Value of Ultrasound for Stability Assessment of Isolated Lateral Malleolar Fractures Compared to Stress Radiography and Arthroscopy

Background@#This study was performed to evaluate the value of using ultrasound for stability assessment of isolated lateral malleolar fractures compared to simple X-ray, stress radiography, and arthroscopy. @*Methods@#This is a prospective cohort study with 25 consecutive patients who underwent an arthroscopic examination and subsequent surgery for isolated lateral malleolar ankle fractures. Before operation, simple and external rotation stress radiographs were obtained. Ultrasound was performed to assess the medial deltoid ligament prior to operation. Arthroscopic findings were used as reference standards. Sensitivity, specificity, and positive and negative predictability were calculated and compared using receiver operating characteristic (ROC) curve analysis for simple radiography, stress radiography, and ultrasound examination. @*Results@#The sensitivity and specificity of ultrasound for tears of the deep deltoid ligament were 94.74% and 66.67%, respectively.But, they were both 100% for complete tears of the ligament. ROC curve analysis showed that the ultrasound examination was significantly more accurate than simple and stress radiography. @*Conclusions@#Ultrasound could be used to assess the instability of isolated lateral malleolar fractures. Commonly used stress radiography appears to overrate the need for operative treatment.

Validation of Electronic Foot Function Index in Patients with Foot and Ankle Disease: A Randomized, Prospective Multicenter Study / 대한족부족관절학회지

PURPOSE: To evaluate the efficiency of the electronic foot function index (eFFI) through a prospective, random based, multi-institutional study. MATERIALS AND METHODS: The study included 227 patients ranging in age from 20 to 79 years, visited for surgery in different 15 institutes, and agreed to volunteer. The patients were assigned randomly into a paper-based evaluated group (n=113) and tablet-based evaluated group (n=114). The evaluation was done on the day of hospital admission and the method was changed on the second day of surgery and re-evaluated. PADAS 2.0 (https://www.proscore.kr) was used as an electronic evaluation program. RESULTS: There were no differences in age and sex in both groups. The intraclass correlation coefficient (ICC) evaluation revealed an eFFI ICC of 0.924, showing that both results were similar. The evaluation time was shorter in the tablet-based group than the paper-based group (paper vs tablet, 3.7±3.8 vs 2.3±1.3 minutes). Thirty-nine patients (17.2%) preferred to use paper and 131 patients (57.7%) preferred the tablet. Fifty-seven patients (25.1%) found both ways to be acceptable. CONCLUSION: eFFI through tablet devices appears to be more constant than the paper-based program. In addition, it required a shorter amount of time and the patients tended to prefer the tablet-based program. Overall, tablet and cloud system can be beneficial to a clinical study.

Isolated Syndesmotic Injury / 대한족부족관절학회지

Syndesmotic injury can either be isolated or associated with bony or ligamentous ankle injury. When it is not associated with an ankle fracture, it may not be easy to diagnose, especially when there is no franck diastasis on a plain radiograph. Without proper treatment, syndesmotic injury can lead to chronic pain due to impingement of scar tissues and instability. It may further lead to ankle arthritis. Early diagnosis with appropriate management is a prerequisite to avoid these problems. Herein, we review and discuss the mechanism of injury, classification, diagnosis, and treatment of isolated syndesmotic injury.

Results of Asian Type Gamma 3 Nail in Treatment of Trochanteric Fractures

PURPOSE: This study was conducted in order to demonstrate the radiologic and clinical results of using the Asian type gamma 3 nail in treatment of trochanteric fractures. MATERIALS AND METHODS: Patients underwent operations with gamma 3 nails between August 2010 and August 2012. For the radiologic evaluation, we analyzed bone quality, fracture pattern, reduction quality, union period, and position of lag screw (tip-apex distance, Cleveland index). For the clinical evaluation, we analyzed mobility score of Palmer and Parker and Jensen's functional score. RESULTS: The mean union was taken at 17.4 weeks (14-25 weeks). Two cases (4.3%) underwent reoperation due to cutting out of the hip screws. The clinical outcomes of Parker and Palmer's average mobility score changed from 7.3 to 5.8 (79%), Jensen's functional score was 1.3 to 1.8 (72%). CONCLUSION: We achieved excellent clinical and radiological outcomes; therefore, Asian type gamma 3 nail is effective in treatment of trochanteric fractures of the femur in Korea.

