Early diagnosis of osteogenesis in the distration gap by using the ultrasound in the ilizarov lengthening / 대한정형외과학회잡지

No abstract available.

A Clinical Analysis of the Scapula Fractures / 대한정형외과학회잡지

Fracture of the scapuls is one of the rare bony injuries seen in hospital practice. Authors reviewed the records and the roentgenograms of forty three patients from April 1976 to March 1987. The results were as follows : l. Of the 43 cases, peak incidence was in the middle aged men with high activity, and age range was 30 to 50 years. 2. The most common cause of injury was the motor vehicle accident. 3. Twenty eight cases of the scapular fracture occurred in the body, and eleven had fractures more than two parts in the scapuls. The most common type was the combined fracture of the body and neck. 4. A severe force was required to produce the injury and 79% of the patients had combined injuries of head and chest. 5. Delay in diagnosis was frequent because of the masking effect of the associated injury. 6. Although results of conservative measurements on the scapular fracture are generally good, we feel that treatment on more active line should be undertaken in young and active patients with fracture involving glenoid.

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.

Rehabilitation of the Disabled and Role of the Orthopaedic Surgeon / 대한정형외과학회잡지

Total rehabilitation covering medical, educational, vocational and social services for the total disabled population is an ideal goal for any country. However, in reality, only a fractional portion of the disabled people is covered by any part of the rehabilitation process, especially in developing countries. Therefore, W.H.O. recommended each country to take an urgent action to adopt the Community Based Rehabilitation Service System incorporating the prevention of the disability and rehabilitation into the already existing Primary Public Health Network with the total involvement of the community resources : The basic philosophy of the delivery system should be modified in accordance with the political, socio-economical state of each country. The present state and problems involved in rehabilitation set up in Korea are discussed and suggestions are made. The key of the problems at moment appears to be the steam-lining the Rehabilitation Delivery System at every administrative level to devise the most simple, effective and practical Rehabilitation Service Delivery System which is easily accessible to any disabled people. Realizing the present development and trend in the field of rehabilitation, active role of the orthopedic surgeon as a main driving horse in the medical rehabilitation and also as a community leader are emphasized.

A Clinical Study of the Tibial Plafond Fractures / 대한정형외과학회잡지

The tibial plafond fractures result from an axial compression snd rotational forces causing variable degrees of metaphyseal disruption, articular damage, and malleolar displscement. It is relatively uncommon but a most difficult fracture to manage. It has been treated in a number of manners, but the best results have been occurred when stable internal fixation is accomplished using plates and screws. Basic steps in reconstruction are restoration of anatomic length of the fibula with plate fixation, reconstruction of the tibial articular surface, cancellous bone grafting of the metaphyseal defect and buttress plating of the distal tibia. The suthor analysed the 20 cases of the tibial plafond frsctures in 17 patients, which were trested at the Department of Orthopedic Surgery, Paik Hospital, Inje Medical College from Jsnuary 1983 to March 1987. The longest durstion of followup was 2 years and 4 months and shortest one was 6 months, and the aversge was one year. The results were as follows : 1. Among the 17 patients, male were 16 and female was one. 2. The major causes of injury were a fall from a height. 3. The most frequent type of fracture was type C by Ruedi and Allgower classification. 4. Regardless of the method of trestment the type A and B were in good and fair result, but the type C were fair in 4 cases and poor in 8 cases. There were 7 cases of snkle fusion in poor group. 5. It is important to remind the basic steps in reconstruction and applied in sn individual csse especially in type C. If anatomic reconstruction of the joint surface can be restored and stable fixation achieved, esrly motion of the ankle joint is made possible. This early motion reduces stiffness of the ankle and win yeild the most sstisfying result. But the anatomic reduction of ank1 joint is difficult to be obtained in each case especially in type C and may consider an ankle fusion.

Technique of Safe Removal for Sublaminar Wiring / 대한정형외과학회잡지

With the expending use of sublaminar segmental instrumentation, various complication, including paraplegia, paresis, dysesthesia and dural tears, have been reported. These findings suggest that the displacement of sublaminar wires toward the spinal eord during extraction followed by spinal cord damage. The cut surface of Luque sublaminar wire is sharp and has a barb and it may cause damage to the spinal cord. The cut end of Luque wire was inserted into the Intracath (a kind of angiocatheter) 16 gauge and pulled parallel to the lamina. And we found the Intracath followed by Lugue wire in the operating field. Lateral view of spine roentgenogram revealed that the radioopaque Intracath was passed under the lamina in 3 mm in depth. When the Luque wire is removed with inserting into the Intracath 16 gauge and pulled parallel to the lamina, the dura can be protected by the cut end of Luque wire.

