The Role of Simple Radiography in the Evaluation of Intraarticular Calcaneal Fracture

Woo-Chun Lee(이우천),Jong-Deuk Rha(라종득),Hyun-Soo Park(박현수),Young-Kil Han(한영길),Byeong-Chun Chang(장병춘),Kea-Hyuak Uhm(엄기혁) 대한정형외과학회 1998 대한정형외과학회지 Vol.33 No.6

족관절 골절에 대한 관절경적 정복술과 관혈적 정복술

김동헌,장병춘,이재성,Kim, Dong-Heon,Chang, Byeong-Chun,Lee, Jae-Sung 대한족부족관절학회 1998 대한족부족관절학회지 Vol.2 No.2

The ankle is a complex structure supporting the entire musculoskeletal system during standing and walking. And so the goals of operative treatment for ankle fractures are to obtain an anatomical reduction that is maintained by stable fixation, resulting in a healed fracture and recovery of normal function. The 64 patients who had ankle fractures were treated by arthroscopic reduction(20 cases) and open reduction (43 cases) in Konkuk university hospital from February 1991 to October 1997 and the results were analyzed in clinical and radiological aspects. The following results were obtained. According to the criteria of Meyer, arthroscopic assisted reduction group had good or excellent results in 18 cases (90%) and open reduction group good or excellent in 35 cases (83%). The difference of the results was not significant statistically, but arthroscopic assisted reduction technique has several advantages over open technique; the best assessment of articular surface, lower wound problem, postoperatively faster rate of rehabilitation and minor discomfort.

족부 및 족관절 부위에서 비복 신경의 해부학 및 수술시의 의미

이우천,박현수,한영길,장병춘,임장운,라종득,Lee, Woo-Chun,Park, Hyun-Soo,Han, Young-Kil,Chang, Byeong-Chun,Rim, Jang-Woon,Rha, Jong-Deuk 대한족부족관절학회 1998 대한족부족관절학회지 Vol.2 No.2

The course of the sural nerve in the calf has been well documented, but there is a general lack of information concerning the distal course of the nerve. The purpose of this study was to describe the distal course of the sural nerve and its surgical implications. Seven fresh amputated specimens were dissected to show the anatomy of the sural nerve in the foot and ankle. At the level of about 10cm proximal to the plantar surface, the sural nerve coursed anteriorly and inferiorly away from the Achilles tendon. 2 to 4 lateral calcaneal branches arose. The first branch of the lateral calcaneal branches coursed along the lateral border of the Achilles tendon, and it arose at 8cm proximal to the plantar surface in 2 specimens, 12cm proximal to the plantar surface in 4 specimens, and at 12cm proximal to the plantar surface in one specimen. The main nerve trunk continued distally plantar to the peroneal tendons and divided into two terminal branches and crossed peroneus longus tendon at the level of the inferior border of the calcaneo-cuboid joint, at about 3cm(range, $2.5\sim3.0$)cm from the plantar surface. In conclusion, a longitudinal incision lateral to the Achilles tendon would cross the path of the sural nerve at about 10cm proximal to the plantar surface. When the first branch of them arise more than 10cm above the plantar surface, a logitudinal incision lateral to the Achilles tendon may be made without damage. The other lateral calcaneal branches will be cut when we make transverse incision paralled to the plantar surface. The terminal branch also may be in danger by the same transverse incision.

노년의 대퇴골 원위부 골절 시 동시에 시행한 전슬관절 성형술 및 금속판 내고정술 : 8예 보고 Report of Eight Cases

김동헌,장병춘,신규철,양준호 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

Supracondylar fracture of the femur can be treated by a wide variety of methods. Although satisfactory results have been achieved with either open and closed treatment, less certain results are obtained for the elderly who have pre-existing osteoarthritis and osteoporosis. Particularly, elderly patients who have preexisting osteoarthritis are at increased risk of posttraumatic arthritis, stiff knee, persistent pain. Primary total knee arthroplasty(TKA) might obviate many of these potential problems and help to return the high-risk patient to an ambulatory functional status immediately. There are few reports about this study. The purpose of this study is to evaluate the results treated by simultaneous internal fixation and TKA for the supracondylar fracture in the elderly who have osteoarthritis of the knee joint. From 1994 to 1998, eight primary TKAs using posterior cruciate sparing PFC knee(Press Fit Condylar, Johnson & Johnson, Raynham, U.S.A) were performed after internal fixation for the supracondylar fracture of the femur with Judet plate or condylar buttress plate by conventional means. Patella was not resurfaced in all knees. According to the M ller classification of the supracondylar fracture of the femur 5 fractures were type A, 2 in type B, 1 in type C. Five patients were female, 3 patients were male. The ages ranged from 66 to 81, with an average of 74 years. Patients were followed for at least 1 year(average 3 years). The mean interval between the injury and operation was 2 weeks(range, 1 week to 4 weeks). Active knee joint exercise was encouraged in a hinge brace under the postoperative pain control. Partial weight bearing was permitted at the postoperative 4 to 6 weeks using crutches. Full weight bearing was allowed after union of the fracture. Fractures were united in all patients and the average duration of bony union was 16 weeks. The average amount of flexion and average flexion contracture for the all patients at the most recent follow-up were 96 degrees (range, 45 to 120 degrees) and 7 degrees (range, zero to 20 degrees), respectively. Using the knee rating score advocated by the American Knee Society, the average postoperative score was 87 for pain and 80 for function. We concluded that simultaneous internal fixation and TKA for supracondylar fracture of the femur in elderly patients who have advanced knee osteoarthritis may provide satisfactory pain relief and function with acceptable morbidity.

