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We report a rare case of neglected fracture dislocation of the second and third carpometacarpal joints, which was treated by arthrodesis of the involved joints.

Background: Malignant fibrous histiocytoma (MFH) is one of the most diffuse and aggressive tumors among soft tissue sarcomas in adults, but still poorly characterized from the molecular viewpoint. MFH cell proliferation is inhibited selectively by imatinib mesylate, a tyrosine kinase inhibitor. The expressions of platelet-derived growth factor receptors (PDGFRs) and c-Kit have been previously examined in MFH cell lines and the inhibitory effect of imatinib mesylate on the MFH cell proliferation was tested. MFH cell lines showed various patterns of PDGFRs and c-Kit expression. Imatinib mesylate inhibited the proliferation of MFH cells that expressed PDGFRs and/or c-Kit., Materials and Methods: Four MFH cell lines were used (Nara H, Nara F, GBS-1 and TNMY1). The mRNA expression of PDGFRs and c-Kit was analyzed using RT-PCR; cell proliferation was analyzed using the MTS assay. Immunohistochemistry was used to analyze the inhibitory effect of imatinib mesylate on phosphorylation of PDGFRs and c-Kit in vivo. The Nara H and TNMY1 cell lines were implanted into nude mice and tumor growth was evaluated daily by measuring the two-dimensional diameters of the tumor nodule., Results: PDGFRs and c-Kit were expressed in Nara F, GBS-1 and TNMY1, but not in Nara H cells. Imatinib mesylate inhibited PDGFRs and c-Kit phosphorylation in TNMY1 cells affecting the tumorigenicity, in the control group (139 mm3 SD +/- 1.03) and treatment group (126.2 mm3 SD +/- 1.63) but did not affect the tumorigenicity of Nara H cells., Conclusion: Imatinib mesylate reduced in vivo tumor growth of MFH that express PDGFRs and c-Kit associated with phosphorylation suppression.

Background: Tumor angiogenesis and vascularization are essential requirements for the growth and metastasis of tumors. There is evidence that overexpression of the vascular endothelial growth factor (VEGF) is correlated with an adverse prognosis in some tumors. The expression of VEGF, its receptors and microvessel density (MVD) of bone and soft tissue tumors was evaluated., Materials and Methods: Tissue specimens of 60 patients including 30 malignant and 30 benign tumors confirmed by biopsy were examined. Expression of VEGF and its receptors (flt-1 and KDR/flk-1) was observed by immunohistochemistry. Tumor angiogenesis was assessed morphologically by measuring intratumoral MVD., Results: Semi-quantitative evaluation of immunoreactivity showed that VEGF was significantly higher in malignant tumors than in benign tumors. A correlation was found between the immunoreactivity of VEGF and KDR. Moreover, correlations were found either between MVD and VEGF or between MVD and KDR/flk-1., Conclusion: Signal transduction, in particular by VEGF and KDR, potentially contributes to the angiogenesis of bone and soft tissue tumor.

Painful snapping of the elbows is rare. We report on a 12-year-old boy with a painful snap in both elbows. High-resolution magnetic resonance imaging of the elbow using microscopy coils detected a synovial fold interposed in each humeroradial joint and was very helpful in establishing the cause of symptoms. Resection of the synovial folds was performed with subsequent relief of symptoms.

We treated a 64-year-old female with bilateral painful snapping elbows due to synovial folds. Resection of the bilateral synovial folds resulted in relief from pain and snapping, and resulted in patient satisfaction. Daily dumbbell exercises of the bilateral elbows starting at an elderly age may have led to the bilateral snapping. Painful snapping elbow is a relatively rare condition, which usually occurs in a unilateral elbow of a younger patient. To our knowledge, bilateral painful snapping elbows triggered by daily dumbbell exercises in older patients have not been previously reported.

