There are controversies in operative management of unstable fracture of fracture-dislocation of the spine. Posterior Stabilization is a good method and there are many benefits, such as the safety method, less complication, easiness to acquire more accurate reduction and more rigid fixation than other methods. Among 141 spinal injury patients who were admitted to this hospital from March, 1980 to November, 1985, twenty two cases of spine fracture and fractuar dislocation who were treated with surgical measures were evaluated and analysed. Our surgical measures were posterior wiring and fusion in cervical spine (7 cases), Harrington instrumentation with or without posterior fusion in thoracolumber spine (12 cases), and others (3 cases). Brief summary of the results is as follows: l. Eighty-six percent of angular deformity was corrected after posterior wiring and posterior fusion and 75%, after Harrington instrumentation, 73%, after Harrington instrumentation and posterior fusion. 2. Eighty four percent of displacement was corrected after posterior wiring and posterior fusion and 65%, after Harrington instrumentation, 71%, after Harrington instrumentation and posterior fusion. 3. Improvement of the neurologic status related to interval between injury and operation was 28% within 24 hours, 11% within a week. 4. No significant differences in the recovery of the neurologic signs were found according tothemethod of surgical treatments. 5. Except for the patients who were seriously compromised or required anterior decompression, immediate posterior stabilization is valuable to provide the better reduction, rigid fixation, promotion of recovery of neural function and early ambulation.
Clinical Study ; Congenital Abnormalities ; Decompression ; Dislocations ; Early Ambulation ; Humans ; Methods ; Neurologic Manifestations ; Spinal Injuries ; Spine

Diastasis of the ankle joints was associated with not only ankle fracture but also with ligamentous rupture. Since keeping anatomical reduction and giving secure stability to the injured ankle is the gole of the treatment for a good outcome, diastasis should not be overlooked from the first time. To obtain this goal, thorough understanding of diastasis and clear-cut diagnostic guide is important. Seventy one patients of ankle diastasis treated at Presbyterian Medical Center from Jan. 1979 to Dec. 1985 were analyzed in clinical and radiological aspect. The results obtained from this study were as followings. l. Among the 71 diastasis patients, male was predominantly 90%. The average age was 32 years old of age. 2. The main cause of diastasis was traffic accident (42 cases) and the other causes were falling from a height, sport injury in order of frequency. 3. In classification of the Lauge-Hansen, the most common mechanism that causes ankle diastasis was supination-external rotation (47.8%). 4. On the degree of the diastasis, complete type was 32.4%, and incomplete type was 67.6%. 5. 67.8% of the ankle injury patients developed ankle diastasis. 6. The average transfixation time was 11 weeks. 7. By the Meyers assessment, clinically 81.6%, radiologically 87. 3% good result can be obtained. 8. Good result could be achieved by early accurate diagnosis and proper operative intervention.
Accidental Falls ; Accidents, Traffic ; Ankle Fractures ; Ankle Injuries ; Ankle Joint ; Ankle ; Classification ; Diagnosis ; Humans ; Ligaments ; Male ; Protestantism ; Rupture ; Sports

Thiphalangeal thumb is characterized by interposition of an extraphalanx between the two normal phalanges of the thumb. The extra-phalanx varies from a small triangular bone to a normal phalanx in what appears to be a thumbless five fingered hand. Triphalangeal thumbs are divided into three types and the treatment differs from associated anomalies and clinical features. We had a bilateral triphalangeal thumbs treated by closed wedge osteotomy to the extra-phalanx.
Fingers ; Hand ; Osteotomy ; Thumb

