Gorham's Syndrome: A Case Report / 대한정형외과학회잡지

Gorham's syndrome is a rare disorder involing a proliferation of vascular channels associated with extensive loss of bony matrix. It starts in bone, but it may secondarily involve soft tissue and adjacent bones. Although the osteolysis usuakky arrests spontaneously, its biologic behavior is difficult to predict. The mechanism of steolysis is unkown, and the role of osteoclasts is controverwial We have experienced one case of Gorham's syndrome affecting the scapula and clavicle, which is reported in this paper with brief review of literature.

Tuberculous Arthritis of the Hip in Children / 대한정형외과학회잡지

Although the incidence of the skeletal tuberculosis is being decreased with improvement of the socioeconomic status, tuberculous arthritis of the hip in children has many problems in fact that there is a relatively high incidence comparing to that of adult, that it is difficult to early detection for its variable clinical feature, and that there are many controversies in its treatment. From Aug. 1981 to Apr, 1988, 14 cases treated at Busan Paik Hospital were analyzed, and the following conclusions were obtained. 1. Surgical treatment of tuberculous arthritis of the hip with early lesion was better than conservative treatment in that it could be made early diagnosis, removed the infected focus, lessened the recurrence rate, and preserved the hip function. 2. A relatively good result in preserving the hip function was obtained with surgical treatment in tuberculous arthritis of the hip with late lesion.

Surgical Treatment In Pott's Paraplegia / 대한정형외과학회잡지

Pott's paraplegia has been frequently serious complication of tuberculous spondylitis, although antituberculous drugs have improved the prognosis and healing of the disease. There are much controvercy on treatement of Pott's paraplegia, which comprises immobilization with or without anterolateral antituberculous drugs, immobilization and early posterior arthrodesis, anterolatear decompression and radical anterior decompression with anterior spinal fusion. The method of anterior decompression and anterior interbody fusion which was introduced by Hdgson since 1956 has good reults. The author analyzed 27 consecutive cases of Pott's parsplegia operated at orthopedic departement, In Je Paik Hospital from May 1980 to August 1988. The results were as follows, 1. Number of cases in child was nine(33%), both sexes were similar. 2. Regions of spine involved were most common at thoracic spine(62%). Number of affected vertebrae was averaged 3.3 vertebrae. 3. There were nineteen early(70%) and eight late(30%) paraplegia. 4. There were two complete and twenty five incomplete paraplegia. 5. In operative finding, inflammatory products and sequestrated material was extrinsic factor in early in paraplegia. 6. The recovery of the paraplegia occur in twenty cases(74%) 7. The recovery of paraplegia after treatment was far better in type of early onset, type of incomplete paraplegia less than one year duration. 8. The radical anterior decompression and anterior interbody fusion was considered as recommendable method for remove of all pathologic foci, recovery of paraplegia and healing the tuberculosis with stability.

Posterior Atlanto / 대한정형외과학회잡지

Atlanto-axial instability is an important condition that may threaten the integrity of spinal cord, leading to tetraplegia or sudden death. Many of these require operative stability, and several different operations have been advocated. Among these methods, Brooks and Jenkins posterior fusion for eleven cases of atlanto-axial instability (fresh fracture of odontoid process in nine, nonunion of odentoid fracture in one, Cl-2 rotary subluxation in one) was performed in Baik Hospital from July 1978 to June 1987, and the following results were obtained. l. Accurate reduction and immediate rigid stability were obtained with Brooks and Jenkins posterior fusion, so early ambulation with simple external support was begun within 2 weeks after operation. 2. Radiological fusion of atlanto-axial instability were seen in average 12 weeks after operation. Therefore posterior atlanto-axial fusion by Brooks and Jenkins method is an excellent method for operative treatment of atlanto-axial instability.

