A Clinical Study on the Treatment of Open Fractures of Tibial Shaft: Using AO External Fixator with Additional Interfragmental Lag Screw Fixation / 대한정형외과학회잡지

Fourty one cases of open fractures of tibial shaft complicated with varying degrees of soft tissue injuries were trested by one-plane unilateral external fixation with AO fixator. In seventeen csses among them, interfragmental lag screw fixation was applied in addition, for more rigidity and stability of the fixation. All of thern were followed up at least for one year and we obtained the following results. 1. Rigid stable external fixation provided by additional minimum internal fixation may not increase the rate of infection but rather enhance prompt primary bone healing. 2. One-plane unilatersl external fixation may facilitate good access to the wound for subsepuent reconstructive procedures, and enhance pain-free early full range of joint motion, thus promote early bone union. 3. Comparing with bilsteral fixation, there wss almost no difference in the union time of the fracture even with one-plsne unilatersl fixation.

A Clinical Study of Tibial Shaft Fracture: Using Plate Fixation on the Medial Surface of the Tibial Shaft / 대한정형외과학회잡지

39 patients with tibial shaft fracture had treated by open reduction and internal fixation with AO DCP and screws applying on the medial surface of the tibia, at the Department of Orthopedic Surgery, Ulsan Dongkang Hospital, from January, 1983 to December, 1985. A clinical study was done on all the 39 cases with the follow-up check over 1 year. In general, because the lateral surface of the tibia is well covered by rich soft tissue, it is popularized to apply the plate on the lateral aspect of the tibia. In our department, we applied the plate on the medial aspect of the tibia, which resulted in mimi-zing soft tissue injuries and, by inserting the screws perpendicular to the surface of the bone, increased stability of the fixation; and therefore resulted in relatively short operation time, relatively low incidences of infection and non-union; but there had been some drawbacks such as focal skin necrosis, hematoma, adhesion after fixatives removal, and cosmetic disfiguring. But there were no problems during the follow up periods. So, this is a recommandable procedure of internal fixation with the plate for the tibial shaft fractures.

Osteonecrosis of the Femoral Head Associated with Polyvinylpyrrolidone Storage / 대한정형외과학회잡지

Eighteen cases of osteonecrosis of the femoral head associated with macromolecular polyvinylpyrrolidone (PVP) deposition were analysed on the basis of clinical, radiologic and pathologic features. The cases were observed during 8 years period from January, 1974 to December, 1981. The pathogenesis of the osteonecrosis of the femoral head due to PVP storage in reticuloendothelial system were discussed in detail. Parenteral administration of high-molecular PVP in repeated, long duration led to osteonecrosis of the femoral head. Storage of PVP in the histiocytes of the bone marrow resulted in osteonecrosis of the femoral head followed by microciculation disturbance. PVP-induced osteonecrosis were manifested as multiple foci of necrosis involving not only the femoral head, other long bones around joints, but also the visceral reticuloendo-thelial system characterized by infiltrates of histiocytes laden with PVP. The patients with PVP induced osteonecrosis complianed multiple joint pain in their early course of the disease. On roentgenogram, osteonecrosis were often noted in the hip, shoulder, knee, and ankle in order or frequency. Foamy histiocytes laden with PVP were characteristic on hematoxylin-eosin stain diagnostic on Weigert's elastica, phosphotungstic acid hematoxylin, and Congo red stains. As far as rationale of the treatment concerning a number of staging systems for Osteonecrosis, the choice of surgical procedures were similar to those given by W.F. Enneking et al. In the series, we have performed two hips in total surface replacement, 26 hips in total hip replacement mostly for 3rd generation-configuration of Charnley prosthesis. In addition, one case for free vascularized fibula graft and trans-trochanteric rotational osteotomy after Sugioka were also included for this study. The result of treatment was rather optimistic. However, complications have occured in 4 hips of 3 patients which required removal of whole prosthetic components. Therefore, we underwent revisional surgery in three out of four hips subsequently during the short post-poerative follow-up. These will be published in the future.

Bone Scan for Diagnosis of Bone Metastasis / 대한정형외과학회잡지

Bone scan measuring bone metastasis were analysed in fifty five patients diagnosed as malignant tumor, seven were primary bone tumor and forty eight were metastatic tumor, who treated in Kyung Hee Hospital from March 1981 to January 1982. The results were as follows: l. In 55 patients, positive bone scan were found in 76.4% of the patients and positive X-ray were found in 56.4%. 2. 7 patients with primary bone tumor showed all positive bone scan, 45 patients with metastatic tumor showed positive bone in 72.9%. 3. Among the patients with metastatic tumor who no clinical symptoms, positive bone scan were found in 59.3% and positive X-ray in 26%. 4. Most common metastatic site was femur in primary bone tumor and vertebra in metastatic tumor. 5. In 48 patients of metastatic tumor, positive bone scan within negative X-ray were found in 56%, negative bone scan within positve X-ray were found in 5%. 6 The lesions showed clod area on bone scan were considered of positive finding as compared with clinical symptom and X-ray finding.

Treatment of Chronic Osteomyelitis by Transplantation of Autogenous Omentum with Microvascular Anastomosis / 대한정형외과학회잡지

Omentum has the characteristic that it readily develops vascular anastomosis with adjacent tissues. It is suitable for eliminating a dead space regardless of the size, shape or site in the treatment of chronic osteomyelitis by use of technique of microvascular anastomoses. We report a case of chronic osteomyelitis treated by transplantation of autogenous omentum with microvascular anastomsis.