• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.75-79
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• 2009

Purpose: To evaluate the outcomes of intra-articular calcaneal fractures treated using AO calcaneal plate surgically. Materails and Methods: Total 15 cases of intra-articular calcaneal fracture that treated with open reduction and internal fixation using AO calcaneal plate were evaluated. The patients were followed over a mean period of 19.8 months. The mean age was 41.6 years. By Sanders classification, there were 2 cases of type II, 10 cases of type III, and 3 cases of type IV. We evaluated radiological outcomes by Bohler angle, Gissane angle, calcaneal hight, calcaneal width and clinical outcomes by Creighton-Nebraska health foundation score. Results: All fractures united at a mean duration of 13.3 weeks. Radiologically, the mean preoperative Bohler angle was $8.5^{\circ}$ and restored to $23.3^{\circ}$. The mean preoperative Gissane angle was $118.7^{\circ}$ and restored to $124.2^{\circ}$. The mean preoperative calcaneal hight was 30.8 mm and restored to 38.9 mm. The mean preoperative calcaneal width was 41.3 mm and restored to 35.3 mm. 10 cases had excellent and good clinical outcomes and 5 cases having fair outcome. Conculsion: In our study, open reduction and internal fixation using AO calcaneal plate showed good results with anatomical restoration of articular surface and stable fixation without late collapse.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.60-67
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• 2009

Purpose: This study was designed to investigate the usefulness of extensile lateral approach for accurate reduction and rigid internal fixation in comminuted intraarticular fractures of calcaneus. Materials and Methods: From October 2002 to May 2007, we managed 55 patients (62 cases) with open reduction and internal fixation using extensile lateral approach. Among these, 38 patients (43 cases) who underwent preoperative and postoperative CT scan were enrolled. All patients were evaluated over 24 months after surgery. Bohler angle and Gissane angle on plain X-ray, displacement and step-off of articular surface of calcaneus on CT scan were measured and we compared the difference between preoperative and postoperative value of them. Clinical results were assessed by using AOFAS Ankle-Hindfoot Scale. Results: The average Bohler angle was restored from $6.8^{\circ}$ to $23.5^{\circ}$ and Gissane angle was improved from $116.4^{\circ}$ to $113.5^{\circ}$ after operation. The average distance of displacement was restored from 4.2 mm to 1.4 mm and step-off of articular surface was recovered from 5.1 mm to 1.3 mm. Clinical results were excellent in 17 cases, good in 18 cases, fair in 3 cases, and poor in 5 cases. 10 cases developed postoperative complications such as skin necrosis, heel pain, limitation of motion of ankle and subtalar arthritis. Conclusion: The extensile lateral approach is valuable for the comminuted intraarticular fractures of calcaneus that enables accurate anatomical reduction and rigid internal fixation by providing direct exposure of subtalar joint.

• Journal of Korean Foot and Ankle Society
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• v.6 no.2
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• pp.149-155
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• 2002

Purpose: To propose a new comprehensive classification system of intraarticular calcaneal fracture based on CT images. Materials and methods: Fourty intraarticular calcaneal fractures which were treated operatively were evaluated retrospectively. We classified fracture types according to severity of comminution on the posterior facet and calcaneocuboid joint by CT images. And we evaluated postoperative results of each fracture types in terms of the quality of fixation and reduction by the postoperative plain radiograghs. Results: By the classification of the posterior facet, 18 cases were P-I, 15 were P-II, and 7 were P-III. Among the P-I cases, 7 were P-IA, 9 were P-IL, 1 was P-IM and 2 were P-IT. According to the classification of calcaneocuboid joint, II cases were C-I, 18 were C-II and 11 were C-III. Qualities of fixation were excellent in 27 cases (67.5%), fair in 9(22.5%) and poor in 4(10%). Qualities of reduction were excellent 23 cases(57.5%), fair in 11(27.5%) and poor in 6(15%). Conclusion: Our new classification system based on the CT images could provide informations about the fracture configuration and severity of comminution around calcaneocuboid joint as well as the posterior facet. And the high grade fractures such as type P-III are need to be taken care of fixation of articular surfaces.

