In children, the cause of angular deformity after the treatment of distal humeral fracture is mainly not dew to the growth problem but the alignment of initial reduction state. The alignment of reduction status can be measured by numerous methods for anatomical reduction. The Baumann angle and lateral humero-capitellar angle are the most useful radiologic measuring methods for the evaluation of the anatomical configuration of distal humerus. But the determination of the straight line along the capitellar growth plate has some difficulties because the curved rounded capitellar shape may overlap the distal humeral metaphysis. So, 4 types classfication suggested by Williamson et. is used for determination of the line eith easy.

The Baumann angle is a valuable measurement method of distal humerus alignment, but as we know, there is no normal range data in Korean children. We measured the normal Baumann angle and lateral humero-capitellar angle using 112 cases normal elbow X-ray films and analysed its significanses.

The results are as follows:

1) The mean baumann angle is 69.2° with 6.2° standard deviation.

2) The mean lateral humero-capitellar angle is 45.3° with 8.2° standard deviation.

3) The Baumann angle and lateral humero-capitellar angle have no differences between ages, sexes, sidedness and types.

4) The 4 types classification by the shape of the capitellar growth plate is a realtively objective and useful method for the measurement of Baumann angle.

5) The Baumann angle has negative value coefficiency with lateral humero-capitellar angle.

Metastatic tumors involving the spine cause severe pain and paraplegia. Vertebral body collapse results in spinal collapse results in spinal instability. In order to promote stability and improve pain, anterior fusion with bone cement and posterior fusion with instruments were used. Retrospective study was carried out of 16 cases of the metastatic tumor of the spine in Ewha Womans University Hospital Orthopedic Surgical dept. from Jan. 1982 to Dec. 1988. We have analyzed the results of treatment and obtained following conclusions.

The results were as follows :

1) Of the 16 patients, the ratio of men to women approximately 3:5 and the high incidence was over 5th. decades.

2) According to tumor classification, reproductive tract tumor was in 4 cases(25%), gastric, lung and hepato-biliary tumors in 2 cases each(12%), thyroid tumor in 1 case(7%) unknown origin in 5 cases(31%).

3) The thoracic spine commonly involved in 12 cases(75%).

4) Anterior fusion with bone cement was in 11 cases and posterior fusion with instrument in 4 cases. Both anterior and posterior fusion was in 1 case.

5) In functional results, the ambulation was achieved in 14 cases postoperatively, in 12 cases at 6 months, and 10 cases finally.

6) The surgical treatment was valuable, because the good results were appeared in 62.5% finally with loss of pain.

Metastatic tumors of the spine often cause severe pain and paralysis because of deformity and neural encroachment. As oncology now extends the life expectancies of these patients, spinal decompression and stabilization are necessary.

2 patients who had vertebral metastases of hepatocarcinoma were operated on by decompressive corporectomy and firm stabilization. They had significant neural recovery and pain relief immediately.

Now, 2 cases are presented with a brief review of literatures.

Spina bifida occulta at the lumbosacral area of a growing child is often associated with a low lying spinal cord that is tethered by one or more forms of intradural abnormalities without producing overt clinical manifestation for a long time. The diagnosis therefore requires a strong clinical suspicision and aggressive investigarion. We reported one case of tethered core syndrome in spina bifida occulta woth brief review of literature.

Postirradiation fracture of pelvis and femoral neck is a rare complication of malignant carcinoma of pelvic organs. According to Leabhart and Bonfiglio(1961), femoal neck fracturare after radiotherapy of pelvic organ carcinoma is about 1.5% among the involved patients and the common sites of primary neoplasms are cervix, uterus, ovary and urethra in order. Acase of 53-year-old female with postirradiation femoral neck fracture was treated at department of orthopedic surgery, Ewha womans University Hospital after 5,000 rad. of radiotherapy for the treatment of urethral malignancy.

