Thyroid hormones have a direct or indirect effect upon longitudinal bone growth and maturation. Deficient levels of thyroid hormone during the growth period are reflected in the skeleton by reduced proliferaion and maturation of chondrocytes, slowed endochondral ossification and delayed epiphyseal closure, Murray (1977) reported symmetrical malformation from multiple centers of ossification within large epiphyses, especially those of the femoral and humeral heads, gives a false impression of fragmentation of these structures. Occasionally a coxa vara deformity may develop. The apparent fragmentation of the capital epiphyses, due in reality to multicentric ossification, might suggest bilateral Partbes diseas, but it would be excessively unusual to find aymmetrical and equal development of Perthes disease of each hip Even though this condition is bilateral in 10 per cent of the cases, the changes are almost always consecutive rather than concurrent, so that symmetrical involvement is highly unusal. Teplick (1976) has shown in the adult, hypothyroid bone abnormalities are less common, These include coxa vara with flattened femoral head. Monroe (1935) reported arthritic changes of the character of the osteoarthritis are common among patients developing myxedema during adult life, Thomas (1933) and Cushing (1937) reported that articular changes occur in about a third of the hypertrophic osteo-arthropathy cases and consist of a synovitis which may progress to actual erosion of the articular surface and analylosis. (continued...)
Adult ; Bone Development ; Cartilage, Articular ; Chondrocytes ; Congenital Abnormalities ; Coxa Vara ; Epiphyses ; Head ; Hip ; Humans ; Humeral Head ; Hypothyroidism ; Legg-Calve-Perthes Disease ; Myxedema ; Osteoarthritis ; Skeleton ; Synovitis ; Thyroid Gland ; Thyroid Hormones

It has been shown that by applying microsurgical techniques to ensure adequate circulation and innervation it is now feasible for free whole muscle grafts to be used as a restoring lost motor power that cannot be reconstructed by simpler means such as tendon transfer. The causes of lost motor power have been direct trauma to the foream, producing loss of musculature secondary to Volkmanns ischemic paralysis, electrical burns or peripheral nerve injury. However, the status of graft in this condition is not yet clear. The purpose of this investigation was to evaluate the morphology of microsurgically grafted muscle by light microscopic and electron microscopic studies and the function of the muscle by the application of electromyography. Sixteen mogrel dogs were divided into two groups. In group I the cranial part of the sartorius muscle was transferred heterotopically, and in group II the cranial part of the sartorius muscle was transferred orthotopically. The results were summerized as follows; 1. The successful rate of grafted muscles using microsurgical technique was 82%. 2. The transplanted muscles could return almost to normal histologically, histochemically and electromyographically. 3. The evidence of the functional recovery of the successfully transplanted muscle may point the way to clinical application of this procedure.
Animals ; Burns ; Dogs ; Electromyography ; Muscles ; Paralysis ; Peripheral Nerve Injuries ; Tendon Transfer ; Transplantation ; Transplants

The purpose of this investigation was to establish that epiphyses could survive and grow when preserving the endosteal and periosteal blood supply in free vascularized long bone including epiphysis grafts. These were compared to nonvascularized free bone transfers and normal controls. Sixteen mongrel puppies 4 months old, were used and were sacrificed 6 months later. Group I (Heterotopic radius transfers): On 8 puppies bilateral, heterotopic radius transfers were performed by exchanging the proximal 8 cm of the radius from one foreleg to the opposite one. In one foreleg the palmar interosseus artery and a concomitant vein were anastomosed to the recipient site vessels after bone fixation, while in the other one vessels were not anastomosed. Group II (Orthotopic radius transfers): On 8 animals in one foreleg, the proximal 8 cm of the radius was excised and replaced to the original site with vascular anastomoses. In opposite foreleg, radiopaque metal marker was inserted in the shaft Scm distal to the radial head for radiological investigation of growth which served as normal controls. All animals were followed with serial scanograms immediately, 2 weeks and 4 weeks postoperatively, and then monthly for 6 months after surgery. Brachial arteriograms were made 4 months after operation. Results: In Group I and II, X-ray showed solid bony unions at the osteotomy sites. In all 16 instances of vascularized bone grafts, the anastomosed vessels were patent on arteriograms performed 4 months postoperatively. The proximal radial epiphyses closed by 2 weeks to 1 month in nonvascularized heterotopic grafts. In vascularized heterotopic and orthotopic grafts, the proximal radial epiphyses closed at 5 months. In normal controls, the epiphyses closed at 6 months. In the vascularized heterotopic grafts, the longitudinal growth of grafted bones averaged 1.5 cm (12% increase to the initial entire radii). In the vascularized orthotopic grafts, the longitudinal growth averaged 1.6cm(13% increase). In the nonvascularized heterotopic grafts, the growth averaged 0.3cm(3% increase) and in the normal controls the growth averaged 2.4 cm (21 % increase). There were statistically significant differences in the final growth between the normal controls and the vascularized orthotopic grafts(p<0.025) or the vascularized heterotopic grafts(p<0.010), and between the nonvascularized grafts and the vascularized orthotopic grafts (p<0.005) or the vascularized heterotopic grafts (p<0.010). No significant differences were found between the vascularized orthotopic and heterotopic transfers (p>0.500). The growth in the vascularized grafts was 65% of normal radial growth.
Animals ; Arteries ; Epiphyses ; Head ; Osteotomy ; Radius ; Transplants ; Veins

