Closed Intramedullary Nailing of Femoral Shaft Fractures / 대한정형외과학회잡지

Since May 1981, the standard method of treatment of the femoral shaft fractures at the Daejeon EuIji Deneral Hospital has been the closed intramedullary nailing technique of Kuntscher. We performed intramedullary nailing on thirty-five fractures of femoral shaft in 35 patients. Closed intramedullary nailing was used in twenty-eight femora and open intramedullary nailing with cerclage wiring in seven fractures, in which large butterfly fragment was present, precluding control of rotation or length, or both. The overall rate of union was 97 percent. The range of motion of the knee at follow up was good in 80%, fair in 14%, poor in 6% (Good Full extension; loss of flexion less than 10 degrees. Fair Any loss of extension;loss of flexion of 10 to 50 degrees, Poor Loss of more than 10 degrees of extension; range of flexion-extension less than 90 degrees). The advantages of this technique include the negligible risk of infection, the rapid stabilization of fracture, thus facilitating management of other associated injuries, the rapid return of function of the knee, and early union of fracture and return to work. It is authors' opinion that when proper equipment and expertise are available, than closed intramedullary nailing is the treatment of choice not only for simple uncomminuted fracture of the femoral shaft but also for open comminuted fractures.

A Clinical Study of Low Back Pain / 대한정형외과학회잡지

As Kelsey stated “Four out of five individuals will have a significant complaint of back painat one time or another in their lives and impairment of the spine are the most frequent cause of time lost from work”., low back pain affects the quality of life for just about everyone, medical and economic impacts of low back pain are enormous. Nevertheless, neither the government not industry has been seriously involved in the study of the cause, prevention, and management of back pain. The purpose of this study was to review and analysis the clinical materials of low back painand draw differences, if any, between discogenic and stenotic low back pain. Three hundreds and fourty nine cases suffering from low back pain and/or sciatic pain, excluded fresh traumatic and inflammatory conditions of the spine, have been admitted and treated at Dept. of orthopaedic surgery, Eul-Ji General Hospital, Dae-Jeon from May, 1981 to April, 1984. They were consisted of H.N.P. (172 cases), Spinal stenosis (61 cases), Spondylolisthesis (42) cases), Degenerative joint Disease of the spine (48 cases), and Others (26 cases). Among them, two hundred and twenty six cases who were followed more than four months were mainly subjectecl to this study.

Clinical Study on Open Fractures of the Tibial Shaft / 대한정형외과학회잡지

Open fractures of the shaft of the tibia occur frequently because of the progression of industrialization, Different methods of treatment have been advocated as regards the care of the open wound and the method of stabilization of the fracture fragments. The reports, published until recently, have differed with respect to rates of morbidity and end results. With this in mind, we reviewed a consecutive series of 30 open fractures of the tibia at the Department of Orthopedic Surgery of the Eulji General Hospital between 1981 and 1983 by a variety of methods. The following results were obtained. 1. The highest incidence of fractures was encountered in 3rd decades(43.3%) and male to female ratio was 4: 1. 2. The most common cause of fractures was traffic accident(66.6%). 3. The most common anatomical level of fractures was middle third of the shaft(46.7%). 4. The severity of injury was classified according to the Ellis classification as follows. Minor group, 8 cases(40%), Moderate group, 8 cases(26.7%,), Major group, 10 cases(33.3%). 5. The most common associated injury was ipsilateral fibular fracture. 6. Of 30 cases, 11 patients(36.6%) had an open wound more than 5cm in length, 10(33.3%.) between 2.5 and Scm and 4(13.4%) below 2.5cm, and primary closure after thorough debridement and copious irrigation was done in 17 cases(56.7%). 7. Pin and plaster method was applied in 3 cases of minor group and 3 of moderate group, intramedullary nailing was applied in 9 of minor group and 5 of moderate group, and Hoffmann device was applied in 10 of major group. 8. The majority of cases(66.7%) were operated on within 1 week after injury, 9(30%) between 1 and 2 weeks and 1(3.3%) between 2 and 3 weeks. 9. The fractures in middle third of the shaft of the tibia treated with intramedullary nailing revea.ed the shortest healing time(average 13 weeks). 10. Complications such as delayed union, infection and disabled joint shiffness were encountered mainly in cases with severe soft tissue injuries.