Low back pain and radiating pain are mainly due to nerve root compression in herniated nucleus pulposus(H.N.P) and treatment of H.N.P is determined by several factors. Recently, many patients can be managed with another conservative treatment, i.e. chemonucleolysis, without surgical risk if selected properly and prepared to prevent anaphylactic shock. During past 1(1/2) years from November 1984 to June 1986, 46 patients with H.N.P. were evaluated managed chemonucleolysis in 38 cases excluding 8 cases of rupture types. And following results were obtained with follow up of 6 months over. 1) Of 46 patients, 30 patients(65%) were between 20-30th age group, and male was predominent. 2) The site was most common in L4-5 space(30 patients, 65%). 3) Of 38 patients excluding 8 patients of rupture cases, 30 patients(79%) were excellent and good. 4) As soon as the procedures were performed in 22cases(good results), radiating pain and neurologic symptoms were disappeared but dull low back and buttock pain were remained in 12 patients(55%) after 6 weeks. 5) The intervertebral disc space narrowing was found from 3rd day on lateral radiograph and this narrowing was noticed above 30% by 1st month. 6) Symptoms were improved in 3 cases among 8 cases of rupture cases in discogram. 7) In 38 cases, there was no complication except chest tightness and skin prickling sensation of 8 cases (21%) on whole body there after the injection of chymopapain, but they were soon disappeared. In summary, chemonucleolysis is indicated in patients with acute onset and predominently radiating pain.

Gold therapy is employed primarily in progressive rheumatoid arthritis which is refractory to the conventional measures such as aspirin-like agents. The benefical effects of gold therapy have been demonstrated by careful double blind trials on rheumatoid arthritis. However, its mechanism of action is poorly understood. A limitation to use the gold salt is its potential hazards and toxicity and great care should be given during gold therapy. This study was done to evaluate the effectiveness of gold salt on rheumatoid arthritis and its adverse effect during therapy. Forty-five rheumatoid arthritis patients who received gold sodium thiomalate at Ewha Womans University Hospital from. December 1983 to June 1985 were analyzed in this study. The results are as follows: 1) The incidence of rheumatoid arthritis was higher in female than in male with the ratio of 5:1 and the higher incidence was seen in the thirties and fourties(58%). 2) The mean duration of disease was 3.1 years, ranging 2 weeks to 11 years. 3) Common type of rheumatoid arthritis were the Classic and Definite type, and they were 18 cases(40%) and 15 cases(40%), respectively. The Probable(9 cases) and the Possible types(3 cases) were less common. 4) The average onset of clinical improvement was 12 weeks after gold therapy and the mean cumulative dose at this period was 550mg. 5) Thirty patients out of 45 patients showed marked to moderate clinical improvement after completion of gold therapy, whereas 12 patients did not respond. 3 patients were intolerated to gold therapy and discontinued due to severe adverse reactions. 6) The adverse reaction was observed in 32 of 45 patients receiving gold therapy for rheumatoid arthritis and the most common side reaction was dermatologic manifestations(21 cases). 7) There was no correlation between eosinophilia and the occurrance of the side effects.

The most striking and obvious difference between the bony skeleton and all of the other forms of connective tissue is that it is the only member of this class to contain inorganic mineral deposits within its extracellular matrix space at almost all stages of its normal development. In actuality, bone mineral is an integral part of bone tissue having individual physical and chemical properties that directly affect those of the tissue as whole So a precise knowledge of the quantitative relationships between the constituents of bone is essential to understand such important matters as the chemistry of calcification, bone as reservoir, the nature of metabolic bone disorders, and the mode of action of parathyroid hormone, thyrocalcitonin, vitamins, sex and adrenal steroids. Therefore, author performed the quantitative analysis of the inorganic calcium and phosphorus in the cortical bone of sternum from the twenty korean people and the following result are obtained;1) In the cortex of sternum the total contents of inorganic calcium phosphate are 44.4% in male and 44.15% in female. 2) Calcium deposited in the cortex of sternum is 27.15%(SD±2.01) in male and 27.11%(SD±1.67) in female and also, phosphorus being 17.25%(SD±1.27) in male and being 17.05%(SD±1.53) in female 3) Molar calcium to phosphorus ratio is 1.57:1 and 1.59:1 in male and female, respectively.

