An Epidemiologic Study of Low Back Pain of Women Working at a General Hospital / 영남의대학술지

BACKGROUND: The aim of this study was to confirm the risk factors for low back pain and injury to improve the prevention and treatment of lower back pain. MATERIALS AND METHODS: An epidemiologic study of low back pain and injury was performed with questionnaires distributed to 471 women working at Yeungnam university hospital. The differences in low back pain and injuries among various hospital departments were analyzed by a one-way analysis of variance (ANOVA), and the relevant factors included in the questionnaire were determined by a factor analysis. RESULTS: The frequency of low back pain in women in the department of diet and in the maintenance department was higher than among the other departments. The frequency of low back pain was mainly related to the frequency of psychosomatic symptoms. In addition, the low back pain was partially related to the frequency of psychosomatic symptoms and partially related to the frequency of pushing during the workday. The degree of disability from low back pain was increased by lifting and hard physical work and was related to the frequency of psychosomatic symptoms and the degree of work dissatisfaction. The frequency of low back injury was increased by increased standing time during work and hard physical work. The frequency of low back injury was related to advancing age and in part to psychosomatic symptoms. CONCLUSION: Lower back pain and its associated complications are related to psychosomatic factors and type of work. Lower back injury is related to physiological factors such as age. For the prevention and treatment of lower back pain, a multidisciplinary approach is required.

A Comparative Study of Trochanteric Fractures Treated with the Intertrochanteric/subtrochanteric Fixation or the Proximal Femoral Nail

PURPOSE: To evaluate the radiographic, clinical results and the complications between who had intertrochanteric fracture, treated with the ITST or the PFN. MATERIALS AND METHODS: We selected each 30 patients of intertrochanteric fracture which were treated with ITST or PFN from July 2002 to November 2005. We evaluated the radiographic results by follow-up radiography and the clinical results with the mobility score of Parker and Palmer, Salvati and Wilson hip function scoring system and Jensen index. RESULTS: The mean distance of lag screw sliding was 4.1 mm at the ITST group and 6.6 mm at the PFN group. Decrease of mobility score of Parker and Palmer, Salvati and Wilson hip function score were similar. Patients complaint pain over lateral thigh area in 5 cases (ITST group) and 8 cases (PFN group). CONCLUSION: The ITST nail and PFN were seen good results in treatment of stable and unstable intertrochanteric fracture.

Prognostic Indicators in Tibial Shaft Fractures ; Serum Creatine Kinase Acticity / 대한정형외과학회잡지

Serum creatine phosphokinase(CPK) levels were measured serially in 20 adults with closed tibial shaft fractures, CPK activity increased significantly after fracture(p < 0.01). High energy and delayed healing fractures had significantly higher levels of CPK than low energy and normally healing fractures, respectively. Thus, CPK determinations could be used to assess the severity of trauma and possible prognosis of the healing in tibial shaft fractures.

Analysis of Weight Distribution under the Feet using Photoelastic Technique / 대한정형외과학회잡지

In spite of large volume of reports, surprisingly little information is avail-able about the function of the foot in standing and there are still many controversies about the exact proportion of the weight distributed in discrete areas of the foot. The purpose of this study is to evaluate about the exact proportion of the weight distribution in discrete areas of the foot through the photoelastic technique. In the results of this study according to the 10 regional division method, 4.4% of the total load of one foot was loaded on the toes(1 st toe, 2.2% ;2nd toe, 0.8%; lateral toes, 1.4%), 27.4% on the metatarsal area(lst metatarsal, 6.6%; 2nd metatarsal 8.7% ; lateral metatarsals, 12.5%), 8.6% on the midfoot(medial midfoot, 1.4%; lateral midfoot, 7.3%) and 59.2% on the heel(medial heel, 31.9%; lateral heel, 27.%), respectively. As in other reports, the toes played little role in weight bearing and the midfoot suggested the presence of the longitudinal arch. The metatarsal area received considerable amount of weight but the priority of the first metatarsal area was not demonstrable, rendering the presence of the transverse metatarsal arch doubtful. The heel received more than half of total weight given in one foot(p < 0.005). No significant difference was demonstrable between the dominant side and the nondominant side other than in midfoot.

