PURPOSE: Nonunion and metal failure as a complication may occur in femoral fractures, which are treated with plate and screw or intramedullary nail. The authors clinically reviewed metal failure patients from initial operation to rehabilitation program, and analyzed the cause of failure and attempted to establish more rational methods of management and prevention. MATERIALS AND METHODS: Seventeen patients of metal failure, treated at Kyungpook National University Hospital from 1989 to 1998, were included in this study. We studied the relationship between the initial site of fracture, type of fracture, time interval of metal failure, configuration of metal failure, probable cause of metal failure, and secondary reconstructive operation for metal failure. RESULTS: Dynamic compression plate was the most frequently (12cases) used implant. The most common site and type of fracture were proximal 1/3 of femoral shaft (8cases) and transverse fractures (11cases). As the configuration of metal failure, breakage of the plate or nail were more common at proximal or distal 1/3 of the shaft. There was no relationship between the time interval of metal failure and the initial site or type of fracture. The most probable cause of metal failure was improper rehabilitation in 6 cases (75%), other causes were another source of external force, inadequate bone support, improper choice of implant and infection. CONCLUSIONS: To prevent metal failure, we must preserve the periosteum and soft tissue, use bone-grafting at the time of treatment and employ cooperative rehabilitation therapy to implement gradual increasing non-weight bearing joint exercise, partial-and full-weight bearing excercise.
Femoral Fractures ; Femur* ; Gyeongsangbuk-do ; Humans ; Internal Fixators* ; Joints ; Periosteum ; Rehabilitation

PURPOSE: The purpose of this paper was to evaluate the treatment results according to bone union, union time, and complications, including infection of unreamed nailing of tibial fractures between closed and open fractures. MATERIALS AND METHODS: We reviewed 64 tibial shaft fractures that were treated with unreamed tibial nail. These included 42 closed fractures and 22 open fractures. RESULTS: Average union time of closed fractures was 19.8 weeks and that of open fractures was 20.2 weeks, nonunion rate were 4/42 and 3/22 in closed and open fractures. Average union time were 19.2, 20.4, 21.3 weeks in open grade I, II, llla fractures. According to the type of fractures, average union time were 18.5, 20.2, 24.6 weeks and nonunion rate were 2/29, 3/26, 2/9 in type A, B, C fractures. According to the level of fractures, average union time were 20.0, 20.3, 19.4 weeks and nonunion rate were 1/5, 4/37, 2/22 in proximal, middle, and distal fractures. There was no significant differences in average period of radiologic union, infection rate and nonunion rate between closed and open fracture group, but longer union time and higher nonunion rate in complex and comminuted fractures (P<0.05). CONCLUSIONS: We consider unreamed intramedullary nailing in the tibial shaft fractures as a good treatment modality for closed and open grade I, II, IIIa fractures
Fracture Fixation, Intramedullary ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Tibial Fractures*

PURPOSE: The purpose of this study is to assist the optimal placement of sacroiliac screw by evaluating the anatomic and radiologic features of upper sacrum. MATERIALS AND METHODS: Fourteen fresh-frozen cadaveric pelvises and 13 normal adults were studied for the evaluation of morphology of first sacrum and dysplastic patterns. Measurement of anatomic parameters and CT imaging of pelvis were performed. Thirty-two patients with complicated pelvic fracture were evaluated for detection of variations in the sacral alar anatomy and slope found in upper sacral segmentation. RESULTS: The mean distance between midpoint of sacrum and sacroiliac joint was 52.75 mm. The height of first sacral body was 21.71 mm. The longest antero-posterior distance in sacral alar was 52.36 mm. The mean angle between the coronal plane of S1 vertebra and anterior aspect of the alar was 29.3 degree. The mean angle between the superior aspect of S1 vertebral body and superior edge of the alar was 34.8 degree. The mean angle between the superior aspect of S1 vertebral body and supero-posterior edge of the alar was 12.5 degree. The studies revealed about 28 to 33% of cases as dysplastic sacrum. CONCLUSIONS: We studied anatomic and radiologic features of upper sacrum in cadaveric and clinical cases to gain information on the optimal placement of sacroiliac screw.
Achilles Tendon* ; Adult ; Cadaver ; Humans ; Pelvis ; Rupture* ; Sacroiliac Joint ; Sacrum ; Spine

