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Ahn JY, Park CH, Jung JW, Lee WC. Plain Radiographs Underestimate Varus Deformity of the Tibial Plafond. J Foot Ankle Surg 2022; 61:836-840. [PMID: 34974979 DOI: 10.1053/j.jfas.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/01/2021] [Accepted: 12/01/2021] [Indexed: 02/08/2023]
Abstract
Understanding plain radiograph in association with 3-dimensional (3D) morphology of the ankle is essential for treatment about varus ankle osteoarthritis (OA). The aims of this study were to investigate whether the alignment of the tibial plafond as determined on plain radiograph reflected the alignment of the tibial plafond on computed tomography (CT) in varus ankle OA and whether the alignment of the tibial plafond changed as the OA progressed. The 3D CT and plain radiographs from 101 ankles with varus ankle OA were analyzed and compared with 40 ankles in control group. The tibial plafond was assessed in the coronal and sagittal planes using 3D CT. The medial angle between the vertical line and the tibial plafond was measured on 3 different coronal plane CT images which was anterior, middle and posterior area of the tibial plafond. The medial distal tibial angle on plain radiograph reflected the posterior area of the tibial plafond on CT. The amount of varus angulation on CT was larger in anterior and middle area of the tibial plafond than the posterior area. There was a difference in the degree of varus of the tibial plafond between control group and OA patients; however, there was no difference among patients in different stages of varus ankle OA. Weightbearing plain radiographs underestimate the varus deformity in anterior and middle area of the tibial plafond and there is no significant difference in deformity of the tibial plafond among patients in different stages of varus ankle OA.
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Affiliation(s)
- Ji-Yong Ahn
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chul-Hyun Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
| | - Jae Woong Jung
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, South Korea.
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Woo I, Park J, Seok H, Kim TG, Moon JS, Chung SM, Park CH. The Fate of Antibiotic Impregnated Cement Space in Treatment for Forefoot Osteomyelitis. J Clin Med 2022; 11:1976. [PMID: 35407582 PMCID: PMC8999527 DOI: 10.3390/jcm11071976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023] Open
Abstract
Forefoot osteomyelitis can be an extremely challenging problem in orthopedic surgery. Unlike conventional methods, such as amputations, antibiotic impregnated cement space (ACS) was recently introduced and perceived as a substitute for amputation. The purpose of this study was to compare clinical features between diabetic and non-diabetic groups and to evaluate the efficacy of ACS in the treatment of forefoot osteomyelitis, by identifying the clinical characteristics of ACS. We inserted ACS into the forefoot osteomyelitis patients and regularly checked up on them, then analyzed the clinical features of the patients and failure reasons, if ACS had to be removed. Average survival rate of ACS was 60% (21 out of 35 cases) and main failure reason was recurrence of infection. There was no significant clinical difference between diabetic and non-diabetic groups. We concluded that ACS could be a possible way of avoiding amputation if infection is under control. ACS seems to be an innovative method with promising results for foot osteomyelitis, but widely accepted indications need to be agreed upon.
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Affiliation(s)
- Inha Woo
- Department of Orthopedics, Yeungnam University Hospital, Daegu 38541, Korea; (I.W.); (J.P.); (H.S.)
| | - Jeongjin Park
- Department of Orthopedics, Yeungnam University Hospital, Daegu 38541, Korea; (I.W.); (J.P.); (H.S.)
| | - Hyungyu Seok
- Department of Orthopedics, Yeungnam University Hospital, Daegu 38541, Korea; (I.W.); (J.P.); (H.S.)
| | - Tae-gon Kim
- Department of Plastic Surgery, College of Medicine, Yeungnam University, Daegu 38541, Korea;
| | - Jun Sung Moon
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Yeungnam University, Daegu 38541, Korea; (J.S.M.); (S.M.C.)
| | - Seung Min Chung
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Yeungnam University, Daegu 38541, Korea; (J.S.M.); (S.M.C.)
