The Treatment of Hip Fracture / 대한정형외과학회잡지

Because most of the hip fracture is endemic to an elderly population, high mortality and morbidity has been encountered due to the fatal complications such as pneumonia, thromboembolism, and decubitus ulceration. So, it is essential to achieve early ambulation with complete reduction by strong interoal fixation divices in order to reduce those complications. As early as 25 years ago McCarroll remarked that this fracture must be considered “unsolved until the incidence of aseptic necrosis and nonunion could be diminished or abolished. Since that time improved reduction method and many new strong fixation divices such as Jewett nail-plate, Massie nail, and compression hip screw have been developed to achieve more accurate reduction and rigid immobilization. The following clinical results were shown by analysis of 117 cases of hip fractures experienced in the Department of Orthopedic Surgery, Seoul National University in the past 5 years from Jan. 1974 to Dec. 1978. 1. Femoral neck fractures were 67 cases and intertrochanteric fractures were 36 cases. 2. The most common cause of hip fractures was slip or fall (70.1%). 3. Incidence of femoral neck fracture was most frequent in the 6th decade, and that of the intertrochanteric fracture was in the 7th decade that is compared with 7th and 8th decade of Caucasian respectively. 4. Old hip fracture more than 3 weeks after trauma was in the 53.6%, and especially that of neck fracture was about 57%. 5. In the classification of the hip fractures, transcervical neck fracture was most frequent (70.1%), and unstable type (79.5%) in the intertrochanteric fracture. 6. Knowles pin was usually used in the stable neck fracture, while compression hip screw used in the unstable neck fracture. 7. Jewett nail-plate was usually used after Dimon-Hughston reduction, and compression hip screw after anatomical reduction in the unstable intertrochanteric fracture. But in the stable fracture either Jewett nail-plate or compression hip screw was usually used after anatomical reduction. 8. Endoprosthesis (26 cases), and total hip replacement arthroplasty (8 cases) were usually carried out in the old femur neck fracture treated by total hip arthroplasty was better than that by endoprosthesis. 9. Avascular necrosis was 13.3%, and nonunion 20% in the femur neck fracture. Nonunion was 12.5%, and delayed union 4.2% in the intertrochanteric fracture. With the above mentioned results, the following conclusion is obtained: 1. It is recommended that open reduction or arthriplasty of the hip should be performed if the closed reduction of the fracture of femoral neck is not adequate. 2. Graden alignment index is a good criteria for adequate reduction of femoral neck fracture. 3. Malunion induces the fate of femoral head to be avascular in the femoral neck fracture. 4. Compression hip screw is a good stabilizer for unstable intertrochanteric fracture. 5. The position of femoral endoprosthesis for delayed or inadequately reduced femoral neck fracture may be replaced by total hip replacement. The clinical result of total hip replacement is far better than that of femoral endoprosthesis In the cases of arthroplasty indication.

Recurrent dislocation of the Patella: Experience with Ten Knees / 대한정형외과학회잡지

Our experience with recurrent dislocation of the patella on ten knees in eight patients seen at Seoul National University Hospital during the last 2 years and eight months is reported. Five were female and three male. The age ranged from seven to 27 years. In four of the patients the onset was attributable to a definite history of trauma, while in one patient the dislocation was considered due to developmental anomalies and in another it was clearly congenital Still another patient had a progressively short limb due to premature closure of the distal femoral epiphysis with accompanying flexion-valgus deformity of the knee, presumably caused by an unrecognized infection during early childhood One adolescent girl had bilateral knock knees. The knock knees were treated successfully by supracondylar osteotomy and one post-traumatic knee by classical Roux-Goldthwait procedure with equally excellent result, The rest were treated by Greens vastus medialis transfer with division of the iliotibial band or reefing of the medial joint capsule when necessary. In one knee dislocation recurred, probably due to avulsion of the transferred vastus, and two knees had residual subluxation and limitation of flexion. The results on the remaining seven knees were excellent.

Osteoblastoma: A Case Report / 대한정형외과학회잡지

Osteoblastoma is a benign lesion somewhat similar to ostoid osteoma histologically but different from it clinically, roentgenologically and grossly. The autors have experienced a case of benign osteoblastoma of the neural arch of the Iumbar spine, and treated the case by total laminectomy and conflrmed with biopsy.

Anterior and posterior Correction for Severe Paralytic Scoliosis / 대한정형외과학회잡지

Since anterior approach to scoliosis was first reported by Dwyer in 1969, many orthopedic surgeons have treated scoliosis of a large variety of causes through a direct approach to the anterolateral portion of its convexity. Four cases of severe and paralytic scoliosis were treated by anterior and posterior approaches of the spine at the Department of Orthopedic Surgery of Seoul National University Hospital from April 1975 to April 1977. Among four cases, one case had bony fusion in the posterior element of the lumbar spine with 126 curvature from T11-to L5, which was corrected by lumber anterior discectomy on the first stage and osteotomy in the posterior element between L2 and L3 following Harrington instrumentation, resulting in 86 curvature. The other three cases were treated by Dwyer instrumentation primarily and then posterior fusion including sacrum with Harrington instrumentation 3 weeks after the first anterior approach, resulting in the average 70.1% correction which is compared with the average correction of 53.8% with Harrington instrumentation in our hospital.

The Use of Halo-femoral Traction in the Treatment of Scoliosis / 대한정형외과학회잡지

Of 29 scoliotic patients treated by Harrington and Dwyer instrumentation, fourteen patients were taken of preoperative cnrrection by halo-femoral skeletal traction for the last two years from June 1974 to June 1976 at the Department of Orthopedic Surgery, Seoul National University Hospital. The correctability of scoliosis by the use of halo-femoral traction was evaluated with roentgenogram study and the following result was obtained. 1. Of the 14 cases, five cases were male and eight were female, and they were between the age of 13 and 29. 2. The etiology of the 14 scoliosis was idiopathic in three, paralytic in eight, congenital in one, and associated with neurofibromatosis in two. 3. The average initial curve was 108 degress with the flexibility of 32.1% on side bending. 4. The average preoperative curve with halo-femoral traction for one week was 75. 1 (30.5% correction), and the end of two week was 68 (37% correction). 5. The average immediate postoperative curve was 58.5 (46.5% correction). 6. The result of traction in the different etiologic type showes no significant difference.

Congenital Agenesis of Odonteid Process: A Case Report / 대한정형외과학회잡지

Anomalous development of the odonteid precess is an uncommon clinical occurence that can seriously impair the integrity af the atlantoaxial articulation. Absence of the odontoid process may be either congenital or acquired, but clinically the etiology is of little importance as the clinical signs and symptoms and the treatment are identical in both. We experienced a case of congenital absence of the odontoid process and good result was obtained from the posterior atlantoaxial fusion with hale-cast.