Experimental Study on the Effects of Suture and Limited Active Motion on Achilles Tendon Healing / 대한정형외과학회잡지

The injured tendon is thought to be healed by, extrinsic healing from tendon sheath and adjacent connective tissue, and intrinsic healing from epitenon and endotenon. About the factors influencing the healing of injured tendon, many authors reported the effects of mobilization, electricity, ultrasound and various druge. Especially, active or passive mobilization had been known to promote the healing process and to reduce adhesion. To investigate the influences of active limited mobilization, intrinsic and extrinsic healing process, right Achilles tendons of 30 New Zealand white rabbits were grouped according to the types of treatments (Group I; tenotomy of Achilles tendon only, Group II; Tenotomy and long leg cast, Group III; surgical repair after tenotomy and long leg cast). The tendon sheath was repaired in all the groups, and the left Achilles tendons were used as control. At six weeks after operation, the tendons were removed and analysed biomechanically using Instron 1000, and histologically. The following results were obtained: 1. There were significant decreased of break strength, in order of Group III, Group I and Group II(p < 0.05). But, no difference was found between control group and Group III. 2. Extension length to the rupture, was decreased significantly in the experimental groups than control group. But there was no difference among the experimental groups. 3. Histologically, dense proliferation of fibroblasts and hypertrophy of tendon was observed in Group I; and matured fibricytic tendon tissues in Group II and III. In Group II, the amount of matured tendon tissues and degree of maturity were less than in Group III. In summary, suture and active limited motion were considered as promoting factors on the tendon healing.

Total Knee Replacement Arthroplasty in Rheumatoid Arthritis / 대한정형외과학회잡지

Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in the synovial membrane, periarticular structures, skeletal muscle and perineural sheath. Eventually, the joints are destroyed, ankylosed and deformed. Therfore, the aim of treatment is to keep the inflammatory process at a minimum, thereby preserving the joint motion, maintaining the health of muscle supplying motor power about the joint and preventing secondary joint stiffness and deformity. Surgical treatment in rheumatoid arthritis has progressed and there have been advances in the relief of pain and increase in the range of motion. Among them the results of total knee arthroplasty (TKA) have improved steadily during the past decade due to refinements in design, fixation, and surgical technique. At orthopedic department of seoul national university hospital, we performed 31 total knee replacement in 18 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1988. Following results were obtained. 1. Knee score increased from 37.8 to 76.9. 2. Tibio-femoral angle was corrected from 0.9° valgus to 5.3° valgus. 3. Conplications were peroneal nerve palsy in 3 knees, instability in 1 knee, tuberculous arthritis in 1 knee. 4. In 25 out of 31 knees, good functional results were obtained.

Treatment of Fibrous Dysplasia / 대한정형외과학회잡지

Authors have reviewed a series of 41 cases of fibrous dysplasia which were treated surgically at the Department of Orthopedic Surgery, College of Medicine, Seoul National University. After mean follow-up of 25 months, we summarized the results as follows; 1. Among the 41 patients, 20 were male patients(M:F= 1:1.05). The average age was 20.2 years old. It was the most common in the 2nd decade(44%). The most common site was femur (53.6%) followed by tibia (28.6%) in monostotic type. Each polyototic patient had 3.8 locations in average. 2. The results were better in skeletally mature patients (86%) than in immature patients (42%). 3. Satisfactory results seemed to be expected in monostotic type (71%) than polyostotic type(33 %) 4. Satisfactory results seemed to be expected in sclerotic type(78%) than cystic type(50%) or ground glass appearance type (62%). 5. Autograft(71%) was superior to xenograft(40%) in our study. However, xenograft only or xenograft with autograft can be a recommendable method of treatment for a very large lesion or for a patient with insufficient graft donor site.

Supracondylar Closing Spring Osetotomy for Correction of Cubitus Varus / 대한정형외과학회잡지

Cubitus varus deformity following elbow fracture in children rarely limits the function of the upper extremity, but the patients and/or their parents often request an operation for the aesthetic purpose. Various surgicsl techniques have been proposed to correct the deformity, however, the complications following operation are still common. We critically reviewed 55 patients with cubitus varus deformity treated by supracondylar closing osteotomy at Seoul National University Hospital between January, 1980 and April, 1989, and report on 25 patients who had at least one year follow-up (average 4.0 years). The results were graded as excellent (13 cases), good (8 cases), and poor (4 cases). The average amount of correction was 29.1 degrees by humero-elbow-wrist angle. There were two cases with ulnar nerve palsy and one case with radial nerve palsy, however, all of which were spontaneously recovered with time. The factors related to poor results were age at operation, degree of deformity, improper wedge size, and nerve palsy. In this article, we also illustrate our new, simple and safe technique of supracondylar closing spring (incomplete) osteotomy based on careful preoperative planning and special attention to surgical details.

