Correction of Long Standing Proximal Interphalangeal Flexion Contractures with Cross Finger Flaps and Vigorous Postoperative Exercises

PURPOSE: We reviewed the results of cross finger flaps after surgical release and vigorous postoperative exercises for long-standing, severe flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. MATERIALS AND METHODS: In 9 patients, all contracted tissue was sequentially released and the resultant skin defect was covered with a cross-finger flap. The cause of the contracture was contact burn in 4, skin graft in 3, and a previous operation in 2. The mean follow-up period was 41.2 months. RESULTS: The mean flexion contracture/further flexion in the joints were improved from 73.4/87.8degrees to 8.4/95.4degrees at the last follow-up. A mean of 19.5degrees of extension was achieved with vigorous extension exercise after the operation. The mean gain in range of motion (ROM) was 79.4degrees. Near full ROM was achieved in 3 cases. There were no major complications. CONCLUSIONS: In severe flexion contractures with scarring of the PIP joints of fingers, cross finger flaps after sufficient release and vigorous postoperative exercise seems to be a reasonable option to obtain satisfactory ROM of the joints.

Distal Chevron Osteotomy with One BOLD Screw(R) Fixation in Hallux Valgus / 대한족부족관절학회지

PURPOSE: To present our experience of distal chevron osteotomy utilizing one BOLD screw(R) as an alternative fixation method which has advantages over the Kirschner (K)-wire fixation. MATERIALS AND METHODS: Between January 2001 and June 2003, 19 patients with a symptomatic hallux valgus deformity underwent 20 distal metatarsal chevron osteotomies with one BOLD screw(R) fixation. The mean age was 55.6 years with a minimum follow up period 12 months. For radiographical evaluation, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were used. For clinical evaluation, we used AOFAS hallux metatarsophalangeal interphalangeal scale and overall satisfaction of the patients. RESULTS: The AOFAS scores improved from mean 47.5 points to mean 68.1 points at postoperative 3 months and mean 86.0 points at last follow-up. The average HVA corrected from 25.3 degrees to 12.7 degrees. The IMA was corrected from 11.6 degrees to 7.6 degrees. The overall satisfaction of the patients was 85%. There was no major complication. CONCLUSION: We demonstrated that distal chevron osteotomy with one BOLD screw(R) fixation has advantages such as no additional procedure, no loss of correction, early rehabilitation, no prominent hardware and skin irritation. This method also showed excellent bone union, correction and patient satisfaction.

Distal Chevron Osteotomy with One BOLD Screw(R) Fixation in Hallux Valgus / 대한족부족관절학회지

PURPOSE: To present our experience of distal chevron osteotomy utilizing one BOLD screw(R) as an alternative fixation method which has advantages over the Kirschner (K)-wire fixation. MATERIALS AND METHODS: Between January 2001 and June 2003, 19 patients with a symptomatic hallux valgus deformity underwent 20 distal metatarsal chevron osteotomies with one BOLD screw(R) fixation. The mean age was 55.6 years with a minimum follow up period 12 months. For radiographical evaluation, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were used. For clinical evaluation, we used AOFAS hallux metatarsophalangeal interphalangeal scale and overall satisfaction of the patients. RESULTS: The AOFAS scores improved from mean 47.5 points to mean 68.1 points at postoperative 3 months and mean 86.0 points at last follow-up. The average HVA corrected from 25.3 degrees to 12.7 degrees. The IMA was corrected from 11.6 degrees to 7.6 degrees. The overall satisfaction of the patients was 85%. There was no major complication. CONCLUSION: We demonstrated that distal chevron osteotomy with one BOLD screw(R) fixation has advantages such as no additional procedure, no loss of correction, early rehabilitation, no prominent hardware and skin irritation. This method also showed excellent bone union, correction and patient satisfaction.

