• Journal of Korean Foot and Ankle Society
• /
• v.14 no.1
• /
• pp.79-83
• /
• 2010

Purpose: To compare the clinical and radiological results between the anterior and posterior screw fixation for the treatment of talar neck fracture. Materials and Methods: Among 30 patients who received surgical treatment for talar neck fracture from 2001 to 2008. Twenty-seven patients with a follow-up period of more than 1 year were divided into two groups. Twelve patients were treated with anterior screw fixation and 15 patients with posterior approaches. We analyzed preoperative, postoperative and follow-up radiographs. Clinical results were evaluated by Hawkins criteria. Results: The posteriorly inserted screws were placed across the more central portion of the talar neck and perpendicular to the plane of fracture (p<0.05). There were no difference in clinical results, the duration of union, and complications including avascular necrosis between two groups. However, 2 patients complained of pain around the talonavicular joint in the anterior insertion group. Conclusion: Although the clinical results were good irrespective of insertion methods, the posterior approach of screw fixation for talar neck fractures allows for a better mechanical advantage than anterioly placed screws. This may allow early motion with a reduced risk of failure of fixation or of displacement of the fracture.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.30 no.4
• /
• pp.359-369
• /
• 2008

Purpose: Fractures of the mandibular condyle accounts for 15% to 30% of all the mandibular fractures and lots of complications are reported. Among these complications, condylar resorption is the most important one to be taken into account. The purpose of this study is evaluating condylar resorption pattern in relation to extracorporeal fixation technique. Patients & methods: Thirty four patients with 42 mandibular condylar fractures were retrospectively examined with an average follow-up of 18.5 months (6-66 months). Male/female ratio is 27 males (7 bilateral cases) and 7 females (1 bilateral case). Applicated surgical techniques were extracorporeal fixation via submandibular approach and extracorporeal fixation via intraoral approach. We compared radiographic views of post-operative periods with that of most long term follow up in 34 operated sites respectively. Result: There were 2 generalized condylar resorption sites and 3 partial resorption sites with clinical implications. Others (29 joints) showed good healing or satisfactory adaptive state of temporomandibular joints clinically. Radiologically, signs of partial condylar resorption and/or osteoarthrosis were diagnosed in 11 patients. But, 8 out of the 11 patients didn't show significant clinical symptoms, which means successful adaptive remodeling of the surgically located condylar head. Conclusion: From the above results, intentional ramal osteotomy, temporary detachment of the fractured condyle and extracorporeal fixation technique seems to be effective and useful in those cases of condylar fractures in which reduction of the dislocated condyle is very difficult or virtually impossible.

• Journal of Chest Surgery
• /
• v.8 no.1
• /
• pp.37-44
• /
• 1975

Authors have reviewed the records of seven patients of multiple rib fractures with severe flail chest who were admitted to Hanyang University Hospital during the 3 years period from 1972 through 1975. Of the seven patients studied, automobile accidents led to the injuries in 4 cases, two patients were injured in fall from a tree and on the ox-heading. All who had a blunt trauma without any open wound on the chest. The numbers of the fractured ribs accounted for 6 to 9 of the ribs including double fractures from 3 to 5 ribs. The left side fractures occurred in the 6 patients and in the right only one patient. Thus the flail segment was more often located in the left antero-lateral position than in the right lateral position [the ratio was 6:1].. All cases had associated injuries. The injuries and multiple fractures were the most common associated injuries occurring in four and five of the patients respectively. The patients were classified as having associated head injuries when they were admitted in comatose or semicomatose state. When a major degree of instability of the thoracic cage exists, adequate respiratory change is not possible. For this reason the tracheostomy was performed in five patients in an acutely injured patient with flail chest only after an endotracheal tube has been inserted or after an endotracheal suction. All patients had secondary complications in the pleural cavity, such as hemothorax or hemopneumothorax with or without intrapulmonary hemorrhage and subcutaneous emphysema. Therefore, closed thoracostomy was performed in five patients in the emergency room. The thoracotomy was required in four patients: immediate operation without closed thoracostomy was performed in two patients and the thoracotomy was indicated in two patients after closed thoracostomy, because of increasing intrathoracic hemorrhage. As to the fixation of the flail segments, authors employed two techniques; one was towel clip traction of the flail segments and the other was intramedullary insertion of Kirschner`s wire in to the double fractured rib fragments for the fixation of the flail segments [Kirschner`s wire fixation]. Because` of an different results in the course of treatment between two techniques, data from patients with towel clip traction was compared with those from patients with thoracotomy and Kirschner`s wire fixation of the flail segments. Of the three patients with towel clip traction, two patients required bronchoscopic toilet due to lung atelectasis which developed because of inadequate motion of thoracic cage and poor expectoration. This was in contrast to the four patients with thoracotomy and Kirschner`s wire fixation, who didn`t these complication because of adequate motion of the thoracic cage and subsequent good expectoration.

