Trivia that Counts

No abstract available.

Septic Hip in a Child due to H.influenzae: Problems with a Recent Experience / 대한정형외과학회잡지

We report a case of acute septic arthritis of the hip in a child due to H. influenzae with review of the problems encountered. A one year and 9 months-old male child was admitted because of fever, limping and restlessness of 48-hour duration. Under the impression of septic arthritis of the right hip, blind broad-spectrum antibiotic regimen was initially instituted. Fever subsided immediately and two blood cultures yielded no growth, as did joint tapping. But fever recurred on the 8th day of admission. MRI demonstrated fluid collection in the right hip. Arthrotomy yielded thin pus. The antibiotic regimen was shifted to vancomycin, according to the culture report of S. aureus. However, spiking fever continued. On the 4th week of admission, recheck MRI demonstrated fluid collection in and out of the hip joint. A second arthrotomy yielded frank pus. H. influenzae was reported in pus culture for the first time, being susceptive only to chloramphenicol. Fever was down to normal temperature after injection of urfamycin. Radiograph on the 17th day after the 2nd arthrotomy revealed posterior dislocation of the right hip. MRI demonstrated granulation tissue within the acetabulum. Open reduction confirmed granulation tissue without pus. This case suggests: 1. Routine blind antibiotic regimen for gram-positive and negative organisms in the initial phase of treatment may fail in the rare case of H. influenzae. This may lead the surgeon to miss the optimum time of surgical intervention despite early diagnosis, 2. Arthrotomy may fail if not followed by antibiotics sensitive to the pathogen. 3. Delayed pathologic dislocation may ensue due to invasion of granulation tissue.

Total Hip Arthroplasty for Fused Hips / 대한정형외과학회잡지

The conversion of the fused hip to THA may be used for patients with painful pseudoarthrosis, and malposition of the arthrodesed hip. It may also be used for patients with disabling pain in the ipsilateral knee, contralateral hip or lower back. Nineteen fused hips have been converted to total hip arthroplasty from January 1985 to December 1993. They were followed up for an average of 6 years. The causes of the fused hip were post-traumatic osteoarthritis (8 cases), tuberculous arthritis (6 cases), ankylosing spondylitis (3 cases) and rheumatoid arthritis (2 cases). The results of THA were satisfactory in all cases. The average Harris hip score after THA was improved from 56 to 84.1. The results of THA were best in patients with tuberculous arthritis and poorest in patients with ankylosing spondylitis. The average range of motion after THA is as follows: flexion 82 degree, abduction 28 degree, adduction 16 degree, external rotation 27 degree and internal rotation 13 degree. The average leg length discrepancy improved from 3 cm to 1.5 cm. The conversion of the fused hip to THA improves the patient s quality of life, so it is a useful treatment for the fused hip.

Fracture of the Ipsilateral Femur after Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: Although considered uncommon, periprosthetic fracture of the femur after hip arthroplasty is a serious complication that can be difficult to treat. Authors analyzed the types of fracture and modality of treatment. MATERIALS AND METHODS: Between Jan. 1983 and Dec. 1997, 17 cases of postoperative periprosthetic fractures had been treated at our hospital. These cases were followed up for an average of 58 (13-123) months. The fractures were classified according to Duncan and Masri classification. Three cases of type A, and 6 cases of type B1, 3 cases of type B2, 3 cases of type B3 and 2 cases of type C. The 3 cases of type A and 2 cases oftype B1 were conservative treatments. The 4 cases of type B1 were treated with open reduction and internal fixation with bone graft. The 3 cases of type B2 and 3 cases in type B3 were treated with long stem revision. The 2 cases of type C were treated with open reduction and internal fixation with bone graft. RESULTS: Bony union happened in all cases. The results according to Beals and Tower criteria were excellent in 12 cases, good in 3 cases and poor in 2 cases. CONCLUSIONS: The most frequent cause of periprostic fracture was trauma and other causes were loosening and osteolysis. Proper treatment method of periprosthetic fracture were important for stability of femoral stem

A Modified Colonna Capsular Arthroplasty For Old Unreduced DDH in Late Childhood and Adolescence: A Mid-term follow-up study / 대한정형외과학회잡지

