No abstract available.
Diffusion of Innovation ; Humans ; Learning Curve ; *Orthopedic Procedures/adverse effects

Cervical spinal stenosis can be diagnosed indirectly by measuring the anteroposterior diameter or Pavlovs ratio in simple cervical spinal radiographs. The purposes of this study were to assess the trasverse areas of the spinal canal,the dural tube and the spinal cord of the cervical spine of normal adults by magnetic resonance imaging (MRI), and to find the possible correlationship among the MRI results. T1-weighted MR images of the cervical spine of 100 normal adults were evaluated by measuring the transverse areas of the three structures in the axial plane. The maximal transverse areas of the spinal cord was 84.5mm2 at C5 and the minimal transverse areas of the dural tube and spinal canal were 153.6mm2 and 232.4mm2 at C6, respectively. The transvere areas of the spinal canal correlated better with the dural tube areas than with the spinal cord areas. The areas of the spinal canal, the dural tube and the spinal cord in MRI correlated better with the sagittal diameter than with the Pavlov's ratio in simple lateral radiographs.
Adult* ; Humans ; Magnetic Resonance Imaging* ; Spinal Canal* ; Spinal Cord* ; Spinal Stenosis ; Spine

Stenosing peroneal tenosynovitis is one of the rather common causes of pain and disability following calcaneal fracture. In practice, however, attention is focused on fracture healing and the development of subtalar degenerative arthritis, and impingement or adhesion of the peroneal tendons within their sheaths due to bony protrusion or distorted anatomy resulting in disability and pain on weight bearing is too frequently overlooked. We diagnosed and treated four cases of stenosing peroneal tenosynovitis, three of which were associates with subtalar arthritis, in a relative short period of time. We proposed that orthopaedists treating calcaneal fractures be aware of this entity as distinct causes of pain.
Arthritis ; Fracture Healing ; Osteoarthritis ; Tendons ; Tenosynovitis ; Weight-Bearing

In Korea, owing to effective vaccination, occurences of poliomyelitis begen to decrease rapidly from 1964 and in recent years less than 10 cases of acute infection are being reported annually. However, patients crippled with poliomyeltis residua, mainly the legacy of the many epidemics of 1950s, and early 1960s, are many and pose a social and national problem as well as a personal and family ordeal. We reviewed 536 patients with residual poliomyelitis admitted and treated at Seoul National University Hospital during the past 18 years, from 1963 to 1980 They were divided into four chronological groups; the first, 1993 to 1968, the second 1968 to 1973, the third, 1974 to 1977, and the fourth, 1978 to 1980, In each group, based on in-patient records, and out-patient records, epidemology, deformities, and treatment were extensively reviewed. The followings are the outcome of this investigation 1. The male-to-female ratio was 53.7%: 46.3%, The male majority, distinct in the first group with 63. 7%, became less conspicuos in the fouth group with 50. 3%. 2. Average age oe admission, which was 10. 7 years in the first group, had increased decidedly to 17. 8 years in the fourth group. 3. The age of onset was most frequent between 1 to 2 years with 45.8% and next frequent between 7 to 12 months with 23. 5%. The ages below 5 years occupied 97. 6% of the cases. 4. The year of onset was most frequent from 1961 to 1963 with 28.7%. The incidence markedly and steadily decreased thereafter. 5. 94. 5% of the cases were unvaccinated. The remaining cases, except one, had had incomplete vaccination. 6. Fever, with 74. 0% was by far the most frequent initial symptom. Vomiting and diarrhea were the next frequent symptoms. 7. Of the 60% of the patients who had had any previous treatment, 25. 9% had operations and 20. 4% had braces and crutches. 8. Average number of admissions per patient were 1. 7 and average number of operations were l. 9. Average length of hospitalization was 39. 2 days. 9. 23. 6% of the patents had hip deformities, of which flexion defermity was most frequent with 4. 7%. Soutter fasciotomy or Campbell operation was employed in order to correct flexion deformity. In the earlier groups, Mustard operation, Sharrard operation, Ober-Barr operation, and pem-berton osteotmy were commonly practiced, whereas in the later groups, Thomas-Thompson-Straub operation, combined Thomas-Thompson-Straub and Ober-Barr operation, Salter osteotomy, Chiari osteotomy, Steel osteotomy were favored. 10. 45.2% of the patients had knee and leg deformities, of which flexion deformit; was most frequent with 14.5%. Flexion-valgus-external rotation deformity and flexion-valgus deformity with 4.6% and 4.5%, respectively, followed next. 11. 83. 9% of the patients had foot and toe deformities, of which equinovarus deformity occupied 6. 5% equinovalgus deformity 6.8%, and clawing of great toe 25. 2%. Triple arthodesis was done most frequently with 45. 9% of the cases, or 282 feet. Jone's operation or its modification, Tendo Achilles lengthening, plantar fasciotomy, and Peroneal tendon transfer were also frequntly performed. 12. There was leg length inequality in 90%. of the cases, Epiphysiodesis and femoral shortening were carried out, except for 4 cases of stapling in the earliest group, and femoral lengthening was done in 3 cases. 13. Spineal deformity was found in 19.7 % Of the cases, of which scoliosis was most freqent with 11. 5%. 7% of the cases had pelevic obliquity. Lumbodorsal fasciotomy, and postrior spinal fusion with Harrington instrument were carried out in order to ameliorate these deformities. 14. Deformities in the upper extremity were found in 3.6% of the patients. Procedures carried out inclulded shoulder fusion, Saha's operation, Steindler's flexorplasty, sternocleidomastold transfer, wrist fusion and opponensplasty, etc. 15. Generally, there was marked improvement of disability after treatment. The patients having moder.ate to severe limping decreased from 41.3%, preoperatively, to 25% after operation.
Age of Onset ; Animals ; Arterial Switch Operation ; Braces ; Clubfoot ; Congenital Abnormalities ; Crutches ; Diarrhea ; Fever ; Foot ; Hip ; Hoof and Claw ; Hospitalization ; Humans ; Incidence ; Knee ; Korea ; Leg ; Leg Length Inequality ; Male ; Osteotomy ; Outpatients ; Poliomyelitis ; Scoliosis ; Seoul ; Shoulder ; Spinal Fusion ; Steel ; Tendon Transfer ; Toes ; Upper Extremity ; Vaccination ; Vomiting ; Wrist

