital degloving injuries.

The Effect of Total Radiation Dose on Normal Spinal Cord of Hybrid Mice: Early Pathological Changes / 대한치료방사선과학회지

Radiation myelitis is a rather rare, but irreversible fatal complication, Etiology, pathologic change, clinical symptoms and the method of diagnosis have been studies, pathogenesis of post-irradiation myelitis and the level of tolerance dose still remain controversial. Thoracolumbar spine of 110 hybrid mice were irradiated with orthovoltage x-ray machine. Mild capillary congestion and axonal welling were observed in 1,000rad irradiated specimens were also observed. These results suggest that 5,000 rad is not a completely safe tolerable dose which have been accepted and we cannot exclude direct radiation damage to nerve tissue as the causative pathology of radiation myelitis in addition to blood vessel damage.

A Clinical Study of Fat Embolism / 대한정형외과학회잡지

The fat embolism is a complication which occurs rarely in cases of long bone of lower extremity and pelvic bone fractures or after severe injury of soft tissue, and may result in an embolism in the lungs, brain, heart, kidneys and other important vessels when fat globules flow from bone marrow into such areas. There has been much adverse criticism about the pathogenesis of fat embolism including the incidence, diagnosis and treatment of it, and studies on this subject have been prevalent in recent years. The following results have been obtained through the study of 9 cases of fat embolism at the Department of Orthopaedic Surgery, Dong San Medical Center, Keimyung University during the period from 1973 to 1984. 1. By sex and age distribution, most of the patients were under the age of 40 and there were more male than female patients. 2. Seven cases were caused by traffic accidents and two were caused by falls accompanied by multiple fractures of the femur and pelvic bone. 3. Symptoms generally occured within 48 houres after trauma, however some cases were within 12 houres, some were 5 days and others 12 days. Clinical symptoms which were present at the time admission revealed increased erythrocyte sedimentation tates and decreased hemoglobin and platelete in most cases. Bilateral infiltrates and cotton ball appearances were found in all cases on thoracic radiology, but no fat globules were found in the urine or in frozen sections of clotted blood. 4. Blood gas analysis was performed in 4 cases and Pa02 under 60mmHg found in all cases increased gradually after treatment. 5. Of the 9 cases with fat embolism 6 cases completely recovered and three cases expired.

The Clinical Study of Subtrochanteric Fracture of the Femur / 대한정형외과학회잡지

The Subtrochanteric fracture requires long period healing time and is difficult for treatment because it occurs in bone that is predominantly cortical and high stress concentrates in this region. The Subtrochanteric fracture is difficult for the reduction and maintenance because many of these fractures are comminuted from high velocity trauma and the angulation rotation occurs by the influence of the surrounding large and powerful muscles. During the period of February, 1980 to April, 1985, 62 cases of Subtrochanteric fractures were admitted and treated at the Department of Orthopedic Surgery, School of Medicine, Keimyung University, and results were obtained as follows: 1. Of 62 cases, 42 in man and 20 in woman and diffuse in ages. 2. Causes of Subtrochanteric fractures were 32 cases of traffic accidents, 21 cases of fall or slip down, 5 cases of others, and 3 cases of pathologic fractures. 3. Of 62 cases, Type I by Zickel classification was predominant (33 cases), and Type III-A, “three-part spiral fracture“ by Seinsheimer was predominant (24 cases). 4. The better results can be achieved through the bone graft in severe comminuted fracture and through the provision of good cortical load-bearing medially between the fragment during the reduction and fixation. 5. Earlier bone union and low complication of metallic failure and nonunion were achieved with Compression Hip Screw rather than Jewett nail. 6. The causes for the 6 metallic failure cases were comminuted fracture of medial cortical bone, failure in contact and fixation of medial free fragment, and weight bearing before complete union was achieved. 7. There was a breakage in nail-plate junction when Vitalium jewett nail was used. Also there were breakage and loosening of screws when Stainless steel Jewett nail was used. 8. Further studies in the advantages and disadvantages of Zickel nail, Ender nail, Compression Hip Screw, and Kuntscher nail treatment of subtrochanteric fracture are needed.

Synovial Chondromatosis / 대한정형외과학회잡지

Synovial chondromatosis is an uncommon benign lesion characterized by metaplastic cartilage formation within the synovial connective tissue which disintegrates into the joint and continues to grow. Of the eight cases of synovial chondromatosis seen by the authors, three cases involved the knee, two of these were bilateral, three cases involved the elbow, one the hip joint and one the proximal phalanx of the right middle finger. The diagnosis of synovial chondroamtosis was made by histopathological findings of the excised mass. Most synovial chondromatosis cases obtained favorable results by removing masses from the joint and at the same time performing a partial synovectomy, except one case in which degenerative arth ritis had developed proeoperatively.

