• Journal of Korean Foot and Ankle Society
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• v.26 no.2
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• pp.59-65
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• 2022

The posterior malleolar fracture is relatively common fracture of the foot and ankle, but several aspects of this are still controversial. If the posterior malleolus is involved in the ankle fracture, the prognosis is usually poor. A computed tomography scan is essential for accurate diagnosis and treatment planning. Although indirect reduction and the anterior to posterior screw fixation technique have the advantages of a small incision with the requirement of relatively simple skills, direct open reduction and fixation from the posterior side provide a more biomechanically stable and accurate reduction. The precise reduction of the posterior malleolar fragment helps to achieve congruency of the tibia and fibula in the incisura and contributes to syndesmotic stability. It is important to determine the indications for surgical treatment by comprehensively evaluating the three-dimensional structure of the posterior malleolar fracture and all related injuries to the ankle.

• Journal of Nutrition and Health
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• v.39 no.2
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• pp.171-183
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• 2006

This study was conducted to examine dietary factors affecting bone status in the rural aged men. Quantitative ultrasound measurements (QUS) of bone, that may reflect certain architectural aspects of bone, have been shown to be associated with bone mineral density and fracture. Information of diet and anthropometry was collected in 164 aged men. Dietary intake data were obtained by 24-hour recall method. Measurements of the speed of sound (SOS, m/s), at distal radius, mid-tibia, phalanx, were performed using Omnisense 7000S analyzer (Sunlight Ltd., Tel Aviv, Israel). T-scores for bone SOS measurements at distal radius, mid-tibia and phalanx were 0.60, 0.03 and -0.42 respectively. The prevalence of osteopenia by use of the WHO criteria was 17.7% at the mid-tibia and 25.3% of the subjects at the distal radius. Age were negative association with bone SOS at three sites. Osteopenia group of radius were significantly lower in total foods and vegetable intakes than normal group. After adjusted for age, vegetable intakes were significantly and positively related to bone SOS at the radius. The bone SOS of the tibia were significantly and positively related to vegetable protein, iron, folate and vegetable intakes, but negatively related to fat intakes. Multiple regression analysis showed that bone SOS of tibia was positively associated with folate intakes. Vegetable intakes were positively associated with the bone SOS at three sites. These results indicate that the consumption of vegetables, sources of folate, may have a effect on bone status of men.

• Archives of Reconstructive Microsurgery
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• v.15 no.1
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• pp.17-25
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• 2006

Twelve cases in eleven patients with segmental bone defects were treated with contralateral fibula free flap and ipsilateral island fibula flap in an antegrade, retrograde or bidirectional flow fashion. Five cases were managed with free flaps and seven were with ipsilateral fibula island transfer. Among seven cases, antegrade fashion was three, retrograde was three, and bidirectional was one. All patients were related with open tibial fractures and its sequelae except one who had open foot bone fracture. According to Gustilo's classification, ten patients were type IIIb and one was type IIIc. Basically, antegrade-flow flaps based on the peroneal vessels as in the conventional free flap were used for the proximal or middle one-third tibial defects. On the contrary, retrograde-flow flaps based on the communicating branch between the peroneal and posterior tibial vessels were used for the middle or distal one-third of the tibia. Bidirection-flow flap based on intact peroneal vessels were used for the middle portion of the tibia. The patients who have undergone ipsilateral fibula island flap had one of the following problems: a previously failed free flap, below-knee amputation of the opposite leg because of open tibial fracture, refusal to use the contralateral sound leg, or poor general condition to stand a lengthy operation. Six of the patients who have got ipsilateral fibula island flap also had an associated fibula fracture on the same leg, which was ultimately used as one of the osteotomy sites. The follow-up period was from 1 to 10 years. Two cases of free flap were failed: one patient had below-knee amputation and the other patient had ipsilateral fibula transfer. Other cases were successful and excellent hypertophy of the transferred fibula was achieved. Time to bone union ranged from 4 to 11 months. Time to full weight bearing was from 5 to 13 months after surgery. All of the transferred fibulas showed hypertrophy after weight bearing. In one case, stress fracture was developed during ambulation, which was healed conservatively. Nonunion occurred in two cases, which were treated with a long leg cast and cancellous bone graft, respectively. Length discrepancy of the legs was noted. The limb was shorter by an average 0.5 cm in three cases, longer by 1.1 cm in one case. In the case of island fibula transfer, limited arc of rotation was not a problem. Other disabling complications were not seen. We believe that these diverse modalities using a vascularized fibula will make us more comfortable to handle major bone defects.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.80-85
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• 2008

