Purpose: The purpose of this study was to analyze the results of the treatment of hallux valgus with metatarsal double osteotomy and longitudinal pin fixation. Materials and Methods: We reviewed 19 patients (21 feet) who had been treated by metatarsal double osteotomy and longitudinal pin fixation for the moderate or severe hallux valgus with increased distal metatarsal articular angle (DMAA), between 1999 and 2004. They were followed prospectively for a minimum of 20 months. Functional outcomes were measured via Hallux metatarsophalangeal-Interphalangeal (HMI) scale and Mayo clinic forefoot scoring system (FFSS). Radiographically, we assessed pre, postoperative and at the last follow-up, the hallux valgus angle (HVA), 1st and 2nd intermetararsal angle (IMA), DMAA. Results: The average preoperative HVA, IMA, DMAA measured $36.76^{\circ}$, $13.62^{\circ}$, $26.00^{\circ}$, respectively. At the last follow-up, HVA, IMA, DMAA measured $9.57^{\circ}$, $7.14^{\circ}$, $9.33^{\circ}$. The correction of HVA, IMA, DMAA were $27.19^{\circ}$, $6.48^{\circ}$, $6.67^{\circ}$. At the last follow-up, there were no recurrences and complications, except two patients complained of unsatisfactory stiffness in the 1st metatarsophalangeal joint and subjectively rated their results as fair. The others rated that as excellent or good. At the last follow-up, statistically, the mean HMI scale and FFSS improved significantly from pre-operative score. Conclusions: In the treatment of moderate or severe hallux valgus with increased DMAA by metatarsal double osteotomy and longitudinal pin fixation, we had good functional and radiological results without recurrences and significant complications. But the stiffness in the 1st metatarsophalangeal joint warrants further study.
Purpose: To study the relationship of the 1st to 2nd intermetatarsal angle(1-2 IMA) between the intra-operative and weight bearing postoperative anterior-posterior(AP) radiography, and evaluate the intra-operative predictability for the postoperative 1-2 IMA after proximal metatarsal osteotomy(PMO) in the hallux valgus deformity. Materials and Methods: 20 cases of moderate to severe hallux valgus patients were included in this study. After the oblique PMO(Ludloff procedure) was performed and the osteotomy site was fixed temporarily, the AP view was taken intra-operatively. About 10 weeks after surgery, postoperative weight bearing AP view was taken. The pre -. intra -, and postoperative 1-2 IMAs were compared and ana lysed statistically. Results: The 1-2 IMAs of the weight bearing preoperative, non-weight bearing intra-operative and weight bearing postoperative AP view were $15.9^{\circ}{\pm}1.8^{\circ},\;4.7^{\circ}{\pm}2.1^{\circ}$, and $6.8^{\circ}{\pm}2.5^{\circ}$ (Mean${\pm}$SD) respectively. The postoperative 1-2 IMA was greater than intra-operative measurement by $2.1^{\circ}{\pm}1.8^{\circ}$ (range; $-1^{\circ}$ to $6^{\circ}$) which was stastistically significant(p<0.05). To get less than $9^{\circ}$ postoperatively as an average normal, intra-operative 1-2 IMA should be within $3.8^{\circ}$ to $5.2^{\circ}$ (95% confidence interval), and intra-operative 1-2 IMA should be within $3.4^{\circ}{\pm}$to $5.4^{\circ}$(95% confidence interval) to get more than $6^{\circ}$ difference between preoperative and postoperative 1-2 IMA, which is regarded as more than average correction by the distal metatarsal osteotomy. Conclusion: In hallux valgus surgery, it should be considered that intra-operative 1-2 IMA was less than the postoperative. To achieve postoperative 1-2 IMA less than $9^{\circ}$ and more than correction angle of $6^{\circ}$, it is suggested that the intra-operative 1-2 IMA should be measured less than about $5^{\circ}$.
Purpose: To analyze relation between age or parameters measured before operation and cartilage erosion of the first metatarsal head measured during operation. Materials and Methods: The study was targeted at 56 patients and 79 feet, who underwent Scarf osteotomy or Scarf and Akin osteotomy from November 2009 through November 2010, and whose cartilage lesion of the first metatarsal head referred to the cartilage grade III or IV of the International Cartilage Repair Society. The measurement parameters were age, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle. The cartilage erosion of the first metatarsal head was measured by one surgeon using cellophane. Occupancy rate and frequent involved sites of the cartilage erosion were recorded using Auto$CAD^{(R)}$ and adobe Illustrator CS4 program. SPSS correlation test and T-test were used for statistical analysis of the parameters and the cartilage erosion. Results: The cartilage erosion was incurred frequently in the sagittal groove and the site where subluxation or dislocation of the tibial sesamoild bone occurred but frequent involved sites had no statistical significance with cartilage erosion. The age showed a statistical significance with the cartilage erosion in the correlation test (p=0.003). Especially, the group of over 51 year old patients was turned out to have association with the cartilage erosion, compared to the group of below 51 (p=0.007). But, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle were no statistical significance with the cartilage erosion. Conclusion: We found the more the age of patients increased (especially above 51), the more cartilage erosion increased. And it is thought that we pay attention to reduce tibial sesamoid bone.
