258 feet of patients with flatfoot were evaluated in this paper. The incidence of flatfoot is about 0.6% of the general population. The longitudinal arch was depressed in all of our cases of flatfoot, and there have been many patients suffering from pain after some kinds of heavy work. But there were no definite correlations found between the depression of the longitudinal arch and clinical symptom. The sag in the naviculo cuneiform joint is the most common X-ray finding in this series (93%), followed by the talo-navicular sagging (27%), Degenerative arthritis of the inter-tarsal joints was frequently found after the adolescent period. The talo-navicular joint was involved in arthritic changes in 60% of the cases, the subtalar joint 46% and the naviculo-cuneiform joint 42%. The prevalence of these changes was not increasing with the increasing age, so it is poatulated that the degenerative changes begin early in adolescent period. Accessory tarsal bones were more frequently seen in patients with flatfoot than in normal population. and the neck of the talus was usually deviated inferomedially. Now that the arthriric changes are very prevalent in the triple joints, there are many cases of flatfoot that should undergo the triple arth odesis inevitably if his conservative treatment was failed.
Adolescent ; Depression ; Flatfoot ; Foot ; Humans ; Incidence ; Joints ; Neck ; Osteoarthritis ; Prevalence ; Subtalar Joint ; Talus ; Tarsal Bones

No abstract available.
Animals ; Knee Joint* ; Knee* ; Rats* ; Tretinoin*

No abstract available.
Diagnosis* ; Osteoma, Osteoid*

The fracture of the upper end of the femur is unique in orthopedics because it is endemic to an elderly population with special problem. In trochanteric fractures open reduction and internal fixation, with a hip nail used to maintain reduction, have become the standard treatment protocol for the elderly. Unlike fractures of the femoral neck, nonunion and avascular necrosis is rare but more frequently complicated by fatal sequele, such as pneumonia, thromboembolic disease, and decubitus ulceration. In order to achieve early ambulation of a patient with a trochanteric hip fracture, two conditions must be met: The implant used for fixation must be strong enough to withstand loadings exerted upon it during fracture healing, and the fracture itself must be rendered stable in a suitably reduced position. The treatment of the fracture of the femoral neck has a long and frustrating history. As recently as 20 years ago McCarroll remarked that this fracture must be considered “unsolved” until the incidence of aseptic necrosis and nonunion could be diminished or abolished. But now with adequate reduction, impaction, accurate internal fixation with newer devices, and carefully supervised postoperative care the fracture of the femoral neck can be expected to heal at least 90 per cent of the patients. A lower incidence of recognizable aseptic necrosis has been reported under these circumstances. X-ray films of 94 cases of hip nailing for hip fractures were collected in the Department of Orthopedic Surgery of Seoul National University Hospital. Twenty seven cases considered to be failed in hip nailing were analysed radiologically, and following results were obtained. 1. The incidence of failed hip nailing was most frequent in the fifties with average age of 54. 6 years, which seemed somewhat younger than that of the hip fracture. There was no sexual difference. 2. Hip nailings were failed in 23 cases of the femoral neck fractures and in 4 cases of the trochanteric fractures, which revealed respectively 52.3% and 8.2% of failure. Among these the technical failure was 22.7% in femoral neck fractures and 6.1% in trochanteric fractures. 3. Among the various fixation devices, Smith-Petersen nail or hip screws which has no side plate to fix the shaft rigidly showed high failure rates. 4. In all cases the etiology of the failed hip nailing was functional, such as failure of reduction, failure of fixation, penetration of the head, avaseular necrosis, infection, and inadequate postoperative management. 5. Most cases of femoral neck fractures which was not achieved near anatomical reduction was failed in fixation. 6. Too long or short nails showed high failure rates. In view point of this, hip nail should fix the lateral cortex, calcar femorale and center of subchondral bone, even in the trochanteric fracture. So devices such as heavy compression sliding nail or multiple pinning were more desirable to achieve complete fixation. 7. When, in the fresh fractures of the femur neck cannot be reduced to an anatomical or slightly overcorrected position, endoprosthesis should be considered seriously. When the joint is abnormal, the total hip arthroplasty can reduce morbidity and mortality, and also shorten the hospitalization.
Aged ; Arthroplasty, Replacement, Hip ; Clinical Protocols ; Early Ambulation ; Femoral Neck Fractures ; Femur ; Femur Neck ; Fracture Healing ; Head ; Hip Fractures ; Hip ; Hospitalization ; Humans ; Incidence ; Joints ; Mortality ; Necrosis ; Orthopedics ; Pneumonia ; Postoperative Care ; Pressure Ulcer ; Seoul ; X-Ray Film

