Anterior Knee Pain in Patients with Cerebral Palsy

BACKGROUND: The aim of this study was to identify the risk factors for anterior knee pain in patients with cerebral palsy. METHODS: This prospective study investigated the risk factors for anterior knee pain in 127 ambulatory patients with spastic cerebral palsy in terms of walking pain, resting pain, and provocative pain. Demographic data analysis and physical examination for measuring the knee flexion contracture and unilateral and bilateral popliteal angles were performed. Patellar height was measured on radiographs, and patella alta was identified. The risk factors for anterior knee pain were analyzed using multivariate analysis with a generalized estimating equation. RESULTS: Seventy-seven patients were found to have patella alta based on the radiographic measurements (60.6%). Overall, sixteen patients (12.6%) had either unilateral or bilateral anterior knee pain. Of these, 6 patients showed a visual analogue scale (VAS) 7. Age was found to be a significant risk factor for walking pain and resting pain with odds ratios (ORs) of 1.08 (95% confidence interval [CI], 1.02 to 1.14) and 1.09 (95% CI, 1.03 to 1.15), respectively. In the multivariate analysis, knee flexion contracture was a significant protective factor with an OR of 0.92 (95% CI, 0.85 to 0.98). CONCLUSIONS: Approximately 12.6% of ambulatory patients with spastic cerebral palsy were found to have anterior knee pain in our hospital-based cohort study. Age was found to be a significant risk factor for anterior knee pain while walking and resting.

Intravascular Papillary Endothelial Hyperplasia in Foot Adherent to a Saphenous Nerve Branch: A Case Report / 대한족부족관절학회지

Intravascular papillary endothelial hyperplasia (IPEH) has appeared in the literature under a variety of names, including Masson's tumor, Masson's hemangioma, and Masson's pseudoangiosarcoma. It is a benign lesion of the skin and subcutaneous tissue characterized by reactive proliferation of vascular endothelial cells with papillary formations. The clinical picture is not specific and the lesion resembles malignant angiosarcoma clinically and histopathologically. Therefore, it is often mistaken for angiosarcoma and a group of other benign and malignant vascular lesions. We report on a case of IPEH adherent to peripheral nerve treated with operative excision.

Buddy Taping: Is It a Safe Method for Treatment of Finger and Toe Injuries?

BACKGROUND: Buddy taping is a well known and useful method for treating sprains, dislocations, and other injuries of the fingers or toes. However, the authors have often seen complications associated with buddy taping such as necrosis of the skin, infections, loss of fixation, and limited joint motion. To our knowledge, there are no studies regarding the complications of buddy taping. The purpose of this study was to report the current consensus on treating finger and toe injuries and complications of buddy taping by using a specifically designed questionnaire. METHODS: A questionnaire was designed for this study, which was regarding whether the subjects were prescribed buddy taping to treat finger and toe injuries, reasons for not using it, in what step of injury treatment it was use, indications, complications, kinds of tape for fixation, and special methods for preventing skin injury. Fifty-five surgeons agreed to participate in the study and the survey was performed in a direct interview manner at the annual meetings of the Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand, in 2012. RESULTS: Forty-eight surgeons (87%) used buddy taping to treat finger and toe injuries, especially proximal interphalangeal (PIP) injuries of the hand, finger fractures, toe fractures, metacarpophalangeal injuries of the hand, and PIP injuries of the foot. Sixty-five percent of the surgeons experienced low compliance. Forty-five percent of the surgeons observed skin injuries on the adhesive area of the tape, and skin injuries between the injured finger and healthy finger were observed by 45% of the surgeons. CONCLUSIONS: This study sheds light on the current consensus and complications of buddy taping among physicians. Low compliance and skin injury should be considered when the clinician treats finger and toe injuries by using buddy taping.

