A case of slipped capital femoral epiphysis developed during growth hormone treatment / 대한내과학회지

Slipped capital femoral epiphysis (SCFE) is the most common orthopedic hip disorder occuring in adolescence. In this condition, the femoral head (epiphysis) displaces, or slips on the femoral neck through the region of the growth plate. This condition can occur only before the epiphyseal plate closes. The exact etiology is unknown, although it has been associated with obesity, hanical abnormalities, physeal abnormalities, endocrine disturbances (hypothyroidism, growth hormone deficiency, hypogonadism). Interestingly, SCFE was observed in growth hormone deficiency and in patients treated with growth hormone. We report a case of an adolescent male with glycogen storage disease Ia and growth hormone deficiency who developed SCFE during treatment with recombinant human growth hormone. A 17-year-old male was admitted for pain of left hip which was exacerbated by walking 15 days ago. He was diagnosed glycogen storage disease Ia and growh hormone deficiency 2 years ago and treated growth hormone therapy with recombinant human growth hormone at the dose of 2 unit/day. The diagnosis of SCFE was confirmed radiologically. From the time of admission, he received skin traction on the left hip joint and stopped to inject growth hormone and treated surgically with internal fixation of the epiphysis with use of 3-cannulated screw. The patient is followed at out-patient clinic without postoperative complication.

A Comparison of Radiographs of the Hallux Valgus and Normal Foot in Women over Forty Years Old on Weight-bearing and Wonweight-bearing / 대한정형외과학회잡지

To investigate changes in the radiographic appearance during weight-bearing in hallux valgus and examine the significance of the weight-bearing view, a comparative study was performed. Both normal and hallux valgus patients, who were all women over forty years old were studied. We reviewed radiographs of 100 normal feet in 50 patients and 70 symptomatic hallux valgus feet in 40 patients. Dorsoplantar radiographs were taken during weight-bearing and nonweight-bearing. Quantifiable angles were identified on dorsoplantar films in both the weight-bearing and nonweight-bearing positions. The measured angles were the hallux valgus angle, intermetatarsal angles between the first and second metatarsals, the second and third metatarsals, the third and fourth metatarsals, the fourth and fifth metatarsals, the first and fifth metatarsals, and the second and fifth metatarsals, and the interphalangeal angle. The hallux valgus angles in both groups were not constant on weight-bearing, whereas the intermetatarsals angle between the first and second metatarsals in both groups increased significantly on weight-bearing. The results show that most of the changes thought to occur with weight-bearing cannot be consistently demonstrated. Obtaining a weight-bearing view may not be routinely indicated in all patients.

Morphometry of Wrist in Korean Adults Using Plain Radiograph / 대한정형외과학회잡지

Currently, many techniques for the diagnosis of carpal disorders have been developed. Plain radiograph is the most simple and low-cost procedure that offers various information on the normal wrist. Nonetheless, a sufficient amount of morphometric database for Koreans has not been studied. In this study, the authors reviewed 100 cases of plain posteroanterior radiograph of the wrist in normal Korean adults for both sexes in order to establish normal databases. Various parameters were measured, and comparisons between the sexes, age groups, foreign databases and other domestic databases were made. The results were as follows. 1. In all measurements of the length and ratio except ulnar variance, there were significant differences between the sexes. But there was no significant difference between the sexes in angular measurements. No significant difference in measurements were found among the groups based on their age. 2. The average ulnar variance was 0.6 mm, and it was higher than Europeans and Americans. 3. The average carpal height ratio was 53.5% and significantly lower in females, but the revised carpal height ratio was higher. This means that the length of the capitate is shorter and the length of the third metacarpal bone is relatively longer in females, if the carpal height is constant. 4. The carpal-radial distance ratio, the carpal-ulnar distance ratio, and the carpal width-carpal height ratio were significantly lower in females. This means that the carpal width is relatively narrower in females. The authors hope that information concerning normal roentgenographic measurements of the wrist can help to diagnose the carpal disorders including the diseases appearing carpal collapse or carpal translation and to design wrist implants.

