• Journal of Korean Academy of Nursing
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• v.24 no.4
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• pp.517-528
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• 1994

The purpose of this study was to compare the circumference, skinfold thickness and strength of the normal and casted lower limb prior to casting and following removal of the cast. The subjects for the study were nine orthopedic patients who had had long and short leg casts due to a tibial, fibula, or calcaneus fracture, or to a lateral collateral ligament rupture. Circumference, skinfold thickness, and strength of the normal and casted lower limb following removal of the cast were compared with those prior to the application of the cast. Measurements were made before cast application and after removal of the cast. Skinfold thickness was measured by fat caliper, circumference was measured by tape and strength was determined by measuring the length of time the leg was held elevated at 45$^{\circ}$. The results can be summarized as follows 1. There was no change in the normal limb in the circumference of the midthigh and midcalf after casting as compared to before cast application. 2. In the casted limb the circumference of the midthigh decreased by 3.23% and that of the midcalf decreased significantly by 7.49% during the period of casting. 3. In the normal limb skinfold thickness of the quadriceps decreased and that of gastrocnemius increased by 20.63% during the period of cast application. 4. In the casted limb skinfold thickness of the quadriceps decreased significantly by 12.37% and that of gastrocnemius decreased by 10% during the period of cast application. 5. Strength of the normal lower extremity decreased significantly by 48.37% and that of casted lower extremity decreased remarkably by 73.07% during the period of cast application. 6. Circumference of the midthigh and the midcalf decreased significantly by 7.6% and 9.4% respectively on the casted side as compared to the normal side. Skinfold thickness of the quadriceps and the gastrocnemius on the casted side decreased by 6.12% and 18.55% respectively as compared to the normal side and strength in the lower extremity on the casted side decreased significantly by 44.32% as compared to the nor-mal side. From these results, it may be concluded that muscle atrophy occurs in the casted lower limb and muscle strength of the normal lower limb are also reduced during the period of application of a leg cast.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.67-75
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• 2009

Purpose: This study evaluated the clinical outcomes of debridement arthroplasty using the posteromedial approach in elbow joints with pain and bony limitation of motion. Materials and Methods: This study involved 16 elbows in 16 patients with pain and bony limitation of motion, which were treated by debridement arthroplasty using the posteromedial approach from March 2005 to March 2008. The mean follow up period was 27.6 (13~52) months. The clinical outcomes were analyzed using the Visual Analogue Scale(VAS) for pain scale, the preoperative and postoperative range of motion and the Mayo Elbow Performance Scores(MEPS). Results: The VAS was decreased significantly from a preoperative mean of 4.5 to a postoperative mean 1.1 (p<0.001). The average arc of motion improved significantly from $61.6 (0~90)^{\circ}$ preoperatively to $109.4 (80-120)^{\circ}$ postoperatively (p<0.001). The MEPS also improved significantly from 59.4 to 85.6 postoperatively (p<0.001). There were no complications, such as hematoma and elbow instability. Conclusion: Debridement arthroplasty using the posteromedial approach is a useful surgical procedure in the elbow joint with pain and bony limitation of motion, where all compartments can be debrided, the ulnar nerve can be manipulated easily and damage to the medial collateral ligament can be minimized.

• Journal of the Korean Society of Radiology
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• v.82 no.3
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• pp.613-623
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• 2021

Purpose To evaluate the MRI findings and clinical factors that are characteristic of patients who ultimately undergo surgery for medial epicondylitis. Materials and Methods Fifty-two consecutive patients who were diagnosed with medial epicondylitis and underwent an elbow MRI between March 2010 and December 2018 were included in this retrospective study. The patients' demographic information, clinical data, and MRI findings were evaluated. All variables were compared between the conservative treatment and surgical treatment groups. Logistic regression analyses were conducted to identify which factors were associated with surgical treatment. Results Common flexor tear (CFT) tear size showed a statistically significant difference in both the transverse and longitudinal planes (p < 0.001, p = 0.013). The CFT abnormality grade significantly differed in both the transverse and longitudinal planes (p = 0.022, p = 0.003). A significant difference was also found in the medial collateral ligament abnormality (p = 0.025). Logistic regression analyses showed that only the transverse diameter of the CFT tear size (odds ratio: 1.864; 95% confidence interval: 1.264-2.750) was correlated with surgical treatment. Conclusion Of patients diagnosed with medial epicondylitis, patients with a larger transverse CFT tear size tend to undergo surgical treatment ultimately.

