만성 족관절 외측 불안정증

정홍근,박재용,박종태,Jung, Hong-Geun,Park, Jae-Yong,Park, Jong-Tae 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.2

Severe ankle sprain secondarily leads to chronic lateral ankle instability in 20-30%. Many surgical procedures have been presented for reconstruction of the lateral ankle instability, but controversy still remains for the ideal surgical option. Br$\ddot{o}$strom procedure or its modifications have been widely used but they have some limitations for the instabilities for the over-weight, physically high demanding patients and especially for significantly deficient or attenuated ligaments. Moreover the tenodesis procedures using peroneus brevis tendon are non-anatomical and sacrifice important lateral stabilizing tendon. Therefore recently, many reconstructive procedures for lateral ankle instability utilizing free allograft or autograft tendon have been introduced to anatomically stabilize the lateral ligaments to various degrees.

동통성 부 주상골

정홍근,박종태,Jung, Hong-Geun,Park, Jong-Tae 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.3

Accessory navicular is a congenital anomaly of the tuberosity of the navicular from a secondary ossification center. The accessory navicular is occasionally the source of pain and local tenderness over the medial side of midfoot. If conservative treatment fails for the painful accessory navicular, surgical treatment is required. There are several surgical option for accessory navicular, which vary from simple excision, percutaneous drilling, modified Kidner procedure and osteosynthesis of the accessory ossicle to the navicular body. In addition, symptomatic flatfoot deformity should be addressed concomitantly.

거골하 유합술 시 전방 및 후방 관절면 고정술식과 후방 관절면 단독 고정술식의 비교

정홍근,조형원,박현우,박종태,Jung, Hong-Geun,Cho, Hyeoung-Woen,Park, Hyun-Woo,Park, Jong-Tae 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.2

Purpose: Subtalar arthrodesis has been the gold standard for the painful subtalar joint disorders. Successful subtalar arthrodesis requires fusion of the 3 facet joints. The purpose of the study is to compare the clinical outcome of the posterior fixation (P2) and anterior-posterior (A1P1) fixation technique for subtalar arthrodesis which enhance anterior and middle facet fixation. Materials and Methods: The study is based on the 20 feet (19 patients) of the subtalar arthrodesis utilizing cannulated screws from September 2006 to September 2009 with at least 1-year follow-up. Two fixation techniques were utilized for the subtalar arthrodesis: 1) posterior fixation only (P2, 7 feet, 35%) and 2) anterior-posterior (A1P1) fixation method (13 feet, 65%). Visual Analog Scale Pain (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (maximum: 94 points), the time for returning to daily living and the patient satisfaction were also evaluated. Results: Average follow-up period were 13.2 months (12-3 mo). The AOFAS score improved from preoperative average 45 (0-68) to 81.6 (62-94), while VAS score was decreased from average 8.0 (3-10) to 1.8 (0-5) at final follow-up. Ninety-five percent of the patients were satisfied with surgery. All the patients returned to daily living at average 7.2 months (2-15 mo) post-surgery. Radiographically, 2 techniques both showed 100% fusion of the posterior compartment of the subtalar joint. Postoperative complications were 1 case of low grade infection and 1 case of sural nerve neuralgia. Conclusion: The subtalar arthrodesis using A1P1 fixation technique showed better fusion rate of the anterior compartment of the subtalar joint compared to P2 fixation technique although the 2 techniques both showed similar favorable clinical outcome. Therefore the A1P1 fixation technique is found to be a viable option to address chronic painful subtalar joint disorders to enhance the anterior compartment fixation.

OLT; 거골의 골연골 병변

정홍근,박재용,김태훈,Jung, Hong-Geun,Park, J.Y.,Kim, T.H. 대한관절경학회 2010 대한관절경학회지 Vol.14 No.3

반월형 근위 중족골 절골술에 대한 보강적 축성 K-강선 고정술 : 생체역학적 연구

정홍근,김유진,Jung, Hong-Geun,Kim, You-Jin,Guyton, Gregory 대한족부족관절학회 2003 대한족부족관절학회지 Vol.7 No.2

