Purpose: To find out the priority of which procedure has had a better outcome both clinically and radiographically between the two groups, one is treated by primary repair and the other by modified Brostr$\ddot{o}$m's procedure, by comparing the postoperative ankle joint stability and the patient's degree of satisfaction. Material and methods: 16 cases were taken into consideration whose number of severed ligaments were at least two or more of the lateral collateral ligaments of the ankle, and also were confirmed intraoperatively. Among them, 8 cases were treated with primary repair and the other 8 cases were treated with primary repair and the other 8 cases by modified Brostr$\ddot{o}$m's procedure. Results: There was no distinguishable difference for the patient's degree of satisfaction between the two procedures above mentioned. In 3 cases treated with primary repair, functional instability was observed. In case of postoperative ankle joint stability, 7 of 8 cases treated by modified Brostr$\ddot{o}$m's procedure has revealed increased joint stability. And 3 of 8 cases which were treated by primary repair have showed postoperative residual instability. Conclusion: Actually, the severed ligament can not maintain its normal strength though several months has elapsed, and possible residual instability could be remained. Therefore, it can be expected that modified Brostr$\ddot{o}$m's procedure also would be a .good method in obtaining suitable ankle joint stability as well as subtalar joint stability because of its reinforcement using extensor retinaculum.

Objectives: This study was done to determine the prevalence of radiographic ankle osteoarthritis (OA) in Korean women with clinical primary ankle OA. Methods: This analysis involved 160 Korean women who visited our out patient clinic due to ankle joint pain. Ankle AP and lateral weight-bearing radiographs were evaluated retrospectively to check whether they have radiographic OA or not. Radiographs were read for features of ankle OA using School classification. Demographic factors and radiographic findings in both radiographic ankle OA group and non-radiographic ankle OA group were analyzed by the student t-test, the chi square test and the Pearson's analysis. A p value <0.05 was considered significant. Results: The prevalence of radiographic ankle OA in Korean women is 18.2 % in patient between 18 and 39 years and is 55.6 % in patient over 40. There was significant difference between two groups with age (P<0.001) and relatively strong correlation between radiographic OA and age (r=0.474, P<0.001). Conclusion: These results show that the prevalence of Korean women with radiographic changes of ankle OA was 45 % and there was relatively strong correlation between age and radiographic ankle OA.

Most of Danis-Weber type B fracture has an oblique fracture plane proximal posteriorly to distal anteriorly. In these cases, the lateral plate has become widely accepted. However some limitation to the use of the lateral plate exist. The plate must be bent accurately and the screws in the distal fragment must be unicortical to avoid penetration into the joint, predisposing it to poor fixation in the osteoporotic bone. In 1982, Brunner and Weber introduced the antiglide plate for fixation of the shaft oblique fracture of the distal fibula, but it has not widely used. The author reviewed 21 cases treated by antiglide plate fixation from March, 1995 to March, 1999 which could be follow-up more than 1 year. We analysed the result radiographically and clinically using Ankle-Hindfoot scale(100 % total) of the American Orthopedic Foot and Ankle Society. The results obrained were as follows: 1. All fracture were united at average 8 weeks clinically and radiographically. 2. According to the Ankle- Hindfoot scale, 8 cases were above 90 points, 11 cases were beet ween 80 and 89 points and two cases were below 80 points. 3. One case had an injury to intermediate dorsal cutaneous nerve.

It has been known that the ankle arthrodesis is a common surgical procedure for treating the ankle arthrosis and deformity that do not respond to the non-operative treatment. To date, various surgical techniques for the ankle arthrodesis have been reported. Clinical and biomechanical trials have shown that the rigid internal fixation leads the increased rate of the union. The ankle arthrodesis may be complicated with the nonunion, delayed union, malunion, and infection. In cases of the Charcot joint of the ankle in diabetic patients, however, arthrodesis could reduce the disadvantage of the nonoperative treatment, such as the loss of the reduction, progressive collapse, multiple ulcerations and infection. The object of this case report is to report our experience of a successful ankle arthrodesis using an anterior T plate in treating the unstable ankle of a diabetic patient, associated with the ankle fracture and the neuropathy. The surgical approach of this technique is simple so that it would allow less soft tissue injury, and this procedure would be regarded as one alternative to provide the rigid internal fixation in the ankle arthrodesis.

