The Incidence of Deep Vein Thrombosis after Various Types of Knee Surgery / 대한정형외과학회잡지

Purpose@#The purpose of this study was to evaluate the incidence of deep vein thrombosis (DVT) after various types of knee surgery and to identify patients at high risk. @*Materials and Methods@#This retrospective was conducted using the medical records of knee surgeries conducted by one surgeon at Gachon University Gil Medical Center between May 2019 and December 2020. The occurrence of DVT was determined by venous ultrasonography 4 to 6 days after surgery, and the incidence of DVT was determined for arthroscopic ligament surgery, arthroscopic meniscus surgery, arthroplasty, and osteotomy. Patients diagnosed with DVT were treated with a pharmacological agent for 3 months, and DVT was reevaluated by Doppler sonography at 3 months postoperatively. @*Results@#Among a total of 221 cases, 75 cases (33.9%) were diagnosed with DVT. The incidence of DVT was significantly dependent on type of surgery, that is, anterior cruciate ligament surgery (ACL) 29.4%, meniscus surgery 30.2%, artroplasty 33.3%, and osteotomy 52.4%. In 60 of the 75 cases, DVT was successfully managed without complication by pharmacologic treatment. On the other hand, in 3 cases, pharmacologic treatment was stopped due to side effects. The other 15 cases were managed conservatively. A significant correlation was found between tourniquet application and incidence of DVT, and in the arthroplasty group, age and DVT were significantly correlated. However, surgical time was not correlated with DVT. @*Conclusion@#The incidence of DVT after knee surgery is significantly dependent on type of surgery. We believe that the absence of any severe complication, such as systemic or pulmonary embolism, related to DVT was due to early detection and adequate pharmaceutical management. Furthermore, we recommend that tourniquet not to be applied to patients at high risk of DVT.

Epidemiology of Achilles Tendon Rupture in South Korea: Claims Data of the National Health Insurance Service from 2009 to 2017

Background@#The incidence of Achilles tendon rupture and its trend has not been studied in Asia. The purpose of this nationwide study was to analyze the trend of incidence and surgical treatment of tendon ruptures in South Korea based on sex, age, and income level of patients, as well as seasonal variation. @*Methods@#A descriptive epidemiologic study was performed based on the data collected retrospectively from the Korea National Health Insurance Service. Data of all outpatients and inpatients were collected from approximately 52 million residents of South Korea, primarily diagnosed with Achilles tendon rupture from 2009 to 2017. @*Results@#A total of 112,350 patients had Achilles tendon rupture, of which 44,248 patients underwent surgical treatment during the study period. The overall, age-specific, and sex-specific incidence of Achilles tendon rupture and surgical treatment showed an increasing trend. Patients in the age group of 41 to 50 years showed the highest increase in incidence. Regarding season, higher incidence was reported during spring and summer, whereas the lowest incidence was found in winter. Higher income level was associated with increased incidence of the condition. @*Conclusions@#The incidence of Achilles tendon rupture and surgical treatments increased rapidly in patients between 41 and 50 years of age. Patients in the higher income quintile groups experienced more Achilles tendon injury than those in lower income groups, and fewer ruptures were observed during winter.

The effect of interleukin-8 in the early stage after anterior cruciate ligament reconstruction with remnant preservation

Purpose@#We studied the effect of interleukin-8 (IL-8) as the factor for angiogenesis in the joint fluid of remnantpreserved anterior cruciate ligament reconstruction (RP-ACLR). @*Materials and methods@#We measured 12 cytokines in joint fluid by multiplex assay and assessed the relationship between IL-8 and vascular endothelial growth factor (VEGF) concentrations. The signal intensity and mean sagittal diameter via postoperative magnetic resonance imaging (MRI) scans were evaluated and the stress X-ray image was analyzed at 3, 6, and 12 months after operation. @*Results@#The IL-8 concentration was highest 3 months postoperatively in those patients who underwent RP-ACLR.Clinical data also showed that the signal intensity and stress radiography of the knee graft were significantly better at the early postoperative stage.Discussion: Our results show that IL-8 plays an important role in angiogenesis within 3 months after RP-ACLR. This effect yields better recovery after operation. RP-ACLR patients with high knee stability in clinical data were identical to those with high expression of IL-8 in experimental data. Therefore, IL-8 has been shown to help revascularization and ligamentization of the grafted tendon. These results indicate that IL-8 in RP-ACLR is an important factor for angiogenesis after operation. Unfortunately, the relationship of IL-8 and VEGF in vivo has not been studied. @*Conclusion@#Our results showed that the IL-8 concentration was very high within 3 months after RP-ACLR operation. The increase in concentration of IL-8 over time was consistent with the increase in VEGF concentration.In the IL-8 clinical setting, MRI analysis showed that ACL synovialization and tension were better in patients who underwent the remnant preservation method. In addition, it was shown that RP-ACLR may be advantageous for early anterior stability within 1 year post operation and beneficial for tendon graft in the early stage post operation.Taken together, our findings suggest that IL-8 may contribute to angiogenesis which is helpful for revascularization and ligamentization of the graft tendon in the early stages of RP-ACLR.

