• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.220-226
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• 2007

Purpose: The distal clavicle has a biomechanical structure different from that of the proximal or middle 1/3 clavicle, and delayed union or nonunion occurs frequently in a distal clavicle fracture. The authors obtained favorable results from an open reduction and bone grafting of the distal clavicle nonunion. We report the results together with review of the relevant literature. Materials and Methods: The subjects were 8 patients(average age, 38.9) who had undergone surgery for distal clavicle nonunion from August 2003 to May 2006. Nonunion occurred after surgical treatment in 4 cases, and after conservative treatment in the other 4. In all cases, the patients complained of pain. Results: The mean follow-up duration was 14 months, and radiological union was observed in 8 weeks on average. In all cases, the range of shoulder joint motion was normal at the end of the follow-up observation. In the functional evaluation, 7 cases showed excellent results and 1 case showed good results. Conclusion: Surgical treatment is a safe and reliable treatment for distal clavicle fracture nonunion because it can achieve early rehabilitation and union.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.161-168
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• 2010

Purpose: Surgical approaches to the condylar neck and subcondyle area can cause some morbidity such as, facial nerve injury, time-consuming nature and external scar etc. So many surgeons hesitate using open reduction and internal fixation for the treatment of subcondylar fractures. We report open reduction and internal fixation of subcondylar fractures in 13 adult patients via transmasseteric approach. Methods: From 2007 to 2009, 13 adults with subcondylar fracture of mandible were treated with open reduction and internal fixation via transmasseteric approach. A preauricular incision was extended downwards in a curvilinear fashion in the cervicomastoid skin crease. Skin flap was elevated above the SMAS layer. Masseter muscle was splitted at the anteroinferior edge of the parotid gland. After the fracture was reduced, fixed with appropriate plates and screws. All operation were performed under general anesthesia. Results: Mean follow-up period was 13.3 months. There were no signs and symptoms of facial nerve injury, difficulty in mouth opening, or malocclusion. Dissection time was roughly within 30 minutes. Conclusion: Transmasseteric open reduction and internal fixation of mandible subcondylar fracture can be performed with excellent visualization, and inconspicuous scar. It also offers swift access to the subcondylar area while substatially reducing the risk to the facial nerve and eliminating the complications associated with transparotid approaches.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.142-149
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• 2009

Purpose: We wanted to assess the radiological and clinical results and the prognostic factors after an operation for capitellar fractures associated with/without other injury around the elbow. Materials and Methods: Among the 25 patients (mean age: 49 years-old) who underwent open reduction and internal fixation for capitellar fractures, there were nineteen type 1 fractures and six type 3 fractures. The mean follow up period was 14.8 months. We assessed the factors affecting the radiological and functional results, such as the fracture pattern, the patient age and the surgical approaches. Results: In 24 of 25 patients, bony union was achieved at postoperative 1 year. There were eighteen excellent, four good, two fair and one poor functional results according to the Broberg and Morrey elbow score. The most common type was type 1 and the most common associated injury was lateral condylar fracture. The patients with type 1 fracture rather than the patients with type 3 fracture and the patients who had an extraarticular associated fracture rather than an intraarticular associated fracture had better clinical outcomes. Conclusion: 22 (88%) of the patients were satisfied at the result. The type of capitellar fracture and an associated intraarticular elbow fracture were shown to be important prognostic factors in this study.

• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.46-52
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• 2009

