Tenosynovial Bilateral Lipoma Arborescens of the Ankle in Adults / 대한족부족관절학회지

Lipoma arborescens or synovial lipomatosis is a rare disorder that is characterized by mature fat infiltration of the hypertrophic synovial villi, most frequently affecting the supra-patellar pouch of the knee. This paper presents a case of lipoma arborescens of the ankle joint bilaterally in an adult patient with involvement of both the intra-articular synovium and the synovial sheath of the tendons around the ankle.

Hindfoot Endoscopy for the Treatment of Posterior Ankle Impingement Syndrome: A Comparison of Two Methods (a Standard Method versus a Method Using a Protection Cannula) / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the clinical results between two different methods of hindfoot endoscopy to treat posterior ankle impingement syndrome. MATERIALS AND METHODS: Between January 2008 and January 2014, 52 patients who underwent hindfoot endoscopy were retrospectively reviewed. Two methods of hindfoot endoscopy were used; Group A was treated according to van Dijk and colleagues' standard two-portal method, and group B was treated via the modified version of the above, using a protection cannula. For clinical comparison, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, time required to return to activity, and the presence of complications were used. RESULTS: There was no statistically significant difference in the AOFAS scores at the final follow-up, and there was also no statistically significant difference in the times for the scores to return to the preoperative level. There were no permanent neurovascular injuries and wound problems in either group. CONCLUSION: Use of protection cannula may provide additional safety during hindfoot endoscopy. We could not prove whether protection cannula can provide superior safety for possible neurovascular injury. Considering the possible safety and risk of using additional instrument, the use of this method may be optional.

Comparison of the Results between Cadaveric and Radiological Measurements of Calcaneus / 대한족부족관절학회지

PURPOSE: We wanted to compare the results between cadaveric and radiological measurements of calcaneus. MATERIALS AND METHODS: Sixty three calcaneus of 33 cadavers donated between December 2012 and December 2014 were actually measured. Computed tomography (CT) images of 244 calcaneus in 122 patients of the same age group with cadavers were radiologically measured. Maximum length, maximum width, maximum height, Bohler angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were measured. RESULTS: In cadaveric measurement, the mean maximal height, length, and width were 41.8+/-3.3 mm, 73.3+/-3.4 mm, and 40.7+/-2.2 mm, respectively. In radiological measurement, the mean maximal height, length, and width were 38.5+/-4.3 mm, 74.0+/-5.7 mm, and 44.7+/-1.4 mm, respectively. In cadaveric measurement, the mean Bohler angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were 32.1degrees+/-6.2degrees, 110.8degrees+/-8.1degrees, 55.8degrees+/-6.8degrees, and 59.7degrees+/-4.6degrees, respectively. In radiological measurement the mean Bohler angle, Gissane angle, Fowler-Phillip angle, and tala-articular angle were 32.6degrees+/-3.8degrees, 113.7degrees+/-5.7degrees, 62.2degrees+/-3.9degrees, and 61.6degrees+/-6.3degrees, respectively. The mean maximal height was significantly higher in the cadaveric measurement group (p<0.001) and the mean maximal length and width were significantly higher in the radiologic measurement group (p<0.001, p<0.001). The mean Gissane angle, Fowler-Philip angle, and Bohler angle were significantly higher in the CT group (p=0.001, p<0.001, p=0.016, respectively). There was no significant difference in the mean tala-articular angle (p=0.352). CONCLUSION: Significant differences in length parameters were observed between the cadaveric measurement group and the radiologic measurement group. However, no significant differences in angular measurements were observed between the two groups. The authors carefully conclude that radiological measurement values may be different from actual values in the calcaneus.

Intraoperative Three-Dimensional Imaging in Calcaneal Fracture Treatment

BACKGROUND: To compare the effectiveness of intraoperative three-dimensional (3D) image and conventional two-dimensional (2D) fluoroscopic images, which are used in the treatment of acute calcaneal fractures. METHODS: We retrospectively analyzed 40 patients who suffered calcaneal fracture and underwent surgery at Inje University Busan Paik Hospital. The patients were divided into two groups. Only 2D fluoroscopy was used to evaluate 20 patients of group 1. On the other hand, 3D fluoroscopy was performed on the remaining 20 patients of group 2; 3D fluoroscopy was performed on these patients after they were extensively evaluated by 2D fluoroscopy during surgery. We reviewed the radiographic and clinical outcomes of these patients, whose average follow-up period was 42.6 months. RESULTS: In group 2, 3D fluoroscopy detected four cases (20%) of articular incongruence and screw misplacement. All these complicated cases were corrected during surgery. At the final follow-up session, the mean American Orthopedic Foot and Ankle Society (AOFAS) hind foot score was 78.3 (range, 65 to 95) in group 1 and 82.3 (range, 68 to 95) in group 2. CONCLUSIONS: Intraoperative 3D imaging of calcaneal fractures is considered to be useful in evaluating the congruence of joints and the placement of implants.

Failure of Reduction for Ankle Fracture-Dislocation Caused by Tibialis Posterior Tendon Interposition: A Case Report / 대한족부족관절학회지

Fracture and fracture-dislocation of the ankle may be caused by a variety of mechanisms. In addition to the fracture, injury of soft tissue such as ligaments, tendons, nerves, and muscles may occur. Among these, tibialis posterior tendon injury is difficult to identify due to swelling and pain at the fracture site. There is no clear finding in radiological examination, therefore, it is found during surgery. In this case, irreducible fracture-dislocation of the ankle due to tibialis posterior tendon interposition was observed after the primary operation. The authors obtained satisfactory results in performance of a secondary operation assisted with arthroscopy.