Legg-Perthes' disease, as avascularity of the femoral head that often arises in the child of a particular age group, is a serious disease of which the frequency is more than the osteochondroses of the other part, and the cause of Legg-Perthes disease is obscure up to now, but the pathogenesis and, pathology are more clearly understood. Twenty patients with Legg-Perthes disease were managed at the department of Orthopaedic Surgery of Hanyang University hospital from May, 1972 till September, 1977 and were studied according to the method of Catterals classification arid arthrogram. The following conclusion were made. 1. The age group with the highest frequency was that from 6 to 9 years (40%) and the ratio of male: female was 6: 1. 2. The stage of disease s progress when patient went to hospital was almost fragmentation stage as 17 persons of the whole. 3. By arthrogram Spherical form of femoral head was 15%; Round form 45%; Flatten form 40%. 4. The longer the period from onset to beginning of treament was the more femoral head flattened. 5. There was the most number of patient as 13 persons of the whole wearing abduction internal rotation brace. 6. From the view point of arthrogram the more spherical the femoral head was the better the prognosis was; otherwise the worse.
Arthrography ; Braces ; Child ; Classification ; Disease ; Female ; Head ; Humans ; Legg-Calve-Perthes Disease ; Male ; Methods ; Osteochondrosis ; Pathology ; Prognosis

Hospitals and medical research institutions have vast holdings of tissues stored in tissue banks. Tissue can end up in a tissue bank for many different reasons. Tissue samples are taken as part of normal diagnostic procedures, and the remaining samples after analysis may be stored for secondary analysis to confirm the diagnosis, for quality control or for research purposes. If the tissues have been stored properly, in principle, it is possible to perform almost all the genetic tests. This opens up possibilities for an expanded use of such tissues in medical research, and therefore tissue banks have become scientifically and economically valuable resources. New genetic testing technologies with their scientific and economic potential are raising ethical concerns about the use of older, stored tissue samples, in particular those that were obtained for one purpose and can now be used for other purposes. Much of these tissues was obtained without consent or with a consent that does not cover genetic testing. There are no general ethical guidelines that can decide whether a specific research project is justifiable. In some cases, proxy consent or an analysis of ownership may be useful. However, use of tissue samples, in most cases, will depend on whether the project is worthwhile and ethically acceptable according to today's standards.
Diagnosis ; Genetic Testing ; Humans* ; Informed Consent ; Ownership ; Proxy ; Quality Control ; Tissue Banks

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

ACL plays an important role in stability of knee joint and its injury causes instability of joint which is known as the initiation of problem knee. Reconstruction of the anterior cruciate ligament would be preferred to the primary repair in treatment. And recently with the advance of arthroscopic technique and development of bone-patellar tendon-bone (BPB) graft material, the result of reconstruction is somewhat superior to that of primary repair. Authors compared the results of 20 primary repairs (Group I ) and 20 reconstructions (Group II) among 64 acute ACL injury treated Sung-Ae General Hospital from January 1989 to December 1994. The results were as follows: 1. Most common associated injuries were medial collateral ligament rupture and medial meniscal tear. 2. Group I showed postoperatively 13 negative anterior drawer test, 12 negative Lachmann test and 12 negative pivot shift test and group II showed postoperatively 17 negative anterior drawer test, 15 negative Lachmann test and 17 negative pivot shift test. (p<0.05) 3. In postoperative Lysholm knee scoring scale, group I showed 86 points and group II showed 93 points (p<0.05). 4. In postoperative KT-1000 arthrometer, 12 cases in Group I and 16 cases in Group II showed less than 2mm difference with sound side (p<0.05).
Anterior Cruciate Ligament ; Collateral Ligaments ; Hospitals, General ; Joints ; Knee ; Knee Joint ; Rupture ; Transplants

A case of femoral lengthening was performed at the Hanyang University Hospital for a 29 year old male patient who hed a 3.0 cm shortening of the left lower extremity. This patient incurred a comminuted segmental fracture of the left femur in a car accident in 1969 when he was 21 years old. At that time, open reduction and internal fixation with Kuntscher nail was done at a private clinic. The fracture was united firmly, but shortening of the left lower extremity developed progressively. At the time of admission to our hospital in 1976, he had a 3.0 cm shortening of the left femur on scanogram and complained of limping. Femoral lengthening was employed by step cut Z ostectomy on the left femur and 3.0 cm lengthening was achieved during the operation by traction with 2 Steinmann pins, one of which was inserted vertically in the greater trochanter, and the other was inserted horizontally in the distal femur. A special plate and screws were modified at our hospital and were attached and fixed to the osteotomy site. Bone gaps which developed after lengthening of the femur were filled with an autogenous iliac bone graft. The patient was followed up for 9 months after the operation, and the last X-ray showed a firm bony union without any specific complications. On pbysical examination at the present time, there is no longer a shortening of the left lower extremity clinically and gait is normal without limping.
Femur ; Gait ; Humans ; Lower Extremity ; Male ; Osteotomy ; Traction ; Transplants

