Tuberculosis of the Spine Part I: Clinical Study on Anterior Fusion for Spinal Tuberculosis / 대한정형외과학회잡지

No abstract available in English.

Part II : Long term Follow / 대한정형외과학회잡지

No abstract available in English.

Arthroscopy of the Knee Joint: A Study of 100 Knees / 대한정형외과학회잡지

No abstract available in English.

Free Vascularized Bone and Joint Transplantaion Using Microsurgery / 대한정형외과학회잡지

We have experienced 11 cases of large bony defect that were treated using microsurgery since 1981. Free vascularized bone transplantation was performed in 8 of them, vascularized bone transposition in 2 cases, and free vascularized joint transplantation in the remaining 1 case. The causes of the large bony defect were primary bone tumor (4 cases), congenital pseudoarthrosis (3 cases), open comminuted fracture (2 cases), sequela of osteomyelitis (1 case), and post-traumatic ankylosis of PIP joint of second finger (1 case). As a donor, fibula was used in 8 cases, iliac crest in 1 case, rib in 1 case and in the remaining 1 case, the second M-P joint of foot was transplanted. In 9 of 11 cases, successful result was obtained and 2 cases were failed because of vascular damage following tibial lengthening in one case and infection on the grafted area in the other one. From the above data and review of articles, following conclusions were obtained. 1. Fibula is thought to be the most appropriate donor for the large bony defect in the extremity, especially in lower extremity, but the donor site must be determined according to the anatomical and physilogical condition of the patient. 2. After mechanical lengthening of the extremity, it is recommened to perform the microvascular surgery after sufficient time for the recovery of vascular damage. But further studies are required for the identification of the change in the vascular tissue following stretching and its recovery time. 3. Progression of the ossification in the epiphysis of transplanted iliac crest was observed and this finding proposed us the idea that the epiphyseal plate injury or leg length discrepancy will be able to be treated with free vascularized epiphyseal plate transplantation and the reconstruction of the destroyed joint of growing children will be possible using free vascularized joint transplantation. 4. As the technique become more popular, the free vascularized bone transplantation is being used for the reconstruction of the extremity more frequently, but it seems to be wise to restrict its indication to cases which are impossible to be treated with more simple methods such as vascularized bone transposition or pedicled bone graft.

The Association Between Degenerative Arthritis of the Lumbar Spine and Obesity / 대한정형외과학회잡지

Degenerative arthritis of the lumbar spine is one of the main causes of the low back pain over the fifth decade of life. Nowadays, it seems that the number of obese person increases gradually and the role of Obesity in the development of articular degeneration remains controversial. The authors studied 100 cases of the primary degenerative arthritis of the lumbar spine clinically and statistically and compared 50 cases among these with 2 control groups, with and without low back pain, from Mar. 1982 to Sep. 1982. The results were as follows: 1. Among the patients with the degenerative arthritis of the lumbar spine, the ratio of male to female was 1:4, and the age group with the highest frequency was the 6th decade (47%) 2. 44% was obese in the arthritis group and 26% in the control group with low back pain and 12% in the control group without low back pain. 3. The relative risk of the hypothesis that the arthritic patient is obeser than the patient with low back pain but without degenerative changes on X-ray was 2.3, but the hyposthesis was proved to be statistically insignificant. The relative risk of the hypothesis that the arthriticpatient was obeser than the patient without low back pain and degenerative changes on X-ray was 6.3 and proved to be statistically significant.

Clinical Application of Arthroscopy in the Patients with Internal Derangement of the Knee / 대한정형외과학회잡지

We applied arthroscopy in the diagnosis of thirty four patients with internal derangement of the knee from March to August, 1982. Its results were compared with clinical diagnosis and arthrographic findings. We also performed arthrofomy in twenty nine patients and the final diagnosis enabled us to evaluate the diagnostic accuracy of each method. The accuracy of clinical diagnosis was 63.4%. Arthrographic findings were correct in 77.8%. The diagnostic accuracy of arthroscopy was 92.3% with one false negative case. Unnecessary operations were avoided in five patients with the assistance of negative findings of arthroscopy. Arthrography and arthroscopy were complementary in the diagnosis of internal derangement of the knee.