Computed Tomography Image Analysis of the Fusion Site of Subtalar Arthrodesis for Traumatic Arthritis after a Displaced Intraarticular Calcaneal Fracture

PURPOSE: The study examined the fusion site and characteristics of the subtalar arthrodesis after intraarticular calcaneal fractures using computed tomography. MATERIALS AND METHODS: The clinical results and computed tomographic analysis of the fusion site were reviewed in 18 patients who were followed-up for a minimum of six months after undergoing subtalar arthrodesis due to traumatic arthritis caused by an intra-articular calcaneal fracture from December 2012 to April 2017. RESULTS: An evaluation of clinical results after subtalar arthrodesis revealed statistically significant improvements. In all cases, arthritis was found in the injured articular surface, which was displaced superolaterally from the initial primary fracture line of the calcaneus. Six months after arthrodesis, the subtalar fusion rate was 80.0% (16/20). Of these, 14 cases had a cannulated screw inserted in the uninjured site that is medial to the primary fracture line. Joint fusion was observed on the uninjured articular surface in 17 cases (85.0%). CONCLUSION: Joint fusion was initially achieved at the uninjured posterior facet after subtalar arthrodesis due to traumatic arthritis caused by a displaced intra-articular calcaneal fracture. This suggests that meticulous surgical techniques and cannulated screw positioning at the uninjured site will promote joint fusion.

Outcomes of Severe Comminuted Distal Radius Fractures with Pronator Preserving Approach

PURPOSE: We investigate the outcomes of treatment of patients with severe comminuted distal radius fractures with volar plate fixation using a pronator-preserving approach. MATERIALS AND METHODS: Fourteen patients with severe comminution of the distal radius fractures for whom anatomical reduction of the fractures was deemed difficult to achieve with traditional approaches were enrolled. The gender ratio was 8 males to 6 females, and the average age of the patients was 64.9 years. According to the AO/OTA classification of fractures, 2 patients had 23-A3 fractures, 7 patients had 23-C2, and 5 patients had 23-C3. Radial length, radial inclination, and volar tilt were measured for radiologic evaluation. Modified Mayo wrist score (MMWS) was used for clinical outcome. RESULTS: Bony union was achieved in all 14 patients without signs of complications. The average time-to-union was 4.3 months (3-6 months). The radiological findings at the final follow-up were as follows: the average radial inclination was 20.5degrees; the average volar tilt, 7.57degrees; and the average radial length, 11.8 mm. At the final follow-up, the results of the MMWS were 'Fair' in 1 patient, 'Good' in 4, and 'Excellent' in 9. CONCLUSION: We propose that a pronator-preserving approach is an effective treatment for severe comminuted distal radius fracture.

Treatment of Superficial Peroneal Nerve Entrapment Syndrome under Local Anesthesia using Ultrasonogram / 대한족부족관절학회지

PURPOSE: To review the outcomes of surgical treatment for superficial peroneal nerve entrapment. MATERIALS AND METHODS: Ultrasonogram was used for diagnosis and surgical treatment. Seven superficial peroneal nerve entrapment were surgically treated with follow up of average 16 months (range, 6~29 months). Three patients were male and four patients were female with mean age 36.7 years (range, 19~51 years). Four cases developed after repetitive ankle sprain and three cases had no etiology. RESULTS: Operation was performed mini-open and subcutaneous fasciotomy under local anesthesia. The results were excellent in two cases, good in four cases, fair in one case. CONCLUSION: Ultrasonogram was useful for diagnosis and surgical treatment of superficial peroneal nerve entrapment syndrome.