Total Rupture of Peroneus Longus Tendon Through an Os Peroneum Fracture Treated by Tendon Transfer (A Case Report) / 대한족부족관절학회지

Fracture of os peroneum can occur, but the fracture fragments are seldom displaced. Complete rupture of peroneus longus through the fracture of the os peroneum causing displacement of the fracture fragments is not well reported in the literature. Differential diagnosis with bipartite os peroneum or calcific tendinitis is important because misdiagnosis of the tendon rupture can lead to serious sequela including chronic pain, ankle instability, and peroneal compartment syndrome. We report a case of complete rupture of peroneus longus associated with fracture of the os peroneum with a review of the literature.

Calcific Tendinitis of Peroneus Longus Tendon (A Case Report) / 대한족부족관절학회지

Calcific tendinitis usually occurs in the supraspinatus tendon of the shoulder. Calcific tendinitis of the peroneus longus tendon has not been reported on the Korean journals. Differential diagnosis includes bipartitis os peroneum, os peroneum fracture and peroneal tendinitis. We report a rare case of calcific tendinitis of the peroneus longus tendon which responded well with the conservative treatment.

Recovery of Muscle Power Following Early Weight-Bearing and Ankle Exercise after Surgical Repair of Acute Achilles Tendon Rupture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical results of early functional treatment after surgical repair of acute Achilles tendon rupture and to evaluate the isokinetic and isometric concentric plantar flexion peak torque and muscle endurance. We wanted to provide objective results of the functional improvement and the effect of early rehabilitation. MATERIALS AND METHODS: On a retrospective basis, we studied 52 cases of acute Achilles tendon rupture who visited our clinic between March 2007 and August 2009. Eleven patients (9 male, 2 female) were available for the follow-up more than 12 months and their mean final follow-up duration was 18.2 (12 to 39) months. We performed early weight-bearing and ankle exercise after surgical repair of acute Achilles tendon rupture. At final follow-up, patients were evaluated with clinical and functional examination using Arner-Lindholm scale and American Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale and patients' subjective satisfaction. In addition, the isokinetic and isometric concentric plantar flexion peak torque and muscle endurance were evaluated. RESULTS: Evaluating the clinical results using the Arner-Lindholm scale, we had 4 excellent cases and 7 good cases. The average AOFAS score was 88.9 (68 to 100) points at final follow-up. The patients' subjective satisfaction was excellent in 5 cases and good in 6 cases. The isokinetic concentric plantar flexion peak torque was restored to 92.2% (30degrees/sec) and 97.0% (120degrees/sec) in relation to the intact side at final follow-up. The isometric concentric plantar flexion peak torque was restored to 89.4% at 10o dorsiflexion, 84.4% at neutral, and 84.0% at 20degrees plantar flexion of the ankle position in relation to the intact side. The muscle endurance of ankle plantar flexor was 62.37% for the intact side and 59.16% for the injured side that there was no difference between the intact and injured side (p=0.79). CONCLUSION: The clinical results and the satisfactory restoration of muscle power and endurance support early full weight bearing and exercise as an acceptable form of rehabilitation.

Proximal Flexor Hallucis Longus Tendon Transfer for the Ossification of the Achilles Tendon: A Case Report / 대한족부족관절학회지

Ossification of the Achilles tendon is a rare condition that is characterized by the presence of an ossific mass contained within the substance of the tendon. The ossified mass is usually asymptomatic but when it grows large and painful, it deteriorates the function of Achilles tendon. We report a case of ossification of the Achilles tendon, which was successfully treated by removal of the ossific mass and proximal flexor hallucis longus (FHL) tendon transfer.

Autogenous Osteochondral Graft for Freiberg's Disease: A Case Report / 대한족부족관절학회지

Freiberg disease is a osteochondrosis of the lesser metatarsal heads. Various surgical treatment have been recommanded including joint debridement and metatarsal head reshaping, metatarsal dorsal wedge osteotomy, metatarsal head excision and joint arthroplasty. Autogenous osteochondral graft for the treatment of Freiberg disease is an effective restorative procedure that provides early range of motion exercise, weight bearing, and reduces other morbidity. We report a case of late stage Freiberg disease treated with arthrotomy, removal of loose body and autogenous osteochondral graft.

