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Purpose: To examine the efficacy, safety, and clinical outcomes of distraction osteogenesis through the physis (PDO) or through subphyseal osteotomy (SPDO) in patients with atrophic-type congenital pseudarthrosis of tibia with proximal tibial dysplasia., Methods: To validate the efficacy and safety of PDO and SPDO, radiographic and clinical parameters were compared between 5 patients who underwent proximal tibial metaphyseal or metadiaphyseal lengthening as a control (group 1) and 7 patients who underwent PDO or SPDO (group 2). Postoperative complication was also compared between the groups., Results: A significant difference in terms of healing index (group 1, 83.3±24.7 d/cm; group 2, 35.0±11.1 d/cm; P=0.001) and percentage increase (11.0%±3.7% vs. 23.1%±10.5%, P=0.034) was observed between the 2 groups. According to the Paley classification, group 1 included 1 "problems" case and 3 "obstacles" cases, whereas group 2 included 2 "problems" cases and 1 "obstacles" case. According to the Lascombes classification, group 1 included 2 grade IIIb cases and 3 grade IV cases, whereas group 2 included 6 grade I cases and 1 grade IIa case. Severe complications were significantly higher in group 1 compared with the group 2 (P=0.007)., Conclusions: This study demonstrated that PDO or SPDO can be effectively and safely performed for tibial lengthening in atrophic-type congenital pseudarthrosis of tibia patients with proximal tibial dysplasia., Level of Evidence: Level III.

Rationale: Plantar fasciitis is a common cause of foot pain presenting with morning stiffness and plantar area pain. This case study is to optimize the management in patient with plantar fasciitis accompanied by apparent high-arch foot., Patient Concerns: A 55-year-old women presented with plantar fasciitis accompanied by apparent high-arch foot. The pain presents for the heel and pelvic areas with long-distance walking., Diagnoses: She was diagnosed with plantar fasciitis accompanied by apparent high-arch foot for physical examination and plain radiographs. In muscle performance and dynamic postural stability tests, indicated the muscle weakness and postural instability., Interventions: The patient was treated with manual therapy such as joint and soft tissue mobilization interventions including plantar fascia and gastrocnemius stretching, but the heel and pelvic pain were aggravated during long-distance walking. After hip strengthening exercises, the heel and pelvic pain significantly improved., Outcomes: The 3-month follow-up revealed that the heel and pelvic pain did not occur in the long-distance walking, and there was no pain and discomfort at one year follow-up., Lessons: To optimize the management in patient with plantar fasciitis accompanied by apparent high-arch deformity, clinicians should try to identify the hip abductor muscles weakness, and therapists should consider incorporating hip strengthening exercises.

Background: Hip fracture in elderly patients is a serious health concern due to the associated morbidity and mortality. Although acute kidney injury after hip fracture is known to be a significantly poor prognostic factor for morbidity and mortality, the literature regarding the risk factors for acute kidney injury after hip fracture is insufficient. This study aimed to investigate the incidence and associated risk factors for acute kidney injury in patients with femoral neck fracture., Methods: A total of 248 patients who underwent an operation for femoral neck fracture between January 2011 and January 2015 were retrospectively analyzed. Acute kidney injury was defined according to the Kidney Disease: Improving Global Outcomes guidelines., Results: The incidence of acute kidney injury was 17.7% (n = 44). Risk factors for acute kidney injury included diabetes mellitus, pre-existing renal disease, preoperative blood urea nitrogen (BUN), preoperative estimated glomerular filtration rate (eGFR), preoperative haemoglobin (Hb) level, type of operation, postoperative creatinine level and intraoperative hypotension (P <  0.05). After controlling for confounding variables, intraoperative hypotension was only the independent risk factor for acute kidney injury (P = 0.012)., Conclusions: Acute kidney injury was found to occur frequently after surgery for femur neck fracture. Surgeons should be aware of acute kidney injury when planning the management of patients with femoral neck fracture and consider that the duration of intraoperative hypotension is a risk factor for acute kidney injury.

