Unilateral Menisco-Meniscal Ligament / 대한정형외과학회잡지

Menisco-meniscal ligaments in knee joint are known as four variants, anterior and posterior transverse meniscal ligament, medial and lateral oblique menisco-meniscal ligament. The ligament which originates from the anterior horn of the meniscus and attached to the posterior horn of the same meniscus, so-called unilateral menisco-meniscal ligament is extremely rare in English literature. The authors experienced a case of medial unilateral menisco-meniscal ligament with posterior horn tear of the medial meniscus in a 49-year-old man. We report this case with a review of literature.

Bipartite Medial Cuneiform Combined with Accessory Navicular: A Case Report / 대한족부족관절학회지

Accessory navicular is a congenital anomaly appearing in the secondary ossification center on the tuberosity of the navicular that may cause flatfoot. Bipartite medial cuneiform is another rare congenital anomaly occurring as two primary ossification centers in the medial cuneiform. The authors report a rare case of symptomatic bilateral accessory navicular with bipartite medial cuneiform and flatfoot deformity in a 19-year-old man with a review of the literature.

Complications of Scarf Osteotomy for Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the frequency of troughing and stress fracture, which are the major complications of scarf osteotomy, and to suggest methods to prevent these complications. MATERIALS AND METHODS: We reviewed 243 cases of 137 patients treated with the scarf osteotomy for hallux valgus from January 2005 to December 2012. The mean follow-up period was 2.8 years. During the scarf osteotomy, a long oblique longitudinal osteotomy was performed in order to decrease the possibility of troughing and stress fracture. Radiographs of lateral view of the foot were obtained and the thicknesses of the first metatarsal base at the sagittal plane were measured and compared. RESULTS: There was no troughing during fragment translation and screw fixation intraoperatively. Radiographs of lateral view of the foot taken preoperatively and at the last follow-up showed that the mean thickness of the first metatarsal was 22.4 mm preoperatively and 21.6 mm at the last follow-up, with a mean difference of 0.8 mm. And no stress fracture was observed. CONCLUSION: To prevent troughing and stress fracture, a long oblique longitudinal cut, parallel to the first metatarsal plantar surface, was performed, making both ends of the proximal segment truncated cone-shape, and securing the strong bony strut of the proximal segment. No troughing or stress fracture was experienced with scarf osteotomy.

Scarf Osteotomy for the Treatment of Recurred Hallux Valgus / 대한족부족관절학회지

PURPOSE: Recurrence is one of the most common complications after primary correction for hallux valgus deformities. The purpose of this study was to evaluate the usefulness of Scarf osteotomy with axial decompression in the treatment of recurrent hallux valgus. MATERIALS AND METHODS: From April 2006 to April 2011, 14 cases (12 patients) of recurrent hallux valgus were managed with shortening Scarf osteotomy. Preoperative and postoperative radiographs were reviewed for the measurement of the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the amount of the 1st metatarsal shortening. Clinical outcomes including the visual analogue scale (VAS), the AOFAS score, and the range of motion [ROM] of the 1st metatarsophalangeal (MTP) joint were evaluated. RESULTS: The mean HVA decreased from 27.9 degrees to 5.2 and the mean IMA decreased from 12.9 to 3.4. The mean VAS improved from 5.3 to 0.3 and the mean AOFAS score improved from 41 to 90. The mean amount of the 1st metatarsal shortening was 3.4 mm (2-5). The mean ROM of the 1st MTP joint improved from 22 degrees (15-35) to 68 (55-75). CONCLUSION: Scarf osteotomy associated with axial decompression can be a useful revision procedure for the treatment of recurrent hallux valgus deformity.

Stress Fracture of the Patella in a Child / 대한정형외과학회잡지

Stress fracture usually occurs in physically active individuals as a result of repetitive strenuous muscle and tendon forces acting on bones that have not adapted to such forces. To the best of our knowledge, the literature contains few reports of stress fracture of the patella. We report herein on a case of a nine-year-old female who developed a stress fracture in the patella after running.

