A cavernous Hemangioma After a Removal of a Pigmented Villonodular Synovitis in Mid-foot (A Case Report) / 대한족부족관절학회지

Hemangioma are not rare tumors. They can be found in almost any of the vascular structures of the body. Hemangiomas involving the deep structures of the extremities may produce extremely difficult therapeutic problems for the orthopedic surgeon. Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder that affects synovium, tendon sheath and bursa. Although the condition can present in any joint, knee joint is the most commonly affected site and only 2.5% of cases occur in foot and ankle joint. We have experienced a patient who has of foot and report an optimal method of surgical treatment. Authors report the result of hemangioma in mid-foot which arise from removal of a pigmented villonodular synovitis that has low out break rate of benign tumor in mid-foot with literature review.

Surgical Treatment of Cervical Spondylotic Myelopathy / 대한정형외과학회잡지

Myelopathy or dysfunction of the spinal cord, can be caused by degenerative processes of the cervical vertebrae. Cervical spondylotic myelopathy can be divided into five distinct syndromes on the basis of clinical presentation by Ferguson. Absolute indication for surgery is the progression of neurologic deficit. Decompression may be achieved using an anterior, posterior, or a combined approach, but each patient has unique clinical conditions that require individualized treatment. The purpose of the study was to evaluate the operative results by the clinical manifestation. In evaluating the results, the evaluation system established by the Japanese Orthopedic Association was employed. The average preoperative score in the 14 patient was 8.7 points and the average postoperative score was 12.7 points. The better results have been obtained for those who were managed with decompression within 1 year after onset of symptoms and those who had lateral type. In conclusion, the prognosis for the recovery of the spinal cord function is related with the onset of clinical symptoms and degree of neurological deterioration, so early detection and operative decompression for cervical spondylotic myelopathy may be the best method for the prevention of those unwanted and potentially devastating neurological deteriorations.

Tibial tunnel Placement in Arthroscopic ACL Reconstruction using Preoperative Radiographic Measurement / 대한정형외과학회잡지

A major cause of less than ideal results following intraarticular anterior cruciate ligament (ACL) reconstruction has been imprecise nonanatomic tunnel position for graft placement either in the femur, the tibia, or both. Lack of defined constant reference landmarks for reproducible tunnel placement has contributed to this problem on both sides of the joint. The purpose of this study was to define constant anatomic intraarticular and extraarticular landmarks that can be used as definitive reference points to reproducibly create a tibial tunnel for ACL reconstruction that (1) results in an impingement-free graft in full extension; (2) positions the tibial tunnel such that the sagittal tunnel-plateau angle is parallel with the sagittal intercondylar roof-plateau angle in full extension to minimize shear seen by the graft at the tibial tunnel inlet. Preoperative full extension and 90degrees flexion lateral radiographs were obtained. Preoperative measurements of the tibial tunnel-tibial shaft angle and distance from inferior pole of patella to entry point of tibial tunnel were useful tool for impingement free, Blumensaats line paralleling ACL reconstruction with autogenous bone patella tendon bone graft. The average tibial tunnel-tibial shaft angle was 34+/-4.59degrees (male), 33.5+/-3.37degrees (female). The mean distance between patella inferior pole and tibial tunnel entry point was 6.62+/-0.61cm (male), 6.21+/-0.89cm (female). This study sought to define constant anatomic landmarks extraarticularly as well as intraarticularly that can be used to reliably create an ideal tibial tunnel for ACL reconstruction.

Minimum Flexion Angle of the Knee Joint during Femoral Tunneling and Interference Screw Fixation in Endoscopic ACL Reconstrution / 대한정형외과학회잡지

