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

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

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*

No abstract available in English.
Talus

After discovery of Penicillin by Fleming in 1939, a great improvement in the treatment of osteomyelitis has been made and the mortality rate in acute stage was markedly decreased. But due to misplacement of antibiotics, and the improper treatment of the osteomyelitis, the tendency to chronicity and various sequellae of the osteomyelitis are still persist. So, it will be of importance to reconsider the management of various sequellae of pyogenic osteomyelilis. We reviewed 3 cases of sepsis, 10 cases of pathologic fracture, 6 cases of sepsis, 6 cases of malignant turnor developed in an old draining sinus, 2 cases of bone defect, 3 cases of joint contracture and 4 cases of deformity and growth disturbance 604 cases of osteomyelitis treated at National Medical Center between 1972 to 1983. The results were as follows: 1. Established sepsis was noted in 3 cases, and one of these patient dead. We treat these patients with high dose of the antibiotics accompanied by decompression of the lesion. 2. Pathologic fracture developed in 10 cases, which was treated with either conservative or operative treatment. All cases obtained good union except one. 3. Spuamous cell carcinoma developed in 6 cases around the old draining sinus. All cases were treated with amputation. Theres no recurrence except one. 4. Bone defect developed in 2 cases. A case of bone defect in humeral shaft was treated with vascularized fibular graft and obtained firm union and good function. 5. Joint contracture was treated with soft tissue release and even joint fusion in severe case. The results were not gratifying. 6. Deformity and growth disturbance of limbs were treated with soft tissue release, osteotomy and stapling. Most of the cases obtained good results, but limb length discrepancy was not recovered satisfactorily.
Amputation ; Anti-Bacterial Agents ; Congenital Abnormalities ; Contracture ; Decompression ; Extremities ; Fractures, Spontaneous ; Humans ; Joints ; Mortality ; Osteomyelitis ; Osteotomy ; Penicillins ; Recurrence ; Sepsis ; Transplants

In 1974, bipolar endoprosthesis was first introduced by Bateman & Giliberty. It has theoretical advantages including minimizing acetabular wear, possible reduction of incidence of stem loosening, lessening of dislocation and easy revision procedure. Various methods for the treatment of fracture of the femur neck have been developed & performed, but it is still called “the unsolved fracture” in certain situation. But the role of it as primary treatment of fracture of the femur neck continues to be controversial. Current clinical results encourage its continued use and expansion of indication. Authors reviewed and analysed 21 cases of bicentric endoprosthesis and 1 case of Giliberty endoprosthesis those have been operated at the Department of Orthopaedic Surgery, National Medical Center from 1981 to 1983. Following results were obtained, l. According to disorder distribution, 14 cases were neglected fracture of femur neck, 2 old fracture, 1 idiopathic femoral head necrosis and 2 avascular necrosis & 1 non-union complicated by femoral neck fracture. 2. Among 20 cases, 8 cases were operated within 1/2 1 month after injury and 6 cases within 1 3months 3. Harris lateral appmach was used in 16 cases (80%) and Modified Gibson approach in 4 cases (20%). There were no significant differences in morbidity during operation and postoperative complication. 4. We used femoral stems those head diameter was 22 and 32mm(Charnley & Miiller type) and head pieces those diameter was 48-51 mm in male and 44–48 mm in Ifemale. 5. 3 cases were stiff in inner bearing without acetabular erosion. 6. In 6 cases more than 2 years followup 1 degree CE angle of Wiberg was increased in 2 cases of youngage respectively without associated hip joint pain. 7. Although inclination of head piece was vertical in 8 cases, fracture and dislocation were not found. 8. The circumference of head piece and opposite femoral head was measured and compared. There were 12 cases (mean 12.6 mm) that of head piece larger than opposite femoral head and 3 cases smaller than opposite femoral head. 9. There was 4 cases of complication (3 patients) and still no reoperation and revision converted to T.H.R. 10. With regard to average 18 months of follow-up, 7 cases of 81–90 Harris hip-rating score, 6 of 91–100, 4 of 71–80 and 3 of 61–70.
Acetabulum ; Dislocations ; Femoral Neck Fractures ; Femur ; Femur Neck ; Follow-Up Studies ; Head ; Hip Joint ; Humans ; Incidence ; Male ; Neck ; Necrosis ; Postoperative Complications ; Reoperation

Gas gangrene is a potentially lethal dissease, but fortunately uncommon. Profound toxicity and rapid progression are characteristic of this disease. Therefore the success of the treatment in this disease is largely depended on early diagnosis and treatment. The treatment includes debridement and decompression, amputation if ncessary, adequate entibiotic therapy, administration of antitoxin, hyperbarit oxygen therapy and general supportive therapy. The authors have reviewed 9 cases of gas gangrence, which were identified by bacteriologically out of 14 cases of suspicious gas gangrene. All cases were treated in our department from 1981 to 1985. The results are summarized as follows: 1. The culture studies of clostridium were specified in 5 cases of Cl. perfringens, 2 cases of Cl. septicum, 1 case of Cl. bifermentans and 1 case of Cl. sporogenes. 2. All 9 patients underwent debridement, antibiotic therapy, hyperbaric oxygen therapy and general supportive therapy. We had not used gas gangrene anti-toxin, beceuse of the value of antitoxin is uncertain and subjects the patient of the danger of hypersensitivity reactions. 3. In 7 patients involving only the extremities, amputations were inveitable on 3 patients due to irreversible gangrenous changes on the involved extremities. And one of them died due to septic shock. 4. In 2 patients involving the trunk, one of them died due to renal failure.
Amputation ; Clinical Study ; Clostridium ; Debridement ; Decompression ; Early Diagnosis ; Extremities ; Gas Gangrene ; Humans ; Hyperbaric Oxygenation ; Hypersensitivity ; Oxygen ; Renal Insufficiency ; Shock, Septic

The trochanteric fracture occurs through the wide metaphyseal area, giving it high potential for healing and results in low incidence of non union. Even in the treatment of unstable trochanteric fracture, the results are relatively good with the advancement of fixation devices and reduction methods. The authors experienced 10 cases of non-union of trochanteric fractures from 1975 to 1984 and followed them up for more than 1 year at Orthopaedic department of National Medical Center. The results are as follows, l. Of reduction methods in primary operation, anatomical reduction was performed in 6 cases, medialization in 2 cases. Of fixation devices, compression hip screw was used in 2 cases, Jewett nail in 3 cases and others in 3 cases. 2. The probable causes of non-union were fixation failure in 6 cases, inadequate immobilization in 2 cases, infection in 2 cases and trauma in 1 case. The other 2 cases were not treated. 3. In secondary operation, anatomical reduction was performed in 3 cases, valgus reduction in 3 cases and valgus with medialization in 2 cases. Of fixation devices, compression hip screw was used in 3 cases, Judet plate in 3 cases and Jewett nail in Z cases. 4. The time interval between the last operation and bony union was 4.2 months clinically and 6.6 months radiologically in average. 5. During follow-up, hip pain was noted in 2 cases. Limited range of motion of hip and knee in 4 cases.
Femur ; Follow-Up Studies ; Hip ; Hip Fractures ; Immobilization ; Incidence ; Knee ; Range of Motion, Articular