In 1961, Salter had devised the innominate osteotomy in treating C.D.H, which has been one of the most popular methods in these days. 14 hips with 12 patients who have been admitted and received Salters innominate osteotomy in the department of orthopaedic surgery, National Medical Center, from Feb. 1974 to Dec. 1976, were evaluated as for the results. Clinical analysis and follow-up study were carried out in 14 hips with C.D.H. and the following results were obtained. The mean age of the cases was 34 months, and sex preponderance of female to male was 11: 1. The ratio of left to right was not significantly different. 2 cases of complication out of 12 cases was found; redislocation and subluxaiton respectively. The age of first detection of C.D.H., was surprisingly late around 18 months old. In addition, approximately 12 months has elapsed between the first detection of C.D.H. and the first consultation to doctor. Assesment of the result was carried out by Severine and Macays method respectively; Radiological evaluation was as followings: (Severine) Excellent: 4, Good: 8, Fair: 1, Poor: 1. Clineal evaluation was as followings: (Macay) Excellent: 4, Good: 7, Fair: 1, Poor; 1, Failure: 1.
Equidae ; Female ; Follow-Up Studies ; Hip ; Humans ; Male ; Methods ; Osteotomy

Femoral neck fracture has given marked attention to the orthopaedic surgeon due to complications, such as avascular necrosis of femoral head, non-union and degenerative arthritis, moveover common in older age group since early part of the 20th century. It is one of disabling and unsolved problems, so various techniques and implants were introduced and applied. Percutaneous Knowles pinning is one of simple, safe and reasonably effective method in treating femoral neck fracture, provided it is performed correctly. Nineteen cases of femoral neck fracture treated with precutaneous Knowles pinning at the Department of Orthopaedic Surgery, National Medical Center were analyzed and following result were obtained. l. Among the 19 cases, 13 cases were female and 6 cases were male, and high incidence was noted in older age group. 2. The amout of bleeding during operation was less than 100ml and the operative time was less than one and half hour under the local anesthesia in majority. 3. Good result was obtained in the group of operation less than 3 days after initial injury compared to more than 3 days group. 4. There was high complication rate in poor group than acceptable group according to Garden alignment index and we could predict the end result by aid of alignment index. 5. There was no cast immobilization in case of stable reduction, good fixation and good Rapport. 6. Bony union was established within 4.7 months in non-displaced fracture and 7.3 months in displaced fracture in average. 7. There were 1 case of avascular necrosis. 3 cases of non-union and 2 cases of degenerative osteoarthritis and poor results were correlated with Garden stage.
Agriculture ; Anesthesia, Local ; Female ; Femoral Neck Fractures ; Femur Neck ; Femur ; Head ; Hemorrhage ; Humans ; Immobilization ; Incidence ; Male ; Methods ; Necrosis ; Operative Time ; Osteoarthritis

Several observation suggest that the antimelanocyte autoantibodies could play a role in melanocyte destruction. Some experiments indicate that melanocyte antibodies from patients with vitiligo can kill melanocyte in vitro. In these experiments, we demonstrated that vitiligo patient's sera containing antimelanocyte antibodies can lyse cultured human melanocytes by complement activation. Melanocyte cytotoxicity was measured using the ethidium bromide/ acridine orange viability assay. Significant melanocyte cytotoxicity was seen in sera from patients with both active and inactive vitiligo(p<0.01). Melanocyte cytotoxicity measured with complement-mediated cytotoxicity decreased after systemic steroid treatment(p<0.05) ; however melanocyte cytotoxicity showed no significant change with systemic PUVA therapy.
Acridine Orange ; Antibodies ; Autoantibodies* ; Complement Activation ; Ethidium ; Humans ; Melanocytes ; PUVA Therapy ; Vitiligo*

