• 대한족부족관절학회지
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• 제18권2호
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• pp.43-47
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• 2014

Hallux valgus is a lateral deviation of the first phalanx and medial deviation of the first metatarsal at the first metatarsophalangeal (MP) joint. Its incidence has increased due to developing footwear. The etiologies include fashion footwear, genetic causes, anatomical abnormality around the foot, rheumatoid arthritis, and neuromuscular disorders. Physiologic alignment of the first MP joint is maintained by congruent and symmetric alignment of the articular surface of the first proximal phalanx and first metatarsal head, physiologic relationship of the distal first metatarsal articular surface and the first metatarsal shaft axis, and stable balance of soft tissue around the first MP joint and stable tarsometatarsal joint. Several factors have been associated with hallux valgus, including pes planus, hypermobility of the first tarsometatarsal joint, flattened shape of the first metatarsal head, increased distal metatarsal articular angle, and deformation of the medial capsular integrity. History and physical examination are very important to diagnosis of hallux valgus. Simple radiography provides information on deformity, particularly in weight-bearing anteroposterior and lateral radiographs. Understanding the etiologies and pathophysiology is very important for success in treatment of patients with hallux valgus.

• 치과방사선
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• 제7권1호
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• pp.49-52
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• 1977

The authors had observed a case of cleidocranial dysostosis of 42 years old unmarried woman. The observation was founded upon roentgenogram of skull P-A view, orthopantomograph, cephalometric view, chest P-A view and wrist X-ray view. The patient gave a dwarfic impression with 145㎝ body height and concaved mandibular prognastic facial feature. The palate was narrowed and extremely high arched. The eruption state of teeth were extremely poor, only four teeth were erupted, composed of upper third molar and lower three deformed teeth. The skull P-A view of roentgenogram reveals overlying metopic suture, extends from the nasion to the sagittal suture, and the suture are delayed up to date and many wormian bones are formed. On the cephalometric view the maxilla is underdeveloped and produce the false mandibular prognathism. Twenty four impacted teeth can be detected by orthopantmograph, twelve in upper jaw and twelve in lower jaw. There are many supernumerary teeth, one in upper jaw and seven in lower jaw. On the chest P-A view, the clavicles are totally aplastic, but a vestige of clavicle is visible in the right side. On the wrist roentgenogram, the epiphyseal ossification of distal phalanx, mesial phalanx and proximal phalanx is delayed.

• Archives of Plastic Surgery
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• 제45권1호
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• pp.62-68
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• 2018

Background Amputation is commonly performed for toe necrosis secondary to peripheral vascular diseases, such as diabetes mellitus. When amputating a necrotic toe, preservation of the bony structure is important for preventing the collapse of adjacent digits into the amputated space. However, in the popular terminal Syme's amputation technique, partial amputation of the distal phalanx could cause increased tension on the wound margin. Herein, we introduce a new way to resect sufficient bony structure while maintaining the normal length, based on a morphological analysis of the toes. Methods Unlike the pulp of the finger in the distal phalanx, the toe has abundant teardrop-shaped pulp tissue. The ratio of the vertical length to the longitudinal length in the distal phalanx was compared between the toes and fingers. Amputation was performed at the proximal interphalangeal joint level. Then, a mobilizable pulp flap was rotated $90^{\circ}$ cephalad to replace the distal soft tissue defect. This modified toe fillet flap was performed in 5 patients. Results The toe pulp was found to have a vertically oriented morphology compared to that of the fingers, enabling length preservation through cephalad rotation. All defects were successfully covered without marginal ischemia. Conclusions While conventional toe fillet flap coverage focuses on the principle of length preservation as the first priority, our modified method takes both wound healing and length into account. The fattiest part of the pulp is advanced to the toe tip, providing a cushioning effect and enough length to substitute for phalangeal bone loss. Our modified method led to satisfactory functional and aesthetic outcomes.

• 대한골관절종양학회지
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• 제6권2호
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• pp.88-91
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• 2000

골연골종은 양성 골종양의 약 40%를 차지하는 매우 흔한 종양이나 수지골의 관절내에서 발생한 예는 아주 드물며, 국내 보고는 아직까지 없었다. 12세 남아가 제 3수지의 근위지 관절의 무통성 종물을 주소로 내원하였다. 이학적 검사상 관절 운동 범위는 정상이었고, 운동시 동통이나 압통은 없었다. 종물의 크기는 $8{\times}3$mm 정도였으며, 경계는 약간 불분명하였고 가동성은 없었다. 단순 측면 사진상 근위지골의 원위 골간단부에 원형의 종물이 피질골로부터 발생하였으며 피질골을 파괴하지는 않았다. 육안 소견상 연골 조직으로 둘러싸인 종괴를 형성하였으며, 현미경적 소견상 연골모에 둘러싸인 정상적 해면골의 소견을 보였다. 이에 저자들은 수지골의 관절내에서 발생한 골연골종을 문헌 고찰과 함께 보고하는 바이다.

