The fractures of the distal femur are difficult to treat due to its severity of injuries and various complications. Recently, the complications including nonunion, delayed union and joint stiffness have decreased with development of new fixation device, technics and encouraging the early joint motion. We studied 50 cases of fractures treated at our hospital from January, 1980 to July, 1988 and the results obtained from this study were as follows:1. The age distribution was between 11 and 77 year-old, and the 3rd. 4th. decades were 64 % of total patients. 2. The most common cause of injuries was traffic accident(62%), and the open fractures were more common than the fractures of other reports(48%). 3. The types of fracture were unicondylar(21 cases), simple supracondylar(8), and intercondylar (21), according to Chiron's classification, and the intercondylar fractures were subdivided into type I (2 cases), type II A(6), type II B(10) and type III (3) by Neer's. 4. Among the 50 cases, the conservative treatments were done in 19 cases and the surgical one in 31 cases. The conservative treatments were done for undisplaced or minimal displsced fractures and the cases whose general conditions were so poor that operation were impossible. 5. In surgical treatments, the open reduction and the internal fixation(25 cases), the externsl fixation(4), the knee fusion(1) and the A-K amputation(1) were done. 6. The postoperative complications were joint stiffness(11 cases), malunion(3), delayed union(3) and infection(3). 7. The satisfactory results could be obtained by the open reduction and rigid internal fixation followed by early continous passive motion exercise of knee joint.
Age Distribution ; Classification ; Clinical Study ; Femur ; Fractures, Open ; Humans ; Joints ; Knee ; Knee Joint ; Postoperative Complications

No abstract available.

The fractures of tibial shaft are common and open injury are also frequenly accompanied. Since the AO unreamed interlocking nail is solid type compared to present tubular type nail, it has no dead space, and without reaming the intramedullary blood supply can be preserved and the soft tissue trauma can be minimized. Therefore it can be used with minor risk of infection in the treatment of open tibial shaft fractures without secondary operation such as in the cases using external fixaters. Especially in Orientals, whose tibial medullary canal is narrower than Smm, it can be used ideally. From October 1991, we have experienced 14 cases of tibial shaft fractures treated with AO unreamed interlocking nail. Among 14 cases, the open fractures were 8, 4 cases were type 1 and 4 cases were type 2 by Gustilo classification. Among 6 cases of closed fractures, 4 cases had risk of post operative infection due to accompanying soft tissue injuries, such as abrasion or bulla and 2 cases had narrow intramedullary canal less than 8mm. There was no postoperative infection in all cases including open fractures, and the soft tissue defect could be reconstruted by muscle transfer, etc. The AO unreamed interlocking nail is thought to be recommendable in the treatment of open tibial shaft fracture, closed fracture with risk of postoperative infection, and also the fracture with narrow canal diameter less than 8mm.
Classification ; Fractures, Closed ; Fractures, Open ; Soft Tissue Injuries ; Tibia

Recently, tuberculosis of bone and joint is decreased with good nutrition and environment, development of preventive medicine and improvement of treatment regimen. But it is still one of the common inflammatory diseases in Korea, and must be considered in the differential diagnosis of common orthopedic complaints. There are few reports on extraspinal tuberculosis of bone and joint. Forty one cases of extraspinal tuberculosis of bone and joint were studied in our department from January 1988 to August 1993. The results were as follows; l. Extraspinal tuberculosis of bone and joint were 41 cases (39 patients, 27.8% of 147 tuberculosis of bone and joint including spine). 2. The proportion of children and young adults was 56%, hips were involved in 11 cases, knee joints in 8 cases, ankle joints in 6 cases, feet in 6 cases and elbow joints in 5 cases. 3. Coexisting pulmonary tuberculosis was found in 19 patients and active lesion in 15 patients. 4. Confirmative diagnosis could be made by smear and culture of the lesion or pathologic findings or recently available polymerase chain reaction(PCR) method. 5. Various treatment, such as antituberculous medication, external immobilization, synovectomy, curettage and bone graft, arthrodesis, had been carried out. 6. Reactivation of other site was found in 7.3%(3 cases) and resistant tendency was found in 9.7%(4 cases).
Ankle Joint ; Arthrodesis ; Child ; Curettage ; Diagnosis ; Diagnosis, Differential ; Elbow Joint ; Foot ; Hip ; Humans ; Immobilization ; Joints ; Knee Joint ; Korea ; Methods ; Orthopedics ; Preventive Medicine ; Transplants ; Tuberculosis ; Tuberculosis, Pulmonary ; Young Adult

To evaluate the results of anterior decompression and fusion with autogenous bone graft for cervical disc disease, the authors reviewed 18 cases of cervical disc herniation which were treated surgically at Inje Univ. Paik Hosp. from 1990 to 1994 with special interest in the thickness of the bone graft. All cases have been followed for more than 12 months. We try to know the clinical results of anterior decompression and fusion with autogenous bone graft. At this treatment, controversial point is a ideal thickness of graft and the width of distraction. Therefore, we follow up the correlation between thickness of graft on roentgenogram and clinical results. The clinical results were satisfactory as excellent in 11 cases, good in 5 cases according to criteria of Robinson et al. Successful fusion occured in 16 cases within 3 months after their initial procedure, and fusion failure resulted in 2 cases. 3mm distraction from baseline disc height was considered ideal thickness of graft after anterior decompression and all cases healed successfully. We concluded that 3mm distraction from baseline disc height is necessary for successful decompression & fusion.
Decompression ; Follow-Up Studies ; Transplants

