The tibia is the most commonly fractured bone of all the long bones. In this age of vehicular accidents, the tibia is frequently subjected to high energy trauma. Anatomically the tibia has poor soft tissue coverage and poor blood supply. Therefore severe injury on the tibia can lead to severe complication and major disability. 41 adult patients with comminuted fracture of the tibial shaft were treated by OR/IF with D.C.P. and bone graft at the Department of Orthopedic Surgery, Kyungpook University Hospital from January 1978 to June 1986. These were analysed according to mechanism of injury, degree of comminution, timing of operation, soft tissue injury and operation time. Bone union and end results of treatment were reviewed. The results were as follows Of 41 cases, causes of injury were vehicular accident in 32 cases. 34 cases had associated injury on other part of body and average injury per case was 1.7 injuries. Based on the classification of Johner and Wruhs, the B group with butterfly fragment was 27 cases and C group was 14 cases. Among the B group, B2 was most common as 14 cases. Average union time was 18 weeks and delayed union and nonunion were 6 cases. Degree of comminution of fracture might be important fractor to bone union. According to the end result of Johner and Wruhs, excellent and good were 31, fair and poor were 10. Of the 41 cases, 10 cases had permanent disability. 4 cases had angular and rotational deformity alone and 1 case had shortening of tibia more than 1 cm, 1 case had both of them. Limited R.O.M. of ankle joint (>50%) occured in 4 cases. The post-operative infection occured in 6 cases, 3 were superficial infection but 3 cases were osteomyelitis. OR/IF with D.C.P. on comminuted tibial shaft fracture was a risk operation. Therefore proper method of treatment should be selected according to degree of comminution, timing of operation, presence or abscence of open wound and associated injury.
Adult ; Ankle Joint ; Butterflies ; Classification ; Clinical Study ; Congenital Abnormalities ; Fractures, Comminuted ; Gyeongsangbuk-do ; Humans ; Methods ; Orthopedics ; Osteomyelitis ; Soft Tissue Injuries ; Tibia ; Transplants ; Wounds and Injuries

Soft tissue defect on dorsum of hand requires immediate soft tissue cover to achieve early wound closure and to minimize wound infection and scarring. If the tendon or bone was exposed and the deep structures were absent, flap was required to provide adequate protection and allow proper function of the underlying structures. Small size in skin loss can easily be covered with local flaps but major defects involving the dorsal aspect of the hand should be coverd with distant flaps, free flaps or radial forearm flaps. Techniques in distant flaps require staged procedures and free flap transfer to obtain soft tissue cover in a single stage require microsurgical techniques. The reverse radial forearm flap is a fasciocutaneous flap based on the radial artery which together with its two venae comitantes lies invested in a condensation of the deep fascia known as the lateral intermuscular septum. The authors had treated 5 cases of distally based reverse forearm flap for soft tissue reconstruction on 2 patients of crushing injury with soft tissue defect on hand, a patient with Marjolin's ulcer on dorsum of hand due to previous burn scar and a patient with soft tissue necrosis on dorsum of both hands due to extravasation of adriamycin during chemotherapy. It has proved to be one of the saftest, simple and effective one-stage method of soft tissue reconstruction in hand without long term immobilization. The results of these operation in cover of soft tissue defect have been satisfactory.
Burns ; Cicatrix ; Doxorubicin ; Drug Therapy ; Fascia ; Forearm ; Free Tissue Flaps ; Hand ; Humans ; Immobilization ; Methods ; Necrosis ; Radial Artery ; Skin ; Tendons ; Ulcer ; Wound Infection ; Wounds and Injuries

Here, a case of a 59-year-old man with rotator cuff tear and impingement syndrome caused by an ossified coracoacromial ligament is presented. Ossification of the coracoacromial ligaments can occur because of degenerative changes due to trauma or repeated stress, which can lead to impingement syndrome. Therefore, when coracoacromial ligament ossification is present, rotator cuff damage due to impingement syndrome should be considered. Here, we conducted arthroscopic subacromial decompression, removal of the ossified coracoacromial ligament, and supraspinatus and subscapularis tendon repairs. We achieved satisfactory surgical outcomes without relapse; therefore, we report this case with a literature review.
Decompression ; Humans ; Ligaments* ; Middle Aged ; Recurrence ; Rotator Cuff ; Shoulder ; Shoulder Impingement Syndrome* ; Tears ; Tendons

