Sixteen cases under the age of 19 were underwent surgical treatment for hernlated lumbar intervertebral disc over 10 years of period in the Department of Orthopaedic Surgery,Catholic Medical College. The results were obtained as follows: 1. The incidence was 5.2% of all herniated lumbar intervertebral disc patients who treated surgically, but no sexual predilection. 2. Nine cases (56.3%) had a definite previous history of injuries. 3. Average intervals between the onset of clinical symptoms and the operation were 9.2 months. 4. Neurologic deficits are less severe and frequent (8 cases, 50%) but the clinical symptoms do not differ from than that of the adult. 5. 7 cases (43.8%) revealed definite reptured lumbar intervertebral discs and 5 cases (31.3%) are diffuse buldging of annular fibers in operative findings. 6. According to histopathological study, 8 cases show degenerative fibrocartilagenous changes in surgical specimen. 7. The radiological abnormalities of lumbar spine are less common than that of the adult. 8. Excellent or good results were found in 12 cases (75%) but two cases required a further surgical procedure. 9. In generally, hernlated Iumbar intervertebral disc in teenagers show better results and more rapid recovery of clinical symptoms by surgical treatment, and less residual symptoms than that of the adult.
Adolescent ; Adult ; Clinical Study ; Humans ; Incidence ; Intervertebral Disc ; Neurologic Manifestations ; Spine

423 cases were underwent surgical treatment for herniated lumbar intervertebral disc during 12 years, and for these cases clinical analysis was done. The result were obtained as follows: 1. Among 423 surgically treated patients 20 are teenagers and male to female ratio was 309 (73.0%) to 114 (27.0%). 184 cases (43.2%) had a definite trauma histories, the types of injuries were lifting weight, direct trauma and slip down in order of frequency. 2. The teenagers had more severe tension sign and stiff back, while neurological dificits were less common in teenagers (45%) than the one in adult(55.2%). Average interval between the onset of clinical symptoms and time of operation were 3.4 months. 3. The definite discal rupture was found in 292 cases (69.0%) and the annular discal bulging were faund in 89 cases (21.0%). The most common site of lesions were between L 4-5 vertebrae (76.8%) and the next between L5-51 and L3-4 vertebrae. 4. The majority of surgically removed discs showed degenerative changes histopathologically. 5. Intervertebral discal space changes on X-ray after surgery were the narrowing of space, eburnation of end plate, spur formation and segmental instability, etc. 6. In this series of disc surgery were persistent backache, tingling and/or numbness in the leg, stiffback and limited S.L.R., etc., and the post-operative complications were subcutaneous hematoma, soft tissue infection, drop foot and diskitis, etc..
Adolescent ; Back Pain ; Clinical Study ; Discitis ; Female ; Foot ; Hematoma ; Humans ; Hypesthesia ; Intervertebral Disc ; Leg ; Lifting ; Male ; Rupture ; Soft Tissue Infections ; Spine

No abstract available in English.
Clinical Study ; Humans ; Upper Extremity

Two collateral ligaments, accessory collateral ligaments, volar plate which prevent hyperextension of digital joints, fibrous flexor sheath which attached to volar plate, intrinsic and extrinsic muscles were contribute to the stability of the digital joints. Among them, two collateral ligaments were most important as a static stabilizer. Especially, the instability of fingers due to the rupture of ulnar collateral ligament of metacarpophalangeal joint of thumb and radial collateral ligament of index will attenuate the pinch power and maybe a cause of chronic painful limited finger motions. So, they should be repaired if ruptured completely. During the period of May 1980 to Oct. 1985, 17 cases of ruptured collateral ligaments 5 cases in thumb, 12 cases in fingers were treated surgically and followed up for average 8 weeks. The results were that normal range of digital joint motion were obtained in 14 cases and instabilities were disappeared in 16 cases and pain free in 12 cases. Therefore, careful clinical evaluation to detact therupture of collateral ligament of dig.ital joint after hand injury and then appropriate management could restore the best function of hand.
Chronic Pain ; Clinical Study ; Collateral Ligaments ; Fingers ; Hand ; Hand Injuries ; Joints ; Metacarpophalangeal Joint ; Muscles ; Reference Values ; Rupture ; Thumb