More than 100 surgical methods were described as the treatment of recurrent patella dislocation. These can be divided into two categories, the proximal, dynamic reconstruction and the distal, static reconstruction. We treated a case of recurrent patella dislocation with a new method, using gracilis. The tendon of gracilis was dissected and cut at the point about 7cm proximal to the insertion. A 'H' shaped slot was made subperiosteally in the anterior surface of patella. The both ends of cut gracilis tendon were imbedded into the 'H' shaped slot of patella and sutured. So the gracilis tendon could act as a static and dynamic stabilizer. The result was excellent at 1 year follow up.
Dislocations ; Follow-Up Studies ; Methods ; Patella ; Tendons

In order to compare the effects of the flexible external fixations with the rigid one on fracture healing, rabbits tibiae were fractured surgically and each fracture were immobilized with external devices using graphites (the group I), plastics (the group II) and stainless steel (the group III). At six weeks after fracture, clinical and radiological union rates in group I, II and III were 91% 73% and 60% respectively. The rabbits tibiae were load in 4-point bending test to determine the mechanical properties of the fracture healing. The means and standard errors of maximum bend moment of the fractured tibiae were 11. 30±2.33kg.f. cm., 8.55±2.02kg.f. cm. and 9.79±2.09kg.f. cm. in group I, II and III respectively. These data may suggest that a certain amount of the flexibility (ex, graphite) or motion is better than the rigidity (ex, stainless steel) in fracture healing by the method of the external immobilization).
Fracture Healing ; Graphite ; Methods ; Plastics ; Pliability ; Rabbits ; Stainless Steel ; Tibia

This study was planned by the necessities of basic information about the effects of Korean Ginseng upon fracture healing and biomechanical properties of bone. Three hundred white mice were used for this study, and we could have tested the biomechanical properties in one hundred and nintyfour. The bones of the white mice were evaluated by testing gross stability, radiological appearance, and biomechanical properties. It appears that Korean Ginseng has an excellent effect upon early phase of fracture healing of the bone. The summary of this study are as follows: 1. With near maximal dose, Korean Ginseng showed very excellent effect upon early phase of the fracture healing. 2. There was no apparent effect on remodeling phase of the fracture healing with Korean Ginseng of near maximal dose. 3. Korean Ginseng appeared to have no effect on fracture healing with minimal dose. 4. Upon biomechanical properties of the bone, Korean Ginseng was seemed to be effective with near maximal dose. But, there was no definite evidence for that.
Animals ; Fracture Healing ; Mice ; Panax

Four cases of subungal exostosis are presented. All of them were young male and big toe was involved in 2 cases. Histological features of subungal exostosis was characteristic; the cancellous bony stalk was capped mainly fibrocartilage, although scattered areas of hyaline cartilage were also found where enchondal ossification occured. Superficial to this cartilaginous cap, there was fibrous tisse covering. When terminal phalax of a toe shows deformity of nail and skin changes due to hard mass, radiological examination is required for the proper diagnosis and treatment. Complete local excision is required but damage to the nail bed during excision should be avoided.
Congenital Abnormalities ; Diagnosis ; Exostoses ; Fibrocartilage ; Hallux ; Humans ; Hyaline Cartilage ; Male ; Skin ; Toes

