Eun Sun Moon

Significance of laboratory and radiologic findings for differentiating between septic arthritis and transient synovitis of the hip.

Although significant differences exist in the methods of treatment and prognoses of septic coxitis and transient synovitis in children complaining of acute hip pain, similar symptoms are present in these two diseases at the early stages, and differential diagnosis is difficult. To differentiate between these two diseases, the authors evaluated the clinical, serologic, and radiologic findings and tried to determine factors that could be used as diagnostic criteria. The authors performed a retrospective study by evaluating medical records, plain hip radiographs, and clinical findings in 97 patients with transient synovitis and 27 patients with septic arthritis. Univariate analysis showed significant differences in body temperature, serum WBC count, and ESR and CRP levels of the two patient groups. Plain radiographs showed a displacement or blurring of periarticular fat pads in all patients with acute septic arthritis, and multivariate regression analysis showed that body temperature >37°C, ESR >20 mm/h, CRP >1 mg/dL, WBC >11,000/mL, and an increased hip joint space of >2 mm were independent multivariate predictors of acute septic arthritis. The authors conclude that the independent multivariate predictors are effective indices for the differential diagnosis of acute septic coxitis and transient synovitis.

Patient-Related Factors and Complications After Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

Background: Tenotomy of the long head of the biceps tendon (LHBT) has been reported to provide reliable pain relief and require little postoperative rehabilitation. Complications such as cosmetic deformity, decrease in elbow flexion strength, decrease in supination strength, and fatigue discomfort have been reported after tenotomy of the LHBT. Purpose: To evaluate the complications of arthroscopic tenotomy of the LHBT in the shoulder–specifically, cosmetic deformity, decreased elbow flexion strength, and a cramplike arm pain–and to identify the patient-related factors that affect the rate of complications after tenotomy, such as, age, sex, involvement of the dominant arm, and body mass index (BMI). Study Design: Case series; Level of evidence, 4. Methods: In sum, 132 patients were evaluated. They had a mean age of 63 years (range, 26 to 82 years) at the time of surgery and a mean follow-up of 21 months (range, 12 to 53 months). The presence of so-called Popeye deformity, a cramplike arm pain at resisted elbow flexion, and strength of elbow flexion were evaluated. The development of each complication was compared by age, sex, involvement of the dominant arm, and BMI. Results: Of the 132 patients, 60 (45%) had Popeye deformity, and it was significantly more frequent in men (76%) than women (31%) (P < .001). However, statistical analysis showed no difference in Popeye deformity frequency by age, arm dominance, or BMI. Male sex was found to be the only risk factor associated with the development of Popeye deformity, with an odds ratio of 10.21 versus women (95% confidence interval, 3.97 to 26.27; P < .001). Ten patients (8%) complained of a cramplike arm pain. Elbow flexion strength decreased in 60 patients (45%), although no intergroup differences were found for elbow flexion strength. Conclusion: The current study showed a 45% prevalence of Popeye deformity and 8% cramplike arm pain on exertion after tenotomy of the LHBT. Among patient factors such as sex, age, dominant arm relation, and body mass index, the male sex was the only factor correlated with occurrence of a Popeye deformity. Other factors did not show any correlation with deformity, elbow flexion strength, and cramplike arm pain.

Expression and Significance of TGF-β Isoform and VEGF in Osteosarcoma

This article demonstrates that the degree of VEG expression could be used as a clinically signific prognostic factor in osteosarcoma.

The correlation between coxa magna and final outcome in Legg-Calve-Perthes disease.

This study evaluated the final outcome of coxa magna that developed as a sequela of Legg-Calve-Perthes disease. The final outcomes at skeletal maturity were assessed by the Stulberg classification in 85 children with unilateral Perthes disease. Among them, 21 children had a bilateral arthrogram at the active stage of the disease, and the arthrogram measurements were compared with those measured at disease healing and at skeletal maturity. Coxa magna was observed in 53% (45/85), with a mean increase in 20.0 ± 7.2%. These coxa magna and resulting acetabular deformities occurred in the early stage of the disease. In 68 hips with mild (1-9% increase) or moderate (10-19%) coxa magna, the final results were Stulberg I or II in 57 hips and III in 11. In 17 hips with severe coxa magna (≥20%), the results were I or II in one hip, III in nine, and IV in seven. This means that 41% of the hips with severe coxa magna might have osteoarthritis later in life.

Deformity of the femoral head following vascular infarct in piglets.

