To evaluate the neurologic and functional improvement of anterior decompression and fusion in patients with cervical spin injury, the clinical records and x-rays of 17 patients who were treated at Gyeong-Sang National University Hospital between January 1989 and December 1993 were analyzed. The results were as follows 1. There were complete injuries of the cord in six cases, incomplete injuries in nine and nerve root injuries in two. All the patients were treated using anterior decompression and autogenous iliac bone graft with cervical plate fixation within 7 days after trauma. 2. The average time lapse from the operation to radiological union was 9.2 weeks(range;7–14 weeks). 3. The prognosis for neurologic recovery mainly depends on the severity of the initial neurologic status. The recoveries of neurologic deficit were complete in four cases, partial in ten and none in three. The motor index improved from 45.6 to 64.6 and the modified Barthel index was 71.2 points at the last follow-up. 4. The clinical results were excellent in nine cases, good in three, fair in two and poor in three. In conclusion, anterior decompression and fusion with bone graft and cervical plate provided early mobilization and rehabilitation, and improved neurological function in a considerable portion of the patient who had neurologic deficits after cervical spine injuries.
Decompression ; Early Ambulation ; Follow-Up Studies ; Humans ; Neurologic Manifestations ; Prognosis ; Rehabilitation ; Spine ; Transplants

The tibia is the most commonly fractured bone of all the long bones. In this age of vehicular accidents, the tibia is frequently subjected to high energy trauma. Anatomically the tibia has poor soft tissue coverage and poor blood supply. Therefore severe injury on the tibia can lead to severe complication and major disability. 41 adult patients with comminuted fracture of the tibial shaft were treated by OR/IF with D.C.P. and bone graft at the Department of Orthopedic Surgery, Kyungpook University Hospital from January 1978 to June 1986. These were analysed according to mechanism of injury, degree of comminution, timing of operation, soft tissue injury and operation time. Bone union and end results of treatment were reviewed. The results were as follows Of 41 cases, causes of injury were vehicular accident in 32 cases. 34 cases had associated injury on other part of body and average injury per case was 1.7 injuries. Based on the classification of Johner and Wruhs, the B group with butterfly fragment was 27 cases and C group was 14 cases. Among the B group, B2 was most common as 14 cases. Average union time was 18 weeks and delayed union and nonunion were 6 cases. Degree of comminution of fracture might be important fractor to bone union. According to the end result of Johner and Wruhs, excellent and good were 31, fair and poor were 10. Of the 41 cases, 10 cases had permanent disability. 4 cases had angular and rotational deformity alone and 1 case had shortening of tibia more than 1 cm, 1 case had both of them. Limited R.O.M. of ankle joint (>50%) occured in 4 cases. The post-operative infection occured in 6 cases, 3 were superficial infection but 3 cases were osteomyelitis. OR/IF with D.C.P. on comminuted tibial shaft fracture was a risk operation. Therefore proper method of treatment should be selected according to degree of comminution, timing of operation, presence or abscence of open wound and associated injury.
Adult ; Ankle Joint ; Butterflies ; Classification ; Clinical Study ; Congenital Abnormalities ; Fractures, Comminuted ; Gyeongsangbuk-do ; Humans ; Methods ; Orthopedics ; Osteomyelitis ; Soft Tissue Injuries ; Tibia ; Transplants ; Wounds and Injuries

