A Case of Recurrent Liver Abscess Due to Choledochoduodenal Fistula / 영남의대학술지

Cholelithiasis, duodenal ulcer, duodenal perforation and tumor invasion may lead to choledochoduodenal fistula (CDF). CDF often has no specific symptoms and may be incidentally detected in an upper gastrointestinal radiographic study or endoscopy; but in some cases, it may be accompanied by recurrent cholangitis and liver abscess. In this paper, a case of recurrent liver abscess caused by CDF is reported. A 62-year-old female was admitted to the authors' hospital because of right upper quadrant pain and fever. The abdominal computed tomography showed a liver abscess in the right lobe. A duodenal fistulous orifice was detected with endoscopy, and a contrast was injected through the duodenal orifice using a catheter under fluoroscopy. The injection of the contrast revealed a fistulous track between the duodenal bulb and the common hepatic duct. In fistulas complicated by recurrent liver abscess, surgery or medical management may be needed. The CDF in this case study was treated via endoscopic clipping.

Endobronchial Stent Insertion to Manage Hemoptysis caused by Lung Cancer

Hemoptysis in patients with lung cancer is not uncommon and sometimes have dangerous consequences. Hemoptysis has been managed with various treatment options other than surgery and medicine, such as endobronchial tamponade, transcatheter arterial embolization and radiation therapy. However, these methods can sometimes be used only temporarily or are not suitable for a patient's condition. We present a case in which uncontrollable hemoptysis caused by central lung cancer was successfully treated by inserting a covered self-expanding bronchial stent. The patient could be extubated and was able to undergo further palliative therapy. No recurrent episodes of hemoptysis occurred for the following three months. As our case, airway stenting is a considerable option for the tamponade of a bleeding lesion that cannot be successfully managed with other treatment methods and could be used to preserve airway patency in a select group of patients.

Intracranial Fibroxanthoma in an Infant: a Case Report

A primary fibroxanthoma of the central nervous system is very rare. We present a case of an infantile fibroxanthoma that arose from the cranial dura mater in a six-month-old girl with US, MRI and PET/CT features that mimicked a meningioma. The tumor appeared as a large, well-circumscribed echogenic mass in the right parieto-occipital area on US. The tumor was seen as isoattenuated to slightly hypoattenuated on pre-contrast CT scan and as hypometabolic on PET/CT. As seen on T2-weighted image, the mass was heterogeneously hyperintense to the gray matter. The mass was isointense on T1-weighted image and homogeneously strongly enhanced on contrast enhanced T1-weighted image.

Anesthetic Experience of Adrenalectomy with Primary Aldosteronism - Report of two cases / 대한마취과학회지

Primary aldosteronism is a clinical syndrome manifested by hypertension, hypokalemia and hyporeninemia in which autonomous secretion of aldosterone from the adrenal gland increased. Primary aldosteronism caused by aldosterone-producing adenoma is a surgically treatable conditon. For the first case, operation was performed on a 34 year old woman with this condition, under general anesthesia with N2O-O2-Fentanyl. And the other case was 37 year old man Those patients recovered uneventfully.

A Case of Treatment of Macular Subretinal Neovascularization with the Red-Light Krypton Laser

A case of macular subretinal neovascular membrane was treated by red-light krypton photocoagulation. We used continuous red-light krypton laser(647.1nm) because this light is not absorbed by the hemoglobin in the retinal hemorrhage or by the macular luteal pigment(Xanthophyll). 3 weeks after treatment there was no specific change in the treated area. 6 weeks later, we found that the treated area showed some regression of subretinal neovascular membrane. After 3 monthes, the destruction of the subretinal neovascular membrane was complete, and the visual acuity was improved.

