Wedge-Shaped Resection for Massive Xanthomatosis of Achilles Tendon / 대한정형외과학회잡지

Purpose@#Xanthomatosis of the Achilles tendons is rare. In some patients, however, the lesions in the Achilles tendon need to be removed, which may be painful and disfiguring. While studies of successful surgical outcomes for the total resection and reconstruction of the Achilles tendon have been reported, reconstruction surgery has a technical challenge, and extended surgical exposures are required. This study analyzed five cases of bilateral xanthoma of the Achilles tendon, which was treated surgically using a wedge-shaped tendon-sparing approach to eliminate the need for tendon reconstruction. @*Materials and Methods@#From July 2010 to May 2018, five patients with xanthomatosis in both Achilles tendons underwent wedgeshaped tendon preserving surgery. The average age was 49 years (range, 40–55 years), and the follow-up period was 21.4 months (range, 12–31 months). The patients consisted of three males and two females. Complications related to surgery were recorded. The outcome measures included the range of motion of the ankle joint, American Orthopaedic Foot and ankle Society (AOFAS) ankle/hindfoot score, and visual analogue scale (VAS) for overall satisfaction at the last follow-up. The availability of a single-limb heel raise and returning time to work were also measured. @*Results@#Wound dehiscence that did not require secondary surgery was noted in one patient. At the last follow-up, the range of motion of the ankle joint was normal in all patients. The mean AOFAS ankle/hindfoot score was 91 (range, 85–96) and the VAS for the overall satisfaction ranged from 8 to 10. The average time between surgery and return to work was 27.6 days (range, 17–58 days) and all patients could perform a single-limb heel raise test. @*Conclusion@#The tendon-sparing technique, which can preserve the anatomical functioning of the Achilles tendon, could be an excellent surgical approach because it has very promising functional and cosmetic surgical outcomes in patients with Achilles tendon xanthomatosis.

Brachymetacarpia and Brachymetatarsia in Patients with Multiple Hereditary Exostosis

Background@#Multiple hereditary exostosis is a common autosomal dominant inherited musculoskeletal disorder that manifests with multiple osteochondromas. The clinical manifestations and pathological characteristics of osteochondromas found in the long bone and genetic alterations related to multiple hereditary exostosis have been widely reported. In this study, we investigated the characteristics of brachymetacarpia and brachymetatarsia associated with multiple hereditary exostosis. @*Methods@#Of the 133 patients with a diagnosis of multiple hereditary exostosis who were recruited from 2005 to 2018, 101 patients who underwent plain radiography after 10 years of age were included. There were 55 male (54.5%) and 46 female (45.5%) patients. Brachymetacarpia or brachymetatarsia was diagnosed when disruption of the Lièvre parabola connecting the metacarpal or metatarsal heads was observed on plain radiographs. Three orthopedic surgeons individually reviewed hand and foot plain radiographs. @*Results@#Of the 101 patients, 41 patients (40.6%) had more than 1 brachymetacarpia (88 cases) or brachymetatarsia (81 cases). Among 41 cases, 22 (53.7%) were male and 19 (46.3%) were female. The mean age at the time of radiographic evaluation of the hands and feet was 14.6 years (range, 10–63 years). Shortening was most commonly found in the 3rd and 4th metacarpal or metatarsal bones. @*Conclusions@#We found a relatively high incidence of brachymetacarpia and brachymetatarsia in our patients. Physicians should suspect the presence of brachymetacarpia and brachymetatarsia when treating patients with multiple hereditary exostosis.

