Analysis of the Disposal Rate of Fresh Frozen Femoral Head in the Bone Bank of a Single Hospital / 대한정형외과학회잡지

Purpose@#This study analyzed the increase in disposal rate of femoral heads in the bone bank of a single hospital from medical disease and drug history, as assessed by the Korean health insurance review and assessment service. @*Materials and Methods@#The disposal rate and cause of 340 femoral heads were analyzed according to the regulations of the bone bank based on the standard model of the Ministry of food and drug safety. @*Results@#One hundred and seven (33%) of 323 femoral heads collected from 2009 to 2018, and 65 (46%) of 142 femoral heads collected from 2015 to 2018 were discarded. The most common causes were related to the history of dementia and the administration of radioisotope for nuclear medicine. @*Conclusion@#The current methods and screening tools can lead to errors in disposing of the available tissues in a bone bank. Thus, improved standards and screening methods are needed.

The Frequency of Occult Intertrochanteric Fractures among Individuals with Isolated Greater Trochanteric Fractures / 대한고관절학회지

PURPOSE: Isolated greater trochanteric (GT) fractures are often identified using plain radiography of patients with post-traumatic hip pain. In many cases, the fracture extends to form an occult intertrochanteric fracture. We conducted a study to determine the frequency of occult intertrochanteric fractures in patients diagnosed with isolated GT fractures using plain radiographs. MATERIALS AND METHODS: Among 3,017 individuals who visited our emergency department with a trauma-induced pertrochanteric femur fracture between July 2004 and March 2018, 100 patients diagnosed with isolated GT fractures using plain radiographs were retrospectively analyzed. Patients were divided into two groups, those with: i) isolated GT fractures (group A) and ii) occult intertrochanteric fractures (group B). In addition, plain radiographs, magnetic resonance imaging results, and treatment methods were further analyzed in each group. If surgery treatment was needed, it was performed by one surgeon, and in all cases, a 2-hole dynamic hip screw was used. RESULTS: Among the 100 cases of isolated GT fractures diagnosed using plain radiograph, additional examinations revealed that 10 (10.0%) were suffering from isolated GT fractures alone, while the remaining 90 (90.0%) were further diagnosed with occult intertrochanteric fracture. Gender, age, mechanism of injury, and bone mineral density did not correlate with fracture type. CONCLUSION: In our analysis, 90% of injuries initially diagnosed as isolated GT fractures were found to extend into occult intertrochanteric fractures upon further examination with additional imaging modalities. Therefore, additional evaluation should be performed to test for the potential presence of occult intertrochanteric fractures and to establish appropriate treatment plans.

Treatment of Proximal Femur Osteomyelitis Occurred after Proximal Femoral Nail Antirotation Fixation, with Antibiotic Cement-coated Tibia Intramedullary Nail: A Case Report / 대한고관절학회지

Antibiotic cement-coated intramedullary nails maintain a locally high antibiotic concentration while contributing to bone stability. We present a case of femoral subtrochanteric fracture in a patient with an infected nonunion who was successfully treated for an infection and nonunion using an antibiotic cement-coated tibial intramedullary nail. A 79-year-old woman with a right femoral subtrochanteric fracture underwent internal fixation using proximal femoral nail antirotation (PFNA). She developed osteomyelitis with nonunion at the surgical site 10 months postoperatively. We decided to insert an antibiotic cement-coated tibial intramedullary nail. After coating the nail with bone cement mixed with antibiotics, bone fixation was achieved by inserting the nail at the site of the PFNA. The patient's symptoms improved, symptoms from the infection disappeared, and bone union was confirmed. Osteomyelitis occurred because of postoperative infection following a proximal femoral fracture. Antibiotic cement-coated tibial intramedullary nails are an effective option to treat patients with osteomyelitis of the femur and achieve bone union where nonunion persists with shallow a intramedullary femoral canal.

