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Correction of Sesamoid after Proximal Metatarsal Osteotomy and Distal Soft Tissue Procedure in Hallux Valgus (무지외반증 치료에서 근위 중족골 절골술과 원위 연부조직 교정술 후 종자골의 교정정도)

  • Jung, Hwa-Jae;Shin, Hun-Kyu;Chang, Il-Sung;Lee, Jong-Keun
    • Journal of Korean Foot and Ankle Society
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    • v.9 no.1
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    • pp.74-80
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    • 2005
  • Purpose: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. Materials and Methods: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). Results: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). Conclusion: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.

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Treatment of Hallux Valgus with Modified McBride Procedure and Proximal Metatarsal Crescentic Osteotomy (McBride씨 변형 술식과 근위 중족골 반월형 절골술을 이용한 무지 외반증의 치료)

  • Lee, Ju-Hong;Park, Jong-Hyuk
    • Journal of Korean Foot and Ankle Society
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    • v.9 no.1
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    • pp.81-86
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    • 2005
  • Propose: This study was retrospectively to review the surgical results for moderate to severe hallux valgus corrected with a modified McBride procedure and proximal metatarsal crescentic osteotomy. Materials and Methods: Between August 1997 and August 2001, 15 patients with 22 bunion underwent surgical correction and were followed for an average 29.3 months (range, 18 to 53 months). Clinical results were evaluated with AOFAS clinical rating system for hallux and radiological measurements were done preoperatively and at a minimum of 12 months postoperatively. Results: The average AOFAS clinical rating score improved from 47.5 to 86.0. Union of the osteotomy site occurred at 9.5 weeks except one delayed union. The hallux valgus angle improved an from $36.5^{\circ}$ to $15.7^{\circ}$ and the intermetatarsal angle improved from $17.4^{\circ}$ to $8.6^{\circ}$ on average. Dorsiflexion of the first metatarsal at the osteotomy site was present in three (13.6%) with average $4^{\circ}$. Complications were two recurred deformity, one hallux varus and one painful transfer lesion. There was a high level of satisfaction with clinical results in 11 patients (73.3%) with 17 feets and cosmesis in 18 feets (81.8%). Conclusion: Modified McBride procedure and proximal metatarsal crescentic osteotomy based on careful patient selection and meticulous technique showed satisfactory outcome for moderate to severe hallux valgus.

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Proximal Metatarsal Wedge Osteotomy with Single Screw Fixation in Treatment of Hallux Valgus (무지 외반증의 치료에서 단일 나사못을 이용한 근위 중족골 쐐기 절골술)

  • Choi, Jae-Yeo;Shin, Hun-Kyu;Chang, Il-Sung;Kang, Dong-Ho
    • Journal of Korean Foot and Ankle Society
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    • v.9 no.1
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    • pp.87-93
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    • 2005
  • Purpose: We conducted this study to examine the clinical results of the proximal metatarsal wedge osteotomy using a single screw fixation and the distal soft tissue procedure in patients with moderate to severe hallux valgus deformity. Materials and Methods: Between February 2002 and February 2004, we performed these procedures on 12 patients (15 cases). The 6 cases of all patients had mild to moderate instability in the first MTC (metatarsocuneiform) joint. We estimated the clinical outcomes, the radiological findings and complications. Results: AOFAS score was improved from preoperative 41.5 points to 87.7 points lastly on average. The mean correction angle of HVA and IMA was $23.8^{\circ}$ and $6.6^{\circ}$, respectively. The mean position of tibial sesamoid was 2.67 before surgery and 0.87 after surgery. The mean shortening of the first metatarsal bone was 3.07 mm after surgery. There was no pain and complications on the first MTC joint except the breakage of screw in one case and instability of the first MTC joint was improved postoperatively. Conclusion: We obtained good clinical and radiographic outcomes in our series. So, proximal metatarsal wedge osteotomy using a single screw fixation and distal soft tissue procedure seems one of the good surgical treatments for moderate hallux valgus deformity.