• Journal of Korean Foot and Ankle Society
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• v.5 no.1
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• pp.35-42
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• 2001

Purpose: To analyze the results of conservative or surgical treatment after computed tomograhy(CT) classification in intraarticular calcaneal fractures. Materials and methods: From January 1996 to May 1999, we prospectively analyze 23 cases of intraarticular calcaneal fractures who were treated conservatively or operated by open reduction and internal fixation by extensive L-shaped lateral approach after CT classification. Results: A functional scoring system of 0-100 points which was based upon the responses to AOFAS Ankle-Hindfoot Scale for the operative group was at 82.8, compared with 73.2 for the non-operative group, and these were meaningful statistically(P<0.05). Of type I fracture, in the operative group there were 2 excellent results and in the non-operative group there were 2 excellent results, 1 good result. or type II fractures, in the operative group there were 2 excellent results, 3 good results, 1 fair result and in the non-operative group there were 1 good result, 1 fair result, 2 poor results. Of type III fractures, in the operative group there were 2 fair results, 2 poor results and in the non-operative group there were 1 fair result, 3 poor results. Bohler angles of subtalar joint were changed from initial average $13.3^{\circ}$ to postoperative average $20.9^{\circ}$ for the operative group compared with from initial average $15.5^{\circ}$ to follow-up average $14.8^{\circ}$ of the non-operative group(P<0.01). Conclusions: Computed tomography in the evaluation of intraarticular calcaneal fractures is effective tool. We believed that open reduction and internal fixation in all Crosby & Fitzgibbons type II and according to degrees of comminution reducible type III for the intraarticular calcaneal fractures is more effective method than conservative treatment.

• Journal of Korean Foot and Ankle Society
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• v.16 no.3
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• pp.175-180
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• 2012

Purpose: To evaluate the radiological and clinical results after open reduction and internal fixation with calcaneal F plate and locking calcaneal plate using lateral extensile approach in the treatment of intra-articular calcaneal fracture Materials and Methods: This study included 34 cases of 33 patients followed up for at least 6 months postoperatively. F plate was applied in 18 cases (Group 1), locking plate was used in 16 cases (Group 2) and compared radiological and clinical results between two groups. Results: Radiollogically, the mean Bohler angle was improved from $5.5^{\circ}$ preoperatively to $20.1^{\circ}$ postoperatively and $18.8^{\circ}$ at the last follow up in group 1 and $8.6^{\circ}$ preoperatively, $21.4^{\circ}$ postoperatively and $20.3^{\circ}$ at last follow up in group 2. Bone union was observed in all cases and 4 cases of screw loosening were noted in Group 1 with extended fracture to anterior process. At the last follow up, both groups showed clinical results in American orthopedic foot and ankle society ankle hindfoot score, 76(77 in Sanders type II and 75 in type III) in group 1 and 72(73 in type II and 70 in type III) in group 2. Conclusion: F plate and locking plate showed firm fixation and satisfactory clinical results in the treatment of intra-articular calcaneal fracture. We suggest applying locking plate in cases with extended fracture to anterior process, considering screw loosenings in those who were treated with F plate fixation.

• Journal of the Korean Orthopaedic Association
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• v.55 no.6
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• pp.503-510
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• 2020

Purpose: Bipolar hemiarthroplasty is used as an alternative to open reduction and internal fixation for unstable intertrochanteric fractures in elderly patients. Recent advances in medical systems and technologies have resulted in increased survival rates after intertrochanteric fractures of the femur, requiring selection of the appropriate femoral stems considering the mid- to long-term duration of survival. Hemiarthroplasty was performed for unstable intertrochanteric fractures using a double tapered quadrilateral femoral stem (C2 stem), and the clinical and radiological results were evaluated as a five-year follow-up post-surgery. Materials and Methods: From January 2004 to December 2013, 43 patients (43 hips) who underwent hemiarthroplasty with a C2 stem were enrolled in this study. Their mean age was 78.6 years (range, 70-84 years), and the mean follow-up period was 85.4 months (range, 60-96 months). During the follow-up period, clinical parameters, such as the changes in pain, walking ability, and functional status, were examined. Radiologically, changes in the proximal femur, such as osteoporosis and bone resorption of cortical bone, were noted. Complications that occurred during the follow-up period, such as dislocation and prosthetic features, were also reviewed. Results: Initially, the pain was relieved postoperatively, but it increased four years after surgery. The walking ability was reduced by two steps in nine patients after 60 months, and the Harris hip score was reduced significantly postoperatively after two to three years. Radiologically, cortical osteoporosis occurred in 14 patients. Five patients developed cortical bone resorption. Four of them showed nonunion of the trochanteric fracture fragments, and three of them suffered reverse oblique fractures. Conclusion: Careful selection considering the general health condition and remaining lifespan of the patient would be necessary for primary hip hemiarthroplasty using a 3C type cementless femoral stem for unstable intertrochanteric fractures in elderly patients with osteoporosis.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.175-182
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• 2005

