A clinical anaysis of nonunion of the long bones in lower extremity / 대한정형외과학회잡지

No abstract available.

Biomechanical study on the fixation with adjunctive methylmethacrylate for the femoral intertrochanteric fracture / 대한정형외과학회잡지

No abstract available.

The Clinical Survey on Scaphoid Fractures / 대한정형외과학회잡지

Scaphoid fractures are the most common fracture and early diagnoses are very important because of preventing from serious complications such as nonunion, avascular necrosis, and disability of wrist joint. There are a few reports of clinical survey of scaphoid fractures, but not to be reported the evaluation for the close relation among mechanism, modes of treatment, especially operation and late complications. This paper reports more clear corelationships among them as mentioned as above through clinical study of scaphoid fractures. The authors have surveyed the clinical study of 26 cases of scaphoid fractures from July, 1983 to November, 1989 at Department of Orthopedic Surgery, Haewha hospital of Korea University. The following conclusions were obtained through clinical survey. 1. Among 26 cases, they were 25 males and one female between 20 and 50 years of age, and ocalization was 16 in right and 10 in left. They were 21 fresh fractures and five nonunions. 2. Mechanism of injuries had revealed fall down or slip down in 13 cases, roller injury in five cases, fisting injury in four cases, direct trauma in two cases, and traffic accident in two cases. Fracture loeation was four cases in proximal 1/3, 17 cases in middle 1/3, and five cases in distal 1/3. 3. Operations using volar approachs in 12 cases and dorsal approachs in three cases had been done for ten cases of displaced fresh fractures and five cases of neglected nonunions. 4. Eleven undisplaced fresh fractures were treated with short arm thumb spica cast but one with. long arm cast. Of ten displaced fresh fractures treated by open reduction, seven cases were treated with Herbert screw, two cases with K-wire, and one case with treated by open reduction and bone graft with Herbert screw fixation in three cases, K-wire fixation in one case, and open reduction with bone graft in one case. 5. Unions were obtained at average 11.5 weeks in eight of 11 cases treated with conservative treatment for fresh fractures, 12 weeks in eight of 10 open reduction cases of fresh fractures, and 20 weeks in three of five neglected nonunion cases. 6. Of eleven conservatively treated cases, two cases resulted in nonunion and other one case in avascular necrosis. Of ten treated with open reduction, one complicated in delayed union, other one nonunion. Of five neglected nonunion cases treated by open reduction added with bone graft, one remained in nonunion and other one case complicated with arthritis and nonunion.

Treatment of Unstable Intertrochanteric Fracture of the Femur: Cpmparision between Sliding Compression Hip Screw and Jewett nail Plate / 대한정형외과학회잡지

Commonly used internal devices to fix the stable and unstable intertrochanteric fractures are fixed nail plate (Jewett nail, Holt nail), sliding nail plate (compression hip screw) and intramedullary device (Ender, Harris nail). The choice of internal device is influenced by the general coditions of patients, the pattern of fracture and the personal preference of surgeon. There are many reports that sliding nail plate appears to give better result than fixed nail plate because the latter device leads to high failure rate. Twenty nine unstable intertrochanteric fractures treated with Jewett nail plate (group I) and sliding compression hip screw (group II) between 1981 and 1988 were reviewed after minimal twelve months follow up. Group I comprised of fourteen cases, Group II, of fifteen. There were seventeen males and twelve females. The ages ranged from thirty-two to seventy-eight years, the average age being 57.8 years. Eighteen cases were caused by slip down; eight, traffic accident; and three, fall down. The average operation time was 124 minutes in group I and 148 minutes in group II. The average amout of blood loss was 1024cc in group I and 1040cc in group II. The average time to union was 13 weeks in group I and 12.9 weeks in group II. In Jewett nail plate fixed group, there were three complication; one coxa vara, and superior migration of nail, and one subcapital fracture and one superficial wound infection. In sliding compression hip screw group, one was complicated with coxa vara. Above results suggest that the use of Jewett nail plate in unstable intertrochanteric fracture could be got good results with method using compression hip screw.

