• 대한족부족관절학회지
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• 제24권2호
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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.

• 대한족부족관절학회지
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• 제16권4호
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• pp.247-256
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• 2012

Purpose: This study was performed to evaluate the clinical outcomes of operative treatment using mini-open sinus tarsi approach for displaced intraarticular calcaneal fractures. Materials and Methods: We studied 18 cases (16 patients) of intraarticular calcaneal fractures who were treated with sinus tarsi approach by same surgeon. The mean age of patients was 44.8 years, and mean follow-up period was 17.2 months. The measurement of B$\ddot{o}$hler angle, Gissane angle, the degree of articular surface depression, and the period to union were performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). Results: B$\ddot{o}$hler angle and Gissane angle had improved significantly from preoperative average $9.8^{\circ}$, $117.6^{\circ}$to average $22.4^{\circ}$, $113.4^{\circ}$ immediate postoperatively, and had maintained to average $21.8^{\circ}$and $114.2^{\circ}$ at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 5.2 mm to 1.2 mm at the last follow-up. All cases achieved bone union, and the period to union was average 10.5 weeks. AOFAS score was average 86.2 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the CNHF scale. Therefore, 16 cases (88.8%) achieved satisfactory results. Conclusion: The minimally invasive sinus tarsi approach using headless compression screw seems to be an effective surgical method for displaced intraarticular calcaneal fractures, because of the possibility of accurate restoration of articular surface and the low risk of postoperative soft tissue complications.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.75-80
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• 2001

Purpose : We have evaluated the morbidity of donor site after transfer of free fibular osseous and osteocutaneous flap to defect site of bone and soft tissue due to chronic osteomyelitis of long tubular bone, open fracture with bony defect, bone or soft tissue tumor and congenital anomaly. Materials and methods : The 54 cases of 79 cases to be carried out from May, 1982 to May, 2001 which could be followed up were reviewed. There were forty nine in male and five in female. The mean age was 35(4 to 66)years old and mean follow up period is 21.3 month(12 to 72). We have retrospectively analyzed the various postoperative complications such as compartment syndrome, donor site infection, skin defect, hypesthesia, hammer toes, ankle instability and activity of daily living by help of questionnaire, telephone, physical examination, follow up x-ray study and chart. Results : In the total 54 cases the medication period for pain control after operation were classified into three groups under 2 weeks(49 cases), from 2 weeks to 6 weeks(3 cases) and over 6 weeks(2 cases). The postoperative morbidity were occurred in total 12 cases(compartment syndrome: 0, infection : 2, skin defect: 1, hypesthesia: 5, hammer toe: 2 ankle pain: 2 discomfort in activity of daily living: 0), and also the morbidity rates of donor site were 23.5% in osseous flap and 21.6% in osteocutaneous flap were occurred. There was no statistical significonce in morbidity between osseous and osteocutaneous free fibular flap transfer(P>0.05). Discussion : In general the morbidity of free fibular flap transfer was relatively high but it did not have any effect on daily activity of living. We think that the meticulous operation technique, detailed wound care and early range of motion exercise will reduce the morbidity of donor site of flap.

• Archives of Reconstructive Microsurgery
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• 제25권2호
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• pp.65-68
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• 2016

Acute bone shortening and delayed lengthening by Ilizarov surgery have been used to treat a wide range of soft tissue injuries including open fracture, osteomyelitis of the tibia and lower leg amputation. It has advantages such as bone lengthening as well as minimizing the loss of damaged tissues via tissue expansion. Here, we report a case of 52-year-old male with satisfactory results through acute bone shortening, replantation, and gradual bone lengthening after complete amputation of the ankle with related literature reviews.

• 대한정형외과학회지
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• 제55권3호
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• pp.253-260
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• 2020

