The Fate of Butterfly Fragments in Extremity Shaft Comminuted Fractures Treated with Closed Interlocking Intramedullary Nailing

PURPOSE: For conservative treatment of shaft fractures, the butterfly fragments that were somewhat larger in the closed intra-medullary (IM) nailing. The results of treatment were monitored using radiography separately for the weight-bearing femur and non-weight-bearing humerus. MATERIALS AND METHODS: 27 from Group I and 31 from Group II. In the two groups, the displacement and angulation changes in the fragments, and the degree of improvement of these two factors, were compared using follow-up radiography. RESULTS: The mean angulation of fragments in Groups I and II were 9.2degrees and 9.6degrees, and the mean degree of displacement of the fragments in Groups I and II were 16.7 mm and 21.2 mm, respectively. Follow-up radiography showed that the above factors improved in both groups. The degree of displacement was significantly lower in the normal cases than in the complicated cases (p=0.001). CONCLUSION: Displacement and angulation gradually improved in both groups. It was found that the degree of displacement after the initial reduction is more important than the influence of anatomical position or weight bearing. This indicates that care should be taken when inserting IM nails to prevent displacement or angulation.

Osteoarthritis of Hip in a Hypogammaglobulinemia Patient / 대한정형외과학회잡지

Hypoglobulinemia is characterized by functional or quantitative abnormalities of one or more components of the immune system. It is typically manifests as recurrent infections that usually start in childhood. These recurrent infections cause various clinical symptoms. Infectious or aseptic arthritis can develop, and especially in bone and joint abnormalities. No case of arthritis in a patients with hypogammaglobulinemia has been reported, so we report on the management of osteoarthritis of the hip in a hypogammaglobulinemia patient.

Dose Related Effect of Extracorporeal Shock Wave Therapy in Lateral Epicondylitis / 대한스포츠의학회지

The aim of this study was to investigate the dose-related effects of extracorporeal shock wave therapy (ESWT) on the lateral epicondylitis of the elbow. Between March 2005 and March 2008, 66 patients who had been treated with extracorporeal shock wave therapy due to lateral epicondylitis of elbow formed the subjects. The subjects were divided into the 1st, 2nd and the 3rd treatment group and evaluated the clinical outcomes by visual analog scale (VAS) and a simple elbow test (SET) at immediate treatment, posttreatment 6 and 12 months, retrospectively. Changes in VAS score between the 2nd and 3rd treatment group and between the 1st and 3rd treatment group showed significant difference only at posttreatment 1 month group (p=0.001, 0.2, 0.1), (p=0.03, 0.08, 0.3), but Visual Analog Scale score at posttreatment 1 month showed no difference within the groups (p=1.0, 0.2, 0.07). SET within and between the groups showed significant difference at posttreatment 6 and 12 months (p<0.05).

The Clinical and Radiological Availability of Percutaneous Balloon Kyphoplasty as a Treatment for Osteoporotic Burst Fractures

STUDY DESIGN: We retrospectively assessed the results of percutaneous balloon kyphoplasty (KP) by clinical and radiological methods. PURPOSE: To evaluate the outcome of KP as a treatment for osteoporotic burst fractures. OVERVIEW OF LITERATURE: Many surgeons are concerned about the possibility of neurological complications after percutaneous kyphoplasty for osteoporotic burst fractures, secondary to intra-canal cement leakage. METHODS: We performed KP as a treatment for osteoporotic burst fractures. We studied 12 patients/13 vertebrae. The two control groups consisted of patients who only underwent conservative treatment and those who underwent posterior instrumentation and fusion. We measured each preoperative/postoperative vertebral kyphotic deformity angle (KDA) using simple lateral spine images and checked for leakage of cement, as well. The preoperative/postoperative visual analog scale (VAS) scores for back pain, degree of daily activity, and postoperative complications were evaluated. RESULTS: The mean improvement in KDA after KP was 9.7+/-2.2degrees. The mean preoperative and postoperative VAS scores for back pain were 8.3+/-0.4 and 3.1+/-0.17, respectively. Regarding the control group, the mean postoperative VAS score for the conservative group and the posterior surgery group decreased by 4.5+/-0.17 and 3.2+/-0.19, respectively. There was no statistically significant difference between the KP and posterior surgery groups (p=0.125). However, there was a statistically significant difference between the KP and conservative treatment groups (p=0.012). CONCLUSIONS: KP is safe and useful for treating osteoporotic burst fractures.