Congenitial elevation of the scapula, more commonly referred to as Sprengel's deformity, first was described by Eulenberg in 1963. After then, many authors have reported this abnormal condition and many surgical spproaches have been described. When evaluating a patient with congenital elevation of the scapula for surgical correction, cosmetic severity, functional impairment, associated congenital anomalies and the child's age should be consicdered. Since July, 1981, we have tried surgical correction in 8 patients with this deformity, and followed up for more one year except one patient. 6 patients between 3 years and 11 years of age were trested with Green's operation, and 2 patients, 22 years and 26 years of age were treated with supraspinous portion resection only. All of 7 patients, whose follow-up period is more than one year, gained more thsn 1 grade of cosmetic improvement, mean 17 of combined abduction and mean 1.6 cm of acspular lowering. Keloid formation was most common complication and was prevented by meticulous subcutsneous and subcuticular suture. Brschial plexus palsy was most serious complication and was prevented by avoiding overcorrection or by clavicular osteotomy or intraoperative EST.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Keloid ; Osteotomy ; Paralysis ; Scapula ; Sutures

No abstract available in English.
Clinical Study

The authors have reviewed 63 resistant clubfeet of 40 patients who were treated by modified Turco's operstion at the Department of Orthopaedic Surgery, Seoul National University Hospital during the eight years period from July, 1979 to June, 1987. The procedure performed by the senior author(D.Y.L.) is essentially similar to Turco's original technique, but with the following modifications :(a) A curvilinear skin incision instead of Turco's straight oblique incision. (b) Aponeurotic tenotomy of the abductor hallucis. (c) Medial capsulotomies of the first metatarso-medial cuneiform joint, medial cuneiformnavicular joint and release of the medial extension of the tibialis anterior insertion. (d) Z-plastic lengtening of the tibialis posterior tendon instead of tenotomy (e) Plantar fasciotomy The average age at the time of operation was 23.4 months, the youngest being 4 months and the oldest being 6 year and 7 months. The follow-up period was minimum 12 months and maximum 6 years, the average being 27.4 months. The cases were analysed radiologically and clinically, and following observations were made. l. AP and lateral talocalcaneal angles were corrected satiafactorily in 60 feet(95%) and 59 feet(94%), respectively. The Talocalcaneal indices were corrected satisfactorily to over 40 in 60 feet(95%). 2. The talo-first metatarsal angles, which reflect adduction of the fore-foot, were corrected satisfactorily to within +10°in 55 feet(87%). 3. Good and fair results were obtained in 54 feet(86%) in the radiological evaluation. 4. Adduction deformity of the forefoot was responsible in most cases of radiologically unsatisfactory results. 5. Among 40 feet of 26 pstients who were evaluated clinically by the Wynne-Davis method, 33 feet were rated good and 7 feet were rated fair. No poor results were found clinically. 6. Senior author's modification of additional forefoot medial release is an important addition to Turco's original technique and effectively reduced unsatisfacotory results.
Clubfoot ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Humans ; Joints ; Metatarsal Bones ; Methods ; Seoul ; Skin ; Tendons ; Tenotomy

