Animal Experiment of Legg-Calve-Perthes Disease in Piglets, Puppies and Growing Rabbits / 대한고관절학회지

No abstract available.

The Long Term Results of Femoral Varus Osteotomy in Patients with Legg-Calve-Perthes Disease

PURPOSE: The purpose of this study was to evaluate the long term results of performing femoral varus osteotomy (FVO) for the treatment of Legg-Calve-Perthes disease (LCPD). MATERIALS AND METHODS: We selected 35 LCPD patients who received FVO and they were followed up to the time their skeletons' matured. The inclusion criteria were patients in a fragmentation stage, the patients were in Catterall group III or IV, and the patients underwent a teleoroentgenographic examination at the time of full skeletal maturity. RESULTS: The radiological outcome at the time of skeletal maturity was assessed using Stulberg's classification. The final results were 4 hips in class I, 17 hips in class II, 13 hips in class III, one hip in class IV and none in class V. The satisfactory results (good+fair hips) were 34 hips (97%). Significant shortening (>10 mm) was observed in 12 hips (34%). In 35 patients, 5 (14%) had same leg length (less than 2 mm difference), 27 (77%) had shortening of 2 mm or more, and 3 had lengthening of 2 mm or more in the operated limb. Of these 12 patients with significant shortening, only 3 patients (9%) showed shortening of 21 mm or more. CONCLUSION: FVO is a reliable method for managing LCPD in patients who are in Catterall group III or IV and who are in the fragmentation stage of disease.

Hip Development after Reduction in Developmental Dislocation of the Hip: Long-term Follow-up to Skeletal Maturity of 64 Hips / 대한정형외과학회잡지

PURPOSE: The serial radiographs of 64 children with unilateral developmental dislocation of the hip (DDH) were reviewed in order to follow the natural hip development with age after a concentric reduction. MATERIALS AND METHODS: All patients were treated with a closed (22 patients) or open reduction (42 patients) and were followed up to the age of skeletal maturity. The radiographic measurements including the acetabular angle (AA), Sharp angle (SA), center-edge angle (CEA), acetabulum-head index (AHI) and neck-shaft angle (NSA) were obtained in 6 age groups; 0-2 years, 2-4, 4-8, 8-12, 12-16, 16 and over. RESULTS: The rate of acetabular development evaluated by both the AA and SA, was greatest before 4 years of age and continued to a lesser extent until skeletal maturity. The neck-shaft angle also continuously and gradually improved after the concentric reduction until skeletal maturity. Acetabular coverage of the femoral head, which was evaluated by the CEA and AHI, reached the normal level in the 8-12 year age group and was maintained a normal level through to skeletal maturity. CONCLUSION: The hip dysplasia continued to improve until skeletal maturity. Therefore, it is recommended that secondary surgery should not be performed if the X-ray shows continuous improvement and a concentric reduction is maintained.

The development of Genu Valgum of the Affected Limb in Legg-Calve-Perthes Disease

Purpose: Genu valgum in Legg-Calve-Perthes disease (LCPD) is not a known complication. We investigated whether this valgus tendency is a complication of femoral varus osteotomy (FVO) or the sequela of the disease process itself, and what are the related factors. Materials and Methods: 35 patients treated by FVO and 38 by abduction orthosis (AO) were selected for this study. Only those patients with unilateral involvement, fragmentation stage, Catterall Group III or IV, and who were followed-up to full skeletal maturity were included in the study. We measured mechanical axis deviation percentage and hip-knee-ankle angle for femorotibial alignment, and mechanical lateral distal femoral angle and medial proximal tibial angle (mMPTA) for knee orientation on teleoroentgenograms and compared the affected and normal limbs. Results: All measurements, excluding the mMPTA, demonstrated a tendency of relative genu valgum versus the opposite normal limbs. This tendency was observed in both groups. There was no statistically significant difference between the two groups. Conclusion: Genu valgum occurred in 66% to 70% of the LCPD patients. Four factors were found to be significantly correlated with valgus shift: increased medial bowing of the femoral neck, decreased acetabulum head index, coxa magna, and limb shortening. Multivariate regression analysis identified limb shortening as the factor most responsible for valgus shift.