• Journal of the Korean Arthroscopy Society
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• v.10 no.1
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• pp.53-60
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• 2006

Purpose: This study is to analyze the clinical and radiological results after arthroscopic reduction and internal fixation of intra-articular fractures of lateral tibial plateau. Materials and Methods: The subject of the study are the 13 cases of the patients visited orthopedics surgery during March year 2000 to August year 2004 because of intra-articular fractures of lateral tibial plateau and were treated with arthroscopic reduction and internal fixation. X-rays and CT or MRI were both carried out to identify the precise pattern of fracture and the degree of depression which showed out to be all type 2 by Schatzker fracture classification. And in 9 of the cases, autogenous and allogenous bone grafts were given as bone loss were severe. The average age was 48, age group between 31 and 66, and average follow up period of about 38 months ($13{\sim}65months$). Radiological ratings were given by comparing the X-rays of degree of joint congruency before and after the operation, functional ratings by analyzing IKDC score and Lysholm score. Combined injuries observed after arthroscopy were posterior cruciate ligament injury in 1 case, meniscus injury in 4 cases and medial collateral ligament in 2 cases. Results: During follow up, X-rays showed well-maintained reduction of articular surface in all cases and no complications such as joint depression, fracture reduction loss, angular deformity or malunion were found. Average Lysholm score at last follow up was 87 points ranging from 65 to 97, in 8 of the cases excellent, 3 good, 1 fair and 1 poor according to Lynsholm classification. Average IKDC score was 92 (from 82 to 99). Conclusion: Not only does arthroscopic reduction of lateral tibial plateau fracture bring exact reduction of articular surface, but also, is considered to be a good way of operation to diagnose and treat combined injuries of knee joint using arthroscopy.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.209-213
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• 2006

Purpose: Conventional transtibial approach for the anterior cruciate ligament (ACL) reconstruction tended to place the femoral tunnel in too vertical position (11 or 1 o'clock), which could provide the postoperative anteroposterior (AP) stability but not provided the rotational stability. Therefore we present a surgical technique to make the transtibial femoral tunnel at 10 or 2 o'clock position. Surgical approach: To make a transtibial femoral tunnel at the 10 or 2 o'clock position, the direction and position of the tibial drill guide was important. We set the tibial drill guide at $40{\sim}45$ degrees and the intraarticular guide tip was 1 mm anterior and medial to the conventional site. The starting point for the guide pin on the proximal tibia was proximal to the pes anserinus and anterior to the medial collateral ligament. The tibial tunnel was initially drilled 1mm less than the diameter of the graft. Then femoral offset guide could be easily placed at 10 or 2 o'clock position through the tibial tunnel. The tibial tunnel and the femoral tunnel of 30 mm in length were made with the reamer that was same size with the graft. Conclusion: We report a surgical technique to create a transtibial femoral tunnel at 10 or 2 o'clock position in ACL reconstruction to provide the rotational stability as well as the AP stability.

• Journal of Veterinary Clinics
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• v.26 no.2
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• pp.144-149
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• 2009

Chondrocytes and synovial fluid derived markers are used to monitor for osteoarthritis(OA). Specific inhibitors, known as tissue inhibitors of metalloproteinases(TIMP), regulate the proteolytic activity of matrix metalloproteinases(MMP). This study investigated whether MMP and TIMP levels were altered in synovial fluid and cartilage following the experimental induction of OA in canines. Twenty mature beagle dogs underwent a unilateral surgical transection of the cranial cruciate ligament and the medial collateral ligament as well as a medial meniscectomy. Matrix metalloproteinase-2 and MMP-9 levels were assayed using Western blot and TIMP-2 levels were measured with enzyme-linked immunosorbent assays four weeks after OA induction. Increased MMP-2 expression was observed in chondrocytes isolated from cartilage following OA induction, but MMP-9 expression decreased. Matrix metalloproteinase-2 and MMP-9 levels in synovial fluid from the OA induced joint significantly increased compared to those of the sham group. Tissue inhibitors of metalloproteinase-2 concentrations were higher in chondrocytes from the OA cartilage, yet TIMP-2 remained lower in the synovial fluid of OA. This suggests the elevated release of MMP-9 over MMP-2 into the synovial fluid following the cartilage degradation-related death of chondrocytes after OA. Osteoarthritis can be further deteriorated by increased MMP activity in the synovial fluid because TIMP-2 exist low concentration into the extracellular matrix. As a result, MMP activity, particularly MMP-9 activity, can be useful as a biomarker in diagnosing and monitoring the early stages of canine OA.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.4
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• pp.281-301
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• 1993

