A retrospective study on 218 patients indicated the ultrasound Doppler to diagnose the vascular pathology in the pelvic limb has shown that the image of ultrasound found the artherosclerosis in the major arteries, which frequently occurred in the patients with the blood supply insufficiency for limb during movement. The lesion of vasculitis and arterial thrombosis and embolism only located in the minor arteries and not found by ultrasound. When finding the lesion of artherosclerosis included thrombolism in the medium or major arteries, the patients should be indicated the angiography to identify and evaluate generally for next indications
ultrasonography ; Angiography ; Pelvis ; Wounds and Injuries ; Extremities

Fractures of the humeral neck are relatively common, but their anatomical complexities make closed reduction difficult sometimes, and in case of reduction it is tough to maintain the position. Even open reduction of the fracture also faces multiple problems including poor functional recovery of the shoulder joint. The Department of Orthopedic Surgery of Seoul Adventist Hospital developed a device of external fixation for 13 humeral neck fractures. We used this method for displaced and unstable fractures of humeral neck from December 1987 to March 1989. Satisfactory results were obtained in 11 cases and poor results in 2 cases. We think our method is a effective useful way of treatment for humeral neck fractures, and its main advantages are as follows:1. Using proximal and distal bars, fracture can be easily reduced and firmly maintained. 2. Active motion exercise can be started early and functional recovery of the shoulder joint can be highly predictable. 3. It is quite convenient for treating combined fracture or external wound of same extremity.
Extremities ; Methods ; Neck ; Orthopedics ; Seoul ; Shoulder Joint ; Wounds and Injuries

Drainage ; Extremities ; injuries ; surgery ; Humans ; Reconstructive Surgical Procedures ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps

OBJECTIVETo analyze the features, diagnosis and treatment of limb arterial injuries caused by traffic accidents.

METHODSA total of 43 patients with limb arterial injury admitted in our department over the past 30 years (about 50% of them happened during the last 10 years) were analyzed retrospectively in this article. The popliteal, femoral and brachial arteries were mainly involved, accounting for 43.2%, 20.5% and 20.5% respectively of all the involvements. There were 35 cases of open injury and 9 of close injury. The involved vessels were transected in 43.2% of the cases and contused in 40.9%. All the patients had various complications, such as fractures, dislocations and severe soft tissue injuries. The injured vessels were repaired by means of end-to-end anastomosis in 10 cases, autogenous vein graft in 23 cases and intraluminal hydraulic dilatation in 4 cases.

RESULTSSuccessful limb salvage was achieved in 34 cases initially, whereas 10 amputations were carried out due to injuries to popliteal arteries in 7, femoral arteries in 2 and humeral artery in 1 and severe soft tissue damages in 9 cases. Twenty-nine patients were followed up for 1-156 months, with the average of 48.8 months. There was good circulation in 22 cases and certain ischemia in 5 cases. Two amputations were carried out in the late stage because of popliteal artery thrombosis after repair in 2 cases. There was no death in this series.

CONCLUSIONSThe limb arterial injuries caused by traffic accidents are severe and complicated. It is proposed that particular attentions should be paid to the features in diagnosis and treatment for this type of injury and special efforts should be made for both life saving and limb salvage.

Accidents, Traffic ; Adult ; Brachial Artery ; injuries ; Extremities ; blood supply ; injuries ; Female ; Femoral Artery ; injuries ; Humans ; Male ; Popliteal Artery ; injuries ; Retrospective Studies

Heterotopic ossification (HO) is frequently seen on rehabilitation units after spinal cord injuries, fractures, brain injuries, and limb amputations. Currently, there is no effective treatment for HO other than prophylaxis with anti-inflammatory medications, irradiation, and bisphosphonate administration. These prophylactic treatments are not effective for managing ectopic bone once it has formed. Here we describe three cases of established neurogenic HO treated with radiation therapy (RT). All patients had decreased serum alkaline phosphatase (ALP) and bone-specific ALP levels with decreased pain but increased range of motion immediately after RT. Post-treatment X-rays revealed no further growth of the HO. All patients maintained clinical and laboratory improvements 4 or 6 months after the RT. Our results suggest that RT is safe and effective in decreasing pain and activity of neurogenic HO.
Alkaline Phosphatase ; Amputation ; Brain Injuries ; Extremities ; Humans ; Ossification, Heterotopic* ; Radiotherapy ; Range of Motion, Articular ; Rehabilitation ; Spinal Cord Injuries

OBJECTIVE: To observe the changes of electrocardiogram and serum cardiac troponin I at the early stage of severe crush injury in rats. METHODS: Crush injury was produced in Sprague-Dawley rats. The changes of electrocardiogram were recorded with the standard II, the serum levels of cardiac troponin I were studied by automated chemiluminescence assay. RESULTS: The ST segment elevated considerably after crush injury and lasted 24 h, the levels of serum cTnI were much higher than those of the control groupes after 6 h of injury. CONCLUSION Cardiomyocyte injury was induced in the early phase of crush injury.
Animals ; Crush Syndrome/physiopathology* ; Electrocardiography ; Extremities/injuries* ; Female ; Heart Injuries/physiopathology* ; Male ; Rats ; Rats, Sprague-Dawley ; Troponin I/blood*

