Radial Neck Fracture with 90° Complete Displacement: Report of 3 Cases / 대한정형외과학회잡지

Complete fractures of radial neck or proximal radial epiphysis with 90° displacement are very rare, and only several cases were reported in the literatures. We have experienced 2 cases of radial neck fracture with 90° posterior displacement and one case with anterior displacement. All of them were treated operatively. We followed up these 3 cases more than 15 months and report the results with review of literatures.

Glycogen Metabolism and Glucose Uptake Rate of the Skeletal Muscle after Hind / 대한정형외과학회잡지

The effects of hind-limb immobilization by skeletal fixation of bilateral ankle and knee joints. for sither one or five weeks on glycogen concentrations, glycogen resynthetic activities and insulin responses to glucose uptake of hind-limb muscles were studied on male Splague-Dawley rats. There were significant drops in muscle wet weight to body weight ratio of immobilized soleus and plataris. In the group immobilized for one week, the ratios of sleous and plantaris were decreased by 11% and 38% respectively; and in the group immobilized for five weeks, the ratios were decreased by 42% in both muscles equally. The glycogen concentration and glycogen resynthetic activities of soleus and plantaris muscles in immobilized rats were decreased significantly in the one week group. However, in the five week group, these values were increased significantly compared to the values of those muscles of the one week group. The increased values of the five week group did not exceed those of the control group. The glucose uptake rate of the soleus muscle of the hind-limbs immobilized for one week and for five weeks were studied in vitro. The basal glucose uptake rate of the muscle of the control group was 8.4 ± 0.77Mol/gm/20min. The values of basal rate and insulin responses to the glucose uptake rates in the doses of physiological and supramaximal on the soleus muscles immobilized for one week was significantly decreased, but after immobilization for five weeks, these values were not significantly different statistically those from of the control group statistically.

Clinical analysis of Posterior Spinal Instrumentation in Unstable Thoracolumbar Fracture and Fracture Dislocation / 대한정형외과학회잡지

Various methods of spinal instrumentation have been used for treatment of unstable fracture & fracture-dislocation of thoraco-lumbar spine. Recently, newly designed short segment fixation devices using pedicle screw were designed and there was a trend to use this posterior short segment instrumentation using pedicle screw. We have used AO internal fixator as posterior instrumentation for unstable spine fracture of thoracolumbar spine since November, 1987. Previously we used Harrington instrumentation and Luque rod wiring for treatment of unstable fracture of thoracolumbar spine and we reported the results of clinical analysis of those systems on Feb, 1987. We analyzed the clinical results of 93 cases those who underwent operative treatment using each posterior instrumentation system for unstable fracture and fracture-dislocation of thoraco-lumabr spine at our hospital from Dec. 1983 to Oct. 1989. Among that 93 cases, the Harrington instrumentation were 35 cases, Luque rod instrumentation were 36 cases and AO internal fixator were 22 cases. The results were as follows:1. The most commonly injured level was Ll (44 case) and followed by T12(33 cases, 86%). 2. By Francis Denis classification, Burst type fracture was most common(42 cases, 45%). 3. Change of kyphotic angle were checked on lateral X-ray view. There no significant differences between those groups using H-rod(58.64%), Luque-rod(54.8%), and AO internal fixator(60.1%) on immediate post-op X-ray. But there noticed least loss of correction of kyphotic angle when using AO internal fixator comparing with other groups. 4. The correction rates of height of anterior and middle column were checked by Denis-Edward method, there noticed best correction rate in AO internal fixator group. 5. The ROM of trunk were checked, there were no significant differences in H-rod, L-rod, and AO internal fixator group in long term follow up.

Treatment of the Sequelae of Septic Hip in children: Report of 2 Cases / 대한정형외과학회잡지

Septic arthritis of the children's hip causes acute or chronic inflammatory change in structure about the joint, and results in serious destruction. Due to recent advance of the diagnostic technique and of the antibiotics, the incidence of it's sequelae is decreased. The management of acute stage with antibiotics and early surgical drainage has been well established in the literature, but the management of residual anatomic deformity is less documented, and little comprehensive classification or treatment program has been outlined. We experienced two patients who had sequelae induced by delayed diagnosis and improper treatment. One had a complete loss of femoral neck with femoral head remaining in the acetabulum. Femoral neck reconstruction was performed using proximal femur : i.e., Open reduction of femoral head to femur shaft with distal transfer of greater trochanter (1st stage) followed by varus osteotomy(2nd stage) and follow-up period was 3.5 years. Another had loss of femoral head and neck, dislocation of the hip, and Larsen's trochanteric arthroplasty was performed with 6 Years follow-up. Satisfactory results were obtained in both patients who had reconstructive surgery, so we report these cases with related literatures.