Analysis of Operative Treatment and the Outcome of the Lumbar Disc Surgery in Lumbar Disc Herniation / 대한정형외과학회잡지

A herniated lumbar intervertebral disc has been the most common cause of low back pain and sciatica since Mixter and Barr reported it in 1934. Our methods of treatment were the conservative treatment and the excision of the herniated disc for a limited number of carefully selected cases. The results of disc surgery relate to a number of factors, unquestionably the most important being patient selectivity. We emplopyed Finneson's lumbar disc surgery predictive score card to determine the relationship between patient selection and the outcome of lumbar disc surgery in operative cases. This report is to give a clinical review of 46 cases of the herniated disc upon which surgical removal were performed at Eul-Ji General Hospital from March 1981 to July 1982. The results were obtained as follows: 1. The most common age group were 21 to 40 year old. 2. In 46 surgically treated cases, 34 cases were male (74%) and 12 cases were female (26%). 3. The bulging of disc was found in 25 cases and the ruptured disc was found in 14 cases. The most common site of the lesion was L4-5 intervertebral disc with 30 cases (65%) and the next L5-Sl intervertebral disc with 10 cases (22%). 4. The outcomes of lumbar disc surgery were evaluated at follow-up as good in 77 per cent, fair in 11 per cent, marginal in 7 per cent and poor in 5 per cent of the patients. 5. The predictive scores of each result category were averaged and were as follows; Good: 77.1, Fair: 67.3, Marginal: 58.0, Poor: 40.0 6. The average predictive scores of each result category fell within the anticipated parameters of the score card. 7. The score card may be utilized as reliable system for presurgical patient selection.

Giant Extra-Capsular Synovial Chondroma of the knee joint: A Case Report / 대한정형외과학회잡지

Extra-capsular synovial chondroma is a rare condition in which metaplastic cartilaginous mass is formed by the cartilage nodule within the synovial connective tissue break through the joint capsule and continue to proliferate. The authors have experienced a case of giant extracapsular synovial chondroma, affecting the knee joint of 54 years old woman. A case of giant extra-capsular synovial chondroma is reported with brief review of literature.

Clinical Study on Hip Fractures / 대한정형외과학회잡지

Fractures of the hip are usually classified first according to their anatomic location. Isolated fractures of the lesser or greater trochanter are not common and rarely requir surgery, Femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures are common categories that usually require open reduction and internal fixation. These fractures most often occur in elderly patients. The prognosis of these three major categories of hip fractures seems to be entirely different because of their anatomic characteristics. Seventy three cases of hip fractures were experienced at the Department of Orthopedic Surgery, Eul-Ji General Hospital over the period from Jan. 1975 to Aug. 1980 and the following results were obtained. 1. Of the 73 hip fractures, femoral neck fractures were 28 cases (38.5%), intertrochanteric fractures were 23 cases (31.5%), subtrochanteric fractures 11 cases (15%), and acetabular, fractures 11 cases (15%). 2. Traffic accident was the major cause of hip fractures in our series. 42 cases (57.2%) were caused by traffic accident, whereas 27 cases (37.0%) by a fall from the height. 3. Hip fractures occured most frequently in the age group from 31 to 50 years (53.5%). Male to female ratio was 2:1. 4. Cases caused by traffic accident visited hospital earlier than the others. 5. The most common type was Garden's type IV (53.6%) in the femoral neck fractures, Boyd-Griffins type Il (47.8%) in the intertrochanteric fractures, and Fielding's type II (54.5%) in the subtrochanteric fractures. 6. Metal devices used to fix hip fractures were Knowles pin, Jewett nail plate, compression hip screw, plate and screws, and Kuntscher nail. Internal fixation was done anatomical reduction has been achieved in stable fractures, and Dimon-Hughston reduction in unstable fractures. 7. Postoperative cast immobillzation was performed in 13 cases of 21 femoral neck fractures, 15 cases of 22 intertrochanteric fractures and 6 cases of 11 subtrochanteric fractures. The average duration of immobilization was 10 to 12 weeks. 8. Incidence of avascular necrosis in femoral neck fractures was 16.7%, nonunion in intertrochanteric fractures was 11.8%, and nonunion is subtrochanteric fractures was 12.5%.

