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Shiunko is a traditional botanic formula (ointment) which is used clinically for the treatment of wounded skin caused by cuts, abrasions, frost or burn. The aim of this study was to evaluate the effect of Shiunko on epithelization of wounded skin. Experimental cutting wounds on the back skin of Sprague-Dawley rats were induced. Different bacterial inoculations (Pseudomonus aeruginosa and Staphylococcus aureus) and treatment (Shiunko, Povidone-iodine and saline) were arranged herein. The incidences of infection and the speed of epithelization were evaluated. We observed that the incidences of wound infection following Pseudomonas aeruginosa inoculation were lower on both the Shiunko-treated group (0%, p<0.01) and Povidine-iodine-treated group (5%, p<0.05), than the saline-treated group (40%). The Shiunko-treated group reported higher percentages of complete epithelization not only on the sterilized wounds (100%) but also on the contaminated wounds (90%) when compared to the saline-treated group (60% sterilized wounds, 40% and 50% contaminated wounds) on day 7 (p<0.01). Povidone-iodine did not promote epithelization of wounded skin, whereas Shiunko did.

Fibro-osseous pseudotumor of digits (FOPD) is an uncommon histological diagnosis. Clinical and imaging findings may resemble high-grade sarcoma or infection. We describe a patient with progressive pain and swelling at the dorsal surface of the first web space. MRI and CT imaging revealed an intramuscular heterogenous soft tissue mass defined by a mineralized peripheral ring. Core needle biopsy diagnosed FOPD. Eight months later a matured ossified nodule that was quite smaller than the initial soft tissue mass was excised. The patient is symptom free without local recurrence at 1 year follow up. Soft tissue masses of the hand pose a challenging diagnostic and therapeutic issue. An in depth interpretation of clinical, imaging and histology findings is important to avoid erroneous diagnosis and treatment.

Acute carpal tunnel syndrome is an orthopaedic emergency that requires prompt surgical treatment. We describe two rare cases of this condition, one secondary to pyogenic infection and one secondary to prolonged pressure on the upper limb brought on by overdose.

Vibrio vulnificus may cause severe soft tissue infections of the upper extremity. This pathogen usually gains access to soft tissues either by direct inoculation through a penetrating injury by an infected marine animal or by exposing abraded skin to contaminated water. We report five patients with Vibrio vulnificus hand infections following superficial hand injuries incurred within 24 hours after uneventful handling of fish. This clinical observation, together with the fact that the physiologic characteristics of human sweat simulate the natural environment of the Vibrio vulnificus, support the assumption that human skin may serve as a reservoir for Vibrios. The anamnesis in patients presenting with hand infection should essentially include an inquiry regarding recent, albeit uneventful, fish handling.

A case of a 35-year-old male with necrotizing fasciitis of the hand is presented. Clinical manifestations of necrotizing fasciitis are discussed and intraoperative findings are highlighted to illustrate the disease process that initially affects the deep layer of the superficial fascia.

Penetrating sea urchin spine injuries, can lead to devastating, irreversible consequences. Persistent inflammation, cutaneous granuloma, neuroma, tenosynovitis, arthritis and destructive arthritis, leading to permanent loss of function and digit amputation, can occur. We present a case of a patient who developed sea urchin spine arthritis of the proximal interphalangeal joint. Only 17 cases of sea urchin spine arthritis of the hand have been documented in the medical literature. However, in this case, the article also includes sequential radiographs, histopathological slides, and intra-operative photographs.

Background: Total Elbow Arthroplasty (TEA) for the rheumatoid arthritis (RA) has been popularized since 1980s. The outcomes of TEA using any type of implant design for RA has been satisfactory. On the other hand, many orthopedicians experience several postoperative complications. Among them, postoperative infection has still being the most troublesome and difficult to treat. This study is to clarify the causes of postoperative infection of TEA using Kudo’s prosthesis for RA and discuss how to manage and prevent infection.

Methods: 421 TEAs were performed for 405 cases with RA at the authors’ institute during the period between 1982 and 2007. They were followed up for 1~25 years (Av. 12.3 years). The authors examined pain, the range of motion, roentgenograms and complications postoperatively. We were able to start treatment within 4 weeks after occurrence of infection. For surgical management of infected TEAs, debridement of the synovium and removal of the prosthesis with loosening were performed for all cases. In addition, all cases have been regularly and strictly followed-up with the elbow protector to prevent recurrence of infection since 2008.

Results: There were 98 TEAs with the postoperative complications (23.3%). Eight out of 98 TEAs were infected (1.9%). Five of eight infected TEAs were primarily at the surgical scar site infection (SSSI) (60%), unknown causes in two, hematogenous course in 1. It’s obvious that surgical scar site infection (SSSI) was the leading cause of postoperative infection in this study. Thus, the authors made the elbow proctor to avoid injuries of the skin around surgical scar site (SSS). Since 2008, all of the TEAs and revised TEAs have been applied with this protector.

Conclusions: The authors reported 8 infected TEAs: 5 cases were revised, 2 with the brace, 1 had above the elbow amputated. The regular and meticulous follow up and application of the elbow protector were useful to prevent infection of post-TEAs using Kudo’s prosthesis in RA. Since 2008, there have been no infection of post TEAs and revised TEAs.

One of the serious complications of Seymour fractures is infection. A 24-year-old male presented with the open infected distal phalanx fracture of the middle finger. Wound debridement, irrigation, use of antibiotics and external fixation with the aid of mini-Ilizarov provided a resolution to the infectious process and enabled us to achieve a stable osseous union in correct position.