Four Cases of Multiple Epiphyseal Dysplasia in One Family / 대한정형외과학회잡지

The clinical entity of Dysplasia Epiphyseal Multiplex was first descrihed by Fairbank in 1935, characterized by the disturbance of endochondral ossification in hoth epiphyseal centers and regions of physeal growth. It manifests itself radiologically as late appearance and mottling of the ossification centers and clinically as short stature, stubby digits and painful stiffness of multiple joints. It is typically transmitted as an autosomal dominant trait though recessive forms have been described. The spine is normal apart from a mild increased lumbar lordosis. Many patients are referred to an orthopaedic surgeon for bilateral Perthes disease, as was one of the authors cases. This Paper reports four cases of multiple epiphyseal dysplasia which affected one family.

Cartilage Overgrowth of the Femroal Head and Acetabulum in Legg - Calve - Perthes' Disease as Viewed on MRI / 대한정형외과학회잡지

Eighteen patients(19 affected hips and 17 unaffected hips) with Legg-Calve-Perthes' disease(LCP) were reviewed to evaluate the relationship between medial joint space widening and lateral subluxation of the femoral head. MRI was used to evaluate components in widened medial joint space in radiographs. There was increased cartilage thickness of the femoral head and acetabulum and increased joint tluid which represented synovial hypertrophy in the widened medial joint space in radiographs. Increased cartilage thickness was found at the mediai aspect of the femoral head and at the lateral and posterior walls of the acetabulum when compared to unaffected hips and normal control hips. Widening of the medial joint space was related to lateral subluxation of the femoral head during the fragmentation or remodeling stage, not always during the avascular stage, in LCP. Widening of the medial joint space did not change remarkably after a Salter osteotomy or femoral varus derotational osteotomy because of the remaining cartilage thickness.

Osteotomy of the Tibial Tubercle in difficult Total Knee Arthroplasty

Exposure with the tibial tubercle osteotomy was done for ten revisions and one primary total knee replacements out of 200 total knee arthroplasties performed from 1985 to 1996. The cases were analyzed with regard to complications and technical considerations. The preoperative diagnoses were infected total knee arthroplasty in seven, aseptic loosening in three and one ankylosed knee. Eixtensive exposure was achieved enough for debridement and reimplantation. The tubercle was fixed with two or three 3.5mm screws. The average duration of follow up was 30 months. Post operative knee flexion averaged 87 degrees. There were two complications, one avulsion of the fragment and one tibial fracture. The advantage of this procedure included wide exposure for difficult knee surgeries and more proximal fixation for improved flexion.

Two - Stage Revision of Infected Total Knee Arthroplasty using Antibiotics: Impregnated Cement Spacer

Purpose of the study. The purpose of this study was to evaluate the result of treatment of the infected total knee arthroplasty by two-stage revision. Material. Out of twenty eight total knee arthroplasty revisions, 13 revisions were performed for infected total knee arthroplasties between 1985 and l.996. Two cases of infected total knee arthroplasties were treated by immediate replacement and four cases by arthrodesis. Seven infected total knee arthroplasties had been revised by two-stage revision and followed-up for 38.6 months in average (range, 18-105 months). They were one male and six female patients of 61.6 years old in average. The primary cause of arthroplasty was osteoarthritis in all. Infection was diagnosed by preoperative aspiration, culture of the pus from draining sinus and culture of surgical specimen. Five cases revealed positive growth of causative bacteria, while two were not identified. METHOD: The protocol for two-stage revision began with tbe removal of infected implants and cement. The surrounding bony and soft tissue were thoroughly debrided and cleaned. The dead space between femur and tibia was filled with antibiotics-impregnated cement spacer and beads. Wound was closed and the leg was placed in soft knee brace. Patients received intravenous antibiotic therapy based on culture results for 4-6 weeks. Reimplantation was followed using total condylar prosthesis of posterior stabilizing type in five and semiconstrained type in two cases. RESULT: Two-stage revision was successful in six cases. One case revealed the recurrence of infection eleven months after reimplantation and underwent the repetition of the same two-stage procedure. At the final follow-up, the average Hospital for Special Surgery score was 81.l points, the average Knee Society knee score was 78.6 points and the average functional score was 76.7 points. Patients could regain average 100 degrees of knee flexion. CONCLUSION: The result of two-stage revision for infected total knee arthroplasty was satisfactory, showing that this can be the method of choice for infection treatment and functional restoration. This procedure using antibiotics-impregnated cement spacer and beads can control infection and improve functional results.