The Early Result of Anterior Rotational Osteotomy in the Treatment of Osteonecrosis of the Femoral Head / 영남의대학술지

In transtrochanteric rotational osteotomy to treat osteonecrosis of the femoral head, the necrotic superior anterior femoral head is rotated anteriorly around the longitudinal neck axis so that the weight bearing force is transferred to the intact posterior surface. The ratio of transposed intact articular surface of the femoral head to the weight-bearing surface of the acetabulum on postoperative anteroposterior view of the hip roentgenograph is the most important indicator of the prognosis. During the period from December 1992 to June 1994, we treated 31 hips in 28 patients who were indicated for the anterior rotational osteotomy among the patients of osteoncrosis of the femoral head. Among the patients, male were 27 and female was one. Age distribution was from 13 to 62 years old and mean age was 44.3. According to the Ficat and Arlet classification, II A was most in number as 16 II B was 7 and III was 8. As their etiolgic factors, alcohol was most in number as 18, steroid was 3, idiopathic was 5 and trauma was 2. The mean rate of the intact area of the posterior part of the femoral head to the total articular surface on the preoperative lateral view of the hip roentgenograph was 41.8%. The mean ratio of transposed intact articular surface of the femoral head to the weight bearing surface of the acetabulum was 53.8% Fixation devices were screws or dynamic hip screw.

A clinical data management by personal computer in orthopaedics / 대한정형외과학회잡지

No abstract available.

The Use of Ender Nails in Treatment of the Tibial Shaft Fractures / 대한정형외과학회잡지

Fractures of the tibial shaft are the most common among the long bone fractures, and have much difficulty in treatment due to their enumerous complications. 21 patients with fracture of the tibial shaft were treated with Ender nails under the image intensifier at the Department of Orthopedic Surgery, Yeungnam University Hospital from December 1986 to September 1988. The result was sumarized as follows :1. The average age was 37.3 and the number of male was three times of the female. The most common cause was traffic accident. 2. 14 cases out of 22 were closed fracture and the remsining 5 were open. The comminuted and segmental fractures were 17(77.3%) and the most common fracture site was middle one third. 3. Aversge interval from injury to operation was 6.5 days and in 15 cases show the associated injurues. 4. The mean duration of the bone union was 17.6 weeks and in 2 cases show the delayd union. 5. 10 complications were noted such as shortening, varus deformity, delayed union, ankle motion limitation, nail irritation, and soft tissue infection.

Glycogen depletion / 대한정형외과학회잡지

In this study, the glycogen depletion and repletion of 4 hind limb skeletal muscles which are composed of different type of muscle fibers were investigated in the streptozotocin induced diabetic rats. At sixth day after intraperitoneal injection of streptozotocin (65mg/kg, BW), the plasma insulin level was decreased to 28.2 ±4.16u U/ml comparing with the level of 49.3 ±9.41 in control rats, And it showed approximatly 300% increment of the level of blood glucose concentration in the sedentary diabetic rats. The soleus (slow oxidative), rad gastrocnemius (fast oxydtive glycolytic), extensor digitorum longus (fast oxidative glycolytic and fast glycolytic mixed), and white gastrocnemius (fast gltycolytic) were subjected in this study. The decreased amount of glycogen in the muscles by 3 minutes treadmill running in disbetic rats was larger than that of control rats. The largest amount of depletion was observed in the soleus in diabetic rats. The repleted amount of muscle glycogen was measured at 2 hours after glucose ingestion (25% glucose sol., 2ml/10gm BW). In the control rats, the highest amount of glycogen was repleted in the soleus, but lowest in white gastrocnemius. The repleted amount of glycogen in soleus, red gastrocnemius, and extensor digitorum longus was lower in the muscles of diabetic rats than in control rats, but no difference was observed in white gastroenemius muscles. These data suggest that glycogen synthetic activities of all of muscles except the muscles which are composed of fast glycolytic fiber, were stimulated by insulin.