목적: 하지, 특히 정강이 앞 부분이나 발, 발목에서의 연부조직 결손은 피복에 어려움이 있다. 저자들은 하지의 개방성 골절 또는 폐쇄적 골절 후 수상부위에 발생한 다양한 연부조직 결손에 대하여 역행성 표재 비복동맥 피판술을 사용하여 피복을 시행한 예들을 수집, 분석하여 그 임상적 결과를 보고하고자 한다. 대상 및 방법: 2003년 8월부터 2018년 4월까지 하지의 골절 후 수상 부위에 발생한 연부조직 결손에 대하여 역행성 비복동맥 피판술을 시행받은 환자를 대상으로 하였다. 수술 후 최소 6개월 추시가 가능했던 16명의 환자를 대상으로 하였으며, 평균 추시기간은 18개월이었다. 8예는 개방성, 다른 8예는 폐쇄적 골절 후 발생한 합병증으로 연부조직 결손이 발생했다. 피판의 평균크기는 51.9 cm²였으며, 가장 큰 피판의 크기는 10×15 cm²였다. 결과 분석을 위해 수술 후 피판의 생존 여부와 추가 술식, 합병증 등을 조사하였다. 결과: 최종 추시 시 이식 피판은 모두 생존하였으며, 공여부에 별다른 합병증도 발생하지 않았다. 수술 후 단기 추시 당시 1예에서 경계부의 부분 괴사 소견이 발견되었으나 변연절제술과 1차 봉합을 통해 회복되었다. 다른 1예에서는 혈종이 발생하여 추가로 혈종제거술을 시행하였으며, 추시기간 내 피판은 성공적으로 생존하였다. 이식부의 미용적 목적으로 피판 축소수술이 3예에서 시행되었고, 피판부를 절개하고 접근하여 내고정물을 제거하거나 추가적 내고정술을 시행한 건이 3예였었다. 결론: 역행성 표재 비복동맥 피판술은 하지 골절과 동반된 연부조직 결손의 치료에 있어 적극적 적용을 고려할 만한 유용한 술기의 하나가 될 수 있을 것으로 생각된다.

• 대한정형외과학회지
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• 제52권1호
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• pp.49-58
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• 2017

목적: Sanders 4형 관절내 종골 골절에 대한 관혈적 정복술 및 내고정술과 일차성 거골하 관절 유합술의 임상적 결과를 분석하고자 하였다. 대상 및 방법: 2003년 3월부터 2013년 11월까지 Sanders 4형 종골 골절로 진단되어 관혈적 정복술 및 내고정술을 시행한 11예와 일차성 거골하 관절 유합술을 시행한 11예를 비교 분석하였다. 평균 추시 기간은 34.6개월(18-72개월)이었다. 술 후 6, 12개월 및 최종 추시 시 American Orthopedic Foot and Ankle Society's ankle-hindfoot scale (AOFAS) 점수 및 visual analogue scale pain (VAS) 통증 점수를 측정하였고 환자 만족도, 직장 복귀 여부 및 술 후 합병증을 조사하였다. 결과: 최종 추시 시 AOFAS 점수 및 VAS 점수는 양 군 간 의미 있는 차이는 보이지 않았으나(p>0.05) 일차성 거골하 관절 유합술을 시행한 군에서 환자의 만족도가 높았다(p=0.008). 관혈적 정복술군에서 증상을 동반한 거골하 관절염으로 이차성 거골하 관절 유합술을 5예(45.5%)에서 시행하였다. 결론: 양 군 간 임상적으로 의미 있는 결과의 차이는 보이지 않았으나 일차성 거골하 관절 유합술이 술 후 만족도가 높아 빠른 일상 복귀를 필요로 하는 환자 혹은 2차 수술이 불가피할 것으로 예상되는 경우 일차성 거골하 관절 유합술을 고려해 볼 수 있을 것으로 생각된다.

• Journal of Yeungnam Medical Science
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• 제9권1호
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• pp.130-136
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• 1992

본 영남대학교 의과대학 부속병원 정형외과에서는 1986년 12월에서 1991년 11월까지 경부 간부 골절 31례에 대하여 Ender nail을 시행하여 다음과 같은 결과를 얻었다. 1. 환자의 평균연령은 37.3세였고, 남자에게서 3배가 많았으며, 교통사고가 가장 많은 원인이었다(67%). 2. 폐쇄성 골절이 20례, 개방성 골절이 11례였으며, 분쇄골절과 분절골절이 18례(57.7%)였고, 중간부 골절이 16례로 가장 많았다. 3. 동반손상이 19례에서 있었고, 수상후 수술까지의 기간은 평균 7.6일이었다. 4. 평균 골유합 기간은 18.9주였으며, 2례에서 지연유합을 보였다. 5. 합병증으로 하지 단축이 2례, 각형성 변형이 3례, 관절 운동 제한 2례, 감염이 연부조직에 1례 있었다. 이상 경골 간부골절 치료에 사용한 Ender nail은 시술의 간편성, 적절한 고정성과 운동성, 비교적 폭넓은 적용 범위등으로 좋은 치료 결과를 기대할 수 있는 방법으로 사료된다.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.114-119
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• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.