• Journal of Biomedical Engineering Research
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• v.32 no.2
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• pp.165-176
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• 2011

The femoral nerve innervates the quadriceps muscles and its dermatome supplies anteromedial thigh and medial foot. Paralysis of the quadriceps muscles due to the injury of the femoral nerve results in disability of the knee joint extension and loss of sensory of the thigh. A child could walk independently even though he had injured his femoral nerve severely due to the penetrating wound in the medial thigh. We measured and analyzed his gait performance in order to find the mechanisms that enabled him to walk independently. The child was eleven-year-old boy and he could not extend his knee voluntarily at all during a month after the injury. His gait analysis was performed five times (GA1~GA5) for sixteen months. His temporal-spatial parameters were not significantly different after the GA2 or GA3 test, and significant asymmetry was not observed except the single support time in GA1 results. The Lower limb joint angles in affected side had large differences in GA1 compared with the normal normative patterns. There were little knee joint flexion and extension motion during the stance phase in GA1 The maximum ankle plantar/dorsi flexion angles and the maximum knee extension angles were different from the normal values in the sound side. Asymmetries of the joint angles were analyzed by using the peak values. Significant asymmetries were found in GA1with seven parameters (ankle: peak planter flexion angle in stance phase, range of motion; ROM, knee: peak flexion angles during both stance and swing phase, ROM, hip: peak extension angle, ROM) while only two parameters (maximum hip extension angle and ROM of hip joint) had significant differences in GA5. The mid-stance valleys were not observed in both right and left sides of vertical ground reaction force (GRF) in the GA1, GA2. The loading response peak was far larger than the terminal stance peak of vertical ground reaction curve in the affected side of the GA3, GA4, GA5. The measured joint moment curves of the GA1, GA2, GA3 had large deviations and all of kinetic results had differences with the normal patterns. EMG signals described an absence of the rectus femoris muscle activity in the GA1 and GA2 (affected side). The EMG signals were detected in the GA3 and GA4 but their patterns were not normal yet, then their normal patterns were detected in the GA5. Through these following gait analysis of a child who had selective injuries on the knee extensor muscles, we could verify the actual functions of the knee extensor muscles during gait, and we also could observe his recovery and asymmetry with quantitative data during his rehabilitation.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.253-260
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• 2020

Purpose: Soft tissue defects of the distal lower extremity are commonly accompanied by a fracture of the lower extremities. Theses defects are caused by the injury itself or by complications associated with surgical treatment of the fracture, which poses challenging problem. The reverse superficial sural artery flap (RSSAF) is a popular option for these difficult wounds. This paper reviews these cases and reports the clinical results. Materials and Methods: Between August 2003 and April 2018, patients who were treated with RSSAF for soft tissue defects of the lower third of the leg and ankle related to a fracture were reviewed. A total of 16 patients were involved and the mean follow-up period was 18 months. Eight cases (50.0%) of the defects were due to an open fracture, whereas the other eight cases (50.0%) were postoperative complication after closed fracture. The largest flap measured 10×15 cm² and the mean size of the donor sites was 51.9 cm². The flap survival and postoperative complications were evaluated. Results: All flaps survived without complete necrosis or failure. One case with partial necrosis of the flap was encountered, but the wound healed after debridement and repair. One case had a hematoma with a pseudoaneurysmal rupture of the distal tibial artery. On the other hand, the flap was intact and the wound healed after arterial ligation and flap advancement. A debulking operation was performed on three cases for cosmetic reasons and implant removal through the flap was performed in three cases. No flap necrosis was encountered after these additional operations. Conclusion: RSSAF is a relatively simple and safe procedure for reconstructing soft tissue defects following a fracture of the lower extremity that does not require microsurgical anastomosis. This can be a useful treatment option for soft tissue defects on the distal leg, ankle, and foot.

