• Journal of Korean Foot and Ankle Society
• /
• v.27 no.2
• /
• pp.58-66
• /
• 2023

Purpose: This study aimed to evaluate the effectiveness of deltoid ligament repair on syndesmotic stabilization in patients with acute ankle fractures with ruptured deltoid and syndesmotic ligaments. Materials and Methods: The medical records of 41 patients (41 ankles) who underwent surgery for Weber type B ankle fracture with ruptured deltoid and syndesmotic ligaments were retrospectively analyzed. The mean follow-up duration was 36 months (range 18~65 months). Patients were divided into two groups: those that underwent deltoid ligament repair (the deltoid group) and those who did not (the non-deltoid group). Both groups were also divided into two subgroups, namely, the D1/S1 group, which underwent syndesmotic screw fixation, or the D2/S2 group, which did not. Medial clear space (MCS), tibiofibular clear space (TFCS), anterior fibular line (AFL) ratio, and posterior fibular line (PFL) distance were measured, and visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Foot Function Index (FFI) scores were evaluated. Results: TFCS changed significantly after surgery in the D2 and S1 groups (p=0.01, p=0.03, respectively). Subgroup MCSs, TFCSs, and AFL ratios were not significantly altered by surgery in the four subgroups (p=0.82, p=0.45, p=0.25, respectively). However, postoperative PFL distances were significantly different in the D2 and S1 groups and the S1 and S2 groups (p=0.02, p=0.02, respectively). Mean TFCS decreased significantly after surgery in the D2 and S1 groups. The postoperative VAS, AOFAS scores, and FFI were not significantly different between the subgroups (p=0.44, p=0.40, and p=0.46, respectively). Conclusion: Deltoid ligament repair seemed to restore ankle stability without addressing syndesmosis in Weber type B ankle fractures with rupture of deltoid and syndesmotic ligaments.

• Clinics in Shoulder and Elbow
• /
• v.27 no.1
• /
• pp.72-78
• /
• 2024

Background: Clinical outcomes after fixation of distal humerus intraarticular fractures are directly related to the quality of reduction. The use of three-dimensional (3D)-printed fracture models can benefit preoperative planning to ensure good reduction. This review aims to determine if surgery performed with 3D printing assistance are faster and result in fewer complications and improved clinical outcomes than conventional methods. We also outline the benefits and drawbacks of this novel technique in surgical management of distal humerus fractures. Methods: A systematic literature search was carried out in various electronic databases. Search results were screened based on title and abstract. Data from eligible studies were extracted into spreadsheets. Meta-analysis was performed using appropriate computer software. Results: Three randomized controlled trials with 144 cases were included in the final analysis. The 3D-printed group had significantly shorter mean operating time (mean difference, 16.25 minutes; 95% confidence interval [CI], 12.74-19.76 minutes; P<0.001) and mean intraoperative blood loss (30.40 mL; 95% CI, 10.45-60.36 mL; P=0.005) compared with the conventional group. The 3D-printed group also tended to have fewer complications and a better likelihood of good or excellent outcomes as per the Mayo elbow performance score, but this did not reach statistical significance. Conclusions: Three-dimensional-printing-assisted surgery in distal humerus fractures has several benefits in reduced operating time and lower blood loss, indirectly decreasing other complications such as infection and anemia-related issues. Future good-quality studies are required to conclusively demonstrate the benefits of 3D printing in improving clinical outcomes.

• Journal of the Korean Orthopaedic Association
• /
• v.52 no.1
• /
• pp.25-32
• /
• 2017

