The Results of the Ultrasonographic Evaluation for the Contralateral Achilles Tendon in Patients with Acute Achilles Tendon Rupture / 대한스포츠의학회지

Purpose@#This study was performed to evaluate changes in Achilles tendon (AT) characteristics of asymptomatic tendons in patients with acute AT ruptures on the contralateral side by using ultrasonography. @*Methods@#From January 2016 to December 2018, 31 patients were enrolled. The contralateral asymptomatic ATs were assessed: (1) fluid collection of paratenon, (2) echogenicity, and (3) thickness. The ATs were divided into the distal, middle, and proximal thirds for evaluation and were assessed before the surgery, as well as at 6 weeks, 3 months, 6 months, and 12 months after the surgery. At each time, pain in the tendons was recorded. @*Results@#In all cases, it was observed that there was a hypoechoic lesion or fluid collection of the paratenon, which did not show a significant change over time. There was no significant difference in tendon thickness according to the period in the distal and proximal areas, and significant differences were observed only in the middle area (p＜ 0.05). A new pain around the tendon occurred most often at 6 weeks after surgery (eight cases of 31 cases, 25.8%). Eight cases of pain (47.1%) remained at 12 months after surgery. @*Conclusion@#In patients with acute AT rupture, ultrasonographic hypoechoic lesions or fluid collections of the paratenon were initially observed on the contralateral tendon, but this did not show significant changes over time. A significant change in tendon thickness was observed in the middle area, but this did not show a close association with pain.

Assessment of Noncontiguous Posterior Malleolar Fractures in Distal One-Third Tibia Shaft Fractures with Proximal Fibula Fractures

Purpose@#Posterior malleolar fractures after intramedullary nail surgery rarely occur in distal tibia shaft fractures. The importance of preoperative ankle evaluation in preventing these fractures is also common knowledge. There are no studies in the literature on posterior malleolar fractures in distal onethird tibia shaft fractures except for distal metaphyseal tibia fractures to the best of our knowledge. The purpose of this study was to evaluate the incidence and radiological features of posterior malleolar fractures in distal one-third tibia shaft fractures with proximal fibula fractures. @*Materials and Methods@#Thirty-one patients diagnosed with distal one-third tibia shaft fractures with proximal fibula fractures from January 2016 to May 2021 were retrospectively reviewed. With the aid of plain radiographs and computed tomography (CT) scans, the fracture patterns of the tibia and fibula were classified according to the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification, and posterior malleolar fractures were identified. The fracture pattern was classified according to the Haraguchi classification, and the angle between the bimalleolar axis and the posterior malleolar fracture line was measured when there was a posterior malleolar fracture. @*Results@#Out of the 31 distal one-third tibia shaft fractures with proximal fibula fractures, 16 cases (51.6%) had noncontiguous posterior malleolar fractures that were confirmed on a CT scan, while 3 cases (18.8%) were visible on initial plain radiographs. There was no statistically significant variation seen in the presence of a posterior malleolar fracture in the tibia (p=0.15) and fibula (p=0.87) fractures.According to the Haraguchi classification, there were 15 posterolateral-oblique fractures (Type I) and 1 medial-extension fracture (Type II), and the mean angle was 24.5°. @*Conclusion@#Noncontiguous posterior malleolar fractures occurred in approximately half of the distal one-third tibia shaft fractures with proximal fibula fractures, and a CT scan was considered necessary to diagnose posterior malleolar fractures before surgery

Removal of Lumbar Synovial Cyst Using Biportal Endoscopic Surgery: A Case Report

The synovial cyst of the spine may be caused by degenerative changes or instability of the spine. The most common site of spinal synovial cyst is the lumbar spine. If conservative management is failed, the operation must be considered. So far, microscopic cyst removal has been considered a treatment of choice. Recently, biportal endoscopic surgery is now becoming increasingly common in spine surgery and has the advantage of minimizing damage to related structures such as muscle, bone, and nerve. There was a case in which the synovial cyst of the L4–5 level was successfully removed through a biportal endoscopic surgery, so we would like to report it with a literature review.

Infected Epidermoid Cyst Including Multiple Nails at the Amputated Thumb Stump: A Case Report

Fingertip amputation is a common injury among trauma occurring in the upper extremity. After amputation of the fingertip, there are several treatment options according to the degree of damage. Also, the skin flap is sometimes performed when skin defects are accompanied. Among the complications associated with fingertip injury, cyst formation at the amputation stump is rare but some cases have been reported based on the pathologic findings. There was a case of an infected epidermal inclusion cyst containing multiple nail plates at the amputation stump of the thumb, so we would like to report it with a review of the literature.

Deep-Seated Giant Lipoma on the Hand Inducing Carpal Tunnel Syndrome

Lipoma is a very frequent benign soft tissue tumor, but its occurrence in the hands is rare. Lipoma in the hands is generally asymptomatic; however, symptoms may develop if local neurovascular structures are compressed due to size or location of the lipoma. Carpal tunnel syndrome, which is a compressive neuropathy of the median nerve, is the most common neuropathy in the hands and presents pain, numbness, hypoesthesia, and atrophy of the thenar muscle. We present a case of carpal tunnel syndrome by deep-seated giant lipoma with a literature review.