Pathoanatomical Factors Responsible for Femoral Shortening in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to determine the relative contributions made by pathoanatomical factors responsible for femoral shortening in Legg-Calve-Perthes disease (LCPD), and to devise a method of reducing the amount of residual shortening based on a better understanding of its pathoanatomy and developmental pattern in LCPD. MATERIALS AND METHODS: We measured shortening of three anatomical components, namely, the femoral epiphysis, neck, and diaphysis on the teleoroentgenograms of 106 LCPD patients, comprised of 35 children with active disease, 24 in the healing stage, and 47 at skeletal maturity. RESULTS: The proportional contributions made by these 3 anatomical components to residual shortening at skeletal maturity were; 20% by the epiphysis (epiphyseal flattening), 53% by the neck (physeal growth retardation), and 27% by the diaphysis (underuse atrophy). These contributions differed according to disease stage and shortening severity. Mean diaphyseal shortening was 3.9 mm at skeletal maturity, but this increased to 5.8 mm when only patients with severe shortening (20 mm or more) were included. CONCLUSION: Our findings suggest that diaphyseal shortening is likely to be minimized by the implementation of limb exercise programs.

Radiographic Evaluation on the Forefoot: Based on the Two Different Data (1982 and 2004) / 대한족부족관절학회지

PURPOSE: We compared the bony arrangements of the forefoot in 2 different years, 1982 and 2004, to determine any changes with time period of 22 years. MATERIALS AND METHODS: The radiographs of 200 normal Korean adults, 100 male and 100 female volunteers, were evaluated both in 1982 and 2004. The radiographic results were evaluated with as follows; hallux valgus angle (HVA), intermetatarsal angle (IMA), morphology of metatarsal head and relative anterior protrusion of the metatarsals and the phalanges. The mean ages were 38 years (23-52years) in 1982, and 37 years (24-50years) in 2004. RESULTS: The mean of HVA decreased from 15.6 degrees in 1982 to 14.3 degrees in 2004 (p=0.047), and the mean of IMA increased from 8.0 degrees in 1982 to 9.4 degrees in 2004 (p=0.031). The morphology of metatarsal head and relative anterior protrusion of the metatarsals and the phalanges were not different between the two study years. CONCLUSION: Comparing with those of 1982 measurements, we found an increase of IMA and a decrease of HVA. A prospective study may be needed to illuminate course of the changes.

Radiographic Changes in Forefoot Geometry with Weightbearing: Hallux Valgus Angle, Intermetatarsal Angle, and Medial Sesamoid / 대한족부족관절학회지

PURPOSE: To determine the radiographic changes in forefoot geometry with weight-bearing. MATERIALS AND METHODS: The forefoot radiographs of 100 normal Korean adults, 50 male and 50 female volunteers, were evaluated both in nonweight-bearing and weight-bearing. The mean age was 27 years with range of 21-39 years. Those with normal feet were selected from volunteers having no history of foot problems or other musculoskeletal diseases. RESULTS: The changes of measured angle between phalanges and metatarsals with weight-bearing were as follows; Hallux valgus angle was noted to increase in 20% of the feet, decrease in 59%, and remained unchange in 21%. Intermetatarsal angle 1~2 was noted to increase in 76% of the feet, decrease in 3%, and remained unchange in 21%. Intermetatarsal angle 1~5 was noted to increase in 95% and remained unchange in 5%. Shift in medial sesamoid on weight-bearing was also not consistent. Lateral shift was noted in 27%, no shift in 66%, medial shift in 7%. CONCLUSION: The generalized concept that the angles between bones and shift of medial sesamoid in the forefoot will change consistently with weightbearing was not found.

Sesamoids and Accessory Bones of the Forefoot in Normal Korean Adults / 대한족부족관절학회지

PURPOSE: To determine the locations and incidences of sesamoids and accessory bones of the forefoot in normal Korean adults. MATERIALS AND METHODS: The plain radiographs of the forefoot of 400 volunteers, 200 males and 200 females, were taken. The three orthopedic surgeons participated in the radiographic evaluation independently. Persons who had history of foot problem or injury were excluded. RESULTS: Sesamoids of first metatarsophalangeal joint were nearly always present; medial 99% and lateral 100%. The bipartite sesamoid was more common in medial (9.8%) and in female (17.0%) than in lateral (0.3%) and in male (2.5%). Sesamoids of the interphalangeal joint of the first toe were seen in 35.8%. Sesamoids of metatarsophalangeal joints in other four toes were rarely observed. Their incidences were 5% in second toe, 0.8% in third, 0% in fourth, and 2.8% (lateral) and 7.5% (medial) in fifth. Sesamoids of interphalangeal joint in four lesser toes were not observed except two cases (0.5%) in the fifth toe. Accessory bone was very rarely observed. Os vesalianum was observed in five feet (1.3%), Os intermetatarseum in 14 feet (3.5%), and Os cuneo-metatarsal I tibiale in none. CONCLUSION: We determined the location and incidences of sesamoids and accessory bones of the forefoot, and we expected this to help to diagnose the forefoot problem.