The Effect of Prophylactic Cable Fixation for Prevention of Femoral Fractures in Hemiarthroplasties

PURPOSE: The purpose of this study was to assess the effect of a prophylactic cable fixation for prevention of femoral fractures in cementless bipolar hemiarthoplasties. MATERIALS AND METHODS: Forty-eight cementless bipolar hemiarthroplasties with prophylactic cable fixations on the femur were performed in patients >65 years of age between January 2004 and August 2008 (group 1). The control group which did not undergo prophylactic cable fixation included 48 cases (group 2). The mean age was 75.4 years (group 1) and 73.6 years (group 2). The patients were followed up for an average of 19.1 (group 1) and 18.3 months (group 2). The intra-operative fracture rates were compared. Additionally, operative time, estimated blood loss (EBL), and length of hospital stay were compared. Radiologic assessment for stem stability was performed. Clinical assessment was evaluated by the thigh pain and Jensen's functional score, and Parker & Palmer's mobility score. RESULTS: There was no fractures in the cabled group (1), and 4 fractures (8.3%) in the control group (2; p=0.041). The mean operative time was 172 minutes (1) and 162 minutes (2), the EBL was 866 cc (1) and 855 cc (2), and the duration of admission was 36 (1) and 35 days (2), respectively. Radiologically, subsidence was 1.59 mm (1) and 1.67 mm (2). Clinically, one (1) and two (2) thigh pains were recorded and the functional score of Jensen was 2 (1) and 2.2 points (2), and the mobility score of Parker and Palmer was 5.2 (1) and 5.3 points (2), respectively. CONCLUSION: Prophylactic cable fixation is effective for reducing intra-operative femoral fractures.

Treatment of Acute Achilles Tendon Rupture Using Krackow Suture Technique / 대한족부족관절학회지

PURPOSE: We try to evaluate the clinical results of the acute Achilles tendon rupture treated with Krackow suture technique. MATERIALS AND METHODS:We reviewed 27 patients with acute Achilles tendon rupture treated between October 2005 and September 2007. There were 26 complete ruptures and 1 incomplete rupture. All were ruptured at tendinous area. There were 21 men and 6 women, and mean age was 38 years. We repaired ruptured Achilles tendon with Krackow suture technique. The results were evaluated with Arner-Lindholm scale for patients' satisfaction, strength of calf muscle power, calf circumference, and ankle motion. The average follow-up was 29 months. RESULTS:The patients' subjective clinical results was excellent in 25 cases and good in 2 cases. There were 15 cases of less than 1 cm, 6 cases of 1~3 cm, and 1 case of more than 3 cm in the calf circumference difference between the normal and affected leg. There were 20 cases of less than 5 degrees, and 2 cases of more 5 degrees in the difference of range of motion between the normal and affected ankle. We had an experience of postoperative deep infection in one diabetic patient. CONCLUSION: We had a good clinical result for acute Achilles tendon rupture treated with Krackow suture method. So we recommand Krackow suture technique for acute Achilles tendon rupture.

Closed Reduction and Fixation of Metatarsal Head and Neck Fractures Using Antegrade Intramedullary K-wire (6 Cases Report) / 대한족부족관절학회지

Metatarsal head and neck fractures are injuries that often result from a direct blow of a heavy objects to the metatarsal head. The head is often impacted or displaced to the plantar aspect that if not treated may cause malunion which later induces painful plantar calluses. If the fracture fragment is large enough, closed reduction may be successfully performed, but when the fragment is small or closed reduction is unsuccessful, open reduction is needed. We present our reduction and fixation technique for the metatarsal head and neck fractures using antegrade intramedullary Kirschner wire (K-wire) without opening the fracture site or infringing the metatarsophalangeal (MTP) joint which allows immediate motion of the joint and partial weight bearing in a stiff soled shoe.

