• Clinical and Experimental Pediatrics
• /
• v.65 no.5
• /
• pp.254-261
• /
• 2022

Background: The use of systemic steroids for 6+ weeks in children is associated with decreased bone mineral content (BMC) and density (BMD). However, the effects of a shorter duration of use on BMD are unknown. Purpose: To determine the effect of the use of systemic steroids for 2-6 weeks on BMD and BMC in pediatric patients. Methods: Twenty-five pediatric patients (21 with tuberculosis, 2 with systemic juvenile idiopathic arthritis, 1 with inflammatory bowel disease, 1 with autoimmune hemolytic anemia) who received systemic steroids for 2-6 weeks and 25 age- and sex-matched controls were enrolled. BMC, BMD, and z scores of the whole body (WB), lumbar spine (LS), nondominant distal radius (DR), and total body less the head (TBLH) were determined by dual-energy x-ray absorptiometry at baseline, the end of steroid therapy or 6 weeks (whichever was earlier; first follow-up), and at the end of 3 months from baseline (second follow-up) in patients and at baseline in controls. The values were adjusted for confounding variables. Continuous and categorical variables were compared using Student t test and the chi-square test or Fisher exact test, respectively. Pairwise comparisons employed Bonferroni correction. Results: Statistically significant decreases in BMC, BMD, and all z scores were observed. BMC declined by 5.37%, 2.08%, 1.82%, and 2.27%, and 11.42%, 3.75%, 3.34%, and 4.17% for WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. Similarly, BMD declined by 2.01%, 2.31%, 2.18%, and 1.70% and 4.59%, 3.76%, 3.14%, and 3.50% for the WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. A significant negative correlation was found among bone densitometric parameters, duration, and cumulative dose. Conclusion: The use of systemic steroids for 2-6 weeks in pediatric patients decreased the BMD and BMC of trabecular and cortical bones, an effect that persisted after discontinuation.

• Archives of Hand and Microsurgery
• /
• v.24 no.1
• /
• pp.63-67
• /
• 2019

Spontaneous rupture of the extensor pollicis longus (EPL) tendon can occur in the 3rd extensor compartment after a distal radius fracture involving Lister's tubercle, steroid injections, or rheumatoid arthritis. We report a case of spontaneous rupture of the EPL tendon in a 26-year-old male patient who played a rhythm game, which requires repetitive wrist motions to play the drums. We also provide a comprehensive literature review along with the case report. From the authors' point of view, excessive and repetitive motion of the wrist, as shown in our case, can be a potential cause of spontaneous rupture of the EPL tendon.

• Anatomy and Cell Biology
• /
• v.56 no.1
• /
• pp.46-53
• /
• 2023

It is unclear whether forearm and crural muscle fibers extend distally across the wrist and ankle joints, respectively. We hypothesized, in late-term fetuses, an over-production of muscle bellies extending over the joint. Muscle fibers in histological sections from unilateral wrists and ankles of 16 late-term fetuses (30-40 weeks) were examined and compared with 15 adult cadavers. Muscle fibers of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) in fetuses, especially muscle bellies to the third and fourth fingers, were found to extend far distally beyond the radiocarpal joint. The extensor digitorum and extensor pollicis longus on the extensor side of the wrist were found to carry distally-extending muscle fibers, but these fibers did not extend beyond the distal end of the radius. In the ankle, most muscle bundles in the flexor hallucis longus (FHL), fibularis brevis (FB) and extensor digitorum longus extended distally beyond the talocrural joint, with most FB muscle fibers reaching the level of the talocalcaneal joint. In adult cadavers, muscle fibers of the FDP and FHL did not reach the levels of the radiocarpal and talocrural joints, respectively, whereas the FB muscle belly always reached the talocalcaneal joint. Similarly, some of the FDS reached the level of the radiocarpal joint. Generally, infants' movements at the wrist and ankle could result in friction injury to over-extended muscle. However, the calcaneal and FDP tendons might protect the FB and FDS tendons, respectively, from friction stress.

• Clinics in Shoulder and Elbow
• /
• v.27 no.1
• /
• pp.3-10
• /
• 2024

Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.

