The fractures which develop from a already structually damaged or weakened bones are called pathologic fracture and it can be caused by many different diseases. The way of treatment and prognosis of these pathologic fractures differ in many ways according to causative factors. So, regarding frature that developes without definite history of trauma, one shoud approach them with concepts of pathologic fracture. In the cases of pathologic fracture caused by metastatic bone tumors, physicians are employing more aggressive methods of treatment these days. Authors have analysed 87 cases of pathologic fracture who were admitted to department of orthopedic surgery, Severance Hospital during the period of 10 years(from Jan. 1976 to Dec. 1985). Those cases of osteoporosis were all excluded from the study. The conclusion were as follows : 1. There were no discrepancies regarding sexes but 69% of patients were over forty years of age. 2. Fifty percent of pathologic fracture were fractures of femur. 3. Most common causes were metastatic bone tumors(55%), and 36% of these were with unknown primary lesions. 4. In the cases that were caused by metastatic bone tumor, sugical treatment was performed on 46% of these cases. And most cases of patients who were treated with surgical methods improved in pain and ambulation state, especially in patients with use of bone cement.
Femur ; Fractures, Spontaneous ; Humans ; Orthopedics ; Osteoporosis ; Prognosis ; Walking

PURPOSE: We intended to check the growth rates and phenotypic markers of chondrocytes in the dedifferentiated cells cultivated in various conditions in order to establish the ideal culture system for implantation. MATERIALS AND METHODS: Culturing rabbit chondrocytes from proximal tibia, we checked the phenotypes at first, second, and third week. Then we cultured the chondrocytes in different circumstances such as monolayer or three dimensional gel in the presence or abscence of TGF-B1, and checked the growth rates and phenotypic markers. RESULTS: There was no difference in growth rates and mRNA level of type I, type II collagen and aggrecan between the cells cultured in monolayer and three dimensional gel of collagen. However, the responses of the cells to TGF-B1, were quite different between these two groups. In monolayer culture, the expression of type I collagen was depressed by TGF-B1 while the growth rate was markedly increased. Oppositely in three dimensional culture, the mRNA level of type I collagen was markedly increased and the growth rate was completely suppressed by TGF-B1. The expression of type II collagen could be detected only in TGF-B1-treated cells cultured in three dimensional gel for 4 or more days. The mRNA level of aggrecan was also increased by TGF-B1, in the cells cultured in three dimensional gel. CONCLUSIONS: These results suggest that the number of chondrocytes can be efficiently expanded by culturing the cells in monolayer and the phenotypes of chondrocyte can be restored by culturing the cells in three dimensional gel containing TGF-B1. The application of semi-solid gel containing differentiated chondrocytes in physeal implantation should be further evaluated
Aggrecans ; Chondrocytes* ; Collagen ; Collagen Type I ; Collagen Type II ; Phenotype ; RNA, Messenger ; Tibia ; Transforming Growth Factor beta1*

PURPOSE: This study was designed to compare fracture healing in normal and ovariectomized rat, and to evaluate the effect of intermittent administration of parathyroid hormone on fracture healing in osteopenic animal model, MATERIALS AND METHODS: Four-months-old mature female Sprague-Dawley rats were randomly elivided into 5 groups. Group I underwent a sham operation, and others (Group II-V) were ovariectomized. At three months after ovariectomy or sham operation, standardized bilateral transverse tibial fractures were created and intramedullary nailings with Kirschner wire were performed. The rats were then treated with daily subcutaneous injection of placebo in Groups I and II, 17beta-estradiol in Group III, low doses of recombinant human PTH (1-84) in Group IV, and high doses of recombinant human PTH (1-84) in Group V for 4 weeks. At day 30 of post-fracture the animals were sacrificed and fracture healing was assessed with histologic/histomorphometric analysis and three-point bending mechanical testing. RESULTS: On histologic/histomorphometric evaluation of sham operation group, the fracture callus mainly consisted of dense trabecular bone. On the other hand, Groups II and III seemed to have much looser cancellous network, abundant in fibrous marrow. In parathyroid hormone-treated g roups, external callus consisted of more dense trabecular, woven bone than that of Groups II or III, and especially the high doses of parathyroid hormone-treated group was comparable to the sham operation group in terms of per cent trabecular bone volume (Group I>V>IV>III=II, P<0.05). Mechanical testing indicated that ultimate load was reduced in Group II and III compared to sham operated or parathyroid hormone-treated groups (Group I=V>IV>III=II, P<0.05). Other significant differences were the increase in absorbed energy at ultimate load of Groups I and V (Group I=V>IV=III=II, P<0.05), and increase in ultimate stress of Groups I and V (Group I=V>IV=II=III, P<0.05). CONCLUSIONS: On the basis of this study, it may be concluded that fracture healing is delayed in the ovariectomy-induced osteopenic rat model. Our experiment also showed dose-related stimulation of parathyroid hormone in the strength of fracture, and that antiresorptive agents such as estrogen had no effect. Further study is needed in large animal model, and attention should be focused on systemic/long-term effect of parathyroid hormone and its relationship with local growth factors in fracture healing.
Animals ; Bone Density Conservation Agents ; Bone Marrow ; Bony Callus ; Estrogens ; Female ; Fracture Fixation, Intramedullary ; Fracture Healing* ; Hand ; Humans ; Injections, Subcutaneous ; Intercellular Signaling Peptides and Proteins ; Models, Animal ; Ovariectomy ; Parathyroid Hormone* ; Rats* ; Rats, Sprague-Dawley ; Tibial Fractures

