Extratendinous migration of calcific tendinitis of the rotator cuff: imaging findings and clinical characteristics with temporal changes

Purpose@#The aim of this study was to analyze the imaging findings and clinical characteristics of extratendinous migration of calcific tendinitis of the shoulder with temporal changes. @*Methods@#Seventy-six patients with extratendinous calcific tendinitis of the shoulder diagnosed by ultrasonography (US) or magnetic resonance imaging (MRI) were enrolled in this retrospective study. Clinical symptoms and imaging findings (on radiography, US, and MRI) of extratendinous calcific tendinitis during an acute painful attack were analyzed. Temporal changes were analyzed in 28 patients before an acute attack and 40 patients after an acute attack. For comparison, 65 patients with intratendinous calcific tendinitis were included. @*Results@#Patients with extratendinous calcific tendinitis had a significantly higher average visual analogue scale (VAS) score (8.8±1.6) than the intratendinous group (6.4±2.2) (P<0.001). The fragmented type (80.5%) was the most common shape on US; sonographic black hole appearance (14.6%) and echogenic fluid (9.8%) were characteristic findings of intrabursal calcifications. In 28 patients with previous radiographs, radiographic type III (78.6%) was dominant and the location of calcific deposits changed (82.1%) during the acute painful attack, which was also perceivable in 12 patients with previous US or MRI. In follow-up radiographs of 40 patients, calcifications shrunk by more than 50% or became invisible in 82.5% of patients, with symptom improvement (VAS score, 8.9±1.5 to 1.9±1.2). Follow-up US and MRI of 16 patients also showed decreased size (56.3%) or disappearance (43.7%) of calcific deposits. @*Conclusion@#Extratendinous calcific tendinitis has distinctive imaging features, the temporal changes of which correlate well with clinical symptoms.

Initial Plain Radiographs versus MR Imaging: Comparison of Prognostic Efficacy in Legg-Calve-Perthes Disease

PURPOSE: To evaluate if at the time of diagnosis of Legg-Calve-Perthes disease, MR imaging is superior to radiographs for identifying patients with a favorable long term prognosis as determined by maintenance of a spherical configuration of the femoral head epiphysis on follow-up radiographs. MATERIALS AND METHODS: We retrospectively analyzed plain radiographs and MR images of 48 femoral heads in 41 patients with Legg-Calve-Perthes disease at time of diagnosis. Femoral head involvement was estimated on initial plain radiographs and MR images using the Catterall classification. Prognosis as determined by maximum femoral head deformity was determined on follow-up radiographs evaluated according to Stulberg classification. RESULTS: Catterall classification of greater than 1 at MR imaging had 100% sensitivity (14/14) for detecting patients with a poor prognosis as indicated by deformity of the femoral head on follow-up radiographs (Stulberg class > 2). Initial radiographs had a lower sensitivity of 57% (8/14) for detecting patients with poor prognosis. Specificity for MR imaging was 21% (7/34) which was not significantly different from 32% (11/34) specificity for initial radiographs. CONCLUSION: Catterall group 1 at initial MR imaging indicates favorable prognosis for Legg-Calve-Perthes disease. Patients with more extensive involvement of the femoral head can have a good outcome, however they are at risk for loss of spherical configuration of the femoral head and subsequent osteoarthritis in adulthood. MR imaging may be superior to radiographs for identifying a subgroup of patients with favorable prognosis.

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.

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.

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.

MR Imaging of Osteonecrosis of the Femoral Head with Rapidly Destructive Coxarthrosis / 대한정형외과학회잡지

PURPOSE: In this study, we investigated the magnetic resonance (MR) imaging characteristics of rapidly destructive coxarthrosis (RDC) caused by osteonecrosis of the femoral head. MATERIAL AND METHOD: We reviewed 11 hip MR images (10 patients) of osteonecrosis of the femoral head with RDC. MR findings of 11 RDC were compared with those of Ficat stage IV osteonecrosis of the femoral head as a control. RESULTS: The MR findings of osteonecrosis, involving the entire femoral head, bone marrow edema in the acetabulum, intraarticular loose bodies on the inferomedial portion of the hip joint, and synovial proliferation were significant in RDC as compared with those of osteonecrosis of the femoral head only. CONCLUSION: Distinct findings of MR imaging in conjunction with plain radiographs could be used to facilitate diagnosis, treatment, and prognosis in RDC.

