Since 1856, Mayer13) coined the term “osteotomy” for a tibial resection for an angular deformity, various shapes and designs of osteotomies in long bone or pelvis have been popularized to treat the malunion, osteoarthritis of hip and knee, bow leg, L.C.P., or C.D.H. etc. The purpose of corrective osteotomy for tibia is so different from that of upper extremity because it must be restored the weight bearing alignment, and equalize or minimize the leg length discrepancy. We respectively reviewed 14 cases with various angular deformities on tibia who were treated at Dept. of Orthopaedic Surgery, Catholic Medical College from Jan. 1976 to Dec. 1984. The results obtained were as follows: 1. Causes of angular or rotational deformities of tibia were malunion in 11, bow leg in 2 and partial closure of distal tibial epiphysis in l. 2. Ten cases of tibial deformities exceeded over the 10° of medial or lateral angulation and 15° of anterior or posterior bowing were corrected for normal weight-bearing alignment in lower leg. And a rotational deformity may be so disabling to walk as to require surgery. So four cases of tibial angular deformities combined with more than 20° of external rotation and 5° of internal rotation were corrected for normal good looking walks. 3. The maximum length that can be gained by an opening wedge osteotomy was near the point of maximum angluation, but it could be changed by the cause of deformity and patient's age. We've done 4 cases of opening and 10 cases of closing wedge osteotomy. 4. Angular deformity in one plane due to fracture in children under 10 years of age may be corrected spontaneously by growth, but deformities due to bow leg or epiphyseal injury cann't be expected any spontaneous correction of deformity by growth. So three cases of tibial deformities due to bow leg or epiphyseal injury in children were corrected in earlier after recognition of that deformities because of possible damage to articular cartilage and the combined rotational deformities. 5. A slight deformity if the angulation involves near a joint, knee or ankle could be seriously disabling and so must be correctcd earlier. 6. Functional results of the corrective wedge osteotomy in angular and rotational deformities of tibia were excellent, good, fair in 4, 7 and 3, respectively.
Ankle ; Cartilage, Articular ; Child ; Congenital Abnormalities ; Epiphyses ; Genu Varum ; Humans ; Knee ; Knee Joint ; Leg ; Numismatics ; Osteoarthritis, Hip ; Osteotomy ; Pelvis ; Tibia ; Upper Extremity ; Weight-Bearing

No abstract available.
Neck*

To study why the palmar capsular connections between radius and lunate remain intact in perilunate ligamentous injury of the wrist joint, and to compare the material properties of the short radiolunate, long radiolunate, and radioscaphoid region of the radioscaphocapitate ligaments (as the extrinsic ligaments) with those of the intrinsic ligaments of the previous papers, the anatomical and mechanical characteristics of those three palmar radiocarpal ligaments of twenty cadavers were measured and tested by a servo-hydraulic test machine. In spite of its small cross-sectional area (24% of short radiolunate ligament), the radioscaphoid ligament demonstrates a failure load of 58% and a stress of 260% of the short radiolunate ligament, and toughness similar to both the short and long radiolunate ligaments. This suggests that the radioscaphocapitate ligament may contribute as an initial constraint to perilunate injury. The failure load of the scapholunate ligament might be smaller than previously reported due to testing strain rate, which coupled with its short initial length may make it more vulnerable to injury at lower applied loads. The short radiolunate ligament, in spite of the largest width and cross-sectional area, has a failure load and toughness similar to the long radiolunate ligament. The material properties of short and long radiolunate ligaments may explain why the rest of the carpals persistently dislocate or fracture about lunate.
Cadaver ; Ligaments* ; Radius ; Wrist Joint ; Wrist*

