STUDY DESIGN: We analysed the pre-vertebral soft tissue measurements in cervical spine trauma patients. OBJECTIVES: We tried to determine the sensitivity and specificity of soft tissue measurements in patients with radiographically proven cervical spine fracture and to investigate the diagnostic value of the measurements. SUMMARY OF LITERATURE REVIEW: Widening of the pre-vertebral soft tissue is a well recognized sign in injury of the cervical spine. But the diagnostic value of this widening is still controversial. MATERIALS AND METHODS: Width of the prevertebral soft tissue on lateral cervical spine radiographs was measured for 52 patients with a history of cervical spine trauma and for 53 patients complaining of cervical discomfort without a history of trauma. As a normal Korean adult standard, 7mm at C2 level, 8mm at C3 level, and 16mm at C6 level were considered the upper limit. Width of the prevertebral soft tissue was measured as a distance between antero-inferior margin of the body of cervical spine and the most posterior border of the larynx and trachea. RESULTS: A C2 prevertebral soft tissue measurement of more than 7mm had a sensitivity of 35% and a specificity of 86%. A C3 measurement of more than 8mm had a sensitivity of 35% and a specificity of 72%. A C6 measurement of more than 16mm had a sensitivity of 30% and a specificity of 80%. CONCLUSIONS: The prevertebral soft tissue measurement seems to be of limited diagnostic value. Further study may be required to determine more acceptable limits of normal cervical spine measurement in Korean population.
Adult ; Humans ; Larynx ; Sensitivity and Specificity ; Spine* ; Trachea

79 patients with suspected H.N.P. of lumbar vertebrae were studied from June 1983 to June 1986 who had had both metrizamide myelography and computed tomography. Comparative study of the findings from clinical examination, CT and myelography of them are as follows. l. In physical examination, S.L.R.T. was most common sign, 58 patient(73.4% of study group) showed positive in S.L.R.T.(30~70 range). Of these positive patients in S.L.R.T. 41.4% was the patients who were younger than 30 years of age and also had pressure sign of nerve root on CT and myelography. These group showed highest positive rate in S.L.R.T. 2. In CT and myelographic study, the most frequent occurence of H.N.P. were seen in L4–5, L5–S1, L3–4 in order and myelography showed higher positive rate in L4–5 intervertebral space while CT showed higher positive rate in LS–S1. 3. On CT, facet joint arthritis or stenosis were seen in 49.4% of the study group and 53.7% of computed tomographic positive patients of H.N.P. 4. Corresponding rate of positive sign of H.N.P. between CT and myelographic findings were seen 71 intervertebral spaces, which means 84.5% of 84 positive spaces on CT and 88.8% of 80 positive spaces on myelography. 5. In 49 intervertebral spaces clinical sign, CT and myelographic findings were all positive. In another words 58.3% of 84 positive intervertebral spaces on CT and 61.3% of 80 positive spaces on myelography showed all positive sign on clinical examentation, CT and myelography. 6. L5–Sl intervertebral spaces showed most controversial results in comparative study of CT and myelography. 7. 25 of 26 positive spaces on CT(96.2%) and 23 of 26 positive spaces of myelography(88.5%) were confirmed by operation and all 3 false-negative on myelography were found in L5–Sl intervertebral space. 8. Most diagnostic differences were seen in L5–S1, which has wider epidural space. CT showed higher sensitivity than myelography in this study. For its higher sensitivity and non-invasiveness CT is thought to be first recommendable method for diagnosis of H.N.P. and myelography is recommended as second best choice where diagnostic differences are seen.
Arthritis ; Constriction, Pathologic ; Diagnosis ; Epidural Space ; Humans ; Lumbar Vertebrae ; Methods ; Metrizamide ; Myelography ; Physical Examination ; Zygapophyseal Joint