Background In Legg-Calvé-Perthes disease (LCPD), 4 major patterns (coxa plana, coxa magna, coxa vara, subluxation) of the femoral head are commonly observed. However, direct observation of pathological specimens is rarely possible. An animal model of LCPD may clarify the pathogenesis of femoral head deformity. Animals and methods In 26 piglets, we interrupted the vascular supply to the capital femoral epiphysis by cutting the ligamentum teres and ligating the femoral neck containing the epiphyseal artery. 6–7 piglets in each experimental group were killed at early (2 and 4 weeks: P2 and P4), intermediate (12 weeks: P12), and late (20 weeks: P20) periods. We examined the extracted femoral heads macroscopically and radiographically. Results The mean decrease in epiphyseal height was 1.5 mm, 4.1 mm, 5.0 mm, and 7.5 mm in P2, P4, P12 and P20, respectively (rs = 0.76, p = 0.002). The mean increase of diameter was 4.1 mm, 6.9 mm, and 6.8 mm in P4, P12 and P20, respectively. Decrease of the articulotrochanteric distance was mild in P2 and P4, and severe in P12 and P20. Subluxation of the femoral head was observed only in P12 and P20 piglets. Interpretation The piglet model of LCPD was useful in the early stage of devascularization for investigation of the developmental pattern of femoral head deformity. However, when the piglets had grown to 20 weeks old or more—that is, to full skeletal maturity—the femoral head and acetabulum showed severe deformities that were most likely caused by heavy body weight. ▪

The effects of subluxation of the femoral head with avascular necrosis in growing rabbits.

Abstract: To validate the adverse effects of subluxation of the femoral head in Legg-Calvé-Perthes disease, the authors made an experimental model of Perthes disease with subluxation in growing rabbits by interrupting the epiphyseal artery (devascularization) and immobilizing the knee in extension (immobilization). Seventy-two rabbits, 4 to 5 weeks old, were divided into three groups: group A with both devascularization and immobilization (25 rabbits), group B with devascularization only (25 rabbits), and group C with immobilization only (22 rabbits). In each experimental group, four to six rabbits each were killed at 1, 2, 4, 8, and 12 weeks. After reviewing the serial radiographs and gross specimens, the authors found six radiologic and six macroscopic abnormalities. The incidence and the severity of deformity in group A rabbits were higher than that of groups B or C in terms of the overall incidence of deformities (P < 0.001), head deformity scores (P < 0.001), and the incidence of a total collapse of the capital femoral epiphysis. In conclusion, subluxation of the immature femoral head with avascular necrosis in rabbits increased femoral head deformities.

Why does outer joint motion predominate in bipolar hip prosthesis?Experimental and clinical studies

Background Theoretically, the motion of a bipolar hip prosthesis is most likely to occur at the inner joint if the frictional coefficients are equal at both surfaces. However, many studies have suggested that most motion occurs at the outer joint. Material and methods We performed an analysis of motion in a cadaveric bone model and in 50 patients during fluoroscopic examination, to determine how the motion is distributed between the two joints and what factors contribute to this distribution. Results The motion distributions varied widely between the patients. However, there was a relative preponderance (63–90%) of outer motion in all directions of leg movement in addition to a persistent coexistence of motion at both joints in 44 of 50 patients. This preponderance of outer motion was the result of an early impingement of the acetabular cup and structural differences between the two joints. Interpretation An adjustment of the positive eccentricity and a decrease in the frictional torque of the inner joint as a result of better lubrication and smoothness can be expected to improve the motion distribution, thus reducing the amount of acetabular erosion.

Computed tomographic findings of osteochondritis dissecans following Legg-Calvé-Perthes disease.

Routine radiographs in the follow-up study of Legg-Calvé-Perthes disease patient have generally been plain radiographs of the anteroposterior and frog-leg lateral view. Recently, several reports have found that osteochondritis dissecans can develop in 2% to 4% of Legg-Calvé-Perthes disease patients. Early roentgenographic recognition of this lesion is very important for its long-term prognosis. However, follow-up examination of the lesion using plain radiography is sometimes not satisfactory in terms of delineating the lesion. Accordingly, the authors performed computed tomography and three-dimensional reconstruction in 13 hips with osteochondritis dissecans following Legg-Calvé-Perthes disease and were able to obtain more precise information on the extent of the involvement, the degree of healing, the stability of the osteochondral fragment, and the location of the dislocated loose body.

SURGICAL TREATMENT OF PSEUDOSYNDACTYLY OF CHILDREN WITH EPIDERMOLYSIS BULLOSA: A CASE REPORT

Recessive dystrophic epidermolysis bullosa (RDEB) is an uncommon and severe disorder characterised by trauma-induced blisters, intractable skin ulcers, scarring, milia, and nail dystrophy. We report the good result of both surgical release of fingers allowing spontaneous epithelisation without skin grafting and post-operative meticulous skin care without splinting, followed-up for one year.

Why does outer joint motion predominate in bipolar hip prosthesis

BACKGROUND Theoretically, the motion of a bipolar hip prosthesis is most likely to occur at the inner joint if the frictional coefficients are equal at both surfaces. However, many studies have suggested that most motion occurs at the outer joint. MATERIAL AND METHODS We performed an analysis of motion in a cadaveric bone model and in 50 patients during fluoroscopic examination, to determine how the motion is distributed between the two joints and what factors contribute to this distribution. RESULTS The motion distributions varied widely between the patients. However, there was a relative pre-ponderance (63-90%) of outer motion in all directions of leg movement in addition to a persistent coexistence of motion at both joints in 44 of 50 patients. This preponderance of outer motion was the result of an early impingement of the acetabular cup and structural differences between the two joints. INTERPRETATION An adjustment of the positive eccentricity and a decrease in the frictional torque of the inner joint as a result of better lubrication and smoothness can be expected to improve the motion distribution, thus reducing the amount of acetabular erosion.