Posterior Interosseous Nerve Syndrome: Report of 4 Cases / 대한정형외과학회잡지

Entrapment of the posterior interosseous nerve is an uncommon syndrome characterized by an inability to extend the fingers and thumb. This entity bas become recognized increasingly since reported in 1966 by Capener and Muholland et al. The pathogenesis could be explained as an anatomical basis. And various cases were reported that trauma, local swelling, inflammation, postural and iatrogenic factors were concerned with the causes. In recent 4 cases of posterior interosseous nerve syndrome were experienced at Busan National University Hospital and following result were obtained.1l. Arcade of Frohse, fibrous band, recurrent radial artery are important compressive factors. 2. Surgical decompression led to an effective cure. 3. Tendon transfer is indicated after severe degenerative change.

A Clinical Study on Hematogenous Osteomyelitis in Children / 대한정형외과학회잡지

Although antibiotics have greatly improved the results of treatment of hematogenous osteomyelitis, hematogenous osteomyelitis in children is still complex and difficult disease by which severe deformity and disability may result. A retrospective clinical study of 44 cases of hematogenous osteomyelitis in children was done at Department of Orthopaedic Surgery, Busan National University Hospital from January 1980 to February 1985. The results were as follows: 1. The ratio between males and females was 2.1: 1, and the prevalent age gmup was from 11 to 15 years. 2. The common sites of involvement were femur and tibia in orders. 3. At initial surgical treatment, fenestration in acute stage and saucerization in chronic stage were commonly performed. And at surgical wound management, primary closure with closed continuous irrigation was most frequently performed. 4. Children with acute clinical presentations tended to have more unsatisfactory results, probably because of delay of diagnosis and treatment, simple soft tissue drainage at initial surgical treatment, secondary closure at surgical wound management and inadequate parenteral antibiotic therapy.

Clinical Observations of Internally Fixed Supracondylar Fractures of Humerus in Children / 대한정형외과학회잡지

A supracondylar fracture of the humerus is the most common fracture of the elbow in children, and it may also be one of the most difficult fracture to treat. To obtain a good result after a supracondylar fracture of the humerus, an accurate reduction is needed. This region of humerus is very thin, and even if reduction is obtained it may be unstable. 104 children with 104 supracondylar fractures of the humerus were managed at the Department of Orthopedic Surgery, Busan National University Hospital from Jan. 1979 to Dec. 1983. Of 104 patients, 48 cases which fixed internally were reviewed and following results were obtained. 1. The average age was 7.6 years, ranged from 18 months to 15 years, and 68.8% were bodys. The left humerus was affected in 58.3%. 2. In type of fracture, extension type was 95. 8%. Type II was 12 cases (26.1%), Type III 22( 47.8 and Type IV 12 (26.1%). Posteromedial displacement was 75% (35 cases). 3. Average loss of motion was 11.9°, and change of carrying angle was 5.1° In change of range of motion by the final follow-up date, during 3 to 6 months that was relatively high by 37.5°, and then the change was improved. During 2 to 5 years the change was 5. 6°, and 1 to 2 years that was similiar to the whole average by 11.7°. 4. By the modified Mitchell & Adams criteria for grading results, excellent were obtained in 30.4%, good in 45.3% fair in 10.0% and poor in 6.3%. Namely, satisfactory was 93.7% and unsatisfactory was 6.3%.

A Study on the Changes of the Femoral Head following Treatment of Congenital Dislocation of the Hip / 대한정형외과학회잡지

Although the incidence of avascular necrosis of the pmximal end of the femur has declined by early diagnosis and gentle dynamic reduction, it is still one of the major complication in treatment of congenital dislocation of the hip. From 65 cases, followed up at least one year after reduction at the Department of Orthopaedic Surgery, Busan National University Hospital from January, 1980 to June, 1984, the authom studied the factom causing avascular necrosis of the femoral head and its radiographic classification. The following results were obtained. 1. Based on Salter's criteria, avascular necrosis of the femoral head was considered in 16 of the 65 hips, a rate of 24.6%. 2. Based on the classification of Bucholz and Ogden, radiographic patterns of avascular necrosis were: type 1, 6(37.5%); type 2,3(18.8%); type 3, 5(31.3%); type 4, 2(12.5%). 3. Generally, the older the child when treatment was initiated, the more likely was avascular necrosis to develop, and the more severe was its damage. 4. The incidences of avascular necrosis in various treatments were: Pavlik harness, 10%; manipulative reduction, 17%; medial approach open reduction 40%; Salters innominate osteotomy only, 36%; femoral osteotomy with pelvic osteotomy, 20%. The high incidence in medial approach open reduction and Salters innominate osteotomy may be due to failure of previous manipulative reduction. 5. The preliminary traction of 14 days or more substantially reduced the incidence of avascular necrosis. 6. There was particularly high incidence of avascular necrosis in cast immobilization of Lorenz position. 7. The correlation between adductor tenotomy and avascular necrosis was not noticed. There was no avascular necrosis in the normal contralateral hip after cast immobilization.

