• Journal of the Korean Orthopaedic Association
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• v.56 no.6
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• pp.540-545
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• 2021

A transverse fracture is the most common type of displaced patella fracture requiring surgery. These fractures are commonly fixed with parallel Kirschner wires or screws that cross the fracture line, often with an additional tension band. Nevertheless, conventional fixation methods of patella fractures have prevalent complications caused by the protrusion of wires or pins. These complications necessitate additional surgery for hardware removal, increase medical cost, and can limit the function of the knee joint. This paper reports cases treated with a minimally invasive load-sharing percutaneous suture of the patella tendon. The procedure provides reliable fixation for transverse patella fractures, minimizes soft tissue injuries, preserves blood flow, and reduces postoperative pain. In addition, the procedure also reduces the irritation and pain caused by the internal fixture, thereby reducing the risk of restricted knee joint movement.

• Archives of Plastic Surgery
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• v.50 no.6
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• pp.593-600
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• 2023

Background Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee jointmobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps. Methods A multicenter retrospective study was conducted enrolling patients who underwent to a pedicled, chimeric gastrocnemius musculocutaneous-medial sural artery perforator (GM-MSAP) or lateral sural artery perforator (GM-LSAP) flap for knee coverage in total knee arthroplasty (TKA) recurrent infections and oncological or traumatic defects of the upper leg from 2018 to 2021. Outcomes evaluated were the successful soft tissue reconstruction and flap complications. Surgical timing, reconstruction planning, technique, and rehabilitation protocols were discussed. Results Twenty-one patients were included in the study. Nineteen GM-MSAPs and 2 GM-LSAPs were performed (soft tissue reconstruction in infected TKA [12], in infected hardware [4], and in oncological patients [5]). Donor site was closed primarily in 9 cases, whereas a skin graft was required in 12. Flap wound dehiscence (1), distal flap necrosis (1), distal necrosis of the skin paddle (1), and donor site infection (1) were the encountered complications. Flap reraise associated to implant exchange or extensive debridement was successful without requiring any further flap surgery. Conclusion The propeller-perforator GM-MSAP offers qualitative defect coverage and easiness of multiple flap reraise due to skin availability and its laxity.

• Journal of Korean Neurosurgical Society
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• v.30 no.11
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• pp.1284-1290
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• 2001

Objective : PCB cervical instrument is a newly introduced fusion device which comprises cervical plate, cage (spacer) and screw system. It is developed to enhance fusion rate and stability, as well as to reduce complications related to hardware failure. We investigated the efficacy of clinical and radiological results of PCB instrument and Lubboc bone. Methods : From August, 1998 to October, 1999, authors performed 54 cases of anterior cervical interbody fusion with PCB instrument and Lubboc bone. Retrospective analysis was undertaken based on clinical and radiological findings. Clinical improvement was evaluated according to Odom's criteria. Cervical plain films and tomography were taken every 2 months to evaluate the degree of interbody fusion and disc height changes. Results : Bone fusion was observed in 36 cases(90%) over 6 months after operation, and during which time there was no significant interval change. There were 3 cases of hardware dislodgement. Disc height was increased significantly and preserved in all cases. Clinical outcome over good degree was seen more than 94% of patients. Conclusion : Longer follow-up period and comparative studies to similar instrument appear to be necessary, but this instrumentation system has shown high fusion rate and fewer adverse effects in our series. We believe this system might be indicated for the treatment of cervical trauma and degenerative disease in selective cases.

• Journal of Trauma and Injury
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• v.29 no.1
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• pp.22-27
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• 2016

Purpose: The optimal method of fixation of symphysis pubis (SP) diastasis in pelvic ring injuries is still controversial. In this study, we investigated the radiological and the clinical results of a precontoured 4.5-mm symphysis pubis (SP) plate with tension band wiring (TBW) after an anterior pelvic injury in pelvic fractures. Methods: We treated 25 patients with traumatic SP diastasis by open reduction and internal fixation with plates and wires. We used a four-hole 4.5-mm precontoured SP plate with a tension band wiring. Results: Patients with a SP with TBW fixation achieved excellent or good results at final follow-up. Post-operative complications included two (8%) patients with metal work movement. The mean symphyseal width was smaller in 4.5 mm SP plate with TBW during 1-year follow up period. Conclusion: A precontoured symphysis pubis plate (4.5 mm) with figure-of-eight fashion tension band wiring shows favorable radiological results, excellent or good clinical outcome, and a lower complication (hardware failure and revision surgery).

• Journal of Dental Rehabilitation and Applied Science
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• v.19 no.2
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• pp.125-137
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• 2003

The use of screw-retaind prosthesis on an osseointegrated implant is a popular treatment modality offering relative ease in the removal of the restoration. One of the complications associated with this modality is the loosening of the abutment and coping screws. Loosening of the screws results in patient dissatisfaction, frustration to the dentist and, if left untreated, component fracture. There are several factors which contribute to the loosening of implant components which can be controlled by the restorative dentist and lab technician. This article offers pratical solutions to minimize this clinical problem and describes the factors involved in maintaining a stable screw joint assembly. To avoid joint failure, adherence to specific clinical, as well as mechanical, parameters is critical. With respect to hardware, optimal tolerance and fit, minimal rotational play, best physical properties, a predictable interface, and optimal torque application are mandatory. In the clinical arena, optimal implant distribution; load in line with implant axis; optimal number, diameter, and length of implants; elimination of cantilevers; optimal prosthesis fit; and occlusal load control are equally important.

