• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.130-134
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• 2010

Purpose: The aim of this study was to evaluate the result of combined first metatarsal and calcaneal osteotomy for static cavovarus deformity of the foot. Materials and Methods: We performed a dorsal closing wedge $1^{st}$ metatarsal osteotomy and a lateral and upward displacement calcaneal osteotomy for 9 patients, 12 feet (6 male and 3 female). The mean age at the time of operation was 37 years and the mean followup period was 27 months. The causes of deformity were 2 poliomyelitis, 1 cerebral palsy, 1 Charcot-Marie-Tooth disease and 5 idiopathic type. Five lateral ligament reconstructions of the ankle and six percutaneous Achilles tendon lengthenings were added. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of AOFAS ankle-hindfoot score and talo-$1^{st}$ metatarsal, calcaneus-$1^{st}$ metatarsal and calcaneal pitch angles were checked with weight bearing radiographs in lateral projection. Results: Talo-$1^{st}$ metatarsal and calcaneal pitch angles were reduced from the mean preoperative values of $21^{\circ}$ and $25^{\circ}$ to $12^{\circ}$ and $19^{\circ}$, respectively, at last followup. Also, calcaneus-$1^{st}$ metatarsal angle was increased from the mean $114^{\circ}$ to $114^{\circ}$. The mean AOFAS score was improved from 44.5 points preoperatively to 89.2 points at followup. There were 1 metatarso-cueiform joint nonunion, 1 sural nerve injury and 3 remaining symptomatic claw toes. Conclusion: Combined first metatarsal and calcaneal osteotomy appears to be an effective procedure for the treatment of adult static cavovarus foot.

• 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.12 no.2
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• pp.185-188
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• 2008

Purpose: Zone I fractures of the fifth metatarsal bone can generally be treated by conservative methods while both surgical and conservative methods are used for zone II fractures. However, the clinical results of conservative treatment have been rarely reported. The purpose of this study is to report the clinical results of conservative treatment for zone I and II nondisplaced fractures. Materials and Methods: Between July 2007 and August 2008, consecutive thirty seven patients (38 fractures) with zone I and II fractures of the fifth metatarsal bone were treated with tolerable weight bearing and minimum duration of immobilization based on pain on weight bearing. We evaluated the duration of immobilization, time to clinical and radiographic union, and time to pre-injury activity level. Results: Clinical and radiological union were achieved in all patients without any complications including malunion or nonunion. The mean duration of immobilization was 28.7 days. The mean 33.1 days and 48.9 days were required for clinical union and radiographic union respectively, after the initial injury. The mean time to pre-injury activity level was 4.8 months. Conclusion: Our study shows that the acute nondisplaced zone I, II fracture of fifth metatarsal bone can be treated effectively using tolerable weight bearing and minimum duration of immobilization, which is based on the pain on weight bearing.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.102-104
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• 2011

Purpose: The standard treatments of hand fractures today are fixations by K -wires, metal plates, wires and lag screws. But it is very difficult to reconstruct fractures by placing implants into small bony fragments especially in the comminuted fractures and intra-articular fractures. This paper describes a simple method of reconstruction with Histoacryl$^{(R)}$ for comminuted and intra-articular fractures in hands. Methods: 2 cases with comminuted and intra-articular fractures by crushing injury were reconstructed with Histoacryl$^{(R)}$. We performed applying Histoacryl$^{(R)}$ with swab on the bone cortex carefully to avoid Histoacryl$^{(R)}$ infiltrating into the medulla. We could rearrange and fixate bony fragments using only Histoacryl$^{(R)}$, in addition, metal plates, K-wires, wires, and lag screws could be used for secondary fixation if needed. Results: Post-operative X-ray finding of 2 patients assured that the bony fragments of the hand fractures maintained their original positions. Significant displacement and deviation, infection, nonunion, and malunion during the follow-up period were not observed. Conclusion: This study showed the possibility of using Histoacryl$^{(R)}$ in addition as a simple method of fixation in the comminuted and intra-articular hand fractures.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.63-72
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• 1997

