Shoulder Motion after Scapulothoracic Arthrodesis of the Facioscapulohumeral Type of Progressive Muscular Dystrophy ( PMD ) / 대한정형외과학회잡지

Many patients who have facioscapulohumeral muscular dystrophy eventually have instability of the scapula due to weakness of the muscles which stabilize the scapula. However, a subset of these patients have sufficient strength in the supraspinatus and deltoid muscle to abduct the arm if the scapula has been stabilized. In four patients who had facioscapulohumeral type of progressive muscular dystrophy, scapulothoracic arthrodesis was done for the treatment of limited unstable shoulder motion, especially flexion and abduction and symptomatic winging of the scapula caused by the loss of scapular stability from July 1994 to Feb.1995. The purpose of this study was to report 5 cases who obtained permanent stability after the scapulothoracic arthrodesis and compare the pre- and postoperative glenohumeral motion. The average preoperative active abduction was 74 degrees, which was improved to l35 degrees at the last follow up in 4 cases except unsatisfied 1 case. The average preoperative active flexion was 66 degrees, which improved to 140 degrees at last follow up. The average preoperative UCLA shoulder score was 18.4 points, which improved to 29.6 points at the last follow up. They were doing well in activity of daily living except unsatisfied one case. The scapulothoracic arthrodesis in the facioscapulohumeral type of the progressive muscular dystrophy is successful in achieving scapular stability so it is valuable for selected patients, as it improves appearance, enhances function, and increases tolerance to exercise.

The Results of Open Release in Carpal Tunnel Syndrome / 대한정형외과학회잡지

Forry-two symptomatic hands of 29 patients with carpal tunnel syndrome operated during the period from Marth 1986 to December 1993 were analized in clinical aspect. Among 29 patients, 3(10.3%) were male and 26(89.7%)were female. The syndrome occured on the right side in 10(34.5%) patients, on the left in 6(20.7%) patients, and on both in 13(44.8%) patients. The causes of the syndrome were idiopathic(90.5%), trauma(7.1%), mass(2.4%). Paresthesia(57.1%) was the most common chief complanit, followed by numbness(35.7%), pain(21.4%), weakness(9.5%). Thenar muscie atrophy occured in 84.8%, positive Tinel sign in 83.3% and positive Phalen sign in 90.0%. Delay of motor conduction velocity of median nerve was noted in all cases and delay of sensory nerve conduction velocity in all cases. Denervation finding such as fibrillation or sharp waves were seen in all cases. The carpal tunnel release was performed in all cases, and 31 cases were treated by carpal tunnel tunnel release with internal neurolysis. 35 cases(83.3%) were excellent or good results. The cases were long duration were poorer results. No significant difference was found between the results in cases treated by carpal tunnel release alone and those in cases treated by carpal tunnel release with internal neurolysis of median nerve.

Radiologic Analysis in Normal Glenohumeral Joint / 대한정형외과학회잡지

We measured several relationships of humeral and glenoid articular surfaces with radiologic analysis in the 60 shoulders of normal adults(the 30 males and 30 females) who were without pain and limitation of motion. The average age was 29.1 year-old in the males(from 26 to 39), 27.7 year-old in the females(from 20 to 34). The results of measurement were as follows. The average radius of curvature of humeral head was 28.8±1.9mm in the males, 25.3±2,3mm in the females. The average radius of curvature of glenoid was 34.5±3.5mm in the males, 29.3±2.8mm in the females and there was difference between the radius of curvature of humeral head and glenoid about 4-Smm. Average surface area ratio of humeral head versus glenoid was 1.8±0.2 in male, 2.0±0.2 in female. The average thickness of humeral head from anatomical neck was 23.1±1.5mm in the males, 20.5±2.lmm in the females and there was distance between the radius of curvature of humeral head and the thickness of humeral head about 5 me and it was suggested that humeral head was not hemisphere. The average neck shaft angle of humerus was 51.6±4.8 degree in the males, 52.7±3.8 degree in the females. The average flare index was 3.6±0.6 in the males, 3.9±0.7 in the females, so that metaphysis of female was broader than that of male. The lateral humeral offset was 68.5±3.8mm in the males, 63.6±4.3mm in the females. The average distance from the greater tuberosity of humerus to the lateral acromion process was 20.1±3.9mm in the males, 17.6±5.1mm in the females. The average distance of upper surface from the humeral head to the greater tuberosity of humerus was 6.5±1.4mm in males, 5.9±2.0mm in females. The distance from the humeral head to the undersurface of acromion was 9.5±3.1mm in the males, 7.7±3.5mm in females. Our measurement of normal glenohumeral relationship would be useful in the diagnosis of shoulder disorders and in the design of prosthestic reconstruction in Korean. Further study would be required for the analysis of the three dimensional relationship because of the limitation of our two dimensional analysis.

