• 대한족부족관절학회지
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• 제7권2호
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• pp.238-249
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• 2003

Purpose: To report the clinical result of the intraarticular calcaneus fracture after open reduction and internal fixation with plate by lateral approach. Materials and Methods: Thirty-six calcaneal fractures of 33 patients(29 men and 4 women) were treated by open reduction and internal fixation using an lateral approach from March, 1997 to May, 2002 and were followed more than one year. The autogenous iliac bone graft was done in 2 cases but the others didn't. Radiographically B?hler angle and Gissane angle on simple lateral radiograph were measured and in the 15 cases, the step-off(gap) of posterior facet joint on post-operative CT images were followed. The Salama method was used for evaluation of clinical results. Results: According to Sanders classification, 19 cases of the 36 cases were classified as type II. Type III fracture were found in 12 cases and type IV in 5 cases. The following results were obtained: twenty-two cases(61.1%) out of 36 cases were estimated as good or excellent. The good results or more were obtained in 15 cases(78.9%) in type II and 7 cases(58.3%) in type ill, but no case in type IV. B?hler angles were improved from preoperative average 1.6?to postoperative average 23.4?, Gissane angle was improved from preoperative 107.2?to postoperative 122.8?, respectively. Among 36 cases, Computed tomography was carried out in 15 cases. The postoperative step-off (gap) of posterior facet joint on computed tomography was filled with cancellous bone. Satifactory results was obtained in 7 cases with 2mm gap or less and in 6 cases of 2-5mm. There were no satifactory results in 2 cases with 5mm gap or more. Conclusion: Open reduction and internal fixation for intra-articular fracture of calcaneus was thought to be a good treatment modality. It is thought that the lateral approach is one of the good one for surgical treatment, and that accurate reduction of the posterior facet, acceptable recovery of B?hler angle are more important to obtain best results.

• 대한족부족관절학회지
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• 제14권2호
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• pp.151-156
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• 2010

Purpose: To analyze the clinical and radiological results of operative treatment in patients with tongue type intra-articular calcaneal fracture, and to compare the open reduction and Essex-Lopresti technique. Materials and Methods: We examined a consecutive series of 42 patients who received surgical treatment for tongue type calcaneal fracture (24 cases of the open reduction and 18 cases of the Essex-Lopresti technique) and the postoperative data was compared with a minimum 1 year follow-up. The clinical outcome was analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and Salama's criteria. The preoperative, postoperative, and last follow-up changes in the Bohler angle was radiologically analyzed. Results: There were no significant differences between the two groups in terms of the clinical and radiological results at the last follow-up. However, for the Sander's type 3 and 4 fractures, the open reduction group showed more improvement of AOFAS score and less reduction loss in the Bohler angle. Conclusion: Although the clinical results were good irrespective of surgical technique, the open reduction and internal fixation can improve clinical outcome and reduce the reduction loss as compared with the Essex-Lopresti technique in the comminuted tongue type calcaneal fracture.

• 대한족부족관절학회지
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• 제7권1호
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• pp.109-114
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• 2003

Purpose: The purpose of this study is to evaluate the effectiveness and indications of the modified Essex-Lopresti reduction in calcaneal fractures. Materials and Methods: We reviewed retrospectively 41 cases of displaced intraarticular calcaneal fractures. The fracture was reduced with Essex-Lopresti technique with modification in compression of the lateral wall with the specially designed compression device instead of the operator's hands. We evaluated the results of treatment by AOFAS scale and the radiographic parameters including the Bohler's angle, calcaneal width, calcaneofibular distance and the congruency of the posterior facet. Results: Boler's angle was restored from 11 to 29.6 degrees on average, heel width was reduced to 112% of contralateral value, the calcaneofibular gap was restored up to 87.9% of contralateral side, and the articular surface of the posterior facet was restored less than 2 mm of step off and less than 2 mm of gap. AOFAS scale averaged 87 points. The quality of reduction was best in Sander's type II fractures. Small sized fragments in type III fractures could not be reduced. The results were better when the reductions were performed within 24 hours of injury. Conclusion: The modified Essex-Lopresti reduction was less invasive, easy to perform, and the results of treatment were similar to those of open reduction; it seemed to be a reasonable alternative for the selected intraarticular calcaneal fractures.

