A Clinical Study on the Fracture of the Proximal Humerus / 대한정형외과학회잡지

In recent years, there has been a tendency to advocate operative treatment as the method of choice for certain fractures of the proximal humerus. But the management of this fracture is still under debate, especially in the elderly patients. Seventy eight patients with displaced fractures of the proximal humerus were reviewed, and the results were as follows ; l. Among the 78 patients, the ratio of males and females was 44:34 and the highest incidence was between the ages of 40 and 49 years. 2. The most common cause of injuries was traffic accident (57.7%), and falling or slipped down was in 33.3%. 3. According to the classificatoin of Neer, the commonest type was two part fracture (60.3%). 4. Fifty-three cases were treated conservatively, and surgical treatment was done at 25 cases. At old age, or patients with severe associated injury, external fixation was done (12 cases), and one case of four-part fracture was treated by prosthetic replacement. 5. The results were analyzed according to Neer's criteria, and 38 cases (48.7%) showed good, 25 cases (32.1%) was fair, and 15 cases (19.2%) was poor. 6. Total cases with complication were 19 (24.4%), and joint stiffness was most common (10 cases). 7. At elderly patient above 50 years old, the result of surgical treatment was satisfactory in 72.7%, and 58.8% was so when treated conservatively. And the external fixation showed slightly better result than that of internal fixation.

Treatment of the Displaced Fractures of the Proximal Humerus by External fixation / 대한정형외과학회잡지

Treatment by External Fixation with External Compression Device was used for the displaced fractures of the proximal humerus. Especially in the old aged patient and patient with severe associated injury, this method was excellent for the early, painless motion of the shoulder and then good functional result. This experimental treatment was performed in 8 patients, and its merits were as follows: 1. The technique of operation was relatively easy, and was possible within a short time with minor injury. 2. The quality of reduction was good in all cases. 3. By the compression effect on the fracture site and firm maintenance of reduction during the treatment, solid healing as in internal fixation was possible. 4. Firm maintenance of reduction & minimal injury of soft tissue made possible early painless and wide ROM exercise, and then good functional result.

Morquio's Syndrome: A Case Report / 대한정형외과학회잡지

Morquio's syndrome is a very rare disease, which is characterized by dwarfism, flattening of the vertebral body, marked spinal kyphosis, widespread affection of the epiphyses and normal intelligence. The authors experienced a case of Morquio's syndrome with typical clinical and radiological findings. The patient underwent bilateral supracondylar varus osteotomies for severe genu valgum deformities.

A Clinical Study of the Femoral Neck Fractures in Elderly Patient / 대한정형외과학회잡지

Authors clinically analysed the end results of the 58 elderly patients having fresh femoral neck fracture who were treated with multiple Knowles pinning, compression hip screw and femoral head replacement. All these 58 patients were treated between January 1982 and December 1986 at the Presbyterian Medical Center, Chonju. The factors that influenced the clinical results were analysed by type of fractures, early and late post-operative complications, quality of the fractured bone(osteoporosis), and functional evaluation with Jesse's hip grading method at least post-operative two year later. The results were summerized as follows : 1. The slip down was the most common cause of injuries. The transcervical type and Garden's type 153 was the most common type of fractures. 2. Average time interval between injury and diagnosis is 6 days. In case of delayed diagnosis, the fractures showed more displacement. 3. The osteoporotic change of femoral neck and spine was increased as physiological age advanced in parallel. 4. As the osteoporosis advanced, the fractures showed more displacement. 5. As the kosteoporosis advanced, the final results were worse, 6. The group treated with compression hip screw showed less complication and better functional result than patients operated with multiple knowles pinning. 7. This study suggests that the important factors that influenced the clinical results were type of fracture, the interval between injury and operation, method of trearment, and the quality of the fractured bone(degree of osteoporosis).

