Thin Split-Thickness Toe Nail-Bed Grafts for Nail Bed Defects in Subungal Exostosis: Two Cases Report / 대한골관절종양학회지

We reviewed the clinical features of 2 patients who underwent surgery for subungal exostosis, focusing on postoperative deformity of the nail. The lesion destroyed the nail bed and was excised with a direct approach. then thin split-thickness sterile matrix graft was done after excision of the tumor because the defect of the nail bed was large. Good postoperative appearance of the nail was obtained by thin split-thickness sterile matrix graft. The use of thin split-thickness sterile matrix graft for the replacement of a nail bed defect can regain a smooth, adherent, and normal-looking nail and avoid donor-site morbidity. Thin split-thickness toe-nail bed graft is a good choice for the prevention of postoperative deformity.

Lisfranc Injury Repair with the TightRope(TM) Device: A Case Report / 대한족부족관절학회지

Lisfranc injury is complex and difficult to treat. Making the correct diagnosis and achieving an anatomical reduction are important factors in regard to achieving a favorable outcome with this injury. We describe a new technique that we have found to be useful for stabilizing Lisfranc injury. This method is relatively fast and simple, and it provides non-rigid fixation. Also, it eliminates the need for implant removal. To date, we have achieved predictable results for stabilizing and treating this injury with the use of a TightRope(TM) Device, instead of traditional interfragmental screw fixation. In this report, we describe a case in which this method was used with satisfactory short-term results.

MR Imaging in a Child with Scurvy: a Case Report

Scurvy is very rare disease in industrialized societies. Nevertheless, it still exists in higher risk groups including economically disadvantaged populations with poor nutrition, such as the elderly and chronic alcoholics. The incidence of scurvy in the pediatric population is very low. This study reports a case of scurvy in a 5-year-old girl with cerebral palsy and developmental delay based on MRI findings.

Arthroscopic ACL Reconstruction Using Bone-Patellar Tendon-Bone Allograft with Flip Technique / 대한정형외과학회잡지

PURPOSE: We report the result of arthroscopic ACL reconstruction using a bone-patellar tendon-bone allograft with the Flip technique. MATERIALS AND METHODS: From October 2002 to August 2003, 21 cases of arthroscopic ACL reconstruction were performed using the Flip technique. The average age and follow-up period was 29.3 years old (17-46) and 13.7 months (10-20), respectively. Physical examinations, such as Lachman test, pivot shift test and measured a quantitative KT-2000 testing, the Lysholm, IKDC, and Tegner scores were performed and the results were compared with those of the final evaluation. RESULTS: Final results of the Lachman test were 1+ in 9 patients, 2+ in 1 patient, and the pivot shift was positive in only 1 patient. Preoperative evaluation revealed an average score with a KT-2000 of 6.8 mm, a Lysholm score of 50.4, an IKDC score below C in all cases and a Tegner score of 3.0. However, the final results showed a KT-2000 of 3.2 mm, a Lysholm score of 86.2, an IKDC score above B in all cases and a Tegner score of 6.6. CONCLUSION: Arthroscopic ACL reconstruction using allogeneic bone-patellar tendon-bone graft with the Flip technique showed excellent functional results with a resolution of the graft-tunnel length mismatch.

MR Findings of Synovial Sarcoma with Intraosseous Involvement: Case Report

Synovial sarcoma is rare soft tissue tumor mesenchymal origin. Osseous involvement of synovial sarco-ma is rare. A 24-year-old man presented with pain and swelling of the lower extremity. MRI of the lower extremity demonstrated a large mass encircling tibia with osseous involvement. Surgical excision of the mass was done and the mass was diagnosed as biphasic synovial sarcoma with bone marrow involvement. We also discuss the other imaging findings of synovial sarcoma on MRI.

