PURPOSE: The purpose of this study is to evaluate the effectiveness of low-dose gabapentin for interdigital neuroma. MATERIALS AND METHODS: Between April 2000 and June 2003, 32 patients (39 feet) with interdigital neuroma were treated with using low-dose gabapentin. Two of the 32 patients were male, and thirty were female, and the average age was 47.4 years. The follow-up was 6 to 44months (mean 15.1 months). All cases were diagnosed by physical examination and ultrasonography or MRI. Low-dose gabapentin (300-600 mg) was prescribed and shoe modification was recommended. The patients were evaluated through questionnaire. RESULTS: Neuroma was found in twenty one cases at the third intermetatarsal space, and thirteen at the second intermetatarsal space. The sensitivity of ultrasonography was 96% and that of MRI was 79%. Overall satisfaction was rated as excellent or good by 18 cases (57%). Average pain relief ratio was 50.3%, and in 14 cases, more than 80% of pain relief was noted. Nine (28%) of 32 patients showed they had no activity restrictions, such as daily activities or work, whereas 8 (25%) had mild restrictions and 15 (47%) had major restrictions. Twelve of 15 patient with major restrictions had been treated operatively (neurectomy; 10 cases, decompression; 2 cases). One case had gastrointestinal problem. CONCLUSION: Low-dose gabapentin for interdigital neuroma was one of the effective conservative treatments. The operation may be preserved for patient with the persist symptoms, nevertheless the conservative treatments and use of low-dose gabapentin.
Decompression ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroma* ; Physical Examination ; Shoes ; Ultrasonography

PURPOSE: The result of cementless total knee arthroplasty with posterior cruciate ligament retention in rheumatoid arthritis patients was evaluated. MATERIALS AND METHODS: Thirty patients (fifty knees) followed up after cementless total knee arthroplasty with posterior cruciate ligament retention was evaluated clinically and radiologically. Average follow up was 9.2 years(5.1~14.3). RESULTS: The mean HSS knee score improved from 47.4 preoperatively to 81.8 postoperatively, and the mean range of motion of 89.7 degrees preoperatively to 101.2 degrees postoperatively. The mean tibiofemoral angle was 4.9 degrees valgus. Posterior instability was observed in 1 case(2%) at the most recent follow up. Radiolucent line was observed in 41 cases(82%), and osteolysis was observed around tibial component in 13 cases(26%), and around femoral component in 4 cases(8%). Eight cases(16%) of revision was due to 1 case of aseptic loosening and osteolysis each, and the other due to polyethylene wear of patellar or tibial component. CONCLUSION: Although there are osteopenia in rheumatoid arthritis compared to osteoarthritis, cementless total knee replacement with posterior cruciate retention showed stable fixation. However, the new method for initial fixation of tibial component is needed because osteolysis around tibial component tended to start around cancellous screws.
Arthritis, Rheumatoid* ; Arthroplasty* ; Arthroplasty, Replacement, Knee ; Bone Diseases, Metabolic ; Follow-Up Studies ; Humans ; Knee* ; Osteoarthritis ; Osteolysis ; Polyethylene ; Posterior Cruciate Ligament ; Range of Motion, Articular

Kienböck’s disease is an avascular necrosis of the lunate that can be accompanied by a lunate fracture. Although numerous studies on Kienböck’s disease have been conducted, its natural history is incompletely understood and there is no consensus for treatment. Various wrist arthroscopic surgeries have been attempted owing to the increasing interest in wrist minimal-invasive surgery. Traditionally, the Lichtman classification, based on the osseous status, is used widely to assess Kienböck’s disease. On the other hand, age, vascular condition, and cartilage status are also important when making a treatment plan for Kienböck’s disease. This article introduces a new classification and treatment algorithm combining osseous, vascular and cartilage classifications. Moreover, the roles and limitations of arthroscopy in this new algorithm are reviewed, and the author’s preferred treatment protocol based on staging is introduced.