• Journal of Korean Neurosurgical Society
• /
• v.49 no.3
• /
• pp.163-166
• /
• 2011

Objective : Both the paraspinal muscle sparing approach and percutaneous screw fixation are less traumatic procedures in comparison with the conventional midline approach. These techniques have been used with the goal of reducing muscle injury. The purpose of this study was to evaluate and to compare the safety and efficacy of the paraspinal muscle sparing technique and percutaneous screw fixation for the treatment of L5-S1 spondylolisthesis. Methods : Twenty patients who had undergone posterior lumbar interbody fusion (PLIF) at the L5-S1 segment for spondylolisthesis were prospectively studied. They were divided into two groups by screw fixation technique (Group I : paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Clinical outcomes were assessed by Low Back Outcome Score (LBOS) and Visual Analogue Scale (VAS) for back and leg pain at different times after surgery. In addition, modified MacNab's grading criteria were used to assess subjective patients' outcomes 6 months after surgery. Postoperative midline surgical scarring, intraoperative blood loss, mean operation time, and procedure-related complications were analyzed. Results : Excellent or good results were observed in all patients in both groups 6 months after surgery. Patients in both groups showed marked improvement in terms of LBOSs all over time intervals. Postoperative midline surgical scarring and intraoperative blood loss were lower in Group II compared to Group I although these differences were not statistically significant. Low back pain (LBP) and leg pain in both groups also showed significant improvement when compared to preoperative scores. However, at 7 days and 1 month after surgery, patients in Group II had significantly better LBP scores compared to Group I. Conclusion : In terms of LBP during the early postoperative period, patients who underwent percutaneous screw fixation showed better results compared to ones who underwent screw fixation via the paraspinal muscle sparing approach. Our results indicate that the percutaneous screw fixation procedure is the preferable minimally invasive technique for reducing LBP associated with L5-S1 spondylolisthesis.

• Clinics in Shoulder and Elbow
• /
• v.25 no.3
• /
• pp.230-235
• /
• 2022

Background: Unstable distal clavicles experience high non-union rates, prompting surgeons to recommend surgery for more predictable outcomes. There is a lack of consensus on the optimal method of surgical fixation, with an array of techniques described in the literature. We describe an alternative method of fixation involving the use of a distal clavicular anatomical locking plate with Fibertape cerclage augmentation in our series of patients. Methods: Nine patients (8 males and 1 female), with a mean age of 36 years, who sustained unstable fracture of the distal clavicle in our institution were treated with our described technique. Postoperative range of motion, functional and pain scores, and time to radiographic union were measured over a mean follow-up period of 10 months. Incidences of postoperative complications were also recorded. Results: At the last patient consult, the mean visual analog scale score was 0.88±0.35, with a mean Disabilities of the Arm, Shoulder, and Hand (DASH) score of 1.46±0.87 and American Shoulder and Elbow Surgeons (ASES) score of 94.1±3.57. The mean range of motion achieved was forward flexion at 173°±10.6°, abduction at 173°±10.6°, and external rotation at 74.4°±10.5°. All patients achieved internal rotation at a vertebral height of at least L2 with radiographical union at a mean of 10 weeks. No removal of implants was required. Conclusions: Our described technique of augmented fixation of the distal clavicle is effective, produces good clinical outcomes, and has minimal complications.

• Journal of the Korean Arthroscopy Society
• /
• v.2 no.1
• /
• pp.25-32
• /
• 1998

The distinction between isolated and combined injuries is crucial both for treatment and prognosis. For most combined injuries, surgical treatment continues to be favored over nonoperative treatment. It is generally agreed that isolatel PCL injuries do well without surgery. There has been an interest by many authors to fix the graft directly to the posterior aspect of the tibia(tibial inlay). With this procedure, tibial graft fixation will be more direct and theoretically reduce the bending effects of the graft with a fixation site far away from the tibial insertion. Modified tibial inlay technique, which is the posterior approach does not require the patient to be in the prone or lateral decubitus position during the operation. Use of a double-bundle reconstructive technique is attractive and has been performed by some surgeons. At this time, this procedure is still being investigated and should not be routinely used in the clinical setting until studies have indicated an advantage over current single-bundle techniques. However theologically, double-bundle reconstructive technique is more useful in severe posterior unstable knee. Recent advances have increased our knowledge of the anatomy and mechanical characteristics of the PCL. Basic science research has further increased our awareness of the interaction of the posterolateral structures with the PCL. To achieve restoration of normal posterior laxity, it is critical to address the posterior as well as the postero-lateral structures. Surgical treatment is often complex and requires a wide range of surgical techniques and skills to treat associated injuries. When the PCL is reconstructed, most surgeons choose to reconstruct the anterolateral component using a graft of sufficient size and strength. The initial postoperative rehabilitation should be addressed cautiously in an effort to avoid excessive forces on delicate repairs and reconstructions in these complex injuries. Further research is necessary to evaluate new surgical approaches such as double-bundle reconstructions and tibial inlay techniques as well as improved techniques for capsular and collateral ligament injuries.

