Il-Hyung Park

Distal tibia metaphyseal fractures treated by percutaneous plate osteosynthesis.

Twenty-one patients with fractures of the distal tibial metaphysis, some with minimal displacement in the ankle, were treated by percutaneous plate osteosynthesis with a narrow limited contact-dynamic compression plate. Using the classification by the Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association, 17 fractures had no articular involvement, whereas four included intraarticular extension. At final followup (mean, 20 months), all the fractures healed without second procedures and the mean union time was 15.2 weeks. One patient had malalignment of the limb with 10° internal rotation, but there were no angular deformities greater than 5° or any shortening greater than 1 cm. All patients had excellent or satisfactory ankle function. There were no infections or any soft tissue compromise. Percutaneous plate osteosynthesis is a safe and worthwhile method of managing such fractures, which avoids some of the complications associated with conventional open plating methods.

A TGF-?-inducible cell adhesion molecule, ?ig-h3, is downregulated in melorheostosis and involved in osteogenesis

Melorheostosis is a rare bone disease characterized by linear hyperostosis and associated soft tissue abnormalities. The skin overlying the involved bone lesion is often tense, shiny, erythematous, and scleodermatous. In order to look for genes differentially expressed between the normal and involved skin, we cultured skin fibroblasts from the skin lesions of several afflicted patients, and identified differentially expressed genes by reverse dot‐blot hybridization. We found that the genes human TGF‐β‐induced gene product (βig‐h3), osteoblast‐specific factor 2, osteonectin, fibronectin, and type I collagen were all downregulated in the affected skin fibroblasts, with βig‐h3 the most significantly affected. The expression of βig‐h3 was induced by TGF‐β in both affected and normal fibroblasts. In an effort to determine the mechanism of bone and skin abnormalities in melorheostosis, we made recombinant βig‐h3. Both immobilized and soluble recombinant βig‐h3 proteins with or without an RGD motif inhibited bone nodule formation of osteoblasts in vitro. Taken together, our results suggest that altered expression of several adhesion proteins may contribute to the development of hyperostosis and concomitant soft tissue abnormalities of melorheostosis, with βig‐h3 in particular playing an important role in osteogenesis. J. Cell. Biochem. 77:169–178, 2000.

Analysis of early failure of the locking compression plate in osteoporotic proximal humerus fractures

BackgroundAlthough there has been continuous evolution in the management of fracture fixation, treatment for osteoporotic proximal humerus fractures is still challenging to trauma surgeons. The purpose of this study was to report early failure of the locking compression plate (LCP) in the treatment of osteoporotic proximal humerus fracture and characterize the mode of failure.MethodsNine patients, older than 65 years, underwent internal fixation with the use of a locking compression plate and had early failure within 4 weeks postoperatively. According to Neer’s classification, five were included in a two-part surgical neck fracture, three in a three-part fracture, and one in a four-part fracture.ResultsAll failures occurred with back-out of the plate—screw construct, leading to varus displacement in eight patients and plate breakage in one. Revision surgery was performed in six patients using replating and tension band wiring with a bone graft, and three patients underwent hemiarthroplasty. The average UCLA score was 25 points for the hemiarthroplasty group and 30 points for the reconstruction group.ConclusionsEarly postoperative failure of the LCP developed within 4 weeks with a presentation of en bloc back-out of the plate-screw construct and plate breakage. Possible risk factors included malreduction, loss of medial support, and negligence of tension band sutures on the tuberosities.

