Carpal Tunnel Syndrome Caused by Persistent Median Artery and Bifid Median Nerve in an Adolescent / 대한정형외과학회잡지

Carpal tunnel syndrome is rare in children. When it does occur in children, the most common causes reported are mucopolysaccharidosis and mucolipidosis. The median artery is a transitory vessel that develops from the axillary artery in early embryonic life and does not normally survive until postfetal life. In a small percentage of individuals, however, it persists into adulthood and is frequently accompanied by a bifid median nerve. A persistent median artery can be a cause of carpal tunnel syndrome in adults, but it is extremely rare in children and adolescents. This paper reports a case of a carpal tunnel syndrome caused by a persistent median artery and bifid median nerve in a 13-year-old girl.

Management of Anterior Cruciate Ligament Injuries in Children and Adolescents / 대한정형외과학회잡지

With the increased participation in sports activity, there is an increased tendency of anterior cruciate ligament (ACL) injuries in children and adolescents. Nonsurgical management including activity modification, bracing, and physical therapy, is best used for patients with partial tears involving < 50% of the ACL diameter. In patients with complete ruptures, chronological, physiological, and skeletal maturity must be assessed to select the appropriate surgical technique. This paper reviews the management of ACL tears in skeletally immature patients.

Novel Mutation (c.8725T>C) in Two Siblings With Late-Onset LAMA2-Related Muscular Dystrophy

No abstract available.

Novel Mutation (c.8725T>C) in Two Siblings With Late-Onset LAMA2-Related Muscular Dystrophy

No abstract available.

Management of Flexible Flatfoot in Chidren and Adolescent / 대한정형외과학회잡지

Most children and adolescents with flexible flatfeet are asymptomatic and most do not require treatment. Scant convincing evidence exists to support the use of inserts or shoe modifications for effective relief of symptoms, and there is no evidence that those devices change the shape of the foot. Surgical correction is indicated for failure of prolonged nonsurgical attempts to relieve pain that interferes with normal activities and occurs under the medial midfoot and/or in the sinus tarsi. Osteotomies with supplemental soft-tissue procedures or arthroereisis are the suggested operative procedures for symptomatic flatfoot. An associated contracture of the heel cord is present in nearly all cases. Concurrent rigid forefoot supination deformity should be addressed as well.

Transplantation of a Scaffold-Free Cartilage Tissue Analogue for the Treatment of Physeal Cartilage Injury of the Proximal Tibia in Rabbits

PURPOSE: The purpose of this study was to investigate the effects of transplantation of an in vitro-generated, scaffold-free, tissue-engineered cartilage tissue analogue (CTA) using a suspension chondrocyte culture in a rabbit growth-arrest model. MATERIALS AND METHODS: We harvested cartilage cells from the articular cartilage of the joints of white rabbits and made a CTA using a suspension culture of 2x107 cells/mL. An animal growth plate defect model was made on the medial side of the proximal tibial growth plate of both tibias of 6-week-old New Zealand white rabbits (n=10). The allogenic CTA was then transplanted onto the right proximal tibial defect. As a control, no implantation was performed on the left-side defect. Plain radiographs and the medial proximal tibial angle were obtained at 1-week intervals for evaluation of bone bridge formation and the degree of angular deformity until postoperative week 6. We performed a histological evaluation using hematoxylin-eosin and Alcian blue staining at postoperative weeks 4 and 6. RESULTS: Radiologic study revealed a median medial proximal tibial angle of 59.0degrees in the control group and 80.0degrees in the CTA group at 6 weeks. In the control group, statistically significant angular deformities were seen 3 weeks after transplantation (p<0.05). On histological examination, the transplanted CTA was maintained in the CTA group at 4 and 6 weeks postoperative. Bone bridge formation was observed in the control group. CONCLUSION: In this study, CTA transplantation minimized deformity in the rabbit growth plate injury model, probably via the attenuation of bone bridge formation.

Prevalence of Vitamin D Deficiency in Korean Children Presenting with Nonspecific Lower-Extremity Pain

PURPOSE: Although interest in the role played by vitamin D in bone health is increasing, little is known about the role of this vitamin in musculoskeletal pain in children. This study aimed to assess the prevalence of vitamin D deficiency in children presenting with nonspecific lower extremity pains. MATERIALS AND METHODS: From 2011 to 2012, 183 children underwent evaluation for nonspecific lower-extremity pains. Patients with valid causes, such as fractures or transient synovitis, were excluded, as were those with underlying medical conditions, such as cerebral palsy and metabolic disease. Ultimately, 140 patients met the inclusion criteria. Levels of serum 25-hydroxy vitamin D [25-(OH)D], the ideal indicator of vitamin D status, were measured in these children. RESULTS: Eighty-seven boys (62.1%) and 53 girls (37.9%) were included. The mean age at presentation was 5.2 years (range, 2-15). Serum 25-(OH)D levels were or =30 ng/mL in only 5.0%. Most patients visited the hospital in the winter (41.4%) (summer, 12.9%), and serum 25-(OH)D levels were also lowest in the winter (17.2+/-5.5 ng/mL). CONCLUSION: This study found a high prevalence of vitamin D deficiency or insufficiency in Korean children with nonspecific lower-extremity pains, indicating a positive association between vitamin D deficiency and growing pains. More attention should be directed toward vitamin D and its role in the optimization of bone health.

