Supracondylar fractures of the femur following total knee arthroplasty are rare complication with reported rates ranging from 0.3% to 2.5%. Union of the fracture in proper alignment, without disruption of prosthetic component fixation and with maintenance of 90 of knee motion, is impotant in treatment of this type of fracture. Modalties of treatment are conservative or operative methods and operative treatment are open reduction 4 internal fixation, intramedullary nailing, revision arthroplasty using a prosthesis with a long stem and closed reduction and external fixation, but there are controversies in the method of treatment. Between Apr. 1989 and Jul. 1994, 10 patients were treated for supracondylar fracture of the ipsilaterai femur following total knee atthroplasty and 2 cases of them had arthrop]asty at other hospital. Average age of patients was 53 years (29-68 years), nine patients were women and one was man. The preoperative diagnosis was rheumatoid arthritis in four, degenerative osteoaithritis in three, posttraumatic osteoarthritis in one and tuberculosis sequelae of the knee in two. In nine cases mechanism of injury were slip down and in one was fall down. The interval hetween arthroplasty and fracture was an average of 22 months (9-79months). Two cases we.re treated with closed reduction and cast immobilization, one case was treated with open eduction and in1ernal fixation and seven patients of' ten cases were treated with closed intramedullay Ender nailing. The average foIlow-up period after fracture was 25 months (3 - 74months). We evaluated the results as the range of motion, bony union at simple radiograph and Knee Rating Score of Hospital for Special Surgery at last follow up. Eight cases of supracondylar fracture occuned among 350 patients, 514 cases of total knee arthroplasty which were operated at Kyung Hee Univcrsity Hospital between Apr. 1989 and Jul. 1994 and incidence was 1.6%. At the last follow up, all 10 cases achieved bony union and 7 cases using Ender naiIing achieved clinical bony union which enabled patients to do weight-bearing without pain at postoperative 6-8 weeks and radiological union was achieved at postoperative 12 weeks. Range of motion were average 105 degrees (80 J.20 degrees) hefore fracture and 86 degrees (6S 120 degrees) at the last follow up and HSS Knee rating score were average 80.3 points (59 94 points) before fracture and average 78.8 points (66-89 points) at the last follow up. At 7 cases using Ender nailing, range of motion were average 106 degrees (90 11S degrees) hefore fracture and 91 degrees (6S-105 degrees) at last follow up and HSS Knee rating score were average 80.6 points (59-94 points) before fracture and average 80.3 points (72-89 poiints) at the last follow up. Closed iintramedullary Ender nailing is a gecommendable operative method in the treatment of supracondylar fracture following total knee arthroplasty considering to good bony union, satisfactory functional result, easy operative technique and less postoperative complication.
Arthritis, Rheumatoid ; Arthroplasty* ; Diagnosis ; Female ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Immobilization ; Incidence ; Knee* ; Osteoarthritis ; Postoperative Complications ; Prostheses and Implants ; Range of Motion, Articular ; Tuberculosis ; Weight-Bearing

The suprapatellar plica is a remnant of the embryonic septum separating the suprapatellar pouch from the knee joint. Complete type of suprapatellar plica is rarely reported and its clinlical significance is controversial. The purpose of this study is to verify the complete type of suprapatellar plica as an important cause of anterior knee pain and to evaluate the clinical results after arthroscopic excisien of it. From September 1991 to April 1997, we studied prospectively 54 patients, 90 knees which were diagnosed as cornplete type of suprapatellar plica preoperatively. The mean age was 32 years (15-57 years) and sex distribution was 14 males and 40 females. For the preoperative diagnosis, we checked clinical symptom, past history, physical finding and plain X-ray routinely and performed bone scan, double contrast arthrogram and MRI, if necessary. All patients complained vague anterior knee pain at standing, sitting, stair climbing and exercise for long times. All 90 knees were examined arthroscopically. Among them, 80 knees had complete type of suprapatellar plica and remaining 10 knees had other findings. After all, positive predictive value of preoperative diagnosis for complete type of suprapatellar plica was 89%. Among 36 patients diagnosed as bilateral preoperatively, 33 patients(92%) were confirmed as bilateral in arthroscopic examination. After arthroscopic excision of plica, clinical results were total relief of pain in 19 knees(24%), improvement in 55 knees(69%), no change in 6 knees(7%) and none of worsening. In conclusion, complete type of suprapatellar plica should be considered as an important cause of anterior knee pain especially which is vague, intermittent and bilateral.
Diagnosis ; Female ; Humans ; Knee ; Knee Joint ; Magnetic Resonance Imaging ; Male ; Prospective Studies ; Sex Distribution