관절 내시경술에 의한 퇴행성 슬관절염의 치료

김동헌,장병춘,신규철,이재성 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

The arthroscopic surgery is an increasingly accepted procedure for the treatment of symptomatic arthritic knee. Authors reviewed the operative results of arthroscopic surgery in 35 knee joints of 27 patients from 1993 to 1997. 1. The average age of patients was 64 years old and the primary diagnosis was degenerative osteoarthritis in all patients. 2. Preoperative symptomes and signs were pain(98%), tenderness(85%), swelling(85%), decreased range of motion(71%) and effusion(55%). 3. The operative procedures were irrigation and synovectomy(20%), abrasion arthroplasty(57%), partial menisectomy and abrasion arthroplasty(23%). 4. The symptoms and signs were improved postoperatively: according to Nine point scale, the good results were recorded at postoperative 6 months and follow-up 2 years in nearly all patients. 5. The complications were minimal. Authors concluded that arthroscopic surgery is considered as a reliable method in the treatment of degenerative osteoarthritis of the knee but not as a curable method, needing a long term observation.

고령의 대퇴 경부 골절과 전자간부 골절에서 시행한 양극성 고관절 반치환술 임상 결과의 비교

김동헌,장병춘,신규철,강대술 대한골절학회 1999 대한골절학회지 Vol.12 No.3

The peritrochanteric fracture remains one of the most common and potentially devastating injuries in the geriatric population. The goal of treatment is early ambulation to prevent the complications such as pressure sore, pneumonia, deep vein thrombosis, pulmonary embolism and long time hospitalization by open reduction and internal fixation or closed reduction and internal rotation. In femoral neck fracture, many surgeons agree on the bipolar hemiarthroplasty but there is controversy about that treatment in intertrochanteric fracture. We have tried to assess the clinical outcome of bipolar hemiarthroplasty for the intertrochanteric fracture as compared with femoral neck fracture in old age. Ninty-five bipolar hemiarthroplasties were performed at our hospital, between January 1991 and February 1996. We selected 65 patients who had been followed for at least one year. Forty of sixty-five patients had femoral neck fractures and twenty-five of them intertrochanteric fractures. The results were as follows: 1. Regardless of using the cement, the partial weight bearing ambulation time after operation was 10.3 days in femoral neck fracture, 19.5 days in intertrichanteric fracture. 2. At one year follow-up the average Modified Harris Hip Score was 88.9 in femoral neck fracture, and 87.5 in intertrochanteric fracture. 3. Postoperative complications in case of femoral neck fracture included thigh pain in 4 patients, heterotopic ossification in 1, intraoperative fractures of the femoral shaft in 2, leg length inequality in 1 and dislocations after bipolar hemiarthroplasties in 3. And those in case of intertrochanteric fractures were thigh pain in 2 patients, heterotopic ossifications in 2, intraoperative fractures of the femoral shaft in 2 and dislocation after bipolar hemiarthroplasty in l. 4. There were no statistically significant differences in the clinical functional score and complications between intertrochanteric and femoral neck fracture groups, therefore bipolar hemiarthroplasty can be recommended as one of the treatment of intertrochanteric fracture as well as femoral neck fracture in the elderly patient.

전 슬관절 및 전 고관절 성형술 후 삶의 질의 변화

신규철,김동헌,장병춘,김동혁 대한슬관절학회 1998 대한슬관절학회지 Vol.10 No.1

We reviewed 40 consecutive patients having a primary total hip replacement(THR) and 60 patients having a primary total knee replacement(TKR) for osteoarthritis to compare the quality of the(QoL) before and after operation. Bilateral arthroplasties were perfomed 10 cases of THR and 25 cases of TKR. We used a modified Harris hip score and a knee score of American knee society, the Rosser Lndex Matrix and authors' evaluation system to generate these scores. Quality of life was highly improved by Rossers and authors evaluation system after THR and TKR. The median values of QoL scores before and after operation were significantly different(p$lt;0.05). The median preoperative QoL score in THR was better than in TKR. Postoperative QoL scores for both groups were similar. Quality of life evaluated by Rossers score and authors evaluation system in bilateral THR was better than bilateral TKR. We think better quality of life in bilateral THR over bilateral TKR by authors evaluation system is because the hip joint is more stable and has better range of motion than knee joint. We conclude that change of life style including the use of bed, toilet seat elevation, and the use of dinning table will be neccesary after bilateral TKR.

