We used skeletal scintigraphy which had a high sensivity in the diagnosis of acute fractures in clinically suspected scaphoid fracture to elevate diagnostic accuracy, and then evaluated the results. From February 1993 to April 1994, twenty patients with a clinical suspicion of a scaphoid fracture in spite of normal skeletal films had been examined with skeletal scinigraphy of the wrist Sensitivity was 100%, specificity 30.8%, positive predictable value 43.8%, and negative predictable value 100%. The patients with positive scintigraphy and normal x-ray were free from symptoms in 4-6 weeks in spite of no treatment. In conclusions, Skeletal scintigraphy is of major importance in carpal trauma to rule out scaphoid fracture. Information obtained through scintigraphy often proved a prerequisite both for the retrospective identification of the fracture and for repeat directed skeletal view. The lesions in the distal radius and other carpal bones may clinically mimic a scaphoid fracture. and the authors feel to need further specific diagnostic tools such as MRI in cases with carpal injuries and scinitigraphic uptake indicative of a fracture when even skeletal views turn out normal. However, scintigraphy doesn't seem to be a guide of trament in these patients.
Carpal Bones ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Radionuclide Imaging ; Radius ; Retrospective Studies ; Sensitivity and Specificity ; Wrist

Anterior plate fixation of the cervical spine enhance anterior grafting technique and provide good primary stability to allow early mobilization without significant external support. This facilitastes nursing and shortens rehabilitation time. Although these advantages, the screw technique is risky and time-consuming since purchasing of posterior cortex is needed for obtatining maximum stability. The authors have tried to a technique of purchasing only near cortex. The objectives of this study were review of the result of this technique and the determining the factor influencing screw loosening. One hundred and five screws used in twenty-one patients for conventional cervical plate fixation from September 1990 to February 1994 were reviewed. Average age was forty-two years old ranged from nineteen to sixty-five. Patients with trauma were six and degenerative diseases were fifteen. Two screws were inserted in C3 bodies, ten in C4, thirty-two in C5, thirty-four in C6, ten in C7, two in Tl and fifteen in grafted bone. Twenty-four screws(16%) in six patients(28.6%) were loosened. Usually the first loosening was noted at about one month after operation. The incidence of loosening was significantly higher in lower cervical region(p < 0.001) and older age(p < 0.05). The disease entity or sex were not significant factor. This technique showed high rate of screw loosening especially in older age group or lower cervical lesion. We think the indication of this technique should be limited in young patient with upper cervical lesion.
Early Ambulation ; Humans ; Incidence ; Nursing ; Rehabilitation ; Spine ; Transplants

We describe an extra-articular triplane fracture of distal tibia in a twelve-year-old boy. This variant of the triplane fracture has been largely ignored in the literature. The clinical significance of recognizing this fracture is that, although it constitutes an epiphyseal fracture, it remains extra-articular. We treated this case by open reduction and internal fixation of both distal tibia and fibula. However, unlike the standard triplane fracture that exits through the tibiot alar joint, this variant may be treated acceptably with less that an anatomical reduction, therefore avoiding the need for surgical management.
Fibula ; Humans ; Joints ; Male ; Tibia

Open fractures of the tibial shaft have a high incidence of complication and often result in poor outcomes. The most common method of stabilization is the external fixation by way of the Ilizarov method but the small diameter interlocking intramedullary nailing has also been introduced. The purpose of this study is to analyze the result of Ilizarov method and to compare its results with those of delayed intramedullary nailing used in the treatment of open tibial shaft fractures. We analyzed 81 patients with open tibial shaft fractures, treated using Ilizarov external fixator, or by delayed locked intramedullary nailing between January 1987 and December 1994. The follow-up period was an average 14.5 months. Out of the 81 patients, 58 patients were treated by nails and 23 patients by Ilizarov external fixators. Both groups were given the same initial management but the operation of the nailing group was delayed until proper soft tissue coverage and healing of the wound were evident. In the Ilizarov method group, 58 fractures obtained union within 26 to 53 weeks (average of 32.8 weeks) and in the nailing group, 23 fractures showed union within 14 to 51 weeks (average of 21.2 weeks). There was a significant difference between the two groups (P<0.05). Complications in the Ilizarov group included 4 nonunions, 12 delayed unions, 3 malalignments, 14 wound infections and 13 stiff ankles. There were no nonunion, 10 delayed unions, 8 malalignments, 6 wound infections and 11 stiff ankles in the nailing group. In this study, the Ilizarov group had more delayed unions and nonunions took a longer period of time to obtain the union, and had a more limited range of motion in the ankle, than the nailing group. The nailing group was easier to manage, especially in the soft tis-sue procedure, and it did not require a high level of compliance while having a relatively low risk of malunion.
Ankle ; Compliance ; External Fixators* ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Fractures, Open ; Humans ; Ilizarov Technique ; Incidence ; Range of Motion, Articular ; Wound Infection ; Wounds and Injuries

Neurofibroma, one of the peripheral nerve tumor, is a complex benign tumor arising from skin, deep soft tissue, nerve tissue and bone. The incidence of peripheral nerve tumor is relatively low and it may occur either solitarily or diffusely. Plexiform neurofibroma, a type of neurofibroma, develops characteristically in the patients with von Recklinghausen's disease and its exact incidence is unknown. The case reports of solitary plexiform neurofibroma not associated with von Recklinghausen's disease were extremely rare. We reported a case of solitary plexiform neurofibroma on the median nerve.
Humans ; Incidence ; Median Nerve* ; Nerve Tissue ; Neurofibroma ; Neurofibroma, Plexiform* ; Neurofibromatosis 1 ; Peripheral Nervous System Neoplasms ; Skin

