Suture Technique in Treatment of Displaced Proximal Humeral Fractures / 대한정형외과학회잡지

PURPOSE: To find out the advantages and disadvantages of the suture technique and improve the method of operation. MATERIALS AND METHODS: Postoperative follow-up of at least one year was possible in thirteen cases including 7 surgical neck fractures and 6 three-part fractures. The results were analysed radiographically and clinically using a modified UCLA scale. RESULTS: There was one non-union and except for that case, the average union time was 10.2 weeks. Active forward flexion averaged 140 degrees, external rotation 50 degrees and internal rotation between T12 and L1 vertebra. The clinical results were 3 excellent, 5 good and 4 fair. There was no significant corelation (P=0.538) between fracture type and clinical results statistically. But for above 65 years, the UCLA scale averaged 25.8 points and for under 65 years, 31.6 points (P=0.006 ) . CONCLUSION: The use of a suture technique for these displaced fracture without the use of metals achieved a high percentage of acceptable results. But in order to achieve good stability and early exercise, the neck fragment had to be impacted into the humeral head and the medial and lateral part of the neck fracture should be fixed together. Therefore, it is difficult to use this method for severely comminuted neck fractures.

The Effect of TitaniumI Surface Treatment on Osteoblast-Like Cell Attachment and Proliferation / 대한치주과학회지

In clinical therapy, the current goal of dental implants is to enhance quantity and quality of osseointegration. Surface roughness and oxide structure are considered to influence the behavior of adherent cells. The purpose of this study is to evaluate the effect of different surface treatment on cellular response. The attachment and proliferation of osteoblast-like cell on sandblasted, sandblasted and etched, thermal oxidated surfaces have been compared. Sandblasting was done with Al2O3 particles(grain size of 50micrometer), etching was processed with NH4OH : H2O2 : H2O(1:1:5) at 90degrees C for 1 minute. Thermal oxidation was followed sandblasting and etching at 400degrees C, 600degrees C, 800degrees C for 2 hours. Measurement of surface roughness after the different treatment did not show any differences of Ra value between terated surfaces. Cell attachment and proliferation were increased during experiment period, but no difference was observed. SEM evaluation revealed a similar pattern of osteoblastlike cells, well attached with dendritic extension and producing numerous matrix vesicles on cell surface. The results of this study showed that oxide layer alteration by thermal oxidation did not affect the attachment and proliferation of osteoblast-like cells. This suggests the possibility that the cellular responses are further influenced by surface roughness than titaniun oxide structure. This study was supported by a grant(HMP-98-G-2-035-B) of the HAN(highly advanced National) Projected, Ministry of Health & Welfare, R.O.K

Interaction of cytokines in osteolysis / 대한정형외과연구학회지

PURPOSE: Osteolysis has become a major cause of aseptic loosening in total hip arthroplasty. Macrophages phagocytose wear debris from implants and release the pro-inflammatory mediators such as IL-1beta, IL-6, TNF-alpha and nitric oxide. We evaluated the effects of metal patricles on the release of bone-associated cytokines and nitric oxide from J774 mouse macrophage cell line. MATERIALS AND METHODS: Titanium-Aluminum-Vanadium (Ti6Al4V) and Cobalt-Chrome-Aluminium (CoCr) particles were loaded and nitric oxide production was measured indirectly by the nitrite assay. The effect on cell proliferation, and apoptosis were also investigated with non-isotopic proliferation assay, and ELISA to DNA and histone. The levels of two proinflammatory cytokines, IL-6 and TNF-alpha, were measured with ELISA. The modulatory effect of anti-inflammatory cytokine on the nitrite, IL-6 and TNF-alpha production was additionally investigated. RESULTS: Nitrite levels increased after administration of Ti6Al4V and CoCr particle. IL-10 and IL-4 inhibited the production of nitrite with TiAl4V particle, but not in significant amount with CoCr particles. Cellular proliferative activity decreased and apoptosis increased after administration of Ti6Al4V and CoCr particle. Levels of IL-6 and TNF-a increased with both particles. IL-10 and IL-4 inhibited the production of IL-6 and TNF-alpha in varying degrees. CONCLUSION: Our data confirmed the increased production of pro-inflammatory cytokines and nitric oxide with metal particles and the inhibitory effect of IL-10 and IL-4 on the production of these substances, and suggest differences in the specific action between different metal particles.

