Dysplasia epiphysealis captitis femoris is a rare syndrome which after the hip joing in childhood. Pedersen(1960) was the first to differentiate dysplasia epiphysealis capitis femoris(DECF) from Perthes' disease. Scattered reports of this entity have appeared, and in 1964 Meyer defined the syndrome through explanation of its clinical and radiological characteristics. There is a clinical significance that DECF is clinical-radiologic syndrome which resemble Perthes' disease but has important differences, especially in its treatment and prognosis, We experienced two cases of DECF which are misdiagnosed as Perthes' disease. Therefore, pediatricians should keep in mind the possibility of the DECR among the Perthes' disease of younger children.
Child ; Hip ; Humans ; Prognosis

Although many reports have been published about Legg-Calve-Perthes disease, developmental dysplasia of hip, it is difficult to gain a satisfactory results in treatment. We experienced 9 year-old girl with ipsilateral neglected DDH combined with contralateral LCPD, and treated with Klisic operation for DDH and femoral valgus osteotomy for hinged abduction of LCPD. We gained satisfactory results and report this rare case.
Child ; Female ; Hip ; Humans ; Legg-Calve-Perthes Disease ; Osteotomy

Twenty five patients (twenty seven hips) who had Chiari osteotomy at Kang Nam St. Marys Hospital between 1980 and 1995 were reviewed to evaluate the factors in the operative technique that contribute to successful outcome and assess the clinical results in various conditions. The length of follow-up ranged from one to fourteen years and the age of at operation ranged from four to twentythree years. Eighteen patients had developmental dysplasia of the hip: four, septic hip: three had another disorders, Prior to the Chiari osteotomy, fourteen hips had an femoral osteotomy and four, trochanteric arthroplasty. We used to the standard osteotomy as described by Chiari with certain modification. A pneumatic saw and osteotome are used instead of Gigli saw. This technique is simple procedure to make the correct level and angle. Bone graft was not performed in all cases even the osteotomy was displaced more than 50 percent of the iliac width. The overall results were 12 excellent, eight good, five fair, and two poor. In eleven patients, the osteotomy had to be displaced more than 50 percent to provide good coverage of the femoral head. Their results were good or excellent. A good result will be obtained if enough attention is paid to displacing the osteotomy. The osteotomy using the pneumatic saw provides accurate level and direction of osteotomy and it is an simple procedure also.
Adolescent* ; Arthroplasty ; Child* ; Femur ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteotomy* ; Transplants

PURPOSE: To assess the clinical results of surgical treatment for established nonunion of the lateral humeral condyle and to determine the factors necessary for successful outcome. MATERIALS AND METHODS: 12 patients with nonunion of the lateral humeral condyle underwent open reduction, autogenous iliac bone graft and internal fixation with two smooth or treated K-wires between 1994 and 1999. Mean age was 16 years and the mean follow-up period was 2 years and 8 months. RESULTS: All of the patients achieved solid union at the nonunion site and were free of pain in the elbow upon strenuous activities. Average union time was 7.2 weeks after the surgery. Aggressive anatomical reduction of the fragment must not be undertaken because it may disturb a well adapted joint congruity in adults. Rigid internal fixation with iliac bone graft and preservation of the blood supply of the distal fragment are important factors for a successful outcome. The range of motion of the elbow joint decreased 10.5 degrees on average after surgery. Valgus deformity improved in four of six patients. CONCLUSION: The patients with symptomatic established nonunion are good candidates for surgery, even adults.
Adult ; Congenital Abnormalities ; Elbow ; Elbow Joint ; Follow-Up Studies ; Humans ; Joints ; Range of Motion, Articular ; Transplants

