Avulsion Fracture of the Posterior Cruciate Ligament from Femoral Insertion Occurred in a Patient with Residual Poliomyelitis: A Case Report

Avulsion fracture of the posterior cruciate ligament from its femoral insertion is quite rare, particularly in adults, and the treatment guidelines have not been established. A 68-year-old female patient with residual poliomyelitis presented with an avulsion fracture of the femoral insertion of the posterior cruciate ligament after a falling accident and was treated with arthroscopic headless compression screw fixation and pull-out suture of the avulsed ligament. We report this case with a relevant discussion of this type of injury.

Classification and Management of Fixed Paralytic Pelvic Obliquity / 대한정형외과학회잡지

In order to group the pelvic obliquity into clinically useful classification and to develop appropriate guidelines for treatment, we evaluated 55 patients who had been treated between 1985 and 1993 for pelvic obliquity after poliomyelitis. Age at surgery ranged from 15 years to 49 years (average 27 years). Fixed pelvic obliquity after poliomyelitis was classified into two major types according to the level of the pelvis relative to the short limb and into four subtypes in each type according to the direction and severity of scoliosis. Forty-six patients had obliquity with the pelvis down (type I), and nine patients had the pelvis up (type II) on the short limb side. Subtype A: straight spine with localized lower lumbar compensatory angulation, mainly at the L4-5 intervertebral space. Subtype B: mild scoliosis with convexity to the short limb side, Subtype C: mild scoliosis with convexity opposite to the short limb side. Subtype D: moderate to severe paralytic scoliosis, which has a convexity to the short limb side in type I and opposite to the short limb side in type II. In the pelvis of type I-A, I-B and I-C deformities, abduction contracture of the hip was released on the side of affected short limb, and lumbodorsal fasciotomy was performed on the contralateral side of short limb, where iliolumbar angle converged and the pelvis was elevated, if necessary. In most cases, hip instability existed on the side of short limb and it was treated with triple innominate osteotomy, which also contributed to leg length equalization by lengthening. In type II-A, II-B and II-C deformities, it was necessary to perform a triple innominate osteotomy on the side of affected short limb with adducted unstable hip in most cases. Lumbodorsal fasciotomy was performed above the iliac crest of elevated hemi-pelvis with short limb, where iliolumbar angle converged. In case of abduction contracture of contralateral hip, contracted fascia was released. In the pelvis that had a type I-D or type II-D deformities, treatment might include bony surgeries such as spinal fusion or triple innominate osteotomy, with appropriate soft tissue release. We propose a systemic and comprehensive classification for fixed pelvic obliquity after poliomyelitis. According to this classification, we and decide to combine corrective surgeries, and find the side where the surgery should be performed.

The Shelf Procedure for the Dysplastic Hip in Poliomyelitis Patients / 대한정형외과학회잡지

The hip joint subluxation and dislocation due to poliomyelitis worsen the limping and caused the painful hip. Shelf procedure has been described as a safe, conservative and reliable approach to the of a dysplastic acetabulum. We performed shelf procedure for the dysplastic hip in poliomyelitis in thirteen patients since May, 1990. The age at operation was 21 to 38 years old and three of them were male and ten were female. All the patients were followed up for average 2.5 years(1-4. 5yrs). The hip joints showed better stability after shel'f procedure and less limping. There was no complication except one redislocation.

Final Follow-up of Epiphysiodesis at Skeletal Maturity in Residual Poliomyelitis / 대한정형외과학회잡지

During the twenty two years, Aug. 1963 through Aug. 1985, we performed 83 cases of epiphysiodesis on patients with leg length discrepancy due to poliomyelitis. In an attempt to determine the accuracy of predicted correction, we analyzed predicted final discrepancy at the time of operation and actual final discrepancy at or near skeletal maturity. Of the 83 cases, 30 cases were available for final evaluation. Among four methods of prediction that have been employed, those of White and Stubbins, and Anderson, Green and Messner were statistically reliable. The method of Gill and Abbott was statistically not reliable in our series, presumably because it utilizes percentile distribution of stature based on Caucasian population in the United States. Mosley's prediction was also made on 8 of the cases. However, we were unable to reach statistically significant conclusion, obviously because of short period of preoperative assessment on limited number of cases at this time. Prediction of correction on 5 cases in which both lower extremit.ies were affected, was statistically not reliable in all methods employed.

