Surgical Treatment of Fractures of the Ankle / 대한정형외과학회잡지

The ankle is an important joint supporting the entire musculoskeletal system during standing and walking. Current opinion has emphasized necessity of anatomical reduction and rigid internal fixation for a displaced or unstable fracture of the ankle. The purpose of this study was to evaluate the correlation of the adequate surgical operative methods and postoperative care with prognosis. The authors analysed 104 cases of ankle fracture, treated operatively in Department of Orthopedic Surgery of Dae-Han Hospital from January 1991 to December 1994, followed up more than one year. The results were as follows: 1. According to the classification of Lauge-Hansen and Danis-Weber, the most common type was supination-external rotation and type B, respectively. 2. The most common cause of injury was slip down and the others were traffic accident, fall down and direct trauma. 3. According to the criteria of Meyer, the result of treatment was good or excellent in 94 cases (90.4%) radiologically and in 91 cases (87.5%) clinically. 4. The complications were 5 cases of traumatic arthritis, 3 cases of malunion, 2 cases of non-union and 1 case of infection. 5. The early ROM exercise after accurate reduction and rigid internal fixation was very important in treatment of fracture of the ankle.

Operative Treatment of the Carpal Scaphoid Nonunions / 대한정형외과학회잡지

We had treated 24 patients who had nonunions of the carpal scaphoid from June 1987 to September 1995. 17 of 24 nonunions of carpal scaphoid were treated by K-wires fixation and autogenous iliac bone grafts. Another 7 cases were treated by Herbert screw fixation and autogenous iliac bone graft. 24 patients were followed up average 42.6 months and obtained following results; l. Among 24 cases, 23 cases were men and 19 cases were the third and fourth decade. Most common injury was the falling accidents (11 cases: 45.8%). 2. Most common pattern of fractures was waist type (20cases: 83.3%) in anatomical site and transverse type (15 cases: 75.0%) in pattern of fracture line. 3. Preoperative scapholunate angles (mean 52.9degrees: K-wires, 69.1degrees: Herbert screw) has been improved after open reduction and internal fixation by K-wires or Herbert screw (mean 46.2degrees: K-wires, 51.1degrees: Herbert screw). 6 cases had DISI deformity preoperatively with scapholunate angles over 70degrees (mean 80.0degrees: K-wires, 84.0degrees: Herbert screw) has been corrected after ORIF (mean 48.0: K-wires, 58.0: Herbert screw). 4. Bony unions were obtained in average 13.2 weeks in K-wires group and 9.8 weeks in Herbert screw group. 5. 13 cases (76.5%) in K-wires group and 6 cases (85.7%) in Herbert screw group were excellent and good result by Maudsley method. 6. The complications and sequalaes were present 4 cases in K-wires group with degenerative arthritis on radioscaphoidal and scapholunate joint and collapse of proximal pole and 1 case in Herbert screw group with screw malposition. So, We were thought that ORIF with K-wires and Herbert screw was effective treatment for nonunions of carpal scaphoid, especially Herbert screw fixation and autogenous iliac bone graft. In comparison of bony union and results of treatment, Herbert screw group was more effective than K- wires group.

Operative Treatment of Fracture of The Proximal Humerus / 대한정형외과학회잡지

Recently, the incidence of fracture and dislocation of the proximal humerus has been increased with increment of traffic accident and industrial accident. Although most proximal humeral fractures can be treated satisfactorily by simple conservative treatment, the displaced fracture or fracture-dislocatiion of the proximal humerus demands special treatment and judgement. It has been reported that the results of the surgical treatment of the unstable fracture of the proximal humerus was better than that of conservative treatment. The authors analysed 32 cases displaced fracture or fracture-dislocation of the proximal humerus treated operatively which were followed up more than 1 year at the Dae Han Hospital from June, 1990 to May, 1993. The obtained results were as follows; l. According to Neer's classification, there were 2-part fracture in 3 cases(9%), 3-part in 17 cases(54%), 4-part in 2 cases(6%), fracture-dislocation in 8 cases(25%) and head splitting in 2 cases(6%). 2. The clinical results by Neer's criteria were excellent in 9 cases(28%), good in 14 cases(44%), fair in 7 cases(22%), and poor in 2 cases(6%) among the 32 cases. 3. The complication were limitation of motion in 4 cases, avscular necrosis of humeral head in 2 cases, nonunion in 1 case, delayed union in 1 case, ectopic ossification in 1 case and malunion in 1 case. 4. In the unstable fracture of the proximal humerus treated by accurate reduction and rigid fixation with intensive rehabilitation can be obtained, relatively satisfactory results because of the inability to maintain an acceptable closed reduction.

