• 대한족부족관절학회지
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• 제24권1호
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• pp.25-30
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• 2020

Purpose: Generally, the treatment of ankle trimalleolar open fractures is divided into two stages: external fixation and debridement; and secondary internal fixation. On the other hand, this two-stage operation takes considerable treatment time and is challenging in procedures requiring reduction. The purpose of this study was to evaluate the radiologic and clinical results of an immediate one-stage internal fixation operation considering the wound conditions to overcome two stage operation disadvantages. Materials and Methods: From September 2009 to January 2018, 24 cases of ankle trimalleolar open fractures, who underwent immediate internal fixation and were followed up for at least one year, were studied retrospectively. The open wound was divided into the Gustilo-Anderson classification. Open reduction and internal fixation were performed on every medial and lateral malleolar fracture. On the other hand, with posterior malleolar fractures, surgical or conservative treatment was performed depending on the fragment size. The radiologic outcome was evaluated using the Burwell and Charnley criteria and American Orthopaedic Foot and Ankle Society (AOFAS) scores, and complications, such as infection and posttraumatic arthritis, were used for the clinical evaluation. Results: The wound was classified into eight cases (33.3%) of type I, 11 cases (45.8%) of type II, and five cases (20.8%) of type IIIa. The degree of reduction was anatomical, fair, and poor in 16 cases (66.7%), six cases (25.0%), and two cases (8.3%), respectively. The mean AOFAS score was 79 points, and there were complications, such as infection in three cases (12.5%) and post-traumatic arthritis in two cases (8.3%). Conclusion: Satisfactory results were obtained through immediate surgical treatment in ankle trimalleolar open fractures of types I, II, and IIIa.

• 대한족부족관절학회지
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• 제10권1호
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• pp.7-10
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• 2006

Purpose: We analyzed the ankle bony abnormality of patients with marked ankle instability who had chronic ankle sprain more than 3 years. Materials and Methods: We evaluated the chronic ankle sprain (more than 3 years) patients with marked ankle instability tested by varus stress test and anterior draw test from March 2000 to December 2005. Eighty-nine patients (104 ankle) were evaluated and there were 38 males and 51 females. The mean age of patient at the time of diagnosis was 34.5 (range, 18 to 56 years). The average duration of morbidity was 7 years and 3 months (range, 3 years and 3 months to 21 years). The patients who had history of dislocation, fracture, malalignment, operated patients, and rheumatoid ones were excluded. Plain radiographs of AP, lateral, oblique and mortise view were checked. Results: Radilologic abnormalities were found at 74 ankles (71%) among 104 ankles. Frequent sequences of location were anterior talotibial osteophyte, medial malleolar osteophyte, Os subfibulare, lateral malleolar osteophyte. Posteior osteophyte, ankle arthritis, talar articular defect were rarely found. Conclusion: Seventy-one percent among patients with chronic ankle sprain and marked ankle instability showed more than one radiologic abnormalities. Thus, more exclusive and accurate ankle examination should be performed in these patients.

• 대한정형외과학회지
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• 제54권1호
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• pp.45-51
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• 2019

목적: 족관절 내과 절골술 및 대형신연기를 이용하여 전내측 접근법으로 수술적 처치를 시행한 제3형 거골 경부 골절 환자들의 임상적, 방사선적 결과를 후향적으로 분석하여 보고하고자 하였다. 대상 및 방법: 2009년 3월부터 2016년 8월까지 조선대학교병원에서 족관절 내과 절골술 및 대형신연기를 이용하여 전내측 접근법으로 수술적 처치를 시행한 제3형 거골 경부 골절 환자 중 12개월 이상 추시가 가능했던 12명(12예)을 대상으로 하였다. 술 후 6주에 외래 추시 시 시행한 전후면 및 측면 단순 방사선 사진으로 Hawkins sign의 유무를 확인하였고 술 후 3개월에 자기공명영상 촬영을 시행하여 무혈성 괴사 여부를 판정하였다. 이후 3개월 간격으로 단순 방사선 사진 및 임상 증세 기반으로 골유합 여부 및 시기를 판정하였고 술 후 12개월에 시행한 단순 방사선 사진으로 후외상성 관절염 발생 여부 및 Takakura stage를 판정하였으며 미국족부족관 절정형외과학회(American Orthopaedic Foot and Ankle Society, AOFAS)의 족관절-후족부 수치(ankle-hindfoot score)를 조사하여 분석하였다. 결과: 7예에서 술 후 3개월에 시행한 자기공명영상상 무혈성 괴사가 발생하였으나 모두 술 후 12개월 추시에서 수술적 처치 없이 AOFAS 점수 83.86±4.53점이라는 결과를 얻었다. 전 예에서 평균 5.3개월에 방사선적 골유합을 얻었고 총 10예에서 방사선적 후외상성 관절염이 발생하였으나 모두 Takakura stage IIIA 이하로 보존적 처치를 통하여 일상생활이 가능하였다. AOFAS 족관절-후족부 수치는 평균 85.17점으로 측정되었다. 그 외 합병증으로 2예에서 얕은 창상 감염이 발생하였다. 결론: 제3형 거골 경부 골절 환자의 수술적 치료에 있어 족관절 내과 절골술 및 대형신연기를 이용한 전내측 접근법은 외측 절개 없이 해부학적 전위 골편의 정복을 얻을 수 있어 거골의 혈류를 비교적 보존할 수 있는 수술적 접근법 중 하나가 될 수 있을 것으로 판단된다.