Peroneal Nerve Entrapment Caused by an Atypical Popliteal Cyst in a Child: A case report

Baker's cyst is commonly associated with intraarticular pathology such as degenerative arthritis. Few cases of neural compression by a Baker's cyst in the popliteal fossa have been reported with intraarticular pathology. We report a case of peroneal nerve compression by an atypical Baker's cyst in a child without intraarticular pathology. A 10-year-old boy had 6-month history of the left foot drop without a known trauma. There was no swelling or pain in the knee. The electrodiagnostic study demonstrated a profound lesion of the deep peroneal nerve and a mild denervation of the superfical peroneal nerve. Magnetic resonance images displayed an atypical Baker's cyst originating from the popliteal fossa and extending to the posterolateral side of the fibular head. Clinical and electrophysiological findings improved after aspiration of the cyst.

Posterior Interosseous Nerve Syndrome: Report of 4 Cases / 대한정형외과학회잡지

Entrapment of the posterior interosseous nerve is an uncommon syndrome characterized by an inability to extend the fingers and thumb. This entity bas become recognized increasingly since reported in 1966 by Capener and Muholland et al. The pathogenesis could be explained as an anatomical basis. And various cases were reported that trauma, local swelling, inflammation, postural and iatrogenic factors were concerned with the causes. In recent 4 cases of posterior interosseous nerve syndrome were experienced at Busan National University Hospital and following result were obtained.1l. Arcade of Frohse, fibrous band, recurrent radial artery are important compressive factors. 2. Surgical decompression led to an effective cure. 3. Tendon transfer is indicated after severe degenerative change.

A Clinical Study on Hematogenous Osteomyelitis in Children / 대한정형외과학회잡지

Although antibiotics have greatly improved the results of treatment of hematogenous osteomyelitis, hematogenous osteomyelitis in children is still complex and difficult disease by which severe deformity and disability may result. A retrospective clinical study of 44 cases of hematogenous osteomyelitis in children was done at Department of Orthopaedic Surgery, Busan National University Hospital from January 1980 to February 1985. The results were as follows: 1. The ratio between males and females was 2.1: 1, and the prevalent age gmup was from 11 to 15 years. 2. The common sites of involvement were femur and tibia in orders. 3. At initial surgical treatment, fenestration in acute stage and saucerization in chronic stage were commonly performed. And at surgical wound management, primary closure with closed continuous irrigation was most frequently performed. 4. Children with acute clinical presentations tended to have more unsatisfactory results, probably because of delay of diagnosis and treatment, simple soft tissue drainage at initial surgical treatment, secondary closure at surgical wound management and inadequate parenteral antibiotic therapy.

Clinical Observations of Internally Fixed Supracondylar Fractures of Humerus in Children / 대한정형외과학회잡지

A supracondylar fracture of the humerus is the most common fracture of the elbow in children, and it may also be one of the most difficult fracture to treat. To obtain a good result after a supracondylar fracture of the humerus, an accurate reduction is needed. This region of humerus is very thin, and even if reduction is obtained it may be unstable. 104 children with 104 supracondylar fractures of the humerus were managed at the Department of Orthopedic Surgery, Busan National University Hospital from Jan. 1979 to Dec. 1983. Of 104 patients, 48 cases which fixed internally were reviewed and following results were obtained. 1. The average age was 7.6 years, ranged from 18 months to 15 years, and 68.8% were bodys. The left humerus was affected in 58.3%. 2. In type of fracture, extension type was 95. 8%. Type II was 12 cases (26.1%), Type III 22( 47.8 and Type IV 12 (26.1%). Posteromedial displacement was 75% (35 cases). 3. Average loss of motion was 11.9°, and change of carrying angle was 5.1° In change of range of motion by the final follow-up date, during 3 to 6 months that was relatively high by 37.5°, and then the change was improved. During 2 to 5 years the change was 5. 6°, and 1 to 2 years that was similiar to the whole average by 11.7°. 4. By the modified Mitchell & Adams criteria for grading results, excellent were obtained in 30.4%, good in 45.3% fair in 10.0% and poor in 6.3%. Namely, satisfactory was 93.7% and unsatisfactory was 6.3%.

