1.Musculoskeletal Surgeries for Optimization of Ambulation Ability in Patients with Spastic Cerebral Palsy.
Journal of the Korean Medical Association 2008;51(5):475-482
Cerebral palsy is a disorder of movement and posture that arises from a congenital or acquired lesion of the immature brain. While the underlying cause is static, the musculoskeletal manifestations are progressive overtime. A variety of gait abnormalities are common, and orthopedic surgery typically is indicated when contractures or deformities decrease functions, cause pain, or interfere with activities of daily life. Surgical procedures should be scheduled to minimize the number of hospitalizations and interference with school and social activities. They can be divided into several groups of procedures; (1) to correct static or dynamic deformity, (2) balance muscle power across a joint, (3) reduce spasticity, and (4) stabilize uncontrollable joints. The clinical decision-making paradigm, consisting of clinical history, physical examination, diagnostic imaging, quantitative gait analysis, and examination under anesthesia makes it possible for single stage multi-level surgeries to reduce the long-term morbidity.
Anesthesia
;
Brain
;
Cerebral Palsy
;
Congenital Abnormalities
;
Contracture
;
Diagnostic Imaging
;
Gait
;
Hospitalization
;
Humans
;
Joints
;
Muscle Spasticity
;
Muscles
;
Orthopedics
;
Paralysis
;
Physical Examination
;
Posture
;
Walking
2.Treatment of Medial Epicondyle Fracture without Associated Elbow Dislocation in Older Children and Adolescents.
Yonsei Medical Journal 2012;53(6):1190-1196
PURPOSE: Displaced medial humeral epicondyle fractures with or without elbow dislocation have been treated with open reduction and fixation using K-wires or screws. The purpose of this study is to evaluate the clinical and radiological outcomes of surgical treatments of medial humeral epicondyle fracture without elbow dislocation according to the fixation methods. MATERIALS AND METHODS: Thirty-one patients who had undergone open reduction and fixation of the displaced medial humeral epicondyle fracture without elbow dislocation were included. Group I consisted of 21 patients who underwent fixation with K-wires, and Group II comprised 10 patients who underwent fixation with cannulated screws. Immediate postoperative, final follow-up and normal anteroposterior radiographs were compared and the clinical outcome was assessed using the final Japanese Orthopaedic Association (JOA) elbow assessment score. RESULTS: On the immediate postoperative radiographs, the distal humeral width in Group II was larger than that in Group I. On the final follow-up radiographs, the epicondylar position in Group I was lower than that in Group II. There was no significant difference in the distal humeral width, epicondylar position and joint space tilt between the immediate postoperative, final follow-up radiographs and the normal side within each group. There was no significant difference in the final JOA score between groups. CONCLUSION: Open reduction followed by K-wire fixation or screw fixation of the displaced medial humeral epicondyle fracture without elbow dislocation in older children and adolescents resulted in improved radiologic outcome and good elbow function in spite of diverse radiologic deformities.
Adolescent
;
Bone Screws
;
Bone Wires
;
Child
;
Dislocations/*prevention & control
;
Elbow Joint/*pathology
;
Female
;
Humans
;
Humeral Fractures/*surgery
;
Male
3.Extracorporeal Shock Wave Therapy for the Treatment of Refractory Plantar Fasciitis.
Woo Jin CHOI ; Jin Woo LEE ; Yoon Hae KWAK
Journal of Korean Foot and Ankle Society 2007;11(1):51-56
PURPOSE: The objective of this study was to report the outcomes of patients treated with extracorporeal shock wave therapy (ESWT) for refractory plantar fasciitis of the foot. MATERIALS AND METHODS: From November 2005 to October 2006, a total of sixty-two patients with refractory plantar fasciitis were treated with extracorporeal shock wave therapy. The main outcome measurements were visual analogue scale (VAS) and Roles and Maudsley score evaluated before treatment and at one and six months after treatment. RESULTS: Roles and Maudsley score was excellent (0%), good (6.4%), fair (35.4%) and poor (58.2%) before treatment which improved to excellent (56.5%), good (38.7%), fair (4.8%) and poor (0%) at final follow-up. VAS scores also significantly improved after ESWT (p<0.05). There was no statistically significant correlation between clinical results and body mass index (BMI) (p=0.102). CONCLUSION: Extracorporeal shock wave therapy appears to be an effective and safe treatment modality for refractory plantar fasciitis and may help the patient to avoid surgery for refractory heel pain.
Body Mass Index
;
Fasciitis, Plantar*
;
Follow-Up Studies
;
Foot
;
Heel
;
Humans
;
Shock*
4.Acellular Dermal Allograft Transplantation in Patients with Scleromalacia After Pterygium Excision.