Cementless Total Hip Arthroplasty Using Dual Offset Titanium Tapered Stem: At Least 7-Year Follow-Up / 대한정형외과학회잡지

PURPOSE: The purpose of current study is to evaluate the midterm results of cementless primary total hip arthroplasty (THA) using a dual offset titanium tapered stem. MATERIALS AND METHODS: A retrospective analysis of 102 cases (84 patients), with a minimum of 7-year clinical follow-up, was performed. All of the cases consisted of patients who underwent primary cementless THA, using a dual offset titanium tapered stem in The Catholic University of Korea, Bucheon St. Mary's Hospital between July 2004 and May 2009. Clinical results were analyzed via the Harris hip score, level of thigh pain, squeaking around hip joint, and complication rate. Radiologic results were examined with stability and location of inserted prosthesis, hypertrophy of femoral cortex, and osteolysis. RESULTS: Out of the 102 cases (84 patients; 47 males and 37 females), with the mean age of 55.9 years (range, 27–79 years) and mean follow-up period of 99.2 months (range, 84–132 months). The mean Harris hip score was 53.8 preoperatively (range, 26–75) and improved to 93.5 postoperatively (range, 74–100) (p=0.000). All of the cases gained stable bony fixation on the final follow-up, including 2 cases of intra-operative proximal femur fracture. Calcar remodeling was observed in 94 cases, however, they were irrelevant with stem stability. Cortical hypertrophy of femur was seen in 12 cases and thigh pain in 4 cases; nonetheless, they were not relevant (p=0.067). There was 1 case of squeaking sound during joint movement. Hip dislocation occurred in 1 case early after the procedure, but the event was due to excessive anteversion of the acetabular cup, in which a revisional replacement procedure of the acetabular cup was conducted. No sign of ceramic breakage was observed. There were 2 cases of heterotrophic ossification. CONCLUSION: Results from a 7-year follow-up of cementless THA using dual offset titanium tapered stem were encouraging in both clinical and radiologic evaluations.

Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients

PURPOSE: The purpose of this study is to evaluate the postoperative outcomes of elderly patients with stable 2-part intertrochanteric femur fractures surgically treated using dynamic hip screw with 2-hole side plate. MATERIALS AND METHODS: From February 2008 to January 2014, 50 patients older than the age of 65 years, who had been followed-up for more than 6 months after the operation at The Catholic University of Korea, Bucheon St. Mary's Hospital were enrolled. A clinical evaluation of the skin incision length, operating time, and ambulatory status, using Clawson's Ambulation Capacity Classification, was performed, and a radiologic evaluation of Fogagnolo reduction quality, tip-apex distance (TAD), Cleveland index, sliding extent of lag screws, time duration till bony union, and complications was also done. RESULTS: The mean skin incision length was 9.8 cm (range, 8-13 cm), the mean operating time was 41.4 minutes (range, 30-60 minutes), and 32 patients recovered their ambulatory function. Forty-eight patients gained bony union, and the time lapsed till union was average 10.6 weeks (range, 8-16 weeks). The evaluation of postoperative radiologic images showed the following reduction statuses by the Fogagnolo classification: 46 cases of "Good", 3 cases of "Acceptable," and 1 case of "Poor." Moreover, the mean TAD was 18.9 mm (range, 9.0-24.9 mm). While 45 cases fit into the zone 5 of the Cleveland index, other 3 were within zone 8 and the other 2 were within zone 6. The mean sliding length of the lag screws were 4.9 mm (range, 0.1-19.4 mm). There were a case of nonunion and a case of periprosthetic infection with nonunion as complications. CONCLUSION: Using dynamic hip screws with 2-hole side plate for stable 2-part intertrochanteric femur fractures in elderly patients showed satisfactory results with respect to the recovery of ambulatory functions and bony union.

Comparison of Perioperative Blood Loss in Primary Non-cemented Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis and Osteonecrosis of the Femoral Head / 대한고관절학회지