Experimental Treatment of the Patella Fractures by Modified Tension Band and External Fixator / 대한정형외과학회잡지

Experimental treatment by open reduction and internal fixation with modified tension band combined with external compression device was used for the patella fractures. Early post operative continuous passive motion and early weight bearing exercise was followed. This method was excellent for treatment of the patella fractures and prevention of post operative complications such as limitation of motion and post-traumatic arthritis of the knee joint. This experimental treatment was performed in 5 patients. and the results are as follows :1. Treatment by modified tension band combined with external fixator is useful for any type of the patella fracture. 2. By continuous passive motion and programed post operative rehabilitation, early painless recovery of wide range of motion of the knee joint and early weight bearing became possible. 3. Complications such as pain on motion, post-traumatic arthritis and limitation of motion of the knee joint was not seen. 4. This method is excellent for treatment of the patella fractures, and we are now trying to memodel the external fixator for cosmetic improvement and prevention of pin site problems.

Comparative Clinical Study Between Plating and Intramedullary Nailing of Femoral Shaft Fractures in Adult / 대한정형외과학회잡지

Various methods have been used in the treatment of femoral shaft fractures in adults. In recent years, generally accepted two methods are intramedullary nailing and plate fixation. We followed and reviewed 121 cases of femoral shaft fracture in 116 patients, treated by operation in Orthopaedic Department, Presbyterian Medical Center, Chonju from 1980 to 1986. All cases were devided into 2 groups, intramedullary nailing(24 cases) and plate fixation (97 cases), and the two groups were compared each other. The results are as follows : 1. Most of intramedullary nails were used in relatively younger age group, before 50 yesrs of age. 2. The mean bony union time in plate fixation was 14 weeks and that in intramedullary nailing was 17.4 weeks. They showed about 3 weeks of difference. 3. In the group, whose operations were performed within 2 weeks after injury, showed high rate of bone union within 6 months, but in those whose operations were delayed more than 2 weeks showed marked decrease in bone union. And the rate of decrease was greater in plate fixation. 4. The recovery of knee joint motion above 110 was greater in intramedullary nailing (87.5%) than that in plate fixation(79.3%). 5. There was no difference in functional recovery between plate fixation and intramedullary nailing. 6. The complications, including delayed and nonunion, infection, metal failure, and limitation of knee joint motion, were more in plate fixation. 7. The risk of refracture is higher in plate fixation. Therefore plates must be removed after some period.

Triphalangeal Thumb: Case Report / 대한정형외과학회잡지

Thiphalangeal thumb is characterized by interposition of an extraphalanx between the two normal phalanges of the thumb. The extra-phalanx varies from a small triangular bone to a normal phalanx in what appears to be a thumbless five fingered hand. Triphalangeal thumbs are divided into three types and the treatment differs from associated anomalies and clinical features. We had a bilateral triphalangeal thumbs treated by closed wedge osteotomy to the extra-phalanx.

A Clinical Studyl of Diastasis of the Ankle Joint / 대한정형외과학회잡지

Diastasis of the ankle joints was associated with not only ankle fracture but also with ligamentous rupture. Since keeping anatomical reduction and giving secure stability to the injured ankle is the gole of the treatment for a good outcome, diastasis should not be overlooked from the first time. To obtain this goal, thorough understanding of diastasis and clear-cut diagnostic guide is important. Seventy one patients of ankle diastasis treated at Presbyterian Medical Center from Jan. 1979 to Dec. 1985 were analyzed in clinical and radiological aspect. The results obtained from this study were as followings. l. Among the 71 diastasis patients, male was predominantly 90%. The average age was 32 years old of age. 2. The main cause of diastasis was traffic accident (42 cases) and the other causes were falling from a height, sport injury in order of frequency. 3. In classification of the Lauge-Hansen, the most common mechanism that causes ankle diastasis was supination-external rotation (47.8%). 4. On the degree of the diastasis, complete type was 32.4%, and incomplete type was 67.6%. 5. 67.8% of the ankle injury patients developed ankle diastasis. 6. The average transfixation time was 11 weeks. 7. By the Meyers assessment, clinically 81.6%, radiologically 87. 3% good result can be obtained. 8. Good result could be achieved by early accurate diagnosis and proper operative intervention.