Posterior Impingement Syndrome of the Ankle Joint in Classical Ballet Dancer / 대한정형외과학회잡지

In the classical ballet dancers, ankle joints are frequently overused. Especially the Pointe and the Releve are the two basic steps of ballet dance which cause the narrowing of the posterior aspect of the ankle joint. Posterior impingement syndrome of the ankle joint is defined as impingement occuring at the anatomical interval between the posterior tibial articular surface and os calcis. The purpose of this study is to describe the anatomy and etiology of this injury and to review the non-operative and operative treatments. Sixteen cases of posterior impingment syndrome had been treated between March 1994 and March 1995. Ten dancers were professional and six were students. The patients was divided 3groups by etiologic factor. Group 1 is anatomical problem factor, Group 2 is overuse factor and Group 3 is ankle sprain factor. Thirteen dancers (81.2%) improved with conservative treatment including local steroid injection. Among the other three dancers, operation was performed in one case. The other two cases stopped dancing. The result was good in one dancer after operation. In the classic ballet dancers, posrerior impingement syndrome was frequent disorder and major etiologic factors are anatomical problem and overuse. Operation was necessary in only group l. It is good result in conservative treatment and operation.

Flexor hallucis Longus Tendinitis in Classical Ballet Dancer / 대한정형외과학회잡지

Flexor hallucis longus tendinitis is a common overuse syndrome in classic ballet dancers. To describe the clinical symptoms, diagnosis and non-operative and operative treatment, we evaluated twenty ballet dancers from march 1994 to August 1995. For the diagnosis, Tomasen test was helpful clinically and MRI was essential for surgical intervetion to find a tendon degeneration. Patients were classified into three groups by symptoms and clinical stages. All of the Group 1 and 2 were recovered by means of the conservative treatment. Two dancers belongs to Group 3 showed a severe degeneration of tendon on the MRI scan, finally was taken the an operation. Release of the tarsal tunnel were performed. Six months after operation, they could return to dancing.

Soft Tissue Reconstruction Using Peroneal Myocutaneous Island Flap / 대한정형외과학회잡지

The Authors newly designed one of the Myocutaneous Falp modifying the peroneal island flap. This flap involved a part of peroneal muscle and skin on the outer side of leg and pedicle consisting of the peroneal artery and vein as an island flap. It was useful on soft tissue and skin defect of ipsilateral leg or foot region, which area was needed thicker one than simple cutaneous flap. We have treated four patients using this flap and achieved satisfactory results.

A Clinical Study of the Diabetic Foot / 대한정형외과학회잡지

With the advancement of modern medicine, diabatic foot gangrene rather than acute metabolic complications are eneountered as serious problem. The diabetic gangrene, one of the angiopathic and neuropathic complications, is difficult in treatment because of wound infection and delayed healing. The authors reviewed a series of 47 cases in 40 patient of diabetic gangrene that treated in orthopedic department of Eulji General Hospitsl, Seoul, from January 1982 to December 1987. We summarized the obtained results as following. 1. The overall incidence of diabetic gangrene was 0.42%, and 77.5% of patients with gangrene were in over 50 year age group. 2. 72.5% of patients with gangrene were 5–14 years in duration of diabetes. 3. The most common predisposing factor was local pressure(45%), and the most common site of lesions was big toe(34%). 4. Bacterial infections were shown in 90% of cases, and the most common organism wasstaphylococcus(56%).5. Diabetic retinopathy was the most common associated complication and neuropathy, nephropsthy in order. 6. According to the Wagner's classification, grade 4 lesion was most common(47%). 7. There was no correlation between primary healing and the lowest palpable pulse. 8. The overall rate of primary healing was 57%.

