No abstract available.

The ankle joint is a modified complex hinge joint which plays an important role in weight bearing, walking and standing. Hence, the ankle injuries include not only fractures of bone but often also the rupture of ligaments and soft tissues, so if the structures were not accurately repaired, many complications may be developed. The authors have reviewed a series of 70 cases of ankle fractures which were treated in department of orthopaedic surgery of Inha hospital from January 1988 to February 1992. Among the seventy cases, 41 patients (59.4%) were male, and 28 patients (40.6%) were female. Average age was 41.4 years and 3 cases (4.35%) were open fracture. The most common cause was slipping 34 cases (48.6%) and the other causes were traffic accident 23 cases (32.9%), fall from height 6 cases (8.6%), direct blow 5 cases (7.0%) and sports injury 2 cases (2.9%) in order. The rusults obtained form this study were as follows. l. According to the classification fo Lauge-Hansen, the most common fracture mechanism was supination-external rotation injury (24 cases: 34.4%). 2. Among them, 51 cases were treated by operative treatment and 19 cases by conservative treatment. 3. Ten cases (14.3%) in this series were complicated; traumatic arthritis in 7 cases, infection in 2 cases and nonunion 1 case. 4. Open reduction and internal fixation and early anatomical reduction were better than closed reduction and delayed reduction. 5. The incidence of traumatic arthritis occured higher in the cases treated with closed method.
Accidents, Traffic ; Ankle Fractures ; Ankle Injuries ; Ankle Joint ; Ankle ; Arthritis ; Athletic Injuries ; Classification ; Female ; Fractures, Open ; Humans ; Incidence ; Joints ; Ligaments ; Male ; Methods ; Rupture ; Walking ; Weight-Bearing

From July 1989 to February 1993, twelve patients were analysed for infected bone loss which treated with radically debriding all infected dead bone and closed suction-irrigation system with antibiotics and internal lengthening by using the external fixator. The results are summarized as follows. 1, The average time for application of external fixation was 30.7 weeks in tibia, 27 weeks in femur and average time for bone union was 31.5 weeks in femur, 34.2 weeks in tibia. 2. Soft tissue defects were treated with split thickness skin graft in 6 cases, secondary closure in 4 cases, gastrocnemius rotational flap in 2 cases. 3. The length of bone defects after infected bone excision ranged from 2cm to 9.3cm, averaging 4.5cm. The bone defect was treated by internal lengthening after corticotomy with the Ilizarov apparatus in 4 cases, the Orthofix external fixator in 8 cases. 4. Four cases in this series were complicated; one pin tract infection, one angulation deformity, one checkrein deformity, one flexion contracture of knee joint. 5. Infection was managed with radical debriding infected dead bone and closed suction-irrigation system with antibiotics in all cases. 6. We recommend that the infected bone loss can be effectively managed with radically debriding dead bone and closed suction-irrigation system with antibiotics and lengthening with Ilizarov apparatus or Orthofix external fixator.
Anti-Bacterial Agents ; Congenital Abnormalities ; Contracture ; External Fixators ; Femur ; Humans ; Knee Joint ; Skin ; Tibia ; Transplants

No abstract available.
Perfusion*

Popliteal artery entrapment syndrome (PAES) occurs when an abnormal anatomic relationship between the popliteal artery and the surrounding musculotendinous structures causes repeated arterial compression with exercise. The most commonly reported causes of this syndrome have been anomalies of the medial head of the gastrocnemius muscle as it relates to the course of the popliteal artery. PAES can result in calf claudication, aneurysm formation, distal arterial emboli, or popliteal vessel thrombosis. This syndrome is a rare but potentially limb threatening anatomical anomaly occurring predominently in young adults. We experienced two cases who have suffered from a coldness and pain of lower leg. Angiogram and MRI were performed and we diagnosed as a popliteal artery entrapment syndrome. We report two cases of rare anomalous origin of the gastrocnemius muscle in intraoperative findings.
Aneurysm ; Extremities ; Head ; Humans ; Leg ; Magnetic Resonance Imaging ; Muscle, Skeletal* ; Popliteal Artery* ; Thrombosis ; Young Adult

