A clinical study of scoliosis was carried out on 296 cases of structural scoliosis in the department of orthopaedic surgery, Hanyang University Hospital for 26 years and 6 months between Jan. 1963 and June 1989. The results obtained were as follows: l. Idiopathic scoliosis was the most common cause of strctural scoliosis. 2. The ratio between male and female was 1:1.7(110:186). 3. The most common site of scoliosis was the lumbar region for paralytic scoliosis and thoracic region for idiopathic scoliosis. 4. In idiopathic scoliosis, the thoracic curve was convex to the right in 79.1%. The thoracic curve in the combined type with double curvature was convex to the right in the most 80.4% of both idiopathic and paralytic scoliosis. 5. Severe curvatures over 80° was observed in 30.8% of paralytic scoliosis and in 5.6% of idiopathic scoliosis, being more frequent in paralytic than in idiopathic scoliosis. 6. The number of vertebrae involved in the major curve of scoliotic region was between 6 and 9 in most cases of both paralytic and idiopathic scoliosis. 7. Rotation grade was increased with the degree of eurvature in either paralytic or idiopathic scoliosis. Wedging was increased with the degree of curvature in idiopathic scoliosis, but no significant correlation with the degree of curvature was observed in paralytic scoliosis. 8. Of 37 cases of congenital scoliosis, 19 cases(51.4%) of them were caused by hemivertebra and the majorty of this congenital anomaly was located at the lumbar region. 9. The therapeutic effect of correction with Milwaukee brace was better on idiopathic scoliosis (15.8%) than in paralytic scoliosis(9.8%).10. In paralytic scoliosis treated with posterior spinal fusion without instrumentation, the postoperative correction was achieved in 48.7% of the cases studied with the final correction angle of 49.9°and the correction loss was observed in 12.7%. The postoperative correction with combined anterior or posterior spinal fusions with instrumentation was achieved in 51.7% with final correction angle of 53.0° and the correction loss was observed in 7.9%.11. With instrumentation, the postoperative correction rate of the structural curvature was achieved in 49.6% of the cases studied and the correction loss was observed in 5.1%. The best results were obtained in the thoracic curvature with 3.9% of the correction loss. 12. Three cases of postoperative complications was observed in this study: pseudoarthrosis and bending of graft with some loss of correction following the posterior fusions without instrumentation, and displacement of distraction hook on rod with Harrington instrumentation.
Braces ; Clinical Study ; Female ; Humans ; Lumbosacral Region ; Male ; Postoperative Complications ; Pseudarthrosis ; Scoliosis ; Spinal Fusion ; Spine ; Transplants

Low back pain has been recognized as a general symptom rather than a specific disease entity, especially when musculoskeletal lesions of the low back, hysteric conversion symptoms and visceral lesions are present. Today, the development of industry, the complexity of living methods and the execution of medical insurance have increased the number of the patients who have low back pain. In view of the suggestion that the patients who have attacks of low back pain are increasing in our society, and that, at the present time, there is little clinical study of it, the author considered that a study of his current experience would be of some general interest. In this thesis the records of 413 in-patients, whose chief complaint was low back pain and who were treated as such at Han Yang University Hospital, Department of Orthopedics between the periods from May 1972 to April 1978, were studied. The following results can be recognized by observing and analyzing their charts, physical findings and X-ray findings. 1. Of the patients suffering from lumbago, 33.2% were caused by the discogenic origin. Thus, the discogenic orgin was the most common cause of Iumbago, and male:55.4%, female: 4.6%. 2. According to simple L-S spine X-ray findings of the discogenic origin, 35.8%, of the decrease of the lumbar lordotic curve; 30.7% of the narrowing of the intervertebral space. Besides them, some cases of the lumbar scoliosis, osteoarthritic changes, soteoporosis, Knuttson's phenomenon and Schmorls node were appeared. And, 15.3% though they were thought to be the discogenic origin according to their symptoms and the physical findings, had no specific abnormal findings, suggesting that the patients are relatively young and their duration of lumbago is short. 3. Of the lumbar disc herniation, the herniation between the fifth lumbar and the first sacrum was most frequently appeared, 49.5% and the herniation between the fourth lumbar and fifth lumbar formed 41.3%, and the herniation between the third and the fourth lumbar was 2.8%. 4. Of spondylolistheses, the highest proportion, 66.7%, occured in the fifth lumbar level. And in the degree of slipping, 96.3% came under the grade 1 of Meyerding's method. 5. The frequency of anomaly, among the patients with lumbago, appeared as follows; spina bifida formed 12.6%: sacralization, 8.0%: lumbarization, 4.6%: tropism, 3.6%. 6. Of the patients with discogenic origin, 91.2% were under conservative treatment and 8.8% were under operative treatment. 7. Of the patients with Tbc spine, 35.9% were under conservative treatment, and 64.1% under operative treatment. Among the methods of operation, curettage and anterior interbody fusion was 80%: posterior interbody fusion, 12%: incision and drainage, 8%. 8. In the treatment of spondylolistheses, 66.7% were under conservative treatment, and 33.3% under operative treatment. In the operatlve methods, 6 cases were performed by posterior spinal fuslon by H-sahped bone graft: and 3 cases, postero-lateral spinal fusion.
Clinical Study ; Curettage ; Drainage ; Female ; Humans ; Insurance ; Low Back Pain ; Methods ; Orthopedics ; Sacrum ; Scoliosis ; Spinal Dysraphism ; Spinal Fusion ; Spine ; Spondylolisthesis ; Transplants ; Tropism

