Freer Test for an Intraoperative Evaluation of a Lisfranc Joint Injury: A Technical Report

양기원,이홍섭,박성철,정구민,Young, Ki Won,Lee, Hong Seop,Park, Seongcheol,Jeong, Gu Min Korean FootAnkle Society 2020 대한족부족관절학회지 Vol.24 No.4

Failure to achieve stable fixation during surgery for a Lisfranc joint injury leads to subtle instability that causes dysfunction and posttraumatic osteoarthritis. Therefore, it is important to check for appropriate fixation during surgery. This paper reports a test that evaluates the joint instability dynamically during the open reduction of the Lisfranc joint and checks the stability after fixation. a Freer elevator was inserted into the interosseous area between the medial cuneiform and second metatarsal base, and a twisting force was applied to evaluate the dynamic instability of the Lisfranc joint. After fixation of the Lisfranc joint, the stability of the fixation could be tested by trying this maneuver with the Freer elevator. Overall, the Freer test can be considered a valuable test in open surgery for a Lisfranc joint injury.

족부 족관절에 흔히 발생하는 스포츠 손상: 외측 족관절 불안정성

양기원,이경태,김진수,Young, Ki-Won,Lee, Kyung-Tai,Kim, Jin-Su 대한정형외과스포츠의학회 2007 대한정형외과스포츠의학회지 Vol.6 No.1

족부 족관절 영역의 스포츠 손상에서 가장 많은 것은 외측 족관절 불안정성이다. 이미 이에 대하여 많은 연구 및 발표가 있어 왔다. 이 가운데 아직 결론에 도달하지는 않고, 진행중인 논제에 대하여 간략하게 살펴보고자 한다. 외측 족관절 불안전성 환자를 치료함에 있어서 좀 더 좋은 결과를 얻는데 도움이 될 것으로 생각한다. Lateral ankle instability is one of common injury in sports medicine. Already many studies were done with scientific data and clinical relationship. This review article wants to discuss about controversial subject of ankle instability. It will be conducted more precise diagnosis and treatment.

봉합사 고정을 이용한 Akin 절골술

양기원,이경태,김재영,차승도,김응수,Young, Ki-Won,Lee, Kyung-Tai,Kim, Jae-Young,Cha, Seung-Do,Kim, Eung-Soo 대한족부족관절학회 2004 대한족부족관절학회지 Vol.8 No.2

Purpose: The purpose of this study was to document the results of fixation with ethibond suture in akin osteotomy and its advantages. Materials and Methods: From May 2001 to January 2004, Akin osteotomy was performed in 218 patients. We reviewed 110 patients (114 feet) who were possible radiographic evaluation more than 6 months after operation. 110 feet had hallux valgus and 4 feet had hallux valgus interphalangeus. 105 patients were female and 5 were male. The average age was 43.8 years old (18 to 68 years old). The average follow up was 9 months (6 to 23 months). After performing the Akin osteotomy at 7 mm from the proximal articular surface of the proximal phalanx, one hole is made on either side of the osteotomy site with a K-wire. The passer was passed through the both holes and the ethibond was passed. And then, the ethibond was tied tightly. 2 sutures in 66 feet and 1 suture in 48 feet were made. Radiographic bone union at 6 months follow up was regarded as success and loss of the reduction, nonunion was regarded as failed. Results: In the radiographic evaluation, bony union were made at 6 months follow up in all feet. There was no difference between 2 sutures and 1 suture, and the knots were removed in 3 feet because of skin irritation. Conclusion: The fixation of the osteotomy site using suture material was an effective method in Akin osteotomy. The advantage of this procedure was unnecessity of the material removal.

족관절 수술 후 발생한 통증에 대한 체외충격파의 치료 효과

양기원,김진수,전성한,이도현,Young, Ki Won,Kim, Jin Su,Jeon, Sung Han,Lee, Do Hyun 대한정형외과초음파학회 2015 대한정형외과 초음파학회지 Vol.8 No.1

