This study consisted of 66 peritrochanteric fractures which were treated by the modified Gamma nail (Asian Pacific nail) from August 1993 to October 1995. Sixty-one intertrochanteric fractures and five subtrochanteric fractures were treated in our institution. Average length of follow-up was 15.0 months. Four patients died during follow-up. The results were as follows; Lag screws were ideally introduced in 55 (83%) cases. The mean length in lag screw sliding was 4.3 mm in stable trochanteric fractures and 5.7 mm in unstable ones. Fifty-one out of 62 patients (82%) were returned to their previous ambulatory status. Intraoperative complications were as follows; distal crack (3 cases); rotation of femoral head (2 cases); entry point crack (I case); medialization of proximal fragment (7 cases); and missing of the interlocking screw (1 case). All of these complications did not affect the outcome. All medial cortical gaps were closed after sliding of lag screws. Three distal cracks did not propagate to the shaft. Postoperative complications were a case of superior cut-out, and two second fractures after falls. Callus formed more early in the stable trochanteric fractures (5+/-2.1 weeks) than unstable fractures (7.3+/-2.1 weeks). It was statistically significant. Union time between stable and unstable trochanteric fractures was not statistically significant. In conclusion, the Asian Pacific (AP) nail could appropriately fix the osteoporotic peritrochanteric fractures in elderly patient. It could offer early rehabilitation to these patients and decrease the mortality and morbidity.
Aged ; Asian Continental Ancestry Group ; Bony Callus ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary* ; Head ; Hip Fractures ; Humans ; Intraoperative Complications ; Mortality ; Postoperative Complications ; Rehabilitation

Mechanically the symphysis pubis serves to anchor the ends of the two weight bearing arches of the pubis-the femorosacral and ischiosacral arches. Under normal conditions it has been found to exceedingly resistant to separation. Sacroiliac strain is also uncommon because the sacroiliac ligaments are very strong and the movement which produce a torsion strain upon the joint is more likely to cause a strain of thinner capsular ligaments surrounding the small lumbosacral joints. We experienced a case of separation of the symphysis pubis and 2 cases of sacroiliac strain during and after spontaneous labor.
Joints ; Ligaments ; Pubic Bone ; Weight-Bearing

Ossification of the ligamentum flavum (OLF) has been recognised as a definite clinical entity as an ossification of the posterior longitudinal ligament. It has been known that the incidence of OLF is high in Japan and OLF usually occurs in the thoracic and lumbar region. Recently OLF has received considerable attention as a cause of myelopathy. OLF is quite distinct from “hypertrophy” of the ligamentum flvum. We experienced 2 cases of OLF with neurological symptom, which were treated by decompressive laminectomy and removal of the ossified ligamentum flavum. So remarkable symptomatic improvement was obtained.
Incidence ; Japan ; Laminectomy ; Ligamentum Flavum ; Longitudinal Ligaments ; Lumbosacral Region ; Spinal Cord Diseases ; Spine

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

No abstract available.
Spine*

With an aging population, osteoporotic vertebral collapse is an increasingly common condition. This compression fractures has been considered a benign entity, quite responsive to conservative treatment. In a rare patients, however, a major neurologic complication and painful kyphosis despite conservative treatment can develop. Therefore, the purpose of this present study is to analyze the surgical results of 14 patients with severe back pain, an increasing kyphosis and neurologic deficits caused hy osteoporotic vertebral collapse following minor trauma, who were treated surgically. Presenting signs and symptoms included severe back pain with progression of kyphosis in 6 patients and increasing neural deficit in 8 patients. Of 14 patients, eight patients had an intravertebral cleft sign (vacuum sign). Indications for surgery included increasing kyphotic deformity, intractable pain, or increasing neurologic deficit. There was no correlation between intravertebral cleft sign and neurologic deficit. However, patients who had intravertebral cleft sign had not well respond to conservative treatment. As treatments, combined anterior and posterior fusion in 8, anterior fusion in 4, posterior instrumentation, and wide decompressive laminectomry in one patient, respectively, were carried out. The final correction of the deformity averaged 0.3 degrees. Therefore. correction of kyphosis was not favorably maintained because of variable surgical methods, and sinking of graft bone or instrumentation into the osteoporotic vertebral bodies. However, pain was reduced significantly in all patients. In addition neurological symptoms improved in 7 patients. One patient underwent reoperation with nnterior inierbody tusion together with anterior instrument because of an increasing kyphosis, neurologic. iymptoms and scvcre hack pain following wide decompressive laminectomy. There was no complication relatecl to instruments. The authors strongly helieved that surgical intervention has highly satisfactory results in patients who have intravertehral cleft sign with persistent back pain despite conservative treatment, and proressive or persistent neurologic deficits following osteoporotic vertebral collapse.
Aging ; Back Pain ; Congenital Abnormalities ; Fractures, Compression ; Humans ; Kyphosis ; Laminectomy ; Neurologic Manifestations ; Osteoporosis ; Pain, Intractable ; Reoperation ; Transplants

