Comparison between Operative and Conservative Treatment of the 5th Metacarpal Neck Fracture / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results between conservative and operative treatments and to give guidelines in the treatment of angulated fifth metacarpal neck fracture. MATERIALS AND METHODS: The 43 cases of fifth metacarpal neck fracture (25 operative cases, 18 conservative case) were reviewed. The functional and radiologic results between two groups were evaluated. RESULTS: Both the operative group (preop.: 41.9 degree) and the conservative group (preop.: 39.7degree)showed satisfactory results (operative group: 15.3 degree, conservative group: 24.1degree) immediately after the correction. The maintenance of angulation correction was superior in operative group (15.7degree) than in conservative group (34.2degree), and patients' subjective satisfactions were superior in operative group too. Depressed knuckle on dorsum of hand was more frequently observed in conservative group (38.9%) than operative group (4%). Functional result in both groups was good. CONCLUSION: Because the correction of angulation was not maintained well in conservative group and a large portion of complications often occurred in cases of angulation more than 40 degree, operative treatment is needed in cases of angulation of fractured site more than 40 degree in the fifth metacarpal neck fracture.

Fracture and Dislocation of Carpometacarpal Joint Excluding Thumb / 대한정형외과학회잡지

PURPOSE: We present our operative experiences with uncommon carpometacarpal (CMC) injuries, excluding the thumb. MATERIALS AND METHODS: Twenty four fractures and dislocations of the CMC joint excluding thumb, which were followed up for an average of 18 months were reviewed retrospectively. Emphases were placed on associated injuries, radiographic findings, treatment and complications. RESULTS: The average age of patients was 35 years with 14 cases of indirect trauma as an injury mechanism. Eighteen of 24 cases involved the 4-5th CMC joint, one case involved the 2-3rd joint and one case involved the 3-4th joint. In addition, there were 4 cases that involved all of the CMC joints. Seven cases were operated upon by closed reduction and percutaneous pinning, 16 cases were treated by open reduction and internal fixation, and 1 case received fusion for neglected injury. Eighteen cases had satisfactory results, 2 cases had residual pain, 2 cases showed a limitation of motion and 2 cases had grip weakness. CONCLUSION: Proper diagnosis and treatment of CMC joint injuries can reduce complications and avoid additional procedures.

Diagnosis and Treatment of Pisiform Injury / 대한정형외과학회잡지

PURPOSE: To establish modality of diagnosis and treatment in pisiform injuries by analysis of its clinical experiences. Materials & Methods : Twelve fractures and one dislocation of the pisiform that were followed up for more than twelve months were reviewed retrospectively. RESULTS: Eight cases had associated injuries on the wrist or hand of ipsilateral side. Eight cases were diagnosed by routine radiography and three cases required additional special radiography such as the supinated oblique view or carpal tunnel view. One case was diagnosed by computed tomography. Cast immobilization was performed in nine cases and three cases underwent internal fixation. Pisiform was excised in one chronic dislocation case. The results were usually satisfactory but two cases showed pisotriquetral arthritis and one of them underwent excision of pisiform. CONCLUSION: The diagnosis of pisiform injury may accompany some difficulties due to associated carpal injuries. Routine radiography is sufficient for the screening of it if attention is paid and specific radiography such as supinated oblique view or carpal tunnel view may be very useful for confirmation. As conservative treatment alone shows good result, operative fixation is recommended for limited cases. The excision of pisiform is required in case of pisotriquetral arthritis or neglected chronic dislocation.

Traumatic False Aneurysms of the Upper Extremity: 2 Case Reports / 대한정형외과학회잡지

An aneurysm in the upper extremity is rarer than in the lower extremity, and a traumatic false aneurysm is very rare. We encountered two patients with a traumatic false aneurysm in the upper extremity. The first case developed from a posterior interosseous artery injury after an internal fixation using a plate and circumferential wiring for a comminuted fracture of the proximal shaft of radius associated with a dislocation of the left elbow joint. This patient was managed by excision of the false aneurysm, and ligation of the artery. The second case developed from a radial artery catheterization on the left wrist. This was managed by excision of the false aneurysm and an end-to-end anastomosis and resulted in the disappearance of the false aneurysm and a good vascular patency. We report two rare cases of traumatic false aneurysm in the upper extremity and a review of the literature.

Metastatic Bone Tumor in Hand: Report of 2 Cases / 대한정형외과학회잡지

The metastatic malignant tumor of the hand is rare condition, and has difficulty in diagnosis at presentation due to simulating other diseases such as osteomyelitis, felon, paronychia, rheumatoid arthritis, and so forth. The treatment of them is very limited and the prognosis is poor. We experienced and going to report two cases of metastaic tumor of the hand, one was from rectal cancer which associated with rheumatoid arthritis and another was from brochogenic carcinoma.