• Journal of the Korean Orthopaedic Association
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• v.56 no.6
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• pp.484-490
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• 2021

Purpose: A rheumatoid forefoot deformity includes severe hallux valgus and claw toe of the four lateral toes. The authors intended to analyze the mid-term results of the modified Hoffman procedure for a rheumatoid forefoot deformity. Materials and Methods: Twenty-two feet of eighteen patients were followed up for more than two years after the modified Hoffman procedure. The mean age was 54.7 years, and the mean follow-up period was three years and four months. Clinically visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) MP-IP score were analyzed preoperatively and postoperatively. The postoperative complications, the satisfaction of patients, and the presence of plantar callosity were also analyzed. Radiographically, the hallux valgus angle, the 1st intermetatarsal angle, the 1st interphalangeal angle, the 1st interphalangeal joint arthritic change after the operation, and the dorsiflexion angle and the time to union of the 1st metatarsophalangeal joint were analyzed. Results: Clinically, the VAS and AOFAS score were respectively improved from 7.1 points and 30.3 points preoperatively to 1.5 points and 83.1 points postoperatively (p<0.001). All patients were satisfied with the results. Plantar callosity disappeared in all cases. Radiographically, the mean hallux valgus angle, the 1st intermetatarsal angle, and the 1st interphalangeal angle changed from 52.8°, 13.3°, and 7.5° preoperatively to 16.2°, 8.7°, and 14.6° postoperatively (p<0.001). The mean dorsiflexion angle of the 1st metatarsophalangeal joint was 17.2° postoperatively. The mean time to radiographic union of the 1st metatarsophalangeal joint was 11.1 weeks. There were two cock-up deformities of the lesser toe, one wound problem, and two hallux interphalangeal joint arthritis as a complication. There were no cases of nonunion of the 1st metatarsophalangeal joint. Conclusion: The modified Hoffman procedure appears to be a safe and satisfactory procedure for a rheumatoid forefoot deformity.

• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.157-163
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• 2019

Purpose: To investigate the incidence and associated factors of delirium after orthopedic surgery. Materials and Methods: A total of 2,122 cases, who were older than 20 years and underwent orthopedic surgery at a single medical center during a one year period were included. Among them, 132 patients who were diagnosed with delirium after surgery under the Diagnostic and Statistical Manual of Mental Disorders-V criteria and medicated under the consultation of a psychiatrist were included in the study The differences in the incidence of delirium and several affecting factors were analyzed. Results: The overall incidence of delirium after surgery was 6.2% (132 in 2,122 cases). The mean age of the delirium group was 77.4 years (range, 54-92 years), which was higher than that of the non-delirium group (58.1 years). The percentage of women in the delirium group was 63.6% (84 in 132 cases), which was higher than that of the women in the non-delirium group (49.0%). The incidence of delirium after surgery was 9.3% (85 in 916 cases) due to trauma and 3.9% (47 in 1206 cases) due to disease. The incidence of postoperative delirium according to the surgical region was 29.2% (7 in 24 cases) in two or more regions, 13.7% (72 in 526 cases) in the hip, and 9.6% (14 in 146 cases) in the spine, 3.5% (20 in 577 cases) in the knee-lower leg, 2.5% (5 in 199 cases) in the foot-ankle, 2.4% (11 in 457 cases) in the shoulder-elbow, and 1.6% (3 in 189 cases) in the forearm-wrist-hand. Delirium occurred more rapidly in women and surgery due to disease, and the duration of delirium was longer in patients with dementia and major depressive disorders. Conclusion: The incidence of postoperative delirium was high in cases of surgery due to trauma and in cases of surgery in two or more sites. The incidence of postoperative delirium according to a single surgical region was higher in the order of the hip, spine, and knee. Active intervention is needed regarding the correctable risk factor.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.141-147
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• 2005