A Study on the Conduction Veloctiy of the Median and Ulnar Nerves in Healthy Korean / 대한정형외과학회잡지

It is obvious that the examination of nerve conduction as a diagnostic tool is a relatively new field of interest with a state of still undergoing evaluation and improvement. Problems of technique and interpretation notwithstanding, determination of nerve conduction has progressed to a level where it is now used routinely as a part of the electrodiagnostic examination. The present study has been undertaken to determine the normal range of the motor nerve conduction velocity, distal motor latency, amplitude of the muscle action potentials, sensory nerve conduction velocity, distal sensory latency, amplitude and duration of the sensory nerve action potentials of median and ulnar nerves in healthy Korean. One hundred twenty healthy subjects (sixty male and sixty female) were examined. Their ages ranged from 5 to 69 in years and the subjects were arranged in three age groups of 5–9 years, 10–49 years and 50–69 years. The results obtained were as follows: l. In median nerve, mean values for motor nerve conduction velocity, distal motor latency, and amplitude of the muscle action potantials were 56.57± 4.55 (45.2–69.4) m/sec, 3.02±0.48 (1.6–4.5) msec, and 14.2±5.0 (4–28) mV, respectively. 2. In ulnar nerve, mean values for motor nerve conduction velocity, distal motor latency, and amplitude of the muscle action potentials were 58.60±5.06 (43.5–71.4) m/sec, 2.35±0.50 (1.3–4.1) msec, and 11.7±3.7(4–22) mV, respectively. 3. In median nerve, mean values for sensory nerve conduction velocity, distal sensory latency, amplitude and duration of the sensory nerve action potentials were 63.50±5.63 (53.1–75.9) m/sec, 2.37±0.38 (1.0–3.4) msec, 45.5±16.9 (13–120)u V, and 1.68±0.29 (0.9–2.5) msec, respectively. 4. In ulner nerve, mean values for sensory nerve conduction velocity, distal sensory latency, amplitude and duration of the sensory nerve action potentials were 65.34±5.16 (50.6–78.1) m/sec, 2.09±0.38 (1.3–3.2) msec, 45.6±17.5 (12–118) uV, and 1.54±0.32 (0.8–2.5) msec, respectively. In comparison of the obtained values of two nerves. 5. A significant difference was observed between motor nerve conduction studies of the median and ulnar nerves. 6. A significant difference was observed between sensory nerve conduction studies of the median and ulnar nerves except amplitude of the sensory nerve action potentials. 7. Nerve conduction velocity was significantly faster in sensory nerve than in motor nerve. In comparison of conduction velocities among 3 age groups. 8. Motor nerve conduction velocity of the median and ulnar nerves was slow in age groups of 5–9 years and 50–69 years as compared with that of age group of 10–49 years. 9. Sensory nerve conduction velocity of median nerve was slow in age groups of 5–9 years and 50–69 years as compared with that of age group of 10–49 years, and sensory nerve conduction velocity of ulnar nerve was slow in age group of 50–69 years as compared with that of age groups of 5–9 years and 10–49 years.

The Association between Degenerative Arthritis and Obesity / 대한정형외과학회잡지

It has been known that the obesity is one of the predisposing factors of the primary degenerative arthritis of knee. And nowadays, it seems that the number of obese person increases gradually in Korea. The authors studied 50 cases of the degenerative arthritis of knee clinically and statistically, compared with 50 cases of the control group, in the Department of Orthopedic Surgery, Seoul National University Hoispital from Jan. to Aug. 1981. The results were as follows: l. Among the degenerative arthritis of knee, the ratio of male: female was 1:9, and the age group with the highest frequency was the 5th. decade (48%). 2. Thirty-two cases (64%) was obese in the degenerative arthritis group, and 7 cases (14%) was obese in the control group. 3. The incidence of obesity in the degenerative arthritis group was 13.5 times higher than that in the control group, and it was highly significant statistically.

