No abstract available.
Fractures, Open*

There are many procedures for the treatment of acute A-C injury which have many complications such as limitation of shoulder motion, post traumatic arthritis, recurrence of dislocation etc. From September 1985 to February 1992 at Haesung Hospital, Ulsan, 62 patients with grade I complete A-C dislocation had been treated surgically by modified Phemister method. We report 42 cases with at least 1 year follow up. The following results are obtained. 1. There are no limitation of shoulder motion in all cases. 2. The comparision of coraco-clavicular interval after surgery(1.43mm) with that of follow up (2.13mm) shows no significant difference. 3. We experience 15 cases who have resorption of distal clavicle or arthritic change in x-ray film. 4. Clinical results shows that excellent in 20 cases, good in 10 cases, fair in 11 cases, poor in 1 case. From the above result, we suggest the modified phemister method is good procedure in the treatment of acute A-C dislocation.
Arthritis ; Clavicle ; Dislocations ; Follow-Up Studies ; Humans ; Methods ; Recurrence ; Shoulder ; Ulsan ; X-Ray Film

There have been many debates concerning operative decompression of treatment of thoracolumbar burst fractures with retropulsed bone fragment. From March 1988 to February 1992, authors treated thirty-three thoracolumbar burst fractures by using transpedicular screw fixation and posterior fusion via the posterior approach. We attempted to reduce retropulsed fragment by ligamentotaxis alone and not to do posterolateral nor anterior decompression. After the reduction of fractured spine by posterior instrumentation, we tried to determine the efficiency of reduction of the retropulsed fragment by ligamentaxis along. As a method, we compared the change of anteroposterior, transverse to diameter and area of spinal canal of fractured spine between preoperative and the postoperative situation. The results were as follows; 1. The mean anteroposterior and transverse diameter of the spinal canal on computed tomogram film was 10.1mm & 21.8mm preoperatively & 12.4mm & 23.2mm postoperatively, showing an increase. 2. The area of spinal canal of involved spine on CT film was evaluated preoperatively & post-operatively, the mean spinal canal invasion rate decreased from 36.3% preoperatively to 14.3% postoperatively. 3. The degree of reduction of middle height on plain x-ray and reduction of spinal canal invasion on computed tomogram were statistically correlated(p < 0.01). 4. There was no correlation between the degree of canal narrowing and degree of neurologic impairment. also, there was no correlation between the reduction of retropulsed fragments and subsequent neurologic impairment. 5. There was the relatively satisfactory enlargement of the spinal canal on computed tomogram at the follow-up So we suggest that it is possible to get enough decompression through reduction of retropulsed fragment by ligamen to taxis alone without posterolateral decompression.
Decompression ; Follow-Up Studies ; Methods ; Spinal Canal ; Spine

The radial head forms articulation with radial head fossa of proximal ulna and capitellum, and it ditectly contributes pronation and supination of forearm and also flexion and extension of elbow. There were debates in treatment of radial head fracture especially in displaced or communited fracture. From January 1982 to February 1992, we experienced and analysed 29 cases of radial head fracture. They were treated with conservative treatment or operative treatment according to type The results were as follows; 1. We could get better results with open reduction and internal fixation with miniscrew than radial head excision in type 11 radial head fracture. 2. There were unfavorable results of valgus instability, weakness in all cases of radial head excision.
Elbow ; Forearm ; Head ; Pronation ; Supination ; Ulna

The development of the arthroscopic surgery technique presented a great method in the reconstruction of anterior cruciate ligament. There were many debates about the timing of reconstruction in the acute anterior cruciate ligament injury. However, it was regarded true that primary reconstruction in the acute phase have higher complication rate of arthrofibrosis than in the chronic phase. Many authors recommended delay of reconstruction at least 3 weeks in acute tear of anterior cruciate ligament. In contrast, some surgeons have tried to suture the ruptured anterior cruciate ligament accompanied by 'over-the-top' augmentation with the hamstring tendon or the artificial ligament arthroscopically. Since Jan. 1992, the authors have implanted the synthetic polyester ligament(ABC ligament; Surgicraft, U.K.) into the substance of ruptured ligament proper and fixed at the 'over-the-top' position without any procedure for repair of the ruptured anterior cruciate ligament. Our indication for this surgery is only acute rupture of anterior cruciate ligament with good stump condition. We report the clinical results of 22 cases at 20.3 months follow-up(mean) preliminarily. l. On measurement of pre-operative and post-operative differences between the normal and the affected side by Telos stress X-ray study and KT-2000 arthrometer. Differences were markedly improved from 5.6mm(mean: pre-op) to 1.9mm(mean: post-op) on Telos stress X-ray study(on 15 Kp stress) and both knee showed minimal differences on KT-2000 study(2.2mm on 9Kp, 2.5mm on maximum stress) at the time of follow-up. 2. The average Lysholm score was 82. By Clancy criteria, the 20 cases(91%) showed good and excellent results. 3. Second look arthroscopy was available in three cases. In two cases, there were marked fibrous proliferation around the ligament. The stability felt good on probing. We could observe healing-like appearance of ruptured ACL with minimal fibrous tissue proliferation in one another case.
Anterior Cruciate Ligament ; Arthroscopy ; Follow-Up Studies ; Knee ; Ligaments ; Methods ; Polyesters ; Rupture ; Surgeons ; Sutures ; Tears ; Tendons