Diagnosis and Treatment of Brown Tumor / 대한정형외과학회잡지

PURPOSE@#Brown tumor is a tumor-like disease that can occur as a linked disease of hyperparathyroidism which can causes osteoporosis, osteitis fibrosa cystica, pathologic fractures. Brown tumor has been reported as a case report, but there is no comprehensive report on the exact diagnosis and principle of management for osseous lesion. The purpose of this study is to report the treatment and results of osseous lesions through 5 cases.@*MATERIALS AND METHODS@#From February 2004 to May 2015, five cases of Brown tumor were diagnosed in Chosun University Hospital and Chonnam National University Hospital orthopedic department. Medical records and radiographs were reviewed retrospectively. Parathyroid tumors were surgically removed, and surgical treatment and observation were performed for orthopedic osseous lesions.@*RESULTS@#The mean length of the long axis of the symptomatic osseous lesion was 6.2 cm (4.5–9.0 cm). An average of 7.6 (range, 3 to 14) of high uptake osseous lesion showed in whole body bone scan. The absolute value, T-score and Z-score of the vertebrae and proximal femur were adequate for diagnosis of osteoporosis using dual energy X-ray absorptiometry bone mineral density at diagnosis and recovered to normal at the last follow-up. In laboratory tests, serum concentrations of total calcium, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, and parathyroid hormone were helpful to diagnosis and normalized upon successful removal of parathyroid adenoma or cancer.@*CONCLUSION@#For accurate diagnosis of Brown tumor, it should be accompanied by systemic examination as well as clinical symptoms, laboratory tests and radiologic examination for osseous lesions. And a good prognosis can be expected if the hyperparathyroidism is treated together with the comprehensive treatment of osseous lesions.

Diagnosis and Management of Hip Dislocation in Patients with Kabuki Syndrome

BACKGROUND: Kabuki syndrome is a rare genetic disorder characterized by distinct dysmorphic facial features, growth deficiency, intellectual disabilities, unusual dermatoglyphic patterns, and skeletal abnormalities. The incidence of hip dislocation in Kabuki syndrome ranges from 18% to 62%. We reviewed the outcomes of management of hip dislocations in patients with Kabuki syndrome with special attention to the diagnostic processes for hip dislocation and Kabuki syndrome. METHODS: Among 30 patients with mutation-confirmed Kabuki syndrome, we selected six patients who had hip dislocations and reviewed their medical records and plain radiographs. The modes of presentation and diagnostic processes for both hip dislocations and Kabuki syndrome were investigated. The management and treatment outcomes of hip dislocations in patients with Kabuki syndrome were evaluated. RESULTS: The average age of patients at the time of diagnosis of hip dislocation was 7.7 months (range, 1 week to 22 months). None of the patients were diagnosed as having Kabuki syndrome at that time. Two patients were treated with a Pavlik harness; one, with closed reduction; two, with open reduction and later pelvic and/or femoral osteotomies; and one, with open reduction combined with pelvic osteotomy. The patients were followed up for 5.8 years on average (range, 2.0 to 10.5 years). The radiologic outcome was graded as Severin IA or IB for three patients who were older than 6 years at the latest follow-up (mean age, 9.9 years; range, 7.8 to 12.4 years). In the remaining three patients younger than 6 years (mean age, 3.8 years; range, 2.7 to 5.3 years), the lateral center edge angle was more than 15°. The clinical diagnosis of Kabuki syndrome was made during follow-up after hip dislocation treatment and confirmed by mutational analysis at a mean age of 4.7 years. The mean interval between the diagnosis of hip dislocation and Kabuki syndrome was 4.0 years. CONCLUSIONS: The management of hip dislocation by conservative or surgical method showed successful results. Awareness of Kabuki syndrome could lead to an early diagnosis of this rare disease in patients with hip dislocation and allow for early detection of other underlying conditions and multidisciplinary management.

Evaluation of the Outcomes according to Etiology in the Pediatric Pes Planovalgus after Lateral Column Lengthening: By Radiologic and Pedobarographic Measurements / 대한정형외과학회잡지

