Triple arthrodesis was performed on 167 feet in 153 patients at the Department of Orthopaedic Surgery, Seoul National University Hospital, during the 19 years from July 1957 to March 1976. Review of statistics, technical problems, and complications has led to following conclusions. 1) Of the total of 167 feet, residual poliomyelitis was the most common etiology with 127 feet (76%). 2) The youngest age was 5 years and the oldest 54 years, the 12–17 year group with 84 feet occupying half of the cases. 3) 79 feet (46.7%) had equinovarus deformity and 27 feet had equinocavovarus. 13 feet had no deformities. 4) Hoke's lazy S incision was utilized in 110 feet and Olliers incision in 57 feet. Hokes technique was employed in 118 feet and Lambrinudi's technique or its modification in 44 feet, while in the 5 feet without deformity exeresis alone was performed. Steinmann pins were used in 121 feet for temporary internal fixation and staples were used in 39 feet. 7 feet had no internal fixation. The senior author (D.Y.L.) routinely employs Hoke's incision, Hoke triple arthrodesis and Steinmann pin fixation, while when there is no deformity simple exeresis may be performed. 5) In our opinion, Hoke triple arthrodesis can correct any deformity and is particularly suitable in severely deformed rigid feet, since excision and replacement of the head of the talus affords better exposure and mobilization as well as easier set-up of the foot. 6) Whenever necessary, triple arthrodesis was combined with tendo Achilles lengthening, percutaneous plantar fasciotomy, posterior capsulotomy, medial or posteromedial release, subtalar and midtarsal wedge osteotomy, tibiotalar arthrodesis, supramalleloar osteotomy, and transmetatarsal osteotomy, followed by cast wedging or tendon transfers if indicated. 7) There was no nonunion in our cases. Clinically significant skin necrosis and wound sloughing occurred in 8 feet, gross postoperative infection in 2 feet, secondary osteoarthritis of the ankle in 2 feet, significant residual equinus deformity in 8 fret(in seven tendo Achilles lengthening was not done and in the one with tendo Achilles lengthening the deformity had been extreme and rigid), residual varus deformity in 3 feet, and residual valgus in 1 foot. These major complications occurred mostly in older children and adults, in whom deformities were severe and rigid and extensive surgery was necessary in order to achieve adequate correction. In such feet, correction is extremely difficult and greater risks of a variety of complications demand meticulous attention to technical details and postoperative care.
Adult ; Ankle ; Arthrodesis ; Child ; Clubfoot ; Congenital Abnormalities ; Equinus Deformity ; Foot ; Head ; Humans ; Necrosis ; Osteoarthritis ; Osteotomy ; Poliomyelitis ; Posterior Capsulotomy ; Postoperative Care ; Seoul ; Skin ; Talus ; Tendon Transfer ; Wounds and Injuries

Marfan Syndrome is a rare congenital disease characterized by the abnormalities of Sheletal system, eye and cardio-vascular system which was initially desiribed by Marfan in 1896. One case of marfan syndrome was treated at the department of Orthopedic Surgery, College of Medicine, Seoul National University for multiple skeletal deformities. Moderate degree of scoliosis was treated with Milwaukee brace and finger deformities with Z-plasty and full thickness skin graft.
Braces ; Congenital Abnormalities ; Fingers ; Marfan Syndrome ; Orthopedics ; Scoliosis ; Seoul ; Skin ; Transplants

