Malignant Tenosynovial Giant Cell Tumor Presenting as an Extra-Articular Superficial Soft-Tissue Mass in a Knee

Malignant tenosynovial giant cell tumor (TsGCT) is a rare disease that can arise as a recurrent lesion or co-exist with a benign TsGCT lesion. Here we report a rare case of malignant TsGCT in a 73-year-old male with a history of lymphoma. The tumor appeared as a superficial soft-tissue mass in the subcutaneous fat tissue of the left knee.

Prognostic Indicators of Extremity Liposarcoma / 대한정형외과학회잡지

Purpose@#The aim of this retrospective study was to define the prognostic factors for liposarcoma to aid in the selection of effectivetreatments. @*Materials and Methods@#This study analyzed 41 cases out of 45 cases diagnosed with and treated for liposarcoma 2002 to 2015; 4 casesof well-differentiated liposarcoma were excluded. The effects of sex, age, site, stage, and histological classification on survival wereanalyzed retrospectively. For 28 cases diagnosed with myxoid liposarcoma, additional analysis was performed after the inclusion of roundcell components. @*Results@#The mean age at diagnosis was 52.05 years (range 25–82 years) and the average follow-up period was 63.7 months. The diseasefreesurvival rate was 43.2%. Most factors, including sex and age, were not significantly associated with the survival rate. On the otherhand, the stage (Musculoskeletal Tumor Society stage) was significantly associated with the survival rate. The survival rate of patients withmyxoid liposarcoma was 69% and the local recurrence and metastasis results varied according to the presence of round cells. @*Conclusion@#The stage of liposarcoma and the sex of the patient were found to be effective factors for prognosis. When planning thetreatment for liposarcoma, the treatment outcome for liposarcoma differs according to several prognostic factors.

Treatment of Enchondroma in the Hands and Feet / 대한정형외과학회잡지

Purpose@#The purpose of this study was to suggest an appropriate treatment method by comparing nonsurgical treatment and surgical treatment for enchondroma in the hands and feet. @*Materials and Methods@#Seventy four cases with enchondroma of the hands and feet from January 1996 to March 2017 were selected to evaluate the functional outcomes. Thirty cases were treated with nonsurgical treatment, and 44 cases were treated with surgical treatment, such as curettage only or curettage with a bone graft. The mean follow-up period was 18.1 months. The functional results were analyzed using the Wilhelm and Feldmeier formula. @*Results@#The mean age was 38 years, and the age range was between eight and 69 years. According to the Wilhelm and Feldmeier formula, the mean score of hand enchondroma was 3.09±0.85 and 3.20±0.91 in the non-operative and operative group, respectively. The mean scores of the foot except for the grip strength were 2.57±0.79 and 2.75±0.50, respectively. No significant difference was observed according to the functional results. Among the 18 cases of enchondroma with pathological fractures, nine cases were treated non-surgically and nine cases were treated by surgically. In all 18 cases, complete bone healing was observed at the final follow-up. @*Conclusion@#Relatively satisfactory results were obtained in both surgical and nonsurgical treatment and there was no significant difference in functional outcomes. In cases of enchondroma in the hands and feet, nonsurgical treatment can also be a good treatment option.

A Rare Manifestation of Solitary Primary Bone Lymphoma of the Finger: a Case Report

Primary extranodal bone lymphoma involving the peripheral extremities is extremely rare. Here, we report a definitive case of diffuse large B-cell lymphoma involving the phalangeal bone of the 3rd finger. Systemic evaluation revealed the lesion as the only site of lymphoma involvement.

Calcifying Aponeurotic Fibroma of the Knee: a Case Report with Radiographic and MRI Finding

Calcifying aponeurotic fibroma (CAF) is an uncommon benign tumor and a locally aggressive fibroblastic lesion. It commonly affects the palmar side of the hand and fingers, and the soles of the feet. The typical clinical manifestations are known as a poorly circumscribed, slow-growing, and asymptomatic firm mass. Most CAFs usually reveal low to intermediate or isointensity on T1-weighted images, and strong heterogeneous enhancement. However, various signal intensities on T2-weighted images have been reported depending on the degree of hypocellularity or the amount of calcification or collagen within the tumor. This report provides the radiographic and MRI finding of CAF arising in uncommon site, the knee region, of a 19-year-old male who presented with a painful and palpable mass.

