Additional Reduction Screw Fixation Technique for Pertrochanteric Hip Fractures:A Novel Method to Prevent Excessive Sliding in Cephalomedullary Nail Surgery / 대한고관절학회지

Extramedullary (EM) reduction, defined as the medial cortex of the head–neck fragment located outside the medullary canal of the distal shaft fragment, has been introduced to prevent excessive postoperative sliding or failure of the lag screw in pertrochanteric fracture surgeries. Favorable EM reduction results have recently been reported in several clinical and biomechanical studies. Despite these efforts, maintaining the head–neck fragment in an EM position is periodically a difficult and challenging problem. Herein, the technique for reduction and maintenance of the head–neck fragment was introduced in an EM position using a Kirschner wire and partially threaded cannulated screw fixation via screw fixation from EM to the head–neck fragment, which was positioned inferior to the lag screw on the femoral calcar, also called the reduction screw. The authors utilized this reduction screw in 34 pertrochanteric fracture surgeries using a cephalomedullary nail and fracture union was acheive in all cases by a minimum one-year follow-up period without surgical complications.

MRI Measurement of the Intercondylar Notch and Correlation to Anterior Cruciate Ligament Injuries / 대한정형외과학회잡지

Notch stenosis had been thought to be related with anterior cruciate ligament (ACL) injury. The purpose of this study is to evaluate the possible relationship between notch stenosis and ACL injury. We measured the notch seen on the axial section in MRI at popliteal groove. We have retrospectively analyzed 116 cases of knee MRI. All cases were divided into three groups ; Group I were fifty six normal knee. Group II were thirty knee with contact ACL injuries. Group III were thirty knee with non contact ACL injuries. The result were as follows; 1. Statistically significant difference was found in the notch width index (NWI) between group I and group III but no significant differences was found in the NWI between group I and group II. 2. Statistically significant correlation to non-contact ACL injuries was found in the NWI at both anterior and posterior outlet of the notch. 3. An unique shape of the notch was found in the majority of group III.There seemed to be an obvious relationship between notch stenosis and non-contact ACL injuries.

Acute Suppurative Arthritis in Neonatal Period / 대한정형외과학회잡지

Acute suppurative arthritis in neonates is very difficult to diagnose early since it does not show typical clinical picture and as a results, delayed diagnosis and improper treatment often leads to permanent disability in patient. To prevent the sequelae follwing acute suppurative arthritis, early surgical treatment and administration of antibiotics are essential. We analysed 15 affected joints in 11 neonates less than 1 month old who were treated by surgical treatment and administration antibiotics. The results were as follows. 1) As for the specific joint involved, those affecting hip joint were most frequent(8 joint: 53%), followed by knee joint(5 joints: 33%) and shoulder(2 joints: 14%). Acute osteomyelitis was simultaneously occurred in 10 joints(67%). 2) As for clinical symptoms and signs, 10 cases (91%) showed limited range of motion with the clinical symptoms and signs similar to neonatal sepsis. 3) As for the causative organism, Gram-negative bacilli was the most frequent one(40%), followed by Staphylococcus aureus(27%) and candida albicans. No organisms were identifiable in four joints(27%). 4) As for the sensitivity test to antibiotics, group of staphylococcus aureus was found sensitive to newer cephalosporins while those of gram-negative bacilli to amikacin in 83%. 5) Average time between the first clinical symptom and operation was 5.14days. 6) The hip joint had yielded most complications(5 cases) followed by knee and shoulder joint, one for each. The accompanying osteomyelitis and delayed treatment were contributing factors to complications.

The Treatement of ankle Fracture / 대한정형외과학회잡지

The ankle stability has a vital role in normal gait and walking. An accurate and anatomic reduction with rigid fixation has been emphasized as important regimens as well as early motion and weight bearing exercises. The authors analysed 90 cases(88 patients) of ankle fractures which were admitted and treated in orthopedic department, Chung-Ang Gil General Hospital from March 1987 to May 1992. Males were affected 1.7times than female and the age group of third and fourth decades constituted 60.2%. The most common cause was vehicle accident(35 cases; 38.9%). According to Lauge-Hansen classification, supination-external rotation type was most common(32 cases; 35.6%). Accoompanyng injuries were noted on 45 cases(50%) and fractures in lower extremities were most common(17 cases; 18.9%). According to meyer's assessment of result, the clinical and radiologic results were better in operative method than conservative ones. From the evaluation of clinical results, anatomic reduction and rigid internal fixation of lateral malleoli and distal tibiofibular joint are more important factors. Complications are resulted in 19cases(21.1%) and traumatic arthritis is the most common (10 cases; 11.1%). The extent and degree of injury was an important factor in an overall results of treatment as well as the anatomic reduction of fracture alignment.

Clinical Results of Segmental spinal instrumentation in Unstable Fracture and Fracture / 대한정형외과학회잡지

Segmental Spinal Instrumentation (S.S.I.) is considered to the effective operative procedure in unstable fracture and fracture-dislocation of the thoracolumbar spine, providing improved correction effect, high rate of fusion and immediate rigid fixation which obviates the need for postoperative immobilization. Retrospective study was carried out of 24 cases of fracture or fracture-dislication of the thoracolumbar spine, There were treated with Harrington rod instrumentation and sublaminar wiring (8 cases) and Luque rod instrumentatiom and sublaminar wiring (16 cases) in Soonchnhyang University, from January 1986 to June 1988. We have analyzed the results of treatment, which were as follows ; 1. Thoracolumbar junction (T12 Ll) was most commomly involved segment (63%) and falling from a height was most common cause of injuries. 2. The most common type by Denis classification was burst fracture (38%). 3. About improvement of neurologic status by injury site and type of instrumentation, thoracolumbar junction (38.5%) and lumbar spine (35%) were better prognosis than thoracic spine (8.75%). 4. In commparison with kyphotic deformity and displacement, Harrington rod (66.4%) was better than Luque rod (58.9%) in postoperative correction. Also in total correction, Harrington rod was better than Luque rod in spite of more or less large amount of loss of correction. words : Thoracolumbar spine, Unstable fracture-dislocation, Segmental spinal instrumentation (S.S.I.)