Arthroscopy of the knee joint is an essential diagnostic procedure of the knee joint lesions because of its high diagnostic accuracy, simple procedure, high safty and low morbidity. We applied arthroscopy in the diagnosis of 62 patients with pain, swelling, limitation of motion and giving way of the knee joint from Jan. 1987 to Dec. 1991 at Ewha Womans University Hospital. Only 49 patients of these were followed over 6 months and we analysed and compared with clinical diagnosis and rthroscopic findings.

The results were follows :

1) Patients with knee joint lesions were most common in 3rd and 4th decades.

2) Patients with traumatic history were 57.1% (28 patients).

3) Most common lesions were meniscal lesion and most commonly used method of treatment after arthroscopy was meniscectomy.

4) Three patients with internal derangement of knee were diagnosed meniscal injury after arthroscopy.

Many patients disabled the knees by severe rheumatiod and degenerative arthritis have been treated with total knee replacement arthroplasty since 1970. Total knee arthroplasty(TKA) afforded much improvement in pain relief and function. We analyzed the result in 32 knees who were performed TKA at Department of Orthopaedic Surgery. Ewha Womans University Hospital from May 1987 to July 1992.

The results were as follows.

1) There were 25 females and 3 males, their mean age was 53 years old.

2) Preoperative etiology was degenerative arthritis in 20 cases, rheumatoid arthritis in 8 cases and osteonecrosis in 4 cases.

3) Knee joint function by Hospital for Special Surgery(HSS) knee rating score was increased from 55.3 points preoperatively to 87.0 points postoperatively.

4) The tibiofemoral angle was changed from 7.4 degree varus to 5.5 degree valgus.

5) The prosthesis type used were Press Fit Condylar(PFC) in 18 knees. Anatomic Modular Knee(AMK) in 6 knees, Miller-Galante(MG) in 4 knees and Porous Coated Anatomic(PCA) in 4 knees.

6) Complication was only one case of knee due to concomitant postoperative deep infection and skin necrosis.

The patient of herniated intervatebral disc of lumbar spine was treated as conservatively and did respond well in majority. But in patient who had not responded to conservative therapy, opeative method was performed such as open discectomy, chemonucleolysis, or automated percutaneous lumbar discectomy.

Open discectomy is useful for most patients but still carries the risk of general anesthesia and risk to sofi tissues. joints. nerves, and the invariable production of epidural fibrosis. Chemonucleolysis was introduced by Smith in 1964 as an alternative method but, it carries many complications such as anaphylaxis, subarachnoid hemorrhage, transverse myelitis, and severe back pain. Because of reducing this complications automated percutaneous lumbar discectomy has been advocated as an alternative treatment of herniated intervertebral disc in selected patients.

Twenty patients with symptomatic lumbar disc herniation were treated with automated percutaneous lumbar discectomy from August 1989 to October 1991 in Ewha Women University Hospital. They were followed up for more than 12 months. Changes in the objective and subjective signs and aymptoms of patients were examined preoperatively and postoperatively.

The results were as follows :

1) Age was ranged from 14 to 54 years with average 30 years, and 12 males and 8 females.

2) LA-5 was the most commonly involved level(80%).

3) In MRI classification subannular herniation was 11 cases and subligamentous herniationwas 4 cases.

4) Average duration of procedure was 31 minutes. and average amount of tissue aspirated was 3.9cc and average hospitalization period was 5 days.

5) Clinical results were satisfactory in 85% and unsatifactory in 15% of patients.

6) Unsatisfactory results were combined stenosis, insufficient removal of disc material, or recurred herniation of interverebral disc.

7) There was no significant complications postoperatively.

From this results, automated percutaneous lumbar discectomy is a good treatment method for selected cases of lumbar dsic herniation.

It has been well known that the knee joint is burdened on motion and weight bearing and structurally, it is more frequently injured than other joints. And ligamentous injuries of the knee joint are frequent, because of the increasing traffics and popularity of sports.

In seems to be important to understand on the mechanism of injury, method of physical examination and treatment of the ligamentous injuries of the knee.

The purpose of this paper is to get accurate diagnosis and proper treatment. Sixty-four cases of ligamentous injuries in patients who were admitted and treated at the Department of Orthopedic Surgery of Ewha Womans University Hospital from March 1989 to February 1992 have been reviewed.

The results of this study were as follows :

1) The ligamentous injuries of the knee were more prevalent in male 2.2 times than female. and frequently occured in second to third decades(65.6%).

2) Traffic accident was the most common causes, and the most frequent associated injuries were fractures.

3) The most frequently ruptured ligment was medial collateral ligament and its most common site of rupture was femolar attachment.

4) Frequently, lateral collateral ligament was detached from the femoral attachment, anterior and posterior cruciate ligaments were ruptured through their substances.

5) There were twelve cases of isolated cruciate ligament injury, four cases were posterior and others were anterior.

6) Excellent or good result was obtained in most cases by both operative and nonoperative treatment.

The olecranon fracture is intra-articular fracture anatomically. So the fracture should be reduced completely. We experienced 46 cases of olecranon fracture from January. 1985 to December. 1989.

The results were as follows ;

1) The fracture was more in adult than child.

2) The most common cause was fall down from height.

3) The undisplaced type I fractures were treated with conservative management. the results were satisfactory.

4) The displaced fractures should he treated with operative method for stability of elbow and prevention of limitation of motion.

5) The tension band wiring technique was not difficult and widely used method in treatment of displaced fracture. The most common complication was protrusion of K-wire, but careful technique would prevent the complication.