Therapeutic Approach to Humeral Pathologic Fracture Caused by Benign Bone Tumor / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to suggest an appropriate therapeutic approach by making a comparison between conservative therapy and surgical therapy for a pathologic fractures of the humerus caused by benign bone tumor. MATERIALS AND METHODS: We selected 15 cases with a pathologic fracture of the humerus caused by benign bone tumor from January 2000 to April 2014 to evaluate the fracture union period and remission of primary bone tumor. Eight cases were treated with conservative therapy, and 7 cases by surgical therapy. The mean age was 13.1 years, and the age range was between 1 year and 19 years; there were 8 male cases and 7 female cases. The mean follow-up period was 24.9 months, with a range from 4 months to 72 months. We evaluated the remission of primary benign tumor in accordance with the ‘Modified Neer classification’ system. RESULTS: There was no statistically significant difference in age, sex, and mean follow-up period between the two groups. The pathologic fracture was united in all cases without secondary displacement. There was no statistically significant difference in the fracture union period (p=0.164) and remission of primary benign tumor (p=0.931) between the two groups. CONCLUSION: We suggest that both conservative and surgical therapies can be a treatment for pathologic fracture of the humerus caused by benign bone tumor.

Replantation for Segmental Amputation of the Digits and Hand: A Case Report

Segmental amputation of the digits and hand has been described as a contraindication for replantation because of poor results. We report the results of replantation for a patient who experienced multi-segment amputation of the hand. A 39-year-old man presented six hours after an accident, while using a straw cutter, that caused a multi-segment amputation of the entire palm and digits. The replantation surgery took 18 hours. We observed the patient gain satisfactory function of the hand. For replantation of a multi-segment amputation, connecting as many blood vessels as possible without tension is most important.

A Comparative Study of TRIGEN™ INTERTAN Nail (InterTAN) and Proximal Femoral Nail Antirotation 2 (PFNA2) in the Patients with Intertrochanteric Fractures

PURPOSE: The primary purpose of this study was to demonstrate that the TRIGEN™ INTERTAN nail (InterTAN) could show better clinical outcome compared to the proximal femoral nail antirotation 2 (PFNA2) for treatment of intertrochanteric fracture in the elderly. MATERIALS AND METHODS: Between March 2009 and December 2013, 164 patients with intertrochanteric fractures who met our inclusion and exclusion criteria were enrolled in this study. Evaluation variables, including operation time, blood loss during the operation, incidence of perioperative complications, clinical results at the last follow-up, and radiographic findings were assessed for comparison of the 2 implants. RESULTS: Intraoperative lateral wall fracture was significantly higher in the PFNA2 group (p<0.05) and tip apex distance was significantly higher in the InterTAN group (p<0.05). Sliding of the proximal fragment at the last follow-up was significantly higher in the PFNA2 group. However, there was no significant difference in union rate, time to union, postoperative complications, and clinical outcomes at the last follow-up between the 2 groups. CONCLUSION: Based on these data, clinical outcomes at the last follow-up were equivalent between InterTAN and PFNA2.

Reconstruction of Postburn Contracture of the Forefoot Using the Anterolateral Thigh Flap

BACKGROUND: Severe forefoot deformities, particularly those involving the dorsum of the foot, cause inconvenience in daily activities of living including moderate pain on the dorsal aspect of the contracted foot while walking and difficulty in wearing nonsupportive shoes due to toe contractures. This paper presents clinical results of reconstruction of severe forefoot deformity using the anterolateral thigh (ALT) free flap. METHODS: Severe forefoot deformities were reconstructed using ALT flaps in 7 patients (8 cases) between March 2012 and December 2015. The mean contracture duration was 28.6 years. RESULTS: All the flaps survived completely. The size of the flaps ranged from 8 cm × 5 cm to 19 cm × 8 cm. The mean follow-up period was 10 months (range, 7 to 15 months). There was no specific complication at both the recipient and donor sites. There was one case where the toe contracture could not be completely treated after surgery. All of the patients were able to wear shoes and walk without pain. Also, the patients were highly satisfied with cosmetic results. CONCLUSIONS: The ALT flap may be considered ideal for the treatment of severe forefoot deformity.

