Ankle Arthrodesis: A Comparison of Anterior Approach and Transfibular Approach

BACKGROUND: The purpose of this study was to compare clinical and radiological results of arthrodesis performed by the anterior approach and by the transfibular approach in ankle osteoarthritis. METHODS: Sixty patients underwent open arthrodesis (38 by the anterior approach and 22 by the transfibular approach). The visual analogue scale score and the American Orthopedic Foot and Ankle Society (AOFAS) score were examined clinically, and radiological examination was performed on the alignment of the lower extremity and bone union. RESULTS: Both groups showed significant improvement in AOFAS score (from 39.8 to 58.3 in the anterior approach group and from 44.5 to 60.7 in the transfibular approach group). There was no significant difference in AOFAS score at the last follow-up in both groups. The time to fusion was 13.5 weeks in the anterior approach group and 11.8 weeks in the transfibular approach group. Nonunion occurred in four cases in the anterior approach group and in one case in the transfibular approach group. CONCLUSIONS: Ankle arthrodesis by the anterior approach and the transfibular approach showed comparably good clinical results.

A Comparative Study of Surgical Treatment Result in the Ruptured Achilles Tendon: Minimal Incision Percutaneous Repair and Open Repair / 대한정형외과학회잡지

PURPOSE: To compare and analyse the clinical outcomes between minimal-incision percutaneous repair and open repair among the surgical treatments for Achilles tendon ruptures. MATERIALS AND METHODS: We retrospectively analyzed and compared the outcomes between 25 patients with minimal incision percutaneous repair (group 1) and 30 patients with open repair (group 2), from January 2006 to June 2014. The postoperative clinical evaluations were done by Arner-Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, overall patient's satisfaction, and cosmetic satisfaction of scar. RESULTS: There were statistically significant differences between the two groups with respect to AOFAS hind foot score, mid-calf circumference differences, overall patient's satisfaction, and satisfaction of scar; the group 1 showed better achievement. There was no statistical difference between two groups in regards to other clinical outcomes. In group 1, there were 2 cases of sural nerve hypoesthesia, which fully recovered spontaneously at about 6 months after the surgery. In group 2, there were 3 cases of deep vein thrombosis, re-rupture, and deep infection. CONCLUSION: We recommend minimal incision percutaneous repair as one of the effective surgical treatment options for Achilles tendon ruptures.

Incidence of Tarsal Coalition: An Institutional Magnetic Resonance Imaging Analysis / 대한족부족관절학회지

PURPOSE: Tarsal coalition results from defects during the developmental stage and produes ankle pain and limitations in the range of motions. Its incidence has been reported to be 1%, but there has not been any reports with respect to Koreans. Therefore, we evaluated the prevalence of tarsal coalition in Koreans. MATERIALS AND METHODS: Between 2005 and 2014, we analyzed a total of 733 cases of foot and ankle magnetic resonance imaging (MRI) in our hospital. There were 391 men and 342 women. All MRI readings were read by a radiologist in our hospital. We classified the coalitions in accordance with the histological and anatomical characteristics, and calculated the prevalence in each group. Moreover, we tried to determine the prevalence of tarsal coalitions in accordance with sex, age, and proportion of the symptomatic tarsal coalitions. RESULTS: There were a total of 11 MRIs of tarsal coalition—9 talocalcaneal coalitions, 1 calcaneocuboidal coalition, and 1 calcaneonavicular coalition. Nine tarsal coalitions were observed in men and 2 in women. CONCLUSION: Through this study, we found that the prevalence of tarsal coalition, including the asymptomatic patients, is similar to the previously known prevalence (1%). By getting more MRIs of the foot and ankle, we could better represent the prevalence of tarsal coalitions in Koreans.

