The intramedullary nailing for the tibial fracture has been used in selected cases of fresh diaphyseal fracture and nonunion. However, with modern technical improvement such as image intensifier and interlocking, the indications have been expanded considerably. Interlocking intramedullary nailing has been popularized because it enables preservation of the range of motion of the joint, early weight bearing and early bony union. Between August, 1989 and July, 1991 interlocking nailing in the tibial fracture has been performed for 53 cases with follow up more than one year. The results were as follows; 1. All were treated with closed nailing and static locking was performed as a principle. Only three cases needed dynamization of the 47 patients treated with static locking nailing. 2. The union rate was 96.296 and mean period of fracture union was 15.2 weeks. 3. In the distal one third of fracture, rigid fixation could be achieved by adjusted length by cutting the distal end. 4. In 7 proximal tibial fractures, 4 fractures were accompanied with complications such as nonunion, angulation deformity and shortening. Therefore, interlocking nail is inadequate treatment of proximal unstable fractures. 5. In the delayed and nonunion treated by interlocking nailing, bony union was achieved in all 3 cases without bone graft and cast immobilization.
Congenital Abnormalities ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Immobilization ; Joints ; Range of Motion, Articular ; Tibia ; Tibial Fractures ; Transplants ; Weight-Bearing

Ipsilateral fractures of the femoral neck and shaft represent many difficulties in diagnosis and treatment. The femoral neck fracture of this injury is commonly missed on initial evaluation. The overlooked femoral neck fracture may lead to higher risk of complications such as avascular necrosis of the femoral head, nonunion and coax vara. The authors reviewed nine cases of ipsilateral femoral neck and shaft fracture treated in our clinic from September 1989 to May 1995, and average follow-up period was 33 months(range, 12 to 101 months). The results obtained were as follows : 1. The most common cause of injury was traffic accident, and three femoral neck fractures were missed initially. 2. The most common site of femoral neck fractures was basicervical in 7 cases, and that of shaft fracture was middle 1/3 shaft in 5 cases. 3. The most common associated injury was ipsilateral knee injury(6 cases). 4. Five cases were treated with femoral reconstruction nail, two with multiple neck-pinning and retrograde interlocking IM nail, one with multiple screws for neck fracture and long dynamic compression plate for shaft fracture, and the other, multiple neck-pinning and antegrade interlocking IM nail. 5. The complications were a refracture of the shaft after removal of interlocking nail and a delayed union of shaft fracture which had been treated by reconstruction nailing. Coxa vara, delayed union and metal loosening were found in femoral neck fracture site, but all that were clinically acceptable. In conclusion, the fracture of femoral neck should be kept in mind not to be lost in case of high velocity-femoral shaft fracture, and if found, it should be treated with anatomical and rigid internal fixation in femoral neck fracture having first priority. Recently reconstruction nail for the treatment of these fractures was widely used, but that is technically difficult and might destroy the neck fracture during shaft fracture fixation. We recommend retrograde interlocking nail followed by multiple neckpinning might be safe and stable fixation for the ipsilateral neck and shaft fracture.
Accidents, Traffic ; Coxa Vara ; Diagnosis ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Fracture Fixation ; Head ; Knee ; Neck ; Necrosis

Femoral fractures in adults frequently need an extensive dissection for attainment of adequate internal fixation, frequently leading to nonunion, infection and derangement of joint motion. Retrograde IM nailing, compared to the conventional methods, has advantages of reducing periarticular soft tissue dissection and establishing a load sharing construct reducing hardware failure. The purpose of this study is to verify the advantages of retrograde IM nailing by retrospective evaluation of the results of adult femoral fractures treated by this technique. The matrials were 17 femoral fractures in 15 patients treated by retrograde IM nailing and followed up for more than 1 year. The fracture was located in the middle third of the shaft in 5 and distal third in 12. The latter consisted nf 6 cases of type Al, 4 cases of type A2 and 2 cases of type A3 by Miiller's classification. The results were as follows; 1) Fracture union was achieved at an average of 17.5 weeks. 2) Full range of knee motion was gained in 15/17 knees (88%). 3) Complication occurred in 2 knees. One nonunion and one angulatory malunion. 4) There was no infection, no femoral shortening or implant failure. In conclusion, retrograde IM nailing of adult femoral fracture is an effective method in selected cases such as far distal femoral fracture, ipsilateral femur neck and shaft fractures, floating knee, post-TKR femoral fracture and so on. The merits of this technique are rigid fixation which is difficult to obtain with others, no need of fracture table, short operative time and mimium blood loss. However, It has potential problems such as difficulty in insertion of proximal locking screw and need for an arthrotomy to remove hardware.
Adult* ; Classification ; Femoral Fractures ; Femur ; Femur Neck ; Fracture Fixation, Intramedullary* ; Humans ; Joints ; Knee ; Operative Time ; Retrospective Studies