We have experienced 11 cases of large bony defect that were treated using microsurgery since 1981. Free vascularized bone transplantation was performed in 8 of them, vascularized bone transposition in 2 cases, and free vascularized joint transplantation in the remaining 1 case. The causes of the large bony defect were primary bone tumor (4 cases), congenital pseudoarthrosis (3 cases), open comminuted fracture (2 cases), sequela of osteomyelitis (1 case), and post-traumatic ankylosis of PIP joint of second finger (1 case). As a donor, fibula was used in 8 cases, iliac crest in 1 case, rib in 1 case and in the remaining 1 case, the second M-P joint of foot was transplanted. In 9 of 11 cases, successful result was obtained and 2 cases were failed because of vascular damage following tibial lengthening in one case and infection on the grafted area in the other one. From the above data and review of articles, following conclusions were obtained. 1. Fibula is thought to be the most appropriate donor for the large bony defect in the extremity, especially in lower extremity, but the donor site must be determined according to the anatomical and physilogical condition of the patient. 2. After mechanical lengthening of the extremity, it is recommened to perform the microvascular surgery after sufficient time for the recovery of vascular damage. But further studies are required for the identification of the change in the vascular tissue following stretching and its recovery time. 3. Progression of the ossification in the epiphysis of transplanted iliac crest was observed and this finding proposed us the idea that the epiphyseal plate injury or leg length discrepancy will be able to be treated with free vascularized epiphyseal plate transplantation and the reconstruction of the destroyed joint of growing children will be possible using free vascularized joint transplantation. 4. As the technique become more popular, the free vascularized bone transplantation is being used for the reconstruction of the extremity more frequently, but it seems to be wise to restrict its indication to cases which are impossible to be treated with more simple methods such as vascularized bone transposition or pedicled bone graft.
Ankylosis ; Bone Transplantation ; Child ; Epiphyses ; Extremities ; Fibula ; Fingers ; Foot ; Fractures, Comminuted ; Growth Plate ; Humans ; Joints ; Leg ; Lower Extremity ; Microsurgery ; Osteomyelitis ; Pseudarthrosis ; Ribs ; Tissue Donors ; Transplants

Fractures of the hip are usually classified first according to their anatomic location. Isolated fractures of the lesser or greater trochanter are not common and rarely requir surgery, Femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures are common categories that usually require open reduction and internal fixation. These fractures most often occur in elderly patients. The prognosis of these three major categories of hip fractures seems to be entirely different because of their anatomic characteristics. Seventy three cases of hip fractures were experienced at the Department of Orthopedic Surgery, Eul-Ji General Hospital over the period from Jan. 1975 to Aug. 1980 and the following results were obtained. 1. Of the 73 hip fractures, femoral neck fractures were 28 cases (38.5%), intertrochanteric fractures were 23 cases (31.5%), subtrochanteric fractures 11 cases (15%), and acetabular, fractures 11 cases (15%). 2. Traffic accident was the major cause of hip fractures in our series. 42 cases (57.2%) were caused by traffic accident, whereas 27 cases (37.0%) by a fall from the height. 3. Hip fractures occured most frequently in the age group from 31 to 50 years (53.5%). Male to female ratio was 2:1. 4. Cases caused by traffic accident visited hospital earlier than the others. 5. The most common type was Garden's type IV (53.6%) in the femoral neck fractures, Boyd-Griffins type Il (47.8%) in the intertrochanteric fractures, and Fielding's type II (54.5%) in the subtrochanteric fractures. 6. Metal devices used to fix hip fractures were Knowles pin, Jewett nail plate, compression hip screw, plate and screws, and Kuntscher nail. Internal fixation was done anatomical reduction has been achieved in stable fractures, and Dimon-Hughston reduction in unstable fractures. 7. Postoperative cast immobillzation was performed in 13 cases of 21 femoral neck fractures, 15 cases of 22 intertrochanteric fractures and 6 cases of 11 subtrochanteric fractures. The average duration of immobilization was 10 to 12 weeks. 8. Incidence of avascular necrosis in femoral neck fractures was 16.7%, nonunion in intertrochanteric fractures was 11.8%, and nonunion is subtrochanteric fractures was 12.5%.
Accidents, Traffic ; Acetabulum ; Aged ; Clinical Study ; Female ; Femoral Neck Fractures ; Femur ; Hip Fractures ; Hip ; Hospitals, General ; Humans ; Immobilization ; Incidence ; Male ; Necrosis ; Orthopedics ; Prognosis