Purpose: The purpose of this study was to investigate the changes in structural properties of an osteochondral cylinder graft-recipient construct after autologous osteochondral transplantation., Methods: A full-thickness cylindrical osteochondral defect (5 mm in diameter and 3 mm in depth) was made on the femoral condyle of a mature female Japanese white rabbit using the Osteochondral Autograft Transfer System (OATS; Arthrex, Naples, FL). The defect was repaired with an osteochondral plug (6 mm in diameter and 3 mm in depth) taken from the contralateral femoral condyle using the OATS. The implanted osteochondral grafts were evaluated immediately after surgery and at postoperative weeks 1, 3, 8, and 12. The stiffness of articular cartilage was analyzed using a tactile sensor system (AXIOM, Fukushima, Japan), which measures stiffness based on changes in resonance frequency when a vibrating tactile sensor touches articular cartilage. The specimens were stained with hematoxylin and eosin and serial sections were examined microscopically., Results: The cartilage stiffness of the graft immediately after surgery was 107,695.1 N/m, which was not statistically different from the normal cartilage stiffness (100,027.5 N/m). The stiffness at postoperative weeks 1, 3, 8, and 12 was 95,386.8, 92,899.3, 95,969.8, and 104,683.7 N/m, respectively. The stiffness at postoperative weeks 1, 3, and 8 was significantly lower than the normal cartilage stiffness and the stiffness at postoperative week 12 was the same as normal cartilage. A new bone formation with an increase of bone trabeculae between the osteochondral cylinder graft and the recipient was observed at postoperative weeks 1, 3, and 8. Thereafter, at postoperative week 12, bone trabeculae decreased to the same level as observed in a normal model due to the progress of bone remodeling., Conclusions: The stiffness of articular cartilage of the osteochondral graft was normal at the time the graft was initially placed and at postoperative week 12. However, the stiffness at postoperative weeks 1, 3, and 8 was lower than the normal cartilage stiffness., Clinical Relevance: Care should be taken when planning the rehabilitation program at an early phase after osteochondral transplantation.

Stress fractures of the olecranon caused by repetitive stress force have infrequently been reported as a cause of elbow pain in adult athletes, engaged in throwing and pitching sports. We diagnosed as a stress fracture of the olecranon by clinical and radiographic findings and treated surgically. The patient returned to playing baseball at a competitive level and was asymptomatic 4 months after the first operation. However, the patient re-injured the olecranon and a second surgical treatment was performed almost 1 year after the first operation. After the second surgery, the patient returned to playing baseball at a competitive level and was free from elbow symptoms. We presented a stress fracture of the olecranon in a semi-professional adult baseball player and suggested that surgical treatment is necessary.

A nine-year-old boy fell on his outstretched hand and was diagnosed with simultaneous fractures of the scaphoid and the capitate. The patient was treated conservatively with a cast for two months. Fracture of the capitate healed, however, fracture of the scaphoid resulted in non-union. We treated scaphoid non-union with an iliac bone graft and internal fixation. Three years after surgery, the patient had neither complaints nor complications and union of the scaphoid was confirmed on the radiographs.

Acute tendon rupture of the extensor pollicis longus (EPL) is rare. We present acute EPL tendon rupture associated with avulsed fracture of the second metacarpal at the insertion of extensor carpi radialis longus. Tendon rupture of the EPL was repaired with end-to-end suture and avulsed fracture of the second metacarpal base was treated with open reduction and internal fixation.

Spontaneous rupture of the extensor pollicis longus (EPL) tendon is uncommon in sports activities. We report a rare case of a professional downhill skier presenting with a rupture of the EPL tendon. Repetitive motion of the wrist joint appeared to cause the rupture. The patient was treated successfully with tendon transfer of the extensor indicis proprius.

We focused on the establishment of a trial procedure for the collection and distribution of Japanese liver tissues obtained from waste surgical resections for drug development and research use. The following procedures were prepared for this project: the pretreatment of liver tissues before storage, their storage at 4 degrees C, the transport of liver samples, the setting up of a communication network among the participating hospitals and laboratories and the approval of each ethics committee. Thirteen liver samples (1.6-7.6 g) obtained from patients whose livers were excised due to cirrhosis, hepatocellular carcinoma, cholangiocarcinoma, or metastasis from colorectal carcinoma and were donated for research. Informed consent was obtained from every patient. Freshly isolated human hepatocytes were prepared from nine liver samples (viability 34.3-86.1%). Four samples were unsuitable to prepare hepatocytes. The profile of testosterone metabolism as 6beta-, 2beta-, 16beta-, 16alpha- and 2alpha-hydroxytestosterone and androstenedione in freshly isolated hepatocytes was shown to be specific for human liver. The 6beta-hydroxylation activity catalyzed by CYP3A4/5 indicated a high level of metabolism (139-996 pmol/min/million cells). Levels of 7-ethoxycoumarin O-deethylation and glucronidation activities were sufficient for analysis in freshly isolated human hepatocytes. We conclude that liver tissues from waste surgical resections supplied from a participating hospital can constitute a valuable source of freshly isolated human hepatocytes for drug development and safety evaluation.

