• Journal of Korean Foot and Ankle Society
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• v.20 no.4
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• pp.170-175
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• 2016

Purpose: The aim of this study is to evaluate the effectiveness of surgical treatment in adolescent patients suffering from navicular stress fracture. Materials and Methods: A total of 11 adolescent patients aged 14 to 19, who underwent an operation for navicular stress fracture between 2005 and 2008 were recruited. Clinical outcomes were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) score. Results: The mean VAS score before the operation was 7.7. A score of 2.9 was confirmed at final follow up after the operation. The mean final follow-up period was 22.1 months. There was a statistically significant improvement in the VAS score between before and after the operation (p=0.01), and similarly, the AOFAS score also showed an improvement, from 46.5 to 80.7 (p=0.01). The pain that remained after the operation, according to the VAS score, was severe in three patients (27.3%), tolerable in seven patients (63.6%), and free of pain in one patient (9.1%). Conclusion: In navicular stress fracture in adolescents, careful selection of patients who could benefit from surgical treatment is recommended.

• Journal of Korean Foot and Ankle Society
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• v.18 no.2
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• pp.68-71
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• 2014

Purpose: The purpose of this study is to report the results of culture test at the time of removal of metal devices used for management of ankle fractures and for analysis of contributing factors. Materials and Methods: We reviewed medical records of 132 patients with lower tibia and ankle fracture who had their metal devices removed during the period from January 2010 to February 2014. Patients with clinical signs of infection were excluded. Culture test was performed by taking the granulation tissue around the metal device at the time of removal. We divided the subjects into two groups, culture positive and negative. We then performed a retrospective review of each medical record of multiple factors that might contribute to the culture results, including laboratory results, medical history, material and size of metal device, indwelling period, and whether or not it was open injury. Results: Among 132 cases, six were culture positive. Enterococcus was detected in two cases and the others were Staphylococcus. No significant difference in medical history of patients and laboratory results, including C-reactive protein level, was observed between the culture positive and negative group. Culture positive rate was 5.4% in titanium and 3.9% in stainless steel. In terms of metal size, culture positive rate was 5.1% in small plates, 6.7% in large plates, and culture negative in intramedullary nails. The average indwelling period of metal device was 61.5 weeks in the culture positive group, and 68.6 weeks in the negative group. Nine cases were open fractures and all were in the culture negative group. Conclusion: Whether or not the culture result was positive, there were no meaningful contributing factors. Presence of bacterium on the metal device could not be screened by any laboratory results or other factors.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.156-162
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• 2008

Purpose: Open fractures of the foot and ankle require prompt repair of the wound due to the complexity of anatomy, insufficiency of soft tissues and inadequate blood supply. Early flaps and skin grafts are used for this purpose yet general condition of the patient as well as local wound environment often precludes such treatment options. Vacuum- Assisted Closure (VAC) is recently being used in such cases. This study was done to validate the use of VAC together with silver antimicrobial dressing materials in contaminated open fracture wounds. Materials and Methods: We have selected 10 patients with Gustillo-Anderson type III open fractures of the foot & ankle treated with VAC and silver antimicrobial dressing materials from March 2007 to January 2008. The relationship between duration of treatment with wound size, contamination, and degree of soft tissue damage was analyzed. Results: The average age of patients was 36.6 years. The average amount of VAC application time was 23.4 days. Silver dressing materials were used for 16.8 days. Average wound healing time was 51.9 days. Statistically significant relationship was found between wound size, VAC application time and silver dressing material application time. No complications such as osteomyelitis were found after treatment. Conclusion: VAC technique is recently being used in open fractures with wide skin and soft tissue defects, producing good results. A wide array of dressing materials such as silver dressing is in development. We have incorporated the VAC technique together with silver dressing materials in the treatment of open fractures and achieved complication free results.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.45-50
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• 2007

