• Journal of Korean Foot and Ankle Society
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• v.27 no.3
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• pp.87-92
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• 2023

Purpose: Concomitant ankle injuries associated with tibial shaft fractures can affect postoperative ankle joint pain and various postoperative ankle complications. This study compared the clinical outcomes between surgical treatment and conservative treatment of concomitant ankle injuries associated with tibial shaft fractures. Materials and Methods: From January 2015 to June 2020, a retrospective study was conducted on 118 tibia shaft fractures at the orthopedics department of the hospital. Associated ankle injuries were analyzed using plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative stress exams. The clinical outcomes were compared using the pain visual analog scale (pain VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score (AOFAS score), and Karlsson-Peterson ankle score (KP score). Results: Seventy-two (61.02%) of the 118 cases were diagnosed with associated ankle injuries. Fifty-six cases underwent surgery for the ankle injury, and 16 cases underwent conservative treatment. The clinical results (according to the pain VAS score, AOFAS score, the KP score) were 1.79±1.26, 94.48±4.03, and 94.57±3.60, respectively, in the surgical treatment group, and 3.00±1.03, 91.06±3.02, and 91.25±3.31, respectively, in the conservative treatment group. Conclusion: Surgical treatment showed better clinical outcomes than conservative treatment in concomitant ankle injury in tibia fractures. Therefore, surgical treatment produces better clinical outcomes than conservative treatment in concomitant ankle injuries in tibia fractures. Hence to improve the clinical outcomes, more attention is needed on ankle joint injury in tibial shaft fractures for selecting suitable surgical treatments for those patients.

• Journal of Korean Foot and Ankle Society
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• v.10 no.1
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• pp.88-91
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• 2006

Purpose: To evaluate the effect on clinical course of heterotopic ossification of distal tibiofibular syndesmosis after ankle fractures. Materials and Methods: From June 2001 to May 2004, we found nine cases of heterotopic ossification of distal tibiofibular syndesmosis after ankle fractures. There were 8 male patients and 1 female patient; their mean age was 42 years old. There were 6 Weber type B and 2 Weber type C fractures, and there is 1 case with posterior malleolus fracture only. Among them, 8 ankle fractures were operated. Follow up period was averaged for 14 months. We were able to review radiographs at initial injury and to review clinical menifestation and radiographs at last follow up. We used an ankle-hindfoot scoring system of AOFAS which combined symptom, function and alignment with maximum score of 100 point. Results: In all cases ankle dorsiflexion and plantarflexion were not significantly different from that of the contralateral side. The patients who had developed heterotopic ossification in distal tibiofibular syndesmosis had a similar functional score. The mean ankle-hind foot score was 94 points. Conclusion: We concluded that the heterotopic ossification of distal tibiafibular syndesmosis after ankle fractures had little effect on clinical course and range of motion of ankle joint.

• Journal of Korean Medicine Rehabilitation
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• v.28 no.1
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• pp.167-173
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• 2018

The purpose of this study is to report the effect of Korean medicine rehabilitation therapies in two patients with ankle fractures who underwent Open Reduction with Internal Fixation (ORIF). Two patients with fractures who received ORIF received acupuncture, electroacupuncture, herbal medicine, and physical therapy during hospitalization. Patients were evaluated for AOFAS score, NRS, ROM, and ankle circumference. Case 1 was improved from 30 points to 62 points on the AOFAS score, from 8 to 2 on the NRS, and from 33 cm to 30 cm on the ankle perimeter. ROM was improved in all directions. Case 2 showed an AOFAS score of 64 to 90 points, frome 5 to 2 on the NRS, and from 25 cm to 23.5 cm on the ankle perimeter. ROM was improved in all directions. The results of this study suggest that the treatment of Korean medicine has a meaningful effect on improvement and rehabilitation of ankle fracture patients who have received ORIF.

• Journal of Korean Medicine Rehabilitation
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• v.21 no.2
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• pp.289-297
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• 2011

Objectives : This study was planned to show the influences of acupuncture treatment on peroneus muscles of acute inversion ankle sprain patients. Methods : This study was carried out on the 24 patients who had been treated for their acute inversion ankle sprain from July 1 to December 31, 2010 in the department of oriental rehibilitaion medicine, Dongsuwon oriental medicine hospital. And we divided those 24 patients into 2 groups; group A took near acupuncture point needling treatment on the peroneus muscles along with common treatment, group B took common treatment only. To evaluate the efficiency of each treatment, all patients were examined with visual analogue scale(VAS) and ankle-hindfoot scale(AHS) score before treatment and after the 3rd treatment. Results : On the AHS scores, there's no significant difference between the two groups after the treatment. And on the VAS scores, group A who took near acupuncture point needling treatment on the peroneus muscles along with common treatment showed higher change of VAS than group B who took common treatment only, but it did not show statistical significance in VAS score. Conclusions : In this study, there is no significant effect between common treatment only and near acupuncture point needling treatment on the peroneus muscles along with common treatment for acute ankle sprain.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.40-45
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• 2009

