• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.162-168
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• 2009

Purpose: To evaluate the efficiency of the minimally invasive percutaneous plate osteosynthesis (MIPPO) with locking compression plate (LCP) for distal tibial metaphyseal intra-articular fracture compared with extra-articular fracture. Materials and Methods: From February 2006 to June 2008, 21 patients with distal tibia metaphyseal intra-articular fracture and 20 patients with extra-articular fracture were treated operatively by MIPPO technique with LCP and followed for at least one year. In the group with intra-articular fracture, mean age was 48.85 years old and a mean follow-up was 15 months. In the other group with extra-articular fracture, mean age was 52.35 years old and a mean follow-up was 14.5 months. The type of fracture was evaluated using the AO/OTA classification and open-fractures were according to the Gustilo-And gron classification. Radiologic evaluation with fracture healing and tibial alignment, clinical evaluation with Olerud and Molander ankle score and restriction of motion were done for treatment. Results: According to AO/OTA classification, There were 21 type A, 15 type B, 5 type C. Average union time of the intra-articular fracture (type B, C) was 18.7 weeks. Average union time of the extra-articular fracture (type A) was 17.1 weeks. All fractures were healed without malunion. There were no difference of mean restriction angle between intra-articular fracture (ankle dorsiflexion was 3.57 degree, plantar-flexion was 5.95 degree) and extra-articular fracture (ankle dorsiflexion was 3 degree, plantar-flexion was 3.75 degree). There were no difference of Olerud and Molander ankle score between them as a mean score of intra-articular and extra-articular was 89.25, 91.25 each other. As a complication, there were 3 case of skin necrosis, 8 case of discomfortable skin tenting by plate and 1 superficial infection, but could be healed by conservative care. Conclusion: MIPPO technique, combined articular reduction, with LCP of distal tibial metaphyseal fracture was a good method with high functional recovery.

• Clinics in Shoulder and Elbow
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• v.20 no.4
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• pp.195-200
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• 2017

Background: This study investigated and evaluated the clinical outcomes of intra-articular lesions of traumatic anterior shoulder dislocation (TASD) associated with greater tuberosity (GT) fracture of the humerus. Methods: Subjects included 20 patients who were surgically or non-surgically treated for GT fracture of the humeurs with TASD, and followed-up for at least 2 years. The mean follow-up period was 54.1 months (range, 24-105 months). Of the 20 patients, 12 were treated surgically. Intra-articular lesions were identified randomly on magnetic resonance imaging scans (repeated thrice) by experienced radiologists and orthopedic surgeons. The accompanying intra-articular lesions were left untreated. Clinical outcomes were evaluated by Simple Shoulder Test (SST) and Western Ontario Shoulder Instability index (WOSI) at the last follow-up. Results: Intra-articular lesions were identified in 19 patients: 7 Bankart lesions, 15 humeral avulsion of the glenohumeral ligament lesions, 3 glenoid avulsion of the glenohumeral ligament lesion, and 6 inferior capsular tears. Two or more intra-articular lesions were identified in 6 patients. The mean SST score was 10.9 and the mean WOSI score was 449.3 at the last follow-up. Conclusions: For GT fracture of the humerus with TASD, a high frequency of diverse intra-articular lesions was identified. There were no incidence of recurrent shoulder dislocations, and good clinical outcomes were obtained without treatment of the intra-articular lesions. We thereby comprehend that although intra-articular lesions may occur in TASD associated with GT fracture of the humeurs, merely treating the GT fracture of the humerus is sufficient.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.85-90
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• 2009

Purpose: Nonunion of intra-articular fractures of calcaneus is rarely reported complication. We present our experiences with 4 patients (5 cases) treated operatively for nonunion after intra-articular fracture of calcaneus. Materials and Methods: 4 patients (5 cases) with nonunion of intra-articular fracture of calcaneus after operative treatment were followed for 4 years (from 2002 to 2006). For assessment, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Visual Analogue Scale (VAS) were assessed for clinical outcome and the union of fracture site, the talocalcaneal height and the angle of talar declination were determined for radiologic outcome. Results: The mean talocalcaneal height was 6.94 cm (range, 5.9${\sim}$7.6 cm) preoperatively and 7.34 cm (range, 6.0${\sim}$8.3 cm) at last follow-up. The mean angle of talar declination was 5.68 degrees (range, 4.6${\sim}$8 degrees) preoperatively and 13.1 degrees (range, 5.7${\sim}$21 degrees) at last follow-up. The mean preoperative AOFAS score and VAS were 20.4 (range, 14${\sim}$36) and 4 (range, 3${\sim}$6), respectively. At last follow-up, these scores improved to a mean of 59.6 (range, 54${\sim}$68) and 3 (range, 2${\sim}$4), respectively. Unions of previous nonunion site of intra-articular fracture of calcaneus were achieved in all 4 patients (5 cases). Conclusion: The reconstructive procedure for nonunion of intra-articular fracture of calcaneus showed good results in terms of bone union, radiologic results and functional improvement than preoperative state. Because the plantar pain for the inferior angular formation in nonunion site may happen, we will pay attention to reduction of fragment.

• Journal of Korean Foot and Ankle Society
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• v.4 no.1
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• pp.35-38
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• 2000

Osteochondral fracture is common in adolescent and usually occurs in the knee and ankle. Many authors have written concerning osteochondral fracture of the ankle joint, however, many of these pertain only to the talus. The author has found an osteochondral fracture of the articular surface of the medial malleolus within the ankle joint not previously described. We report a case of this lesion that was treated by arthroscopic osteochondral fragment removal.