A Clinical Study of Anterior Interbody Fusion for Low Back Pain: Using an Effective Device , Reduction Spreader / 대한정형외과학회잡지

There are many experiences and principles about posterior approach in the spine as surgical procedure in the treatment of the patients with low back pain. And the anterior approach to the disc with its excision and bone graft, less known to others, has become a relatively safe procedure with the increasing experience. The greatest advantage of anterior lumbar interbody fusion is that the reduction of lumbar vertebral slipping is possible, the distance between the involved bodies is well maintained and the rate of fusion increases by spreading the vertebral bodies and putting into the measured bone bloc especially in the patients with severe segmental instability or spondylolisthesis. We analysed 48 patients having anterior interbody fusion by using a specially designed reduction-spreader during eight years, from January 1.978 to December 1985. The results were as follows: 1. Among 48 cases, 20 cases were male and 28 cases were female; 12 cases were in the fourth decade and 19 cases were in the fifth decade-most common in the fifth decade. 2. 28 cases were at the level of L4–L5, 16 cases were L5–S1, and 4 cases were two levels(L3–L4 L4–L5 and L4–L5 LS–Sl). 3. Retroperitoneal approach was used for the L3–L4 and L4–L5, and transperitoneal approach was used for the L5–S1. 4. After distraction between the involved vertebral bodies using an effective device, reduction-sprea-der, a pair of full thickness iliac bone grafts were impacted into the interspace, maintaining the reduction after removal of the reduction-spreader. 5. Fusion was achieved between 3 months and 6 months in 46 cases except 2 cases. 6. Overall clinical results were as follows: good in 42 cases, fair in 6 cases. 7. The anterior interbody fusion using the reduction-spreader is found to be useful method in the treatment of low back pain with spinal instability diagnosed by lumbar flexion-extension lateral roentgenograms.

Analysis of Radiological Change Following Reduction of Congenital Dislocation of the Hip / 대한정형외과학회잡지

Development of acetabulum and epiphysis of the femoral head following reduction in seventy-four patients with ninty-one congenitally dislocated hips were assessed radiologically. Acetabular index, CE angle of Wiberg, neck-shaft angle of the femur and overgrowth of the pelvis and femur were measured according to the various treatment. To evaluate results, the method of treatment was divided into four groups; closed reduction, open reduction, open reduction combined with pelvic osteotomy and modified Klisic operation (open reduction, pelvic osteotomy, femoral osteotomy and so on). Each treatment was compared with three subgroups according to ages; first subgroup was belong to patients under one year of age, second from one year to three years, third over three years. This paper agrees to Harris (1976) and Lindstrom (1979) about improvement of acetabular index and CE angle of Wiberg that showed a rapid rate of repair in the first 6 months and thereafter slowly progressed to normal range of degree. Overgrowth of pelvis and femur was also noticed in cases of hips treated pelvic and/or femoral osteotomy, moreover even in cases of open reduction only. The goal of this preliminary investigation may be supposed to propose the idea which method of treatment to the first visiting patient will approach the most satisfactory final result.

Comparison Between Ender Nail and Compression Hip Screw in the Treatment of Intertrochanteric Fracture of Femur / 대한정형외과학회잡지

Intertrochanteric fracture of femur is increasing in their incidence. Recently Ender nail and compression hip screw are very popular but they have disadvantage in the treatment of intertrochanteric fracture of femur. We have treated 49 cases of intertrochanteric fractures from December 1979 to October 1985 using Ender nail(31 cases) and compression hip screw(18 cases) respectively and compared the results. The summary of the results obtained were as follows: l. Average operation time was 72 minutes in Ender nail group and 146 minutes in compression hip screw group. 2. Average blood loss was 154ml in Ender nail group and 661ml in compression hip screw group. 3. Roentgenographic union was obtained in 12 weeks in both groups. 4. Minor postoperative complications were 24 cases in Ender nail group and 3 in compression hip screw group. Among 24 complications of Ender nail group, 19 were about the knee joint. Our conclusion is that Ender nailing is useful modality in the treatment of unstableintertrochanteric fractures who are old and high risk patients.