No abstract available.
Talus*

Twenty-seven consecutive patients who had post-traumatic stiffness of the elbow were treated by operative soft tissue release or by soft tissue release and distraction arthroplasty. The purpose of this study was to describe the method of operation and postoperative management and to evaluate the results in the patients who had operative treatment for the post-traumatic stiffness of the elbow. The type of operative procedure was determined by whether the factors limiting motion were extra-articular (extrinsic) or intra-articular (intrinsic) and by pre-operative radiographic evaluation. The soft tissue release was performed by staged adhesiolysis through lateral or combined lateral and medial approaches. And if the factors limiting motion included a severe intraarticular lesions, distraction arthroplasty using the Judet or Oganesian apparatus was added to soft tissue release. The mean pre-operative arc of active motion was 42 degrees. At follow-up examination, nineteen to sixty-six months postoperatively, the mean post-operative arc of active motion was 103 degrees. There were nine complications (33 percent) in twenty-seven patients. All of them was transient ulnar nerve paresthesia. And we analysed the final results with Mayo elbow performance index for the evaluation of clinical outcome. Twenty-five (93%) of twenty-seven patients had satisfactory result according to Mayo elbow performance index. We conclude arthrolysis with or without distraction arthroplasty is useful for the treatment of posttraumatic elbow stiffness. However, the accurate anatomical knowledge, operative skill, and careful postoperative rehabilitation program were needed in the operative treatment of post-traumatic elbow stiffness.
Arthroplasty ; Elbow* ; Follow-Up Studies ; Humans ; Paresthesia ; Rehabilitation ; Surgical Procedures, Operative ; Ulnar Nerve

PURPOSE:Ghrelin is an endogenous ligand of the growth hormone secretagogue receptor, and stomach is the major site of ghrelin secretion. The purpose of this study is to compare the serum ghrelin concentrations between patients with type 2 diabetes mellitus (DM) and normal adults. We studied also whether serum ghrelin levels in the patients with type 2 DM are correlated with body mass index (BMI), serum insulin, lipid profiles, and creatinine levels. METHODS:Forty patients with type 2 DM and forty normal adults were included in this study. We measured heights and weights of the subjects and calculated their BMIs. Blood samples were obtained to measure the ghrelin concentration and their sera were stored at -20degreeC until used. In all subjects, serum ghrelin levels were measured using the commercially available Ghrelin(human) EIA kit. RESULTS:No differences of mean values were detected between the control group and the type 2 diabetic group for age, body weight, BMI, and the levels of serum total cholesterol, triglyceride, HDL cholesterol, and creatinine. But ghrelin level of the type 2 diabetic group (71.1+/-30.5 ng/L) was significantly lower than the control group (139.7+/-36.9 ng/L). In the control group, the ghrelin level showed positive correlation with HDL cholesterol (Pearson's correlation coefficient=0.37, P<0.05). In the diabetic group, the ghrelin level showed weakly positive correlation with insulin concentration. However, there was no significant relationship between serum ghrelin and various parameters in the diabetic patients group. CONCLUSION: In this study, ghrelin concentration in type 2 diabetic patients was lower than that in the control group. In the control group, serum ghrelin concentrations were positively correlated with HDL cholesterol. In the type 2 diabetic group, there was no significant correlation between insulin and ghrelin concentrations.
Adult ; Body Mass Index ; Body Weight ; Cholesterol ; Cholesterol, HDL ; Creatinine ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Ghrelin* ; Humans ; Insulin ; Receptors, Ghrelin ; Stomach ; Triglycerides ; Weights and Measures

Calvarium protects the brain, the most important organ. The defect of calvarium results in not only deformity but also fatal injury from the trauma. The cranial bone defects result from 1) removal of bone flap for intracranial decompression or infection 2) fracture 3) excision of tumor 4) craniectomy for craniosynostosis. The goals of cranioplasty are to protect the brain from trauma and make the aesthetically acceptable contour. From 1990 to 1995, we experienced twelve cases of cranioplasty using autogenous bone graft; 5 cases with rib bone, 3 cases with iliac bone, 2 cases with calvarial bone, and 2 cases with rib and calvarial bones. The result was very excellent without any significant complications.
Brain ; Congenital Abnormalities ; Craniosynostoses ; Decompression ; Ribs ; Skull ; Transplants*