ABSTRACT
The report on compression neuropathy of the ulnar nerve at the elbow was first submitted by Panas in 1878. Therafter many authors have reported on etiology, pathoanatomy, method of treatment and prognosis of tardy ulnar nerve palsy. But there are some controversies about method of treatment and prognosis. We reviewed 15 patients of tardy ulnar nerve palsy resulted from the fracture of the lateral condyle of the humerus during the growing period. The result obtained are as follows. 1. All 15 patients with tardy ulnar nerve palsy were resulted from non-union of lateral condyle and cubitus valgus deformity. 2. Average carrying angle was 28 degrees. 3. Intial symptoms were pain and paresthesia of the hand in all 15 patients. Eight of them also had atrophy of intrinsic muscle and seven patients had clawing deformity of fingers. 4. Preoperative severity of ulnar neuritis according to Osborne's classification was Grade I; 1 case, Grade lI; 6 case, Grade III; 8 cases. 5. Submuscular transposition of ulnar nerve was performed in 11 and subcutaneous in the other 4 patients. 6. In all patient, pain was markedly improved within a few months after transposition of nerve. Improvement of hypothenar atrophy was obtained in 5 out of 8 and interosseous atropy in 3 out of 7 cases. Clawing was improved in 5 out of 8 cases. 7. Postoperative status of ulnar neuritis by Osborne's criteria was Normal; 1, Grade I; 4, Grade II; 7, Grade III; 3 cases. 8. Postoperative complications were decreased sensation in the medial aspect of forearm in 3 cases and recurrence of nerve compression symptom in 1 csse. 9. Internal neurolysis with anterior transposition of nerve would be recommandable in Grade III severe ulnar neuritis and in case of firm consistency of nerve at the operative field.
Subject(s)
Animals , Humans , Atrophy , Classification , Congenital Abnormalities , Elbow , Fingers , Forearm , Hand , Hoof and Claw , Humerus , Methods , Paresthesia , Postoperative Complications , Prognosis , Recurrence , Sensation , Ulnar Nerve , Ulnar NeuropathiesABSTRACT
Fractures of the femoral neck in children are uncommon and usually occur as a result of severe trauma due to their anatomical and physiologic characteristics. There are many difficulties during the treatment period and high incidence of complications such as avascular necrosis, coxa vara and premature epiphyseal closure. Twenty-three cases of fractures of the femoral neck in children which were treated at Kyung-Pook National University Hospital from Aug., 1980 to May, 1989 were analyzed both clinically and radiologically. The results were as follws: l. Among the 23 cases, higher incidence was in girls(13 cases, 56.5%) and the highest incidence was between the age of 11 and 13 years(8 cases, 34.8%). 2. The main cause of fracture was traffic accident(16 cases, 69.6%). 3. The most common type of fracture was the transcervical type(9 cases, 39.1%) and 17 cases (73.9%) were displaced fractures. 4. Associated injuries occurred in 13 cases(56.5%), and the common associated injuries were extremity fractures, head injuries and pelvic bone fractures. 5. Minimally displaced 7 cases(30.4%) were treated by closed reduction & internal fixation, and neglected, irreducible 15 cases(65.2%) by open reduction & internal fixation and undisplaced intertrochanteric fracture(1 case) by closed reduction & hip spica cast. 6. Twenty-three cases were followed from 8 months to 9 years and average period of follow-up studies was 28 months. The results were good in 5 cases(71.4%), fair in 2 cases (28.6%) in closed reduction & internal fixation, and good in 9 cases(60%), fair in 2 case(13.3%), poor in 4 cases(26.7%) in open reduction & internal fixation. 7. Complications were developed in 11 cases(47.8%), and premature epiphyseal closure were in 7 cases(30.4%), and avascular necrosis were in 6 cases(26.1%), and coxa vara were in 3 cases (13%), and delayed union was in 1 case and infection was in 1 case. 8. As a result, we recommend early closed reduction & internal fixation as the favorable method of treatment for the fracture of the femoral neck in children better than open reduction & internal fixation or conservative methods.