PURPOSE: The purpose of this study is to compare the perioperative blood loss in primary non-cemented total hip arthroplasty (THA) performed for rapidly destructive coxarthrosis (RDC) with the perioperative blood loss in primary non-cemented THA for typical osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS: From January 2000 to December 2013, 19 patients were diagnosed with RDC (group 1) and 40 patients were diagnosed typical Ficat stage IV ONFH (group 2), comparison of perioperative blood loss between group 1 and group 2 in primary noncemented THA was done. Patients with preoperative usage of steroid or anticoagulants medication and with hemodynamic abnormal blood test results were excluded. The blood loss was measured up to the fifth post operation day and calculated with formula proposed by Mercuriali, Inghilleri and Nadler. RESULTS: Non-compensated blood loss calculated in milliliters of red blood cells was 362 mL (standard deviation [SD], 187; range, 77-675) in group 1 and 180 mL (SD, 145; range, 53-519) in group 2. Compensated blood loss was 630 mL (SD, 180; range, 380-760) in group 1 and 503 mL (SD, 260; range, 190-1, 505) in group 2. The total blood loss after primary non-cemented THA is greater when surgery is performed for RDC than for ONFH, with the volume of 992 mL (SD, 300; range, 457-1, 434) in group 1 and 683 mL (SD, 360; range, 226-1, 975) in group 2 respectively. CONCLUSION: Total perioperative blood loss was significantly greater in RDC than in ONFH in primary non-cemented THA.

Incidence and Risk Factors of Subsequent Hip Fractures in Korea: Multicenter Study

This study analyzes the incidence of subsequent hip fractures and its risk factors in the northwestern region of Korea. We analyzed hip fracture patients who visited any of the 5 teaching hospitals in the Bucheon and Incheon area from January 2000 to December 2010. Medical records were reviewed and presence of subsequent hip fractures, alcohol history, marital status, live in solitude, dementia, dizziness, American society of anesthesiologists score, osteoporosis treatment after fracture, body mass index (BMI) and initial bone mineral density were analyzed. The average follow-up period was 12 months (range 1-130 months). A total of 2,546 patients (women 1,770, men 776) who had experienced hip fractures were included. Of these, subsequent hip fractures were found in 233 patients (9.2%) (women 187, men 46). Mean age at the time of the first fracture was 79.2 yr old (range 50-100 yr). The average interval between the first fracture and the subsequent hip fractures was 30.2 months (range 4 days-154 months). In this large-scale, retrospective, multicenter study, overall incidence of subsequent hip fractures is 9.2%. Independent risk factors of subsequent fracture are women, BMI<22 kg/m2, and being unmarried.

Comparative Analysis of Two Cementless Stems in Total Hip Arthroplasties in Patients with Osteonecrosis of Femoral Head: Summit(R) Stem and Bencox(R) Stem

PURPOSE: We compared the clinical and radiological outcomes of total hip arthroplasty (THR) using Summit and Bencox stems. MATERIALS AND METHODS: The patients who underwent cementless total hip arthroplasty were recruited with a satisfactory condition of a minimum three years of follow-ups after THR. Those patients were divided into two groups, those with Summit stems and those with Bencox stems. Summit stems were in 36 patients(40 hips), and Bencox stems in 36 patients(48 hips). Summit and Bencox stems had 78 months and 42.2 months as a mean follow-up, respectively. The clinical and radiological evaluations of femoral components were performed. RESULTS: There was no difference in clinical results between the two groups. Under the radiological findings, there were no osteolytic changes or loosening. Osseointegration was detected at an average of 6.4 months(3-12 months) in the Bencox stem on the distal portion of the femoral stem, and cortical hypertrophy was detected on 6 hips with a Summit stem. CONCLUSION: The clinical and radiological evaluations in both systems showed excellent outcomes at the three year follow-ups, and there was no statistical difference on the clinical and radiological results between the two groups. Thigh pain and cortical hypertrophy were not detected in the Bencox stem, and that wound would be caused by surface treatment methods of the femoral stem, and morphological differences.

Development of Korean Academy of Medical Sciences Guideline Rating the Physical Impairment: Lower Extremities

Lower Extremities Committee of Korean Academy of Medical Sciences Guideline for Impairment Rating develops new guidelines which are based on McBride method, American Medical Association Guides, Disability evaluation by The Korean Orthopaedic Association, The Korean Neurosurgery Society, and Korean Academy of Rehabilitation Medicine. The committee analyzed and discussed to create an ideal method practical in Korea. Our committee endeavors to develop new methods which are easy to use, but are suitable for professional use and also independent from the examinee's intentions. The lower extremities are evaluated on the basis of anatomic change, functional change, and diagnosis based evaluation. Nine methods are used to assess the lower extremities. Anatomic assessment includes leg length discrepancy, ankylosis, amputation, skin loss, peripheral nerve injury, and vascular disease. In functional assessment, range of motion and muscle strength are included. Diagnosis-based assessments are used to evaluate impairment caused by specific fractures, deformities, ligament instability, meniscectomies, post-traumatic arthritis, fusion of the foot, and lower extremity joint replacements.

