Scintigraphic Evaluation of the Viability of Living and Dead Bone Grafts: An Experimental Study on Rabbit's Tibiae / 대한정형외과학회잡지

The author studied the validity of bone scintigraphy in the assessment of viability and anastomotic patency of free bone grafts revascularized by microvascular anastomoses and also compared them with conventional free devascularized bone grafts and osteotomies. Sixty rabbits were divided into three different groups, and scintigraphy was carried out using technetium labeled methylene diphosphonate on revascularized living bone grafts, conventional devascularized bone grafts and osteotomies. Of these, 38 rabbits could be followed up to 6 weeks. Analyzing the histologic, radiographic and scintigraphic data, the following results were obtained. 1. Free living bone grafts, revascularized by periosteal blood supply from the posterior tibial artery, revealed incomplete bone cell survival on histologic sections taken at 6 weeks after operation. In the osteotomy group the distal fragments were completely viable. Living bone grafts with failed anastomosis and dead bone grafts were almost completely necrotic. 2. Radionuclide uptake in dead bone grafts and living bone grafts with failed anastomosis increased gradually up to 6 weeks after operation. Radionuclide uptake in living bone grafts with patent anastomosis increased rapidly during the first 2 weeks, and increased gradually thereafter up to 6 weeks. In the osteotomy group radionuclide uptake also increased rapidly during the first 2 weeks but decreased slowly thereafter up to 6 weeks. 3. Radionuclide uptake at 6 weeks after operation became comparable to that of the adjacent host bone and there was no significant difference among the various groups. On the basis of the experimental results, the author derived following conclusions. 1. The differences of radionuclide uptake among the various living and dead bone grafts were most remarkable at 2 weeks following the grafting procedure. The radioactivity was highest following osteotomy which preserved blood supply, and it was lower in the living bone grafts with patent anastomosis, while that in the dead bone grafts and living bone grafts with failed anastomosis was lowest. 2. The time factor in performing scintigraphy was most important in assessing the viability of bone grafts and anastomotic patency. The optimal time to assess the viability and anastomotic patency appeared to be 2 weeks after grafting.

Lunate Dislocation (A Review of Six Cases) / 대한정형외과학회잡지

Six cases of lunate dislocation were treated in the departments of orthopaedic surgery, Hangang Sacred Heart Hospital and Kangnam Sacred Heart Hospital, Hallym College during the period from March 1, 1978 to August 31, 1982. The results were as follows; l. Among the total 6 cases, two cases had lunate dislocation only and the other four had associated injuries of the same wrist joints. 2. Marupulative reduction was successful in only one case. Five cases were treated by open reduction, and for four of them internal fixation was tried. 3. Postoperative roentgenograms showed acceptable reductions in all cases except one which redislocation occurred. This case showed lunate dorsiflexion instability and was treated with extensor carpi radialis longus tenodesis. 4. The cases with pure lunate dislocation yielded better functional recovery than those with associated carpal injuries.

A 2 Cases of Ectopic Bone Formation Treated by Radiation Therapy / 대한정형외과학회잡지

It is generally accepted that ectopic bone should be removed after full maturation. Removal of immature ectopic bone was attempted combined with immidiate postoperative irradiation to suppress its recurrence. The authors report two cases immature heterotropic bone resection around elbow joint followed by 2000 Rad midplane irradiation given in ten fractions over fourteen days. The results obtained are as follows: 1. There was no evidence of recurrence after removal of immature ectopic bone. 2. Improved range of joint motion was observed during 3 months and 6 months posteroperatively.

A Clinical Study of the Tibial Condylar Fractures / 대한정형외과학회잡지

Fractures of the tibial condyles, involving as they do weight-bearing articular surfaces and important soft tissues such as collateral ligaments, cruciate ligaments and semilunar cartilages present a variety of problems in treatment and prognosis. Apley, Slee, and others maintained the opinion that most fractures of the tibial condyles could be managed conservatively. On the other hand, Rombold, Schatzker, and others seemed to consider closed treatment to be virtually a form of therapeutic nihilism and adviced open reduction. But recently most authors agree that the method of treatment has to be selected in each individual case, and recommend anatomical reduction of the fracture as possible and early knee motion. During 7 years period from January 1974 to July 1981, of the tibial condylar fractures treated at the department of orthopaedic surgery, Han Gang Shim Hospital, 41 cases that could be followed have been analysed according to the cause, classification, method of treatment and result. The following results were obtained from the analysis of 41 tibial condylar fractures. l. Of the 41 cases, 34 (83%) were male and 7 (17%) were female. 2. Of the 41 cases, 32 (78%) were due to traffic accident, 25 pedestrian, 7 occupant, 8 (20%) were due to fall from height. 3. Of the 41 cases, 31 (76%) were associated with other injuries. 4. Of the 41 cases, 30 were treated by conservative method with functionally acceptable result in 22 cases (73%) and 11 were treated by open reduction with functionally acceptable result in 9 cases (82%). 5. According to the Hohl and Luck's criteria, acceptable functional result was obtained in 31 (76%) cases.

