Avulsion Fracture of Calcaneal Apophysis in an Adolescent Gymnast: A Case Report

The avulsion fracture of calcaneal apophysis by Achilles tendon in children is quite rare. It may occur with the injury of the apophysis on the calcaneal tuberosity in the children below the age of 12 to 15 before the union of the apophysis. The authors surgically treated a 14-year-old gymnast with the avulsion fracture of the calcaneal tuberosity who injured at the landing of the floor exercise. Radiographs at the fourteen months of follow-up showed slight irregularity of the calcaneal tuberosity but there were no pain or limitation of activity. We report a case with the review of literatures.

The Expression of Extracellular Matrix mRNA in the Chondrocytes of the Femoral Head Affected by Avascular Necrosis

PURPOSE: The aim of this study was to evaluate the expression of type II collagen, aggrecan, VEGF-A and PEDF mRNAs in the human chondrocytes derived from the articular cartilage of the femoral heads with avacular necrosis (AVN). MATERIALS AND METHODS: We cultured human chondrocytes that were primarily derived from the articular cartilage of femoral heads with AVN. We evaluated the mRNA expression of type II collagen, aggrecan, VEGF-A and PEDF. RESULTS: The chondrocytes of the AVN group showed decreased expressions of type II collagen mRNA and aggrecan mRNA (p0.05). CONCLUSION: The cartilage matrix's formation ability was found to be decreased in the chondrocytes of the femoral heads affected by AVN.

Fracture-Dislocation of the Carpometacarpal Joint with the Fracture of Hamate

PURPOSE: To evaluate the classification and treatment results about the injury of carpometacarpal (CMC) joint with the fracture of hamate. MATERIALS AND METHODS: The authors categorized into 3 types (I, II, III) according to the location of injured CMC joint and type II was subdivided into 2 type (a, b) according to the size of coronal fragment of hamate fracture-type I: fracture-dislocation of 5th CMC joint with small-sized fragment or avulsion fracture of hamate, type IIa: fracture-dislocation of 4th and 5th CMC joint with small-sized fragment or avulsion fracture of hamate, type IIb: fracture-dislocation of 4th and 5th CMC joint with coronal fracture of hamate body presenting an oblique or coronal splitting fracture, and type III: type II injury associated with injury of 3rd CMC joint or coronal plane fracture of capitate. All cases were carried out the operative treatment. And radiologic results and clinical results were evaluated. RESULTS: Type I were 2 cases, type IIa 4, type IIb 5, and type III 3. Twelve of 14 cases were excellent or good results, 1 case (type III) was fair, and 1 case (type IIa) was poor. All cases obtained anatomic reduction of CMC joint. But, the posttraumatic arthritis was observed in 1 case (poor) and the displacement of non-fixed hamate fragment was observed in 1 case (fair). CONCLUSION: We think that it may get more favorable outcomes by the fixation of the relative large fragment of hamate with anatomical reduction of CMC joint.

Effect of Alcoholon the Expression of VEGF-A,PEDF,and VEGFR-2 of Osteoblast in Avascular Necrosis of Femoral Head / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine the effect of alcohol on the expression of VEGF-A, PEDF, and VEGFR-2 in human osteoblasts. MATERIALS AND METHODS: Human osteoblasts primarily derived from the intertrochanteric region of the femur with osteonecrosis and fracture (control) were cultured with alcohol (0, 20, 100, 150 mM). The level of cell proliferation and the expression levels of VEGF-A mRNA, PEDF mRNA, and VEGFR-2 mRNA was evaluated according to the alcohol concentrations and the culture periods. RESULTS: Osteoblasts with the added alcohol showed an early increase in cell population, and a subsequent decrease or steady level thereafter compared with those without alcohol (p<0.05). The osteoblasts in the osteonecrosis group showed an increase in VEGF-A mRNA and PEDF mRNA expression at high alcohol concentrations (100, 150 mM), resulting in an decreased VEGF-A/PEDF ratio, while those in the control group showed an increase in VEGF-A mRNA expression and a decrease in PEDF mRNA expression, resulting in an increase in the VEGF-A/PEDF ratio (p<0.05). CONCLUSION: Alcohol stops the proliferation of osteoblasts and can cause an imbalance between VEGF-A and PEDF, thereby inhibiting the neovascularization of osteonecrosis.

Sliding after Internal Fixation of Stable Intertrochanteric Fracture of the Femur

PURPOSE: To evaluate the risk factors of sliding after internal fixation with sliding compression hip screw in stable intertrochanteric fracture of the femur. MATERIALS AND METHODS: From March 2000 to April 2003, 61 stable intertrochanteric fractures (Kyle-Gustilo type II) were treated operatively with sliding compression hip screws. The patients were 40 females and 21 males with an average age of 74 (range, 54~99). We measured vertical and horizontal shortening in regard to age, sex, bone mineral density, neck-shaft angle, cancellous bone defect, and the existence of lessor trochanter fracture on postoperative 6 months. RESULTS: The average vertical shortening was 4.1 mm (0~22 mm) and the average horizontal shortening was 7.3 mm (0~30 mm). Age, sex, bone density and neck-shaft angle were not significantly related with vertical and horizontal shortening (p>0.05). Vertical shortening was significantly greater in the group with cancellous bone defect and in the group without lesser trochanter fracture (p<0.05). CONCLUSION: Proper management for fracture site and fixation was needed to make it stable because the stable intertrochanteric fracture with cancellous bone defect and intact lesser trochanter could be induced into unexpected sliding.

Effect of Displacement and Morphological Change of Medial Meniscus on Early Osteoarthritis of the Knee

PURPOSE: We investigated relationship between displacement and morphologic changes of medial meniscus and articular cartilage loss on magnetic resonance (MR) Images in early osteoarthritis of the knee. MATERIALS AND METHODS: Ninety-three cases with symptomatic knee and early osteoarthritis on the plain radiographs underwent MR imaging of the knee. We measured displacement, tear, and morphological changes of medial meniscus according to the amount of articular cartilage loss on coronal and sagittal MR images. RESULTS: The mean medial meniscal displacement was greater in cartilage loss group(4.3+/-2.8 mm) than control group(2.2+/-1.9 mm). The mean anterior meniscal displacement was greater in cartilage loss group (3.6+/-2.3 mm) than control group(1.9+/-1.2 mm). But meniscal displacement was not correlated with articular cartilage loss (p>0.05). The morphological changes of medial meniscus were 53.4%(31/58) in cartilage loss group and 11.4% (4/35) in control group (p<0.05). CONCLUSION: In early osteoarthritis of the knee, displacement and morphological changes of medial menisci had correlation with articular cartilage loss in MRI study.