Dorsomedial Cutaneous Nerve Conduction Study in Hallux Valgus

OBJECTIVE: To show the prevalence of the dorsomedial cutaneous nerve (DMCN) injury in the hallux valgus and to evaluate whether the sensory nerve damage contributes to pain and sensory impairment in the great toe. METHOD: Sixty feet of healthy adults (normal group) and 26 feet of patients with hallux valgus (hallux valgus group) were evaluated with sensory nerve conduction study of DMCN. The prevalence of the nerve injury was compared between the two groups. Sensory nerve action potentials of DMCN in hallux valgus feet were analyzed and compared according to the patient's symptom and the severity of the radiographic measurements of the feet. RESULTS: The prevalence of DMCN injury was 42.3% of the hallux valgus group. The peak latency of the DMCN sensory action potential of the symptomatic feet showed statistically significant delay compared to the asymptomatic group (p<0.05). Delay of the peak latency and decrement of the amplitude of the DMCN were statistically significant among the three groups as the valgus deformity worsened (p<0.05). CONCLUSION: DMCN injury should be considered in addition to soft tissue injury or arthritis in the differential diagnosis of the pain, burning sensation or numbness associated with hallux valgus.

The Results of Arthroscopic Meniscal Repair Evaluated by Second-Look Arthroscopy

The purpose of this study is to morphologically evaluate the results of arthroscopic meniscal repair by sec- ond-look arthroscopy. We performed the arthroscopic meniscal repair in 40 menisci of 39 knees between March 1994 and August 1997. Among them, 18 menisci of 17 knees were evaluated by second-look arthroscopy at 3 rnonths postoperatively. Lateral meniscus was 9 and medial meniscus was 9. The morpho- logical results were classified with completely healed, incompletely healed, and failed. The overall results showed that 13 menisci completely healed, 3 menisci incompletely healed, 2 menisci failed. The type of tear was 14 peripheral longitudinal tears, 1 oblique tear(incompletely healed), 1 transverse tear(completely healed with augmentation of fibrin clot), 1 tear at posterior tibial attachment, and 1 complex tear(completely healed). 3 menisci had associated lesions that had not been treated, of which 1 incompletely healed, 2 failed. Chronic cases, in which time interval between injury and repair was 6 weeks later, were 8 menisci(4 completely healed, 2 incompletely healed, and 2 failed). 10 long peripheral longitudinal tears of more fhan 2.5cm were resulted in 6 completely healed, 2 incompletely healed, and 2 failed. 5 longitudinal tear with a wide peripher- al rim(>2mm) were resulted in 1 completely healed, 2 incompletely healed, and 2 failed. The good result was expected when the tear was repaired in acute phase after injury and associated lesion was treated. For chronic tears, tears of avascular zone and wide longitudinal tears, the healing enhancement techniques such as fibrin clot insertion, abrasion of meniscus and synovium, and trephination must be taken into consideration.

Chevron Osteotomy as the Treatment of Moderate to Severe Hallux Valgus Deformity / 대한정형외과학회잡지

Chevron osteotomy is one of the most widely used distal metatarsal osteotomies in the treatment of hallux valgus in adults. We performed chevron osteotomy on 11 feet (7 patients), and the combination of proximal metatarsal osteotomy and distal soft tissue procedure on 6 feet (4 patients) for painful hallux valgus associated with an increased hallux valgus angle (>35 degrees) and 1/2 intermetatarsal angle (>13 degrees). The results were as follows: 1. In the chevron osteotomy, the average correction of hallux valgus angle was 28.8 (19-36) degrees and the average loss of correction was 7.6 (3-18) degrees. The average correction of 1/2 intermetatarsal angle was 7.8 (6-13) degrees and the average loss of correction was 4.3 (1-10) degrees. 2. In the combination of proximal metatarsal osteotomy and distal soft tissue procedure, the aver age correction of hallux valgus angle was 34.3 (26-42) degrees and the average loss of correction was 4 (1-7) degrees. The average correction of 1/2 intermetatarsal angle was 9.8 (4-14) degrees and the average loss of correction was 2 (0-5) degrees. 3. The radiographic result of the combination method was significantly better statistically than that of the chevron osteotomy alone. 4. In the chevron osteotomy, the metatarsalgia of the great toe was subsided in 10 of 11 feet (91%) and the patients were satisfied with the cosmetic and functional result of their operation. Recurrence of hallux valgus deformity and superficial wound infection were seen in each case (9.1%). 5. In the combination of proximal metatarsal osteotomy and distal soft tissue procedure, the metatarsalgia of the great toe was subsided in all feet and postoperative complication was not found. In our studies, the chevron osteotomy applied to moderate to severe hallux valgus deformity was found as a relatively good radiographic result, but a recurrence of hallux valgus deformity was checked, compared with the combination of proximal metatarsal osteotomy and distal soft tissue procedure. Therefore, the chevron osteotomy can be applied to moderate to severe hallux valgus deformity but for the best result, the other procedure in addition will be necessary.