The Treatment of Humeral Shaft Fracture by Functional Bracing / 대한정형외과학회잡지

The recent trend in method of long bone fracture had been toward bracing or closed medullary nailing except for certain fractures that fall within well-established surigcal criteria. Functional bracing is gaining widespread acceptance in management of tibial, femoral, and forearm fractures and is well suited to humeral shaft fractures. Twenty four cases of humeral shaft fractures were treated with functional brace and early mobiliza tion from October 19S2 to June 1984 at Busan National University Hospital and the results were as follows. 1. The fracture sites were composed of middle third in 15 cases, distal third in 6 cases, and proximal third in 3 cases and the fracture shapes were transverse in 10 cases, oblique and spiral in 5 cases respectively, and comminuted in 4 cases. 2. The average time from injury to functional bracing was 13.0 days and to discontinuance of the functional brace was 9.0 weeks. 3. Nonunions have not been encountered in all cases. The residual angulation was under 20degrees in all but one and the most common deformity was varus in 20 cases. Minimum limitation of motion, mostly a loss of the last few degrees of external rotation, was detected after follow-up of 2 months but did not present any clinical problem. 4. The achievement of rapid and uninterrupted osteogenesis without undesirable functional or cos- metic deficit could be listed as the advantage.

A Clinical Observation of Girdlestone Operation / 대한정형외과학회잡지

We clinically reviewed and analysed 19 patients treated as Girdlestone operation with or without Batchelor osteotomy at the Department of Orthopedic Surgery, Busan National University Hospital from April 1979 to June 1981. The results were as follows: 1. The underlying disease were infected pinning and nailing of 8 cases, pyogenic hip of 4 cases, failed total hip arthroplasty of 4 cases, tuberculous hip of 2 cases and femur neck fracture of 1 case. 2. Satisfactory results were obtained in 7 or 8 cases treated as secondary Girdlestone operation over 50 years of age. 3. Postoperative shortening ogleg length was 3.2cm in average (from 1.7cm to 5.0cm), which was average 2.5cm at 12 weeks traction and average 3.7cm at 6 weeks traction. 4. Postoperative average range of motion was; flexion to 80 degrees and abduction to 30 degrees. There was statistical significancy in activity of daily living of hip function at 12 weeks traction in postoperative score. 5. 6 cases out of 11 cases without pain in postoperative condition showed severe bony contacts and ir- regularities of proximal portion of the operated femur radiologically.

Study on LD Isoenzyme Activity in Synovial Fluid of Joint Diseases / 대한정형외과학회잡지

The authors investigated LD activity and isoenzyme of total serum and joint fiuid in 18 cases of rheumatoid arthritis, 11 cases of degenerative arthritis, 6 cases of traumatic arthritis, and 10 cases of healthy control. The samples of serum examined were obtained from the anterior cubital vein and joint fluid from the knee joint except 2 cases of the rheumatoid arthritis, which were obtained from the wrist joint, in Busan National University Hospital from the April to July 1981. Total serum LD activity was measured by method of Caboud-Wroblewski and isoenzyme fractions were analysed by cellulose acetate electrophoresis. The results obtained were as follows: l. In the patients with joint diseases, total serum LD activity was significantly increased than that of healthy control. 2. The LD1 isoenzyme of joint fiuid was increased in degenerative arthritis than that in rheumatoid arthritis, and LD3 and LD5 isoenzymes were significantly increased in rheumatoid arthritis than that in degenerative arthritis. 3. In correlation between total LD and LD isoenzymes activities in joint fluid, total LD activity of rheumatoid arthritis was correlated with decrease of LD1 isoenzyme and increase of LD5 isoenzyme activity, and total LD activity of the degenerative arthritis was correlated with increase of LD1 isoenzyme activity. 4. In correlation between isoenzyme activity and gamma globulin of joint fluid, LD3 and LD5 isoenzyme activity in rheumatoid arthritis and LD4 in degenerative arthritis was correlated with increase of gamma globulin.