Purpose: End-stage ankle arthritis is frequently combined with ankle-hindfoot deformity or ankle instability and therefore additional surgical procedures are often required when performing total ankle arthroplasty. We report the short term clinical and radiographic results of the total ankle arthroplasty with/without the combined adjunctive surgical procedures. Materials and Methods: The study is based on the 17 ankles (16 patients) of end-stage ankle arthritis that were treated with $HINTEGRA^{(R)}$ Total ankle prosthesis (Newdeal, Lyons, France) total ankle arthroplasty (TAA) from 2004 to 2007 with at least 12 months follow-up. The combined adjunctive procedures as well as the VAS pain score, AOFAS score, radiographic measurements and patient satisfactions were evaluated. Results: Average follow-up period was 29 months (13${\sim}$55 months), and the age was average 62 years (39${\sim}$75 years) old. Among total of 17 ankles, varus deformity and lateral ankle instability were found in 4 cases and 3 cases respectively. Twenty additional procedures such as Achilles triple hemisection (9), calcaneal displacement osteotomy (4) and lateral ankle ligament reconstruction (3) were performed in adjunct to TAA in 13 ankles. VAS pain score improved from preoperative average 8.4 (7${\sim}$10) to 2.0 (0${\sim}$5) and the AOFAS functional score improved from 41.8 points (13${\sim}$71 points) to 90.6 (77${\sim}$100 points) at final follow-up. Ninety-four percent of the patients were satisfied with the surgery. Conclusion: We confirmed that many adjunctive combined surgical procedures are often necessary in addressing the end-stage ankle arthritis (74%) with total ankle arthroplasty. We also achieved quite good clinical and radiographic short term results, although the long term follow-up study with larger number of cases are needed in the future.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.52-58
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• 2005

Purpose: To analyze the overall clinical outcome, overall assessment, and patient's satisfaction rate of subtalar arthrodesis using the cannulated compression screw. Materials and Methods: This study is based on 17 patients, 17 feet who underwent subtalar arthrodesis using the cannulated compression screw from March, 1997 to March, 2004 with at least 1 year follow-up. The average follow-up period was 33.0 months (12 to 72 months). Functional results were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS) score, and Visual Analysis Scale (VAS) pain score, patients' returning to previous occupation and patients' satisfaction rate were also evaluated. Results: The mean AOFAS scores at final follow-up were 80.4 points (range $66{\sim}92$). The satisfactory rates were as follow. Thirteen patients (76.4%) were at least satisfied with surgical result at final follow-up. Patients' VAS pain score was average 2.8 points ($1{\sim}6$). Fourteen (82.3%) patients returned to previous job at mean postoperative period of 11.3 months (range 3-18 months). Patients' work efficiency after returning to previous occupation was 68.7% (range $33{\sim}100%$). There were 9 complications which were 3 cases of sural nerve injury, 1 case of valgus malunion, and 5 cases of the hindfoot residual pain. Conclusion: We obtained the satisfactory functional results with relatively high patient satisfaction rate of 76%. So we conclude that subtalar arthrodesis using the cannulated compression screw is a reliable method for addressing the painful end-stage subtalar osteoarthritis and unreconstructible comminuted calcaneal fractures. However we also found out that average 11 months were necessary for patients to return to their job.

• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.133-140
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• 2019

Purpose: This study examined the radiological and clinical outcomes of tibiotalocacalcaneal arthrodesis using retrograde intramedullary nailing in a severe hindfoot deformity and ankle/subtalar arthritis. Materials and Methods: A total of 22 patients (22 cases) with a severe hindfoot deformity and arthritis underwent tibiotalocalcaneal arthrodesis with retrograde intramedullary nails. The average age was 57.4 years (22-82 years) and the mean follow-up was 29.6 months (12-74 months). The radiological outcomes included an assessment of the preoperative and postoperative coronal ankle alignment, hindfoot alignment, sagittal alignment, and postoperative union time. The clinical outcomes were evaluated using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and postoperative complications. The results were analyzed statistically by dividing the patients into two groups based on a 10° angle of deformity. Results: Regarding the preoperative coronal ankle alignment, 14 patients had a mean varus deformity of 17.8°±14.5° and six had a mean valgus deformity of 8.1°±6.6°. Postoperatively, a satisfactory postoperative coronal ankle alignment of less than 5° was obtained in all patients. Regarding the preoperative hindfoot alignment, 12 patients showed a mean varus deformity of 15.2°±10.5° and six had a mean valgus deformity of 8.1°±4.2°. In total, 94.4% (17 patients) had satisfactory postoperative hindfoot alignment of less than 5°. Radiological union was achieved in 90.9% at an average of 19.2 weeks (12-32 weeks) and there were 2 cases of nonunion. The clinical outcomes showed improvement in the mean VAS and AOFAS scores (p<0.001, p<0.001, respectively). Even a preoperative severe deformity more than 10° showed a significant deformity correction of coronal ankle alignment and hindfoot alignment, postoperatively (p<0.001, p<0.001, respectively). No significant differences were found between the patients with a preoperative coronal ankle deformity more than 10° and those less than 10° regarding the mean postoperative coronal ankle alignment (p=0.162). Conclusion: Tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing is an acceptable technique for achieving satisfactory deformity correction, high union rate with minimal complications, and improvement of the clinical outcomes. In addition, tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing is considered an effective treatment option, particularly in severe ankle and hindfoot deformities.