Re-evaluation of Association between Thrombotic Diasthesis and Legg-Calve-Perthes Disease / 대한정형외과학회잡지

Legg-Calve-Perthes disease (LCP) has been reported to be associated with hypofibrinolysis and a deficiency in coagulation. The goal of this prospective study was to confirm or refute these findings and to establish a guide for a screening test. The coagulation systems of twenty-three patients with Legg-Calve-Perthes disease were evaluated by means of the tests which included prothrombin time, activated partial thromboplastin time, antithrombin-III (AT-III), protein C, protein S, lipoprotein(a), and anticardiolipin antibody (ACA). Study subjects were 21 males and 2 females. Mean age was 8.7 years. No abnormal results were found for Antithrombin-III and Protein S, but 2 patients had low Protein C level. Two of 23 patients had Lipoprotein(a) values greater than 30 mg/dl. Another two patients had positive finding for Anticardiolipin antibody. There were no statistical differences in all parameters between Catterall group stage in the patients with Legg-Calve-Perthes disease. We were unable to establish an association between thrombotic tendency and Legg-Calve-Perthes disease based on this prospective study. So, routine screening of patients with Legg-Calve-Perthes disease for abnormalities of antithrombotic factors would be not warranted.

Cervical and Thoracic Intervertebral Disc Calaification in 6 an Year Old Girl: A Case Report / 대한정형외과학회잡지

Intervertebral disc calcification is rare in children, and known as a spine disease of unknown cause. Since the original description by Baron in 1924, about 200 cases have been reported worldwide. This disease is usually self-limited and responds to a conservative management unless there is an evidence of disc herniation into the spinal canal with associated neural symptoms. We experienced a case of intervertebral disc calcification in a 6-year-old girl and report the clinical and radiographic findings in detail.

Type II Floating Shoulder: Report of 4 cases / 대한정형외과학회잡지

In the literature, the scapular neck fracture with ipsilateral acromioclavicluar dislocation(type I), mid-clavicular fracture(type II) or sternoclavicular dislocation(type III) is defined as floating shoulder. Authors managed 4 cases of type II floating shoulder, 3 cases by open reduction and internal fixation for the clavicular fracture only and 1 case by conservative therapy. The final results were excellent in 3 cases of the operative group and good in 1 case of the conservative group, by UCLA shoulder rating scale. There were no complications, including drooping or limited motion in the operative treatment group. However, there was shoulder pain in the case of the conservative treatment. It is thought that internal fixation for the clavicular fracture only may be the simple and sufficient treatment method for type lI floating shoulder.

MRI Staging of Legg - Calve - Perthes ( LCP ) Disease / 대한정형외과학회잡지

One of the most important prognostic factors in LCP disease is the extent of epiphyseal involvement. Magnetic resonance imaging is considered to be the technique of choice for early diagnosis of Legg-Calve-Perthes disease. Gadolinium-enhanced spin-echo MR images were obtained after nonenhanced Tl-weighted(spin-echo) and T2-weighted(gradient-echo) images. Four different areas were identified in the femoral epiphysis(necrosis, regenerative, cartilaginous and normal fatty bone tissue). The histological evolution of LCP is well described by Catterall and others. Comparing their description with our MRI finding, we suggest classification of LCP into three phases: (I) necrosis, (II) regeneration(IIa-early and IIb-late) and (III) reossification and sequale. T2 weighted image was useful in the early stage and Tl weighted image was useful in the later stage for evaluation of involved extent of the disease. With MRI, we think that we can find out the stage of LCP more early and rationally, pathological factors more easily and appropriate time for operation exactly. we believe that MRI is more adequate method to decide the stage of LCP disease.

Clavicula Pro Humero Procedure for an Osteosarcoma in the Proximal Humerus: A case report / 대한정형외과학회잡지

Osteosarcoma is one of the most common malignant bone tumors except for multiple myeloma. The current managements of the osteosarcoma patients include preoperative chemotherapy, definitive operation and postoperative chemotherapy with tremendous improved oncologic results by lots of Orthopedic Oncologists. The definitive operations are either limb-salvage operations or amputation. Limb-salvage operations include autograft, allograft, tumor prosthesis, or its combination. However, we have a difficulty to use allograft due to Korean traditonal customs. Authors managed the 6 year-old female patient with the osteosarcoma on the proximal metaphysis of the right humerus by wide-margin resection and reconstruction with a clavicula pro humero procedure with an excellent result, which technique was devised and developed by W. Winkelmann in Germany.

Subacute Hematogenous Ostemyelitis in Children / 대한정형외과학회잡지

Subacute hematogenous ostemyelitis is mostly likely due to an altered relationship between host and pathogen, associated with increase host resistance, decreased virulence of the causative organism and/or antibiotics modification. In a retrospective study of the hematogenous ostemyelitis in 156 cases, 19 cases of them were the subacute form of the ostemyelitis. Pain is the most consistent symptom and most of the constitutional symptoms were usually mild. However, the ESR was often elevated. From our data, the following results were obtained. 1. The most common skeletal involvement was the distal part of the tibia(8 out of 19 patients). 2. The causative organism was staphylococcus aureus by the bacterial culture of the specimens. 3. In the literature, acute hematogenous ostemyelitis rarely cross the physis in patients older than 18 months of its age. However, subacute ostemyelitis frequently does cross the physis(5 out of 19 patients). 4. Cross physeal lesions were healed without any permanant damage to the growth plate in our cases(5 out of 19 patients). 5. All patients except for one case were treated by curettage and antibiotics. 6. The mush higher incidence of the cross physeal lesions may be expected by MRI in identifying the lesion. 7. Seven out of 19 patients had radiographic findings similar to eosinophilic granjuloma, Ewing's sarcoma or osteosarcoma.