No abstract available.
Cryotherapy* ; Leishmaniasis, Cutaneous* ; Metronidazole*

No abstract available.
Myiasis*

The case reported here, concerns a spontaneous low-flow fistula between the carotid arterial network and the cavernous sinus, with ophthalmological symptoms such as conjunctival congestion and diplopia in a 41-year-old woman. The patient has suffered from diabetes without trauma history. Patient's ocular symptoms and signs were only present in the left eye with best-corrected visual acuity 0.04 at the time of presentation. Other ophthalmic findings were exophthalmos, elevated intraocular pressure, and visual field defects. Enlarged extraocular muscles and proptosis were found on orbital computed tomography leading to the misdiagnosis of orbial pseudotumor or thyroid rbitopathy. Carotid angiography showed dural carotid-cavernous sinus fistula, which involved left-side internal and external carotid arterial network and right-side internal carotid arterial network. Orbital color Doppler imaging showed a flow reversal with a systolic component in the enlarged superior ophthalmic vein. We were able to diagnose dural carotid-cavernous sinus fistula. Dural carotid-cavernous sinus fistula was closed successfully by embolization via the vein without omplication. The visual acuity, proptosis, and dilated and tortuous vessels of the conjunctiva improved.
Adult ; Angiography ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Conjunctiva ; Diagnostic Errors ; Diplopia ; Estrogens, Conjugated (USP) ; Exophthalmos ; Female ; Fistula* ; Humans ; Intraocular Pressure ; Muscles ; Orbit ; Thyroid Gland ; Veins ; Visual Acuity ; Visual Fields

A 38-year-old woman was presented with a dark brown plaque on the abdomen. Clinically, the tumor was simulating the appearance of dysplastic nevus. Microscopically, the cells of the stratum malphighii lay in a disordered pattern. Many cells in the epidermis were atypical and melanin pigment was mainly in the basal layer of the epidermis and the upper dermis. Diagnosis of pigmented Bowen's disease was made. Pigmented Bowen's disease is rarely found at body sites other than the anogenital area.
Abdomen ; Adult ; Bowen's Disease* ; Dermis ; Diagnosis ; Dysplastic Nevus Syndrome ; Epidermis ; Female ; Humans ; Melanins

This study includes 19 cases of complicated low extremity injury to whom underwent microvascular free-tissue transfer in cases of open comminuted fracture, osteomyelitis, and vascular compromise or extensive soft tissue defect from Nov. 1994 to July 1997. The average time after injury to coverage was 25 days. The nineteen patients underwent a total of nineteen free tissue transfers primarily, and eighteen (94.7 per cent) of the transfers survived. Major complications were encountered recurrent failure of the free tissue transfer in one patient and partial necrosis in the other flap, which were successfully treated by flow-through radial forearm free flap and distally based superficial sural artery flap respectively. Two patients were sustained below knee amputation, one above knee amputation, despite of survival of flaps. This reveals limb salvage in 84 percent. The microvascular reconstruction is a versatile and reliable methods in complicated cases after severe trauma. Free tissue transplantation should be considered as a primary treatment in such complicated cases.
Amputation ; Arteries ; Extremities ; Forearm ; Fractures, Comminuted ; Free Tissue Flaps ; Humans ; Knee ; Limb Salvage ; Lower Extremity* ; Necrosis ; Osteomyelitis ; Tissue Transplantation ; Transplants

The purpose of the study is to describe the cases with prepapillary or peripapillary vascular malformation who have experienced mild vitreous hemorrhage. Five patients [5 eyes], 1 male and 4 females, were included in the study.The vascular malformation was unilaterally present in all patients.Vitreous hemorrhage occurred from the area of retinal vascular malformation near or on the optic nerve, and cleared without further complications. Fluorescein angiographic feature of each eye was normal. Arteriovenous communication, secondary retinal exudation, or vascular leakage from vascular malformation was not observed. Each patient showed improvement in visual acuity of 2 lines or more. This benign, congenital vascular malformation may be non-progressive and infrequently cause mild vitreous hemorrhage.Therapeutic intervention was not necessary in these cases.
Female ; Fluorescein ; Hemorrhage ; Humans ; Male ; Optic Nerve ; Retinaldehyde ; Vascular Malformations* ; Visual Acuity ; Vitreous Hemorrhage

No abstract available.
Hemorrhagic Fever with Renal Syndrome* ; Humans ; Proteinuria*