Effects of prunetin on the proteolytic activity, secretion and gene expression of MMP-3 in vitro and production of MMP-3 in vivo

We investigated whether prunetin affects the proteolytic activity, secretion, and gene expression of matrix metalloproteinase-3 (MMP-3) in primary cultured rabbit articular chondrocytes, as well as in vivo production of MMP-3 in the rat knee joint to evaluate the potential chondroprotective eff ect of prunetin. Rabbit articular chondrocytes were cultured in a monolayer, and reverse transcription-polymerase chain reaction (RT-PCR) was used to measure interleukin-1beta (IL-1beta)-induced expression of MMP-3, MMP-1, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4), and ADAMTS-5. In rabbit articular chondrocytes, the effects of prunetin on IL-1beta-induced secretion and proteolytic activity of MMP-3 were investigated using western blot analysis and casein zymography, respectively. The eff ect of prunetin on MMP-3 protein production was also examined in vivo. The results were as follows: (1) prunetin inhibited the gene expression of MMP-3, MMP-1, MMP-13, ADAMTS-4, and ADAMTS-5; (2) prunetin inhibited the secretion and proteolytic activity of MMP-3; (3) prunetin suppressed the production of MMP-3 protein in vivo. These results suggest that prunetin can regulate the gene expression, secretion, and proteolytic activity of MMP-3, by directly acting on articular chondrocytes.

Recurrent Lipofibromatous Hamartoma of the Median Nerve / 대한정형외과학회잡지

Lipofibromatous hamartoma is a rare tumor of the peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue and very few cases have been described and reported in the literature. Surgical treatments of lipofibromatous hamartoma include partial excision, debulking operation, nerve decompression and so on. We report a case of recurrent lipofibromatous hamartoma of the median nerve that partial excision was done previously but causing secondary carpal tunnel syndrome and a review of the literature regarding the etiology, pathogenesis and surgical management of lipofibromatous hamartoma.

Outcomes from Treatment of Simple Bone Cyst in the Long Bones with Flexible Intramedullary Nailing in Children and Adolescents: A Retrospective Cases Series / 대한정형외과학회잡지

PURPOSE: A retrospective review of cases series about the outcomes of treatment for simple bone cyst in the long bones with flexible intramedullary nailing in children and adolescents. MATERIALS AND METHODS: Eighty-five cases with a simple bone cyst in the long bones diagnosed between April 2002 and December 2007 were enrolled in the study. The mean age of the patients was 10.8 years. Thirteen cases were accompanied by a pathological fracture, and 72 cases were not. Thirty-three cases had a simple bone cyst on the proximal humerus, 41 cases on the shaft of the humerus, and 11 cases on the proximal femur. Steroid injections were performed in 21 cases (group 1), curettage and a synthetic bone graft in 18 cases (group 2), and decompression and fixation using flexible intramedullary nailing in 46 cases (group 3). We followed up all cases for at least 24 months and evaluated the results according to the Capanna classification. RESULTS: The mean duration for absorption and healing of bone cysts was 18.4 months in group 1, 10.6 months in group 2, and 5.8 months in group 3. The complete cure rate according to the Capanna classification was 67% in group 1, 56% in group 2, and 78% in group 3. There was one case of recurrence in group 1 (5%), one case in group 2 (6%), and one case in group 3 (2%), as well as two cases of "no response to treatment" in group 1 (9%) and one case in group 2 (6%). CONCLUSION: Flexible intramedullary nailing for simple bone cysts in children and adolescents is effective for healing cystic lesions with a short healing duration and for mechanical stability.

A Case of Aggressive Digital Papillary Adenoma of the Fifth Finger / 대한정형외과학회잡지

Aggressive digital papillary adenoma is a rare neoplasm of eccrine sweat gland origin. We report a case of aggressive digital papillary adenoma of the fifth finger, together with a literature review.

