Autogenous Osteochondral Graft for Freiberg's Disease: A Case Report / 대한족부족관절학회지

Freiberg disease is a osteochondrosis of the lesser metatarsal heads. Various surgical treatment have been recommanded including joint debridement and metatarsal head reshaping, metatarsal dorsal wedge osteotomy, metatarsal head excision and joint arthroplasty. Autogenous osteochondral graft for the treatment of Freiberg disease is an effective restorative procedure that provides early range of motion exercise, weight bearing, and reduces other morbidity. We report a case of late stage Freiberg disease treated with arthrotomy, removal of loose body and autogenous osteochondral graft.

Tissue Transglutaminase Activates NF-kappaB Pathway in the Atherosclerotic Coronary Artery / 체질인류학회지

Molecular mechanism of nuclear factor-kappaB(NF-kappaB) in the atherosclerosis has been unclear. Recently, NF-kappaB activating function of tissue transglutaminase (tTGase), multifunctional calcium-dependent transamidation enzyme, have been reported in the various tissues like neuroglia. In this report, we investigated the immunoreactivity of tTGase at the human atherosclerotic coronary artery, and examined the effect of tTGase on the well-known proatherogenic NF-kappaB pathway using tTGase-overexpressed cells. Immunohistochemical studies on autopsy samples showed that immunoreactivity of tTGase was markedly elevated in the neointimal tissues of atherosclerotic coronary arteries with progression of disease. Immunohistochemical staining also demonstrated that phosphorylated I-kappaB was activated in the atherosclerotic vessel wall. In vitro study using rat cardiomyoblast (H9c2) and tTGase-overexpressed H9c2 showed that activated tTGase enhanced the phosphorylation of I-kappaB, and this activation was inhibited by tTGase specific inhibitors. These findings suggest that cytosolic tTGase may serve as an activator of NF-kappaB.

Clinical and Radiological Analysis and Results after Anatomical Reduction and Bone Graft for Symptomatic Os Subfibulare / 대한족부족관절학회지

PURPOSE: To analyze the clinical and radiological feature of Os subfibulare and to evaluate the results after anatomical reduction and internal fixation with bone graft for Os subfibulare. MATERIALS AND METHODS: Forty-two cases, which underwent anatomic reduction and bone graft for Os subfibulare from October 1998 to September 2004 were reviewed. We analysed preopertive symptoms and onset of symptoms and radiologically measured the size and amounts of displacement of Os subfibulare under the inversion stress. Postoperatively we evaluated the clinical results measured by Hasegawa method and evidence of union. RESULTS: Preoperatively there were only pain around the lateral malleolus in 16 cases, only instability of ankle joint in 3 cases, and pain and instability in 23 cases. The age of symptom onset averaged 23 years(range, 13-38 years). Radiographically Os sufibulare anteriorly located from lateral malleolus were in 40 cases, posteriorly situated in 2 cases. The size of Os subfibulare ranged from 1 x 4 mm to 8 x 17 mm. In 22 cases of inversion stress view, displacement of the Os sbufibulare averaged 1.5+/-1.1 mm (0 to 5 mm). The postoperative clinical results were excellent in 41 cases, poor in 1 case. There were complications of 1 case of irritation of sural nerve, 1 case of nonunion. CONCLUSION: Anatomic reduction and bone graft is effective treatment method for symptomatic Os subfibulare.

Clinical and Radiological Analysis and Results after Anatomical Reduction and Bone Graft for Symptomatic Os Subfibulare / 대한족부족관절학회지

PURPOSE: To analyze the clinical and radiological feature of Os subfibulare and to evaluate the results after anatomical reduction and internal fixation with bone graft for Os subfibulare. MATERIALS AND METHODS: Forty-two cases, which underwent anatomic reduction and bone graft for Os subfibulare from October 1998 to September 2004 were reviewed. We analysed preopertive symptoms and onset of symptoms and radiologically measured the size and amounts of displacement of Os subfibulare under the inversion stress. Postoperatively we evaluated the clinical results measured by Hasegawa method and evidence of union. RESULTS: Preoperatively there were only pain around the lateral malleolus in 16 cases, only instability of ankle joint in 3 cases, and pain and instability in 23 cases. The age of symptom onset averaged 23 years(range, 13-38 years). Radiographically Os sufibulare anteriorly located from lateral malleolus were in 40 cases, posteriorly situated in 2 cases. The size of Os subfibulare ranged from 1 x 4 mm to 8 x 17 mm. In 22 cases of inversion stress view, displacement of the Os sbufibulare averaged 1.5+/-1.1 mm (0 to 5 mm). The postoperative clinical results were excellent in 41 cases, poor in 1 case. There were complications of 1 case of irritation of sural nerve, 1 case of nonunion. CONCLUSION: Anatomic reduction and bone graft is effective treatment method for symptomatic Os subfibulare.