Elderly patient with Genu Varus deformity is commonly treated by high tibial valgus osteotomy to unload the stress concentration medially. Most of these procedures were performed by closing wedge osteotomies and that revealed some problems. Most require a fairly large scar and later reoperation for implant removal. The Ilizarov apparatus and Ilizarov's principles of deformity correction seem to offer several advantages over other methods of high tibial osteotomy. With the Ilizarov method, distractional open wedge technique offers a biomechanically sound, predictably accurate, and reproducible method of correcting an extremity's mechanical axis deviation. From December 1991 to December 1993 at the department of orthopaedic surgery, Pusan National University Hospital, 5 patients(7 tibia) underwent the operation of correction of the genu varum using Ilizarov external fixator for osteoarthritis. The results were summarized as follows: l. All case were female, and the Mean age was 58 years old. 2. Preoperative mean varus angle were 20° and postoperative mean valgus angle were 6° at final follow-up. 3. The complication was not detected includes limb length descrepancy. 4. Mean Ilizarov external fixator fixation period was 5 months. 5. The results after average 1 year 1 month of follow-up were as follows: Excellent in 2 cases(29%), Good in 4 cases(57%), Fair in 1 case(14%), Poor in 0 case()%). 6. The early clinical and radiologic results were encouraging, although a longer follow-up period is necessary.
Aged ; Busan ; Cicatrix ; Congenital Abnormalities ; External Fixators ; Extremities ; Female ; Follow-Up Studies ; Genu Varum ; Humans ; Ilizarov Technique ; Methods ; Osteoarthritis ; Osteotomy ; Reoperation

The sequential use of ⁹⁹mTc-methylene diphosphonate(⁹⁹mTc-MDP) and ⁶⁷Ga imaging is thought to be useful to diagnose acute hematogenous osteomyelitis, and to determine whether it is active or inactive in chronic osteomyelitis. We compared the results obtained by the sequential use of ⁹⁹mTc-MDP and ⁶⁷Ga imaging with those obtained by the surgical culture and biopsy in 31 patients who were supposed to have the osteomyelitis and admitted to Pusan National University Hospital from July 1987 to July 1989. The results were as follows:l. According to the diagnosis at discharge, 4 cases were normal, 20 cases active osteomyelitis, and 7 cases inactive osteomyelitis. 2. Four normal cases were negative both with ⁹⁹mTc-MDP and with ⁶⁷Ga. Twenty cases of active osteomyelitis showed positive results both with 99mTc-MDP and with ⁶⁷Ga. And of 7 cases of inactive osteomyelitis, 6 cases showed positive ⁹⁹mTc-MDP and negative ⁶⁷Ga, 1 cases was negative both with ⁹⁹mTc-MDP and with ⁶⁷Ga. 3. It is suggested that in active osteomyelitis both ⁹⁹mTc-MDP and ⁶⁷Ga were positive, in inactive osteomyelitis ⁹⁹mTc-MDP positive and ⁶⁷Ga negative and in normal or wastive ostemyelitis both ⁹⁹mTc-MDP and ⁶⁷Ga negative. 4. The sequential use of ⁹⁹mTc-MDP and ⁶⁷Ga imaging was particularly useful to diagnose acute hematogenous osteomyelitis in the case of the obscure diagnosis and supposedly normal radiological finding and to determine whether chronic osteomyelitis is active or complicated by an acute flare-up.
Biopsy ; Busan ; Diagnosis ; Humans ; Osteomyelitis ; Technetium Tc 99m Medronate

Soft tissue reconstruction of the hand remains a challenge for the hand surgeon, who must choose whether to use a local flap, a distant flap or a free flap. Local flaps, derived from tissue immediately adjacent to the primary defect, are the first choice. But there is a shortage of skin in the hand and there are regions of the hand that should not be used as donor sites since cover of the resultant secondary defect with a skin graft would be inappropriate. We used island flaps for the small soft tissue defects in the hand which were difficult to cover with a conventional skin graft or local flap. The results were as follows; 1. The causes of the soft tissue defects were traumatic amputation in 4 cases, camptodactyly in 4 cases, replantation in 3 cases, infection in 3 cases and tumor in 1 case. 2. The sites of the soft tissue defects were thumb tip in 6 cases, fifth finger PIP joint volar aspect in 3 cases, index tip in 2 cases, thumb volar and dorsal surface in 2 cases, third and fourth MP joint dorsal surface in 1 case, fourth finger PIP joint volar aspect in 1 case and first interdigital web space in 1 case. 3. The donor flaps were fourth finger neurovascular island flap in 8 cases, reverse dorsal matacarpal flap in 5 cases and first dorsal metacarpal artery flap in 4 cases. 4. The sizes of the flap were from 1. 0×1. 5cm to 2.0×4.0cm and and average of 1.5×2.0cm. 5. The flaps were survive completely with a touch sensat,ion except 2 cases which were covered by reverse 5th dorsal metacarpal flap.
Amputation, Traumatic ; Arteries ; Fingers ; Free Tissue Flaps ; Hand ; Humans ; Joints ; Replantation ; Skin ; Surgical Flaps ; Thumb ; Tissue Donors ; Transplants

