The high osteogenic potential in children can lead to the spontaneous regeneration of a significant bone loss, however, the site documented in the previous reports was limited to the diaphysis in long bones. We report an exceptional case of a spontaneous regeneration of the whole lateral malleolus, including epiphysis, physis, and metaphysic, after traumatic loss in a three-year-old boy. This case emphasizes the importance of attempts to save as much of the cartilaginous tissues and the periosteum as possible, which have a great osteogenic potential, in themanagement of open would in childrhood.
Child ; Diaphyses ; Epiphyses ; Follow-Up Studies ; Humans ; Male ; Metaphysics ; Periosteum ; Regeneration

Leg length discrepancy or short stature is a significant problem to patient psychosocially, cosmetically, and there has been many efforts for limb lengthening. There are many report about lower limb lengthening since the first description of femoral lengthening by Codivilla in 1905. Although limb lengthening using external fixator was popularized by Anderson, the result was poor because of many difficulties in techniques and complications. Recently, a great progress in lower limb lengthening was made by distraction osteogenesis by llizarov and callotasis by De Bastiani. But as such exter- nal fixator has some problem in technique, cosmesis or complications. Therefore gradual elongation intrameduilary nailing(Albizzia) developed by Guichet in 1986 has gained attention for more stability and relatively less discomfort. We reviewed 18 cases in 11 patients(5 males and 6 females) who visited the department of Orthopedic Surgery of Severance Hospital at Yonsei University with limb leg length discrepancy due to sequeale of poliomyelitis, familial short stature and Turner syndrome. They all underwent lower limb lengthening using Albizzia technique between December 1995 and January l997. The average age at the time of the operation was 22.7 year. Famiiial short stature was in 12 cases(67%), Turner syndrome in 2 cases(11%), and leg length discrepancy due to the sequelae of poliomyelitis in 4 cases(22%). The site of lengthening were 5 cases of femur(28%) and l3 cases of tibia(72%). The latency period was average of 7 days. During the distraction period, 15 ratchetings per day(1 mm/day) were performed. In case of bilaterai femoral lengthenings, average length of gain(LG) was 6.0cm and percentage of increase(PI) l6.8%(16.2-17.4), lengthening index(LI) 1.2 month/cm(0.75-2.2). In case of unilateral femoral lengthening, LG was 3.8cm, Pl 7.8 %, Ll 1.3 month/ cm. In case of bilateral tibial lengthening, average LG was 5.5cm(3.5-6.0~) and Pl 18.8%(12.0-22.9), LI 1.3month/cm(0.67-2.3). In case of unilateral tibial lengthening, LG was 2.9cm(2.3-3.5), P1 9.4 %(7.7-11.7), LI 2.8 month/cm(2.2-3.1). Lengthening index in poliomyelitis by llizarov was 3.l month/cm, but it was 1.3 in femur and 2.8 in tibia hy Albizzia method. There are some advantages and disadvantages or contraindications and indications of the Albizzia technique. We suggest that the Albizzia technique is more stahle, more comfortable and no longer lengthening time compared to external fixator such as Ilizarov.
Albizzia ; External Fixators ; Extremities* ; Femur ; Humans ; Latency Period (Psychology) ; Leg ; Lower Extremity ; Male ; Orthopedics ; Osteogenesis, Distraction ; Poliomyelitis ; Tibia ; Turner Syndrome

No abstract available.
Extremities* ; Ilizarov Technique*

We have reviewed 22 cases of acute rupture of the achilles tenden seen at Naticnal Seoul Ho pital during a seven-year peiod (1974.1 to 1980. 12), 17 treated surgically, and 5 treared cons ervatively, The results of a follow-up review are as follows: 1. Males predominated by a ratio of 21: 1. The mean age for the 22 patients was 29.8 years. Fourteen cases (63.6%.) were in the third decade. 2. The sites of rupture were 13 cases(58.4%.) on the left side and the level of rupture was at the tendon itself on 15 Cases (68.2%). 3. The cause of injury was indirect trauma in 14 cases (63.6%) and the most ccmmon mechanim of injury was a sudden push-off of the foot from the plantar flexed position: seven (50%) of 14 cases. 4. Positive Thompson test was noted in 19(86.3%) of 22 cases. 5. The average period of cast immobilization was 6 weeks in surgically treated cases and 10 weeks in conservatively treated cases. 6. The most common complication was wound infection, which developed in three cases(17.6%) postoperatively. One case of re-rupture (20%) developed after conservative treatment.
Follow-Up Studies ; Foot ; Humans ; Immobilization ; Male ; Rupture ; Seoul ; Tendons ; Wound Infection

A case of gouty polyarthropathy accompanied with carpal tunnel syndrom is reporte, in a 70 year old man. The patient was treated by removal of tophaceous materials surgically in both knee and right wrist joints for the relief of pain. There was a relatively good result postoperatively in the aspect of pain free motion of joints, but he was died of the complication of gouty nephropathy 4 months later after discharge.
Arthritis ; Gout ; Humans ; Joints ; Knee ; Wrist ; Wrist Joint

