Résumé
We have experienced a middle aged male patient with wrist pain, and he showed a cystic lesion within triquetrum in plain radiograph. The curettage and autogenous cancellous bone graft were performed, and the pathology revealed an intraosseous ganglion. So we report a case of intraosseous ganglion in triquetrum and review the literature.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Kystes osseux , Curetage , Pseudokystes mucoïdes juxta-articulaires , Anatomopathologie , Transplants , PoignetRésumé
STUDY DESIGN: This is a prospective study. OBJECTIVES: To evaluate the effects and complications of patient controlled analgesia(PCA) after spinal fusion. SUMMARY OF LITERATURE REVIEW: Spinal fusion was associated with highest pain and dosage of analgesics among the orthopedic procedures due to the nature of its procedure. Higher requirement of analgesics might cause several postoperative complications including severe respiratory depression and death. It is well known that PCA provides better pain relief and lower complications than as needed intramuscular analgesia. MATERIALS AND METHODS: We compaired the efficacy and possible side effects of intravenous PCA(n = 24) with control(n = 13) in patients undergone spinal fusion. The degree of resting pain, movement pain, and side effects were marked by the patients with 100mm visual analog scales. RESULTS: Postoperative pain control with intravenous PCA showed more effective analgesia and higher patient's satisfaction without causing significant side effects. CONCLUSIONS: Intravenous PCA in patients undergone spinal fusion was effective therapeutic modality in the aspect of pain relief, complications, and satisfaction rate. PCA will be a good alternative for as needed intramuscular analgesia after spinal fusion.
Sujets)
Humains , Analgésie , Analgésie autocontrôlée , Analgésiques , Procédures orthopédiques , Douleur postopératoire , Anaphylaxie cutanée passive , Complications postopératoires , Études prospectives , Insuffisance respiratoire , Arthrodèse vertébrale , Échelle visuelle analogiqueRésumé
The purpose of this retrospective study was to evaluate the efficacy of arthroscopic repair of Bankart lesion using the biodegradable polyglyconate implant(Suretac) for the treatment of traumatic anterior shoulder instability. Although the arthroscopic procedure using the Suretac device has some technical advantages over others, there have been reports of the higher failure rate than open procedure. Eight shoulders in 8 patients who had traumatic anterior instability of the shoulder with Bankart lesion were managed with this procedure. They were followed up for average 2 years (range 1 year 4 months to 2 years 5 months). During the follow-up period, all the patients showed full range of motion of the shoulder without recurrence of instability. It was our impression that success rate of the procedure could be improved by careful selection of the patient, the accurate arthroscopic technique, and the good rehabilitation program.
Sujets)
Humains , Études de suivi , Amplitude articulaire , Récidive , Réadaptation , Études rétrospectives , ÉpauleRésumé
In chronic tophaceous gouty arthritis, the treatment may be very difficult due to eroding, replacing and absorbing articular cartilage, deforming arthritis, and fibrous ankylosis by deposition of sodium urate crystals. We reported two cases of chronic tophaceous gouty arthritis which were satisfactorily treated by arthroscopic chondroplasty, debridement of the pannus of granulation tissue and urate salts in the joint, as well as excision of tophi around the joints.
Sujets)
Ankylose , Arthrite , Goutte articulaire , Cartilage articulaire , Cytochrome P-450 CYP1A1 , Débridement , Tissu de granulation , Articulations , Sels , Acide uriqueRésumé
Extensor pollicis longus tendon rupture is well known as a complication of fracture of the distal radius. There is a higher risk that the tendon of extensor pollicis longus will rupture in undisplaced distal radius fracture than in those which are displaced. We have experienced three cases of rupture of the extensor pollicis longus tendon after undisplaced distal radius fracture. Those were treated by tendon graft and tendon transfers. The results were satisfactory without complications. The patients with undisplaced distal radius fracture should be careful concerned about possibility of rupture of extensar pollicis tendon.
Sujets)
Humains , Fractures du radius , Radius , Rupture , Transposition tendineuse , Tendons , TransplantsRésumé
The hook-nail deformity after finger tip amputation is very common problem. This usually occurs after loss of part of the distal pulp, phalanx, and nail bed. This deformity for some patients is a trivial lesion and may be ignored, but it may be of great cosmetic significance or disabling with regard to certain occupations to the others. To correct the deformity, it is necessary to release volarly displaced nailbed, return it to its normal position, and provide adequate support to maintain correction by a carefully planned "antenna" procedure. Deformed nail is removed, tethered pulp is freed from distal phalanx, and then full thickness of the nail bed is elevated and splinted with multiple small Kirschner wires in a straight position like antennae. The coverage of defect created is done by cross finger flap. The knowledge of anatomy and physiology of nail and sorrunding structures is important to obtain good results and reduce secondary deformities. Two cases of antenna procedures for the hook nail deformily is reported with good results.
