A Study on Freeze / 대한정형외과학회잡지

I had an opportunity to visit U.S. Naval Tissue Bank and observed tissue procurement and preservation by freeze-drying method and its clinical application while I stayed in the Naval Hospital, Bethesda in 1954. The freeze-dried tissues, especially bone graft, has shown excellent bone repair experimentally and clinically. Recently the mechanisms of osteoinduction have observed by many researchers and isolated the substance, bone morphogenetic protein, and clarified the interaction between BMP and the determined or inducible osteoprogenitor cells.

A Clinical Study of Anatomic Position Change on the Intra / 대한정형외과학회잡지

Despite a variable degree of comminution, the intra-articular fracture of the distal radius comprises four basic fragments : 1.Radial shaft; 2.Radial styloid; 3.Dorsal medial fragment; 4.Palmar medial fragment. For the period of 3 years from May 1984 to May 1987, 26 patients who had been treated for intra-articular fracture of the distal radius by various methods at the Department of Orthopedic Surgery, Kang Nam Sacred Heart Hospital, Hallym College are presented. According to the objective criteria of Scheck(18) used for calculating the degree of anatomic position change, the result obtained were as follows : 1. The most common fracture type was Type II by Melon(6) classification. 2. The average age of patients was 34 years old. 3. We agree that the accurate anatomic reduction with internal fixation assures better results in the distal radius intra-articular fracture. 4. CT scan was necessary for the accurate diagnosis of articular surface destruction. 5. Accurate relationship of the anatomic and functional result could be analyzed by Scheck(18) and Melon(6) concepts.

A Clinical Study of Segmental Tibial Fracture / 대한정형외과학회잡지

Thirty cases of segmental tibial fracture were treated during the period from January, 1980 to January, 1987. The following results were obtained. 1. Type I, high middle segment, was most common(16 cases, 52%). 2. High incidence of open fracture(22 cases, 71%). 3. Closed fractures were internally fixated whereas open ones, externally. 4. Higher union rates in intramedullary nailing. 5. External fixators, such as Monofixateur, were effective in severe open fractures.

Clinical Study for External Fixators of Open Tibial Fractures / 대한정형외과학회잡지

From August, 1981 to November, 19S5, the Hoffmann and Monofixateur apparatus were employed in the treatment of thirty five open tibial fractures that we considered to have a poor prognosis with more conventional forms of treatment. The results were obtained as follows; l. Application of Monofixateur was minimum iatrogenic soft tissue injuries and easier, simpler than Hoffmann and two external fixators were favorable device with rigidity in wound management. 2. Two external fixators could obtained sufficient stability when 3 or more pins were applied at each fragment of fracture in Hoffmann and 2 or more pins in Monofixateur. Monofixateur could obtained high stability with small number of fixation components and more stronger against anterior-posterior bending and in Hoffmann more stronger against lateral bending. 3. External components of Monofixteur was located in anterior surface, therefore dynamization converted tensile force of anterior surface of tibia to compression force and then bone union was activated. 4. After operation, in Hoffmann correction of compression, distraction and angular, rotational deformity were possible and in Monofixateur correction of compression distraction, and anterior or posterior angulation was possible. 5. Because of rigid stability of two external Bxators, these allowed early movement, avoiding joint stiffness and duration ambulation unilateral assembly of device in position biomechanically favorable. 6. The lateral view of fracture site could not be confirmed accurately due to overlapping of Hoffmann's adjustable connecting rod and bony shadow. In Monofixateur A-P and lateral view of Fx. site could be confirmed. 7. Accurate reduction and compression played a important role in bone union. 8. The time to fixation for all of the fractures averaged 20 weeks in Hoffmann and 16 weeks in Monofixateur. The time to union averaged 24 weeks in Hoffmann and 20 weeks in Monofixateur.

Experience of the Tarsometatarsal Fracture-Dislocation / 대한정형외과학회잡지

Injury of the tarsometatarsal joints is known to be very uncommon. Injury was most frequently seen as the result of high energy trauma and appear to be occuring more frequently. Early recognition was imperative, since significant long-term disability can result from inadequate treatment. We have reviewed and clinically anafysed 14 cases of tarsometatarsal Fracture-Dislocation treated at our clinic during the period frrqn March 1980 to March 1985. The following result were obtained. 1. Majority of cause of injury was traffic accidents in 10 cases(71%). 2. According to the Wilsons classification, First stage of supination was most common. 3. Associated injuried was 92%. 4. There was no significant difference between operative treatment and conservative treatment.

