No abstract available.
Elbow*

Adhesion around tendons of the hand and wrist and subsequent limitation of motion, is one of the major complications after tendon surgery. In addition to the tendon surgery such as tendon repair or graft, infection, open reduction of fracutres, and burn scar contracture could be the casuses of tendon adhesion. Tenolysis and adequate postoperative rehabilitation program, has been proved to be effective in preventing of adhesion, whatever the cause may be, if its continuity is maintained. In order to evaluate the efficiency and problems of tenolysis, we reviewed 37 fingers of 31 patients who had been treated by tenolysis at Seoul National University Hospital from 1981 to 1991. There were 20 men and 11 women, and the average age was 28.2 years(9-45 years). The causes of adhesion were various; 24 fingers(64%) after tendon repair or tendon graft, 3 fingers(8%) after infection, 4 fingers(10%) after treatment of fracture, 4 fingers(10%) after burn scar contracture, and the other 2 fingers(5%) after curettage of enchondroma. Involved tendon were flexor tendon in 28 fingers and extensor in 9. The average duration of follow-up was 17 months(13 months to 4 years). Active motion of involved finger was started within 2 days after operation. The Total Active Motion(TAM) after operation was average 213°(100°-260°), compared to 123°(40°-180°) before operation. According to Strickland formula which was modified by us, the postoperative results were excellent in 17 fingers, good in 9 fingers, fair in 6 fingers and poor in 5 fingers. In 24 cases who had tenolysis after repair or graft, 19 case(79%) were rated as excellent or good. But in 7 cases whose causes of adhesion were infection or burn scar contracture, only 3 cases(42%) were rated as excellent or good. Compairing the results between younger(less than 30 years of age) and older(more than 30 years of age) group, the younger group showed excellent and good in 8496 and the older group in 41%, The complications were tendon rupture in 3 fingers and minor infection in 2 fingers, respectively. In summary, tenolysis was considered as a useful procedure to improve function of tendon bound down in scar tissue. And the results were better in younger age group(p < 0.05) and in previous tendon repair or graft(p < 0.05) group.
Burns ; Chondroma ; Cicatrix ; Contracture ; Curettage ; Female ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Male ; Rehabilitation ; Rupture ; Seoul ; Tendons ; Transplants ; Wrist

Congenital radial clubhand is a rare deformity, which is characterized by total or partial absence of the radial ray of forearm and hand. We experienced 9 radial clubhands in 7 patients during the last 12 years. Excluding 3 clubhands in 2 patients which were very mild in their deformity, 6 clubhands in 5 patients were operated. Radialization was done in 5 clubhands, and centralization in one. Concomitant corrective osteotomy of ulna was combined in all. The results of the surgical treatment were evaluated by ; radiological findings including Hand-forearm angle(HFA), Hand-forearm position(HFP) and Ulnar bowing(UB) range of motion of the wrist ; and parents' satisfaction. Patients were followed up for average 2 years and 6 months, ranging from 1 to 6 years. All the radiological findings were improved. Although their range of wrist motion was not increased, this was changed into more functional position, that is the radial deviation decreased but ulnar deviation increased. Most parents were satisfied with the surgical results.
Congenital Abnormalities ; Forearm ; Hand ; Humans ; Osteotomy ; Parents ; Range of Motion, Articular ; Ulna ; Wrist

Intrinsic plus deformity, which results in severe functional impairment of the hand, is caused by contracture of intrinsic muscles. This deformity can be resulted from many causes such as ischemic damage, spasm of intrinsic muscles, thermal injury, and so on. The surgical release of tightened intrinsic muscles, may be the only solution to make usable hand, especially for severe cases. Sixty five digits in 22 patients who were operated on from 1982 to 1992, were evaluated retrospectively, to analyse the effects of surgery for intrinsic plus hand. Among 65 digits, 13 were thumbs and 52 fingers. The mean age of the patients was 26 years and 8 months and 17 cases were males and 6 females. The causes were ischemic damage by laceration or crushing injuries in 11 patients, compartment syndrome in 5, cerebral palsy in 5, and burn in one. Involved digits were thumb only in 4 patients, thumb and fingers in 9, and fingers in nine. All the digits were classified preoperatively by Zancolli's classification. In 13 thumbs retropulsion contracture was 4 and adduction-antepulsion contracture was nine. All of the thumbs were treated by intrinsic release and Z plasty(or rotational flap). Other procedures including arthrolysis, arthrodesis and tendon reconstruction were combined in 9 thumbs. In 52 fingers, in addition to distal release, arthrolysis was combined in 12 fingers, and arthrolysis plus volar plate release were combined in 4 fingers. For the assessment, our criteria, based on subjective satisfaction of the patient and range of motion, was used. The duration of follow up was from one year to 9 years with the average of 26 months. In 14 thumbs the results were excellent in 2, 6 good, 4 fair, and one poor. In 52 fingers excellent was 12, 24 good, 13 fair, and 3 poor. In summary we could improve the function of intrinsic plus deformity by appropriate sugery, and their results were good.
Arthrodesis ; Burns ; Cerebral Palsy ; Classification ; Compartment Syndromes ; Congenital Abnormalities ; Contracture ; Female ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Lacerations ; Male ; Muscles ; Range of Motion, Articular ; Retrospective Studies ; Spasm ; Tendons ; Thumb