Result of Wolter Plate Fixation for the Treatment of Dislocation of Acromioclavicular Joint and Clinical Importance of Coracoclavicular Ligament Repair

PURPOSE: To evaluate the clinical result of the Wolter plate fixation for the acromioclavicular joint dislocation and the necessity of coracoclavicular ligament repair with the operation. MATERIALS AND METHODS: Twenty three patients operated between January 2003 to September 2005 with over 6 months of follow-up period were studied. The Constant-Murley scoring system was administered on 6 months postoperatively and stress films were taken for the surveillance of acromioclavicular joint and coracoclavicular distance after plate removal. All patients were classified into two groups in that coracoclavicular ligament was repaired (10 cases) or not (13 cases) and the clinical indices described above were compared. RESULTS: With the Wolter plate fixation for the acromioclavicular joint dislocations, 20 cases of Constant-Murley scores were more than 'good' except complicated 3 cases. The scores of the repaired group were 7 cases of excellent, 2 cases of good and 1 case of moderate to poor, and that of not-repaired group were 6 cases, 5 cases and 2 cases respectively. With mean coracoclavicular interspace on x-ray at postoperative 6 months, repaired group showed residual 9% of displacement from initial 194% but not-repaired group showed 28% from initial 188%. There's no statistically significant difference in clinical scores between two group (p=0.072) and neither was residual coracoclavicular interspace displacement (p=0.067). CONCLUSION: Short term follow-up of Wolter plate fixation for the acromioclavicular dislocation showed acceptable clinical results and there was no statistically significant difference between two groups of repaired coracoclavicular ligaments and not repaired.

Treatment of Osteoporotic Unstable Intertrochanteric Fractures: Comparative Study between using Dynamic Hip Screw and Additional Trochanter Stabilizing Plate / 대한정형외과학회잡지

PURPOSE: To compare the effectiveness of a trochanter stabilizing plate with a dynamic hip screw, with using a dynamic hip screw only in the treatment of an unstable intertrochanteric fracture of elderly patients. MATERIALS AND METHODS: From January 2000 to December 2004, 70 patients, who were treated surgically for unstable intertrochanteric fractures, were evaluated. The patient s age were above 65 years and the T-score 0.05), but the postoperative functional loss of the hip joint was significantly lower in the group 2 (p<0.05), who required additional surgery due to reduction loss or metal failure. CONCLUSION: Although it is a relatively simple technique, the use of DHS with TSP is more effective for the buttress effect on proximal fragment and additional fixation of great trochanter than just DHS only. It decreases the excessive slippage of the lag screw, lateral displacement of the greater trochanter and postoperative functional loss of the hip joint. Therefore, it may be a useful treatment for unstable or comminuted intertrochanteric fractures in elderly patients with osteoporosis.

The Influence of Androgen Deficiency and Osteopenia on Fracture Healing in Orchiectomized Rats / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the effect of testosterone deficiency and osteopenia on fracture healing using orchiectomized adult rats. MATERIALS AND METHODS: Fifty-two 3 month old male rats were used. Animals were divided into 3 groups. Group 1 received sham operations and groups 2 and 3 were orchiectomized. At 4 weeks, right tibial shaft fractures were administered in all animals. Afterwards in group 3, testosterone was injected intra-peritoneally for 4 weeks. After 8 weeks of breeding, animals were sacrified for morphometrical, histopathological and biomechanical testing. RESULTS: No nonunion or delayed union was observed. Differences in tibial volumes and circumferences between the fracture site and the corresponding contralateral site were less in groups 2 and 3 than in group 1, with statistical significance. The yield strength and the trabecular area of the fractured tibiae were significantly lower in group 2, but group 3 and group 1 were similar. CONCLUSION: Even though there was no evidence of compromised fracture healing, both of the androgen deficiency and osteopenia induced by orchiectomy negatively influenced callus volume and strength. But osteopenia did not influece callus strength. The above results demonstrate the positive effect of testosterone injection on fracture healing.

DEXA T-score Concordance and Discordance Between hip and Lumbar Spine / 대한척추외과학회지

OBJECTIVE: To evaluate the concordance, or discordance, of the osteoporotic diagnosis between femur neck and lumbar spine, using DEXA T-scores and the WHO classification. MATERIALS AND METHODS: The BMD (Define?) on both hips and of the lumbar spine of 718 Korean females were measured. The mean age of the subjects was 55.5 years (31-91). The BMD data were obtained from 3 hip regions and from the lumbar spine, anteroposteriorly, using dual-energy x-ray absorptiometry (Lunar). The BMDs of femur neck and the L2-4 vertebrae were classified into normal (a T-score >-1), osteopenia (-1 < or = T-score < -2.5) and osteoporosis (-2.5< or =T-score) using the WHO definitions. RESULTS: There was significant correlation between the femur neck and lumbar BMDs (r=0.772). However, the discordance rate was 33% for all the cases, but this was 20% in the subjects below 50 of age, 31% in the subjects in their 50's, 47% in their 60's and 42% when 70 or above. The discordance rates of the normal, osteopenic and osteoporotic groups were 21, 54 and 17% respectively, with the highest discordance rate in the osteopenia group. Among the 649 persons in the normal or osteopenia groups, in relation to the femur neck BMD, there were 67 (10.3%) in the osteoporotic group with L2-4 BMD. But the reverse situation was only 12 persons from 594 (2.0%). (Eds note: this whole section makes little sense? What were the BMDs? The last sentence is completely meaningless.) CONCLUSIONS: The discordance rate between the femur neck and lumbar spine was as high as 33%, and was the highest in the osteopenia persons in their 60's. Therefore, in these persons the BMD of both sites should be checked together, but if not, the lumbar BMD should be checked first.