The Change of Articular Cartilage Thickness of the Knee Joint Related to Age in Korean

PURPOSE: The purpose of this study is to assess the change of the articular cartilage thickness resulting from physiological aging in normal Korean people without any disease in knee joint. MATERIALS AND METHODS: Voluntary participants of 81 cases, physically normal and free from knee joint disease at present or in the past, were chosen for our research program. The subjects were divided into young, middle and old age group respectively for the male and female; and articular cartilage thickness using MRI were measured. RESULT: Each of the three groups reveals the tendency of decrease in the thickness of the knee joint cartilage in all of the age groups along with the increase of the age. The cartilage thickness according to age for both sex, except for the tibial medial condyle, decreased significantly. For the male subjects, the degree of decrease in cartilage thicknes indicates difference in each sections. However, in case of female, the change of articular cartilage thickness in overall sections showed more significantly decreased in young to middle age group than in middle to old age group. CONCLUSION: The results revealed the normal articular cartilage thickness of knee and time that the thickness of articular cartilage was decreased with age. And we could evaluate the severity of degenerative change of articular cartilage by comparison to normal articular cartilage thickness.

New Modified Chevron Osteotomy for Hallux Valgus / 대한족부족관절학회지

PURPOSE: In this study, we tried to develop the technique of osteotomy for hallux valgus. The new modified technique of osteotomy was accomplished with even more greater stability, accurate correction of the deformity and more effective than 'chevron' osteotomy in terms of correction of the deformity. MATERIALS AND METHODS: Between March 1998 and December 2001, 55 cases of new modified osteotomy for hallux valgus were performed for 39 patients, 16 of whom underwent operation of both feet. Operations were made for 34 women and 5 men whose average age was 46 years old (range, 20~71 years). Average follow up period was three years (range, 2~5 years), and during the follow up, the patients underwent physical examination and assessment with use of the American Orthpaedic Foot and Ankle Society's hallux-metatarso-phalangealinterphalangeal scale8) and standard foot radiographic measurements16). RESULTS: 37 patients (53 cases) out of 39 patients (55 cases) had no pain, good cosmesis, and all of the patients were satisfied with the results of the operation. Two had occasional mild discomfort. The average score according to the hallux-metatarso-phallangeal-interphalangeal scale8) was 93.2 points (range, 78~100 points). The average preoperative intermetatarsal angle was 14.4 degrees, which was decreased to 7.9 degrees after the osteotomy with an average correction of 6.5 degrees and The average preoperative hallux valgus angle was 34.1 degrees, which was decreased to 11.1 degrees after the osteotomy with an average correction of 23 degrees. This new modified technique would prevent the angulation or shortening at the osteotomy site and it was also even more stable at osteotomy site, and could do even more effective and accurate correction of the deformity than conventional Chevron osteotomy. CONCLUSION: New modified chevron osteotomy for the treatment of symptomatic hallux valgus was done in 55 cases, and the results were satisfactory in all cases. This method was more stable at the osteotomy site than conventional Chevron osteotomy and was also possible to do more accurate and more effective correction of the deformity. It was also easy to control the distal fragment of first metatarsal bone.

Total Knee Arthroplasty Without Patellar Resurfacing / 대한정형외과학회잡지

PURPOSE: To Analyze the Clinical Results of the Total Knee Arthroplasty without Patellar Resurfacing. MATERIALS AND METHODS: One hundred and eight Total Knee Arthroplasties (Nexgen(R), Zimmer, USA) without resurfacing of the patella, were performed between February 1995 and September 1999, and 89 cases followed up for more than 36 months were analyzed in this study. The follow up period ranged from 36 to 70 months (average 52 months). The diagnosis was degenerative joint disease in 83 cases (93%), rheumatoid arthritis in 5 cases (6%) and avascular necrosis of medial femoral condyle in 1 case (1%). The clinical results were evaluated according to Knee Society Clinical Rating System. RESULTS: The mean preoperative knee score was 34 points (range 5-63 points) according to the Knee Society Clinical Rating System, and the mean preoperative functional score was 38 points (range, 10-61 points). The mean postoperative knee score was 91 points (range 65-98 points) and the mean postoperative functional score 89 points (range, 63-100 points). The current study shows that patellar complications associated with unresurfacing did not occur, with the exception of 2 cases of persistent peripatellar pain, which resolved by a postoperative 6 months with conservative treatment. The patellofemoral joint space was also well preserved even at the 3 and 5 year follow-ups. CONCLUSION: Complications of total knee arthroplasty, such as patellar dislocation or subluxation, rupture of the patellar tendon, and fracture of the patella, can be avoided by not resurfacing the patella. On the basis of our results, there is little evidence to support routine patellar resurfacing in total knee arthroplasty.