Purpose: The purpose of this study was to analyze the radiological and clinical outcomes in elderly patients with unstable intertrochanteric femur fractures in accordance with the length of intramedullary nail. Materials and Methods: Between August 2009 and December 2014, a total of 139 patients-older than 65 years of age with AO/OTA classification of 31-A2 unstable intertrochanteric femur fracture-who has been followed-up for at least 1 year after the treatment with internal fixation by using an intramedullary nail were enrolled for this retrospective control study. The subjects were classified into two groups according to the length of intramedullary nail: 106 patients in the short group (group I) and 33 patients in the long group (group II). For radiological assessments, the reduction state, time to union, and implant related complications were examined. The clinical outcomes were assessed by preoperative hemoglobin, operating time, intraoperative bleeding amount, blood transfusion rate, hospitalization period, and Charnley hip pain scoring system at the final follow-up. Results: The postoperative radiographs showed good or acceptable reduction in all cases. The mean time of radiologic bone union was 4.8 months, and there was no difference between the two groups. With respect to surgical time, the group II was found to take longer (57.87 minutes) than the group I (45.65 minutes) (p=0.003). The bleeding amount during surgery of the group II was greater (288.78 ml) than that of the group I (209.90 ml) (p=0.046). The clinical results at the final follow-up were found to be satisfactory in both groups. Conclusion: In cases of good reduction of the fracture from the treatment of unstable intertrochanteric femur fracture accompanying the posteromedial fragment in elderly patients, both groups-long and short intramedullary nails-showed satisfactory radiological and clinical outcomes.

• Journal of the Korean Orthopaedic Association
• /
• v.52 no.1
• /
• pp.49-58
• /
• 2017

Purpose: To compare clinical outcome of Sanders type IV intra-articular calcaneal fracture treated with open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis (PSTA). Materials and Methods: Between March 2003 and November 2013, 22 patients with 22 Sanders type 4 intra-articular calcaneal fractures were included in this study. Of these, 11 were treated with ORIF (ORIF group), and 11 were treated with ORIF and PSTA (PSTA group). The mean follow-up period was 34.6 months (range, 18-72 months). Clinical outcomes were assessed along with the American Orthopedic Foot and Ankle Society's ankle-hindfoot scale (AOFAS score), and the visual analogue scale pain score (VAS score) at 6-month, 12-month, and last follow-up. Patient satisfaction, return to previous occupation and postoperative complications were also investigated. Results: The results for ORIF did not differ from those for PSTA based on the last follow-up AOFAS scores or the VAS scores (p>0.05). However, patient satisfaction was significantly higher in the PSTA group (p=0.008). Secondary subtalar arthrodesis was conducted in five patients (45.5%) of the ORIF group within 2 years postoperatively. Conclusion: We were unable to demonstrate a significant difference in clinical outcomes between ORIF and PSTA; however, the patient satisfaction was higher in the PSTA group. PSTA may be a suitable choice for patients who need fast recovery to daily activity and to prevent the need for secondary subtalar arthrodesis.

• Journal of the Korean Orthopaedic Association
• /
• v.54 no.4
• /
• pp.317-326
• /
• 2019

Purpose: To compare and analyze the rate of prevention of two venous thromboembolism prophylaxis guidelines in patients with artificial joint arthroplasty and hip joint fracture. Proper prophylaxis for preventing thromboembolism in orthopedic surgery is significant because of this fetal complication. Materials and Methods: This study compared and retrospective analyzed the rate of prevention using the medical records and radiographs of patients who underwent orthopedic surgery from March 2009 to February 2011 according to the American College of Chest Physicians (ACCP) guidelines and from March 2012 to February 2014 according to the American Academy of Orthopedic Surgeons (AAOS) guidelines. Results: The guidelines for venous thromboembolism prophylaxis have been applied to patients with artificial joint replacement and hip joint fracture, the compliance rate of the ACCP guidelines was 56.0% before surgery, 67.0% after surgery with chemical prophylaxis, and 80.5% with mechanical prophylaxis. In addition, the compliance rate of the AAOS guidelines was 74.1% with chemical prophylaxis, and 88.3% with mechanical prophylaxis, which was higher than the ACCP guidelines. The compliance rates of mechanical and chemical prophylaxis before and after surgery of the ACCP guidelines, and the compliance rate of mechanical and chemical prophylaxis of the AAOS guidelines were compared and analyzed. The results revealed statistical significance (p<0.05) before and after total knee replacement arthroplasty and hip joint fracture internal fixation and total high risk orthopedic surgery. Conclusion: Raising the compliance rate of prophylaxis of venous thromboembolism in high risk orthopedic surgery is necessary and people should follow the guidelines for a unified direction depending on which situation they are in.