A clinical analysis was done on 23 patients (24 hips) with fracture of the femoral neck, who had been admitted and treated at our Orthopedic department during the period of 4 years, from Jan. 1984 to May 1988. The results were as follows 1. 23 patients were comprised of 4 males and 19 females, and 11 patients were over 65 years old. 2. 18 cases of 24 cases were due to minor traumas such as slipping down, and for over 65 years old, all cases were due to simple minor traumas, 8 cases were showed a severe osteoporosis, below grade 3 of the Singh's index. 3. 14 cases of 24 cases were displaced subcapital fractures, and 6 cases displaced transcervical fractures. Only 4 cases were the undisplaced transcervical fractures. 4. In treatment of fractures internal fixations after manipulation were performed in 14 cases and primary arthroplasties in 10 cases. Secondary arthroplasties were done in complicated 4 cases of 14 cases treated with internal fixations. 5. Complications after internal fixation were developed in 7 cases out of 14 cases, avascular necrosis in 6, nonunions in 2, pin migrations in 3, and metal failure in 1 case. 6. In 14 arthroplasty immediate surgical fitness of femoral stem were related to late loosening of femoral stem (correlation coefficient γ=–0.68, p<0.01).
Arthroplasty ; Clinical Study* ; Female ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Humans ; Male ; Necrosis ; Orthopedics ; Osteoporosis

The normal values of glycogen contents in skeletal muscles in commonly used experimental animals and men were studied. In addtion, this study was designed to know the relationship between amount of exercise and glycogen content in muscle, and to know the causes of species difference. Glycogen contents were determined in quadriceps, gastrocnemius, and triceps in mouse, rat, rabbit, and man. The results of this study as follows: The value of glycogen content in human skeletal muscle is significantly higher than that of experimental animals. The heavier the body weight of experimental animal, the higher the value of glycogen content in each muscle. The value of glycogen content in gastrocnemius is higher than that of quadriceps. The value of glycogen content in quadriceps is higher than that of triceps.
Animals ; Body Weight ; Glycogen ; Humans ; Male ; Mice ; Muscle, Skeletal ; Rats ; Reference Values

Patella position in the normal knee jolnt has been discussed by many authors such as Boon-Itt 1930, Blumensaat 1938, and Insall 1971. But measure with Boon-Itt's method was so complicated and with Blumensaat's was denied by others due to inefficacy. Insall suggested more simple and clinically applicable method that was based on the fact that patellar tendon is inelastic. Now, we measured 100 healthy Korean knee accordlng to Insall's method. The following results were obtained in the study, 1. The length of the patellar tendon is 4.45 In males, 4.08 In females, and 4.26±0.40 cm. in average. (p<0.001) 2. The length of the patella is 4.51 in males, 4.09 In females, 4.36±0.40 cm. in average. (p<0.001) 3. The length of the patellar tendon (LT) and the dlagonal length of the pattella (LP) are almost same (LT: LP is 0.99 in both males and females, 98% of normal knees are contained within the difference of +20%). Difference above this limit may mean high-riding patella. 4. Blumensaats line on the distal femur doesnt pass the lower pole of the patella but the Iine passes 1 cm. below it in average. 5. The length of the patella (LP) and of the width of the femoral condyles at Blumensaat's line (WCBL) are almost same. When LP is markedly decreased in comparison with WCBL, this case may suggest hypoplasia of the patella. 6. Height of insertion of the patellar tendon (Hl) dlffers among various indlviduals. Its length is cllnically not so significant.
Female ; Femur ; Humans ; Knee Joint ; Knee ; Male ; Methods ; Patella ; Patellar Ligament

The object of this study was to determine the physiological range of talar tilt angle of the Korean and to establish the basis for diagnosis and treatment of the lateral instability of the ankle. The anteroposterior inversion stress view of both ankles was taken in the 108 healthy Korean who had no history of ankle injury or disease. The sagittal stress films were also performed on 96 ankles (48 cases) of these to further define the physiological limits of the sagittal mobility of the normal talus. We compared these two values of normai mobility of talus to deterrnine the significance and relationship of the rwo. The results obtained were as follows: 1) Talar tilt over 10 degrees was seen in only 6 ankles (1.9%) and most of the ankles (279 ankles, 88.4%) showed a tilt less than 5 degrees. 2) Normal talar tilt angle was increased in 30 degrees plantarflexed position than in 90 degrees neutral position of ankle. In 12 cases the value was different between the right and the left; but there was no significant difference between the sexes. 3) The anterior displacement index over 200 was seen in only 5 ankles (5.2%). 4) There was gross positive inter-relationship between physiological. range of talar tilt angle and talar sagittal mobility.
Ankle ; Ankle Injuries ; Diagnosis ; Talus

