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

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

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*

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

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

PURPOSE: Using proteomic analysis, this study was performed to see the characteristics of proteins expression in the muscles of spastic cerebral palsy patients. MATERIALS AND METHODS: We studied twelve specimens from six patients with spastic cerebral palsy, three patients with myelomeningocele, and three normal people who underwent orthopaedic surgeries due to trauma. We studied the extracted proteins showing differences in the two-dimensional electrophoresis, and the prominent thirteen proteins were re-evaluated by proteomics and the reverse transcriptional polymerase chain reaction, which was to clarify the relationship between gene and protein expression. RESULTS: Among fifteen proteins, six proteins were found to be higher in normal people, and nine were found to be higher in the groups of patients by spot histogram. The results of proteomic analysis with MALDI-TOF for fifteen proteins showed that the expression of DJ-1 was related to cerebral palsy. CONCLUSION: This study shows that strong expression of DJ-1 is related to spasticity and cerebral palsy. We showed for the first time the possibility of any relationship between spastic condition and DJ-1 expression.
Cerebral Palsy ; Electrophoresis ; Humans ; Meningomyelocele ; Muscle Spasticity ; Muscles ; Polymerase Chain Reaction ; Proteins ; Proteomics

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

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

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

PURPOSE: Patients with planovalgus show various abnormal gaits and these are affected by the different length and velocity of the muscles around knee and ankle. The purpose of study is to compare the length and velocity of gastrocnemius in cerebral palsy with planovalgus by ankle plantarflexion-knee extension couple. MATERIALS AND METHODS: 22 patients with spastic diplegia who have planovalgus were included. The mean age was 12 years (5 years~18 years). Group I consisted of 7 patients with knee flexion more than 30 degrees and Group II consisted of 15 patients with knee flexion less than 15 degrees during mid-stance phase. Normal groups were consisted of 15 normal children. RESULTS: In patients with planovalgus, ankle dorsiflexion during stance was decreased but ankle plantarflexion was not different compared to normal. There is no difference in the percent length of gastrocnemius compared to normal, but the velocity was decreased. The percent length of gastrocnemius was decreased in group I, but there were no difference in the velocity. CONCLUSION: The decreased velocity of gastrocnemius is the cause of disability of ankle plantarflexion-knee extension couple and the variable length of gastrocnemius is the cause of variability of abnormal gait.
Animals ; Ankle ; Cerebral Palsy ; Child ; Foot ; Foot Deformities ; Gait ; Humans ; Knee ; Muscle, Skeletal ; Muscles