Diabetes mellitus is one of troublesome disorder for the orthopaedic patient who should be operated on some other problems. Internist will advice and take care of them as far as diabetic problem is concern. However, orthopaedic surgeon should fully understand and follow every details about the condition of his own patient. Gamerin-Davalos hadclassified the diabetes mellitus into four types of potentiate, chemical and clinical diabetes. Potentiate form is not detectable at present method. The chemical and latent chemical forms are subclinical types and will be detected by the special examinations. In the orthopaedic practice, surgeon should keep in mind and perform proper tests for any suspecious symptomes or histories related to diabetes mellitus. Administration of insulin for the diabetes should be full doses but nerve be over-dosed. Neuropathy, vascular changes and infections are the common complications to diabetic patient and closely influence to the prognosis of major surgery. Ellenbery et al. had emphasized that the neuropathy is not a complication but rather a concomitant feature of diabetes mellitus. It may appear nerve root symptome to confuse with the herniated intervertebral disc. Vascualr change of the thickening of capillary basement membrane will causes gangrene of extremities and unexpected massive bleeding during surgery. Susceptibility of infection on diabetic patient is well known fact and in case of chronic osteomyelitis or tuberculosis of bone persist for long time without specific reason, surgeon should check once for the posibility of diabetes mellitus. Administration of any general anesthetic agents will elevate blood sugar level especially the ether, however, fluothane is a selective one at present. In case of surgery on diabetic patient, aceton uria and CO2 combining power should be checked closely for four to five days post-operatively. Blood sugar level should be kept slightly elevated during and post-operative period for diabetic patient. Surgeon should check his patient for any complications in case of increased dose of insulin is required post-operatively.
Anesthetics ; Basement Membrane ; Blood Glucose ; Capillaries ; Diabetes Mellitus ; Ether ; Extremities ; Gangrene ; Halothane ; Hemorrhage ; Humans ; Insulin ; Intervertebral Disc ; Methods ; Osteomyelitis ; Prognosis ; Tuberculosis

A case of osteochondritis dissecans of both knee joints is developed in 15 year old boy. Since the original articles of Paget, Koning and others were reported, many theories as to etiology and pathogenesis have been proposed but exact cause has been unknown. Many Joint may show evidence of osteochondritis dissecans but lateral aspect of medial femoral condyle of knee is by far the most frequent site. Under the diagnosis of osteochondritis dissecans of both knees with clinical symptoms and X-ray finding, the one was treated with excision of framents and curettage, and the other treated with drilling of fragments. In follow up study for one year, the result was good without any complaints.
Curettage ; Diagnosis ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Knee ; Male ; Osteochondritis Dissecans ; Osteochondritis

Two cases report on osteogenesis imperfecta tarda and review of literature has been made. The rare genetic disorder, osteogenesis imperfecta tarda is familiar to most orthopedic surgeons because of management of fracture and skeletal deformities, espicially bowing of long bone. Its clinical manifestations are known as bony fragility, blue sclera and deafness less frequently ligamentous laxity but its etiological factor is obscure; The basic defect is thought to involvement some abnormality of collagen. Recently the bony weakness caused by increased bony turnover rate. One case of osteogenesis imberrfecta tarda in 8 year old male was belonged to tarda type 1. (Falvo-classification), who could not walk due to marked anterolateral bowing of right tibia and the another to tarda type II. in 13 year old male with fresh fracture of right femoral shaft. The former was performed corrective multible osteotomy, realignment and intramedullary rod fixation for correction of bowing deformity of right tibia, and the later was managed the fracture of right femoral shaft with Russels traction and hip spica cast. The result of reported therapeutic mesure was good.
Collagen ; Congenital Abnormalities ; Deafness ; Fibrinogen ; Hip ; Humans ; Ligaments ; Male ; Orthopedics ; Osteogenesis Imperfecta ; Osteogenesis ; Osteotomy ; Sclera ; Surgeons ; Tibia ; Traction

The analysis of 48 infants of congenital torticollis and the result of their conservative treatment are reported. The abnormalities of their neck were noticed by mothers within three months of infant life but mostly at three to four weeks. The ratio of male to female was 9:7 and incidence of right and left was 30 to 18. The mass located mostly(50%) at middle third of the sternocleidomastoid muscle belly. The prominence of incidence were noticed on the abnormality of fetal position in the uterus, mode of delivery and also on the baby of elderly primipara. About 67% of cases were breech(46%) and transverse(21%) position prenatally and 67% were delivered by forceps(41.7%), vacum and induction(12.5%each). The age of mother at delivery has close relationship between congenital torticollis with about two third of them are born of 29–34 year old mother and primipara infants were 61%. For the treatment, daily stretch exercises of affected sternocleidomastoid muscle was done by physical therapist for 20–30 times in two separate session. The effect can be noticed by the gradual correction of rotation deformity first and then the mass become soften and smaller. The next change is the correction of deviation deformity but the mass remain last. However, the mass remaining one fourth of original size was absorbed spontaneously without further treatment. The result of complete cure in ten weeks of treatment were 43(90%) out of 48 patients and the remianing five cases required for 15 weeks of treatment. In conclusion the congenital torticollis can be treated effectively by stretch exercises when it began within three months of age of the patient. A hundred per cent effect of cure may be obtained in ten weeks of treatment in case of initial treatment is begin within four weeks of age and required for 15 weeks of treatment on 4–12 weeks old infants.
Aged ; Congenital Abnormalities ; Exercise ; Female ; Humans ; Incidence ; Infant ; Male ; Mothers ; Neck ; Physical Therapists ; Torticollis ; Uterus

