• Journal of Korean Foot and Ankle Society
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• v.6 no.2
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• pp.201-207
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• 2002

Purpose: To present the clinical analysis of the results obtained in 38 cases of displaced intraarticular calcaneal fractures undergone combined percutaneous axial pin fixation of calcaneal body and minimal internal fixation using extensile lateral approach. Materials and Methods: From March 2000 to February 2002, thirty-eight displaced intraarticular fractures of the calcaneus in 35 patients were fixed with 3.5mm cannulated screws and percutaneous 2.5mm K-wires. The extensile lateral approach was used in all cases. The average follow-up period was 16 months. Clinical evaluation was assessed according to the Ankle-Hind Foot Scale of American Orthopedic Foot and Ankle Society. Results: The clinical results were graded as excellent in 8 cases(21%), good in 22 cases(58%), fair in 6 cases(16%), and poor in 2 cases(5%). Two cases of poor result were type IV of Sanders classification. The postoperative reduction status of the articular surface was analyzed by computed tomography in all cases and was found to be less 2mm of step off in 30 cases and between 2 and 4mm in 8 cases. Unsatisfactory results were correlated with severity of articular comminution and failure to obtain accurate reduction of the articular surface. Using early functional postoperative care, all fractures healed without secondary displacement except 1 case on an average of ten weeks. Two cases had superficial necrosis of the wound margins, however, secondary wound healing was uneventful and skin grafting was not needed. Conclusion: Combined minimal internal fixation and percutaneous pin fixation using extensile lateral approach is useful operative method of intraarticular calcaneal fractures because providing enough stability to permit functional aftercare and allowing excellent anatomical reduction. In addition, this method diminishes the risk of lateral soft tissue problems.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.298-303
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• 2023

Unstable pelvic ring injuries are potentially life-threatening and associated with high mortality and complication rates in polytrauma patients. The most common cause of death in patients with pelvic ring injuries is massive bleeding. With resuscitation, external fixation can be performed as a temporary stabilization procedure for hemostasis in unstable pelvic fractures. Internal fixation following temporary external fixation of the pelvic ring yields superior and more reliable stabilization. However, a time-consuming extended approach to open reduction and internal fixation of the pelvic ring is frequently precluded by an unacceptable physiologic condition and/or concomitant injuries in patients with multiple injuries. Conservative treatment may lead to pelvic ring deformity, which is associated with various functional disabilities such as limb length discrepancy, gait disturbance, and sitting intolerance. Therefore, if the patient is not expected to be suitable for additional surgery due to a poor expected physiologic condition, definitive external fixation in combination with various percutaneous screw fixations to restore the pelvic ring should be considered in the acute phase. Herein, we report a case of unstable pelvic ring injury successfully treated with definitive external fixation and percutaneous screw fixation in the acute phase in a severely injured polytrauma patient.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.71-75
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• 2004

Purpose: The purpose of this study was to evaluate retrospectively the clinical results of closed reduction and percutaneous screw fixation for unstable injuries on stress radiographs in subtle injuries of Lisfranc joint. Materials and Methods: From June 1997 to March 2003, 6 cases of unstable injuries on stress radiograph in subtle injuries of Lisfranc joint were treated by percutaneous cannulated screw fixation after closed reduction. All cases were injuried by indirect force (twisting injury). The average diastasis between the 1st and 2nd metatarsal base was 3 mm (2-4 mm) on initial nonweight bearing AP radiograph. The average follow-up period was 20 months. Clinical evaluation was assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score. Results: The AOFAS midfoot score was average 86 (80-90) points. The average diastasis between 1st and 2nd metatarsal base was 2 mm (1-3 mm) on weight bearing AP radiograph in final follow up. The final diastasis was increased slightly than diastasis in initial postoperative radiographs. But the clinical results were good. There was no correlation between the degree of diastasis and the clinical results. On weight bearing lateral radiograph, the average difference with normal foot in the distance between plantar aspect of 5th metatarsus and medial cuneiform was 2 mm (0-3 mm). One case had mild arthritic change on the radiographs. Conclusion: When the Lisfranc injuries, especially in the subtle injuries were suspicious, the stress views are helpful to assess stability of the Lisfranc injuries and planning of treatment. For unstable injuries on stress radiographs in subtle injuries of Lisfranc joint, closed reduction and percutaneous screw fixation is useful method to expect good clinical results.

• Journal of Korean Foot and Ankle Society
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• v.4 no.1
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• pp.19-22
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• 2000

Fracture and dislocation of the four lateral metatarsal head and neck at the metatarsophalangeal joint, which may be associated with a hyperextension force, axial load, and additional rotating force, has rarely been reported. The patient was a 32-year-old man who sustained the injury in a motor vehicle accident. Manual reduction was easily performed but maintenance of reduction was difficult, due to the associated fractures of the metatarsal necks. Thus percutaneous internal fixation with Kirshner's wires was required.

