A Case of Primary Hyperparathyroidism / 대한내분비외과학회지

A 65 years old male, who had complained of severe lower back pain with generalized muscular weakness, nausea and constipation since last 18 months, showed typical loboratory and radilogical findings of primary hyperparathyroidism. It had extensive skeletal involvement and some urological complication. The mass, which was palpated in the right upper corner of the thyroid, was surgically completely removed. It was measured 8×4×3 cm, and was weighed 38 gm. Microscopic examination revealed adenoma of the parathyroid gland consisting of small dark chiefe ells. Postoperative course has been satisfactory. (

Clinical Experiences of Triple Arthrodesis / 대한정형외과학회잡지

This is an analysis of 137 feet of triple arthrodesis over a period of 23 years.1964–1987. The average period of follow-up was 4 years and 2 months. The results are as follows. 1. The ratio of male to female was 64 to 68 cases, and right to left was 75 to 62 feet. 97 feet(70. 8%) were operated on between late 1960 and early 1970. 89 cases(67.4%) came for their initial examination when they were aged between 9–20 years. Age at the surgery was between 55/12–50 years, and among them 134 feet(97.8%) were operated after age of 8 years. 2. 128(93.4%) out of 132 cases were residual poliomyelitis, and 97(70.8%) out of 137 feet were equinovarus. 3. 100 out of 132 cases receiving triple arthrodesis also received a total of 179 additional procedures simultaneously to achieve better correction. The major additional procedure was. Achilles tendon lengthening in 81 cases followed by plantar fasciotomy in 49 cases. 4. Surgical approach was by Ollier's method, and arthrodesis by Lambrinudi's method. 5. 134 out of 137 feet required triple arthrodesis in order to correct the deformity. On this operative procedure it was utmost important to dissect the tarsal bones and surrounding soft tissues thoroughly to loosen and rearrange the joints. In this way even severe deformity was corrected satisfactorily. 6. At the time of Achilles tendon lengthening by Z-plasty deviding it longitudinally, on the tibial side the tendon was cut at the calcaneal attatchment, and on the fibular side at the proximal end. We think that this produced more efficient and satisfactory results especially in the correction of equinovarus. 7. Internal fixation was done by one staple on 110 feet and two staples on 7 feet. On one staple use, it was inserted connecting the talus and the cuboid. More firm contact between two bones as it progressing into bone was achieved by placing with slightly spread legged staple. 8. We could not find any pseudoarthrosis or delayed union. It is assumed the reason for this was good dissection of bone and joint, firm internal and external immobilization, and good postoperative management. 9. Talar and navicular necrosis occurred in 6 feet(4.4%), but did not affect the final fusion of the arthrodesis. In relatively severe necrosis, we found flattening of the talus and complaint of considerable pain but nevertheless, no special additional procedure was done. 10. We found some cases of postoperative degenerative hypertrophic osteoarthritis in tibio-talar and navicular-cuneiform joint. We feel this phenomenon is due to compensatory stress emanating from the fusion of three joint, and new contact of articular surfaces with changed biomechanical force. 11. When doing triple arthrodesis, the optimal age for surgery is 10-12 years, i.e., before the completion of bone growth, the reason is during the remaining period of bone growth, there is opportunity for the bone and other tissues to adjust to the newly formed stresses of weightbearing and joint motion. 12. Of a total of 137 feet receiving triple arthrodesis, excellent results were seen in 31(23%), good in 82(60%), fair 20(14%) and failed in 4(3%).