Osteosarcoma of the Metacarpal Bone / 대한정형외과학회잡지

Osteosarcoma commonly develops around the knee joint, and rarely in the hand. Patients with osteosarcoma of the hand often present with pain and swelling, and osteosarcoma of the hand has a biological behavior that differs from that of osteosarcoma at conventional sites. However, although it usually occurs in the older age group, compared with conventional osteosarcoma, the most common sites of hand osteosarcoma correlate with the most active growth and longest growing bones in the hand like conventional osteosarcoma, particularly in the metacarpophalangeal joints in the second and third digits. However, development of osteosarcoma in the metacarpal bone of the hand in an elderly patient has not yet been reported in the country. Thus, we report on two cases of osteosarcoma in the metacarpal bone of the hand in elderly patients, treated by ray amputation of the digit and preoperative and postoperative chemotherapy.

Soft Tissue Masses Showing Low Signal Intensity on T2-weighted Images: Correlation with Pathologic Findings

OBJECTIVE: The aims of this article are to differentiate soft tissue masses showing low signal intensity on T2-weighted images (T2WIs) according to the histopathologic findings. CONCLUSION: To know relatively small numbered soft tissue masses with low signal intensities on T2WIs adding characteristic location, morphology, signal intensities on other sequences might be helpful for differential diagnosis of mostly nonspecific soft tissue tumors on MRI.

Intramuscular Sparganosis in the Gastrocnemius Muscle: A Case Report

Sparganosis is a parasitic infection caused by the plerocercoid tapeworm larva of the genus Spirometra. Although the destination of the larva is often a tissue or muscle in the chest, abdominal wall, extremities, eyes, brain, urinary tract, spinal canal, and scrotum, intramuscular sparganosis is uncommon and therefore is difficult to distinguish from a soft tissue tumor. We report a case of intramuscular sparganosis involving the gastrocnemius muscle in an elderly patient who was diagnosed using ultrasonography and MRI and treated by surgical excision. At approximately 1 cm near the schwannoma at the right distal sciatic nerve, several spargana worms were detected and removed.

Diagnostic Value of MRI in Schwannoma / 대한골관절종양학회지

PURPOSE: To diagnose soft tissue tumor, such as lipoma and Schwannoma, magnetic resonance imaging (MRI) is sufficient in most cases. However, various characteristics are found in MRI images of Schwannoma, thus other type of tumors are often misdiagnosed as Schwannoma with MRI images. In this study, we evaluate the diagnostic value of specific MRI findings of Schwannoma. MATERIALS AND METHODS: From January 2002 to May 2013, 104 patients who are suspected as Schwannoma rith MRI images are included in data, and the final diagnosis is confirmed with biopsy. Patients are divided into group 1 and group 2 who are confirmed as Schwannoma and other disease with biopsy, respectively. RESULTS: 92 patients were diagnosed as Schwannoma (group 1) and 12 patients were diagnosed as other disease (group 2). We investigate the diagnostic value of specific MRI findings of Schwannoma. 41 patients of group 1 (45%) and 0 patients of group 2 (0%) showed target sign, 47 patients of group 1 (51%) and 2 patients of group 2 (17%) showed fascicular sign, 44 patients of group 1 (48%) and 5 patients of group 2 (42%) showed fat split sign, 28 patients of group 1 (30%) and 1 patients of group 2(9%) showed nerve entering and exiting sign, and 8 patients of group 1 (9%) and 6 patients of group 2 (50%) showed none of four specific findings on their MRI images. 52 patients of group 1 (57%) and 5 patients of group 2 (42%) have tumors on the pathway of nerve. Target sign could be considered as the best diagnostic value of the sign we investigate (p<0.05). CONCLUSION: Although specific MRI findings have powerful diagnostic value, patients are often misdiagnosed as Schwannoma with MRI findings. Therefore, if patients who are suspected as Schwannoma based on MRI findings have no target sign on their MRI images, we should consider the possibility of other disease.