Treatment of Comminuted Fracture of Distal Humerus in Adults / 대한정형외과학회잡지

The majority of fractures of the distal humerus in adults involves the articular surface and also shows the shape of T or Y type and comminuted fracture, this type of fracture is rare in human fractures. The fracture of the distal humerus occurs more frequently in adults than children and has more complications and is more difficult to treat. There are various rnethods of treatments. The Orthopedic Surgery dept of Keimyung Univ. School of medicine has carried out the follow-up studies among 26 cases of inpatients with comminuted fractures, of the distal humerus (who have been admitted to the hospital) from the period beginning Jan, 1978 to May, 1983, and the results are as follows: 1. There were more frequently occured in male (53.8%), and mean age was 43.5 years. 2. There were no bilateral fractures and more common in right side (57.7%) 3. Traffic accidents were the most frequent cause (46.1%), followed by slipping down(38.5%), falls from height, and athletic injuries. 4. The Tyte IIl (50.0%) was most common by Riseborough and Radin classification followed by the order of type IV, type II and type I . 5. In the case of operative treatment, the duration of immobilization took a shorter period than with conservative treatment and the former showed a relatively good prognosis. 6. Better prognosis was obtained by using K-wire fixation, especially in the case of severe comminuted type IV fracture.

Clinical Study of Acetabular Fracutre / 대한정형외과학회잡지

No abstract available in English.

Bone Peg Fixation of the Femoral Head Fracture Associated with Posterior Dislocation of the Hip / 대한정형외과학회잡지

Seven cases of traumatic fractured femoral heads with posterior dislocation of the hip were treated at the Keimyung University Hospital between November 1973 and December 1981. All cases were followed from 6 months to 8 years. Five cases were caused by traffic accidents. The other two cases were caused by a landslide. In six cases, at first a closed reduction was performed under general anesthesia and the femoral head was reduced in the acetabulum, but in 5 of the 6 cases head fragments were not reduced. So, after one or more days, open reductions were performed on the remaining 5 cases by internal fixation with iliac bone pegs (two-four). In the remaining one case of the 6, who had a head injury and an intestinal rupture, after the closed reduction, one head fragment was reduced but not anatomically. But because of his poor general condition, conservative treatment was taken. During conservative treatment redislocation and displacement of the head fragment occurred at the 4th week after the closed reduction was done. So this case was also treated by the above method. The 7th case, who has an ipsilateral femoral neck and intertrochanteric fracture, was reduced by primary open reduction. By the classification of the Pipkins, there were 4 cases of Type I and Type II, III and IV each had I case. The post operative X-ray and follow-up study showed that two were classified as excellent, four as good and the one who had the ipsilateral femoral neck and intertrochanteric fracture (Pipkin's Type III) was classified as poor.

A Clinical Study of the Tibial Condylar Fractures which had Open Reductions / 대한정형외과학회잡지

The tibial plateau fracture is a fracture of the proximal end of the tibia, involving the articular surface and the supporting metaphysis of a major weight bearing joint. This fracture frequently accompanies soft tissue injury such as ligaments and menisci. So it often produces disability of the knee joint. Of the tibial plateau fractures which had been treated by open reductions at Keimyung University Hospital between May 1971 and December 1981, the 28 cases that were followed for 1 year to 3 years have been analysed according to its cause, classification, treatment and result. Open reduction is indicated in anyone with one or more of the following deformities as shown by roentgenograms: a compression greater than 6-8mm and a split greater than 5mm of the condyle. Anatomical considerations and a clinical end result study of the 28 fractures emphasize that the unacceptable results were from comminution of the fracture, associated soft tissue injury, osteoporosis, infection and other conditions that prevent early knee motion. Twenty-two cases (79 per cent) out of Twenty-eight revealed the rating of “ACCEPTABLE” according to Roberts criteria.

Osifying Fibroma of the Bibia / 대한정형외과학회잡지

Ossifying fibroma is a relatively rare benign primary bone tumor which arises typically within the jaw bones and only rarely affects the long bones. In 1966, Kempson first described ossifying fibroma of the long bones because the lesion has a histologic pattern like the ossifying fibroma of the jaw. This rare lesion resembles monostotic fibrous dysplasia but can be differentiated from it on histologic and clinical grounds. Histologically, ossifying fibroma is characterized by osteoblasts rimming spicules of bone within a fibrous stroma with evidence of lamellar transformation of bone, and clinically by frequent recurrence and aggressive progression of the lesion. Because of its rarity, we present a case of ossifying fibroma which arised in the right tibia of a 34 month old boy.

