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Esophageal Fistula* ; Tuberculosis, Spinal*

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Animals ; Lordosis* ; Spine*

The first metacarpal base fracture is classified as extra-articular fracture, intra-articular fracture and epiphyseal injury. Intra-articular fracture was firstly described in 1882 by Bennett and Rolando described about Y shape comminuted fracture in the first metacarpal base in 1910. In 1938, Robert wrote about oblique fracture injured by first metacarpal base fracture. First metacarpal base fracture can be adjusted easily by C/R, but it is difficult to maintain the good axis. In case of fail of reduction, malunion, joint stiffness and traumatic arthritis can be shown as complications and finally some problems in grasping and pinching are resulted. Therefore, firstly the most accurate reduction, secondarily effective method to maintain the condition and thirdly the protection of limitation of motion are goal of treatment. Authors reviewed 17 cases treated by 0/R & C/R for the past 5 years from 1975 to 1980 at National Medical Center, especially reviewed the cases of which observation more than 1 year was possible. The results were as followings: 1. The incidence of first metacarpal base fracture was 1.0% of all fractures & dislocations. 2. Out of 17 cases, there were 14 male and right side 9 cases and left side was 8 cases. 3. The most common case of fracture was injury at work and traffic accident, sports injury, slipping down and falling down. 4. The method of treatment were C/R & percutaneous pinning in 10 cases and 0/R & K-wire fixation were 7 cases. 5. The result of treatment showed 8 excellent, 1 good, 1 fair, out of 10 cases of C/R and percutaneous pinning. In 0/R and K-wire fixation, 4 excellent, 2 good, and 1 fair showed out of 7 cases. 6. Soft tissue infection was appeared from 1 case of open fracture which accompanied second metacarpal fracture as complication and it caused adduction contracture in first web space.
Accidental Falls ; Accidents, Traffic ; Arthritis ; Athletic Injuries ; Clinical Study ; Contracture ; Dislocations ; Fractures, Comminuted ; Fractures, Open ; Hand Strength ; Humans ; Incidence ; Intra-Articular Fractures ; Joints ; Male ; Metacarpal Bones ; Methods ; Soft Tissue Infections

Fractures of the phalanges of the hand are very common. Many are minor and likely to have a good result. However many other phalangeal fractures cause significant and prolonged disability. Non-union of the tubular bones of the hand are uncommon occurrence, but are often associated with functional deficits. The authors have reviewed 7 cases of non-union of the phalanges which were treated in the department of orthopaedic surgery, National Medical Center from 1978 to 1985. The results were summarized as follows: 1. The non-union of phalangeal bone was defined by clinical symptoms and signs and roentgenological examination. 2. The incidence of non-union of phalangeal bone fractures was 0.9% (7/771 cases.) 3. of 7 patients, there were 6 in male and 1 in female. 4. Non-union occurred more commonly in the second decade and the group between 10 and 30 years of age. 5. Seven cases, all were the right handed, but injury was developed in the left hands except two cases. 6. The causes of non-union were thought as open wound (7 cases), type of fracture (simple or comminution:3 cases), inadequate immobilization (4 cases) and overtraction (1 case). 7. of 7 cases, 4 cases were treated with bone peg graft and K-wire fixation and 2 cases with excision of distal fragment. 8. The clinical union was 9 weeks in average.
Clinical Study ; Female ; Fractures, Bone ; Hand ; Humans ; Immobilization ; Incidence ; Male ; Transplants ; Wounds and Injuries

T The Flexor tendon injury caused by trauma of hand and forearm is commonly reported and earlier treatment for trauma is recommendable. But in many cases, earlier treatment is often not possible due to degree of injured tissues and infection. Specially in cases of severe trauma and damage of tendon sheath and pulley, the solution of limitation of motion is still remained as a difficult problem up to present due to scar tissue adhesion to surrounding tissues even after the primary treatment. The Department of orthopaedic surgery of National Medical Center during four years from 1981 to 1985 have treated 22 patients (27 fingers) of old flexor tendon injuries with tendon reconstruction and followed up more than for 6 months for clinieal study arrd the results ase as follows: 1. The old flexor tendon injuries are composed of 18 patients of the first decade and the second decade, especially in male. 2. The main causes of injury were deep lacerations by sharp objects (12 patients, 55.6%) and crushing injuries (9 patients, 40.8%). 3. Tendon injuries were mostly occurred in the index and ring finger. The incidence rate was equal between the 2 fingers, 25.7% representatively. Most of the injuries (21 cases, 77.8%) occurred in the zone II (Kleinert classification). 4. According to Boyes' classification, Grade 2 was 16 patients (19 cases): Grade 4, 3 patients (4 cases): Grade 3, 2 patients (3 cases): and Grade 5, 1 patient. 5. The operation method in zone II was free tendon graft in 10 cases and staged tendon graft in 7 cases. 6. The timing of operation depends on whether the open wounds were completely healed or not as well as subsidence of swelling. In case of swelling. In case of stiff fingers normal range of motions should be restored by vigorous exercise before operation. 7. According to the assessment based on strickland and Glovac, 20 cases out of 22 cases (13 cases of free tendon graft and 9 cases of staged tendon graft were satisfactory result.
Cicatrix ; Classification ; Clinical Study ; Fingers ; Forearm ; Hand ; Humans ; Incidence ; Lacerations ; Male ; Methods ; Reference Values ; Tendon Injuries ; Tendons ; Tissue Adhesions ; Transplants ; Wounds and Injuries