Study design: Clinical results were retrospectively analyzed in 11 patients with fractures of talar neck who were treated in our department from Jan. 1994 to Dec. 1999. Objective: The purpose of this study is to evaluate the short-term results and to assess the prognostic factors of talar neck fractures. Material and Method: 11 cases with fractures of talar neck were reviewed retrospectively with minimum 1 year follow-up. There were 8 men & 3 women, and the average age was 25. The most common cause was traffic accident. According to the modified Hawkins classification, type I was in 4 cases, type II in 5, type III in 2, and type IV was none. All type I fractures were treated conservatively, and others were treated operatively. Results: According to Hawkins criteria, there was excellent result in 7 cases(64%), good in 2(18%), and fair in 2(18%). Post-traumatic arthritis occurred in 2 cases, but there was no avascular necrosis. Conclusion: Careful selection of method of treatment and urgent management are important prognostic factors in talar neck fractures. The longer follow-up in more cases is necessary to evaluate the long-term clinical results and complications more accurately.

Purpose: To analyze the results of conservative or surgical treatment after computed tomograhy(CT) classification in intraarticular calcaneal fractures. Materials and methods: From January 1996 to May 1999, we prospectively analyze 23 cases of intraarticular calcaneal fractures who were treated conservatively or operated by open reduction and internal fixation by extensive L-shaped lateral approach after CT classification. Results: A functional scoring system of 0-100 points which was based upon the responses to AOFAS Ankle-Hindfoot Scale for the operative group was at 82.8, compared with 73.2 for the non-operative group, and these were meaningful statistically(P<0.05). Of type I fracture, in the operative group there were 2 excellent results and in the non-operative group there were 2 excellent results, 1 good result. or type II fractures, in the operative group there were 2 excellent results, 3 good results, 1 fair result and in the non-operative group there were 1 good result, 1 fair result, 2 poor results. Of type III fractures, in the operative group there were 2 fair results, 2 poor results and in the non-operative group there were 1 fair result, 3 poor results. Bohler angles of subtalar joint were changed from initial average $13.3^{\circ}$ to postoperative average $20.9^{\circ}$ for the operative group compared with from initial average $15.5^{\circ}$ to follow-up average $14.8^{\circ}$ of the non-operative group(P<0.01). Conclusions: Computed tomography in the evaluation of intraarticular calcaneal fractures is effective tool. We believed that open reduction and internal fixation in all Crosby & Fitzgibbons type II and according to degrees of comminution reducible type III for the intraarticular calcaneal fractures is more effective method than conservative treatment.

Treatment of calcaneal fraclure is difficult and full of controversy still and choice of treatment of the displaced intracalcaneal fracture is not available yet. Furthermore, the treatment of old calcaneal fracture with displaced subtalar joint or malunited calcaneal fracture is really difficult and painful to solve the problem other than subtalar arthrodesis, ignoring conservative treatment, excision of bone mass and/or adhesiolysis, which is/are a kind of palliative or salvage treatment in stead of definitive treatment that restores smooth articular surface of the subtalar joint as far as we can. Authors had some experiences treating this difficult old and displaced calcaneal fractures. Some of them were malunited already. Hereby we report our favorable results to treat the fractures with surgical reduction (reconstruction) and internal fixation without bone graft. We recommend reconstruction of the displaced subtalar joint even though it is not congruent and partly gone to get subtalar motion insead of palliative operation such as subtalar fusion, which can be done later and long term potential cause of mid tarsal arthrosis of the foot.

Purpose: To evaluate the clinical and functional results of ankle arthroplasty and to analyze the complications in total ankle arthroplasty. Materials and Methods: Between October 1988 and October 1991, the total ankle arthroplasty had been performed in eight ankle joints of seven patients.. There were five patients with rheumatoid arthritis, one with osteoarthritis and one with traumatic arthritis. One patient had bilateral replacement. New Jersey type of prosthesis was used in six patients and one patient was performed with Odland type of prosthesis. The average age at surgery was 42.3 years (range, 33-54 years). The average follow-up period was 8.2 years (range, 6-10.5 years). Clinical evaluation was assessed according to the Ankle-Hind Foot Scale of American Orthopedic Foot and Ankle Society. Results: The average score was 81.4 (range, 76 - 90) at the most recent follow-up. All patients were satisfied with their clinical results. Relief of pain was excellent in most patients, but postoperatively there was no significant improvement in range of motion. One patient had arthrodesis at three year six months after total ankle arthroplasty due to deep infection. Conclusion: This study shows total ankle arthroplasty is a good alternative treatment in selected cases of osteoarthritis and rheumatoid arthritis.

