• Archives of Hand and Microsurgery
• /
• v.23 no.4
• /
• pp.239-247
• /
• 2018

Purpose: We investigated occurrence of reduction loss after extension block (EB) Kirschner wire fixation or additional interfragmentary fixation (AIF) and clinical results including extension lag of the distal interphalangeal joint for treating bony mallet finger. Methods: Forty-six patients were included with a mean follow-up of 28 months (range, 12-54 months). Twenty-seven patients were treated with EB K-wire fixation (Group A) while 19 patients were treated with AIF (Group B). We checked radiologic factors, such as amount of articular involvement, volar subluxation, mallet fragment angle, reduction loss, range of motion including extension lag, and functional outcomes using Crawford's criteria. Results: Reduction loss occurred in eight patients (17%). Differences in mean extension lag, age, preoperative volar subluxation and mallet fragment angle between patients with reduction loss and those with reduction maintaining were significant. However, there were no significant differences in gender, hand dominance, amount of articular involvement, AIF, or further flexion between reduction loss and reduction maintaining. As for patterns of displacement, there was a significant relationship between gap or step-off and extension lag. Using Crawford's evaluation criteria, functional outcomes were excellent in 31, good in 10, fair in 3, and poor in 2 patients. Conclusion: Reduction loss should be careful in older age, smaller mallet fragment angle and preoperative volar subluxation.

• Clinics in Shoulder and Elbow
• /
• v.13 no.2
• /
• pp.217-222
• /
• 2010

Purpose: We wanted to evaluate the clinical outcomes after operative treatment using two suture anchors and Kirschner wire for treating acute Rockwood type V acromioclavicular joint dislocation Materials and Methods: Between May 2006 and May 2009, 10 patients underwent surgical treatment for acute Rockwood type V acromioclavicular joint dislocation using two suture anchors and Kirschner wire and they were followed for a mean of 12.0 (range: 7-31) months. We analyzed the functional results by the Korean shoulder score, the Constant-Murley score and the reduction state of the acromioclavicular joint at the last follow-up. Results: All the cases achieved a satisfactory outcome. The mean Korean shoulder score was 89.9 (range: 81-100) points and the mean Constant-Murley score was 87.8 (range: 82-93) points. According to the radiologic findings, 8 patients achieved anatomical reduction of the acromioclavicular joint: there was a slight loss of reduction in one patient and a partial loss of reduction in one patient. None of the patients had deep infection or re-dislocation. Conclusion: The operative treatment using two suture anchors and Kirschner wire may be used for acute Rockwood type V acromioclavicular joint dislocation, and it has an advantage in that it can prevent chondral injury of the joint.

• Archives of Hand and Microsurgery
• /
• v.23 no.4
• /
• pp.248-253
• /
• 2018

Purpose: The purpose of this study was to evaluate the clinical results of anatomic reduction of bony mallet finger using modified-intrafocal pinning technique. Methods: From March 2014 to October 2017, 18 patients with bony mallet finger were treated with modified-intrafocal pinning technique. Kirschner-wire was used to directly reduction the bony fragment, and extension block pinning and distal interphalangeal joint fixation were additionally performed to minimize the loss of reduction. Postoperative pain, range of motion, and radiological evaluation were performed. Duration of bone healing, functional recovery and complication rate were evaluated and Crawford's criteria was used to determine functional outcome after surgery. Results: Bone union was achieved in all cases after a postoperative mean of 6 weeks (5-7 weeks). An average of $2.8^{\circ}$ ($0^{\circ}-10^{\circ}$) extension loss occurred in all patients. All patients showed satisfactory joint congruency and reformation of the joint surface, the mean flexion angle of the distal interphalangeal joint at the final follow-up was $72.2^{\circ}$ ($70^{\circ}-75^{\circ}$). According to Crawford's classification, 12 patients (66.7%) were excellent and 6 patients (33.3%) were good. Conclusion: Modified-intrafocal pinning technique is a method of obtaining anatomical bone healing by directly reduction and fixation of the bony fragment. Combined with other conventional percutaneous pinning procedures, it is expected that good results can be obtained if applied to appropriate indications.

