BACKGROUND:This study aims to evaluate the results and the safety of a novel fixation method we developed for syndesmosis injuries that we call the "embrace" technique.METHODS:Between March 2018 and October 2020, a total of 67 patients with ankle fractures and syndesmotic injuries underwent syndesmosis fixation with the embrace technique at our institute. Plain radiographs and computed tomographic (CT) scans were obtained preoperatively. Postoperative radiographic assessment included anteroposterior (AP) and lateral radiographs and CT scans of both ankles. Additionally, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, Olerud-Molander Ankle Score, and visual analog scale (VAS) score were used for postoperative assessment.RESULTS:The mean age was 27.6 ± 10.9 (range, 14-56) years. The mean follow-up time was 30.3 ± 6.2 (range, 24-48) months. There were no malreductions indicated by any CT parameter except fibular rotation in a postoperative comparison between 2 sides. We found significant preoperative-postoperative changes in anterior difference, posterior difference, and fibular rotation but no significant preoperative-postoperative difference in fibular translation. There was no significant postoperative difference between the affected-side and normal-side measurements of any parameter. Complications included delayed wound healing, lateral pain because of wire knot irritation (11.9%), and medial fiber wire irritation (7.5%). The mean AOFAS, Olerud-Molander, and VAS scores at the last follow-up were 94.4 ± 6.8 (range, 84-100), 95.4 ± 6.1 (range, 80-100), and 0.68 ± 1.0 (range, 0-3) points, respectively.CONCLUSION:In our cohort, this novel technique proved to be an effective method for syndesmosis fixation in patients with ankle fractures associated with very good radiologic and patient-reported outcomes.LEVEL OF EVIDENCE:Level IV, case series.

Anaplastic transformation of papillary thyroid carcinoma (PTC) at distant metastatic sites is extremely rare, and there have been fewer than 20 reported cases in the literature. A 61-year-old woman presented with 1-week history of dyspnea. Her past medical history was remarkable because, 19 years ago, she underwent nearly total thyroidectomy and radical neck dissection due to PTC. Computed tomography of the chest revealed a 1.7 cm nodule in the lung and diffuse pleural thickening. Gun biopsy of the lung nodule revealed metastatic PTC with typical histology. However, the pleural biopsy predominantly showed anaplastic pleomorphic and spindle sarcomatoid carcinoma with microscopic focus of PTC. Immunohistochemical results showed both anaplastic sarcomatoid and PTC components positive for TTF-1, galectin-3 and PAX-8, thus supporting anaplastic transformation of PTC at the metastatic site. Subsequently the patient received 1 cycle of cisplatin-based chemotherapy but died from the disease 4 months after diagnosis. Although it is rare, anaplastic transformation of PTC should be considered during differential diagnosis of patients who present with exclusive sarcomatoid morphology at metastatic sites and have a history of PTC. We report another case of anaplastic transformation of PTC, found at pleural metastasis, together with the immunohistochemical profile and a literature review.

Syndesmotic injury can either be isolated or associated with bony or ligamentous ankle injury. When it is not associated with an ankle fracture, it may not be easy to diagnose, especially when there is no franck diastasis on a plain radiograph. Without proper treatment, syndesmotic injury can lead to chronic pain due to impingement of scar tissues and instability. It may further lead to ankle arthritis. Early diagnosis with appropriate management is a prerequisite to avoid these problems. Herein, we review and discuss the mechanism of injury, classification, diagnosis, and treatment of isolated syndesmotic injury.

