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Ayush Balaji, Akira Toga, Jun Kano, Atsuki Fujimaru, Taisuke Matsumoto, Shojiro Katoh Department of Orthopedic Surgery, Edogawa Hospital, Tokyo, JapanCorrespondence: Akira TogaDepartment of Orthopedic Surgery, Edogawa Hospital, 2-24-18 Higashikoiwa, Edogawa-ku, Tokyo, 160-8582, JapanTel +81-3-3673-1221Fax +81-3-3673-1229Email akira.toga@gmail.comAbstract: We describe the case of a 76-year-old Asian female patient who presented with severe pain and a valgus deformity of the right knee. Her past medical history included neurofibromatosis, which resulted in a severe anterior slope of the right knee, limb shortening, and congenital pseudarthrosis. She was diagnosed with severe anterolateral osteoarthritis and eburnation of the right knee that was treated surgically with a lateral unicompartmental knee arthroplasty (UKA). Bone and cartilage fragments were removed from the joint space and a UKA implant (Zimmer®) with dimensions of 29 mm × 50 mm was inserted. Perioperative imaging revealed that the procedure resulted in the correction of the valgus deformity. Pain was reduced and the patient was able to walk for 10 meters with support during the immediate postoperative period. One week post-surgery, the patient sustained an oblique tibial fracture that extended from the medial edge of the implant to the medial slope of the proximal tibia. This complication may have been attributed to large implant size or sagittal overcutting. The fracture was treated surgically with a rotated anterolateral locking plate (A.L.P.S®) inserted into the distal tibia. The patient was capable of ambulation at full weight load at two months after the second procedure. It is critical to recognize that there are no standard protocols that can be used to guide the treatment of neurofibromatosis-induced osteoarthritis. The specific preoperative condition of the individual patient plays a large role in determining the appropriate treatment option. In this case, the availability of custom-fitted UKA implants might have improved outlook, we understand that these devices are costly and may not be available at all hospitals. However, we strongly believe that the “gold standard” in these cases is patient-specific treatment that addresses the issues of the highest concern using the resources that are available at that time.Keywords: skeletal deformities, limb shortening, stress fracture, knee implants

Akira Toga,1 Ayush Balaji,2 Taisuke Matsumoto,1 Atsuki Fujimaru,1 Hideaki Murakami,1 Shojiro Katoh1 1Department of Orthopedic Surgery, Edogawa Hospital, Tokyo, Japan; 2Yokohama International School, Yokohama, JapanCorrespondence: Akira TogaDepartment of Orthopedic Surgery, Edogawa Hospital, 2-24-18 Higashikoiwa, Edogawa-ku, Tokyo 160-8582, JapanTel +81-3-3673-1221Fax +81-3-3673-1229Email akira.toga@gmail.comAbstract: The present case report describes a pediatric patient who presented with flexor digitorum profundus (FDP) entrapment after a forearm fracture. The patient was diagnosed with a Bado type I Monteggia fracture. The fracture was reduced using closed reduction under fluoroscopy followed by Kirschner’s wire fixation. This case is unique because the FDP was found entrapped in the fracture site 2 weeks post-operation and was managed using conservative therapy. FDP entrapment is typically managed by surgical intervention, and there have been no previous reports of conservative management. The FDP was released using passive extension of the index finger under general anesthesia, and no irreversible damage to the tendon or muscle was found. This case report demonstrates the potential for conservative therapy in the management of FDP entrapment after forearm fractures.Keywords: pediatric fracture, entrapment of FDP, conservative therapy, dynamic tenodesis effect, forearm fracture, rehabilitation

The inhibitory effect of 6-/7-substituted (2'-oxo) pteridines and ichthyopterin was examined for sepiapterin reductase. 6-Acetonylisoxanthopterin and 6-acetonyl-2,4-diamino-7-hydroxypteridine showed pronounced competitive inhibitory effects to sepiapterin reductase and Ki values were 0.38 μM and 90 μM, respectively. Ichthyopterin and 6-acetonyl-7-hydroxylumazine showed weak noncompetitive inhibitory effects and Ki values were 2.4 mM and 1.1 mM, respectively. 7-Acetonylxanthopterin exhibited no inhibition to sepiapterin reductase.