PURPOSE: Clinical and radiologic results of operative versus nonoperative treatment were compared in patients 70 years or older who had an unstable distal radius fracture. MATERIALS AND METHODS: From March 2007 to April 2009, 49 patients who had an unstable distal radius fracture treated nonoperatively (22 patients) or operatively (27 patients) were investigated. The radiologic results between the two patient groups were compared based on bone union, dorsal tilt, radial inclination and radial shortening. The clinical results were compared based on disabilities of arm, shoulder & hand (DASH) score, the patient-rated wrist evaluation (PRWE) score, the grip strength and the motion range of the wrist joint. RESULTS: At the last follow-up examination, DASH score, PRWE score, the flexion, supination and radial deviation of wrist joint and the grip strength did not showed significant difference. Among the patients who received non-operative treatments, 18 of 22 showed radiologically recognizable deformation; average dorsal tilt of 11.9degrees, the average radial inclination of 18.9degrees, and average radial shortening of 3.8 mm. The patients who received operative treatments showed average volar tilt of 3.3degrees, radial inclination of 18.8degrees+/-3.7degrees, and radial shortening of 1.5 mm. Three patients showed radiologically recognizable deformation. CONCLUSION: Our results suggest that nonoperative treatment is initially recommended in patients with the age of 70 years or older who have an unstable distal radius fracture in terms of functional results.
Arm ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Radius ; Radius Fractures ; Shoulder ; Supination ; Wrist ; Wrist Joint

PURPOSE: The purpose of this study is to evaluate the functional and aesthetic outcomes of the reconstruction of complicated open wounds with exposure of the bone, periosteum, or tendon using AlloDerm(R) and skin graft in hand and foot. MATERIALS AND METHODS: Seven cases of hand and 4 cases of foot were treated with combined AlloDerm(R) graft and split thickness skin graft in a single stage for managing the soft tissue defect of extremities where bone, periosteum, or tendon were exposed but flap operation was not feasible. The mean postoperative follow-up period was 30 months (range: 14-48 month). Postoperatively, we assessed graft taking rate, wound healing process, and the recovery of motion of hand and foot. RESULTS: AlloDerm(R) and skin graft were readily assimilated into the wound in all cases. The mean postoperative range of motions of the 5 fingers with exposed digital tendons were 89.2% of the normal side. Reconstructions of wound in the foot were successfully settled without unstable scar or ulcer in all cases. CONCLUSION: Composite grafting with AlloDerm(R) and autologous skin graft for reconstruction of complex open wound in hand and foot where deep structures are exposed provides stable reconstruction of the wound with high taking rate, successful recovery of tendon gliding motion by preventing adhesion.
Cicatrix ; Collagen ; Extremities ; Fingers ; Follow-Up Studies ; Foot ; Hand ; Hand Injuries ; Periosteum ; Skin ; Tendons ; Transplants ; Ulcer ; Wound Healing

Ganglion cysts are benign soft tissue tumors most commonly encountered in hand and wrist. Sixty to seventy percent of these are found in the dorsal aspect of the wrist. They are more common in the twenties to forties and in female. Its origin and pathogenesis remain unproved and there are several theories for genesis of ganglion. Non-surgical treatment is unreliable with a high recurrence rates. Open surgical excision is still golden standard treatment for wrist ganglion. Recently Arthroscopic excision has been tried to reduce unsightly scar and some complications, but still has some limitations. We reviewed the current literature available on wrist ganglion.
Cicatrix ; Female ; Ganglion Cysts* ; Hand ; Humans ; Recurrence ; Wrist*

Pseudoaneurysms might be caused by perforation of an artery with hematoma formation between the arterial wall and the surrounding tissue after penetrating injury, intervention or operation. The frequency of radial artery pseudoaneurysm as a complication of cannulation is known for 0.048%. We report one case of radial artery pseudoaneurysm after single arterial blood gas analysis at wrist, which was managed by excision followed by vein graft.
Aneurysm, False ; Arteries ; Blood Gas Analysis ; Catheterization ; Hematoma ; Radial Artery ; Transplants ; Veins ; Wrist

PURPOSE: Norepinephrine is initially used to increase blood pressure in patients with septic shock. It increases blood flow to vital organs but decrease the flow to end-organs resulting in ischemic changes in end-organs. We report five patients with ischemic necrosis of upper and lower extremities after using norepinephrine in septic shock. MATERIALS AND METHODS: We retrospectively reviewed medical record of five patients with ischemic necrosis of upper and lower extremities after treating septic shock from March 2010 to March 2011. RESULTS: Five patients developed ischemic necrosis of upper and lower extremities during intensive care. All patients experienced septic shock due to medical problems, which required norepinephrine to increase blood pressure. After conservative treatment, stump revision or below knee amputation were done. CONCLUSION: We believe that more active treatment and protection of the end-organs will be needed to prevent poor prognosis during the recovery of septic shock.
Amputation ; Blood Pressure ; Humans ; Critical Care ; Knee ; Lower Extremity ; Medical Records ; Necrosis ; Norepinephrine ; Prognosis ; Retrospective Studies ; Shock, Septic ; Upper Extremity