Clinical Study of Acetabular Fractures / 대한정형외과학회잡지

Acetabular fractures are relatively uncommon, but when they occur they often result in permanent disability due to management difficulties. Undisplaced acetabular fractures have a good prognosis but major displaced acetabular fractures have always given rise to difficulty and concern during treatment and have a variable prognosis in different reports. In order to restore excellant function to a displaced acetabular fracture, anatomic open reduction and secure internal fixation followed by early mobilization are neccessary. And in order to approach fracture of acetabulm safely and with maximum ease, it is neccessary to understand the pathologic anatomy. The authors studied the sex and age distribution, clssification according to roentgenographic findings, associated injuries and methods of treatment of 49 patients who were admitted to the department of orthopedic surgery of our hospital from January, 1976 to June, 1981 under the diagnosis of acetabular fracture. The results of treatment of 31 patients who were followedup over a 6month period were as follows: 1. The mean age was 37 years, the range being from 17 to 71. 2. The most common cause of injury was traffic accidents (38 cases: 77.6%) which was followed by falls from heights (5 cases;10.2%). 3. Thirty cases were treated by conservative mea ures and 19 by surgery. The results were as follows: Excllent-10(32.3%), Good-14 (45.2%), Fair-6(19.3%), Poor-1 (3.2%), 4. The one case that had a poor result was a “T” shaped fracture with a central dislocation, which was impossible to reduce surgically due to severe comminution. 5. If the grossly displaced fragments are present they should be reduced and fixed surgically. But only if anatomical reduction and secure internal fixation is possible, surgery should be done. With a severely comminuted fracture, medial wall fracture, or central fracture-dislocation, surgical treatment is difficult therefore conservative treatment is better. 6. It is of great help to have various methods of roentgenography, conventional tomography, and computed axial tomographic scan in order to understand the pathologic anatomy of complicated acetabular fractures. 7. If surgery is attempted, it is essential to achieve an anatomic reduction and firm fixation by fully understanding the pathologic anatomy and by choosing an appropriate approach and fixative device.

Synovial Chondromatosis / 대한정형외과학회잡지

Synovial chondromatosis is an uncommon benign lesion characterized by multiple cartilagenous and osteocartilagenous nodules of the synovium and loose bodies. The affection is monoarticular and most commonly involves the knee and has an unknown etiology. Of the five cases of synovial chondromatosis experienced by the authors, both knee joints were involved in a case, two the elbow joint, and one the proximal phalanx of the left middle finger. The diagnosis of synovial chondromatosis was made by the histopathological findings of the excised masses.

Clinical Observation on the Primary Bone Tumors / 대한정형외과학회잡지

A total of 189 cases of primary bone tumors reviewed and analysed clinically and pathologically at the Department of Orthopedic Surgery, Presbyterian Hospital, Taegu, Korea during the 15 years period from july, 1964 to june, 1979. The results were obtained as follows: 1. In 189 cases of primary bone tumors, 87 cases (46%) were benign and 102 cases (54%) were malignant. 2. Osteochondroma was the most common benign bone tumor (31.0%) and followed by simple bone cyst (14.9%), enchondroma (14.9%) and giant cell tumor (13.8%). 3. Osteosarcoma was the most common primary malignant bone tumor (45.0%) and followed by fibrosarcoma (17.7%) and chondrosarcoma (12.8%). 4. 22 cases were solitary and 5 cases were multiple Iesions of osteochondroma. The knee joint area was the most common site of osteochondroma (59.2%) and peak incidence was in the second decade. 5. Simple bone cyst was 13 cases. The sex distribution of simple bone cyst showed 5.5 times of the male predominence. The knee joint area was the most common site of simple bone cyst (76.9%) and its peak incidence was in the first and second decade (61.5%). Seven of 13 cases of simple bone cyst were seen pathological fracture and three of its cases were recurred. 6. In 13 cases of enchondroma, 6 cases were solitary and 7 cases were multiple lesions. The common site was phalanges of the hand and its peak incidence was in the second and third decade of life. 7. Giant cell tumor was 16 cases and to be divided into pathologically Grade 1 & 11 12 cases (75%) and Grade III 4 cases (25%). The sex distribution of giant cell tumor was 8 males and 8 females. The average age of giant cell tumor was 36.1 years with the peak incidence in the third and forth decade of life. 8. The average age of osteogenic sarcoma was 23.1 years with the peak incidence in the second decade of life. The sex distribution of osteogenic sarcoma was 25 males (54.3%) and 21 females (45.7%). The common sites of osteogenic sarcoma were distal femur and proximal tibia and proximal humerus in 41 cases (89.1%). 9. The average age of fibrosarcoma was 28.1 years with the peak incidence in the second and third decade of life. The sex distribution of fibrosarcoma was 12 males (66.6%) and 6 females (33.3%). The common site of fibrosarcoma were femur and tibia in 9 cases (50%). 10. Chondrosarcoma were 13 cases. The sex distribution of chondrosarcoma showed 5.5 times of the male predominence. The knee joint area was the most common site of chondrosarcoma (46.1%) and its peak incidence was in the third and forth decade of life.