Supracondylar Fractures of the Femur / 대한정형외과학회잡지

Supracondylar Fractures of the femur are not as cammon as femoral neck or intertrochanteric fractures, but their treatment may be just as difficult. Few surgeons have had extensive experience with this complex fractures of uncommon frequency. Until a few years ago, conservative treatment was considered superior to internal fixation of supracondylar fractures of the femur in adults. However, the development of new fixation devices and techniques has, according to several investigations, improved the results of the treatment of these fractures. The following clinical results were shown by analysis of 27 cases of femoral supracondylar fractures experienced in the Department of Orthopedic Surgery, Capital Armed Forces General Hospital in the past 3 years from Jan. 1977 to Oec. 1979. 1. The most common cause of these fractures were traffic accidents. 2. Of 27 cases, 11 cases were treated by conservative method, 16 cases were treated by open reduction and internal fixation. 3. Anatomical reduction and rigid internal fixation led to 80% of good to excellent results whereas only 33.4% of good to excellent results were obtained in patients in whom the fixation was not absolutely rigid. 4. In the treatment of supracondylar fractures of the femur, anatomical reduction and rigid internal fixation (80% of good to excellent results) resulted in better functional recovery after union of fractures than conservative treatment (45.5%).

Solitary Bone Cyst of the Capitate: A Case Report / 대한정형외과학회잡지

Solitary bone cyst are usually found in the juxta-epiphyseal region of metaphysis of long bones of children. They are rarely seen in non-tubular bones. The following case describes what we believe to be a solitary cyst of the capitate. Cyst was treated by radical curettage and packing with autogenous iliac bone. The most recent evaluation 7 months after surgery showed no discomfort.

A STUDY OF SCOLIOSIS Part I. Surgical Treatment / 대한정형외과학회잡지

No abstract available in English.

Failed Hip Nailing in Hip Fractures: A Radiological Analysis / 대한정형외과학회잡지

The fracture of the upper end of the femur is unique in orthopedics because it is endemic to an elderly population with special problem. In trochanteric fractures open reduction and internal fixation, with a hip nail used to maintain reduction, have become the standard treatment protocol for the elderly. Unlike fractures of the femoral neck, nonunion and avascular necrosis is rare but more frequently complicated by fatal sequele, such as pneumonia, thromboembolic disease, and decubitus ulceration. In order to achieve early ambulation of a patient with a trochanteric hip fracture, two conditions must be met: The implant used for fixation must be strong enough to withstand loadings exerted upon it during fracture healing, and the fracture itself must be rendered stable in a suitably reduced position. The treatment of the fracture of the femoral neck has a long and frustrating history. As recently as 20 years ago McCarroll remarked that this fracture must be considered “unsolved” until the incidence of aseptic necrosis and nonunion could be diminished or abolished. But now with adequate reduction, impaction, accurate internal fixation with newer devices, and carefully supervised postoperative care the fracture of the femoral neck can be expected to heal at least 90 per cent of the patients. A lower incidence of recognizable aseptic necrosis has been reported under these circumstances. X-ray films of 94 cases of hip nailing for hip fractures were collected in the Department of Orthopedic Surgery of Seoul National University Hospital. Twenty seven cases considered to be failed in hip nailing were analysed radiologically, and following results were obtained. 1. The incidence of failed hip nailing was most frequent in the fifties with average age of 54. 6 years, which seemed somewhat younger than that of the hip fracture. There was no sexual difference. 2. Hip nailings were failed in 23 cases of the femoral neck fractures and in 4 cases of the trochanteric fractures, which revealed respectively 52.3% and 8.2% of failure. Among these the technical failure was 22.7% in femoral neck fractures and 6.1% in trochanteric fractures. 3. Among the various fixation devices, Smith-Petersen nail or hip screws which has no side plate to fix the shaft rigidly showed high failure rates. 4. In all cases the etiology of the failed hip nailing was functional, such as failure of reduction, failure of fixation, penetration of the head, avaseular necrosis, infection, and inadequate postoperative management. 5. Most cases of femoral neck fractures which was not achieved near anatomical reduction was failed in fixation. 6. Too long or short nails showed high failure rates. In view point of this, hip nail should fix the lateral cortex, calcar femorale and center of subchondral bone, even in the trochanteric fracture. So devices such as heavy compression sliding nail or multiple pinning were more desirable to achieve complete fixation. 7. When, in the fresh fractures of the femur neck cannot be reduced to an anatomical or slightly overcorrected position, endoprosthesis should be considered seriously. When the joint is abnormal, the total hip arthroplasty can reduce morbidity and mortality, and also shorten the hospitalization.