Hematoma Distraction Arthroplasty after Trapeziectomy in Advanced Osteoarthritis of the Trapeziometacarpal Joint / 대한정형외과학회잡지

PURPOSE: To investigate the clinical usefulness of hematoma distraction arthroplasty to treat advanced trapeoziometacarpal osteoarthritis of the thumb. MATERIALS AND METHODS: We studied 12 cases (1 male, 11 females) with osteoarthritis of the thumb that was managed with hematoma distraction arthroplasty using K-wire fixation. Of the 12 cases, 7 were Littler-Eaton stage III and 5 were Littler-Eaton stage IV. We investigated operation time, preoperative and postoperative visual analogue scale (VAS) score, preoperative and postoperative range of motion, grip power and radiologic changes. RESULTS: The mean patient age was 53.2 (39-61) years and the mean duration of follow-up was 19.5 (14-27) months. The average operation time was 52 minutes. The mean VAS scores at 6 and 12 months after the operation were 1.3 and 0.7, respectively. The range of motion and grip power of the finger improved postoperatively (15% in abduction, 18% in adduction, 25% in flexion, 14% in extension, 66% in grip power of the finger). On a simple 12-month postoperative radiologic exam, the interval between the scaphoid and first metacarpal bone had decreased 6.5 mm compared with the preoperative interval. CONCLUSION: The surgical treatment using hematoma distraction arthroplasty for trapeziometacarpal osteoarthritis is an effective method for pain relief, improvement of motion range and finger-grip power.

Results of the Kapandji Procedure in the AO Type C Distal Radius Fracture in Patients over Age 60

PURPOSE: To evaluate the clinical and radiologic results of the Kapandji procedure in AO classification type C distal radius fracture patients over 60 years old. MATERIALS AND METHODS: Twenty-one type C distal radius fracture patients over the age of 60 years who were treated with the Kapandji procedure from June 2004 to June 2009 in our hospital and had a post-operative follow-up period of more than 1 year were enrolled. The volar tilt, radial inclination, and radial length were measured for the radiographic analysis using the modified Lidstrom scoring system about post-operative reduction loss in every follow-up radiogram. The clinical result was assessed with a visual analogue scale (VAS) and Korean Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) score at the last follow-up. RESULTS: The mean radiologic loss of volar tilt was 1.1degrees and the mean loss of radial length was 2.6 mm and the mean radial inclination loss was 2.7degrees compared with the immediate post-operative period and last follow-up period. The average VAS and DASH scores were 1.4 and 15.9. CONCLUSION: The radiologic results of closed reduction and percutaneous pinning using the Kapandji technique for distal radius AO type C fracture patients over 60 years of age was not satisfactory. Nevertheless, the clinical results were satisfactory.

Treatment of Enchondromas of the Hand with Curettage, Autoiliac Bone Graft and Contact Cryotherapy

PURPOSE: The purpose of this study was to evaluate the effectiveness of contact cryotherapy as an adjuvant therapy after intralesional curettage and autoiliac bone graft of enchondromas of the hand. MATERIALS AND METHODS: Thirty seven cases in 30 patients (17 males, 13 females) with enchondromas of the hand who underwent curettage, contact cryotherapy and autoiliac bone graft between July 2004 and March 2010 were reviewed with a minimum follow-up of 1 year. Radiologic evaluations were done periodically. Mean follow-up period was 26 months (range: 12-54 months). The radiologic results were evaluated according to the degree of new bone formation based on the Tordai's criteria. RESULTS: According to the Tordai's criteria, 33 cases (89%) were group I, and 4 cases (11%) were group II. There was no case of group III, which meant recurrence. Bone healing was achieved at average 4.8 months (range: 4-5.3 months) after the operation. There was no cryotherapy-related complication such as pathologic fracture, bone necrosis and skin necrosis during the follow-up periods. CONCLUSION: We suggest that the contact cryotherapy can be used as an effective adjuvant therapy for treatment of enchondroma of the hand without complications.

