PURPOSE: Soft tissue or muscle adhesion to the Porous Polyethylene Sheet Implant (PPSI) can cause postoperative extraocular motility disturbance after orbital fracture repairs using PPSI. This study was designed to examine the efficacy of amniotic membrane transplantation in the suppression of fibrosis between orbital connective tissue and PPSI. METHODS: Twelve New Zealand white rabbits were grouped as A, B, and C and conventional PPSI were implanted between orbital connective tissue and orbital floor in group A; PPSI with a barrier surface (PPSI-B) in group B; PPSI with amniotic membrane transplantation in group C. The implants were harvested at 8 weeks postoperatively, and stained with Masson trichrome and hemaoxylin and eosin staining techniques. RESULTS: In group A, the PPSI demonstrated dense adhesion on both the soft tissue implant and the bone implant interfaces. A lot of fibroblasts were observed on the surface of PPSI. In group B, the PPSI-B demonstrated less fibrosis over the barrier surface, and less fibroblasts than in group A. In group C, the PPSI with amniotic membrane transplantation manifested least fibrous adhesion among three groups. CONCLUSIONS: In orbital fracture repair, amniotic membrane transplantation could reduce the fibrosis between orbital connective tissue and PPSI, and might prevent the postoperative extraocualr motility disturbance.
Amnion* ; Connective Tissue* ; Eosine Yellowish-(YS) ; Fibroblasts ; Fibrosis* ; Orbit* ; Orbital Fractures ; Polyethylene* ; Rabbits

Calcific tendinitis usually occurs in the supraspinatus tendon of the shoulder. Calcific tendinitis of the peroneus longus tendon has not been reported on the Korean journals. Differential diagnosis includes bipartitis os peroneum, os peroneum fracture and peroneal tendinitis. We report a rare case of calcific tendinitis of the peroneus longus tendon which responded well with the conservative treatment.
Diagnosis, Differential ; Shoulder ; Tendinopathy ; Tendons

PURPOSE: This study was performed to compare the anatomic differences of the fibular incisura of the tibia between ankle fractures with and without syndesmotic injuries. MATERIALS AND METHODS: 42 patients were involved in this study: Group I was composed with 14 cases of ankle fractures with syndesmotic injuries; Group II was composed with 14 cases of ankle fractures without syndesmotic injuries; Group III was composed with 14 cases of volunteers. The height averaged 170.1 cm (range, 159~181 cm) in group I, 168.9 cm (range, 156~184 cm) in group II, and 170.4 cm (range, 161~77 cm) in group III. The mean height did not show a statistically significant difference between groups (p>0.05). All patients were taken axial computed tomography. The length of anterior and posterior facets, angle between anterior and posterior facet, and depth of the fibular incisura of the tibia were measured. RESULTS: The mean length of the anterior facet was 11.5 mm (range, 9.2~15.7 mm) in group I, 12.2 mm (range, 7.3~17.0 mm) in group II, and 10.3 mm (range, 8.7~14.0 mm) in group III (p>0.05). The mean length of the posterior facet was 12.3 mm (range, 9.0~14.5 mm) in group I, 11.0 mm (range, 7.3~16.2 mm) in group II, and 13.0 mm (range, 9.2~15.9 mm) in group III (p>0.05). The mean angle between anterior and posterior facet was 139.1 degrees (range, 125.5~154.0 degrees) in group I, 144.2 degrees (range, 134.7~152.6 degrees) in group II, and 131.5 degrees (range, 117.6~144.4 degrees) in group III (p<0.05). The mean depth of the fibular incisura of the tibia was 4.1 mm (range, 3.2~5.8 mm) in group I, 4.6 mm (range, 3.1~7.1 mm) in group II, and 3.1 mm (range, 1.5~4.0 mm) in group III (p<0.05). CONCLUSION: There are some statistical differences of angle between anterior and posterior facet and depth of the fibular incisura of the tibia between ankle fractures with and without syndesmotic injuries.
Animals ; Ankle ; Humans ; Tibia

Syndesmotic injury can either be isolated or associated with bony or ligamentous ankle injury. When it is not associated with an ankle fracture, it may not be easy to diagnose, especially when there is no franck diastasis on a plain radiograph. Without proper treatment, syndesmotic injury can lead to chronic pain due to impingement of scar tissues and instability. It may further lead to ankle arthritis. Early diagnosis with appropriate management is a prerequisite to avoid these problems. Herein, we review and discuss the mechanism of injury, classification, diagnosis, and treatment of isolated syndesmotic injury.
Ankle ; Ankle Fractures ; Ankle Injuries* ; Arthritis ; Chronic Pain ; Cicatrix ; Classification ; Diagnosis ; Early Diagnosis ; Ligaments ; Sports

Synovial chondromatosis is an uncommon disorder characterized by cartilaginous proliferation in the synovium. The cartilaginous nodules occur in the synovial membrane of a joint, bursa, or tendon sheath. It frequents large joints including knee, hip, and elbow. Synovial chondromatosis originating from the first metatarsal is extremely rare. We report a case of 37-year-old man with synovial chondromatosis of the first metatarsal.
Adult ; Chondromatosis, Synovial ; Elbow ; Hip ; Humans ; Joints ; Knee ; Metatarsal Bones ; Synovial Membrane ; Tendons

