We had treated 24 patients who had nonunions of the carpal scaphoid from June 1987 to September 1995. 17 of 24 nonunions of carpal scaphoid were treated by K-wires fixation and autogenous iliac bone grafts. Another 7 cases were treated by Herbert screw fixation and autogenous iliac bone graft. 24 patients were followed up average 42.6 months and obtained following results; l. Among 24 cases, 23 cases were men and 19 cases were the third and fourth decade. Most common injury was the falling accidents (11 cases: 45.8%). 2. Most common pattern of fractures was waist type (20cases: 83.3%) in anatomical site and transverse type (15 cases: 75.0%) in pattern of fracture line. 3. Preoperative scapholunate angles (mean 52.9degrees: K-wires, 69.1degrees: Herbert screw) has been improved after open reduction and internal fixation by K-wires or Herbert screw (mean 46.2degrees: K-wires, 51.1degrees: Herbert screw). 6 cases had DISI deformity preoperatively with scapholunate angles over 70degrees (mean 80.0degrees: K-wires, 84.0degrees: Herbert screw) has been corrected after ORIF (mean 48.0: K-wires, 58.0: Herbert screw). 4. Bony unions were obtained in average 13.2 weeks in K-wires group and 9.8 weeks in Herbert screw group. 5. 13 cases (76.5%) in K-wires group and 6 cases (85.7%) in Herbert screw group were excellent and good result by Maudsley method. 6. The complications and sequalaes were present 4 cases in K-wires group with degenerative arthritis on radioscaphoidal and scapholunate joint and collapse of proximal pole and 1 case in Herbert screw group with screw malposition. So, We were thought that ORIF with K-wires and Herbert screw was effective treatment for nonunions of carpal scaphoid, especially Herbert screw fixation and autogenous iliac bone graft. In comparison of bony union and results of treatment, Herbert screw group was more effective than K- wires group.
Congenital Abnormalities ; Humans ; Joints ; Male ; Osteoarthritis ; Transplants

Articular cartilage is a highly differentiated tissue, lacking a vascular supply and having only limited regenerative capability. Cut or other mechanical damage restricted to the cartilage does not repair. Experimentally and clinically, cartilage defect that penetrate the subchondral bone undergoes repair through the formation of tissue usually characterized as fibrous, fibrocartilaginous or hyaline-like cartilaginous tissue. There is little definitive informations about local or systemic factors that control the differentiation of mesenchymal cells to osteoblast, chondroblast or fibroblast. Our study was designed to evaluate the effect of transforming growth factor-beta (TGF-pl) and autogenous periosteal graft on the healing of osteochondral defect of distal femur of rabbit and also the possibility of these method to be clinically applicable to human. The experimental model used in the present study for including cartilage in rabbit was based mainly on the model used by Frukawa et al14). in rabbit. A full thickness osteochondral defect of 80 rabbit were made with 2mm diameter of drill-bit and electrically driven drill. Experimental animals were divided into four group: 1) group I, osteochondral defect only, 2) group II, osteochondral defect with infiltration of phosphate buffer solution, 3) group III, osteochondral defect with infiltration of TGF-Bl, 4) group IV, osteochondral defect with autogenous periosteal graft. The healing of the defect was assessed at 1 week, 3 weeks, 5 weeks, 12 weeks after operation by gross and histochemical examination. At 1 week, fibrinoid material in edge to edge arcade arrangement was present in group I,II,III,IV. At 3 weeks, spindle shaped undifferentiated mesenchymal cell present in the periphery of fibrinous network, but there is no appearance of mesenchymal cell in group I,II. At 5 weeks, essentially complete repopulation of the defect with progressive differentiation of cells to chondroblast, chondrocyte, osteoblast and synthesis of cartilage and matrix in their appropriate location in group III and IV were found. At 12weeks, hyaline like cartilage formation was observed in group III and IV. but early trace of degeneration of the cartilage were seen in many defect with the prevalence and intensity of the degeneration increasing at group I and 3 . Our study demonstrated in detail the repair of full-thickness defect in rabbit articular cartilage extending into cancellous bone of the marrow cavity under influence of local growth factor (TGF-pl) and autogenous periosteal graft. Excellent reconstruction of articular cartilage was observed in TGF- Bl infiltration group and autogenous periosteal graft group as early as 5 weeks after the creation of defect. Although the further study should be carried out for their clinical application, we conclude that TGF-Bl regulates the overall mechanism of matrix constituent in connective tissue and autogenous periosteal graft have a chondrogenic potential to repair major osteochondral defect. these suggest that TGF-Bl and autogenous periosteal graft may be a important pathophysiological regulator of chondro- genesis.
Animals ; Bone Marrow ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Connective Tissue ; Femur ; Fibrin ; Fibroblasts ; Humans ; Hyalin ; Models, Theoretical ; Osteoblasts ; Prevalence ; Transplants*

