Diagnosis of Osteomyelitis by the Sequential Use of ⁹⁹mTc / 대한정형외과학회잡지

The sequential use of ⁹⁹mTc-methylene diphosphonate(⁹⁹mTc-MDP) and ⁶⁷Ga imaging is thought to be useful to diagnose acute hematogenous osteomyelitis, and to determine whether it is active or inactive in chronic osteomyelitis. We compared the results obtained by the sequential use of ⁹⁹mTc-MDP and ⁶⁷Ga imaging with those obtained by the surgical culture and biopsy in 31 patients who were supposed to have the osteomyelitis and admitted to Pusan National University Hospital from July 1987 to July 1989. The results were as follows:l. According to the diagnosis at discharge, 4 cases were normal, 20 cases active osteomyelitis, and 7 cases inactive osteomyelitis. 2. Four normal cases were negative both with ⁹⁹mTc-MDP and with ⁶⁷Ga. Twenty cases of active osteomyelitis showed positive results both with 99mTc-MDP and with ⁶⁷Ga. And of 7 cases of inactive osteomyelitis, 6 cases showed positive ⁹⁹mTc-MDP and negative ⁶⁷Ga, 1 cases was negative both with ⁹⁹mTc-MDP and with ⁶⁷Ga. 3. It is suggested that in active osteomyelitis both ⁹⁹mTc-MDP and ⁶⁷Ga were positive, in inactive osteomyelitis ⁹⁹mTc-MDP positive and ⁶⁷Ga negative and in normal or wastive ostemyelitis both ⁹⁹mTc-MDP and ⁶⁷Ga negative. 4. The sequential use of ⁹⁹mTc-MDP and ⁶⁷Ga imaging was particularly useful to diagnose acute hematogenous osteomyelitis in the case of the obscure diagnosis and supposedly normal radiological finding and to determine whether chronic osteomyelitis is active or complicated by an acute flare-up.

In Vitro Effects of Ascorbic Acid on the Repair Process of the Fetal Rat Femur Damaged by Cyclophosphamide / 대한정형외과학회잡지

After bone damage of the fetal rat femurs induced by administrating cyclophosphamide(CP),(1/8 LD50) to the pregnant rat on 13th day of gestation, the effects of serum and ascorbic acid on the repair process of the bone during organ culture were studied, histologically and scanning electron microscopically. CP-damaged fetal femurs harvested at 20 days of gestation were cultured fro 2, 5 and 7 days in the waymouth media(WM) with or without fetal bovine serum(FBS) and ascorbic acid, and were observed with light microscope and JSM-35C scanning electron microscope. The results were as follows:1. CP-damaged bone tissue cultured in WM with 10% FBS showed relatively enhanced activities in the differentiation of chondrocytes and ossificstion as compared to that cultured in WM. 2. CP-damaged bone tissue cultured in WM with 10% FBS and 100µg/ml ascorbic acid, showed increase in the length of the bone marrow cavity, and active formation of new osteoid and collagen bundles. 3. The bone tissues cultured in WM with 10% FBS and 400µg/ml ascorbic acid revealed active deposition of bone matrix, thickening of periosteum and marked elongation of the bone marrow cavity. 4. Bone trabeculae of CP-damaged femurs cultured for 2 days in WM showed poor cell proliferation and insignificant bone matix formation. 5. The number of new cells and the amount of the collagen fibrils increased on the bone trabeculae of the bone cultured in WM with 10% FBS as compared to that cultured in WM and this increase was enhanced as the culture time progressed. 6. A remarkable increase was noted in the number of cells and collagen fibrils in the bone tissues cultured in WM with 10% FBS and ascorbic acid than in those cultured in WM with 10% FBS. 7. The number of the spherules formed by cellular component with collagen fibrils is more numerous than that formed by calcospherites associated with collagen fibrils.

