• 대한족부족관절학회지
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• 제10권2호
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• pp.213-217
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• 2006

Purpose: To evaluate the clinical and radiological results of tibio-talo-calcaneal arthrodesis using ipsilateral distal fibula buttress which had advantages of extended operative field and release of contracted soft tissue. Materials and Methods: We retrospectively reviewed 4 postraumatic compartment syndrome, 2 residual poliomyelitis, 1 posttraumatic osteoarthritis with subtalar joint infection and 1 posttarumatic sciatic nerve palsy patients who underwent a tibio-talo-calcaneal arthrodesis from April, 1996 to March, 2002. Each of the cases was notable for a severe rigid equinovarus, persistent pus drainage of calcaneal area and paralytic foot. The mean duration of follow up was 18 months (range, $13{\sim}42$ months). The pain, function and alignment were evaluated by the modified ankle hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) and patients satisfaction clinically. The radiological union were evaluated by plain AP and lateral radiographs. Results: The AOFAS score improved from 58 points (range, $47{\sim}78$) preoperatively to 82 (range, $60{\sim}89$) postoperatively. Patents satisfaction checked at 12 months after operation had favorable results (excellent and good 80%). Union rate was 100% radiographically and the mean duration of union was 12.5 weeks (range $8{\sim}22$ weeks). There was 2 cases of superficial pin tract infection and one protrusion of screw. Conclusion: Tibio-talo-calcaneal arthrodesis using ipsilateral distal fibula buttress was good modality of arthrodesis which provides wide operative field and release of contracted soft tissue in some cases of contracted foot.

• 대한족부족관절학회지
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• 제14권1호
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• pp.58-65
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• 2010

Purpose: This study was performed to evaluate the clinical outcomes of operative treatment using porous hydroxyapatite for intraarticular calcaneal fracture of joint depression type. Materials and Methods: Twenty patients with intraarticular calcaneal fracture were followed up for more than 1 year. The period to union was calculated to evaluate the osteoconductivity of porous hydroxyapatite used as bone graft substitute. The measurement of Bohler angle, Gissane angle and the degree of articular surface depression was performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). Results: Bohler angle and Gissane angle had improved significantly from preoperative average $10.4^{\circ}$, $117.8^{\circ}$ to average $22.6^{\circ}$, $113.5^{\circ}$ immediate postoperatively, and had maintained to average $21.2^{\circ}$ and $114.4^{\circ}$ at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 4.8 mm to 1.5 mm at the last follow-up. All cases achieved bone union, and the interval to union was average 12.8 weeks. AOFAS score was average 85.2 points at last follow-up. There were 7 excellent, 10 good, and 3 fair results according to the CNHF scale. Therefore, 17 cases (85%) achieved satisfactory results. Conclusion: Plate fixation using porous hydroxyapatite seems to be one of effective treatment methods for intraarticular calcaneal fracture of joint depression type, because of supporting the reduction of subtalar articulation by augmenting bony defect and facilitating bone formation. Further evaluation about long-term radiological changes and histological analysis on hydroxyapatite implantation site should be required.

• 대한족부족관절학회지
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• 제20권3호
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• pp.112-115
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• 2016

Purpose: We aimed to investigate the safety zone for Achilles tendon insertion in the posterior aspect of the calcaneus via the use of magnetic resonance imaging (MRI) when planning for insertional Achilles tendinopathy. Materials and Methods: This study included 95 patients. The MRI of midsagittal plane of the ankle joint was used to measure the proximal and distal insertion point for the Achilles tendon in the posterior aspect of the calcaneus. Patients were divided into three groups according to the proportion of the distal insertion point out of the entire calcaneal length: the proximal, middle, and distal insertion groups. Results: The mean proximal and distal insertion points for the Achilles tendon were measured as 1.05 cm (0~2.11 cm) and 2.36 cm (1.60~2.93 cm), respectively. When the posterior aspect of the calcaneus was used as the reference plane, none of the patients was in the proximal insertion group, while 75 and 20 patients were in the middle and distal insertion groups, respectively. The insertion portion was longer in the distal insertion group ($1.47{\pm}0.25cm$) than in the middle insertion group ($1.27{\pm}0.35cm$). Statistically significant differences with respect to the length of the insertion portion were observed between the two groups (p=0.008). Conclusion: Removal of more than 1 cm below the superior margin of the posterior calcaneus may be dangerous. An MRI study on the Achilles tendon of patients without hindfoot deformity or tendinopathy revealed various insertional characteristics. Preoperative MRI evaluation is safer than relying solely on the simple radiological assessment when planning for insertional Achilles tendinopathy.