Treatment of Old Achilles Tendon Rupture using Modified Flexor Hallucis Longus Tendon Transfer / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the clinical results of the old Achilles tendon rupture treated with modified flexor hallucis longus (FHL) tendon transfer. MATERIALS AND METHODS: Seventeen patients with old Achilles tendon rupture treated with modified FHL tendon transfer between March 2004 and February 2008 were enrolled in this study. Technically FHL was pass through the distal portion of the ruptured tendon instead of the drilled hole made on the calcaneus. The mean age of the patients was 37 years (range, 22~67 years), mean follow-up period was 28 months (range, 12~30 months). Patients' subjective satisfaction, calf circumferential diameter, range of motion of ankle and AOFAS ankle-hind foot score and Arner-Lidholm score was evaluated. RESULTS: The average gap between the ruptured tendon was 52 mm (range, 47~56 mm). The AOFAS score improved from 47 pre-operatively to 91 points at the last follow-up. Sixteen patients were satisfied with the result free from discomfort, a patient had mild discomfort who had DM. fourteen patients had decreased range of motion less than 5 degrees while 2 patients had more than 7 degrees decrease compared to the intact side but had no discomfort in daily activities. Nine patients had less than 1 cm calf circumferential diameter difference and 7 patients had 1 to 3 cm diameter difference compared to the intact side. One who had more than 3 cm diameter difference had deteriorated muscle strength. CONCLUSION: Modified FHL tendon transfer can be a useful technique for the treatment of old Achilles tendon rupture when the gap is with large gap placed too proximal.

Synovial Chondromatosis of the First Metatarsal(A Case Report) / 대한족부족관절학회지

Synovial chondromatosis is an uncommon disorder characterized by cartilaginous proliferation in the synovium. The cartilaginous nodules occur in the synovial membrane of a joint, bursa, or tendon sheath. It frequents large joints including knee, hip, and elbow. Synovial chondromatosis originating from the first metatarsal is extremely rare. We report a case of 37-year-old man with synovial chondromatosis of the first metatarsal.

Anatomical Differences of the Fibular Incisura of the Tibia between Ankle Fracture with Syndesmotic Injury and without Syndesmotic Injury / 대한족부족관절학회지

PURPOSE: This study was performed to compare the anatomic differences of the fibular incisura of the tibia between ankle fractures with and without syndesmotic injuries. MATERIALS AND METHODS: 42 patients were involved in this study: Group I was composed with 14 cases of ankle fractures with syndesmotic injuries; Group II was composed with 14 cases of ankle fractures without syndesmotic injuries; Group III was composed with 14 cases of volunteers. The height averaged 170.1 cm (range, 159~181 cm) in group I, 168.9 cm (range, 156~184 cm) in group II, and 170.4 cm (range, 161~77 cm) in group III. The mean height did not show a statistically significant difference between groups (p>0.05). All patients were taken axial computed tomography. The length of anterior and posterior facets, angle between anterior and posterior facet, and depth of the fibular incisura of the tibia were measured. RESULTS: The mean length of the anterior facet was 11.5 mm (range, 9.2~15.7 mm) in group I, 12.2 mm (range, 7.3~17.0 mm) in group II, and 10.3 mm (range, 8.7~14.0 mm) in group III (p>0.05). The mean length of the posterior facet was 12.3 mm (range, 9.0~14.5 mm) in group I, 11.0 mm (range, 7.3~16.2 mm) in group II, and 13.0 mm (range, 9.2~15.9 mm) in group III (p>0.05). The mean angle between anterior and posterior facet was 139.1 degrees (range, 125.5~154.0 degrees) in group I, 144.2 degrees (range, 134.7~152.6 degrees) in group II, and 131.5 degrees (range, 117.6~144.4 degrees) in group III (p<0.05). The mean depth of the fibular incisura of the tibia was 4.1 mm (range, 3.2~5.8 mm) in group I, 4.6 mm (range, 3.1~7.1 mm) in group II, and 3.1 mm (range, 1.5~4.0 mm) in group III (p<0.05). CONCLUSION: There are some statistical differences of angle between anterior and posterior facet and depth of the fibular incisura of the tibia between ankle fractures with and without syndesmotic injuries.