• Journal of Veterinary Clinics
• /
• v.23 no.3
• /
• pp.291-299
• /
• 2006

During long bone lengthening, there are many disadvantages including axial deviation, malalignment and re-fracture which are commonly encountered inspite of its proven abilities. To study the effects of intramedullary K-wire application on the lengthening of long bone, ten skeletally mature mongrel dogs were separated into two groups(Group I, II). Right femurs of group I(5 dogs) were fixed with only monolateral external fixator after subperiosteal osteotomy. Right femurs of group II(5 dogs) were fixed with mono lateral external fixator and intramedullary K-wire after subperiosteal osteotomy. Lengthening was started at 7 days after the surgery with the rate of 0.5 mm per day for 5 weeks and the dogs were sacrificed after 15 weeks postoperatively to examine histologic differences and evaluate bone mineral density. Radiographic examination at an interval of two weeks was done to evaluate the type of callus formed and to analyze complications including instability of external skeletal fixation and axial deviation. Bone mineral density at the lengthened area and contralateral nonlengthened area were measured using quantitative computerized tomography. Histological examination of regenerated bone was performed using Masson's trichrome stain method. The radiographs demonstrated poor callus formation, higher incidence of axial deviation and screw loosening in the group I compared to the group II. The bone mineral density at the lengthened area in the group II was higher than that of the group I(P<0.05). Histological examination showed that the new bone trabeculae in the group II were greater than that of the group I. In conclusion, the combination of monolateral external fixator and intramedullary K-wire can prevent pin loosening, axial deviation and reduce healing period in dogs.

• Journal of Biomedical Engineering Research
• /
• v.26 no.2
• /
• pp.123-127
• /
• 2005

Compression Hip Screw (CHS) is one of the most widely-used prostheses for the treatment of intertrochanteric fractures because of its strong fixation capability. Fractures at the neck and screw holes are frequently noted as some of its clinical drawbacks, which warrant more in-depth biomechanical analysis on its design variables. The purpose of this study was to evaluate changes in the strength with respect to the changes in design such as the plate thickness and the number of screw holes. Both mechanical test and FEM analysis were used to systematically investigate the sensitivities of the above-mentioned design variables. For the first part of the mechanical test, CHS (n=20) were tested until failure. The CHS specimens were classified into four groups: Group Ⅰ was the control group with the neck thickness of 6-㎜ and 5 screw holes on the side plate, Group Ⅱ 6-㎜ thick and 8 holes, Group Ⅲ 7.5-㎜ thick and 5 holes, and Group Ⅳ 7.5-㎜ thick and 8 holes. Then, the fatigue test was done for each group by imparting 50% and 75% of the failure loads for one million cycles. For the FEM analysis, FE models were made for each group. Appropriate loading and boundary conditions were applied based on the failure test results. Stresses were assessed. Mechanical test results indicated that the failure strength increased dramatically by 80% with thicker plate. However, the strength remained unchanged or decreased slightly despite the increase in number of holes. These results indicated the higher sensitivity of plate thickness to the implant strength. No fatigue failures were observed which suggested the implant could withstand at least one million cycles of fatigue load regardless of the design changes. Our FEM results also supported the above results by showing a similar trend in stress as those of mechanical test. In summary, our biomechanical results were able to show that plate thickness could be a more important variable in design for reinforcing the strength of CHS than the number of screw holes.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.2 no.2
• /
• pp.77-81
• /
• 2003