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Outcome of Nonoperative Treatment for Proximal Plantar Fasciitis: Comparative Analysis According to Plantar Fascia Thickness (근위 족저 근막염의 비수술적 치료 결과 : 족저 근막 두께에 따른 비교 분석)

  • Yoon, Kwang-Sup;Jung, Hong-Geun;Bae, Eui-Jung;Kim, Tae-Hoon
    • Journal of Korean Foot and Ankle Society
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    • v.12 no.2
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    • pp.122-127
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    • 2008
  • Purpose: To evaluate the clinical outcome of proximal plantar fasciitis after nonoperative treatment, and also to find the correlation of the heel pain with the plantar fascia thickness measured by ultrasonography. Materials and Methods: The study is based on 41 patients, 46 feet of the proximal plantar fasciitis that were treated conservatively with at least 12 months follow-up. All were treated with heel pad, Achilles and plantar fascia stretching and pain medications for at least 3 months. Heel ultrasonography was performed at the beginning of the treatment to measure the plantar fascia (PF) thickness and the echogenicity. PF thickness over 4 mm and less were grouped in to group A and B respectively to compare the clinical outcome. Results: Average thickness of the PF at the calcaneal attach was 5.2 mm. Symptom duration before the treatment was average 13.2 month; group A being 14.6 months and group B being 9.0 months with no significant difference (p=0.09). As functional evaluation, Roles-Maudsley score improved from 3.4 initially to 2.3 at final follow-up, while morning heel pain also improved from average VAS pain score of 7.2 to 4.0. However Maudsley and VAS score both didn't show statistical difference between the 2 groups (p>0.05). Conclusion: Plantar fasciitis improved substantially with the nonoperative treatments. However, the 2 groups, divided according to 4 mm thickness by ultrasonography, didn't show significant difference in either symptom duration or in the clinical outcomes.

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EVALUATION OF TIGHTNESS OF PROXIMAL TOOTH CONTACT IN PERMANENT DENTITION

  • Kim, Kyoung-Hwa;Jung, Jae-Hyun;Kim, Hee-Jung;Chung, Chae-Heon;Oh, Sang-Ho
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.6
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    • pp.553-560
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    • 2008
  • STATEMENT OF PROBLEM: Proximal contact plays an important role in the stability and maintenance of the integrity of the dental arches. However, it is difficult to evaluate quantitatively the tightness of proximal tooth contact (TPTC). PURPOSE: The aim of this study was to measure the TPTC in permanent dentition. MATERIAL AND METHODS: Ten young adult volunteers with healthy dentition participated in this experiment. The TPTC between the teeth of both the maxilla and the mandible was measured at rest state by a novel device which records the TPTC by pulling of a stainless steel strip (0.03 mm thick) using the electric motor. One-way ANOVA test was used to compare the values in all measured area. When a statistically significant difference was calculated, Bonferroni correction was applied. Independent samples t-test was used to compare the values in male and female. RESULTS: The lowest TPTC and the highest TPTC was measured between the lower central incisors (0.87 ${\pm}$ 0.20 N), and between the lower left first molar and second molar (1.99 ${\pm}$ 0.68 N), respectively. All TPTC per quadrant demonstrated a similar pattern of a continuous increased gradient in an anterior-posterior direction. There are no significant difference between the maxilla and mandible. CONCLUSION: The TPTC was measured quantitatively by a novel device and decreased progressively in a posterior-anterior direction.

Correlation between in vitro Plant Regeneration of Apple Cotyledon and Light Condition, Polarity of Explant (사과 자엽의 기내 식물체 재분화와 배양 광조건 및 절편체 극성과의 관계)

  • 안현주;예병우;임용표;신용억
    • Korean Journal of Plant Tissue Culture
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    • v.27 no.1
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    • pp.19-23
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    • 2000
  • The experiment was carried out to investigate the influence of light condition and polarity of explant on adventitious shoot formation from cotyledon of apple in vitro The treatment of light culture after 10days dark treatment showed effective result than other treatments on the rate of adventitious shoot formation on light intensity treatments and also the treatment of blue light treatment after 4days dark treatment showed more effective result than other treatments in light quality treatments. The polarity of explant influence on adventitious shoot formation. Adventitious multiple shoot formation occured at the proximal end of an excised cotyledon. In other words. shoot organogenesis occured at the proximal cut surfaces of both proximal and distal explants rather than at the distal cut surface of proximal explants.

