Superficial Fibromatosis Mimicking Glomus Tumor of the Second Toe

Various types of tumor can occur in the subungual space, including glomus tumors, subungual exostosis, hemangioma, epidermal cysts, and malignant tumors. While fibromatosis can occur at various sites throughout the body, it is very rarely seen in the toe. Here, we are the first to report a case of superficial fibromatosis mimicking a glomus tumor in the subungual space of the second toe. The presentation of this condition shows the possibility of encountering uncommon superficial fibromatosis in the distal phalanx of the toe, and suggests that superficial fibromatosis should be included in the differential diagnosis of a glomus tumor in the toe.

Hallux Rigidus with Osteochondroma of the Hallucal Proximal Phalanx (A Case Report) / 대한족부족관절학회지

Small osteophytes are frequently encountered in the foot and ankle, and not to be confused with true osteochondromas, which are relatively uncommon in this region. Osteochondromas are the most common benign osseous neoplasm, occurs in the metaphysis of the long bone. It is rarely found in bones of the foot. Treatment of the osteochondroma is usually conservative, unless symptoms usually pain, are progressive rapid growth, and malignant transformation is suspected. We experienced a rare case of hallux rigidus with osteochondroma of the hallucal proximal phalanx which cause pain and corn of the plantar.

Nodular Hidradenoma on the Fourth Finger

Nodular hidadenoma is known as an eccrine sweat gland origin that arises in the skin and occurs as a solitary tumor in most cases. Although it is not uncommon, it is rarely occurs in the hand. We report a case of nodular hidadenoma of the fourth finger with a brief review of the literatures.

Radiographic Detection of Osteoporotic Vertebral Fracture without Collapse

BACKGROUND: On retrospective basis, we investigated the detection of osteoporotic vertebral fractures (OVFs) without radiologic collapse using a modified Yoshida's classification, which was designed by the authors. METHODS: We observed 82 cases in 76 patients with confirmed OVFs without collapse at the thoracolumbar junction. The following factors were measured: age, gender, body mass index (BMI, kg/m2), bone mineral density (BMD, mg/cm3), type of a modified Yoshida's classification. The correct diagnosis rate for the presence and location of OVFs and the correct diagnosis rate according to the morphological type by a modified Yoshida's classification of the OVFs were analyzed. RESULTS: The mean BMI was 21.2; mean BMD, 44.1; and T-score, -4.4. As for the four subtypes of anterior cortical morphological change, there were 14 cases of the protruding type, 12 cases of the indented type, 5 cases of the disrupted type and 8 cases of the prow type. As for the three subtypes of endplate depression, there were 20 cases of upper endplate depression, 12 cases of lower endplate depression and 11 cases of endplate slippage type. According to the examiners, there was a significant difference between being informed before and after the modified Yoshida's classification. For the relationship of examiners and the type of fracture, there was a significant difference between being informed before and after the modified Yoshida's classification, particularly in the protruding type and the upper plate type. CONCLUSIONS: A modified Yoshida's classification can be helpful for the diagnosis of OVFs without radiologic collapse in a simple radiograph.

Analysis of Clinical Features of Hip Fracture Patients with or without Prior Osteoporotic Spinal Compression Fractures

