A Clinical Study on the Treatment of Tibial Shaft Fracture in Adult / 대한정형외과학회잡지

Sixty four cases of tibial shaft fracture in adult were treated by various methods at Department of Orthopedic Surgery, Koryo General Haspital during 3 years from March 1983 to Feb. 1986. The resuIts of 'treatment of these cases were analysed according to method of treatment, type and level of fracture, and degree of injury, in attempt to seek the most suitable method of treatment. The following results were observed 1. Of 64 cases of tibial shaft fracture, 24 cases were treated by cast immobilization, 16 cases by 0/ R and plate, screw fixation, 17 cases by Ender I-M nailing, 7 cases by Hoffmans ext. fixator. 2. The most common site of fracture was middle 1/3 of the shaft (62.5%). 3. On the union time of fracture, I-M nailing by use of Ender nail was more rapid than other methods of treatment. (average: 16.2 Wks. POD) 4. On the time of weight bearing, earlier weight bearing was possible by Ender I-M nailing than other method of treatment. 5. On the complications of fracture, fewer complications were developed after Ender I-M nailing than other method of treatment. 6. According to Modified Ellis classification, more rapid union was obtained by C/R and cast imm-obilization in the case of Minor degree, no significant difference among each group in the case of Moderate degree.

A Clinical Analysis of Treatment of Intertrochanteric Fractures between the Fixation with Ender Nail and Sliding Screw Plate / 대한정형외과학회잡지

The incidence of the interochanteric fracture of femur is increasing and this increase is likely to continue for many years due to increase of traffic accident and old people. The primary goal in the treament of an elderly patient with an intertrochanteric fracture is to return the patient to his prefracture activity as soon as possible. Rapid mobilization of a pain free patient helps to prevent skin ulceration, pneumonia, urinarystasis, thromboembolic disease and other complications of confinement to bed in the eldery. For there reasons, treatment of intertrochanteric fractures by surgical methods has become the standard procedure. The authors treated 53 cases of intertrochanteric fractures from March 1978 to February 1985 with Ender nail or sliding screw plate. The results obtained as follows: l. In the 34 cases where sliding screw plates were used, the patients average age was 49.4 years old and in the 19 cases where Ender nails were used, the average in age was 63.2 and therefore, compared to the sliding screw plate, the patients using Ender nails were about 13.8 years older. 2. In the cases where Ender nails were used, the average operation hours took in the average of 55 minutes and whereby, in the cases where sliding dcrew plates were used, took in the average of 125 minutes, and during the operation time, the amout of hemorrhage in the cases of Ender nail was about 150ml and the sliding scew plate resulted in about 610ml. 3. The average weight bearing period in the cases which Ender nails were used took in the average of 2.5 weeks, where by the sliding scew plates took in the average of 9.8 weeks. 4. In the cases where Ender nails were used, the radiological bony union time was about 12.7 weeks and the sliding screw plate took about 16.1 weeks. 5. In the cases of Ender nail, if, in the geriatric age, the indication is chosen well, it will result in a benefial treatment method.

Myotonia Dystrophica: A Case Report / 대한정형외과학회잡지

Myotonia dystrophica(Synonym: Myotonia atrophica, Dystrophia myotonia, Steinert's disease) is a autosomal dominant hereditary multisystemic disorder involving several organs besides skeletal muscle, and commonly called with myotonia congenita, paramyotonia congenita as myotonia. Although most cases are of adult onset, where a mother has the disease, neonatal dystrophia myotonia can occur in her offspring. The main feature is a steadily progressive muscle dystrophy, complicated by myotonia, which is a failure of muscles to relax normally after a forceful contraction. Steinert in 1909 was the first to report the finding of atrophic testes and baldness in patients with myotonia dystrophica, and the other clinical feature of myotonia dystrophica were reported by many authors after that time. We are reporting a case of myotonia dystrophica, which showing familial history with brief review of literature.

Poymyositis; A Case Report / 대한정형외과학회잡지

Polymyositis is uncommon, nonsuppurative Connective tissue disorder. We have experienced a case of polymyositis. Patient was a 20-y.ear old female in good healthy appearance with history of mild, progressive muscle weakness of lower extremities and inability to walk up and down of stairs in recent 3 weeks. Her symptoms were mainly subjective and individual muscle test revealed no abnormalities, but evidences of primary myopathy were easily obtained by muscle biopsy, electromyogram and several enzyme values. We are reporting a case of polymyositis with brief review of literature.