Free vascularized fibula is often used in orthopaedic reconstructive surgery because the fibula is a straight cortical bone, long enough, and has a long vascular pedicle. But morbidity is occurred at the donor site which may cause problems at the ankle in children. We reviewed 10 causes who had free vascularized fibula transfer at the Department of Orthopaedic Surgery, Yonsei University College of Medicine from January 1984 to June 1989. This study is attempted to evaluat the effects of fibular defect on the ankle in children and the results of treatment. Free vascularized fibula transfer was done in 5 cases due to ossifying fibroma, 3 cases due to nonunion of fracture and 2 cases due to congenital pseudoarthrosis. The average valgus deformity was 3 degrees in 2 cases in which distal tibiofibular fixation was done with one screw and 6 degrees in 8 cases in in which distal tibiofibular fixation was not done. Three cases had severe valgus deformity and secondary operation was done. The attended type of operation was distal tibiofibular fusion in 3 cases. The valgus deformity was changed after distal tibiofibular fusion from 4 degrees to 3 degrees in 3 cases. The size of fibular defect did not effect on the degree of valgus deformity of the ankle. In conclusion, fibular defect can cause valgus deformity of the ankle in children and early distal tibiofibular fusion is recommended to prevent valgus deformity of the ankle in growing child who as defect on fibular.
Ankle ; Child ; Congenital Abnormalities ; Fibroma, Ossifying ; Fibula ; Humans ; Pseudarthrosis ; Tissue Donors

Poliomyelitis was first described in medical literature in 1789 by Underwood, an English physician. In 1909, Landsteiner and Popper confirmed the etiology of the poliomyelitis from a virus. Thereafter with clinical application of Salk and Sabin vaccinations, and marked improvements in control of poliomyelitis, the incidence of this disease has markedly decreased in developed nations. In Korea, Miyoshi was the first to report an epidemic of poliomyelitis in Dae Goo in 1939. Statistical analysis is presented of 752 cases of the late effects of the poliomyelitis who were admitted to Orthopedic Department of the Severance Hospital during the ten year period from Jan. 1961 to Dec. 1971. Results of this study are as follows: 1. The incidence in males was greater than in females (males 59.3%, females 40.7%). 2. 95.3% of the 752 cases were found to occur under the age of four years, and highest peak by age occurred between 12 and 24 months (38.7%) 3. The peak duration of deformities was from 3 years to 5 years (29.1%) 4. Difference between the incidences of the city and of the rural areas was not determined. There was no difference between the age distribution of the onset in Seoul, in the medium-sized cities and in rural areas. 5. Paralytic poliomyelitis was observed even in vaccinated children 2.5% of total cases after one injection of Salk vaccine, 1.6% after two injections of Salk vaccine, and 1.3% after three injections of Salk vaccine, and 0.2% followed a combination of Salk and Sabin vaccination. 6. Deformity of the upper extremity was only 1.2% of that of the total body. But deformity of the lower extremity was 93.9% of the total. There was no difference between the deformities in both sides. In deformities of the lower extremities, deformities of the foot were most common (29.3% of the total), those of the knee 21.3%, those of the hip 10.9%, those of the toes 8.6% and those of the legs were 8.0% Deformities of the spines were 4.4% and those of the pelvis were 0.5%. In individual deformities, discrepancy in leg length was most common (15.8% of the total), equinovalgus 7.9%, external tibial torsion 7.7%, claw toe 6.8%, equnovarus 6.2%, knock knee 5.6% and combination of flexion, abduction and external rotation of the hip was 5.4%. 7. The locations of the paralyses were found to be 90.7% in the lower extremities, 7.6% in the upper extremities, 1.5% in the trunk and 0.2% in the neck. In involvement of the upper extremities, the most frequent were in the Triceps brachii (0.5% of involvements of the total body muscles), Deltoideus (0.5%) & Biceps brachii (0.4%). In the involvement of the lower extremity, Tibialis anterior was found to be the most frequent (6.1% of invelvements of the total body muscles), Iliopsoas 6.1%, Quadriceps 6.1% and Tibialis posterior was 6.0%. Generally, the muscles of the upper extremity were more frequently affected in mild involvement than in severe involvement except that the Opponens pollicis was slightly more frequently affected in severe involvement than in mild involvement. However the muscles of the lower extremities were slightly more frequently affected in severe involvement than in mild involvement. Especially the Tibialis anterior, Quadriceps, Tibialis posterior, and hip adductors were more frequently affected in severe involvement than in mild involvement. Generally in the muscles of the upper and lower extremities, the proximal muscles were involved more frequently than that of the distal. There was no difference between the frequencies of the invelvements of right and left sides. 8. Taking associated paralysis into account it was shown that certain muscles that receive nerve supply from the same segment were paralysis or weakened together. Tibialis anterior and Tibialis posterior, Quadriceps and hip adductors, Quadriceps and hip flexors were the most numerous combinations of the associated paralysis. 9. Looking at spinal segment innervation in relation to miId affection of muscles, the highest incidence was found in the first lumbar segment. In segment incidence of severe paralysis the highest incidence was found in the second and third lumbar segments.
Age Distribution ; Child ; Congenital Abnormalities ; Daegu ; Developed Countries ; Female ; Foot ; Genu Valgum ; Hammer Toe Syndrome ; Hip ; Humans ; Incidence ; Knee ; Korea ; Leg ; Lower Extremity ; Male ; Muscles ; Neck ; Orthopedics ; Paralysis ; Pelvis ; Poliomyelitis ; Poliovirus Vaccine, Inactivated ; Seoul ; Spine ; Statistics as Topic ; Toes ; Upper Extremity ; Vaccination

