Venous Thromboembolism and Superficial Femoral Artery Obstruction after Femur Intertrochanteric Fracture: A Case Report / 대한고관절학회지

As the elderly population increases, occurrence of hip fractures has shown a rapid increase, and posttraumatic and postoperative venous thromboembolism can lead to fatal complications. Current prophylactic management includes mechanical and chemical prophylaxis. A 76-year-oldfemale, who was lost to follow-up after diagnosis of pulmonary thromboembolism four years ago, was admitted to our emergency room for a right intertrochanteric fracture. Before the operation, the thromboembolism recurred and was treated with anticoagulation medication. Bipolar hemiarthroplasty and fixation of the greater trochanter with a hook plate were performed 18 days after the trauma. Superficial femoral artery obstruction and venous thromboembolism occurred on the first day after the operation.

Internal Fixation of Humeral Shaft Fractures Using Anterior Plating Technique

PURPOSE: To evaluate clinical results after anterior plate fixation for humeral shaft fractures. MATERIALS AND METHODS: We evaluated 20 patients with a humeral shaft fracture. Anterior plate fixation with anterolateral approach to the humeral shaft was performed in all cases. Time to fracture healing, presence of complications such as radial nerve injury, and range of motion of the affected shoulder and elbow joint were assessed. RESULTS: All fractures were united and the mean healing time was 16 weeks (range, 12 week to 1 year). There were one nonunion and one postoperative radial nerve palsy. The nonuion was treated with a longer plate and bone grafting, resulting in union. The radial nerve palsy recovered at 4 months after operation. Two preoperative radial nerve injury recovered spontaneously at 6 to 8 months. The mean flexion of elbow was 125degrees and mean extension was 0degrees. The mean flexion of shoulder was 170degrees and mean extension was 170degrees. CONCLUSION: Internal fixation of humeral fractures using anterior plating technique is recommended as a reliable method to regain satisfactory range of motion of the elbow and shoulder.

Osteochondroma of the Metacarpal Head in a Child: A Case Report

The osteochondroma is the most common benign bone tumor which occurs in the metaphyseal portion of long bone. The osteochondroma is rare in hand and extremely rare in the intraarticular location of the hand. We present a case of intraarticular osteochondroma which occurred at the fourth metacarpal head of the hand in a child patient.

Cauda Equina Syndrome due to Epidural Hematoma After Lumbar Epidural Block : A Case Report / 대한척추외과학회지

Cauda equina syndrome after epidural block is a rare complication, but it requires emergency surgery when it is diagnosed. A 65-year-old man who underwent epidural block at a local clinic was admitted with right lower leg weakness and decreased leg sensation, severe lower radiating pain, dysuria and decreasing sensation in the perianal region. Magnetic resonance image showed protruded disc material between L4-L5 and a hematoma that occupied most of the spinal canal and this was compressing the spinal cord. These findings were diagnostic for cauda equina syndrome after epidural block and so laminectomy, excision of the herniated disc and removal of the hematoma were done. At 6 months follow-up, the neurologic symptoms were resolved except for the dorsiflextion of the ankle and the big toe. We report here on a case of cauda equina syndrome as a rare complication after epidural anesthesia.

Retrograde Intramedullary Nailing or the Treatment of Segmental Femoral Shaft Fracture Including Distal Part

PURPOSE: To evaluate the usefulness of the retrograde intramedullary nailing for the treatment of segmental femoral shaft fracture including distal part. MATERIALS AND METHODS: We reviewed 15 patients of segmental femoral fracture, who had treated with retrograde intramedullary nailing and followed-up more than 1 year from January 2003 to October 2007. There were 10 men, 5 women, and the mean age was 45 years old. There were associated fracture in 10 cases. We evaluate the time for union, non-union and malunion by radiologic finding and functional assessment by Sanders' criteria. RESULTS: The mean time of union was 21 weeks. There was one delayed union in proximal fracture site. There was no shortening more than 1.5 cm, no angular deformity more than 10 degrees, no postoperative infection or instability. According to Sanders' criteria, there were excellent clinical results in 9 cases, good results in 5 cases and fair result in 1 case. CONCLUSION: The retrograde intramedullary nailing can be a useful method for treatment of segmental femoral shaft fracture including distal part.

