• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.135-145
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• 1998

In 1980 Morrison and O'Brien reported their experiences about the reconstruction of amputated thumb using wrap-around neurovascular free flap from the great toe with a nonvascularized iliac bone graft. From then it has been considered to be a good reconstructive procedure for the amputated thumb, but it's indication has been limited distal to the metacarpophalangeal(MP) joint. We have performed 37 cases of wrap-around free flap from the great toe for the reconstruction of thumb amputated at distal or proximal to the MP joint and investigated their functional results according to the level of amputation. Level of amputation was distal to the MP joint in 25 cases and proximal to it in 12 cases. Pinching and grasping power, two point discrimination and the amount of opposition to the other fingers were compared to the uninjured hand. Pinching and grasping power were not significantly different according to the level of amputation but the amount of two point discrimination was significantly high in the cases amputated proximal to the MP joint. The opposition of reconstructed thumb to the other fingers was completely possible in all cases amputated distal to the MP joint. In 12 cases amputated proximal to the MP joint of the thumb, opposition was completely possible in 6 cases in which the iliac bone block was fixated in the position of $30^{\circ}$ flexion and $45^{\circ}$ internal rotation but in 6 cases in the fixation of $30^{\circ}$ flexion and $30^{\circ}$ internal rotation, the opposition of reconstructed thumb to the ring and little fingers were impossible in 5 cases and only to the little finger in 1 case. In this study, we concluded that even if amputation proximal to the MP joint, it is no more contraindication of the wrap-around free flap procedure for thumb reconstruction, however in these cases we recommend iliac bone block fixation in the position of $30^{\circ}$ flexion and $45^{\circ}$ infernal rotation for the better functional outcome.

• Clinics in Shoulder and Elbow
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• v.15 no.1
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• pp.37-42
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• 2012

Purpose: To consider the proper management of proximal humerus fracture on gunshot wounds. Materials and Methods: A 28-year-old male patient, who sustained a gunshot injury on the left arm 5 days ago, was admitted through the emergency department. Although he underwent an emergency surgery (bullet fragment removal and debridement), there remained bullet fragments around the proximal humerus fracture site. The wound seemed to be infected and a partial dehiscence occurred. No neurologic deficit was noted. Immediate exploration and debridement were performed, and an external fixator was applied to restore the anatomical alignment and manage the wounds. Intravenous antibiotics were administered. On the 9th postoperative day, wound debridement was done again, and cement beads mixed with antibiotics were inserted. After two weeks, the external fixator was removed, and the pin sites were closed after debridement. One week later, the open reduction and internal fixation with locking compression plate and screws were done. Result: At 3 months after the internal fixation, the bone union was obtained with satisfactory alignment of the humerus. Conclusion: The severity of the soft tissue injury influences the fracture management plan. Further, the risk on lead toxicity should be considered.

• Journal of Korean Foot and Ankle Society
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• v.17 no.1
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• pp.23-27
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• 2013

Purpose: The optimal management for ankle fracture in elderly patients remains controversial. This study was undertaken to review the results of surgical treatment of ankle fracture in the elderly and to compare with other studies. Materials and Methods: The participants in this study were 33 patients over the age of 65(average 71.5 years) who underwent surgical treatment of ankle fracture from January 2004 to December 2011. The study was a retrospective review of outcomes after open reduction and internal fixation (ORIF) of ankle fractures. To measure the clinical outcomes, we assessed postoperative complications, the pre- and post-operative mobility status, fracture union status, the time of fracture union and the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot scale. The level of patient satisfaction was also identified. Results: Delayed wound healing occurred in three patients(9.1%) but their wounds healed with repeated dressings without additional surgical treatment. Malunion occurred in one patient(3%). One patient(3%) had postoperative infection but healed with antibiotic treatment. 24 patients(96%) returned to preoperative mobility status. VAS score was lower than 2 in all patients. Bone union occurred with the 3.8 months (average months) after the surgery in all patients. Average AOFAS score was 87.4 and these were similar results as other studies of young patients. All patients were satisfied with surgical outcomes according to interviews. Conclusion: Surgical treatment of ankle fractures in the elderly can carry a significant risk of delayed wound healing and infection but incidence is relatively low. Internal fixation of ankle fractures in the elderly can be undertaken safely and the majority of patients can expect good outcome.

• Clinics in Shoulder and Elbow
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• v.18 no.2
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• pp.68-74
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• 2015

