A Clinical Analysis of Suparacondylar Fracture of the Femur in Adult / 대한정형외과학회잡지

The treatment of supracondylar fracture of the femur remains a difficult problem because of the wide range of portential complications. In the past, authors thought conservative treatment was superior to operative treatment of supracondylar fracture of the femur. In addition, the advent of the Cast-Brace introduced the change in concept of the conservative treatment. Recently, however, the advances in the techniques and in the devices used in intemal fixation have encouraged the operative treatment. Tibiofemoral angle, gap or stepping of the articular surface of the distal femur, range of motion of the knee, and pains in the knee were used to evaluate the following results investigated by statistical study(T-test). These clinical results were shown by analyzing 49 cases of supracondylar fracture of the femur trea ted in the Department of Orthopedic Surgery, Hallym College of Medicine, from Jan. 1980 to Dec. 1983 1. We end result of each patient was evaluated by scaled score value calculated from above mentioned criteria. 2. The mean value of the operative treatment(35 cases) was 31.03±5.52, while that of the conservative treatment(14 cases) was 27.71±4.56. 3. The mean value of the group which began the exercise of the knee joint within 2 weeks (33 cases) was 32.24±4.43. The mean value of the other group which began the exercise of the knee joint after 2 weeks(16 cases) was 25.78±4.56. This difference of means between two groups was statistically significant. Beginning the knee joint exercise within 2 weeks has large effect on the result of the treatment. 4.The results of treatment in patient over age of 50 were graded as fair irrespective of methods of treatment. 5. Various devices were used in intemal fixation but there was no difference in the results. 6. We mean value of the Tibiofemoral angle(difference from normal angle) in the operative treatment was 2.37±6.25 and that of the conservative treatment was 8.04±4.62. Both of the above method of treatment showed a varus trend, especially in the conservative treatment. In statistical study, through, there was no significance in two methods.

A Clinical Study of the Fractures of the Femoral Neck in Children / 대한정형외과학회잡지

Fractures of the femoral neck in children are rare and usually occur as a result of severe trauma. They are one of the most challenging injuries to treat. Their complication rate is high and their anatomic and physiologic characteristics make treatment difficult. The commonly encountered complications are avascular necrosis, nonunion, coxa vara and premature fusion of epiphyseal plate. Treatment of these fractures remains an unsolved problem but accurate reduction held with adequate internal fixation would appear to offer the best chance for succesful results. We report our observations in the treatment of eighteen cases of fracture of the femoral neck in children. Included is a review of references. The results obtained are as follows: 1. Among 18 patients, 11 were boys and 7 were girls. the highest incidence was between the ages of 5 and 7 years. 2. The main causes of fractures were traffic accidents in 10 cases (55.5%), falling from a height, and slipping down. 3. The commonest type of fracture was the cervicotrochanteric type (47.4%). Twelve cases were displaced fractures (66.7 %). 4. The range of Pauwels angle varied from 20° to 70°. 5. The commonly associated injuries were pelvic bone fractures, extremity fractures, skull fractures and soft tissue injuries. 6. Nine cases were treated by skin traction and plaster cast. Five cases ere treated by closed reduction and internal fixation with K-wires or knowles pins. 7. In 13 of the 18 cases, follow-up studies were done for an average period of 18 months. 8. The results were analyzed according to the Ratliffs assessment. Among the 13 cases, 10 cases showed good results, two fair and one poor. 9. All cases treated by closed reduction and internal fixation showed good results without complications. 10. Complications developed in five cases (38.5%), three cases of avascular necrosis and two cases of coxa vara. Among these five cases, one case of avascular necrosis developed as a result of neglect of the fracture and the others as a result of too conservative a treatment. 11. Secondary treatment of trochanteric arthroplasty was required in only one neglected case. This was further by avascular necrosis and the results were poor. 12. As a result, we recommond closed reduction and internal fixation as the most favorable method of treatment for the fracture of the femoral neck in children.

Surgical Management of Bone Infection (14 Cases Treated by papineau's Method) / 대한정형외과학회잡지

Papineau's technique represents an excellent method of dealing with serious bone infections with significant bone and soft tissue loss. The procedure is carried out in three stages: the 1st stage is the excision of infected bone and soft tissue, stabilization of the fracture site, the 2nd stage is the cancellous bone grafting, and the 3rd stage is the skin coverage. During the period from June 1980 to September 1982, our limited experience with 14 cases has been extremely satisfactory; 1. This method is applicable to traumatic osteomyelitis and some cases in which the infection has been blood borne. 2. Successful bone grafting in the presence of infection depends upon; a. complete sequestrectomy and removal of all infected tissue b. an adequate vascular bed for the graft c. no dead space d. sufficient immobilization.