Anterior Cruciate Ligament Reconstruction using an Allo-Cortical Bone Interference Screw and a Bone-Patella Tendon-Bone Autograft / 대한정형외과학회잡지

PURPOSE: We report the results of arthroscopic ACL reconstruction using an allo-cortical bone interference screw and a bone-patellar tendonbone (BPTB) autograft. MATERIALS AND METHODS: A preoperative average KT-2000 tests was 6.8 mm (+/-1.3 SD), Lysholm score 71.8 (+/-8.4 SD), Tegner score 3.2 (+/-0.6 SD) and IKDC score was below C in all cases. At the final follow-up, the average KT-2000 test score was 2.3 mm (+/-0.8 SD), Lysholm score 91.2 (+/-5.3 SD), Tegner score 6.8 (+/-1.4 SD) and the IKDC score was above B in all except two cases. The MRI findings of 3 and 6 months after operation showed diffuse bony edema around an allo-cortical bone interference screw. The shape of screw was well demarcated. At 12 months after operation, the bony edema was markedly decreased and the shape of screw was poorly demarcated. RESULTS: A preoperative average KT-2000 tests was 6.8 mm (+/-1.3 SD), Lysholm score 71.8 (+/-8.4 SD), Tegner score 3.2 (+/-0.6 SD) and IKDC score was below C in all cases. At the final follow-up, the average KT-2000 test score was 2.3 mm (+/-0.8 SD), Lysholm score 91.2 (+/-5.3 SD), Tegner score 6.8 (+/-1.4 SD) and the IKDC score was above B in all except two cases. The MRI findings of 3 and 6 months after operation showed diffuse bony edema around an allo-cortical bone interference screw. The shape of screw was well demarcated.At 12 months after operation, the bony edema was markedly decreased and the shape of screw was poorly demarcated. CONCLUSION: The allo-cortical bone interference screw is one of a fixation materials in ACL reconstruction using a BPTB autograft, if does not seen to have the disadvantages of metallic or bioabsorbable interference screws.

Arthroscopic ACL Reconstruction using Bone-patellar Tendon-bone Autograft and Bioabsorbable Interference Screw / 대한정형외과학회잡지

PURPOSE: We report the results of arthroscopic ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft and a bioab-sorbable interference screw (Bioscrew, poly L-lactic acid, Linvatec co., USA). MATERIALS AND METHODS: From January 1998 to December 1998, we performed 39 cases of arthroscopic ACL reconstruction using BPTB autograft and a bioabsorbable interference screw. The average follow-up period was 2 years and 8 months. We performed KT-2000 testing and measured the IKDC, Tegner and Lysholm scores preoperatively and compared these with the results of a final evalua-tion. We performed second-look arthroscopy on 4 cases and observed the degree of degradation of the bioabsorbable interference screw. RESULTS: Preoperative evaluation revealed an average range with a KT-2000 of 8.1 +/-3.4 mm, a Lysholm score of 66.2 +/-16.3, an IKDC score below C in all cases and a Tegner score of 3.7 +/-0.9, but final results showed a KT-2000 of 2.8 +/-2.2 mm, a Lysholm score of 91.7 +/-7.5, an IKDC score above B in all except 3 cases and a Tegner score of 6.9 +/-1.1. Second-look arthroscopy at 3 and 12 months post-operatively showed no degradation of the bioabsorbable interference screw, but there was partial degradation of the bioabsorbable inteference screw at 21 and 33 months. CONCLUSION: Bioabsorbable interference screws seems a reasonable alternative to metallic screws in ACL reconstruction. Bioab-sorbablescrew implanted in humans may take much longer to degrade than expected, more study is needed.

