Comparison Study of Intertrochanteric Fractures Treated with Intertrochanteric/subtrochanteric Fixation with a Standard vs a Mini-incision

PURPOSE: To evaluate the radiographic, clinical results between who had intertrochnateric fracture, treated with ITST with a standard or a mini-incision. MATERIALS AND METHODS: We selected each 20 patients of intertrochanteric fracture which were treated with ITST with a standard incision or a mini-incision from June 2004 to July 2006. We compared of mean operative time, transfusion doses and postoperative VAS score between two groups. We evaluated the radiographic results by follow-up radiography and the clinical results with the mobility score of Parker and Palmer and Salvati and Wilson hip function scoring system. RESULTS: Mean operative time, transfusion doses and postoperative VAS score were significantly less in the mini-incision there were 87.8 min., 2.0 pints and 4.2 for the standard group versus 40.3 min., 1.1 pints and 3.3 for the mini group. The radiographic results were not significantly different. Decrease of mobility score of Parker and Palmer and Salvati and Wilson hip function scoring system were similar. CONCLUSION: Mini-incision significantly reduces operative time, transfusion doses and postoperative pain for fixation intertrochanteric fracture treated with ITST.

The Comparison of LC-DCP versus LCP Fixation in the Plate Augmentation for the Nonunion of Femur Shaft Fractures after Intramedullary Nail Fixation

PURPOSE: The purpose of this study was to evaluate the efficacy of the surgical treatment through the comparison of LC-DCP (Limited Contact-Dynamic Compression Plate) versus LCP (Locking Compression Plate) fixation in the plate augmentation for the nonunion of femur shaft fractures after intramedullary nail fixation. MATERIALS AND METHODS: Twenty-four patients with the nonunion of femur shaft fractures after intramedullary nail fixation who underwent plate augmentation were evaluated from Mar. 2001 to Sept. 2005. The group with LC-DCP augmentation was done bicortical screw fixation and the group with LCP was done monocortical fixation. RESULTS: There was one case of nail breakage in LC-DCP group, but sound bony union were achieved uneventfully in all the cases of both group. LCP fixation was slightly superior to LC-DCP fixation in view of the bony union time, operating time, postoperative Hb down, amount of postoperative transfusion, but there was no statistical difference (p>0.05). CONCLUSION: We got the satisfactory results after monocortical LCP augmentation as well as bicortical LC-DCP fixation and have concluded that monocortical LCP fixation was an effective treatment option for nonunion of femur shaft fracture occurred after Intrmedullary nail fixation.

Comparison of Arthroscopic Anterior Cruciate Ligament Reconstruction between Autologous Hamstring Tendonand Bone-patellar Tendon-bone Graft: Short Term FollowUp / 대한정형외과학회잡지

PURPOSE: To evaluate the stability, activity level and clinical results of an autologous hamstring and Bone-patellar tendon-bone (BPTB) graft in an Anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Between September 1997 and January 2003, 22 patients with an ACL reconstruction with an autologous four strand hamstring tendon, and 30 patients with a BPTB autograft were enrolled in this study. At the time of the final follow-up, the patients were evaluated by stress radiographs using a Telos instrument, the Lysholm score, Tegner activity score, IKDC activity grades, and anterior kneeling pain. RESULTS: An evaluation of the anterior laxity using the Telos instrument revealed no significant difference in the hamstring and BPTB groups: side to side difference 2.6 mm in the hamstring group vs 2.3 mm in the BPTB groups (p>0.05). The Lysholm score improved from a preoperative score of 58 to a postoperative score of 88 in the hamstring groups and from 56 to 91 in the BPTB groups. The Tegner score for the hamstring groups was 2.4 preoperatively and 5.8 at the final follow up, and the Tegner score for the BPTB groups were 2.3 and 6.2 preoperatively and after the last follow-up, respectively. The Tegner score was similar in the two treatment groups (p>0.05). According to the IKDC rating system, 9% were normal and 64% were almost normal in the hamstring group. In the BPTB group, 10% were normal and 67% were almost normal. Anterior kneeling pain after a reconstruction with the hamstring tendon autograft (13%) was significantly less common than with the patellar tendon autograft (37%)(p<0.05). CONCLUSION: The hamstring autograft for an ACL reconstruction decreased the incidence of anterior kneeling pain and produced equivalent clinical results to the BPTB autograft.