Paraspinal Ancient Schwannoma of the Dorsal Ramus Nerve: A Case Report

OBJECTIVES@#We report a case of paraspinal ancient schwannoma located at the upper thoracic level that mimicked an atypical lipoma or complicated epidermoid cyst.SUMMARY OF LITERATURE REVIEW: Few case reports of paraspinal schwannoma have been reported and the incidence of ancient schwannoma in the paraspinal muscle layer is very rare.@*MATERIALS AND METHODS@#A 39-year-old man complained of a growing palpable back mass for 5 years. He experienced aggravated chronic discomfort around the mass while lying down. Both T1- and T2- weighted magnetic resonance imaging (MRI) showed a well-capsuled and heterogeneous high-signal mass in the muscle layer at the level from the T1 to T4 vertebral bodies on the right side of the midline. The tumor was completely removed by en bloc resection.@*RESULTS@#The pathologic examination revealed S-100 protein expression with degenerative changes. The lesion was diagnosed as an ancient schwannoma.@*CONCLUSIONS@#Schwannoma is one among the multiple possible causes of benign back masses. If a mass reveals a well-encapsulated heterogeneous mass on contrast MRI, a schwannoma should be suspected.

Trends in the Diagnosis of Osteoporosis in Patients with Distal Radius Fractures Based on a National Claims Database

BACKGROUND: A history of osteoporotic fractures is strongly associated with the subsequent osteoporotic fractures. To prevent subsequent fractures, the diagnosis and treatment of osteoporosis following osteoporotic fractures are very important. A distal radius fracture (DRF) is the second most common type of osteoporotic fracture in South Korea. We analyzed the rate of osteoporosis diagnosis within 6 months post-DRF.METHODS: We used data from the Korean Health Insurance Review and Assessment Service nationwide claims database from 2010 to 2016. International Classification of Diseases, 10th revision codes and procedures codes were used to identify patients aged over 50 years with newly diagnosed DRFs; the osteoporosis assessments of these patients were then analyzed. We used Cochran-Armitage trend test to examine trends in osteoporosis diagnosis.RESULTS: A search of database identified 77,209 DRFs in patient aged above 50 years of age from 2011 to 2016. Among these patients, only 19,305 (25.0%) underwent diagnostic examination for osteoporosis. The number of osteoporosis examinations increased slightly, but not significantly, every year (P=0.061).CONCLUSIONS: Clinicians who treat DRFs shoulder also evaluated patients for osteoporosis after DRFs.

Symptomatic Tophaceous Gout in the Bilateral Patellae

Tophaceous gout is an inflammatory arthropathy caused by hyperuricemia. Gout shows typically episodic acute and chronic pain with arthritis due to synovitis induced by deposition of monosodium urate crystals. Tophus which is deposits of crystals could be formed around mainly peripheral joints such as the first metatarsophalangeal joint but might be presented in any other joints. Even though gout of unilateral patella has been reported severally, tophaceous gout of bilateral patellae has been rarely seen. We present a case of gout of bilateral patellae with literature review.

Paraspinal Ancient Schwannoma of the Dorsal Ramus Nerve: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: We report a case of paraspinal ancient schwannoma located at the upper thoracic level that mimicked an atypical lipoma or complicated epidermoid cyst. SUMMARY OF LITERATURE REVIEW: Few case reports of paraspinal schwannoma have been reported and the incidence of ancient schwannoma in the paraspinal muscle layer is very rare. MATERIALS AND METHODS: A 39-year-old man complained of a growing palpable back mass for 5 years. He experienced aggravated chronic discomfort around the mass while lying down. Both T1- and T2- weighted magnetic resonance imaging (MRI) showed a well-capsuled and heterogeneous high-signal mass in the muscle layer at the level from the T1 to T4 vertebral bodies on the right side of the midline. The tumor was completely removed by en bloc resection. RESULTS: The pathologic examination revealed S-100 protein expression with degenerative changes. The lesion was diagnosed as an ancient schwannoma. CONCLUSIONS: Schwannoma is one among the multiple possible causes of benign back masses. If a mass reveals a well-encapsulated heterogeneous mass on contrast MRI, a schwannoma should be suspected.

Rotational Long Scarf Osteotomy on Hallux Valgus in Elderly Patients with Osteoporosis / 대한정형외과학회잡지

PURPOSE: This paper reports an experience of rotational long scarf osteotomy for elderly patients with a hallux valgus deformity. MATERIALS AND METHODS: From January 2005 to July 2014, 37 cases in 24 patients over 70 years of age, who received rotational long scarf osteotomy for hallux valgus and were followed-up for at least 3 years, were evaluated. The bone mineral density (BMD) was checked in all cases preoperatively. The mean age at surgery was 73.9 years old. The mean follow-up period was 5.1 years. The plantar head fragment was rotated medially to correct the distal metatarsal articular angle (DMAA) and to cross the two cortices to form an “X” shape to prevent troughing. In the operating room, the DMAA was measured before and after rotation of the plantar head fragment. The hallux valgus angle, 1st intermetatarsal angle, range of motion of the first metatarsophalangeal (MTP) joint and American Orthopedic Foot and Ankle Society (AOFAS) score were measured both preoperatively and in the final follow-up. In addition, stress fractures were checked in the routine follow-ups. RESULTS: The average T-score of the preoperative BMD was −3.54. The mean DMAA measured in the operation room was corrected from 24.8° to 6.7°. The 1st intermetatarsal angle was corrected from 17.6° to 6.2° and hallux valgus angle was corrected 36.7° to 6.5°. The average range of motion of the first MTP joint was improved from 37.4° preoperatively to 64.3° in the final follow-up, and the average AOFAS scores were improved from 56.4 preoperatively to 89.2 at the final follow-up. No troughing was observed in any of the patients. In 3 cases, screw fixation failure made an additional screw necessary to obtain stability between the two fragments. No stress fractures were observed at the follow-up. CONCLUSION: The rotational long scarf osteotomy produced the effect of a DMAA correction. The rotational long scarf osteotomy might correct the DMAA and improve the clinical score in elderly hallux valgus patients.