Symptomatic Ganglion Cyst at the Facet Joint of the Lumbar Spine / 대한척추외과학회지

Ganglion cyst of the lumbar facet joint is a rare elsion. We have experienced a patient who had right leg radiating pain and he was diagnosed with ganglion cyst in the lumbar facet joint. On the MRI images, an 0.8cm sized round mass was located on the anterior aspect of the right side facet joint between the 4th and 5th lumbar vertebra. It was compressing the right 4th spinal root. After surgical excision, his symptoms were disappeared. Ganglion cyst of the spine occurs most commonly in the facet joint between the 4th and 5th lumbar vertebra, which is the most mobile back joint. It must be considered as part of the differential diagnosis of herniated lumbar intervertebral disc.

Chorpart's Dislocation: A Case Report / 대한족부족관절학회지

The midtarsal joint which consists of the talonavicular and calcaneocuboid joints lies transversely across the medial and lateral arches of the foot. Complete dislocation of this joint unassociated with fracture is extremely rare. A 36 year-old male who was injured by motor vehicle accident came to help for his left midfoot pain and deformity. We misdiagnosed as subtalar dislocation. Closed reduction was performed. We reviewed initial and post-reduction X-rays, and then we diagnosed as Chopart's dislocation. CT scan was taken; it showed fracture of the anterior process of the calcaneous.

Operative Treatment of Floating Shoulder

PURPOSE: Conservative treatment of displaced ipsilateral compound fractures of clavicle and scapula neck or gleonoid cavity, causing a floating shoulder, cannot expect satisfactory results in all of them. We reviewed 9 operative cases of floating shoulders and analyzed the results with review of literature. MATERIALS AND METHODS: Nine patients with floating shoulders were operated from July 1996 to August 2000 were reviewed. Patient's age was in average 38.3 years old. Associated injuries were 4 cases of rib fractures and 1 case of humerus shaft fracture. Other injuries included 3 hemothorax, 2 pneumothorax, 1 brachial plexus injury, and 1 ulnar nerve injury. Operation for both clavicle and scapula fracture was done in 6 cases, and surgery was done for only clavicle in 3 cases. Internal fixation for clavicle was done with 3.5 mm AO reconstruction plate in 4 cases and Dynamic Compression Plate in 5 cases. RESULTS: Clinical results by Hardegger method showed 7 cases of excellent, 1 case of good, and 1 case of poor. Complications include 2 cases of limitation of motion of shoulder joint and one case of residual pain. CONCLUSION: Floating Shoulder is caused by high-energy trauma, therefore initial assessment of associated injuries should be done carefully. In evaluating the articular surface of the glenoid and positions of the fracture fragment, CT evaluation is very useful in planning the surgical treatment. Clinical results after surgery can give satisfactory results.

Palmar Divergent Dislocation of Scaphoid and Lunate

A 28-year-old man presented with a palmar divergent dislocation of the scaphoid and lunate. He was treated with an open reduction and an internal fixation with two Kirschner's wires after the 25th day of trauma due to a neurological injury. The results were satisfactory after 18 months follow up without any evidence of avascular necrosis and traumatic arthritis of the scaphoid and lunate. The patient had no limitation in motion or intermittent wrist pain. We reported this case with a brief review of relevant literatures.

The Operative Treatment for Carpal Boss / 대한정형외과학회잡지

PURPOSE: Carpal boss of the hand is a rare lesion. This study was conducted to recognize the clinical patterns of this disease entity and to evaluate the diagnosing modalities, differencial diagnosis, and results after operative treatment. MATERIALS AND METHODS: We report upon 7 operative cases of carpal boss of the hand. There were 5 females and 2 males with an aver-age age of 35.4. The mean follow up period for patients in this study was 15 months. The dominant hand was affected in 4 cases and the small ganglion was associated with the carpal boss in 4 cases. RESULTS: The average duration of conservative treatment before surgical treatment was 8.3 months. All of the patients had taken NSAIDs prior to surgery and 4 patients had received a corticosteroid injection at least once. All of the patient had surgical treatment and complete symptomatic relief was achieved in 6 cases. One patient had no symptomatic relief. CONCLUSION: We operated upon patients who did not respond to conservative treatment or in whom the carpal boss associated with a ganglion, 5 of 7 cases showed a satisfactory result. In view of these results, we recommended that operative treatment should be con-sidered in such cases.

