No abstract available.

No abstract available.
Femoral Fractures

No abstract available.
Femoral Fractures

We analyzed the factors of importance for nonunion in series of 91 open fractures of tibial diaphysis which were treated with external fixation. Factors analyzed included, age and sex of the patients, the mechanism of injury, the amount of soft tissue damage, the grade of comminution, the level at which the tibia was fractured, the presence of an intact fibula, the presence of the multiple injuries, the type of the external fixation used(AO external fixator, EXTOR; monotube external fixator, Ilizarov), and the need to supplement the stability of the reduction. We found that the amount of soft tissue damage and comminution of the fracture played a role in the development of the nonunion.
Diaphyses ; External Fixators ; Fibula ; Fractures, Open ; Humans ; Multiple Trauma ; Tibia ; Tibial Fractures*

Bone defect occurs due to various causes, such as neoplasms, cysts, trauma, infection, congenital disease and surgical intervention. Autograft is generally considered to be the gold standard in bone graft surgery. But, allograft, xenograft and bone substitutes have been used because of complication and limited quantity of autograft. Calcium sulfate is one of the bone substitutes. We reviewed and analyzed 18 cases with bone defects that were treated with calcium sulfate from January 1997 to April 1997. We used the Osteoset' pellets that contained calcium sulfate 98%, produced by Wright Medical Technology Inc. in U.S.A., to fill defects in all cases. Except in 2 cases, autogenous cancellous bone from patients own iliac crest was mixed with calcium sulfate from 30% to 50%. Follow-up time averaged 13.7 months(range, from 12 to 15 months). The degree of absorption of calcium sulfate and new bone growth at conventional roentgenography was represented by percentage at each follow-up. The results were as follows. First, 8 weeks after operation, 93% of calcium sulfate was absorbed. Second, 6 months after operation, nearly 90% of new bone growth was observed. Third, until last follow-up, there was no noticeable complication, such as infection or foreign body reaction. We concluded that calcium sulfate might be on effective material for bone defects because of rapid absorption rate and easy recognition of new bone growth.
Absorption ; Allografts ; Autografts ; Bone Development ; Bone Substitutes* ; Calcium Sulfate* ; Calcium* ; Follow-Up Studies ; Foreign-Body Reaction ; Heterografts ; Humans ; Radiography ; Transplants

PURPOSE: The purpose of this paper was to evaluate the treatment results according to bone union, union time, and complications, including infection of unreamed nailing of tibial fractures between closed and open fractures. MATERIALS AND METHODS: We reviewed 64 tibial shaft fractures that were treated with unreamed tibial nail. These included 42 closed fractures and 22 open fractures. RESULTS: Average union time of closed fractures was 19.8 weeks and that of open fractures was 20.2 weeks, nonunion rate were 4/42 and 3/22 in closed and open fractures. Average union time were 19.2, 20.4, 21.3 weeks in open grade I, II, llla fractures. According to the type of fractures, average union time were 18.5, 20.2, 24.6 weeks and nonunion rate were 2/29, 3/26, 2/9 in type A, B, C fractures. According to the level of fractures, average union time were 20.0, 20.3, 19.4 weeks and nonunion rate were 1/5, 4/37, 2/22 in proximal, middle, and distal fractures. There was no significant differences in average period of radiologic union, infection rate and nonunion rate between closed and open fracture group, but longer union time and higher nonunion rate in complex and comminuted fractures (P<0.05). CONCLUSIONS: We consider unreamed intramedullary nailing in the tibial shaft fractures as a good treatment modality for closed and open grade I, II, IIIa fractures
Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Tibial Fractures*

PURPOSE: The purpose of this study is to assist the optimal placement of sacroiliac screw by evaluating the anatomic and radiologic features of upper sacrum. MATERIALS AND METHODS: Fourteen fresh-frozen cadaveric pelvises and 13 normal adults were studied for the evaluation of morphology of first sacrum and dysplastic patterns. Measurement of anatomic parameters and CT imaging of pelvis were performed. Thirty-two patients with complicated pelvic fracture were evaluated for detection of variations in the sacral alar anatomy and slope found in upper sacral segmentation. RESULTS: The mean distance between midpoint of sacrum and sacroiliac joint was 52.75 mm. The height of first sacral body was 21.71 mm. The longest antero-posterior distance in sacral alar was 52.36 mm. The mean angle between the coronal plane of S1 vertebra and anterior aspect of the alar was 29.3 degree. The mean angle between the superior aspect of S1 vertebral body and superior edge of the alar was 34.8 degree. The mean angle between the superior aspect of S1 vertebral body and supero-posterior edge of the alar was 12.5 degree. The studies revealed about 28 to 33% of cases as dysplastic sacrum. CONCLUSIONS: We studied anatomic and radiologic features of upper sacrum in cadaveric and clinical cases to gain information on the optimal placement of sacroiliac screw.
Achilles Tendon* ; Adult ; Cadaver ; Humans ; Pelvis ; Rupture* ; Sacroiliac Joint ; Sacrum ; Spine

