Traumatic dislocation of the hip presents serious problems that may lead to avascular necrosis, nerve palsy, post-traumatic arthritis even when reduction is promptly and adequately carried out. Among them avascular necrosis is the most important prognostic factor, so the early detection of this complication has critical significance for final result. Bone scan has been considered one of early diagnostic test, but recently MRI replaced its role for imaging in the detection of early AVN, treatment monitoring and prediction of prognosis. Authors prospectively studied the early finding of MRI to detect avascular necrosis of the femoral head and to predict prognosis in traumatic hip dislocation and fracture-dislocation. From December 1990 to November 1994, 12 case of dislocation and fracture-dislocation of the hip were studied . In follow up period ranging from 19 months to 65 months, 10 case had excellent or good result. All cases had abnormal MRI finding such as paraarticular edema, capsular bulging, joint effusion, femoral head fracture, but findings such as femoral head signal changes were dectected in only 3 cases. Among the 3 cases, 1 case had developed AVN and 2 cases were uneventful. Other complications were 3 cases of posttraumatic arthritis, 2 cases of incomplete sciatic nerve palsy, and 1 case of heterotrophic ossification. Although early MRI finding at posttrauma 2weeks gave less specific information, it could give good information for risk group and follow up control with more cases. Although it is expensive, MRI can be one of the most reliable reference in early diagnosis of AVN and prediction of prognosis in traumatic dislocation and fracture- dislocation of the hip with non-invasive method.
Arthritis ; Diagnostic Tests, Routine ; Dislocations ; Early Diagnosis ; Edema ; Follow-Up Studies ; Head* ; Hip Dislocation* ; Hip Joint ; Hip* ; Joints ; Magnetic Resonance Imaging* ; Necrosis ; Paralysis ; Prognosis ; Prospective Studies ; Sciatic Neuropathy

ACL plays an important role in stability of knee joint and its injury causes instability of joint which is known as the initiation of problem knee. Reconstruction of the anterior cruciate ligament would be preferred to the primary repair in treatment. And recently with the advance of arthroscopic technique and development of bone-patellar tendon-bone (BPB) graft material, the result of reconstruction is somewhat superior to that of primary repair. Authors compared the results of 20 primary repairs (Group I ) and 20 reconstructions (Group II) among 64 acute ACL injury treated Sung-Ae General Hospital from January 1989 to December 1994. The results were as follows: 1. Most common associated injuries were medial collateral ligament rupture and medial meniscal tear. 2. Group I showed postoperatively 13 negative anterior drawer test, 12 negative Lachmann test and 12 negative pivot shift test and group II showed postoperatively 17 negative anterior drawer test, 15 negative Lachmann test and 17 negative pivot shift test. (p<0.05) 3. In postoperative Lysholm knee scoring scale, group I showed 86 points and group II showed 93 points (p<0.05). 4. In postoperative KT-1000 arthrometer, 12 cases in Group I and 16 cases in Group II showed less than 2mm difference with sound side (p<0.05).
Anterior Cruciate Ligament ; Collateral Ligaments ; Hospitals, General ; Joints ; Knee ; Knee Joint ; Rupture ; Transplants

Ankylosing spondylitis is a chronic inflammatory disease of unknown etiology that affects spine, sacroiliac joint, and the large joints of the extremities, and lead to fibrous or bony ankylosis and deformity. The rigid ankylosed spine of ankylosing spondylitis is prone to fracture by minimal trauma, and the resulting fractures likely to be unstable and damage to spinal cord or cauda equina. The authors report a case of paraplegia in ankylosing spondylitis after open reduction of the femoral trohanteric fracture.
Ankylosis ; Cauda Equina ; Congenital Abnormalities ; Extremities ; Femur ; Joints ; Paraplegia ; Sacroiliac Joint ; Spinal Cord ; Spine ; Spondylitis, Ankylosing

The method of treatment of acromioclavicular dislocation is controversial, and conservative and surgical treatment have been reported to be both successful. Recently, many surgeons tend to treat the acromioclavicular dislocation with anatomical reduction of acromioclavicular joint and rigid internal fixation because of many disadvantages of conservative methods. We report 24 cases of acute acromioclavicular dislocation treated with modified Phemister method from March 1989 to December 1992. The follow-up ranged from 12 months to 31 months with 16.5 months on average. The results are as follows. l. Among 24 cases, 21 cases are males and 20 cases are in 3rd decade to 5th decade. 2. The most common cause of injuries is falling down, followed by traffic accident. 3. Associated injuries are fractures in 5 cases, spleen rupture in 1 case. 4. Except 1 case with spleen rupture, 23 cases were treated within 2 weeks after injury. 5. Preoperative difference in C-C distance on stress view is 8.6mm on average, ranged from 6mm to 18mm. 6. Clinical results were excellent in 11 cases, good in 10 cases, fair in 2 case, and poor in 1 case. 7. Complications were pin migration in 1 case and symptomatic acromioclavicular arthritis in 1 case.
Accidental Falls ; Accidents, Traffic ; Acromioclavicular Joint ; Arthritis ; Dislocations ; Follow-Up Studies ; Humans ; Male ; Methods ; Rupture ; Spleen ; Surgeons