Physeal Remodeling after Internal Fixation of Slipped Capital Femoral Epiphysis / 영남의대학술지

PURPOSE: To evaluate physeal remodeling after internal fixation of slipped capital femoral epiphysis, We performed a retrospective review of the medical records and radiographs of 14 children (17 cases) who had had slipped capital femoral epiphysis. MATERIALS AND METHODS: We reviewed 14 patients who had slipped capital femoral epiphysis. They were divided two groups. Group I were in situ pinning with single screw and group II were corrective osteotomy with multiple pinning. We identified physeal remodeling camparing with their preoperative, postoperative and last follow-up radiographs with measuring physeal- shaft angle. RESULTS: Early closure of the physis was observed in 6 cases among 14 patients (17 hips). Compared with their postoperative radiographs, the last follow up radiographic study revealed that physeal remodeling was observed in 4 patients (4 hips) at group I (mean, 7.8degree), in 2 patients (3 hips) at group II (mean, 10.7degree). CONCLUSION: In this study, physeal remodeling was observed in 4 patients (4 hips) in group I and 2 patients (3 hips) in group II. The incidence of physeal remodeling was related with degree of epiphyseal slippage, and age was not related with physeal remodeling potential.

The Effect of Long Chain N-3 Polyunsaturated Fatty Acids on Development of Collagen-induced Arthritis in Rats / 영남의대학술지

BACKGROUND: The treatment of rheumatoid arthritis still depend on conserve therapy in major. Recent studies report that n-3 polyunsaturated fatty acids(PUFA) could modulate the incidence and progress of arthritis. The purpose of this study was to investigate the effects of n-3 PUFA on the development of collagen-induced arthritis in rats. MATERIALS AND METHODS: Female Louvain rats were used for this experiment. Rats were randomly assigned into either normal(n=8) or collagen-immunized groups, and collagen immunized groups were divided into control(n=8, normal diet) and n-3 PUFA(n=8, 5% n-3 PUFA in diet) groups. One week after feeding n-3 PUFA to rats, they were immunized with type II collagen emulsified in incomplete Freund's adjuvant into tail and back. Development of arthritis was confirmed by x-ray and microscopic examination. RESULTS: Incidence of arthritis at the 5th week after immunization was 38% in control and 0% in n-3 PUFA. Rats with arthritis showed edema in hind paws and inflammation in synovial membrane of the knee joint. Plasma glucose and insulin were not changed by both of immunization and diet. Plasma triglycerides and cholesterol concentrations were decreased by n-3 PUFA. CONCLUSION: n-3 PUFA may prevent or treat collagen-induced arthritis in rats. Further studies are needed for action mechanism of it.

The Effect of Long Chain N-3 Polyunsaturated Fatty Acids on Development of Collagen-induced Arthritis in Rats / 영남의대학술지

BACKGROUND: The treatment of rheumatoid arthritis still depend on conserve therapy in major. Recent studies report that n-3 polyunsaturated fatty acids(PUFA) could modulate the incidence and progress of arthritis. The purpose of this study was to investigate the effects of n-3 PUFA on the development of collagen-induced arthritis in rats. MATERIALS AND METHODS: Female Louvain rats were used for this experiment. Rats were randomly assigned into either normal(n=8) or collagen-immunized groups, and collagen immunized groups were divided into control(n=8, normal diet) and n-3 PUFA(n=8, 5% n-3 PUFA in diet) groups. One week after feeding n-3 PUFA to rats, they were immunized with type II collagen emulsified in incomplete Freund's adjuvant into tail and back. Development of arthritis was confirmed by x-ray and microscopic examination. RESULTS: Incidence of arthritis at the 5th week after immunization was 38% in control and 0% in n-3 PUFA. Rats with arthritis showed edema in hind paws and inflammation in synovial membrane of the knee joint. Plasma glucose and insulin were not changed by both of immunization and diet. Plasma triglycerides and cholesterol concentrations were decreased by n-3 PUFA. CONCLUSION: n-3 PUFA may prevent or treat collagen-induced arthritis in rats. Further studies are needed for action mechanism of it.