There are many methods for treatment of solitary bone cyst. But the recurrence rate was relatively high and beside, serious complications may be followed. Recently, simple topical of steroid into cyst was contrived and the result was know as same or even better than surgical management. A patient of solitary bone cyst who had been failed two times by surgical intervention was treated with topical steroid injection for several times. Two years following up, the result was good. No evidence of recurrency was seen and was shown good healing process

Acetabulum is very important in weight bearing and maintaining the normal contour for the function of hip joint. Acetabular fractures are uncommon, because of incongruity, displaced acetabular fractures result in early post-traumatic osteoarthritis. Anatomical reduction and stable internal fixation of acetabular fracture improves the prognosis of the displaced fracture, but the internal fixation of acetabular fracture still represents one of the most difficult tasts in hip surgery. During the period of June 1975 to June 1984, 52 cases were treated in the Department of Orthopaedic Surgery, Ewha University College of Medicine, and results were summarized as follows,1) In the treatment methods of the acetabular fracture, I couldn't assert firmly that a surgical treatment was more desirable than a conservative one when I valued their results. And so, I have chosen the formation for a severe degree of fractures or in accordance with fracture-sites, and adapted the latter for a severe comminuted or non-displaced fracture. 2) The posterior wall acetabulum or the displaced fracture of a dome could be accurately reduced by a possible operation which was considered as a helpful treatment method in preventing the traumatic arthritis for the prognosis. 3) There was no avascular necrosis of femoral head among 52 cases. 4) In case which was difficult to be reduced on author's operation procedure, the fracture could be easily reduced with a born-hook in drill hole, and also the new fixation was effective by inserting screws into the main fragment and wiring them together not to move in case difficult to be fixed. 5) The Marvin Tilie's classification was of use in selecting the conservative treatment or the surgical one.

It is well known that the continuous irrigation method is effective to control the pyogenic osteomyelitis. However, there are no reports concerning the period of continuous irrigation method as to how long the method is applied for treating the pyogenic osteomyelitis. Some authors have determined its period depending on patient's conditions, characteristics of draining fluid and results of bacterial culture. Therefore, this experiment was performed to determine the physiological or pathological effects of the continuous irrigation to the normal bone and the time when the effects to normal bony tissue happened. In author's tudy, 30 house rabbits are used for determining the period that the normal bone is pathologically changed by experimental continuous irrigation method. The continuous irrigation in normal femoral shaft bone of rabbit set up dead bone formation began at the early of 5 weeks so in diseased bone such as osteomyelitis is the period of the continuous irrigation may be shorter than that of normal bone. I assumed that the period of the continuous irrigation sustaining 4 week-duration may not be occurred any problems to bony tissue.

Diseases or traumas involving the spine occasionally cause severe vertebral body collapse to result in either spinal instability or neural deficit, or both. In methods of treatment, conventional decompressive laminectomy results in neural improvement, but it can cause local instability of spine and lead progressive neural deficit. Vertebral stabilization by using bone cement(methylmethacrylate) provides immediate stabilization and avoids bulky external-fixation devices and external supports. We report two cases of thoracic spinal stabilization by using bone cement.

From march 1980 to August 1983, fourteen patients with fractures of the clavicle were treated by open reduction and internal fixation with threaded steinman pin at department of orthopadic surgery of Ehwa university hospital. The results were as followings; 1) Average duration of union of the fractures was 8.9 weeks. 2) Non-union was occured in one case, which was united by autogenous bone graft. 3) By open reduction and internal fixation, abnormal external appearance, such as bony protrusion and shortening was not noted and with early motion of the shoulder joint, disturbance of the joint function was minimized. 4) Open reduction and internal fixation in fractures of the clavicle was recommended in severe comminuted fracture, clinical non-union and heavy worker.

The authors experienced three cases of posterior hip dislocations associated with femoral head fractures which are very rare condition. One of them was treated with closed method and the others were treated with surgical method. The result of treatment in three cases was good.

