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

Hand injuries in the industries have been steadily increasing in this country in recent years. All structures are damaged when a hand is caught in punch presses, gears or under falling objects. Irreversible loss of blood supply to the part is only real indication for primary amputation. Statistical observations were carried out on 240 patients of hand injuries who were treated at the Deparement of Orthopedic Surgery, College of Medicine, Hanyang University from May, 1972 to April, 1977 and following results were obtained. 1. The peak incidence was in the age group from 11 to 20 years in 83 cases(38.4%) and of the 226 patients, 204(85.0%) were male and 36(15.0%) were female. 2. In general, the incidence of hand injuries per year was annually increased and was much more occurred on April than other months of year. 3. The injured ratio of both hands was almost equal and main causes of hand injury were industrial accident (72.1%), traffic accident(12.9%) and electric accident(6.3%). 4 Most of hand injured patients(81.7%) arrived at our hospital within 6 hours after accidents 5. Of 240 injuries, 78(32.5%) were crushing injury with open comminuted fracture, 39(16.2%) were open fracture and 30(12.5%) were closed fracture. 6. Of injured fingers, 126(51.2%) were mondigit and the remained were polydigits. 7. The most frequency of monodigit injury was index finger(32.5%) and of polydigits injury was middle finger(28.2%) 8. In mondigit amputation, index finger were generally amputated at metacarpo-phalangeal joint and middle finger at proximal phalangeal level. 9. Of 457 injuries with facture, 213(46.6%) were treated by debridement and primary suture, and 94 (20.6%) by debridement and open reduction with Kirschner wire fixation. 10. Of 240 patients, 46 cases(19.2%) were infected and the main causative organisms were pseudomonas aeruginosa (41.3%), Staphylococcus aureus(17.3%) and Alkaligenus fecalis(10.9%).
Accidental Falls ; Accidents, Occupational ; Amputation ; Clinical Study ; Debridement ; Female ; Fingers ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Hand Injuries ; Hand ; Humans ; Incidence ; Joints ; Male ; Orthopedics ; Pseudomonas aeruginosa ; Staphylococcus ; Sutures

The altered hemodynamics of arteriovenous fistul lead to overvascularization with trophic hypertrophy of a part or ulceration and tissue necrosis following local circulatory decompensation. A twenty years old female had been suffered from chronic ulcerative dermatitis on the dorsal aspect of left foot and multiple hemangioma on ber left great toe. The ligation of main communicating vessel and excision of fistula masses were performed in the surgical treatment. The ulceration on the dorsal aspect of left foot was healed completely and the size of hemangioma was reduced.
Arteriovenous Fistula ; Dermatitis ; Female ; Fistula ; Foot ; Hemangioma ; Hemodynamics ; Humans ; Hypertrophy ; Ligation ; Necrosis ; Toes ; Ulcer

The congenital dislocation of the hip is one of the most common congenital disease in the field of the orthopedic surgery. For the normal development of the acetabulum and femoral head, the displaced femoral head shouid be replaced in the acetabular socket as early as possible. In most cases treated in proper time, closed reduction is successful. If not, operative correction will almost always be necessary due to abnormal changes of the acetabulum and femoral head. We experienced 33 cases in 32 patients of the congenital dislocation of the hip at the Department of Orthopedic Surgery of Hanyang University Hospital from May, 1972 to December, 1980. The results obtained were as follows: 1. The most common aged group at the first visit was ranged from 12 months to 24 months and the preponderance of girl to boy was 3.6:1. 2. The ratio of left to right side was 1.6:1. 3. In delivery history, there were 3 cases of breech presentation, 1 case of Cesarean section and 1 case of prematurity. The associated congenital anomaly was observed in a case of which combined internal tibial torsion and talipes metatarsus varus deformity. 4. In 33 cases in 32 patients, 22 cases were treated conservatively and 11 cases were treated surgically. The results of treatment were excellent in 21 cases, good in 11 cases and fair in 11 case. We experienced 4 cases of neglected congenital dislocation of the hip in the period of late childhood, 3 cases were treated with Chiari osteotomy and the other 1 case was treated with Colonna capsular arthroplasty. The overall results were excellent.
Acetabulum ; Arthroplasty ; Breech Presentation ; Cesarean Section ; Clinical Study ; Clubfoot ; Congenital Abnormalities ; Dislocations ; Female ; Head ; Hip ; Humans ; Male ; Metatarsus ; Orthopedics ; Osteotomy ; Pregnancy