Metal Failure of the Internal Fixation Device for the Treatment of the Femur Fracture / 대한정형외과학회잡지

PURPOSE: Nonunion and metal failure as a complication may occur in femoral fractures, which are treated with plate and screw or intramedullary nail. The authors clinically reviewed metal failure patients from initial operation to rehabilitation program, and analyzed the cause of failure and attempted to establish more rational methods of management and prevention. MATERIALS AND METHODS: Seventeen patients of metal failure, treated at Kyungpook National University Hospital from 1989 to 1998, were included in this study. We studied the relationship between the initial site of fracture, type of fracture, time interval of metal failure, configuration of metal failure, probable cause of metal failure, and secondary reconstructive operation for metal failure. RESULTS: Dynamic compression plate was the most frequently (12cases) used implant. The most common site and type of fracture were proximal 1/3 of femoral shaft (8cases) and transverse fractures (11cases). As the configuration of metal failure, breakage of the plate or nail were more common at proximal or distal 1/3 of the shaft. There was no relationship between the time interval of metal failure and the initial site or type of fracture. The most probable cause of metal failure was improper rehabilitation in 6 cases (75%), other causes were another source of external force, inadequate bone support, improper choice of implant and infection. CONCLUSIONS: To prevent metal failure, we must preserve the periosteum and soft tissue, use bone-grafting at the time of treatment and employ cooperative rehabilitation therapy to implement gradual increasing non-weight bearing joint exercise, partial-and full-weight bearing excercise.

Prognostic Factors in Outcome of Operative Treatment of Achilles Tendon Rupture / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to assist the optimal placement of sacroiliac screw by evaluating the anatomic and radiologic features of upper sacrum. MATERIALS AND METHODS: Fourteen fresh-frozen cadaveric pelvises and 13 normal adults were studied for the evaluation of morphology of first sacrum and dysplastic patterns. Measurement of anatomic parameters and CT imaging of pelvis were performed. Thirty-two patients with complicated pelvic fracture were evaluated for detection of variations in the sacral alar anatomy and slope found in upper sacral segmentation. RESULTS: The mean distance between midpoint of sacrum and sacroiliac joint was 52.75 mm. The height of first sacral body was 21.71 mm. The longest antero-posterior distance in sacral alar was 52.36 mm. The mean angle between the coronal plane of S1 vertebra and anterior aspect of the alar was 29.3 degree. The mean angle between the superior aspect of S1 vertebral body and superior edge of the alar was 34.8 degree. The mean angle between the superior aspect of S1 vertebral body and supero-posterior edge of the alar was 12.5 degree. The studies revealed about 28 to 33% of cases as dysplastic sacrum. CONCLUSIONS: We studied anatomic and radiologic features of upper sacrum in cadaveric and clinical cases to gain information on the optimal placement of sacroiliac screw.

Treatment Using Unreamed Intreamedullary Nailing for Closed and Open Tibial Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this paper was to evaluate the treatment results according to bone union, union time, and complications, including infection of unreamed nailing of tibial fractures between closed and open fractures. MATERIALS AND METHODS: We reviewed 64 tibial shaft fractures that were treated with unreamed tibial nail. These included 42 closed fractures and 22 open fractures. RESULTS: Average union time of closed fractures was 19.8 weeks and that of open fractures was 20.2 weeks, nonunion rate were 4/42 and 3/22 in closed and open fractures. Average union time were 19.2, 20.4, 21.3 weeks in open grade I, II, llla fractures. According to the type of fractures, average union time were 18.5, 20.2, 24.6 weeks and nonunion rate were 2/29, 3/26, 2/9 in type A, B, C fractures. According to the level of fractures, average union time were 20.0, 20.3, 19.4 weeks and nonunion rate were 1/5, 4/37, 2/22 in proximal, middle, and distal fractures. There was no significant differences in average period of radiologic union, infection rate and nonunion rate between closed and open fracture group, but longer union time and higher nonunion rate in complex and comminuted fractures (P<0.05). CONCLUSIONS: We consider unreamed intramedullary nailing in the tibial shaft fractures as a good treatment modality for closed and open grade I, II, IIIa fractures

