• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.29-35
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• 2012

Purpose: In surgical treatment of the medial orbital wall fractures, restoring the original position of the orbital wall is difficult in some cases. Under such condition, the orbital wall is often reconstructed with synthetic material, without bony reduction, which is considered to be the conventional reconstruction. The purpose of this study is to compare the outcomes of anatomical reconstruction, which restores the bony wall to the anatomical position, from that of the conventional reduction in the isolated medial orbital wall fractures. Methods: Thirty patients, who underwent reconstruction surgery for the isolated medial orbital wall fractures from March 2007 to August 2011, were reviewed retrospectively. The surgical outcomes of two groups, the conventional reconstruction group (15 patients) and the anatomical reconstruction group (15 patients), were studied in 2 measurements, a one day before and 6 months after the surgery. The changes of orbital volume were calculated by the images from a computed tomography scan and enophthalmos was measured by a Hertel exophthalmometer. Results: The orbital volume ratio was decreased by an average of 1.05% in the conventional reconstruction group, while in the anatomical reconstruction group, the ratio decreased by 5.90% (p<0.05). The changes in the Hertel scale were 0.20 mm in the conventional reconstruction group, and 0.70 mm in the anatomical reconstruction group. However, the difference in the Hertel scale was statistically insignificant (p>0.05). Conclusion: In conclusion, the anatomical reconstruction technique of the isolated medial orbital wall fracture results in a better outcome than that of the conventional reconstruction, in terms of restoring of the original orbital volume and anatomic position. Thus, it can be considered as a useful method for the isolated medial orbital wall fractures.

• Journal of the Korean Arthroscopy Society
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• v.14 no.1
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• pp.49-52
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• 2010

Purpose: We introduce arthroscopically assisted mini-open rotator cuff repair using anterolateral approach. Operative Technique: Placing lateral decubitus position on general anesthesia, a standard arthroscopic glenohumeral examination is performed to evaluate lesions of shoulder joint through posterior and anterior portal. And then arthroscope is placed in the subacromial space and we evaluate the size of the torn tendon and perform arthroscopic acromioplasty through lateral portal. A 3 to 4 cm skin incision is performed from anterolateral edge of acromion to distal and dissected along to raphe between anterior and middle deltoid. A deltoid retractor is then placed, allowing direct visualization of the rotator cuff and humeral head. As torn tendon is tagged by traction suture, we try to anatomical reduction on the footprint and then perform single row or double row repair of the rotator cuff using suture anchors. To prevent avulsion of the deltoid from the acromion, additional sutures by bone tunnel with acromion and deltoid is performed. Conclusion: This technique is useful procedure to get direct approach to anterior portion of supraspinatus tendon and to need lesser deltoid retraction than portal extension approach due to dividing along to raphe between anterior and middle deltoid. Also it provide better visualization of the superior portion of subscapularis and infraspinatus.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.137-146
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• 1996

There has been no general agreement about optimal time for nerve surgery in the closed brachial plexus injury(BPI). From our early experiences, we knew by chance that spontaneous recovery in BPI patients may begin even later than 8 months after injury. Authors' strategy, which was based on our early experiences, for the treatment of closed fresh injury was 'wait and see' unlit 8 months after injury. From 1985 to 1994, we observed 103 patients with BPI. All of them did not have any operation until 8 months after injury. There were 95 men and 8 women with a mean age of 29 years. Motorcycle injury(31%) and vehicle accident(28%) were main causes of injury. Whole plexus types were observed in 56 patients(54%), upper plexus types in 29(28%), lower plexus types in 3(3%), and infraclavicular types in 15(15%). Electromyography was performed in all patients. This was repeated every three months to detect the recovery. Results were evaluated by authors' criteria, in which AMA system of brachial plexus impairment was modified. Duration of follow up was average 25 months. 47 patients(46%) showed spontaneous improvement, which was initially detected at average 7.8 months(range,3 months-16 months) after trauma by electromyography. The average score of these 47 patients improved from 14.8 points to 39.8 points.31 patients(30%) had nerve surgery such as nerve graft, neurotization or neurolysis. Average duration from injury to nerve surgery, was 10 months. Among 31 patients who had nerve surgery, 16 patients improved from preoperative 21.5 points to postoperative 36.3 points in average. Because spontaneous recovery began in average 7.8 months after injury, we think that it would be better to 'wait and see' for at least one year in patients with closed BPI expecting spontaneous recovery.

• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.143-147
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• 2012

A triple disruption of the SSSC, an extremely rare injury, has been reported by only a few authors. We present a patient who had sustained a triple disruption of the SSSC: coracoid and scapular spine fractures, and an acromioclavicular joint separation. Treatment consisted of an anatomical restoration of the SSSC, with maintenance of the acromiohumeral and coracohumeral distances; this was achieved by open reduction and internal fixation of the fractures and of the separation. Six months after surgery, the injured shoulder was asymptomatic, with full range of motion. Five years after surgery, at the final follow-up, the function of the SSSC had been restored to the patient's complete satisfaction.