Consideration of Various Medial Capsulorrhaphy Methods in Hallux Valgus Surgery / 대한족부족관절학회지

PURPOSE: Medial capsulorrhaphy is additional hallux reduction method following various hallux reduction procedures and we are going to report author's opinion about several methods of medial capsulorrhaphy. MATERIALS AND METHODS: We performed three kinds of medial capsulotomy and imbricatory capsulorrhaphy in hallux valgus surgery. Through 8 cadavar study, we compared the easiness of sesamoid reduction and hallux valgus angle reduction. Also, we measured thickness of capsule in various portions. RESULTS: Longitudinal capsule incision and imbrication was useful in sesamoid reduction and vertical procedures was useful in hallux valgus angle reduction. The capsule thickness was measured thickest in dorsal and distal portioin. CONCLUSION: The methods of medial capsulorrhaphy should be planned preoperatively considering individual hallux deformities. These selected medial capsulorrhaphy can help the reduction of hallux valgus deformity correction and its maintenance

The Early Results of Linear Distal Metatarsal Osteotomy with Minimal Incision for Correction of Hallux Valgus / 대한족부족관절학회지

PURPOSE: Good results using minimal invasive hallux valgus surgery has been reported recently. We evaluate the usefulness of linear distal metatarsal osteotomy with minimal skin incision in mild and moderate hallux valgus deformity. MATERIALS AND METHODS: Twenty-eight patients (thirty-one cases) who had mild to moderate hallux valgus deformity and underwent linear distal metatarsal osteotomy using minimal skin incision were evaluated between February 2005 and February 2006. Hallux-metatarsophalangeal-interphalangeal scale of AOFAS (American Orthopaedic Foot and Ankle Society) score was used as clinical evaluation. Preoperative, postoperative, after pin removal, and final follow up plain radiographs were used as radiologic evaluation. RESULTS: Twenty-six cases (83%) among thirty-one cases showed more than average satisfaction, Average AOFAS score were improved from 63.2 points (range 45-74 points) to 86.4 points (range 67-93 points). Preoperative radiologic index of IMA 14.0 degrees (range 10-18 degrees), HVA 30.2 degrees (range 19-39 degrees), DMAA 13.8 degrees (range 5-23 degrees) were improved postoperatively as IMA 8.3 degrees (range 5-10 degrees), HVA 10.5 degrees (range 2-20 degrees), DMAA 7.2 degrees (range 0-14 degrees) correctively. Mean operative time was 15.5 minutes (range 11-18 minutes) and mean operative time was 5.6 days (range 2-8 days). CONCLUSION: Despite small skin incision and short operative time and admission period, linear distal metatarsal osteotomy with minimal skin incision showed similar results with conventional distal metatarsal osteotomy. Thus, it was thought to be useful operation in mild and moderate hallux valgus deformity.

Acetabular Development after Operative Treatment of Developmental Dislocation of the Hip / 대한정형외과학회잡지

PURPOSE: To examine the acetabular development after the surgical treatment of a developmental dislocation of the hip (DDH). MATERIALS AND METHODS: The serial radiographs of 27 hips were evaluated. The measurement included: acetabular index, CE angle, Smith's h/b, c/b ratio, medial joint space, and center-head distance discrepancy (CHDD). All the patients were followed up until they were at least 10 years old. The overall results were evaluated using the modified Severins classification (group I & II, satisfactory; group III & IV, unsatisfactory). RESULTS: In the satisfactory group, the average acetabular index at 1 and 3 years after the pelvic osteotomy was 6% were in the unsatisfactory group. CONCLUSION: The most reliable factors for predicting normal acetabular development after surgery were an acetabular index <25 degrees and a CHDD <6%. If the hips do not meet the criterion of a CHDD <6% after the osteotomy of one component (either the pelvic or femur) then the other component must be osteotomized.

Sacral Perineural Cyst: A Case Report / 대한정형외과학회잡지

A sacral perineural cyst is composed of an arachnoid membrane of the nerve root at the sacral region. We performed a wide posterior decompression and cystectomy in a patient who suffered from back pain with pain radiating in both lower extremities, and whose MRI findings coincided with those of a sacral perineural cyst. Clinical improvement was observed during the follow-up review. We report the surgical treatment with a review of the relevant literature.

