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Postaxial polydactyly of the foot is one of the most common congenital malformations. Only a few cases of postaxial polydactyly with a partial duplication of the fifth metatarsal without a supernumerary digit have been reported, and both metatarsal heads were united to form a common joint with the proximal phalanx in all of those cases. We present a rare case of postaxial polydactyly with a partial duplication of the fifth metatarsal characterized by dual metatarsal heads and an extra proximal phalanx bud, without a supernumerary digit.

Background: The accuracy of meniscal measurement methods is still in debate. Hypothesis: The authors’ protocol for radiologic measurements will provide reproducible bony landmarks, and this measurement method of the lateral tibial plateau will correlate with the actual anatomic value. Study Design: Controlled laboratory study. Methods: Twenty-five samples of fresh lateral meniscus with attached proximal tibia were obtained during total knee arthroplasty. Each sample was obtained without damage to the meniscus and bony attachment sites. The inclusion criterion was mild to moderate osteoarthritis in patients with mechanical axis deviation of less than 15°. Knees with lateral compartment osteoarthritic change or injured or degenerated menisci were excluded. For the lateral tibial plateau length measurements, the radiographic beam was angled 10° caudally at neutral rotation, which allowed differentiation of the lateral plateau cortical margins from the medial plateau. The transition points were identified and used for length measurement. The values of length were then compared with the conventional Pollard method and the anatomic values. The width measurement was done according to Pollard’s protocol. For each knee, the percentage deviation from the anatomic dimension was recorded. Intraobserver error and interobserver error were calculated. Results: The deviation of the authors’ radiographic length measurements from anatomic dimensions was 1.4 ± 1.1 mm. The deviation of Pollard’s radiographic length measurements was 4.1 ± 2.0 mm. With respect to accuracy—which represents the frequency of measurements that fall within 10% of measurements—the accuracy of authors’ length was 98%, whereas for Pollard’s method it was 40%. There was a good correlation between anatomic meniscal dimensions and each radiologic plateau dimensions for lateral meniscal width ( R2 = .790) and the authors’ lateral meniscal length ( R2 = .823) and fair correlation for Pollard’s lateral meniscal length ( R2 = .660). The reliability of each radiologic measurement showed good reliability (intraclass correlation coefficients, .823 to .973). The authors tried to determine the best-fit equation for predicting meniscal size from Pollard’s method of bone size, as follows: anatomic length = 0.52 × plateau length (according to Pollard’s method) + 5.2, not as Pollard suggested (0.7 × Pollard’s plateau length). Based on this equation—namely, the modified Pollard method—the percentage difference decreased, and the accuracy increased to 92%. Conclusion: Lateral meniscal length dimension can be accurately predicted from the authors’ radiographic tibial plateau measurements. Clinical Relevance: This study may provide valuable information in preoperative sizing of lateral meniscus in meniscal allograft transplantation.

technique for guide wire placement during meniscal allograft transplantation (MAT) is usually based on the parapatellar approach that is not in the anatomical direction of meniscal horn bony insertions. Here, we present a surgical technique to achieve the correct anatomical position of the meniscal graft using the transpatellar approach.a guide wire was introduced through the patellar tendon in the direction of the meniscal insertion sites passing the lateral tibial spine. The insertion plane of the guide wire was approximately at the medial aspect of the tibial tuberosity and slightly medial to the midplane of the patellar tendon. After confirmation with C-arm, the guide wire was cut at the level just beneath the patellar tendon. The knee was then brought to the extension position which lessened the tension of the patellar tendon and retracted it to the medial aspect to expose the end of the guide wire. Drilling and insertion of bone block was performed accordingly.eleven consecutive patients with total or near-total meniscectomy of the knee underwent MAT with the described technique. The mean extrusion taken on 1-year postoperative non-weight-bearing MRI was 1.6 mm (range 0.5-2.9 mm). None of the patients presented with symptoms requiring a secondary surgery at the time of review.the described technique focuses on achieving correct positioning of the tibia tunnel through the patellar tendon and tunnel reaming in the extended knee position via the mini-open parapatellar approach during lateral MAT. This "transpatellar approach" could be an effective method for anatomical placement of meniscal graft.

We report a case of an 86-year-old man diagnosed with bilateral elastofibroma dorsi who was managed conservatively after a two year follow-up. An elastofibroma dorsi is a benign, slow-growing tumor that is most often located in the inferior periscapular area in elderly patients. It should be considered to differentiate them from other soft tissue tumors located at the inferior periscapular region. Increased awareness of these characteristics will decrease the incidence of a misdiagnosis of elastofibroma dorsi as a malignancy and avoid unnecessary surgery.

Postaxial polydactyly of the foot is one of the most common congenital malformations. Only a few cases of postaxial polydactyly with a partial duplication of the fifth metatarsal without a supernumerary digit have been reported, and both metatarsal heads were united to form a common joint with the proximal phalanx in all of those cases. We present a rare case of postaxial polydactyly with a partial duplication of the fifth metatarsal characterized by dual metatarsal heads and an extra proximal phalanx bud, without a supernumerary digit.

