The Supracondylar Osteotomy for the Angular Deformity Followed by a Fracture Arround the Elbow / 대한정형외과학회잡지

The elbow injury is frequent among the children. The cubitus varus and cubitus valgus deformities are the common late complications of the elbow fracture. Although, these deformities rarely limit elbow function, the correction is frequently requested due to cosmetic problem and/or tardy ulnar nerve palsy. We performed 33 supracondylar closed wedge osteotomies from Jan. 1976 to Jan. 1986, of which 27 cases were cubitus varus, and 6 cases were cubitus valgus at Yonsei University College of Medicine. The results were as follows; 1. Cubitus varus deformity was more common than cubitus valgus; the ratio was 4.5 : 1. 2. The most common initial injury resulted in such angular deformity of elbow was supracondylar fracture of humerus. 3. The duration of plaster-cast immobilization after operation was much longer in cases who operated over 15 years old than under 15 years old. 4. There is no relationship between the duration after initial injury and the result of operation. 5. The result of supracondylar osteotomy was excellent in 11 cases(33.3%), good in 17 cases(51.5 %), and poor in 5 cases(15.2%). 6. Three fourths of cases resulted in excellent and good result were under 15 years old. 7. It is recommeneed that the angular deformity of elbow is corrected early rather than at the conclusion of growth.

Open Reduction of Calcaneal Fracture / 대한정형외과학회잡지

Calcaneal fractures involving subtalar joint can be associated with prolonged and severe disability. Many different methods have been tried for the treatment in order to search for better results. From March 1983 to December 1985, 8 cases of calcaneal fractures involving subtalar joint were treated by open rcduction and internal fixation. and the results were as follows: 1. Satisfactory results were obtained from 7 cases out of 8. 2. Anatomic reduction was obtained by open reduction and internal fixation. 3. When medial approach failed, combined lateral and medial approaches gave better visualization of articular fecets and ensured anatomic reduction.

Clinical Effects of Diadynamic Currant for Patients with Pain in the Back and Extremities / 대한정형외과학회잡지

The treatment of pain in the back and extremities remains empirical. The application of surface electrodes to the dorsal columns of the spinal cord has been used by Shealy. The rationale. for dorsal column stimulation has been the “gate control theory” of pain proposed by Melzack and Wall. Transcutaneous electrical nerve stimulation is well recognized for its effectiveness in pain relief. The authors studied 48 cases of group A (physiotherapy, medication) and compared them with 43 cases of group B(physiotherapy, medication 'and diadynamic current), in the Department of Orthopedic Surgery, Yonsei University Hospital, from April, 1983, to June, 1984. The results were as follows: 1. Significant relief of pain was noted in group B in long term follow up of acute pain in the back and extremities. 2. In long term follow-up of group B, there was more improvement than in group A, especially when there was radiating pain in the extermities with or without back pain. 3. In long term follow-up according to the causes of the pain, there was more improvement in group B than in group A in cases of herniated nucleus pulposus and low back syndrome. From a consideration of these studies, it was concluded that satisfactory results were obtained from diadynamic current treatment for the patient with pain in the back and extremities.

Clinical Study on treatment of Diabetic Gangrene / 대한정형외과학회잡지

Diabetic gangrene is a common complication of diabetes mellitus, and its an incidence which has an increasing tendency. And its treatment is very difficult because of the high incidence of delayed wound healing. The diagnostic method to determine the level of amputation for treatment of ischemic limb was reported by many authors, but it still has many controversies. From January 1973 to December 1982, 60 cases in 55 patient of diabetic gangrene were treated at the Department of Orthopedic Surgery Severance Hospital. The result of treatment of diabetic gangrene according to the level of amputation, primary healing rates, and complication were studied. The results obtained are as follow; l. Among 55 patients, 34 male and 21 female, 50 patients(90.9%) were older than 51 years. 2. There was no correlation between primary healing and palpating arterial pulsation at the amputation level, also there was no correlation between primary healing and obstruction of proximal artery in arteriography. 3. It wasrecommended to correct hemoglobin level above 12.1gm% before treatment for primary healing at the operation site. 4. Debriment and skin graft were indicated with the grade I lesion. Whenever they amputate and attempt to do primary healing at the operation site, the ideal level is the site where the skin temperature is between 33.1℃ to 34℃. 5. High delayed healing rate(71.4%) was anticipated in below knee amputation with grade IV lesion with low skin temperature(below 32℃). 6. Among 12 patients who took Pylon prosthesis and started early weight bearing walking after major amputation, 10 patients(83.3%) were healed orimarily. 7. Operative mortality was 5.4% and 5 year mortality after operation due to diabetic gangrene was 16.9%.

