No Abstract available.

Several techniques are now avallable for the treatment of fractuers of the shaft of the femur. We must be aware of the advantages, disadvantages and Ilmitation of each if we are to select the proper treatment for each patient. During last decades treatment had been varied markedly from time to time and from place to place. Before Word War II, most fractures of the femoral shaft were treated conservatively either by skeletal traction or by manipulation and immobilization in a spica cast. After medullary fixation was Introduced during that war, it became popular, and until 1960 many surgeons considered it as the treatment of choice for most of these fractures. If the case is properly selected the medullary fixation is almost perfect, provlded no complications develop; convalescence can be shortened and resldual disability can be decreased. We had experienced 14 complications among the 78 cases of Kuntscher nailing from may, 1974, to May, 1980. The results are as follows: 1. We operated 78 cases with Kuntscher nail among the 121 femoral shaft fractures. 2. 14 (17.95%) complications developed among the 78 cases of the Kuntscher nailing. 3. Technical errors were incarcerated nailing with thick nail, too long nail and thin nailing. 4. Early postoperative complications within a year were infection, bendlng, bursitis, angulation and rotation. 5. Late complications after one year were proximal or distal migration and refracture.
Bursitis ; Convalescence ; Femur ; Humans ; Immobilization ; Postoperative Complications ; Surgeons ; Traction

Actinomycosis infection can involve most part of the human body including mouth, cervicoface, chest, abdomen and pelvis. Cardiac involvement occurs in less than 2 percent of the infection of actinomyces israelii and pericardial involvement is rare. 34 year male was admitted because of chest pain and general weakness for several months. Echocardiography revealed akinesia of apex suggesting myocardial infarction and large pericardial effusion. Under the impression of pericardial effusion from tuberculosis infection, the patient was started on anti-tuberculosis medicine. Pericardial window operation with pericardial biopsy was performed 7 days later when the patient failed to show a significant improvement. Pericardial biopsy confirmed actinomycosis infection. During admission, the patient had a cerebral infarction with left hemiparesis. The patient was treated with high dose penicillin and improved symptomatically. Echocardiography showed resolution of pericardial effusion.
Abdomen ; Actinomyces ; Actinomycosis* ; Biopsy ; Cerebral Infarction* ; Chest Pain ; Echocardiography ; Human Body ; Humans ; Male ; Mouth ; Myocardial Infarction* ; Paresis ; Pelvis ; Penicillins ; Pericardial Effusion ; Thorax ; Tuberculosis*

PURPOSE: A laterally spreading tumor (LST) has its own characteristic features and growth pattern. Information about LST is scanty in Korea, therefore this study was designed in order to contribute to the literature. METHODS: In this study, 43 patients with LSTs were included. The diagnoses were made by colonoscopy in all cases. Treatment options included endoscopic resection, transanal excision, and surgical resection. In reviewing and analyzing the cases, we made a special emphasis on size, classification, histology, and treatment. RESULTS: The most frequent location was the rectum, followed by the sigmoid colon and the ascending colon in that order. Lesions smaller than 20 mm accounted for 69.8%. Granular homogeneous LSTs, 41.9%. Lesions larger than 20 mm, except granular homogeneous LSTs, showed an abrupt increase in malignancy rate. Tubular adenomas accounted for 65.1%. The overall malignancy rate was 20.9%, and the submucosal cancer rate, 9.3%. There were no malignancies in the granular homogeneous LSTs. The malignancy rate for the mixed-nodule type lesions was 33.3% (4/12), and the nongranular LSTs, 38.5% (5/13). Polypectomy was done in 37.2% of the lesions, endoscopic mucosal resection (EMR) in 16.3%, and endoscopic piecemeal mucosal resection (EPMR) in 16.3%. The overall endoscopic resection rate was 83.7% (36/43). EMR was applicable to lesions smaller than 20 mm, and EPMR to those larger than 20 mm. Transanal resection was done in 2 cases with lesions. Five cases were resected surgically. Four of them were submucosal invasive lesions, and one, a mucosal lesion which was wide and had initially been thought to be a submucosal cancer. There were two recurrences during the average 15-month follow-up period. The follow-up rate was 81.4% (35/43). Of these 2 recurring cases, one patient was treated endoscopically and the other, transanally. CONCLUSIONS: LSTs show different behavior depending on the endoscopic classification. Granular homogeneous LSTs are seldom larger than 30 mm and are good candidates for endoscopic treatment. The mixed-nodule type and the nongranular type show a marked predisposition to malignancy when they are over 20 mm, and nongranular-type LSTs have a higher rate of submucosal invasive cancers. Thus, in the cases of the mixed-nodule and nongranular types, careful consideration should be given for deciding between endoscopic treatment and surgical resection. Complete resection should be assured to prevent recurrence, and follow-up surveillance is required in all lesions for more than 3 to 5 years.
Adenoma ; Classification ; Colon, Ascending ; Colon, Sigmoid ; Colonoscopy ; Diagnosis ; Follow-Up Studies ; Humans ; Korea ; Rectum ; Recurrence

