• 대한족부족관절학회지
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• 제13권2호
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• pp.179-183
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• 2009

The triplane fracture has been described as a fracture of the distal tibial epiphysis occurring across three planes-sagittal, transverse and coronal. The characteristic pattern of fusion of distal tibial epiphysis explains the special configuration of the fragments in the triplane fracture. According to Dias-Tachdjian classification, triplane fracture is classified two part fracture, three part fracture, four part fracture and two part fracture with extension to the medial malleolus. Among four types, two part triplane fracture with extension to the medial malleolus is a relatively rare injury and generally is not treated by closed reduction. Such fractures should have an anatomic reduction and adequate fixation to restore the joint congruity and obtain an anatomic reduction of the growth plate to prevent a future growth deformity. This is usually best accomplished with an open reduction and screw fixation or k-wire fixation. We experienced two part triplane fracture with extension to medial malleolus and check the CT to define the extent of the injury completely. And then we underwent open reduction and screw fixation for the fracture. As a result, we present four cases of two part triplane fracture with extension with review of related literatures.

• 대한족부족관절학회지
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• 제12권1호
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• pp.14-19
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• 2008

Purpose: We tried to understand the effects of the derotational closing wedge Akin osteotomy during the operation for the hallux valgus with pronation of great toe. Materials and Methods: Eighty five patients who had undergone Akin osteotomy among the eighty seven patients who had been treated with Scarf osteotomy with hallux valgus were included in this study. Derotational supination was added on the medial closing wedge Akin osteotomy at the base of proximal phalanx and it was secured with K-wire, headless screw or staple. We measured and analyzed pre- and post-operative hallux primus valgus angle and hallux pronational rotatory angle. Results: The hallux primus valgus angle improved an average of $14{\pm}2.98$ degrees to $-1{\pm}1.68$ degrees with the hallux pronational rotatory angle respectively from $24.8{\pm}7.64$ degrees to $4.7{\pm}4.22$ degrees. Conclusions: After the metatarsal osteotomy for the treatment of the hallux valgus with the pronation of great toe, derotational closing wedge Akin osteotomy can give us a belief that it can correct the hallux primus valgus angle and hallux pronational rotatory angle also and it can be a helpful method for minimizing the recurrence rate of the hallux valgus deformity.

• 대한족부족관절학회지
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• 제14권2호
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• pp.146-150
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• 2010

Purpose: Pilon fracture has several serious complications such as joint stiffness, arthrosis and delayed angular deformity. We report short-term results of new treatment modality using distracted dynamic external fixators and early controlled ankle motion. Materials and Methods: Eight cases of severe pilon fractures for which we tried small plate fixation and additional distracted dynamic external fixators from July 2007 to June 2009 were included. Half passive continuous ankle joint motion was allowed under free hinged ring fixators after the operation. The external fixators were removed after two or three months from the surgery. We investigated joint space by radiograph, joint pain, range of motion, patient's satisfaction of treatment protocol. Results: Joints were distracted when external fixators were applied and mean 28% of space loss developed after removal of external fixators. In most of cases, satisfactory alignments were maintained. Regarding range of joint motion, mean dorsiflexion angle was 15 degrees and mean plantarflexion angle was 32 degree in the condition of wearing external fixators. There was mean 8% reduction of range of motion but no further progression of ankle stiffness after removal of external fixators. Dorsiflexion was not improved after that, but plantarflexion angle was improved 10% even after removal of external fixators. Patients were generally in compliance with the treatment protocols with high level of satisfaction. Conclusion: We got good results with distracted dynamic external fixators and early continuous half-passive joint motion for pilon fractures in terms of joint pain and range of motion. Therefore we suggest this new protocol as an alternative modality for severe pilon fractures.