A Study on the Laboratory Findings in Experimental Osteomyelitis Caused by Staphylococcus aureus / 대한정형외과학회잡지

Even though various kinds of diagnostic and therapeutic measures have been used for the detection and cure of the acute osteomyelitis, this disease is difficult to be eradicated in many clinical cases. However it is rather easy to treat once this disease can be detected in early stage. So far radiological examination and many kinds of maneuvers including blood culture, clinical laboratory, xeroradiography, computed tomography have been performed for the early detection of this disease but invalid in the most cases. Recently some authors reported that the bone scanning was useful for the early detection of acute osteomyelitis, but this method also had difficulty in differential diagnosis and uncertaninty of its activity. This study aims to try to find methods of early detection of acute osteomyelitis. Experimental osteomyelitis was developed by the inoculation of Staphylococcus aureus to proximal tibias of 39 young rabbits already sclerosed by solution of sodium morrhuate. By comparing the clinical, radiological, bacteriological and laboratory findings in sequence from 2 days to 7 weeks after inoculation, the following results were obtained. 1. The incidence of experimental osteomyelitis after inoculation of staphylococcus aureus SNUH-S-188 in suspension of 1×10(7) colony forming units was 84%, 74%, and 79% in radiological, blood culture and pathologic examination respectively. 2. The leucocytosis was noticed only in early stage and slight degree of anemia was found during the 1st and 2nd weeks after inoculation. The sedimentation rate was increased only in early acute stage and same was eosinophil count. The leucocyte alkaline phosphatase(LAP) and platelet count. showed no significant abnormal changes. 3. Lymphocyte and eosinophil turned over from normal and eosinophil was predominant in experimental osteomyelitis. 4. Serum calcium, phosphorus, total protein and albumin showed significant decrease in all stages and was conversely paralle1 to changes in groin temperature. The level of BUN was normal indicating normal kidney function in experimental osteomyelitis. 5. Even though the enzymes of which showed no significant changes enrolled alkaline phosphatase and serumgluiamicoxalic-transaminase(S-GOT), but some increa.e was attained to 27% and 44% respectively. 6. It is important and significant to find continuous increase of lactic dehydrogenase (LDH) and creatine phosphokinase (CPK) since 48 hours after inoculation and author, think these will be the reliable and sensitive indices in early detection of the development of osteomyelitis and efficacy of therapeutic measures.

Electromechanical and Bioelectrical Charateristics of Fracture Healing / 대한정형외과학회잡지

It is widely blieved that the new bone formation is provoked by fine electrical stress to bone. There have been maay experimental studies that showed much efforts to define these small amounts of electricity, and these fine electricities are being used in the orthopedic field for the treatment of various fractures, nonunions and pseudsrthrosia The auther has checked the electrical potentials changing in the course of fractvre hesling in rabbits femur. Comparing these data with that of the normal control group, the following results were obtained. 1. In the normal rabbit's femur the electrical potentisl was 13.6mV less on the concave side than on the convex side. This finding can be explained by the existence of stress generated potential or piexoelectricity. 2. Electrcal potentials on the fractured femoral sites were lowered significantly from that of the control group. So auther could confirm the existence of bioelectrical generated by increased electrical activity of the living bone. 3. The electrical potential of the fractured femoral site has been decreased 50% and 20% as low as that of the normal site at 8 weeks respectively. It is expected that these lowered electrical potentials may become dose to the normal values when the changed metabolic process due to the fractured bone is no longer functioning and it is believed to take human 2 years to get the normal value.