Etiologic Factors of Delayed and Non / 대한정형외과학회잡지

Delayed and non-union of the femur shaft fractures in adult have been increased in spite of improvement of method of treatment. In geheral, the principal factors predisposing to delayed and non-union have been known as infection, disturbances of the blood supply, poor immobilization (inadequate rigid fixation), distraction of fracture site. 43 cases of the femur shaft fractures in adult over 18 years old examined at the department of orthopedic surgery, Korea General Hosipital, during the period of January 1973 to January 1982, were divided into two Groups; Group A was 31 cases, which had been taken solid bony union as control group and Group B was 12 cases, which had been developed delayed and non-union. Group A and B were analysed to find out other etiologic factors such as liver function which were suspicious to result in delayed or non-union of the fracture except above mentioned principal factors. The results were as follows, l. In delayed and non-union group (Group B), the interval of age was 20 to 40 years of age, open fracture was 33.4% comparing to control(6.5%), comminuted fracture was 83%, comparing to control (42%), the time interval to operation was delayed over 2 weeks(18%) comparing to control(8%g), and gap between fractured ends after internal fixation was more than 2mm in 33% comparing to control(absent), and liver function, especially, SGOT, and SGPT was bad in 46% comparing to control(13.4%). 2. All 3 cases ot infection in fracture site were in delayed and non-union group, tracture level, associated injury and postoperative immobilization were not concerned with delayed and non-union between two groups.

Epidural Block for the Treatment of Low Back Pain and Sciatica / 대한정형외과학회잡지

In spite of numerous dinical and patho-anatomical studies made in the past, there are still different opinions concerning the mechanism of low back pain. The sciatic symptoms in degenerative lumbar disc disease may arise from the direct mechanical effect of pressure exerted by protruding disc material on nerve roots, and that such symptoms may therefore be relieved by surgical decompression of the nerve roots, has been widely accepted for nearly 40 years. There is, however, a good deal of evidence, both from operative and histological findings as well as from indirect sources, which suggests that inflammatory changes present in and around affected nerve roots may also be of importance in the production of sciatic symptoms in lumbar disc disease. The possibility that, at least in some cases, these inflammatory changes could contribute significantly or even predominantly to the production and persistence of sciatic symptoms, has stimulated many attempts to treat sciatica by means of local antiinflammatory measures in particular, corticosteroid injections. We have studied the effect of the injection of mixture triamcinolone and local anesthetic (1% xylocaine or 0.5% marcaine) comparing with the effect of usual conservative treatment of low back pain and sciatica. Of the 92 patients suffered from lumbago & sciatica, who were treated from 1979. 7 to 1981. 7 in Korea and Jae Il general hospital, 44 patients were treated with intermittent epidural block, 12 patients with continuous epidural block and 36 patients were treated only with usual conservative treatment. The results of clinical observation were as follows: 1. The causative disease were herniated nucleus pulposus in 60 patients (64%), lumbar sprain in 12 (13%), degenerative joint disease of spine in 11 (12%),… 2. The epidural block cases were divided into acute group (symptoms less than 3 months) and chronic group (symptoms longer than 3 months). The over all improvement of the acute group was 22 of 27(81%) and of the chronic group was 22 of 29(76%). The duration of symptoms didnt influenced significantly the effect of epidural block. 3. Therapeutic effect of epidural block was as follows; complete relief 22 of 56(39%), marked relief 13 of 56(23%), slight relief 9 of 56(16%), no improvement 12 of 56(22%). The over all improvement was resulted in 44 of 56(78%): intermittent epidural block 34 of 44(77%), continuous epidural block 10 of 12(83%). 4. Therapeutic effect of conservative treatment was as follows; complete relief 10 of 36(28%), marked relief 7 of 36(19%), slight relief 4 of 36(11%), no improvement 15 of 36(42%). The over all improvement of symptoms was resulted in 21 of 36(58%). 5. Follow up period of epidural block patients were 3 months in average, and persistent relief of symptom were obtained in 12 out of 20 patients(60%), and recurrence of symptom were in 6 of 20 patients(30%). It is considered that epidural block will shorten the time of recovery from severe pain, avoid hospitalization or long periods of bed rest and allow earlier physiotherapy. In addition it may avoid the need for surgical intervention to produce rapid relief of acute pain and give to patient economic, psychologic benefit.

Primary Malignant Fibrous Histiocytoma in the Long Bones: 2 Cases / 대한정형외과학회잡지

Malignant fibrous histiocytama is currently defined as a malignant primary bone tumor, and that may contain fibromatoua, xanthomatous, or histiocytic elementa, varing widely in the degree of anaplasia that is present. The principal lesions to be considered in the differential diagnoais of malignant fibrous histiocytoma are osteogenic sarcoma and fibrosarcoma. Malignant fibrous histiocytoma is more sensitive to chemotherapeutic ageata than are osteosarcama and fibrosarcama. In this paper 2 cases sre reported, including the one in which the tumor arose in a midahaft of the femur and the other one arosein the upper metaphyseal portion of the tibla.