Finger Lengthening by Callotasis / 대한정형외과학회잡지

Indications for bone lengthening in the hand are less common than for the lower extremity. From 1991 to 1993 authors had performed nine hand bone lengthenings in the eight patients, based on callotasis and chondrodiastasis, Average age at the time of surgery was 18 years old(from 4 to 31 years old). Diagnoses included traumatic amputations in 7 cases and congenital syndactyly of both hand with hypoplastic digits in 2 cases. Sites of lengthening were metacarpal bone in 7 cases, phalangeal bone in 2 cases. Eight of 9 lengthening procedures resulted in complete consolidation of the bone gap after the single stage procedure. In one case secondary bone graft was required for the bone defect. Average consolidation period was 16 weeks(from 10 weeks to 22 weeks). Average gained length was 14.6mm (from 6 to 30mm) and average percent of gained digital bone length was 48%. There were minimal complications including marginal necrosis of skin, numbness and bone tip exposure and were responsed to conservative manage, but stump revision for bone tip exposure was performed in one case. In all cases followed to completion and for 1 to 3 years postoperatively, there was improvement of function with key pinch. The callotasis lengthening is one of the useful method of short hand bone lengthening to improve function of hand and cosmetic demand.

The Bankart Procedure in the Traumatic Recurrent Dilocation of the Shoulder / 대한정형외과학회잡지

Fifteen shoulders in 15 patients with traumatic recurrent anterior dislocation were performed from Sept. 1993 to April 1994. The position in which the dislocation occurred were abduction and external rotation in 10 cases, but most likely direct injuries in the 13 cases. The average interval between the initial and second dislocation was 5.4 months, and the average frequency of dislocation was 15 times per year. Physically, crank test in 13, fulcrum test in 12, sulcus test in 4, and jerk test in 3 cases were positive. The classic Bankart lesions were 4 cases, the bony Bankart lesions in 11 cases, so all of them had an abnormal tension on the inferior glenohumeral ligament. The Hill-Sachs lesions were associated in 14 cases, the Superior Labrum Anterior Posterior lesion in 1 case. Traditional Bankart procedure in 12 cases, traditional method and shift surgery simultaneously for inferior laxity in 3 cases were performed. In 4 cases of bony Bankart lesion with large bone fragment, anterior capsule and subscapularis muslce was splitted during exposure. Velpeau sling was applied in a daytime for postoperative immobilization, exercise with 90° of flexion but no external rotation was permitted during 3 weeks after operation. After than 140° of flexion and 40° of flexion and averag 57° of external rotation. There was no recurrence in our series. The result at follow up were exellent in 9 cases, good in 6 cases.

Ganglion in extensor tendon of the hand: case report / 대한정형외과학회잡지

Ganglion is a common clinical entity, usually superficial in location, therefore easily diagnosed and most common tumors of the hand which represent 50 to 70% of all soft tissue tumors of the hand. The soft mucin filled cyst is attached to the adjacent underlying joint capsule, tendon, or tendon sheath. The most common ganglion is the ganglion on the dorsal side of wrist, with its origin at the scapulolunate ligament and is usually located between the extensor digitorum communis of the index finger and the extensor pollicis longus tendons. Intratendinous ganglion is very rare lesion that originates within the tendon, which has been reported 10 cases in earliest articles and 1 case in Korean article. We report one case of ganglion that arose within the extensor digitorum communis of the middle finger.