We aimed to investigate the clinical characteristics of slipped capital femoral epiphysis (SCFE) in patients aged less than 10 years and identify the efficacy of physeal-sparing procedures in this age group. Demographic data of 18 SCFE patients aged less than 10 years were compared with those of 71 older patients to investigate the clinical characteristics. The efficacy of physeal-sparing procedures (n=5) was investigated compared with that of in-situ screw fixation (n=13). Obese children were noticeably more common among SCFE patients aged less than 10 years (P=0.034). The slip angle improved significantly more in the physeal-sparing subgroups (P=0.038) without the occurrence of further slippage. Moreover, physeal-sparing procedures allow persistent growth of the proximal femoral physis. However, most of the patients in the physeal-sparing subgroup needed additional surgeries when the proximal femoral physis outgrew the implant. Obesity may be associated more with early-onset SCFE (onset<10 years). Physeal-sparing procedures are safe and effective in preventing leg-length discrepancy and allowing the remodeling of the deformed proximal femur in this age group.

Case: A 14-year-old boy with multiple epiphyseal dysplasia (MED) presented with right hip pain and stiffness. Radiographs revealed a deep notch at the superolateral part of the femoral head, which abutted the lateral corner of the acetabulum. Articulated hip distraction (AHD) was used to reduce the femoral head and obliterate the notch. At the 4-year follow-up, the radiographs showed a well-preserved joint space, and the patient had functional improvement., Conclusion: AHD may be an effective way to address and obliterate a superolateral femoral head notch and promote regeneration of the femoral head in a patient with MED.

Purpose: To investigate the arthroscopic pathoanatomy of the transverse acetabular ligament (TAL) and determine whether a TAL incision is necessary for the concentric reduction of developmental dysplasia of the hip (DDH) in infants and young children., Methods: We retrospectively reviewed patients who underwent arthroscopic-assisted reduction for DDH between July 2008 and April 2016. The indications for this intervention included patients in whom closed reduction failed and those who did not require bone operations. The arthroscopic findings and the effect of the TAL incision on DDH reduction were evaluated. TAL pathology was apparent when it was pulled superiorly or hypertrophied., Results: We identified a consecutive series of 13 patients (13 hips). Two patients with teratologic dislocation were excluded. There were 9 girls, 8 first-born infants, and 3 breech-position infants. Six patients showed positive Ortolani test findings. In all cases the TAL was considered not hypertrophied when it appeared as a narrow, cord-like structure that was continuous and in smooth transition with the TAL-labral ring, without prominence or elongation. All postreduction magnetic resonance imaging scans showed reduced femoral heads; however, residual subluxation was observed in 8 of 11 hips owing to the interposed anteroinferior labrum. On arthrography at 6 weeks after reduction, the femoral head was located deeper in the acetabulum and the medial dye pool width was within 2 mm in all patients., Conclusions: The TAL was not observed to be hypertrophied or stretched in any of the DDH patients, and it did not act as an obstacle to reduction. After the TAL incision, the gap of the cut margin was not remarkably widened, although there were varying degrees of release. The incision of the TAL does not appear to result in the immediate alteration of the TAL-labral ring in favor of deeper acetabular seating or to enhance reduction., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Recent clinical studies have suggested that systemic metal ion levels are significantly elevated at midterm follow-up in patients with ceramic-on-metal (COM) bearing. However, it is not clear whether there is a correlation between patient-related factors including the lifestyle and elevated levels of serum metal ions following COM total hip arthroplasty (THA)., Methods: Serum metal levels were measured in 201 patients (234 hips) including 121 COM patients (140 hips) and 80 non-COM patients (94 hips). The Harris Hip Score, University of California, Los Angeles activity scale score, and Western Ontario and McMaster Universities Osteoarthritis Index score were measured and radiographs were obtained for the analysis., Results: Significantly higher levels of cobalt (Co) and chromium (Cr) were detected in the serum of the COM THA group (Co: 1.86 ± 4.0 μg/L; Cr: 1.81 ± 2.87 μg/L) than those of the non-COM THA group (Co: 0.27 ± 0.14 μg/L; Cr: 0.19 ± 0.25 μg/L; P < .001). The serum metal levels of patients who achieved the squatting position and the kneeling position were significantly higher than those of patients who could not squat (Co: P = .033; Cr: P = .074) and kneel (Co: P = .049; Cr: P = .031). The metal ion levels of the COM THA group correlated with the total range of motion (Co: P = .0293; Cr: P = .0399)., Conclusion: Patients who underwent a 36-mm COM THA showed high serum metal levels although good clinical outcomes at the midterm follow-up. We found that COM THA patients who were capable of greater range of motion, squatting, and kneeling are at risk of metal ion-related problems., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Osteogenesis imperfecta (OI) is a heritable skeletal disorder characterized by bone fragility and low bone mass. Recently, loss-of-function mutations of WNT1 have been reported to be causative in OI or osteoporosis. We report an OI patient with novel compound heterozygous WNT1 missense mutations, p.Glu123Asp and p.Cys153Gly. Both mutations are found in the exon 3, and the p.Glu123Asp is the most proximal N-terminus missense mutation among the reported WNT1 missense mutations in OI patients. In vitro functional analysis reveals that while expression of wildtype WNT1 stimulates canonical WNT1-mediated β-catenin signaling, that of individual WNT1 mutant fails to do so, indicative of the pathogenic nature of the WNT1 variants. Although the pathogenic mechanism of WNT1 defects in OI has yet to be uncovered, these findings further contribute to the implications and importance of functional relevance of WNT1 in skeletal disorders., (Copyright © 2017. Published by Elsevier Masson SAS.)