Purpose: The most important thing in curing Malignant melanoma is surgical excision, operating method is wide excision. The author et al. studied 5-year survival rate of each stage and appropriate surgical margin after operating wide excision and immuno-chemotherapy. Materials and methods: From March 1995 to August 2003, wide excision and immunochemotherapy were operated to 35 patients (17 males and 18 females) who were diagnosed as malignant melanoma and followed up. Excision was done around 2 cm from edge of tumor regardless of the size or effected degree of the skin, and flap or full thickness skin graft was used for skin deficit that was not covered after excision. As for immuno-chemotherapy, method that prescribes 400 mg of dacarbazine (DTIC) and 3 million IU of interferone-${\alpha}$ in combination was used. Immuno-chemotherapy was operated to patients in over stage III. We used AJCC stage that was revised in 2002. Local recurrence, local metastasis and distant metastasis were investigated for these patients as well as the 5-year survival rate of each stage. Results: Most frequently 15 cases(42.8%) occurred in foot, 5 cases(14.2%) occured in ankle, 2 cases(5.7%) in leg, 2 cases(5.7%) in thigh and 5 cases(14.2%) in hand. The incidence of each stage were 8 cases(22.8%) in IA, 9 cases(25.7 %) in IB, 4 cases(11.4%) in IIA, 2 cases(5.7%) in IIB, 1 cases(2.8%) in IIIA, 2 cases(5.7%) in IIIB, 2 cases(5.7%) in IIIC and 7 cases(20.0%) in stage IV. 5-year survival rate of each stage were 94.1% in stage I, 66.8% in stage II, 40% in stage III and 14.3% in stage IV. Conclusion: 5-year survival rate of stage IV was low in malignant melanoma. In treatment of malignant melanoma, staging before operation is important as operation methods are different from each stage. We recommend wide excision which remove around 1~3 cm from margin of tumor up to each thickness.

• Childhood Kidney Diseases
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• v.7 no.2
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• pp.166-173
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• 2003

Purpose : The cause and pathogenesis of $Henoch-Sch\"{o}nlein$ purpura has been studied for many years but the results are disappointing. Recently the hypothesis that abnormalities involving the glycosylation of the hinge region of immunoglobulin Al(IgAl) may have an important role in the pathogenesis of $Henoch-Sch\"{o}nlein$ purpura is being approved. $Henoch-Sch\"{o}nlein$ purpura is the most common vasculitis Ihat affects children and the prognosis is good. But if kidney invovement occurs, the course may be chronic and troublesome. So we evaluated children with $Henoch-Sch\"{o}nlein$ purpura especially from the point of epidemiology and clinical manifestations. Methods : Investigation of 124 children who were diagnosed with $Henoch-Sch\"{o}nlein$ purpura at Inje University Ilsan Paik Hospital from December 1999 to July 2003 was performed retrospectively through chart review. Efforts were made to get informations about the profile, epidemiology, clinical manifestations, progress of the disease and recurrence rate of patients. Results : The patients were 69 boys and 55 girls, with a mean age of $6.1{\pm}2.7$ years at the time of data collection. The male to female ratio was 1.25 : 1. The occurrence rate was much higher in autumn(from September to November, 31.5%) and winter(from December to February, 28.2%) than in spring and summer, with a peak in November. Joint involvement was shown in 66.9% of patients mostly on the foot/ankle(75.9%), knee(39.8%). Seventy(56.5%) out of 124 patients had abdominal pain and 10 patients(8.1%) showed bloody stools. Renal involvement was observed in 24 patients(19.4%) after 21.1 days on the average. IgA was elevated in 10 of 21 patients(47.6%). $C_3$ and $C_4$ levels were normal in 40 of 49 patients (81.7%) and 47 of 48 patients(97.9%), respectively Antistreptolysin-O(ASO) titer was elevated over 250 Todd units in 29 of 62 Patients(46.8%). Mycoplasma antibody titer was elevated in 21 of 49 patients(42.9%) equal or greater than 1:80. Radiologic studies were peformed in 23 patients. Seven patients(30.4%) showed bowel wall thickening and one of them received intestinal resection and anastomosis operation due to terminal ileum necrosis. Eighty four patients took steroid 1.4 mg/kg/day in average. Recurrence rate was 2.5 in 37 patients(29.8%). Conclusion : $Henoch-Sch\"{o}nlein$ purpura in childhood appears most in about 6 years of age. The occurrence rate is much higher in autumn and winter relatively. Diagnosis can be made through the perspective history taking and the inspection of clinical manifestations, but the laboratory findings are not of great help. A small portion of the patients might show abdominal pain or arthritis before purpura develops, therfore various diagnosis can be made. Radiologic evaluation should be performed to avoid surgical complications in cases accompanying abdominal pain, and long term follow up should be needed especially in patients suffering from kidney involvement. In about 30% of the patients $Henoch-Sch\"{o}nlein$ purpura would recur. Steroid can be used safely without side effects.