Sujets)
Humains , Amputation chirurgicale , Fils métalliques , Malformations , Doigts , Professions , Physiologie , AttellesRésumé
We recently treated an infant with abnormal calcification in the soft tissues of the wrist and hand caused by an intravenous injection of calcium gluconate for treatment of neonatal hypocalcemia. The cause of the soft tissue calcifications was quite puzzling, if the incident of calcium gluconate extravasation had been overlooked, because the lesions mimicked for cellulitis or abscesses and treated as such. All radiographic evidence of calcification gradually resorbed by conservative management.
Sujets)
Humains , Nourrisson , Nouveau-né , Abcès , Gluconate de calcium , Calcium , Cellulite sous-cutanée , Main , Hypocalcémie , Injections veineuses , PoignetRésumé
The hamate fracture is very rare condition. The mechanism of fracture may be attributed to direct trauma by rolling down. We have experienced a case of fracture of the body of the hamate bone. It was treated by conservative method. The result was satisfactory with conservative treatment without traumatic arthritis, nonunion, ulnar nerve palsy, flexor digitorum profundus tendinitis & limitation of motion. A case of fracture of the body of the hamate bone is reported with brief review of literature.
Sujets)
Arthrite , Os hamatum , Méthodes , Tendinopathie , Neuropathies ulnairesRésumé
The incidences of posttraumatic avascular necrosis of the femoral head were variably reported. In 1980, Calandruccio reported its incidence of 14% in nondisplaced femoral neck fracture and 50% in displaced ones. In general, the prophylactic methods, such as core decompression, bone graft and trochanteric osteotomy were recommended for the treatment of early stages of femoral head avascular necrosis(Ficat-Arlet stage 1 or 2), while the primary replacement surgery for the advanced ones (Ficat-Arlet stage 3 or 4). One of our authors(Y.K. Chung) has performed five cases of corticocancellous bone grafts using combined autogenous free fibular graft and iliac cancellous bone graft, for the post-traumatic femoral head AVN from January 1985 to December 1989 at our hospital, and the following results are obtained: 1. Among the forty nine displaced adult femoral neck fractures, there were five eases of avascular necrosis(10. 2%). 2. There were three male patients and two female ones, and the average age of injury was 48 years old(30 to 57). 3. According to the type of fractures, there were four cases of subcapital fracture and one of transcervical fracture. All of the patients were performed closed reduction and internal fixation with compression hip screw system, including additional Knowles pinning in two cases. 4. Histological study with the excised femoral head, showed that there was no bony union between the grafted cancellous bone and the necrotic head, and the grafted bone has been changed to amorphous necrotic tissue. However, we found a solid consolidation of the grafted bone and the femoral neck portion.
Sujets)
Adulte , Femelle , Humains , Mâle , Décompression , Fractures du col fémoral , Fémur , Col du fémur , Tête , Hanche , Incidence , Nécrose , Ostéotomie , TransplantsRésumé
No abstract available.
Résumé
No abstract available.
Résumé
Fractures of the tibial condyles, involving as they do weight-bearing articular surfaces and frequently accompanied by soft tissue injuries such as collateral ligaments, cruciate ligaments, and menisci present a variety of problems in treatment and prognosis. Slee, Apley, and others maintained the opinion that most fractures of the tibial condyles could be managed conservatively. On the other hand, Rombold, Schatzker, and others seemed to consider closed treatment to be virtually s form of therapeutic nihilism and adviced open reduction. But recently most authors agree that the method of treatment has to be selected in each individual case, and recommand anatomical reduction of the fracture as possible and early knee motion. The authors have treated 17 cases of tibial condylar fractures with arthroscopic management and extraarticular distal approach in the Department of Orthopedic surpery, Kang Dong Sacred Heart Hospital from Oct. 1986 to Jul. 1989. Of the above cases, 11 cases could be followed for a period of anywhere from 1 year to 31/2 years and analysed according to the cause, classification, treatment, and result. The following results were obtained from the analysis of 11 tibial condylar fractures. l. Of the 11 cases, 7 (63.6%) were male and 4 (36.4%) were female. 2. Of the 11 cases, 7 (63.6%) were due to traffic accident (5 pedestrians, 2 occupants) and 3 (27.3%) were due to fall from height. 3. Among 11 cases, 7 (63.6%) were associated with other injuries. 4. Bone graft was needed in 5 cases. 5. All were treated by arthroscopic management with anatomically and functionally good results. 6. By arthroscopic mangement, it was easy to find and treat the accompanying intraarticular lesion. 7. With early active and C.P.M. exercise, almost full range of motion was obtained in all cases.