The Treatment of Humeral Shaft Fracture by Functional Bracing / 대한정형외과학회잡지

The recent trend in method of long bone fracture had been toward bracing or closed medullary nailing except for certain fractures that fall within well-established surigcal criteria. Functional bracing is gaining widespread acceptance in management of tibial, femoral, and forearm fractures and is well suited to humeral shaft fractures. Twenty four cases of humeral shaft fractures were treated with functional brace and early mobiliza tion from October 19S2 to June 1984 at Busan National University Hospital and the results were as follows. 1. The fracture sites were composed of middle third in 15 cases, distal third in 6 cases, and proximal third in 3 cases and the fracture shapes were transverse in 10 cases, oblique and spiral in 5 cases respectively, and comminuted in 4 cases. 2. The average time from injury to functional bracing was 13.0 days and to discontinuance of the functional brace was 9.0 weeks. 3. Nonunions have not been encountered in all cases. The residual angulation was under 20degrees in all but one and the most common deformity was varus in 20 cases. Minimum limitation of motion, mostly a loss of the last few degrees of external rotation, was detected after follow-up of 2 months but did not present any clinical problem. 4. The achievement of rapid and uninterrupted osteogenesis without undesirable functional or cos- metic deficit could be listed as the advantage.

The Clinical Observation on Acetabular Fracture / 대한정형외과학회잡지

The clinical observation was performed on 32 patients of acetabular fracture, who had been admitted and treated at Department of Orthopedic Surgery, College of Medicine, Busan National University from January 1980 to December 1983. The results obtained were as follows. 1. The prevalent age ranged from 20 to 50 years, which comprised 71.9% and the ratio between males and females was 2.6: l. 2. The causes of injury were 16 cases of traffic accident, which comprised the highest incidence, 10 falling down and 6 direct blow. 3. According to Letournels classification, 21 cases (65.6%) were simple fractures, llcases(34.4%) were associated fractures. 4. Total patients associated injuries of another part of body were 24 cases#{75.0%) among them pelvic bone fracture was the most common fractured case and cerebral concussion was the most common soft tissue injury. 5. 2 types of treatment were performed, one was 18 conservative treatment and the other was 14 surgical treatment which was performed by open reduction and internal fixation. 6. The satisfactory result of conservative treatment was 61.6% and surgical treatment was 85.7. 7. The complications were 7 cases(21.9) of degenerative arthritis, ectopic ossification in 2cases (6.3%), avascular necrosis, superficial infection, and secondary displacement of fracture site in 1 case(3.1%) respectively. 8. The anatomical reduction and internal fixation was an important factor in treatment of acetabular fracture, especially in severe displaced articular fracture.

A Clinical Observation on Spinal Stenosis / 대한정형외과학회잡지

A clinical observation was made on 35 patients who were admitted to the Department of Orthopedic Sugery, Busan National University Hospital, 29 of whom had undergone operation from January 1979 to December 1983. The results obtained were as follows: 1. The peak incidence of age ranged from 51 to 60 years, which comprised 16 cases (45.7%) 2. The type of theDisease'were 15 cases with degenerative spinal stenosis, which comprised highest incidence, 11 cases with combined spinal stenosis, 6 cases with spondylolisthesis, 2 cases with idiopathic spinal stenosis and 1 case with iatrogenic spinal stenosis. 3. The duration of symptom before admisson ranged from 3 months to 20 years. Duration over 3 years comprised 54.3% of highest incidence. 4. The most common symptom on admission was pain in low back and leg, which comprised 31 cases (88.6%) and 4 cases had no specific neurologic deficit. 5. Myelogram was performed in 30 cases, C.T. scan in 7 cases and the most common myelographic finding was bilateral single level hour glass defect in 8 cases (26.7%). 6. Decompressive surgerys were done on 30 cases and post-operative results obtained were as follows: excellent in 11 cases (36.7%), good in 13 cases (43.3%), fair in 4 cases (13.3%) and poor in 2 cases (6.7%).

Rhabdomyosarcoma of the Lower Leg in Newborn / 대한정형외과학회잡지

Rhabdomyosarcoma which was first described by Weber has generally been considered an uncommon tumor of striated muscle. Recently it was classified as four types as embryonal, alveolar, pleomorphic, and botryoid type by Horn and Enterline. A fourth type, sarcoma botryoides was generally recognized as a variant of the embryonal type. Al1 of these tumors tend to have a short clinical course, but the survival time seems to be slightly improved by sugical excision followed by radiotherapy and chemotherapy. Authors report one case of rhabdomyosarcoma, which was seen in the right lower leg and showed a rapid growing nature to die, which experienced in Busan National University Hospital, February, 1983.

