Tuberculosis of the bone and joints is one of the genralized manifestation or solitary localized lesion. Although the incidence of the tuberculous osteomyelitis of long bone is decreasing with good neutrition, development of preventive medicine and improvment of treatment regimen, it is still one of the common diseases in Korea and must be considered in the differentil diagnosis of common orthopaedic complaints. Thirty five cases of tuberculous osteomyelitis of long bone were studied in our department from Junuary 1973 to December 1984. The results are as follows: 1. Long bone tuberculous osteomyelitis were 35 cases (6.6%) from the overall tuberculous lesion of the bone and joints. (534 cases) 2. Childrean and young adults were common age group. 3. Concomitant pulmonary tuberculosis was found in 11 cases. 4. Radiologic findings showed variable lesions including osteolytic, cystic, sclerotic and destructive forms. 5. Confirmative diagnosis could be made by smear, culture of the lesion and pathologic findings. 6. The overall results treated with curettage and bone graft as well as proper antituberculous medication were satisfactory.
Clinical Study ; Curettage ; Diagnosis ; Humans ; Incidence ; Joints ; Korea ; Osteomyelitis ; Preventive Medicine ; Transplants ; Tuberculosis ; Tuberculosis, Pulmonary ; Young Adult

Recently, the treatment principles of congenital dislocation of the hip has been altered markedly. The importance of concentric reduction and its maintenance during growth period in CDH has been stressed by many authors. Acetabular remodelling capacity has been argued between many authors, because it was critical criteria about the determination of operating period and methods. Authors selected 25 cases of congenital dislocation of the hip, which was treated by closed reduction, open reduction and femoral osteotomy to obtain concentric reduction of the hip. And we analyzed the change of acetabular angle and femoral anteversion in two group: Group 1-below 2 years and Group 2-from 2 years to 4 years old. The results were as follows: 1. The change of acetabular angle was improved markedly: average 15° in the Group I and average 13° in the Group 2 in 2 years. 2. The change of femoral anteversion in the Group I was markedly improved: average 15°, but, the in the Group 2 was not significant: average 6°. 3. It was thought that the perfomance of femoral osteotomy without innominate osteotomy in the Group 2, could achieve the satisfactory acetabular remodelling.
Acetabulum ; Dislocations ; Hip ; Osteotomy

Recently, the incidence of hematogenous osteomyelitis tends to increase dse to abuse of the antibiotics and resistent organisms to antibiotics. The three main causes of complication to be chronic stage in hematogenous osteomyelitis were failure of early diagnosis, inadequate choice of antibiotics with insufficient duration and insufficient surgical intervention. Furthermore, hematogenous osteomyelitis of fibula in children has low incidence, so the possibility of chronicity is able to be increased because of delayed diagnosis and inadequate treatment. During the period of 10 yesrs extending from 1977 to 1986, we have treated 12 cases of hematogenous fibular osteomyelitis in children and clinical analysis was made about comparison with prevalent hematogenous osteomyelitis of distal femur or proximal tibia. The following results were obtained; 1. The incidence in males was 1.4 times grester than females. 2. The incidence of involved sites was 2 times dominant in Rt, and all cases were observed in proximal and distal metaphyseal area of fibula. 3. Clinical symptomes and signs were pain, local heat, redness and local tenderness in all of acute cases and 70% of chronic cases with sinus formation and pathologic Fx. 4. ESR was elevated to average 42 mm/hr in all acute cases highestly, but highest leucocytosis was observed in subacute case. 5. Definite bone changes in radiologic findings was observed in only subacute and chronic cases, and uptake of radioisotope in bone scan was observed in 2 acute cases, which were all performed. 6. Causative organism was only staphylococcus aureus, and high sensitive antibiotics to taphylococcus aureus were Cephalosprin, Cloxacillin, Amikin and observed resistance to penicillin(82.5%) and tetracycline(82.5%). 7. Early diagnosis, adequate antibiotic choice with sufficient duration and early surgical decompression and drainage were considered to be essential part of management of hematogenous fibular osteomyelitis and preventing its chronicity.
Amikacin ; Anti-Bacterial Agents ; Child ; Cloxacillin ; Decompression, Surgical ; Delayed Diagnosis ; Drainage ; Early Diagnosis ; Female ; Femur ; Fibula ; Hot Temperature ; Humans ; Incidence ; Male ; Osteomyelitis ; Staphylococcus aureus ; Tibia

After amputation of the extremities, many patients developed problematic sequelae such as loss of function, cosmetic point of view, and psychiatric problems. For period of eleven yesrs from 1976 to 1986, we performed amputation of the fingers in 461 persons, and problematic sequelae were noted in 181 cases of 105 persons. The results were as follows : 1. Causes of the amputation were trauma, infection, burn, frost bite, tumors, and vascular diseases in that order of frequency. 2. Problematic sequelae of the fingers were scar contracutre, scanty soft tissue, neuroma, bony spur formation, deformities, hypersensitivity, ulceration, phantom pain, and depression in that order of frequency. 3. Problematic sequelae in amputation of the fingers could be classified as functional, cosmetic and psychiatric problems. In most instances, the primary concern of a particular patient was amputation itself, and this kind of psychiatric problems should be taken into consideration in the treatment of the amputated fingers.
Amputation ; Burns ; Cicatrix ; Congenital Abnormalities ; Depression ; Extremities ; Fingers ; Humans ; Hypersensitivity ; Neuroma ; Phantom Limb ; Ulcer ; Vascular Diseases

