Homodigital Reverse Pedicle Island Flap for Reconstruction of the Great Toe: A Case Report

Reconstruction of the distal portion of the great toe has always represented a difficult problem to surgeons. There are many methods of flap reconstruction described for foot defects, but none for tip of the great toe. We report a case of reconstruction of the great toe using a homodigital reverse pedicle island flap method. A 25-year-old man had a crushing injury at the distal phalanx of the left great toe. A homodigital reverse pedicle island flap was raised from the dorso-medial aspect of the proximal phalanx of the great toe based on the distal dorsal arcade. The flap covered the exposed distal phalanx and stump was closed without shortening. He made an uncomplicated recovery and when seen 6 months later he had a good cosmetic and functional result. A homodigital reverse pedicle island flap is described for the reconstruction of the distal part of the great toe. It involves only a single stage procedure with minimal donor site morbidity and provides a good cosmetic results.

Long-term Follow-up Results of the Free Vascularized Fibular Graft in Congenital Pseudarthrosis of the Tibia / 대한정형외과학회잡지

PURPOSE: To report the long-term follow-up results of a free vascularized fibular graft (FVFG) for the treatment of patients with congenital pseudarthrosis of the tibia (CPT). MATERIALS AND METHODS: Fourteen patients with CPT, who underwent FVFG and were followed-up for more than 4 years, were enrolled in this study. The average age at FVFG was 4.5 years (range, 1~10.6 years) with an average follow-up of 11.6 years (range, 4~26.6 years). In 11 cases, 24 additional procedures were performed due to the secondary problems, such as delayed union, nonunion, leg length discrepancy, and deformity of the tibia. The clinical and radiological data were reviewed to evaluate the outcomes of the FVFG. RESULTS: Bone union and hypertrophy of the fibular graft was observed in all cases. The average time of union in 7 cases, in whom bone union was achieved without the aid of any supplementary procedures, was 6.7 months (range, 3.5~11 months). At the last follow-up, the mean limb length discrepancy was 2.5 cm (range, 0~8 cm), and the average anterior apex and valgus angulation of the tibial shaft were 18.4degrees (range, 0~85degrees) and 9.9degrees (range, -5~34degrees), respectively. The mean ankle alignment was valgus 7.2degrees (range, -3~30degrees), and the mean range of motion of the ankle joint was dorsiflexion 17degrees and plantar flexion 30degrees. CONCLUSION: FVFG is an effective procedure in congenital pseudarthrosis of the tibia which has the advantages of allowing a more aggressive resection of the abnormal bone and scar tissue and as well as resolving the bone defect after resecting the lesion. This procedure is expected to produce a better clinical result if rigid internal and external fixation are performed.

Reconstruction of Tibia Defect with Free Flap Followed by Ipsilateral Vascularized Fibular Transposition

Segmental defects of the tibia after open fractures, sepsis and a tumor surgery are among the most difficult and challenging clinical problems. Tibia defects in these situations are complicated with infection and are resistant to conventional bone grafting techniques. The aim of this study is to report the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of tibia defects. Ten patients had free flap followed by IVFT in the period 1989~2007. Mean age was 25.3 years. The patients were followed for an average of 3.4 years. All flaps were survived including 1 case with venous thrombosis requiring additional surgery. The average time to union of proximal and distal end was 5.2 months, 8.2 months, each other. All transposed fibula were viable at last follow-up. IVFT offers the advantages of a vascularized graft. In patients with large bone and soft tissue defects combined with infection, free flap followed by IVFT is an useful and reliable method without microvascular anastomosis.

The Efficacy of Proximal Row Carpectomy / 대한정형외과학회잡지

PURPOSE: To evaluate the effects of proximal row carpectomy. MATERIALS AND METHODS: We performed a retrospective review of the cases of 14 patients who had undergone proximal row carpectomy between April 1996 and January 2006. All of the patients were men with an average age of 37.5 years (range, 25-64 years). The mean follow-up period was 59 months (range, 18-101months). Evaluation of results was based on x-ray analysis, pain relief, the ability to return to work, activity level, range of motion (ROM) and grip strength. Pain relief was classified as very satisfied, satisfied, dissatisfied and very dissatisfied. RESULTS: The subjective results of pain relief were very satisfied in 6 cases, satisfied in 7 cases, dissatisfied in 1 case. 7 cases (50%) returned to previous occupations and 11 cases (79%) had little restriction on their daily activities. The total arc was improved from average 42 degree to 59 degree. The grip strength using Jamar dynanometer was increased from average 7.8 lbs (10.5% of the unaffected side) to average 33 lbs (44% of the unaffected side). CONCLUSION: Proximal row carpectomy is an effective surgery with preserving ROM and function for patients with wrist pain and diminished function if it is done within proper indication.