Radiographic Evaluation on the Forefoot: Based on the Two Different Data (1982 and 2004) / 대한족부족관절학회지

PURPOSE: We compared the bony arrangements of the forefoot in 2 different years, 1982 and 2004, to determine any changes with time period of 22 years. MATERIALS AND METHODS: The radiographs of 200 normal Korean adults, 100 male and 100 female volunteers, were evaluated both in 1982 and 2004. The radiographic results were evaluated with as follows; hallux valgus angle (HVA), intermetatarsal angle (IMA), morphology of metatarsal head and relative anterior protrusion of the metatarsals and the phalanges. The mean ages were 38 years (23-52years) in 1982, and 37 years (24-50years) in 2004. RESULTS: The mean of HVA decreased from 15.6 degrees in 1982 to 14.3 degrees in 2004 (p=0.047), and the mean of IMA increased from 8.0 degrees in 1982 to 9.4 degrees in 2004 (p=0.031). The morphology of metatarsal head and relative anterior protrusion of the metatarsals and the phalanges were not different between the two study years. CONCLUSION: Comparing with those of 1982 measurements, we found an increase of IMA and a decrease of HVA. A prospective study may be needed to illuminate course of the changes.

Radiographic Changes in Forefoot Geometry with Weightbearing: Hallux Valgus Angle, Intermetatarsal Angle, and Medial Sesamoid / 대한족부족관절학회지

PURPOSE: To determine the radiographic changes in forefoot geometry with weight-bearing. MATERIALS AND METHODS: The forefoot radiographs of 100 normal Korean adults, 50 male and 50 female volunteers, were evaluated both in nonweight-bearing and weight-bearing. The mean age was 27 years with range of 21-39 years. Those with normal feet were selected from volunteers having no history of foot problems or other musculoskeletal diseases. RESULTS: The changes of measured angle between phalanges and metatarsals with weight-bearing were as follows; Hallux valgus angle was noted to increase in 20% of the feet, decrease in 59%, and remained unchange in 21%. Intermetatarsal angle 1~2 was noted to increase in 76% of the feet, decrease in 3%, and remained unchange in 21%. Intermetatarsal angle 1~5 was noted to increase in 95% and remained unchange in 5%. Shift in medial sesamoid on weight-bearing was also not consistent. Lateral shift was noted in 27%, no shift in 66%, medial shift in 7%. CONCLUSION: The generalized concept that the angles between bones and shift of medial sesamoid in the forefoot will change consistently with weightbearing was not found.

Sesamoids and Accessory Bones of the Forefoot in Normal Korean Adults / 대한족부족관절학회지

PURPOSE: To determine the locations and incidences of sesamoids and accessory bones of the forefoot in normal Korean adults. MATERIALS AND METHODS: The plain radiographs of the forefoot of 400 volunteers, 200 males and 200 females, were taken. The three orthopedic surgeons participated in the radiographic evaluation independently. Persons who had history of foot problem or injury were excluded. RESULTS: Sesamoids of first metatarsophalangeal joint were nearly always present; medial 99% and lateral 100%. The bipartite sesamoid was more common in medial (9.8%) and in female (17.0%) than in lateral (0.3%) and in male (2.5%). Sesamoids of the interphalangeal joint of the first toe were seen in 35.8%. Sesamoids of metatarsophalangeal joints in other four toes were rarely observed. Their incidences were 5% in second toe, 0.8% in third, 0% in fourth, and 2.8% (lateral) and 7.5% (medial) in fifth. Sesamoids of interphalangeal joint in four lesser toes were not observed except two cases (0.5%) in the fifth toe. Accessory bone was very rarely observed. Os vesalianum was observed in five feet (1.3%), Os intermetatarseum in 14 feet (3.5%), and Os cuneo-metatarsal I tibiale in none. CONCLUSION: We determined the location and incidences of sesamoids and accessory bones of the forefoot, and we expected this to help to diagnose the forefoot problem.

