Heel Pad Reconstruction using Doresalis Pedis Free Flap or Rotation Flap / 대한정형외과학회잡지

Eleventh heel pad reconstruction with neurovascularized dorsalis pedis free flap or rotation flap have performed during recent three years in department of Orthopedic Surgery, Kyung Hee University Hospital. Neurovascularized dorsalis pedis free flaps were seven and neurovascularized dorsalis pedis rotation flaps were four. All patients had complained of painful limping and ulceration in grafted heel. In 5 months to 34 months follow up study, the following results were obtained. The success rate of dorsalis pedis flap was 100% except one partial peripheral necrosis. The weight bearing function and tactile protective sensation on reconstructed heel pads were excellent. Neurovascularized dorsalis pedis free flap or rotation flap is recommended to satisfactory methods in heel pad reconstruction. Neurovascularized dorsalis pedis rotation flap easier and safer technique than neurovascularized dorsalis free flap.

“V” Shape Corrective Osteotomy of the Long Bone / 대한정형외과학회잡지

French method of wedge osteotomy has been widely used to correct the cubitus varus deformity, but it is difficult to correct the rotational deformity, gunstock deformity effectively and to fix the distal fragment rigidly because the supracondylar area of the humerus has an anatomical characteristic of short distance in A-P plane. We can design a new method of “V” shape osteotomy to correct the cubitus varus and apply this method to the deformities of the tibia and femur. Ten cases of “V” shape corrective osteotomy were performed in the Department of orthopedic Surgery, Kyung Hee University. Of these, 5 cases were cubitus varus deformities, 3 cases were deformities of tibia and 2 cases were deformities of femur. The results were obtained as follows. 1. The cubitus varus and gunstock deformities are corrected effectively without unnecessary bony loss. 2. The rotational deformity can be corrected in stable position due to the “V” shape contact surface. 3. The contact area is so wide and oblique that it may be ease to manage the distal fragment and we may expect good union process with early ROM exercise due to rigid fixation. 4. Additional change of the corrective angle can be possible. 5. This method is also effective for the correction of the deformity caused by partial epiphyseal closure of the long boen, using partial open wedge osteotomy.

Free Vascularized Fibular Graft Using Microsurgical Technique / 대한정형외과학회잡지

It is notoriously difficult to obtain a sound bony union of large segmental bone defects secondary to trauma or following tumor resection, infected nonunion, congenital pseudarthrosis of the tibia, and avascular necrosis of the femoral head with conventional methods. Recent advances in microsurgery have made it possible to provide a continuing circulation of blood in bone grafts so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. Thus, the grafted bone is achieved more rapid stabilization of bone fragments separated by a large defect without sacrificing viability. Thirty nine cases of the free vascularized fibular graft had been performed in the Department of Orthopedic Surgery, Kyung Hee University Hospital during the period of 3 years from October 1978 to December 1981. Of these, ll cases were congenital pseudarthrosis of the tibia, 4 cases were tuberculous spondylitis, 4 cases were infected nonunion, 7 cases were large segmental bone defects secondary to trauma, 9 cases were avascular necrosis of the femoral head and the other was one case. The results were obtained as follows: 1. The advantages of free vascularized living fibular graft are one stage procedure, resistance of torsion and angular stress, union with rapid hypertrophy of the graft, a shorter immobilization period and more rapid incorporation of the graft into the recipient area. 2. Free vascularized fibular graft can be widely used in the field of Orthopedic surgery. 3. The fibula is the bone best suited for reconstruction of a defect in a long bone. 4. In children, distal tibiofibular synostosis must be performed. 5. For prevention of clawing toe, the muscles around the bone is meticulously dissected, 6. Evaluation by selective arteriography and isotopic scanning both before and after operation may be used to assess the viability of the fibula graft.

Computerized Tomography in Orthopedic Surgery / 대한정형외과학회잡지

The utility of computerized tomogaphy in the study of the anatomy, and pathology of the musculoskeletal system has been the subject of considerable interest since the introduction of CT scanning. It provides an accurate and detailed cross-sectional image of normal anatomical structures and shows the relation of masses to these structures. In order to assess the utility of computed tomography, we analyzed the 92 clinical cases. We divided our experience into three major categories: spinal lesios, pelvic (including hip) lesions, and lesions of extremities. The advent of a new prototype scanning device has made it possible to exam a variety of abonormalities in the orthopedic diseases in a manner not previously possible.

Treatment of Femoral Neck Fracture (Twenty-nine Cases Treated by Multiple Knowles Pinning and Compression Hip Screw) / 대한정형외과학회잡지

It has been emphasized that treatment of hemoral neck fracture is early anatomical reduction and rigid internal fixation to reduce severe complications such as avascular necrosis or non-union.Operative treatment were developed recently with development of radiological technique. This study reviewed twenty-nine patients of femoral neck fracture treated by internal fixation between December 1973 and December 1979. There are eleven casesof Garden's stage I or II fracture with multiple Knowles pinning and eighteen cases (All Gardens stage) treated with compression hip screw, and followed for a minimum of nine months with an average eighteen months. The results were as follows; 1. Eleven cases with minimal displaced fracture (Garden's stage I or II) treated by multiple Knowles pinning were revealed good results. 2. In total eighteen cases treated by compression hip screw, nine cases (Garden's stage I or II) were revealed good results and other nine cases (Garden's stage I or II) were revealed fair or poor results. 3. Eleven cases of mlutiple Knowles pinning and nine case of compressian hip screw used for undisplaced fracture (Garden's stage I or II) were revealed good results without regard to internal fixation devices. 4. Avascular necrosis were four cases in nine cases(44%) of displaced fracture. 5. Non-union were not found in this aeries.