Neurofibromatosis is a disease which involves both neuroectodermal and mesodermal tissue, and is characterized by cafe-au-lait spot, multiple subcutaneous neurofibromas, elephantiasis neuromatosa, a positive family history, and specific dystrophic osseous changes such as scoliosis, penciling of ribs, vertebral scalloping, a paravertebral soft tissue tumor, and congenital pseudarthrosis. The classic type of scoliosis in neurofibromatosis was known as a sharp localized short curve that is often rapidly progressive and produces severe deformity with dystrophic changes, but another form with long gentle curve is reported. Since conservative treatment is usually unsuccessful, posterior fusion with or without Harrington instrumentation is the treatment of choice even in young age when the curve is progressive. This paper was aimed to review our experience with 11 patients having neurofibromatosis and scoliosis, who were treated with posterior fusion and Harrington instrumentation from Jan. 1971 to Dec. 1980, and the results were as follows: 1. The average age that spinal deformity was observed was 7.7 years old, but the average age at treatment was 14.4. 2. Cafe-au-lait spot was observed in all cases, subcutaneous nodule in 7 cases, local gigantism in 2 cases, and positive family history in 3 cases. 2 cases were combined with congenital spinal anormalies. 3. Specific pattern in spinal deformity was not significant. There were 7 short curves less than 5 vertebrae involved and 6 long curves more than 6 vertebrae involved. 4. There were 5 kyphosis which had more than 50°, and those were usually combined with severe scoliosis. 5. Preoperative average degree of scoliosis was 93.8, and the final correction was 41.2° (43.9%) with loss of correction 5.3°(5.7%) after 3.2 year follow-up in average. 6. It shouid be educated for early detection at home and school, and for the importance of early treatment for the scoliosis, to prevent rapid increase of scoliosis in neurofibromatosis.
Cafe-au-Lait Spots ; Congenital Abnormalities ; Elephantiasis ; Follow-Up Studies ; Gigantism ; Humans ; Kyphosis ; Mesoderm ; Neural Plate ; Neurofibroma ; Neurofibromatoses ; Neurofibromatosis 1 ; Pectinidae ; Pseudarthrosis ; Ribs ; Scoliosis ; Spine

Most orthopedic surgeons were aimed at the rigid internal fixation on the surgical treatment of the fracture. And the compression plate was developed and regarded as an excellent rigid internal fixation device by its advantages of accurate anatomical reduction, early joint mobilization and shortening of the duration of the fracture healing, which are chief aim of A.S.I.F. method. During the period of January 1970 to December 1979, 67 cases of diaphyseal fractures of the long bones were treated with compression plate according to A.S.I.F. method at the Department of Orthopedic Surgery, College of Medicine, Seoul National University and results were obtained as follows: 1. The age of patient was ranged from 15 to 77, and the highest incidence was in the 3rd decade male group (31.4%). 2. Old fracture cases were slightly more than fresh cases, and the fresh femur fracture was the commonest. 3. The periods of the postop immobilization of fresh fractures were 3.7 weeks in humerun fracture, 6.3 weeks in forearm fractures, 8.7 weeks in femur fracture and 7.0 week in tibia fracture, and in old fractures about 4 weeks was longer than fresh fractures. 4. The bony union was accomplished in all cases between 8 week and 24 week. 5. The complication were 4 superficial infections, 4 deep infections, 1 delayed union and 9 joint stiffnesses. 6. Compression plate fixation is considered as an excellent method for the treatment of the fractures of the long bones.
Clinical Study ; Femur ; Forearm ; Fracture Healing ; Humans ; Immobilization ; Incidence ; Internal Fixators ; Joints ; Male ; Methods ; Orthopedics ; Seoul ; Surgeons ; Tibia

We performed total hip arthroplasty on a young male adult with paralytic dislocation of the hip due to poliomyelitis. Because of extreme shortening, as well as instability and weakness, the patient was unable to bear weight on the limb. Pastoperative course was complicated by ectopic ossification that compromised the hip and knee motion. Another young male adult with severe spastic cerebral palsy underwent total hip arthroplasty because of an intractable pain due to degenerative arthritis. Initial attempt coupled with adductor tenotomy and obtuator neurectomy ended in gross loosening and acetabular protrusion. Revision consisted of extensive soft tissue release and bone grafting of acetabular defect and use of a protrusion cup and an extra-long stem. Postoperative course was complicated by long-standing serous aseptic discharge from the wound which was controlled by antibiotics and prolonged recumbency. Indications for total hip arthroplasty in paralytic hips are rare and should be reserved for the most crippling conditions and one must be prepared fvr technical difficulties and a variety of complications with a prospecs for less than optimum results.
Acetabulum ; Adult ; Anti-Bacterial Agents ; Arthroplasty, Replacement, Hip ; Bone Transplantation ; Cerebral Palsy ; Dislocations ; Extremities ; Hip ; Humans ; Knee ; Male ; Ossification, Heterotopic ; Osteoarthritis ; Pain, Intractable ; Poliomyelitis ; Spectinomycin ; Tenotomy ; Wounds and Injuries

