Bone Marrow Edema Syndrome of the Foot and Ankle in Adolescents / 대한정형외과학회잡지

Bone marrow edema syndrome of the foot and ankle in adolescents is extremely rare. The correct diagnosis and appropriate treatment are often delayed because of the nonspecific clinical signs. This paper reports two cases of bone marrow edema syndrome of the foot and ankle in adolescents with a review of the relevant literature.

Surgical Treatment of Macrodystrophia Lipomatosa Involving Superficial Peroneal Nerve in the Foot and Ankle / 대한정형외과학회잡지

Macrodystrophia lipomatosa is a congenital disease characterized by gradual proliferation in the mesenchymal cell, such as fibroadipose tissue. Pathologically, fatty tissue is deposited in the nerve sheath, periosteum, bone marrow, and subcutaneous tissue, contributing to the macrodactyly of the foot. To date, there has not been any report on macrodystrophia lipomatosa of the superficial peroneal nerve in the Korean orthopedic literature. Conservative approach, such as decompression or debulking surgery, is recommended due to neurogenic dysfunction. However, we report a 43-year-old male with macrodystrophia lipomatosa involving the superficial peroneal nerve of the right foot and ankle, who underwent a second toe ray amputation as well as soft tissue and nerve resection.

An Analysis of the Foot and Ankle-related Questions on the Korean Orthopedic In-Training Examination / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the questions pertaining to the foot and ankle on the Korean Orthopedic In-Training Examination (KOITE) between 2012 and 2016. MATERIALS AND METHODS: Questions regarding the foot and ankle on KOITE during the five-year period (2012∼2016) were analyzed. Number of foot and ankle questions, topics, taxonomic classification, imaging modalities, and cited references related to each question were analyzed. RESULTS: The average number of foot and ankle questions was 35, accounting for 7.0% (35/500) of all KOITE questions. All questions were categorized into three topic areas: disease (51.4%, 18/35), trauma (31.4%, 11/35), and basics (17.1%, 6/35). Taxonomy 3 (decision-making type questions) was the most common (42.9%, 15/35). References that are commonly used for each question were Campbell's Operative Orthopedics (100%, 35/35) and the textbook of The Korean Orthopaedic Association (74.3%, 26/35). CONCLUSION: This analysis can be valuable to not only orthopaedic surgery residents to improve their knowledge of orthopedics, but also to instructors for optimizing their education programs.

Acute Shortening and Delayed Lengthening in Management of Lower Leg Amputation: A Case Report

Acute bone shortening and delayed lengthening by Ilizarov surgery have been used to treat a wide range of soft tissue injuries including open fracture, osteomyelitis of the tibia and lower leg amputation. It has advantages such as bone lengthening as well as minimizing the loss of damaged tissues via tissue expansion. Here, we report a case of 52-year-old male with satisfactory results through acute bone shortening, replantation, and gradual bone lengthening after complete amputation of the ankle with related literature reviews.

Calcaneal Insufficiency Fracture after Ipsilateral Total Knee Arthroplasty

Insufficiency fracture of the calcaneus is a rare entity. In the absence of trauma, evaluating a painful ankle in an elderly patient can be difficult and also it might be overlook the insufficiency fracture. We experienced a case of insufficiency calcaneus fracture that occurred after ipsilateral total knee arthroplasty. Here, we report our case with a review of literatures.

Posttraumatic Arteriovenous Hemangioma of the Hypothenar Eminence in a Car Mechanic / 대한정형외과학회잡지

Arteriovenous hemangiomas are found mainly in the limbs and scalp, and are common in women and children. However, there have been very limited reports concerning posttraumatic arteriovenous hemangioma, and none was reported in the medical literature regarding posttraumatic arteriovenous hemangioma of hypothenar eminence causing neurologic symptoms. We report a case of arteriovenous hemangioma of hypothenar eminence after recurrent trauma that was successfully treated by an excision of the mass and vein graft.

Lisfranc's Joint Injuries / 대한족부족관절학회지

Lisfranc joint injuries are rare and account for 0.2% of all injuries. The pattern of Lisfranc injuries varies from low-energy ligamentous sprain to high-energy fractures or crushing injuries. Early diagnosis and appropriate treatment of Lisfranc injuries are important to prevent chronic foot pain and dysfunction.

Bilateral Open Transcalcaneal Fracture with Talonavicular Dislocation: A Case Report

Although calcaneal fracture is relatively common in ankle injury, open intraarticular calcaneal fracture with dorsal dislocation of the navicular from talus is extremely rare and severe injury. There are few data which are available concerning the injury mechanism and treatment options. The purpose of this report is to describe a case with bilateral open transcalcaneal fracture with talonavicular dislocation and to discuss the prevalence, mechanism of this injury, and treatment options.

