The primary aims in the management of fractures in the aged and malignant neoplastic fracture should be relief of pain, mobilization as soon as possible, and return to normal environment and activities within resonable time. Unfortunately, in many cases there is so much osteoporosis and comminution of the fracture in the aged person, and so much destruction of bone in malignant neoplastic fractures that secure internal fixation and early return to normal activity are difficult and impossible by conventional method. The author had been treated the three cases of the fracture in elderly person and a case of pathologic fracture of giant cell tumor in proximal third of tibia by use of methylmethacrylate as an adjunct in the internal fixation of the fracture. The results obtain were as follows: 1. The use of methylmethacrylate for fixation is not difficulty technically and obtain rigid stabilization after operation. 2. The three cases became ambulatory, bearing partial and full weight on affected extremities by use of crutch at an average two week after operation. 3. There are no complication postoperatively because of early ambulation. 4. A case of malignant giant cell tumor was performed amputation at postoperative eight months because of more destruction and extension of bone and tumor tissue.
Aged ; Amputation ; Early Ambulation ; Extremities ; Fractures, Spontaneous ; Giant Cell Tumors ; Humans ; Methods ; Methylmethacrylate ; Osteoporosis ; Tibia

We experience still a number of cases of residual polipmyelitis with severe deformities which have not been treated for more than 10 years in Korea. During the period of January to August in 1970, 40 cases of residual poliomyelitis had corrective operations performed at Department of Orthopedic Surgery, Pusan National University Hospital. Among those Two cases showed extreme deformities of hips and knees, having not been treated at all for past 18 years. There were flexion contractures of hips 50/80(Rt/Lt) and knees 90/90 in case 1 and flextion contractures of hips 75/90 and knees 80/100 in case 2. Various controversial methods of surgical treatment have been described since 1914 when Soutter introduced a procedure for flexion contracture. In case 1 the procedures of Soutter and Yount, division of the hamstring tendons and posterior capsulotomy of knee were performed by the authors. The bilateral contractures were not corrected completely and the residual deformities remained. In case 2 a compelet correction was obtained by release of iliopsoas insertion and supracondylar osteotomy combined with the operations done in case 1. From this clinical observation the authors reached to the conclusion that the release of insertion of iliopsoas muscle and supracondylar osteotomy are the essential procedures for correction of flexion contracture of hip and knee.
Busan ; Congenital Abnormalities ; Contracture ; Hip ; Knee ; Korea ; Orthopedics ; Osteotomy ; Poliomyelitis ; Posterior Capsulotomy ; Tendons

Clinical observation was performed on the 84 hips of 72 patients which were replaced by total hip, who were treated at Department of Orthopedic Surgery, College of Medicine, Busan National University, from March 1978 to March 1981. The follow-up period of each case varied from 1 to 4 years. The results obtained were as follows: 1. The peak age incidence ranged from 51 to 60 years, which comprised 37.1% (23 patients) of total cases. 2. The causes of the hip diseases were; 25 cases of post-traumatic avscular necrosis of the head, which comprised highest incidence, 19 osteoarthritis, 14 primary avscular necrosis of the head, 4 ankylosing spondylitis, and 3 rheumatoirl arthritis. 3. The most commonly used prosthesis was Muller type in 64 cases (88.9%); Trapezoidal-28 in 3 cases; Ceramic-metal type in 4 cases; and modified Muller type by Japanese in 1 case. 4. Anterolateral approach was used in all cases except for the 3 cases in whom anterior approach was made. In most cases, greater trochanter osteotomy was not performed except for the 9 cases in whom operative field were poorly exposed without osteotomy. 5. Several complications developed; perforation of femur shaft and acetabulum during the operation in 1 case each, Post-operative deep seated infection in 2 cases, thrombophlebitis in 1 case, wire breakage in 2 cases, stem failure in 1 case, and femoral shaft fracture in 1 case. 6. Postoperative functional evaluation by the Merle d'Aubigne and Postel method was done; pain relief in 92.4%, mobility recovery in 71.6% and functional inprovement in 70.1% belonged to grade 5 and 6. Relief of pain is the most prominent effect of the total hip rep1acement surgery in this series.
Acetabulum ; Arthritis ; Arthroplasty, Replacement, Hip ; Asian Continental Ancestry Group ; Busan ; Femur ; Follow-Up Studies ; Head ; Hip ; Humans ; Incidence ; Methods ; Necrosis ; Orthopedics ; Osteoarthritis ; Osteotomy ; Prostheses and Implants ; Spondylitis, Ankylosing ; Thrombophlebitis