Subtrochanteric fracture of the femur is more difficult to treat than other bone fracture. Subtrochanteric fracture occurs in bone that is predominently cortical and biomechanical analyeis of stress in the femur ahowed that there is a high concentration of stress in the subtrochanteric region. These two factors, involvement of cortical bone tissue and concentration of stress, frequently have been mentioned as reasons for the high incidence of complications in the treatment of these fractures. The authors treated 23 cases of subtrochanteric fracture of the femur in 1974 through 1981, at the Department of Orthopaedic Surgery, School of Medicine, Soon Chun Hyang College. The results were as follows: 1. Of 23 cases of subtrochanteric fracture, 15 cases occurred in man, 8 cases in woman. 2. The most common cause of fracture was due to traffic accident. 3. Of 23 cases of subtrochanteric fracture, 9 cases were type lI, and 7 cases were type I & II by Fielding's classification. 4. 19 cases out of 23 were treated by means of the open reduction and internal fixation. As the internal fixation material, we used Kuntscher nail, Smith-Peterson and Thornton plate, Compression hip screw and plate until December 1978, and Zickel nail from January 1979. 5. The mean duration of bony union in subtrochanteric fracture treated by Zickel nail was shorter than the other implants. The incidence of complications such as coxa vara, delayed union, metal breakage occurred higher in the cases treated by Kuntscher nail, Smith-Peterson nail and Thornton plate, Campression hip screw and plate. 6. Zickel nail is one of the good implant for the treatment of subtrochanteric fracture of the femur.
Accidents, Traffic ; Bone and Bones ; Classification ; Coxa Vara ; Female ; Femur ; Fractures, Bone ; Hip ; Humans ; Incidence

Open long bone fracture is frequently difficult to reduce and maintain, especilly when there is extensive soft tissue damage. Infection, instability, malalignment and soft tissue complication often result in prolonged mobidity or failure. The Hoffmann's apparatus have merits, that can easily correct distracted, angular or rotational deformity of fracture site during early post-operative period, and stable fixation facilitates easily to the care of soft tissue injury. In addition, the affected limb can be elevated with balanced suspension, possible early exercise of neighboring joints. But we have exerienced some problems during treatment of fracture with Hoffmann's transfixation method. From February 1980 to December 1981, Hoffmann's transfixation method was employed in treatment of twenty-one patients that considered to have a poor prognosis with conversional forms of treatment. The results were obtained as follows; 1. For correction of distracted, angular, or rotational deformity, the fracture site should be reduced accurately. 2. Hoffmann pins should be transfixed as one plane and parrallel to each other. 3. Rigidity of fixation can be increased by increasing number of pins, actually three or more pins should be applied at each fragment of fracture. 4. Hoffmann's apparatus is more complex for management, more expensive and requires skillful technique compared with other external fixation apparatus. 5. The lateral view of fracture site could not be confirmed accurately due to overlapping of Hoffmann's adjustable connecting rod and bony shadow. 6. The main cause of injuries was due to traffic accidents in 17 cases (81%), involving tibia in 18 cases, femur in 2 cases and humerus in 1 case. 7. In the sixteen cases which could be assessed, the average times for external transfixation was 13.9 weeks and then followed by early weight bearing with P.T.B. cast or brace. The average time of bony union was 26.4 weeks. 8. The final result was excellent in 7 cases, good in 5 cases, acceptable in 3 cases, poor in 1 case.
Accidents, Traffic ; Braces ; Congenital Abnormalities ; Extremities ; Femur ; Fractures, Bone ; Fractures, Open ; Humans ; Humerus ; Joints ; Methods ; Prognosis ; Soft Tissue Injuries ; Tibia ; Weight-Bearing