The Treatment of Femoral Shaft Fractures by Cast Brace / 대한정형외과학회잡지

10 cases of femoral shaft fractures were treated by cast brace during the past 5 years from May, 1975 to August, 1979 at the Department of Orthopedic Surgery, Korea General and Jae II Hospital, The results were summarized as follows; 1. Of the 10 cases, 8 cases were male and 2 were female, and age distribution was between 14 and 65. 2. 5 cases were treated by cast brace from the start as the primary treatment and the other 5 were by other method initially and followed by cast brace secondarily. 3. One of 5 cases treated by early cast brace developed delayed union and the other one of 5 cases treated by late cast brace secondarily developed non-union, which were treated by open reduction and internal fixation with cancellous bone graft. 4. The cast brace was applied within the first 6 weeks after fracture and average application time was 9. 7 weeks in the cases treated by early cast brace, which was compared with 12.5 weeks in the late cast brace group. 5. Average time of fracture healing was 13.5 weeks in the early cast brace group and 18. 5 weeks in the late cast brace group. 6. In three of 10 cases, counter traction was applied to reduce the limb shortening during bed rest.

Statistical Study of the Lumosacral Angles in Lumbago Patients / 대한정형외과학회잡지

The purpose of this study is to assess the differences of the lumbosacral angles between the lying and standing position among Iumbago patients. Among Iumbago patients the following diseases with known causes were exclused in this study; spondylolisthesis, spondylolysis, pure herniated nucleus pulposus, tuberculous spondylitis, congenltal anomalies, trauma and psychosis etc. Only the following with unknown causes were included; idlopatic lumbago, hernlated nucleus pulposus with bone and joint changes, instability and degenerative osteoarthritis. The following lumbosacral angles were measured and evaluated in 460 lumbago patients; 271 patients in the lying position and 189 patients in the standing position. 1. Ferguson angle 2. Sacrovertebral angle (Mitchell angle) 3. LS horlzontal angle 4. Promonotorium angle 5. Line of weight bearing The results were summarized as follows; 1. Ferguson angle Lying position 38.4 Standing positon 35.3 Sacrovertebral angle 140.7 142 L5 horizontal angle 20.4 17.4 Promontorlum angle 134.4 134.9 2. Ferguson and L5 horizontal angles in lumbago patients were increased in the lying position and decreased in the standing position as compared with the angles in normal individuals (control group). 3. Sacrovertebral angle In lumbago patients was decreased in the lying position. 4. Promonotorium angle in lumbago patients was increased in the lying and standing position. 5. Judging by the Iine of weight bearing, Iumbago patients in the:lying position showed more instability as compared with that in the standing position group.

Modified High Tibial Osteotomy / 대한정형외과학회잡지

Treatment of unstable cervical spine fracture by skull traction is time consuming procedure, and treatment by Halo appratus has many advantages but it is very expensive. Bone cement has been applied occasionally as an adjunct to metallic internal fixation in treating patient with malignancy, i.e. limited life expectancy. Internal fixation with bone cement in addition to routine posterior fusion with bone graft is tried eliminate the need of application of complicated external immobilization in treating unstable cervical spine fracture of young patient. We experienced two cases of posterior cervical fusion using bone cement with satisfactory results. The advantages of this method are: 1. Rapid and solid fixation 2. Early ambulation 3. Reduce complicated external support 4. Reduce the date of hospitalization.

Pollicization: Two Cases report / 대한정형외과학회잡지

Absence of the thumb, either traumatic or congenical, causes a severe deficiency in hand function; in fact grasp and pinch are almost impossible. Thus when the thumb is partially or totally absent, reconstructive surgery is appealing. Usually the thumb should be reconstructed only when amputation has been at the metacarpophal-angeal joint or at a more proximal level. The procedures for reconstruction of the thumb are well known. They include transposition of a digit, procedures to lengthen the thumb metacarpal and methods of total reconstruction including a pedicle graft to obtain sensibility. Although pollicization (transposition of a finger to replace an absent thumb) endangers the finger, that is worthwhile, especially in complete bilateral absence of the thumb or in bilateral traumatic amputation. The each finger with a part or the whole of the metacarpal, has been transplanted to the stump of the metacarpal of the thumb or the trapezium. When all of the fingers are normal, the index finger is the best choice for thumb replacement because of its circumferential size, phalangeal length, independent motion and proximity to the thenar eminence. Recently this operation has been done with conservation of all nerves, vessels, tendons and muscles. We have had two pollicization operations (transposition of index finger) in the patient of bilateral traumatic amputation of the thumbs. Four months later excellent pinch and grasp with normal sensibility in the reconstructed thumbs were obtained with all remaining digits.