Knotting of a pulmonary artery catheter (PAC) is a rare, but well-known complication of pulmonary artery (PA) catheterization. We report a case of a double-knotted PAC with a large loop in a patient with hepatocellular carcinoma (HCC) undergoing liver transplantation, which has been rarely reported in the literature. A PAC was advanced under pressure wave form guidance. PAC insertion was repeatedly attempted and the PAC was inserted 80 cm deep even though PAC should be normally inserted 45 to 55 cm deep. However, since no wave change was observed, we began deflating and pulling the balloon. At the 30-cm mark, the PAC could no longer be pulled. Fluoroscopy confirmed knotting of the PAC after surgery (The loop-formed PAC was shown in right internal jugular vein); thus, it was removed. For safe PA catheterization, deep insertion or repeated attempts should be avoided when the catheter cannot be easily inserted into the pulmonary artery. If possible, the insertion of PACs can be performed more safely by monitoring the movement of the catheter under fluoroscopy or transesophageal echocardiography.
Carcinoma, Hepatocellular ; Catheterization ; Catheterization, Swan-Ganz ; Catheters* ; Echocardiography, Transesophageal ; Fluoroscopy ; Humans ; Jugular Veins* ; Liver Transplantation ; Pulmonary Artery*

CHARGE syndrome is a rare genetic disorder with CHD7 gene mutation. CHARGE is an acronym for coloboma (C), heart disease (H), atresia of choanae (A), retardation of growth (R), genitourinary malformation (G), and ear abnormalities (E). Patients with CHARGE syndrome need to undergo many surgeries due to their various congenital anomalies. Since airway abnormalities frequently accompany CHARGE syndrome, general anesthesia remains a challenge. Here we report a case of difficult intubation in a 35-month-old boy with CHARGE syndrome during general anesthesia and the experience of successful intubation using D-blade of C-MAC® video laryngoscope.
Airway Management ; Anesthesia, General ; CHARGE Syndrome* ; Child* ; Child, Preschool ; Coloboma ; Ear ; Heart Diseases ; Humans ; Intubation* ; Laryngoscopes* ; Male ; Nasopharynx ; Pediatrics

Arterial dissections usually arise from an intimal tear and can allow the development of an intramural hematoma. Dissection occurs frequently in the aorta or its branches and also occurs commonly in the internal carotid or vertebro-basilar arteries. The condition is rare in the intracranial cerebral arteries, especially above the supraclinoid segment of the internal carotid artery. The diagnosis of arterial dissection used to be made by conventional cerebral angiography. But recently, magnetic resonance imaging (MRI) is helpful to diagnose arterial dissection. We report two cases of middle cerebral arterial dissection using MRI.
Aorta ; Arteries ; Carotid Artery, Internal ; Cerebral Angiography ; Cerebral Arteries ; Diagnosis ; Hematoma ; Magnetic Resonance Imaging* ; Middle Cerebral Artery*

Traumatic dissection of the aorta is a fatal injury that requires rapid diagnosis and treatment. In assessing acute thoracic aortic injury, transesophageal echocardiography (TEE) has recently compared favorably with standard diagnostic modalities such as computed tomography, magnetic resonance imaging and aortography. These latter include time-consuming, contrast injection and the transportation of the patient to another area, requiring the interruption of resuscitative efforts. But, TEE includes less invasive nature, shorter procedure time, no contrast injection, portability at bedside, ability to be done concurrently other procedures such as resuscitation or hemodynamic monitoring and has high sensitivity and specificity for the evaluation of trauma patients with suspected injuries of the thoracic aorta. TEE may be suggested as primary diagnostic modality in suspected traumatic aortic injury in emergency department. We report two cases of traumatic aortic dissection diagnosed early by transesophageal echocardiography in the emergency department.
Aorta ; Aorta, Thoracic ; Aortography ; Diagnosis ; Echocardiography, Transesophageal* ; Emergencies* ; Emergency Service, Hospital* ; Hemodynamics ; Humans ; Magnetic Resonance Imaging ; Resuscitation ; Sensitivity and Specificity ; Transportation

In this case report, we describe the use of ultrasound in the administration regional anesthesia for a super-super obese patient. A 23-year-old female patient (height 167.2 cm, weight 191.5 kg, body mass index 68.6 kg/m²) was admitted to the hospital for surgical repair of an anterior talofibular ligament rupture. We used ultrasound to help facilitate the administration of regional anesthesia. In the sagittal view of the lumbar spine, (with the patient in a sitting position) we were able to identify the border between the sacrum and the lumbar vertebral; in the transverse view, we were able to identify the transverse process, posterior dura, vertebral body, and the distance from the skin to the posterior dura. After skin marking, regional anesthesia was successfully performed. Based on this case study, we suggest that ultrasound can be very useful in regional anesthesia for severely obese patients.
Anesthesia ; Anesthesia, Conduction ; Body Mass Index ; Female ; Humans ; Ligaments ; Obesity ; Rupture ; Sacrum ; Skin ; Spine ; Ultrasonography ; Young Adult