In the treatment of proximal tibial condyle fracture, it should be considered that it can often accompany injuries of the collateral ligament, both cruciate ligament, and the menisci of the knee. Moreover it is necessary to restore anatomical congruity of the articular surface accurately. We performed reduction of the depressed articular fragment under monitoring of arthroscopy and fixed with cannulated cancellous screws and accompanied by bone graft under the control of image intensifier in 2 cases of Type I(Pure cleavage) and 3 cases of type II(cleavage with depression) fractures. The results were very satisfactory. Arthroscopy assisted reduction and fixation are very useful method in the treatment of proximal tibial condyle fracture because of (1) the minimized operative morbidity, (2) the ability to evaluate and manage associated intraarticular pathology simultaneously, (3) the rapid rehabilitation, (4) the achievement of good reduction comparable to open reduction.
Arthroscopy ; Collateral Ligaments ; Knee ; Ligaments ; Methods ; Pathology ; Rehabilitation ; Transplants

Owing to the advancement of imaging techniques which include the CT scan, it became easier to evaluate fracture patterns of calcaneal fractures accurately. Moreover, it is possible to obtain good results with operative treatment as a consequence of the development of good operative equipment and new operative technique. In 1988, Regazzoni and Benirschke in 1990, recommended L-shaped extensive lateral approach for calcaneus which provide extensive exposure of calcaneus and so allow easier reduction and fixation. We carried out L-shaped extensive lateral approach in 11 cases from June, 1993 to April, 1994. This approach did not produce any skin problems and allowed excellent anatomical reduction and fixation. But we experienced some severe causalgia on the heel region in several cases. We tried to analyse the cause of pain and concluded that it was the damage to the lateral calcaneal branch of the sural nerve. We are reporting the problems of tbis approach.
Calcaneus ; Causalgia ; Heel ; Skin ; Sural Nerve ; Tomography, X-Ray Computed

No abstract available.

Background/Aims: Recently, distal radial approach (DRA), called as snuffbox approach, has gained the interest of interventional cardiologists, but there is a lack of data about the feasibility of DRA as an alternative route for primary percutaneous coronary intervention (PCI). Methods: A total of 138 patients presenting with ST-elevation myocardial infarction (STEMI) in whom primary PCI via the DRA was attempted at three hospitals from October 2017 to September 2019 were analyzed. Results: The success rate of snuffbox puncture in the setting of STEMI was 92.8% (128/138). Successful primary PCI via the DRA was achieved in all 128 patients. The snuffbox puncture time, defined as the time interval from local anesthesia induction to successful sheath cannulation, was 2.7 ± 1.6 minutes, and snuffbox puncture was performed within 5 minutes in 95.3% of patients. Moreover, the percentage of the puncture time in the door-to-balloon time was 3.3%. The left DRA was selected in 103 patients (80.5%), and primary PCI via the DRA was performed using a 6-Fr guiding catheter in 125 patients (97.7%). There was no major bleeding; however, there were four cases (3.1%) of access-site complications, including three cases of local hematoma (≤ 5 cm diameter) and one case of local numbness, which improved 3 months later. Conclusions In the setting of STEMI, the DRA could be a feasible alternative access route for primary PCI.

Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction (STEMI) pa-tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention (PPCI) were analyzed. We used propensity score matching (PSM) to control differences of baseline characteristics between culprit only intervention (CP) and multivessel percutaneous coronary interventions (MP), and between double vessel disease (DVD) and triple vessel disease (TVD). The major adverse cardiac event (MACE) was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE (14.2%vs. 8.6%, P=0.01), any cause of revascularization (10.6%vs. 5.9%, P=0.01), and repeated PCI (9.5%vs. 5.7%, P=0.02), as compared to DVD patients during one year after discharge. MP reduced MACE effectively (7.3%vs. 13.8%, P=0.03), as compared to CP for one year, but all cause of death (1.6%vs. 3.2%, P=0.38), MI (0.4%vs. 0.8%, P=1.00), and any cause of revascularization (5.3%vs. 9.7%, P=0.09) were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD. MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.