No abstract available in English.
Constriction

Even though closed treatment of Colles' fracture leads to satisfactory clinical results, many patients who have had such a fracture are found to have permanent disability and poor function of hand and wrist. Malunion occurs frequently following Colles' fracture and there is considerable disability, pain and deformity associated with this lesion. Such deformity of wrist can usually be prevented by proper treatment, but if deformity developes, better function and a normal appearing wrist can be restored by a corrective osteotomy. The authors experienced 6 cases of malunited Colles' fracture which had been treated by corrective osteotomy, Darrach resection, and osteoclasis, etc.
Colles' Fracture ; Congenital Abnormalities ; Hand ; Humans ; Osteotomy ; Wrist

Thirteen Polio patients with leg length inequality were undergone Ilizarov lengthening procedures and have been followed along for an average two years(range, 1-3.8 years) after removal of the fixator. The age of patients(M:F=7:6) ranged from 18.0 to 32.2 years(average 26.4 years). The difference of true leg length averaged 2.1cm with the tibia being 3.3cm the femur, 1.2cm. The corticotomy was done at the proximal tibia and distal fibula in all case. The fixation period of the Ilizarov apparatus averaged 9.3 months. The length gain averaged 3.0cm for an average 3.8cm inequality. The healing index averaged 3.1mon/cm. Two out of thirteen patients complained of pain in the operated leg. The limping gait was improved in all patients except one. According to Paley's classification, there were ten cases of problems, one obstacle and four true complications. The problems were pin site infection controled with local antibiotics injection. There was one case of obstacle; tibial valgus deformity developed during lengthening. True complications included peroneal nerve injury, aggravation of preexsiting equinovalgus and claw toe deformities, aggravation of preexsiting valgus deformity of ankle and tibial valgus deformity. The complications execpt in one case of peroneal nerve palsy were solved out by the secondary procedures. In summery, the bone healing by distraction osteogenesis with the Ilizarov technique was relatively delayed in polio patients and it seems necessary to modify the technique to shorten the prolonged external fixation period.
Ankle ; Anti-Bacterial Agents ; Classification ; Congenital Abnormalities ; Femur ; Fibula ; Gait ; Hammer Toe Syndrome ; Humans ; Ilizarov Technique ; Infection Control ; Leg Length Inequality ; Leg ; Osteogenesis, Distraction ; Paralysis ; Peroneal Nerve ; Poliomyelitis ; Socioeconomic Factors ; Tibia

There are many difficult problems and various methods in the treatment of difficult fractures of the femur. Form May 1991 to August 1994, 9 cases of difficult fractures of the femur were treated with Ilizarov external fixator. We obtained good result for all cases as follow : 1. There were 1 case of severely segmental and comminuted fracture with bone loss, 3 cases of infected nonunion after internal fixation(2 cases combined with bone loss), 2 cases of non-union after internal fixation and 3 cases of severely segmental and comminuted fractures. The traffic accident injury was in 6 cases and the falling down injury was in 3 cases. 2. The bone union was obtained in all cases and the duration of Ilizarov external fixator application was minimum 7.7 months up to 19 months with an average of 1.3 months and full weight bearing was possible in all cases after removal of the Ilizarov external fixator. 3. We experienced 9 complication; there were 6 cases of pin tract infection which were controlled by antibiotic injection at that site and there were three cases of limitation of motion of knee. So we conclude that the Ilizarov external fixation technique is one of the effective methods for the treatment of difficult fracture of the femur(ex. segmental, comminuted fracture, bone defect, osteomyelitis and nonunion) in spite of having experienced only few cases.
Accidental Falls ; Accidents, Traffic ; External Fixators ; Femur ; Fractures, Comminuted ; Knee ; Osteomyelitis ; Weight-Bearing

Soft tissue related complications are quite frequent in limb lengthening. Muscle fibers may proliferate or regenerate after stretching injury over 10-20% of their original length. However, the cells which are engaged in this phenomenon are not confirmed yet. We chased the S-phase cells (phase for DNA replication) in the posterior leg muscle during limb lengthening by immunohistochemical technique. We lengthened the tibiae of fifteen New Zealand white rabbits. We divided them into three groups and each group is consisted of five rabbits. In group 1, we lengthened the left tibiae by 10% of their original length, in Group 2, 20%, and in group, 3, 25%, respectively, At the end of lengthening posterior muscles of lengthened left side and of controlled right side were fixed and processed for Immunohistochemical staining which could detect the incorporation of bromodeoxyuridine(BDU). Labelling index(LI:% of positively stained S-phase nuclei) of group 1 was zero. LI of groups for more than 20% lengthening (sum of group 2 and 3) was statistically significant. In conclusion, nuclei around or within the muscle tissue are in S-phase during limb lengthening which means proliferation of the muscle fivers or of the certain cells that abut muscle fibers.
Bromodeoxyuridine ; DNA ; Extremities ; Immunohistochemistry ; Leg ; Muscles ; Rabbits ; Tibia