Conservative management of stable thoraco-lumbar fractures / 대한정형외과학회잡지

No abstract available.

A clinical study of the adult long bone shaft fractures of the lower limb treated with DCP / 대한정형외과학회잡지

No abstract available.

Clinical analysis of Posterior Spinal Instrumentation in Unstable Thoracolumbar Fracture and Fracture Dislocation / 대한정형외과학회잡지

Various methods of spinal instrumentation have been used for treatment of unstable fracture & fracture-dislocation of thoraco-lumbar spine. Recently, newly designed short segment fixation devices using pedicle screw were designed and there was a trend to use this posterior short segment instrumentation using pedicle screw. We have used AO internal fixator as posterior instrumentation for unstable spine fracture of thoracolumbar spine since November, 1987. Previously we used Harrington instrumentation and Luque rod wiring for treatment of unstable fracture of thoracolumbar spine and we reported the results of clinical analysis of those systems on Feb, 1987. We analyzed the clinical results of 93 cases those who underwent operative treatment using each posterior instrumentation system for unstable fracture and fracture-dislocation of thoraco-lumabr spine at our hospital from Dec. 1983 to Oct. 1989. Among that 93 cases, the Harrington instrumentation were 35 cases, Luque rod instrumentation were 36 cases and AO internal fixator were 22 cases. The results were as follows:1. The most commonly injured level was Ll (44 case) and followed by T12(33 cases, 86%). 2. By Francis Denis classification, Burst type fracture was most common(42 cases, 45%). 3. Change of kyphotic angle were checked on lateral X-ray view. There no significant differences between those groups using H-rod(58.64%), Luque-rod(54.8%), and AO internal fixator(60.1%) on immediate post-op X-ray. But there noticed least loss of correction of kyphotic angle when using AO internal fixator comparing with other groups. 4. The correction rates of height of anterior and middle column were checked by Denis-Edward method, there noticed best correction rate in AO internal fixator group. 5. The ROM of trunk were checked, there were no significant differences in H-rod, L-rod, and AO internal fixator group in long term follow up.

Treatment of the Sequelae of Septic Hip in children: Report of 2 Cases / 대한정형외과학회잡지

Septic arthritis of the children's hip causes acute or chronic inflammatory change in structure about the joint, and results in serious destruction. Due to recent advance of the diagnostic technique and of the antibiotics, the incidence of it's sequelae is decreased. The management of acute stage with antibiotics and early surgical drainage has been well established in the literature, but the management of residual anatomic deformity is less documented, and little comprehensive classification or treatment program has been outlined. We experienced two patients who had sequelae induced by delayed diagnosis and improper treatment. One had a complete loss of femoral neck with femoral head remaining in the acetabulum. Femoral neck reconstruction was performed using proximal femur : i.e., Open reduction of femoral head to femur shaft with distal transfer of greater trochanter (1st stage) followed by varus osteotomy(2nd stage) and follow-up period was 3.5 years. Another had loss of femoral head and neck, dislocation of the hip, and Larsen's trochanteric arthroplasty was performed with 6 Years follow-up. Satisfactory results were obtained in both patients who had reconstructive surgery, so we report these cases with related literatures.

A Clinical Study of Lateral Condyle Fracture of Distal Humerus in Children / 대한정형외과학회잡지

In dealing with lateral condylar injuries of humerus, the chance of pitfalls and having a poor functional result with poor management is much greater because it is a physeal injury involving intraarticular surface. Lateral condylar physeal injuries of distal humerus have been regarded as Salter-Harris Type IV injury. But indeed, true Salter-Harris type IV injury of lateral condyle of distal humerus are rare. It should be regarded as Salter-Harris type II injury. Previously Milch classified the lateral condyle fracture of distal humerus as type I and type II after Stimson's description. It seems to be most useful to plan therapeutic modalities by classification of lateral condyle fracture on the basis of stage of displacement proposed by Jakob et al and Milch's type. Authors performed clinical analysis about lateral condyle fracture of distal humerus in children. Among 79 cases, who were treated at department of orthopaedic surgery, Hyundai haesung hospital from Mar. 1982 to Mar. 1988, it was possible to follow up in 30 cases. The result were as follows ; 1. The age incidence was confined from age of 3 to age of 12. Peak age was around 6. 2. Most of fractures were Milch's type II (75 cases) in contrast to Milch's type I (4 cases). 3. Precise differentiation of stage I and II displacement was needed for evaluation of stability of fracture and planning treatment modalities. 4. In case of stage II displacement, cast immobilization alone was insufficient. K-wire fixation was needed for prevention of displacement and better result. 5. In all of cases(30 cases) overgrowth of lateral condyle and spur formation were noticed but it has no clinical disabilities. 6. There were no significant differences of outcome between different fracture types and different stage of displacement. But significant differences of outcome were noticed how treatment performed. Accurate anatomical reduction and stable fixation was needed. 7. 2 cases of severe cubitus varus(20') were occured. In 21 cases, carrying angle were changed, valgus change were more common than varus change. It was thought to be relative undergrowth of lateral condyle of humerus and malunion as its causes. 8. In all cases, there were no loss of R.O.M.