9 Cases of femoral head fractures treated in Seoul National University Hospital were reviewed. They were classified according to Pipkin, and assessed according to Ebstein's criteria. The longest follow-up was 3 years and the shortest 6 months, the average being 1 year and 6 months. l. 8 cases were injured due to auto accident and there was no one who had worn seatbelt. 2. 1 case of intestine rupture and 2 cases of homothorax were accompanied. 3. There were 1 excellent, 1 good, and 1 poor results in 3 cases of Pipkin type 1, 1 fair result in 1 case of Pipkin type 2, 1 good and 1 fair results in 2 cases of Pipkin type 3, 1 good and 2 fair results in 3 cases of Pipkin type 4. 4. The following complications were encountered, 2 cases of sciatic nerve palsy, 1 case of avascular necrosis of femoral head, 1 case of traumatic arthritis.
Arthritis ; Follow-Up Studies ; Head ; Intestines ; Necrosis ; Rupture ; Sciatic Neuropathy ; Seoul

No abstract available.
Aged* ; Femur Neck* ; Femur* ; Humans

Giant cell tumor of the spine is regarded as a cllnically mallgnant tumor because of its difficulty in diagnosis, cord compression and its frequent recurrence. The consensus of current report on giant cell tumor is that local resection is the treatment of choice where it is feasible. In the spine, however, because of its inoperable location, irradiation has become an accepted mode of treatment, although the results of which are at best uncertain. Total spondylectomy Is a formidable undertaking and its report is scarce. In 1966, Lievre reported total spondylectomy of the fourth lumber vertebra. In 1968, Stener and Johnsen performed total spondylectomy of three vertebral bodies, the eleventh thoracic through the first lumbar. Recently, in the summer of 1979, Edwards reported prosthetic replacement after total spondylectomy. This report presents our experience with giant cell tumor of the thlrd lumbar vertebra, which was successively treated by an excislonal biopsy through anterior retroperitoneal approach, complete removal of the vertebral body and interbody fusion of the adjoining vertebrae through an anterior medlan transperitoneal approach, and finally by excislon of the remaining posterior elemsnt and a posterior H-graft supplimented by loop wire flxation. At six month follow-up, fusion was solid and there was no exidence of recurrence of the tumor.
Biopsy ; Consensus ; Diagnosis ; Follow-Up Studies ; Giant Cell Tumors ; Giant Cells ; Mortuary Practice ; Recurrence ; Spine

The value of double contrast arthrography in meniscal lesions was studied in 58 patients with clinical findings suggestive of meniscal lesion. In all cases, arthrotomy was performed and meniscal lesions were found in 52 patients. The arthrographic findings were compared to clinical and operative findings and the following results were obtained. 1. The diagnostic accuracy of arthrography in meniscal lesions was 84.5% 2. The diagnostic accuracy of the clinical findings was 69%, but the accuracy was increased to 91.4% with the aid of arthrographic findings. 3. Arthrography would be unnecessary if the clinical findings highly suggest the meniscal lesion. 4. Arthrography is thought to be a useful diagnostic method for meniscal lesions.
Arthrography ; Diagnosis ; Humans ; Knee ; Methods

In the treatment of an infected ununited fractures of a long bone, it often is difficult to achieve union and eradicate the infection. Over the past two decades, the electrical behaviour of bone has been studied with increasing interest and several reports reveal that electricity can stimulate osteogenesis. We have experienced 11 cases of infected non-union who were treated by immobilization plus direct current stimulation from January, 1980 to July, 1982. In all cases satisfactorv union occurred within averaging 8.1 months. The results obtained are as follows: 1. The direct current stimulation has revealed to be effective with antibiotics and some kinds of immobilization in treatment of infected non union. 2. If bone graft is combined with electrical stimulation, time from beginning of electrical treatment to union is shortened, as compared with cases of electrical stimulation alone. 3. The electrical stimulation is preferable to other surgeries in treatment of infected non-union due to its effectiveness and simplicity. 4. It is considered treatment of chronic osteomyelitis with silver anode is not due to electrically generated silver ion but its electricity per se. 5. To prevent refracture and assure complete healing, continued immobilization such as cast brace, walking cast, or conventional brace is necessary after electrical stimulation for the time being.
Anti-Bacterial Agents ; Braces ; Electric Stimulation ; Electricity ; Electrodes ; Fractures, Ununited ; Immobilization ; Osteogenesis ; Osteomyelitis ; Silver ; Transplants ; Walking

Three children with osteogenesis imperfecta who were treated with fragmentation, realignment and intramedullary rod fixation (Sofield and Millar, 1959) have been followed up for considerable period. Repeated fractures in other sites as well as deformities occurred in overgrown part as the children grew up necessitated further operations of same kind. However, level of activity afterwards was found very much enhanced by the operations in general.
Child ; Congenital Abnormalities ; Humans ; Osteogenesis Imperfecta ; Osteogenesis

It has been emphasized that the treatment of choice for the trochanteric fracture of the femur is open reduction and rigid internal fixation. Regarding the stability of the fracture, most reports were focused on the comminution of the medial cortex, but few reports were paid attention to the additional fracture of the greater trochanter. This paper was aimed to evaluate the fragment of the greater trochanter on the maintenance of reduction. We treated 23 cases of unstable trochanteric fractures in which 16 cases were treated with Dynamic Hip Screw (DHS) alone, and 7 cases were treated with DHS and additional DHS Trochanter Stabilizing Plate (TSP). We compared the two groups and the results were as follows: 1. The average lag screw slipping distance was 17.1mm in DHS Group and 10.0mm in TSP Group. 2. The average distance of lateral displacement of greater trochanter over the trochantric fractures was 11.5mm in DHS Group and no change in TSP Group. The above results suggested that the comhined use of DHS Trochanter Stabilizing Plate with Dynamic Hip Screw provided good results in the treatment of uristable intertrochanteric fractures with completely detached greater trochanter and reverse oblique fracture.
Femur* ; Hip Fractures* ; Hip*