No abstract available.
Breast*

In order to compare mechanical stability of the Ilizarov external fixation methods for treatment of pilon fracture of the tibia, six human amputed tibiae were utilized to simulate Ruedi type I, II, and III fractures anatomically and non-anatomically reduced. Six fracture models which were either anatomically(3) or non-anatomically(3) reduced were first stailized by the Ilizarov construct composed of two tibial rings and foot assembly with connecting rods and ankle hinges and underwent axial load compression test using Instron. And then same tests were repeated on the models in which ankle hinges between the tibial rings and foot assembly were removed to examine biomechanical effect of the ankle hinges on the fracture stability. When the fracture model was fixed by the construct without ankle hinges, 720 N-780 N were required to disrupt fracture stability. When the fracture was non-anatomically reduced and was fixed by the construct without ankle hinges, 420 N-520 N were required to disrupt the fracture stability. The current study suggests that Ilizarov fixation system should have the construct composed of two tibial rings and foot assembly with connection rods and ankle hinges to prevent fracture destabilization during early ankle motion and weight-bearing in the tibial pilon fracture.
Ankle ; Foot ; Humans ; Methods ; Tibia ; Weight-Bearing

No abstract available.

There have been several reports that total knee arthroplasty(TKA) was most likely to survive successfully if the coronal tibiofemoral angle was close to 7 degree of valgus, the accepted normal. In order to know whether the postoperative coronal tibiofemoral angle influences the result of total knee arthroplasty, we examined the 152 TKA cases in 106 patients which had been performed at Department of Orthopaedic Surgery, Seoul National University Hospital from Jan. 1987 to Dec. 1991. In our series the average follow-up period was 31 months(range, 13 months to 75 months). Coronal tibiofemoral angles of all cases were checked on weight bearing anteroposterior plain X-rays and were divided into three groups(less than valgus 2° ; valgus 3° to 7° ; greater than valgus 8°). All cases were analyzed on the knee score of Hospital for Special Surgery and the American Knee Society total knee arthroplasty roentgenographic evaluation and scoring system and the cases with radiolucent lines wider than 2mm were checked. Three groups were analyzed comparatively with statistical means(Wilcoxon signed rank test, X² test). There were no significant differences in the clinical results of total knee arthroplasty according to the postoperative coronal tibiofemoral angle. Lateral subluxation of the patella occurred more frequently when the postoperative coronal tibiofemoral angle was above valgus 8°. In the tibial components of group lesser than valgus 2°, the frequency of radiolucent lines wider than 2mm was higher than those of other groups, but its significance should be examined through long term follow-up.
Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Humans ; Knee ; Patella ; Seoul ; Weight-Bearing

Although long-term studies of total knee arthroplasty(TKA) have confirmed reliable relief of pain and maintenance of function, survivorship at nine to ten years has been inconsistent with late component loosening being the most frequent mode of failure. Tibial component failure has been more frequent than failure of the femoral or patellar component in most TKA series. Encouraged by the early results of porous-ingrowh femoral and patellar components, and aware of retrieval studies showing poor bone ingrowth into tibial components, the “hybrid” method of fixation with an uncemented femoral component and a cemented tibial component, has been introduced and incorporated the potential advantages of both traditional fixation techniques. Between January 1987 and December 1991, forty-five “hybrid” TKAs(group I) were performed in degenerative arthritis and evaluated retrospectively in comparison with the results of nineteen noncemented porous-coated TKAs(group II) in degenerative arthritis. The average follow-up period was 31 months(range, 14 to 60 months) in group I and 26 months(range, 13 to 63 months) in group II. Using the knee rating scale of the Hospital for Special Surgery and the American Knee Society Roentgenographic Evaluation and Scoring System, clinical and radiological comparative study between two groups was performed. Pain scores, range of motion and HSS knee scores improved in both groups, but there was no significant difference between group I and group II(p>0.05). In both groups, the scores of radiolucent lines were significantly higher in zone 1 and 4 of A-P roentgenograph of the tibial component than in other zones(p < 0.05). The tibiofemoral angle was corrected from varus 2.7° to valgus 5.8° in group I and from varus 3.4° to valgus 4.6° in group II. There was no significant differences in component position and scores of radiolucnet lines between group I and group II. In conclusion, there were no significant differences in clinical and radiological results between the “hybrid” and the cementless groups. Results of this study suggest that both the hybrid fixation and the comentless techniques can reliably provide satisfactory clinical and radiological results in properly selected degenerative arthritis patients. But the final outcomes of this study need further evaluation through long term follow-up.
Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Humans ; Knee ; Methods ; Osteoarthritis ; Range of Motion, Articular ; Retrospective Studies ; Survival Rate