Sixteen patients who underwent 18 modified Colonna capsular arthroplasty for old unreduced DDH1 between 1984 and 1992 were recalled and critically reviewed. The average age at operation was 11.5 years (range, 8.1 to 14.5 years). The average follow-up period was 7 years and 1 month (range, 5 to 13 years). All of the patients had pain or discomfort of the hip and limp. Femoral shortening was combined in all patients, and 13 hips required concurrent pelvic osteotomy (Chiari osteotomy in 5 hips Salter innominate osteotomy in 1 hips and Steel s osteotomy in 2 hips) or slotted shelf augmentation (5 hips) due to small and shallow acetabulum relative to the femoral head. In the remaining 5 hips which had thick medial acetabular wall acetabular reaming alone was performed. At the latest followup, 9 hips showed excellent 5, good; and 4, fair results according to the modified Harris hip score and IOWA hip score. In addition, all patients except one were satisfied with the outcome in terms of regaining hip stability and decrease in pain or discomfort and limp. Radiological evaluation revealed progressive, significant increase in size of the femoral head and sphericity improvement in 12 hips. The sphericity of the femoral head did not improve in other 2 hips. In the remaining 4 hips, in which preoperative femoral head shape was relatively aspherical, the sphericity worsened after affection of ischemic necrosis or osteoarthrosis. Complications included undisplaced femoral neck fracture during physiotherapy in 2, ischemic necrosis in 2, heterotropic ossification in 2, acetabular protrusio due to too much reaming in 3 hips, and residual subluxation requiring additional pelvic surgery in 2 hips, In conclusion, we believe that modified Colonna capsular arthroplasty with femoral shortening is valid, if properly done, in the reconsruction of painful hip with old unreduced DDH in late childhood and adolesence.

Two-Stage Reimplantation for the Treatment of Infected Total Knee Arthroplasty / 대한정형외과학회잡지

Deep infection following arthroplasty of the knee is a serious complication resulting in pain, discharge and loss of function. The incidence of deep infection ranges from 1% to 2% in a majority of reported series. There are several options for treatment of infected total knee arthroplasty: (1) antibiotic suppression, (2) debridement, (3) resection arthroplasty, (4) reimplantation, (5) arthrodesis, (6) amputation. Among them, recent reports have favored a two-staged regimen exchanging the prosthesis in an infected knee by using an antibiotic impregnated cement spacer. The result of our study support this option for treatment. We have experienced 14 cases of two-staged reimplantation in infected total knee arthroplasty, diagnosed according to the criteria described by Bengstons and followed up for more than two years. The average interval from prosthesis removal to revision was 6.85 weeks. Prior to revision, the average knee score was 50 points, and the average range of motion was 74 degree. After revision, the average knee score was 81 points. The average range of motion was 95 degree. Our protocol for the treatment successfully eradicated the deep infection in 13 patients, only a patients who had severe rheumatoid arthritis was the sole documented case of reinfection.

The Effect of the Heel Cord Advancement on the Calcaneal Growth in Spastic Cerebral Palsy / 대한정형외과학회잡지

Heel cord advancement(HCA), which has been applied for the correction of equinus deformity in spastic cerebral palsy, has some theoretical advantages. However, HCA has also theoretical disadvantage that the procedure remove the tensile force exerting to the calcaneal apophysis. In order to evaluate the effect of HCA on the calcaneal growth, we compared the changes of calcaneal and foot lengths between the operated feet and non-operated feet after HCA. Among the 54 patients who had been treated with HCA at Seoul National University Childrens Hospital from March 1990 to August 1995, we excluded the cases who had been treated bilaterally, and also excluded hemiplegic patients in whom the ipsilateral feet were already shortened and the growth rates are different between the ipsilateral and contralateral foot. Seven patients who met the criterior of this study were included for the evaluation. There were 3 diplegics and 4 paraplegics, and average age at operation was 10 years and 6 months(range; 7 year 8 months-16 year 5 months). Average follow-up period was 3 years and 5 months(range; 2 years-4 years 9 mos). Total calcaneal lengths, anterior and posterior part of calcaneal lengths were measured on the standing lateral radiographs of the foot and ankle. Ratios of the operated limb over the non-operated limb were calculated for the three parameters. Ratios of posterior part of calcaneal lengths decreased significantly(P=0.031). Ratios of total calcaneal lengths decreased and ratios of anterior part of calcaneal lengths increased. However, the changes of two ratios were not significant. Ratios of posterior part calcaeal lengths over total calcaneal length decreases significantly(P=0.016). In conclusion, HCA can cause calcaneal growth retardation, especially posterior part of calcaneus, due to removal of physiologic tensile force of Achilles tendon.