Sixteen patients who had radial head fractures were treated with open reduction and internal fixation using Herbert screws (10 patients), and with silastic prosthetic replacement (6 patients) from March, 1992 to December, 1994 in Chungnam National University hospital. The average duration of follow up was 19.5 months. The purpose of this study is to examine the role of Herbert screw fixation and silicone replacement arthroplasty and to asscess the clinical results of two groups functionally, radiologically in raidial head fractures. By functional rating index (modified After B.F. Morrey et al), the results were classified as excellent (9 patients), good (6 patients), fair (No patient) and poor (1 patient). Nine of the ten patients treated by open reduction and internal fixation using Herbert screws had resulted in excellent or good. All patients were inserted silastic implants were showed excellent or good results. Especially, in Mason Type III radial head fractures, three of four patients treated by Herbert screws and all 5 patients treated by silastic prosthesis were considered to excellent or good results. We concluded that Herbert screw fixation or silastic prosthetic replacement had satisfactorily appeared to be the alternative treatment option for Mason Type III radial head fractures.
Arthroplasty, Replacement ; Chungcheongnam-do ; Follow-Up Studies ; Head* ; Humans ; Prostheses and Implants ; Silicones

161 patients with tibia fracture were treated by closed intramedullary nailing at the department of Orthopedic Surgery, Eul-Ji General hospital, Dae Jeon, during 5 years from January, 1988 to April, 1993. 134 of these patients were performed with Kiintscher IM nailing and 27 patients with Ender nailing. Rigid IM nailing is the method of choice in tibia shaft fracture with rigid fixation, low complication, wide indication and early weight bearing, but the treatment of segmental fracture of the tibia will have many difficulties because of severe displacement, severe comminution, massive soft tissue damage and lack of blood supply at fracture site. Either antegrade or retrograde Ender nailing was of value for the management of segmental fracture which was too proximally or too dixtally located to insert interlocking screws, open fracture and soft tissue injury around Kiintscher insertion site. The result as fllows; 1. 43 fractures were open and 118 were closed. 69 fractures involved the distal portion, 55 fractures the middle portion, 13 fractures the proximal portion of the tibia and 24 fractures were segmental. 2. Among the 161 eases, 114 cases were male and 47 cases were female, the most common ages were ranged from 21 year to 30 year, involving 44 cases. 3. The most common cause was traffic accident. 4. Average intervals from injury to operation were 6.34 days(closed fracture) and 9.84 days(open fracture). 5. The mean durations of the bone union were 18.90 weeks(closed fracture) and 16.46 weeks(open fracture). 6. Complication included 7 cases delayed union, 3 cases nonunion, 8 cases superficial infection, 4 cases joint stiffness, 3 cases nail migration, 2 cases angular deformity, 2 cases rotational deformity, 1 cases osteomyelitis.
Accidents, Traffic ; Congenital Abnormalities ; Daejeon ; Female ; Fracture Fixation, Intramedullary ; Fractures, Open ; Hospitals, General ; Humans ; Joints ; Male ; Methods ; Orthopedics ; Osteomyelitis ; Soft Tissue Injuries ; Tibia ; Weight-Bearing