The Measurement of Normal Talus in Korean Cadaver / 대한족부족관절학회지

PURPOSE: To investigate the measured values of the talus in Koreans. MATERIALS AND METHODS: We measured 88 tali from 44 cadavers that have been donated between December 2012 and December 2015. Of the cadavers, 27 were male and 17 were female. Their mean age was 73 years. The length and width of the talus were measured using a digital goniometer and vernier caliper. RESULTS: The values of cadaveric measurement, mean maximal width and length, width and length of the dome anterior, width and length of the posterior facet, height and length of the trochlear medial facet, and height and length of the trochlear lateral facet were 43.6±2.6 mm, 56.5±3.3 mm, 32.5±2.0 mm, 42.2±2.7 mm, 22.2±2.2 mm, 34.7±2.0 mm, 15.3±1.3 mm, 33.3±2.9 mm, 25.3±3.3 mm, and 30.8±2.4 mm for men and 38.9±1.6 mm, 53.6±2.4 mm, 27.9±2.1 mm, 37.4±3.2 mm, 20.6±0.8 mm, 31.9±1.2 mm, 13.6±2.6 mm, 28.4±2.5mm, 24.9±2.1 mm, and 28.9µ1.4 mm for women, respectively. The size of the talus showed an accuracy of 86% when anteroposterior diameter was greater than 59 mm. A difference in the size of the right and left talus was not observed. The mean inclination and declination angles were 24.4°±4.2° and 28.2°±5.4° for men, and 24.6°±3.6° and 24.7°±6.7° for women (p=0.980, p=0.018), respectively, at least 15°, which showed a big difference for every object up to 37°. CONCLUSION: This paper, to the best of our knowledge, is the first study to measure the talus in Koreans. There were differences by gender and ethnicity in the in measured talus values. The measurements were smaller than European-Americans and greater than Japanese.

Intraoperative Three-Dimensional Imaging in Calcaneal Fracture Treatment

BACKGROUND: To compare the effectiveness of intraoperative three-dimensional (3D) image and conventional two-dimensional (2D) fluoroscopic images, which are used in the treatment of acute calcaneal fractures. METHODS: We retrospectively analyzed 40 patients who suffered calcaneal fracture and underwent surgery at Inje University Busan Paik Hospital. The patients were divided into two groups. Only 2D fluoroscopy was used to evaluate 20 patients of group 1. On the other hand, 3D fluoroscopy was performed on the remaining 20 patients of group 2; 3D fluoroscopy was performed on these patients after they were extensively evaluated by 2D fluoroscopy during surgery. We reviewed the radiographic and clinical outcomes of these patients, whose average follow-up period was 42.6 months. RESULTS: In group 2, 3D fluoroscopy detected four cases (20%) of articular incongruence and screw misplacement. All these complicated cases were corrected during surgery. At the final follow-up session, the mean American Orthopedic Foot and Ankle Society (AOFAS) hind foot score was 78.3 (range, 65 to 95) in group 1 and 82.3 (range, 68 to 95) in group 2. CONCLUSIONS: Intraoperative 3D imaging of calcaneal fractures is considered to be useful in evaluating the congruence of joints and the placement of implants.

Chronic Recurrent Multifocal Osteomyelitis on the Distal Tibia and Fibula / 대한정형외과학회잡지

Chronic recurrent multifocal osteomyelitis (CRMO) is a non-infectious inflammatory bone disease that occurs mainly in children and adolescents. The clinical presentation shows imprecise bone pain, while radiologic findings and histologic exam are similar to those of infectious osteomyelitis. It is a rare disease, which is difficult to distinguish from other diseases, therefore it could be misdiagnosed. We report on a case of CRMO on the distal tibia and fibula in an 11-year-old boy.

Fracture and Dislocation of Lisfranc Joint: Treatment with Screw and Kirschner Wire / 대한족부족관절학회지

PURPOSE: The purpose of this study is to retrospectively analyze the clinical results of screws and Kirschner wire (K-wire) fixation in patients with fracture dislocation of Lisfranc joint and the consequence of screw breakage. MATERIALS AND METHODS: Sixty patients underwent Lisfranc joint open reduction and removal of internal fixators from January 2007 to December 2011. Forty-nine cases (81.7%) underwent operations with screw alone, and 11 cases (18.3%) underwent operations with both screws and K-wires. Type of internal fixators, duration of internal fixator removal, breakage of internal fixators and satisfaction with reduction were investigated. Additionally, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scales were analyzed. RESULTS: The internal fixator was broken in 5 cases (8.3%). The average duration of instrument removal was 154 days in the non-broken screw group and 268.6 days in the broken screw group (p<0.05). The average AOFAS midfoot scale was 77.4 in the non-broken screw group and 74.2 in the broken screw group. The most commonly damaged portion was the first tarsometatarsal (Lisfranc) joint. CONCLUSION: Treatment with screws and K-wires was effective in patients with fracture dislocation of Lisfranc joint. The appropriate time for screw removal should be considered.