A Clinical Study of Acromioclavicular Dislocation Treated with Modified Phemister Method / 대한정형외과학회잡지

The authors had experienced 24 cases of aeromioclavicular dislocation from 1980 to 1988 at Korea university Haehwa hospital with at least 6 months follow up. They were treated by modified Phemister method. Ther were twenty-three males and one female. The ages ranged from eighteen to fifty-eight, the average was 31.6 years. The following results were obtained. 1. The most common cause of injuries was sports injury, followed by fall down and traffic accident. 2. There were twenty-two type III and type IV according to Rockwood and Green classification. 3. Duration between injury and operation were less than 1 week in 21 cases, between 1 to 2 weeks in 2 cases and more than 2 weeks in 1 case. 4. Clinical results according to Ejeskar classification were excellent in 16 cases(66.7%), good in 6 cases(25%), and acceptable in 2 cases(8.3%). 5. There were five complications : two K-wire breakage, two recurrent dislocation and one lateral end fracture of right clavicle.

A Clinical Study of Femoral Neck Fracture / 대한정형외과학회잡지

We analysed forty-six cases of femoral neck fracture treated with internal fixation and followed for more than one year at Korea University Hospital from January 1979 to June 1986 and the following results were obtained. 1. Sex distribution was 23 cases(50%) male and 23 cases(50%) female, and average age was sixty years old (range from 21 to 91 years). 2. The most common cause of injury was slip down(76%). 3. The most common type of fracture was Garden's type III(46%) and Pauwels' type III (67%). 4. In cases of internal fixation, the most commonly used method was closed reduction and multiple pinning under the local aneshtesia(83%). 5. Bony union was established within 5.9 months in average. 6. Among forty six cases, 7 cases(15%) of avascular necrosis, 4 cases(9%) of malunion, and 2 cases(4%) of nonunion was occurred. 7. The clinical results were excellent in twenty cases(43%), good in sixteen cases(35%), fair in seven cases(15%), and poor in three cases(7%) according to Lunceford's assessment.

A Clinical Analysis of the Ankle Fractures / 대한정형외과학회잡지

The ankle is a complex, weight bearing joint and its injury result in a severe functional disturbance of complex anatomical characteristics. It is very important to understand the mechanism of trauma in order to make definite diagnosis and proper treatment. The authors analysed 52 cases(52 patients) of the ankle fractures which were admitted and treated in Orthopaedic department, Korea University Hospital from Sept. 1980 to Dec. 1986. The results obtained were as follows : l. Of the 52 cases, male was 32 cases(61.5%), female was 20 cases(38.5%) and average age of the patients was 32.9 years. 2. The causes of the injury were slipping down, traffie accident, falling down and sports injuries, in orders. 3. Open fractures were 8 cases(15.4%) and closed fractures were 44 cases(84.6%). The most common type of the ankle fracture was supination-extenal rotation type(18 cases, 34.1%) and next was pronation-external rotation type(15 cases, 30%), according to the classification of Lauge-Hansen. 4. 38 cases(73.1%) were treated by open reduction and 14 cases(26.9%) by closed reduction, and average duration of immobilization was 7.7 weeks in open reduction and 10.4 weeks in closed reduction. 5. The associated fractures other than ankle was 15 cases(28.8%). 6. The better results were obtained from open reduction and the worst results obtained from pronation-dorsiflexion type, according to the criteria of Meyer. 7. The complication was 7 cases(13.5%), traumatic arthritis 4 cases, malunion 2 cases and nonunion 1 case. 8. Accurate reduction and rigid internal fixation of the fractured lateral malleolus, distal fibular and distal tibiofibular diastasis was important in treatment of the ankle fracture.

Scintimetric Evaluation of Femoral Neck Fractures by Tc-99m-MDP: Experimental Study in the Mature Rabbits / 대한정형외과학회잡지

In femorsl neck fracture, viability of the femoral head depends on the revascularization of the femoral head. The purpose of this study is to observe the effect of early fixation and anatomical reduction by measuring the Tc-99m-MDP uptake ratio of the femoral head in experimental animsls. Femoral neck region of 20 mature rabbits were osteotomized completely and divided into 2 groups ; each group consisted of 10 rsbbits. Group 1 had two Kirschner wire fixation after osteotomy and anatomic reduction. Group 2 had no fixation after osteotomy. The uptake ratio of Tc-99m-MDP of the femoral head in each group were measured st the intervals of 24 hours, 48 hours, 1 week, 2 weeks, 3 weeks, and 4 weeks, respectively. The results obtained were as follows ; 1. In experimental group 1, the mean uptake ratio of the femoral head was 0.72±0.13 at 1 day after operation, increased to a level of 1.44±0.14 at 1 week, increased to a maximal value of 2. 90±0.36 at 3 weeks and decreased to a level of 1.10+0.12 at 4 weeks. 2. In experimental group 2, the mean uptake ratio of the femoral head was 0.70±0.10 at 1 day, 0.64±0.13 at 1 week, decreased to a maximal value of 0.33±0.05 at 3 weeks and 0.47±0.05 at 4 weeks, showing decreased level below 1.0. The results suggest that early anatomicsl reduction and rigid fixation of femoral neck fracture is helpful for revascularization of the femoral head and prevention of non union.