PURPOSE: To determine the upper limit of peripheral nerve lengthening without loss of function, the recovery time of peripheral nerve palsy due to nerve lengthening and their histological changes. MATERIALS AND METHODS: Twelve adult New Zealand rabbits weighing about 2.5 kg were assigned to the following groups. Group 1 (n=6) was subjected to slow tissue expansion with 30% of nerve lengthening while group 2 (n=6) was rapid expansion with 40% lengthening of nerve. The expanders were refilled every 2 times during the 2nd and 4th weeks making a total four times of expansion. The rabbits were assessed in terms of affected leg paralysis, neural length gain, EMG with nerve conduction velocity and histological changes. RESULTS: In group 1 (n=6), paralysis on affected leg was found in one rabbit and was recovered spontaneously on the 4th weeks after expander removal. In Group 2 (n=6), paralysis was found in four rabbits, and three of them were recovered on 4, 5 and 9 weeks after removal of the expander. EMG study showed increase in distal latency of 2.50+/- 0.20 m/sec, and decrease in nerve conduction velocity of 62.49+/- 5.30 m/sec compared to normal side with 1.89+/- 0.14 m/sec and 75.39+/- 7.82 m/sec. The mean neural length gain was 6 mm (30% of 20 mm of initial pre-experimental nerve length) in group 1 and 8 mm (40% of 20 mm) in group 2. Light microscopic examination revealed the loss of segmental myelination, decrease of myelination, and vacuolation. Electron microscopic examination showed that the normal ring shaped contour of axon was changed to convoluted shape.
Adult ; Axons ; Humans ; Leg ; Myelin Sheath ; Nerve Expansion ; Neural Conduction ; Paralysis ; Peripheral Nerves ; Rabbits ; Sciatic Nerve* ; Tissue Expansion*

Surgical treatment of compressive ulnar neuropathy at the elbow has been performed with a wide variety of techniques. Among these techniques, anterior submuscular transposition of the ulnar nerve has been regarded as the method of choice by many authors. It has many advantages including a low recurrence rate, scar-free vascular bed, and protection from repeated trauma to the nerve. However, anterior submuscular transposition is technically demanding and requires more extensive soft tissue dissection. On the other hand, anterior subfascial transposition is less invasive, requires a relatively shorter operation time than the submuscular technique, and also can be done safely even in patiensts with elbow arthritis. We evaluated the clinical results of anterior submuscular transposition compared with anterior subfascial transposition. Fifteen patients underwent anterior submuscular transposition and ten patients underwent anterior subfascial transposition of the ulnar nerve. The mean follow-up time was 15 months (range 10 to 38 months) in the anterior submuscular transposition group and 7 months (range 6 to 15 months) in the anterior subfascial transposition group. According to the outcome status determination algorithm devised by Mowlavi, 3 patients (20%) showed total relief, 10 patiensts (66.7%) improvement and 2 patients (13.3%) no changes in the anterior submuscular transposition group. In the anterior subfascial transposition group, 2 patients (20%) showed total relief, 7 patients (70%) improvement and 1 patient (10%) displayed no changes. Statistically there was no significant difference of the clinical results between the two surgical techniques. Therefore we would suggest anterior subfascial transposition of the ulnar nerve as a preferred method for treatment of cubital tunnel syndrome.
Arthritis ; Cubital Tunnel Syndrome ; Elbow ; Follow-Up Studies ; Hand ; Humans ; Recurrence ; Ulnar Nerve ; Ulnar Neuropathies

No abstract available.
Spine*

BACKGROUND: We evaluated whether the unilateral spinal anesthesia using a 26-gauge Quincke needle provides more adequate or hemodynamically stable spinal anesthesia than the conventional spinal anesthesia in orthopedic patients. METHODS: Fifty-eight ASA 1 or 2 patients aged from 18 to 65 years undergoing unilateral lower limb surgery were included. All patients were placed in the lateral position with the side to be operated on dependent and received a 8 mg 0.5% hyperbaric bupivacaine through a 26-gauge Quincke spinal needle for 80 seconds. Local anesthetic was injected with the needle orifice turned toward the dependent side, then the immediate supine position (conventional group, n = 34), or the lateral position (unilateral group, n = 24) was maintained for 15 minutes. Hemodynamic variables, as well as loss of cold, pinprick sensation and motor block on both sides were recorded. RESULTS: All the 23 patients in the unilateral group had adequate spinal anesthesia, whereas 6 out of 34 patients of the conventional group (17.6%) had inadequate to failed spinal anesthesia (P < 0.05). There were significant differences in the degree of motor block on the dependent side of lower extremities between the two groups. Motor block of grade 0 to 1 on the dependent side were 23.5% and 0% in the conventional and unilateral group, respectively (P < 0.05). Unilateral sympathetic or sensory block were not observed in the unilateral group. No differences in blood pressure, heart rate changes were observed between the two groups. CONCLUSIONS: The present study does demonstrate clinically relevant advantages of a lateral position for 15 minutes, either in terms of adequacy of spinal anesthesia or differential motor block using a 26-gauge Quincke spinal needle in orthopedic patients.
Anesthesia, Spinal* ; Blood Pressure ; Bupivacaine ; Heart Rate ; Hemodynamics ; Humans ; Lower Extremity ; Needles* ; Orthopedics ; Sensation ; Supine Position

