Subtalar Arthroereisis Using Kalix® Sinus Tarsi Implant for Pediatric Flexible Flatfoot / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the radiographic and clinical outcomes of subtalar arthroereisis as a method of treatment for pediatric flexible flatfoot. MATERIALS AND METHODS: We retrospectively investigated 14 feet among 10 patients with flexible flatfoot, who were treated with a subtalar arthroereisis using a sinus tarsi implant between March 2007 and June 2012. Radiographically, the talo-1st metatarsal angle, talar declination, and calcaneal pitch angle have all been measured on lateral radiographs. The talo-navicular coverage angle and talo-1st metatarsal angle was measured on anteroposterior (AP) radiographs and tibio-calcaneal angle was assessed by hindfoot alignment view. Visual analogue scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used for clinical evaluation. RESULTS: The mean follow-up was 48.7 months (16–98 months), and the mean age was 11.6 years (6–19 years). Radiographically, the mean pre-operative and postoperative values measured by the lateral foot radiograph were −25.1° and −7.5° for talo-1st metatarsal angle, 37.4° and 23.2° for talar declination, and 8.3° and 15.0° for calcaneal pitch angle, respectively. The mean preoperative and postoperative values measured by foot AP radiograph were 23.0° and 11.9° for talo-navicular coverage angle and 17.2° and 9.0° for talo-1st metatarsal angle, respectively. Moreover, tibio-calcaneal angle improved from valgus 17.4° on average to 4.5° on average. Clinically, the VAS score and AOFAS score was improved from 5.8 to 1.5 and from 61.8 to 90.4, respectively. Complication was sinus tarsi pain that occurred in 5 cases (35.7%). CONCLUSION: We achieved a satisfactory correction of pediatric flexible flatfoot deformities via subtalar arthroereisis, using a sinus tarsi implant with favorable radiographic and clinical measures. However, high potential complication rate of postoperative sinus tarsi pain on weight-bearing should carefully be considered.

Features of Lateral Malleolar Fractures in Elderly Patients and Clinical Outcome of Locking Compression Plate Fixation / 대한정형외과학회잡지

PURPOSE: Several studies have reported on the biomechanical advantages of a locking compression plate (LCP) for treatment of lateral malleolar fracture. However, few studies have reported clinical outcome after treatment of lateral malleolar fracture using a LCP in elderly patients. Thus, this study investigated the trends of lateral malleolar fractures in elderly patients and evaluated the clinical and radiological outcome of treating them using a 'locking compression distal fibula plate'. MATERIALS AND METHODS: Twenty-one patients (male: 3, female: 18) over 65 years old, who were followed-up for at least one year were enrolled in this study. They were treated surgically with open reduction and internal fixation using a LCP for lateral malleolar fracture from 2011 to 2014. Lauge-Hansen and Danis-Weber classification were used for preoperative classification of fractures. Visual analog scale (VAS) pain scores, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, 4-graded subjective satisfaction and post-operative range of motion were used for the clinical evaluation. Time to bone union, non-union, mal-union, metal failure and implant loosening were assessed for radiographic outcomes. RESULTS: The mean age of patients was 71.2 years old, pain VAS and AOFAS score was 1.6 points and 94.2 points, respectively and 18 cases (85.7%) showed more than satisfaction in subjective satisfaction. Comminuted fracture was observed in 8 cases (38.1%) and lag screw insertion was performed in 7 ankles (33.3%). The mean bony union period was 3.6 months. There were 5 cases of mal-union, no case of non-union and metal failure. CONCLUSION: Satisfaction level of elderly patients with lateral malleolar fracture was significantly associated with only pain at the final follow-up. Fixation with a LCP distal fibula plate can sometimes lead to metal irritation but largely resulted in good clinical outcome without serious complication.