A Clinical Study of Femur Neck Fractures / 영남의대학술지

A clinical analysis was done on 23 patients (24 hips) with fracture of the femoral neck, who had been admitted and treated at our Orthopedic department during the period of 4 years, from Jan. 1984 to May 1988. The results were as follows 1. 23 patients were comprised of 4 males and 19 females, and 11 patients were over 65 years old. 2. 18 cases of 24 cases were due to minor traumas such as slipping down, and for over 65 years old, all cases were due to simple minor traumas, 8 cases were showed a severe osteoporosis, below grade 3 of the Singh's index. 3. 14 cases of 24 cases were displaced subcapital fractures, and 6 cases displaced transcervical fractures. Only 4 cases were the undisplaced transcervical fractures. 4. In treatment of fractures internal fixations after manipulation were performed in 14 cases and primary arthroplasties in 10 cases. Secondary arthroplasties were done in complicated 4 cases of 14 cases treated with internal fixations. 5. Complications after internal fixation were developed in 7 cases out of 14 cases, avascular necrosis in 6, nonunions in 2, pin migrations in 3, and metal failure in 1 case. 6. In 14 arthroplasty immediate surgical fitness of femoral stem were related to late loosening of femoral stem (correlation coefficient γ=–0.68, p<0.01).

Glycogen Contents in Skeletal Muscles in Men and Different Species of Experimental Animals / 대한정형외과학회잡지

The normal values of glycogen contents in skeletal muscles in commonly used experimental animals and men were studied. In addtion, this study was designed to know the relationship between amount of exercise and glycogen content in muscle, and to know the causes of species difference. Glycogen contents were determined in quadriceps, gastrocnemius, and triceps in mouse, rat, rabbit, and man. The results of this study as follows: The value of glycogen content in human skeletal muscle is significantly higher than that of experimental animals. The heavier the body weight of experimental animal, the higher the value of glycogen content in each muscle. The value of glycogen content in gastrocnemius is higher than that of quadriceps. The value of glycogen content in quadriceps is higher than that of triceps.

A Clinical Study on Trochanteric Fractures of the Femur / 대한정형외과학회잡지

A clinical study was done for 103 cases of the trochanteric fractures which were admitted and treated at the department of orthopedic surgery, Kyungpook National University Hospital during the period of 9 yeras from January 1972 to December 1980. Following results were obtained: 1. Of the 103 cases of the trochanteric fractures, 73 cases were in man, with peak age at 6th decade and 21 out of 30 in woman were over 50 years of age. 2. Causes of the fracture were ear accidents in 67 cases and “slip or fall down” in 36 cases. 3. According to the classification of the trochanteric fractures by Boyd and Griffin, most common type was type 11 in 40 cases and followed by type 111 in 27, type 1 in 24 and type 1V in 12. 4. Upon the treatment, 53 out of 103 cases were conservatively treated with Thomas splint and skeletal tractior. Those cases were mostly combined injury on other organs. Open reduction and internal fixation was done on 50 cases with Jewett nail in 48, Zickel nail in 1 and Judet plate with screw in 1. Most of unstable fractures were reduced by Dimon-Hughston method and fixed with Jewett nail. 3. Union of thef ractures ranged from 10 to 16 weeks, average 13 weeks, by open reduction with internal fixation and from 12 to 24 weeks, average 17. 5 weeks, by conservative treatment. 6. Complications were encountered 31% of those cases with conservative treatment and 16% of those cases with operative treatment. Major complicationss after the conservative treatment were decubitus ulcer in 14 cases (27%), coxa vara deformity in 8(16%) and urinary tract infections in 5(10%).

