RESUMO
Background@#Volar plate avulsion fractures of the proximal interphalangeal (PIP) joint are a common hand injury and have been treated conservatively with favorable results. We assumed that conservative treatment of volar plate avulsion fractures of the PIP joint would be unsuccessful if the fracture fragment, even if small, was much displaced or rotated and that delayed excision of the avulsion fractures would result in good outcomes. We report clinical and radiological outcomes of conservative treatment of volar plate avulsion fractures of the PIP joint and risk factors for failure of conservative treatment. @*Methods@#We retrospectively reviewed the clinical and radiological outcomes of 88 volar plate avulsion fractures (85 patients) treated conservatively at first. In 18 of these fractures, delayed excision of the fracture fragment was required after an average of 75 days of conservative treatment for limited motion or pain of the joint. We compared parameters between failed cases and successful cases after conservative treatment. @*Results@#Compared to the successful cases, the failed cases had a higher prevalence of joint dislocation at the time of injury and greater pain, larger flexion contracture, and less further flexion after conservative treatment. The shape, comminution, and size of the fracture fragments were not related with the need for operation, but the operative cases had greater displacement and rotation of the fracture fragments than the conservative cases. After fragment excision, postoperative protection of the joint was not necessary, pain was reduced, and the mean range of motion increased. @*Conclusions@#The presence of joint dislocation and greater displacement and rotation of the fragments may be associated with the failure of conservative treatment of volar plate avulsion fractures. Failed cases after conservative treatment could be resolved by delayed fragment excision with favorable results. Therefore, it might be appropriate to consider conservative treatment at first in almost all volar plate avulsion fractures of stable PIP joints.
RESUMO
In these days, computing environment turns to web environment and a lot of hospitals build information system. A medical services through the web provide patients and doctors with convenience and help experts to communicate with each other. Initially, web provided static text information, but nowadays needs of interactivity between client and server is increasing. In order to diagnose heart diseases, we use 12 channel ECG, stress ECG, holter ECG, etc. These data are a lot of correlation with each other but there are little system managed them with integration. To enhance management efficiency and share medical information, it is necessary to develop integrated ECG management system based the web. In this paper, we use common object request broker architecture(CQRBA) to implement the system. The CORBA is to apply object oriented concept to web. We can implement application easily and reduce costs to maintain and repay because server objects and client objects exist independently. We developed a System to integrate these data using network and to raise management efficiency. we focus on the performance of object web and the implementation of ECG management system based on the web.