Nail Lengthening using the Eponychial Flap / 대한정형외과학회잡지

PURPOSE: We wanted to introduce a nail lengthening technique with an eponychial flap for treating finger tip amputation, and we review the relevant literature. MATERIALS AND METHODS: Twenty-five patients who received eponychial flap surgery between November 2001 and April 2006 were enrolled in this study. Retrospectively, the patients were asked, by using a questionnaire, about their satisfaction with their nail shape and length. The preoperative findings and the findings at the last follow up and the contralateral finger nail lengths were measured with a ruler and those were all compared according to the percentage of change. RESULTS: The average operation time was fourteen minutes (range: 10 to 19 minutes). All the flaps survived and there was no infection, congestion of the flap, or additional deformity of nail. The average follow up period was five months. The nails were lengthened an average of 0.35 cm. The last follow up questionnaire showed that the patients were satisfied with their nail's appearance with an average score of 95.5 points. CONCLUSION: Nail lengthening using an eponychial flap is a convenient, safe and aestheticall pleasing procedure.

Forearm Length Discrepancy in Unilateral Congenital Proximal Radioulnar Synostosis / 대한정형외과학회잡지

PURPOSE: Forearm lengths in cases of unilateral congenital radioulnar synostosis, were analysed radiographically to evaluate the amount of length discrepancy according to different types. MATERIALS AND METHODS: We measured the ulnar length ratio (length of affected forearm/length of unaffected forearm) in 15 cases of uni-lateral congenital radioulnar synostosis. We observed two distinct radiographic patterns. Type I (Lamda type) appeared to be of gamma character grossly, and showed severe radial bowing and a severely hypoplastic radial head. Type II (Chi type) seemed x like in character, showed mild radial bowing and a mildly hypoplastic, or normal radial head. RESULTS: Nine cases were type I and 6 were type II. The ulnar length ratio was 0.89 in type I and 0.98 in type II. Significant differences were formed in the ulnar length ratios between normal subject and type I, and between type I and type II (p<0.05). The equation determined by simple linear regression analysis in a patient of type I, who had been followed for 10 years, was'ulnar length ratio=0.959-0.013 X age (year)'. CONCLUSION: Unilateral congenital radioulnar synostosis can be classified into two types according to radiological morphology. This classification can be helpful in the prediction of forearm length discrepancy, and in the determination of surgical treatment type.

Arthroscopy of the Wrist and Ulnar Shortening Osteotomy for the Treatment of the Ulnar Impaction Syndrome / 대한정형외과학회잡지

PURPOSE: This is a retrospective analysis of patients with ulnar impaction syndrome, who were diagnosed by wrist arthroscopy and treated by simultaneous ulnar shortening osteotomy. MATERIALS AND METHODS: Six patients with ulnar impaction syndrome, in whom there was an arthroscopic diagnostic confirmation of the disease had an arthroscopic debridement and ulnar shortening osteotomy. Conservative treatment over a period of more than six months had failed in each patient. The minimum duration of the follow up was one year. The ulnar variance was measured using Kreder's method, and the results were clinically analysed using Chun and Palmer's wrist score as well as radiographically. RESULTS: The Palmer's stages of TFCC injury were 2A (one), 2B (four), 2C (one) on arthroscpic finding. The results were excellent in 4 and good in 2 (preoperative: 3 were fair, and 3 were poor). The wrist score increased from 63 to 94. The ulnar variance changed from +3 mm to -1 mm. CONCLUSION: When an ulnar impaction syndrome is suspected on clinical grounds and by radiographic findings, the pathoanantomy should be assessed arthroscopically. If the arthroscopy reveals Palmer's stages 2A, 2B, 2C, arthroscopic debridement and ulnar shortening osteotomy is a useful method for the treatment of ulnar impaction syndrome.

One-stage Corrective Osteotomy for Malunion of Distal Radius Fracture using an Iliac Bone Graft / 대한정형외과학회잡지

PURPOSE: One-stage corrective osteotomy of a symptomatic malunion of a distal radius fracture, is not easy because of the contracture of surrounding soft tissues. We have treated these malunions by a one-stage corrective osteotomy procedure that uses an intraoperative gradual distraction method of the osteotomy site. We have analysed the clinical and radiological results of our procedure, retrospectively. MATERIALS AND METHODS: We have operated on 7 wrists of 7 patients who had malunion of a distal radius fracture who complained of both wrist pain and functional impairment. The distal radius was osteotomized and distracted gradually for 20 to 30 minutes using a lamina spreader. Then the gap was filled with a pre-designed iliac bone graft. The results were analysed functionally using the Cooney's wrist score, cosmetically using Ladd's method, and radiologically using Kreder's method. RESULTS: The Cooney's wrist score improved from an average 44 preoperatively to 91 at the latest follow-up. The clinical results were excellent in 4 patients, good in 2 patients and fair in one patient. CONCLUSION: A one-stage corrective osteotomy with iliac bone graft using a laminar spreader is followed by creep phenomenon is an useful method for the treatment of the malunion of distal radius fracture.

