A Predictive Method for the Femoral Head Necrosis by the Observation of the Bleeding from the Cannulated Screw in Patients of the Femoral Neck Fractures / 대한정형외과학회잡지

PURPOSE: The aim of this study was to examine the validity of using cannulated screws as a method for predicting avascular necrosis of the femoral head after a fixation of fractures in patients with femoral neck fractures. MATERIALS AND METHODS: Between March 1999 and January 2001, 44 patients with a femoral neck fracture that had been fixed with cannulated screws were enrolled in this study. The follow up period was more than 25 months and the mean age of the patients was 51 years (range, 18 to 76 year). Blood drainage in the holes of the screw head was checked. There were 38 cases in the bleeding group, and 6 cases in the non-bleeding group. The development of head necrosis was evaluated using plain radiography. The validity of the relationship between the two groups and head necrosis was evaluated by the sensitivity, specificity, the positive predictive value, and the negative predictive value. RESULTS: An avascular necrosis of the femoral head developed in 7 cases (16%). Only one of the 38 patients in the bleeding group developed head necrosis (2.6%). However, all those in the non-bleeding group developed head necrosis (100%). The sensitivity was 86%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 97%. CONCLUSION: Bleeding from holes in the cannulated screws is a simple and accurate perfusion assessment for predicting the development of an avascular necrosis of the femoral head after a femoral neck fracture.

Recovery of Motion Fraction and Shoulder Function ofter Operative Treatment of Shoulder Instability / 대한정형외과학회잡지

PURPOSE: We expected the motion fraction could be checked, with simple radiographic examination, according to the guide-line of fluoroscopic technique, and recovery of the function also could be correlated with the improvement of the motion fraction. MATERIALS AND METHODS: We measured the motion fraction of the glenohumeral and scapulothoracic movement using fluoroscope in 30-degree intervals of arm elevation in the scapular plane. The ratio of glenohumeral to scapulothoracic movement (thetaGH/thetaST) was 1.6 for the full range of motion in scapular plane. During arm elevation, scapular tilting from the coronal plane was decreased from 42 degrees to 20 degrees tilting as well as internal rotation (scapular extension). We also measured the motion fraction (thetaGH/thetaST) and functional recovery of the shoulder in 11 patients after operative treatment of the shoulder instability in 15 patients from December 1996 to August 1997. RESULTS: We could find out a significant correlation between the recovery of motion fraction and shoulder function. These results would be applied in planing rehabilitation program after treatment of the shoulder instability. CONCLUSIONS: The measuring technique of glenohumeral to scapulothoracic movement (thetaGH/thetaST) with fluoroscopy could be applied to the simple radiographic measurement at the out-patient clinic in order to identify the pathology and recovery of shoulder motion after treatment

Surgical Treatment of Postencephalitic Epilepsy

Encephalitis is often followed by chronic intractable epilepsy. Many of these patients pose significant challenges to the localization of seizure generators and to the strateges for management of intractable epilepsy. The authors analysed 17 patients with postencephalitic epilepsy(PEE), who underwent resective surgeries. Most patients had been accompanied by coma, convulsive status epilepticus, and focal motor deficit at the time of encephalitis. MRI studies showed variable degree of brain damage: hippocampal sclerosis only(n=5), neocortical gliosis only(n=6), and both(n=5). Analysis of ictal semiology revealed a predominant temporo-limbic seizure pattern in 7, a variable extralimbic patterns in 6, and unclassified in 4 patients. Surgical resection includes temporal(n=11), frontal(n=3), centroparietal(n=1), multilobar(n=2), and callosotomy(n=2). Surgical outcome was graded as class 1(n=8), class 2(n=2), class 3(n=4), and class 4(n=3). It is concluded that surgical result was promising despite the traditional concerns about localizing problem in the setting of PEE. Surgical treatment should be, therefore, considered if localizing information is persistent. Intracranial EEG recording was very useful to delineate the area of seizure onset. MRI abnormalities were not always correlated with ictal onset zone in the patients with PEE.

Efficacy and Complication Rates for the Ilioinguinal Approach to Fractures of the Acetabulum / 대한정형외과학회잡지

To evaluate the efficacy and the complication rates of the ilioinguinal approach for satisfactory reduction in complex acetabular fracture except for poserior wall or column fractures, twenty consecutive patients undergoing ilioinguinal approach for open reduction with internal fixation of acute, displaced fracture(3/89-10/93) were reviewed. There were six elementary and fourteen associated fracture patterns. Two among them were open fractures. Fifteen were male and five female with a mean age of forty-four years. three patients those associated with a comminuted quadrilateral plate required to buttress the medial wall with a spring plate modified from a one-third tubular plate as a part of reconstruction plates assembly. Indirect reduction of the involved and opposite column was achieved mainly with lateral traction through the great trochanter. Two patients with associated fracture pattern needed to undergo combined anterior and posterior approach. A satisfactory reduction(concentric, gap < 3mm, step-off < 2mm) was obtained 85% of the cases. There were four kinds of perioperative complications: transient sciatic nerve palsy(one after double incision), hematoma(one), loss of fixation(one), lateral cutaneous nerve of thigh injury(two). There were no infections and functionally significant heterotropic ossification. In conclusion, the morbidity of an extended surgical approach previously recommended for complex acetabular fractures can be avoided.

Functional Evaluation of Tumor Prosthetic Arthroplasty for the Malignant Bone Tumor around the Knee: Interim Report / 대한정형외과학회잡지

With the recent development of tumor prosthesis, limb salvage technique has attributed to the preservation of the limb function in patients with malignant bone tumors around the knee without substantial difference of local recurrence and the survival rate. From Feb., 1991 to Sep., 1992, 9 patients were treated with limb salvage operation with total knee arthroplasty due to the malignant bone tumor around the knee at Dept. of Orthopedic Surgery, Kyungpook National University Hospital. We applied the above procedure mainly to young adult whose tumor was expected to be excised wide marginally without damaging major neurovascular structures. We evaluated the functional status of all 9 patients(4 osteosarcoma, 2 chodrosarcoma, 2 malignant fibrohistiocytoma, 1 malignant giant cell tumor) to estimate the efficacy of limb salvage operation with tumor prosthesis total knee arthroplasty. Mean follow up period was 10 months. Primary tumor site was 4 in distal femur, 5 in proximal tibia and stage was 4 IIa, 5 IIb. Range of the motion of knee is maximum 0°

Clipping of Funsiform Aneurysm at the Mid-baslar Artery Trunk

No abstract available.