운동선수의 제5 중족골 피로골절

이경태,박영욱,제갈혁,김준범,Lee, Kyung-Tai,Park, Young-Uk,JeGal, Hyuk,Kim, Jun-Beom 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.2

Fractures located at the metaphyseal/diaphyseal junction at the base of the fifth metatarsal were first described by Sir Robert Jones in 1902. However, ever since, there has been disagreement and debate regarding the diagnosis, classification, pathomechanics, the incidences, and potential causes of delayed unions and nonunions, and the optimal method of treatment. It appears to be widely agreed that proximal fractures of the metaphyseal/diaphyseal region of the fifth metatarsal are prone to delayed union or even nonunion. Several classifications of proximal fifth metatarsal stress fractures have been devised. Torg et al. classified fractures involving the proximal part of the diaphysis of the fifth metatarsal into three types. The Torg classification is a good grading system that can be used to determine the type of surgery needed as well as for the prediction of prognosis. The ''plantar gap'' might add to the decision-making process for surgery and improve the prediction of patient prognosis. In addition, the new classification using 'plantar gap' might be used for classification of fifth metatarsal stress fracture. Fifth metatarsal stress fractures can be treated conservatively or surgically, and excellent results have been reported for surgery with rapid recovery in athletes. Intramedullary screw fixation has become a popular form of fixation for fifth metatarsal stress fractures. Bone grafting presents the problems of a longer recovery time and additional skin incision for harvesting. The modified tension band wiring is an useful and simple option for surgical treatment of challenging fifth metatarsal stress fractures.

Clinical Article : 운동선수에서 발생한 장무지 굴곡근 건초염에 대한 초음파 평가

이경태 ( Kyung Tai Lee ),김준범 ( Jun Beom Kim ),박영욱 ( Young Uk Park ),제갈혁 ( Hyuk Jegal ),전재균 ( Je Gyun Chon ),이종근 ( Jong Geun Lee ) 대한스포츠의학회 2013 대한스포츠의학회지 Vol.31 No.2

The purpose of this study was to investigate the ultrasonographic features of flexor hallucis longus (FHL) tenosynovitis in sports players. High-resoluted ultrasound was used to measure the thickness and echogenicity of the flexor hallucis longus at the posteromedial ankle, especially the fibro-osseous tunnel, for 60 sports players (120 feet). They were compared with their asymptomatic feet. There were two group; group 1 was symptomatic feet, 2 was asymptomatic. The 36 males (72 feet) and 24 females (48 feet) had an average age of 21.3 years (range, 18.23 years). Thickness, echogenicity of the tendon on each group were evaluated by the ultrasonography and the results were statistically analyzed. The mean thickness of the FHL on group 1 was 3.4±1.2 mm, 2.1±1.3 mm on group 2. There was significant difference between two groups (p=0.002). The thickness of FHL based on gender and location was not significant different (p>0.05). For group 1, increased thickness of the FHL and reduced echogenicity, peritendious fluid collection were observed in ultrasonographic findings.Increased thickness (>3 mm) and hypoechoic lesion, peritendinous fluid collection of the tendon were sonographic findings at the posteromedial ankle in the FHL tenosynovitis. The authors suggested that Ultrasonography is a valuable and alternative tool for the evaluation of FHL tenosynovitis.

제5중족골 피로골절의 형태 분석: 시상면 및 관상면상의 위치

이경태 ( Kyung Tai Lee ),양기원 ( Ki Won Young ),박영욱 ( Young Uk Park ),제갈혁 ( Hyuk Jegal ),서정현 ( Jeong Hyun Seo ) 대한스포츠의학회 2016 대한스포츠의학회지 Vol.34 No.2