Purpose: The biomechanics and kinematics of knee joint were reviewed in this article. And then the common sports injuries were presented. Anatomy and Kinetics: None of the pairs of bearing surfaces in the knee joint is exactly congruent This allows the knee six degrees of freedom of motion. Tibiofemoral Kinematics: In flexion and extension, the axis of motion is not perpendicular to the medial-lateral plane of the joint, nor is it perpendicular to the axis of longitudinal rotation. This results in coupled varus angulation and internal rotation with flexion and in valgus angulation and external rotation with extension. Patellofemoral Articulation: Loads across the patellofemoral joint are indirectly related to the angle of knee flexion and directly related to the force generated within the quadriceps mechanism. Fractures of the Patella: Nonoperative treatment is indicated if the extensor mechanism is intact and if displacement of fragment is minimal. The specific type of internal fixation depends on the fracture pattern. It is important to repair retinaculum. Acute and Recurrent Patellar Instability: The degree of dysplasia and the extent of the instability play a large part in determining the success of nonoperative treatment. Patients who experience recurrent dislocations and patients with major anatomic variations require surgery to minimize their instability. Sports Injuries in School-age Atheletes: Patellar pain in young athletes groups a number of conditions, including Idiopathic Adolescent Anterior Knee Pain, Osgood- Schlatter Disease, and Sinding-Larsen-Johansson Disease.

• Journal of Trauma and Injury
• /
• v.26 no.3
• /
• pp.111-124
• /
• 2013

Purpose: We should prepare proper medical service for disaster control as South Korea is not free from terrorism and war, as we experienced through the two naval battles of the Yeonpyeong, one in 1999 and the other in 2002, the sinking of Cheonan in 2010, and the attack against the border island of Yeonpyeong in 2010. Moreover, North Korea's increasingly bellicose rhetoric and mounting military threats against the world demand instant action to address the issue. The aim of this article is to describe our experience with three patients with combat-related gunshot and explosive injuries to their extremities and to establish useful methods for the management of patients with combat-related injuries. Methods: Three personnel who had been injured by gunshot or explosion during either the second naval battle of the Yeonpyeong in 2002 or the attack against the border island of Yeonpyeong in 2010 were included in our retrospective analysis. There were one case of gunshot injury and two cases of explosive injuries to the extremities, and the injured regions were the left hand, the right foot, and the right humerus. In one case, the patient had accompanying abdominal injuries, and his vital signs were unstable. He recovered after early initial management and appropriate emergency surgery. Results: All patients underwent emergent surgical debridement and temporary fixation surgery in the same military hospital immediately after their evacuations from the combat area. After that, continuous administration of antibiotics and wound care were performed, and definite reconstructions were carried out in a delayed manner. In the two cases in which flap operations for soft tissue coverage were required, one operation was performed 5 weeks after the injury, and the other operation was performed 7 weeks after the injury. Definite procedures for osteosynthesis were performed at 3 months in all cases. Complete union and adequate functional recovery were achieved in all cases. Conclusion: The patient should be stabilized and any life-threatening injuries must first be evaluated and treated with damage control surgery. Staged treatment and strict adherence to traditional principles for open fractures are recommended for combat-related gunshot and explosive injuries to the extremities.

• Clinics in Shoulder and Elbow
• /
• v.2 no.2
• /
• pp.187-198
• /
• 1999

Purpose: The authors compared the results of Ender nailing for the proximal humerus fractures with those of the conservative methods radiographically. Materials and Method: Nine patients(mean age: 69 years.) received Ender nailing, and the other nine patients, conservative treatments(mean age: 73 years). All fractures were 2 part fractures. The Ender nails were inserted either through posterior elbow approach or transepicondylar approach. A simple Velpeau bandage was applied to the conservative treatment group. The average follow-up was 15 months. Results: The initial status of the anatomical reduction, i.e., the values of the medial shift, overlapping and the varus agulation, were little changed at follow-up radiographs in both the Ender nailing group and the conservative treatment group. There was no significant difference for the status of anatomical reduction between the Ender nailing group and the conservative treatment group. The stability of fixation by Ender nails, i.e., the degree of fanning out of the nails was poor in most cases. Not a few problems/complications happened in cases of Ender nailing group; back­ing out of the nail in three cases, penetration of the nails into the humeral heads in 3, fractures or cracking of the humerus around the nail insertion area in 4 and reduction loss in one. Conclusion: We could not get better results with the use of Ender nail. We use no longer Ender nails for the proximal humerus fractures. Further studies are needed for the better option for the proximal humerus fractures.