PURPOSE: Pes planovalgus is one of the most common foot deformities among pediatric orthopedic diseases and is divided into idiopathic and neuromuscular planovalgus according to its etiology. This study evaluated the radiologic and pedobarographic outcomes of the treatment for pes planovalgus in children treated with lateral column lengthening, compared the outcomes according to the etiology, and investigated the correlation between the radiologic and pedobarographic findings. MATERIALS AND METHODS: Sixty-three patients (97 feet), who underwent lateral column lengthening, were divided into groups of 30 patients (47 feet) with neuromuscular disease and 33 patients (50 feet) with idiopathic etiology. The preoperative, immediately postoperative, 1 year, and 3 year follow-up radiographic measurements on the plain radiograph antero-posterior (AP) and lateral view were compared. In pedobarography, the foot pressures were subdivided into 4 areas to measure the contact time, contact area, peak pressure, and maximum force. The pre- and postoperative pedobarographic measurements were compared and the correlations between the radiographic and pedobarographic measurements were evaluated. RESULTS: The radiographic index at the 1st postoperative year and 3rd postoperative follow-up did not show significant differences according to the etiology. In pedobarography, idiopathic planovalgus showed a significant increase in the maximum force in the hindfoot and forefoot. The correlation between the radiologic findings and pedobarographic findings was statistically significant between the tibiocalcaneal angle in the lateral view and the maximum force, and the contact area of hindfoot on pedobarography, between tibiocalcaneal angle in the lateral view and the contact area of the toes in idiopathic planovalgus. In neuromuscular planovalgus, the peak pressure in the hindfoot had a strong negative correlation with talonavicular coverage angle in the AP view and talo-1st metatarsal angle, and the talohorizontal angle in the lateral view. CONCLUSION: Lateral column lengthening is an effective surgical procedure for flatfoot patients. On the other hand, the radiographic examination has limitations for accurate assessments of the postoperative results and prognosis. Qualitative and quantitative evaluations are available by pedobarography and it is a useful instrument for an evaluation of planovalgus when used in conjunction with radiography.

Prognostic Factors in Acetabular Development Following Reduction of Developmental Dislocation of the Hip in Patients under the Age of 24 Months / 대한정형외과학회잡지

PURPOSE: The aims of this study are to evaluate the outcome of treatment for developmental dislocation of the hip (DDH) in children under the age of 24 months who underwent open reduction (OR) or closed reduction (CR) and to determine radiologic prognostic factor. MATERIALS AND METHODS: A total of 90 hips of 88 children under the age of 24 months treated for DDH were included. The treatments for these children were CR in 29 hips and OR in 61 hips. All patients were followed up for more than 5 years. Radiographic evaluations, including acetabular index (AI), Yamamuro's distance a and b, center-edge angle (CEA), sourcil shape, and teardrop shape have been proposed to indicate the degree of DDH. Hips were reclassified according to the Severin criteria (classes I and II, satisfactory; classes III and IV, unsatisfactory). RESULTS: Among the 90 hips, 67 hips (74.4%) were included in the ‘satisfactory group’, while 23 hips (25.6%) were included in the ‘unsatisfactory group’. In the CR group, 23 hips (79.3%) were included in the ‘satisfactory group’, while 6 hips (20.7%) were included in the ‘unsatisfactory group’. In the OR group, 44 hips (72.1%) were included in the ‘satisfactory group’, while 17 hips (27.9%) were included in the ‘unsatisfactory group’. There was no significant difference between the reduction methods. At 1 year follow-up after reduction, the AI improvement in the ‘satisfactory group’ (8.1° [23.4%]) was significantly higher than that in the ‘unsatisfactory group’ (6.7° [18.5%]) (p=0.012). A significant difference of the mean CEA values was observed between the ‘satisfactory group’ and the ‘unsatisfactory group’ 3 years after the treatment (p=0.001). Five years after reduction, the V shape of teardrop and the upward shape of acetabular sourcil were observed in 2 hips (3.0%) and 4 hips (6.0%) of the ‘satisfactory group’, respectively, whereas the corresponding findings were observed in 3 hips (13.0%) and 5 hips (21.7%) of the ‘unsatisfactory group’, respectively (p=0.023, 0.005). CONCLUSION: The improvement of AI at 1-year and CEA at 3-year follow-ups, as well as teardrop shape and sourcil shape at 5-year followup, were reliable radiographic prognostic factor of DDH.

