Surgical Treatment of Ganglions in Foot and Ankle / 대한족부족관절학회지

PURPOSE: To evaluate the results of surgical treatment and relationship between the recurrence and characteristics of ganglions in foot and ankle. MATHERIALS AND METHODS: Seventeen cases of ganglions located in foot and ankle, excised at St. Benedict Hospital from Mar. 1993 to Apr. 2003, were included in the study. All of cases were analyzed retrospectively in terms of age, sex of the patients, location and size of the ganglion, symptom, operative method as well as recurrence rate were evaluated. The mean follow up was 1.8 years (11 months~6.5 years). RESULTS: The size of ganglion ranged from 0.5 cm to 5.0 cm with mean size of 2.5 cm. The most common area of ganglion was the dorsum of foot and pain was the primary chief complain The recurrence was found in 4 cases (23.5%): 1 of them occurred among 8 cases the diameter of which was less the 2.5cm and other 3 occurred among 9 casees larger than 2.5cm. 12 cases were completely excised mass with no recurrence. But 5 cases were incompletely excised & ligated stalk of mass and 4 cases of them were recurred. A correlation was only observed between complete excision and low recurrence rate. CONCLUSION: Recurrence rate of ganglions in foot and ankle was high and the correlation was obstained between complete excision and low recurrence rate.

The Expressions of CD117 (c-kit) and Her-2/neu in Malignant Bone and Soft Tissue Tumors / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine the prevalence of c-kit (CD117) and Her-2/neu expressions in malignant bone and soft tissue tumors and to identify a possible predictive role in patients with these malignancies. MATERIALS AND METHODS: A retrospective study was conducted on 40 archival paraffin-embedded tissue specimens of patients with 32 malignant bone tumors (23 osteosarcomas, 9 chondrosarcomas) and 8 synovial sarcomas. The gene expressions levels were evaluated by immunohistochemistry. RESULTS: C-kit expression was observed in 13 out of 23 osteosarcoma patients (56.5%), 4 out of 9 chondrosarcoma patients (44.4%) and 4 of 8 synovial sarcoma patients (50.0%). In particular, the relationship between c-kit expression and gender (p=0.044), a pulmonary metastasis (p=0.044), and the tumor cell grade (p=0.023) in osteosarcoma were found to be statistically significant. On the other hand, Her-2/neu expression was not found in any of the 40 cases under study. CONCLUSION: These results suggest that the c-kit expression appears to play an important role in the development of a malignant bone tumor and synovial sarcoma. In particular, it should be noted that c-kit expression is found frequently in an osteosarcoma with a pulmonary metastasis. In this respect, the tyrosine kinase inhibitors can be considered to be significant in the treatment of a malignant bone tumor and a synovial sarcoma. However, Her-2/neu does not appear to play any significant role in these malignancies.

The Clinical Comparison of Ganglions in Hand and Foot / 대한족부족관절학회지

PURPOSE: To compare clinical characteristics of ganglions in hand & Foot. MATERIALS AND METHODS: Seventeen cases of ganglions located in foot and fifty-five cases in hand. Excised from Mar.1988 to Apr.2003, were included in the study. The clinical characteristics and recurrence ratio were evaluated RESULTS: The mean size of 2.2 cm in hand and 2.5 cm in foot. The most common area of ganglions are dorsum of foot and wrist. The cosmetic problem of palpable mass is the primary chief complaint of ganglions on hand and the pain is that of foot. The recurrence was found in 5 cases in hand and 4 cases in foot. The recurrence was related to incomplete excision of ganglion in foot and the large size of ganglion and incomplete excision of ganglion in hand. CONCLUSION: recurrence ratio in the cases of foot is higher than that of hand. The ganglions in foot and hand need to treated by meticulous surgical excision to prevent the recurrence.

