• Journal of Trauma and Injury
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• v.26 no.3
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• pp.163-169
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• 2013

Purpose: This study was conducted to confirm the anatomic conformity of the new periarticular locking plates designed by Zimmer on Korean adult bones and to identify the structures at risk during the application of these implants. Methods: The study was performed on the humerus, radius, and tibia of 10 adult cadavers(6 males and 4 females) procured from the cadaveric lab of our hospital. Anteroposterior (AP) and lateral X-rays were taken to confirm that the cadavers were free of any unusual lesions or anatomic variations. We used the 3.5-mm proximal humerus plate, 2.7-mm distal radius plate, 3.5- and 5.0-mm proximal tibia plates, and 3.5-mm distal tibia plate developed by Zimmer, Inc. (Zimmer periarticular locking plate). The longest plate from each group was used to confirm anatomical conformity. Standard approaches were used for each area, and soft tissue was retracted in order to pass the plate beneath the muscle. The position of the plate was confirmed using standard AP and lateral view X-rays. After this procedure had been completed, the region was dissected along the length of the implant to determine the conformity of the implant to bone and the penetrations of screws into the articular surface or violations of any vital structures, such as nerves, blood vessels, or tendons. Results: Excellent anatomical conformity was observed with Zimmer periarticular locking plates for Korean adults. The tibial nerve and the posterior tibial artery were found to be structures at risk when applying a distal tibial plate. Conclusion: Additional posterolateral fixation is recommended when dealing with cases of tibial plateau fracture when the fracture line extends to the posterolateral cortex. We recommend taking proper views using 10~15 degrees of internal rotation to ensure correct screw length and, thus, avoid penetration of vital structures and tendons.

• 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.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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• pp.1-6
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• 1995

Giant cell tumors are primary bone tumors originating from non-osteoblastic connective tissue. The sites of involvement were commonly distal femur, proximal tibia, proximal humerus, distal radius and others (including os calcis, ilium and sacrum). Giant cell tumor located around knee joint has been difficult to treat because of local recurrence following curettage with or without bone graft. Although primary resections reduce recurrence of the lesion, the joint function will be markedly impaired. Marginal excision was very often complicated by a loss of joint integrity since all the giant cell tumors occupy juxtaarticular positions. Techniques involving physical adjuncts(high speed burr and electric cauterization) have been used in the hope of decreasing the rate of local recurrence and avoiding the morbidity of primary resection. A meticulous clinical, radiological and histological evaluation is needed to choose the correct treatment, keeping in mind the possibility of recurrence after each treatment modality.

• Journal of Korean Foot and Ankle Society
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• v.24 no.1
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• pp.19-24
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• 2020

Purpose: Anterolateral minimally invasive plate osteosynthesis (MIPO) was performed to treat patients with distal tibial fractures associated with open fractures or extensive soft tissue injuries, which is limited medial MIPO. The treatment results of the anterolateral MIPO technique were evaluated and analyzed. Materials and Methods: Seventeen patients with distal tibial fractures associated with an open fracture or large bullae formation on the distal tibia medial side were treated with anterolateral MIPO using anterolateral locking plates. Within 24 hours of visiting the emergency room, external fixation was applied, and the medial side wound was managed. After damage control, the anterolateral locking plate was applied using an anterolateral MIPO technique. The union time, nonunion, or malunion were evaluated with regular postoperative radiographs. The ankle range of motion, operative time, blood loss, Iowa score, and wound complications were investigated. Results: Radiological evidence of bony union was obtained in all cases. The mean time to union was 16.7 weeks (12~25 weeks). The mean operation time was 44.0 minutes. Regarding the ankle range of motion, the mean dorsiflexion was 15°, and the mean plantarflexion was 35°. Satisfactory results were obtained in 15 out of 17 cases; five results were classified as excellent, four were good, and six were fair. The mean blood loss was 125.2 mL. Two complications were recorded. Conclusion: In distal tibial fractures with severe medial soft tissue damage caused by high-energy trauma, the staged anterolateral MIPO technique using anterolateral locking plates is a useful alternative treatment to achieving optimal wound care, rapid union with biological fixation, and intra-articular reduction.

• Journal of Korean Foot and Ankle Society
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• v.7 no.2
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• pp.274-278
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• 2003

Rare complications of distal tibia fracture are claw-toe deformity, cavus deformity and checkrein deformity. These complications may be due to contracture of the muscles of the deep posterior compartment of the leg after a compartment syndrome. These 4 cases were treated by selective tendon lengthening of flexor tendon at the retromalleolar level.

