In the diagnosis of acute spinal trauma, meticulous physical examination and history taking is the most important tool and auxilliary support support can be given by plain X-ray, CT or myelography, etc. But these cannot show the state of cord injury directly. On the contrary, MRI shows the cord directly as well as the soft and bony tissues. We analysed retrospectively 39 patients who suffered from acute spinal trauma at the level of cervical and thoracic spine and had their spine MRI taken. We verified the meaningful correlation between the signal change in the spinal cord on MRI and the degree of neurologic deficit and prognosis, using Frankel classification and trauma motor index at the time of admission and the final follow-up.
Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Myelography ; Neurologic Manifestations ; Physical Examination ; Prognosis ; Retrospective Studies ; Spinal Cord ; Spine

In 1974, bipolar endoprosthesis was first introduced by Bateman & Giliberty. It has theoretical advantages including minimizing acetabular wear, possible reduction of incidence of stem loosening, lessening of dislocation and easy revision procedure. Various methods for the treatment of fracture of the femur neck have been developed & performed, but it is still called “the unsolved fracture” in certain situation. But the role of it as primary treatment of fracture of the femur neck continues to be controversial. Current clinical results encourage its continued use and expansion of indication. Authors reviewed and analysed 21 cases of bicentric endoprosthesis and 1 case of Giliberty endoprosthesis those have been operated at the Department of Orthopaedic Surgery, National Medical Center from 1981 to 1983. Following results were obtained, l. According to disorder distribution, 14 cases were neglected fracture of femur neck, 2 old fracture, 1 idiopathic femoral head necrosis and 2 avascular necrosis & 1 non-union complicated by femoral neck fracture. 2. Among 20 cases, 8 cases were operated within 1/2 1 month after injury and 6 cases within 1 3months 3. Harris lateral appmach was used in 16 cases (80%) and Modified Gibson approach in 4 cases (20%). There were no significant differences in morbidity during operation and postoperative complication. 4. We used femoral stems those head diameter was 22 and 32mm(Charnley & Miiller type) and head pieces those diameter was 48-51 mm in male and 44–48 mm in Ifemale. 5. 3 cases were stiff in inner bearing without acetabular erosion. 6. In 6 cases more than 2 years followup 1 degree CE angle of Wiberg was increased in 2 cases of youngage respectively without associated hip joint pain. 7. Although inclination of head piece was vertical in 8 cases, fracture and dislocation were not found. 8. The circumference of head piece and opposite femoral head was measured and compared. There were 12 cases (mean 12.6 mm) that of head piece larger than opposite femoral head and 3 cases smaller than opposite femoral head. 9. There was 4 cases of complication (3 patients) and still no reoperation and revision converted to T.H.R. 10. With regard to average 18 months of follow-up, 7 cases of 81–90 Harris hip-rating score, 6 of 91–100, 4 of 71–80 and 3 of 61–70.
Acetabulum ; Dislocations ; Femoral Neck Fractures ; Femur ; Femur Neck ; Follow-Up Studies ; Head ; Hip Joint ; Humans ; Incidence ; Male ; Neck ; Necrosis ; Postoperative Complications ; Reoperation

No abstract available.
Constriction, Pathologic* ; Fetal Death*

The authors report a case of acute nontraumatic spinal epidural hematoma which extending from C4 to C6. A 70-year-old woman was presented with neck pain and left hemiparesis. T1-weighted magnetic resonance image revealed a mass isointense to the spinal cord and the mass was slightly enhanced after administration of gadolinium. T2-weighted images revealed high signal in the left posterolateral part of the spinal canal at the level of C4-C6. Evacuation of an epidural hematoma was performed with laminectomy. The pathological examination did not reveal any malformation within this hematoma. The patient showed complete recovery of the deficits. Medical investigation yielded thrombocytopenia and splenomegaly derived from liver cirrhosis. Thrombocytopenia and mechanical factor may be considered as etiologic factors in this case.
Aged ; Female ; Gadolinium ; Hematoma ; Hematoma, Epidural, Spinal* ; Humans ; Laminectomy ; Liver Cirrhosis ; Neck Pain ; Paresis ; Spinal Canal ; Spinal Cord ; Spine* ; Splenomegaly ; Thrombocytopenia

No abstract available.
Mass Screening* ; Prospective Studies*

In addition to general charceteristics of tibial fracture, segmental tibial fracture is commonly combined with extensive soft tissue injury, comminution and displacement with poor blood supply in its middle segment. According to recent reports, intramedullary nailing was regarded as the excellent method in the management of this kind of fracture. Twenty-one cases were treated at the department of Orthopaedic Surgery, National Medical Center from January 1980 to December 1987 and following results were obtained; 1. Most common type of fracture was Type I (38.1%). Almost all the fractures were accompanied by open wounds(85.7%) and GIIIB open wounds were 12 cases(57.1%). 2. A verage union time was 31.8 weeks(union rate, 76.2%) and showed marked difference between closed fracture(20.2 weeks) and GIIIB open one(38.6 weeks). 3. Better results were seen in 8 cases of intramedullary nailing(average union time, 24.2 weeks), while all the plating method showed non-union in 3 cases of open wound.
Fracture Fixation, Intramedullary ; Methods ; Soft Tissue Injuries ; Tibia ; Tibial Fractures ; Wounds and Injuries