Intra-articular Avulsion Fractures of the Malleolus in Chronic Ankle Pain / 대한족부족관절학회지

PURPOSE: We report our results of arthroscopic treatment of symptomatic avulsion fracture of the malleolus in chronic ankle pain, and also analyzed the clinical and radiological features for evaluating the good candidate for arthroscopic treatment. MATERIALS AND METHODS: Fourteen patients who were diagnosed with intra-articular avulsion fractures of the malleolus received arthroscopic surgery and were followed up for at least a year. The clinical and radiological characters including MRI and arthroscopic findings were reviewed. Clinical assessments were done according to the AOFAS score system. RESULTS: There was a history of inversion type of the injury in most cases and local tenderness of lesion site was a unique. MRI study showed thickened anterior talofibular ligament (ATFL) in 8 cases (57%) and discontinued ATFL in 3 cases (21%). Enhanced signal surrounding soft tissue corresponding to synovial inflammation and impingement was found in 12 cases (86%). Preoperative score of all patients were 74.0+/-5.5, which improved to 89.3+/-6.7 at the follow-up after the treatment (P<0.001). CONCLUSION: Most patients had history of injury and localized tenderness in the area coinciding with radiological findings. Thickened ATFL and contrast enhancement around the ossicle were frequently found. Symptomatic avulsion fractures of the malleolus associated with the clinical and radiological findings above could be a good candidate for arthroscopic treatment.

Intra-articular Avulsion Fractures of the Malleolus in Chronic Ankle Pain / 대한족부족관절학회지

PURPOSE: We report our results of arthroscopic treatment of symptomatic avulsion fracture of the malleolus in chronic ankle pain, and also analyzed the clinical and radiological features for evaluating the good candidate for arthroscopic treatment. MATERIALS AND METHODS: Fourteen patients who were diagnosed with intra-articular avulsion fractures of the malleolus received arthroscopic surgery and were followed up for at least a year. The clinical and radiological characters including MRI and arthroscopic findings were reviewed. Clinical assessments were done according to the AOFAS score system. RESULTS: There was a history of inversion type of the injury in most cases and local tenderness of lesion site was a unique. MRI study showed thickened anterior talofibular ligament (ATFL) in 8 cases (57%) and discontinued ATFL in 3 cases (21%). Enhanced signal surrounding soft tissue corresponding to synovial inflammation and impingement was found in 12 cases (86%). Preoperative score of all patients were 74.0+/-5.5, which improved to 89.3+/-6.7 at the follow-up after the treatment (P<0.001). CONCLUSION: Most patients had history of injury and localized tenderness in the area coinciding with radiological findings. Thickened ATFL and contrast enhancement around the ossicle were frequently found. Symptomatic avulsion fractures of the malleolus associated with the clinical and radiological findings above could be a good candidate for arthroscopic treatment.

Fractures of the Wrist and Hand after Punching Injury / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to describe the patterns and results of treatment of fractures of the hand and wrist after punching injury. MATERIALS AND METHODS: The authors retrospectively reviewed 91cases of fractures of the hand and wrist after punching injury in 67 patients from January 1998 to September 2002. The mean follow-up was 18 months. The mean age was 25.7 years old, ranging from 11 years old to 41 years old. The results were evaluated by modified criteria of Bruce and Maudsley. RESULTS: The most common fractures were metacarpal base fractures (42.9%), and the second most common fractures were distal metacarpal fractures (19.8%). Metacarpal base fractures were usually combined with dislocation of carpometacarpal joint, especially in the fourth and fifth metacarpal bone and single fifth metacarpal bone (29.7%). There were a few complications of limitation of motion (4 cases), pain (1 case), angular deformity of distal metacarpal bone (1 case), malunion of metacarpal shaft (2 cases) and nonunion of metacarpal shaft (1 case). There were excellent results in 84 cases, good in 4 cases and fair in 3 cases. CONCLUSION: The most common fractures after punching injury were metacarpal base fractures, especially the forth and fifth metacarpal bone. Distal metacarpal and metacarpal shaft fractures were mostly single fractures. There were diverse patterns of fracture-dislocation of the hand and wrist after punching. We must be careful to evaluate combined injury when a patient visits after punching injury.