Measurement of Normal Calcaneus in Korean Cadavers: A Preliminary Report / 대한족부족관절학회지

PURPOSE: The purpose of this report is to evaluate the measured values of normal Korean calcaneus by conduct of a cadaveric study. MATERIALS AND METHODS: A total of 42 calcanei were obtained from Korean cadavers. A digital goniometer was used for measurement of Bohler's angle, Gissane angle, posterior facet articular inclination angle, and Fowler-Philip angle of calcaneus. A vernier caliper was used for measurement of the maximal antero-posterior length, maximal transverse width, and maximal height of calcaneus. RESULTS: The average Bohler's angle, Gissane angle, posterior facet articular inclination angle, and Fowler-Philip angle was 32.3degrees+/-5.0degrees, 114.4degrees+/-8.2degrees, 61.2degrees+/-4.4degrees, and 60.3degrees+/-7.6degrees. The average maximal antero-posterior length, maximal transverse width, and maximal height of calcaneus was 74.2+/-3.0 mm, 43.0+/-4.0 mm, and 42.5+/-3.0 mm. CONCLUSION: The measured values of normal Korean calcaneus were lower than the values reported in the international literature. Therefore, development of appropriate instruments reflecting the anatomical characteristics of Koreans will be needed.

Rupture of Achilles Tendon after Steroid Injection in Achilles Tendinitis (A Report of Five Cases) / 대한족부족관절학회지

PURPOSE: The purpose of the study was to investigate five cases with chronic Achilles tendon rupture that occurred after steroid injections. MATERIALS AND METHODS: In our hospital, we experienced five cases of chronic Achilles tendon rupture from September 2010 to March 2012. All patients had got steroid injection for Achilles tendinitis at the other hospitals, and their heel pain was aggravated when they visited our outpatient department. After treatment, signs and symptoms of Achilles tendon rupture were developed and the diagnosis was confirmed by ultrasonography or magnetic resonance imaging (MRI). Surgical treatment was done for Achilles tendon rupture. RESULTS: There was difference between intra-operative findings of Achilles tendon rupture and usual chronic Achilles tendon rupture. Unlike usual findings of chronic Achilles tendon rupture whose scar tissue or tissue attenuation are found around the defect area of Achilles tendon, there were partial necrosis of tendon severe adhesion with surrounding tissue, extensive defect and longitudinal rupture on ruptured area. Also, severe inflammation of paratenon, granulation and fibrinoid deposit were found on biopsy findings in four cases. CONCLUSION: Based on review of data about relative risk and benefit of local corticosteroid injection to inflammatory lesion in Achilles tendon, it requires more attention to Achilles tendon rupture following local corticosteroid injection.

Clinical Results Comparing Transtibial Technique and Outside in Technique in Single Bundle Anterior Cruciate Ligament Reconstruction

PURPOSE: To compare the clinical results of single-bundle anterior cruciate ligament (ACL) reconstruction using the conventional transtibial technique and the anatomical outside-in technique for femoral tunneling. MATERIALS AND METHODS: From 2007 to 2011, 89 patients who received ACL reconstruction were followed for > or =1 year were enrolled in the study. The conventional transtibial technique was used in 41 patients and the outside-in technique, in 48 patients. Femoral tunnel angle measurement and three-dimensional computed tomography (3D CT) were used for radiologic assessment of the location of femoral tunnel and Lysholm score and other tests were used for clinical assessment. RESULTS: Both techniques did not reveal statistical differences in the clinical assessment. However, in International Knee Documentation Committee subjective knee evaluation, the sum of two questionnaire items regarding instability showed a statistically significant difference (p=0.01). In the pivot shift test, the anatomical outside-in technique showed outstanding rotational stability over the transtibial technique (p=0.04). The mean femoral tunnel inclination in coronal plane were 69.2degrees and 30.3degrees, respectively, for both techniques, and 21.6degrees and 50.8degrees, respectively in sagittal plane, showing statistically significant differences on simple radiography (p=0.04, 0.05). A 3D CT was performed in 17 patients with the conventional transtibial technique and 25 patients with the outside-in technique. Coefficients of variation were 0.33 and 0.13, respectively, from dorsal border of the condyle and 0.67 and 0.24, respectively, from the roof of intercondylar notch. CONCLUSIONS: Femoral tunnels created with the outside-in technique have superior knee joint rotational stability compare to the transtibial technique. Therefore, the outside-in technique could be considered as a valuable technique in single-bundle ACL reconstruction.

