Partial Resection of Posterior Calcaneal Tuberosity for Haglund's Disease / 대한정형외과학회잡지

Haglunds deformity is a prominence at posterosuperior portion of the calcaneus. Extrinsic irritation on this prominence can give rise to retrocalcaneal bursitis or Achilles tendinitis. Partial resection of the posterosuperior aspect of the calcaneus was performed on 7 heels with Haglunds disease. All patients were reviewed both by radiographic examination and by questionnaire after an average 14.5 months. All but one patient showed an excellent result in a view point of pain relief. The average passive dorsiflexion angle of the ankle was improved from 5 to 25 degree, postoperatively. There was no complication such as recurrence, wound problem or paresthesia.

Proximal Metatarsal Chevron Osteotomy Combined with Modified McBride Procedures for Hallux Valgus Patients / 대한정형외과학회잡지

Seventy cases of moderate to severe hallux valgus deformities were operated by proximal metatarsal chevron osteotomy combined with modified McBride procedures from September 1994 to September 1996. The hallux valgus angle improved from an average of 35.1 degrees to 12.1 degrees postoperatively. The first intermetatarsal angle improved from an average of 15.4 degrees to 7.9 degrees. The position of sesamoids was normalized and the metatarsal bone shortened minimally. Union occurred in 6 weeks. Subjectively, pain was relieved in 95% of the patients, while walking and standing abilities improved in 90%. The shoewear improved in only 60% of the patients, showing less satisfactory results compared to other factors. In terms of complications, two recurrences occured but were treated without repeat surgery. Two malunions and four superficial wound infections occurred. In conclusion, proximal chevron metatarsal osteotomy combined with modified McBride procedures is a reliable operation as regards stability, technical ease, low complications and satisfactory results for moderate to severe Hallux valgus deformities.

Surgical Treatment of Lower Lumbar Burst Fractures / 대한정형외과학회잡지

Burst fractures of lower lumbar spine are rare and have not been well delineated in the literature. Treatment and management considerations for lower lumbar burst fractures are somewhat different from the rest of spine because this area only has the cauda equina and nerve roots. The purpose of this study was to analyse the clinical and radiological results and to determine operative approach. The authors analysed the 16 patients who had been treated with spinal instrumentation (Cotrel- Dubousset, Danek, Kaneda) from Dec. 1990 to Dec. 1994, and following results were obtained. 1. The classification of fracture by Francis-Denis method was B type in 7 cases, A type in 6 cases, E type in 2 cases, and D type in 1 case. 2. By the load-sharing classification, six points or less in 11 patients (first group) and seven or more in 5 patients (second group). In first group lordosis was corrected from 20.4degreespreoperatively to 32.6degrees postoperatively and 24.1degrees at the end of follow-up. In second group lordosis was corrected from 14.8degrees preoperatively to 21.3degrees postoperatively and 0.8degrees at the end of follow-up. 3. The short segmental fixation through posterior approach yielded good result in the first group, but poor result in the second group with complications including two cases of loss of reduction and one case of screw breakage. As a result, posterior approach might be more perferable in first group and anterior approach in the second group.

Treatment of the Ipsilateral Fractures of the Scapular Neck and Clavicle / 대한정형외과학회잡지

Scapular fractures are being seen with increasing frequency in our mechanized society, specially in patients who have multiple injuries. Most of the scapular fractures have been treated non-operatively, with early mobilization of the shoulder. The result of such functional treatment have been predictably good. However, this non-operative approach may not yield such good results in patients who have a fracture of the scapular neck in association with the ipsilateral clavicular fracture or other double disruptions of the superior shoulder suspensory complex. Ipsilateral fractures of the scapular neck and clavicle disrupt the suspensory mechanism of the shoulder resulting in fuctional loss and deformity. From January 1989 to June 1995, twelve patients were identified with this specific pattern of injury. The follow up period was 39.2 months in average. Seven patients were treated operatively using 3.5mm DCP or reconstruction plate, and five patients were performed K-wire fixation or wiring. Upon review all were healed radiographically. According to the scoring system of Rowe, five patients had an excellent fuctional result, five had a good result, and two had a fare result. The average score for the twelve patients was 85 points. The results of our retrospective study show that operative treatment for these complex fractures is safe and that functional recovery is predictably good.