No abstract available.
Female ; Mammaplasty*

We evaluated the scapular shape, dispiacement and rotation in 10 cases of Sprengel deformity using three-dimensional computed tomography in order to investigate its clinical usefulness. Standard views, including trunk posterior view, scapular true posterior view and medial view, were taken, and the 3-D image was rotated in three axes to visualize the omovertebral bony connection. In the trunk posterior view, the amount of superior displacement of the affected scapula was measured using the glenoid level as reference, and the rotational deformity by the tilting of the base of scapular spine. Scapular dysplasia was evaluated in the scapular true posterior and medial views. The presence, size, and anchoring points of omovertebral bone were assessed in various view points. There was a tendency of inverse correlation hetween superior displacement and rotational deformity of scapula. In most cases, the affected scapulae were convex at their medial borders and concave at their lateral borders, with increased width/height ratio. The anchoring point of omovertebral connection appeared to determine the scapular shape, level, and amount of rotation. Three-dimensional CT was helpful in preoperative planning.
Congenital Abnormalities* ; Imaging, Three-Dimensional ; Scapula ; Spine

No abstract available.
Fetus* ; Humans* ; Infant, Newborn* ; Keratins*

No abstract available.
Osteotomy*

The authors reviewed 50 patients of congenital dislocation of the hip who had surgical treatment at the Department of Orthopedic Surgery, Seoul National University Children's Hospital from October, 1985 to August, 1993. We investigated the contributing factors to coxa magna after surgical treatment and it's relationship to the avascular necrosis of femoral head, and observed the influnce of coxa magna on the development of the hip joint. Coxa magna was defined as a femoral head with the greatest diameter 15% greater than the opposite side. To assess the development of the acetabulum in the hips with coxa magna, radiographical horizontal and vertical parameters were measured preoperatively, and at postoperative 1 year, 2 year, and 3 year or more. Twenty-one of fifty hips had coxa manga. The incidence of coxa magna increased in patients who had open reduction at younger age(average 30 months), compared to older age(average 44 months). Neither femoral osteotomy nor pelvic osteotomy increased statistically the incidence of coxa magna. Avascular necrosis of femoral head did not necessarily resulted in coxa magna. There were not statistically significant differences in the coverage ratios of femoral head by the acetabulum between coxa magna positive and negative groups, because lateral acetabular growth accompanied in accordance with enlargement of femoral head in the majority of cases with coxa magna. Open reduction alone caused concomitant vertical overgrowth of ipsilateral hemi-pelvis with resultant pelvic tilt and leg length inequality(IHD>5mm, upto 2cm) in 6 of 10 cases. The patients, who had coxa magna with good radiological results by Severin's classification, underwent open reduction at younger age and had lesser enlargement of the femoral head, compared to those with fair or poor results.
Acetabulum ; Classification ; Dislocations ; Head ; Hip Joint ; Hip ; Humans ; Incidence ; Leg ; Necrosis ; Orthopedics ; Osteotomy ; Seoul

No abstract available.
Humans ; Longitudinal Ligaments* ; Spine*

llizarov technique is versatile enough to afford simultaneous or staged correction of complex deformities of the long bone. According to the conventional llizarov method, angulation, shortening, rotation and translation deformities are corrected sequentially in that order. Appropriate placement of the hinges enables simultaneous correction of angulation, shortening along with translation. However, when additional rotational correction is needed, major modification of the frame is mandatory and moreover, undesirable shearing force ensues on the newly formed regenerate bone. Inclined hinges composed of universal joints in llizarov frame has inherent potentiality to provide simultaneous correction of the angular and rotational deformities. The authors geometrically analyzed the inclined hinge technique. Table and graph were presented to determine the exact values of surgical parameters for a given deformity. When the hinge axis was displaced from the center of deformity maintaining its orientation and inclination, simultaneous correction of translation and/or shortening in addition to angulation and rotation occurred, which was confirmed by computer graphic simulation study; 1. An inclined hinge axis displaced along the longitudinal bisector line resulted in translation along the direction perpendicular to the hinge axis projected on the horizontal plane. 2. An inclined hinge axis displaced along the transverse bisector line resulted in translation along the direction of the hinge axis projected on the horizontal plane as well as lengthening or shortening. Therefore, judicious placement of inclined hinge axis enables, theoretically, simultaneous correction of angular, rotational, translational deformities along with shortening in particular cases. In practical application, the inclined hinge technique helps lessen the number of subsequent frame modifications or at least reduce the amount of residual deformities to be corrected by next step.
Computer Graphics ; Congenital Abnormalities ; Ilizarov Technique ; Joints ; Methods

