The visual acuity measured preoperatively by hand-held laser interferometer was compared to the visual acuity measured postoperatively by Han s visual acuity in 86 cataractous eyes treated by phacoemulsification with posterior chamber IOL insertion in order to get the prediction of postoperatively corrected visual acuity. The follow up period was at least 4 weeks. In the 56 cases with immature cataract and normal retina, the postoperative visual acuity was predictable within 2 lines in 52 eyes (92.8%). In 20 eyes with mature cataract including nuclear sclerosis, postoperative Han's visual acuity was predictable within 2 lines in 7 eyes (35%), and one patient showed positive disparity. In 15 eyes with retinopathy, 10 eyes (66.7%) showed positive disparity and 3 eyes (20%) showed negative disparity. We concluded that the hand-held laser interferometer is a reliable method to predict the postoperative visual acuity in immature cataract with normal retina.
Cataract* ; Follow-Up Studies ; Humans ; Phacoemulsification ; Retina ; Sclerosis ; Visual Acuity*

Conjunctivodacryocystorhinostomy(CDCR) with a Pyrex tube is an accepted procedure for the treatment of epiphora resulting from obstructed canaliculi. We analyzed the success rate, complications and it's treatment of 181 eyes who underwent CDCR with a Pyrex tube at Wallace Memorial Baptist Hospital between september 1986 and march 1996. Straight tubes, 18mm long(70 of 181 eyes; 38.7%) was most commonly used. Of 181 eyes, 172 eyes(95%) were successful. Complications of CDCR included submergence of Pyrex tube (13 of 181 eyes; 7.2%), tube extrusion(9 of 181 eyes; 4.9%), tube extraction(5 of 181 eyes; 8.9%). Of the 9 eyes of tube extraction, 7 eyes were 20mm in length, and the exchange of 20mm for 18mm was performed under topical anesthesia and two eyes, 18mm in length were replaced by 16mm in length. It was successful in 3 eyes but 6 eyes were dissatisfied because of residual tearing. In 13 eyes of tube submergence, tubes were sutured with 5-0 nylon to the skin of medial canthus and was successful in 10 eyes but was failed in 3 eyes. Of 181 eyes, 5 eyes(2.8%) lost their tube. 4 patients came for treatment 24 hours after tube loss and 1 patients came for treatment 72 hours after tube loss. A simple tube reinsertion was successful in all cases. Other complications were granuloma formation(16 of 181 eyes; 8.8%), conjunctival growth over the tube opening(8 of 181 eyes; 4.4%) and infection (5 of 181 eyes; 2.8%). Granuloma recurred two times in 4 eyes, three times in 2 eyes, four times in 1 eyes and was resected effectively each time under topical anesthesia. Conjunctival overgrowth was treated with conjunctival resection and tube manipulation. The infection resolved completely on consecutive treatment with topical and oral antibiotics.
Anesthesia ; Anti-Bacterial Agents ; Follow-Up Studies* ; Granuloma ; Humans ; Lacrimal Apparatus Diseases ; Nylons ; Protestantism ; Skin

Kienböck’s disease is an avascular necrosis of the lunate that can be accompanied by a lunate fracture. Although numerous studies on Kienböck’s disease have been conducted, its natural history is incompletely understood and there is no consensus for treatment. Various wrist arthroscopic surgeries have been attempted owing to the increasing interest in wrist minimal-invasive surgery. Traditionally, the Lichtman classification, based on the osseous status, is used widely to assess Kienböck’s disease. On the other hand, age, vascular condition, and cartilage status are also important when making a treatment plan for Kienböck’s disease. This article introduces a new classification and treatment algorithm combining osseous, vascular and cartilage classifications. Moreover, the roles and limitations of arthroscopy in this new algorithm are reviewed, and the author’s preferred treatment protocol based on staging is introduced.