Congenital diaphragmatic eventration is an abnormal elevation of the diaphragm as a result of developmental failure of muscular fibers during the fetal period. Mediastinal shift to the contralateral side may cause significant compression of the affected chest contents resulting in compromised pulmonary function especially when bilaterally involved. The differentiation between congenital diaphragmatic eventration and diaphragmatic hemia is very difficult but eventration has a better perinatal outcome compared to diaphragmatic hernia. We report a case of congenital diaphragmatic eventration on left side with good perinatal outcome after plication in which the initial prenatal diagnosis of diaphragmatic hernia was made by prenatal ultrasonography.
Diaphragm ; Diaphragmatic Eventration* ; Hernia, Diaphragmatic* ; Prenatal Diagnosis ; Thorax ; Ultrasonography ; Ultrasonography, Prenatal

No abstract available.
Hemorrhage*

The mortality and morbidity of peritrochanteric fractures in the elderly are great due to preexisting diseases, the osteoporosis, and poor general conditions. Since the complications sometimes lead to death, it is utmost important to reduce the complications and to prevent them. Authors had experienced 42 peritrochanteric fractures over 65 years old from January, 1988 to December, 1992. Age incidence was distributed from 65 to 93 years. The sites of fractures were 17 femoral neck, 24 intertrochanteric, 1 subtrochanteric. The mortality at postoperative 6 months was 10.2%. The postoperative complications were 6 cardiovascular diseases, 3 pneunonia, 3 pressure sore etc. The results according to interval between injury and operation were not significant, but reducing risk factors following check-up of general conditions was significant. It was necessary in treatment of elderly peritrochanteric fractures to check the general conditions, to reduce risk factors, to choose appropriate method of operation and anesthesia, and to operate as soon as possible by experienced surgeon. Postoperative early ambulation was also significant at good results. The percutaneous pinning under local anesthesia was an recommendable method in patients with severely poor general conditions.
Aged ; Anesthesia ; Anesthesia, Local ; Cardiovascular Diseases ; Early Ambulation ; Femur Neck ; Humans ; Incidence ; Methods ; Mortality ; Osteoporosis ; Postoperative Complications ; Preexisting Condition Coverage ; Pressure Ulcer ; Risk Factors

A finite element analysis has been utilized to analyze stress and strain fields and design a new configuration in orthopedics and implant dentistry. Load transfer and stress analysis at implant bone interface are important factors from treatment planning to long term success. Bone configuration and quality are different according to anatomy of expecting implantation site. The purpose of this study was to compare the stress distribution in maxilla and mandible according to implant length and bone engagement types. A three dimensional axi-symmetric implant model(Nobel Biocare, Gothenburg, Sweden) with surrounding cortical and cancellous bone were designed to analyzed the effects of bone engagement and implant length on stress distribution ANSYS 5.5 finite element program was utilized as an interpreting tool. Three cases of unicortical anchorage model with 7, 10, 13mm length and four cases of bicortical anchorage model with 5, 7, 10 and 13mm lenght were compared both maxillary and mandibular single implant situatiion. Within the limits of study, following conclusions were drawn. 1. There is difference in stress distribution according to cortical and cancellous bone thickness and shape. 2. Maximum stress was shown at the top of cortical bone area regardless of bone engagement types. 3. Bicortical engagement showed less stress accumulation when compared to unicortical case overall. 4. Longer the implant fixture length, less the stress on cortical bone area, however there is no difference in mandibular bicortical engagement case.
Dentistry ; Finite Element Analysis* ; Mandible ; Maxilla ; Orthopedics

BACKGROUND: Diabetic ketoacidosis(DKA) is serious acute metabolic complication and the most important cause of high morbidity and mortality of diabetes. The object of this study is to examine the clinical characteristics of patients with DKA who had a prior history of diabetes or not. METHOD: Authors reviewed retrospectively the medical records of 49 cases adimitted to Kyungpook National University Hospital from January 1991 to June 1997 with a diagnosis of DKA and classified cases as type I, type II and newly diagnosed diabetics according to prior history of diabetes. RESULTS: 1. Of 49 cases of DKA, 24(49%) were classified as type I, 17(35%) as type II from data available in the medical records, and 8(16%) had DKA as the initial manifestation of the disease. 2. The male to female ratio was 0.5 : 1 in type I, 1.1 : 1 in type II and 1.7 : 1 in newly diagnosed diabetics, and the mean age was 24.4 in type I, 57.9 in type II and 23.9 years old in newly diagnosed diabetics. 3. The mean duration between initial diagnosis of diabetes and the occurrence of DKA was 2.6 in type I and 6.9 years in type II diabetes. The occurrence of DKA within 2 years of initial diagnosis of diabetes was 54% in type I and 18% in type II diabetes, but the occurrence of DKA after 5 years of initial diagnosis of diabetes was 17% in type I and 47% in type II diabetes. 4. The precipitating factors of DKA were identified in 88% in type I, 76% in type II and 38% in newly diagnosed diabetics, and the most common precipitating factor was omission of treatment in both type I and type II(type I: 56%, type II: 35%). 5. The altered mental status was correlated with increased osmolality (p<0.05), but not with other laboratory values such as pH, bicabonate, glucose, anion gap and dehydration status(p>0.05). CONCLUSION: It is necessary to conduct early aggressive evaluation for early diagnosis and proper treatment of DKA, because DKA occurs in patients with prior history of type II diabetes and without prior diabetic history as well as patients with prior history of type I diabetes.
Acid-Base Equilibrium ; Dehydration ; Diagnosis ; Early Diagnosis ; Female ; Glucose ; Gyeongsangbuk-do ; Humans ; Hydrogen-Ion Concentration ; Male ; Medical Records ; Mortality ; Osmolar Concentration ; Precipitating Factors ; Retrospective Studies