• 대한족부족관절학회지
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• 제15권4호
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• pp.207-211
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• 2011

Purpose: To evaluate the results of conservative treatment of zone I, II $5^{th}$ metatarsal base fracture. Materials and Methods: Between May 2004 and June 2010, a total of 58 patients of zone I, II $5^{th}$ metatarsal base fractures were included in this study. The mean length of follow-up was 13.5 months (12~36 months). All of the patients were treated with full-weight-bearing short leg cast immobilization for 4 weeks and wooden sole shoes for 4 weeks. The results were evaluated about the radiographic union, the midfoot scale of American Orthopaedic Foot and Ankle Society (AOFAS), the tenderness on fracture site and other complications. Results: All patients were able to return to their prior levels of activity. The mean time for union as shown on radiographs was 45.5 days, and the mean midfoot scale of AOFAS was 99.7 points. There were no nonunions or refractures during the follow-up. Conclusion: The conservative treatment with full-weight-bearing short leg cast and wooden sole shoes seems to give good results for zone I, II $5^{th}$ metatarsal base fracture.

• 대한족부족관절학회지
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• 제15권1호
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• pp.18-21
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• 2011

Purpose: To evaluate the clinical and radiological results of internal fixation with tension band wiring for the fracture at the base of fifth metatarsal bone. Materials and Methods: From January 2008 to December 2009, 15 cases with displaced fracture at the base of fifth metatarsal were analyzed and average follow up period was 13.8 months. Lawrence classification was used to classify fracture type. We evaluated clinical results by American Orthopedic Foot Ankle Society (AOFAS) midfoot score and radiological results by union time. Complications was also checked. Results: According to classification, zone I fracture were 11 cases and zone II fracture were 4 cases. Bony union was achieved in all cases after 7 weeks. In the final follow-up, average AOFAS score was 94. There were no complications except hardware irritation. Conclusion: Satisfactory results were obtained after tension band wiring for the fifth Metatarsal base fracture in zone I fracture or comminuted zone II fracture for which it is not easy to be fixed with screw.

• 대한족부족관절학회지
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• 제11권1호
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• pp.67-71
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• 2007

Purpose: To evaluate clinical results of the 5th proximal metatarsal intraarticular fracture (Zone I) with displacement treated operatively and to evaluate predisposing factors of the 5th proximal metatarsal fracture (Zone I). Materials and Methods: 11 patients treated for the 5th proximal metatarsal fracture (Zone I) operatively and 10 patients treated conservatively between Jan 2003 and Dec 2005, were followed for more than one year. Functions were graded by AOFAS foot scoring system and union time and postoperative complications were also evaluated. Calcaneal pitch angle was also evaluated. Results: Clinically there were no much difference in results. Clinical points were 94.5 in the operative group and 92.3 in the conservative group. At the last follow-up, the radiographic results showed union in all cases. During the follow-up period, there were no significant complications. But in the conservative group, displaced fracture with calcaneal pitch angle over 30 degree tends to show delayed union and time to loss of pain tends to be prolonged. Conclusion: Calcaneal pitch angle is thought to predisposing factor for 5th metatarsal base fracture. Operative treatment is viable option for the 5th proximal metatarsal intraarticular fracture with displacement and with calcaneal pitch angle over 30 degree. In cases of cavovarus foot deformity, we think operative treatment should be considered with deliberation and long term follow-up study for peroneal tendinopathy should be needed.

• 대한족부족관절학회지
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• 제20권3호
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• pp.131-134
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• 2016

Purpose: This study aimed to evaluate the outcomes, including the complications, of open reduction and internal fixation using a headless cannulated compression screw for a fifth metatarsal base fracture. Materials and Methods: We retrospectively investigated 11 patients with 5th metatarsal base fracture who were treated with a headless cannulated compression screw. The mean follow-up period was 13 months (8~15 months), and the mean age was 46.5 years (21~70 years). We analyzed the patients' sex, age, time to union, amount of fracture displacement, and complications. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score was used for clinical assessment. Results: The average amount of displacement decreased significantly from 3.4 mm (2.1~5.2 mm), preoperatively, to 0.4 mm (0~1.3 mm), postoperatively (p<0.001). The average bone union time was 54.1 days (41~68 days). There were no complications, such as a metal failure, irritation, and loss of a reduction. The mean AOFAS midfoot score was 97.7 (90~100) at 6 months, postoperatively. Conclusion: We suggest that a headless cannulated compression screw for 5th metatarsal base fracture is a useful and alternative method for a firm fixation without complications.