Clinical Study on Fractures of Femoral Neck / 대한정형외과학회잡지

A clinical analysis was done on forty-five patients with fracture of the femoral neck, who have been admitted and treated at our orthopedic department during the period of 6 years, from January 1975 to December 1980. The following results were obtained: Age over 60 comprised 60% of the patients. Male to female ratio revealed no significant difference, being 21 to 24. However, with advancing age, female was affected more frequently than male. The major cause of injuries were “fall or slip down” occuring in 33 patients (73.3%) and “hit by car” in 12 patients (26.7%). Of the 39 patients in whom Garden's calssification of fracture could be applied. Stage II was the most common type occuring in 29 patients (75%), followed by Stage N in 6(15.4%), and Stage 5 in 4 (10%). Of the total 45 cases, forty patients were reduced and fixed with multiple Knowles pins and two patients with Jewett nail. Three patients with neglected treatment of the fracture for over 1 to 4 months were treated with primary replacement arthroplasty of the femur in two and total hip replacement in one. Fractures were united within 3 months in 10 patients (23%), 4 to 6 months in 19 patients (45.2%), and non-union in 2 patients. Relationship between accuracy of reduction using Gardens alignment index and develepment of avascular necrosis was evaluated. Of the 27 patients with reduction in the range of 155 180 in both frontal and lateral views, 3 patients were developed avascular necrosis, and of the 9 patients with reduction of less than 155 in frontal view or greater than 180 in lateral view, 4 patients were developed avascular necrosis.

Anatomical Study Designed to Clarify the Mechanism of the Pivot Shift / 대한정형외과학회잡지

There has been much dispute about the pathomechanics and the significance of the test even among the most competent surgeons in this field. Some have claimed that the posterolateral capsule must be torn to initiate the pivot shift. Some have even gone as far as to deny the importance of the anterior cruciate ligament as a main stabilizing structure of the knee. We evaluated the concept of MacIntosh in anatomical studies which were carried out at the both Pathology and Orthopedic department of Kyungpook National University, School of Medicine, Taegu Korea. Experiments have been carried out to study the etiology of anterolateral instability and the production of a pivot shift sign. In the cadaver knees and A/K amputation knees, which did not have any sign of instability or osteoarthritis, the anterior cruciate was severed by a short medial incision. We could immediately detect a pivot shift. No pivot shift resulted however when the posterolateral capsule was completely divided first and the anterior cruciate left intact, or when the medial collateral ligament and medial capsule were cut. If both the anterior cruciate and posterolateral capsule were divided the pivot shift became more prominent than after cutting the anterior cruciate alone. When the medial collateral ligament including the capsular structures was completely severed, however, the pivot shift disappeared. In summary the experiments show the following: 1. An isolated rupture of the anterior cruciate ligament or its combination with a partial tear of the medial collateral ligament may be detected with the pivot shift sign. 2. If the rupture of the medial collateral ligament is complete the pivot shift test can be negative in spite of a tear of the anterior cruciate ligament.

Talar Tilt Angle(A Comparative Study with Sagittal Mobility of the Normal Ankle) / 대한정형외과학회잡지

The object of this study was to determine the physiological range of talar tilt angle of the Korean and to establish the basis for diagnosis and treatment of the lateral instability of the ankle. The anteroposterior inversion stress view of both ankles was taken in the 108 healthy Korean who had no history of ankle injury or disease. The sagittal stress films were also performed on 96 ankles (48 cases) of these to further define the physiological limits of the sagittal mobility of the normal talus. We compared these two values of normai mobility of talus to deterrnine the significance and relationship of the rwo. The results obtained were as follows: 1) Talar tilt over 10 degrees was seen in only 6 ankles (1.9%) and most of the ankles (279 ankles, 88.4%) showed a tilt less than 5 degrees. 2) Normal talar tilt angle was increased in 30 degrees plantarflexed position than in 90 degrees neutral position of ankle. In 12 cases the value was different between the right and the left; but there was no significant difference between the sexes. 3) The anterior displacement index over 200 was seen in only 5 ankles (5.2%). 4) There was gross positive inter-relationship between physiological. range of talar tilt angle and talar sagittal mobility.