Osteochondroma of the Proximal Phalanx of the Fourth Toe(A Case Report) / 대한족부족관절학회지

Osteochondroma is the most common benign bone tumor which commonly occurs in the metaphysis of the long bones such as proximal humerus, tibia, and distal femur. It is rarely found in bones of the foot. Although they are benign lesions, when they occur in the foot, they are typically identified earlier than other regions because of the low proliferation of subcutaneous tissue in the region and may cause symptoms. We experienced a rare case of osteochondroma in a 60-year-old male which cause pain and swelling of the fourth toe.

Solitary Osteochondroma of Fibula in Distal Tibiofibular Joint causing Valgus Deformity of Ankle: A Case Report / 대한족부족관절학회지

The osteochondroma is a cartilage-capped exostosis resulting from an error in the regulation of normal chondrocyte proliferation and maturation that leads to a normal bone growth. Although exostoses are benign lesions, they are often associated with characteristic progressive skeletal deformities and may cause clinical symptoms. Surgery can prevent progression and provide correction for certain deformities. We experienced a rare case of solitary osteochondroma in a 21-year-old male which caused the valgus deformity of the ankle.

Clinical and Radiological Analysis and Results after Anatomical Reduction and Bone Graft for Symptomatic Os Subfibulare / 대한족부족관절학회지

PURPOSE: To analyze the clinical and radiological feature of Os subfibulare and to evaluate the results after anatomical reduction and internal fixation with bone graft for Os subfibulare. MATERIALS AND METHODS: Forty-two cases, which underwent anatomic reduction and bone graft for Os subfibulare from October 1998 to September 2004 were reviewed. We analysed preopertive symptoms and onset of symptoms and radiologically measured the size and amounts of displacement of Os subfibulare under the inversion stress. Postoperatively we evaluated the clinical results measured by Hasegawa method and evidence of union. RESULTS: Preoperatively there were only pain around the lateral malleolus in 16 cases, only instability of ankle joint in 3 cases, and pain and instability in 23 cases. The age of symptom onset averaged 23 years(range, 13-38 years). Radiographically Os sufibulare anteriorly located from lateral malleolus were in 40 cases, posteriorly situated in 2 cases. The size of Os subfibulare ranged from 1 x 4 mm to 8 x 17 mm. In 22 cases of inversion stress view, displacement of the Os sbufibulare averaged 1.5+/-1.1 mm (0 to 5 mm). The postoperative clinical results were excellent in 41 cases, poor in 1 case. There were complications of 1 case of irritation of sural nerve, 1 case of nonunion. CONCLUSION: Anatomic reduction and bone graft is effective treatment method for symptomatic Os subfibulare.

Clinical and Radiological Analysis and Results after Anatomical Reduction and Bone Graft for Symptomatic Os Subfibulare / 대한족부족관절학회지

PURPOSE: To analyze the clinical and radiological feature of Os subfibulare and to evaluate the results after anatomical reduction and internal fixation with bone graft for Os subfibulare. MATERIALS AND METHODS: Forty-two cases, which underwent anatomic reduction and bone graft for Os subfibulare from October 1998 to September 2004 were reviewed. We analysed preopertive symptoms and onset of symptoms and radiologically measured the size and amounts of displacement of Os subfibulare under the inversion stress. Postoperatively we evaluated the clinical results measured by Hasegawa method and evidence of union. RESULTS: Preoperatively there were only pain around the lateral malleolus in 16 cases, only instability of ankle joint in 3 cases, and pain and instability in 23 cases. The age of symptom onset averaged 23 years(range, 13-38 years). Radiographically Os sufibulare anteriorly located from lateral malleolus were in 40 cases, posteriorly situated in 2 cases. The size of Os subfibulare ranged from 1 x 4 mm to 8 x 17 mm. In 22 cases of inversion stress view, displacement of the Os sbufibulare averaged 1.5+/-1.1 mm (0 to 5 mm). The postoperative clinical results were excellent in 41 cases, poor in 1 case. There were complications of 1 case of irritation of sural nerve, 1 case of nonunion. CONCLUSION: Anatomic reduction and bone graft is effective treatment method for symptomatic Os subfibulare.