BACKGROUND: To analyze and compare the clinical characteristics including bone mineral density (BMD) in a group who had operation of hip fracture with or without prior osteoporotic spinal compression fractures. METHODS: Two hundred forty patients who had undergone operation of hip fractures were evaluated, 127 patients who had with prior osteoporotic spinal compression fractures were in group I, and 113 patients without prior spinal fractures were in group II. In each group, we measured age, gender, body mass index (BMI, kg/m2), BMD (mg/cm3), type of hip fractures, concomitant diseases, presence of secondary hip fracture and history of percutaneous vertebroplasty. RESULTS: The mean age of group I was 79.4 years (male/female: 28/99) and that of group II was 77.6 years (male/female: 37/76). The mean BMI of group I was 21.3 kg/m2 and that in group II was 22.0 kg/m2. The mean BMD and T-score of group I were 41.1 mg/cm3 and -4.45 and those in group II were 51.0 mg/cm3 and -4.17 (P<0.05). The numbers of patients of neck and intertrochanter fracture of group I were 31 and 96 patients and those in group II were 61 and 52 patients. Sixty in group I and 45 in group II patients had concomitant diseases. Thirteen patients had undergone percutaneous vertebroplasty and 18 patients (7.5%) had second hip fractures. CONCLUSIONS: The hip fracture patients who had with prior osteoporotic spinal compression fractures had lower BMD compared to the hip fracture patients without previous spinal compression fractures.

Osteoporotic Lumbar Compression Fracture in Patient with Ankylosing Spondylitis Treated with Kyphoplasty

Ankylosing spondylitis (AS) is an inflammatory disease primarily affecting the spine. Osteoporosis can be a complication of AS and associated with low bone mineral density. As well, spinal fractures in the AS are usually unstable and may cause neurologic deficit at the mainly cervical region with low energy trauma. However, reports of lumbar compression fracture in AS are very rare. Thus, we report a 73-year-old male patient with osteoporotic L3 compression fracture with AS treated with kyphoplasty which has no symptom improvement with conservative treatment. Kyphoplasty is a useful procedure option in the treatment of the lumbar compression fracture in AS.

Intramuscular Ganglion of the Quadriceps Femoris

Ganglion cysts are common lesions that are most often found around the joints of the hands and feet. Ganglia around the distal femur usually occur within the synovial membrane or tendon sheath, but rarely within muscles. Several cases of intramuscular ganglions in the hand and wrist have been reported, but a ganglion cyst in the quadriceps muscle has rarely been addressed in studies. In this report, we present a 17-year-old patient with a painful movable mass in the intramuscular area of the quadriceps femoris that was diagnosed by ultrasound and treated by excision and biopsy.

The Relation of Paraspinal Muscles and Degenerative Lumbar Spondylolisthesis / 대한정형외과연구학회지

OBJECTIVES: To evaluate the cross-sectional area (CSA) and the moment arm length (MAL) of the paraspinal muscles in the degenerative lumbar spondylolisthesis patients compared to the matched control patients, which is through contribution to the stability of the back. MATERIALS AND METHODS: We studied a comprised of 25 degenerative lumbar spondylolisthesis on L4/5 patients and a controlled group with 42 chronic lower back pain patients. In both groups, we measured body mass index (BMI, kg/m2). On the standing lateral radiographs, we measured the total lumbar lordosis, and segmental lumbar lorodosis using Cobb's methods. We measured the degree of slippage by Meyerding classification. The CSA of erector spinae (CSA) and CSA of psoas were measured at the L4/5 level by using the MRI. The statistical analysis were performed to know the relationship between the CSA and the MAL of erector spinae, and the BMI. Multifidus and erector spinae atrophy were evaluated at the L4/5 level and the degree of fatty atrophy was estimated using three grades : mild, moderate, and severe. RESULTS: The patient group and the controlled group BMI (kg/m2) were 25.27+/-3.8 and 24.47+/-3.24. In patient group, Meyerding classification grade I was 92%. Total lumbar lordosis and each segmental lordosis were measured mean angle 44.54degrees(24.9degrees~70.4degrees), and each 9.23degrees(L3/4), 10.27degrees(L4/5), 18.81degrees(L5/S1). Pearson's rho indicated a positive association between the CSA and BMI (rho=0.603, p= 0.001), between the CSA of psoas and BMI (rho=0.445, p=0.026), and between the CSA and MAL (rho=0.627, p=0.001) in the degenerative lumbar spondylolisthesis patients. In terms of the CSA versus MAL, there was a positive association in the both groups (rho=0.627, p=0.001, MAL=0.0008 CSA+/-5.293 in the degenerative lumbar spondylolisthesis group; rho=0.812, p=0.000, MAL=0.001 CSA+/-5.245 in the control group with using linear regression analysis). Independent t-test revealed that both groups had statistically different mean values (p=0.038) in terms of the CSA. Proportion of fat deposits in the multifidus and erector spinae muscle at the L3/4 level were all mild grades. CONCLUSION: The patients with degenerative lumbar spondylolisthesis had atrophied erector spinal muscles, which means harmful because of the poor compensation for the lower back load and poor assists to the lumbar stability. This suggests that the biomechanical factor of the muscles influence to the lumbar disability.