A Clinical Study on Isolated Posterior Cruciate Ligament Injury of the Knee / 대한정형외과학회잡지

The posterior cruciate ligament has been considered the basic stabilizer which performs important functions because of its location and orientation within the knee joint. Therefore, failure to recognize or to repair its tear results in a poorly functioning knee. An isolated injury to the posterior cruciate ligament is believed to be unconmon and is seen most commonly in association with other ligamentous injury and dislocation of the knee joint. But recently its injuries are of frequent occurrence because of increasing traffic accident and sports activities as football, soccer, and skiing. The authors experienced 12 cases of isolated posterior cruciate ligament injury from March, 1978 to February, 1982 at the Department of Orthopaedic Surgery, Capital Arrned Forces General Hospital and the results were as follows: 1. The most common cause of injury was passenger traffic accident (5 cases) and followed by soccer (4 cases), football (2 cases), and skiing (1 case). 2. There were 3 causative mechanisms by which the posterior cruciate ligament was injured; anteroposterior force on the front of the knee joint (5 cases), hyperextension of the knee joint (4 cases), and posteriorly directed rotatory force (3 cases). 3. Tears of the posterior cruciate ligament occured at its tibial attachment (5 cases), with avulsion of a bone fragment at its tibial attachment (3 cases), at its femoral attachment (2 cases), and its mid-portion (1 case). 4. The major findings in this injury included giving-way or instability on walking, abrasion or contusion over the anterior proximal tibial surface, presence of a posterior drawer sign, sagging of the tibia, bloody effusion, and X-ray evidence of avulsion fracture. 5. One case was treated conservatively and 11 cases surgically using screw fixation and direct or pull through suture through a posterior S-shaped incision (5 cases), medial parapatellar and posterior S-shaped incision (3 cases), and medial hockey-stick incision (3 cases) and were immobilized in a long leg cast with 30 to 45 degrees of the knee flexion for 6 to 7 weeks. 6. The results evaluated by Apleys method were excellent in 8 cases; good in 2 cases, and fair in 2 cases.

Treatment of Lower Limb Fractures by External Skeletal Fixator Preliminary report / 대한정형외과학회잡지

A consensus of current surgical practice favors external skeletal fixation in the patients with open fractures, where it can be difficult to achieve a good position and fixation by the usual methods and ipsilateral multiple fractures where it is desirable to avoid prolonged immobilization of adjacent joints. From March, 1979 to December, 1981, 34 patients with lower limb fractures were treated by the method of external skeletal fixator. 22 patients had open comminuted fractures with extensive soft tissue injuries and 12 patients had multiple fractures which were difficult to reduce and maintain in alignment. In the 30 patients which could be assessed, the final result was excellent or good in 23 patients, acceptable in 5 patients, and poor in 2 patients.

Stress Fractures in Pubic Bone: Report of 3 Cases / 대한정형외과학회잡지

The occurence of stress fracturea at sites such as the metatarsal, tibia, fibula, and femur in military trainee and certain other very physically active groups has been reported frequently, but literature regarding stress fractures of the inferior pubic ramus has been very sparse. Authors spresent 3cases of stress fracture which was found in inferior pubic ramus in the newly recruited soldier in training corps; 1 case unilaterally and 2 cases bilaterally.

Clinical Observation of Acute Suppurative Arthritis of Hip in Children / 대한정형외과학회잡지

The authors did clinical analysis of 34 cases of suppurative athritis of hip for period of three years from Jan. 1973 to Jan. 1976 at Dept. of Orthopedics, Catholic Medical Center. Through this study following results were obtained. 1. Most of the patients were under the age of 6 years including twenty-six males and eight females. 2. Lag period to treatment in 10 cases was within 3 days, 14 cases within a week: most of these series were treated within a week. 3. Frequent clinical symptom and signs were pain on hip 34 cases, fever 30 cases, limited motion of hip 24 cases and flexion contracture 8 cases. 4. Causative micro-organism was isolated in the cases of diseased hip: Staphylococcus aureus in. 24 cases, β-hemolytic streptococcus in 8, pneumococcus 1, and Gram positive bacillus 1 cases. 5. The laboratory findings included leucocytosis over 15,000 per mm in 31 cases, increased erythrocyte-sedimentation rate 15mm per hour in 33 cases. All the cases were leucocytosis with increased ESR but. 5 were only increased ESR. 6. In authors experience early incision and drainage with specific antibiotics were a choice of treatment in the acute supprative arthritis of hip 7. Result become progressibly less satisfactory in proportion in the length of time after onset at which treatment is started. a) When sufficient time has elapsed for adhesion to develop the pocket to the head thus can not be drained properly by the active movements. Indeed, it is possible, that may be actually harmful in promoting absorption from such pocket. b) In case of long standing erosion of cartilage with denuded bone areas hinder or prevent efficient active movements. c) In case of long duration, blood stream infection is an ever present danger, as well as a aggrevation of existing organic disease by the infective process.