Operation Fee and Insurance Charge of Hallux Valgus Surgery / 대한족부족관절학회지

PURPOSE: The purpose of this study was to figure out the appropriate and systemic insurance charge for the hallux valgus operations. MATERIALS AND METHODS: 5 Hospitals for hallux valgus operations were analyzed how they have been charging the national health insurance corporation for their operation fees and how to use the estimated guide and authoritive interpretation through the guide book of health insurance medical treatment grant expense and the guide book of Health insurance medical treatment. RESULTS: There are nothing for guiding principle of hallux valgus operations in both books but a guide of Mcbride operation which is approved 'JA-93-KA and JA-31' for operation fee. So majority of hospitals have charged operation fee depending on their own interpretations they like. According to the guide books, there was a authoritive interpretation that simultaneous operation of osteotomy and tendon transfer for cerebral palsy and flat foot can be eatimated as 'osteotomy +JA-93-NA'. CONCLUSION: Distal soft tissue procedure should be approved as 'JA-93-NAx100%+JA-31x50%' according to the the estimated guide and authoritive interpretation if transected adductor hllucis is transfered to first metatarsal head. So distal chevron osteotomy could be 'JA-30-1-RAx100%+JA-31x50%', proximal metatarsal osteotomy could be 'JA-93-NAx100%+JA-31-50%+JA-30-1-RAx50%', first metatarsocuneiform joint arthrodesis could be 'JA-93-NAx100%+ JA-31x50%+JA-73-RAx50%'.

The Modified Brostrom Procedure for Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the surgical results of modified Brostrom procedure for chronic lateral ankle instability and to assess whether or not associated injuries may affect postoperative satisfaction. MATERIALS AND METHODS: Twenty-four patients with chronic lateral ankle instability were evaluated retrospectively from August 1998 to March 2002. Average age was 29.3 years. All patients were performed pre & postoperative ankle anteroposterior and lateral view, stress anterior drawer and varus test using Telos device, MRI and intraoperative arthroscopic evaluations before ligament reconstruction. RESULTS: Of the 24 cases, 23 cases was improved more than average 12 points on AOFAS scales. On modified scales of Hamilton, 3 excellent, 20 good, 1 fair results. On stress view, average 2.2 mm difference was improved on anterior drawer test and average 1.7 degree on varus test. Associated injuries were 8 osteochondral defects, 4 anterior impingements, 2 loose bodies, 2 os subfibulare, 2 os submalleolare and 2 partial ruptures of peroneus brevis. 8 cases with no associated injuries rated excellent or good. CONCLUSION: The modified Brostrom procedure is believed to be an effective and successful method for chronic lateral ankle instability that didn't respond to conservative treatment. Because associated injuries in chronic lateral ankle instability may affect postoperative satisfaction, appropriate detection and treatment may need for postoperative satisfaction.

Selective Microscopic Decompression for Multi-level Lumbar Spinal Stenosis: More than 5 Years Follow Up / 대한척추외과학회지

STUDY DESIGN: A rectrospective study of microscopic lumbar decompressions was performed elderly patients suffering from multiple level of lumbar stenosis. OBJECTIVES: The Purpose of this study were to assess the outcome of this procedure performed only microscopic decompression on multiple lesions in 5 years follow up and to identify the clinical features of the elderly patients with multiple stenosis. SUMMARY OF BACKGROUND DATA: There was a common to perform fusion and instrumentation in spinal stenosis surgery, because of extensive decompression and instability. However the introduction of microscope in spine operation can minimize lesions and the incidence of spinal fusion. MATERIALS AND METHODS: Twenty-one patients were identified as having had a microscopic decompression without arthrodesis, for degenerative lumbar spinal stenosis over 60 years. The follow up period was more than 5 years. The clinical results was evaluated by Low-Back Outcome scale. RESULTS: Ten cases were above good results in two levels involved 14 cases, 4 cases above good results in three levels involved 6 cases, one case above good results in four levels. In the cases of affected duration, 4 of 5 cases in less than 1 year, 8 of 12 cases in 1 to 5 years, 3 of 4 cases in more than 5 years were above good results by the criteria. We had calculated the average score (54.8) and concluded that the long-term outcome of decompressive surgery in the elderly is good. CONCLUSION: Selective microscopic decompression is one of the effective method for the elderly patients or patients with osteoporosis in addition to multiple stenotic lesions. And preoprative root block is also useful for selective microscopic decompression.