| | - Chul Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu 38541, Korea
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Abstract
BACKGROUND Late-stage varus ankle arthritis is thought to be associated with varus of the tibial plafond and hindfoot. However, some late-stage varus arthritis show hindfoot valgus, which can be explained by subtalar subluxation with opposite directional motion between the talus and calcaneus. We hypothesized that late-stage varus ankle arthritis with hindfoot valgus could improve with repositional subtalar arthrodesis and supramalleolar osteotomy (SMO). The purpose of this study was to investigate the clinical and radiographic results of the repositional subtalar arthrodesis combined with SMO for late-stage varus ankle arthritis with hindfoot valgus. METHODS This study includes 16 consecutive patients (16 ankles) with late-stage varus ankle arthritis of Takakura stage 3-b and hindfoot valgus who were treated using repositional subtalar arthrodesis combined with SMO and followed for a minimum of 2 years. Clinical results were assessed with the visual analog scale (VAS) and the Foot Function Index (FFI). Radiographic results were assessed with standard parameters measured on weightbearing foot and ankle radiographs. Clinical and radiographic results were evaluated preoperatively and at the last follow-up. RESULTS VAS and FFI significantly improved after surgery. Mean talar tilt angle improved from 12.8 ± 2.8 degrees to 3.9 ± 3.1 degrees (P < .001). Talus center migration and Meary angle significantly improved after surgery. Medial distal tibial angle, lateral talocalcaneal angle, hindfoot moment arm, and talonavicular coverage angle significantly changed after surgery. Radiographic stage improved in 15 ankles (93.8%) after surgery. CONCLUSION In this series with minimum 2-year follow-up, we found that late-stage (Takakura stage 3-b) varus ankle arthritis with hindfoot valgus clinically and radiographically improved with repositional subtalar arthrodesis combined with SMO. LEVEL OF EVIDENCE Level IV, prognostic.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jaeyoung Kim
- Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA
| | - Ji Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Korea
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Park JJ, Son WS, Woo IH, Park CH. Combined Transfibular and Anterior Approaches Increase Union Rate and Decrease Non-Weight-Bearing Periods in Ankle Arthrodesis: Combined Approaches in Ankle Arthrodesis. J Clin Med 2021; 10:jcm10245915. [PMID: 34945209 PMCID: PMC8706894 DOI: 10.3390/jcm10245915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 02/05/2023] Open
Abstract
The transfibular approach is a widely used method in ankle arthrodesis. However, it is difficult to correct coronal plane deformity. Moreover, it carries a risk of nonunion and requires long periods of non-weight-bearing because of its relatively weak stability. We hypothesized that the transfibular approach combined with the anterior approach in ankle arthrodesis wound yield a higher fusion rate and shorter non-weight-bearing period. This study was performed to evaluate the clinical and radiographic results and postoperative complications in ankle arthrodesis using combined transfibular and anterior approaches in end-stage ankle arthritis. Thirty-five patients (36 ankles) with end-stage ankle arthritis were consecutively treated using ankle arthrodesis by combined transfibular and anterior approaches. The subjects were 15 men and 20 women, with a mean age of 66.5 years (46-87). Clinical results were assessed using the visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) scores, and the ankle osteoarthritis scale (AOS) preoperatively and at the last follow-up. Radiographic results were assessed with various radiographic parameters on ankle weight-bearing radiographs and hindfoot alignment radiographs. All clinical scores significantly improved after surgery. Union was obtained in all cases without additional surgery. Talus center migration (p = 0.001), sagittal talar migration (p < 0.001), and hindfoot alignment angle (p = 0.001) significantly improved after surgery. One partial skin necrosis, two screw penetrations of the talonavicular joint, and four anterior impingements because of the bulky anterior plate occurred after surgery. In conclusion, combined transfibular and anterior approaches could be a good method to increase the union rate and decrease the non-weight-bearing periods in ankle arthrodesis.
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Affiliation(s)
- Jeong-Jin Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu 42415, Korea; (J.-J.P.); (I.-H.W.)
| | - Whee-Sung Son
- Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, Seoul 08308, Korea;
| | - In-Ha Woo
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu 42415, Korea; (J.-J.P.); (I.-H.W.)
| | - Chul-Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu 38541, Korea
- Correspondence: ; Tel.: +82-53-620-3640
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Abstract
BACKGROUND Repair of acute Achilles tendon rupture using the Achillon device is a representative mini-open repair technique; however, the limitations of this technique include the need for special instruments and decreased repair strength. A modified mini-open repair using ring forceps might overcome these limitations. PURPOSE To compare the Achillon device with ring forceps in mini-open repairs of acute Achilles tendon rupture. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Fifty patients (41 men and 9 women) with acute Achilles tendon rupture on 1 foot were consecutively treated using mini-open repair techniques. The first 20 patients were treated using the Achillon device (Achillon group), and the subsequent 30 were treated using a ring forceps (forceps group). Clinical, functional, and isokinetic results and postoperative complications were compared between the groups at the last follow-up. Clinical evaluations were performed using the AOFAS (American Orthopaedic Foot and Ankle Society) score, Achilles Tendon Total Rupture Score, length of incision, and operation time. Functional evaluations included active range of motion of the ankle joint, maximum calf circumference, hopping test, and single-limb heel rise (SLHR). Isokinetic evaluations were performed using the isokinetic test for ankle plantar flexion. RESULTS The AOFAS score (P = .669), Achilles Tendon Total Rupture Score (P = .753), and length of incision (P = .305) were not significantly different between the groups (mean ± SD, 90.1 ± 8.7, 88.3 ± 9.9, and 2.7 ± 0.3 cm in the Achillon group vs 92.2 ± 9.4, 89.9 ± 10.9, and 2.5 ± 0.4 cm in the forceps group, respectively). Operation times in the Achillon group were significantly shorter than those in the forceps group (41.4 ± 9.6 vs 62.8 ± 14.1 minutes, P < .001). The maximum height of the SLHR (P = .042) and the number of SLHRs (P = .043) in the forceps group (79.7% ± 7.4% and 72.9% ± 10.2%) were significantly greater than those in the Achillon group (75.3% ± 7.1% and 66.7% ± 11.0%). No significant differences were detected between the groups in mean peak torques for plantar flexion at angular speeds of 30 deg/s (P = .185) and 120 deg/s (P = .271). There was no significant difference in the occurrence of postoperative complications between the groups (P = .093). CONCLUSION The ring forceps technique is comparable to the Achillon technique with respect to clinical, functional, and isokinetic results and postoperative complications. Given that no special instrument is required, the ring forceps technique could be a better option for acute Achilles tendon rupture repair.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Hongfei Yan
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jeongjin Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Korea
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Na HD, Yan H, Park CH. Misdiagnosis of Pyoderma Gangrenosum Increases Medical Costs and Prolongs Hospital Stay: A Case Report. INT J LOW EXTR WOUND 2021; 22:428-433. [PMID: 33891524 DOI: 10.1177/15347346211011870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, immunological ulcerative, and necrotic inflammatory skin disease that can be easily misdiagnosed as cellulitis, abscess, diabetic foot ulcer, and other infectious diseases. Misdiagnosing PG leads to unnecessary surgical incision and debridement, which further exacerbates the lesion, ultimately leading to longer treatment periods and higher medical costs. Therefore, early and accurate diagnosis of PG is extremely important for its treatment. In particular, PG should be suspected in patients with inflammatory bowel disease.