I have experienced two cases of non-ossifying fibroma in the metaphysis of the proximal tibia and metaphysis of the distal femur. Roentgenologic studies showed loculated cyst-like bony defect and they were treated with complete curettage. The historical studies revealed them to typical non-ossifying fibroma, and the patients have been showing good conditions po-stoperatively.

Fibrous dysplasia of the bone is a relatively rare condition characterized by fibrous tissue replacement of skeleton, it may be monostotic with confined to one bone, or polyostotic with situated in many bones. Favored locations are long bones of the lower extremities and fibrous dysplasis may produce defective growth and deformity, pathologic fracture, and pain in any bone, basically the bone structure is replaced to variable degree by avascular fibrous tissue, and formed thin trabeculae of bone. The author experienced 3 cases of fibrous dysplasia that are 2 cases tomonostotic and 1 case of polyostotic lesions and a brief review was done with literatures.

Fractures of the distal third of the femur proved to be very difficult to treat regardless of selection of treatment method whether surgical or nonsurgical. There are too many difficulties in both accurate reduction with traction and subsquent maintenance of reduction with cast when nonsurgical methods were used, as compared with the problems encountered with accurate internal fixation. Also, there are too many complications when nonoperative methods were used. Recent development of more efficient metallic devices for internal fixation and cast brace, and traction methods will improve the results of the treatments. Forty one cases of supracondylar, intercondylar, and condylar fractures of the femur, which were treated at the department of orthopaedic surgery, college of medicne, Ewha Womans Univeristy during the period from March 1970 to December 1982 has been analysed clinically, and following results were obtained:1) Among 41 cases, 27 cases(65.9%) were male. The most common cause was traffic accident with 25 cases(61.0%) and next was slipping with 7 cases(17.1%). 2) By the Neer's classification, intercondylar fractures of the femur were observed in 27 cases(65.9%), and the most commcn was type III with 11 cases. 3) By the evaluation of Schatzker and Lambert, the results of treatment were satisfactory in 72.7% of the patient with operative method, and only in 37.5% of the patient with conservative method. 4) The results, in the cases of inadequate initial management, severe comminuted supracondylar and intercondylar fractures of the femur, open fractures, prolonged immobilization of the knee joint for 13 weeks, and delayed operative internal fixation of more than 4 weeks were usually fair to good. 5) The results, in the cases of mobilization of the knee joint at 6 weeks from injuries and at 1 week from operative internal fixation were usually excellent to good. 6) Author's methods which consist of making the Z-incision of tensor fascia lata for wide exposure of the operative field, using bone hooks, and temporary fixation by two K-wires were satisfactory for easy reduction of the distal fragment-

Tuberculous tenosynovitis of the hand is a rare condition and it should be differentiated from other soft tissue mass. The authors treated the case with surgical treatment and antituberculous chemotherapy.

Management of bed-ridden patients with polyarticular rheumatoid arthritis poses a considerable challenge to the orthopaedic surgeon. Current techniques of total joint replacement provide for the potential restoration of joint function in patients previously considered inoperable due to far-advanced joint destruction. Because many patients with far advanced polyarticular rheumatoid arthritis will predictably require more than one total joint replacement before an improved functional status will occur, the question of multiple joint replacement arises. We have had a bilateral total kneereplacement in the chronic polyarticular rheumatoid patient. Three years after the operation, the patient has slight pain and motion of full extension to 90'flexion. Bilateral total knee replacement improved mobility and reduced pain in this patient.