A Clinical Study of the Severe Ankle Fracture / 대한정형외과학회잡지

The primary goal of treatment of the adult ankle fracture is to effect the returning of normal func tion that is accomplished by the accurete reduction and rigid internal fixation followed by the early institution of motion. The authors have reviewed a series of 41 cases of the bimalleolar and trimalleolar ankle fractures that treated in Orthopedic Department of Eulji General Hospital, Seoul, from January 1982 to June 1986. With the duration of follow-up of average 13.2 months, we summarized the obtaind results as followings. l. Among the forty one patients, thirty one was male patient(M: F =3.1: 1). The average age was 33.2 years old. 2. The main cause of the fracture was traffic accident, 18 cases(43.9%) and other causes were slipping down(24.4%), fall from a height(14,6%), industrial injury(12.2%) and other injuries(4.9%). 3. According to the modified Lauge-Hansens classification, the supination-external type was most common (41.5%). 4. As a diagnostic method, the computerized tomography was also available. 5. All cases were treated by open reduction and internal fixation with the good radiologic results of 91.3% in bimalleolar fractures and 88.9% in trimalleolar fractures. 6. Of the bimalleolar fractures, ten patientz showed normal range of motion in 2 to 4 weeks, average 18.4 days, by early joint exercise.

Range of Active Motion and Axial Angles of the Wrist Joint in Normal Adult Korean / 대한정형외과학회잡지

With a ordinary goniometer, we measured the range of active motion of the wrist flexion, extension, ulnar and radial deviation in 120 normal adult subjects ranging in age from 20 to 49 years old. Normal limits were determined for the male and female groups, for the age groups, and for the right and left sides, respectively. The data were compared with the axial angles in roentgenograms that described by T.E. Keats in 1966. And we have undertaken a study of the correlation between the range of motion and the axial angles. The results were as following: 1. Range of active motion (degrees±standard deviation) Rexion; 73.9 ±6.386. extension; 65.9 ±5.164 unlar deviation; 28.3 ±5.124 radial deviation; 18.6±2.556 2. Axial angles (degrees±standard deviation) P-A view;73.8±3.985 lateral view;79.7±4.777 3. Males had a smaller range of motion than female in wrist joint. 4. The right side showed a smaller range of motion than the left. 5. There were no correlations between the range of motion and the axial angles.

Computed Tomography in Pelvic Fracture / 대한정형외과학회잡지

Computed tomography (CT) has been shown to be useful in evaluation of the intracranial lesion. But now, computed tomography has been appealing as a new radiologic modality applicable to diagnosis and treatment in orthopaedic surgery. The two-dimentional picture, in one tomographic cut of any part under investigation, was able to increase the sensitivity or resolution of detection of lesion and able to overcome the disadvanages of conventional roentgenography. Eighteen patients who injuried pelvic fracture were examined by computed tomography after evaluated by plain radiography and occasionally by standard tomography. In six cases, we get a new additional diagnosis which are not found in conventional radiography. We have found that CT was more sensitive than plain radiography in detecting the sacroiliac joint injury and its around structure injury and hip joint integrity. Of more importance, clinical sign and symptom are valuable in diagnostic process.

Percutaneous K-wire Fixation of Colles' Fracture A Prospective Study of Twenty Seven Cases / 대한정형외과학회잡지

27 Colles' fracture were treated with closed reduction and percutaneous k-wire fixation under the C-arm fields, from July 1980 to September 1984 at the Department of Orthopedic Surgery of Eul Ji Hospital. The average duration of the follow up was 4.9 Months. A prospective study was made and evaluated under the subjective and objective criteria of Gartland and Werley, and the objective criteria of Scheck. The results of this study were as follows: 1. The incidence was high in 4th and 5th decade as 66. 5%, not significant between females and males, 45% of the cause of injury was falling accident. 2. In 27 cases, showed the satisfactory result about 92.6%, but, in the eomminuted intraarticular fracture group, 2(15.4%) out of 13 cases showed unsatisfactory result. 3. Better result was obtained with more secure reduction and skillful technique, in certain case, considered that the open reduction and internal fixation with k-wires would be better than percutaneous k-wire fixation. 4. In the aspect of hand motion and the concept of improved anatomical restoration and maintenance would lead to improved function, ideal method was percutaneous k-wire fixation and casting after closed reduction under the C-arm fields.