Cubital Tunnel Syndrome by Anconeus Epitrochlearis in an Adolescent / 대한정형외과학회잡지

Compression neuropathy of the ulnar nerve due to anconeus epitrochlearis muscle is rare in adolescents. It is usually known that the hypertrophied muscle in adult or weightlifting athletes compresses the ulnar nerve. There were only few case reports in children and adolescent relevant to athletic activities. In this case, a non-athlete 15-year-old girl developed compression ulnar nerve neuropathy caused by an anconeus epitrochearis muscle. This case is remarkable as an anconeus epitrochearis muscle is uncommon in non-athlete children and adolescent since a literature review revealed no previous report.

Surgical Treatment of Both Forearm Bone Fracture

No abstract available.

Kimura's Disease of the Trunk / 대한정형외과학회잡지

Kimura's disease is a very rare, benign, lymphoproliferative inflammatory disorder of unknown etiology. A 48 year-old man had multiple soft tissue masses in his trunk, which was diagnosed as Kimura's disease by histopathologic evaluation. Here, we report the case with a review of the literature.

Successful general anesthesia for cervical spine fusion in a patient with spondyloepiphyseal dysplasia congenita: A case report

Spondyloepiphyseal dysplasia congenita (SEDC) is a kind of skeletal dysplasia, inheritable condition. The clinical features of SEDC are dwarfism, myopia with or without retinal detachment, coxa vara, thoracic dysplasia with respiratory failure and laryngotracheal stenosis. A point of particular concern to anesthetists is odontoid hypoplasia which, combined with ligamentous laxity, leads to atlantoaxial instability. We report successful general anesthesia for cervical spine fusion of a patient with SEDC.

Sural Artery Flap for the Treatment of Osteomyelitis of the Lower Leg / 대한정형외과학회잡지

PURPOSE: We report our experiences with a sural artery flap for the treatment of soft tissue defects in the lower leg with osteomyelitis. MATERIALS AND METHODS: From 1998 to December 2004, 35 patients underwent sural artery flap surgery for soft tissue coverage in the lower leg. Among them, 13 cases also had osteomyelitis. The defects were located at the proximal 1/3 of the lower leg in 2 cases, middle 1/3 in 2 cases, and around the ankle in 9 cases. A distally based sural artery flap was performed in 11 cases, and 2 cases were treated with a proximally based sural artery flap. RESULTS: The size of the defects ranged from 3x3 cm to 15x10 cm. Two cases showed marginal superficial necrosis that required debridement and secondary closure. After an average follow-up period of 33 months, the osteomyelitis was cured in all cases without recurrence. CONCLUSION: A sural arteriolized flap is useful for the treatment of osteomyelitis in the lower leg accompanied by a soft tissue defect.

Causes and Surgical Treatment of Idiopathic Genu Vara / 대한정형외과학회잡지

PURPOSE: To determine the underlying causes of idiopathic genu vara, and to evaluate the results of surgery. MATERIALS AND METHODS: Radiographic measurements were made using a standing orthoroentgenogram and a computerized axial tomography scan. Functional and cosmetic results after surgery were evaluated according to the causes. RESULTS: The patients with idiopathic genu vara were categorized into three groups: a group associated with increased femoral anteversion, a group associated with tibia vara and increased external rotation of the tibia, and a group associated with tibia vara. Satisfactory functional and cosmetic results were obtained after corrective surgery based on actual causes. CONCLUSION: An accurate analysis based on the rotational and angular deformities is needed to make a surgical treatment plan for idiopathic genu vara.

The "Four-in-One" Procedure for Habitual Patellar Dislocation in Children with Formation Failure of Femoral Trochlea and Generalized Ligamentous Laxity : A Preliminary Report / 대한정형외과학회잡지

Purpose: To evaluate the clinical results of a "Four-in-One" procedure for a habitual dislocation of the patella in children with generalized ligamentous laxity and formation failure of the femoral trochlea. Materials and Methods: Five knees in 4 patients were included in this study. The average age of the patients at the time of surgery was 5.9 years and the subjects were followed up for an average of 41.6 months postoperatively. The clinical results were evaluated using the criteria of the Kujala's scoring system as well as a physical examination and radiological findings. Results: During the follow-up period, there were no recurrent dislocations, knee joint pain, limitations of motion or gait disturbances in any of the cases. The mean Kujala score was 96.8. Two cases had complications related to wound healing but they healed eventually. Conclusion: The "Four-in-One" procedure, which include the lateral retinacular release, medial vector augmentation, semitendinosus tenodesis, and patellar tendon transfer is recommended for a habitual dislocation of the patella in children with generalized ligament laxity and formation failure of the femoral trochlea.