Tumors involving the proximal humerus confront the surgeon with the problem of both eradicating the osseous lesions and restoring shoulder joint function. This problem is magnified because of the biomechanical complexity of the shoulder, its anatomic configuration, and its inherent lack of stabillity. With the increased interest in limb-sparing resection for lesions in the area, efforts are being made to improve the reconstructive techniques. These include leaving a flail shoulder, an being made to improve the reconstructive techniques. These include leaving a flail shoulder, an arthrodesis using intercalery graft between the scapula and the remaining humerus, or if the glenoid is preserved, an arthroplasy. From January 1984 to December 1993, 23 patients with a malignant or locally aggressive bone tumor in the proximal humerus were treated by limb-sparing surgery in Seoul National University Hospital. Histologic diagnosis included osteosarcoma(6), chondrosarcoma(2), Ewing's sarcoma(1), metastatic bone tumor(11), and recurred giant cell tumor(3). Options for reconstruction following limb-sparing resection in our cases were 10 prosthetic arthroplasties, 3 arthrodeses with an living fibula graft, and 10 arthroplasties with intramedullary nailing and cementization. We performed a retrospective analysis in view of tumor eradication and performance status with modified functional evaluation system of Musculoskeletal tumor Society. In 7 cases(74%), good or fair performance status was acquired with average 3.6 years follow-up(6 months-11 years). Each option for reconstruction resulted in relatively good outcome but rather better result was acquired in giant cell tumor and chondrosarcoma. Estimated survival rates by Kaplan-Meier's method, 5 year survival rate was 81% in primary malignant bone tumors(12), 76% in stage Ⅱ B malignancies(5) with 4 years and 4 months follow-up. There was no regional recurrence in primary malignant bone tumors but there were three cases in which distant pulmonary metastases were found in follow-up. Complicationss were one soft tissue infection, two nonunions in arthrodesis with a living fibula graft and one dislodgement of prosthesis in prosthetic arthroplasty. In summary, each option for limb-sparing surgery in malignant bone tumor of proximal humerus might result in rather satisfactory outcome in performance and survival rate when effective preoperative and postoperative chemotherapy were performed in adequately selected cases.
Arthrodesis ; Arthroplasty ; Chondrosarcoma ; Diagnosis ; Drug Therapy ; Extremities ; Fibula ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Giant Cell Tumors ; Giant Cells ; Humans ; Humerus ; Methods ; Neoplasm Metastasis ; Prostheses and Implants ; Recurrence ; Retrospective Studies ; Scapula ; Seoul ; Shoulder ; Shoulder Joint ; Soft Tissue Infections ; Survival Rate ; Transplants