Correlation of Correction Angle with Pain at First Metatarsophalangeal Joint in the Treatment of Hallux Valgus / 대한정형외과학회잡지

PURPOSE: We evaluated the correlation between correction angle and pain of the first metatarsophalangeal joint in the treatment of hallux valgus. MATERIALS AND METHODS: The 28 cases (20 patients) with moderate to severe hallux valgus deformity and pain of the first metatarsophalangeal joint who underwent the distal soft tissue procedure and proximal metatarsal closing wedge osteotomy, were divided into two groups, Group I: no pain of the first metatarsophalangeal joint after surgery, and Group II: with persisting pain. We analyzed the correc-tion angle and pain of the first metatarsophalangeal joint in each group, preoperatively and at the last follow-up. All of the patients were women and their mean age was 58 years old. The average follow-up time was 18 months. RESULTS: At the last follow-up, the 21 feet (75%) were free of pain of the first metatarsophalangeal joint. In 7 feet (25%) pain persisted. In group I, sufficient deformity correction was obtained, but in group II, the deformity was corrected insufficiently. A high correlation was observed between correction angle and pain relief. CONCLUSION: A high correlation was obtained between correction angle and pain of the first metatarsophalangeal joint in the treatment of hallux valgus deformity. Therefore, in view of the patient's expectation of pain relief, meticulous attention should be paid to the correction of hallux valgus deformity.

The Effect of Syndesmotic Screw of Ankle Fracture with Distal Tibiofibular Diastasis / 대한정형외과학회잡지

The general consensus of the treatment for ankle fracture is anatomical reduction and restoration of the distal tibiofibular relationship. In general, stabilization of the disrupted syndesmosis may be achieved by repairing ruptured ligament; fixing associated fractures of the fibular, avulsed tubercles, and medial malleolus; or by placing a screw between the tibia and the fibular to hold the syndesmosis in position until some degree of syndesmotic ligament healing can occur. However, the managements of syndesmosis remain controversial. The purpose of this study is to evaluate the effect of the syndesmotic fixation in the ankle fractures. The patients with syndesmotic disrupted ankle fracture, who were treated operatively between 1990 and 1995 at St. Benedict Hospital, were divided into the two groups based on whether trans-syndesmotic screw was used or not. The group I included 42 ankle fractures that were treated with trans-syndesmotic screw, while the group II included 28 ankle fractures that were treated without syndesmotic screw. The results obtained from this study were as follows. 1). There was no significant difference of the clinical result between the two groups. 2).When the diastasis was satisfactorily reduced after rigid, anatomic medial and lateral fixation, syndesmotic screw fixation was not required to maintain the integrity of the tibiofibular joint.

Regenerate Bone Healing According to Osteotomy Methods in Ilizarov lengthening / 대한정형외과학회잡지

The Ilizarov technique for gradual distraction osteogenesis was developed in the 1950s. A correctly performed osteotomy is essential to the success of distraction osteogenesis and prepares for limb lengthening. Between Sept. of 1991 and 1994, thirty-four patients were treated by Ilizarov technique at St. Benedict Hosp. and Gang-Dong Hosp.. And then assigned to two separate groups : a corticotomy group (group A) and osteotomy group (group B; osteotomy with Gigli saw or osteotomy with multiple drill holes and osteotome). The regenerate segments were evaluated weekly for the first six weeks after operation. After the initial six-week evaluation period, observations of these segments were continued through a series of monthly radiographs. Distraction began on postoperative day seven in group A and on day eleven in group B; and continued at a rate of 1 mm/day and a frequency of 4 times/day. Group A displayed new bone formation earlier than group B: group A's mean was 16.5 ± 4.9 days, while B's mean was 25.3 ± 4.6 days. The first bridging callus occurred earlier in group A than it did in group B: A's mean was time of 36.7 ± 9.9 days, while B's mean was 44.0 ± 7.9 days. There was no significant difference between groups A & B in terms of first cortical formation : A's mean was 86.9 ± 24.0 days, and B's mean was 100.6 ± 25.2 days. There was no significant difference between groups A & B in terms of the bone healing index : A's mean was 41.6 ± 13.5 days and B's mean was 41.15 ± 8.10 days.