Treatment of Diskogenic Low Back Pain Using Epidural Steroid / 대한정형외과학회잡지

Today, the exact causal relationship between prolapsed intervertebral disk and sciatica remains unclear. Murphy has proposed that inflammation rather than mechanical pressure is the basis of back pain and sciatica, and that causal irritant is likely to be a chemical product of disk degeneration. The administration of steroids into the epidural space reduces the inflammatory process of the neural structure is well known. We have studied the effect of injection of methylprednisolone acetate (Depomedrol) comparing with the effect of operative treatment. One hundred and eleven cases suffuring from diskogenic low back pain had been treated at Wallace Memorial Baptist Hospital during 2.5 years period from May 1979 to Nov. 1981. The results were as follows: 1. Sixteen patients (14%) stated that they had no relief from the injection, 24(22%) were moderately improved, 52(47%) were markedly improved and 19(17%) were completely relieved of symptoms. 2. The candidates for laminectomy which were confirmed by myelogram had complete improvement in 12%, marked improvement in 39%, moderate improvement in 21%, no relief in 28%.

The Treatment of Tibial Shaft Fracture with Total Contact Short Leg Cast / 대한정형외과학회잡지

The incidence of tibial fracture is increasing due to increasing tendency of traffic and industrial accidents. In general, the tibial fracture is treated with closed method but it is difficult because of its anatomical cbaracteristics. We have been treated tibial fractures with total contact short leg cast which supports the 7 points such as tibial condyle, tuberosity, margo anterior, medial malleolus, fibular head, lateral malleolus and heel rigidly and molding it as trangiular shape like the tibia using both palms and fingers The advantages of this cast sre to prevent rotation, to promote osteogenesis with early weight bearing and to prevent ankylosis of knee joint. In fact, the sverage healing time was 14weeks Rotation, nonunion, angulation ove cast sore, nerve injury were not noticed and the shortening was 4. 1mm in closed fractures, 5. 3mm in open fractures.

The Treatment of Supracondylar Fracture of the Humerus in Children / 대한정형외과학회잡지

Supracondylar fracture of the Humerus is the most common fracture of the elbow in children and frequently there are accompanying complications. A total of 78 children with supracondylar fracture of the humerus were treated at the Wallace Memorial Baptist Hospital, Busan, Korea, during a recent 5 year period. Of these, 33 patients were treated by lateral skeletal traction through olecranon pin and 14 of these were followed up for more than 6 months. 1. The average age was 7.2 years and the male and female ratio was 2.4:1. The left humerus was involved in 49 patients (62.5%). 2. Of all fractures, 94.4% were the extension type and 5.6% were the flexion type. 3. Satisfactory results wire obtained in 31 of 33 cases who were treated by lateral skeletal traction. Among these, 14 cases were followed up for more than 6 months. Final results were analyzed according to Mitchells classification; excellent results were obtained in 11 cases (78.6%), good results in 3 cases (21.4%) and there were no unsatisfactory results. 4. In 11 cases in which immediate closed reduction or Dunlops traction followed by closed reduction was unsuccessful, satisfactory results were obtained in 10 of 1 1 cases by using lateral skeletal traction. Therefore, we think that it is possible to treat most of the manual reduction failure patients by lateral skeletal traction. 5. There were two treatment failures using lateral skeletal traction. In one case, the brachialis muscle was buttonholed by the proximal fragment, and in the other case, the patient was treated 8 days after injury and marked hematoma formation between the fracture fragment was noted. 6. During treatment by lateral skeletal traction, infection developed through the pin tract in 2 cases. These were treated by the administration of antibiotics and there were no complications such as osteomyelitis nor did this effect the final results. 7. Incomplete radial nerve palsy developed in 3 cases. However, in all cases recovery was spontaneous with 4 weeks. 8. The average hospital stay for patients treated by lateral skeletal traction was 14.2 days. Prologed hospitalization is ane of the chief disadvantages of lateral skeletal traction. However, if we can minimized the number of hospital days by early cast immobiiization when the fracture is stable, lateral skeletal traction will prove to be a good method which can be expected to yield unlformly satisfactory results which are not surpassed by any other method of treatment. Since this method has been instituted at this hospital, very few patients have undergone open reduction because of fracture malalignment.

Accessory Hamstring Muscle: A Case Report / 대한정형외과학회잡지

Accessory hamstring muscle is rare in incidence. In the popliteal region, it often simulates soft tissue tumor since it may be manifest as popliteal swelling. We experienced a case of accessory hamstring muscle which simulated popliteal tumor on physical examination.

A Clinical Study of Neglected Rupture of the Achilles Tendon / 대한정형외과학회잡지

Since rupture of the Achilles tendon was first reported by Pare in 1575, various caues and diagnostic and therapeutic methods have been described by many workers. Almost all these workers agree that with early diagnosis and early treatment the prognosis is good. But the incidence of misdiagnosis by the physician as well as the patient's own neglect of his condition is disconcertedly high one. Nevertheless, negiected rupture of the Achilles tendon may lead to good results by proper selection of tbe operative method. In this report 16 cases of neglected ruptures of the Achilles tendon, in which treatment had been delayed more than 3 weeks were reviewed. A follow-up study of more than 6 months was made on 14 of these cases treated during the 5 year period from February 1973 to August 1977. The results are summarized as follows: 1. The causes responsible for the neglected ruptures were misdiagnosis by the physician in 62.5% and the patient's own neglect of his condition in 25% of the cases. The patient, in many cases, failed to seek medical treatment because of the rapid disappearance of pain, the absence of an open wound, ability of mild ankle plantar flexion, and the ability to walk. 2. Neglected rupture of the Achilles tendon occured most commonly in man of 4th decade. 3. Left side injuries were more common than right side injuries with a ratio of 9:7. 4. Ruptures by indirect injury were more common than by direct injury with a ratio of 9:7, and were most common during recreation and sports activities. 5. The most frequent site of rupture was 2 to 6 cm above the insertion of the tendon with 81% of the cases. 6. The end-to-end suture with pull-out wire method and Lindholm's operative method gave good (Excellent or Satisfactory) results in neglected rupture of the tendon as well. 7. Even in cases of neglected Achilles tendon rupture, normal function can be regained in approximately 6 months post-operatively if proper method of treatment is selected.