The Role of Thrombophilia and Hypofibrinolysis in Legg-Calv-Perthes Disease / 대한정형외과학회잡지

PURPOSE: The object of present study was to investigate the relationship between LCPD and the abnormality of certain plasma proteins affecting clot mechanism and fibrinolysis in patients with LCP disease. MATERIALS AND METHODS: Twenty-five consecutive patients who had been diagnosed as LCP disease were matched with twenty-five controls for gender, age (2-year range) , and the time of presentation (1-year range) . There were twenty-three boys and two girls. The mean age of the children when the LCP disease was diagnosed was 6.7 years ( range, 2.1-12.8 years) , and the mean age at the time of the present study was 7.9 years ( range, 3.4 - 13 year) . Thrombotic disorders were investigated for protein C activity/antigenicity, protein S activity/antigenicity, antithrombin III, anticardiolipin antibody Ig G, anticardiolipin antibody Ig M, lupus antibody. Fibrinolytic disorders were investigated for tissue type plasminogen activator (t-PA) , plasminogen, plasminogen activator inhibitor-1 (PAI-1) , alpha 2 plasmin inhibitor, lipoprotein (a) . Wilcoxon rank sum test was used for the comparison. RESULTS: There was no significant difference in coagulation system and fibrinolytic system between patients and controls. CONCLUSION: Our results suggest that abnormality in coagulation and fibrinolytic system is not associated with Legg-Calv -Perthes disease.

Treatment of Tibial Fractures with the Ilizarov Method / 대한정형외과학회잡지

Between 1987 and 1992, 86 tibial fractures were treated with the Ilizarov external fixator at Gyeong-Sang National University Hospital and Okpo Hospital. The mean follow-up period was 31.4 months. Sixty-six were open fractures and twenty were closed fractures with severe comminution. In 66 open fractures, there were 9 Gustilo type I, 10 type II, and 47 type III fractures. Of 66 open fractures, 22 had bone defects ranged from 2cm to 17cm and 16 had extensive loss of soft tissue. Twenty-two bone defects were treated with cancellous bone grafts in 8 cases, bifocal osteosynthesis with bone graft in 12 cases, and trifocal osteosynthesis with bone graft in 2 cases. Thirty-four extensive soft tissue defects were treated with split-thickness skin graft, musculocutaneous flap, soft tissue transportation with ring used in bifocal, trifocal osteosynthesis, and acute shortening of fracture site. Of 20 closed fractures, 14 were treated with cancellous bone graft for decreasing union time and 6 were treated with monofocal compression without bone graft. The mean time to union was 20.5 weeks in closed fractures, and 35.4 weeks in open fractures. Of 40 complications, 12 were knee and ankle joint contractures, 12 were soft tissue and bone infections of pin tract, 5 were refracture, 5 were angular deformities of 10 degree or more, 5 were delayed union, and 2 were nonunion. According to Tucker's classification, the results were graded as excellent in 31, good in 38, fair in 12, and poor in 5 cases. Primary or secondary bone graft is necessary for early bony union and anatomical reduction combined with bone graft could prevent the complications of delayed union and nonunion.