A Comparison of Outcomes after Acute and Chronic Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes of a reconstruction with an autogenous hamstring tendon for an acute and chronic anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS: We reviewed 71 patients who had undergone an ACL reconstruction with an autogenous hamstring tendon from December 2003 to June 2006. The patients were divided into two groups, reconstruction for an acute injury with 34 knees and reconstruction for a chronic injury with 37 knees. The clinical results were evaluated using the Lysholm score, International Knee Documentation Committee (IKDC) score, Lachman test, Pivot shift test, KT-1000 arthrometer, and a Cybex isokinetic test for the strength of the knee flexor and extensor. The presence of associated intra-articular lesions was also investigated. RESULTS: There were no significant differences between the two groups in terms of the stability evaluated by the Lachman test, pivot shift test and KT-1000 arthrometer at the final follow-up (p=0.732, 0.479, 0.078). However, the acute group scored significantly higher with respect to the clinical outcome measured by the Lysholm scores and IKDC rating system at the final follow-up (P=0.042, 0.012). There was a significantly higher incidence of associated intra-articular lesions in the chronic group than those in the acute group (P=0.003). CONCLUSION: A reconstruction for acute ACL injuries showed more satisfactory clinical results and less associated intraarticular lesions than a reconstruction for chronic ACL injuries.

Treatment of Unstable Intertrochanteric Fracture in Elderly Patients : Comparison between the Results of Internal Fixation Using Compression Hip Screw and Cemented Bipolar Hemiarthroplasty

PURPOSE: To perform comparative analysis between the results of internal fixation using compression hip screw and cemented bipolar hemiarthroplasty in unstable intertrochanteric fracture in elderly patients. MATERIALS AND METHODS: From January 2001 to October 2006, we reviewd 73 patients, who were treated surgically for unstable intertrochanteric fractures, with a minimum of 2 years follow up. The patient's age was older than 60 year old. The patients were divided into two groups and evaluated, retrospectively. One group was treated with cemented bipolar hemiarthroplasty (Group A, 34 cases), and the other group was treated with compression hip screw (Group B, 39 cases). We evaluated the amount of intraoperative bleeding, operative time, clinical results and complications between the two groups. RESULTS: The amount of intraoperative bleeding and operative time were no statistically significant between the two groups. Group A showed a better result than Group B for clinical outcome using Johnson Daily Activity of Life. Complications in the group A were comprised of dislocation (1 case), nonunion of greater trochanter (1 case), infection (1 case) and loosening (1 case), and those in the group B were comprised of loss of fixation (8 cases) and infection (1 case). CONCLUSION: We found that short-term outcomes of cemented bipolar hemiarthroplasty for unstable intertrochanteric fractures were satisfactory. However, a longer-follow up period is necessary to clarify the efficacy of cemented bipolar hemiarthroplasty.

Results of Revision Surgery in the Lumbar Spine / 대한정형외과학회잡지

PURPOSE: This report examined the surgical treatment results and suggests proper treatment guidelines for revision surgery in the lumbar spine. MATERIALS AND METHODS: This study examined 97 patients, who underwent revision surgery from 1996 to 2004 with a follow-up of at least 1 year. The causes of revision surgery, treatment modalities and results of treatment were analyzed. The clinical results were evaluated using the Kirkaldy-Willis criteria. RESULTS: In the ninety-seven patients, recurred disc herniation (37 cases, 35 cases: same level, 2 cases: different level) was the leading cause of revision surgery. The other causes were spinal stenosis (17 cases), epidural fibrosis (9 cases), pseudoarthrosis (9 cases), junctional stenosis (9 cases), infection (8 cases), segmental instability (4 cases), metal failure (2 cases) and cyst (2 cases). Spinal fusion was performed in 91 patients, and decompression only was performed in the remaining 6 patients. The clinical results according to reasons for failure were good in cases of recurrent disc herniation. The results of spinal fusion were more successful than that of decompression only (p= 0.002). The results of short segment fusion were more satisfactory than those of long segment fusion (p=0.043). In the final follow-up results, excellent and good results according to Kirkaldy-willis criteria were found in 62 cases. CONCLUSION: Spinal arthrodesis is an effective treatment modality for revision surgery in the lumbar spine. However, long segment arthrodesis should be considered carefully because of the high level of disappointing results. In addition, selective arthrodesis of the pathologic level is recommended in revision surgery of the lumbar spine.