Distraction Epiphysiolysis as a Method of Limb Lengthening / 대한정형외과학회잡지

We, at Department of Orthopedic Surgery, College of Medicine, Pusan National University, applied epiphyseal distraction as a method of limb lengthening, using unilateral one-plane pin fixator(ORTHOFIX) and bilateral multi-plane ring fixator(SEQUOIA) to three children with limb length discrepancies and angulation deformity due to injury of epiphyseal plate, and obtained following results. l. At first case, on whose distal femoral physis, bone bridge occupied about 20% of total epiphyseal plate and distributed mainly on the lateral side. At 10 days of distraction, epiphysiolysis occurred from the lateral side at first and angulation deformity was corrected. Epiphysiolysis on the medial side of physis appeared apparently after 60mm distraction. Bone lengthening of 4.2cm and correction of 25 valgus deformity were achieved after 72mm distraction for about 10 weeks. The percentage of increase in the initial length achieved was 11.67% and healing index was 27.86. 7 months later, loss of lengthening of 2.7cm was observed and it was considered that this was due to relatively short corticalization phase. 2. At second case, on whose distal tibial physis, bone bridge occupied about 40% of total epiphyseal plate and distributed on the medial side. At 10 days of distraction, epiphysiolysis occurred on the medial side of the epiphyseal plate, but not on the lateral side and instead of further lengthening, valgus deformity of the ankle appeared. It was thought that asymmetric distraction was attributed to the difference between the force applied on the medial side and that applied on the lateral side of the epiphyseal plate by unilateral one-plane pin fixation. 3. At third case, on whose distal tibial physis, bone bridge occupied about 75% of total epiphyseal plate. No epiphysiolysis occurred. there was a difficulty in observation of epiphysiolysis because ring fixator was overlapped with the epiphyseal plate on radiographs.

Clinical Observation on Residual Subluxation after Treatment of Congenital Dislocation of the Hip / 대한정형외과학회잡지

Hips with residual subluxation after treatment of congenital dislocation of the hip in children who were admitted in department of orthopaedic surgery, Pusan National University Hospital, from January 1980 to October 1987, are investigated with clinical data, X-ray findings, classification and treatment. Hips with residual subluxation after treatment were followed most commonly by closed reduction and cast immobilization, 15 cases, and by innominate osteotomy, 5 cases. Conservative methods as broom-skick cast or abduction brace were done for the treatment of residual subluxation in all cases, except 2 cases of femoral osteotomies. Degree of improvement was determined by periodically measuring C–E angle, acetabular index, migration percentage and the distance from tear-drop to medial metaphysis of proximal femur. The results were as follow :1. Hips with residual subluxation after treatment were found most commonly after closed reduction and cast immobilization. 2. Residual subluxation was classified as Grade Zero to Grade three by measuring the distance from tear-drop to medial metaphysis of proximal femur. There was 12% of Grade I, 48% of Grade II and 40% of Grade III. 3. The mean normalization periods from Grade I to normal, from Grade II to normal, from Grade III to normal, were 14.7 months, 26.3 months, 37.1 months, respectively. 4. Thirteen cases which more than one and half years of follow-up were possible showed improvements in acetabular index from 30.5°to 22.9°, C–E angle from 5.7°to 25.4° and migration percentage from 34.4% to 18.8%, 5. There were relatively poor results in the hips with residual subluxation after innominate osteotomy.

A Clinical Study of Benign Bone Tumors Treated by Partly Deproteinised Xenograft(Kiel Bone) / 대한정형외과학회잡지

The use of lyophilised bone from calves as a heterograft was introduced by Maatz and Bauermeister in 1957 as an alternative to autografts and freeze-dried homografts which were then in general use. The Kiel bone was known to possess no antigenecity and serial radiographs revealed that it is incorporated into the recipient site by a process of creeping substitution from surrounding bone. In patients with benign bone tumors, the surgical dead space was filled with Kiel bone graft in the departments of orthopedic surgery, Pusan national university hospital. The results were followed up for more than 14 months, and were evaluated by the palin film findings. The results were as follows : l. Of the 22 cases, satisfactory result was obtained in 18 cases(81,8%). 2. The mean lesion size(diameter of lesion/diameter of bone)of success cases was 61.6%, and the mean lesion size of failed cases was 82.8%. 3. The duration from the Kiel bone graft to the evidence of new bone formation and remodelling was 10.5 months on an average with a range of 7months to 15months, and the duratin from the Kiel bone graft to the complete resorption of the Kiel bone was 45.7 months on an average with a range of 29 months to 66 months. 4. The causes of the failed cases were thought to be incomplete removal of the lesion, decreased vascularity due to repeated surgery, large size of the lesion, and the potentiality of tumor, 5. It was difficult to evaluate success rate according to underlying disease because the number of the cases was not large enough, but giant cell tumor showed high recurrence rate.