Management of Melorheostosis / 대한정형외과학회잡지

Melorheostosis is a very rare sclerosing bone disease with pain, joint stiffness, and limitation of motion. Its characteristic on radiography is a dense bone formation along the side of the bone, resembling the flow of candle grease. Various conservative or surgical methods have been practiced in treating pain and deformities. This is a report on the successful treatment result of six cases of melotheostosis, involving the metatarsal, metacarpal, clavicle, and tibia, which weretreated by conservative and operative treatment methods.

The Use of Locking Compression Plate for Stabilization of Existing and Impending Pathologic Fractures at Long Bones with Metastatic Cancer / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the results and the advantages of the operative treatment of metastatic pathologic fractures in long bones using locking compression plates. MATERIALS AND METHODS: Twenty-five patients (28 cases) who underwent open reduction and internal fixation with a locking compression plate with or without cement augmentation for pathologic fractures in long bones resulting from metastatic cancer between 2004 and 2013 were reviewed retrospectively. Mean age at the time of surgery was 62.8 years. Pathologic fractures occurred in 11 cases in the humerus, 11 cases in the femur, and 6 cases in the tibia. Functional analysis of Musculoskeletal Tumor Society (MSTS) scores, functional restoration condition of patients with upper extremity involvements, and interval to wheelchair ambulation in patients with lower extremity involvements was performed. Pain relief (visual analogue scale, VAS) and operation time, postoperative satisfaction with individuals, and complications were evaluated. RESULTS: Mean operation time was 81.3 minutes and mean MSTS scores were 19.8. Mean time from operation to wheelchair ambulation was 3.3 days. Mean VAS improved from 8.1 preoperatively to 2.9 at 1 week postoperatively. Most patients reported that they were more than 'satisfied' One transient radial nerve palsy and one late complication of screw breakage and reduction loss had occurred at postoperative 3 months. CONCLUSION: Internal fixation with a locking compression plate in metastatic pathologic fractures can be an effective treatment option in the meta or diaphyseal area of long bones.

Persistent Bleeding Following a Stapled Hemorrhoidopexy

A stapled hemorrhoidopexy (SH) is widely used for treatment of patients with grades III and IV hemorrhoids. The SH is easy to perform, is associated with less pain and allows early return to normal activities. However, complications, whether severe or not, have been reported. Here, we present the case of a female patient with persistent bleeding after a SH. The bleeding was caused by the formation of granulation tissue at the stapler line, diagnosed with sigmoidoscopy, and successfully treated via transanal excision (TAE) under spinal anesthesia. The biopsy showed inflammatory granulation tissue. After the TAE, her symptom was completely gone.

Surgical Resection of Malignant Bone Tumors / 대한정형외과학회잡지

Malignant bone tumors are less common than other tumors, and we often make a misdiagnosis. However, due to its severity and prognosis we should not pass over the malignant bone tumor, because it is one of the important diseases to diagnose. Specific techniques are available for the resection and reconstruction of malignant bone tumors from the body involving extremities. In particular, it is necessary to establish guidelines for elimination of tumor cells as much as possible and minimize the malfunction. Knowledge of the staging system and guide lines for resection margin is required for treatment of malignant bone tumors.

Bone Transport for Reconstruction in Benign Bone Tumors

BACKGROUND: The aim of this study was to assess the results of using the Ilizarov apparatus to transport bones in the treatment of benign bone tumors. METHODS: Seven patients (six males and one female) with benign bone tumors were treated by bone transport with an Ilizarov apparatus at our institution. Their mean age at surgery was 14.4 years (range, 4.8 to 36.9 years). The histological diagnoses were osteofibrous dysplasia (4), giant-cell tumor (1), intraosseous cavernous hemangioma (1), and aneurysmal bone cyst (1). Three radiological indices were used for evaluating the results: an external fixation index, a distraction index, and a maturation index. The bone and functional results were evaluated according to the Association for the Study and Application of the Method of Ilizarov classification. RESULTS: Five patients had bone union at the reconstructed site, one patient had a local recurrence, and the other had a nonunion at the docking site. The mean length of distraction was 7.3 cm (range, 5.1 to 12.1 cm). The mean external fixation index was 26.0 day/cm (range, 19.8 to 32.5 day/cm), the distraction index was 9.6 day/cm (range, 6.8 to 12.0 day/cm), and the maturation index was 14.9 day/cm (range, 8.0 to 22.5 day/cm). Ultimately, the bone and the functional results were rated excellent in six cases and good in one case. CONCLUSIONS: Bone transport using the Ilizarov apparatus is a good treatment option in patients with bone defects after the resection of an active or aggressive benign bone tumor.

