• Archives of Plastic Surgery
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• 제44권1호
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• pp.53-58
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• 2017

Background Adequate fixation of replanted digits is essential not only for short-term healing but for long-term function. Various bony fixation methods using Kirschner (K-) and intraosseous wire are available in replantation. We examined clinical and radiographic outcomes of fixation methods on bone union after digital replantation. Methods A single institutional retrospective review identified 992 patients who had undergone 1,247 successful replantations between July 2009 and September 2015. Exclusion criteria included amputations of the distal phalanx, comminuted fractures, and intra-articular fractures. Patients were classified according to 5 categories of fixation methods: single K-wire, double longitudinal K-wires, cross K-wires, wire with, and wire without K-wire support. Bone union was evaluated by 5-month postoperative X-ray and fixation outcomes were compared across the 5 groups. Results The exclusion criteria were applied, and 88 patients with 103 replanted digits remained for analysis. Single K-wire fixation was used in 40 digits, double longitudinal K-wires in 30, and cross fixation in 14. Wire with and without K-wire support was required in 15 and 4 digits. Nonunion was observed in 32 digits (31.1%), of which 13 required additional operations such as bone graft or corrective osteotomy. The highest percent of nonunion was observed after cross fixation (35.7%) and the lowest after wire alone (25.0%). Conclusions In this study, contrary to general knowledge, we found that single K-wire fixation was not associated with poorer outcomes. Successful bone union outcomes may be achieved by careful selection of bone fixation methods. This study provides useful information for planning bone fixation in digital replantation.

• 대한두개안면성형외과학회지
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• 제23권5호
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• pp.220-227
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• 2022

Background: Frontal sinus fractures are relatively rare. Their surgical management significantly differs depending on whether the posterior wall is invaded and the clinical features vary. A bicoronal incision or endoscopic approach can be used. However, the minimally invasive approach has been attracting attention, leading us to introduce a simple and effective surgical method using multiple-threaded Kirschner wires. Methods: All patients had isolated anterior wall fractures without nasofrontal duct impairment. The depth from the skin to the posterior wall was measured using computed tomography to prevent injury. The edge of the bone segment on the skin was marked, a threaded Kirschner wire was inserted into the center of the bone segment, and multiple Kirschner wires were gently reduced simultaneously. Results: Surgery was performed on 11 patients. Among them, seven patients required additional support for appropriate fracture reduction. Therefore, a periosteal elevator was used as an adjunct through a small sub-brow incision because the reduction was incomplete with the Kirschner wire alone. The reduction results were confirmed using facial bone computed tomography 1 to 3 days postoperatively. The follow-up period was 3 to 12 months. Conclusion: The patients had no complications and were satisfied with the surgical results. Here we demonstrated an easy and successful procedure to reduce a pure anterior wall frontal sinus fracture via non-invasive threaded Kirschner wire reduction.

• Archives of Plastic Surgery
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• 제43권2호
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• pp.189-196
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• 2016

Background Several techniques have been designed to treat fifth metacarpal fractures reported to be effective. However, these methods cannot be easily applied to the fourth metacarpal due to its central anatomical position. In this study, we sought to analyze the functional outcomes of patients who underwent transverse pinning for a fourth metacarpal bone fracture. Methods A total of 21 patients were selected and their charts were retrospectively reviewed. After fracture reduction, two transverse Kirchner wires were first inserted from the fifth metacarpal to the third metacarpal transversely at the distal part of the fractured bone, and then another two wires were inserted at the proximal part of the fractured bone. The splint was removed approximately one week postoperatively and the Kirchner wires were removed four to five weeks postoperatively. Patients started active and passive exercise one week after the operation. Pain visual analog scores, total active and passive motion, and the active and passive range of motion of the metacarpophalangeal joint and grip strength were evaluated. Results Dorsal angulation improved from a preoperative value of $44.2^{\circ}$ to a postoperative value of $5.9^{\circ}$. Six weeks after surgery, functional recovery parameters, such as range of motion and grip strength, had improved to 98% of the function of the normal side. No major complication was observed. Conclusions We suggest that the transverse pinning of fourth metacarpal bone fractures is an effective treatment option that is less invasive than other procedures, easy to perform, requires no secondary surgery, minimizes joint and soft tissue injury, and allows early mobilization.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.102-104
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• 2011