Arthroscopic Assisted Management of Displaced Intraartieular Calcaneal Fractures / 대한정형외과학회잡지

Although the management of fractures of the calcaneus still remains controversial, open reduction and internal fixation is gaining in popularity as the method of choice for the treatment of displaced intraarticular calcaneal fractures. However, open methods can make several complications such as neurovascular injury and infection. Thus we have performed the new technique of arthroscopic reduction and minimal internal fixation for displaced intraarticular calcaneal fractures in 5 cases. The results were evaluated between 12 and 16 months after surgery. A Bohler angle was restored to 25degrees-40degrees in all cases. Anatomical reduction of articular surface were obtained from 4 cases out of 5. No complications were found except 1 peroneal tendinitis. The clinical results by Creighton-Nebraska health foundation assessment for fractures of the calcaneus were 3 excellent, 1 good and 1 fair. Even though this was a few case and a short term follow-up study, the arthroscopic assisted management of displaced intraarticular calcaneal fracture induced a little complications and satisfactory results.

The Effect of Recombinant Human Growthn Hormone on Prevention of Osteoporosis in Ovariectomized Rat / 대한정형외과학회잡지

GH concentration in plasma decline with age. GH and GH response to GHRH are influenced by sex hormones, thereby changing around the menopause. In several aspects, features of aging resemble those of a state of GH deficiency. It has been argued the declining GH function, along with other factors, might be a causal factor in osteoporosis. The purpose of this study was to investigate that postmenopausal osteoporosis in ovariectomized rat could be prevented by rhGH. Fifty-four Sprague-Dawley rats(weight 140-200g) were devided 3 groups. Group 1(n=18) was sham operation; Group 2(n=18) was ovariectomized and received subcutaneous injection with 0.05 cc normal saline; Group 3(n=18) was ovariectomized and received subcutaneous injection with 0.2 IU rhGH. Group 2 and 3 were injected daily, 6 day per week. Each group was devided three subgroups(n=6) and were sacrificed at 6 week, 10 week, 14 week, respectively. Group 2 showed a significant increase in body weight, femur length, serum IGF-1 level, serum PICP and ICTP level at 6 weeks, 10 weeks, 14 weeks and a significant decrease in ash weight of tibia, width of bony spicules, at 14 weeks than Group 1. Group 3 demonstrated a significant increase in body weight, femur length, serum IGF-1, serum PICP and ITCP levels and a insignificant decrease in ash weight of tibia and width of bony spicules, at 6 weeks, 10 weeks, 14 weeks than Group 1. At 14 weeks, Group 3 showed a significant increase in serum IGF-1, Serum PTH, Serum PICP. From these data, we conclude that although rhGH administration leads to an activation of bone turnover and more stimulation of bone formation, it does not prevent a bone loss in ovariectomized rat.

