In open wounds of the hand that have exposed bone or tendons, management may be difficult. Compared with conventional cutaneous pedicle flaps, the fascial radial flap transfer has several advantages : (1) one operation is required by one operating team reliably and easy to perform, (2) the appearance is not bulky, (3) the donor area is closed primarily, and (4) the hand is free for early motion of the shoulder and the elbow. One potential disadvantage is the permanent loss of the contribution of the radial artery to the circulation of the hand. One case of the fascial radial flap transfer was performed at the Department of Orthopaedic Surgery of Hanyang University Hospital, and satisfactory result was obtained.
Elbow ; Hand ; Humans ; Radial Artery ; Shoulder ; Tendons ; Tissue Donors ; Wounds and Injuries

In spite of numerous clinical and patho-anatomical studies made in the past, there are still different opinions concerning the machanism of low back pain. We have focused attention on the posterior structures as an alternative source of low back pain with leg radiation, so we have studied and analyzed the effect of the injection of mixture methylprednisolone acetate suspension (20-40 mg) and local anesthetic (1% procaine, 1cc) into the posterior facet joint. In this paper, the records of 41 in-patients who have chiefly compalned of low back pain wlth leg radiation and have been treated at the Departmnt of Orthopedics, Han Yang University Hospital from May, 1979 to April, 1980 were studied. The following results are recognized by observing and analyzing their chief complalnts, physical examination, x-ray findings, the effect of facet block and the follow-up studies after facet block. 1. Low back pain with sciatica was 1.9 times more common in female than male, and frequently occured In 4th to 6th decades (75.7%). 2. The abnormal findings of plain x-rays were osteophyte (35.6%), marginal sclerosis (27.1%), narrowing of disc spce (18.6%), lumbarization (11.9%), spina bifida (3.4%), and tropism (3.4%). 3. The most frequent site of abnormal posterior facet joints was at the level between 4th and 5th lumbar vertebra (42.9%), and all were on lower lumber region. 4. The range of lumbar motion was decreased in the cases of abnormal posterior facet jolnt or degenerative changes, and it was especially more decreased in the combined cases. 5. The effect of facet block was as follows; In initial assessment, 29 of 41 cases (70.7%) showed complete rellef and one month later, 16 of 29 cases (55.2%) showed continuous rolief, 4 of 18 cases (22.2%) which were followed for 3 more months showed complete relief. 6. The effect of facet block according to pain character was as follows: 20 of 26 cases (76.9%) of numbness, 5 of 6 cases (83.3%) of dull pain and 4 of 8 cases (50.0%) of radlating pain were completely relleved and a case of burning pain was partially relleved.
Burns ; Female ; Follow-Up Studies ; Humans ; Hypesthesia ; Leg ; Low Back Pain ; Male ; Methylprednisolone ; Orthopedics ; Osteophyte ; Physical Examination ; Procaine ; Sciatica ; Sclerosis ; Spinal Dysraphism ; Spine ; Tropism ; Zygapophyseal Joint

Replantation of a severed limb is an elective procedure and, as such, the decision to carry it out must be assessed anew in each case. The arm is progressively more valuable from shoulder to fingers, the leg, on the contrary, is progressively of less significance. Especially, the replantation of severed hand at the level of carpal bones or wrist joint is technically more difficult than at the level of forearm or arm. We have a successful case of replanted hand at the level of intercarpal joint without bony shortening.
Arm ; Carpal Bones ; Carpal Joints ; Extremities ; Fingers ; Forearm ; Hand ; Leg ; Microsurgery ; Replantation ; Shoulder ; Wrist Joint

Microsurgical compoeite tissue transplantation to date has contributed to reconstructive surgery by expediting transfer of large blocks of tissue. We have performed the first successful transplantation of microneurovascular tendocutaneous free flap from the dorsum foot to the defect of dorsum hand including extensor tendons. We considered the free flap with extensor tendons from the dorsum foot was the best donor site for functional recovery of the defect of dorsum hand. Two cases of tendocutaneous free flap transplantation were performed at the Department of Orthopedic Surgery of Hanyang University Hospital, and satisfactory results were obtained.
Foot ; Free Tissue Flaps ; Hand ; Humans ; Orthopedics ; Tendons ; Tissue Donors ; Tissue Transplantation ; Transplants

The increased knowledge of the cutaneous circulation of the body and refinements in surgical technique have provided the basis for the successful microvascular transfer of various muscle, skin and myocutaneous free flap. We have found the tensor fascia lata(TFL) inyocutaneous flap to be reliable one and its transfer as a free flap. The TFL myocutaneous free flap was first introduced by Hill et al in 1978 and our two cases report were first introduced in Korea. Two cases of microvascular TFL myocutaneous free flap transfer were performed at the department of Orthopaedic Surgery of Hanyang University Hospital and satisfactory result was obtained from the one of those.
Fascia Lata ; Fascia ; Free Tissue Flaps ; Korea ; Skin

