Contribution of Lateral Ankle Instability Evaluation with MRI to Proximal Fifth Metatarsal Fracture / 대한족부족관절학회지

PURPOSE: One of the main contributors to proximal fifth metatarsal fracture is ankle inversion and the incidence of recurrence may increase in patients with ankle instability. So, the authors confirmed the patients of proximal fifth metatarsal fracture with ankle instability by checking the history and magnetic resonance imaging (MRI) and assessed the value of MRI as therapeutic prognosis and clinical indicators for prevention of recurrence. MATERIALS AND METHODS: Patients with proximal fifth metatarsal fractures visited our hospital during recent five years were reviewed. 35 patients with suspected damage by ankle inversion had been identified a history of ankle instability and checked the hindfoot malalignment through hindfoot alignment view and MRI was performed prospectively. The patients was devided to three groups on the location of fracture site and the groups were compared each other. RESULTS: The mean time from injury to checking MRI was 10.7 days. There was no structural abnormality and was no significant difference according to the location of fracture. The patients with history of ankle inversion were 31(88.6%) and the patients with history of chronic or recurrent injury were 22 patients (62.9%). The lesion of MRI related to lateral ankle instability were identified in all patients. CONCLUSION: This study noted a high incidence of lateral ankle instability that was identified by MRI in the patients of proximal fifth metatarsal fracture. Aggressive treatment for lateral ankle instability should be needed for complications as proximal fifth metatarsal fracture to reduce the recurrence and occurrence.

Reconstruction for Chronic Lateral Instability of the Ankle by Chen Method / 대한족부족관절학회지

PURPOSE: This study was designed to evaluate the clinical and radiographical results of anatomical reconstruction by Chen method for chronic lateral ankle instability. MATERIALS AND METHODS: Fifteen patients with chronic lateral ankle instability who had undergone anatomical reconstruction of anterior talofibular and calcaneofibular ligaments by Chen method were evaluated retrospectively. Average age of the patients was 31.3 years, and average follow-up period was 15.5 months. Preoperative and postoperative radiographs including varus stress view and magnetic resonance imaging (MRI) were analyzed. The clinical evaluation was performed according to the American Orthopaedic Foot and Ankle Society (AOFAS) scale. RESULTS: Radiographically average talar tilt angle was 15.3degrees preoperatively, and the difference with contralateral normal side was 10.1degrees. At last follow up, talar tile angle and the difference with contralateral side improved to 5.9degrees and 1.3degrees respectively. AOFAS scale was 66.6 preoperatively and 87.3 postoperatively. In MRI findings, four patients had associated intra-articular lesion such as articular cartilage defect, synovitis and osteoarthritis. The talar tilt angle improvement and AOFAS scale of patients without intra-articular lesion was better than those of four patients with intra-articular lesions. Surgical wound pain occurred in six patients and sural neuropathy in three patients. CONCLUSION: The anatomical reconstruction by Chen method was an easy and effective procedure for symptomatic chronic lateral ankle instability. Careful operative technique may prevent the surgical wound pain and sural neuropathy.

The Change of the Mechanoreceptors of Injured Achilles Tendon According to the Immobilization Periods / 대한족부족관절학회지

PURPOSE: This study was designed to determine the quantitative changes of the numbers of the mechanoreceptors in the experimentally tenotomized Achilles tendon of rabbits as compared with short-term immobilization and long-term immobilization. MATERIALS AND METHODS: 14 white rabbits were used. After tenotomizing the right Achilles tendon, the subjects were divided into 2 groups according to the periods of immobilizaton. The left side of each Achilles tendon of the rabbits were used as controls. The tendons were stained with a modified gold-chloride method. RESULTS: The number of mechanoreceptor was significantly decreased in the tenotomized Achilles tendon group than the control group (p0.01). CONCLUSION: The injured Achilles tendons may more vulnerable to injury because of the decreased numbers of mechanoreceptors, but no difference between the periods of immobilization. It may suggest that post-operative immobilization period may not affect on the outcome of operative treatment from the viewpoint of mechanoreceptors.