Purpose: To evaluate the usefulness of minimally invasive arthroscopy-assisted plate removal of a laterally inserted periarticular distal femur plate used for the treatment of AO type-C distal femur fractures. Materials and Methods: From October 2002 to November 2005, we evaluated 17 patients whose plates were removed through minimally invasive arthroscopy-assisted plate-removal technique and 15 patients who got their plates removed through conventional method without using arthroscopy, 32 patients in total. All these patients included in this study initially underwent open reduction and internal fixation of the distal femoral fractures with a lateral plate, and complained of continued pain over the lateral femoral condyle after the fracture fixation. The average age was 42.6 (ranges: 20~66) and initial fracture types included 16 cases of C1, 11 cases of C2, and 5 cases of C3 following AO/ASIF classification guidelines. Measured outcomes included: associated intra-articular pathologies, time needed to return to activities of daily living, patients' overall satisfaction, complications following the removal of hardware, and pain before and 6 months after the operation. Results: The distal-most end of the plate was placed in the knee joint in all cases and damage of the lateral articular capsule was found in 23 cases. Continuous wound discharge after surgery was found in one case who underwent arthroscopy-assisted plate removal, and it was treated by irrigation and re-suture. Average time needed to return to activities of daily living was 7 days in arthroscopy assisted group and 7.6 days in conventionally removed group. Fourteen patients (82.4%) who underwent arthroscopyassisted plate-removal reported above 'fair' satisfaction and the Visual analog scale pain score decreased from 4.9 to 1.9, six months after the plate removal. Thirteen patients(86.7%) who underwent conventional plate removal reported above 'fair' satisfaction and the Visual analog scale pain score decreased from 5.2 to 2.5, six months after the operation. Conclusion: Through minimally invasive arthroscopic-assisted plate removal, intrarticular pathology of the knee joint was able to be simultaneously identified and treated at the time of hardware removal. Damage of lateral capsule of the knee joint caused by the inserted plate for the treatment of type C distal femoral fracture was very frequently found and following the plate removal, patients experienced an improvement in pain score. We therefore recommend routine lateral distal femoral plate removal if the bony union is attained in such cases as type C distal femoral fractures whose distal most end of the plates are located in the joint.

• Journal of the Korean Orthopaedic Association
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• v.55 no.6
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• pp.495-502
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• 2020

Purpose: The aim of this study was to assess the effectiveness of domestically developed volar locking plate which has the concept of double-tiered subchondral support (DSS) in maintaining the reduction after distal radial fracture surgery. Materials and Methods: From July 2017 to December 2018, 54 patients were assessed. Plain radiographs were obtained immediately after surgery and at the last follow-up, and the radiographic parameters were measured in those images: radial length, radial inclination, volar tilt, ulnar variance, and distal dorsal cortical distance. The patients were subdivided into their age, type of fracture, and the position of the plate to evaluate the influence of each factors on the reduction maintenance. Results: Distal dorsal cortical distance in radiographs after the surgery was 5.91 mm (standard deviation, ±1.95 mm) on average. Significant differences in the radial length (p=0.038) and ulnar variance (p=0.001) were observed between immediately after surgery and at the last follow-up. When the parameters were evaluated by dividing the patients into subgroups according to the three specific factors, the ulnar variance showed a significant increase at the last follow-up when the patients were included 65-years-old or older. AO/OTA type C3 fracture, and Soong classification grade 0 plate position (p=0.007, p=0.012, p=0.046, respectively). Conclusion: Using the domestically developed DSS-type volar locking plate, significant reduction after distal radial fracture surgery could be maintained successfully. On the other hand, further study will be needed to determine about the reduction loss of the lunate facet identified in special cases that deal with fractures in elderly patients, unstable AO/OTA type C3 distal radial fractures, and Soong classification grade 0 plate position.

• Journal of the Korean Arthroscopy Society
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• v.6 no.1
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• pp.31-36
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• 2002

Objective : The purpose of this study was to evaluate the clinical and radiological results after treatment of old ACL(anterior cruciate ligament) avulsion fracture of tibia. Materials and Method : 11 cases who were followed up at least 2 years after treatment in chronic ACL avulsion fracture of tibia were included in this study. The average age of patients was 26(9-66) years and the mean period of follow up was 53(24-131) months. After evaluation of the lesion and treatment of associated lesion under arthroscope, open reduction and internal fixation or fragment removal was performed. Pull-out suture was performed in 8 cases, screw fixation in 2 cases. Results : The Lysholm knee score was 64.3 in average preoperatively and improved to 96.2 average at follow up. On the Lachman test, there were mild(+) instabilities in 7 cases, moderate(++) in 4 cases. On the postoperative Lachman test, there were no instabilities in 9 cases, mild(+) instabilities in only 2 cases. According to Meyers and Mckeever's evaluation protocol, 9 cases $(81.8\%)$ were excellent, 2 case $(18.2\%)$, good. On preoperative instrumented anterior laxity test with $Telos^{\circledR}$, side to side difference in 201b was 7.8(10-4) min in average and 2.1(6-0) mm in average at follow-up. Conclusion : In chronic ACL avulsion fracture, it is thought that combination of arthroscopic evaluation of associated injury and open reduction and fixation and fragment removal can bring about satisfactory results.

