Avulsion Injury of Lumbosacral Nerve Roots Associated with Femur Fractures: A case Report / 대한정형외과학회잡지

Avulsion of cervical nerve roots by traction injury to the shoulder girdle is well known, but, on the other hand, traumatic avulsion of lumbosacral nerve roots is exceedingly rare. The rarity of avulsion of lumbosacral nerve roots reflects the natural laxity of the roots and the strength and stability of the bony pelvis which offers support and protection to the nerve roots against stretching and rupture during trauma. We experienced a case of avulsion injury of L-S nerve roots associated with femoral shaft fracture. The myelography and C-T findings demonstrated multiple pseudomenigocele of dural sac at the level of the right L2, 3, 4, 5 and Sl S2 nerve roots.

The Treatment of Tibial Shaft Fractures by Closed Kuntscher I / 대한정형외과학회잡지

Frature of the tibial shaft is the most common fracture of the long bone and the treatment has become one of the most controversial subjects in orthopedic surgery. 61 cases of tibial shaft fracture in adults were treated by closed Kuntscher I-M nailing at the department of Orthopedic Surgery, Dae-Jeon Eul-Ji Hospital during 5 years from January, 1983 to December, 1987. In this paper we are reporting our result of 52 selected cases which we could follow up more than 6 months. The results were as follows. 1. The mean duration of clinical bone union was 9.6 weeks and that of radiological bone union was 15.6 weeks. 2. 6 cases of complication were noted with a little impairment of function finally. The complication were ankle joint stiffness(2), superficial infection(1), irritation of protruded nail(2) and bursting fracture(1). 3. Closed Kuntscher and occasionally combined interlocking I-M nailing are relatively short operative procedure with rigid fixation, low complication, wide indication and early weight bearing. So we consider them to be good methods of treatment for tibial shaft fractures.

Congenital Absence of Extensor Indicis Proprius Tendon, Bilateral: A Case Report / 대한정형외과학회잡지

The congenital absence of the extensor indicis proprius tendon was never reported but authors experienced one case of bilateral absence of the extensor indicis proprius tendon and treated by transfer of the extensor digiti quinti with good result.

Surgical Treatment of Spondylolisthesis with Knodt's Distraction Rod Instrumentation: Comparative Study with Fusion in situ / 대한정형외과학회잡지

The basis of surgical treatment of spondylolisthesis lies in the restoration of stability to the unstable spine and the decompression of the entrapped nerve root. Knodt's distraction rod has been thought to be one of effective distraction instruments promoting fusion for lumbar spine surgery. From December 1981 to May 1987, we performed surgical treatment of spondylolisthesis with Knodt's distraction rod instrumentation in 15 patients (Group I ) and fusion in situ in 7 patients (Group II ). Clinical analysis and changes of radiographic measurements of above two methods were evaluated and obtained following results. l. In Group I, the percentage slip and slip angle decreased to 12.1 ±6.3% and 0.2 ±6.6°, postoperatively, from 20.9 ±8.4% and 7.5 ±5.6°, respectively. In Group II, changed from 13.4 ±9.4%, 7.8 ±6.1°to 11.4 ±9.6%, 11.0 ±5.2°, respectively. 2. In Group I, the average reduction rate was 42.1% postoperatively, but decreased to 20.5% at follow-up. 3. The percentage posterior disc height increased to 49.0 ±6.7% postoperatively, from 27.4 ±10.0% in Group I and decreased to 34.7 ±5.3% at follow-up. But, in Group II, no significant changes observed. 4. The lumbar lordosis in Group I and Group II, decreased to 26.0 ±8.3°and 29.8 ±13.8°, postoperatively, from 35.5 ±7.8°and 37.6 ±1.4°, respectively. 5. There was no significant difference in clinical results between two groups. 6. Postoperstive complications in Group I, were one case of rod breakage with pseudarthrosis, 3 cases of voiding difficulty and superficial wound infection, in Group II, were 2 cases of superficial wound infection and 3 cases of transient voiding diffeculty.

A Clinical Study of Fracture and Dislocation of the Cervical Spine / 대한정형외과학회잡지

The cervical spinal injuries may impose a fatal result or permanent neurological disability according to the severity of injury. Authors performed a clinical study consisting of 54 patients who have visited Daejeon Eulji General Hospital for the care of fracture and dislocation of the cervical spine from May 1981 to Jan. 1986, and obtained the following results. 1. The prevalent age distribution was between third and forth decade and the ratio between male and female was 3.5:1 and the most common cause of injury was traffic accident(53.7%). 2. The most common site of injury was CS, 6(22.2%) and the most frequent mechanism of injury was Aexion-rotation type(55.0%). 3. At initial examination, 39 patients(72.2%) had neurological damage and among these, 18 were complete paralysis below the level of injury, 12 were incomplete paralysis, 9 were nerve root injuries. 4. Operative treatment was performed on 24 patients, these were Rogers' posterior fusion on 19 patients, Brooks and Jenkins' atlantoaxial fusion on 3 patients, occipitocervical fusion on 1 patient and excision of hactured fragment on 1 patient. 5. There were no evidences of neurological recovery in completely paralyzed patients, but among incompletely paralyzed and nerve root injured patients, neurological recovery was found in 57.1% of conservatively treated patients and in 71. 4% of operated patients. 6. Radiological stability was found in entire patients who received operative treatment, but, in conservatively treated patients, remained 1 late instability.

Closed Intramedullary Nailing of Femoral Shaft Fractures / 대한정형외과학회잡지

Since May 1981, the standard method of treatment of the femoral shaft fractures at the Daejeon EuIji Deneral Hospital has been the closed intramedullary nailing technique of Kuntscher. We performed intramedullary nailing on thirty-five fractures of femoral shaft in 35 patients. Closed intramedullary nailing was used in twenty-eight femora and open intramedullary nailing with cerclage wiring in seven fractures, in which large butterfly fragment was present, precluding control of rotation or length, or both. The overall rate of union was 97 percent. The range of motion of the knee at follow up was good in 80%, fair in 14%, poor in 6% (Good Full extension; loss of flexion less than 10 degrees. Fair Any loss of extension;loss of flexion of 10 to 50 degrees, Poor Loss of more than 10 degrees of extension; range of flexion-extension less than 90 degrees). The advantages of this technique include the negligible risk of infection, the rapid stabilization of fracture, thus facilitating management of other associated injuries, the rapid return of function of the knee, and early union of fracture and return to work. It is authors' opinion that when proper equipment and expertise are available, than closed intramedullary nailing is the treatment of choice not only for simple uncomminuted fracture of the femoral shaft but also for open comminuted fractures.