A New Classification for Idiopathic Genu Vara

PURPOSE: Past classification for the treatment of idiopathic genu vara depended simply on the measurement of distance between the knees, without attention to the rotational profile of the lower extremity. We retrospectively analyzed anatomical causes of idiopathic genu vara. PATIENTS AND METHODS: Twenty eight patients with idiopathic genu vara were included in this study. All patients were surgically treated. To evaluate the angular deformity, a standing orthoroentgenogram was taken and the lateral distal femoral angle and the medial proximal tibial angle were measured. In order to assess any accompanying torsional deformity, both femoral anteversion and tibial external rotation were measured using computerized tomographic scans. A derotational osteotomy was performed at the femur or tibia to correct rotational deformity, and a correctional osteotomy was performed at the tibia to correct angular deformity. RESULTS: Satisfactory functional results were obtained in all cases. Genu vara was divided into 3 groups according to the nature of the deformity; group 1 (6 patients) with increased femoral anteversion, group 2 (10 patients) with proximal tibial varus deformity alone, and group 3 (12 patients) with proximal tibial varus deformity accompanied by increased external tibial rotation. CONCLUSION: The success seen in our cases highlights the importance of an accurate preoperative analysis that accounts for both rotational and angular deformities that may underlie idiopathic genu vara.

Refractures of the Upper Extremity in Children

Purpose: To investigate the etiologic factors related to refractures of the upper extremity in children. Patients and Methods: Eighteen refractures were divided into three groups according to the location of the initial fractures. They were analyzed in terms of the type of refractures, fracture patterns, and the existence of an underlying deformity. Results: Of nine supracondylar fractures of the humerus, two involved refractures at the supracondylar region, and the other seven involved the lateral condyle. Underlying cubitus varus was present in six cases. Of three lateral condylar fractures of the humerus, one had a refracture at the supracondylar region, and two cases involved the lateral condyle. One had an underlying cubitus varus. All but one case in the humeral fractures group were late refractures, and were treated with surgery. Of six repeat forearm fractures, five were early type and occurred at the original site within nine weeks, four at the diaphysis of both bones of the forearm, and one at the diaphysis of the ulna. All cases in the forearm fractures group, save one, had volar angulation before the refracture, and were treated conservatively. Conclusion: In the humerus, the underlying cubitus varus was the most important predisposing factor for refractures and lateral condyle fractures were common. In the forearm, volar angulation of the diaphysis was related to refractures, and complete and circular consolidation of the primary fracture of the forearm was thought to be important in prevention.

Hepatocyte Growth Factor, Vascular Endothelial Growth Factor and Tumor Necrosis Factor-Alpha in Patients with Kawasaki Disease

PURPOSE: Kawasaki disease (KD) is a multisystemic inflammatory vasculitis. Cytokines and growth factors have been implicated in the development of coronary lesions in KD. Hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) are thought to stimulate endothelial cell proliferation and induce angiogenesis in vivo. However, the precise mechanism of how HGF and VEGF produce coronary artery disease in children is still unknown. We measured serum levels of HGF, VEGF and tumor necrosis factor-alpha (TNF-alpha) in KD and investigated the association of these factors with the development of coronary artery lesions. METHODS: Serum levels of HGF, VEGF and TNF-alpha were measured in 24 KD patients (group 1, 8 patients with normal coronary artery; group 2, 16 patients with coronary artery lesions) and 21 controls (group 3, 10 afebrile controls; group 4, 11 febrile controls). Blood samples from each study subjects were drawn before and after intravenous immunoglobulin (IVIG) therapy and in the convalescent stage. RESULTS: The HGF levels before IVIG therapy were significantly higher in group 1 and 2 than in group 3 (P<0.05). The VEGF levels were significantly higher in group 1 and 2 than group 3 and 4 (P<0.05). The TNF-alpha levels before IVIG therapy were significantly higher in group 1 and 2 than group 3 and 4 (P<0.05). Serial serum levels of HGF, VEGF and TNF-alpha in KD patients with coronary artery lesions were high before IVIG therapy and decreased after IVIG therapy and in the convalescent stage. In the acute KD patients with coronary artery lesions serum VEGF levels correlated significantly with TNF-alpha levels (r=0.456). CONCLUSION: Serum HGF, VEGF and TNF-alpha levels can be used as a valuable marker not only for early diagnosis of Kawasaki disease, but also for differential diagnosis of other febrile diseases.

