Spontaneous Achilles Tendon Rupture in a Patient with Ankylosing Spondylitis

No abstract available.

Superficial Fibromatosis Mimicking Glomus Tumor of the Second Toe

Various types of tumor can occur in the subungual space, including glomus tumors, subungual exostosis, hemangioma, epidermal cysts, and malignant tumors. While fibromatosis can occur at various sites throughout the body, it is very rarely seen in the toe. Here, we are the first to report a case of superficial fibromatosis mimicking a glomus tumor in the subungual space of the second toe. The presentation of this condition shows the possibility of encountering uncommon superficial fibromatosis in the distal phalanx of the toe, and suggests that superficial fibromatosis should be included in the differential diagnosis of a glomus tumor in the toe.

Hallux Rigidus with Osteochondroma of the Hallucal Proximal Phalanx (A Case Report) / 대한족부족관절학회지

Small osteophytes are frequently encountered in the foot and ankle, and not to be confused with true osteochondromas, which are relatively uncommon in this region. Osteochondromas are the most common benign osseous neoplasm, occurs in the metaphysis of the long bone. It is rarely found in bones of the foot. Treatment of the osteochondroma is usually conservative, unless symptoms usually pain, are progressive rapid growth, and malignant transformation is suspected. We experienced a rare case of hallux rigidus with osteochondroma of the hallucal proximal phalanx which cause pain and corn of the plantar.

Acute Compartment Syndrome of the Lower Leg and Foot / 대한족부족관절학회지

Acute compartment syndrome of the lower leg and foot is a surgical emergency. The clinical symptoms is an important clue to diagnose compartment syndrome. In cases of ambiguous diagnosis, unconscious patients and children additionally need a intracompartmental pressure measuring. Immediate fasciotomy should be performed when clinical signs are obvious or when delta pressure is less than 30 mmHg or intracompartmental pressure is greater than 30 mmHg. Fasciotomy of the lower leg can be performed either by one lateral single incision or double incision, which of the foot mainly has a dorsal or medial incision. A delayed in diagnosis that leads to a delay in treatment can result in devastating disability. Acute compartment syndrome of the lower leg and foot is a relative rare but serious complication of which a surgeon should be aware.

Intractable Plantar Keratoses due to Interphalangeal Sesamoid Bone of the Hallux (A Case Report) / 대한족부족관절학회지

A sesamoid bone can occasionally be found under the interphalangeal joint of the hallux. These had anatomical variants and usually remain asymptomatic, it is uncommon for symptomatic cases of painful plantar keratoses or irreducible dislocation of interphalangeal joint of the hallux with incarcerated sesamoid. While the latter has a few cases, the former has not reported in Korea. We experienced a rare case of intractable plantar keratoses due to interphalangeal sesamoid bone of the hallux which may reqire excision.

Asymptomatic Pulmonary Embolus Following Percutaneous Kyphoplasty: A Case Report / 대한골다공증학회지

Percutaneous vertebroplasty is a relatively recent procedure in the treatment of osteoporotic vertebral compression fractures. Bone cement embolism is a severe and potentially life-threatening complication of percutaneous vertebroplasty with cement. The risk for cement pulmonary embolism ranges between 3.5 and 23% for osteoporotic fractures. Bone cement leakage may be usually more frequent with vertebroplasty than with kyphoplasty. We experienced a 69-year-old female patient of an asymptomatic pulmonary embolus (length 8 cm) after kyphoplasty for an osteoporotic vertebral compression fracture