BACKGROUND: The increasing number of outpatient surgery which requiring the rapid, smooth induction of anesthesia with rapid recovery may lead to the use propofol or sevoflurane. Our objective was to compare the hemodynamic responses and recovery profiles obtained by sevoflurane inhalation with propofol infusion using a laryngeal mask airway (LMA) in an ambulatory setting. METHODS: Forty patients undergoing knee arthroscopic surgery were randomized into two groups. The laryngeal mask airway insertion was accomplished by using the voluntary maximal vital capacity breathing method (VCB) with sevoflurane 7% in nitrous oxide 50% (sevoflurane group) or by the infusion of propofol (target: 7microgram/ml) (propofol group). Under BIS monitoring (40-60), anesthesia was maintained by sevoflurane (2-3%) or propofol (range of 3.7-4.2microgram/ml) with spontaneous respiration. Time to loss of consciousness (LOC) and LMA insertion from induction of anesthesia, hemodynamic responses, end tidal CO2, and recovery profiles were evaluated. RESULTS: The mean time to LOC and to successful LMA insertion were similar in the groups. Hemodynamic responses in the sevoflurane group were not significantly different from those of the propofol group. However, in both groups, systolic and diastolic blood pressure were lower at the time of loss of consciousness and 5 min of after LMA insertion versus preinduction and LMA insertion values (P<0.05). Heart rate was significantly lower in the propofol group (P<0.05). After cessation of anesthesia, hemodynamic responses and to the time for LMA removal or to the time for responding to a verbal command were similar in both groups. CONCLUSIONS: Sevoflurane inhalation and propofol infusion anesthesia with spontaneous respiration provided comparable conditions for outpatient surgery.
Ambulatory Surgical Procedures ; Anesthesia ; Arthroscopy* ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Inhalation ; Knee* ; Laryngeal Masks* ; Nitrous Oxide ; Outpatients* ; Propofol ; Respiration ; Unconsciousness ; Vital Capacity

PURPOSE: This study undertaken to evaluate the clinical results between the fixation of both bones and the fixation of the only tibia for extra-articular distal tibial and fibular fracture, and to know if the fixation of both bones could be needed. MATERIALS AND METHODS: In a retrospective study from 1994 to 1999, thirty-seven patients who underwent internal fixation with plate and screws for both bones (Group I : 17 cases) and only tibia (Group II : 20 cases) for extra-articular distal 1/3 tibial and distal 1/4 fibular fractures, which were above distal tibio-fibular syndesmosis, were evaluated the period of union, range of motion and operative time. RESULTS: The union period of tibia was 124 days (Group I) and 126 days (Group II) and the cases of full ROM were 16 / 17 cases (94.1%) in Group I and 18 / 20 cases (90.0%) in Group II. The mean score was 94.6 points in Group I and 91.3 points in Group II by Baird scoring system (P>0.05), and the operative time was 147 minutes (Group I) and 106 minutes (Group II) (P<0.05). CONCLUSION: The clinical results in extra-articular distal tibial and fibular fractures, which were distal 1/4 and above distal tibio-fibular syndemosis, treated with internal fixation of the only tibia were as good as internal fixation of both bones. We thought that there is no need to fix distal fibular fracture in these cases.
Humans ; Operative Time ; Range of Motion, Articular ; Retrospective Studies ; Tibia*

A thickened soft tissue impingement after total knee replacement arthroplastyis a complication that causes pain and is usually developed between patella and femoral component such as patellar clunk syndrome. But we experienced a case that medial and lateral synovial tissues were impinged between femoral component and polyethylene liner after total knee replacement arthroplasty with medial pivot prosthesis for degenerative arthritis and were treated with arthroscopic excision. We report this case with literature review.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Knee ; Osteoarthritis ; Patella ; Polyethylene ; Prostheses and Implants