Relationship between Soft Tissue Damages and Spinal Cord Injury in Lower Cervical Spine Trauma / 대한정형외과학회잡지

PURPOSE: To determine the implications of soft tissue damage and to evaluate the correlations between the extent of soft tissue damages and spinal cord injury after a lower cervical spine trauma. MATERIALS AND METHODS: This study analyzed the medical records, plain radiograms, and MRI of the consecutive 89 patients who underwent operative treatment in the lower cervical trauma. The radiological parameters of soft tissue damage including anterior longitudinal ligament (ALL), intervertebral disc (Disc), posterior longitudinal ligament (PLL), ligamentum flavum (LF), interspinous ligament (ISL), supraspinous ligament (SSL), posterior muscle group (PM), cord compression (CC), and cord signal changes (CS) were evaluated using plain radiograms and magnetic resonance imaging. The relationship between the level of cord injury and the type of soft tissue damage, injury type and severity was determined. RESULTS: There was a significant correlation between the extent of cord injury and the injury type. Cord injury frequently occurred as a result of compressive extension (3 of 4 cases), combined injury (4 of 7 cases) and distractive extension (14 of 23 cases). On the other hand, only 11 of the 16 cases with compressive flexion had a cord injury. In the distractive-extension cord injury cases (2 out of 10 cases in stage I, 12 out of 13 cases in stage II) the frequency of cord injury increased with increasing degree of the soft tissue damage. The incidence of cord injury was higher in the distractive-flexion cases (stage I, 0 out of 6 cases, stage II, 8 out of 35 cases, stage III, 3 out of 5 cases), (p=0.082). Multiple logistic analysis revealed a significant correlation between the cord injury and soft tissue damage including parameters such as the injury type, PLL injury, CC and CS. There was more frequent cord injury encountered in patients with more extensive injuries to the posterior neck muscles (p=0.063). CONCLUSION: There was a significant correlation between the injury type and the incidence of cord injury. In distractive extension and distractive flexion, there was more increasing incidence of cord injury with increasing severity of the injury. In addition, there was a high incidence of cord injury associated with not only the injury type but also a PLL and posterior neck muscle injury.

Results of Anterior Cruciate Ligament Reconstruction Using Autogenous Four-Strand Hamstring Tendon

PURPOSE: This study presented the clinical outcomes at a minimum one year following anterior cruciate ligament (ACL) reconstruction using autogenous four-strand hamstring tendon and measured the strength of the knee flexor and extensor after tendon harvest. MATERIALS AND METHODS: Twenty seven patients who had a symptomatic ACL insufficiency underwent ACL reconstruction using four-strand hamstring autograft from Dec. 2003 to Jun. 2004. The patients were evaluated according to clinical findings (Lachman test, pivot shift test), standard knee scales (Lysholm, IKDC), and KT-1000 manual-maximal side-to-side difference. Functional test including one-leg hop test for distance and vertical jump test was performed and the strength of the knee flexor and extensor was measured using Cybex isokinetic test at last follow-up. RESULTS: At the time of follow-up, the average Lysholm score improved from 63.0 preoperatively to 95.0 and overall IKDC evaluation showed 14 patients was graded as A, 13 as B. There were 18 patients (66.6%) in negative Lachman test and also 25 patients (92.6%) in negative pivot shift test. The average KT-1000 manual-maximal side-to-side difference was 2.1+/-1.2 mm. One-leg hop distance and one-leg vertical jump test showed 12.3% and 22.3% decrement than uninvolved side. On isokinetic cybex test, peak extensor torque was 80.0% and 82.7% and peak flexor torque was 91.2% and 89.4% at the angular velocity of 60 degrees and 180 degrees/sec compared to the contralateral leg. CONCLUSION: ACL reconstruction using autogenous four-strands hamstring tendon seems to be a viable option for restoring stability with good clinical result and less donor site morbidity.

Analysis for the Factors Influencing Bone Union in Segmental Tibial Shaft Fractures Treated with Interlocking Intramedullary Nailing

PURPOSE: To find the factors influencing bone union in segmental tibial shaft fractures treated with interlocking intramedullary nailing, and to find the special attentions during operation based on this factors. MATERIALS AND METHODS: This retrospective study made to investigate the medical records and plain radiograms of 32 patients who treated with interlocking intramedullary nailing. We statistically analyzed the correlation between bone union time and factors influencing bone union, including fracture site, fracture pattern, Melis type, open fracture, nail diameter, reaming, postoperative gap, postoperative angulation. RESULTS: The factors that showed the significant difference statistically were fracture site, Melis type, open fracture, postoperative gap, postoperative angulation. The factors that showed no significant difference statistically were fracture pattern, nail diameter, reaming. CONCLUSION: We recommend that surgeons should be considered the site and type, open fracure in preoperative stage. During operation, try to reduce it accurately without angulation and gap if possible. And so, the careful planing of treament can be expected with a high rate of union and a low rate of complication.