Purpose: Proximal crescentic metatarsal osteotomy(PMO) is one of the most common procedures for correcting moderate to severe degree hallux valgus deformity. Although screw fixation is used for osteotomy site stability, loss of reduction can occur. The purpose of this study is to compare the sagittal plane stability of the conventional crescentic PMO fixed with a single screw with that of the crescentic PMO fixed with 1 screw and 2 supplemental K -wires. Material and Methods: Ten matched pairs of cadaveric foot specimens were used for the proximal crescentic metatarsal osteotomy. For one foot specimen of each pair, crescentic osteotomy was fixed with 4mm long threaded cannulated screw, while the matched pair was prepared by adding two axial 1.6mm K-wires to the conventionally fixed 4mm screw. The extensometer was used to measure the osteotomy gap as the metatarsal head was loaded continuously until failure using a servohydraulic MTS Mini Bionix test frame. The strength of fixation was normalized with the bone mineral density (BMD) of the paired specimen $(N{\times}cm^{2}/gm)$, Result: The average strength of the crescentic PMO with axial K-wire fixation ($458.8cm^{2}/gm$, S.D. 434.3) was significantly higher than the standard crescentic PMO ($367.5cm^{2}/gm$, S.D. 397,9) (p=0.05). Conclusion: Supplemental fixation with two axial K-wires can be added to the crescentic PMO to enhance the initial fixation stability to prevent the loss of reduction or dorsal malunion.

고도의 무지 외반증에서 역갈매기형 중족골 절골술 및 Akin 절골술의 치료

정홍근,오정환,김태훈,박재용,강민석,Jung, Hong-Geun,Oh, Jeong-Hwan,Kim, Tae-Hoon,Park, Jae-Yong,Kang, Min-Seok 대한족부족관절학회 2010 대한족부족관절학회지 Vol.14 No.1

Purpose: This study analyzed the clinical and radiographic outcome of the severe hallux valgus corrected with proximal reverse chevron metatarsal osteotomy and Akin osteotomy. Materials and Methods: The study was based on 18 feet (15 patients) of severe hallux valgus (hallux valgus angle ${\geq}40^{\circ}$ or intermetatarsal angle ${\geq}18^{\circ}$) treated with proximal reverse chevron metatarsal osteotomy and followed for more than 1 year. Akin osteotmy was added in 72% of the patients. Clinically preoperative and postoperative AOFAS Hallux Metatarsophalangeal-interphalangeal score, VAS pain score and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, hallux valgus interphalangeal angle, the intermetatarsal angle and sesamoid position before and after the operation were analyzed. Results: AOFAS Hallux Metatarsophalangeal-interphalangeal score improved from 54.5 (25-78) to 87.7 (70-100) and VAS pain score decreased from 6.0 (3-8) to postoperative 1.2 (0-5). Ninety-six percents of the patients were satisfied with results. Radiologically hallux valgus angle was decreased from $43.3^{\circ}(31-58^{\circ})$ preoperatively to $6.8^{\circ}(-8-27^{\circ})$ postoperatively. The intermetatarsal angle was decreased from $18.4^{\circ}(11-24)^{\circ}$ preoperatively to $5.3^{\circ}(1-12^{\circ})$postoperatively. The sesamoid subluxation was improved from $2.8{\pm}0.4$ preoperatively to $0.4{\pm}0.6$ postoperatively. Conclusion: Proximal reverse chevron metatarsal osteotomy and lateral soft tissue release with additional Akin osteotomy is good treatment option for severe hallux valgus.

내측 활주 종골 절골술과 거골하 관절 제동술로 치료한 성인의 특발성 유연성 편평족 -1예 보고-

정홍근,변우섭,유문집,Jung, Hong-Geun,Byun, Woo-Sup,Yoo, Moon-Jib 대한족부족관절학회 2004 대한족부족관절학회지 Vol.8 No.2

There have been many reports about surgical treatments of flexible flatfoot in children and acquired adult flatfoot deformity due to posterior tibial tendon dysfunction common in the 5th and 6th decades. However there has been a controversy for surgical treatment guideline for painful idiopathic flexible flatfoot deformities in young adults. Therefore, we present a 27-year-old female with severe painful idiopathic flexible flatfoot who was treated with medial sliding calcaneal osteotomy and subtalar arthroereisis using $Kalix^{(R)}$ (Newdeal SA, Vienne, France) endoprosthesis and had good clinical outcome with high patient satisfaction at 10 months follow-up postoperatively.

설상형 종골 골절의 부정 유합 후에 발생한 Haglund씨 증후군 - 3례 보고 -

정홍근,노한진,Jung, Hong-Geun,Rho, Han-Jin 대한족부족관절학회 2000 대한족부족관절학회지 Vol.4 No.1

Haglund's syndrome produces retrocalcaneal bursitis or achilles tendinitis due to impingement of posterior superior bursal projection of calcaneus on insertional fibers of achilles tendon. Haglund's syndrome has been mainly associated with wearing rigid counter shoes and with athletes. We experienced three case of late sequelae of secondary Haglund's syndrome after malunion of tongue type calcaneus fracture. It is to be the first description of secondary Haglund's syndrome after calcaneus malunion and also the first report as the late complication of calcaneus fractures. Three cases were all tongue type intraarticular fractures and were treated with $45^{\circ}$ superior angle resection of superior calcaneal tuberosity. Clinical results by modified Rowe score were excellent with complete pain relief for all three cases.