Clinical Results of Ankle Fractures / 대한정형외과학회잡지

The ankle is a modified complex hinge joint consisting of the distal tibio-fibula joint (Syndesmosis), and the ankle joint proper(hinge joint), and is important in weight bearing, standing and walking. So, the goals of treatment of ankle fracture are anatomical positioning of talus in the mortise and regaining a smooth articular suface. Unless these requisites are achieved by treatment, post-traumatic arthritis is likely to occur. We analyzed 120 cases of ankle fracture, most of which were treated surgically by A-0 method, in Department of Orthopaedic Surgery, Hyundai Haesung Hospital from January, 1982 to December 1985. The results are as follows; 1. The most common victim was 3rd–4th decades man, and the cause was direct blow. 2. The most common type was pronation-external rotation type of Lauge-Hansen classification, and Type A of Danis-Weber type. 3. The more favorable result was noted in Danis-Weber type A than type B and type C,and noted worst result in pilon fracture. 4. Favorable results can be gained by semi-tubular plate in fibular fracture than any other fixation material. 5. On application of semi-tubular plate, there were no significant differences in results between that placed posteriorly and that placed laterally. 6. We did not transfix the distal tibio-fibular joint in stable Danis-Weber type C injury without any specific sequellae. 7. We obtained better result by removal of transfixing screw 6 weeks after operation. 8. We obtained good results with only 3 weeks immobilization after operation.

Clinical Results of Segmental Spinal Instrumentation in Unstable Fracture and Fracture-Dislocation of the Thoracolumbar Spine / 대한정형외과학회잡지

Segmental Spinal Instrumentation is effective operative procedure in unstable fracture and fracture-dislocation of the thoracolumbar spine, providing rigid spinal stability and reduces needs of external support and complications. Fifty nine patients with unstable fracture and fracture-dislocation of thoracolumbar spine were treated with Harrington rod instrumentation and sublaminar wiring(31 patients) and Luque rod instrumentation with sublaminar wiring(28 patients) in Hyun Dai Hae Seong Hospital, Ulsan, Paik Hospital, Pusan from Dec. 1983 to April 1986. We have analyzed the results of treatment about two type of S.S.I. and obtained following conclusions; l. In 59 patients, T12 level injury was 17 cases, Ll level was 25 cases and so T12 and Ll involvement were 71%. 2. By Francis Denis classification, 28 cases were burst type fracture, 20 cases were fracture-dislocation type, 6 cases were seat belt type and 5 cases were wedge compression type. 3. In Harrington rod with S.S.I., initial kyphotic angle was 22.4° and postoperative angle was 7.4° and correction rate was 66.9%; in Luque rod with S.S.I., preoperative kyphotic angle was 21.7° and postoperative angle was 6.5° and correction rate 69.6%. So there was no difference of correction rate in two type of S.S.I. 4. In Harrington rod with S.S.I., the loss of reduction was 1.2° and the loss was 7%; in Luque rod with S.S.I., the loss of reduction was 7.2° and the loss rate was 48%. So the loss of reduction of Luque rod with S.S.I. was greater than that of Harrington rod with S.S.I. 5. After removal of implants, Luque rod with S.S.I. patients have better range of motion than Harrington rod with S.S.I. patients clinically, but it needs more follow-up because of a few cases(18 cases).