Purpose: The goal of this study was to analyze the effect of graft sizing on the histologic property of articular cartilage in autologous osteochondral transplantation., Type of Study: Histologic analysis using an animal model., Methods: Eighteen skeletally mature female Japanese white rabbits were used in this study and divided into 2 groups based on the surgical procedure. Group I: A cylindrical fragment (7 mm in diameter and 5 mm in depth) was harvested at the femoral condyle using the Osteochondral Autograft Transfer System (Arthrex, Naples, FL), then precisely returned to the defect from which the fragment was originally harvested. This surgical model supposes that the articular surface geometry of the osteochondral graft exactly matches that of the cartilage lesion; however, the osteochondral graft is not the same size as the defect in this model because of the surrounding gap that corresponds to the blade thickness of the chisel used to take the graft. Group II: A 1-mm larger osteochondral fragment (8 mm in diameter and 5 mm in depth) taken from the contralateral femoral condyle was transplanted to the osteochondral defect made as in group I, achieving a tight fit. Specimens were stained with Safranin-O fast green and analyzed microscopically at 4, 12, and 24 weeks after surgery., Results: In group I, histologic examination revealed an increase in cartilage thickness and cell density during the implantation period. Round and polygonal hypertrophic clusters of chondrocytes with cytoplasmic vacuoles were observed. By contrast, in group II, the thickness of the articular cartilage was almost the same as that of the normal adjacent cartilage with no significant change observed., Conclusions: It is suggested that sizing of the implanted osteochondral fragment plays an important role in preserving the histologic properties of cartilage., Clinical Relevance: This study suggests that osteochondral graft stability may influence the histologic properties of the repaired cartilage. It is preferable to implant the slightly oversized graft into the cartilage lesion in autologous osteochondral transplantation to preserve the histologic properties of cartilage.

Two cases of nonunion of the hook of the hamate were treated with low-intensity pulsed ultrasound. The patients were baseball players and had been injured as a result of hitting repeatedly. Nonunion was detected on computed tomography (CT) and was exposed to ultrasound for 20 min a day for 4 months. In both cases pain at the hypothenar eminence disappeared, and bone union was confirmed on CT at the end of the ultrasound treatment.

Muscle-derived cells can differentiate into chondrogenic cells. In our present study, we investigated the pattern of expression of Sox9, a transcription factor known to play a key role in chondrogenesis, in a rat myoblastic cell line, L6. In addition, we evaluated expression of type II collagen and myogenic regulatory markers by reverse-transcript polymerase chain reaction. We also investigated the effect of transforming growth factor (TGF)-beta3, which is known to induce chondrogenesis, on Sox9 mRNA expression. On the first day of culture, we observed a high expression of Sox9. However, on the seventh day of culture, there was a decline in the level of Sox9 and type II collagen mRNAs and an increased expression of Myf5 and myogenin mRNAs. Sox9 mRNA expression was increased after stimulation of TGF-beta3 at 2, 6, and 24 hr. Cartilage nodules were observed in L6 cells treated with TGF-beta3 and dexamethasone. These results indicated that L6 myoblasts originally possess the capacity to differentiate into chondrogenic cells, but that capacity is lost as the cells differentiate toward the myogenic lineage. In addition, TGF-beta3 may modulate Sox9 mRNA expression in L6 cells and retain the capacity to differentiate into chondrogenic lineage.

Purpose: To develop an optimal autologous osteochondral transplantation technique, we analyzed the thickness and curvature of the femoral condyle., Type of Study: Basic research for surgical technique, anatomic study., Methods: Eight cadaveric femoral condyles were sectioned sagittally into 8 slices. Photographs of each slice were digitized, and the thickness and curvature of the overlaying cartilage were analyzed using a National Institutes of Health image program., Results: The average thickness of the cartilage was 1.69 mm. The minimum and maximum values were measured at 0.22 mm and 3.65 mm, respectively, with the thinnest part seen in the sulcus terminalis (the groove for meniscus). The average curvature of the cartilage was 4.4 m(-1). The minimum and maximum values were measured at -20.0 m(-1) and 27.2 m(-1), respectively., Conclusions: When the chondral lesion is assumed at the weight bearing area of the medial or lateral femoral condyle, the anterior portion of the sulcus terminalis (the groove for meniscus) in the middle section of the lateral condyle is considered to be the optimal donor site.

