Skin Graft Remains a Clinically Good Treatment Strategy for Chronic Diabetic Wounds of the Foot and Ankle / 대한족부족관절학회지

Purpose@#The purpose of this study was to evaluate the surgical outcome of split-thickness skin graft (STSG) for chronic diabetic wounds of the foot and ankle. @*Materials and Methods@#The medical records of 20 patients who underwent surgery for chronic diabetic wounds of the foot and ankle between October 2013 and May 2018 were reviewed. Surgical management consisted of consecutive debridement, followed by negativepressure wound therapy and STSG. We used an acellular dermal matrix between the wound and the overlying STSG in some patients with wide or uneven wounds. Patient satisfaction, comorbidities, wound size and location, length of hospital stay, wound healing time, and complications were investigated. @*Results@#Of 20 patients, 17 (85.0%) were satisfied with the surgical outcome. Eight patients had diabetic wounds associated with peripheral vascular disease (PVD), 7 patients had diabetic wounds without PVD, and 5 patients had acute infection superimposed with necrotizing abscesses. The mean size of the wound was 49.6 cm 2 . The mean length of hospital stay was 33.3 days. The mean time to wound healing was 7.9 weeks. The mean follow-up period was 25.9 months. Complications included delayed wound healing (4 cases) and recurrence of the diabetic wounds (2 cases), which were resolved by meticulous wound dressing. @*Conclusion@#STSG remains a good treatment strategy for chronic diabetic wounds of the foot and ankle.

Use of Ultrasonography for Foot and Ankle Sports Injuries / 대한정형외과학회잡지

Sports injuries of the foot and ankle are commonly encountered in clinical practice. Ultrasound is very useful for the diagnosis of such injuries, because it is more economical, readily accessible, and can perform a dynamic study compared to magnetic resonance imaging. This review focused on the sonographic features of common foot and ankle sports injuries.

Subtalar Arthroscopy and Posterior Endoscopy / 대한정형외과학회잡지

The application of arthroscopy is becoming increasingly widespread due to the development of surgical instruments and techniques. Subtalar pathology can cause chronic pain in the hindfoot, but it is often misdiagnosed as a lesion of the adjacent ankle joint, which can lead to delayed diagnosis and treatment. Subtalar arthroscopy and posterior endoscopy are good methods to confirm and treat the posterior pathology of the subtalar joint and posterior ankle joint.

Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux

BACKGROUND: To describe the clinical and magnetic resonance imaging findings of ganglion cysts with effusion in the flexor hallucis longus tendon sheath around the hallux to evaluate their origin. METHODS: Patients with recurrent or painful ganglion cysts around the hallux with effusion in the flexor hallucis longus tendon sheath who underwent surgical treatment at St. Vincent's Hospital from February 2007 to August 2016 were investigated. Surgical indication was a painful or recurrent mass caused by the cystic lesions. Those without effusion of the flexor hallucis longus tendon sheath were excluded. We assessed the clinical and magnetic resonance imaging findings. RESULTS: Magnetic resonance imaging findings in all patients showed several ganglion cysts around the hallux and large fluid accumulations within the flexor hallucis longus tendon sheath. Regarding the location, six ganglion cysts were on the dorsomedial aspect, one on the plantar medial aspect, seven on the plantar lateral aspect, and one in the toe pulp. Ten patients showed joint effusions in both the metatarsophalangeal and interphalangeal joints, two in the metatarsophalangeal joints, and three in the interphalangeal joints. There were communication stalks with a tail shape or abutment between ganglion cysts with surrounding joint effusions. Intraoperatively, connections between ganglion cysts, the synovial cyst of the flexor hallucis longus tendon sheath, and surrounding joints were seen. CONCLUSIONS: Synovial fluid accumulation in the metatarsophalangeal or interphalangeal joint supplies the synovial cyst of the flexor hallucis longus tendon sheath and subsequently ganglion cysts in the hallux. In clinical practice, the surgeon should carefully check surrounding joints with tendon sheaths to prevent recurrence of the ganglion cysts around the hallux.

