Dislocation of the metacarpophalangeal joint of the finger is rare except thumb. We experienced a case of volar dislocation of little finger and 2 cases of dorsal dislocation of index finger. The mechanism of injury seems to be direct trauma to the dorsum of hand with the metacarpophalangeal joint acutely flexed in volar dislocation and the dorsal dislocation is forced the metacarpophalangeal joint into hyperextension. In 1957, Kaplan advocated the triple incision, that is release of the volar fibrocartilageous plate, the natatory ligament, and the superficial transverse metacarpal ligament, exposing the operation field through a palmar approach. The recommended treatment for such very rare injury is open reduction through nalmar approach in dorsal dislocation, and dorsal approach in volar dislocation; the single most important element preventing reduction is interposition of the volar plate within the joint space in dorsal dislocation and the obstacles of volar dislocation are entraped dorsal capsule and partial ruptured extensor tendon. In dorsal dislocation, we advocated only half release of volar fibrocartilage for lessor trauma of soft tissue and reduction was made easily after release of 1/2 volar fibrocartilage. We report this rare and interesting cases with review of literature.
Dislocations ; Fibrocartilage ; Fingers ; Hand ; Joints ; Ligaments ; Metacarpophalangeal Joint ; Tendons ; Thumb

Stress fractures have been well documented in the lower extremity. Stress fractures of the upper extremities are uncommon. We report a case of an ulna stress fracture in a 32 year old female non-professional golfer.
Female ; Fractures, Stress ; Humans ; Lower Extremity ; Ulna ; Upper Extremity

To determine whether simple curettage is recommendable for the solitary enchondroma of hand, the results of the simple curettage and the curettage with bonegraft were compared in the respects of operation time, the degree of new bone formation, healing time and complications. Thirty five patients have been evaluated to assess the results of treatments. The bone healing and the degree of new bone formation have been evaluated according to the criteria of Tordai (l990). The bone healing had been achieved at average 7.4 months after operation in the simple curettage group and at average 4.6 months in the curettage with bonegraft group (P<0.05). According to Tordai's criteria, among the simple curettage patients, 9 cases (64%) were group I, 5 cases (36%) were group II, no case was group III. Among the curettage with bonegraft patients, 16 cases (76%) were group I, 4 cases (19%) were group II, 1 case (5%) was group III. No significant difference was observed between the two groups in the degree of new bone formation (P=0.05). Although the healing time was longer in the simple curettage group, no significant difference was found in the degree of new bone formation. The pain of the bone donor site was absent in the simple curettage group, and the simple curettage can reduce the operation time. The curettage alone is a recommendable treatment for solitary enchondroma in hand.
Chondroma* ; Curettage* ; Hand* ; Humans ; Osteogenesis ; Tissue Donors

After reconstruction of anterior cruciate ligament, increased idameter of femoral or tibia1 bone tunnel has been obsened on plain radiogram. The etiology of radiographic tunnel enlargement is not well understood and the significance of this tunnel enlargement is unknown. This retrospective study reviewed tibial tunnel diameter in 34 cases of anterior cruciate ligament reconstructions. And we evaluated the correlation between the tibial tunnel enlargement and the position of screw fixation, instability, choice of graft, and clinical results at 1 year postoperatively. AII operation was per formed using a single incision technique. After 3 or 4 months and one year after operation, the diameter of tibial tunnel was measured with digital caliper on the plain radiogram. Tibial tunnel sclerotic margins were measured in the level Of medial tibial plateau on the lateral view of knee. Average tunnel enlargement of 3 allografts was 1.62mm and that of 15 autografts was 2.03mm. No significant difference was seen in KT-10000 arthrometer measurements between enlarged group (amount of enlage-ent >+1 S.D) and not-enlarged group (less than +1 S.D). No coelation was present between the increased tunnel diameter and Lysholm score. Cases with 10mm or more vertical distance between the most proximal point of tihial interference screw and the level of m4eial tibial plateau had average 1.15mm tibial tunnel enlargement and cases with less than 10mm vertical distance ha & I average 2.52mm tibial tunne] enlargement;the difference was not significant (P>0.05). The tibial tunnel enlargement was not correlated with position of screw, clinical results, stability of knee. The tibial tunnel enlargement was not caused hy only mechanical factor such as motion of intra-tunnel portion of graft-tendon.
Allografts ; Anterior Cruciate Ligament* ; Autografts ; Knee ; Retrospective Studies ; Transplants