The Change of the Mechanoreceptors of Injured Achilles Tendon According to the Immobilization Periods / 대한족부족관절학회지

PURPOSE: This study was designed to determine the quantitative changes of the numbers of the mechanoreceptors in the experimentally tenotomized Achilles tendon of rabbits as compared with short-term immobilization and long-term immobilization. MATERIALS AND METHODS: 14 white rabbits were used. After tenotomizing the right Achilles tendon, the subjects were divided into 2 groups according to the periods of immobilizaton. The left side of each Achilles tendon of the rabbits were used as controls. The tendons were stained with a modified gold-chloride method. RESULTS: The number of mechanoreceptor was significantly decreased in the tenotomized Achilles tendon group than the control group (p0.01). CONCLUSION: The injured Achilles tendons may more vulnerable to injury because of the decreased numbers of mechanoreceptors, but no difference between the periods of immobilization. It may suggest that post-operative immobilization period may not affect on the outcome of operative treatment from the viewpoint of mechanoreceptors.

Effect of Chronic Foot Disease to Bone Mineral Density of the Affected Lower Limb / 대한족부족관절학회지

PURPOSE: Pain or discomfort caused by foot diseases may lead to abnormal gait, resulting in decreased bone mineral density (BMD) of the affected lower limb. We analyzed the effect of foot affection to BMD and its clinical significance. MATERIALS AND METHODS: Bilateral hip BMD was evaluated in 93 patients with unilateral chronic foot disease. To minimize statistical errors, we excluded patients with medical histories that had influence on BMD. Analysis was based on the results of BMD tests at the first visit. All patients denied past medical intervention for osteoporosis. The difference in density between bilateral limbs was determined by comparing BMDs of the neck, upper neck, trochanter and total area of hip. RESULTS: Test results revealed the decrease of BMD in the lower limb with the affected foot, compared to the unaffected side. This decrease was significant in the area of the trochanter (p<0.05). There was no marked difference of BMD in relation with duration of affection, underlying disease or age. Pertaining the location of foot affection, the hindfoot group showed significant decrease in BMD compared to the forefoot group. The group with affection in bone and joint also showed a marked decrease in BMD compared to the soft tissue group (p<0.05). CONCLUSION: Pain and discomfort caused by chronic foot diseases can lead to a decrease in the BMD of the affected lower limb. This may increase the risk of complications such as osteoporotic fracture and muscular atrophy.

Combined First Metatarsal and Calcaneal Osteotomy for Fixed Cavovarus Deformity of The Foot / 대한족부족관절학회지

PURPOSE: The aim of this study was to evaluate the result of combined first metatarsal and calcaneal osteotomy for static cavovarus deformity of the foot. MATERIALS AND METHODS: We performed a dorsal closing wedge 1st metatarsal osteotomy and a lateral and upward displacement calcaneal osteotomy for 9 patients, 12 feet (6 male and 3 female). The mean age at the time of operation was 37 years and the mean followup period was 27 months. The causes of deformity were 2 poliomyelitis, 1 cerebral palsy, 1 Charcot-Marie-Tooth disease and 5 idiopathic type. Five lateral ligament reconstructions of the ankle and six percutaneous Achilles tendon lengthenings were added. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of AOFAS ankle-hindfoot score and talo-1st metatarsal, calcaneus-1st metatarsal and calcaneal pitch angles were checked with weight bearing radiographs in lateral projection. RESULTS: Talo-1st metatarsal and calcaneal pitch angles were reduced from the mean preoperative values of 21degrees and 25degrees to 12degrees and 19degrees, respectively, at last followup. Also, calcaneus-1st metatarsal angle was increased from the mean 114degrees to 144degrees. The mean AOFAS score was improved from 44.5 points preoperatively to 89.2 points at followup. There were 1 metatarso-cueiform joint nonunion, 1 sural nerve injury and 3 remaining symptomatic claw toes. CONCLUSION: Combined first metatarsal and calcaneal osteotomy appears to be an effective procedure for the treatment of adult static cavovarus foot.

Stress Fracture of the Proximal Fibula in Military Recruits

BACKGROUND: We wanted to report on stress fracture of the proximal fibula and to suggest the pathomechanism of this fracture. METHODS: Between April 2004 through April 2005, the military recruits who complained of leg pain during the 6 weeks basic training in the Republic of Korea Marine Corps education and training group were evaluated according to their clinical manifestations and plain radiographs. RESULTS: Twelve recruits of 635 recruits who complained leg pain were diagnosed as having fibular stress fracture. Eleven cases (10 recruits) appeared at the junction of the proximal and middle 1/3 of the fibula and 2 cases (2 recruits) were in the middle 1/3 of the fibula, as assessed radiologically. Tenderness was the most reliable clinical manifestation. All the fractures occurred after repetitive walking or jumping in a squatting position. Conservative treatments that included bed rest, immobilization and non-steroidal anti-inflammatory drugs administration according to the symptom severity were satisfactory. CONCLUSIONS: Proximal fibular stress fracture is not rare in military recruits. The shearing force on the proximal fibula and the repetitive stress by walking or jumping in a squatting position contribute to the stress fracture of the proximal fibula.

