There are many procedures for stabilizing the foot but all frail feet, all complete drop feet, and all calcaneocavus deformities due to paralysis are best treated by pantalar fusion. Hunt and Thompson advised one stage pantalar arthrodesis by astragalectomy and replacement of the denuded bone in paraiytic feet resulting from poliomyelitis. At the Presbyterian Medical Center, Jeonju, Korea, 12 one stage pantalar arthrodesis were performed between 1973 and 1978 and following observations were made. 1. Seven of the patient had pantalar fusions because of poliomyelitis. 2. Five feet were equinovarus and 4 had frail feet with varying amounts of varus or valgus of the forepart of the foot and of the heel. 3. Nine patients were considered to have a good result, two had a fair and one was failure 4. Length of immobilization was from 13 weeks to 37 weeks and the average length of immobilization was 17 weeks. 5. In one stage pantalar arthrodesis, there was no complication except one non-union and the period of hospitalization was decreased.
Arthrodesis ; Clubfoot ; Congenital Abnormalities ; Foot ; Heel ; Hospitalization ; Humans ; Immobilization ; Jeollabuk-do ; Korea ; Paralysis ; Poliomyelitis ; Protestantism

PURPOSE: This study was performed to determine the optimal treatment volume of patients treating with radiation therapy for intracranial germ cell tumor. MATERIALS AND METHODS: From 1993 to 1998, 19 patients with intracranial germ cell tumors treated by gamma knife radiosurgery were analyzed. The location of tumor was as follows; 9 cases on pineal region, 1 case on suprasellar region, and 9 cases of multiple lesion. 7 patients were pathologically verified; 5 cases of germ cell tumor and 2 cases of non germinomatous germ cell tumor. Tumor volume was ranged from 2.4 cm3 to 74 cm3. Irradiation dose was 10 Gy to 20 Gy with 50% isodose curve. Follow up period was 10 months to 54 months. RESULTS: Recurrences were observed in 14 cases among 19 (74%) patients. Complete remission and partial remission were achieved in 2 (11%) and 10 (53%) respectively. No response was observed in 7 (36 %). 2 cases were recurred within original tumor bed. 6 cases were recurred beyond but contiguous with tumor bed. Ventricular relapses separated from pretreatment tumor bed were 3. Spinal recurrences were 4. Among 8 recurred cases of which tumor volume is smaller than 20 cm3, 2 were recurred within original tumor bed, 4 were recurred beyond but contiguous with tumor bed, and 1 spinal recurrence. Meanwhile, 6 cases of which tumor volume larger than 20 cm3, 1 case was recurred beyond but contiguous with tumor bed, 2 ventricular recurrences separated with original tumor bed, and 3 spinal recurrences. 5 cases which did not show any recurrence sign showed characteristics of single lesion, tumor volume smaller than 20 cm3 and normal tumor marker. All of 4 cases of spinal recurrences happened in the case having ventricular invasion or lesion. Among 9 cases having multiple lesion, only 3 cases recurred within original tumor bed or around tumor bed, the other 6 cases recurred separated from pretreatment tumor bed. CONCLUSION: Gamma knife radiosurgery is not recommended for the treatment of intracranial germ cell tumor. It is because of small treatment volume and inadequate radiation dose that are characteristics of gamma knife radiosurgery. Tumor volume, ventricular invasion or ventricular lesion in multiple lesion are important factors to be considered for the wide field radiation therapy. Tumor volume smaller than 20 cm3, single lesion, no ventricular lesion or invasion, and normal tumor marker are ideal indications for small involved field radiation therapy. Prophylactic spinal irradiation seems to be necessary when there is ventricular lesion, ventricular invasion, and multiple lesions. When the tumor volume is larger than 20 cm3, multiple lesions, abnormal tumor marker, and whole ventricular irradiation or partial brain irradiation would be possible and neoadjuvant chemotherapy would be most beneficial in these group.
Brain ; Drug Therapy ; Follow-Up Studies ; Germ Cells* ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Radiosurgery* ; Recurrence ; Tumor Burden