Purpose: The standard treatments of hand fractures today are fixations by K -wires, metal plates, wires and lag screws. But it is very difficult to reconstruct fractures by placing implants into small bony fragments especially in the comminuted fractures and intra-articular fractures. This paper describes a simple method of reconstruction with Histoacryl$^{(R)}$ for comminuted and intra-articular fractures in hands. Methods: 2 cases with comminuted and intra-articular fractures by crushing injury were reconstructed with Histoacryl$^{(R)}$. We performed applying Histoacryl$^{(R)}$ with swab on the bone cortex carefully to avoid Histoacryl$^{(R)}$ infiltrating into the medulla. We could rearrange and fixate bony fragments using only Histoacryl$^{(R)}$, in addition, metal plates, K-wires, wires, and lag screws could be used for secondary fixation if needed. Results: Post-operative X-ray finding of 2 patients assured that the bony fragments of the hand fractures maintained their original positions. Significant displacement and deviation, infection, nonunion, and malunion during the follow-up period were not observed. Conclusion: This study showed the possibility of using Histoacryl$^{(R)}$ in addition as a simple method of fixation in the comminuted and intra-articular hand fractures.

• Clinics in Shoulder and Elbow
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• 제23권4호
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• pp.198-202
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• 2020

Simple clavicle fractures can achieve satisfactory results through conservative treatment, and the less frequency of nonunion. Non-union or malunion can occur in displaced clavicle fractures or comminuted shaft fractures. Treatment of displaced comminuted clavicle shaft fractures is performed by holding together the free fragments with interfragmentary screws or wires and fixing them to the clavicle with a plate. Therefore, we performed interfragmentary fixation using open reduction and internal fixation with bioresorbable screws (Mg-Ca alloy, Resomet bioresorbable bone screw; U&I Corp.) and bioresorbable wires (Mg-Ca alloy, Resomet bioresorbable K-wire and pin, U&I Corp.) for displaced comminuted clavicle fractures (Robinson type 2B) and additionally used a metal plate. We expected decreased irritation and infection due to absorption after surgery. We report four cases that were treated in this way.

• 구강회복응용과학지
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• 제23권1호
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• pp.43-53
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• 2007

The purpose of this experimental study was to examine the effect of the decontamination of carbon dioxide ($CO_2$) laser in treatment of ligature-induced peri-implantitis in dogs. A total 24 implants with a sandblasted with large-grit and acid-etched (SLA) surface were inserted in six mongrel dogs. After a 3-month healing period, experimental peri-implantitis characterized by a bone loss of about 3mm was established by inducing with wires. And then wires were removed and plaque control was implemented. Surgical treatment involving flap procedure + debridement of implants surface with chlorhexidine and saline (group 1), flap procedure + GBR with absorbable collagen membrane (Bio-Gide) and mineralized bone graft (Bio-Oss) (group 2), and flap procedure + $CO_2$ laser application + GBR (group 3) was performed. The animals were killed 8 weeks and 16 weeks after treatment, respectively. A histomorphometric analysis confirmed statistically considerable new bone formation within the limit of the 5 most coronal threads in group 3 compared with group 1 at 16 weeks (P<0.05). And intragroup analysis showed considerable increase of new bone formation in group 3 at 16 weeks compared with 8 weeks (P<0.05). The present study demonstrates considerable new bone formation after treatment of experimental peri-implantitis with flap procedure, $CO_2$ laser application and GBR.