The Use of Xenograft ( Lubboc(r)) for Pelvic Osteotomy in Children / 대한정형외과학회잡지

The purpose of this study is to present a novel method of harvesting autogenous bone graft and to analyze the behavior of xenograft used for pelvic osteotomy in young children. Twenty hips of eighteen patients underwent pelvic osteotomies using xenograft (Lubhoc) from Sep. 1993 to Jun. 1996. In fitteen hips, we harvested autogenous bone avoiding damage to the chondroapophysis of iliac crest and t'illed the donor site with the xenograft. It supplemented the autogenous bone at the osteotomy site in eleven hips, and was used as a wedge without autogenous hone in five hips. During the followup, no growth disturbance of iliac crest was found. The xenograft incorporation was satisfactory at the graft donor sites and the osteotomy sites where it supplemented the autogenous bone, however, unsatistactory at the osteotomy sites where it was used alone. Our novel method of harvesting bone graft from young pelvis may help prevent growth disturbance of lilac crest, and Luhhoc is useful as space-filler of donor site and suppiementary to the autograft in pelvic osteotomy of young children.

Fibrodysplasia Ossificans Progressiva / 대한정형외과학회잡지

Fibrodysplasia ossificans progressive (FOP) is an extremely rare disabling disorder characterized by progressive heterotopic ossification associated with congenital digital malformations. The purpose of this study is to delineate the problems in diagnosis and treatment of this rare disease, and to present their solutions. Nine Korean FOP patients have been followed up for average 7.2 years. Their medical records and radiographs were reviewed, and they were reexamined directly or interviewed by telephone. There were 6 female and 3 male patients. The age at the time of this study averaged 13.3 years (range, 4 to 23). In 5 cases, the first clinical manifestation was migrating scalp and neck mass at the age of 1-2 years. The diagnosis was delayed for 3 year and 5 months at average although all the patients had pathognomonic big toe anomaly. Surgical excision of heterotopic ossification in an attempt to increase the joint motion was performed in 4 cases but in vain. Posterior spinal fusion in 1 case failed to prevent progression of scoliosis and trunk decompensation. Disodium etidronate, tried in 3 patients, brought no effective symptom relief. All the patients in their 20's were household ambulators. Understanding the clinical manifestation of this disease enables early diagnosis, by which unnecessary and harmful procedures such as surgical biopsy or excision can be avoided, although no effective treatment has been developed.

Factors Affecting Recurrence After Soft Tissue Release for Talipes Equinovarus in Arthrogryposis Multiplex Congenita / 대한정형외과학회잡지

Talipes equinovarus deformity associated with arthrogryposis multiplex congenita(AMC) is rigid and its treatment is still controversial. The purpose of this study is to review the trend of recurrence after soft tissue release, and to delineate the risk factors affecting recurrence. Forty-one clubfeet in 24 AMC patients underwent soft tissue release as the first operation at the average age of 1 year 2 months (range, 6 months - 5 years 11 months) and were followed up for an average of 5 year 6 months (range, 2 years 1 month 14 years 5 months). Types of soft tissue release were Turcos posteromedial release (PMR) in 26 cases and posteromediolateral release (PMLR) using the modified Cincinati incision in 15 cases. Recurrences occurred in seventeen clubfeet (41%). A variety of recurrent deformity was corrected by redo PMR or PMLR, osteotomy, talectomy, arthrodesis, or Ilizarov technique. Average number of operations was 1.5 per case. Four parameters were analyzed in relation to recurrence: type of arthrogryposis, initial equinus deformity, type of primary soft tissue release, and age at the first operation. Recurrence occurred in proportion to the severity of initial equinus deformity, and was more frequent in amyoplasia type than in distal arthrogryposis type. However, neither the type of soft tissue release nor the age at the first operation was significant contributing factor to recurrence.

