Pseudoaneurysm is one of the complications of arterial injuries by trauma. The case report in children is rare, although not in adult. A 7-year and 10-month girl was visited with the complaints of pain and a mass in her right leg. At first, the radiograph of right tibia showed a remarkable cortical erosion from without, suggesting mass effect by a soft tissue tumor. She had a history of fracture of right tibia, and then manipulative reduction and K-wire fixation at 11 months ago. Arteriography showed a formation of the pseudoaneurysm originated from the posterior tibial artery. The operation was done through the ligation of artery at proximal and distal to pseudoaneurysm, and then excision of mass. At 5 year follow-up, the configuration and function of right foot was normal. Eventually, the cause of the mass formation is thought by the trauma of fracture fragment at the time of accidents, but the possibility of penetrated injuries by K-wire should be ruled out, which is used frequently in children's fracture. We experienced a case of traumatic pseudoaneurysm of posterior tibal artery with tibial fracture, especially occurred in pediatric patient, and presented the result of long-term follow-up.
Adult ; Aneurysm, False* ; Angiography ; Arteries ; Child* ; Female ; Follow-Up Studies ; Foot ; Humans ; Leg ; Ligation ; Tibia ; Tibial Arteries* ; Tibial Fractures

PURPOSE: To study the availability of the radiological classification for incongruent hallux valgus deformities, which has been used as the key to the algorithm for selecting surgical options. MATERIALS AND METHODS: To determine radiological severity, 257 cases of incongruent hallux valgus deformities were studied. The hallux valgus angle (HVA) and the 1/2 intermetatarsal angle (IMA) were measured in each case. Following Mann's radiological classification system, the HVA and IMA were compared to determine any similarity in severity. The distal metatarsal articular angle (DMAA) was also measured to observe the extent of its effect on the incongruent deformity. RESULTS: The HVA was 36.1degrees on average (range, 16-60degrees) and the 1/2 IMA was 15.8degrees on average (range, 5-30degrees). In 126 cases (49.1%), the severity between the 1/2 IMA and HVA coincided with the index classification, whereas. 131 cases (50.9%) did not correspond. Overall, the severity of approximately half the cases, could not be graded. The DMAA was 15.6degrees on average (range, 0-40degrees) and 133 cases (51.8%) demonstrated a value above normal value (>15degrees). CONCLUSION: The radiological classification system used as a guide for surgical decision-making needs to be revised, due to the overt limits of correspondence between the severity of the 1/2 IMA and HVA. Because the HVA would be influenced by both the lateral subluxation and bony deformity around the first metatarsophalangeal joint, it is reasonable to consider these factors on the HVA as elements to be corrected individually, instead of the HVA alone.
Classification* ; Congenital Abnormalities* ; Hallux Valgus* ; Hallux* ; Metatarsal Bones ; Metatarsophalangeal Joint ; Reference Values

PURPOSE: The purpose of this study was to investigate the effects of growth hormone (GH) on muscle during limb lengthening. MATERIALS AND METHODS: Sixty rats underwent tibial lengthening of approximately 30% using a protocol consisting of a latency period 4 days, a distraction period of 30 days with a rate of 0.25 mm twice per day, and a consolidation period of 27 days. Recombinant GH was administered to 30 of the rats (100 g/kg/day) and the same dose of normal saline to the remaining 30 rats, during the period from operation to sacrifice. Histopathologic, immunohistochemical, and electrophysiologic studies were performed on the tibialis anterior compare the muscle responses of GH treated lengthened limbs (GL), GH treated non-lengthened limbs (GN), saline treated length-ened limbs (CL), and saline treated non-lengthened limbs (CN) at postoperative days 34 and 61. RESULTS: Histologic injury scores were worst in the CL, in which vimentin expression was also greatest. Cell proliferation, determined by proliferating cell nuclear antigen (PCNA) staining, was greatest in the GL, in which desmin expression was also greatest. Electrophysiologi-cal methods showed better muscle function was retained in the GL than the CL. CONCLUSION: These results suggest that GH can reduce muscle damage during limb lengthening by enhancing myogenesis and decreasing fibrogenesis.
Animals ; Bone Lengthening ; Cell Proliferation ; Desmin ; Extremities ; Growth Hormone* ; Latency Period (Psychology) ; Muscle Development ; Proliferating Cell Nuclear Antigen ; Rats ; Regeneration* ; Vimentin