족관절 족배 굴곡 각도의 측정

이우천,박현수,한영길,조정진,장병춘,이재율,엄기혁,라종득 대한스포츠의학회 1998 대한스포츠의학회지 Vol.16 No.1

Clinical measurement of ankle motion includes tarsal and tarsometatarsal as well as tibiotalar motion, and it is affected by knee position and weight-bearing. The purpose of this study is to determine the problem of each method of measurement, the difference in the angles measured by various methods, and to suggest a reference data to assess the tightness of the Achilles tendon. Dorsiflexion range of 80 healthy ankles was measured by 8 different methods. The dorsiflexion range of the Group 1, 2, 3 was measured when the foot was not weight-bearing and the knee was flexed 90° with the foot in inversion, eversion, and neutral position respectively and the means and standard deviation of each group were 13.8±5°, 27.5°±6° and 23.4±5° respectively. The dorsiflexion range of the Group 4, 5, 6 was measured with the foot in inversion, eversion and neutral position when the foot was not bearing weight, and the knee was extended and the means and standard deviations of each group were -6±5°, 10±4° and 7±4° respectively. The dorsiflexion range of the Group 7 and 8 was measured with the knee in flexed or extended position, when the subject was bearing weight and the mean and standard deviation of each group were 44±7° and 38±7° respectively. There were statistically significant differences between each group within the Groups 1·2·3, Groups 4·5·6, Groups 3·6 and Group 7·8(p<0.01). In conclusion, the measurement of dorsiflexion range of ankle motion need to be done with the foot in neutral position to minimize the effect of the shape of the foot or the motion in the foot. Measurement in weight-bearing condition is not recommended, because it might be affected by the degree of weight bearing. The difference in the dorsiflexion range between the Group 3(measured with the knee flexed) and the Group 6(measured with the knee extended) is 15.9±4.9°, and it be used as a reference angle to assess the presence of Achilles tightness.

경골 근위부 골절의 치료

김경순,김동헌,장병춘,신규철,강대술 대한골절학회 1998 대한골절학회지 Vol.11 No.2

The treatment of proximal tibial fracture is an area of great controversy. Because open and comminuted fractures are common, selection of fixation method of the proximal tibial fracture is more difficult than any other fractures. Many authors reported high rate of malunion and loss of reduction. The purpose of this study is to compare the results of the proximal tibial fractures depending on the fixation method. We evaluated the records of 35 patients (36 fractures) who had been treated with intramedullary nailing, plate and screws and external fixation from January 1989 to January 1996. The mean period of follow-up was 12months. Of the 36 fractures, 8 fractures were with intramedullary nailing, 12 fractures with plate and screws, 16 fractures with external fixator. In intramedullary nailing group, the average time of bony union was nineteen weeks (16 - 27), in plate and screws fixation group twenty three weeks (18-31) and in external fixation group 22 weeks (19-29). The complications of intramedullary nailing group were 3 nonunion., 1 delayed union, I varus deformity, 2 anterior angulations and 2 cases of deep of plate and screws group were 1 nonunion, 3 delayed stiffness infections and in most fractures partial stiffness of external fixator group were 1 nonunion, 1 delayed union, infections and 3 cases of knee joint stiffness. wound infection. The complications union, I deep wound infection, 2 of knee joint. The complications of 1 deep wound infection, 6 pin tract infections and 3cases of knee joint stiffness. In our cases, if there is open wound higher than Gustilo grade III-B and severe comminuted fracture initially, the external fixation is more preferred for wound management and also more advantageous method for the patients who got a multiple trauma in abdomen, chest and head injuries. In closed fractures and Gustilo grade I, II open fractures, intramedullary nailing is considered to be more preferable method. But the anatomy of proximal tibia made nailing these fractures technically difficult. In conclusion, we consider each method of fixation is useful fixation method of the proximal tibial fracture, hut each method should be selected advertently depending on the severity of soft tissue injury and the degree of comminution of the fractures.

거골하 관절 운동의 측정

이우천,박현수,한영길,조정진,장병춘,라종득 대한스포츠의학회 1998 대한스포츠의학회지 Vol.16 No.1

Subtalar motion occurs in all three planes and it is impossible to measure it accurately by clinical examination. There are many studies with so different normal ranges that we can not believe it represents the motion of the same joint. We presumed that the motion measured when the foot moves freely in all three planes will be different from that measured when the foot movement is restricted in one or two planes. We measured inversion and eversion of 80 feet in 40 young healthy adults. The range of inversion and eversion when the foot moves freely in three planes was 28.9±6.2˚, 9.6±3.3˚, when the sagittal plane movement was restricted, those were 10.4±4.9˚, 8±3.4˚ respectively, when the sagittal and transverse plane movement was restricted, those were 9.7±3.6˚, 7.2±3.2˚ respectively. The above result shows that we can get a far greater range of motion when the foot moves freely in three planes. It seems to be more reasonable to measure the range of motion of the subtalar joint while the foot moves in all planes.