A Case of Scalp Angiosarcoma

Angiosarcoma is very rare but highly malignant soft tissue tumor derived from the vascular endothelium. This tumor is most commonly found in the skin and subcutaneous tissues. Angiosarcoma is known to cause early and widespread metastasis leading to a very poor prognosis of less than 24 months. We report a case of angiosarcoma developed in the temporoparietal scalp of a 84-year-old man. The patient was referred for us consultation after failed systemic antibiotic treatment, incision drainage treatment for "cellulitis" by the general physician. We performed excision and biopsy. The histologic finding of the lesion showed that irregular, complex vascular channels in dermis. The tumor cells were positive for Factor VIII-related antigen. The lesion was confirmed as cutaneous angiosarcoma. We recommended a radical surgery and reconstruction followed by adjuvant radiation, but the patient refused. The patient was expired 2 months thereafter because of a massive hemorrhagic pleural effusion by suspicious distant metastasis. Authors reported important aspects of clinical findings, histologic features and therapeutic options of the scalp angiosarcoma.

The Measurement Method of the Skin Amount to Be Excised in the Upper Blepharoplasty

No abstract available.

Effects of bFGF on the Regeneration of Non-vascularized and Vascularized Nerve Graft in Rats / 대한정형외과학회잡지

PURPOSE: This paper compares the effect of basic fibroblast growth factor (bFGF) on the regeneration process in non-vascularized nerve grafts and vascularized nerve grafts in the case of poor recipient bed condition. MATERIALS AND METHODS: One hundred and six Wistar rats were divided into 4 groups; CNG (Conventional nerve graft, n=25), CNG-F (Conventional nerve graft treated with bFGF, n=27), VNG (Vascularized nerve graft, n=25), and VNG-F (Vascularized nerve graft treated with bFGF, n=29). Each type of nerve graft was 6 mm in length, and inserted into a silicone tube, to prevent revascularization from the recipient bed. The bFGF solution (10 L, 400 ng/mL) was injected into the silicone tube in the CNG-F and VNG-F groups, and collagen solution (10 L, 2.4 mg/mL) was injected in the CNG and VNG groups. RESULTS: The latency period delay decreased and the amplitude of motor action potential, the number of myelinated axons, and the number of large myelinated axons (over 5 m in diameter) increased significantly in the CNG-F group versus the CNG group 4 weeks after the operation. The amplitude of the motor action potential, the mean diameter, the number of myelinated axons, and the number of large myelinated axons increased significantly in the VNG-F group versus the CNG-F and the VNG groups 2 and 4 weeks after the operation. CONCLUSION: These results suggest that vascularized nerve graft treated with bFGF is one of the best ways of repairing the segmental peripheral nerve defect.

Delayed Local Infection in Tibial Fracture Treated with Plate Fixation / 대한정형외과학회잡지

Plate fixation is being regarded as one of the reliahle fixation method in the management of tibial fractures. But this technique may leave many complications including infection. However, delayed local infection which developed several weeks after open reduction on the tibia has been rarely described as a complication in the literatures. The purpose of this study is to evaluate the contributing factors to the delayed locaI infection in tibial fracture treated with plate fixation. Authors reviewed and analyzed the 60 cases of tihial fracture that were treated with plate and screws from 1989 to 1996. Analyses dealt with fracture classification, laboratory and radiographic findings and the site of plate application. We defined a delayed local infection as a condition in which patient has infection signs on Jaboratory and physical examination at or over 8 week post-operation without any evidence of osteomyelitis on plain radiographs. We found 7 cases of delayed local infection out of 60 tibial fractures from 8 to 21 weeks postoperatively with an average of 14.1 weeks. All the 7 cases that had been treated with plate on medial aspect of tibia were treated by administration of antibiotics without surgery such as debridement or removal of hardwares. Authors concluded that the medial plating was the most important factor of the development of delayed local infection(Z=1.78).

Treatment of Avascular Necrosis of the Femoral Head with Free Vascularized Fibular Graft / 대한정형외과학회잡지