Short-Term Results of the Total Ankle Arthroplasty with Mobility Total Ankle Prostheis / 대한정형외과학회잡지

PURPOSE: Recently, minimally constrained 3-component total ankle systems have been often performed to address painful ankle arthritis. We report early clinical and radiographic outcome of the total ankle arthroplasty with Mobility system for end-stage ankle arthritis. MATERIALS AND METHODS: Total ankle arthroplasty was performed with Mobility total ankle system in 40 ankles (39 patients) from November 2008 to January 2013. The mean age at surgery was 63.7 years (range, 50-78 years). The mean follow-up duration was 20.8 months (range, 12-56 months). The primary etiology for ankle arthritis was post-traumatic arthritis (26 ankles, 65%). The outcome was assessed based on visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot function score, patient satisfaction and radiographic measurements. RESULTS: There was a significant reduction in VAS pain score from an initial average of 7.7 points (range, 5-10 points) to 2.8 points at the final follow-up (range, 0-7) (p<0.05). The mean AOFAS score improved significantly from 46.8 (range, 15-68) preoperatively to postoperatively 82.4 (range, 63-100) (p<0.05). Eighty-one percent of patients were satisfied with the result. Combined surgeries, such as Achilles tendon percutaneous lengthening, were performed in twenty-one cases of 40 ankles. CONCLUSION: The current short term results of Mobility total ankle arthroplasty showed a quite favorable functional and radiographical outcome with few major complications. However, the long term follow-up study with larger number of cases is needed in the future.

Analysis of Clinical and Radiographic Outcome of the Reconstructive Surgery for the Cavovarus Foot Deformity / 대한족부족관절학회지

PURPOSE: Reconstructive surgeries for equinocavovarus foot deformities are quite variable, including hind-midfoot osteotomy or arthrodesis, soft tissue procedure, tendon transfers, etc. Comprehensive evaluation of the deformity and its etiology is mandatory for achievement of successful deformity correction. Few studies in this field have been reported. We report on the clinical and radiographic outcome of reconstruction for cavovarus foot deformities. MATERIALS AND METHODS: The study is based on 16 feet with cavovarus foot deformities that underwent bony and soft tissue reconstructive surgery from 2004 to 2008. We evaluated the etiologies, varieties of surgical procedures performed, pain score, functional scores, and patient satisfaction and measured the radiographic parameters. RESULTS: The average age at the time of surgery was 39.4 years old, with a male/female ratio of 9/4 and an average follow-up period of 23.9 months (range, 12~49 months). The etiologies of the cavovarus deformity were idiopathic 7 feet, residual poliomyelitis 5 feet, Charcot-Marie-Tooth disease 2 feet, and Guillain-Barre syndrome and hemiplegia due to cerebrovascular accident sequela 1 foot each. Lateral sliding calcaneal osteotomies were performed in 12 feet (75%), followed by Achilles tendon lengthening and plantar fascia release in 11 feet (69%), and first metatarsal dorsiflexion osteotomy/arthrodesis and tendon transfer in 10 feet (63%). Visual analogue scale pain score showed improvement, from an average of 4.2 to 0.5 points. American Orthopaedic Foot and Ankle Society ankle-hindfoot score showed significant improvement, from 47.8 to 90.0 points (p<0.05). All patients were satisfied. Ankle range of motion improved from 27.5degrees to 46.7degrees. In radiographic measurements, calcaneal pitch angle improved from 19.1degrees to 15.8degrees, Meary angle from 13.0degrees to 9.3degrees, Hibb's angle from 44.3degrees to 37.0degrees, and tibio-calcaneal axis angle from varus 17.5degrees to varus 1.5degrees. CONCLUSION: We achieved successful correction of cavovarus foot deformities by performing appropriate comprehensive reconstructive procedures with improved functional, radiographic measures and high patient satisfaction.

