Tibial tunnel placement during endoscopic anterior cruciate ligament (ACL) reconstruction has received increased emphasis in the recent literature. Tibial tunnel length is a factor that affect graft fixation, potential impingement, and graft abrasion. Appropriate tunnel length is a critical tecpnical consideration. A tunnel that is too long may make distal fixation and femoral tunnel placement difficult... A tunnel that is too short results in graft extrusion, necessitating supplemental fixation techniques. This grafl-tunnel mismatch can be avoided if fhe sum of the tibial tunnel length plus the intraarticular distance of ACL is equal to or greater than the graft tendon length plus 20mm (the minimum interference fixation possible when using the smallest available 20 mm long interference screw). Authors published an article to determine the reiationship between the length of patellar tendon and that of anterior cruciate ligament, to calculate the tibial tunnel length through the dissection of 19 cadaveric knees (ACL length (mm)=0.73 X Patellar tendon length-2.69 (p Anterior Cruciate Ligament ; Cadaver ; Humans ; Knee ; Patellar Ligament ; Tendons ; Transplants

Diabetes mellitus is one of troublesome disorder for the orthopaedic patient who should be operated on some other problems. Internist will advice and take care of them as far as diabetic problem is concern. However, orthopaedic surgeon should fully understand and follow every details about the condition of his own patient. Gamerin-Davalos hadclassified the diabetes mellitus into four types of potentiate, chemical and clinical diabetes. Potentiate form is not detectable at present method. The chemical and latent chemical forms are subclinical types and will be detected by the special examinations. In the orthopaedic practice, surgeon should keep in mind and perform proper tests for any suspecious symptomes or histories related to diabetes mellitus. Administration of insulin for the diabetes should be full doses but nerve be over-dosed. Neuropathy, vascular changes and infections are the common complications to diabetic patient and closely influence to the prognosis of major surgery. Ellenbery et al. had emphasized that the neuropathy is not a complication but rather a concomitant feature of diabetes mellitus. It may appear nerve root symptome to confuse with the herniated intervertebral disc. Vascualr change of the thickening of capillary basement membrane will causes gangrene of extremities and unexpected massive bleeding during surgery. Susceptibility of infection on diabetic patient is well known fact and in case of chronic osteomyelitis or tuberculosis of bone persist for long time without specific reason, surgeon should check once for the posibility of diabetes mellitus. Administration of any general anesthetic agents will elevate blood sugar level especially the ether, however, fluothane is a selective one at present. In case of surgery on diabetic patient, aceton uria and CO2 combining power should be checked closely for four to five days post-operatively. Blood sugar level should be kept slightly elevated during and post-operative period for diabetic patient. Surgeon should check his patient for any complications in case of increased dose of insulin is required post-operatively.
Anesthetics ; Basement Membrane ; Blood Glucose ; Capillaries ; Diabetes Mellitus ; Ether ; Extremities ; Gangrene ; Halothane ; Hemorrhage ; Humans ; Insulin ; Intervertebral Disc ; Methods ; Osteomyelitis ; Prognosis ; Tuberculosis

No abstract available in English.
Fractures, Bone

We reviewed 40 cases of femoral shaft fractures in children treated with split Russel traction and initial fracture angulation above 10 degree. The treatment of femoral shaft fractures in children is various according to age. Satisfactory results have been reported with split-Russel traction. At an average follow-up of 33 months, we obtained following results about remodelling of fracture site & physeal site, possible acceptable angulation of fracture. 1. The average time of traction was 18 days, and hip spica cast was applied for 28 days. 2. Malunion within 25degrees in flexion & 23degrees in valgus & 24degrees in varus was well corrected spontaneously. 3. Average correction of initial angular deformity was 86% at last follow up. 4. Anterior angulation was corrected at 83%, varus 87%, valgus 88%. 5. Remodelling according to direction of deformity was no statistical correlation (P>0.05), and then spontaneous correction of angular deformity was same without relation to direction of deformity. 6. Remodelling according to site was statistical correlation (P<0.05), fracture site 26%, physes 74%. And proximal physes 36%, distal physes 38%.
Child* ; Congenital Abnormalities* ; Follow-Up Studies ; Hip ; Humans ; Traction*