Category: Sports Introduction/Purpose: Chronic ankle instability with generalized joint hypermobility (GJH) is considered a contraindication for the modified Broström procedure. The most widely accepted definition of GJH is a Beighton-Horan score of ≥4 on a 9-point scale. However, it is not clear if this criterion can be applied to determine the GJH that would lead to a poor outcome after the modified Broström procedure. Methods: The modified Broström procedure was performed in 32 patients with chronic ankle instability with GJH, if the contralateral uninjured ankle showed a normal varus talar tilt and anterior talar translation during the stress tests. We hypothesized that when the contralateral uninjured ankle shows a normal varus talar tilt and anterior talar translation during stress tests in patients with GJH, GJH may have a smaller effect on the ankle ligaments, and the modified Broström procedure in these cases may have satisfactory outcomes. The mean patient age at surgery was 21.7 years. The mean follow-up duration was 27.4 months. Results: The Karlsson-Peterson ankle score significantly improved from 63.6 ± 7.1 points (p< 0.001; 95% CI, 22.1 – 29.7) preoperatively to 90.4 ± 6.7 points at the final postoperative follow-up. Sixteen patients were very satisfied with the results, 10 patients were satisfied, 3 patients rated their satisfaction as fair, and 1 patient was dissatisfied with the results. We stratified the clinical outcomes according to the Beighton scores. There was no correlation between the Beighton scores and the Karlsson- Peterson ankle scores at the last follow-up (Spearman’s correlation coefficient, -0.11; p= 0.591). However, 1 patient with a Beighton score of 8 points and 1 patient with a score of 9 points had lower Karlsson-Peterson ankle scores (82 and 85, respectively) compared to the average scores at the last follow-up. Conclusion: The modified Broström procedure was successful in patients with chronic ankle instability with GJH, if the contralateral uninjured ankle showed a normal varustalar tilt and anterior talar translation during the stress tests. The repaired ligaments may eventually stretch out in patients with GJH secondary to connective tissue disorders such as Marfan syndrome as these patients have been found to have inherent connective tissue extensibility. However, GJH includes mild joint hypermobility without any symptoms or problems except increased joint range of motion. When the contralateral normal ankle shows negative stress tests that the modified Broström procedure may be successful.

In the present technique report, we describe a useful noninvasive traction technique that uses a 6-inch elastic bandage that can be obtained in every operating room and can be easily applied around the patient's ankle and the surgeon's waist to offer a stable traction force during minimally invasive plate fixation of distal tibial fractures. This technique frees the surgeon's hands to focus on applying other forces, such as rotational, varus, or valgus forces, to reduce the fracture and stabilize the reduction and alignment during percutaneous insertion and fixation of the plate. This technique, although simplistic and old-fashioned, is also useful for the closed reduction of distal tibial physeal injuries in children, because it can provide a significant amount of traction force while allowing the surgeon to apply other forces for fracture reduction. This technique can be used in the emergency room, where an ankle distractor is not usually present, and in some cases could be useful during ankle arthroscopy.

Intravascular fasciitis of the common femoral veinHong-Gi Lee, Ju Yeon Pyo, Yong Wook Park, and Jae Yoon RoHong-Gi LeeDepartment of Surgery, Hanyang University Guri Hospital, Guri, Korea, Ju Yeon PyoDepartment of Pathology, Hanyang University Guri Hospital, Guri, Korea, Yong Wook ParkDepartment of Pathology, Hanyang University Guri Hospital, Guri, Korea, and Jae Yoon RoDepartment of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, USAPublished Online:August 28, 2015https://doi.org/10.1024/0301-1526/a000460PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreFiguresReferencesRelatedDetailsCited byRecurrent intravascular fasciitis of the common femoral vein: A case reprotAnnals of Vascular Surgery - Brief Reports and Innovations, Vol. 2, No. 3A case of intravascular fasciitis involving a finger17 December 2021 | The Journal of Dermatology, Vol. 49, No. 4Intravascular Fasciitis of the Jugular Vein Mimicking Thrombosis and Sarcoma: A Case Report27 September 2021 | Frontiers in Surgery, Vol. 8Intravascular Fasciitis in the Femoral Vein with Hypermetabolic Signals Mimicking a Sarcoma: The Role of Preoperative Imaging Studies with Review of LiteratureVascular Specialist International, Vol. 37, No. 1Intravascular fasciitis presenting as recurrent deep venous thrombosisJournal of Vascular Surgery Cases and Innovative Techniques, Vol. 6, No. 4A Rare Case of Intravascular Fasciitis Misdiagnosed as Deep Venous ThrombosisAnnals of Vascular Surgery, Vol. 62Ultrasonographic features of intravascular fasciitis: case report and review of the literature15 May 2017 | Journal of the European Academy of Dermatology and Venereology, Vol. 31, No. 10 Volume 44Issue 5September 2015ISSN: 0301-1526eISSN: 1664-2872 InformationVasa (2015), 44, pp. 395-398 https://doi.org/10.1024/0301-1526/a000460.© 2015Hogrefe AGKeywordsFemoral veinintravascular fasciitisnodular fasciitisPDF download