In order to study the effect of ascorbic acid on the growth of the fetal rat long bones in calcium free culture medium, fetal femurs from rat fetus on 19th day of gestation were cultured for 1, 3, 5, 7 and 9 days in medium described below. Culture media used were MEM, Ca++
Animals ; Ascorbic Acid ; Bone and Bones ; Bone Marrow ; Bone Matrix ; Calcium ; Cartilage ; Chondrocytes ; Collagen ; Culture Media ; Cytoplasm ; Diaphyses ; Epiphyses ; Femur ; Fetus ; Formaldehyde ; Glutaral ; Methods ; Micropore Filters ; Microscopy ; Microscopy, Electron ; Osmium ; Periosteum ; Pregnancy ; Rats ; Stainless Steel

In the treatment of DDH, generally we have used the acetabular index (AI) and the center-edge (CE) angle as diagnostic factors for hip dysplasia. However, it is sometimes difficult to mark the exact lateral edge of the acetabulum to measure these factors due to indistinct bony shadows on the image of the dysplastic hip. The purpose of this study was to evaluate the lateral edge of the acetabulum to determine the location of the most accurate marking point on the plain radiograph. Using plain radiograph, we studied 53 patients with DDH which were treated with closed reduction. 26 patients were studied using plain radiograph and another method: 16 patients with 3- DCT, 4 patients with MRI, and 6 patients with arthrograph. According to this study, the most lateral bony margin of the acetabular roof on the plain radiograph indicates the antero-lateral portion of the acetabulum. The lateral edge of the sourcil indicates the lateral margin of the centro-lateral (mid-superior) portion of the acetabulum. The marking point on the lateral end of the sourcil reflects a dysplastic condition of the acetabulum, especially in the mid-superior portion of the acetabulum.
Acetabulum* ; Hip ; Hip Dislocation ; Humans ; Magnetic Resonance Imaging

The cement-free hip prosthesis coated with hydroxyapatite was developed to obtain primary firm fixation by an enhanced anatomic design and secondary biologic stable fixation by hydroxyapatite which is bioactive and has the same chemical and structural components with those of human bone tissue in total hip arthroplasty. Between January 1992 and June 1994, we used ABG cement free hip prosthesis (Anatomique Benoist Giraud, Howmedica Europe, Staines, England) in 28 hips (avascular necrosis of femoral head; 17, osteoarthritis; 6, posttraumatic arthritis; 3, rheumatoid arthritis; 2) of 25 patients in Pusan National University Hospital. Those cases had a minimum of two years and maximum of four years and five months (average three years and six months) of follow up, including analysis of the clinical and radiological data. The results were obtained as follows: 1. The average Modified Harris Hip Score increased from 51 points preoperatively to 96 points at last follow up. Almost all cases (97%) were excellent or good results in Modified Harris Hip Score. 2. In radiologic results, no migration of the cup, no change in the inclination of the cup, ar.d no oste-olysis around the cup and the stem were observed. Endosteal bone apposition around the cup was found in 54% of the cases and subcortical cancellous densification around the stem was found in 89%. This results indicate that we obtained direct and biologic firm fixation without fibrous tissue interposition between bone and metallic component by inducing on-growth of bone. 3. In the radiologic follow up according to the initial bone quality, it was demonstrated that the incidences of cortical hypertrophy, calcar resorption, and radiolucent line in type B and type C were higher than those in type A. The early clinical and radiological results of the cement-free hip prosthesis coated with hydroxyapatite are encouraging, although a longer follow up period is necessary.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Hip* ; Bone and Bones ; Busan ; Durapatite* ; Europe ; Follow-Up Studies ; Head ; Hip ; Hip Prosthesis ; Humans ; Hypertrophy ; Incidence ; Necrosis ; Osteoarthritis