Divergent placement of the femoral interference screw has been described as a major pitfall in single incision endoscopic reconstruction of the anterior cruciate ligament. This study reviews the radiographic results in 30 consecutive endoscopic single-incision ACL reconstructions using interference screw fixation to find a method to reduce the divergent femoral screw fixation. We measured the angles which were determined by a line through axis of femoral bone block and axis of interference screw in anteroposterior and lateral view of knee(APD/LD),through axis of femoral tunnel and axis of tibial tunnel in the full extension-anteroposterior view(AFT),through the longitudinal axis of distal femoral shaft and axis of femoral tunnel in the anteroposterior and lateral view(APFT/LFT). Average LD(4.96+/-62degrees) was significantly larger than average APD(1.303+/-13degrees) (P=0.008). Significant correlation was present between APD and APFT(g=-0.3882, P=0.034), between LD and LFT(gamma=0.6933, P=0.000) and other variables had no significant correlation. The femoral divergence in the anteroposterior plane occurred in the case with small angle between longitudinal axis of femoral shaft and that of femoral tunnel, and vice versa in lateral plane. During drilling of femoral tunnel, more than 90 flexion causes LFT to increase and the risk of femoral divergence increases. Therefore, in the anteroposterior plane, angle between femoral tunnel and longitudinal axis of femoral shaft shoud be made as large as possible and flexion of knee should not be more than 90 during drilling of femoral tunnel.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Axis, Cervical Vertebra ; Knee ; Patellar Ligament*

There are many epidemiologic studies to find the relationship between disease occurrence and categorized exposure variables which are measured in continuous scales. Recently, it has been found that the differential misclassification can arise when exposure variables are observed with measurement errors and categorized for the analysis. Even though the differential misclassification leads to serious misclassification bias, there is no theoretical attempt to correct the misclassification bias occuring in these circumstances. In this paper, we propose a new statistical method to reduce the misclassification bias due to dichotomizing continuous exposure variables. Since the exposure values are more likely to be misclassified when the true exposure values are close to the cutoff point, the method proposed here gives smaller weights in these case and more weights when these values are far from cutoff point. Simulation studies are performed to compare the bias and the power of the proposed method compared to other methods. Main results are as follows: 1. The proposed method produces the smaller bias and the higher power than the simple method which modifies misclassified data using sensitivity and specificity of exposure misclassification. 2. When the standard deviation of the measurement error are moderately large, the bias and the power of the proposed estimate are somewhat better than those of the modified estimate which excluding the misclassified observations in the analysis. In conclusion, the method proposed here is found to be useful in epidemiologic studies when continuous exposure variables are obtained with measurement error and categorized in the analysis.
Bias (Epidemiology) ; Sensitivity and Specificity ; Weights and Measures

The analysis of 48 infants of congenital torticollis and the result of their conservative treatment are reported. The abnormalities of their neck were noticed by mothers within three months of infant life but mostly at three to four weeks. The ratio of male to female was 9:7 and incidence of right and left was 30 to 18. The mass located mostly(50%) at middle third of the sternocleidomastoid muscle belly. The prominence of incidence were noticed on the abnormality of fetal position in the uterus, mode of delivery and also on the baby of elderly primipara. About 67% of cases were breech(46%) and transverse(21%) position prenatally and 67% were delivered by forceps(41.7%), vacum and induction(12.5%each). The age of mother at delivery has close relationship between congenital torticollis with about two third of them are born of 29–34 year old mother and primipara infants were 61%. For the treatment, daily stretch exercises of affected sternocleidomastoid muscle was done by physical therapist for 20–30 times in two separate session. The effect can be noticed by the gradual correction of rotation deformity first and then the mass become soften and smaller. The next change is the correction of deviation deformity but the mass remain last. However, the mass remaining one fourth of original size was absorbed spontaneously without further treatment. The result of complete cure in ten weeks of treatment were 43(90%) out of 48 patients and the remianing five cases required for 15 weeks of treatment. In conclusion the congenital torticollis can be treated effectively by stretch exercises when it began within three months of age of the patient. A hundred per cent effect of cure may be obtained in ten weeks of treatment in case of initial treatment is begin within four weeks of age and required for 15 weeks of treatment on 4–12 weeks old infants.
Aged ; Congenital Abnormalities ; Exercise ; Female ; Humans ; Incidence ; Infant ; Male ; Mothers ; Neck ; Physical Therapists ; Torticollis ; Uterus

A case of osteochondritis dissecans of both knee joints is developed in 15 year old boy. Since the original articles of Paget, Koning and others were reported, many theories as to etiology and pathogenesis have been proposed but exact cause has been unknown. Many Joint may show evidence of osteochondritis dissecans but lateral aspect of medial femoral condyle of knee is by far the most frequent site. Under the diagnosis of osteochondritis dissecans of both knees with clinical symptoms and X-ray finding, the one was treated with excision of framents and curettage, and the other treated with drilling of fragments. In follow up study for one year, the result was good without any complaints.
Curettage ; Diagnosis ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Knee ; Male ; Osteochondritis Dissecans ; Osteochondritis