Correlation Analysis of Reduction for Intra-Articular Calcaneal Fracture and Clinical Outcomes Using Postoperative Computed Tomography / 대한족부족관절학회지

PURPOSE: We evaluated the correlation of postoperative clinical outcomes and radiologic findings using computed tomography and simple X-ray in intra-articular calcaneal fractures. MATERIALS AND METHODS: The current study is based on 41 feet, 38 patients with displaced intra-articular fracture who underwent surgical treatment with at least one year of follow-up. Evaluation of clinical outcome included American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, and subjective satisfaction. A simple X-ray was used in evaluation of preoperative and postoperative Gissane angle, Bohler angle, and calcaneal fracture width. Computed tomography scan was performed for evaluation of preoperative and postoperative articular step-off and articular gap in all cases. Finally, we evaluated the correlation of the postoperative clinical outcomes and radiologic findings based on the measurement. RESULTS: The average postoperative AOFAS score and VAS score was 84.1+/-8.5 and 2.2+/-2.2. Subjective satisfaction was excellent in 15 cases, good in 19 cases, and fair in seven cases. The average Bohler angle was restored from 11.1degrees to 24.7degrees (p0.05), and the average width was restored from 45.8 to 35.0 mm (p<0.05). The average articular step-off and gap were decreased from 6.3 to 2.0 mm and from 11.1 to 4.6 mm, respectively (p<0.05). No significant correlations were observed between the clinical outcome and Gissane angle, Bohler angle, and width, and there was no significant correlation between the clinical outcome and Sanders classification. However, postoperative articular step-off showed correlation with VAS and AOFAS score and articular gap showed correlation with VAS score. CONCLUSION: The clinical outcome did not show correlation with Bohler angle and Gissane angle but did show correlation with anatomical reduction of the posterior facet joint.

Supramalleolar Tibial Osteotomy for Medial Compartment Ankle Osteoarthritis / 대한정형외과학회잡지

PURPOSE: The aim of this study is to evaluate the clinical and radiologic outcomes of supramalleolar tibial osteotomy for medial compartment ankle osteoarthritis (OA) and to verify the efficacy of the supramalleolar osteotomy. MATERIALS AND METHODS: This study is based on 9 ankles of the medial compartment ankle OA treated with supramalleolar tibial osteotomy from August 2007 to June 2011 with at least 1 year follow-up. As for the functional evaluation, visual analogue scale (VAS) pain scores and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were evaluated. On radiographs, tibial anterior surface (TAS) angles, tibial lateral surface angles were measured. The severity of ankle OA was classified by the Takaura staging system. RESULTS: The mean VAS pain scores improved to 0.6 and AOFAS scores improved to 89.3. Radiographically, TAS angle increased to 93.5degrees postoperatively. Seven ankles showed improvement of the ankle arthritis grading from IIIa to II according to Takakura's staging. CONCLUSION: Supramalleolar tibial osteotomy for patients with medial compartment varus ankle OA showed satisfactory clinical and radiological outcome. We confirmed that the procedure is recommendable for medial compartment varus ankle OA especially for Takakura stage IIIa.

Extracorporeal Shock Wave Therapy versus Platelet-rich Plasma Injection for the Treatment of Lateral Epicondylitis: A Prospective Randomized Clinical Trial

PURPOSE: To compare clinical outcomes of extracorporeal shockwave therapy and platelet-rich plasma injection for the treatment of lateral epicondylitis of the elbow. MATERIALS AND METHODS: Consecutive patients with a lateral epicondylitis who had refractory elbow pain more than 6 months and no response to treatment more than 3 months were recruited for this study. Diagnosis was made on the basis of physical examination and ultrasound imaging study. Prospective randomized trial was performed between two treatment groups; extracorporeal shockwave therapy versus platelet-rich plasma injection. Fifty patients for each group were allocated based on the results of power analysis. Disabilities of arm, shoulder and hand (DASH) scores obtained before treatment and at 1 year after the last treatment were compared between two groups. RESULTS: Both groups showed significant improvement of DASH scores after treatment. The patients who had platelet-rich plasma injection showed significantly greater improvement of DASH scores (from 37.0 to 11.1) than the patients who had extracorporeal shockwave therapy (from 41.9 to 29.9). CONCLUSION: Better subjective outcomes can be expected after platelet-rich plasma injection compared with extracorporeal shockwave therapy in patients with a refractory lateral epicondylitis.