Subject(s)
Child , Humans , Clinical Study , Coxa Vara , Craniocerebral Trauma , Extremities , Femur Neck , Follow-Up Studies , Hip , Incidence , Methods , Necrosis , Pelvic BonesABSTRACT
Scaphoid fracture is the most common carpal bone fracture and its treatment is frequently delayed due to difficulties of diagnosis. Nonunions and avascular necrosis are commonly developed due to peculiar blood supply. Though most of the undisplaced fracture, diagnosed early, can be managed easily by plaster of Paris immobilization, many cases of delayed diagnosis, displaced fractures and nonunions are difficult to treat and its outcome is not uniform. Ruse reported good results by iliac bone graft via volar approach and several internal fixation methods are reported such as K-wire, compression screw, Herbert screws etc. Recently, many suthors advocated accurate anatomical reduction in fear of volar and dorsal intercalary segmental instability. We reviewed 30 cases of scaphoid fracture at the department of orthopedic surgery, Kyungpook national university hospital, from June, 1986 to April, 1989 and obtained the following results. l. Among 30 cases of scaphoid fractures, 27 cases(90 %) were males. 2. Twenty one cases(70%) were between second decade and third decade. 3. The fracture mechanism is hyperdorsiflexion of the wrist during slip down or fall down in 21 cases(70%). 4. Right side is 17 cases(57%) and left 13 cases. Middle 1/3 fracture occupies 24 cases(80%) in anatomical location. 5. Among 15 cases of the fresh fracture, 11 cases(93%) attained bone union by plaster pf Paris immobilization. 6. Among 18 cases of operation, 3 cases were acute transscaphoid perilunar dislocation(TSPD), 1 case was delayed TSPD, 5 were delayed unions and 9 were monunions. Operative methods were Herbert screw fixations in 8, Herbert screw fication with iliac bone graft in 4, Russe's bone grafts in 6 cases. 7. The results of the treatment were classified according to the bone union status and range of motion of the wrist. In operative treatment, excellent and good results were obtained in 6 and 11 cases respectively, poor result in 1 case. In conservative treatment, excellent and good results in 6 and 5 cases respectively, fair in 1 case.
Subject(s)
Humans , Male , Calcium Sulfate , Carpal Bones , Clothing , Delayed Diagnosis , Diagnosis , Immobilization , Necrosis , Orthopedics , Range of Motion, Articular , Transplants , WristABSTRACT
The carpal tunnel syndroms is the most common peripheral nerve entrapment syndrome. The typical symptom is pain, numbness and paresthesia in the median nerve territory of the hand and progressive thenar atrophy. When the symptom is mild and its duration is short, conservative treatment such as splinting or local steroid injection is considered, but when neurological deficit is promiment and conservative treatment is not effective, surgical decompression is indicated.Authors reviewed 15 patients (23 cases) of carpal tunnel syndrome treated with surgical decomression at the Department of Orthopedic Surgery, Kyung-pook National University Hospital from March 1983 to October 1988. The follow up results are as follows; 1. Preoperatively, Tinel sign was present in 17 cases. Phalen test was positive in 17 cases. Sensory disturbance was present in 8 cases. Thenar muscle atrophy was present in 19 cases. Motor weakness was present in 13 cases. 2. Preoperatively, delay of motor conduction velocity of median nerve was noted in 15 cases (65.2%) and sensory nerve conduction velocity in 20 cases (86.9%). Denervation findings such as fibrillation or sharp waves were seen in 15 cases (65.2%). 3. The operative findings were as follows; Synovial hypertrophy in 12 cases, hypertrophy of transcarpal ligament in 4 cases, pseudoneuroma in 3 cases, ganglion in 2 cases, neurilemmoma in 1 case, gout in 1 case. 4. As the operative findings, median nerve had evidence of compression beneath the transcarpal ligament, consisting of flattening. narrowing and decreased epineurial vascularity. 5. External neurolysis was performed in all cases. 6. In case of long duration and severe thenar atrophy, internal neurolysis would be recommendable. 7. Fllow up period was ranged from 7 months to 6 years. 8. 19 cases (82.6%) were excellent or good results.