Malignant laryngeal tumors include a variety of histologic types with different biologic features, each calling for a different therapeutic approach and giving rise to a different prognosis. We experienced a case of laryngeal adenosquamous carcinoma which is an extremely rare neoplasm in larynx. The lesion is histologically distinctive because of the presence of mixed areas of unequivocal adenocarcinoma and squamous cell carcinoma. Differential diagnosis include adenoid squamous cell carcinoma and mucoepidermoid carcinoma. It is found that combined surgery and additional radiation therapy is necessary because the biologic behavior and prognosis of this neoplasm are considered as more aggressive and worse than that of conventional squameus cell carcinoma.
Adenocarcinoma ; Adenoids ; Carcinoma, Adenosquamous* ; Carcinoma, Mucoepidermoid ; Carcinoma, Squamous Cell ; Diagnosis, Differential ; Larynx* ; Prognosis

PURPOSE: This study is a retrospective analysis of patients who had undergone surgical treatment for non-union of distal humerus fracture. We evaluated them in terms of causes of injury, radiologic findings, and clinical outcomes such as prognosis. MATERIALS AND METHODS: Seven consecutive radiologic patients who were confirmed to have nonunion of a distal humerus fracture underwent reoperations. These patients had already undergone operations for distal humerus fractures. This survey was held from 2005 to 2010. The average period up to diagnosis of non-union after the first operation was 7.4 months (4 to 16 months). The mean follow-up period was 24.6 months (12 to 65 months). Each patient was graded functionally according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand Score. RESULTS: Osteosynthesis was performed by internal fixation with plates and screws and then a bone graft for non-union of the distal humerus fracture. The average range of motion within the elbow joints was found to be a flexion contracture of 18.8 degrees (0~30 degrees) and further flexion of 120.2 degrees (102~140 degrees). Among postoperative complications, three cases of medium-degree stiffness, two cases of medial column nonunion, and one case of dissociation of the internal fixator were reported. CONCLUSION: Stable internal fixation for maintenance reduction status is essential after accurate initial anatomical reduction. We concluded that nonunion could be prevented by additional surgical treatment such as autogenous bone graft, if it is necessary.
Arm ; Contracture ; Dissociative Disorders ; Elbow ; Elbow Joint ; Follow-Up Studies ; Hand ; Humans ; Humerus ; Internal Fixators ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Transplants

PURPOSE: We present the clinical and radiological results of open reduction and internal fixation for scaphoid fracture with retrograde headless screw fixation via dorsal approach. METHODS: This study carried out a survey targeting 15 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture without previous operation, 2 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture with previous operation and 8 patients who have a trans-scaphoid perilunate dislocation. We figured out a mechanism of injury, and clinical symptom, radiologic findings. The surgery was done with open dorsal approach which is retrograde headless screw fixation internally, with or without bone graft. We analyzed the result by Maudsley method, in terms of bone union, duration for union, radiologic finding, clinical outcomes. RESULTS: After surgery, 22 of 25 patients had union result on fracture and other 3 patients had nonunion result. It took 12 weeks to achieve bone union on average. Based on radiograhs, we had one case of partial avascular necrosis of proximal fragment without clinical symptoms. We had one case of each scaphoid nonunion without previous operation, with operation and trans-scaphoid perilunate dislocation had arthritic change and non-symptomatic nonunion result. In terms of clinical outcome, 22 patients showed satisfactory results and 3 patients had slight limitation of range of motion. CONCLUSION: Retrograde headless screw fixation with or without bone graft for the treatment of scaphoid fracture is recommendable.
Dislocations ; Humans ; Necrosis ; Transplants

PURPOSE: This study was designed to measure time-dependent changes in muscle excursion and collagen content after tenotomy, and to analyze the correlation between muscle excursion and collagen content in a rabbit model. MATERIALS AND METHODS: Twenty-four rabbits underwent tenotomy of the second extensor digitorum longus (EDL) muscles on the right legs and were randomly assigned to three groups based on the period of time after tenotomy (2, 4, and 6 weeks). The second EDL muscles on left legs were used as controls. At each time after tenotomy, passive muscle excursion and collagen content, determined by hydroxyproline content, were measured bilaterally, and the ratio of each value to the normal one was used. RESULTS: The mean ratio of muscle excursion after tenotomy to the value of the control decreased in a time-dependent fashion: 92.5% at 2 weeks, 78.6% at 4 weeks, and 55.1% at 6 weeks. The mean ratio of hydroxyproline content in muscle to the value of the control increased in a time-dependent fashion: 119.5% at 2 weeks, 157.3% at 4 weeks, and 166.6% at 6 weeks. There was a significant negative correlation between the ratio of hydroxyproline content in muscle after tenotomy to the control values and the ratio of muscle excursion after tenotomy to the control values (r=-0.602, p=0.002). CONCLUSION: The decrease in muscle excursion seems to correlate with the increase in collagen content in the muscle in a time-dependent fashion following tenotomy.
Animals ; Collagen/*metabolism ; Hydroxyproline/metabolism ; Muscle, Skeletal/*metabolism ; Rabbits ; Tendon Injuries/*metabolism ; Tendons ; Tenotomy ; Time Factors

