The Effect of Dwyer's Osteotomy and the 1st Metatarsal Osteotomy for Cavovarus Correction on Radiographic Parameters / 대한족부족관절학회지

PURPOSE: Several techniques have been introduced for correction of pes cavo-varus deformity. We retrospectively reviewed and compared the data of patients who underwent 1st metatarsal osteotomy alone, Dwyer's osteotomy alone, and 1st metatarsal osteotomy combined with Dwyer's osteotomy to determine the effect on radiographic parameters. MATERIALS AND METHODS: Data on 28 cases in 27 consecutive patients recruited from 2006 to 2014 who underwent 1st metatarsal osteotomy alone (group F), Dwyer's osteotomy alone (group H), or 1st metatarsal osteotomy followed by Dwyer's osteotomy (group HF) with a minimum 1-year follow-up were reviewed retrospectively. RESULTS: Calcaneal pitch angle on the standing foot lateral radiographs was significantly decreased after the operation in groups H and HF whereas Meary angle was decreased in groups F and HF. Hindfoot alignment angle and ratio on the hindfoot alignment view were improved in groups H and HF. Maximal medial cuneiform height reduction was observed in group HF. 1st ray was significantly shortened in groups F and HF. CONCLUSION: Combined forefoot and hindfoot operation took the largest correction power of all radiologic parameters.

Treatment of Isolated Posterior Malleolus Fracture in the Ankle / 대한정형외과학회잡지

PURPOSE: An isolated posterior malleolar fracture in the ankle is very rare. We treated eight cases of isolated posterior malleolar fracture, and describe the clinical features and outcomes of treatment. MATERIALS AND METHODS: Between from March 2008 to February 2012, eight cases of isolated posterior malleolar fracture were treated in Ilsan Paik Hospital. The mean age of patients was 30 years (11-49 years); six patients were male and five were right. Slip down (4 cases) was the most common injury mechanism. We treated four cases surgically, three cases by cast and one case by ankle brace. We could not recognize three cases of isolated posterior malleolar fracture at first. The time delay to diagnose unrecognized isolated posterior malleolar fracture was nine days, 56 days and 110 days respectively. We were able to diagnose the unrecognized isolated posterior malleolar fracture using computed tomography (two cases) and magnetic resonance imaging (one case). RESULTS: The main symptom was painful swelling. The average for articular involvement of the posterior malleolar fragment was average 21.4%, and average displacement was 1.25 mm. We treated three cases surgically using a posterior lateral approach and one case using a posterior medial approach. The average American Orthopaedic Foot and Ankle Society score was 92.5 at the last follow-up. CONCLUSION: The isolated posterior malleolar fracture is very rare and if it is neglected, persistent ankle pain can remain. Isolated posterior malleolus fracture should be included as one of the differential diagnoses after ankle trauma.

Analyses of Timing of Single Heel Raise and Muscle Power after Achilles Tendon Repair / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to analyze the progress of muscle rehabilitation for patients with acute Achilles tendon rupture, who underwent Achilles tendon repair, checking capable time of single heel raise and isokinetic plantar flexion power. MATERIALS AND METHODS: From March 2006 to June 2011, 42 of 81 patients were excluded and the other 39 patients, who underwent surgery due to acute Achilles tendon rupture in our institute, were enrolled in this study. The operation and rehabilitation were constantly performed according to the author's method. Isokinetic plantar flexion power was measured at three months post-operation, capable time of single heel raise was assessed, and clinical results of the last follow up were measured and analyzed. RESULTS: Single heel raise was possible at an average of 14 weeks and three days, and repetitive single heel raise more than 10 times was possible at an average of 20 weeks. The peak torque of 30degrees/s plantar flexion was mean 69 Nm. The peak torque of 120degrees/s was 41 Nm. Assessment at three months post-operation showed 69% power, compared to the contralateral leg. The group of patients who were able to perform single heel raise within three months, showed better Achilles tendon total rupture score and foot and ankle outcome score at last follow up, and showed better plantar flexion power at three months post-operation. CONCLUSION: At the last follow up, we can expect better clinical results and muscle power in patients who are able to perform single heel raise early treatment of acute Achilles tendon rupture.

