Clinical Significance of Arthrography in Legg-Calve-Perthes' Disease / 대한정형외과학회잡지

Legg-Perthes' disease, as avascularity of the femoral head that often arises in the child of a particular age group, is a serious disease of which the frequency is more than the osteochondroses of the other part, and the cause of Legg-Perthes disease is obscure up to now, but the pathogenesis and, pathology are more clearly understood. Twenty patients with Legg-Perthes disease were managed at the department of Orthopaedic Surgery of Hanyang University hospital from May, 1972 till September, 1977 and were studied according to the method of Catterals classification arid arthrogram. The following conclusion were made. 1. The age group with the highest frequency was that from 6 to 9 years (40%) and the ratio of male: female was 6: 1. 2. The stage of disease s progress when patient went to hospital was almost fragmentation stage as 17 persons of the whole. 3. By arthrogram Spherical form of femoral head was 15%; Round form 45%; Flatten form 40%. 4. The longer the period from onset to beginning of treament was the more femoral head flattened. 5. There was the most number of patient as 13 persons of the whole wearing abduction internal rotation brace. 6. From the view point of arthrogram the more spherical the femoral head was the better the prognosis was; otherwise the worse.

The clinical Study of Scoliosis / 대한정형외과학회잡지

A total of 132 cases of structural scoliosis have been followed since Jan. 1963 up to Dec. 1976 at the Hanyang University Hospital. The present paper classified scoliosis according to the etiology and analyzed curve patterns and spinal deformties such as rotation and wedging. Various kinds of treatment were done and these included Milwaukee brace, posterior spinal fusion with or without Harrington instrumentation. The end results of these treatment were also analyzed. The results concluded from the present studies were as follows: 1. Poliomyelitis was the most common cause of structural scoliosis. Of 132 cases of scoliosis, paralytic scoliosis was 48.5% while idiopathic scoliosis was 31.1% and congenital scoliosis 9.8%. 2. In paralytic scoliosis lumbar curves were the most common pattern and thoracic and thoracolumbar curves were the next. 3. In idiopathic scoliosis, the most common pattern was the right thoracic. 4. Very severe curves over 80° were more frequent in paralytic than in idiopathic scoliosis, showing the percentage of 20.3% in paralytic scoliosis and 10.3% in idiopathic scoliosis respectively. 5. The number of vertebrae involved in primary curve was approximately the same in both paralytic and idiopathic scoliosis. 6. In paralytic scoliosis, as the curves progressed, rotation of vertebrae became more marked in lumbar curve than in thoracic curve, while wedging deformity was more severe in thoracic curve than in Jumbar curve. 7. The tendency of the rotation and wedging in thoracic and lumbar curve was the same in both idiopathic scoliosis and paralytic scoliosis. When the degree of curves was the same, rotation and wedging were slightly more severe in idiopathic than in paralytic scoliosis. 8. In congenital scoliosis hemivertebrae were the most common anomaly and the majority of congenital anomalies were located at lumbar region. 9. Treated with Milwaukee brace, 22.1% of original curve angle was corrected in idiopathic coliosis, 9.8% in paralytic scoliosis, and 7.3% in congenital scoliosis, respectively. The Milwaukee brace was effective in thoracic and thoracolumbar curves but not in lumbar curves. 10. In paralytic scoliosis treated with posterior spinal fusion without Harrington instrumentation, the final degree was 43.2 and the correction loss was 12.6% but with both posterior fusion and Harrington instrumentation, the final degree was 50.2 and the correction loss was 6.8%. 11. There were 2 cases of complication after posterior spinal fusion without Harrington instrumentation. One was pseudarthrosis and the other was bending of graft with some loss of correction. One case of complication occured after posterior spinal fusion with Harrington instrumentation. It was a case of displacement of distraction hook on the rod.

