The treatment of extensive soft tissue injury of lower extremities is known to be one difficulty in the field of orthopedic surgery. At present, reconstructive surgery with free flap is being employed under the microscopy actively. But the size of defect is found larger than the maximum size of one free flap frequently. The authors present 6 cases of a combined scapular flap and latissimus dorsi flap for extensive soft tissue injury of the lower extremities at the department of orthopedic surgery of Severance hospital, during years period from 1983 to 1985. The results of the study are as follow: l. A one stage reconstruction of extensive soft tissue injury was done with a combined scapular flap and latissimus dorsi flap. 2. In spite ofa few complications of donor and recipient sites, the advantage of combined scapular flap and latissimus dorsi flap exceed the any methods that have been employed in functional and plastic aspects. 3. There was no limitation of motion of the shoulder in spite of the excision of the large combined scapular flap and latissimus dorsi flap around the axillary area. 4. The primary closure of the donor sites was feasible. 5. The reconstructive surgery of the extensive soft tissue injury using the above combined scapular flap and latissimus dorsi flap can be used without restriction as to the age of the patient.
Free Tissue Flaps ; Humans ; Lower Extremity ; Microscopy ; Orthopedics ; Plastics ; Shoulder ; Soft Tissue Injuries ; Superficial Back Muscles ; Tissue Donors

Spondyliolisthesis is the major structural changes in the spine and is more directly related to the low back pain syndrome. The many operative techniques have been used but each of them had several disadvantage as well as advantage. Since the anterior lumbar fusion in spondylolisthesis was introduced by Carpener in 1932, many authors have reported the favorable results regard to anterior arthrodesis in spine. Ideally the system of spine fixation is mechanically efficient and anatomical restoration of deformed structure. The anterior interbody fusion is more satisfactory to this deal fixation of spine than any other surgical method. We reviewed the cases of fifty seven patients who underwent anterior interbody fusion with autoiliac bone grafts for spondylolisthesis and were followed for one to twelve years. 1. The most common type was isthmic type in 61% and the degenerative type was observed in 25%. 2. The fifty lumbar vertebra slipping was observed most commonly and in two patinets, L4 and L5 vertebra slipped simultaenously. 3. In radiological results, we obtained complete fusion of grafts to vertebra in 73%, incomplete fusion in 15% and absorption of graft noticed in seven patients(12%). 4. We obtained the favorable results in 84% patients clinically. 5. The clinical results was not correlated with roentgenografic evidence of union. 6. Anterior discectomy and arthrodesis with autoiliac bone graft was a safe procedure in grade I and II spondylolisthesis but in grade III, the procedure was not recommended. 7. The simple Knight-Kim back brace was satisfactory to immobilization after anterior interbody fusion without graft union failure.
Absorption ; Arthrodesis ; Braces ; Diskectomy ; Humans ; Immobilization ; Low Back Pain ; Methods ; Spine ; Spondylolisthesis ; Transplants

The purposes of this study were to detect the indices of evaluating for degree of compression and to detect the indices of recovery after decompression in different time intervals in the animal model of 50 percent compression of the cauda equina, through the examination of neurologic status and electrodiagnosis. Twenty-one male dogs, weighing between nine and eleven kilogram, were used. Three experimental groups were studied. One group (5 dogs) served as controls. In the other groups, the cauda equina was constricted by 50 percent to produce chronic compression, and decompression was done after 2 weeks compression in one group and 4 weeks compression in another group. The dogs in which the cauda equina had been decompressed at 2 weeks, showed the recovery of sensory evoked potentials at 2 weeks after decompression and bulbocavernosus reflexes at 4 weeks. The dogs in which the cauda equina had been decompressed at 4 weeks, showed the recovery of sensory evoked potentials and bulbocavernosus reflexes at 4 weeks after decompression. In both groups of the cauda equina compression, motor evoked potentials were partially recovered by 6 weeks after decompression. The initial neurological deficits in both groups were improved by 6 weeks. The cauda equina revealed that the epidural scar tissue in compressed site was more severe in 4 weeks compression group. But the substance of the cauda equina did not have any pathological changes in gross examination. Microscopically, neural tissue was showed the normal appearance without pathological changes in all groups. In conclusions, the early decompression of cauda equina revealed that the onset of recovery was more faster and the amplitude of recovery was larger comparing with delayed decompression in electrodiagnostic test. Also, the surgical decompression itself was helpful to improve the electrodiagnostic changes around 4 weeks after decompression. Sensory evoked potential was improved at the first and motor evoked potentials was recovered after disappearance of the claudication.
Animals ; Cauda Equina* ; Cicatrix ; Decompression* ; Decompression, Surgical ; Dogs* ; Electrodiagnosis ; Evoked Potentials ; Evoked Potentials, Motor ; Humans ; Male ; Models, Animal ; Polyradiculopathy ; Reflex