Analysis of Ankle Bony Abnormality in the Patients with Chronic Ankle Sprain and Marked Ankle Instability / 대한족부족관절학회지

PURPOSE: We analyzed the ankle bony abnormality of patients with marked ankle instability who had chronic ankle sprain more than 3 years. MATERIALS AND METHODS: We evaluated the chronic ankle sprain (more than 3 years) patients with marked ankle instability tested by varus stress test and anterior draw test from March 2000 to December 2005. Eighty-nine patients (104 ankle) were evaluated and there were 38 males and 51 females. The mean age of patient at the time of diagnosis was 34.5 (range, 18 to 56 years). The average duration of morbidity was 7 years and 3 months (range, 3 years and 3 months to 21 years). The patients who had history of dislocation, fracture, malalignment, operated patients, and rheumatoid ones were excluded. Plain radiographs of AP, lateral, oblique and mortise view were checked. RESULTS: Radilologic abnormalities were found at 74 ankles (71%) among 104 ankles. Frequent sequences of location were anterior talotibial osteophyte, medial malleolar osteophyte, Os subfibulare, lateral malleolar osteophyte. Posteior osteophyte, ankle arthritis, talar articular defect were rarely found. CONCLUSION: Seventy-one percent among patients with chronic ankle sprain and marked ankle instability showed more than one radiologic abnormalities. Thus, more exclusive and accurate ankle examination should be performed in these patients.

Bernese Periacetabular Osteotomy for Treatment of Acetabular Dysplasia / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiologic results of Bernese periacetabular osteotomy in treating acetabular dysplasia. MATERIALS AND METHODS: We evaluated the results of 24 Bernese periacetabular osteotomies performed in 21 patients (18 female, 3 male). The osteotomies were performed through an ilioinguinal approach in 20 cases, and dual (anterior and posterior) approaches in 4 cases. The mean age of the patients at the time of surgery was 23.4 years (range, 13.1-36 years). The average follow-up period was 26 months (range, 12-48 months). The Harris hip score was used for clinical evaluation. Radiological changes of acetabular angle, CE angle, acetabular depth, and femoral head coverage were measured. RESULTS: Clinically, the mean Harris hip score improved from 59.3 preoperatively to 88.3 postoperatively. All four radiological measurements improved significantly after surgery (Wilcoxon Rank Sum test, p<0.05). The following complications were noted: superficial skin infection (1 case), posterior column fracture (3 cases), temporary sciatic nerve symptoms (2 cases), and conversion to total hip arthroplasty (2 cases). CONCLUSION: Bernese periacetabular osteotomy is an effective surgical treatment for acetabular dysplasia in adults.

Operative Treatment of Adult Flexible Flatfoot with Young's Tenosuspension: Case Report / 대한족부족관절학회지

We present the case of an adult flexible flatfoot that was managed with dynamic and multiplarnar approaches which consist of Young's tenosuspension, Evans osteotomy, posterior tibialis tendon advancement with flexor digitorum longus tendon transfer and Lapidus procedure.

Long Term Follow-up of Avascular Necrosis after Talar Fracture and Dislocation: 5 Cases / 대한족부족관절학회지

PURPOSE: To report our opinions of management about avascular necrosis following operative treatment of talar fracture and dislocation. MATERIALS AND METHODS: We followed up 5 patients who were diagnosed as talar avascular necrosis after operation of talar fracture and dislocation. Clinical and radiological analysis were performed. The mean age of patients was 36 years. There were 4 males and 1 females. The average follow up was 51 months. Hawkins scoring system was used as clinical evaluation. RESULTS: Regardless of radiological sclerotic finding, all patients showed satisfactory clinical result. Despite arthritic change in one patient, there were no further radiological and clinical deterioration to require salvage procedure. CONCLUSION: Most avascular necrosis after operative treatment of talar fracture and dislocation showed satisfactory result with conservative treatment. Thus, salvage operation such as talectomy or ankle fusion should be reserved in cases of intractable ankle pain and claudication.

Long Term Follow-up of Avascular Necrosis after Talar Fracture and Dislocation: 5 Cases / 대한족부족관절학회지

PURPOSE: To report our opinions of management about avascular necrosis following operative treatment of talar fracture and dislocation. MATERIALS AND METHODS: We followed up 5 patients who were diagnosed as talar avascular necrosis after operation of talar fracture and dislocation. Clinical and radiological analysis were performed. The mean age of patients was 36 years. There were 4 males and 1 females. The average follow up was 51 months. Hawkins scoring system was used as clinical evaluation. RESULTS: Regardless of radiological sclerotic finding, all patients showed satisfactory clinical result. Despite arthritic change in one patient, there were no further radiological and clinical deterioration to require salvage procedure. CONCLUSION: Most avascular necrosis after operative treatment of talar fracture and dislocation showed satisfactory result with conservative treatment. Thus, salvage operation such as talectomy or ankle fusion should be reserved in cases of intractable ankle pain and claudication.