A Osteochondroma of Calcaneus with Gouty Arthritis of the Subtalar Joint (A Case Report) / 대한족부족관절학회지

Osteochondroma, which is an osteocartilaginous exostosis, is essentially the most common primary bone tumor. These benign neoplasms are generally asymptomatic and have a relatively small potential for adverse effects. Calcaneal osteochondroma is rare, furthermore osteochondroma accompanying with gouty arthritis is very rare. Also, the subtalar joint is not a classic site of acute gout. In this report, we report the case of a patient who experienced an unusual calcaneal osteochondroma with undiagnosed gouty arthritis of the subtalar joint.

Posterior Lumbar Interbody Fusion Using Compressive Bone Graft with Allograft and Autograft in the Pyogenic Discitis

STUDY DESIGN: This is a retrospective study. PURPOSE: To evaluate the advantages and effects of posterior lumbar interbody fusion (PLIF) using allograft and posterior instrumentation in the lumbar pyogenic discitis, which are resistant to antibiotics. OVERVIEW OF LITERATURE: To present preliminary results of PLIF using a compressive bone graft with allograft and pedicle screw fixation in the lumbar pyogenic discitis. METHODS: Fifteen patients who had lumbar pyogenic discitis were treated by posterior approach from May 2004 to July 2008. The mean follow-up duration was 27.2 +/- 18.68 months. The standing radiographs of the lumbar spine and clinical results were compared and analyzed in order to assess the bony union, the changes in the distance between the two vertebral bodies and the changes in the lordotic angle formed between the fused bodies immediately after surgery and at the final follow-up. RESULTS: Fifteen solid unions at an average of 15.2 +/- 3.5 weeks after operation. The mean preoperative lordotic angle of the affected segments was 14.3 +/- 15.1degrees, compared to 20.3 +/- 12.3degrees after surgery and 19.8 +/- 15.2degrees at last follow-up. For the functional result according to the Kirkaldy-Willis criteria, the outcome was excellent in 9, good in 5, fair in 1, and there were no poor cases. The average visual analogue scale score was decreased from 7.4 before surgery to 3.4 at 2 weeks postoperative. CONCLUSIONS: The main advantage in the procedure of PLIF using compressive bone graft with allograft and post instrumentation is early ambulation. We believe that this is another good procedure for patients with poor general condition because a further autograft bone harvest is not required.

A Comparative Study of Surgical Treatment in the Ruptured Achilles Tendon: Minimal incision and Open repair / 대한족부족관절학회지

PURPOSE: The purpose of this study was to compare and analyse the clinical outcomes of minimal incision repair and open repair in ruptured Achilles tendon. MATERIALS AND METHODS: We retrospectively analyzed the outcomes of 10 patients with minimal incision repair (group 1) and 19 patients with open repair (group 2) from February 2007 to June 2011. The postoperative clinical evaluations were done by Arner-Lindholm scale, AOFAS score, overall patient's satisfaction and cosmetic satisfaction of scar. RESULTS: There was no statistical difference between two groups in Arner-Lindholm scale, AOFAS score, overall patient's satisfaction (p=1.21, 0.87, 1.07). There was statistically high rate of cosmetic satisfaction in group 1(p<0.001). There were no complications in group 1. Complications occurred in three patients (deep infection, rerupture, deep vein thrombosis) of group 2. CONCLUSION: Treatment of minimal incision repair in Achilles's tendon ruptures showed high rate of cosmetic satisfaction and low rate of complication's, but there were no significant differences with open repair in other clinical outcomes. The minimal incision repair could be recommended as one of the effective treatment for the Achilles's tendon ruptures.