Carpal Injuries / 대한정형외과학회잡지

In carpal injury, a good functional end result seems to correlate with final anatomic alignment of carpus after treatment. Some cases are often misdiagnosed and result in inadequate treatment. Forty six cases of carpal injuries were analysed which were treated for 9 years from 1975 to 1984 at the Department of Orthopedic Surgery, Seoul National University Hospital. The observations can be summarized as follows. 1. The male to female ratio was 3.5: 1 and 82% of total cases were in the third and fourth decades. 2. The most frequent cause of injury was fall from height with outstretched hand. 3. Trans-scaphoid perilunar dislocation and its variant were the most common diagnosis in this analysis. 4. All of the scapho-lunate dissociation showed volar flexion intercalated segmental instability with scapho-lunate gap more than 2 mm in our series. 5. In 11 cases of trans-scaphoid perilunar dislocation and its variant, carpal collapse was found in 10 cases. In 5 cases dorsiflexion intercalated segmental instability pattern and in one case volar flexion intercalated segmental instability pattern were found to be present. 6, There was an increase in scapho-lunate angle in all cases of dorsiflexion intercalated segmental instability, but a decrease in scapho-lunate angle is not a consistent finding in volar flexion intercalated segmental instability. 7. In 24 cases more than 6 months follow-up, excellent and good results were obtained in 20 cases. 8. As a result of above findings, authors conclude that scapho-lunate gap more than 2mm has diagnostic value in scapho-lunate dissociation but that dorsiflexion intercalated segmental instability or volar flexion intercalated segmental instability only means the changes in the relationship between carpal bones and does not have definite or specific diagnostic value for a specific carpal injury.

Our Experience with Steel's Triple Innominate Osteotomy On Paralytic Hips and Septic Hip Residua / 대한정형외과학회잡지

In 1973, Steel described triple innominate osteotomy in which the ischium, the superior pubic ramus and ilium superior to the acetabulum are divided and the acetabulum is repositioned anterolaterally and is stabilized by a bone graft and metal pins. Its goal is to establish a stable hip for dislocation or subluxation of the hips in older children and adults on whom it is impossible to correct effectively the instability by any one of the more conventional osteotomies, i.e. Salter's, Pemberton's or Chiari's, or by the capsular arthroplasty of Colonna. During the eleven years and eight months, from December 1973 to August 1985, at the Department of Orthopedic Surgery, Seoul National University Hospital, we performed Steel's triple innominate osteotomy on 41 cases, of which 37 were residual poliomyelitis and 4 septic hip residua. 4 cases of residual poliomyelitis were lost during follow up. The remaining 37 cases were reviewed for the efficacy and limitations of triple innominate osteotomy. We observed following conclusions: 1. Aside from congenital dislocation and dysplasia of the hip, paralytic conditions, such as residual poliomyelitis, are good indications of Steel's triple innominate osteotomy in older children, adolescents and young adults. Acetabular acclivity is adequately reduced and stability is improved. 2. Septic hip residua, including healed tuberculosis, is another indication of triple innominate osteotomy, particularly when total hip arthroplasty is contemplated. 3. When abductors are partially paralyzed, triple innominate osteotomy alone results in appreciable increase in abductor power, by providing a better muscle tension. 4. Substantial gain in leg length is an added advantage of triple innominate osteotomy. An average of 1.74 cm was gained at osteotomy site in our series. In adults, when limb shortening is relatively m i nor, triple innominate osteotomy alone can be a more convenient alternative to conventional, more formidable method of leg length equalization, such as femoral lengthening. This is particularly true when there is some instability or when abductors are weak. 5. Following improvement in mechanical stability by triple innominate osteotomy, weak abductors and extensors may be augmented by appropriate muscle transfer, resulting in more stable hip functionally. 6. In a hypermobile paralytic hip, iliopsoas tenotomy is neither necessary nor desirable at the time of osteotomy. When the hip is dislocated, or when the hip has marked flexion deformity, iliopsoas tenotomy fascillitates adequate correction, but this greatly increases the risk of neurological complication.

Hand Tumors / 대한정형외과학회잡지

Hand tumors arise from the skin, subcutaneous tissue, tendons, nerves, blood vessels, and bones, and are of many different types. Most of them are benign but malignant lesions also occur, although only rarely. The authors have encountered 115 cases of tumors of the hand at Seoul National University Hospital between 1975 and 1984 and the following results were obtained; l. In our series of 115 cases of hand tumors (bone tumor; 47 cases, soft tissue tumor; 68 cases), most of them are benign (110 cases, 96%). 2. There are no demonstrable differences in the sex and distribution. 3. Of the bone tumors in the hand, enchondroma is most common (25 cases, 53%), followed by giant cell tumor (9 cases, 19%), and osteochondroma (7 cases, 15%). 4. Of the soft tissue tumors in the hand, ganglion is most common (28 cases, 41%), followed by hemangioma (16 cases, 24%), and xanthoma (8 cases, 12%). 5. Of the treatment modalities of bone tumors in the hand, the most frequent one is curettage and bone graft (26 cases, 53%), followed by excision, and en bloc resection and bone graft (8 cases, 16%, respectively). 6. Of the treatment modalities of soft tissue tumors in the hand, the most frequent one is excision (64 cases, 93%). 7. Although giant cell tumor, hemangioma, and lymphangioma are classified as benign histologically, their clinical course appears to be malignant, because of incomplete excision and recurrence.

