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관절 내 종골 골절에서 Ollier 접근법을 이용한 나사못 고정술 시 삼면 피질골 이식
방태정,배서영,우승훈,정형진,Bang, Taejung,Bae, Su-Young,Woo, Seung Hun,Chung, Hyung-Jin 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.1
Purpose: Bone grafting is often necessary to maintain a reduction and prevent delayed collapse of reduced fracture in a treatment of severely displaced comminuted intra-articular calcaneal fractures. Herein, we analyzed the usefulness and necessary conditions to perform tricortical-allobone grafting in open reduction of calcaneal fracture via the Ollier approach. Materials and Methods: We performed a retrospective review of 57 intra-articular calcaneal fractures that underwent an operation via the Ollier approach between April 2009 and April 2015. They were divided into two groups: Group 1 (n=17) included those with tricortical-allobone grafts underneath the posterior facet fragment, and group 2 (n=40) included cases without a bone graft. We measured the $B{\ddot{o}}hler$ angle, Gissane angle, height, and width of the calcaneus at preoperative, postoperative, and final follow-up radiograph. We measured the sagittal rotational angle of the posterior facet fragment of preoperative computed tomography to analyze the effect and necessary conditions for bone grafting. We also reviewed the clinical results by the American Orthopaedic Foot and Ankle Society (AOFAS) scale, visual analogue scale (VAS), and any complications. Results: According to the Sanders classification, there were 3 type-II fractures, 12 type-III fractures, and 2 type-IV fractures in Group 1; whereas in Group 2, there were 26 type-II fractures, 13 type-III fractures, and 1 type-IV fracture (p=0.002). Regarding the preoperative radiologic parameters, there were significant differences in the $B{\ddot{o}}hler$ angle (p=0.006), Gissane angle (p=0.043), and rotational angle of the posterior facet fragment (p=0.001). No significant difference was observed in the preoperative calcaneal height and width, as well as postoperative radiologic parameters. There was no significant clinical difference between the two groups (p=0.546). Conclusion: We suggest that a tricortical-allobone graft may be useful in open reduction and screw fixation via the Ollier approach for displaced intra-articular calcaneal fracture with a bony defect after reduction of collapsed posterior facet fragment. This graft can contribute to the stable reduction via a small approach, even without a plate.
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방태정 ( Tae Jung Bang ),김순규 ( Sun-kyu Kim ),정형진 ( Hyung-jin Chung ) 대한골절학회 2016 대한골절학회지 Vol.29 No.3
거골 골절은 드물지만 종종 심각한 합병증을 유발할 수 있기 때문에 적절한 처치가 중요한 골절이다. 거골 골절에서는 경부 및 체부의 골절이 대부분을 차지하고 있다. 거골 경부 골절에 대해 응급 수술을 시행할 것인가 정규 수술을 시행할 것인가에 있어서는 논란의 여지가 있다. 하지만 연부조직의 안정화 이후 정규 수술을 시행 했을 때 상처 합병증의 발생 가능성을 줄일수 있다. 충분한 시야 확보와 해부학적 정복을 얻기 위해 가장 추천되는 도달법은 전내방과 전외방의 두 개의 절개를 사용하는 이중 도달법이다. 고정 방법은 여러 가지 방법이 존재하며 분쇄 경부 골절의 경우에는 금속판의 사용이 필수적이라고 할 수 있겠다. 예후는 골절 당시의 전위 정도와 연관이 있으며, 정상적인 후족부의 기능의 회복을 위해서는 관절면의 회복과 축의 정렬이 필수적이다. 합병증으로는 외상성 관절염, 무혈성 괴사, 부정유합, 불유합 등이 알려져 있다. Although talus fractures are uncommon, proper management is important because they are often associated with severe complications. Talar neck and body fractures occupy most of the talar fractures. It remains controversial whether talar neck fractures require emergent or elective treatment. Elective definitive fixation, however, may reduce risks of wound complications. Many surgeons recommend dual surgical approaches-anteromedial and anterolateral-to allow accurate visualization and anatomic reduction. Although there are various methods of fixation, the use of plates is necessary in comminuted talar fractures. Outcomes may vary and will be dependent on the degree of the initial fracture displacement. It is necessary to restore articular congruency and axial alignment for normalizing hindfoot function. Common complications include posttraumatic arthritis, avascular necrosis, malunion, and nonunion.
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무지외반증에서 저상형 금속판 고정을 이용한 근위 개방형 절골술의 임상적 결과: 근위 갈매기형 절골술 후 K-강선 고정술과의 비교
서은석,방태정,전숙하,Seo, Eun-Seok,Bang, Tae-Jung,Jeon, Suk-Ha 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.4
Purpose: To present clinical results of proximal first metatarsal opening wedge osteotomy and low profile plate fixation in hallux valgus deformity. Materials and Methods: Thirty-two patients (39 feet) underwent surgery for hallux valgus deformity. Fourteen patients (18 feet; Group A) underwent proximal first metatarsal opening wedge osteotomy fixed with low profile titanium plate ($Arthrex^{(R)}$), and 18 patients (21 feet; Group B) underwent proximal chevron osteotomy with two K-wires. Improvement in hallux valgus angle (HVA), 1, 2 intermetatarsal angle (IMA), range of motion of 1st metatarsophalangeal joint, VAS score, and the length of first metatarsal on weight-bearing radiograph were evaluated preoperatively and at final follow-up. Results: HVA improved from $36.2{\pm}6.6$ degrees to $11.7{\pm}5.1$ degrees, and 1, 2 IMA improved from $15.7{\pm}2.6$ degrees to $7.2{\pm}1.9$ degrees. VAS score improved from $7.2{\pm}1.2$ to $1.4{\pm}0.9$. There were no significant differences clinically and radiologically. Conclusion: Proximal first metatarsal opening wedge osteotomy with stable fixation using low profile plate may be an effective surgical option for correction of hallux valgus deformity.
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