Objectives: We reviewed the results of arthroplasty of the great toe with hallux valgus in rheumatoid patients, using a Swanson flexible hinge toe implant protected by grommet., Materials and Methods: Sixteen patients (26 feet) with rheumatoid arthritis were operated on from 1996 to 1999. (fifteen women, one man). The average age was 59.8 years (range, 48-73 years). The average follow-up period was 3.0 years (range, 1.0-4.5 years). In each patient, the hallux valgus angle (HVA) was measured before and after surgery, and implant breakage and radiolucency around the implant were evaluated on radiographs., Results: Average HVA was 47.7 degrees preoperatively and 19.3 degrees postoperatively. No implant breakage was observed in 76.9% of the feet. Radiolucency of more than 2 mm was observed in only 3.8% of the feet., Conclusions: These findings suggest that arthroplasty using a Swanson flexible hinge toe implant with a grommet is useful for treatment of hallux valgus in rheumatoid patients.

We have investigated the effect of the insufficient autologous osteochondral graft on healing of the large articular cartilage defect using a rabbit model. An osteochondral defect, 7 mm in diameter, was made on the patellar groove of the femoral condyle and repaired with two surgical procedures: Group I, the osteochondral fragment as half as the defect was grafted. The graft was unstable and the size of the graft was smaller than the defect. This is a model of the insufficient autologous osteochondral graft to the large articular cartilage defect; Group II, the defect was left empty. At 2, 4, 12, and 24 weeks after the surgery, the specimens were analyzed macroscopically and histologically. To evaluate the microscopic morphology, a histologic grading scale composed of 5 categories was used. In Group I, although the graft sank a little, a grafted cartilage survived and the reparative fibrous tissue filled the defect covering implanted cartilage. In contrast, in Group II, the defect was only partially covered by fibrocartilaginous tissue with a faintly staining matrix. Throughout the entire observed periods, the scores of the repaired cartilage in Group I are significantly higher than those in Group II. Even the half size of osteochondral graft has an effect to reduce the size of the cartilage defect such as the spacer and leads to better healing compared to the cartilage defect untreated. In case that it is hard to transplant an optimal osteochondral graft because of large cartilage lesion, even the small and unstable osteochondral plug should be transplanted.

Objectives: To compare the strength of interference screw fixation of the tendon to suture button fixation and staple fixation methods., Design: Biomechanical study., Methods: The femurs and flexor digitorum tendon of twelve rabbits were used. The tendon was attached to the medial condyle of the femur using one of the following three surgical procedures: (a) interference screw fixation: tendon-junction screw was used as an interference screw, (b) suture button fixation: the tendon was inserted through a hole and attached with a button on the opposite side, and (c) staple fixation: the tendon was attached using two staples. Strengths of the attached tendons were then measured using a universal testing machine., Results: The ultimate failure load of interference screw fixation was 62.8 +/- 9.0 N, whereas that of suture button fixation was 13.9 +/- 3.8 N and staple fixation was 23.9 +/- 2.6 N., Conclusion: Interference screw fixation provides significant initial fixation strength (p < 0.05).

Objective: To investigate the effect of low-intensity pulsed ultrasound exposure on the healing of injured medial collateral ligaments., Methods: Thirteen male Sprague Dawley rats were used in the study. After surgical transection of the bilateral medial collateral ligaments, the ligament of 1 knee received low-intensity pulsed ultrasound exposure (30 mW/cm2 for 20 minutes daily), whereas no ultrasound was applied to the contralateral knee (control side). Eight rats were killed at 12 days after surgery, and 5 rats were killed at 21 days. The bilateral knees of 5 rats were used for mechanical testing at each of the 2 periods, and 12-day specimens of the remaining 3 rats were prepared for the electron microscopic examination. The knees of 5 additional rats were used to obtain mechanical data of the normal uninjured medial collateral ligament., Results: On the 12th day, the low-intensity pulsed ultrasound-treated side exhibited significantly superior mechanical properties when compared with the control side in ultimate load, stiffness, and energy absorption (P < .05). However, the treatment did not afford any mechanical advantage when tested on the 21st day. The mean diameter of the fibril was significantly larger on the treatment side than on the control side (P < .05)., Conclusions: Low-intensity pulsed ultrasound exposure is effective for enhancing the early healing of medial collateral ligament injuries.

We tested the tensile strength of the Achilles tendon attachment to the calcaneus in skeletal mature and immature rabbits. The mean ultimate failure load was 179.6+/-28.6 N in the mature animals, and 138.5+/-36.1 N in the immature animals ( P<0.05). Although direct insertion was clearly observed histologically in the mature animals, direct insertion was not obvious in the immature animals. In the mature animals, failure occurred partly at the attachment zone (50%) and partly at the tendon zone (50%). In the immature animals, failure occurred at the attachment zone in 85% and at the tendon zone in 15%.