Hae Yoon SONG ; Jae Seok IM ; Ju Young KWAK
Journal of the Korean Ophthalmological Society 2008;49(10):1685-1689
PURPOSE: To report two cases of successful acellular dermal allograft transplantation for scleromalacia following pterygium excision. CASE SUMMARY: A 72-year-old female patient developed scleromalacia on the nasal side of the right eye, and a 79-year-old female patient developed scleromalacia with inflammation on the nasal side of the left eye. They had previous histories of pterigia removal on the sites of scleromalacia. Acellular dermal allograft (AlloDerm(R), Lifecell, NJ, USA) transplantations were done. After the operations, inflammation and pain ameliorated and the grafts survived without any particular complications. CONCLUSIONS: In treating scleromalacia, the transplantation of acellular dermal allografts produced relatively satisfactory results without undesirable problems commonly encountered when using conventional materials.
Aged
;
Eye
;
Female
;
Humans
;
Inflammation
;
Pterygium
;
Transplantation, Homologous
;
Transplants
5.Correction of Congenital Metacarpal Synostosis with Polypropylene Mesh as an Interpositional Material.
The Journal of the Korean Orthopaedic Association 2013;48(4):314-318
Metacarpal synostosis is an uncommon congenital hand malformation characterized by the coalescence of two or more adjacent metacarpals. Patients visit the hospital due to abduction deformity, which is usually a mild deformity or a minor functional deficit. This is one of the reasons why the patient goes to the hospital late and foregoes proper management with early detection and treatment. A number of surgical procedures ranging from simple to complex have been employed for treatment of this deformity. We describe our experience with a longitudinal osteotomy, realignment of component metacarpals with the metacarpophalangeal joint, and interposition of a non-absorbable polypropylene mesh used for inguinal hernia for correction of the abducted deformity and prevention of recurrence of synostosis while minimizing morbidity.
Congenital Abnormalities
;
Hand
;
Hernia, Inguinal
;
Humans
;
Metacarpal Bones
;
Metacarpophalangeal Joint
;
Osteotomy
;
Polypropylenes
;
Recurrence
;
Surgical Mesh
;
Synostosis
6.Altered Synthesis of Cartilage-Specific Proteoglycans by Mutant Human Cartilage Oligomeric Matrix Protein.
Yoon Hae KWAK ; Jae Young ROH ; Ki Seok LEE ; Hui Wan PARK ; Hyun Woo KIM
Clinics in Orthopedic Surgery 2009;1(4):181-187
BACKGROUND: The mechanism by which mutant cartilage oligomeric matrix protein (COMP) induces a pseudoachondroplasia phenotype remains unknown, and the reason why a mutation of a minor protein of the growth plate cartilage causes total disruption of endochondral bone formation has not yet been determined. The current study was performed to investigate the effects of mutated COMP on the synthesis of the cartilage-specific major matrix proteins of Swarm rat chondrosarcoma chondrocytes. METHODS: The Swarm rat chondrosarcoma chondrocytes transfected with a chimeric construct, which consisted of a mutant gene of human COMP and an amino acid FLAG tag sequence, were cultured in agarose gel. Formation of extracellular proteoglycan and type-II collagen by the cells was evaluated by immunohistochemical staining and measuring the (35)S-sulfate incorporation. RESULTS: No difference was observed for the detection of type-II collagen among the cell lines expressing mutant COMP and the control cell lines. Histochemical staining of sulfated proteoglycans with safranin-O showed that lesser amounts of proteoglycans were incorporated into the extracellular matrix of the chondrocytes transfected with the mutant gene. (35)S-sulfate incorporation into the cell/matrix fractions demonstrated markedly lower radiolabel incorporation, as compared to that of the control cells. CONCLUSIONS: Mutation of COMP has an important impact on the processing of proteoglycans, rather than type-II collagen, in the three-dimensional culture of Swarm rat chondrosarcoma chondrocytes.
Aggrecans/analysis/*biosynthesis
;
Animals
;
Cells, Cultured
;
Chondrocytes/*metabolism
;
Chondrosarcoma/metabolism
;
Collagen Type II/*biosynthesis
;
Extracellular Matrix/*metabolism
;
Extracellular Matrix Proteins/*genetics
;
Glycoproteins/*genetics
;
Humans
;
Mutation
;
Rats
;
Transfection
7.Use of Allograft in Skeletally Immature Patients for Calcaneal Neck Lengthening Osteotomy.