Diagnosis and Treatment of Tarsal Tunnel Syndrome / 대한정형외과학회잡지

Tarsal tunnel syndrome is an entrapment neuropathy of the tibial nerve and its branches within the tarsal tunnel, which usually occurs as a result of a space-occupying lesion, trauma or foot deformity. The typical symptoms are pain and paresthesia of the foot at the dermatome of involved nerve branches, and the diagnosis can be made through careful history taking and physical examination. Treatments include conservative management and surgery. Although the reported results of surgical treatment vary, surgical decompression can yield satisfactory outcomes in cases of tarsal tunnel syndrome with a space-occupying lesion.

Gait Analysis of Symptomatic Flatfoot in Children: An Observational Study

BACKGROUND: Flatfoot deformity is a lever arm disease that incurs kinetic inefficiency during gait. The purpose of this study was to measure the degree of kinetic inefficiency by comparing the gait analysis data of a flatfoot group with a normal control group. METHODS: The patient group consisted of 26 children (21 males and 5 females) with symptomatic flatfoot. They were examined with gait analysis between May 2005 and February 2014. Exclusion criteria were patients with secondary flatfoot caused by neuromuscular disorders, tarsal coalition, vertical talus, or others. Patients' mean age was 9.5 years (range, 7 to 13 years). The gait analysis data of the study group and the normal control group were compared. RESULTS: The mean vertical ground reaction force (GRF) in the push-off phase was 0.99 for the patient group and 1.15 for the control group (p < 0.05). The mean ankle moment in the sagittal plane during the push-off phase was 0.89 for the patient group and 1.27 for the control group (p < 0.05). The mean ankle power in the sagittal plane during the push-off phase was 1.38 for the patient group and 2.52 for the control group (p < 0.05). The aforementioned results show that patients with pes planovalgus had a reduction of moment, power, and GRF in the push-off phase during gait. CONCLUSIONS: Symptomatic flatfeet had a moment inefficiency of 30% and power inefficiency of 45% during gait compared to feet with preserved medial longitudinal arches.

Treatment of Massive Defect in Achilles Tendon with Tendon Allograft: A Case Report / 대한족부족관절학회지

Deep infection of Achilles tendon is one of the serious complications that occur after open repair of the tendon. It sometimes leads to a very large tendon defect during the course of treatment. We report on a case of massive defect in Achilles tendon, which was successfully treated with Achilles tendon allograft and flexor hallucis longus tendon transfer.

Operative Treatment of Acquired Adult Flatfoot / 대한족부족관절학회지

Acquired adult flatfoot deformity is characterized by flattening of the medial longitudinal arch and dysfunction of the posteromedial soft tissues, including the posterior tibial tendon. When the non-operative treatment fails to result in improvement of symptoms, surgery should be considered. Operative techniques include flexor digitorum longus tendon transfer, calcaneal medial slide osteotomy, lateral column lengthening, and arthrodesis of the hindfoot. The principle of correcting the deformity while avoiding overcorrection and excessive stiffness is important in achievement of good outcomes in these patients.

Unusual metatarsophalangeal joint deformity in an advanced rheumatoid foot

No abstract available.

Operative Treatment of Hallux Valgus / 대한족부족관절학회지

Hallux valgus, or a 'bunion', is a deformity characterized by lateral deviation of the big toe. Surgery is indicated when conservative treatments have failed to result in improvement of symptoms. Operative techniques include simple bunionectomy, distal soft tissue procedure, phalangeal osteotomy, metatarsal osteotomy (distal, shaft, or proximal), arthrodesis (metatarsophalangeal or tarsometatarsal), or resection arthroplasty. Good results are expected when the selection of operative technique is based on the correct treatment principle.

Bunionette Deformity / 대한족부족관절학회지

The bunionette, or a 'tailor's bunion', is a lateral bony prominence of the fifth metatarsal head. A bony deformity itself rarely causes symptom but if a painful inflammation of the overlying soft tissue is accompanied, it needs treatment. Conservative care using a shoe modification, padding, or orthosis is effective in most cases. Surgical management is indicated when the conservative methods have failed to improve symptoms, and the techniques include exostectomy, metatarsal osteotomies (distal, diaphyseal, or proximal), metatarsal head resection or fifth ray resection. We reviewed the etiology, clinical features, radiographic classification, nonoperative and operative treatments of the bunionette.

Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients

BACKGROUND: Bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients is a viable option that can prevent the complications of an open reduction, such as nonunion and metal failure. This study evaluated the clinicoradiological results of cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. METHODS: Forty hips were followed for more than 2 years after cementless bipolar hemiarthroplasty using a Porocoat(R) AML Hip System. The mean age was 78.8 years and the mean follow-up period was 40.5 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using a range of indices. RESULTS: At the last follow-up, the mean Harris hip score was 80.6 points. There were one case of hip pain and one case of thigh pain. Twenty-four cases (60%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 23 cases (57.5%) of fixation by bone ingrowth and 17 cases (42.5%) of stable fibrous fixation. There were no cases of osteolysis. Eleven cases (27.5%) of new bone formation were found around the stem. All stems were stable without significant changes in alignment or progressive subsidence. CONCLUSIONS: The short-term results of cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.

Ceramic on Ceramic Cementless Total Hip Arthroplasty Using a Large Diameter Head / 대한정형외과학회잡지

PURPOSE: The authors evaluated the clinical and radiological results of ceramic on ceramic articulation cementless total hip arthroplasty using a large diameter head. MATERIALS AND METHODS: Seventy-two hips were followed for more than 2 years after ceramic on ceramic articulation cementless total hip arthroplasty using a 36 mm diameter head. The mean patient age was 62 years (range: 50-85), and the mean follow-up period was 35.3 months (range: 25-53). The Harris hip score, the postoperative inguinal pain and the thigh pain were analyzed clinically. The radiological results were assessed using various radiological indices. RESULTS: The mean Harris hip score improved from preoperative 57.5 points to postoperative 94.8 points. The postoperative mean flexion of hip was 109degrees (range: 100degrees-125degrees), external rotation was 42degrees (range: 35degrees-49degrees) and abduction was 35degrees (range: 30degrees-45degrees). There was one case of inguinal pain. Radiologically, all the stems demonstrated stable fixation without progressive subsidence of the stem or significant change in the cup obliquity. A radiolucent line was observed around the stem in 4 cases (5.6%) and around the cup in 2 cases (2.8%). Endosteal new bone formation was observed around the stem in 28 cases (38.9%) and around the cup in 26 cases (36.1%). There was no osteolysis around the stem or the cup. CONCLUSION: The short-term results of ceramic on ceramic cementless total hip arthroplasty using a large diameter head demonstrated satisfactory results.

Treatment of Hallux Valgus with Distal Chevron Metatarsal Osteotomy / 대한족부족관절학회지

PURPOSE: The authors intended to analyze the operative results of mild to moderate hallux valgus treated with distal chevron metatarsal osteotomy. MATERIALS AND METHODS: Twenty six feet of twenty three patients were followed for more than 1 year after the distal chevron metatarsal osteotomy. Biplanar osteotomy with wedge resection was done when the distal metatarsal articular angle (DMAA) was increased. The mean age was 39 years, and the mean follow up period was 27 months. Clinically preoperative and postoperative AOFAS hallux MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, the 1st intermetatarsal angle, DMAA and sesamoid position before and after the operation were analyzed. RESULTS: Distal chevron osteotomy was done in 15 cases and biplanar osteotomy was done in 11 cases. Clinically AOFAS scale was increased from 65.3 points preoperatively to 92.2 points postoperatively. Two patients were not satisfied with the results. Radiologically hallux valgus angle was decreased from 21.9degrees preoperatively to 8.5degrees postoperatively. The first intermetatarsal angle was decreased from 11.8degrees preoperatively to 6.7degrees postoperatively. DMAA was decreased from 11.8degrees preoperatively to 5.5degrees postoperatively. There was one case of minor wound infection. CONCLUSION: Distal chevron metatarsal osteotomy appears to be safe and satisfactory procedure for mild to moderate hallux valgus.

