An experimental comparison of old degenerated nerve autografts with fresh nerve autografts in rats / 대한정형외과학회잡지

No abstract available.

Clinical Study of Steroid Induced Side Effects in Orthopedic Field / 대한정형외과학회잡지

Clinical study of 40 cases who have used steroid preparations was done during past 6 months from March 72 to September 72. 1. The youngest patient was twenty, the oldest seventy-four and the average fifty-two. Eighty percent was included between from 41 to 70 year of age. 2. And the sex ratio was 1:4.7. 3. Diagnostic incidence was 47.5% in degenerative arthritis and 40% in rheumatoid arthritis. 4. The causes of administration were multiple joint pain (35%), lumbago (27.5%) and pain on knee joint (25%) in order. 5. Prednisolone (60%), dexacortisil (25%) and dexamethasone (12.5%) were used in 97.5%. 6. The source of steroid was drung store (95%) or doctor (5%). 7. The time from first dose to last dose was less than 1month (20%), 1–3 month(10%), 4–6 month (7.5%) and more than 1 year (52.5%). And 3 cases have used for more than 5 years, 8. Eighteen cases (45%) used steroid continuously and 22 cases (55%) irregularly. 9. Transient effectiveness was experienced in 92.5% with steroid administration, that was one of the causes of steroid usage without doctor's prescription. 10. The side effects were as follows; moon face (62.5%), ulcer (20%), fat deposition (15%), osteoporosis (15%), peripheral edema (10%), elevation of blood pressure (7.5%), malar flush(7.5%), vertebral compression fracture (7.5%), obesity (5%), psychotic change (5%), pyogenic arthritis (5%), diabetes (2.5%), sepsis (2.5%), adrenal insufficiency (2.5%), avascular necrosis (2.5%) and stress fracture of femur neck (2.5%).

The Effect of Orthopaedic Operations upon Postoperative Arterial Oxygen Tension / 대한정형외과학회잡지

To 48 adult patients general and spinal anethesia was administered for elective orthopedic (intra-thoracic and extremity) and abdominal(general and gynecological) operations. Radial artery was cannulated and postoperative change of PaO2 was observed for 7days. The results are as follows: 1) General anesthesia administered for operations on the legs results in a reduction of PaO₂ which is maximal immediately after discontinuation of anesthesia, gradually returns toward normal in a 3-hour period, and becomes normal on the first postoperative day. 2) General anesthesia administered for thoracomy and laparotomy is followed by the same early changes, which do not return toward normal in the first 3 hours. Reduciton of PaO₂ persists, and PaO₂ continue to deteriorate for several days, not completely returning to normal even 7days post-operatively. 3) When spinal anesthesia is administered for laparotomy, PaO₂ does not begin to fall untill several hours after the end of operation. The subsequent course follows as that in 2, above. 4) When spinal anesthesia is administered for operation on the legs, PaO₂ does not change significantly throughout the postoperative period. 5) Thus, it is concluded that late forms of postoperative hypoxemia is influenced primarily not by the method of anesthesia, but by site of operation.

A clinical observation of congenital dislocation of the hip / 대한정형외과학회잡지

Early diagnosis and treatment of congenital dislocation of the hip is the only means of obtaining good results with consistent regularity. But a large number of congenital dislocation of the hip remain undiagnosed before the child begins to walk. One hundred and nine cases of congenital dislocation of the hip had been clinically diagnosed and 48 cases of them were treated conservatively or operatively at Department of Orthopedic Surgery, College of Medicine, Seoul National University from January, 1965 through September, 1975 with following results. 1. Among 109 cases of congenital dislocation of the hip, 48 cases were admitted and treated. In recent 10 years the number of the out-patient was increasing. 2. The preponderance of female to male (4:1) was found. 3. The age ranged between 3 months and 24 years, and 46 cases (42%) between 12 and 24 months. 4. In most cases the chief complaint was limping. 5. The associated congenital anomalies were observed in 3 cases of the series, comprising two cases of arthrogryposis multiplex congenita and one case of hydrocephalus. 6. The scetabular index was increased in affected hip. 7. The ratio of unilateral cases to bilateral ones was 100: 9, and right to left was 47: 53. 8. Closed reduction was satisfactory in 25 cases under 2 years of age. 9. Open reduction was necessary in 18 cases of failed closed reduction and 5 cases of redislocation. 10. Eleven cases of Salter's operation, 4 cases of Pembertons operation, 2 cases of Colonnas operation, and 8 cases of derotational osteotomy were performed to increase the stability of the hip joint.