OBJECTIVES: To induce osteogenesis of cultured mesenchymal stem cells(MSCs) isolated from rat bone marrow in vitro and in vivo. METHODS: Bone marrow cells were isolated from Spraugue-Dawley rats and seeded in culture medium. MSCs were isolated from bone marrow cells and cultured. For in vitro induction of osteogenesis, MSCs were cultured in osteogenic medium. After 2 weeks, evaluation of osteogenesis was performed with alkaline phosphatase(ALP) activity, ALP immunochemical stain, von-Kossa stain for mineral deposition, and Northern blot analysis for osteocalcin m-RNA. For in vivo induction of osteogenesis, MSCs were seeded on Collagraft strips. The Collagraft strips seeded with MSCs were grafted in the subcutaneous tissue of the back of immunocompromised rats. Grafted Collagraft strips were harvested 3, 6, 9, 12 weeks after graft and stained with H-e ad toluidine blue-O stai. RESULTS: In vitro assay ALP activity was 121.27 p-nitrophenol nmol/106cell in osteogenesis induced MSCs and 75.53 p-nitrophenaol nmol/106cell in control groups. Osteogenesis induced MSCs were stongly stained by ALP immunochemical stain. Von Kossa stain showed black mineral deposition. There were strong bands in Northern blot analysis for osteocalcin m-RNA. H-E stain showed penetratin of cellular component into the pores of Collagraft strip in all specimen and showed formation of osteoid from 6 weeks after graft. Toluidine blue-O stain showed blue staining cartilagious component from 3 weeks after grafting. CONCLUSION: We could induce osteogenesis from mesenchymal stem cells in vitro and in vivo. Based on the results of this study, bone graft might be able to replaced by a new method in the near future.
Animals ; Blotting, Northern ; Bone Marrow Cells ; Bone Marrow* ; Mesenchymal Stromal Cells* ; Osteocalcin ; Osteogenesis* ; Rats* ; Subcutaneous Tissue ; Transplants

Thirty years ago a major arterial laceration was devasting injury, threatening survival of the limb in almost every case. Increased awareness of vascular injuries and of feasibility of immediate and more advanced arterial repair techmique reduced the amputation rate. The authors reviewed 163 patients of vascular injuries in extremities, who were admitted to Severence Hospital of the Yonsei University College of Medicine from January, 1979 to December, 1986. The results were follows : 1. Among the 163 patients, 146 patients were male patients. 2. Most of the victims were in their twenties. 3. The most common cause in the upper extremity was glass injury. The most common cause in the lower extremity was being struck by moving vehicles. 4. More complications in vascular injuries were associated with severe soft tissue crushing and comminuted fracture of the bone. 5. More favorable results can be gained through the use of microvascular techniques than through conventional techniques in vascular reconstruction.
Amputation ; Clinical Study ; Extremities ; Fractures, Comminuted ; Glass ; Humans ; Lacerations ; Lower Extremity ; Male ; Upper Extremity ; Vascular System Injuries