Enchondroma of a Digit Treated by Curettage Only / 대한정형외과학회잡지

PURPOSE: Retrospectively, to evaluate the result of treatment by curettage only, enchondroma of the digits. MATERIALS AND METHODS: Fifty-nine cases in 30 patients (male 11, female 19), from July 1997 to Febuary 2002, were reviewed with a minimum follow up of 1 year. Thirty patients were treated for enchondroma of the digits (including Ollier's disease 9, and Maffucci syndrome 2) by curettage only, and the degree of healing was evaluated radiologically. The average duration of follow up was 28.6 months (12-65 months). RESULTS: The radiologic results were evaluated according to the degree of new bone formation by the criteria suggested by Tordai. Group I achieved 79.7% overall and 89.5% for solitary enchondroma, meaning complete healing with normal cortical thickness and a bone defect of less than 3 mm. The average duration of consolidation was 12.4 months, and 8.1months for solitary enchondorma. No recurrence or other complication occured. CONCLUSIONS: Curettage alone is a good treatment option for enchondroma of the digits as comparing with autogenous bone graft, which has the disadvantages of pain, infection, and immobilization.

Operative Treatment of Floating Shoulder

PURPOSE: Conservative treatment of displaced ipsilateral compound fractures of clavicle and scapula neck or gleonoid cavity, causing a floating shoulder, cannot expect satisfactory results in all of them. We reviewed 9 operative cases of floating shoulders and analyzed the results with review of literature. MATERIALS AND METHODS: Nine patients with floating shoulders were operated from July 1996 to August 2000 were reviewed. Patient's age was in average 38.3 years old. Associated injuries were 4 cases of rib fractures and 1 case of humerus shaft fracture. Other injuries included 3 hemothorax, 2 pneumothorax, 1 brachial plexus injury, and 1 ulnar nerve injury. Operation for both clavicle and scapula fracture was done in 6 cases, and surgery was done for only clavicle in 3 cases. Internal fixation for clavicle was done with 3.5 mm AO reconstruction plate in 4 cases and Dynamic Compression Plate in 5 cases. RESULTS: Clinical results by Hardegger method showed 7 cases of excellent, 1 case of good, and 1 case of poor. Complications include 2 cases of limitation of motion of shoulder joint and one case of residual pain. CONCLUSION: Floating Shoulder is caused by high-energy trauma, therefore initial assessment of associated injuries should be done carefully. In evaluating the articular surface of the glenoid and positions of the fracture fragment, CT evaluation is very useful in planning the surgical treatment. Clinical results after surgery can give satisfactory results.

Operative Treatment of Tardy Ulnar Nerve Palsy / 대한정형외과학회잡지

PURPOSE: To compare postoperative outcomes in tardy ulnar nerve palsy. MATERIALS AND METHODS: Between January 1997 and June 2000, 31 patients with the tardy ulnar nerve palsy, who have received operative treatment were divided into a traumatic group and an idiopathic group, and were analyzed with respect to preoperative factors, severity, nerve conduction velocity and postoperative result retrospectively. RESULTS: The traumatic group was composed of 17 cases and the idiopathic group of 14 cases. The average age was 35.7 years in the traumatic group, and 50.6 years in the idiopathic group, and this was statistically different (p=0.001). Other factors were not statistically different between the two groups. The improvement rate, which excluded mild degree patients, was 58.3% (7 in 12 cases) in the traumatic group and 90.9% (10 in 11cases) in the idiopathic group, and this was statistically different (p=0.048, ) and favorable in the idiopathic group. CONCLUSION: In cases of tardy ulnar nerve palsy of the elbow joint, the symptoms and the nerve conduction velocity were statistically no different between the two groups. The postoperative result in the traumatic elbow deformity patients was poorer than that in the idiopathic group.

Palmar Divergent Dislocation of Scaphoid and Lunate

A 28-year-old man presented with a palmar divergent dislocation of the scaphoid and lunate. He was treated with an open reduction and an internal fixation with two Kirschner's wires after the 25th day of trauma due to a neurological injury. The results were satisfactory after 18 months follow up without any evidence of avascular necrosis and traumatic arthritis of the scaphoid and lunate. The patient had no limitation in motion or intermittent wrist pain. We reported this case with a brief review of relevant literatures.

