In order to determine the beneficial or detrimental effects of motion on fracture healing, rabbits femora were fractured surgically and each fracture was immobilized with a apecially designed external skeletal flxation device, which permitted a controlled spontaneous angulatory motion. in the first control group no motion was permitted; in the second group 5 degrees, and in the third group 10 degrees of angulatory motion was permitted. At 7th post-operative week, the bony union rates were 79%, 93%, and 54% In the first, second and third groups, respectively. Radiographically, the fractures were united most sufficiently in the second group. The ultimate bending load was signlficantly greater In the second group than the control but no significant differences were observed between the other groups. The ultimate bending stress and the modulus of elasticity were significantly greater ln the second group than the control and the third group, but no signlficant dlfferences were observed between the control and the third group. Fracture healing was significantly enhanced in the second group as compared to the control and the third group. It is suggested that a certain amount of motion at the fracture site enhances fracture healing, while excessive motion hinders it. Such enhancement seems to be related with the motion itself, and not wlth the muscle or jolnt function, since the rabbits Included in this study permitted the spontaneous full weight bearing which also permitted near normal muscle and joint function.
Elastic Modulus ; Fracture Healing ; Joints ; Rabbits ; Weight-Bearing

Maffuccis syndrome was first reported by Maffucci, an Italian, in 1881. It is manifested by unilateral multiple hemangiomas and enchondromas. It is congenital but is not hereditary. We encountered a case of this rare syndrome, with which bleeding tendency was combined. All who have multiple hemangioma on his unilateral side of the body should be checked with bone X-rays to rule out this syndrome. This syndrome is noted for transformation to malignant tumors. When there is pain or enlargenent of the tumor without any significant trauma, biopsy is in order. There can develop bleeding tendency due to microangiopathic coagulopathy which is associated with throm-bocytopenia and hypofibrinogenemia.
Biopsy ; Chondroma ; Hemangioma ; Hemorrhage

Photoplethysmography(PPG) employs an infrared light-emitting diode to transmit light into the skin noninvasively. Light reflected from blood cells is received by a photocell or phototrotransistor which permits recording of the pulsatile cutaneous microcirculation. The use of PPG for vascular measurements in extremities is not new. Since Hertzmann, in 1938, first described the technique to measure skin blood flow, a few investigators have used PPG for clinical application. However, experimental reports on the photoplethysmographic assessment of blood flow after arterial reanastomosis are rare. We assessed the changes of blood flow after reanastomosis of the femoral artery in rabbits using photoplethysmography. We divided 20 rabbits into 3 experimental groups. In Group I, the femoral artery was surgically exposed and clamped for 60 minutes. In Group II, the femoral artery was surgically exposed and clamped, as in Group I, and then severed and anastomosed crudely in order to creat thrombus formation. In Group IU, the femoral artery was prepared as Group II and then anastomosed carefully to ensure patency. Blood flow was measured by photoplethysmography on the anteromedial aspect of the right hind leg, every 15 minutes for the fisrt 2 hours, at the 3rd day, I week, and II weeks post-operatively. The following results were obtained l. After the removal of vascular clamp, the mean time for the pulse wave to return to normal form was 63±24.0 minutes in Group I and 63±18.7 minutes in Group III. There was no statistically significant difference beween the two groups. When the wave form was normalized, it remained so continuously. 2. After the removal of vascular clamp, the mean time for the wave amplitude to return to normal was 108±11.2 minutes in Group I and 102±16.4 minutes in Group III. There was no statistically significant difference between the two groups. 3. The thrombosis which obstructed blood flow was formed within the first 60 minutes(mean time: 49±12.4 minutes) in all the animals in Group II. When the thrombosis was formed, it was readily detected by the change of wave form and by decrease in amplitude. 4. It is concluded from this experiments the changes of blood flow after reanastomosis of the femoral artery in rabbits were accurately assessed by PPG. It is suggested that PPG can be used clinically in monitoring blood flow after arterial reanastomosis.
Animals ; Blood Cells ; Extremities ; Femoral Artery ; Humans ; Leg ; Microcirculation ; Photoplethysmography ; Rabbits ; Research Personnel ; Skin ; Thrombosis

