Treatment of the Segmental Fractures of Tibia with Ilizarov External Fixation

PURPOSE: To emphasis an effectiveness of the Ilizarov circular external fixator in treatment of the complicated segmental fractures of the tibia MATERIALS AND METHODS: We had analyzed 15 cases in 14 persons, treated from November 1993 to March 2000. We analyzed several considering factors including age, etiology, type of fracture, number of the segmentation, associated injuries, open or closed fracture, healing time, additional bone graft, clinical results and complications. RESULTS: The mean period of follow up was 22 months. The mean age was 45 years. The etiology was traffic accident in 13 persons. Open fracture were 11 cases (73%). Associated injuries were noted in 8 persons (53%). The number of segmentation were three segments in 9 cases (60%) and four segments in 6 cases (40%). Additional manipulations after first application were needed in 10 cases (67%). Bone graft were performed in 5 fracture site (9.8%), proximal fracture site in two and distal in two, middle in one. Mean period of application of external fixator for healing was 8.1 Months. Procedures for soft tissue injuries performed in 3 cases including two split thickness skin graft and distant flap surgery. The results were graded as excellent in 5 cases, good in 2 cases, fair in 1 cases, poor in 7 cases. Limitation of motion in ankle joint was major cause of poor results CONCLUSION: We considered that ilizarov circular external fixator is one of effective treatment modality in treatment of the complicated segmental tibia fractures.

Dislocation of the Elbow in Children / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the clinical manifestations of elbow dislocation in children and to suggest an appro-priate treatment modality for this rare injury. MATERIALS AND METHODS: We analyzed 17 cases, treated from September 1989 to July 2000. The factors examined included; age, sex, etiology, direction, associated injuries, method of treatment, results and complications. Clinical results were evaluated using the grading system of Linscheid and Wheeler. RESULTS: The mean age was 10 years 4 months. Etiologies were; fall from a height 8 cases, slip down 7 cases and unknown 2 cases. The directions of the dislocations were posterior 14 cases, posterolateral 2 cases, and posteromedial 1 case, with no anterior dislocation. Associated injuries were noted in 14 cases (82.4%), and 8 of these cases were treated by open reduction and internal fixation. The remaining 9 cases were treated by closed reduction followed by a long arm cast. The mean period of immobilization was 3.8 weeks. One case was complicated with a myositis ossificans, which resulted in spontanous remission. Results were excellent in 15 cases, and good in 2 cases with no poor cases. CONCLUSION: The incidence of associated fractures (82.4%) was higher in this study than in previous reports. A careful examination is necessary to identify associated injuries and achieve stability with the surgical procedure, which should be followed by early active exercise.

Clinical Symptoms of Internal Disc Disruption of the Cervical Spine / 대한척추외과학회지

STUDY DESIGN: This study reviewed 20 patients who were diagnosed as internal disc disruption (IDD) of the cervical spine. Clinical symptoms were analyzed retrospectively. OBJECTIVES: To assess the various symptoms of IDD of the cervical spine. Summary of Literature Review : Several studies have demonstrated the symptoms of lumbar spine IDD. No studies have attempted to show the symptoms of cervical spine IDD. MATERIALS AND METHODS: A group of patients, who showed chronic neck pain and referred pain to upper limbs after a certain trauma, was materials of this study. All these patients were examined with simple X-ray, flexion-extension views, magnetic resonance image (MRI). When intractable pain was prolonged over 6months in spite of conservative treatment, patient was admitted and performed discogram and computed tomograpy (CT) for a definite diagnosis. There were 20 patients who were diagnosed as IDD from July 1996 to June 2001, and clinical symptoms were analyzed retrospectively. RESULTS: The various symptoms of the IDD of the cervical spine were chronic neck pain (100%), shoulder pain (95%), headache (90%), interscapular pain (80%), arm pain and paresthesia (75%), insomnia (75%), hand pain and paresthesia (60%), periocular pain (60%), forearm pain and paresthesia (50%), chin pain (50%), subjective weakness of upper extremity (45%), periauricular pain (40%) and tinnitus (30%). CONCLUSION: We are led to believe that patients who have chronic neck pain, shoulder pain, interscapluar pain, and other symptoms after a certain trauma of cervical spine are clinically diagnosed as IDD of the cervical spine, although X-ray and MRI are normal. Definite diagnosis of these patients would be made by a discogram, if similar or identical pain is provocated.

