Acute unstable tibial shaft fractures are common in these days of high energy trauma. There are many options for this common and complicated fracture. Flexible intramedullary nailing using closed technique is prevalent in that this has much technical, functional, and physiological advantages. We reviewed 51 cases of acute tibial shaft fractures treated with flexible intramedullary nailing. There were 3 nonunions (6%), and two refractures. Among 46 united cases, 8 cases (17 %) showed no bridging callus formation within 20 weeks. Followings are the results of average time reaching each of radiological bony progression stage for 46 united cases. l. Average time to earliest discernible callus formation (stage I) was 13.3 weeks (range:8-21 weeks). 2. Average time to definite and bridging callus formation (stage II) was 18.1 weeks (range:8-32 weeks). 3. Average time to some oblitetation of fracture line (stage III) was 32.8 weeks (range:17-50 weeks). 4. Average time to complete obliteration of fracture line (stage IV) was 14.0 months(range:12-18 months).
Bony Callus ; Fracture Fixation, Intramedullary ; Tibia

No abstract available.
Hemorrhage*

Many kinds of operations have been devised to treat Kienböck's disease with variable results. But no one have mentioned about the advantage of early motion in distraction to prevent the fibro-osseous ankylosis and carpal collapse. Two cases with Kienböck's disease were treated by the complete excision of the lunate and replacement of it with pronator quadratus muscle pedicled rectangular bone graft. Once these procedures were accomplished, the distraction-motion devices were used to maintain the joint surfaces separated at predetermined distances while kinematically normal joint motion was gradually restored. Although the experience is limited to two cases, the final results seem to be very promising.
Ankylosis ; Arthroplasty ; Joints ; Transplants

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

The Palmaris longus tendon is important not because of its function but because of its usefulness as a donor tendon. Variations in the palmaris longus muscle ar elfrequent and the most common variation of the muscle is its absence. The incidence of absence of this muscle varies in different racial groups. Reinmann and his coworkers found the palmaris longus muscle absent in 12.9% of in their 1,600 limbs surgery. We have experiened 307 cases of palmaris longus graft surgery and found that there were 4 cases of absence of the palmaris longus tendon. We examined 2,000 limbs of Korean to see the presence of the palmaris longus muscle. Among 1,000 persons, the muscle was absent bilaterally in 11 persons(1.1%). It was absent unilaterally in 32 persons(3.2%). The probability that the muscle is absent in any single limb is 2.7%. There was no significant differences in the incidence of absence by sex or right and left side.
Extremities ; Humans ; Incidence ; Tendons ; Tissue Donors ; Transplants

Congenital anomalies of the hand were reviewed, which were treated at Seoul National University Hospital from 1973 to 1982. The Conclusions are as follows. 1. Polydactyly is the most common congenital anomaly of the hand in this series. The next common congenital hand anomalies are trigger digit, syndactyly in that order. 2. Better results had been obtained with early reconstructive surgery within one year after birth. 3. Authors propose a new classification of polydactyly. In Joint type (type 1), the extradigit has its own epiphysis in its origin,and in Epiphyseal plate type (type 2) the extradigit do not have its own epiphyseal plate and seems to be derived from the physis of the more developed adjacent digit. We observed 22 cases of joint type and 10 cases of epiphyseal plate type. 4. 6 cases of macrodactyly had been observed. The complicated reconstructive surgery such as Tsuge and Barsky operation resulted in digital necrosis. So more simple and effective operation such as symphalangization would be attempted.
Classification ; Epiphyses ; Growth Plate ; Hand ; Joints ; Necrosis ; Parturition ; Polydactyly ; Seoul ; Syndactyly ; Trigger Finger Disorder

No abstract available.
Skull Base* ; Skull*

No abstract available in English.
Child ; Hip ; Humans

It appears that frequency of fractures of the aceta ulum is increasing with the number of automobiles on our roads and when they occur they seem to pose difficulties of management. Because, the anatomy of this region is complicated, making surgical approaches difficult. Second, the patients often have major associated injuries, making early operative treatment hazardous. Third, the fractures are often severly comminuted, leading many surgeons to beleave that operative reduction is impossible. Finally, and unfortunately, the fractures are often missed. The aim of treatment must be to restore the fractured acetabulum to its normal anatomy followed by early motion to promote healing and restore function. Undisplaced acetabular fractures have a good prosis with conservative treatment but patients with displaced fractures of the acetabulum not reduced by manipulation and traction should be considered candidates for open reduction. The author experienced 72 cases of acetabular fracture patients who were admitted to the department of Orthopaedic Surgery of Catholic Medical College and Center from January 1979 to August 1983. The results of 48 patients who were followed up over 6 months period were as follows; l. Among 72 cases(44 were male and 28 were female), the most common causes of acetabular fracture was pedestrian struck by car. 2. 56 were treated conservatively and 16 were treated surgically. The result were as follows; Excellent-15(31%), Good-23(48%), Fair-8(17%), Poor-2(4%). 3. 72 cases were classified by Letournel classification. The most common type was posterior wall fracture(14 cases), and second most was T-shaped fracture(13 cases). 4. If the grossly displaced fragments are present they should be reduced and fixed surgically if surgical approach can be done. 5. It is essential to understand the pathologic anatomy of the acetabulum in order to approach the acetabular fracture sefely and with maximum ease.
Acetabulum ; Automobiles ; Classification ; Clinical Study ; Humans ; Male ; Surgeons ; Traction

The instability of the degenerative spondylolisthetic lumbar spine was clinically evaluated by patients symptoms and serial radiograms. With X-ray films of patients lumbar spine, the lumbosacral angle, the sacral angle, the vertebral height difference between anterior and posterior surface of the 5th lumbar vertebra and the level of intercristal line were analysed. And the results of treatment were analysed too. The Results were as follows: 1) In degenerative spondylolisthetic L3 and L4 spines, facets were arranged in sagittal plane and sacrum was vertically arranged, but in L5 facets were coronally arranged and sacrum and in horizontal plane. 2) The lumbosacral angle was 149.9 and the average difference between anterior and posterior height of L5 vertebral body was 3mm. These results revealed that sacrum was more vertical and the 5th vertebral body was more rectangular, so lumbar lordosis was decreased as a whole. 3) The intercristal line was passed at IA or L4–5 interspace in 72.1% of cases(normal:95.8%), so L4 vertebra was placed in higher level. 4) In group A posterolateral fusion was done in 2 cases. Among group B and C, operation was done in 9 cases;4 cases with laminectomy and 5 cases with laminectomy and posterolateral fusion. Two years after surgery, slipping and instability were far advanced in 2 laminectomized cases for whom posterolateral fusion was followed later. 5) Unstable group of degenerative spondylolisthesis with severe neurological symptoms and claudication must be treated by decompressive laminectomy and posterolateral fusion, especially in patients under 60 years of age. 6) Young woman having flattened lumbar curve without slipping, narrowed disc space of L4–5, high-seated L4 and vertical sacrum is thought to be in prespondylolisthetic stage of degenerative origin; therefore, intensive back muscle exercise to prevent the slipping should be performed and periodic X-ray examinations should be followed up to detect the progress of the disease.
Animals ; Back Muscles ; Female ; Humans ; Laminectomy ; Lordosis ; Sacrum ; Spine ; Spondylolisthesis ; X-Ray Film