Biomechanical Analysis of Unilateral-Ring Hybrid External Fixation / 대한정형외과연구학회지

The mechanical stiffness of Unilateral-Ring Hybrid External Fixation(URHEF) was analyzed and compared with conventional Ilizarov circular external fixation system and unilateral fixation with DynaExtor(R). Our URHEF is basically a unilateral external fixation system which affords easier incorporation and removal of the Ilizarov rings(200mm in diameter) coupled with connecting clamps at anytime, if needed. It allows controlled axial micromotion in due time. For mechanical test, URHEF system was constructed using a DynaExtor(R) fixed with two or three half pins(6 mm in diameter) attached with two proximal and distal Ilizarov rings fixed with an olive pin and a half pin on each ring. Unilateral fixation system was constructed with a DynaExtor(R) fixed with 2 or 3 half pins. Ring fixation system was constructed with four Ilizarov rings(140mm in diameter). Ilizarov system were assembled into 90degrees-90degrees and 45degrees-13 5degrees configurations with 2 olive pins, respectively. The distance between the center of pylon and the pin-clamp interface was equalized, being 70mm, in all the systems. Stiffness in axial compression, anteroposterior and lateral bending was measured. On axial compression and lateral bending tests, URHEF was stiffer than DynaExtor(R) and Ilizarov systems. On anteroposterior bending test, URHEF was less stiff than 90degrees-50degrees configuration of the Ilizarov system but stiffer than 45degrees-135degrees configuration. Considering the fact that instead of 90degrees-90degrees transfixing pin fixatin system, 45degrees-135degrees configuration system is generally used in clinical practice, URHEF appears to be significantly stiffer than unilateral(DynaExtor(R)) and circular (Ilizarov)fixation systems. This mechanical study implicates that URHEF can be beneficially applied in the clinical use with assurance of mechanical stability.

The Rotating Total Knee Arthroplasty: 67 Cases Reports

Total knee arthroplasty of Sledge type is difficult to perform successfully in severely damaged knee that has poor bone-stock and ligament instability. High rate of loosening has be.en found in total hinge type and kinematic rotating hinge type, so we considered use of tibia rotating prosthe,,is that allows motion with stability would be a good option. The indications of this type are severe varus deformity, bone loss, incompetent ligament, or revision. We studied 67 cases of total knee arthroplasty using Endo Model rotating total knee arthroplasty (WALDEMAR LINK GmbH & Co. Germany), which had been performed from January, 1991 to June, 1994. Thirty knees out of 67 cases were degenerative osteoarthritis, 15 posttraumatic arthritis, 11 rheumatoid arthritis, 5 revision arthroplasty, 2 sequelae of pyogenic arthritis, etc. Thirteen knees out of 67 cases had patellar resurfacement. Twenty-six out of 67 cases had bone graft. Using the Knee Rating Score of Hospital for Special Surgery, 3S were excellent and 2 l good.

Comparison of Energy Consumption According to The Joint Deformities of The Lower Extremity in Sagittal Plane / 대한정형외과학회잡지

Background. Ultimate goal for the treatment of the deformities in the lower extremities is to minimize the energy requirement and conserve the energy on walking and daily living. The normal energy saving mechanism is usually broken down in the patients with the deformities in the lower extremity, and they need more energy consumption. This is the reason why they feel fatigue frequently. It is well known that the deformity in the lower extremity cause excessive energy consumption. Objectives. There is no report that compared the energy consumption according to the deformities of the lower extremity. When we decide the priority of the treatment in cases of multiple deformities, it will be important to understand the energy demand according to each deformity. Therefore, it is the purpose of this study that assess the energy consumption according to the various types of lower extremity deformities. Method. We induced the multiple deformities in ten normal adults with the brace artificially. The induced deformities are as follows: Equinus deformity; mild (10degrees), moderate (20degrees), severe (30degrees), Knee flexion deformity; mild (10degrees), moderate (20degrees), severe (30degrees), Hip flexion deformity; mild (10degrees), moderate (20degrees), severe (30degrees). For the control group, same braces were applied without any deformity. Oxygen consumption was measured for the energy consumption with the Oxygen Consumption Meter (Morgan Oxylog II, Morgan Ltd. England). Heart rate was checked with the Telemonitor (Dynascope, Fukuda Ltd, Japan). We evaluated the inspired volume, oxygen rate, oxygen cost, and heart rate in each group and compared the data among the groups. Result. Energy consumption was higher in the hip deformity group, in the knee deformity group, and in the ankle deformity group in that order. Conclusion. When there are concomitant deformities in hip, knee and ankle, the priority of treatment may be hip, knee and ankle, in that order in terms of energy consumption.