A Perspective Review of Residual Poliomyelitis Patients Admitted to Seoul National University Hospital during the Past Eighteen Years / 대한정형외과학회잡지

In Korea, owing to effective vaccination, occurences of poliomyelitis begen to decrease rapidly from 1964 and in recent years less than 10 cases of acute infection are being reported annually. However, patients crippled with poliomyeltis residua, mainly the legacy of the many epidemics of 1950s, and early 1960s, are many and pose a social and national problem as well as a personal and family ordeal. We reviewed 536 patients with residual poliomyelitis admitted and treated at Seoul National University Hospital during the past 18 years, from 1963 to 1980 They were divided into four chronological groups; the first, 1993 to 1968, the second 1968 to 1973, the third, 1974 to 1977, and the fourth, 1978 to 1980, In each group, based on in-patient records, and out-patient records, epidemology, deformities, and treatment were extensively reviewed. The followings are the outcome of this investigation 1. The male-to-female ratio was 53.7%: 46.3%, The male majority, distinct in the first group with 63. 7%, became less conspicuos in the fouth group with 50. 3%. 2. Average age oe admission, which was 10. 7 years in the first group, had increased decidedly to 17. 8 years in the fourth group. 3. The age of onset was most frequent between 1 to 2 years with 45.8% and next frequent between 7 to 12 months with 23. 5%. The ages below 5 years occupied 97. 6% of the cases. 4. The year of onset was most frequent from 1961 to 1963 with 28.7%. The incidence markedly and steadily decreased thereafter. 5. 94. 5% of the cases were unvaccinated. The remaining cases, except one, had had incomplete vaccination. 6. Fever, with 74. 0% was by far the most frequent initial symptom. Vomiting and diarrhea were the next frequent symptoms. 7. Of the 60% of the patients who had had any previous treatment, 25. 9% had operations and 20. 4% had braces and crutches. 8. Average number of admissions per patient were 1. 7 and average number of operations were l. 9. Average length of hospitalization was 39. 2 days. 9. 23. 6% of the patents had hip deformities, of which flexion defermity was most frequent with 4. 7%. Soutter fasciotomy or Campbell operation was employed in order to correct flexion deformity. In the earlier groups, Mustard operation, Sharrard operation, Ober-Barr operation, and pem-berton osteotmy were commonly practiced, whereas in the later groups, Thomas-Thompson-Straub operation, combined Thomas-Thompson-Straub and Ober-Barr operation, Salter osteotomy, Chiari osteotomy, Steel osteotomy were favored. 10. 45.2% of the patients had knee and leg deformities, of which flexion deformit; was most frequent with 14.5%. Flexion-valgus-external rotation deformity and flexion-valgus deformity with 4.6% and 4.5%, respectively, followed next. 11. 83. 9% of the patients had foot and toe deformities, of which equinovarus deformity occupied 6. 5% equinovalgus deformity 6.8%, and clawing of great toe 25. 2%. Triple arthodesis was done most frequently with 45. 9% of the cases, or 282 feet. Jone's operation or its modification, Tendo Achilles lengthening, plantar fasciotomy, and Peroneal tendon transfer were also frequntly performed. 12. There was leg length inequality in 90%. of the cases, Epiphysiodesis and femoral shortening were carried out, except for 4 cases of stapling in the earliest group, and femoral lengthening was done in 3 cases. 13. Spineal deformity was found in 19.7 % Of the cases, of which scoliosis was most freqent with 11. 5%. 7% of the cases had pelevic obliquity. Lumbodorsal fasciotomy, and postrior spinal fusion with Harrington instrument were carried out in order to ameliorate these deformities. 14. Deformities in the upper extremity were found in 3.6% of the patients. Procedures carried out inclulded shoulder fusion, Saha's operation, Steindler's flexorplasty, sternocleidomastold transfer, wrist fusion and opponensplasty, etc. 15. Generally, there was marked improvement of disability after treatment. The patients having moder.ate to severe limping decreased from 41.3%, preoperatively, to 25% after operation.