Surgical Treatment of Metastatic Bone Tumors / 대한정형외과학회잡지

Metastatic bone tumors can lead to development of pathological fractures which may cause incessant pain. Hypercalcemia and hypercalciuria may develop secondary to skeletal metastasis and recumbency, leading to death from cardiac and renal sequeale. The proper surgical treatments of the metastatic bone tumor offer many advantages in relief of pain, simplifying nursing care, restoring resonable mobility and prevent complications. The authors reviewed 24 cases of metastatic bone tumors which received surgical treatment at Severance Hospital from January 1976 to March 1982. The results were obtained as follows: 1. Twenty four among three hundred patients with metastatic bone tumors were treated surgically. 2. There was no sexual preference and 66.7% were observed in the age of 51 to 70 group. 3. The most common site of operation was the femur. 4. The methods of operation were as follows: Resectionoflesion.....................5 Replacement with prosthesis..........3 Open reduction and internal..........10 Spinal fusion..........................2 Laminectomy............................4 5. All cases had received various types of ancillary treatment: radiation in 8 cases, 131I radioactive isotope in 1 case, chemotherapy in 2 cases, hormone therapy in 1 case, radiation and chemotherapy in 3 cases and conservative pain control in 9 cases. 6. Among the 15 followed cases, nine survived more than 6 months and 3 cases longer than 1 year after surgery. The pain was relieved markedly in twenty-three patients, and ambulated well with brace support.

Cubitus Varus Deformity following Long-term Crutch Walking in Crippled Children (Crutch Elbow) / 대한정형외과학회잡지

Cubitus varus deformity caused usually by malunion in supracondylar fracture or epiphyseal injuries of the elbow joint, but the other causes of cubitus varus deformity have not been reported. 7 cases of cubitus varus deformity were found among the patients in Sam Yook Childrens Rehabilitation Center in Oct. 1981 all of whom used crutches in order to ambulate due to late sequele of poliomyelitis. The results were as follows. l. After long-term crutch walking, cubitus varus deformity and bowing around the proximal forearm were seen among the patients who mis-used the crutches. 2. Gross carrying angle was greater than radiographic carrying angle and it caused by hypertrophy of the extensor muscle group in forearm and bowing around the proximal forearm. 3. Etiologic factors of the cubitus varus deformity were considered to be improper measurement of the crutches, degree of paralysis of lower extremity and duration of the crutch walking, etc. 4. The mechanism of this deformity could be explained biomechanically by the abnormal axial loading onto the elbow following long-term crutch walking. 5. The correct measurement of the crutches and proper flexion of the elbow during crutch walking were stressed.

Clinical Analysis on the Metastatic Bone Tumors / 대한정형외과학회잡지

A total of 200 cases of metastatic bone tumors was treated at the Yonsei Medical Center during the 5 years period from January 1976 to December 1980. The results of clinical radiological and pathologic analysis are as followings. 1. Among 200 cases of metastatic bone tumors, common site of cancer comprised the lung (30.5%), breast (15.0%), uterus (8.5%), stomach (6.4%), thyroid (3.5%), liver (3.5%), kidney (3.5%), nasopharynx (3.0%), and prostate (2.0%). In male, common primary sites of cancer were lung, stomach, kidney, oropharynx in decreasing order of incidence and in female, breast, uterus and lung. 2. In metastatic bone tumors, 75.5% were observed in the age group between 41 and 70 year of age, and average age was 53.1 years. 3. The sex distribution was 107 males (53.1%) and 93 females (46.5%). 4. The bones affected most frequently in this series were as followings; In only 9 cases (4.5%), metastasis to bone distal to the elbows and knees occurred. 5. Clinical features in this series were classified according to various conditions. Bone pain noticed on 163 cases (81.5%), fatigue on 152 cases (76.0%) and weight loss on 128 cases (64.0%). 6. Pathologic fractures occurred on 22 cases (11.0%); among them, 13 cases on the femur, 5 cases on the vertebrae, and 1 case on the acetabulum, humerus, rib and clavicle respectively. 7. Hematologically, serum calcium and phosphorus was noticed within normal limits. Serum alkaline phosphatase was slightly elevated and serum acid phosphatase was elevated in all cases of prostatic carcinoma. Serum albumin/ globuline ratio was slightly reversed (3.4/3.5mg%). 8. Radiologically, 86 cases were osteolytic, 10 cases were osteoblastic and 44 cases were mixed type. False negative on X-ray examination with positive finding of scan with 99mTc-MDP were found in 17 cases (27.4%). 9. All cases was treated by various methods; among this series, radiation and chemotherapy performed in 57 cases, radiation in 49 cases, chemotherapy in 14 cases, hormone therapy in 16 cases and radioisotope therapy in 5 cases. For 22 pathologic fractures, conservative treatment was performed in 9 cases, open reduction and internal fixation in 13 cases, open reduction and internal fixation with acrylic cement in 5 cases.