• Applied Microscopy
• /
• v.24 no.3
• /
• pp.1-9
• /
• 1994

Pardosa astrigera possessed eight eyes arranged in three rows on the frontal carapace. A pair of small anterior lateral eyes (ALE) flanked each side by an anterior median eyes (AME) lay along the anterior margin that was situated on the anterior row of clypeus. The anterior lateral eye was composed of cornea, vitreous body, and retina. Cornea was made up mainly of exocuticle lining the cuticle. Lens in anterior lateral eye was biconvex type which bulged into the cavity of the eyecup. Outer and inner central region of lens were approximately spherical with radius of curvature $5.6{\mu}m$ and $12.5{\mu}m$, respectly. Vitreous body formed a layer between the cuticular lens and retina. They formed biconcave shape. Retina of the anterior lateral eyes was composed of three types of cells: visual cells, glia cells, and pigment cells. The visual cells were unipolar neuron, as were the receptor of the posterior lateral eye. But cell body was unique to the anterior lateral eyes. They were giant cell, relatively a few in number, and under the layer of vitreous bodies. Each visual cell healed rhabdomeres for a short stretch beneath the cell body. Rhabdomes were irregulary pattern in retina and electron dense pigment granules scattered between the rhabdomes. Glia cell situated at the cell body of visual cell and glia cell process reached to rhabdomere portion. Below the rhabdome, tapetum were about $30{\mu}m$ distance from lens, which composed of 4-5 layers. It was about $25{\mu}m$ length that intermediate segment of distal portion of visual cell. Electron dense pigment granules between the intermediate segment were observed.

• Journal of Life Science
• /
• v.20 no.12
• /
• pp.1758-1763
• /
• 2010

Osteoporosis is a complex systemic skeletal disease and a major public health concern worldwide. It is a heritable disorder characterized mainly by low bone density and/or low trauma osteoporotic fractures, both of which have strong genetic determination. However, the specific genetic variants determining risk for low bone density are still largely unknown. Here, we performed association analysis to elucidate the possible relationship between genetic polymorphisms in the SQSTM1 gene and low bone density. By examining a total of 7225 (men: 3622, women: 3603) subjects from the Korean population in the Korean Association REsource (KARE) study, we discovered that SQSTM1 gene polymorphisms were associated with bone density. The results of the BD-RT (bone density estimated by T-score at distal radius) showed that three SNPs (rs513235, rs3734007, and rs11249661) within the SQSTM1 gene were significantly associated with bone density. The results of the BD-TT (bone density estimated by T-score at midshaft tibia) showed that four SNPs (rs513235, rs3734007, rs2241349, and rs11249661) were significantly associated with bone density. The three SNPs (rs513235, rs3734007, and rs11249661) had common significance in both BD-RT and BD-TT. In summary, we found statistically significant SNPs in the SQSTM1 gene that are associated with bone density traits. Therefore, our findings suggest SQSTM1 gene could be related to pathogenesis of osteoporosis.

• Clinics in Shoulder and Elbow
• /
• v.16 no.2
• /
• pp.130-134
• /
• 2013

A painful pseudoarthrosis will develop due to a delay in diagnosis and treatment, and surgical care is required. Treatment of pseudoarthrosis is really difficult because the acromion is a thin flat bone that is difficult to be fixed firmly. A 52-year-old woman with multiple trauma had an acromial fracture that was not detected until it had caused pain after ambulation. Open reduction and internal fixation with a variable angle locking compression plate for distal radius and autogenous iliac bone graft were performed. At nine months after the operation, there was partial tear in the supraspinatus tendon, and arthroscopic repair of the supraspinatus tendon was performed. At nine months after the operation, radiographs showed a complete union. At three months after tendon repair, the patient had excellent function of the shoulder. We have reported a case of a successful treatment of nonunion and pseudoarthrosis of acromial fracture that is difficult to be fixed.

• Journal of the Korean Society of Radiology
• /
• v.15 no.3
• /
• pp.321-327
• /
• 2021