Isometric positioning of the ACL graft is an important consideration in successful reconstruction of the ACL-deficient knee. The purpose of this study is to get a certain guideline in the endoscopic one-tunnel technique of anterior cruciate ligament reconstruction by measuring the skin angle and determine the degree of minimum flexion of the knee joint during femoral tunneling and interference screw fixations. To get the guide lines, first we get the tibial tunnel angle parallel to the Blumensaat's line from fully extended lateral knee joint radiography. Secondly measure the differences between angles of the femur-tibia shaft and anterior thigh-leg skin. Then measure the minimum femur-tibia flexion angle does not perforated the posterior cortex of the distal femur during femoral tunneling. Intraoperative measuring the angle between interference screw guide pin and tibial tunnel to get the parallelism of the femoral tunnel and interference screw. The results were as follows; The average femur-tibia shaft angle with 30degrees anterior thigh-leg skin angle was 30.2+/-1.75degrees, with 45degrees was 45.2+/-1.23degrees, with 60degrees was 61.9+/-4.23degrees, with 75degrees was 78.6+/-2.62degrees, with 90degrees was 97.8+/-3.96degrees. Predetermined sagittal tibial tunnel vector on the 0degrees extension knee joint lateral radiographs were applied to the several knee joint dynamograms. The mean minimum flexion angle of the femur-tibia shaft that doesn't perforate the posterior cortex of the femur was 45+/-1.58degrees (male), 44.5+/-4.97degrees (female). The average angle between interference screw guide pin and tibial tunnel was 23.0+/-2.23degrees. The findings of the present study suggest that anterior thigh-leg skin angle can be used instead of the true femur-tibia shaft angle. Less knee flexion angle makes good arthroscopic view during the tibio-femoral tunneling and interference screw fixation.

Spinal Canal Remodelling after Stabilization of Thoracolumbar Burst Fractures / 대한정형외과학회잡지

About half of all burst fractures at the thoracolumbar junction lead to neurological impairment and several clinical series have demonstrated a statistically significant correlation between canal encroachment and neurologic impairment, but not directly related. Spontaneous canal remodelling over time due to bone resorption has been observed in conservatively treated burst fractures. The aim of this study was to measure spinal canal remodelling after stabilization of burst fractures. So, we evaluated 22 cases of surgically stabilized burst fractures of thoracolumbar junction about pre and postoperative spinal canal stenotic ratio and canal remodelling by bone resorption over time. The results were as follows; l. Pedicle splaying increases the spinal canal area and necessitates correction. 2. Patients with neurological deficits had average 53% encroachment and the neurological normal patient had a canal compromise of 33.9%. 3. Postoperatively canal encroachment had decreased to a mean of 17.4% and further reduced by resorption of bony fragment to a mean of 8.3% within 14 months. In conclusions, remodelling of the spinal canal by resorption of encroaching bone fragments is a consistent feature in surgically stabilized thoracolumbar burst fractures and most patients regain their prefracture canal demensions within 14 months.

Hydrogen Peroxide Production in Neutrophils after Tourniquet Release / 대한정형외과학회잡지

The use of lower extremity tourniquets for procedures of the lower leg is considered routine in orthopedic surgery, but, lower extremity tourniquets do harm occasionally. While the tourniquet is inflated, metabolic changes such as increased PaCO2 , lactic acid, and serum potassium and decreased level of PaO2 and pH occur in the ischemic limb. Deflation of tourniquet results in release of anaerobic metabolic products during ischemia into systemic circulation. In this ischemia/reperfusion situation, oxygen free radicals could potentially be produced during the reperfusion period by several mechanisms. One of these mechanisms is release of intracellular superoxide or hydrogen peroxide by activated neutrophils in the area. These reactive oxygen species(ROS) could be a causative factor for the postreperfusion no-flow, lung injury, induction of tourniquet shock, etc. The purpose of this clinical study was to investigate the effect of tourniquet deflation on the hemodynamic changes, changes of blood gas analysis, and hydrogen peroxide production using flow cytometric analysis of fluorescent DCF(Dichlorofluorescein). Quantitative analysis of fluorescent DCF was performed in resting and fMLP(N-formyl-methyonyl-leucyl-phenylalanine) or PMA(phorbol myristate acetate) stimulated neutrophils. Also differences of these factors between two groups of tourniquet time, one is less than one hour and the other more than one to two hours, were analysed. The hemodynamics(blood pressure, pulse rate), arterial PO2, bicarbonate, base excess, and hydrogen peroxide production showed no significant change before and after tourniquet release(p>0.05). Arterial pH and PaCO2 decreased significantly until 10 and 5 minutes after tourniquet release, respectively(p>0.05). Tourniquet time didn’t reveal any significances differences. These results indicate that tourniquet application with400mmHg pressure and less than 2 hours does not release significant hydrogen peroxide into systemic circulation during reperfusion period after tourniquet release.