Polydactyly is one of the most common congenital anomalies of the limb, however its surgical treatment varies from simple excision to reconstruction. The purpose of this study is to present out classification of polydactyly in which the type of surgery was concerned primarily. Two hundred and thirty five digits(134 fingers and 101 toes) in 188 patients were operated from 1980 to 1992. We divided the polydactyly into two types-the simple type, in which the extradigit arises from only one digit, and the complex type in which the extradigit connects more than two adjacent main digits. The simple type was subdivided into joint type(type I), in that the extradigit has its own joint in its origine; epiphyseal type(type II), the extradigit share common epiphysis with main digit; and hypoplastic type(type III), the extradigit is connected only by soft tissue to the main digit. The epiphyseal type(type II) was further divided into subtype A(type IIA), in that the origin seems to be directly derived from the epiphysis; and subtype B(type IIB), which resemble an osteochondroma. Type III and type IIB can be treated by simple excision, however the type I and type IIB can be treated by arthroplasty with or without osteotomy as well as excision of extradigit. Result of surgical treatment in 1 digit of the simple form, which siginifies the extradigit arising from only one digit, are good in 193 digits(91%), fair 14(6.6%), and poor 5(2.4%) after an average follow-up period of 20 months. Our principles in the surgical treatment of polydactyly was treatment according to the type, and early treatment.
Arthroplasty ; Classification ; Epiphyses ; Extremities ; Fingers ; Follow-Up Studies ; Humans ; Joints ; Osteochondroma ; Osteotomy ; Polydactyly

Being a rare disease entity, there have been few references about the cleft hand in Korea. We evaluated the postoperative cosmetic results of 17 cleft hands in 14 patients, who were treated surgically at the Department of Orthopedic Surgery of Seoul National University Hospital, from 1982 to 1993. Among 14 patients, 8 were males. Bilateral cleft hands were in five patients and unilateral in 9. Three of five patients who had bilateral cleft hands, were treated surgically on both hands. Remaining two patients had an operation on one hand which affected more severely. Average age at the time of operation was 2 years and 5 months(5 months-10years). Average duration of follow-up was 34 months(1 year 1 month-7years 5 months). By Lange's classification, typical patterns were 16 hands and atypical pattern one. By Flatt's classification, there were 8 hands of I b, 7 I c, 1 I a, 1 II. One patient had family history whose father had both cleft hands and feet. Congenital anomalies other than cleft hand were associated in 10 of 14 patients. Two patients had 3 associated anomalies, 4 patients 2, and 4 patients one. Syndactyly was the most common associated anomaly of affected cleft hand. Central cleft was closed by Snow-Littler technique in 4 hands(24%), Barsky method in 12(71%) and others in 1(6%). Metacarpal bone was treated by intermetacarpal ligament reconstruction in 1 hand(6%), excision only 7(41%), transfer of 2(rd) metacarpal to 3(rd) metacarpal base after excision 5(29%), and 2(rd) metacarpal corrective osteotomy 3(18%). Complications were in 2 hands; one wound dehiesence of cleft, and one partial necrosis of skin. The cosmetic results of surgical treatment were graded into good, fair or poor by the parents-Good ; when parents were satisfied with the result, Fair; improved cosmesis but not satisfied, and Poor; no improvement after surgery. Good was in 16 hands and fair in one.
Classification ; Fathers ; Follow-Up Studies ; Foot ; Hand ; Humans ; Korea ; Ligaments ; Male ; Methods ; Necrosis ; Orthopedics ; Osteotomy ; Parents ; Rare Diseases ; Seoul ; Skin ; Syndactyly ; Wounds and Injuries

