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

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

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

No abstract available.
Epidural Abscess*

No abstract available.
Intervertebral Disc*

No abstract available.
Knee Joint* ; Knee* ; Tuberculosis*

The methods of treatment of spondylolisthesis range from posterior fusion to instrumentation, and circumferential fusion. Combined anterior and posterior fusion with instrumentation had been carried out in one or two stages and satisfactory results were obtained in nighteen cases with follow-up period of one year to four years at department of orthopedic surgery of Ewha Womans University Hospital from 1987 to 1991. The results were as follows: 1. Of 19 patients, 7 patients were male and 12 patients were famale. 2. The isthmic type was 12 cases (63.1%) and the 5th lumbar vertebral involvement is common (12 cases, 63.1%). 3. The operative treatment was as follows: Posterior fusion with instrumentation was 8 cases, and anterior fusion with instrumentation was 11 cases. 4. The combined anterior and posterior fusion with instrumentation had been carried out in one stage operation at 8 cases, and two stage operation was done at 11 cases. 5. The average operation time was 3.0 hrs in one stage operation, 3.1 hrs in two stage operation, and the average amount of blood loss was 22cc/Kg in one stage, 17cc/Kg in two stage. 6. The satisfactory results were obtained in 19 cases, but there was no specific difference between one stage and two stage operation.
Female ; Follow-Up Studies ; Humans ; Male ; Orthopedics ; Spondylolisthesis

Kyphotic deformity of thoracic or lumbar spine is generally developed as a consequence of Scheuerman's kyphosis, ankylosing spondylitis, congenital kyphosis, tuberculous kyphosis, spinal tumor, senile kyphosis, trauma and extensive laminectomy etc. The method of treatment is usually conservative. However, in severe kyphosis, gross abnormaility and neurologic complications, and the compression of cardiopulmonary system are resulted and then surgery may be indicated. Since the report of spinal osteotomy by Smith-Peterson, several treatment options have been reported. Despite improved techniques for treating spinal kyphotic deformities, correction of severe and acutely angled deformities are less effective and resulting many complications. We propose the use of a new method of posterior closing spinal osteotomy for the treatment of severe and acutely angled kyphotic deformity to minimize the complications and for effective correction. We report the technique and results of this method in two cases of tuberculous kyphosis and a case of ankylosing spondylitis.
Congenital Abnormalities ; Kyphosis ; Laminectomy ; Methods ; Osteotomy ; Spine ; Spondylitis, Ankylosing