The patella is one of the most important components of the knee extension mechanism, and position of patella relates to some diseases of the knee, especially recurrent dislocation of the patella and Osgood-Schlatter s diseases. We checked the patella to patella tendon ratio in normal persons as well as in cases with recurrent dislocation of patella, chondromalacia of patella, degenerative arthritis of the knee and Osgood Schlatter s disease by means of Insall and Salvati method. The following results were obtained: 1) The ratio was 1.048 in normal persons. 2) The ratio was 0. 845 in recurrent dislocations. 3) The ratio was the same as normal in cases of the acute stage of Osgood-Schlatter's disease but chenged to 1. 236 in the late healing stage after 18 years of age. 4) The ratio in chondromalacia of the patella and degenerative arthritis of the knee was not significantly different from the normal.
Cartilage Diseases ; Chondromalacia Patellae ; Clinical Study ; Dislocations ; Humans ; Knee ; Methods ; Osteoarthritis ; Patella ; Patellar Ligament

Shoulder kinematics is important, as it is associated with shoulder arthropathy and pain mechanisms. Various static and dynamic analysis methods are prevalent for shoulder kinematics. These include 2-dimensional plane x-ray, computed tomography, and magnetic resonance imaging, cadaver study, electromagnetic motion analysis, transcortical bone pins technique, and in vivo 3-dimensional motion analysis. Although these methods provide the value of the shoulder kinematics angle, they are unable to explain why such changes occur. Since each method has its pros and cons, it is important to understand all factors accurately, and to choose a method that best meets the purpose of the researcher.
Biomechanical Phenomena* ; Bone Nails ; Cadaver ; Magnetic Resonance Imaging ; Magnets ; Methods ; Shoulder*

As the arthroscopic surgery of the knee joint has taken rapid strides recently, the knowledge of the structure and deveIopment of the joint are getting needed more and more. An embryological study about the development of the human knee joint was carried out using a total of 23 knees of human embryos. Serial sections of 23 embryos aged 5-8 postovulatory weeks (12-31 mm C.R.) and 3-dimensional reconstruction were examined. The embryos have been staged according to Carnegie's 'developmental stages'. The femur, tibia and fibula had begun to undergo chondrification by stage 18. The patella had commenced chondrification at stages 23. As the mesenchymal model began to chondrify, concomitant changes occurred in the region of the presumptive knee joint to create the interzone (stage 19-20). The following structures became condensed successively: patellar tendon (18-19), lateral collateral ligament and popliteus tendon (19-20), cruciate ligaments (20-22), meniscus (21-22). In summary, the differentiation from a generalized cellular blastema to a joint resembling the adult in form and arrangement occurred in only a relatively few days. By the end of the embryonic period proper (stage 23, 8 postovulatory weeks), all the elements of the knee joint were present in a form and arrangement closely resembling those of the adult. It seems that the embryological studies are more required to clarify the structures having many variants such as synovial plica, meniscus, and the development of the joint cavity through this study.
Adult ; Arthroscopy ; Embryonic Structures ; Femur ; Fibula ; Humans* ; Joints ; Knee Joint* ; Knee* ; Lateral Ligament, Ankle ; Ligaments ; Patella ; Patellar Ligament ; Tendons ; Tibia

Tuberculosis of the vertebral column is a slowly developing disease, characterized by pain, spinal deformity, and occasionally paralysis. The following varieties of vertebral tuberculosis are commonly recognized, such as a central variety, metaphysial tuberculosis (inter-vertebral articular type), an anterior or periosteal variety, appendiceal tuberculosis, and a true tuberculous arthritis. Among these appendiceal tuberculosis is rare. This form of Potts disease may be unilateral or bilateral and may be isolated or present at multiple levels. Disk space changes and deformity are minor features, but large paravertebral abscesses are invariable. Extradural extension may lead to the development of paraplegia. Two cases of destructive lesions at the neural arch of 10th. and 11th. thoracic vertebra were revealed to be appendiceal tuberculosis. All cases treated with antituberculous medication, radical curettage and body jaket casts and made recoveries. Patients had no complaints and no evidence of recurrence. A brief summary of the literature is submitted.
Abscess ; Arthritis ; Congenital Abnormalities ; Curettage ; Humans ; Paralysis ; Paraplegia ; Recurrence ; Spine ; Tuberculosis ; Tuberculosis, Spinal