Pseudoaneurysm of the Lateral Inferior Genicular Artery after Arthroscopic Partial Meniscectomy of Lateral Meniscus: A Case Report / 대한스포츠의학회지

Arthroscopic meniscectomy of the knee is generally a safe and effective procedure with a low rate of vascular complications. The authors encountered a case of a pseudoaneurysm of the lateral inferior genicular artery after arthroscopic partial meniscectomy of lateral meniscus. The pseudoaneurysm was treated successfully using transcatheter embolization. No recurrence of the hemarthrosis was observed in the patient after a follow-up of 2 years.

Two Stage Procedure with a Temporary Antibiotic-impregnated Cement Spacer of Infected Hallux Interphalangeal Joint (A Case Report) / 대한족부족관절학회지

The interphalangeal joint (IPJ) of the hallux has received little attention compared with the first metatarsophalangeal joint. But, the hallucal IPJ has several disorders such intra-articular fractures, dorsal dislocation, alignment disorder, and inflammatory or degenerative arthritis. Among these disorders septic arthritis of the IPJ of the hallux is rare. We report a case of sepsis of the hallucal IPJ and adjacent underlying osteomyelitis without neuropathic problem and was performed through infected soft tissue and osseous debridement, temporary antibiotic-impregnated cement spacer, and delayed intercalary allogenic fibular bone graft with K-wire fixation.

Superficial Peroneal Nerve Entrapment Syndrome (A Case Report) / 대한족부족관절학회지

Superficial peroneal nerve entrapment is an uncommon compression neuropathy, and is frequently associated with a fascial defect and a muscle hernia. The standard treatment of that was the nerve decompression by complete or limited fasciotomy. But, we experienced a case of superficial peroneal nerve entrapment had satisfactory surgical outcome by fascial repair of peroneus muscle.

Clinical Characteristics of Ankle Fracture in Osteoporotic Patients Over Sixty-five Years of Age / 대한골다공증학회지

OBJECTIVES: Fracture of multiple sites can occur by minor trauma because decreased bone quality and bone density in osteoporotic patients. To investigate clinical characteristics of ankle fracture in osteoporotic patients over sixty-five years of age. MATERIALS AND METHODS: From January 2009 to December 2011, excluding distal tibial shaft and pilon fracture, 40 patients (over 65 years old) who were diagnosed the osteoporosis and observed over 6 months after ankle surgery. We measured age, gender, body mass index (BMI, kg/m2), bone mineral density (BMD, mg/cm3) and T-score through P-QCT. Type of fracture was classified into Danis-Weber and AO classification and whether or not of syndesmotic injury and concomitant disease. Surgery performed under AO principle. We investigated by wound healing, fixation failure and bone union during follow-up.