A Study of 23 Unicameral Bone Cysts of the Calcaneus: Open Chip Allogeneic Bone Graft versus Percutaneous Injection of Bone Powder with Autogenous Bone Marrow

Background: The treatment of unicameral bone cyst varies from percutaneous needle biopsy, aspiration and local injection of steroid, autologous bone marrow, or demineralized bone matrix to curettage and open bone-grafting. The purpose of this study was to compare the results of open chip allogeneic bone graft versus percutaneous injection of demineralized bone powder with autogenous bone marrow in management of calcaneal cysts. Materials and Methods: Twenty-three calcaneal unicameral cysts in 20 patients were treated. Lyophilized irradiated chip allogeneic bone (CAB) and autogenous bone marrow were used for treatment of 13 cysts in 11 patients, and 10 cysts in 9 patients were treated with percutaneous injection of irradiated allogeneic demineralized bone powder (DBP) and autogenous bone marrow. There were 11 males and 9 female patients with mean age of 17 years. Results: The patients were followed for an average of 49.4 months. Complete healing was achieved in 9 cysts treated with chip allogeneic bone and in 5 cysts treated with powdered bone. Four cysts treated with CAB and 3 cysts treated with DBP healed with a defect. Two cysts treated with powdered bone and autogenous bone marrow were classified as persistent. No infections or pathological fractures were observed during the followup period. Conclusion: Percutaneous injection of a mixture of allogeneic bone powder with autogenous bone marrow is a minimal invasive method and could be an effective alternative in the treatment of unicameral calcaneal bone cysts. The postoperative morbidity was low, the hospital stay was brief, and patients comfort for unrestricted activity was enhanced.

Multicentric giant cell tumor of bone: ten lesions at presentation

The case of a 19-year-old man with multicentric and subsequent metachronous giant cell tumor of bone is presented. Ten lesions were identified at presentation and eventually two more lesions developed. The multiplicity of 12 lesions over a 40-month period is most unusual.

Articular Surface Area of the Coronoid Process and Radial Head in Elbow Extension: Surface Ratio in Cadavers and a Computed Tomography Study In Vivo

PURPOSE To quantify the articular surface area ratio of the radial head to the coronoid process to gain a better understanding of the stress distribution across these articulations and possibly to explain the patterns of osteoarthritis that are commonly seen in the elbow. METHODS Thirty cadaveric elbows were harvested and dissected to allow measurement of the radial head and coronoid process articular surfaces. The articular surface areas were measured using the Image J program (National Institutes of Health, Chicago, IL). Twelve men were recruited for this study, and all received a computed tomography (CT) scan of the elbow. A 3-dimensional image of the proximal radioulnar articular surface was created using volume rendering. All specimens were measured 3 times by 2 observers. RESULTS In the cadaveric measurements, the mean area of the radial head articular fossa was 247.3 +/- 52.6 mm(2) (mean +/- SD). The mean area of the medial facet of the coronoid process was 232.29 +/- 36.5 mm(2), and the mean area of the lateral facet was 141.9 +/- 33.3 mm(2). The articular surface area ratio of radial head to coronoid process was 1:1.5. In the CT measurement, the mean area of the radial head articular fossa was 258.9 +/- 26.3 mm(2). The mean area of the coronoid process articular surface was 376.9 +/- 37.0 mm(2). The articular surface area ratio of radial head to coronoid process was 1:1.46. CONCLUSIONS The ratio of articular surface area of radial head to coronoid process is 1:1.51 in cadavers and 1:1.46 using a CT in vivo, which is the reverse of the reported force transmission ratio across the elbow joint.

High bifurcation of median nerve at the wrist causing common digital nerve injury in endoscopic carpal tunnel release.

A 45-year-old right-handed woman was treated by endoscopic carpal tunnel release under local anaesthetic. When cutting the proximal half of the flexor retinaculum with the retrograde blade, she complained of an electric shock-like pain in her middle and ring fingers. Open exploration of the carpal tunnel was performed and a laceration of the middle/ring common digital nerve, which bifurcated at the unusually high level of the wrist crease, was found.