Changes of KSR and CRP after Total Knee and Hip Arthroplasty

PURPOSE: To study the changes of ESR and CRP after total hip arthroplasty(THA) and total knee arthroplasty(TKA). MATERIALS AND METHODS: We tested the values of ESR and CRP of total 61 patients, who received THA or TKA. The levels of ESR and CRP were compared before operation, on the 2nd, 4th post-op. Day, 1st, 2nd, 3rd week after operations. RESULTS: The peak level of ESR was reached on the 4th post-op day(70.7mm/hr) in unilateral TKA group, but on the 7th day(53.2em/hr) in bilateral group. The peak level of ESR was reached on the 4th day in unilateral THA group(71.5mm/hr), as was in bilateral group(50.6em/hr). The values of ESR were declined to the normal range until the 3rd week except 9 cases(15%). The peak level of the CRP of TKA(14.0mg/dL, 15.0mg/dL) and THA(12.7mg/dL, 17.7mg/dL) in unilateral and bilateral group were reached on the 2nd day after operations. After the peak level, the values of CRP were abruptly declined to the normal and pre-op level until the 3rd week. CONCLUSION: The highest value of the CRP revealed on the 2nd post op day in bilateral group and declined to the normal range at 2nd week. The peak value of the ESR showed on the 4th post-op day, but the peak value of the bilateral group was low and the range of increase was narrow when compared with the unilateral group. The value of CRP after post-op 2 weeks could be used as the index of normal and infection in TKA or THA.

In Vitro Bone Formation by Osteoblasts in Calcium Metaphosphate and Highly Purified Bovine Xenograft (Lubboc(R)) / 대한정형외과학회잡지

PURPOSE: This study was performed to compare osteogenic capacity according to the scaffold, i.e., calcium metaphosphate on purified bovine collagen (Lubboc(R)). MATERIALS AND METHODS: Calcium metaphosphate and Lubboc blocks were immersed within a bone marrow cell suspension from New Zealand white male rabbit anterior superior iliac spine to produce cell-biomaterial complexes. These were cultured for 5 weeks in osteogenic media and differences with bone densitometry, light microscopic examination, electron microscopic examination, concentration of osteocalcin from osteoblasts were then evaluated. RESULTS: In light microscopic examination, more organized tissue was observed in the Lubboc(R) group. By electron microscopy osteoblasts and the matrix were densely overlapped on the surface of the Lubboc(R) group, whereas cells were scattered on the calcium metaphosphate. Immunohistologic examination for osteocalcin was definitely positive in the Lubboc(R) group, but the reaction on the calcium metaphosphate was unclear, and densitometry revealed that Lubboc(R) (0.028 gms/cm2) showed a statistically significant higher density than calcium metaphosphate (0.026 gms/cm2). CONCLUSION: Highly purified bovine collagen was more effective than calcium metaphosphate in osteogenesis in vitro.

Non-traumatic Avascular Necrosis of the Femoral Head / 영남의대학술지

Avascular necrosis of the femoral head is a debilitating disease that leads to destruction of the hip joint in patients who are in the third, fourth, or fifth decade of life. The total societal cost is so high because these patients are generally young, hold jobs, and have a considerable life expectancy. Therefore, we have to delay or eliminate the need for total hip replacement as possible as we can. The purpose of this review id to provide a current perspective of avascular necrosis of the femoral head.