One of the commonest and most serious problems of the injured hand is flexion contractures of the fingers. Such deformities not only functionally impair the digit, but also reduce or restrict the functional capability of the entire hand. We reviewed 150 digits of 73 patients with flexion contractures of the fingers which had been treated at National Medical Center from Jan. 1976 to Dec. 1985. The results were as follows: 1. The duration of flexion contractures which were scattered from 4 months to 17 years and average duration of contracture was 20.6 months. 2. The methods of treatment were Z-plasty, adhesiolysis, capsulotomy, excision of both collateral ligaments, stripping of extensor mechanism and volar plate and release of flexor tendon sheath according to injury mechanism and duration of contracture. 3. The postoperative results showed up 32 (21.3%) excellent, 78 (52%) good, 24 (16%) fair and 16 (10.7%) poor. 4. The postoperative results of burned injury which showed up-8 excellent, 11 good out of 20 cases they are supposed to have satisfactory results. 5. Crushing injury which had intraarticular fracture or comminution show up unsatisfactory results. 6. It seems obvious that the early active motion of interphalangeal joint is important to improve joint function. 7. The arc of motion was retained in a more functional position postoperatively than preoperatively.
Burns ; Clinical Study ; Collateral Ligaments ; Congenital Abnormalities ; Contracture ; Fingers ; Hand ; Humans ; Intra-Articular Fractures ; Joints ; Tendons

The flexor tendon injuries of the finger are very difficult to treat satisfactorily. Early treatment is desirable, but not always posaible. In addition, joint stiffness and limitation in gliding of the tendon caused by adhesion, make the problem more complex. From 1978 until 1988, 13 patients (14 eases) underwent operations for free tendon graft, and 10 patients (13 eases) for staged tendon graft at the Department of Orthopaedic Surgery, National Medieal Center. They have been followed up for clinical study, and the result was summarized as follows:1. Old flexor tendon injuries were common in the teen and twenties, especially in male. 2. They occurred in the index (10 Cases, 37.0%) and middle (8 cases, 29.6%) fingers most commony, especially zone II (62.9%). 3. The result was evalusted according to the method designed by Strickland and Glovac. In 19 out of 27 cases, satisfactory result (excellent and good) was yielded. 4. In cause, deep laceration by sharp object was better in the result than crushing injury. 5. The interval between the injury and the operation ranged from 1 month through 11 years, averaging 16 months, and is supposed to have little relation to the result. 6. The preoperative state is supposed to have much relation to postoperative result, judging from 100% of satisfactory result in Grade I compared with 40% in Grade V according to Boyes preoperative classification. 7. Little difference is seen in the result between free tendon graft and staged tendon graft. And 5 cases complicated by adhesion, rupture of grafted tendon and wound infection yielded poor result.
Adolescent ; Classification ; Clinical Study ; Fingers ; Hand ; Humans ; Joints ; Lacerations ; Male ; Methods ; Rupture ; Tendon Injuries ; Tendons ; Transplants ; Wound Infection

Cysts of the meniscus are rare lesion of the knee. They may present as a local tumor or mimic signs of an internal derangement of the knee. So it is difficult to diagnose and apt to overlook in physical examination. Also they almost always have combined pathology of the involved meniscus, such as, meniscal tear or discoid meniscus. The pathologic basis of the meniscal cyst is controversial, but rece 2. Most of the patients had tear of the involved meniscus, but the patients with discoid meniscus did not have gross tears or previous trauma history. nt works suggest the etiology is infiltration of joint fluid through micro and macro tears in the meniscus. In the past, complete excision of the meniscus as well as cyst was thought to be the treatment of choice to prevent recurrences. But nowadays, the trend is changed as preserving the involved meniscus, when no tear of the meniscus is found to prevent enevitable degenerative changes after total meniscectomy. We experienced 6 cases of meniscal cyst during recent 2 years and obtained following results. 1. Precise joint line evaluation is much more important in the diagnosis of the meniscal cyst before making special study. 2. Most of the patients had tears of the involved meniscus, but the patients with discoid meniscus did not have gross tears or previous trauma history. 3. When the cyst is located anteriorly in the joint line, it is prominent in flexed position of the knee; and when located posteriorly, prominent in extended position of the knee. 4. Excision of the cyst and reattachment of the meniscus were thought to be good method when the cyst was located in the parameinscal area without gross tear of the involved meniscus.
Diagnosis ; Humans ; Joints ; Knee ; Methods ; Pathology ; Physical Examination ; Recurrence ; Tears