Total Talar Extrusion without Soft Tissue Attachments

Total talar extrusion without a soft tissue attachment is an extremely rare injury and is rarely reported. Appropriate treatment remains controversial. We describe the long-term outcomes of two patients who had complete talar extrusion without remaining soft tissue attachment treated with arthrodesis. Both of our patients had complications such as infection and progressive osteolysis. We suggest reimplantation of the extruded talus after thorough debridement as soon as possible as a reasonable option unless the talus is contaminated or missing, because an open wound may arise from inside to outside.

Traumatic Femoral Head Fracture without Hip Dislocation: A Case Report / 대한고관절학회지

The incidence of femoral head fracturesafter posteriorhip dislocation is approximately 5-15%, and femoral head fractures are highly associated with posterior dislocation. Femoral head fractures can cause avascular necrosis of the femoral head or post-traumatic osteoarthritis; therefore, diagnosis and appropriate treatment is important. We present a case of femoral head fracture without hip dislocation, as well as a literature review.

The Incidence of Venous Thromboembolism in Trauma Patients with Pelvic or Acetabular Fracture

PURPOSE: To evaluate the incidence of venous thromboembolism (VTE) in trauma patients with pelvic or acetabular fracture and determine high risk factors. MATERIALS AND METHODS: Twenty-three patients who had a pelvic or acetabular fracture were enrolled between March 2011 and February 2012. All patients had mechanical and chemical prophylaxis and underwent deep vein thrombosis (DVT) computed tomography around 2 weeks after injury for evaluation of VTE. The relationships between VTE and each of sex, age, body mass index, injury severity score, intensive care unit stay, transfusion, operation time, coagulopathy, and associated injury were analyzed. RESULTS: A total of 8 patients developed VTE (34.8%), of which 5 had DVT, 2 had pulmonary embolism (PE), and one had both DVT and PE. The group with a VTE risk score of 14 or more had a significantly higher incidence of VTE. CONCLUSION: Careful attention is needed in management of patients with pelvic or acetabular fracture.

Fractures of the Proximal Fifth Metatarsal: Percutaneous Bicortical Fixation

BACKGROUND: Displaced intraarticular zone I and displaced zone II fractures of the proximal fifth metatarsal bone are frequently complicated by delayed nonunion due to a vascular watershed. Many complications have been reported with the commonly used intramedullary screw fixation for these fractures. The optimal surgical procedure for these fractures has not been determined. All these observations led us to evaluate the effectiveness of percutaneous bicortical screw fixation for treating these fractures. METHODS: Twenty-three fractures were operatively treated by bicortical screw fixation. All the fractures were evaluated both clinically and radiologically for the healing. All the patients were followed at 2 or 3 week intervals till fracture union. The patients were followed for an average of 22.5 months. RESULTS: Twenty-three fractures healed uneventfully following bicortical fixation, with a mean healing time of 6.3 weeks (range, 4 to 10 weeks). The average American Orthopaedic Foot & Ankle Society (AOFAS) score was 94 (range, 90 to 99). All the patients reported no pain at rest or during athletic activity. We removed the implant in all cases at a mean of 23.2 weeks (range, 18 to 32 weeks). There was no refracture in any of our cases. CONCLUSIONS: The current study shows the effectiveness of bicortical screw fixation for displaced intraarticular zone I fractures and displaced zone II fractures. We recommend it as one of the useful techniques for fixation of displaced zone I and II fractures.