We have evaluated the clinical results following the 46 cases of free vascularized osteocutaneous fibular flap transfer to the tibial defect combined with skin and soft tissue defect, which were performed from May 1982 to January 1997. Regarding to the operation, flap size, length of the grafted fibula, anastomosed vessels, ischemic time of the flap and total operation time were measured. After the operation, time to union of grafted fibula and the amount of hypertrophy of grafted fibula were periodically measured through the serial X-ray follow-up and also the complications and results of treatment were evaluated. In the 46 consecutive procedures of free vascularized osteocutaneous fibular flap transfer, initial bony union were obtained in the 43 grafted fibulas at average 3.75 months after the operation. There were 2 cases in delayed unions and 1 in nonunion. 44 cutaneous flaps among the 46 cases were survived but 2 cases were necrotized due to deep infection and venous insufficiency. One necrotized flap was treated with latissimus dorsi free flap transfer and the other was treated with soleus muscle rotational flap. Grafted fibulas have been hypertrophied during the follow-up periods. The fracture of grafted fibula(15 cases) was the most common complication and occurred at average 9.7 months after the operation. The fractured fibulas were treated with the cast immobilization or internal fixation with conventional cancellous bone graft. In the cases of tibia and fibula fracture at recipient site, the initial rigid fixation for the fibula fracture at recipient site could prevent the fracture of grafted fibula to the tibia.

• Clinics in Shoulder and Elbow
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• v.15 no.1
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• pp.43-51
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• 2012

Purpose: We sought to determine the appropriate management modality for clavicle fracture through the review of current literature. Materials and Method: This article provides an overview of the knowledge regarding clavicular fracture in adults, including epidemiology, classification, surgical indication, current technique, and results. We also addressed recent debates: the range of the surgical indication for mid-clavicular fracture and the introduction of anatomically precontoured plate as a new treatment modality. Result and Conclusion: Nonsurgical treatment has been regarded as the first choice in the management of clavicle fractures. Quite recently, mounting evidence has shown that adverse outcomes, after a nonsurgical treatment, such as nonunion and malunion, were more prevalent than previously assumed. Accordingly, the indications for surgical fixation appear to be broadening. However, given that the ideal treatment option remains to be determined, the appropriate treatment of clavicle fractures should be tailored based on careful assessment of individual patient's data and preference.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.95-100
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• 2003

Purpose: To evaluate the incidence, contributing factors, and clinical results of refracture of proximal 5th metatarsal stress fracture treated operatively in athletes Materials and Methods: This study included 8 patients who had been treated for refracture of proximal 5th metatarsal stress fracture with operaton. Their charts & radiologic findings were evaluated retrospectively. Results: The overall incidence of refracture was 13%. Main contributing factors were time of return to sports activity and associated deformities such as cavus foot or flat foot. Seven cases were managed with nonoperative treatment, and we added percutaneous pin fixation under local anesthesia in one case. Bony union was seen at average 8. 5 weeks in 7 cases except 1 nonunion and all of 8 patient returned to athletics at average 16 weeks. Conclusion: The incidence of refracture of proximal 5th metatarsal stress fracture treated operatively in athletes was relatively high. Time of rerum to sports activity must be decided very carefully on individual situation and further imaging study may be helpful for bony union evaluation. The non-operative treatment may have a good result if bone graft was done initially.