Effect of Polyethylene Particles on Osteoblasts in Pathogenesis of Osteolysis / 대한정형외과학회잡지

PURPOSE: To determine the role of osteoblast in the pathogenesis of osteolysis, we evaluated cell proliferation and differentiation of culturedosteoblasts by adding retrieved polyethylene particles. MATERIALS AND METHODS: We cultured the osteoblasts primarily isolated from rat neonate calvariums and then added polyethylene particles retrieved from osteolysis tissue. We evaluated cell proliferation, alkaline phosphatase activity, the expression of Type I procollagen mRNA, the expression of osteocalcin mRNA, bone nodule formation, and the expression of osteoprotegerin (OPG) mRNA and receptor activatorof NF-kappa B ligand (RANKL) mRNA according to culture periods. RESULTS: Particle groups showed statistically significant decrease in cell proliferation after the 7th day. The expression of type I procollagen mRNA increased on the 14th day. The bone nodules appeared at the 7th day and increased with time. There was no appearance of bone nodule in the control group. The expression of OPG mRNA in particle groups was not changed. The expression of RANKL mRNA was significantly increased in high concentration particle group (4 mg/mL) on the 14th day. CONCLUSION: Polyethylene particles ceased the proliferation of osteoblasts and produced early extracellular matrix maturation and mineralization process in vitro and increased the expression of RANKL promoting osteoclast activities.

Effect of Growth Factors on Type I Collagen Synthesis in Cultured Rabbit's Deep Flexor Tendon Cell / 대한정형외과학회잡지

PURPOSE: This study focuses on the change of the expression of type-I collagen mRNA and extent of collagen synthesis caused by four kinds of growth factos (TGF-b, IGF-I, EGF, PDGF) and their combinations to elucidate the effects of growth factors on rabbit's flexor tendon. MATERIALS AND METHODS: Cells were isolated from rabbit's flexor tendons and cultured with DMEM containing 0.5% fetal bovine serum. Growth factors were then given either independently or in combination. On the 5th, 10th, and 15th day, the cells were collected and the cell proliferation rate was analyzed. The expression of type-I collagen mRNA was analyzed by Northern blot. RESULTS: The expression of type-I collagen mRNA increased significantly in the IGF, PDGF, PDGF/EGF, and PDGF/IGF groups (p<0.05). Western blot analysis showed that the extent of type-I collagen synthesis in culture media was similar to the type-I collagen mRNA expression. CONCLUSION: Based on this study, we conclude that PDGF and IGF individually, and the combinations PDGF/IGF and PDGF/EGF were most effective at aiding the healing process in rabbit's flexor tendon.

Fracture and Dislocation of Carpometacarpal Joint Excluding Thumb / 대한정형외과학회잡지

PURPOSE: We present our operative experiences with uncommon carpometacarpal (CMC) injuries, excluding the thumb. MATERIALS AND METHODS: Twenty four fractures and dislocations of the CMC joint excluding thumb, which were followed up for an average of 18 months were reviewed retrospectively. Emphases were placed on associated injuries, radiographic findings, treatment and complications. RESULTS: The average age of patients was 35 years with 14 cases of indirect trauma as an injury mechanism. Eighteen of 24 cases involved the 4-5th CMC joint, one case involved the 2-3rd joint and one case involved the 3-4th joint. In addition, there were 4 cases that involved all of the CMC joints. Seven cases were operated upon by closed reduction and percutaneous pinning, 16 cases were treated by open reduction and internal fixation, and 1 case received fusion for neglected injury. Eighteen cases had satisfactory results, 2 cases had residual pain, 2 cases showed a limitation of motion and 2 cases had grip weakness. CONCLUSION: Proper diagnosis and treatment of CMC joint injuries can reduce complications and avoid additional procedures.