• 대한족부족관절학회지
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• 제1권1호
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• pp.43-50
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• 1997

The tarsometatarsal joint complex is formed by articulation of the five metatarsal bases with the three cuneiform bones and the cuboid bone. Fracture-dislocation of tarsometatarsal area are difficult to recognize on standard radiographs. The exact diagnosis is occasionally delayed. As a result, improper treatment and late sequelae remains. We decided to make a study of patients with normal foot radiographs on 200 cases. Standard radiographic evaluation was used to study the normal variants of the foot and to evaluate the coincided alignment of the lisfranc joint. Accurate accessment on AP & lateral & $30^{\circ}$ oblique projection of radiographs are very adventageous & important, and next final outcome was detected. : 1. Coincided alignment below 1mm and unfolded lisfranc joint on AP projection was well visalized on 1st cuneiform-metatarsal lateral border and 2nd cuneiform-metatarsal medial border. 2. Coincided alignment below 1mm and unfolded lisfranc joint on oblique projection was well visualized on 2nd cuneiform-metatarsal lateral border and 3rd cuneiform-metatarsal medial border and 3rd cuneform-metatarsal lateral border. 3. More proximal location of 2nd lisfranc joint compared to another joint was 196 cases (98%). It is due to inceleration of 2nd metatarsal base between 3rd & 1st cuneiform. 4. 3rd lisfranc joint was volarward position compared to 2nd listranc on lateral projection at 191 cases (95.5%). It's due to anterior covexity of lisfranc joint. 5. Wide dorsal sided 2nd lisfranc is investigated at 189 cases (94.5%). Because of it. 2nd & 3rd lisfrances are mainly volar dislocated usually. 6. Notching on 5th metatarsal base is visible on 171 cases (85.5%). 7. 4th lisfranc joint had offset normally within $2\sim3mm$ at 98 cases (49%). 8. 5th Lisfranc joint had normally offset within $2\sim3mm$ at 99 cases (49.5%). 9. On lateral projection, slight dorsal location of cuneiform to metatarsal base is investigated at 82 cases (41%).

• 대한정형외과학회지
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• 제56권2호
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• pp.150-156
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• 2021

목적: 제5 중족골 기저부 골절의 위치와 전위, 관절 침범, 분쇄 등의 특징이 조기 체중부하 치료의 결과에 어떤 영향을 미치는지 알아보고자 하였다. 대상 및 방법: 2013년 1월부터 2017년 7월까지 인제대학교 부산백병원에 내원하여 제5 중족골 기저부 제1, 2 구역 골절로 진단 받은 총 34명의 34예를 대상으로 하였다. 평균 추시 기간은 13개월(6-15개월)이었다. 동 기간 동안 수술적 치료를 시행한 경우는 없었고 1명의 경우 추시 기간 중 이전 골절 부위와 다른 부위의 재골절로 제외되었으며 총 33예 모두 보존적 치료를 시행하였다. 족부의 전후면, 측면 및 경사 방사선 촬영 및 컴퓨터 단층 촬영을 시행하여 골절의 위치와 전위, 관절 침범, 분쇄의 정도를 평가하였다. 33명의 모든 환자에게 있어서 수상 직후부터 단하지 석고고정 혹은 탈착 가능한 부츠형 보조기를 선택하여 착용 후 통증이 허용되는 범위 내에서 부분적인 체중부하를 허용한 뒤 통증이 소실되면 일반 신발 또는 수술 후 신발을 착용 후 전 체중부하를 시행하게 하였다. 임상적 결과로 최종 추시 시에 American Orthopedic Foot and Ankle Society (AOFAS) score를 평가하였다. 외래 추시 시 족부의 단순 방사선 촬영을 하여 방사선적 골유합 시기와 업무로의 복귀 시기를 확인하였다. 결과: 총 33명의 환자가 본 연구에 참여하였고(남자 9명, 여자 24명), 환자들의 평균 나이는 48.7세(16-80세)였다. 제1 구역이 24명, 제2 구역이 9명이었고 전체 33명의 환자 중 22명에서 2 mm 이상의 골절 전위가 관찰되었고 관절 침범은 9명, 분쇄 골절은 5명에서 관찰되었다. 제1 구역에서 제2 구역에 비하여 통계적 의미 있는 업무로의 복귀를 보였고 최종 추시 시 AOFAS score는 우수한 결과를 보였고 통계적 차이는 없었다. 골절의 전위 정도, 관절 침범 여부, 분쇄 정도를 분류, 비교하였을 때 방사선적 유합 시기, 업무 복귀 시기에 있어 통계적 차이는 없었으며 모든 경우에 있어 최종 추시 시 만족할 만한 결과를 보였다. 결론: 제5 중족골 기저부 골절에서 골절의 위치, 전위, 관절 침범, 분쇄 여부에 관계없이 조기 체중부하를 허용하여도 만족할 만한 임상적 결과를 얻을 수 있다. 제5 중족골 기저부 골절에서 조기 체중부하하 보존적 치료는 우수한 임상 결과를 얻을 수 있는 좋은 치료 방법이라 생각된다.