PURPOSE: The present study was performed to determine the optimum conditions(RPM, load, sharpness of drill) for drilling human cortical bone with standard drill, and to evaluate the histological changes occuring in bone after drilling. MATERIALS AND METHODS: in experiment I, we measured temperature elevations and the durations of temperature elevation in cadaveric femoral cortices at specific distances from the drill hole wall while drilling. The effects of drilling force, speed and new versus worn drill on the termperature were determined. In experiment II, we also measured temperature elevations in the same manner in porcine femoral cortices and evaluated the histological changes occuring in bone after drilling. RESULTS: In experiment I, the most significant temperature elevation(68.4degrees C ) was found when worn drill was used. The lower drilling force and faster speed resulted in 55.1degrees C and 45.8degrees C temperature elevation, respectively. However, drill diameter was not a significant factor for temperature elevation. In experiment II, greater heat production was measured with worn drill, at lower drilling forces, at faster drill speed. The acute histologic reactions in bone were hyperemia, degeneration of osteocytes, change in bone stainability, tears, and fragmentation of the bone edges around the drill holes. The observed histological changes were proportional to the amount of trauma produced, that is, the greater the degree of thermal irritation, the greater the degree of histologic activity. CONCLUSION: In cortical drilling, greater heat production was measured with worn drill, at lower drilling forces, at faster drill speed and the greater the degree of thermal irritation, the greater the degree of histologic activity. A further study of the reaction of bone to drilling at longer intervals of time at different conditions may possibly show whether aseptic thermal necrosis could be prevented.
Cadaver ; Hot Temperature* ; Humans ; Hyperemia ; Necrosis* ; Osteocytes ; Thermogenesis*

Fibronectin(FN) is a multifunctional glycoprotein with ARG-GLY-ASP(RGD) sequences that has been known as an important constituent of extracellular matrix in bone. 17-beta estradiol, bone active hormone has been reported to stimulate the in vitro production of several extracellular matrix proteins. Though it is known that estrogen withdrawal causes a significant diminition in PTH induced FN production, the hormonal regulation of FN production in bone has not been thoroughly studied. Especially the study using immunoelectron microscopy about FN production is rare. So, the author undertook tile present study to pursue the effect of estrogen on the distribution of fibronectin in the process of bone matrix formation with immunoelectron microscopy. Four to five weeks old female Sprague-Dawley rats, weighing about 150 gm, were used as experimental animals. It was grouped as ovariectomy group, sham operation group, ovarectomy with estrogen injection group, and normal control group. Each group was sacrificed at 1 week, 3 weeks and 5 weeks postoperatively. Ovaries were removed under the pentobarbital anesthesia, and for the estrogen injection group, 0.25 mg/kg of 17-beta estradiol was injected subcutaneously after oophorectomy. Immunoelectromicroscopic findings were as follows. 1 At the one week after operation, the distributions of gold particles, show the fibronectin reaction in osteoid, are similar in the control group, sham operation group, and ovariectomy with estrogen injection group at intermediate reactions, but it is severely decreased in the ovariectomy group as a weak reaction. 2. At there weeks after operation, the distributions of gold particle are similar in the control group, sham operation group and ovariectomy with estrogen injection group as intermediate reactions, but it is also decreased in the ovariectomy group as a weak reaction. 3 At the five weeks after operation, all the groups have similar distributions of gold particles as intermediate reaction. It is suggested that the estrogen secreted in ovary, partially effects on the fibronectin formation in the matrix of developing bone, and other factors stimulate and compensate the fibronectin formation with removal of ovaries.
Anesthesia ; Animals ; Bone Matrix ; Estradiol* ; Estrogens ; Extracellular Matrix ; Extracellular Matrix Proteins ; Female ; Fibronectins* ; Glycoproteins ; Humans ; Microscopy, Immunoelectron ; Ovariectomy ; Ovary ; Pentobarbital ; Rats* ; Rats, Sprague-Dawley ; Tibia*

Leg length discrepancy in the growing children was developed by multiple causes; such as congenital, infection, traumatic, and mechanical facotrs etc. The discrepancy have been treated by several methods including bony lengthening which is preferable method, but epiphysiodesis also has been one of the valuable methods in which was applied to the treatment of mild to moderate leg length discrepancy in the growing children. We report on patients(15 cases) with leg length discrepancy treated by percutaneous epiphysiodesis since July 1986. There were 8 males and 7 females and the average age of them was 12.6 years old. And we also performed an experimental study which was to find out the effectiveness of the pereutaneous physeal destruction comparing the techningues between curette and drill in the bony models. The causes of leg length discrepancy were trauma in 8 cases and osteomyelitis in 2 cases, congenital dislocation of the hip in 2 cases, poliomyelitis, Legg-Galve-Perthes disease, congenital hemihypertropy in each 1 case. The average preoperative leg length discrepancy was 2.6cm(range:1.9-3.7cm), and average anticipated discrepancy without operation have been 3.7cm(range:2.2-6.3cm) at maturity. The final discrepancy was 0.9cm after 43 months follow-up. According to the result by experimental study, percutaneous epiphysiodesis with curette technique would be more effective and safe than drill thchnique. Percutaneous epiphysiodesis might be one of the useful methods for the treatment of mild to moderate degree of leg length discrepancy in the growing children, and also could be applied combining with bony lengthening for treatment of severe degree of leg length discrepancy.
Child ; Dislocations ; Female ; Follow-Up Studies ; Hip ; Humans ; Leg ; Male ; Methods ; Osteomyelitis ; Poliomyelitis