There has been much dispute about the pathomechanics and the significance of the test even among the most competent surgeons in this field. Some have claimed that the posterolateral capsule must be torn to initiate the pivot shift. Some have even gone as far as to deny the importance of the anterior cruciate ligament as a main stabilizing structure of the knee. We evaluated the concept of MacIntosh in anatomical studies which were carried out at the both Pathology and Orthopedic department of Kyungpook National University, School of Medicine, Taegu Korea. Experiments have been carried out to study the etiology of anterolateral instability and the production of a pivot shift sign. In the cadaver knees and A/K amputation knees, which did not have any sign of instability or osteoarthritis, the anterior cruciate was severed by a short medial incision. We could immediately detect a pivot shift. No pivot shift resulted however when the posterolateral capsule was completely divided first and the anterior cruciate left intact, or when the medial collateral ligament and medial capsule were cut. If both the anterior cruciate and posterolateral capsule were divided the pivot shift became more prominent than after cutting the anterior cruciate alone. When the medial collateral ligament including the capsular structures was completely severed, however, the pivot shift disappeared. In summary the experiments show the following: 1. An isolated rupture of the anterior cruciate ligament or its combination with a partial tear of the medial collateral ligament may be detected with the pivot shift sign. 2. If the rupture of the medial collateral ligament is complete the pivot shift test can be negative in spite of a tear of the anterior cruciate ligament.
Amputation ; Anterior Cruciate Ligament ; Cadaver ; Collateral Ligaments ; Daegu ; Dissent and Disputes ; Gyeongsangbuk-do ; Humans ; Knee ; Korea ; Orthopedics ; Osteoarthritis ; Pathology ; Rupture ; Surgeons ; Tears

A clinical analysis was done on forty-five patients with fracture of the femoral neck, who have been admitted and treated at our orthopedic department during the period of 6 years, from January 1975 to December 1980. The following results were obtained: Age over 60 comprised 60% of the patients. Male to female ratio revealed no significant difference, being 21 to 24. However, with advancing age, female was affected more frequently than male. The major cause of injuries were “fall or slip down” occuring in 33 patients (73.3%) and “hit by car” in 12 patients (26.7%). Of the 39 patients in whom Garden's calssification of fracture could be applied. Stage II was the most common type occuring in 29 patients (75%), followed by Stage N in 6(15.4%), and Stage 5 in 4 (10%). Of the total 45 cases, forty patients were reduced and fixed with multiple Knowles pins and two patients with Jewett nail. Three patients with neglected treatment of the fracture for over 1 to 4 months were treated with primary replacement arthroplasty of the femur in two and total hip replacement in one. Fractures were united within 3 months in 10 patients (23%), 4 to 6 months in 19 patients (45.2%), and non-union in 2 patients. Relationship between accuracy of reduction using Gardens alignment index and develepment of avascular necrosis was evaluated. Of the 27 patients with reduction in the range of 155 180 in both frontal and lateral views, 3 patients were developed avascular necrosis, and of the 9 patients with reduction of less than 155 in frontal view or greater than 180 in lateral view, 4 patients were developed avascular necrosis.
Agriculture ; Arthroplasty, Replacement ; Arthroplasty, Replacement, Hip ; Clinical Study ; Female ; Femoral Neck Fractures ; Femur ; Femur Neck ; Humans ; Male ; Necrosis ; Orthopedics

A clinical study was done for 103 cases of the trochanteric fractures which were admitted and treated at the department of orthopedic surgery, Kyungpook National University Hospital during the period of 9 yeras from January 1972 to December 1980. Following results were obtained: 1. Of the 103 cases of the trochanteric fractures, 73 cases were in man, with peak age at 6th decade and 21 out of 30 in woman were over 50 years of age. 2. Causes of the fracture were ear accidents in 67 cases and “slip or fall down” in 36 cases. 3. According to the classification of the trochanteric fractures by Boyd and Griffin, most common type was type 11 in 40 cases and followed by type 111 in 27, type 1 in 24 and type 1V in 12. 4. Upon the treatment, 53 out of 103 cases were conservatively treated with Thomas splint and skeletal tractior. Those cases were mostly combined injury on other organs. Open reduction and internal fixation was done on 50 cases with Jewett nail in 48, Zickel nail in 1 and Judet plate with screw in 1. Most of unstable fractures were reduced by Dimon-Hughston method and fixed with Jewett nail. 3. Union of thef ractures ranged from 10 to 16 weeks, average 13 weeks, by open reduction with internal fixation and from 12 to 24 weeks, average 17. 5 weeks, by conservative treatment. 6. Complications were encountered 31% of those cases with conservative treatment and 16% of those cases with operative treatment. Major complicationss after the conservative treatment were decubitus ulcer in 14 cases (27%), coxa vara deformity in 8(16%) and urinary tract infections in 5(10%).
Classification ; Clinical Study ; Congenital Abnormalities ; Coxa Vara ; Ear ; Female ; Femur ; Gyeongsangbuk-do ; Hip Fractures ; Humans ; Methods ; Orthopedics ; Pressure Ulcer ; Splints ; Urinary Tract Infections