• 대한족부족관절학회지
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• 제1권1호
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• pp.51-58
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• 1997

The purpose of this study is to evalute the efficacy af the Ilizarov external fixation for the surgical treatment. of the tibial plafond fractures. We reviewed retrospectively fourteen cases of tibial plafond fractures with moderate to severe soft. tissue damage, which were fixed with Ilizarov external fixator. Using the AO Muler classification, there were four Type C1 fractures, six Type C2 and four Type C3. In most, of the cases, the ankles were operated on with other associated fractures within a few days after injury. We reduced the fracture indirectly by soft issue taxis and fixed externally across the ankle joint. using the circular external fixator with tensioned wires and ankle hinge. In cases of inadequate closed reduction, we applied limited open reduction and internal fixation. Range of motion exercise began immediately. Postoperative follow-up averaged fourteen months (ranges, 8-30 months). Overall clinical results rated good or excellent in 7 cases, fair in 4 and poor in 3. There were three cases of pin tract infection which were resolved with short-term antibiotics and local care; one delayed wound closure in a patient. whose fracture was associated with Type III open wound; one wound slough in a patient associated with Type II open wound, which was closed later by skin graft; and one osteoarthritis. From this review, we concluded that cross-ankle circular external fixation with tensioned wires with or without. limited open reduction is a reasonable alternative for the treatment of the tibial plafond fractures with severe soft tissue damage.

• 대한두개안면성형외과학회지
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• 제9권2호
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• pp.55-61
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• 2008

Purpose: The purpose of this study is to evaluate the effectiveness of internal fixation method of $Medpor^{(R)}$ implant with $BioSorb^{TM}FX$ screw which is used for prevention of enophthalmos in posteriorly extended large orbital floor fracture. Methods: From Jun. 1997 to Dec. 2007, 21 patients who were diagnosed with posteriorly extended large orbital floor fractures were classified into two groups. One group(n=11) had undergone reduction surgery with regular $Medpor^{(R)}$ sheets without any fixation method, while the other group(n=10) had their $Medpor^{(R)}$ sheets fixed with the $BioSorb^{TM}FX$ screws. The two groups were evaluated by comparison of their enophthalmos degree and effectiveness. Results: In the non-fixation group, six patients had enophthalmos preoperatively and three of them showed persistent enophthalmos postoperatively. In postoperative CT examination, displacement of $Medpor^{(R)}$ implant with soft tissue impaction into maxillary sinus was observed in the patients. In the screw fixation group, three patients had enophthalmos preoperatively, but none of them suffer from complication such as residual enophthalmos, soft tissue impaction, muscle entrapment or optic nerve compression postoperatively. Conclusion: Internal fixation method of $Medpor^{(R)}$ implant with $BioSorb^{TM}FX$ screw on the medial surface of orbital floor provides firm stabilization of implants and surrounding soft tissues and can be an effective option especially when postoperative implant displacement or malposition was expected.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1982년도 제16차 학술대회연제순서 및 초록
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• pp.12-12
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• 1982

기관절개술은 1649년 Fienus가 처음으로 호흡곤란 환자에게 시술하고 Tracheotomy라 명명한 이래 기도확보, 기관 및 기관지로 부터 분비물 제거 및 산소공급을 목적으로 이용되어 많은 생명을 구하고 있다. 그러나 기관절개술후 성문하부의 협착, 기관연화, 기관절개공주위의 육아조직, 기관점막의 부종, 정신적인 의존 및 제 1기관륜 상부의 절개등으로 인한기관 Cannula 발거곤란증이 수반되기도 한다. 저자들은 1980년 4월 산업재해로 인한 두개내혈종 및 다발성늑골골절등으로 진단되어 타종합병원에서 개두술과 기관절개술을 받은 21세 남자환자에서 기관 Cannula 발거곤란증을 경험하였기에 중간보고하는 바이다. 1981년 11월 본원 이비인후과에 전원시 간접후두경 검사상 성대 및 가성대에 심한 부종이 있었으며 성대는 부정중위로 고정되어 있었고 기관지경검사상 성문하부에 협착이 인지되어 Jackson 식도 Bougie를 이용하여 3차에 걸쳐 Bougination으로 기관확장을 시도하였으나 효과가 없었다. 1981년 2월 협착부위의 기관륜과 윤상연골에 수직절개를 한 후 직경 1. 2cm의 Teflon tube를 협착부위에 삽입하고 9개월간 유치시킨 후 제거하고 Corking을 하여 현재 양호한 경과를 취하고 있다.