A Clinical Study on Whiplash Injury / 대한정형외과학회잡지

In recent years, with increased number and higher speed of the automobiles, the incidence of the so-called whiplash injury has been increasing. The author had studied the clinical symptoms and signs, roentgenographic findings, associated injuries and treatment of the sixty four patients who had admitted to the Yonsei Medical Center under the diagnosis of the whiplash injury excluding the patients who had sustained an associated injuries those may cause neurologic symptoms and signs during the period of eight years from January, 1972 to December, 1979. and sumnerized the results as followings. 1. Among the sixty four patients, thirty one (48.4%) were male and thirty three (51.6%) were female. The most prevalent age were third and fourth decades (62.5%). 2. The causes were rear-end collision, falling of a car, front-end collision, falling of an airplane in an air-pocket and sudden deceleration of a car in the order of frequency. 3. The admission period were longest in the cases of falling of a car (13.3 days) and shortest in the cases of sudden deceleration of a car (9.4 days). 4. Fifty one (79.7%) were returned to the general activity in two weeks and fifty seven (89.1%) were out of the hospital in three weeks. 5. On admission. the patients were suffered from the symptoms and signs as followings, headache, limitation of the motion in neck, neckache, paresthesia, dizziness and dysphagia in the order of frequency. 6. Roentgenograms show loss of lordotic curve in twenty eight (43.7%) and prevertebral swelling in seven (10.3%). 7. Thirty six (56.3%) were associated with other injuries as followings; multiple contusion, teeth injuries, scalp laceration. There were thirteen cases (36.1%) of cerebral concussion. 8. In all the cases, we used analgegics and muscle relaxants until the neck pain subsided. We had performed cervical traction, hot packs in selected cases. Twelve (18.8%) needed cervical braces or Thomas collar at discharge.

Resistant Congenital Culbfoot / 대한정형외과학회잡지

The most important congenital abnormality of the foot is clubfoot or talipes equinovarus, a deformity easy to diagnose but difficult to correct completely, even in the hands of an experienced orthopaedic surgeon. Furthermore approximately 50% of congenital clubfoot are resistant to non-operative methods such as manipulation and cast correction and consequently, under these circumstances, continuation of non-operative treatment leads to eventual failure, due either to incomplete correction, or recurrence of the deformity. In such resistant clubfoot it is better judgement to perform a relatively minor soft tissue operation at the time for resistance rather than to delay surgical treatment and beforced to perform a major operation at a late date for recurrence. Eighteen patients who presented twenty-five resistant congenital clubfoot abnormalities were followed at our department for 9 years and 4 months from February of 1970 to May of 1979. These were subjected to analysis clinically and radiologically, and the following results were obtained. 1. These patients consisted of: 11 male patients, 7 female patients, 11 single clubfeet and 7 bilateral clubfeet. 2. Age categories at operation were as follows: 6 feet below 1 year old, 8 feet 1 year old, 5 feet 2 years old, 3 feet 3 years old and one each age 4, 5 and 6. 3. Treatment period before operation: 19 clubfeet for 3 months to 6 months, 6 clubfeet for 7 months to 1 year. 4. Operations performed: posterior release-four, medial and posterior release-twelve, medial-plantar and posterior release-three, one stage posteromedial release-four, Evans procedure-one and tibialis anterior to lateral cuneiform-one. 5. Operations performed at an early age showed better results than those performed on older patients. 6. Of all operations performed the one stage posteromedial release with internal fixation showed the best results.