Treatment of Impingement Syndrome in Shoulder / 대한정형외과학회잡지

The authors reviewed the clinical results of treatment for the impingement syndrome in 33 patients, 36 cases at the Department of Orthopaedic Surgery, Medical College, Kyung Hee University from November 1989 to March 1992. Follow-up evaluations averaged 23 months. The average age was 49 years old and there were 16 men and 17 women. The right shoulder was involved in 25 cases and the left in 11. The prominent complaint was pain with impaired shoulder function, especially in abduction, external rotation and flexion. The average duration of symptoms was 11 months ranged from 1 month to 7 years. Twenty one cases were managed with conservative therapy only, consisting of rest, physical therapy, analgesic and antiinflammatory drugs. Operation was performed in 15 of 36 cases. Anterior acromioplasty was done in 11 cases and arthroscopic decompression in 4 cases. In all patients with operative management, relief of pain and improvement of shoulder function were obtained and complications were not observed. Average preopperative shoulder rating score was 38.2 and postoperative score was 87. In 14 cases(71%) of conservative management, the symptoms were improved but still persistent in 6 cases(29%). Average initial shoulder rating score was 47 and follow up score was 68.4. In the analysis of above results, operative treatment was effective when symptoms are persistent and fail to respond to conservative management.

Arthroscopic Manipulation in Frozen Shoulders / 대한정형외과학회잡지

Frozen shoulders improve mostly by the conservative management, such as medication therapy and positive physical therapy. Despite the vast majority regain motion and have reduced pain with gentle but persistent exercises, patients do not always spontaneously recover motion. Arthroscopic manipulation may be recommanded in patients whose symptoms last more than 6 months or when the conservative treatment fails and severe stiffness is primarily originated. Nineteen cases of frozen shoulder underwent arthroscopic manipulation under the general anesthesia from February, 1990 to February, 1992. All but one case had shoulder pain and 13 cases(68.4%) had trivial trauma history at the time of symptom onset. One of the chief complaint was the limitation of motion; abduction: 19 cases, external rotation: 17 cases, flexion: 13 cases, extension: 11 cases, internal rotation: 8 cases and adduction: 7 cases. Average abduction range at the time of admission was 63.9°. In the average 23 months follow up(15 months to 3 year 2 months), painless was shown in 13 cases and significantly decreased pain in 6 cases, and all the patients were satisfactory with the results. The range of the abduction motion was changed from 64° to nearly normal. All of the patients improved by 1 month to 4 months, average 2.9 months. We propose arthroscopic manipulation could be recommended in the treatment of frozen shoulder if an appropriate conservative treatment is not effective.

A clinical study of the unstable pelvic bone fracture using slatis trapezoid compression frame / 대한정형외과학회잡지

No abstract available.

Clinical Study of Arthrogram in Ankle Fracture / 대한정형외과학회잡지

The Ankle joint is a modified complex hinge joint which plays an importnat role in weight bearing, walking and standing. Injuries about the ankle joint cause destruction of not only bony architecture but also the ligament and soft tissue components. We performed arthrography in 52 cases of ankle fracture. The Result obtained from this study was as follow; The ligament & interosseous membrane injuries were more severe, when fracture of lateral malleolus was occured higher level than ankle joint.

Chevron Osteotomy for the Treatment of hallux Valgus / 대한정형외과학회잡지

Hallux valgus has been defined as a static subluxation of the first metatarsophalangeal joint with lateral deviation of the proximal phalanx on the first metatarsal head from the longitudinal axis of the first metatarsal with medial deviation of the first metatarsal. And first-second metatarsal angle is increased as well as bursal hypertrophy over the medial eminence of the first metatarsal head. Many procedures have been reported for the treatment of the hallux valgus ranging from resection arthroplasty to distal first metatarsal or basal first metatarsal osteotomy. Of these, Johnson and Corless have required sufficiently good results in the modifying Mitchell osteotomy into Chevron osteotomy. The Chevron procedure is an osteotomy involving the distal portion of the first metatarsal, lateral displacement of the metatarsal head with exostosectomy, and tightening of the medial capsular structures. Authors studied 17 cases in 10 patients with the hallux valgus deformity treated by Chevron osteotomy at the Department of Orthopedic Surgery, Capital Armed Forced General Hospital from September 1987 to September 1989. The results were as follows; 1. Seven patients (12 cases) were male and three patients (5 cases) were female. All patients had bilateral hallux valgus deformity. 2. The average first-second intermetatarsal angle was 11 degrees and average valgus angle was 32 degrees, preoperatively. They were corrected to 9 degrees and 14 degrees respectively. 3. The metatarsalgia of the great toe was subsided in all cases and they were satisfied with the result of their operations in respect to cosmetically and functionally. Avascular necrosis of capital fragment, nonunion, and dorsal angulation were not developed in any case. But, one case had marginal skin necrosis, presumably due to excessive compressive dressing. 4. Chevron osteotomy is a technically easy procedure and it can be obtained early bone healing with less complication.