• Clinics in Shoulder and Elbow
• /
• v.11 no.2
• /
• pp.165-171
• /
• 2008

Purpose: The purpose of this study was to introduce a new surgical technique and to evaluate the preliminary results after operative treatment with using TightRope$^{(R)}$ for treating acute acromioclavicular joint dislocation. Material and Methods: We studies 10 patients who were followed up for more than 6 months after operative treatment with using an TightRope$^{(R)}$. A longitudinal incision approximately 4cm in length was made from 1cm medial to the acromioclavicular joint to the coracoid process, and then coracocalvicular ligament augmentation using TightRope$^{(R)}$ was done after splitting the deltoid. For postoperative stability, two 1.6 mm Kirschner wires were inserted temporarily across the acromioclavicular joint in all cases. The radiologic results on the serial plain radiographs and the clinical results according to the UCLA score were analyzed. Results: Radiologically, 7 cases showed anatomical reduction, 2 cases showed a slightly loss of reduction and 1 case showed partial loss of reduction. Clinically, 6 cases were excellent, 3 cases were good and 1 case was fair. Conclusion: Coracoclavicular ligament augmentation using TightRope$^{(R)}$ for treating acute acromioclavicular joint dislocation is a minimally invasive, safe procedure that provides satisfactory radiologic and clinical preliminary results. Yet the long-term results have to be analyzed to determine the final results of this procedure.

• Journal of the Korean Arthroscopy Society
• /
• v.10 no.1
• /
• pp.53-60
• /
• 2006

Purpose: This study is to analyze the clinical and radiological results after arthroscopic reduction and internal fixation of intra-articular fractures of lateral tibial plateau. Materials and Methods: The subject of the study are the 13 cases of the patients visited orthopedics surgery during March year 2000 to August year 2004 because of intra-articular fractures of lateral tibial plateau and were treated with arthroscopic reduction and internal fixation. X-rays and CT or MRI were both carried out to identify the precise pattern of fracture and the degree of depression which showed out to be all type 2 by Schatzker fracture classification. And in 9 of the cases, autogenous and allogenous bone grafts were given as bone loss were severe. The average age was 48, age group between 31 and 66, and average follow up period of about 38 months ($13{\sim}65months$). Radiological ratings were given by comparing the X-rays of degree of joint congruency before and after the operation, functional ratings by analyzing IKDC score and Lysholm score. Combined injuries observed after arthroscopy were posterior cruciate ligament injury in 1 case, meniscus injury in 4 cases and medial collateral ligament in 2 cases. Results: During follow up, X-rays showed well-maintained reduction of articular surface in all cases and no complications such as joint depression, fracture reduction loss, angular deformity or malunion were found. Average Lysholm score at last follow up was 87 points ranging from 65 to 97, in 8 of the cases excellent, 3 good, 1 fair and 1 poor according to Lynsholm classification. Average IKDC score was 92 (from 82 to 99). Conclusion: Not only does arthroscopic reduction of lateral tibial plateau fracture bring exact reduction of articular surface, but also, is considered to be a good way of operation to diagnose and treat combined injuries of knee joint using arthroscopy.

• Journal of the Korean Arthroscopy Society
• /
• v.10 no.1
• /
• pp.45-52
• /
• 2006

Purpose: We evaluated the results of operative treatment of tibial plateau fractures using both arthroscopy and fluoroscopy. Materials and Methods: From May 1999 to February 2003, tibial plateau fractures were treated with arthroscopy. Tweenty seven patients are followed up over two years and the average follow-up period was fourty one months. We classified the fractures according to the Schatzker classification. We reduced the fracture over 2mm depression and displacement on articular surface in simple radiologic finding. Firstly, we treated the associated injuries and reduced the fractures using Steinmann pins. Then, we accomplished internal fixation or external fixation. Both the postoperative clinical and radiological results were evaluated by Rasmussen system. Results: In all tweenty seven cases, the fractures were healed completely in average fourty one months. According to Rasmussen classification, we obtained the excellent or good results in 23 cases. An average range of motion was between 2.5 degrees and 130 degrees. However, postoperative infection developed in one case and the other had loss of reduction. Conclusions: We consider that arthroscopically assisted operative treatment of tibial plateau fracture is a useful method. We can reduce joint surface correctly and treat associated injuries with arthroscopy. There are less complications.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.8 no.2
• /
• pp.115-120
• /
• 2009

Purpose: To evaluate the outcomes of three different surgical approaches in treating a distal radius fracture with dorsal communition. Materials and Methods: From April, 2006 to May, 2009, 49 patients over age of 60years old with unstable dorsal communition distal radius fracture were analyzed. We compared maintainability of reduction by radiological follow-up observations and clinical outcomes using Mayo wrist scores. One-Way ANOVA test was performed to examine the statistical correlation between the methods. Results: All three approaches provided satisfactory post-op reduction results. However, follow-up observations showed significant loss of reduction in the external fixation only group compared to the added bone graft group and the volar anatomical locking plate group (P<0.05). Mayo wrist score was indifferent between the three groups. Conclusion: Treatment of a distal radius fracture with severe dorsal communition using an external fixation only appears to be insufficient in maintaining reduction of a cancellous bone defect.

