A Study of Tibio / 대한정형외과학회잡지

The object of this study was 336 Korean patients with degenerative arthritic knees and 1000 Koreans with normal knees who had visited the department of orthopaedic surgery of Hanyang University hospital during the period fmm January, 1980 to June, 1981. The purpose of this study was to investigate the changes of tibio-femoral angles and metaphysealdia physeal angles in response to the degenerative changes of the knees. By the roentgenogram, tibio-femoral angles and metaphyseal-diaphyseal angles were measured and those angles were analized statistically. The results were as follows 1. In young age group, the incidence of the degenerative arthritic knees was more frequent in male than in female. However, in the middle and older age groups, the incidence was higher in female than in male. 2. The mean value of tibio-femoral angle of the degenerative arthritic knees was −3.41°±0.22. It was about 1° varus compared with the normal mean value of −4.46°±0.27. The mean value of tibio-femoral angle in normal Korean was reduced appmximately 3°±5°valgus compared with the Westem normal peoples: 3. In general, the valgus tendency appeared a little more in the knees of female than in those of male. 4. The varus tendency was in pmportion to the degree of the aggrevation of the degenerative arthritis in the knees. 5. The mean value of metaphyseal-diaphyseal angle in normal Korean was 3.53°±0.24. It was 3°–4° varus compared with the Western normal peoples. 6.The varus was increased more in the standing position, in the state of weight bearing position, than in the supine position.

Reconstruction of the Posterior Cruciate Ligament Using the Medial Meniscus / 대한정형외과학회잡지

Biomechanically, the posterior cruciate ligament has been considered the basic stabilizer in the knee, So a torn cruciate ligament should be sutured as soon as possible, otherwise within a few weeks it will undergo resorption, making suture impossible. Currently available reconstructive procedures of the posterior cruciate ligament are often inadequate. We have performed 6 cases of the reconstruction of the posterior cruciate ligament using medial meniscus. The results were as follows; 1. Functionally all cases were improved and objectively 5 cases(83.3% ) among them were achieved stability of the knee rather than preoperative condition. 2. Reconstruction of the posterior cruciate ligament using medial meniscus is technically simple and reliable and can therefore be recommended. But further investigation is necessary to answer question regarding the long term results.

A Clinical Study of Non-Union and Delayed Union / 대한정형외과학회잡지

No abstract available in English.

The Morphological Study on the Proximal Part of the Humerus in the Korean Adults / 대한정형외과학회잡지

The structures forming the shoulder joint are very complex and the biomechanical effects of them on the joint are not clearly lunderstood. Frequently the long head of the biceps brachii muscle is dislocated naturally and it has been said that the supratubercular ridge, the depth, and angle of medial wall of the intertubercular groove are important. And the angles between the long axis of the humerus and the axis of head and neck are important clinically. So the authors studied them in the 105 specimens of the Korean adults humerus. The results are as follows: 1. The complete type of the supratubercular ridge was present in 22.9% and the partial type was in 53.3% 2. If the ridge was present, the spur of the lesser tubercle was present in 67.5% and if not present, the spur was in 8%. 3. The angle of medial wall of the intertubercular groove was variable, and the angle less than 45 was 13.41°. 4. The angles between the long axis of the humerus and the axis of head and neck were much greater in male than female (P<0.05). 5. The average diameter of the head of the humerus was 4.42±0.4cm in male and 4.4±0.4cm in female (P < 0.05).