Purpose: To evaluate and compare the outcome between interlocking IM nailing and LCP fixation in the treatment of distal metaphyseal tibial fracture. Materials and Methods: From January 2000 to December 2007, 17 patient were treated by interlocking IM nail and 13 patient were treated by LCP fixation for distal metaphyseal tibial fracture. Results: According to AO classification, there were 2 type A1 fracture (12%), 6 type A2 fracture (36%), 3 type A3 fracture (18%), 4 type B1 fracture (24%), 1 type B3 fracture (6%), 1 type C1 fracture (6%) in interlocking IM nailing group and 1 type A2 fracture (7.7%), 2 type A3 fracture (15.4%), 3 type B1 fracture (23%), 3 type B2 fracture (23%), 3 type C1 fracture (23%), 1 type C2 fracture (7.7%) in LCP fixation group. The clinical functional outcome (according to AOFAS score) is 75.6 point in IM nailing group and 81.5 point in LCP fixation group. In IM nailing group, 65% of patient showed satisfactory result and In LCP fixation group, 77% of patient showed satisfactory result. Conclusion: There is no difference on clinical results between IM nailing and MIPPO (minimal invasive percutaneous plate osteosynthesis) group in the treatment of distal tibia fracture. But MIPPO group have higher subjective satisfactory score and less complication rate. The weakness of our study is a small case number and limited follow-up and we believe a better designed prospective study will be needed.

• Journal of Korean Orthopaedic Sports Medicine
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• v.9 no.2
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• pp.114-120
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• 2010

Anterior tibial diaphyseal stress fracture have a propensity for delayed union or nonunion and have risk of complete fracture after minor trauma. So, careful evaluation and optimal management are mandatory to succeed in treatment. It is also important to decide the point of time of return to full activity. We report experience of treatment for complete fracture of the delayed union of anterior tibial diaphyseal stress fracture as an athletic injury.

• Journal of Acupuncture Research
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• v.39 no.1
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• pp.64-69
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• 2022

The risk of stress fractures is associated with rheumatoid arthritis (RA), which can aggravate bone loss. We report the case of a patient who was on long-term medication for RA presenting with lower extremity pain on the left and swelling without trauma. Magnetic resonance imaging and plain radiographs at the previous hospital showed no signs of fracture, but radiographs performed later, revealed a stress fracture of the left distal tibia. The stress fracture may have occurred due to multiple reasons such as long-term use of methotrexate and glucocorticoids, active RA, postmenopausal state, and immobility. Suspicion of a stress fracture should not be ruled out especially in RA patients with persistent pain, even if the radiographical findings are normal. Additional imaging and follow-ups are essential. The patient's pain was relieved with Korean medicine treatments, which suggests their potential application for stress fractures in RA patients.

• Korean Journal of Veterinary Research
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• v.51 no.4
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• pp.297-301
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• 2011

The racehorses that under arthroscopic surgery due to be injured his limbs were studied during exercise or training at Busan Race Park from 2005 to 2010. Rate of arthroscopic surgical treatments was 1.4% (63/4,642). Affected bones were radius, radial carpal bone, third carpal bone, proximal phalanx, third metacarpal bone, femur, tibia, proximal sesamoid bone and intermediate carpal bone. The lesions were fracture, chip fracture, slap fracture, osteochonrosis, and osteochondrotitis dissencans. Number of patients under arthroscopic surgery were 63. Success horses of returned to racetrack or tried to return to racetrack were 58, and 5 horses were in training or resting at the time of publication. Success horses of returned to their previous use in the patients were 49 horses (84.4%) and no returned to the racetrack were 9 horses (15.6%) in 58 horses.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2003.06a
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• pp.698-700
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• 2003

This paper presents a model and analysis techniques for a unilateral external fixator to achieve fracture reduction and deformity correction in long bones precisely. through fixator joint adjustment. Combining the kinematic analysis with a graphic model of the tibia and the fixator allowed 3D simulation and visualization of the adjustments required to reduce fracture or correct bone deformity after osteotomy. The model and analysis technique can be used for fixator evaluation and clinical application planning.

• Journal of Korean Foot and Ankle Society
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• v.17 no.3
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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.

• 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.