Radiographic Diagnosis of the Osteoporotic Vertebral Fractures / 대한골다공증학회지

Osteoporotic vertebral fractures are associated with increased morbidity and mortality. Morbidity associated with these fractures includes pain and decreased physical function, which have a significant impact on the quality of life. The detection of osteoporotic vertebral fracture is based mainly on the identification of vertebral collapse, but this can be misleading in the presence of a fracture without radiologic collapse. And the diagnosis of vertebral fractures in simple radiographs is difficult because of normal variants and degenerative change of vertebrae. We review the various methods for evaluating osteoporotic vertebral fractures based on simple radiography or dual-energy X-ray absorptiometry (DXA). The preferred method may be Genant's semiquantitative method which was developed in an attempt to reduce subjectivity associated with visual diagnosis of osteoporotic vertebral fracture. Recently, vertebral fracture assessment (VFA) by DXA can be used to detect vertebral fractures in asymptomatic patients undergoing routine BMD measurements. Yoshida's classification is useful alternative method in the incidental vertebral fracture diagnosis with a morphological change in the anterior bone cortex.

Intramuscular Ganglion of the Quadriceps Femoris

Ganglion cysts are common lesions that are most often found around the joints of the hands and feet. Ganglia around the distal femur usually occur within the synovial membrane or tendon sheath, but rarely within muscles. Several cases of intramuscular ganglions in the hand and wrist have been reported, but a ganglion cyst in the quadriceps muscle has rarely been addressed in studies. In this report, we present a 17-year-old patient with a painful movable mass in the intramuscular area of the quadriceps femoris that was diagnosed by ultrasound and treated by excision and biopsy.

Analysis of Clinical Features of Hip Fracture Patients with or without Prior Osteoporotic Spinal Compression Fractures

BACKGROUND: To analyze and compare the clinical characteristics including bone mineral density (BMD) in a group who had operation of hip fracture with or without prior osteoporotic spinal compression fractures. METHODS: Two hundred forty patients who had undergone operation of hip fractures were evaluated, 127 patients who had with prior osteoporotic spinal compression fractures were in group I, and 113 patients without prior spinal fractures were in group II. In each group, we measured age, gender, body mass index (BMI, kg/m2), BMD (mg/cm3), type of hip fractures, concomitant diseases, presence of secondary hip fracture and history of percutaneous vertebroplasty. RESULTS: The mean age of group I was 79.4 years (male/female: 28/99) and that of group II was 77.6 years (male/female: 37/76). The mean BMI of group I was 21.3 kg/m2 and that in group II was 22.0 kg/m2. The mean BMD and T-score of group I were 41.1 mg/cm3 and -4.45 and those in group II were 51.0 mg/cm3 and -4.17 (P<0.05). The numbers of patients of neck and intertrochanter fracture of group I were 31 and 96 patients and those in group II were 61 and 52 patients. Sixty in group I and 45 in group II patients had concomitant diseases. Thirteen patients had undergone percutaneous vertebroplasty and 18 patients (7.5%) had second hip fractures. CONCLUSIONS: The hip fracture patients who had with prior osteoporotic spinal compression fractures had lower BMD compared to the hip fracture patients without previous spinal compression fractures.

Osteoporotic Lumbar Compression Fracture in Patient with Ankylosing Spondylitis Treated with Kyphoplasty

Ankylosing spondylitis (AS) is an inflammatory disease primarily affecting the spine. Osteoporosis can be a complication of AS and associated with low bone mineral density. As well, spinal fractures in the AS are usually unstable and may cause neurologic deficit at the mainly cervical region with low energy trauma. However, reports of lumbar compression fracture in AS are very rare. Thus, we report a 73-year-old male patient with osteoporotic L3 compression fracture with AS treated with kyphoplasty which has no symptom improvement with conservative treatment. Kyphoplasty is a useful procedure option in the treatment of the lumbar compression fracture in AS.