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Affiliation(s)
- Ho D Na
- College of Medicine, 65676Yeungnam University, Daegu, Republic of Korea
| | - Hongfei Yan
- College of Medicine, 65676Yeungnam University, Daegu, Republic of Korea
| | - Chul H Park
- College of Medicine, 65676Yeungnam University, Daegu, Republic of Korea
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Park CH, Na HD, Chang MC. Clinical Outcomes of Minimally Invasive Repair Using Ring Forceps for Acute Achilles Tendon Rupture. J Foot Ankle Surg 2021; 60:237-241. [PMID: 33358383 DOI: 10.1053/j.jfas.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/07/2020] [Indexed: 02/08/2023]
Abstract
Mini-open techniques using special devices, introduced to preclude the complications of open and percutaneous techniques, have limited usefulness because of the need for the devices and the weak strength of the repair. We developed a mini-open technique using a ring forceps. This technique is easy to use and increases the strength of the repair with crossed sutures. Twenty-six consecutive patients were treated using a mini-open technique using a ring forceps for acute Achilles tendon rupture. American Orthopaedic Foot and Ankle Society (AOFAS) scores and Achilles tendon total rupture scores (ATRS) were evaluated at the last follow-up. The active range of motion of ankle joint and maximum calf circumference (MCC) were measured and compared with the uninjured side at the last follow-up, as well as hopping and single-limb heel-rise (SLHR) tests and isokinetic tests for ankle plantarflexion. AOFAS score and ATRS were 92.2 ± 9.4 and 89.9 ± 10.9, respectively, at the last follow-up. The MCC (p = .035) and maximum height of SLHR (p = .001) were significantly different between uninvolved and involved legs. No significant differences in mean peak torques for plantarflexion at angular speeds of 30°/s (60.9 ± 23.6 vs 50.8 ± 20.4 Nm/kg; p = .299) and 120°/s (31.6 ± 16 vs 29.6 ± 17.7 Nm/kg; p = .776) were observed between uninvolved and involved legs. The mini-open technique using a ring forceps for acute Achilles tendon rupture showed satisfactory clinical outcomes and favorable functional outcomes without complications.
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Affiliation(s)
- Chul Hyun Park
- Professor, Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea.
| | - Ho Dong Na
- Surgeon, Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Min Cheol Chang
- Professor, Department of Physical Medicine and Rehabilitation, Yeungnam University Medical Center, Daegu, Korea
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Park CH, Gwak HC, Kim JH, Lee CR, Kim DH, Park CS. Peroneal Tendon Subluxation and Dislocation in Calcaneus Fractures. J Foot Ankle Surg 2021; 60:233-236. [PMID: 33468399 DOI: 10.1053/j.jfas.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 02/08/2019] [Accepted: 09/01/2019] [Indexed: 02/08/2023]
Abstract
The present study investigated the relationship between type of calcaneal fractures and subluxation or dislocation of peroneal tendon. Also, we investigated clinical outcomes of patients with both calcaneal fractures and dislocations or subluxations of peroneal tendons in early surgical treatments (at the time of surgery for calcaneal fractures) and delayed surgical treatment (at the time of surgery for calcaneal plate removal) for dislocations or subluxations of peroneal tendons. We included 151 patients with calcaneal fractures who were followed for ≥2 years after surgery. Among them, 21 cases (13.9%) required reduction for peroneal tendon subluxation or dislocation. Reductions of peroneal tendons were performed at the time of surgery for calcaneal fractures in 11 cases, whereas the other 10 cases were performed during surgery for calcaneal implant removal. As classified by Essex-Lopresti, 94 cases (62.3%) were joint depression type and 17 (18.1%) were accompanied by dislocations or subluxations of peroneal tendons, whereas 57 (37.7%) were tongue type and 4 (7.0%) were accompanied by dislocations or subluxations of peroneal tendons. As classified by the Sanders system, 96 cases (63.6%) were Sanders A fracture lines, and 18 (18.8%) were accompanied by dislocations or subluxations of peroneal tendons. In 55 cases (36.4%) without Sanders A fracture lines, 3 (5.5%) were accompanied by dislocations or subluxations of peroneal tendons. In conclusion, calcaneal fractures with peroneal tendon dislocations are more common in joint depression type and Sander A type. Also, after a ≥2-year follow-up period, there were no significant differences in visual analog scale or foot and ankle outcome score whether reduction of peroneal tendons was done with reduction of fracture or removal of implant of calcaneus.