• Archives of Reconstructive Microsurgery
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• 제13권1호
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• pp.7-13
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• 2004

Purpose: The purpose of this study was to present the clinical analysis of the results and our experience of the replantation surgery of the great toe. Materials and Methods: Between March 1995 and December 2002, twelve great toes, amputated from the distal phalanx to proximal phalanx were replanted. The complete types were 5 cases and incomplete types were 7 cases. The guillotine injuries were 4 cases and the crushing injuries were 8 cases. Results: Replantation in eleven out of the twelve amputations survived. The cases of revision were 3 cases due to venous thrombosis. Patients were followed up for a mean period of 2.2 years. The mean total active motion of the first MTP joint was $80^{\circ}$. The fusion of IP joint was carried in 7 cases due to the amputation of the IP joint level. The shortening of the replanted great toes was present, with average 0.9cm. The two point discrimination was 7-8mm except 2 cases with loss of nerve. Conclusion: Although replantation of the great toe remains to be controversial, replantation of the great toe should be considered in well-motivated patients because successful replantation regains an important component of the foot and good functional, cosmetic results.

• 한국운동역학회지
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• 제22권4호
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• pp.387-394
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• 2012

The purpose of this study was to compare and analyze the finger pressure and kinematic variables in the forehand hairpin net shot between skilled elite players and less skilled recreational players. Eight elite players(age: $18.1{\pm}0.8yrs$, height: $176.8{\pm}1.5cm$, weight: $640.9{\pm}48.6N$) with minimum of 6 years of experience and eight recreational players(age: $27.9{\pm}1.6yrs$, height: $177.1{\pm}6.1cm$, weight: $820.5{\pm}62.8N$) with less than one year experience were recruited in this study. For each trial being analyzed, four critical instants were identified from the video recordings: Right heel contact1 (E1), Right toe-off (E2), Right heel contact2 (E3), and Shuttlecock Impact (E4). Each hairpin net shot was broken into consecutive phases: E1~E2 (Right Landing Phase: RLP), E2~E3 (Sliding Step Phase: SSP), and E3~E4 (Impact Phase: IP). Temporal parameters, shuttlecock speed, linear and angular kinematics of body segments, and finger pressures were computed for this study. The results showed that The finger pressure of the ring finger and the middle finger for the skilled group during an impact had significantly greater than those of unskilled group. It is possible that all fingers were not used in the same manner when the racket was gripped in forehand hairpin. The result also suggested that the ring finger and the middle finger pushed the racket from top to bottom while having the mid-phalanx and proximal phalanx of index finger as an axis.

• 한국정보통신학회:학술대회논문집
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• 한국정보통신학회 2015년도 춘계학술대회
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• pp.391-394
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• 2015

임상에서는 GP-BP (Greulich-Pyle and Bayley-Pinneau) 법과 TW3 (Tanner-Whitehouse 3) 법을 사용하여 골연령을 평가하고 있다. Hand AP 영상에서 골성숙도 평가는 전문의의 임상적 경험에 의해 이루어지며 이는 정성적 평가로 모든 전문의마다 동일하게 적용되지 않고 있는 실정이다. 이러한 실정 속에서 TW3 방법이 아닌 새로운 방법을 고안 및 평가하기 위해 2014년 3월부터 2015년 3월까지 양산P병원에서 성장판 검사를 시행한 소아 70명(남 35명, 여 35명)을 대상으로 TW3에서 골성숙 가중치가 가장 높은 7부위를 선정하여 성장판과 골말단 부위의 길이를 측정하여 골연령별 길이의 차이를 측정하였으며 통계적 유의성을 평가하기 위해 회귀분석을 실시하였다. 각 골연령 마다 특정범위에 상응하는 평균과 표준편차 값이 나타났으며, 골연령이 증가할수록 성장판과 뼈 말단부 길이가 규칙성 있게 감소하였다. 여아의 경우 남아에 비해 골성장이 빠르므로, 남아보다 길이 평균값이 전체적으로 작은 값을 가졌다. 이는 12~14세 초경이 나타남에 따라 초경 전후 길이 감소 변화가 크게 나타났기 때문이다. 그 결과 값으로 회귀분석을 하였으며 도출된 값을 분석한 결과 통계적으로 유의함을 알 수 있었다.