• Journal of Trauma and Injury
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• 제28권2호
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• pp.55-59
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• 2015

Purpose: To compare clinical and radiographic outcomes of between two and three Kirschner wire(K-wire) intramedullary fixation for fractures in the neck of the metacarpal bone. Methods: A single institutional retrospective review identified 28 cases of metacarpal fractures between March 2010 and August 2014. Each of the cases met the inclusion criteria for closed, extra-articular fractures of the neck of the metacarpal bone. The patient groups were divided by the number of K-wire. Outcomes were compared for range of motion of the metacarpophalangeal joint, radiographic parameters, and period until union. Results: The fractures were treated with either 2 Kirschner wire fixation (n=10) or 3 Kirschner wire fixation (n=18). The active range of motion of metacarpophalangeal joint and radiographic result showed no statistically significant difference between the two groups. The mean union period was 5.9 weeks. However, four cases suffered distal head perforation in 2 K-wire fixation group and one case in 3 K-wire fixation group. Conclusion: Multiple retrograde intramedullary Kirschner wire fixation is a good treatment of choice for fractures in the neck of the metacarpal bone. To prevent metacarpal head perforation, it is preferred to use three K-wires than two K-wires.

• Archives of Plastic Surgery
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• 제33권3호
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• pp.379-382
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• 2006

Clinodactyly is defined as an angulation of a digit in the radio-ulnar plane. This anomaly can be congenital, dominantly inherited, or acquired due to trauma or inflammation. Although the deformity usually causes little functional impairment, correction is made because of cosmetic problems. Male subject, with polydactyly on thumb(Wassel's type VII) received first surgery at the age of one. And at the age of six, abnormal growth on the radial side of the first metacarpal bone and ulnar deviation of the distal phalanx of the thumb at the interphalangeal joint had developed. The authors used the growing bony segment from the first metacarpal bone as a bone graft for the correction of clinodactyly on thumb. Z-plasty incision was made on the concave(ulnar) side of thumb and a wedge osteotomy was made on the distal phalanx. The bone graft was inserted into the gap of the distal phalanx of the thumb and fixed it with K-wires. Deformity of the metacarpal bone and clinodactyly on thumb was corrected effectively without donor site morbidity with noticible growth of the grafted metacarpal bone 12 months after surgery.

• 한국임상수의학회지
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• 제35권5호
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• pp.215-217
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• 2018

A one-year-old, intact male, 24 kg, mixed breed dog was referred to the Animal Medical Center, Iksan, Chonbuk, Korea for treatment of a gunshot wound to the head. Physical examinations revealed bilateral nasal bleeding and open-mouth breathing. Radiographic examination showed fracture of the right maxilla bone and multiple fractures of the nasal bone. A $1cm{\times}1cm{\times}1.8cm$ region of mineral opacity material was observed in the right-cranial ventralnasal cavity and a $6mm{\times}6mm{\times}9mm$ region of mineral opacity material was present in the left-cranial dorsal-nasal cavity. The surgical procedure involved removal of bone fragments and the lodged bullet as well as the installation of three intraosseous wires. At two weeks after surgery, the patient exhibited no complications and had a good prognosis.

• Journal of Trauma and Injury
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• 제34권3호
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• pp.170-176
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• 2021

Purpose: Traumatic sternal fractures are rare but quite disabling injuries. Timely fixation of sternal fractures reduces pain and prevents respiratory complications. However, the fixation technique should be simple, effective, and readily available in local circumstances. Methods: From January 2014 to March 2020, seven patients with sternal fracture/dislocation underwent steel wire fixation with the new "Timala" technique. In this technique, adjacent ribs are anchored with two steel wires to form an "X" in front of the fractured segment of the sternum. Patients were followed up clinically and radiologically. Results: Six of the patients were men and one was a female. Five of them had injuries due to falls and two were injured in road traffic accidents. Their age ranged from 18 years to 76 years, with a median age of 41 years. All seven patients experienced immediate recovery from pain and showed evidence of fracture healing on postoperative chest X-rays and clinical examinations. Conclusions: Anchoring ribs to fix the sternum with steel wire is a safe, effective, easily available, and reproducible method to fix sternal fractures or dislocations.