BACKGROUND: The gaitaids are helpful for the patients of gait disturbance, but there was no study about the quantitative assessment of the effectiveness of gaitaids of several different types. But proper use of gaitaids is important for the disabled who is suffered from falls with or without trauma. The appropriate prescription of gaitaids is coming from the objective assessment for gaitaids. METHODS: We evaluated the 'balance index(BI)', which is originally suggested assessment scale by author, for the five different gaitaids :mono-cane, quad-cane, forearm crutch, axillary crutch, walker We assessed the difference of B.1 with or without using each gaitaids examined by 50 healthy adults and 20 stroke patients. RESULTS: The BI in the normal adult was 34.5+/-2.7, and 21.0+/-6.9 in the stroke patients. The balance index o( walker user was 37.6+/-1.4, which was the highest score. The BI of quad-cane was 30.1 +/-4.8, which was the next highest score and the BI of mono-cane, forearm crutch, axillary crutch were 25.5+/-5.6, 25.5+/-5.7, 25.5+/-5.4, which were lower than that of quad-cane. CONCLUSION: It can be suggested that the walker is the most effective for the support balance on gait and the quad-cane is more effective than mono-cane or crutches for balance support.
Adult ; Canes ; Crutches ; Forearm ; Gait ; Humans ; Prescriptions ; Stroke ; Walkers

PURPOSE: To evaluate the radiological and clinical effects of early eightbearing after distal reverse oblique osteotomy of bunionette. MATERIALS AND METHODS: Between 2009 and 2015, 52 patients who underwent surgical treatment at our hospital for bunionette deformity with a minimum follow up of one year were included in the study. Postoperatively, foot cast was applied and full weightbearing was permitted in 28 patients. And short leg splint was applied with only partial weightbearing using crutches allowed in 24 patients. Clinical scores were evaluated. Radiologically, the 4th~5th intermetatarsal angle (IMA), and 5th metatarsophalangeal angle (MPA) were analyzed preoperatively and at the final follow up visit. RESULTS: The visual analogue scale and American Orthopaedic Foot and Ankle Society scores improved in the partial weightbearing group and full weightbearing group, but without significant differences. The average 4th~5th IMA and average 5th MPA correction also did not showed significant differences between the partial weightbearing group and full weightbearing group. Moreover, the full weightbearing group did not encourage non-union rate compared with the partial weightbearing group. CONCLUSION: Effective bone union may be achieved through early weightbearing, resulting in better clinical outcomes. It is considered that early weightbearing did not have any effect on the changes of IMA and bone union.
Ankle ; Bunion, Tailor's* ; Congenital Abnormalities* ; Crutches ; Follow-Up Studies ; Foot ; Humans ; Leg ; Osteotomy* ; Splints ; Weight-Bearing*

STUDY DESIGN: A case report. OBJECTIVES: To report the case of a patient whose preoperative imaging results seemed to show metastatic spine tumor but who actually had a vertebral pathologic fracture caused by spine tuberculosis. SUMMARY OF LITERATURE REVIEW: Tuberculosis spondylitis is classified into peridiscal, central, anterior, and posterior spondylitis according to the portion involved, and central spondylitis can be mistaken as a tumor. MATERIALS AND METHODS: Imaging studies were performed in a 79-year-old female with progressive lower extremity weakness. We found a T12 pathologic vertebral fracture, which was suspected to be metastatic cancer. RESULTS: We performed surgery and found spine tuberculosis in the pathological and immunological examinations. Two weeks postoperatively, the patient could walk with crutches and underwent anti-tuberculosis therapy. CONCLUSIONS: Even when the results of imaging studies predict spinal metastasis, we should keep in mind the possibility of spinal tuberculosis.
Aged ; Crutches ; Decompression ; Female ; Fractures, Spontaneous ; Humans ; Lower Extremity ; Neoplasm Metastasis ; Spine ; Spondylitis ; Tuberculosis ; Tuberculosis, Spinal*

