Four Cases of Multiple Epiphyseal Dysplasia in One Family / 대한정형외과학회잡지

The clinical entity of Dysplasia Epiphyseal Multiplex was first descrihed by Fairbank in 1935, characterized by the disturbance of endochondral ossification in hoth epiphyseal centers and regions of physeal growth. It manifests itself radiologically as late appearance and mottling of the ossification centers and clinically as short stature, stubby digits and painful stiffness of multiple joints. It is typically transmitted as an autosomal dominant trait though recessive forms have been described. The spine is normal apart from a mild increased lumbar lordosis. Many patients are referred to an orthopaedic surgeon for bilateral Perthes disease, as was one of the authors cases. This Paper reports four cases of multiple epiphyseal dysplasia which affected one family.

Cartilage Overgrowth of the Femroal Head and Acetabulum in Legg - Calve - Perthes' Disease as Viewed on MRI / 대한정형외과학회잡지

Eighteen patients(19 affected hips and 17 unaffected hips) with Legg-Calve-Perthes' disease(LCP) were reviewed to evaluate the relationship between medial joint space widening and lateral subluxation of the femoral head. MRI was used to evaluate components in widened medial joint space in radiographs. There was increased cartilage thickness of the femoral head and acetabulum and increased joint tluid which represented synovial hypertrophy in the widened medial joint space in radiographs. Increased cartilage thickness was found at the mediai aspect of the femoral head and at the lateral and posterior walls of the acetabulum when compared to unaffected hips and normal control hips. Widening of the medial joint space was related to lateral subluxation of the femoral head during the fragmentation or remodeling stage, not always during the avascular stage, in LCP. Widening of the medial joint space did not change remarkably after a Salter osteotomy or femoral varus derotational osteotomy because of the remaining cartilage thickness.

Cartilage Overgrowth of the Femroal Head and Acetabulum in Legg-Galvé-Perthes' Disease as Viewed on Mri / 대한정형외과학회잡지

Eighteen patients(19 affected hips and 17 unaffected hips) with Legg-Galvé-Perthes' Disease(LCP) were reviewed to evaluate the relationship between medial joint space widening and lateral subluxation of the femoral head. MRI was used to evaluate components in widened medial joint space in radiographs. There was increased cartilage thickness of the femoral head and acetabulum and increased joint fluid which represented synovial hypertrophy in the widened medial joint space in radiographs. Increased cartilage thickness was found at the medial aspect of the femoral head and at the lateral and posterior walls of the acetabulum when compared to unaffected hips and normal control hips. Widening of the medial joing space was related to lateral subluxation of the femoral head during the fragmentation or remodeling stage, not always during the avascular stage, in LCP. Widening of the medial joint space did not change remarkably after a Salter osteotomy or femoral varus derotational osteotomy because of the remaining cartilage thickness.

Proximal Tibiofibular Arthrolysis in High Tibial Osteotomy / 대한정형외과학회잡지

High tibial osteotomy has been widely accepted as a method of treatments for middle-aged varus osteoarthritides with uncompartmental involvements. There have been several reports regarding the managements of fibula and their complications during the valgization procedure of tibia. They are, for example, osteotomy of fibular diaphysis or neck and excision of fibular head. Each level of fibular management is often complicated by nonunison, peroneal nerve palsy and lateral instability respectively. We have reviewed 20 cases of cases of high tibial osteotomy using proximal tibiofibular arthrolysis performed between March 1987 and February 1993. This method has proved excellent exposure of upper lateral tibia for the wedge removal, internal fixation and relief of the tethering effect of fibula. There was no peroneal nerve palsy relate to this degenerative change of the proximal tibiofibular was 3.4mm(range 1-11mm) and there was neither degenerative change of the proximal tibiofibular joint nor varus instability. In conclusion the arthrolysis of proximal tibiofibular joint can be highly recommended in high tibial osteotomy.