Buschke-Ollendorff Syndrome: A Case Report / 대한정형외과학회잡지

The osteopoikilosis is commonly known as harmatoma in which metaphyseal and epiphyseal area of long bones and the bone of pelvis, hands, feet and et al, contain islands of dense cortical bone with normal Harversian system without any symptoms. The radiologic findings of the osteopoikilosis is multitude of oval or well-circumscribed areas of increased density, 2 to 10 mm in size, in symmetrical distribution and normal uptake in bone scan. Buschke-Ollendorff syndrome, which is transmitted by autosomal dominant, is characterized by the association of osteopoikilosis and connective tissue nevi which are popular and symmetrically distributed lesions on chest, back, buttock, thigh or arm. Authors report three Buschke-Ollendorff syndrome, studied by CT scan, MRI, bone scan and bone and skin biopsy, among five patients associated with osteopoikilosis found by simple radiologic study from ten members in one family with their pedigree.

Freeman-Sheldon Syndrome: Report of Two Cases in a Family / 대한정형외과학회잡지

Freeman-Sheldon Syndrome is one of the very rare genetic diseases which primarily affects face, hands and feet. At first, Freeman and Sheldon described this syndrome as cranio-carpo-tarsal dystrophy in 1938 and later Burian, as "whistling face" syndrome in 1963. There were 60 cases of reports in the world up to now, and only one paper with 5 cases in a family was reported in Korea. The authors report 2 cases of Freeman-Sheldon Syndrome associated with bilateral inguinal hernias and undescended tests in a family, briefly review the literature and alert orthopaedic surgeons to this condition.

Anterior impingement of the Ankle Treated by Arthroscopic Removal of bony Spur / 대한정형외과학회잡지

From September 1992 to April 1994, we reviewed 7 patients after arthroscopic surgery for anterior impingement in the ankle, who complained ankle pain and limitation of motion. All patients were mem and main symptoms were severe pain at full dorsiflexion of ankle and limitation of motion. Bony spur was located on the anterior aspect of tibia, and it was possible to resect the tibial bony spur arthroscopically without distraction devices. Mean operation time was 55 minutes. Pain, swelling and limitation of motion were much improved. There was no postoperative complication. Arthroscopic resection of the anterior tibial bony spur is an effective treatment for anterior impingement in the ankle.

Chondrocyte allograft transplantation for damaged growth plate reconstruction

The growth plate is responsible for longitudinal bone growth. The problem of repair of damaged growth plate in children has never been adequately solved. The purpose of this study is to investigate the ability of the cultured chondrocyte for the prevention of bony bridge and repairment of damaged growth plate. Chondrocytes were obtained from the new born canine epiphyseal plate and was cultured in high density. Fourteen days later they formed micromass easily removable from the culture flask. Twenty dogs were divided into two groups; in group I, the medial proximal tibial growth plate was destroyed and then cultured chondrocytes were transplanted into the defect, and in group II, the medial proximal tibial growth plate was left in destroyed state. Each left leg was remained as a control. The growth pattern was observed radiographically and histologically until 16 weeks after graft. 4 weeks after the operation, the angular deformity had been observed, and 31 degrees of angulation was noted at the 16th week in group II, while there was less than 8 degrees of angulation and nearly normal growth in most of dogs of group I (8 of 10 dogs). The other 2 dogs had shown 20 degrees angulation. In group II, there was definite bony bridge on the medical proximal growth plate. In group I, initially, the cultured chondrocyte remained as a amorphous cartilagenous mass, but as time progressed, amorphous cartilagenous mass had formed cartilagenous matrix which was proved by Safranin-O staining. Although this study showed the role of cultured chondrocyte as a method of preventation of bony bridge formation and possibility to repair of growth plate, further studies should be done to prove the reconstruction of the growth plate.

