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*

Sixteen patients who underwent 18 modified Colonna capsular arthroplasty for old unreduced DDH1 between 1984 and 1992 were recalled and critically reviewed. The average age at operation was 11.5 years (range, 8.1 to 14.5 years). The average follow-up period was 7 years and 1 month (range, 5 to 13 years). All of the patients had pain or discomfort of the hip and limp. Femoral shortening was combined in all patients, and 13 hips required concurrent pelvic osteotomy (Chiari osteotomy in 5 hips Salter innominate osteotomy in 1 hips and Steel s osteotomy in 2 hips) or slotted shelf augmentation (5 hips) due to small and shallow acetabulum relative to the femoral head. In the remaining 5 hips which had thick medial acetabular wall acetabular reaming alone was performed. At the latest followup, 9 hips showed excellent 5, good; and 4, fair results according to the modified Harris hip score and IOWA hip score. In addition, all patients except one were satisfied with the outcome in terms of regaining hip stability and decrease in pain or discomfort and limp. Radiological evaluation revealed progressive, significant increase in size of the femoral head and sphericity improvement in 12 hips. The sphericity of the femoral head did not improve in other 2 hips. In the remaining 4 hips, in which preoperative femoral head shape was relatively aspherical, the sphericity worsened after affection of ischemic necrosis or osteoarthrosis. Complications included undisplaced femoral neck fracture during physiotherapy in 2, ischemic necrosis in 2, heterotropic ossification in 2, acetabular protrusio due to too much reaming in 3 hips, and residual subluxation requiring additional pelvic surgery in 2 hips, In conclusion, we believe that modified Colonna capsular arthroplasty with femoral shortening is valid, if properly done, in the reconsruction of painful hip with old unreduced DDH in late childhood and adolesence.
Acetabulum ; Adolescent* ; Arthroplasty* ; Femoral Neck Fractures ; Follow-Up Studies* ; Head ; Hip ; Humans ; Iowa ; Necrosis ; Osteoarthritis ; Osteotomy ; Steel

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*

Heel cord advancement(HCA), which has been applied for the correction of equinus deformity in spastic cerebral palsy, has some theoretical advantages. However, HCA has also theoretical disadvantage that the procedure remove the tensile force exerting to the calcaneal apophysis. In order to evaluate the effect of HCA on the calcaneal growth, we compared the changes of calcaneal and foot lengths between the operated feet and non-operated feet after HCA. Among the 54 patients who had been treated with HCA at Seoul National University Childrens Hospital from March 1990 to August 1995, we excluded the cases who had been treated bilaterally, and also excluded hemiplegic patients in whom the ipsilateral feet were already shortened and the growth rates are different between the ipsilateral and contralateral foot. Seven patients who met the criterior of this study were included for the evaluation. There were 3 diplegics and 4 paraplegics, and average age at operation was 10 years and 6 months(range; 7 year 8 months-16 year 5 months). Average follow-up period was 3 years and 5 months(range; 2 years-4 years 9 mos). Total calcaneal lengths, anterior and posterior part of calcaneal lengths were measured on the standing lateral radiographs of the foot and ankle. Ratios of the operated limb over the non-operated limb were calculated for the three parameters. Ratios of posterior part of calcaneal lengths decreased significantly(P=0.031). Ratios of total calcaneal lengths decreased and ratios of anterior part of calcaneal lengths increased. However, the changes of two ratios were not significant. Ratios of posterior part calcaeal lengths over total calcaneal length decreases significantly(P=0.016). In conclusion, HCA can cause calcaneal growth retardation, especially posterior part of calcaneus, due to removal of physiologic tensile force of Achilles tendon.
Achilles Tendon ; Ankle ; Calcaneus ; Cerebral Palsy* ; Child ; Equinus Deformity ; Extremities ; Follow-Up Studies ; Foot ; Heel* ; Humans ; Muscle Spasticity* ; Seoul

To evaluate the effect of intertrochanteric femoral derotational osteotomy(IFDO) on the sagittal plane kinematics and kinetics of the hip and pelvis in spastic cerebral palsy, we compared the preoperative and post-operative results of 3 dimensional gait analysis. Intertrochanteric femoral derotational osteotomy alone without psoas procedure was performed in 34 hips of cerebral palsy patients with increased femoral anterversion regardless of preoperative dynamic or static hip flexion contracture. Those who had other concomitant hip procedures were excluded. There were 24 diplegics and 10 hemiplegics. Mean age of the patients at the time of operation was 9.1 years (range, 4.9 to 22). They were divided into three subgroups according to the degree of dynamic hip flexion contracture; 13 patients with normal hip extension in terminal stance (group I), 13 patients with maximum hip extension in terminal stance between 0 and 15 degrees (group II), and 8 patients with maximum hip extension in terminal stance of more than 15 degrees (group III). The gait analysis included clinical assessment, video-taping, 3D-kinematics and kinetics, and dynamic EMG. Linear parameters of gait, kinematic parameters, sagittal plane hip moment parameters, and total hip energy parameters were compared. Postoperatively, cadence and double support time decreased, whereas walking velocity and stride length increased in all groups. Maximum and minimum pelvic tilt were improved in all groups. The range of pelvic tilt improved in all groups except group I. Hip flexion-extension curve shifted into extension in all groups. Marked improvement in maximum hip extension in stance and the range of hip motion were observed in all groups. The sum of extensor moment decreased, whereas that of flexor moment increased significantly in all groups. The conversion timing from extensor to flexor moment significantly improved in group I and II. The decrease of power generations of Hl and the increase of power absorptions of H2 were significant in all groups. However, there were no significant changes in power generation of H3 in all groups. The changes of peak power generation timing of H3 was not consistent among the groups. Femoral derotational osteotomy at the intertrochanteric level brings the lesser trochanter forward resulting in iliopsoas lengthening effect. We found significant improvement of the sagittal plane kinematics and kinetics of the hip and pelvis when IFDO alone was performed without psoas tenotomy. The psoas lengthening procedure may be considered secondarily at the time of hardware removal after full evaluation of the psoas lengthening effect.
Absorption ; Biomechanical Phenomena ; Cerebral Palsy* ; Contracture ; Family Characteristics ; Femur ; Gait ; Hip* ; Humans ; Kinetics ; Muscle Spasticity* ; Osteotomy* ; Pelvis* ; Tenotomy ; Walking