Hypoxia Increases the Expression of ICAM-1 in Cultured Human Synovial Fibroblasts / 대한류마티스학회지

OBJECTIVE: Hypoxic conditions are thought to be exist in inflamed arthritic synovium.Several in vitro and in vivo studies indicate that hypoxia can initiate events that lead to pro-adhesive changes.Therefore,this study was designed to examine the effects of hypoxia on the expression of ICAM-1 by cultured human synovial fibroblasts. METHODS: Synovial fibroblasts were isolated from patients with RA and cultured at hypoxic condition.To quantify the expression of ICAM-1 mRNA in synovial fibroblasts,RT-PCR was performed.The levels of cytokines in culture supernatants were measured by ELISA.The activation of NF-

Clinical Diagnosis of Acute ACL Injury of Knee Joint / 대한정형외과학회잡지

PURPOSE: To report and assess the clinical symptoms and signs, which are the most reliable for diagnosis of acute anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS: We analyzed 79 patients who were confirmed to have an ACL rupture by arthroscopy from January 1995 to December 1999. The T-test was used for statistical analysis. RESULTS: There is no statistical difference of frequency of the clinical symptoms and signs of the ACL ruptures. The most frequent clinical symptom is pain, and sign is hemarthrosis. The Lachman test is the most sensitive test of acute ACL rupture in our cases. CONCLUSION: To increase the accuracy of clinical diagnosis of ACL injury, repeated and accurate history taking and physical examination including above symptoms and signs are important.

Disc Extrusion on Lower Cervical Facet Joint Fracture - Dislocation / 대한정형외과학회잡지

PURPOSE: To evaluate the incidence of disc extrusion and neurologic deficit, the relation between disc extrusion and neurologic deficit and the treatment results according to our basic treatment principles in lower cervical facet joint fracture and dislocations MATERIALS AND METHODS: Twelve patients were evaluated, 8 male and 4 female with an average age of 41 years comprised the group. Six injuries were attributable to automobile accidents, 5 to fall from building, bed, floor and hill, and one to stand on her head. One case was distractive-flexion stage (DFS) 1, 9 cases with DFS 2 and 2 cases with DFS 3. Plain X-ray, CT, Myelo CT and MRI were used as a diagnostic tools. As a treatment criteria, feasibility of closed reduction, status of neuroglogic injury, and stability of injured spine were considered. Anterior cervical discectomy and fusion in accompanied disc extrusion, posterior reduction and fusion with triple wiring in unreduced dislocation, and anterior decompression and fusion in incomplete cord and root injury were selected as a basic treatment principles. RESULTS: Ten out of 12 cases (83%) showed neurologic deficits, 2 complete cord injury, 1 incomplete cord injury, and 7 radiculopathy. Nine out of 12 (75%) demonstrated disc extrusion and all disc extruded patients had neurologic deficits. Anterior cervical discectomy and fusion (ACDF) were performed in 5 cases, ACDF and posterior reduction with triple wiring (PRTW) in 4 cases, PRTW in 1 case, and skull traction and philadelphia brace in 2 cases. Seven radiculpathy patients were completely recovered and one incomplete cord injury patient can ambulate with spastic gait after surgery. There were 2 bed sore and 1 pneumonia in complications. CONCLUSION: Soft disc extrusion should be evaluated carefully with MRI and CT in lower cervical spine injury with the facet joint fracture-dislocations before the decision of treatment. As disc extrusion always accompanies neurologic deficit, it must be surgically treated by anterior cervical discectomy and fusion.

Surgical Treatment of Supra and Intercondylar Fracture of the Femur / 대한정형외과학회잡지

We performed a retrospective analysis of the results of surgical treatment of sixteen patient with comminuted fracture of the distal femur from September 1993 to August 1995 and evaluated the efficacy of the angled blade plate as one of the fixation devices used. The fractures were limited to C2 and C3 fracture classifed according to the AO classification. After an average follow-up of 13 months (range, 9 to 24 months), all of the fractures had healed. Postoperatively, the arc of flexion was limited between 90degrees and 125degrees in eight, normal arc in five, and severely restricted arc of joint motion was present unexceptionally in three patients with deep infection. In angular deformity, average 5.8degrees of valgus and 2.4degrees posterior angulation were showed. The functional results by Sanders-Swiontkowski-Rosen-Helfet rating system were showed excellent in 3, good in 7, fair in 3, and poor in 3 cases. The overall results were seen to be excellent to good in ten cases (62.5%) but in twelve patients using the angled blade plate, excellent to good results were showed 10 patients (83.3%). We attribute the favorable results in our series to restoration of the articular surface through the modified extensile approach, sufficient stable fixation using the angled blade plate with conforming to the concept of bridge plate, routinely performing the bone graft for medial buttress and bone healing, and early mobilization of the extremity.