• 대한족부족관절학회지
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• 제12권2호
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• pp.174-179
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• 2008

Purpose: We evaluated the clinical results of the intraarticular calcaneal fractures treated using Ollier approach by inexperienced orthopaedic surgeon. Materials and Methods: Between August 2003 and May 2007, Of the total 46 cases, 12 cases (9 patients) of displaced intraarticular calcaneal fracture who underwent open reduction and internal fixation using Ollier approach were evaluated. The means of age was 50.5 years. According to the Sanders classification, there was no type I case and 8 cases of type II, 1 case of type III, and 3 cases of type IV. We evaluated the treatment result by assessing radiologic parameters ($B{\ddot{o}}hler$ angle, Gissane angle, and calcaneal height/width) and clinical outcomes (VAS and AOFAS score). Results: The means of follow-up period was 25.3 months. The means of B.hler angle was improved from $2.4^{\circ}$ to $26.1^{\circ}$. Radiologic and clinical union was achieved in all cases without additional procedures. Excellent result were noted in 2 cases, good in 5 cases, fair in 4 cases, and poor in 1 case. We experienced 2 cases of minor complications; 1 case of mild wound infection and 1 case of hypoesthesia on foot dorsum. Radiologic findings of subtalar arthritis were present in 2 cases. Conclusion: Ollier approach seems to be helpful to inexperienced orthopaedic surgeons for the treatment of intraarticular calcaneal fractures in that it enables them to achieve considerable clinical outcomes without serious complications.

• 대한족부족관절학회지
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• 제8권1호
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• pp.101-106
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• 2004

Purpose: To determine the efficacy of the SDBBA (Subtalar distraction bone block arthrodesis) procedure on patients with late complication of intra-articular calcaneal fractures including subtalar joint arthritis and anterior ankle impingement syndrome. Materials and Methods: Five cases in which the SDBBA procedure was implemented were followed for more than one year. All five patients were male with an average age of 56. Clinically, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the pain score were assessed. Radiographically, the talocalcaneal height and the talar inclination angle were determined. Results: All five patients achieved subtalar joint fusion. The average pre-operative AOFAS score was 22.8 scores (range, 8-32 scores). At last follow-up, these scores improved to an average of 72.4 scores (range, 64-82 scores). The average pre-operative pain score was 8.2 scores (range, 7-10 scores). At last follow-up, these scores improved to an average of 13.2 (range, 12-15 scores). The average pre-operative talocalcaneal height was 72.8 mm (range, 70-77 mm), average post-operative talocalcaneal height improved to 79.8 mm (range, 78-84 mm). At final follow-up, these measurement was slightly decreased to average 78.6 mm (range, 74-83 mm). The average pre-operative talar inclination angle was 13.2 degrees (range, 12-15 degrees), average post-operative talar inclination angle improvedto 19.2 degrees (range, 15-24 degrees). At final follow-up, these measurement was slightly decreased to average 18.6 degrees (range, 12-24 degrees). Four patients achieved successful outcomes. One patient developed a wound infection with subsequent sural neuropathy as well as collapse of the bone graft. Conclusion: This study shows that the SDBBA procedure successfully restores the talocalcaneal height and tibio-talar relationship. This procedure is useful in surgically managed patients with talo-calcaneal height loss and anterior ankle impingement syndrome due to the late complications of calcaneal intra-articular fractures.

• 대한족부족관절학회지
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• 제14권1호
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• pp.73-78
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• 2010

Purpose: The purpose of this study is to analyze the clinical and radiological results of minimally invasive percutaneous screw fixation in intra-articular calcaneal fractures and its complications. Materials and Methods: This study is based on 30 intra-articular calcaneal fractures that treated by index operation from June 2005 to November 2006 with at least 6 months follow-up. We assessed the clinical and radiological outcomes and complications. Results: According to Sanders classification, there were 8 in type IIA, 7 in type IIB, 3 in type IIIAB, 6 in type IIIBC, 6 in type IV. And according to Essex-Lopresti classification, there were 9 in the tongue type, 21 in the joint depression type. Average follow-up period was 14.6 months (range: 6-23 months). Average interval between from injury to operation was 2.3 days. Average AOFAS score was 87.7 (range: 52-92). Satisfactory results were obtained in 22 cases (73.3%) by AOFAS score and in 20 cases (66.7%) by VAS score (mean: 3.4). Radiological results improved from 8.7 to 20.3 degrees in the Bohler angle and from 40.2 mm to 52.1 mm in calcaneal height. Postoperative complications were 2 skin and soft tissue problems and 1 sural neuropathy. Conclusion: Minimally invasive percutaneous screw fixation may be useful alternative surgical method in the management of Sanders type II and III calcaneal fractures, which is possible to achieves the anatomical restoration and minimizes postoperative complication in patients with high risks of soft tissue compromise and allows relatively early operation.