Acetabular bone deficiencies encountered during the revision hip arthroplasties should be recon- structed to provide the implant stability and to restore the normal center of rotation of hip and the leg length. We revised the loosened acetabular cup by grafting fresh-frozen bulk femoral head and inserting uncemented cup in 17 hips of 15 patients. The average follow-up period was 2 years and 3 months. The acetabular bone deficiencies were type 2A in 6 hips, type 2B in 8, type 3A in 1 and type 3B in 2 by Paprosky's classification. Three blocks of femoral head were grafted in 3 type 3 deficiencies, but only one in type 2 deficiencies. The cup-host bone contact was 41% on the average. However, the cup-host bone contact in the zone I was present only in 12 out of 17 hips and its average was 14%. Incorporation of the allograft into the host bone occurred between 5 months and 1 year and 7 months (average, 8,6 months) after revision surgery. Significant radiographic loosening sign was noted only in 2 hips which had not only type 3B bone deficiencies reconstructed with 3 blocks of femoral head allograft but also no cup-host bone contact in zone I . The bulk allograft of fresh-frozen femoral head demonstrated acceptable results in type 2 acetabular bone deficiencies, although the follow-up period was relatively short. Reconstruction of type 3B acetabular bone deficiencies by using multiple blocks of femoral head allograft had been failed. We presumed that the lack of the graft stability and the intimate contact between the grafts and host bone was the cause of failure.
Acetabulum* ; Allografts* ; Arthroplasty ; Classification ; Follow-Up Studies ; Head* ; Hip ; Humans ; Leg ; Transplants

A total of 188 cases of primary bone tumor was reviewed and analyzed clinically and pathologically at the Department of Orthopaedic Surgery, Presbyterian Medical Center, Jeonju, Korea during the 10 years period from January, 1970 to December, 1979. The results were obtained as follows: 1. 58 cases were benign and 130 cases were malignant. 2. Osteochondroma was the most common benign bone tumor and followed by giant cell tumor, simple bone cyst, osteoma and fibrous dysplasia. 3. Giant cell tumor was 15 cases, which were divided pathologically into benign(Grade I & II) 8 cases and malignant (Grade III) 7 cases. and treated by curretage, curettage & bone graft, arthrodesis, irradiation and amputation. 4. The most common primary malignant bone tumor was osteosarcoma, and it was followed by chondrosarcoma, fibrosarcoma and multiple myeloma. 5. Osteosarcoma was 60 cases and it occured commoly around knee joint area. 6. Treatment of primary malignant bone tumor contained of amputation, chemotherapy and irradiation.
Amputation ; Arthrodesis ; Bone Cysts ; Chondrosarcoma ; Curettage ; Drug Therapy ; Fibrosarcoma ; Giant Cell Tumors ; Jeollabuk-do ; Knee Joint ; Korea ; Multiple Myeloma ; Osteochondroma ; Osteoma ; Osteosarcoma ; Protestantism ; Transplants

The fat embolism is often major camplication of major trauma and demands the attention of physicians treating patients with bony injury. We have experienced 5 cases of fat embolism. In all cases there was a latent period between injury and onset of symptoms. This varied from 16 hours to 48 hours. There was marked variation in clinical presentation and laboratory finidngs. One case was died of complication of fat embolism.
Embolism, Fat ; Humans

The trochanteric region of femur is composed of cancellous bone, and so trochanteric fractures are seldome subject to the complication of non-union or proximal fragment necrosis. Cinicians agree that these fractures should be treated by proper alignment of the fragments and operative internal fixation, but disagreement persists about the type of reduction and the technique of internal fixation. Kaufer said that non-anatomical stable reduction.
Clinical Study ; Femur ; Hip Fractures ; Necrosis