Purpose: Bone tumor occurred in femur frequently involve proximal intertrochanteric region or distal metaphyseal region. Sometimes, the pathologic fracture can happen according to the size of tumor due to the substantial biomechanical stresses. Therefore, the prognosis can be improved biomechanically by the angled blade plate considering the anatomic configuration after the excision of tumor. Materials and Methods: Between October 1991 and April 2005, there were a total of 16 patients(17 cases) who were treated by the excision of tumor and internal fixation with the angled blade plate for bone tumor occurred in femur. After the excision of tumor, we filled the cavity by bone graft in 11 cases and bone cement in 6 cases. The internal fixation was used by angled blade plate in all cases. Result: The average follow-up time was 55.5 months(6-144 months) in 16 patients(17 cases). No metal failure occurred after the operation. Reoperation was performed in 4 cases due to tumor recurrence, and the internal fixation was firm until that. Conclusion: The angled blade plate can prevent the fracture until grafted bone incorporated to host bone, and protect fragile connection between cement and host bone.

• Journal of Veterinary Clinics
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• v.31 no.6
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• pp.519-522
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• 2014

A 2-year-old, 2 kg Maltese dog was evaluated for progressive tetraparesis and neck pain. The dog had been treated with steroids for the preceding 2 weeks after unknown trauma but was deteriorating progressively and had become tetraparetic. The dog was presented with a non-ambulatory tetraparesis. Radiographic and computed tomographic examinations revealed a transverse C2 fracture with subluxation of the atlantoaxial joint and C2-C3. In addition, hydrocephalus was observed on magnetic resonance imaging. Stabilization of C1-C3 using screws, wires, and polymethyl methacrylate (PMMA) was performed. Application of ventral screws, wires, and PMMA resulted in improvement of the clinical signs after 4 weeks, and the dog could walk as before the tetraparesis 6 weeks after the operation. This stabilization method is an effective surgical treatment for management of cervical instability.

• Journal of the Korean Orthopaedic Association
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• v.56 no.6
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• pp.498-503
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• 2021

Purpose: The aim of this study were to find ideal entry point of straight antegrade humeral intramedullary nail (SAHN) for the treatment of proximal humerus fracture in Korean and to analyze anatomical conformity using computed tomography. Materials and Methods: From May 2014 to October 2016, the study was conducted retrospectively on 74 Korean patients who had taken computed tomography on both normal and affected shoulder joint as result of shoulder injury. The mean age of the patients was 64.5 years (range, 22-95 years). Radiologic evaluation was done using multiplanar reconstruction technique of the computer tomography on normal proximal humerus. We located ideal entry point of SAHN as the point where humerus intramedullary center axis and humeral head meet. Distance between the entry point and local anatomical landmark was measured. We defined the critical distance as the distance between entry point and the most medial point of the supraspinatus attachment site. For adequate fixation and avoidance of injury to rotator cuff, critical distance should be over 8 mm according to Euler, and we defined the critical type when it is less than 8 mm. Critical distance, sex, age, height, body weight, body mass index was evaluated for the statistical significance. Results: The ideal entry point was as follows: the mean anteroposterior distance, the sagittal distance to the lateral margin of bicipital groove, was 11.5 mm and the mean mediolateral distance, the coronal distance to the lateral margin of grater tuberosity, was 20.5 mm. The mean critical distance, distance from the entry point to the just medial to insertion of the supraspinatus tendon, was 8.0 mm. Critical type with critical distance less than 8 mm was found in 41 in 74 patients (55.4%). Conclusion: The ideal entry point of SAHN in Korean was located on 11.5 mm posteriorly from the lateral margin of bicipital groove and 20.5 mm medially from lateral margin of greater tuberosity. More than half of the cases were critical type. Since critical type can possibly cause rotate cuff injury during nail insertion on entry point, surgeon should consider anatomical variance before choosing surgical option.

• Journal of Veterinary Clinics
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• v.32 no.5
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• pp.417-421
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• 2015

Bone grafting is widely used to bridge major bone defects or to promote bone union. Natural calcium carbonate (CC) has been used as a bone substitute material and used to scaffold for bone morphogenetic protein (BMP). The aims of this study is to evaluate the biocompatibility of cuttlebone (CB) and hydroxyapatite from CB (CBHA). Each material was shaped into disks (5 mm in diameter and 2 mm in thickness). To test biocompatibility, the disks were implanted into the dorsal subcutaneous tissue in mice. Fibrous capsule thickness around each disk was evaluated histologically at 2 and 4 weeks after implantation. Concerning biocompatibility, fibrous capsule thickness of CBHA was significantly thinner than that of CB and CHA (p < 0.05) at 2 and 4 weeks after implantation. Based on the clinical and histological results, CBHA would be a safe material for use inside the body and has more effective osteoconduction than CB.