Distally based Ulnar Artery Flap for Reconstruction of Hands

PURPOSE: We reconstructed the skin defect of hands exposing tendons and/or bone with distally based ulnar artery flap and report our cases. MATERIALS AND METHODS: Between March 2005 and September 2007, 6 cases of skin defect were reconstructed with distally based ulnar artery flap. Defect site were 5 cases of hand dorsal side and 1 case of hand volar side. The average defect size was 3x3 cm2. There were 4 men and 2 women and mean age was 55.5 years. We evaluated the viability of flap, postoperaive complication, healing time, patient's satisfaction. RESULTS: There was no flap failure in 6 cases. But 1 case with recurrent discharge was healed with several times adequate debridement and delayed suture. 1 case with flap edema which might be due to venous congestion was healed with hand elevation and use of low molecular weight heparin. Mean time to heal the skin defect was 4 weeks. No infection and recurrence was found in follow up period. Cosmetic results as judged by patients were that 3 cases are good and 3 cases are fair. CONCLUSION: Distally based ulnar artery flap is good treatment method among the numerous methods in the cases of skin defect, with soft tissue exposed, which is not covered with debridment and skin graft. Distally based ulnar artery flap is useful method for the skin defect of hands because it is simple procedure, has constant blood supply and relatively good cosmetic effect.

Intramedullary K-wire Fixation for Displaced Fracture of Distal Radius

PURPOSE: To evaluate indications and effectiveness of intramedullary K-wire fixation for distal radial fractures. MATERIALS AND METHODS: Twenty one fractures of distal radius treated with intramedullary K-wire fixation from April 2001 to September 2002 were evaluated. The mean age was 67.8(range 46~82). Severely comminuted intra-articular fractures and Barton's fractures were excluded. One or two K-wires were added percutaneously. To assess the functional result, we used Green and O'Brien score system. The radiographic assessment included a scoring system based on measurements of radial length, radial inclination, volar tilt and step-off of the radial articular surface. RESULTS: Average follow up period was 13.5 months. In functional result, excellent and good result were obtained in 18 cases (86%). In radiologic result, mean loss of radial length, radial inclination and volar tilt were 0.9 mm, 1.4degrees, 0.9degrees, respectively. CONCLUSION: The advantages of intramedullary K-wire fixation were relatively simple procedure, low occurrence of soft tissue complications and early wrist motion. Intramedullary K-wire fixation was good to maintaining reduction in osteoporotic bone.

Internal Fixation of Clavicle Lateral and Fracture with Mini T-plate

PURPOSE: To evaluate the effectiveness of a mini T-plate fixation in clavicle lateral end fractures. MATERIALS AND METHODS: We reviewed eleven cases of calvicle lateral end fracture which were treated with open reduction and internal fixion with mini T-plate from May 2000 to December 2004. The follow up period was 12 months minimum. The radiologic result, pain and shoulder function were evaluated by the ASES shoulder score. RESULTS: All cases showed satisfactory results. Seven cases (63%) were excellent, and four (37%) cases were good. There were no fair or poor results. All cases showed radiologic union by the fifteenth week. No complications such as metal breakage, limited motion, infections were seen. CONCLUSION: This study demonstrates that using a mini T-plate fixation which is easy and induces no injury of acromiocalvicular joint, contributes to provide stable fixation in clavicle lateral end fractures.

