The rationale for proximal tibial osteotomy is to correct the abnormal loading stresses on the knee that are caused by an abnormal tibiofemoral axis in the coronal plane. Aithough there are many methods of fixation including cast, staple and external fixation, Coventry staple has been used widely. But Coventry staple has some disadvantages such as inadequate fixation, long term cast immobilization and rehabilitation. The purpose of this study is to demonstrate the superior performance of Miniplate staple which was designed by authors(Johnson & Johnson Orthopaedics, New Milton, UK) over the conventional Coventry staple. We have analyzed the clinical results including postoperative rehabilitation course of 3I cases who had proximal tibial osteotomy fixed with Miniplate staple. Preoperative diagnosis was osteoarthritis(OA) in 24 cases(77.4%) and physiologic genu varum in 7 cases(22.6%). 1. Hospital for Special Surgery knee score was average 72.2 points preoperatively, 90.1 points postoperatively in osteoarthritis and average 94.1 points preoperatively, 99.7 points postoperativeiy in physiologic genu varum. 2. The average tibiofemoral angle was varus 5.8 degrees preoperatively and valgus 8.7 degrees postoperati vely. 3. The active ROM exercise started at 5.3 days, standing at 13.3 days, crutches ambulation at 20.2 days and ambulation without crutches at 46.3 days after operation. In conclusion, more rigid fixation and rapid mobilization was possible with newly designed Miniplate staple in proximal tibial osteotomy.
Axis, Cervical Vertebra ; Crutches ; Diagnosis ; Genu Varum ; Immobilization ; Knee ; Osteoarthritis ; Osteotomy* ; Rehabilitation ; Walking

STUDY DESIGN: Case study of two cases. OBJECTIVES: The aim of our study is to describe the rare MR imaging patterns of infectious spondylitis. SUMMARY OF LITERATURE REVIEW: It is generally accepted that the intravertebral cleft sign is not shown in cases of infection or malignancy, and thus, its recognition can obviate unnecessary imaging or biopsy because of its benign significance. MATERIALS AND METHODS: Two patients are presented who developed worsening back pain after a minor trauma. Preoperative MR images of these patients showed intravertebral fluid and benign vertebral compression fractures. Anterior decompression and fusion were done and the bacteria isolated from the intraoperative cultures were Listeria monocytogenes and Mycobacterium tuberculosis, respectively. RESULTS: After 2 years of follow-up, the patients were free of pain, without signs of infection, and showed correct fusion. CONCLUSIONS: MR findings in infectious spondylitis may simulate the patterns of osteoporotic VCFs.
Back Pain ; Bacteria ; Biopsy ; Decompression ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Listeria monocytogenes ; Magnetic Resonance Imaging ; Mycobacterium tuberculosis ; Spondylitis*

PURPOSE: We analyzed the oncological outcome and prognostic factor of the chondrosarcoma arising from benign bone tumor due to malignant transformation. MATERIALS AND METHODS: From April 1986 to April 2009, 18 cases were considered eligible. We analyzed retrospectively the patient's characteristics and prognostic factors that affect to the local recurrence and distant metastasis. RESULTS: As classified by primary benign bone tumor, 4 cases were solitary osteochondroma, 11 cases were multiple osteochondromatosis and 3 cases were multiple enchondromatosis. The mean follow-up period was 85 months. The 5-year disease free survival rate of 18 patients was 85.9%. Their overall MSTS score was 25.2 (84%). There were local recurrence in 3 cases and no distant metastasis. We found that tumor location and surgical margin affected to the prognosis significantly. CONCLUSION: In secondary chondrosarcoma patients, the prognosis was good relatively and tumor location and surgical margin are important prognosis factor.
Chondrosarcoma ; Disease-Free Survival ; Enchondromatosis ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Osteochondroma ; Osteochondromatosis ; Prognosis ; Recurrence ; Retrospective Studies

Trendelenburg position has been used for the low abdominal and pelvic surgery or for the management of the hypotensive patients. But, various adverse effects can also occur in steep Trendelenburg position, of which brachial plexus injury has been known as the most common nerve injury during this position under the general anesthesia especiaUy when the shoulder braces are used. We experienced a case of brachial plexus palsy in a 53 year old woman who had a laparas-copy assisted vaginal hysterectomy(LAVH) under the general anesthesia for myoma uteri for four and a half hours. During the operation she was in a 30 degree-tilting Trendelenburg and combined lithotomy position with her arms tucked at her side with drawsheet and shoulder braces were placed over the acromioclavicular joints bilaterally. In the morning of the postoperative 1st day, she complained the right shouder pain and the right arm tingling sensation and weakness. After needle electromyography and nerve conduction study, it was decided that she got an intraoperative brachial plexus injury mainly involving the lateral cord of the brachial plexus, resulting from the nerve compression caused by shoulder braces in Trendelenburg position. The symptoms were improved after the physical therapy and she was recommended to take more physical therapy after discharge.
Acromioclavicular Joint ; Anesthesia, General ; Arm ; Braces ; Brachial Plexus* ; Electromyography ; Female ; Head-Down Tilt ; Humans ; Hysterectomy, Vaginal* ; Middle Aged ; Myoma ; Needles ; Neural Conduction ; Paralysis* ; Sensation ; Shoulder ; Uterus

