In general. femoral neck fracture in young adult presents poor prognosis due to the high velocity injury, high angle shear fracture, and poor candidate for arthroplasty. In addition to the relative rarity of the injury, the high incidence of aseptic necrosis and nonunion have been reported in the management of these fractures. 25 cases of femoral neck fracture in young adult were treated with multiple pinning and analyzed at Sung-Ae general hospital from 1987 to 1994 after 28 months follow up in average with review of charts, X-ray and clinical result. There were 18 male and 7 female, 5 cases of them had significant polytrauma to other organs or skeletal system, authors tried to treat them as soon as possible to decrease the interval time between fracture and fixation (the average time was 39.7 hours.) Union occurred in all of Garden stage I (4 cases) and II (4 cases), but in Garden stage III (7 among 8 cases) and IV (7 among 9 cases) the union rate was lower. Average union time was 16.5 weeks. The incidence of complications (12%, 3 among 25 cases) was higher in displaced fractures group (Garden stage III, IV) and also in poorly reduced group of Garden’s alignment index. In conclusion, the prognosis of femoral neck fractures in young adult was related with mainly initial reduction and rigid fixation than the initial injury.
Agriculture ; Arthroplasty ; Female ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Hospitals, General ; Humans ; Incidence ; Male ; Multiple Trauma ; Necrosis ; Prognosis ; Young Adult

Microscopic polyangiitis is a systemic small-vessel vasculitis, which may involve multiple organs, but cardiac involvement is relatively rare. We report a case of microscopic polyangiitis with multiple organ involvement, in which myocardial infarction was the early manifestation of the disease. A 53-year-old man presented with sudden papulovesicular eruptions and swellings on the face, posterior neck, dorsa of both hands and fingers, and with diffuse erythematous patches on the back. He had suffered from renal dysfunction, arthralgia, and hypertension for more than 8 years. He had been admitted to the department of cardiology for acute myocardial infarction and had suffered from recurrent gastrointestinal bleeding, renal failure, acute pancreatitis and sepsis during the admission. Histopathologically, small-vessel leukocytoclastic vasculitis with out granuloma was seen. Direct immunofluorescence showed no immune deposite. A high serum level of P-ANCA was detected by ELISA.
Acute Kidney Injury ; Antibodies, Antineutrophil Cytoplasmic ; Arthralgia ; Cardiology ; Enzyme-Linked Immunosorbent Assay ; Fingers ; Fluorescent Antibody Technique, Direct ; Granuloma ; Hand ; Hemorrhage ; Humans ; Hypertension ; Microscopic Polyangiitis* ; Middle Aged ; Myocardial Infarction* ; Neck ; Pancreatitis ; Sepsis ; Vasculitis

This study was conducted to assess the amount of nursing services for psychiatric inpatients and to estimate psychiatric nursing costs by using the RBRVS. Full details of medical services, including physician and nursing services, for psychiatric inpatients were surveyed and data of general characteristics of hospitals and patients were also collected. The cost of nursing activities was estimated by the multiple conversion factor which was drawn from the Korean RBRVS Development Project to the RBRVS score of each nursing activities, which was drawn from the results of Korean Nurses Association (KNA)'s projects about nursing RBRVS development and cost of nursing activities. The data about 89 inpatients from 3 general hospitals with psychiatric departments were analyzed. The total cost of nursing activities for each patient per admission day was from KRW 22,185 to KRW 27,954 by hospital, and KRW 25,220 in average. The percent of nursing cost to the total cost of medical services was from 36% to 48% by characteristics of patients and 41.4% in average. The cost of nursing activities estimated in this study was between the existing NHI fee schedule and the one suggested by KNA. It is considered as appropriate and acceptable level compared to the total amount of medical services. In the process of KNA's activities to get nursing fee in NHI fee schedule, results of additional studies to estimate the cost of nursing activities balanced with total cost of medical services in every departments should be found and utilized.
Fee Schedules ; Fees and Charges ; Hospitals, General ; Humans ; Inpatients ; Nursing ; Nursing Services ; Psychiatric Nursing*