• Archives of Craniofacial Surgery
• /
• v.23 no.1
• /
• pp.23-28
• /
• 2022

Background: Intermaxillary fixation (IMF) is a technique that allows for the reduction and stabilization of mandibular fractures. Several methods of IMF, such as self-tapping screws or arch bars, have been developed. This study aimed to validate the usefulness of IMF with a self-tapping screw compared to IMF with arch bars with focus on the patients' perspective. Methods: We retrospectively reviewed the medical records of all patients who were treated for mandibular fractures at our hospital between August 2014 and February 2021. A total of 57 patients were enrolled in this study. Thirteen patients were excluded from the analysis: three patients were lost to follow-up, and 10 patients did not undergo IMF. Finally, 44 patients were analyzed, of which 31 belonged to the arch bar group, and 13 belonged to the screw group. Patient discomfort and pain during IMF application and removal were analyzed using a patient self-assessment questionnaire. The surgeon also assessed oral hygiene, IMF stability, and occlusion. Results: We applied IMF to 34 men (77%) and 10 women (23%). The mean age of the patients was 37.3 years. The most common fracture site was the angle (30%), followed by the parasymphysis (25%), the body (23%), the condyle (11%), and the ramus (11%). Patient discomfort and oral hygiene were statistically favorable in the screw group. The IMF application time was statistically shorter in the screw group (p< 0.001). IMF stability was not statistically different between the two groups. The pain score during IMF removal was lower in the screw group (p< 0.001). Conclusion: Compared to arch bars, IMF screws provide more comfort during the IMF period, help maintain favorable oral hygiene, and have a shorter application time. From the patient's perspective, IMF screws are an excellent alternative to conventional arch bars when applicable.

• Proceedings of the KSME Conference
• /
• 2008.11a
• /
• pp.1527-1532
• /
• 2008

45% of the sports accidents is the knee damage and the representative case is the damage of an Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament(PCL). Although the past different views of ACL reconstruction comes to an agreement, the disputes of PCL is remained yet. The most important engineering approach for these various surgery techniques is accurately to understand and to evaluate the fatigue behavior depending on the stress flow and the stress distribution under the allotted load and the cyclic load, which are caused by the graft fixing device, the proximal tibia of the PCL reconstructing structure. Therefore, this study is the basic research of these above facts. The current transtibial tunnel surgery using the cadaveric Achilles tendon grafts is chosen for the various PCL reconstruction. The relationships between the slippage, the extension ratio, and the slippage ratio by the heel bone fixing method and the soft tissue fixing method of the Achilles tendon were also defined. This research will be the essential data to help the resonable operating techniques for the next PCL reconstruction.

• Journal of Veterinary Clinics
• /
• v.34 no.1
• /
• pp.47-49
• /
• 2017

Fracture stabilization techniques continue to evolve and provide approaches that minimize the iatrogenic trauma associated with surgical procedures. Minimally invasive plate osteosynthesis (MIPO) is a recently described method of biological internal fixation performed by introducing a bone plate via small insertional incisions that are remote to the fracture site. Indirect reduction techniques can generally be utilized when performing MIPO. In this case report, we describe MIPO of a radius-ulna fracture by indirect reduction using circular external fixation for alignment and distraction in a dog.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.19 no.2
• /
• pp.157-166
• /
• 1997

Treatment of condylar fracture is still controversial, but the indication of surgical mangement is increased due to improved fixation methods and surgical techniques. In this article, we report our clinical and radiological results with the use of lag screw osteosynthesis for fixation of fractured mandibular condyle. 12 case of condyle fracture treated by open reduction and fixation with lag screw were monitored for an average of 10 months (range from 6 months to 19 months) postoperatively. The obtained results are as follows : 1. Postoperative maximum mouth opening is achieved over 40mm except one patient. 2. Although slight crepitus and deviation of mandible during mouth opening were found, Temporomandibular joint problem is satisfactory in all but one patient. 3. Distal migration of screw and resorption of fractured fragment were found in each 2 patients, but good functional recovery was achieved in all. According to the above results, we think that lag screw osteosynthesis is relatively indicated in level III or IV condylar fracture.