No abstract available.
Aged ; Aged, 80 and over ; Comorbidity ; *Geriatrics ; Humans ; *Orthopedics ; Patient Care Team ; Quality of Life ; Recovery of Function

Adhesion around tendons of the hand and wrist and subsequent limitation of motion, is one of the major complications after tendon surgery. In addition to the tendon surgery such as tendon repair or graft, infection, open reduction of fracutres, and burn scar contracture could be the casuses of tendon adhesion. Tenolysis and adequate postoperative rehabilitation program, has been proved to be effective in preventing of adhesion, whatever the cause may be, if its continuity is maintained. In order to evaluate the efficiency and problems of tenolysis, we reviewed 37 fingers of 31 patients who had been treated by tenolysis at Seoul National University Hospital from 1981 to 1991. There were 20 men and 11 women, and the average age was 28.2 years(9-45 years). The causes of adhesion were various; 24 fingers(64%) after tendon repair or tendon graft, 3 fingers(8%) after infection, 4 fingers(10%) after treatment of fracture, 4 fingers(10%) after burn scar contracture, and the other 2 fingers(5%) after curettage of enchondroma. Involved tendon were flexor tendon in 28 fingers and extensor in 9. The average duration of follow-up was 17 months(13 months to 4 years). Active motion of involved finger was started within 2 days after operation. The Total Active Motion(TAM) after operation was average 213°(100°-260°), compared to 123°(40°-180°) before operation. According to Strickland formula which was modified by us, the postoperative results were excellent in 17 fingers, good in 9 fingers, fair in 6 fingers and poor in 5 fingers. In 24 cases who had tenolysis after repair or graft, 19 case(79%) were rated as excellent or good. But in 7 cases whose causes of adhesion were infection or burn scar contracture, only 3 cases(42%) were rated as excellent or good. Compairing the results between younger(less than 30 years of age) and older(more than 30 years of age) group, the younger group showed excellent and good in 8496 and the older group in 41%, The complications were tendon rupture in 3 fingers and minor infection in 2 fingers, respectively. In summary, tenolysis was considered as a useful procedure to improve function of tendon bound down in scar tissue. And the results were better in younger age group(p < 0.05) and in previous tendon repair or graft(p < 0.05) group.
Burns ; Chondroma ; Cicatrix ; Contracture ; Curettage ; Female ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Male ; Rehabilitation ; Rupture ; Seoul ; Tendons ; Transplants ; Wrist

Congenital radial clubhand is a rare deformity, which is characterized by total or partial absence of the radial ray of forearm and hand. We experienced 9 radial clubhands in 7 patients during the last 12 years. Excluding 3 clubhands in 2 patients which were very mild in their deformity, 6 clubhands in 5 patients were operated. Radialization was done in 5 clubhands, and centralization in one. Concomitant corrective osteotomy of ulna was combined in all. The results of the surgical treatment were evaluated by ; radiological findings including Hand-forearm angle(HFA), Hand-forearm position(HFP) and Ulnar bowing(UB) range of motion of the wrist ; and parents' satisfaction. Patients were followed up for average 2 years and 6 months, ranging from 1 to 6 years. All the radiological findings were improved. Although their range of wrist motion was not increased, this was changed into more functional position, that is the radial deviation decreased but ulnar deviation increased. Most parents were satisfied with the surgical results.
Congenital Abnormalities ; Forearm ; Hand ; Humans ; Osteotomy ; Parents ; Range of Motion, Articular ; Ulna ; Wrist

