Various methods have been used in the treatment of femoral shaft fractures in adults. In recent years, generally accepted two methods are intramedullary nailing and plate fixation. We followed and reviewed 121 cases of femoral shaft fracture in 116 patients, treated by operation in Orthopaedic Department, Presbyterian Medical Center, Chonju from 1980 to 1986. All cases were devided into 2 groups, intramedullary nailing(24 cases) and plate fixation (97 cases), and the two groups were compared each other. The results are as follows : 1. Most of intramedullary nails were used in relatively younger age group, before 50 yesrs of age. 2. The mean bony union time in plate fixation was 14 weeks and that in intramedullary nailing was 17.4 weeks. They showed about 3 weeks of difference. 3. In the group, whose operations were performed within 2 weeks after injury, showed high rate of bone union within 6 months, but in those whose operations were delayed more than 2 weeks showed marked decrease in bone union. And the rate of decrease was greater in plate fixation. 4. The recovery of knee joint motion above 110 was greater in intramedullary nailing (87.5%) than that in plate fixation(79.3%). 5. There was no difference in functional recovery between plate fixation and intramedullary nailing. 6. The complications, including delayed and nonunion, infection, metal failure, and limitation of knee joint motion, were more in plate fixation. 7. The risk of refracture is higher in plate fixation. Therefore plates must be removed after some period.
Adult ; Clinical Study ; Fracture Fixation, Intramedullary ; Humans ; Jeollabuk-do ; Knee Joint ; Protestantism

Experimental treatment by open reduction and internal fixation with modified tension band combined with external compression device was used for the patella fractures. Early post operative continuous passive motion and early weight bearing exercise was followed. This method was excellent for treatment of the patella fractures and prevention of post operative complications such as limitation of motion and post-traumatic arthritis of the knee joint. This experimental treatment was performed in 5 patients. and the results are as follows :1. Treatment by modified tension band combined with external fixator is useful for any type of the patella fracture. 2. By continuous passive motion and programed post operative rehabilitation, early painless recovery of wide range of motion of the knee joint and early weight bearing became possible. 3. Complications such as pain on motion, post-traumatic arthritis and limitation of motion of the knee joint was not seen. 4. This method is excellent for treatment of the patella fractures, and we are now trying to memodel the external fixator for cosmetic improvement and prevention of pin site problems.
Arthritis ; External Fixators ; Humans ; Knee Joint ; Methods ; Patella ; Range of Motion, Articular ; Rehabilitation ; Weight-Bearing

Treatment by External Fixation with External Compression Device was used for the displaced fractures of the proximal humerus. Especially in the old aged patient and patient with severe associated injury, this method was excellent for the early, painless motion of the shoulder and then good functional result. This experimental treatment was performed in 8 patients, and its merits were as follows: 1. The technique of operation was relatively easy, and was possible within a short time with minor injury. 2. The quality of reduction was good in all cases. 3. By the compression effect on the fracture site and firm maintenance of reduction during the treatment, solid healing as in internal fixation was possible. 4. Firm maintenance of reduction & minimal injury of soft tissue made possible early painless and wide ROM exercise, and then good functional result.
Humans ; Humerus ; Methods ; Shoulder

PURPOSE: To evaluate the accuracy and reliability of method for prediction of rotationally neutral state of the femur by comparing with contra-lateral lesser trochanter. MATERIALS AND METHODS: The rotationally neutral state of the femur was measured by comparing the shape of the opposite side of the lesser trochanter in a normal group of 100 adult. Each examination was performed independently by three observers. The observers predicted a position presumed to be neutral by comparing the shape of lesser trochanter with that of contra-lateral side previously recorded by the C-arm image intensifier. We evaluated the mean angular discrepancy that is different from the neutral point and assessed the inter-observer variations. RESULTS: The mean angular discrepancy (SD) was 3.4 degree(+/-2.4); 3.5 degree(+/-2.4) by observer-1,3.5 degree (+/-2.8) by observer-2, 3.2 degree(+/-2.2) by observer-3. There was no inter-observer variation (p=0.87). 77% of all observers indicated below 4 degree and no one over 15 degree. CONCLUSIONS: The method of comparing the shape of both lesser trochanters is considered to be effective in determining the rotational status of the femur. It could be used as a practical method in the operation of the femoral fracture for prevention of rotational deformity intra-operatively
Adult ; Congenital Abnormalities ; Femoral Fractures ; Femur* ; Humans ; Observer Variation

Objective: Traumatic brain injury (TBI) is an important public health concern due to its high prevalence and mortality rate among young people. We investigated the clinical and social characteristics of patients who visited the emergency department due to TBI in whom brain computed tomography, was performed by age. Methods: We retrospectively analyzed 15,567 TBI patients who received a brain computed tomography evaluation at the emergency department of Korea University Hospital from March 2013 to February 2016. We divided patients into age groups by decade and analyzed factors such as sex, trauma mechanism, need for operation, hospitalization, and results of treatment. Results: The mean age was 42.0±22.8 years; the most common age group was the 50s (16.5%). Except for the age group over 70 years, males predominated. Under 9 years of age, public ambulance usage rate was lower than in other age groups. Regarding severity based on the Glasgow Coma Scale score, the proportion of mild cases was higher in those under 9 years of age (99.3%) and the proportion of severe cases was higher in those in their 20s (4.6%). The most common injury mechanism was blunt trauma, followed by car accidents. For those under 9 years of age, falls were more common than in other age groups. Only 20.5% of TBI patients were hospitalized and 11.9% were treated surgically, while 70.6% of patients were discharged home after treatment. Conclusion TBI may present with different characteristics depending on the age of the patients, thus prevention policies and clinical practice should be tailored to age.

