Glomus Tumors of the Fingers: A Report of 66 Cases

PURPOSE: We reviewed 66 cases of the glomus tumors in the hands. The purpose of this study was to review the characteristic signs and symptoms of glomus tumors and the surgical outcomes. We made hypothesis that (1) our guideline for surgical excision are reliable and (2) our surgical technique is efficient and less harmful to the nail root. MATERIALS AND METHODS: The clinical diagnosis was made with occasional radiological studies and surgical excision was performed according to our indications. Patients with electrical shock-like pain by touching (the essential symptom) and at least 2 of 4 clinical signs and symptoms (cold hypersensitivity, paroxysmal pain that radiated proximally, blue discoloration, nail deformity for dorsal tumor or a palpable nodule for pulp tumor) underwent surgical excision. RESULTS: The duration of symptoms of the patients was about 5.3 years. No difference of prevalence was found in both hands, but the thumb and the middle finger were more affected than the other fingers. The mean follow up period was 2.4 years and none of the patients complained the same characteristic pain at the last visit. CONCLUSION: To the best of our knowledge, this report is the largest case series about glomus tumors in the finger tip. The clinical signs and symptoms are important to make a diagnosis of glomus tumors, and surgical excision is the treatment of choice.

Measurement of Canal Encroachment Using Axial and Sagittal-Reconstructed Computed Tomographic Images in Thoracolumbar Burst Fractures

STUDY DESIGN: A retrospective study. OBJECTIVES: The aim of this study was to examine the usefulness of axial and sagittal-reconstructed CT images in the evaluation of spinal canal encroachment by thoracolumbar burst fractures. SUMMARY OF LITERATURE REVIEW: The dimensions of spinal canal encroachment by burst fractures have been described using axial CT images in the thoracolumbar region and sagittal-reconstructed images in the lower cervical region. However, the validity and reliability, depending on the measuring method, have not been fully evaluated. MATERIALS AND METHODS: A hundred and ninety-nine patients, who had diagnosed as a thoracolumbar burst fracture, were included in this study. Three orthopedic surgeons independently measured the canal encroachment of the burst fragment in the axial CT images and the sagittal-reconstructed images using the ratio of spinal length (method 1) and the ratio of area (method 2). The validity for the evaluation of the deformity and fracture stability was evaluated. In addition, the reliability of each method was assessed. RESULTS: Sixty-seven stable burst fractures and 132 unstable burst fractures were assessed. The mean kyphotic angle of stable and unstable burst fracture were 11.89 +/- 8.49degreesand 15.90 +/- 9.63degrees(P=0.005). The mean canal encroachment ratios of stable fracture were 17.21 +/- 15.82 % (axial-method 1), 16.71 +/-16.49 % (axial-method 2), 19.54 +/- 17.03 % (sagittal reconstructed-method 1), and 11.75 +/- 12.33 % (sagittal reconstructed-method 2). The mean canal encroachment ratios of unstable fracture were 31.54 +/- 17.10 % (axial-method 1), 29.67 +/- 18.47 % (axial-method 2), 28.53 +/- 18.60 % (sagittal reconstructed-method 1), and 21.20 +/- 15.11 % (sagittal reconstructed-method 2). There was no relationship between the fracture deformity and the canal encroachment ratio in all 4 methods. All ratios in the 4 method showed significant differences in the evaluation of fracture stability. All methods except method 1 in the sagittal-reconstructed images showed significant differences in the assessment of neurologic compromise. CONCLUSIONS: The measurement of a canal encroachment area using axial and sagittal-reconstructed images was valid in the description of fracture stability.

Ankle Arthrodesis using Cannulated Screws & Hybrid Type Rigid External Fixation in Diabetic Charcot Neuroarthropathy / 대한족부족관절학회지

PURPOSE: The diabetic charcot neuroarthropathy of ankle is an infrequent site (around 5%), but is definitely the location that, because of the instability and progressive deformity it involves, cause ulceration in a high percentage of patients, and this can then become a reason for amputation. However, the treatment of this disastrous disease is still challenging. We analyzed the clinical and radiological results of ankle arthrodesis by our fixation method in Charcot neuroarthropathy. MATERIALS AND METHODS: Seven cases that were diagnosed as charcot neuroarthropathy of ankle arthrodesis were followed for more than 16 months postoperatively. Mean age was 57 years, and the mean follow-up period was 27 months. Anterior approach was used in arthrodesis, and internal fixation by 3 or more cannulated screws and hybrid type external fixation were used. Auto iliac bone for grafting was combined in all cases. External fixator was kept for 3 months without weight-bearing. Then, boots brace was applied for more 3 months allowing partial weight-bearing. Four cases had minor complications such as pin site infection. Preoperative and postoperative AOFAS score, time to fusion and postoperative complications were checked. RESULTS: Postoperative fusion was completed in all cases, and the mean time to fusion was 3.4 months. No postoperative complication was checked. At the last follow-up, the mean AOFAS score had increased from 54 points to 72 points. Patient's satisfaction was over 80%. CONCLUSION: Satisfactory results were obtained after ankle arthrodesis using internal and hybrid type external fixation combined with auto iliac bone graft in charcot neuroarthropathy with minor complications.