The aid of treatment in patellar fracture is the restoration of knee joint function and quadriceps muscle power. In this series, we experienced 37 cases of patellar fractures from March 1981 to March 1987 which were treated with operative care and followed-up at least 2 years at Department of the Orthopedic Surgery, College of Medicine, Ewha Womans University.

The results were as follow :

1) Most fractures were encountered in man from twenties to thirties.

2) The traffic accident was the most prevalent cause(17 cases, 47%) and 24 cases(65%) of fracture were induced by direct injury.

3) The most frequent configration of fractures was comminuted.

4) Among the operative methods, the result of the tension band wiring was superior to other operative methods, but not significantly.

5) The long-term result of patellar fracture with operative management following trauma may be directly related to this initial damage, involvement of articular surface, duration of immobilization and operative method.

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.

Recently, the incidence of fracture of tibial shaft has risen as a result of rapidly increased automobile and industrial accidents. Seventy adult patients with butterfly fracture of the tibia were treated at the Depatment of Orthopaedic Surgery. Ewha Womans University Hospital from january, 1977 to December, 1986. A retrospective clinical study was done on 70 cases. The results were as follows : 1) Fractures were predominant in male and the twenties. 2) According to the Johner's criteria, middle segments showed the highest incidence(88.6%). 3) Valgus, varus, extension & flexion types were in the ratio 60 : 3 : 2 : 5. 4) Closed Kuntscher nailing group showed the earliest bone union and among the lateral DCP fixation, varus type showed earlier bone union than other types. 5) Among the valgus type fractures that treated with DCP fixation without autogenous bone graft. there were medial cortical absorptions in 10 cases and 5 patients complained of pain and tenderness. But there was no such complication in the bone graft group.

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.

The author reviewed 12 cases of giant cell tumors which sere treated between January 1980 to May 1986. The results of various methods of treatment applied were compared & literatures surveyed. The following results were obtained. 1) The highest incidence occurred in twenties and there was no difference in sex distribution. 2) The most frequent site was the intertrochanteric area of the femur & 4 cases (33%) occurred around the knee joint. 3) As the primary treatment, curettage & bone graft was performed in 5 cases, curettage & cementation in 2 cases, resection in 2 cases, local excision in 1 cases & radiotherapy in 1 case. 4) 3 cases recurred and their primary treatment was curettage & bone graft. 5) As the secondary treatment, curettage & bone graft was performed in 1 case & curettage & cementation in 2 cases.

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.

Component loosening is the main important problem in cemented total hip replacement arthroplasty(THRA). And cementless THRA is recommended in recent years to provide the biological fixation of the components. During past 3 years from July 1982 to June 1985, 23 cases of cementless THRA were carried out at Dept. of Orthopedic Surgery, Ewha Womans University hospital and following results were obtained. 1) There was no difference in sex distribution. Age distribution was variable from 22 years old to 78(average 57.2), and 20 cases(87%) was above 40 years old. 2) The primary diseases were 8 cases of avascular necrosis of the femoral head; 8 of femoral neck fracture; 4 of osteoarthritis: 2 of old tuberculosis and 1 of fused hip due to healed tuberculosis. 3) Types of implants were 9 cases of Harris/Galante, 6 of A.M.L. type, 5 of Ceramic Prosthesis and 3 of P.M. type. 4) Intraoperative complication was 1 case of femoral shaft penetration. Postoperative complications were 2 cases of superficial infection and 2 cases of dislocations. 5) The functional results were increased from 45 to 85.5 points by Harris scores and from 5.9 to 9.8 points by D'Aubigne scores.

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.

Even with the conservative treatment, the humeral shaft fractures can be easily united with about 95% of union rate. According to Boyd(1961, 1965), the humeral shaft is the third of all the non-union of the shaft of long bones in the order of femur and tibia. From June 1978 to May 1985, 14 cases of non-union of humeral shaft were treated at Dept. of Orthopedic Surgery, Ewha University Hospital and the following results were obtained. 1) Of 14 cases, 8 were traffic accident and 4 were industrial injury. All were 20-40 age group and 13 cases were male. 2) The site was 9 cases of mid. 1/3, 3 cases of lower 1/3 and 2 of upper 1/3. The comminuted fracture was 12 cases and 2 cases were transverse. 3) The initial treatment after injury was 13 cases of operative methods; 9 cases were plate fixation; 3 cases, screw fixation; 1 case, intramedullary nailing. The other 1 case was conservative method. 4) The probable causes of non-union were complex. The most frequent one was inadequate internal fixation of 9 cases, 3 cases of inappropriate external immobilization and the other 2 were unknown. 5) 8 cases were treated with plate fixation, 2 cases with autogenous bone graft, 1 with EST(electric stimulation therapy) and 1 with intramedullary nailing. 6) Postoperative immobilization was done with long arm cast or shoulder spica cast. 7) All cases were united and the average union time was 9.1 weeks. Limitation of motion of shoulder and elbow was recovered with physiotherapy.

The intramedullary nailing of long bone fractures, particularly, fractures of the shaft of femur in adults, is a satisfactory technique as it fulfills the objectives of fracture management. Malunion is, however, a significant problem with intramedullary nailing of the Kuntscher type, the major problem is malrotation which occurs either at the time of the operation or as a result of rotatory instability. Another from of malunion that occurs is shortening of the fracture site especially in the presence of comminution. Klemm & Schellmann(1972), and King(1980) has shown, however, by using interlocking cross-pinning technique that stable fixation can be achieved with no significant shortening and this development has extended the indications of intramedullary nailing. Four cases of femoral shaft fractures were treated by interlocking intramedullary nailing and good results were obtained at Ewha Womans University Hospital, Department of Orthopedic Surgery, Since February, 1985.

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.