Nonunion of the distal humerus is rare and diffcult to treat. It presents to surgeon a double challenge : to obtain bony union of the nonunion and to preserve the mobility of the joint. Six patients who had been treated for a nonunion of the distal humerus at National Medical Center from 1980 to 1988 were reviewed. Three of them were extraarticular and the rests were intraarticular fractures. Two had been open fractures. Five had been associated with nerve injury. Senile osteoporosis was noted in two. Four had been initially treated by 0/R and I/F; one, by irrigation, debriment and traction, followed by 0/R and I/F. The average time from the initial treatment to the treatment of nonunion was 20 months, ranging 3 to 44 months. The type of nonunion was reactive in one and nonreactive in five. All patients had pain, instability and limited motion of the elbow. Four who had perfomed surgical treatment for the nonunion were successful in obtaining bony union. Two who had not performed the operation were supported with the elbow brace to relieve the pain and prevent the progression of the deformity. At follw-up(average 21.6 months, ranging 5 to 39 months), functional end result was good in one; fair in four; poor in one, according to the functional rating system of Jupiter et al. In spite of success in union, the functional disability was major long-term problem. The probable causes of nonunion in our cases were unsatisfactory C/R and insufficient immobilization time, incomplete 0/R and inadequate I/F, insufficient postoperative immobilization time, senile osteoporosis, underlying systemic disease, and focal infection in fracture site.
Braces ; Congenital Abnormalities ; Elbow ; Focal Infection ; Fractures, Open ; Humans ; Humerus ; Immobilization ; Intra-Articular Fractures ; Joints ; Jupiter ; Osteoporosis ; Traction

Cemented total hip replacement is one of the established methods of treatment in various hip joint disorder in adults in spite of the high incidence of the complications. The authors report a clinical experience of 39 patients(47 hips) among the 111 patients (126 hips) who were treated with cemented total hip replacement from May 1973 to August 1985 at the Department of Orthopaedic Surgery of National Medical Center. The follow-up period ranged from 3 years to 11 years and 6 months with an average of 6 years and 9 months. The results are follows : 1. The functional results were good or excellent in 73% using Harris Hip Score. 2. The rate of mechanical loosening was 34.8% in femoral components, and 28.3% in acetabular components, and 19.6% in both components. 3. Average rate of socket wear was 0.243mm/yr in Charnley type prosthesis and 0.32mm/yr in Miieller type prosthesis. 4. Age, types of prosthesis, follow-up period showed stastical correlation with functional results(p<0.05). 5. Follow-up periods affected the incidence of radiographic loosening(p<0.05). 6. The relationship between follow-up periods and wear was stastically significant(p<0.05). 7. Septic loosening occurred in one case, who was eventually given Girdle-stone operation. 8. The rate of trochanteric non-union was 16.6% and ectopic bone formation occurred in 23.4%.
Acetabulum ; Adult ; Arthroplasty, Replacement, Hip ; Femur ; Follow-Up Studies ; Hip ; Hip Joint ; Humans ; Incidence ; Osteogenesis ; Prostheses and Implants

OBJECTIVE: This study was performed to evaluate the efficacy, safety and complications of tension-free vaginal tape (TVT) combined with total hysterectomy under general anesthesia. METHODS: Retrospective comparison of 76 women treated by TVT procedure with total hysterectomy from January 2003 to December 2003. All patients had undergone preoperative evaluation including history taking, physical examination, pelvic examination, 1-hour pad test and urodynamic test, and then were operated under general anesthesia. There were 65 patients combined with LAVH (laparoscopic assisted vaginal hysterectomy), 6 patients combined with VTH (vaginal total hysterectomy) and 5 patients combined with TAH (total abdominal hysterectomy). RESULTS: The mean follow up and hospital day were respectively 13 months (range 6-18 months) and 7.6 days (range 6-15 days). Objective and subjective success rate were respectively 97.4% (cured 92.1%, improved 5.3%) and 97.4% (cured 88.1%, improved 9.3%). Preoperative and postoperative 1-hour pad test were respectively 36.4 gm and 4.1 gm (p<0.001). Complications were bladder perforation (6.6%), voiding dysfunction (7.9%) and overactive bladder syndrome (7.9%). CONCLUSION: Conclusively, the cure rate was 88.1% in the TVT combined with hysterectomy when performed under general anesthesia.
Anesthesia, General ; Female ; Follow-Up Studies ; Gynecological Examination ; Humans ; Hysterectomy* ; Physical Examination ; Retrospective Studies ; Suburethral Slings* ; Urinary Bladder ; Urinary Bladder, Overactive ; Urodynamics