Purpose: to investigate the etiology and the results of surgical treatment of the symptomatic accessory navicular in adults. Materials and Methods: Between 1996 and 2000, 17 cases in 16 adult patients who were older than 20 years were diagnosed as painful accessory na vicular. 11 patients could recall a twisting injury of the ankle, and 8 of them were inversion sprain. 4 patients had tibialis posterior tendon lesions. 13 feet of 12 patients were treated by resection of accessory navicular, the synchondrosis, the medial portion of the navicular and reattachment of tibialis posterior tendon without transposition. 9 feet in 8 patients were followed for more than one year after surgery. In 4 patients with tibialis posterior tendon lesions, additional procedures were performed according to the state of the lesion. Results: All were type II accessory navicular bone which had synchondroses. There was gross motion of the synchondrosis in 'the operating field in all feet. Of the 9 feet which were followed for more than one year after surgery, results were excellent in five and good in four. Conclusion: The painful accessory navicular in adult might be closely associated with inversion ankle sprain, and also with the tibialis posterior tendon lesions. Satisfactory result could be obtained without transposition of the tibialis posterior tendon to the undersurface of the navicular and immediate postoperative weight bearing does not have harmful effect on the result.

Purpose: The purpose of this study is to report the result of endoscopic assisted curettage and bone graft for the treatment of simple bone cyst in the calcaneus. Materials and Methods: Three cases in three patients who had curettage and bone graft of simple bone cyst in the calcaneus under endoscopic view were prospectively reviewed. A minimum follow-up of 1 year was required for entrance into the study. The results of treatment were clinically and radiologically assessed. Results: One case with preoperative heel pain gained complete relief of the pain at postoperative four weeks. All three cases had radiological union of grafted bone at an average of thirteen weeks after the operation. Shortened hospitalization and decreased postoperative pain were remarkable. Complications such as infection, skin necrosis, nerve injury, and, fracture were not seen. There was no evidence of the recurrence of the cyst in all three cases. Conclusion: Endoscopic assisted curettage and bone graft of simple bone cyst in the calcaneus is thought as an effective alternative procedure avoiding the possible complications of the classic method.

Purpose: We analyzed 35 patients of malignant tumors of the foot and ankle to evaluate clinical manifestation. result of treatment and prognosis. Materials and Methods: Thirty five patients who were histologically confirmed for malignant tumors of the foot and ankle from September 1984 to May 1999 were investigated. Results: There were 16 males and 19 females. with an average age 38.3 years. Ten tumors were originated from bone and 25 from soft tissue; osteosarcoma (8) was the most common bone tumor and synovial sarcoma (8) and malignant melanoma (6) were common in soft tissue tumors. Surgical procedures included; marginal resection (2), limb salvage procedure after wide resection (5) for bone tumors, and amputation (12), wide resection (4), marginal resection (5) for soft tissue tumors. In some cases, perioperative chemotherapy and radiotherapy were given. There were 2 local recurrences and 11 metastases; 5 metastases were found at the time of initial diagnosis. Average follow-up was 3.5 years. Conclusion: We conclude that suspicion and early diagnosis are important in malignant tumors of the foot and ankle, and the resection margin must be obtained more thoroughly during surgery with perioperative adjuvant therapy, if necessary.

We experienced a case of soft tissue osteochondroma in the foot. The 43-years-old male was complained palpable mass and mild pain at the heel for 3 years. The plain radiograpy revealed a bony mass without connection of neighbor bone in the heel. The osteochondroma in the soft tissue is rare benign tumor. The mass was removed en bloc. The gross and histologic findings were consistent with osteochondroma. The differential diagnosis includes myositis ossificans, tumoral calcinosis, synovial chondromatosis, soft tissue osteochondroma, and true osteochondroma which arises from bone. The symptom was improved. After postoperative 1 year, recurrence was not.

Intra-osseous ganglion is an uncommon benign bone tumor caused by an intramedullary metaplastic event. Two cases of the intraosseous ganglion of the foot are presented; one in the metatarsus and the other in the talus. Follow-up averaged 14 months. Satisfactory results were obtained with curettage, cancellous bone graft from the ipsilateral calcaneus. No recurrence and complications occurred during the period of follow-up.

편평족은 내측 세로궁이 소실되어 족저부가 편평하게 되는 변형의 총칭으로, 소아에서 흔하 고 보호자들의 관심이 많은 질환이다. 이학적 검사상 후족부의 외반과 전족부의 외전소견을 보이며, 감별질환을 위해 정확한 이학적 검사와 방사선학적 검사를 필요로 한다. 원인으로는 유연성 편평족, 종골 외반, 선천성 수직 거골, 부주상골, 족근골 결합등이 있으며 정상적 유 아의 경우 시간경과에 따라 저절로 호전되는 유연성 편평족이 대부분이다. 따라서 병적 편평족이 아닌 경우 편평족의 원인과 양호한 자연경과를 보호자에게 설명하는 것이 중요하다. 본 논문에서는 소아 편평족의 감별질환을 위한 각 질환에 있어서의 이학적 소견과 검사소견 그리고 이들의 치료에 대해 살펴 보고자 한다.