Patella Position in the Normal Knee Joint / 대한정형외과학회잡지

Patella position in the normal knee jolnt has been discussed by many authors such as Boon-Itt 1930, Blumensaat 1938, and Insall 1971. But measure with Boon-Itt's method was so complicated and with Blumensaat's was denied by others due to inefficacy. Insall suggested more simple and clinically applicable method that was based on the fact that patellar tendon is inelastic. Now, we measured 100 healthy Korean knee accordlng to Insall's method. The following results were obtained in the study, 1. The length of the patellar tendon is 4.45 In males, 4.08 In females, and 4.26±0.40 cm. in average. (p<0.001) 2. The length of the patella is 4.51 in males, 4.09 In females, 4.36±0.40 cm. in average. (p<0.001) 3. The length of the patellar tendon (LT) and the dlagonal length of the pattella (LP) are almost same (LT: LP is 0.99 in both males and females, 98% of normal knees are contained within the difference of +20%). Difference above this limit may mean high-riding patella. 4. Blumensaats line on the distal femur doesnt pass the lower pole of the patella but the Iine passes 1 cm. below it in average. 5. The length of the patella (LP) and of the width of the femoral condyles at Blumensaat's line (WCBL) are almost same. When LP is markedly decreased in comparison with WCBL, this case may suggest hypoplasia of the patella. 6. Height of insertion of the patellar tendon (Hl) dlffers among various indlviduals. Its length is cllnically not so significant.

Subungual Melanoma of Left Thumb: A Case Report / 대한정형외과학회잡지

The following case report concerns a rare subungual melanoma of left thumb which metastasized into the ipsilateral axilla. Subungual melanoma, or melanotic whitlow, is a malignant lesion requiring early diagnosis and urgent treatment. Unlike melanomas located elsewhere on the skin of the body, subungual melanomas are shielded by the nails, which handicaps the securing of a biopsy by the clinician. We report a case of subungual melanoma in a 61 year-old man who had a 6 months history of painful axillary mass.

Epidemiology of Traffic Accidents / 대한정형외과학회잡지

A retrospective study has been made of 6,184 cases of motor vehicle accidents which had been reported to Automobile Insurance Co., Taegu Branch, from Jan. 1,1977 to Dec. 31, 1977. It was considered necessary to find out some preventive measures which could be obtained from the epidemiological facts. The aim of this study was not to indicate direct preventive measures but to focus attention on fields in which best results should be given by the preventive measures. Third decade of age group showed the highest numbers of accident casualties, as much as 23%, and preschool age group showed 5%. Casualties showed a maximum during the winter and a minimum during the summer. Highest occurrence of accidents was on Saturday, 17.5% and least on Friday, 11.1%. On working days, highest occurrence was during afternoon and early evening(4 p.m.–9 a.m.), coinciding with the time for home-bound traffic after work and another maximum at an hour before curfew. There was smaller increse in occurrence at the time when people go to work in the morning. Least accidents occurred in the early hours of the morning. In the 2,751 accidents involving dollision between motor vehicles, sustained injuries-i.e;48.1% of the total casualties in passengers in vehicles and a much higher incidence than in accidents involving pedestrians. In accidents involving pedestrians in the urban area, 51.2% of casualties sustained injuries on the street and 39% at pedestrians crossings. Accidents involving collision between motor vehicles and bicycles accounted for 17.2% of casualties in the urban area. Of these, 79.2% were injured in accidents on the street, and in general, the injuries were more serious than those sustained by passengers in cars.