From a biomechanical standpoint, the main pathologic abnormality of fifth metatarsal stress fracture is the location where repetitive tensile stress concentrated. Decreasing tensile force in this region would be a proper treatment. Therefore, the purpose of this study is to evaluate the precise sagittal and coronal location of the fifth metatarsal stress fracture. Between June 2012 and May 2013, 38 athletes with a fifth metatarsal stress fracture were treated. To evaluate the precise sagittal location of the fracture, the entire length of the fifth metatarsal was measured and the distance from tuberosity to the fracture line was measured. To evaluate the precise coronal location of the fractures, coronal computed tomography images were obtained for incomplete fracture cases. The fracture location was classified as four quadrants. Thirty patients were classified into zone III fracture. However, the fracture is located in zone II for remaining eight cases. The median value of ratio between whole length and the distance from tuberosity to the fracture was 0.35 (range, 0.29-0.40) Among 33 incomplete fracture cases, there were 28 patients whose fracture developed in plantolateral quadrant, four patients at the lateral side and a patient for plantar side. The main pathologic abnormality is at the plantar lateral side because of the repetitive stress concentrated there.

청각적 생체 되먹임 훈련과 공차기 훈련이 뇌졸중 환자의 체중지지율에 미치는 영향

전현주 ( Hyun Ju Jun ),이진수 ( Jin Su Lee ),김기종 ( Ki Jong Kim ),제갈혁 ( Jegal Hyuk ),남기원 ( Ki Won Nam ) 대한물리의학회 2014 대한물리의학회지 Vol.9 No.4

PURPOSE: The purpose of this study was of scale using auditory biofeedback training and kinging training on walking speed and weight bearing ratio in patients hemiplegia with stroke to determine of the effects of such training would be maintained even after stopping the intervention. METHODS: The 30 subject were classified into three groups : 12 times, 3 times a week receiving the control, the experimental group scale using auditory and kicking training for 4 weeks. In addition, all subjects in the control group and experimental groups received the same general exercise treatment 12 times, 3 times a week for 4 weeks, and underwent follow-up tests. The significance of differences between the control group and the experimental groups was analysis by repeated-ANOVA, Interaction time and groups was analysis by repeated-ANOVA. In case where there were differences, post-hot tests were conducted using repeated measure ANOVA. RESULTS: There were significant differences in 10 m walking speed and weight bearing ratio between the control group and experimental group after the performance of the scale using auditory training and kicking training. Scale using auditory biofeedback training 4 weeks was more effective than kicking training. After 8 weeks weight bearing ratio maintained on scale using auditory training. CONCLUSION: These finding suggest that the scale using auditory biofeedback training and kicking training has positive effects on hemiplegia with stroke.

운동선수에서 발생한 제5중족골 근위부 견열 골절의 불유합에 대한 수술적 절제술

이경태 ( Kyung Tai Lee ),김준범 ( Jun Beom Kim ),양기원 ( Ki Won Young ),박영욱 ( Young Uk Park ),김진수 ( Jin Su Kim ),제갈혁 ( Hyuk Jegal ) 대한스포츠의학회 2011 대한스포츠의학회지 Vol.29 No.2

The purpose of this study was to evaluate the clinical results of surgical excision of symptomatic nonunion of fifth metatarsal base avulsion fracture in athletes. From February 2008 to December 2009, six athletic patients who had a symptomatic nonunion of fifth metatarsal base avulsion fracture underwent surgical excision of ununited bony fragment and they were followed for more than 12 months. The mean age was 18.5 years and the mean follow-up period was 13 months. The clinical results were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scoring system and Visual Analogue Scale (VAS) scoring system and statistically analyzed (SPSS ver. 18.0). The AOFAS and VAS score was improved in all patients. The mean AOFAS forefoot score was improved from 58.6±5.7 preoperatively to 95±5.4 postoperatively, which indicated significant difference (p=0.024). The mean preoperative VAS score was 8.0±0.6 and the mean postoperative VAS score was 1.6±0.5 cm, which indicated significant difference (p=0.023). There were no postoperative problems and functional loss on the operation lesions. The surgical excision of symptomatic nonunion of fifth metatarsal base avulsion fracture in athletes was found to be one of the ideal treatment option for early return to full activity and relief of pain.