A Case of Nail-Patella Syndrome Who Presented with Characteristic Electron Microscopic Findings / 대한신장학회잡지

Nail-patella syndrome is a relatively rare autosomal dominant disorder characterized by dysplastic nail, hypoplastic or absent patella, and dislocation of radial head and iliac horns. In addition, renal abnormalities have been reported. The usual clinical signs of the renal involvement are asymptomatic proteinuria, microscopic hematuria, and in some cases progression to end stage renal disease. We present the case of adult with nail-patella syndrome, who developed proteinuria. Electron microscopy revealed irregular thickening of the glomerular basement membrane with areas of rarefaction, giving rise to a pathognomonic "moth-eaten" appearance.

The Usefulness of Arthroscopy in Children with Knee Problems

PURPOSE: The aims of this review were to evaluate the usefulness of arthroscopy and to study of different types of knee pathology in children under 15 years old. MATERIALS AND METHODS: From January 1980 to January 2000, we retrospectively reviewed and analyzed 31 children (38 knees) under 15 years old, were performed arthroscopy at our department The use-fulness of arthroscopy was assessed by relating the prearthroscopic diagnosis to the intraarthroscopic findings. The procedure was classified as "not useful "when no additional information was obtained, "useful "when a doubtful diagnosis was confirmed and additional information was obtained, and "very useful "when a totally different diagnosis was reached and the cases of internal derangement. RESULTS: Total 46 lesions of 38 knees were found in arthroscopic finding. Most frequent pathology was meniscal lesions (26 cases), next were ligament injury (6 cases). Arthroscopy was found to be very useful, useful, not useful in 40%, 16%, 44%, respectively of children. CONCLUSION: In this study, the most common arthroscopic findings are meniscal lesions (57%). 56% of all cases were classified as useful and very useful. Overall, arthroscopy is an effective diagnostic and therapeutic tool that can be used safely in children.

Unipolar Release of the Sternocleidomastoideus in Congenital Muscular Torticollis in Children / 대한정형외과학회잡지

PURPOSE: This study was conducted to evaluate the results and usefulness of the unipolar release of sternocleidomastoideus for the treatment of congenital muscular torticollis in children. MATERIALS AND METHODS: From March 1991 to March 1999, we retrospectively reviewed and analyzed 19 congenital muscular torticollis patients who were treated by the unipolar release of sternocleidomastoideus. Patients were followed for an average of 4.3 (range, 1.3 to 9.3) years. Clinical results were evaluated cosmetically and functionally, in a manner similar to that used by Canale et al. RESULTS: Of the 19 cases, 15 patients (79%) were good, 4 (21%) poor, and none were fair in the initial operation. Overall results were 79% good after initial operation and 89% good including after reoperating upon 2 cases. CONCLUSION: Simple unipolar release of sternocleidomastoideus in congenital muscular torticollis showed high rate of success (79%). Therefore, we considered it to be an effective primary surgical procedure for the treatment of congenital muscular torticollis.

Plate Fixation for Sacroiliac Joint Separation Through the Anterior Approach / 대한정형외과학회잡지

PURPOSE: To analyze the clinical and radiological results of open reduction and plate fixation through the anterior approach for sacroiliac joint separation in unstable pelvic fracture. MATERIALS AND METHODS: We retrospectively reviewed fifteen cases treated by open reduction and plate fixation through the anterior approach from January 1994 to July 2000. Cases were followed up for more than one year, and the radiological results were evaluated according to the largest displacement and leg length discrepancy. The clinical results were evaluated according to pain and functional disabilities. RESULTS: Ten patients had mild pain not requiring analgesics, and one patient had a slight limp. The average sacroiliac joint separation improved from a mean preoperative value of 13.5 mm (range, 10-23 mm) to a mean postoperative value of 4.8 mm (range, 3-6 mm). Leg length discrepancy, which averaged 11 mm (range, 3-28 mm) preoperatively, decreased to 3.5 mm (range, 0-6 mm) postoperatively. All patients attained anatomical reduction postoperatively and no patient experienced loss of fixation during the follow up period. CONCLUSION: Open reduction and plate fixation for unstable pelvic fracture through the anterior approach is a useful method, as evidenced by the satisfactory clinical and radiological results.