Ligament injuries of the knee joint are very common among competitive athletes. Acrurate assessment ot the nature of these injuries is a prerequisite for appropriate therapy. The purpose of this study is to evaluate the significance of MRI findings in assesing the status of ACL tear and associated injuries. 31 cases of ACL injuries were examined and reconstructed arthroscopically from Jan. 1997 to Sep. 1997 at Kyung Hee University Hospital. 1n all cases, we reviewed preoperative physical and MRI findings and performed postoperative radiologic assessments. Results were as follows; 1. Lachman test and Pivot shift test were positive in all 31 cases but anterior drawer test was positive in 29 case,s. 2. In MRI findings, 24 cases were interpretated as complete ACL tear and / cases as inccomplete ACL tear. But these 7 cases were confirmed as complete tear in mthroscopic exanunation with careful probing of ACL fiher. 3. MRI showed associated meniscal injuries in 19 cases(61%)-14 cases(74%) at medial meniscus, 5 cases(26%) at lateral meniscus. All cases were confirmed arthroscopically. In conc1usion, physical findings are more reliable than MRI findings in diagnosing the complete ACL tear and deciding the ACL reconstruction. But MRI findings are very helpful to assess the associated injuries and plan the treatments.
Anterior Cruciate Ligament ; Athletes ; Equidae ; Humans ; Knee Injuries ; Knee Joint ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial

No abstract available in English.
Knee Prosthesis ; Knee

Systemic lupus erythematosus is a systemic disorder which has frequent involvement of gastrointestinal tract. Non specific symptoms such as anorexia, nausea, diarrhea and abdominal pain are well known symptoms when the gastrointestinal tract is involved. The most feared gastrointestinal complication of systemic lupus erythematosus is lupus enteritis. The pathological change in lupus enteritis is usually a result of mesenteric vasculitis. Major complications such as intestinal bleeding and perforation may occur and sometimes result in sugery. Because of high mortality rate in case of major complications, early diagnosis and appropriate treatment is very important. We experienced three patients with lupus enteritis who presented with severe abdominal pain and dirrhea. They were diagnosed by characteristic radiographical findings of small bowel series and barium study. All radiographical findings has been resolved completely with the steroid therapy. Conclusively we can induce complete remission by steroid therapy alone, if we diagnose lupus enteritis in the early period of disease course.
Abdominal Pain ; Anorexia ; Barium ; Diarrhea ; Early Diagnosis ; Enteritis* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Lupus Erythematosus, Systemic ; Mortality ; Nausea ; Vasculitis

PURPOSE: To analyze the clinical and radiological results of bilateral TKA with and without patellar resurfacing in osteoarthritic patient. MATERIALS AND METHODS: We have prospectively studied 17 patients who had bilateral TKA and whose patella was resurfaced on one side and not on the other. Criteria of patient selection include no preoperative patellofemoral pain and bony eburnation of articular cartilage. The Ortholoc Modular. prosthesis was implanted on both sides by same surgeon using identical technique in all cases. The mean follow-up period was 10.6 years. Evaluation was performed annually using HSS (Hospital for Special Surgery) knee rating score and radiological parameters including tibiofemoral angle, width of patella, length of patella, thickness of patella, tilt of patella and shift of patella. RESULTS: On the basis of long term follow-up results, there was no significant difference between resurfaced and unresurfaced group in clinical and radiological study. According to radiological findings as time passed, tibiofemoral angle and patellar thickness decreased but patellar length and width increased in both groups. There was no relationship between HSS knee score and radiological result in both groups. CONCLUSION: This study showed that long term clinical and radiological results of TKA does not depend on patellar resurfacing. Author can propose that patellar resurfacing is not always required in patients with relatively good condition in articular surface of patella.
Arthroplasty* ; Cartilage, Articular ; Follow-Up Studies ; Humans ; Knee* ; Patella* ; Patient Selection ; Prospective Studies* ; Prostheses and Implants