This etiology of Freiberg's disease, an idiopathic avascular necrosis of the second metatarsal head, has not been clarified. In 1979, Gauthier and Elbaz treated 53 cases of the advanced Freiberg's disease by a new technique, that is, dorsal closing wedge osteotomy, and their result was successful. Recently, in 1989, Zollinger identified that the load per surface area is concentrated at the dorsal rather than plantar surface of the second metatarsal head during walking by an experimental dynamic study, and this theory explained why the lesion of the disease is confined to the dorsal surface of the second metatarsal head, and provided a basic concept on the dorsal closing wedge osteotomy. The authors reviewed 5 cases of Freiberg's disease treated by dorsal closing wedge osteotomy from September 1989 to February 1994, and the average follow-up period was 2 years and 5 months(range, 12 to 50 months). The results were as follows; 1. All were female, and the average age at the time of operation was 29.4 years(range, 22 to 43 years). 2. All were pain-free at the last follow-up. 3. The range of motion(ROM) of the metatarsophalangeal joint was increased postoperatively; average ROM: preoperative, 33°/ postoperative 77°; mean gain of ROM, 44° So, dorsal closing wedge osteotomy is a recommendable procedure for the treatment of advanced Freiberg's disease.
Female ; Follow-Up Studies ; Head ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Necrosis ; Osteotomy ; Walking

PURPOSE: To study the results of intravitreal tissue plasminogen activator (tPA) and expansile gas injection for the treatment of submacular hemorrhage in age-related macular degeneration (AMD). METHODS: Eleven consecutive patients (11 eyes) with submacular hemorrhage in AMD were included in this study. All patients were treated with intravitreal injections of tPA and C3F8 gas. Postoperatively, patients' follow-up period were at least 3 months. Outcome measures included early and final visual acuity, age, disc areas of hemorrhage, duration of symptoms, displacement of blood from the fovea, and final macular status. RESULTS: The maximum diameter of the hematoma ranged from 2 to 10 disc diameters. The mean duration of submacular hemorrhage was 7.5 days. Submacular blood was completely displaced in 7 patients (64%) and partially in four (36%). Best postoperative visual acuity improved in 7 eyes; in 6 eyes (55%), the improvement was two or more lines. Final visual acuity improved in 7 eyes (64%), remained stable in 2 eyes (18%), and worsened in 2 eyes (18%). Choroidal neovascularization positioned at subfovea in 7 eyes (64%) and juxtafovea in 4 eyes (36%). No significant difference was found between postoperative visual recovery and these factors. CONCLUSIONS: Our findings suggest that intravitreal tPA and expansile gas injection are safe and of useful for displacing hemorrhages secondary to age-related macular degeneration. Final visual acuity was limited by the underlying choroidal neovascularization of AMD.
Choroidal Neovascularization ; Displacement (Psychology) ; Eye ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Intravitreal Injections ; Macular Degeneration ; Outcome Assessment (Health Care) ; Tissue Plasminogen Activator ; Visual Acuity

PURPOSE: To study the development of inferior shoulder subluxation after surgery for proximal humerus fractures. To analyze the mechanism development of such subluxation and the association between different types of proximal humerus fractures, quality of reduction achieved the method of operation performed. MATERIALS AND METHODS: A retrospective analysis of 45 proximal humerus fractures that were treated by surgery between March 1997 and July 2002 was done. All patients had a minimum of 12 months of postoperative follow up. Preoperative radiographs were classified by the Neer's classification. Different operative treatment methods, post reduction alignment and the degree of postoperative subluxation if present, were analysed. In order to evaluate effect of loss of negative intraarticular pressure, we compared this series with 15 cases of recurrent shoulder dislocation treated by open Bankart operation. RESULTS: 13 patients out of 45 (29%) developed immediate postoperative inferior shoulder subluxation. 3-part fractures of the proximal humerus showed a higher incidence of the same than the 2-part types. The better reduced fractures had lesser rates of subluxation. Open reduction (39%, 11 patients) results in an increased incidence of inferior subluxation than closed methods of reduction (13%, 2 patients). CONCLUSION: Inferior subluxation of the humeral head after surgery for the proximal humerus fracture can occur and persist till postoperative period of 2 months. Deltoid muscle tone affected by shortening of humeral neck plays an important role. Early active exercise for restoration deltoid tone may be effective in prevention of inferior subluxation.
Classification ; Deltoid Muscle ; Follow-Up Studies ; Head* ; Humans ; Humeral Head ; Humerus* ; Incidence ; Neck ; Postoperative Period ; Retrospective Studies ; Shoulder ; Shoulder Dislocation

Microparticle induced inflammatory reaction has been extensively studied as a potential cause of implant loosening. However, there has been little in vivo study on the effect of the particles on the preserved cartilage in partial joint replacements. The purpose of this study was to determine in vivo effects of microparticles on the articular cartilage. Ninety rabbit knee joints were challenged repeatedly with 1-3 micron commercial pure titanium (Ti) and 1-45 micron ultra high molecular weight polyethylene (PE). After 12 weeks, patella and distal femur were harvested for determination of degenerative change by light and scanning electron microscope. The results are as follows: 1, In the joints without exposure of the subchondral bone, neither Ti nor PE elicited significant change. However, simultaneous introduction of both particles resulted in significant degeneration of the articular cartilage. 2. With the subchondral bones exposed, Ti and PE both induced significant cartilage degeneration. In this condition the PE particles were more detrimental than the Ti particles in causing degeneration of the articular cartilage. Although there exists a species difference, these results imply that the longevity of partial joint replacements may be shortened not only by mechanical problems, but also by the microparticles causing secondary degenerative change.
Cartilage ; Cartilage, Articular* ; Femur ; Joints ; Knee Joint* ; Knee* ; Longevity ; Molecular Weight ; Patella ; Polyethylene ; Titanium

