Radiographic Changes in Forefoot Geometry with Weightbearing: Hallux Valgus Angle, Intermetatarsal Angle, and Medial Sesamoid / 대한족부족관절학회지

PURPOSE: To determine the radiographic changes in forefoot geometry with weight-bearing. MATERIALS AND METHODS: The forefoot radiographs of 100 normal Korean adults, 50 male and 50 female volunteers, were evaluated both in nonweight-bearing and weight-bearing. The mean age was 27 years with range of 21-39 years. Those with normal feet were selected from volunteers having no history of foot problems or other musculoskeletal diseases. RESULTS: The changes of measured angle between phalanges and metatarsals with weight-bearing were as follows; Hallux valgus angle was noted to increase in 20% of the feet, decrease in 59%, and remained unchange in 21%. Intermetatarsal angle 1~2 was noted to increase in 76% of the feet, decrease in 3%, and remained unchange in 21%. Intermetatarsal angle 1~5 was noted to increase in 95% and remained unchange in 5%. Shift in medial sesamoid on weight-bearing was also not consistent. Lateral shift was noted in 27%, no shift in 66%, medial shift in 7%. CONCLUSION: The generalized concept that the angles between bones and shift of medial sesamoid in the forefoot will change consistently with weightbearing was not found.

Radiographic Changes in Forefoot Geometry with Weightbearing: Hallux Valgus Angle, Intermetatarsal Angle, and Medial Sesamoid / 대한족부족관절학회지

PURPOSE: To determine the radiographic changes in forefoot geometry with weight-bearing. MATERIALS AND METHODS: The forefoot radiographs of 100 normal Korean adults, 50 male and 50 female volunteers, were evaluated both in nonweight-bearing and weight-bearing. The mean age was 27 years with range of 21-39 years. Those with normal feet were selected from volunteers having no history of foot problems or other musculoskeletal diseases. RESULTS: The changes of measured angle between phalanges and metatarsals with weight-bearing were as follows; Hallux valgus angle was noted to increase in 20% of the feet, decrease in 59%, and remained unchange in 21%. Intermetatarsal angle 1~2 was noted to increase in 76% of the feet, decrease in 3%, and remained unchange in 21%. Intermetatarsal angle 1~5 was noted to increase in 95% and remained unchange in 5%. Shift in medial sesamoid on weight-bearing was also not consistent. Lateral shift was noted in 27%, no shift in 66%, medial shift in 7%. CONCLUSION: The generalized concept that the angles between bones and shift of medial sesamoid in the forefoot will change consistently with weightbearing was not found.

Comparison of High Tibial Osteotomy: Opening versus Closing Wedge Osteotomy / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of an opening wedge osteotomy for an osteoarthritic knee, and compared these results with those of a closing wedge osteotomy. MATERIALS AND METHODS: The study included 27 patients (29 cases) with an opening wedge osteotomy (Group A) and 30 patients (30 cases) with a closing wedge osteotomy (Group B). The radiological results obtained regarding the degree of osteoarthritis, femur-tibia angle, tibial alignment, posterior tibial slope and patellar height using the Insall-Salvati's method were analyzed. HSS score was used for evaluation of the clinical results. RESULTS: Preoperatively, there were no significant differences between the two groups regarding the degree of osteoarthritis, the femur-tibia angle, tibial alignment, posterior tibial slope, and patellar height. Two years after surgery, the femur-tibia angle and tibial alignment were significantly improved to 7.7degrees valgus and 1.3degrees valgus, respectively, and the patellar height was not changed significantly in group A. Similar degrees RESULTs were obtained in group B. The tibial posterior slope increased from 3degrees to 10.7degrees in group A and decreased from 4degrees to 3.7degrees in group B. Clinically, the HSS score was improved from 74 points preoperatively to 93 points 2 years postoperatively in the opening group, and was similar to the improvement observed in the closing group. The complications included 1 delayed union in the opening group, and 3 cases of superficial peroneal nerve palsy and 1 delayed union in the closing group. CONCLUSION: An opening wedge osteotomy is a relatively simple and safe procedure that gives similar radiological and clinical outcomes to a closing wedge osteotomy, without peroneal nerve palsy. However, surgeons should take care in preventing an increase in the tibial posterior slope.