The original technique for endoscopic anterior cruciate ligament reconstruction has several potential complications because of constraints imposed by working through the tibial tunnel: improper femoral tunnel placement, violation of the femoral tunnel posterior wall, femoral interferenc screw divergence, graft laceration during screw insertion, and distal tibial bone block prr>trusion. We performed 25 endoscopic anterior cruciate ligament reconstructions with bone-tendon-bone graft using a mo3ified technique that minimizes each of these problems, through the use of a anteromedial portal more centrally and distally placed than the original that portal. Postoperative radiographic review showed femoral screw divergence in 20% of cases (2 in the anteroposterior plane, 2 in the lateral plane and 1 in both planes), but the average angles (AP: 0.52+- 1.85, Lateral: 1.48+-3.30) were insignificant. There was no graft damage during screw insertion or grafttunnel mismatch. We concluded that this modified technique allows simplified, reproducible tunnel and interference screw placement.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Knee ; Lacerations ; Transplants

To evaluate the intra-articular pathology of popliteal cysts of knee, we performed arthroscopy on patients with popliteal cysts between February 1992 and February 1995. Thirty-one patients (32 cases) have been treated by excision of cyst after arthroscopy. Mean duration of follow-up was 15 months (13-19 months). Location of cysts was in the right knee in 17 cases, in the left knee in 13 cases, and bilateral in one case. Pain or swelling was present in 12 (38%), giving-way was reported by 4 cases. Three cases revealed quadryceps atrophy. The McMurray test was postive in 6 cases. After arthroscopy, the cysts were excised. Ninteen cases (59%) had associated intra-articular lesions: seven medial meniscal tears, two lateral meniscal tears, seven had chondral damages, one had medial plica syndrome, and one had rheumatoid arthritis, Communication between the cyst and the knee was present in 7 cases (22%), all of whom were over 40 years of age. Thirteen cases was younger than 30 years of age, and 11 cases of these cases had no intra-articular pathology. Two other cases had lateral meniscal tears and medial plica syndrome, respectively. We recommend arthroscopy in middle and older aged patients with popliteal cysts for evaluating and treating intra-articular lesions.
Arthritis, Rheumatoid ; Arthroscopy* ; Atrophy ; Follow-Up Studies ; Humans ; Knee* ; Pathology ; Popliteal Cyst*

Fractures of the shaft of the humerus due to muscle violence esp. from throwing hand grenades are uncommon. Even so there are reports from many authors documenting such fractures from throwing a javerin, baseball, hand grenade and arm wrestling. Fractures of this type are usually spiral in nature; located between the middle and distal third of the humerus. We have treated four such cases during activities in which hand grenades were thrown. These fractures were sustained by military recruits in the Department of Orthopaedic Surgery, Capital Armed Forces General Hospital from Jan. 1980 Dec. 1980.
Arm ; Baseball ; Hand ; Hospitals, General ; Humans ; Humerus ; Military Personnel ; Violence ; Wrestling

Eighty four patients with 104 calcaneal fractures which were treated at the dept. of orthopaedic surgery, Inchon Christian Hospital from October, 1979 to September, 1983 were clinically analysed and the results were as follows; 1. 72 patients were male and 12 patients were female. The male were more injuried in the ratio of 6:l. 2. Their ages were ranged from 6 yrs. to 66 yrs. (average; 35.4 yrs.) and the half of the patients were occured at the 3rd and 4th decade. They admitted for average 7.6/7 weeks. 3. The main cause was a fall from a height in 62 patients (73.8%) and its average height was 4.5m. 4. The open fractures were occured in 13 feet (12.5%) and the spine fracture was associated in 16 patient (19%). 5. The 104 cases were classified according to the Rowe and Essex-Lopresti classification. Fractures involving subtalar joint were 74 feet (71.2%) and the Rowes type V were 58 feet(55.8%). 6. The 22 cases were treated by elosed reduction and axial pin fixation, 10 cases were treated by open reduction and the subtalar fusion was done at 2 cases. Others were treated by cast immobilization with or without closed reduction. The satisfactory result was obtained in 64 cases(61.5%). 7. The most common problem after any treatment was persistent foot pain, especially beneath the lateral malleolus.
Calcaneus ; Classification ; Clinical Study ; Female ; Foot ; Fractures, Open ; Humans ; Immobilization ; Incheon ; Male ; Spine ; Subtalar Joint