The ankle, which at times bears up to five times the body weights, is the most congruous joint of lower extremity, but its complex articulations are as not yet understood completely. The injuries to the ankle joint include not only injuries that cause distruption of the bony architecture of ankle but often injuries of significant syndesmotic ligamentous. One hundred and sixty two cases of ankle fractures in adult which were treated at the Department of Orthopedic Surgery, College of Medicine, Ewha Womans University, during the period from March, 1982, were analysed clinically and the following results were obtained ; 1) In 162 cases of ankle fractures, 122 cases(77.2%) were male, and the most common cause was traffic accident. The most common type, according to the Lauge-Hansen's classification, was pronation-external rotation with 58 cases(35.8%). 2) According to the Colton's criteria, the result of treatment with open reduction and internal fixation was not comparable to that with closed reduction. 3) Good functional result in ankle fracture and associated ligamentous injuries were depend on three factors such as, anatomic restoration of articular surface, early range of motion, and early weight bearing. 4) For the satisfactory function of the mortise, the fibular must be restored to normal length, correctly positioned in the groove of the tibia, and effectivey anchored to the tibia through the syndesmosis.

64 cases of patellar fractures, which were treated as the Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University during the period from March 1970 to December 1981 has been analysed clinically. The following results were obtained. 1. In 64 cases of patellar fractures, 51 cases(79.7%) were male, and most common age group was 21-40 years old male, and than most common cause was traffic accident, and common mechanism of fracture were direct trauma with 44 cases. 2. Most common operative method were wiring in 26 cases(40.6%), and then partial patellectomy in 14 cases(21.9%) next. 3. The 18 cases treated by surgically in 48 hours from onset to time of operation, shows 1-2 weeks short in period of recovery time than late treated, and no evidence of complication. 4. The 64 cases of patellar fractures, treated by surgically 49 cases between by conservative 15 cases as indicated, were not found in differentiate time of recovery. 5. In conservative and surgical treatment, when the knee joint was immobilized in 10-15 degree flexion or full straight with cylinder cast in certain period of time, author experienced short recovery time of knee joint function in 10-15 degree flexion group after the discontinuence of the cast. 6. Author experienced more significant aid about function of knee that in 14 cases of partial patellectomy, remained more large fragment, and proximal pole than distal pole.

Recent progress in microvascular surgery has opened new clinical possibilities in tissue transplantation, replantation by the direct anastomosis of vessels about onemm in external diameter. However in spite of continous training, the use of improved microscopes, instrument and suture material, it is still dificult to obtain high patency rate. Increasing facility obtained only by repeated operation upon the experimental animal reduce the false rate of arterial anastomosis and should make availability on additional and mastery technic in repeated experimental exercise for operation preocedure requiring the anastomosis of small artery. The purpose of this paper is to describe the instrument being used and to point out their use in end to end end anastomosis of femoral artery of rat, and to emphasize the role and important factors in the surgical repair of small artery with suture techniquq. Preliminary experimental study for microvascular anastomosis was projected to three step. The femoral artery of living rat was used in last step about 30 case, and then obtained patency rate 19 case and false 11 case. The result to the analysis for false 11 case are as follows. 1. Two case by insufficient dissection of femoral artery of rat. satisfactory dissection is from its emergence at the inguinal ligament to its bifurcation, and the greater mobilization, the easier femoral artery of rat is to approximate, turnover, and revise, if necessary. Dissection of tissue must be slow to avoid vessel damage. 2. One case by extreme vascular spasm. Due to manipulation, especially cold, dry, contact with fresh blood, vessel is usually spasm. Vascular spasm can be reversed by topical applcation of 1% lidocain and by keeping constant moisture with warm 37℃ Ringer solution. Vessel trauma by rough handling is not responded by lidocain or irrigation. 3. Three case by unskilled handling of clamp-approximation. Questionable problem is on which side the clamp should be placed? Which clamp should be placed on proximal or distal? How far apart the clamp should be placed and where they should be applied? Which should be closed first, the proximal clamp or the distal one? Above description was solved. 4. Threee case by unskilled microvascular suturing. Questionable problem is where the guide suture should be placed? How large a bite should be taken? How many suture will be required? Above description was solved. 5. Two case by thrombosis after vascular anastomosis. Thrombosis has been a major problem. Surgical trauma of vessel and unskilled technique of anastomosis were lead to thrombosis formation in microvascular surgery. Patency rate after microvascular surgery depends mainly upon good visualization of vascular anatomy and good technique including tissue dissection and microvascular suturing, gentle manipulation of vessel, fine and appropriate instrument.

