Fractures of the acetabulum are relatively uncommon. But if fractures of the acetubulum are not accurately evaluated, classified, and reduced anatomically, major sequalae and complications are frequently developed. Because of complicated anatomy, difficulty with surgical exposure, severe comminution, and major associated injuries, the treatment of displaced acetabular fractures between conservative and operative methods is still controversial. We reviewed thirty five cases of displaced acetabular fracture treated operaively from January 1984 to December 1991. The prevalent age was the fourth decade. There was twenty seven cases of associated injuries, twenty two dislocations of the hip. According to the Letournel's classification, the most common fracture type was posterior wall and both column type. The fracture was fixed internally with only screws in thirteen cases and with plate and screws in twenty two cases. Among thirty five patients, five patients were lost in the follow up and another five patients had followed up lesser than one year. The mean duration of follow-up afrer the operation was three years (range, one to eight years). Among twenty five patients who had followed up more than one year, the satisfactory results were achieved in nineteen patients (76%) and the poor results were achieved in three patients (8%). The complications were post-traumatic arthritis, avascular necrosis of femoral head, osteomyelitis in iliac bone, skin necrosis, and heterotopic ossification.
Acetabulum ; Arthritis ; Classification ; Dislocations ; Follow-Up Studies ; Head ; Hip ; Humans ; Necrosis ; Ossification, Heterotopic ; Osteomyelitis ; Skin

No abstract available.
Ossification, Heterotopic*

Monteggia fracture-dislocation was described as a fracture of proximal third of the ulnar with a dislocation of radial head by G. Monteggia in 1814. Bado named Monteggia lesion as a fracture of ulnar at any level and a dislocation of radial head. The authors reviewed sixty-three patents of Monteggia fracture who were treated at department of orthopedic surgery, Yonsei university college of medicine from 1980. 1. to 1985. 12. We emphasis especially on cause of injury, classification, direction of radial head dislocation, level of ulnar fracture site, treatment and result. The results were as follows: 1. There were 22 children and 41 adults among 63 patients. 2. The male was affected more frequenty than female (49:14) . The ratio between male and female was 3. 5: l. 3. The most common cause of injury was falling down (54%) in children and car accident (51%) in adults. 4. According to Bado classification, type I was 68%, type II 11%, type III 18% and type IV 3%. 5. The partial posterior interosseous nerve injury was noticed in 12 cases and the superficial radial nerve injury was in 3 cases. The nerve injury was recovered spontaneously in all cases. Dislocation of radial head was as follows: Anterior dislocation was 38%, anterolateral 41%, lateral 8%, posterior 10% and posterolateral 3 % 7. Location of ulnar fracture site was as follows: Metaphysis was 22%, proximal 1/3 24%, junction of proximal 1/3 and middle 1/3 38%, middle 1/3 14% and distal 1/3 2%. 8. Closed reduction of radal head dislocation was done in 45 cases, open reduction in 10 cases and radial head excision in 6 cases. 9. Closed reduction of ulnar fracture was done in 26 cases and open reduction 35 cases. 10. We obtained 93% favorable results in children and 71% in adults. Not only the prognosis of ch ildren was better than adults but also the recovery time of children was shorter than adult's.
Accidental Falls ; Adult ; Child ; Classification ; Clinical Study ; Dislocations ; Female ; Head ; Humans ; Male ; Monteggia's Fracture ; Orthopedics ; Prognosis ; Radial Nerve

Calvarium protects the brain, the most important organ. The defect of calvarium results in not only deformity but also fatal injury from the trauma. The cranial bone defects result from 1) removal of bone flap for intracranial decompression or infection 2) fracture 3) excision of tumor 4) craniectomy for craniosynostosis. The goals of cranioplasty are to protect the brain from trauma and make the aesthetically acceptable contour. From 1990 to 1995, we experienced twelve cases of cranioplasty using autogenous bone graft; 5 cases with rib bone, 3 cases with iliac bone, 2 cases with calvarial bone, and 2 cases with rib and calvarial bones. The result was very excellent without any significant complications.
Brain ; Congenital Abnormalities ; Craniosynostoses ; Decompression ; Ribs ; Skull ; Transplants*

To evaluate the effect of shortening the latent period for distraction osteogenesis, the authors experimented with distraction osteogenesis for a 24-hour latent period in the mandibles of rabbits. This study was carried out on 32 New Zealand white rabbits, each weighting 2000 to 2500 gm. Twenty animals were used for the control group and 12 for the experimental group. A unilateral external fixation device was applied to the left mandible. The mandibles were lengthened at 1 mm per 24 hours for 10 days. Five rabbits from the control group and three from the experimental group by random selection were sacrificed on the first day, and at the second, fourth and eighth week of the consolidation period. After lengthening bone densities at the site of the left mandibular bony lengthening were measured by quantitative computer tomography (QCT) and dual energy x-ray absorptiometry (DXA). As a result, the DXA value showed no difference compared to the control group after two week's consolidation. The trabeculae were thicker and had begun to be surrounded by lamellar bone both in the control and experimental groups histologically. In conclusion, the results of this study indicate that the osteogenetic effect in the experimental group was nearly the same as in the control group. If stable fixation and minimal periosteal dissection were performed during the procedure, the latent period would not be an important factor in distraction osteogenesis of membranous bone.
Absorptiometry, Photon ; Animals ; Bone Density ; External Fixators ; Mandible* ; Osteogenesis* ; Osteogenesis, Distraction ; Rabbits*