Kim, Taik-Seon;Kim, Hak-Jun;Park, Young-Hwan;Lim, Hyung-Tae
Journal of Korean Foot and Ankle Society
/
v.15
no.2
/
pp.62-67
/
2011
Purpose: The authors evaluated the differences between K-wires and Cannulated screw, plate for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. Materials and Methods: There were 62 patients (79 feetz) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. We divided the patients into 4 groups, Two K-wire fixed group as A, one cannulated screw fixed group as B. Two cannulated screw fixed group as C, Plate fixed group as D, Group A were patients (26 feet) and Group B were patients z(9 feet), Group C were patients (31 feet) and Group D were patients (13 feet). Preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patient. ANOVA test and Student t-test were done for statistical analysis. Results: Mean follow up period was 43.8 months (range: 12~82 months). Preoperative mean IMA was $16.4{\pm}3.5$, $17.7{\pm}11.3$, $17.3{\pm}5.9$ and $16.6{\pm}2.3$ degrees in respectively group A, B, C, D. Immediate postoperative mean IMA was $5.6{\pm}3.4$, $7.3{\pm}4.4$, $7.6{\pm}4.4$ and $6.7{\pm}2.8$ degrees in respectively group A, B, C, D. The final mean IMA was $8.9{\pm}4.5$, $15.2{\pm}7.5$, $10.3{\pm}4.4$ and D $7.7{\pm}3.5$ degrees in respectively group A, B, C, D. There were significant statistical increase in final mean IMA of group B and C (p<0.05). Conclusion: The IMA was significantly increased in the group which used one or two cannulated screw for fixation on follow up, therefore more caution should be needed when using one or two cannulated screw fixation technique after proximal chevron osteotomy.
Purpose: To study the reliability of intra- and interobserver reliability in angular measurement of hallux valgus deformity by assessing hallux valgus angle (HVA) and the 1st to 2nd intermetatarsal angle (1-2 IMA) through using computerized system. Materials and Methods: 20 cases of moderate to severe hallux valgus patients were included in this study. With the standing anteroposterior view of foot, the HVA and 1-2 IMA were calculated by computerized measurement system of Infinity cooperation, called ${\pi}$-view, with its software tools. Using the statistical software program, SPSS (version 12th), we interpreted the results which were measured by two independent observers. Results: In the intraobserver measurement, the HVA of observer A showed reliability ($32.5^{\circ}{\pm}6.9$ and $33.1^{\circ}{\pm}6.8$)(p<0.05). 1-2 IMA in observer A was not regarded as reliable ($16.9^{\circ}{\pm}2.8$ and $17.1^{\circ}{\pm}2.8$)(p>0.05). In the results of observer B, HVAs were measured as $35.7^{\circ}{\pm}7.6$ and $36.2^{\circ}{\pm}7.7$, and were not reliable (p>0.05). 1-2 IMA in observer B was not reliable as well ($17.0^{\circ}{\pm}0.8$ and $20.8^{\circ}{\pm}1.5$)(p>0.05). In the interobservers' measurements, the first and the second results of HVA were $3.2^{\circ}{\pm}3.6$ and $3.1^{\circ}{\pm}3.1$, reliable within the 95% confidence interval (p<0.05). 1-2 IMAs were $0.1^{\circ}{\pm}1.9$ and $3.73^{\circ}{\pm}1.3$, which were not reliable (p>0.05). Conclusion: In the angular measurement of the hallux valgus by computerized system, the HVA and 1-2 IMA showed less error range in the interobserver's results, compared with the previous studies about the manual measurement. However, our results failed to show the statistical reliability of intra- and interobserver's measuring. Therefore, even the computerized angular measurements in the severity of hallux valgus require development of the measuring methods and software tools.
Purpose: In the professional soccer team, we performed pre-seasonal physical examination and analyzed the results to establish a standardization data in relation to their position. Materials and Methods: We performed physical examination to the professional soccer team, consisted 34 player's average age 24.9 years. The examination performed were questionnaire on history, musculoskeletal examination, muscle power test, physiologic test, functional test. Results: According to the relationship between player position and injury pattern,. Knee injuries are most frequent on history. Physical examination outcome was that forward were prone to flexor hallucis longus tendinitis, midfielder for chronic ankle instability, defender for achilles tendinitis. Isokinetic test was done at dominant side, Peak torque to body weight ratio was 55.1%. Physiologic test checked body fat percentage was midfielder was superior as 19.8 (SD 2.9). Functional test out-come was that back strength 125 N. sergeant jump 59.6 cm, reaction time 208.5 sec, flexibility 19.2 m/s, side step 39.9 cm. Conclusion: Pre-seasonal physical examination gave us the standardization data and preventive measurement could be advocated from this results.