Old Unreduced Isolated Anterior Dislocation of Radial Head: Report of 2 Cases / 대한정형외과학회잡지

Isolated radial head dislocation, without an associated fracture of the ulna in adult, is rare. Two cases which can be thought as old unreduced isolated radial head dislocation were experienced in this hospital. Dislocated radial heads have not been reduced, however the cases revealed normal elbow motion including pronation and supination. We report these cases with a review of the literature.

The Early diagnostic Significance of Bone Marrow Pressure in Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

The early diagnosis of osteonecrosis of the femoral head is difficult because the radiologic change usually appears after some pregression of the disease process. The value of bone marrow pressure measurement for esily detection of the osteonecrosis has been studied by many authors. We measured bone marrow pressure in avascular femoral head and compared with patient's age, stage of osteonecrosis and radiological types. And also we measured bone marrow pressure in osteoarthritic hip. The results were following:l. In 95% of osteonecrosis of the femoral head, BMP is increased. 2. There is no correlative change between BMP and radiological stage. 3. In steroid induced osteonecrosis, BMP increase is predominent after provocative test. 4. Radiological type seems to influence more significant BMP change than radiological stage. 5. The diagnostic accuracy of the early stage of osteonecrosis of the femoral head is 97% in average. 6. Osteoarthritic hip also shows increased BMP. 7. Baseline pressure is highest in greater trochanteric area, but subchondral area shows most sensitive change. 8. The provocative pressure is lower than baseline pressure in the necrotic center of the head. The increase of the BMP of the femoral head osteonecrosis not specific butvery sensitive. But the measurement of BMP of the femoral head is very useful method for early detection of AVN of the femoral head.

The Treatment of Recurrent Anterior Dislocation of the Shoulder by Modified Bristow Operation / 대한정형외과학회잡지

A review of sixteen cases of the modified Bristow operation for recurrent anterior dislocation of the shoulder from Feb. 1987 to Feb. 1989 was presented and the following results were obtained. 1. The age of initial dislocation varied from 12 years to 27 years of age with the average of 17.3 years. 2. The age at operation varied from 21 years to 30 years of age with the average of 23.3 years. 3. The times of dislocation vaaried form 7 to 40 times with the average 23.8 times. 4. The average loss of abduction and external rotation were 5.9 and 12.5 degree respectively. 5. The complications and recurrence were not observed in this period

Synovial Sarcoma in the Calf Muscle Fascia: A Case Report / 대한정형외과학회잡지

Synovial sarcoma is an uncommon, highly malignant soft tissue tumor usually arising from the synovial lining of a joint, bursa and tendon sheath. Occurence in muscle fascia is extremely rare. We present a case of synovial sarcoma of the left calf muscle fascia, which was confirmed by microscopically sarcomatous growth of spindle cells and irregular small multiloculation. Above knee amputation was done.

A Familial Osteopetrosis / 대한정형외과학회잡지

Osteopetrosis is a very rare bone dysplasia characterized by failure of resorption and persistence of calcified chondroid and primitive bone. In 1904 Albers-Schonberg first described the radiological appearance of marble bone. This is named osteopetrosis by Karshner in 1926. A fulminating form is manifested from birth in which fractures and deformity, hydrocephalus and cranial nerve palsies lead to early death from intractable anemia and intercurrent infection. In other cases the stigmata are delayed until later childhood, when retardation of growth and of mental and sexual development occurs, and not infrequently accompanied by rickets, dental caries and osteomyelitis. We have experienced a familial osteopetrosis, father and three siblings, which was thought to be a autosomal dominant inheritance. One of those family, 20 years old man, has been complained of anemia and low back pain without radiating pain to the lower extremities. The other 3 patients has not been complained of any other clinical symptoms. But X-Ray examination of the entire skeletal survey of those members of the family have revealed the uniform opacity of long bones and flat bones.

