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PURPOSE: To analysis the efficacy of MRI in assessing fracture configuration and frequency of associated soft tissue injuries in tibial plateau fractures. MATERIALS AND METHODS: In the plain films and MRI of 47 cases with tibial plateau fractures,every fracture was classified by findings on plain film and MRI respectively according to the Schatzker system and they were compared with each other. The degree of displacement and depression of the fracture fragments were measured on plain film and MRI. RESULTS: MRI was more accurate in determining the classification of the fracture and measuring the displacement and depression of fragments. Fracture classifications were changed in 12 cases. Especially in Schatzker VI cases, articular step off over 2 mm and articular fragments over 2X2 cm were revealed in detail by MRI. Evidence of internal derangement of the knee was found in 38 (80.8%) cases. CONCLUSION: Most of the cases with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatment plan.
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Clasificación , Depresión , Rodilla , Ligamentos , Imagen por Resonancia Magnética , Traumatismos de los Tejidos BlandosRESUMEN
Ewing's sarcoma (ES)/PNET is common in both axial and appendicular skeletons, but is extremely rare in the talus. Here, we report a case of ES/PNET of the left talus in a 29-year-old male patient diagnosed by fine needle aspiration cytology, and review the literature on similar cases. The cytological smears were composed of individually dispersed small round cells and occasional clusters of loosely cohesive cells. The tumor cells were fragile, frequently exhibiting naked nuclei. Two distinct types of cells were observed. The light (chief) cells displayed round or slightly oval nuclei with frequent indentations, generally inconspicuous nucleoli, and a thin rim of cytoplasm, which sometimes harbored small vacuoles. The dark cells were smaller, displaying scanty cytoplasm with dense hyperchromatic nuclei, intermixed with chief cells, and often manifesting as small molded groups. However, no significant nuclear pleomorphisms or mitoses were noted. Tumor cells in the cell block revealed positive cytoplasmic glycogen, as determined by a PAS stain with diastase control, and also exhibited positive immunoreactivity for CD99.
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Adulto , Humanos , Masculino , Amilasas , Biopsia con Aguja Fina , Citoplasma , Hongos , Glucógeno , Mitosis , Sarcoma de Ewing , Esqueleto , Astrágalo , VacuolasRESUMEN
PURPOSE: To evaluate the clinical stability and function after an arthroscopic anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. MATERIALS AND METHODS: Fifty-nine patients could be evaluated and the mean follow-up period was 47 months (24-75 months). The evaluation included a detailed history, a physical examination, a KT-1000 arthrometer measurement, and the rating systems of Lysholm, IKDC and Shelbourne. RESULTS: Fifty-four patients (92%) had a negative pivot shift. Forty-five patients (77%) had a negative Lachman test. Forty-eight patients (82%) had less than a 3 mm difference of maximal manual difference by KT-1000 arthrometer. The prone heel height difference was less than 1 cm in 37 patients (63%). The mean Lysholm score was 89.5. Forty-five patients (76%) were normal or nearly normal for the measured parameters. Patello-femoral pain was not a significant problem for most of the patients who had a mean Shelbourne score of 88.5. CONCLUSION: Reconstruction of the ACL with a bone-patellar tendon-bone autograft resulted in a reliable and predictable outcome without having significant patello-femoral pain after 2 to 6 years'follow-up.
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Humanos , Reconstrucción del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Autoinjertos , Estudios de Seguimiento , Talón , Examen FísicoRESUMEN
Treatment for the femoral shaft fractures in adolescents is somewhat controversial. These fractures have been treated nonoperatively, but adolescents tolerate prolonged immobilization less well than younger children and conservative treatment in this age group may result in more complicationssuch as malunion, shortening and angular deformities more often than those in the younger age group. Recently there has been a tendency to choose the operative method rather than traditional traction and casting technique for femoral shaft fractures in elderly children and adolescent The purpose of this study is to find better treatment for the femoral shaft fractures in adolescents. Fifty six femoral shaft fractures in 56 patients aged 10 to 14 years old were treated with traction followed by casting, open reduction and internal fixation with plate, closed intramedullary nailing, or external fixation using A-0 external fixator, and evaluated respectively for at least 1 year. External fixation may be benefit to patients with concomittant injuries and result in psychological settle down, early mobilization out of bed, short hospital stay, save of cost,and early return to daily living activities without any disadvantages such as malunion, leg length discrepancy or awareness of growing arrest in spite of negligible pin tract infection. Result of this study suggests that external fixation for the femoral shaft fractures may be an one of the attractive treatment option in adolescents.