The Operative Treatment for Carpal Boss / 대한정형외과학회잡지

PURPOSE: Carpal boss of the hand is a rare lesion. This study was conducted to recognize the clinical patterns of this disease entity and to evaluate the diagnosing modalities, differencial diagnosis, and results after operative treatment. MATERIALS AND METHODS: We report upon 7 operative cases of carpal boss of the hand. There were 5 females and 2 males with an aver-age age of 35.4. The mean follow up period for patients in this study was 15 months. The dominant hand was affected in 4 cases and the small ganglion was associated with the carpal boss in 4 cases. RESULTS: The average duration of conservative treatment before surgical treatment was 8.3 months. All of the patients had taken NSAIDs prior to surgery and 4 patients had received a corticosteroid injection at least once. All of the patient had surgical treatment and complete symptomatic relief was achieved in 6 cases. One patient had no symptomatic relief. CONCLUSION: We operated upon patients who did not respond to conservative treatment or in whom the carpal boss associated with a ganglion, 5 of 7 cases showed a satisfactory result. In view of these results, we recommended that operative treatment should be con-sidered in such cases.

Operative Treatment for Isolated Distal Ulnar Shaft Fracture

This study retrospectively evaluated the effectiveness of an open reduction and internal fixation of a tension band wiring technique for treating displaced or unstable comminuted distal ulnar shaft fractures without a radial fracture. Ten patients were treated for an isolated distal ulnar shaft fracture. There were 6 cases of a fracture 2.5 cm below the lower end of the ulna, and 4 cases with the fracture being 2.5 cm to 5 cm away from the lower end of the ulna. The authors classified the fractures of the distal ulnar into 3 types: a type I-simple fracture, a type II-comminuted fracture without a distal radioulnar joint (DRUJ) involvement, and a type III- comminuted fracture with DRUJ involvement. There were 3 cases of a type I fracture, 4 of type II and 3 of type III. The open reduction and internal fixation using tension band wiring were performed in 10 of these cases. After the operation, the wrist was placed in a cast for six weeks before active movement was allowed. The clinical results were excellent in 7 cases, good in 2 and poor in 1. In conclusion, tension band wiring surgery is recommended for treating an isolated distal ulnar with unreduced displaced fractures, in a comminuted fracture that cannot be maintained by a closed reduction and when there is the potential encroachment of fracture fragments in the DRUJ.

Palmar Divergent Dislocation of the Scaphoid and Lunate / 대한정형외과학회잡지

Fracture and dislocation of carpal bones are usually presented as lunar or perilunar dislocation. Palmar divergent dislocation of the scaphoid and lunate has only been reported in 4 cases until now. We experienced a case of palmar divergent dislocation of the scphoid and lunate with a fall from height injury in a 28-year-old male patient. We treated with open reduction and internal fixation with two Kirschner's wires. The result was satisfactory without evidence of avascular necrosis or traumatic arthritis of the scaphoid and lunate after 12months of follow up. We report upon this case with a brief review of the literature.

Traumatic False Aneurysms of the Upper Extremity: 2 Case Reports / 대한정형외과학회잡지

An aneurysm in the upper extremity is rarer than in the lower extremity, and a traumatic false aneurysm is very rare. We encountered two patients with a traumatic false aneurysm in the upper extremity. The first case developed from a posterior interosseous artery injury after an internal fixation using a plate and circumferential wiring for a comminuted fracture of the proximal shaft of radius associated with a dislocation of the left elbow joint. This patient was managed by excision of the false aneurysm, and ligation of the artery. The second case developed from a radial artery catheterization on the left wrist. This was managed by excision of the false aneurysm and an end-to-end anastomosis and resulted in the disappearance of the false aneurysm and a good vascular patency. We report two rare cases of traumatic false aneurysm in the upper extremity and a review of the literature.