Background: The purpose of our study was to evaluate the functional and radiologic outcomes of additive augmentation sutures through rotator cuff for proximal humeral fractures stabilized locking plate in elderly patients. Methods: We enrolled 74 patients over the age of 60 years who received internal fixation using locking plates for proximal humeral fractures. Of these, 50 patients had additive augmentation sutures through rotator cuff. The mean age at the time of surgery was 72.1 years (range, 60-89 years), and the mean follow-up period was 17.5 months (range, 12-62 months). The humeral neck-shaft angle and humeral head height were used as radiological markers to assess the effect of additive augmentation sutures through rotator cuff. We allocated the patients who received additive augmentation sutures into group A and those who did not into group B. Results: At the final follow-up, the mean Korean Showlder Society score and Constant scores were $88.96{\pm}12.1$ and $86.6{\pm}11.9$, respectively, in group A and $86.21{\pm}11.8$ and $85.3{\pm}11.7$, respectively, in group B (p=0.368, 0.271). At the final follow-up, the mean loss in humeral neck-shaft angle from the time of immediate postoperative measurement was $1.6^{\circ}$ in group A and $4.8^{\circ}$ in group B, whereas the mean loss in humeral head height was 0.82 mm in group A and 0.52 mm in group B (p=0.029, 0.178). Conclusions: The surgical outcomes of internal fixation using locking plates for proximal humeral fractures were clinically and radiologically good in elderly patients over the age of 60 years without any observable complications. Further, the loss of humeral head shaft angle at the final follow-up from its initial postoperative measurement was significantly smaller in patients who received an additive augmentation suture than in those who did not. Thus, we conclude that augmentation sutures are a beneficial option for elderly patients that clinicians can consider at the time of surgical decision making.

• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.89-95
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• 2006

Purpose: Arthroscopic repair of rotator cuff tears are many techniques that have been developed to improve the initial postoperative strength of the repair. There was a doubt that current arthroscopic cuff repairs using a single row of suture anchors reproduce insufficient area of the anatomic cuff insertion, and concerns about failure of fixation often lead surgeons to limit early motion. Newer technique of double-row repair in arthroscopic treatment may provide initial stronger fixation and more contact with bone at the repair site than single-row repair did. We studied the comparison between clinical outcomes of arthroscopic single- and double-row repair in cuff tears at 1year postoperatively. Materials and methods: We retrospectively analyzed 40 shoulders with single-row repair and 38 shoulders with double-row repair of full-thickness rotator cuff tears between May 2002 and October 2004. Out of total 78 shoulders, 42 (54%) were male patients and 36 (46%) were female patients and the mean age at surgery was 56 years. All patients were diagnosed by physical examination and MRI. At 1year' follow-up after operation, we evaluated with the ASES and the Constant scoring system, and measured muscle power of abduction, internal and external rotation of the affected shoulder then compared with each other. Results: Mean ASES scores and Constant scores in double-row repair group improved more than single-row repair group significantly at 1year postoperatively. Muscle power of abduction and internal rotation, especially abduction power, improved more significantly in double-row repair group than in single-row repair. Conclusion: Arthroscopic double-row repair for the full thickness rotator cuff tear may be a superior technique, which showed better clinical outcomes and restoration of muscle power compared with single-row repair at relatively short period of postoperative follow-up. Restoration of footprint close to normal anatomy by double-row repair seems to play an important role in the recovery of muscle strength.

• Korean Journal of Cleft Lip And Palate
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• v.8 no.2
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• pp.71-79
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• 2005

Purpose: Maxillary hypoplasia is a common developmental problem of cleft lip and palate. Fair results with distraction osteogenesis have been reported especially when these patients need a large amount of maxillary advancement, instead of orthognathic surgery. The purpose of this study is to evaluate the clinical results with a relatively new distractor, $TS-MD^{(R)}$ (Trans-sinusoidal maxillary distractor, KLS Martin, Tuttlingen, Germany) which was used for the advancement of the maxilla in the cleft patients. Patients and Method: Distraction osteogenesis using $TS-MD^{(R)}$ was performed for four CLP patients (three males and one female) who had maxillary hypoplasia. All patients were over 16 years old. As three patients showed mandibular prognathism as well, bilateral sagittal split ramus osteotomy for mandibular setback was performed at the same time. After consolidation periods of 4 to 12 weeks, the distraction devices were removed and miniplates were placed for simultaneous internal fixation. Results: Three patients showed a large amount of incisal overbite but one patient did not have sufficient maxillary advancement. Le Fort I osteotomy, maxillary advancement and internal fixation should have been performed for the patient when removing the distraction devices. Different from the $clinician{\box}s$ expectation, the amount of maxillary advancement using $TS-MD^{(R)}$ was not sufficient, although the device has rigid mechanical property. Rotation of maxilla during distraction forward and downward was also observed. Conclusion: Even though the maxillary advancement with $TS-MD^{(R)}$ device could be achieved, the clinical control of some characteristics related with the device was necessary. More clinical studies on $TS-MD^{(R)}$ should be performed.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.142-149
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• 2009

Purpose: We wanted to assess the radiological and clinical results and the prognostic factors after an operation for capitellar fractures associated with/without other injury around the elbow. Materials and Methods: Among the 25 patients (mean age: 49 years-old) who underwent open reduction and internal fixation for capitellar fractures, there were nineteen type 1 fractures and six type 3 fractures. The mean follow up period was 14.8 months. We assessed the factors affecting the radiological and functional results, such as the fracture pattern, the patient age and the surgical approaches. Results: In 24 of 25 patients, bony union was achieved at postoperative 1 year. There were eighteen excellent, four good, two fair and one poor functional results according to the Broberg and Morrey elbow score. The most common type was type 1 and the most common associated injury was lateral condylar fracture. The patients with type 1 fracture rather than the patients with type 3 fracture and the patients who had an extraarticular associated fracture rather than an intraarticular associated fracture had better clinical outcomes. Conclusion: 22 (88%) of the patients were satisfied at the result. The type of capitellar fracture and an associated intraarticular elbow fracture were shown to be important prognostic factors in this study.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.623-628
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• 2009