목적: 발목 및 족부 수술을 시행한 후 통증이 발생한 경우에 통증을 감소 시키기 위해 체외 충격파 치료(ESWT)를 시행하고 그 효과를 알아보고자 한다. 대상 및 방법: 2009년부터 2013년까지 시행한 족관절 주변 수술 후 통증이 발생한 환자 21명을 대상으로 하였다. 석고 고정을 제거하고 2개월이 지난 후에도 압통을 호소하고, 시각동통점수(VAS) 점수가 4점 이상인 경우에 ESWT를 4회 시행하였다. 각 회 및 최종 추시 상의 VAS 점수를 확인하였으며 ESWT 전과 최종 추시에서 미국 족부족관절학회 후족부-족관절(AOFAS) 점수를 비교하였다. 환자의 만족도 및 불편감을 확인하였다. 결과: 수술 전 VAS는 평균 4.7점이었으며 수술 후 통증이 발생한 시점은 VAS는 평균 6.0점이었다. 수술 후 ESWT를 시작한 기간은 평균 4.5개월이었으며, 시행 후 1, 2, 3주 및 최종 추시에서 VAS는 각각 4.8, 3.2, 2.3, 2.9점이었다. ESWT 시행 후 최종 추시는 평균 9.4개월있었다. VAS 점수는 최종 추시에서 수술 후 발생한 통증이 의미 있게 감소하였으며(p<0.001), ESWT 4회 시행 후보다 최종 추시에서 통증 점수가 증가하였으나 유의하지는 않았다(p=0.189). AOFAS 점수는 수술 전 평균 60점에서 최종 추시상 86점으로 회복되었다(p<0.001). 환자는 매우 만족이 12례(57%), 만족이 4례(19%), 변화 없음이 3례(14%) 및 불만족이 2례(9%)였다. 1례에서 ESWT 중 어지러움 및 오심을 호소하였다. 결론: 수술 후 발생한 통증 치료에 ESWT를 사용하여 심각한 합병증은 없이 76%에서 통증의 호전을 보았다. Purpose: To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) for postoperative pain after surgery around ankle. Materials and Methods: We included 21 patients who performed an operation around ankle from 2009 to 2013. 4 times ESWT were applied to the patients who have tenderness more than visual analog scale (VAS) point 4. We evaluated the VAS at each sessions and final follow-up, and American Orthopedic Foot and Ankle Society ankle-hindfoot score (AFOAS) was checked at preoperative and final follow-up. Patient's satisfaction and complications were surveyed. Results: Preoperative VAS was mean 4.7, postoperative pain VAS was mean 6.0 at 4.5 months follow-up. The VAS after ESWT each session at 1, 2, 3 weeks and final follow-up were 4.8, 3.2, 2.3, 2.9, respectively. Mean final follow-up period was 9.4 months. Final VAS were significantly decreased (p<0.001). Final VAS were increased from VAS at last session of ESWT, however, not significant (p=0.189). AOFAS significantly improved from preoperative 60 to final follow-up 86 (p<0.001). Excellent was 12 patients (57%), good was 4 patients (19%), no change was 3 patients (14%) and poor was 2 patients (9%). 1 patient complained a dizziness and nausea during ESWT. Conclusion: ESWT for postoperative pain after ankle surgery shows satisfactory pain reduction in 76% of all patients without severe complication.

족근 주상골에 발생한 유골골종 - 증례 보고 -

양기원,이경태,이세영,김완섭,최성이,Young, Ki-Won,Lee, Kyung-Tai,Lee, Se-Young,Kim, Wan-Seop,Choi, Sung-I 대한족부족관절학회 2002 대한족부족관절학회지 Vol.6 No.2

Delay in diagnosis is possible in bone tumor located in the foot because it is rare. We experienced one case of osteoid osteoma located at the navicular bone of the foot which was slowly progressive and complicated with calcaneocuboidal joint, talonavicular joint arthritis. Osteoid osteoma of the navicular bone in the foot is rare. It bring about unwanted delay in diagnosis, complication. It is necessary to diagnose and treat in early situation to prevent complication and unnecessary operation.