ACL plays an important role in stability of knee joint and its injury causes instability of joint which is known as the initiation of problem knee. Reconstruction of the anterior cruciate ligament would be preferred to the primary repair in treatment. And recently with the advance of arthroscopic technique and development of bone-patellar tendon-bone (BPB) graft material, the result of reconstruction is somewhat superior to that of primary repair. Authors compared the results of 20 primary repairs (Group I ) and 20 reconstructions (Group II) among 64 acute ACL injury treated Sung-Ae General Hospital from January 1989 to December 1994. The results were as follows: 1. Most common associated injuries were medial collateral ligament rupture and medial meniscal tear. 2. Group I showed postoperatively 13 negative anterior drawer test, 12 negative Lachmann test and 12 negative pivot shift test and group II showed postoperatively 17 negative anterior drawer test, 15 negative Lachmann test and 17 negative pivot shift test. (p<0.05) 3. In postoperative Lysholm knee scoring scale, group I showed 86 points and group II showed 93 points (p<0.05). 4. In postoperative KT-1000 arthrometer, 12 cases in Group I and 16 cases in Group II showed less than 2mm difference with sound side (p<0.05).
Anterior Cruciate Ligament ; Collateral Ligaments ; Hospitals, General ; Joints ; Knee ; Knee Joint ; Rupture ; Transplants

Traumatic dislocation of the hip presents serious problems that may lead to avascular necrosis, nerve palsy, post-traumatic arthritis even when reduction is promptly and adequately carried out. Among them avascular necrosis is the most important prognostic factor, so the early detection of this complication has critical significance for final result. Bone scan has been considered one of early diagnostic test, but recently MRI replaced its role for imaging in the detection of early AVN, treatment monitoring and prediction of prognosis. Authors prospectively studied the early finding of MRI to detect avascular necrosis of the femoral head and to predict prognosis in traumatic hip dislocation and fracture-dislocation. From December 1990 to November 1994, 12 case of dislocation and fracture-dislocation of the hip were studied . In follow up period ranging from 19 months to 65 months, 10 case had excellent or good result. All cases had abnormal MRI finding such as paraarticular edema, capsular bulging, joint effusion, femoral head fracture, but findings such as femoral head signal changes were dectected in only 3 cases. Among the 3 cases, 1 case had developed AVN and 2 cases were uneventful. Other complications were 3 cases of posttraumatic arthritis, 2 cases of incomplete sciatic nerve palsy, and 1 case of heterotrophic ossification. Although early MRI finding at posttrauma 2weeks gave less specific information, it could give good information for risk group and follow up control with more cases. Although it is expensive, MRI can be one of the most reliable reference in early diagnosis of AVN and prediction of prognosis in traumatic dislocation and fracture- dislocation of the hip with non-invasive method.
Arthritis ; Diagnostic Tests, Routine ; Dislocations ; Early Diagnosis ; Edema ; Follow-Up Studies ; Head* ; Hip Dislocation* ; Hip Joint ; Hip* ; Joints ; Magnetic Resonance Imaging* ; Necrosis ; Paralysis ; Prognosis ; Prospective Studies ; Sciatic Neuropathy

The authors report the clinical results of ten cases of complex supracondylar fractures treated by external fixation with a mean follow up of 21 months. Six cases were closed comminuted fracture, and four cases were open fractures. By AO classification six cases were type C2, two type C3, one type Al, and one type A3. Four cases had associated vascular injury. Reduction was performed by closed method in eight cases, and two cases were reduced through open wound. All cases healed at average of 142 days. Final healing of all cases occurred with an average range of motion of 3°-119° except one case which required reapplication due to infected nonunion with a gap. In nine cases of the ten functional results were rated as "good", and one case was "fair" by Iowa Knee Rating Scale. In conclusion, definitive external fixation can be a good alternative treatment modality despite previous recommendations to limit external fixation to temporary application in cases of limb salvage, such as severe comminution or pre-existing infection.
Classification ; External Fixators ; Femur ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Iowa ; Knee ; Limb Salvage ; Methods ; Range of Motion, Articular ; Vascular System Injuries ; Wounds and Injuries

