Experimental Study of Distraction Epiphysiolysis: Rabbit Model / 대한정형외과학회잡지

Shortening and angular deformities in children are one of important orthopedic management problem. Conceptually, lengthening of the short side in treatment of limb length inequality is, in most instance, the most attractive approach to this problem. Throughout the evolution of lengthening procedures, the method that has remained most consistently acceptable is osteotomy followed by gradual distraction. However, the idea of increasing the length of or modifying the axis of s bone during growth by means of distraction of the grwoth plate is relatively new. Recently, Monticelli and Spinelli have had experience with a new and novel method of lower limb lengthening by physeal distraction. We have studied the results of effect of distraction epiphysiolysis and the use of nonsteroidal anti-inflammatory agents to impede bone bridge as well as premature epiphyseal closure. There are some reports in which indomethacin could prevent reformation of a bone bridge between the epiphysis and metaphysis without inhibiting normal growth and bone remodeling. For this study, a total of 30 rabbits with an initial weight of about 600 gram was used. At operation two K-wires(l.lmm in diameter) were drilled percutaneously on parallel trscks through the epipaysis and diaphysis of proximal tibia. Epiphyseal distraction of Turnbuckle type designed at our school was applied on each side of K-wire insertion at the tibia. The correct position of pin was confirmed by radiography and the rate of distraction is 0.5–1mm per day. Distrsction was continued for 3–6 weeks and radiographs was taken every 2 weeks. Some rabbits was sacrified sfter removal of distractor. Through these examination, following results were obtained. 1. Seperation of the epiphysis from the metaphysis occurred after average 3 days, and it always occurred in the zone of provisional calcification. 2. Short term results of growth plate distraction looked promising and longer limbs were seen, but long term results were unsstisfactory with premature epiphyseal closure and bone bridge formation occuring in many cases. 3. The role of indomethacine to impede bone bridge formation across the seperated growth plate could be observed, and was found that shortening could be possibly decreased. 4. Distraction epiphysiolysis would be one of valuable leg lengthening procedure at an age when the subjects bone growth is nearly complete, and also the administration of indomethacin with growth plate distraction might be effective to diminish the significant Change of shortening or angulation in high-risk juvenile fractures.

A Clinical Study of the Tibial Plafond Fractures / 대한정형외과학회잡지

Fractures of the ankle joint that involve the tibial plafond result from axial compression and rotational forces causing variable degrees of rnetaphyseal disruption, articular damage, and malleolar displacement. Management of these fractures has been described as difficult and often discouraging. Recommended treatments have included manipulation and cast application, calcaneal traction using pins in plaster or external fixators, vertical transarticular pin fixation, percutaneous pinning of large fragments and immobilization in a plaster cast, fibular stabilization alone, limited open reduction of so-called key fragments, immediate motion with the foot in traction, primary arthrodesis, and even immediate amputation. But, the best results of treatment reported for this fracture have followed early open reduction and rigid internal fixation to restore length, reconstruction of the plafond, primary cancellous bone grafting, tibial buttress plates, early motion, and prolonged non-weight-bearing. We reviewed 40 cases of tibial plafond fractures treated at the Department or Orthopaedic Surgery, Yonsei University, Wonju College of Medicine, during 7 years from January 1980 to December, 1986. The longest duration of follow-up was 5 years and 4 months, the shortest one was 6 months, and the average was 2 years. The results were as follows: 1. Of the 40 cases, male were 32, female were 8. 2. The major causes of the injury of the ankle were fall down and traffic accident. 3. The tibial plafond fractures were classified into 5 types, according to the degree of displacement of the plafond, articular comminution, and metaphyseal disruption. Our cases were relatively in even distribution. 4. Regardless of the types of the fracture, better results were obtained by treatment with open reduction and rigid internal fixation than by any other ones. 5. Complications including superficial wound infection (4 cases), osteomylitis. (2 cases), delayed union (2 cases), non-union (2 cases) were observed. 6. This study suggest that the important variables that influenced the clinical result were the type of fracture, the method of treatment, and the quality of the reduction.

Clinical Study of Traumatic Fracture and Dislocation of the Elbow Joint / 대한정형외과학회잡지

The elbow joint is the most commonly dislocated-joint in the body except for the shoulder, and in children less then 10 years old, it is the most frequently dislocated articulation. The injury and the treatment are well described in most standard textbooks, but the characteristic findings and follow-up evaluations are not generally recognized. Authors have clinically analyzed 45 cases of traumatic fracture and dislocation of the elbow joint which are treated between January, 1975 and June, 1985 at the Department of Orthopedic Surgery, Wonju Medical College of Yonsei University. The results were as follows; 1. The age incidences were in even distribution except in the old ages where the incidence was low and the male to female ratio was 7: 3. 2. The major cause of the injury of the elbow was fall down (60%). 3. Posterior and posterolateral dislocations were about 60% of all cases. 4. Associated fractures were 35.6% of all the elbow dislocations, of which medial epicondyle fracture had the highest incidence. 5. Complications including ulnar nerve injury (3 cases), median nerve injury(1 case), radial nerve mjury(1 case), rupture of brachial artery(2 cases), recurrent dislocation(1 case) and calcification of ligament(2 cases) were observed. 6. Pure elbow dislocation occurred in 13 cases (28.9%). 7. The average immobilization period for patient with non-operative treatment (45%) and operative treatment(55%) were 7 days and 3 weeks, respectively, and much better results were seen in patients with non-operative treatment than in operative treatment and in shortened immobilization period.