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

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

Gas gangrene is a potentially lethal dissease, but fortunately uncommon. Profound toxicity and rapid progression are characteristic of this disease. Therefore the success of the treatment in this disease is largely depended on early diagnosis and treatment. The treatment includes debridement and decompression, amputation if ncessary, adequate entibiotic therapy, administration of antitoxin, hyperbarit oxygen therapy and general supportive therapy. The authors have reviewed 9 cases of gas gangrence, which were identified by bacteriologically out of 14 cases of suspicious gas gangrene. All cases were treated in our department from 1981 to 1985. The results are summarized as follows: 1. The culture studies of clostridium were specified in 5 cases of Cl. perfringens, 2 cases of Cl. septicum, 1 case of Cl. bifermentans and 1 case of Cl. sporogenes. 2. All 9 patients underwent debridement, antibiotic therapy, hyperbaric oxygen therapy and general supportive therapy. We had not used gas gangrene anti-toxin, beceuse of the value of antitoxin is uncertain and subjects the patient of the danger of hypersensitivity reactions. 3. In 7 patients involving only the extremities, amputations were inveitable on 3 patients due to irreversible gangrenous changes on the involved extremities. And one of them died due to septic shock. 4. In 2 patients involving the trunk, one of them died due to renal failure.
Amputation ; Clinical Study ; Clostridium ; Debridement ; Decompression ; Early Diagnosis ; Extremities ; Gas Gangrene ; Humans ; Hyperbaric Oxygenation ; Hypersensitivity ; Oxygen ; Renal Insufficiency ; Shock, Septic

With improvement of anterior fixation devices, anterior instrumentation-fusion in treatment of thoracolumbar fracture becomes as effective as posterior interbody fusion which has mainly been used up to now. Also, computerized tomography enables us to diagnose the spinal fracture accurately including retropulsive bony fragment and degree of narrowing of spinal canal. We analyzed 18 cases which were treated with anterior interbody fixation in thoracolumbar fracture from Mar. 1977 to Oct. 1986 in Orthopaedic dept. of National Medical Center. The results were as follows ; 1. The mechanism of injury involved falling down in 7 cases, traffic accident 5 cases, and miner injury in 4 cases. 2. The clsssification of fracture by Denis method was compression fracture in 4 cases, bursting fracture in 11 cases, Seat-belt injury in 1 case, Fx-dislocation in 2 cases. 3. The methods of internal fixation were iliac bone graft only in 8 cases, anterior Harrington rod in 2 cases, Webb implant in 6 cases, and Zielke rod in 2 cases. 4. The average preoperative kyphotic angulation was 19.5(range 10 to 22) and immediate postoperative angulation was 10.1(range 2–16). The correction rate was 48%, and the loss of correction was 2.8(range 2–13). The final correction rate was 38.1% with implants, 29.1% without implants. 5. Early operation can get better neurologic recovery. 6. Firm and stsble fixation device is needed.
Accidental Falls ; Accidents, Traffic ; Fractures, Compression ; Methods ; Miners ; Spinal Canal ; Spinal Fractures ; Transplants

Nonunion of the distal humerus is rare and diffcult to treat. It presents to surgeon a double challenge : to obtain bony union of the nonunion and to preserve the mobility of the joint. Six patients who had been treated for a nonunion of the distal humerus at National Medical Center from 1980 to 1988 were reviewed. Three of them were extraarticular and the rests were intraarticular fractures. Two had been open fractures. Five had been associated with nerve injury. Senile osteoporosis was noted in two. Four had been initially treated by 0/R and I/F; one, by irrigation, debriment and traction, followed by 0/R and I/F. The average time from the initial treatment to the treatment of nonunion was 20 months, ranging 3 to 44 months. The type of nonunion was reactive in one and nonreactive in five. All patients had pain, instability and limited motion of the elbow. Four who had perfomed surgical treatment for the nonunion were successful in obtaining bony union. Two who had not performed the operation were supported with the elbow brace to relieve the pain and prevent the progression of the deformity. At follw-up(average 21.6 months, ranging 5 to 39 months), functional end result was good in one; fair in four; poor in one, according to the functional rating system of Jupiter et al. In spite of success in union, the functional disability was major long-term problem. The probable causes of nonunion in our cases were unsatisfactory C/R and insufficient immobilization time, incomplete 0/R and inadequate I/F, insufficient postoperative immobilization time, senile osteoporosis, underlying systemic disease, and focal infection in fracture site.
Braces ; Congenital Abnormalities ; Elbow ; Focal Infection ; Fractures, Open ; Humans ; Humerus ; Immobilization ; Intra-Articular Fractures ; Joints ; Jupiter ; Osteoporosis ; Traction