Crush-Cleavage Fracture in Thoracolumbar and Lumbar Spine: Comparative Study with Type B Burst Fracture / 대한정형외과학회잡지

We noticed a group of thoracolumbar and lumbar spine fractures showing a unique fracture pattern that consisted of 1) superior disc injury, 2) crush fracture of the upper half of the vertebral body, 3) sagittal fracture of the lower half of the vertebral body, 4) bone fragments in the spinal canal, and 5) lamina fracture. Some of these fracture patterns were present in type B burst fracture of Denis classification. The purpose of this study was to compare the difference between crush-cleavage fracture and type B burst fracture in the viewpoint of neural canal involvement and neurologic status, and functional outcome with surgical treatment. Ten cases were identified as crush-cleavage fractures in 22 type B burst fractures during a 5 year period from Mar. 1989 to Jun. 1993 at the Department of Orthopedic Surgery of Chonbuk National University Hospital. Four out of 10 crush-cleavage fractures and 4 out of 12 type B burst fractures were paraparetic. Crush-cleavage fracture must be an unstable thoracolumbar comminuted fracture, but there were no significant differences in the neural canal involvement, incidence of neurologic deficit, and in the functional outcome, compared with type B burst fracture (P>0.05). It could be classified as a progressed form of type B burst fracture in Denis classification, or as a burst-split fracture in Magerl classification in the anatomical viewpoint. In conclusion, crush-cleavage fracture must be a variant of burst fracture.

Complications in the Treatment of Comminuted Fracture and Nonunion by Ilizarov Procedure / 대한정형외과학회잡지

We reviewed the records of thirty-four patients who had been managed with the Ilizarov technique for the comminuted intra- and extra-articular fractures and nonunion of the long bones with or with-out bone defect. The goal of this study is to analysis the clinical complications of the Ilizarov technique, and to find out the methods solving them. 1. This study comprises 34 patients who were treated by Ilizarov technique at the Chonbuk National University Hospital from March, 1992 to June, 1993. 2. Among 34 cases, 22 were comminuted intra- and extra-articular fractures, and 12 were nonunion of the long bones. 3. The complications were divided intd problem, obstacle and complication; problem in 16 cases, obstacle in 11 cases and complication in 6 cases. 4. We conclude that the Ilizarov technique is a useful method in management of the severe commi- nuted fractures and the nonunion of the long bones, but we have to consider the complication sincerely and endeavor to reduce them.

Assessment of Sliding Hip Compression Plate in the Intertrochanteric Fracure of the osteoporotic Bone / 대한정형외과학회잡지

The incidence of intertrochanteric fracture of femur in young adult is relatively high in our home than other countries. But recently the incidence in elderly patient is progressively increased due to prolongation of average life span and increased activity. Various devices has been developed and the result of treatment has been improved, but the morbidity after fracture in elderly patient remains high because of poor general condition and osteoporosis. We tried to assess the availability of SHCP(sliding hip compression plate) in the intertrochanteric fracture of the osteoporotic bone by the review of the 27 cases below Singh index III that we experienced from September, 1989 to June, 1993 at the Department of Orthopedic Surgery of Chonbuk National University Hospital. The results were as follows: 1. Mean age was 68 years. Type III in Tronzo classification was most common(51.9%). Singh index II was 17 cases(63%) and grade III was 10 cases(37%). 2. In 23 cases(88.8%), anatomical reduction was performed. The bony union was gained at average 15.8 weeks. The serious complications were 1 penetration and 1 osteoarthritis of hip. 3. Satisfactory results were obtained in 88% of patients by the functional class of Clawson DK.