Effect of Alternative Splinting at Extension and 90degrees Flexion on Range of Motion after Open Reduction and Internal Fixation of Distal Femur Fracture

PURPOSE: To evaluate the usefulness of early range of motion exercise by using 90degrees knee flexion splint after open reduction and internal fixation in fracture of distal femur. MATERIALS AND METHODS: We reviewed twenty-six cases of distal femur fractures which were treated with open reduction and internal fixation from February 2002 to November 2003. One group (group A) were treated by using 30degrees knee flexion splint, the other group (group B) were treated by using 90degrees flexion and full extension splint alternativley by post-operative 1 week. The follow up period was minimally 12 months. The range of motion and Schatzker and Lambert criteria were evaluated. RESULTS: The mean period to gain 90degrees knee flexion was 11.4 (7~14) weeks in group A, and 6.6 (3~8) weeks in group B. Mean range of motion was 94.7degrees (average flexion contracture 9.5degrees ) in A group and 108.7degrees (average flexion contracture 6.3degrees ) in B group at 12 weeks follow-up. According to Schatzker and Lambert criteria, excellent result was achieved in 10 cases (38%), good result in 13 cases (50%), fair result in 3 cases (12%). CONCLUSION: This study demonstrates that alternative splinting at extension and 90degrees flexion contribute to early recovery of range of motion in distal femur fractures treated with internal fixation.

Gottron's Acrogeria Syndrome: a case report / 대한정형외과학회잡지

Gottron's acrogeria syndrome is a rare genetic disease of unknown etiology with some features suggestive of accelerated aging. The typical clinical presentation consists of premature aging of the skin with atrophy of the cutis and the subcutis. After a brief review of the literature available on this syndrome, we report a case of Gottron s acrogeria syndrome in a 19 year-old man whose right rectus femoris muscle had a fibrotic contracture.

Medial Approach of Supracondylar Fracture of the Humerus in Children / 대한정형외과학회잡지

The Supracondylar fracture of the humerus is the most common elbow fracture in children. In general, accurate anatomic reductio, the least regional trauma as possible and the maintenance of the reduction are necessary to obtain excellent results. Lateral and posterior approach is commonly used method for the treatment of supracondylar fracture of the humerus in children. But lateral and posterior approach has some troubles in reduction of fracture and Kirschner wire fixation. From March 1988 to February 1993, seventeen supracondylar fractures of the humerus were treated by means of medial approach and followed from 8 monts to 13 months with an average 10 months. There were some advantages in medial approach. Reduction was easy and ulnar nerve was not damaged by medial approach at insertion of Kirschner wire and no more another incision. The results obtained are as follows. Postoperative vascular impairment or Volkmann's ischemia was not complicated and neurologic deficits accompanied with injury were all recovered completely. According to Mitchell and Adams' criteria, all had satisfactory results.

A study for the change of articular cartilage and synovium of rabbit knee after osmic acid injection / 대한정형외과학회잡지

No abstract available.

A glomus tumor on the distal arm: a case report / 대한정형외과학회잡지

No abstract available.

A study of hand lesion exposed by radiation / 대한정형외과학회잡지

No abstract available.

Experimental Study for Peripheral Nerve Reconstruction using Skeletal Muscle and Omentum / 대한정형외과학회잡지

The experimental study for peripheral nerve reconstruction was performed using degenerated skeletal muscle and omentum. At the sciatic nerves of 26 rabbits, about 10mm gaps were made under ketamine anesthesia. Degenerated skeletal muscles were made through the procedure of freezing with liquid nitrogen and thawing in distilled water. And omenta were taken through midline abdominal incisions. On 14 rabbits of experimental group, the nerves were connected with the degenerated skeletal muscles and surrounded with the omenta. On 6 rabbits of control group, the nerve gaps were connected with the degenerated skeletal muscles without surrounding with the omenta. And the other 6 rabbits of control group, the gaps were lets without further treatment. After 3, 6, 9 and 12 weeks, the results were compared using light microscope and transmission electron microscope. There were contractions and fragmentations at the skeletal muscles during the freezing and thawing. There were nerve regenerations through the degenerated skeletal muscles. The nerve tissues of the experimental group were more abundant than the control group using the degenerated skeletal muscles only.