Biomechanical analysis of Korean Ilizarov Fixator / 대한정형외과학회잡지

The purpose of this study is to evaluate biomechanical stability of Korean Ilizarov fixator before clinical application. We measured the ultimate tensile load and stiffness of Ilizarov smooth wire and olive wire, bending stiffness of half-pin, ultimate compressive load and stiffness of Ilizarov ring using Instron 1331. Four types of Ilizarov assembly were tested for measuring stiffness of axial compression, anteroposterior bending, and lateral bending. There were group I fixed with only smooth wires; group II with only olive wires; group III with wires and half-pins; and group IV with only half-pins. The results of Korean Ilizarov apparatus were compared to those of American Ilizarov apparatus using unpaired t-test. The ultimate tensile strength of Korean smooth wire was greater than that of American wire. The ultimate tensile strength of Korean olive wire was lower than that of American wire. There was no significant difference of stiffness of axial compression, anteroposterior bending, and lateral bending between American and Korean apparatus. There was no significant difference of axial compression stiffness and bending stiffness between group III and group IV. In conclusion, Korean Ilizarov apparatus can be used with good stability for treatment of fracture, internal bone transport, and limb lengthening according to this biomechanical study.

Spinal stenosis in Charcot spine of the lumbosacral area / 대한척추외과학회지

STUDY DESIGN: This case report presents a 50-year-old patient with tabetic Charcoal spinal arthropathy combined with spinal stenosis, and its management. OBJECTIVES: To present the case report and follow-up results of Charcoal arthropathy with spinal stenosis of the lumbosacral spine, which was treated by circumferential fusion with instrumentation and decompressive laminectomy. LITERATURE REVIEW: Most reports of Charcot spine mention the etiology, clinical characteristics, pathology, and management of the condition. Surgical management of Chariot spines with spinal stenosis are rare. There is no report of the two-stage procedure of circumferential fusion and decom-pression for Charcot spine with spinal stenosis. MATERIALS AND METHODS: The patient complained of back pain, radiating pain to both lower legs, and 100m neurologic claudication. Serologic testing was positive in VDRL and FTA-ABS tests. Surgical treat-nent consisted of anterior resection of the L5 body with an autogenous iliad bone graft. It was followed by a posterior wide laminectomy of L5 for spinal stenosis, and CD instrumentation with transpedicular screws was applied to L3-S1 with lateral bone graft. RESULTS: At 27 months follow-up, clinical symptoms of back pain and radiating pain were disappeared. The patient walked without claudication, and satisfied with her condition. Firm bony fusions from L3 to S1 were obtained. There was no evidence of further destruction or neural compromise in the 27 months following surgery. CONCLUSION: A case of Charcoal arthropathy of the lumbosacral spine with spinal stenosis of L3-5 and L5-S1 has been reported, and the pathology, clinical features, and management of this condition were discussed. Circumferential fusion for Charcot spine and wide decompressive laminectomy for spinal stenosis are advisable.

Ilizarov Method for Knee Arthrodesis in Septic Knee Joint / 대한정형외과학회잡지

Although joint infection with severe destruction remains a serious problem and severe bone loss is relative contraindication of arthrodesis, knee arthrodesis is most commonly a salvage procedure. Its goals are to relieve pain and restore the patient to functional level of activity. The purpose of this study is to evaluate the results and complications of Ilizarov method for knee arthrodesis in the presence of infection. We retrospectively reviewed the records of twelve patients who had managed with knee arthrodesis with Ilizarov method. Indications for the operation included a infected skeletal defect secondary severe open trauma in four patients, an infection at the site of an arthroplasty in three (with failure of previous arthrodesis with monofixator in one), an infected charcot joint in four and one pyogenic arthritis spreading from osteomyelitis of proximal tibia. The average age of the patients at the time of operation was fifty-three years (range twenty-two to eighty years). Follow-up averaged 17 months. The minimum follow up periods was 9 months. Average duration of Ilizarov fixator application was 7.2 months. In 3 cases we performed corticotomy and internal bone transport to treat large bone defect (17cm, 8cm, 6.5cm). Autoiliac bone graft was done in fusion site in two cases, and in three cases we performed bone graft at the docking site. Solid osseous union occured in each patient. There was no reinfection and nonunion. Average shortening was 3.4 cm. Complications were related to pin tract. When last seen, all patients were free of pain and could walk without cruthes or cane. Despite its pin tract problems, bulky cumbersome and expensive apparatus, the Ilizarov method is one of effective method for knee arthrodesis in the presence of infection and large bone loss especially.

Cartilage Overgrowth of the Femroal Head and Acetabulum in Legg-Galvé-Perthes' Disease as Viewed on Mri / 대한정형외과학회잡지

Eighteen patients(19 affected hips and 17 unaffected hips) with Legg-Galvé-Perthes' Disease(LCP) were reviewed to evaluate the relationship between medial joint space widening and lateral subluxation of the femoral head. MRI was used to evaluate components in widened medial joint space in radiographs. There was increased cartilage thickness of the femoral head and acetabulum and increased joint fluid which represented synovial hypertrophy in the widened medial joint space in radiographs. Increased cartilage thickness was found at the medial aspect of the femoral head and at the lateral and posterior walls of the acetabulum when compared to unaffected hips and normal control hips. Widening of the medial joing space was related to lateral subluxation of the femoral head during the fragmentation or remodeling stage, not always during the avascular stage, in LCP. Widening of the medial joint space did not change remarkably after a Salter osteotomy or femoral varus derotational osteotomy because of the remaining cartilage thickness.