Diagnostic Value of Arthrometer (KT-2000) in Patients with Anterior Knee Instability / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to present the usefulness of arthrometer (KT-2000) in patients with anterior knee instability and to assist in evaluating an objective prognosis after anterior cruciate ligament reconstruction. MATERIAL AND METHOD: We analyzed the manual maximum anterior displacement, passive anterior displacement at 30Ib force and compliance index between 15Ib and 30Ib, measured by KT-2000 in 82 cases of patient who had unilateral anterior knee instability and 40 cases of volunteers, as control group, who had no history of knee injury. We used the Paired and Independent t-test for statistical analysis. RESULTS: In control group, the mean value of manual maximum anterior displacement is 0.8 +/- 0.9mm, passive anterior displacement, 1.4 +/- 1.3mm and compliance index, 1.1 +/- 1.1mm. In patient group, the mean value of manual maximum anterior displacement is 7.1 +/- 2.7mm, passive displacement, 6.1 +/- 2.6mm and compliance index, 3.8 +/- 1.8mm. We found that the patient group was revealed much higher degree of anterior displacement than the control group (p<0.005) . CONCLUSION: KT-2000 is objective and quantitative in diagnosis of anterior knee instability.

Comparison Between Allograft Mixed with Local Bone and Autograft in Posterolateral Lumbar Fusion / 대한척추외과학회지

STUDY DESIGN: A prospective study. OBJECTIVES: To determine the usefulness of allograft and compare the result of allograft mixed with local bone and autograft in posterolateral lumbar fusion. SUMMARY OF LITERATURE REVIEW: Allograft is used for the purpose of spinal fusion, especially in the scoliosis surgery. In some studies allograft is not recommended in posterior lumbar spinal fusion alone. MATERIALS AND METHODS: Fifteen patients underwent one level posterolateral lumbar fusion using freeze-dried allograft mixed with local bone. We compared them with twenty four patients using autogenous iliac bone graft mixed with local bone about radiographic fusion grading, duration of fusion and clinical outcomes. RESULTS: Radiographic fusion grading of allograft was 7 cases of grade 1, 5 cases of grade 2, 3 cases of grade 3, and grading of autograft was 21 cases of grade 1, 2 cases of grade 2, 1 cases of grade 3. Bone fusion was complete after 11.1 months in allograft and 6.7 months in autograft. Clinically, there were 4 excellent, 9 good, 2 fair cases in allograft and 10 excellent, 11 good, 3 fair cases in autograft. CONCLUSIONS: Allograft was inferior to autograft in posterolateral lumbar fusion because allograft mixed with local bone reduced radiographic fusion grading and prolonged duration of bone fusion.

Arthroscopic-assisted Treatment of the Tibial Condylar Fracture

PURPOSE: Recently, there are many good reports on the arthroscopic management of tibial condylar fractures. But, it may be appropriate for selected tibial condylar fractures and also needs a skilled technique. So we report the results of the tibial condylar fractures treated by the arthroscopy and limited percutaneous fixation or the arthroscopic-assisted management with conventional internal fixation without arthrotomy. MATERIALS AND METHODS: From June 1996 to December 1997, we treated 22 cases of the tibial condy- lar fractures including relatively comminuted one and analysed the results of patients who have been observed at least 1 year with Porters knee evaluation criteria. RESULTS: In 18 out of 22 cases, the results were Acceptable on symptoms(excellent 3, good 15, fair 4), in 18, on function(excellent 10, good 8, fair 3), in 21, on appearance(excellent 12, good 9, fair 1) and in 20, on radiographic appearance(excellent 11, good 9, fair 2). Overall results were Acceptable in 18 cases(82%) and Unacceptable in 4 cases(18%). CONCLUSION: The arthroscopic-assisted management with conventional internal fixation without arthrotomy can be the recommendable treatment for the tibial condylar fractures, including relatively comminuted one, without complications.

Clinical Diagnosis of Meniscus Injury of Knee Joint / 대한정형외과학회잡지

PURPOSE: To report the differences between previous articles in Korea on the common occurence of lateral meniscus tears and our cases, and also which clinical symptoms and signs are the most reliable for diagnosis of meniscal tear. MATERIALS AND METHODS: We analysed 118 patients who were confirmed to have a meniscal tear by arthroscopy from May 1996 to May 1998. The Chi-Square test was used for statistical analysis. RESULTS: There is no statistical difference of frequency between tears of the medial meniscus and those of the lateral meniscus. The most frequent clinical symptom is feeling of subluxation and sign is McMurray test. A combination of McMurray and squatting test is the most frequent positive sign of meniscal tear in our cases. CONCLUSIONS: In our cases, the frequency of medial meniscus tears is more common than those of the previous articles in Korea. To increase the accuracy of clinical diagnosis of meniscal tear, repeated and accurate history taking and physical examination, including above symptoms and signs are very important.

