Purpose: To retrospectively compare the fixation methods for reattaching a trochanteric fragment in a pertrochanteric fracture treated with bipolar hemiarthroplasty. Materials and methods: Forty cases of an unstable femur pertrochanteric fracture were analyzed and followed up for average of 19(6~40) months. There were 18 cases fixed with tension band wiring (group 1), 7 cases treated using modified tension band wiring with K-wires (group 2) and 15 cases treated with the GTRD (Greater Trochanteric Reattachment Device) (group 3). Result: Group 1 was treated with simple a surgical procedure and the results were good. The second group had firm fixation postoperatively but required additional surgery in two cases to remove the K-wires because of wire migration after ambulation. Group 3 had relatively good results but required more dissection and a longer operating time. Conclusion: Tension band wiring or GTRD are good fixation methods for reattaching trochanteric fragments in pertrochanteric fractures. Moreover, tension band wiring is recommended for old osteoporotic patients due to a simple procedure and firm fixation. The use of modified tension band wiring using K-wire or a Steinmann-pin should not be used due to the possibility of distant migration.
Femur* ; Hemiarthroplasty* ; Humans ; Retrospective Studies ; Walking

To control such a hemorrhage, a displaced pelvic ring must be rapidly reduced and stabilized with a pelvic binder, an external fixator, or a pelvic clamp. Among them, pelvic clamps can be life-saving but pin malposition may cause vascular complications. We present a case of superior gluteal artery pseudoaneurysm caused by AO pelvic C-clamp pin malposition.
Aneurysm, False* ; Arteries* ; External Fixators ; Hemorrhage ; Pelvis

The incidence of acetabular fractures in the elderly has increased because of the increasing elderly population. To determine the treatment plan for acetabular fractures, the patient's age, gait ability, presence or absence of osteoporosis and osteoarthritis, underlying disease, and fracture pattern should be considered. The application of total hip arthroplasty for acetabular fractures with the proper indications can be expected to have a good prognosis. In this paper, the application of total hip arthroplasty as a treatment method for acetabular fractures is divided into acute and delayed phases.
Acetabulum ; Aged ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Gait ; Hip ; Humans ; Incidence ; Methods ; Osteoarthritis ; Osteoporosis ; Prognosis

BACKGROUND AND OBJECTIVES: An occult primary tumor is defined as histologic evidence of malignancy in the cervical lymph nodes with no apparent primary site of origin for the metastatic tumor. MATERIALS AND METHODS: Twenty-three patients who have failed to detect primary tumor on their initial physical examinations, endoscopy and other imaging studies, underwent endoscopy-guided biopsy under the general anesthesia. The histologic examination of frozen sections was done in the operation room. For those failing to give results by the histologic study, we performed the ipsilateral tonsillectomy biopsy. RESULTS: Nine primary lesions were identified: four cases of tonsillar fossa, one case each of nasopharynx, base of tongue, hypopharynx, supraglottis, and esophagus. In the three of the four tonsillar cancer cases, the primary foci were also identified by tonsillectomy biopsy. All the patients whose primary foci were tonsillar fossa showed metastasis of the jugulodigastric lymph node. CONCLUSION: Our results indicate that patients who are considered to have occult primary tumor should be evaluated by endoscopy-guided biopsy under the general anesthesia. Also, this study finds that if the histologic result of the frozen section were negative, ipsilateral tonsillectomy can be justified, especially for patients who show metastasis of jugulodigastric cervical lymph node.
Anesthesia, General ; Biopsy* ; Endoscopy ; Esophagus ; Frozen Sections ; Humans ; Hypopharynx ; Lymph Nodes ; Nasopharynx ; Neoplasm Metastasis ; Physical Examination ; Tongue ; Tonsillar Neoplasms ; Tonsillectomy*

PURPOSE: We wanted to analyze the clinical outcomes of prospectively randomized surgeries between internal fixation and hemiarthroplasty for treating unstable intertrochanteric hip fracture in elderly patients. MATERIALS AND METHODS: From January, 2004 to December, 2007, 62 cases of unstable intertrochanteric fracture that underwent internal fixation or hemiarthroplasty were analyzed retrospectively for the clinical outcomes with using the SF-36. Thirty cases were treated with internal fixation and 32 cases were treated with hemiarthroplasty. The clinical outcomes, as assessed by using the SF-36, were statistically analyzed with using SPSS for Windows. RESULTS: Hemiarthroplasty show a better result than internal fixation for pain, limping and the support scales in the 70~79 years old group, and the limping scale was also better in the over 80 years old group (P<0.05). There were no differences between the two groups according to age. Four cases of internal fixation failed due to loss of fixation (3)and nonunion (1), and 4 cases of hemiarthroplasty failed due to infection (2) and revision for dislocation (2). CONCLUSION: Primary hemiarthroplasty should be more beneficial than osteosynthesis, such as performing internal fixation, for treating unstable intertrochanteric fracture in elderly patients because of the reduced pain and early ambulation that are due to the early stabilization.
Aged ; Dislocations ; Early Ambulation ; Hemiarthroplasty ; Hip ; Humans ; Retrospective Studies ; Weights and Measures