Incidence Patterns of Pediatric and Adolescent Orthopaedic Fractures According to Age Groups and Seasons in South Korea: A Population-Based Study

BACKGROUND: Fractures which need urgent or emergency treatment are common in children and adolescents. This study investigated the incidence patterns of pediatric and adolescent orthopaedic fractures according to age groups and seasons in South Korea based on population data. METHODS: Data on the number of pediatric and adolescent patients under the age of 18 years who utilized medical services due to fractures were retrieved from the Health Insurance Review and Assessment service in South Korea. The data included four upper extremity and two lower extremity fractures according to four age groups (0-4 years, 5-9 years, 10-14 years, and 15-18 years). Incidences of the fractures were calculated as the incidence per 10,000 per year, and patterns according to age groups and seasons were demonstrated. RESULTS: The annual incidence of clavicle, distal humerus, both forearm bone, distal radius, femoral shaft and tibial shaft fractures were 27.5, 34.6, 7.7, 80.1, 2.5, and 9.6 per 10,000 per year in children and adolescents, respectively. Clavicle and distal radius fractures showed significant seasonal variation for all age groups but femoral shaft fracture showed no significant seasonal variation for any of the age groups. CONCLUSIONS: The four upper extremity fractures tended to show greater variations than the two lower extremity fractures in the nationwide database in South Korea. The study results are believed to be helpful in the planning and assignment of medical resources for fracture management in children and adolescents.

Thin Split-Thickness Toe Nail-Bed Grafts for Nail Bed Defects in Subungal Exostosis: Two Cases Report / 대한골관절종양학회지

We reviewed the clinical features of 2 patients who underwent surgery for subungal exostosis, focusing on postoperative deformity of the nail. The lesion destroyed the nail bed and was excised with a direct approach. then thin split-thickness sterile matrix graft was done after excision of the tumor because the defect of the nail bed was large. Good postoperative appearance of the nail was obtained by thin split-thickness sterile matrix graft. The use of thin split-thickness sterile matrix graft for the replacement of a nail bed defect can regain a smooth, adherent, and normal-looking nail and avoid donor-site morbidity. Thin split-thickness toe-nail bed graft is a good choice for the prevention of postoperative deformity.

Prevalence of Obesity in Ambulatory Patients with Cerebral Palsy in the Korean Population: A Single Institution's Experience

BACKGROUND: There is a worldwide tendency of an increasing prevalence of obesity. Therefore, this study aimed at determining whether such a trend exists among cerebral palsy (CP) patients. We also tried to compare this trend with the trend in the general population. We also discuss the importance of obesity trends in CP patients. METHODS: This retrospective study was performed on 766 ambulatory patients who were diagnosed with CP since 1996 in our institution. The associations among the prevalence of obesity and the body mass index, age, gender, the type of CP, the gross motor function classification system and the time of survey were investigated. RESULTS: The overall prevalence of obesity was 5.7%, and the overall prevalence of obesity together with being overweight was 14.6% for the ambulatory patients with CP. The prevalence of obesity and of obesity together with being overweight did not show a statistically significant temporal increase. On the other hand, age and gender were found to affect the body mass index of the ambulatory CP patients (p < 0.001 and 0.003, respectively). CONCLUSIONS: The extent of obesity and being overweight in the ambulatory patients with CP in this study was far less than that reported in the United States (US). In addition, it appears that the differences of the prevalence of obesity in children and adolescents between those with and without CP are disappearing in the US, whereas the differences of the prevalence of obesity in children and adolescents between those with and without CP seem to be becoming more obvious in Korea. Accordingly, care should be taken when adopting the data originating from the US because this data might be affected by the greater prevalence of obesity and the generally higher body mass indices of the US.

Outcome Assessment of Surgical Treatment of Transverse Plane Deformities in Spastic Hemiplegia / 대한정형외과연구학회지

PURPOSE: We are trying to develop the objective index, which represents the gait pathology of transverse plane in cerebral palsy for outcome assessment of surgical intervention. MATERIALS AND METHODS: We evaluate 23 spastic hemiplegics with pre- and post-operative 3D gait analysis and 13 able-bodies. Mean pelvic rotation (MPR), maximum pelvic rotation (XPR), Mean hip rotation (MHP), Foot progression angle (FPA) in stance were extracted from the kinematic data and principal component analysis was used to make an index for transverse plane gait pathology, so-called transverse index (TI) . RESULTS: Transverse index for able-bodies was 40+/-29. In spastic hemiplegics, transverse indices were 151+/-59 preoperatively, 68+/-44 postoperatively. CONCLUSION: We present the index for transverse plane gait pathology by the way of multivariate study.