PURPOSE: There have been few reports about the endoscopic carpal tunnel release (ECTR) in elderly patients and its efficacy and safety are not well-known. We evaluated the clinical outcomes of ECTR using Agee technique in patients older than 65 years. MATERIALS AND METHODS: From October 2000 to January 2007, thirty-five patients (42 hands) who underwent ECTR using Agee technique were enrolled. The average age of the patients was 67.2 years (range, 65-71 years). The duration of symptoms averaged 10 months (range, 6-33 months). For evaluation of the clinical outcomes, physical examination and subjective assessment of the hand function using the Boston carpal tunnel questionnaire were performed at postoperative 1-year follow-up and compared with those obtained at preoperative evaluation. The mean follow-up period was 18 months (range, 12-24 months). RESULTS: There were no neurovascular injury and scar tenderness. At postoperative 1-year follow-up, paresthesia, numbness, Phalen's sign, tinel sign, two point discrimation, and grip power were significantly improved compared with those obtained at preoperation. According to the Boston questionnaire, symptom severity score improved from 3.43 preoperatively to 1.89 postoperatively, and functional status score improved from 3.18 preoperatively to 2.21 postoperatively (p<0.05). Thenar atrophy still remained in 32 hands (76.2%). CONCLUSION: Although thenar atrophy did not improve in many cases, symptom severity and functional status scores improved in most patients treated with ECTR. The single portal ECTR is a safe and efficacious treatment option in elderly patients with carpal tunnel syndrome.
Aged ; Atrophy ; Boston ; Carpal Tunnel Syndrome ; Cicatrix ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Hypesthesia ; Paresthesia ; Physical Examination ; Surveys and Questionnaires

PURPOSE: Olecranon nonunion after surgical management is relatively rare, but it leads to limitation of motion of joint or instability. This retrospective study was conducted in order to analyze the cause and result of treatment. MATERIALS AND METHODS: We analyzed 11 cases treated for nonunion of olecranon fractures. Nonunion was classified according to the spot of the lesion and the extent of articular surface damage. Evaluation was performed using Mayo elbow performance score (MEPS), Oxford elbow score (OES), Disabilities of the Arm, Shoulder and Hand (DASH) scores, and the range of motion. RESULTS: According to the spot of the lesion and the extent of articular surface damage, nonunion was categorized as IA (2 cases), IIA (5 cases), and IIIA (4 cases). One case of IA underwent nonunion fragment excision and the remaining cases were treated by bone grafting. A plate was used in seven cases and the other three cases had both plate and tension band wiring fixation. All nonunions finally became union. The 11 patients with one year follow-up had average MEPS of 87.7 points (range: 60-100 points), average OES of 43.2, and average DASH score of 18.8 points. Complications included limitation of motion (2 cases) and ulnar nerve symptoms (3 cases). CONCLUSION: Bone grafting and fixation by plate may be beneficial. In addition, excision can be useful in type I.
Arm ; Bone Transplantation ; Elbow ; Follow-Up Studies ; Hand ; Humans ; Joints ; Olecranon Process* ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Ulnar Nerve

PURPOSE: Calcific lesion of the hand is infrequently recognized, presenting with severe pain and swelling of the affected joint. The purpose of this study is to describe clinical features associated with this condition by reviewing surgically treated patients. MATERIALS AND METHODS: A retrospective study was carried out in 11 patients who had operation clinical and radiographic data were collected by medical records. RESULTS: Eight patients were females and three were males with age ranging between 27-75 years (mean: 48 years). By location, five cases of interphalangeal joint, three cases of metacarpophalangeal joint of thumb, two cases of carpal tunnel and one case of distal ulna area were noted. Interval between symptom presentation and operation was 9.4 month (range: 6-18 month). During 10 month follow-up (range: 6-12 month), recurrence had not occurred. CONCLUSION: Although the prevalence of calcific lesion of hand and wrist is low, it may cause severe pain and swelling. If conservative treatment fails or any nerve compression symptom develops, surgical removal of the calcific lesion is recommended.
Female ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Metacarpophalangeal Joint ; Prevalence ; Recurrence ; Retrospective Studies ; Thumb ; Ulna ; Wrist