While there is little controversy about the surgical resection for the torn discoid lateral meniscus, there are some contradictory reports for the treatment of discoid lateral meniscus without tear. Some authors argue that initial treatment should be observation after diagnostic arthroscopy in the cases without tear. Others reported that excellent results were obtained after partial resection of the discoid lateral meniscus without tear or with slight degeneration. We reviewed our series of symptomatic discoid lateral menisci without tear, confirmed by arthroscopic examination. We retrospectively reviewed 8 knees in 8 patients who had had partia! Meniscectomy for discoid latera1 meniscus without tear, confirmed by arthroscopic examination. They were 5 males and 3 females. The average age was 22.8 years (range, 7 to 57 years). The average duration of follow-up was 2 years and three months. The patients had continuing pain and locking or snapping preoperatively. Preoperative MRI had grade Il intrameniscal signal in all the cases. The patients were evaluated hy Lysholm pain score and total Lysholm score. There were 7 complete types and one incomplete type. The average Lysholm pain score and the total Lysholm score improved from 13.1, 67.8 preoperatively to 28.8. 97.9, at the last follow-up, respectively. Mechanical symptoms including click and 1ocking were disappeared in all, and no complication was obser ved. We suggest that symptomatic discoid lateral meniscus should he resected e.ven though there is no tear visible on arthroscopy, especially when the MRl shows grade lI intrameniscal signal.
Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Knee ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial* ; Retrospective Studies

From January 1982 to December 1991, we experienced 96 hands of 66 patients with Dupuytren's disease in Seoul National University Hospital. We performed retrospective analysis of these 96 hands of 66 patients and the results were as follows. Among 66 patients, 60 patients (91%) were male and 51 patients (77%) were in sixth or seventh decade, the average age 58.1 years. Occupations of 66 patients were manual laborer(18 patients, 28%), farmer(15 patients, 22%), sportsman(4 patients, 6%) and deskworker(29 patients, 44%). Among the diseases such as diabetes mellitus, alcoholics, epilepsy known as associated with Dupuytren's disease, diabetes mellitus was more common in our cases, whereas alcoholics and epilepsy were relatively rare. There was no case in which family history was present. Both hands were involved in 30 patients, right hand only in 30 patients, and left hand only in 6 patients. Right hand was involved in 60 patients(91%), whereas left hand was involved in 36 patients(55%). The case in which only the 4th finger was involved was most common(42 hands, 44%). The 4th finger was affected most frequently(81 hands, 84%). In diabetic patients, the middle finger was involved more frequently than in non-diabetic patients(p < 0.05). Most of patients(83 hands, 86%) had symptoms of flexion contracture, nodule or contracted cord simultaneously. Surgical treatment was per- formed in 32 hands of 22 patients, with the results of excellent in 24 hands(75%), good in 6 hands(19%) and no recurrence, in average follow-up 3.6 years(2.6 years to 5.0 years). In conclusion, it might be thought that Dupuytren's disease in which surgical treatment was required was relatively rare in Korean and even if necessary, partial fasciectomy resulted in rather good result.
Alcoholics ; Contracture ; Diabetes Mellitus ; Dupuytren Contracture ; Epilepsy ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Male ; Occupations ; Recurrence ; Retrospective Studies ; Seoul

Implantation of a blastocyst within the endocervical canal is termed a"cervical pregn-ancy", which is one of the most dangerous forms of ectopic pregnancy. It is even less common, but the incidence appear to be increasing, in part due to newer forms of assisted reproduction. Proper management is indicated as soon as the diagnosis is suspected. Hemorrhage may be massive and sometimes fatal. In the past, hysterectomy was often the only choice available because of profuse hemorrhage that accompanied attempts at removal of the cerv- ical pregnancy. We report two cases of cervical pregnancy treated conservatively without hysterect- omy. Hemorrhage from the implantation site was controlled by intracervical placement of a Foley catheter balloon without hemostatic cervical sutures at 3 and 9 o clock. Immediate insertion of a Foley catheter into the cervical canal and inflation of the catheter bulb after endocervical suction curettage appears to be a simple and effective technique of managing cervical pregnancy in a patient who wishes to maintain childbearing capacity.
Blastocyst ; Catheters ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Inflation, Economic ; Pregnancy* ; Pregnancy, Ectopic ; Reproduction ; Sutures ; Vacuum Curettage

No abstract available.
Colon, Descending* ; Leiomyosarcoma*