No abstract available.

Management of bed-ridden patients with polyarticular rheumatoid arthritis poses a considerable challenge to the orthopedic surgeon. Five such illustrative cases are presented. Case 1, a 46 year old woman, previously had Knowles pinning and fibular graft done for a neck fracture of the right hip with avascular necrosis. With a new subcapital fracture and pinns, total hip arthroplasty was done. Due to osteoporosis and anatomical distorsion surgery, the stem of the prosthesis protruded through the femoral shaft. At two year follow-up, although confined to house, the stem was unloosened and she was free of pain, while she had developed painful avascular necrosis on the opposite side. Case 2, a 49 year old woman, had had bilateral total hip arthroplasty, one with and the other without trochanteric osteotomy, for avascular necrosis. She was free of symptoms except for pain due to trochanteric nonunion. After two years, re-wiring solved the problem. Case 3, a 48 year old female,had had multiple joint pain for 17 years, including the crippling both knees with flexion deformity of 90 and 50 degrees. Bilateral total knee arthroplasty was done with subsidence of pain and gain in motion. Case 4, a 52 year old woman, had multiple joint pain and stiffness for 13 years, being bed-ridden for the last two years. A case of classical rheumatoid arthritis, she had flexion contracture of both knees of 90 snd 95 degrees and an equinus deformity of the right ankle. Her hands and wrists were stiff and elbows and shoulders were also involved. Posterior capsulotomy was followed by bilateral total knee arthroplasty and a total ankle on the right. Postoperative course was complicated by delayed wound healing and subluxation. She was made ambulatory with a walker with Lofstrand crutches and a whole body suspension. Case 5, a 14 year old girl with classical juvenile rheumatoid arthritis, was bed-ridden since the age of seven. She had flexion deformity of both knees of 130/110 and also af both hips. Ankles, wrists, elbows and shoulders were also involved. On each knee, posterior capsulotomy and synovectomy, bone shortening and supracondylarosteotomy and hamstring transfer were done, followed by grsdusl extension by skeletal traction and cast wedging. The hospital course was prolonged because of peroneal palsy and pressure sore of tbe heel on the left and skin necrosis of the lateral wound of the right knee. Hwoever, the child went home ambulating with a bilateral long leg brace and crutches with a Lof-strand platform on the right.
Ankle ; Arthralgia ; Arthritis, Juvenile ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Braces ; Child ; Congenital Abnormalities ; Contracture ; Crutches ; Elbow ; Equinus Deformity ; Female ; Femur ; Follow-Up Studies ; Hand ; Heel ; Hip ; Humans ; Knee ; Leg ; Neck ; Necrosis ; Orthopedics ; Osteoporosis ; Osteotomy ; Paralysis ; Posterior Capsulotomy ; Pressure Ulcer ; Prostheses and Implants ; Shoulder ; Skin ; Traction ; Transplants ; Walkers ; Wound Healing ; Wounds and Injuries ; Wrist