Subject(s)
Humans , Atrophy , Carpal Tunnel Syndrome , Decompression, Surgical , Denervation , Follow-Up Studies , Ganglion Cysts , Gout , Hand , Hypertrophy , Hypesthesia , Ligaments , Median Nerve , Muscular Atrophy , Neural Conduction , Neurilemmoma , Orthopedics , Paresthesia , Peripheral Nerves , SplintsABSTRACT
The search for useful bone graft substitutes historically has focused on biologic alternatives. TCP has a 36% porosity and variable pores ranging from 100 to 300µm in diameter. They are biocompatible, easy fabricated into any size or shape, and offer a chemical environment and surface conductive to new bone formation. The porous scaffolding of the TCP permits rapid bone ingrowth. Gradual replacement of the ceramic with mature remodelling bone is noted as bioresorption of the TCP proceeds. The author investigated with TCP to evaluate the effect on the healing process of canine femoral bone defect as a bone graft substitutes. Five mongrel dogs(12Kg) were used in this study. Two holes(3.5mm) were created artificially with drill on the lateral surface of both right and left distal femora metaphyseal area in each dog under general anesthesia with nembutal. After creating artificial bone defects, 1 bone defect hole was filled with biodegradable TCP ceramic and adjacent other one was used as a control site wthout filling any implant material. The interval of each observation was 4, 6, 8, 10, 12 weeks after implantation and examined by means of radiology, histology with light and electron microscope. The results obtained were as follows; 1. Lamellar bone was formed around TCP 8 weeks after implantation. 2. In peripheral areas of TCP, collagen fibers, cytoplasm of osteoclasts & osteoblasts present in micropores of TCP. Osteocytes appeared around TCP with time. 3. In central areas of TCP, amorphous matrix was deposited in micropores in the early phase(4 weeks), but later collagen fibers & cytoplasmic processes appeared. 4. Osteoclasts were collected around TCP granules. Size of TCP granules in the periphery was gradually decreased. 5. Foreign body reaction within tissue was not shown during a whole experimental period. 6. Radiologically, opacity of implanted TCP was gradually decreased, and spillage on soft tissue of TCP was resorbed rapidly.
Subject(s)
Animals , Dogs , Anesthesia, General , Ceramics , Collagen , Cytoplasm , Femur , Foreign-Body Reaction , Osteoblasts , Osteoclasts , Osteocytes , Osteogenesis , Pentobarbital , Porosity , TransplantsABSTRACT
Flexor tendon grafting is a well-proved procedure for the restoration of tendon defects in the hand. The results are not entirely predictable, it offers a good expectation of successful outcome. Authors have performed the tendon graft in thirteen cases of flexor tendon injury of the hand during the period from September '79 to January '82 and evaluated the results. The followings were the results obtained. 1. Male was eleven, female was two. Age distribution is from 4 to 38 years. 2. Injured fingers were thumb 6, index 2, middle finger 4 and little finger 1 cases. The site of the primary injury was on area of Bunnell's Zone II in all cases. 3. Time interval from tendon injury to flexor tendon graft was 6 weeks to 19 months (average 5.6 months). 4. The results of tendon grafts rated as excellent 2 cases and good 3 cases in preoperative Good group; excellent 1, good 3 and fair 1 in “Scar” group; fair 1 and 1 poor in “Joint” group; fair 1 in “Salvage” group. In the thumbs, the results were better than in the fingers. 5. Degrading the postoperative results were flexion contracture in 3 cases, lack of flexion ROM in 2 cases and bowstringing in 2 cases. 6. Pinch power of the finger where tendon graft was performed was 52% of that of the opposite healthy finger. 7. As complication, bowstringing was observed in 2 cases and recurvatum deformity of the PIP joint in one case.
Subject(s)
Female , Humans , Male , Age Distribution , Congenital Abnormalities , Contracture , Fingers , Hand , Joints , Tendon Injuries , Tendons , Thumb , TransplantsABSTRACT
The object of this study was to determine the physiological range of talar tilt angle of the Korean and to establish the basis for diagnosis and treatment of the lateral instability of the ankle. The anteroposterior inversion stress view of both ankles was taken in the 108 healthy Korean who had no history of ankle injury or disease. The sagittal stress films were also performed on 96 ankles (48 cases) of these to further define the physiological limits of the sagittal mobility of the normal talus. We compared these two values of normai mobility of talus to deterrnine the significance and relationship of the rwo. The results obtained were as follows: 1) Talar tilt over 10 degrees was seen in only 6 ankles (1.9%) and most of the ankles (279 ankles, 88.4%) showed a tilt less than 5 degrees. 2) Normal talar tilt angle was increased in 30 degrees plantarflexed position than in 90 degrees neutral position of ankle. In 12 cases the value was different between the right and the left; but there was no significant difference between the sexes. 3) The anterior displacement index over 200 was seen in only 5 ankles (5.2%). 4) There was gross positive inter-relationship between physiological. range of talar tilt angle and talar sagittal mobility.