Clinical Expreiences of Congenital Pseudarthroses and Non-Unions by Direct Current Stimulation / 대한정형외과학회잡지

Congenital pseudarthroses and non-unions have been recognized as some of the most challenging problems in orthopaedic surgery. with a standard surgical procedure, such as bone grafting, nailing, plating or a combination of these, it was frequently failed to unit. After repeated surgical failures, amputation has been the main course. With the advent of an electrical control of osteogenesis, however, this dismal outlook is brightening. The earliest report of the use of electrical energy to directly stimulate bone healing seems to be in 19th century, but it was not reliable. In this century, the electrical properties of bone were first described by Yasuda et al in 1953. After then, several investigators have shown that the application of small amounts of the electrical current to bone stimulates osteogenesis at the site of the cathode. Clinical trials using various froms in the treatment of delayed union, non-union, and congenital-pseudarthrosis began early in the 1970's. Constant direct current, pulsed current, and electromagnetically induced current have all been used clinically to heal bone defects with varying degrees of success. But, to-this date it is unknown what is the mechanism of stimulating bone healiag with electricity, and which from of electricity is most efficient in stimulating osteogenesis. We have experienced direct current stimulation to promote osteogenesis in 9 cases of non-union and 4 cases of congenital pseudarthses of the tibia from august, 1978 to december, 1980. Of 9 non-unions, 7 (77.8%) achieved solid bony union. We had obtained bony union in 4cases of non-union only with the electrical stimulation. In 4 cases of congenital pseudarthses of the tibia, all cases achieved solid bony union with the electrical stimulation and bone graft, but in 3 cases, refractures were occurred. At this moment, our conclusions from this study are as followa. I. Direct current stimulation is one of the reliable methods inducing ostengenesis. 2. Regular follows-up and determination of the stimulator integrity are essential steps in the electrical stimulation. 3. Combined treatment with the electrical stimulation and bone graft have markedly improved the success rate. 4. In direct current stimulation of congenital pseudarthsis, the mechanically sound bony alignment, massive bone graft and protection using long leg brace seem to be mandatory procedures.

A Clinical Study on the Diaphyseal Fractures Treated with Compression Plate / 대한정형외과학회잡지

Most orthopedic surgeons were aimed at the rigid internal fixation on the surgical treatment of the fracture. And the compression plate was developed and regarded as an excellent rigid internal fixation device by its advantages of accurate anatomical reduction, early joint mobilization and shortening of the duration of the fracture healing, which are chief aim of A.S.I.F. method. During the period of January 1970 to December 1979, 67 cases of diaphyseal fractures of the long bones were treated with compression plate according to A.S.I.F. method at the Department of Orthopedic Surgery, College of Medicine, Seoul National University and results were obtained as follows: 1. The age of patient was ranged from 15 to 77, and the highest incidence was in the 3rd decade male group (31.4%). 2. Old fracture cases were slightly more than fresh cases, and the fresh femur fracture was the commonest. 3. The periods of the postop immobilization of fresh fractures were 3.7 weeks in humerun fracture, 6.3 weeks in forearm fractures, 8.7 weeks in femur fracture and 7.0 week in tibia fracture, and in old fractures about 4 weeks was longer than fresh fractures. 4. The bony union was accomplished in all cases between 8 week and 24 week. 5. The complication were 4 superficial infections, 4 deep infections, 1 delayed union and 9 joint stiffnesses. 6. Compression plate fixation is considered as an excellent method for the treatment of the fractures of the long bones.