No abstract available.
Cicatrix* ; Contracture* ; Forearm* ; Hand*

No abstract available.

The Ilizarov technique has been used successfully in the treatment of nonunion of long bone accompanied by infection, severe bone and soft tissue defects, and deformity. We report the results of treatment of 21 cases of nonunion using the Ilizarov technique. There were 20 males and 1 female with an average age of 34.2 years (range, 8-72 years). The average follow up period was 45 months (range, 12-74months). Infected nonunion(15/21 cases) was the most common cause of nonunion. The treatment methods include simple compression method(4 cases) and internal and external bone transport method(17 cases). Bony union was achieved in 20 cases out of 21 cases. One case is still having difficulty in achieving union. The mean time to union was 7.3 months in femurs and 6.3 months in tibias. The amount of bone defect that developed after the removal of infected bone fragments and soft tissue averaged 3.8cm (range, 2.3-9cm). The healing index, in cases of bone transport, was an average of 45 days per cm (range, 30-62 days per cm). Complications developed in 17 cases out of 21 cases. Pin site infection occurred in 5 cases, premature consolidation in ~1 case, angulation deformity in 2 cases, LOM of the knee in 2 cases, equinus deformity in 2 cases, ankle stiffness in 3 cases, and nonunion in 1 case. The Ilizarov technique is thought to be effective in the treatment of complicated nonunion combined with shortening, deformity, bone defect and infection. However, in order to reduce complications caused by the Ilizarov method, accurate surgical techniques and postoperative care are necessary.
Ankle ; Congenital Abnormalities ; Equinus Deformity ; External Fixators* ; Female ; Femur ; Follow-Up Studies ; Humans ; Ilizarov Technique ; Knee ; Male ; Postoperative Care ; Tibia

The conventional therapy for supracondylar fracture of the femur is open reduction and internal fixation with plate and screws. But, wide dissection of the thigh with the following devascularization of the distal femur caused a high incidence of complications like joint stiffness, delayed union, nonunion, infection and loosening or breakage of plate and screws. On the contrary, interlocking intramedullary nailing does not need the exposure of the fracture so that soft tissue dissection and devascularization can be minimized. Undoubtedly, rapid healing by abundant formation of callus is promoted, irrespective of the degree of comminution. We reviewed 9 cases of interlocking intramedullary nailing for supracondylar and intercondylar frtures of the distal part of the femur at Pusan National University Hospital from November 1993 to December 1995. The mean time to union was 14 weeks (range, 11-23weeks). According to Rating System of Neer et al., excellent was 7 cases, satisfactory in 1 case and unsatisfactory in 1 case. Interlocking intramedullary nailing was applied to Type A, C1 and C2 of the AO classification but considered difficult to apply to Type B and C3. For the firm fixation and the prevention of nail breakage, the nail should be inserted deepest in order to place two distal screws as distally as possible from the fracture site. If necessary the distal tip of nail was cut off for use. Interlocking intramedullary nailing does not need the exposure of fracture site. Satisfactory result could be obtained by reducing complications such as joint stiffness, delayed union, nonunion, infection and breakage of implants caused by wide dissection of the thigh with the following devascularization of the distal femur for the open reduction and internal fixation with plate and screws. It also could be obtained by performing early ROM exercise with firm, fixation.
Bony Callus ; Busan ; Classification ; Femur* ; Fracture Fixation, Intramedullary* ; Incidence ; Joints ; Thigh