The 17 patients with 22 resistant clubfeet were treated with modified Turco's operation with or without combining release of calcaneocuboid joint at Department of Orthopaedic Surgery, Hanyang University School of Medicine between 1896 and 1991. They were analysed preoperatively and postoperatively with chinical and radiological methods. In patients who were treated with combined procedures, the latetal talocalcaneal angle and anteroposterior talo-first metatarsal angle in radiological findings were showed better improvement(p < 0.05), and anteroposterior talocalcaneal angle was also showed better improvement but not significant statistically, than those who were treated with modified Turco's operation alone. The final results of combined procedures were better than that of modified Turco's operation. And the most common characteristic physical findings in resistant clubfoot were small heel, deep longitudinal crease on the medial aspect of midfoot area and a single transverse crease on the posterior heel just proximal to the insertion of the tendocalcaneus. So we suggest these physical findings may be expectance for the resistance of the congenital clubfoot to conservative treatment, but it need further comparative study.
Clubfoot ; Heel ; Humans ; Joints ; Metatarsal Bones

The goals of treatment of the slipped capital femoral eiphysis(SCFE) are to stabilize the slipped epiphysis, prevent further slipping and induce early closure of the epiphyseal plate. Mutiple pinning was used for the treatment but in recent years, percutaneous in-situ fixation technique with 1 or 2 cannulated screws is preferred due to the advantages of low rate of complication such as pin penetration. We report the results of experimental study and the functional results after percutaneous pinning. The purpose of the experimental study was the investigation for changes of the screw length and the site of screw entry point according to the degree of slipping by bony model. The entry point of the screw was changed toward anterior and proximal portion of femoral neck and the length of inserting screw was changed to be shorter according to the degree of slip. We have treated 10 patients(13 hips) with slipped capital femoral epiphysis(SCFE) at our department since Jan. 1989. Among them, 6 patients(7 hips) could be followed for more than 2 years. There were 5 boys and 1 girl. One case was affected on the both hip. The average age at operation was 11.8 year old. All cases were obese. Degree of slipping was showed 6 cases in mild and 1 case in moderate. The slipping of acute onset was 3 cases, acute-on chronic 3 cases and chronic 1 case. In radiographic results, 6 cases were showing in Grade 0, 1 case was in Grade II. In functional results, 3 cases were excellent, 3 cases in good and 1 case in poor. One poor functional result was a case complicated by chondrolysis.
Epiphyses ; Female ; Femur ; Femur Neck ; Growth Plate ; Hip ; Humans ; Slipped Capital Femoral Epiphyses

OBJECTIVE: The gout characterized by hyperuricemia is a disorder of purine metabolism and clinical manifestations were seen such as arthritis and tophi in the subcutaneous fitssues. But clinical symptoms were not correlated with the serum level of uric acid. So we analysis of clinical orthopaeclic manifestations and associated factors in gout. METHODS: We have reviewed the medical records, radiography and clinical results of forty six patients admitted at out department between july 1981 and July 1990. RESULTS AND SUMMARY: 1) OF the forty-six patient, 44 cases(95.6%)were male and two female. The age at initial attack was 47.7 year-old in average, from 13 to 66 year-old. 2) Hyperuricemia was associated with obesity in 17 cases(40%), and hyper-tension in 16 cases(35%). 3) The level of uric acid in serum was 9.7mg/% in average on admission and 5.9mg/% on discharge after treated with allopurinol about 2 weeks. 4) The first metatarsophalangeal joint was involved in 28 cases(60.9%) and the ankle joint in 12 cases. Topbus was observed in 14 cases(30.4%) and they were surgically treated in 10 cases.
Aged ; Allopurinol ; Ankle Joint ; Arthritis ; Arthritis, Gouty* ; Female ; Gout ; Humans ; Hyperuricemia ; Male ; Medical Records ; Metabolism ; Metatarsophalangeal Joint ; Obesity ; Radiography ; Uric Acid

Subacute osteomylitis is far less common than acute osteomyelitis, characterized by insidious onset of the symptoms of mild local pain or discomfort without any acute systemic illness. Radiographic findings are not infrequently confused with benign or malignant bone tumors. From Jan, 1983 to Dec. 1991, we experienced twelve patients with subacute osteomylitis of long bones. Our clinical observations were as follows. 1. There were 11 boys and one girl with an average age of 9.7 years(range, 30months-16years). 2. The involved sites were proximal in 1, distal radius in 3, midshaft of femur in 3, distal femur in 2, proximal tibia in 1, and distal tibia in 2 cases. 3. All patients had insidious onset of mild to moderate pain. ESR was increased in 9 cases(75%) with a mean value of 44 mm/hr, but leukocytosis was not found. 4. According to the Green and Edwards' classification, there were type 1 in 1, type 2 in 3, type 3 in 3, and type 6 in 5 cases. 5. Eleven patients had operative treatment. The remaining one patient was treated by antibiotic treatment. 6. Primary treatment was successful in 11 patients who were followed for and average 9.5 months. One patients was lost to follow-up.
Child ; Classification ; Clinical Study ; Female ; Femur ; Humans ; Leukocytosis ; Lost to Follow-Up ; Osteomyelitis ; Radius ; Tibia