Result of Joint Preserving Surgery Using Axial Shortening Metatarsal Osteotomy for the Treatment of Severe Hallux Valgus and Claw Toes Deformity in Advanced Rheumatoid Arthritis / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the effect of axial shortening metatarsal osteotomy on the treatment of advanced rheumatoid arthritis patients with severe hallux valgus and claw toe deformity of lesser toes which is used for preserving the metatarsophalangeal joint. MATERIALS AND METHODS: From January 2005 to June 2009, 18 cases of axial shortening metatarsal osteotomy in advanced rheumatoid arthritis were reviewed ; all of them followed up for more than 2 years after surgical procedures and the mean follow up period was 3.4 years. We performed axial shortening Scarf osteotomy and Akin osteotomy for hallux valgus and Weil osteotomy with soft tissue release for claw toe of lesser toes, respectively. We measured preoperative and postoperative hallux valgus angle, each metatarsal shortening length and the range of motion of the metatarsophalangeal joints through radiographic and clinical examination and compared them each other. Clinical results were evaluated by American Orthopedic Foot and Ankle Society (AOFAS) score and subjective satisfaction of the patients. RESULTS: The hallux valgus angle was reduced from the preoperative mean value of 44.8 degree to 9.0 degree postoperatively and the range of motion of the metatarsophalangeal joint of great toe and lesser toes was increased from the mean of 21.7 degree and 11.0 degree preoperatively to 38.0 degree and 32.5 degree, respectively at postoperation. Also, the mean AOFAS score was improved from 26.5 points to 67.4 points. CONCLUSION: Axial shortening osteotomy is a useful method to correct the deformity and preserve the metatarsophalangeal joint for severe hallux valgus and claw toe deformity in advanced rheumatoid arthritis.

The Modified Phemister Operation with the Suture Anchor Added for the Augmentation of Conoid Ligament in Acute Acromioclavicular Dislocation

PURPOSE: The purpose of this study was to present methods and results for the modified Phemister operation, with a suture anchor added for augmentation of the conoid ligament in cases of acute dislocation of the acromioclavicular joint. MATERIALS AND METHODS: We evaluated 14 cases of acute dislocation of the acromioclavicular joint. This included 11 cases of Rockwood type 3, and 3 cases of type 5. The mean age of patients was 45.2 years. We operated on them using an anchor for augmentation of the conoid ligament in the modified Phemister operation. The average follow-up period was 14 months and post-operative clinical analysis was conducted using the Weitzman classification, VAS Score, Constant Score and KSS Score. RESULTS: According to Weitzman scores, 13 cases were evaluated as excellent, and one case was good. They had mean joint ranges of forward elevation of 170.7degrees, lateral elevation of 166.4, external rotation of 68.2, and internal rotation to the level of T7. The mean VAS Score was 1.9, mean Constant Score 90.8, and the mean KSS Score 91. Radiologic analysis indicated that all cases had a good result. CONCLUSION: The modified Phemister operation with a suture anchor added for augmentation of the conoid ligament is very effective clinically in acute dislocations of the acromioclavicular joint.

Operative Treatment of the Bilateral 1,4th Brachymetatarsia with Painful Callosity and Hallux Varus using Massive Metatarsal Axial Shortening: A Case Report / 대한족부족관절학회지

In general, the operative treatment of the brachymetatarsia is the lengthening of the affected metatarsal bone due to the cosmetic problem rather than the functional one. We experienced 22 year-old female bilateral congenital foot deformities such as hallux varus and 1,4th brachymetatarsia treated with reverse Scarf osteotomy on the hallux varus and massive axial metatarsal shortening Weil osteotomy on the 2,3,5th metatarsals which could reconstruct the normal metatarsal parabola.

Clinical Result of Arthroscopic Capsular Release and Repair for SLAP II Lesion with Stiffness

PURPOSE: We assessed the clinical results after the operative treatment of type 2 SLAP lesion with stiffness. MATERIALS AND METHODS: 13 patients who had SLAP lesion with stiffness were treated with arthroscopic capsular release, SLAP repair and treatment of the associated lesion. The average follow-up period was above 12 months. RESULTS: The postoperative mean VAS was scored 1.5 and the postoperative ROWE score was 92.3, which showed a significant improvement after the operation (P<0.001). The mean range of motion was a significantly improved after the operation (P<0.001). The ROWE score was excellent for all the cases. CONCLUSION: Arthroscopic capsular release and SLAP repair and treatment of the associated lesion in patients with type 2 SLAP lesion with stiffness are effective treatments for the increasing the range of motion and decreasing the pain.

The Effect of Derotational Closing Wedge Akin Osteotomy for the Treatment of Hallux Valgus with the Pronation of Great Toe / 대한족부족관절학회지

PURPOSE: We tried to understand the effects of the derotational closing wedge Akin osteotomy during the operation for the hallux valgus with pronation of great toe. MATERIALS AND METHODS: Eighty five patients who had undergone Akin osteotomy among the eighty seven patients who had been treated with Scarf osteotomy with hallux valgus were included in this study. Derotational supination was added on the medial closing wedge Akin osteotomy at the base of proximal phalanx and it was secured with K-wire, headless screw or staple. We measured and analyzed pre- and post-operative hallux primus valgus angle and hallux pronational rotatory angle. RESULTS: The hallux primus valgus angle improved an average of 14+/-2.98 degrees to -1+/-1.68 degrees with the hallux pronational rotatory angle respectively from 24.8+/-7.64 degrees to 4.7+/-4.22 degrees. CONCLUSIONS: After the metatarsal osteotomy for the treatment of the hallux valgus with the pronation of great toe, derotational closing wedge Akin osteotomy can give us a belief that it can correct the hallux primus valgus angle and hallux pronational rotatory angle also and it can be a helpful method for minimizing the recurrence rate of the hallux valgus deformity.