Various methods have been used in the treatment of femoral shaft fractures in adults. In recent years, generally accepted two methods are intramedullary nailing and plate fixation. We followed and reviewed 121 cases of femoral shaft fracture in 116 patients, treated by operation in Orthopaedic Department, Presbyterian Medical Center, Chonju from 1980 to 1986. All cases were devided into 2 groups, intramedullary nailing(24 cases) and plate fixation (97 cases), and the two groups were compared each other. The results are as follows : 1. Most of intramedullary nails were used in relatively younger age group, before 50 yesrs of age. 2. The mean bony union time in plate fixation was 14 weeks and that in intramedullary nailing was 17.4 weeks. They showed about 3 weeks of difference. 3. In the group, whose operations were performed within 2 weeks after injury, showed high rate of bone union within 6 months, but in those whose operations were delayed more than 2 weeks showed marked decrease in bone union. And the rate of decrease was greater in plate fixation. 4. The recovery of knee joint motion above 110 was greater in intramedullary nailing (87.5%) than that in plate fixation(79.3%). 5. There was no difference in functional recovery between plate fixation and intramedullary nailing. 6. The complications, including delayed and nonunion, infection, metal failure, and limitation of knee joint motion, were more in plate fixation. 7. The risk of refracture is higher in plate fixation. Therefore plates must be removed after some period.
Adult ; Clinical Study ; Fracture Fixation, Intramedullary ; Humans ; Jeollabuk-do ; Knee Joint ; Protestantism

Experimental treatment by open reduction and internal fixation with modified tension band combined with external compression device was used for the patella fractures. Early post operative continuous passive motion and early weight bearing exercise was followed. This method was excellent for treatment of the patella fractures and prevention of post operative complications such as limitation of motion and post-traumatic arthritis of the knee joint. This experimental treatment was performed in 5 patients. and the results are as follows :1. Treatment by modified tension band combined with external fixator is useful for any type of the patella fracture. 2. By continuous passive motion and programed post operative rehabilitation, early painless recovery of wide range of motion of the knee joint and early weight bearing became possible. 3. Complications such as pain on motion, post-traumatic arthritis and limitation of motion of the knee joint was not seen. 4. This method is excellent for treatment of the patella fractures, and we are now trying to memodel the external fixator for cosmetic improvement and prevention of pin site problems.
Arthritis ; External Fixators ; Humans ; Knee Joint ; Methods ; Patella ; Range of Motion, Articular ; Rehabilitation ; Weight-Bearing

Authors clinically analysed the end results of the 58 elderly patients having fresh femoral neck fracture who were treated with multiple Knowles pinning, compression hip screw and femoral head replacement. All these 58 patients were treated between January 1982 and December 1986 at the Presbyterian Medical Center, Chonju. The factors that influenced the clinical results were analysed by type of fractures, early and late post-operative complications, quality of the fractured bone(osteoporosis), and functional evaluation with Jesse's hip grading method at least post-operative two year later. The results were summerized as follows : 1. The slip down was the most common cause of injuries. The transcervical type and Garden's type 153 was the most common type of fractures. 2. Average time interval between injury and diagnosis is 6 days. In case of delayed diagnosis, the fractures showed more displacement. 3. The osteoporotic change of femoral neck and spine was increased as physiological age advanced in parallel. 4. As the osteoporosis advanced, the fractures showed more displacement. 5. As the kosteoporosis advanced, the final results were worse, 6. The group treated with compression hip screw showed less complication and better functional result than patients operated with multiple knowles pinning. 7. This study suggests that the important factors that influenced the clinical results were type of fracture, the interval between injury and operation, method of trearment, and the quality of the fractured bone(degree of osteoporosis).
Aged ; Clinical Study ; Delayed Diagnosis ; Diagnosis ; Femoral Neck Fractures ; Femur Neck ; Head ; Hip ; Humans ; Jeollabuk-do ; Methods ; Osteoporosis ; Protestantism ; Spine