Intraarticular Anatomic Variants Associated with Discoid Meniscus / 대한정형외과학회잡지

Discoid meniscus in the knee joint is common. From July 1990 through June 1994, the authors performed arthroscopy on 968 symptomatic knee joints. One hundred and six knees of 102 patients had discoid meniscus. Of the 106 knees, 14(13.2%) cases were associated with other intraarticular anatomic variants. There were 7(6.6%) cases with anomalous insertion of the anterior horn of the medial meniscus into the anterior cruciate ligament, and 7(6.6%) cases with anterior transposition of the insertion of the anterior cruciate ligament below the anterior tibial margin like the insertion of the posterior cruciate ligament. Of the 14 patients, the discoid meniscus were reshaped in 11 knees, partially resected in 2 knees, and one patient was treated with repair of a peripheral tear and reshaping. But had no treatment in associated intraarticular anatomic variants. The follow up was done from 24 to 54 months(average 37 months) after surgery. The results were excellent in 8 knees ; good in 4 knees and fair in 2 knees(Ikeuchi scale, 1982) The patients with excellent or good results were satisfied as were the authors, and these anatomical variants other than the discoid meniscus were not related to the patient's symptoms.

Treatment of Tibial Bone Defect by Internal Bone Transport Using Ilizarov Method / 대한정형외과학회잡지

We reviewed twenty-six tibial bone defects which had been treated by internal bone transport to evaluate the results and complications and of the Ilizarov method. The causes of defects were open fracture(13 cases) and infected non-union(13 cases) The mean bone defect was 8.2 cm, ranging from 2 cm to 20 cm, in open fracture and 6.5 cm, ranging from 2 cm to 17 cm, in infected nonunion. All cases attained bone union. The mean radiologic consolidation index was 1.3 month/cm. The mean external fixation time was 18.5 months, ranging from 4 months to 33 months. Complications were pin-tract infection(20 cases), equines contracture of ankle(4 cases), knee flexion contracture(1 case), axial deviation(5 cases), valgus deformity of ankle(1 case), leg length discrepancy(7 cases), stress fracture at corticotomy site(2 cases), delayed union(1 case), infection recurrence(1 case), soft tissue invagination(3 cases) and refracture(2 case). The Ilizarov method is a useful treatment for tibial bone defects. Bone grafting at the docking site is recommended in order to shorten the treatment time and to avoid refracture and nonunion.

Proximal Tibiofibular Arthrolysis in High Tibial Osteotomy / 대한정형외과학회잡지

High tibial osteotomy has been widely accepted as a method of treatments for middle-aged varus osteoarthritides with uncompartmental involvements. There have been several reports regarding the managements of fibula and their complications during the valgization procedure of tibia. They are, for example, osteotomy of fibular diaphysis or neck and excision of fibular head. Each level of fibular management is often complicated by nonunison, peroneal nerve palsy and lateral instability respectively. We have reviewed 20 cases of cases of high tibial osteotomy using proximal tibiofibular arthrolysis performed between March 1987 and February 1993. This method has proved excellent exposure of upper lateral tibia for the wedge removal, internal fixation and relief of the tethering effect of fibula. There was no peroneal nerve palsy relate to this degenerative change of the proximal tibiofibular was 3.4mm(range 1-11mm) and there was neither degenerative change of the proximal tibiofibular joint nor varus instability. In conclusion the arthrolysis of proximal tibiofibular joint can be highly recommended in high tibial osteotomy.

Anterior Decompression Treatment in the Cervical Spine Injuries with Neurologic Deficits / 대한정형외과학회잡지

To evaluate the neurologic and functional improvement of anterior decompression and fusion in patients with cervical spin injury, the clinical records and x-rays of 17 patients who were treated at Gyeong-Sang National University Hospital between January 1989 and December 1993 were analyzed. The results were as follows 1. There were complete injuries of the cord in six cases, incomplete injuries in nine and nerve root injuries in two. All the patients were treated using anterior decompression and autogenous iliac bone graft with cervical plate fixation within 7 days after trauma. 2. The average time lapse from the operation to radiological union was 9.2 weeks(range;7–14 weeks). 3. The prognosis for neurologic recovery mainly depends on the severity of the initial neurologic status. The recoveries of neurologic deficit were complete in four cases, partial in ten and none in three. The motor index improved from 45.6 to 64.6 and the modified Barthel index was 71.2 points at the last follow-up. 4. The clinical results were excellent in nine cases, good in three, fair in two and poor in three. In conclusion, anterior decompression and fusion with bone graft and cervical plate provided early mobilization and rehabilitation, and improved neurological function in a considerable portion of the patient who had neurologic deficits after cervical spine injuries.

Femoral lengthening and deformity correction by the ilizarov method / 대한정형외과학회잡지

No abstract available.