Femoral fracture, dislocation of the hip, or tasumatic amputation of the ipsilateral lower extremity is a rare injury. There has been only a few reports describing their managements. All amputated limbs are vulnerable to fracture, which occur frequently around the hip. Conservative treatments are not always adequate for the managements of fracture and dislocation of the hip and operative procedures are needed in almost patients. Among various operative measures, prosthetic replacement surgery may be indicated in cases of non-united fracture of the femoral neck, avascular necrosis of the femoral head, pathological fracture, or osteoporosis. We performed two cases of total hip replacement for the non-united fracture of the femoral neck(case 1) and the avascular necrosis of the femoral head(case 2) in the ipsilateral lower limb amputees, each. The early results were known to be very satisfactory postoperatively. The first patient was followed for 17 months and the second patient for 22 months. 1. P.C.A. femoral stems and acetabular cups were used without cement in both cases. A operative time was 2 hours and 22 minutes in the first case, 1 hour 45 minutes. in the second case. 2. There were no significant intraoperative or postoperative complications. 3. The functions of each hip were evaluated postoperatively by the method of Jesse and showed satisfactory results. 4. During the follow-up period, roentgenogram showed no significant bony changes around the femoral stems and acetabular cups. 5. The prosthetic replacement is also valuable for the treatment of the fracture-dislocation of the hip in the lower limb amputee.
Acetabulum ; Amputation ; Amputees ; Arthroplasty, Replacement, Hip ; Dislocations ; Extremities ; Femoral Fractures ; Femur Neck ; Follow-Up Studies ; Fractures, Spontaneous ; Head ; Hip ; Humans ; Lower Extremity ; Methods ; Necrosis ; Operative Time ; Osteoporosis ; Postoperative Complications ; Surgical Procedures, Operative

This is a follow-up study of 88 cases of cementless total hip replacement in 77 patients(59 males and 18 female), using AML, PCA and HGP prostheses, performed at the Department of Orthopaedic Surgery, Yonsei University Wonju College of Medicine, between September 1984 and December 1987. The follow-up period ranged from 18 to 56 months, the average being 34 months. The youngest patient was 21 and the oldest one was 79, the average being 47 years. The results were as follows:1. The average of Harris hip score was 89.7 points(Preop, 55.4 pints) at one year for 77 patients and 91.4 points at two years for 68 patients. 2. Radiographic analysis. a. Radiodense line:10 cases(11.4%) around the acetabular cup. 20 cases(22.7%) around the femoral stem. b. Calcar resorption:4 cases with AML stem(4/30), 2 cases with HGP stem(2/7). c. Subsidence:5 cases in PCA group(5/51).d. Radiological loosening:1 cases in PCA stem(1/51). 3. Intraoperative complications a. Femur neck fracture:15 cases(17%);5 cases in PCA group(5/51), 8 cases in AML group (8/31), and 2 cases in HGP group(2/7). b. Lateral collateral ligament tear:One case in PCA prosthesis(1/51). 4. Postoperative complications a. Prosthetic joint dislocation occured in 3 cases:1 case, closed reduction after tight adductor release:2 cases, cup reinsertion due to poor cup position. 5. Heterotopic ossification developed in 5 cases(5.7%) without significant loss of ROM. 6. Postoperative infection developed in 2 cases(2.3%):One superficial and the other deep. All were treated successfully with systemic antibiotics after irrigation and debridement.
Acetabulum ; Anti-Bacterial Agents ; Arthroplasty, Replacement, Hip ; Debridement ; Dislocations ; Femur Neck ; Follow-Up Studies ; Gangwon-do ; Hip ; Humans ; Intraoperative Complications ; Joints ; Lateral Ligament, Ankle ; Male ; Ossification, Heterotopic ; Passive Cutaneous Anaphylaxis ; Postoperative Complications ; Prostheses and Implants