Clinical Experiences of Poliomyelitis / 대한정형외과학회잡지

This is an analysis of 1282 cases of poliomyelitis from patient records gathered over a 20 year period from the year of 1964. The results are as follows : 1. The most visits recorded in any one year were 301(23%) in 1965. The most visits recorded in a 5 year period were 961(67%) in the years of 1965–1969. 2 Of a total of 1158 cases whose year of onset was recorded, the earliest onset was in 1900: only one case. Since 1981 no new onsets have been recorded. However, the majority of cases : 1014(87%) showed an onset between 1955–1974. 3. Of a total of 1282 cases whose place of residence at primary examination was recorced, 891(70%) resided in Seoul and 391(30%) in the rural areas. 4. Of a total of 1282 cases whose sex was recorded, males comprised 777(61%) and females 505(39%). 5. Of a total of 883 cases whose season of onset were recorded: 526(60%) onsets occured in the warm, 272(31%) in the cool, and 85(9%) in the cold season of yesr. 6. Of a total of 1155 cases whose age at onset was recorded, the youngest was 4 months and the oldest 28 years of age. The largest group comprising 915 cases(79%) were two years of age or younger. 7. Of a total of 1146 cases whose period between onset and primary visit was recorded: 182(16%) were in acute, 414(36%) were within convalescent, and 732(64%) were in residual stage. 8. Of a total of 1268 cases whose age at initial examination was recorded, 233(18%) were two years or younger, 1021(81%) were 14 years or younger. 9. Of a total of 445 cases whose vaccination history was recorded, 234(53%) had been vaccinated prior to onset. Of those only 112(48%) had completed the required course of vaccincation. 10. Of the total of 1282 cases, deformities resulting from muscular paralysis were recorded in 1099(86%) cases. The number of deformities occuring in these cases totalled 3141: 189 deformities(6%) were in the trunk, 64(2%) were in upper extremity, and 2888(92%) were in lower extremity. Among the lower extremity, 1270(40%) were in the foot. The most frequent single deformity was knee flexion with the total of 464(15%). 11. Of a total of 798 cases whose leg length was verified, 394 were measured by scanogram and 404 cases by measurement of actual leg length. The greatest leg length discrepancy was 12cm in a 17 year-old male, and the most average discrepancy in those bone growth completing, age of 17–20 years, was 3.2cm. 12. Of a total of 1282 cases, 503(39%) cases had prescriptions for supportive devices, but only 316(25%) cases actually had made and wore them. Among those prescriptions, the most common type prescribed was the long-leg brace, which totalled 351. 13. Of the total of 1282 cases, 449(35%) received 1297 surgical procedures, an average of 2.9 per patient. The operations on soft tissue comprised 734(57%) procedures : 348 tendon transplantations with the most(170 procedures) on peroneals, 147 tendon lengthenings with the most(146 procedures) on Achilles tendon, and 234 fasciotomies with the most (117 procedures) on iliotibial band. The operations on bone and joint comprised 563(43%) procedures : 274 leg length equalizations with the most(172 procedures) of growth stimulation, 186 arthrodeses with the most(115 procedures) of triple arthrodesis of the foot, and 92 osteotomies with the most(41 procedures) on tibis. 14. Since problems remaining in the residual stage of poliomyelitis are almost always permanent, observation of these cases over a long period of time has generated invaluable experience from which we have gained considerable knowledge. 15. It has been a revelation to see the considerable degree of compensation in growing children such as a decrease in leg length discrepancy as the end of growth approached. Cases of so called hand-knee gait showing hypertrophy of fingers have lost this in a few years, following corrective measures. 16. We feel that all cases of leg length discrepancy do not need to be treated uniformly, considering the power of the ability of growing children to compensate without any inter vention. 17. Prediction of type of motion or deformities using physical examination of muscular paralysis is very difficult because the compounding factors of not only the paralysis of various muscles but the individual characteristics. The age, sex, lifestyle, motivation etc. have been shown to have an over-riding influence. 18. Decisions to brace or operate should not be made hastily but only after careful and thorough examination. We saw many quite severely disabled cases walk remarkably well without braces or surgery by their own means of compensation or device. 19. Cases with almost no lower extremity muscle power except for 20–30% hip rotators could walk surprisingly well using the sartorius muscle as a main controlling force. So we dubbed their manner of walking the sartorius gait. 20. Bracing can be very burdersome, and decisions to brace should not be made on the textbook alone. Some cases happily choose surgery over bracing. 21. For one time surgical procedure, it is better to choose bone over soft tissue for a better result. When the surgery is two stage, soft tissue surgery done after bone and joint surgery has healed will produce better results. 22. We must all realize that not only poliomyelitis, but also all chronic diseases need mental treatment as well as physical. Because, in rehablitation mental disablity is more harmful than physical in the final analysis.