Arthrographic Evaluation in Developmental Dislocation of the Hip: Comparison Between Hip Arthrogram and Operative Findings / 영남의대학술지

One of the main purposes in the treatment of developmental dislocation of the hip is to achieve and maintain concentric, congruent, and stable reduction. The arthrogram perform an important role in the diagnosis and treatment of developmental dislocation of the hip. The arthrogram provides much information about the soft tissue status of the hip joint. Limbus and ligamentum teres is exactly evaluated so we can plan the reduction and treatment before operation. 18 preoperative hip arthrograms of 17 children treated for developmental dislocation of the hip from 1992 to 1998 were reviewed. The limbus, ligamentum teres and transverse acetabular ligament were compared with the pathoanatomy seen at the time of open reduction. Arthrography proved reliable in identifying the limbus and ligamentum teres. So we recommend that arthrography must be performed before closed or open reduction. Also, we recorded the radiographic parameters: acetabular index, acetabular floor thickness, center edge(CE) angle of Wiberg, and Y-coordinate. The center edge(CE) angle of Wiberg obtained from arthrography was measured more accurately than from simple roentgenograms because the ossification of the femoral head was frequently located eccentrically in the developmental dislocation of the hip.

A Comparison Study between Conservative Treatment and Reconstruction with Autogenous BPTB Augmented with Kennedy LAD in the Injuries of PCL

The posterior cruciate ligament is the primary static restraint to posterior translation of the tibia and provides proprioception within the knee. The goals of treatment in the injuries of PCL are restoration of normal tibiofemoral stability and reduction of long term osteoarthrosis of the knee. The purpose of this study is to cornpare functional outcome, muscle power, and posterior stability between conservative treatment and reconstruction with autogenous RPTB augmented with Kennedy LAD in PCL injuries. Twenty-seven patients with PCL rupture who have been treated from November 1990 to May 1996 were reviewed. The patiens were divided into conservative group and reconstruction group. Conservative treatment was done in 15 patients and reconstruction by autogenous bone patellar tendon bone with Kennedy LAD was performed in 12 patients. All patients were evaluated with posterior stress x-ray films, KT-2000 knee ligament arthrometer, Cybex 340 isokinetic dynamometer, subjective Cincinnati symptom rating scale and Lysholm knee score, complication. The results were as follows; 1. Mild and moderate posterior instability was remained in spite of BPTB graft and need more stable fixation technique and vigorous rehabilitation program. 2. At the angular velocity of 90 degree/sec and 180 degree/sec, the muscle strenth of quadriceps was decreased after PCL injury in both group in the test of Cybex 340 isokinetic exercises. The power of hamstrings were not changed after PCL injuries. 3. Average Lysholm knee score was 89 points in reconstruction group and 78 points in conservative group and average Cincinnati symptom-rating scale was 8.4 points in reconstruction group and 7.1 points in conservative group. More satisfied functional results and subjective symptoms were revealed in the reconstruction group and statiscal significancy (p<0.05) was showed when comparing conservative group with reconstruction poup. 4. Good clinical results did not always coincidence with lesser posterior instability and clinical results were influenced by associated injury of the knee. The more combined ligament injury of the knee, the worse clinical results.

Slipped Capital Femoral Epiphysis(SCFE) / 영남의대학술지

Slipped capital femoral epiphysis(SCFE) is a disorder in which there is a gradual or acute disruption through the capital physeal plate. The physiolysis is through a widened zone of hypertrophy, which is weakened due to altered chondrocytic maturation and endochondral ossification. The cause or causes of SCFE remain uncertain. the association of obesity and adolescent age with growth rate are predisposing factors. The possibility that most patients with subclinical hormonal abnormality were proved. The goal of treatment of slipped capital femoral epiphysis is to reatore the function of the hip and delay the development of degenerative osteoarthrosis by prevention of additional displacement of the epiphysis. We report 10 patients(12hips) with SCFE who were treated by surgical means and followed along for more than one year, at Yeungnam University Hospital, from 1989 to 1996. There were six boys and four girls. The average age at operation was 11.8 years. Seven cases occurred in the left hip, one case in the right and 2 cases had bilateral involvement, five cases had a history of minor trauma on affected hip. Among hormonally studied six patients, panhypopituitarism patient was one case; decreased testosterone, two; decreased growth hormone, two; and decreased thyroid hormone, one. According to clinical stage, two cases were the acute type; five cases, acute on chronic type; and three cases, chronic type. On the radiological grades of slipping, mild slippage were nine hips; moderate, one; and severe, two. The eleven hips were treated by pin fixation in situ, and one, by cuneiform osteotomy. On the average follow-up of 2.6 years, ten hips were excellent or good functional results, two hips were failure.

