1. Two hundred and fifty cases of fractures of the tibia treated at the orthopedic department of the Catholic Medical College during period of January, 1966 to September, 1971 were subjected to analysis. 2. The evaluation was done according to the classification of Ellis. Among 250 cases of the tibial fractures 120 being mild grade, 63 moderate grade and 67 severe grade. 3. Of 6 groups, 1st group was treated with toe to groin cast, 2nd group was treated with functional below the knee cast, 3rd group was treated with pin & plaster, 4th group was treated with 1–2 screw fixation & wiring, 5th group was treated with plate fixation and 6th group was treated with intramedullary nailing. 4. The healing time is almost proportional to the severity of the fracture grade and also the better prognosis largely depends on the mild grade. 5. We experienced 9 cases of non-union (3.6%), 19 cases of delayed union (7.6%) in most of moderate and severe grade.
Classification ; Fracture Fixation, Intramedullary ; Groin ; Knee ; Orthopedics ; Prognosis ; Tibia ; Tibial Fractures ; Toes

Blunt trauma severe enough to cause fracture of the long bones of the lower extremity may seriously damage adjacent arteries either by direct or indirect force. Diagnosis of disruption or thrombosis by this combination of injuries, is frequently delayed until the opportunity to salvage the extremity is lost. This error will result in an excessively high amputation rate. From September 1971 to August 1972, six Cases with or without fracture were treated at the Orthopedic Department of the Catholic Medical College. Of these six, three resulted in amputation by losing the chance to make the early diagnosis of injury.
Amputation ; Arteries ; Diagnosis ; Early Diagnosis ; Extremities ; Lower Extremity ; Orthopedics ; Thrombosis ; Vascular System Injuries

Just as hyperbetalipoproteinemia is the most common kind of familiar hyperlipoproteinemia, hyperprebetalipoproteinemia or increased very low density lipoprotein (VLDL) and its associated hypertriglyceridemia is an abnormality frequently found in association with several metabolic and nutritional disorders. This VLDL abnormality is demonstrable in high percentage of insulin dependent diabetic children before they receive treatment. It is also observed in many older, overweight, insulin resistant diabetic, with poor control of diabetes. An elevation of VLDL was also observed after ethanol intake. A mild to moderate degree of VLDL elevation is the most frequently observed from of clinical hyperlipidemia. Many investigators reported that hyperprebetalipoproteinemia (hypertriglyceridemia) is associated with an increasing incidence of coronary artery disease. As opposed to hyperbetalipoproteinemia, hyperprebetalipoproteinemia is prone to influence on the development of atherosclerosis in the middle and older aged persons which indicates the importance of triglyceride determination in these aged groups. There has been relatively rare study reported on the triglyceride metabolism in patients with congestive heart failure, essential hypertension and liver disease in Korea. This study was designed to determine serum triglyceride, free fatty acid and glycerol in the disease mentioned in Busan University Hospital between jan. 1975 and December 1976 and analized the change of lipid profile in each different condition. The results were as follows; 1. The mean of serum FFA, triglyceride and glycerol in the 37 normal were as follows 502.32+/-146.54microEq/L, 111.84+/-40.53mg% and 432.00+/-212.13microM/ml. 2. 23 patients with congestive heart failure showed a significant reduction in serum triglycerides (91.96+/-27.80mg%) and a significant increase in serum free fatty acid (576.77+/-129.67microEqL) and glycerol (432.50+/-212.13microM/ml). 3. In 15 patients with essential hypertension a significant elevation of serum triglycerides (149.38+/-42.28mg%) was noted. 4. In 13 patients with liver cirrhosis, a reduction in serum triglycerides (80.50+/-34.27mg%) was noted.
Atherosclerosis ; Busan ; Child ; Coronary Artery Disease ; Estrogens, Conjugated (USP)* ; Ethanol ; Glycerol* ; Heart Failure* ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II ; Hyperlipoproteinemia Type IV ; Hyperlipoproteinemias ; Hypertension* ; Hypertriglyceridemia ; Incidence ; Insulin ; Korea ; Lipoproteins ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Metabolism ; Nutrition Disorders ; Overweight ; Research Personnel ; Triglycerides*

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

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

Subtrochanteric fracture is well known for its difficulty in management, though various devices of rigid fixation have been developed. Each internal fixation device requires a lot of surgical instruments and the surgeon must be skillful in using them. Osteo self-compression plate which was preoperatively bent to fit the contour of the lateral surface of the subtrochanteric region was proved to be technically easy to fix these fractures without causing major complication. Present authors recommend to use this prebent Osteo self-compression device to treat this fracture when the surgical instruments are not fully equipped, and suitable fixation devices are not available, and/or the surgeon has no experience in handling the newly developed surgical instruments for the subtrochanteric fracture.
Internal Fixators ; Surgical Instruments

The intra-articular osteochondroma arising from soft tissue is very rare and has been reported less than a dozen cases in the English literature. This tumor is the result of extrasynovial metaplasia of the fibrous capsule or of the adjacent connective tissue of a joint. The authors experienced a case of giant intra-articular osteochondroma of the right knee in a 37 year-old man which arised from the medial meniscus. Histology as well as gross findings were consistent with osteochondroma. Excision of the mass with attached meniscus relieved symptoms. No recurrence, or malignant change was identified up to 1 year after excision.
Connective Tissue ; Joints ; Knee ; Menisci, Tibial ; Metaplasia ; Osteochondroma ; Recurrence

Diaphyseal fractures of the long bone associated with massive soft tissue injury or severe comminution is difficult to treat. Fracture healing is often delayed due to the damaged soft tissue, deep seated wound infection, fracture instability and poor local circulation. The delayed fracture healing necessitates prolonged immobilization of the limb which results in joint stiffness. Various type of fracture treatment was suggested for this type of fractures to ease the treatment. The Wagner's apparatus was one of the device to treat it, which was originally introduced as a device for controlled leg lengthening. Its use also has been expanded to serve as a rigid unilateral external fixation frame for fracture. In order to obtain satisfactory fracture union without adjacent joint contracture, the Wagner's apparatus has been employed by us in three cases who were hospitalized in Kangnam St. May's Hospital. The experience of this technique was very encouraging; therefore we recommend its wide application in fracture treatment in cases of the patient who can not receive the bilateral external fixation frame.
Contracture ; Extremities ; Fracture Healing ; Humans ; Immobilization ; Joints ; Leg ; Lower Extremity ; Soft Tissue Injuries ; Wound Infection