Two hundreds cases of spine tuberculosis were treated surgically for the period of 7 years between 1970 and 1976 at Seoul National University Hospital and following results were obtained. 1. Many patients failed to be treated with conservative method. Spontaneous fusion was found in 10% of 200 cases with long duration of disease. Anterior fusion was performed in 166 cases and posterior fusion was carried out in 34 cases. In those 34 cases, anterior currettage was combined in 7 cases, anterior fusion combined in 19 cases in which 7 cases were performed anterior and posterior fusion at one stage. Posterior fusion alone was carried out only in 8 cases. 2. Anterior fusion is indicated for: a. decompression in cord involvement b. confirmation of diagnosis c. involvement of one joint space in children d. mild to moderate kyphosis in adult 3. Anterior and posterior fusion is indicated in: a. severe kyphosis for solid funsion b. involvement of more than two joint spaces in children to prevent increasing kyphosis c. one stage operation was technically possible and has many advantages 4. Posterior fusion is indicated in: a. poor general condition b. technically difficult cases.
Adult ; Child ; Decompression ; Diagnosis ; Humans ; Joints ; Kyphosis ; Methods ; Seoul ; Spine ; Tuberculosis

Hereditary sensory neuropathy is a unusual disease which is charcterized by mutilating acropathy with cutaneous sensory loss and complete absence of sensory apparatus. We experienced a case of bereditary sensory neuropathy Type 2.
Hereditary Sensory and Autonomic Neuropathies

Initial success with total hip arthroplasty on those severely crippled, painful hips in elderly people has prompted its application to a broad variety of conditions; namely, primary and secondary osteoarthritis, rheumatoid arthritis, avascular necrosis of the femoral head, and failed arthroplasties. Some have attempted it on previously arthrodesed hips, while others have successfully treated failed Girdlestone by total hip arthroplasty. To date, however, total hip arthroplasty remains essentially a procedure for older people. It has been greatly emphasized that total hip arthroplasty on 29 cases of residual hips secondary to pyogenic or tuberculous infection occurred during childhood. All were young adults ranging from 17 to 56 years of age, with a mean age of 32. 1 years. None of the hips had active infection at time of operation, although in 2 cases biopsy, at the arthroplasty, revealed chronic granulomatous inflammation. The hips had bony or fibrous ankylosis,or pseudarthrosis with dislocation, and presented marked flexion deformity, bony hypoplasia, limb shortening, and muscle atrophy. In 6 cases, arthroplasty was preceded by preliminary anterior soft tissue release and osteotomy of the ankylosis, followed by skeletal traction. In one case, anterior release through a separate incision was carried out on the same setting prior to arthroplasty. Lateral approach with trochanteric osteotomy was routinely employed, except in two in which the hip was approached posteriorly without trochanteric osteotomy. Trapezoidal-28 prosthesis was used in 17 cases, 5 of which were of short neck, thin stem sized, 7 of which were of medium neck small stem sized. Muller prosthesis was used in 8 cases, 7 of which were of standard neck standard stem sized. One small straight stem Charnley prosthesis failed and was later replaced by a custom-made Charnley stem prosthesis. Two offset bore ovoid cup and Charnley extra-small stem were used. In addition to routine preoperative, intraoperative, and postoperative antibiotics, Kanamycin was mixed to cement routinely. There was no postoperative wound infection. In two cases with presumably healed tuberculosis, infection recurred after arthroplasty. In all the remaning hips, painless serviceable function was restored, especially in view of diverse range of motion in orientals. In the oriental life style, the importance of a mobile hip cannot be overstressed.
Aged ; Ankylosis ; Anti-Bacterial Agents ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Biopsy ; Congenital Abnormalities ; Dislocations ; Extremities ; Femur ; Head ; Hip ; Humans ; Inflammation ; Kanamycin ; Life Style ; Muscular Atrophy ; Neck ; Necrosis ; Osteoarthritis ; Osteotomy ; Prostheses and Implants ; Pseudarthrosis ; Range of Motion, Articular ; Surgical Wound Infection ; Traction ; Tuberculosis ; Young Adult