Soft tissue defect on dorsum of hand requires immediate soft tissue cover to achieve early wound closure and to minimize wound infection and scarring. If the tendon or bone was exposed and the deep structures were absent, flap was required to provide adequate protection and allow proper function of the underlying structures. Small size in skin loss can easily be covered with local flaps but major defects involving the dorsal aspect of the hand should be coverd with distant flaps, free flaps or radial forearm flaps. Techniques in distant flaps require staged procedures and free flap transfer to obtain soft tissue cover in a single stage require microsurgical techniques. The reverse radial forearm flap is a fasciocutaneous flap based on the radial artery which together with its two venae comitantes lies invested in a condensation of the deep fascia known as the lateral intermuscular septum. The authors had treated 5 cases of distally based reverse forearm flap for soft tissue reconstruction on 2 patients of crushing injury with soft tissue defect on hand, a patient with Marjolin's ulcer on dorsum of hand due to previous burn scar and a patient with soft tissue necrosis on dorsum of both hands due to extravasation of adriamycin during chemotherapy. It has proved to be one of the saftest, simple and effective one-stage method of soft tissue reconstruction in hand without long term immobilization. The results of these operation in cover of soft tissue defect have been satisfactory.
Burns ; Cicatrix ; Doxorubicin ; Drug Therapy ; Fascia ; Forearm ; Free Tissue Flaps ; Hand ; Humans ; Immobilization ; Methods ; Necrosis ; Radial Artery ; Skin ; Tendons ; Ulcer ; Wound Infection ; Wounds and Injuries

Urge incontinence with uninhibited detrusor contraction has been known to be a typical findings observed in the supraspinal neurologic disorders such as cerebrovascular accident(CVA). However, voiding difficulty with significant amounts of residual urine are frequently noted in the patients with organic brain diseases. Also, little is known about the exact causes of voiding difficulty in aged people without obstruction. Herein, Resnik at all have identified a specific physiological abnormality-detrusor hyperreflexia with impaired contractility (DHIC)- a distinct physiological subset of detrusor hyperreflexia. DHIC presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. We evaluated the symptoms and urodynamic findings for the 50 patients with supraspinal neuropathies and, also for the 28 elderly peoples complaining voiding dysfunction without evidence of bladder outlet obstruction or, pathologies in the brain. Of the 50 patients with parenchymal brain disease, 41 had CVA, 6 had Parkinson's disease and, 3 had senile dementia. Age of patients ranged from 52 to 89 years and 63 patients of them was man. As a results of urodynamic study; DHIC was noted in 36, DH (detrusor hyperreflexia) in 24, DH with obstructive pattern in 8, ID (impaired detrusor contractility) in 5, normal findings in 5 patients. Of the 36 patients with DHIC, CVA were noted in 19, senile dementia in 1, and, normal aged peoples in 16 cases. In 24 patients with DH, CVA were noted in 9, senile dementia in 1, Parkinson's disease in 6 and, normal aged peoples in 8 cases. Of the 8 patients showed DH with obstruction, CVA was present in 7 and, senile dementia in 1 cases. Of the 5 patients with IDC, CVA was present in 2 and, normal aged peoples in 3 cases. Patients showed DHIC, DH with obstruction and IDC complained obstructive symptoms more frequently than irritative symptoms. On the contrary, DH patients complained irritative symptoms more frequently than obstructive symptoms. Mean fraction of volume voided was 48% in DHIC and 23% in DH with obstruction, which were significantly less than 77% in DH. With this study, hyperreflexic contraction of detrusor was observed in 68(87%), and decreased contractility in 41 patients(53%). The fact that the patients showed DHIC was substantially older than those with DH may imply the decreased contractile function of the detrusor muscle by the aging process. It is also interesting that more than 90% (27/28) of the aged peoples without any pathologies exhibited abnormal findings in urodynamic study explain that the aging process itself may induce the changes of the bladder contractility. Urge incontinence due to DH has been known to be the most common findings in supraspinal lesion. However, these results showed that the impairment of detrusor contractility was also commonly found in the patients with supraspinal lesions and, in aged peoples. Treatment for the DHIC seem to be a dilemma for both the patients and physicians, and it may need emptying of residual urine in addition to the administration of anticholinergics or smooth muscle relaxants.
Aged ; Aging ; Alzheimer Disease ; Brain ; Brain Diseases ; Cholinergic Antagonists ; Humans ; Muscle, Smooth ; Nervous System Diseases ; Parkinson Disease ; Pathology ; Reflex, Abnormal* ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Incontinence, Urge ; Urodynamics