• Clinics in Shoulder and Elbow
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• 제19권2호
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• pp.105-109
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• 2016

Arthroscopy is recognized as an important adjunct in treatment of intra-articular fractures. The author reports on successful treatment of a displaced transverse glenoid cavity fracture, reduced and fixed with arthroscopic assist, using two cannulated screws perpendicular to the fracture surface, in a patient with frail chest. One screw passed through the Neviaser portal, and the other screw passed through the base of the coracoid process. Arthroscopy assisted reduction and 2 cannulated screw fixation through the Neviaser portal and coracoid base appears to be a good method for treatment of transverse glenoid fractures.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2009년도 제17차 학술대회
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• pp.191-191
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• 2009

• Clinics in Shoulder and Elbow
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• 제15권2호
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• pp.130-137
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• 2012

목적: 골다공증이 있는 노인환자에서 상완골 원위부 관절부위 골절로 관혈적 정복술 및 내고정술과 주관절 전치환술 시행 후 기능적 결과에 대해서 평가 보고하였다. 대상 및 방법: 2007년1월부터 2009년 10월까지 상완골 원위부 관절내 골절을 주소로 내원한 65세 이상의 환자 24명을 대상으로 하였으며 18명은 후방 도달법을 이용하여 관혈적 정복술 및 내고정술을 시행하고 (Fig. 1), 6명은 주관절 전치환술을 시행하였다 (Fig. 2). 평균 추시 기간은 16.3 개월 이였으며 골절형태는 AO 분류로 8명이 C2, 16명이 C3 형태의 골절이였다. 추시 시 모든 환자들은 방사선촬영 및 신체검사를 시행하였고, Mayo 주관절 수행점수, 및 DASH 점수를 이용하여 임상적 결과를 측정하였다. 결과: Group I 18예 모두 골유합 되었으며 골절부터 골유합까지 평균 기간은 14주였다. 합병증으로 2예에서 주두골 절골부위에 불유합이 관찰되었으며 척골신경증상을 보였던 2예 중 1예는 전방이전술에도 불구하고 개선되지 않았다. Mayo 주관절 수행점수는 평균 87.0점이였으며, DASH 점수는 평균 32.4점이였다. 마지막 추시 시에 시행한 이학적 검사에서 굴곡은 평균 121.0도 (95~145도), 굴곡구축은 평균 12도 (0~35)이였다. Group II 6예 모두 추시 기간내 합병증은 없었으며, Mayo 주관절 수행점수는 평균 89.1점 이였으며, DASH 점수는 평균 44.3점이었다. 마지막 추시 시에 시행한 이학적 검사에서 굴곡은 평균 125.1도 (100~145도), 굴곡 구축은 평균 12.6도 (0~30)이였다. 결론: 골다공증을 동반한 고령의 상완골 원위부 관절내 골절 환자에서 적절한 환자 선택시 내고정술 뿐만 아니라 전치환술에서도 단기 추시 시 만족할만한 결과를 보임을 확인할 수 있었다.

• 대한관절경학회지
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• 제10권1호
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• pp.53-60
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• 2006

목적: 본 연구는 관절면을 침범한 경골 외과 골절 환자의 관절경적 정복 및 내고정술 후 임상 결과와 방사선적 결과를 분석하고자 하였다. 대상 및 방법: 2000년 3월에서 2004년 8월까지 본원 정형외과를 방문한 관절면을 침범한 경골 외과 골절 환자 중 관절경적 정복 및 내고정술을 시행한 13례를 대상으로 하였다. 정확한 골절의 양상 및 함몰의 정도를 파악하기 위하여 단순 방사선 사진 및 전산화 단층 촬영 또는 자기 공명 영상 촬영을 같이 시행하여 분석한 Schatzker 골절 분류상 전례가 제 2형에 해당하였으며, 9례에서는 골결손이 심하여 자가골 및 동종골을 이용한 골이식을 시행하였다. 평균 연령은 $48(31{\sim}66)$세였고, 평균 추시기간은 $38(13{\sim}65)$개월이었다. 동반손상은 후방 십자 인대 손상 1례, 반월상 연골 손상 4례, 내측 측부 인대 손상 2례가 관찰되었다. 방사선학적 평가는 술전, 술후 및 최종 추시시 단순 방사선 사진에서 관절면 정복의 정도를 비교하였고, 기능적 평가는 IKDC 점수와 Lysholm 점수를 후향적으로 분석하였다. 결과: 최종 추시시 단순 방사선 사진상 전례에서 관절면의 정복이 잘 유지되고 있었고, 함몰이나 골절 정복 소실, 각 변형, 부정유합 등의 합병증은 관찰되지 않았다. Lysholm 점수는 평균 $87(65{\sim}97)$점이었고, Lysholm 분류상 우수(exellent) 8례, 양호(good) 3례, 보통(fair) 1례, 불량(poor) 1례이었으며. IKDC 점수는 평균 $92(82{\sim}99)$점이었다. 결론: 경골 외과 골절시 관절경적 정복은 관절면의 정확한 정복을 얻을 수 있을 뿐만 아니라 관절경을 통한 슬관절 동반 손상의 진단 및 치료를 위한 좋은 술식으로 사료된다.