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.

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

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.

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.

No abstract available

The sequelae of unstable fracture of the cervical spine were tragic. The first objective of treatment is protection of the spinalcord during reduction and stabulization. Since 1933, skeletal traction which was introduced by Crutchfield and modified by Vinke, Barton and others, has been used for reduction of fracture-dislocation of the cervical spine. 4 cases of fracture and dislocation of the cervical spine were treated at this department. 2 cases of them, one was quadriplegic and the other revealed nerve root irritation sign, were performed posterior spine fusion and recovered. The third who had fracture-dislocation between C5 and C6 with ankylosing spondylitis was died in the early course. The 4th who hadfracture-dislocation between C5 and C6 with transsection of the spinal cord was also died at home 7 weeks after trauma.

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 basic principles and practical application of open fracture managements are discussed. The main aims of open fracture treatment are the control of shock as a life saving procedure and prevention of infection of the wound. The complete debridement of the wound is the one way to prevent infection, however, the trouble some problems are soft tissue closure and hardware implant for the fracture fixation. Skin closure including other soft tissues should be made primarily or as soon as possible in behalf of control infection but in secure state of the wound. The implant for the fixation of fracture should be limited for prevention of further infection of the wound. Multiple threaded pins and external fixation such as Hoffmann or Denham fixture are recommended for the open fracture treatment effectively. Systemic administration of properly selected anti-biotics are essential for the control of infection because of the all open fractures are contaminated at the time of injury.

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.

The present status of traffic conditions is reviewed, especially in the urban area on the basis to seek for the prevention of traffic accident. The large cities of our country have not yet solved the mass transportation system in rush hour. Subway covers only a limited number of people in Seoul. The most of peoples have to depend on the city bus system which are too hard to give them proper service on time. The questionaries had been made for the traffic status on the 3,234 persons who are legislators and administrators of traffic law, drivers, pedestrians and businessmen of transportation and insurance company. Also the drivers who had auto-accident and accident wounded persons were interviewed for their particular accident. The review has made also on the traffic and criminal laws which are applied for the drivers with accident. The results of this studies are summarized as follows: 1. The very heavy charge was made against drivers who have had traffic accident with person injuried. The charge were not only against the violations of traffic law but include arrest by the criminal law on the basis of the result of injury of the person. 2. The charge against automobile accident with injuried person should be legislated in the traffic law instead of criminal law. Because of the injury was caused by auto-accident which has some different point of views in breaking law as an accident. 3. The almost of all the chauffeurs had continuous driving more than 15 hours a day. It is expected to be reduced by the proper administration of the labor system for the chauffeurs. 4. The traffic rules should become a part of living for both of driver and pedestrian in keeping them to avoid the traffic accident. 5. The automobile liability insurance service should be improved in someway to prevent the arrest of driver by police on the accident. 6. The permanent and temporary plans should made immediately for the relief of the urban traffic mess in rush hour by the construction of more subway or expressway for the city bus. 7. More rate of automobile accident was observed in younger drivers and the main causes of accident were responsible on each of the drivers and pedestrians in a half.