Pulse wave velocity and ankle brachial index in adolescents with essential hypertension / 소아과

PURPOSE: Pulse wave velocity(PWV) and ankle brachial index(ABI) are not only noninvasive methods used to assess arterial stiffness in adults, but also useful, simple ways to estimate the severity of hypertension, end stage renal disease and atherosclerosis in adults. But there are few studies on PWV and ABI in adolescents and children. In this study, hypertensive adolescents were compared to normal individuals to find out the usefulness of PWV as the index of progress in the disease. METHODS: 413 teenagers were divided into three groups. The first group consisted of adolescents that only had hypertension(Group 1:23 teenagers). The second group consisted of the adolescents who had hypertension with obesity(Group 2:17 teenagers), and the last group was the normal subjects(Group 3:328 teenagers). Weight, height and body mass index were measured. Simultaneous measurements of systolic, diastolic and average blood pressure were obtained from the four extremities. PWV, ABI, ejection time and preejection period were also measured. RESULTS: Right brachial-ankle PWV was significantly higher in both group 1 and group 2 compared with group 3, and significantly higher in group 2 compared with group 1. Likewise, left brachial-ankle PWV also showed significantly higher values in both group 1 and group 2 compared with group 3, and also higher values in group 2 compared with group 1. Positive correlations were found between the systolic, diastolic, average blood pressure and PWV. There were also positive correlations between the blood pressure and weight, body mass index. CONCLUSION: Higher PWV was demonstrated in adolescents with essential hypertension compared to normal subjects. Follow-up study is needed to evaluate the progress.

Effects of Changes in Mechanical Loading on Endochondral Bone Formation in Hindlimb-suspended Rats / 항공우주의학회지

BACKGROUND: To examine the effects of changes in mechanical loading on endochondral bone formation, a simulated rat model of weightlessness was introduced and the changes in the growth plate were evaluated. METHODS: Unloading condition on the hindlimb of Sprague-Dawley rats was created by fixing a tail and lifting the hindlimb. Six rats aged 6 weeks old were assigned to each group of unloading and reloading with their control group. Unloading was maintained for three weeks, and then reloading was applied for another one week afterwards. Histomorphometry for the assessment of vertical length of the growth plate, 5-bromo-2'-deoxyuridin (BrdU) immunohistochemistry for cellular kinetics, and biotin nick end labeling TUNEL assay for chondrocytes in the growth plate were performed. RESULTS: The vertical length of the growth plate and the proliferative potential of chondrocytes were decreased in the unloading group than those of the control group. Inter-group differences were more significant in the proliferative and hypertrophic zones. Reloading increased the length of growth plate and proliferative potential of chondrocytes as evidenced by the increase of the ratio of positive BrdU stained cells. However, the apoptotic changes in the growth plate were not affected by the alterations of the weight bearing. CONCLUSION: Alterations in the weight bearing induced changes in the chondrocytic proliferative potential of the growth plates and had no effect on the apoptosis occurrence. This may suggest that deprived weight bearing due to various clinical situations hamper normal longitudinal bone growth. Further studies regarding the factors for reversibility of chondrocytic proliferation upon variable mechanical stresses are needed.

Altered Cellular Kinetics in the Growth Plate according to Alterations in the Weight Bearing / 대한정형외과연구학회지

PURPOSE: To examine the effects of change in the weight bearing on the growth plate metabolism, a simulated animal model of weightlessness was introduced and the chondrocytes' cellular kinetics were evaluated. MATERIALS AND METHODS: Unloading condition on the hind-limb of Sprague-Dawley rats was created by fixing a tail and lifting the hind-limb. Six rats aged 6 weeks old were assigned to each group of unloading, reloading, and control groups of unloading or reloading. Unloading was maintained for three weeks, and then reloading was applied for another one week thereafter. Histomorphometry for the assessment of vertical length of the growth plate, 5-bromo-2'-deoxyuridin (BrdU) immunohistochemistry for cellular kinetics, and biotin nick end labeling TUNEL assay for chondrocytes in the growth plate were performed. RESULTS: The vertical length of the growth plate and the proliferative potential of chondrocytes were decreased in the unloading group than those of control groups. Inter-group differences were more significant in the proliferative and hypertrophic zones. Reloading increased the length of growth plate and proliferative potential of chondrocytes as evidenced by increase of the ratio of positive BrdU stained cells. However, apoptotic changes in the growth plate were not affected by the alterations of weight bearing. CONCLUSION: Alterations in the weight bearing induced changes in the chondrocytic proliferative potential of the growth plate and have no effects on the apoptosis occurred. This may suggest that deprived weight bearing due to various clinical situations hamper normal longitudinal bone growth, and further studies regarding the factors for reversibility of chontrocytic proliferation upon variable mechanical stresses are needed.