An Analysis of Cases Referred from the Primary Healthcare Institution with Suspected Developmental Dysplasia of the Hip: A Prospective Study / 대한정형외과학회잡지

PURPOSE: A prospective, epidemiological investigation was performed in the patients referred to our hospital with suspected developmental dysplasia of the hip (DDH). MATERIALS AND METHODS: Of the 121 patients referred from the primary healthcare institutions, with suspected DDH from January 2006 to December 2007, 82 patients who were able to be followed up for at least 2 years were enrolled in this study. Confirmation of the diagnosis was determined by patient history, physical examination, simple radiographs, and ultrasonography. Epidemiological investigation was performed in the total 82 cases which were referred from the primary healthcare institution and were confirmed as having DDH, and at least a 2-year follow up was performed in all these cases. RESULTS: Of the 82 cases, 56 cases (68.3%) were within normal limits (W.N.L.), 15 cases (18.29%) were confirmed as having DDH, and 11 cases (13%) were diagnosed with several different diseases other than DDH. Compared to the total 82 cases, the percentage of females, presence of family history was statistically higher in the cases confirmed as having DDH. However, the incidence of breech presentation was not statistically different between all cases. 61 cases were referred by pediatricians and 21 cases were referred by orthopedic surgeons to the primary healthcare institution, and the diagnostic rate of DDH was statistically higher in the cases referred by orthopedic surgeons (p>0.05). CONCLUSION: The rate of confirmation of the suspected diagnosis of DDH would hopefully increase through the establishment of physical examination protocols or radiologic study and systematic training programs that could be applied in the primary healthcare institution.

Simple Subperiosteal Hematoma with a Periosteal Reaction Mimicking a Malignancy / 대한정형외과학회잡지

A benign periosteal reaction, which can occur after trauma or stress, has a solid and uninterrupted appearance on radiography. In contrast, an aggressive periosteal reaction, which may indicate a malignancy, appears as a Codman's triangle or with a spiculated and sunburst pattern. In the present case, an 11-year-old boy with a previous injury to the distal radial growth plate presented with diffuse osteolysis on the distal radial metaphysis and decreased opacity of the lateral side cortex on plain radiograph. A Codman's triangle-like lesion was seen on the lateral side of the distal radius, and a few spicules were observed on the medial side of the distal radius. A T2-weighted coronal magnetic resonance image revealed a mass that had stripped the periosteum; the mass had heterogeneous signal intensity and a fl uid-fluid level on axial views. The margins of the mass were unclear, but enhanced. Suspecting a primary malignancy, we performed a biopsy. The pathology revealed that the mass was a simple hematoma.

A Retrospective Comparative Study of Internal Fixation with Contoured Plate Using Bicortical Screw Versus a Double Plate in Comminuted Olecranon Fractures / 대한정형외과학회잡지

PURPOSE: To analyze the clinical result of a contoured plate fixation using a bicortical screw and a double plate fixation in the surgical treatment of an adult's comminuted olecranon fracture. MATERIALS AND METHODS: A total of 22 patients were classified by Mayo classification as Type IIB (17) and Type IIIB (5). All patients enrolled in the study were treated between July 2002 and September 2009. Twelve patients were operated on using the contoured plate internal fixation using a bicortical screw procedure classified as group 'A'. The 10 patients operated on by a double plate fixation were classified as group 'B'. The Mayo elbow performance score was used to compare postoperative clinical results based on total points in 4 categories: pain, range of motion, articular stability, and articular function. RESULTS: The clinical results of using the Mayo elbow performance score of group 'A' were that 10 scored in the 'excellent' range and 2 scored in the 'good' range the following: in group 'B' were in the excellent range and 3 were in the good range. Both groups showed satisfactory results. Postoperative elbow exercises in group 'A' commenced 7.8 (5-14) days on average, postoperatively. For 'B' group, post-operative elbow exercises began 4.5 (3-7) days following the operation. With regard to the exercise and the range of elbow motion, group 'A' averaged 113.5 degrees and group 'B' averaged 112 degrees. After surgery, the average durations until the bone union were 3.8 (2.4-5.6) months for group 'A' and 4 (2.5-5) months for group 'B', respectively. CONCLUSION: There was no significant difference in the clinical results between patients treated with the contoured plate internal fixation using a bicortical screw or the internal fixation using a double plate in the surgical treatment of adults with comminuted olecranon fracture or dislocation. Therefore, both types of operative approach are acceptable.

