The Surgical Treatment of Trochanteric Fracture / 대한정형외과학회잡지

The incidence of trochanteric fracture of the femur is increasing, which is likely to continue for many years because of an increase in traffic accidents and the population of elderly people. The primary goal in the treatment of an elderly patient with an intertrochanteric hip fracture is to return the patient to his prefracture activity without any complication, as soon as possible. Rapid mobilization with stable internal fixation helps to prevent skin ulceration, pneumonia, urinary stasis, thromboembolic disease and other complications of confinement to bed in the elderly. Stable internal fixation depends mainly upon the fracture type and operative techniques. A clinical study of operative techniques was done in twenty three patients with trochanteric fracture of the femur who had been admitted and treated surgically at the Orthopaedic Department of W.M.B.H. during of two years from Mar. 1982 to Feb. 1984. The following are brief descriptions of the operative techniques. l. An L-shape incision and refiection of the vastus lateralis muscle provided wide exposure and facilitated anatomical reduction under direct vision. 2. The nail insertion site was selected at a slightly eccentric position anterior to rather than exactly midway from the opposite lateral cortex of the lesser trochanter. Therefore the nail could be laid rigidly between the thick anteromedial cortex and the posteromedial calcar portion. 3. The best stable position among the fracture line, the neck shaft angle and the nail plate could be obtained by the yoking procedure. It also allowed for later proximal migration of the shaft fragment and fracture impaction without impingement on the base of the barrel.

Reapir of the Torn Achilles Tendon, Using the Plantaris Tendon / 대한정형외과학회잡지

A major problem in the repair of the torn Achilles tendon has been providing the restoration of the anatomic continuity such that virtually normal plantar flexion power and ankle mobility result. Continuity should be restored without subsequent pain, disconfiguration, occupational limitations. If possible, postoperative complications, or tendon-rerupture should be avoided. Surgeons have long advocated the use of strips of facia and other tissues, including the plantaris tendon, to reinforce the repair of the torn Achilles tendon, The repair effected by these methods not infrequently is bulky and not too secure. Non-absorbable suture materials utilizing in the end to end anastomosis of the torn Achilles tendon cause sinus formation and discharge of suture materials. A secure method of repair for the tom Achilles tendon, which decreases sinus formation and is not bulky, should be required. The plantaris tendon, which has been used as a reinforcing material, can be utilized in the end-to-end anastomosis of the torn Achilles tendon by detaching from the muculotendinous junction. The 11 patients with the torn Achilles tendon were treated by end-to-end anastomosis using the plantaris tendon as suture material. The postoperative results were staisfactory without significant functional deficit and complication.

Treatment of Kienbock's Disease Using Fascia Latae: Two Cases Report / 대한정형외과학회잡지

Avascular necrosis of the carpal lunate (Kienbock's Disease) was first described by Peste in 1843. It's etiology is still unknown. Since Lippman, in 1949, there have been many operative treatments for this disease but they had many complications and technical difficulties. The treatment of Kienbock's disease by resection of the lunate and replacement with fascia lata through the dorsal approach is very simple in operation method and its results were satisfactory in follow up study for postop 12, 18 months. We report two cases of Kienbock's disease with brief review of literature.

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 For period of 4 years from Jan. 1980 to Dec. 1983, 54 children with dispaced supracondylar fracture of the humerus were classified by direction of displacement of distal fragment and treated by immediate closed reduction after lateral skeletal traction. 32 cases of these were followed up for more than 6 months. The results were obtained as follows.: 1) The most common incidence (79.6%) was 5 to 12 years of age and male and female ratio was 2.4 : l. The left humerus was involved in 35 cases (64.8%). 2) Of all fracture, extension type was 96.3% and flexion type 3.7%. 3) Under the exact anteroposteier and lateral views, fractures were classified by displaced direction of distal fragment. Immediate closed reduction was done by using thick and strong periosteal hinge after lateral skeletal traction. The more accurate anatomical reduction was obtained by maintenance of reduction state and further correction during lateral skeletal traction, and complications such as VIC, loss of reduction were lessened probably. 4) For follow up study of 32 cases, final result were analized according to Mitchells classification. Excellent results were obtained 23 cases (71.9%) Good results were 8 cases (25.0%) Unsatisfactory result was 1 case (3.1 %) 5) In 2 cases of treatment failure, the brachialis muscle was buttonholed by metaphyseal spike of the proximal fragment. 6) During lateral skeletal traction, superficial infection was developed through pin tract in 4 cases. These were treated by the administration of antibiotics and there were no complication such as osteomyelitis.

BCG Osteomyelitis: A Case Report / 대한정형외과학회잡지

BCG osteomyelitis occurs in the infants and children as complication of BCG vaccination and its occurrence is very rare. It involves the metaphysis of the long bone and its development is chiefly hematogenous spread and direct inoculation. Radiologic feature shows well demarcated, eccentrically located destruction in the metaphysis of the long bone and soft tissue swelling about the lesion but periosteal reaction was absent initially. We experienced a case of BCG osteomyelitis which occurs in the left proximal humerus in 3 month after BCG vaccination.