Relationships of Bone Mineral Density, Blood Pressure, and Physical Characteristics of Third and Fourth Decade College Students / 대한정형외과연구학회지

The purpose of this study was to analyze the relationship of body mass index (BMI), bone mineral density (BMD) and blood pressure (BP) in third and fourth decade college students. Total of 114 (67 male and 47 female) students who received health examination in April 2010 participated in this research. Bone status was measured by a peripheral dual energy X-ray absorptiometry method and T-score was calculated via WHO guideline. For body composition measurements, body fat, height and weight were measured and BMI was calculated. Among male students, 3.6% belong to the UW (under weight) group, 49.1% to the NW (normal weight) group, 18.2% to the OW (over weight) group and 29.1% belong to the obese group, while 2.1% of female students belong to the UW group, and 68.1% to the NW group, 14.9% to the OW group and 14.9% belong to the obese group. Differences of body weight among male and female students were statistically significant (p<0.001). Above overweight groups showed higher systolic and diastolic BP than normal group. Differences among two groups were statistically significant (systolic BP: p=0.041, diastolic BP: p=0.021). The mean BMI of normal BP group is 22.6+/-2.87, hypertension group is 24.1+/-2.95. Differences among two groups were statistically significant (p=0.045). The mean T-score of male students is -0.1+/-1.17, female is -0.6+/-0.88(total -0.5+/-0.91). Differences of T-score among male and female students were statistically significant (p=0.007). In conclusion, our results showed that many college students had the problems in the BMI, BMD and BP, and BP increased according to the increase of BMI. Therefore, nutritional education and weight control is required for normal blood pressure and bone health.

Usefulness of Kyphoplasty in Sacral Insufficiency Fracture: A Case Report

Kyphoplasty has recently attended as a potential treatment for sacral insufficiency fracture. We report a 85-years-old female patient with osteoporotic S1 insufficiency fracture with absence of trauma history treated with kyphoplasty which has no symptom improve with conservative treatment. Kyphoplasty is an effective and useful procedure in the treatment of the sacral insufficiency fracture, additionally reviewed of the literatures.

Popliteal Artery Pseudoaneurysm after Arthroscopic Posterior Cruciate Ligament Reconstruction: A Case Report / 대한스포츠의학회지

The pseudoaneurysm of the popliteal artery following an arthroscopic posterior cruciate ligament reconstruction is rare. We present a case of the delayed pseudoaneurysm of the popliteal artery after arthroscopic posterior cruciate ligament reconstruction. Open excision of the pseudoaneurysm and pin-point repair were done. Retrospectively reviewing the case, we found that the relation of the popliteal artery and posterior cruciate ligament on preoperative magnetic resonance images can predict the complication of pseudoaneurysm of the popliteal artery.

Multiple Non-contiguous Spine Fractures with Concomitant Injuries: A Case Report

Multiple non-contiguous spinal fracture is a special type of multi-level spinal injury, which is rare but most frequently occur in motor vehicle accident or a falling from a height. We report five patients of multiple non-contiguous spinal fractures. All patients underwent segmental pedicle screws fixation without fusion for preserving facet joints and minimizing blood loss and operation time. We performed necessary operation for any concomitant injuries at the same day.

Analysis of Osteoporotic Spinal Compression Fractures in Whole Spine Sagittal MR Images

OBJECTIVES: To analyze the fracture type and adjacency of accompanied fractures in acute osteoporotic spinal compression fracture using whole spine sagittal MRI (WS-MRI), and to know the relation of sagittal vertical axis (SVA), body mass index (BMI), and lumbar bone mineral density (BMD). METHODS: From June 2007 to December 2010, 167 patients who had acute spinal compression fractures confirmed by WS-MRI divide in three groups. 82 patients (M/F : 25/57) who had acute fractures only were in group 1, 79 patients who had acute and old fractures were in group 2, and 20 patients who had acute fractures after vertebroplasy were in group 3. To analyze the fracture type and adjacency of accompanied fractures in acute osteoporotic spinal compression fractures which combined chronic fracture or vertebroplasty using the WS-MRI and compared with the control group who had no spinal fractures measured the SVA. In all groups, we measured BMI, and BMD. RESULTS: In WS-MRI, 31 patients in group 1 had L1 which was the most common fracture site. Twenty two patients had chronic fractures and more than 3 remote levels at the acute fracture site in group 2 and especially among there 14 patients have each level in cervicothoracic and lumbar vertebrae. In group 3 had old fracture and adjacent fracture was 14 and 11 patients. Compared with the control group, all groups had increased SVA, especially in group 2 which has acute and chronic compression fractures. They have no significantly difference of BMI in each group, but group 2 and 3 had a significant lower BMD than group 1. CONCLUSION: Fourteen patients of coexisting fractures in acute osteoporotic spinal compression fractures with WS-MRI which could be missed in the conventional MRI. Additionally this study suggests that longer SVA causes sagittal imbalance, and BMD is more relative than BMI in refractures of chronic compression fracture patients.

