• The Academic Congress of Korean Shoulder and Elbow Society
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• 1998.03a
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• pp.59-59
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• 1998

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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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.

• Journal of Korean Foot and Ankle Society
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• v.24 no.2
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• pp.87-93
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• 2020

Purpose: This study evaluated the clinical results of surgical treatment with minimally invasive plate osteosynthesis for treating displaced intra-articular fractures of the calcaneus in comparison with conventional lateral extensile approach plate osteosynthesis. Materials and Methods: Of 79 cases of Sanders type II or III calcaneus fractures, 15 cases treated with the minimally invasive calcaneal plate (group M) and 64 cases treated with lateral extensile approach calcaneal plate (group E) were identified. After successful propensity score matching considering age, sex, diabetes mellitus history, and Sanders type (1:3 ratio), 15 cases (group M) and 45 cases (group E) were matched and the demographic, radiologic, and clinical outcomes were compared between the two groups. Results: The median time of surgery from injury was 2.0 days in group M and 6.0 days in group E (p=0.014). At the six months follow-up, group M showed results comparable with those of group E in radiographic outcomes. In the clinical outcomes, group M showed better postoperative American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores than did group E (p=0.001, p=0.008). A greater range of subtalar motion was achieved at the six months follow-up in group M (inversion 20.0° vs. 10.0°, p=0.002; eversion 10.0° vs. 5.0°, p=0.025). Although there were no significant differences in complications between the two groups (1 [6.7%] vs. 7 [15.6%], group M vs. group E; p=0.661), there was only one sural nerve injury and no wound dehiscence and deep infection in group M. Conclusion: Minimally invasive plate osteosynthesis showed superior clinical outcomes compared with that of the conventional lateral extensile approach plate osteosynthesis in Sanders type II or III calcaneus fractures. We suggest applying minimally invasive plate osteosynthesis in Sanders type II or III calcaneus fractures.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.167-172
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• 2005

Purpose: We report our results of arthroscopic treatment of symptomatic avulsion fracture of the malleolus in chronic ankle pain, and also analyzed the clinical and radiological features for evaluating the good candidate for arthroscopic treatment. Materials and Methods: Fourteen patients who were diagnosed with intra-articular avulsion fractures of the malleolus received arthroscopic surgery and were followed up for at least a year. The clinical and radiological characters including MRI and arthroscopic findings were reviewed. Clinical assessments were done according to the AOFAS score system. Results: There was a history of inversion type of the injury in most cases and local tenderness of lesion site was a unique. MRI study showed thickened anterior talofibular ligament (ATFL) in 8 cases (57%) and discontinued ATFL in 3 cases (21%). Enhanced signal surrounding soft tissue corresponding to synovial inflammation and impingement was found in 12 cases (86%). Preoperative score of all patients were $74.0{\pm}5.5$, which improved to $89.3{\pm}6.7$ at the follow-up after the treatment (P<0.001). Conclusion: Most patients had history of injury and localized tenderness in the area coinciding with radiological findings. Thickened ATFL and contrast enhancement around the ossicle were frequently found. Symptomatic avulsion fractures of the malleolus associated with the clinical and radiological findings above could be a good candidate for arthroscopic treatment.

• 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.151-155
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• 2015

Purpose: The purpose of this study was to analyze the frequency and patterns of intra-articular lesions detected during ankle fracture surgery using ankle arthroscopy. Materials and Methods: Thirty patients (31 ankles) who underwent open reduction and internal fixation combined with ankle arthroscopy for acute ankle fracture at Inje University Busan Paik Hospital from June 2011 to September 2013 were evaluated. The ankle fractures were classified according to the AO/OTA (AO Foundation and Orthopaedic Trauma Association) classification and the intraarticular injuries were identified by ankle arthroscopy. Osteochondral lesions of the talus were divided into nine subtypes based on their locations, and the ligament injuries were classified according to avulsion fracture and rupture. Results: Using arthroscopy, abnormality in the distal tibiofibular ligament was found in 21 cases and osteochondral lesions and defects of the talus larger than 5 mm were detected in 26 cases. Among ligament injuries, anterior inferior tibio-fibular ligament injury was found in 14 cases, posterior inferior tibio-fibular ligament injury was found in two cases, deep deltoid ligament injury was found in three cases, and deep transverse tibio-fibular ligament injury was found in five cases. The locations of the osteochondral lesions were on the antero-lateral, antero-medial, centro-medial, centro-central, centro-lateral, and postero-lateral talus in 11, one, two, one, two, and nine cases, respectively. Conclusion: With early diagnosis and treatment arthroscopy performed at the time of intra-articular fracture surgery is expected to result in a good outcome.

• Journal of Korean Foot and Ankle Society
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• v.16 no.3
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• pp.175-180
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• 2012

Purpose: To evaluate the radiological and clinical results after open reduction and internal fixation with calcaneal F plate and locking calcaneal plate using lateral extensile approach in the treatment of intra-articular calcaneal fracture Materials and Methods: This study included 34 cases of 33 patients followed up for at least 6 months postoperatively. F plate was applied in 18 cases (Group 1), locking plate was used in 16 cases (Group 2) and compared radiological and clinical results between two groups. Results: Radiollogically, the mean Bohler angle was improved from $5.5^{\circ}$ preoperatively to $20.1^{\circ}$ postoperatively and $18.8^{\circ}$ at the last follow up in group 1 and $8.6^{\circ}$ preoperatively, $21.4^{\circ}$ postoperatively and $20.3^{\circ}$ at last follow up in group 2. Bone union was observed in all cases and 4 cases of screw loosening were noted in Group 1 with extended fracture to anterior process. At the last follow up, both groups showed clinical results in American orthopedic foot and ankle society ankle hindfoot score, 76(77 in Sanders type II and 75 in type III) in group 1 and 72(73 in type II and 70 in type III) in group 2. Conclusion: F plate and locking plate showed firm fixation and satisfactory clinical results in the treatment of intra-articular calcaneal fracture. We suggest applying locking plate in cases with extended fracture to anterior process, considering screw loosenings in those who were treated with F plate fixation.

• Clinics in Shoulder and Elbow
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• v.20 no.1
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• pp.49-56
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• 2017

Since the olecranon fractures are caused by relatively low-energy injuries, such as a fall from standing height, they are usually found without comminution. Less commonly they can be developed by high-energy injuries and have severe concomitant comminution or injuries to surrounding structures of the elbow. Because the fracture by nature is intra-articular with the exception of some avulsion-type fracture, a majority of olecranon fractures are usually indicated for surgical treatment. Even if there is minimal displacement, surgical treatment is recommended because there is a possibility of further displacement by the traction force of triceps tendon. The most common type of olecranon fracture is displaced, simple non-comminuted fracture (that is, Mayo type IIA fractures). Although tension band wiring was the most widespread treatment method for these fractures previously, there is some trends toward fixation using locking plates. Primary goal of the surgery is to restore a congruent joint and extensor mechanisms by accurate reduction and stable fixation so that range of motion exercises can be performed. The literature has shown that good clinical outcomes are achieved irrespective of surgical fixation technique. However, since the soft tissue envelope around the elbow is poor and the implants are located at the subcutaneous layer, implant irritation is still the most common complication associated with surgical treatment.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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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.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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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.