Changes in the Gastrocnemius and Soleus Muscle Length during Gait in CP Patients with an Equinus Deformity / 대한정형외과학회잡지

PURPOSE: To measure the muscle length of the gastrocnemius and soleus during gait in CP patients with an equinus deformity before and after surgery. MATERIALS AND METHODS: Twelve CP patients with an equinus deformity (17 limbs) were examined by gait analysis preoperatively and postoperatively. The patient group was further classified into the TAL and Strayer group according to the surgical technique. The mean age and mean follow-up periods were 14.3 years (5-25 years) and 15.3 months (12.5-18.5 months), respectively. The muscle length of the Gastrocnemius and Soleus was measured during gait using the SIMM program linked to a gait analysis system. RESULTS: The ankle ROM, knee ROM, maximal muscle length and peak-to-peak excursion during gait improved after surgery. There was a significant difference between the preoperative and postoperative measurements (p0.05). The muscle length of the soleus was elongated during gait after the Strayer procedure. CONCLUSION: Patients with an equinus deformity had a contracted triceps muscle, which was elongated after surgery. These changes were quantified by a comparison of the preoperative and postoperative measurements.

Cementless Bipolar Hemiarthroplasty for Femoral Neck Fractures in Elderly Patients / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate clinicoradiological outcomes after cementless bipolar hemiarthroplasty in elderly patients with femoral neck fractures. MATERIALS AND METHODS: Eighty hips-all in patients greater than 70 years of age-were followed for more than 2 years after undergoing cementless bipolar hemiarthroplasty with a tapered cementless stem (Lima SPH-C2(R)). The mean age was 76 years, and the mean follow-up period was 37 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using various radiological indices. RESULTS: At last follow-up, the mean Harris hip score was 80.2 points. There was one case of significant hip pain. Fifty-five cases (68.7%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 47 cases (58.7%) of bone ingrowth and 33 cases (41.3%) of stable fibrous fixation. There were no cases of osteolysis, and 30 cases (37.5%) exhibited new bone formation around the stem. All stems were stable without significant alignment change or progressive subsidence. CONCLUSION: Short-term outcomes proved to be satisfactory in elderly patients undergoing cementless bipolar hemiarthroplasty for femoral neck fractures.

Translational Movement of the Tibiofemoral Joint in Normal Gait: 3-Dimensional Measurement / 대한정형외과연구학회지

PURPOSE: The purpose of this study was to quantify the translational movement at the tibiofemoral joint during normal walking using 3-D motion capture technique. MATERIALS AND METHODS: Study group was 30 healthy volunteers (15 Males, 15 females) without a history of musculoskeletal problems. Mean age was 20.4 years (18~25). Helen-Hayes Markes system was adopted for the basic study. Two more markers were added to generate 2 virtual markers using SKB (Skeletal builder) program. One virtual marker (alpha) was set on the mid point of intercondylar notch of distal femur. The other virtual marker (beta) was set on the tibial spine. Translational movement of beta relative to alpha was measured during normal walking. RESULTS: Linear parameters and kinematic results were within normal limits with no statistical difference between male and female or right and left. On the sagittal plane, tibial spine translated posteriorly as the knee flexed. Posterior translation of 2.6 mm at the loading response and 13.7 mm at the peak knee flexion were measured. Vertical translation showed three up and down patterns with distraction of 7.3 mm at the end of first single support period, 9.6 mm at the end of double support period and 10.3 mm at the midswing phase. On the coronal plane, medial and lateral translation was minimal during stance phase. Lateral translation of 3.3 mm occurred at the swing phase. CONCLUSIONS: The amount of the translation of tibia on the femur at the knee joint during walking could be useful information for the preoperative and postoperative evaluation of the patients with pathologic knees.

