Radiographic Evaluation of the Normal Distal Tibiofibular Syndesmosis in Neutral to Dorsiflexion on Weight-Bearing / 대한스포츠의학회지

Purpose@#Reliable landmarks of ankle syndesmosis change in various positions is important for managing ankle injury. The purpose of our study was to investigate and compare radiographic landmarks of normal ankle in various positions. @*Methods@#The study involved both ankle radiographs of 30 subjects (15 males, 15 females) without clinical or radiographic abnormality. Tibiofibular clear space (TFCS) and tibiofibular overlap (TFO) were measured on anteroposterior (AP) and mortise radiographs in non-standing (NS) and standing (S) neutral and dorsiflexion 10° (DF10) and 20° (DF20). The radiographic measurements were used to calculate means, standard deviations, and intra- and interobserver reliabilities, and compare TFCS and TFO in various positions and genders. @*Results@#On the AP view, the mean TFCS in NS, S, DF10, and DF20 positions were 4.00±0.97, 4.00±0.83, 4.35±0.95, and 4.45±0.89 mm and the mean TFO on the same positions were 6.58±2.27, 4.27±1.90, 3.44±1.96, and 2.38±1.91 mm. On the mortise view, the mean TFCS in NS, DF10, and DF20 positions were 3.62±0.88, 4.08±0.86, and 3.88±0.97 mm and the mean TFO on the same positions were 3.57±2.13, 2.31±1.77, and 3.57±2.14 mm. The reliabilities in all positions except TFCS on some positions were excellent. No measurement was significantly different between females and males except TFO in NS on mortise view (p=0.006) and DF10 on AP view (p=0.032). @*Conclusion@#Increase of TFCS and decrease of TFO on AP view reflects syndesmosis change from NS to DF20 on standing. Clinically, the effect of weight-bearing and reliability of TFO should be considered.

Visually Indistinguishable Intractable Neuroma Management after Below Knee Amputation: A Case Report / 대한족부족관절학회지

Symptomatic neuromas after amputation can be troublesome to treat and make it difficult to properly fit a brace. Surgical management is required when conservative management such as prosthetic socket modification or local injections fail. However, small cutaneous nerves adhere to adjacent soft tissue and they are difficult to locate. The authors suggest that ultrasonography guided tattoo localization using a charcoal suspension is useful to find a visually indistinguishable neuroma.

Predictors for Amputation in Patients with Diabetic Foot Wound

PURPOSE: Diabetic foot wound (DFW) is known as a major contributor of nontraumatic lower extremity amputation. We aimed to evaluate overall amputation rates and risk factors for amputation in patients with DFW. MATERIALS AND METHODS: From January 2014 to December 2017, 141 patients with DFW were enrolled. We determined rates and risk factors of major amputation in DFW and in DFW with peripheral arterial occlusive disease (PAOD). In addition, we investigated rates and predictors for amputation in diabetic foot ulcer (DFU). RESULTS: The overall rate of major amputation was 26.2% in patients with DFW. Among 141 DFWs, 76 patients (53.9%) had PAOD and 29 patients (38.2%) of 76 DFWs with PAOD underwent major amputation. Wound state according to Wagner classification, congestive heart failure, leukocytosis, dementia, and PAOD were the significant risk factors for major amputation. In DFW with PAOD, Wagner classification grades and leukocytosis were the predictors for major amputation. In addition, amputation was performed for 28 patients (38.4%) while major amputation was performed for 5 patients (6.8%) of 73 DFUs. Only the presence of osteomyelitis (OM) showed significant difference for amputation in DFU. CONCLUSION: This study represented that approximately a quarter of DFWs underwent major amputation. Moreover, over half of DFW patients had PAOD and about 38.2% of them underwent major amputation. Wound state and PAOD was major predictors for major amputation in DFW. Systemic factors, such as CHF, leukocytosis, and dementia were identified as risk factors for major amputation. In terms of DFU, 38.4% underwent amputation and the presence of OM was a determinant for amputation.

Non-osseous Coalition of the Third Metatarsal-Lateral Cuneiform Joint: A Case Report / 대한족부족관절학회지

This paper reports a rare case of the symptomatic third metatarsal (MT3) - lateral cuneiform (LC) in a 55-year-old male who presented with complaints of severe intermittent pain in his right foot. Plain radiographs and computed tomography scans revealed sclerosis and irregularity at this joint. The intraoperative findings demonstrated a fibrocartilaginous coalition. The pain had improved one year after removing the MT3-LC joint by en bloc and arthrodesis.

