• The Journal of the Korean bone and joint tumor society
• /
• v.13 no.2
• /
• pp.81-87
• /
• 2007

Purpose: Chondroblastoma of bone is rare with the potential for local recurrence and metastasis. A retrospective review of 30 patients with chondroblastoma of bone treated at a single institution during a 24-year period was conducted to determine the clinical outcome and relevant prognostic factors. Materials and Methods: Thirty patients with biopsy-proven chondroblastoma of bone, treated between September of 1981 and September of 2005, were retrospectively reviewed. There were 16 men and 14 women with an average follow-up period of 7.2 years (range, 1.6~21.2). The most common sites were the distal femur (n=7), proximal humerus (n=6), proximal tibia (n=6) and proximal femur (n=4). The average age of the patients was 20 years (range, 12~47) with closed physes in 20 patients(67%.) Twenty-seven patients(90%) were treated by curettage of the tumor with or without bone grafting or cementing. Three patients(10%) were treated with en bloc resection. Clinical and pathological factors reported to be associated with poor outcome were analyzed. Results: Four local recurrences(13%) developed in postoperative 4, 6, 7 and 16 months. These patients underwent further curettage (once in 2 patients and twice 2) and had no further recurrence. All patients showed no evidence of disease at the final follow-up. Local recurrence developed in the two cases which removal of the tumor was incomplete. Curettage and bone-grafting (1) and cementing (1) were performed in the two other cases with local recurrences. In contrast, no local recurrences were observed in the 3 cases treated with en-bloc resection. The status of physes or the histologic presence of aneurysmal bone cyst, the anatomic location of the tumor did not affect local recurrence. Conclusion: Adequate removal of the tumor with aggressive curettage or en bloc resection seems to be necessary to prevent local recurrence in chondroblastoma. The status of physes, the histologic presence of aneurysmal bone cyst or the anatomic location of the tumor was not related with local recurrence.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.5 no.1
• /
• pp.63-68
• /
• 2006

Purpose: To assess the effectiveness of the Locking compression plate (LCP) after open reduction for the treatment of the displaced clavicular shaft fracture, the clinical and radiologic outcome of the patients who were managed with the LCP for internal fixation after open reduction has been analyzed. Materials and Methods: We reviewed 26 cases with a displaced clavicular shaft fracture treated by internal fixation using Locking compression plate after open reduction between May 2003 and November 2004. The patients were followed up for at least six months period, and final postoperative outcome was evaluated using clinical results based on Kang's criteria, radiologic signs of fusion. Results: All fractures united by an average of 9.3 weeks without delayed union and showed fast recovery of motion fraction and shoulder function. In addition,24 cases without the fractures of proximal humerus recovered to normal range of shoulder notion within 2.9 weeks. Clinically, according to Kang's criteria, the outcome was good or better in 22 patients. The complications included shoulder joint dysfunction in two cases and keloid formation in one case, and no other complications were observed. Conclusion: The internal fixation using LCP for the treatment of displaced clavicular shaft fracture is a safe, reliable method of treatment, with few complications, and offers rapid recovery of shoulder joint function and bone union.

• The Journal of the Korean bone and joint tumor society
• /
• v.1 no.1
• /
• pp.68-76
• /
• 1995

To evaluate the clinical result of surgical treatment of malignant tumors in shoulder girdle, nine patients who were treated in Department of Orthopedics, Catholic University Medical College between January 1991 and December 1993, were evaluated. There were 5 men, 4 women. The mean age at operation was 47 years(range from 22 to 64 years). Of 9 patiens, 2 were soft tissue tumors(1 MFH, 1 dermatofibrosarcoma protuberance); one was treated with forequarter amputation, and the other with wide excision, Seven were bone tumor(2 chondrosarcoma, 1 osteosarcoma, 1 MFH, 1 plasmacytoma, 1 thyroid carcinoma metastasis, 1 malignant schwannoma); one patient was treated with segmental excision of proximal humerus, 4 with Malawer type I-A resection and arthroplasty or arthrodesis, 1 with Malawer type V-B resection and arthrodesis. Five patients received adjuvant chemotherapy, with or without local radiation therapy, and one patient received radiation therapy alone. All patients have survived now, but I had local recurrence. Functional results of arthrodesis and arthroplasty were similar.