No abstract available.
Abscess* ; Citrobacter koseri

BACKGROUND: Although a number of indices of diastolic function based on transmitral flow have been proposed, no single factor seems to be adequate for seperating patients with normal from with abnormal diastolic functions. Pulsed Doppler echocardiography of pulmonary venous flow(PVF) is another non-invasive method to evaluate left ventricular diastolic performance. The purpose of this study is to evaluate the normal PVF pattern by TEE. METHOD: We performed pulsed-wave Doppler studies of the PVF and of the mitral flow by transesophageal-(TEE) and transthoracic echocardiography(TTE) in a healthy young adults. RESULTS: In TEE, all sublects showed four phases of the PVE pattern ; two antewgrade systolic phase(early and late : SE and SL), one antewgrade diastolic phase(D) and one retrograde diastolic phase(A). In TTE, there were three phases of the PVF pattern ; two antewgrade phase(systolic, diastolic) and one retrograde diastolic phase but we couldn't find out early systolic phase flow. Peak velocity of each phase of PVF was as follows:SE was 48.9+/-14.1cm/sec, SL was 56.3+/-16.1cm/sec, D was 52.6+/-14.9cm/sec. The timing of SL flow was correlated significantly with that of peak aortic flow(r=0.42, p=<0.01), while the timing of D flow and that of A flow were correlated significntly with timing of mitral E peak and A peak, respectively(r=0.84, p<0.01 ; r=0.80, p<0.01). CONCLUSIONS: In the young normal subject, PVF showed four phase of flow pattern and could be easily obtained by TEE. Furthermore it may be used for evaluation of left ventricular function.
Echocardiography, Doppler, Pulsed ; Echocardiography, Transesophageal* ; Humans ; Ventricular Function, Left ; Young Adult*

OBJECTIVES: The objectives of this study is to compare the differences of fetal heart rate (FHR) variables between preterm and term pregnancies after acoustic stimulation using computerized analysis of fetal heart rate. METHODS: Eighty-two normal pre-term and term pregnancies entered to this study after conventional 20-minutes nonstress test(NST) and 10-minutes acoustic stimulation test (AST). Acoustic stimulations were performed using Fetal Acoustic Stimulator (Model 146, Corometrics, US). We analyzed the FHR response after acoustic stimulation using our on-line computerized FHR analysis system, HYFM-I & II software. The changes of loss of signal, baseline FHR, variability, number of fetal movements, and number of FHR accelerations were analyzed numerically. RESULT: The mean baseline FHR was increased in term pregnancies from 141+/-7.0bpm to 152.7+/-9.7bpm, and in preterm pregnancies from 144.6+/-6.8bpm to 156.8+/-10.2bpm, respectively. The mean baseline FHR was significantly increased in both term and preterm pregnancies (p<0.01. paired t-test). The variability of FHR was increased in term pregnancies from 18.2+/-6.4bpm to 22.6+/-5.0bpm and in preterm pregnancies from 17.8+/-5.5bpm to 22.7+/-5.9bpm, respectively. The variability of FHR was also significantly increased in both term and preterm pregnancies. (p<0.01. paired t-test) CONCLUSION: The mean baseline FHR and the variability of FHR was significantly increased both preterm and term pregnancies. But the difference of each FHR variables between preterm pregnancies and term pregnancies was not statistically significant in this study.
Acceleration ; Acoustic Stimulation* ; Acoustics* ; Female ; Fetal Heart* ; Fetal Movement ; Heart Rate, Fetal* ; Pregnancy

The rationale for proximal tibial osteotomy is to correct the abnormal loading stresses on the knee that are caused by an abnormal tibiofemoral axis in the coronal plane. Aithough there are many methods of fixation including cast, staple and external fixation, Coventry staple has been used widely. But Coventry staple has some disadvantages such as inadequate fixation, long term cast immobilization and rehabilitation. The purpose of this study is to demonstrate the superior performance of Miniplate staple which was designed by authors(Johnson & Johnson Orthopaedics, New Milton, UK) over the conventional Coventry staple. We have analyzed the clinical results including postoperative rehabilitation course of 3I cases who had proximal tibial osteotomy fixed with Miniplate staple. Preoperative diagnosis was osteoarthritis(OA) in 24 cases(77.4%) and physiologic genu varum in 7 cases(22.6%). 1. Hospital for Special Surgery knee score was average 72.2 points preoperatively, 90.1 points postoperatively in osteoarthritis and average 94.1 points preoperatively, 99.7 points postoperativeiy in physiologic genu varum. 2. The average tibiofemoral angle was varus 5.8 degrees preoperatively and valgus 8.7 degrees postoperati vely. 3. The active ROM exercise started at 5.3 days, standing at 13.3 days, crutches ambulation at 20.2 days and ambulation without crutches at 46.3 days after operation. In conclusion, more rigid fixation and rapid mobilization was possible with newly designed Miniplate staple in proximal tibial osteotomy.
Axis, Cervical Vertebra ; Crutches ; Diagnosis ; Genu Varum ; Immobilization ; Knee ; Osteoarthritis ; Osteotomy* ; Rehabilitation ; Walking