Clinical Analysis of Supracondylar Fracture of The Humerus in Children / 대한정형외과학회잡지

130 cases of the suprarcondylar fractures of the humerus in children were analysed. 60 cases were immobilized with plaster splint without closed reduction. 22 cases were closedly reduced and immobilized with plaster splint. 47 cases were closedly reduced and were fixed percutaneously with K-wires. 39 cases were operatively reduced and were fixed with K-wires. The following results were obtained. 1. The average age was 7.9 years, and the male and female ratio was 2.7: 1. 2. The extension type was 96.2% and the flexion type was 3.8%. 3. The left side (64.6%) was more frequently involved. 4. As associated complications, nerve injury (4.6%), vascular injury (2.3%), open fracture (2.3%), and associated fracture (2.3%). were developed. During treatment incomplete ulnar nerve palsy (2.3%), pin tract superficial infection(3.1%), severe cubitus varus deformity(4.6%), severe limitation of elbow motion(11.6%) were also developed. 5. Final results in the Holmberg's 4 Groups according to Mitchell & Adams' criteria showed that the more the displacement of fracture is increased, the more the poor result is also increased. 6. In spite of the selection of the more severe cases for surgery, the results of the operative cases were better than those achieved by closed reduction in the easier cases. 7. In the displaced fractures, immediate open reduction brings the satisfactory results and minimizies the sequellae.

Clinical Failures of Internal Fixation / 대한정형외과학회잡지

Since the first attemt of internal fixation not much more than a century ago, implants have come to play an important role in orthopaedic surgery. Yet little has been reported about complications which may result from implant surgery. During the period of May 1980 to April 1984, 32 cases of fixation failures were treated in the Department of Orthopaedic Surgery, Hallym College, Kang Nam Sacred Heart Hospital and results were obtained as follows: 1. The most common area involved femoral shaft, but the highest rate was distal femur. 2. The most common period of failure was between 2 to 4 months postoperatively. 3. The leading cause of failure was remaining defects at fracture site. 4. The authors recommend accurate reduction of fracture and bone graft, if necessary, adequate immobilization postoperatively and co-coperation of patient to avoid failure of implant.

The Incidence of Deep Vein Thrombosis in the Lower Extremity / 대한정형외과학회잡지

Deep vein thrombosis is a frequently lethal complication following musculoskeletal surgery and skeletal trauma. For this study on incidence of deep vein thrombosis, we examined the data on 40 patients with contrast venography. Thrombosis limited to the veins in the calf of the leg was shown in 10 patients by venography. None of these patients had clinical symptoms of deep vein thrombosis or indicating embolism. We therefore concluded that the incidence of deep vein thrombosis of the lower extremity after injury or operation in Korea is not so rare as was considered before.

Femoral Neck Fractures in Young Adults / 대한정형외과학회잡지

A fracture of the femoral neck in a young adult differs from the same fracture in an older patient in the following respects; 1. A relatively uncommon injury. 2. A significant difference in the severity of trauma. 3. A less satisfactory result. At the point of view, we studied the femoral neck fcartures in 15, 20- to 50-year-old patients. The aims were to analyze why these fractures occur in young adults, and what results can be expected after internal fixation. The results were as follows; 1. Common in men (3:1). 2. 80% (12/15 cases) of the fractures were caused by severe trauma. 3. The 3 cases (20%) were associated with the other fractures. 4. The factors infuencing the clinical results and complications in our study; a. Severity of trauma. b. Degree of displacement. c. Existence of posterior comminution. d. Time interval between accident and operation. 5. The multiple pinning got the more rigid fixation and diminished the rate of fixation failure. 6. All cases were achieved good to acceptable reduction. 7. Satisfactory functional results were achieved in 93.3%. 8. The rate of avascular necrosis was 15.4% (2/13 cases). It is concluded that the most of femoral neck fractures in younger patients occur because of the significant trauma. In our study, the incidence of avascular necrosis was not greater than in order patients. Therefore, to get as good a result as possible it seems important to perform the anatomical tion and rigid internal fixation with or without bone graft.

