Fatigue Fractures of Tibial and Fibular Shaft in Soldiers / 대한정형외과학회잡지

A fatigue or stress fractures is one in which there is no initial overt break in bone continuity. Rather, there is a gradual alteration in bone architecture as a result of repeated stress. The stresses are submaxmum and usually are the result of unaccustomed activity. If continued, they may eventually result in a complete fracture. Fatigue fractures have been described in almost every bone in the body, but they are more common in the bones of the lower extremities. Fatigue fractures are commonly seen in military personnel, especially at basic training center, and have been noted in athletes, ballet dancers, laborers, and even pregnant women. The following clinical results were shown by analysis of 57 cases of stress fractures experienced in the Department of Orthopaedic Surgery, Capital Armed Forces General Hospital from Jan. 1978 to Sep. 1979. 1. In 57 fatigue tractures in military recruits, 48 were in the tibial shaft and 9 were in the fibula. 2. The main cause of the fatigue fractures was running on hard roads, and the other causes were marching on hard surfaces, playing football, and long jumping. 3. The site of predilection in the tibia was the proximal one third of the shaft, occurring in 35 (72.9%) of the cases. In the fibula the junction of the upper and middle thirds was most frequently affected, occurring in 4 (44.4%) of the cases. 4. Most of the tibial and fibular fatigue fractures were grade I (40 cases among 57), showing periosteal reaction only on one or two cortices. 5. All soldiers were treated by immediate stoppage of physical activity, with no plaster immobilization or non weight bearing.

A Clinical Study of Ankle Injuries / 대한정형외과학회잡지

Ankle injuries include not only disruption of bony architecture of ankle joint but also significant ligamentous and soft tissue injuries as well. Since ligamentous injury frequently has more serious implication than fracture, it is important that be recognized and included in the plan of treatment. The goal of treatment of ankle fracture is the establishment of the normal ankle joint. To obtain the this goal, the fracture should be reduced as accurately as possible (by open or closed), the fracture fragment must be retained in position until healing is secure, ligamentous structure should be repaired when indicated, and joint motion should be restored. The following clinical results shown by analysls of 108 cases of ankle injuries experienced in the Department of Orthopaedic Surgery, Capital Armed Forces General Hospital, from Jan. 1977 to June 1979. 1. The main cause of the injuries was falling from a height and the other causes were direct violence, traffic accident, and injuries in order. 2. All but one of the fractures could be classified in the manner described by Lauge-Hansen and the type of supination-external rotation was most common type in this series. 3. Ninty-two (85.1%) patients were treated by open reduction and internal fixation of both malleoli and sixteen by closed method. 4. The average period of cast immobilization was 8 weeks after closed reduction and that of open reduction was 6 weeks. 5. The good clinical results were achieved in 95 petients and the better results were obtained in fracturers treated in operative interventions.

An Experimental Study of the Effect of Kirschner-wire and Screw insertion upon the Epiphyseal Plate of the Distal Femur in the Growing Rabbit / 대한정형외과학회잡지

The effect of surgical traumata upon the epiphyseal plate of the growing bone has been controversial among many authors. The resultant deformity subsequent to the epiphyseal plate injury-yields numerous different pattens and any of the explarations of the pathogenesis is also not accepted for all. Therefore, the author made an experiment to elucidate more clearly the histological changes of the epiphyseal plate of immature rabbits following insertion of Kirschner-wire and screw. Thirty rabbits weighing 700–1200gm were divided into 2 groups, as following snd the direction of longitudinal insertion from articular surface of the epiphysis of the distal femur. Group 1: lnsertion of Kirschner-wire Group 2: Insertion of screw The animals were sacrificed at 1, 2, 4, 8, and 10 weeks after the operative procedure and the histological examination of the injured epiphyseal plate of distal femur were made. The summary of the histological findings were follows: 1. The margin of the epiphyseal plate adjoining the Kirschner wire showed a new osseous tissue which formed a bony bridge running from the epiphysis to the metaphyseal bony trabeculae. 2. The margin of the damaged epiphyseal plate adjoining the screw revealed new bone formation and the amounts of the reactive new bone is less than Kirschner-wire. 3. Histological findings of the epiphyseal plate showed to be uniform and normal except in the adjacent area of the Kirschner-wire and screw.