The management of ipsilateral fractures of the femoral neck and shaft has proved to be a challenge to the orthopedist. Most major institutions have treatment protocols that emphasize early rigid stabilization of the femoral neck fracture to minimize the incidence of avascular necrosis of the femoral head and the shaft fractures were fixed prior to definitive neck stabilization. Whenever possible, patients should be followed for a minimum of three years to rule out aseptic necrosis of the femoral head. These dual fractures are usually encountered in the young, associated with high-velocity accidents and usually accompanied by multiple system trauma. At the department of orthopedic surgery, Eul Gi General Hospital, from June, 1986 to August, 1993, 21 cases of the concomitant ipsilateral femoral neck and shaft fractures had been treated. The mean follow-up was 2.8 years(ranging from 1.6 to 5.8 years). The diagnosis of femoral neck fracture was delayed in two patients. Seventeen of the 21 cases underwent surgery had a relatively satisfactory functional outcome without complication of femoral head. In two patient, a symptomatic varus nonunion and varus malunion developed. In two cases, osteonecrosis of femoral head developed and one case of these patients was treated with Meyer techniqe of muscle pedicle graft. Our series emphasize that the recommended treatment consists of a closed intramedullary fixation of the femoral shaft fracture followed by ASNI screw fixation of the femoral neck fracture, with good long term functional results and minimum complication. And approaches to the treatment of concomitant femoral neck and femoral shaft fractures should be selected according to the skill and experience of the surgeon and the availability of equipment.
Clinical Protocols ; Diagnosis ; Femoral Neck Fractures ; Femur ; Femur Neck ; Follow-Up Studies ; Head ; Hospitals, General ; Humans ; Incidence ; Neck ; Necrosis ; Orthopedics ; Osteonecrosis ; Transplants

OBJECTIVES: To isolate and culture of human muscle cells by manipulating culture conditions. METHODS: Muscle samples were obtained during total hip replacement or bedside muscle biopsy. We isolated myoblasts from freshly obtained human muscle tissue by trypsin and collagenase digesion. RESULTS: Selective isolation of myoblasts was identified through histologic examination by light-microscope. We identified monoc]onal antibodies(Leu-19) as molecular markers in human skeletal muscle were expressed. CONCLUSIONS: This study demonstrated that it had been possible to culture morphologically and immunelogically identifiable myoblasts isolated from human skeletal muscle tissue.
Arthroplasty, Replacement, Hip ; Biopsy ; Collagenases ; Humans* ; Muscle Cells* ; Muscle, Skeletal ; Myoblasts ; Trypsin

Stomach cancer is the most popular tumor in Korea but the prognosis following extensive surgery and chemotherapy has not improved for many years. Conventional external radiotherapy also has some limitation, namely, a cancerocidal dose cannot be delivered to tumors because of low radiation tolerance of adjacent critical sensitive organs. In order to overcome these limitations of curative surgery and external radiotherapy, intraoperative radiotherapy was proposed in many centers and the results were excellent. We treated two cases of locally advanced gastric cancers with IORT by using NEC 18 MeV Linear Accelerator after standard subtotal resection of the stomach. After treatment, the patients are in good conditions so far, but in order to evaluate the effectiveness of IORT, a study will be performed on the survival rates between patients treated by IORT and those treated by surgery alone.
Drug Therapy ; Humans ; Korea ; Particle Accelerators ; Prognosis ; Radiation Tolerance ; Radiotherapy ; Stomach ; Stomach Neoplasms* ; Survival Rate

An imaginative innovation to shorten hospital stays as a means to reduce patient charges, is out-patient surgery. This procedure also minimized the inconvenience and disruption of the family unit, reduced the opportunities for cross-infection, and freed hospital beds for the more seriously ill patients Since the concept of out-patient surgical service was organized, managed, and performed in the Hanyang Medical Center, we had experience of 132 ambulatory anesthetics during the last two years (from Jan. 1974. to Dec. 1975 ). The results are summarized as follower 1. Preanesthetic examination should be routinely checked with Hb., Hct., urinalysis and chest x-ray. 2. Premedication should be administered preanesthetically, atropine sulfate intravenously. 3. ASA class 1 patients should be chosen for short (less than 1 hour) procedures. 4. Anesthesia is induced with Epontol+S.C.C. and maintained with Halothane+N2O+O2. 5. We suggest that ambulatory anesthesia should be more carefully planned, organized, and managed.
Anesthesia* ; Anesthetics ; Atropine ; Humans ; Length of Stay ; Outpatients ; Premedication ; Thorax ; Urinalysis