Surgical Treatment of Old Radial Nerve Palsy Associated with Nonunion of Humeral Shaft Fractures / 대한정형외과학회잡지

INTRODUCTION: Radial nerve palsy is a fairly common complication of fracture of the humerus. We know that if axonal continuity is not restored within a reasonable period of time, motor end plates and muscle atrophy, distal segments constrict, and sensory reception is substantially less than it was before the injury. So in cases of humeral shaft nonunion associated with complete, old radial nerve palsy, the nerve should be explored with surgical treatment becoming necessary. PURPOSE: The purpose of this study is to compare the results of primary and secondary radial nerve palsy and to investigate the influence of age, delay in nerve surgery, and length of nerve defect on the results of nerve surgery in humeral shaft nonunion associated with complete, old radial nerve palsy. MATERIALS AND METHODS: From March 1985 to March 1996, 32 cases who had complete radial nerve palsy associated with humeral shaft nonunion were treated by various surgical treatments, such as neurolysis or nerve graft for the injured nerve. The ages of the patients studied ranged from 12 to 66 years (average 38.3 years). The interval between operation or trauma that caused radial nerve palsy and nerve surgery ranged from 6 to 23 months (average 10.8 months). The cause of radial nerve palsy were initial trauma in 18 cases and operations for fracture in 14 cases. The practical cause of radial nerve palsy were found by surgical exploration: 13 cases were severe atrophy and adhesion of nerve by surrounding scar tissue, 15 cases were cross section of nerve and 4 cases were entrapment between the site of fracture or by DCP plate. RESULTS: The overall recovery rate of radial nerve palsy was 56.3%. CONCLUSIONS: In the author's experience, the amount of nerve tissue lost and delayed time of surgery causes a more unfavorable prognosis. Early surgery is recommended for radial nerve palsy associated with humeral shaft nonunion.

Skin Island Flaps Supplied by the Vascular Network of the Saphenous Nerve / 대한정형외과학회잡지

INTRODUCTION: Skin defect below the knee joint presents difficult problems, particularly, when combined with fractures, nonunion or osteomyelitis. Many procedures have been described to resurface the defects in this area. Common useful methods include skin graft, local randomized or island flaps and free flaps. But, arterial studies have demonstrated a relatively poor supply that attribute late healing of both soft and bony tissues in pretibial area. So most textbooks have advised against the use of local flaps in pretibial area below the knee for several decades. An anatomic study, which showed the role of the vascular axis which follows the superficial sensory nerves in supplying the skin, developed the concept of a neuroskin island flap. PURPOSE: To present a clinical experience of neuroskin island flaps based on the saphenous nerve, MATERIALS AND METHODS: From September 1995 to December 1997, a total 12 neuroskin island flaps supplied by the vascular axis of the saphenous nerve were performed to close defects in pretibial area below the knee. RESULT: All cases survived completely without any specific complications. CONCLUSIONS: The neuroskin flaps based on the saphenous nerve are versatile and reliable and especially indicated for limited defects in the pretibial area below the knee joint which are not good indications for other better-known flaps.

