No abstract available.

Osteonecrosis (Avascular necrosis) of the bone is a known complication of systemic corticosteroid therapy and may he dose related. It also has been associated less commonly with nonsteroida1 chemotherapy. Nonetheless, avascular necrosis of bone has heen reported infrequently in children who have received antileukemia regimens including prednisone. We report our experience with one adolescent girl with acute lymphocytic leukernia (ALL) who developed hoth femoral condylar osteonecrosis presenting bone pain after aggressive chemotherapy that including high cumulative dosage of corticosteroid as well as other antileukemia agents. We performed arthroscopic surgery with debridement, multiple drilling and screw fixation to the lesion sites. Eight months after operation, she was free of pain with full range of both knee movements. We got good resuit according to Hughston criteria.
Adolescent ; Arthroscopy ; Child ; Debridement ; Drug Therapy ; Drug Therapy, Combination* ; Female ; Humans ; Knee* ; Osteonecrosis* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prednisone

No abstract available.
Hyperostosis, Sternocostoclavicular*

No abstract available.
Hip Joint* ; Hip*

Soft tissue reconstruction of the hand remains a challenge for the hand surgeon, who must choose whether to use a local flap, a distant flap or a free flap. Local flaps, derived from tissue immediately adjacent to the primary defect, are the first choice. But there is a shortage of skin in the hand and there are regions of the hand that should not be used as donor sites since cover of the resultant secondary defect with a skin graft would be inappropriate. We used island flaps for the small soft tissue defects in the hand which were difficult to cover with a conventional skin graft or local flap. The results were as follows; 1. The causes of the soft tissue defects were traumatic amputation in 4 cases, camptodactyly in 4 cases, replantation in 3 cases, infection in 3 cases and tumor in 1 case. 2. The sites of the soft tissue defects were thumb tip in 6 cases, fifth finger PIP joint volar aspect in 3 cases, index tip in 2 cases, thumb volar and dorsal surface in 2 cases, third and fourth MP joint dorsal surface in 1 case, fourth finger PIP joint volar aspect in 1 case and first interdigital web space in 1 case. 3. The donor flaps were fourth finger neurovascular island flap in 8 cases, reverse dorsal matacarpal flap in 5 cases and first dorsal metacarpal artery flap in 4 cases. 4. The sizes of the flap were from 1. 0×1. 5cm to 2.0×4.0cm and and average of 1.5×2.0cm. 5. The flaps were survive completely with a touch sensat,ion except 2 cases which were covered by reverse 5th dorsal metacarpal flap.
Amputation, Traumatic ; Arteries ; Fingers ; Free Tissue Flaps ; Hand ; Humans ; Joints ; Replantation ; Skin ; Surgical Flaps ; Thumb ; Tissue Donors ; Transplants

The purpose of this study was to evaluate the results and complications in difficult periarticular fractures of the knee treated with a circular(Ilizarov) external fixator. The mean follow-up period was 34 months(range: 12-55 months). Of the 27 cases, 12 cases involved fractures of distal femur (two M ller type A3, four type C2, six type C3) and 15 cases involved fractures of the proximal tibia (one Schatzker type V, eight type VI, two segmental, four metaphyseal comminuted fractures). Twenty-two cases(81%) were open fractures and most of the cases were open intra-articular comminuted fractures. The average duration of external fixation was 7.7 months (9.8 months for the distal femur cases, 6.5 months for the proximal tibia cases and 11.5 months for the cases which required lengthening, and 6 months in the non-lengthening group). In 8 cases, in which bone lenthening was done, no leg length discrepancy occurred after lengthening. The mean length gained was 5.9 cm and the mean healing index was 1.8 months/cm (1.8months/cm in distal femur cases and 1.9 months/cm in proximal tibia cases). According to Neers criteria, the treatment results for cases involving distal femur fracture were as follows: six satisfactory, three unsatisfactory, three failures; cases with proximal tibia fractures had these results: nine excellent, three satisfactory, three unsatisfactory. Average range of motion was 67 degrees in distal femur fracture cases and 114 degrees in proximal tibia fracture cases. According to Paleys complication grading system, six problems, six obstacles, and eight com- plications occurred. In conclusion, the Ilizarov external fixator can be a useful treatment method in periarticular fractures of the knee with severe intra-articular or metaphyseal comminution, bone loss, severe soft tissue injury, or multiple associated injury. Its use can reduce the associated complications such as leg length discrepancy, infection, and nonunion.
External Fixators* ; Femur ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Knee* ; Leg ; Range of Motion, Articular ; Soft Tissue Injuries ; Tibia