A Clinical Study of Ankle Fracture / 대한정형외과학회잡지

The ankle joint is a modified complex hinge joint which plays an important role in weight bearing, walking and standing. Injuries about the ankle joint cause destruction of not only bony architecture but often also the ligamentous and soft tissue component. So the goal of the treatment of ankle fracture is restoring normal relations of ankle mortise and regaining a smooth articular surface. The author have reviewed 84 cases of ankle fractures which were treated through the admission in the Orthopedic Department, In Je Medical College Pusan Paik Hospital from June 1979 to August 1986. The average duration of the follow-up was one year. The results obtained from this study were as follows : 1. The most common type was Danis-Weber type C. Nexts were B and A in order. According to the classification of Lauge-Hansen, the most common type was Pronation-external rotstion(39.2%). 2. In Danis-Weber type B and C, satisfactory result was obtained by operative treatment. 3. Danis-Weber's classification was very practical criteria for treatment of the ankle fracture.

Reconstruction of Posterior Cruciate Ligament Using Patella Tendon Graft / 대한정형외과학회잡지

It is generally accepted that posterior cruciate ligament is the prime stabilizer and perhaps the most importent ligament in the knee. We agreed that primary repair or reconstruction of ruptured posterior cruciate ligament is essential. Recently Clancy reported good results to correct knee instability due to rupture of the posterior cruciate ligament with a procedure that employes a free graft of one-third of the patella tendon with its tibial and patella attachments. The free patella tendon graft has been shown to revascularize readly, develop resonably high tensile strengh, allow bone to bone healing, have excellent static stability and not to deprive the knee of a significant stabilizer. So, we analized the 10 cases of the posterior cruciate ligament injuries who were admitted and treated reconstruction using free patella tendon graft in Busan Paik Hospital between May, 1984 to Dec, 1986 and obtained the following results. 1. In 8 cases, obtained satisfactory results. In 2 cases, obtained unsatisfactory results due to combined other compartment injuries, but improved posterior stability than preoperative status. 2. Reconstruction of posterior crucitae ligament using free patella tendon graft was excellent procedure for regaining of static stability of the knee.

A Clinical Study on Pathologic Fractures of Long Bones / 대한정형외과학회잡지

Pathologic fracture is a bresk of bony continuity within an abnormal bone. The abnormslity ma be due to systemic skeletal disease, infection, primary benign and malignant tumor, or metastati carcinoms. Among these, metastatic carcinoma to bone is most common cause of pathologic fractur excluding those due to osteoporosis. When considering the msnagement, pathologic fractures due to systemic skeletal disease usually heal with conservative treatment, while others often require operative treatment. We have experienced 20 cases of pathologic fracture in long bones for 8 years from 19 to 1987. The results were as follows ; 1. The average sge was somewhat different according to underlying diseases Malignant tumorous lesion; 53 years Benign tumorous lesion ; 17 years Chronic osteomyelitis, 42 years 2. The most common cause was malignant tumorous lesion, 8 cases(40%). 3. The most frequent site was femur, 17 cases(85%). 4. Surgical treatment was done in 17 cases(85%), and conservative treatment was done in 3 cas(1sw). 5. In 3 cases of pathologic fractures due to metaststic tumor, the pain was markedly relieved and essy nursing care was possible immediately after operation.

The Treatment of Tibial Shaft Fractures by Ender's Nailing / 대한정형외과학회잡지

Between July 1982 and July 1985, we treated thirty-one fractures of the tibial shaft by intramedullar ary Ender's nailing at the Department of orthopedic Surgery of Pusan Paik Hospital. Reductions of the fractures were achieved by closed method in 25 cases and open method in 6 cases. The results were as follows. 1. The average age was 34. 5 years and the most common cause of injury was traffic accident(67.7%) 2. Nineteen cases (61%) were closed fracture and 12 cases (39%) open. Seventeen cases (55%) were simple fracture and 14 cases (45%) comminuted. The most common level of the fracture was middle third of the tibial shaft. 3. Twenty cases (64.5%) had associated injuries and average interval from injury to operation was 11. 8 days. 4. The average healing time was 16.7 weeks and the time prolonged in comminuted fractures than in simple fractures. 5. Complications were one case of valgus deformity (11°), one case of delayed union with pseudoane urysm of anterior tibial artery on fracture site and one case of infected nonunion in Grade III open comminuted fracture. 6. Ender nails are relative ease of nailing, allow early weight bearing and decrease complication. Ender nailing is considered to be a good method in treating tibial shaft fracture especially for management of multiple injured patient and when other procedures have failed.