Insufficiency Stress Fractures of the Femoral Neck in Elderly Patients

PURPOSE: We wanted to compare the insufficiency stress fractures of the femoral neck (group I) with the traumatic femoral neck fractures (group II) in patients who were 70 years of age and older. MATERIALS AND METHODS: Between January 2000 and October 2006, we evaluated 10 insufficiency stress fractures among 191 femoral neck fractures in patients who were 70 years of age and older. We compared these fractures with the traumatic femoral neck fractures by using the bone mineral density (BMD), neck-shaft angle, the hip axis length (HAL) and the ratio of the HAL to the femoral neck width. RESULTS: The incidence of insufficiency stress fracture was 5.2%. There were 6 cases of displaced fractures and 4 cases of non-displaced fractures. All of non-displaced fractures revealed the tension (transverse) type. The mean neck-shaft angle was 130.45 degrees in group I and this was 131.94 degrees in group II. The mean HAL was 117.6 mm in group I and 115.3 mm in group II, and the ratio of the HAL to the femoral neck width was 0.30 in each group. The BMD (T-score) was -3.73 in group I and -3.4 in group II. CONCLUSION: The BMD of the insufficiency fracture group was significantly lower than that of the traumatic femoral neck fracture group. However, there were no significant differences in the neck-shaft angle, the HAL and the ratio of the HAL to femoral the neck width between the 2 groups.

Soft Tissue Disease around the Hip

Hip pain is a common but nonspecific symptom that has many etiologies. Due to the complex anatomy of the hip and pelvis, locating the exact origin of pain may be difficult. Soft tissue diseases around the hip are relatively rare and their clinical symptoms are often nonspecific. For such patients, it is necessary to understand various hip diseases, and do proper history taking and examination to correctly diagnose and treat soft tissue diseases of the hip. Advances in imaging studies such as MRI and ultrasonography can provide accurate information on soft tissues. This article reviews the soft tissue diseases of the hip that are experienced by clinics. It may be helpful in the differential diagnosis of hip pain arising from soft tissue structures and in the treatment of such diseases.

Short Term Results of Cementation of a Polyethylene Liner into a Well-Fixed Metal Shell

PURPOSE: To evaluate the radiological and clinical results of cementation of a polyethylene liner into a well-fixed metal shell in revision total hip arthroplasty. MATERIALS AND METHODS: From November 2001 to April 2006, 11 cases (10 patients) were included in this study. There were 5 males (6 cases) and 5 females with a mean age of 54.3 years. The mean follow-up period was 35.2 months. The acetabular shells were stable and their position was acceptable in all cases. Pre-existing screws were removed and screw holes were filled with allogenic bone. The inner surface of the metal shells and convex backside of the liners were roughened with a burr. The clinical results were evaluated using the Harris hip score (HHS) and the radiological results with evidence of a positional change in the acetabular cup and liner, and the progression of osteolysis around the cup. RESULTS: The mean HHS was 69.5 points preoperatively and 89.2 at the last follow up. There was no change in the cup and liner position or progression of the osteolytic lesion around the femoral or acetabular components. CONCLUSION: Cementation of a polyethylene liner into a well-fixed metal shell showed satisfactory results in revisional total hip arthroplasty with a short term follow-up period.

Comparison of the Results between Distal Chevron Osteotomy and Proximal Metatarsal Osteotomy for the Treatment of Moderate Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the treatment outcomes of distal chevron osteotomy with those of proximal metatarsal closing wedge osteotomy in patients with moderate severity hallux valgus. MATERIALS AND METHODS: Forty-two patients (51 feet) who were underwent either distal chevron osteotomy (Group I, 22 patients, 27 feet) or proximal metatarsal closing wedge osteotomy (Group II, 20 patients, 24 feet) for the correction of moderate hallux valgus deformity were evaluated retrospectively. We assessed the radiographic results with several parameters including hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). And clinical results with modified AOFAS score at last follow-up. RESULTS: There were no significant differences in IMA, HVA and DMAA between two groups preoperatively. We can achieve the good results with both procedures, but mean HVA and IMA of group II was significantly lower than those of group I. There was some loss of correction in group I at the last follow-up. There was no significant difference in clinical results according to modified AOFAS scoring between two groups at the last follow-up. CONCLUSION: The proximal metatarsal closing wedge osteotomy for the hallux valgus with moderate severity is better treatment option to achieve better radiographic correction and to prevent loss of correction or recurrence than distal chevron osteotomy.