The approach toward paralytic hips in children with subluxation or dislocation has been essentially conservative and palliative, frequently.accepting the subluxation or dislocation. Buster Brown belt, ischial seat brace, or crutches with non-weight bearing is frequently prescribed. For obvious reasons, both the patient and the surgeon are reluctant to resort to hip fusion, and muscle or tendon transfer about the hip cannot be expected to function in the presence of subluxation or dislocation. On the other hand, deformities about the hip are corrected successfully by standard procedures, such as adductor tenotomy, Soutters fasciotomy, and Campbells iliac crest transfer. In severe, fixed deformities in older children, the overall balance may be restored by varus or valgus osteotomy of Irwin, leaving the deformities uncorrected. Jones varus osteotomy is aimed at reduction of the hip, but it ignores the factor of remodeling and is of temporary benefit. More recently, Salters and Pembertons osteotomies have been suggested in the treatment of paralytic subluxation or dislocation, but the lack of remodeling remains unchallenged. During the period of 14 years, from October 1963 to May 1976, we operated on 132 hips in 108 cases of paralytic hips, mostly in children, at Seoul National University Hospital. Of the total cases, 104 cases were residual poliomyelitis, 3 cases cerebral palsy, and one case meningomyelocele, Operative procedures carried out on these hips were as follows: Soutters abductor fasciotomy; 35 Campbells iliac crest transfer; 22 Lumbodorsal fasciotomy; 20 Ober-Barrs erector spinae and tensor fasciae latae transfer; 29 Thomas-Thompson-Straubs external oblique transfer; 15 Sharrards iliopsoas transfer; 6 Mustards iliopsoas transfer; 20 Legg-Dicksons tensor fasciae latae transfer; 8 Blecks iliopsoas recession; 1 Hip fusion; 2 Pembertons pericapsular osteotomy; 28 Salters innominate osteomy; 26 Steels triple osteotomy; 1 Chiari's osteomy; 1 Soft tissue release operations were carried out whenever necessary, either prior to or at the time of reconstructive surgery. In 39 hips, osteotomies were either combined at the same time or were followed by muscle or tendon transfers, while in the earlier 4 hips osteotomy alone resulted in recurrence of subluxation or dislocation and required repeat osteotomy combined with muscle transfer, and in another hip, recently, osteotomy was complicated by infection and muscle transfer has been postponed to date. In our experience with paralytic hips, when subluxation or dislocation is present, either muscle or tendon transfer alone or osteotomy or arthroplasty alone will likely fail or, at best, will be ineffective. Most satisfactory and' permanent results were obtained when these hips were aggressively treated by maximum correction of deformities followed by combined mechanical(osteotomy or arthroplasty) and functional (muscle or tendon transfer) stabilizations. This often permits elimination of the brace and hip fusion is seldom necessary, thus resulting in functional salvage of a flail hip. Also, any surgery on the knee and the foot of the same limb is greatly enhanced by reconstruction of the hip.
Arthroplasty ; Braces ; Cerebral Palsy ; Child ; Congenital Abnormalities ; Crutches ; Dislocations ; Extremities ; Fascia ; Foot ; Hand ; Health Resorts ; Hip ; Humans ; Knee ; Meningomyelocele ; Mustard Plant ; Osteotomy ; Poliomyelitis ; Recurrence ; Seoul ; Steel ; Surgical Procedures, Operative ; Tendon Transfer ; Tendons ; Tenotomy

Since the independent reports of Charcot and Marie and of Tooth, in 1886, interest in this familial disease has centered largely in the genetic and diagnostic aspects, and yet references in the literature to Surgical management are rare and inexact. Our experience with Charcot-Marie-Tooth disease in 4 patients operated at Seoul National University Hospital during the last 3 years is reported. Of 6 cases of Charcot-Marie-Tooth disease which have been studied, 4 patients have undergone surgery for the correction or amelioration of the crippling foot deformity. The authors' operation has consisted of triple arthrodesis, medial release, lengthening of the Achilles tendon, tendon transfer which was available and present evidence that properly designed surgical treatment can correct, prevent, or materially reduce disability of the deformed feet. Of the 4 cases reported here, all have either been reviewed or the patients have been interviewed in the last year. On the basis of adequate follow-up observations, thesurgical procedure outlined have been shown to improve the crippled condition. In spite of progressive musele wasting, the operative treatment could prevent or ameliorate the deformity. Three cases of Charcot-Marie-Tooth disease were evaluated in a long-term follow-up after having undergone surgery to correct their foot deformity. Excellent results were achieved from three of them which were maintained at final follow-up, and one is being gollowed up.
Achilles Tendon ; Arthrodesis ; Charcot-Marie-Tooth Disease ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Foot Deformities ; Humans ; Seoul ; Tendon Transfer ; Tooth

Congenital hemihypertrophy is one of the more unusual and interesting errors of nature found in the human race. The hemihypertrophy was first described by Meckel in 1822, and the first case was recorded by Wagner in 1839. Since that time, over 140 cases have been reported. The purpose of this article is to report an additional case along with review of previous literatures.
Continental Population Groups ; Humans