The Marjolin's ulcer is the malignant lesion developed in a burn scar or chronic fistula. Due to the low prevlalence of this lesion, there has been disagreement in its clinical features, methods of treatment, and prognosis. We evaluated 19 cases of patients who had been admitted to Severence Hospital from Jan. 1970 to Dec. 1958. The results were as follows : 1. The previous lesion was burn scar in 52% of the cases and fistula of chronic osteomyel-itis in 32%. 2. The mean latent period was 31.5 years. 3. The initial symptoms were increased pain(74%), discharge with foul odor(68%) and bleeding(58%). 4. Upon histological examination, all of the cases were squamous cell carcinoma. 5. The rate of recurrence of metastasis at time of diagnosis was 32%. 6. Of the 16 patients treated by surgery, local recurrence was noted in 4 cases. Three of these cases were patients who had been treated by excision and split thickness skin graft. 7. The time interval for local recurrence ranged from 6 months to 11 months(average 8. 8 months). In conclusion, the squauious cell carcinoma of the Marjolin's ulcer seems to have a worse prognosis than other squamous cell carcinoma and it requres aggressive treatment. The burn scar or chronic fistula that occured in elderly patients especially required more adequste treatment and close observation.
Aged ; Burns ; Carcinoma, Squamous Cell ; Cicatrix ; Clinical Study ; Diagnosis ; Fistula ; Humans ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Skin ; Transplants ; Ulcer

In 1973, Daniel and Taylor reported the first successful microsurgical transplantation of the groin flap as a one-stage reconstrutive procedure. The free vascularized groin flap has several advantages, such as its potenitally large size, comfortable position of the patient during operation, minimal donor site morbidity, possible coverage of the donor site scar with a bikini, its multiple arterial and venous system, and the potential for incorporating bone with the overlying skin. The authors perfomed free groin flaps in 36 patients at Severance Hospital, Yonsei University College of Medicine from January 1985 to August 1988. The results were as follows : 1. Good results were obtained in 26 of 36 cases with a 72.2% success rate. The results were better in the upper extremity than the lower extremity. 2. The anatomical classification of the superficial circumflex iliac artery was as follows : a common origin of the superficial circumflex iliac artery and the superficial inferior epigastric artery in 39.5% of cases, an absent superficial inferior epigastric artery with a large compensatory superficial circumflex iliac artery in 36.8%, separate origins of the two vessels in 7.9%, and an origin from a profunda femoral artery in 15.8%. This result was similar to that of Daniel and Taylor. 3. The average diameter of the artery was 1.0mm and the average length of the vascular pedicle was 9.0mm. 4. The results were better in the end to side anastomosis than the end to end anastomosis, but there was no statistical significance. 5. In the 10 failed cases, free scapular flaps were performed in 4 cases, skin grafts in 5 cases, and the cross leg flap in one case. 6. The donor sites healed well by primary closure without functional disturbance except in one cases in which secondary closure was done. In conclusion, the free vascularized groin flap can be used without restriction as a onestage reconstruction of an extensive soft tissue injury of the extremity.
Arteries ; Cicatrix ; Classification ; Epigastric Arteries ; Extremities ; Femoral Artery ; Groin ; Humans ; Iliac Artery ; Leg ; Lower Extremity ; Skin ; Soft Tissue Injuries ; Tissue Donors ; Transplants ; Upper Extremity

The trestment of extensive soft tissue injury of the extremities is known to be one difficulty in the field of Orthopedic Surgery. The authors present a study of 55 free vascularized scapular flaps, 12 free vascularized parascapular flaps and 9 combined scapular and latissimus dorsi flaps for extensive soft tissue injury of the extremities at the Department of Orthopedic Surgery, Severance Hospital from March 1983 to December 1988. The results of the study are as follows:1. The pedicles of the flap were consistent in length and diameter. 2. The flap was uniform and relatively thin in thickness in free scapular and psrascapular flaps 3. There was no limitation to motion of the shoulder despite excision of the scapular and parascapular flap. 4. Primary closure of the donor flap was feasible in almost all cases. 5. Reconstruction of a 1arge soft tissue defect was possible with scapular and parascapular flap in one stage. 6. The free vaseularized scapular flap and parascapular flap would be recommended of one-stage reconstructional surgery for extensive soft tissue defects.
Clothing ; Extremities ; Humans ; Orthopedics ; Shoulder ; Soft Tissue Injuries ; Superficial Back Muscles ; Tissue Donors