• 대한족부족관절학회지
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• 제8권1호
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• pp.71-75
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• 2004

Purpose: The purpose of this study was to evaluate retrospectively the clinical results of closed reduction and percutaneous screw fixation for unstable injuries on stress radiographs in subtle injuries of Lisfranc joint. Materials and Methods: From June 1997 to March 2003, 6 cases of unstable injuries on stress radiograph in subtle injuries of Lisfranc joint were treated by percutaneous cannulated screw fixation after closed reduction. All cases were injuried by indirect force (twisting injury). The average diastasis between the 1st and 2nd metatarsal base was 3 mm (2-4 mm) on initial nonweight bearing AP radiograph. The average follow-up period was 20 months. Clinical evaluation was assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score. Results: The AOFAS midfoot score was average 86 (80-90) points. The average diastasis between 1st and 2nd metatarsal base was 2 mm (1-3 mm) on weight bearing AP radiograph in final follow up. The final diastasis was increased slightly than diastasis in initial postoperative radiographs. But the clinical results were good. There was no correlation between the degree of diastasis and the clinical results. On weight bearing lateral radiograph, the average difference with normal foot in the distance between plantar aspect of 5th metatarsus and medial cuneiform was 2 mm (0-3 mm). One case had mild arthritic change on the radiographs. Conclusion: When the Lisfranc injuries, especially in the subtle injuries were suspicious, the stress views are helpful to assess stability of the Lisfranc injuries and planning of treatment. For unstable injuries on stress radiographs in subtle injuries of Lisfranc joint, closed reduction and percutaneous screw fixation is useful method to expect good clinical results.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.112-120
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• 1996

We peformed tendon transfer with a microvascular free flap for recovery of handicapped function and reconstruction for the skin and soft tissue loss. We review the clinical data of 11 children who underwent these operation due to injured foot by pedestrian accident from January, 1986 to June, 1994. The mean age of patients was 5.6 years old(3-8). Five cases underwent tendon transfer and microvascular free flap simultaneously. Another 6 cases underwent operations separately. The time interval between tendon trasnfer and microvascular free flap was average 5.6 months(2-15 months). The duration between initial trauma and tendon transfer was average 9.6 months(2-21 months). The anterior tibial tendon was used in 6 cases. Among these, the technique of splitting the anterior tibial tendon was used in 5 cases. The posterior tibial tendon was used in 3 cases and the extenosr digitorum longus tendon of the foot in 2 cases. Insertion sites of tendon transfer were the cuboid bone in 3 cases, the 3rd cuneiform bone in 3 cases, the 2nd cuneiform bone in 1 case, the base of 4th metatarsal bone in 1 case, and the remnant of the extensor hallucis longus in 3 cases. The duration of follow-up was average 29.9 months(12-102 months). The clinical results were analysed by Srinivian criteria. Nine cases were excellent and 2 cases were good. The postoperative complications were loosening of the tranferred tendon in 2 cases, plantar flexion contracture in 1 case, mild flat foot deformity in 1 case and hypertrophic scar in 2 cases. So we recommend the tendon transfer with a microvascular free flap in the case of injured foot of children combined with nerve injury and extensive loss of skin, soft tissue and tendon.