Two-Stage Tendon Reconstruction Using Hunter Silicone Rod Prosthesis / 대한정형외과학회잡지

Flexor tendon injuries of the “no man's land”(Zone2) in the hand have long been considered one of the problem areas for hand surgeons because of the frequently unsatisfactory result of treatment. Two-stage tendon reconstruction using the silicone rod prosthesis is one of the recent valuable procedures for management of severely damaged hand. From Aug. 1977 to Jun. 1978, the authors performed this procedure using “Hunter Silicone Rod” on 4 cases of flexor tendon injuries accompanied by deep cicatrix of soft tissue and stiffness of finger joints. The follow-up results were excellent in 3 cases out of the 4, and poor in the remaing case which had marked wound infection and stiffness of finger joints.

Progressive Muscular Dystrophy (Report of 32 cases) / 대한정형외과학회잡지

Progressive muscular dystrophy is a genetically determined myopathy of unknown etiology and is a primary degenerative disease of skeletal muscle fibers. The authors reviewed 32 cases of progressive muscular dystrophy and made following observations. 1. The types among the 32 cases were as follows. 1) Duchenne type ; 16 2) Limb-Girdle type ;12 3) Facioscapulohumeral type ;3 4) Distal myopathy ;1 5) Ocular myopathy ;0 2. 13 of the 32 patients had relevant family history. 3. In general, creatinine excretion was decreased in 24-hour urine and creatine was increased. 4. 6 of the 10 patients tested had increased serum C.P.K. level.

An epidemiologic Study of Tennis Elbow in Tennis Player / 대한정형외과학회잡지

The etiologic factors of tennis elbow have been obscure in spite of increased concern and study. The true pathologic changes in tennis elbow are also not well established. The authors anslized 300 tennis players for a history of tennis elbow, finger size, body weight,weight and grip size of racket etc. The results were as follows; 1. 68 among 300 players have suffered from tennis elbow more than one time (22.7%). 2. There were no difference in correlation between body weight and racket weight. 3. Most players have used improper grip, especially in those who have suffered from tennis elbow.

Total Knee Replacement Report of Three Cases / 대한정형외과학회잡지

Stability, mobility, and freedom from pain are the requirements of a normal knee. Arthrodesis of a knee damaged by disease or injury will satisfy two of the three requirenents. The current status of knee replacement surgery suggests that high density polyethylene and chrome cobalt alloy or stainless steel are acceptable materials for use in the intra-articular environment of knee. These prosthetic components of artificial knees can be firmly cemented into bone and provide acceptable slinical results if used within their design limits. We have had 3 total knee replacements in the chronic rheumatoid patients. The results of 2 Geometric knee replacements and 1 Guepar knee replacement were assessed from 5 months to 2 years after operation. Total knee replacement improved mobility and reduced pain in these patients.

The Cloward Operation of the Cervical and Lumbar Spine / 대한정형외과학회잡지

Anterior cervical interbody fusion and posterior lumbar interbody fusion of the Clowards technique is based on those; 1. removal of the painful disc. 2. stabilization of the unstable joint by interbody fusion. This technique has many advantages compared with the others including followings; 1. very simple technique. 2. low morbidity. 3. rapid recovery. 4. no need of the external support device postoperatively. We operated 5 cervical spines and 2 lumbar ones. This is the report of their follow up study in 2 to 2 years.