A 14 Cases of Recurrent Shoulder Dislocation Treated by Modified Bristow Operation / 대한정형외과학회잡지

A recurrent shoulder joint dislocation was performed on fourteen cases who were treated by modified Bristow operation from June, 1978 to April, 1981. and following results were obtained. 1. The age of initial dislocation varied from 13 years to 23 years of age with the average of 18. 6 years. 2. The age at operation varied from 20 years to 28 years of age with the average of 23 years. 3. The duration of recurrent dislocaticn varied from 2 years to 8 years with the average of 4.4 years. 4. The times of dislocation varied from 6 to 50 times with the average of 17.1 times. 5. The roentgenograms showed the Hill-Sachs' Iesion in 10cases (71.4%), subluxation in 4 cases (28.6%), and glenoid rim abnormality in 2 cases. 6. The operative findings were Bankart's lesion in II cases(78.6%), glenoid rim erosion in 2 case, and subscapularis laxity in 2 case. 7. The complication and recurrence were not observed in this period. 8. The average limitation of abduction and external rotation were 5. 7 and 12. 2 degree respectively.

Metallic Failures after Compression Plate Fixation Clinical Analysis of 12 Cases / 대한정형외과학회잡지

The twelve cases of metallic failure after compression plate fixation which were observed and treated at Department of Orthopedic Surgery, Busan National University Hospital were clinically analysed. The results were summerized as follows; 1. Age and sex of the patients was male in his active age in life. 2. The causes of fracture were traffic accidents and industrial accidents. The sites of fracture were femur in 11 cases and tibia 1 case. 3. The types of fracture were comminuted in 11 cases and short oblique in 1 case. 4. The 6 patients were not cooperative and began walking at their will after postoperative 4 weeks despite doctors order of nonweight bearing. Average duration of immobilization was 6 weeks. 5. Metallic failure occurred as screw failure in 1 case, plate failures through empty hole in 4 cases and plate failures through hole filled with screw nearest to the sites of fracture in 7 cases. 6. Interval between operation and metallic failure was 6.25 months average. The 75% of the metallic failure occurred between 4 to 7 months. 7. Treatments of metallic failures were cast immobilization with bone grafting in 1 case at tibia, intramedullary nailing with bone grafting in 1 case at femur and compression plate fixation with bone grafting in 10 cases at femur. 8. Causes of failure after internal fixation 1). Insufficient bone support Inadequate inter-fragmentary compression 9 cases Absence of cancellous bone graft 8 cases Empty plate hole 4 cases Remaining defects 3 cases 2). Inadequate postoperative treatment 6 cases.

Arthrographic Measurement of the Normal Knee Joint in Adult / 대한정형외과학회잡지

Several measurements were performed about 105 cases of normal stress A-P arthrographic findings in adult knee including discoid without tearing or osteoarthritis, those were selected from 166 cases examined arthrographicaliy under same technical condition due to suspicious internal derangement of the knee from October 1976 to March 1980. After stastistical analysis and comparative study about chondrai thickness, chondral index, meniscal size, meniscal index, intermeniscal distance, type of meniscus, communication between knee and proximal tibiofibular joint, following results were obtained. 1. Chondral thickness of normal articular cartilage was not related to joint size, but almost same value individually. Mean chondral thickness In P and P points was 2.90±0.63mm, 2.90±0.62mm, 2.93±0.64mm, 2.92±0.65mm in lateral, medial femoral condyle and lateral, medial tibial condyle in order. Age change was not seen statistically. 2. The size of meniscus was correlated nearly proportional with that of the joint. Mean lateral meniscus size (transverse meniscal length × meniscal thickness) was 12.55±2.50mm × 6.53±0.7mm in male and 10.13±2.25mm × 6.02±0.52mm in female. That of medial meniscus was 9.79+1.54mm × 5.85+ 0.45mm in male, and 7.72±1.64mm × 5.36±0.92mm in female. Age change was not seen statistically either. 3. Mean intermeniscal distance was 60.21x2.74mm in male, 53.34±3.31mm in female and occupied 83% in male, 82% in female of joint size each other. 4. In types of meniscus, normal type was 8.10%, infantile type dlscoid 12.4%, intermediate type 2.9%, primitive type 3.7% each other. 5. Communications between knee joint and proximal tibiofibular joint were seen in 24%.