Homotransplantation of Cultured Chondrocytes to prevent bony bridge formation and to help repair of the Damaged Growth Plate: An Experimental Study in a Canine tibial model / 대한정형외과학회잡지

The purpose of this study was to investigate the ability of cultured chondrocytes to prevent formation of bony bridge and possibly to repair of the damaged growth plate. Growth cartilage cells were obrained from the new born canine epiphyseal plates and was culture-expanded in high density. It took 14 days until formation of micro mass of cartilage cells which was easily removable from the culture flask. Twenty dogs were divided into two groups: group I (10), the medial side of growth plate of right proximal tibia was destroyed and cultured chondrocytes were homografted into the defect: and group II (10), the medial side of growth plate of right proximal tibia was destroyed and was left as it was. Left leg was served as a control. Serial radiological and histological observation were made until 16 weeks after homografting to determine the growth parrern. Following results were obtained. 1. In group I, 8 of 10 dogs had near normal growth with little angular deformity of the tibia, averaging 8° at post-op 16 weeks. Two dogs had 20° angulation at 16 weeks post-surgery. In contrast in group II, angular deformity was obvious at 4 weeks post-surgery, reaching 31° at 16 weeks post-surgery. 2. In group II, bony bridge was consistently formed on the medial side of the proximal tibia. In group I, the cultured chondrocytes initially appeared to be an amorphous cartiagenous mass, which, however, remained to contribute to matrix formation as time went on. 3. This study showed the ability of cultrued chondrocytes to prevent formation of bony bridge and possibly to repair the damaged growth plate. To prove the effectiveness of homografting of the growth cartilage cells for reconstruction of the growth plat, further studies should be followed.

A Clinical Study of Postoperative Infection in Posterior Spinal Surgery with Pedicle Screw System / 대한정형외과학회잡지

In the treatment of spinal disorder, the introduction of pedicle screw system is an innovation in modern spinal surgery. This kind of new instrumentation provides correction, adjustment, stabilization, firm fixation and short segment fusion. Everybody should know that these complexities of instrumentation will increase the rated of complications, especially postoperative infection. Postoperative infections continue to be a source of frustration for patients and surgeons, and can lead to significant postoperative difficulties. So we analysed the postoperative infection from the 284 cases we operated on during the September 19S8 to August 1992 and obtained following results: 1. There were 17 cases(6.0%) of postoperative infection. Among them Scases(2.8%) were deep infection. 2. Average fused segments were 3.64 and 2. 96 in deep infection and control group respectively. 3. Staphylococcus aureus was the most frequent organism. Other recurring organisms were St. epidermidis, Enterobacter cloacae and so on. Many patients had multiple organisms. 4. Most significant risk factors for postoperative infection were obestity and prolonged surgery. 5. Just preoperative prophylactic antibiotic administation is more valuable than no prophylaxis and too early administration. 6. Postoperative acute deep infection is is not as easily diagnosed. The clinical manifestation such as sudden increase in pain at the operative site is the most valuable sign. 7. Maintaining the instrumentation in place, continuous irrigation system and the appropriate parenteral antibiotics were the choice of treatment.

Chemonucleolysis using Chondroitinase ABC: An Expreimental Study / 대한정형외과학회잡지

Chymopapain and collagenase are well known chemonucleolytic agents for lumbar disc herniation. However, these enzymes have serious problems occasionally, such as severe neurotoxicity or anaphylaxis even fatal to patients. Chondroitinase ABC, a metabolic product of Proteus vulgaris, has a specific action on the proteoglycans of the nucleus pulposus, but rarely no effect on the intrathecal nerve tissues of vessels. Seventy eight rabbit lumbar discs were evaluated radiographically and histologically after injection of chondroitinase ABC 40U/ml per disc and compared with buffer injected group and nonigected control group. There was considerable disc space narrowing of the chondroitinase ABC injected group which was verified radiographically and histologically(p < 0.01). A zone of Safranin 0 depletion was present in the ventral anulus fibrosus adjacent to the nucleus pulposus in all treated discs, indicating proteoglycan loss. On electron microscopic findings there were collapse of chondrocytes and notochordal cells. All of these findings are corresponding to the evidence that chondroitinase ABC may be another chemonucleolytic agent by decreasing disc volume and thereby decompressing spinal cord or nerve roots. All histologic effects of chondroitinase ABC were confined to intervertebral disc tissues. Chondroitinase ABC deserves to be a study object for the alternative of chemonucleolysis.

Arthroscopic meniscal repair: A clinical review / 대한정형외과학회잡지

No abstract available.

The clinical findings of the knee joint tuberoulosis and treatment with synovectomy for preservation of the knee joint motion / 대한정형외과학회잡지

No abstract available.

Intradural extramedullary myxopapillary ependymoma in filum terminale: A case report / 대한정형외과학회잡지

No abstract available.

Rotational remodelling of femoral fracture: experimental study in puppies / 대한정형외과학회잡지

No abstract available.