Treatment of the Chronic Achilles Tendon Rupture by Lindholm Method / 대한족부족관절학회지

PURPOSE: This retrospective study was designed to evaluate the treatment results of chronic Achilles tendon rupture by Lindholm method. MATERIALS AND METHODS:Between 2002 and 2006, we performed the reconstruction of the Achilles tendon by using of the gatrocnemius-sloeus fascia known as Lindholm method. Ten cases of ten patients were enrolled in this study (8 men and 2 women). The mean age of the patients at the time of operation was 49 years (range, 32~66 years). The mean follow-up duration was 15.2 months (range, 12~19 months). The retrospective review of the clinical history, physical examination, the American Orthopedic Foot and Ankle Society (AOFAS) score were conducted. RESULTS:The mean AOFAS score before surgery was 74.10+/-2.56 and that of the latest follow-up was 90.60+/-5.72. The excellent results were six and good results were four patients. Eight patients were normal triceps power and the others were good. The average of heel to floor distance was 4.5 mm less in the operated legs than the contralateral ones in each patient, but there was no significant difference (p>005). The average of calf muscle circumference in the mid-leg was 7.5 mm less in the operated legs than the contralateral ones and there was significant difference (p<0.05). The active range of motion of the ankles, mean plantarflexion was 40 degrees and dorsiflexion was 16.8 degrees in operated side. The contralateral side was 43 degrees in plantarflexion and 19 degrees in dorsiflexion. No case showed rerupture of the reconstructed Achilles tendon. One patient had the superficial wound infection which was treated successfully by antibiotic therapy. CONCLUSION: It was suggested that the overall results of Lindholm method for the chronic Achilles tendon rupture indicated satisfactory outcomes

Associated Lesions of Magnetic Resonance Image in the Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: This retrospective study was designed to determine the type and frequency of associated lesions in patients with chronic lateral ankle instability who had modified Brostrom lateral ankle ligament reconstruction. MATERIALS AND METHODS:Between 2004 and 2007, 60 cases of 60 patients were enrolled in this study. A retrospective review of the magnetic resonance images of the affected ankle was conducted by two orthopedic surgeons who did not get any information about intraoperative findings and the lesions were admitted when two doctors were coincident. RESULTS:The overall incidence of associated lesions found in this study was about 83%. Peroneal tenosynovitis was the highest frequency (32%), followed by osteochondral lesion of talus (28%), anterolateral impingement (15%), Os subfibula (13%), Os trigonum (12%), ankle synovitis (12%), anterior tibiofibular ligament tear (15%), anterior bony spur (7%). Another findings were loose bodies (5%), flexor tendon tenosynovitis (5%), medial osteophyte (3%). CONCLUSION: Identifying these associated lesions will be helpful in treating chronic lateral ankle instability especially when the surgeon have a plan to operate the instability. We suggest that the better results can be obtained when the associated lesions are corrected simultaneously.

Modified Scarf Osteotomy for Hallux Valgus with Lesser Metatarsalgia / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the radiological and clinical results of modified scarf osteotomy for hallux valgus with lesser metatarsalgia. MATERIALS AND METHODS: Total 19 patients (24 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 46.4 years. The mean follow-up time was 14.8 months. We modified original scarf osteotomy by adding the procedure of closing wedge osteotomy at the medial side of distal fragment for achieving of the supination of the first metatarsal head. Additionally, Akin osteotomy of the first proximal phalanx was done in 16 patients (20 feet) and no lesser metatarsal operation was done. First-second intermetatarsal, hallux valgus and distal metatarsal articular angles were analyzed radiologically before and after the operation. And 3-dimensional CT was used to evaluate the supination of the first metatarsal head. Clinical results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) score and persistence of lesser metatarsalgia. RESULTS: First-second intermetatarsal and hallux valgus angles were reduced from the mean pre-operative values of 14.2degrees and 32.5degrees to 8degrees and 12.5degrees, respectively, 12 months after the operation. And the supination of the first metatarsal head was confirmed by 3-dimensional CT. The mean AOFAS score improved from 41.4 points pre-operatively to 87.2 points at follow-up. Lesser metatarsalgia still remained in 2 patients (2 feet). CONCLUSION: Modified scarf osteotomy would be an effective surgical procedure, especially, for achieving downward displacement and supination of the first metatarsal head in hallux valgus with lesser metatarsalgia.