Intrinsic plus deformity, which results in severe functional impairment of the hand, is caused by contracture of intrinsic muscles. This deformity can be resulted from many causes such as ischemic damage, spasm of intrinsic muscles, thermal injury, and so on. The surgical release of tightened intrinsic muscles, may be the only solution to make usable hand, especially for severe cases. Sixty five digits in 22 patients who were operated on from 1982 to 1992, were evaluated retrospectively, to analyse the effects of surgery for intrinsic plus hand. Among 65 digits, 13 were thumbs and 52 fingers. The mean age of the patients was 26 years and 8 months and 17 cases were males and 6 females. The causes were ischemic damage by laceration or crushing injuries in 11 patients, compartment syndrome in 5, cerebral palsy in 5, and burn in one. Involved digits were thumb only in 4 patients, thumb and fingers in 9, and fingers in nine. All the digits were classified preoperatively by Zancolli's classification. In 13 thumbs retropulsion contracture was 4 and adduction-antepulsion contracture was nine. All of the thumbs were treated by intrinsic release and Z plasty(or rotational flap). Other procedures including arthrolysis, arthrodesis and tendon reconstruction were combined in 9 thumbs. In 52 fingers, in addition to distal release, arthrolysis was combined in 12 fingers, and arthrolysis plus volar plate release were combined in 4 fingers. For the assessment, our criteria, based on subjective satisfaction of the patient and range of motion, was used. The duration of follow up was from one year to 9 years with the average of 26 months. In 14 thumbs the results were excellent in 2, 6 good, 4 fair, and one poor. In 52 fingers excellent was 12, 24 good, 13 fair, and 3 poor. In summary we could improve the function of intrinsic plus deformity by appropriate sugery, and their results were good.
Arthrodesis ; Burns ; Cerebral Palsy ; Classification ; Compartment Syndromes ; Congenital Abnormalities ; Contracture ; Female ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Lacerations ; Male ; Muscles ; Range of Motion, Articular ; Retrospective Studies ; Spasm ; Tendons ; Thumb

Polydactyly is one of the most common congenital anomalies of the limb, however its surgical treatment varies from simple excision to reconstruction. The purpose of this study is to present out classification of polydactyly in which the type of surgery was concerned primarily. Two hundred and thirty five digits(134 fingers and 101 toes) in 188 patients were operated from 1980 to 1992. We divided the polydactyly into two types-the simple type, in which the extradigit arises from only one digit, and the complex type in which the extradigit connects more than two adjacent main digits. The simple type was subdivided into joint type(type I), in that the extradigit has its own joint in its origine; epiphyseal type(type II), the extradigit share common epiphysis with main digit; and hypoplastic type(type III), the extradigit is connected only by soft tissue to the main digit. The epiphyseal type(type II) was further divided into subtype A(type IIA), in that the origin seems to be directly derived from the epiphysis; and subtype B(type IIB), which resemble an osteochondroma. Type III and type IIB can be treated by simple excision, however the type I and type IIB can be treated by arthroplasty with or without osteotomy as well as excision of extradigit. Result of surgical treatment in 1 digit of the simple form, which siginifies the extradigit arising from only one digit, are good in 193 digits(91%), fair 14(6.6%), and poor 5(2.4%) after an average follow-up period of 20 months. Our principles in the surgical treatment of polydactyly was treatment according to the type, and early treatment.
Arthroplasty ; Classification ; Epiphyses ; Extremities ; Fingers ; Follow-Up Studies ; Humans ; Joints ; Osteochondroma ; Osteotomy ; Polydactyly

Being a rare disease entity, there have been few references about the cleft hand in Korea. We evaluated the postoperative cosmetic results of 17 cleft hands in 14 patients, who were treated surgically at the Department of Orthopedic Surgery of Seoul National University Hospital, from 1982 to 1993. Among 14 patients, 8 were males. Bilateral cleft hands were in five patients and unilateral in 9. Three of five patients who had bilateral cleft hands, were treated surgically on both hands. Remaining two patients had an operation on one hand which affected more severely. Average age at the time of operation was 2 years and 5 months(5 months-10years). Average duration of follow-up was 34 months(1 year 1 month-7years 5 months). By Lange's classification, typical patterns were 16 hands and atypical pattern one. By Flatt's classification, there were 8 hands of I b, 7 I c, 1 I a, 1 II. One patient had family history whose father had both cleft hands and feet. Congenital anomalies other than cleft hand were associated in 10 of 14 patients. Two patients had 3 associated anomalies, 4 patients 2, and 4 patients one. Syndactyly was the most common associated anomaly of affected cleft hand. Central cleft was closed by Snow-Littler technique in 4 hands(24%), Barsky method in 12(71%) and others in 1(6%). Metacarpal bone was treated by intermetacarpal ligament reconstruction in 1 hand(6%), excision only 7(41%), transfer of 2(rd) metacarpal to 3(rd) metacarpal base after excision 5(29%), and 2(rd) metacarpal corrective osteotomy 3(18%). Complications were in 2 hands; one wound dehiesence of cleft, and one partial necrosis of skin. The cosmetic results of surgical treatment were graded into good, fair or poor by the parents-Good ; when parents were satisfied with the result, Fair; improved cosmesis but not satisfied, and Poor; no improvement after surgery. Good was in 16 hands and fair in one.
Classification ; Fathers ; Follow-Up Studies ; Foot ; Hand ; Humans ; Korea ; Ligaments ; Male ; Methods ; Necrosis ; Orthopedics ; Osteotomy ; Parents ; Rare Diseases ; Seoul ; Skin ; Syndactyly ; Wounds and Injuries

