Comminuted Pilon Fractures: Comparative Outcome Analysis according to Surgical Techniques

PURPOSE: To evaluate the overall surgical outcome of the tibial pilon comminuted fractures and perform the comparative analysis between the limited internal fixation-external fixation group and the delayed open reduction-internal fixation (ORIF) group. MATERIALS AND METHODS: From June 1997 to June 2004, 17 tibial pilon comminuted fractures were treated with the limited internal fixation-external fixation (6 cases) or the delayed open reduction-internal fixation (11 cases). The average age of the patients was 47.7 years (range: 41~63 years), male was fourteen patients, female was three. Follow-up period was average 33.6 months (range: 12~84 months). The clinical outcomes were evaluated by using AOFAS ankle-hindfoot score and patient satisfaction was also evaluated. RESULTS: AOFAS score at final follow-up was 80.4 points, and 88% of the patients were satisfied with the results. AOFAS scores of the external fixation group and the delayed ORIF group were average 77.0 points and 82.2 points respectively, which did not show the statistical difference (p>0.05). Bony union was achieved at average 16.0 weeks. There were 18 complications such as skin necrosis. CONCLUSION: We have achieved relatively encouraging functional results and high patient satisfaction for pilon comminuted fractures, without significant result difference between the two surgical techniques.

Treatment of Diaphyseal Fractures of Forearm Both Bones: Comparison between Plate Fixation and Rush Pin Intramedullary Nailing

PURPOSE: To compare the functional results between the plate fixation and Rush pin insertion for the treatment of diaphyseal fractures of the forearm both bones. MATERIALS AND METHODS: We reviewed 51 patients who were treated for diaphyseal fractures of the both forearm bones from 1995 to 2003, and evaluated them with Anderson's method. Eighteen patients were treated with plate fixation of both bones (group I), 14 patients treated with of the Rush pin insertion of the radius and plate fixation of the ulna (group II), 11 patients treated with plate fixation of the radius and Rush pin insertion of the ulna (group III), and 8 patients treated with Rush pin insertion of forearm both bones (group IV). RESULTS: Seventeen out of eighteen cases obtained favorable result (94.4%) in group I, 12 out of 14 cases (85.7%) in group II, 7 out of 11 cases (63.3%) in group III, and 4 out of 8 cases (50.0%) in group IV with statistically significant differences between the groups (p=0.04). CONCLUSION: Plate fixation of forearm both bones yield the best result. Thus, plate fixation of both forearm bones is recommended in treating the diaphyseal fractures of both forearm bones. At least one bone is recommended to be fixed with a plate if it is not possible to fix both forearm bones with plates.

Treatment of the Distal Femur Fracture with Retrograde Intramedullary Nailing

PURPOSE: To evaluate the results and complications of the retrograde intramedullary nailing for the treatment of distal femur fracture. MATERIALS AND METHODS: Thirty three patients who received retrograde IM nailing for fractures of the distal femur between October 1998 to December 2003. Average age was 53.8+/-17 (17~86) years. The average follow up period was 19.4 (12~36) months. Clinical information included age, sex distribution, associated fracture and fracture was classified by AO classification. Functional result was evaluated by Schatzker's criteria. RESULTS: The most common cause of injury was traffic accident (60%). The type of fracture were 6 A1 cases, 5 A2 cases, 11 A3 cases, 5 C2 cases, 6 C3 cases by AO classification. Among the 33 cases, 15 cases were excellent, 9 good, 6 fair and 1 failure according to Schatzker's criteria. Average union time was 9.7+/-3.5 months. CONCLUSION: Treatment of distal femur fracture with retrograde intramedullary nailing was useful due to its minimal invasiveness and early range of motion, more rigid fixation.