A Study of Prognostic Factors of Conservative Treatment in Plantar Fasciitis / 대한족부족관절학회지

PURPOSE: We analyzed to find out prognostic factors in the conservative treatment for the plantar fasciitis. MATERIALS AND METHODS: The data were collected from 145 patients, 159 feet (M:F = 51:108) with conservative treatment and analyzed for possible prognostic factors : sex, age of onset, the duration of symptom before treatment, pain score before treatment, the duration for symptom remission, medication period, calcaneal pitch angle, and presence of calcaneal spur. RESULTS: The duration of symptom before conservative treatment is affected to the prognosis, and the borderline of the effective period was about 6 months. CONCLUSION: With the conservative treatment of the plantar fasciitis, we found that (1) the duration of symptom before the conservative treatment was a prognostic factor, and (2) if the period before the conservative treatment was more than 6 months, the other treatment option such as surgery should be considered for this chronic group.

Ultrasonographic Appearances of the Plantar Fasciitis / 대한족부족관절학회지

PURPOSE: This retrospective study was designed to evaluate the appearances of plantar fasciitis by ultrasonography. MATERIALS AND METHODS: 48 cases of unilateral plantar fasciitis were enrolled in this study. Plain radiograph and real- time sonography of both feet were perfomred and the results were compared between the affected feet and controlateral symptomless feet. Calcaneal spur were observed on plain radiograph and thickness of plantar fascia, hypoechogenecity, blurring of border of plantar fascia, perifascial effusion, wavy plantar fascia were observed on sonography. RESULTS: Women (35 cases) and left feet (30 cases) were more frequent than men and right feet. Thickness of plantar fascia in affected site was thicker than normal site (p<0.01). Hypoechogenecity was observed only in 39 cases (81%) affected site, blurring of border of plantar fascia in affected site was 30 cases (62%) and 7 cases (15%) in normal site, perifascial effusion was observed only in 38 cases (79%) affected site, wavy plantar fascia in affected site was 43 cases (90%) and 2 cases (4%) in normal site. Calcaneal spur in affected site was 36 cases (75%) and 33 cases (69%) in normal site. CONCLUSION: Sonography is a useful diagnostic procedure for the plantar fasciitis especially in the unilateral plantar fasciitis.

Neural Injuries in Ankle Sprain / 대한족부족관절학회지

PURPOSE: The neural injuries by the sprain around the ankle joint may contribute the chronic pain. Authors analyzed the incidence and the contributing factor of the neural injuries in ankle sprain. MATERIALS AND METHODS: 52 patients (54 cases) were involved in this retrospective study. Patient with diabetes or spinal disease were excluded. Plain radiograph and MR image were evaluated. Treatments were consisted of cast immobilization for 4 weeks with weight bearing ambulation following bracing for 8 weeks. Neurologic evaluation were performed at 3 months, 6 months, 12 months post-injury period and each neural injury were confirmed by electromyography or lidocaine block test. RESULTS: The average age was 39 years old and 34 cases were male and 20 cases were female. Rupture of the anterior talofibular ligament was observed in 48 cases, distal anterior tibiofibular ligament in 37 cases, calcaneofibular ligament in 6 cases. One cases revealed no injury of the ligament. Neural injuries around ankle was observed in 13 cases ; superficial peroneal nerve in 9 cases, sural nerve in 5 cases, saphanous nerve in 1 case. Neural injury was not influenced by the degree of ligament injuries but by the incidence numbers of ankle sprain. All cases were treated conservatively and symptom was subsided in all but 2 cases. CONCLUSIONS: Although the incidence is relatively low, the neural injuries in ankle sprain may occur in the recurrent ankle sprain and conservative treatment for neural injuries is satisfactory.