Clinical Results of the Multiple Drilling for Osteochondral Lesion of the Medial Talar Dome / 대한정형외과학회잡지

PURPOSE: To evaluate the treatment outcomes of transmalleolar multiple drilling with a K-wire for an osteochondral lesion of the medial talar dome after an mean follow-up period of 77 months. MATERIALS AND METHODS: Among patients treated surgically for a symptomatic osteochondral lesion of the talus between March 1997 and December 2002, sixteen ankles (fifteen patients) with a medial talar dome lesion were treated by transmalleolar multiple drilling and followed-up for at least 3 years. The average age at the time of surgery was 34.4 years (range, 19-58 years). The mean follow-up period was 77 months (range, 41-107 months). RESULTS: At the latest follow-up, the average VAS at motion decreased from 6.8 to 2.1 (p=0.004). The AOFAS score improved from 64 points to 86.2 points (p=0.001). The 8 ankles in those less than thirty years of age at that time of surgery showed a VAS at motion of 1.8 and an AOFAS score of 91.1 points. In contrast, 8 ankles in those who older than thirty one years of age had a VAS at motion of 2.4 and an AOFAS score of 81.2 points. The younger group showed a significantly better AOFAS score than the older group (p=0.001). However, there was no significant difference in the VAS score (p=0.22). CONCLUSION: Multiple drilling has a good effect in pain control and ankle function for patients with an osteochondral lesion of the medial talar dome 10 mm. The procedure is particularly effective and useful in younger patients.

Bankart Repair for the Traumatic Anterior Shoulder Instability : At Least 6 Years Follow-up / 대한정형외과학회잡지

PURPOSE: This study compared the long-term clinical results of an open Bankart procedure for anterior shoulder instability with those from an arthroscopic procedure, and evaluated the factors influencing the final outcomes and recurrence. MATERIALS AND METHODS: One hundred thirty three shoulders with a Bankart repair of a traumatic anterior shoulder instability with a follow-up period of at least 6 years were enrolled in this study. Sixty-seven shoulders had an open repair and sixty-six shoulders, an arthroscopic repair. The mean age at the time of the operation was 27.7 years (range, 17 to 62 years). The mean follow-up period was 100 months (range, 72 to 141 months). RESULTS: At the last follow-up, the pain score during motion improved from 3.86 to 1.36. Forward flexion and external rotation at the side decreased to a mean of 3 degrees, 9 degrees in the open group and a mean of 1 degree, 4 degrees in the arthroscopic group. Sixty-two (93%) and 59 shoulders (89%) in the open and arthroscopic group could return to their pre-injury sports activities, respectively. At a mean 12.5 months after surgery, 14 shoulders (10.5%) experienced a redislocation. There were 6 (9%) and 8 (12%) redislocations in the open and arthroscopic groups, respectively. CONCLUSION: The open group showed relatively better results than the arthroscopic group but there was no significant difference between two groups. Both open and arthroscopic Bankart procedures are effective methods that produce acceptable results when a precise surgical technique and proper postoperative rehabilitation are carried out.

Clinical Outcomes of Semiconstrained Total Elbow Arthroplasty : Non-traumatic Arthritisversus Traumatic Arthritis / 대한정형외과학회잡지

PURPOSE: This study evaluated the clinical and radiological outcomes of semiconstrained total elbow arthroplasty. MATERIALS AND METHODS: Thirty-nine elbows with semiconstrained total elbow arthroplasty and who were followed up for at least 3 years were enrolled in this study. There were 29 and 10 cases in the non-traumatic arthritis and traumatic arthritis groups, respectively. The mean age at the time of surgery was 53.9 years, and the mean follow-up period was 54 months. RESULTS: At the last follow-up, the pain score during motion decreased from 7.37 to 1.23. The Mayo elbow performance score was 86. The mean loss of terminal extension improved from 32degrees to 11degrees and the mean maximum flexion improved from 90.3degrees to 125.2degrees. Radiology analysis, 15 elbows showed radiolucency and 8 elbows showed loosening. There were 13 cases of radiolucency and 7 cases of loosening in the non-traumatic arthritis group. In the traumatic arthritis group, there were 2 cases of radiolucency and 1 case of loosening. CONCLUSION: Semiconstrained total elbow arthroplasty for non-traumatic and traumatic arthritis of the elbow produced satisfactory functional results. The non-traumatic arthritis group had a higher incidence of radiolucency and loosening than the traumatic group.

Clinical Results of Arthroscopic Repairin Full-thickness Rotator Cuff Tears / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of arthroscopic repair for full thickness rotator cuff tears. MATERIALS AND METHODS: One hundred shoulders with arthroscopic rotator cuff repair for full thickness rotator cuff tears, with the exception of massive tears, were enrolled in this study. The average age at the time of surgery was 52 years (range, 23-74 years). The mean follow-up period was 48 months (range, 15-92 months). Thirty-two cases had small-sized tears, 51 cases had medium- sized tears and 17 cases had large-sized tears. RESULTS: At the final follow-up, the average UCLA score improved from 18.25 to 31.7 with 34 excellent (34%), 55 good (55%) and 11 poor results (11%). The UCLA score was 31.91 in the group less than 50 years of age and 31.54 in the group over 51 years of age (p=0.592). The UCLA score was 31.7in the group of small-sized tears, 31.75 in those with medium-sized tears, and 31.5 in those with large-sized tears (p=0.952). The stiff group had 148degrees and 154degrees of forward flexion and abduction, respectively, and non-stiff group had 161o and 163o of forward flexion and abduction, respectively (p=0.046, 0.049). CONCLUSION: An arthroscopic repair of full thickness rotator cuff tears produced excellent clinical results. The age and the size of the tear did not affect the results but the stiff group showed inferior results at the range of motion compared with the non-stiff group.