Pulmonary Function in Spine Deformity / 대한정형외과학회잡지

The deformed and rigid spine presenting moderate to severe kyphosis and scoliosis results in a restriction of function of the lung best characterized spirographically by a reduction in vital capacity. When the lesion involves the thoracic spine, restriction of function is more marked. Spinal deformities such as kyphosis and scoliosis develop from various causes. Tuberculous spondylitis, a main cause of kyphosis and scoliosis, is increasingly found in Korea. Cardiorespiratory dysfunction caused by spinal deformity poses another problem besides the spinal deformity perse. To perform therapeutic measures such as Harrington instrumentation, with or without preoperative localizer cast and halofemoral traction, as well as anterior interbody fusion, evaluation of pulmonary function and arterial gas analysis preoperatively is helpful to prevent and reduce postoperative cardiorespiratory failure or complications. The authors have reviewed the results of arterial gas analyses and pulmonary function tests on 35 cases of scoliosis and 60 cases of kyphosis done at the Department of Orthopedic Surgery, Seoul National University Hospital, from January 1975 to February 1978. The results were as follows: 1. Average degree of scoliosis in 35 cases was 89; vital capacity 60% of normal, and maximum breathing capacity 72%. Average degree of dorsal spine kyphosis in 38 cases was 93.5; vital capacity 38%, and maximum breathing capacity 73% Average degree of lumbar spine kyphosis of 22 cases was 79; vital capacity 77%, and maximum breathing capacity 84%. 2. Static values for pulmonary function such as vital capacity and dynamic values such as maximum breathing capacity hed a significant negative correlation with the severity of scoliosis and kyphosis. 3. Decrease in vital capacity due to scoliosis and kyphosis correlated positively with decrease in maximum breathing capacity. 4. Arterial oxygen saturation had a significant negative correlation with the severity of scoliosis and kyphosis.

Experimental Study on Tissue Fluid Influenced by Antibiotic-Acrylic Bone Cement Composite / 대한정형외과학회잡지

Failure of total joint replacement is often due to infection. Many efforts have been made to reduce the rate of infection. The use of antibiotic-acrylic bone cement composites for the preventlon and treatment of infection after joint replacement surgery has been advocated. Early reports of clinical success using bone cement containing antibiotics are encouraging, but different results of antibacterial effect of antibiotic-acrylic bone cement were reported in vitro and in vivo studies. The purpose of this experiment is to determine the effectiveness of bone cement itself on bacterial growth, stability of antibiotics in cured bone cement, and whether antibiotic acrylic bone cement composites produce an effective antimicrobial concentration in tissue fluid of hip joint and if so, the duration of it. 30 rabbits were used as test animal: 3 each for hemiarthroplasty and for hemiarthroplasty with the insertion of bone cement as control; 6 each for dicloxacillin, cephacetrile, gentamycin and amlkacin impregnated bone cements. Antibiotic activities were measured by disk diffusion method and tube dilution method using tissue fluid collected through tube inserted in the hip joint of the animals. The results were as follows: 1. Bone cement itself does not have antibacterial effec: on the growth of Staphyiococcus aureus and Escherichia coli. Antibiotic impregnated acrylic bone cements showed antibacterial effects which were stable for 3 weeks in vitro test. 2. After the insertion of antibiotic-acrylic bone cement composites, maximal concentrations of antibiotics in tissue fluid were measured at 1 hour. The concentration of antibiotics remained in tissue fluid at relatively high level for 2 days, and decreased abruptly there after. Inhibition zones in disk diffusion method could be measured until 3rd day in dicloxacillin group and 4th day in cephacetrile, gentamycin and amikacin group. No antibacterial effect could be measured in control groups. 3. On first postoperative day the concentrations of antibiotics in tissue fluid were measured as 64 mcg/ml in dicloxacillin group and 128 mcg/ml in cephacetrille, gentamycin and amikacin group. The antiblotic activities in tissue fluid could be measured for 6 days in dicloxacillin group and 7 days in cephacetrile, gentamycin and amikacin group using tube dilution method. No antibiotic activities were measured in tissue fluid of control groups. As a result of this study, it is proved that the concentration of antibiotics in tissue fluid of hip joint can be maintained above the level of minimal inhibitory concentration for about a week when antibiotic-acrylic bone cement composite is used in joint replacement arthroplasty. The impregnation of antibiotics in crylic bone cement is proved to be effective in the prevention of exogenous infection, especially in the protection of damaged tissue prone to infection postoperatively.