Experimental Study on Changes in 99mTc-MDP uptake of the Tibia during Blood-Flow and Skeletal phases / 대한정형외과학회잡지

The purpose of this study is to observe the changes in 99mTc-MDP uptake of the tibia during blood-flow and skeletal phases and determine the clear borderline between both phases. Serial 99mTc-MDP uptake measurements were performed, as control, in ten matured rabbits with skin incision only and in thirty matured rabbits with fractures of middle and distal one-third of tibia, at ten minutes, thirty minutes, one hour, two hours and four hours after injection of bolus. A value in uptake ratio was calculated by measurements of 99mTc-MDP uptake at each observation time for analogous regions of normal and fractured tibia applied with or without tourniquet. The results obtained were as follows: 1. Group I (skin incision only in ten rabbits) 1) Without tourniquet, the mean 99mTc-MDP uptake ratio tibia was value of 1.05 at ten minutes, 0.97 at thirty minutes, 0.99 at one hour, 1.01 at two hours, 0.97 at three hours and 1.08 at four hours. 2) With tourniquet, the mean 99mTc-MDP uptake ratio of tibia was value of 0.61 at ten minutes, 0.64 at thirty minutes, 0.76 at one hour, 0.98 at two hours, 0.94 at three hours and 1.05 at four hours. 2. Group II (fracture with K-wire fixation in twenty rabbits) 1) Without tourniquet, the mean 99mTc-MDP uptake of tibia was value of 0.73 at ten minutes and 0.80 at two hours. 2) With tourniquet, the mean 99mTc-MDP uptake ratio of tibia was value of 0.45 at ten minutes and 0.76 at two hours. 3) There were no significant change of the 99mTc-MDP uptake ratio in two to four hours after fracture whether the tourniquet was applied on or not. 3. In cases with tourniquet application, there were no significant changes of 99mTc-MDP uptake ratio during two to four hours in group I anda II. This experiments suggest the optimal time for evaluation of the skeletal phase is in two hours following the injection of bolus (99mTc-MDP).

Singificance of Bone Scan in the Early Diagnosis of Acute Osteomyelitis / 대한정형외과학회잡지

Bone imagings have played important role in early detection of acute osteomyelitis. In acute osteomylitis, bone scan findings precede the appearance of bone change on radiograph. Also, recent studies have reported accuracies of bone scan in diagnosis of osteomyelitis ranging from 84% to 100%. But, in above datas, bone scan reading were only qualitative studies. So we have reviewed Technetium-99m labelled methylen dipho sphonate(99mTc-MDP) scan on 21 patients who had been diagnosed acute osteomyelitis by clinical symptoms, blood culture, pus culture and operative findings from January, 1984 to September, 1985. The purpose of this study is to establish the quantitative study of bone scan using computed pixel counting method. The 21 cases were classified into group I and group II according to initial radiographic findihgs. The group I showed normal radiographic finding or soft tissue swelling without osseous change. The group II showed osseous change. The results obtained were as follows: 1. We obtained positive bone scans in the all cases which were confirmed acute osteomyelitis. 2. We experienced diagnosis of acute osteomyelitis by bone scan which was confirmed as early as 48 hours after onset of clinical symptom. 3, In group I, the average uptake ratio of 99mTc-MDP was 3.22±0.82 ranging from 2.20 to 4.80. 4. In group II, the average uptake ratio of 99mTc-MDT was 6.20±2.27 ranging from 4.00 to 9.40. (p <0.001).

A Malignant Lymphoma of the Ilium: One Case Report / 대한정형외과학회잡지

Malignant lymphoma of the bone is a rare, but involves the shaft or metaphysis of the bone, producing destruction, frequently pelvis, spine, skull and femur. Most of the patients are over thirty years old and equal sex distribution. The authors experienced one case of lymphoma involving the left ilium.