Treatment of Tibial Plateau Fractures using Ilizarov Fixation (Schatzker Type IV, V, VI)

PURPOSE: To evaluate the effectiveness of Ilizarov fixation in tibial plateua fractures (Schatzker type IV, V, VI), the clinical and radiological results were analysed retrospectively. MATERIALS AND METHODS: Of the tibial plateau fractures (Schatzker type IV, V, VI) which had been treated by using Ilizarov fixatrion method at Dankook university from June 1995 to June 2004, we clinically, radiologically analysed the 47 cases with follow-up study of a mean 38 months. Overall results which were evaluated according to Blokker's evaluation system. RESULTS: The average start time of the range of motion excercise was 4.2 weeks, and the average start time of partial weight bearing was 4.6 weeks. Results which were evaluated according to Blokker's evaluation systems were "satisfactory" in 8 cases (80%) of the type IV fractures, in 9 cases of the type V fracures, and in 18 cases (69%) of the type VI. Overall results were "satisfactory" in 35 cases (74.4%), "unsatisfactory" in 12 cases (25.5%). CONCLUSION: When use Ilizarov fixation in tibial plateau fracture (Schatzker type IV, V, VI), we have many advantages that the early start time of the range of motion, the early start time of weight bearing, the acceptable results of Blokker's evaluation system. Therefore, we conclude that Ilizarov fixation in tibial plateua fracure (Schatzker type IV, V, VI) is effective.

Adult Idiopathic Flexible Flat Foot Treated with Medial Sliding Calcaneal Osteotomy and Subtalar Arthroereisis: Report of 1 Case / 대한족부족관절학회지

There have been many reports about surgical treatments of flexible flatfoot in children and acquired adult flatfoot deformity due to posterior tibial tendon dysfunction common in the 5th and 6th decades. However there has been a controversy for surgical treatment guideline for painful idiopathic flexible flatfoot deformities in young adults. Therefore, we present a 27-year-old female with severe painful idiopathic flexible flatfoot who was treated with medial sliding calcaneal osteotomy and subtalar arthroereisis using Kalix(R) (Newdeal SA, Vienne, France) endoprosthesis and had good clinical outcome with high patient satisfaction at 10 months follow-up postoperatively.

Surgical Treatments and Clinical Outcomes for Idiopathic Osteoarthritis of the Tarsometatarsal Joints / 대한족부족관절학회지

PURPOSE: The purpose of the study was to identify the subtypes of idiopathic osteoarthritis of the tarsometatarsal joints based on accompanying hindfoot, midfoot, or foot deformities and their corresponding surgical options and also to evaluate the overall clinical results. MATERIALS AND METHODS: The study included 59 patients (67 feet) with idiopathic tarsometatarsal joint osteoarthritis. Tarsometatarsal fusion was performed for tarsometatarsal joint and accompanied secondary change was divided into subtypes and various bony reconstruction was carried out. The patients were evaluated with the AOFAS midfoot score and FFI. The average patient age was 60.2 years with 40.6 months follow-up. Fifty-four feet (80.6%) had been treated with realignment fusion. Twenty-six feet had first and second tarsometatarsal joint fusion, and 20 feet had first tarsometatarsal fusion only. Six subtypes were identified based on associated foot deformities: 1) in-situ without deformities (18%), 2) pes planovalgus (45%), 3) rockerbottom (15%), 4) cavus foot (1%), 5) hallux valgus (12%), and 6) hallux valgus with pes planovalgus or rockerbottom (9%). Plantar-medial closing-wedge resection was used in 10 feet to correct rockerbottom. For pes planovalgus, a medial sliding calcaneal osteotomy was done. Lateral column lengthening with medial sliding calcaneal osteotomy was done for severe pes planovalgus, and triple arthrodesis was done for rigid pes planovalgus. Hallux valgus was corrected with the Lapidus procedure (85.7%). RESULTS: AOFAS midfoot scores improved from preoperative 34.1 points to postoperative 83.9 points (p<0.05). The Foot Function Index postoperatively also showed significant improvement (p<0.05), with a high satisfaction rate (86.6%). There were 29 complications, most commonly sesamoid pain. CONCLUSION: Idiopathic tarsometatarsal OA feet can be classified into six categories. Pes planovalgus feet should be treated with medial sliding calcaneal osteotomy, lateral column lengthening, or triple arthrodesis in addition to tarsometatarsal joint realignment fusion. Rockerbottom and hallux valgus deformities should also be addressed.