Treatment of Developmental Dislocation of the Hip in Walking Age / 영남의대학술지

The patients of developmental dislocation of the hip(DDH) are almost found after walking age because of early diagnosis of DDH in younger children is not easy. A controversy still exists as to the relative value of closed and operative management in the treatment of a child who has reached walking age. This study is a report of the results of 16 patients(17 cases) in developmental dislocation of the hip who have visited our hospital at the age of 9 months to 3 years old, and have been followed more than 12 months (12-112 months) on review of plain radiographs and arthrograms. The results were as follows 1. The age at diagnosis was 16.4 months(9-31 months) in average. The methods of treatment were conservative for 8 cases, and operation for 4 cases and secondary operation for 5 cases who were failed with conservative therapy. 2. By Severin's radiologic grade, the result was good in 4 cases, fair in 3 cases and poor in 1 case in conservative treatment. In operative treatment, fair was in 2 cases and poor in 2 cases. In secondary operative -patients who were failed with conservative therapy, good was in 2 cases, fair in 2 cases and poor in 1 case. 3. Avascular necrosis of femoral head was developed in 3 cases. 4. In the good reduction as determined by arthrogram according to Race and Herring, we can get a favorable result in conservative treatment, and in the poor reduction as determined by arthrogram, the better

Follow up study of the changing pattern of BMD(Bone Mineral Density) after lower limb fracture / 대한정형외과학회잡지

No abstract available.

Treatment of tibial fractures by interlocking intramedullary nailing / 영남의대학술지

The adequate treatment of tibia fracture is one of the most difficult due to severe commiuntion, open wound, delayed union, angulation deformity and infection. We treated 38 fractures of the tibia by Interlocking intramedullary nail from Feb. 1983 to Mar. 1993. 35 cases of the tibia fracture were fresh, 13 cases of fracture were open. The other 3 cases were delayed union and nonunion. The Mean follow-up was 14.0 months. The results were as followings. 1. Of the 38 fractures, 37 fractures united and the mean union time was 18.7 weeks. 2. Interlocking intramedullary nail could be used to the majority of fractures of the proximal & distal tibia shaft. fractures. 3. The Im erlocking nail had rigid rotational stability and was appropriate for the treatment in severe unstable fractures, commninution and open-with bone loss. 4. Delayed union or nonunion was a good indication for intramedullary nailling. 5. The major-complication were valgus deformity of 2 cases, varus deformity of 1 case, 1 case deep infection. 6. Interlocking intramedullary nailing provided rigid fixation of . fracture and then made early joint motion exercise and ambulation.

Percutaneous K-wire fixation of supracondylar fracture of humerus in children / 영남의대학술지

During the period from March 1990 to November 1993, 22 children with diplaced supracondylar fracture of humerus were treated by closed reduction and percutaneous K-wire fixation at department of Orthopaedic surgery in Yeungnam University. All fracture were treated with closed reduction under the general anesthesia and percutaneous pinning. After the fracture was internally fixed, intraoperative anteroposterior reontgenograms of each distal humerus were compared. Only anatomical reduction ensured good result,, because the main cause of late cubitus varus was medial tilting of distal fragment. We could follow up 10 patients more than one year. By Flynn's criteria, satisfactory result were obtained in 9 of the 10. Unsatisfactory one had a limitation in flexion of elbow joint, but had no problem in cosmetic feature. In short term follow up of 7 patients, 5 patients had a satisfactory result, too. There were no neurovascular complication and hospitalization was shortened to 11.4 days. Closed reduction and percutaneous pinning provided stabillity, vascular safty, simplified management, reduced hospital stay. This is safe and reliable technique for obtaining and maintaining an exellent reduction.