The Association between the Bone Mineral Density and Spinal Osteoarthritis in Osteoporotic Thoracolumbar Compression Fractures

OBJECTIVES: The purpose of this study was to determine the association between the bone mineral density (BMD) and severity of spinal osteoarthritis (spondylosis) in osteoporotic spinal compression fracture. METHODS: Fifty six patients were evaluated 66 cases had an osteoporotic thoracolumbar compression fracture between January 2008 and June 2010. The average patient age was 76.2 years (M/F : 8/48). Age and body mass index (BMI, kg/m2) were measured, and the BMD was performed using peripheral quantitative computed tomography (pQCT). Simple thoracolumbar (T-L) spine lateral radiography was evaluated for three criteria: presence of osteophytes, disc space narrowing and vertebral body sclerosis. The findings were graded 0 to 3 and analyzed statistically for a correlation with the BMD and fractured vertebrae. RESULTS: Acute compression fractures comprised of 15 cases and the most common site of acute fractures with old fractures was lumbar spine (L1; 30 cases, 45.4%). The average of BMI was 23.32 and BMD (T-score) was -4.47. Pearson's rho showed a positive association between the weight, height and the BMD (P < 0.01). In terms of the BMD versus spondylosis, there was a positive association with high score in the high order cortical bone. Compression fractures occurrence rate in the absent and present of spondylosis was 74.3% and 22.4%, and 69% occur in the spinal segmental with no bony spur with chi-square test (P < 0.01). CONCLUSION: In the present of spondylosis was high score of cortical BMD and low rate of compression fracture. Spondylosis could be one of a factor of the occurrence in acute and adjacent compression fracture after old fractures.

Deep Vein Thrombosis after Fusion Operation of Osteoporotic Spinal Compression Fracture / 대한골다공증학회지

The risk of deep vein thrombosis (DVT) is well studied for some orthopedic surgery. However, the incidence of postoperative DVT is less well-defined in patients who have spinal surgery. In addition, there is insufficient evidence to suggest that screening patients before spinal surgery and to use of prophylactic method such as anticoagulants, compression stockings, and pneumatic compression device. We experienced a 78-year-old female patient of DVT after fusion operation with pedicular screws in T12 osteoporotic compression fracture. As risk of DVT after major spinal surgery is fairly low, it seems reasonable to consider prophylactic management after spinal surgery in old aged patients with difficult ambulation.

Comparison of Adjacent Spinal Compression Fracture after Old Osteoporotic Spinal Compression Fracture and Percutaneous Vertebroplasty / 대한골다공증학회지

OBJECTIVES: New adjacent spinal compression fractures occur not only in patients with osteoporotic spinal compression fractures after vertebroplasty but also in untreated old spinal compression fractures. The objective was to analyze and compare the characteristics in a group who had untreated old osteoporotic spinal compression fractures with those who had adjacent spinal compression fractures, which occurred after a vertebroplasty. MATERIALS & METHODS: From April 2006 to April 2009, 103 patients who had undergone vertebroplasty were evaluated. Eighteen patients (22 cases) who had untreated old osteoporotic spinal compression fractures were in group I, and 12 patients (13 cases) who had adjacent spinal compression fractures, which occurred after a vertebroplasty were in group II. In each group, we measured age and gender, body mass index (BMI), lumbar bone marrow density (BMD), sagittal index, and compression rate at the initial fracture site.