A Clinical Study of Lateral Condyle Fracture of Distal Humerus in Children / 대한정형외과학회잡지

In dealing with lateral condylar injuries of humerus, the chance of pitfalls and having a poor functional result with poor management is much greater because it is a physeal injury involving intraarticular surface. Lateral condylar physeal injuries of distal humerus have been regarded as Salter-Harris Type IV injury. But indeed, true Salter-Harris type IV injury of lateral condyle of distal humerus are rare. It should be regarded as Salter-Harris type II injury. Previously Milch classified the lateral condyle fracture of distal humerus as type I and type II after Stimson's description. It seems to be most useful to plan therapeutic modalities by classification of lateral condyle fracture on the basis of stage of displacement proposed by Jakob et al and Milch's type. Authors performed clinical analysis about lateral condyle fracture of distal humerus in children. Among 79 cases, who were treated at department of orthopaedic surgery, Hyundai haesung hospital from Mar. 1982 to Mar. 1988, it was possible to follow up in 30 cases. The result were as follows ; 1. The age incidence was confined from age of 3 to age of 12. Peak age was around 6. 2. Most of fractures were Milch's type II (75 cases) in contrast to Milch's type I (4 cases). 3. Precise differentiation of stage I and II displacement was needed for evaluation of stability of fracture and planning treatment modalities. 4. In case of stage II displacement, cast immobilization alone was insufficient. K-wire fixation was needed for prevention of displacement and better result. 5. In all of cases(30 cases) overgrowth of lateral condyle and spur formation were noticed but it has no clinical disabilities. 6. There were no significant differences of outcome between different fracture types and different stage of displacement. But significant differences of outcome were noticed how treatment performed. Accurate anatomical reduction and stable fixation was needed. 7. 2 cases of severe cubitus varus(20') were occured. In 21 cases, carrying angle were changed, valgus change were more common than varus change. It was thought to be relative undergrowth of lateral condyle of humerus and malunion as its causes. 8. In all cases, there were no loss of R.O.M.

Clinical Results of Ankle Fractures / 대한정형외과학회잡지

The ankle is a modified complex hinge joint consisting of the distal tibio-fibula joint (Syndesmosis), and the ankle joint proper(hinge joint), and is important in weight bearing, standing and walking. So, the goals of treatment of ankle fracture are anatomical positioning of talus in the mortise and regaining a smooth articular suface. Unless these requisites are achieved by treatment, post-traumatic arthritis is likely to occur. We analyzed 120 cases of ankle fracture, most of which were treated surgically by A-0 method, in Department of Orthopaedic Surgery, Hyundai Haesung Hospital from January, 1982 to December 1985. The results are as follows; 1. The most common victim was 3rd–4th decades man, and the cause was direct blow. 2. The most common type was pronation-external rotation type of Lauge-Hansen classification, and Type A of Danis-Weber type. 3. The more favorable result was noted in Danis-Weber type A than type B and type C,and noted worst result in pilon fracture. 4. Favorable results can be gained by semi-tubular plate in fibular fracture than any other fixation material. 5. On application of semi-tubular plate, there were no significant differences in results between that placed posteriorly and that placed laterally. 6. We did not transfix the distal tibio-fibular joint in stable Danis-Weber type C injury without any specific sequellae. 7. We obtained better result by removal of transfixing screw 6 weeks after operation. 8. We obtained good results with only 3 weeks immobilization after operation.

Clinical Results of Segmental Spinal Instrumentation in Unstable Fracture and Fracture-Dislocation of the Thoracolumbar Spine / 대한정형외과학회잡지

Segmental Spinal Instrumentation is effective operative procedure in unstable fracture and fracture-dislocation of the thoracolumbar spine, providing rigid spinal stability and reduces needs of external support and complications. Fifty nine patients with unstable fracture and fracture-dislocation of thoracolumbar spine were treated with Harrington rod instrumentation and sublaminar wiring(31 patients) and Luque rod instrumentation with sublaminar wiring(28 patients) in Hyun Dai Hae Seong Hospital, Ulsan, Paik Hospital, Pusan from Dec. 1983 to April 1986. We have analyzed the results of treatment about two type of S.S.I. and obtained following conclusions; l. In 59 patients, T12 level injury was 17 cases, Ll level was 25 cases and so T12 and Ll involvement were 71%. 2. By Francis Denis classification, 28 cases were burst type fracture, 20 cases were fracture-dislocation type, 6 cases were seat belt type and 5 cases were wedge compression type. 3. In Harrington rod with S.S.I., initial kyphotic angle was 22.4° and postoperative angle was 7.4° and correction rate was 66.9%; in Luque rod with S.S.I., preoperative kyphotic angle was 21.7° and postoperative angle was 6.5° and correction rate 69.6%. So there was no difference of correction rate in two type of S.S.I. 4. In Harrington rod with S.S.I., the loss of reduction was 1.2° and the loss was 7%; in Luque rod with S.S.I., the loss of reduction was 7.2° and the loss rate was 48%. So the loss of reduction of Luque rod with S.S.I. was greater than that of Harrington rod with S.S.I. 5. After removal of implants, Luque rod with S.S.I. patients have better range of motion than Harrington rod with S.S.I. patients clinically, but it needs more follow-up because of a few cases(18 cases).