A Clinical Study of Congenital Dislocation of the Hip / 대한정형외과학회잡지

The congenital dislocation of the hip is one of the most common congenital disease in the field of the orthopedic surgery. For the normal development of the acetabulum and femoral head, the displaced femoral head shouid be replaced in the acetabular socket as early as possible. In most cases treated in proper time, closed reduction is successful. If not, operative correction will almost always be necessary due to abnormal changes of the acetabulum and femoral head. We experienced 33 cases in 32 patients of the congenital dislocation of the hip at the Department of Orthopedic Surgery of Hanyang University Hospital from May, 1972 to December, 1980. The results obtained were as follows: 1. The most common aged group at the first visit was ranged from 12 months to 24 months and the preponderance of girl to boy was 3.6:1. 2. The ratio of left to right side was 1.6:1. 3. In delivery history, there were 3 cases of breech presentation, 1 case of Cesarean section and 1 case of prematurity. The associated congenital anomaly was observed in a case of which combined internal tibial torsion and talipes metatarsus varus deformity. 4. In 33 cases in 32 patients, 22 cases were treated conservatively and 11 cases were treated surgically. The results of treatment were excellent in 21 cases, good in 11 cases and fair in 11 case. We experienced 4 cases of neglected congenital dislocation of the hip in the period of late childhood, 3 cases were treated with Chiari osteotomy and the other 1 case was treated with Colonna capsular arthroplasty. The overall results were excellent.

Osteocutaneous Free Flap Transfer by Microsurgical Technique / 대한정형외과학회잡지

A microvascular osteocutaneous free flap is totally detached from its origin and reattached at a distant site, in one stage, by the use of microvascular anastomosis to maintain its viability. The advantages of microvascular osteocutaneous free flap trsnsfer are more rapid healing, greater resistance to infection, less risk of absorption than conventional bone grafts, and shortened hospitalization. Two cases of microvascular osteocutaaeous free flap transfer were performed at the department of Orthopaedic surgery of Hanyang University Hospital, and satisfactory results were obtained.

Synovial Sarcoma of the Ulna: A Case Report / 대한정형외과학회잡지

Synovial sarcoma is an uncommon, malignant tumor which originates from the synovial lining of the joints, bursae and tendon sheaths. But it rarely occurs from bones. We have experienced a synovial sarcoma of the left ulna. Microscopically cleft spaces lined by epithelioid cells and bundle formation by spindle spaped cells were seen. Above elbow amputation of the left arm was done.

A Clinical Study on Pyogenic Osteomyelitis / 대한정형외과학회잡지

Pyogenic osteomyelitis is at times tragic disease from which severe deformity and disability may result. The incidence and mortality rate of pyogenic osteomyelitis have decreased strikingly since penicillin became available for general use in the treatment of pyogenic osteomyelitis in 1944 and had a dramatic effect. Recently, since the use of new antlblotics, the effect of treatment has been expected in Pyogenic osteomyelitis. But causative organisms of pyogenic osteomyelitis was gradually increasing in resistance to antibiotics. There is also a trend of gradual increase of pyogenic osteomyelltis due to Gram negative bacilli. The author has been analysed 134 patients on whom followup was observed for a minimum of six months at the Department of Orthopedic Surgery of Hanyang University from May, 1972 to December, 1978. The results were as follows: 1. The incidence of pyogenic osteomyelitis is a trend of gradual increase with 14.2% in 1973, 15.7% in 1975 and 26.9% in 1978. 2. Sex ratio was 2.6: 1 (Male: Female): Age distribution showed the group between 5 and 15 years old was 20 patients(62.5%) in acute osteomyeIitis, and the group between 15 and 30 years oId was 52 Patients (51%) In chronic osteomyelitis. 3. The order of involved bones is femur(41%), tibia(27.8%) and humerus(10.4%). 4. Erythrocyte sedimentation rate was remarkably increased in 92.8% of male and 86.5% of female. 5. The causative organism was mostly staphylococcus aureus(84%) in acute osteomyelitis, and Staphylococcus aureus(44.8%), mixed organisms(20.9%) and Gram negative, bacilli(8.3%) in chronic osteomyelitis. Especially, mixed cases with Staphylococcus aureus and Gram negative bacilli contain 55% of mixed organisms. 6. Penicillin was most resistant (79.7%) to Staphylococcus aureus. Cloxacillin was most susceptable (91.3%) to Staphylococcus aureus. 7. The treatment of acute osteomyelitis showed arrest(72.7%) in case of massive antibiotics by early finding of clinical symptom, but if clinical symptoms were not improved within 48 hours with the use of antibiotics, early decompression was done and was arrested(84.6%) in acute osteomyelitis. Closed continuous irrigatlon with saucerization was done and was arrested(85.7%) in chronic osteomyelitis.