PURPOSE: Calcific lesion of the hand is infrequently recognized, presenting with severe pain and swelling of the affected joint. The purpose of this study is to describe clinical features associated with this condition by reviewing surgically treated patients. MATERIALS AND METHODS: A retrospective study was carried out in 11 patients who had operation clinical and radiographic data were collected by medical records. RESULTS: Eight patients were females and three were males with age ranging between 27-75 years (mean: 48 years). By location, five cases of interphalangeal joint, three cases of metacarpophalangeal joint of thumb, two cases of carpal tunnel and one case of distal ulna area were noted. Interval between symptom presentation and operation was 9.4 month (range: 6-18 month). During 10 month follow-up (range: 6-12 month), recurrence had not occurred. CONCLUSION: Although the prevalence of calcific lesion of hand and wrist is low, it may cause severe pain and swelling. If conservative treatment fails or any nerve compression symptom develops, surgical removal of the calcific lesion is recommended.
Female ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Metacarpophalangeal Joint ; Prevalence ; Recurrence ; Retrospective Studies ; Thumb ; Ulna ; Wrist

PURPOSE: This study was designed to measure time-dependent changes in muscle excursion and collagen content after tenotomy, and to analyze the correlation between muscle excursion and collagen content in a rabbit model. MATERIALS AND METHODS: Twenty-four rabbits underwent tenotomy of the second extensor digitorum longus (EDL) muscles on the right legs and were randomly assigned to three groups based on the period of time after tenotomy (2, 4, and 6 weeks). The second EDL muscles on left legs were used as controls. At each time after tenotomy, passive muscle excursion and collagen content, determined by hydroxyproline content, were measured bilaterally, and the ratio of each value to the normal one was used. RESULTS: The mean ratio of muscle excursion after tenotomy to the value of the control decreased in a time-dependent fashion: 92.5% at 2 weeks, 78.6% at 4 weeks, and 55.1% at 6 weeks. The mean ratio of hydroxyproline content in muscle to the value of the control increased in a time-dependent fashion: 119.5% at 2 weeks, 157.3% at 4 weeks, and 166.6% at 6 weeks. There was a significant negative correlation between the ratio of hydroxyproline content in muscle after tenotomy to the control values and the ratio of muscle excursion after tenotomy to the control values (r=-0.602, p=0.002). CONCLUSION: The decrease in muscle excursion seems to correlate with the increase in collagen content in the muscle in a time-dependent fashion following tenotomy.
Animals ; Collagen/*metabolism ; Hydroxyproline/metabolism ; Muscle, Skeletal/*metabolism ; Rabbits ; Tendon Injuries/*metabolism ; Tendons ; Tenotomy ; Time Factors

The extension type locked metacarpophalangeal joint of the little finger is an extremely rare condition characterized by loss of flexion with little or no loss of extension. The most common cause for locking is entrapment of a strap of the ruptured palmar plate. We treated a locked metacarpophalangeal joint of the little finger due to a hyperextension injury. The mechanism of locking was a torn part of the palmar ligament that forcefully rides across the prominence of the radial condyle of the metacarpal bone together with the accessory collateral ligament. These dislocated parts of the ligament formed a constricting bundle that prevented closed reduction. Locking was released successfully by an open reduction using the dorsal approach of the metacarpophalangeal joint without complication.
Collateral Ligaments ; Fingers* ; Ligaments ; Metacarpophalangeal Joint* ; Palmar Plate

PURPOSE: To evaluate the clinical features, results, and prognosis of posterior interosseous nerve injury related to fracture or dislocation of the proximal radius. MATERIALS AND METHODS: From patients with posterior interosseous nerve injury between January, 1985 to December 2002, fourteen patients were selected. There were 2 cases with fracture of the proximal radius alone, 6 cases with fracture of both bones of the forearm, 5 cases with Monteggia fracture, and 1 case of radius head fracture. Eight cases showed nerve injury at the time of trauma, 3 cases after open reduction, and 3 cases after hardware removal. The involved nerve was explored in patients without spontaneous recovery for further treatment. Final range of motion, motor function, and satisfaction were used to assess the results. RESULTS: Seven cases, all with closed fracture, showed spontaneous recovery. The average time of recovery was 6.2 weeks. The remaining 7 cases were treated by neurorraphy (1 case), neurolysis (1 case), sural nerve graft (2 cases), and tendon transfer (3 cases). All cases showed satisfactory results. CONCLUSION: Traumatic posterior interosseous nerve injury rarely happens. Injury after closed fracture usually shows spontaneous recovery. Injury can also take place during open reduction or hardware removal. In cases without spontaneous recovery, The prognosis is generally good after proper treatment.
Dislocations ; Forearm ; Fractures, Closed ; Head ; Humans ; Monteggia's Fracture ; Paralysis* ; Prognosis ; Radius ; Range of Motion, Articular ; Sural Nerve ; Tendon Transfer ; Transplants