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Affiliation(s)
- Chul-Hyun Park
- Associate Professor, Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Yeungnam Medical Center, Daegu, Republic of Korea
| | - Heui-Chul Gwak
- Professor, Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea.
| | - Jung-Han Kim
- Associate Professor, Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - Chang-Rack Lee
- Associate Professor, Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - Deok-Hee Kim
- Surgeon, Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - Chul-Soon Park
- Resident, Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea
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Abstract
AIMS No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. METHODS Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of motion (ROM), Böhler's angle and calcaneal width, and posterior facet reduction. RESULTS Although four patients (12.5%) in the ELA groups and none in the STA group experienced complications, the difference was not statistically significant (p = 0.113). VAS and AOFAS score were significantly better in the STA group than in the ELA group at six months (p = 0.017 and p = 0.021), but not at 12 months (p = 0.096 and p = 0.200) after surgery. The operation time was significantly shorter in the STA group than in the ELA group (p < 0.001). The subtalar joint ROM was significantly better in the STA group (p = 0.015). Assessment of the amount of postoperative reduction compared with the uninjured limb showed significant restoration of calcaneal width in the ELA group compared with that in the STA group (p < 0.001). CONCLUSION The ELA group showed higher frequency of wound complications than the STA group for Sanders type 2 calcaneal fractures even though this was not statistically significant. Cite this article: Bone Joint J 2021;103-B(2):286-293.
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Affiliation(s)
- Chul Hyun Park
- College of Medicine, Yeungnam University, Daegu, Republic of Korea, Daegu, Korea
| | - Hongfei Yan
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Jeongjin Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
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Jeong K, Jung KJ, Bae J, Kim J, Seo J, Park CH, Kim S, Song IH. Laser sterilization of hydroxyapatite implants as an alternative to using radioactive facility. Optik 2020. [DOI: 10.1016/j.ijleo.2020.165200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Choo YJ, Park CH, Chang MC. Rearfoot disorders and conservative treatment: a narrative review. Ann Palliat Med 2020; 9:3546-3552. [PMID: 32787369 DOI: 10.21037/apm-20-446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023]
Abstract
Rearfoot disorders are frequently encountered in clinical practice. We reviewed common rearfoot disorders and present conservative treatments, focusing on shoe modification and the application of insoles or orthoses. Achilles tendinopathy is caused by excessive mechanical loads on the gastrocnemius and soleus muscles. Heel lifts, rocker shoes, and the AirHeel Brace can be used to reduce symptoms. Haglund's deformity is an osseous prominence of the posterosuperior part of the calcaneus bone, the pain from which can be alleviated by reducing pressure on the affected area by appropriately modifying the back of the shoe to prevent contact with the lesion. The pain from retrocalcaneal bursitis can be controlled by lifting the heel and loosening the shoe counter. Plantar fasciitis causes plantar heel pain, and its orthotic treatments include the application of a heel cup, heel pad, heel wedge, Thomas heel, and night splint. Calcaneal stress fractures are generally caused by repetitive loads and occur mainly in sporting activities. Patellar tendon-bearing (PTB) orthoses are helpful in reducing the load on the calcaneal bone. Heel fat pad atrophy refers to the loss of the fat pad that absorbs shock in the heel. To reduce pain caused by heel fat pad atrophy, rocker soles, heel pads, and solid ankle cushion heels (SACHs) may be used. Tarsal tunnel syndrome is caused by compression of the tibial nerve within the tarsal tunnel and its symptoms can be managed by rocker soles, supporting medial arches, Thomas heels, and SACHs. Shoe modification or application of orthoses can be helpful for managing rearfoot pain. However, for the active and wide application of these conservative treatment methods, more clinical studies should be conducted.
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Affiliation(s)
- Yoo Jin Choo
- Production R&D Division Advanced Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Deagu, Republic of Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
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Jung KJ, Lee GW, Park CH, Lee TJ, Kim JY, Sung EG, Kim SY, Jang BI, Song IH. Mesenchymal Stem Cells Decrease Oxidative Stress in the Bowels of Interleukin-10 Knockout Mice. Gut Liver 2020; 14:100-107. [PMID: 31158947 PMCID: PMC6974321 DOI: 10.5009/gnl18438] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/20/2019] [Accepted: 03/29/2019] [Indexed: 02/05/2023] Open
Abstract
Background/Aims: Inflammatory bowel disease (IBD) is an autoimmune disease characterized by chronic inflammation mainly in the large intestine. The interleukin-10 knockout (IL-10 KO) mouse is a well-known animal model of IBD that develops spontaneous intestinal inflammation resembling Crohn's disease. Oxidative stress is considered to be the leading cause of cell and tissue damage. Reactive oxygen species (ROS) can cause direct cell injury and/or indirect cell injury by inducing the secretion of cytokines from damaged cells. This study evaluated the effects of mesenchymal stem cell (MSC) on the progression of IBD. Methods: In this study, human bone marrow-derived MSCs were injected into IL-10 KO mice (MSC). Oxidative stress and inflammation levels were evaluated in the large intestine and compared with those in control IL-10 KO mice (CON) and normal wild-type control mice (Wild). Results: The levels of ROS (superoxide and hydrogen peroxidase) and a secondary end-product of lipid peroxidation (malondialdehyde) were considerably higher in the CON, while superoxide dismutase and catalase levels were lower in the MSC. Inflammation-related marker (interferon-γ, tumor necrosis factor-α, IL-4, and CD8) expression and inflammatory histological changes were much less pronounced in MSC than in CON. Conclusions: MSCs affect the redox balance, leading to the suppression of IBD.
