The tibial plateau fracture which involving articular surface of the proximsl tibia is very common in pedestrian injury of the traffic accident and sometimes results in significant disability in knee joint function. The authors analized 40 cases of the tibial plateau fracture treated in our depsrtment during the year 1980 through 1985. The results obtained are as follows : l. 15 cases were treated by conservative methods. 2. 25 cases were treted by operative methods. 3. 33 cases(82.5%) were “Acceptable” group according to Roberts criteria.
Accidents, Traffic ; Knee Joint ; Tibia

No abstract available.
Knee*

No abstract available.
Hip

No abstract available.
Osteoma, Osteoid* ; Spine*

It would be naive to assume that any operative procedure is the solution to the problem of sacral pressure sore in the field of the orthopaedic surgery. The procedures outlined here involve the creation of compound myocutaneous flaps of the gluteus maximus muscle, skin, and the subcutaneous tissue. The myocutaneous flap us- ing the gluteus maximus muscle is a vascular flap instead of a random flap, with better blood supply for healing and advantage of an increased amount of cushion effect. We present an alternative method which will provide satisfactory and substantial soft tissue coverage in sscral pressure sores.
Methods ; Myocutaneous Flap ; Pressure Ulcer ; Skin ; Subcutaneous Tissue ; Surgical Procedures, Operative

Nowdays steroid injection into the epidural space is increasing gradually by pain clinic physician in order to control of low back and radiculating pain. But, there are a few reports about the effect of methylprednisolone that is injected into the epidural space on the plasma cortisol levels. So we undertook to determine the effect of epidural methylprednisolone acetate(Depomedrol) on the hypothalamus-pituitaryadrenal axis by checking plamsa cortisol levels. 9 patients were given 80 mg of methylprednisolone acetate and 10 ml of 0.25% bupicaine epidurally 3 times of injection at weekly intervals and checked the plasma cortisol levels of 1 hour before and after each injection respectively. The levels of plasma cortisol were also checked at first and 4th week after the last injection. The results are as follows: The baseline plasma cortisol level is 11.21+/-6.38mg%. The plasma cortisol levels of 1 hour before and after 2nd injection are 3.94+/-5.38 and 4.11+/-7.10mg%. The plasma cortisol levels of 1 hour before and after 3rd injection are 2.01+/-1.33 and 2.90+/-4.31mg%. The palsma cortisol level of 1st week after the last injection is 1.76+/-1.03mg%. The plasma cortisol level of 4th week after the last injection is 7.45+/-2.38mg%.
Axis, Cervical Vertebra* ; Epidural Space* ; Humans ; Hydrocortisone ; Low Back Pain ; Methylprednisolone* ; Pain Clinics ; Plasma

This paper was prepared to determine the effects of degree of initial angulation and the method of treatment toward the end results, and also to report cases of twenty-one children with a radial neck lowed up more than 12 months. The results are as follows: 1. An average follow up period was 34 months, and were ranged from 12 months to 70 months. 2. Displacement patterns of fracture were angulation in 5 cases, partial translocation in 11cases, and total displacement in 5 cases, and translocated fracture was most frequent. According to the degree of angulation, in 10 cases angulation was minor(below 30 degrees), in 8 cases moderate(30–60 degrees), and in 3 cases severe (above 60 degrees). 3. One case was treated by simple cast immobilization, 9 cases were treated by gentle closed reduction, 3 cases were by percutaneus pin reduction with K-wire, 7 cases were by open reduction and K-wires fixation, and 1 case was by closed reduction and incorporating cast immobilization. 4. The results of 20 cases were excellent in range of motion without specific complication. Without considering about the method of treatment, when angulation was severe, more time was required for recovery(Wilcoxon 2-simple test P < 0.02). When the degree of angulation was less than 60 degree, the functional recovery was faster with closed reduction than with open reduction, but with the angulation more 60 degree, there was no significant difference(Spearman correlation coefficient=0.599, P value < 0.05). In conclusion, the severity of initial displacement and the method of treatment were considered to be factors that could affect the recovery time.
Child ; Follow-Up Studies ; Humans ; Immobilization ; Methods ; Neck ; Range of Motion, Articular