• Journal of Korean Neurosurgical Society
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• v.48 no.5
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• pp.452-454
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• 2010

Traumatic atlantoaxial rotatory fixation (AARF) with accompanying odontoid and C2 articular facet fracture is a very rare injury, and only one such case has been reported in the medical literature. We present here a case of a traumatic AARF associated with an odontoid and comminuted C2 articular facet fracture, and this was treated with skull traction and halo-vest immobilization for 3 months. After removal of the halo-vest immobilization, his neck pain was improved and his neck motion was preserved without any neurologic deficits although mild torticolis was still observed in closer inspection.

• Journal of Korean Foot and Ankle Society
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• v.11 no.2
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• pp.221-225
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• 2007

Purpose: To evaluate the clinical results of operative treatment of the intra-articular calcaneal fracture with injectable calcium sulfate ($MIIG^{TM}$). Materials and Methods: Between March 2004 and October 2006, a total 19 intra-articular calcaneal fracture (16 patients) with a large bony defect that underwent operative treatment with plate fixation and injectable calcium sulfate ($MIIG^{TM}$) with minimum follow-up of one year following. The mean age at time of surgery was 44.7 years (23 to 54). All of the cases were type 2 and 3 on the basis of Sanders classification. The lateral L shaped approach was used in all cases. Full weight bearing on the affected extremity was regained at an average 10 weeks postoperatively. Results: The mean Bohler angle was improved from $2^{\circ}$ ($-18.5{\sim}12.5^{\circ}$) preoperatively to $23.8^{\circ}$ ($12{\sim}37.5^{\circ}$) and the angle at last follow-up was $22.5^{\circ}$ ($11.5{\sim}37.5^{\circ}$), showing about 0.3 degree decline compared to postoperative Bohler angle. Only two case of whitish leakage of graft material but other complication were none. Conclusion: $MIIG^{TM}$ augumentation of displaced intra-articular calcaneal fracture with large bone defect seems to bo useful method for initial stabilized and plate fixation.

• Journal of Korean Foot and Ankle Society
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• v.17 no.3
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• pp.182-188
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• 2013

Purpose: We evaluate clinical manifestations and radiologic features of ankle fracture & dislocation, as well as the usefulness of computed tomography on posterior ankle fracture & dislocation to study factors contributing to ankle fracture & dislocation. Material and Methods: Ankle dislocation was defined as the center of talar body being translated over the cortex of tibia on AP or lateral view on simple X-ray. Surgical treatments of 30 patients from January 2007 to March 2012 were categorized according to the injury mechanism, the direction of dislocation and fracture site. Joint involvement of posterior malleoalr fracture was evaluated through simple x-ray and computed tomography. We treated surgically if posterior malleolus fracture involves more than 25% of dital tibial articular surface. Thereafter, clinical outcomes were identified through radiographs and by using the AOFAS score. Results: The mean age was 42(13-78) years old, and slip down was the most common injury mechanism (13 cases). Car accident (6 cases) and fall accident (4 cases) were the next frequently found injury mechanisms. As for the types of ankle fracture, posterior fracture and dislocation (21 cases, 43.3%) was most commonly found. Out of these 21 cases, 15 cases involved trimalleolar fracture, and 19 cases were associated with posterior malleolar fracture. Danis-weber type B and C patients were 11 cases and 10 cases respectively. Articular involvement of posterior malleolar fracture turned out to be average 27.9%(5.1%~49.1%) on simple x-ray. The rate was evaluated as average 31.7%(12.6%~55.3%) on computed tomography which was conducted 15 times, and led us to more meaningful data. Conclusion: Anterolateral fracture and dislocation often accompanied open dislocation. Posterior fracture dislocation was most commonly found. Posterior malleolus was an important factor that ensures posterior stability of the ankle joint. Computed tomograph is useful to evaluate the articular involvement of posterior malleolar fracture.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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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.

• Journal of Korean Foot and Ankle Society
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• v.19 no.4
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• pp.137-141
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• 2015

Recently, open reduction and internal fixation has been the treatment of choice for displaced intra-articular calcaneal fractures for many orthopaedic surgeons. However controversy still surrounds the optimal treatment with regard to whether displaced intra-articular calcaneal fractures should be treated operatively or conservatively. Conservative treatments include use of splint, rest, leg elevation, icing, use of analgesics and early mobilization. Operative treatment is open reduction and internal fixation, performed through an extensile lateral approach with interfragmentary screws and application of a neutralization plate. We reviewed the question of whether operative treatment by open reduction and internal fixation provides a benefit compared with conservative treatment for displaced intra-articular calcaneal fractures.

• Clinics in Shoulder and Elbow
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• v.22 no.2
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• pp.113-117
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• 2019

Treating distal humerus fractures, especially those involving intra-articular lesions, is complex and often technically demanding. Although there still exist many controversial issues, the goal of treatment is to establish anatomical stable fixation by restoring the two columns and the articular surface. Universally, a posterior midline incision is applied, and the approach varies according to the further management of the triceps or olecranon. Evidence supports dual plate fixation as the optimal fixation method, and debates regarding appropriate plating configuration are still ongoing. As multiple clinical studies comparing results of parallel and perpendicular plate fixation have shown no actual difference, it is important to place the plates according to the fracture configuration.