ABSTRACT
Tarsometatarsal injury has not been paid much attention due to it is unusual frequency. But the cases of tarsometatarsal injuries are on the increase in proportion to the increasing "high energy trauma injury" resulted from the traffic and industrial accidents. The purpose of this study is both assessing the relative effects among clinical results, final radiologic findings, treatment results and symtoms. In view of the results so far achieved from 20 cases of tarsometatarsal fracture dislocation which had been treated at Sung-Ae general hospital from January 1990 to December 1993, the results were as follows: 1. Thirteen cases were treated by open reduction and 3 cases were treated by closed reduction with smooth pins but no reduction loss were experienced. 2. Traumatic arthrosis could be observed in 14 cases but there were no influences on the functional end results. 3. Anatomical results correlated with pain. 4. Anatomical or neraly anatomical reduction was considered as most important factor of prognosis.
Subject(s)
Accidents, Occupational , Joint Dislocations , Hospitals, General , PrognosisABSTRACT
Congenital fibrosarcoma of neonate is a very rare malignant tumor prone to behave aggressively with a tendency to local recurrence without metastasis. It is characteristically composed of collagenous fibroblasts and herringbone pattern in histology. We experienced a case of congenital fibrosarcoma on the left thigh and report this case with some review in literature with 1½ year follow up.
Subject(s)
Humans , Infant, Newborn , Collagen , Fibroblasts , Fibrosarcoma , Follow-Up Studies , Neoplasm Metastasis , Recurrence , ThighABSTRACT
Transient synovitis of the hip is non-specific inflammation and self limited condition, which is most common cause of painful limping in children under 10 years of age. Ultrasonography presents some merits, simple, rapid, non-invasive, low cost, repetitive to assess soft structures in and around the hip joint compared to other diagnostic methods. We prospectively studied 32 cases of unilateral transient synovitis at OPD from Jan. 1988 to Oct. 1989 using 5-7.5 MH, probe ultrasonography. 2-times serial check up in symptomatic and asymptomatic stage about capsule thickness and bone-capsule distance in 3 different positions of the both hips were performed for comparision. The following results were obtained; 1. Boys were 25 cases (78%) and 26 cases (83%) were between 3 and 7 years old of age. 2. Bone-capsule distance in ultrasonography revealed abnormal increase in 72%. 3. External rotation position showed wider bone-capsule distance than other position. 4. Capsule thickness was 3.3mm in diseased and 3.0mm in sound, 0.3mm decrease after treatment. 5. Bone-capsule distance was 4.5mm in symptomatic stage, 2.7mm in asymptomatic stage, 1.8mm decrease after treatment in averge.
Subject(s)
Child , Humans , Hip Joint , Hip , Inflammation , Prospective Studies , Synovitis , UltrasonographyABSTRACT
Fractures of the tibia are frequently encountered in mordern civilized society. Especially, those in distal 1/3 of the tibia have so many problems, such as angular deformity, osteomyelitis and nonunion because of anatomically scanty soft tissue. Many modalities of the treatment of fracture of distal 1/3 of the tibia were introduced. Among them, interlocking IM nailings were considered as one of the best modality. But, in interlocking IM nail, reaming of the medullary canal which destroys the endosteal circulation and causes thermal necrosis of the inner aspect of the cortical bone results in delayed union. And also, procedure for distal screw fixation is difficult and time-consuming. As for using flexible IM nails for fractures of distal 1/3 of the tibia, it was considered as not so satisfactory method due to lack of stability of fixation. However, the stability of fixation can be strengthened with fanning of the nails in distal fragment, using more than 3 nails and delay the protected weight bearing. Authors studied 25 cases of fractures of distal 1/3 of the tibia treated with closed flexible IM nailing at Sung Ae General Hospital, from July., 1987 to July., 1989, and obtained following results: 1. Among 25 cases, 4th decades were most common and males were more commonly involved. 2. Traffic accidents were the most common causes of injury and majority of 16 open fractures and 19 comminuted fractures, were caused by high energy mechanism. Among open fractures, type II were most common. 3. Two angular deformities less than 10 degrees, one proximal migration and one checkrein deformity were observed as complications, but, no clinically significant complications were noted. 4. The time for radiological union were 14.5 weeks in group without fibular fracture and 15.1 weeks in group with fibular fracture, and 14.0 weeks in closed fracture group and 17.2 weeks in open fracture group, and average in 15.6 weeks.
Subject(s)
Humans , Male , Accidents, Traffic , Clinical Study , Congenital Abnormalities , Fractures, Closed , Fractures, Comminuted , Fractures, Open , Hospitals, General , Methods , Necrosis , Osteomyelitis , Tibia , Weight-BearingABSTRACT
In 1984, Gustilo subgrouped type III open fracture into III a, III b and III c according to the severity, soft tissue damage and vascular injury. Type III c open fracture presents serious problems especially possible amputation due to vascular insufficiency, so emergency vascular surgery with bone fixation by using plate, IM nail fixator is mandatory. We reviewed 10 cases of type III c open fracture of the forearm and evaluated the bone healing process according to fixation method, intramedullary nailing and plating treated at Orthopaedic Department of Sung-Ae General Hospital from Feb. 1986 to Aug. 1988. The folliwing results were obtained: l. All cases were industrial accidents, 9 cases in right, and the mean age was 24.1 ranging from 17 to 34. 2. There were 4 cases of the radial & ulnar artery rupture and 6 cases of the radial artery rupture, 7 cases were treated end to end anastomosis and 3 cases with vein graft. 3. The fracture level of ulna & radius was same in all cases, 7 cases in distal one-third, 2 cases in middle one-third and 1 case in proximal one-third. 4. The average time of union was 14.1 weeks in the radius and 14.5 weeks in the ulna. 5. The fixation methods were plating in 7 cases and IM nailing in 3 cases. 6. The complications were non-union in 1 case, osteomyelitis in 2 cases and refracture in 1 case. 7. The functional result was excellent in 1 case, satisfactory in 3 cases, unsatisfactory in 5 cases, and failure in 1 case according to the rating system of Anderson.