Injuries of the cervical spine from C3 down to C7 are complex and potentially devastating injuries. The treatment of this condition is complicated and controversial. However, there is an increasing tendency to stabilize unstsble cervical spine injuries surgically with the benefit of good stability of the spine, easy nursing care, early mobilization and rehabilotation. We analysed clinically the 26 patients with unstable lower cervical spine injuries st the department of orthopaedics, National Medical Center from Jan. 1979 to Dec. 1988. The results obtained were as follows:1. The prevalent age distribution was between 20 and 50 years of age(71%), and the ratio between male and female was 6: l. 2. The most common cause of the injury was traffic accident(42%), and the most frequent mechanism of injury was distractive-flexion type(42%). 3. In the overall clinical evaluation, 73% of the patients were judged to have had excellent and good results, and the range of the motion was more limited in the patient who underwent posterior fusion due to wide level of fusion. 4. The patients with distractive-flexion injuries with minimal neurologic deficit were at risk of late instability following conservative treatment, and therefore open reduction and posterior fusion may be advisable. 5. The patients who were given posterior fusion were noted to have a few significant late changes, but the patient with anterior fusion carried a high incidence of progressive kyphotic deformity and persisting, pain. 6. When anterior fusion is used in the patient with posterior instability for the purpose of cord decompression, anterior cervical plate is valuable than the fusion with graft only in view of preventing progressive kyphotic deformity.
Age Distribution ; Congenital Abnormalities ; Decompression ; Early Ambulation ; Female ; Humans ; Incidence ; Male ; Neurologic Manifestations ; Nursing Care ; Spine ; Transplants

The posterior cruciate ligament, because of its location and axial role in knee function, was assumed to be a fundamental stabilizer for the knee joint. Reconstruction of the posterior cruciate ligament has been a demanding operation due to difficulties of appropriate graft material. Posterior cruciate substituing material should be biocompatible, durable, stress-strain capable and ease to be used. Achilles tendon autografts were thought to meet these criteria. Recently, we have advocated partial Achilles tendon autograft in reconstructive operation of posterior cruciate ligament with promising result. Posterior cruciate ligament reconstructions were done in 8 knees, with follow-ups ranging from 7 to 23 months, averaging 13 months. The results were as followings: l. Average preoperstive knee score was 46 and it was improved up to 88 after operation. 2. Among the 8 knees, 3 belonged to the excellent, 4 to good, and 1 to fair groups respectvely. 3. Achilles tendon autograft turned out to be a good substitute for the posterior cruciate deficient knee. The results were promising. Achilles tendon autograft regarded to be suitable for the posterior cruciate liagament reconstruction and desirable features of this autogenous graft included distinguished biocompatability, mechanical stability in fixation strength as well as stress-strain capability, and consistency in reproducible operative technique.
Achilles Tendon ; Autografts ; Follow-Up Studies ; Knee ; Knee Joint ; Posterior Cruciate Ligament ; Transplants

The anterior cruciate ligament has been considered one of the basic stabilizers in the knee as a very complex in its function. A large number of treatment regimens and philosophies showed controversies in its treatment. And we have experienced recurrence of the instability after operation of the injured ligament. So, the authors devised a new operative technique for the loose anterior cruciate ligament, that is, distal davancement of the loose anterior cruciate ligament with a bone-block as a biomechanical fixation. We have performed 11 cases of the anterior cruciate ligament using distal advancement method. The results were as follows; 1. Eleven cases (92%) showed good results by the rating system of Cincinnati sports-medicine and Orthopaedic Center. 2. The distal advancement of the anterior cruciate ligament is technically simple and biomechanically reasonable, but further investigation is necessary to answer the question regarding the long term results.
Anterior Cruciate Ligament ; Knee ; Ligaments ; Methods ; Philosophy ; Recurrence

Thirty-nine cases of tuberculosis of the knee were treated at the Department of Orthopaedic Surgery, National Medical Center during the 10 yesrs from Jsn. 1977 to Dec. 1986. The results were as followings 1) Total cases of tuberculosis of bone and joint were 411. Among them, knee joint occupied 39 cases (9.5%) 2) Age and sex distribution were not remarkable. 3) Average duration of disease were 27 months. 4) In 56.1% of the pstients, chemotherapy wss given prior to admission. 5) Tbe main associated tuberculosis lesions were pulmonsry tuberculosis (53.9%). 6) Erythrocyte sedimentation rate was increased in 61.6%. 7) The incidence of associated running draining sinus were 25.6%, and majority of the causative microorganisrn was Staphylococcus aureus in complicated mixed infection. 8) Various treatment, such as conservative, synovectomy, curettage, and arthrodesis, had been carried out. 9) Overall recurrence rate was 9.1%.
Arthrodesis ; Blood Sedimentation ; Clinical Study ; Coinfection ; Curettage ; Drug Therapy ; Incidence ; Joints ; Knee Joint ; Knee ; Recurrence ; Running ; Sex Distribution ; Staphylococcus aureus ; Tuberculosis