Nerve Compression Syndromes of the Upper Extremities / 대한정형외과학회잡지

Nerve compression syndromes can be caused by compression of the peripheral nerve from interior or exterior of the nerve. In the upper extremities, brachial plexus, ulnar nerve and median nerve can be compressed in thoracic outlet syndrome, cubital tunnel syndrome and carpal tunnel syndrome respectively. Because these syndromes are caused by compression, decompressive management can be expected to be the principle of treatment. From Jan. 1980 to Dec. 1988, 94 patients were admitted and treated for nerve compression syndromes of the upper extremities in Seoul National University Hospital. Among these, 52 patients suffered from carpal tunnel syndrome and operation was performed to 86 hands. Twelve patients suffered from thoracic outlet syndrome and 25 from cubital tunnel syndrome. Ten patients were treated with conservative method and 84 with decompressive surgery. Satisfactory results were obtained in 92.3% of carpal tunnel syndrome and 84% of cubital tunnel syndrome. Of 4 operated cases of thoracic outlet syndrome, 3 cases were satisfactory.

Clinical analysis of Peripheral Nerve Injury / 대한정형외과학회잡지

Peripheral nerve injury occurs mostly in company with tendon and muscle injuries, fractures, or dislocations. Because of the disabilities and socioeconomic loss caused by such injuries, much attention must be paid to the initial treatment, and later to the reconstruction and rehabilitation. At department of Orthopedic Surgery, Seoul National University Hospital, 336 patients of nerve lesion were treated from Jan, 1980 to Dec, 1988. Among them 128 patients were nerve compression syndrome (carpal tunnel 52 patients, cubital tunnel 40 patients, thoracic outlet 16 patients, others 20 patients), and 50 patients were brachial plexus injury, and 168 cases were peripheral nerve injury. 50 patients of the peripheral nerve injury were treated with reconstruction and 118 patients were treatred with neurorrhaphy, nerve graft, and neurolysis. Of the 118 patients, 94 patients were followed up for more than one year, and the results of neurorrhaphy, nerve graft and neurolysis were analyzed. In 46 patients (73.0%) of the patients treated with neurorrhaphy, 7 patients (58.3%) with nerve graft, and 15 patients (78.9%) with neurolysis, good or excellent results were obtained.

Brachial Plexus Injury / 대한정형외과학회잡지

During the period from January 1980 to September 1988, 59 patients suffering from brachial plexus injury, have admitted to Seoul National University Hospital. Fifty-four patients were male and 5 patients were female, and age ranged from 6 to 58 years (mean:26.8 years). The most common cause of injury was traffic accident accounting for 66% (39patient), and among them 24 patients(62%) had the motor cycle accident. Birth injury, stab or gun shot wound, fall down and industrial hazard were following causes. Fracture and dislocation of involved limb accompanied in 19 patients(32%) and 2 patients of arterial injury were also found. EMG and cervicsl myelography with or without CT were performed in almost all the patients and MRI was performed in selected patients. Forty-five patients(76%) had supra-clavicular lesion and 14 patients (24%) had infra-clavicular lesion. In supra-clavicular lesion, upper roots or whole roots were involved in most of cases. Forty-nine cases were treated with conservative treatment for more than 8 months and operative procedures were performed in 36 cases. In operative cases, 30 patients were followed up for more than 1 year (average 24.3 months). Signs of root avulsion were found in 25 out of 31 cases of cervical myelography. MRI was performed in 7 cases, but it was inconclusive in diagnosis of root involvement. Infra-clavicular lesion showed better prognosis than supra-clavicular lesion. In supra-clavicular lesion, upper root involvement had the best prognosis. A pseudocyst detected by myelography usually precluded recovery in the root at the level of pseudocyst. Result of reparative treatment was better than that of conservative treatment. Overall satisfactory result in reparative treatment was 36%. However, if we include neurological improvement, positive result was 53%. Complete recovery was gained in half cases of neurolysis and other half showed no recovery, but all the cases of neurotization showed poor result. Reconstructive surgery including arthrodesis or muscle transfer can be effective treatment method, if it is performed properly on a selective patient.