Meshed Stab Incision for Severe Swelling after Foot and Ankle Injury: A Technical Report / 대한족부족관절학회지

Swelling is a body's natural reaction to foot and ankle injury to mount a healing inflammatory response. To some degree, swelling is necessary for healing and is something that cannot be avoided following injury. However, post-traumatic swelling may have an adverse effect on wound healing and surgery can often be delayed due to preoperative swelling. We report on a unique technique of making multiple meshed stab incisions around the site of injury to reduce soft tissue swelling and promote wound healing.

Treatment of Anchor Suture with Kirschner Wires Fixation for Chronic Perilunate Dislocation

Chronic lunate dislocations are very rare injuries comprising of less than 10% of all wrist injuries. Volar lunate dislocations account for less than 3% of perilunate dislocations. We present a case of a missed volar lunate dislocation for 6months after initial injury. He fell down and had hyperextension injury during his sports activity. When the patient visit in our hospital, neurologic symptom was developed in distribution of median nerve. Tingling sensation and radiation symptom was found in affected hand. A plain radiograph revealed a volar lunate dislocation. Nerve conduction studies confirmed compression of the median nerve at the wrist, carpal tunnel level. Operation was performed with open reduction of lunate, fixation with K-wires and anchor suture. The outcome was excellent in relieving pain, function, range of motion, grip strength. There was improvement in Mayo wrist score and disabilities of the arm, shoulder and hand score. So we report a patient and a operation technique which can be considered in similar cases.

Modified Brostrom Procedure with Suture Anchor & PushLock Anchor in Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: The purpose of our study was to perform a comparison of the outcomes of the modified Brostrom procedure using only a suture anchor compared with using a suture anchor with a pushlock anchor. MATERIALS AND METHODS: This was a retrospective study of chronic lateral ankle instability that underwent a modified Brostrom procedure using a bioabsorbable suture anchor & a pushlock anchor, performed by a single surgeon. A total of 88 patients were enrolled in the study. The function of the patient's ankles were scored using the American Orthopaedic Foot and Ankle Society (AOFAS), visual analogue scale (VAS) both preoperatively and postoperatively. RESULTS: The difference in the overall means between the group A and group B was not statistically significant. But, the patient's satisfaction was better in the group B, and there were more complications in the group A. CONCLUSION: The technique presented here uses the modified Brostrom procedure with pushlock anchors to prevent the problems associated with subcutaneous knot irritation.

A Case of Synovial Hemangioma of the Knee

We report an unusual case of a 17-years-old male with complaints of pain and swelling of the left knee for the last 3 years with limitation of movement. He presented with spontaneous hemarthrosis of the knee joint. Magnetic resonance imaging revealed an intra articular mass. Arthroscopic excision was performed and the histology was characteristic of synovial hemangioma. After 1 year, the patient was completely asymptomatic and showed no signs of recurrence.

Comparative Study of Posterior Lumbar Interbody Fusion with Posterolateral Fusion in Degenerative Lumbar Spinal Disorders

STUDY DESIGN: A retrospective study. OBJECTIVES: The authors found that problems such as axial pain, donor site pain, loss of reduction, loosening or failure of fixation materials occurred relatively frequently after posterolateral fusion. For this, we had views on the ideas that the problems could be improved by an operation that fused vertebral bodies. Furthermore, we performed posterior lumbar interbody fusion and wanted to know the results. SUMMARY OF LITERATURE REVIEW: We performed posterior lumbar inter-body fusion as an alternative, due to complications of autoiliac bone graft that has complications, such as donor site pain. MATERIALS AND METHODS: Sixty patients with single segment degenerative lumbar disease were treated with decompression, pedicle screws fixation, and spinal fusion. The patients were followed-up for more than 2 years. Thirty patients, who had undergone posterolateral fusion with autologous iliac bone graft, were classified as the "group 1". The second 30 patients, who underwent posterior lumbar interbody fusion with cage and local bone graft, were classified as the "group 2". The operation time, blood loss, fusion rate, lumbar lordotic angle, segmental angle were compared between the 2 groups. The clinical outcomes were evaluated by Kim's functional evaluation scale. RESULTS: The operation time was shorter in group 2 (142.74 minutes vs 171.64 minutes), there was a statistical difference between the 2 groups. Intraoperative blood loss was more in group 2 (563.40 vs 551.78 mL), but total blood loss, including postoperative drained blood was less in group 2. The bony fusion rate was 90% in group 1, 97% in group 2. For the lumbar lordotic angle, the last outcome was less than the preoperative value. There was no statistical difference between the 2 groups. The segmental angle in group 1, the last outcome was less than the preoperative value. The segmental angle in group 2 was maintained the value through pre-operation to post-operation. Clinical outcomes were satisfactory in group 1 (96.67%) & in group 2 (100%). In group 1, 7 patients experienced pain at the iliac graft donor site. In group 2, there were 2 cases of retroposition of the cage. CONCLUSIONS: In the posterior lumbar interbody fusion group, operation time was shorter, total blood loss was less than in the posterolateral fusion group. Restoration and maintenance of the segmental angle in sagittal and coronal radiographs showed better outcomes, axial pain and iliac donor site pain were less. It is the authors' position that posterior lumbar interbody fusion is an alternative operation to supplement the faults of posterolateral fusion.

