We present our technique for reconstruction of the posterior cruciate ligament (PCL) using the quadrupled hamstring tendons with EndoButton(Acufex Microsurgical, Mansfield, MA). This paper describes the surgical technique of the procedures and reports the preliminary results in 10 patients with a more than 12 months follow-up. There were 8 males and 2 females ranging in age from 17 to 37 years (average 25 years). The average time from injury to operation was 3 weeks (range; 2 weeks to 4 weeks). Of ten patients, 6 were classified as an isolated tear, 2 were associated with lateral collateral ligament tears. A torn meniscus was present in 2 cases. We used one-incision technique. The results of these PCL reconstructions with a minimum follow-up of 12 months are as follows. Patients were evaluated preand postoperatively using the Lysholm, and Hospital for Special Surgery Knee ligament rating scales. Average knee ligament evaluation scores were Lysholm preoperative 48, postoperative 87.6; and Hospital for Special Surgery preoperatively 33.5, postoperative 88.8. We chose the semitendinosus and gracilis tendons with EndoButton fixation for PCL reconstruction for specific reasons: (1) No injury to the extensor mechanism and (2) Easy passage of the graft through the tibial tunnel. (3) The problem about the screw and patellar bone-tendon-bone can be resolved. (4) It preserves intact meniscofemoral ligament, some intact fibers of PCL bundle. (5) When rupture of the PCL is associated with ACL tear, each ligament should be reconstructed. In such a case, we preserve patellar tendon for reconstruction of the ACL, The technique presented here is not applicable to all individuals requiring PCL reconstruction but does provide significant advantages to those patients for whom it is utilized. Although the clinical results are very promising at this length of follow up, long-term study is required to evaluate our PCL reconstruction procedure more precisely.
Female ; Follow-Up Studies ; Humans ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Male ; Patellar Ligament ; Posterior Cruciate Ligament* ; Rupture ; Tendons ; Transplants* ; Weights and Measures

From 1963 to 198I, we have performed Colonna's capsular arthroplasty on 7 children. Three of the hips had congenital dislocations and four hips had pathologic dislocation. The results on these cases, including some long term follow-up were satisfactory. Since Colonna first published his technique in 1932 ideal indications for the classical arthroplasty have largely been replaced by those of more recently developed procedures such as Salter's innominate osteotomy, Chiaris osteotomy and etc. We feel, however, that there still seems today a narrower, but distinct domain of usefulness left for the capsular arthroplasty, and that new indications need to be redefined. We propose the following criteria for such purpose. First, congenital dislocations of the hip in children beyond 6 years of age, which is the upper age limit of Salter's innominate osteotomy, and below 8 years of age, which is the upper age limit o original Colonna's capsular arthroplasty. Second, teratogenic congenital dislocations in which the shallow and slanted acetabulum renders otherwise stable, deeply seated acetabulum with a prospect for a concentric remodelling unlikely. Third, pathologic dislocations secondary to septic hip in children 3 to 8 years of age in which a pain-free, stable and reasonably mobile hip often betrays rentgenographic imaginations and renders reconstructive procedures in adult life feasible.
Acetabulum ; Adult ; Arthroplasty ; Child ; Dislocations ; Follow-Up Studies ; Hip ; Humans ; Imagination ; Osteotomy ; Retrospective Studies

In performance of total hip replacement in the cases of acetabular deficiency, a few authors suggest cement inforcement with screws fixation or bone graft with resected femoral head for repair of it. In our cases another problem was loss of femoral head with acetabular deficiency, therefore resected femoral head could not be used. Our solution to this problem is to use the ilium, as a bone graft and to attach it to the acetabular wall to provide bone stock for the reconstruction. In six hips followed for over one year, all grafts appeared to be united and none showed evidence of resorption. All hips are functionally good and no case shows loosening.
Acetabulum ; Arthroplasty, Replacement, Hip ; Head ; Hip ; Ilium ; Transplants

Congenital anomalies of the hand were reviewed, which were treated at Seoul National University Hospital from 1973 to 1982. The Conclusions are as follows. 1. Polydactyly is the most common congenital anomaly of the hand in this series. The next common congenital hand anomalies are trigger digit, syndactyly in that order. 2. Better results had been obtained with early reconstructive surgery within one year after birth. 3. Authors propose a new classification of polydactyly. In Joint type (type 1), the extradigit has its own epiphysis in its origin,and in Epiphyseal plate type (type 2) the extradigit do not have its own epiphyseal plate and seems to be derived from the physis of the more developed adjacent digit. We observed 22 cases of joint type and 10 cases of epiphyseal plate type. 4. 6 cases of macrodactyly had been observed. The complicated reconstructive surgery such as Tsuge and Barsky operation resulted in digital necrosis. So more simple and effective operation such as symphalangization would be attempted.
Classification ; Epiphyses ; Growth Plate ; Hand ; Joints ; Necrosis ; Parturition ; Polydactyly ; Seoul ; Syndactyly ; Trigger Finger Disorder

