Camptodactyly is a non-traumatic flexion deformity of the PIP joint of the digit (except thumb) and one of rare congenital anomalies of the hand. It may be a clinical manifestation of some other syndrome and may not be a disease of its own right. It is very difficult for this particular problem to get satisfactory results. We analysed 36 digits of 19 patients, whom we treated and followed up for an average of 1.7 years from 1982 to 1988 at the Department of Orthopedic Surgery, Seoul National University Hospital. The following results were obtained. 1. Male to Female ratio is 8: 11 and age ranged from 14 months to 32 years old. 2. Unilateral and single digit involvement is twice more commonly found than bilateral and multiple digit involvement respectively. 3. Third digit is the most frequently involved one in our series. 4. Besides soft tissue contractures on the volar aspects of the PIP joints, other pathologic findings are thick reddish glistening palmar skin in 6 patients, tendon problems in 4 patients and bone-joint hypoplasia in 1 patient. 5. We have done 3 types of operation, that is, skin graft, flexor tenotomy with skin Z-plasty, extensor reconstruction with flexor tenotomy and skin Z-plasty. The results of operations ranged from good to poor, however most cases showed above fair results at the final follow-up. 6. Camptodactyly seems to be a disease of various etiologies and pathologies. And it is strongly suggested that the treatment of this syndrome should be individualized according to their pathologies found at surgery.
Congenital Abnormalities ; Contracture ; Female ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Orthopedics ; Pathology ; Seoul ; Skin ; Tendons ; Tenotomy ; Transplants

In Korea, owing to effective vaccination, occurences of poliomyelitis begen to decrease rapidly from 1964 and in recent years less than 10 cases of acute infection are being reported annually. However, patients crippled with poliomyeltis residua, mainly the legacy of the many epidemics of 1950s, and early 1960s, are many and pose a social and national problem as well as a personal and family ordeal. We reviewed 536 patients with residual poliomyelitis admitted and treated at Seoul National University Hospital during the past 18 years, from 1963 to 1980 They were divided into four chronological groups; the first, 1993 to 1968, the second 1968 to 1973, the third, 1974 to 1977, and the fourth, 1978 to 1980, In each group, based on in-patient records, and out-patient records, epidemology, deformities, and treatment were extensively reviewed. The followings are the outcome of this investigation 1. The male-to-female ratio was 53.7%: 46.3%, The male majority, distinct in the first group with 63. 7%, became less conspicuos in the fouth group with 50. 3%. 2. Average age oe admission, which was 10. 7 years in the first group, had increased decidedly to 17. 8 years in the fourth group. 3. The age of onset was most frequent between 1 to 2 years with 45.8% and next frequent between 7 to 12 months with 23. 5%. The ages below 5 years occupied 97. 6% of the cases. 4. The year of onset was most frequent from 1961 to 1963 with 28.7%. The incidence markedly and steadily decreased thereafter. 5. 94. 5% of the cases were unvaccinated. The remaining cases, except one, had had incomplete vaccination. 6. Fever, with 74. 0% was by far the most frequent initial symptom. Vomiting and diarrhea were the next frequent symptoms. 7. Of the 60% of the patients who had had any previous treatment, 25. 9% had operations and 20. 4% had braces and crutches. 8. Average number of admissions per patient were 1. 7 and average number of operations were l. 9. Average length of hospitalization was 39. 2 days. 9. 23. 6% of the patents had hip deformities, of which flexion defermity was most frequent with 4. 7%. Soutter fasciotomy or Campbell operation was employed in order to correct flexion deformity. In the earlier groups, Mustard operation, Sharrard operation, Ober-Barr operation, and pem-berton osteotmy were commonly practiced, whereas in the later groups, Thomas-Thompson-Straub operation, combined Thomas-Thompson-Straub and Ober-Barr operation, Salter osteotomy, Chiari osteotomy, Steel osteotomy were favored. 10. 45.2% of the patients had knee and leg deformities, of which flexion deformit; was most frequent with 14.5%. Flexion-valgus-external rotation deformity and flexion-valgus deformity with 4.6% and 4.5%, respectively, followed next. 11. 83. 9% of the patients had foot and toe deformities, of which equinovarus deformity occupied 6. 5% equinovalgus deformity 6.8%, and clawing of great toe 25. 2%. Triple arthodesis was done most frequently with 45. 9% of the cases, or 282 feet. Jone's operation or its modification, Tendo Achilles lengthening, plantar fasciotomy, and Peroneal tendon transfer were also frequntly performed. 12. There was leg length inequality in 90%. of the cases, Epiphysiodesis and femoral shortening were carried out, except for 4 cases of stapling in the earliest group, and femoral lengthening was done in 3 cases. 13. Spineal deformity was found in 19.7 % Of the cases, of which scoliosis was most freqent with 11. 5%. 7% of the cases had pelevic obliquity. Lumbodorsal fasciotomy, and postrior spinal fusion with Harrington instrument were carried out in order to ameliorate these deformities. 14. Deformities in the upper extremity were found in 3.6% of the patients. Procedures carried out inclulded shoulder fusion, Saha's operation, Steindler's flexorplasty, sternocleidomastold transfer, wrist fusion and opponensplasty, etc. 15. Generally, there was marked improvement of disability after treatment. The patients having moder.ate to severe limping decreased from 41.3%, preoperatively, to 25% after operation.
Age of Onset ; Animals ; Arterial Switch Operation ; Braces ; Clubfoot ; Congenital Abnormalities ; Crutches ; Diarrhea ; Fever ; Foot ; Hip ; Hoof and Claw ; Hospitalization ; Humans ; Incidence ; Knee ; Korea ; Leg ; Leg Length Inequality ; Male ; Osteotomy ; Outpatients ; Poliomyelitis ; Scoliosis ; Seoul ; Shoulder ; Spinal Fusion ; Steel ; Tendon Transfer ; Toes ; Upper Extremity ; Vaccination ; Vomiting ; Wrist

