Comprehensive Analysis for Risk Factors of Lower Extremity Amputation as a Treatment of Complicated Diabetic Foot / 대한족부족관절학회지

PURPOSE: The diabetic foot lesions are intractable, and aggravation often leads to amputation. None or minor amputation group was treated debridement or toe amputation and major amputation group was treated Ray, Lisfranc, Chopart, Below Knee and Above Knee amputation. We investigate the risk factors for major limb amputations among patients with diabetic foot lesion. MATERIALS AND METHODS: The subjects were 73 diabetic foot lesion patients (83 diabetic foot lesions) treated at our department from January 2006 to December 2010. Non or Minor amputation group of 44 cases were treated with debridement or toe amputation. Major amputation group of 39 cases were treated with Ray, Lisfranc, Chopart, below or above Knee amputation. We investigated socioeconomic factors, diabetes mellitus related factors and wound related factors and laboratory factors. Statistical analysis was done by Students t-test, Chi-square test, Mann-Whitney's U test. RESULTS: In our analysis, wound size, wound classification (Wagner classification, Brodsky classification), white blood cell counts, polymorphoneuclear neutrophil percentage, hemoglobin, C-reactive protein and albumin were risk factors for major amputation (p<0.05). CONCLUSION: Low education level, nutritional condition, premorbid activity level and progressed wound condition were observed in major amputation group compared with non or minor amputation group. In the major amputation group, higher white blood cell count, C-reactive protein level and lower albumin level were observed. Together with maintenance of adequate nutritional condition, early detection of lesions and foot care for early treatment is important. Therefore, active investigation with full risk evaluation of vascular complication is also important.

Achilles Tendon Rupture Associated with Ipsilateral Bimalleolar Fracture: A Case Report / 대한족부족관절학회지

We report here on a case of Achilles tendon rupture associated with ipsilateral bimalleolar fracture that was caused by ski injury. The association of an ankle fracture with rupture of the Achilles tendon is even more infrequent, although both injuries alone are extremely common. We treated as a operation of Achilles tendon repair with Krackow method and open reduction with Tension-band wiring technique for bimalleolar fracture.

Bilateral Inferior Shoulder Dislocation with Greater Tuberosity Fracture: A Case Report / 대한정형외과학회잡지

We report here on a case of bilateral inferior shoulder dislocations (bilateral luxatio erecta) with greater tuberosity fracture that was caused by vehicle trauma. We manually reduced the dislocations at the emergency room. After 7 months of conservative treatment with rehabilitation, the range of motion and muscle strength of the shoulders recovered to almost normal.

Treatment of Subsesamoid Arthritis of the Metacarpophalangeal Joint of the Thumb: Volar Plate Reinforcing Technique after Sesamoid Excision / 대한정형외과학회잡지

PURPOSE: To report the clinical outcomes of a volar plate reinforcing technique with free tendon grafts after sesamoid excision for the surgical treatment of subsesamoid arthritis of the metacarpophalangeal (MCP) joint of the thumb. MATERIALS AND METHODS: Eleven consecutive patients that underwent sesamoid excision and volar plate reinforcement using a palmaris longus free tendon graft were enrolled. There were 7 males and 4 females, with an average age of 46 (range, 30-56 years). Post-traumatic arthritis after a hyperextension injury of the thumb was present in 9 patients. Two patients had idiopathic arthritis. All patients were evaluated by objective and subjective criteria, the mean follow-up duration was 19 months (range, 12-35 months). RESULTS: The results were satisfactory overall (3 excellent, 7 good, 1 poor). The mean grip strength and pinch strength significantly improved from 63.0% and 51.3%, respectively, preoperatively, to 84.9% and 88.9%, postoperatively. The mean range of motion for the MCP joint was -5.9/50.9 degrees. The mean DASH and MHQ scores showed significant improvement compared to the preoperative scores. CONCLUSION: The early clinical results suggest that the described technique is a safe and effective option for subsesamoid arthritis of the MCP joint of the thumb.