PURPOSE: The purpose of this study was to evaluate the oncologic outcomes of parosteal osteosarcoma (POS) and to ascertain the fates of patients after local recurrence (LR). MATERIALS AND METHODS: The authors retrospectively reviewed 22 POS patients with an average follow-up of 114 months (range: 36-235 months). Seven of the 22 patients were referred after LR. There were 17 Stage IB and 5 Stage IIB (G2, 2; dedifferentiation, 3). Tumors were located in the femur (11) and in other locations (11). Initial surgical margins were wide in 10, marginal in 5, and intralesional in 7. Correlations between clinico-pathologic variables and LR and clinical courses after LR were evaluated. RESULTS: The 10-year overall survival rate was 85.7%. Three (14%) patients developed distant metastasis and all of them succumbed to the disease. Nine (41%) patients developed LR. Tumor location, resection type, and surgical margin were found to be correlated with LR. At final follow-up, 7 of the 9 patients that experienced local failure achieved no evidence of disease. CONCLUSION: A substantial risk of misdiagnosis exists, especially for POS in other than a femoral location. Recurrent tumor re-excision is possible in most cases; however, patients with an aggressive recurrence pattern deserve special attention.
Diagnostic Errors ; Femur ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Osteosarcoma ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: We analyzed the oncologic characteristics and outcome of patients with inflammatory myofibroblastic tumor of extremities. MATERIALS AND METHODS: Among the soft tissue tumor patients who were treated between 1999 and 2012, 5 patients who were pathologically confirmed as the inflammatory myofibroblastic tumor of extremities were analyzed retrospectively. RESULTS: There were 1 man and 4 women with mean age of 44 years (37-55 years). The average follow up was 34.6 months (8-87 months). All patients underwent surgical treatment. Only 1 patient had wide resection margin and remaining 4 had marginal (3) or intralesional (1) resection margin. All of 4 patients without wide resection margin developed local recurrence at 10.3 months (8-19 months). Malignant transformation to fibrosarcoma was occurred in 2 patients who developed local recurrence, and 1 patient developed multiple metastases to lung, liver and lymph nodes and expired at 37 months. Three of 5 patients had tumor location abutted to or invasion to major arteries and 1 patient had tumor invading sciatic nerve. CONCLUSION: It is observed that inflammatory myofibroblastic tumor of extremities is usually located near the major neurovascular structure. Wide resection should be considered as the initial surgical treatment because this tumor showed a high local recurrence rate and possibility of malignant transformation.
Arteries ; Extremities ; Female ; Fibrosarcoma ; Follow-Up Studies ; Humans ; Liver ; Lung ; Lymph Nodes ; Myofibroblasts ; Neoplasm Metastasis ; Recurrence

BACKGROUND: There has been controversy over the prevalence of recoarctation in infants treated by subclavian flap aortoplasty (SFA) for coarctation of the aorta. To assess the rate of recurrence of coarctation after SFA, we reviewed the surgical results of SFA in infants with coarctation of the aorta. MATERIAL AND METHOD: Between 1986 and 1998, a total of 25 patients less than 1 year of age (12 neonates and 13 infants) underwent SFA for aortic coarctation. Age at operation was 3.0+/-3.0 months (mean +/- standard deviation); mean weight was 5.0+/-1.4kg. Classic SFA was performed in 20 patients, reversed SFA in 2 patients, subclavian artery reimplantation in 2 patients and the combined resection-flap aortoplasty in one. The aortic clamping time ranged from 20 to 88 minutes(mean 35.8 minutes). There were one operative death and two late deaths. There was no case of paraplegia or left arm ischemia in complications. Twenty-one (84%) of 24 hospital survivors were followed for 26.0+/-24.0 months. The risk of recoarctation in neonates (33.3%) was a little greater than infants (25.0%) without statistical significance. CONCLUSION: This study revealed that SFA resulted a relatively high incidence of recarctation in infants. It is desirable to select other methods of surgical treatment (combined resection-flap aortoplasty, extended end-to-end repair etc.) for severe isthmic coarctation or hypoplasia of the distal aortic arch in infants, instead of choosing SFA indiscriminately.
Aorta, Thoracic ; Aortic Coarctation* ; Arm ; Constriction ; Humans ; Incidence ; Infant* ; Infant, Newborn ; Ischemia ; Paraplegia ; Prevalence ; Recurrence ; Replantation ; Subclavian Artery ; Survivors