Changes of Paraspinal Muscles in Postmenopausal Osteoporotic Spinal Compression Fractures: Magnetic Resonance Imaging Study

BACKGROUND: To investigate the changes of cross sectional area (CSA) in paraspinal muscles upon magnetic resonance imaging (MRI) and bone mineral density (BMD) in postmenopausal osteoporotic spinal compression fractures. METHODS: We reviewed 81 postmenopausal women with osteoporosis, who had underwent MRI examination. The patients were divided into 51 patients who had osteoporotic spinal compression fractures (group I), and 30 patients who without fractures (group II). Group I were subdivided into IA and IB, based on whether they were younger (IA) of older (IB) than 70 years of age. We additionally measured body mass index and BMD. The CSA of multifidus, erector spinae, paraspinal muscles, psoas major (PT), and intervertebral (IV) discs were measured. The degree of fatty atrophy was estimated using three grades. RESULTS: The BMD and T-score of group I were significantly lower than those of group II. The CSA of erector spinae, paraspinal muscles, and PT in the group I was significantly smaller than that of group II. The CSA of paraspinal muscles in group IB were significantly smaller than those of group IA. The CSA of erector spinae, mutifidus, and PT in group IB were smaller than those of group IA, but the difference was not statistically significant. Group 1 exhibited greater fat infiltration in the paraspinal muscle than group II. CONCLUSIONS: Postmenopausal osteoporotic spinal compression fracture is associated with profound changes of the lumbar paraspinal muscle, reduction of CSA, increased CSA of IV disc, and increased intramuscular fat infiltration.

Radiographic Detection of Osteoporotic Vertebral Fracture without Collapse

BACKGROUND: On retrospective basis, we investigated the detection of osteoporotic vertebral fractures (OVFs) without radiologic collapse using a modified Yoshida's classification, which was designed by the authors. METHODS: We observed 82 cases in 76 patients with confirmed OVFs without collapse at the thoracolumbar junction. The following factors were measured: age, gender, body mass index (BMI, kg/m2), bone mineral density (BMD, mg/cm3), type of a modified Yoshida's classification. The correct diagnosis rate for the presence and location of OVFs and the correct diagnosis rate according to the morphological type by a modified Yoshida's classification of the OVFs were analyzed. RESULTS: The mean BMI was 21.2; mean BMD, 44.1; and T-score, -4.4. As for the four subtypes of anterior cortical morphological change, there were 14 cases of the protruding type, 12 cases of the indented type, 5 cases of the disrupted type and 8 cases of the prow type. As for the three subtypes of endplate depression, there were 20 cases of upper endplate depression, 12 cases of lower endplate depression and 11 cases of endplate slippage type. According to the examiners, there was a significant difference between being informed before and after the modified Yoshida's classification. For the relationship of examiners and the type of fracture, there was a significant difference between being informed before and after the modified Yoshida's classification, particularly in the protruding type and the upper plate type. CONCLUSIONS: A modified Yoshida's classification can be helpful for the diagnosis of OVFs without radiologic collapse in a simple radiograph.

Medial Malleolar Insufficiency Fracture of the Ankle in an Elderly Patient with Osteoporosis

Insufficiency fracture is a type of stress fracture, which is the result of normal stresses on abnormal bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. An early diagnosis is best made with a bone scan or magnetic resonance imaging, as radiographs may initially appear normal. Insufficiency fractures of the lower leg and ankle are less common. Furthermore, reports of medial malleolar insufficiency fracture without any history of trauma in elderly patients are extremely rare. Thus, we report a case with a medial malleolar insufficiency fracture of the ankle in an elderly patient with osteoporosis. This case shows that we should be aware of the possibility of encountering an uncommon medial malleolar insufficiency fracture as a cause of pain in the ankle region of an elderly patient with osteoporosis.

Pseudoaneurysm of the Lateral Inferior Genicular Artery after Arthroscopic Partial Meniscectomy of Lateral Meniscus: A Case Report / 대한스포츠의학회지

Arthroscopic meniscectomy of the knee is generally a safe and effective procedure with a low rate of vascular complications. The authors encountered a case of a pseudoaneurysm of the lateral inferior genicular artery after arthroscopic partial meniscectomy of lateral meniscus. The pseudoaneurysm was treated successfully using transcatheter embolization. No recurrence of the hemarthrosis was observed in the patient after a follow-up of 2 years.