A retrospective study has been made of 784 cases of road traffic casualties who were treated at the Soon-Chun-Hyang Hospital between July 1980 and December 1981. This study was conducted to find out the nature and pattern of the traffic accident from the clinical and epidemiological standpoints. In additions, the mode of injury from the road accidents were persued which might help to reduce the misdiagnosis rate. The results obtained were as follows: l. In this survey, male dominated in numbers (casualty rate, 70%). The highest incidence was in the age group between 31–40 year (26.5%). The predominance was found in younger casualties (ages between 21–50 years, 72.1% of all casualties). 2. The large number of casualties followed the rush hours. There was a peak between 10PM to midnight. The explanation for this high incidence during the hours was the hurry-up life due to midnight crufew, pedestrian's carelessness and hurry-scurry, and the negligence of traffic rules, the poor labor conditions and weariness due to drivers long continuous working hours, especially in taxi drivers. The highest seasonal incidence was in October. 3. The high incidences were in drivers and students; the drivers were the commonest victims in car passenger accidents and students were injured by pedestrians accidents respectively. The causes of high risk of injury in drivers were intimately related with their vocational aptitudes, the employment status, the driving attitudes and car maintainances; and in students, their carelessness and emotional instability, unsolved mass transportation system and their negligence of traffic rules were listed as the causative factors. 4. Over 51.8% of all casualties were injured by passenger car accidents, and 21.5% were by truck and other types of special vehicles. 5. Approximately 60% of victims were injuried in the road as pedestrian and other 40% were in the car as passengers. In general, the pedestrian injuries were more serious than those sustained in the car as passengers. 6. About 40% of total pedestrian casualties sustained injury at pedestrian's cross road. 7. About 80%of injured drivers were in the drunken state on arrival, and 20.4% of pedestrians were also heavily drunken. 8. The trauma risk was about twice higher in the front-seated passengers than the rear-seated ones in the car. In buses, the highest incidence was in the passengers seated in the front 1/3 of the seats. 9. Orthopaedic (40.5%) and head injuries (38.2%) were the commonest types of the injuries among the hospitalized casualties; about 35% of total patients had the tibial fractures. 10. Of the 784 cases, 479(61.6%) victims arrived hospital within 30 minutes after accident, and among them only 94 cases (12%) were transported by ambulance from the accident site to the hospital.
Accidents, Traffic ; Ambulances ; Aptitude ; Craniocerebral Trauma ; Diagnostic Errors ; Employment ; Humans ; Incidence ; Male ; Malpractice ; Motor Vehicles ; Occupations ; Pedestrians ; Retrospective Studies ; Seasons ; Tibial Fractures ; Transportation

The new trial to apply the closed I-M nailing for 23 cases of long bone fracture has been used our department, loss of hematoma, further damage to periosteum and soft tissue were prevented; the risk of infection was reduced; and the early functional use of extremities without additional superflous external fixation could be made. The results obtained were as follows; 1. There was no case of non-union or other complication. 2. The average bone union rate was 26.1 weeks in femur, 22 weeks in tibia, or 11.5 weeks in forearm. 3. The advantages is simple method and be able to do early ambulation without following muscular atrophy or ankylosis. 4. The patients were satisfactory about cosmetic problem after operation. 5. The merits of this operation were the short hospitalization and early adaptation of social activity. 6. In conclusion, closed I-M nailing is method of choice for long bone shaft fracture when internal fixation is indicated and our operative is useful and simple.
Ankylosis ; Early Ambulation ; Extremities ; Femur ; Forearm ; Fracture Fixation, Intramedullary ; Fractures, Bone ; Hematoma ; Hospitalization ; Humans ; Methods ; Muscular Atrophy ; Periosteum ; Tibia