Based on clinical, operative and pathological finding in twenty six cases of giant cell tumor, treated by curettage and bone graft in 14 and resection and bone graft in 5 buring 19 years, from 1958 to 1976, following results were obtained. Even in this study, according to others, giant cell tumors were mostly located around the knee in 16 cases. Following up results postoperatively, the overall recurrence rate of giant cell tumor was 38 percent. Especially in curettage and bone graft, it was recurred in 43 percent. Tumor located around the knee and vertebrae showed higher rate of recurrence than those in other sites. Four of the six patients who had an episode of recurrence recurred within the second years, and the other one in the third years after curettage and bone graft. All the two cases who had experienced a second recurrence were resulted in recurrence within second years after curettage and bone graft. Three of six patients treated by curettage and bone graft as secondary treatment had no recurrence.
Curettage ; Giant Cell Tumor of Bone ; Giant Cell Tumors ; Giant Cells ; Humans ; Knee ; Recurrence ; Spine ; Transplants

Neoplastic disease of the spine can be a most difficuIt and perflexing problem. Nineteen cases of tumors in the the spine were studied in the Department of Orthopedic Surgery, Seoul National University Hospital for 5 years and 6 months from January 1972 to June 1977. The results were as follows; 1. In 19 cases of tumors of the spine, primary tumor was 6 cases and metastatic tumor was 13 cases. 2. Primary tumors of the spine show hemangioma, osteochondroma, chondrosarcoma, giant cell tumor, chordoma, and chondromyxoid fibroma with each of one case 3. Primary sites of the metastatic tumors were lung (2 cases), genito-urinary system (2 cases), gastro-in testinal tract, skin, bone (each l case), and unknown (5 cases). 4. Thoracic and lumbar spines were most fregeuntly involved (75%). 5. Primary tumors were treated by radical excision and metastatic tumors by consevstive 6. Tumors of the spine must be differenciated from any diseases of the spine and the clinician must be alert that any spine lesion could be tumorous condition.
Chondrosarcoma ; Chordoma ; Fibroma ; Giant Cell Tumors ; Hemangioma ; Lung ; Orthopedics ; Osteochondroma ; Seoul ; Skin ; Spine

Sacro-iliac joint is, as other joints, the prediIection site of tuberculous or pyogenic arthritis as well as primary or metastatic tumor. The writers reviewed twenty cases of sacro-iliac lesion performed at the Department of Orthopedic Surgery, Seoul National University Hospital, for the period of five years from June 1972 till May 1977. 1. They are tuberculous arthritis eleven, pyogenic arthritis five, ankylosing spondylitis two(one associated with spinal stenosis, the other with hip invoIvement), osteosarcomatosis one, metastatic tumor from adenocnrcinoma of prostate one 2. Infection is the predominant Iesion in sacro-iliac joint, and tuberculous arthritis is twice than pyogenic arthritis. 2. Early diagnosis of sacro-iliac lesion is difficult, but S-I stress test is a valuable finding. 4. Two of eleven cases of tuberculous arthritis, two of five cases of pyogenic arthritis with mild involvement were treated conservatively without sequele, but in more advanced cases, surgical intervention was preformed.
Arthritis ; Early Diagnosis ; Exercise Test ; Hip ; Joints ; Orthopedics ; Prostate ; Seoul ; Spinal Stenosis ; Spondylitis, Ankylosing

Authors examined 30, 000 minifilms(boys and girls each 15, 000) which were taken for survey of pulmonary tuberculosis for the students of the first grade, middle school in Seoul(average 13 years old), to determine the ineidence rates of scoliosis. It was considered lateral curvature of spine more than 10 degrees as non-postural scoliosis, which were analyzed for the presence of bony abnormality, sex incidence, degree of curvature, distribution of size of curvature, patterns of curvature, and direction of curvature. Following results were obtained. 1. The overall incidence of scoliosis was 1. 46%; female 1. 86% and male 1.07%. 2. Scoliosis due to bony abnormality was found in 4 cases. 3. Degrees of curvature; 10°-19°
Female ; Humans ; Incidence ; Korea ; Male ; Scoliosis ; Spine ; Tuberculosis, Pulmonary