Sujets)
Femelle , Humains , Mâle , Accidents de la route , Classification , Ligaments collatéraux , Main , Coeur , Genou , Ligaments , Méthodes , Orthopédie , Piétons , Pronostic , Amplitude articulaire , Traumatismes des tissus mous , Tibia , Transplants , Mise en chargeRésumé
Surgical stabilization using instrumentation for thoracolumbar injuries offers several advantages such as nearly anatomic reduction of fractures, protection of neurologic structures and most importantly early ambulation of the patient. The treatment of fracture-dislocation of the thoracolumbar spine has been progressively improved over the past decades and recently a lot of new device have been introduced to improve fixability of the involved vertebrae three dimensionally and short segmental fixation as possible. The authors have treated 17 cases of unstable thoracolumbar fracture using Cotrel-Dubousset instrumentation in the Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital from Jan. 1988 to Jan. 1989 with the following results: 1. Bursting fractures are the most common type(52.9%) of mechanism of injury. 2. Excellent anatomic reductions were obtained and compression, wedging and local kyphotic deformities were nicely corrected. 3. Short segmental fixation can preserve the maximal spinal mobility. 4. No significant loss of reduction or loosening of implant was found. 5. Remarkable neurologic recoveries were observed in cases of incomplete cord lesion. 6. Significant neurologic recovery was found in patients treated with laminectomy and Cotrel-Dubousset instrumentation.
Sujets)
Humains , Malformations , Lever précoce , Coeur , Laminectomie , Orthopédie , RachisRésumé
The intramedullary nailing for the fractured tibia has been used in selected cases of fresh diaphyseal fracture and non-union. However, with modern technical improvements, the indications could be expanded considerably. With interlocking nailing technic we can treat various types of tibia fracture, which were unsuitable for intramedullary nailing previously. Stability can be achieved with transverselyinserted bolts which anchor the implant directly to the cortical bone, thereby controllinglength, alignmentandrotation of the fracture as well as permitting early joint motion and weight bearing. Between May 1985 and Feb. 1988, interlocking nailings were performed for 54 cases oftivial fractures, of which 40 cases were acute fracture and 10 were non-union and 4 weremalunion. We obtained the following results ; 1. Closed nailing technic was accomplished in 40 cases and 14 cases were opened. 2. Dynamic and static interlocking nailings were done in 8 and 46 cases respectively. 3. Full weight could be borne on 5th postoperative day in transverse or short oblique fracture cases, 2 weeks in nonunion and malunion cases and 4 weeks in comminuted or segmental fracture cases. 4. The mean fracture healing period was 11.5 weeks in dynamic interlocking cases and 13 weeks in static nailing cases. 5. According to the functional classification of Klemm and Borner, out of 54 cases 36 were excellent, 14 were good, 3 were fair and one was poor.
Sujets)
Classification , Ostéosynthese intramedullaire , Consolidation de fracture , Articulations , Tibia , Mise en chargeRésumé
Cubitus varus deformity following supracondylar frscture of the humerus in children is one of the major complications. The angle between long axis of humeral shaft and the line formed by connecting lower margin of trochlea and capitellum has been described by authors as a new method of radiological assessment for the indirect measurement of carrying angle. From the author's retrospective radiological study in 115 normal children and 41 supracondylar fractured children, the results were as follows;1. In the 115 normal arms, the mean vslue of T-C angle was 1049±3.8° 2. In the 115 normal arms, a significant relationship was found between the Baumann angle and T-C angle. 3. In the 115 normal arms, a significant relationship was found between the Baumsnn angle and the Carrying angle. 4. In the 115 normal arms, a significant relationship was found between the T-C angle and the Carrying angle. 5. In the 41 injured arms, reliability test was performed for the excluding of effect of the environment. The results was that T-C angle was more reliable than Baumann angle as a indirect measurement method of the Carrying angle. From above results, it is suggested that T-C angle can be reliably used to predict the Carrying angle and prevent cubitus varus deformity in supracondylar fracture of humerus.