The results of 17 fractures of tibial shaft treated with Rush nails under the image intensifier and early weight bearing are reported. Thirteen of these fractures were closed. All fractures were united between 12 and 21 weeks clinically, 17 and 26 weeks radiologically after operation. All cases were healed without significant complications, such as fracture disease. The advantages of this method were as follows; 1) normal knee motion and early weight bearingare possible during healing. 2) There is a relatively rapid restoration of bone continuity. This method of treatment for tibial shaft fractures were indicated as follows; 1. Mid-shaft fracture. 2. Segmental fracture of shaft. 3. Expectation of compression force at fracture surface by weight bearing. 4. Open fracture of shaft.
Fractures, Open ; Knee ; Methods ; Tibia ; Weight-Bearing

The Kuntscher nail has been used widely for the treatment of femoral shaft fracture with the advantage of early weight bearing and early joint movement. But it has some disadvantages that are harmful in bone-union by the wide intramedullary reaming, and rotation and bending of the device. Schneider devised four flanged nail to be able to eliminate the disadvantage of the Kiintscher nail. The author have experienced the 16 cases of Schneider nailing in the fractures of femoral shaft at the Department of Orthopaedic Surgery, Ewha Womans University Hospital from Feb., 1982 to Apr., 1984. The following results were obtained. 1. There were common in male (14 cases) and active ages (13 cases). 2. The most common cause was trauma with 14 cases and the other was pathological fracture. 3. Indications of Schneider nailing were wide than those of Kiintscher nailing. 4. Usual intervals between the injury and operation was one week. 5. Mean operating time was one hour and 25 minutes, and blood loss during the operation was 410cc. 6. After treatment, we usually permitted the exercises of quadriceps setting and non-weight bering walking within 1 week, partial-weight bearing walking within 4 weeks and full weight bearing walking within 4 months. 7. The results of 13 cases among 15 cases were better than good. 8. There were no complications such deformities as rotation, shortening and angulation because of specialized structure of Schneider nail. Also, Schneider nailing could prevent the nonunion and infection because there was need of reaming the medullary canal.
Congenital Abnormalities ; Exercise ; Female ; Fracture Fixation, Intramedullary ; Fractures, Spontaneous ; Humans ; Joints ; Male ; Walking ; Weight-Bearing

Syphilis was known to be generalized disease and it had been decreased until 1960's. But, it has been increased again recently. The author analysed the 22 cases of congenital syphilis which were treated at department of orthopaedic surgery at Ewha Womans University Hospital from Jan. 1979 to July 1983 and the following results were obtained. 1. There were no significant changes of the number of patient by years. 2. Common symptom and sign were hepatosplenomegaly(84%), fever(62%) and skin changes(50%), and pseudoparalysis was observed in one case. 3. Radiologic bone changes were observed in 11 cases (50%) and the following results were obtained: a. Below the two week old, there was relatively low incidence of bone change with 22%. b. There was high incidence of bone change in prematurity with 75%. c. Common features of bone changes were periosteal reaction, osteochondritis and metaphysitis (91%). Pathologic fracture was observed. in one case. 4. Although we have observed the bone changes only in 50% of cases, all the other reports has reported more than 80% and we thought that radiologic bone change would aid the diagnosis of congenital syphilis.
Clinical Study ; Diagnosis ; Female ; Fractures, Spontaneous ; Humans ; Incidence ; Osteochondritis ; Skin ; Syphilis ; Syphilis, Congenital

Twenty nine cases of segmental tibial fracture were treated at Ewha Womans University Hopital, Department of Orthopedic Surgery, during the period from January, 1970 to December, 1984. The following results were obtained. 1. Most common fracture level was type I, high middle segment, occurred about 12 cases (41.4%). 2. In view of the higher incidence of open fracture (16 cases, 55.1%) and comminuted fracture (22 cases, 75.9%), fracture was caused by high velocity. 3. Various external and internal fixation methods were applied, but higher union rate was seen in the cases of Küntscher nailing and plating with bone graft. 4. Excluding the cases of type V, average union rate was 28.5 weeks and open fracture (ave. 29.6 weeks) required more longer union rate than closed fracture (ave. 26 weeks). 5. Higher rate of complication (21 cases, 72.4%) was noted than other types of tibial fracture. 6. Good result was obtained for treatment of 5 cases of delayed union or non-union by plating and bone graft than any other methods.
Clinical Study ; Female ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Humans ; Incidence ; Orthopedics ; Tibia ; Tibial Fractures ; Transplants

There are many procedures for the treatment of acromioclavicular separation but there are still controversies concerning the best management of these injuries. The cases of 20 acromioclavicular separations and 3 distal end fractures of clavicle were treated by conservative method with modified Kenny Howard sling-halter using long arm cast at the department of Orthopedic Surgery, College of medicine,Ewha Womans University, during the thirty six months period from March 1982 to February 1985. The following results were obtained. 1. The average duration of immobilization was 5 weeks at the grade II of acromioclavicular separation and fracture of distal end of clavicle and 6 weeks at the grade III of acromioclavicular separation. 2. The functional results were 17 excellents(73.8%), 5 goods(21.9%), and 1 fair(4.3%). 3. The complications were 3 frozen shoulders(13.0%), 2 subluxations(8.6%), and 1 skin necrosis on the elbow(4.3%). 4. The authors immobilized the upper extremity with long arm cylinder cast of 90° flexion position instead of initial harness, so that it was applied easily and the patient felt very comfortable. 5. When the fracture and severe displacement were occurred at the midthird of the clavicle, it could be reduced and maintained with the long arm cylinder cast and strap.
Arm ; Clavicle ; Female ; Humans ; Immobilization ; Methods ; Necrosis ; Orthopedics ; Skin ; Upper Extremity