BACKGROUND: The effective ventricular function during ejection and filling is likely to depend on the coordinated action of the longitudinally and circumferentially orientated myocardial fibers and the function of these longitudinal fibers has not been extensively studied. METHODS: The role of longitudinally and circumferentially orientated fibers in left ventricular wall motion was evaluated by M-mode echocardiograms of the mitral ring(whose motion reflect long axis change) and the standard minor axis(left ventricular posterior wall), simultaneous recordings of phonocardiograms and electrocardiograms on the paper (speed 100mm/sec), in 24 healty individuals, 17 patients with mitral stenosis, 11 patients with open mitral commissurotomy and 17 mitral valve replaced patients. RESULTS: In the controls long axis shortening significantly preceded minor axis shortening (phase difference between two axes : 20+/-3 msec, mean+/-SEM) during early systole, indicating left ventricle become more spherical. This phase difference was also observed in the patients with mitral stenosis and in those with open mitral commissurotomy. In patients with mitral valve replacement(MVR) whose papillary muscles had been sectioned, the onset of long axis shortening was more delayed during early systole than that of short axis(-33+/-6msec) and the end of shortening was also prolonged to early diastole more than that of normal controls (54+/-3 msec vs 90+/-8 msec, mean+/-SEM, p<0.01 by t-test). CONCLUSION: We observed the time relations between long and short axis motion in normal controls. It can be concluded that the reversed time relation in patients with MVR is one of the important factors which may effect negatively on ventricular function and long-term prognosis, thus the surgical procedures to preserve papillary annular continuity should be considered in patients with mitral valvular disease. And the controlled, prospective, clinical trials with homogenous groups of patients are needed to evaluate the potential benefits of papillary annular continuity in preserving atrio-ventricular interaction in patients undergoing mitral valvular surgery.
Axis, Cervical Vertebra* ; Diastole ; Echocardiography ; Electrocardiography ; Heart Valve Diseases* ; Heart Ventricles ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Papillary Muscles ; Prognosis ; Systole ; Ventricular Function

Ureteroscopy has been used widely to remove ureteral calculi, especially distal ureter stones. Also extracorporeal shock wave lithotripsy (ESWL) has widened its applicability to ureter stones including distal ureter stones. In this study we tried to evaluate the exact role of ureteroscopic manipulation to get rid of ureter stones in the era of ESWL. Success rates and complications of 111 ureteroscopic stone removal procedures performed from December 1986 to May 1995 and those of another 369 patients managed with ESWL from May 1989 to May 1995 were analyzed. Success was defined as complete removal of the stones or residual stones less than 2 mm, immediate postoperatively in ureteroscopic manipulation and 2 weeks after ESWL. The success rate of the ureteroscopic manipulation was 38.9% (7/18), 46.2% (6/13) and 67.5% (54/80) in upper, middle and lower ureter stones, respectively. According to the size of the stone, success rate was 72.4% (21/29), 63.5% (40/63) and 14.3% (9/63) when it was less than 5 mm, 6 to 10 mm and larger than 10 mm. So the overall immediate postoperative success rate of ureteroscopic stone removal was 60.4%, and in another 8.9% of the patients the residual fragmented stones were expelled spontaneously in one month after the procedure. Complications were found in 9.9% of the procedures, including 5 mucosal avulsions and 2 ureteral strictures Success rate of the single session of ESWL was 64% without any differences regardless of the location of the stones in ureter, and it increased up to 88% when another 2 more sessions were tried. Success rate of the single session of ESWL according to the size of the stone was 91.7% (22/24), 67.9% (144/215) and 53.89S (70/130) in stones less than 5 mm, 6 to 10 mm and more than 10 mm, respectively. Complications were found in 3.4% of the patients, including 1.7% of steinstrasse and 1.4% of severe nausea and vomiting. From these observations we can conclude that it seems to be mandatory to renovate the indications of the ureteroscopic stone removal procedures in the era of ESWL.
Constriction, Pathologic ; Humans ; Lithotripsy ; Nausea ; Shock ; Ureter* ; Ureteral Calculi* ; Ureteroscopy ; Vomiting