It has been well known that the knee joint is burdened on motion and weight bearing and structurally, it is more frequently injuried than other joints. Injuries to the ligaments of the knee joint are of frequent occurrence because of the increasing traffics and popularity of sports. It seems to be impotant to study on the mechanism of Injury, method of physical examination and treatment of the Iigamentous injuries of the knee. The purpose of this paper is to get accurate diagnosis and proper treatment. 68 cases of ligamentous injuries in 65 patients who were admitted and treated at the Department of Orthopaedic Surgery of Hanyang University Hospital from May, 1975 to April, 1979 have been reviewed. The results of this study were as follows: 1. The ligamentous injuries of the knee were more prevalent in male 4.9 times than female; and frequently occured in 20 to 30 decades (60%). 2. Traffic accident was the most common cause, and the most frequent injury associated with the ligament injuries of the knee was fracture. 3. Medial collateral ligament was ruptured most frequently and its tibial attachement was the most common site of the rupture. 4. Frequently, lateral collateral ligament was detached from the fibular attachment, anterior and posterior cruciate ligaments were ruptured through their substances. 5. There were 3 cases of isolated cruciated ligament injury, one was anterior and others were posterior. 6. Excellent or good result was obtained in 77.3% by operative treatment and in 93.3% by nonoperative treatment. 7. Early repair (under two weeks) gave much better results than late repair.
Accidents, Traffic ; Clinical Study ; Collateral Ligaments ; Diagnosis ; Female ; Humans ; Joints ; Knee Joint ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Male ; Methods ; Physical Examination ; Posterior Cruciate Ligament ; Rupture ; Sports ; Weight-Bearing

To evaluate the radiographic characteristics of osteochondritis dissecans (OCD) and useful parameter for predicting mechanical stability, we retrospectively analysed 26 plain radiographic examinations and seven MR imagings in 28 cases of OCD in 24 patients. Typical radiologic findings were osteochondral defect with sclerotic rim of variable thickeness and osteochondral fragment. Sites of osteochondral defect were medial (35.9%) or lateral (32%) femoral chondyle and medial (7.1%) or lateral (25%) side of talar dome. Sclerotic rim was seen in 24 cases (85%) and osteochondral fragments including nine loose bodies were seen in 21 cases (75%). The size of osteochondral defect with unstable fragment (average 2.05cm) and loose body (2.04cm) in the knee joint were similar to, but statistically larger than that with stable fragment (1.35cm). All osteochondral defects were well visualized on MR images. Abnormalities of articular cartilage and effusion in the interface between the parent bone and fragment were seem in five cases of which there were confirmed three unstable cases arthroscopically. We conclude that size of defect may be a good parameter for predicting mechanical stability and MRI may be useful in the diagnosis of OCD and determining the methods of treatment.
Cartilage, Articular ; Diagnosis ; Humans ; Knee Joint ; Magnetic Resonance Imaging ; Osteochondritis Dissecans* ; Osteochondritis* ; Parents ; Retrospective Studies

Neurilemmomas of the extremities are nerve sheath tumors involving peripheral nerves of the extremities. We analyzed MR images of 16 surgically proved tumors in 12 patients and compared the MR images with gross pathologic specimens in two tumors (2/16). Spin echo T1-weighted images were obtained in all the patients but T2-weighted images were obtained in six patients with a gradient echo technique. Gadolinium dimeglumine enhanced T1-weighted images were obtained in 11 patients (15/16). Signal on T1-weighted images was iso or slightly higher than that of the adjacent muscles. Signal on T2-weighted images ranged from homogeneous high to heterogeneous. After Gadolinium injection, all the 15 tumors showed enhancement. Small sized tumors were enhanced homogeneously but there was a tendency tobe enhanced heterogeneously to the central portion with peripheral rim enhancement as the size of the tumors increased. Pathologically, the enhanced portion was correlated the with solid protion was correlated the with solid portion of the tumors. Also encapsulation of the mass (12/16), suspended nerve strings (9/16) and bony erosion (1/16) were detected. MR characteristics of neurilemmoma include heterogeniety on enhanced T1 and T2 weighted images, encapsulation, and suspended nerve strings. Signal heterogeneity on enhanced T1 and T2 weignted images may be attributed to the variable cellularity, cystic changes, vascularity and focal hemorrhage of the tumors.
Extremities ; Gadolinium ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Muscles ; Nerve Sheath Neoplasms ; Neurilemmoma* ; Peripheral Nerves ; Population Characteristics

