A clinical analysis was done on forty-five patients with fracture of the femoral neck, who have been admitted and treated at our orthopedic department during the period of 6 years, from January 1975 to December 1980. The following results were obtained: Age over 60 comprised 60% of the patients. Male to female ratio revealed no significant difference, being 21 to 24. However, with advancing age, female was affected more frequently than male. The major cause of injuries were “fall or slip down” occuring in 33 patients (73.3%) and “hit by car” in 12 patients (26.7%). Of the 39 patients in whom Garden's calssification of fracture could be applied. Stage II was the most common type occuring in 29 patients (75%), followed by Stage N in 6(15.4%), and Stage 5 in 4 (10%). Of the total 45 cases, forty patients were reduced and fixed with multiple Knowles pins and two patients with Jewett nail. Three patients with neglected treatment of the fracture for over 1 to 4 months were treated with primary replacement arthroplasty of the femur in two and total hip replacement in one. Fractures were united within 3 months in 10 patients (23%), 4 to 6 months in 19 patients (45.2%), and non-union in 2 patients. Relationship between accuracy of reduction using Gardens alignment index and develepment of avascular necrosis was evaluated. Of the 27 patients with reduction in the range of 155 180 in both frontal and lateral views, 3 patients were developed avascular necrosis, and of the 9 patients with reduction of less than 155 in frontal view or greater than 180 in lateral view, 4 patients were developed avascular necrosis.
Agriculture ; Arthroplasty, Replacement ; Arthroplasty, Replacement, Hip ; Clinical Study ; Female ; Femoral Neck Fractures ; Femur ; Femur Neck ; Humans ; Male ; Necrosis ; Orthopedics

The extensive traumatic wound has posed a serious problem to the surgeon. Various drugs and dressing methods have been used for this kind of wound but there has been no ideal method. The pigskin xenograft was used initially for the treatment of burn wound. The salutary effect of porcine xenograft are the stimulation of growth of healthy granulation tissue, as well as epithelial borders, inhibition of bacterial growth and pain relief. We have performed porcine xenograft in 20 cases having extensive traumatic wound with skin defect from January 1981 to February 1982. The results obtained are as follows: 1. Protect large open wound until autograft are available. 2. Alleviate pain in the wound. 3. Promote granulation tissue growth which is needed for early autograft. 4. Protect the exposed wound areas (bone and tendon) from infection. 5. The healing time of the wound depended upon the severity and the state of underlying tissue in the wound rather than wound size.
Autografts ; Bandages ; Burns ; Granulation Tissue ; Heterografts ; Methods ; Skin ; Wounds and Injuries

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

No abstract available.
Joints*

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

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

We studied the morphologic changes and the expression of cytokines of major organs by blocking CD14 and CD11c/CD18, which are known to be receptors of lipopolysaccharide (LPS), in the LPS induced endotoxemic mice. In 2 and 8 hours after initial intraperitoneal injection of 10 mg/kg of LPS into the mice, 500 microgram/kg of anti-CD14 antibody (Ab) and/or the same dosage of the anti-CD11c/CD18 Ab were administered intravenously, respectively or concomitantly. Under the light microscope, the LPS only and the LPS with the anti-CD14 Ab injected groups (group 1 and 2) showed marked acute inflammation in the organs, especially in the lung and liver, but the LPS with the anti-CD11c/CD18 Ab only or with both anti-CD14 and anti-CD11c Abs injected groups (group 3 and 4) revealed only mild acute inflammation. Under the electron microscope, there was marked inflammation in the group 1 and 2 such as marked infiltration of neutrophils, monocytes/ macrophages, lymphocytes, aggregation of platelets, and marked edematous change of endothelial cells with separation from the basement membrane. However in the group 3 and 4, there was only mild inflammation such as mild infiltration of neutrophils in the tissue or aggregation of neutrophils in the capillaries and sinusoids with mild endothelial swelling. The expressions of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1alpha (IL-1alpha), detected by RT-PCR method, was remarkable in the group 2, but minimal in the group 3 and 4. We conclude that blocking the CD11c/CD18 with anti-CD11C/CD18 Ab is effective for the prohibition of biologic reactions and diminution of the inflammation induced by the LPS, even in the LPS induced endotoxemia.
Animals ; Basement Membrane ; Capillaries ; Cytokines ; Endothelial Cells ; Endotoxemia* ; Inflammation ; Injections, Intraperitoneal ; Interleukin-1alpha ; Liver ; Lung ; Lymphocytes ; Macrophages ; Mice ; Neutrophils ; Tumor Necrosis Factor-alpha