Despite the technical improvements in Internal flxation of neck fracture were made in recent years, complications, such as non-union of the fracture and avascular necrosis of the femoral head, are not infrequent. Various operative techniques have been proposed to secure the reduced fracture fragment till union, and to restore or improve the circulation in the femoral head. One of them is muscle-pedicle bone graft to the fracture site of neck. It is very important if one can predict the vascularity of the femoral head prior to treatment and also the healing process of the neck fracture during treatment. In the past, there have been considerable investigations to achieve these goal, but no method universally has been accepted as reliable and practical. Among them, Intra-osseous venography (I.O.V.) and sclntimetry utilizing the isotope trace techniques were widely used in recent. Authors adopted a cephalic and trochanteric I.O.V. to observe the fracture healing and to predict viabillty of the femoral head, and also tried a new technique (Indirect cepallc I.O.V.) to perform both techniques of I.O.V. at the same time. With the ald of image Intensifler, a bone marrow needle Is inserted 1 inch below the greater trochanter of femur, and when the tip of the needle is reached 0.5 to 1.0 cm near to fracture line in the marrow cavity, about 25 cc of 75% Urograffin is Injected by speed of 1 cc per second with sereial X-rays taken at 1,3,5 and 15 minutes (trochanteric I.O.V.). Then already inserted puncture needle for trochanteric I.O.V. are more advanced through the fracture line of the neck into the femoral head. About 10 cc of 75% Urograffin Is Injected by speed of 1 cc per second with serial X-rays taken (Indirect cephallc I.O.V.). The merits of this indirect cophalic l.O.V. via trochanteric route is that it is also simple and Practical and there is no significant complication: such as septic arthritis of hlp & thrombophlebitis. Difficulties of inserting the needle through the trochanter and the neck into the head and occasional unwanted hip-arthrogram are listed as the main demerits of this technique. But these demerits can be minimized by the accurate image intensifier control. A positive trochanteric venography is one in which venous drainage is established across the fracture site with opaque contrast medium being spread out diffusely into the head, and eventually draining out into the surrounding soft tissue via draining velns. While positive cephalic venography via trochanteric route is one in which contrast medium is spread out diffusely in the head and trochanteric region via crossing veins. Hereby, we performed internal fixation and an autogenous muscle-bone pedicle graft composed of the quadratus femoris muscle in 4 cases of femoral neck fracture which are confirmed that there are head viability by using of the cephalic I.O.V.. Since then, we checked the both I.O.V. every 6 wks post-operatively. The results seemed to be good in regard to bony union in all 4 cases, and we have also found that cephalic and trochanteric I.O.V. are a useful diagnostic tool in hip fracture.
Arthritis, Infectious ; Bone Marrow ; Drainage ; Femoral Neck Fractures ; Femur Neck ; Femur ; Fracture Healing ; Head ; Hip ; Methods ; Neck ; Necrosis ; Needles ; Phlebography ; Punctures ; Thrombophlebitis ; Transplants ; Veins

One of a fairly common cause of painful hips in children is the transient synovitis which subcide in short time by bed rest. This transient synovitis is also called as observation hip, irritable hip, coxitis serosa seu simplex, transitory hip arthritis, transitory coxitis, acute transient epiphysitis, toxic synovitis, and intermittent hydrathrosis etc. It is not clear what is the exact cause of transient synovitis but many authors agree infection, trauma and allergic conditions can be cause of that disease. The disease is of interest, not because it is a disabling condition, but because of the difficulties encountered in differentiating it from more serious disease of the hip such as Legg-Calve-Perthes disease, tuberculosis, osteomyelitis and etc. Of the 67 cases so diagnosed at the catholic medical college from 1975 to, 1980, 30 were reviewed and reported. Following observation were made: 1. The main symptom was pain of sudden onset in the region of the hip joint with a limp on the: affected side. 2. The patients mean age was 7.4 yrs and the sex ratio of boy & girl revealed 1. 7:1. 3. Radiological abnormalities of the soft tissue shadow of the affected hip joint was noted at 24 cases (80%), among them the gluteal sign(50%) are more prominent than others Bone scanning with Tc was performed at 13 cases. Increased uptake density of radio-active isotopes found at 6 cases (46%). 4. The treatment was conservative including bed rest, skin traction on the affected leg, non weight bearing, antibiotics and anti-inflammatory drug. 5. Two hips among them revealed later as s Legg-Calve-Perthes disease and tuberculous arthritis of hip joint.
Anti-Bacterial Agents ; Arthritis ; Bed Rest ; Child ; Clinical Study ; Female ; Hip Joint ; Hip ; Humans ; Isotopes ; Leg ; Legg-Calve-Perthes Disease ; Male ; Osteomyelitis ; Serous Membrane ; Sex Ratio ; Skin ; Synovitis ; Traction ; Tuberculosis ; Weight-Bearing