Spinal Stenosis: Review of 40 Cases / 대한정형외과학회잡지

Spinal stenosis is defined as any type of narrowing of the main spinal canal, nerve canal or foramina caused by bony or sourrounding soft tissues. Its pressure symptoms are characterized by ill localized back pain, and usually bilateral chronic sciatica. During the past 80 years, the knowledge subjected to the spinal stenosis has been inproved but still many problems are remaining to be solved. Recently, the diagnosis and treatment of spinal stenosis have been facilitated due to introduction of computerized tomographic scanning apparatus. During the period of 3 years, from May 1979 to March 1982, we experienced 40 cases of spinal stenosis at Han Gang Sacred Heart Hospital and Gang Nam Sacred Heart Hospital. In study of this 40 cases clinical and radiological evaluation were made and obtained following result (25 cases of which were operated on). 1. The most common type was degenerative one (50%) 2. There were 16 males and 24 females (4:5) 3. The age distribution showed a peak incidence is the third decade (25%) 4. The most common chief complaint on admission was ill localized chronic sciatica (50%) 5. Decompressive surgery was carried on 25 cases such as; Laminectomy only (8%), Posterolateral fusion (20%), Both Laniinectomy and posterolateral fusion (72%) 6. The longest follow-up was 3 years and the shortest one was 4 months and the average was one year and four months. The outcome of follow-up were; excellent (52%), good (40%), fair (8%), poor (0%).

A Case Report of Clear Cell Sarcoma in Thigh / 대한정형외과학회잡지

Malignant tumors arising from tendon and aponeurosis are very rare. Among those reported most have been interpreted as synovial sarcoma or fibrosarcoma until Enzinger in 1965 described a new type which he called “Clear Cell Sarcoma of Tendon and Aponeurosis”. The tumor has a uniform and distinctive clinical and morphological pattern which distinguishes it from other groups of tenosynovial tumors. The problem of its histogenesis remains, especially its relation to synovial sarcoma. In this paper, we reported one case which is believed to be “Clear Sarcoma in the thigh”.

Vitamin D Resistant Rickets / 대한정형외과학회잡지

The discovery and synthesis of vitamin D and the elucidation of the role of sunlight in the activation of the vitamin D precursors changed the syndromes of rickets from a therapeutic enigma to a socioeconomic and public health problem. Since Albright in 1937 first described vitamin D resistsnt rickets, which did not respond to treatment with the usual dose of vitamin D, it has progressively become a common form of rickets in practice. In addition, as the result of increasing understanding of renal physiology and careful investigation, a spectrum of renal tubular abnormalities have been identified which cause clinical rickets and which in many cases are insensitive to even large doses of vitamin D. We have reported a case of an unusual form of vitamin D resistant rickets which did not easily respond to treatment with high doses of vitamin D and was associated with hypocalcemia in multiple pathologic fractures in the lower extremities of the patient.

A Study on the Sourcees of Postoperative Wound Infection in Patients with Open Fracture / 대한정형외과학회잡지

The purpose of this paper is to define the bacterial sources of wound infection after surgery including debridement for open fractures. Total number of patients were 123 during surgery July 1975 to Oct. 1976 at Hangang Sacred Heart Hospital. Out of 123 cases 17 were infected postoperatively. Serial bacterial cultures were performed for specimens taken from the contaminated wound in emergency room and by exposing the Petri-dishes in the operating room. Additional cultures were carried out for 17 specimens taken from the infected wounds postoperatively. Positive bacterial cultures from the initial wounds were obtained in 71 cases (57.7%) out of 123 contaminated wounds in emergency room. Setting monitoring of air contamination in conventional operating room, 51 colonies of bacterial growth per 1 hour exposure were noted and common organisms were colliform bacilli, streptococci and staphylococci in order. Postoperative wound infection rate was 13. 8%. Common pathogens were staphylococcus aureus, coliform bacilli and pseudomonas and kanamycin was most effective antibiotics. The retrospective bacteriological studies for 17 infected cases elucidated following results: 1) Organisms of same species; from initial wound and infected wound postoperatively 7 cases 2) Organisms of same species; from air contamination in the operating room and infectected wound postoperatiyely 5 cases 3) Organism of same species; from air contamination in the operating room, initial wound and infected wound postoperatively 1 case 4) Others (contagious or endogenous origin) 4 cases The results reveal that the initial contaminated open fracture and air contamination during surgery are the main sources of postoperative infection. Four cases which the infectious sources were not determined included in contagious origin dogmaticaIly.