Treatment of Bunionette Deformity with Diaphyseal Oblique Osteotomy / 대한족부족관절학회지

PURPOSE: The authors intended to evaluate the results of symptomatic bunionette treated with a diaphyseal oblique osteotomy. MATERIALS AND METHODS: Nine patients were followed for more than 1 year after diaphyseal oblique osteotomy for a bunionette deformity with plantar callosity. The mean age was 43 years (23-69 years), and the mean follow-up period was 27 months (12-70 months). As a combined disorder, 7 patients had hallux valgus, for which 3 distal metatarsal oteotomies, 3 proximal osteotomies, and 1 double osteotomy were performed. Clinically, preoperative and postoperative AOFAS MP-IP scale, patient's satisfaction, postoperative complications were analyzed. Radiologically, the 4th intermetatarsal angle and the 5th metatarso-phalangeal angle were analyzed. RESULTS: Clinically, AOFAS MP-IP scale was increased from 59 points preoperatively to 93 points postoperatively, and all patients were satisfied with the results. The plantar callosity had all disappeared at the final follow up. The 4th intermetatarsal angle was decreased from 12.6degrees preoperatively to 4.3degrees postoperatively, and the 5th metatarso- phalangeal angle was decreased from 21.9degrees preoperatively to 2.4degrees postoperatively. There were no significant postoperative complications. CONCLUSION: Diaphyseal oblique osteotomy of the 5th metatarsal appears to be safe and satisfactory procedure for the treatment of a symptomatic bunionette with plantar callosity.

The Effect of the Acromion Shape on Rotator Cuff Tears / 대한정형외과학회잡지

PURPOSE: The shape of the acromion was analyzed radiologically to assess the effect on rotator cuff tears. MATERIALS AND METHODS: The rotator cuff tear group consisted of 91 patients with a mean age 55.6 years (range, 27-85 years) and the normal shoulder articular disease (control) group consisted of 100 subjects with a mean age of 42.9 years (range, 18-72 years). The lateral extension of the acromion and the lateral acromial angle were measured on an oblique coronal MRI, and the anterior covering of the acromionon was measured on a supraspinatus outlet view. RESULTS: The lateral extension of the acrominon of the rotator cuff tear group of patients and the control group of subjects was 0.70+/-0.07 and 0.64+/-0.10, respectively. The lateral acromial angle was 72.6+/-6.5degrees and 76.4+/-6.5degrees, respectively, and the anterior covering of the acromion was measured to be 0.55+/-0.13 and 0.51+/-0.14, respectively. In a comparison with the control group of subjects, the lateral extension of the acrominon of the rotator cuff tear group of patients was larger and the lateral acromial angle was smaller; these findings were statistically significant (p<0.001). In addition, the correlation coefficients of the lateral extension of the acromion to the lateral acromial angle in the rotator cuff tear group of patients and in the control group of subjects was -0.44 and -0.46, respectively; a statistically significant correlation was seeen (p<0.001). CONCLUSION: The results suggest that the measurement of the lateral extension of the acromion and the lateral acromial angle determines the shape of the acromion, and thus it may represent a useful marker to confirm the interrelationship of a rotator cuff tear.

Treatment of Moderate Hallux Valgus with Proximal Chevron Metatarsal Osteotomy and Distal Soft Tissue Procedure / 대한족부족관절학회지

PURPOSE: The authors intended to analyze the operative results of moderate hallux valgus with proximal chevron metatarsal osteotomy and distal soft tissue procedure. MATERIALS AND METHODS: Seventy feet of fifty-seven patients were followed for more than 1 year after the proximal chevron metatarsal osteotomy. The mean age was 47.2 years, and the mean follow up period was 2 years and 3 months. Clinically preoperative and postoperative AOFAS MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. RESULTS: Additional Akin osteotomy was performed 48 out of 70 feet. Clinically AOFAS MP-IP scale was increased from 60.4 points preoperatively to 89.8 points postoperatively. Ninety-four percents of the patients were satisfied with the results. Radiologically hallux valgus angle was decreased from 34.8 degrees preoperatively to 12.8 degrees postoperatively. The intermetatarsal angle was decreased from 15.7 degrees preoperatively to 8.0 degrees postoperatively. Hallux valgus interphalangeal angle was increased from 7.4 degrees preoperatively to 9.8 degrees postoperatively. There were 3 recurrences, 1 hallux varus and 3 minor wound infections. There were no nonunion or malunion of the 1st metatarsal. CONCLUSION: Proximal chevron metatarsal osteotomy with distal soft tissue procedure and additional Akin osteotomy appears to be safe and satisfactory procedure.