Stabilization of the unstable spine created by the posterior decompression is as important as the decompression itself in the treatment of spinal stenosis. The purpose of this study is to evaluate the effectiveness of C-D pedicle screw fixation in stabilization after lumbar decompression, in reduction of spondylolisthesis and in restoration of the lumbar sagittal curvature. C-D pedicle screw fixation was performed in 102 spinal stenosis patients after posterior lumbar decompression and fusion during the period from March 1987 to December 1988. Their age ranged from 15 to 72 years with an average of 49.1 years. There were 34 males and 68 females. The follow up was from 6 to 21 months with an average of 12.5 months. The causes of spinal stenosis were degenerative in 50 patients, spondylolisthesis in 39, iatrogenic in 9 and degenerative lumbar scoliosis in 4. Objective clinical results showed significant improvement of claudication, SLR limitation, motor weakness, sensory and DTR changes in most patients. Following results were obtained from the study of C-D pedicle screw fixation after posterior decompression in lumbar spinal stenosis.1. C-D pedicle screws provide the secure fixation that allows early ambulation and shorter hospital stay. 2. C-D pedicle screws enable the reduction of spodylolisthesis at the time of posterior stabilization. 3. C-D pedicle screw fixation is successful in the restoration and maintenance of sagittal curvature of the lumbar spine. 4. C-D pedicle screw fixation enables the correction of scoliosis at the time of posterior decompression.
Decompression ; Early Ambulation ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Pedicle Screws ; Scoliosis ; Spinal Stenosis ; Spine ; Spondylolisthesis

Metaphyseal Chondrodysplasia is a disease characterized by metaphyseal ossification leading to shortening of stature. The extremities, especially lower, and mainly affected, resulting in a disproportionate drarfing which spares the trunk. The first case was reported in a patient with irregular metaphysis of lower extremities and hands, and severe shorteness of stature by Murk Jansen in 1934. A milder form of Metaphyseal Chondrodysplasia was noted in 1949 by Schmid, which is more common and transmitted in autosomal dominant. Mckusick recently reported another form of Metaphseal Chondrodysplasia, and other types were reported, but they are extremly rare, and of little clinical significance. In the Schmid type, patient is normal at birth, but characteristically shortness of stature, bowed leg, and waddling gait developed at biginning of walking. Ali labratory findings including serum calcium level, phosphorous, alkaline phosphatase, renal function test is normal in Metaphyseal Chondrodysplasia. The most difficult differential diagnosis is Vitamin D-resistant rickets in clinical and x-ray findings. The only treatment is careful observation and properly timed corrective surgery. Authors experienced on case of Schmid type of Metaphyseal Chondrodysplasia which had been treated with Vitamin D under impression of rickets for 1 year before the case was consulted to Orthopedic Department. Proximal tibial osteotomy and subtrochanteric valgus osteotomy were performed for the correction of genu varum and coxa vara deformity with satisfactory results for one year follow up.
Alkaline Phosphatase ; Calcium ; Congenital Abnormalities ; Coxa Vara ; Diagnosis, Differential ; Extremities ; Follow-Up Studies ; Gait ; Genu Varum ; Hand ; Humans ; Leg ; Lower Extremity ; Orthopedics ; Osteotomy ; Parturition ; Rickets ; Rickets, Hypophosphatemic ; Vitamin D ; Walking

No abstract available in English.
Arthritis, Infectious ; Dislocations ; Hip