Diagnostic Availability of Pedobarography and Correlation of Radiographic and Pedobarographic Measurements in Pediatric Flexible Flatfoot / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the diagnostic availability and to examine the co-relation between pedobaragraphy and radiography of pediatric flexible flatfoot. MATERIALS AND METHODS: Seventeen patients and ten normal children were studied. In radiographic evaluation, the talo-1st metatarsal angle was measured on anteroposterior radiographs; and the talo-1st metatarsal angle, the talo-horizontal angle, the calcaneal pitch, and the talocalcaneal angle were measured on lateral radiographs. In pedobarography, foot pressures were subdivided into eight areas for measurement of contact time, ratio of measured area and to investigate the relation between the degree of the medial deviation of the Center of pressure line and the radiographic measurements. RESULTS: Flat foot group and normal group showed statistically significant difference in every angle measured in lateral radiographs. The foot pressure ratios of the lateral sides in forefoot and the medial and lateral sides of midfoot and the medial side of hindfoot between the flexible flatfoot group and normal group showed statistically significant difference in pedobarography and ratio of contact area in forefoot and hindfoot showed significant change in statistics but no changes in contact time. The relation between pedobarography and radiography was investigated: foot pressure of the medial and lateral side of forefoot and the talocalcaneal angle showed significant relation in statistics and foot pressure of the medial and lateral side of mid foot and every angle measured in lateral radiographs showed significant relation in statistics. Contact time of midfoot and every radiographic value measured in lateral radiograph showed significant relation in statistics and contact area of forefoot and midfoot showed significant relation with every radiographic value measured in lateral radiographs. In addition, medial deviation of center of pressure line showed significant relation in statistics with talus-first metatarsal angle measured on anteroposterior radiographs and talo-horizontal angle and talus-first metatarsal angle measured on lateral radiographs. CONCLUSION: The results of this study showed correlation between radiologic methods and pedobarography in diagnosis of pediatric flexible flatfoot and pedobarography is an useful tool in quantitative and qualitative analysis of the degree of foot deformity and medial deviation of center of pressure line.

Role of Matrix Metalloproteinase (MMP) 2 and MMP-9 in Soft Tissue Sarcoma

BACKGROUND: We investigated the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in malignant fibrous histiocytoma (MFH), and determined whether these could be useful as prognostic factors. METHODS: Among patients treated from 1993 to 2007, 30 cases of MFH were evaluated. Immunohistochemical staining was performed for MMP-2, MMP-9, TIMP-1, and TIMP-2 using paraffin wax-embedded blocks of MFH tissues. Reverse transcriptase polymerase chain reaction (RT-PCR) and Western blot and zymography were performed using fresh tissues obtained from 17 of the 30 cases. The levels of MMP and TIMP expression were compared between the MFH and normal control groups, and between non-metastatic and metastatic MFH groups. RESULTS: Expression levels of MMP-2, MMP-9, TIMP-1, and TIMP-2 were higher in the MFH group than the control group by RT-PCR, Western blotting, and zymography. Immunohistochemical staining revealed that MMP-2 and MMP-9 protein expression was higher in the metastatic than in the non-metastatic group. The expression levels of MMP-2 and TIMP-1 were significantly higher in the metastatic than in the non-metastatic group (p 0.05). Finally, gelatin zymography analysis showed that the expression levels of the pro- and active forms of MMP-2 were significantly higher in the metastatic group (p 0.05). CONCLUSIONS: These results suggest that MMP-2, MMP-9, TIMP-1, and TIMP-2 may have important roles in the development and progression of MFH, and that the degree of expression of these metalloproteinases and their inhibitors, especially MMP-2, could be useful as prognostic factors related to metastasis in MFH.