No abstract available.
Congenital Abnormalities*

Collagen is the major structural protein in the human body, especially in connective tissues. There are more than 13 types of collagen. Among them, type II collagen is a main component of articular cartilage structure. Altered immunological conditions against type II collagen may be closely related to the pathologic conditions of joint, especially arthritis. Since 1977, animal model for collageninduced arthritis(CIA) has been developed and used in the investigation of arthritis. In those animals, high titers of anti-type II collagen antibody were noticed. Pathologic findings were similar to rheumatoid arthritis of human, which suggested that rheumatoid arthritis might be one of the autoimmune diseases. There had been many reports about elevation of serum and synovial level of anti-type II collagen antibody in rheumatoid arthritis patients. But majority of them did not discriminate the antibody titers according to the type of immunoglobulin(i.e. IgG, IgM). And the question whether the elevated antibody titers are cause or effect of the arthritis is still in controversy. In this study, the serum levels of anti-type II collagen antibody were determined in 82 persons(35 degenerative arthritis patients, 24 rheumatoid arthritis patients and 22 normal controls without any joint problem) via ELISA method. In each person the serum IgG, IgM and IgG+M+A antibody levels against bovine type IIcollagen and chicken typeII collagen were determined individually. Statistical evaluation of these data among degenerative arthritis group, rheumatoid arthritis group and normal control group was performed. The results were as follows; 1. Degenerative arthritis group revealed significant elevation of anti-type II collagen antibody(IgG, IgG+M+A) compared to normal control(p < 0.05). 2. Rheumatoid arthritis group showed significant elvation of IgM and IgG+M+A compared to normal control. 3. Between degenerative arthritis and rheumatoid arthritis group, no sigificant difference was noticed. 4. Rheumatoid arthritis group showed significant increase of IgM antibody level compared to normal control. 5. Female rheumatoid arthritis group showed significant increase of IgM level compared to female degenerative arthritis group. These findings suggested that the elevation of anti-type II collagen antibody titer is not specific for rheumatoid arthritis and related with general pathologies destroying articular cartilage. And it is suggested that anti-type II collagen antibody associated with rheumatoid arthritis is mainly IgM proportion, especially in female patients. So further investigation of anti-type II collagen antibody associated with rheumatoid arthritis is needed to target IgM antibody.
Animals ; Arthritis ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Cartilage, Articular ; Chickens ; Collagen ; Collagen Type II ; Connective Tissue ; Enzyme-Linked Immunosorbent Assay ; Female ; Human Body ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Joints ; Methods ; Models, Animal ; Osteoarthritis ; Pathology

Cubitus varus is a complex three-dimentsional deformity. In addition to deformity on varus-valgus plane, internal torsion of distal humerus is frequently combined. Also limitation of flexion-extension could be associated in some patients. Surgical correction of the cubitus varus after skeletal maturity, could have some different clinical course from those of growing children. However there have been few papers dealing with the surgical treatment of cubitus varus in adults. From May 1988 to December 1993, 23 patients who were older than 17 years of age, had correc- tive osteotomy for cubitus varus considering its three planes of the deformity at Seoul National University Hospital. To prevent serpentine deformity medial displacement of distal fragment was also combined during operation. The avereage age was 26 years(17-47), and the average follow-up after the operation was 1 year and 6 months(6 months-3 years). The presumed diagnosis of initial injury deduced from history and preoperative radiograms, was supracondylar fracture in 19 cases(86.4%). Others were lateral condylar fracture of humerus in two, and fractures associated with elbow dislocation in two. The average age at the time of initial injury was 8 years(2-14), and average delay from occurrence of deformity to the operation, were 13 years. Tardy ulnar nerve palsy was associated in 3 cases(13.6%). The preoperative average angle of cubitus varus was 26 degrees(16-45), flexion contracture 11 degrees(-5
Adult ; Bony Callus ; Child ; Congenital Abnormalities ; Contracture ; Diagnosis ; Dislocations ; Elbow ; Follow-Up Studies ; Humans ; Humerus ; Myositis Ossificans ; Osteotomy ; Paralysis ; Radial Nerve ; Range of Motion, Articular ; Seoul ; Tourniquets ; Traction ; Ulnar Neuropathies

There has been a few articles dealing with the incidence of congenital anomalies of the hand in Korea. In this paper, we have analyzed patients who have visited the hand clinic of Seoul National University Children s Hospital from March 1993 to February 1995 to study the relative incidence of congenital anomalies of the hand. We regarded more than two visits of the same patients as one. They were categorized into two groups by our classification system. First group consisted of the patients who showed hand anomaly only. The other group consisted of the patients who had anomalies in the other sites as well as in the hand. The first group was divided into two subgroups; the patients who had single entity of hand anomaly, and those who had more than two entities of hand anomalies. From the clinical analysis based on above criteria, following results were obtained. There were 626 anomalies in 547 patients, 319 (58.3%) males and 228 (41.7%) females (1.4: 1). Unilateral involvements of hand anomaly were noted in 385 (70.3%) patients (229 in right, 156 in left) and bilateral in 162 (29.7%). As a whole, the most common anomaly was trigger thumb (16.5%) and the second was polydactyly (16.1%). Other anomalies, in order of frequency, were syndactyly, camptodactyly, hypoplasia, brachydactyly, cleft hand and so on. In the first group who had hand anomaly only, there were 407 patients who had single entity of hand anomaly. Among these, trigger thumb were 25.3%, and polydactyly 16.2%. There were 68 patients who had multiple entities of anomalies. Among these, the syndactyly was the most common anomaly (23.9%) and the polydactyly was the next (16.2%). Fifty eight (10.6%) patients had anomalies in the hand as well as in the other site. Among these, camptodactyly was the most commonly found (36.5%) and polydactyly was the next common variety (19.0%) in the hand. In the anomalies which occurred in other than hand, arthrogryposis multiplex congenita was the most common (30.0%). Syndactyly of the foot (22.9%) and polydactyly of the foot (18.6%) were the next common anomalies.
Arthrogryposis ; Brachydactyly ; Child ; Classification ; Female ; Foot ; Hand* ; Humans ; Incidence* ; Korea ; Male ; Polydactyly ; Seoul ; Syndactyly ; Trigger Finger Disorder