• Archives of Reconstructive Microsurgery
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• 제3권1호
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• pp.24-31
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• 1994

저자들은 1980년 1월부터 1993년 5월까지 종골부위의 피부결손이나 또는 골결손을 동반한 연부조직 손상이 있었던 총 22례 환자에 대하여 유리피판술 또는 생골및 생피부편 이식술을 시행하고 최저 1년 이상 추시하여 다음과 다음과 같은 결과를 얻었다. 1. 유리 피부편의 크기는 최저 $7cm{\times}6cm$에서 최대 $28cm{\times}10cm$로 평균 $12.1cm{\times}9.2cm$였고, 유리 골편의 크기는 각각 $4cm{\times}3cm$, $5cm{\times}4cm$였다. 2. 재건술에 이용된 방법으로 유리 피부피판술은 족배 비판 11례, 서혜부 피판 2례, 전완부 피판 2례였고, 유리 피부근피판술은 활배근 피부근피판 3례, 대퇴근막장근 피부근피판 2례였으며, 골결손을 동반한 연부조직 손상인 경우 2례에서 생장골 피부편을 이식하였다. 3. 총 22례중 19례에서 유리편이 생존하여 86.4%의 성공율을 보였으며, 수술후 혈전증 2례와 감염이 발생하였던 1례에서 실패하였다. 이상의 결과로 볼 때, 고식적인 방법으로 치료하기 어려운 발뒤꿈치의 연부조직 또는 골결손의 치료로서 미세수술을 이용한 유리편 재건술이 유용한 방법으로 사료되며, 발뒤꿈치의 감각신경 회복에 대하여는 향후 지속적인 연구가 필요한 것으로 사료된다.

• 대한족부족관절학회지
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• 제7권2호
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• pp.238-249
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• 2003

Purpose: To report the clinical result of the intraarticular calcaneus fracture after open reduction and internal fixation with plate by lateral approach. Materials and Methods: Thirty-six calcaneal fractures of 33 patients(29 men and 4 women) were treated by open reduction and internal fixation using an lateral approach from March, 1997 to May, 2002 and were followed more than one year. The autogenous iliac bone graft was done in 2 cases but the others didn't. Radiographically B?hler angle and Gissane angle on simple lateral radiograph were measured and in the 15 cases, the step-off(gap) of posterior facet joint on post-operative CT images were followed. The Salama method was used for evaluation of clinical results. Results: According to Sanders classification, 19 cases of the 36 cases were classified as type II. Type III fracture were found in 12 cases and type IV in 5 cases. The following results were obtained: twenty-two cases(61.1%) out of 36 cases were estimated as good or excellent. The good results or more were obtained in 15 cases(78.9%) in type II and 7 cases(58.3%) in type ill, but no case in type IV. B?hler angles were improved from preoperative average 1.6?to postoperative average 23.4?, Gissane angle was improved from preoperative 107.2?to postoperative 122.8?, respectively. Among 36 cases, Computed tomography was carried out in 15 cases. The postoperative step-off (gap) of posterior facet joint on computed tomography was filled with cancellous bone. Satifactory results was obtained in 7 cases with 2mm gap or less and in 6 cases of 2-5mm. There were no satifactory results in 2 cases with 5mm gap or more. Conclusion: Open reduction and internal fixation for intra-articular fracture of calcaneus was thought to be a good treatment modality. It is thought that the lateral approach is one of the good one for surgical treatment, and that accurate reduction of the posterior facet, acceptable recovery of B?hler angle are more important to obtain best results.