Two Stage Procedure with a Temporary Antibiotic-impregnated Cement Spacer of Infected Hallux Interphalangeal Joint (A Case Report) / 대한족부족관절학회지

The interphalangeal joint (IPJ) of the hallux has received little attention compared with the first metatarsophalangeal joint. But, the hallucal IPJ has several disorders such intra-articular fractures, dorsal dislocation, alignment disorder, and inflammatory or degenerative arthritis. Among these disorders septic arthritis of the IPJ of the hallux is rare. We report a case of sepsis of the hallucal IPJ and adjacent underlying osteomyelitis without neuropathic problem and was performed through infected soft tissue and osseous debridement, temporary antibiotic-impregnated cement spacer, and delayed intercalary allogenic fibular bone graft with K-wire fixation.

Clinical Characteristics of Ankle Fracture in Osteoporotic Patients Over Sixty-five Years of Age / 대한골다공증학회지

OBJECTIVES: Fracture of multiple sites can occur by minor trauma because decreased bone quality and bone density in osteoporotic patients. To investigate clinical characteristics of ankle fracture in osteoporotic patients over sixty-five years of age. MATERIALS AND METHODS: From January 2009 to December 2011, excluding distal tibial shaft and pilon fracture, 40 patients (over 65 years old) who were diagnosed the osteoporosis and observed over 6 months after ankle surgery. We measured age, gender, body mass index (BMI, kg/m2), bone mineral density (BMD, mg/cm3) and T-score through P-QCT. Type of fracture was classified into Danis-Weber and AO classification and whether or not of syndesmotic injury and concomitant disease. Surgery performed under AO principle. We investigated by wound healing, fixation failure and bone union during follow-up.

Prediction of Bone Cement Leakage in Patients Receiving Vertebroplasty by MRI Finding / 대한골다공증학회지

OBJECTIVES: To identify MRI predictors of bone cement leakage, we compared pre operative MRI and postoperative CT. MATERIALS AND METHODS: Between October 2004 to March 2009, percuataneous vertebroplasties were performed in 58 patients from 167 patients of spine compression fracture. Among them, 37 patients took MRI before vertebroplasty and CT after operation to figure bone cement leakage. In 37 patients, 45 vertebras (T9; 1, T10; 3, T11; 5, T12; 8, L1; 11, L2; 9, L3; 4, L4; 3, L5; 1) preoperative MRI was taken to measure the presence of cortical disruption of the vertebral body and vacuum or cystic portion, severity of body compression, bone cement amount and bone cement amount/ severity of body compression ratio. RESULTS: In postoperative CT scan of 42 vertebrae with bone cement, leakage was detected in 17 vertebrae (37.7%). However, no patients displayed any neurological symptoms or required surgery. Endplate cortical disruption was related to an increase risk of intervertebral bone cement leakage (P<0.05). Bone cement leakage tended to occur less frequently when there is a vacuum or fluid collection (P<0.05). No other factors showed significant relation with cement leakage. CONCLUSIONS: Vertebroplasty group in magnetic resonance imaging of cortical damage to the vertebral endplates and fluid collection or vacuum changes when that can be useful to predict the leakage of bone cement after vertebroplasty group findings suggest.

The Relation of Paraspinal Muscles and Degenerative Lumbar Spondylolisthesis / 대한정형외과연구학회지