Congenital Anomalies of the Hand: A Clinical Study / 대한정형외과학회잡지

Malformations of the hand in newborn infants are comparatively uncommon, and the forms which these malformations assume are extremely varied, some being so bizzare as to almost defy description. The etiology of congenital anomalies of the hand has not been conclusively established, but at the present time the most acceptable theories are those of maldevelopment due to teratogens or of mutations which are subsequently inhereted. This paper is based upon our own series of 99 anomalies in 93 patients who were hospitalized and treated at Severance Hospital during the period between 1965 and 1979 and the following results were obtained. 1. There were 56 males and 37 females in 93 patients and the ratio between male and female was 1.5: 1. 2. Right hands were involved in 49 patients, left hands were in 33 patients, and both hands were in 11 patients. 3. The most common type of anomalies were polydactylism (60.6%), next were syndactylism (24.3%), and the following anomalies were found; congenital finger deficiency, congenital constriction band, camptodactyly, cleft hand, congenital clasped thumb, and symphalangism. 4. 33 associated congenital anomalies were found in 27 patients, in which, anomalies of the foot were most common. 5. Prenatal history such as drug ingestion, eclampsia or difficult labor, and prematurity were found, but no genetic or familial history could be obtainable. 6. Treatment was stressed upon the function of hand rather than cosmetic appearance.

Electromyography in Diagnosis of the Herniated Lumbar Disc / 대한정형외과학회잡지

The diagnostic accuracy of myelography, electromyography, and clinical-neurological findings in 64 patients on whom the presence of herniated intervertebral disc was proved surgically from March, 1974 to February, 1980 in Severance Hospital was discussed and the results of this study was compared with those in comparable studies in the literature. 1. Of the cases in which operation revealed disc herniation or protrusion, the clinical neurological diagnosis was correct in 71.9%, the myelographic diagnosis was coincided in 79.7%, the electromyographic diagnosis was agreed in 73.4%. 2. In the patients which the patellar tendon reflex was weak or absent, operation revealed a herniation between L3 and L4 in 66.7%. The disc herniation bewteen L4 and L5 was noted in 93.0% of patients with weakness of the extensors of the great toe. Of the patients in whom the Achilles tendon reflex was weak or absent, operation revealed a tumbosacral disc herniation in 87.0%. 3. If the myelogram showed lumbar disc changes, these changes were confirmed at operation in the same level in all patients. 4. A disc herniation between L3 and L4 was demonstrated in aH cases of the patients had L4 denervation of the electromyographic findings. The disc herniation between L4 and L5 was seen in 93.0% of them had L5 denervation. A lumbosacral disc herniation was noted in 83.3% of them had 51 denervation. 5. Polyphasic motor units were significant in the absence of diagnosis of the herniated lumbar disc. 6. Signs of denervation in the spinal muscalature but not in the leg muscles were considered significant in patients with diagnostic problems of the lumbar radiculopathy. In summary, it is suggested that electromyography is not superior to the myeolgraphy or the clinicalneurogical examination. But the electromyography aids the surgeon in the dlagnosis of a compression lesion of a specific nerve root.