Osteosarcoma with Adenocarcinoma of Lung in Li-Fraumeni Syndrome: A Case Report / 대한골관절종양학회지

Li-Fraumeni syndrome (LFS) is an autosomal dominant hereditary disorder characterised by a variety of different tumor types in children and young adults. That contains with a germline mutation in the tumor suppressor gene Tumor Protein p53 (TP53). That is extremely rare. Furthermore, this is sometimes overlooked. Here, we report a case of LFS which was confirmed by mutational analysis of the p53 gene. Also, literature review is intended to improve understanding of this disease entity.

Prognostic Factors and Outcome in Childhood and Adolescent Osteosarcoma: Single Institution Experience / 임상소아혈액종양

BACKGROUND: Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. The aim of this study was to evaluate survival and the prognostic factors in children and adolescent osteosarcoma.METHODS: Twenty-seven patients with osteosarcoma diagnosed at Chonnam National University Hwasun Hospital between Apr. 2004 and Feb. 2013 were retrospectively reviewed.RESULTS: Fourteen patients were males and the median age at diagnosis was 13.0 years. The most common tumor site was distal femur and 5 patients had metastasis at diagnosis. All patient but one who underwent definitive surgery at diagnosis received preoperative chemotherapy. The 5-year overall survival (OS) and event free survival (EFS) rate for all patients were 65.7+/-10.2% and 55.6+/-11.0%, respectively. Ten patients (37.0%) experienced relapse or progression of the disease. Among them, 3 patients are alive without any evidence of disease at the time of this writing. Seven among 8 dead patients died of relapse/progression of the disease. The 5-year EFS rate was significantly higher for patients with tumor volume <100 cm3 (n=14) at diagnosis than others (n=10) (70.7+/-14.6% vs. 37.5+/-16.1%, P=.031). Age, histologic type, metastasis at diagnosis and histologic response to preoperative chemotherapy did not have a significant effect on OS and EFS.CONCLUSION: Although chemotherapy has improved outcomes of osteosarcoma, relapse or progression is the most common cause of treatment failure. A higher tumor volume at diagnosis was identified as a poor prognostic factor. Future studies incorporating a larger number of patients are required to further delineate the prognostic factors in osteosearcoma.

Gradual Lengthening of the Ulna in Patients with Multiple Hereditary Exostoses with a Dislocated Radial Head

PURPOSE: Multiple hereditary exostoses of the forearm typically form in the distal ulna, causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exostoses inhibit the growth of the ulna, leading to an acquisition of a varus deformity in the radius, which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cosmetic problems. MATERIALS AND METHODS: We retrospectively reviewed the cases of four patients who had deformities of the forearm with radial head dislocation associated with multiple hereditary exostoses, and evaluated the radiologic and clinical results of excision of the osteochondromas from the distal ulna and gradual ulnar lengthening with an Ilizarov external fixator. RESULTS: Good clinical and radiological results were obtained after a mean follow-up of 25 months. At the most recent follow-up, radial bowing, ulnar shortening, carpal slip, and the pronation/supination arch of the forearm had improved. There was little change in terms of preoperative radial articular angle and the flexion/extension arch of the elbow by the most recent follow-up. CONCLUSION: Treatment of four forearms from four patients by excision of osteochondromas and gradual lengthening of the ulna with an Ilizarov external fixator spontaneously reduced dislocations of the radial heads without the need for any additional operative intervention. All patients were satisfied with the final results.