OBJECTIVES: To evaluate the cross-sectional area (CSA) and the moment arm length (MAL) of the paraspinal muscles in the degenerative lumbar spondylolisthesis patients compared to the matched control patients, which is through contribution to the stability of the back. MATERIALS AND METHODS: We studied a comprised of 25 degenerative lumbar spondylolisthesis on L4/5 patients and a controlled group with 42 chronic lower back pain patients. In both groups, we measured body mass index (BMI, kg/m2). On the standing lateral radiographs, we measured the total lumbar lordosis, and segmental lumbar lorodosis using Cobb's methods. We measured the degree of slippage by Meyerding classification. The CSA of erector spinae (CSA) and CSA of psoas were measured at the L4/5 level by using the MRI. The statistical analysis were performed to know the relationship between the CSA and the MAL of erector spinae, and the BMI. Multifidus and erector spinae atrophy were evaluated at the L4/5 level and the degree of fatty atrophy was estimated using three grades : mild, moderate, and severe. RESULTS: The patient group and the controlled group BMI (kg/m2) were 25.27+/-3.8 and 24.47+/-3.24. In patient group, Meyerding classification grade I was 92%. Total lumbar lordosis and each segmental lordosis were measured mean angle 44.54degrees(24.9degrees~70.4degrees), and each 9.23degrees(L3/4), 10.27degrees(L4/5), 18.81degrees(L5/S1). Pearson's rho indicated a positive association between the CSA and BMI (rho=0.603, p= 0.001), between the CSA of psoas and BMI (rho=0.445, p=0.026), and between the CSA and MAL (rho=0.627, p=0.001) in the degenerative lumbar spondylolisthesis patients. In terms of the CSA versus MAL, there was a positive association in the both groups (rho=0.627, p=0.001, MAL=0.0008 CSA+/-5.293 in the degenerative lumbar spondylolisthesis group; rho=0.812, p=0.000, MAL=0.001 CSA+/-5.245 in the control group with using linear regression analysis). Independent t-test revealed that both groups had statistically different mean values (p=0.038) in terms of the CSA. Proportion of fat deposits in the multifidus and erector spinae muscle at the L3/4 level were all mild grades. CONCLUSION: The patients with degenerative lumbar spondylolisthesis had atrophied erector spinal muscles, which means harmful because of the poor compensation for the lower back load and poor assists to the lumbar stability. This suggests that the biomechanical factor of the muscles influence to the lumbar disability.

Superficial Peroneal Nerve Entrapment Syndrome (A Case Report) / 대한족부족관절학회지

Superficial peroneal nerve entrapment is an uncommon compression neuropathy, and is frequently associated with a fascial defect and a muscle hernia. The standard treatment of that was the nerve decompression by complete or limited fasciotomy. But, we experienced a case of superficial peroneal nerve entrapment had satisfactory surgical outcome by fascial repair of peroneus muscle.

Relationships of Bone Mineral Density, Blood Pressure, and Physical Characteristics of Third and Fourth Decade College Students / 대한정형외과연구학회지

The purpose of this study was to analyze the relationship of body mass index (BMI), bone mineral density (BMD) and blood pressure (BP) in third and fourth decade college students. Total of 114 (67 male and 47 female) students who received health examination in April 2010 participated in this research. Bone status was measured by a peripheral dual energy X-ray absorptiometry method and T-score was calculated via WHO guideline. For body composition measurements, body fat, height and weight were measured and BMI was calculated. Among male students, 3.6% belong to the UW (under weight) group, 49.1% to the NW (normal weight) group, 18.2% to the OW (over weight) group and 29.1% belong to the obese group, while 2.1% of female students belong to the UW group, and 68.1% to the NW group, 14.9% to the OW group and 14.9% belong to the obese group. Differences of body weight among male and female students were statistically significant (p<0.001). Above overweight groups showed higher systolic and diastolic BP than normal group. Differences among two groups were statistically significant (systolic BP: p=0.041, diastolic BP: p=0.021). The mean BMI of normal BP group is 22.6+/-2.87, hypertension group is 24.1+/-2.95. Differences among two groups were statistically significant (p=0.045). The mean T-score of male students is -0.1+/-1.17, female is -0.6+/-0.88(total -0.5+/-0.91). Differences of T-score among male and female students were statistically significant (p=0.007). In conclusion, our results showed that many college students had the problems in the BMI, BMD and BP, and BP increased according to the increase of BMI. Therefore, nutritional education and weight control is required for normal blood pressure and bone health.