A fracture of the affected extremity in patients with Klippel–Trenaunay–Weber syndrome can be fatal due to massive bleeding and show poor results. A 42-year-old male presented with an old fracture of the right femoral shaft with metal failure. We planned an operation to remove the previously fixed plate and to perform re-fixation using an intra-medullary nail. Preoperative angiography was performed and the arteriovenous malformations were embolized in order to reduce the risk of bleeding. After angiography, the previously fixed plate was removed.After the operation, a second angiography was performed immediately and the venous malformation was embolized. One week after the first operation, a second operation was performed in order to reduce the fracture and to perform re-fixation using an intramedullary nail. The patient is being followed without major complication over a period of seven years after surgery. We recommend careful planning of preoperative and postoperative angiography and embolization in order to reduce the risk of bleeding in patients with Klippel–Trenaunay–Weber syndrome.

BACKGROUND: Epidurally administered clonidine represents an approach to control the pain after cesarean section that produces analgesia by an alpha 2-adrenergic mechanism and may provide postoperative analgesia without nausea, pruritus, and respiratory depression associated with systemic or intraspinal opioid administration. This study was undertaken to evaluate the analgesic effect according to the dose of appropriate bolus and the combination of epidural morphine and clonidine after cesarean section. METHOD: Forty five women, ASA physical status 1 or 2, scheduled for elective cesarean section were randomly assigned to receive epidural administration for postoperative pain control. Group A (n=15) received 1 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 150 g clonidine. Group B received 2 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 300 g clonidine. Group C received 3 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 450 g clonidine. Each combination of drug was injected at Bromage scale 1 after surgery. RESULTS: All groups showed relatively stable hemodynamic status. Analgesic effect was significantly better in Group B and C than Group A (p<0.05). Sedative effect was not a problem in all groups. The incidence of side effects in Group C was more than Group B, which than Group A, but almost cases did not require treatment. CONCLUSION: 2 mg morphine and 75 g clonidine bolus followed by 4 mg morphine and 300 g clonidine with excellent analgesic effect and less side effects is considered as adequate dose in postoperative pain control after cesarean section with epidural anesthesia.
Analgesia ; Anesthesia, Epidural* ; Cesarean Section* ; Clonidine* ; Female ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative ; Pregnancy ; Pruritus ; Respiratory Insufficiency

Intrathecal administration of morphine for pain relief became popular since Pert, et al (1973) reported the opioid receptors in spinal cord. It is obvious now morphine bas prolonged and profound analgesic effect with few compl-ications but the leant dose which produces sufficient analgsia with insignificant complication is still controversial. The dosage of intrathecal morphine used for postoperative analgesia has varied from 0.1 mg to 2 mg, but significantly low dosage was required br direct intrathecal route than by epidural one to reach the appropriate analgesic CSF concentration. We selected 60 Patients (50 for cesarean section, 10 for total hysterectomy) and divided into 3groups to compare the effects respectively. Group l : 20 patients receiving 0.05mg of intrathecal morphine, Group ll : 20 patients receiving 0.1 mg of intrathecal morphine, Group lll : 20 Patients receiving 0.2 mg of intrathecal morphine The results are as follows ; 1) The analgesic effects of group l and ll were good and similiar, but 2 of group l and 1 of group ll required a single supplementary intramuscular demerol 6 hours after intrathecal morphine injection. The quality of analgesia was judged to be better in group lll than in group I and ll. 2) The duration of analgesia of group lll was a little longer than group I and ll, which showed similar duration. 3) The side effects of group l, ll and lll were similar, but pruritus was noted twice as much in group in lll than in group l and ll.
Analgesia ; Cesarean Section ; Female ; Humans ; Meperidine ; Morphine* ; Pregnancy ; Pruritus ; Receptors, Opioid ; Spinal Cord