Paralytic scoliosis is a disease characterized by its long severe curve and the continuous progression of the deformity even after cessation of growth. It is also resistent to conservative treatment and more patients require surgical treatment than those with idiopathic or congenital curvature. Patients suffer from marked limitation of normal activities in walking and sitting due to imbalanced paralysis of trunk muscles and pelvic obliquity. The indication for the conservative treatment with Milwaukee brace allowing for skeletal growth in a straight alignment is much limited and surgical correction and fusion are almost always indicated even in a young age. This paper was aimed to review our experience with ninteen patients with paralytic scoliosis who were treated with various methods of preoperative corrections and surgery from Jan. 1970 to Dec. 1981 and the following results were obtained. 1. The average age when scoliosis was observed was 7.7 years but the average age of surgery was deferred to 17.7 years. 2. No treatment had been done until most of the patients could no longer maintain balanced posture in sitting and walking due to collapsing spine and marked pelvic obliquity. 3. The causes of paralysis were poliomyelitis in 15 cases, meningocele in two, cerebral palsy and Charcots disease in each one. 4. Preoperative average degree of scoliosis was 107.8° and the final correction was 47.9°(44.4%) with loss of correction 3.6° (3.4%) after 5.6 years of follow-up in average. 5. The more severe the curve was, the more flail was the spine and the more correction could be obtained. 6. Preoperative correction was performed for 16 cases and Harrington instrumentation and posterior fusion were performed for all cases except one meningocele with defect of posterior element in which Dwyer instrumentation was indicated. 7. Breakage of Harrington rod was observed in two cases 1.3 and 3.8 years postoperatively but no problem arose from it in seven and two years of follow-up respectively. 8. Significant pelvic obliquity was observed in seven cases, which were treated by Harrington instrumentation with sacral bar or sacral hook and posterior fusion extended to sacrum.
Braces ; Cerebral Palsy ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Meningocele ; Muscles ; Paralysis ; Poliomyelitis ; Posture ; Sacrum ; Scoliosis ; Spine ; Walking

27 Colles' fracture were treated with closed reduction and percutaneous k-wire fixation under the C-arm fields, from July 1980 to September 1984 at the Department of Orthopedic Surgery of Eul Ji Hospital. The average duration of the follow up was 4.9 Months. A prospective study was made and evaluated under the subjective and objective criteria of Gartland and Werley, and the objective criteria of Scheck. The results of this study were as follows: 1. The incidence was high in 4th and 5th decade as 66. 5%, not significant between females and males, 45% of the cause of injury was falling accident. 2. In 27 cases, showed the satisfactory result about 92.6%, but, in the eomminuted intraarticular fracture group, 2(15.4%) out of 13 cases showed unsatisfactory result. 3. Better result was obtained with more secure reduction and skillful technique, in certain case, considered that the open reduction and internal fixation with k-wires would be better than percutaneous k-wire fixation. 4. In the aspect of hand motion and the concept of improved anatomical restoration and maintenance would lead to improved function, ideal method was percutaneous k-wire fixation and casting after closed reduction under the C-arm fields.
Accidental Falls ; Colles' Fracture ; Female ; Follow-Up Studies ; Hand ; Humans ; Incidence ; Intra-Articular Fractures ; Male ; Methods ; Orthopedics ; Prospective Studies

Computed tomography (CT) has been shown to be useful in evaluation of the intracranial lesion. But now, computed tomography has been appealing as a new radiologic modality applicable to diagnosis and treatment in orthopaedic surgery. The two-dimentional picture, in one tomographic cut of any part under investigation, was able to increase the sensitivity or resolution of detection of lesion and able to overcome the disadvanages of conventional roentgenography. Eighteen patients who injuried pelvic fracture were examined by computed tomography after evaluated by plain radiography and occasionally by standard tomography. In six cases, we get a new additional diagnosis which are not found in conventional radiography. We have found that CT was more sensitive than plain radiography in detecting the sacroiliac joint injury and its around structure injury and hip joint integrity. Of more importance, clinical sign and symptom are valuable in diagnostic process.
Diagnosis ; Hip Joint ; Humans ; Radiography ; Sacroiliac Joint

The cervical spinal injuries may impose a fatal result or permanent neurological disability according to the severity of injury. Authors performed a clinical study consisting of 54 patients who have visited Daejeon Eulji General Hospital for the care of fracture and dislocation of the cervical spine from May 1981 to Jan. 1986, and obtained the following results. 1. The prevalent age distribution was between third and forth decade and the ratio between male and female was 3.5:1 and the most common cause of injury was traffic accident(53.7%). 2. The most common site of injury was CS, 6(22.2%) and the most frequent mechanism of injury was Aexion-rotation type(55.0%). 3. At initial examination, 39 patients(72.2%) had neurological damage and among these, 18 were complete paralysis below the level of injury, 12 were incomplete paralysis, 9 were nerve root injuries. 4. Operative treatment was performed on 24 patients, these were Rogers' posterior fusion on 19 patients, Brooks and Jenkins' atlantoaxial fusion on 3 patients, occipitocervical fusion on 1 patient and excision of hactured fragment on 1 patient. 5. There were no evidences of neurological recovery in completely paralyzed patients, but among incompletely paralyzed and nerve root injured patients, neurological recovery was found in 57.1% of conservatively treated patients and in 71. 4% of operated patients. 6. Radiological stability was found in entire patients who received operative treatment, but, in conservatively treated patients, remained 1 late instability.
Age Distribution ; Clinical Study ; Dislocations ; Female ; Hospitals, General ; Humans ; Male ; Paralysis ; Spinal Injuries ; Spine