Wrist PA-grip view is used to diagnose triangular fibrocartilage complex (TFCC) tear because it can easily diagnose damage to the surrounding wrist ligaments. However, despite advances in radiology equipment, distortion of images due to geometric elements still has many limitations. In this paper, we propose a method that can minimize the distortions of images by analyzing the distortions occurring in the wrist PA-grip view. A source of image distance (SID) were set at 130 cm and 150 cm for comparison with 110 cm. Depending on the SID, the phantom of wrist was moved at 0, 2, 4, 6, 8, and 10 cm in the X-axis and Y-axis directions, respectively. For quantitative evaluation, the difference of distance between the radius and ulna was measured in picture archiving and communication system (PACS) system. As a qualitative evaluation, survey was conducted among 20 radiologic technologists who examined the Wrist PA-grip view. The Kruskal Wallis test was performed to compare the distortion according to the phantom movement in the X-axis and Y-axis directions based on the SID, and the Tukey test was performed as a post-test. In the quantitative evaluation results, the measured values obtained in the X-axis was not significantly different in all groups (p>0.05). The measured values obtained in the Y-axis was significantly different in the most groups (p<0.05). Therefore, to reduce distortion while maintaining image quality, we recommend what examine the SID at 150 cm than 110 cm.

• The Journal of the Korean bone and joint tumor society
• /
• v.19 no.2
• /
• pp.56-63
• /
• 2013

Purpose: This study was performed to evaluate the efficiency of demineralized bone matrix (DBM, Genesis$^{(R)}$) used for bone defect after operative traetment of benign bone tumors by clinical and radiological methods. Materials and Methods: DBM was used to treat bone defect after operative treatment of benign tumor from February 2012 to May 2013. Total 25 benign bone tumor cases (15 males, and 10 females) with mean age of 30.3 were studied. The diagnoses were solitary bone cyst in 9 cases, non ossifying fibroma in 5, fibrous dysplasia in 5, aneurysmal bone cyst in 3 and enchondroma in 3. In categorization by location of tumor, there were 5 cases of distal femur, 4 of proximal tibia, 3 of proximal femur, 3 of proximal humerus, 3 of phalanx, 2 of distal radius, 2 of hip bone, 2 of calcaneus, and 1 of scapula. Autogenous bone was used with DBM in 6 cases, and only DBM used in 19 cases. Mean periods of follow up were 8.7 months (range: 6 to 14 months). Amount of graft resorption and bone formation was observed with compare of post operation radiograph and the difference was shown by percentage. Resorption level was measured by DBM level which could be observed from simple x-ray, and bone formation level by bone trabecular formation level at impaired site. Results: Twenty three cases of total 25 cases showed bone union. In the 23 cases, more than 98% DBM resorption was observed after mean 4.3 months, and more than 98% bone formation was observed after mean 6.9 months. Lesser bone defect sizes showed faster bone formation and it was statistically significant (p=0.036). But other comparative studies on other factors such as, sex, age of patients and combination of autogenous bone were no statistically significant differences in graft resorption and bone formation. And there was no significant complication in periods of follow-up. Conclusion: Demineralized Bone Matrix (Genesis$^{(R)}$) is thought to be useful treatment for bone defect after operative treatment of benign bone tumor, however longer follow-up periods appears to be needed.

• The korean journal of orthodontics
• /
• v.29 no.2 s.73
• /
• pp.183-195
• /
• 1999

Growth and development evaluation of patients with growth potential is of great importance for orthodontic treatment planning. Timing of orthodontic intervention greatly depends on one's developmental status, thus if there is a difference in skeletal maturation among malocclusion types different treatment timing should be applied. The objective of this study was to evaluate and compare skeletal maturation among different malocclusion types. The samples used in this study was 38 Class I, 36 Class II and 33 ClassIII females aging from 8 to 10 years. Handwrist X-rays were taken with 6 month interval till 12-13 years of age. The results were as follows. 1. There was no skeletal maturity difference among different malocclusion types. 2. The hamular process of hamate was observed at $9.16{\pm}0.72$ years, pisiform bone at $9.13{\pm}0.71$ years and the ulnar sesamoid at $10.34{\pm}0.84$ years. 3. The timing of epiphyseal capping on the third finger was $10.96{\pm}0.80$ years for distal phalanx and $11.27{\pm}0.87$ years for middle phalanx, $11.12{\pm}0.85$ years for proximal phalanx of the first finger, $11.21{\pm}0.82$ years for radius and $11.62{\pm}0.85$ years for middle phalanx of the fifth finger. 4. The appearance of pisiform bone showed high correlation with appearance of hamular process of hamate(r=0.91) and ulnar sesamoid bone appearance showed high correlation with advanced ossification of hamular process(r=0.86). Timing of epiphyseal capping among different parts showed high correlation(r=0.80-0.90). 5. The shape of middle phalanx of the fifth finger showed the highest variability ($20.6\%$).