Congenital pseudarthroses and non-unions have been recognized as some of the most challenging problems in orthopaedic surgery. with a standard surgical procedure, such as bone grafting, nailing, plating or a combination of these, it was frequently failed to unit. After repeated surgical failures, amputation has been the main course. With the advent of an electrical control of osteogenesis, however, this dismal outlook is brightening. The earliest report of the use of electrical energy to directly stimulate bone healing seems to be in 19th century, but it was not reliable. In this century, the electrical properties of bone were first described by Yasuda et al in 1953. After then, several investigators have shown that the application of small amounts of the electrical current to bone stimulates osteogenesis at the site of the cathode. Clinical trials using various froms in the treatment of delayed union, non-union, and congenital-pseudarthrosis began early in the 1970's. Constant direct current, pulsed current, and electromagnetically induced current have all been used clinically to heal bone defects with varying degrees of success. But, to-this date it is unknown what is the mechanism of stimulating bone healiag with electricity, and which from of electricity is most efficient in stimulating osteogenesis. We have experienced direct current stimulation to promote osteogenesis in 9 cases of non-union and 4 cases of congenital pseudarthses of the tibia from august, 1978 to december, 1980. Of 9 non-unions, 7 (77.8%) achieved solid bony union. We had obtained bony union in 4cases of non-union only with the electrical stimulation. In 4 cases of congenital pseudarthses of the tibia, all cases achieved solid bony union with the electrical stimulation and bone graft, but in 3 cases, refractures were occurred. At this moment, our conclusions from this study are as followa. I. Direct current stimulation is one of the reliable methods inducing ostengenesis. 2. Regular follows-up and determination of the stimulator integrity are essential steps in the electrical stimulation. 3. Combined treatment with the electrical stimulation and bone graft have markedly improved the success rate. 4. In direct current stimulation of congenital pseudarthsis, the mechanically sound bony alignment, massive bone graft and protection using long leg brace seem to be mandatory procedures.
Amputation ; Bone Transplantation ; Braces ; Electric Stimulation ; Electricity ; Electrodes ; Humans ; Leg ; Magnets ; Osteogenesis ; Pseudarthrosis ; Research Personnel ; Tibia ; Transplants

Experiences of 26 cases of electrical bone stimulation on normal adult rabbits was documented in this paper. The cathodic electrode was introduced longitudinally into the medullary cavity of the proximal tibia and the anodic electrode was introduced transversely in the distal femur of the same side. The contralateral tibia was used as the control, of which the Teflon coated Kirschner wire was introduced longitudinally into the medullary cavity. 10uA of direct current was passed continuously through the fixed wires between the proximal tibia and distal femur. At the second, fourth and sixth week, random bone scan with 99m-Tc was performed and the animals were sacrificed. The specimen X-rays of the tibia and femur were taken and the specimens were prepared for the microscopic study. The followings are obtained from this experimental study. 1. The rate of new bone formation is 69.2% in the stimulated group and 7.7% in the control group. There were also fibrosis and cartilage formation as well as the new bone formation. The fibrosis and cartrilage formation are observed only in the electrically stimulated side and their occurances are 69.2% and 11.1% respectively. So The new bone formation and fibrosis are definitely increased in the bones of the cathodic electrical stimulation than those of the control side. 2. The intramembraneous ossification is the predominent feature of this electrically stimulated new bone formation. 3. Bone and soft tissue necrosis was the main microscopic feature in the anode side. 4. Since new bone, fibrous tissue and sometimes new cartilage were observed in this study, it seems that the cathodic electrical stimulation is not specific for the new bone formation, but induce crude tissues such as bone, cartilage, fibrous tissue or vessels. Furthermore, it can be postulated that the 10uA electrical stimulation is only one of the best electrical environment for the formation of the crude tissues, especially for bone and fibrous tissue.
Adult ; Animals ; Cartilage ; Electric Stimulation ; Electrodes ; Femur ; Fibrosis ; Humans ; Necrosis ; Osteogenesis ; Polytetrafluoroethylene ; Rabbits ; Tibia