Radiation therapy is used for the palliative treatment of malignant tumors and the radiation induced osteonecrosis is one of the well documented complications. Especially, in pelvic region, there are a few reports for osteonecrosis of the femoral head and acetabulum after the radiation therapy for the the malignant tumors such as cervical carcinoma or prostatic cancer. Roentgenographic changes that are caused by radiation include the rarefaction of bone and coarsening of the trabeculae. The radiolucencies tend to coalesce and patchy sclerosis appears. In acetabular region, this Pagetoid appearance mimics the findings of other malignant bone tumors, the recurrence of preexisting malignant peivic tumors and other infectious condition. After the diagnosis is confirmed, the treatment for the femoral head and acetabulum is also difficult. The authors report one case of osteonecrosis of the femoral head and acetabulum following radiation therapy which had many difficulties in its diagnosis and treatment.
Acetabulum* ; Diagnosis* ; Head* ; Osteonecrosis* ; Palliative Care ; Pelvis ; Prostatic Neoplasms ; Recurrence ; Sclerosis

Thumb opposition is essential for all precision handling, in daily activity. Thenar muscle wasting is common in long-standing severe carpal tunnel compression. Unfortunately, muscle wasting rarely recovers after decompression of the nerve. A single-stage procedure, combining carpal tunnel release and opponensplasty, is therefore a logical proposal. Between July of 1993 and May of 1996, 15 patients of carpal tunnel syndrome with thenar muscle atrophy were operated upon Camitz-Littler opponensplasty at Kyungpook University Hospital; combination of palmaris longus transfer and median nerve decompression as a simultaneous procedure. Postoperative thumb opposition was assessed by means of three separate indices-maximal palmar abduction, spatial rotation, thumb-to-finger apposition. Results for an average post-operative follow-up of 12.0 months were achieved 'good' by 86.7%. We concluded that palmaris longus transfer as an opponensplasty carried out in combination with carpal tunnel release is a simple and effective procedure for restoration of opposition in case of severe carpal tunnel syndrome.
Carpal Tunnel Syndrome ; Decompression ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Logic ; Median Nerve ; Muscular Atrophy ; Thumb

BACKGROUND: The purpose of this study was to determine the tibial fixation strength provided by different intraosseous soft tissue graft lengths within the tibial tunnel. METHODS: Porcine tibial bones and digital flexor tendons were used for testing. Bone mineral densities of proximal tibial medial condyles were measured, and two-strand tendon bundles of 8 mm diameter were used. An intraosseous graft length of 2 cm was used in group 1 (n = 10), and a graft length of 4 cm was used in group 2 (n = 10). Tunnels were 4 cm in length and 8 mm in diameter. Tibial fixation was performed using a suture tied around a screw post with a washer and an additionally inserted 7 x 20 mm bioabsorbable screw. After applying preconditioning loading of 10 cycles, 1,000 cycles between 70-220 N were applied at a frequency of 1 Hz. Graft slippage and total graft movement were recorded. Ultimate tensile strength was measured by pull-out testing at an Instron crosshead speed of 1,000 mm/min. RESULTS: No significant intergroup difference was found for total graft movement after cyclic loading (slippage in group 1, 1.2 mm and group 2, 1.2 mm, respectively, p = 0.917; and total graft movement in group 1, 3.3 mm and group 2, 2.7 mm, respectively, p = 0.199). However, mean ultimate tensile strength in group 2 was significantly higher than that in group 1 (group 1, 649.9 N; group 2, 938 N; p = 0.008). CONCLUSIONS: In a porcine model, ultimate tensile strength was greater for a 4 cm long intraosseous flexor tendon in the tibial tunnel. However, no intergroup difference in graft slippage or total graft movement was observed. The results show that a 2 cm intraosseous graft length in the tibial tunnel is safe and has sufficient strength (> 450 N) for adequate rehabilitation after anterior cruciate ligament reconstruction.
Animals ; Anterior Cruciate Ligament/injuries/*physiopathology/surgery ; *Anterior Cruciate Ligament Reconstruction ; Biomechanical Phenomena ; Bone Density ; Models, Animal ; Swine ; Tendons/*transplantation ; Tensile Strength ; Tibia/*surgery