A Immunohistochemical Analysis of Collagen of Transverse Carpal Ligament in Patients with Carpal Tunnel Syndrome / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine differences in the specific collagen types of the transverse carpal ligament (TCL) in patients with carpal tunnel syndrome (CTS) and a control group without CTS. MATERIALS AND METHODS: Surgical specimens from 19 dissected TCLs in patients with idiopathic CTS and 5 controls without CTS were taken (1x1 cm2). We analyzed the manifestations of collagen types I and III by immunohistochemical staining. RESULTS: We found a homogeneous manifestation of type I and III collagens in the control group. However, in CTS patients, type III collagen was sporadically found around the perivascular and pericellular area, and type I collagen showed no definite differences between the two groups. The cellularity in CTS patients was much lower than that in the control group. CONCLUSION: The TCL in CTS patients shows reduced manifestation of type III collagen and less cellularity. These intrinsic changes may play a role in the different manifestations of collagen types in TCL.

The Effect of Demineralized Bovine Cancellous Bone (Osteovit(R)) on the Repair of Full-thickness Cartilage Defect in Rabbits / 대한정형외과연구학회지

PURPOSE: We observed the chondrogenic potential of demineralized bovine cancellous bone (Osteovit(R)) in the repair of osteochondral defects of rabbits. MATERIALS AND METHODS: Full-thickness osteochondral defects of 3.3mm in diameter and 6mm in depth were created on the medial femoral condyle of the knee joint of 36 skeletally mature New Zealand white rabbits. In the right knee, the defect was filled with the demineralized bovine cancellous bone matrix (Osteovit(R)), and in the left knee, the defect was left untreated as a control. At postoperative 3, 6 and 12 weeks, the quality of repair tissue was evaluated by Pineda's semiquantative histological grading scale system. The inflammatory reaction was evaluated by observing the granuloma, foreign body type giant cell, infiltration of inflammatory cell, foreign body and fibrosis. RESULTS: The defects that were filled with demineralized bone matrix showed poorer repair results and more severe inflammatory reaction than the untreated defects, at postoperative 3, 6 weeks. The demineralized bone matrix was completely absorbed after 12 weeks. CONCLUSION: The demineralized bovine cancellous bone (Osteovit(R)) was not helpful for the regeneration of the osteochondral defect of the articular cartilage in rabbit. Remarkable inflammatory reaction to the heterogenic material seemed to be the main cause of the poorer regeneration of the osteochondral defect filled with bovine bone matrix.

A Case of Adenocarinoma of the Lung Associated with Multi-oragn Infarctions / 결핵

The relationship between neoplastic disease and thromboembolic disorders has been recognized since 1865, when Armand Trousseau first reported a high incidence of venous thrombosis in a series of patients with gastric carcinoma. The overall incidence of thromboembolic disease in patients with cancer has been reported to vary 1% to 15%. In a prospective study, Ambrus and associates reported that thrombosis and/or bleeding was the second most common cause of death in hospitalized cancer patients. We report a case who presented as a thromboembolic disease and subsequently confirmed to have an underlying lung malignancy. This 45 years old male patient visited our hospital with abdominal pain and distention of 3 days duration. Abdominal CT scan revealed multiple splenic and renal infarctions. On 20th hospital day, drowsy mental status was developed and hemorrhagic cerebral infarction was noted in brain CT scan. Chest CT scan revealed a 4cm sized spiculated mass on left lung apex and multiple paratracheal lymph adenopathy. With surgical biopsy of left supraclavicular lymph nodes, this patient was confirmed to have adenocarcinoma.

Changes of Bone Meneral Density of the Distraction Gap and Adjacent Parent Bone in Callotasis of the Cnanine Tibia / 대한정형외과학회잡지

