Evaluating the clinical relevance of codon 594 (g>a) polymorphism of estrogen receptor alpha in knee osteoarthritis.

UNLABELLED: It has been reported that oestrogen receptor alpha (ER-α) polymorphisms are associated with knee osteoarthritis (OA). In this study, we assessed whether there was any association between the codon 594 (G>A) polymorphism in ER-α and radiographic features of OA or patient function. Radiographs, WOMAC score and patient reported time of symptom onset were assessed in 194 patients presenting for total knee replacement at Ramathibodi hospital over a one year period. ESR-1 genotyping was assessed. There were 107 (55.15%) patients with common homozygote (GG), 78 (40.20%) patients with heterozygote (GA) and nine (4.65%) patients with rare homozygote (AA). There was poor correlation (r = <0.2) between group difference in the radiographic parameters, time of onset of symptom , or in WOMAC scores. This polymorphism is not associated with the clinical features of knee osteoarthritis. The role of this polymorphism is unlikely then to be used as a biological marker predicting the progression of knee OA. KEY WORDS: Oestrogen receptor alpha polymorphism, Knee osteoarthritis, Radiographic feature, Functional score.

Idiopathic Chondrolysis of the Hip ( ICH): Report of three Cases.

Idiopathic Chondrolysis of the Hip (ICH) is a rare condition, occurring mostly in black female adolescence. It is characterized by the rapidly progressive destruction of articular cartilage in the hip joint resulting in premature degeneration and subsequent joint arthrosis. We report three cases of ICH: a 13-year old boy presented with left knee pain, an 11-year old girl with right hip pain and a 12-year old girl with right thigh pain. All of them had the same characteristic radiographic findings. The initial treatment was started conservatively. Surgical treatment was performed in one patient in order to confirm diagnosis and correct deformity.

Down's syndrome presented with clubfoot deformity: a case report.

A 1 month old girl was referred to the orthopaedic clinic with bilateral clubfoot deformities. At birth, clinical examination showed the typical characters of Down's syndrome and the diagnosis was confirmed by chromosome study. These two conditions appear improbable as their basic pathologies are entirely different. In our patient, the translocation type at the long arm of chromosome 21 was determined in the chromosome study. This result has never been reported in the literature.

Spontaneous recovery of trigger thumbs in children.

Forty-two children with trigger thumb were reviewed to determine the possibility of spontaneous recovery and the outcome of treatment. There were 22 boys and 20 girls. All of them had a normal physical examination at birth. Ten patients had spontaneous recovery within 3 months of their initial visit. Thirty-two patients underwent surgical release. All of them had satisfactory results. Our findings suggest that spontaneous recovery of trigger thumb in children is possible and may be related to a traumatic cause for the condition. Delaying operation until after the age of 3 years will not affect the outcome.

Trigger finger in children.

Trigger finger in children is a rare condition. Thirty-three patients with 45 trigger fingers (40 thumbs and five other fingers) were reviewed. As no case was detected at birth, the condition was suggested to be developmental. Surgi cal release was performed in 31 cases, with satisfactory results in all cases. Ten of 31 cases were older than 3 years (range, 3-5 years). The age of the patient when the operation was indicated could be between 1 and 5 years.

Slipped capital femoral epiphysis in Ramathibodi Hospital.

Slipped capital femoral epiphysis is rare in Asiatic Indonesian-Malays. Seven cases (9 hips) of this condition in Ramathibodi Hospital including five boys (average age, 12.5 years) and two girls (average age, 13 years) were reviewed. Most of the cases (4 out of 7) were acute on chronic and mild slips. No endocrine disorder was observed in all cases. All of the patients had a body weight above the mean of the normal population, four of which were obese. For the treatment, a single screw fixation including one case with cancellous and six cases with cannulated type were used. In the follow-up of average 2.5 years, six cases had satisfactory results. Avascular necrosis occurred in one case with mild and chronic slips in which a cancellous screw was used. It is concluded that obesity is the important factor related to the etiology in this study and probably is the same in other developing countries. The effect of a cancellous screw causing avascular necrosis is still questionable.

The heel-pad compressibility.

Heel-pad thickness and compressibility were studied in the feet of 400 normal subjects by loaded and unloaded lateral radiographs. The normal unloaded heel-pad thickness was 18.70 +/- 2.46 mm. The thickness was greater in men than in women and increased with age. The heel-pad compressibility index was 0.53 +/- 0.09. The compressibility increased with age, but there was no significant difference with gender. An increase in body weight led to an increase in heel-pad thickness and loss of elasticity.

Problems in surgical treatment of congenital clubfoot.

Twenty-three patients with 32 congenital rigid clubfeet treated by posteromedial release were reviewed after a follow-up averaging 33 months. The feet were assessed both clinically and radiologically; a satisfactory result was obtained in 17 feet inspite of residual deformity of forefoot adduction. Early operation and adequate postoperative immobilisation were major factors in contributing to a satisfactory result.

Chondrodysplasia punctata: a case report.

Chondrodysplasia Punctata is a rare condition in which there are numerous punctate areas of calcification in the epiphysis. The disease involves not only skeletal but also the cardiovascular, cutaneous, ocular and central nervous system. We present a newborn case with clinical as well as radiographic findings similar to Chondrodysplasia Punctata.