Solitary Osteochondroma of Fibula in Distal Tibiofibular Joint causing Valgus Deformity of Ankle: A Case Report / 대한족부족관절학회지

The osteochondroma is a cartilage-capped exostosis resulting from an error in the regulation of normal chondrocyte proliferation and maturation that leads to a normal bone growth. Although exostoses are benign lesions, they are often associated with characteristic progressive skeletal deformities and may cause clinical symptoms. Surgery can prevent progression and provide correction for certain deformities. We experienced a rare case of solitary osteochondroma in a 21-year-old male which caused the valgus deformity of the ankle.

Roles of Distal Centralizer in Cemented Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study was performed to find out the influencing factors on cement mantle thickness in cemented total hip arthroplasty. MATERIALS AND METHODS: Eighty patients were randomly enrolled who received total hip arthroplasty with the third generation cementing technique. Four types of femoral prosthesis (20 patients in each type) were used: Centralign (Zimmer, Warsaw, IN), Precision (Howmedica, Rutherford, NJ), Omnifit (Osteonics, Allendale, NJ), and Elite Plus (Depuy, Warsaw, IN). Size of femoral prosthesis, diameter of stem tip, shape and size of centralizer, and the condition of cement mantle on the radiograph were analyzed. RESULTS: Between the two groups of same or above C1 (> or =C1; A, B, and C1, n=69) and C2 (n=11) by Barrack classification, there was no difference in age, sex, underlying disease, size of applied stem, Dorr ratio, and the distance between stem tip and plug. The difference of distal diameter between centralizer and stem was less than 2 mm in 18 patients, and same or above 2 mm in 62 patients. C2 was more frequently observed in patients with the diameter difference or =2 mm (22.2% vs. 11.3%). However, C2 developed in all types of femoral stems, irrespective of their shapes, even the diameter difference was > or =2 mm. CONCLUSION: The diameter of distal centralizing device should be at least 2 mm larger than that of stem tip for an optimal cement mantle thickness. In addition, centralizers investigated in this study should be carefully used, and more improved shape of centralizer is required for the successful cement mantle formation.

Analysis of Complications after Treatment of Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: Problematic late sequelae are common following a calcaneal fracture regardless of the initial treatment. We retrospectively evaluated the painful conditions and reviewed the results of the operative treatment in patients with previously treated calcaneal fractures. MATERIALS AND METHODS: Between October 1996 and September 2001, forty-three patients who underwent subsequent surgical treatment for late sequelae of calcaneal fracture were reviewed. The initial treatment consisted of only immobilization in a cast in 7 patients, closed reduction with pin fixation (Essex-Lopresti technique) in 22 and open reduction and internal fixation in 14. Painful conditions in the hind foot included subtalar arthritis in 31 patients, calcaneofibular impingement in 13, peroneal tendinitis in 6, displaced posterior bony fragment in 3, sural neuritis in 2, subtalar and midtarsal arthritis in 1 and displaced plantar bony fragment in 1. The surgical procedures for the late complications were performed at a mean of 19 months (range, 6 to 35 months) after the injury and consisted of lateral wall ostectomy and in situ subtalar fusion in 28 patients, only lateral wall ostectomy in 5 patients, lateral wall ostectomy and subtalar distraction arthrodesis in 3, removal of displaced posterior bony fragment in 3, sural nerve transposition in the peroneus brevis in 2, triple arthrodesis in 1 and removal of displaced plantar bony fragment in 1. Mean postoperative follow up period was 57 months (range, 33 to 82 months). The results of treatment were evaluated on the basis of pain, improvement in the ability to perform activities of daily living, to return to work or to a pre-injury level of activity. RESULTS: Pain was partially relieved in 38 patients (88%), but not relieved in 5. Function improved in 34 patients (79%), and 32 (74%) returned to work or to a pre-injury level of activity. There was a trend that the longer the interval between the injury and the operation, the longer the subsequent interval until the patient returned to full activities or work. CONCLUSION: Meticulous physical examination and intensive prompt treatment for remaining pain after initial treatment of calcaneal fractures are recommended for patient's satisfaction and returning to work.