Ankylosing spondylitis is a chronic inflammatory disease of unknown etiology that affects spine, sacroiliac joint, and the large joints of the extremities, and lead to fibrous or bony ankylosis and deformity. The rigid ankylosed spine of ankylosing spondylitis is prone to fracture by minimal trauma, and the resulting fractures likely to be unstable and damage to spinal cord or cauda equina. The authors report a case of paraplegia in ankylosing spondylitis after open reduction of the femoral trohanteric fracture.
Ankylosis ; Cauda Equina ; Congenital Abnormalities ; Extremities ; Femur ; Joints ; Paraplegia ; Sacroiliac Joint ; Spinal Cord ; Spine ; Spondylitis, Ankylosing

The method of treatment of acromioclavicular dislocation is controversial, and conservative and surgical treatment have been reported to be both successful. Recently, many surgeons tend to treat the acromioclavicular dislocation with anatomical reduction of acromioclavicular joint and rigid internal fixation because of many disadvantages of conservative methods. We report 24 cases of acute acromioclavicular dislocation treated with modified Phemister method from March 1989 to December 1992. The follow-up ranged from 12 months to 31 months with 16.5 months on average. The results are as follows. l. Among 24 cases, 21 cases are males and 20 cases are in 3rd decade to 5th decade. 2. The most common cause of injuries is falling down, followed by traffic accident. 3. Associated injuries are fractures in 5 cases, spleen rupture in 1 case. 4. Except 1 case with spleen rupture, 23 cases were treated within 2 weeks after injury. 5. Preoperative difference in C-C distance on stress view is 8.6mm on average, ranged from 6mm to 18mm. 6. Clinical results were excellent in 11 cases, good in 10 cases, fair in 2 case, and poor in 1 case. 7. Complications were pin migration in 1 case and symptomatic acromioclavicular arthritis in 1 case.
Accidental Falls ; Accidents, Traffic ; Acromioclavicular Joint ; Arthritis ; Dislocations ; Follow-Up Studies ; Humans ; Male ; Methods ; Rupture ; Spleen ; Surgeons

Intramedullary nailing was generally accepted as an excellent method in the treatment of femoral shaft fracture to provide rigid fixation of the fracture, to allow early motion of the joint, and to ensure bony union. We analyzed 100 cases of the fractures of the femoral shaft treated with closed and open intramedullary nailing from January 1988 to May 1994, to compare the results of open and closed intramedullary nailing of femoral shaft fractures and to assess complications and technical problems in intramedullary nailing. The results were as follows: 1. Male was predominant and peak incidence was in the third decades. 2. The most common causes of fracture was traffic accident and associated injuries were in 62 cases. 3. Location of fractures was middle one-thirds in most cases, and Winquist-Hansen Classification type II was the most common. 4. In all cases except 3 cases, operations were done within 2 weeks after injury, and open nailing was done in 66 cases and closed nailing in 34 cases. 5. The average union time was 16.1 weeks in closed IM nailing group, and 20.5 weeks in open IM nailing group and 18.7 weeks in average. 6. The complications was delayed union, nonunion, infection, shortening, failure of distal locking screws and femur neck fracture.
Accidents, Traffic ; Classification ; Femoral Neck Fractures ; Femur ; Fracture Fixation, Intramedullary ; Humans ; Incidence ; Joints ; Male ; Methods

Congenital fibrosarcoma of neonate is a very rare malignant tumor prone to behave aggressively with a tendency to local recurrence without metastasis. It is characteristically composed of collagenous fibroblasts and herringbone pattern in histology. We experienced a case of congenital fibrosarcoma on the left thigh and report this case with some review in literature with 1½ year follow up.
Collagen ; Fibroblasts ; Fibrosarcoma ; Follow-Up Studies ; Humans ; Infant, Newborn ; Neoplasm Metastasis ; Recurrence ; Thigh