Melorheostosis Associated with Synovial Chondromatosis / 대한정형외과학회잡지

Melorheostosis is a rare entity while causes pain and stiffness in a limb and has an unknown etiology. It is characterized by roentgenographic appearance of melting wax dripping down one side of a candle along the major axis of long bone. The present case represents a melorheostosis of the left tibia accompanied by synovial chondromatosis in the left knee. Good result was obtained by arthrotomy of the left knee and removal of the bony masses in the joint.

Traumatic Bowing of the Bone in Children: Report of 3 Cases / 대한정형외과학회잡지

Bowing of one or both bones of the forearm in children following acute trauma was first recognized by Borden in 1974. Since then, a total of 30 cases have been reported in the English literature. The injury is a result of an acute plastic deformation of the tubular bones due to mainly a longitudinal compression force, and is charactcrized by: 1) a broad fixed curvature of the entire bone, 2) absence of periosteal new bone formation on later roentgenograms, and 3) partial correction of the curvature through cortical remodeling in young children. In this paper, three cases of traumatic bowing of the tubular bone in children are presented: one traumatic bowing of both forearm bones in 15 years old girl and two traumatic bowing of fibulae in combination with fractures of diaphysis of the tibiae of the same legs in 6 years old girl and 6 years old boy respectively. Manipulative reduction for the bowing of the both forearm bones corrected remarkably the plastic curvature, whereas manipulation for the bent fibulae with fractures of the tibiae failed to reduce the curvature, causing no delay in fracturt healing. These three cases are of special interest from two points of view. The first case was caused by tangential force instead of a longitudinal one and was associated with ulnar nerve paralysis which has eventually been recovered. The other two cases occurred in the lower leg in which plastic deformation, according to previous report, would not develop because of the lack of intrinsic curvature of the tibia and fibula.

Glomus Tumor / 대한정형외과학회잡지

Glomus tumor is a painful small subcutaneous mass as described by William Wood in 1812. Although seen infrequently and difficult to diagnose, the tumor has been interest to the profession for many years. The normal glomus is an end-organ apparatus which is a remarkable arteriovenous anastomosis functioning without an intermediary capillary bed. Distributed widely over the surface of the body in the deepest layer of the corium or in the stratum reticuiare of the skin, it is most abundant at the distal ends of the extremities. The main function of the glomus body is to aid in the regulation of the skin circulation and, therefore, the peripheral blood pressure and temperature. Glomus tumor represents a hypertrophy of the normal glomus. The gross appearance is that of small soft encapsulated tumor, pink or purple in color, almost always less than one centimeter in diameter if it is located subungually. The microscopic appearance of the tumor closely resembles that of normal glomus, the principal difference being a marked increase in the number of glomal cells (epithelioid cells) and nonmyelinated nerves. Glomus tumor may occur at any age but is most frequent in the middle age of life. Pain, tenderness and temperature sensitivity are the classic triad of symptoms. Complete surgical excision is the treatment of choice for the glomus tumors. Successful removal of the tumor leads to complete relief of pain and return to normal function. This paper is aimed to report on our experience with 3 cases of subungual glomus tumor which were successfully treated by complete excision and to review the literature.