Rising Incidence of Hip Fracture in Gwangju City and Chonnam Province, Korea

The purpose of study was to determine the incidence of hip fracture in 2001, to compare this with that of 1991, and to identify possible causes of change. Patients aged 50 yr or more living in Gwangju City and Chonnam Province, Korea, and who sustained a fracture of the hip during 2001 were investigated. Only patients who were admitted to hospitals for primary treatment of the first hip fracture were selected. There were 1,152 patients. A comparison of fracture incidences for 1991 and 2001 showed considerable increase during the 10-yr period. The total annual number of hip fractures rose from 247 in 1991 to 1,152 in 2001 and the fracture incidence also increased remarkably from 3.3 persons per 10,000 population in 1991 to 13.3 in 2001, representing a 4-fold increase over 10-yr. The reasons for this rising trend of hip fracture were not fully explained. However, an increase in the elderly population, an increase in osteoporosis, and an increase in injurious falls could partly account for the observed increase.

Simultaneous Occurrence of Bilateral Legg-Calve-Perthes Disease in Identical Twins / 대한정형외과학회잡지

This report describes simultaneous bilateral Legg-Calve-Perthes disease (LCPD) development in four-year-old identical male twins. Moreover, the twins showed head involvement patterns with mirror symmetry. We included a review of the literature on this rare condition and discussed the genetic risks associated with LCPD.

Responsible Factors for Femoral Shortening in Piglet Legg-Calve-Perthes Disease Models / 대한정형외과학회잡지

PURPOSE: To know the proportional contribution of causative factors to the femoral shortening in Legg-Calve-Perthes disease. MATERIALS AND METHODS: In twenty piglets, 4 to 5 weeks old, vascular supply to the capital femoral epiphysis was interrupted by ligating the femoral neck containing the epiphyseal artery. RESULTS: Mean femoral shortening in piglets sacrificed at 4 weeks after devascularization was 7.4 mm. In detail, the shortening was 2.5 mm (34%) in the epiphysis and 4.9 mm (66%) in the neck and diaphysis. Mean femoral shortening in piglets sacrificed at 8 weeks after operation was 12.1 mm. The distribution of shortening was 4.6 mm (38%) in the epiphysis and 7.5 mm (62%) in the neck and diaphysis. Mean femoral shortening in piglets sacrificed at 20 weeks after operation was 20.7 mm. The distribution of shortening was 4.0 mm (19%) in the epiphysis and 16.7 mm (81%) in the neck and diaphysis. CONCLUSION: We determined the proportional contribution to the residual shortening according to the causative factors.

Femoral Head Deformity in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: To determine the developmental patterns of 4 major deformities of femoral head commonly observed in Legg-Calve-Perthes disease (LCPD): coxa plana, coxa magna, coxa vara, subluxation. MATERIALS AND METHODS: We reviewed the clinical records and radiographs of 85 unilateral LCPD children who were followed up from the early stage of disease to full skeletal maturity. Four major deformities were measured and observed during 3 periods: the active disease stages of avascular necrosis and fragmentation, the healing stage, and skeletal maturity. RESULTS: All four deformities were first observed at early stages of the disease, avascular or fragmentation stage. Appearance rates were 79% in coxa plana, 28% in coxa magna, 35% in coxa vara, and 27% in subluxation. The gradual progression of deformities with time which was demonstrated at the healing stage and at skeletal maturity were observed in all except subluxation. And this gradual increase was supposed to be dependent on the normal bony growth with aging. CONCLUSION: We determined the developmental pattern of major deformities of the femoral head. And this determination will help to understand the natural course of deformity which is clinically important in terms of late osteoarthritis.

Late Complications of Legg-Calve-Perthes Disease / 대한정형외과학회잡지

No abstract available.