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Adolescente , Anciano , Niño , Humanos , Actividades Cotidianas , Anomalías Congénitas , Ambulación Precoz , Fijadores Externos , Fijación Intramedular de Fracturas , Inmovilización , Pierna , Tiempo de Internación , TracciónRESUMEN
The function of the meniscus and subsequently the importance of meniscus preservation are well known. Thirty-two patients who underwent arthroscopic meniscus repair between 1993 and 1995 were studied retrospectively. Twenty menisci were repaired using modified Henning inside-out technique and the remaining twelve meaisci, outside-in technique. The average delay in surgery was two hundred days. Follow-up was done from 1 year to 3 years (average 22.4 months). The medial meniscus was repaired in 22 cases and the lateral meniscus including two saucerized discoid meniscus in 10 cases. Fourteen patients had anterior cruciate ligament (ACL) tear and other associated knee injuries were lateral condyle fra'cture of femur in one case and lateral condyle &acture of tibia in one case. Assessment of the result was based on the evaluation form of the International Knee Documentation CommitteegKDC). Twenty-seven patients (84.3%) were normal to nearly normal. Abnormal and severely abnormal results were mainly affected by the result of treatment of ACL tear.
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Humanos , Ligamento Cruzado Anterior , Fémur , Estudios de Seguimiento , Rodilla , Traumatismos de la Rodilla , Meniscos Tibiales , Estudios Retrospectivos , TibiaRESUMEN
The purpose of this study is to make an emphasis the necessity of the dynamization after interlocking intramedullary nailing. We reviewed 75 cases of the fractures of the shaft of femur or tibia fixed with static interlocking intramedullary nailing. We excluded the cases in whom the locking screws were removed for the purpose of the relief of pain from the irriataion by those screws. The parameter we reviewed were the type of fracture, postoperative gap between the major fragments. Early callus formation, the union time, postoperative dynamization and controlled weight bearing. In those cases in which the contact surface between the major fragments was more than 50% and there noticed no early callus within 6 weeks after operation, the union time was shortened after dynamization, when the contact surface was less than 50% and there noticed no early callus, the union time was shortened after bone graft and dynamization which resulted in some shortening in the length in acceptable ranges. In cases with a major gap of more than 2mm, the union time was shortened after dynamization. The rate of early callus formation was a little higher in cases with postoperative controlled weight bearing than those to whom we did not permit a controlled weight bearing.
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Callo Óseo , Fémur , Fijación Intramedular de Fracturas , Tibia , Trasplantes , Soporte de PesoRESUMEN
The ultrasound is also helpful to make the diagnosis of a variety of soft tissue tumors bacause of its safety, low cost, non-invasiveness and usefulness. We analysed ultrasonographic findings of 43 cases of soft tissue tumors which were histopathologically confirmed by biopsy and obtained the following results. The ultrasonography could effectively image not only the presence, size and location of the lesion, but also the relationship between the lesion and the adjacent structures. And this method could easily identify the consistency of the lesion, solid or cystic nature, be used to guide the percutaneous biopsy and aspiration without exposure to radiation, and afford the differentiation of malignant lesion from benign one. It could also define the eritities of soft tissue tumors by the nature of internal echo, margin of the lesion, internal echo homogeniety, post-acoustic enhancement, and so on.
