The Relationship between Body Mass Index and Diabetic Foot Ulcer, Sensory, Blood Circulation of Foot on Type II Diabetes Mellitus Patients / 대한정형외과학회잡지

PURPOSE: Excessive weight bearing from obesity may induce pains in the lower extremity and resulting functional abnormality. Here we aimed to identify the relationship, it is intended to identity relationship obesity has with diabetic foot ulcer, sensory function, and blood circulation in diabetic patients. MATERIALS AND METHODS: We included patients who hospitalized or visited the department of orthopedic surgery for the treatment of diabetic foot ulcer, between January 2010 and December 2015. Among them, those aged over 30 years, diagnosed with diabetes with a progression of more than one year, and an HbA1c level of less than 7.5% were included for final analysis. For obesity, body mass index (BMI) was used, those with a BMI of over 18.5 kg/m2 were included. Using the Asian cut point of World Health Organization, patients were classified into normal, overweight, or obese. For foot ulcers, patients were classified using the Wagner ulcer classification. For sensory function, it was measured by scoring it with Semmes-Weinstein monofilament of International Working Group on the Diabetic Foot (IWGDF). Moreover for blood circulation, ankle-brachial index (ABI) was measured. RESULTS: For the sensory function, it was found that the overweight group obtained the highest score and the obesity group obtained the lowest score. For ABI, the overweight group scored the highest and the normal group scored the lowest. Moreover diabetic foot ulcer was the highest in the obesity group and the lowest in the normal group. From these results, it was considered that BMI had no relationship with sensory or blood circulation of the feet. However, the relationship between the diabetic foot ulcer and BMI showed statistical significance; according to the result of regression analysis, BMI of diabetic patients had a positive correlation with diabetic foot ulcer. CONCLUSION: This study showed that the sensory function and blood circulation of the feet had no relationship with diabetic foot ulcer; however, BMI appears to have a positive correlation with diabetic foot ulcer. Moreover, it seems to be a good index for determining the risk of diabetic foot ulcer.

The Result of Using an Additional Mini-Locking Plate for Tibial Pilon Fractures

PURPOSE: We evaluated the usefulness of an additional, 2.7 mm mini-locking plate for tibial pilon fractures. MATERIALS AND METHODS: We studied 21 patients (14 males and 7 females), who were treated with a 2.7 mm mini-locking plate via the anterolateral approach for tibial pilon fractures between September 2012 and April 2014. The mean age was 43.85 years, and the mean follow-up period was 16.6 months. The radiologic outcomes were graded by the Burwell and Charnley modified system and clinical outcomes were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score. RESULTS: The mean union period was 14.3 weeks. At the final follow-up, radiologic results showed 16 excellent results, 4 fair results, and 1 poor result. The average VAS was 3.4 points; the average AOFAS score was 81.8 points. During the follow-up period, there were three cases of posttraumatic osteoarthritis and one case of superficial skin infection. CONCLUSION: Additional anterolateral, 2.7 mm mini-locking plate may be a good treatment method to manage tibial pilon fractures.

A 3-dimensional Printed Molding Technique for the Management of Humeral Head Osteomyelitis

There are many methods of making cement spacer in patients who require a two-staged operation for humeral head osteomyelitis. However, limitation of motion after the first surgery—due to inadequate size and insufficient intra-articular space for second surgery—remain to be an issue. To mitigate this issue, we made a cement spacer with the same size and shape of the patient humeral head. Four patients with humeral head osteomyelitis were enrolled in this study. To make the cement spacer, we used the Mimics program, and designed the molding box by a reverse engineering technique. We evaluated the range of motion and pain using a Constant score. The mean abduction was 50° (40°–60°), forward flexion was 50° (30°–70°), and average Constant score was 47.75 (44–52). Three-dimensional printed molding technique is one of the effective methods for humeral head osteomyelitis allowing for daily activities prior to the second surgery.

A 3-dimensional Printed Molding Technique for the Management of Humeral Head Osteomyelitis

There are many methods of making cement spacer in patients who require a two-staged operation for humeral head osteomyelitis. However, limitation of motion after the first surgery—due to inadequate size and insufficient intra-articular space for second surgery—remain to be an issue. To mitigate this issue, we made a cement spacer with the same size and shape of the patient humeral head. Four patients with humeral head osteomyelitis were enrolled in this study. To make the cement spacer, we used the Mimics program, and designed the molding box by a reverse engineering technique. We evaluated the range of motion and pain using a Constant score. The mean abduction was 50° (40°–60°), forward flexion was 50° (30°–70°), and average Constant score was 47.75 (44–52). Three-dimensional printed molding technique is one of the effective methods for humeral head osteomyelitis allowing for daily activities prior to the second surgery.