PURPOSE: The cerebral inflammatory reactions accompanied with epilepsy could play a role in intervening the possible changes of cerebral molecular structure during or after seizure. This study was intended to examine how much proinflammatory cytokines like interleukin (IL)-1beta, IL-6 and tumor necrosis factor (TNF)-alpha are expressed in animal model with seizures of mesial temporal lobe epilepsy and how their concentration in serum changes on the basis of phase, so that it could determine possible association between the development of epileptic seizures and the expression of cytokines. METHODS: Twenty Sprague-Dawley rats as experimental group had kainic acid (KA) administered intraperitonealy, and then, their behavioral patterns were monitored and recorded. In 4 and 24 hours after KA was administered, their bloods were taken respectively to determine the concentration of cytokines. The serum concentrations of IL-1beta, IL-6 and TNF-alpha were measured by means of enzyme linked immunosorbent assay (ELISA). The concentrations of IL-1beta, IL-6 and TNF-alpha were compared with controls, and also the phased variations of their concentration were determined. RESULTS: All rats in experimental group revealed various behaviors and seizure reactions. The serum concentrations of IL-1beta, IL-6 and TNF-alpha taken from rats in 4 and 24 hours after KA administration were more significantly increased than controls respectively (p<0.01). There was no significant variation in concentration of IL-1beta and IL-6 based on time phase, but there was significantly higher concentration of TNF-alpha in serum taken in 24 hours after KA administration than in 4 hours (p<0.05). CONCLUSION: These results show that seizure activity causes the elevation of proinflammatory cytokines and activates inflammatory reactions.
Animals ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Epilepsy ; Epilepsy, Temporal Lobe ; Interleukin-1beta* ; Interleukin-6* ; Interleukins ; Kainic Acid ; Models, Animal ; Molecular Structure ; Rats* ; Rats, Sprague-Dawley ; Seizures* ; Tumor Necrosis Factor-alpha*

BACKGROUND: The interstitial cell of Cajal (ICC), the cell of origin for gastrointestinal stromal tumor (GIST), expresses CD117 (c-kit) which is a receptor for KIT ligand in cell membranes. It is immunohistochemically positive for CD117, CD34 and vimentin, but not for alpha-smooth muscle actin (SMA). METHODS: We performed the immunohistochmical study with anti-CD117, anti-CD34, anti-VMT and anti-alpha-SMA in paraffin-embedded tissue of 28 GISTs and 19 smooth muscle tumors arising in the gastrointestinal tract, mesentery, omentum and retroperitoneum (GISMT) to determine the precise nature of GIST cells. RESULTS: The positive rates of CD117, CD34 and vimentin in extraGISTs were significantly higher than in GISMTs. The positive rate of alpha-SMA in GIST was not significantly different than in GISMTs. CONCLUSIONS: A subset of GISTs may express alpha-SMA as well as CD117 and the cell of their origin may be a ICC precursor cell which is capable of differentiating bidirectionally into ICC and smooth muscle cell. This explains why GISTs may arise out of gut where ICC is not present and that they may represent the tumors arising from ICC precursor cell present around the gastrointestinal tract.
Actins* ; Cell Membrane ; Gastrointestinal Neoplasms ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Immunohistochemistry ; Mesentery ; Myocytes, Smooth Muscle ; Omentum ; Proto-Oncogene Proteins c-kit ; Smooth Muscle Tumor ; Stem Cell Factor ; Vimentin*