PURPOSE: The study of the causative factors, surgical approachs and the clinical course of symptoms related to sciatic nerve injury after THR. MATERIAL AND METHODS: A retrospective review of 6 patients with sciatic nerve injury in 669 hips total hip arthroplasty during the period from Jan., 1986 to Dec., 1994. Each patient's record was reviewed with respect to age, sex, possible etiology, clinical course, surgical approach, treatment, and clinical condition at follow-up examination. RESULTS: ➀ The increased prevalence of nerve palsy was seen in revision surgeries(4 cases, 3.2%) compared to primary arthroplasty(2 cases, 0.4%) ➁ There was 2 cases(0.8%) of sciatic nerve injury in direct lateral approach and posterior approach, 4 cases(1%) ➂ Possible mechanisms of nerve injury included excessive soft tissue traction(3 cases), electrical thermal injury(1 case), Trochanteric fracture during femoral stem removal(1 case), and overlengthening of femur(1 case). ➃ The isolated peroneal division of the sciatic nerve was injured in 5 cases, and the both peroneal and tibial divisions were injured in one case. ➄ At a following period of 5 month, recovery of neurologic function was complete in con case, and two years follow up, 4 cases had a enough recovery of neurologic function(modified Sunderland scale 1,2). However, remained one case had a persistent severe weakness & dysesthesia at even 3 years follow-up. The prognosis for neurological recovery was related the degrees to which the nerve was damaged.
Arthroplasty, Replacement, Hip ; Femur ; Follow-Up Studies ; Hip ; Humans ; Paralysis ; Paresthesia ; Prevalence ; Prognosis ; Retrospective Studies ; Sciatic Nerve

No abstract available.

The superior volume maintenance of membranous over endochondral bone grafts, which was shown in several studies has provided the basis for its preferred clinical use as an onlay grafting material on the craniofacial skeleton. The scientific rationale for this seeming embryological advantage, however, has never been proven, Since the cortical component of membranous bone is proportionally greater than that of endochondral bone, it follows that membranous grafts would show greater volume maintenance over time. Our hypothesis is that the pattern of onlay bone graft resorption is primarily determined by a graft's micro-architecture (relative cortical and cancellous composition) rather than its embryololgical origin(membranous versus endochondral). Fourty adult New Zealand white rabbits were used for this study. There were 8 animals in each of 4 groups. The rabbits of each group were sacrificed at 3, 8, and 16 weeks. Four types of grafts were placed subperosteally, onto each rabbit's cranium: a hydroxyapatite, a cortical bone graft of membranous origin, a cortical bone graft of endochondral origin and a cancellous bone graft of endochondral origin. Membranous bone grafts were obtained from the lateral mandible and endochondral bone grafts were obtained from the ileum. In order to determine post-sacrifice volume and density of the bone grafts, a caliper technique and bone densitometry(bone densitometer: LUNAR, DPX-L, U.S.A.) were performed on all of the bone grafts. Bone graft specimens were histologically examined at 3, 8, and 16 weeks.The measurement of volume and density show that there is a statistically greater resumption in the cancellous endochondral bone grafts for all parameter, compared to either the endochondral or membranous cortical bone grafts or hydroxyapatite at all time points(p< 0.05). In addition, there is no significant difference in the resorption rates between the endochondral and membranous cortical bone grafts for all parameters at all time points. By placing cortical bone grafts and cancellous bone grafts on the recipient sites separately, we have shown that the former grafts maintain their volumes, widths and projections significantly better than the latter grafts. Futhermore, we found no statistical difference in resorption rates between the two cortical bone grafts of different embryologic origins, a finding which has never been previously shown. Bone volume fraction, measured with bone densitometry, was shown to be higher in cortical bone than in cancellous bone at all time points, further illustrating the differences between cortical and cancellous bone.From our results, we believe cortical bone to be a superior onlay-graftiong material, independent of its embryololgic origin.
Adult ; Animals ; Biological Factors* ; Densitometry ; Durapatite ; Humans ; Ileum ; Inlays* ; Mandible ; Rabbits ; Skeleton* ; Skull ; Transplants*