Validation of the Korean Version of the Neck Pain and Disability Scale

STUDY DESIGN: A prospective study. PURPOSE: To evaluate the reliability and validity of the adapted Korean version of the Neck Pain and Disability Scale (NPDS). OVERVIEW OF LITERATURE: The validity of Korean version of NPDS has not been completely demonstrated yet. METHODS: Translation/retranslation of the English version of NPDS was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the visual analog scale (VAS) measure of pain, NPDS and the previously validated Short Form-36 (SF-36) were mailed to 91 patients, who had been surgically treated for degenerative cervical disease. Eighty-one patients responded to the first mailing of questionnaires and 69 of the first time responder returned their second survey. Factor analysis and reliability assessment by kappa statistics of agreement for each item, the intraclass correlation coefficient and Cronbach's alpha were conducted. Concurrent and construct validity were also evaluated by comparing the responses of NPDS with the results of VAS and responses of SF-36. RESULTS: Factor analysis extracted 3 factors. All items had a kappa statistics of agreement greater than 0.6. The NPDS showed excellent test/re-test reliability. Internal consistency of Cronbach's alpha was found to be very good. The NPDS was correlated with the VAS. The Korean version of NPDS showed good significant correlation with SF-36 total score and with single SF-36 domains scores. CONCLUSIONS: The adapted Korean version of the NPDS was successfully translated and is considered suitable for outcome assessments in the Korean-speaking patients with neck pain.

Skin Necrosis after High Dose Vasopressor Infusion in Septic Shock: Two Case Reports / 대한구급학회지

Survival sepsis campaign recommends that vasopressor therapy is required to maintain mean arterial pressure (MAP) > or = 65 mmHg. However, the absolute maximum dose of vasopressor is difficult to determine. Herein, we report 2 cases of severe skin necrosis after high dose vasopressor infusion to maintain the recommended MAP in septic shock. In our first case, norepinephrine 1.0-2.0 microg/kg/min and vasopressin 0.03-0.1 U/min were infused for 5 days; in the second case, dopamine 10-20 microg/kg/min and norepinephrine 0.25-2.5 microg/kg/min were infused for 7 days. Severe ischemic skin lesions, which required amputations, developed in both cases. The clinical appearance of the skin lesions in the 2 cases was different because of the unique distribution of target receptors for different vasopressors. Thus, when high dose vasopressors are required to achieve recommended MAP, extra vigilance is required. Further studies for dose adjustment are needed.

Baker's Cyst with Intramuscular Extension into Vastus Medialis Muscle

Baker's cysts are one of the most common cystic lesions around the knee joint and mainly caused by fluid distension of the gastrocnemius-semimembranous bursa that is situated along the medial side of the popliteal fossa. Typically, a Baker's cyst extends along the intermuscular planes around the knee joint and may enlarge any direction. However, it is mostly located in the inferomedial or superficial layers of the knee joint and less commonly extends laterally or proximally. Expansion of the cyst tends to respect the intermuscular planes, and Baker's cysts along the intramuscular route have been rarely reported. Thus, we report a case of Baker's cyst with intramuscular extension into the vastus medialis muscle.

Risk Factors for Cardiovascular Complications Following Hip Surgery / 대한고관절학회지

PURPOSE: This study was performed in order to analyze the incidence of postoperative cardiovascular complications in patients who had undergone hip surgery and to identify risk factors associated with these complications. MATERIALS AND METHODS: A total of 1,390 patients who had undergone hip surgery from 1998 to 2008 were divided into case or control groups according to occurrence of postoperative cardiovascular complications. Both groups were sorted and analyzed by age, gender, mode of operation, bilaterality and history of preoperative cardiovascular disease. Postoperative cardiovascular complication was defined as having any condition including myocardial infarction, congestive heart failure, unstable angina, arrhythmia, hypotension, or pulmonary thromboembolism during the surgical admission period. RESULTS: Forty three out of 1,390 patients(3.1%) experienced cardiovasucular complications and 1 patient (0.07%) died. Increasing patient age (P=0.001), history of bilateral hip surgery (P=0.000), hypertension (P=0.002), coronary artery disease (P=0.000) or valvular heart disease (P=0.010), and ASA category 3 (P=0.000) were all associated with significantly higher incidence of cardiovascular complications. CONCLUSION: Intensive preoperative management though adequate hypertension control and prevention of coronary artery occlusive disease for patients who are elderly or receiving bilateral operation will help decrease the incidence of postoperative cardiovascular complications after hip surgery.