• 대한족부족관절학회지
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• 제16권4호
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• pp.247-256
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• 2012

Purpose: This study was performed to evaluate the clinical outcomes of operative treatment using mini-open sinus tarsi approach for displaced intraarticular calcaneal fractures. Materials and Methods: We studied 18 cases (16 patients) of intraarticular calcaneal fractures who were treated with sinus tarsi approach by same surgeon. The mean age of patients was 44.8 years, and mean follow-up period was 17.2 months. The measurement of B$\ddot{o}$hler angle, Gissane angle, the degree of articular surface depression, and the period to union were performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). Results: B$\ddot{o}$hler angle and Gissane angle had improved significantly from preoperative average $9.8^{\circ}$, $117.6^{\circ}$to average $22.4^{\circ}$, $113.4^{\circ}$ immediate postoperatively, and had maintained to average $21.8^{\circ}$and $114.2^{\circ}$ at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 5.2 mm to 1.2 mm at the last follow-up. All cases achieved bone union, and the period to union was average 10.5 weeks. AOFAS score was average 86.2 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the CNHF scale. Therefore, 16 cases (88.8%) achieved satisfactory results. Conclusion: The minimally invasive sinus tarsi approach using headless compression screw seems to be an effective surgical method for displaced intraarticular calcaneal fractures, because of the possibility of accurate restoration of articular surface and the low risk of postoperative soft tissue complications.

• 대한족부족관절학회지
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• 제16권4호
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• pp.229-234
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• 2012

Purpose: The purpose of this study is to find out clinical and radiological outcomes in 70 patients of both calcaneal fracture. Materials and Methods: From March 1993 to March 2011, 70 patients underwent non-operative management or operative management at our hospital. Conservative management was performed in 15 cases of undisplaced fracture (Group A). Operative management was performed in 125 cases including 32 cases of undisplaced fracture (Group B), 60 cases of joint depression type fracture (Group C), 33 cases of tongue type fracture (Group D). Results were evaluated by VAS score, AOFAS score, circle draw test, Bohler angle (BA), Gissane angle, width & height of calcaneus. Results: VAS scores were 2.0 in group A, 2.0 in group B, 2.2 in group C, 2.7 in group D. AOFAS scores were 90.4 in group A, 91.9 in group B, 72.2 in group C, 79.2 in group D. Circle draw tests were 8.4 cm in group A, 10.1 cm in group B, 7.6 cm in group C, 7.9 cm in group D. Bohler angles (BA) and Gissane angles were $19.1^{\circ}$, $96.7^{\circ}$ in group A, $21.8^{\circ}$, $119.1^{\circ}$ in group B, $26.3^{\circ}$, $121.2^{\circ}$ in group C, $19.7^{\circ}$, $119.7^{\circ}$ in group D. Calcaneal widths and heights were 39.5 mm, 31.6 mm in group A, 32.7 mm, 37.0 mm in group B, 34.4 mm, 39.2 mm in group C, 35.2 mm, 38.7 mm in group D. Conclusion: The main cause of bilateral calcaneal fracture is an injury from a fall, and the cases were more frequently occurred in men than women. Also the fracture in the right side tend to occur more severely compared to the left side. The surgical treatment shows better results than conservative treatment in bilateral calcaneal fracture.

• 대한족부족관절학회지
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• 제19권1호
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• pp.11-17
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• 2015

Purpose: To report the radiographic and clinical results of 6.5 mm cancellous full threaded buttress screw or Steinmann pin fixation to maintain a reduction of calcaneal posterior facet depression fracture. Materials and Methods: From June 2009 to June 2012, 50 consecutive cases with calcaneal joint depression fracture that underwent open reduction and screw or pin fixation were enrolled in this study. A 6.5 mm cancellous full threaded screw was inserted from the posteroinferior aspect of the calcaneal tuberosity to the posterior facet (group A) or Steinman pin was inserted from the posterosuperior aspect of the calcaneal tuberosity to the calcaneocuboidal joint (group B). Both preoperative and postoperative Bohler and Gissane angles were measured radiographically, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale on the final follow-up were assessed. Results: The mean age of patients was 44.1 years, and the mean follow-up period was 27.2 months. According to the Sanders classification, 28 cases were type II and 22 cases were type III. In Sanders type II, Bohler and Gissane angles improved significantly from $10.1^{\circ}$ and $126.2^{\circ}$ preoperatively to $27.2^{\circ}$ and $117.1^{\circ}$, respectively, in the immediate postoperative radiograph, and at the final follow-up, $26.6^{\circ}$ and $118.6^{\circ}$, respectively. In Sanders type III, Bohler and Gissane angles improved significantly from $5.0^{\circ}$ and $129.8^{\circ}$ to $29.9^{\circ}$ and $119.3^{\circ}$, respectively, in the immediate postoperative radiograph, and $26.9^{\circ}$ and $120.2^{\circ}$ at the final follow-up. All cases achieved bony union, and the average period until complete union was 13.3 weeks. AOFAS ankle-hindfoot scale was 82.6 in Sanders type II and 77.3 in Sanders type III at the final follow-up. Conclusion: A 6.5 mm cancellous full threaded buttress screw or Steinman pin fixation is a noninvasive treatment method with a merit of being able to maintain the bearing capacity of the posterior facet comparable to plate fixation.