An epidemiological investigation of 878 workers(male 812, female 66) who suffered from low back injury(LBI) in some workplace of Pusan city from January 1 to December 31 in 1992 was carried out to obtain the various informations of the prevention and management in the occupational low back pain(LBP). The results were summarized as follows: 1. The mean age of LBP workers was 39.3±10.4(18-67) in male 48.5±12.6(21-69) in female workers. And the most common age groups were the 4th decade in male and the 6th decade in female workers. 2. In the frequency distribution of LBI according to the kind of industry, manufacturing industry was most frequent, and industry of construction, transport-storage-communication were the next in order. Among manufacturing industry, LBI of metallic products and machinery was the most frequent. 3. The occupational frequency of LBP was technical worker, monotonous worker, driver of automobile, driver of heavy equipment and office worker in order. 4. The cumulative percentage of LBI was 6.9% at the first day of employment and 90.8% until 10 years after employment. 5. The mean working duration from employment to onset of injury was 1081 days(about 2.9 years) and the working duration according to occupation was the shortest in driver of heavy equipment(502 days) and longest in office worker(1982 days). 6. The careless handling of object was the most common cause of LBI, and fall down, slip down, collision and traffic accidents were the next in order. 7. The most common cause of LBI according to occupation was traffic accident in driver of automobile, fall down in driver of heavy equipment and careless handling of object in office worker respectively. 8. The case of localized LBI were 517(58.9%) and the cases of LBI combined with other injuries, such as head, neck, trunk, arm or leg, were 361(41.1%) 9. Lumbar sprain was the most frequent diagnosis of LBI, and Herniated Nucleus Pulposus(HNP) and lumbar fracture were the next in order. 10. In multiple injuries, LBI combined with multiple body injury was the most frequent, and the next was LBI combined with arm and leg, with trunk, with head and with neck in order. 11. LBI combined with multiple body injury was the main injury in fall down, slip down and traffic accident, and lumbar sprain was the main injury in careless handling of object.
Accidents, Traffic ; Arm ; Automobiles ; Back Injuries ; Busan ; Diagnosis ; Employment ; Epidemiologic Studies ; Female ; Head ; Humans ; Leg ; Male ; Multiple Trauma ; Neck ; Occupations ; Spine ; Sprains and Strains

Elderly patient with Genu Varus deformity is commonly treated by high tibial valgus osteotomy to unload the stress concentration medially. Most of these procedures were performed by closing wedge osteotomies and that revealed some problems. Most require a fairly large scar and later reoperation for implant removal. The Ilizarov apparatus and Ilizarov's principles of deformity correction seem to offer several advantages over other methods of high tibial osteotomy. With the Ilizarov method, distractional open wedge technique offers a biomechanically sound, predictably accurate, and reproducible method of correcting an extremity's mechanical axis deviation. From December 1991 to December 1993 at the department of orthopaedic surgery, Pusan National University Hospital, 5 patients(7 tibia) underwent the operation of correction of the genu varum using Ilizarov external fixator for osteoarthritis. The results were summarized as follows: l. All case were female, and the Mean age was 58 years old. 2. Preoperative mean varus angle were 20° and postoperative mean valgus angle were 6° at final follow-up. 3. The complication was not detected includes limb length descrepancy. 4. Mean Ilizarov external fixator fixation period was 5 months. 5. The results after average 1 year 1 month of follow-up were as follows: Excellent in 2 cases(29%), Good in 4 cases(57%), Fair in 1 case(14%), Poor in 0 case()%). 6. The early clinical and radiologic results were encouraging, although a longer follow-up period is necessary.
Aged ; Busan ; Cicatrix ; Congenital Abnormalities ; External Fixators ; Extremities ; Female ; Follow-Up Studies ; Genu Varum ; Humans ; Ilizarov Technique ; Methods ; Osteoarthritis ; Osteotomy ; Reoperation

The tibial plateau fracture involving the articular surface clinically is a very important injury which often can cause disabilities of the knee joint. Open reduction and internal fixation have been proposed as the optimal treatment of patient with Schatzker's type VI tibial plateau fracture because of the decrease in the functional impairment of the knee joint by allowing early motion. But the injury to the soft tissue is usually severe, which may lead to wound complications after internal fixation. Also delayed union, nonunion, and infection after such operation is not a few. Recently some authors have studied about the external fixation or minimal internal fixation as the treatment for tibial plateau fracture. The purpose of the current study was to compare the results of two different operative methods. The authors analyzed 9 cases of Schatzker's type VI tibial plateau fracture surgically treated at the Pusan National University Hospital from March 1991 to August 1994. The follow-up period ranged from 1 year to 4 year 7 months. The results were obtained as follows. 1. Of the 9 cases, 7 were male and 2 were female, the major population were the 6th and 7th decades. 2. The most common cause of this injury was traffic accident in 7 cases(78%). 3. About the fracture pattern, the most commom type was intercondylar fracture type in 5 cases(56%), the next one lateral condyle fracture type in 4 cases (44%). 4. Common associated injuries were ipsilateral fibula fracture in 8 cases(89%) and ipsilateral femur fracture in 4 cases(44%). 5. Six cases were treated by open reduction and internal fixation, and 3 cases were treated by external fixator. 6. According to Poster's criteria, the results were “Acceptable” in 7 cases(89%), “Unacceptable” in 2 cases(11%).
Accidents, Traffic ; Busan ; Diaphyses ; External Fixators ; Female ; Femur ; Fibula ; Follow-Up Studies ; Humans ; Knee Joint ; Male ; Methods ; Tibia ; Wounds and Injuries

Fractures of the patella are intra-articular fractures of a sesamoid bone. The goal of treatment is to restore the function of the extensor mechanism and congtvity of the articular surface of the knee. So postoperative traumatic arthritis is minimized by an accurate reduction of the articular surfaces. We analyzed nine cases of the patella fractures which were treated by the use of arthroscopy to allow visualization of and working inside of joints, and the use of the image-intensifier fluoroscope to allow real-time vi.sualization of the skeleton. The results were as follows The fixation of patelia fractures using an arthroscopy could be applied to transverse or vertical fractures without comminution and severe osteoporosis. 2. In the treatment of two types of patella fractures (simple transverse e rnarginal vertical fractures without comminution), clinically satisfactory results were obtained through the accurate reduction of articular surface using an arthroscopy and image intensifier.
Arthritis ; Arthroscopy* ; Intra-Articular Fractures ; Joints ; Knee ; Osteoporosis ; Patella* ; Sesamoid Bones ; Skeleton