축구의 특별한 손상: 서혜부 손상

양기원,김진수,김준호,김장열,박성률,최재혁,Young, Ki-Won,Kim, Jin-Su,Kim, Jun-Ho,Kim, Jang-Yeol,Park, Sung-Ryul,Choi, Jae-Hyuck 대한정형외과스포츠의학회 2006 대한정형외과스포츠의학회지 Vol.5 No.2

서혜부 손상은 축구 손상의 약 10% 정도를 차지하고 있다. 이런 손상은 경기 중 컷팅이나, 사이드 스텝, 가속, 감속, 급격한 방향 전환 등의 긴장력이 서혜부에 가해질 때 발생 할 수 있다. 증상 또한 다양해서, 수일 내에 복귀 할 수도 있으나 동통이 심해져서 운동을 포기해야 할 경우까지 있다. 또한, 어느 한 질환에 국한된 것이 아니기 때문에 서혜부에 동통이 발생할 경우 여러가지 질환을 염두에 두어야 하며, 흔한 손상으로는 서혜부 주변의 근육 및 인대 손상이며 그 외에 신경압박 증상(nerve entrapment), 탈장(hernia), 복부 근육 약화(sportsman's hernia), 치골유합부염(symphysitis), 피로골절 (stress fracure) 및 고관절 질환 등을 들 수 있다. The Incidence of groin injury was about 10% in football player These injuries occur most commonly in athletes participating in sports Involving cutting, quick accelerations and decelerations and sudden directional changes. Symptoms may range from intermittent episodes of mild discomfort to severe and chronic career-ending pain. Groin injuries may result from a variety of causes. We must keep in mind that many other conditions may also affect the groin. Because of the anatomy of the region is so complex. Ligament/muscle strains, nerve entrapment syndromes, sportsman's hernia, symphysitis, stress fractures and various hip pathologies are reviewed as causes of groin pain are reviewed as common causes of groin pain.

만성 외측 발목 불안정증의 수술적 치료

양기원,이홍섭,황지선,Young, Ki Won,Lee, Hong Seop,Hwang, Ji Sun 대한족부족관절학회 2021 대한족부족관절학회지 Vol.25 No.1

Surgical treatments for chronic lateral ankle instability include anatomic repair, anatomic reconstruction using an auto or allograft, non-anatomic reconstruction, and arthroscopic repair. Open anatomic repair using the native ligament with or without reinforcement of the inferior extensor retinaculum is commonly performed in patients with sufficient ligament quality. Non-anatomical reconstruction using the adjacent peroneus brevis tendon is typically used only in patients with poor-quality ligament remnants or when previous repair failed. Anatomical reconstruction can be considered in patients in whom anatomical repair is expected to fail and when performed using auto or allografts can provide good to excellent short-term results, although the long-term outcomes of these methods remain unclear. Arthroscopic repair can provide good to excellent short-term clinical outcomes, but evidence supporting this technique is limited. The advantages and disadvantages of various surgical methods should be compared, and appropriate treatment should be implemented based on patient characteristics.

무지 외반증 환자에서 스카프 절골술을 이용한 치료

양기원,이경태,김재영,이희동,Young, Ki-Won,Lee, Kyung-Tai,Kim, Jae-Young,Lee, Hui-Dong 대한족부족관절학회 2003 대한족부족관절학회지 Vol.7 No.2

Purpose: The purpose of this study was to the evaluate the clinical and radiographic results and complication of the Scarf osteotomy which is one of the surgical treatment of Hallux valgus. Material and Method: Fifty feet (30 patients) of moderate to severe hallux valgus deformity were operated by Scarf osteotomy procedure from January 2002 to July 2002. Patients were asked about their satisfaction in terms of pain, appearance and motion. The AOFAS clinical ratio scales and radiographic results for hallux valgus were evaluated. Result: The mean Hallux valgus angle improved from an average of 30.6 degrees to 9.0 degrees and the first intermetatarsal angle improved from an average 13.3 degrees to 5.2 degrees respectively. The preoperative mean AOFAS score was 58 points and on last follow up AOFAS score improved to 88 points. Complication which including troughing, nonunion, malunion was not developed. Conclusion: We found that Scarf osteotomy is a reliable operation for mild to moderate Hallux valgus deformity as regards firm fixation and early postoperative ambulation and large contact area for union.