• Journal of Korean Foot and Ankle Society
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• v.8 no.2
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• pp.157-160
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• 2004

Purpose: This study aimed to investigate and compare the micro-structural profiles of trabecular bone from different facets at the ankle joint. Materials and Methods: In a fresh cadaver ankle, four cored 10 mm of diameter cylindrical specimens of trabecular bone were harvested from the distal tibia, the talar dome, the medial malleolus, and the lateral malleolus. Using a micro-computed tomography, two-dimensional and three-dimensional micro-structural indices of the trabecular bone were analyzed. Results: Each specimen from the tibia, talus, medial malleolus, and the lateral malleolus showed unique micro-structural pattern. Tibia versus talus, the talus was seen a higher bone volume fraction and a wider supporting zone subchondrally whereas the tibia was seen a relatively lower bone volume fraction and a much narrower supporting zone subchondrally. Lateral malleolus versus medial malleolus, the lateral malleolus was seen the thicker but sparse trabeculae pattern whereas the medial malleolus was seen the thinner but more compact trabecular pattern. Conclusion: Each four locations from the different facet at the ankle joint have distinct own micro-structural patterns of the trabecular bone, suggesting different mechanical properties.

• Journal of Veterinary Clinics
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• v.29 no.2
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• pp.198-201
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• 2012

A one-month-old, male Hanwoo calf was presented to Chonbuk Animal Medical Center with non-weight bearing lameness on its right hindlimb. The radiograph and CT scan showed a Salter-Harris III fracture at the distal tibia. Following open reduction, the fracture was stabilized by cross-pins. A temporal external skeletal fixator was used as an additional support for 5 weeks. 5 weeks after surgery, bone fracture had successfully healed with no complication. At 2 years after surgery, the calf could walk almost normally although intermittent weight-bearing lameness after active exercise. This is a rare case that the combined use of temporal external fixation and cross-pins fixation was sufficiently effective for treating a distal tibial physeal fracture in a calf.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.183-188
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• 2019

Purpose: Bone contusion is usually treated with conservative therapy for 3 months. Bone contusion around knee and hip joints has been extensively reported on, but there are scant reports on this condition in foot and ankle joints. This study evaluated the nature, characteristics and location of bone contusion around foot and ankle joints to enlighten clinicians on how to better treat this disease entity. Materials and Methods: We classified bone contusion of the 76 patients into three types (102 sites; 47 ankle sprains, 18 traffic accidents, 11 falls) according to the Costa-Paz system with employing magnetic resonance imaging (MRI), and the study then analyzed the common sites and areas of occurrence according to the mechanism of injury and duration of pain after first conducting conservative therapy. Results: Of the 76 patients (102 sites) on the MRI, 43 case (42.2%) for talus, 19 cases for distal tibia, and 12 cases for calcaneus were involved. The classification, according to the Costa-Paz system, was Type I, 51 cases; Type II, 32 cases; and Type III, 19 cases. The duration of pain after conservative treatment was 12.15±2.17 weeks for Type I, 14.5±2.15 weeks for Type II, and 21.0±3.8 weeks for Type III. Conclusion: The most common location of post-traumatic bone contusion around both the foot and ankle is the talus, distal tibia, and calcaneus. The most common type of injury noted on MRI is a diffuse signal with change of the medullary component (Type I), In cases of bone contusion extending to a subjacent articular surface or disruption or depression of the normal contour of the cortical surface (Types II, III), the patients' pain appears to last longer. Thus, it is necessary to consider a longer period of conservative treatment in cases of Types II and III bone contusion because the patients' pain may last longer than 3 months.

• Korean Journal of Applied Biomechanics
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• v.31 no.1
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• pp.16-23
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• 2021

Objective: The purpose of the study was to compare the acceleration and shock attenuation (SA) of the runners with/without low back pain (LBG vs. NLBG) while running at 2.5 m/s, 3.0 m/s, 3.5 m/s and 4.0 m/s. Method: 15 adults without low back pain (age: 23.13±3.46 years, body weight: 70.13±8.94 kg, height: 176.79±3.68 cm, NLBG) and 7 adults with low back pain (age: 27.14±5.81 years, body weight: 73.10±10.74 kg, height: 176.41±3.13 cm, LBG) participated in this study. LBG was recruited through the VAS pain rating scale. All participants ran on an instrumented treadmill (Bertec, USA). Results: The LBG shows statistically greater vertical acceleration at the distal tibia during running at 3.5 m/s and 4.0 m/s and greater shock attenuation from the distal tibia to the head during running at 3.5 m/s compared with the NLBG during running (p<.05). As the speed increased, there was a statistically significant increase in vertical/resultant acceleration and shock attenuation for both groups. Conclusion: The findings indicated that the runners with low back pain (LBG) experience greater impact and shock attenuation compared with non-low back pain group (NLBG) during fast running. However, it is still inconclusive whether high impact on the lower extremity during running is the main cause of low back pain in the population. Thus, it is suggested that the study on low back pain should observe the characteristics of impact during running with individuals' low back pain experience and clinical symptoms.

• Archives of Plastic Surgery
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• v.50 no.5
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• pp.501-506
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• 2023

This article portrays the authors' experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of "spare parts" in reconstructive microsurgery. This case describes the successful use of the osteocutaneous distal tibia turn-up fillet flap that allowed "lowering the level of the amputation" from a through knee to a below-knee amputation (BKA) to preserve the knee joint function. We comprehensibly review reports of turn-up flaps which effectively lower the level of amputation, also applying "spare-parts" surgery principles and explore how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-up fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.