Femoral Fracture in Non-Cemented hip Arthroplasty / 대한정형외과학회잡지

The femoral fracture, occurred associated with the cemented hip arthroplasty, is well-known cornplication but the proximal femoral fractures of the noncemented hip arthroplasty, were occurred more than those. Among the 290 patients, who were treated by the noncemented hip arthroplasty from Dec. 1987 to April 1992, the 24 cases of the femoral fracture were experienced and the results were as follows: 1) of the 24 cases, the male was nine and the female was fifteen. The age distribution was mostly occurred between 41 and 60 years old and most fracture were developed in 1 1mm stem size. In revision cases, 225mm stem length (Wagner) was common. The locations of fracture were proximal 1/3 (type I: 19 cases), tip (type II; 1 case), distal 1/3 (type III; 1 case) and comminuted (type IV; 3 cases) by Johansson; siclassification. 2) The femoral fracture was mostly developed during the stem insertion and the fracture site in anatomical stem was only proximal femur. 3) 1n cases of revision, most of the fractures were occured on the anterior or lateral side of the femur. It was difficult to manage the fracture because of the severe osteoporosis and comminution. 4) As the problem of the operative technique, the fracture incidence can be decreased by accurate preoperative measurement and it must be cautious in the stem more than 225 mm length, which were used in revision case. 5) The circumferential wiring for proximal and plate & screws in middle and distal were done as the treatment of fracture and the results were all good, but stem tip fracture in osteoporotic patients was troublesome. We think that long plate(>8 holes) & both cortex purchase and bone graft are best methods so far.

Recurrent anterior Dislocation of the Shoulder-Analysis of the Bristow Bristow and the Combined Bakert and Putti: Platt Operation / 대한정형외과학회잡지

Numerous operations have been described to treat the recurrent anterior dislocation of the shoulder, but no one procedure was accepted as the choice of operation. We perforemed 6 Bristow procedures and 5 combined Bankart and Putti-Platt procedures and examined six shoulders by arthroscope from sep. 1989 to Sep. 1992, and we analysed the pathologic feature and the results of them. The average follow-up period was 2.2 years. 1. There were 8 males and 3 females and their average age was 33.7 years. The mean age in initial dislocation was 28 years. 2. The number of recurrent dislocation before operation was 17.9 times and the average duration of the disease was 5.7 years. 3. The pathologic lesions observed in intraoperative field were Hill-Sachs lesion (72.7%), Bankart lesion (90.9%), and the erosion of the glenoid rim (54.5%). On arthroscopic examination of 6 cases, Hill-Sachs lesion was found in 4 cases, Bankart lesion was seen in all of 6 cases, and the erosion of the glenoid rim was observed in 4 cases. 4. The average range of the limitation of external rotation was 17.3 and its significant difference was not observed between 2 operative groups. 5. By Rowes rating sheet, 4 cases of 5 combined Bankart and Putti-Platt operations were excellent and 1 case was good. 6. In conclusion, combined Bankart and Putt-Platt operation was considered as a good surgical procedure in the treatment of recurrent anterior dislocation of the shoulder.

A Clinical Study of the tibial Pilon Fractures / 대한정형외과학회잡지

Fractures of the tibial pilon are the severe injuries to the ankle joint resulted from axial compression, shear and/or rotational forces. The mangement has been notoriously difficult due to the comminution of the distal tibia, articular incongruity and soft tissue trauma. The advocated treatment sequence of fibular reconstruction, restoration of the articular suface, bone grafting of defects and the use of an anterior or medial neutralization plate, early movement and delayed weight bearing, were performed recently and the best results have been obtained. The results of treatment of 18 cases were analysed at the Department of Orthopedic Surgery, Chonbuk National University Hospital and Chong ju Lee Rha Hospital from Mar. 1982 to Aug. 1989. The results were as follows. 1. The most frequent type of fracture was type III according to Ruedi and Allgower's classification. 2. The operative treatment was performed with plates and screws in fourteen cases. 3. The overall good and fair results were 72%.

Synovial Chondromatosis of the Shoulder: A Case Report / 대한정형외과학회잡지

Synovial chondromatosis is a rare monoarticular disorder which often involves the knee, hip and the elbow but the shoulders are less frequently affected. The diagnosis depends on the important radiographic and operative findings as well as histopathological criteria. We have experienced the synovial chondromatosis developed in the left shoulder of a 37 year-old male who was diagnosed by CT scan, axillary angiography and microscopic findings and treated at Chonbuk National University Hospital.