It is essential to define the accurate location and extent of bony bridge in relation to the epiphyseal plate for operation of partial epiphyseal plate closure by bony bridge resection. Since magnetic resonance imaging(MRI) provides excellent tissue contrast and multiplaner image, it could be applied to the diagnosis and mapping of bony bridge of epiphyseal plate. A thirteen year old female with post-traumatic epiphyseal injury of ankle was diagnosed by MRI. We could assess the bony bridge accurately by direct sagittal and coronal images and excellent tissue contrast of MRI.
Ankle ; Diagnosis ; Female ; Growth Plate ; Humans ; Magnetic Resonance Imaging

Treatment of femoral shaft fractures in children is varying according to age. Satisfactory results have been obtained with longitudinal skin traction, split Russell traction, ordinary Russell traction, 90-90 skeletal traction, and immediate application of a spica cast(2,4,6,11,15). Most authors use one or more techinques routinely. It is safe and convenient to use single treatment protocol to treat all fractures of same type, Distal femoral skeletal traction with the knee and hip flexed 90 degrees and with the thigh hanging free, using the trunk as counter traction, has been used routinely for femoral shaft fractures in children(age 4-12). We reviewed 30 cases of femoral shaft fractures in children treated with 90-90 skeletal traction. 1. The average age of the patients was 6.8 years(range, 4-12 years), and almost all were caused by pedestrian injury. 2. The average time of traction was 48 days(range, 28-75), and 12 cases(40%) were treated without spica cast application. 3. Four among 30 cases developed angular deformity exceeding acceptable range(15° in AP view, 20° in lateral view), and three of them were proximal third fractures. 4. The older the patient, the longer the duration of limited activity and the more tendency of angular deformity. 5. 90-90 skeletal traction is easy, safe and convenient to treat all femoral shaft fractures of the children between four and ten years old.
Child ; Clinical Protocols ; Congenital Abnormalities ; Hip ; Humans ; Knee ; Skin ; Thigh ; Traction

No abstract available.
Tendons*

This paper presents the result and statistical analysis of the experiment, in which selective anterior or posterior rhizotomy were carried out under microscopic surgery. The materials used for the experiment were 48 young rabbits, and they were divided into four groups. The group I, which was used as control, was subjected to lower dorsal bilateral laminectomies with dural incision, the group II to laminectomies with three right posterior rhizotomies, the group III to laminectomies with three right anterior rhizotomies, and the group IV to laminectomies with three right anterior and posterior rhizotomies. Scoliosis was induced in group Il, Ill and IV. There was no significant statistical difference in the degrees of curvatures among these three groups. The convexity of the curvature faced to the side of the divided roots. In group III and IV, scoliotic curvatures were obvious within two weeks, but there were no considerable changes thereafter. In group Il, the curves progressed slowly up to the 12th week. They were statistically significant at the 4th week and increased continuously thereafter. The histological findings in the group III and IV showed denervation atrophy of the paravertebral muscles at the apex of the curvature, but there was little or no muscle atrophy in the group I and II. We came to a conclusion from the experimental results that scoliosis may be induced not only by anterior root paralysis but also by selective posterior root paralysis.
Atrophy ; Denervation ; Laminectomy ; Muscles ; Muscular Atrophy ; Paralysis ; Rabbits ; Rhizotomy ; Scoliosis