A Clinical Study of Tarsometatarsal Joint Injuries / 대한정형외과학회잡지

Authors reviewed and clinically analysed 34 cases of trasometatarsal joint injury treated at the Orthopedic department of Pusan National University Hospital during the period from January 1975 to December 1979, and following results were obtained. 1. The incidence was higher in male and the active age group of 20-40. 2. Among the causes, traffic accidents were 22 cases (64.7%) and crushing injuries in the industrial field were 6 cases (17.6%). 3. Fracure-dislocations were higher than simple dislocation. 4. According to the Wilsons Classifications, the injuries were classified as follows. First stage of supination (51), 11 cases (32.4%): First stage of pronation (P1), 8 cases (23.5%): Plantar-flexion alone (PF), 4 cases (11.8%): Second stage of supination (S2), 3 cases (8.8%): Second stage of pronation (P2), 2 casese (5.9%): And finally direct crushing injuries,were 6 cases (17.6%): 5. Associated injuries were fracture of the metatarsal bone in 15 cases (44.1%), fractures of the tarsal bone in 7 cases (20.6%) and severe soft tissue injuries in 6 cases (17.6%), 6. The operative treatments with early anatomical reduction were obtained better results than conservative treatment. 7. As complications, pain in 31 cases (91.2%), bony deformity in 26 cases (76.5%), motion limitation in 32 cases (94.1%), skin necrosis in 3 cases (8.8%) and traumatic arthritis in 23 cases (67.6%) were observed.

A Clinical Study on the Cavernous Hemangiomas Developed in Skeletal Muscles of the Extremities / 대한정형외과학회잡지

Authors analysed 19 cases with Cavernous Hemangiomas of Skeletal Muscles in Extremities. Those were confirmed clinicopathologically for the period of 2 years from October 1976 to September 1978, and following results were obtained. 1. The age of initial visit varied from 6 months to 42 years of age with the average of 17.7 years. Seventeen patients(89.5%) were under 30 years of age. 2. The age of initial onset of symptoms varied from birth to 36 years of age with the average of 13.1 years. Seventeen patients(89.5%) were under 20 years of age. 3. The duration of disease varied from 6 months to 17 years with the average of 4.6 years. 4. The ratio of male and female was 9:10. 5. Chief complaints were a swelling or mass in 17 cases(89.5%), pain in 13 cases(68.4%), tenderness in 6 cases(31.6%), and impairment of function in 5 cases(26.3%). 6 The size of a mass varied from a nut size to an adult fist one, and its shape appeared oval with the average 8.1 by 4.6 cm in 12 cases, and round with the average 5.5 cm in 7 cases. 7. The site of involvement distributed to lower extremities in 10 cases(52.7%), upper ones in 9 cases(47.4%). Among extremities(thigh, leg, arm and forearm) the most common site was forearm. 8. Considering the number of involed muscles, most frequently they developed in a single muscle with 11 cases(57.9%). 9. By history, The symptoms were initiated or aggravated by trauma in 3 cases(15.8%). 10. Plain roentgenograms showed the swelling of soft tissue in 9 cases(47.4%) and phleboliths in 8 cases(42.1%). 11. Considering the methods of treatment, complete resection was possible in 17 cases(85.7%), in the remaining 2 cases only incomplete resection could be done.