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Affiliation(s)
- Kyong Jin Jung
- Department of Anatomy, Yeungnam University College of Medicine, Daegu,
Korea
- Smart-Aging Convergence Research Center, Yeungnam University College of Medicine, Daegu,
Korea
| | - Gun Woo Lee
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu,
Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu,
Korea
| | - Tae Jin Lee
- Department of Anatomy, Yeungnam University College of Medicine, Daegu,
Korea
| | - Joo Young Kim
- Department of Anatomy, Yeungnam University College of Medicine, Daegu,
Korea
| | - Eon Gi Sung
- Department of Anatomy, Yeungnam University College of Medicine, Daegu,
Korea
| | - Seong Yong Kim
- Department of Biochemistry and Molecular Medicine, Yeungnam University College of Medicine, Daegu,
Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu,
Korea
| | - In Hwan Song
- Department of Anatomy, Yeungnam University College of Medicine, Daegu,
Korea
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Park CH, Kim GB. Tibiofibular relationships of the normal syndesmosis differ by age on axial computed tomography-Anterior fibular translation with age. Injury 2019; 50:1256-1260. [PMID: 31064651 DOI: 10.1016/j.injury.2019.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/10/2019] [Accepted: 04/21/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION This study aimed to assess the tibiofibular relationships of normal syndesmosis on axial computed tomography (CT) images and evaluate the measurement differences by gender, age, and body sides. PATIENTS AND METHODS The cases of 120 volunteers who underwent bilateral ankle CT were retrospectively reviewed. Volunteers were divided into three groups of 40 (20 men and 20 women) as follows: 20-40, 40-60, and 60-80 years old. Radiographic evaluation included the anterior tibiofibular clear space (ATFCS), posterior tibiofibular clear space (PTFCS), anterior tibiofibular interval (ATFI), length of incisura (LI), depth of incisura (DI), and fibular width (FW). Each measured parameter was compared based on gender, age, and body sides. To calibrate anatomical variations among the volunteers, ATFCS, PTFCA, and ATFI were expressed as ratios of FW. RESULTS PTFCS and ATFI were significantly larger in the men (p = 0.001, 0.001). LI and FW were significantly smaller in the women (p <0.001, <0.001). Calibrated ATFCS, PTFCS, and ATFI did not differ between the genders. ATFCS, PTFCS, and ATFI were significantly different among the age groups (p = 0.001, 0.001, and <0.001, respectively). These calibrated parameters showed significant differences according to age (p = 0.009, 0.006, and <0.001, respectively). There were no significant differences between sides. All CT measurements, except DI, showed high intra- and inter-observer reliabilities. CONCLUSIONS Axial CT images of the normal syndesmosis showed significant differences according to gender and age, but not between sides. In light of the anatomical variation, narrowing of the syndesmotic joint due to anterior translation of the fibula following aging may represent the most significant finding. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Hyeonchungno 170, Nam-gu, Daegu, 42415, Republic of Korea
| | - Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Hyeonchungno 170, Nam-gu, Daegu, 42415, Republic of Korea.
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Abstract
Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
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15
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Abstract
INTRODUCTION The osteochondral fracture of the talus is an uncommon condition, therefore, there are controversies for the optimal treatment. We report a novel surgical technique of bone peg fixation for osteochondral fracture of the talus. MATERIALS AND METHODS We report two cases that underwent bone peg fixation for the acute osteochondral fractures of talus. Clinical and radiographic evaluations were performed at the last follow-up. RESULTS At the last follow-up, mean ROM of ankle joint was 50° (range 45°-55°). Additionally, mean VAS and AOFAS score were 0 and 100 at the last follow-up, respectively. All patients obtained bone union without complication at the last follow-up radiographs. CONCLUSIONS This case study shows good clinical and radiographic results with autologous bone peg fixation in patients with acute osteochondral fractures of the talus. LEVEL OF EVIDENCE V, expert opinion.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Hyeonchungno 170, Namgu, Daegu, 42415, Republic of Korea.
| | - Chang Hyun Choi
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Hyeonchungno 170, Namgu, Daegu, 42415, Republic of Korea
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Ryu SM, Ahn MW, Park CH, Lee GW, Song IH, Ahn HS, Kim J, Kim S. Effect of water glass coating of tricalcium phosphate granules on in vivo bone formation. J Biomater Appl 2018; 33:662-672. [PMID: 30396326 DOI: 10.1177/0885328218808038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recently, some authors introduced a water glass (WG, sodium-silicate glass; Na2O·SiO2·nH2O) coating over tricalcium phosphate (TCP) bioceramic to modulate its resorption rate and enhance the bone cell behaviors. In this study, four different types of granular samples were prepared to evaluate the ability of new bone formation in vivo using micro-computed tomography and histology. METHODS Four types sample groups: group A (pure HA as a negative resorption control); group B (pure TCP as a positive resorption control); group C (WG-coated TCP as an early resorption model); and group D (same as group C but heat-treated at 500°C as a delayed resorption model). Cylindrical tube-type carriers with holes were fabricated with HA by extrusion and sintering. Each carrier was filled densely with each granular sample. Four types of tubes were implanted into the medial femoral condyle and medial tibial condyle of New Zealand White rabbits. RESULTS The HA group (A) showed the lowest amount of new bone formation. All the TCP sample groups (B, C, and D) showed more new bone formation. On the other hand, among the TCP groups, group C (early resorption model) showed slightly more bone formation. The amount of residual bioceramics was most abundant in the HA group (A). All the TCP sample groups showed less residual bioceramics than group A. Among the TCP groups, group C showed slightly more residual bioceramics. Group B showed the lowest amount of residual bioceramics. CONCLUSIONS The WG-coated TCP sample (group C) is the best bone substitute candidate because of its proper biodegradation rate and the Si ions release because the WG-coated layer reduces the material resorption and enhances the new bone formation. That is, the WG-coated TCP is believed to be the best material for the application of an artificial bone substitute material.