The Effects of Electrical Nerve Stimulation on Glycogen Content of the Slow and Fast Twitch Muscles in Rats / 대한정형외과학회잡지

This study observed the changes of the glycogen content in extensor digitorum and soleus by electrical stimulation on the sciatic nerve with various frequencies, and the result were compared with those of treadmill running exercise. The results are summarized as follows ; The glycogen content of extensor digitorum longus was greater than that of the soleus in the normal group, and the reducing amount of glycogen content of extensor digitorum longus was greater than that of the soleus by overnight fasting. As the frepuency of electrical stimulation was increased by 2, 5 and 10Hz., the glycogen content of the extensor digitorum longus was slightly reduced or changed minimally. As the loading period of clectrical stimulation was increased to 30 and 90minutes, the glycogen content of extensor digitorum longus was much reduced from early stage, and that of the soleus was the same tendency as the frepuency increased. The glycogen content of the extensor digitorum longus was proportionally reduced by treadmill running excercise, and that of the soleus was much reduced from the early stage. In summary, based on the experimental evidence of this investigation, it showed the different physio-chemical responses of th fast and slow twitch muscle fibers by electrical stimulation, and also not the equal responses of muscle fibers by electrical stimulation and treadmill running exercise.

The Measurement of Tissue Pressure Beneath a Tourniquet in the Thigh, and Normal Blood Flow Recovery Time After a Tourniquet Release / 대한정형외과학회잡지

A bloodless field is essential for orthopedic surgery. Although a touriquet is necessary, it is dangerous because of soft tissue damage. We studied the soft tissue pressure beneath a tourniquet in the thigh to identify the accurate pressure for the bloodless field, and recovery time of normal blood flow after tourniquet release as related to the time of tourniquet use. From June, 1986, to Marth 1987, the soft tissue pressure of 21 lower extremities beneath the tourniquets was measured by the slit catheter method, and the noraml blood flow recovery time of 21 lower extremities after the tourniquet release was measured by a photoplethysmograph. The results were follows : Tourniquet pressure of 400 mmHg was enough for a bloodless field. So we can prevent the tissue damage due to excessive tourniquet pressure. The soft tissue pressure beneath a tourniquet was not affected by the age, weight, height or thigh circumference of the subjects. The recovery time to normal blood flow after tourniquet relase was prolonged with the time of tourniquet use. The recovery time to normal blood flow after tourniquet relase was not affected by age, weight, height, or thigh circumference of the subjects.

A Case of Separation of the Symphysis Pubis in Association with Delivery / 영남의대학술지

Separation of the symphysis pubis in association with delivery is very rare. The Korean orthopedic and obstetrical literature pertaining to this syndrome is absent. The physiological widening is small and asymptomatic, but a separation of more than one centimeter may occur and in usually symptomatic. A twenty-six-year-old woman of separation of symphysis pubis associated with delivery was treated successfully with the treatment of reduction and pelvic band, with absolute bed rest in the lateral decubitus position.

A Clinical Study on the Fractures of the Femoral Neck in Children / 영남의대학술지

Fractures of the femoral neck in children are rare and usually the result of severe trauma. The femoral necks in children, in contrast to those of adults, have many anatomic and physiologic differences. Among the late complications encountered are avascular necrosis, coxa vara, premature closure of the proximal capital femoral epiphysis and nonunion. In spite of careful management, significant complication rate often results. Nine cases of fractures of the femoral neck in children which were treated at Yeungnam University Hospital from June 1984 to August 1987 were reviewed. The results obtained are as follows: 1. The main causes of fractures were traffic accidents (5 cases). 2. Among 9 patients, 6 were girls and 3 were boys. 3. According to the classification of Delbet and Colonna, the transcervical fracture (6 cases) was the commonest type. 4. 4 cases were treated by closed reduction and internal fixation, 3 cases were treated by open reduction and internal fixation. 2 cases were treated by skin traction and cast. 5. The results were analyzed according to Ratliff's assessment. 6 cases showed good results, and 3 cases showed poor results. 6. Early diagnosis and good fixation method seemed to be vital to prognosis.