Thermal Injury Complicating Improperly Reamed Intramedullary Nailing of the Tibia: A Case Report

Endosteum and bone marrow thermal necrosis caused by reaming during tibial intramedullary nail insertion, and unskilled operation of soft tissue penestration by reamer resulted in chronic osteomyelitis and soft tissue defect. So, several times of free flaps were done but the result was unsuccessful. At last, the authors performed radical necrotic bone resection and internal bone transport using Ilizarov external fixator. The authors report case with literature review.

Prognostic Factors That Affect the Surgical Outcome of the Laminoplasty in Cervical Spondylotic Myelopathy

BACKGROUND: This study examined the prognostic factors that affect the surgical outcome of laminoplasty in cervical spondylotic myelopathy patients by comparative analysis. METHODS: Thirty nine patients, 26 males and 13 females, who were treated with laminoplasty for cervical myelopathy from September 2004 to March 2008 and followed up for 12 months or longer, were enrolled in this study. The mean age of the subjects was 62.4 years (range, 37 to 77 years). The patients' age, number of surgical segments, spinal cord compression ratio, segment number, level, localized marginal pattern of high signal intensity within the spinal cord in the T2 image, preoperative Japanese Orthopaedic Association Scoring System (JOA) score with the recovery ratio were compared respectively. The JOA score was used for an objective assessment of the patients' preoperative and postoperative clinical status. The recovery ratios of surgery were graded using the Hirabayashi equation. Statistical analysis was carried out using Pearson correlation analysis. RESULTS: The patients' JOA score increased from a preoperative score of 11.1 (range, 5 to 16) to a postoperative score of 14.9 (range, 7 to 17). The average recovery ratio was 65.8% (range, 0 to 100%). The number of segments with high signal changes in the T2 image, a localized marginal pattern with high signal change, signal intensity changes in the upper cervical spinal cord were inversely associated with the recovery ratio, whereas the spinal cord compression ratio showed a significant positive correlation. However, the currently known prognostic factors, such as number of surgical segment, age, and preoperative JOA score, showed no statistically significant correlation. CONCLUSIONS: The number of segments, localized marginal pattern, rostral location of signal intensity c hanges with a high signal change in the T2 image and a low spinal cord compression ratio in cervical spondylotic myelopathy patients treated by laminoplasty can indicate a poor prognosis.

Heterotophic Ossification in the Thenar Eminence and the Thumb: A Case Report

Heterotopic ossification is defined as a reactive disease with mature lamellar bone formation in soft tissue. We experienced a case of heterotopicc ossification occurred on the thenar eminence and the thumb without trauma. We report this rare case with a review of the relevant literature.

Clinical Results of Carpal Tunnel Release with Open Minimal Incision

PURPOSE: To find out the clinical usefulness of carpal tunnel release with open minimal incision MATERIALS AND METHODS: We studied 149 patients (152 carpal tunnel) who were able to follow up for more than 6 months after being treated with carpal tunnel release with open minimal incision from January 2000 to January 2006. We compared the clinical results of this procedure using recovery time, the disappearance of symptoms, the presence of the kelloid and the scar tenderness and analyzed preoperative and postoperative VAS score of tingling sensation, dull sensation, inappropriate hand movement, muscle weakness, edema, palmar pain as subjective satisfaction. We used the independent t-test for the statistical significance. RESULTS: All cases had complete disappearance or marked improvement in symptoms, and there was no kelloid formation. Residual symptoms and tenderness of the scar was found in 8 cases (5.4%), but gradually disappeared. In last follow up, tingling sensation decreased from 7.8 to 1.0 and dull sensation from 7.0 to 1.5, inappropriate hand movement from 4.8 to 1.1, muscle weakness from 5.9 to 0.8, edema from 2.0 to 0.5, palmar pain from 2.1 to 0.2 in preoperative and postoperative VAS score, all were significantly improved statistically (P<0.05). CONCLUSIONS: We think that carpal tunnel release with open minimal incision has little complication and is a safe and effective operation method having similar effect with endoscopic surgery or conventional open surgery.