OBJECTIVE: To investigate the relationship between motor evoked potential (MEP) response and the severity of motor paralysis, evaluated according to the Korean disability evaluation system in patients with spinal cord injury (SCI). METHODS: We analyzed 192 lower limbs of 96 SCI patients. Lower limbs were classified according to their motor scores, as determined by the International Standards for Neurological Classification of Spinal Cord Injury: motor score <10 (group 1); ≥10 and <15 (group 2); ≥15 and <20 (group 3); and ≥20 (group 4). MEP responses were classified as ‘normal’, ‘delayed’ or ‘absent’, based on their onset latency, which was compared between the different motor score groups. RESULTS: MEP responses and limb motor scores were highly correlated (p<0.001). There was a significant difference of MEP responses between the motor score groups (p<0.001). MEP response was markedly poorer in motor group 1 (limb motor score <10) than in the other three groups (p<0.0001). However, there were no differences between the three groups with motor scores of 10 or above. CONCLUSION: Clinical utility of MEP as a complimentary tool to manual muscle tests could be limited to discriminating motor score groups with severe paralysis, i.e., single lower limb motor power grades of 0 or 1, and from grade 2, 3, and 4, or above, in the Korean disability evaluation system.
Classification ; Disability Evaluation ; Evoked Potentials, Motor* ; Extremities ; Humans ; Lower Extremity ; Paralysis* ; Spinal Cord Injuries* ; Spinal Cord*

Soft tissue defect combined with an open fracture is a very challenging problem to the orthopaedic surgeon. Many complicated open fractures remain with soft tissue defect, chronic osteomyelitis, and sometimes terminate with major limb amputation. Soft tissue defect should be reconstructed as soon as possible, particularly when the bone, tendon, or neurovascular structures are exposed. Exposure for longer than a week significantly increases the risk of secondary infection and tissue necrosis. For the simple soft tissue defect, negative pressure wound closure technology has been introduced and many superficial wounds have been treated successfully using this method. For the more complicated wounds, many kinds of local flaps, pedicled flaps, muscle and fascisocutaneous flaps can be indicated according to the characteristics of the wounds. The free flaps including free vascularized bone graft can be considered as a final choice for the most difficult wound problems. In this article, various reconstruction strategies for soft tissue defect after traumatic open fracture are reviewed.
Amputation ; Coinfection ; Extremities ; Fractures, Open ; Free Tissue Flaps ; Necrosis ; Osteomyelitis ; Surgical Flaps ; Tendons ; Transplants ; Wounds and Injuries

PURPOSE: In order to avoid functional disability that may be caused by radical excision or amputation in extremity soft tissue sarcomas, authors employed limb-conserving surgery together with extemal radiation therapy plus interstitial brachytherapy. MATERIALS AND METHODS: From June 1995 to Febrary 1997, 10 extremity soft tissue sarcoma patients were treated with limb-conserving surgery and external radiation therapy plus interstitial brachytherapy. In six patients, whose histologic diagnoses were made at the time of surgery, wide or marginal excision and interstitial brachytherapy was done 4 weeks before postoperative external radiation therapy. In four patients whose histologic confinnations were done before definitive treatment, preoperative external radiation therapy was given 4 weeks before surgery and interstitial brachytherapy. The types of surgery were wide excision in five patients, and marginal excision in five patients. Gross or microscopic residual was left at the surgical resection margins in four patients. The brachytherapy dose ranged from 17.5 Gy to 24 Gy and external beam radiation did from 40 Gy to 45 Gy. RESULTS: With the median follow-up duration of 21.5 months(range: 13 to 29 months); one local recurrence, and three new distant metastases were observed. There were three patients with wound complications attributable to the current treatment regimen. CONCLUSION: Satisfactory local tumor control may be achievable with limb-conserving surgery and external radiation therapy plus brachytherapy in patients with extremity soft tissue sarcomas, while more caution should be used to avoid wound problems.
Amputation ; Brachytherapy* ; Diagnosis ; Extremities* ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Sarcoma* ; Wounds and Injuries

Using computerized motion analysis techniques, kinematics of foot trajectories were quantitatively analyzed in twelve rats before and after dorsal spinal cord hemisection at the T6 level. Although overground locomotion in these animals returned to normal within four weeks, some kinematic variables during treadmill locomotion did not recover to pre-lesion level. Immediately following dorsal hemisection, amplitudes of both hindfeet horizontal and vertical movements were dramatically reduces. However, in three weeks, the amplitudes of horizontal movement(stride length) became significantly larger than of pre-lesion strides. On the other hand, amplitude of hindlimb vertical movement showed very little recovery. Forelimb-hindmill coordination was also disrupted initially but returned to normal within three weeks. The duration of hindlimb swing phase became significantly longer after sectioning and gradually recovered, but never to pre-lesion levels. Interestingly, amplitudes of forelimb vertical movement. which was depressed initially, became significantly largery three weeks after lesioning. A dramatic increase in the statistical variation of limb kinematics, which persisted even after motor recovery, is an important parameter for the evaluation of neural deficits in spinal cord injuries. Kinematic analysis is a sensitive technique for the detection of minor motor deficits following nerve injuries.
Animals ; Biomechanical Phenomena ; Extremities ; Foot ; Forelimb ; Hand ; Hindlimb ; Locomotion* ; Rats* ; Spinal Cord Injuries ; Spinal Cord*