Operative Treatment of Symphyseal Disruption / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of open reduction and internal fixation for disrupted symphysis pubis in unstable pelvic injuries. MATERIALS AND METHODS: Eighteen symphyseal disruptions were treated by open reduction and internal fixation from 1994 to 1998. There were 12 Tile type B and six type C injuries. In 12 patients, anterior fixation was performed whereas six patients were treated by anterior and posterior fixation. The clinical and radiological results were reviewed retrospectively at a mean of 20.4 months (range, 12 to 44 months) . RESULTS: The average symphyseal displacement improved from a preoperative value of 37.3 mm (range, 10-87 mm) to a postoperative value of 6.5 mm (range, 2-14 mm) . Leg length discrepancy which averaged 11.8 mm (range, 4-30 mm) preoperatively was decreased to 2.3 mm (range, 0-7 mm) postoperatively. Open reduction and internal fixation was associated with a higher percentage of excellent results except in osteoporotic bone. Two patients with osteoporosis had a loss of fixation. Complications were infrequent. CONCLUSION: Open reduction and internal fixation are desirable techniques for symphyseal disruption. But the supplemental wire fixation with plate would be recommended for elderly patients who show obvious signs of osteoporosis.

The Prevalence and Surveillance of Deep Vein Thrombosis after Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: To establish the incidence of deep vein thrombosis among Koreans after primary total hip arthroplasty and the usefulness of color doppler ultrasonography for routine noninvasive screening for deep vein thrombosis. MATERIALS AND METHODS: We performed prospective, randomized routine venography and color doppler ultrasonography before and after operation in a consecutive series of 89 primary total hip arthroplasty in which no form of prophylaxis was used. RESULTS: Of the 89 cases, eleven (12.4%) were found to have deep vein thrombosis (three proximal veins and eight distal veins) by bilateral venography. Most of the thromboses except two were asymptomatic. No patient had a symptomatic pulmonary embolism. Statistical analysis of risk factors, age, gender, weight, height, fixation method, and duration of operation time, were performed and there was no statistical difference (P>0.05). The reliability of color doppler ultrasonography for detection of deep vein thrombosis was demonstrated. CONCLUSIONS: We found insufficient evidence to recommend routine thromboprophylaxis in primary total hip arthroplasty among Koreans. The authors recommend that routine bilateral color doppler ultrasonography screening be considered after primary total hip arthroplasty for detection of deep vein thrombosis

Treatment of Tibial Fractures using the Ilizarov External Fixator / 대한정형외과학회잡지

The purpose of this study is to evaluate the effectiveness of Ilizarov external fixator in the treatment of difficult tibial fractures. We analyzed 37 cases with closed or open comminuted tibial fractures and unstable segmental fractures, treated with Ilizarov external fixator between August 1993 and August 1997. Among them, 21 cases were treated with simple application of Ilizarov external fixator. A compression of the fracture site (6 cases), translation (2 cases) and internal transportation technique (2 cases) were applied, and bone graft was applied in 5 cases. We obtained bony union in all cases with Ilizarov method except one case converted to intramedullary nailing due to delayed union. The average time required for bone union were 21 weeks in closed fractures, 26.2 weeks in open fractures. The complications developed were as follows; pin irritation in 14 cases, pin tract infection in 9 cases, adjacent joint contracture in 3 cases, delayed union in 1 case and malunion in 1 case. According to Tuckers classification, the results were graded as excellent in 18 cases, good in 14 cases, fair in 3 cases, poor in 2 cases. In conclusion, Ilizarov external fixation is one of the useful treatment option in closed or open comminuted tibial fractures and unstable segmental fractures.