Interaction of cytokines in osteolysis / 대한정형외과연구학회지

PURPOSE: Osteolysis has become a major cause of aseptic loosening in total hip arthroplasty. Macrophages phagocytose wear debris from implants and release the pro-inflammatory mediators such as IL-1beta, IL-6, TNF-alpha and nitric oxide. We evaluated the effects of metal patricles on the release of bone-associated cytokines and nitric oxide from J774 mouse macrophage cell line. MATERIALS AND METHODS: Titanium-Aluminum-Vanadium (Ti6Al4V) and Cobalt-Chrome-Aluminium (CoCr) particles were loaded and nitric oxide production was measured indirectly by the nitrite assay. The effect on cell proliferation, and apoptosis were also investigated with non-isotopic proliferation assay, and ELISA to DNA and histone. The levels of two proinflammatory cytokines, IL-6 and TNF-alpha, were measured with ELISA. The modulatory effect of anti-inflammatory cytokine on the nitrite, IL-6 and TNF-alpha production was additionally investigated. RESULTS: Nitrite levels increased after administration of Ti6Al4V and CoCr particle. IL-10 and IL-4 inhibited the production of nitrite with TiAl4V particle, but not in significant amount with CoCr particles. Cellular proliferative activity decreased and apoptosis increased after administration of Ti6Al4V and CoCr particle. Levels of IL-6 and TNF-a increased with both particles. IL-10 and IL-4 inhibited the production of IL-6 and TNF-alpha in varying degrees. CONCLUSION: Our data confirmed the increased production of pro-inflammatory cytokines and nitric oxide with metal particles and the inhibitory effect of IL-10 and IL-4 on the production of these substances, and suggest differences in the specific action between different metal particles.

Cellular Proliferation and Apoptosis during Endochondral Fracture Healing / 대한정형외과학회잡지

PURPOSE: The authors investigated the process of endochondral ossification quantitatively and objectively in respect to proliferation and apoptosis. MATERIALS AND METHODS: Fractures were made on the left tibiae of 72 male Sprague-Dawley rats. The fracture callus was harvested at the 5th, 7th, 9th, 11th, 14th, and the 21st day after fracture. Cellular DNA content was analyzed with image cytometry, and proliferative index was determined from the data. The Ki-67 antigen expression was semiquantitatively measured by the immunohisto-chemical method. TUNEL was used for in situ localization of apoptotic cells. The expression of cell cycle inhibitors, P21 and P27, was investigated with Northern blotting. RESULTS: The proliferation index was highest on the 5th day, then gradually decreased until the 11th day. The expression of Ki-67 antigen gradually decreased with time. Apoptotic cells increased in accordance with enhanced bone formation within chondroid callus. The expression of p21 and p27 was highest on the 11th and the 14th day. CONCLUSIONS: These findings show that proliferative activity decreased with the reduction of mesenchymal tissue and the appearance of mature chondroid tissue. The apoptosis of hypertrophic chondrocytes occurred in accordance with enhanced bone formation. P21 and P27 had a certain role in the differentiation of chondrocytes.

Treatment of Acute Acromioclavicular Dislocation by a Modified Bosworth Method / 대한정형외과학회잡지

PURPOSE: To find out the problem of modified Bosworth method and improve the method of operation. MATERIALS AND METHODS: 21patients treated with modified Bosworth method were evaluated after a minium follow-up period of two years. The results were analysed clinically and reontgenographically. RESULTS: In postoperative X-ray evaluation, the coracoclavicular interval of the operated side was decreased by an average of 0.8 mm compared with that of the normal side. There was no significant difference in coracoclavicular interval between after screw removal and last follow-up. Loosening of the screw was seen in 3 of the 5 cases overcorrected by more than 2 mm and the result was fair in two of them. A satisfactory result was obtained in 17 (81.1%) of the 21 cases. CONCLUSION: Modified Bosworth method for acute complete acromioclavicular dislocation yields better results provided the overcorrection and anterior displacement of the clavicle are appropriately protected.

Assessment of Bone Mineral Density by Dual energy X-ray Absorptiometry in Korean Postemenopausal Women / 대한정형외과학회잡지

Osteoporosis represents reduced amount of bone mass per unit volume as compared with controls of the same age and sex. The purpose of this study was to show how bone mineral densities of spine and intertrochanteric area decrease with aging, to investigate the relationship between the bone mineral densities (BMD) of the two areas, and to obtain fracture threshold values. We measured BMD of lumbar vertebrae and intertrochanteric areas by Dual Energy X-ray Absorptiometry (DEXA) from 241 postmenopausal women. 190 normal postmenopausal women comprised non-fracture group and there were 50 fresh thoracolumbar fracture patient and 31 intertrochanteric fracture patients in whom the fractures were not caused by high energy trauma. The mean bone mineral density values of non-fracture group were significantly higher than those of fracture groups and significant correlation held between bone density of spine and that of intertrochanteric area in non-fracture group and fracture groups. The fracture threshold was 0.837 g/cm3 in spine fracture group and 0.792 g/cm3 in the intertrochanteric fracture group.