Enhancement of Vasculogenesis and Osteogenesis Using Granulocyte-Colony Stimulating Factor in the Rat Model of Tibial Distraction Osteogenesis / 대한정형외과학회잡지

PURPOSE: Proper speed of distraction is critical for successful new bone formation in distraction osteogenesis. The purpose of this study was to evaluate the effect of granulocyte-colony stimulating factor (G-CSF) on formation of new blood vessels and new bones in the rat model of tibial distraction osteogenesis (DO) to develop enhancement method of bone formation while increasing the distraction speed. MATERIALS AND METHODS: Forty two rat-tibial DO models were included in this study, and were divided into 3 groups; group I (rapid distraction), group II (rapid distraction with G-CSF), and group III (slow distraction). The amount of bone formation and relative blood flow were analyzed by sequential radiographs and laser Doppler perfusion imaging (LDPI). Blood sampling was done before G-CSF injection, at 2 weeks and 5 weeks after G-CSF injection and surface expression such as Scal-1+ and C-kit+ of endothelial progenitor cells (EPCs) was analyzed by fluorescence-activated cell sorter (FACS) for the effects of G-CSF in inducing mobilization of EPCs. RESULTS: The amount of new bone formation in the distraction gap on serial radiographs was higher during the consolidation period in groups II and III than in group I but, the difference was not significant (p>0.05). The relative blood flow in the distraction gap in groups II and III increased more significantly than in group I (p<0.05). FACS analysis showed an increased EPCs fraction after G-CSF injection. CONCLUSION: We demonstrated that G-CSF administration ameliorated bone formation and blood flow during rapid distraction in the rat model of tibial distraction osteogenesis. We think that G-CSF has an effect on mobilization of EPCs resulting in an increase in the blood flow.

Autosomal Recessive Multiple Epiphyseal Dysplasia in a Korean Girl Caused by Novel Compound Heterozygous Mutations in the DTDST (SLC26A2) Gene

Multiple epiphyseal dysplasia is caused by heterogenous genotypes involving more than six genes. Recessive mutations in the DTDST gene cause a phenotype of recessive multiple epiphyseal dysplasia (rMED). The authors report a 9-yr old Korean girl with the rMED phenotype having novel compound heterozygous mutations in the DTDST gene, which were inherited from both parents. This is the first Korean rMED case attributed to DTDST mutations, and expands the spectrum of diseases caused by DTDST mutations.

Spontaneous and Simultaneous Rupture of Bilateral Quadriceps Tendons in a Patient with Chronic Renal Failure: A Case Report / 대한스포츠의학회지

Spontaneous bilateral rupture of the quadriceps tendons without a significant history of trauma is an uncommon disease. It is generally associated with mechanical factors and coexisting systemic and local factors are taken into consideration in the pathogenesis of these ruptures. In patients with some chronic systemic diseases, simultaneous rupture can occur spontaneously or with minor trauma. We present a case of patient with chronic renal failure on hemodialysis for the past 9 years, who sustained this injury, and subsequently had surgical repair of both tendons. We performed a preoperative magnetic resonance imaging to confirm the diagnosis, then we repaired the ruptured quadriceps tendons and performing MRI postoperatively 1 yr later. He regained his normal knee joint functions 1 yr after the operation.

Analysis of Treatment Outcomes for Open Fractures of the Tibia in Children / 대한정형외과학회잡지

PURPOSE: Our objective was to analyze outcomes of treatment for open fractures of the tibia in children according to the classification of Gustilo-Anderson type. MATERIALS AND METHODS: We reviewed thirty five pediatric patients who underwent surgery for open fractures of the tibia between June 1998 and June 2007. We followed up over more than 1 year. Fractures were grouped into three types according to Gustilo-Anderson classification (Types I, II, and III). External fixation or flexible intramedullary nailing was used as the surgical method. We analyzed the period required to achieve radiologic bony union, tibial alignment, leg length discrepancy and complications. Clinical outcomes were assessed using the Karlstrom-Olerud method. RESULTS: Radiologically, bony union was achieved in 11.35+/-3.08 weeks, 10.50+/-2.20 weeks, and 21.62+/-7.19 weeks for types I, II, and III, respectively. Delayed union occurred in one case of type II and 3 cases of type III fractures. Complications such as nonunion, malunion and osteomyelitis were seen only in type III. Clinical outcomes showed excellent or good results in all cases except one (type III). CONCLUSION: Excellent outcomes for open fractures of the tibia in children can be obtained regardless of Gustilo-Anderson type when adequate procedures are performed.