• Journal of the Korean Orthopaedic Association
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• v.54 no.6
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• pp.547-556
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• 2019

Purpose: This study evaluated the results of surgical treatment for residual or recurrent deformity after the conservative treatment of idiopathic clubfoot. Materials and Methods: Fifty-one cases (32 patients), who were followed up to skeletal maturity, were reviewed retrospectively. The mean age at the last follow-up was 18.7 years. The surgical options included selective or comprehensive soft tissue release, tendon lengthening and transfer, and various types of osteotomy. The radiology measurements included the talocalcaneal angle and talo-first metatarsal angle in the anteroposterior (AP) view, and the talocalcaneal angle and calcaneal pitch in the lateral view. The radiology measurements were compared with the normal values for adults. The clinical evaluations were made using the ankle-hindfoot score and the midfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS): excellent (>85), good (71-85), pair (56-70), and poor (<56). Results: At the last follow-up, the percentages of the 51 cases, whose parameter values fell within the normal ranges were as follows: in the AP view, 41.2% (talocalcaneal angle); and 90.2% (talo-first metatarsal angle). In the lateral view, the percentage was 84.3% (talocalcaneal angle). For the calcaneal pitch, the percentages were 61%. The mean AOFAS score was 88.1±10.7 on the ankle-hindfoot score and 86.7±11.5 on the midfoot score. Conclusion: The long-term outcome of patients with idiopathic clubfoot, who underwent surgical treatment after conservative treatment, was found to be 43%-90% of the normal range of radiographic indices. Clinically, the mean AOFAS scores were "excellent". Therefore, a satisfactory result can be obtained by analyzing the elements of deformity more accurately and then using the selective operation method, even if the non-surgical correction method fails.

• Journal of Acupuncture Research
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• v.34 no.3
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• pp.139-152
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• 2017

Objectives : This study reports the clinical effects of miniscalpel needle therapy in patients with carpal tunnel or tarsal tunnel syndrome. Methods : Three patients with carpal tunnel syndrome (CTS) or tarsal tunnel syndrome (TTS) (first case, patient with CTS and TTS; second case, patient with CTS; and third case, patient with TTS) were treated with miniscalpel needle (MSN) therapy and integrative Korean medical treatment. The Numeric Rating Scale (NRS), Neuropathic Pain Scale (NPS), Boston scale score, and AOFAS (American Orthopaedic Foot and Ankle Society) ankle-hindfoot score were measured. Results : In general, outcome measures after treatment showed improvement in all cases. In the first case (CTS and TTS), scores on the NRS, NPS, and Boston scale decreased, and AOFAS ankle-hind foot scores increased. In addition, Tinel's sign showed improvement. In the second case (CTS), scores on the NRS, NPS, and Boston scale, and Tinel's sign, were decreased. In the third case (TTS), scores on the NRS and NPS, and Tinel's sign, showed improvement, and AOFAS ankle-hind foot scores were increased. Conclusion : These results suggest that MSN therapy has a meaningful clinical effect in CTS and TTS.

• Journal of Korean Foot and Ankle Society
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• v.3 no.1
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• pp.19-25
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• 1999

The purpose of this study Is to assess the retained range of motion[RROM] of the foot after arthrodesis of the ankle joint, which might help designing the angle of arthrodesis. We reviewed the results including the RROM in 14 cases of ankle arthrodesis. Underlying causes included trauma group(six posttraumatic arthritis) and disease group(three osteoarthritis, three Charcot joints, one chronic synovitis and one pyogenic arthritis). We measured the RROM on the lateral roentgenograms of the ankle in full dorsiflexion and plantarflexion, The results were assessed by the AOFAS hindfoot scale[score]. The RROM in sagittal plane was $23.4{\pm}5.3$ degrees and the score was 71.5 points on average. The RROM and the score were $26.8^{\circ}{\pm}2.1$, 81.2 points respectively in trauma group and $20.8^{\circ}{\pm}5.6$, 64.3 points in disease group; $26.6^{\circ}{\pm}2.3$, 83.4 points in cases younger than 40 years of age and $21.6^{\circ}{\pm}5.7$, 64.9 points in the older. The mean score was 77.3 points in cases whose RROM were $24^{\circ}$ or more and 61 points in cases of less RROM; 69.6 and 73.4 points in cases with and without adjacent degenerative arthritis respectively. The score was 69.7, 73.3 and 71.5 points in cases whose angle of arthrodesis was in dorsiflexion, neutral, plantarflexion respectively. In conclusion, after ankle arthrodesis RROM of the foot was $23.4^{\circ}$, and the more the RROM, the higher the score. In cases with sufficient amount of RROM, the angle of fusion on sagittal plane might not influence the result significantly.