Delayed Diagnosed Stage 1, 2 Distractive Flexion Injury of the Cervical Spine

STUDY DESIGN: Retrospective study. PURPOSE: To examine the clinical and radiologic characteristics of patients with stage 1 and 2 distractive flexion injury according to Allen's classification and who were not diagnosed immediately after injury, and to analyze the outcomes of surgical treatments. OVERVIEW OF LITERATURE: For the diagnosis of stage 1 and 2 distractive flexion injury in the lower cervical spine, attention should be paid when performing radiographs as well as when interpreting the radiographs. METHODS: The study was conducted on 10 patients (group 1) with stage 1 or 2 distractive flexion injury and who were not diagnosed immediately after injury from January 2003 to January 2009. The control group (group 2), 16 distractive flexion injury patients who were diagnosed immediately were selected. The simple radiographs, the degree of soft tissue swelling and the magnetic resonance imaging findings of the two groups were compared, and the clinical and radiologic results were examined. RESULTS: The degree of the prevertebral soft tissue swelling of group 1 was lower in group 1, and it was statistically significant (p = 0.046). The fusion was achieved in all cases (100%) in group 1, however, re-displacement as well as the loss of reduction occurred in one case, despite of delayed fusion and good clinical result. In group 2, bone fusion was achieved in 15 cases of 16 cases (94%). CONCLUSIONS: For the diagnosis of stage 1 and 2 distractive flexion injury in the lower cervical spine, it is desirable to perform computed tomography if diagnosis is not clear. Even if the diagnosis is delayed, stage 1 and 2 distractive flexion injury could be readily reduced by traction, and the treatment outcomes are considered to be comparable to those of the patients diagnosed immediately after injury.

Body Mass Index in Patients with Early Posterior Tibial Tendon Dysfunction in Korea / 대한정형외과학회잡지

PURPOSE: Posterior tibial tendon dysfunction (PTTD) is known as the most common cause of adult acquired flatfoot syndrome and is common in middle-aged obese women. The purpose of this study was to describe the relationship between BMI (body mass index) and early stage PTTD in Korea. MATERIALS AND METHODS: Between May 2005 and June 2006 we evaluated 42 patients (58 feet) who were diagnosed and treated for early stage PTTD. We analyzed demographic data such as sex, age, BMI, physical findings, radiologic findings and clinical results. RESULTS: All 42 patients were women; their mean age was 52.6 years. Of the 42, 77% were middle aged (40-69). Increased BMI was detected in 75% of the 42 patients. There was no statistical significance in age-matched comparisons of BMI in Korea (p>0.05), or in the correlation between BMI and progression (p=0.293). Non-obese patients had superior clinical results (p=0.017). CONCLUSION: Overweight and obesity are commonly seen in patients with early stage PTTD in Korea but there do not appear to be any significant correlation between obesity and early stage PTTD and also no significant correlation between obesity and progression to later stages.

Treatment of the Posterior Malleolar Fracture Using Posterior Approach

PURPOSE: For fixation of the large posterior malleolar fracture fragment, indirect anterior fixation with cannulated screw has been widely used, but the anatomical reduction is not always obtained. The purpose of this article is to evaluate the clinical result of posterior malleolar fractures treated with anatomical reduction and internal fixation using posterior approach. MATERIALS AND METHODS: We have analyzed the 15 patients with posterior malleolar fractures, treated with posterior approach from August 2005 to August 2008. The mean follow up period was 17.6 months, We have reviewed the perioperative joint integrity, method of operation, postoperative care, bony union and complication. A clinical outcome was evaluated by AOFAS (American orthopedic foot and ankle society) scaling system and Olerud & Molander scoring system. RESULTS: Among 15 cases, posterolateral approach and posteromedial approach were chosen in 9 cases and 6 cases respectively. The radiologic unions were achieved at 12.4 (12~18) weeks. Mean AOFAS score was 90.3 (72~98), and Olerud & Molander score was "excellent" in 5 cases, "good" in 7 cases, "fair" in 1 case and "poor" in 2 cases. Postoperative complications in 2 cases revealed a posttraumatic arthritis and a scar band contracture respectively. CONCLUSION: In posterior malleolar fracture of ankle joint, the integrity of joint has closely affected clinical outcomes. We suggest that a posterior approach for posterior malleolar fracture with especially incarcerated fragments and comminuted fractures, can be a useful method for anatomical reduction and stable fixation, and satisfactory clinical results.

Ankle Arthrodesis in Very Unstable Charcot Arthropathy using Autogenous Fibular Strut Bone Graft (A Case Report) / 대한족부족관절학회지

Charcot arthropathy of the foot and ankle is characterized by a combination of sensory, motor and autonomic peripheral neuropathy leading to gross swelling, bony destruction and finally severe bony deformity with joint instability. We report a case of very unstable Charcot arthropathy in ankle joint managed with ankle arthrodesis using fibular strut bone grafting technique.