Treatment of Subtrochanteric Fracture of the Femur by Zickel I-M Nail / 대한정형외과학회잡지

Subtrochanteric fracture of the femur are difficult to treat successfully. Although performing operative treatment, the incidence of mechanical complications is higher than other sites of long bones. Among many factors influenced management of subtrochanteric fracture, there are three more important factors which subtrochanteric area composed mainly of cortical bone, high concentration of stress, and influenced to surrounding large and powerful muscles. During the period of Nov. 1979 to Sep. 1981, 10 cases of subtrochanteric fracture of femur were treated by Zickel I-M nail at the Department of Orthopedic Surgery, College of Medicine, Korea University, and results were obtained as follows: l. Of 10 cases of subtrochanteric fracture, 8 cases occured in man, and 2 cases in woman. 2. Causes of 10 cases of subtrochanteric fracture were fall down or slip in 6 cases, and T-A in 4 cases. 3. Of 10 cases of subtrochanteric fracture, 2 cases were type I, 6 case were type II, and 2 cases were type lll by Zickel's classification. 4. There are no significant complieatioris except 1-2 cm shortening in the 2 cases of unstable comminuted intertrochanteric fracture. 5. Zickel nail is the good implant for rigid fixation of subtrochanteric fracture or subtrochanteric fracture extend to intertrochanteric area of the femur, if suitable indication.

Subcutaneous Angiolymphoid Hyperplasia of the Inguinal Region and Anteromedial Side of the Proximal Thigh: A case report / 대한정형외과학회잡지

Subcutaneous angiolymphoid hyperplasia is an uncommon disease characterized by eosinophilia, proliferation of the capillary vessels and lymphoid tissue and infiltration of the inflammatory cell, especially eosinophils. The etiology of the disease are obscure, but probably trauma, lower grade infection, nervous factor & hormonal status etc. The predilection sites are face, ears, scalf & neck, but rarely reported in the extremities. We experienced a case of subcutaneous angiolymphoid hyperplasia of the inguinal region and anteromedial side of the proximal thigh in a 10 year-old man who complained pain and tenderness on the above region. The patient was treated by excision with satisfactory result.

An Experimental Study of the Effect of Bone Cement upon the Epiphyseal Plate of Growing Rabbits / 대한정형외과학회잡지

Acrylic bone cement is now widely used in surgery for many purposes. Therefore, the effect of bone cement on the growth plate of a growing bone may be an interesting subject, particularly in the orthopedic field. The authors carried out an experiment to study the effect of bone cement on the growth plate of the bone, using 32 growing rabbits weighing from 800 to 1000 gm, which were divided into 2 main groups. In Group I, which was the control group, the growth plates were injured mechanically by inserting a Kirschner wire and a stainless screw, 1.5 mm and 2.5 mm in diameter, respectively, which were then removed. In Group II, the growth plates were also injured by the same method as in Group I, and bone cement was inserted into the holes made by the insertion of the Kirschner wire and the screw. Then the histological findings of the injured plates were studied at 2, 4, 6 and 10 weeks after injury. Following observations were made. 1. In Group I, in which the growth plates were only mechanically damaged, the histologic changes were localized only in that portion of the plate which had been injured by a wire or a screw, leaving the rest of the plate relatively normal. In Group II, the extent and severity of the injury were more wide and severe. 2. Proliferation of mesenchymal fibroblasts and deformity of the growth plate were more severe in Group II. 3. In both groups the extent and severity of growth plate injury were more marked when injured by a screw.

Total Hip Replacement of Pathologic Fracture in Fibrous Dysplasia involving Proximal Part of the Femur / 대한정형외과학회잡지

The fibrous dysplasia, divided into 3 categories of the monostotic, polyostotic and extraskeletal forms, is a relatively rare disease which was first reported by Well in 1922 and shows a characteristic findings replacing the medullary cavity of noe or more bones by the pathologically proliferating fibrous connective tissues. In a consequence, the structural integrity of the diseased bone becomes weakened and suffers frequent episodes of pathologic fracture and deformities of the bone, which are most common around the hip. Various operative methods and instruments have been tried to manage the pathologic fracture around the hip recently. The authors report a satisfactory resnlt of total hip replacement for the pathologic fracture in a patient of the fibrous dysplasia involving the proximal half of the right femur.