We report two cases of migration of K-wires from the acromioclavicular joint to the neck. A 73-year-old man complained of right shoulder pain for one month and had undergone orthopedic surgery because of acromioclavicular joint dislocation about 27 years earlier. Another 56-year-old man complained of left shoulder pain and neck pain for 5 years and had undergone orthopedic surgery because of acromioclavicular joint dislocation about 25 years earlier. In both cases, we took X-rays to look for the cause of shoulder pain and discovered broken and migrated K-wires in the neck. We removed the K-wires from the trapezius muscle and the paraspinal muscle respectively. K-wire fixation technique is simple and effective but should be followed up with X-rays periodically. In addition, we should warn patients of the possibility of migration of K-wire. And it is desirable for us to avoid using K-wire near major neurovascular structures like the sternoclavicular joint and the clavicle.

We report the case of a heterotopic ossification in the subscapularis muscle. A 30-year-old woman was diagnosed as a heterotopic ossification in the right subscapularis muscle. X-rays, a CT scan and a MRI showed bone-like lesions in the muscle. The location of the ossification was both inferior and anterior to the joint. The mass nearly bridged between the proximal humerus and the inferior portion of the coracoid process. Symptoms did not respond to rest, NSAIDs for 3 months and to stretching exercises treatment for 6 months. Excision and biopsy was performed through deltopectoral approach. Disodium Etidronate was administered during the postoperative period. She regained normal range of motion postoperatively and improved in the shoulder pain after performing strengthening exercises with Therabands. We think that a cause of limitation of the shoulder was impingement between the mass and the coracoid process, and that another cause was adhesion between the mass and the joint capsule. We conclude that excision and postoperative rehabilitation exercises are good methods for a heterotopic ossification in the subscapularis muscle for those that are nonresponsive to nonoperative treatments.

Distal metatarsal osteotomy and the modified McBride procedure have each been used for the treatment of mild to moderate hallux valgus. However, few studies have compared the results of these 2 procedures for mild to moderate hallux valgus. The purpose of the present study was to compare the results of distal chevron osteotomy and the modified McBride procedure for treatment of mild to moderate hallux valgus according to the severity of the deformity. We analyzed the data from 45 patients (49.5%; 48 feet [49.0%]), who had undergone an isolated modified McBride procedure (McBride group), and 46 patients (50.5%; 50 feet [51.0%]), who had a distal chevron osteotomy (chevron group). We subdivided each group into those with mild and moderate deformity and compared the clinical and radiologic outcomes between the groups in relation to the severity of the deformity. The improvements in the American Orthopaedic Foot and Ankle Society scale score and the visual analog scale for pain were significantly better for the chevron group for both mild and moderate deformity. The chevron group experienced significantly greater correction in the hallux valgus angle and intermetatarsal angle for both mild and moderate deformity. The chevron group experienced a significantly greater decrease in the grade of sesamoid displacement for patients with moderate deformity. The McBride group had a greater risk of recurrence than did the chevron group for moderate deformity (odds ratio 14.00, 95% confidence interval 3.91 to 50.06, p < .001). The results of the present study have demonstrated the superiority of the distal chevron osteotomy over the modified McBride procedure for mild to moderate deformity. For patients with moderate deformity, the McBride group had a greater risk of hallux valgus recurrence than did the distal chevron group. Therefore, we recommend distal chevron osteotomy rather than a modified McBride procedure for the treatment of mild and moderate hallux valgus.

Isolated rupture of the patella tendon is an infrequent injury that usually occurs in patients under 40 years of age. Most of these patients are seen for treatment immediately after injury and can undergo direct surgical repair with favorable results [1]. Surgical management of neglected patella tendon rupture is more difficult than that of acute ruptures, and the results are less favorable because of retraction, adhesion, atrophy of the quadriceps muscle and proximal patella migration [1–3]. Here, we report a case of patella tendon rupture neglected for 55 years, treated successfully using Achilles tendon allograft. Good functional results were achieved with intensive rehabilitation. The patient was asked if data relating to the case could be submitted for publication, and he consented.

Peripheral nerve sheath tumors are relatively uncommon soft tissue tumors, and the incidence of peripheral nerve sheath tumors localized to the plantar surface of the foot, without symptoms of tarsal tunnel syndrome, is even more rare. In this report, we present the rare case of a patient with a peripheral nerve sheath tumor originating from the medial plantar nerve in the plantar vault. The tumor was enucleated and fully excised under microscopic inspection using fine-tipped instrumentation, without en bloc resection of the associated nerve trunk. Surgeons should consider peripheral nerve sheath tumor as a cause of plantar foot pain, despite the rarity of this disorder. Level of Clinical Evidence: 4