A Clinical Study of the Proximal Humeral Fractures / 대한정형외과학회잡지

Most fractures of the proximal humerus are managed well to simple conservative treatment. But open reduction and interhal fixation of the fragment is definitely indicated in certain types of displaced fractures. Thirty eight cases of fractures of the proximal humerus which were treated at Inje Medical College from January 1980 to December 1985 were analyzed both clinically and radiologically accordingto Neer's classification and the following results were obtained. l. Among the 38 patients, the ratio of male and female was 2.2:1 and the highest incidence was in the fifth decades. 2. The main cause of fracture was traffic accident, 20 cases (52. 6%) and the the next one was falling from a height. 3. According to the classification of Neer, one part acture(52.6%) was the most common type. 4. The common associated injuries were fracture of the lower extremities and forearms. 5. Thirty two cases(84.2%) were treated by conservative treatment and six cases by operative treatment. 6. Thirty eight cases were followed form 6 months to 5 years and 6 months, average 14.3 months, and the results were analyzed according to Neers criteria and 26 cases (68. 6%) showed excellent results. 7. Two cases of limitation of shoulder motion were observed as a complication and one cases of paralysis of deltoid muscle by axillary nerve injury was observed. Excellent functional result could be obtained by a simple external support with early motion in a minimal displacement of proximal humeral fracture. Satisfactory functional result could be obtained by a open reduction and internal fixation with early motion in a severely displaced fracture. But long term immobilization of shoulder could have a poor functional result.

Radiographic Measurement of Normal Adult Cervical Spinal Region in the Korean Population / 대한정형외과학회잡지

Radiographic measurement of cervical spine is very important in cervical spine injury especially those without fracture. Authors measured the retropharyngeal space, retrotracheal space, lordortic curve and sagittal diameter of cervical spinal canal in 148 cases of normal adult male. The results are as follows: 1 . In normal Korean adult male maximum retropharyngeal space is 7mm in C, level and Smm in Cs level. Maximum retrotracheal space is 16mm in C, level. 3. Loss of normal lordotic curve is shown in 21 cases(14.2%), 4. Average sagittal diameter of C, level is 21.27mm-it's the largest of all the cervical spinal cana1s, and that of C, level is 16.15mm-it's the smallest.

A Clinical study of the High Tibial Osteotomy in Osteoarthritic Knees with Varus Deformity / 대한정형외과학회잡지

During the period of 5 years and 5 months, from January 1979 to May 1984, we treated 27 cases(17 patients) of osteoarthritis with genu varum deformity by high tibial osteotomy. The results were as follows: l. In the 27 cases of the high tibial osteotomy, 24 cases were female and 3 cases were male. 2. Of the etiology of the osteoarthritis with genu varum, 14 female patients had primary one and 3 male patient knees were related with infection(2 patients) and trauma (1 patient). 3. Preoperative varus angles, ranging from 0° to 20°, 6.4° in an average and postoperative valgus angles, ranging from 5° to 15°, 8° in an averge. 4. In a review of the high tibial osteotomy, good and fair results were noted in 26 cases (96.3%) of the knees after average 2 years of follow-up. 5. The high tibial osteotomy is found to be useful method in the treatrnent of the osteoarthritic knee with varus deformity.

Variations of Insertions of the Abductor Pollicis Longus and the Extensor Pollicis Brevis in Korean / 대한정형외과학회잡지

The purpose of this study was the presence of accessory tendon and its anatomical variation of insertion of the abductor pollicis longus and extensor pollicis brevis. 1. Among 46 cases, all had one or more accessory tendon except one which inserted into the base of the first metacarpal bone on its anterolateral surface with a single tendon. 2. Among 45 cases (which had one or more accessory tendon), the abductor pollicis longus tendon inserted into the trapezium in 30 cases(66.6%), and thenar muscles in 38 cases (84.4%). 3. Among 46 cases, the extensor pollicis brevis tendon inserted into the proximal phalanx in 30 cases(65%) and into the distal phalanx with extensor pollicis longus in 8 cases (18%) and into both in 8 cases (18%). 4. Among 22 cadavers, symmetry of insertion of the abductor pollicis longus noticed in 16 cases (88 and extensor pollicis brevis in 21 cases (95%).

Volar Plate Arthroplasty of Proximal Interphalangeal Joint of Finger / 대한정형외과학회잡지

Pain, premature degenerative arthritis, stiffness and persisting subluxation are common sequalae of fracture dislocations of the proximal interphalangeal joints of the fingers. With disruption of greater than 40% of the volar articular surface of the middle phalanx, it is un- likely that congrous stable reduction can be achieved. And the most severe injuries are caused by longitudinal compression force, which drives the middle phalanx where the middle phalanx eventually comes to rest. Many authors had reported a variety of method for the treatment of the unstable fracture dislocation with no satisfactory results except Eaton(1980). In his ten years experience the volar plate arthroplasty for acute and chronic fracture dislocations got a good results with satisfactory range of motion and no pain on motion. Authors had been treated two cases of chronic fracture dislocations of the proximal interphalangeal joint with Eatons volar plate arthroplasty followed by good results in one year followed-up study.