• 대한족부족관절학회지
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• 제14권2호
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• pp.140-145
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• 2010

Purpose: The diabetic charcot neuroarthropathy of ankle is an infrequent site (around 5%), but is definitely the location that, because of the instability and progressive deformity it involves, cause ulceration in a high percentage of patients, and this can then become a reason for amputation. However, the treatment of this disastrous disease is still challenging. We analyzed the clinical and radiological results of ankle arthrodesis by our fixation method in Charcot neuroarthropathy. Materials and Methods: Seven cases that were diagnosed as charcot neuroarthropathy of ankle arthrodesis were followed for more than 16 months postoperatively. Mean age was 57 years, and the mean follow-up period was 27 months. Anterior approach was used in arthrodesis, and internal fixation by 3 or more cannulated screws and hybrid type external fixation were used. Auto iliac bone for grafting was combined in all cases. External fixator was kept for 3 months without weight-bearing. Then, boots brace was applied for more 3 months allowing partial weight-bearing. Four cases had minor complications such as pin site infection. Preoperative and postoperative AOFAS score, time to fusion and postoperative complications were checked. Results: Postoperative fusion was completed in all cases, and the mean time to fusion was 3.4 months. No postoperative complication was checked. At the last follow-up, the mean AOFAS score had increased from 54 points to 72 points. Patient's satisfaction was over 80%. Conclusion: Satisfactory results were obtained after ankle arthrodesis using internal and hybrid type external fixation combined with auto iliac bone graft in charcot neuroarthropathy with minor complications.

• 대한족부족관절학회지
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• 제12권2호
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• pp.140-144
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• 2008

Purpose: The purpose of this study is to compare the treatment outcomes of distal chevron osteotomy with those of proximal metatarsal closing wedge osteotomy in patients with moderate severity hallux valgus. Materials and Methods: Forty-two patients (51 feet) who were underwent either distal chevron osteotomy (Group I, 22 patients, 27 feet) or proximal metatarsal closing wedge osteotomy (Group II, 20 patients, 24 feet) for the correction of moderate hallux valgus deformity were evaluated retrospectively. We assessed the radiographic results with several parameters including hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). And clinical results with modified AOFAS score at last follow-up. Results: There were no significant differences in IMA, HVA and DMAA between two groups preoperatively. We can achieve the good results with both procedures, but mean HVA and IMA of group II was significantly lower than those of group I. There was some loss of correction in group I at the last follow-up. There was no significant difference in clinical results according to modified AOFAS scoring between two groups at the last follow-up. Conclusion: The proximal metatarsal closing wedge osteotomy for the hallux valgus with moderate severity is better treatment option to achieve better radiographic correction and to prevent loss of correction or recurrence than distal chevron osteotomy.

• 대한족부족관절학회지
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• 제17권2호
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• pp.93-99
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• 2013

Purpose: Proximal metatarsal chevron osteotomy for hallux valgus is followed by significant amount of postoperative pain. Periarticular multimodal drug local injection can be an option for pain control. This study was attempted to evaluate the efficacy of the morphine as multimodal drug and to confirm the effect of periarticular multimodal drug local injection on controlling early postoperative pain. Materials and Methods: Between March 2012 and June 2012, 22 patients received proximal metatarsal chevron osteotomy for the correction of hallux valgus deformity. 10 patients (Group A) received periarticular injection of the test solution made with morphine, ropivacaine, ephinephrine and ketorolac. 12 patients (Group B) received periarticular injection of the test solution without morphine. The visual analog scale (VAS) was checked at 2, 4, 6, 8 hours, 1 day and 2 days each after surgery. Results: The VAS score at postoperative 2 hours to 1 day between two groups showed no significant difference, but the VAS score at postoperative 2 days was significantly higher in Group A compared to the VAS score of group B. The amount of additional pain control (tramadol HCL) between two groups showed no significant difference for 3 days after surgery. Conclusion: Periarticular multimodal drug local injection was effective in reducing pain after hallux valgus surgery regardless of mixing with morphine.

• 대한족부족관절학회지
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• 제7권1호
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• pp.115-118
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• 2003

Purpose: We are going to present a report from clinical and radiographic results of hallux valgus done only by soft-tissue procedure, when intermetatarsal joint is totally unfit under mild to moderate deformity. Materials and Methods: As a retrospective study, among all the patients who went under the surgery for hallux valgus, and of those who were possible to follow up,(excluding those whose intermetatarsal joint is fit) it was done over 28 cases (18 patients). the soft-tissue procedure was all done by Modified Mc Bride. Results: Hallux valgus angle and intermetatarsal angle each showed correction of $19.4^{\circ}$ and $5.2^{\circ}$, and from the final follow up, they were each decreased by $5.1^{\circ}$ and $1.5^{\circ}$. 21% (6case) were recurred, in one case, the intermetatarsal angle decreasing 120 and the other 5 case all decreased by $13^{\circ}$. Conclusion: when the intermetatarsal joint is unfit and there is no degenerative change, and, if the intermetatarsal angle is not large, moderate hallux valgus can show a good result, just by the distal soft-tissue procedure. a critical indication and a well through out preparation can reduce unneccessary surgeries.