Total Knee Arthroplasty Without Patellar Resurfacing / 대한정형외과학회잡지

PURPOSE: To Analyze the Clinical Results of the Total Knee Arthroplasty without Patellar Resurfacing. MATERIALS AND METHODS: One hundred and eight Total Knee Arthroplasties (Nexgen(R), Zimmer, USA) without resurfacing of the patella, were performed between February 1995 and September 1999, and 89 cases followed up for more than 36 months were analyzed in this study. The follow up period ranged from 36 to 70 months (average 52 months). The diagnosis was degenerative joint disease in 83 cases (93%), rheumatoid arthritis in 5 cases (6%) and avascular necrosis of medial femoral condyle in 1 case (1%). The clinical results were evaluated according to Knee Society Clinical Rating System. RESULTS: The mean preoperative knee score was 34 points (range 5-63 points) according to the Knee Society Clinical Rating System, and the mean preoperative functional score was 38 points (range, 10-61 points). The mean postoperative knee score was 91 points (range 65-98 points) and the mean postoperative functional score 89 points (range, 63-100 points). The current study shows that patellar complications associated with unresurfacing did not occur, with the exception of 2 cases of persistent peripatellar pain, which resolved by a postoperative 6 months with conservative treatment. The patellofemoral joint space was also well preserved even at the 3 and 5 year follow-ups. CONCLUSION: Complications of total knee arthroplasty, such as patellar dislocation or subluxation, rupture of the patellar tendon, and fracture of the patella, can be avoided by not resurfacing the patella. On the basis of our results, there is little evidence to support routine patellar resurfacing in total knee arthroplasty.

Changes of Clinical Outcomes after Decompression and Fusion for Spinal Stenosis during 2-Year Follow-up Periods / 대한척추외과학회지

STUDY DESIGN: A prospective study OBJECTIVE: To assess the clinical outcomes after the surgical treatment of spinal stenosis, using patient-centered measurements at the serial follow-up times. SUMMARY OF LITERATURE REVIEW: Patient-centered measurements are appropriate to assess the clinical outcomes of surgery for spinal stenosis. MATERIALS AND METHODS: Thirty-seven patients underwent posterior decompression and posterolateral fusion, with an iliac autograft using pedicle screw instrumentation. They were assessed for their pain using a visual analog scale, and the Oswestry disability index for the preoperative functional disability, at 6 weeks, 3 and 6 months, and at 1 and 2 years, postoperatively. RESULTS: The pain, as measured by the visual analog scale, was 7.42 points before the operation, and 4.12 and 2.76 six weeks and 1 year after the operation, respectively. Compared with the pre-operation scores, 44% has improved after 6 weeks, and 73% after a year. The functional disability, as measured by the Oswestry disability index, was 56.5% before the operation, and 32.13 and 20.1% three months and 1 year after the operation. Compared with the pre-operation, 43% recovered after 3 months, and 65% after a year. The state of recovery state in the functional disability continued for 2 years after the operation. The disability recovered more slowly than the pain. CONCLUSIONS: Patient-centered measurements were found to be appropriate for assessing the clinical outcomes to surgery for spinal stenosis. After decompression and fusion for spinal stenosis, the pain and functional disability both improved for 1 year after the operation, with no worsening in the postoperative improvements at 2 years.

Immunohistochemical Analysis of the EGFR and VEGF Expression in Human

The EGFR has been proposed as a stimulator of cell growth in some neoplasms. The VEGF play an important role in angiogenesis of several tumors. This study aimed to determine the EGFR and VEGF expression in colorectal adenocarcinoma and to correlate the expression of these gene with variable prognostic factors. Significant relationship was observed between the EGFR and histopathologic differentiation or lymph node involvement. But EGFR had no relation to depth of invasiveness or serum CEA level. On the other hand, VEGF had only relation to histopathologic differentiation. VEGF had no relation to lymph node involvement, depth of tumor invasiveness or serum CEA level. We conclude that EGFR expression in human colorectal adenocarcinoma was significantly associated with prognosis. But VEGF expression was not associated with prognosis. More studies are needed to determine whether EGFR expression is a clinically valuable prognostic factor.