Purpose: To evaluate the short-term clinical outcomes of total ankle arthroplasty for the post-traumatic osteoarthritis. Materials and Methods: Fourteen patients who had undergone total ankle arthroplasty from February 2005 to June 2006 were reviewed. Eleven patients were male and three patients were female. The mean age was 52.8 years (range, 33 to 69 years). The mean follow-up duration was 15.9 months (range, 12 to 24 months). Primary injuries were pilon fractures in eight cases, malleolar fractures in three, ankle syndesmotic injury in one, talus fracture and dislocation in one, and distal tibial physeal injury in one. Visual analogue scale (VAS), Range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and complications were evaluated. Results: The mean VAS improved from 8.6 preoperatively to 2.6 at last follow-up. The mean ROM improved from 24.6 degrees preoperatively to 33.1 degrees postoperatively. The mean AOFAS score improved from 44.5 points preoperatively to 75.1 points postoperatively. Radiographically, all components were stable, but there were component malpositions in two cases, including one varus malposition of tibial component and one increased anterior translation of talar component. Complications were deep infection in one case, intraoperative malleolar fracture in three, marginal wound necrosis in two, and heterotopic ossification in one. One prosthesis was revised because of deep infection. Conclusion: Total ankle arthroplasty for the post-traumatic osteoarthritis is believed to be an useful method for preservation of the motion, relief of the pain and high satisfaction of patients in short-term results.

• Journal of Korean Foot and Ankle Society
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• v.15 no.2
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• pp.102-106
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• 2011

Recently, development and improvement in joint replacement therapy, the need for arthrodesis has been decreasing. However, result of joint replacement is not always satisfactory, and most cases are rather indicative to ankle arthrodesis than ankle replacement. Often, ankle arthrodesis can be more beneficial salvage method to treat cases with failure in joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation. In cases with large bone defect that need to be treated with ankle arthrodesis using internal fixation, it is difficult to fill the defect with conventional auto-iliac bone or all-bone graft. Thus, we make a report on our experience in treating 2 cases with ankle arthrodesis using auto-fibular bone graft and plate fixation.

• Journal of the Korean Orthopaedic Association
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• v.56 no.4
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• pp.334-340
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• 2021

Purpose: This study analyzed the bone mineral densities of the lumbar vertebrae and femurs of patients with ankle fractures to determine the correlation between ankle fractures and osteoporosis. Materials and Methods: From April 2002 to July 2014, one hundred consecutive ankle fracture patients with bone mineral density tests performed within post-traumatic one year were enrolled. The patients were divided into three age groups according to their age at the time of injury (group 1: <50, group 2: 50-69, group 3: ≥70). The types of ankle fractures were classified into unimalleolar, bimalleolar and trimalleolar fractures. The bone mineral density was analyzed using the T score, Z score, absolute value (g/cm²) of the lumbar spine (L1-L4), femur neck, femur intertrochanter, and total femur. Results: There were 3.2 times more females with ankle fractures than males, and the prevalence of osteoporosis according to age group was 0% in the group under 50 years, 24.2% in the 50 to 69-year-old group, and 15% in the group over 70 years. Osteoporosis was found in 30% of patients with a trimalleolar fracture in the 50 to 69-year-old group. In all patient groups, a lower age indicated a higher frequency of unimalleolar fractures. The relationship between the bone mineral density and the type of fracture is that the frequency of trimalleolar fracture increased with decreasing T score of the lumbar vertebrae and the absolute value of bone mineral density (g/cm²) and the Z score of the femur neck, but there were no other indicators. Conclusion: Among the 100 patients with ankle fractures, females were more common than males, because osteoporosis was less severe in males. The incidence of unimalleolar fracture was higher than that of trimalleolar fracture. On the other hand, the correlation between the ankle fractures and the bone mineral density of the femur and lumbar spine was not significant.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.118-123
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• 2009