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study was to compare factors that influence degenerative changes in patients undergoing total laminectomy and patients undergoing partial laminectomy. SUMMARY OF LITERATURE REVIEW: Lumbar or lumbosacral fusion with total or partial laminectomy may result in adjacent segment problems of the upper segment. However, the differences between the two procedures that may influence adjacent segment instability are still controversial. MATERIALS AND METHODS: We evaluated 95 patients, followed up for at least 2 years, who had been treated with short level (at most 2 levels) posterior lumbar interbody fusion with pedicle fixation, secondary to spinal stenosis. Treatment procedures included total laminectomy (42 cases) and partial laminectomy (53 cases). We analyzed the preoperative status of the intervertebral discs (Thompson grade), difference of disc height, and difference between preoperative segmental sagittal angle and last follow-up sagittal angle. We excluded cases that required revision secondary to infection, nonunion, or hematoma formation. However, we included cases that required revision due to adjacent segmental problems during the follow-up period. RESULTS: The mean age of the patients treated with total laminectomy was 59.0+/-10.9 years, and of the patients treated with partial laminectomy was 58.8+/-10.2 years. The preoperative Thompson grade showed no statistical difference. The difference in disc height and segmental sagittal angle between the preoperative and last follow-up examinations showed no statistical difference between the two groups. CONCLUSIONS: There was no significant difference in the radiographic or clinical outcomes based on removal or preservation of posterior structures. Nevertheless, we need further follow-up to evaluate adjacent segment degeneration.
Follow-Up Studies ; Hematoma ; Humans ; Intervertebral Disc ; Laminectomy ; Retrospective Studies ; Spinal Fusion ; Spinal Stenosis

X-ray films of the lumbosacral spine are necessary in the evaluation of all patients who are considered to have lumbar disc disease. Several positive X-ray film findings are of possible significance, and although not in themselves diagnostic, they are compatible with, lumbar disc disease. Among patients treated and diagnosed by surgical operation for lumbar disc nerniation from August, 1978 to February, 1981 at Korea University Hospital, 132 cases with their simple X-rays available for study were selected. Height of intervertebral disc space(Hurxthal method), spurrings, changes in facet joint, size of spinal canal(Johnes & Thomson method), lumbosacral angle(Ferguson method), congenital defect were studied and measured in simple films. Lumbar disc herniation was most frequent at L4-L5 intervertebral space(65.5%). The incidence of positive radiological findings were 85.6%. 1. Intervertebral disc space narrowing was found in 25%, 59.3% and 50% at L3-4, L4-5 and L5-S1 level respectively. 2. Peripheral osteophyte formations in the bodies of lumbar vertebrae were found in 44.7%. 3. Narrowing and/or sclerotic changes of facet joint were observed in 31.06%, subluxation in 14.39% and facet tropism in 5.3%. 4. The overall mean size of spinal canal at L4 vertebral level was 1:4.325 in male, 1:3.898 in female and at L5, 1:3.772 in female. Narrowed spinal canal in this series were found in 25.6%, at L4 and 17.2% at L5. 5. The overall mean lumbosacral angle was 32.4 degree in male and 31.5 degree in female. Spondylolysis was observed in 4.54%, spondylolisthesis in 3.03%, lumbarization in 8.3% and sacralization in 1.51%.
Congenital Abnormalities ; Female ; Humans ; Incidence ; Intervertebral Disc ; Korea ; Lumbar Vertebrae ; Male ; Osteophyte ; Spinal Canal ; Spine ; Spondylolisthesis ; Spondylolysis ; Tropism ; X-Ray Film ; Zygapophyseal Joint