Surgical Treatment for the Knee Flexion Deformity in Spastic Cerebral Palsy / 대한정형외과학회잡지

Equinus deformity of ankle, adduction and flexion deformity of hip and flexion contracture of knee are most common deformities in spastic cerebral palsy. There were many surgical treatment methods according to its causes. Authors has analysed 115 patients(224 operation) who had been operated with three procedure (Modified Egger's op, Proximal hamstring elongation, Distal hamstring elongation) and compared the results of these procedure at Sam Yook Rehabilitation Center from Jan. 1980 to Dec. 1987. The following results are obtained: 1. The results of Modified Egger's operation were unsatisfied because of complicaLion and little angle correction ability of flexion contracture of knee joint. 2. Even though there was no differences in angle correction ability of flexion contracture of knee joint between two procedures, the results of proximal hamstring elongation were superior to them of distal elongtion because early walking ability is more easily improved.

The Assessment of Bone Mineral Density in Postmenopausal and Senile Osteoporosis Using Quantitative Computed Tomography / 대한정형외과학회잡지

Osteoporosis is a skeletal condition that is characterized by reduction in bone volume and an increased vulnerability to fracture, practically of the proximal femur and vertebrae. Unfortunately, osteoporosis does not usually become obvious until a patient presents with a fracture. For this reason, it has been referred to as the silent epidemic. While radiological examination remains the mainstay of diagnosis, there are certain disadvantages associated with this technique. Almost one third of the skeletal mass must be lost before osteoporosis becomes apparent on a plain radiograph and radiological artifacts are not uncommon. Many methods have been developed for quantitative assessment. of the skeleton. So osteoporosis can be detected early and its progression and response to therapy can be carefully monitored. Recently, quantitative computed tomography(QCT) has been investigated as a means for non-invasive quantitative determination of bone mineral density of the spine. Highly signifcant correlation have been found between vertebral trabecular mineral amount and quantity determined by QCT. Furthermore vertebral strength and failure load have been found to correlate well with trabecular density determined by QCT. Authors has analysed bone mineral density(BMD) of 213 patients who visited Severance Hospital, Yonsei University College of Medicine from Jan. 1988 to Sept. 1989. The aims of this study is to compare BMD of osteoporosis group with that of mormal group, to investigate correlation between BMD and age distribution, and to estimate fracture threshold in osteoporosis group. Following results were obtained:l. After 20 years of age, men lose an average of 0.83 per cent of bone per year, and women lose an average of 0.96 per cent per year. Such lost in women seems to be accelerated during and after menopause. 2. The bone mineral densities for the osteoporosis group are lower than those for the normal group by 28.4% for male and 29.7% for female. There was little difference between sex. 3. It is suggested that 90mg/cm3 of BMD is the fracture threshold for the osteoporosis group. 4. The compression fracture rate among post-menopausal women is 38.8%.

Fractures of the Femoral Neck in Children / 대한정형외과학회잡지

Fractures of the femoral neck in children are rare and usually severe violence to occur, which accounts for the high frequency of associated injuries. Since the femoral neck in children has many anatomic and physiologic differences, not only are there many difficulties during the treatment period, but complications such as post-traumatic coxa vara, avascular necrosis of the femoral head, and premature epiphyseal closure may occur, sixty-two cases in sixty patients of fractures of the femoral neck in children which were treated at Severance Hospital, Yonsei University College of Medicine from Jan. 1971 to Dec. 1987 and at Young-Dong severance Hospital, Yonsei University college of Medicine from May. 1983 to Dec. 1987 were analyzed both clinically and radiologically. The following results were obtained: l. Of the 62 cases, the ratio of boys to girls was approximately 2:1 and the highest incidence was between 4 to 6 years old. 2. The main cause of fracture was traffic accidents, which occurred in 33 cases(53.2%). 3. According to the classification of Delbet and Colonna, the cervicotrochanteric fracture was the most common type(41.9% of the cases) and 29 cases(46.8%) were displaced fractures. 4. Thirty two cases(51.6%) were treated by conservative treatment and twenty eight cases (45.2%) by closed reduction and internal fixation. 5. Common associated injuries were genito-urinary tract injury, soft tissue injury, long bone fracture and pevic bone fractures. 6. All cases were followed for from 14 months to 15 years, average 8 years. 7. The results were analyzed according to Ratliff's assessment and 41 cases(66.1%) showed good results. 8. The total number of cases with complications was 33(53.2%). The most common complication being coxa vara and premature epiphyseal closure(32.2%). 9. Secondary treatment was done in 7 cases and correction osteotomy was done in 4 cases which had showed a good results. The authors found that for the treatment of type IV fractures, closed reduction followed by plaster of Paris immobilization was adeguate but for type I, II, III after early closed reduction, internal fixation was performed as soon as possible using threaded pins as the internal fixation device. The results were poor in type I and type II, fractures with severe displacement, and in cases in which the treatment was delayed due to associated injury.