Purpose: We wanted to evaluate the relating factors for deformities of the foot after tibial fracture and the outcome of respective surgical treatment. Materials and Methods: We studied thirty-two patients (thirty-five feet) who had foot deformities after tibia fracture. The age, gender, shape, location, concurrent soft tissue injury and operative treatment of tibial fracture were analysed and outcome of the surgical treatment was investigated. Results: Deformities of the foot mostly occurred in open fractures of Gustilo type 3 or closed fracture with severe soft tissue injury. Variable surgical treatments such as simple release, lengthening, Z-plasty and osteotomy were performed. The AOFAS ankle-hind foot scale was improved from average of 37.3 points preoperatively to an average of 77.2 points at the last follow up. The Maryland foot score was from 42.9 to 90.2 and AOFAS Lesser Toe Metatarso-phalangeal interphalangeal scale was from 42.9 to 90.5. Radiological correction was also improved from 21.9 degrees to 7.9 degrees (Meary angle), from 112.2 to 138.5 (Hibb's angle) and from 33.8 to 25.9 (Calcaneal pitch). Conclusion: We proposed that great care should be taken of treatment for the tibial fracture and early detection and proper management of the foot deformities are crucial.

• Journal of Korean Foot and Ankle Society
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• v.18 no.1
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• pp.24-28
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• 2014

Purpose: The purpose of this study is to evaluate the clinical and radiographic results of internal fixation using multiple Kirschner wires (K-wires) for the fifth metatarsal base fracture. Materials and Methods: We retrospectively reviewed 14 patients with a displaced fifth metatarsal base fracture. We measured the distance of fracture displacement on the foot oblique radiograph pre- and post-operatively. We evaluated the clinical results using the visual analog pain scale at six weeks and three months postoperatively and the American Orthopaedic Foot and Ankle Society (AOFAS) mid-foot score at six months postoperatively. Results: In our series, 10 cases were zone I fracture and four cases were zone II fracture. We achieved anatomical reduction and bony union in all of our cases. The average time to bone union was 43 days. The degree of pain around the fifth metatarsal base was significantly decreased after surgery. The average AOFAS score was 95 at six months postoperatively. Conclusion: Multiple K-wire fixation is a relatively simple fixation method for displaced fifth metatarsal base fractures. If we place a K-wire into the medial cortex of the fifth metatarsal, we could prevent proximal migration of the K-wire.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.106-108
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• 2009

Calcaneus fracture with a subtalar dislocation are extremely rare. A case of a joint depression type calcaneus fracture with a lateral dislocation of the calcaneal posterior facet and tuberosity is presented. We treated it with open reduction and internal fixation with Steinmann pins and K-wires through limited posterior approach and obtained satisfactory radiographic and clinical outcome.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.99-104
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• 2005

Purpose: The purpose of this study was to investigate usefulness of locking compression plate (LCP) as an open reduction technique by evaluating clinical results obtained from the patients with lateral malleolar fracture treated by internal fixation using LCP after open reduction. Materials and Methods: Among the patients with lateral malleolar fracture, the 28 patients who were treated by internal fixation using Locking compression plate after an open reduction and were able to be followed up for more than 6 months were included in this study. Final postoperative evaluation was done based on the Meyer's clinical and radiologic evaluation system. Results: All cases achieved anatomical reduction and fixation of the reduction postoperatively. 28 minutes were taken meaningly from the incision to the fixation of LCP plate after the anatomical reduction. Everage bony union time was 8.2 weaks, and the result was excellent in 23 cases (82%), good in 5 cases (17%) and poor result was abscent according to the criteria of Meyer et al. One case of post traumatic arthritis and one case of superficial infection on the operation site were found, but non-union, delayed union and malunion were not occurred. Conclusion: The internal fixation after open reduction using LCP is an effective treatment method in treating lateral malleolar fracture of the ankle since it offers advantages including easy application and a greater stability due to its capability of maintaining exact anatomical reduction even though the screw does not penetrate the medial cortex of fibular to add the stability and rigidity of the fixation.