Multi-dimentional Correction of the Scarf Osteotomy for the Treatment of Hallux Valgus / 대한족부족관절학회지

PURPOSE: Scarf osteotomy can provide the simultaneous correction of the hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA1-2), DMAA and the plantar displacement of the fragment. The study was conducted to understand the multi-dimensional correction of the hallux valgus. MATERIALS AND METHODS: Fourty eight patients who had undergone Scarf osteotomy with hallux valgus at more than 30 degrees of HVA and more than 15 degrees of IMA1-2 were studied. Before an osteotomy, a reference K-wire was inserted to the 1st metatarsal head. After the osteotomy, the plantar fragment was moved laterally and the proximal end of the fragment was forced beyond the distal end which resulted in an internal rotation of the head fragment to correct the DMAA. RESULTS: The HVA improved an average of 33.3 degrees to 7.7 degrees with the IMA1-2 respectively from 15.4 degrees to 6.5 degrees. The DMAA improved an average of 19.5 degrees (5.2-30.9 degrees) to 4.5 degrees (0.4-13.8 degrees). By checking the angle, which was at an average of 25 degrees between the plantar surface of the foot and the osteotomy plane, the average distance of 1.9 mm (1.18-3.1 mm) of plantar displacement was measured using the value of sine (sin 25 = 0.422). CONCLUSIONS: It is possible to correct the HVA, IMA1-2 and DMAA simultaneously with one osteotomy making the lateral shift, the internal rotation and the plantar displacement of the plantar head fragment as desired. Despite the technicality and difficulty of the Scarf osteotomy, once familiarized through myriad procedures, all disadvantages are outweighed by the success and satisfaction of both patient and surgeon.

Comparative Study of Bipolar Hemiarthroplasty and Second Generation Intramedullary Nailing on Treatment of Elderly Unstable Peritrochanteric Femoral Fractures

PURPOSE: To evaluate and compare the clinical and radiological outcome of bipolar hemiarthroplasty and second generation intramedullary nailing for elderly unstable peritrochanteric femoral fracutre. MATERIALS AND METHODS: From January 2000 to July 2004, 56 elderly unstable peritrochanteric fractures were treated with a bipolar hemiarthroplasty (34 cases) or a ITST intramedullary nailing (22 cases). The fractures were classified using the OTA/AO classification. The clinical results were evaluated by walking capability, hip joint pain, and thigh pain. The radiological results were evaluated on the basis of the radiographs at follow-up. RESULTS: In bipolar hemiarthroplasty group, The mean operation time was 134 minute, the mean blood loss was 648 ml. In intramedullary nailing group, The mean operation time was 103 minute, the mean blood loss was 386 ml. There were no different walking ability between prefracture and postoperative state in 22 cases (65%) of bipolar hemiarthroplasty group, 18 cases (80%) of intramedullary nailing group respectively. There were 5 cases (14%) hip joint pain in bipolar hemiarthroplasty group and 4 cases (18%) thigh pain in ITST intramedullary nailing group postoperatively. CONCLUSION: Comparing the operation time, blood loss, and walking ability, ITST intramedullary nailing group show superior clinical outcomes than bipolar hemiarthroplasty group. However, The effort for decreasing postoperative thigh pain might be required.

Kohler's Disease of the Tarsal Navicular: Long-Term Follow-up of 12 Years: A Case Report / 대한족부족관절학회지

Kohler's disease is an uncommon idiopathic osteochondrosis of the tarsal navicular. The diagnosis is clinical and the natural history is benign. The treatment is symptomatic, including shoe supports when the symptoms are mild and initial cast immobilization for at least 8 weeks when the symptoms are more intensive. The final clinical outcome is always favorable. Although it has been fully described both clinically and radiologically, There have been a few long-term follow-up reports in worldwide. This case report presents a Kohler's disease of the tarsal navicular with long-term follow-up of 12 years.

Kohler's Disease of the Tarsal Navicular: Long-Term Follow-up of 12 Years: A Case Report / 대한족부족관절학회지

Kohler's disease is an uncommon idiopathic osteochondrosis of the tarsal navicular. The diagnosis is clinical and the natural history is benign. The treatment is symptomatic, including shoe supports when the symptoms are mild and initial cast immobilization for at least 8 weeks when the symptoms are more intensive. The final clinical outcome is always favorable. Although it has been fully described both clinically and radiologically, There have been a few long-term follow-up reports in worldwide. This case report presents a Kohler's disease of the tarsal navicular with long-term follow-up of 12 years.