Experiences in the adjuvant chemotherapy with adriamycin on two cases of osteogenic sarcoma of the femur and tibia and one case of Ewing's sarcoma of the femur are presented.

The two cases of the osteogenic sarcoma were treated by a combination of radical amputation and chemotherapy.

One case of the Ewing's sarcoma was treated by the megavoltage radiotherapy and chemotherapy.

One patient with the osteosarcoma died of late pulmonary metastasis 13 months after the diagnosis and treatment, however, this patient had discontinued hie chemotherapy in three months. And also his initial amputation was delayed four months from initial diagnosis because of his hesitation.

Other two cases of osteogenic and Ewing's sarcoma are carrying on normal active daily life without local recurrance or pulmonary metastasis 11-17 months after the diagnosis of the osteogenic and Ewing's sarcoma respectively.

The observation and follow up period of our cases are too short to permit definite conclusions. However, preliminary results and the review of the literatures strongly support the possibility that adjuvant chemotherapy has improved the prognosis of the patients with the malignant bone tumors.

A clinical analysis was mode on the 106 cases of the pelvic fracture and summarized as follows.

1) The most frequent cause of pelvic fracture was the automobile accident with 77(72.7%) out of 106 cases.

2) The most common type of pelvic fracture was the fracture of single ramus of public bone in 45.2% of patient. Malgaigne fracture were eleven (10.4%) including four of verticak shear type and three lateral compression type.

3) The 76 cases (68.3%) out of 106 pelvic fracture had been accompanied other injuries elsewhere. 47 of those had fractures of other bone or dislocations and rest of them had soft tissue injuries.

4) The 21 cases had hematuria including nine cases of bladder or urethral injuries. Two cases out of six urethary injury had the late complication of urethral stricture.

5) The severe internal hemorrhage had complicated on nine cases. No surgical intervention was done, however, two of them were expired due to uncontrolable internal hemorrhage.

Initial report of Milkman's syndrome was in 1930 with the characteristic findings of multiple, symmetrical, spontaneous, pseudofractures as a mild type of osteomalacia. However, the exact cause of the disease is not clearly defined yet. A case report was made on the cases of Milkman's syndrome of 24 and 44 year old women. Both of them had pseudofracture on proximal part of femur bilaterally and normal walking were disturbed due to pain. The younger patient had additional looser's zone on the ulna and the older case had on the scapula and rib. They are responded well to the treatment with Vitamin D₂ and D₃ 50,000 I.U. Daily each. The looser's zone had disappeared completely or almost all on radiological examination in seven to ten months of treatment.

The analysis of 100 patients of cogenital torticollis and the result of their conservative treatment are reported. The abnormalities of their neck were noticed by mothers within three months of infant life but mostly at three to four weeks. The ratio of male to female was 3:2 and incidence of right and left was 68 to 32. The mass located mostly(50%) at middle third of the sternocleidomastoid muscle belly. The prominence of incidence were noticed on the abnormality of fetal position in the uterus, mode of delivery and also on the baby of elderly primipara. 54 cases were breech and 13 cases were transverse position prenatally and 73 cases were delivered by forceps, vacuum and induction. The age of mother at delivery has close relationship between congenital torticollis with 47cases of them are born of 29~34 year old mother and primipara infants were 67cases. For the treatment, daily stretch exercises of affected sternocleidomastoid muscle were done by physical therapist for 20~30 times in two separate session. The effect can be noticed by the gradual correction of rotation deformity first and then the mass becomes soften and smaller. The next change is the correction of deviation deformity and the mass absorption. The result of complete cure in 10 weeks of treatment were 76 cases out of 100 patients. The remaining 21 cases required for 15 weeks of treatment and three cases were discontinued treatment by their parents. In conclusion the congenital torticollis can be treated effectively by stretch exercises when it began within three months of age of the patient. A hundred percent effect of cure may be obtained in 10 weeks of treatment in case of initial treatment is begun within four weeks of age and required for about 15 weeks of treatment on 4~12 weeks old infant.