Prosthetic Replacement for Severe Proximal Humeral Fractures / 대한정형외과학회잡지

The authors have reviewed 11 cases of prosthetic replacement for severe proximal humeral fractures which were treated from March 1989 to December 1993, paying particular attention to the range of motion attained after surgery and the factors which influence the limitation of shoulder motion. The results of this study were as follows: l. Among the 11 cases, 10 cases showed sttisfactory pain relief. 2. Active motion of the shoulder averaged 91° of forward flexion, 72.8° of abduction and 35° of external rotation. 3. The humeral offset averaged 30.9mm in normal shoulder and 18.9mm in affected shoulder. 4. In 6 cases which the humeral offset measured over 20mm, active motion averaged 104° of forward flexion and 83° of abduction and 5 cases showed satisfactory results. 5. In 5 cases which the humeral offset measured under 20mm, active motion averaged 104° of forward flexion and 83 of abduction and 5 cases showed unsatisfactory results. 6. Prosthetic replacements were performed within 1 week after injury in 7 cases and among these 5 cases showed satisfactory results. The range of motion after prosthetic replacement for severe proximal humeral fracture was disappointing. We concluded that limited range of motion is mainly due to reduced humeral offset and restoration of humeral offset by appropriate reattachment of greater tuberosity will allow better clinical result.

A Comparison of using Interlocking IM Nail versus Plate Fixation in Humeral shaft fractures / 대한정형외과학회잡지

The tibial pilon fracture has been described as difficult fracture to manage. We have reviewed 23 cases of tibial pilon fractures from Mar. 1987 to Feb. 1993 at our hospital. 1. The fractures were classified into five types according to the system of Ovadia and Beals and the methods of treatment were divided into two groups; 9 cases were treated with Ilizarov device(Group I). 6 cases out of Group I were type 3, 4 and 5. Other methods were performed in 14 cases(Group II). 8 cases out of Group II were type 3, 4, and 5. 2. In type 3, 4 and 5 fractures, there were 86 per cent good and fair radiographic results in Group I and 63 per cent good and fair results in Group II. 3. Satisfactory results were obtained by the treatment of Ilizarov method especially in type 3, 4 and 5 fractures. The advantages of Ilizarov device were its primary reduction with ligamentotaxis, easy open reduction due to proximal and distal stabilization, minimal soft tissue injury and minimal internal fixation.

Tension-band wiring of displaced proximal humeral fractures / 대한정형외과학회잡지

No abstract available.

Treatment of the tibial shaft fractures with ender nails / 대한정형외과학회잡지

No abstract available.

Computed Tomography Findings in Failed Chemonucleolysis / 대한정형외과학회잡지

Chemonucleolysis is a significant innovation in the treatment of herniated lumbar disc disease. The prodedure is relatively safe and the results are highly acceptable, but in most studies, the failure rate is 20-25%. Computed tomography was performed from January, 1986 to June, 1987 at the Department of Orthopedic Surgery, Yonsei University on six patients with herniated lumbar discs who did not improve with chemonucleolysis. The results of this study are as follows : 1. The herniated lumbar disc remained unchanged in 4 cases and was reduced in 2 cases. 2. In 2 cases of hernia reduced, the development of a diffuse annular bulging was noted and compression of the dural sac unchanged. 3. Chemonucleolysis was carried out at two levels in 2 cases and the herniated lumbar disc was not changed in these cases. 4. Thickening of the ligament flavum was noted in 1 cases. 5. Computed tomography findings after chemonucleolysis were good correlation with the clinical results in failed cases. In the cases not relieved the symptoms over 3–6 months after chemonucleolysis, it is necessary follow up computed tomography to decide the further treatment.

Isolated Fractures of the Greater Trochanter Report of 6 Cases

Isolated fractures of the greater trochanter are unusual injuries. Because of their relative rarity and the unsettled controversy regarding their etiology and pathogenesis, several methods of treatment have been advocated. Furthermore, the reports on this particular type of injury are not plentiful and the average textook coverage afforded to this entiry is limited. These fractures are seen as two distinctly different types which occur in different age groups. The first type are epiphyseal separations which are found in the adolescent population, ususlly from seven to seventeen years of age. In this type, the mechanism of injury is muscle contraction that results in avulsion of the entire trochanteric apophysis and it can be displaced up to 6 cm. The second type is a comminuted fracture of the greater trochanter seen in adults. In this type, the mechanism of injury is usually a direct blow to the greater trochanter that results in a comminuted fracture, and only a part of the greater trochanter is generally involved.