Range of Motion of Great Toe after Sesamoidectomy: A Cadaveric Study / 대한족부족관절학회지

PURPOSE: Regardless of potential and actual complications, the sesamoidectomy either tibial side or fibular side or both, had been used as a surgical option for various pathologic conditions. The objective of this cadaveric study was to identify the changes of range of motion of great toe after sesamoidectomy. MATERIAL AND METHODS: Eight fresh cadaver legs were used. The angular changes of the hallucal articulations were measured by traction of the flexor hallucis longus tendon at the proximal border of fibro-osseous tarsal tunnel and by traction of the extensor hallucis longus tendon at the superior border of inferior extensor retinaculum. The measurement started at neutral position and proceeded to the maximum for respective tendons. After sesamoidectomy either partial or total, same procedures were repeated and the angular changes were measured. RESULTS: In flexion of great toe, there were significant metatarsophalangeal angular differences at 1 cm traction in total sesamoidectomy and lateral sesamoidectomy. In extension of great toe, there were significant metatarsophalangeal angular differences at more than 2 cm traction in total sesamoidectomy. In other measurements, there were no significant angular changes of the hallucal articulations. CONCLUSION: The sesamoidectomy resulted in change of motion of great toe. Statistical analysis showed that the significant increases in the initial flexion and maximal extension occurred with total sesamoidectomy and the significant increase in the initial flexion occurred with lateral sesamoidectomy.

Impact of Weight Bearing Surface on Fractures of the Talus / 대한족부족관절학회지

PURPOSE: The fracture of talus has critical complications and results in various clinical outcomes. The purpose of this study is to evaluate clinical outcome and influence on involvement of ankle and subtalar joint. MATERIALS AND METHODS: From December 1999 to December 2008, a total of 66 fractures and dislocations of talus was treated with minimal 9 months follow up period. Ankle-hindfoot scale of the American Orthopedic Foot& Ankle Society (AOFAS) was used to evaluate the clinical outcome. The complications and sequential radiologic findings were also analyzed. RESULTS: There were 28 neck fractures, 11 lateral process fractures, 10 body fractures, 7 osteochondral fractures, 4 posteromedial tubercle fractures and 4 medial process fractures. In 38 cases, there were concomitant injuries. Ipsilateral ankle fracture, which found in 19 cases, was most common. The surgical treatment was performed in 36 cases. Mean AOFAS score was 85.5 (range, 72 to 96). In 13 of 47 cases, one or more fracture lines involving weight bearing surface were confirmed. The involvement of ankle or subtalar joint had resulted in unsatisfied outcome. Complications were developed as follows, post-traumatic arthritis in 8 cases, avascular necrosis in 3 cases, and deep infection in 2 cases. CONCLUSION: The involvement of ankle or subtalar joint in fractures of talus seemed to be common and to impact the clinical outcome. Meticulous consideration about that will be positively necessary.

Flexible Intramedullary Nail Fixation of Pediatric Femoral Shaft Fracture

PURPOSE: To traditional treatment of pediatric femoral shaft fracture has been a traction and spica cast application. But flexible intramedullary nail fixation has been introduced as an alternative to other treatment modalities. With this in mind, we analyzed the clinical and radiologic results of flexible intramedullary nail fixation of pediatric femoral shaft fractures. MATERIALS AND METHODS: We analyzed 12 patients (13 cases) who were treated with flexible intramedullary nail and followed up for at least 6 months at the department of Orthopedic Surgery, Inje University Ilsan Paik Hospital since May, 2002. RESULTS: In all 12 patients (13 cases) involving 1 case with reoperation because of reduction failure, average duration of bone union was 12.6 weeks. There were no considerable complications except mild post-op knee pain and limitation of motion. CONCLUSION: In spite of relatively short term study, a flexible intramedullary nail fixation seems to be a useful method without serious complications on pediatric femoral shaft fracture. However, in big or older pediatric patients, interlocking intramedullary nail fixation may be a better choice rather than a flexible nail fixation because of it's insufficient stability.