• 대한장애인치과학회지
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• 제7권1호
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• pp.38-43
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• 2011

Treatment of the mandibular fracture consists of reduction and fixation. Primary wire & Arch bar are perhaps the ideal method for intermaxillary fixation. But, daily feeding, swallowing, speech, and in some instances, respiration is difficult to maintain during the period of intermaxillary fixation, owing to muscle weakness, emotional disorder and poor oral hygiene in a position of the long-term bed disabled patient with multiple injuries. Therefore, Intermaxillary fixation is not applied in the disabled bed patient, the alternative methods must be obtained. In the case of the mandibular fracture, because of the absence of weight bearing, osseous union may eventually occur even without immobilization if the patient is maintained without wound infection on a controlled soft diet. For the purpose of the prevention of the wound infection, the establishment of an drainage on the oral lacerated wound is necessary for the removal of the hematoma & seroma in the fracture site. This is the report of a case that was managed conservatively without the intermaxillary fixation in the long-term disabled bed patient with a mandibular compound fracture.

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.230-235
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• 1998

Fractures of the scapula are relatively uncommon injuries and treatment in the vast majority of cases remains nonsurgical and the results have been quite satisfactory. But the scapular fracture itself may be neglected because of its high incidence of many kinds of associated injuries so its delayed treatment sometimes gives bad and unpredictable results. Although open reduction and internal fixation has been accepted as the treatment of choice for displaced intra-articular fractures in many anatomical regions, there has been no definite treatment principles of surgical indications and approaches in the glenohumeral joint. At our institution, II displaced intra-articular fractures of the glenohumeral joint were treated with open reduction and internal fixation from March 1993 to February 1997. This paper reports the results of treating 11 displaced intra­articular fractures of the glenoid by open reduction and internal fixation. There were 10 men and one woman and the fractures were classified according to Ideberg : Type Ⅰa(4), Type Ⅱ(3), Type Ⅲ(1), Type IV(1), Type Va(1), and Type Vc(1).

• 대한족부족관절학회지
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• 제7권2호
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• pp.250-257
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• 2003

Purpose: Pilon fracture is caused by high energy and axial compression forces, and it is often associated with severe comminution and soft tissue injury. Recently, limited internal fixation of this fracture may avoid the soft tissue complications associated with formal open reduction and internal fixation and avoid incongruity of joint margin associated with conservative treatment. We have treated Ovadia and Beals type II or III pilon fracture with limited internal fixation and the results were satisfactory. Materials and Methods: We analyzed 15 cases of Ovadia and Beals type II or III fractures who were treated by limited internal fixation(K-wire or screw fixation) from January 1995 to December 2000. The average follow up period was 20 months(range, 12 to 38 months). According to the Ovadia and Beals classification, seven cases were type II, and eight cases were type III. Radiographic results were assessed by Ovadia and Beals criteria. We also assessed the functional results by Mast and Teipner criteria. Results: Radiographic results showed good in 67% and fair in 33% of cases. Clinical results showed good in 73% and fair in 27% of cases. There were no complications such as wound infection and skin necrosis, but traumatic arthritis were 2 cases. Conclusion: Pilon fractures are high energy injuries with significantly associated soft tissue damage and traumatic arthritis. Limited internal fixation offers good solution to Ovadia and Beals type II or III fracture.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권4호
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• pp.255-263
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• 2011

Introduction: Maxillomandibular fixation (MMF) is essential before surgery under general anesthesia in maxillofacial trauma patients. MMF is used basically to reconstruct the occlusion and occlusal stability to recover the facial shape and oral functions. The arch bar and wire is a traditional method for MMF, but it can not only bring pressure to the periodontal ligaments and teeth but also cause a penetrating injury to the surgeons. Materials and Methods: In this study, 198 patients with an open reduction using a manual reduction without MMF from September 2005 to May 2010 in Dankook University Dental Hospital were subjected to a follow-up evaluation during the postoperative 4 months periods. This study evaluated the incidence of complications according to the condition of the patient (gender, age), the state of bony union of the fracture sites and a numeric rating scale evaluation for postoperative pain scoring. Results: 1. The complications were classified into major and minor according to the seriousness, and the major complication rate was as low as 2.02%. Only 2 cases of re-operations (1.01%) were encountered. In the classification according to the fracture line, plate fracture was observed in both cases of mandibular symphysis fracture, and angle fractures and loosening of two screws were noted in the case of mandibular angle fracture. 2. The complication rate was similar regardless of gender and age. 3. The degree of bony union was satisfactory, and the complication rate was reduced as the bony union improved. 4. More patients complained of pain as the operation time was increased. Conclusion: The use of MMF is not always necessary if a skilled assistant is provided to help manually reduce the fracture site. Compared to other studies of mandibular fracture surgery using MMF, the complication rate was similar using only manual reduction and the patients' discomfort was reduced without MMF.