• Clinics in Shoulder and Elbow
• /
• v.14 no.1
• /
• pp.1-5
• /
• 2011

Purpose: The purpose of this study was to evaluate the radiologic and clinical outcomes after operative treatment using endobuttons for unstable distal clavicle fractures. Materials and Methods: Between October 2007 and September 2009, 9 consecutive patients who were followed up for at least more than 12 months after operative treatment using a TightRope$^{(R)}$ were studied. The radiologic results on the serial plain radiographs and the clinical results according to the American Shoulder Elbow Surgeons (ASES) score were analyzed. Result: Bony union was shown in 8 cases (88.9%) and the average time to union was 12.9 (range: 9~16) weeks. The average coracoclavicular distances at the postoperative and final follow-up were 5.6 mm and 6.2 mm, respectively, with no statistically significant difference (p>0.05). The average ASES score was 90.3 (range: 78~96) and the clinical outcomes were 6 excellent, 2 good and one fair. There were no complications such as implant failure or infection except for one case of nonunion due to loss of the initial reduction. Conclusion: A major advantage of TightRope$^{(R)}$ fixation for unstable distal clavicle fractures is that no further surgery is needed to remove the implant. We suggest that this technique provides an alternative for fracture with a distal fragment, which is difficult to fix.

• Journal of the Korean Arthroscopy Society
• /
• v.3 no.2
• /
• pp.127-131
• /
• 1999

Avulsion fractures of the intercondylar eminence of the tibia are not uncommon. In the displaced avulsion fracture, anatomical reduction and firm fixation of fracture fragments are needed but the most of the conventional operative techniques including arthroscopic technique are relatively complex and need. The results were not always satisfactory due to the risk of postoperative complications such as wound infection, premature epiphyseal closure and loss of fixation after early motion etc. So we describe a simple and safe modified method of arthroscopic reduction and fixation for avulsion fractures of the intercondylar eminence of the tibia. In our thirteen cases, we achieved anatomical reduction and secure fixation using cannulated screw through the three arthroscopic portals (anterolateral, medial mid-patellar and central). Postoperatively, immediate limited range of motion of the knee and partial weight bearing were possible. Additional use of the washer afforded safe fixation of comminuted avulsion fracture. The advantage of this technique includes its technical simplicity, easy removal of hardware, ability to treat comminuted type IV fracture with washer, no additional skin incision, no damage to growing plate in growth children and less morbidity.

• Journal of Oral Medicine and Pain
• /
• v.37 no.4
• /
• pp.205-211
• /
• 2012

A 35 year-old female presented with the complaint of sudden occurrence of bite change and concurrent opening limitation, as well as pain in the right temporomandibular joint (TMJ) during mouth opening. From her history it was revealed that she had simple clicking of right TMJ for several years before onset of these symptoms, and that the clicking sound subsided recently after development of opening limitation. On clinical examination, anterior open bite, midline shift of the mandible to right, and premature contacts on left posterior teeth were observed. Maximum mouth opening and lateral movement to left were also restricted. On magnetic resonance images, the right TMJ showed anterior disc displacement without reduction and the posterior joint space is greatly collapsed by retrusion of the condyle. It was thought that the sudden occurrence of occlusal change would be resulted from abrupt displacement of the mandible associated with development of the anterior disc displacement without reduction. The stabilization appliance traction therapy was performed initially for first 3 months along with physical and pharmacologic therapy. However, the anterior open bite and opening limitation didn't resolve and the position of mandible still remained altered. So the stabilization appliance was changed to intermaxillary traction device. Then the mandible returned progressively to normal position and the occlusion became more stable and comfortable. After 5 months of intermaxillary traction therapy, the anterior open bite was dissolved completely and the occlusion became stabilized satisfactorily along with recovery of normal mouth opening range. On post-treatment magnetic resonance image, remodeling of condylar head was observed.