• 대한치과교정학회지
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• 제29권2호
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• pp.183-195
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• 1999

성장기 환자의 교정치료에서 신체의 성장 발육상태를 파악하는 것은 중요한 의미를 갖는다. 특히 부정교합에 따라 성장 발육시기가 차이를 보인다면 교정치료 시기의 선택에 있어서 이에 대한 고려가 있어야 하므로 부정교합의 양상에 따른 성장 발육상태를 평가하는 것이 필요할 것이다. 이에 본 연구에서는 부정교합 분류에 따라 골성숙도에 차이가 있는지를 조사하기 위해, 8-10세의 여자 I급 부정교합자 38명, II급 부정교합자 36명, III급 부정교합자 33명을 대상으로 약 6개월 간격으로 12-13세까지 누년적으로 촬영한 수완부골 방사선 사진을 이용하여 골성숙도를 평가한 결과 다음과 같은 결론을 얻었다. 1. 부정교합에 따른 골성숙도의 차이는 없었다. 2. 유구골의 구상돌기 (hamular process)는 $9.16{\pm}0.72$세, 두상골(pisiform bone)은 $9.13{\pm}0.71$세, 모지척측 종자골(ulnar sesamoid)은 $10.34{\pm}0.84$세에 관찰되었다. 3. 골단이 골간을 둘러싸는 시기는 셋째 수지의 원심부 지절과 중간 지절에서 각각 $10.96{\pm}0.80$세, $11.27{\pm}0.87$세였으며, 첫째 수지의 근심부 지절에서는 $11.12{\pm}0.86$세, 요골에서는 $11.21{\pm}0.82$세, 다섯째 수지의 중간 지절에서는 $11.62{\pm}0.85$세였다. 4. 두상골의 출현은 유구골 구상돌기의 출현과(r=0.91), 모지척측 종자골의 출현은 구상돌기의 진행성 화골시기와 높은 상관관계를 보였으며(r=0.86), 골단이 골간을 둘러싸는 시기는 여러 부위가 상호간에 높은 상관관계를 나타내었다(r=0.80-0.90). 5. 다섯째 수지의 중간 지절의 형태가 가장 변이가 심하였다($20.6\%$).

• 대한족부족관절학회지
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• 제11권1호
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• pp.28-34
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• 2007

Purpose: To evaluate the clinical and radiographical results of triple osteotomy as a treatment for adult hallux valgus with highly increased distal metatarsal articular ankle (DMAA). Materials and Methods: From October 2003 to April 2005, we retrospectively reviewed 7 hallux valgus patients (3 cases: moderate, 4 cases: severe) treated with triple osteotomy and followed-up for more than 1 year after operation. The mean follow up was 15.1 months. The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and the length of 1 : 2 metatarsal bone were measured. Proximal chevron osteotomy and distal biplanar chevron osteotomy were done in 1st metatarsal bone. Akin osteotomy was added to the base of the proximal phalanx. The clinical result was assessed using the AOFAS Hallux score, tenderness on the medial eminence, ROM of 1st metatarsophalangeal joint, calluses and patient satisfaction. Results: The mean HVA and IMA was improved from $37.5^{\circ}$ and $13.4^{\circ}$ to $10.5^{\circ}$ and $6.2^{\circ}$ respectively. The mean DMAA was corrected from $34.2^{\circ}$ to $11.2^{\circ}$ and mean shortening of 1st metatarsal was 2.4 mm (0.9-5.8 mm). The mean AOFAS hallux score was improved from 66.4 to 92.5 and VAS score (pain on the medial eminence) from 4.3 points to 0.4 points. Metatarsalgia disappeared in all cases and there was no complications such as necrosis of the metatarsal head. Conclusion: Triple osteotomy for adult hallux valgus with a highly increased DMAA is effective and should be considered as a part of the treatment armamentarium.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.187-190
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• 2010

Purpose: Pediatric trigger thumb is a condition of flexion deformity of the interphalangeal (IP) joint. The known surgical treatment is the release of the flexor pollicis longus by transection of the A1 pulley. We report two cases of pediatric trigger thumb that were resolved by releasing of additional pulley as well as A1 pulley. Methods: From March 2006 to April 2008, a total of 10 children with trigger thumb were operated. In two cases, transection of only the A1 pulley was insufficient to relieve the triggering. When more distally dissection, we found an additional pulley. After release of the additional pulley, the full extension of IP joint is obtained. Results: There were no significant complications. In 8 cases, the trigger thumbs were resolved by transecting only the A1 pulley, does not extend beyond the base of the proximal phalanx. In one case, the additional pulley was found to be more distal to the A1 pulley. It was necessary to extend the release up to the half in the proximal phalangeal shaft. In other case, the additional pulley was immediately adjacent to the A1 pulley. Conclusion: In most cases of trigger thumb, division of just A1 pulley is sufficient to relieve the triggering. However, dividing the A1 pulley in two patients proved to be insufficient to relieve the flexed deformity. In these cases, we found that the additional pulley, different from previous known A1 pulley, had existed, which must be transected to allow full excursion of flexor pollicis longus.