Treatment of Non / 대한정형외과학회잡지

During the period of 25 years from Apr. 1959 to Jan. 1984, 58 patients of non-tuberculous infec-tion of the spine (53 pyogenic osteomyelitis and 5 iatrogenic and primary discitis) were admitted and treated at our department. Clinical analysis was carried out following results were obtained. 1. The incidence was higher in the 3rd and 4th decade and the sex ratio between male and female was 2.1:1 2. The relative frequency of the commonly involved sity were lumbar(60), thoracic(17.), cervical(9%), lumbosacral(7%), thoracolumbar(3.5%), cervicothoracic(1.5%), in that orders. 3. The morbidity period less than 1 month was only in 22% and that less than 1 year was only 4. The frequent clinical symptoms and signs were back pain(91), tenderness(88%), muscle spasm (76%), and fever and chillness(41%). 5. The causative microorganism was identified in 43 cases among which 77% was coagulase positive staphylococcus. 6. Expected spontaneous bony fusion was not found in any case of 9 follow-up cases of conservatively treated group, while excellent bony union was noticed in all 16 follow-up cases of anterior fusion group except one. 7. Anterior spinal fusion seems be to indicated in those cases such as with failure of conservative treatment, paraplegia, concomitant mechanical instability, long duration of sinus tract and even with dubious bacteriological diagnosis. 8. Anterior spinal fusion for pyogenic osteomyelitis and discitis has the advantages, that is eradication of diseased foci with easier bacteriological diagnosis, cord decpmpression, increase of bony stability, and promotion of bony union. 9. Laminectomy was indicated in those cases with epidural abscess. 10. Bone scan and computed tomography were useful in the early diagnosis and evaluation of treatment results.

Diagnosis and treatment of osteoid osteoma: review of 45 cases / 대한정형외과학회잡지

No abstract available.

A biomechanical study on diaphyseal defect filled with polymethylmethacrylate / 대한정형외과학회잡지

No abstract available.

The Cytotoxic Effect of Methotrexate Loaded Bone Cement on the Osteosarcoma Cell Lines / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to investigate the feasibility of bone cement as a vehicle of methotrexate, and potent chemotherapeutical drugs for osteosarcoma, and to evaluate the cytotoxic effect of the eluted methotrexate on osteosarcoma cells. MATERIALS AND METHODS: Various amounts of methotrexate were mixed with bone cement to make pellets containing corresponding dosages of methotrexate. The elution experiment was performed. The amount and the rate of elution, the duration of elution, and the elution pattern were checked daily by measuring the absorbance for four weeks. The cytotoxic effect of the eluted methotrexate on SaOS2 and MG63 osteosarcoma cells was examined by MTT assay, and the results were analyzed according to the concentration of the methotrexate and time. RESULTS: The amount of eluted methotrexate was the greatest during the first day, then the amount decreased rapidly until the end of the first week, reaching its plateau in the third week. The amount of eluted methotrexate from the pellets averaged 6.1% during the first week, and 9.6% during the four weeks. The concentration of eluted methotrexate was 130 to 10,000 times higher than the minimum inhibitory concentration throughout the experimental period. As a result of the cytotoxic effect of the eluted methotrexate, the number of viable tumor cells decreased significantly after 72 hours of exposure, and the viable cells were hardly seen after one week. CONCLUSIONS: In conclusion, the methotrexate eluted from the bone cement has sufficient cytotoxic effect on osteosarcoma cells in vitro, and the results suggest that local chemotherapy using a methotrexate loaded cement may be applicable in the management of osteosarcoma after evaluation of its long-term effect.

Effect of composite of bone morphogenetic protein and plaster of paris on healing of bone defect in the rat tibia / 대한정형외과학회잡지

No abstract available.

