In the treatment of elderly hip fracture, early mobilization as a means of reducing early postoperative morbiyt and morbidity is mandatory. Even though Ender nailing have many advantages, most serious problems with use of Ender nailing method are distal migration of nails, subsequent loss of fixation and limited knee joint motion. To prevent these difficult problems, we have used distal wiring technique with Ender nailing since 1988. In operation, we performed Ender nailing as usual manner under image intensifier and for the prevention of the nail migration, we performed circumferential wiring through the each Ender nail eye and above the adducter tubercle of the distal femur. Forty six cases were available with minimum follow-up of six months which were healed radiologically and clinically (Mean follow up: 21 months). The mean age was 74 years (Range: 52 years-88 years)and showed 26 cases of famale and 20 cases of male. The radiological morphometry using Singh index showed poor bone quality: 36 cases were below Grade III and the fracture type was classified by Tronzo criteria. In results, patients who had Ender nailing with distal wiring showed no distal migration, however one case of proximal migration was observed at the beginning stage of this technique. So, in elderly trochanteric fracture, to reduce the complication of the Ender nailing, especially nail migration, the authors recommend the Ender Nailing with distal wiring technique.
Aged ; Early Ambulation ; Femoral Fractures ; Femur ; Follow-Up Studies ; Hip ; Humans ; Knee Joint ; Male ; Methods

Acromioclavicular joint injuries are recently increased, but there are still controversies as to the proper choice of treatment. We treated thirty cases of acromioclavicular injuries, among these, twenty five cases were done by operative method and five cases conservatively from August 1979 to June 1988. The results were as follows, 1. The injuries were composed of one case of Type 1, 7 cases of Type 2 and 22 cases of Type 3. 2. The result of conservative treatment consisted of 2 cases of good, 1 case of fair and 2 cases of poor. 3. The final outcome of operative method was better than that of conservative one, which consisted of 16 cases of good and 9 cases of fair. 4. The cause of fair results in operative method was thought to residual lexity of the repaired coracoclavicular ligament. 5. The key point of operative treatment in acromioclavicular separation was firm and strong reconstruction of the coracoclavicular ligament. 6. Modified method of coracoclavicular ligament reconstruction using coracoacromial ligament with bone block has been tried.
Acromioclavicular Joint ; Ligaments ; Methods

No abstract available.
Classification*

No abstract available.
Branchial Region* ; Branchioma*

No abstract available.
Fractures, Open*

No abstract available.
Caloric Tests*

The purpose of early reduction and internal fixation of the trochanteric fracture is early mobilization and reducing the complication rate. The morbidity and mortality rates remain high in elderly patients with this type of injury. This is due to reduced tolerance to prolonged bed rest, lenghy operation, and massive soft tissue dissection and blood loss. We feel the Ender method has the advantages of ease performance, decreased operating time, and immediate weight bearing in most cases. Total 23 cases of trochanteric fracture of the femur was treated at the Department of Orthopaedic Surgery of National Medical Center during the period from June, 1985 to December, 1987. The results were as follows : l. Out of 23 patients, 16 patients were female and the mean age was 71 year old. 2. The most common cause was the injury from slip down. 3. By the Tronzo classification, the most common type was type III. (14 cases) 4. The average duration from accident to operation was 4.5 days and average blood loss was 210 ml during operation. 5. The average bony union was obtained in 16.4 wks. 6. For prevention of distal pin migration, we performed circumferential wiring through the eye of distal pin in 6 cases and resulted in no migration until complete bony union.
Aged ; Bed Rest ; Classification ; Early Ambulation ; Female ; Femur ; Fracture Fixation, Intramedullary ; Humans ; Methods ; Mortality ; Weight-Bearing

