• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.41-49
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• 2015

Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.

• 대한관절경학회지
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• 제16권2호
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• pp.180-184
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• 2012

진균에 의한 감염성 관절염은 면역 억제 치료자, 약물 남용자, 장기간의 항생제 투여자 등에서 발생하는 드문 질환으로 특히 건강한 성인에서의 감염은 매우 드물다. 진균에 의한 슬관절의 감염성 관절염은 국내에서 2예의 보고가 있으나, 건강한 성인에서 발생한 진균성 슬관절염은 아직 보고된 바가 없는 실정이다. 이에 저자들은 건강한 성인에서 반복적인 관절 내 스테로이드 주사 후 발생한 진균성 관절염 및 이와 동반한 슬와낭종의 관절경적 치료를 경험하여 문헌 고찰과 함께 보고하는 바이다. 진균성 슬관절염은 특징적인 임상상이 없는 드문 질환으로, 진단에 있어 어려움이 있으므로 면밀한 관찰과 주의를 요한다.

• 대한족부족관절학회지
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• 제22권1호
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• pp.8-15
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• 2018

Ankle osteoarthritis is a debilitating condition that causes severe pain associated with functional impairment and decreased activity. Ankle osteoarthritis, unlike that of the knee or hip joint, is rare in primary arthritis. Most cases are traumatic arthritis that occur after ankle sprain or fractures or chronic ankle instability. Although ankle fusion has been regarded as the standard treatment of ankle osteoarthritis in the past, total ankle arthroplasty (TAA) is increasing due to the development of the implant design and surgical techniques. TAA is biomechanically superior to ankle fusion by preserving the movement of the ankle joint. In particular, it is functionally superior to ankle fusion because it enables normal joint motion during gait. In addition, there is an advantage of preserving the movement of the hindfoot and reducing the abnormal stress applied to the adjacent joints after ankle fusion to prevent the occurrence of long-term adjacent joint arthritis. Although the short-term and mid-term results of TAA have been reported to be excellent, long-term follow-up has a relatively low survival rate and high complication rate compared to total knee or hip arthroplasty. Therefore, continuous and further research is needed.

• 대한정형외과스포츠의학회지
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• 제10권2호
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• pp.100-104
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• 2011

이 연구의 목적은 근위 경골 절골술 후 대퇴골의 회전각도와 슬관절 운동범위 및 주관적 환자 만족도 사이의 상관 관계를 분석하는 것이다. 2004년 6월부터 2008년 8월까지 고위 경골 절골술을 시행한 15명의 원발성 골 관절염 환자들이 연구 대상으로 수술 전 후 슬관절 CT를 시행하였다. 9명은 여자였으며 6명은 남자였다. 수술 전 후 슬관절의 CT를 촬영하여 대퇴골 회전 각도(TEA (Fig. 1) 및 Akagi's line (Fig. 2)으로 측정)를 백분율로 환산하여 분석하였으며 수술 후 슬관절 운동 각도와 주관적 만족도(Lysholm)의 상관관계를 확인하였다. 통계적 기법은 Kendall's 및 Spearman's nonparameter correlation coefficient 로 검정하였다. 결과상 대퇴골회전 정도와 수술 후 슬관절의 운동 각도는 의미 있는 상관 관계가 없으며 대퇴골 회전 정도와 수술후 환자의 주관적 만족도와는 의미 있는 상관 관계가 있었다. 따라서 이런 점을 알고 수술적 계획을 세운다면 보다 좋은 임상결과를 얻을 수 있을 것이다.

• 대한족부족관절학회지
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• 제20권4호
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• pp.145-151
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• 2016

Purpose: To evaluate the reliability of preoperative and postoperative distal metatarsal articular angle (DMAA) measurements and to determine whether such reliability is different in accordance with the foot and ankle fellowship and the number of years in practice. Materials and Methods: Between July 2012 and June 2014, a total of 20 patients (24 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic hallux valgus deformity. DMAA were measured twice with an interval of two weeks between the preoperative and postoperative dorsoplantar radiographs by four observers; two of whom were foot and ankle surgeons (A and B), one knee surgeon, and one senior resident. The intraobserver reproducibility and interobserver reliability were assessed by intraclass correlation coefficients. Moreover, the limit of agreement between the preoperative and postoperative DMAA measurements were assessed using a Bland-Altman plot. Results: The intraobserver reproducibility of the foot and ankle surgeon A, knee surgeon, and senior resident improved from 0.796, 0.575, and 0.586 preoperatively to 0.968, 0.864, and 0.864 postoperatively, respectively. The interobserver reliability of foot and ankle surgeon A-B, foot and ankle surgeon A-knee surgeon, and foot and ankle surgeon A-senior resident improved from 0.874, 0.688, and 0.677 preoperatively to 0.971, 0.917, and 0.838 postoperatively, respectively. Conclusion: The intra- and interobserver reliabilities for DMAA measurement improved after proximal chevron osteotomy. Therefore, the necessity of additional procedures to correct the increased DMAA should be reevaluated after proximal chevron osteotomy in the hallux valgus with an increased DMAA.

• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.398-406
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• 2018

Background: Hypoalbuminemia (serum albumin < 3.5 g/dL) is associated with increased morbidity and mortality in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, costs associated with hypoalbuminemia remain unknown. This study investigated the effect of serum albumin on direct treatment costs, length of stay (LOS), and readmissions for primary and revision THA and TKA patients. Methods: All adult patients at a single institution undergoing primary or revision THA or TKA between January 2014 and December 2016 were retrospectively reviewed. Patients were stratified by preoperative serum albumin level. The primary outcome was total direct costs at index hospitalization. Secondary outcomes included LOS and readmission within 30 days. Multivariable regressions were utilized to adjust for demographics and comorbidities. Results: Of 3,785 patients, 114 (3.0%) had hypoalbuminemia. After adjustment, hypoalbuminemia was associated with a 16.2% increase in costs (${\beta}=0.162$; 95% confidence interval [CI], 0.112 to 0.213; p < 0.001), representing an average cost increase of $3,383 (95% CI, $2,281 to $4,485) relative to costs for serum albumin > 4.5 g/dL. The increased total costs were significantly higher in revision ($4,322, p = 0.034) than in primary ($3,446, p < 0.001) procedures. In adjusted regression, each 1.0 g/dL increase in serum albumin yielded a 6.6% reduction in costs (${\beta}=-0.066$; 95% CI, -0.090 to -0.042]; p < 0.001), for average savings of $1,282 (95% CI, $759 to $1,806) per unit albumin. Adjusted regressions demonstrated that a 1-point increase in serum albumin reduced readmissions by 53% (odds ratio, 0.47; 95% CI, 0.31-0.73; p = 0.001) and LOS by 0.6 days (${\beta}=-0.60$; 95% CI, -0.76 to -0.44; p < 0.001). Conclusions: Hypoalbuminemia is associated with increased total direct costs, LOS, and readmissions following primary and revision THA and TKA. Future efforts to predict and address total costs should take into consideration the patient's preoperative serum albumin levels.

• 근관절건강학회지
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• 제29권2호
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• pp.81-90
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• 2022

Purpose: The purpose of this study was to evaluate the efficacy of applying a defecation encouragement program for patients undergoing total knee replacement arthroplasty (TKRA). Methods: This program was based on the nursing best practice guideline: prevention of constipation in the older adult population by the National Guideline Clearing House (NGC) in 2011, which included fluid intake, bowel training, and abdominal and pelvic floor exercises. A team of one orthopaedic clinical nurse specialist and six orthopaedic nurses with a 10 years of clinical experience applied and assisted patients with the program. Formal counsel was provided by one orthopaedic doctor, one gastroenterologist, and one exercise therapist. Patients who defecated one day prior to or on the day of TKRA surgery were included. Data collected from 72 subjects were analyzed using SPSS/WIN 21.0. Results: Time until first defecation after surgery was 2.4±1.1 days in experimental group, which was significantly shorter than the 3.5±0.9 days in control group (t=4.28, p<.001). Constipation assessment scale showed significantly lower points (t=2.55, p=.013) in experimental group (1.3±1.2) compared to control group (2.6±2.6). The experimental group and control group were 17.3±7.67 and 23.7±14.43, respectively, and the experimental group used less laxatives (t=2.83, p=.021). Conclusion: A defecation encouragement program was proved to be an appropriate nursing intervention for patients undergoing TKRA. This study confirmed that constipation is a nursing problem that can be sufficiently prevented if nurses are interested and encourage defecation.

• Clinics in Shoulder and Elbow
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• 제17권4호
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• pp.194-196
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• 2014

A ganglion is a benign cystic mass, commonly found around a joint or tendon sheath. It frequently occurs at the wrist, foot, ankle, and knee. Intratendinous ganglion has been rarely reported, and intratendinous ganglion of the long head of biceps brachii is extremely rare. According to our literature review, this is the third case of intratendinous ganglion of the long head of biceps brachii, and the first case of arthroscopic treatment. Therefore we report a case of an arthroscopic treatement for an intratendinous ganglion of the long head of biceps brachii.

• Journal of Chest Surgery
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• 제3권1호
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• pp.55-58
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• 1970

The problem of phlebothrombosis is an important one, not only because of its local effects, but because of the propensity for portions of the venous clot to berak off and travel back to the heart and into the pulmonary Artery. The result of pulmonary embolism, unfortunately is still as prominent a cause of death today as it was before the advant of modern advances in treatment and prevention. This paper reports a case of thrombosis of left common iliac vein left hypogastric vein and left common femoral vein, who had been bedmidden for two weeks because of left knee joint arthritis. Successfully treated with transabdominal direst venous thrombectomy and anticoagulant heparin. Authors also reviewed the references.

• 대한족부족관절학회지
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• 제13권2호
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• pp.211-213
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• 2009

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder that affects synovium, tendon sheath and bursa. Although the condition can present in any joint, knee joint is the most commonly affected site and only 2.5% of cases occur in foot and ankle joint. PVNS occurs in two types: localized and diffuse. Localized type is characterized by focal involvement of the synovium with either nodular or pedunculated masses, Diffuse type affects virtually the entire synovium. Diffuse type has reported more recurrence rate. We have experienced a patient who has diffuse type PVNS of ankle joint and report an optimal method of surgical treatment.