Tuberculous Spondylitis Complicated with Descending Aortic Pseudoaneurysm: Report of 1 Case / 대한척추외과학회지

Tuberculous spondylitis is not rare disease. Today the posterior instrumentation and posterior or posterolateral fusion concomitant with the anterior decompression and anterior interbody fusion have been used for the treatment of spinal tuberculosis. The authors experienced a case of tuberculous spondylitis complicated with descending aortic pseudoaneurysm. An aneurysm is defined as a localized dilatation of an artery that is at least one-half the size greater than is expected for that artery. Pseudoaneurysm occurring after previous operation, trauma, and infection. Erosion of the thoracic aorta with the development of an fistula in the presence of infection is an unusual and difficult problem to manage. We report a case and review related articles briefly.

The Effect of Pamidronate on Prevention of Osteoporosis in Ovariectomized Rats / 대한정형외과연구학회지

Many agents for the treatment of osteoporosis are broadly classified as inhibitors of bone resorption and stimulators of bone formation. Many pharmacological derivatives of bisphosphonates are used in the treatment of osteoporosis by inhibiting osteoclast-mediated bone resorption. Although the pamidronate, derivative of bisphosphonates, has a potent antiresorptive activity, there are only a low reports about prevention and treatment of postmenopausal osteoporosis using it. The purpose of this study is to evaluate the changes of bone metabolism and bone mass after pamidronate administration during the early period of estrogen deficiency. Ninty-five Sprague-Dawley rats (weight 233-243 g) were divided into 3 groups. Group 1(n=28) was performed sham operation. Group 2 (n=25) was both ovariectomized and intravenously injected with 0.5 cc normal saline. Group 3 (n=42) was both ovariectomized and intravenously injected with 0.1 mg/kg pamidronate. During the first 8 weeks normal saline or pamidronate was intravenously injected twice a week(q 3 day or q 4 days). After 4 weeks of observation without injection the experiental animals were sacrificed at postoperative 12 weeks. There were statistically significant decrease in the body weight and the weight of uterus in group 1 compared with group 2, 3. There was statistically significant decrease in the bone mass of the spine, proximal femur, proximal tibia in the group 2 compared with group 1, 3. The difference of bone mass between group 1 and 3 was statistically insignificant. Serum osteocalcin and PICP concentration were significantly increased in group 2 and 3 compared with group 1. But there was no statistical significance between group 2 and 3 in serum osteocalcin and PICP concentration. Serum ICTP concentration was significantly decreased in group 1 and 3 compared with group 2, but the difference between group 1 and 3 was insignificant. These results suggests that the administration of the pamidronate during the early period of estrogen deficiency can inhibit bone resorption and prevent trabecular bone loss of the spine, proximal femur and proximal tibia metabolically.

A comparision study between autogenous nerve graft and Silicone tubing method in segmental defect of sciatic nerve in rats / 대한정형외과학회잡지

Recently autogenous nerve graft was usually used for segmental defect of peripheal nerve injury. In case of inappropriate size or amount of donor nerve graft, there were many studies included nerve regeneration with special nerve conduit material. To compare the result of autogenous nerve graft with that of silicone tubing method in segmental defect of sciatic nerve, the experiments were carried out on adult rats with autogenous nerve graft on the left side and silicone tubing on the right side. The results were as follows; 1. Myelinated nerve fibers were larger in silicone tubing method than autogenous nerve graft at postop. 4 weeks. 2. There was no difference in nerve regeneration in both groups at postop. 12 weeks. 3. Some atrophic changes were showed in denervated muscles in both groups at postop. 4 weeks. Skeletal muscle changes between the two groups were meagre. 4. Perineural adhension was rare in silicone tubing group in contrast to autogenous nerve graft group. 5. Nerve Conduction Velocity was similar between autogenous nerve graft and silicone tubing method after 4 weeks postoperatively. In conclusion, this study suggests that silicone tubing can be useful method to repair the large nerve gaps and has a potential clinical utilization in large segmental nerve defect.