Electrical Stimulation for Early Axonal Regeneration after Nerve Surgery in Brachial Plexus Injury / 대한정형외과학회잡지

Peripheral nerve injury is relatively common in post-trauma surgery. Although various microsurgical techniques and repair methods can recover the continuity of the injurcd nerve. But, functional recovery achive is difficult. The purpose of this study examines the effect of electrical stimulation on muscle strength or sensibility increase in hrachial plexus injury with clinical results. We have retrospectively analyzed 44 cases of brachial plexus injury. The group(20 cases) which received nerve surgery and electrical stimulation was compared with the group(24 cases) which received nerve surgery only. Electrical stimulation was performed to nerve for axonal regeneration-strength & sensibility(18 cases) and to muscle for strengh(2 cases). All cases had heen evaluated for motor power recovery by 24 months after nerve surgery. A significant difference(P<0.05) between the power of elhow flexion and shoulder abduction, hut not sensibility of forearm in the two groups suggests that electrical stimulation to nerve or muscle enhanced the progress of nerve regeneration or muscle strength respectively. The results suggest that electricai stimulation is promising supplementary method for functional recovery in brachial plexus injury.

The Diagnostic Value of MRI in Traumatic Brachial Plexus Injury / 대한정형외과학회잡지

Exploration of the injured brachial plexus is very hard due to the close approximation with other vital structures and the anatomic complexity. It is essential to identify the exact level and type of traumatic brachial plexus injury (BPI) to decide the appropriate surgical approach for the injury and to infer the postoperative prognosis. However, it can be difficult to image the brachial plexus because of the anatomic properties. The purpose of this study is to analyze the diagnostic value of MRI according to various planes of the level and the type of the traumatic BPI. In sixty patients with traumatic BPI, whose diagnosis was confirmed by clinicopathological and surgical findings, the preoperative MRI films were reread retrospectively. Brachial plexus injuries were divided into two groups of preganglionic BPI and postganglionic BPI, and then postganglionic BPI was divided into 3 subgroups of Zone I, Zone II and Zone III by major adjacent structures such as scalenus anterior muscle and pectoralis minor muscle. The accuracy of MRI was investigated with the confirmed diagnosis on axial, sagittal and coronal planes. In preganglionic BPI, the accuracy of MRI was 96% on axial plane and it was statistically significant compared to sagittal and coronal planes. In postganglionic BPI, the accuracy of MRI was 100% on sagittal plane and 86% on coronal plane in Zone I, but it was not significant statistically. In Zone II and III the accuracy of MRI were 89% and 80% on sagittal plane, and 61% and 60% on coronal plane, but it was not significant statistically. In conclusion, the MRI can provide useful guidance to diagnose preganglionic and postganglionic BPI. Axial imaging is considered better for preganglionic lesion and sagittal imaging for postganglionic BPI, but it demands further study on larger number of subjects with traumatic RPI.

Flexorplasty of Elbow in Brachial Plexus Injuries / 대한정형외과학회잡지

One of the most basic function in brachial plexus injury is the recovery of elbow flexion. So the important purpose in nerve surgery of brachial plexus injury is the recovery of the function of the musculocutaneous nerve. However, failure of the recovery of function of the biceps through surgery or in cases of neglected nerve surgery of more than 1 year needs the consideration of tendon transfer or free vascularized muscle graft. In these failed or neglected brachial plexus injury, flexorplasty is more often indicated because of associated surrounding muscle weakness or paralysis. We analyzed the functional results in brachial plexus injured 12 patients who underwent elbow flexorplasty between June, 1987 and Aug. 1994. In 2 patients, the elbow flexorplasty was augmented by a glenohumeral arthrodesis. The mean length of the follow-up was 52 months. The mean are of active flexion following flexorplasty was 81 degrees. The postoperative active Supination and loss of elbow extension was 40 and 28 degree respectively. At final objective evaluation, 6 patients were judged to have excellent; 2 good; 1 poor; 3 failure. At final subjective evaluation, 3 patients were judged to have excellent; 3 good; 3 failure.

Indirect signs of anterior cruciate ligament injuries at mr imaging

No abstract available.

Avulsion fracture of the tibial attachment of the posterior cruciate ligament treated with screw fixation / 대한정형외과학회잡지

No abstract available.