Trend of Bacteriological Sensitivity to Antibiotics on Orthopedic Infection: An analysis of 195 specimens / 대한정형외과학회잡지

One hundred and ninety-five cases of Orthopedic infection with positive bacteriology were reviewed with respect to their causative organism and sensitivity to antibiotics from Jan. 1974 to Dec. 1978 in Orthopedic Department of Seoul National University Hospital. The results were also compared with previous reports of our Department. The following observations were made ; 1) The identified causative microorganisms were 13 species. The Staphylococcus aureus continues to be the most frequent offender occupying 65.9% of total, which seems slight increasing tendency. 2) The increasing tendency of resistant Staphylococci to variable antibiotics was evident and Penicillin-resistant strains were proved in 82.8% of this series. 3) Of the antibiotics used during past two decades, the least resistant and cheap antibiotics to the Staphylococci were Chloramphenicol and Kanamycin. 4) The Streptococci occupied only 4.7% of total, suggesting decrease in incidence and also suggesting increase in incidence of Gram negative Bacilli. 5) The antibiotic sensitivity of Streptococci and Gram negative Bacilli were not changed significantly as compared with previous reports at our Department.

Limbic Bone of Vertebra 3 case of acute symptomatic limbic bone of vertebrae / 대한정형외과학회잡지

Limbic bone or persistant epiphysis seen roentgenographically on the anterosuperior aspects of the vertebral bodies represents another form of discal extrusion, seperating a small fragment of bone from the body of the involved vertebra. Lindblom, in 1951, demonstrated the pathophysiology with discography. Anterior herniation of the nucleus pulposus was also revealed by discography by Cloword and Buzaid in 1952. The authors reviewed 3 cases of limbic bone of the vertebrae.

The Use of the Longitudinal Traction and Anterior Spinal Fusion in A Patient with the Tuberculous Kyphosis / 대한정형외과학회잡지

The beneficial effect of the longitudinal traction-either halo-femoral or halo-pelvic and the anterior spinal fusion in some spinal disorders is well documented. This paper is a report of a patient who is suffering from spine tuberculosis with severe kyphosis and incomplete paraplegia. He was treated satisfactorily by applying a Crutchfield tong-femoral traction for four weeks followed by anterior spinal fusion. It is authors concept that the early cases of the active spine tuber-culosis with advancing kyphosis can be effectively treated by using the above mentioned method without introducing more complicated combination of the spinal osteotomy, halo-pelvic distraction and spinal fusion.

Squamous Cell Carcinoma Arising From Chronic Osteomyelitis: A Report of One Case / 대한정형외과학회잡지

Squamous cell carcinoma is a rare complication of chronic osteomyelitis. Squamous cell carcinoma of extremity campromises approximately 1 to 2% of all squamous cell carcinoma and of these 2.5 to 4.5% are secondary to chronic osteomyelitis. Biopsy of squamous cell carcinoma, which arises in the proliferating edge of the cutaneous ulcer and invades the bone, should include tissues from all portion of sites of ulcer including bone marrow spaces. But histological diagnosis may be difficult becasue of preexisiting and coexisisting metaplasia and pseudo-epitheliomatous hyperplasia. With prompt and aggressive surgical treatment, the prognosis for patient with squamous cell carcinoma secodary to chronic osteomyelitis is good. Routine regional lymphadenectomy at site of amputation seems unnecessary. This case report represets an unusual bone marrow involvement of squamous cell carcinoma which was complicated by femur fracture.

The effects of antibiotic Incorporation to Acrylic bone Cement upon Bacterial Viability and its Physical Properties / 대한정형외과학회잡지

Infection is one of the most serious complications following total hip replacement arthroplasty. Many modifications of procedures have been advocated in order to reduce the rate of infection with varying success. Incorporation of antibiotic to bone cement is one such approach. However, there still remains some reluctancy to adopt this method on account of dubious antibiotic effect at the expense of weakening of physical properties. Possible emergence of resistant organisms and hypersensitivity are additional drawbacks to be considered. The present experiments were undertaken to study the effectiveness of antibacterial activity of cement-antibiotic admixtures in vitro and in vivo as well as change of physical properties produced by the incorporation. As conclusions, antibiotic-mixed bone cements have evident effects on growth of inoculated organisms sensitive to added antibiotics whereas cured bone cement itself has been proved not to have any antibacterial activity. The leaching of antibiotics occurs fairly soon, the great majority of the amount within several days. The rest shows slow, delayed leaching over period of three weeks. The weakening of physical properties was not so significant to forbid the application. Resistance to tensile and bending stress was more reduced than that to compression stress. The mixing of two antibiotics(Cephaloridine and Gentamicin powder) together to bone cement revealed double-edged effectiveness to either of gram-positive or negative organisms without any significant illeffects on hardness of cured cement, It is suggested that mixture of two antibiotics to bone cement renders broader blind coverage to unknown causative micro-organisms of postoperative deep infection of total hip replacement arthroplasty.