Recurred Intraneural Ganglion on Superficial Peroneal Nerve (A Case Report) / 대한족부족관절학회지

Intraneural ganglilon of superficial peroneal nerve was rare condition around foot and ankle. we experienced a case of recurred intraneural ganglion of superficial peroneal nerve on foot. We treated the case with idendify of intraarticular branch of ganglion. We report the case with a review of literature.

Subtalar Distraction Arthrodesis Using Frozen Allobone Graft by Interpositional Structural / 대한족부족관절학회지

PURPOSE: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. MATERIALS AND METHODS: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. RESULTS: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). CONCLUSION: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.

Intraneural Ganglion Cyst in Foot and Ankle / 대한족부족관절학회지

PURPOSE: Pathogenesis of intraneural ganglion is controversial, however, the synovial theory that the intraarticular region is the origination of disease has come into the spotlight nowadays. But there are a few researches about intraneural ganglion in foot and ankle. We studied 7cases of intraneural ganglion. We are going to prove the synovial theory by indentifying articular branch of intraneural ganglion. MATERIALS AND METHODS: From August 2003 to May 2011, we evaluated 7 ouf of 8 patients diagnosed as a intraneural ganglion in foot and ankle. The gender ratio were 4 male and 3 female, and the mean age at the time of surgery was 52.9 years. Clinically, we checked pre and post operative symptom, muscle tone and whether loss of muscle tone and sensation exists. We analyzed surgical records and preoperative MRI and compared those with intra-operative finding. RESULTS: In MRI analysis of 7cases, the connection around the joints were confirmed, and 1 case was confirmed in the retrospective analysis of MRI. Intraneural ganglions occurred in medial plantar nerve 3 cases, lateral plantar nerve 1 case, superficial peroneal nerve 1 case and sural nerve 1 case. We could not found recurrence during the follow up periods. Most patients relieved pain after operation, but recovery of sensation was unsatisfactory. We could find some cases pathological finding of the nerve intraoperatively, and clinical result of that cases was poor. CONCLUSION: Intraneural ganglion can occur in various parts in foot and ankle. We concluded that the intranneural ganglion originated from joint by identifying the artichlar branch of ganglion. Due to its small size, it is difficult to find articular branch in operation field. But we do our best to find and remove articular branch. Currently, considering the small amount of research in foot and ankle, more research about articular brach is needed.

Traction Apophysitis of Medial Malleolus: Two Cases report / 대한족부족관절학회지

9 and 10 years old boys presented with pain and swelling without history of trauma around medial malleolar right and left ankle. The swelling was diffuse with tenderness on anterior aspect of medial malleolus. The X-rays revealed fragmented accessory ossification center of medial malleolus an symptomatic side. Traction apophysitis was diagnosed because MRI revealed multiple foci of hypointensity in T1 and T2 weighted images of symptomatic medial malleolus apophysis. Patient was treated in conservative treatment by short leg cast for three or four weeks with restriction of sports activity and improved symptoms.

Clinical Result of Modified Percutaneous Repair Technique of Ruptured Achilles Tendon / 대한족부족관절학회지

PURPOSE: To investigate the results of percutaneous repair technique of Achilles tendon ruptures, and to describe the surgical technique. MATERIALS AND METHODS: We retrospectively analyzed the outcomes of 73 patients with ruptured Achilles tendon from October 1995 to September 2009. 28 patients were excluded due to short follow up period. 34 patients were male and 11 patients were female. The mean patient age was 37.19 (10~62) years. The location of rupture site was 6.58 cm proximal to the tendon insertion into the calcaneus on average. Mean follow up period was 55 months and All patients were surgically repaired using percutaneous technique with sural nerve isolation. RESULTS: Arner-lindholm score were excellent in 32 (71%), good in 12 (27%), poor in 1 (2%) case. 44 cases (98%) had the score more than good. Mean American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot function score was 92.93 (67~100). We had 1 case of superficial infection, 1 case of soft tissue irritation by suture knot. CONCLUSION: Percutaneous repair with sural nerve isolation in treating ruptured Achilles tendon showed low complication rate and reliable clinical outcome.