Study on the Circulating Fat Macroglobule in Fracture / 대한정형외과학회잡지

Fat embolism is a condition in which fat appears in the circulating blood, not in the fine emulsion of a metabolic lipemia, but in droplets large enough to occlude arterioles and capillaries. It may occur as a complication of fracture, particularly multiple fractures of the long bones, pelvis, and ribs.. Since Zenker described the first case of fat embolism in 1862 there has never been a reliable diagnostic test for this condition. Lipid changes in the blood and demonstration of macroglobules could be used as aids for early post- traumatic fat embolism syndrome. The purpose of the present,study was to analyze the blood lipid changes in the fracture and to determine their value in the early detection of fat embolism syndrome. Twenty-three patients with at least one diaphyseal fracture of the lower extremity or a pelvic and spine fracture were included in the study. The mean age of the patients was 30.3 years. Men outnumbered women by a ratio of 2.9:1. Nineteen of the patients were injured in traffic accidents, two patients in fall, and one in the industrial accident. Ten volunteers were used for the control studies, nine men and one woman. Their mean age was 22.8 years. For determination of blood lipids blood sample was taken from cubital vein. The flrst blood sample was taken from tbe patients less than 2 hours after the iniury, and the later samples were obtained respectively in 12, 24, 48 and 72 hours, and 7 days after injury. The samples were centrifuged immediately (2,500 rpm, 4 min.). After centrifugation, each sample of plasma or serum was divided into two aliquots. The one aliquot was studied without flltering and the other was filtered through 8 microns millipore filter (Watmann No. 40. filter paper). Determination of triglyceride, cholesterol, and phospsolipids in blood was made from the unfiltered aliquot and from the other filtrate. Two groups were formed for comparission of the results; 1) Fracture Group; 2) Non-fracture Group as control. The triglycerides was determined using the technic of the micromethod of Van Handel and Elversmith, and the cholesterol was determined by the technic of Rosenthals color reagent method. For the determination of phospholipids Youngburg, modified method was used of The results of the study lead us to conclude that: 1. The triglycerides, cholesterol, phosphollpids fractions in the unflltered allquot was slightly higher than those of the filtrate. 2. Less than two hours after injury the triglycerides concentration in blood of fracture group was similar to the concentrations of the controls. But the triglycerides and macroglobule concentration in 12 and 24 hours after fracture were higher than those of the control group. 3. The average concentration of blood cholesterol level in fracture group was slightly higher than the control. Especially the serum concentrations of cholesterol in 12, and 24 hours after fracture were much higher than those of the controls. Statistically significant differences between the groups were observed. 4. The average phospholipids concentration in fracture patients was slightly higher than the average phospholipids concentration of the control but no significant differences between the groups were observed. 5. As to the total lipids, the average concentration of fracture group was little bit higher than the concentration of the control. There was no statistical differences between the fracture and the control group. 6. The concentrations of the total lipids gradually increased after 40 years of age. 7. The concentration of total serum lipids was increased in femoral fracture in site, and in multiple fractures than single fracture.

A Clinical Study of the Spine Injury / 대한정형외과학회잡지

In recent years the rate of the spine Injury tends to be on the increase year by year as the rate of traffic and industrial accidents are increased. During industrial, sports and automobile accidents are occurred, the various forces were exerted by the mechanism, “flexion, extension, flexlon-rotation, vertlcal compression and shearing.” These exercise their effects on the vertebral bodies, the neural arches and intervertebral disc and the contents of the spinal cord, depending on direction and intensity of the trauma, and the posture and muscular attitude existent at the movement. Once the neurological Iesion has been diagnosised and the type of vertebral injury has been established and particularly after a decision has been made as to whether the spinal injury is stable or unstable, a rational method of treatment can be decised upon: Our treatment consists of providing the best condition for recovery from the spine injury, preventlng further neurologlcal damage in the unstable area, achieving stable bone and llgament heallng ln satisfactory position, preventing metabolic compllcations from being fatal, mobllizing the patient early, and rehabilitating to provide maximum fuctlonal independence with the remaining-muscle power avallablc to the cord injury patient. One hundred and fifty seven spine fracture and dislocation patients were clinically observed and evaluated from Jan. 1972 to Dec. 1978 in our study. The result of this study may be summerized as follows: 1. Out of the patients, there were 135 male and 22 female cases. The ratio between male and female was 6.1:1. The majority (84.7%) of the spine injuries was found in the age of 20 to 50 years. Fifty-two percent of the cases was caused by industrial accidents. 2. The most common site of the lesion occurred between T-11 and L-2 vertebrae (71.8%). 3. In cervical injury, fracture dislocation type was most common (50%), and especially, pure dislocation by extension mechanism was 12.5% but in thoracolumbar iniury, simple anterior wedge compression fracture was most common (66.6%) and there were no pure dislocations just like cervical spine injury cases. 4. Fifty seven cases of the total were complicated by paraplegia, of which 62.5% in cervical region and 31.6% in thoracolumbar region were noticed. The most frequent type of the injury in which paraplegia developed was the fracture dislocation (73.8%) and the most common site of the lesion was between the T-12 and the L-2 vertebrae. 5. Open reduction was performed in 9 cases out of 24 cervical spine injury patients and in 41 cases out of 133 thoracolumbar injury patients. 6. Prognosis of neurologic recovery in initially complete lesion was poor, regardness of treatment. In the cervical lesion cases there were no patients who were recovered. But in the other sites about 10.5% of initially complete lesion showed partial neural recovery comparing to 62.5% of initially incomplete lesions. 7. Progressive deformity is often noted as a complication of spine fracture or dislocation when solid fusion fails to develop. The increment of kyphosis after treatment is as follows: Simple wedge fracture