Fractures of the femur are one of the most frequent injuris which Orthopedic Surgeons are called upon to treat. The incidence of femoral fractures has risen by the results of rapid increase in traffic accident, industrial accident, and prolongation of life expectancy in adults. Two hundred and ninty eight consecutive femur fractures were treated at the Department of Orthopedic Surgery, Hanyang University, during the period of May 1972 to September 1977 were reviewed. The results were as follows; 1. The fractures occured commonly in the 6 to 10 years age group (46.1%) in children and in the 21 to 40 years age group (48.2%) in adults. Males comprised 217 cases (71.1%). 2. Fractures were caused by traffic accident (72.2%) mainly and especially in old aged fractures of the femoral neck and intertrochanter were caused by fell down from a height. 3. Closed fractures were 258 cases (84.7%) and transversefractures were the most common type in, children, and comminuted fractures were the most common type in adults. 4. The freguent fracture site was transcervical fracture of femoral neck, type 3.4 (by Tronzo) of the. intertrochanteric fracture and middle third of femoral shaft. There were no differences between medial and lateral femoral condyle fractures. 5. Associated injuries were common in young adults in 165 cases and in order of frequency, these were fractures of the tibia and fibula, pubics, skulls, patella and ribs etc. 6. Better results were obtained with conservative treatment in children and operative treatment in adults. 7. The period of bony union in children was 7.6 weeks with Bryants traction 9.3 weeks with Russel traction, 8.6 weeks with cast immobilization, 10 weeks with 90-90 skeletal traction and 10.8 weeks with Bohler-braun skeletal traction. 8. The period of bony union in adults was 17 weeks with Kuntscher nail, 13.6 weeks with compression plate and screw fixation, 18 weeks with Bohler-braun skeletal traction and 19weeks with cast brace in femoral shaft fracture. 9. Complications were much more frequent in adults than in children and it were treated well Postoperative infection was occured in 5 cases (1.7%) and they cured well with sequestrectomy, curettage and continuous antibiotics administration. 10. The Bryants traction under 2 years of age, 90-90 skeletal traction over 5 years of age in children and compression plate and screw fixation in adults were further recommended.
Accidents, Occupational ; Accidents, Traffic ; Adult ; Anti-Bacterial Agents ; Braces ; Child ; Clinical Study ; Curettage ; Femoral Fractures ; Femur ; Femur Neck ; Fibula ; Fractures, Closed ; Fractures, Comminuted ; Humans ; Immobilization ; Incidence ; Life Support Care ; Male ; Orthopedics ; Patella ; Ribs ; Skull ; Surgeons ; Tibia ; Traction ; Young Adult