• Progress in Medical Physics
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• v.17 no.3
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• pp.144-152
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• 2006

The telemedicine using independent client-server system via networks can provide high quality normalized services to many hospitals, specifically to local/rural area hospitals. This will eventually lead to a decreased medical cost because the centralized institute can handle big computer hardware systems and complicated software systems efficiently and economically, Customized cancer radiation treatment planning for each patient Is very useful for both a patient and a doctor because it makes possible for the most effective treatment with the least possible dose to patient. Radiation planners know that too small a dose to the tumor can result in recurrence of the cancer, while too large a dose to healthy tissue can cause complications or even death. The best solution is to build an accurate planning simulation system to provide better treatment strategies based on each patient's computerized tomography (CT) image. We are developing a web-based and a network-based customized cancer radiation therapy simulation system consisting of four Important computer codes; a CT managing code for preparing the patients target data from their CT image files, a parallel Monte Carlo high-energy beam code (PMCEPT code) for calculating doses against the target generated from the patient CT image, a parallel linear programming code for optimizing the treatment plan, and scientific data visualization code for efficient pre/post evaluation of the results. The whole softwares will run on a high performance Beowulf PC cluster of about 100-200 CPUs. Efficient management of the hardware and software systems is not an easy task for a hospital. Therefore, we integrated our system into the client-sewer system via network or web and provide high quality normalized services to many hospitals. Seamless communication with doctors is maintained via messenger function of the server-client system.

• Journal of Korean Neurosurgical Society
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• v.41 no.2
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• pp.105-110
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• 2007

Objective : This purpose of this study was to determine the clinical efficiency and applicability, and to analyze the radiologic findings of the anterior cervical approach using two synthetic cages for interbody fusion. Methods : A total of 41 patients with cervical diseases underwent anterior discectomy and interbody fusion with the PEEK $Solis^{TM}$ cage in 21 patients and the carbon composite $Osta-Pek^{TM}$ cage in 20 patients. Outcome assessment was done using Odom's criteria. Radiological assessment was performed with respect to subsidence, bony fusion and lordosis. The mean follow-up period was 13 months. Results : There were 34 [92.9%] successful cases. The average height of the disc space 12 months after surgery compared the height just after surgery was decreased over 3mm in 4 cases, indicating severe subsidence. The use of these synthetic cages have provided the increase in postoperative cervical lordosis. Conclusion : There were no significant differences between the $Solis^{TM}$ and $Osta-Pek^{TM}$ cages on clinical and radiologic outcomes. Both $Solis^{TM}$ and $Osta-Pek^{TM}$ cages showed low subsidences and complications associated with hardware with good clinical outcomes, high fusion rates, restored disc heights, and restored cervical lordosis.

• Journal of Korean Neurosurgical Society
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• v.37 no.3
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• pp.201-206
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• 2005

Objective: To evaluate the accuracy and safety of C1-C2 transarticular screw insertion, we retrospectively review surgical records and postoperative radiological findings. Methods: From January 2001 to October 2003, the C1-C2 transarticular screw fixation and posterior wiring with iliac bone grafts was performed in 16 patients. 6 patients had rheumatoid arthritis which caused cervical instability, 3 patients had os odontoideum, 3 patients had type 2 odontoid process fracture, 3 patients had traumatic transverse ligament injury and 1 patients who had been managed with C1-C2 wire fixation had psoriatic arthritis. Results: Osseous fusion was documented in 15 patients(93.8%). Only one patient was recorded screw loosening because of postoperative infection. One patient had only one screw placed because of abnormal anatomical structure, one patients was breakage of a Kirschner wire, and one screw was medial location to lateral mass of C1, but clinical results was excellent and radiological instability was not noted. Conclusion: The author's experience demonstrates that C1-C2 transarticular screw fixation with wired bone graft is a safe procedure with higher fusion rate but precaution is needed to avoid the neural damage, vertebral artery injury, and hardware failure.

• Journal of Korean Neurosurgical Society
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• v.42 no.5
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• pp.367-370
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• 2007

Objective : There are numerous reports on the primary stabilizing effects of the different cervical cages for cervical radiculopathy. But, little is known about the subsidence which may be clinical problem postoperatively. The goal of this study is to evaluate subsidence of cage and investigate the correlation between radiologic subsidence and clinical outcome. Methods : To assess possible subsidence, the authors investigated clinical and radiological results of the one-hundred patients who underwent anterior cervical fusion by using $AMSLU^{TM}$ cage during the period between January 2003 and June 2005. Preoperative and postoperative lateral radiographs were measured for height of intervertebral disc space where cages were placed intervertebral disc space was measured by dividing the sum of anterior, posterior, and midpoint interbody distance by 3. Follow-up time was 6 to 12 months. Subsidence was defined as any change in at least one of our parameters of at least 3 mm. Results : Subsidence was found in 22 patients (22%). The mean value of subsidence was 2.21 mm, and mean subsidence rate was 22%. There were no cases of the clinical status deterioration during the follow-up period No posterior or anterior migration was observed. Conclusion : The phenomenon of subsidence is seen in substantial number of patients. Nevertheless, clinical and radiological results of the surgery were favorable. An excessive subsidence may result in hardware failure. Endplate preservation may enables us to control subsidence and reduce the number of complications.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.124-135
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• 2017

Background In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA. Methods A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis. Results A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported. Conclusions Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.