PURPOSE: Recently, incidental small renal tumors detected by computerized tomography(CT) or ultrasonography(US) have been increasing. Differentiation between the small renal cell carcinoma and benign tumorous lesions is often difficult. To reduce the unnecessary surgical interventions for these small renal tumors, we anayzed the radiologic findings of surgically removed small renal tumors(less than 3cm in diameter) and evaluated whether radiologic studies would predict their histologic findings. MATERIALS AND METHODS: Radiologic findings of 28 renal cell carcinomas(RCC), 7 angiomyolipomas(AML), 4 cysts including 2 multilocular cysts and 1 oncocytoma were analyzed, retrospectively. Density, contour, and heterogenity of the tumors on CT were evaluated, while echogenecity, posttumoral enhancement, peritumoral hypoechoic rim, and intratumoral cystic change on US were evaluated. RESULTS: Tiny fat density on CT was found in 4 of 7 AMLs and 1 of 28 RCCs. On US, 3 of 6 AMLs and 1 of 24 RCCs showed marked hyperechogenecity identical to the renal sinus fat. AMLs showed fat density in 4 of 7(57.1%) on CT and marked hyperechogenecity in 5 of 7(71.4%) on US, respectively. Two AMLs which showed hypoechogenecity and no fat density had less than 5% of fat on histologic examination while others had more than 30% of fat. All AMLs, oncocytoma and most RCCs(73%) showed exophytically out-bulging growth pattern while all benign cysts showed endophytic growth. Posttumoral sonic enhancement was found in 3 of 4 cysts and 1 of 24 RCCs. Peritumoral hypoechoic rim and intratumoral cystic changes were identified in 8 of 24(33%) and 7 of 24(29%) RCCs, respectively, while no such findings were detected in other tumors and cysts. CONCLUSIONS: Fat density on CT or marked hyperechogenecity identical to renal sinus fat on US strongly suggest angiomyolipoma, whereas endophytic growth pattern and posttumoral enhancement on US favor benign cyst. In the meantime, absence of above findings combined with peritumoral halo and/or intratumoral cystic change indicate renal cell carcinoma which should be explored.
Adenoma, Oxyphilic ; Angiomyolipoma ; Carcinoma, Renal Cell ; Retrospective Studies* ; Ultrasonography

PURPOSE: Recently, incidental small renal tumors detected by computerized tomography(CT) or ultrasonography(US) have been increasing. Differentiation between the small renal cell carcinoma and benign tumorous lesions is often difficult. To reduce the unnecessary surgical interventions for these small renal tumors, we anayzed the radiologic findings of surgically removed small renal tumors(less than 3cm in diameter) and evaluated whether radiologic studies would predict their histologic findings. MATERIALS AND METHODS: Radiologic findings of 28 renal cell carcinomas(RCC), 7 angiomyolipomas(AML), 4 cysts including 2 multilocular cysts and 1 oncocytoma were analyzed, retrospectively. Density, contour, and heterogenity of the tumors on CT were evaluated, while echogenecity, posttumoral enhancement, peritumoral hypoechoic rim, and intratumoral cystic change on US were evaluated. RESULTS: Tiny fat density on CT was found in 4 of 7 AMLs and 1 of 28 RCCs. On US, 3 of 6 AMLs and 1 of 24 RCCs showed marked hyperechogenecity identical to the renal sinus fat. AMLs showed fat density in 4 of 7(57.1%) on CT and marked hyperechogenecity in 5 of 7(71.4%) on US, respectively. Two AMLs which showed hypoechogenecity and no fat density had less than 5% of fat on histologic examination while others had more than 30% of fat. All AMLs, oncocytoma and most RCCs(73%) showed exophytically out-bulging growth pattern while all benign cysts showed endophytic growth. Posttumoral sonic enhancement was found in 3 of 4 cysts and 1 of 24 RCCs. Peritumoral hypoechoic rim and intratumoral cystic changes were identified in 8 of 24(33%) and 7 of 24(29%) RCCs, respectively, while no such findings were detected in other tumors and cysts. CONCLUSIONS: Fat density on CT or marked hyperechogenecity identical to renal sinus fat on US strongly suggest angiomyolipoma, whereas endophytic growth pattern and posttumoral enhancement on US favor benign cyst. In the meantime, absence of above findings combined with peritumoral halo and/or intratumoral cystic change indicate renal cell carcinoma which should be explored.
Adenoma, Oxyphilic ; Angiomyolipoma ; Carcinoma, Renal Cell ; Retrospective Studies* ; Ultrasonography