Preoperative Templating in PACS for Total Hip Replacement / 대한정형외과학회잡지

PURPOSE: The objective of our study was to compare preoperative "Monitor Templating" with postoperative results for total hip replacement and to investigate the accuracy of "Monitor Templating" that was carried out by monitoring with picture archiving communication system (PACS). MATERIALS AND METHODS: Forty five patients underwent primary cementless total hip replacements. For setting parameters, we located the 10cm rod placed in the medial thigh on anteroposterior view of both hips and in the anterior thigh on Lowenstein lateral view. We measured implant sizes and the predictive value of corrective change in leg length and horizontal offset, by using radiographs magnified 120% of the anteroposterior views of both hips and Lowenstein lateral view of PACS on 27 inch monitor. We examined the correlation between preoperative monitor templating and the actual implant size, postoperative leg length and horizontal offset difference. RESULTS: The preoperative monitor templating showed a high rate of coincidence with the actual implant size, the postoperative leg length, and the horizontal offset difference. The averages in accurate prediction were 98% in the acetabular cup, 98% in the femoral stem, 97% in the postoperative actual difference of leg length, and 97% in the horizontal offset. With regard to leg length discrepancy, the sick limb was on average 4.7 mm shorter and 0.5 mm longer postoperatively than the contralateral limb. The average ratio of horizontal offset of the sick limb to the contralateral limb was 94.6% preoperatively and increased to 97.8% postoperatively. CONCLUSION: Preoperative "Monitor Templating" using PACS images on 26 inch monitor is an easy and effective method for predicting implant size, correcting leg length discrepancy and restoring horizontal offset.

Posterior Decompression and Fusion in Patients with Multilevel Lumbar Foraminal Stenosis: A Comparison of Segmental Decompression and Wide Decompression

STUDY DESIGN: This is a prospective study. PURPOSE: We compared the outcomes of segmental decompression and wide decompression in patients who had multilevel lumbar foraminal stenosis with back pain. OVERVIEW OF LITERATURE: Wide decompression and fusion in patients with multilevel lumbar foraminal stenosis may increase the risk of perioperative complications. METHODS: From March 2005 to December 2007, this study prospectively examined 87 patients with multilevel lumbar foraminal stenosis and who were treated by segmental or wide decompression along with posterior fusion using pedicle screw fixation, and these patients could be followed-up for a minimum of 2 years. Of the 87 patients, 45 and 42 patients were assigned to the segmental decompression group (group 1) and the wide decompression group (group 2), respectively. We compared the clinical and radiological outcomes of the patients in these two groups. RESULTS: There were no significant differences between groups 1 and 2 in terms of the levels of postoperative pain based on the visual analogue scale, the Oswestry Disability Score, the clinical results based on the Kirkaldy-Willis Criteria, the complication rate or the posterior fusion rate. On the other hand, the mean operating times in groups 1 and 2 were 153 +/- 32 minutes and 187 +/- 36 minutes, respectively (p < 0.05). The amount of blood loss during surgery and on the first postoperative day was 840 +/- 236 ml and 1,040 +/- 301 ml in groups 1 and 2, respectively (p < 0.05). CONCLUSIONS: These results suggest that segmental decompression offers promising and reproducible clinical and radiological results for patients suffering from multilevel lumbar foraminal stenosis.

Post-operative Changes of Cerebral Glucose Metabolism in Patients with Lumbar Spinal Stenosis with Pre-operative Anxiety: Statistical Parametric Mapping Analysis of F-18 FDG Brain PET

STUDY DESIGN: A prospective study. PURPOSE: To assess postoperative changes in cerebral glucose metabolism in anxiety patients with lumbar spinal stenosis (SS). OVERVIEW OF LITERATURE: Although an association between preoperative anxiety and abnormal cerebral glucose metabolism may exist, only a limited number of studies using F-18 fluorodeoxyglucose positron emission tomography (FDG PET) have evaluated preoperative to postoperative changes in cerebral glucose metabolism in SS patients in detail. METHODS: The present study was designed to assess preoperative to postoperative changes in cerebral glucose metabolism in anxiety patients with SS. F-18 FDG PET with statistical parametric mapping analyses was used to compare preoperative and postoperative regional brain glucose metabolism in 18 SS patients. RESULTS: F-18 FDG PET scans showed postoperative activation of several brain clusters in gray matter. These included left parahippocampus, left cerebellar tonsil, left inferior semi-lunar lobule, and right cerebellar tonsil. Areas that were deactivated postoperatively were the right insula, left fusiform gyrus, left orbitofrontal cortex, left inferior frontal gyrus, left middle frontal gyrus, left precuneus, and left inferior frontal gyrus. CONCLUSIONS: SS patients with preoperative anxiety showed altered cerebral glucose metabolism at postoperative follow-up.