The tibia is the most commoniy fractured of all the long bones of the body. Recently, the incidence of shaft fractured of tibia has risen as a result of rapid increase in automobile accidents, industrial accidents and other sports injuries. Fracture of the tibial shaft is extremely difficult to treat and a greater incidence of osteomyelitis, delayed union and nonunion of bone than in those of the full length of the tibia surface is throat, open fracture is more frequent in this bone than in any other major bones. Two hundred eighty patients (293 cases) of the fracture of tibial shaft were treated and managed at the Department of Orthopedic Surgery, Hanyang University Hospital from May, 1975 to December, 1977. The results were as follows: 1. The rate of fracture union was accelarated under the age of 20 years but it was slow in aged group. 2. A better prognosis (fracture union) was shown in proximal one third of the tibia than middle one third and lower one third of the tibia. 3. According to the classification of Ellis, the higher delayed and nonunion rate was shown in major severity group than moderate and minor severity group. 4. A better prognosis of the fracture type was shown in the spiral and oblique fracture than in the transverse, comminuted and segmental fractures. 5. Open fracture of the tibia united later than closed fracture, especially in positive culture sensitivity test. 6. There was a prolonged rate of union about 2 weeks in cases of associated fibula fracture. 7. The proper time of weight bearing of the shaft fracture of the tibia was helpful in fracture union. 8. A better prognosis was shown in the non-operative treatment than operative treatment, especially in PTB cast after long leg cast.
Accidents, Occupational ; Athletic Injuries ; Automobiles ; Classification ; Clinical Study ; Fibula ; Fractures, Closed ; Fractures, Open ; Humans ; Incidence ; Leg ; Orthopedics ; Osteomyelitis ; Pharynx ; Prognosis ; Tibia ; Weight-Bearing

Thumb reconstruction with a free neurovasculsr wrap around flap from the great toe by microsurgery had been first reported by O'Brien, Macleod and Morrison in 1980. We have performed one case of thumb reconstruction with psrtial first metstarsus for loss of thumb except pulp and one digital vessel by microsurgery. The results were summerized as followings ; 1. This one stage procedure has the unique advantage to reconstruct a thumb almost identical to the origin. 2. This technique allows preservstion of the toe and the secondary defect results in no significant morbidity.
Free Tissue Flaps ; Microsurgery ; Thumb ; Toes

Supracondylar fracture of the humerus is the most common fracture about the elbow in children, and frequently accompanies neurovascular complications. It is one of the most difficult to manage and is frequently associated with significant residual complications. In the treatment of supracondylar fracture of the humerus, prompt and accurate reduction without additional trauma is mandatory. 114 patients with supracondylar fracture of the humerus who were admitted and treated at the Department of Orthopedic Surgery of Hanyang University Hospital from May, 1972 to May, 1981 have been reviewed. The results obtained are as follows: 1. Supracondylar fractures of the humerus frequently occurred between the ages of 5 and 12 years (77.2%), and the sex ratio was 2.5:1 in male to female. 2. Of all fractures, 96.5% were the extension type and 3.5% were the flexion type. According to the Holmberg classification, type IV fractures were most common. 3. In the injuries associated with fracture, there were 6 ipsilateral forearm fractures, 6 neural injuries, 4 vascular injuries, and 2 neurovascular injuries. In 8 traumatic neuropathies, median nerve was involved most commonly, and they were recovered spontaneously within 6 week except 1 case, which was repaired surgically. 4. Most cases were treated successfully by early manipulative reduction, but in the presence of neurovascuiar signs and symptoms, continuous traction or open reduction was indicated. 5. The result of treatment of the conservative treatment group was better than that of the operative treatment group.
Child ; Classification ; Clinical Study ; Elbow ; Female ; Forearm ; Humans ; Humerus ; Male ; Median Neuropathy ; Orthopedics ; Sex Ratio ; Traction ; Vascular System Injuries

Biomechanically, the posterior cruciate ligament has been considered the basic stabilizer in the knee, So a torn cruciate ligament should be sutured as soon as possible, otherwise within a few weeks it will undergo resorption, making suture impossible. Currently available reconstructive procedures of the posterior cruciate ligament are often inadequate. We have performed 6 cases of the reconstruction of the posterior cruciate ligament using medial meniscus. The results were as follows; 1. Functionally all cases were improved and objectively 5 cases(83.3% ) among them were achieved stability of the knee rather than preoperative condition. 2. Reconstruction of the posterior cruciate ligament using medial meniscus is technically simple and reliable and can therefore be recommended. But further investigation is necessary to answer question regarding the long term results.
Knee ; Ligaments ; Menisci, Tibial ; Posterior Cruciate Ligament ; Sutures

