• 대한족부족관절학회지
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• 제9권1호
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• pp.31-37
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• 2005

Purpose: To report our opinions of management about avascular necrosis following operative treatment of talar fracture and dislocation. Materials and Methods: We followed up 5 patients who were diagnosed as talar avascular necrosis after operation of talar fracture and dislocation. Clinical and radiological analysis were performed. The mean age of patients was 36 years. There were 4 males and 1 females. The average follow up was 51 months. Hawkins scoring system was used as clinical evaluation. Results: Regardless of radiological sclerotic finding, all patients showed satisfactory clinical result. Despite arthritic change in one patient, there were no further radiological and clinical deterioration to require salvage procedure. Conclusion: Most avascular necrosis after operative treatment of talar fracture and dislocation showed satisfactory result with conservative treatment. Thus, salvage operation such as talectomy or ankle fusion should be reserved in cases of intractable ankle pain and claudication.

• 대한족부족관절학회지
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• 제1권2호
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• pp.119-125
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• 1997

The fracture and fracture-dislocation of the neck of the talus (Hawkins' type I-IV) are uncommon injuries and represent only 0.12 to 0.32% of all fracures. Authors clinically evaluated in 12 cases Whom treated fracures of the neck of the talus, at department of orthopaedic surgery, Sun General Hospital, from 1990 to 1996, and the following results are obtained. 1. Of 12 cases, there were 11 males and 1 female, average age was 30 years. 2. Causes of fracture was fall down injury in 7 cases(58%), traffic accident in 4 cases(33%), direct trauma in 1 case(8%). 3. According to the classification by Hawkins' type I in 2 cases(17%), type II in 7cases (58%), type III in 3cases(25%). 4. Associated injuries were calcaneal fracture in 3 cases, fracture-dislocation of talus in 3 cases, subtalar dislocation in 3 cases, medial malleolar fracture in 5 cases, soft tissue injury in 3 cases, femur and tibia fracture in 1 case, and lumbar Spine compression fracture in 1 case. 5. Average time to operation after injury was 2.5 days. 6. In 2 cases were treated conservatively and 10 cases were treated open reduction and internal fixation with screw or K-wire. 7. Complications were avascular necrosis in 4 cases, post traumatic arthritis in 2 cases, skin necrosis in 4 cases, and then ankle fusion was done in 2 cases. 8. High rate of complication was seen in the talar neck fracture associated with calcaneal fracture. In the analysis of above results, evaluated by Hawkins' scoring system were excellent to fair in 75%.

• 대한족부족관절학회지
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• 제17권3호
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• pp.182-188
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• 2013

Purpose: We evaluate clinical manifestations and radiologic features of ankle fracture & dislocation, as well as the usefulness of computed tomography on posterior ankle fracture & dislocation to study factors contributing to ankle fracture & dislocation. Material and Methods: Ankle dislocation was defined as the center of talar body being translated over the cortex of tibia on AP or lateral view on simple X-ray. Surgical treatments of 30 patients from January 2007 to March 2012 were categorized according to the injury mechanism, the direction of dislocation and fracture site. Joint involvement of posterior malleoalr fracture was evaluated through simple x-ray and computed tomography. We treated surgically if posterior malleolus fracture involves more than 25% of dital tibial articular surface. Thereafter, clinical outcomes were identified through radiographs and by using the AOFAS score. Results: The mean age was 42(13-78) years old, and slip down was the most common injury mechanism (13 cases). Car accident (6 cases) and fall accident (4 cases) were the next frequently found injury mechanisms. As for the types of ankle fracture, posterior fracture and dislocation (21 cases, 43.3%) was most commonly found. Out of these 21 cases, 15 cases involved trimalleolar fracture, and 19 cases were associated with posterior malleolar fracture. Danis-weber type B and C patients were 11 cases and 10 cases respectively. Articular involvement of posterior malleolar fracture turned out to be average 27.9%(5.1%~49.1%) on simple x-ray. The rate was evaluated as average 31.7%(12.6%~55.3%) on computed tomography which was conducted 15 times, and led us to more meaningful data. Conclusion: Anterolateral fracture and dislocation often accompanied open dislocation. Posterior fracture dislocation was most commonly found. Posterior malleolus was an important factor that ensures posterior stability of the ankle joint. Computed tomograph is useful to evaluate the articular involvement of posterior malleolar fracture.

• 대한족부족관절학회지
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• 제15권4호
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• pp.247-250
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• 2011

Talar fracture and total dislocation, each known as one of rare injuries mainly caused by high-energy trauma, tend to cause avascular necrosis, post-traumatic arthritis, non-union, skin necrosis and infection because of weak blood supply. The authors have experienced and reports a total talus dislocation of 16 year old male associated with medial malleoalr fracture, who showed relatively good result by early reduction and operation.