A Clinical Study on the Cervical Spine Injuries / 대한정형외과학회잡지

With the development of spinal fusion and internal fixation, rehabilitation mediclne, urinary control and antibiotics, the outlook for patients with cervical spine injuries has brightened considerably, as compared with half a century ago. However, splnal cord injury still remains as one of the most devastating accidents that man can Incur and still survive. There is increasing tendency to stabllize unstable cervical spine injuries surglcally for the benefit of early mobilization,.early rehabilitation, easy nursing care, and rigid stability of the spine. A clinical study was performed on 72 patients with 76 fractures and fracture-dislocatlons of the cervical spine, who were hospitalized and treated at Severance Hospital during the period between January 1970 and December 1978 and the following results were obtained. 1. The prevalent age distribution was between 30 and 50 years of age (59.7%), and the ratio between males and females was 5:1. The most common cause of injury was falling from a height (51.4%). 2. In overall patients, neurologic damage was found at first examination in 69.4%, and among these, complete paralysis below the injured level In 41.7%, incomplete paralysis in 25%, and nerve root injury in 2.7%. 3. The mechanisms of injury included flexion-rotation (50%), extension-distraction (18%), flexion-compression (12.5%), pure flexion (5.5%), axial compression (5.5%), and unclassified (8.3%). 4. Among 72 patients, emergency decompressive laminectomy was performed on 10 patients, anterior interbody fusion on 15 patients, posterior fusion with wiring on 3 patients and the rest of patients were treated conservatively. 5. There was no significant difference in the recovery of neurologic loss between conservatively and surgically treated patients, but it was thought better to stabilize the unstable fracture-dislocations surgically for early mobilization and rehabllitatlon.

A Clinical Study on Fracture of Shaft of Forearm Bones / 대한정형외과학회잡지

To achieve full pronation and supination after fracture, many authors have pointed out the importance of the length of the bones, the absence of the angulatory deformity and rotational deformity, maintenance of the interosseous space and the curves of the radius, especially the lateral bowing of the radius. Over the years many methods of open reduction and internal fixation or the closed method have been advocated and comparisons have been made between the groups treated by the conservative method and open reduction and internal fixation. The authors have reviewed 108 cases of the fracture of the shaft af the forearm bones from 1 January 1971 to 31 March 1979 which were treated in Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine. The following results were obtalned from analysis of the cases studies. 1. There was no difference between the conservative treatment group and the open reduction and internal fixation group for fractures of the radius or ulna alone in fracture heallng time, but there was delay in fracture healing time in the open reduction and internal fixation group compared to the conservative treatment group for fractures of both forearm bones. 2. Satisfactory functional results were shown in the open reduction and internal fixation group rather than in the conservative treatment group. 3. Angulatory deformities were shown in 47.2% of the conservative treatment group and 14.8% of the open reduction and internal fixatlon group. 4. In selected cases, an Evan's tuberosity view was taken and rotational deformities were shown in 30.0% of the conservative treatment group and in 8.8% of the open reduction and internal fixation group. 5. There was no difference between the conservative treatment group and the open reduction and internal fixatlon group in non-union rate and delayed union rate.