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Endoscopic-Assisted Curettage of Brodie Abscess in Proximal Tibia - A Case Report - (경골 근위부에 발생한 Brodie 농양에서 내시경을 이용한 소파술 - 증례 보고 -)

  • Ku, Jung-Hoei;Cho, Hyung-Lae;Park, Man-Jun;Choi, Seung-Hyun
    • Journal of the Korean Arthroscopy Society
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    • v.11 no.2
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    • pp.134-138
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    • 2007
  • Brodie abscess is a localized form of subacute or chronic osteomyelitis which is common in children but may also occur in adulthood. When Brodie abscess is located in the posterior metaphysis of the proximal tibia, open biopsy and curettage have a difficulty in approach to the lesion and can cause neurovascular injury or soft tissue contamination. We report a case wherein a novel surgical technique was used to treat a Brodie abscess in the posterior proximal tibial metaphysis in 48 year-old-male with endoscopic-assisted curettage by commercial anterior cruciate ligament targeting device(Rigid Fix; Mitek, Johnson & Johnson, Norwood, MA). Two portals were created toward the abscess site and, through each portal interchangeably, the granulation tissue and sclerotic bone could be excised. We believe that endoscopic-assisted curettage presents safe technique, decreased morbidity, accurate assessment of the extent of the abscess and possible improvement in long-term outcomes.

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The Outcomes of Proximal Humerus Fractures with Medial Metaphyseal Disruption Treated with Fibular Allograft Augmentation and Locking Plate

  • Kim, Doo Sup;Yoon, Yeo Seung;Kang, Sang Kyu;Jin, Han Bin;Lee, Dong Woo
    • Clinics in Shoulder and Elbow
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    • v.20 no.2
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    • pp.90-94
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    • 2017
  • Background: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. Methods: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. Results: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was $127.5^{\circ}$. Conclusions: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

Operative Treatment with Intramedullary Fibular Strut Allograft for Osteoporotic Proximal Humerus Fracture

  • Chun, Yong-Min;Lee, Wonyong
    • Clinics in Shoulder and Elbow
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    • v.20 no.2
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    • pp.95-99
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    • 2017
  • Background: The purpose of this study was to investigate the clinical and radiological outcomes of locking plate fixation with fibular strut allograft to manage unstable osteoporotic proximal humerus fractures. Methods: We retrospectively reviewed 15 patients who underwent open reduction and locking plate fixation with fibular strut allograft for osteoporotic proximal humerus fracture between July 2011 and June 2015. For functional evaluation, we evaluated visual analogue scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and active range of motion. For radiological evaluation, shoulder true anteroposterior (AP) and AP in $20^{\circ}$ external rotation, as well as the axillary view were taken at two weeks, six weeks, three months, six months, and one year. And the neck-shaft angle was measured on the AP view in $20^{\circ}$ external rotation view. Results: At the one-year follow-up, mean VAS pain score and all shoulder scores, including ASES score and UCLA shoulder score, exhibited satisfactory clinical outcomes. All patients obtained bone union between three and six months post-procedure. Moreover, the mean immediate postoperative neck-shaft angle was $138^{\circ}{\pm}4^{\circ}$, and at one-year follow-up, the neck shaft angle was $137^{\circ}{\pm}5^{\circ}$. There was no significant difference between the preoperative and postoperative values (p=0.105). Conclusions: For the unstable two-part and three-part osteoporotic proximal humerus fractures with medial calcar comminution, the use of fibular strut allograft with locking plate fixation was effective in maintaining the initial status of reduction and exhibiting the satisfactory functional and radiological outcomes.

Correction of Distal Interphalangeal Joint Extension Lag Using Spiral Oblique Retinacular Ligament Reconstruction (나선빗인대 재건을 이용한 원위지관절 신전장애의 교정)

  • Moon, Kyung Hwan;Kim, Jin Soo;Lee, Dong Chul;Ki, Sae Hwi;Roh, Si Young;Yang, Jae Won
    • Archives of Plastic Surgery
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    • v.33 no.4
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    • pp.480-484
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    • 2006
  • Purpose: A lot of surgical techniques were tried to correct extension lag of distal interphalangeal joint. Spiral oblique retinacular ligament reconstruction is the one of correction techniques. Methods: From January 2004 to January 2005, a total of 13 extension lag of distal interphalangeal joint corrections were performed using spiral oblique retinacular ligament reconstruction for 11 patients. After dorsal incision exposing from base of distal phalanx to proximal phalanx, the new ligament(half of lateral band or graft tendon) lies distally at the dorsum of the distal phalanx and passes volarly and proximally along the side of the middle phalanx and anterior and obliquely across the front of the proximal interphalangeal joint to the opposite side of the digit at the proximal phalanx. Results: 5 of 6 mallet finger deformities and 7 swan neck deformities were corrected, which were both extension lag of distal interphalangeal joint and hyperextension of proximal interphalangeal joint. Conclusion: As a result, spiral oblique retinacular ligament reconstruction is an effective and recommendable method for correction of mallet finger deformity and swan neck deformity.