The application of the Halo-pelvic apparatus in Quadriplegia with Unstable fracture-dislocation of cervical spine / 대한정형외과학회잡지

The head-pelvic skeletal traction was first attempted in 1958 by Arther R. Hodgson., and was described. The Halo skull traction apparatus by Perry and Nickel (1959), the method were provided for immobilising the unstable cervical spine, correction of the Scoliotic deformity, Tuberculotic Kyphosis, and other deformed disease. We performed Halo-pelvic apparatus,after posterior-fusion of unstable cervical spine, on a 24 year old male, with Quadriplesia due to Fracture-dislocation of the 7th cervical spine in May 1976. The following were the condition to be met: 1) Rigid stabilization and improved the cervical pain. 2) progressive adjustable., longitudinal traction for reduction 3) The patient was able to sitting position withont other Supports. 4) No pressure sores developed as happens beneath a cast. 5) Ease of patient management and taking of Roentogenogram.

Neurovaseular Island Pedicle Graft for Restoration of Sensation After Amputation of Fingertip Pulp / 대한정형외과학회잡지

A case of the neurovascalar island pedicle graft for restoration of sensation after amputation of both thumb fingertip pulp in 17 years old male patient is presented at Department of Orthopedic Surgery, College of Medicine, Korea University. Tho island pedicle graft is suggested by Esser firstly and it is very difficult and excitement. At postoperative follow up check within one month, we obtained very good result without other complications.

A Case of Giant Cell Tumer of Tendon Sheath Associated with Regional Bone Destruction / 대한정형외과학회잡지

An giant cell tumor arising from the tendon sheath and other soft tissue of the extremities, hasbeen of clinical and pathologic interst for many years, which is the second most common tumor of the hand, but it is not common in other location. One case of tendon sheath giant cell tumor with regional bone destruction on the pharangeal bone is presented which experienced at Department of Orthopaedic Surgery, Korea University recently. At first, the lesion of bone that is confused with Enchondroma in roentgenographically, which is confirned regional bone destruction of tendon sheath giant cell tumor by histologically. The tumor is composed of a vascularized network of spindle shaped or ovoid stromal cell regularly and rather interspersed with multinuclear cell and xanthoma cells. We report a case of giant cell tumor of tendon sheath and review of literature.

The Histological Change of the Fractured epiphyseal Plate of the Distal End of the Femur in the Growing Rabbit / 대한정형외과학회잡지

The orthopaedic treatment regarding to the residual deformity secondary to epiphyseal plate injury is the most important thing. Author particularily interested in the microscopic finding upon the repair of damaged transepiphyseal fracture of the distal femoral end of growing rabbits. Experimentally this type of fracture is produced surgically and fixation is achieved by two Kirshner wires; one Kirshner wire is inserted obliquely through the metaphysis. A total of 10 growing rabbits were fed with normal diet, and each 5 rabbits were psacrified by 8 and 10 weeks after the surgical procedure respectively and histological change is examined. No rabbit had infection for those experiment. The results of observation were summarized as follows:1. The ruptured epiphyseal plate due to osteotomy through epiphyseal plate was found to be healed by new bone and fibrotic tissue, not by cartilage regeneration. 2. The epiphyseal plate in the small part of fracture fragments revealed as follows; a. The arrangement of cartilage zones revealed marked irregularity. b. The form and the character of cartilage cells revealed an abnormality such as the hyperophy or the atrophy of cells or both. c. The necrotic area revealed at the several places. d. The thickness of epiphyseal plate revealed more narrowing and irregularity. 3. The effect on the kirschner wires were seen as follows; a. There was no evidence of cartilage regeneration on the margin of the damaged epiphyseal plate. due to Kirschner-wire insertion b. The adjacent tissues around the both kirschner Wires revealed pretty heavy new bone formation.

A Case Report of Enchondroma on Right Ischjum / 대한정형외과학회잡지

The Enchondroma is a benign cartilage forming harmartoma arising chiefly from short tubular bones on hands and feet. If on a long tubular bone or flat bone such as femur or ilium, it is most likely to be a true neoplasm such as chondrosarcoma, not a harmartoma. A case of enchondroma was reported. It occurred over right ischium of 19 years old male and was found incidentally by roentgenogram. The lesion was biopsied and diagnos's was confirmed by histologic examination. It was treated by curretage with filling of cavity with bone chips. Post operative-course was uneventful.