Result of Midfoot Fusion with Locking Plate / 대한족부족관절학회지

PURPOSE: The purpose of this study was to compare and analyze the results of midfoot arthrodesis with locking plate fixation and the other instruments. MATERIALS AND METHODS: Twenty one patients, a total of 22 feet who underwent midfoot arthrodesis at our institution were reviewed retrospectively from January 2006 to December 2011. Locking plates were used in 9 cases, and the other instruments such as K-wires, screws, staples were used in 13 cases. Radiologic union time was evaluated and compared between both groups. Preoperative & postoperative AOFAS midfoot scores were evaluated and compared as clinical results. RESULTS: The average AOFAS score was rising from 69.7 to 89.4 in locking plate group and from 67.6 to 80.7 in the other instrument group. There was no statistically significant difference in two groups (p=0.179). The mean radiologic union time was 10.2 weeks in locking plate group, 12.6 weeks in the other instrument group with no significant difference (p=0.062). One case of peroneal nerve irritation was detected as a complication in locking plate group. One case of peroneal nerve irritation and 1 case of superficial wound infection with skin sloughing were detected in the other instrument group. CONCLUSION: There was no statistically significant difference for union time and clinical results in both groups. A locking plate can be one of the useful option for midfoot arthrodesis.

Treatment of Congenital toe Anomalies / 대한족부족관절학회지

There are many different type of congenital toe anomalies such as syndactyly, polydactyly which are more common, and less frequently macrodactyly and curly toe. Congenital anomaly of hand can decrease the hand function and easy to be visualized, so the early treatment of anomaly is natural and recommended. On the other hand, Congenital anomaly of foot rarely decrease the foot function and was hidden in the shoe, so treatment of anomaly was delayed frequently. However, the surgery can be needed, as the foot getting grown-up, discomfort of shoe fitting or intractable plantar keratosis due to secondary deformation of foot can occur. A distinct feature and surgical consideration was compared with congenital anomaly of hand and it should be taken into account in the treatment of adult toe anomalies.

Treatment of Talonavicular Subluxation Accompanied by Calcaneal Malunion: A Case Report / 대한족부족관절학회지

There may be complications after comminuted or intraarticular calcaneal fracture regardless of the initial treatment. Transcalcaneal talonavicular dislocation is rarely reported severe form of calcaneal fracture. We experienced a neglected transcalcaneal talonavicular subluxation case, who had been treated for intraarticular calcaneal fracture conservatively. Subtalar distraction bone block fusion was done for calcaneal malunion with talonavicular subluxation. Inspite of successful subtalar fusion, pain was persisted because of talonavicular re-subluxation with arthritis and calcaneocuboid arthritis. So, second operation, the talonavicular and calcaneocuboid fusion, was done. After union achieved, the patient's foot pain was improved. Calcaneal malunion combined with talonavicular subluxation and unstable transverse tarsal joint, such as this case, initial triple arthrodesis could be considered.

Effectiveness of a Pre-Operative Lateral Decubitus Position Radiologic Examination Using a Goniometer and Rod in THRA

PURPOSE: For inserting an acetabular cup with the correct inclination angle, we checked the pelvic tilts using the lateral decubitus position X-ray and a goniometer and pointer. The accuracy of the cup inclination at the targeted angles was evaluated after insertion of the cup at an adjusted angle with using a goniometer and pointer. MATERIALS AND METHODS: Between January 2008 and December 2009, 56 hips in 50 patients who underwent total hip replacement arthroplasty (THRA) were enrolled. The mean age at the time of surgery was 63.8 years. There were 31 male patients (36 hips) and 19 female patients (20 hips). The preoperative diagnoses included osteonecrosis of the femoral head in 27 hips, secondary osteoarthritis in 10 hips and femoral neck fracture in 14 hips. The preoperative pelvic tilts were evaluated according to the lateral decubitus position X-ray with using a goniometer and pointer. The target inclination angle was 40degrees for 27 hips that underwent ceramic-on-ceramic THRA. The target inclination angle was 45degrees for the 29 hips that underwent ceramic-on-polyethylene THRA. The inclination of the cup was evaluated after inserting the acetabular cup at the adjusted angle using a goniometer and pointer. RESULTS: The mean inclination angle of the acetabular cup was 39.3degrees for the ceramic-on-ceramic THRA and 44.4degrees for the ceramic-on-polyethylene THRA. There were no significant differences between the 40degrees and 45degrees (P=0.059, P=0.071). CONCLUSION: The pelvic tilt can be evaluated by checking the lateral decubitus X-ray with a goniometer and pointer. Insertion of an acetabular cup at the adjusted angle could be a credible method for reducing the variability of cup inclination.