Treatment in Distal Humerus Fracture with Anatomical Y Plate

PURPOSE: To evaluate the clinical results of this modified anatomical Y-plate in treatment of distal humerus fracture and factors that affect the results. MATERIALS AND METHODS: From April 1991 to January 2002, 40 cases (16 male, 24 female) of distal humeral fractures were treated using a modified anatomical Y plate. The patient's age, gender, pain, range of motion, instability, function, bone union, and complication were recorded. RESULTS: At the operation, the mean age of patients is 49.5 years (12~74 years) and mean follow up period is 18 months (13~82 months). In the range of motion, mean flexion is 122.1 degrees (75~140 degrees) and mean flexion contracture is 11.4 degrees (0~30 degrees). Results by Morrey's functional evaluation include 15 excellent, 23 good and 2 fair cases. There are 2 excellent and 5 good cases in patients of supracondylar fracture which didn't involve the articular surface (A2, A3 type of AO classification), and 13 excellent, 18 good and 2 fair cases in patients of intracondylar fracture which involve the articular surface (B2, C1, C2, C3 type). But there is no statistical significance in results between two groups. There are 3 excellent, 3 good cases in 6 open fracture and 2 excellent, 6 good and 1 fair case in 9 patients with multiple trauma. The patient's age, gender, open fracture, multiple trauma, and intraarticular fracture did not affect the results. CONCLUSION: Satisfactory results can be obtained if the modified anatomical Y-plate is used to treat a distal humerus fracture, regardless of many factors affecting the results.

The Correlation between Peripheral Facial Neuropathy and Oropharyngeal Dysfunction

OBJECTIVE: To know the correlation between the grading of facial neuropathy by facial nerve conduction study (FNCS) and dysphagia severity by videofluoroscopic swallowing study (VFSS) in patients with acute peripheral facial palsy (PFP). METHOD: Twenty patients with acute PFP were recruited for this study. The causes of acute PFP were limited to idiopathic Bell's palsy and Ramsay-Hunt syndrome. The time interval from the onset of PFP to study of FNCS and VFSS was 10 to 14 days. The severity of PFP was graded according to House-Brackmann facial nerve grade (H-B FNG). Percent degeneration grade (PDG) was determined by FNCS. Baseline-to-peak amplitude of compound muscle action potentials in orbicularis oris muscle was used as an evaluation parameter. Oral transit time (OTT), pharyngeal transit time (PTT), pharyngeal delay time (PDT) and dysphagia limit were obtained by VFSS. RESULTS: There was a significant correlation between PDG and H-B FNG. The severity of oropharyngeal dysfunction was increased as the severity of the PDG increases. Delayed OTT, delayed PDT, and/or reduced dysphagia limit were revealed as a presentation of oropharyngeal dysfunction in acute PFP. CONCLUSION: The severity of PFP and oropharyngeal dysfunction were significantly correlated. And so we think that precise evaluation and adequate management of oropharyngeal dysfunction will be needed in acute PFP patients.

Recurrent Tetraplegia in Mixed Type Neurocysticercosis: A case report

Neurocysticercosis is the most common parasitic disease of the central nervous system. Generally, the spinal cord involvement of neurocysticercosis is very rare. We experienced a 52-year-old female patient presented with tetraplegia. She was diagnosed as mixed type neurocysticercosis involving brain parenchyma, ventricle and cervical spinal cord. She underwent an operation of intradural mass removal with cervical laminectomy. In spite of gradual improvement in activities of daily livings, muscle power and sensation, she revealed the fluctuation of mental status and tetraplegia, possibly associated with perilesional inflammation, twice during the period of admission. So, we administered prednisolone 20 mg and albendazole 800 mg a day for a week per event and then her mental status and aggravated tetraplegia were improved. After comprehensive rehabilitation for 4 months, her ASIA impairment scale changed from ASIA C to ASIA D with the improvement of modified Bathel index, Functional independence measure and Mini-mental status examination scores.

Effect of Botulinum Toxin A on Bruxism after Brain Injury

We wanted to report three cases of bruxism who were intractable to conventional management such as dental protection or medication but responded to motor point blocks (MPB) with botulinum toxin-A (BTX-A) on mastication muscles. Untreated, bruxism causes unfavorable complications of masseter hypertrophy, headache, temporomandibular joint destruction, and furthermore total dental wear and malnutrition. Our three patients had no previous history of bruxism or any neuromuscular disorder. They were presented with decreased cognitive function and severe bruxism about 6 months after brain injury. We managed the patients with MPB of BTX-A on each masseter and temporalis muscles. Bruxisms were markedly improved about 2 weeks after MPB without any complications. On follow-up 6 months after MPB, two of three patients remained free of bruxism and another patient revealed attenuated bruxism with decreased severity and frequency. Therefore, we think that MPB with BTX-A could be considered as a treatment option for severe bruxism in brain-injured patients.