A Case of Os Subtibiale / 대한정형외과학회잡지

Os Subtibiale, inconstant bone over the tip of the medial malleolus, is the very unusual findings and extreme rarity of the condition. We experienced a case of Os subtibiale in a 24 year old man who complained pain and tenderness an the bilateral medial malleolar region. The patient was treated by excision with satisfactory result.

Clinical Observations on Juvenile Rheumatoid Arthritis

Juvenile rheumatoid arthritis (JRA) is basically the same disease as rheumatoid arhritis in the adult. However juvenile rheumatoid arthritis has many features that differ from rheumatoid arthritis in the adult, and since the onset of the disease occurs before the age of puberty, variable alterations in growth may occur. In this study, fifty cases of juvenile rheumatoid arthritis treated at Severance Hospital from January 1970 to December 1977 were analysed clinically and the following results were obtained. 1. By classification, the polyarticular type (46%) was most frequent, followed by the pauciarticular type (34%) and systemic type (20%) in order. 2. The most frequent joint affected was the knee (82%) followed by the ankle (60%), hand (22%), wrist (20%), etc. 3. The extra-articular manifestations on admission were high fever (40%), rash (16%), carditis (14%), lymphadenopathy (14%), etc. 4. Laboratory findings on admission showed increased ESR (88%), positive rheumatoid factor (15.5%), positive ANA (16.6%), etc. 5. Clinical symptoms were managed medically and surgically with aspirin, salicylates and steroids, physical therapy, and synovectomy.

Clinical Observation on Juvenile Rheumatoid Arthritis / 대한정형외과학회잡지

Juvenile rheumatoid arthritis is basically the same disease as rheumatoid arthritis in the adult. However juvenile rheumatoid arthritis has many features that differ from rheumatoid arthritis in adult, and since the onset of the disease occurs before the age of puberty variable alteration in growth may occur. Still, in his classic description of 22 cases of rheumatoid arthritis in children, emphasized the florid form of the disease with fever, lymphadenopathy, and splenomegaly. Since the time of Still many more children with chronic arthriits, which is called Stills disease in England and juvenile rheumatoid arthritis in the United States, have been described, and it has become apparent that the disease has extremely variable manifestations. Forty cases of juvenile rheumatoid arthritis treated at the Severance Hospital from June 1970 to June 1976 were analysed clinically and the following results were obtained. 1. On type classification, the polyarticular type (45%) was most frequent followed by the pauciarticular type (35%) and systemic type (20%) in order. 2. The most frequent joint affected was the knee (77.5%) followed by the ankle (55%), wrist (20%),. elbow (17.5%), etc. 3. The extra-articular manifectations on admission were high fever (42%), rash (20%), carditis (17%) hepatosplenomegaly (12%), etc. 4. Laboratory findings on admission showed increased ESR (85%), positive rheumatoid factor (14.3%),. positive ANA (2.5%), etc. 5. Treatment and drugs were aspirin (57.5%), salicylate and steroid (37.5%), physical therapy (25%), synovectomy (2.5%).

A Clinical Study of Knee Joint Fractures / 대한정형외과학회잡지

The knee joint is the largest weight bearing joint. Knee joint fractures involve the articular surface and damage the surrounding soft tissues, and permanent deformities, especially joint stiffness, instability of the knee joint, post-traumatic arthritis, etc, may ensue following treatment. Many authors have recommended various methods of treatment for these fractures, This study is to present 77 cases of knee joint fractures which were treated at Severance Hospital from January 1965 to December 1974. The results of clinical study were as follows: 1. The causes of injury were traffic accident(75.3%), falling(15.6%) and direct blow(9.1%). 2. There were 63 males and 14 females in the series, 3. Age span was generally 10~40 Years. 4. Among the 77 cases, 42 were femoral condylar fractures, 28 were tibial condylar fractures, and 7 were tibial spine fractures. 5. In femoral condylar fractures, 27 cases were treated by conservative method and 13 cases underwent open reduction, and the clinical end results were satisfactory in 79.2% by conservative method and 54.5% by operative treatment. 6. In tibial condylar fractures, 14 cases were treated by conservative method and 12 cases by operation. Satisfactory results were obtained in 66.7% by conservative treatment and in 72.7% by operation.