Pseudoaneurysm or false aneurysm is one of the late complication of a missed or untreated arterial injury. Most traumatic aneurysms in the extremities are false, and they are usually caused by penetrating trauma. The diagnosis of pseudoaneurysm is suggested by the presence of one or more of the followings: an expanding ill defined mass with or without pulsation, a bruit, pain, paresthesia or paralysis due to nerve compression, an absent peripheral pulse, or signs of ischemia. Although plain radiographs may demonstrate a nonspecific soft tissue mass, arteriography is essential in defining the false aneurysm or aneurysms and differentiating them from other soft-tissue masses. We are reporting the case of a patient who had a false aneurysm of the posterior tibial artery after open fracture of tibial shaft.
Aneurysm ; Aneurysm, False* ; Angiography ; Diagnosis ; Extremities ; Fractures, Open ; Humans ; Ischemia ; Paralysis ; Paresthesia ; Tibial Arteries*

No abstract available.
Congenital Abnormalities* ; Humerus* ; Osteotomy*

No abstract available.
Spine*

No abstract available.
Knee* ; Lipoma*

OBJECTIVE: For the past quarter of a century, the medical treatment of rheumatoid arthritis has been both illustrated and influenced by the therapeutic pyramid. In this plan of sequential drug administration, the initial choice, the base of pyramid, is aspirin or one of the many other NSAIDs. Droxicam, a new NSAID, is a pro-drug of piroxicam and acts by inhibition of PGE2~. Although it belongs to oxicam family, it is characterized by being a pro-drug of piroxicam, the molecule undergoing conversion by hydrolysis once dissolved in the digestive tract. So, its analgesic and anti-inflammatory potentials are the same as those of piroxicam, but G-I trouble, its major adverse effect, is less troublesome. This study was aimed to evaluate the clinical efficacy and safety of Droxicam. METHODS: Thirty three cases of active RA had been selected, 20mg of Droxicam was administrated to them per oral daily for 4 weeks and changes in pain score, numbers of tender/swollen joints, severity of their tenderness/swelling, duration of morning stiffness, grip strength, ESR and side effects of the drug were estimated. RESULTS: l. Pain rated by the patients with visual analogue scale was improved. the average pain score decreased gradually as follows: 7.0 in preadministration, 5.0 in the second weeks of post-treatment and 3.7 in the fourth weeks. 2. The numbers of tender/swollen joints and severity of their tenderness/swelling were gradually decreased after treatment. 3. Average durations of morning stiffness were 70.6 minutes in pre-administration, 67.3 in 2weeks and 59.7 in 4weeks after treatment, and average grip strengths were 45.5, 45.8, and 47,5mmHg in orders. 4. Average ESR decreased after administration : 41.3mm/hour in pre-treatment and 32.3mm/hour in 4weeks after administration. 5. Untoward effects were G-I trouble, edema, dizziness and weight gain. CONCLUSIONS: In summary, Droxicam seems to be useful drug in the treatment of active PA. However, further longterm follow-up is necessary.
Anti-Inflammatory Agents, Non-Steroidal ; Arthritis, Rheumatoid ; Aspirin ; Dizziness ; Edema ; Follow-Up Studies ; Gastrointestinal Tract ; Hand Strength ; Humans ; Hydrolysis ; Joints ; Piroxicam ; Weight Gain

Ipsilateral fractures of the femoral neck and shaft represent many difficulties in diagnosis and treatment. The femoral neck fracture of this injury is commonly missed on initial evaluation. The overlooked femoral neck fracture may lead to higher risk of complications such as avascular necrosis of the femoral head, nonunion and coax vara. The authors reviewed nine cases of ipsilateral femoral neck and shaft fracture treated in our clinic from September 1989 to May 1995, and average follow-up period was 33 months(range, 12 to 101 months). The results obtained were as follows : 1. The most common cause of injury was traffic accident, and three femoral neck fractures were missed initially. 2. The most common site of femoral neck fractures was basicervical in 7 cases, and that of shaft fracture was middle 1/3 shaft in 5 cases. 3. The most common associated injury was ipsilateral knee injury(6 cases). 4. Five cases were treated with femoral reconstruction nail, two with multiple neck-pinning and retrograde interlocking IM nail, one with multiple screws for neck fracture and long dynamic compression plate for shaft fracture, and the other, multiple neck-pinning and antegrade interlocking IM nail. 5. The complications were a refracture of the shaft after removal of interlocking nail and a delayed union of shaft fracture which had been treated by reconstruction nailing. Coxa vara, delayed union and metal loosening were found in femoral neck fracture site, but all that were clinically acceptable. In conclusion, the fracture of femoral neck should be kept in mind not to be lost in case of high velocity-femoral shaft fracture, and if found, it should be treated with anatomical and rigid internal fixation in femoral neck fracture having first priority. Recently reconstruction nail for the treatment of these fractures was widely used, but that is technically difficult and might destroy the neck fracture during shaft fracture fixation. We recommend retrograde interlocking nail followed by multiple neckpinning might be safe and stable fixation for the ipsilateral neck and shaft fracture.
Accidents, Traffic ; Coxa Vara ; Diagnosis ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Fracture Fixation ; Head ; Knee ; Neck ; Necrosis

No abstract available.
Tibial Fractures*

No abstract available.
Tibial Fractures*

Femoral fractures in adults frequently need an extensive dissection for attainment of adequate internal fixation, frequently leading to nonunion, infection and derangement of joint motion. Retrograde IM nailing, compared to the conventional methods, has advantages of reducing periarticular soft tissue dissection and establishing a load sharing construct reducing hardware failure. The purpose of this study is to verify the advantages of retrograde IM nailing by retrospective evaluation of the results of adult femoral fractures treated by this technique. The matrials were 17 femoral fractures in 15 patients treated by retrograde IM nailing and followed up for more than 1 year. The fracture was located in the middle third of the shaft in 5 and distal third in 12. The latter consisted nf 6 cases of type Al, 4 cases of type A2 and 2 cases of type A3 by Miiller's classification. The results were as follows; 1) Fracture union was achieved at an average of 17.5 weeks. 2) Full range of knee motion was gained in 15/17 knees (88%). 3) Complication occurred in 2 knees. One nonunion and one angulatory malunion. 4) There was no infection, no femoral shortening or implant failure. In conclusion, retrograde IM nailing of adult femoral fracture is an effective method in selected cases such as far distal femoral fracture, ipsilateral femur neck and shaft fractures, floating knee, post-TKR femoral fracture and so on. The merits of this technique are rigid fixation which is difficult to obtain with others, no need of fracture table, short operative time and mimium blood loss. However, It has potential problems such as difficulty in insertion of proximal locking screw and need for an arthrotomy to remove hardware.
Adult* ; Classification ; Femoral Fractures ; Femur ; Femur Neck ; Fracture Fixation, Intramedullary* ; Humans ; Joints ; Knee ; Operative Time ; Retrospective Studies

Revision after primary total hip arthroplasty is usually much more difficult than the first time, and the results are typically not as satisfactory as that after most primary total hip arthroplasties. Revision requires more operative time and more blood loss, and there are higher incidences of infection, thromboembolism, dislocation, nerve palsy and perforation/fracture of the femur. The complexities of revision surgery underscore the importance of precise technique when performing primary arthroplasties. Thoughtful and thorough preoperative planning will certainly provides the patient with the best opportunity for long-term success.
Arthroplasty ; Dislocations ; Femur ; Hip ; Humans ; Incidence ; Operative Time ; Paralysis ; Thromboembolism