BACKGROUND: Median sternotomy remains the standard approach used by surgeons for most intracardiacscar we have tried to use alternative skin incision (bilateral subm-ammary skin incision) to median sternal skin incision, In this study we have tried to compare different postoperative results of wound between two different skin incisional methods. MATERIAL AND METHOD: Between June 1997 and June 1998, a bilateral subma-mmary skin incision combined with v operations but the residual scar is cosmetically unsatisfactory. To avoid an unsightly midline ertical sternotomy was performed in 21 pediatric female patients (submammary group)to repair acyanotic congenital heart disease. after the period we carried out a retrograde sion controls in whom there were 23 pediatric patients (control group). RESULT: Patients' age ranged from 14 to 96 months(mean 38.2 months) Mean duration of subcutaneous drains using Hemovac which was used only in the patients of submammary group was 4.2 days and total amount of the drained effusion was 51.1 ml. Postoperative wound complications included wound eruption in one patient wound disruption in one patient and skin necrosis in 3 patients in submammary group and included wound disruption in 4 patients in controls. mean duration required for wound healing was 15,5 days in submammary group versus 10.4 days in controls. The mean scar length was 12.5 cm in submammary group versus 11.3 cm in controls. The average follow-up was 8.2 months in submammary group versus 9.0 months in controls. In submammary group 3 patients parents(14.3%) were pleased with their cosmetic results of wound scar but 8(38.1%) were dissatisfied. Among the 23 patients in control group 8(34.8%) were pleased but 8(34.8%) complained ofunhappiness with the scar.
Cicatrix ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart* ; Humans ; Necrosis ; Skin* ; Sternotomy* ; Thoracic Surgery* ; Wound Healing ; Wounds and Injuries*

BACKGROUND: Because of the high complication rate of anatomical reconstruction after periacetabular resection, the strategy of resection alone has been revisited. However, in terms of complications and functional outcome, whether resection hip arthroplasty (RHA) shows a superior result to that of pelvic ring reconstruction remains controversial. METHODS: We compared 24 RHAs and 16 pasteurized autograft-prosthesis composite (PPC) reconstructions regarding the complication rates, operative time, blood loss, and functional outcome. RESULTS: Compared to 16 PPC hips, 24 RHA hips showed lower major and minor complication rates (p < 0.001), shorter surgical time (p < 0.001), and superior Musculoskeletal Tumor Society scores (p < 0.001). Of the 24 RHA hips, bony neo-acetabulum was identified in 7 on computed tomography and partial neo-acetabulum in 9; the remaining 8 had no bony acetabular structure. The average time to bony neo-acetabulum formation was 7 months (range, 4 to 13 months). CONCLUSIONS: RHA for periacetabular tumors can be an excellent alternative to anatomical reconstruction. It offers short surgical time, low complication rates, and functional results comparable to those of other reconstruction methods. However, this procedure is indicated for patients who can accept some limb shortening, and a tumor should be confined to the periacetabular area.
Acetabulum ; Arthroplasty* ; Extremities ; Hip* ; Humans ; Operative Time ; Treatment Outcome

PURPOSE: We analyzed the oncologic outcome of the malignant transformed benign giant cell tumor of bone. MATERIALS AND METHODS: Between January 2000 and February 2012, 5 cases were referred with suspicious malignant transformation of benign giant cell tumor. No patients underwent radiation therapy. RESULTS: After referral, all patients received the wide excision of the tumor and its' pathologic diagnosis were osteosarcoma. As classified by the location of tumor lesion, 3 cases were located in the distal femur, 1 case was in the distal radius and 1 case was in the proximal femur. The average latent period between diagnosis of benign giant cell tumor and diagnosis of secondary malignant giant cell tumor was 49.2 months. (range, 24-126 months) The mean follow-up period was 21.6 months. There were subsequent local recurrence in 2 cases and 3 patients developed distant metastasis. All patients with lung metastasis were dead. CONCLUSION: Malignant transformation of benign giant cell tumor of bone can be occurred within 5 years. Therefore, when benign giant cell tumor suspicious malignant transformation, it is necessary to do more aggressive treatment.
Femur ; Follow-Up Studies ; Giant Cell Tumor of Bone ; Giant Cell Tumors ; Giant Cells ; Humans ; Lung ; Neoplasm Metastasis ; Osteosarcoma ; Radius ; Recurrence ; Referral and Consultation