The rationale for proximal tibial osteotomy is to correct the abnormal loading stresses on the knee that are caused by an abnormal tibiofemoral axis in the coronal plane. Aithough there are many methods of fixation including cast, staple and external fixation, Coventry staple has been used widely. But Coventry staple has some disadvantages such as inadequate fixation, long term cast immobilization and rehabilitation. The purpose of this study is to demonstrate the superior performance of Miniplate staple which was designed by authors(Johnson & Johnson Orthopaedics, New Milton, UK) over the conventional Coventry staple. We have analyzed the clinical results including postoperative rehabilitation course of 3I cases who had proximal tibial osteotomy fixed with Miniplate staple. Preoperative diagnosis was osteoarthritis(OA) in 24 cases(77.4%) and physiologic genu varum in 7 cases(22.6%). 1. Hospital for Special Surgery knee score was average 72.2 points preoperatively, 90.1 points postoperatively in osteoarthritis and average 94.1 points preoperatively, 99.7 points postoperativeiy in physiologic genu varum. 2. The average tibiofemoral angle was varus 5.8 degrees preoperatively and valgus 8.7 degrees postoperati vely. 3. The active ROM exercise started at 5.3 days, standing at 13.3 days, crutches ambulation at 20.2 days and ambulation without crutches at 46.3 days after operation. In conclusion, more rigid fixation and rapid mobilization was possible with newly designed Miniplate staple in proximal tibial osteotomy.
Axis, Cervical Vertebra ; Crutches ; Diagnosis ; Genu Varum ; Immobilization ; Knee ; Osteoarthritis ; Osteotomy* ; Rehabilitation ; Walking

Treatment of infected nonunions of long bone is confronted with various difficult problem, e.g. eradication of infection and osseous union even in the presence of devastating infection. To solve this problem various method were proved including exerternal fixation, electrical stimulation and functional casting method with some success. Intreating these difficult infected nonunions, we adopted another program which includes through debridment of the infected and necrotic soft tissue and bone, autogenous bone graft, rigid internal fixation of fragments and ope.n drainage of the wound until union of the fracture. We treated 8 cases of infected nonunions with this method from march, 1980 to september 1983 and results are as follows: 1. Satisfactory union was obtained within average 5 months. 2. In some cases pus drainage continued even after osseous union but it was easily controlled after removal of fixation devices. 3. After bone union and removal of internal fixation devices, some kind of protective measures, e.g. crutches and braces were used for about 6 montes to prevent refracture. 4. In conclusion our method is considered to be an effctive means is treating infected nonunion of fractures.
Braces ; Crutches ; Drainage ; Electric Stimulation ; Internal Fixators ; Methods ; Suppuration ; Transplants ; Wounds and Injuries

It has been established that total hip replacement arthoplasty is one of the most excellent treatment modalities of adult hip joint disease. But aseptic loosening of the acetabular component is a main cause of revision and acetabular defects must be supported to engage the acetabular cup. Many authors have been managed this problem with the various methods of using acetabular ring, bone cement, autogenous or allogeoous bone graft and bipolar endoprosthesis. As the time goes on, it is inevitable that the numbers of revision arthroplasty cases will increase. We observed 36 patients, 39 cases of revision arthroplasty from 1981 and analysed the cases. 27 cases were treated by autogenous lilac block bone to support the acetabular defects. Complete or incomplete iliac block bone was grafted to superior, medial and posterior aspect of acetabulum. Some screws were inserted when they are needed for bone graft fixation. Hip spica casts were applied in 24 cases for 2 or 3 months and crutches were used for about 3 months. Pre-and postoperative hip joint functions by Harris score was increased form average 58.2 to 81.3(23.1 points increment). Sixteen cases were followed up for more than one year and all the bone grafts were united well without bone resorption. We found that autogenous iliac block bone can support the acetabular defects satisfactorily in revision arthroplasty cases.
Acetabulum ; Adult ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Bone Resorption ; Crutches ; Hip ; Hip Joint ; Humans ; Transplants

STUDY DESIGN: Prospective physical measurement of the sagittal vertical axis (SVA). PURPOSE: To evaluate a simple method for measuring SVA by analyzing its relationship with radiographic measurements and clinical appearance. OVERVIEW OF LITERATURE: No studies have examined physical measurements using the cranial center of gravity (CCG) in a relaxed standing position. METHODS: The physical measurement of the horizontal distance between CCG and spina iliaca posterior superior (CCG-SIPS) was measured using a straight ruler in 252 healthy volunteers and 56 patients with adult spinal deformity. Health-related quality of life (HRQOL) was evaluated using the Oswestry disability index (ODI), and clinical symptoms were assessed according to standing status and the presence of gastroesophageal reflux disease (GERD). RESULTS: CCG-SIPS increased with age in the volunteer group and strongly correlated with radiographic SVA in the patient group (r=0.984). Differences increased between CCG-SIPS in patients in the relaxed position and radiographic SVA with an increase in sagittal malalignment (r=0.692, p<0.001). ODI with high sagittal malalignment (CCG-SIPS>120 mm) was significantly larger in the patient group than in the group with low sagittal malalignment (59.9±18.8 vs. 45.1±17.0; p=0.004); these patients (CCG-SIPS>120 mm) needed crutches or walkers for standing. The patient group with GERD had significantly larger sagittal malalignment than the group without GERD (160.3 mm vs. 81.0 mm). CONCLUSIONS: The CCG-SIPS correlated with age and strongly reflected radiographic SVA and HRQOL in the patients. Moreover, it reflects a relaxed posture without a backward shift in the radiographic position even in patients with severe sagittal malalignment. The critical limit of CCG-SIPS can be relevant to clinical appearance, including standing assistance (>120 mm) and the existence of GERD (>150 mm). Thus, it will be a useful predictor of true SVA in clinical practice before radiographic evaluation.
Adult* ; Congenital Abnormalities* ; Crutches ; Gastroesophageal Reflux ; Gravitation ; Healthy Volunteers ; Humans ; Methods ; Posture ; Prospective Studies ; Quality of Life ; Volunteers ; Walkers