PURPOSE: We wanted to assess the radiological and clinical results and the prognostic factors after an operation for capitellar fractures associated with/without other injury around the elbow. MATERIALS AND METHODS: Among the 25 patients (mean age: 49 years-old) who underwent open reduction and internal fixation for capitellar fractures, there were nineteen type 1 fractures and six type 3 fractures. The mean follow up period was 14.8 months. We assessed the factors affecting the radiological and functional results, such as the fracture pattern, the patient age and the surgical approaches. RESULTS: In 24 of 25 patients, bony union was achieved at postoperative 1 year. There were eighteen excellent, four good, two fair and one poor functional results according to the Broberg and Morrey elbow score. The most common type was type 1 and the most common associated injury was lateral condylar fracture. The patients with type 1 fracture rather than the patients with type 3 fracture and the patients who had an extraarticular associated fracture rather than an intraarticular associated fracture had better clinical outcomes. CONCLUSION: 22 (88%) of the patients were satisfied at the result. The type of capitellar fracture and an associated intraarticular elbow fracture were shown to be important prognostic factors in this study.
Elbow ; Elbow Joint ; Follow-Up Studies ; Humans

Tufted angioma is a rare slowly progressive vascular tumor, characterized by histopathologic findings of numerous angiomatous lobules of "cannonball" appearance within the dermis. It affects children but occurs infrequently at birth. It appears as a clinical imitator of hemangioma of infancy (HOI), so it needs to be differentiated from HOI. Clinically, lesions most often present as red to purple, indurated or nodular plaque, and are usually located on the neck, upper trunk or proximal limb. We report six cases of tufted angioma of congenital onset. We undertook immunohistochemical study using CD31, D2-40 and GLUT1 to rule out other vascular tumors or malformations, particularly HOI. These cases may demonstrate the keys of differential diagnosis between HOI and tufted angioma, which share common features clinically and rarely histopathologically.
Child ; Dermis ; Diagnosis, Differential ; Extremities ; Hemangioma ; Humans ; Iodine Compounds ; Neck ; Parturition ; Skin Neoplasms

PURPOSE: To evaluate the results of operative treatment for the unstable ulnar metaphyseal fractures associated with a distal radius fracture in osteoporotic patients. MATERIALS AND METHODS: Retrospective study was done on 10 patients with a ulnar metaphyseal fracture which was remained unstable after reduction and fixation of the distal radius fracture between March 2002 and Feb 2006. The average age was 72 years old. The mean follow up period was 25 months. Of 5 cases of Biayni type 1, 2, 3 fracture, 4 cases were treated with closed reduction and percutaneous pinning and one with open reduction and internal fixation with plate. All type 4 fractures were treated with ulnar resection. Range of motion, visual analogue scale for pain and grip strength were measured and clinical results were evaluated by Cooney's method. RESULTS: In ulnar fixation group, average motion was 68.5, 45.5, 65.3 and 75.8 degrees for flexion, extension, supination and pronation, respectively. The average grip strength was 102% of uninjured hand. In ulnar resection group, average motion was 65.5, 50.4, 75.2 and 75.5 degrees for flexion, extension, supination and pronation, respectively. The mean grip strength was 86.7% of uninjured hand. According to Cooney's method, there were excellent in one patient, good in seven, fair in one and poor in one. Fair and poor results were noted in case of AO type C fractures. CONCLUSION: Unstable ulnar metaphyseal fractures associated with distal radius fractures in osteoporotic patients can be treated successfully with ulnar fixation or resection. Ulnar resection is useful option in selected cases such as severe comminuted fractures.
Follow-Up Studies ; Fractures, Comminuted ; Hand ; Hand Strength ; Humans ; Osteoporosis ; Pronation ; Radius ; Radius Fractures ; Range of Motion, Articular ; Retrospective Studies ; Supination