New V-shaped Technique in SLAP Repair (Comparison of Cinical Results Between New V-shaped Repair and Conventional Rapair Technique in Arthroscopic Type II SLAP Surgery)

PURPOSE: The purpose of this study was to compare clinical outcomes between the new V-shaped repair method and conventional methods for the arthroscopic repair of Type II SLAP lesions. MATERIALS AND METHODS: Our study population consisted of 23 people treated with the new V-shaped repair method or conventional methods in the arthroscopic repair of Type II SLAP lesions at our institution between May 2006 and October 2008. Eleven shoulders were treated using the new V-shaped repair method. Twelve shoulders were treated using conventional methods. The average follow up period was 15 months. For evaluation of clinical results, we used UCLA and VAS pain scores. RESULTS: Comparing change scores (preoperative vs. postoperative states) there were no significant differences in UCLA score or VAS score between the two groups. CONCLUSION: The new V-shaped repair technique elicits similar clinical results with conventional arthroscopic repair techniques and thus can be considered a useful alternative when using an absorbable suture that is anchor linked with only one suture.

Treatment of Type 2 Distal Clavicle Fracture using Wolter Plate

PURPOSE: This study examined the clinical results of the treatment of type 2 distal clavicle fracture with using a Wolter plate. MATERIALS AND METHODS: Between 2004 and 2007, 16 patient treated for type 2 distal clavicle fracture using a Wolter plate were included in this study. Their average age was 32.6 years and the postoperative mean follow-up period was 22.9 months. The reduction and union were qualified according to the immediate post-operative and final radiographs. The functional outcome was evaluated by Kona's system and the Constant score RESULTS: By Kona's functional evaluation, there were 12 cases with excellent results, 3 cases with good results and 1 case of fair results and the average Constant score was 90. All 16 cases showed bony union. As complications, there was 1 case in which the protruded hook of the plate could be palpated at the skin, and 1 case showed an acromial fracture, but all the cases dispalyed successful bony union and there was no acromioclavicular joint arthritis, infection or any other complications. CONCLUSION: Wolter plate fixation for type 2 distal clavicle fracture is a reliable surgical method for satisfactory reduction and rigid fixation, a lower incidence of nonunion and excellent clinical result

Sterile Abscess at the Heel Pad: A Case Report / 대한족부족관절학회지

Heel abscesses present as heel pain that progressively worsens, with associated tenderness and fullness a the heel pad. To our knowledge, there are fews reports in the literature describing a spontaneous heel pad abscess. A 48-years old woman presented spontaneously with pain, erythema, edema and increased warmth to this right foot. She has no underlying disease and steroid injection history. A radiologic examination was suggestive of an abscess. Follow incision and drainage, cultures that were taken during the surgical procedure did not produce any organism. The patient was discharged home and recovered from the abscess without recurrence or further surgical intervention.

Surgical Results of Intradural Extramedullary Tumors

BACKGROUND: To report the treatment results of 12 patients who underwent a total excision of intradural extramedullary tumors. METHODS: Twelve cases of histopathologically confirmed intradural extramedullary tumors were treated surgically between February 2002 and March 2005. There were 8 males and 4 females with an average age of 42.6 years. The mean postoperative follow-up period was 24.2 months. The histopathological findings, locations of the tumors, and clinical results were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel classification. RESULTS: The histopathological results are as follows: 4 cases of a meningioma, 4 cases of a schwannoma, 2 cases of an epidermoid cyst, 1 case of an arachnoid cyst, and 1 case of an ependymoma. The locations of the tumors were as follows: 7 cases in the thoracic region, 4 cases in the lumbar region, and 1 case in the cervical region. At the final follow-up, a 2-grade and 1-grade improvement was observed in 1 and 7 cases, respectively. There were no changes in the Frankel grade in 4 cases. The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Postoperatively, there were 2 cases of cerebrospinal fluid leakage and 2 cases of paresthesia. CONCLUSIONS: Intradural extramedullary tumors detected by MRI are mostly benign and good clinical results can be obtained when treated surgically. Therefore, more active surgical approaches by orthopedic surgeons are recommended to decrease morbidity.