The Clinical Study on the Discoid Semilunar Cartilage / 대한정형외과학회잡지

The first description on the discoid meniscus was made by Young in 1889 and was known as it affects only the lateral meniscus for a long time. However, Cave and Staples had reported the two cases of discoid changes on medial meniscus in 1941. Smillie(1948) had stated that the menisci exist as cartilagenous discs at an early stage of fetus and remain in discoid shape congenitally. Kaplan(1957) reported that the discoid meniscus is not caused by congenitally but acquired in relation of joint motion. A clinical analysis is made on the 22 discoid meniscus which were removed surgically and summarized as follows: 1. The click sound on walking, tenderness and positive McMurray test were important as diagnostic criteria and were present all of the cases. 2. The most of the discoid meniscus were found in first and second decade in 13 cases(76.5%) out of 22. The five cases were bilateral. 3. The discoid change of the meniscus had no sex defferences in their incidence but lateral involvement were far superior than in ten times. 4. The discoid meniscus shows degenerative change microscopically 17(77.3%). 5. The clinical result of surgical removal of discoid meniscus was satisfactory in resuming their full activities in six weeks.

Reflections on the Past and a challenge to the Future: On the Occasion of the 20 th Anniversary / 대한정형외과학회잡지

No abstract available.

Bon Abscesses Treated by Bone Graft / 대한정형외과학회잡지

We have treated three cases of bone abscesses, two in proximal tibia and one in os calcis, by radical excision and filling the remaining bone cavity with autogenous iliac bone graft. We have observed them postoperatively for one to six years. They have not shown any sign of recurrence and they are carrying out their normal daily activity without any restriction. Eventhough it is against the basic fundamental of surgery to lay bone grafts in an infected area, our treatment was successful. We believe that this was resulted from the administration of the broad spectrum antibiotics, complete excision of the diseased tissue, gentle handling of the tissue at the surgery, and relatively perfect postoperative care. When the remaining bone cavity after the surgery of the osteomyeIitis can not filled by the usual method such as muscle pedicle graft, especially in the proximal metaphyseo-epiphyseaI region of the tibia, fresh cancellous bone graft immediately after the radical excision, and primary closure of the operative wound may be tried. It seems that this method brings rapid and permanent heaIing of the chronic osteomyelitis. Thus the patient can leave hospital earlier, pays Iess expense, and returns to his work earlier.

Clinical Experience with Epiphyseal Stapling

For the correction of leg length discrepancy in children, epiphyseal stapling was done for 41 epiphyses on 25 cases. The time of the stapling operation was chosen by using the chart of Green and Anderson, so that the leg length would be equal automatically at the end of epiphyseal bone growth. In this way an operation to remove the staples according to Blount's method was eliminated, an operation which usually injures the epiphyseal cartilage and often results in angular deformities. Also it eliminated the fear of retarding or stopping epiphyseal bone growth after holding the epiphyseal plate by staples for a long period. All 3/64 inch and some of the 5/64 inch rod staples were broken, and the rest of the 5/64 inch rod staples were widely open. Therefore, in the later period of this experiment, the authors used three period of this experiment, the authors used three 7/64 inch rod staples as a unit. Because the staples are to resist continuously the tremendous growing power of the epiphysis, danger always exists until growth ceases. Therefore, selecting staples with adequate strength and conducting close follow-up studies at frequent intervals are very important in preventing complications. In the average period of observation of 3 years and 2 months, the average discrepancy of leg length was decreased from 6.5cm to 2.3cm instead of the gradual increase that occurs in untreated cases.