Supracondylar Osteotomy in Cubitus Varus and Cubitus Valgus / 대한정형외과학회잡지

Cubitus varus and valgus is one of late complication of elbow fracture, and this deformity is caused usually by malunion in supracondylar fracture or epiphysial injury of the elbow joint. 40 supracondylar closed wedge osteotomies (on cubitus varus 25, cubitus valgus 15) were performed at the supracondylar level and were fixed with two K-wires or French method. The following results were obtained: 1. The frequency of deformity of cubitus varus was higher than that of cubitus valgus: cubitus varus, 25 cases and cubitus valgus, 15 cases. 2. Injury of the supracondylar of the humerus frequentry occured between the age of 6 and 15 (65%). 3. In cubitus varus the degree of deformity ranging from −11° to −30° was the most common whereas in cubitus valgus that ranging from 30° to 40°, 4. Incomplete ulnar nerve palsy was revealed in 15 postoperative cases of cubitus varus of which 3 cases were treated by anterior transposition. In all cubitus valgus, tardy ulnar nerve symptom was disappeared after correction. 5. Nerve damage could be avoid by performing the closed wedge osteotomy and upper connection combind with posterolateral incision in cubitus varus and medial incision in cubitus valgue. 6. Internal fixation associated with cross pinning with two K-wires or French method were performed and good result was obtained without complication even though older case.

Clinical Study for Achilles Tendon Rupture / 대한정형외과학회잡지

Achilles tendon is the most powerful tendon of the body and increases efficiency in weight bearing and walking capability. Since pares' report about the rupture of the Achilles tendon many authors have reported various causes, diagnostic and therapeutic methods. Most of the authors emphasized the early diagnosis and treatment resulted in good prognosis. There are many methods for the diagnosis of the Achilles tendon, roentgeography, angiography, electromyography, histologic examination and Thompsons test. The causes of the rupture of the Achilles tendon are direct and indirect injury. The two methods of treatment are conservative management and surgical treatment. Whether the cause of the injury is direct or indirect, restoration of function after treatment must be emphasized and the proper method of treatment must be determined by the degree of injury. Clinical analysis was done on 15 cases of Achilles tendon rupture treated at Orthopedic Department of Capital Armed Forces General Hospital from Oct. 1973 to Oct. 1978 with the following results. 1. In sex distribution, there were 13 male cases and 2 female cases and the age range of 20 to 30 years old was the most frequent (67%). 2. There was no difference In frequency between the right and the left side. 3. Achilles tendon rupture was two times more frequent in indirect cause than direct cause, especially after falling from heights and exercises. 4. The most frequent site of rupture was 2–5 Cm. above the insertion of the tendon (80%). 5. By means of a cost immobilization, good result was obtained in fresh partial rupture of the tendon. 6. Good results were obtained by end-to-end suture in fresh cases and reconstructive surgery in old cases. 7. Most of the patients returned to their jobs about 6 months after the operation.

Intraosseous Neurilemmoma of the Tibia: A Case Report / 대한정형외과학회잡지

Intraosseous Neurilemmomas are very rare tumor and most of them are arose in the mandibular bone. A case report is made on the intraosseous neurilemmoma in the distal shaft of tibia which belong very rarely seen in the area of bone. The case was a 23 year old male who had multicystic lesion on the distal shaft of right tibia with marginal this sclerotic change on the radiological examination. The lesion of intraosseous neurilemmoma was confirmed by the microscopic examination after surgical treatment of curettage and bone graft. Also a review of literature on the neurilemmoma was made and reported.

The clinical significances of Intra-Osseous Venography in the Hip injuries: A preliminary report / 대한정형외과학회잡지

We have many unsolved problems about the femoral neck fracture, especially non-union of the fracture and avascular necrosis of the femoral head. It seems clear that underlying these are two basic problems; first, the mechanical difficulties in maintaining secure fixation; and second, biological factors interfering with union, paramount of which is damage to the blood supply of the femoral head. Intra-capsular fracture of the femoral neck heals in the same way as other intra-articular fractures-only by endosteal and not by periosteal repair. If the femoral head has an intact blood supply, repair appears early on both sides of the fracture. But if the femoral head is not viable, this repair appears only on the neck side of the fracture. It can migrate into the head and heal the fracture only if there is close apposition and rigid fixation of well reduced fracture fragments. Clearly the femoral neck fracture heals not by periosteal callus but by callus arising from the marrow supporting structure. Yet there is still no reliable clinical method of determining early the union of the femoral neck fracture and the viability of the femoral head. The femoral head intra-osseous venography, first described by Hulth (1953), to predict viability of the femoral head after fracture of the femoral neck has been carried by various previous authors (Hulth1953 1956 1958, Dahlgren 1959, Harrison 1962, Hulth and Johansson 1962, Nagai 1962). However, they did not mention healing process of fractures of the femoral neck in these studies. To observe the fracture healing and to predict the viability of the femoral head, authors adopted a femoral trochanteric intra-osseous venographic technique. The precedure was carried out under the control of a T-V image intensifier. Venous drainage of the femoral head parallels the arterial supply. There are several venous drainage routes in the hip region; the medial and lateral circumflex vein, gluteal vein, nutrient vein, femoral vein, vein of the ligamentum teres and obturator vein. With the aid of a T-V image intensifier, a bone marrow needle is driven 1 inch below the femoral greater trochanter. When the tip of the needle is in the marrow cavity, about 30cc, of 75% Urograffin is injected. Next X-rays are taken at intervals of 2 seconds, the last film at 5 minutes. A positive venography is one in which venous drainage is seen, and opaque fluid is seen in mottled distribution throughout neck region and part of the head. A negative venography is one in which no venous drainage is seen, on the contrary, opaque fluid pools within the trochanteric region are evident and remain for at least 5 minutes. A positive venography indicates that the head has an intact circulation, thus it may be predicted that the fracture can unite and the head is alive. Negative venography suggests that fracture union is not and will not take place and that the head may be dead. This study provided information about fracture heaIing processes and vascularities of the femoral head and its surrounding tissues during and after fractures healing. We have found that trochanteric intra-osseous venography is a useful diagnostic tool in hip injuries.

Congenital dislocation of the Both Knee: A Case Report / 대한정형외과학회잡지

A case of congenital dislocation of the both knees in a newborn infant which is a very rare condition and difficult to treat, is reported together with the reviews of the literature and the discussion of the future therapeutic programme of the condition.