Subungual Glomangiosarcoma: A Case Report / 대한정형외과학회잡지

Glomangiosarcoma is a histopathologically defined extremely rare malignant tumor that accompanies a glomus tumor usually, but its has benign clinical course characteristically. It shares common ultrastructural and immunohistochemical features with glomus tumor, and transformed possibly from glomus tumor". Glomangiosarcoma shows more sarcomatous appearance histologically than glomus tumor, however with no malignant behavior(i.e. recurrence or metastasis) was expressed. We experienced a case of glomangiosarcoma form subungual region treated by marginal excision and no recurrence or metastasis was developed untill 1 year and 6 months postoperatively.

Relationship between Traumatic Spinal Canal Stenotic Ratio and Neurologic Injuries in Thoracolumbar Unstable Fractures / 대한정형외과학회잡지

Several reports on burst fractures of the thoracolumbar spine have noted that the neural canal encroachment caused by bone in the canal did not correlate with the neurologic status of the patient. But in the thoracolumbar spine the average percent compromise was significantly higher in those patients with complete and incomplete lesions, compared with those patients with no neural deficits. In this study, we evaluated 38 patients with unstable thoracolumbar fractures, operated from March 1989 to February 1993 to know the amount of neural canal compromise, demonstrated on computed tomography scans with neurologic status, level of injury and type of fractures. Among them 22 patients had neurologic deficit and 16 did not neurologic deficit. The results were as follows; 1. 19(76%) of 22 patients with disruption of the posterior spinal elements had neurologic defictis. 2. In the group with neurologic deficits, the stenotic ratio was 44% at the epiconus level, 55% at the conus medullaris, level and 63% at the cauda equna level. 3. The average A-P diameter of the bony fragments retropulsed into the spinal canal was 4.5mm at the epiconus level, 5.2mm at the conus medullaris level and 6.0mm at the cauda equina level. 4. Unstable bursting fracture and fracture dislocation showed higher incidence of neurologic injury and percentage of spinal stenotic ratio than those of flexion distraction and wedge compression fracture. In conclusion, the higher the level of the injured vertebrae, the smaller the size of the retropulsed fragment needed compromise the neural tissues. We suggest that it is necessary to get enough decompression for restoration of spinal canal and recovery of neurological function and computed tomography was more sensitive than any other modality in detection the reduction of the retropulsed bony fragment into spinal canal.

Treatment of the tibial shaft fractures with ender nails / 대한정형외과학회잡지

No abstract available.

Surgical Repair of Achilles Tendon Ruptures: 3 Tissue Bundle Technique / 대한정형외과학회잡지

Since Pare's first report on Achilles tendon rupture in 1575, many authors have presented numerous operative and nonoperative methods for its treatment. Numerous controversies following its treatment have been concerned with the selection of its treatment method, which could minimizing the complications and enable early ambulation. We analysed 98 cases of Achilles tendon rupture in adults which were treated by direct repair, three-tissue bundle technique, or Plantaris/Peroneus augmentation repair for 3(1)/4 years from Oct. 1986 to Dec. 1989. We compared with types of cast after operation, periods for immobilization, and ankle motion of dorsiflexion at postoperative 6 weeks & long-term follow up. The results obtained from this study were as follows; l. After repair by three-tissue bundle technique, a short leg cast was applied, and then a weight bearing was started at postoperative 3 weeks. It can be demonstrated to shorten hospitalization and early ambulation when compared to other surgical techinques. 2. The patients who were repaired with the three-tissue bundle techinque averaged 12.5° dorsiflexion at the time of cast removal at postoperative 6 weeks, compared to 0°, 1° plantar flexion, and 4.4° plantar flexion with other techniques. The former group was significantly better than that of the latter group, and these differences were not present at long-term follow up. 3. On follow up period, discoverd complications were rerupture of Achilles tendon in 8 cases and mild wound infection in 3 cases, but the patients who were repaired by the three-tissne bundle technique showed no complications except mild wound infection in one case.

Ultrasonographic Evaluation of Ostogenesis at the Femoral Fracture Site in Children : Comparative Study with Plain Film / 대한정형외과학회잡지

No abstract available.