A Clinical Study of Fractures and Fracture / 대한정형외과학회잡지

A retrospective study was carried out of 125 cases of fractures or fracture-dislocations of the thoracolumbar spine. These were treated by either operative or nonoperative methods at the Kang Nam Sacred Heart Hospital of Hallym medical college during the period of Jan. 1980 to Oct. 1983. A comparison of clinical and radiographic findings regarding stability of spine, neurologic recovery, and back pain demonstrates distinct similarities and differences as follows: 1. Operative methods were found to be more efficient in correcting deformity and restoring stability than nonoperative methods. 2. No difference could be detected in degree of neurological recovery between operative and nonoperative methods in paraplegic patients. 3. Pain was more pronounced in the patients treated by nonoperative methods. 4. A classification of injuries based on radiographic findings is not satisfactory to confirm stability. There is a need for several methods of classification in order to planning the treatment program.

A Clinical Study of the Fractures of the Femoral Neck in Children / 대한정형외과학회잡지

Fractures of the femoral neck in children are rare and usually occur as a result of severe trauma. They are one of the most challenging injuries to treat. Their complication rate is high and their anatomic and physiologic characteristics make treatment difficult. The commonly encountered complications are avascular necrosis, nonunion, coxa vara and premature fusion of epiphyseal plate. Treatment of these fractures remains an unsolved problem but accurate reduction held with adequate internal fixation would appear to offer the best chance for succesful results. We report our observations in the treatment of eighteen cases of fracture of the femoral neck in children. Included is a review of references. The results obtained are as follows: 1. Among 18 patients, 11 were boys and 7 were girls. the highest incidence was between the ages of 5 and 7 years. 2. The main causes of fractures were traffic accidents in 10 cases (55.5%), falling from a height, and slipping down. 3. The commonest type of fracture was the cervicotrochanteric type (47.4%). Twelve cases were displaced fractures (66.7 %). 4. The range of Pauwels angle varied from 20° to 70°. 5. The commonly associated injuries were pelvic bone fractures, extremity fractures, skull fractures and soft tissue injuries. 6. Nine cases were treated by skin traction and plaster cast. Five cases ere treated by closed reduction and internal fixation with K-wires or knowles pins. 7. In 13 of the 18 cases, follow-up studies were done for an average period of 18 months. 8. The results were analyzed according to the Ratliffs assessment. Among the 13 cases, 10 cases showed good results, two fair and one poor. 9. All cases treated by closed reduction and internal fixation showed good results without complications. 10. Complications developed in five cases (38.5%), three cases of avascular necrosis and two cases of coxa vara. Among these five cases, one case of avascular necrosis developed as a result of neglect of the fracture and the others as a result of too conservative a treatment. 11. Secondary treatment of trochanteric arthroplasty was required in only one neglected case. This was further by avascular necrosis and the results were poor. 12. As a result, we recommond closed reduction and internal fixation as the most favorable method of treatment for the fracture of the femoral neck in children.

A Case Report of Irreducible Anterior Dislocation of Proximal Interphalangeal Joint of a Finger / 대한정형외과학회잡지

Dislocation and subluxation of proximal interphalangeal joint of a finger are relatively common and reduction by closed method is normally easily achieved. However anterior dislocation of a proximal interphalangeal joint is an uncommon injury that produces permanent joint stiffness unlike the more common radial, ulnar, and dorsal dislocations. The case reported here is irreducible due to the displacement of the intact lateral band and interposition of the central slip between the joint.

A Clinical Study of the Tibial Plateau Fractures / 대한정형외과학회잡지

The tibial plateau fracture is a fracture of the proximal end of the tibia, involving the weight bearing articular surface. This fracture often presents some problems in treatment and prognosis, because it is frequently accompanied by soft tissue injuries such as collateral ligament, cruciate ligament and menisci. During a period of 3 1/2 years, from Febuary 1980 to July 1983, We observed 78 cases of tibial plateau fractures at Gang Nam Sacred Heart Hospital. Of the above cases, 40 could be followed for a period of anywhere from 3 months to 3 years. They have been analysed according to the cause, classification, method of treatment and final result of treatment. Among these 21(52.5%) were treated by cast immobilization, 3(7.5%) by skeletal traction, 16 (40%) by open reduction and internal fixation. Thirty two cases (80% ) out of 40 indicated the result of the Acceptable group according to Hohl and Lucks criteria.

Giant Cell Tumor Involving the Sixth Cervical Spine: One Case Report / 대한정형외과학회잡지

While a giant cell tumor most frequently involves the distal end of the femur and proximal end of the tibia, involvement of the cervical spine is quite rare. Recently we observed a patient with a giant cell tumor affecting the sixth cervical vertebra. This is regarded as a clinically malignant tumor because its nature and difficulty in diagnosis and treatment We easily confirmed the extent of the lesion by CT scanning with Metrizamide. The treatment was palliative tumor ressection. This case of a giant cell tumor affecting the sixth cervical vertebra is reported with a brief review of the literature.