Abdominal actinomycosis is a rare and chronic progressive disease, especially in children. Clinically, it has non-specific symptoms and diagnostic findings as well as low prevalence, making it very difficult to diagnose prior to intraoperative pathological confirmation. For this reason, abdominal actinomycosis is commonly misdiagnosed as appendicitis. After the histopathological diagnosis of abdominal actinomycosis is made, patients should be administered an appropriate antibiotic such as penicillin. Here we describe a case of appendiceal actinomycosis in an 18-year-old girl who was initially diagnosed with acute appendicitis.
Actinomycosis* ; Adolescent ; Appendiceal Neoplasms ; Appendicitis* ; Child ; Diagnosis ; Female ; Humans ; Penicillins ; Prevalence

Atlato-axial instability is a serious condition that often requires operation. Atlanto-axial subluxation may cause severe symptoms; and threaten the intergrity of the spinal cord, leading to quadriplegia or sudden death. A techique of combining C1-C2 posterior screw fixation with a supplemental bone wire fusion has been advocated for the management of atlantoaxial instability. It was used in 9 patients with this disorder. Patients ages ranged from 20 years to 52 years; follow-up period ranged from 3 to 16 months with a mean of 9.8 months. All nine patients gained immediate rigid fixation of C1,2 with this technique. Of these 9 patients, instability occurred due to trauma in seven, os odotoideum in one and os odontoideum with trauma in another one. One patient was presented with nonunion and C1,2 instability after a Halovest applications a result of type II odontoid fracture. All 9 patients were placed in a philedelphia collar for 12weeks and all achieved solid fusion. Posterior atlantoaxial facet screw fixation provides immediate multidirectional rigid fixation of C1,2 and is mechanically superior to siring or clamp fixation. This technique maximizes success without the need for a supplemental rigid external orthosis.
Bone Wires ; Death, Sudden ; Follow-Up Studies ; Humans ; Orthotic Devices ; Quadriplegia ; Spinal Cord ; Spinal Fusion ; Transplants*

BACKGROUND: Intravenous administration of rocuronium induces intense pain in most patients (60-100%). This could be harmful during anesthesia induction because of the unintended reflex movement of an unconscious patient in response to the pain. Previous studies have reported that remifentanil effectively reduces rocuronium-induced pain and withdrawal movements. This study was designed to evaluate the EC50 and EC95 of remifentanil to prevent withdrawal movements in children. METHODS: We enrolled a total of 171 pediatric patients scheduled for general anesthesia in this study. Remifentanil was administrated by target-controlled infusion. Effect-site target concentrations ranged from 0.5 to 3.0 ng/ml. At each concentration, experiments were repeated in 10-20 patients. Propofol 2 mg/kg and rocuronium 0.9 mg/kg were administrated after equilibration of plasma and effect-site target remifentanil concentration. The withdrawal movements were graded on a 4-point scale. The EC50 and EC95 of remifentanil to prevent rocuronium-induced withdrawal movements were determined by using a logistic regression model. RESULTS: The logistic regression model showed that the probability of preventing rocuronium-induced withdrawal movement was as follows: exp (-3.49 + 2.07 x remifentanil concentration) / (1 + exp [-3.49 + 2.07 x remifentanil concentration]). EC50 and EC95 were 1.69 ng/ml (95% confidence intervals [CIs], 1.42-1.87) and 3.11 ng/ml (95% CIs, 2.79-3.72), respectively. CONCLUSIONS: Administration of remifentanil at an effect-site target concentration of 3.1 ng/ml could effectively prevent rocuronium-induced withdrawal movements.
Administration, Intravenous ; Anesthesia ; Anesthesia, General ; Child* ; Humans ; Logistic Models ; Pediatrics ; Plasma ; Propofol ; Reflex

The following is the authors' case report of a 24-year-old man with solitary osteochondroma on the C1 posteior arch. The patient experienced an acute onset of cervical cord compression symptome after rotation injury. Cervical magnetic resonance imaging and cervical computed tomography reveald extensive extradural cervical spinal cord compression. As a result surgical removal of osteochondroma was performed. Osteochondroma is a rare cause of spinal pathology and neurological dysfunction. The above case of cervical osteochondroma with spinal cord compression is reported and the patholgical, clinical and radiological features are discussed with brief review of the literature.
Humans ; Magnetic Resonance Imaging ; Osteochondroma* ; Pathology ; Spinal Cord Compression ; Young Adult

Pulmonary arteriovenous malformations (PAVMs) are induced right to left shunt and if untreated properly, those may cause severe neurological problems. A 35-year-old man who had a headache checked into an emergency room to define a brain abscess in his brain with CAT scan as well as to examine suspicious two PAVMs in his chest X-ray. Not long after the surgical management of the brain abscess, he suffered recurrent convulsive movements. We would proceed to operate his PAVMs to prevent recurrent critical neurologic complications such as brain abscess or meningitis.
Animals ; Arteriovenous Malformations ; Brain ; Brain Abscess ; Cats ; Emergencies ; Headache ; Meningitis ; Periodontitis ; Seizures ; Telangiectasia, Hereditary Hemorrhagic ; Thorax