모턴씨 신경종

양기원(Ki-Won Young),이홍섭(Hong-Seop Lee) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.4

전족부 통증의 가장 흔한 원인 중 하나인 모턴씨 신경종은 다른 말로 지간 신경종이라고도 불린다. 지간 신경종은 족지의 지간 신경이 횡형 중족골 골간 인대를 지나면서 압박되어 나타나는 압박성 신경병증이고 진정한 종양은 아니다. 병리적 소견은 신경 주위 섬유화, 축삭 돌기의 변성 등이 보인다. 전족부 통증이 자주 보이는 증상이며 압박되는 신경 분지에 따라서 발가락으로의 방사통 등이 나타난다. 진단은 자세한 병력 청취 및 압박 검사 등의 신체 검사를 통해 진단할 수 있고 초음파 또는 자기공명영상촬영으로도 진단이 가능하다. 치료로는 보존적 방법을 우선적으로 권장하나 증상의 완화가 관찰되지 않을 때에는 수술적 절제 또는 감압을술 추천한다. Morton’s neuroma, also known as interdigital neuroma, is a common cause of forefoot pain. It is a compressive neuropathy of the interdigital nerve, which is compressed by the overlying transverse metatarsal ligament. It is not a true tumor. The symptoms are forefoot pain that radiates into the toes, according to the involved nerve branches. Its histological findings are fibrosis around the nerve, demyelination. The clinical diagnosis can be obtained from a detailed history and physical examination, such as the compressive test. Moreover, ultrasonography and magnetic resonance imaging can also be used. Conservative treatment is the common initial treatment modality for interdigital neuroma. Surgical excision or decompression is indicated after a failure of conservative treatments.

족부 족관절에서 발생한 상피낭종

양기원(Ki-Won Young),김진수(Jin-Su Kim),조주원(Joo-Won Joh),염철현(Cheul-Hyun Yeom),박영욱(Young-Uk Park),이경태(Kyung-Tai Lee) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.2

목적: 족부, 족관절에서 발생하는 상피낭종의 발생위치 및 절제술 시행 후 재발률을 확인하고자 한다. 대상 및 방법: 2004년부터 2011년 까지 절제술 후 조직학적으로 상피낭종이 확진된 환자 37명에 대하여 종양의 발생 위치 및 크기를 측정하였고, 수술 전후 시각동통점수(visual analogue scale, VAS)와 수술 후 추시상 재발여부 및 만족도를 확인하였다. 결과: 제1 족지가 15예(40.6%)로 가장 많았으며, 발목 7예(18.9%), 제2 족지 6예(16.2%), 제3 족지 4예(10.8%), 제4 족지 1예(2.7%), 제 5 족지 2예(2.7%) 및 뒤꿈치가 2예(2.7%)였다. 측정이 가능하였던 35명에서 평균 크기는 15.5×15.0×7.9 ㎜였다. 수술 전 VAS는 평균 6.5점에서 절제술 후 평균 1.0점으로 감소하였다. 7명(18.9%, 제1 족지: 5예, 제2 족지: 2예)에서 재발하였고, 수술 후 아주 만족이 30명(81.0%), 만족한 경우 2명(5.4%), 불만족한 경우가 5명(13.5%)이었다. 재발 후 재수술을 4명에서 시행하였고, 재수술 후 1예에서 다시 재발하였다. 결론: 족부, 족관절에 발생한 상피낭종은 절제술 후 18.9%의 재발률을 가지므로 절제술 시 주의를 요한다. Purpose: To document post-excision recurrence rates for epidermal cysts of the foot and ankle by location. Materials and Methods: The authors retrospectively reviewed epidermal cysts confirmed histologically by excisional biopsy in 37 patients (male 20, female 17) from 2004 to 2011. Cyst locations and sizes were analyzed and preoperative and postoperative pain levels were compared using a visual analogue scale (VAS). Rates of recurrence and patient satisfaction levels were also measured. Results: Epidermal cysts occurred most commonly on the 1st toe (15 cases, 40.6%), followed by the ankle (7 cases, 18.9%), 2nd toe (6 cases, 16.2%), 3rd toe (4 cases, 10.8%), 4th toe (1 case, 2.7%), 5th toe (2 cases, 5.4%), and heel (2 cases, 5.4%). Average cyst size in 35 cases was 15.5×15.0×7.9 ㎜. VAS reduced from 6.5 preoperatively to 1.0 postoperatively. Cysts recurred in 7 cases (18.9%); on the 1st toe in 5 and on the 2nd toe in 2. Thirty patients (81.0%) were very satisfied with treatment results, 2 patients (5.4%) were satisfied, and 5 (13.5%) were not satisfied. Recurrence occurred in 4 cases, and in one of these cases the cyst recurred after second excision. Conclusion: The excision of epidermal cysts in the foot and ankle area was found to have an 18.9% recurrence rate. To achieve good results, the precise location of cysts should be determined by imaging study before excision, and cysts must be excised completely.