Neuropathic Joints / 대한정형외과학회잡지

Neuropathic joint, which was originally described by Charcot in 1868, has been reported by many authors since that time. Charcot's joint is a feature of various conditions, such as syringmyelia, diabetes mellitus, congenital indifference to pain and leprosy, but it is mostly depended upon tertiary syphilis. In the past few decades. the occurance of this arthropathy however, seemed to decrease with the discovery of antibiotics and efficient control of syphilis in many countries. But syphilis has become popularized in recent years because of the rapid development of transportation and an offence against public deoency throughout the world. Authors experienced 3 cases of Charcots joint in Our Lady of Mercy Hospital, Catholic Medical College, two of them were tabetic, one diabetic in origin, which affected four knee joints, two ankle joints and one tarsometatarsal joint. The patients were treated conservatively without surgical intervention on the affected joints. One was lost for foIlow up after being discharged from the hospital against medical advice and the res two cases have been on follow up. This paper is auned to illustrate the importance of clinical aspects of neuropathic joints which seemed to be in the tendency of increase in recent years. in spite of development of efficient managements of the causative diseases.

Macrodactyly: A Case Report / 대한정형외과학회잡지

Macrodactyly, a disproportionate enlargement of one or more fingers or toes, is generally regarded as a rare congenital malformation. The skin, finger nail, subcutaneous fat tissue, vessels, nerves, tendons and phalanges are all enlarged. and the basic lesion appears to be the accumulation of fibrofatty tissue. The authors have recently experienced a case of pedal macrodactyly occured in the 4th and 5th toes of right foot, which was treated with ablation of the involved toes at the level of 4th and 5th metatarsal shaft. Postoperative course was uneventful. This paper is to present a case of pedal macrodactyly in 18 years old boy, experienced recently at our department and review the references relevant to macrodactyly.

Patient with Low Back Pain and Cornell Medical Index / 대한정형외과학회잡지

The cornell medical index is self-administered instrument that collects a large body of significant medical and psychiatric data. The original C. M. I. consists of 195 questions, but authors selected 60 questions from the original C. M. I. to simplify it. The purpose of this investigation is to clarify if there are any correlations between low back pain and extraskeletal disorders. This investigation was conducted on 144 in-and out-patients who were treated at the Department of Orthopaedic Surgery,Our Lady of Mercy Hospital, Catholic Medical College from Jan. to July 1977. Among them 75 patients were male,69 patients were female, and 22 patients had decompression laminectomy and discectomy. The results of this investigation are as follows; 1. The majority of patients with low back pain are 2nd to 4th decade. (Male: 30±10.7) (Femal:36.1±10.5) 2. Average number of complaints is 19.9/60 in male, 21.8/60 in female. 3. Complaints in section F(Fatigability) and G(mental) are predominant in all cases. 4. There are no significant difference in number of complaints between the operative and non-operative case, and between each decade.

Juvenile Disc Herniation / 대한정형외과학회잡지

Disc herniation is commonly thought to be disease of young and middle aged adult and the backache during adolescence and childhood frequently mislead the doctor to suspect other conditions such as epiphysitis, spondylolysis, and infection of vertebral column, etc. During the period of 1967~1977, 26 cases of juvenile disc herniation were collected at Catholic Medical College and the authors analysed these cases and the results are as follows. 1. The incidence was 3.4% of all disc herniation. 2. There was no sex predilection. 3. The clinical symptoms do not differ from that of the adult cases, but sensory disturbance and motor weakness appear less frequently. 4. Good result was obtained after the surgical removal of the involved disc. 5. The etiology of the disc herniation in childhood and adolescence is thought to be superimpositon of trauma over the preceding degenerative changes in disc.

The Tibio-Femoral Angle and the Intergonal Distance in Korean Children / 대한정형외과학회잡지

No abstract available in English.

Pyogenic Osteomyelitis of the Ischium: A Report of Three Cases / 대한정형외과학회잡지

No abstract available.