PURPOSE: We reported clinical results of autologous tricorticocancellous bone grafting and plate-screw fixation for nonunion of the forearm bones. MATERIALS AND METHODS: Ten patients with nonunion of the forearm bones that underwent surgical treatment were evaluated. Tricorticocancellous bone grafting which was harvested from the iliac crest and plate-screw fixation were performed. Radiologic bone union was evaluated based on the simple radiographs. At the final follow-up, range of motion was measured and the Anderson scale was used for functional evaluation. RESULTS: Radiologic bone union was achieved in all cases. The mean range of motion was 139degrees of elbow flexion, 3degrees of flexion contracture, 73degrees of forearm pronation, 72degrees of supination, 70degrees of wrist flexion, and 70degrees of wrist extension. Anderson scale was excellent in 6 patients, satisfactory in three, and unsatisfactory in one. CONCLUSION: Autologous tricorticocancellous bone grafting and rigid plate-screw fixation is a reliable method to achieve successful healing of forearm bone nonunions.
Bone Transplantation ; Contracture ; Elbow ; Follow-Up Studies ; Forearm ; Humans ; Pronation ; Range of Motion, Articular ; Supination ; Wrist

PURPOSE: The purpose of this study was to analyze carpal alignment and evaluate the interobserver reliability of the several parameters using three-dimensional computed tomography (3D-CT) in normal Koreans. MATERIALS AND METHODS: The study included 42 wrists with no history of wrist pain or abnormality by physical examination. 3D-CT scanning was performed with each patient in zero position; the arm abduction against the trunk; the elbow flexed 90degrees; the forearm in neutral position using the stabilizing device. The three observers measured the carpal alignment parameters including distal radius articular angle, radiolunate angle, radioscaphoid angle, radiocapitate angle, radio-3rd metacarpal angle, scapholunate angle, lunocapitate angle, luno-3rd metacarpal angle. RESULTS: The mean distal radius articular anglewas 12.8degrees+/-2.6degrees, the mean radiolunate angle was 0.9degrees+/-4.6degrees, the radioscaphoid angle was 54.4degrees+/-5.3degrees, the mean radiocapitate angle was 1.7degrees+/-2.1degrees, the mean radio-3rd metacarpal angle was -1.2degrees+/-2.5degrees, the mean scapholunate angle was 53.4degrees+/-7.8degrees, the mean lunocapitate angle was 0.8degrees+/-4.7degrees and the mean luno-3rd metacarpal angle was -2.1degrees+/-5.0degrees. All parameters have excellent interobserver reliability. CONCLUSION: The normal mean values and ranges of carpal alignment angles measured by using 3D-CT may be of assistance in the evaluation of carpal alignment in patients.
Arm ; Elbow ; Forearm ; Humans ; Physical Examination ; Radius ; Wrist

PURPOSE: The aims of this study were to introduce a new method of percutaneous carpal tunnel release and report its results. MATERIALS AND METHODS: After preoperative ultrasonographic mapping, a percutaneous carpal tunnel release was performed using the wire rope through two skin needle punctures. Forty wrists of 30 patients were evaluated restrospectively in terms of the symptomatic resolution and complications. The mean age of patients was 53.7 years ranging from 44 to 79 years. The mean follow-up period was 12.8 months ranging from 6 to 18 months. RESULTS: All cases showed complete relief or marked improvement of symptoms postoperatively. There was no neurovascular injury or other major complication. At postoperative 6 months follow-up, according to the Boston questionnaire, symptom severity score improved from 3.67+/-0.25 preoperatively to 1.55+/-0.33 postoperatively, and functional status score improved from 3.52+/-0.38 preoperatively to 2.09+/-0.42 postoperatively. All patients regained grip strength and pinch strength after surgery. CONCLUSION: The percutaneous carpal tunnel release using the preoperative ultrasonograhic mapping and the wire rope is an effective, reliable and safe method with the benefits of less postoperative pain and early recovery.
Boston ; Carpal Tunnel Syndrome ; Follow-Up Studies ; Hand Strength ; Humans ; Needles ; Pain, Postoperative ; Pinch Strength ; Punctures ; Surveys and Questionnaires ; Skin ; Wrist

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: We evaluated the results of treatment for proximal interphalangeal joint fractures using an external dynamic traction device. MATERIALS AND METHODS: This study included nine patients with a proximal interphalangeal joint fracture. All patients were treated using an external dynamic traction device. At the mean follow-up of 10.1 months, the range of motion of the involved interphalangeal joint was measured. The clinical outcome was evaluated using Steel's scoring method. RESULTS: The average range of motion was 95degrees (range: 75degrees-110degrees). According to Steel's scoring method, three cases showed excellent results, two cases showed good results, and four cases showed fair results. CONCLUSION: The external dynamic traction device is useful and effective in treating proximal interphalangeal joint fractures. It enables reduction by ligamentotaxis and active and passive range of motion in the early stages of treatment.
Fingers ; Follow-Up Studies ; Humans ; Intra-Articular Fractures ; Joints ; Range of Motion, Articular ; Research Design ; Traction