A Clinical Study of the Malgaigne Fractures / 대한정형외과학회잡지

The incidence of pelvic fractures with or without dislocation of the sacro-iliac or symphysis pubis, is continually increasing. Such injuries not only are serious but can result in disabling complications and deaths. The author reviewed 57 cases of Malgaigne fractures treated at the orthopedic department of Kyungpook National University Hospital during the period from January 1978 to December 1977, and analized as to the cause of injury by mechanical forces, type of fracture, average duration for treatment and complications. We have adopted the classification of unstable fractures of Dunn and Morris. The fractures were classified as followes: vertical shear, 11: bucket handle, 8: lateral compression, 6: straddle, 5: total pelvic disruption, 4: dislocation, 3. Twenty-four patients were male thirteen, female. Traffic accident caused the injury in twenty-seven of the patients, accident of mine and factory, each three. Two fell from heights. Frequent associated soft tissue injuries were rupture of bladder (6 patients) and rupture of urethra (10 patients) The principle of treatment consisted of skeletal traction through the lower limb (supracondyle of femur) on the involved side and balance skin traction on the normal side. Pelvic sling were used. In lateral compression type, reduction was obtained by application of lateral skeletal traction with pelvic screw. Traction was continued for eight weeks. After discarding the traction physiotherapy start in bed and continued for further four weeks. Complete reduction of the displaced fragment and an adequate period of immobilization in recumbency is necessary to obtain the best results in treatment of Malgaigne fractures.

Primary Hyperparathyroidism: Report of one case / 대한정형외과학회잡지

Primary hyperparathyroidism is chronic disease which exhibits variable complex of symptoms suggestive of multiple system involvement. The authors have treated a case of primary hyperparathyroidism which was caused by parathyroid adenoma. The patient, 48 years old male, has been complained of back pain and polyarthralgia for five years. Radiologically, subperiosteal resorption along the radial margin of the middle phalanges and disappearance of lamina dura were noticed. In laboratory findings, serum calcium was increased, serum phosphate was decreased and alkaline phosphatase was markedly increased. Parathyroid adenoma was excised under the diagnosis of parathyroid adenoma. Four months after removal of parathyroid adenoma, improvement was noted in clinical feature, laboratory findings and radiologic findings of bone.

Clinical Analysis fo the Postoperative Infection in Traumatic Patients / 대한정형외과학회잡지

Clinical analysis of ths pcstoperative infection has been made on 511 traumatic patients, who had been admitted and operated in Orthopedic Department of Kyungpook National University Hospital during the period from January, 1972 to June, 1975. The following results were obtained. 1. Of the total 511 traumatic patients operated, 39 cases were infected, the infection rate being 7.6%. 2. The infection rate was higher (21.2%) in case of mutiple trauma than single trauma(3.6%) and also higher rate of infection was seen in the open wound(8.7%) than closed one(4.1%). 3. The most frequently involved sites of the trauma were the tibia and the femur occupying 51.9% of the total, and the next were the forearm and hand in decreasing order, but the highest infection rate was seen in the cases with hand injury(11.6%). 4. The incidence of infection was 15.7% in the debrided wound of crushing injury 14.0% in the cases with open fracture, and 4.1% in the closed fracture. 5. In relation to the operating time consumed, the infection rate was 5.0% in the cases of less. than 2 hours but it rose up to 9.4% when operation time exceeded 4hours, suggesting that the longer is the operating time the higher is the infection rate. 6. The infection rate was relatively low in the open wounds operated within 6 hours after injury and also it is low when operation was done within 1 week in case of closed wound. 7. Of the isolated microorganisms, tho coagulase positive staphylococcus was the most frequent offender occupying 33.3% of the total, and was relatively sensitive to kanamycin, vibramycin, and albamycin. The next frequent organism was pseudomonas and was relatively sensitive to gentamicin.

Rentgenographic Analysis of Lumbo-Sacral Spine of the Patients With Low Back Pain / 대한정형외과학회잡지

It has been known that the inducing factors of low back pain are numerous such as songenitaI anormalies, degenerative, traumatic and inflamatory pricess of the spine and its adjacent structures. Despite many relevant literatures upon low back pain, it has been also known that to differentiate causes of low back pain is difficult but very important for treatment. Exclusive of those who had defenite trauma history of spine, 704 cases low back pain in adult, treated at Dept. of Orthopedic surgery Kyungpook University Hospital during recent 3yr & 4 months were reviewed and analyzed by the X-ray findings of lumbar spine. Anterioposterior and Iateral films of lumbar spine were available in each cases but oblique fiIms and myelography was also available as indicated, The results obtained were as follows. 1. The roentgenograms of the spine of 704 cases were reviewed. 494 cases revealed structual changes of the spine. 273 cases were non specific. 2. Of 494 cases reavold structual changes, 273 cases were disease entities, 190 cases were bony abnormalities, and combined cases were 67. 3. Among 273 cases of disease, disc herniation was most common except osteoarthritis(32cases) Tuberculous, spondylolitis, 23cases and pyogenic spondylolitis was 3 cases. 4. Among 257 cases of Bony afnormalities, spina bifida was most common (128 cases). 5. Degenerative changes of the spine was appeared in 3rd. decades (4.8%) and the incidence and severity increased with age. 6. Among 34 cases of multiple abnormalities, 33 cases were combined with spina bifida.