Neurilemmomas of the extremities are nerve sheath tumors involving peripheral nerves of the extremities. We analyzed MR images of 16 surgically proved tumors in 12 patients and compared the MR images with gross pathologic specimens in two tumors (2/16). Spin echo T1-weighted images were obtained in all the patients but T2-weighted images were obtained in six patients with a gradient echo technique. Gadolinium dimeglumine enhanced T1-weighted images were obtained in 11 patients (15/16). Signal on T1-weighted images was iso or slightly higher than that of the adjacent muscles. Signal on T2-weighted images ranged from homogeneous high to heterogeneous. After Gadolinium injection, all the 15 tumors showed enhancement. Small sized tumors were enhanced homogeneously but there was a tendency tobe enhanced heterogeneously to the central portion with peripheral rim enhancement as the size of the tumors increased. Pathologically, the enhanced portion was correlated the with solid protion was correlated the with solid portion of the tumors. Also encapsulation of the mass (12/16), suspended nerve strings (9/16) and bony erosion (1/16) were detected. MR characteristics of neurilemmoma include heterogeniety on enhanced T1 and T2 weighted images, encapsulation, and suspended nerve strings. Signal heterogeneity on enhanced T1 and T2 weignted images may be attributed to the variable cellularity, cystic changes, vascularity and focal hemorrhage of the tumors.
Extremities ; Gadolinium ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Muscles ; Nerve Sheath Neoplasms ; Neurilemmoma* ; Peripheral Nerves ; Population Characteristics

The determination of the normal position of angiographic sylvian triangle was carried out in the 100 Korean subjects over the age of 12 in accordance with Vlahovitch's method for the clinical purpose of evaluating distorsion and displacement of the sylvian triangle in the pathological condition. And each measurement of the anterior and posterior extremities and inferior point of sylvian triangle was compared with the determination by Vlahovitch. The following results were obtained: 1. The anterior extremity of sylvian triangle was close to or on the line MM in the great majority, showing the mean location at 0.89+/-2.69 mm in front of the line. The posterior extremity of sylvian triangle revealed more variable position, at 9.60+/-7.94 mm posterior to the line AA The inferior point of sylvian triangle lies at the junction of one-fourth of AA and one-third of AO with variation of 2.21+/-2.43 mm above the line of one-fourth of AA and 2.28+/-2.04 mm posterior to the line of one-third of AO. 2. Angles of sylvian triangle: Anterosuperior angle:76.28((P-95(12.77(). Posterior angle:27.91((P-95(6.81(). Inferior angle:73.73((P-95(12.49(). 3. Height of sylvian triangle: One-fourth the hemispheric height. 4. Length of superior insular line: One-third the hemispheric height. 5. Distance of superior insular line from external meatus along the hemispheric height: One-half the hemispheric height.
Extremities

Following is a case report of giant cell tumor of the metacarpal bone of rlght thumb treated with surgical method. The metacarpal bone except both articular surfaces was excised and replaced with an autogenous iliac bone graft. The graft bone was fixed with 3 Kirschner's wires and the thumb was immobilized with plaster cast. There has been no evidence fo recurrence during the 6 years following and function of the hand is normal.
Casts, Surgical ; Giant Cell Tumors ; Giant Cells ; Hand ; Methods ; Recurrence ; Thumb ; Transplants