Arthrographic Finding of Meniscus Tear / 대한정형외과학회잡지

Double-contrast arthrography of the knee, that is roentgenographic examination of the supporting structures of the knee joint with the aid of the radiopaque dyes, has been utilized infrequently until recent years in our country. A growing appreciation of the advantages of arthrography, increased experience with the technique, and an increasing ability to interprete the arthrogram have led to more frequent use of this diagnostic aid. Double-contrast arthrography of the knee is of particular value in the examination of the patient with an atypical history of in jury and unusual physical findings, or in the individual with an acute injury who cannot tolerate a manipulative physical examination. Its use has led to greater diagnostic acumen prior to operative intervention and in many cases has aided the orthopedic surgeon in determing whether or not surgery indicated and in surgical exploration. And its accuracy of the diagnosis of the meniscus tear has been very high, greater than 90% in many series. The followings are summary of result; 1) Double-contrast arthrography of the knee is a valuable diagnostic procedure. 2) Prolonged observation and procrastination in the treatment of patients with symptomatic knees could be avoided. 3) There were no complications of arthrography and all patients returned to work immediately after the procedure. 4) In this series, 2 cases out of the 6 cases of the torn lateral meniscus were not demonstrated correctly by arthrography. From this result, it is suggested that the interpretation of arthrographic findings is somewhat difficult at present time. In future, further experience and study for arthrography is demanded for more accurate interpretation of the conditions of the structures of the knee joint and also is desired to compare with the arthroscopic findings.

A Correlative Study in the Clinical and Pathological Aspects of Rheumatoid Arthritis / 대한정형외과학회잡지

It has been thought the histological features of rheumatoid arthritis do not reliably indicate the degree of activity or prognosis of the disease and that they are not specific for that condition (Hemerman, 1963). Recently, however, Muirden and Mills (1971) found in rheumatoid joints submitted for synovectomy a direct correlation between the degree of lymphocytic infiltration and joind damage. Lymphocytes might play a helpful role in protection of the rheumatoid joint. Muirden (1970) has also reported a significant relationship between histological estimates of the extent of the iron deposits nd the grades of roentgenographic changes in biopsied joints. The present study directed to confirm and analyze the changes in the clinical and pathological aspects, with the cases synovectomized at Korea and Severance Hospital, Seoul, Korea. Resuits: Clinical and histological studies were made on 21 cases of “classical” and “definite” rheumatoid arthritis submitted to the Department of Orthopaedic, Korea General Horsital and the Department of Pathology, Yonsei University College of Medicine, during the period from 1966 to 1975, and results were as follows. 1 In age distribution, 16 cases (76.2%) were in the interval between 21 and 51 years old: the mean age was 33.5 years old. The sex distribution showed approximately a three fold female predominance with 16 females (76.2%) to 5 male cases (23.8%). 2. The most common chief complaint recorded were morning stiffness and multiple joint pain. Other symptoms, in descending order of occurrence were tenderness, synovial swelling, flexion deformity, joint swelling and subcutaneous nodules. The interval from initial complaint to admission varied from 7 months to 15 years, with a mean interval of 5.9 years. 3. Serological studies for rheumatoid factor were done on 15 cases and eight (53.3%) were found to be positive while seven cases (46.7%) were negative. The positive cases had longer histories and were in older age groups than the negatives. 4. Histologic findings were characterized by proliferation of suface lining cells of synovium, infiltration of lymphocytes, proliferation and thickeness of the vessels, and synovial villi, deposition of fibrins and hemosiderins and infiltration of acute inflammtory celIs. Each of the characteristics studied was ratect on a scaled score ranging from 0 to 3 from 1 to 3. For each patient the scaled scores were totaled and the totals ranged between 6 and 18 with a mean score of 10.5 5. Roentgenographic findings were characterized by swelling of the soft tissues swelling of the joints,. narrowed space of the joint cavity, and destruction of bone. Each of the characteristics studied was rated. on a scaled score ranging from 0 to 3 or from 1 to 3. For each patient the scaled scores were totaled and the totals ranged between 3 and 11 with a mean score of 7.1. 6. There was no significant correlation between histologic findings such as synovial hyperplasia or infiltration of lymphocytes, and clinical findings such as age, duration of histories, presence of rheumatoid factor, roentgenographic findings or surgicaI findings.

Kaposi's Sarcoma with Skeletal Lesion: A case report / 대한정형외과학회잡지

The morphologic unit of the disease process currently referred to as Kaposi's sarcoma consists of a complex growth of vascular channels and mesenchymal cells of various types and in different phases of differentiation. Kaposi's sarcoma, with its characteristic skin lesion, is an entity familiar to the pathologist and dermatologist. This case report represents an unusal bone cortex involvement of Kaposi's sarcoma with skin lesion in a lower extremity, which has survived for 26 years without no specific abnormality in laboratory study and no specific clinical change.

Two cases of Benign Mesenchymoma arising in Thigh and Forearm / 대한정형외과학회잡지

The criteria for a mesenchymoma are that it should be composed of at least two mesenchymal elements not ordinarily found together in a tumor. This report dealt with two cases of benign mesenchymoma arising, one in the left thigh and the other in the left forearm. To diagnose of this tumor on X-ray preoperatively was difficult. The tumors were excised as much as possible, and mesenchymal derivatives characteristic of the tumor was described in detail.