• 대한족부족관절학회지
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• 제14권1호
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• pp.16-20
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• 2010

Purpose: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. Materials and Methods: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle ${\geq}40^{\circ}$ or intermetatarsal angle ${\geq}18^{\circ}$) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal-interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. Results: AOFAS Hallux Metatarsophalangeal-interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from $43.3^{\circ}(31-58^{\circ})$ preoperatively to $6.8^{\circ}(-8-27^{\circ})$ postoperatively. The intermetatarsal angle was decreased from $18.4^{\circ}(11-24)^{\circ}$ preoperatively to $5.3^{\circ}(1-12^{\circ})$postoperatively. The sesamoid subluxation was improved from $2.8{\pm}0.4$ preoperatively to $0.4{\pm}0.6$ postoperatively. Conclusion: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.

• Applied Microscopy
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• 제38권2호
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• pp.107-115
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• 2008

콩팥의 모세여과관문은 토리모세혈관, 내피세포, 혈관사이바탕질, 토리바닥막, 발세포로 구성되어 있다. 콩팥의 노화가 일어나게 되면 형태학적 변형이 일어난다고 보고되었는데, 그 중 흰쥐의 경우 생쥐나 사람보다 노화에 따른 토리의 형태가 다양하게 관찰된다는 보고가 있다. 하지만 이런 연구들은 대부분 단면 위주로, 형태변화에 관한 입체적인 연구는 부족한 실정이다. 본 연구에서는 3개월이 지난 성숙한 흰쥐와 24개월이 지난 노화 흰쥐의 토리 모세여과관을 비교하여 그에 따른 형태변화를 광학 및 투과전자현미경을 이용하여 관찰하였으며, 이러한 결과를 바탕으로 연속절편을 통해 컴퓨터 프로그램을 기반으로 한 3차원 재구성을 시행하였다. 그 결과 노화 흰쥐의 토리에서 요공간의 확장, 모세혈관 내피세포의 변형, 토리바닥막의 비대, 혈관사이바탕질의 확장을 관찰할 수 있었다. 또한 3차원 재구성을 시행한 결과 노화 흰쥐의 토리에서 바닥막 경계의 붕괴 현상, 발세포 핵막의 조각화와 분절 양상, 발세포 세포돌기의 부분적인 수축과 세포돌기의 가늘어짐으로 인한 여과틈새의 확장을 관찰할 수 있었다. 이상의 결과로 미루어 볼 때, 노화가 진행되면 토리의 여과관문의 변형으로 인하여 콩팥의 생리학적 역할과 조절이 영향을받을 것으로 사료된다.

• Physical Therapy Rehabilitation Science
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• 제9권1호
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• pp.10-17
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• 2020

Objective: Hallux valgus (HV) is a common musculoskeletal deformity that is accompanied with pain and continues to decrease one's quality of life and ability to perform daily life activities by affecting gait and static stability. Therefore, this study aimed to investigate the effect of the angle of HV (HVA) and to compare the one-legged stance and gait parameters in young adults with less HV and severe HV. Design: Cross-sectional study. Methods: Forty young adults were divided into two groups, where HVA ≥15° (n=20) was defined as HV, and HVA <15° (n=20) was defined as normal. For balance ability, the center of pressure (COP) path, velocity, length of axis of the COP path, deviation of the x-axis and y-axis, and percentage of foot pressure were measured, and gait, the foot rotation angle, step length, percentage of each phase of the gait cycle, time change from the heel to forefoot, and maximum pressure of the forefoot and midfoot were measured. Results: Significant differences were found in sway length and time change from heel to forefoot during walking between the normal and HV groups (p<0.05). Most parameters were not associated with the HVA, but parameters such as length of axis and time to change from heel to forefoot were significantly associated with the HVA (p<0.05). Conclusions: These results suggest that most one-legged stance and gait parameters were not significantly affected by the HVA in young adults; therefore, future studies are needed in order to address other dynamic parameters and other methods of gait analysis for detecting clinically meaningful conditions.