A Clinical Study of Replantation of Amputated Upper Limbs and Digits / 대한정형외과학회잡지

Since the first report of completely amputated thumb replantation by Tamai in 1965, replantation surgery has been popularized with increasing success rate and improving functional regain. Recently, difficult replantation such as traction avulsion amputation has been challenged and good success rate and function have been reported. We have analized 34 cases of upper extremity and finger replantation in 23 patients, which were performed at the Dept. of Orthopedic surgery. Hyun Dai Hae Seong Hospital, Ulsan, Korea, from June 1982 to January 1986. The results were as follows: 1. Male patients were 22, female was 1, left upper limbs and digits injuries were more prevalent(16: 7), and average age was 25 years old. 2. The most common injury was done by cutting machine. 3. The number of amputations of fingers were almost same in all fingers and most prevalent in zone III(26 cases, Danial classification). 4. Success rate of replantation was 82.4% In cases of less than 6 hrs ischemic time, the rate was 93.4%, and more than 6 hrs ischemic time, rate was 33.3% 5. Performing arterial anastomosis prior to venous anastomosis, can find out main draining vein, and with one vein and one artery anastomosis, can get good results distal to zone IV. 6. Functional results were satisfactory, evaluating by modified. Tamai score, average 87.5. 7. 6 cases of digital replantations distal to sublimis tendon insertion have good results functionally, cosmetically and technically easy (Tamai score 98). 8. 5 cases of traction avulsion amputations needed many additional surgery to restore function, but end results were relatively satisfactory.

Management of Sequellae of Pyogenic Osteomyelilis / 대한정형외과학회잡지

After discovery of Penicillin by Fleming in 1939, a great improvement in the treatment of osteomyelitis has been made and the mortality rate in acute stage was markedly decreased. But due to misplacement of antibiotics, and the improper treatment of the osteomyelitis, the tendency to chronicity and various sequellae of the osteomyelitis are still persist. So, it will be of importance to reconsider the management of various sequellae of pyogenic osteomyelilis. We reviewed 3 cases of sepsis, 10 cases of pathologic fracture, 6 cases of sepsis, 6 cases of malignant turnor developed in an old draining sinus, 2 cases of bone defect, 3 cases of joint contracture and 4 cases of deformity and growth disturbance 604 cases of osteomyelitis treated at National Medical Center between 1972 to 1983. The results were as follows: 1. Established sepsis was noted in 3 cases, and one of these patient dead. We treat these patients with high dose of the antibiotics accompanied by decompression of the lesion. 2. Pathologic fracture developed in 10 cases, which was treated with either conservative or operative treatment. All cases obtained good union except one. 3. Spuamous cell carcinoma developed in 6 cases around the old draining sinus. All cases were treated with amputation. Theres no recurrence except one. 4. Bone defect developed in 2 cases. A case of bone defect in humeral shaft was treated with vascularized fibular graft and obtained firm union and good function. 5. Joint contracture was treated with soft tissue release and even joint fusion in severe case. The results were not gratifying. 6. Deformity and growth disturbance of limbs were treated with soft tissue release, osteotomy and stapling. Most of the cases obtained good results, but limb length discrepancy was not recovered satisfactorily.

The Treatment of Non-union of Humeral Shaft / 대한정형외과학회잡지

The non-surgical treatment for the fresh humeral shaft fracture would appeared to be not sufficient in respect of immobilization and maintenance of the contact surface of the fracture ends, which have had stimulated surgeons to perform internal fixation. This might be one of the reasons to produce non-union of humeral shaft fracture, supplemented by increasing incidence of fractures due to car and machinary accident. Authors have experienced 18 cases of non-union of humeral shaft fracture and accomplished solid union in all cases by osteosynthesis accompanied by autogenous bone graft. In detail: 1. Non-union was prevalent in the agr group of 20 to 40 and mostly in male. Site of non-union was found mostly at the lower 2/3. 2. The cause of the fracture was mainly due to the car and machinary accident. Initial treatments were surgical in 14 out of 18 cases, and 12 cases of this surgically treated group were treated within 2 days after the injury. 3. On retrospective analysis of medical records and X-ray films, probable cause of the non-union were supposed to be too early performed inadequate internal fixation and post-operative infection in the operated cases, whereas distraction of fracture ends due to poor external fixation and infection in the cases treated conservatively. 4. 16 cases of established non-union were treated by authors with rigid internal fixation and additional bone graft, and 1 case with bone graft only. 5. Authors have utilized shoulder spica or long arm cast post-operatively for 1 to 4 months. 6. Union was obtained in all cases. Developed transient radial nerve palsy in 4 cases; and neighbouring joints contracture in 2 cases, which required considerable time of physical therapy.