No abstract available.
Kinetics* ; Wrist*

Total hip replacement arthroplasty is the most commonly used method in the surgical treatment of degenrative arthritis of the hip nowadays. If degenrative arthritic changes of the hip is caused mainly by abnormal femoral head, and the acetabular chnages are secondary to it, replacement of the femoral head without acetabular implanting can be expected to elicit regenerative acetabular changes secondary to the newly implanted femoral head component with spherical contour. 8 cases of degenerative arthritis of the hip were treated with bipolar endoprosthesis at the Seoul National University Hospital from January, 1987 to November, 1988 Acetabular reaming to the subchondral bone was performed in all the cases. In 2 cases, bone graft was added for augmentation of the thin medial wall. The mean follow-up was 15.5 months ranging from 12 to 26 months. The results were compared with 18 cases treated with total hip replacement arthroplasty during the same period. Both two groups showed no significant difference in the postoperative improvement of the range of motion and Harris score. In 2 cases treated with bipolar endoprosthesis, follow-up radiographs demonstrated some improvement of the degenerative changes such as subchondral sclerosis or cyst, which suggests the occurrence of the regenerative reaction in the scetabular side. 7 cases among 8 cases were pain-free, and 1 case had mild pain. In conclusion, bipolar endoprosthesis can be considered as another useful, less invasive method with shorter operation time in the surgical treatment of degenerative arthritis of the hip although more expericnces and longer follow-up are needed.
Acetabulum ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Head ; Hip ; Methods ; Osteoarthritis ; Range of Motion, Articular ; Sclerosis ; Seoul ; Transplants

Cervical spine injury, because of its increasing frequency and catastrophic neurological complication, has attracted many attention of every orthopedic surgeons. Moreover, the indications of surgical treatment and the indications of anterior or posterior fusion have been argued till now. Forty-one patients with cervical spine injury had been treated operatively at Department of Orthopedic Surgery, Seoul National University Hospital from January, 1980 to April, 1987. The surgically treated patients were followed up from 1 year to 7 years with average duration of 2.5years. We performed this study to define the advantages of the surgical treatment, the indications of the anterior and posterior fusion, the postoperative neurological changes, the importance of early reduction, and the result of surgical treatment in late instability cases and obtained the following results. 1. Flexion-rotation injury, in twenty three patients(56.0%), was the most frequent mechanism of injury. 2. Anterior decompression and fusion was performed in 8 patients(19.5%) when there were neural compression by fractured bone fragment or ruptured intervertebral disc material and rupture of anterior longitudinal ligament with hyperextension injury, without poterior ligament complex injury, and posterior fusion and wiring in 33 patients(80.5%) when there were upper cervical spine(C1, C2) injuries and posterior ligament complex injury. 3. Neurological involvements were observed in 35 patients(85.4%) on arrival, and partial and complete neurological recoveries were obtained in 20 patients(57.1%) out of 35 patients postoperatively. 4. Neurological recovery was obtained in 80% when the closed reduction was performed within 12 hours after the injury and only 40% after 12 hours. 5. Neck pain and/or neurology was improved in all 9 patients with late instability postoperatively. 6. Postoperative complication rate was totally 43.9%, but direct surgical complications were 2 cases(4.9%) out of 18 cases.
Decompression ; Humans ; Intervertebral Disc ; Ligaments ; Longitudinal Ligaments ; Neck Pain ; Neurology ; Orthopedics ; Postoperative Complications ; Rupture ; Seoul ; Spine ; Surgeons

It is essential to define the mechanical and morphological characteristics of bone in undrestanding the mechanism and treatment of fractrues of bone. We already reported the results of bending study in 1983 and tension study in 1987 to assess the mechanical and morphological changes of bone according to the growth. Following these studies, we performed torsion study on growing long bone to have better understanding of the characteristics of bone. In order to assess the mechanical and morphological properties of fracture of growing bone by torsion, we divided 100 Newzealand white rabbits(40 1-month-old rabbits, 20 3-months old rabbits and 40 5-months-old rabbits) into 6 experimental groups according to their maturity and side : Group 1(right femur of 1 month old), Group 2( left femur of 1 month old), Group 3(right femur of 3 months old), Group 4(left femur of 3 months old), Group 5(right femur of 5 months old), Group 6(left femur of 5 months old). Each group of femora were loaded in torsion with varing distance and the following results were obtained: 1. Fracture shapes were composed of the spiral component and the vertical component which connected the two ends of the spiral component. 2. Younger bones revealed greater deformation angle and apex angle but less obliquity than older bones. 3. When the gap between the grips were lengthened three times, there was a very signi ficant increase of deformation angle and obliquity but apex angle was decreased and the fracture angle showed little change. 4. It was necessary to measure the apex angle and obliquity in the morphological description of fractures by torsion. 5. We observed when a certain degree of angular deformity was applied on a bone at a certain age, the fracture was occured through the tension failure regardless of types of loading forces.
Congenital Abnormalities ; Femur ; Hand Strength ; Humans ; Infant, Newborn ; Rabbits