Intramedullary Kirschner Wire Fixation for Forearm Fractures in Children

PURPOSE: To evaluate the clinical and radiological results of intramedullary fixation using Kirschner wires (K-wires) for the treatment of unstable forearm fractures in children. MATERIALS AND METHODS: Forty-three children who underwent intramedullary fixation using K-wires for the treatment of a forearm bone fracture were evaluated. The rodiological results were based on the time to union and angular deformity at last follow-up. The clinical results were analyzed according to Price criteria. RESULTS: Average union time was 6.9 weeks. Preoperatively, average angular deformity of radius is 11.4 degrees in anteroposterior (AP) view and 15.3 degrees in lateral view. In case of the ulna, arerage angular deformity was 8.3 degrees in AP view and 12.7 degrees in lateral view. At last follow up, average angular deformity of radius was 1.5 degrees in AP view and 1.6 degrees in lateral view. In case of the ulna, arerage angular deformity was 1.3 degrees in AP view and 2.5 degrees in lateral view. According to the criteria of Price et al., 42 patients (97%) were excellent and one patient (3%) was good. No specific complication was observed. CONCLUSION: An intramedullary fixation using K-wires is an attractive treatment option for unstable forearm fractures in children in terms of safety, excellent cosmesis, short hospitalization, easy hardware removal, and providing excellent radiological and clinical results.

Heterotopic Ossification of a Partially Ruptured Achilles Tendon (A Case Report) / 대한족부족관절학회지

Heterotopic ossification of Achilles tendon is known to be related with history of prior Achilles tendon surgery, trauma, Achilles tendon rupture. We report a case of heterotopic ossification of partially ruptured Achilles tendon and treated by surgical removal of ossification and V-Y advancement with tendon repair.

Irreducible Fracture of Calcaneus due to Flexor Hallucis Longus Tendon Interposition: A Case Report / 대한족부족관절학회지

In closed calcaneus fractures, the occurrence of FHL interposition in subtalar joint is relatively rare and difficult to diagnosis preoperatively. But careful physical examination and significant radiologic findings could be useful tools to diagnosis preoperatively. This findings is shearing off a superior medial fragment made up of the sustentaculum talus connected to a significant portion of the medial wall and medial aticular surface of the posterior facet.

Malignant Melanoma of the Foot / 대한족부족관절학회지

PURPOSE: We reviewed the clinical finding of malignant melanoma of the foot in korean because it's advanced stage and extended lesion at diagnosis. MATERIALS AND METHODS: Retrospective study was enforced about the 11 cases who has diagnosed to malignant melanoma of the foot from February 1995 to March 2004. The mean follow up period was 61 months. In this study we used age, sex, site, depth, histology, clinical stage, precursor lesion, misdiagnosis, interval to diagnosis, survival time, survival. RESULTS: Average age was 58 years and number of female was six. Common site of involvement were heel of plantar surface (6 cases) and subungual area (2 cases). Depths of involvement were 0.3 to 10 mm, most common histological type was acral lentiginous melanoma (7 cases), stage 5 according to classification of Clark were 5 cases and stage 2 or more according to clinical staging were 8 cases. precursor lesion were benign melanocytic nevi (2 cases) and ill defined (9 cases). Chief complaint were increasing of size, color change, pain and ulceration. CONCLUSION: Malignant melanoma of the foot usually arise at nonvisible area and is easy to be misdiagnosed or delayed treatment. So it is hard to early diagnosis and have poor prognosis. So we need education and effort to early detection and diagnosis.

Nonunion in Bilateral Ball and Socket Ankle Joint / 대한족부족관절학회지

Ball-and-socket deformity of the ankle joint is a rare entity that is usually associated with inequality of leg length, fibular hyperplasia, coalition of the ankle, and ray deficiency. Etiology is unknown, congenital itself or secondary to congenital conditions in the ankle. Nonunion of medial malleolar is rare in bilateral ball and socket ankle joint without lower leg deformity. We report upon this case, and include brief reviwe of the literature.

Irreducible Ankle Fractures by Locked Posterior Malleolar Fragment: Case Report / 대한족부족관절학회지

Irreducible fracture dislocation of the ankle associated with comminuted displaced fracture of posterior malleolus is rare. Locked posterior malleolar fragments interfere with reduction of fibula or talus in ankle fractures. Prompt recognition and appropriate surgical approaches are necessary to achieve anatomical reduction of the ankle fractures.