Treatment of Acetabular Fractures / 대한정형외과학회잡지

Acetabular fractures are usually caused by violent external force such as car clash and commonly accompany injuries of the other parts of the body. And there has been long controversy between conservative and operative treatments. A clinical analysis was performed on the 29 patients with acetabular fractures, who had been treated at seoul National University Hospital from 1973 to 1982, mainly focussed on the result of treatment. Followings are the summary of the result. 1. Conservative treatment was done in 52% and operative treatment in 48%. 2. Mean follow-up period was 1 year and 8 months. 3. The result of treatment was good or fair in 53% of conservative treatment group comparedto 71 in operative treatment group. 4. Primary total hip replacement was done in one case of bursting fracture combined with fracture of femur neck and the result was good. 5. Superior and bursting fractures showed the worst result(poor in 83%). 6. Degenerative arthritis with or without avascular necrosis was the most common complication (45 %) and it was more common in conservative treatment group (60 vs. 29%). 7. From above results it could be said that operative treatment in acetabular fractures, if carefully done with reasonable indications, would improve the result and decrease the rate of degenerative arthritis.

The Significance of Computerized Tomography in Spinal Stenosis / 대한정형외과학회잡지

Spinal stenosis is a localized narrowing of spinal canal due to strurctural abnormalities. Its symptoms are obscure, and characterized by chronic, poorly localized, bilateral nerve root compression signs. Computerized tomography(CT) has been accepted as almost an absolute diagnostic method for spinal stenosis after its application in the orthopedic field. During the period of 2 years, from March 1982 to March 1984, 26 cases of spinal stenosis were treated surgically after botlt CT scanning and myelography. We obtained following results about advantage of CT scanning in spinal stenosis. 1. Myelography showed following findings: Hourglass defect 9, Complete block 8, Unilateral focal defect 4, Uniform narrowing 1, Mixed 2, Negative finding 2. Myelographic finding was not specific for spinal stenosis and diagnostic accuracy was inferior to CT. 2. The type of spinal stenosis was identified by CT scan finding. Of 26 cases, 21 cases were degenerative spinal stenosis, of which central stenosis was present in 7 cases, and lateral stenosis was present in all cases. The remaining 5 cases were combined type, and both central and lateral stenosis were present in all cases. 3. The diagnostic accuracy,in localizing the level of stenosis was 61.5% by myelography, and 96.2% by CT scan. CT was especially superior to myelography in the localization of the multi-segmental stenosis. 4. CT gives valuable information about extent and degree of stenosis, especially lateral recess stenosis, thus helping the surgeon to decide on the extent of decompressive lamininectomy preoperatively.

The Significance of Bone Scan in Trauma in Orthopaedic Field / 대한정형외과학회잡지

Clinical experience with 99mTc-methylenediphosphonate was presented in 115 patients with trauma, who were treated at Seoul University Hospital from Jan. 1980 to Dec. 1983. The results were summarized as followings: 1. Bone scan exhibited increased uptake in all cases examined within 1 year of trauma and the frequency of scan positivity was diminished as the interval between trauma and the scan increased. 2. The possible factors associated with positive scans in cases more than 2 years after trauma were malunion and post-traumatic arthritis, but the age, general condition of the patient were not appeared to be significantly related to persistent positive scan. 3. Bone scan was thought to be sensitive enough to detect early stress fracture ot accompanied by radiographic abnormali ty. 4. It seemed to be reasonable to judge that the fracture was old when the bone scan of vertebral compression fracture in the young age group was negative except very early stage of trauina. 5. Bone scan was very sensitive to find early post-traumatic avascuhr necrosis in femoral neck fracture when the roentgenographic finding was equivocal.

Chondromyxoid fibroma of iliac bone: Report of a Case / 대한정형외과학회잡지

A case of chondromyxoid fibroma, which was experienced at Seoul National University Hospital, is presented with a brief review of the literature, because of its relative rarity in incidence, its unusual location and its huze size in demension which seems to be largest in reported series in literatures.

Two Case Report of Surgical Treatment for Vertebra Plana due to Gosinophilic Granuloma / 대한정형외과학회잡지

Two cases of vertebra plana due to eosinophilic granuloma were experienced and successfully treated by anterior fusion of the involved spines at the department of Orthopedic Surgery in Seoul National University Hospital. Literature on the subject was reviewed.

Hemangioma in Peripheral Nerves: A Report of Two Cases / 대한정형외과학회잡지

Hemangioma in peripheral nerves is a very rare condition. Two such conditions are experienced. One case aceompanied by nerve symptom was observed in ulnar nerve and was operated on by extirpation of the tumor including the nerve and was followed by nerve grafting. The other case involved the median nerve had no signs of nerve irritation and was also treated by tumor extirpation.