Prognostic Factors and Outcome in Childhood and Adolescent Osteosarcoma: Single Institution Experience / 임상소아혈액종양

BACKGROUND: Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. The aim of this study was to evaluate survival and the prognostic factors in children and adolescent osteosarcoma. METHODS: Twenty-seven patients with osteosarcoma diagnosed at Chonnam National University Hwasun Hospital between Apr. 2004 and Feb. 2013 were retrospectively reviewed. RESULTS: Fourteen patients were males and the median age at diagnosis was 13.0 years. The most common tumor site was distal femur and 5 patients had metastasis at diagnosis. All patient but one who underwent definitive surgery at diagnosis received preoperative chemotherapy. The 5-year overall survival (OS) and event free survival (EFS) rate for all patients were 65.7+/-10.2% and 55.6+/-11.0%, respectively. Ten patients (37.0%) experienced relapse or progression of the disease. Among them, 3 patients are alive without any evidence of disease at the time of this writing. Seven among 8 dead patients died of relapse/progression of the disease. The 5-year EFS rate was significantly higher for patients with tumor volume <100 cm3 (n=14) at diagnosis than others (n=10) (70.7+/-14.6% vs. 37.5+/-16.1%, P=.031). Age, histologic type, metastasis at diagnosis and histologic response to preoperative chemotherapy did not have a significant effect on OS and EFS. CONCLUSION: Although chemotherapy has improved outcomes of osteosarcoma, relapse or progression is the most common cause of treatment failure. A higher tumor volume at diagnosis was identified as a poor prognostic factor. Future studies incorporating a larger number of patients are required to further delineate the prognostic factors in osteosearcoma.

Erdheim Chester Disease (ECD): A Case Report / 대한골관절종양학회지

Erdheim Chester disease (ECD) is very rare non-Langerhans cell histiocytosis (LCH) which occurs in the skeletal system and multiple organs. As it is progressive, sometimes it causes fatal results. However, it is often misdiagnosed as LCH or multiple bone metastasis and, thus, is very difficult to diagnose. In Korea, only 10 cases were first reported in 1999. In particular, there have been a few orthopedic approaches or reports in English-speaking literatures, and no report has been issued in Korea. The authors performed bone biopsy in patients with knee and lower extremity pain who were referred for the integrated treatment. We attempts to report this diagnosis experience with literature review.

Heterotopic Ossification Mimics Neurogenic Tumor: A Case Report / 대한골관절종양학회지

Heterotopic ossification is an abnormal bone formation after surgery or without any reason. Large joint, such as hip and knee joint, is a known most common site. Operation itself and postoperative early range of motion exercise are risk factors. We present a case of heterotopic ossification mimics neurogenic tumor after high tibial osteotomy.

Treatment Outcomes of Advanced Stage Malignant Melanoma in Hand and Foot after Amputation in Korean Patients

BACKGROUND: A retrospective study was conducted to review the overall survival and treatment outcomes of high grade melanoma in the extremity to explore the clinical features of malignant melanoma of the hand and foot, and the therapeutic efficacies and survival rate after amputation. METHODS: The clinical data of 30 patients with malignant melanoma of the hand and foot (confirmed by pathological examination), who were admitted and treated in our hospital between 2001 and 2010, were analyzed retrospectively. We analyzed variables affecting overall and disease-free survival. RESULTS: Thirty patients (18 men and 12 women) treated with an amputation procedure for malignant melanoma in the hand or foot constituted the study cohort. The average age of the patients at the time of diagnosis was 58.7 years. Univariate analysis for overall melanoma survival revealed that diagnosis at over 70 years of age, postoperative lymph node metastasis, and location of the tumor were significant prognostic factors. And on the Kaplan-Meier survival curve, old age, American Joint Committee on Cancer stage and postoperative lymph node metastasis showed statistically significant differences in the 5-year survival rate. Also, amputation with aggressive lymph node dissection showed improved long term survival in advanced stage melanoma. CONCLUSIONS: In Korean melanoma patients, for the treatment of high grade melanomas in the extremities after amputation, early diagnosis and postoperative follow-up for evaluation of lymph node metastasis are critical factors for long-term survival. And by performing lymph node dissection during amputation, we may improve the survival rate in advanced stage melanoma patients.