Treatment of Colles' Fracture with Percutaneous Pinning / 대한정형외과학회잡지

Colles' fracture is a common injury encountered in emergency departments. Despite the frequent experience of every orthopedic surgeon with Colles' fracture, considerable variation remains in the treatment of fracture of the distal radius. Everyone nearly agress that reduction of the fracture is not difficult, but maintenance of reduction is the problem. Eighty patients with Colles' fracture were treated with closed reduction and percutaneous pinning under the C-arm fields and followed up more than 1 year, from January 1990 to May 1993 at the Department of Orthopedic Surgery, Dae Han Hospital. The results of this study were as follows: 1. The fractures were classified according to the system of Gartland and Werley. Of the 80 cases, 12(5%) were type 1; 25(31%) type 2; and 43(54%) type 3. 2. Complications were such as; temporary neuropathy of median nerve 2 cases, redisplacement 2 cases, radiocarpal arthritis 1 cases, stiff hand 1 case and shoulder hand syndrome 1 case. 3. The overall assessment showed exellent in 29 patients(36.2%), good in 44 patients(55,0%) and poor in 7 patients(8.8%) under the subjective and objective criteria of Gartland and Werley and the objective criteia of Scheck. 4. The results were mainly correlated with maintenance of an anatomical reduction. 5. The percutaneous pinning was suitable for anatomical restoration and maintence, had less com plication and more advantage such as the early range of joint and simple technique. Conclusively, it was considered to be one of ideal method for the treatment of Colles' fracture in selected cases.

Operative Treatment of Fracture of the Tibial Condyle / 대한정형외과학회잡지

The fracture of the tibial condyle involving the articular surface can produce some disability of the knee joint because it is frequently accompanied by soft tissue injury to the ligaments and menisci. Accurate anatomical reduction and rigid internal fixation with early mobilization is known to provide good results. The authors analysed 50 cases of the fracture of the tibial condyle which were treated with recent method(anatomical reduction, rigid fixation and early joint motion) at the Dae Han Hospital from January, 1988 to May, 1993. The results were summerized as follows: 1. The associated injuries were ligamentous injury in 24 cases(48%), fibular fracture in 21 cases(42%), femur fracture in 7 cases(14%) and meniscal injury in 7 cases(14%). 2. According to Hohl's classification, the split compression type was most common in 17 cases(34%), and there were 14 comminuted type(28%), 8 local compression type(16%), 7 total condylar compression type(14%) and 4 split type(8%). 3. Method of internal fixation were plate & screw in 32 cases(64%), tibial bolt & screw in 18 cases(36%), bone graft in 31 cases(62%), ligament repair in 24 cases(48%) and menisectomy in 4 cases(8%). 4. The clinical result by Insall's criteria were excellent in 37 cases(74%), good in 8(16%), fair in 3(6%), poor in 2(4%) among 50 cases.

Concomitant Ipsilateral Femur Neck Fracture Associated with Comminuted Femur Shaft Fracture: Clinical Review of Four Cases / 대한정형외과학회잡지

Ipsilateral fractures of the femur neck and shaft show diagnostic difficulties and complexity of the treatment. This femoral double fracture, when not initially diagnosed, carries a much high risk of complications, such as aseptic necrosis of the femoral head. Early recognition is of importance. The definitive treatment of a fractured femur should be begun after the ipsilateral hip and the knee joint have been examined clinically and radiologically. At the Department of Orthopedic Surgery, Dae Han General Hospital, from July 1985 to March 1990, four cases of the concomitant ipsilateral femur neck and shaft fracture had been treated and followed-up for 2.4 years in average (ranging from 1.1 to 4.7 years).