Osteogenesis Imperfecta / 대한정형외과학회잡지

Osteogenesis Imperfecta is a rare affection characterized by fragility of the bones, blue sclerae, and deafness, less frequently by hypermobility of the joints. The etiology is unknown, but it appears to be a mesenchymaldefect. A cases of osteogencesis imperfecta (tarda form) in a 18 yesrs old male is presented with a review of the literatures. The chief complaints were bowing deformity of the all extremites and blue sclera. In this cases, other typical features such as deafness and hypermobility of the joints were not observed. X-ray showed multiple malunited fraeture, of all long bones of extremities except Ieft humerus. For the treatment of bowing deformity of right humerus, multiple corrective osteotomy and intramedullary nailing was performed and the result was good.

A Clinieal Study of Bone Union in Fracture Patients associated with Spastic Paralysis / 대한정형외과학회잡지

Sixty fracture patients (98 fractures) with spastic paralysis due to brain damage have been treated and managed at the Department of Orthopedic Surgery and Neurosurgery, Kyungpook National University Hospital during the 3 years period from June 1970 to June 1973. The authors experenced many problems such as nonunion, malunion which results of spasticity and exuberant callus formation. Up to now, there has been a few literatures regarding in the particular field. They were analysed clinically and the results of this study are as follows: 1. Immobilization of fracture site was unstable due to repeated and continued severe muscle spasm and many cases developed severe deformity which necessitated secondary correction. 2. The cases were handled with conservative or operative method according to the patients condition and less deformities were found in the cases which treated with skeletal traction. 3. Exuberant callus formation was observed very frequently in the healing stage of fractures associated with spastic paralysis. 4. In order to detect of inducing factors of exuberant callus formation, the authors studied blood chemistries including calcium, phosphorus, alkalinephosphatase and acid-phosphatase of the patients but no significant changes were found.

Delayed palsy of Posterior Interosseous Nerve due to compression of the Arcade of Frohse and old anterior dislocation of the radial head / 대한정형외과학회잡지

A cause for spontaneous paralysis of the posterior interosseous nerve has been sought for many years. In recent times an increasing number of reports on this subject has appeared. This paper describes a probable anatomical factor, the arcade of Frohse, in non-traumatic progressive paralysis of the posterior interosseous nerve. Though this arcade, described by Frohse (Frohse and Fraenkel 1908), the posterior interosseous nerve passes to enter the plane between the two heads of the supinator muscle. In this case, the arcade of Frohse may well play in causing progressive paralysis of the posterior interosseous nerve, with old anterior dislocation of the radial head. Paralysis of the muscles supplied by this nerve with no evidence of recovery should be treated by exploration and splitting of the arcade of Frohse.

A Case of Severe Hypersensitivity Reaction to Para-Amino Salicyic Acid / 대한정형외과학회잡지

Hypersensitivity reactions against para-aminos alicylic have been recorded infrequently in the literature. It is the purpose of this report to emphasize the possible occurence of severe reactions which may result in death if unrecognized. The recognition of the early signs and symptoms of a hypersensitivity reaction to antituberculous drugs is all important because serious consequences can ensue from continued administration of the drug after the first sign of a reaction. This case present acute liver failure as part of a generalized hypersensititivity reaction to para-aminosalicylic acid, based on clinical findings liver function test, course and response to cortison derivatives.