• The Journal of the Korean bone and joint tumor society
• /
• v.17 no.1
• /
• pp.11-16
• /
• 2011

Purpose: This study was aimed to analyze the incidence and the anatomical distributions of HME (Hereditary Multiple Exostoses) on upper limbs and its related change in alignment of the upper limbs in HME patients. Materials and Methods: Thirty eight patients who had been diagnosed HME between 2001 and 2009, were categorized into two groups; (1) group A (1-2 involvements); (2) group B (${\geq}$3 involvements). We checked the carrying angle, VAS (Visual Analogue Scale), limitations in daily activities, cosmetic satisfaction according to the number of exostoses invasion. Results: Among the 38 patients, 23 patients (43 cases) had exostoses in the upper limbs. The locations of exostoses in the upper limbs were proximal humerus in 33 cases (30%), distal ulna in 31 cases (28.2%), and distal radius in 24 cases (21.8%). The carrying angle of group A and B was $10.7^{\circ}$, $13.8^{\circ}$, VAS was 1.3, 3.5, and the limitations in daily activities was 7.3, 6.6 of 8 points. The cosmetic satisfactory cases were 13 and 10 cases, respectively. Conclusion: The deformity in upper limbs was observed in 65% of the HME patients. As the number of invasion increases, carrying angle and VAS were increased but limitations in daily activities and cosmetic satisfaction were decreased.

• Clinics in Shoulder and Elbow
• /
• v.16 no.2
• /
• pp.107-114
• /
• 2013

Purpose: This study is designed to evaluate the clinical and radiographical results for the displacement of fracture fragments after interlocking intramedullary nailing in humeral shaft fractures. Materials and Methods: We retrospectively reviewed the results of 8 cases of humeral shaft fractures that have displacements of over 10 mm and under 20 mm after interlocking intramedullary nailing between July 2004 and August 2011. The mean age was 54.1 years (range, 43 to 70 years) and there were 3 male and 5 female patients. Radiographically, the time to bony union, change of displacement and angulation of the fracture site, and degree of improvement of these two factors were measured. Clinically, the range of motion of shoulder and elbow joints, postoperative pain and complications were evaluated. Results: All cases showed complete bony union in last follow-up. The mean time to bony union was 16.1 weeks. At the last follow-up, almost all cases had normal range of motion of shoulder and elbow joints. But, one case had stiffness of shoulder joint. Therefore, arthroscopic capsular release and manipulation was performed. One case had transient shoulder pain and the other case had transient elbow pain. In the two cases, pull-out of proximal interlocking screw were noted, but they finally had bony union. Conclusion: Although considerable displacement of fracture fragments after interlocking intramedullary nailing in humeral shaft fractures was present, we had excellent radiographical and clinical outcomes. Therefore, an additional procedure, such as open reduction or another fixation for the fracture site, was not necessary.

• Tuberculosis and Respiratory Diseases
• /
• v.64 no.3
• /
• pp.224-229
• /
• 2008

Erdheim-Chester disease (ECD) is a rare disease that is characterized by multi-organ involvement of foamy histiocytes. It causes systemic inflammation, and also demonstrates various clinical manifestations and has a poor prognosis. We encountered a case of ECD in a patient that had been treated for underlying polycythemia vera. As far as we know, this is the first reported case worldwide where ECD developed in association with polycythemia vera. A 59-year-old man visited our hospital due to pleuric pain at the right side of the chest. Pleural tissue that was obtained following a thoracoscopic biopsy showed non-Langerhan's cell histiocytosis, suggesting the presence of ECD. The histiocytes stained positively for CD68, but were negative for S-100 and CD1a. The patient also complained of pain at both hips and the right shoulder area. An X-ray and magnetic resonance image demonstrated that the lesion showed sclerosis and osteolysis in both the proximal femur and right humerus. Treatment was started with predinisolone, and subsequently cyclophosphamide was added. ECD is a very rare multi-systemic disease, and its cause and therapeutic options have not yet been defined. ECD has a poor prognosis. Therefore, we believe that additional case studies are needed prior to the determination of a novel therapy for ECD.