No abstract available.
Hyperostosis, Sternocostoclavicular*

No abstract available.
Tibia*

Hips with residual subluxation after treatment of congenital dislocation of the hip in children who were admitted in department of orthopaedic surgery, Pusan National University Hospital, from January 1980 to October 1987, are investigated with clinical data, X-ray findings, classification and treatment. Hips with residual subluxation after treatment were followed most commonly by closed reduction and cast immobilization, 15 cases, and by innominate osteotomy, 5 cases. Conservative methods as broom-skick cast or abduction brace were done for the treatment of residual subluxation in all cases, except 2 cases of femoral osteotomies. Degree of improvement was determined by periodically measuring C–E angle, acetabular index, migration percentage and the distance from tear-drop to medial metaphysis of proximal femur. The results were as follow :1. Hips with residual subluxation after treatment were found most commonly after closed reduction and cast immobilization. 2. Residual subluxation was classified as Grade Zero to Grade three by measuring the distance from tear-drop to medial metaphysis of proximal femur. There was 12% of Grade I, 48% of Grade II and 40% of Grade III. 3. The mean normalization periods from Grade I to normal, from Grade II to normal, from Grade III to normal, were 14.7 months, 26.3 months, 37.1 months, respectively. 4. Thirteen cases which more than one and half years of follow-up were possible showed improvements in acetabular index from 30.5°to 22.9°, C–E angle from 5.7°to 25.4° and migration percentage from 34.4% to 18.8%, 5. There were relatively poor results in the hips with residual subluxation after innominate osteotomy.
Acetabulum ; Braces ; Busan ; Child ; Classification ; Dislocations ; Femur ; Follow-Up Studies ; Hip ; Humans ; Immobilization ; Osteotomy

We, at Department of Orthopedic Surgery, College of Medicine, Pusan National University, applied epiphyseal distraction as a method of limb lengthening, using unilateral one-plane pin fixator(ORTHOFIX) and bilateral multi-plane ring fixator(SEQUOIA) to three children with limb length discrepancies and angulation deformity due to injury of epiphyseal plate, and obtained following results. l. At first case, on whose distal femoral physis, bone bridge occupied about 20% of total epiphyseal plate and distributed mainly on the lateral side. At 10 days of distraction, epiphysiolysis occurred from the lateral side at first and angulation deformity was corrected. Epiphysiolysis on the medial side of physis appeared apparently after 60mm distraction. Bone lengthening of 4.2cm and correction of 25 valgus deformity were achieved after 72mm distraction for about 10 weeks. The percentage of increase in the initial length achieved was 11.67% and healing index was 27.86. 7 months later, loss of lengthening of 2.7cm was observed and it was considered that this was due to relatively short corticalization phase. 2. At second case, on whose distal tibial physis, bone bridge occupied about 40% of total epiphyseal plate and distributed on the medial side. At 10 days of distraction, epiphysiolysis occurred on the medial side of the epiphyseal plate, but not on the lateral side and instead of further lengthening, valgus deformity of the ankle appeared. It was thought that asymmetric distraction was attributed to the difference between the force applied on the medial side and that applied on the lateral side of the epiphyseal plate by unilateral one-plane pin fixation. 3. At third case, on whose distal tibial physis, bone bridge occupied about 75% of total epiphyseal plate. No epiphysiolysis occurred. there was a difficulty in observation of epiphysiolysis because ring fixator was overlapped with the epiphyseal plate on radiographs.
Ankle ; Bone Lengthening ; Busan ; Child ; Congenital Abnormalities ; Epiphyses, Slipped ; Extremities ; Growth Plate ; Humans ; Methods ; Orthopedics

No abstract available.
Calcaneus* ; Osteomyelitis*