Stenosing peroneal tenosynovitis is one of the rather common causes of pain and disability following calcaneal fracture. In practice, however, attention is focused on fracture healing and the development of subtalar degenerative arthritis, and impingement or adhesion of the peroneal tendons within their sheaths due to bony protrusion or distorted anatomy resulting in disability and pain on weight bearing is too frequently overlooked. We diagnosed and treated four cases of stenosing peroneal tenosynovitis, three of which were associates with subtalar arthritis, in a relative short period of time. We proposed that orthopaedists treating calcaneal fractures be aware of this entity as distinct causes of pain.
Arthritis ; Fracture Healing ; Osteoarthritis ; Tendons ; Tenosynovitis ; Weight-Bearing

In the past several years, total hip replacement arthroplasty has become an established procedure in the management of painful arthritic hips in older adults. It is still gaining an increasing popularity as experience has accumulated and indications broadened. The authors reviewed the first 47 total hip replacement arthroplasties in 41 patients performed at the Department of Orthopedic Surgery, Seoul National Univerity Hospital, during the period of 4 years and 8 months, from April 1972 to November 1976. The longest follow-up was 4 years and 8 months and the shortest 1 month, the average being 2 years and 1 month. The youngest age was 17 years and the oldest 71 years, the average being 41 years. There were 26 males and 15 females. The underlying etiology was as follows: primary osteoarthritis 4 hips, avascular necrosis 12 hips, septic hip residua 18 hips (pyogenic 11 hips, tuberculosis 7 hips), rheumatoid arthritis 3 hips, failed previous operation 3 hips (failed endoprosthesis 2 hips, failed total hip replacement 1 hip), secondary osteoarthritis 5 hips (congenital dislocation 4 hips, Legg-Perthes disease 1 hip), and nonunion of femoral neck 2 hips. Following types of prosthesis were used; Sbarbaro 3, Charnley 8 (including custom-made extralong, narrow stem and extra-small stem prostheses), Muller 22, and Trapezoidal-28 14. The results were evaluated by the methods of Harris and d'Aubigne, both preoperatively and postoperatively, In the average, Harris' score improved from 57 to 92 (gains of 35) and the d'Aubigne rating from 10.4 to 16.8 (gains of 6.2) following operations.
Adult ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Dislocations ; Female ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Legg-Calve-Perthes Disease ; Male ; Necrosis ; Orthopedics ; Osteoarthritis ; Prostheses and Implants ; Seoul ; Tuberculosis

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

The author studied the validity of bone scintigraphy in the assessment of viability and anastomotic patency of free bone grafts revascularized by microvascular anastomoses and also compared them with conventional free devascularized bone grafts and osteotomies. Sixty rabbits were divided into three different groups, and scintigraphy was carried out using technetium labeled methylene diphosphonate on revascularized living bone grafts, conventional devascularized bone grafts and osteotomies. Of these, 38 rabbits could be followed up to 6 weeks. Analyzing the histologic, radiographic and scintigraphic data, the following results were obtained. 1. Free living bone grafts, revascularized by periosteal blood supply from the posterior tibial artery, revealed incomplete bone cell survival on histologic sections taken at 6 weeks after operation. In the osteotomy group the distal fragments were completely viable. Living bone grafts with failed anastomosis and dead bone grafts were almost completely necrotic. 2. Radionuclide uptake in dead bone grafts and living bone grafts with failed anastomosis increased gradually up to 6 weeks after operation. Radionuclide uptake in living bone grafts with patent anastomosis increased rapidly during the first 2 weeks, and increased gradually thereafter up to 6 weeks. In the osteotomy group radionuclide uptake also increased rapidly during the first 2 weeks but decreased slowly thereafter up to 6 weeks. 3. Radionuclide uptake at 6 weeks after operation became comparable to that of the adjacent host bone and there was no significant difference among the various groups. On the basis of the experimental results, the author derived following conclusions. 1. The differences of radionuclide uptake among the various living and dead bone grafts were most remarkable at 2 weeks following the grafting procedure. The radioactivity was highest following osteotomy which preserved blood supply, and it was lower in the living bone grafts with patent anastomosis, while that in the dead bone grafts and living bone grafts with failed anastomosis was lowest. 2. The time factor in performing scintigraphy was most important in assessing the viability of bone grafts and anastomotic patency. The optimal time to assess the viability and anastomotic patency appeared to be 2 weeks after grafting.
Cell Survival ; Osteotomy ; Rabbits ; Radioactivity ; Radionuclide Imaging ; Technetium ; Tibia ; Tibial Arteries ; Time Factors ; Transplants