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Affiliation(s)
- Seung Min Ryu
- 1 Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, Korea
- 5 Department of Orthopedic Surgery, Military Manpower Administration Gwangju and Jeollanam-do Regional Office, 119 Yangnim-ro, Dong-gu, Gwangju, Korea
| | - Myun Whan Ahn
- 1 Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, Korea
| | - Chul Hyun Park
- 1 Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, Korea
| | - Gun Woo Lee
- 1 Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, Korea
| | - In Hwan Song
- 2 Department of Anatomy, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu, Korea
| | - Hyo Sae Ahn
- 3 Department of Orthopedic Surgery, Bon Hospital, 8, Seunghak-ro, Saha-gu, Busan, Korea
| | - Jooseong Kim
- 4 Materials Science and Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk, Korea
| | - Sukyoung Kim
- 4 Materials Science and Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk, Korea
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Kim CH, Moon JS, Chung SM, Kong EJ, Park CH, Yoon WS, Kim TG, Kim W, Yoon JS, Won KC, Lee HW. The Changes of Trends in the Diagnosis and Treatment of Diabetic Foot Ulcer over a 10-Year Period: Single Center Study. Diabetes Metab J 2018; 42:308-319. [PMID: 29885115 PMCID: PMC6107356 DOI: 10.4093/dmj.2017.0076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/13/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aims to describe the trends in the severity and treatment modality of patients with diabetic foot ulcer (DFU) at a single tertiary referral center in Korea over the last 10 years and compare the outcomes before and after the introduction of a multidisciplinary diabetic foot team. METHODS In this retrospective observational study, electronic medical records of patients from years 2002 to 2015 at single tertiary referral center were reviewed. Based on the year of first admission, patients were assigned to a group either before or after the year 2012, the year the diabetes team launched. RESULTS Of the 338 patients with DFU, 229 were first admitted until the year 2011 (group A), while 109 were first admitted since the year 2012 (group B). Mean age was higher in group B, and ulcer size was larger than those of group A. Whereas duration of diabetes was longer in group B, glycemic control was improved (mean glycosylated hemoglobin, 9.48% vs. 8.50%). The proportion of minor lower extremity amputation (LEA) was increased, but length of hospital stay was decreased (73.7±79.6 days vs. 39.8±36.9 days). As critical ischemic limb increased, the proportion of major LEA was not decreased. CONCLUSION Improved glycemic control, multidisciplinary strategies with prompt surgical treatment resulted in reduced length of hospital stay, but these measures did not reduce major LEAs. The increase in critical ischemic limb may have played a role in the unexpected outcome, and may suggest the need for increased vascular intervention strategies in DFU treatment.
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Affiliation(s)
- Choong Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Seung Min Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Jung Kong
- Department of Nuclear Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Woo Sung Yoon
- Division of Vascular Surgery, Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Tae Gon Kim
- Department of Plastic Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Woong Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Ji Sung Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyu Chang Won
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyoung Woo Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
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18
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Abstract
BACKGROUND The anterior half of the peroneus longus tendon (AHPLT) has been reported to be an effective autograft for ligament reconstruction with respect to strength and safety. However, there is little information regarding donor site morbidity after harvesting the AHPLT. Furthermore, to the best of our knowledge, there has not been a study on the isokinetic evaluation of ankle plantar flexion and eversion after AHPLT harvesting. PURPOSE To evaluate the clinical and radiographic results after lateral ankle ligament reconstruction using the AHPLT. We further investigated whether harvesting the AHPLT for lateral ankle ligament reconstruction decreases the strength of ankle plantar flexion and eversion. STUDY DESIGN Case series; Level of evidence, 4. METHODS Thirty consecutive patients (31 cases) were treated by anatomic lateral ligament reconstruction using the AHPLT. For the clinical assessment, visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Karlsson-Peterson scores were evaluated preoperatively and at the last follow-up. For the radiographic assessment, talar tilt angle and anterior talar displacement were measured preoperatively and at the last follow-up. The peak isokinetic torques for ankle plantar flexion at angular velocities of 30 and 120 deg/s and eversion at angular velocities of 30 and 60 deg/s were measured at a minimum of 1 year after surgery. RESULTS The mean VAS score improved significantly from 6.4 ± 1.7 preoperatively to 1.6 ± 1.5 at the last follow-up ( P < .001). The mean respective AOFAS and Karlsson-Peterson scores improved significantly from 57.2 ± 12.8 and 66.9 ± 13.6 preoperatively to 89.0 ± 10.0 and 93.3 ± 5.7 at the last follow-up ( P < .001). The mean talar tilt angle improved significantly from 15.3° ± 6.2° preoperatively to 3.4° ± 3.0° at the last follow-up ( P < .001), and the mean anterior talar displacement improved significantly from 10.2 ± 3.3 mm preoperatively to 6.3 ± 1.9 mm at the last follow-up ( P < .001). No significant differences were observed between the uninvolved and involved legs in the mean peak torque for plantar flexion at angular speeds of 30 deg/s ( P = .517) and 120 deg/s ( P = .347) or for eversion at angular speeds of 30 deg/s ( P = .913) and 60 deg/s ( P = .983). CONCLUSION Anatomic lateral ligament reconstruction using the AHPLT showed good clinical and radiographic results without a significant decrease in the peroneus longus strength. Lateral ligament reconstruction using the AHPLT may be a good surgical option for the treatment of chronic ankle instability.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Inje University Seoul Paik Hospital, Seoul, Korea
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19
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Abstract