Femoral Lengthening: A case report / 대한정형외과학회잡지

A case of femoral lengthening was performed at the Hanyang University Hospital for a 29 year old male patient who hed a 3.0 cm shortening of the left lower extremity. This patient incurred a comminuted segmental fracture of the left femur in a car accident in 1969 when he was 21 years old. At that time, open reduction and internal fixation with Kuntscher nail was done at a private clinic. The fracture was united firmly, but shortening of the left lower extremity developed progressively. At the time of admission to our hospital in 1976, he had a 3.0 cm shortening of the left femur on scanogram and complained of limping. Femoral lengthening was employed by step cut Z ostectomy on the left femur and 3.0 cm lengthening was achieved during the operation by traction with 2 Steinmann pins, one of which was inserted vertically in the greater trochanter, and the other was inserted horizontally in the distal femur. A special plate and screws were modified at our hospital and were attached and fixed to the osteotomy site. Bone gaps which developed after lengthening of the femur were filled with an autogenous iliac bone graft. The patient was followed up for 9 months after the operation, and the last X-ray showed a firm bony union without any specific complications. On pbysical examination at the present time, there is no longer a shortening of the left lower extremity clinically and gait is normal without limping.

Synovial Fluid Analysis as a Diagnostic Aid in Arthritis / 대한정형외과학회잡지

Extensive knowlege of the characteristics of synovial fluid has been available for at least the past 30 years, when a Monograph on the subject by Kling first appeared in 1938. Since that time, Ropes, Bauer(1953) and Hollander (1960, 1961, 1965) have published classic. Monographs on their extensive studies and findings of synovial fluid. Specific laboratory tests for diagnosis of various forms of arthritis are usually lacking. For example, the test for the rheumatoid factor in serum may be helpful in establishing the diagnosis of rheumatoid arthritis, but these are often negative in early cases and L. E. phenomenon is often negative in the early stage or between severe exacerbations of the Systemic lupus erythematosus. It has become increasingly clear during the past 10 years that synovial fluid analysis is both the most valuable and yet the most neglected differential diagnostic test for arthritis. Studies of synovial fluid have presented a virtually unexplored frontier in the investigation of arthritis. So, we studied the synovial fluid from 100 cases of various forms of arthritis in the Department of Orthopedic Surgery, Severance Hospital from May, 1968 to May, 1969. 100 cases of arthritis are; 30 cases of Osteoarthritis, 20 cases of Traumatic athritis, 25 cases of Rheumatoid arthritis, 10 cases of Septic arthritis, 5 cases of Tuberculous arthritis, and 10 cases of Non-specific bursitis. The synovial fluid were aspirated from the involved joints in aseptic conditions and follwing studies were done. 1) General appearance. 2) Mucin content by Acetic acid PPT. or Ropes test. 3) Viscosity by Drop test. 4) Cell count by Wright s stain. WBC: Total and differential count. RBC count. 5) Synovial sugar by Folin Wu method. 6) Fasting blood sugar by Folin Wu method. 7) Sugar difference between synovial sugar and Fasting blood sugar. 8) Total protein by Kingsley s Biuret method. 9) Bacterial culture in Septic arthritis. 10) Microscopic examination. RA cells by Sternheimer-Malbin stain in Rheumatoid arthritis. Cartilage fragments with simple wet preparations in Osteoarthritis. 6 kinds of arthritides were grouped into 3 categories based on the degree of inflammation of the synovial membrane as reflected by synovial fluid changes according to Ropes and Bauer s classification(1953). The first group, consisting of Osteoarthritis and Traumatic arthritis, was associated with mild inflammatory reactions and increased amount of fluid, but no significant changes in the number of WBC, sugar concentration, or quality of mucin. The second group was characterized by more sever inflammation of the synovial membrane and included Rheumatoid arthritis, Septic arthritis and Tuberculous arthritis. The second group was associated with decreased mucin content, increased WBC, polymorphonuclear leucocytes, RBC and protein and decreased amount of synovial sugar. RA cells were found in all cases of Rheumatoid arthritis and cartilage fragments in Osteoarthritis under the light microscope. The third group, an intermediate group-Non specific bursitis might have some distinguishing characteristics of synovial fluid but these were not usually diagnostic.