• 대한두개안면성형외과학회지
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• 제13권1호
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• pp.22-28
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• 2012

Purpose: In accordance to an increased interest in facial appearance and the popularization of computed tomography scanning, the number of diagnosis and treatment of blowout fractures has been increased. The purpose of this article is to review pure blowout fracture surgery through transconjunctival incision focusing on complications and their management. Methods: In this retrospective study, 583 patients, who had been treated for pure blowout fracture through transconjunctival incision from 2000 to 2009, were evaluated. Their hospital records were reviewed according to their sex, age, fracture site, preoperative presentations, time interval between trauma and surgery, and postoperative complications. Results: According to postoperative follow-up results, there were early complications that included wound dehiscence and infection (0.2%), hematoma (insomuch as extraocular movement is limited) (0.7%), lacriminal duct injury (0.5%), and periorbital nerve injury (0.7%). In addition, there were late complications that lasted more than 6 months, that included persistent diplopia (1.7%), extraocular movement limitation (0.9%), enophthalmos (1.0%), periorbital sensation abnormalities (1.0%), and entropion (0.5%). Conclusion: We propose the following guidelines for prevention of postoperative complications: layer by layer closure; bleeding control with the epinephrine gauzes, Tachocomb, and Tisseel; conjunctival incision 2 to 3 mm away from punctum; avoidance of excessive traction; performing surgical decompression and high dose corticosteroid therapy upon confirmation of nerve injury; atraumatic dissection and insertion of Medpor Barrier implant after securing a clear view of posterior ledge; using Medpor block stacking technique and BioSorb FX screw fixation; performing a complete resection of the anterior ethmoidal nerve during medial wall dissection; and making an incision 2 to 3 mm below the tarsal plate.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권2호
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• pp.160-163
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• 2005

This study was designed to assess skeletal stabilily after surgical correction of mandibular prognathism by bilateral saggital split ramus osteotomy(BSSRO) and fixation with absorbable screws. From July 2001 to September 2003, 30 patients with Class III malocclusion were treated with BSSRO and mandibular setback. They underwent fixation with Biosorb$^{TM}$ FX screws. Cephalograms were obtained preoperatibely, 2 or 3 days postoperatively, and about 12 months after the operation. Changes in the position of lower incisor tip, B point, and pogonion were examined on lateral cephalograms. The mean mandibular setback just after surgery was 10.6mm. 12 months after surgery, mean relapse at pogonion represented 17.9% and 15.1% at B point. Our results suggest that fixation of the bony segments with absorbable screws after BSSO may be used effectively in properly selected cases.

• 대한족부족관절학회지
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• 제6권2호
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• pp.201-207
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• 2002

Purpose: To present the clinical analysis of the results obtained in 38 cases of displaced intraarticular calcaneal fractures undergone combined percutaneous axial pin fixation of calcaneal body and minimal internal fixation using extensile lateral approach. Materials and Methods: From March 2000 to February 2002, thirty-eight displaced intraarticular fractures of the calcaneus in 35 patients were fixed with 3.5mm cannulated screws and percutaneous 2.5mm K-wires. The extensile lateral approach was used in all cases. The average follow-up period was 16 months. Clinical evaluation was assessed according to the Ankle-Hind Foot Scale of American Orthopedic Foot and Ankle Society. Results: The clinical results were graded as excellent in 8 cases(21%), good in 22 cases(58%), fair in 6 cases(16%), and poor in 2 cases(5%). Two cases of poor result were type IV of Sanders classification. The postoperative reduction status of the articular surface was analyzed by computed tomography in all cases and was found to be less 2mm of step off in 30 cases and between 2 and 4mm in 8 cases. Unsatisfactory results were correlated with severity of articular comminution and failure to obtain accurate reduction of the articular surface. Using early functional postoperative care, all fractures healed without secondary displacement except 1 case on an average of ten weeks. Two cases had superficial necrosis of the wound margins, however, secondary wound healing was uneventful and skin grafting was not needed. Conclusion: Combined minimal internal fixation and percutaneous pin fixation using extensile lateral approach is useful operative method of intraarticular calcaneal fractures because providing enough stability to permit functional aftercare and allowing excellent anatomical reduction. In addition, this method diminishes the risk of lateral soft tissue problems.