Analysis of the Deformities of the Foot after Tibial Fracture and Outcome of the Surgical Treatment / 대한족부족관절학회지

PURPOSE: We wanted to evaluate the relating factors for deformities of the foot after tibial fracture and the outcome of respective surgical treatment. MATERIALS AND METHODS: We studied thirty-two patients (thirty-five feet) who had foot deformities after tibia fracture. The age, gender, shape, location, concurrent soft tissue injury and operative treatment of tibial fracture were analysed and outcome of the surgical treatment was investigated. RESULTS: Deformities of the foot mostly occurred in open fractures of Gustilo type 3 or closed fracture with severe soft tissue injury. Variable surgical treatments such as simple release, lengthening, Z-plasty and osteotomy were performed. The AOFAS ankle-hind foot scale was improved from average of 37.3 points preoperatively to an average of 77.2 points at the last follow up. The Maryland foot score was from 42.9 to 90.2 and AOFAS Lesser Toe Metatarso-phalangeal interphalangeal scale was from 42.9 to 90.5. Radiological correction was also improved from 21.9 degrees to 7.9 degrees (Meary angle), from 112.2 to 138.5 (Hibb's angle) and from 33.8 to 25.9 (Calcaneal pitch). CONCLUSION: We proposed that great care should be taken of treatment for the tibial fracture and early detection and proper management of the foot deformities are crucial.

Application of Ganz Surgical Hip Dislocation Approach in Pediatric Hip Diseases

BACKGROUND: Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases. METHODS: Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15.1 months (range, 6 to 29 months). Diagnoses included hereditary multiple exostoses in 9 hips, slipped capital femoral epiphysis in 7, Legg-Calve-Perthes disease in 4, osteoid osteoma in 1, pigmented villonodular synovitis in 1, and neonatal septic hip sequelae in 1. Medical records were reviewed to record diagnoses, principal surgical procedures, operative time, blood loss, postoperative rehabilitation, changes in the range of hip joint motion, and complications. RESULTS: Femoral head-neck osteochondroplasty was performed in 17 patients, proximal femoral realignment osteotomy in 6, open reduction and subcapital osteotomy for slipped capital femoral epiphysis (SCFE) in 2, core decompression and bone grafting in 2, hip distraction arthroplasty in 2, and synovectomy in 2. Operative time averaged 168.6 minutes when only osteochondroplasty and/or synovectomy were performed. Hip flexion range improved from a preoperative mean of 84.7degrees to a mean of 115.0degrees at the latest follow-up visit. Early continuous passive motion and ambulation were stressed in rehabilitation. No avascular necrosis of the femoral head was noted up to the time of the latest follow-up visit, except for in one SCFE patient whose surgical intervention was delayed for medical reasons. CONCLUSIONS: Ganz surgical hip dislocation provides wide exposure of the femoral head and neck, which enables complete and precise evaluation of the femoral head and neck contour. Hence, the extensive impinging bump can be excised meticulously, and the circulation of the femoral head can be monitored during surgery. The Ganz procedure was useful in severe pediatric hip diseases and allowed for quick rehabilitation with fewer complications.

Treatment of O dontoid Fractures with Single Anterior Screw Fixation / 대한정형외과학회잡지

PURPOSE: To evaluate the availability and safety of single anterior screw fixation in the treatment of type II and III odontoid process fractures through an analysis of the treatment outcomes. MATERIALS AND METHODS: This study analyzed 16 patients who underwent surgery between May 1996 and Oct. 2003 by single anterior screw fixation for type II and III odontoid process fractures with at least a 1 year follow up. The radiographic findings such as the fusion rate, union time, changes in the fracture shape, and metal migration were evaluated. In addition, the Robinson modification criteria were used for the clinical assessment. RESULTS: There were 12 and 4 patients with Anderson and D'Alonzo type II and type III fractures, respectively. Of the 16 patients, 15 (93%) achieved bony union after an average of 13.8 weeks. There were 2 cases of malunion with a normal range of cervical motion, and 1 case requiring posterior fusion as a result of nonunion. A full range of cervical motion was maintained in 11 cases. Three cases had a limitation of less than 25% and 2 cases had a limitation greater than 25%. CONCLUSION: Single anterior screw fixation is an effective treatment modality with a high fusion rate and low complication rates. However, precise preoperative planning and technical experience is essential for preventing unwanted complications.

Disturbance of Toe Walking in Mid-lumbar Spinal Stenosis: Three Cases Report / 대한척추외과학회지

We report three cases of toe walking disturbance due to mid-lumbar spinal canal stenosis, which is a condition rarely reported in the literature. A severe bilateral S1 root lesion, associated with spinal stenosis at L3-4, is described. The diagnosis was obtained using computed tomography myelography (CTM) and magnetic resonance imaging (MRI). The findings at L5-S1 were minimal, and did not justify the patients clinical symptoms (disturbance of toe walking), but a detailed radiological evaluation revealed severe spinal stenosis at L3-4, which was assumed to be the cause of the S1 nerve root compression. A decompressive laminectomy, posterolateral fusion and posterior stabilization were performed. The pain and claudication had disappeared at the last follow-up evaluation, but the clinical symptom associated with the S1 root (toe walking) had not recovered.