STUDY DESIGN: This is a retrospective study. OBJECTIVES: To verify the efficacy of the separate curve derotation technique by segmental pedicle screw fixation in King type V adolescent idiopathic scoliosis(AIS). SUMMARY OF BACKGROUND DATA: King type V AIS is commonly treated by fusion of both the upper and the lower thoracic curve. However, both curves fusion often leads to undesirable shoulder asymmetry by relative overcorrection of the more flexible lower thoracic curve. METHODS: Fourteen patients subjected to both curve fusion with segmental pedicle screw fixation by separate curve derotation were analyzed after a minimum follow-up of 2 years. The group comprised 11 females and 3 males with a mean age of 15.9 years. All patients had upper left thoracic and lower right thoracic curve pattern. The upper thoracic curve was 46.2+/-10.3degrees with a flexibility of 39.6%. The lower thoracic curve was 54.3+/-14.5degrees with a flexibility of 59.1%. Preoperatively, shoulder was level in 4, left elevated in 8 and right elevated in 2 patients. RESULTS: At the final follow up, the upper thoracic curve was corrected to 21.5+/-8.7degrees showing a correction of 52.8%. The lower thoracic curve was corrected to 20.0+/-10.6degrees showing a correction of 63.5%. All the patients had improvement of shoulder height difference and trunk balance clinically and radiologically. CONCLUSIONS: Segmental pedicle screw fixation and separate derogation is an effective method of restoring shoulder symmetry and maintainig trunk balance in King type V AIS.
Adolescent* ; Female ; Follow-Up Studies ; Humans ; Male ; Pliability ; Retrospective Studies ; Shoulder

OBJECTIVES: This study was conducted to estimate the incidence rate, and to identify the risk factors for the occupational low back pain among shipyard workers. METHODS: The study subjects consisted of 9,784 workers who were employed in a ship-building industry(excluded workers who had a history of low pack pain before 1995 or did not take periodic health examination in 1995). The cases were 220 people who experienced back pain from January 1, 1996 to December 31, 1998. To assess risk factors for occupational low back pain, Cox propotional hazard model was used. RESULTS: During the recent three years from 1996 to 1998, the incidence rate per 1,000 persons was 7. 8 in 1996, 8. 8 in 1997, and 3. 1 in 1998. The main causes of work-related low back pain were sprain, strain and disc herniation. Lifting was the most common cause of back pain(35. 3%), and carrying(10.2%) and pulling(8.0%) were followed. In Cox proportional harzard model, independent risk factors for back pain were body mass index(R.R.; 1.54, 959o C.I.: 1.06-2.25), shift work(R.R.; 1.65, 95% C.I.: 1.19-2.28), and lifting heavy material(R.R. ; 3.95, 95% C.I: 2.29-6.82). CONCLUSIONS: This study suggests that the risk factors of back pain in shipyard workers were body mass index, shift work and lifting.
Back Pain ; Body Mass Index ; Humans ; Incidence* ; Lifting ; Low Back Pain* ; Proportional Hazards Models ; Risk Factors* ; Sprains and Strains

STUDY DESIGN: A retrospective study. PURPOSE: To determine the exact distal fusion level in the management of thoracolumbar/lumbar adolescent idiopathic scoliosis (TL/L AIS) using pedicle screw instrumentation (PSI). OVERVIEW OF LITERATURE: The selection of distal fusion level remains controversial in TL/L AIS. METHODS: Radiographic parameters of 66 TL/L AIS patients were analyzed. The patients were grouped according to the distal fusion level; L3 group (fusion to L3, n=58) and L4 group (fusion to L4, n=8). The L3 group was subdivided into L3A (L3 crosses the mid-sacral line with rotation of less than grade II, n=33) and L3B (L3 does not cross the mid-sacral line or rotation is grade II or more, n=25) based on both bending radiographs. All of the patients in the L4 group had the same location and rotation of L3 in bending films as that of patients in the L3B group. An unsatisfactory result was defined as a lowest instrumented vertebral tilt (LIVT) of more than 10degrees or coronal balance of more than 15 mm. RESULTS: Among the 3 groups, there was a significantly lesser correction in the TL/L curve and LIVT in the L3B group. Unsatisfactory results were obtained in 3 patients (9.1%) of the L3A group, in 15 patients (68.2%) of the L3B group, and in 1 patient (12.5%) of the L4 group with a significant difference. CONCLUSIONS: In TL/L AIS treatment with PSI, the curve can be fused to L3 with favorable radiographic outcomes when L3 crosses the mid-sacral line with rotation of less than grade II in bending films. Otherwise, fusion has to be extended to L4.
Adolescent* ; Humans ; Retrospective Studies ; Scoliosis* ; Spinal Fusion