PURPOSE: We studied to know the relationship between meniscal injury & defect of articular cartilage and its clinical importance. MATERIALS AND METHODS: 252 patients were selected, who undergone arthroscopic surgery for meniscal injury from May 1997 to December 2001. We excluded patients with severely progressed osteoarthritis or degenerative changes in simple X-ray. Physical examinations, simple X-rays, MRI & arthroscopic photographs were taken for all patients. And the results were analyzed according to age, duration from accident to operation and type of meniscal injury RESULTS: 40 cases (15.9%) showed defects of articular cartilage with meniscal injury. Among them, 18 cases (45%) in femur, 10 cases (25%) in tibia, and 12 cases (30%) in both. Incidence of articular cartilage defect was significantly higher in patients over the age of forty (p<0.01) and in those with a history longer than six months (p<0.05). Posterior horn tears were associated with the highest incidence of articular cartilage defect, but were also associated with a longer history and with older patients. CONCLUSION: In patients with meniscal injury, older age, long duration of symptom and tear at posterior horn have higher incidence of articular cartilage defect, especially femoral condyle. The reason for this is not entirely clear but these patients need close attention and early treatment.
Animals ; Arthroscopy* ; Cartilage, Articular* ; Femur ; Horns ; Humans ; Incidence ; Magnetic Resonance Imaging ; Osteoarthritis ; Physical Examination ; Tibia

PURPOSE: To investigate the rate of lateral retinacular release and the contributing factors between the patellar resur- faced total knee arthroplasty(TKA) and patellar retained TKA. MATERIAL AND METHODS: From Jan. 2003 to Jan. 2006, 179 cases(90 patella retained, PR; 89 patellar resurfaced, PS) were enrolled in this study. To investigate the contributing factors on the lateral retinacular release along the patellar replacement, the preoperative and postoperative radiographic evaluation was done. Patellar height, congruence angle and medial displacement was measured with the Merchant view. Anterior-posterior knee distance was measured at a lateral film. The statistical significance between two groups was analyzed using the student's t-test. RESULTS: Lateral retinacular release was done in 59 of 179 cases. Thirty-six cases of PR group and 23 cases of PS group were undertaken. The rate of lateral retinacular release was higher in PR group(p<0.05). The difference between preoperative and postoperative patellar height at a Merchant was 2.5, 0.5mm reduction in PS and PR group respectively. PS group showed more medial displacement(mean 2.5mm) than PR group(mean 1.2mm)(p<0.05). CONCLUSION: In PR group, higher rate of a lateral retinacular release was shown than PS group. Less reduction of patellar height and less medial displacement of patella might be related with the high rate of a lateral retinacular release in PR group.
Arthroplasty* ; Knee* ; Patella*

PURPOSE: This study was performed to investigate the differences in the expression of matrix metalloproteinase-3 in degenerative scoliosis compared with other degenerative disc disease of the spine. MATERIALS AND METHODS: The intervertebral disc materials were obtained during discectomies. Six, 13 and 12 cases of herniated nucleus pulposus, spinal stenosis and degenerative lumbar scoliosis, respectively, were included in the experimental group. The expression of MMP-3 was evaluated three times that of the means, in the immunohistochemical staining, western blotting using anti human MMP-3 antibody and RT-PCR with MMP-3 primer, respectively. RESULTS: On the immunohistochemical stains, extensive and strong staining was noted in the discs of degenerative lumbar scoliosis compared to those with spinal stenosis and HNP. In the western blotting, greater expression of MMP-3 was noted in the discs of degenerative lumbar scoliosis (mean optical density: 20.68) than in other degenerative disc diseases (SS: 6.24, HNP: 2.0). In the RT-PCR, a similar result was shown (DLS: 62.1, SS: 27.4 and HNP: 10.4). There were statistically significant differences between degenerative lumbar scoliosis and degenerative disc disease (p<0.05). CONCLUSION: Rapid degeneration of the intervertebral disc might be an important factor in the pathogenesis of degenerative lumbar scoliosis. MMP-3 could be a key enzyme for the rapid degeneration of the intervertebral discs, especially in degenerative lumbar scoliosis.
Blotting, Western ; Coloring Agents ; Diskectomy ; Humans ; Intervertebral Disc ; Scoliosis* ; Spinal Stenosis ; Spine