목 적: 나사산 Steinmann 핀을 이용한 쇄골 중간부 불유합의 치료의 임상적 및 방사선적 결과를 평가하고자 하였다. 대상 및 방법: 보존적 치료 후 발생한 쇄골 중간부 골절부의 불유합에 대해 나사산 Steinmann 핀의 골수강내 고정술을 시행했던 16명의 환자 들 중 1년 이상 추시 관찰이 가능했던 10명을 대상으로 하였다. 환자의 평균 나이는 56세 (18세~70세)였으며, 비후성 불유합을 보인 경우가 2례, 위축성 불유합이 8례였다. 전 례에서 자가 장골 이식술을 함께 시행하였으며, 임상적 평가는 술 후 5개월에 Kona 등의 평가 방법을 이 용하였다. 결 과: 전 례에서 평균 9주 (7~12.5주)에 감염 또는 핀의 이동 및 파손 등이 발생하지 않고 골유합을 얻었으며, Kona 등의 평가 방법에 따 라 4례에서 "최우수", 5례에서 "우수", 1례에서 "보통"의 임상적 결과를 얻었다. 합병증으로 1례에서 핀의 외측 말단에 의한 피부 자극 증상이 나타났으나, 골유합을 얻은 후 핀을 제거함으로써 증상이 소실되었다. 결 론: 성인 쇄골 중간부 골절의 보존적 치료 후 발생한 불유합의 치료로 나사산 Steinmann 핀을 이용한 골수강내 고정 및 골 이식술을 이 용하여 만족할 만한 결과를 얻었으며 연부 조직 손상을 최소화하면서, 비교적 견고한 내 고정을 얻을 수 있으며, 조기에 견관절 운동이 가능하 며, 국소 마취하에서도 핀의 제거가 용이한 점 등의 장점이 있어 효과적인 치료 술식이라고 생각한다.

Purpose: This study was aimed to evaluate the clinical and radiologic results of revision total hip arthroplasty using a cementless cup and a morselized femoral head allograft in acetabular bone deficiency. Materials and Methods: From January 1992 to December 1999, the authors performed 37 revision total hip arthroplasties using morselized femoral head allografts and cementless cup. This study evaluated the clinical and radiologic results, at a mean follow-up of 50 months. We evaluated the Harris hip score clinically, and the displacement of acetabular cup by Yoder’'s criteria. Location and progression of radiolucent area within acetabular zone, which was defined by DeLee and Charnley was observed and recorded. Results: Mean Harris hip score was improved from 50.6 preoperative to 89.2 at final follow-up. A radiolucent zone between host bone and graft bone was observed in 5 cases, and between graft bone and cup in 7 cases, but all of these were less than 2 mm. The change of cup angle more than 4 degrees were observed in 3 cases in Gross type 4, 4 mm superior migration of acetabular cup was observed in 1 case in Gross type 3 and 5 mm horizontal migration was observed in 1 case in Gross type 4. Conclusion: Although the early results in revision total hip arthroplasty have been encouraging to date except for Gross type 4, a more long term follow-up study with a larger size cases are needed.

Intraosseous lipomas are extremely rare and this incidence has been reported to be less than one per 1,000 primary bone tumors. Because of its rarity, information of this tumor is obtained from case reports. We report a case of intraosseous lipoma that developed in the proximal humerus. The patient was a 69-year-old male who had experienced night pain and intermittent pain at the proximal humerus for 10 years. Simple x-ray revealed a well demarcated osteolytic lesion, which was measured 4 cm in width with a central calcific lesion. There was no cortical destruction in the proximal humerus. He was treated by currettage without bone graft, thereafter his symptoms were relieved.

Fracture of tibial intercondylar eminence has a clinical importance in aspect of associated ligament injury, limited range of motion and joint instability. The purpose of this study is to evaluate the intercondylar eminence fracture and to compare the results of treatment by method of arthroscopic reduction and pull-out suture with results of conservative treatment. The results were evaluated with Mayers and McKeever’s criteria of result and instability. 23 cases of avulsion fracture of tibial intercondylar eminence were reviewed. Most common type was type II. Most common cause was traffic accident. Closed reduction and cast immobilization was performed in 12 cases, of which 10 cases had above good result initially, reduction with pull-out suture by arthroscopy was performed in 11 cases, of which 10 cases had above good result. Type IIIB fracture were reduction with minimal arthrotomy because of the arthroscopic reduction was difficult. 2 cases of instability were in type IIIA and type IIIB. An instability case of type IIIA was treated non-operatively and the other of type IIIB was treated pull-out suture. 1 case of extension limitation was in type II which was treated non-operatively because of multiple injury.

Authors report 42 cases of humeral shaft fractures, which were treated with plate fixation in 19 cases and intramedullary(IM) nailing in 23 cases, from January 1992 to December 1996. The average time of operation in plate fixation was 100 minutes and that in IM nailing was 65 minutes. The nonunion in plate fixation was 2(10.5%)cases and that in IM nailing was 4(17.4%)cases. Other complications of plate fixation were 2 cases of wound infection and 2 cases of radial nerve palsy. Those of IM nailing were 1 case of limited motion of the shoulder and 1 case of wound infection. After reviewing above results, we concluded that there were no marked difference between the two operative method in bone union of humeral shaft fracture