An anatomic study on the junctura tendinum in the 4th intermetacarpal space and its clinical implication

We report results of anatomic study in the fourth intermetacarpal space, focusing on the pattern of junctura tendinum and variations of extensor tendons of the little finger with its clinical implication on snapping of the little finger. Fifty unpaired cadaveric hands were dissected from the wrist to the middle phalanx of the ring and little fingers. The type of junctura tendinum was judged based on Von Schroders classification and the relationship with EDC were recorded. EDC to the little finger and EDM were dissected and the numbers were recorded. Forty six hands (92%) exhibited a junctura tendinum in the fourth intermetacarpal space and it was Type III in 42 hands (84%). The EDC‐little finger was absent in 76% (38 of 50 hands). When present, EDC‐little finger originated most commonly as single thin tendon. The absence of an EDC‐little finger was associated with increased incidence of Type III junctura tendinum (37 of 38 hands). An EDM was present in all 50 hands running from the fifth dorsal compartment. Based on these clinical and anatomic studies, we considered that the snapping of the little finger is more likely subluxation of junctura tendinum rather than subluxation/dislocation of EDC of the little finger. Clin. Anat. 23:56–60, 2010.

Elastic nailing of tibia shaft fractures in young children up to 10 years of age.

INTRODUCTION Although tibia shaft fractures in children usually have satisfactory results after closed reduction and casting, there are several surgical indications, including associated fractures and soft tissue injuries such as open fractures. Titanium elastic nails (TENs) are often used for pediatric tibia fractures, and have the advantage of preserving the open physis. However, complications such as delayed union or nonunion are not uncommon in older children or open fractures. In the present study, we evaluated children up to 10 years of age with closed or open tibial shaft fractures treated with elastic nailing technique. METHODS A total of 16 tibia shaft fractures treated by elastic nailing from 2001 to 2013 were reviewed. The mean patient age at operation was 7 years (range: 5-10 years). Thirteen of 16 cases were open fractures (grade I: 4, grade II: 6, grade IIIA: 3 cases); the other cases had associated fractures that necessitated operative treatments. Closed, antegrade intramedullary nailing was used to insert two nails through the proximal tibial metaphysis. All patients were followed up for at least one year after the injury. Outcomes were evaluated using modified Flynns criteria, including union, alignment, leg length discrepancies, and complications. RESULTS All fractures achieved union a mean of 16.1 weeks after surgery (range: 11-26 weeks). No patient reported knee pain or experienced any loss of knee or ankle motion. There was a case of superficial infection in a patient with grade III open fracture. Three patients reported soft tissue discomfort due to prominent TEN tips at the proximal insertion site, which required cutting the tip before union or removing the nail after union. At the last follow-up, there were no angular or rotational deformities over 10° in either the sagittal or coronal planes. With the exception of one case with an overgrowth of 15 mm, no patient showed shortening or overgrowth exceeding 10mm. Among final outcomes, 15 were excellent and 1 was satisfactory. SUMMARY Even with open fractures or soft tissue injuries, elastic nailing can achieve satisfactory results in young children, with minimal complications of delayed bone healing, or infection.

Open wedge high tibial osteotomy using three-dimensional printed models: Experimental analysis using porcine bone

BACKGROUND The purpose of this study was to evaluate the usefulness of three-dimensional (3D) printed models for open wedge high tibial osteotomy (HTO) in porcine bone. METHODS Computed tomography (CT) images were obtained from 10 porcine knees and 3D imaging was planned using the 3D-Slicer program. The osteotomy line was drawn from the three centimeters below the medial tibial plateau to the proximal end of the fibular head. Then the osteotomy gap was opened until the mechanical axis line was 62.5% from the medial border along the width of the tibial plateau, maintaining the posterior tibial slope angle. The wedge-shaped 3D-printed model was designed with the measured angle and osteotomy section and was produced by the 3D printer. The open wedge HTO surgery was reproduced in porcine bone using the 3D-printed model and the osteotomy site was fixed with a plate. Accuracy of osteotomy and posterior tibial slope was evaluated after the osteotomy. RESULTS The mean mechanical axis line on the tibial plateau was 61.8±1.5% from the medial tibia. There was no statistically significant difference (P=0.160). The planned and post-osteotomy correction wedge angles were 11.5±3.2° and 11.4±3.3°, and the posterior tibial slope angle was 11.2±2.2° pre-osteotomy and 11.4±2.5° post-osteotomy. There were no significant differences (P=0.854 and P=0.429, respectively). CONCLUSION This study showed that good results could be obtained in high tibial osteotomy by using 3D printed models of porcine legs.