The pelvis is a ring structure with strong ligamentous support. This support includes the symphysis pubis, the anterior and posterior sacroiliac ligaments, and the strong sacrospinous and sacrotuberous ligaments. Since the pelvis is a ring, disruption of any protion of the ring is always associated with disruption in another portion of the ring. Massive pelvic disruption is an important and often life threathening injury. It is usually due to a motor vehicle accident, a fall from a height, industrial injury, and so on. The authors reviewed 28 cases of unstable pelvic fracture treated at the orthopaedic department of Catholic Medical Center during the period from January 1975 to December 1980, and the injury was classified according to the Pennal and Tiles method, and analyzed the clinical data as to the cause of mechanical violence, type of fracture and treatment, post-traumatic pelvic instabilities, and the results. The persistant post-traumatic pelvic instability was assessed by physical examination, and Chamberlain and Trostlers stress Roentgen view of the pelvis. The clinical results obtained were as follows: 1. The incidence of the unstable pelvic fracture was 17.7% (28) of all pelvic fractures (158). The incidence of injury in male was approximately 5 times more frequent than female, and most of the patients were in the 3rd to 5th decade of their life. The causes of injury were road accident (54%), coal mine accident and fall from a height in orders. 2. The four-rami fracture with posterior disruption due to the lateral compression injury was the most common type of unstable pelvic fractures. 3. In conservatively treated patients, the pelvic instability persisted in 37.5% (6 in 16 cases) of the cases and all of them necessitated the joint stabilizing operation. Twelve cases were treated operatively. Among them, performed operations include wiring of symphysis pubis in 2 and sacroiliac joint fusion in 4 within 4 weeks after injury. But for the other 6 cases in which pelvic instability persisted in spite of the sufficient conservative treatment, sacroiliac joint fusion or sacroiliac joint fusion together with a symphyseal plate fixation were done. 4. Satisfactory results was obtained in 62.51% (10 in 16 cases) of nonoperated cases, and 91.7% (11 in 12 cases) of operated group. Authors consider that the most important step in the management of traumatic pelvic instability are; firstly the early recognition of the correlation of the fracture-fragments; the fracture mechanism, and the possible presence or the post-traumatic pelvic instability, and secondly finalizing the therapeutic plan. Early surgical stabilization of the duration of the treatment and the residual disability.
Clinical Study ; Coal ; Female ; Humans ; Incidence ; Joints ; Ligaments ; Male ; Methods ; Motor Vehicles ; Pelvis ; Physical Examination ; Pubic Bone ; Sacroiliac Joint ; Violence

No abstract available in English.
Child ; Hip ; Humans

Little is known of the clearance mechanism of blood in the joint and it is still controversial. In order to clarify the possible mechanism of the clearance, rabbits own venous blood was injected into their own right knee joints of twenty-four normal adult rabbits and the opposite left knee joints served as control. The animal were killed at 12 hours, 1, 2, 3, 4, 7, 14 and 21 days after intra-articular injection of autologous blood. For histological and histochemical studies, the fresh synovial tissues were obtained from infrapatellar regions. The sections were stained by the alcian-blue (pH 2.5) for mucopolysaccharides and methylgreen pyronin for ribonucleic acid (R.N.A.). And finally, for metachromasia the sections were stained with toluidine blue (pH 2.5). In hematoxylin-eosin stained preparation, the synovial cells did not show any gross alterations in the early stages of experiment, but there was an increasing infiltreation of some inflammatory cells into the synovial and subsynovial tissues. Many erythrocytes were found lying free between the synovial cells, in the synovial matrix and subsynovial tissues. Any synovial change that shows a patchy thickening of the synovium due to increase in both the size and number of synovial cells and villous proliferation, became marked at the fourth day after experiment. On the seventh day villous proliferation were still seen but persist in an attenuated form. These changes converted to nearly normal from two weeks after experiment. With methyl-green pyronin stain for R.N.A., the synovial cell showed a definite increase in number in pyroninophilic granules and in intensity of staining reaction at two days of hemarthrosis and these findings were seen even in the third week specimens. After 12 hours of experiment, the synovial cells and the matrix showed a quite clear positive reaction with alcine-blue. And these changes showed a most strong positive reactions at 24 hours of experiment. But after 24 hours the synovial cells gradually showed a decreasing tendensy in intensity of staining reaction to alcian-blue. Since the fourth day of experiment the synovial and subsynovial tissues were closer to normal with alcian-blue. Toluidine blue gave only faint metachromasia to the very rarely in the deeper layer of synovium. We confirmed some of the injected erythrocytes escaped from the joint into the synovium and were cleared from the joint, and blood cells are clears from the joint by phagocytosis of synovial cells. It is suggested that these changes correlates with various histological and metabolic changes of the synovial membrane following a experimental hemarthrosis.
Adult ; Animals ; Blood Cells ; Deception ; Erythrocytes ; Glycosaminoglycans ; Hemarthrosis ; Humans ; Injections, Intra-Articular ; Joints ; Knee Joint ; Knee ; Phagocytosis ; Rabbits ; RNA ; Synovial Membrane ; Tolonium Chloride ; United Nations

No abstract available in English.
Arthroplasty ; Elbow ; Fascia Lata ; Fascia