Intramuscular Myxoma of the Foot: A Case Report / 대한족부족관절학회지

Intramuscular myxoma is a rare benign myxoid tumor that is difficult to differentiate from other benign soft tissue tumors and sarcoma, and as a result, intramuscular myxoma is commonly misdiagnosed as another type of soft tissue tumor. Accordingly, awareness of the existence of this condition is a fundamental requirement for treatment decision-making. Furthermore, although intramuscular myxoma appears grossly to be well-circumscribed, it can infiltrate adjacent soft tissue microscopically. Tumor resection is the recommended treatment, but appropriate surgical margin sizes remain controversial. To the best of our knowledge, this is the first South Korean report to be issued on the treatment of intramuscular myxoma of the foot.

The Antibiotic Cement Coated Nail and Masquelet Technique for the Treatment of Infected Nonunion of Tibia with Bone Defect and Varus Deformity

Infective nonunion after fracture surgery can cause persistent pain and inflammatory exudate in patients, requiring long-term treatment. To treat infective nonunion, radical debridement of infective bone and soft tissue should be performed, followed by stable internal fixation and bone graft. Multiple treatment strategies need to be considered according to the classification of chronic osteomyelitis, size of the bone defect, degree of bone malalignment, and severity of the soft tissue injury. This paper reports a case of a patient treated with an antibiotic cement-coated nail and a Masquelet technique to treat the infected nonunion of the tibia with a bone defect and varus deformity.

Comparison of the Outcomes according to the Injury Type of the Short Radiolunate Ligament in Fracture-Dislocation of the Radiocarpal Joint / 대한정형외과학회잡지

Purpose@#Radiocarpal dislocation (RCD), which is caused by high-energy trauma, often involves radial styloid fractures and short radiolunate ligament (SRLL) injuries. Although SRLL injuries may occur as a simple rupture at the attachment site of radius, it may occur with a relatively large avulsed-fragment in the volar rim of the lunate facet of the radius. This study aimed to differentiate the injury type of SRLL and assess the differences in the treatment results depending on the treatment methods that have been applied in RCD with radial styloid fractures. @*Materials and Methods@#Eighteen patients managed surgically with RCD were enrolled in this study. The patients were classified as Group 1 and Group 2 by using the Dumontier method. In this study, Group 2 was subdivided into 2A (purely ligamentous or small avulsion fracture of the volar rim of lunate facet) and 2B (large avulsed-fragment enough to internal fixation) according to the injury type of SRLL.Groups 2A and 2B were treated with direct repair and screw fixation, respectively. Pain, range of motion of the wrist joint, grip strength, and complications on final radiographs were examined. The outcomes were evaluated using patient-rated wrist evaluation (PRWE), and modified Mayo wrist score (MMWS). @*Results@#All patients were Group 2 (six and twelve patients in 2A and 2B, respectively). The mean flexion to extension arch recovered 79%,and the mean grip strength was 72.9% of the uninjured side. Group 2A showed better recovery in extension, flexion and pronation than Group 2B, but there was no difference in radial deviation, ulnar deviation, supination, grip strength and pain. No differences in the PRWE and MMWS were observed between two groups. Complications included traumatic arthritis in seven patients and residual instability in five patients. @*Conclusion@#When the SRLL was injured, the involvement of a large avulsion fracture on the anterior plane of the radiolunate did not affect the test results. On the other hand, it should be observed cautiously because avulsion fractures tend to disturb the joint’s reduction through rotation or displacement. In addition, anatomical reduction and sturdy internal fixation are important for restoring the function of the SRLL.