BACKGROUND Traditionally, Gustilo Anderson grade IIIb open tibial fractures have been treated by initial wide wound debridement, stabilization of fracture with external fixation, and delayed wound closure. The purpose of this study is to evaluate the clinical and radiological results of staged treatment using negative pressure wound therapy (NPWT) for Gustilo Anderson grade IIIb open tibial fractures. MATERIALS AND METHODS 15 patients with Gustilo Anderson grade IIIb open tibial fractures, treated using staged protocol by a single surgeon between January 2007 and December 2011 were reviewed in this retrospective study. The clinical results were assessed using a Puno scoring system for severe open fractures of the tibia at the last followup. The range of motion (ROM) of the knee and ankle joints and postoperative complication were evaluated at the last followup. The radiographic results were assessed using time to bone union, coronal and sagittal angulations and a shortening at the last followup. RESULTS The mean score of Puno scoring system was 87.4 (range 67-94). The mean ROM of the knee and ankle joints was 121.3° (range 90°-130°) and 37.7° (range 15°-50°), respectively. Bone union developed in all patients and the mean time to union was 25.3 weeks (range 16-42 weeks). The mean coronal angulation was 2.1° (range 0-4°) and sagittal was 2.7° (range 1-4°). The mean shortening was 4.1 mm (range 0-8 mm). Three patients had partial flap necrosis and 1 patient had total flap necrosis. There was no superficial and deep wound infection. CONCLUSION Staged treatment using NPWT decreased the risks of infection and requirement of flap surgeries in Gustilo Anderson grade IIIb open tibial fractures. Therefore, staged treatment using NPWT could be a useful treatment option for Gustilo Anderson grade IIIb open tibial fractures.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Hospital, Daegu, Korea
| | - Oog Jin Shon
- Department of Orthopedic Surgery, Yeungnam University Hospital, Daegu, Korea
- Address for correspondence: Prof. Oog Jin Shon, Department of Orthopedic Surgery, Yeungnam University Hospital, Daemyung-dong 317-1, Nam-gu, Daegu 705-717, Korea. E-mail:
| | - Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University Hospital, Daegu, Korea
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Park CH, Shon OJ, Seo JS, Kim GB. Midshaft clavicle fracture with ipsilateral acromioclavicular joint separation found during serial follow-up. J Orthop Sci 2016; 21:399-402. [PMID: 26740446 DOI: 10.1016/j.jos.2015.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 12/04/2014] [Accepted: 12/11/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
| | - Oog Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea.
| | - Jae Sung Seo
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
| | - Gi Beom Kim
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
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21
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Abstract
Fracture of the posterior process of the talus with concomitant subtalar dislocation is rare; thus, the mechanism of injury, appropriate treatment, and prognosis are unclear. We report the case of a 50-year-old male with a fracture of the posterior process of the talus with concomitant subtalar dislocation that was recognized early and successfully treated operatively.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, Korea.
| | - Kang Hyun Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, Korea
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Abstract
Giant cell tumor in small bones is a rare condition characterized by extensive bony destruction and a high recurrence rate. Intralesional excision with curettage and autologous bone grafting has been used as a standard treatment method for giant cell tumor of the bones. We report the case of a 30-year-old female with giant cell tumor of the talar body. She was followed up for 19 years after intralesional curettage and autologous bone grafting treatment.
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Affiliation(s)
- Kwang-Soon Song
- Department of Orthopedic Surgery, Keimyung University Hospital, Daegu, Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Hospital, Daegu, Korea.
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23
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Abstract
BACKGROUND The purpose of this study was to introduce our technique of arthroscopic excision of the os trigonum in the lateral decubitus position through anterolateral, centrolateral, and posterolateral portals and also to investigate the safety and clinical results of this technique. METHODS Between May 2007 and May 2011, 23 ankles of 23 consecutive patients underwent subtalar arthroscopic removal of the os trigonum in a lateral decubitus position. Twenty patients were male and 3 were female. All patients injured their ankles during sports activities. Mean duration of postoperative follow-up was 18 months, and no patients were lost to follow-up. Clinical evaluations were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analog scale (VAS) for pain. The time to return to work and sports activities was assessed. RESULTS Average AOFAS ankle-hindfoot score increased from 71.3 (range, 59-85) preoperatively to 94.7 (range, 90-100) postoperatively, and VAS for pain decreased from 6.7 (range, 3-10) to 1.5 (range, 0-3). Average plantarflexion of the ankle increased from 28.8 degrees (range, 15-40) preoperatively to 42.5 degrees (range, 25-50) postoperatively. Mean time to resumption of sports activities was 6.7 weeks (range, 5-12). There were no major complications in any patient. CONCLUSION Arthroscopic excision of a symptomatic os trigonum using anterolateral, centrolateral, and posterolateral portals in the lateral decubitus position was a safe and effective technique. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
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Park CH, Ju TJ, Kim YW, Dan JM, Kim JY, Kim YD, Seo JS, Park SY. Hemin, heme oxygenase-1 inducer, attenuates immobilization-induced skeletal muscle atrophy in mice. Life Sci 2013; 92:740-6. [PMID: 23439326 DOI: 10.1016/j.lfs.2013.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/15/2013] [Accepted: 02/11/2013] [Indexed: 02/05/2023]
Abstract
AIMS The present study examined the effect of the heme oxygenase (HO)-1 inducer hemin on skeletal muscle atrophy induced by single limb immobilization in mice. MAIN METHODS Immobilization was conducted in the left hindlimb of C57BL/6 mice for 1 week and the right hindlimb was used as a control. Hemin (30 mg/kg) was administered intraperitoneally once a day during the immobilization period. Gastrocnemius muscles were used for analysis. Muscle weight was measured to quantify degree of atrophy, and exhaustion treadmill test was performed to assess muscle function. KEY FINDINGS Immobilization increased HO-1 protein levels in skeletal muscle, which was further increased by hemin treatment. Immobilization induced weight loss and a functional reduction in skeletal muscle, which were attenuated by hemin treatment. Gene expression and protein levels of MuRF1 and atrogin-1 were increased by immobilization and hemin treatment attenuated the increment. The phosphorylation of mTOR and p70S6k was decreased by immobilization in skeletal muscle and hemin had no effect on mTOR and p70S6k phosphorylation. Gene expression of the antioxidants superoxide dismutase and glutathione peroxidase 1 in skeletal muscle was reduced by immobilization and hemin treatment recovered the reduction. Immobilization increased levels of carbonylated protein and nitrotyrosine in skeletal muscle, which was reversed by hemin treatment. Gene expression of inflammatory cytokines was increased by immobilization and was normalized as a result of hemin treatment. SIGNIFICANCE These results suggest that hemin attenuates immobilization-induced skeletal muscle atrophy through the suppression of protein degradation via its anti-oxidant and anti-inflammatory properties.