The bone formation of periarticular connective tissue after head injury and total hip arthroplasty is included in the category of heterotopic ossification. Induction of a new bone formation in the soft tissue is related to various materials such as bone morphogenic protein. The alkaline phosphatase and acid phosphatase act as important factors in the formation and absorption of the bone. The acid phospatase has the important function of acting as the control with specific activity of phosphatase in vivo. Cholecalciferol induces absorption of the calcium in the alimentary tract and bone resorption and increment of bone calcification, whereas disodium etidronate inhibits the deposition and dissolution of calcium salt and formation of heterotopic bone. This paper reports on the relationship of alkaline phosphatase and various phosphoaminoacid phosphatase which affect the cellular differentiation and remodelling in the heterotopic ossification, with the effect of cholecalciferol and disodium etidronate on the heterotopic bone induction in rats. The following results were obtained: 1. The contents of the calcium in the implanted bone matrix increased markedly from two to five weeks. There was no changes in the calcium content by cholecalciferol or in the administration of small doses of disodium etidronate (5mg/kg). However, in the administration of large dose of disodium etidronate (25mg/kg), calcium mobilization was totally suppressed for the whole period of the experiment. 2. The protein content in the implanted bone matrix did not much change for the whole period of the experiment and the administratinn of cholecalciferol or disodium etidronate also had no effect on the protein content. 3. The activities of alkaline phosphatase in the implanted bone matrix peaked at two weeks in control or cholecalciferol group, whereas disodium etidronate admninstration caused the highest activity in the third week. 4. The activity of acid phosphatase in the implanted bone matrix increased in first and third weeks by cholecalciferol treatment. Disoidum etidronate inhibited the activity of the acid phosphatase in the first, fourth & sixth weeks of implantation. 5. The activity of phosphoserine phosphatase increased due to cholecalciferol treatment, but was significantly inhibited by disodium etidronate (25mg/kg) treatment. 6. The activity of phosphothreonine phosphatase in the implanted bone matrix slightly increased due to cholecalciferol treatment, whereas the activity decreased significantly for the whole period of the experiment by disodium etidronate (25mg/kg) treatment. 7. The activity of phosphotyrosine phosphatase in the implanted bone matrix was not change much for the whole period of the experiment and the administration of cholecalciferol or disodium etidronate had no effect on the activity of phosphotyrosine phosphatase. In conclusion, the disodium etidronate (25mg/kg) almost completely inhibited the molilization of calcium and the activities of acid phosphatase, phosphoserine and phosphothreonine phosphatases. Therefore, it can be suggested that the above phosphatases are closely related to the action mechanism of disodium etidronate.
Absorption ; Acid Phosphatase ; Alkaline Phosphatase ; Animals ; Arthroplasty, Replacement, Hip ; Bone Matrix ; Bone Resorption ; Calcium ; Cholecalciferol ; Connective Tissue ; Craniocerebral Trauma ; Etidronic Acid ; Ossification, Heterotopic ; Osteogenesis ; Phosphoric Monoester Hydrolases ; Phosphoserine ; Phosphothreonine ; Protein Tyrosine Phosphatases ; Rats

In our review of 36 hematogenous osteomyelitis nine cases were subacute form. Distal tibia was the most commonly involved location(four of nine patients). According to the modified Robert's classification cross-physeal lesions were the most common type(four of nine patients). In most of the cases the clinical findings and laboratory data were not much helpful for current diagnosis. Four patients had radiographic findings similar to those of tumors such as Ewing' s sarcoma, osteoid osteoma or bone cyst. Magnetic resonance imaging was useful in the identification of early lesions. In three patients Staphylococcus aureus was isolated by bacterial culture of biopsy specimen. In the remaining six patients diagnosis was made by histological evaluation. All patients except one were treated by curettage and antibiotics. In the other patient the disease showed a tendency of spontaneous healing without operative intervention and antibiotics. Cross-physeal lesion seemed to be a typical finding of the subacute osteomyelitis.
Anti-Bacterial Agents ; Biopsy ; Bone Cysts ; Child ; Classification ; Curettage ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Osteoma, Osteoid ; Osteomyelitis ; Retrospective Studies ; Sarcoma ; Staphylococcus aureus ; Tibia