A total of 132 cases of structural scoliosis have been followed since Jan. 1963 up to Dec. 1976 at the Hanyang University Hospital. The present paper classified scoliosis according to the etiology and analyzed curve patterns and spinal deformties such as rotation and wedging. Various kinds of treatment were done and these included Milwaukee brace, posterior spinal fusion with or without Harrington instrumentation. The end results of these treatment were also analyzed. The results concluded from the present studies were as follows: 1. Poliomyelitis was the most common cause of structural scoliosis. Of 132 cases of scoliosis, paralytic scoliosis was 48.5% while idiopathic scoliosis was 31.1% and congenital scoliosis 9.8%. 2. In paralytic scoliosis lumbar curves were the most common pattern and thoracic and thoracolumbar curves were the next. 3. In idiopathic scoliosis, the most common pattern was the right thoracic. 4. Very severe curves over 80° were more frequent in paralytic than in idiopathic scoliosis, showing the percentage of 20.3% in paralytic scoliosis and 10.3% in idiopathic scoliosis respectively. 5. The number of vertebrae involved in primary curve was approximately the same in both paralytic and idiopathic scoliosis. 6. In paralytic scoliosis, as the curves progressed, rotation of vertebrae became more marked in lumbar curve than in thoracic curve, while wedging deformity was more severe in thoracic curve than in Jumbar curve. 7. The tendency of the rotation and wedging in thoracic and lumbar curve was the same in both idiopathic scoliosis and paralytic scoliosis. When the degree of curves was the same, rotation and wedging were slightly more severe in idiopathic than in paralytic scoliosis. 8. In congenital scoliosis hemivertebrae were the most common anomaly and the majority of congenital anomalies were located at lumbar region. 9. Treated with Milwaukee brace, 22.1% of original curve angle was corrected in idiopathic coliosis, 9.8% in paralytic scoliosis, and 7.3% in congenital scoliosis, respectively. The Milwaukee brace was effective in thoracic and thoracolumbar curves but not in lumbar curves. 10. In paralytic scoliosis treated with posterior spinal fusion without Harrington instrumentation, the final degree was 43.2 and the correction loss was 12.6% but with both posterior fusion and Harrington instrumentation, the final degree was 50.2 and the correction loss was 6.8%. 11. There were 2 cases of complication after posterior spinal fusion without Harrington instrumentation. One was pseudarthrosis and the other was bending of graft with some loss of correction. One case of complication occured after posterior spinal fusion with Harrington instrumentation. It was a case of displacement of distraction hook on the rod.
Braces ; Clinical Study ; Congenital Abnormalities ; Lumbosacral Region ; Poliomyelitis ; Pseudarthrosis ; Scoliosis ; Spinal Fusion ; Spine ; Transplants

Ankylosing spondylitis is a chronic inflammatory disease of unknown etiology that affects spine, sacroiliac joint, and the large joints of the extremities, and lead to fibrous or bony ankylosis and deformity. The rigid ankylosed spine of ankylosing spondylitis is prone to fracture by minimal trauma, and the resulting fractures likely to be unstable and damage to spinal cord or cauda equina. The authors report a case of paraplegia in ankylosing spondylitis after open reduction of the femoral trohanteric fracture.
Ankylosis ; Cauda Equina ; Congenital Abnormalities ; Extremities ; Femur ; Joints ; Paraplegia ; Sacroiliac Joint ; Spinal Cord ; Spine ; Spondylitis, Ankylosing

The method of treatment of acromioclavicular dislocation is controversial, and conservative and surgical treatment have been reported to be both successful. Recently, many surgeons tend to treat the acromioclavicular dislocation with anatomical reduction of acromioclavicular joint and rigid internal fixation because of many disadvantages of conservative methods. We report 24 cases of acute acromioclavicular dislocation treated with modified Phemister method from March 1989 to December 1992. The follow-up ranged from 12 months to 31 months with 16.5 months on average. The results are as follows. l. Among 24 cases, 21 cases are males and 20 cases are in 3rd decade to 5th decade. 2. The most common cause of injuries is falling down, followed by traffic accident. 3. Associated injuries are fractures in 5 cases, spleen rupture in 1 case. 4. Except 1 case with spleen rupture, 23 cases were treated within 2 weeks after injury. 5. Preoperative difference in C-C distance on stress view is 8.6mm on average, ranged from 6mm to 18mm. 6. Clinical results were excellent in 11 cases, good in 10 cases, fair in 2 case, and poor in 1 case. 7. Complications were pin migration in 1 case and symptomatic acromioclavicular arthritis in 1 case.
Accidental Falls ; Accidents, Traffic ; Acromioclavicular Joint ; Arthritis ; Dislocations ; Follow-Up Studies ; Humans ; Male ; Methods ; Rupture ; Spleen ; Surgeons

The transobturator tape (TOT) procedure is a relatively safer than tension-free vaginal tape (TVT) operation but it may cause vascular injury. Recently we experienced a case using uterine artery embolization for the patient with uterine artery bleeding after TOT.
Hemorrhage* ; Humans ; Suburethral Slings* ; Uterine Artery Embolization* ; Uterine Artery* ; Vascular System Injuries

With the increasing number of surgery for incontinence, voiding dysfunction after anti-incontinence surgery will continue to be a problem. The patient with postoperative voiding dysfunction may present with primarily storage symptoms or voiding symptoms, or a combination of both. Detailed knowledge of the preoperative voiding status may aid in the diagnosis of voiding dysfunction. Diagnosis is based on history, physical examination, urinalysis and postvoid residual volume, but additional informations from urodynamic study and cystoscopy are useful. Patients with postoperative voiding dysfunction should be initially treated conservatively with intermittent or continuous catheterization, fluid restriction, anticholinergics and pelvic floor physiotherapy. When conservative treatment fails, surgical intervention should be done. It is important to distinguish between midurethral sling and other procedures because the timing and type of intervention vary. In case of midurethral sling, loosening or cutting the tape has had excellent results. Prevention of obstruction during surgery may be the best way to avoid reoperation.
Catheterization ; Catheters ; Cholinergic Antagonists ; Cystoscopy ; Humans ; Pelvic Floor ; Physical Examination ; Reoperation ; Residual Volume ; Suburethral Slings ; Urinalysis ; Urodynamics