Treatment of Unstable Intra-articular Fracture of Distal Radius: Comparison of Closed Reduction and External Fixation versus Open Reduction and Internal Fixation / 대한정형외과학회잡지

PURPOSE: To compare the functional and radiographic results of the treatment in unstable intra-articular fractures of distal radius by closed reduction and external fixation versus open reduction and internal fixation. MATERIALS AND METHODS: Forty cases of unstable intra-articular fractures of distal radius were treated either by application of closed reduction and external fixation (CREF) or by open reduction and internal fixation (ORIF) between March 1989 and June 1997. They were followed up for more than one year. To assess the functional results, we used Green and O' Brien' s score system and for the radiographic results, measured volar tilt, radial inclination and radial length. RESULT: In functional results, excellent to good results were obtained in 19 cases (76%) in the CREF group and 10 cases (80%) in the ORIF group, and the average score was 81.4 and 82.8 by the Green and O' Brien' s score system. In radiographic results, mean loss of volar tilt, radial inclination and radial length were 1.4 degree (13.4%), 2.0 degree (9.0%), 1.3 mm (10.3%) in the CREF group and 1.2 degree (10.8%), 1.6 degree (6.1%) and 1.2 mm (11.5%) in the ORIF group on last follow-up radiographs. There was no evidence of statistical difference between two groups in functional and radiographic results (P>0.05). CONCLUSIONS: If an appropriate operative method is selected according to the presence of several properties, including the pattern of fracture, the general condition and activity of patient and the degree of soft tissue injury, the two operative managements are considered useful to restoring articular congruity and alignment and to allow early postoperative range of motion exercise

Surgical treatment of Quadrant Hemivertebra in Congenital Kyphoscoliosis / 대한척추외과학회지

STUDY DESIGN: Sixteen patients with congenital kyphoscoliosis were evaluated the clinical and radiological results according to the treatment method. OBJECTIVES: To provide a guideline for surgical treatment of congenital kyphoscoliosis SUMMARY OF LITERATURE REVIEW: Congenital kyphoscoliosis is an abnormal coronal and sagittal curvature of spine that is caused by the presence of vertebral anomalies, which causes a significant deformity and disability. Correction of the deformity is challenging and accompanied by high risk of complications. Many methods of operative treatment were recommended with various results. MATERIALS & METHODS: We reviewed 16 patients of congenital kyphoscoliosis who were operated from 1984 to 1997, and follow-up periods were over 12 months in all. The average age of surgery was 12 years (ranged from 4 to 20 years). Nine cases were operated by excision of quadrant hemivertebra through combined anterior & posterior approach and 6 cases were treated only by posterior instrumentation and one underwent posterior on bloc spondylectomy. RESULTS: The type of curves were thoracic in 5, thoracolumbar in 9, lumbar area in 2 patients. Average angle of kyphosis was 55 degree preoperatively, 25 degree postoperatively, and 39 degree at the follow up study. Average angle of scoliosis was 48 degree, 22 degree, and 27 degree, respectively. In 9 cases corrected by excision of quadrant hemivertebra; kyphotic angle was changed from 62degrees preoperatively, to 22degrees postoperatively and to 36 degree at the end of follow up study, while scoliotic angle was changed from 47degrees, to 12degrees and to 21degrees, respectively. In 6 cases corrected by posterior instrumentation kyphotic angle was changed from 52degrees preoperatively, to 33degrees postoperatively and to 48degrees degree at the follow up study, while scoliotic angle was changed from 53degrees, to 33degrees and to 37degrees, respectively. CONCLUSION: Excision of quadrant hemivertebra through combined anterior and posterior approach or posterior instrumentation were resulted in significant loss of correction during the remaining growth period due to the secondary change of adjacent vertebrae. So, to obtain better correction and to reduce the recurrence of deformity, more aggressive approach including the concept of three dimentional osteotomy involving the upper and lower adjacent curve may be considered.