Treatment of Tibial Fractures by Interlocking Intramedullary Nailling / 대한정형외과학회잡지

We treated 74 fractures of the tibia by Interlocking intramedullary nail from Jan. 1982 to Mar. 1988. 58 of the fractures were fresh, 11 of these were open fractures. The other had 14 delayed union and nonunion and 2 ostetomy for malunion. Mean follow-up was 12.4 month and we analysed as follows: 1. Of 74 fractures, 73 fractures united and then the union rate was 98.5%. 2. Interlocking IM nail could be used to the majority of fractures of the shaft of tibia from 6cm below the knee joint to 5cm above the ankle joint. 3. Interlocking nail had rigid rotational stability and was appropriate for the treatment of severe unstable fractures. 4. Delayed union or nonunion was a good indication for intramedullary nsilling. 5. The major complication was deep infection. When the fixation was rigid with intramedullary nail, bone union was progressed in spite of infection. 6. Interlocking Intramedullary nailing provided rigid fixation of fracture and then it made possible early joint motion exereise and ambulation.

Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

We studied about 437 patients(620 hips) who were diagnosed osteoncrosis of the femoral head in Kyung Hee University Hospital during last 15 years and analysed the epidemiologic distribution and relation with other diseases. In 437 patietns, nontraumatic femoral head necrosis(NTFHN) were 340 patients(77.8%) and traumatic femoral head necrosis(TFHN) were 97 patients(22.2%). The male was more affected in ratio of 4:1, especially higher in NTFH about 4.6:1. The peak incidence of age distribution was 4th and 5th decades. The most frequent probable etiologic factors in NTFN was idiopathic(137 patients, 40.3%) and followed by alcoholic(124 patients, 36.5%), steroid induced(53 patients, 15.6%). The cases of bilateral involvement in NTFHN were 182 patient(53.5%). The steroid induced cases(69.8%) were higher than other cases in bilaterality. Liver disease was the most frequent associated disease and it was followed by diabetes mellitus and renal disease. In steroid induced cases, the underlying causes of its medication were nephrotic syndrome(12 patients), arthralgia(8 patients) and dermatologic diseases(7 patients), etc. The abnormal findings of selologic studies in NTFN were hyperlipidemia(28.1%), hyperuricemia (17.0%) and increased transmainase(18.5%) and there was contact relationship between hyperilipidemia and increased transmainase. Marked declination of Harris score was found between stage II and stage III in the course progression of NTFHN. The annual incidence of femoral head osteoncerosis increased gradually

Reliability of Singh's index Checked by the Dual Photon X-ray Absorptiometry(LUNAR D.P.X) / 대한정형외과학회잡지

There are several methods available to check bone masses. One of them is Singhs index which is singlest way with grading trabecular pattern of the proximal femur on anteroposterior X-ray film and the other is recently developed Dual Photon X-ray Absorptiometry which measures bone mineral contents. Some authors proclaim that Singh's index has low accuracy, objectiveness and reproducibility. So we studied for reliability of Singh's index and correlation between Singh's index and bone mineral contents measured by Dual Photon X-ray Absorptiometry in 65 patients. There are significant differences between 3 orthopedic surgeons in interpreting Singh's index (interpersonal difference). There are significant differences between first and second interpretation out of same surgeons (intrapersonal difference). There are significant differences interpretating among interpreted Singh's indices from films of different radiological exposures in the same radiograph. There are fair correlations(0.60-0.66) between Singhs index and bone mineral density. The Singh's index was overestimated in low bone mineral density with under-exposed radiograph, but Singh's index was under-estimated in high bone mineral density with over-exposed radiograph. Singh's index can be useful in clinical application by some modification.

Interlocking Intramedullary Nailing Versus conventional Kuntscher Intramedullary Nailing for Fracture of the Femoral Shaft / 대한정형외과학회잡지

We studied 75 cases of conventional Kuntscher intramedullary nailing and 52 cases of interlocking intramedullary nailing from July 1980 to October 1988 for femur shaft fractures. The conventional Kuntscher intramedullary nailing was used for fresh fracture and the interlocking intramedullary nailing was used not only fresh fracture, but also unstable fracture, nonunion and pathologic fracture. The conventional Kuntscher intramedullary nailing was frequently used in middle one-third level, but the interlocking intramedullary nailing could be applied widely from subtrochanteric area to supracondylar level in femur. The average operation time in patient who had no associated injury was 3.6 hours in conventional Kuntscher intramedullary nailing and 3.25 hours in interlocking intramedullary nailing. Time period for union was much less in interlocking intramedullary nailing than conventional Kuntscher intramedullary nailing. Some kinds of immobilization was needed shortly in conventional Kuntscher intramedullary nailing but immediate postoperative ambulation was possible in interlocking intramedullary nailing. Interlocking intramedullary nailing can prevent the angulation, shortening and trochanteric bursitis due to migration of the intramedullary nail.