A fracture of the distal tibial articular surface is fortunately an uncommon injury, since it can be exeptionally difficult to manage. The term plafond is gar'nering general acceptance since there is no anatomic name for the specific location of this fracture. The term was introduced more than 50 years ago in American orthopaedic literature to describe these injuries. The literal meaning of plafond is the underside of a floor, i.e., a ceiling, so the term refers to that portion of the distal articular surface of the tibia which articulates with the superior articular surface of the talus. It excludes the medial malleolar joint surface. Fracture of the plafond have also been called compression, pylon, Malgaigne and explosion fractures. A plafond fracture is defined as one caused primarily from direct axial compression resulting in elevation andgor displacement of all or part of the distal articular surface of the tibia, excluding isolated or combined fractures of the medial and posterior malleoli that are recognizably caused by rotational forces. We reviewed 16 cases(14 patients) of tibial plafond fractures treated at the Department of Orthopaedic Surgery of Soan Chun Hyang University Hospital during 8.5 years period from June 1974 to December 1982. The longest duration of follow-up was 5 years and 6 months, the shortest, 6 months, and the average, 1 year and 6 months. They were classified according to Moore et al., and assessed according to the criteria of Joy et al. The following results were obtained: l. Of the 14 patients, male were 12, female were 2. 2. The average age of the patients was 38 years old. 3. The most common causative injury was fall-down. 4. The most common type in radiological study was dorsiflexion type. 5. In method of treatment, operative treatment was done in 9 cases and non-operative in 6 cases. 6, The average duration of the cast immobilization in non-operative treatment was 12 weeks and operative, 10 weeks. 7. Better results were obtained by operative treatment than non-operative treatment. 8, The complications were encounted in 1 case of non-operative, 2 cases of operative treatment. 9. We agree that the accurate anatomical reduction with rigid internal fixation assures better results in the tibial plafond fracture.
Clinical Study ; Explosions ; Female ; Follow-Up Studies ; Humans ; Immobilization ; Joints ; Male ; Methods ; Talus ; Tibia

OBJECTIVE: Behcet? disease (BD) is a chronic inflammatory disorder affecting several organs. The etiology of BD remains unclear, although genetic factors, infectious agents, and immune mechanisms have been studied. The association of BD with certain genetic factors, especially HLA-B51 antigen, is well known in some geographical areas. Nevertheless, the familial occurrence of BD is rare. In this paper, HLA phenotype was evaluated in one family member showing the clustering of BD. METHODS: The serological tissue typing of HLA class I and class II antigens was performed by standard National Institutes of Health microlymphocytotoxicity method in seven family members in which four siblings were affected by BD. The diagnosis of BD was established by the criteria of the International Study Group of BD in these four siblings. RESULTS: In this family study, all members had HLA-A2 and DQ3 antigens. Although HLA-B51 antigen was positive in six out of seven family members, BD was developed in three of the six having HLA-B51 antigen. Three siblings had the exact same HLA phenotype. However, only one person had BD among three siblings with identical HLA phenotype. In addition, all siblings who developed erythema nodosum-like lesion had HLA-B51 antigen. CONCLUSION: This family suggests that the familial clustering of BD may not be explained solely by a susceptible HLA phenotype. The environmental factor or other genetic factors besides HLA-B51 might play a role in the development of BD. Furthermore, more studies and information will be needed to clarify the role of A2 and DQ3 antigens in BD.
Diagnosis ; Erythema ; Histocompatibility Antigens Class II ; Histocompatibility Testing ; HLA Antigens* ; HLA-A2 Antigen ; HLA-B51 Antigen ; Humans ; National Institutes of Health (U.S.) ; Phenotype ; Siblings