Vitamin D Resistant Rickets with Secondary Hyperparathyroidism: Report of a Case / 대한정형외과학회잡지

Rickets is a syndrome, characterised pathophysiologically by a failure of normal mineralization of bone and epiphyseal cartilage and clinically by skeletal deformity in growing children. The four principal causes of rickets are; vitamin D deficency, renal tubular insufficiency, chronic renal insufficiency, and hypophosphatasia. Of these, vitamin D resistant rickets may result from primary defect in function of the renal tubular reabsorption for phosphorus, later accompsnied with secondary hyperparathyroidism. We experiened a rare case of hypophosphstemic vitamin D resistant rickets accompanied with secondary hyperparathyroidism in adolescence.

A Clinical Observation of Hip Fractures / 대한정형외과학회잡지

One hundred and forty eight cases of hip fractures experienced in the Department of Orthopedic Surgery of Seoul National University Hospital were analyzed, and following results were obtained. 1. Femoral neck fractures were 79 cases and trochanteric fractures were 69 cases 2. The most common cause of the hip frsctures was fall-down or slip-down (96 cases-65%). 3. Incidence of the femoral neck fracture was most frequent in the 6th decade, and that of the trochanteric fracture was in the 8th decade. 4. Sex ratio (male: femalein) incidence was 2.9:1 in the age groups before 50 years, and 1:1.8 after 50 years. 5. In classification of the hip fractures, transcervical fracture was most common (74%) in femoral neck fractures. And type 3 & 4 was 57% according to the method of Tronzo in trochanteric fractures. 6. Metals for internal fixation were S-P nail, S-P nail & plate, Knowles pin, Jewett nail, and compression hip screw etc. Especially we performed endoprosthesis frequently in old femoral neck fractures. 7. Significant delayed post-operative complications were head penetrations of the metals (15.5%), avscular necrosis (37.9%), nonunion (15.5%), and varus deformity (20.7%) in femoral neck fractures.

Clinical Observation of the Arthodesis of the Hip: Review of 42 Cases / 대한정형외과학회잡지

Various types of arthroplasty has been performed to obtain mobile joint in the treatment of the hip disease. In the view of stabilization and painlessness of the hip joint arthrodesis has been the treatment of choice in many hip problems, especially in unilateral tuberculosis of the hip. There are many kinds of techniques to gain arthrodesed hip: intra-articular only, extra-articular and combined method. The author reviewed the 42 cases of the arthrodesis of the hip performed at Dept. of Orthopedic surgery, SNUH during the period of 1964 to 1972 with following results. 1. Among 42 patients, there were 29 males and 12 females. Age group of predominence was 2 nd and 3rd decade (66.7%). 2. Thberculosis was the most common causative disease (61.9%) and remainders were fracturedislocation and avscular necrosis of femoral head. Average duration of illness was 3.8 years 3. The operative techniques were 21 Ghomley method (50%) and 11 Davis (26.2%). Satisfactory fusion was gained in 25 cases(92.6%) among 27 cases which follow-up study were possibe for more than 6 months. 4. There was no definite difference in fusion rate between Ghomley and Davis techniques. 5. Satisfactory fusion was gained with Davis technique in avascular necrosis of femoral head. 6. The fusion rate was superior in less than 39 years age group (95%).