The Treatment of Tibial Shaft Fractures by Interlocking Nailing / 영남의대학술지

The treatment of tibial shaft fracture has become one of the most controversial subjects in orthopedic surgery. Comminuted, segmental and rotationally unstable fractures or bone defect at fraction site have problems of the fixation. The interlocking nail solve these problems. We have experienced 8 cases of the tibial shaft fractures treated with interlocking nail from 1986 to 1988. Authors analyzed these cases and out own clinical study. The results were as follows. 1. The average bone union rate was about 15 weeks. 2. The interval between operation and crutch walking was 4.3 weeks. 3. The merits of this operation were the short hospitalization and early adaptation of social activity. 4. The advantage is be able to do early ambulation without following muscular atrophy or joint stiffness. 5. The results were assessed on clinical examination and radiographic appearance by Hamza et al. An excellent results were 7 cases and good result was 1 case.

The Roles of Initial Level of Glycogen Content in Muscle and of Available Substrate on Muscle Glycogen Repletion in Rats / 대한정형외과학회잡지

This study examined the roles of the initial level of muscle glycogen content and available substrate on glycogen repletion in muscle. The rats were randomly assigned to normal, starvation and exercise groups. The glycogen content of muscle was lowered by starvation and exercise for the purpose of this experiment. The normal rats remained sedentary in their cage without any restriction of food and water. The exercise and starvation groups were divided each group into two subgroups depending on the degree of stress, i.e. 16 and 64 hours starvation, and 30 minutes and 2 hours exercise loading. All experimental aninals sacrificed 9~10 O'clock in the morning. The glycogen content of gastrocnemius and liver were 0.416+0.0433 and 1.70+0.410gm/100gm wet tissue in normal rats, respectively. The glycogen content of gastrocnemius in stravaton groups was reduced to 83.5 and 75.5% of the values of normal groups by starvation for 16 and 64 hours, respectively. In exercise group, the content of glycogen was reduced to 63.7 and 49.8% of the normal group by 30 minutes and 2 hours exercise loading, respectively, After above exercise loading and forced starvation, glucose, 2.0gm/100gm body weight was ingested, and 2 hours later the glycogen content was determined to evaluate the role of initial level of muscle glycogen content on the repletion in gastrocnemius, and the different amount of glucose, 1.0, 1.5 and 2.0mg/100gm body weight, was given orally, and 2 hours later the glycogen content of gastrocnemius was determined to evaluate the role of available substrate on the glycogen repleted in muscle of the lowest initial glycogen content, and the larger the amount of glucose ingestion, the larger amount of glycogen repletion in muscle. The experiment demonstrates that the reducing level of muscle glycogen and increased amount of available substrate are the important factors for the acceleration of muscle glycogen repletion, and in the aspect of repletion of glycogen, the repletion rate of liver glycogen is 2~5 times faster than that of muscle, whereas there is no difference of repletion rate of liver glycogen between starvation and exercise groups.

Glycogen Contents in Skeletal Muscles in Men and Different Species of Experimental Animals / 대한정형외과학회잡지

The normal values of glycogen contents in skeletal muscles in commonly used experimental animals and men were studied. In addtion, this study was designed to know the relationship between amount of exercise and glycogen content in muscle, and to know the causes of species difference. Glycogen contents were determined in quadriceps, gastrocnemius, and triceps in mouse, rat, rabbit, and man. The results of this study as follows: The value of glycogen content in human skeletal muscle is significantly higher than that of experimental animals. The heavier the body weight of experimental animal, the higher the value of glycogen content in each muscle. The value of glycogen content in gastrocnemius is higher than that of quadriceps. The value of glycogen content in quadriceps is higher than that of triceps.