Application of the Gracilis or Pectoralis Musculocutaneous Free Flap to restore finger fiexion after destruction of forearm flexors had been reported by a surgical team at the Six Peoples Hospital at Shanghi in 1976. Viability is maintained by microvascular anastomoses of the muscles artery and vein to a suitable artery and vein in the recipient site. Gracilis is suitable for obtaining the dynamic requirement of transplanted forarm flexors. We presented two cases of muscle transplantation using Gracilis Musculocutaneous Free Flap for the loss of function of the long flexors to digits due to Volkmanns ischemic contracture of which one was after supracondylar fracture and the other was infection after deep laceration on elbow. In both cases transplanted muscles survived but funtioning was well in one case and other case was not good due to the previous infection. In first case, excellent grip strength and nearly a full flexor finger movement was provided by transplanted muscles.
Arteries ; Elbow ; Fingers ; Forearm ; Free Tissue Flaps ; Hand Strength ; Ischemic Contracture ; Lacerations ; Microsurgery ; Muscles ; Transplantation ; Veins

No abstract available in English.
Hallux ; Thumb

Two cases of old unreduced radial head dislocation in children were experienced in this hospital. These were the results of neglected Monteggia fracture. Dislocated radial heads were reduced under direct vision and the anular ligaments were reconstructed. Follow up study taken 9 months and 6 years respectively after operation revealed excellent elbow motion including pronation and supination. The radial nerve palsy which had been developed in one of the two patients after injury was recovered spontaneously after reduction of the radial head without opening of the Arcade of Frohse. Then we are reporting these cases with a review of the literature.
Child ; Dislocations ; Elbow ; Follow-Up Studies ; Head ; Humans ; Ligaments ; Monteggia's Fracture ; Paralysis ; Pronation ; Radial Nerve ; Supination

A tibial plateau fracture was first described in the literature by Thamhayn, in 1852. It is a fracture of the proximal end of the tibia, usually involving an articular surface. The fracture is regarded as serious as it involves a major weight bearing joint and loss of function results in a high percentage disability of the extremity. Of the tibial plateau fractures treated at Hanyang University Hospital between June 1972 and August 1979, the 44 cases that could be followed for three months to two years have been analysed according to its cause, classification, treatment and result. Open reduction is indicated in anyone of or a combination of the following deformities as shown by roentgenograms: 1. a vertical depression in the plateau of greater than eight milimeters; 2. a horizontal displacement of the lateral or medial condyle of greater than four milimeters; 3. valgus or varus instability of the knee one or more milimeters in excess of that of the uninjured knee. Manipulation under anesthesia with skeletal traction is indicated in severe comminuted fracture that it is difficult to reduce with internal fixation, and open fracture that it is inevitable to delay operation. Plaster immobilization is indicated in the remaining situations except those of open reduction and skeletal traction. Anatomical considerations and a clinical end-result study of the 44 fractures emphasize the vulner-ability of the lateral tibial plateau to a valgus force on the extended knee. Among the 44 cases twenty-two (50 percent) were treated by plaster immobilization, 2 (4.5 percent) by skeletal traction, and 20 (45.5 percent) by operation. Thirty-nine cases (88.6 percent) out of 44 revealed the rating of “ACCEPTABLE” according to Hohl and Luck criteria.
Anesthesia ; Classification ; Clinical Study ; Congenital Abnormalities ; Depression ; Extremities ; Fractures, Comminuted ; Fractures, Open ; Immobilization ; Joints ; Knee ; Tibia ; Traction ; Weight-Bearing

Angiography has been playing important roles in diagnosis and treatment in the field of orthopaedic surgery. Conventional angiography is the most reliable and widely used method in diagnosis of peripheral arterial disease. But the clinical use of the conventional angiography has been limited by the risk of possible complications and time-consuming procedures. Radionuclide sngiography is rapidly performed, rapidly interpretable and time-saving procedure for the visualization of arterial tree prior to vascular intervention in the critically ill patient. We have analyzed and compared the 22 cases who had taken radionuclide angiography and conventional angiography simultaneously from November, 1986 to August, 1987 in Department of Orthopaedic Surgery, Hanysng University Hospital. The results were as follow 1. Radionuclide angiography is simple, non-invasive, accurste, reproducible method. It eliminstes the discomfort and morbidity of conventional angiography and can be done on an outpatient basis at a much lower cost. It is useful in the patients who may be allergic to the contrast medium. 2. In cases of arterial occlusion, radionuclide angiogrpahy is also useful in the evsluation of obstruction of major artery and can be substituted for conventionsl angiography. 3. For the purpose of evaluation of success in the cases of vascular reconstruction, radionuclide angiogrphy also demonstrate the vasculsr blood flow without any risk. 4. Although rsdionuclide angiography has limitstion in snatomic detsil, it could be psrtially substituted for conventionsl angiography in the diagnosis of vascular anomalies or tumors.
Angiography ; Arteries ; Critical Illness ; Diagnosis ; Humans ; Methods ; Outpatients ; Peripheral Arterial Disease ; Radionuclide Angiography ; Trees