The studies about tibial spine fracture were less frequently reported, especially in its sdult type, had different opinions according to authors. Meyers and McKeever described it had frequedntly occured as isolated injury without associated ligamentous injury of the same knee in children and mainly caused by bicycle accident. They had classified it by three different types according to the shape of it, managed conservatively type I, II,IIIA, and recommanded simple suturing with absorbable materials as operative method. But, in our cases it had frequently occured in adult and combined with ligamentous injury at the same knee including ACL and MCL. Also, it had frequently been caused by major trauma such as traffic accident. Previous method of management including simple stainless steel wiring had scored poor results in these complicated fractures. The author reviewed 24 cases of the tibial spine fracture treated at the Department of Orthopaedic Surgery, National Medical Center from June, 1980, to June, 1988, and the following results were obtained. 1. The most common causes of the injury were traffic accident (12 cases) and associated with rupture of medial collateral ligament in 7 cases. 2. The fracture was classified as four different types according to its pattern and comminution and most commen types were III and IV, scored 8 cases and 7 cases irrespectively. 3. Initially, closed sreduction and cast immobilization was performed in 15 cases, of which 8 cases had poor results with non-union of the fracture and instability. 4. Simple stainless steel wiring in 2 cases scored poor results and distal advancement of ACL with double wiring revealed good results in these cases. 5. One case of type II fracture had persistently positive anterior drawer sign and subjective instability and needed distal advancement of ACL and double wiring. 6. Distal advancement of ACL and double wiring was performed in 6 cases of which 4 cases revealed excellent results and 2 cases did good ones.
Accidents, Traffic ; Adult ; Child ; Classification ; Collateral Ligaments ; Humans ; Immobilization ; Knee ; Ligaments ; Methods ; Rupture ; Spine ; Stainless Steel

Cemented total hip replacement is one of the established methods of treatment in various hip joint disorder in adults in spite of the high incidence of the complications. The authors report a clinical experience of 39 patients(47 hips) among the 111 patients (126 hips) who were treated with cemented total hip replacement from May 1973 to August 1985 at the Department of Orthopaedic Surgery of National Medical Center. The follow-up period ranged from 3 years to 11 years and 6 months with an average of 6 years and 9 months. The results are follows : 1. The functional results were good or excellent in 73% using Harris Hip Score. 2. The rate of mechanical loosening was 34.8% in femoral components, and 28.3% in acetabular components, and 19.6% in both components. 3. Average rate of socket wear was 0.243mm/yr in Charnley type prosthesis and 0.32mm/yr in Miieller type prosthesis. 4. Age, types of prosthesis, follow-up period showed stastical correlation with functional results(p<0.05). 5. Follow-up periods affected the incidence of radiographic loosening(p<0.05). 6. The relationship between follow-up periods and wear was stastically significant(p<0.05). 7. Septic loosening occurred in one case, who was eventually given Girdle-stone operation. 8. The rate of trochanteric non-union was 16.6% and ectopic bone formation occurred in 23.4%.
Acetabulum ; Adult ; Arthroplasty, Replacement, Hip ; Femur ; Follow-Up Studies ; Hip ; Hip Joint ; Humans ; Incidence ; Osteogenesis ; Prostheses and Implants

Fracture of acetabular are relatively uncommon, but when they occur they seem to pose management difficulties for attending surgeon. They are, however, important injuries because they may give rise to disabling symptoms. Furthermore, they are increasing in frequency due to the increasing number of traffic accidents. Forty cases of acetabular fracture were treated in the National Medical Center during the period 1980 to 1987. The short summary of observation were as follows : 1) There was a preponderance of young patients, the majority being in the 31–40 age group(68%). The ratio between males and females was 2.6:1. 2) The most common cause of injury was traffic accident(68%). 3) The most common associated fracture was pelvic bone fracture(48%), and most common associated other injury was abdominal visceral injury(30%). 4) The most common fracture was posterior wall fracture(28%) following to Judet & Letournel's anatomocal clsssification. 5) Twenty-five fracture(63%) were treated by conservative measures, and 15 fractures (37%) were treated by open reduction and internal fixation. 6) The results were as follows : excellent in 13(33%), good in 19(47%), fair in 5(13%), and poor in 3(7%). 7) The complication of acetabular fracture were traumatic arthritis in 6 cases, sciatic nerve injury in 2 cases, avascular necrosis of femoral head in 2 cases. 8) Not only choice of treatment but also determination of surgical approch require accurate assessment of the fracture pattern in this region of complex bony architecture by careful radiologic analysis.
Accidents, Traffic ; Acetabulum ; Arthritis ; Female ; Head ; Humans ; Male ; Necrosis ; Pelvic Bones ; Sciatic Nerve