A Study on the Foot and Ankle Disease of Shelter-based Homeless People / 대한족부족관절학회지

PURPOSE: Foot and ankle disease (FAD) is a frequent cause of morbidity among the homeless population. Various conditions, exacerbated by malnutrition, poor lifestyle habits, psychiatric disorders, physical injuries, poor hygiene, and limited access to healthcare, have been described in this population. The purpose of this study was to investigate the cognition and management status of FAD in shelter-based homeless people. MATERIALS AND METHODS: Fifty-two male and twenty-five female volunteer homeless individuals were recruited from two homeless shelters. Each person completed a questionnaire assessing any presence of pain, pain management, as well as foot and ankle care status. A foot and ankle surgeon examined the physical status of the individual's foot and ankle, including tenderness and instability. A radiologic evaluation was done for 18 male and 11 female homeless people who agreed to participate in this test for the existence osteophyte or joint space narrowing representing osteoarthritis and some reference angles for hallux valgus, flatfoot and cavus foot. RESULTS: Homeless people had higher prevalence of body mass index, diabetes, and smoking than the general population. The most prevalent infectious disease was fungal infection (male 78%, female 68%), with a low compliance of management for FAD. CONCLUSION: Although most of shelter-based homeless people showed an acceptable foot and ankle management status, the potential risk for FAD development and exacerbation of mild FAD was high.

The Operative Management of Navicular Stress Fractures in Adolescence / 대한족부족관절학회지

PURPOSE: The aim of this study is to evaluate the effectiveness of surgical treatment in adolescent patients suffering from navicular stress fracture. MATERIALS AND METHODS: A total of 11 adolescent patients aged 14 to 19, who underwent an operation for navicular stress fracture between 2005 and 2008 were recruited. Clinical outcomes were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) score. RESULTS: The mean VAS score before the operation was 7.7. A score of 2.9 was confirmed at final follow up after the operation. The mean final follow-up period was 22.1 months. There was a statistically significant improvement in the VAS score between before and after the operation (p=0.01), and similarly, the AOFAS score also showed an improvement, from 46.5 to 80.7 (p=0.01). The pain that remained after the operation, according to the VAS score, was severe in three patients (27.3%), tolerable in seven patients (63.6%), and free of pain in one patient (9.1%). CONCLUSION: In navicular stress fracture in adolescents, careful selection of patients who could benefit from surgical treatment is recommended.

The Indication of Ankle Lateral Ligament Reconstruction Using Tendon Graft in Chronic Ankle Instability / 대한족부족관절학회지

PURPOSE: The purpose of this study is to review the indications of ankle lateral complex reconstruction using tendon graft. MATERIALS AND METHODS: We searched PubMed using the index, "ankle, instability, lateral ligament, reconstruction" from 1990 to present (September 30, 2015). We excluded 1) modified Brostrom operation (MBO), 2) conventional tenodesis surgery, 3) review article, 4) technical note, and 5) articles written in another foreign language. We reviewed 24 papers through the publication events, operational method, the indications of surgery, and the specific features of the patient group. RESULTS: There were the indications of 1) previous ligament surgery failure, 2) situation when ligament repair is impossible due to the ligament defect, 3) severe instability (preoperative talar tilt >15degrees, anterior draw >10 mm or the difference of contralateral side talar tilt >5degrees, anterior draw >3 mm), and 4) overweight (body mass index >30 kg/m2). Other considerations included 1) generalized joint laxity and 2) workers, highly-demanded or athlete highly-affected by instability. CONCLUSION: The ankle lateral complex reconstruction using tendon graft could be indicated in patients with the possibility of MBO failure with several considerations.

Comparison of Angle Measurements on Hallux Valgus with Two Different Methods Using Digital Images / 대한족부족관절학회지

PURPOSE: To study inter- and intra-observer reliabilities of computerized measurements of the angular parameters of hallux valgus deformity, using two different kinds of software tools for angle measurement on the digital radiography. MATERIALS AND METHODS: On 35 digital radiographies of standing foot anteroposterior view of hallux valgus, two observers (A, B) independently measured hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA1-2) twice, using two methods. In method I, an angle was determined from duplicated lines to longitudinal axes made for bisecting line on the target bones with software tool. In method II, an angle was calculated automatically and directly from bisecting lines (longitudinal axes) made on the target bones. We compared two methods using paired t-test to determine significance of differences. Inter- and intra-observer reliabilities were evaluated using the intraclass correlation coefficients (ICC). RESULTS: There were no significant differences between measurements of method I and II for each observer (p>0.05) and intraobserver reliability were good. (ICC>0.9) Inter-observer reliability for method I and II was good of the HVA (ICCs, 0.912 and 0.905) and moderate of the IMA1-2 (ICCs, 0.505 and 0.537). There were interobserver differences in HVA of method I and II. CONCLUSION: No significant difference was found statistically between measurements of method I and II. Both methods I and II would be acceptable to measure angular parameters of hallux valgus deformity.

Synoivial Chondromatosis of the Ankle Joint and Flexor Hallucis Longus Tendon Sheath / 대한족부족관절학회지

Synovial chondromatosis is a benign lesion forming multiple round cartilagenous nodules or osseous loose bodies in joint cavity. Predilection sites are known as knee, hip and elbow joints. However, the involvement of ankle joint was rarely reported in the literature. Moreover, extraarticular chondromatosis in synovial sheath or bursa of extremities is extremely rare. We present a case of synovial chondromatosis of the left ankle joint and flexor hallucis longus tendon sheath.

