Incidence and Risk Factors of Ipsilateral Foot and Lower Limb Reamputation in Diabetic Foot Patients / 대한족부족관절학회지

PURPOSE: To evaluate the incidence and risk factors of ipsilateral reamputation after lower limb amputation in the patient with diabetic foot lesions. MATERIALS AND METHODS: Between May 2005 and June 2009, 88 patients who underwent lower limb amputation were analyzed. Group 1 consisted of 73 patients who didn't have a ipsilateral reamputation after lower limb amputation and group 2 consisted of 15 patients who underwent reamputation. We compared several factors between two groups, such as age, gender, BMI, ABI, Wagner classification, wound culture, site of amputation, vascular surgery, the period of diabetes mellitus, chronic renal failure. RESULTS: Fifteen (17%) of 88 patients had a ipsilateral limb reamputation and 13 patients (87%) of them underwent reamputation within 6 months. When we compared the two groups, average age was 59.3 (range, 48-74 years); 62.9 (range, 44-78 years). Age was significantly associated with reamputation rate (p=0.02) and no reamputation after initial amputation above ankle joint was found. Other factors did not show statistically difference between both groups. CONCLUSION: There were no significant difference between diabetic limb amputation and reamputation group in our concerned risk factors except age and amputation level. There should be careful consideration when determine level of amputation in diabetic foot lesions especially in elder patients.

Negative-Pressure Wound Therapy Using Modified Vacuum-Assisted Closure in Patients with Diabetic Foot Ulcers / 임상당뇨병

Diabetic foot ulcers (DFU) are common and serious complications of diabetes mellitus. The prognosis of DFU may be very poor even during early stages depending on the general conditions of patients, and amputation is often required to manage DFU. Various therapeutic approaches to DFU have been introduced, and among these negative-pressure wound therapy using vacuum-assisted closure (VAC-NPWT) is particularly noteworthy. We performed VAC-NPWT in three patients with complicated DFU. We used a modified VAC-NPWT protocol, which used wall suction and curaVAC(R). Dressing changes were performed every week, which was longer than standard method. All of our cases improved with granulating wound beds and were cleared of bacterial infection by the end of modified VAC therapy. These modifications reduced the costs of VAC-NPWT without introducing associated side effects. We recommend the active application of VAC-NPWT for complicated DFU, although this recommendation should be confirmed by large randomized controlled studies.

Multiple Bilateral Thoracic Perineural Cysts: A Case Report

STUDY DESIGN: Case report OBJECTIVES: We report a case of relatively rare multiple bilateral perineural cysts. SUMMARY OF LITERATURE REVIEW: Tarlov cysts, also known as perineural cysts are most often found in the sacral region, but there are a few cases reported in the thoracic region. In particular, there are very few cases of multiple bilateral thoracic perineural cysts. MATERIALS AND METHODS: A woman aged 65 years with perineural cysts in the bilateral T10-T11 and T11-12 neural foramens, underwent a T10-11-12 decompressive laminectomy and resection of the cyst. RESULTS: Satisfactory results were obtained for the patient after surgery. CONCLUSIONS: For more detailed and definitive treatment of thoracic perineural cysts, additional cases are required.

Multiple Noncontiguous Fractures in Cervical Spine: Cases Report

STUDY DESIGN: Cases report OBJECTIVES: We report 2 cases of relatively rare cervical fracture. SUMMARY OF LITERATURE REVIEW: Although numerous studies in the literature have investigated cervical spine injuries, patients with multiple-level cervical fractures have not been commonly described. Multiple non-contiguous cervical fractures are distinctively unusual. MATERIALS AND METHODS: First case was a girl aged 8 years and 4 months who had multifocal compression fracture of C3, 5, 6 & T7, 8 without spinal cord injury. Second case was a thirty nine-year-old female who had Type I Hangman's fracture and compression fractures of C3, 7. RESULTS: We had satisfactory results of them treated nonsurgically. CONCLUSIONS: We should remind that cervical spinal column can incur multiple injuries in variant patterns.

Treatment for the Lumbosacral Soft Tissue Defect after Spine Surgery

The lumbosacral area is one of the most frequently operated spine regions because of the prevalence of disease in that area. Although a lumbosacral soft tissue defect after surgery due to inflammation and other causes is rare, such soft tissue defects are difficult to treat. Therefore, suitable methods for treating lumbosacral soft tissue defects are necessary. Therefore, this study introduces a case-treated with a transverse lumbosacral rotational flap.