A New Ambulatory Approach using a Hip Hinge Thigh Cast Brace for the Treatment of Femoral Shaft Fractures in Children (Clinical Study in 24 Cases) / 대한정형외과학회잡지

No abstract available in English.

Surgical Management of Bone Infection (14 Cases Treated by papineau's Method) / 대한정형외과학회잡지

Papineau's technique represents an excellent method of dealing with serious bone infections with significant bone and soft tissue loss. The procedure is carried out in three stages: the 1st stage is the excision of infected bone and soft tissue, stabilization of the fracture site, the 2nd stage is the cancellous bone grafting, and the 3rd stage is the skin coverage. During the period from June 1980 to September 1982, our limited experience with 14 cases has been extremely satisfactory; 1. This method is applicable to traumatic osteomyelitis and some cases in which the infection has been blood borne. 2. Successful bone grafting in the presence of infection depends upon; a. complete sequestrectomy and removal of all infected tissue b. an adequate vascular bed for the graft c. no dead space d. sufficient immobilization.

Modified Weaver and Dunn Technique in the Treatment of Acromioclavicular Separation / 대한정형외과학회잡지

Thirty one cases of acromioclavicular injuries were treated in both Kangnam Sacred Heart Hospital and Hangang Sacred Heart Hospital during the period from May 1974 to April 1981. Three cases were classified to type 2 injuries and twenty eight were type 3. Among 31 cases one of the type 2 injuries was treated with closed reduction followed by thoracobrachial cast and remaining thirty received surgical treatment. Twenty one cases were operated on by technique of Weaver and Dunn, 8 cases by modified Phemister method and one case by Stewart technique. Preperative and postoperative stress film were evaluated and cap the coracoclavicular distance were measured. In twelve complete dislocation the authors modified the original Weaver and Dunn procedure by taking a bone chip along with the acromial end of the coracoacromial ligament. This seemed to provide a strong bony fulcrum for the suture of the ligament to clavicle as well as promoting bone to bone union. The results of this modified procedure were excellent.

Spinal Stenosis: Review of 40 Cases / 대한정형외과학회잡지

Spinal stenosis is defined as any type of narrowing of the main spinal canal, nerve canal or foramina caused by bony or sourrounding soft tissues. Its pressure symptoms are characterized by ill localized back pain, and usually bilateral chronic sciatica. During the past 80 years, the knowledge subjected to the spinal stenosis has been inproved but still many problems are remaining to be solved. Recently, the diagnosis and treatment of spinal stenosis have been facilitated due to introduction of computerized tomographic scanning apparatus. During the period of 3 years, from May 1979 to March 1982, we experienced 40 cases of spinal stenosis at Han Gang Sacred Heart Hospital and Gang Nam Sacred Heart Hospital. In study of this 40 cases clinical and radiological evaluation were made and obtained following result (25 cases of which were operated on). 1. The most common type was degenerative one (50%) 2. There were 16 males and 24 females (4:5) 3. The age distribution showed a peak incidence is the third decade (25%) 4. The most common chief complaint on admission was ill localized chronic sciatica (50%) 5. Decompressive surgery was carried on 25 cases such as; Laminectomy only (8%), Posterolateral fusion (20%), Both Laniinectomy and posterolateral fusion (72%) 6. The longest follow-up was 3 years and the shortest one was 4 months and the average was one year and four months. The outcome of follow-up were; excellent (52%), good (40%), fair (8%), poor (0%).

A Case Report of Clear Cell Sarcoma in Thigh / 대한정형외과학회잡지

Malignant tumors arising from tendon and aponeurosis are very rare. Among those reported most have been interpreted as synovial sarcoma or fibrosarcoma until Enzinger in 1965 described a new type which he called “Clear Cell Sarcoma of Tendon and Aponeurosis”. The tumor has a uniform and distinctive clinical and morphological pattern which distinguishes it from other groups of tenosynovial tumors. The problem of its histogenesis remains, especially its relation to synovial sarcoma. In this paper, we reported one case which is believed to be “Clear Sarcoma in the thigh”.

Fibromatosis (Report of Two Cases) / 대한정형외과학회잡지

The authors report two unusual tumors detected in the right scapula and around left aciatic nerve. Although fibromatosis is benign tumor, the nature is notorious for an aggreasive clinical couras with a tendency to recur in high percentage. Recently we have encountered two instances of fibromatosis, and presented with abort discussion of the clinical pathologic aspects with some review in literatures.