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Biopsia , Diagnóstico , Métodos , UltrasonografíaRESUMEN
The AO internal fixation system(the Fixateur Interne) is effective in reducing and stablizing a variety of unstable thoracolumbar fracture patterns. It is relatively effective in decompressing the canal of retropulsed bony fragments associated with burst fracture. Sixty-Two patients with unstable thoracolumbar spine fractures were treated with the AO internal fixator. They were followed for an average of 21 months(range 15-29 months). A compartive radiographic analysis of kyphosis and vertebral height was made using pre-operative, post-operative and follow-up radiogram. Changes in neural canal compromise were measured in 18 cases of burst fractures. Failure of instrumentation occured in 9 cases which were carefully analyzed. Recently, we've constructed the system of which the Schanz screws would be directed divergently in sagittal plane in the hope that the load to the screws might be reduced, thus the failure rate.
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Humanos , Estudios de Seguimiento , Esperanza , Fijadores Internos , Cifosis , Tubo Neural , Columna VertebralRESUMEN
No abstract available.
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Fijadores Externos , Fracturas Intraarticulares , Radio (Anatomía)RESUMEN
The patella is an important component of the extensor mechanism of the knee. It serves to increase the mechanical advantage of the quadriceps muscle by increasing its lever arm. Therefore, if possible, when the patella is fractured, it should be repaired rather than excised. Present surgical techniques for the patellar fractures utilizes principles of anatomic reduction with repair of any associated retinacular tears, rigid internal fixation, and early institution of joint motion exercises. To compare the efficacies of the commonly used wiring techniques, we performed tension tests with transversely bisected patellar models fixed with circumferential wiring, Magnuson wiring, modified tension band wiring and modified tension band wiring combined with circumferential wiring. Also, we reviewed 66 surgically treated patellar fractures from Jan. 1984 to Dec. 1988, when we had given every effort to preserve the patella using modified tension band wiring or modified tension band wiring combined with circumferential wiring. l. According to the results of the tension tests, modified tension band wiring and Magnuson wiring were more rigid than circumferential wiring and the rigidity of modified tension band wiring was much increased when combined with circumferential wiring. 2. Of the 66 cases, 46 cases were treated with modified tension band wiring combined with circumferential wiring, and the remainder were treated with modified tension band wiring. 3. On the whole, good and excellent results were achieved in 87.9% (58 cases). Unsatisfactory results were obtained in 15.0% of cases treated with modified tension band wiring and in 10.9% of cases treated with modified tension band wiring combined with circumferential wiring. 4. Most of the unsatisfactory cases were so severely comminuted that could not be achieved anatomic reduction, rigid internal fixation and early joint motion exercises.
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Brazo , Ejercicio Físico , Articulaciones , Rodilla , Métodos , Rótula , Músculo Cuádriceps , LágrimasRESUMEN
Since the finite element method(FEM) was introduced to the orthopaedic biomechanics, it has been applied with increasing intrest to investigate bone, bone-prosthesis, and fracture fixation device, etc., in terms of stress, strain, force, and displacement. The authors implemented the FEM for the "intact" and the "fractured long bone models respectively to observe the mechanical behaviors of the plate fixation for the long bone fractures, and we observed the followings;l. In the intact model, stresses are evenly distributed and smoothly changed. 2. The maximum equivalent von-Mises stress in the fracture model is higher than that in the intact one. 3. Stresses on the plate are much higher than those on the bony surface in the fracture model. 4. Stresses for the bony surface beneath the plate in the fracture model are much lower than those in the intact model;however, stresses are highly concentrated around the screws. 5. Although two-thirds of total compressive load is transmitted through the fracture site area, maximum von-Mises stress in the fracture site is much lower than that in the plate. 6. High stresses are found at the areas between the plate holes and the screw heads. 7. Shearing forces of the screws are higher at the near and end screws from the fracture site.
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Fijación de Fractura , Fracturas Óseas , CabezaRESUMEN
Carpometacarpal and metacarpophalangeal joints of the thumb exhibit relatively wide range of motion, which may act as a shock absorber. So dislocation of these joints are relatively rare. Furthermore, a complete dislocation of the thumb metacarpal by simultaneous dislocation of carpometacarpal and metacarpophalangeal joints is a very rare injury, and only a few cases were reported in the English literatures. The authors will present a case of a complete dislocation of the thumb metacarpal in a 31 years old female.