Reduction and fixation of a posterior malleolar fracture fragment can be achieved through a direct posterolateral approach between the peroneal and flexor hallucis longus muscles. However, a large posterior malleolar fragment with minimal displacement may be reduced indirectly using ligamentotaxis through the intact posterior inferior tibiofibular ligament (PITFL) after anatomic reduction of the lateral malleolar fracture. A percutaneous reduction and screw fixation technique has been used in combination with this indirect reduction technique. However, organized hematoma or small bone fragments within the fracture gap may sometimes block closure of the fracture gap and hinder anatomic reduction. The percutaneous reduction and fixation technique may not be indicated in such cases as anatomic reduction may not be possible unless these fragments are removed. A more extensive exposure may be required with increased soft tissue dissection to remove small fragments or organized hematoma, risking sural nerve injury and increasing wound healing difficulties. The posterior malleolus may be opened in a book-like manner using the intact PITFL as a hinge for removal of the blocking fragments. However, an additional posteromedial incision may be required when the posterior malleolar fragment is too large, when it is difficult to open the fracture, or when the small fragments are located on the medial side. We describe a technique involving the insertion of an arthroscope into the lateral malleolar fracture for easy removal of these small bone fragments and organized hematoma. Indirect or percutaneous reduction may be attempted after removal of the small blocking fragments. This technique may improve the likelihood of achieving a closed reduction and avoiding the need for a posterolateral approach. Even if a posterolateral approach is performed, arthroscopic removal of fragments will facilitate an easier open reduction and decrease the amount of dissection needed. The arthroscope used for this approach may also be inserted into the ankle joint to assess the reduction of the posterior malleolar fracture.

Objectives. The extracapsular spread (ECS) of metastatic lymph nodes is associated with aggressive tumor behavior, and is regarded as a major risk factor for local recurrence in patients with head and neck squamous cell carcinoma. However, the significance of ECS of metastatic lymph nodes has not been well established in well-differentiated thyroid carcinoma. The purpose of this study was to examine this question.Methods. A retrospective review was performed of 335 patients with papillary thyroid carcinoma who underwent total thyroidectomy with lymph node dissection from April 2001 to December 2009. We analyzed various clinical characteristics, pathologic factors, and the size, number, and ECS of foci in metastatic lymph nodes.Results. On pathologic review, 201 of the patients (56.6%) had lymph node metastasis. This was significantly related to age and tumor size. ECS was noted in 64 of these 201 patients (31.8%), and was significantly related to male gender, tumor size, presence of extrathyroidal extension, metastatic lymph node size, and focus size. Recurrence occurred in 13 patients (3.9%), and the presence of ECS was significantly related to recurrence.Conclusion. ECS of metastatic lymph nodes is an important prognostic factor for loco-regional recurrence in papillary thyroid carcinoma.