Clinical Study on Open Fractures of the Tibial Shaft / 대한정형외과학회잡지

Open fractures of the shaft of the tibia occur frequently because of the progression of industrialization, Different methods of treatment have been advocated as regards the care of the open wound and the method of stabilization of the fracture fragments. The reports, published until recently, have differed with respect to rates of morbidity and end results. With this in mind, we reviewed a consecutive series of 30 open fractures of the tibia at the Department of Orthopedic Surgery of the Eulji General Hospital between 1981 and 1983 by a variety of methods. The following results were obtained. 1. The highest incidence of fractures was encountered in 3rd decades(43.3%) and male to female ratio was 4: 1. 2. The most common cause of fractures was traffic accident(66.6%). 3. The most common anatomical level of fractures was middle third of the shaft(46.7%). 4. The severity of injury was classified according to the Ellis classification as follows. Minor group, 8 cases(40%), Moderate group, 8 cases(26.7%,), Major group, 10 cases(33.3%). 5. The most common associated injury was ipsilateral fibular fracture. 6. Of 30 cases, 11 patients(36.6%) had an open wound more than 5cm in length, 10(33.3%.) between 2.5 and Scm and 4(13.4%) below 2.5cm, and primary closure after thorough debridement and copious irrigation was done in 17 cases(56.7%). 7. Pin and plaster method was applied in 3 cases of minor group and 3 of moderate group, intramedullary nailing was applied in 9 of minor group and 5 of moderate group, and Hoffmann device was applied in 10 of major group. 8. The majority of cases(66.7%) were operated on within 1 week after injury, 9(30%) between 1 and 2 weeks and 1(3.3%) between 2 and 3 weeks. 9. The fractures in middle third of the shaft of the tibia treated with intramedullary nailing revea.ed the shortest healing time(average 13 weeks). 10. Complications such as delayed union, infection and disabled joint shiffness were encountered mainly in cases with severe soft tissue injuries.

Xanthoma of the Achilles Tendon / 대한정형외과학회잡지

Xanthoma tendinosum is a hereditary lipid storage disease marked by formation of papules or nodules in the tendon, especially the extensor tendon of the hand and feet and the Achilles tendon. Xanthoma of the Achilles tendon is a rather rare, interesting orthopaedic condition that has important ramification in internal medicine and dermatology because the lesion is associated with a specific disturbance of lipid metabolism with elevated blood cholesterol level. Author present a case of bilaterally involved Achilles tendon Xanthoma. We performed subtotal resection with gastrocnemius fascial transfer on one side and total resection with peroneus brevis tendon transfer on the other side.

Clinical Study on Hip Fractures / 대한정형외과학회잡지

Fractures of the hip are usually classified first according to their anatomic location. Isolated fractures of the lesser or greater trochanter are not common and rarely requir surgery, Femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures are common categories that usually require open reduction and internal fixation. These fractures most often occur in elderly patients. The prognosis of these three major categories of hip fractures seems to be entirely different because of their anatomic characteristics. Seventy three cases of hip fractures were experienced at the Department of Orthopedic Surgery, Eul-Ji General Hospital over the period from Jan. 1975 to Aug. 1980 and the following results were obtained. 1. Of the 73 hip fractures, femoral neck fractures were 28 cases (38.5%), intertrochanteric fractures were 23 cases (31.5%), subtrochanteric fractures 11 cases (15%), and acetabular, fractures 11 cases (15%). 2. Traffic accident was the major cause of hip fractures in our series. 42 cases (57.2%) were caused by traffic accident, whereas 27 cases (37.0%) by a fall from the height. 3. Hip fractures occured most frequently in the age group from 31 to 50 years (53.5%). Male to female ratio was 2:1. 4. Cases caused by traffic accident visited hospital earlier than the others. 5. The most common type was Garden's type IV (53.6%) in the femoral neck fractures, Boyd-Griffins type Il (47.8%) in the intertrochanteric fractures, and Fielding's type II (54.5%) in the subtrochanteric fractures. 6. Metal devices used to fix hip fractures were Knowles pin, Jewett nail plate, compression hip screw, plate and screws, and Kuntscher nail. Internal fixation was done anatomical reduction has been achieved in stable fractures, and Dimon-Hughston reduction in unstable fractures. 7. Postoperative cast immobillzation was performed in 13 cases of 21 femoral neck fractures, 15 cases of 22 intertrochanteric fractures and 6 cases of 11 subtrochanteric fractures. The average duration of immobilization was 10 to 12 weeks. 8. Incidence of avascular necrosis in femoral neck fractures was 16.7%, nonunion in intertrochanteric fractures was 11.8%, and nonunion is subtrochanteric fractures was 12.5%.