No abstract available.
Motor Endplate*

The first fusions of the spinal column were done by Hibb's and Albee in 1911. The great majority of early fusions were done for tuberculosis or arrest of the deformity of scoliosis. With changing incidence of diseases. fusion is now used most often for conditions occuring as a consequence of degenerative processes and is therefore an elective procedure done for relief of pain. The constant and uncontrollable motion of the spinal column has long been recognized as inimical to fusion and most of the modifications of technique have been designed to provide additional temporary stability to the involved vertebrae during the process of healing. More recently methods have been devoloped for placement of grafts between the vertebral bodies and between the transverse processes of the vertebrae. Fusion in the region is not new but it has not come into common usage because of the relative in accessibility of the region. Reports of it's use have been infrequent but optimistic with regard to the success of fusion. Fusion of a single intervertebral joint, most commonly the lumbosacral articulation, fusion by Hipp's seems to be adequate. If, however, two or more levels are fused by the usual methods, solid union will occur in less than 80% of patients. So we prefer the posterolateral technique for initial fusion of all patients requiring arthrodesis of more than one level. For the periods of 3 years from Jan. 1975 to Jun. 1978. 62 cases of diseased spine were treated by posterolateral fusion and the results of follow-up was as follows. 1. Of all 62 cases, 37 patients (59.7%) were male and 25 patients (40.3%) were femlae. 2. The average age was 29.5 years. 3. The etiology of low backache patients i) Spondylolysis
Arthrodesis ; Congenital Abnormalities ; Dislocations ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Low Back Pain ; Male ; Scoliosis ; Spine ; Spondylolisthesis ; Spondylolysis ; Transplants ; Tuberculosis

The pedicle instrumentation has become a popular way of spinal fixation. Placement of a screw through the pedicle into vertebral body appears to be a very successful way to accomplish spinal fixation. However, the configuration of the pedicle morphometry must be understood. The measurement includes pedicle width, angle of pedicle axis to the transverse plane, ideal screw length, ideal screw entry point and ideal angle. This study was accomplished using computerized axial tomogram(CT) of 704 vertebrae(T10-L5). The results were as follows. 1. Transverse pedicle diameter were narrowest at T10, widest at L5. 2. The pedicle axis is oriented anteromedially at all levels except T11 and T12, then increase from L1 to L5. 3. Screw lengths are fairly constant between all levels, thus the range of screw lengths need is limited. 4. The incidence of pedicle less than 6 mm in the transverse diameter is most common at T10 and followed by levels L1, T12 and L2. Preoperative determination of transpedicular screw diameter and length can be made, by direct measurement from the patient's CT scan.
Incidence ; Thoracic Vertebrae ; Tomography, X-Ray Computed

PURPOSE: Evaluation of clinical and radiologic results of THR using HA-coated femoral stem. MATERIALS AND METHODS: From Jan. 1991 to Dec. 1992, we carried out 177 cases of Total Hip Arthroplasty using hydroxyapatite-coated implants of 167 patients, and among thses, 153 cases in 144 patients were followed up more than 24 months. The implants used were 74 cases of Mallory-Head Hip system, 41 cases of Omnifit system and 38 cases of Profile system. RESULTS: The average Harris Hip Score was 48.3 points preoperatively, 94.7 points at POD 1 year and 95.7 at POD 2 years. Seven patients(5.2%) complained thigh pain at POD 2 years. On the radiologic findings, cancellous condensation was noted around the hydroxyapatite coating region of femoral stem in 84 cases(54.2%), and radiolucent lines were noted at the non-coating region of distal stem in 102 cases(67.7%), but were less than 2mm and not progressive. There was no statistically significant differences among the groups of these three implants(P < 0.05). Comments : This early result of femoral stems with hydroxyapatite-coating was quite satisfactory, however, long-term follow-up studies will be necessary.
Arthroplasty, Replacement, Hip ; Durapatite ; Follow-Up Studies ; Hip ; Humans ; Thigh

No abstract available.
Fetal Development* ; Gestational Age*