Clinical Study of Supracondylar Fractures of the Humerus in Children / 대한정형외과학회잡지

The most common fracture about the elbow joint in chilren is a supracondylar fracture. The displaced fracture is difficult to manage due to the potential danger of Volkmann's ischemia, nerve injury, and malunion, During the period of 6 years from June, 1979 to June, 1985, 63 children with supracondylar fractures of the humerus were treated at Pusan Paik Hospital, Inje Medical College, and analyzed. The results are summarized as follows: 1. The average age was 7.1 years, ranged from 1 year to 14 years, and the male and female ratio was 2.5: l. 2. In type of fracture, extension type was 92% and flexion type was 8%. In displacement of fracture, Grade I was only 2 cases, Grade III and IV were 87.3%. Posteromedial displacement was 42.8% (27 cases). 3. At the time of admission, 15cases(23.8%) accompanied nerve injury, of these median nerve injury (9 cases) was most common. All the patient with nerve injury were completely recovered within 14 months after reduction. 4. Severe cubitus varus was 14.2%, and severe limitation of elbow motion was 1.6%. 5. Of 61 displaced fractures, 37 patients were treated with closed reduction and percutaneous pin fixation. By Flynn's criteria, satisfactory results were obtained in 36 of the 37 patients(97.3%) treated with percutaneous pinning. 6. In the displaced fractures, closed reduction and percutaneous pinning is a satisfactory method for obtaining and maintaining reduction while preserving vascular function, if acute flexion is necessary for stable reduction.

Combined Procedure of Open Reduction and Shortening of the Femur in Treatment of C.D.H. in Older Children / 대한정형외과학회잡지

Older children with neglected ongenital dislocation of the hip is not easily reduced. Even if reduction is achieved, the overstretched muscle tends to resume its original length, provoking either a redilocation or a pressure necrosis with resultant stiffness of the hip joint and deformity. The authors treated 15 cases of the C.D.H. in older children by combined procedure of open reduction, Salter's innominate osteotomy, and femoral shortening with redirection of the femoral head. The results were obtained in 15 operated hips with follow-up from 1 to 5 and 3/12 years. l. We had good results in 11 among 15 cases(73%). 2. Femoral shortening was spontaneously correctd 1.3cm in 1 year, 2.1cm in 2 years follow-up. 3. The improvement of acetabular index following Salter's innominate osteotomy was about 12.4 degrees. 4. We had no serious complication such as avascular necrosis, stiffness, and redislocation, but 3 cases of mild limitation of hip joint motion were noted. 5. Two skin incision were more convenient in operative procedure and handling of instruments than one incision(Klisić).

Histiocytosis-X: A Case Report / 대한정형외과학회잡지

Histiocytosis-X has several mode of presentation, from the mildest solitary eosinophilic granuloma of bone to the most severe, with multiple granulomata in bones and soft tissues. This disease previously described as eosinophilic granuloma, Hand-Schuller-Christian disease and Letterer-Siwe disease. Lichtenstein (1953) used the term histiocytosis-x to encompass the above three names. We experienced a case of histiocytosis-x which had occured at multiple site of bones. The patient has good general condition with complete subsidance of specific symtoms and signs in our thirty-eight months follow up treatment.

A Study of Normal Korean Adult Femur Length and Configuration / 대한정형외과학회잡지

The preoperative measurement of adequate nail length is very important for femoral shaft fracture naiTing Operation. To reduce the disadvantages of scanography which are the fracture site pain, motion and radiation hazard, the simple external measurement method of intramedullary nail length was designated through this study. The fifty normal Korean whose bone growth v:as ceased were chosen for this study. And the lengths with the simple external measurement of thigh and scanogram of femur were compared at both side. The lateral roentgenographic view of femur was checked to analysis of anterior angulation at the proximal one third of femur was checked to analysis of anterior angulation at the proximal one third of femur. The following results were: 1. Femoral length was about 24% body height on an average. 2. The distance between the lower margin of the anterior superior iliac spine and the patellar upper pole (SPD) was equal to the distance between the tip of the greater trochanter and the cented of distal subchondral line. 3. Straight intramedullary nail length was 40 to 45 mm shorter than SPD. 4. The roentgenogram revealed that the femur took its anterior bowing by 9 degrees.

