Clinical Results of Treatment of Nonunion of Long Bones / 대한정형외과학회잡지

Nonunion is one of the most common complications of fracture and surgical treatment is required for union in most cases. Many kinds of treatment modalities for nonunion have been studied, but above all, rigid fixation of fractured fragments and bone graft have been the most commonly used method. In addition, development of fixation devices and electrical stimulation have contributed to solve the difficult problem on treatment of nonunion. 58 cases of nonunion were examined and treated at the Department of Orthopedic Surgery, Seoul National University Hospital from May 1985 to April 1989 and the results were as follows: 1. The frequently involved sites of nonunion were femur (38%), tibia (24%) and humerus (19 %) in order and the male patients were predominant over the females. 2. Causes of nonunion were the failure of immobilization in 25 cases (43%), soft tissue interposition in 12 cases (20%), and infecion in 11 cases (19%) in order. In the closed fracture nonunion occurred more in patients treated with the operative method, 32 cases (53,6%) than in patients treated with the nonoperative method, 15 cases (36.6%). 3. In all cases that osteosynthesis was attempted, rigid fixation and bone graft were performed with the union rate of 88.7% and the average duration for union of 6.1 months.

Revision Arthroplasty in Acetabular Defect / 대한정형외과학회잡지

It has been established that total hip replacement arthoplasty is one of the most excellent treatment modalities of adult hip joint disease. But aseptic loosening of the acetabular component is a main cause of revision and acetabular defects must be supported to engage the acetabular cup. Many authors have been managed this problem with the various methods of using acetabular ring, bone cement, autogenous or allogeoous bone graft and bipolar endoprosthesis. As the time goes on, it is inevitable that the numbers of revision arthroplasty cases will increase. We observed 36 patients, 39 cases of revision arthroplasty from 1981 and analysed the cases. 27 cases were treated by autogenous lilac block bone to support the acetabular defects. Complete or incomplete iliac block bone was grafted to superior, medial and posterior aspect of acetabulum. Some screws were inserted when they are needed for bone graft fixation. Hip spica casts were applied in 24 cases for 2 or 3 months and crutches were used for about 3 months. Pre-and postoperative hip joint functions by Harris score was increased form average 58.2 to 81.3(23.1 points increment). Sixteen cases were followed up for more than one year and all the bone grafts were united well without bone resorption. We found that autogenous iliac block bone can support the acetabular defects satisfactorily in revision arthroplasty cases.

Treatment of Brachydactyly by Skeletal Lengthening / 대한정형외과학회잡지

Twenty-two skeletal lengthenings were performed on eight patients with congenital or traumatic brachydactyly between February 1983 and June 1987. There were nine metacarpal, nine metatarsal and four proximal phalangeal lengthenings. Two different methods have been used for lengthening : single stage lengthening by intercalary bone graft (19 procedures) and two stage distraction lengthening using external fixator (3 procedures). The mean follow up was 1.7 years. The mean lengthening acheived with single stage lengthening was 12.7mm and the mean overall lengthening was 13.1mm. The mean duration of fixation was 7.8 weeks in single stage lengthening and 15.3 weeks in two stage lengthening. Single stage lengthening is thought to be desirable, because it is simple and more lengthening can be acheived by double level lengthening.

A Comparison of Bone Mineral Density in Korean Between Noraml Population Group and Fracture Risk Group by Photon Absorptiometry / 대한정형외과학회잡지