STUDY DESIGN: This study assessed the final functional results after treatment of thoracolumbar burst fractures and compared the relationship between the results and the parameters of reduction and state of the fractures. OBJECTIVES: To define prognostic factors affecting the final results and to present some precautions to minimize the treatment failure. SUMMARY OF LITERATURE REVIEW: In the treatment of the thoracolumbar burst fractures in which flexion loads are predominant, the sagittal contour is crucial to achieve permanent pain-free stability, but definitive therapeutic guidelines have remained a controversal topic. MATERIALS AND METHODS: We reviewed 37 thoracolumbar burst fractures with an average follow up period of 1.8 years: group 1 consisting of 20 cases treated conservatively and group 2 consisting of 17 cases treated surgically with posterior instrumentation. Finally functional results were analysed with the Denis'pain and work scores, and were compared between groups on anterior body height and local kyphosis. RESULTS: A satisfactory pain score less than or equal to P3 was in 15(75%) in group 1 and 15(88.2%) in group 2(p>0.05), but satisfactory work score less than or equal to W3 was in 12(60%) in group 1 and in 14(82.4%) in group 2(p<0.05). But, some loss of body height and local kyphosis in group 1 was not reversely related with functional outcomes. Eight cases in group 1 showing unsatisfactory result in work scores were analyzed as 4 osteoporosis(Jikei grade I, II/III), 3 associated compression fracture of the contiguous vertebra and one combined osteoporosis and compression fracture, showing significant loss of vertebral height and increase of kyphosis(p<0.01). CONCLUSIONS: Functional results of group 1 showing loss of vertebral height less than 50% and increased kyphosis less than 200 were comparable to those of group 2. The osteoporosis and associated compression fracture of adjacent vertebra were the risk group to develop posttraumatic kyphosis and might be added to the surgical indication of the thoracolumbar burst fractures.
Body Height ; Follow-Up Studies ; Fractures, Compression ; Kyphosis ; Osteoporosis ; Spine ; Treatment Failure

No abstract available.
Humans ; Siblings*

Spinal epidural hematoma is a rare complication of epidural anesthesia and most commonly associated with intraoperative or postoperative anticoagulant administration. We describe the case of an acute thoracolumbar epidural hematoma at the T12-L4 level complicated by cauda equina syndrome, which occurred after placement of spinal epidural catheter for anesthesia and anticoagulant therapy for acute myocardial infarction developed postoperatively. In our experience, the spinal epidural catheterization and anticoagulant therapy may potentially increase the risk of epidural hematoma formation.
Anesthesia ; Anesthesia, Epidural* ; Catheterization ; Catheters ; Cauda Equina* ; Hematoma* ; Hematoma, Epidural, Spinal ; Heparin* ; Myocardial Infarction ; Polyradiculopathy*

No abstract available.
Bursitis*

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

Open tibial pilon fractures present extensive soft tissue disruption and common complications such as sepsis or skin slough, and deserve special cosideration in addition to the challenging reconstructive problems. The purpose of this study is to assess the effectiveness of limited internal fixation and external fixation for the treatment of the open tibial pilon fractures, and to introduce some idea in Ilizarov device use. We reviewed 27 open tibial pilon fractures treated with limited internal fixation and external fixation from Feb. 1992 to Mar. 1996(follow-up range, 1 to 5 years). Fracture classification(Ruedi and Allgower) was type I in 5, type II in 10 and type III in 12, open wound type(Gustilo-Anderson) was II in 8, IIIA in 17 and IIIB in two. Secondary procedures were 16 soft tissue procedures, 13 bone graftings and 2 limb lengthening. Mean time for removal of the external fixators was 3.5 months(range, 6 to 21 weeks), and clinical union averaged 4.3 months(range, 12 to 25 weeks). At the time of last follow-up, radiologic grading(Burwell and Charnley) showed 13 good(48%), 10 fair(37%) and 4 poor results(15%). Objective functional grading(Ovadia and Beals) showed 5 excellent(19%), 15 good(56%), 6 fair(22%) and 1 poor(4%), and subjective grading 2 excellent(7%), 16 good(59%), 7 fair(26%) and 2 poor(7%). Common complications included 10 wound sepsis(37%), 6 posttraumatic arthritis(22%) and 5 malunions(19%). In conclusion, we cosider limited internal fixation and external fixation is an effective treatment modality till bone union for open tibial pilon fractures, and Ilizarov method using tension wires crossed only through the fracture fragments can provide a sufficient early and late stability.
External Fixators ; Extremities ; Follow-Up Studies ; Ilizarov Technique ; Sepsis ; Skin ; Tibia ; Transplants ; Wounds and Injuries

Spinal epidural abscess is an uncommon, but a significant disease due to its high morbidity and mortality rate if not diagnosed in time. Although early diagnosis and prompt surgical intervention is needed for better prognosis of this disease, the diagnosis of spinal epidural abscess is often elusive despite modern medical advances, and depends on a high index of suspicion. we report a case of lumbar spinal epidural abscess of unknown origin complicated by cauda equina syndrome.
Cauda Equina* ; Diagnosis ; Early Diagnosis ; Epidural Abscess* ; Mortality ; Polyradiculopathy* ; Prognosis