The Effect of Tension Band Wiring in the Treatment of the Olecranon Fracture / 영남의대학술지

Treatment of the olecranon fractures by prolonged immobilization often results in limited elbow motion. With the use of tension band wiring, anatomical reduction was obtainable, and only a short period of immobilization was needed. We reviewed the cases of 17 patients who underwent surgical treatment of the olecranon fracture. All patients were treated by tension band wiring. In the overall series, we were able to obtain 53 percent excellent, 30 percent good, and 18 percent fair results.

A Case of the Solitary Neurofibroma at the Median Nerve / 영남의대학술지

With respect to the histogenesis of the neurofibroma, there are many controversies, since von Recklinghausen postulated that neurofibromas are mainly fibrous tumors arising from the connective tissue of the nerve sheaths. According to the recent studies through the electron microscope, the neoplastic perineurial cells are regarded as the main components of the tumor. So, the neurofibroma enucleated from the median nerve at the level of proximal arm without resulting neurologic sequale was examine through the light-and electron microscope. Ultrastructurally, this tumor is composed of the perineurial cells, fibroblasts, and collagen fibers. The predominant perineurial cells show distinct basal lamina, and contain abundant microfilaments.

The Surgical Treatment of Claw-Foot / 대한정형외과학회잡지

The claw-foot deformity is only a symptom of some primary lesion, not an entity in itself. The treatment of claw-foot usually depends on the type and severity of the deformity. In the past two years, authors have treated 7 cases of claw-foot, 3 of which were treated by Cole's anterior tarsal wedge osteotomy and 4 cases by Japas “V”-osteotomy of tarsus. In all 7 cases, Steindler's plantar fasciotomy for cavus deformity were combined and 1 case was combined with Achilles tendon lengthening. The followings were noted. 1. AlI patients were military personals and the ages were between 21 to 27 years old male. 2. Two patients were bilateral claw-foot deformity and both sides were operated. 3. The causes were secondary to poliomyelitis in one case and the others were idiopathic. 4. Postoperative complications were skin necrosis in one case and sensory disturbance on the dorsum of the first web space of the foot in 3 cases. 5. All patients can walk and run without pain after average 1 year follow-up period.

A Clinical Analysis of the Supracondylar Fractures of the Femur in Adult / 대한정형외과학회잡지

The frequency of car accidents have contributed to increasing numbers and sevtrities of injuries to the supracondyle of the femur. the supracondylar fractures of the femur have always created complicated problems associated with restoration of the distal articular joint surface, avoidance of subsequent stiffness of the knee Joint, difflculties in management of the fracture. The author reviewed 31 supracondylar fractures of the femur in 31 patients who were treated in the department of Orthopedic Surgery, Kyungpook National University Hospital for the 6 and half years period from Jan., 1973 to Jun.,1979. The incidence of supracondylar fractures was more common in male than in female. Most of fractures occured in persons who are in their third and fourth decades. Ellciting cause were mainly traumatic and most of them were due to car accidents. The author has adopted the classification of supracondylar fracture of the femur by Neer. Of 31 cases of supracondylar fractures, there were 3 cases of Group 1 fracture, 10 cases of Group II-A fracture, 10 cases of Group II-B fracture, and 8 cases of Group III fracture. Sixteen cases were treated conservatively, 15 cases were treated by open reduction and internal flxation with various devices. The result was more satisfactory in cases by open treatment than In closed treatment.

Subungual Melanoma of Left Thumb: A Case Report / 대한정형외과학회잡지

The following case report concerns a rare subungual melanoma of left thumb which metastasized into the ipsilateral axilla. Subungual melanoma, or melanotic whitlow, is a malignant lesion requiring early diagnosis and urgent treatment. Unlike melanomas located elsewhere on the skin of the body, subungual melanomas are shielded by the nails, which handicaps the securing of a biopsy by the clinician. We report a case of subungual melanoma in a 61 year-old man who had a 6 months history of painful axillary mass.