Subject(s)
Accidents, Occupational , Amputation, Surgical , Emergencies , Forearm , Fracture Fixation, Intramedullary , Fractures, Open , Hospitals, General , Methods , Osteomyelitis , Radial Artery , Radius , Rupture , Transplants , Ulna , Ulnar Artery , Vascular System Injuries , VeinsABSTRACT
Multifocal pyogenic arthritis more than four joints is very rare and considered to be related with some conditions such as immune deficiency, alcoholism, diabetes mellitus, steroid abuse, septicemia and gonococcal infection. In early stage, it is important to differentiate from acute rheumatic fever or acute rheumatic polyarthritis. Authors report a case of multifocal pyogenic arthritis on four joints simultaneously with good result.
Subject(s)
Alcoholism , Arthritis , Diabetes Mellitus , Joints , Rheumatic Fever , SepsisABSTRACT
Fractures of the proximal humerus in children are rare and according to Neer and Horwitz, fractures of the proximal humeral epiphysis constitute 3% of all epiphyseal injury. The most frequently reported complications are humeral shortening, varus angulation, and neurovascular complications. Closed anatomic reduction in frscture of the proximsl humerus is very difficult, so reported modes of treatment have ranged from aggressive attempts at reduction to simple neglect. Twenty nine fractures of the proximal humerus in children which were treated at Seve- rance Hospital, Yonsei University, College of Medicine from July 1982 to December 1986 were snalyzed both clinically and radiologically and the following results were obtained. 1. The age of the patients in this series ranged from 3 years to 18 years and the most frequently between the age of 12 years to maturity. And the oldest age was 18 years in male and 17 years in female. 2. Among the 29 frsctures, 21 cases were involving the proximal humeral epiphysis and all the injuries were Salter-Harris type Il epiphyse14 fracture. And 8 cases were fracture through the proximal humeral metaphysis not involving epiphysis. 3. Sixteen cases(55%) hsd associated injuries and the common associated injuries were fracture of the lower extremity, and fracture of same upper extremity were 5 cases(17%). 4. The fracture were graded according to their initial displacement(Neer snd Horwitz) and grade I, 6 cases, grade II, 3 csses, grade , 5 cases and grade IV were 15 cases. 5. Eight cases of grade I and II fractures were treated by simple immobilization. And among the twenty cases of grade III and 1V fractures, 12 cases were trested by closed reduction and immobilization and 9 cases, by open reduction. 6. Regardless of displacement of fractures and modes of treatment, all cases were united between six weeks to twelve weeks with full range of motion and no pain. 7. There were two cases of K-wire loosening, two cases of transient nerve palsy and one case of varus angulation.
Subject(s)
Child , Female , Humans , Male , Clinical Study , Epiphyses , Humerus , Immobilization , Lower Extremity , Paralysis , Range of Motion, Articular , Upper ExtremityABSTRACT
Suppurative arthritis of the knee is a well known complication following intra-articular injection of steroids on the other hand, tuberculous arthritis following such injection is rare. From January, 1981 to April, 1986, 46 patients of tuberculous arthritis of the knee were admitted to Severance Hospital and Yong-Dong Severance Hospital of Yonsei University College of Medicine. Among them 22 patient (48%) had a history of intra-articular injection of steroids and we analyzed them. The results were as follows: 1. The average age was 48.6 years (3–71 years). And sex ratio was in 1:2.7 as female predominant. 2. Initial diagnosis before the steroid injection were osteoarthritis (13 patients), rheumatoid arthritis (6 patients), and traumatic arthritis (3 patients). The fifty percent of the patients were injected by the local practitioner and fourty five percent had a history of accupuncture and moxa cautery. The preoperative diagnosis (diagnosis on admission) were tuberculous arthritis (12 patients), pyogenic arthritis (5 patients), rheumatoid arthritis (3 patients) and osteoarthritis(2 patients). 3. The number of intra-articular injection ranged from 2 to 100 times (average 12.8) during periods ranging from 1 month to 4 years (average 19.2 months). And interval between last injection and confirmation of tuberculous arthritis ranged from 1 week to 2 years (average 7.0 months). 4. Eight patients (36%) had a active or inactive pulmonary tuberculosis. 5. The positive cultures of typical Mycobacteria tuberculosis were obtained from 11 patients 59%). 6. The modalities of treatment were synovectomy or curettage in 16 patients and arthrodesis in 6 patients. And all patients were treated by antibuberculous chemotherapy. In conclusion, we observed that tuberculous arthritis developed not infrequently after intra-articular injection of steroids. And we considered the causes of tuberculous arthritis following intra-articular injection of steroids were; 1) reactivation of dormant injection or hematogenous, spreed due to interferance of host defence mechanisms, 2) contamination by the instrument and equipment, 3) aggravation of preexisting tuberculous lesions. Whenever one try to inject the steroid into joint, bacterial culture foi the pyogenic organism including tuberculosis and fluid analysis from the joint fluid should be done before the injection. We recommend that other method for the confirmation for the tuberculosis is needle biopsy of the synovium. If the symptoms are not improved after injection or the joint shows inflammatory reaction, one must discontinue the injection and reexamine the joint fluid analysis and culture for the confirmation of the infection.