Comparison of Distal Chevron Osteotomy between with and without Adductor Tenotomy in the Treatment of Hallux Valgus / 대한족부족관절학회지

PURPOSE: Authors analyzed and compared the treatment result of distal chevron osteotomy between with and without adductor tenotomy. MATERIALS AND METHODS: 36 patients (60 feet) with a minimum follow-up of one year were involved in this retrospective study. The chevron osteotomy without adductor tenotomy was performed for 20 patients (30 feet) and chevron osteotomy with adductor tenotomy was done for 16 patients (30 feet). The first metatarsophalangeal (MTP) angle and angle between first and second metatarsal longitudinal axis (IM) was measured. The difference of these angles were measured pre-and postoperatively and compared using Student's T-test. RESULTS: In the group of chevron osteotomy with adductor tenotomy, the mean first MTP angle corrected 29 degrees pre-operatively to 9 degrees and the mean first IM angle corrected 16 degrees pre-operatively to 12 degrees. In the group of chevron osteotomy without adductor tenotomy the mean first MTP angle corrected 31 degrees pre-operatively to 11 degrees (P>0.05) and the mean first IM angle corrected 13 degrees pre-operatively to 11 degrees (P>0.05). Deep peroneal neuroma were found in 3 cases of chevron osteotomy with adductor tenotomy. CONCLUSIONS: Adductor tenotomy should be performed in selected patient with chevron osteotomy to prevent deep peroneal neuroma.

Factors Affecting on Conservative Treatment of Morton's Neuroma / 대한족부족관절학회지

PURPOSE: The purpose of this study was to investigate the clinical results of conservative treatment for Morton's neuroma and to analyze the factors which influenced on the results. MATERIALS AND METHODS: In this retrospective study, 101 cases of 83 patients with interdigital neuroma were conservatively treated with follow-up period of at least 6 months. There was no significant difference in results among different age groups, sxes, and lesion sites. However, the results were significantly better if the treatment was started within 6 months after onset. RESULTS: We had 28 excellent results (28%), and 13 good results (13%). Patients were grouped by sex, age, duration of symptom before treatment, affected location. The result of treatment was evaluated by comparing the subject pain and discomfort score of the first vist and last follow-up. CONCLUSION: There are excellent results over 41% by conservative treatment. The results of conservative treatment were not related to age, sex, and lesion site, but were related to pre-treatment period. The shorter the pretreatment period was, the better the results.

Hallux Valgus Angle in Ballet, Mordern and Trditional Dancers / 대한정형외과학회잡지

Various etiologies of hallux valgus and metatarsus primus varus have been reported, but still they are not conclusively established. Furthermore, between hallux valgus and metatarsus primus varus, the question is unanswered as to which is the cause and which is the result. To determine the primary cause and attribution of high heeled position to hallux valgus and metatarsus primus varus, we selected three different types of dancer. Traditional dancers wear cotton sox and strike the heels first to move, modern dancers walk or run and jump on naked feet, and ballerinas stand, walk or jump on their toes with hard wooden shoes, so the latter two types of dancers move with extremely high-heeled position. We analyzed the plain AP roentgenography of 84 feet for 16 ballerinas, 13 modern and 13 traditional dancers. The results were as follows : 1. First metatarsalgia was noted in 38% of modern dancers and 43% of ballerinas but none in traditional dancers. 2. The mean hallux valgus angle was 13.6°±2.7° in traditional dancers, 13.5°±3.8° in modern dancers, 18°±3.3° in ballerinas which are statistically significant between ballerinas and modern, traditional dancers(P 0.01). Therefore, it is concluded that medio-lateral compression of shoes may be the principal contributor for the hallux valgus rather than high heel, and hallux valgus is the primary deformity.

Change of Longitudinal Axis of Radius and Ulna in Cubitus Varus Deformity / 대한정형외과학회잡지

Cubitus varus, which includes deformities of varus, hyperextension and internal rotation, is the most common complication of supracondylar fracture of the humerus in children. For correction of cubitus varus deformity, many operative methods have been reported but postoperative results are not always satifactory. For the purpose of detection of the reason of postoperative residual deformity, we reviewed AP roentgenography of 22 patients of cubitus varus deformity in the view point that change of longitudinal axis of forearm contribute the residual deformity. The results are summerized as follows: 1. Degree of cubitus varus deformity was more severe in the patients whose interval between the injured time and visiting hospital for cubitus varus was longer. 2. Average proximal radial shaft angle was 10.99degrees +/-3.48degrees in normal limb and 15.72degrees+/-4.03degrees in affected limb and average ulnar shaft angle was 7.86degrees+/-3.60degrees, 10.54degrees +/-4.02degrees (P0.05). 3. More severe cubitus varus deformity revealed more change of proximal radial shaft angle of attected limb compare to normal limb. Based on these results, we concluded that correction of the cubitus varus deformity should not be delayed in order to minimize the secondary change of longitudinal axis of foream bones and to obtain satisfacotry cosmetic outcome.