The incidence of spinal tuberculosis has been decreased because of the development of anti-tuberculosis drugs, the use of radical surgical procedures and the improvement in the nations general hygiene. The anterior fusion is the most frequently used surgical measure in the treatment of spinal tuberculosis. One-hundred-eighty cases of spinal tuberculosis were treated by surgery during the 5 years from 1976 to 1980 at Presbyterian Medical Center with the following results: 1. The age distribution showed the peak incidence to be in the third decade. 2. The predilection site was the lumbar area and the percentage was 43.3. 3. In 17.2% of the cases, anti-tuberculosis drug was ingested before surgery. 4. Paraplegia was present in 16.1% of spinal tuberculosis. 5. In paraplegia, most of the location of the involved bodies was in the thoracic and the thoracolumbar vertebrae and the percentage was 79.3. 6. In paraplegia, complete recovery was 82.8%, and incomplete recovery was 10.3%. 7. In 90% of the patients, anterior fusion was done and the union rate was 91%. 8. Kyphosis was the most common in late complication.
Age Distribution ; Clinical Study ; Humans ; Hygiene ; Incidence ; Kyphosis ; Paraplegia ; Protestantism ; Spine ; Tuberculosis, Spinal

Metastatic malignant tumors involving the spine cause destruction of vertebral body, kyphosis and neural deficit. Irradiation relieves the pain and decreases the tumor mass, but sometimes the spine is progressively destroyed and becomes unstable. Traeatment of metastatic tumor involving the spine is difficult. Replacement of the vertebral body with bone cement and high dosage of radiation therapy was recommended by Harrington. The advantages are excision of the tumor mass, firm immobilization and enough irradiation not to recur. Two cases of metastatic carcinoma involving cervical spine were treated by anterior decompression, bone cement fixation and irradiation. One case died seventeen days after surgery due to severe pleural effusion. Another case was treated with irradiation (6,000 rads) after surgery and the pain was relieved. The spine is stable one year after surgery. There is no local recurrence.
Decompression ; Immobilization ; Kyphosis ; Pleural Effusion ; Recurrence ; Spine

After the discovery of penicillin by Fleming in 1939, a great improvement in the treatment of osteomyelitis was obtained and the mortality rate in the acute stage was markedly decreased. But, because of misuse of antibiotics, the resistance of causative organism to antibiotics and the incidence of this disease tended to increase. So, many problems in the treatment and prognosis developed. A clinical study was done of 76 cases of hematogenous osteomyelitis who were treated by authors at the Department of Orthopedic Surgery, Presbyterian Medical Center, from April 1974 to July 1981. The results were as follows: 1. The incidence in males was 1.2 times greater than in females. It occured most often in children between the ages of 11 and 15 years (58%). The most common site of involvement was the tibia and the femur in orders. 2. ESR was elevated in 77% of the patients. 3. The most common causative organism was staphylococcus aureus(+), and the penicillin resistance rate was 86%. 4. The basic management was early decompression and antibiotic administration in acute phase, and saucerization and continuous irrigation in chronic cases. 5. The recurrence was the most common complication.
Anti-Bacterial Agents ; Child ; Clinical Study ; Decompression ; Female ; Femur ; Humans ; Incidence ; Male ; Mortality ; Orthopedics ; Osteomyelitis ; Penicillin Resistance ; Penicillins ; Prognosis ; Protestantism ; Recurrence ; Staphylococcus ; Tibia

Fractures in children differ from those in adults. Because the anatomy, biomechanics, and physiology of a child's skeleton very differ from those of an adult, orthopedic surgeons frequently see differences in the pattern of fractures, the problems of diagnosis, and the method of treatment. So the present study is an clinical analysis of 622 cases of children's fractures under the age of 18 years, who were treated at the department of orthopedic surgery, Presbyterian Medical Center for the past 9 years from 1973 to 1981. Results obtained are as follows: 1. The peak age was 5. 2. The incidence in male was 2 times higher than in female. 3. The most common cause of fractures was traffic accident (65.6% of all cases). 4. The fracture in femur was most common (17.7%). 5. The most common injury combined with fracture was head injury (40.3%). 6. Among the joints elbow was most commonly injuried. 7. The incidence of epiphyseal injury was 10.3%. 8. The most common type of epiphyseal injury by Salter & Harris classification was type II and it's incidence was 57.8% of all epiphyseal injury. 9. 83% of all fractures were conservatively treated. 10. The incidence of complication of all cases was 8.5%.
Accidents, Traffic ; Adult ; Child ; Classification ; Clinical Study ; Craniocerebral Trauma ; Diagnosis ; Elbow ; Female ; Femur ; Humans ; Incidence ; Joints ; Male ; Methods ; Orthopedics ; Physiology ; Protestantism ; Skeleton ; Surgeons