No abstract available in English.
Fractures, Bone

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

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

In our review of 36 hematogenous osteomyelitis nine cases were subacute form. Distal tibia was the most commonly involved location(four of nine patients). According to the modified Robert's classification cross-physeal lesions were the most common type(four of nine patients). In most of the cases the clinical findings and laboratory data were not much helpful for current diagnosis. Four patients had radiographic findings similar to those of tumors such as Ewing' s sarcoma, osteoid osteoma or bone cyst. Magnetic resonance imaging was useful in the identification of early lesions. In three patients Staphylococcus aureus was isolated by bacterial culture of biopsy specimen. In the remaining six patients diagnosis was made by histological evaluation. All patients except one were treated by curettage and antibiotics. In the other patient the disease showed a tendency of spontaneous healing without operative intervention and antibiotics. Cross-physeal lesion seemed to be a typical finding of the subacute osteomyelitis.
Anti-Bacterial Agents ; Biopsy ; Bone Cysts ; Child ; Classification ; Curettage ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Osteoma, Osteoid ; Osteomyelitis ; Retrospective Studies ; Sarcoma ; Staphylococcus aureus ; Tibia

For measurement of the degree of osteoporosis, various methods have been used. The Saville's index of the lumbar spine is very simple method. With the object of studying the reliability and clinical usefulness of Saville's index, authors compared the Saville's index with anteroposterior(A.P.) and lateral Dual x-ray absorptiometry, and the Singh's index with the anteroposterior D.X.A. We took the D.X.A. and simple lumbar spine lateral view in 124 patients in same time and also performed D.X.A. and both hips anteroposterior views in 112 patients, then analyzed the correlation between the A.P. and lateral D.X.A., Saville's index and D.X.A., Singh's index and D.X.A. The results were as follows. 1. The correlation coefficient of the A.P. and lateral D.X.A. was 0.46 and appeared the low degree of correlation. 2. The correlation coefficient of the A.P. and lateral D.X.A. compared with Saville's index were 0.68 and 0.83, respectively. Saville's index appeared the higher correlation in lateral D.X.A. than A.P. D.X.A. 3. The correlation coefficient of Singh's index and D.X.A. was 0.84, appeared nearly the same results of Saville's index with lateral D.X.A. 4. Intrapersonal differences were 36% in Saville's index, 28% in Singh's index. Saville's index appeared higher intrapersonal error than Singh's index. The lateral D.X.A. is more accurate and precise method than A.P. D.X.A. because lateral D.X.A. reduces the influence of soft tissue calcification and degenerative changes of spine. As Saville's index is a grading method based on lateral view of lumbar spine, we think that it should be compared with the lateral D.X.A. Regarding this results, authors suggest that Saville's index is not any accurate measurement of bone quantity, but has clinical usefulness for evaluation of osteroporosis.
Absorptiometry, Photon ; Bone Density ; Hip ; Humans ; Methods ; Osteoporosis ; Spine

Arthroscopically assisted anterior cruciate ligament(ACL) reconsturction provide a technique with less morbidity, less pin, less sacr, lower ris k of sepsis. The magnification offered by arthroscopic visualization also provide a clearer view, more precise location of anatomical landmarks, and the ability to place the graft in the exact anatomic sites. However, in order to accomplish all these goals, the surgeon must possess a high level of psychomotor skills, which take time and practice to develop. Wile this learning curve is being completed, there are occasion when complications will occur, and, realistically these may be difficult to avoid. The purpose of this study is to evaluate author's cases in which complication occurred during the endoscopic one-incision ACL reconstruction using the patellar tendon and to offer some tips on how to avoid them and how to salvage the situation if they do occur. We reviewed 22 complications (11 patients) out of 40 ACL reconstructions performed between May 1994 and December 1995. The complications were divergence(6), graft-tunnel mismatch(5), too anterior tibial tunnel(3), too anterior femoral tunnel(2), too posterior femoral tunnel(2), rotation of screw around the graft(2), guide pin breakage(1), bone plug retraction into the joint(1). It is suggested that arthroscopist should constantly try to avoid the intraoperative complications of arthroscopically assisted ACL reconstruction and follow the precautions and preventive measures recommended.
Intraoperative Complications ; Knee ; Learning Curve ; Patellar Ligament ; Sepsis ; Transplants

Many types of meniscal anomalies were reported. Authors found a double-layered lateral meniscus, with one meniscus overlying another. The 39-year old male patient had torn medial and lateral menisci. We performed partial medial and lateral meniscectomy, and incidentally found that lateral meniscus was double-layered. It was characteristic that the upper small accessory meniscus was firmly connected from the posterior horn to middle segments of the lower main meniscus along its peripheral edge. We left it alone. The symptoms were gone, So, it was thought that this anomaly was not related to the patient's symptoms.
Animals ; Horns ; Humans ; Male ; Menisci, Tibial

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*

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