Apoptosis in the meniscus of human osteoarthritic knee / 대한정형외과연구학회지

PURPOSE: The purposes of this study were to examine whether meniscal degeneration in human osteoarthritis(OA) was related with the occurrence of apoptosis, the expression of nitrotyrosine and Fas. MATERIALS AND METHODS: Menisci were obtained from OA patients undergoing total knee replacement arthroplasty and from normal subjects who were operated an above knee amputaton. According to histologic degeneration, menisci were graded to normal, grade 1(mild), grade 2(moderate), and grade 3(severe). Apoptotic cells were identified by TUNEL method and electron microscopy. Meniscal sections were analyzed by immunohistochemistry for the presence of nitrotyrosine and Fas expression. RESULTS: The number of apoptotic cells were significantly increased in OA meniscus compared with normal meniscus(p < 0.05). The number of apoptotic cells were increased with tissue degeneration. On electron microscopy, the typical chromatin condensation in the OA meniscus was shown in apoptotic cell. The number of Fas-expressing cells was significantly higher in the OA meniscus(p < 0.05). Nitrotyrosine immuno reactivity was prominent in the degenerative menisci(p < 0.05). Fas and nitrotyrosine expression were increased with degree of tissue degeneration. An increase in number of apoptotic cells was correlated with tissue degeneration but not with age . CONCLUSION: Apoptosis was suggested as one of the causes in the tissue degeneration of the human OA meniscus. The development of apoptosis in the meniscus may be related with Fas and nitrotyrosine expression but not with age.

Radiologic Analysis of Primary Hip Replacements on the Porous: Coated Acetabular Component / 대한정형외과학회잡지

Component fixation on the acetabular side is not as much of a problem because of the simpler geometry and loading configuration. It is generally accepted that hemispheric component design is preferable and immediate implant stability can be achieved by using screws or spikes in the porous coated implants. The authors reviewed 130 primary noncemented porouscoated, press fit acetabular component in 110 patients; 84 were AML (Anatomical Medullary Locking) and 46 were HarrisGalante acetabular component. Radiologic analysis at a minimum of 3 years(average 4.5 years) was done with special regards to the vertical and medial migration, screw size and numbers, change of the radiolucent line and its zone with its fate and acetabular cup angles on the acetabular component by the 2 observers. Progressive radiolucent line at the component-bone intersurface were found in 14 cases(11%), frequently located in zone I and zone I & II. No significant vertical, medial migration and change of the acetabular cup angle were found. No screw and spike failure had occurred. No component had to be revised because of loosening. As a whole, in our 3-years experience we report excellent results with porous coated acetabular component although it dose not ensure long-term sucess.

Treatment of Bone Defect with Ilizarov Apparatus in the Tibia / 대한정형외과학회잡지

Bone defect of the long bone continues to challenge orthopedic surgeons. It is usually very difficult to obtain union. Ilizarov ext. fixation has recently gained popularity as a multifactorial approach to the management of tibial bone defect because nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. From February 1992 to May 1993 at the department of orthopedic surgery, Inje University Pusan Paik Hospital, 9 patients aged from 8 to 37 years were treated for tibial bone defect. The causes were open comminuted fractures with initial bone loss and bone defect after removal of infected necrotic bone. Bony defect size was ranged from 2cm to 14cm, averaging 7.2cm. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length discrepancy was achieved by means of external lengthening technique. Soft tissue defects were treated with secondary closure, split thickness skin graft, and muscle flap. The average healing index was 42.8 days/cm. According to Paley's classification the complications were developed as follows; The problem included pin tract infection(9), knee flexion contracture(4), and intractable pain(1), the obstacles included delayed union(3) and premature consolidation(1), the complication included nonunion(9) and equinus ankle(1). At an average 1 years follow up, according to Paley and Catagnl's classification, body and functional results were either excellent or good in 7 cases. So, we recommend that Ilizarov technique is very useful treatment for open fracture with bone loss, bone defect after removal of infected necrotic bone and limb shortening.