Muscle Transposition for Repair of Skin Defects Over Exposed Bone / 대한정형외과학회잡지

The management of chronic skin defect over the pretibial region, sacral pressure sore and other bony protuberant area is extremely difficult due to the presence of necrotic and infected bone, avascular and infected scar tissue, dead space and anatomical sparse of available adjacent structure. The present methods of management include versatile varieties and have left much to be revised, but they often despaired of both surgeon and patient, especially due to persistent chronic osteomyelitis and recurrent ulcer. From January, 1975 to April, 1979, we have had treated 20 such cases with application of muscle flap transposition and following has been observed. 1. The cause of lesion were 11 cases of the traffic accident, 4 cases of the industrial accident, 2 cases of the falling from a height, 2 cases of the pressure sore and 1 case of the chronic osteomyelitis. And 15 cases of them were physically active young adult between 2nd decade to 4th decade. 2. The muscles used for pretibial lesion were medial head of gastrocnemius m., soieus m., flexor digitorum longus m. and peroneus brevis m. Used abductor hallucis m. for medial malleolar defect, gluteus maximus m. for sacral pressure sores and sartorius m. for exposed knee joint. 3. There existed hematoma formation in 2 cases, partial necrosis of transposed muscle in 3 cases and persistent infected sinuses in 3 cases. Other cases except the last 3 cases, which needed another surgical procedure and antibiotic therapy, were controlled without difficulty and all of them did not develope any recurrence of ulcer during the follow up duration. 4. There did not appear to be any significant long term functional residua due to loss of original function of the transposed muscle except somewhat unacceptable cosmetic result. 5. It was 2 months average for the healing cases which did not need a bone graft and 5 months average for the cases needed a bone graft.

Vascular Injuries Associated with the Fractures About the Knee / 대한정형외과학회잡지

Fractures about the knee including the distal femur and the proximal tibia not infrequently result in vaseular injuries of the popliteal artery and the distal part of the femoral artery. This is often followed by circulatory disturbance and jeopadizes the viability of the lower extremity. During the three and a half year period, from January 1973 to June 1976, 20 cases of vascular injuries complicated by fractures about the knee were treated at the Orthopedic Department of Busan National University Hospital. Review of the cases resulted in the following observations. 1. The lower extremity escaped amputation in 45% the cases (9 of the 20 cases) 2. Femoral arteriography showed that the site of injury was proximal to the Soleus insertion. in 17 cases. 3. Types of vascular injury were contusion in 9 cases, laceration in 7 and total disruption in 4. 4. 5 of the 6 extremities that were treated within 12 hours after injury survived, while only 2 out of t he 9 extremities treated after 24 hours following injury escaped amputation. 5. 6 of the 13 extermities (46%) tredted by interval fixation survived, while 1 out of 5 extremities (20%) treated by traction escaped amputation.

Clinical Observation of Supracondylar fracture of Humerus in Children / 대한정형외과학회잡지

Supracondylar fracture of the humerus is the most common fracture of the elbow in children and it can also be one of the most difficult fractures to be treated. A number of methods to manage supracondylar fracture of the humerus in children, have been being practiced and the ideal one is generally agreed with prompt, accurate and anatomical. reduction performed with the least possible trauma, and, it will prevent most complications. It is essential to minimize additional trauma to the already traumatized joint and pericapsular tissues including blood vessles and nerves. 105 patients with supracondylar fracture of the humerus managed at the Department of Orthopedic Surgery, Busan National University from January, 1971 to June, 1976 were reviewed and the following results were obtained. 1. The age of the patients ranged from 2 years to 14 years; the average age was 7. 0 year. 70 patients were boys. 2. The left side was involved in 62 patients; The distal fragment was displaced posterioly in 102 patients and anteriorly in 3 patients The medial displacement in the posteriorly displaced distal fragment was 60 patients. 3. 20 fractures were treated by open reduction and internal fixation. The indications for open reduction were failure to obtain accurate reduction after a few attempts of closed reduction in 15, an open fracture in 2, acute vascular embarrassment in 2, and redisplacement after open reduction in 1. 4. 15 of the 20 fractures treated by open reduction were re-examine 1 to 5 years; The results were normal elbow motion in 10, loss of extension (average 24 degree) in 5, loss of flexion in 2 and neuro-vascular complication in 2.