Treatment of Stiff Knee

PURPOSE: In this study, the effect arthroscopic adhesiolysis and the need for additional quadricepsplasty were evaluated by reviewing the patients 'data. MATERIALS AND METHODS: From July 1996 to January 2002, 18 patients received operation for the stiff knee. The patients were classified into 2 groups according to treatment method - Group 1: arthroscopic adhesiolysis and Group 2: arthroscopic adhesiolysis plus Judet quadricepsplasty. The Judet quadricepsplasty was performed when maximal knee flexion was not achieved over 90 degree even after arthroscopic adhesiolysis. We reviewed primary causes and the duration of contracture of stiff knee. Preoperative, postoperative, and final range of motion was evaluated. RESULTS: Preoperative, postoperative, and final range of motion was evaluated. In group 1, the average range of motion was 34 degree preoperatively, 107 degree intraoperatively, and 103 degree at the last follow-up. In group 2, the average range of motion, 26 degree preoperatively, 67 degree (after arthroscopic adhesiolysis)-115 degree(after quadricepsplasty) intraoperatively, and 112 degree at the last follow-up. CONCLUSION: Arthroscopic adhesiolysis has an effect in releasing intrarticular adhesion. Additional quadricepsplasty should be considered when the duration of contracture is over 12 months and primary causes of stiff knee is distal femur fracture which causes damages in the quadriceps muscle.

Popliteal Artery Occlusion after Total Knee Arthroplasty: A Case Report / 대한정형외과학회잡지

Popliteal arterial occlusion after total knee arthroplasty is a rare complication, and for now various treatment methods have been tried. The authors report a case of acute popliteal artery occlusion after total knee arthroplasty that was treated by thrombectomy.

Operative Treatment of Old Neglected Freiberg's Infraction (Comparison of Three Techniques) / 대한족부족관절학회지

PURPOSE: We compared the results of three surgical procedures of the old neglected Freiberg's disease that was managed with metatarsal head reshaping, metatarsal head resection, and dorsal closing wedge osteotomy. MATERIALS AND METHODS: From march 1996 to July 2002, five cases in six patients whose metatarsal head collapse already progressed underwent operative treatment. We compared the operative results in the view point of the radiographic follow-up and lesser toe metatrasophalangeal joint scale of AOFAS. RESULTS: There were no further joint destruction and loose body formation. Also, lesser toe metatrasophalangeal joint scale of AOFAS improved from average score, 38.5 (range 22~49) of preoperative one to average score, 86.6 (range, 72~100). Especially, the 2 cases that underwent dorsal closing wedge osteotomy showed most favorable result and the 2 cases with metatarsal resection showed next favorable result. The 2 cases with intra-articular loose body removal and metatarsal reshaping showed the least effective result among three operative methods. CONCLUSION: Our Operative experiences of old neglected Freiberg's disease were all satisfactory irrespective of operative options and dorsal closing wedge osteotomy was thought to be most effective method.

Two-stage revision of infected total knee arthroplasty

PURPOSE: To evaluate the result of treatment of the infected total knee arthroplasty by two-stage revision using antibiotics-impregnated cement. MATERIALS AND METHODS: We observed 2 staged revision cases of 11 infected total knee arthroplasty from March 1988 and March 2001. Average follow-up was 39.4 (28-60) months. At the time of infection management, the average age was 64.0 years. Local inflammatory finding, WBC with differential count, erythrocyte sedimentation ratio, C-reactive protein, joint aspiration and intraoperative frozen section (x400) were used to diagnose infection. We assessed knee function according to the knee rating system of the Hospital for Special Surgery (HSS). RESULTS: Prior to revision, the average HSS score was 50.8 points, and the average range of motion was 73.4 degrees. At. final follow-up, the average HSS score was 79.1 points, and the average range of motion was 90.2 degrees. At the last follow up, there were no sign of recurrence of infection clinically and radiologically. CONCLUSION: At least 2 year follow up, the results of two-stage revision using antibiotics-impregnated cement were good.