An explorative study of the contributing factors in changes in one density according to aging / 대한정형외과학회잡지

No abstract available.

The clinical study of the supracondylar fracture of the femur / 영남의대학술지

Recently, the Supracondyle fracture of the femur is so severe and comminuted that it is difficult to treat open reduction and rigid fixation sufficiently due to violent traffic accident and external forces. The associated injuries are accompanied variously. So compliactions of the supracondyle fractures 'including joint.. stiffness, delayed union, infection are serious. However development of internal implant and operation skill result in relatively satisfactory function than conservative management. The authors reviewed. 20 cases of the supracondyle fracture of the femur treated at Yeungnam University Hospital from 1989. Dec. To 1992. Jan. The results were as follows 1. The male was common(70%). The 2nd-4th decade was most(87%). 2. The most common cause of injuries was traffic accident. The rate of open fracture was 35%, most of it was traffic accident. 3. According to the ASIF group classification, 4 cases were type A, 4 in type B, 12 in type C (10 in type C2&C3). 4. Accompanied injuries included multiple fractures in 9 cases and femoral artery injury in 1 case. 5. Among the 20 cases, conservative treatment was done in 5 cases and operative treatment was done in 15 cases. 6. Functional results (by Schatzker criteria) were as follows. The satisfactory results were achieved in 40% of cases in consevative treatment and 67 in operative treatment. 7. The average time of partial weight bearing was 15 weeks. 8. Complications were knee stiffness in 6 cases and 4 in delayed union.

Treatment of the tibia shaft fractures with ender nails / 영남의대학술지

Fractures of the tibial shaft are the most common among the long bone fractures, and have much difficulty in treatment due to their numerous complications. Thirty patients with fractures 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 November 1991. The following results were observed. 1. The average age was 37.3 years and the number of male was three times of the female. The most common cause was traffic accident. 2. Twenty cases out of thirty one were closed fracture and the remaining 11 were open. The comminuted and segmental fractures were 18 (57.7%) in number and the most common fracture site was the middle one third (53%). 3. Average interval from injury to operation was 7.6 days and 19 cases showed associated injuries. 4. The mean duration of the bone union was 18.9 weeks and 2 cases showed the delayed union. 5. Twelve complications were noted such as shortening, varus deformity, delayed union, ankle motion limitation, nail irritation, and soft tissue infection.

Clinical observation and treatment of fracture-dislocation of talus / 영남의대학술지

Talus is an important structure of the ankle joint and its function is critical for ambulation and weight bearing. The talus fracture is rare, but the complications of fracture and dislocation are serious and resulting in avascular necrosis, osteoarthritis. So its treatment is carefully considered at initial status. Authors reviewed 11 cases of fracture and dislocation of the talus treated at Yeungnam university hospital from 1984 to 1991. The longest follow up was 8 years and shortest, 1 years. The results were as follows. 1. There were all males, the average age was 30 years old. 2. The most common cause was fall down (8 cases), and next traffic accident (2 cases), sports injury (1 case). 3. According to Marti-Weber classification, 1 case was type I, 1 in type II, 4 in type III and 5 in type IV. 4. The method of treatment were open reduction and internal fixation in 6 cases, the others were closed reduction in 5 cases. 5. Final results (by Hawkins grading system) were as follows, 3 cases were excellent, 4 cases were good, 1 case was fair and 3 cases were poor. 6. Complications were AVN in 2 cases, degenerative arthritis in 8 cases, malunion in 1 case. 7. The range of motion of the ankle joint was relatively preserved (74%), but in the subtalar joint it was decreased (43%)