• The Journal of the Korean bone and joint tumor society
• /
• v.9 no.1
• /
• pp.24-30
• /
• 2003

Purpose: To clarify the results of simple bone cyst (SBC) treatment in children by percutaneous autologous bone marrow grafting and xenografting. Materials and Methods: We studied seven cases (4 males, 3 females) of SBC, which were treated by percutaneous autologous marrow and heterograft bone grafting from January 1996 to February 1999. Their mean age at surgery was 10 years (6 to 15), and the mean follow-up period was 35.6 months (20 to 52). Three cases were located in the proximal and middle humerus; three cases were in the proximal femur; and one case occurred in the ilium. Mean volume was 14.7 $cm^2$ (10 to 23). Six cases were active, and one was inactive. Five patients had a history of receiving a mean of 3.2 steroid injections. The mean quantity of bone marrow used in treatment was 14.3 ml (10 to 20), and the mean amount of $Lubboc^{(R)}$ heterograft bone (Transphyto S.A. Clermont Ferrand, France) used was 6.4 blocks (5 to 10). Results were analyzed using the modified Neer classification. Results: Five cases completely healed with obliteration of the cyst cavity (Grade IV). Two cases demonstrated sclerosis around a partially visible cyst (Grade III). All treatment results were satisfactory and without intraoperative or postoperative complications. Conclusione: Percutaneous autologous marrow and heterograft bone grafting is recommended as an effective treatment method for simple bone cyst. It offers ease of operative technique, a high rate of healing, a low recurrence rate, low morbidity, a low incidence of postoperative complications, and free from bone graft donor site problems.

• The Journal of the Korean bone and joint tumor society
• /
• v.16 no.1
• /
• pp.1-7
• /
• 2010

Purpose: With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications. Materials and Methods: We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. Results: The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%. Conclusion: Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.

• Journal of the Korean Orthopaedic Association
• /
• v.52 no.1
• /
• pp.33-39
• /
• 2017

Purpose: Surgical risks associated with the resection of osteochondroma around the proximal tibia and fibula, as well as the proximal humerus have been well established; however, the clinical presentation and optimal surgical approach for osteochondroma around the lesser trochanter have not been fully addressed. Materials and Methods: Thirteen patients with osteochondroma around the lesser trochanter underwent resection. We described the chief complaint, duration of symptom, location of the tumor, mass protrusion pattern on axial computed tomography image, tumor volume, surgical approach, iliopsoas tendon integrity after resection, and complication according to the each surgical approach. Results: Pain on walking or exercise was the chief complaint in 7 patients, and numbness and radiating pain in 6 patients. The average duration of symptom was 19 months (2-72 months). The surgical approach for 5 tumors that protruded postero-laterally was postero-lateral (n=3), anterior (n=1), and medial (n=1). All 4 patients with antero-medially protruding tumor underwent the anterior approach. Two patients with both antero-medially and postero-laterally protruding tumor received the medial and anterior approach, respectively. Two patients who underwent medial approach for postero-laterally protruded tumor showed extensive cortical defect after resection. One patient who received the anterior approach to resect a large postero-laterally protruded tumor developed complete sciatic nerve palsy, which was recovered 6 months after re-exploration. Conclusion: For large osteochondromas with posterior protrusion, we should not underestimate the probability of sciatic nerve compression. When regarding the optimal surgical approach, the medial one is best suitable for small tumors, while the anterior approach is good for antero-medial or femur neck tumor. For postero-laterally protruded large tumors, posterior approach may minimize the risk of sciatic nerve palsy.