Purpose: Liposomes have been developed as versatile nanocarriers for various pharmacological agents. The effect of surface charges on the cellular uptake of the liposomes has been studied by various methods using mainly fixed cells with inevitable limitations. Live cell imaging has been proposed as an alternative methods to overcome the limitations of the fixed cell-based analysis. In this study, we aimed to investigate the effects of surface charges on cellular association and internalization of the liposomes using live cell imaging., Methods: We studied the cellular association and internalization of liposomes with different surface charge using laser scanning confocal microscopy (LSCM) equipped with live cell chamber system. Flow cytometry was also carried out using flow cytometer (FACS) for comparison., Results: All of the cationic, neutral and anionic liposomes showed time-dependent cellular uptake through specific endocytic pathways. In glioblastoma U87MG cells, the cationic and anionic liposomes were mainly taken up via macropinocytosis, while the neutral liposomes mainly via caveolae-mediated endocytosis. In fibroblast NIH/3T3 cells, all of the three liposomes entered into the cell via clathrin-mediated endocytosis., Conclusions: This study provides a better understanding on the cellular uptake mechanisms of the liposomes, which could contribute significantly to development of liposome-based drug delivery systems.

Purpose: To investigate the clinical and radiologic outcomes and prognostic factors of arthroscopic partial meniscectomy with or without suture repair of the remnant rim and subtotal meniscectomy in children with discoid menisci., Methods: We retrospectively reviewed all consecutive patients aged younger than 18 years who underwent arthroscopy between 2003 and 2012, excluding patients with follow-up less than 2 years, concomitant injuries, underlying diseases, or a lost videotape. Patients were grouped by treatment method: partial meniscectomy with or without suture repair and subtotal meniscectomy. Clinical outcomes were determined based on symptoms, complications, and Lysholm scores. Degenerative changes were assessed radiologically. Risk factors for a lower Lysholm score were investigated., Results: Of 100 knees (86 patients; mean age, 10.7 years), 87 underwent partial meniscectomy with (n = 42) or without (n = 45) suture repair and 13 underwent subtotal meniscectomy. The Lysholm score at a mean of 4.7 years (range, 2.0 to 10.9 years) improved to more than 90, regardless of meniscectomy method (P = .767; 95% confidence interval [CI], -5.1 to 6.9) or the addition of suture repair (P = .797; 95% CI, -3.5 to 4.6). Early degenerative changes were found in 11 knees. Patients aged younger than 10 years at surgery had a 2.37 times higher chance of having excellent Lysholm scores (P = .032; 95% CI, 1.1 to 5.1). A reoperation history was associated with lower Lysholm scores with a marginal significance (P = .054; 95% CI, -0.9 to 12.3)., Conclusions: Arthroscopic partial meniscectomy with stabilization of the unstable remnant rim was effective in preserving knee function with few early degenerative changes during the midterm follow-up period. Subtotal meniscectomy appears to be a valid treatment for unsalvageable cases. There was no difference in outcomes among the partial meniscectomy, partial meniscectomy with suture repair, and subtotal meniscectomy groups. Less satisfactory functional outcomes may follow in children aged 10 years or older or when a reoperation has been performed., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background and Importance: This is the first report of using the superior lateral mass as an alternative starting point for C1 posterior