• 대한족부족관절학회지
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• 제15권2호
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• pp.102-106
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• 2011

Recently, development and improvement in joint replacement therapy, the need for arthrodesis has been decreasing. However, result of joint replacement is not always satisfactory, and most cases are rather indicative to ankle arthrodesis than ankle replacement. Often, ankle arthrodesis can be more beneficial salvage method to treat cases with failure in joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation. In cases with large bone defect that need to be treated with ankle arthrodesis using internal fixation, it is difficult to fill the defect with conventional auto-iliac bone or all-bone graft. Thus, we make a report on our experience in treating 2 cases with ankle arthrodesis using auto-fibular bone graft and plate fixation.

• 대한족부족관절학회지
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• 제13권2호
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• pp.156-161
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• 2009

Purpose: The fracture of talus has critical complications and results in various clinical outcomes. The purpose of this study is to evaluate clinical outcome and influence on involvement of ankle and subtalar joint. Materials and Methods: From December 1999 to December 2008, a total of 66 fractures and dislocations of talus was treated with minimal 9 months follow up period. Ankle-hindfoot scale of the American Orthopedic Foot & Ankle Society (AOFAS) was used to evaluate the clinical outcome. The complications and sequential radiologic findings were also analyzed. Results: There were 28 neck fractures, 11 lateral process fractures, 10 body fractures, 7 osteochondral fractures, 4 posteromedial tubercle fractures and 4 medial process fractures. In 38 cases, there were concomitant injuries. Ipsilateral ankle fracture, which found in 19 cases, was most common. The surgical treatment was performed in 36 cases. Mean AOFAS score was 85.5 (range, 72 to 96). In 13 of 47 cases, one or more fracture lines involving weight bearing surface were confirmed. The involvement of ankle or subtalar joint had resulted in unsatisfied outcome. Complications were developed as follows, post-traumatic arthritis in 8 cases, avascular necrosis in 3 cases, and deep infection in 2 cases. Conclusion: The involvement of ankle or subtalar joint in fractures of talus seemed to be common and to impact the clinical outcome. Meticulous consideration about that will be positively necessary.

• 대한족부족관절학회지
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• 제11권1호
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• pp.45-50
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• 2007

Purpose: To evaluate the short-term clinical outcomes of total ankle arthroplasty for the post-traumatic osteoarthritis. Materials and Methods: Fourteen patients who had undergone total ankle arthroplasty from February 2005 to June 2006 were reviewed. Eleven patients were male and three patients were female. The mean age was 52.8 years (range, 33 to 69 years). The mean follow-up duration was 15.9 months (range, 12 to 24 months). Primary injuries were pilon fractures in eight cases, malleolar fractures in three, ankle syndesmotic injury in one, talus fracture and dislocation in one, and distal tibial physeal injury in one. Visual analogue scale (VAS), Range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and complications were evaluated. Results: The mean VAS improved from 8.6 preoperatively to 2.6 at last follow-up. The mean ROM improved from 24.6 degrees preoperatively to 33.1 degrees postoperatively. The mean AOFAS score improved from 44.5 points preoperatively to 75.1 points postoperatively. Radiographically, all components were stable, but there were component malpositions in two cases, including one varus malposition of tibial component and one increased anterior translation of talar component. Complications were deep infection in one case, intraoperative malleolar fracture in three, marginal wound necrosis in two, and heterotopic ossification in one. One prosthesis was revised because of deep infection. Conclusion: Total ankle arthroplasty for the post-traumatic osteoarthritis is believed to be an useful method for preservation of the motion, relief of the pain and high satisfaction of patients in short-term results.

• 대한족부족관절학회지
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• 제10권1호
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• pp.7-10
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• 2006

Purpose: We analyzed the ankle bony abnormality of patients with marked ankle instability who had chronic ankle sprain more than 3 years. Materials and Methods: We evaluated the chronic ankle sprain (more than 3 years) patients with marked ankle instability tested by varus stress test and anterior draw test from March 2000 to December 2005. Eighty-nine patients (104 ankle) were evaluated and there were 38 males and 51 females. The mean age of patient at the time of diagnosis was 34.5 (range, 18 to 56 years). The average duration of morbidity was 7 years and 3 months (range, 3 years and 3 months to 21 years). The patients who had history of dislocation, fracture, malalignment, operated patients, and rheumatoid ones were excluded. Plain radiographs of AP, lateral, oblique and mortise view were checked. Results: Radilologic abnormalities were found at 74 ankles (71%) among 104 ankles. Frequent sequences of location were anterior talotibial osteophyte, medial malleolar osteophyte, Os subfibulare, lateral malleolar osteophyte. Posteior osteophyte, ankle arthritis, talar articular defect were rarely found. Conclusion: Seventy-one percent among patients with chronic ankle sprain and marked ankle instability showed more than one radiologic abnormalities. Thus, more exclusive and accurate ankle examination should be performed in these patients.

• 대한족부족관절학회지
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• 제18권2호
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• pp.76-79
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• 2014

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.