The mineral content and width of bone can be determined noninvasively by “bone densitometer”, which measures the absorption by bone of a monoenergetic photon beam that originates in a radioactive source(Iodine-125 at 27.3 Kev). The intensity of the beam transmitted by the bone is measured by a scintillation detector. The bone mineral density is obtained from dividing the bone mineral content by bone width. Since Cameron and Sorenson, in 1963, first described the photon absorptiometry, many investigators have studied this method and applied it clinically. In order to determine the bone density of normal koreans, and compare it with that of fracture risk group, we measured the bone density of the distal one third of the nondominant radius in 152 normal persons(55 male, 97 female), and 54 patients(23 male, 31 female) having the risk of spontaneous fracture from the third to seventh decades. This data were also compared with those of normal Caucasians. The results were as follows. 1. The average bone densities(gm/cm2) of normal men from the third to the seventh decades were 0.773 ±0.055, 0.749 ±0.070, 0.770 ±0.060, 0.797 ±0.053, 0.664 ±0.126, respectively and those of normal women were 0.680 ±0.058, 0.680 ±0.036, 0.674 ±0.052, 0.608 ±0.084, 0.523 ±0.093, respectively. 2. The average bone densitied(gm/cm2) of fracture risk men from the third to seventh decades were 0.647 ±0.072, 0.719 ±0.050, 0.729 ±0.085, 0.699 ±0.064, 0.562 ±0.049, respectively and those of fracture risk women were 0.603 ±0.049, 0.061 ±0.021, 0.326 ±0.034, 0.494 ±0.045, 0.430 ±0.035, respectively. 3. There were statistically significantly differences in the bone densities between the normal population group and the fracture risk group. 4. The average bone densities(gm/cm2) of normal koreans were lower than those of normal Caucasians by 0.115 ±0.023 in male, and 0.091 ±0.005 in female. 5. We belive that bone densitometer is an effective tool in early detection and treatment in metabolic bone deseass including osteoporosis.

Study on Basic Culture Method of Tumor Chondrocytes / 대한정형외과학회잡지

In vivo and in vitro culture of rat tumor chondrocytes is a good culture model for physiologic, pathologic and biochemical studies of tumor chondrocytes. Human tumor chondrocyte culture is another method, but it is difficult to maintain a cell line and in vivo culture. So called, Swarm Rat Chondrosarcoma, which wss developed spontaneously in a Spra-gue-Dawley rat and maintained by Dr. R. Swarm, can be cultured in vivo and in vitro at the same time. It is easy to maintain Swarm Rat Chondrosarcoma and is said that there are nearly no notable changes in cellular characteristics during consecutive cultures. In this study, in order to establish the basic culture method of rat tumor chondrocytes, the inoculated tumor mass were studied with swarm rat chondrosarcoma cell line which had been preserved at Orthopedic Research Laboratory of the Msssachusetts General Hospital. In vivo culture, injection of digested 1×10(6) cells, 1×10(7) cells and direct inoculation of tumor of mass were done at each 10 Sprague-Dawley rats group and examination was done at postinoculation 2, 3, 4, 5, 6, 7 and 8 weeks. In vitro culture, 1×10(6)/ml, 2×10(6)/ml and 4×10(6)/ml concentration cell suspensions were plated at 96-well-plate and observed at 2, 3, 4 and S days with inverted microscope. The results of this study are as follows. 1. In vivo culture, the best result was observed at direct inoculation of tumor fragments among 1×10(6) cells, 1×10(7) cells and direct tumor fragments inoculation. 2. The ideal time of obtaining tumor mass growing in rsts is between 4 to 6 weeks after inoculation. 3. In vitro culture, the proper cell density in 96-well-plate was 1 x 10(6)/ml among 1×10(6)/ml, 2×10(6)/ml snd 4 × 10(6)/ml.

A Study on Scoliosis Induced by Resection of Thoracic Spinal Nerves / 대한정형외과학회잡지

Msny clinical and experimental studies trying to elucidate the cause of idiopathic scoliosis have been carried out. There, however, is no established theory to explain it. This paper is aimed at approaching one of various causes of idiopathic scoliosis by producing thoracic scoliosis in growing rabbits with unilateral resection of thoracic spinal nerves. All 43 rabbits were divided into four different groups. The first group(11 rabbits) consisted of rsbbits whose primary anterior and posterior divisions of the unilateral thoracic spinal nerves were resected. The second(11 rabbits) and the third(11 rabbits) were groups of rabbits whose primary anterior and posterior devisions were resected respectively. The fourth(10 rabbits) was the control group. The first group of rsbbits showed the most prominent curvature of the spine. The group of resection of primary posterior division showed less severe scoliosis than the first group but more marked scoliosis than the group of resection of primary anterior division. The biopsy of the denervated muscles included in the scoliosis revealed atrophy. It is concluded from the animal experiments with 43 growing rabbits that unilateral paralysis of the thoracic spinal nerves could be one csuse of iniopathic scoliosis and the primary posterior division of the thoracic spinal nerve contributed to the production of scoliosis more than the primary anterior division.