Block Resection of the Chordoma in Sacrococcygeal Region: A Case Report / 대한정형외과학회잡지

Chordomas are maligaant tumors which arise in the remnants of the embryonic notochord, and exhibit a definite predilection for the extremes of the spinal axis, the great majority arising either in the basioccipital or in the sacrococcy geal regions. Particularly, complete surgical removal is almost impossible, therefore, local recurrence after the surgical removal of this tumor is common or rule. This report describes a csse of chordoma arising sacrococcygeal region treated with block resection.

Congenital Pseudarthrosisof the Tibia: Treated with Free Vascularized Fibular Graft / 대한정형외과학회잡지

It is notoriously difficult to obtain a sound bony union of congenital paeudarthrosis of tbe tibia with conventional methods. This paper is the results of using the free vascularized fibular graft for congenital pseudarthorsis of the tibia in 7 patients since 1978 in this hospital, which is the first attempt in Korea. During the follow-up periods from 9 months to 32 months, 5/7 patients(71%) had good or excellent bony union, 2 patients had bone resorption at tbe distal site of grafted bone and required a second supplementary cancellous bone graft with electrode insertion. So it is thought that the free vascularized fibular graft is one of good methods of treatment for congenital pseudarthrosis of the tibia.

Neurovascular Free Flap Transfer by Microsurgery / 대한정형외과학회잡지

Sixteen microvasular free flap transfers have performed during recent two years in this department, which was first attempt in Korea. Neurovascular free flap was nine and vascular free flap was seven. The donor flaps were thirteen dorsalis pedls falps, two groin flaps and one latissimus dorsi flap respectively. The recipient sites were heel pad loss, vital organ exposure and scar contracture lesions in extremity. Their main cause of soft tissue defect was traumatic in all. All patients have experienced more than two times of split thickness skin graft before free flap transfer. The success rate of vascular free flap transfer was 94%. The only one failure case was due to venous thrombosis, but secondary split thickness skin graft performed with satisfactory result. The follow up period was from 5 months to 20 months. Sweating in transferred free flap was found at all neurovascular free flap within postoperative 4 months. Adequate 2-point discrimination was obtained at six patients of nine neurovascular free flaps and protective sensation seems to progressively improve in remained three patients. Two point discrimination was shortened at hand after neurovascular dorsalis pedis flap transfer in two cases. The weight bearing function at heel pad region and tactile sensation at hand have satisfactorily recovered after free flap transfer. Free flap transfer have many advantages compare to conventional skin graft, such as shorter therapeutic time, lesser physical and economic burdens, primary covering to vital organs and protective sensation of neurovascular free flap transfer. The most important factors are meticulous microvascular operation technique and anatomic knowledge.

Free Toe-to-Thumb Transplantation with Microsurgical Technique / 대한정형외과학회잡지

Although procedures to reproduce the lost thumb through osteoplastic reconstruction and adjacent finger transfer operations appeared reasonably successful in providing for better prehension, nonetheless the methods lacked predictabiiity and too often the results were unacceptable esthetically. In recent years the development of microsurgery and surgical experiences has made it possible to free one stage transplantation of toe to replace missing thumb. Based on our past experiences with limb replantation since 1975, we accomplished the first toe to thumb transplantation done in Korea on October 28, 1978. Therafter we succeeded in one stage toe-to-thumb transplanatation in five cases. The shortest follow up period was thirteen months, and the longest, twenty-three months. One cases was excluded in this report due to short follow up period. Excellent results were achieved in all cases. There were no limping or pain while walking after removal of great toes or second toe. Great toe transplantation is more favorable donor area than second toe in toe-to-thumb transplantation. Free toe-to-thumb transplantation on making a thumb in missing thumb is the most excellent method of thumb reconstruction, but skillful technique and specialized microsurgical training is mandatory.