Result of Multiple Frilling for the Early Stage Nontraumatic Osetonecrosis of the Femoral Head / 대한정형외과학회잡지

Sixty-six cases of nontraumatic osteonecrosis of the femoral head were treated with multiple drilling using 9/64 inch Steinmann pin from May, 1992 to March, 1996. In this study, the results of the cases that were followed more than 2 years were analyzed. Thirty-three hips of 32 patients were included in this study. One case was lost to follow after the last follow-up at postop 19 months. Diagnosis was made by simple x-ray and MRI in all cases. The stage was classified according to the modified Fic.t classification. The extent of lesion was evaluated on coronal and sagittal images of MRI. Multiple drilling was performed with the patients on fracture table under C-arm control using 9/64 Steinmann pin held on a low speed power drill. Depending on the size of lesions, 4 to 13 holes were drilled into head from the lateral cortex of proximal femur. The average duration of follow-up was 30 months (range, 8-48 months). When a head collapsed or was converted to THRA for any reason, the case was determined to be a failure. There were 14 Ficat stage I, 16 stage IIA, I stage IIB and 2 stage III hips. The extent of lesion was ranging from 10 to 88% with an average of 49%. There were 7 cases of failure (overall success rate, 78%). In 4 cases, collapse of head was detected at postop 12, 14, 14 and 19 months and 3 of them were converted to THRA. Three cases were converted to THRA at postop 8, 21 and 41 months because of recurred pain without collapse on x-ray. Ectopic ossification around drill entry site was the only complication and was detected in 9 cases. Even though the follow-up period is short, multiple drilling of small diameter is very simple procedure and the short-term results were encouraging in early stage osteonectosis.

Congenital Muscular Torticollis: Comparative Analysis between Unipolar and Bipolar Release or the Sternocleidomastoid Muscle / 대한정형외과학회잡지

In order to compare the efficacies of some surgical procedures for correction of congenital muscular tortiollis, we evaluate 36 patients who had been treated either by unipolar release (19 patients) or bipolar release (17 patients) of the sternocleidomastoid (SCM) muscle at Seoul National University Children Hospital from August 1985 to June 1993. The average follow up period was 4.1 years (range, 1 year to 7 years and 8 months). The average ages at the time of operation was 3.4 years (range, 11 months to 7 years and 1 month) in the unipolar group and 9.7 years(range, 4 years and 5 months to 16 years and 11 months) in the bipolar group. Postoperatively, flexion and extension range of motion of the neck was not limited of limited less than 10 degrees, if present, in all cases. In rotation motion, 89.4% of the unipolar group and 94.1% of the bipolar group showed no limitation or limitation of less than 10 degrees when compared to the normal side postoperatively. In lateral bending, however, 21.1% of the unipolar group and 21.5% of the bipolar group showed limitation of more than 10 degrees when compared to the normal side postoperatively. Facial asymmetry, which was present in 89.4% of the unipolar group and all cases of bipolar group preoperatively, disappeared in 73.7% of the unipolar group and 23.5% of the bipolar group and improved in 94.1% of the unipolar group and 64.7% of the bipolar group. The over-all functional and cosmetic results were assessed according to the modified Ling's criteria. In function results, 14 patients(73.3%) had excellent or good results in unipolar group and 12 patients(70.6%) in bipolar group. In cosmetic results, 15 patients(78.9%) had excellent or good results in unipolar group and 11 patients(64.7%) in bipolar group. Recurrence rate was higher in the unipolar group (15.8%) than in the bipolar group (5.8%). In conclusion, limitation of lateral bending was more resistant to the treatment than the limitation of rotation. Bipolar release of SCM muscle would be recommendable even in young children in terms of recurecce.