TCVO ) in the Extremities: Report of 4 Cases / 대한정형외과학회잡지

Angiographic procedures and their applications maybe divided into following roups: I) procedures used to increased blood folw, as the angioplasty, II) procedures used to decreased blood flow, as the embolization and local infusion of vasoconstrictors and III) miscellaneous procedures. Transcatheter vessel occlusion was first performed in 1930 by Brook to occlude the carotid cavernous fistula by embolization of the surgically exposed carotid artery with muscle marked with a sliver clip injected directly into the internal carotid artery. Autologous clot, first used by Doppman(1968) to occlude a spinal arteriovenous malformation was quickly adopted use in traumatic hemorrhage with pelvic fracture, nonoperable aneurysm, gastrointerstinal hemorrhage and diagnosis and treatment of the tumors. In Kores, there have been several reports of transcatheter vessel occlusion after Han(1978) made a first report in the radiology part. In orthopedics part of Korea, Kim(1981) and Yoo(1982) reported the cases of surgical treatments of arteriovenous malformation without embolization. Also, in Korea, there has been no report of transcather embolizations of vascular diseases of the extremities, such as huge arterial aneurysm and dilated varicose vein. We reported the 4 cases who were treated at the Chonbuk National University Hospital between January 1987 and April 1988. Transcatheter vessel occlusion have such advantages : 1. The vascular status of the mass can be recognized prior to operation, such as biopsy. 2. Since the bleeding can be reduce, the operation can be performed easily. 3. Nonoperable huge arterial aneurysm could sometimes be treated only with transcatheter vessel occlusion adequately. 4. It can make a differential diagnosis with other vascular anomaly easy.

A Clinical Study of Diaphyseal Fractures of the Radius and Ulna / 대한정형외과학회잡지

Diaphyseal fractures of the radius and ulna present high incidence of malunion and non-union because of difficulty in reduction and maintenance of two mobile, parallel bones in the presence of the pronating and supinating muscles which exert angulatory as well as rotational forces. Over the years various methods of open reduction and internal fixation or the closed method have been advocated, but open reduction, especially fixation with compression plate and screws resulted in more satisfactory results was proved recently by the major clinical reports. From March. 1977 to December. 1985, 59 cases of diaphysesl fractures of the forearm both bone in adult and children were managed in the Department of Orthopedic Surgery, Chonbuk National University Hospital and comparisions have been made between the conservative treatment group and operative group. The obtained results were as follows; 1. The most common csuse of injury was fallen on the outstretched hand in children and traffic accident in adult. 2. The most frequent site of the fracture was middle one-third(50.8%). 3. The most common pattern of the fracture was stable fracture(50.1%). 4. The applied methods for management of the fractures include cast immobilization after manual reduction or skeletal traction, K-wire fixation, compression plate and screws, intramedullary nailing, and combined. 5. Comparision of conservative treated group with operative treated group was as follows. 1) In roentgenologically, excluding those complicated by nonunion or infection, average bone union time of conservative group in children and adolescence was 10.2 weeks and in adult was 16.7 weeks, and of operative group was 13.9 weeks. 2) According to Grace and Eversmann's evaluation, Satisfactory results were shown in 80.0% of children and adolescence group treated by conservative method and 86.7% of adult group trested by compression plate and screws. 3) Among the various internal fixstion methods, compression plate and screws method was the best measure for rapid bone union and functional recovery in adult. 4) Any marked difference between each group was not seen in nonunion, but angulstory and rotational deformity were more common in conservative group and infection was developed 2 cases in operative group only. 6. There was no noticesble difference between each treatment in children and adolescence, but operative treatment, especially compression plate and screws, in adult was more superior to conservative treatment with. regard to bone union time and functional result.

A Clinical Study of Proximal Humeral Fractures / 대한정형외과학회잡지

Fractures of the proximal humerus occur more frequently in older patients but are seen in all ages and emerge epiphyseal separations. The objectives of treatment are restoration of all involved structures to normal anatomical state and a completely functional limb in the shortest time possible. One part and two part fractures were indicated in conservative treatment and surgical treatment in most of three, four part fractures. The results of treatment of forty four cases according to Neer's classification were analysed at the Department of Orthopedic Surgery, Chonbuk National University Hospital from Mar. 1978 to Dec.1985. The results were as follows. 1. The prevalent age distribution was third and fifth decade(48%) . 2. The most common cause of injury was slip down(14 cases, 32%). 3. The most frequent cases of the fractures in Neer's classification were two part fractures(22 cases, 50%). 4. Thirty one cases(71%) were treated by conservative treatment, twelve cases(27%) by open reduction and 1 case(2%) by prosthesis. 5. Good results were in 23 cases(52%) of one and two part fractures, fair in 17 cases(39%) and poor in 4 cases(9%) of two, three and four part fractures.