Distal Transfer of Greater Trochanter in Patients with High-Standing Greater Trochanter by Legg-Calve-Perthes (LCP) Sequelae

PURPOSE: To evaluate the clinical and radiological results of distal transfer of the greater trochanter in patients with a high-standing greater trochanter as a sequela of LCP disease. MATERIALS AND METHODS: Between 1994 and 2005, ten cases (nine patients) underwent distal transfer of a highstanding greater trochanter and were followed up for more than 2 years after surgery. The clinical findings, such as the abduction of the hip, VAS score, and Trendelenburg sign, were evaluated. In addition, the centrotrochanteric distance (CTD) and Lever arm ratio (LAR) were used for the radiographic assessment. RESULTS: The mean range of abduction improved from 27.5degrees to 40degrees , and the VAS score improved from 4.1 to 1.2. Seven cases with positive Trendelenburg sign before surgery showed negative Trendelenburg sign after the surgery. At the last follow-up, the CTD improved from -1.52 cm to -0.2 cm and the LAR decreased from 2.2 to 1.8. CONCLUSION: The distal transfer of the greater trochanter in patients with a high standing greater trochanter as a consequence of LCP is an effective procedure that can reduce the level of hip pain and improve the hip abduction if careful patient selection is performed.

Free Vascularized Fibular Grafts for Treatment of Infected Nonunion of the Tibia

PURPOSE: To analyze the result of free vascularized fibular grafting for treatment of infected nonunion of the tibia with radical bone and soft tissue defect. MATERIALS AND METHODS: 17 patients with infected nonunion of the tibia who underwent a reconstruction using free vascularized fibular grafting were reviewed retrospectively. The mean follow-up period was 70.3 months. We analyzed the results radiographically which included the time of bone union, the amount of hypertrophy of grafted bone and complications. RESULTS: The average length of bone defect was 8.8 cm (5~15 cm), and the average length of fibular graft was 14.1 cm (10~17.5 cm). Bony union was achieved in 11 of 17 cases and the average time of bone union was 5.2 months (4~6 months). There were 6 cases of nonunion. All nonunions developed at the proximal end of graft in patients who underwent fixation using pin and external fixator. Union was eventually achieved in all cases in 6.0 months (5~8 months) after the cancellous bone graft and plate internal fixation. Hypertrophy of grafted bones with more than 20% developed only in 4 cases out of 17. There were 3 cases of stress fracture, however there was no recurrence of infection or serious donor site morbidity. CONCLUSION: Free vascularized fibula grafting is one of the most effective reconstruction options for the infected nonunion of the tibia with radical bone and soft tissue defect. Strong internal fixation using plate and screws is required to reduce the rate of nonunion and stress fracture of grafted fibulas.

Treatment of Subtrochanteric Fractures with Compression Hip Screw

PURPOSE: To evaluate the effectiveness of the compression hip screw, we reviewed the clinical results of cases of femoral subtrochanteric fracture which were treated with compression hip screw. MATERIALS AND METHODS: From May 1997 to June 2004, 20 cases of femoral subtrochanteric fracture, which were treated with compression hip screw and followed up more than 12 months, were reviewed. By the Seinsheimer's classification, there were 1 case of type IIa, 4 cases of type IIb, 2 cases of type IIIa and IIIb, 4 cases of type IV and 7 cases of V. We analyzed the treatment results by bony union time, range of motion, ambulation status and complications. RESULTS: All 20 cases were gained bony union without serious complications and secondary operation. The average bony union time was 19.8 weeks. 17 of 20 cases were recovered pre-injury ambulatory status level. CONCLUSION: The compression hip screw may be effective in treatment of the femoral subtrochanteric fracture with very narrow intramedullary canal, proximal femoral deformity, comminuted fracture with large butterfly fragment, long spiral fracture with medial cortical comminution and combined intertrochanteric fracture.