screw placement, demonstrating the importance of recognizing vertebral artery (VA) anomaly in deciding the surgical strategy for C1 screw placement., Clinical Presentation: A 56-year-old man presented with severe neck pain after a fall. Imaging demonstrated an unstable bursting fracture at C4, C1-2 instability, and a subluxation at C2-3. Computed tomography angiography indicated that the persistent first intersegmental artery was located on the left side. The patient underwent anterior-posterior cervical fixation and fusion. Posterior C1 fixation was done with polyaxial screw rod construct using C1 superior lateral mass on the left side and C1 inferior lateral mass on the right side. The patient had no immediate postoperative deficits. At the 8-month follow-up examination, the patient was neurologically intact with a solid cervical fusion., Conclusion: The third segment of the VA is heterogeneous; therefore, preoperative radiologic studies should be performed to identify any anatomical variations. Using preoperative 3-dimensional computed tomography angiography, we can precisely identify an anomalous VA, thereby significantly reducing the risk of VA injury. To avoid significant morbidities associated with VA injury, a more optimal entry point for C1 fixation can be selected if a persistent first intersegmental artery or fenestrated VA is detected.

The water content of stratum corneum (SC) has been reported to vary depending on the anatomical sites. Each anatomical site respectively have their own proper water content of SC which reflects the status of skin health. Also, this anatomical region can be divided into relatively wet and dry area according to the degree of the water content of SC. In this study, we tried to investigate time series trend of the water content. Skin hydration was measured on the different anatomical sites for the first four seconds using single frequency-susceptance measuring method. It is observed that the slope of the graph for the water content during the first four seconds is different depending on the anatomical sites and can be divided into two groups by the degree of the slope. These grouped areas are well aligned with traditional wet and dry area. It is presumed that the difference of the gradient could be caused by the thickness of SC. In this study, the different gradient of time series trend of water content of SC on different anatomical sites was found, and it could be conveniently used to distinguish the wet and dry area of the skin.

Background/aims: Carcinogenesis is characterized by the abnormal regulation of cell cycle. The abnormal expression of the regulators of cell cycle may be related to the prognosis. Since the clinical significance of the expression of the three proteins in colorectal carcinomas is still controversial, we evaluated the prognostic value of the expression of cyclin E, p27 and mutant p53 in stage II colorectal cancer., Methods: The expression levels of cyclin E, p27 and mutant p53 proteins in 41 patients with stage II colorectal carcinomas were analyzed by immunohistochemistry., Results: In the univariate analysis, the level of CEA at diagnosis was associated with disease relapse. In the multivariate analysis, the clinicopathological variables such as age, gender, site of primary tumor, tumor size, state of tumor differentiation and preoperative plasma CEA level were not associated with disease relapse. When Kaplan-Meier survival curves were constructed to determine the prognosis, cyclin E, p27 and mutant p53 expressions did not predict poor prognosis., Conclusions: Our results suggested that the expression of cyclin E, p27 and mutant p53 proteins did not predict the clinical outcome in the stage II colorectal carcinomas.