The authors have treated 30 cases of trochanteric fracture of the femur from June 1987, to July 1988 at Dong Suwon General Hospital. The 30 cases included, 8 Condylocephalic Kuentscher nailing, 9 Ender nailing, 7 Multiple pinning, 5 Antegrade Kuentscher nailing and 1 Row plating. 1. The shape of condylocephalic Kuentscher nail should be designed differently, contoured circular arc in anteroposterior and angled in lateral plane. In the anteroposterior plane : The length of the radius of the arc is measured by following way. 1) Design the shape of the nail on the X-ray film of the normal femur which was taken in full internal rotation of the leg. 2) Make three points in the femoral film. One is A, midcentral point of the femoral canal of the isthmus. Point B is center of upper lateral quadrant of the femoral head. Point C is apart from medial cortex 5-7mm at the level of entry portal of the nail. 3) Make point D: Draw the perpendicular lines from the right middle of the AB and AC. These lines meet at the point D. AD is radius of the arc of nail. Draw an arc measuring by the length of AD and mold the nail following the arc. In the lsteral plane ; The nail is bent into three or four segments and the length of the longest segment should not be exceeded the permissible length of straight nail, the latter is distance from entry portal of the nail to anterior cortex of the femur where the tip of the inserted nail is impinged, about 15cm. 2. Two different types of the Ender nailings are used depend on the type of the fracture. In intertrochanteric fracture, the trochanter is remained in the distal fragment and acts as the crane post to fix the proximal fragment(interfragmental compression screw fixation) by horizontal screw inserted through the lateral cortex of the distal fragment into medial cortex of the proximal fragment and fixed with another screw inserted into the distal fragment by tension band wiring. In transtrochanteric frscture, the proximal fragment is fixed by two different kinds of the nails, prior to the nailing medial displacement of the distal fragment is not reduced. The first nail is driven along the medial wall of the medullary canal of the distal fragment, the tip of the nail comes out of the fracture site and impinges to the inferomedeial aspect of the head along the out side of the neck. The nail is inserted into the head after correction of nail direction. The second and third nails are inserted through the medullary canal of the fragments. The proximal fragment is fixed between two nail groups. 3. Antegrade Kuentscher nailing is used for undisplaced trochanteric fracture with segmental fracture or comminuted, segmental subtrochanteric fracture. The open reduction and fixation is preferable in comminuted segmental subtrochanteric fracture for its accurate reduction. The authors msde additional several holes, transverse, sagittal (at the dorsum of the nail) oblique holes around the nail, so the interlocking screw can be easily inserted to the nail when the insertion of the screw through the transverse holes are difficult. 4. It's extremely important to study the fracture carefully when the surgeon plans to use the multiple pinning for trochanteric fracture. The fracture configuration has to be determined in regard to expect stability after local pinning especially in lateral plane. The fracture is fixed by horizontal pin, low angle pin, curved buttress pin(or screw) solidly, not parallel as in neck fracture. The curved buttress rush pin should be inserted as acting as the anteromedial or posteromedial buttress.
Femur ; Fungi ; Gyeonggi-do ; Head ; Hospitals, General ; Leg ; Neck ; Radius ; X-Ray Film

Cervical plexus block has been evaluated clinically for surgery of the anterior neck in 13 patients during the 10 months(from July 1981 to April 1982) at the Department of Anesthesiology in Capital Armed Forces General Hospital. We have assessed CPB for technique, onset, anesthetized area, duration, complication and supplimentary agents, and reviewed the anatomical aspects of cervical plexus. The distribution of injected local anesthetics was demonstrated under radiography using Urographin. We experienced incomplete block in 9 cases which needed substitution with Thalamonal. The incidence of complications was few and most significant complication seen in this study was respiratory difficulty. However, There was no evidence for phrenic nerve paralysis. Cervical plexus block was performed safely and effectively for surgery of the anterior neck.
Incidence

BACKGROUND/AIMS: Although alcohol withdrawal syndrome (AWS) is often developed in the patients with alcoholic liver disease, the studies about which clinical factors are associated with the development of AWS have been rarely studied. The aim of this study was to reveal clinical factors indicating a higher risk for the development of AWS at admission. METHODS: The retrospective case-controlled study was conducted among patients with alcoholic liver disease. The cases were divided into two groups according to whether AWS was developed or not. We compared their past medical history, physical examination and laboratory data at admission. RESULTS: AWS was significantly developed in patients who had experienced AWS in the past, increased serum chloride concentration at admission. CONCLUSIONS: It is possible to predict the patients who are more likely develop to AWS by means of past medical history and a serum biochemical test at admission. We suggest more intensive therapy will be required to prevent the development of AWS in these patients. These results are preliminary and need further prospective development and validation, particularly regarding the variety of variables.
Alcoholics* ; Case-Control Studies ; Humans ; Liver Diseases, Alcoholic* ; Physical Examination ; Retrospective Studies

BACKGROUND: On previous reports, the incidence of hepatitis C in Korean leprous patients is too high (55.6~69%). We investigated the percentage of the leprous patients with hepatitis C, genotypes, and risk factors in National Sorokdo Hospital. METHODS: Out of total 714 leprous patients in National Sorokdo Hospital, 147 selected risky patients (with abnormal AST/ALT, platelet Blood Transfusion ; Female ; Genotype* ; Hepacivirus ; Hepatitis C* ; Hepatitis* ; Humans ; Incidence ; Leprosy ; Leprosy, Lepromatous ; Leprosy, Tuberculoid ; Male ; Risk Factors* ; Tattooing