A series of geotechnical surveys and in-situ tests were carried out to evaluate the stability of underground mine cave in an abandoned coal mine. After the closure of the mine, the underground mine drifts have been utilized for a tourist route since 1999. The dimension of the main cave is 5m width, 3m height and 230m length. The surrounding rock mass of the cave is consist of black shale, coal and limestone. Also, the main cave is intersected by two fault zone. Detailed field investigations including Rock Mass Rating(RMR), Geological Strength Index(GSI) and Q classification were performed to evaluate the stability of the main cave and to examine the necessity of reinforcement. Based on the results of rock mass classification and numerical analysis, suitable support design was recommended for the main cave. RMR and Q values of the rock masses were classified in the range of fair to good. According to the support categories proposed by Grimstad & Barton(1993), these classes fall in the reinforcement category of the Type 3 to Type 1. A Type 3 reinforcement category signifies systematic bolting and no support is necessary for the Type 1 case. From the result of numerical analysis, it was inferred that additional support on the several unstable blocks is required to ensure stability of the cave.
In this study, scaled model tests were performed to investigate the stability of twin tunnels with small clearance, where the pillar widths were 0.5D and 0.25D, respectively. The tunnels were supposed to be constructed in anisotropic weathered rocks with $30^{\circ}$ inclined bedding planes, and the model tests were conducted under the condition of lateral pressure ratio, 1. Six types of test models which had respectively different pillar widths and support conditions were experimented, where crack initiating pressures, maximum pressures, failure modes of pillar and deformation behaviors around tunnels were investigated. The models with wider pillar were cracked under higher pressure than the models with shallower pillar. The models with lining support were cracked under higher pressure and showed less tunnel convergence than the unsupported models. The models with both lining and pillar reinforcement were proved to be most stable among the tested models. In particular, as the model of 0.25D pillar width with only lining support showed shear failure of pillar according to the existing bedding planes, so both lining and pillar reinforcement were thought to be indispensable in that case of tunnel.
Recent patterns of infection with digenetic larval trematodes in fresh- water and brackish-water ask were studied in three locations of the river Taewha during the period from April to October, 1988, and compared with the data reported previously in the same river, 0(16 species of fish examined, the encysted larvae of Cyathocotyle orientalis were found most frequently from 9 species of fresh.water fish. The metacercariae of Echinochasmus sp. , Metacercaria hasegawai and Metagonimus yokogawai were found from 8 species, those of Clonorchis sinensis from 7 species, and Exorchis oviformis and Metorchis orientalis from 5 species of fish. The infection rates of fish with C. sinensis metacercariae were not lower than those reported in 1980, whereas their intensity of infection was found lowered in 3 species, Ccreobagrus brevicorpus, Gnathopogon atromaculatus, and Funtungia herzi. The infection rates of 3 species of fish with M. yokogawai metacercariae were lower than the results in 1982, while the rate was higher in 2 species, Zacco platypus, and Z. temmincki, and rather stationary in Flecoglossus altivelis. The intensity of infection in several species of fish appeared rather higher than in 1980. The encysted larvae of C. orientalis, Echinochasmus sp., E. oviformis and Metacercaria hasegawai showed variations in infection rates of fish in 1980 and in the present study. It was found that the rate of infection with digenetic larval trematodes in fresh- water fish was still relatively high in the river Taewha, and the metacercarial burden in the fish varied greatly by different fish in 1980 and in the present study.
This study was performed to make it possible to adjust milk production records which are changing with days in milk more accurately as developing new 305-day adjustment factors considering current circumstance and to offer easier application by converting adjustment factors to formulas. Total 4,264,347 records were used in this analysis after eliminating unusual value and data was classified by first parity and over second parity. Herd-year effects were classified with 2,878 and 19,783 classes in first parity and over second parity, respectively and number of subclass of age-calving season-lactation stage effects were 136 (age 2, calving season 4, lactation stage 17). For calculation of least square mean, SAS GLM was used and multiplicative adjustment factors were developed. The result of error analysis, deviations between means of adjusted yields and cumulated yields were the lowest in new adjustment factor which was developed in this study comparing with other adjustment factors which were developed in the past (94', 02') in first parity and in over second parity, results of adjustment factors which were developed in 2002 and this study were similar. For easier application, formulas of 305-day adjustment factors were developed using SAS NLIN.
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