Fibular shortening and rotational malunion may occur after the operative or nonoperative treatment of ankle fractures. A malunited fracture with fibular shortening and lateral talus shift portends a poor outcome, with pain, swelling, or stiffness often leading to degenerative arthritis. Biomechanical studies have shown that symptoms arise because of increased ankle joint contact pressure resulting from distal fibular displacement and shortening of 2 mm or external rotation of 5 degrees or more. Several techniques have been introduced for lateral malleolar reconstruction, including transverse, oblique, and Z-osteotomy. Transverse osteotomy with bone grafting and internal fixation has been shown to effectively treat fibular shortening. An AO distractor can be used to distract the osteotomy and thus achieve the correct fibular length. After fibular osteotomy, a plate is applied to the distal fibular fragment; one arm of the distractor hooks into the proximal end of the plate, and the other arm is applied to a temporary screw inserted proximal to the plate for distraction. However, this technique requires proximal extension of the incision and exposure for temporary screw placement. This technique requires a special device (AO distractor) that may not be available in some operation rooms. Although a laminar spreader can be used, it can only be used for a transverse osteotomy (not oblique or Z-osteotomy), and it may sometimes be difficult to impact a strut bone graft into the gap when the laminar spreader is positioned in the gap to maintain the distraction. Fibular plate application may not be straightforward when a laminar spreader is placed. Fibular lengthening with a uniplanar external fixator for distraction osteogenesis has been reported. However, the main disadvantage of this technique is the required lengthy external fixation period. Another surgery may be needed to apply a plate for additional stability after external fixator removal because the newly formed bone might fracture. In this article, we describe a novel technique that uses the oblong hole of a locking plate for fibular lengthening and does not require a special device. This technique is straightforward and allows easy control of osteotomy distraction and compression. This technique can also be used during minimally invasive plate osteosynthesis for a shortened and comminuted lateral malleolus fracture to restore the fibular length without opening the fracture site.

Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient's position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction.

213 Copyright c 2014 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received November 26, 2013 Revised May 30, 2014 Accepted May 30, 2014 Address reprint requests to: Ji Hyo Hwang, M.D., Ph.D. Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 150-950, Korea Tel: 82-2-829-5165ᆞFax: 82-2-834-1728 E-mail: hwangjihyo7309@gmail.com

Adenoid cystic carcinoma (ACC) of the breast is a rare special subtype of breast cancer characterized by the presence of a dual cell population of luminal and basaloid cells arranged in specific growth patterns. Most breast cancers with triple-negative, basal-like breast features (i.e., tumors that are devoid of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression, and express basal cell markers) are generally high-grade tumors with an aggressive clinical course. Conversely, while ACCs also display a triple-negative, basal-like phenotype, they are usually low-grade and exhibit an indolent clinical behavior. Many discoveries regarding the molecular and genetic features of the ACC, including a specific chromosomal translocation t(6;9) that results in a MYB-NFIB fusion gene, have been made in recent years. This comprehensive review provides our experience with ACC of the breast, as well as an overview of clinical, histopathological, and molecular genetic features. (c) 2014 Baishideng Publishing Group Inc. All rights reserved.

The purpose of this study was to assess the results of a novel surgical technique for the treatment of chronic lateral ankle instability with attenuated or deficient ligamentous tissue that the modified Broström procedure could not be performed. A lateral ankle ligament reconstruction using the anterior half of the peroneus longus tendon has been performed.

We have recently shown seminal vesicle intraepithelial involvement of prostate cancer in cases with seminal vesicle invasion (pT3b). Based on the manner of seminal vesicle invasion, there could be 2 possible mechanisms of seminal vesicle intraepithelial involvement: direct intraepithelial invasion from prostate carcinoma in the muscular wall of seminal vesicles or intraepithelial involvement of cancer from the invaginated extraprostatic space (IES)/ejaculatory duct system to extraprostatic seminal vesicle. We aimed to clarify the manner and clinicopathological significance of seminal vesicle intraepithelial involvement. Of 1629 consecutive radical prostatectomies, 109 cases (6.7%) showed seminal vesicle invasion in whole-mounted radical prostatectomy specimens. In these pT3b cases, 18 (17%) showed seminal vesicle intraepithelial involvement by prostate cancer. Stromal invasion of the IES/ejaculatory duct system and ejaculatory duct intraepithelial invasion by prostate cancer were identified in 62 and 5 of 109 pT3b cases, respectively. However, the presence/absence of IES/ejaculatory duct system involvement by prostate cancer does not predict seminal vesicle intraepithelial involvement. No statistically significant correlation was observed between all pathologic parameters/biochemical recurrence and the presence/absence of seminal vesicle intra-epithelial involvement in the pT3b cases. These findings suggest that seminal vesicle intraepithelial involvement is more likely due to direct invasion of carcinoma from the muscular wall of seminal vesicles rather than intraepithelial extension from the ejaculatory duct system in the IES. Further studies with a substantially greater case number are needed to clarify the clinicopathological significance of seminal vesicle intraepithelial involvement in a better manner.