Avascular necrosis of the femoral head has been recognized as one of the most serious and frequent complications following the initial treatment of congenital dislocation of the hip. It is now well accepted that this particular complication is iatrogenic and may be avoided by careful and adequate treatment. The reported incidence of avascular necrosis is variable because of various methods of treatment and different diagnostic criteria. We retrospectively reviewed 130 patients(144 hips) with congenital dislocation of the hip, who were treated at Seoul National University Hospital during 10 year-period from January 1974 to December 1983, and found 13 patients (13 hips) with avascular necrosis of the femoral head. We analyed avascular necrosis following treatment of congenital dislocation of the with respect to various methods of treatment, possible causes, types of avascular necrosis, to radiological findings, and to functional results. 1. The incidence of avascular necrosis following treatment of congenital dislocation of the hip in our series was 9.0%(13/144 hips). 2. The average age of the patients with avascular necrosis was 3 years, the youngest being 4 months and the oldest being 10 years. The average follow-up period was 2 year and 2 months. 3. The incidence of avascular necrosis in the closed reduction series was higher in those between 6 months to 18 months with 10.5%, as compared to 7.1% in those 6 months and under 6.7% in those 18 months and over. In the open reduction series, the incidence increased as the age increased, being 5.9%, 12.4%, 15% in the groups 18 months to 3 years, 3 to 6 years, and 6 years and over, respectively. 4. The incidence of avascular necrosis in those who had priliminary traction was 8.3%, where as that in those who had not was 16.6%, being twice as much. 5. The incidence of avascular necrosis decreased as the traction time prolonged, being 9.0% in 7 days or less, 7.7% in 8 to 14 days, 7.1% in 15 to 21 days and nil in 22 days or more. 6. The incidence of avascular necrosis in the skin traction group was 5 times as much with 11.5%, as in the skeletal traction group with 2.2%, despite older age in the latter. 7. The incidence of avascular necrosis in the open reduction group was slightly higher with 9.5%, than in the closed reduction group with 8.6%. 8. All 6 cases of avascular necrosis following closed reduction occurred when Lorenz or frog-leg cast was applied initially after reduction despite attention to avoid extreme abduction. Avascular necrosis were not encountered in those who had Lange or human position cast as the initial form of immobilization. 9. In the closed reduction, avascular necrosis occurred 8.1% in those who had adductor tenotomy and 10.0% in those who had not. In the open reduction, avascular necrosis occurred 7.9% in those who had adductor tenotomy and 18.1% in those who had not, suggesting significant role of adductor tenotomy in the prevention of avascular necrosis. 10. Avascular necrosis was attributable to excessive abduction in 7 hips, to undue pressure of femoral head in one hip, to open reduction in 3 hips, to post-operative infection in one hip, and to non-union of subtrochanteric osteotomy in one hip. 11. Of the 13 hips, following roentgenograms were available in 11. According to the classification of Bucholz and Ogden, type I, II, III, IV were 7, 0, 3, and 1 hips, respectively. 12. Functional results of the 13 hips of avascular necrosis, according to Kalamchi and MacEwen's criteria, were Good, Fair, Poor in 9, 3, and 1 hips, respectively.
Classification ; Dislocations ; Follow-Up Studies ; Head ; Hip ; Humans ; Immobilization ; Incidence ; Necrosis ; Osteotomy ; Retrospective Studies ; Seoul ; Skin ; Tenotomy ; Traction