다발성 유관나사를 이용한 경골-거골-종골간 관절 유합술

정홍근,박신형,유현열,유문집,Jung, Hong-Geun,Park, Shin-Hyung,Yoo, Hyun-Yul,Yoo, Moon-Jib 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.1

Purpose: To report the clinical results of tibio-talo-calcaneal arthrodesis fixed with multiple cannulated screws for the cases of painful ankle and hindfoot arthropathy regardless of any deformity or instability. Materials and Methods: A retrospective analysis was performed upon 10 patients that underwent tibio-talo-calcaneal arthrodesis from October 1999 to May 2006. There were 4 males and 6 females, with an average age of 63 years (43-70). The etioloty of arthrodesis included 5 osteoarthritis, 2 Charcot joints, 1 rheumatoid arthritis, 1 Tbc arthritis and 1 residual poliomyelitis. Chief complaints were pain in 9 cases and instability in 1 case. Three patients had combined severe varus deformity. Tibio-talo-calcaneal arthrodesis using multiple cannulated screws was performed by transfibular approach for all cases and short leg cast was applied for 12 weeks postoperatively. Results: The average follow-up period was 16.5 months (12-26 months). VAS pain score was average 8.2 (7-10) and modified AOFAS score was average 25 (8-40, total 86) preoperatively. At final follow-up, VAS score was average 1.0 (0-3) and AOFAS score improved to average 66 (58-75). There were 4 complications: 2 nonunion, 1 tibia stress fracture and 1 malunion. Seven of 8 patients were satisfied with the results at final follow-up. Conclusion: Fixation with multiple cannulated screws for tibio-talo-calcaneal arthrodesis through transfibular approach is a recommendable surgical option.

요내반족 변형에 대한 재건수술의 임상적 및 방사선학적 결과 분석

정홍근,박재용,이동오,엄준상,정승희,Jung, Hong-Geun,Park, Jae-Yong,Lee, Dong-Oh,Eom, Joon-Sang,Chung, Seung-Hee 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.2

Purpose: Reconstructive surgeries for equinocavovarus foot deformities are quite variable, including hind-midfoot osteotomy or arthrodesis, soft tissue procedure, tendon transfers, etc. Comprehensive evaluation of the deformity and its etiology is mandatory for achievement of successful deformity correction. Few studies in this field have been reported. We report on the clinical and radiographic outcome of reconstruction for cavovarus foot deformities. Materials and Methods: The study is based on 16 feet with cavovarus foot deformities that underwent bony and soft tissue reconstructive surgery from 2004 to 2008. We evaluated the etiologies, varieties of surgical procedures performed, pain score, functional scores, and patient satisfaction and measured the radiographic parameters. Results: The average age at the time of surgery was 39.4 years old, with a male/female ratio of 9/4 and an average follow-up period of 23.9 months (range, 12~49 months). The etiologies of the cavovarus deformity were idiopathic 7 feet, residual poliomyelitis 5 feet, Charcot-Marie-Tooth disease 2 feet, and Guillain-Barre syndrome and hemiplegia due to cerebrovascular accident sequela 1 foot each. Lateral sliding calcaneal osteotomies were performed in 12 feet (75%), followed by Achilles tendon lengthening and plantar fascia release in 11 feet (69%), and first metatarsal dorsiflexion osteotomy/arthrodesis and tendon transfer in 10 feet (63%). Visual analogue scale pain score showed improvement, from an average of 4.2 to 0.5 points. American Orthopaedic Foot and Ankle Society ankle-hindfoot score showed significant improvement, from 47.8 to 90.0 points (p<0.05). All patients were satisfied. Ankle range of motion improved from $27.5^{\circ}$ to $46.7^{\circ}$. In radiographic measurements, calcaneal pitch angle improved from $19.1^{\circ}$ to $15.8^{\circ}$, Meary angle from $13.0^{\circ}$ to $9.3^{\circ}$, Hibb's angle from $44.3^{\circ}$ to $37.0^{\circ}$, and tibio-calcaneal axis angle from varus $17.5^{\circ}$ to varus $1.5^{\circ}$ Conclusion: We achieved successful correction of cavovarus foot deformities by performing appropriate comprehensive reconstructive procedures with improved functional, radiographic measures and high patient satisfaction.