• Journal of Korean Foot and Ankle Society
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• v.1 no.2
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• pp.102-111
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• 1997

The tibial Pilon fracture, which is defined as a comminuted intraarticular fracture of the distal tibia, is difficult to manage because high axial compression and rotational forces to the ankle joint result in impaction, severe comminution, metaphyseal disruption and soft tissue damage. There are variable methods of treatment such as manipulation and cast, calcaneal traction and cast, external fixation, pin and plaster, limited open reduction and external fixation, and open reduction and rigid internal fixation. Though most of authors reported better result after a surgical treatment. than that of conservative treatment, many complications such as posttraumatic arthritis and soft tissue problem still remain troublesome. We have reviewed 19 cases of the tibial Pilon fractures in 18 patients which were treated with limited open reduction and internal fixation from September 1993 to May 1996. The results were as follows: 1. The fractures were classified into five types according to the system of Ovadia and Beals, and the most frequent type was type 3 (53%). The most common cause of injury was traffic accident (47%). 2. All of the cases of type 1 and 2, in which the injury of the ankle joint was less severe, revealed good or excellent clinical results. But in type 4 and 5, because the injury is much severe and accurate reduction is difficult, the clinical results were unsatisfaetory. 3. The most frequent complication was posttraumatic osteoarthritis, and which developed in second frequent complication, was developed m the three cases of type 3 in which the radiographic results were less than fair, but there were no correlation with the clinical results. 4. We could markedly reduce the complications related to the soft tissue problem of Pilon fracture by treatment with limited open reduction and internal fixation, and consider that this is a good method of treatment of Pilon fracture when the injury is less severe and accurate reduction is possible.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.2
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• pp.143-148
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• 2002

Purpose: We examined patients to evaluate the clinical results of traumatic metacarpophalangeal(M-P) dislocations of the thumb, uncommon and irreducible. Materials and Methods: In 11 traumatic M-P dislocations of the thumb, the types of dislocations were 10 dorsal and 1 volar dislocations resulted from the impacted and hyperextended forces on thumb. Authors evaluated the possibility of closed reduction, the anatomical structures interfering with closed reduction, and the surgical approaches. Results: Eight cases were treated with open reduction through volar approach and two cases were treated with closed reduction. Joint fusion was done with a plate in a chronic case. Initial closed reduction was attempted in all cases, but succeeded in only 2 cases because the interposed ruptured volar plate, the flexor pollicis brevis tendon and ulnar sesamoid bone at the volar side of the M-Pjoint were the obstacles to reduce. The metacarpal head was caught in button-hole slit between theflexor pollicis brevis and the ruptured volar joint capsule in all cases. Conclusion: Similar with the M-P joint dislocations of other fingers, the dorsal complex M-P dislocations of the thumb due to hyper extension are unusual and can't easily be reduced by closed manipulation. It is necessary to pay attention to the ruptured volar plate, capsule, the subluxated portion ofthe sesamoid and flexor pollicis brevis as interfering structures.

• Clinics in Shoulder and Elbow
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• v.1 no.2
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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).

• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.135-140
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• 2013

We report a case of recurrent shoulder dislocation and combined proximal humerus fracture in neurofibromatosis type I. A twenty-year-old male patient with known neurofibromatosis type I presented with right shoulder dislocation and proximal humerus fracture following a minor trauma. His injured arm also had large plexiform neurofibromas on the elbow, and the dislocation of the shoulder joint was proven to be recurrent. Bony deformation of the humerus and scapula were revealed on X-ray and computed tomography, as well as multiple neurofibromatic changes of the deltoid and periscapular muscles were noted on magnetic resonance imaging. Open reduction and capsular reconstruction were performed and humeral fracture was stabilized with a reconstruction plate. Satisfactory union and functional result were achieved and the dislocation did not recur until the 7-month followup after the procedure. Recurrent shoulder dislocation and combined proximal humerus fracture in neurofibromatosis type I are rare complications. However, it should still be considered in the orthopaedic evaluation process of the diseases.