• 대한족부족관절학회지
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• 제13권2호
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• pp.162-168
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• 2009

Purpose: To evaluate the efficiency of the minimally invasive percutaneous plate osteosynthesis (MIPPO) with locking compression plate (LCP) for distal tibial metaphyseal intra-articular fracture compared with extra-articular fracture. Materials and Methods: From February 2006 to June 2008, 21 patients with distal tibia metaphyseal intra-articular fracture and 20 patients with extra-articular fracture were treated operatively by MIPPO technique with LCP and followed for at least one year. In the group with intra-articular fracture, mean age was 48.85 years old and a mean follow-up was 15 months. In the other group with extra-articular fracture, mean age was 52.35 years old and a mean follow-up was 14.5 months. The type of fracture was evaluated using the AO/OTA classification and open-fractures were according to the Gustilo-And gron classification. Radiologic evaluation with fracture healing and tibial alignment, clinical evaluation with Olerud and Molander ankle score and restriction of motion were done for treatment. Results: According to AO/OTA classification, There were 21 type A, 15 type B, 5 type C. Average union time of the intra-articular fracture (type B, C) was 18.7 weeks. Average union time of the extra-articular fracture (type A) was 17.1 weeks. All fractures were healed without malunion. There were no difference of mean restriction angle between intra-articular fracture (ankle dorsiflexion was 3.57 degree, plantar-flexion was 5.95 degree) and extra-articular fracture (ankle dorsiflexion was 3 degree, plantar-flexion was 3.75 degree). There were no difference of Olerud and Molander ankle score between them as a mean score of intra-articular and extra-articular was 89.25, 91.25 each other. As a complication, there were 3 case of skin necrosis, 8 case of discomfortable skin tenting by plate and 1 superficial infection, but could be healed by conservative care. Conclusion: MIPPO technique, combined articular reduction, with LCP of distal tibial metaphyseal fracture was a good method with high functional recovery.

• 대한족부족관절학회지
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• 제8권2호
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• pp.166-170
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• 2004

Purpose: To evaluate the results of MIPPO (minimal invasive percutaneous plate osteosynthesis) technique for distal tibial metaphyseal fractures. Materials and Methods: It is a retrospective study of 13 patients who were treated by MIPPO technique for distal tibial metaphyseal fractures from Jan. 2001 to Jan. 2003. The average age was 46.7 years and mean follow-up period was 13.3 months. According to AO classification, there were 8 cases of A1, 3 cases of A2, 1 case of B1 and 1 case of C2. One case of A1 was a Gustilo-Anderson type I open fracture and fibular fractures were combined in 12 cases. We applied anatomical reduction and internal fixation for the fibular fractures and internal fixation on the medial side of the tibia by MIPPO technique for distal tibial metaphyseal fractures. Clinical results were evaluated using radiographic results, Neer score, the starting time of postoperative exercise and clinical complications. Results: According to the Neer score, all cases showed satisfactory results. Active ankle ROM was started at average 2.4 weeks ($2{\sim}4$ weeks) and full weight bearing ambulation at average 5.2 weeks ($4{\sim}8$ weeks) postoperatively. Union of fractures was obtained by average 14.4 weeks ($8{\sim}18$ weeks) postoperatively. Two cases showed $5^{\circ}$ limitation of motion without functional deficits and other cases showed satisfactory ROM results. One case had $6^{\circ}$ valgus deformity without functional deficits. There were not any other complications like soft tissue problems and delayed-or non-union. Conclusion: MIPPO technique for the treatment of distal tibial metaphyseal fractures is a feasible technique with a good clinical outcomes.

• 대한족부족관절학회지
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• 제6권1호
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• pp.92-95
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• 2002

Traumatic ruptures of tibialis posterior tendon are much less common and consequently have received little attention. A tibialis posterior tendon rupture associated with a closed medial malleolar fracture occured in a 32 years old man due to slip down. The tendon rupture was not diagnosed before surgery but was recognized at the time of open operation. The treatment was open reduction and internal fixation at the bony fragments with primary repair of the tendon. This tendon injury, although rare, should be considered in the management of ankle fracture because the tendon rupture could easily have been overlooked and failure to recognize this at the time of injury may result in poor long - term ankle function despite a well- healed fracture.