Purpose: In cases where nasal fractures involve frontal process of maxilla or perpendicular plate of ethmoid, 4 - 5 days of nasal packing may not provide sufficient support for avoiding displacement after packing removal. Therefore a single Kirschner - wire(K - wire) is used as an internal splint when nasal fractures involve the above two areas. Methods: Thirty five patients during the last 3 practical years were treated with a K -wire pinning according to the anatomic locations of nasal fractures. We performed a retrospective study using 13 nasal fractures out of total 35 patients. Among 13 cases, 10 patients involved frontal process of maxilla, and 3 patients were diagnosed as bilateral nasal side wall fractures accompanied with fractures of perpendicular plate of ethmoid. One patient of the last three cases had been augmented with dorsal silicone implant long before the trauma. We analyzed the anteroposterior displacement of key stone area and the width between both lateral walls by comparing immediate postoperative radiographs with 2 month follow - ups. To reduce the errors, the same measurements were taken by two different inspectors, and the mean of each inspector's measurements was compared. Patient satisfaction was analyzed using a questionnaire regarding the esthetic and functional outcomes. Results: Ten patients underwent a longitudinal K - wire fixation in submucoperiosteal plane underneath the frontal process of maxilla. And three patients underwent a transverse K - wire fixation from the one side of lateral wall to the perpendicular plate of ethmoid and to the other side of lateral wall. The mean postoperative anteroposterior displacement of the key stone area measured by two inspectors were 1.84% and 3.06%; mean narrowing of bony pyramid were 1.33% and 1.48%, respectively. Subjective satisfaction scores regarding the esthetic appearance and the maintenance of nasal shape compared with immediate post - operative state with the long term ones were not different (p>0.05). Conclusion: K - wire pinning after closed reduction is a reliable and useful method for the treatment of nasal fractures involving frontal process of maxilla or perpendicular plate of ethmoid. This is because it achieves longer intranasal support after reduction. This method also leaves conspicuous external scar, and minimal soft - tissue injury.

• Journal of the Korea institute for structural maintenance and inspection
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• v.27 no.3
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• pp.12-20
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• 2023

This study presents basic data on how to secure stability by analyzing the change in tensile force of steel rod and the inclination characteristics of PSC BOX in the "Temporary fixation system using internal prestressing tendon", which is mainly applied to construction of superstructures by FCM. To date, it has been difficult to confirm the changes in tension force of the steel rod and the inclination of the PSC BOX because the steel rod was installed vertically inside the pier and the PSC BOX. Therefore, measurement of the change in length of the steel rod and the displacement of PSC BOX were performed using a micro-measured FBG sensor. Comparisons of the calculated tensile force and the residual tensile force of the steel rod revealed that the safety factor decreased in all bridges. The cause was mainly identified to be the loss of tensile force in fixation~1segment, and countermeasures are suggested. The analysis of the inclination characteristics showed that the inclination increased with the segment progresses even in bridges with sufficient safety factor, and the difference before and after the segment was confirmed. In addition, the increase in inclination was related to the loss of tension force in the steel rod, and the stress on the opposite sides of the inclination was further reduced. It is believed that upward tensile force is generated in the steel rod on the opposite side of the inclined side due to the unbalanced moment, causing the difference in stress of the steel rod between the two sides.

• Journal of Trauma and Injury
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• v.36 no.4
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• pp.441-446
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• 2023

Inferior vena cava (IVC) injuries, while accounting for fewer than 0.5% of blunt abdominal trauma cases, are among the most difficult to manage. Despite advancements in prehospital care, transportation, operative techniques, and perioperative management, the mortality rate for IVC injuries has remained at 20% to 66% for several decades. Furthermore, 30% to 50% of patients with IVC injuries succumb during the prehospital phase. A 65-year-old male patient, who had been struck in the back by a 500-kg excavator shovel at a construction site, was transported to a regional trauma center. Injuries to the right side of the infrarenal IVC and the right external iliac vein (EIV) were suspected, along with fractures to the right iliac bone and sacrum. The injury to the right side of the infrarenal IVC wall was repaired, and the right internal iliac artery was ligated. However, persistent bleeding around the right EIV was observed, and we were unable to achieve proximal and distal control of the right EIV. Attempts at prolonged manual compression were unsuccessful. To decrease venous return, we ligated the right superficial femoral vein. This reduced the amount of bleeding, enabling us to secure the surgical field. We ultimately controlled the bleeding, and approximately 5 L of blood products were infused intraoperatively. A second-look operation was performed 2 days later, by which time most of the bleeding sites had ceased. Orthopedic surgeons then took over the operation, performing closed reduction and external fixation. Five days later, the patient underwent definitive fixation and was transferred for rehabilitation on postoperative day 22.