• Journal of Korean Foot and Ankle Society
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• v.23 no.3
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• pp.110-115
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• 2019

Purpose: This study analyzed the clinical and radiological results of Reudi-Allgower type II and III open tibia pilon fracture patients who underwent plate fixation after the recovery of a soft tissue injury after external fixation. Materials and Methods: From 2010 to 2015, this study analyzed 14 patients who were treated for open tibial pilon fractures and could be followed up at least one year. The mean age was 49 years and the average follow-up period was 19 months. An emergency operation was performed for external fixation and open wounds, and secondary surgery was performed for definitive fixation using a plate. The radiological and clinical evaluations were analyzed retrospectively. Complications, such as post-traumatic osteoarthritis and wound infections were also analyzed. Results: The mean duration between two-staged surgery was 21 days and the mean bone union time was 9.2 months. Three cases of delayed union and one case of nonunion were reported. The malunion did not occur in all cases. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 68 points. A limitation of the ankle motion occurred in all cases. In four cases, wound infections due to initial open wounds occurred; one patient underwent a below the knee amputation due to chronic osteomyelitis. Post-traumatic arthritis occurred in 10 cases. Conclusion: Severe comminuted tibial plateau open fractures of Reudi-Allgower type II and III, which are high-energy injuries that result in extensive soft tissue damage, have a higher incidence of complications, such as ulcer problems and osteomyelitis, than closed tibia plateau fractures. Post-traumatic arthritis is the most common complication of tibia plateau open fractures, and staged surgery is recommended because of the relatively satisfactory clinical results.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.56-60
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• 2009

Purpose: Palatal fracture and mandible fracture result in instability of dental arch. Because they divide the maxillary and mandibular alveolus sagittally and / or transversely and comminute the dentition, they permit rotation of dental alveolar segments and significantly increase the potential for fracture malalignment, complicating fracture treatment. Previous treatment of palatal fracture consisted of palatal splint application and rigid palatal vault stabilization. This procedure result in patient's oral discomfort and removal of palate and screw. Mandible fracture often results in malocclusion due to widening of posterior aspect of dental arch. So we introduce more simple method using intermolar traction wiring, which can protect the widening of dental arch and rotation of dental alveolar segment. Methods: Arch bar and intermolar traction wiring with wire 1 - 0, or 2 - 0 was applied. After exposure of fracture line, neutrooclusion was maintained with intermaxillary fixation. And then open reduction & internal fixation on maxillary fracture line, commonly maxillary buttress, alveolar ridge, pyriform aperture except palatal vault or mandibular fracture line. After 1 week, intermolar traction wiring was removed. We checked occlusion and postoperative radiologic finding. Results: From June of 2007 to October of 2007, 10 patient, who have maxillary fracture with palatal fracture and mandible fracture, underwent open reduction & internal fixation with intermolar traction wiring. All have satisfactory occlusion and there were no complication, like gingiva disease, mouth opening impairment and nonunion. Conclusion: The intermolar traction wiring accompany open reduction and internal fixation can be alternative method for restoration of dental arch in facial bone fracture.

• Clinics in Shoulder and Elbow
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• v.18 no.1
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• pp.2-7
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• 2015

Background: The purpose of this study was to evaluate the usefulness and safety of the anterosuperior deltoid splitting approach for fixation of displaced proximal humeral fractures by analyzing the surgical outcomes. Methods: Twenty-three patients who could be followed-up for at least 8 months after the treatment of displaced proximal humeral fractures through the anterosuperior deltoid splitting approach were enrolled. We evaluated the reduction of the fractures and surgery-related complications at the last follow-up using X-ray results and clinical outcomes comprising the University of California at Los Angeles (UCLA) scoring system and the Korean Shoulder Society (KSS) score. Results: At the last follow-up of patients treated using the anterosuperior deltoid splitting approach for internal fixation of proximal humeral fractures, we found 22 cases (95.6%) of bone union, a mean UCLA score of 28.3 (range, 15 to 34) and a mean KSS score of 82.1 (range, 67 to 95). Various surgery-related complications were noted; a case of varus malunion after fracture displacement, a case of nonunion, a case of delayed union, two cases of impingement, and a case of partial axillary nerve injury, which recovered completely through the follow-up. Conclusions: Plate fixation using the anterosuperior deltoid splitting approach could be another reliable option for treating displaced proximal humeral fractures.