It was revealed that the morphology and projection pattern of terminal arbors from single primary afferent are different among distinct fiber types, functional types and the different subdivision of trigeminal sensory nucleus complex(TSNC). But it was not identified the ultrastructural morphology and synaptic connections of terminal arbors from each primary afferent within TSNC. So we employed the intra-axonal horseradish peroxidase(HRP) injection technique to define the terminal arbors of primary afferent fiber from slowly adapting mechanoreceptors in the periodontal ligament of the cat, and examined 66 labeled terminal arbors within the rostrodorsomedial part(Vo.r) of the trigeminal nucleus oralis, electromicroscopically with 90nm serial sections. All the boutons labelled with HRP contained clear, spherical and uniform sized synaptic vesicles(diameter : $47.66{\pm}3.58nm$ ). Most of the labelled boutons were boutons en passant type and they were connected by unmyelinated axonal strand. In which neurofilament and microtubule was not developed but occasionally contained synaptic vesicle in contrast to the myelinated axon. The size of the labelled bouton was relatively small(long diameter : $1.46{\pm}0.24{\mu}m$, short diameter $0.85{\pm}0.26{\mu}m$, average diameter $1.15{\pm}0.24{\mu}m$) and the shape of which varied from dome to elongated shape, but scalloped glomerulus shape was not developed. Each primary ending in Vo.r made synapse with one or two neuronal propiles(average : $1.11{\pm}0.31$), of which, 89.4% of labelled boutons made synapse with only one neuronal pro pile, the remainder, 10.6% of labelled boutons, made synapse with two neuronal propile. So characteristically they made very simple synapse. Most of labelled boutons(80.03%) made asymmetrical synapse only with dendritic shaft or spine, and 6.1% of labelled boutons received symmetrical synapse from pleomorphic vesicle containing axonal ending(p-ending). So presynaptic inhibiton was relatively scarce. Synaptic triad, in which a p-ending is presynaptic both pre-and post-synaptic element of the axo-dendritic contact from the labelled primary ending was not observed.

• Journal of Korean Orthopaedic Sports Medicine
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• v.2 no.2
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• pp.163-167
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• 2003

Purpose: The purpose of this study is to describe causes and injury mechanisms during inline skating and to find preventive measures .Materials and Methods: We have carefully selected 57 patients who have been treated in our hospital and nearby hospital. There are 37 males and 20 females, and mean age is 9 years 9 months (range,6-40 years old) . We have meticulously investigated their injured sites, their favorite location for inline skating , their use of protective means while they were on the wheels and their injury mechanisms . Results: Injury consisted of 50 fractures,1 meniscal tear,2 medial collateral ligament rupture and 4 contusion or sprain. Fracture sites varied as follows : 33(66$\%$) cases in distal radius and ulna,5(10$\%$) in elbow. 3(6$\%$) in diaphysis of humerus, etc Location at the time of injury varied as follows : 22 cases(39$\%$) in their apartment complex, 19 cases in (33$\%$) narrow streets, and 16 cases(28$\%$) in parks Only five patients admitted that any means of protection were used.2 cases only had knee pad on , 1 case put on elbow pad in addition, and 2 cases put on wrist guard as well. However none of the patients had helmet on Conclusion: We would strongly like to stress the importance of using sufficient protections and of choosing area where it is safe to ride, in order to reduce the risk of accidents. In addition, continuous and effective prior education from inline skate circles may be in order before riding the inline skate.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.159-166
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• 2009

Purpose: We wanted to evaluate the surgical results of early mobilization after rigid fixation of small coronoid fracture using the tension band technique Materials and Methods: Eight cases of coronoid fracture were fixed with the tension band technique and using K-wire and wire through the medial approach. All the cases were Regan-Morrey type 2. According to O'Driscoll, they were classified as 5 cases of the tip type (subtype 2) and 3 cases of the anteromedial type (1 case of subtype 2, and 2 case of subtype 3). The associated collateral ligament injuries (6 cases) and radial head/neck fractures (4 cases) were managed simultaneously. After immobilization for 5~7 days, active ROM exercise with a fitted hinge brace started and continued till postoperative 6 weeks. The patients were assessed for pain, ROM and functional disability using the Mayo elbow performance score (MEPS) at an average of 11 months (range: 6~28 months). The ulnar nerve symptoms were also investigated. Results: We observed solid union in all the coronoid fractures without hardware failure. An average of 2.2 wires (range: 2~4) were used. The mean extension was $3^{\circ}$(range: $0^{\circ}\sim25^{\circ}$), the mean flexion was $137^{\circ}$(range: $130^{\circ}\sim140^{\circ}$), the mean pronation was $69^{\circ}$(range: $45^{\circ}\sim90^{\circ}$) and the mean supination was $78^{\circ}$(range: $45^{\circ}\sim90^{\circ}$). The mean MEPS was 96 (range: 65~100). Ulnar nerve symptoms occurred at postoperative one day and persisted in one patient with the terrible triad of taking radial head excision and residual medial instability. Conclusion: The tension band technique uses easily obtained, economic K-wires and the wire was strong enough to permit early elbow ROM exercise and the technique might improve the elbow function. It was especially useful for fixation of multiple small fragments.