Total Ankle Replacement in Pigmented Villonodular Synovitis of Ankle Joint (A Case Report) / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) is a rare proliferative disease affecting joint synovium, tendon sheaths, bursae. The usual treatment for PVNS is a surgical excision. If destructive joint lesions have occurred, complete resections must be performed followed by arthrodesis or arthroplasty. We report a case of a pigmented villonodular synovitis involving an ankle joint which was treated by total ankle replacement for recurrence after simple synovectomy.

Posterior Instability after Posterior Cruciate Ligament Substituted TKA: Case Report / 대한정형외과학회잡지

Posterior instability after a posterior ligament substituted total knee replacement is considered impossible due to the cam and post mechanism. Therefore, it has not been considered easily as a problem necessitating revision surgery. We report two cases of posterior instability after a fixed bearing posterior cruciate ligament substituted total knee replacement with a review of relevant literature.

Anthropometric Study of Distal Femur & Compatibility of Gender Knee Prosthesis in Total Knee Replacement

PURPOSE: The new prosthesis was introduced for female recently considering anthropometric differences of distal femur between male and female. We evaluated the anthropometric measurements of distal femur and compatibility of gender knee prosthesis in total knee replacement . MATERIALS AND METHODS: The candidates were 100 female patients who underwent total knee replacement. We measured the size of resection site which was divided into 6 areas after resection of femur. According to this result, we made a decision which prosthesis would be better fit. Group 1 was whom gender knee prosthesis was used in and group 2 was whom conventional knee prosthesis was used in. RESULTS: Gender knee prosthesis was used in 58cases out of 100 cases (58%). There were significant differences in measurements between group 1 and 2 except anterior flange lengths (p<0.05). Gender knee prosthesis was chosen in 33.4% of size C, in 57.4% of size D, in 70.4% of size E. There were less than 5% discrepancies of width between components and femur. The larger the femur, the lesser the ML/AP ratio. CONCLUSION: Conventional knee prosthesis is adequate to who has smaller distal femur and gender knee prosthesis is adequate to who has larger distal femur in total knee replacement. It is thought that we may select gender knee prosthesis considering the size of femur intraoperatively.

Dislocation of Tibial Insert after Fixed Bearing TKA using Minimal Invasive Surgery: A Case Report

Posterior instability after mobile bearing total knee replacement may be caused by gap imbalance, component malpo- sition, and delayed rupture of posterior cruciate ligament, but could not be easily considered other cause except component breakage in fixed bearing posterior cruciate substituted total knee replacement. The dislocation of tibial polyethylene insert was reported after mobile bearing total knee replacement but rare after fixed bearing total knee replacement. We report a case of dislocation of tibial polyethylene insert that have been found at a patient who had continuing posterior instability after fixed bearing posterior cruciate ligament substituted total knee replacement with a review of article.

Arthroscopically assisted Minimal Invasive Surgery of Calcaneal Intraarticular Fractures / 대한족부족관절학회지

PURPOSE: To evaluate the surgical procedure and results of arthroscopically assisted minimal invasive surgery of calcaneus intraarticular fractures. MATERIALS AND METHODS: Between June 2001 and March 2004, 10 patients were treated with that method. 9 cases were Sanders type 2 fracture and only one case was Sanders 3 fracture. During calcaneal traction using percutaneus K-wire and tension device into the tuberosity fragment, anatomical reduction was performed under direct arthroscopic and fluoroscopic control. After anatomical reduction was achieved, the fragment was fixed with cannulated screws via incisions. RESULTS: The functional results were good to excellent, with an average AOFAS ankle-hindfoot score of 90.4 (range 85-95) and there were no wound problems. CONCLUSION: Arthroscopically assisted minimal invasive surgery allowed exact assessment of the articular surface and allowed anatomical reduction while adhering to the principles of minimally invasive surgery.

Operative Treatment for Hallux Valgus with Proximal Metatarsal Osteotomy in Patients over 55 Years Old / 대한족부족관절학회지

PURPOSE: The purpose of our report was to evaluate the result of operative treatment of hallux valgus in old age patients. MATERIALS AND METHODS: We studied about the clinical & radiologic results of the 31 patients over 55 years old, who had operative treatment of hallux valgus. Clinical evaluation, such as pain, activity limitation, footwear requirement, 1st metatarsophalangeal joint motion, and callosity, was done using AOFAS scale and preoperative and postoperative radiologic parameters, such as hallux valgus angle, intermetatarsal angle, tibial sesamoid position, 1st metatarsal shortening, were evaluated by conventional methods. RESULTS: Objectively, according to AOFAS, the score improved from average of 57.8 to 71.5 postoperatively. The range of motion of first metatarsophalangeal joint was decreased from average of 60.7 to 56.8 degrees. Radiologically, the hallux valgus angle improved from average of 35 to 6.5 degrees and the first intermetatarsal angle improved from average of 14.2 to 4.4 degrees. The position of sesamoid was collected from an average of grade 3.6 to grade 2.2. CONCLUSION: The combination of proximal metatarsal osteotomy, distal soft tissue procedure and Akin osteotomy may yield rather satisfactory clinacal result in severe elderly hallux valgus patients with massive degenerative change and poor soft tissue condition.