Luque introduced new posterior spinal instrumentation by segmental sublaminar wiring for spinal deformity in 1976. This system initially developed for the treatment of paralytic scoliosis, but now its application was extended to treatment of other types of scolisis, spinal fractures and spondylolysthesis. Advantages of this system in scoliosis are better correction force and secure internal fixation enabling early ambulation without external support. Disadvantages include longer operation time, possibilities of epidural bleeding and dural laceration. Luque instrumentation in thoracic and lumbar spine fracture is an effective means of obtaining following goals: provide reduction, maintenance of alignment, restoration of stability, prevention of deformity, low pseudarthrosis rate and early mobilization without external support. Luque instrumentation were carried out in 5 cases at Dept. of O.S. at SNUH from Oct. 1983 to Feb. 1984 with excellent results. The average follow-up period was 7.4 months and there was no complication. Two cases of unstable thoracic and lumbar spine fractures were treated with Luque instrumentation with fusion. The use of double sublaminar wiring with Luque rods, two levels above and two levels below on area of fracture provided early stabilization to allow rehabilitation without external immobilization. Three cases of paralytic scoliosis underwent Luque instrumentation by a modification of the Galveston technique with fusion. Average preoperative curve was 110°(ranged from 101° to 126°). Immediate postoperative correction was 58.7°(46.6%) and average 7 months-following result was 56.3°(48.3%). Operation time averaged 6hr 7min and blood loss was averaged 12 pints. Those patients required instrumentation from the pelvis to middorsal segment, in an effort to control the curve and associated pelvic tilting. In early follow-up the author obtained remarkable correction in paralytic curves, and the pelvic obliquity were well corrected with a pelvis and provid ing with better sitting balance.
Congenital Abnormalities ; Early Ambulation ; Follow-Up Studies ; Hemorrhage ; Humans ; Immobilization ; Lacerations ; Pelvis ; Pseudarthrosis ; Rehabilitation ; Scoliosis ; Spinal Fractures ; Spine

In 5 cases of congenital coxa vara, 7 cases of acquired coxa vara and 4 hips in 3 cases of acquired coxa valga, we performed subtrochanteric osteotomies at Department of Orthopedic Surgery, SeoulNational University Hospital, from December 1980 to February 1984. At a relatively short interim follow-up, following observations were made on the correction of the femoral neck-shaft angle deformities. l. In the congenital coxa vara group, at an average follow-up of 1 year and 3 months, 97.9% of the correction obtained by osteotomy was maintained, based on the roentgenographic measurements of femoral neck-shaft angle. In the acquired coxa vara group, at an average follow-up of 1 year and 2 months, 93.3 % of the correction obtained by osteotomy was maintained. In the acquired coxa valga group, at an average follow-up of 1 year and 5 months, 92.9% of the correction obtained by osteotomy was maintained. 2. At final follow-up, leg length gain averaged 1.26cm in the congenital coxa vara group and 2.23cm in the acquired coxa vara group. An average 0.70cm decrease in leg length was noted in the acquired coxa valga group. 3. Trendelenburg sign, which was positive in all the cases of the congenital and acquired coxa vara group, reverted to negative in all. 4. Slight overcorrection in cases of the acquired coxa vara and undercorrection in cases of the acquired coxa valga, is recommended for later loss of surgically corrected femoral neck-shaft angle. In the congenital coxa vara, it appeared that loss of correction was relatively minor.
Congenital Abnormalities ; Coxa Valga ; Coxa Vara ; Follow-Up Studies ; Hip ; Leg ; Orthopedics ; Osteotomy