Monteggia fracture-dislocation was described as a fracture of proximal third of the ulnar with a dislocation of radial head by G. Monteggia in 1814. Bado named Monteggia lesion as a fracture of ulnar at any level and a dislocation of radial head. The authors reviewed sixty-three patents of Monteggia fracture who were treated at department of orthopedic surgery, Yonsei university college of medicine from 1980. 1. to 1985. 12. We emphasis especially on cause of injury, classification, direction of radial head dislocation, level of ulnar fracture site, treatment and result. The results were as follows: 1. There were 22 children and 41 adults among 63 patients. 2. The male was affected more frequenty than female (49:14) . The ratio between male and female was 3. 5: l. 3. The most common cause of injury was falling down (54%) in children and car accident (51%) in adults. 4. According to Bado classification, type I was 68%, type II 11%, type III 18% and type IV 3%. 5. The partial posterior interosseous nerve injury was noticed in 12 cases and the superficial radial nerve injury was in 3 cases. The nerve injury was recovered spontaneously in all cases. Dislocation of radial head was as follows: Anterior dislocation was 38%, anterolateral 41%, lateral 8%, posterior 10% and posterolateral 3 % 7. Location of ulnar fracture site was as follows: Metaphysis was 22%, proximal 1/3 24%, junction of proximal 1/3 and middle 1/3 38%, middle 1/3 14% and distal 1/3 2%. 8. Closed reduction of radal head dislocation was done in 45 cases, open reduction in 10 cases and radial head excision in 6 cases. 9. Closed reduction of ulnar fracture was done in 26 cases and open reduction 35 cases. 10. We obtained 93% favorable results in children and 71% in adults. Not only the prognosis of ch ildren was better than adults but also the recovery time of children was shorter than adult's.
Accidental Falls ; Adult ; Child ; Classification ; Clinical Study ; Dislocations ; Female ; Head ; Humans ; Male ; Monteggia's Fracture ; Orthopedics ; Prognosis ; Radial Nerve

Fractures of the acetabulum are relatively uncommon. But if fractures of the acetubulum are not accurately evaluated, classified, and reduced anatomically, major sequalae and complications are frequently developed. Because of complicated anatomy, difficulty with surgical exposure, severe comminution, and major associated injuries, the treatment of displaced acetabular fractures between conservative and operative methods is still controversial. We reviewed thirty five cases of displaced acetabular fracture treated operaively from January 1984 to December 1991. The prevalent age was the fourth decade. There was twenty seven cases of associated injuries, twenty two dislocations of the hip. According to the Letournel's classification, the most common fracture type was posterior wall and both column type. The fracture was fixed internally with only screws in thirteen cases and with plate and screws in twenty two cases. Among thirty five patients, five patients were lost in the follow up and another five patients had followed up lesser than one year. The mean duration of follow-up afrer the operation was three years (range, one to eight years). Among twenty five patients who had followed up more than one year, the satisfactory results were achieved in nineteen patients (76%) and the poor results were achieved in three patients (8%). The complications were post-traumatic arthritis, avascular necrosis of femoral head, osteomyelitis in iliac bone, skin necrosis, and heterotopic ossification.
Acetabulum ; Arthritis ; Classification ; Dislocations ; Follow-Up Studies ; Head ; Hip ; Humans ; Necrosis ; Ossification, Heterotopic ; Osteomyelitis ; Skin

Heterotopic ossification(HO) is a frequent complication of total hip arthroplasty(THA), If it is sevre enough, it can convert a successful result of the operation into a poor one. Among several strategies that researches in recent years have tested, radiation therapy have been accepted to have efficacy for prevention of heterotopic ossification by many authors. While postoperative irradiation has been shown to lower the incidence of HO effectively in high risk patients following THA, patients in multiple dose protocols continue to develop some heterotopic ossifiction despite therapy and have some problems. Ninteen patients received single dose exposure to 600 rad delivered within 48 hours of THA with shielding of prosthesis region. The patients were considered high risk group for developing HO because of hypertropic osteoarthritis, post-traumatic osteoarthritis or the presence of previous formed ectopic bone. The average follow up period was 10.2 months(range 6 months
Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Hip ; Humans ; Incidence ; Ossification, Heterotopic ; Osteoarthritis ; Osteogenesis ; Prostheses and Implants