PURPOSE: To evaluate the prognosis of patients with paraquat poisoning by measuring the extent of lunginvolvement, as seen on HRCT. MATERIALS AND METHODS: Forty-one patients with paraquat poisoning were treatedaccording to our hospital's routine protocol and underwent HRCT scanning 1-21(mean 7-8) days later. In 31, theresults were abnormal, and these were retrospectively analysed. Differences in the extent of lung involvement,patient age, ingested amount of paraquat, and blood WBC count were compared between the group of survivors andthose who had died. RESULTS: Among the 31 patients with abnormal HRCT findings, 11 died and 20 patients survived.The extent of lung involvement among the group of survivors was 14.8+/-14.8%; among the deceased group, it was72.3+/-16.3%. The age of the survivors was 37.5+/-13.5(11-67) years, while that of the deceased was25+/-8.9(16-41)years. Those who died showed a significantly higher extent of lung involvement than the survivors,and were younger (p<0.05). There was, however, no significant difference in blood WBC count and ingested amount ofparaquat between the two groups (P>0.05). CONCLUSION: In paraquat poisoning, the extent of lung involvement onHRCT, is useful for prediction of the prognosis and severity of poisoning.
Humans ; Lung* ; Paraquat* ; Poisoning* ; Prognosis* ; Retrospective Studies ; Survivors

Preoperative clinical staging in the prostate cancer does not always accurately predict the surgical-pathological outcome. We evaluated how the clinical staging, and other clinical parameters including preoperative PSA and Gleason`s score could reflect on the surgicopathological findings in 30 patients with prostate cancer, who underwent radical prostatectomy. Twelve of 24 patients with clinical T1 or T2 disease were understaged by clinical staging determined by digital rectal examination, bone scan, and radiologic studies including CT and MRI with endorectal coil. MRI with endorectal coil accurately reflected the extracapsular disease only in 59.1% of 22 patients studied. At the same time, it also showed low sensitivity (50%) with high specificity (100%) in detecting lymph node metastasis. Preoperative levels of PSA in patients with P2, P3, and N+ disease were 17.8 +/- 4.5, 47.9 +/- 11.3, 93.5 +/- 20.5ng/ml, respectively. The level of PSA was less than 20ng/ml in 9 of 12 patients with P2 disease, while they were greater than 20ng/ml in 9 of 12 patients with P3 disease. PSA may have a role to rule out lymph node metastasis when its level is less than 10ng/ml, although it did not reach the statistical significance because of small sample size. Gleason`s scores in patients with P2 disease were quite similar to those in patients with P3 disease (5.92 +/- 0.69 vs 5.67 +/- 0.56), whereas Gleason`s scores in all 6 patients with N+ disease were 9 or greater. Neoadjuvant hormonal therapy with LH-RH analogue and androgen receptor blocker for 1.5 to 3 months had no impact on the reduction of margin positivity or downstaging in 10 patients. PSA failure rate in patients with P2 and P3 disease was 25% at 1 year after operation. PSA is a good marker for differentiating between P2 and P3 disease (,p=0.0214) and can safely rule out N+ disease if its level is below 10ng/ml, while Gleason`s score may reflect the lymph node metastasis when it is 9 or greater (p=0.0012). Among the candidates for radical prostatectomy, selection of the patients on the basis of PSA and Gleason`s score might improve the surgical-pathological outcome.
Digital Rectal Examination ; Gonadotropin-Releasing Hormone ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Prostate* ; Prostatectomy ; Prostatic Neoplasms* ; Receptors, Androgen ; Sample Size ; Sensitivity and Specificity