Responsiveness of Human Intervertebral Disc Cells in Matrix Synthesis To Adenovirus-Mediated Gene Transfer(IGF-1, TGF-beta1 Encoding Genes) / 대한척추외과학회지

BACKGROUND: Genetic modification of cells through gene transfer gains popularity as a sophisticated delivery system in the management of musculoskeletal disease. Anabolic growth factors like IGF-1 BMP-2 OP-1, and TGF-beta1 were candidate for therapeutic purposus for regenerating matrix of intervertebral disc. TGF-beta1, OP-1 and BMP-2 share same pathway i.e. Smad while IGF-1 utilize P13K pathway. Accordingly it is logical to use two cytokine encoding genes which using different signal transduction pathway to upregulate matrix synthesis. PURPOSE: To elucidate the anabolic effect of the combination gene transfer(IGF-1 and TGF-beta1 encoding gene) to human disc cells, cultured in alginate beads. MATERIALS AND METHODS: Lumbar and cervical intervertebral disc tissue was obtained from surgical disc procedure from fifteen patients. After isolation and culture of the cells, cultures were transduced with first, Adenovirus-TGFbeta1 construct(Ad/TGF-beta1) and Ad/IGF-1 respectively, second, with combination of two viral constructs(Ad/TGF-beta1+Ad/IGF-1). Cultures treated with saline and Ad/luciferase served as control. Then cultures were incorporated into alginate beads. Exogenous TGF-beta1(2ng/ml) and IGF-1(100ng/ml) were administered also. Newly synthesized proteoglycan was assessed using S35 incorporation using chromatography on Sephadex G-25 in PD-10 column. RESULTS: In cultures transduced with single therapeutic gene construct, there were statistically significant 2.9 fold(Ad/TGF-beta1 and 1.8 fold(Ad/IGF-1) increase in newly synthesized proteoglycan comparing control(p<0.05). In culture transduced with double combination of therapeutic gene construct, there were 3.9 fold(Ad/TGF-beta1+Ad/IGF-1) increase in newly synthesized proteo-glycan comparing control(p<0.05). Culture treated with TGF-beta1(2ng/ml) showed 3.9 fold increase and IGF-1(100ng/ml) 2.9 fold increase, TGF-beta1+IGF-1 4.2 fold increase in proteoglycan synthesis compared to control. CONCLUSIONS: Combination gene therapy provided efficient mechanism of upregulating matrix regeneration of the human inter-vertebral disc cells.

Apoptosis of Chondro cytes and Its Regulation in Pathogenesis of Osteoarthritis / 대한류마티스학회지

No abstract available.

Adenovirus-Mediated Therapeutic Gene Transfer: Matrix Synthesis of Human Intervertebral Disc Cells / 대한척추외과학회지

STUDY DESIGN: In vitro experiment to determine the matrix synthesis of human intervertebral disc (IVD) cell to adenovirus-mediated therapeutic gene transfer. OBJECTIVES: To elucidate proteoglycan and collagen synthesis of human IVD cells in vitro to adenovirus-mediated transfer of cDNA of transforming growth factor-beta 1(TGF-beta). SUMMARY OF LITERATURE REVIEW: Sophisticated method to delivery of growth factors, in continuous manner, is the genetic modi-fication of disc cells through gene transfer. Confirming susceptibility of human IVD cell to adenovirus, anabolic response of human IVD cells to therapeutic gene transfer should be next step. MATERIALS AND METHODS: IVD tissue was obtained from fourteen patients with grade III, IV degeneration. Isolation and culture of disc cells were performed. Disc cells were treated with either Ad/TGF-beta exogenous TGF-beta. Control cultures were treated with either saline or Ad/luciferase. Newly synthesized proteoglycans were assessed by 35 S-sulfate incorporation using chro-matography on Sepadex G-25 in PD-10 columns. Uptake of 3 H proline was used to measure synthesis of collagen and noncol-lagen protein. RESULTS: Culture treated with Ad/TGF-beta showed 3 fold increase in proteoglycan synthesis (p<0.05), culture with exogenous T G F -beta failed to demonstrate increase in proteoglycan synthesis. In collagen and noncollagen synthesis, cultures with Ad/TGF-beta and exogenous TGF-beta showed similar 3.7 fold increase in collagen and 2.7 fold increase in noncollagen synthesis comparing control (p<0.05). CONCLUSION: Adenovirus-mediated gene transfer appears to be an efficient technique for modulating biologic activity of human intervertebral disc cells in terms of matrix synthesis.