• 한국임상수의학회지
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• 제26권6호
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• pp.644-646
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• 2009

5년령의 체중 4.58 kg 수컷 긴 팔 원숭이가 후지 파행 증상으로 건국대학교 동물 병원에 내원하였다. 신체 검사에서 우측 후지 경골 부위의 연부조직 손상을 보였으며 방사선 사진에서 우측 경골과 비골의 단순 골절이 관찰되었다. 개방형 정복을 실시한 후 tubular dynamic compression plate와 나사를 이용한 고정을 실시하였다. 수술 9주 후 방사선 사진 검사에서 잘 발달된 가골 형성이 골절 부위 피질에서 관찰되었다. 수술 3개월 후 후지 파행 증상을 보이 지 않고 정상 보행이 가능하였다.

• 대한족부족관절학회지
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• 제23권3호
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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.

• 대한족부족관절학회지
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• 제15권2호
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• pp.51-57
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• 2011

Pilon fractures involving distal tibia remain one of the most difficult therapeutic challenges that confront the orthopedic surgeons because of associated soft tissue injury is common. To introduce and describe the diagnosis, current treatment, results and complications of the pilon fractures. In initial assessment, the correct evaluation of the fracture type through radiographic checkup and examination of the soft tissue envelope is needed to decide appropriate treatment planning of pilon fractures. Even though Ruedi and Allgower reported 74% good and excellent results with primary open reduction and internal fixation, recently the second staged treatment of pilon fractures is preferred to orthopedic traumatologist because of the soft tissue problem is common after primary open reduction and internal fixation. The components of the first stage are focused primarily on stabilization of the soft tissue envelope. If fibula is fractured, fibular open reduction and internal fixation is integral part of initial management for reducing the majority of tibial deformities. Ankle-spanning temporary external fixator is used to restore limb alignment and displaced intraarticular fragments through ligamentotaxis and distraction. And the second stage, definitive open reduction and internal fixation of the tibial component, is undertaken when the soft tissue injury has resolved and no infection sign is seen on pin site of external fixator. The goals of definitive internal fixation should include absolute stability and interfragmentary compression of reduced articular segments, stable fixation of the articular segment to the tibial diaphysis, and restoration of coronal, transverse, and sagittal plane alignments. The location, rigidity, and kinds of the implants are based on each individual fractures. The conventional plate fixation has more advantages in anatomical reduction of intraarticular fractures than locking compression plate. But it has more complications as infection, delayed union and nonunion. The locking compression plate fixation provides greater stability and lesser wound problem than conventional implants. But the locking compression plate remains poorly defined for intraarticular fractures of the distal tibia. Active, active assisted, passive range of motion of the ankle is recommended when postoperative rehabilitation is started. Splinting with the foot in neutral is continued until suture is removed at the 2~3 weeks and weight bearing is delayed for approximately 12 weeks. The recognition of the soft tissue injury has evolved as a critical component of the management of pilon fractures. At this point, the second staged treatment of pilon fractures is good treatment option because of it is designed to promote recovery of the soft tissue envelope in first stage operation and get a good result in definitive reduction and stabilization of the articular surface and axial alignment in second stage operation.

• 한국임상수의학회지
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• 제29권2호
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• pp.198-201
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• 2012

한달 된 한우 수송아지가 오른쪽 뒷다리 체중부하를 못하는 문제를 가지고 전북동물의료센터에 내원하였다. 방사선검사와 CT 검사 상에서 Salter-Harris III형의 먼쪽 정강뼈 성장판 골절로 진단하였다. 개방골절정복 후 교차핀을 이용하여 고정한 후 임시 외부 골격 고정장치를 이용하여 5주 동안 추가적인 지지를 실시하였다. 수술 5주 후 방사선사진 검사에서 골절된 뼈의 유합이 관찰 되었다. 수술2년 후 과도한 움직임 뒤에 미약한 체중부하 파행이 관찰 되었지만, 거의 정상 수준으로 보행이 가능하였다. 송아지에서 이와 같은 증례는 매우 드물고 교차핀과 추가적인 임시 외부 골격 고정장치를 이용한 골절 정복법은 먼쪽 정강뼈 골절 치료에 유용하게 사용될 거라고 생각 된다.