A Clinical Study of Replantation of Amputated Upper Limbs and Digits / 대한정형외과학회잡지

Since the first report of completely amputated thumb replantation by Tamai in 1965, replantation surgery has been popularized with increasing success rate and improving functional regain. Recently, difficult replantation such as traction avulsion amputation has been challenged and good success rate and function have been reported. We have analized 34 cases of upper extremity and finger replantation in 23 patients, which were performed at the Dept. of Orthopedic surgery. Hyun Dai Hae Seong Hospital, Ulsan, Korea, from June 1982 to January 1986. The results were as follows: 1. Male patients were 22, female was 1, left upper limbs and digits injuries were more prevalent(16: 7), and average age was 25 years old. 2. The most common injury was done by cutting machine. 3. The number of amputations of fingers were almost same in all fingers and most prevalent in zone III(26 cases, Danial classification). 4. Success rate of replantation was 82.4% In cases of less than 6 hrs ischemic time, the rate was 93.4%, and more than 6 hrs ischemic time, rate was 33.3% 5. Performing arterial anastomosis prior to venous anastomosis, can find out main draining vein, and with one vein and one artery anastomosis, can get good results distal to zone IV. 6. Functional results were satisfactory, evaluating by modified. Tamai score, average 87.5. 7. 6 cases of digital replantations distal to sublimis tendon insertion have good results functionally, cosmetically and technically easy (Tamai score 98). 8. 5 cases of traction avulsion amputations needed many additional surgery to restore function, but end results were relatively satisfactory.

The Methods of Treatment in Estabilished Non-union of Femur Shaft / 대한정형외과학회잡지

The incidence of non-union in the shaft of femur is increasing gradually in spite of considerably improved methods of femoral fracture care. It is necessary that orthopaedic surgeon must draw attention to improve the method of treatment and to prevent the occurance of non-union. This paper presents the follow-up result of 27 cases among 30 established femoral shaft non-union cases, that were treated at the orthopaedic dept. of the National Medical Center from March 1971 to March 1980 by various methods. The study of this series shows the following. l. Amount 27 cases, male was predominant (82%), peak age group was 3rd & 4th decades (52%). 2. The causes of injury were auto-accident (56%), falling down accident (22%), direct blow (11%) & slipping down accident (11%). 3. The most common location was around the mid-shaft of femur (44.4%). 4. The probable causes of non-union were loosening of the implants & metal failure due to improper internal fixation (10 cases), incomplete reduction (7 cases), infection (5 cases) & inadenaute external immobilization (5 cases). 5. Excellent results were obtained by combined method of compression plate, screws & intramedullary nailing with additional autogenous bone graft.

Analysis of Fractures of the Foot and Ankle / 대한정형외과학회잡지

The results of the treatment upon total 132 cases of ankle and foot fractures treated during the period from January 1969 to August 1978 at the Department of Orthopaedic Surgery, National Medical Center have been analysed and reported in this paper. 1. Sex ratio between male and female was 3.7:1. 68 cases (51.5%) cases out of 132 cases were in the age groups of 2nd and 3rd decades. remarkably higher than any other group. 2. 85 cases out of 132 cases were closed fractures and 47 cases were open fractures, but the incidence of the open fracture in higher in the fractures below the metatarsal bones and multiple fractures. 3. 59 cases out of 132 cases were ankle fractures 34 tarsal bone fractures 14 metatarsal bone fractures, 8 phalangeal bone fractures and 20 multiple fractures Accordingly, the incidence of the ankle fracture is higher than other fractures. 4. Ankle fracture was classified in 4 types according to the fracture mechanism (Lauge-Hansen classification). 20 cases out of 59 cases were pronation-abduction type, 15 cases were pronation-external rotation type, 14 cases were supination adduction type and 9 cases were supination-external rotation type. 15 cases out of 59 cases of the ankle fractures were treated by tension band compression internal fixation. The result of this method was much better than other methods. 5. 25 cases out of 35 cases of calcaneal fracture involved subtalar joint according to Rowe classification. 12 cases out of 25 cases of calcaneal fracture involved subtalar joint were Tongue type-C. In the treatment, no relation between restoration tuber angle or Gissane angle and the incidence of complication was obtained. 6. The incidence of the complication, such as secondary oateoarthritis, non union. malunion, occurred higher in the open and multiple fractures than closed and single fractures.