No abstract available.
Thrombocythemia, Essential*

It is generally accepted that the integrity of posterior cruciate ligament plays a major role in knee stability. The rotatory movement is around a point to the back of center of joint where the posterior cruciate ligament lies, and it is a structure which is just as important as the other ligaments. Methods of reconstruction have been described, using semitendinosus tendon, gracilis tendon, popliteus tendon, patellar tendon, iliotibial band, and medial meniscus. We have successfully used the semitendinosus tendon in two patients who sustained neglected rupture of posterior cruciate ligament.
Humans ; Joints ; Knee ; Ligaments ; Menisci, Tibial ; Patellar Ligament ; Posterior Cruciate Ligament ; Rupture ; Tendons

No abstract available.
Compliance*

No abstract available.
Epidural Abscess*

A case report on the ABO-type imcompatible transfusion has been made. The case was O-type, 51 year old male who has been transfused 1,000ml of A-type whole blood during and after the intramedullary nailing of the left femur. He had fall in acute hemoglobinuric renal failure immediately after the transfusion. He has been received peritoneal dialysis (P.D.) at eighth day after mismatched transfusion, to correct the uremic condition. His pre-P.D. labaratory findings were Hb. 4.5gm%, BUN 85mg%, creatinine 12. 2mg% and K 7.0mEq/1. He was well recovering after the P.D. but worse again in 16th day after mismatched transfusion with BUN 114mg%, creatinine 12.4mg% and pulmonary edema. An-other P.D. was performed at 16th day and recovered gradually since then. He had marked maximum amount of urine was 9, 100ml at 36 th day after mismatch transfusion. Following the second P.D. his conditions improved gradually and electrolyte imbalance was controlled caused from polyuric state properly. His renal condition was recovered completely at the ten weeks after the mismatch transfusion.
Acute Kidney Injury ; Blood Transfusion ; Creatinine ; Femur ; Fracture Fixation, Intramedullary ; Humans ; Male ; Peritoneal Dialysis ; Pulmonary Edema ; Renal Insufficiency

The spinal injuries were classified into bursting fracture, fracture-dislocation, seat-belt injury, compression fracture according to the three column theory by Denis. The bursting fracture and fracture-dislocation required the most careful planning. So, myelography, computerized tomography enabled us to diagnose the spinal fracture including retropulsed bony fragment into the spinal canal. There was much controversy as to appropriate treatment af unstable thoraco-lumbar fractures. The frequent surgical treatment of thoraco-lumbar spinal fractures was still posterior spinal instrumentation including Harrington rod system. Since 1964, the use of anterior spinal instrumentation had been started by Dwyer, Dunn, Kostrik, Slot, and Zielke used anterior spinal instrumentation in unstable thoraco-lumbar spinal fractures, but not popular. This study suggested the experience to accomplish the decompression of the neural elements and stabilization of the spine by using Kandea device in unstable thoraco-lumbar spinal fractures. 12 patients treated with this Kaneda device in unstable thoraco-lumbar spinal fractures were analyzed from Dec. 1988 to May, 1989 at the Department of Orthopaedic Surgery, Ewha Womans University Hospital. We obtained the following conclusions. The results were as follows. 1. The common injury mechanism was falling down in 5 cases, the frequent injury site was 1st lumbar vertebra. 2. According to Denis classification, the bursting fractures were in 8 cases(68% ), the fracture-dislocations were in 4 cases(33%). 3. The average preoperative kyphotic angulation was 24.5 degrees(range 8 to 45) and postoperative angulation was 5 degrees(range 2 to 15), the correction rate was 79.6% and correction degree was average 19.5 degrees. 4. The advantages were the fixation of one level above and below the injury site, sufficient neural decompression, firm spinal stabilization, early mobilization with a brace and elimination of the 2nd posterior procedure. 5. The fixation of vertebral plate was difficult due to the invariable size of vertebral plates, especially, in upper thoracic spinal fracture and children's fracture.
Accidental Falls ; Braces ; Classification ; Decompression ; Early Ambulation ; Female ; Fractures, Compression ; Humans ; Myelography ; Spinal Canal ; Spinal Fractures ; Spinal Injuries ; Spine