Arthroscope-guided Closed Reduction and Internal Fixation of the Lateral Malleolar Fracture / 대한족부족관절학회지

PURPOSE: In this study, we introduced an newly developed technique of operation for fracture of lateral malleolus of the ankle. We treated the fracture by close reduction and internal fixation using arthroscopy. MATERIALS AND METHODS: From July 2006 to June 2007, we had treated 23 cases of lateral malleolar fracture (SER type) by closed reduction and internal fixation with arthroscopy and followed them up more six month. Operation time, union time, clinical and functional result were evaluated. RESULTS: After the final follow-up, all the fractures were healed with satisfactory bony union. The subjective result was excellent in 15 cases (65%), good in 8 cases (35%), the objective result was excellent in 13 cases (57%), good in 10 cases (43%), and the roentgenographic result was excellent in 17 cases (74%), good in 6 cases (26%). CONCLUSION: Closed reduction and internal fixation with arthroscopy technique is an effective treatment method in treating lateral malleolar fracture of the ankle since it offers advantages including corrective anatomical reduction and minimizing complication associated with injury of soft tissue.

Treatment of Two- and Three-Part Fracture of Proximal Humerus using LCP

PURPOSE: To evaluate the result and complication of treatment using Locking Compression Plate (LCP) for fracture of proximal humerus. MATERIALS AND METHODS: Between 2004 and 2006, 21 patients with two-part and three-part fractures of the proximal humerus were treated by LCP fixation. Their average age was 54.9 years. Postoperative mean follow-up period was 22.9 months. The reduction was qualified and complication were assessed with final radiographs. The functional outcome was evaluated by Neer's rating system. RESULTS: By Neer's functional evaluation, mean score of shoulder function was 86.3 and 18 case (86%) had excellent or satisfactory results. There was one case of nonunion but no infection or avascular necrosis of the humeral head. No correlation was found between the final result and the type of fracture, age, gender or quality of reduction. CONCLUSION: We obtained satisfactory result of LCP fixation for fracture of proximal humerus in this study. LCP fixation for proximal humerus fracture is a reliable method to obtain satisfactory reduction, rigid fixation and early exercise.

Limited Posterior Approach for the Surgical Treatment of Intraarticular Fracture of Calcaneus / 대한족부족관절학회지

PURPOSE: To evaluate the clinical efficacy of the limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus. MATERIALS AND METHODS: From March 2000 to February 2006, we studied retrospectively 186 patients, 203 cases who were treated with open reduction and internal fixation through limited posterior approach and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared Bohler angle and Gissane angle. RESULTS: By Creighton-Nebraska score, Sanders type 2 was 86.4, type 3 was 74.3, type 4 was 62.4. And by circle draw test, type 2 was 8.9 cm, type 3 was 7.2 cm, type 4 was 5.9 cm. Bohler angle and Gissane angle were 7.6 degrees, 102.4 degrees, and it increased to 23.5 degrees, 128.6 degrees after postoperative 1 year. CONCLUSION: Limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus was considered to an effective treatment modality.

Extracorporeal Shock Wave Therapy for Calcific Tendinitis of the Shoulder / 대한정형외과학회잡지