• Journal of Korean Foot and Ankle Society
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• v.27 no.1
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• pp.1-6
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• 2023

Displaced intra-articular calcaneal fractures are difficult to treat because of complex anatomy and high soft tissue complications. Various surgical approaches have been introduced to solve these problems, but the treatment remains complex. Recently, clinically and radiographically superior results were reported using a subtalar arthroscopy in reducing the posterior facet in both percutaneous and open approaches. In the percutaneous approach, the arthroscopically assistant percutaneous approach must be selected carefully for mild-to-moderately displaced fractures because of the limited view. In the open approach, there is little evidence of the utility of subtalar arthroscopy. Therefore, intraoperative arthroscopy should always be used in conjunction with fluoroscopy to achieve reduction and assess the internal fixation placement.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.55-59
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• 2009

Purpose: We tried to evaluate the usefulness of the arthroscopy in the operative treatment of intra-articular calcaneal fracture. Materials and Methods: Between March 2005 and May 2008, 9 patients with intra-articular calcaneal fractures（Tongue type or Sanders type IIC) were treated with arthroscopically assisted percutaneous reduction and screw fixation. American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), preoperative and postoperative Bohler's angle and the rate of complication were evaluated. Results: AOFAS score at postoperative 1 year was 88.2 (range, 71-92), and mean VAS score was 2.8 (range, 1-4). Bohler angle was improved from preoperative mean $16.2^{\circ}$ to postoperative mean $29.7^{\circ}$. There were no complications such as wound problem, infection or nerve injury. Conclusion: Subtalar arthroscopy provides precise view of posterior facet during the operation. Therefore, it can be a useful tool in treating intra-articular calcaneus fractures, especially tongue type and Sanders type IIC fractures.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.68-77
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• 2003

Purpose: The treatment of calcaneal fractures remains a controversy in orthopaedic field because of its complications. The purpose of this study is to evaluate the efficacy of the treatment of calcaneal fractures and its complications. Materials and Methods: Clinical and radiological results were retrospectively analyzed in 28 patients, 34 cases with fractures of calcaneus which were treated in our department from September 1998 to march 2003. Results: According to the Creighton-Nebraska Foundation Assessment score, there were 3 excellent, 11 good, and 12 fair 6 poor results. Bohler angle was corrected from $8.3^{\circ}$ to $18.3^{\circ}$, Gissane angle was corrected from $121^{\circ}$ to $135^{\circ}$, and calcaneal width was corrected from 46.8mm to 37mm. Conclusion: Open reduction and internal fixation for joint depression type calcaneal fractures thought to be a good method of treatment. Closed reduction and percutaneous axial pinning should be chosed in selected cases of tongue type fractures. In treatment of complicated calcaneal fractures as malunion, subtalar distraction arthrodesis and lateral wall exostectomy will reduce disability of the disease.

• Journal of Korean Foot and Ankle Society
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• v.8 no.2
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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.

• Hip & pelvis
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• v.34 no.2
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• pp.69-78
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• 2022

Fragility fractures of the pelvis (FFP) and fragility fractures of the sacrum (FFS), which are emerging in the geriatric population, exhibit characteristics that differ from those of pelvic ring disruptions occurring in the younger population. Treatment of FFP/FFS by a multidisciplinary team can be helpful in reducing morbidity and mortality with the goal of reducing pain, regaining early mobility, and restoring independence for activities of daily living. Conservative treatment, including bed rest, pain therapy, and mobilization as tolerated, is indicated for treatment of FFP type I and type II as loss of stability is limited with these fractures. Operative treatment is indicated for FFP type II when conservative treatment has failed and for FFP type III and type IV, which are displaced fractures associated with intense pain and increased instability. Minimally invasive stabilization techniques, such as percutaneous fixation, are favored over open reduction internal fixation. There is little evidence regarding outcomes of patients with FFP/FFS and more literature is needed for determination of optimal management. The aim of this article is to provide a concise review of the current literature and a discussion of the latest recommendations for orthopedic treatment and management of FFP/FFS.

• Journal of Korean Orthopaedic Sports Medicine
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• v.2 no.2
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• pp.168-175
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• 2003

Fracture about proximal humerus may be classified as the articular segment or the anatomical neck, the greater tuberosity, the lesser tuberosity, and the shaft or surgical neck. Now, usually used, Neer's classification is based on the number of segments displaced, over 1cm of displaced or more than 45 degrees of angulation , rather than the number of fracture line . Absolute indication of a operative treatment a open fracture, the fracture with vascular injury or nerve injury , and unreductable fracture-dislocation . Inversely, the case that are severe osteoporosis, and eldly patient who can't be operated by strong internal fixation is better than arthroplasty used by primary prosthetic replacement and early rehabilitation program than open reduction and internal fixation. The operator make a decision for the patient who should be taken the open reduction and internal fixation, because it's different that anatomical morphology, bone density, condition of patient. The operator decide operation procedure. For example, percutaneous pinning, open reduction, plate & screws, wire tension bands combined with some intramedullary device are operation procedure that operator can decide . The poor health condition for other health problem, fracture with unstable vital sign and severe osteoporosis , are the relative contraindication. The stable fracture without dislocation is not the operative indication . The radiologic film of the prokimal humerus before the operation can not predict for fracture evaluation. It's necessary to good radiologic film for evaluation of fracture form. The trauma serise is better than the other radiologic film for evaluation. The accessary radiologic exam is able to help for evaluation of bone fragment and anatomy. The CT can be helpful in evaluating these injury, especially if the extract fracture type cannot be determined from plain roenterogram of the proximal humerus, bone of humerus head. If the dislocation is severe anatomically , we could consider to do three dimentional remodelling. The MRI doing for observing of bony morphology before the operation is not better than CT If we were suspicious of vascular injury, we could consider the angiography.