A Clinical Study of Stress Fracture of the Tibia / 대한정형외과학회잡지

The stress or fatigue fracture is well known in military medicine, but it is an unusual occurrence in civilian practice. The stress fracture of metatarsal bone is familiar to most, but in the tibia it is unusual. The clinical symptoms of pain, swelling and limping following strenuous activity were seen in the affected lower leg and proceeded radiological evidence of fracture. 17 cases of stress fracture of tibia were investigated in a military hospital between March 1973 and May, 1974. The results of this study are as follows, 1. The fractures mainly occurred in the upper one third of the tibia (13 cases among 17). 2. The cases with only callus formation were more frequent than the cases with fracture line on the tibia (11 cases among 17). 3. If pain occurs in the lower leg after strenuous activity, there should be attention with serial radiological checking.

Angiography in Bone Tumors / 대한정형외과학회잡지

The present study is concerned with angiographic findings of bone tumors in patients who have been admitted to Severance Hospital from April 1968 to March 1971. Angiography of peripheral tumors is a valuabIe procedure in that it provides important information concerning the presence or absence of a tumor, defines its size and extent, and gives indication of malignancy. Angiography as an additional aid in the diagnosis of malignant bone lesions was first presented by dos Santos, Lamas and Caldos (1931). Begg (1955) stated that a normal angiogram of a limb shows that the branches of the main artery follow a slightly curved and undulating course, and that their calibre slowly and progressively decreases. None of these vessels are seen to reach the periosteum, nor is the nutrient artery ever visible. dos Santos (1931) proposed certain angiographic criteria of malignancy, notably the presence of numerous irregular vessels at the transit of the contrast medium from the arteries to the veins. Margulis(1964)stated a large number of malignant neoplasms are highly vascular and present chaotic patterns. Their vessels have irregular lumina and arteriovenous communications are present within them. Areas of intense contrast staining occupy parts of or the entire tumor. This appearance, frequently described, has been assumed to be characteristic of and uniformly encountered in malignant tumors. Angiographies in the present study include 6 cases of Osteogenic sarcoma, 4 cases of Chondrosarcoma, 2 cases of Giant cell tumor, 1 case of Liposarcoma, 1 case of Kaposis sarcoma, 1 case of Hemangioma, 1 case of Metastatic bone tumor, 1 case of Fibrous dysplasia and 1 case of Neurofibromatosis. Angiography was performed 13 times under local and 5 times under the general anesthesis. 20 to 30cc of 50 per cent Hypaque was utilized for examination. Angiographic findings are as follows: 1. HypervascuIarity is seen in osteogenic sarcoma, giant cell tumor, hemangioma and metastatic bone tumor. But neurofibromatosis and fibrous dysplasia are avascular. 2. Irregularity of the vascular net work seems characteristic in osteogenic sarcoma, hemangioma, and metastatic bone tumor. 3. Blood pools are seen prominently in osteogenic sarcoma, giant cell tumor, hemangioma and metastatic bone tumor. but no blood pools in neurofibromatosis and fibrous dysplasia. 4. Arteriovenous shunt is seen in osteogenic sarcoma, chondrosarcoma, hemangioma and metastatic bone tumor. But there is no A-V shunt in giant cell tumor, liposarcoma, Kaposis sarcoma, neurofibromatosis and fibrous dysplasia. 5. Retention of contrast medium is seen prominently in osteogenic sarcoma and hemangioma. But no retention of contrast medium is noted in liposarcoma, neurofibromatosis and fibrous dysplasia. While I do not regard arteriography as a necessary procedure for the differantial diagnosis of all presumptive bone neoplasms, it is indeed valuable in selected cases, in differential diagnosis of bone tumors and in the demonstration of the vascularity and extent of extraosseous soft tissue masses and it can be helpful in selecting an appropriate biopsy site. By indicating the size ar,d vascularity of a lesion and its major blood supply, it may influence the surgical approach.