Since the first report by Tansini in 1896, the latissimus dorsi muscle free flap has been widely used for various types of soft tissue defect due to reliable anatomy with a sufficient diameter of neurovascular pedicle and a sizable muscle. However, for relatively small soft tissue defect, latissimus dorsi free flap offers several distinct disadvantages of donor site including loss of the posterior axillary fold and flattening of the posterolateral chest wall, weakness of upper arm strength in extension, adduction and internal rotation. We treated three patients having various types of soft tissue defect using segmental latissimus dorsi muscular free flap depending on its descending branch of thoracodorsal neurovascular pedicles. There were no serious complications during 18 months of mean follow-up. We concluded that this method has some advantages such as no weakness of strength of the upper arm including walking on crutches, preserving the posterior axillary fold, preventing winging of the scapula and increased chance of using a flow-through technique. Here we present our cases of reconstruction of soft tissue defect using segmental latissimus dorsi free flap with a review of the literature.
Arm ; Crutches ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Scapula ; Superficial Back Muscles* ; Thoracic Wall ; Tissue Donors ; Walking

PURPOSE: The purpose of this study is to evaluate the outcome after operative treatment with plate fixation in Vancouver B1 and C periprosthetic unstable femoral fractures. MATERIALS AND METHODS: We conducted a retrospective assessment of 15 patients who had under gone treatment for a periprosthetic unstable femoral fracture around primary hip arthroplasty between April 1997 and July 2010. The mean age of patients was 69 years(53 to 82 years) at the time of surgery and the mean duration of follow-up was 29.2 months (six to 110 months). According to Vancouver classification, 10 patients were type B1 and five were type C. According to the time of operation, open reduction and internal fixation was performed using four different plates. Bone graft was applied in all patients, regardless of the type of plate. The present review describes the clinical and radiographic results. RESULTS: All patients were able to ambulate without assistance of crutches or walkers. Of the 15 patients, the fracture site was united in all patients. Postoperative dislocation of the ipsilateral hip was observed in one patient; however, there was no occurrence of further complications, such as infections, nerve injuries, or loosening of the femoral stems. CONCLUSION: In Vancouver type B1 and C fractures, without any loosening of the femoral stems, open reduction with plate fixation using our operative methods provided a satisfactory result.
Arthroplasty ; Crutches ; Dislocations ; Femoral Fractures ; Femur ; Follow-Up Studies ; Hip ; Humans ; Periprosthetic Fractures ; Retrospective Studies ; Transplants ; Walkers

PURPOSE: This study was to determine the efficacy of iliac crest reconstruction using bone cement in reducing pain and morbidity at the donor site in patients undergoing open wedge high tibial osteotomy (OWHTO) with tricortical iliac crest autologous graft. MATERIALS AND METHODS: Thirty-three patients who underwent iliac crest reconstruction using polymethyl methacrylate (PMMA) bone cement (group A) and thirty patients who had no iliac crest reconstruction (group B) were enrolled in this study. All patients were evaluated for pain and functional disability related to graft harvesting using the pain and functional visual analogue scale (VAS) score during hospital stay and at 6 weeks, 3 months, and 6 months postoperatively. RESULTS: There was significant difference between the two groups in terms of pain and function. The pain VAS score was significantly lower in group A than group B during the first 2 weeks postoperatively (p=0.04) and the functional VAS score was also significantly lower in group A during the first 2 weeks postoperatively (p<0.001) in terms of breathing, sitting up from the supine position, and standing up with crutches from the sitting position. CONCLUSIONS: Iliac crest donor site reconstruction using PMMA bone cement in patients undergoing OWHTO significantly decreased pain and improved function during the first 2 weeks postoperatively when compared to patients who underwent OWHTO without iliac crest reconstruction.
Bone Transplantation ; Crutches ; Humans ; Length of Stay ; Osteotomy ; Polymethyl Methacrylate ; Prospective Studies ; Respiration ; Supine Position ; Tibia ; Tissue Donors ; Transplants