The purpose of this experiment was to determine the effect of dividing the periosteum circumferentially on the growth of long bones and the effect of partial division of the periosteum on the formation of angular deformity of growing bones and to investigate the tethering effect of the periosteum on the epiphyseal plate as its possible mechanism. One hundred twenty rabbits, one-month old with average weight of 570g, were divided into four groups. In the first group, the periosteum of the right distal femur was completely divided circumfer- entially; in the control group, the medial aspect of the right distal femur was surgically approached but the periosteum was not divided, in the third group, the medial half of the peristeum of the right distal femur was divided transversely; in the fourth group, the medial half of the periosteum was divided and resutured. Following the operation, X-rays were taken every two weeks until twelfth week and then at twentieth week and the length of the femur and the physis-shaft angle were measured. l. After complete circumferential division of the periosteum, the ratios of right over left femoral length before operation, and two, four, six, eight, ten, twelve, and twenty weeks postoperatively, were 100.0±0.0%, 102.1±0.1%, 102.±0.0%, 102.9±0.0%, 103.5±0.0%, 103.6±0.0%, 103.5±0.0%, and 103.5±0.0%, respectively. The overgrowth was most conspicuous during the first two weeks. On the other hand, in the control group there was slight overgrowth, but this was not statistically significant. 2. After partial division of the periosteum, the physisvhaft angles before operation, and two, four, six, eight, ten, twelve, and twenty weeks postoperatively, were 91.0±1.2, 87.8±2.5,84.4±2.4, 83.1±3.2, 84.2±3.5, 86.4±2.3, 86.2±2.3, and 86.8±1.9, respectively. The valgus deformity was induced most conspicuously during the first four weeks, whereas partial correction of the de- formity took place between the eighth and tenth week postoperatively. After repair of the partially divided periosteum, only 0.9 of angular deformity was observed at sixth week, but this became statistically insignificant at tenth week as were in the complete division and control groups. 3. Histologically, no difference was observed in the cartiage cells of the epiphyseal plate and the bony trabeculae of the metaphysis between the control group and other groups. The divided periosteum regenerated at the ninth week, this being same also in the repaired group. There was no statistical difference in the thickness of the epiphyseal plate between the operated femur and the opposite normal femur in the completely divided group, this being same in the control group. Threr was also no statistical difference in the thickness of the epiphyseal plate between the medical and lateral halves in the partially divided group, this being same in the repaired group. Based on these results, the investigator was able to draw following conclusions. 1. In the growing long bone, complete circumferential division of the periosteum near the epiphyseal plate results in stimulation of growth and lengthening of bone. 2. Partial transverse division of the periosteum results in asymmetrical overgrowth, inducing an angular deformity. 3. It is suggested that the mechanism of overgrowth following division of the periosteum lies in the removal of the tethering effect of the periosteum. These findings may bear clinical implications on leg length inequality and angular deformities following certain fractures and epiphyseal injuries during growth period.
Bone Lengthening ; Congenital Abnormalities ; Femur ; Growth Plate ; Hand ; Humans ; Leg Length Inequality ; Periosteum ; Rabbits ; Research Personnel

From 1993 to 1996, we have used a new modular shoulder prosthesis for the treatment of acute complex fracture of the proximal humerus. The purpose of this study is to evaluate function, pain relief, and patient satisfaction after moduiar hemiarthroplasty for proximal humerus fractures. The stucly included 12 patients (J2 shoulders) with an average age of 68.5 years (range, 60 to 84 years). According to the Neer classification system, there were 3 four-part fracture-dislocations, 5 four-part fractures, 3 three-part fractures, and #I head splitting fracture. 'fhe hemiarthroplasty was pert'ormed at an average of 4 days (range, 3 to 10 days) following injury. Deltopectoral approach was used in all patients, and the prostheses were implanted with cement in ten cases. Follow-up evaluation, at an average of 32 months post-surgery, included clinical and radio- graphic examination. Active forward elevation averaged 120 degrees; external rotation, 35 degrees; and internal rotation, to the first lumbar vertebra. All of patients, except two who had poor results, were graded as good or excellent according to UCLA shoulder rating scale. Complications consisted of one tuberosity dispiacement, one peri-operative death and one loosening of uncemented humeral prosthesis. We concluded that Modular hemiarthroplasty for acute complex fracture of the proximal humerus especially in severely osteoporotic elderly patients facilitated the restoration of humeral length, anatomic repositioning of tuberosities, and precise soft tissue balance, thereby allowing earliermotion to prevent the developement of painful shoulder stiffness.
Aged ; Classification ; Follow-Up Studies ; Head ; Hemiarthroplasty* ; Humans ; Humerus* ; Patient Satisfaction ; Prostheses and Implants ; Shoulder ; Spine