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

The experience of a replacement surgery of ankylosed elbow joint by the Shiers chrome-cobalt hinge prosthesis is introduced with a brief review of literatures.
Arthroplasty ; Elbow Joint ; Elbow ; Prostheses and Implants

Cutaneous larva migrans(CLM) is a ubiquitous self-limiting skin eruption which has intensely pruritic, serpiginous, raised, sharply demarcated, red lesions. It is most frequently caused by larvae of dog and cat hookworms. We report two typical cases of cutaneous larva migrans that appeared as pruritic exanthems in two people after they had travelled in Southeast Asia. It is suggested one should consider cutaneous larva migrans in the differential diagnoses of erythematous pruritic lesions.
Ancylostomatoidea ; Animals ; Asia, Southeastern ; Cats ; Diagnosis, Differential ; Dogs ; Exanthema ; Larva ; Larva Migrans* ; Skin

The spinal injuries were reported by relatively low incidence than other fracture and dislocation in the body. However, the rate of spine injury tend to increase year by year as the rate of traffic accident and industrial accident have been increased. Authors have experienced 403 cases of various type of injuries from Jan, 1966 to Aug. 1971. They were analysed as follows. 1. Out of 330 patient, males were 212 cases (64.2%) and female 118 (37.8%) Among them 74% of cases were between 20 to 40 years of age. About 51.9% of cases of the spinal injury were caused by traffic road accident. 2. The most most common fracture site in the spinal segments were between 12th thoracic spine and 2nd lumbar spine (69.0%) and most common types of spine injury was simple wedge fracture (70.7%) which is induced by flexion violence. 3. The stable injuries of the spine (69.4% 229 cases) were treated by functional methods such as bed rest, early ambulation. Injured spine were not immobilized in cast. They gave a more functional results than rigidly immobilized group. 4. 27 cases (8.2%) were complicated by paraplegia and mostly (59.3%) were caused by rotational fracture-dislocation. The common site of lesion were between D12-L2 (67.4%) 5. Among the 185 cases who were followed over 6 months, sponetaneous spinal fusion within 6 months after injury occured in 166 cases (89.7%) 76.8% of them were fused within 4 months. 6. Among the 27 paralysed cases, 3 were died within 2 weeks of admission, and 3 cases had complete recovery without residua.
Accidents, Occupational ; Accidents, Traffic ; Bed Rest ; Dislocations ; Early Ambulation ; Female ; Humans ; Incidence ; Male ; Paraplegia ; Spinal Fusion ; Spinal Injuries ; Spine ; Violence

Authors presented the gratifying result of treatment of chronic osteomyelitis with overlying skin defect and/or poor skin condition, which developed the wide skin necrosis after saucerization and resulted the second skin graft necessary. Five cases were treated by primary extensive saucerization of tibia which left a cavity with bleeding walls. The exposed bony surface with bleeding walls was covered by delayed free skin graft when the good granulation covered the bony surface. Through this experience, delayed free skin graft is justified the best procedure in these cases to cover the post-surgical raw bone surface and to have primary healing of the bone infection. A method of hemicylindrical pedunculated skin graft to obliterate the deeply excavated surgical bony defect is introduced.
Hemorrhage ; Methods ; Necrosis ; Osteomyelitis ; Skin ; Tibia ; Transplants

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