Change of Segmental Motion After Lumbar Posterolateral Fusion / 대한정형외과학회잡지

PURPOSE: To verify the changes of segmental motion after posterolateral lumbar fusion. MATERIALS AND METHODS: Thirty-eight cases of lumbar posterolateral fusion with good postoperative results and full range of motion, followed up for at least one year were reviewed. We measured the translation and angulation by the Dupuis method on flexion extension radiographs. RESULTS: 1) The motion at adjacent segments was 0.75 mm translation and 6.5 degree angulation at L1-2, 0.75 mm and 8.62 degree at L2-3, 0.95 mm and 9.67 degree at L3-4, 1.17 mm and 10.67 degree at L4-5 and 0.41 mm and 7.41 degree at L5-S1. The motion at L5-S1 was less than that in the control group, but at other levels it was not different. 2) The total range of motion of lumbar spine in the control group was 47.8 degree. In one-segment fusion the range of motion was 31.1 degree(64.9%), in two-segment fusion was 26.8 degree(56.1%) and in three-segment fusion was 14.3 degree(29.8%). The longer the fusion level was, the smaller the total range of motion of lumbar spine was. 3) The percentage of motion at adjacent mobile segments in the fusion group increased more significantly than that in the control group. CONCLUSIONS: Segmental motion at adjacent segment in the fusion group was similar to the motion in the control group. The compensatory increased motion at adjacent mobile segment was not definite, however, the percentage of motion at adjacent segment increased after spinal fusion.

Diagnostic Accuracy of Percutaneous Needle Biopsy of Vertebral Lesions / 대한척추외과학회지

STUDY DESIGN: This retrospective study is to confirm the diagnostic accuracy of percutaneous needle biopsy of vertebral lesions. OBJECTIVES: To evaluate the diagnostic accuracy of percutaneous needle biopsy and the clinical and pathological correlation of vertebral lesions. SUMMARY OF LITERATURE REVIEW: A review of previous articles showed that the diagnostic accuracy of percutaneous needle biopsy of vertebral lesions was between 77-94%. The greatest accuracy was achieved in diagnosis of metastatic disease or infection. MATERIALS AND METHODS: We performed 22 percutaneous needle biopsies in twenty vertebral bodies and two posterior elements under the CT guidance. All biopsies were performed with a 16-gauge Osty-cut bone biopsy needle. There were 1 cervical, 8 thoracic and 13 lumbar biopsies. Transpedicular approach was performed on 13 patients and paraspinal approach on 7 patients. There were 8 malignancies, 9 infections, 2 benign tumors, 2 compression fractures and 1 butterfly vertebra. RESULTS: An accurate diagnosis was made in 18 cases(81.8%) of all cases. Two of the 22 specimens were blood clots and two specimens of tuberculous spondylitis were insufficient for definite diagnosis. Bacteriological studies revealed a causative agent in 43% of pyogenic spondylitis. Histologic diagnosis confirming the clinical suspicion was obtained in 16(80%) of the 20 positive cases. There was no complication. CONCLUSION: Percutaneous needle biopsy under the CT guidance is a safe and accurate method for obtaining a diagnosis of vertebral lesions such as osteolytic lesion and infection.