The Changes of the Bone and Joint of Upper Extremities in Young Baseball Players / 대한정형외과학회잡지

We checked and analysed the clinical and radiological status of the upper extremities of 142 baseball player in childhood and adolescence. The results of this study were as follow:1. The oreder of frequency of pain locations in the upper extremities was elbow, shoulder, and then wrist joint. 2. There was colse relationship between elbow pain and career, but not in shoulder and wrist area. 3. The characteristics of shoulder or wrist pain were diffuse and vague nature, but elbow pain was located in medial aspect. 4. The cubitus valgus and limited elbow ROM in throwing side were found in pitchers or older careers. 5. All players showed cortiocotrabecular hypertrophy of humerus, and high incidence of medial epicondylar changes were noticed with career increased. 6. Main bony changes: Shoulder

Comparative Analysis of Simultaneous and Staged Bilateral Total Knee Arthroplasty / 대한정형외과학회잡지

Between January 1982 and September 1986, at the Department of Orthopaedic Surgery of Kyung Hee University Hospital, 82 total knee arthroplasties were performed in 57 patients. We studied 25 patients (50 Knees) who had been operated by bilateral total knee arthroplasties to compare one stage and two stage operations. The follow-up ranged from 10 months to 5 years and 7 months (average 1 year and 8 months). All operations were performed by one of the authors (D.K.B.), but the follow-up study and the entire medical record were independently evaluated by another authors. The clinical results of preoperative and postoperative assessments and rehabilitation processes are as follows; 1. Group I (10 patients) had both kness replaced by one stage simultaneous operation under same anesthesia, and Group II(15 patients) had replaced by two stage operation at the intervals of 2 weeks. 2. The periods required to do bilateral weight bearing were 10.3 days for Group I, 23.6 days for Group II. 3. Complications in one stage operation was no more than the in two stage operation. 4. The postoperative pain and ROM were not significantly different in both groups. 5. Using the hospital for special surgery rating system, we found the clinical results to be similar in both groups. 6. Comparing to two stage operation, the advantages of one stage operation were shorter operative and tourniquet time, lesser use of antibiotics, reduced medical cost and hospital stay. In conclusion, if patient conditions do not prevent prolonged anesthetic time and surgeons have good surgical techniques, we recommend one stage simultaneous operation in bilateral total knee replacement.

The Removal of Loose Bodies from the Knee Under Arthroscopic Control / 대한정형외과학회잡지

We studied retrospectively twenty-nine operations for removal of loose bodies from the knee under arthroscopic control from August, 1982 to Mach, 1985. We succed to remove loose bodies arthroscopically in 24 knees, but failed in 5 knees. The loose bodies were not visible radiologically in 12knees, and more than one loose body was present in 10 knees. The loose bodies, above Smm in diameter among the removed, were forty three; their mean diameter was 7.5mm and the most large one was 35 mm in diameter. The loose bodies were found most commonly from intercondylar notch area and the most common associated internal derangements was meniscal injury. The mean time for return to work was 2.5weeks(range 1 to 4.5weeks). The operation required considerable arthroscopic expertise and could be technically more exacting than other artroscopic procedures. After average two years and four months follow-up(range one year and five months to three years and eleven months), pain on knee joint was remained in five patients who had taken other associated derangement in same knee, but the patients who had loose bodies in knee joint as only problems were cured completely to normal knee joint function.

Clinical Analysis of Proximal Tibial Osteoarthritic Knee the Preoperative Evaluation and Follow-up Study / 대한정형외과학회잡지

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 the knee. We studied the preoperative clinical status and postoperative results in twenty-two patients (twenty-four knees) who had had a proximal osteotomy for osteoarthritic varus deformity. The mean length of follow-up was 2.6years(Range, 6months to 4.8years). In the preoperative evaluation of the lesion, we used bone scintigraphy to estimate the range and extent of the osteoarthritic change. The scintigraphic results were more sensitive to simple x-ray finding in a disease process. The range of motion of the knee were improved after osteotomy, from 7.7degree-128 degree to 2.6 degree-135degree(5.1degree in flexion contracture and 7 degree in further flexion). Correction of the tibiofemoral angle was performed to the level that we had decided correction angle to 7 degree and 3 degree of overcorrection. The correltion of good clinical results and tibiofemoral angle was dependent on whether the postoperative tibiofemoral angle is more than 5 degree valgus or not.