A Clinical Study on the Psychological Test in Patients with Chronic Low Back Pain / 대한정형외과학회잡지

No abstract available in English.

Clinical Observation of Acute Hematogenous Osteomyelitis in Children / 대한정형외과학회잡지

No abstract available in English.

A Case of Report of Slipped Capital Femoral Epiphysis Associated with Hypogonadism with Turner Mosaicism (XX/XO) and diabetes Inspidus / 대한정형외과학회잡지

No abstract available in English.

A Clinical Study of Trochanteric Fracture of the Femur / 대한정형외과학회잡지

It is generally accepted that trochanteric fractures are best treated by internal fixation as it provide satisfactory reduction and fixation of the fractures allowing early mobilization of the patient thus avoiding general and local complication following this sort of trauma. Fourty-seven cases of trochanteric fracture of the femur were treated at the Department of Orthopedic Surgery, Paik Hospital, Seoul, Inje Medical College from June 1974 to June 1982 and clinical analysis was made with particular emphasis on the comparision between compression hip screw fixation and Jewett nail technique. The result of the analysis are as follows: l. 63% of the male patient belongs to active age group in contrary to common belief in age incidence and the common causes of the injury was traffic accidents and fall from height. 2. By the Tronzo classification of the intertrochanteric fracture, the most common type is type III and type V was predomonant in the traffic accidents group and 87% of all cases belongs to unstable category. 3. Of the seventeen associated injuries, visceral injuries, fracture of the lower extremities, fractures of the upper extremities, fractures of the pelvis were observed in order of frequency. 4. More general complications were observed among the conservatively treated group and local complications occurred mainly in the group treated with Jewett naiL 5. The compression hip screw method seemed to be superior to Jewett nail owi#ng to shorter operation time, less blood loss and less complications. 6. Ender nail appears to be a promising method of treatment in the elderly patient because it had shorter operation time, negligible blood loss, minimal stress to the patient and early mobilization and weight bearing.

Paget's Disease: Case Report / 대한정형외과학회잡지

Pagets disease is a chronic skeletal disease of middle and later life, beginning insidiously and characterized by progressive structural changes and typical deformities occuring in the long bones, pelvis, and cranium. The occurence of Pagets disease is extremely rare in Korea. We have experienced a case of Pagets disease of bone in 67 year-old female affecting mainly the ilium and skull, and we report the case with brief review of the literatures.

Fracture and Dislocation of Cervical Spine / 대한정형외과학회잡지

There was increasing tendency to stabilize unstable cervical spine injuries surgically with the benefit of good stability of the spine, easy nursing care, early mobilization and therefore early rehabilitation. A clinical study was performed on 47 patients with fractures and dislocations of the cervical spine treated at the department of orthopedic surgery, Inje Medical College, Paik Hospital from Jan. 1975 to Dec. 1981. Following is the summery of the our findings. 1. The prevalent age distribution was between 3rd and 6th decade and the ratio between males and females was 10:1. The most common cause of injuries was automobile accident (70%). 2. The most common site of the injuries was C5-6 (34%) and the most frequent mechanism of injury was flexion-rotation type (47%). 3. In overall patients, neurologic damage was found at first examination in 73% and among these, complete paralysis below the injured level in 26%, incomplete paralysis in 11% and nerve root injury in 35%. 4. Among 47 patients, conervative treatment was performed on 9 patients, anterior spinal fusion on 8 patients, anterior spinal fusion with Halo application on 4 patients, posterior wiring with posterior spinal fusion on 16 patients and posterior wiring with anterior spinal fusion on 8 patients. 5. In the several methods of treatment, the posterior wiring with anterior spinal fusion revealed the best results, the correction rate of displacement was 92%, the correction rate of angular deformity 98% and neural recovery rate 72%. 6. The posterior wiring with posterior spinal fusion revealed good results in correction of displacement and angular deformity but required rigid external support for a long time. The anterior spinal fusion revealed poor results in correction of displacement(67%) and angular deformity(38%) and required rigid external support for a long time and had increasing tendency of kyphotic angle after operation. 7. In the treatment of unstable cervical spine injury, we thoughy that early posterior reduction with posterior wiring and followed anterior spinal fusion was ideal for accurate reduction, rigid stability and early mobilization with simple external support.