In 1973, Steel described triple innominate osteotomy in which the ischium, the superior pubic ramus and ilium superior to the acetabulum are divided and the acetabulum is repositioned anterolaterally and is stabilized by a bone graft and metal pins. Its goal is to establish a stable hip for dislocation or subluxation of the hips in older children and adults on whom it is impossible to correct effectively the instability by any one of the more conventional osteotomies, i.e. Salter's, Pemberton's or Chiari's, or by the capsular arthroplasty of Colonna. During the eleven years and eight months, from December 1973 to August 1985, at the Department of Orthopedic Surgery, Seoul National University Hospital, we performed Steel's triple innominate osteotomy on 41 cases, of which 37 were residual poliomyelitis and 4 septic hip residua. 4 cases of residual poliomyelitis were lost during follow up. The remaining 37 cases were reviewed for the efficacy and limitations of triple innominate osteotomy. We observed following conclusions: 1. Aside from congenital dislocation and dysplasia of the hip, paralytic conditions, such as residual poliomyelitis, are good indications of Steel's triple innominate osteotomy in older children, adolescents and young adults. Acetabular acclivity is adequately reduced and stability is improved. 2. Septic hip residua, including healed tuberculosis, is another indication of triple innominate osteotomy, particularly when total hip arthroplasty is contemplated. 3. When abductors are partially paralyzed, triple innominate osteotomy alone results in appreciable increase in abductor power, by providing a better muscle tension. 4. Substantial gain in leg length is an added advantage of triple innominate osteotomy. An average of 1.74 cm was gained at osteotomy site in our series. In adults, when limb shortening is relatively m i nor, triple innominate osteotomy alone can be a more convenient alternative to conventional, more formidable method of leg length equalization, such as femoral lengthening. This is particularly true when there is some instability or when abductors are weak. 5. Following improvement in mechanical stability by triple innominate osteotomy, weak abductors and extensors may be augmented by appropriate muscle transfer, resulting in more stable hip functionally. 6. In a hypermobile paralytic hip, iliopsoas tenotomy is neither necessary nor desirable at the time of osteotomy. When the hip is dislocated, or when the hip has marked flexion deformity, iliopsoas tenotomy fascillitates adequate correction, but this greatly increases the risk of neurological complication.
Acetabulum ; Adolescent ; Adult ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Child ; Congenital Abnormalities ; Dislocations ; Extremities ; Follow-Up Studies ; Hip ; Humans ; Ilium ; Ischium ; Leg ; Methods ; Muscle Tonus ; Orthopedics ; Osteotomy ; Poliomyelitis ; Seoul ; Steel ; Tenotomy ; Transplants ; Tuberculosis ; Young Adult

Experimental findings have suggested that the metabolic activities of articular cartilage can be influenced by mechanical stimuli. Our recent mathematical analysis predicted that cyclic compressive loading may create periods of intermittent negative hydrostatic pressure within the cartilage extracellular matrix. Therefore, we hypothesize that intermittent negative hydrostatic pressure, created in the cartilage extracellular matrix during dynamic compression, has a stimulative effect on the biosynthesis of chondrocytes. In order to test this hypothesis, the present study developed a custom designed negative pressure generator to subject a monolayer culture of chondrocytes to an intermittent negative pressure. It was found that the intermittent negative pressure produced a 40% increase in proteoglycan and a l7% increase in non-collagenous protein synthesis during the pressurization period(p (0.05). The collagenous protein synthesis was not affected by the intermittent negative pressure regimen used in this study. After the intermittent negative pressurization, the metabolic activities of the chondrocytes returned to normal(control level). The intermittent negative pressure also produced an increase in the mRNA signals for aggrecan. Therefore, we conclude that intermittent negative pressure may be one of the major mechanical stimulators of chondrocytes in articular cartilage during dynamic compression.
Aggrecans ; Cartilage ; Cartilage, Articular ; Chondrocytes* ; Collagen ; Extracellular Matrix ; Hydrostatic Pressure* ; Metabolism* ; Proteoglycans ; RNA, Messenger