In order to group the pelvic obliquity into clinically useful classification and to develop appropriate guidelines for treatment, we evaluated 55 patients who had been treated between 1985 and 1993 for pelvic obliquity after poliomyelitis. Age at surgery ranged from 15 years to 49 years (average 27 years). Fixed pelvic obliquity after poliomyelitis was classified into two major types according to the level of the pelvis relative to the short limb and into four subtypes in each type according to the direction and severity of scoliosis. Forty-six patients had obliquity with the pelvis down (type I), and nine patients had the pelvis up (type II) on the short limb side. Subtype A: straight spine with localized lower lumbar compensatory angulation, mainly at the L4-5 intervertebral space. Subtype B: mild scoliosis with convexity to the short limb side, Subtype C: mild scoliosis with convexity opposite to the short limb side. Subtype D: moderate to severe paralytic scoliosis, which has a convexity to the short limb side in type I and opposite to the short limb side in type II. In the pelvis of type I-A, I-B and I-C deformities, abduction contracture of the hip was released on the side of affected short limb, and lumbodorsal fasciotomy was performed on the contralateral side of short limb, where iliolumbar angle converged and the pelvis was elevated, if necessary. In most cases, hip instability existed on the side of short limb and it was treated with triple innominate osteotomy, which also contributed to leg length equalization by lengthening. In type II-A, II-B and II-C deformities, it was necessary to perform a triple innominate osteotomy on the side of affected short limb with adducted unstable hip in most cases. Lumbodorsal fasciotomy was performed above the iliac crest of elevated hemi-pelvis with short limb, where iliolumbar angle converged. In case of abduction contracture of contralateral hip, contracted fascia was released. In the pelvis that had a type I-D or type II-D deformities, treatment might include bony surgeries such as spinal fusion or triple innominate osteotomy, with appropriate soft tissue release. We propose a systemic and comprehensive classification for fixed pelvic obliquity after poliomyelitis. According to this classification, we and decide to combine corrective surgeries, and find the side where the surgery should be performed.
Classification ; Congenital Abnormalities ; Contracture ; Extremities ; Fascia ; Hip ; Humans ; Leg ; Osteotomy ; Pelvis ; Poliomyelitis ; Scoliosis ; Spinal Fusion ; Spine

In order to compare the efficacies of some surgical procedures for correction of congenital muscular tortiollis, we evaluate 36 patients who had been treated either by unipolar release (19 patients) or bipolar release (17 patients) of the sternocleidomastoid (SCM) muscle at Seoul National University Children Hospital from August 1985 to June 1993. The average follow up period was 4.1 years (range, 1 year to 7 years and 8 months). The average ages at the time of operation was 3.4 years (range, 11 months to 7 years and 1 month) in the unipolar group and 9.7 years(range, 4 years and 5 months to 16 years and 11 months) in the bipolar group. Postoperatively, flexion and extension range of motion of the neck was not limited of limited less than 10 degrees, if present, in all cases. In rotation motion, 89.4% of the unipolar group and 94.1% of the bipolar group showed no limitation or limitation of less than 10 degrees when compared to the normal side postoperatively. In lateral bending, however, 21.1% of the unipolar group and 21.5% of the bipolar group showed limitation of more than 10 degrees when compared to the normal side postoperatively. Facial asymmetry, which was present in 89.4% of the unipolar group and all cases of bipolar group preoperatively, disappeared in 73.7% of the unipolar group and 23.5% of the bipolar group and improved in 94.1% of the unipolar group and 64.7% of the bipolar group. The over-all functional and cosmetic results were assessed according to the modified Ling's criteria. In function results, 14 patients(73.3%) had excellent or good results in unipolar group and 12 patients(70.6%) in bipolar group. In cosmetic results, 15 patients(78.9%) had excellent or good results in unipolar group and 11 patients(64.7%) in bipolar group. Recurrence rate was higher in the unipolar group (15.8%) than in the bipolar group (5.8%). In conclusion, limitation of lateral bending was more resistant to the treatment than the limitation of rotation. Bipolar release of SCM muscle would be recommendable even in young children in terms of recurecce.
Child ; Facial Asymmetry ; Follow-Up Studies ; Humans ; Neck ; Range of Motion, Articular ; Recurrence ; Seoul ; Torticollis

Temporal and spatial expression of bmp-2 and bmp-4 was investigated in distraction osteogenesis and fracture healing models in order to delineate their roles in these new hone formation processes. Distraction osteogenesis was performed on the left tihia diaphyses of Sprague-Dawley rats, and was confirmed by serial radiographs and histologicaJ examination. Total RNA was isolated from the distraction gaps and fracture sites sequentially until the postoperative eighth week, and mRNA expression was quantitated hy competitive reverse transcription-polymerase chain reaction(RT-PCR) using specific primers for bmp-2 and bmp-4. In-situ hybridization was performed on the undemineralized tissue section of distraction osteogenesis group. Both bum-2 and bmp-4 mRNA expression increased during distraction osteogenesis and fracture healing. Increase in bmp-2 mRNA expression was more marked and prolonged in distraction osteogenesis compared with fracture healing, whereas bmp-4 mRNA expression was persistently increased in both groups. In-situ hybridization study revealed that hoth bmp-2 and bmp-4 were expressed at eariy osteohlasts producing osteoid, trabeculae-lining osteoblasts and osteocytes of regenerate bone. Enhanced new bone formation in distraction osteogenesis is associated with prolonged and increased expression of BMPs, especially BMP-2. lnspite of their structural similarity, BMP-2 and BMP-4 appear to have their distinct roles in new hone formation.
Bone Morphogenetic Proteins* ; Diaphyses ; Fracture Healing* ; Osteoblasts ; Osteocytes ; Osteogenesis ; Osteogenesis, Distraction* ; Rats, Sprague-Dawley ; RNA ; RNA, Messenger*