Steroid-induced Early Changes in the Femoral Head and Hip Joint in Rats / 대한정형외과학회잡지

PURPOSE: To determine if the early changes to the articular cartilage and synovium of the hip joint in relation to steroid-induced osteonecrosis of the femoral head is either as a preceding factor or as a secondary consequence in the pathomechanism. MATERIALS AND METHODS: Thirty-two Sprague Dawley rats were divided into two groups, 16 receiving a steroid injection and 16 as a control group. Tissue samples of the hip joint were taken from 4 rats from each group every 4 weeks over a 16 week period. The specimens were investigated for the early changes to the articular cartilage, subchondral bone of the femoral head and the synovium after H & E staining and toluidine blue stain. Five histological criteria were applied to determine the cartilage status. RESULTS: Histologically, there was a gradual increase in chondrocyte cloning in the steroid injection group. In addition, synovial hypertrophy and the enlargement of fatty cysts with the loss of hematopoietic cells were observed. CONCLUSION: Synovial hypertrophy and some evidences of articular cartilage degeneration associated with steroid-induced early femoral head osteonecrosis appears to be the result of a direct inflammatory reaction to the steroid injection. This suggests that early presentation of the pathologic lesion in the hip joint might occur without definitive radiological evidence of femoral head osteonecrosis.

Usefulness of Hip Joint AP Plain X-ray Radiographs in Femoroacetabular Impingement

PURPOSE: We wanted to report the usefulness of both hip AP views, which are some of the various radiographs that are used as a primary diagnostic method for identifying the pistol grip deformity of the femur. MATERIALS AND METHODS: There were 27 cases in patients who were from 20 to 50 years old and who had undergone arthroscopic treatment for femoroacetabular impingement (5 cases of both femoroacetabular impingement) from March 2004 to March 2006, Their preoperative radiographs (both hip APs, the frog leg lateral, the groin lateral and the false profile) were investigated; the most narrow point of the femoral neck, the diameter of the femoral head, the length of the femoral head at the midpoint of these two lines (which is assumed to be the anterosuperior prominence of the femoral neck) were measured on both hip AP views. 15 persons of the same age and who didn't have hip joint pain were chosen as the control group (30 cases) and the same measures was performed and then retrospectively compared with the FAI group. RESULTS: In the FAI group, the femoral head diameter was 53.45 mm, the minimal femoral neck length was 37.58 mm and the femoral head length at the midpoint was 41.52 mm. In the control group, the femoral head diameter was 53.38 mm, the minimal femoral neck length was 35.43 mm and the femoral head length at the midpoint was 39.03 mm. The ratio of the femoral head diameter to the minimal femoral neck length was 0.67 in the FAI group and it was 0.65 in the control group; this was similar in both groups. Yet the ratio of the femoral head diameter to the femoral head length at the midpoint was 0.84 in the FAI group and this was 0.75 in the control group (p=0.01). CONCLUSION: We tried to define the actual value that allows physicians to estimate the pistol grip deformity on both hip AP view of the patients who have hip joint pain, and the ratio of the femoral head diameter to the minimal femoral neck length can be a useful primary indicator for diagnosing femoroactabular impingement when this is over 0.8.

Pigmented Villonodular Synovitis of the Ankle Joint / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical manifestations and results of treatment, we have analyzed five cases of Pigmented villonodular synovitis (PVNS) involving the ankle joint, a very rare disease in which the intraarticular joint has active inflammation with hypertrophy of the synovium. MATERIALS AND METHODS: From January 2002 to July 2004, five patients who presented with a mass in the ankle joint had histopathologically confirmed PVNS, retrospectively identified after surgery. Four male patients and one female patient were included in the study. All five patients had preoperative ankle joint swelling and a mass without a history of trauma; all had standard x-rays and three of the five patients had Magnetic resonance imaging (MRI). RESULTS: As a result of the testing there were two localized and three diffuse types identified. For one diffuse type, arthroscopy assisted intraarticular synovectomy was carried out before invasive synovectomy. Mass excision and broad synovectomy were carried out in all cases, and histological evaluations were performed after surgery. For two cases that had incomplete synovectomy, due to adhesions surrounding soft tissue and severe bony invasion, the surgical region was simultaneously treated with postoperative radiation therapy. After an average postoperative follow-up period of 13 months, the pain, swelling and edema resolved and there were no signs of recurrence. CONCLUSION: Mass excision and broad synovectomy provided both accurate diagnosis and successful treatment of PVNS of the ankle joint. In cases where incomplete synovectomy is performed due to anatomical difficulties or bony invasion, combination with postoperative radiation therapy may help reduce the recurrence rate.