Effectiveness of Drain Insertion and Irrigation in the Treatment of Septic Arthritis of the Knee under Local Anesthesia / 대한정형외과학회잡지

Purpose@#Septic arthritis of the knee is an orthopedic emergency that requires early diagnosis and surgical treatment. This study examined the effectiveness of drain insertion and irrigation in the treatment of septic arthritis of the knee under local anesthesia. @*Materials and Methods@#A retrospective study was conducted on nine cases (eight patients) diagnosed with septic arthritis of the knee from September 2017 to February 2020 and treated with drain insertion and irrigation under local anesthesia. After penetrating through the superolateral portal to the superomedial portal and inserting the drain, daily irrigation of approximately 3 L of normal saline was done. The following were investigated: age, sex, underlying disease, cause, degree of osteoarthritis, time from diagnosis to surgery, duration of hospitalization, duration of normalization of C-reactive protein, and smear and culture. @*Results@#The initial white blood cell count of joint fluid was 71,472±51,667/mm3 (32,400–203,904/mm3 ), and polymorphic leukocytes were 91.1%±2.6% (86%–95%). The average time from diagnosis to surgery was 8.3±1.3 hours (6–10 hours), and the irrigation period was 8.2±3.2 days (4–15 days). The average length of hospitalization was 20.8±8.7 days (9–37 days). There was no reoperation or recurrence. Smear and culture tests were not identified. @*Conclusion@#In the treatment of septic arthritis of the knee, the insertion of a drain tube and irrigation under local anesthesia is a relatively fast and simple method to reduce pain by repetitive draining of purulent joint fluid and can be used as an alternative treatment for patients with a risk of general or spinal anesthesia.

Computed Tomography-Based Morphologic Analysis of Osteoarthritis of the Distal Radioulnar Joint Associated with Extensor Tendon Ruptures

Background@#Although the scallop sign is considered the most important risk factor for extensor tendon ruptures (ETRs) in patients with osteoarthritis of the distal radioulnar joint (DRUJ), previous reports provide a limited understanding of the changes at DRUJ, as risk factors were examined in plain radiographs of the wrist. The aim of this study was to assess the changes of DRUJ using axial images of computed tomography (CT) in patients with DRUJ osteoarthritis and associated ETRs and to evaluate the relationship between the changes of DRUJ and ETRs. @*Methods@#Twelve patients with ETRs due to osteoarthritis of the DRUJ were enrolled. The changes of DRUJ were examined on axial images of CT and the following 8 parameters were measured: width of radius, anteroposterior (AP) length of radius, width of sigmoid notch (SN), AP length of SN, AP length of ulnar head, subluxation length of ulnar head, dorsal inclination of SN, and distance from Lister’s tubercle to SN. Radiological parameters of the DRUJ were measured in 60 control wrists without trauma or osteoarthritis, and the patient and control groups were statistically compared. @*Results@#Statistically significant differences were observed between the patient and control groups in all the radiological parameters except for the AP length of SN and AP length of ulnar head. The width of radius, AP length of radius, width of SN, subluxation length of ulnar head, and dorsal inclination of SN were greater and the distance from Lister’s tubercle to SN was smaller in the patient group than in the control group. The width of SN, dorsal inclination of SN, and distance from Lister’s tubercle to SN were statistically significant risk factors among the 8 parameters. @*Conclusions@#ETRs due to osteoarthritis of the DRUJ was related to the changes of DRUJ, especially the changes around SN of the distal radius. In addition to the existing risk factors, a decreased distance from Lister’s tubercle to SN and increased dorsal inclination of SN were identified as new risk factors. Axial images of CT were effective to evaluate degenerative changes at the DRUJ.

Intramuscular Giant Lipoma of the Anterior Compartment of the Ankle: A Case Report / 대한족부족관절학회지

Intramuscular lipomas are benign adipose tumors of the soft tissues that may resemble liposarcomas because of their size, deep location, and occasionally infiltrative growth. An awareness of their existence is fundamental to treating them correctly, and their differential diagnosis from liposarcoma is essential. Magnetic resonance imaging (MRI) is a useful diagnostic tool to differentiate benign adipose tumors from liposarcoma. Marginal excision and biopsy are required for the definite diagnosis and the treatment of symptomatic intramuscular lipomas. To the best of the authors’ knowledge, this is the first report in South Korea regarding the treatment of an intramuscular giant lipoma of the ankle.