No abstract available.
National Health Programs*

Although joint infection with severe destruction remains a serious problem and severe bone loss is relative contraindication of arthrodesis, knee arthrodesis is most commonly a salvage procedure. Its goals are to relieve pain and restore the patient to functional level of activity. The purpose of this study is to evaluate the results and complications of Ilizarov method for knee arthrodesis in the presence of infection. We retrospectively reviewed the records of twelve patients who had managed with knee arthrodesis with Ilizarov method. Indications for the operation included a infected skeletal defect secondary severe open trauma in four patients, an infection at the site of an arthroplasty in three (with failure of previous arthrodesis with monofixator in one), an infected charcot joint in four and one pyogenic arthritis spreading from osteomyelitis of proximal tibia. The average age of the patients at the time of operation was fifty-three years (range twenty-two to eighty years). Follow-up averaged 17 months. The minimum follow up periods was 9 months. Average duration of Ilizarov fixator application was 7.2 months. In 3 cases we performed corticotomy and internal bone transport to treat large bone defect (17cm, 8cm, 6.5cm). Autoiliac bone graft was done in fusion site in two cases, and in three cases we performed bone graft at the docking site. Solid osseous union occured in each patient. There was no reinfection and nonunion. Average shortening was 3.4 cm. Complications were related to pin tract. When last seen, all patients were free of pain and could walk without cruthes or cane. Despite its pin tract problems, bulky cumbersome and expensive apparatus, the Ilizarov method is one of effective method for knee arthrodesis in the presence of infection and large bone loss especially.
Arthritis ; Arthrodesis* ; Arthropathy, Neurogenic ; Arthroplasty ; Canes ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Joints ; Knee Joint* ; Knee* ; Osteomyelitis ; Retrospective Studies ; Tibia ; Transplants

No abstract available.
National Health Programs*

Exposure with the tibial tubercle osteotomy was done for ten revisions and one primary total knee replacements out of 200 total knee arthroplasties performed from 1985 to 1996. The cases were analyzed with regard to complications and technical considerations. The preoperative diagnoses were infected total knee arthroplasty in seven, aseptic loosening in three and one ankylosed knee. Eixtensive exposure was achieved enough for debridement and reimplantation. The tubercle was fixed with two or three 3.5mm screws. The average duration of follow up was 30 months. Post operative knee flexion averaged 87 degrees. There were two complications, one avulsion of the fragment and one tibial fracture. The advantage of this procedure included wide exposure for difficult knee surgeries and more proximal fixation for improved flexion.
Arthroplasty* ; Arthroplasty, Replacement, Knee ; Debridement ; Diagnosis ; Follow-Up Studies ; Knee* ; Osteotomy* ; Replantation ; Tibial Fractures

PURPOSE: To determine the accuracy of MRI on postoperative pain syndrome (POPS), including early complications such as hematoma or infection. MATERIALS AND METHODS: Of the 54 patients with the POPS, we analyzed pre-operative MRI findings compared with operative findings on 39 patients, excluding nonunion, instability, metal failure and pseudarthrosis, who underwent an operation for POPS from December 1994 to June 1997. There were 25 men (64.1%) and 14 women (35.9%), aged from 16 to 68 years (average 44.5 years). They were divided into 5 subgroups and calculated for sensitivity, specificity and positive predictability. RESULTS: MRI accuracy in recurred disc was 84%, scar adhesion, recurred or developed stenosis, infection and hematoma was 100% for each overall accuracy of MRI was 93%. Average interval of reoperation in POPS was 3.2 years. In 21 cases (53.8%), symptoms persisted without pain-free interval after first operation. CONCLUSIONS: Early complications, including hematoma and infection, are easily detected with MRI. Especially if patient complains of severe leg pain or neurologic deficit, MRI is a good diagnostic tool. MRI is a useful method for evaluation of most cases of POPS, but it is limited in evaluating recurred disc or scar adhesion only in T1, T2 weighted image. Therefore, Gd-DTPA enhancement is necessary for an accurate diagnosis.
Cicatrix ; Constriction, Pathologic ; Diagnosis ; Female ; Gadolinium DTPA ; Hematoma ; Humans ; Leg ; Magnetic Resonance Imaging* ; Male ; Neurologic Manifestations ; Pain, Postoperative* ; Pseudarthrosis ; Reoperation ; Sensitivity and Specificity

No abstract available.
National Health Programs*