Reliability of Singh's index Checked by the Dual Photon X-ray Absorptiometry(LUNAR D.P.X) / 대한정형외과학회잡지

There are several methods available to check bone masses. One of them is Singhs index which is singlest way with grading trabecular pattern of the proximal femur on anteroposterior X-ray film and the other is recently developed Dual Photon X-ray Absorptiometry which measures bone mineral contents. Some authors proclaim that Singh's index has low accuracy, objectiveness and reproducibility. So we studied for reliability of Singh's index and correlation between Singh's index and bone mineral contents measured by Dual Photon X-ray Absorptiometry in 65 patients. There are significant differences between 3 orthopedic surgeons in interpreting Singh's index (interpersonal difference). There are significant differences between first and second interpretation out of same surgeons (intrapersonal difference). There are significant differences interpretating among interpreted Singh's indices from films of different radiological exposures in the same radiograph. There are fair correlations(0.60-0.66) between Singhs index and bone mineral density. The Singh's index was overestimated in low bone mineral density with under-exposed radiograph, but Singh's index was under-estimated in high bone mineral density with over-exposed radiograph. Singh's index can be useful in clinical application by some modification.

Clinical Analysis for Prognostic Factors of Intertrochanteric Fractures / 대한정형외과학회잡지

There are many problems in treatment of intertrochanteric fractures due to osteoporosis and unstable pattern of fractures in old ages and they are different from those in young ages, for example, type of fracture, degree of osteoporosis, and general condition, ect. Anthors studied about the prognostic factors of 42 cases among 88 patients with intertrochanteric fractures, who were treated and followed up from Jan. 1982 to Dec. 1987. 1. The patients under 50 years old were mainly males(94.4%) and its chief cause of injury was traffic accident or fall down(72.2%). The cause of injury over 50 years old was slip down on ground(62.9%). 2. The osteoporosis was increased according to increased age of patients and then the unstable type of fracture was increased. In yaung patients, the unstable intertrochanteric fracture was rare despite of high violent injury. 3. The bone union of the follow-up patients was gained at average 13.8 weeks. 4. The sliding degree of lag screw was increased with unstable fracture and the incidence of metal protrusion into joint cavity was increased in the patients of eccentric fixation of lag screw into femoral head. 5. The all cases of complication were occured in osteoporotic patients over 50 years old and their causes were inadequate fixation of unstable fracture. 6. The most important factors in prognosis of intertrochanteric fractures are initial pattern of fractures, degree of osteoporosis and adequacy of reduction state(postop.).

Result of the Proximal Tibial Osteotomy for Osteoarthritic Knee / 대한정형외과학회잡지

The proximal tibial osteotomy is a procedure usually employed for osteoarthritis of the knee with a predominant single compartment involvement accompanied by pain and angular deformity. It has as its objective the shift of the gravitational line of weight from an involved to a relatively uninvolved side of knee. We studied the results of proximal tibial osteotomy in 30 patients (33knees). The mean age was 55.7 years, degenerative osteoarthritis was 31 cases (93.9%) and posttraumatic osteoarthritis was 2 cases (6.1%). The results were as follows; The average distance of osteotomy between the proximal plane and distal plane was 10.3mm. The average preoperative tibiofemoral angle was varus 3.8degrees and average postoperative tibiofemoral angle was valgus 7.6 degrees. The amount of upward displacement of fibular head after proximal tibial osteotomy was from 3mm to 16mm (mean 7.5mm). The preoperative knee rating scale was 52.9 and the postoperative knee rating scale was 78. The complications of proximal tibial osteotomy were 3 cases of transient peroneal nerve palsy and 2cases of Coventry staple loosening, but the nerve palsy was completely recovered and there were no need of staple removal.

Nonunion of a Stress Fracture Through the Olecranon Epiphyseal Plate in an Adolescent Judo Player: A Case Report / 대한정형외과학회잡지

It was reported that many adverse effects occurred to the growth areas of the adolescent player due to repititous strain. The injuries mainly involved in the shoulder and elbow, and named as little leaguers Shoulder and Little Leaguers: Elbow in boy baseball player. But the stress fracture of olecranon epiphyseal plate was rare and reported in a few cases. We reported a case observed in an adolescent Judo Player.

A Comparative Study of Osteocalcin Measured by Radioimmunoassay in Normal / 대한정형외과학회잡지

Osteocalcin is the major noncollagenous protein of the bone matrix and has been described as a sensitive marker reflecting bone turn-over rate. It's believed to play a role in the process of mineralization. The level of osteocalcin is considered to be influenced by other calcium regulating hormones. To obtain the normal value of osteocalcin in Korean young adults and to clarify the usefulness of osteocalcin as a marker reflecting bone turn-over in suspicious disuse-osteporotic patient, author measured the level of osteocalcin by radioimmunoassay. The results are; 1. The mean circulation osteocalcin level in healthy young adults was 4.43+ 1.09ng/ml. 2. In normal Korean male, the serum osteocalcin level was 4.38±1.16ng/ml and in normal Korean female, 4.48±1.02ng/ml. There was no significant difference in both sexes, but the serum osteocalcin level in female reveals some tendency of elevation when compared with male. 3. In suspicious disuse-osteoporotic patients, the mean serum osteocalcin level was 4.21±1.30ng/ml and this result shows no difference from that of normal young adults. 4. The level of osteocalcin measured in the normal young Korean adults shows no difference from the prerecorded INC level measured in the Western people. 5. In conclusion, the normal value of osteocalcin in normal young Korean adults is similar that of western people, and the measurement of osteocalcin in suspicious disuse-osteoporotic patients could not be used as a sensitive marker reflecting bone turn-over.

The Primary Repair of Acute Anterior Cruciate Ligament Injury / 대한정형외과학회잡지

The acute anterior cruciate ligament injury is one of the most common ligament injury of the knee joint and there are many controversies in its treatment. Warren reported that the primary repair for the acute anterior cruciate ligament injuries was good, but some had opposite oppinions. Authors studied 23 patients of actue anterior cruciate ligament injury who were treated by primary repair from January, 1982 to December, 1984. The results were as followings: 1. The most common associated injury was MCL injury and posteromedial capsular injury(13 cases; 56.5%). 2. The most common detachment site of ACL was femoral attachment(11 cases; 47.8%) . 3. A medial Hocky Stick incision was found good in repairing the combined MCL and posteromedial capsular tear with ACL injury. 4. The results were good in 74% by Cincinnati score and in 87% by objective score. It is concluded that primary repair of the acute anterior cruciate ligament tear is cosidered successful.