• 대한족부족관절학회지
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• 제16권2호
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• pp.94-100
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• 2012

Purpose: The purpose of this study is to analyze the clinical features of distal tibia fractures and to evaluate the treatment outcomes of minimally invasive plate osteosynthesis (MIPO). Materials and Methods: From January 2004 to December 2009, 84 cases of 81 patients treated with plate fixation for distal tibia fracture were enrolled in this retrospective review. We investigated age, sex, injury mechanism, fracture patterns, and complications, and the clinical features were analyzed. To evaluate the treatment outcomes of MIPO, we divided into two groups. MIPO group consisted of 55 patients were treated with MIPO technique and conventional group consisted of 18 patients were treated with open reduction and internal fixation with conventional anterolateral plating. The results were compared between two groups by assessing bony union time, operation time, amount of blood loss, range of ankle motion, clinical score by American Orthopaedic Foot and Ankle Society (AOFAS) score, and post-operative complications. Results: The mean age of 81 patients with distal tibia fracture was 54.8 years. According to AO classification, A1:2:3 were 16, 20, 16 patients, B1:2:3 were 2, 8, 7, C1:2:3 were 1, 3, 11 patients. According to injury mechanism, slip down injury was patients, traffic accident was 26, fall from height injury was 14 patients respectively. The type A fractures were lower energy trauma and more older patients. The type C fractures were higher energy trauma and younger patients. MIPO group was better than conventional group in operative time, blood loss, bony union time, and ankle joint motion. In complications, MIPO group showed no nonunion and infection, one malunion, one skin necrosis, nine skin irritations, and one screw breakage. Conventional group showed two nonunion, four infections, two skin necrosis, and one metal failure. Conclusion: Distal tibial fractures caused by low energy trauma were on the increase. Minimal invasive plate osteosynthesis was shorter bony union time and operation time, less blood loss, and larger ankle motions than conventional open reduction and plate fixation.

• 대한정형외과스포츠의학회지
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• 제1권1호
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• pp.61-64
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• 2002

소아에서후방십자인대의경골부착부위의견열골절은발생빈도가매우낮으며그보고된경우도드물다. 이에저자들은슬관절동통과종창을주소로내원하였으며, 슬관절 후방 슬와부에압통과 종창, 혈관절증, 후방 불안정성, 경골의 후방 전위, 슬관절신전제한소견을보이고있으며 방사선학적검사상후방십자인대의경골과간후면 부착부위에견열골절을 보이는13세 소년에게서 슬관절후방슬와부를 통한 견인 봉합술(pull-out suture)로 고정하여 치료한1예의 결과를 문헌 고찰과 함께보고하고자한다.

• 대한족부족관절학회지
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• 제1권2호
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• pp.102-111
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• 1997

저자들은 1993년 9월부터 1996년 5월까지 본원 정형외과에 입원하여 Pilon 골절로 치료받고 1년 이상 추시 가능하였던 19례(18명)를 대상으로 다음과 같은 결론을 얻었다. 1. Ovadia와 Beals의 분류상 제1형이 2례, 제2형이 3례, 제3형이 10례, 제4형이 1례, 제5형이 3례였고, 제3형이 53%로 가장 많았으며, 교통사고와 추락손상 등 고에너지 손상에 의한 골절이 16례로 전체의 약 84%를 차지하였다. 2. 손상의 정도가 비교적 적은 제1형과 제2형에서는 모두 양호 이상의 임상결과를 나타내었으며, 제4형과 5형에서는 손상의 정도가 심하고 이로인한 정확한 정복의 어려움으로 인해 보통 이하의 성적을 나타내었다. 3. 합병증은 외상후 관절염이 6례로 가장 많았으며 손상정도가 심한 3형 이상에서 정확한 정복이 이루어지지 않은 경우에 발생하였으며, 방사선학적 평가가 보통이하였던 제3형 3례에서 부정 유합이 발생하였으나 임상결과와의 연관성은 없었다. 4. 저자들은 제한된 관혈적 정복 및 내고정술로 연부조직의 합병증을 현격히 줄일 수 있었으며, 손상의 정도가 적고 정확한 정복이 가능한 경우, Pilon 골절의 좋은 치료 술식의 하나라고 사료된다.