A Study about the Laxity of the Ankle Joints of the korean Adults / 대한정형외과학회잡지

The normal criteria of the ankle joint laxity of the Korean may be different from that of the western. For the objective study, we designed two devices for the anterior drawer test and inversion stress test. Using the devices we radiologically examined the 120 ankle at neutral and 30 plantar flexed position. The following results were obtained; l. In the talar tilt angle, the minimun angle, the maximun angle and the mean were 1.0°, 12.0°, 3.7° respectively at the neutral position and 1.0°, 19.0°, 4.8° respectively at the 30° plantar flexed position. 2. With the Grace method, the minimum distance, the maximum distance and the mean were 3.Omm, 12.0mm, 5.2mm respectively at the neutral position and 3.0mm, 12.6mm, 6.1mm respectively at the 30 plantar flexed position. 3. With the Kelikian method, the minmum value, the maximum value and the mean were Omm, 7.5mm, 2.2mm respectively at the neutral position and Omm, 8.0mm, 2.5mm respectively at the 30 plantar flexed posion. 4. There was no difference in laxity for the age and sex.

Tension Band Wiring as a Treatment of the Surgical Neck Fracture of the Humerus / 대한정형외과학회잡지

Fractures of the upper end of the humerus are common and account for 4% to 5% of all fractures. They occur more frequently in older patients. In older patient the fracture often results from a minor fall and can be extremely disabling and their management often demands experienced surgical skill and judgement. Fortunately, in 80% of upper humeral fractures none of the four major segment is significantly displaced. These lesions are amenable to simple treatment by early function exercises. In 15% to 20% of upper humeral fractures one or more of the major segment is displaced. They are often unstable, may not be reduced by closed method. Many different methods of open reduction and internal fixation has been used and are still employed. These include wire loops, screw, staples, plates, intramedullary nail, but adequate internal fixation was not easily achieved due to the osteoporosis, displacement and shape of fragment. We treated 8 cases of surgical neck fractures by Rush pin and tension band wiring method. We consider this method as effective, simple and rigid fixation technique to attempt early exercise and to restore normal range of motion.

Reconstruction of Anterior Cruciate Ligament with Iliotibial Band Transfer / 대한정형외과학회잡지

Ligamentous injury of the knee which could be easily occur in sports or traffic accidents resulted in more and severe disability than that of other joints. Rupture of the anterior cruciate ligament which restrain hyperextension, excessive rotation and anterior motion of tibia on femur is the most frequent and significant injury of the knee. Its treatment and clinical significance is one of the most controversial issue and its incidence tends to increase. From 1983 to 1985, modified Scott operation were performed on 10 patients at the department of orthopedic surgery, Chung Ang university hospital. Following results are obtained. 1. No limitation of range of motion of the knee was developed. 2. Intra-articular fixation by use of pull-out wire was done and special consideration was done for the site of fixation on tibia plateau and method of dilatation of posterior capsule. 3. Of the ten patients, nine had negative anterior drawer test, postoperatively.

The Measurement of the Soft Tissue Pressure beneath a Tourniquet in the Arm / 대한정형외과학회잡지

The use of a pneumatic tourniquet is potentially associated with injury to underlying muscles, vessels, and nerves if excessive pressure occurs beneath the toumiquet. In order to minimize the risk of soft tissue injury, the lowest tourniquet pressure that maintains a bloodless operative field should be used. A clinical study was undertaken to evaluate the pneumatic tourniquet setting required for adequate hemostasis in upper extremity surgery. From March to September in 1984, the subcutaneous soft tissue pressure of the 20 upper extremities beneath a pneumatic toumiquet in the arm were measured directly and the following results were obtained. 1. The underlying subcutaneous soft tissue pressure was not affected by adult, age, arm circumference, and blood pressure of normal range. 2. The underlying subcutaneous soft tissue pressure showed direct correlation with the tourniquet pressure respectively. 3. A tourniquet preasure of more than 250 mmHg was not rarely required in a normotensive individual.

Conservative Treatment of Achilles Tendon Rupture / 대한정형외과학회잡지

No abstract available in English.