Subungual squamous cell carcinoma: report of 2 cases.

Subungual squamous cell carcinoma (SCC) is a rare malignant tumor with an indolent course. Its etiology is unknown. It often involves the distal phalanx of the thumb or the index finger, and often presents as a chronic ulcer that is commonly misdiagnosed as chronic paronychia, pyogenic granuloma or verruca vulgaris. Approximately 150 cases of subungual SCC, including one in a Taiwanese patient, have been reported. Here, we report two cases of subungual SCC presenting as a chronic ulcer of the nail bed refractory to antibiotic treatment. One case involved the right thumb, while the other involved the right index finger. Radiographs of both cases showed an osteolytic bone lesion involving the distal phalanx. Excision biopsy revealed SCC in both cases. Both patients received amputation of the involved distal phalanx and showed no signs of reoccurrence during 5 years of follow-up. These findings suggest that all recalcitrant ulcers of the nail bed should be biopsied to facilitate early diagnosis and treatment of subungual SCC.

Periprosthetic bone mineral density of the distal femur after total knee arthroplasty.

Evaluation of the bone mineral density (BMD) was performed in the distal femur around the femoral component of a total knee prosthesis. A total of 48 females were enrolled for this study, including 14 with osteoarthritis of one knee undergoing total knee arthroplasty (TKA) with an Osteonics prosthesis, 14 with osteoarthritis of one knee undergoing TKA with a Whiteside prosthesis, and 20 age-matched normal controls. The BMDs of both knees were measured before operation, and then at 3, 6 and 12 months after operation. The preliminary results demonstrate a significant progressive decrease of BMD in the distal femur of the operated knees after TKA, whereas the BMD of the non-operated knees remains stable. The ratio of BMD between the operated femur and the non-operated femur began to decrease 6 months after operation, and was most obvious at the end of the first year (ranging from 7% to 27%). Further investigation is essential to determine the clinical significance of this loss of periprosthetic bone.

One-stage correction of neglected congenital dislocation of the hip without preoperative traction.

The value of preoperative traction of a neglected congenital dislocation of the hip (CDH) is a controversial issue. A retrospective study was performed to evaluate the effects of one-stage, total correction without traction used in neglected CDH. From April 1984 to November 1988, 64 patients (74 untreated dislocated hips) were operated upon with one-stage total correction without preoperative traction. Their ages ranged from 1 year 2 months to 8 years 6 months. Forty-five patients (53 hips) underwent open reduction and a Salter's osteotomy. Ten patients (11 hips) had additional femoral shortening. Nine patients (10 hips) underwent open reduction and a triple osteotomy with femoral shortening. With a minimum of two years of follow-up, all of the hips were well contained, except for two hips with subluxation and one hip with redislocation (reduced after a secondary operation). Avascular necrosis of the femoral head was evident in three hips (one in each group). All of the patients without complications functioned well without significant leg length discrepancy. The other patients also performed well after their complications were treated. In conclusion, neglected CDH in patients up to nine years of age can be safely and effectively treated by one-stage, total correction without preoperative traction.