Avascular Necrosis of the Femoral Head following Treatment of Congenital Dislocation of the Hip / 대한정형외과학회잡지

Avascular necrosis of the femoral head has been recognized as one of the most serious and frequent complications following the initial treatment of congenital dislocation of the hip. It is now well accepted that this particular complication is iatrogenic and may be avoided by careful and adequate treatment. The reported incidence of avascular necrosis is variable because of various methods of treatment and different diagnostic criteria. We retrospectively reviewed 130 patients(144 hips) with congenital dislocation of the hip, who were treated at Seoul National University Hospital during 10 year-period from January 1974 to December 1983, and found 13 patients (13 hips) with avascular necrosis of the femoral head. We analyed avascular necrosis following treatment of congenital dislocation of the with respect to various methods of treatment, possible causes, types of avascular necrosis, to radiological findings, and to functional results. 1. The incidence of avascular necrosis following treatment of congenital dislocation of the hip in our series was 9.0%(13/144 hips). 2. The average age of the patients with avascular necrosis was 3 years, the youngest being 4 months and the oldest being 10 years. The average follow-up period was 2 year and 2 months. 3. The incidence of avascular necrosis in the closed reduction series was higher in those between 6 months to 18 months with 10.5%, as compared to 7.1% in those 6 months and under 6.7% in those 18 months and over. In the open reduction series, the incidence increased as the age increased, being 5.9%, 12.4%, 15% in the groups 18 months to 3 years, 3 to 6 years, and 6 years and over, respectively. 4. The incidence of avascular necrosis in those who had priliminary traction was 8.3%, where as that in those who had not was 16.6%, being twice as much. 5. The incidence of avascular necrosis decreased as the traction time prolonged, being 9.0% in 7 days or less, 7.7% in 8 to 14 days, 7.1% in 15 to 21 days and nil in 22 days or more. 6. The incidence of avascular necrosis in the skin traction group was 5 times as much with 11.5%, as in the skeletal traction group with 2.2%, despite older age in the latter. 7. The incidence of avascular necrosis in the open reduction group was slightly higher with 9.5%, than in the closed reduction group with 8.6%. 8. All 6 cases of avascular necrosis following closed reduction occurred when Lorenz or frog-leg cast was applied initially after reduction despite attention to avoid extreme abduction. Avascular necrosis were not encountered in those who had Lange or human position cast as the initial form of immobilization. 9. In the closed reduction, avascular necrosis occurred 8.1% in those who had adductor tenotomy and 10.0% in those who had not. In the open reduction, avascular necrosis occurred 7.9% in those who had adductor tenotomy and 18.1% in those who had not, suggesting significant role of adductor tenotomy in the prevention of avascular necrosis. 10. Avascular necrosis was attributable to excessive abduction in 7 hips, to undue pressure of femoral head in one hip, to open reduction in 3 hips, to post-operative infection in one hip, and to non-union of subtrochanteric osteotomy in one hip. 11. Of the 13 hips, following roentgenograms were available in 11. According to the classification of Bucholz and Ogden, type I, II, III, IV were 7, 0, 3, and 1 hips, respectively. 12. Functional results of the 13 hips of avascular necrosis, according to Kalamchi and MacEwen's criteria, were Good, Fair, Poor in 9, 3, and 1 hips, respectively.

Chondrosarcoma / 대한정형외과학회잡지

No abstract available in English.

Revision for Loosened Total Hip Replacement Arthroplasty / 대한정형외과학회잡지

Concomitant with progressive rise in incidence of loosening of conventional total hip replacement arthroplasty which is mainly due to improper surgical technique and cement fixation, has been increased the incidence of revision. In addition to technical failure, there are many risk factors that effect the loosening, such as young active person, obesity, men, osteopomsis, those with bone stock deficiencies as congenital dysplasia of the hip, and those with previous hemiarthroplasties, etc.. Many experimental and clinical studies have been tried to decrease the incidence of loosening in conventional total hip replacement arthroplasty. One of these trials is the cementless total hip replacement arthroplasty with its simplicity of the surgical procedure. We have experienced 426 hips of the total hip replacement arthmplasty in 396 patients from January 1973 to December 1982, among whom 21 hips in 20 patients who had been undertaken revisional arthroplasty were followed up. The longest follow-up was 7 years and 3 months and the shortest was 2 years, the average being 2 years and 4 months. 1. Ankylosis of the hip and sequeale of the infected hip were most common in primary diseases of our revision cases. 2. Revision with cementless total hip replacement arthroplasty of a loosened conventional total hip replacement arthroplasty appears to be available as an effective alternative. 3. Initial attempt with cementlass total hip replacement arthroplasty to prevent loosening after conventional total hip replacement arthroplasty seems to be preferable for patients with ankylosis of the hip or sequeale of the infected hip, especially who are active and young.

Surgical Treatment of Spondylolisthesis / 대한정형외과학회잡지

No abstract available in English.