Production of TGF-beta Transfected Fibroblast and Myoblast Stable Cell Lines and their Viability in Rabbit Achilles Tendon / 대한정형외과학회잡지

Transforming growth factor-beta (TGF-beta) has been suspected as a possible gene therapy candidate for orthopedic diseases. We demonstrated that the TGF-beta gene therapy can be applicable to orthopedic patients. After transfection of TGF-beta cDNA sequence to myoblasts [C2 (280)] and fibroblasts (NIH 3T3), stable cell lines with TGF-beta mRNA expression were selected by Northern analysis. To evaluate the possibility of clinical application of these cells to orthopedic diseases, the cells were injected into rabbit achilles tendon. Intratendinous injection was done to evaluate the viability of the cells and to determine the optimal concentration for in vivo expression. At 6 weeks after injection, the injected tendon was thickened with newly formed collagen. The results from this experiment indicates that these cells survived and stimulated matrix formation in rabbit achilles tendon. We concluded that TGF-beta cDNA transfected cells can be useful in the evaluation of TGF-beta biology in vivo.

Expression of TGF -beta I and II Ligands and Receptors at Epiphyseal Plate and Fracture Callus / 대한정형외과학회잡지

To understand the expression of hoth TGF-beta l and II ligands and the receptors, artificial fracture was made on rat femur. Fracture callus and epiphyseul plate were stained immunohistochemically on 3rd. 7th, 14th, 21st, 42nd and 56th day after trauma. Polyclonal antibody was used to stain TGF-beta I and II ligands and receptors. At epiphyseal plate, both ligand and receptor were expressed from each cell in proliferating and maturing zone. But there was no difference between type I and II except expression time. TGF-beta II ligand and receptor were expressed earlier: they were expressed mostly by the cells at the zone of proliferating cartilage but TGF-beta1 ligand and receptor were expressed mostly hy the cells at zone of maturing cartilage. At fracture site, TGF-beta expression was observed from 3rd day after trauma and it reached its maximum intensity at 2 weeks. It decreased thereafter and disappeared at 6 weeks after trauma. In enchondral ossification area, TGF-beta expressing cells were scattered throughout the enchondral mass. In intramembranous ossification area, the ligands and receptors were expressed from the osteohlasts just heneath the periosteum. ln summary, TGF-beta ligands and receptors were expressed at epiphyseal plate and fracture callus. There was no difference between TGF-beta 1 and 2 expres.ion except the appearance time at epiphyseal plate. We could not draw any conclusion about ligand and rcceptor mechanism with this immunohistochemical staining.

TGF - beta Type II Receptor Anomaly and of Its Functional Restoration in Osteosarcoma Cell Lines / 대한정형외과학회잡지

TGF-p receptor mutation is now considered as one of the carcinogenic process of many tumors. To evaluate whether there is an abnormality in TGF-p type II receptor in osteosarcoma cell lines, we performed Northern analysis, cross-linking assay, luciferase activity and TGF-p growth inhibition assay in four osteosarcoma cell lines: G292, U202, HOS and SaOS. We also transfected the tumor cells with normal TGF-p type II receptor sequence to find if there is a possibility of gene therapy in osteosarcoma. In Northern analysis, Type II receptor expressions were decreased at SaOS, U202 and HOS cell lines. In cross-linking assay, all four cell lines didnt show type II receptor at their cell surface. The growth of these tumor cells were not suppressed by TGF-p. From these findings, we concluded that the normal production of TGF-p type II receptor was impaired in osteosarcoma. The transfection of these tumor cells with normal type II receptor sequence restored growth inhibition by TGF-p. This means even though TGF-p type II receptor is abnormal in osteosarcoma, we can restore its function by transfection of normal sequence. We think that the TGF-p type Il receptor gene therapy can be one of the treatment method for osteosarcoma in the future.

Conservative Treatment of Femoral Shaft Fractures in Children / 대한정형외과학회잡지

Forty-nine children between the ages of 2 and 10 years, treated conservatively for fomoral shaft fracture, were studied clinically and radiographically to access the complications and related factors. They had an average follow-up of 48.8months(range, 12 to 77months). 35 percent of the patients had significant associated injuries. Leg length discrepancies of 10mm to 20mm are observed in 5 cases(10%) of the patients. The average overlap of bone ends at union was 6.5mm. The average growth acceleration was 8.8mm regardless of sex, age, upper limb dominance, fracture site or shape, but was promoted by overriding of the fracture ends at union, There were 16 cases(32%) of excessive angular deformity of 10° to 25° after union. However all deformities were remodelled enough to give normal alignment of the joint surface. The growth plate played on important role in the remodelling process.