Determining the Normal Values of the Korean Version International Knee Documentation Committee Subjective Knee Form

PURPOSE: This study aimed to validate a recent officially approved Korean version of the International Knee Documentation Committee (IKDC) subjective knee form, to determine the standard basis values in a normal Korean population and to use the IKDC for determining the effectiveness of and recovery after an orthopedic procedure. MATERIALS AND METHODS: Five male subject and 5 female subjects (a total of 10 subjects per group) were included in group I (age of 20~30 years old) and Group II (age over 60 years old), respectively, and the patients were without knee joint disturbance and radiologic/clinical abnormality, and all the subjects were examined by an orthopedic knee surgeon. All the subjects were evaluated with the Korean version IKDC subjective knee form. Spearman's analysis was used to test for significant differences between each group. RESULTS: The overall result of the Korean version IKDC subjective knee form in group I was 98.3+/-3.7 (88.5~100.0) on average, and it was 100+/-0.0 for the males and 96.6+/-4.9 (88.5~100.0) for the females with no significant differences (p=0.189) between the two gender. The average score of the IKDC subjective knee form in group II was 86.6+/-5.8 (78.2~93.1) and this was 89.6+/-5.4 (80.1~93.1) for the males and 83.7+/-5.1 (78.2~92.0) for the females with no significant difference (p=0.113) between the two genders. But there was statistically significant differences of the score of the Korean version of the IKDC subjective knee form between group I and group II (p<0.0043). CONCLUSION: We have to consider age differences when using the Korean version of the IKDC subjective knee form, but there are no differences according to gender.

4+5 Extensor Compartmental Vascularized Bone Graft for Stage III Kienbock's Disease : Preliminary Results

PURPOSE: The aim of this study was to evaluate the preliminary results using the 4+5 extensor compartmental vascularized bone graft for the treatment of stage III Kienbock's disease and to report the usefulness of this procedure. METHODS: A retrospective study was carried out on five patients who had undergone 4+5 extensor compartmental vascularized bone graft for stage III Kienbock's disease between Jan. 2005 and Aug. 2006. All patients were composed of two patients in stage IIIA and three patients in stage IIIB according to Lichtman classification. The radiographic findings were evaluated by carpal height ratio, Stahl's index, ulnar variance and scapholunate angle. The clinical outcome was assessed using the Mayo wrist score. RESULTS: The mean age of 43.4 years(range, 21-61) and the mean follow up of 23.6 months(range, 14-31) were presented. All patients were satisfied and the mean Mayo wrist score was 78(range, 70-85). Two patients showed further lunate collapse on follow-up radiographs. Four patients had no pain in the activity of daily living, one patient had a mild occasional pain. CONCLUSION: The 4+5 extensor compartmental vascularized bone graft for the surgical treatment of stage III Kienbock's disease is the effective treatment showing satisfactory clinical results, but a lunate collapse proceeds. Before this operation, the possibility of lunate collapse should be considered.

The Effect of Patellofemoral Overstuffing in Total Knee Arthroplasty

PURPOSE: We aimed to evaluate effect on maximum knee flexion by patellofemoral overstuffing after total knee arth- roplasty MATERIALS AND METHODS: As a prospective inspection we have measured anterior hump height of distal femur in the preoperative true lateral radiographic view in those who had taken total knee arthroplasty with Genesis II which is external rotation laden prosthesis allowing to be inserted parallel to femoral anterior cortex. We compared the thickness of anterior hump height resected during operation and thickness of anterior flange of femoral prosthesis and then considered post operative thickness of patella to estimate the effect of patellofemoral overstuffing in 55 cases comparing maximum knee flexion. RESULTS: The average thickness of resected femoral anterior hump was 7.14+/-1.91mm. Average in hump overstuffing was 1.32+/-1.09mm and postoperative maximum flexion angle was average of 125.6+/-15.5 degree with average decrease of 1.8 degree. In 29 cases, Average of 1.35mm of overstuffing occurred in patella overstuffing and postoperative maximum flexion angle was average of 131.0+/-16.4 degree with average increase of 2.1 degree. Considering change of anterior femoral hump height and thickness of patella, preoperative and postoperative average maximum flexion angle was 128.9+/-14.9, 128.0+/-14.5 degree, repectively in patellofemoral overstuffing with average decrease of 0.9 degree. CONCLUSION: We concluded that the patellofemoral overstuffing does affect the decrease of the angle of maximum flexion in total knee arthroplasty and the effect of hump overstuffing is superior than patellar overstuffing effect.

A Case of Uhls Anomaly

Congenital hypoplasia of the right ventricular myocardium, also known as parchment heart or Uhl's anomaly, is a rare congenital heart defect. It was first described in Oslers principles and Practice of Medicine in 1905 and reviewed by Segall We found 29 reported cases, but there was no reported case in Korea. Recently, we experienced a case of Uhls anomaly associated with patent ductus arteriosus, atrial septal defect, pulmonary atresia and tricuspid abnormality in a 3 month-old infant, which was confirmed by autopsy. We present a case with a brief review of litteratures.