Discoid Semilunar Cartilage / 대한정형외과학회잡지

Discoid semilunar cartilage is an abnormality in which the meniscus is discoid rather than semilunar, and first reported by Young of Glasgow in 1889. 13 cases of discoid semilunar cartilages which were experienced at the Department of Orthopedic Surgery, College of medicine, Seoul National University from Jan. 1956 till Aug. 1972 are reported with review of literature. 1) The incidence was remarkable higher in the male than in the female as 11 versus 2, and higher in the age group of second decade (Average 16.4 year old). 2) Most common site was lateral meniscus, and bilateral discoid meniscus were 3 cases. 3) 3 cases out of 13 cases had complicated rupture of semilunar cartilage, and one case had cyst of the meniscus. 4) Meniscectomy were performed in all cases with successful outcome.

Cystic Lesions in Os Calcis / 대한정형외과학회잡지

The authors experienced six patients who were admitted in Department of Orthopedic Surgery at Seoul National University Hospital during the period of March 1966 to February 1976 with cystic lesions in calcaneus by radiographic findings. The following results were obtained. Among the six patients, four were osteomyelitis, one was eosinophilic granuloma and the other was fibromyxoid sarcoma. They were all similar in radiographic findings, but were different each other in pathologic findings. 2. Diagnosis is very difficult only with the patients history, hematologic and radiographic findings and the pathologic findings is the most important in the final confirmative diagnosis from benign cystic lesions to malignant one. 3. We describe about the kinds and points of the differential diagnosis. of the other discases from the reported six cases.

Failed Hip Nailing in Hip Fractures: A Radiological Analysis / 대한정형외과학회잡지

The fracture of the upper end of the femur is unique in orthopedics because it is endemic to an elderly population with special problem. In trochanteric fractures open reduction and internal fixation, with a hip nail used to maintain reduction, have become the standard treatment protocol for the elderly. Unlike fractures of the femoral neck, nonunion and avascular necrosis is rare but more frequently complicated by fatal sequele, such as pneumonia, thromboembolic disease, and decubitus ulceration. In order to achieve early ambulation of a patient with a trochanteric hip fracture, two conditions must be met: The implant used for fixation must be strong enough to withstand loadings exerted upon it during fracture healing, and the fracture itself must be rendered stable in a suitably reduced position. The treatment of the fracture of the femoral neck has a long and frustrating history. As recently as 20 years ago McCarroll remarked that this fracture must be considered “unsolved” until the incidence of aseptic necrosis and nonunion could be diminished or abolished. But now with adequate reduction, impaction, accurate internal fixation with newer devices, and carefully supervised postoperative care the fracture of the femoral neck can be expected to heal at least 90 per cent of the patients. A lower incidence of recognizable aseptic necrosis has been reported under these circumstances. X-ray films of 94 cases of hip nailing for hip fractures were collected in the Department of Orthopedic Surgery of Seoul National University Hospital. Twenty seven cases considered to be failed in hip nailing were analysed radiologically, and following results were obtained. 1. The incidence of failed hip nailing was most frequent in the fifties with average age of 54. 6 years, which seemed somewhat younger than that of the hip fracture. There was no sexual difference. 2. Hip nailings were failed in 23 cases of the femoral neck fractures and in 4 cases of the trochanteric fractures, which revealed respectively 52.3% and 8.2% of failure. Among these the technical failure was 22.7% in femoral neck fractures and 6.1% in trochanteric fractures. 3. Among the various fixation devices, Smith-Petersen nail or hip screws which has no side plate to fix the shaft rigidly showed high failure rates. 4. In all cases the etiology of the failed hip nailing was functional, such as failure of reduction, failure of fixation, penetration of the head, avaseular necrosis, infection, and inadequate postoperative management. 5. Most cases of femoral neck fractures which was not achieved near anatomical reduction was failed in fixation. 6. Too long or short nails showed high failure rates. In view point of this, hip nail should fix the lateral cortex, calcar femorale and center of subchondral bone, even in the trochanteric fracture. So devices such as heavy compression sliding nail or multiple pinning were more desirable to achieve complete fixation. 7. When, in the fresh fractures of the femur neck cannot be reduced to an anatomical or slightly overcorrected position, endoprosthesis should be considered seriously. When the joint is abnormal, the total hip arthroplasty can reduce morbidity and mortality, and also shorten the hospitalization.