No abstract available.
Korea* ; Orthopedics*

Forty nine cases of the proximai tibial metaphyseal fractures treated and managed at the Department of Orthopedic Surgery, Severance Hospital from Jan. 1971 to Dec. 1980 were analysed in inclinical and radiological aspect. The results obtained from this study were as followings: l. Among the 49 patients, male were 30 patients and female 19 patients (M:F=1.6:1). 2. The main cause of the fractures was the traffic accident, 42 cases (85.7%). 3. The most common type of the fractures was the transverse fracture, 21 cases (42.9%). 4. The better prognosis of the treatment was the closed reduction. 5. The better prognosis of the fracture type was shown in the transverse fracture and the poor prognosis was in the anterior long oblique fracture. 6. In the union time of the fracture, there was no significant differences between the proximal tibial metaphyseal fracture and the tibial shaft fracture.
Accidents, Traffic ; Clinical Study ; Female ; Humans ; Male ; Orthopedics ; Prognosis ; Tibia

We performed twenty three cementless total hip arthroplasties(THA) on seventeen patients, all of whom were diagnosed with steroid-induced avascular necrosis of the hip (AVN). The average age of the patients was 41years, mean follow-up period was 41months (24-74months). The final average Harris hip score was 94 and overall results were excellent. On radiographic evaluation, 17 femoral components met the criteria for bone ingrowth(spot weld) but it was somewhat delayed. There was no evidence of loosening of the femoral and acetabular components. The results of this study suggest that long term steriod treatment does not prevent bone ingrowth. Cementless total hip arthroplasty appears to be a reasonable therapeutic option for steroid-induced avascular necrosis of the hip.
Acetabulum ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Hip ; Humans ; Necrosis

The head patient with musculoskeletal trauma is a challenge to the orthopedic surgeon and its incidence is increasing markedly with the development of modern culture and a high velocity motor vehicle. So, for the purpose of studying the difference between lower extremity fracture concomitant with head injury and only lower extremity fractured patients, we studied the radiologic bone union time, serologic test and heterotopic ossification. For the control group we analysed each 10 patients of only femur and tibia fractures. The following clinical results were obtained by analysis of 46 patients of lower extremity fracture concomitant with head injury, experienced in the Department of Orthopedic Surgery, Yonsei University College of Medicine in past 5 years from Jan. 1980 to Dec. 1984. 1. The mean age was 24.5 yrs old (2~6 yrs old) and the prevalent age was 1st and 3rd decade, and the sex ratio between males and females was 2.8: l. 2. The most common mode of injury was auto-pedestrian injury (84.8%) and the other was falling down injury(15.2%) . 3. The common brain injuries were cetebral contusion with skull fracture (37.0%) and cerebral contusion only(34.8%) . Among 26 patients whos mental states were not alert, 23 patients recovered mental states completely. 4. Serum Calcium, Phosphate, and Alkaline Phosphatase level were no difference between the head injury with lower extremity fractured patients and only lower extremity fractured patients. 5. There were no evidence of early bony union in the patients with head injury. 6. The formation of callus were abundant in the patients of lower extremity fracture with head injury rather than the only lower extremity fractured patients. 7. The incidence of heterotopic ossification was 10.9% and all patients with heterotopic ossification were treated with physiotherapy and all patients recovered fully. 8. The incidence of complication was 17.3% and there was no fat embolic patients. In conclusion, there was no evidence of early bony union, but the callus formation was abundant in the patients of lower extremity fracture concomitant with head injury.
Accidental Falls ; Alkaline Phosphatase ; Bony Callus ; Brain Injuries ; Calcium ; Clinical Study ; Contusions ; Craniocerebral Trauma ; Female ; Femur ; Head ; Humans ; Incidence ; Lower Extremity ; Male ; Motor Vehicles ; Orthopedics ; Ossification, Heterotopic ; Serologic Tests ; Sex Ratio ; Skull Fractures ; Tibia