The relative incidence of cerebral palsy has increased recently over that of poliomyelitis, due to the improvement in the social, medical, and economic status of our country. It is important to check the pathologic reflexes for diagnosis, treatment and prognosis of cerebral palsy. We studied 84 cerebral palsied patients, between 1 to 13 years old, who were treated at our Crippled Childrens Rehabilitation Center. The motor age and pathologic reflexes were checked, and pathologic reflexes were checked, and the relationship between pathologic reflexes and walking was compared. The following results were obtained. 1) With increasing of chronological age, there was a tendericy to increasing of motor age, but the mean motor age did not increase after 8 years in chronological age, and no more than to about 20 months. 2) With increasing of motor age, a tendency to decreasing of frequency of pathologic reflexes was shown. 3) The followings were the most important pathologic reflexes in non walking group: a) positive supporting reaction b) supine lying c) prone lying d) Moro reflex e) asymetrical tonic neck f) protective extensor thrust.
Cerebral Palsy ; Child ; Clinical Study ; Deception ; Diagnosis ; Humans ; Incidence ; Neck ; Poliomyelitis ; Prognosis ; Reflex ; Reflex, Startle ; Rehabilitation Centers ; Walking

In recent years, with increased number and higher speed of the automobiles, the incidence of the so-called whiplash injury has been increasing. The author had studied the clinical symptoms and signs, roentgenographic findings, associated injuries and treatment of the sixty four patients who had admitted to the Yonsei Medical Center under the diagnosis of the whiplash injury excluding the patients who had sustained an associated injuries those may cause neurologic symptoms and signs during the period of eight years from January, 1972 to December, 1979. and sumnerized the results as followings. 1. Among the sixty four patients, thirty one (48.4%) were male and thirty three (51.6%) were female. The most prevalent age were third and fourth decades (62.5%). 2. The causes were rear-end collision, falling of a car, front-end collision, falling of an airplane in an air-pocket and sudden deceleration of a car in the order of frequency. 3. The admission period were longest in the cases of falling of a car (13.3 days) and shortest in the cases of sudden deceleration of a car (9.4 days). 4. Fifty one (79.7%) were returned to the general activity in two weeks and fifty seven (89.1%) were out of the hospital in three weeks. 5. On admission. the patients were suffered from the symptoms and signs as followings, headache, limitation of the motion in neck, neckache, paresthesia, dizziness and dysphagia in the order of frequency. 6. Roentgenograms show loss of lordotic curve in twenty eight (43.7%) and prevertebral swelling in seven (10.3%). 7. Thirty six (56.3%) were associated with other injuries as followings; multiple contusion, teeth injuries, scalp laceration. There were thirteen cases (36.1%) of cerebral concussion. 8. In all the cases, we used analgegics and muscle relaxants until the neck pain subsided. We had performed cervical traction, hot packs in selected cases. Twelve (18.8%) needed cervical braces or Thomas collar at discharge.
Accidental Falls ; Aircraft ; Automobiles ; Braces ; Brain Concussion ; Clinical Study ; Contusions ; Deceleration ; Deglutition Disorders ; Diagnosis ; Dizziness ; Female ; Headache ; Humans ; Incidence ; Lacerations ; Male ; Neck ; Neck Pain ; Neurologic Manifestations ; Paresthesia ; Scalp ; Tooth Injuries ; Traction ; Whiplash Injuries

Various methods have been described for surgical treatment of recurrent shoulder dislocation. Arthroscopic techniques for stabilizing the shoulder have the theoretical advantage of reduced complication, decreased discomfort, and improved motion. The arthroscopic Bankart procedure was performed in 23 cases at Department of Orthopaedic Surgery, Yonsei University College of Medicine, from January, 1991 to December, 1993. This study is an attempt to evaluate results of arthroscopic Bankart procedure by Caspari's technique. Results of this study were as follows: l. According to the clinical evaluation of Rowe, results were excellent in 18 cases, good in 2 cases, fair in 1 cases and poor in 2 case. The prognosis was related to the size of Hill-Sachs lesion. 2. Complication after treatment included 5 cases of knot problem, 1 case of subluxation, and 2 cases of redislocation. Redislocation was developed in one patient who played ice hockey at 2 months after operation and in one patient who played soccer at 8 months after operation. Subluxation was developed in one patient who had psychologic problem. Among 5 patients who had knot prob- lem, two patients had a operation of removal. In conclusion, Caspari's suture technique in arthroscopic Bankart procedure needs some modification on the insertion point of the guide pin and suturing technique. And arthroscopic Bankart procedure by Caspari's technique offers good cosmetic results, low perioperative morbidity, low complications except knot irritation, and excellent results by the Rowe's criteria for patients with anterior shoulder instability.
Arthroscopy ; Hockey ; Humans ; Prognosis ; Shoulder ; Shoulder Dislocation ; Soccer ; Suture Techniques