Juvenile Lumbar Intervertebral Disc Herniation: Five Cases Report / 대한정형외과학회잡지

Lumbar intervertebal disc herniation is common in the fourth to fifth decades because the intervertebral disc undergoes degenerative change. However juvenile lumbar intervertebal disc herniation (under 12 years old) is rare because there is no degenerative change, and the clinical symptoms and treatments are different from those of adults. Herein, our experience of five juvenile lumbar intervertebal disc herniation cases are analyzed and reported.

Clinical Comparison of Ankle Fractures Between the Young and the Elderly / 대한족부족관절학회지

PURPOSE: We compared the clinical features of the ankle fractures treated by operation between the elderly and the young, and reviewed the principles of treatment of the ankle fractures in the elderly. MATERIALS AND METHODS: We reviewed 49 cases of the ankle fractures, which were treated by open reduction from August 1991 to July 2002. Patients aged more than 60 were designated as the elderly, and patients aged between 15 and 33 were designated as the young. The average follow-up period was 13.2 months. Using the Lauge-Hansen classification, We defined stage I or II fractures as low stage and stage III or IV fractures as high stage fractures. RESULTS: There were 15 cases of high stage fractures (78.9%) in the elderly and 11 cases (36.7%) in the young. High stage fracture rate was significantly higher in the elderly (P=0.004). Hospital day, period between primary injury and operation, and union time were significantly longer in the elderly (P<0.001). However, there was no statistical difference in immobilization time between the two groups. The results of treatment were satisfactory clinically and radiologically by the Meyer's criteria in both groups. CONCLUSION: In the elderly, high stage fractures were more common and longer hospitalization and union time were needed than the young. However, the result of surgical treatment was satisfactory.

Expression of RANKL/OPG in Joint Fluids of Periprosthetic Osteolysis / 대한정형외과학회잡지

PURPOSE: This study evaluated the expression level of Receptor Activator of NF-kappaB Ligand (RANKL), Osteoprotegerin (OPG)and other pro-inflammatory cytokines in the osteoarthritic and periprosthetic joint fluid in order to characterize the role of these regulatory proteins in periprosthetic osteolysis. MATERIALS AND METHODS: Joint fluid specimens taken from 47 patients undergoing hip or knee reconstructive surgery were analyzed by enzyme-linked immunoassay (ELISA)in order to determine the relative protein expression level of RANKL, OPG, IL-1beta, IL-6 and TNF-alpha. The fluid from joints with osteoarthritis (15 cases, Group I), implants revised without associated osteolysis (15 cases, Group II)and failed implants with radiographically moderate to severe osteolysis (17 cases, Group III) were compared. The fluids from all cases with implants (Group II and III) was combined (Group IV)and compared with the osteoarthritic joint fluids. RESULTS: RANKL was present in all the fluids at similar concentrations. The OPG levels were significantly lower (2.2-3.9 fold)in Groups II and III than in Group I (p<0.0001). The IL-1beta concentration was significantly higher in Groups II, III and IV and with Group III being the highest (12.1 fold)(p<0.0001). The IL-6 expression level was significantly higher in Group III (2.0 fold)than in Groups I and II (p<0.0001). The TNF-alpha levels were 2.0 times higher in Group III and significantly higher in all implant cases (Group IV)are analyzed (p=0.03). CONCLUSION: Permissive RANKL protein expression coupled with suppressed OPG levels and enhanced osteoclastogenic cytokine expression results in periprosthetic osteolysis.

Ganglion Cyst of the Great Toe / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical features and treatment of ganglion cyst of the hallux. MATERIALS AND METHODS: From August 1990 to December 2002, seven patients with a ganglion cyst of the hallux were treated. Six cases underwent surgical excision and one repeated aspiration. RESULTS: Four cases showed recurrence after the initial surgical excision. Characteristics of the ganglion cyst of the hallux were; (1) mass accompanied by pain, (2) frequent recurrence after surgical excision, and (3) frequent communication with a joint. In one case of ganglion communicating with the interphalangeal joint, the joint of the involved hallux was finally fused due to repeated recurrence. CONCLUSION: Ganglion cyst of the great toe needs to be evaluated by specialized study such as MRI for joint comminucation, and treated by meticulous surgical excision to prevent recurrence.