Dorsal Angulation after Proximal Dome Osteotomy for Hallux Valgus / 대한족부족관절학회지

PURPOSE: We try to retrospectively evaluated the amount of dorsal angulation angle of the first metatarsal commonly occurring as the complication of proximal dome osteotomy for hallux valgus. MATERIALS AND METHODS: Between January 2004 and March 2004, 34 patients who underwent proximal dome osteotomy for moderate to severe hallux valgus. Two of 34 patients were male, and thirty-two were female. The average age was 57.6 years. We measured and compared hallux valgus angle, 1st-2nd intermetatarsal angle, dorsal angulation angle of 1st metatarsal on preoperative, postoperative, postoperative 3 weeks', postoperative 3 months' X-ray. RESULTS: Osteotomy sites were completely united on plane X-ray in all cases. The hallux valgus angle averaged 41.2 degrees (30~60 degrees) at preoperative, 4.3 degrees (-10~20 degrees) at postoperative, 5.5 degrees (-1~20 degrees) at 3 weeks after operation, 7.8 degrees (-2~20 degrees) at 3 months after operation. The 1st-2nd intermetatarsal angle averaged 17.1 degrees (12~24 degrees) at preoperative, 6.3 degrees (0~13 degrees) at postoperative, 7.2 degrees (0~15 degrees) at 3 weeks after operation, 8.7 degrees (0~18 degrees) at 3 months after operation. The dorsal angulation angle averaged 0.4 degrees (0~3 degrees) at postoperative, 1.6 degrees (0~7 degrees) at 3 weeks after operation, 2.1 degrees (0~8 degrees) at 3 months after operation. There were no statistically correlation between increase of dorsal angulation angle of the distal segment of the first metatarsal and increase of hallux valgus angle or 1st-2nd intermetatarsal angle. CONCLUSION: Our results shows that the dorsal angulation of distal fragment occurring after the proximal dome osteotomy in the treatment of hallux valgus may be minimized with meticulous surgery and patient's education.

Surgical Treatment for Painful Instability of the Second Metatarsophalangeal Joint: 1 Case Report / 대한족부족관절학회지

An unstable second metatarsophalangeal joint may produce pain in the forefoot. Plication of stretched lateral ligament and capsule and transfer of the extensor digitorum brevis under the transverse intermetatarsal ligament performed as the primary procedure to stabilize this painful joint. But the pain was not subsided and the proximal phalanx was resubluxated. So, we osteotomized the second metatarsal to restore a normal alignment of the second toe. Then the symptom was subsided. We report a case of painful instability of the metatarsophalangeal joint of the second toe.

Traumatic False Aneurysm: Report of Two Cases / 대한정형외과학회잡지

False aneurysm is one of the complications of untreated arterial injury. Most traumatic aneurysms in the extremities are false, and they are usually caused by penetrating trauma. The pathogenesis of false aneurysm is initiated by a damaged artery that allows hemorrhage into surrounding soft tissue, an encapsulated hematoma is then formed, which undergoes organization, with invasion of fibrin and con-nective tissue, and the endothelialization of its central cavity, which communicates with the arterial defect, forming the false aneurysm. We experienced two cases of traumatic false anerysm of a left anterior tibial artery and a right radial artery, which were treated successfully by end-to-end anastomosis in the former and a saphenous vein graft in the latter.

2 Cases of Accessory Iris Membrane

I experienced 2 cases of accessory iris membrane which had been known to be rare disease, and reviewed them in the literatures. Case 1 was 12 year old female and her visual acuity was 0.3(NC) in left eye and 0.5(NC) in right eye. Both eyes were accompanied with true polycoria and the removal of accessory iris membrane was performed because of poor visual acuity. Postoperatively, pupils became round and visual acuity was increased to 0.8 in both eyes. Case 2 was 14 year old female with pseudopolycoria, but operation was not performed due to relatively good visual acuity, i.e. right eye, 0.2(1.2 X Sph. -2.5D) and left eye, 0.1(1.2 X Sph. -3.0D).

4 Cases of Congenital Aniridia

The authors experienced 4 cases of congenital aniridia associated with other ocular defects. (case 1:20 year old male. case 2 and 3:5 month male, case 4:24 year old female). Three cases of these showed bilateral involvement and one case (case 4) unilateral involvement. Four patients had the following eye defects recorded: 2 cases of cataract (case 1, 2), 2 cases. of optic nerve atrophy (case 3, 4), glaucoma (case 4), and significant exotropia (case 4). Two cases of cataract was operated by aspiration method and the visual acuity corrected with Sph. +11.0 lens was 0.08 in both eyes of case 1. Cyclodialysis was performed for glaucomatous eye and intraocular pressure was decreased from 34.5mmHg to 24.4mmHg. Reoperation was advised but refused by patient.

Three Cases of Malignant Melanoma

We described clinical observations and reviews of literature to three cases of malignant melanoma which occurred in the tarsal conjunctiva. First case of 69 years old man, treated with 25 times of X-ray irradiation (total 5,000 rad) to metastatic cervical tumor mass, and removal of malignant melanoma in lower tarsal conjunctiva. Second case of 36 years old man, treated with 25 times of X-ray irradiation (total 5,000 rad) to metastatic submandibular tumor mass, which was subsided, but 17 times of X-ray irradiation (total 3,400 rad) to malignant melanoma in lower tarsal conjunctiva, which wasn't subsided, so performed exenteration of orbit. Third case of 64 years old woman, performed only removal of malignant melanoma in mucocutaneous junction of upper lid. All three cases were not recurred as now.