The posterior cruciate ligament in the stoutest ligamentous structure in the knee joint. Kennedy and Hawkins have confirmed its strenght to be about 2 times that of the anterior cruciate ligament or tibial collateral ligament. This would appear to offer the support that this ligament has a vital role to play in knee stabilization. But, in the past, non-surgical management was frequently elected either because of the belief that most kness with posterior cruciate insufficiency are asymptomatic or because it is difficult to access surgically. Recently, Hughston and Trickey reported good results after surgical repair of the rupture of the posterior cruciate ligament. And current trend is to repair it surgically. So, we analyzed the 36 cases of acute posterior cruciate ligament injuries, who were admitted and treated surgically in Severance Hospital between Jan. 1981 to Dec. 1985, and obtained the following results. 1. Single rupture of the posterior cruciate ligament largely results in good outcome. 2. When the rupture site is in the substane, we can obtain relatively good results with the augmentation using the medial head of the gastrocnemius. 3. When combined with medial or lateral compartment injuries, the chance of later instability and reconstruction is high.
Anterior Cruciate Ligament ; Clinical Study ; Head ; Knee ; Knee Joint ; Ligaments ; Medial Collateral Ligament, Knee ; Posterior Cruciate Ligament ; Rupture

No abstract available.
Femoral Neck Fractures* ; Femur Neck*

Eighty primary Harris-Galante Porus (HGP) total hip replacements were performed at Severance Hospital from January 1986 to January 1989. A minimum of 18 months follow-up was available for 80 hips in 72 patients, whose mean age was fifty two years. The most common presenting diagnosis was avascular necrosis (47.5%) followed by fused hips (10%), tuberculosis (10%), rheumatoid arthritis (7.5%). Complications included three calcar cracks and two immediate dislocations and 6 cases of mild myositis ossificans. There were no infections and no revisions. The mean Harris hip score was 93 points (range, 74–100 points) at two years. The thigh pain was in nine patients (11 per cent) at one year and in three patients (3 per cent) at two years postoperatively. Radiographic analysis revealed that, a progressive radiodense femoral line developed in 21 hips (26 per cent); a progressive acetabular line in 3 hips (4 per cent); and decreased proximal femoral density in 28 hips (35 per cent). There were no position change of the acetabula and femoral compent. We conclude that the early overall clinical results of HGP total hip replacements are encouraging, at average 30 months. The prognostic significance of the radiographic changes such ar radiodense lines, the changes of the proximal femur and cortical thickening, have to be determined with longer follow-up. Long term follow-up of uncemented HGP total hip replacement is necessary to evaluate the efficacy of such implants.
Acetabulum ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Hip ; Diagnosis ; Dislocations ; Femur ; Follow-Up Studies ; Hip ; Humans ; Myositis Ossificans ; Necrosis ; Thigh ; Tuberculosis

The results of cementless total knee arthroplasty(TKA) have improved steadly during the past decade due to development of design, fixation and surgical technique. We analyzed the results of 45 total knee arthroplasties performed with Anatomic Modular Knee(AMK) prosthesis at the department of Orthopedic Surgery, Yonsei University College of Medicine between June 1989 and December 1991 and compared their results of rheumatoid arthritis(RA) and osteoarthritis(OA) patients. The follow up ranged from 2 years to 4 years and 2 months (average 2 years and 8 months). Using the Hospital for Special Surgery(H.S.S.) rating system and Knee Society(K.S.) clinical rating system, we found that the clinical results were similar for RA group(Average; H.S.S. 86.1, K.S. 81.2/74.4) and OA group(Average; H.S.S. 88, K.S. 87.8/77.1) even though the preoperative knee score was lower in RA group(Average;H.S.S.42.8) than OA group(Average;H.S.S. 57.7). The average age of RA patients was 14 years younger than that of OA patients. The improvement of range of motin and preoperative flexion contracture after TKA was remarkable in RA group. The radiologic evaluation based on Knee Society roentgenographic evaluation system revealed proper alignment of all component and no definite radiologic loosening except 1 case in which postoperative deep infection had occurred. On the basis of this prospective clinical and radiologic review, we concluded that uncemented implantation of AMK prosthsis both in RA and OA patients was encouraging.
Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Contracture ; Follow-Up Studies ; Humans ; Knee ; Orthopedics ; Osteoarthritis ; Prospective Studies ; Prostheses and Implants