Thirteen cases of lengthening of short tubular bone by gradual axial distraction using an unilateral external fixator(Orthofix M-100, Orthofix CP0089) are reported. This study aims to prove effective- ness of gradual distraction for lengthening of short tubular bone and usefulness of the newly designed external fixator. Nine patients had brachymetatarsia and four brachymetacarpia. The etiology was consisted of post-traumatic physeal injury in two and congenital in eleven cases. The average amount of lengthening was 14.5mm(37.0%) in metacarpal bone, and 17.3mm(37.5%) in metatarsal. Complications were angular deformity in 3, pin loosening in 2 cases, and premature consolidation, nonunion and pin site infection in one case, respectively. Cosmetical and functional satisfactory results were obtained in all cases. We believe that callotasis is effective for short tubular bone lengthening. Also we confirmed the newly designed external fixa- tor(Orthofix CP0089) useful.
Bone Lengthening ; Congenital Abnormalities ; External Fixators ; Humans ; Metatarsal Bones ; Osteogenesis, Distraction

Purpose: To investigate the extent of bone ingrowth into the porous-coated acetabular cups as well as the factors that correlated with bone ingrowth in total hip arthroplasty. Materials and Methods: Thirty six Harris-Galante porous-coated acetabular cups that were retrieved through revision surgery were examined in this study. Acetabular cups retrieved due to infection or severely destroyed cups (ed note: severe what?) were excluded. The extent of bone ingrowth into the acetabular cups was grossly measured, and its correlation with the variables including age, gender, weight, height, the duration of fixation, size, number of screws, inclination and anteversion was statistically analyzed. Results: The mean proportion of bone ingrowth was 52.9 21.9%(2~90%) and less than 30% in three cups(8.3%). The pattern and the location of bone ingrowth were not consistent. There was no correlation between the extent of bone ingrowth and age, gender, weight, height, the duration of fixation, cup size, number of screws, size, inclination and anteversion. Conclusion: Harris-Galante porous-coated acetabular cups showed satisfactory bone ingrowth regardless of the variables associated with the demographic or surgical conditions. Surface treatments with a fiber-metal porouscoating appears to be suitable for cementless acetabular cups in terms of the long term results.
Acetabulum* ; Arthroplasty, Replacement, Hip

Objectives: Physicians experience high occupational stress due to heavy workload, responsibility and stressful situations in the medical field. Although occupational stress decreases productivity and increases medical accidents, occupational stress on Korean psychiatrists is not well studied. In this study, we investigated the occupational stress and career satisfaction of Korean psychiatrists. Methods: Electronic surveys were conducted via e-mail, and a total of 266 psychiatrists fully answered the surveys. The surveys consisted of the Korean Occupational Stress Scale (KOSS), career satisfaction and stress inventory for the health professional. Results: The mean KOSS score of Korean psychiatrists was lower than the score of other Korean professions (43.99 vs. 46.03). There are significant differences in the sub-items of KOSS, depending on the lifestyle, the career and the hospital on duty. Psychiatric residents scored significantly higher in job control and occupational climate than psychiatrists. On the other hand, workplace relationships and job insecurity scored significantly higher in psychiatrists. Psychiatrists working in general and university hospitals had higher stress in job demand than psychiatrists working at private psychiatric hospitals. Job control and lack of reward scores were high in psychiatrists working in national psychiatric hospitals, and 21.8% of psychiatrists answered that they would not become a psychiatrist again. Conclusion This study showed the overall job stress level of psychiatrists in Korea, and they were experiencing high job stress in different areas depending on factors, such as position, working environment and living habits.

An exon 19 deletion and a L858R mutation in exon 21 of the epidermal growth factor receptor (EGFR) are the two most common mutations that predict favorable efficacy of EGFR tyrosine kinase inhibitors (TKIs) in patients with non-small cell lung cancer (NSCLC). Many retrospective and prospective studies, as well as meta-analyses including patients with NSCLC with various lines of EGFR TKI treatment, have demonstrated longer progression-free survival and sometimes more favorable overall survival in patients with an exon 19 deletion than those with the L858R or other mutations. In contrast, some clinical studies, including phase III trials, have demonstrated no difference in the efficacy of EGFR TKIs according to the EGFR mutation type. Therefore, the existence of clinically significant differences in sensitivity to EGFR-TKIs among different EGFR mutation subtypes remains controversial. In this review, we summarize the evidence suggesting different outcomes according to the type of EGFR mutation in patients with advanced NSCLC who were treated with EGFR-TKIs, along with their clinical significance. We also discuss possible mechanisms that can explain the different sensitivities to EGFR TKIs between cases with an exon 19 deletion and those with the L858R mutation.
Carcinoma, Non-Small-Cell Lung* ; Disease-Free Survival ; Epidermal Growth Factor* ; Exons ; Humans ; Phosphotransferases* ; Prospective Studies ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor* ; Retrospective Studies

Isolated fractures of lower sacrum are commonly treated conservatively in most cases because of low energy damage and stable fracture. However, surgical treatment is required in displaced unstable fracture. But the surgical technique is not established and even case reports are not common. We reported a case of displaced transverse fracture of the lower sacrum that was treated with an open reduction and dual plate fixation.