The object of this study was 336 Korean patients with degenerative arthritic knees and 1000 Koreans with normal knees who had visited the department of orthopaedic surgery of Hanyang University hospital during the period fmm January, 1980 to June, 1981. The purpose of this study was to investigate the changes of tibio-femoral angles and metaphysealdia physeal angles in response to the degenerative changes of the knees. By the roentgenogram, tibio-femoral angles and metaphyseal-diaphyseal angles were measured and those angles were analized statistically. The results were as follows 1. In young age group, the incidence of the degenerative arthritic knees was more frequent in male than in female. However, in the middle and older age groups, the incidence was higher in female than in male. 2. The mean value of tibio-femoral angle of the degenerative arthritic knees was −3.41°±0.22. It was about 1° varus compared with the normal mean value of −4.46°±0.27. The mean value of tibio-femoral angle in normal Korean was reduced appmximately 3°±5°valgus compared with the Westem normal peoples: 3. In general, the valgus tendency appeared a little more in the knees of female than in those of male. 4. The varus tendency was in pmportion to the degree of the aggrevation of the degenerative arthritis in the knees. 5. The mean value of metaphyseal-diaphyseal angle in normal Korean was 3.53°±0.24. It was 3°–4° varus compared with the Western normal peoples. 6.The varus was increased more in the standing position, in the state of weight bearing position, than in the supine position.
Female ; Humans ; Incidence ; Knee ; Male ; Osteoarthritis ; Posture ; Supine Position ; Weight-Bearing

Although the primary repair has been recognized so far, the tendon graft is reported as a primary treatment method for tendon injury in no man's land of Bunnel, judging from the state of injured hand, the ability of operator and the environment of medical operation. The 27 cases of tendon graft that were operated for 11 years from June, 1973 to June, 1984 in the Department of Orthopedic Surgery, Hanyang University College of Medicine have been followed up for clinical study. The results were as follows: 1. The Material of this study was composed of 13 males (21 cases) and 5 females (6 cases) whose age were from 8 to 39 years old. 2. The injured fingers were classified with 3 thumbs, 6 index fingers, 7 middle fingers, 8 ring fingers and and 3 little fingers out of 27 cases and all injured parts of fingers were Zone II except that of thumb which was Zone IV of Bunnel. 6 patients were injured more than 2 fingers. 3. The duration from tendon injury to tendon graft which scattered from 1 month to 9 years and averaged out to 28.2 months is supposed to have little relation to post-operative results. 4. The post-operative results showed up 9 excellent, 7 good and 1 fair out of 17 cases in good gmup, 3 good and 6 fair out of 9 cases in cicatrix group, 1 fair out of 1 case in nerve damage group at pre-operative state. 5. The post-operative results of thumb which show up 2 excellent, 1 good out of 3 cases were most successful among those of all fingers. 6. The pre-operative state is supposed to have great relation to post-operative state judging from 94% satisfactory results of good group at pre-operative state. 7. As multiple injury makes little difference from single injury, the injured state of each hand is supposed to an important effect on post-operative results. 8. As all electric bumed injury show up fair except that of thumb, they are supposed to have unsatisfactory results.
Cicatrix ; Clinical Study ; Female ; Fingers ; Hand ; Humans ; Male ; Methods ; Multiple Trauma ; Orthopedics ; Tendon Injuries ; Tendons ; Thumb ; Transplants

Recently, there were many cases which was associated with bone defect in the limb and skin defect. We had performed vascularized osteocutaneous fibular transfer with microsurgical technique and experienced early bone union and simutsneous external wound healing. So we, authers, reviewed 12 cases of vascularized osteocutaneous fibular transfer which were performed to the extensive bone defect of the tibia and associated soft tissue injury. And the following remarkable results were obtained. 1. With the uncontrolled bone infection, the vascularized osteocutaneous fibular transfer was able to be performed and there was no non-union. 2. During the follow up period, the grafted fibula had been hypertrophied. 3. In the cases which the fibula were grafted to the defect after the segmental and partial excision of the tibia, in general, the partial weight bearing was able to be started from 3 months to 5 months after the operation, In the cases with segmental and complete excision of the tibia, the partial weight bearing was able to be started from 5 months to 7 month after the operation. 4. In adult, free fibula can be obtained and grafted as 20cm as long and the fibula was a good donor for extensive long bone defect as a compact bone; the skin flap with fibula can be obtained and grafted as 17 × 9cm as large in our experience. 5. In the vascularized osteocutaneous fibula transfer, the skin flap could be confirmed wheather the vascular anastomosis is patent or not as a monitor.
Adult ; Clinical Study ; Extremities ; Fibula ; Follow-Up Studies ; Humans ; Microsurgery ; Skin ; Soft Tissue Injuries ; Tibia ; Tissue Donors ; Transplants ; Weight-Bearing ; Wound Healing