Yoon Hae KWAK ; Kun Bo PARK ; Hui Wan PARK ; Hyun Woo KIM
Yonsei Medical Journal 2008;49(1):79-83
PURPOSE: To date, there have been no studies evaluating the usefulness of allograft as a substitute for autograft in calcaneal neck lengthening osteotomy. This retrospective study examined the results of calcaneal neck lengthening osteotomy using allograft for pathologic flatfoot deformity in children and adolescents with various neuromuscular diseases. MATERIALS AND METHODS: 118 feet in 79 children treated surgically between Mar 2000 and July 2005 were reviewed. The mean age at the time of the operation was 9+3 years (range, 3-17 years) and follow-up averaged 15.4 months (range, 13-21 months) postoperatively. Talo-1st metatarsal angle, talo-calcaneal angle, calcaneal pitch were measured before and after operation and bony union was estimated. RESULTS: Bony union was noted at the latest follow-up and there were no postoperative complications such as reduction loss, infection, nonunion, delayed union or graft loss during the follow-up period in all but one foot. All radiographic indices were improved postoperatively in all cases. CONCLUSION: Our results indicate that use of allograft in calcaneal neck lengthening osteotomy is a useful option for correction of the planovalgus deformity in skeletally immature patients whose enough autobone can not be obtained.
Adolescent
;
Bone Diseases/*congenital/radiography/*surgery
;
*Bone Lengthening
;
*Bone Transplantation
;
Calcaneus/*surgery
;
Child
;
Child, Preschool
;
Female
;
Humans
;
Male
;
*Osteotomy
;
Transplantation, Homologous
8.Operative Treatment of Symptomatic Naviculocuneiform Coalition in Children: 2 Cases Report.
Yoon Hae KWAK ; Won Hyoung SHIN ; Jae Yong PARK
Journal of Korean Foot and Ankle Society 2011;15(3):179-182
Naviculocuneiform coalition is one of uncommon tarsal coalitions and especially symptomatic cases which need operative treatment are rare. Authors report 2 cases of pediatric naviculocuneiform patients who showed symptomatic condition as mainly pain. Plain radiographs, computed tomography or magnetic resolution imaging study showed bony bridge in naviculo-medial cuneiform joint. After over six months conservative treatment, excision of coalition and interposition Tisseel(R) was performed for motion preservation and relief of pain.
Child
;
Humans
;
Joints
;
Magnetics
;
Magnets
9.Subungual Squamous Cell Carcinoma of the Toe: A Case Report.
Ho Jung KANG ; Sung Hoon JUNG ; Yoon Hae KWAK ; Soo Bong HAHN ; Kyoo Ho SHIN
Journal of Korean Foot and Ankle Society 2007;11(1):97-99
Nail bed malignancies are rare entities. Most nail bed malignancies are squamous cell carcinoma (SCC)s. Less than 10% of subungual SCCs occur in the foot. Fifty percent occurred on the hallux and approximately 25% on both the fourth and fifth digits. The correct diagnosis is often delayed because nail bed malignancies are frequently mistaken for benign or infectious processes. SCC on extremities is hard to distinguish from the benign lesion like chronic ulcer, fistula caused by chronic osteomyelitis, and abscess fistula. Attention should especially be paid in diagnosing the subungual lesion because paronychia is a common disease. SCC is the most common carcinoma second to malignant melanoma as a soft tissue malignant tumor in the West, and it involves mainly the head, neck and upper extremities but rarely involves lower extremities, particularly the toes. The authors emphasize the importance of a biopsy for chronic nonhealing lesions by presenting this case.
Abscess
;
Biopsy
;
Carcinoma, Squamous Cell*
;
Diagnosis
;
Extremities
;
Fistula
;
Foot
;
Hallux
;
Head
;
Lower Extremity
;
Melanoma
;
Neck
;
Osteomyelitis
;
Paronychia
;
Toes*
;
Ulcer
;
Upper Extremity
10.Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture.
Yoon Hae KWAK ; Dong Jou SHIN ; Kun Bo PARK
Journal of the Korean Fracture Society 2010;23(1):90-96
PURPOSE: To suggest the most reliable guideline of the treatement for the supracondylar fracture in children by the comparison of the radiographic parameters between forearm supination-elbow extension and forearm pronation-elbow flexion view. MATERIALS AND METHODS: A total of seventy-one patients were included in the study. Baumann, metaphyseal diaphyseal and medial epicondylar epiphyseal angle of normal elbow in extension and flexion view were compared. Finally, the results of Group I (operation with elbow extension view) and Group II (operation with elbow flexion view) were compared. RESULTS: Intraobserver reproducibility and interobserver reliability were better in the Baumann angle with extension view and metaphyseal diaphyseal angle with flexion view. In extension view, Baumann and metaphyseal diaphyseal angle show negative correlation with carrying angle but in flexion view, only metaphyseal diaphyseal angle shows negative correlation. Baumann angle were greater in flexion view and medial epicondylar epiphyseal angle were greater in extension view. There was no statistical difference in the final results of Group I and II. CONCLUSION: Baumann angle was more effective in forearm supination-elbow extension view and metaphyseal diaphyseal angle was more effective in forearm pronation-elbow flexion view. The difference between elbow extension and flexion view should be considered during operation.
Child
;
Elbow
;
Forearm
;
Humans
;
Humerus
;
Lifting