A Case of Adult Onset Still's Disease Misdiagnosed as Septic Arthritis

We present a case of adult onset Still's disease (AOSD) that was misdiagnosed as septic arthritis of the shoulder and knee. A forty-nine-year-old woman was admitted for pain in the left knee. The patient's medical history showed that she had undergone arthroscopic irrigation twice and an open debridement under the diagnosis of septic shoulder at another hospital. The laboratory and joint fluid analysis findings led us to suspect septic knee. Arthroscopic irrigation and antibiotics treatment were performed. At five weeks after discharge, she presented with pain in the same joint, fever, and rash. The symptoms were consistent with Yamaguchi's criteria for AOSD. We started corticosteroid therapy, and clinical remission was achieved. In conclusion, we suggest that AOSD should be considered as a diagnosis of exclusion to avoid misdiagnosis with septic arthritis.

Multiple Pinning in Base Fracture of Distal Phalanx

PURPOSE: The purpose of this study was to evaluate the use of multiple pinning in base fracture of distal phalanx. MATERIALS AND METHODS: We reviewed the results of 8 patients treated with a multiple pinning in fracture of distal phalanx base. There were 7 men and 1 woman, and the mean age was 52.6 years(45~66 years). The type of injury was a crushing injury in 6 patients and, in direct trauma in 2. The injured finger was thumb in 4 patients, index finger in 1, long finger in 1, and ring finger in 2. We used three K-wires for fixative devices in all fractured phalanx. The average removal period of K-wire was 6.5 weeks(5~8 weeks). RESULTS: Postoperatively, immobilization was applied for 6.5 weeks (5~8 weeks). The mean fragment size was 33.8%(10~50%) of long axis of distal phalanx. The range of motion was 1.3degrees (0~5degrees ) in extension lag and 88.1degrees (85~90degrees ) of flexion of the distal interphalangeal joint. CONCLUSION: The multiple pinning of base fracture of distal phalanx was one of the useful method to stabilizing of distal phalanx fracture.

Simultaneous Double Injury of the Interphalangeal Dislocation and Bony Skier's Thumb: A Case Report

Simultaneous double injury of the thumb at the interphalangeal joint and metacarpophalangeal joint occurring at the same time are seldom seen in medical practice. 72 year old male had posterior discation of interphalangeal joint and ulnar collateral ligament injury of metacarpophalangeal joint, as known as skier's thumb after he fell down from the bike. Open posterior dislocation of interphalangeal joint was stabilized by reduction and then skin suture was done. Metacarpophalangeal joint had totally ruptured ulnar collateral ligament with Stener lesion and bony fragment of base of proximal phalanx. The joint was subluxated and was not reduced due to jammed bony fragment. Displaced avulsion fracture of volar plate with ulnar collateral ligament injury was not reported by author's research. The author reduced bony fragment in joint and repaired ulnar lateral ligament. It has been 6 month after the operation and the patient is followed up. The patient has normal range of motion without instability of metacarpophalangeal and interphalangeal joint. We report our experience about simultaneous double injury of thumb and bony skier's thumb.