• 대한족부족관절학회지
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• 제2권1호
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• pp.19-29
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• 1998

The characteristics of the patients after the calcaneal fracture that were associated with an unsatisfactory outcome were subtalar incongruity, decreased Bohler angle ratio of the fractured to the normal side, an age of more than fifty years, work involving strenuous labor, and increased time missed from work due to the injury. The purpose of this study was to examine the reliability of measurements of the range of motion of the subtalar joint. To determine reliability, evaluates of the correlatioinship between the degree of the displacement of the subtalar joint and Circle draw test after the calcaneal fracture. Fifty patients who had had fifty five calcaneal fractures were managed with open reduction and internal fixation. The results were reviewed retrospectively, between 4months and three years after the operation, with use of an evaluation system for the subtalar joint and with plain radiographs. At follow up evaluation, the result was assessed on the basis of restoration of anatomy and function of the subtalar joint. We evaluated the subtalar joint with plain films that consist of anteroposterior projection, lateral projection, calcaneal axial view, and Broden's view, and the measurements of the displacement of the subtalar joint surface after the calcaneal fracture. And we evaluated the range of motion of the subtalar joint with Circle draw test for physical evaluation. Circle draw test was evaluated and demonstrated the motion of flexion-supination-adduction and extension-pronation-abduction of the subtalar joint. And there are correlationship between the degree of the displacement and range of motion of the subtalar joint after the calcaneal fracture. The report critically reviews methords used to measure Circle draw test for physical examination of the follow up after the calcaneal fracture.

• 대한족부족관절학회지
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• 제18권4호
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• pp.165-172
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• 2014

Purpose: We evaluated the correlation of postoperative clinical outcomes and radiologic findings using computed tomography and simple X-ray in intra-articular calcaneal fractures. Materials and Methods: The current study is based on 41 feet, 38 patients with displaced intra-articular fracture who underwent surgical treatment with at least one year of follow-up. Evaluation of clinical outcome included American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, and subjective satisfaction. A simple X-ray was used in evaluation of preoperative and postoperative Gissane angle, B${\ddot{O}}$hler angle, and calcaneal fracture width. Computed tomography scan was performed for evaluation of preoperative and postoperative articular step-off and articular gap in all cases. Finally, we evaluated the correlation of the postoperative clinical outcomes and radiologic findings based on the measurement. Results: The average postoperative AOFAS score and VAS score was $84.1{\pm}8.5$ and $2.2{\pm}2.2$. Subjective satisfaction was excellent in 15 cases, good in 19 cases, and fair in seven cases. The average B${\ddot{O}}$hler angle was restored from $11.1^{\circ}$ to $24.7^{\circ}$(p<0.05), Gissane angle was changed from $121.0^{\circ}$ to $119.0^{\circ}$ (p>0.05), and the average width was restored from 45.8 to 35.0 mm (p<0.05). The average articular step-off and gap were decreased from 6.3 to 2.0 mm and from 11.1 to 4.6 mm, respectively (p<0.05). No significant correlations were observed between the clinical outcome and Gissane angle, B${\ddot{O}}$hler angle, and width, and there was no significant correlation between the clinical outcome and Sanders classification. However, postoperative articular step-off showed correlation with VAS and AOFAS score and articular gap showed correlation with VAS score. Conclusion: The clinical outcome did not show correlation with B${\ddot{O}}$hler angle and Gissane angle but did show correlation with anatomical reduction of the posterior facet joint.