The purpose of this study are to delineate the temporal and spatial changes of bone mineralization at the distraction gap and adjacent parent bone, and to investigate the effect of microaxial dynamization on regenerate bone healing and on development of regional osteopenia at the adjacent parent bone, during callotasis. Sixteen Korean adult mongrel dogs underwent bilateral tibial lengthening by callotasis. To the right hindlimbs, no dynamization was applied and served as control group (group I, and axial elastic dynamization was conffered to the left hindlimbs (group II). Bone mineral density(BMD) was measured by dual X-ray absorptionmetry(DXA) at immediate post-operative day, post-operative 12 day, 22 day, 36 day, 50 day, 65 day, and 85 day. Quantitative computed tomogram(Q-CT) was also taken after sacrifice to analyze temporal changes of mineralization pattern in the distraction gap. The following results were obtained; 1. In both group I and II, the BMD was lowest at the interzone in the distraction gap and increased linearly toward the corticotomy surface. This pattern did not change with time until the consolidation of the distraction gap, but the difference of BMD between the interzone and adjacent parent bone decreased with progress of consolidation. 2. During the distraction period, BMD increased progressively at the distraction gap and adjacent parent bone in both group I and II. During consolidation period, although BMD of the distraction gap still increased progressively, that of the adjacent parent bone decreased progressively in group I; the more distant from the corticotomy surface, the more decreased the relative BMD. in group II, the decrease in BMD of the adjacent parent bone was less than that in group I which was statistically significant in mid-consolidation period. In conclusion, the new bone in the distraction gap during callotasis appeared to form in bilateral direction with linear gradient from interzone toward corticotomy surface. Dynamization during callotasis not only stimulated regenerate bone healing in the distraction gap, but also prevented the occurrence of transient regional osteopenia at the distant part of the adjacent bone during midconsolidation period.

Reconstruction of the Acetabular Bone Defect with Morselized Bone Grafts in Acetabular Cup Revision Screw fixed Hemispherical Cup vs. Bipolar Cup / 대한정형외과학회잡지

The purpose of this study is to evaluate the results of the reconstruction of acetabular bone defect with morselized bone graft in revision of failed acetabular cup, used screw fixed hemispherical cup or bipolar cup as a component. Forty five revisions of an acetabular component that had been performed in 42 patients between 1988 and 1993 at SNUH, and had followed more than two years were included in this study. The revised acetabulum was evaluated by Harris hip score, in terms of osseous union and resorption of the graft, the amount of the migration of the revised components. Cup angle change and radiolucency were also evaluated in screw fixed hemispherical cup. The mean Harris hip score was improved 54 to 87 in screw fixed hemispherical cup and 56 to 78 in bipolar cup. In screw fixed hemispherical cup, osseous union showed within 6 months is 91.3% (21 cases), the graft bone resorption less than 10% of the initial graft thickness is 73.9% (17 cases). In bipolar cup, osseous union within 6 months is 52.2% (12 cases), the graft bone resorption less than 10% of the initial graft thickness is 40.9% (9 cases). The failure of revised acetabular component was five in bipolar cup cases and one in screw fixed hemispherical cup cases. In conclusion, screw fixed hemispherical cup showed better clinical results, earlier graft osseous union, less graft bone resorption and lower failure rate than bipolar cup. There was no significant difference between pure allograft mixed with autograft in clinical and radiological results. So we recommend the technique used morselized allograft with screw fixed hemispherical cup, to reconstruct the acetabular bone defect in acetabular cup revision, though bipolar cup was used in staged operation in severe acetabular bone defect with was unable to fix the acetabular cup with screws.

Osteosarcoma-Thirteen-Year Experience / 대한정형외과학회잡지

Osteosarcoma is the most common primary malignant tumor in the orthopaedic field. Recently, the management of osteosarcoma was evolved in many aspects and the improved results were reported in many articles. The purpose of this study is to evaluate the changes of clinical findings and management modalities in osteosarcoma since 1980. We reviewed 127 osteosarcomas managed from 1980 to 1992. The Enneking surgical stage was as follows; stage I 12 cases, stage II 98 cases and stage III 17 cases. They were subclassified into classic(97 cases), parosteal(12 cases), telangiectatic(5 cases), secondary(4 cases), periosteal(2 cases), gnathic(2 cases), high grade surface(1 cases) and undetermined(4 cases). The disease-free survival rate was evaluated for the patients of stage II classic osteosarcomas treated with amputation(27 cases) or limb-salvage operation(23 cases), and average follow up period of them was 49 months. In 27 cases of amputation adjuvant chemotherapy was administered in 23 cases. And in 23 patients treated with limb-salvage operation, neoadjuvant and adjuvant chemotherapy were done in 19 cases and only adjuvant chemotherapy in 2 cases. The clinical changes since 1980 were as follows: (1) The mean duration from symptom onset to diagnosis was decreased gradually from 6.5 months(1980) to 3.1 months(1992). (2) The proportion of curative surgery was increased from 40%(1980) to 87%(1992) in stage I and II. (3) The proportion of limb-salvage operation was rapidly increased upto 88% since 1985. The 5 year disease-free survival rate of stage II classic osteosarcoma was 36% with amputation and 67% with limb-salvage operation.

One-stage total reconstruction of temporomandibular joint ankylosis and facial asymmetry

No abstract available.

Clinical experiences in nasal tip plasty:elevation of tip

No abstract available.