A clinical Study of Trochanteric Fractures / 대한정형외과학회잡지

Trochanteric fractures frequently occur in the elderly patients and complications such as pneumonia, thromboembolic disease, decubitus ulcer, and urinary tract infection are common. The principle in the treatment of an elderly patient wlth trochanteric fractures have swung from traction to internal fixation due to such complications. Since the introduction of the Smith-Petersen nail, numerous internal fixation devices such as I-beam nail, Thornton plate, Jewett nail, and Holt nail have been developed. Recently compression hip screw is popular because of rigid internal fixation. Also many surgeons such as Evans, Dimon and Hughston, Sarmiento, and Boyd and Anderson have attempted to provide stable fixation of fracture by altering the position of fracture fragments. This report is based on 104 cases of trochanteric fractures who were seen and treated at our orthopedic department during the 13 years period from January, 1965 to December, 1978. The study includes clinical and radiologic observation on our series of trochanteric fractures. The results were summarized as follows: 1. Of 104 cases of trochanteric fractures 79 cases occurred in man, 25 cases in woman and each mean age was 51 years in man, 62 years in woman. 2. The most common cause of fracture was due to traffic accident. 3. Among 104 cases, 73 were treated with open reduction and internal fixation, and 31 were treated conservatively. 4. Of fixation devices, Jewett nails were used in 40 cases, Temple University nails in 9 cases, Mclaughlin nail plates in 5 cases, Moore blade plates in 4 cases, Blount blade plates in 3 cases, Thornton nail plates in 2 cases, Neufeld nail plate in 1 case, Richard compression sliding screw plates in 2 cases, plate and screws in 3 cases, Kuntscher nail in 2 cases, and screws in 2 cases. 5. Of 92 cases of trochanterir fractures, 27 cases were stable fracture and 65 cases were unstable fracture. The method of medial displacement of proximal part of distal fragment in 2 cases with unstable fracture and anatomic reduction in 90 cases with stable and unstable fracture were achieved. 6. The average time to fracture union was 16.6 weeks roentgenologically. There was no significant difference in the union rate between the method of treatment. 7. The average time to weight bearing was 11.8 weeks in operative treatment and 18.3 weeks in conservative treatment. 8. Complicatlon after internal flxation were reduced by early ambulation. 9. The method of medial displacement of proximal part of distal fragment of fracture was achieved in 2 cases of unstable fractures, and obtained satisfactory fracture healing, but had disadvantages such as some limitation of motion of the affected hip, shortening of affected extremlty. 10. Satisfactory result was obtained in 95.5% out of operatlve treatment, and 84% out of non-operative treatment. 11. From a consideration of those series, it was concluded that operative treatment of trochanteric fractures offered the advantages of improved function, economy of hospital beds, less complication, and comfort and early ambulatlon of the patient.

Tibial Lengthening / 대한정형외과학회잡지

Leg length discrepancy in children occurs chiefly as an aftermath of poliomyelitis. In spite of immunization, there remain a few infantile paralysis patients with significant leg length discrepancy. The methods to correct leg length inequality have included epiphysiodesis, long bone shortening and growth stimulation. But the limitation of accomplishing equalization by these methods has made it clear that there is a need for an accurate and uncomplicated leg lengthening method. Anderson and others devised a well controlled distraction apparatus and performed surgery upon many, cases with few complications. This study is a report of 7 consecutive patients all operated on by a reverse method, with the application of the Charnley compression apparatus. The results are as follows. 1. Correction of 2. 5 to 4. 5 cm (average 3.4 cm) was achieved. 2. Major complications were delayed union in 5 cases, pin tract infection in 2 cases and nerve injury in 1 case. 3. When either inadequate union or failure of union of the distracted fragments is established in the mature patients, it is suggested that the fragments should be stabilized with bone graft as soon as possible.