Acetabular fracture is severe injury and is associated with other body injuries severely. It's complications are traumatic arthritis and avascular necrosis of femoral head which induce severe permanent disability and its treatment is equivocal. A clinical study was performed on 70 patients with 65 fresh fractures and 5 old fractures of the acetabulum, who were hospitalized and treated at Severance Hospital from January 1971 to December 1980 and following results were obtained. 1. The prevalent age distribution was between 20 and 50 years of age (75.7%), and the ratio between males and females was 2.2:1. The most common cause of injury was traffic accident (70.%). 2. 56 patients (80.0%) were associated injuries of other parts and the most common associated fracture was pelvic bone fracture and the most common associated soft tissue injury was urological injury. 3. A classification of acetabular fracture was induced from Judet and Letournel's anatomical classification; simple fracture was 45 cases (64.2%), associated fracture was 25 cases (35.8%) and most common hip dislocation was posterior dislocation (31.4%). 4. The methods of treatment were; closed management by using traction for 53 patients, surgical management by open reduction and internal fixation for 12 patients, and hip reconstructive surgery by total hip replacement(2 patients), cup arthroplasty (2 patients), acetabular roof formation by using iliac bone graft (1 patient). 5. The satisfactory result of conservative treatment was (57.8%), surgical treatment was (72.7%), hip reconstructive treatment was (80.0%). 6. The complications of the acetabular fracture were traumatic arthritis (36.1%), avascular necrosis (23.0%), myositis ossificans (6.6%), infection (3.3%). 7. Finally, the results of treatment depend largely on anatomical reduction, early joint motion.
Accidents, Traffic ; Acetabulum ; Age Distribution ; Arthritis ; Arthroplasty ; Classification ; Clinical Study ; Dislocations ; Female ; Head ; Hip ; Hip Dislocation ; Humans ; Joints ; Male ; Myositis Ossificans ; Necrosis ; Pelvic Bones ; Soft Tissue Injuries ; Traction ; Transplants

Fractures of the acetabulum are relatively uncommon. But if fractures of the acetubulum are not accurately evaluated, classified, and reduced anatomically, major sequalae and complications are frequently developed. Because of complicated anatomy, difficulty with surgical exposure, severe comminution, and major associated injuries, the treatment of displaced acetabular fractures between conservative and operative methods is still controversial. We reviewed thirty five cases of displaced acetabular fracture treated operaively from January 1984 to December 1991. The prevalent age was the fourth decade. There was twenty seven cases of associated injuries, twenty two dislocations of the hip. According to the Letournel's classification, the most common fracture type was posterior wall and both column type. The fracture was fixed internally with only screws in thirteen cases and with plate and screws in twenty two cases. Among thirty five patients, five patients were lost in the follow up and another five patients had followed up lesser than one year. The mean duration of follow-up afrer the operation was three years (range, one to eight years). Among twenty five patients who had followed up more than one year, the satisfactory results were achieved in nineteen patients (76%) and the poor results were achieved in three patients (8%). The complications were post-traumatic arthritis, avascular necrosis of femoral head, osteomyelitis in iliac bone, skin necrosis, and heterotopic ossification.
Acetabulum ; Arthritis ; Classification ; Dislocations ; Follow-Up Studies ; Head ; Hip ; Humans ; Necrosis ; Ossification, Heterotopic ; Osteomyelitis ; Skin