Two cases report on osteogenesis imperfecta tarda and review of literature has been made. The rare genetic disorder, osteogenesis imperfecta tarda is familiar to most orthopedic surgeons because of management of fracture and skeletal deformities, espicially bowing of long bone. Its clinical manifestations are known as bony fragility, blue sclera and deafness less frequently ligamentous laxity but its etiological factor is obscure; The basic defect is thought to involvement some abnormality of collagen. Recently the bony weakness caused by increased bony turnover rate. One case of osteogenesis imberrfecta tarda in 8 year old male was belonged to tarda type 1. (Falvo-classification), who could not walk due to marked anterolateral bowing of right tibia and the another to tarda type II. in 13 year old male with fresh fracture of right femoral shaft. The former was performed corrective multible osteotomy, realignment and intramedullary rod fixation for correction of bowing deformity of right tibia, and the later was managed the fracture of right femoral shaft with Russels traction and hip spica cast. The result of reported therapeutic mesure was good.
Collagen ; Congenital Abnormalities ; Deafness ; Fibrinogen ; Hip ; Humans ; Ligaments ; Male ; Orthopedics ; Osteogenesis Imperfecta ; Osteogenesis ; Osteotomy ; Sclera ; Surgeons ; Tibia ; Traction

In recent years the rate of the spine Injury tends to be on the increase year by year as the rate of traffic and industrial accidents are increased. During industrial, sports and automobile accidents are occurred, the various forces were exerted by the mechanism, “flexion, extension, flexlon-rotation, vertlcal compression and shearing.” These exercise their effects on the vertebral bodies, the neural arches and intervertebral disc and the contents of the spinal cord, depending on direction and intensity of the trauma, and the posture and muscular attitude existent at the movement. Once the neurological Iesion has been diagnosised and the type of vertebral injury has been established and particularly after a decision has been made as to whether the spinal injury is stable or unstable, a rational method of treatment can be decised upon: Our treatment consists of providing the best condition for recovery from the spine injury, preventlng further neurologlcal damage in the unstable area, achieving stable bone and llgament heallng ln satisfactory position, preventing metabolic compllcations from being fatal, mobllizing the patient early, and rehabilitating to provide maximum fuctlonal independence with the remaining-muscle power avallablc to the cord injury patient. One hundred and fifty seven spine fracture and dislocation patients were clinically observed and evaluated from Jan. 1972 to Dec. 1978 in our study. The result of this study may be summerized as follows: 1. Out of the patients, there were 135 male and 22 female cases. The ratio between male and female was 6.1:1. The majority (84.7%) of the spine injuries was found in the age of 20 to 50 years. Fifty-two percent of the cases was caused by industrial accidents. 2. The most common site of the lesion occurred between T-11 and L-2 vertebrae (71.8%). 3. In cervical injury, fracture dislocation type was most common (50%), and especially, pure dislocation by extension mechanism was 12.5% but in thoracolumbar iniury, simple anterior wedge compression fracture was most common (66.6%) and there were no pure dislocations just like cervical spine injury cases. 4. Fifty seven cases of the total were complicated by paraplegia, of which 62.5% in cervical region and 31.6% in thoracolumbar region were noticed. The most frequent type of the injury in which paraplegia developed was the fracture dislocation (73.8%) and the most common site of the lesion was between the T-12 and the L-2 vertebrae. 5. Open reduction was performed in 9 cases out of 24 cervical spine injury patients and in 41 cases out of 133 thoracolumbar injury patients. 6. Prognosis of neurologic recovery in initially complete lesion was poor, regardness of treatment. In the cervical lesion cases there were no patients who were recovered. But in the other sites about 10.5% of initially complete lesion showed partial neural recovery comparing to 62.5% of initially incomplete lesions. 7. Progressive deformity is often noted as a complication of spine fracture or dislocation when solid fusion fails to develop. The increment of kyphosis after treatment is as follows: Simple wedge fracture
Accidents, Occupational ; Automobiles ; Catheterization ; Catheters ; Clinical Study ; Congenital Abnormalities ; Diagnosis ; Dislocations ; Female ; Fractures, Compression ; Humans ; Intervertebral Disc ; Kyphosis ; Laminectomy ; Male ; Methods ; Paraplegia ; Posture ; Prognosis ; Spinal Cord ; Spinal Injuries ; Spine ; Sports ; Urinary Bladder