Osteoporosis is defined as a pathologic condition that there occurs no change in the chemical composition of the bone, while bone resorption is abnormally increased, compared with osteogenesis, leading to a decrease in bone amount. Though many varieties of therapy have been tried, no definitely effective method has been found. Ginseng saponin is an importanat component of Korean ginseng and many studies have been performed for investigating its effectiveness. But there has been no report on saponin effects to osteoporosis. The purpose of this studies is to find out the effect of saponin in osteoporosis induced by ovariectomy in rats. For the study, 30 rats underwent sham operation(group I) and 90 rats were ovariectomized. In group ll (30 rats), only ovariectomy was performed. In group III (30 rats), 50mg/kg/day ginseng saponin was administered per oral route and group IV (30 rats) was administrated 150mg/kg/day saponin. All the rats were sacrificed at the 16th week. The sections of the femoral shaft were stained using Villanueva bone stain and the sections of the tibia were stained with hematoxylin-eosin. The femoral shaft and metaphyseal region were applied to compression device for measurements of bone consistency. The effect of saponin increased weight of the femur. The cross sectional area and cortical area of the femoral shaft were significantly higher in 50mg saponin group(group III) than osteoporosis group. But there was no significant difference in the size and number of osteoclast and the percentage of trabecular bone between saponin group(group III ,IV)and osteoporosis group. In the biomechanical test, the consistency of cortical bone was significantly increased in 50mg saponin group than osteoporosis group. In conclusion, saponin had an effect on experimental osteoporosis induced by ovariectomy in rats. As though its precise mechanism was unknown, we considered that its action mechanism was due to osteoblastic activity resulting in a correction of bone mass deficit in osteoporotic rats.
Animals ; Bone Resorption ; Female ; Femur ; Methods ; Osteoblasts ; Osteoclasts ; Osteogenesis ; Osteoporosis ; Ovariectomy ; Panax ; Rats ; Saponins ; Tibia

Distraction osteogenesis techniques have provided more than a clinical treatment of limb length discrepancies and bone deformities. The nature of this mechanical environment and the characteristics of the regenerate bone are not typical of that found elsewhere in the skeleton. The purposes of this study were to investigate the physical and mechanical properties of regenerate bone in different consolidation period (sacrificing at the period of 8, 12, 18, 20, 24, 26 weeks post surgery) and to find out the relationship between both properties. Two ring Ilizarov fixators were applied to the right tibia in 7 large, skeletally mature dogs. A subperiosteal osteotomy of tibia was performed. Postoperatively, after 7 days of latency period, distraction was begun. Distraction of 1mm daily, 3 times per day was continued until radiographic evidence of a 2.5 cm distraction. Sacrifice was at 8, 12, 18, 20, 22, 24, 26 weeks post surgery. Allof the specimens were obtained from regenerate bone and were cutted in the rectangular shape of approximately 8x4x4 mm. Specimens were tested in axial compression and displayed an average modulus of elasticity of 215(sd=184)Mpa, an average yield stress of 3.58(sd=2.54)MPa, an average apparent bone density of 0.399(sd=0.107)g/cc, and an average ash weight density of 0.164(sd=0.084)g/cc. A linear regression of yield stress on modulus of elasticity was significant(p < 0.001) with R-square=0.28, and a slope of 0.007. The radiographic bone densitometry was performed before sacrifice. The results of densitometry of regenerate bone was osteoporotic comparing with those of the opposite tibia which did not be operated in all of the animals. The linear regressions of mechanical properties on physical properties were significant, only 12-34% of the variance in mechanical properties could be explained by the physical properties. In conclusion, based on the observation of the low ash fraction, it would be expected that the relationship between physical properties and mechanical properties may not be strong. This study suggested that the regenerate bone was a composite of bone and non-mineralized tissue until 26 weeks of post surgery. For the more accurate information of material property, testing of real regenerate bone without non-mineralized bone may be necessary.
Animals ; Bone Density ; Congenital Abnormalities ; Densitometry ; Dogs ; Elastic Modulus ; Extremities ; Latency Period (Psychology) ; Linear Models ; Osteogenesis, Distraction ; Osteotomy ; Skeleton ; Tibia

No abstract available.
Ossification, Heterotopic*

No abstract available.
Adolescent* ; Humans ; Intervertebral Disc* ; Spine*