Changes of Bone Meneral Density of the Distraction Gap and Adjacent Parent Bone in Callotasis of the Cnanine Tibia / 대한정형외과학회잡지

The purpose of this study are to delineate the temporal and spatial changes of bone mineralization at the distraction gap and adjacent parent bone, and to investigate the effect of microaxial dynamization on regenerate bone healing and on development of regional osteopenia at the adjacent parent bone, during callotasis. Sixteen Korean adult mongrel dogs underwent bilateral tibial lengthening by callotasis. To the right hindlimbs, no dynamization was applied and served as control group (group I, and axial elastic dynamization was conffered to the left hindlimbs (group II). Bone mineral density(BMD) was measured by dual X-ray absorptionmetry(DXA) at immediate post-operative day, post-operative 12 day, 22 day, 36 day, 50 day, 65 day, and 85 day. Quantitative computed tomogram(Q-CT) was also taken after sacrifice to analyze temporal changes of mineralization pattern in the distraction gap. The following results were obtained; 1. In both group I and II, the BMD was lowest at the interzone in the distraction gap and increased linearly toward the corticotomy surface. This pattern did not change with time until the consolidation of the distraction gap, but the difference of BMD between the interzone and adjacent parent bone decreased with progress of consolidation. 2. During the distraction period, BMD increased progressively at the distraction gap and adjacent parent bone in both group I and II. During consolidation period, although BMD of the distraction gap still increased progressively, that of the adjacent parent bone decreased progressively in group I; the more distant from the corticotomy surface, the more decreased the relative BMD. in group II, the decrease in BMD of the adjacent parent bone was less than that in group I which was statistically significant in mid-consolidation period. In conclusion, the new bone in the distraction gap during callotasis appeared to form in bilateral direction with linear gradient from interzone toward corticotomy surface. Dynamization during callotasis not only stimulated regenerate bone healing in the distraction gap, but also prevented the occurrence of transient regional osteopenia at the distant part of the adjacent bone during midconsolidation period.

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 Effect of Controlled Elastic Dynamization on Regenerate Bone Healing in Distraction Osteogenesis of Canine Tibia / 대한정형외과학회잡지

In order to investigate wheter or not elastic dynamization by axial micromotion enhanced regenerate bone healing in distraction osteogenesis(callotasis), a unilateral external fixator, with which the magnitude of dynamization could be controlled, was applied to the tibiae of 12 Korean adult mongrel dogs, weighting approximately 35kg. Tibiae and fibulae of both sides were osteotomized at the proximal metaphysio-diaphyseal junction and fixed with unilateral external fixators. Distraction was started from the third postoperative day until 2 cm (10% of tibial length) of length gian was achived, at the rate of 0. mm twice a day. When 1 cm (5%) of lengthening was achieved, controlled elastic dynamization of 1 mm (group I), 2 mm (group II), and 3 mm (group III) in magnitude was allowed on left tibia. Right tibia was not dynamized until sacrifice, and served as a control for each group. Plain anteroposterior radiographs and measurements of bone mineral density(BMD) by dual x-ray absorptiometry(DXA) were obtained pre- and post-operatively. Relative ratio of BMD was calculated, dividing the BMD value measured in each period by the BMD value measured at the beginning of dynamization. Mechanical test was performed in uniaxial compression on an Instron machine. Following observations were made: 1. Plain anteroposterior radiography showed that at mid-consolidation phase (postoperative 50th day) the width of callus in the distraction gap increased significantly in all dynamization groups, as compared to their control groups(p 0.05). 3. Axial Compression test revealed that the dynamization group had significantly increased stiffness, maximal load, elastic modulus, and strength, as compared to those of the control group(p < 0.05). In conclusion, controlled elastic dynamization effectively enhances regenerate bone healing in distraction osteogenesis of canine tibia, at 1 mm to 3 mm of magnitude.