Discectomy and Anterior Interbody Fusion for Spondylogenic and Discogenic Back Pain / 대한정형외과학회잡지

A study of the effectivity and reliability of discectomy and anterior interbody fusion with autogenous iliac bone graft for spondylogenic and discogenic back pain and/or radiating pain has been done on 48 patients who had been hospitalized at Severance Hospital between January 1976 to June 1978. To the preoperative symptoms and signs such as the presence of back pain, sciatica, muscle atrophy, sensory change, motor change, spinal motion, deep tendon reflex, S.L.R., knee-chest compression test and Patricks test were checked, and after the operation, the same symptoms and signs were checked as to how they were improved or not. The age range of patients was 17 to 64 years and 40% of them were in the 3rd decade. Before the operation, for the confirmation of the origion of the back pain, we did perform dynamograms for instability and myelograms for root compression and spinal stenosis. The approach to the lesion was mainly retroperitoneal with anterior approach. Bony union after the operation was decided by a plane roentgenogram or clinical signs, and a dynamogram in some cases. The following results were obtained from analysis of the cases studied. 1. Eighty percent of the cases showed improved back pain in postoperative 3rd day and 83% showed improved sciatica in 6 months after the operation. 2. During the operation, the operative dislcogram could be done to verify the level of the lesion and the disc degeneration, disc protrusion, bony spur, narrowing of the joint space and instability during the operation could be confirmed in direct vision, so we could perform the operation for the accurate lesion. 3. Rather than the posterior approach, the anterior approach could allow all the remnants of the disc to be removed thoroughly. 4. In anterior interbody fusion, the strut of iliac bone was firmly impacted with two blocks, so its stability could be maintained, and patient could be mobilized earlier. 5. Clinical union of bone grafts was obtained in between 3 to 6 months and 96% of the cases showed bony union in 9 months. In 14 cases of two level fusions, the bony union was delayed compared to the one level fusion. 6. After the operation, the patient could return with the brace on to the office only within three months. The brace was taken off after the bony union was verified by plane roentgenogram and dynamogram.

Roentgenographic and Clinical Study of Legg-Calve-Perthes' Disease: Review of Forty Six Children / 대한정형외과학회잡지

Forty six cases of Legg-Calve-Perthes disease were reviewed clinically and roentgenographically in order to determine a satisfactory method of assessing the prognosis and to correlate the clinical and roentgenographical results. 1. The patients were children 3 to 12 years of age, with the peak at 6 years. The average age of visit (or diagnosis) was 6.7 years and that of onset was 6.4 years. 2. The total number of hips involved were 49, three cases being bilateral (6. 5%). Boys predominated girls by a ratio of 4.7:1 3. End results in children below 6 years of age were better than those in children above 6 years. The end results of treatment with the containment method were better than those with the noncontainment method. 4. The hips with excellent result had an average of 2.5mm. of uncovering of the femoral head at the time of diagnosis. The degree of uncovering increased as the roentgenographical result deteriorated, in the poor hips the average uncovering being 9mm. The average for the normal side was 2mm. The uncovering at onset is an accurate guide to the likely end result. 5. The Catterall assessment was of reliable prognostic value. In the excellent group, the majority of the hips belonged to Groups 1 and 2, In the poor group, there were no hips in Group 1 and increasing number of hips belonged to Groups 2,3 and 4. 6. The head at risk judged by Gage's sign, calcification of lateral epiphysis, lateral subluxation of the femoral head, and presence of a horizontal epiphyseal line indicated poor prognosis. 7. There was a close correlation between the severity of clinical features and the severity of residual roentgenographic findings.