Comparative Study of the Clinically Diagnosed Herniated Nucleus Pulposus with the Computed Tomographic and Myelographic Finding / 대한정형외과학회잡지

79 patients with suspected H.N.P. of lumbar vertebrae were studied from June 1983 to June 1986 who had had both metrizamide myelography and computed tomography. Comparative study of the findings from clinical examination, CT and myelography of them are as follows. l. In physical examination, S.L.R.T. was most common sign, 58 patient(73.4% of study group) showed positive in S.L.R.T.(30~70 range). Of these positive patients in S.L.R.T. 41.4% was the patients who were younger than 30 years of age and also had pressure sign of nerve root on CT and myelography. These group showed highest positive rate in S.L.R.T. 2. In CT and myelographic study, the most frequent occurence of H.N.P. were seen in L4–5, L5–S1, L3–4 in order and myelography showed higher positive rate in L4–5 intervertebral space while CT showed higher positive rate in LS–S1. 3. On CT, facet joint arthritis or stenosis were seen in 49.4% of the study group and 53.7% of computed tomographic positive patients of H.N.P. 4. Corresponding rate of positive sign of H.N.P. between CT and myelographic findings were seen 71 intervertebral spaces, which means 84.5% of 84 positive spaces on CT and 88.8% of 80 positive spaces on myelography. 5. In 49 intervertebral spaces clinical sign, CT and myelographic findings were all positive. In another words 58.3% of 84 positive intervertebral spaces on CT and 61.3% of 80 positive spaces on myelography showed all positive sign on clinical examentation, CT and myelography. 6. L5–Sl intervertebral spaces showed most controversial results in comparative study of CT and myelography. 7. 25 of 26 positive spaces on CT(96.2%) and 23 of 26 positive spaces of myelography(88.5%) were confirmed by operation and all 3 false-negative on myelography were found in L5–Sl intervertebral space. 8. Most diagnostic differences were seen in L5–S1, which has wider epidural space. CT showed higher sensitivity than myelography in this study. For its higher sensitivity and non-invasiveness CT is thought to be first recommendable method for diagnosis of H.N.P. and myelography is recommended as second best choice where diagnostic differences are seen.

A Clinical Study of Unstable Fractures and Fracture-Dislocations of the Thoracolumbar Spine / 대한정형외과학회잡지

The thoracolumbar spine is relatively easily traumatized and result in serious complications such as neurologic impairment and instability, so its proper management is very important. Formerly the thoracolumbar spine injury was evaluated mainly by plain radiographs, and tomograms if indicated,but because computed tomography visualizes bone and soft tissues three-dimensionally, we tried to compare its value with that of plain radiographs in potentially unstable thoracolumbar injuries. From January 1984, we determined the stability of the potentially unstable thoracolumbar spine injury according to computed tomography finding and compared with plain radiography finding, and the following results were obtained. 1. By Holdsworth classification, it was difficult to determine the stability of the thoracolumbar spine injury. 2. In cases of compression fracture and burst fracture by Denis classification, it was necessary to determine the stability by computed tomography. 3. In cases of unstable burst fracture by McAfee classification, there was no direct relationship between the degree of canal occlusion and neurological deficit, but above 25% in conus medullaris lesion and above 50% in cauda equina lesion usually manifested neurological deficit. 4. In our cases, the neurological status of initial injury was important factor to determine the improvement rate.

Treatment of the Humeral Shaft Fracture: Comparison between Functional Bracing Technique and Closed Intramedullary Fixation with Functional Bracing Technique / 대한정형외과학회잡지

It has been generally agreed that most fractures of the humeral shaft are best treated non-operatively although occasionally there are indications for primary operative treatment. Recent advances in internal fixation techniques and instrumentation have led to an expansion of surgical indications, and operative treatment produces higher rates of nonunion, infection and other associated complication when compared with closed treatmet techniques. Because of the significant morbidity of the operative treatment, closed intramedullary fixation techniques that provide stability of the fracture site without opening and reduce the postoperative complications, were developed. In this paper we document forty two fractures of the humeral shafts that were treated by functional bracing(Group I: 24 cases) and intramedullary fixation with functional bracing(Group II: 18 cases) between October, 1982 and August, 1986. And the obtained results were as follows: 1. The everage healing time was 9 weeks in the Group I, and 11 weeks in the Group II . 2. The non-union has not been encountered in the Group I, but non-union and delayed union were 4 cases (22.2%) in the Group II. 3. The complication rate was 9 cases(37.5%) in the Group I, and was 12 cases(66.7%) in the Group II, but deep infection did not occured in all cases. 4. The residual angulation more than 5 degrees was 20 cases(83.3%) in the Group I, and was 2 cases(11.1%) in the Group Il. However the results of the group Il were inferior ot the group I, of more proper selection of the patients, more accurate technique and adequate type of nails have been used, the better results will be taken.