Effect of the Distraction Rate on the Activity of the Osteoblast Cell Lineage in Distraction Osteogenesis of Rats' Tibiae / 대한정형외과학회잡지

The purpose of this study was to investigate kinetics of the osteblast cell lineage in the periosteum and endosteum according to different distraction rates in callotasis of rats' Tibiae. 120 rats underwent osteotomy at the proximal metaphysio-diaphyseal junction of the left tibia for callotasis. Lengthening was started with varying distraction rates of 0.25 mm (group I), 0.5 mm (group II), 0.75 mm (group III), 1.0 mm (group IV) until 3.5 mm length gain was achieved. The animals that had osteotomy alone without lengthening served as a control(group V). Immunohistochemical staining of proliferating cell nuclear antigen(PCNA), osteocalcin and transglutaminase C(TGase C) were done on the four animals on each group sacrified at post-distraction 1, 3, 5, 7, 14, 28 days in order to observe the temporal changes among the experimental and control groups. At each examination, radiographic and histological studies were also done in order to correlate the immunohistochemical findings. The results obtained are summarized as follow; 1. The staining rate of PCNA was highest at the early distraction(day 1) phase and subsequently decreased in all groups. The staining rate of the cells in the periosteum was significantly higher than that of the cells in the endosteum (p < 0.01). 2. The expression rates of osteocalcin in the periosteum of all groups were significantly higer than those in the endosteum (p < 0.01). 3. The expression rates of TGase C in the periosteum of all groups were significantly higer than those in the endosteum (p < 0.05). 4. Radiological and histological studies revealed that successful regenerate bone healing was achieved in groups, I, II and III but not complete in group IV. In conclusion, immunohistochemical study on callotasis of rats' tibiae revealed that the osteoblast cell lineage in the periosteum is more activated than that in the endosteum for proliferation and differentiation by distraction, suggesting that the periosteum plays a more important role in neo-osteo-genesis in the distraction gap. Daily distraction rate range of 0.25 mm to 0.75 mm in two increments is the appropriate for successful distraction osteogenisis of rat's tibia, but the rate of 0.25 mm a day is significantly better than that of 0.75 mm upon immunohistochemical observation.

Developmental Coxa Vara / 대한정형외과학회잡지

Deveolopmental coax vara represents coax vara not present at birth but rather developing in early childhood, showing a progressive deterioration in the proximal femoral neck-shaft angle during growth. In order to determine the factors that could affect the results of corrective osteotomy, we evaluated the results of 15 developmental coax vara in 12 patients who had been treated with the femoral osteotomy at the Department of Pediatric Orthopedic Surgery, Seoul National University Children's Hospital, from February 1983 to March 1993. Of the 12 patients, there were 6 boys and 6 girls. Three patients had bilateral operations, 5 patients on the right, and the remaining 4 patients on the left. Average at the onset of symptoms was 4 years plus 5 months(range; from 1 year to 7 years plus 2 months), and average age at the tome of operation was 6 years plus 3 months(range; from 2 years plus 4 months to 10 years). We could obtain the following results: 1. Average post-operative loss of neck-shaft angle was 5% in the cases in which post-operative neck-shaft angle was converted more than 130 degrees, and was 8% in the cases in which post-operative neck-shaft angle was converted less than 130 degrees. 2. Loss of neck-shaft angle was higher during the first post-operative period, and was higher in cases in which the triangular osseous defect was persistent post-operatively. There was no correlation between the post-operative neck-shaft angle and disappearance of triangular osseous defect. 3. The femoral anteversion was converted 8.7 degrees to 27.2 postoperatively. 4. The premature arrest of the capital femoral physis was higher in cases in which the neck-shaft angle was less than 130 degrees postoperatively. 5. Leg length discrepancy, which was 2.1 cm preoperatively, did not change in cases in which the neck-shaft angle was more than 130 degrees postoperatively. However, it was converted to 3.3 cm in cases in which the neck-shaft angle was less than 130 postoperatively. 6. we could observe the femoral head deformity in 6 out of 7 cases in which the operation was performed after 7 years of age. We could draw the following conclusion based on our results: 1. We must correct the neck-shaft angle more than 130 degrees. 2. We could not equalize the leg length discrepancy by corrective osteotomy alone. 3. It may be reasonable to perform the corrective osteotomy before 7 years of age.