Treatment of Bone Defect with Ilizarov Apparatus in the Tibia / 대한정형외과학회잡지

Bone defect of the long bone continues to challenge orthopedic surgeons. It is usually very difficult to obtain union. Ilizarov ext. fixation has recently gained popularity as a multifactorial approach to the management of tibial bone defect because nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. From February 1992 to May 1993 at the department of orthopedic surgery, Inje University Pusan Paik Hospital, 9 patients aged from 8 to 37 years were treated for tibial bone defect. The causes were open comminuted fractures with initial bone loss and bone defect after removal of infected necrotic bone. Bony defect size was ranged from 2cm to 14cm, averaging 7.2cm. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length discrepancy was achieved by means of external lengthening technique. Soft tissue defects were treated with secondary closure, split thickness skin graft, and muscle flap. The average healing index was 42.8 days/cm. According to Paley's classification the complications were developed as follows; The problem included pin tract infection(9), knee flexion contracture(4), and intractable pain(1), the obstacles included delayed union(3) and premature consolidation(1), the complication included nonunion(9) and equinus ankle(1). At an average 1 years follow up, according to Paley and Catagnl's classification, body and functional results were either excellent or good in 7 cases. So, we recommend that Ilizarov technique is very useful treatment for open fracture with bone loss, bone defect after removal of infected necrotic bone and limb shortening.

Treatment of the Humerus shaft Fracture with Closed Interlocking medullary Nail / 대한정형외과학회잡지

The interlocking nail is used as a valuable method in treating humerus shaft fracture because of the merit, including relatively simple procedure, one of the most stable fixation methods, and allowing early ROM excericise and low complication. Fourteen pateints with humerus shaft fractures were treated using interlocking nail at the Department of Orthopaedic Surgery Paik Hospital from Jan.1993 to Oct.1994. l. Among the 14 pateints, average age was 34.8 years and 9 cases were male and the most common cause of injury was traffic accident. 2. Associated injury including 3 cases of ipsilateral scapular fracture, I case of ipsilateral clavicle fracture, and 1 case of brachial plexus injury, and 1 case of radial nerve injury. 3. The mean duration of the radiologic bone union was 8.6 weeks. 4. There was no serious post operative complication such as non-union, infection, bending or rotational deformity at fracture site, impingement syndrome, metal failure of the nail or interlocking screws. 5. To prevent the impingement syndrom and rotator cuff injury, we countersinked the proximal end of the nail into the humeral head and minimized skin incision.

The Relatuonship betweeh Clinical Carrying Angle and Baumann's Angle in Treatment of Supracondylar Fracture of the Huerus / 대한정형외과학회잡지

Supracondylar fracfture of the humerus is the most common fracture about the elbow joint in children. Early accurate reduction is very important to obtain good results. The authors reviewed 44 cases of supracondylar fractures treated at Inje Universsity Pusan Paik Hospital from January 1986 to December 1990. Average follow-up time was 1 year 6 months. The results were as follows; 1. Thirty cases were treated with closed reduction and percutaneous pinning, ten with manipulation and cast immobilization, three with skeletal traction and the rest one with open reduction and internal fixation. 2. If there was a difference of the angle within 10-degree in post-reduction X-ray, deformity did not follow at the last follow-up. 3. The common formula was that a change of 5-degree in Baumann's angle corresponded to a 2- degree change in the clinical carrying angle. 4. Baumann's angle did not change between that of initially accepted and that of the final follow up X-ray. So, the authors recommend post-reduction measurements of the Baumann's angle as the adequancy of reduction of supracondylar fractures in children.

Clinicopathologic analysis on 25 cases of giant cell tumor of bone / 대한정형외과학회잡지

No abstract available.

Tuberculous Arthritis of the Hip in Children / 대한정형외과학회잡지

Although the incidence of the skeletal tuberculosis is being decreased with improvement of the socioeconomic status, tuberculous arthritis of the hip in children has many problems in fact that there is a relatively high incidence comparing to that of adult, that it is difficult to early detection for its variable clinical feature, and that there are many controversies in its treatment. From Aug. 1981 to Apr, 1988, 14 cases treated at Busan Paik Hospital were analyzed, and the following conclusions were obtained. 1. Surgical treatment of tuberculous arthritis of the hip with early lesion was better than conservative treatment in that it could be made early diagnosis, removed the infected focus, lessened the recurrence rate, and preserved the hip function. 2. A relatively good result in preserving the hip function was obtained with surgical treatment in tuberculous arthritis of the hip with late lesion.