In the treatment of an infected ununited fractures of a long bone, it often is difficult to achieve union and eradicate the infection. Over the past two decades, the electrical behaviour of bone has been studied with increasing interest and several reports reveal that electricity can stimulate osteogenesis. We have experienced 11 cases of infected non-union who were treated by immobilization plus direct current stimulation from January, 1980 to July, 1982. In all cases satisfactorv union occurred within averaging 8.1 months. The results obtained are as follows: 1. The direct current stimulation has revealed to be effective with antibiotics and some kinds of immobilization in treatment of infected non union. 2. If bone graft is combined with electrical stimulation, time from beginning of electrical treatment to union is shortened, as compared with cases of electrical stimulation alone. 3. The electrical stimulation is preferable to other surgeries in treatment of infected non-union due to its effectiveness and simplicity. 4. It is considered treatment of chronic osteomyelitis with silver anode is not due to electrically generated silver ion but its electricity per se. 5. To prevent refracture and assure complete healing, continued immobilization such as cast brace, walking cast, or conventional brace is necessary after electrical stimulation for the time being.
Anti-Bacterial Agents ; Braces ; Electric Stimulation ; Electricity ; Electrodes ; Fractures, Ununited ; Immobilization ; Osteogenesis ; Osteomyelitis ; Silver ; Transplants ; Walking

No abstract available in English.
Bone Transplantation ; Electric Stimulation ; Pseudarthrosis ; Tibia

Experiment of electrical stimulation using direct current on the tibia of normal adult rabbits was performed for the duration of 1 week, 2 weeks, 3 weeks, 4 weeks, 6 weeks, and 8 weeks. The cathodic electrode, Teflon coated Kirschner wire used in clinical work was introduced into the medullary cavity of the proximal tibia from the tibial tuberosity and the anodic electrode was introduced transversely in the metaphysis of distal tibia on the same side. Twenty micro-ampere of direct current was passed continuously through the fixed wires between the proximal and distal tibia on left side. At the end of first week, second week, third week, fourth, sixth, and eighth week, anodic and cathodic electrode were removed and animals were sacrificed and tibia was obtained for specimen, and then X-rays were taken, and the specimens were decalcified and stained with hematoxylin and eosin. The new bone formation in the medullary canal were measured by the degree of filling in the marrow canal as percentage by the point counting method. The results were as follows. First, Endosteal new bone formation is a main feature, and also periosteal reaction was noted in 27 % of cases. Second, In the first week group, new bone formation is minimal and difference between groups, that is, second, third, fourth, sixth and eight week group, the degree of new bone formation is statistically insignificant. Therefore possibility of short term electrical stimulation of duration of two week or four week is contemplated clinically.
Adult ; Animals ; Bone Marrow ; Electric Stimulation ; Electrodes ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Methods ; Osteogenesis ; Polytetrafluoroethylene ; Rabbits ; Tibia