We reviewed 46 hips of the 36 patients treated with free vascularized fibular graft for avascular necrosis of femoral head with a mean follow-up of 39.9 months (ranging from 2 years to 6 years 4 months). There were thirty-four men and two women. The mean age of patients at the time of operation was 36.6 years (ranging from seventeen to fifty-seven years). The procedure was performed on both hips in ten patients. Of the 46 hips, twenty-nine were idiopathic, ten alcoholic, six steroid induced, and one traumatic. According to Ficats stage, there were eighteen in Stage 2A, fifteen in Stage 2B and thirteen in Stage 3. According to Ohzonos classification, there were four in Type 1B, forty in Type 1C and one in Type 3B. Clinical assessments according to the cause and severity of the disease were evaluated using Harris hip scoring system. Thirty-two hips(69.6%) were excellent, 9 hips(19.6%) were good, 2 hips(4.3%) were fair, and 3 hips(6.5%) were poor. Therefore clinically satisfactory results, including excellent and good, were obtained in 41 hips(89.2%). Radiographic assessments according to healing of avascular necrosis lesion and collapsing the femoral head postoperatively were performed. Thirty hips(65.2%) were excellent, 9 hips(19.6%) were good, 4 hips(8.7%) were fair, and 3 hips(6.5%) were poor. Therefore radiographic satisfactory results were obtained in 39 hips(84.8%). Clinical and radiographic assessments according to Ohzonos classification were also evaluated. Clinically satisfactory result were obtained in 6 hips(100%) of Type 1A and 3B in 33 hips(82.5%) of Type 1C. The etiological factors didn t affect the results. There were two cases of peroneal nerve palsy in which one was irreversible and one case of clawing of great toe as complications. In conclusion, free vascularized fibular graft appears to be a very effective method for Ficats stage 2A, 2B, and early stage 3 of symptomatic avascular necrosis of femoral head, in Ohzonos Type 1C which have a high incidence of collapse.

Chiari Pelvic Osteotomy in Children and Adolescent / 대한정형외과학회잡지

Twenty five patients (twenty seven hips) who had Chiari osteotomy at Kang Nam St. Marys Hospital between 1980 and 1995 were reviewed to evaluate the factors in the operative technique that contribute to successful outcome and assess the clinical results in various conditions. The length of follow-up ranged from one to fourteen years and the age of at operation ranged from four to twentythree years. Eighteen patients had developmental dysplasia of the hip: four, septic hip: three had another disorders, Prior to the Chiari osteotomy, fourteen hips had an femoral osteotomy and four, trochanteric arthroplasty. We used to the standard osteotomy as described by Chiari with certain modification. A pneumatic saw and osteotome are used instead of Gigli saw. This technique is simple procedure to make the correct level and angle. Bone graft was not performed in all cases even the osteotomy was displaced more than 50 percent of the iliac width. The overall results were 12 excellent, eight good, five fair, and two poor. In eleven patients, the osteotomy had to be displaced more than 50 percent to provide good coverage of the femoral head. Their results were good or excellent. A good result will be obtained if enough attention is paid to displacing the osteotomy. The osteotomy using the pneumatic saw provides accurate level and direction of osteotomy and it is an simple procedure also.

A Case of Ipsilateral Neglected DDH Combined with Contralateral LCPD: A Case Report / 대한정형외과학회잡지

Although many reports have been published about Legg-Calve-Perthes disease, developmental dysplasia of hip, it is difficult to gain a satisfactory results in treatment. We experienced 9 year-old girl with ipsilateral neglected DDH combined with contralateral LCPD, and treated with Klisic operation for DDH and femoral valgus osteotomy for hinged abduction of LCPD. We gained satisfactory results and report this rare case.

The significance of radiographic follow-up of mandibular fractures

For many years, healing membranous bone fractures have been known to show a persistent lucency at the fracture interface. Radiographic follow-up has proven to be of little value as a guideline for healing of mandibular fractures. Recently, a fracture has been treated by rigid internal fixation by metallic plate and screws rather than closed reduction and wire fixation, we expected that some difference in the radiographic features of fracture healing. To investigate these questions we undertook a retrospective radiographic and clinical analysis of 33 followed patients with fractures of the body and angle of the mandible from 1993 to 1997. There were 26 male and 7 female patients ranging in age between 5 and 74 years, with an average of 29.7 years. All patients were managed by open reduction with metallic plates and screws. The length of follow-up ranged from 9 to 187 weeks. Total 81 radiographic follow-up films were obtained and divided into 3 grades according to the degree of radiolucency of fracture lines; grade 0 radiolucent fracture line and no evidence of fracture interface calcification, grade 1 decreased radiolucent area and evidence of fracture interface calcification, and grade 2 disappearance of fracture line.Until follow-up of 8 weeks, all of the radiographs showed grade 0. From 8 weeks to 16 weeks, 62.5 percent showed grade 0 and 37.5 percent showed grade 1. From 16 weeks to 48 weeks, 38.5 percent showed grade 1 and 61.5 percent showed grade 2. After follow-up of 48 weeks, all showed grade 2.In this study we have shown that the radiographic disappearance of mandibular fracture lines was usually accomplished by 48 weeks. We feel that radiographic union of the mandible is lagging well behind clinical union, but disapperance of the fracture line in rigidly fixated mandibular fracture was occurred earlier than healed by fibrous union. We propose that radiographic union of the mandible by approximately 1 year can be a guideline for the normal mandibular bone healing.