PURPOSE: To evaluate whether Extracorporeal Shock Wave Therapy (ESWT) is an effective treatment without side effects for chronically painful calcifying tendinitis. MATERIALS AND METHODS: Study subjects were 72 patients (17 males and 55 females) aged 37-64 years, with a mean of 48, showing chronic, symptomatic, calcifying tendinitis of the shoulder refractory to other conventional conservative therapies. Calcifications were type I or type II according to the classification of Gartner, and with a minimum diameter of 10 mm. Patients with type 3 calcific tendinitis were excluded, because this type has a strong tendency to spontaneous resolution. Extracorporeal shock wave therapy comprised one or two treatments, each consisting of 800 shocks, with a frequency of 120 impulse per minute and the energy density of 0.14 mJ/mm2. We assessed the presence and size of calcified deposits at 1, 3, 6 and 12 months by conventional radiography. All patients also underwent clinical examination, and the Constant (and Murley) score and pain were calculated. The intensity of pain was measured with the visual analogue scale (VAS) from 0 to 10 points, where 0 represents the absence of pain and 10 unbearable pain. RESULTS: One month after the treatment, complete resorption of the calcium deposits was observed in 19 patients (26%), partial resorption was observed in 26 patients (36%), and no modification in the calcium deposits was observed in 27 patients (38%). At six months the complete disappearance of the calcium deposits was noted in 42 patients (68%), but in the 10 patients (14%), calcium deposit appeared unchanged. This result is remained unvaried after 6 month follow-up. Using the Constant and Murley score, this study showed a significant decrease in pain and a significant increase in shoulder function (p<0.001). At six months, 76% of the patients presented satisfactory functional result. About 15% reported a subjective and objective recovery, and only 6 patients (8%), classified as poor result but in our series no differences were found between results at 6 month and 12 month follow-up. At 12 month follow-up there were differences in the Constant score between treated shoulder and contralateral side, respectively 77.6 (59-91) and 87.2 (74-96), but not significant. There were no side effects. CONCLUSION: ESWT is an effective treatment without side effects and an alternative therapy for chronically painful calcifying tendinitis of the shoulder refractory to conventional therapies.

Retrograde Intamedullary Nailing for Femoral Fracture

PURPOSE: To evaluate the effectiveness. analyze the result after retrograde intramedullary (IM) nailing in femoral shaft fracture MATERIALS AND METHODS: Thirty-four femoral shaft fracture (32 patients) were operated with retrograde IM nail and followed the result for more than 18 month from march 2001 to march 2003. There were 6 of femoral mid shaft fractures and 28 of distal femur fractures. According to AO classification, there were 1 of A1, 1 of A2, 2 of A3, 2 of C1 in femoral mid shaft fracture and 11 of A1, 7 of A2, 7 of A3, 1 of B1, 2 of C1 in distal femur fracture. They included 5 open fracrures. By Gustilo classification there were 3 of type I, 2 of type II. Through radiologic study we evaluated the time of union, nonunion, malunion. And in clinical evaluation we checked knee function in 18 month after operation. RESULTS: It took 16 weeks (range 12~20 weeks) for average bone uion period. 30 cases out of 34 cases had the bone union but 4 cases showed nonunion. There were not any complication except 3 cases of screw migration. Full rage of motion was gained in 29 cases. However knee stiffness occurred in 5 cases. The knee function through knee score was assessed by showing 28 of excellent, 1 of good, 5 of poor. CONCLUSION: Even though the retrograde intramedullary nailing may have some defect to be able to damage to knee joint in operating, It can be useful surgical technique for femoral shaft fracture in such as ipsilateral fracture or multiple fracture, poor general condition, and so on.

Treatment of Intercondylar Fracture of Distal Humerus in Adult

PURPOSE: To evaluate and report the clinical results of the treatment of distal humerus intercondylar fractures treated with internal fixation through the modified posterior approach. MATERIALS AND METHODS: From January 1999 to October 2003, 20 patient who had intercondyle fracture of the distal humerus treated with internal fixation through the modified posterior approach. We evaluated bone union, complication, postoperative elbow function. RESULTS: The average follow up period was 12.8 months. Nearly all most cases united at 14 weeks in an average. There were two neuropraxia and two hardware failure. The range of the elbow joint motion was flexion contracture 8 degree (5~15 degree) to further flextion 120 degree (75~140 degree) in average. The functional result with Riseborough and Radin's functional scale were as follows; 13 good, 4 fair, 3 poor. CONCLUSION: Not with severe comminuted like type C3 fracture, but in cases with intercondylar distal humerus fracture the modified posterior approach provided satisfactory exposure for open reduction and rigid internal fixation with satisfactory bone union. There was satisfactory bone union and good clinical result in postoperative elbow function.

The Effect of Intraoperative Tourniquet Deflation in Total Knee Arthroplasty

PURPOSE: The aim of this study was to evaluate the effect of tourniquet deflation for hemostasis on postoperative blood loss in total knee arthroplasty. MATERIALS AND METHODS: The tourniquet was deflated intraoperatively before prosthesis insertion, hemostasis was established, and the tourniquet was reinflated before wound closure for 41 patients(Group I) and the tourniquet was not released until after the wound was closed in 46 patients(Group II). The postoperative blood loss was determined by measuring it in the suction drainage during first 24 hours and total blood loss was calculated from the decline in hematocrit. RESULTS: The measured blood loss during first 24 hours for group I averaged 1096 ml, while that for Group II averaged 1036 ml. Total blood loss including hidden blood loss for group I averaged 1639 ml, while that for Group II averaged 1593 ml. CONCLUSION: Tourniquet deflation for hemostasis in primary total knee arthroplasty is not an effective means of reducing postoperative blood loss.