Contrast arteriography and phlebography remain the standard diagnostic techniques for evaluation of peripheral arterial and venous diseases. However, invasive angiographic techniques involve expense, time, discomfort, and potential risks to the patient which preclude their use as routine screening and followup procedures. In order to obtain accurate, objective information to complement the clinical diagnosis of peripheral vascular diseases, many noninvasive diagnostic techniques have recently become available to the clinican. Among these techniques, photoplethysmograph (PPG), strain gauge plethysmograph (SPG), and doppler ultrasound were adopted for our study. Fourty young volunteers were studied as a control group, and twenty peripheral vascular disease patients were studied as a patient group. We obtained average values of PPGa, blood flow, maximum PRT venous reflux folw (MVRF), maximum venous outflow (MVOF), pulse reappearance time (PRT), PRT/2 and pulsatility idex(PI) for control group. Results for patient group were analysed and compared with those of control group. 1. Normal PPGa wave has a steep upslope, a relatively narrow peak, and a dicrotic wave on the downslope which is concave toward the baseline. PPGa reflected skin blood flow sensitively than any other technique. 2. Average forearm blood flow by means of SPG was 5.7±2.0, and that of calf was 3.7±1.4ml/min/100cc tissue. MVOF of forearm was 32.9±10.4, and that of calf was 18.0±7.0ml/min/100cc tissue. Blood flow measurement was not useful for detection of arterial occlusive disease, but MV OF was useful for diagnosis of deep vein thrombosis. 3. PRT, PRT/2, over shooting reaction time by means of SPG have low diagnostic value and PI by means of doppler ultrasound was useful for localization of arterial narrowing or obstruction. 4. Noninvasive diagnostic techniques including PPG, SPG and doppler ultrasound are useful for screening and follow-up procedures in diagnosis of peripheral vascular disease. They are also valuable to supplement angiographic or physical findings.
Angiography ; Arterial Occlusive Diseases ; Complement System Proteins ; Diagnosis ; Follow-Up Studies ; Forearm ; Humans ; Mass Screening ; Peripheral Vascular Diseases ; Phlebography ; Reaction Time ; Skin ; Ultrasonography ; Vascular Diseases ; Venous Thrombosis ; Volunteers

We carried out animal experiment in order to determine the effect of resection of nerves, muscles and tendons on the induction of osteoporosis. One hundred and forty rats, weighing approximately 250 gm, were divided into seven groups. In Group I, as a control group, the three skin incisions, one on the anterior aspect of the knee, one on the anteromedial aspect of proximal thigh, and one on the posterior aspect of proximal thigh were made and wounds were sutured. In Group II, the patellar tendon and the extensor digitorum longus tendon were divided to disable knee extension. In Group III, all the knee flexors were divided. In Group IV, all the knee extensors and flexors were divided. In Group V, the femoral nerve was divided to disable knee extension. In Group VI, the sciatic and obturator nerves were divided to diable knee flexion. In Group VII, the sciatic, and obtrator nerves were all divided. Before the procedures, bone density was measured by photon absorptiometry and postoperatively, the measurement was repeated every two weeks until the eighth week. At the time of each measurement, two rats were sacrificed out of each group and were submitted to microphotographic measurement of the tibial cortices. The results were as follows. l. In the muscle and tendon resection groups (Group II, Group III, Group IV), the bone density significantly decreased two weeks after operation and then, gradually increased four, six and eight weeks. 2. In the nerve resection groups (Group V, Group VI, and Group VII), the bone density decreased significantly two and four weeks after operation and then gradually increased six, and eight weeks after operation. 3. In both motor resection and denervation, the paralysis of both flexors and extensors of the knee, caused more decrease in bone density than the paralysis of either flexor or extensor. 4. In the muscle and tendon resection groups, the bone density was significantly more decrease two weeks after operation when the flexors were resected, but thereafter there was no significant difference between the flexors and extensors resection. In the nerve resection group, the paralysis of knee flexors caused more decrease in bone density than the paralysis of knee extensors throughout the entire experimental period. 5. The nerve resection groups demonstrated significantly more severe loss of bone density than muscle and tendon resection groups throughout the entire experimental period. 6. The values of bone density measured by photon absorptiometry correlated well with the cortical thickness indices. Bssed upon these observations, we came to the following conclusions. 1. The osteoporosis following injuries of the nerve, muscle, and tendon is most significant at two weeks after injury. 2. Denervation causes more severe osteoporosis than muscle and tendon injuries. 3. It is suggested that the photon absorptiometry is a reliable means in the evaluation of the osteoporosis.
Absorptiometry, Photon ; Animal Experimentation ; Animals ; Bone Density ; Denervation ; Femoral Nerve ; Knee ; Muscles ; Obturator Nerve ; Osteoporosis ; Paralysis ; Patellar Ligament ; Rats ; Skin ; Tendon Injuries ; Tendons ; Thigh ; Tibia ; Wounds and Injuries