Proximal Tibia Opening Wedge Osteotomy for Treatment of Genu Recurvatum after Ipsilateral Femoral Shaft Fracture / 대한정형외과학회잡지

In 1988, a new fascioutaneous flap, the Lateral supramalleolar flap, was introduced by Masquelet and Roman. The flap is designed on the lower third of the aspect of leg, and supplied by a cutaneous branch from the perforating branch of the peroneal artery. This perforating branch continues distally deep to the fascia along the anterior ankle and into the foot. This can be use as either proximally based rotation flap or distally based reversed pedicle island flap giving the flap an arc of rotation that allows coverage of the dorsal, lateral and plantar aspects of the foot, the posterior heel and the lower medial portion of the leg. The authors have recently used this flap for 13 cases of foot and ankle soft tissue defect reconstruction and all the cases, except two partial marginal necrosis, good postoperative course. In our opinion, this flap is useful for reconstruction of foot and ankle soft tissue defect which does not need nerve innervation. The main advantages of the flap are as follows 1. It may be a rather large flap(15×9cm2 ). 2. The pedicle is long(8cm) and easy to dissect. 3. The pivot of the pedicle is distal(sinus tarsi) and allows great local possibilities of coverage. 4. It does not require the sacrifice of a main artery.

The Incidences and Locations of Osteochondral Lesions of the Talus in Ankle Fracture / 대한정형외과학회잡지

PURPOSE: An osteochondral lesion of the talus in ankle fracture needs appropriate treatment to prevent traumatic arthritis. Despite the high incidence of an osteochondral lesion in cases of ankle fracture, it is difficult to identify the location of the lesion during open fracture reduction due to limitation of the surgical approach. Therefore, we reviewed retrospectively the MRIs of ankle fractures to determine the incidences and locations of osteochondral lesions of the talus according to ankle fracture injury mechanism. MATERIALS AND METHODS: The MRIs of forty patients with ankle fractures were reviewed. Locations of osteochondral lesions were divided into nine areas; i.e., medial, central, lateral and anterior, central, posterior. Injury mechanisms were divided into supination and pronation groups. RESULTS: Twenty eight (70%) out of 40 patients with ankle fractures had an osteochondral lesion of the talus. Thirteen (46%) patients were allocated to the supination group and 15 (54%) to the pronation group. Lesion locations were; 7 cases of lateral, 1 central, 5 medial and 8 posterior, 3 central, and 2 anterior for supination injury. In cases of pronation injury, 13 were lateral, 1 each central and medial, and 9 posterior, 5 central, and 1 anterior. The incidences of osteochondral lesions were significantly different at the lateral and central areas, and also between the posterior and anterior areas in both the supination and pronation groups. CONCLUSION: For osteochondral lesion in cases of ankle fracture, careful observation of the posterior and lateral areas of the talar dome should be performed and additional treatment should be added for the lesion if required.

Comparison between Screw Fixation and Tension Band Wiring for the Treatment of Medial Malleolar Fractures / 대한정형외과학회잡지

In the treatment of malleolar fracture, anatomical reduction and rigid internal fixation are essential to prevent the complications such as infection, malunion or nonunion, traumatic arthritis, skin necrosis and joint contracture. But it is often difficult to obtain rigid fixation for medial malleolar fracture because of its comminution or thin cortex with osteoporosis. Generally, two operative methods are available for medial malleolar fracture, which are malleolar lag screw fixation and tension band wiring. The purpose of this paper is to analyze which operative method is better for anatomical reduction and rigid fixation and has less postoperative complications for medial malleolar fractures. From March 1992 through March 1995, 88 patients had undergone surgical intervention for medial malleolar fractures. The patients were divided into 2 groups according to operative method for medial malleolar fracture. For one group, malleolar lag screw together with or without a K-wire was used in 48 patients, and for the other group, tension band wiring was used in 40 patients. The average follow-up periods were 14 months in screw fixation group and 13 months in tension band wiring group. The average union time were 15.4 weeks (8-17 weeks) in screw fixation group and 12.2 weeks (6-15 weeks) in tension band wiring group. 27 cases (56%) showed excellent result in screw fixation group and 30 cases (75%) in tension band wiring group. In the patient over 50 years old, 2 (15%) in 13 cases showed excellent result of screw fixation group, while 5 (45%) in 11 cases of tension band wiring group. We concluded that tension band wiring is a better method for medial malleolar fracture to obtain early union and to prevent postoperative complications, especially in the elderly patient.