Limited Intercarpal Arthrodesis in Kienbock's Disease / 대한정형외과학회잡지

PURPOSE: To compare the treatment results of triscaphe and scaphocapitate arthrodesis in Lichtman's stage III Kienbock's disease. MATERIALS AND METHODS: Among 25 cases of Kienbock's disease (Lichtman's stage III), who were followed up more than 1 year after surgery from 1997 March to 2005 March, 15 cases of scaphocapitate and 10 cases of triscaphe arthrodesis were reviewed. The average age was 42.6 and the mean follow-up period was 33 months. The clinical and radiology results were analyzed before surgery and at the last follow-up. RESULTS: In the clinical assessments, there was good pain relief after each procedure and there was a similar limitation of the carpal range of motion before and after surgery. The radiology assessments revealed no difference between the two arthrodeses according to the carpal height ratio and lunate index. Regarding complications, there were 4 cases with a scaphocapitate including 1 nonunion and 4 cases with triscaphe arthrodesis including 2 superficial infections. CONCLUSION: The scaphocapitate arthrodesis is a technically simple, easy reducible to the anatomical position and produces similar clinical and radiology results to triscaphe arthrodesis. Overall, scaphocapitate arthrodesis appears to be an effective method for treating Lichtman's stage III Kienbock's disease.

Avulsion Fracture of the Index Metacarpal Base: Two Case Reports / 대한정형외과학회잡지

Avulsion fractures involving insertions of the radial extensors at the base of the index and middle metacarpals are quite rare. However, avulsion fractures at the insertion site of the extensor carpi radialis longus on the index metacarpal and avulsion fractures involving the extensor carpi radialis brevis insertion at the base of the middle finger metacarpal have been reported. Although there are many reports of fractures of the base of the first metacarpal, there are few recommendations available for treatment of these injury. We report two avulsion fractures at the extensor carpi radialis longus insertion, which were treated with an open reduction and internal fixation of the avulsed bony fragment using a miniplate and screw.

Spinal bone mineral density related with YSM in Korean menopausal women

BACKGROUND: Estrogen deficiency after menopause is a major reason of bone loss in postmenopausal women. YSM (years since menopause) is negatively related with BMD in postmenopausal women. Bone loss after menopause is accelerated in early stage of menopause, and then decreases. There are some evidence that body weight can prevent bone loss in menopausal women. Therefore, we evaluated associations of the general characteristics and lumbar BMD of postmenopausal Korean women, and determined the rate of bone loss after menopause at 5-year interval. METHODS: BMD was measured by DEXA system and physical, anthropometric data including body fat were obtained in 1006 peri - and postmenopausal women. Pearsons correlation coefficient were made among pesical, anthropometric data and lumbar BMD. To determine the contributable factors for lumbar BMD, multiple regression analysis was done. RESULTS: 1) In Pearsons correlation analysis among body composition YSM and spinal BMD, YSM was strongly associated negatively with spinal BMD. 2) On the other hand, weight and BMI was associated positively with spinal BMD. 3) The percent difference in spinal BMD between perimenopause and 5-years after menopause was 15.3% 4) Years since menopause, body weight was revealed as an important factor that predicted spinal BMD by multiple stepwise regression analysis. CONCLUSIONS: We conclude that YSM and body weight were revealed as important factors that can predict spinal BMD in postmenopausal women.

A Case of Fibrous Histiocytoma in Orbit

Fibrous histiocytoma is a slow-growing mesenchymal tumor that most commonly occurs in soft tissue and retroperitoneum, with an occasional occurrence in the orbit. This mesenchymal tumor should be included in the differential diagnosis of orbital mass in adults because this tumor is radioresistant and prone to recurrences and malignant potential if incompletely excised. So complete excision is the treatment of choice. A case report of a healthy 27-year-old woman with a gradually increasing, non tender superonasal mass and proptosis in the left orbit. She also developed diplopia. CT scan and MRI showed a well-marginated and encapsulated homo-geneous 2 x3 cmsized mass in the superonasal portion of the left orbit. The tumor was totally excised under the impression of carvenous hemangioma. In H-E stain, tumor cell revealed a marked cellularity, storiform arrangement of ovoid to spindle cells but there was little nuclear polymorphism, atypism and absent mitosis. Results of immunohistochemical study showed positive cytoplasmic immunoreactivity to alpha-1-ntitrypsin antibody but negative to S-100 protein, smooth muscle actin, Neuron specific enolase. Masson-Trichrome stain showed positive. The final diagnosis of a benign fibrous histiocytoma invading the orbit was confirmed by histopathological examination. There was no recurrence for more than 14 months after complete surgical excision. We present the above case with a brief review of literature.

The Relationship of the Lens Density with the Lens Thickness and the Anterior Chamber Depth

To investigate the relationship of the density change of lens nucleus and cortex with anterior chamber depth and lens thickness, we measured the anterior chamber depth, density and length of lens nucleus and cortex of 312 eyes with a Scheimpflug camera. The mean values of density of lens nucleus and cortex were 108.45+/-46.33CCT and 27.74+/-13.76CCT, respectively. The mean values of the thickness for both were 2.85+/-0.54mm and 1.29+/-0.46mm, respectively. The mean value of anterior chamber depth was 2.93+/-0.49mm. The densities of lens nucleus and cortex were increased significantly with aging, but lens thickness and anterior chamber depth were decreased. The value of anterior chamber depth changes and lens thickness changes were more rapid especially in the 5th and 7th decades compared with other groups(P<0.01), and more rapaid in the density group(100~150CCT) than other group in changing densities(P<0.05), and they were highly correlated with anterior cortex, posterior cortex, nucleus in order at each portion of lens. Both anterior chamber depth changes and lens thickness changes were more rapid in the lens cortex than those in the lens nucleus.