Pachydermodactyly is a rare distinct form of fibromatosis characterized by acquired, asymptomatic dense fibrosis and fibroblastic proliferation around one or more proximal interphalangeal joints. Intralesional triamcinolone injection may be helpful in improving the clinical appearance. A 20-year-old unemployed female patient gave a four years history of progressive swelling of the fingers affecting predominantly the proximal interphalangeal joints of index fingers of left hand and index, middle fingers of right hand. There was no pain and tenderness. Physical examination, complete blood count, antinuclear antibody, rheumatoid factor were unremarkable and radiograph of both hands showed soft tissue swelling only without bony abnormality. We excised the redundant soft tissue from the both sides of proximal interphalangeal joint with longitudinal elliptical fashion. After operation, the fingers of the patient showed marked improvement cosmetically. There were no motor or sensory changes. Pachydermodactyly was first reported in 1996 in Korea. Histologic features include an increased dermal accumulation of collagen and occasionally an increased number of fibroblast. We report for one patient with pachydermodactyly treated with longitudinal elliptical excision and obtained an improvement of clinical appearance.
Antibodies, Antinuclear ; Blood Cell Count ; Collagen ; Female ; Fibroblasts ; Fibroma ; Fibrosis ; Fingers ; Hand ; Humans ; Joints ; Korea ; Physical Examination ; Rheumatoid Factor ; Triamcinolone ; Young Adult

The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the sacroiliac joint. This fracture represents a subset of lateral compression injury. The strong posterior ligaments of sacroiliac joint remain intact and a fracture fragment (crescent shape) involving the posterior superior iliac spines remains firmly attached to the sacrum. We report a patient with atypical pelvic crescent fracture that is mainly influenced by vertical shear injury and is characterized by posterior fracture-dislocations of the sacroiliac joint. In this case report, we review the literature on classification and treatment of atypical type of crescent fracture.
Classification ; Dislocations ; Humans ; Ligaments ; Pelvic Bones ; Sacroiliac Joint ; Sacrum ; Spine

The classification of anteroposterior compression (APC) injury type is based on using static radiographs, stress radiographs are known as a useful adjunct in classifying type of APC pelvic injuries. According to a recent article, the intraoperative stress examination has led to a change in the treatment plan in more than 25% of patients on 22 patients presumed APC type I (symphyseal diastasis <2.5 cm) injuries. Here authors present a case demonstrating a necessity of intraoperative stress test for excluding concealed posterior ring disruption.
Cartilage ; Classification ; Exercise Test ; Humans ; Pelvic Bones ; Pubic Symphysis Diastasis ; Sacroiliac Joint*

In unstable pelvic ring injury, if there is damage to both the anterior and posterior, both anterior and posterior fixation will be needed in order to stabilze the pelvic ring. A female patient complained of dyspareunia due to malunion and additional bone bridge at the inferior ramus of the pelvis. She should have undergone both anterior and posterior fixation, but had undergone anterior fixation only. We report on a patient who was treated successfully with resection of additional bone bridge, scar tissue and adhesive band around the vagina.
Adhesives ; Cicatrix ; Dyspareunia* ; Female ; Humans ; Pelvis* ; Vagina

PURPOSE: To evaluate the CT grading of complications developing after endoscopic sphincterotomy (EST), and their clinical course. MATERIALS AND METHODS: We retrospectively evaluated CT in 19 patients in whom pancreatitis or duodenal perforation developed after EST in 594 patients. The CT grading of pancreatitis was classified as mild, moderate or severe, according to the extent of peripancreatic infiltration; duodenal perforation was classified as mild, moderate or severe grade, according to the extent of fluid collection. We attempted to correlate CT grade with the average duration of hospitalization after EST, treatment method and mortality. RESULTS: Post-EST complications detected on CT were pancreatitis (ten patients, 1.7%) and duodenal perforation (nine patients, 1.5%). In those with pancreatitis, hospitalization after EST lasted an average of nine days in mild cases (n=2), 21 days in moderate (n=1) and 41 days in severe (n=7). Nine of ten patients with pancreatitis were treated conservatively, while the other, whose grade was severe, underwent percutaneous drainage. Eight of these ten recovered; the two who died were severe grade patients, one having been treated conservatively and the other by percutaneous drainage. In patients with duodenal perforation, hospitalization after EST lasted an average of 13 days in mild cases (n=2), 16 days in moderate (n=2) and 37 days in severe (n=5). Four of nine patients with duodenal perforation were treated conservatively, while the other five (severe, four; moderate, one) underwent percutaneous drainage. One patient, graded as severe, expired, but the remaining eight rocovered. Percutaneous drainage was performed mostly in severe grade cases, and among patients thus graded, only three (3/594; 0.5%) died. CONCLUSION: CT is considered useful for predicting the clinical course and prognosis of complications occurring after EST.
Drainage ; Hospitalization ; Humans ; Mortality ; Pancreatitis ; Prognosis ; Retrospective Studies ; Sphincterotomy, Endoscopic*