Operative Treatment for Isolated Distal Ulnar Shaft Fracture

This study retrospectively evaluated the effectiveness of an open reduction and internal fixation of a tension band wiring technique for treating displaced or unstable comminuted distal ulnar shaft fractures without a radial fracture. Ten patients were treated for an isolated distal ulnar shaft fracture. There were 6 cases of a fracture 2.5 cm below the lower end of the ulna, and 4 cases with the fracture being 2.5 cm to 5 cm away from the lower end of the ulna. The authors classified the fractures of the distal ulnar into 3 types: a type I-simple fracture, a type II-comminuted fracture without a distal radioulnar joint (DRUJ) involvement, and a type III- comminuted fracture with DRUJ involvement. There were 3 cases of a type I fracture, 4 of type II and 3 of type III. The open reduction and internal fixation using tension band wiring were performed in 10 of these cases. After the operation, the wrist was placed in a cast for six weeks before active movement was allowed. The clinical results were excellent in 7 cases, good in 2 and poor in 1. In conclusion, tension band wiring surgery is recommended for treating an isolated distal ulnar with unreduced displaced fractures, in a comminuted fracture that cannot be maintained by a closed reduction and when there is the potential encroachment of fracture fragments in the DRUJ.

Palmar Divergent Dislocation of the Scaphoid and Lunate / 대한정형외과학회잡지

Fracture and dislocation of carpal bones are usually presented as lunar or perilunar dislocation. Palmar divergent dislocation of the scaphoid and lunate has only been reported in 4 cases until now. We experienced a case of palmar divergent dislocation of the scphoid and lunate with a fall from height injury in a 28-year-old male patient. We treated with open reduction and internal fixation with two Kirschner's wires. The result was satisfactory without evidence of avascular necrosis or traumatic arthritis of the scaphoid and lunate after 12months of follow up. We report upon this case with a brief review of the literature.

Surgical Treatment of Isolated Distal Ulnar Fracture without Radial Fracture / 대한정형외과학회잡지

Distal radioulnar is a part which has a rotational movement through the function of distal radioulnar joint and extensor carpi ulnaris. The injury mechanism in this area is usually a trauma largely due to traffic accidents. In general these injuries to the distal radioulnar joint are treated by a closed reduction. However, the isolated distal ulnar fracture without radial fracture, which is often called the night stick fracture, is difficult to treat by a closed reduction and a cast immobilization alone, especially if there is a displacement or fracture segment impinging soft tissue or severe comminution. Nonunion has been the frequent outcome with this method of treatment and limitation of rotation of forearm and distal radioulnar joint have occurred due to long period of immobilization or malunion. Thus, a different treatment modality such as open reduction and internal fixation and early active joint motion has arisen as a better treatment modality. In this study, 8 cases of isolated distal ulnar fracture without radial fracture have recieved the operation and the early active joint movement, if a displacement was present either at the time of injury or after the initial closed reduction. As a result, this method has enabled the patients to reduce the rate of complication of nonunion and to recover limitation of joint motion in a shorter time period.

The Redislocation after Open Reduction and Salter's Innominate Osteotomy in Congenital Dislocation of the Hip / 대한정형외과학회잡지

The complications of Salter's innominate osteotomy in the treatment of congenital dislocation of the hip were avascular necrosis of the femoral head, hematoma, rotation of distal pelvic fragment, infection, fracture of femoral shaft and redislocation. Among them the causes of redislocation were technical failure, immobilization failure and absorption the bone graft, etc. We experienced a case of redislocation after open reduction and Salter s innominate osteotomy in congenital dislocation of the hip which was induced by a foreign body reaction to the suture material.