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.

Heel Pad Thickness: Measurement by Simple Plain Radiography / 대한족부족관절학회지

PURPOSE: The heel fat pad has a unique structure that is important for its shock absorbing function. Loss of elasticity and change in the thickness of the heel pad have been suggested as cause of heel pain. The present study shows the relationship between the thickness of heel fat pad and age, sex, obesity and plantar heel pain. MATERIALS AND METHODS: A study of heel pad thickness using plain lateral radiographs, unloaded by body weight, was carried out on 66 patients with plantar heel pain and 326 normal subjects. The population was divided into two or three groups according to their age, sex, body mass index, and the presence of symptom. We evaluated the differences in heel pad thickness between groups, and the relationship between BMI and Sex and Age was also determined, using statistically analytic method by SPSS version 10.1 program. RESULTS: Heel pad thickness was greater in the subject over 40 years old (p<0.001), and in the overweight (p<0.001), and male heel pad was thicker than female (p<0.001). But there was no statistically significant difference for heel pad thickness between normal subject and plantar heel pain group. CONCLUSION: In this study, we found that there is a relationship between heel pad thickness and age, sex, and obesity. But we could not show that the difference of heel pad thickness is contributing factor to plantar heel pain. Although it could not be proved statistically, we believe that a change of heel pad thickness play a role in the development of heel pain. So we are planning to assess a relationship of heel pad elasticity and thickness and plantar heel pain again with prospective study method on the basis of the results of this study.

Flat Foot Survey in 8 Year Old Primary School Children / 대한족부족관절학회지

PURPOSE: To estimate the prevalence of flat foot in the 1st grade primary school children in the Kang-Dong Gu, Seoul, Korea. MATERIALS AND METHODS: We examined 1336 8 year old the first grade children (2672 feet) in primary school at 5 primary school for prevalence of flat foot and the associating factors in Kang-Dong Gu in April 2003. The group was examined with 2 mm-pannel in physical examination at erect position to put diagnosis of flat foot which showed no plantar arch. The height, weight, foot length and foot width were estimated in all children. We used obesity grading system of Korean Pediatric Association for overweight evaluation. RESULTS: We enrolled 728 boys and 608 girls, and prevalences of each gender were 20.8% and 14.9%. The children who had flat foot were 243 and the prevalence of flat foot was 18.2%. The foot length ranges between 152 mm and 300 mm (mean value 183.6 mm, SD 10.6), and the foot width were between 50 mm and 107 mm (mean value 2.16 mm, SD 4.8). Of the 1336 children group, 1215 children (90.0%) were in range of normal weight, 72 children (5.4%) were in grade-1 overweight, 38 (2.8%) were in grade-2 overweigh and, 11 (0.8%) were in grade-3 overweight. The prevalence of flat foot of each overweight group were 16.3%, 34.7%, 39.5% and 45.5%. Overweight in children effected increased prevalence of flat foot. But there were no significant relationship with flat foot in other factors. CONCLUSION: Over all prevalence of flat foot of 8 year old children was 18.2% and most of patients were flexible flat foot. The prevalence of flat foot was influenced by overweight remarkably.

The Percutaneous Pinning of the Displaced Supracondylar Fracture of the Humerus using Skin Traction

PURPOSE: The purpose of this study was to evaluate a new treatment method, which was using intraoperative skin traction and Steinmann(S)-pin for anatomically reduction by gentle manipulation to treat the displaced supracondylar fracture of the humerus with percutaneous pinning. MATERIALS AND METHODS: Clinical analysis was performed on thirty displaced supracondylar fractures (Gartland type III) of the humerus patients with a minimal three month follow up, who were treated percutaneous pinning after reduction with by intraoperative skin traction and S-pin. Clinical results were analyzed according to the Flynn grading system. RESULTS: According to the Flynn grading system, excellent results were obtained in 12 cases (43%), good in 14 case (47%), fair in 4 cases (10%), poor in 0 cases (0%) and we obtained all satisfactory results. There was one case which was reoperated for closed reduction and percutaneous pinning repeatedly due to reduction loss and no case with conversion to open reduction. CONCLUSION: To avoid the forceful manipulation, gentle closed reduction and percutaneous pinning using intraoperative skin traction and S-pin especially for rotational correction in the displaced supracondylar fracture of the humerus is considered to be useful method because showed satisfactory results.