A contrast media is essential for the diagnostic accuracy of vascular structure or soft tissue imaging study. The incidence of extravasation of contrast media is very low (0.03% to 0.17%), but higher (0.25% to 0.9%) when using mechanical infuser. We report a case of 64-year-old female patient suffered from acute compartment syndrome, such as pain, skin discoloration in forearm and limitation of finger movement associated with extravasation of contrast media during the coronary angio-computed tomography.
Compartment Syndromes ; Contrast Media ; Extravasation of Diagnostic and Therapeutic Materials ; Female ; Fingers ; Forearm ; Humans ; Incidence ; Middle Aged ; Skin ; Upper Extremity

PURPOSE: To evaluate clinical and radiological results of SCHT(scapho-capito-hamato-triquetral) fusion in Lichtman stage IIIB or IV Kienbock's disease. MATERIALS AND METHODS: The result of eight cases, operated and followed since December 2002, were analyzed retrospectively. The indication of SCHT fusion was the advanced Kienbock's disease, in Lichtman stage IIIB or IV, with severe fragmentation of lunate. The fragmented lunate was excised and the intercarpal joint between scaphoid and capitate, capitate and hamate, hamate and triquetrum were fused with joint resection, bone graft and multiple K-wires, to make an horse-shoeshaped carpal bone block. The clinical results were evaluated by wrist pain, ROM, any radiologic changes of wrist at last follow-up and Kuschner's method. RESULTS: There were 3 cases of Stage IIIB and 5 cases of stage IV. Mean follow-up period was 28.9 (range 15-53) months, and mean age at the time of operation was 49.4 (range 33~66) years. Two cases were minus ulnar variance, 4 cases were positive and 2 cases were neutral. The wrist range of motion was decreased from 121.8degreesto 90.6degrees(25%). Carpal height ratio was decreased in 1 case. The last follow-up results according to Kuschner's method revealed 4 excellent, 3 good and 1 fair. CONCLUSIONS: SCHT fustion was considered as one of the favorable salvage procedure for the advanced Kienbock's disease. However, biomechanical study using cadaver, long-term follow-up & accumulation of more cases would be needed to confirm its definitive usefulness in the future.
Cadaver ; Carpal Bones ; Carpal Joints ; Follow-Up Studies ; Joints ; Osteonecrosis ; Range of Motion, Articular ; Retrospective Studies ; Transplants ; Wrist

Raynaud's syndrome causes discolorization, ischemic claudication(pain) and necrosis of the digits through insufficiency in the circulation which is induced by intermittent spasms of the digital arteries. From January, 2002 to December, 2004, 10 patients were surgically treated for Raynaud's syndrome. 9 patients were female and 1 patient was male. 2 patients showed unilateral involvement, 8 patients were operated on both hands. 6 patients had necrotic changes on the finger tips due to the disease. Ages ranged from 21 to 60 with an average of 39.1. Ischemic pain, discolorization, and cold intolerance of the digits were the common symptoms. All patients were evaluated with color doppler before the surgery. Two different procedures were applied according to the severity of the disease: Patients with decreased circulation received, what we call a limited digital sympathectomy, i.e. stripping of the adventitia of the ulnar, radial and common digital arteries. An extended procedure, radical digital sympathectomy, was performed on patients with a complete block of circulation. Stripping of the adventitia in these patients also involved the proper digital arteries. Symptoms like discolorization, ischemic pain, and cold intolerance improved immediately after the surgery. The patients did not suffer from pain even with exposure to cold weather. We conclude that digital sympathectomy could improve the symptoms in Raynaud's patients who do not respond to conservative treatment such as calcium channel blocker and other vasodilators.
Adventitia ; Arteries ; Calcium Channels ; Female ; Fingers ; Hand ; Humans ; Male ; Necrosis ; Spasm ; Sympathectomy* ; Vasodilator Agents ; Weather