Operative Treatment for Hallux Valgus with Proximal Metatarsal Osteotomy in Patients over 55 Years Old / 대한족부족관절학회지

PURPOSE: The purpose of our report was to evaluate the result of operative treatment of hallux valgus in old age patients. MATERIALS AND METHODS: We studied about the clinical & radiologic results of the 31 patients over 55 years old, who had operative treatment of hallux valgus. Clinical evaluation, such as pain, activity limitation, footwear requirement, 1st metatarsophalangeal joint motion, and callosity, was done using AOFAS scale and preoperative and postoperative radiologic parameters, such as hallux valgus angle, intermetatarsal angle, tibial sesamoid position, 1st metatarsal shortening, were evaluated by conventional methods. RESULTS: Objectively, according to AOFAS, the score improved from average of 57.8 to 71.5 postoperatively. The range of motion of first metatarsophalangeal joint was decreased from average of 60.7 to 56.8 degrees. Radiologically, the hallux valgus angle improved from average of 35 to 6.5 degrees and the first intermetatarsal angle improved from average of 14.2 to 4.4 degrees. The position of sesamoid was collected from an average of grade 3.6 to grade 2.2. CONCLUSION: The combination of proximal metatarsal osteotomy, distal soft tissue procedure and Akin osteotomy may yield rather satisfactory clinacal result in severe elderly hallux valgus patients with massive degenerative change and poor soft tissue condition.

Double Check Method of Femoral Alignment in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To determine the effectiveness of a double checking method with an extramedullary guide for improving the accuracy of an intramedullary alignment guide in a total knee arthroplasty. MATERIALS AND METHODS: From June 1999 to October 2002. 30 cases of a double checked total knee arthroplasty with an extramedullary guide were classified as Group I, and an other 30 cases of a total knee arthroplasty with an intramedullary guide were classified as Group II. The extramedullary guide was a set 3-finger width medial to the anterior superior iliac spine as a landmark, and was checked by the X-ray findings during surgery. The radiological assessment was carried out by comparing the preoperative and postoperative standing AP view. RESULTS: The postoperative femorotibial angle in Group I was valgus 5.9degrees (5-9degrees) and valgus 7.7degrees (4-11degrees) in Group II. The normal anatomical variation (valgus 6+/-2degrees) was outranged in 1 case (3%) in group I, and 6 cases (20%) in group II. CONCLUSION: Determining the angle of a distal femoral resection only with an intramedullary guide can cause a misalignment by many factors. The double check method with an extramedullary guide can improve the alignment accuracy, and show better results.

Five Year Results of Hydroxyapatite Coated Hip System: Early Severe Wear and Acetabular Osteolysis / 대한정형외과학회잡지

PURPOSE: To assess the midterm results of the hydroxyapatite hip system with acetabular cups, with particular emphasis upon cup wear and loosening, using a computer assisted-3 dimensional technique. MATERIALS AND METHODS: From March 1992 to December 1996, 52 patients (61 hips) were available for inclusion in this study after an average duration of follow up of 6 years and 4 months. Clinical evaluation was performed using the Harris hip scoring system. Initial postoperative and long term follow up films were digitized, and 2 dimensional linear and 3 dimensional wear was measured by using a computer assisted-3 dimensional technique. Acetabular bone changes are described using previous published methods. RESULTS: An analysis of the clinical results showed a mean Harris hip score of 47.2 points preoperatively and 89.8 points at the final visit. The mean polyethylene 3D-linear wear rate was 0.26 mm/year and mean volumetric wear rate was 105.9 mm3/year. In 16 hips (26.2%) the linear wear rate was more than 0.3 mm/year (0.30-0.74 mm/year). Osteolytic changes of the acetabulum were recorded in 51% around acetabular cups, in which considerable wear of the acetabular polyethylene was evident by the five-year radiographic findings. CONCLUSION: Midterm results of hydroxyapatite coated acetabular cups were disappointing in terms of acetabular cup and liner wear, despite early accelerated bone remodeling by hydroxyapatite and excellent early clinical results.