A Rare Extradural Spinal Meningioma with Nocturnal Chest Pain: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a rare case of a spinal extradural meningioma in a patient with longstanding nonspecific thoracic nocturnal pain. SUMMARY OF LITERATURE REVIEW: Meningioma is a frequent intradural extramedullary tumor that is associated with pain, sensory/motor deficits, and sphincter weakness. Spinal meningiomas most commonly occur in the thoracic spine, although they can also be found at other locations. MATERIALS AND METHODS: A 65-year-old woman first visited the cardiac and gastrointestinal departments of our institution due to chest pain 2 years previously. No explanation for the complaint could be found in the heart or other organs. On a computed tomography scan of the thorax, a spinal mass was found a few months before the diagnosis. On magnetic resonance imaging, an extramedullary and extradural mass was observed at T7/8. RESULTS: We performed surgery and found an extradural spinal meningioma upon the histological diagnosis. Postoperatively, the patient could adequately move both legs and feet and the nocturnal chest pain disappeared after surgery without any complications. CONCLUSIONS: Awareness of the rarity and nonspecific symptoms of extradural spinal meningiomas will be beneficial for their accurate diagnosis and proper treatment.

A Rare Extradural Spinal Meningioma with Nocturnal Chest Pain: A Case Report

OBJECTIVES@#To report a rare case of a spinal extradural meningioma in a patient with longstanding nonspecific thoracic nocturnal pain.SUMMARY OF LITERATURE REVIEW: Meningioma is a frequent intradural extramedullary tumor that is associated with pain, sensory/motor deficits, and sphincter weakness. Spinal meningiomas most commonly occur in the thoracic spine, although they can also be found at other locations.@*MATERIALS AND METHODS@#A 65-year-old woman first visited the cardiac and gastrointestinal departments of our institution due to chest pain 2 years previously. No explanation for the complaint could be found in the heart or other organs. On a computed tomography scan of the thorax, a spinal mass was found a few months before the diagnosis. On magnetic resonance imaging, an extramedullary and extradural mass was observed at T7/8.@*RESULTS@#We performed surgery and found an extradural spinal meningioma upon the histological diagnosis. Postoperatively, the patient could adequately move both legs and feet and the nocturnal chest pain disappeared after surgery without any complications.@*CONCLUSIONS@#Awareness of the rarity and nonspecific symptoms of extradural spinal meningiomas will be beneficial for their accurate diagnosis and proper treatment.

The Efficacy of Different Ropivacaine Concentrations (0.5%, 0.6%, vs . 0.75%) for Regional Nerve Block in Lower Extremity: A Prospective Randomized Controlled Trial / 대한정형외과학회잡지

PURPOSE: There have only been a few studies on optimal usage of injection material in the regional nerve block for lower extremity operations. The purpose of this study was to evaluate the efficacy of different concentrations of ropivacaine. MATERIALS AND METHODS: A total of 339 patients underwent lower extremity surgery under ultrasound-guided nerve block (combined femoral and sciatic nerve block) at a Chungnam National University Hospital between March 2016 and February 2017 and were randomly assigned to three groups: Group A (0.5%, 44 ml), group B (0.6%, 30 ml), and group C (0.75%, 30 ml). The interval between nerve block procedure and onset of the complete anesthetic effect (complete anesthetic time) was investigated. The degrees of intraoperative pain, and postoperative pain were evaluated using a visual analogue scale (VAS) score. Patient's satisfaction (0–10) was investigated. To evaluate the efficacy in accordance with the concentration under the same dose and same volume, group A and B were compared with group C respectively. RESULTS: There were 108, 118, and 113, in groups A, B, and C, respectively; and there were no significant differences with respect to the number, age, sex, and type of operation (p>0.05). The mean complete anesthetic times were 78.5, 76.4, and 58.6 minutes, respectively. The mean intraoperative VAS scores were 2.04, 0.62, and 0.24; and the mean postoperative VAS scores (6 hours/12 hours) were 2.41/4.08, 0.27/1.24, and 0.38/1.54. The mean patient's satisfactory scores were 8.53, 9.38, and 9.40, respectively. Compared with group C, group A showed significantly longer complete anesthetic time (p 0.05). Patient's satisfactory scores in both group A and B were similar to group C (p>0.05, p>0.05). There were no specific adverse reactions in all groups. CONCLUSION: Ropivacaine 0.6% as well as 0.75% are safe and effective anesthetics under the same volume (30 ml) for regional nerve block of the lower extremity. However, taking into account of the longer complete anesthetic time, the operation start time must be adjusted.