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Affiliation(s)
- Chul-Hyun Park
- Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Daegu, South Korea
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25
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Abstract
Level of Evidence: V, Expert Opinion
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26
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Hwang SH, Jung KA, Lee WJ, Yang KH, Lee DW, Carter A, Park CH, Hunter DJ. Morphological changes of the lateral meniscus in end-stage lateral compartment osteoarthritis of the knee. Osteoarthritis Cartilage 2012; 20:110-6. [PMID: 22133800 DOI: 10.1016/j.joca.2011.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 11/01/2011] [Accepted: 11/08/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the morphological changes of the lateral meniscus in end-stage lateral compartment osteoarthritis (OA) of the knee. METHODS One hundred fifty-eight knee joints from 133 patients that subsequently underwent total knee joint arthroplasty from January 2008 to December 2009 were enrolled. There were 26 men and 107 women. Their ages ranged from 56 to 81 (mean 67.4 ± 6.5 years). All study participants had complete obliteration of the lateral joint space identified by weight-bearing radiography. Meniscal position was assessed by measuring meniscal subluxation and meniscal height. The meniscal morphology was assessed using a modification of the whole-organ magnetic resonance imaging score (WORMS). The frequency of different meniscal morphology and their respective positions was calculated. RESULTS The predominant type (42.4%, 53.8% and 52.5% in the anterior horn, mid-body and posterior horn, respectively) of abnormal meniscal morphology was a complete maceration/destruction or complete resection. The anterior horn of non-macerated lateral meniscus was more subluxed than that of the non-macerated medial meniscus in patients with lateral OA. CONCLUSION This study suggests that the lateral meniscus in persons with end-stage lateral OA are mostly macerated or destroyed. Also, unlike isolated end-staged medial compartment OA, the anterior horn of the lateral meniscus in isolated end-stage lateral OA is commonly affected.
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Affiliation(s)
- S H Hwang
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
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Shon OJ, Lee DC, Park CH, Kim WH, Jung KA. A comparison of arthroscopically assisted single and double bundle tibial inlay reconstruction for isolated posterior cruciate ligament injury. Clin Orthop Surg 2010; 2:76-84. [PMID: 20514264 PMCID: PMC2867202 DOI: 10.4055/cios.2010.2.2.76] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 06/09/2009] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study evaluated the clinical results of arthroscopically assisted single and double bundle tibial inlay reconstructions of an isolated posterior cruciate ligament (PCL) injury. METHODS This study reviewed the data for 14 patients who underwent a single bundle tibial inlay PCL reconstruction (Group A) and 16 patients who underwent a double bundle tibial inlay PCL reconstruction (Group B) between August 1999 and August 2002. The mean follow-up period in groups A and B was 90.5 months and 64 months, respectively. RESULTS The Lysholm knee scores in groups A and B increased from an average of 43.3 +/- 7.04 and 44.7 +/- 5.02 preoperatively to 88.1 +/- 7.32 and 88.7 +/- 9.11 points at the final follow-up, respectively. In group A, stress radiography using a Telos device showed that the preoperative mean side-to-side differences (SSDs) of 9.5 +/- 1.60 mm at 30 degrees of flexion and 9.8 +/- 1.70 mm at 90 degrees of flexion were improved to 2.8 +/- 1.19 mm and 3.0 +/- 1.1 mm, respectively. In group B, the preoperative SSDs of 10.4 +/- 1.50 mm at 30 degrees of flexion and 10.7 +/- 1.60 mm at 90 degrees of flexion improved to 2.7 +/- 1.15 mm and 2.6 +/- 0.49 mm, respectively. There was no significant difference in the clinical scores and radiologic findings between the two groups. CONCLUSIONS Single bundle and double bundle PCL reconstructions using the tibial inlay technique give satisfactory clinical results in patients with an isolated PCL injury, and there are no significant differences in the clinical and radiological results between the two techniques. These results suggest that it is unnecessary to perform the more technically challenging double bundle reconstruction using the tibial inlay technique in an isolated PCL injury.
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Affiliation(s)
- Oog Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Daegu, Korea.
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