Treatment of the Humerus shaft Fracture with Closed Interlocking medullary Nail / 대한정형외과학회잡지

The interlocking nail is used as a valuable method in treating humerus shaft fracture because of the merit, including relatively simple procedure, one of the most stable fixation methods, and allowing early ROM excericise and low complication. Fourteen pateints with humerus shaft fractures were treated using interlocking nail at the Department of Orthopaedic Surgery Paik Hospital from Jan.1993 to Oct.1994. l. Among the 14 pateints, average age was 34.8 years and 9 cases were male and the most common cause of injury was traffic accident. 2. Associated injury including 3 cases of ipsilateral scapular fracture, I case of ipsilateral clavicle fracture, and 1 case of brachial plexus injury, and 1 case of radial nerve injury. 3. The mean duration of the radiologic bone union was 8.6 weeks. 4. There was no serious post operative complication such as non-union, infection, bending or rotational deformity at fracture site, impingement syndrome, metal failure of the nail or interlocking screws. 5. To prevent the impingement syndrom and rotator cuff injury, we countersinked the proximal end of the nail into the humeral head and minimized skin incision.

The Relatuonship betweeh Clinical Carrying Angle and Baumann's Angle in Treatment of Supracondylar Fracture of the Huerus / 대한정형외과학회잡지

Supracondylar fracfture of the humerus is the most common fracture about the elbow joint in children. Early accurate reduction is very important to obtain good results. The authors reviewed 44 cases of supracondylar fractures treated at Inje Universsity Pusan Paik Hospital from January 1986 to December 1990. Average follow-up time was 1 year 6 months. The results were as follows; 1. Thirty cases were treated with closed reduction and percutaneous pinning, ten with manipulation and cast immobilization, three with skeletal traction and the rest one with open reduction and internal fixation. 2. If there was a difference of the angle within 10-degree in post-reduction X-ray, deformity did not follow at the last follow-up. 3. The common formula was that a change of 5-degree in Baumann's angle corresponded to a 2- degree change in the clinical carrying angle. 4. Baumann's angle did not change between that of initially accepted and that of the final follow up X-ray. So, the authors recommend post-reduction measurements of the Baumann's angle as the adequancy of reduction of supracondylar fractures in children.

Autogeous Bone-Articular Cartilage stored within Abdominal Wall / 대한정형외과학회잡지

Articular cartilage can be damaged by trauma or by progressive degradation caused by disease. Unfortunately, it has a extremely limited capacity for repair and regeneration. The use of joint prosthesis has revolutionized but remains limited in its use. To know the possibility of clinical application of clinical application of autogenous bone-articular graft in open complicated intraarticular fractures we studied the change of bone-articular cartilage defect in medial femoral condyle of rabbits and viability of autogenous bone-articular graft stored within abdominal wall of rabbits. The results were obtained as follows: 1. There was over 90% viability of subchondral bone after 10 days storage in the adbominal wall but the articular cartilage showed degenerative change about 40% after 5 days passed. 2. The bone-articular defect was replaced by undifferentiated mesenchymal tissue and fibrous tissue, postoperative 6 weeks later. 3. In implanted bone-articular cartilage graft at 3 days, the chondrocyte of basal cell layer in articular cartilage was relatively well preserved but in 7 days, transplanted articular cartilage graft showed almost necrotic chage. Most of subchondral bones were well healed with host bone without regard to duration of implantation.

Clinical study of the cementless total hip replacement arthroplasty / 대한정형외과학회잡지

No abstract available.

The treatment of septic arthritis of the knee / 대한정형외과학회잡지

No abstract available.

Clinical study of the femoral neck fractures in adult / 대한정형외과학회잡지

No abstract available.

Treatment of C.D.H. in Children Who are Six to Thirtysix Months Old / 대한정형외과학회잡지

The aims of treatment of children with CDH untreated until walking age should be to reestablish the mechanics of the hip joint and avoid complications, especially avascular necosis, thus delaying the devlopment of osteoarthritis. In the child who is first seen between the ages of one and three years, considerable controversy still exists as to the merit of closed versus operative management. The average 29.3 months follow-up results in fifty congenitally dislocated hips in forty-five children with were between six and thirty-six months old when treatment was begun have been reviewed at the Department of Orthopaedic Surgery, In Je University, College of Medicine, Paik Hospital from June, 1979 to Aug, 1989. The results of this study were as follows: 1. Factors affecting method of treatment were age, degree of dislocation and acetabular index; A. Age 1) The children below ages of 18 months were treatment by closed reduction. 2) The children below ages of 18 months were treatment by open reduction with concomittant procedures. B. Degree of dislocation: Open reduction was more frequently reguired in higher degree of dislocation. C. Acetabular index: It was little influenced on method of treatment. 2. The complications were persisten subuxation (3 cases), temporary irregular ossification (16 cases) and avascular necrosis (1 cases).

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.