Background: Infectious disease (ID) specialists are skilled facilitators of medical consultation who promote better outcomes in patient survival, antibiotic stewardship as well as healthcare safety in pandemic response. This study aimed to assess the working status of ID specialists and identify problems faced by ID professionals in Korea. Methods: This was a nationwide cross-sectional study in Korea. An online-based survey was conducted over 11 days (from December 17–27, 2020), targeting all active adult (n = 281) and pediatric (n = 71) ID specialists in Korea (N = 352). Questions regarding the practice areas of the specialists were divided into five categories: 1) clinical practices of outpatient care, inpatient care, and consultations; 2) infection control; 3) antibiotic stewardship; 4) research; and 5) education and training. We investigated the weekly time-use patterns for these areas of practice. Results: Of the 352 ID specialists, 195 (55.4%; 51.2% [144/281] adult and 71.8% [51/71] pediatric ID specialists) responded in the survey. Moreover, 144 (73.8%) of the total respondents were involved in all practice categories investigated. The most common practice area was outpatient service (93.8%), followed by consultation (91.3%) and inpatient service (87.7%). Specialists worked a median of 61 (interquartile range: 54–71) hours weekly: patient care, 29 (14–37) hours; research 11 (5–19) hours; infection control 4 (2–10) hours; antibiotic stewardship, 3 (1–5) hours; and education/training, 2 (2–6) hours. Conclusion ID specialists in Korea simultaneously undertake multiple tasks and work long hours, highlighting the need for training and employing more ID specialists.

PURPOSE: The purpose of this study was to evaluate the clinical results of the old Achilles tendon rupture treated with modified flexor hallucis longus (FHL) tendon transfer. MATERIALS AND METHODS: Seventeen patients with old Achilles tendon rupture treated with modified FHL tendon transfer between March 2004 and February 2008 were enrolled in this study. Technically FHL was pass through the distal portion of the ruptured tendon instead of the drilled hole made on the calcaneus. The mean age of the patients was 37 years (range, 22~67 years), mean follow-up period was 28 months (range, 12~30 months). Patients' subjective satisfaction, calf circumferential diameter, range of motion of ankle and AOFAS ankle-hind foot score and Arner-Lidholm score was evaluated. RESULTS: The average gap between the ruptured tendon was 52 mm (range, 47~56 mm). The AOFAS score improved from 47 pre-operatively to 91 points at the last follow-up. Sixteen patients were satisfied with the result free from discomfort, a patient had mild discomfort who had DM. fourteen patients had decreased range of motion less than 5 degrees while 2 patients had more than 7 degrees decrease compared to the intact side but had no discomfort in daily activities. Nine patients had less than 1 cm calf circumferential diameter difference and 7 patients had 1 to 3 cm diameter difference compared to the intact side. One who had more than 3 cm diameter difference had deteriorated muscle strength. CONCLUSION: Modified FHL tendon transfer can be a useful technique for the treatment of old Achilles tendon rupture when the gap is with large gap placed too proximal.
Achilles Tendon ; Animals ; Ankle ; Calcaneus ; Follow-Up Studies ; Foot ; Humans ; Mandrillus ; Muscles ; Range of Motion, Articular ; Rupture ; Tendon Transfer ; Tendons

Fracture of os peroneum can occur, but the fracture fragments are seldom displaced. Complete rupture of peroneus longus through the fracture of the os peroneum causing displacement of the fracture fragments is not well reported in the literature. Differential diagnosis with bipartite os peroneum or calcific tendinitis is important because misdiagnosis of the tendon rupture can lead to serious sequela including chronic pain, ankle instability, and peroneal compartment syndrome. We report a case of complete rupture of peroneus longus associated with fracture of the os peroneum with a review of the literature.
Ankle ; Chronic Pain ; Compartment Syndromes ; Diagnosis, Differential ; Diagnostic Errors ; Rupture* ; Tendinopathy ; Tendon Transfer* ; Tendons*

Freiberg disease is a osteochondrosis of the lesser metatarsal heads. Various surgical treatment have been recommanded including joint debridement and metatarsal head reshaping, metatarsal dorsal wedge osteotomy, metatarsal head excision and joint arthroplasty. Autogenous osteochondral graft for the treatment of Freiberg disease is an effective restorative procedure that provides early range of motion exercise, weight bearing, and reduces other morbidity. We report a case of late stage Freiberg disease treated with arthrotomy, removal of loose body and autogenous osteochondral graft.
Debridement ; Head ; Metatarsal Bones ; Osteochondrosis ; Osteotomy ; Range of Motion, Articular ; Transplants ; Weight-Bearing

Metatarsal head and neck fractures are injuries that often result from a direct blow of a heavy objects to the metatarsal head. The head is often impacted or displaced to the plantar aspect that if not treated may cause malunion which later induces painful plantar calluses. If the fracture fragment is large enough, closed reduction may be successfully performed, but when the fragment is small or closed reduction is unsuccessful, open reduction is needed. We present our reduction and fixation technique for the metatarsal head and neck fractures using antegrade intramedullary Kirschner wire (K-wire) without opening the fracture site or infringing the metatarsophalangeal (MTP) joint which allows immediate motion of the joint and partial weight bearing in a stiff soled shoe.
Bony Callus ; Head ; Joints ; Metatarsal Bones ; Neck ; Shoes ; Weight-Bearing