Fixation of a large osteochondral fragment on the posteromedial talus can be performed using medial malleolar osteotomy or an arthroscopic technique with a transmalleolar portal. However, osteotomy can be associated with some morbidity, such as longstanding pain and tenderness at the osteotomy site. Also, it requires longer immobilization. However, the transmalleolar portal damages the tibial articular cartilage, which can later cause pain. In young patients, it can injure the epiphyseal plate. We describe a posterior arthroscopic technique using 3 posterior portals that allow access to a posteromedial osteochondral lesion of the talus and fixation of the osteochondral fragment without malleolar osteotomy or transmalleolar drilling.

Acquired cystic disease-associated renal cell carcinoma (ACD-RCC) is a subtype of renal cell carcinoma (RCC) with unique morphologic features found exclusively in the background of end-stage renal disease. We analyzed the clinicopathologic features and immumoreactive profiles of 12 cases of ACD-RCC to further characterize this recently recognized entity. Review of histologic slides was performed in conjunction with immunohistochemical staining directed to the contemporary diagnostic antibodies and the putative target therapy-related markers. Histologically, the tumors showed characteristic inter-or intracellular microlumens and eosinophilic tumor cells. Intratumoral hemosiderin deposition and degenerating foamy tumor cells were consistent findings which were not previously described. Immunohistochemically, all the tumors were positive for alpha-methylacyl-CoA-racemase, CD10, pan-cytokeratin, PTEN (phosphatase and tensin homolog deleted on chromosome 10) and c-met, while negative for carbonic anhydrase-9, CD57, CD68, c-kit, pax-2, platelet-derived growth factor receptor (PDGFR)-α or vascular endothelial growth factor receptor (VEGFR)-2. Heterogenous staining was found for CK7 and kidney-specific cadherin. Positive reaction to c-met suggests its utility as a plausible therapeutic target in ACD-RCC. Thus, we present the unique morphologic and immunopathologic features of ACD-RCC, which may be helpful in both diagnostic and therapeutic aspects.

Brachymetatarsia, a rare foot deformity, can be congential or acquired in origin and is defined as an abnormal shortening of the metatarsal bone. This shortening is caused by a premature fusion of the metatarsal epiphysis. Gradual distraction osteogenesis, which allows lengthening of the metatarsal while giving adequate time for the soft tissue to adapt to the lengthened bone, is most widely used for operative correction of brachymetatarsia. However, several complications have been reported following distraction osteogenesis for first brachymetatarsia. Oh et al reported cavus foot deformity as a major complication in 4 of 13 first metatarsal lengthenings. Normally, the first metatarsal has approximately 30 degrees of metatarsal inclination in the sagittal plane. However, the short first metatarsal in first brachymetatarsia usually has an increased inclination angle, and its head is situated at a similar level as that of the second metatarsal head in the sagittal plane, maintaining a plantigrade foot (Figure 1). Therefore, when the first metatarsal is lengthened along its longitudinal axis, the first metatarsal head will project downward under the plantar surface of the foot resulting in a cavus foot deformity. This may result in excessive load and pain in the plantar area of the first metatarsal head. Some authors have suggested the use of horizontal distraction in the anterior direction rather than lengthening through the anatomical axis. However, this requires insertion of external fixator pins into the first metatarsal parallel to the plantar surface of the foot, which is difficult in a short and inclined first metatarsal (Figure 1). The short first metatarsal with an increased inclination angle may not accept the most distal pin in a horizontal direction parallel to the plantar surface of the foot or the dorsal cortex of the metatarsal head may break during lengthening (Figure 1). In this article, we describe a technique that corrects the increased inclination angle of the short metatarsal before the lengthening. This allows insertion of 4 pins at the center of the first metatarsal and lengthening along the longitudinal axis without subsequent plantar projection of the first metatarsal head and subsequent development of cavus deformity of the foot.