• Clinics in Shoulder and Elbow
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• 제20권4호
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• pp.230-235
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• 2017

Background: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. Methods: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. Results: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. Conclusions: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.

• The Korean Journal of Pain
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• 제13권2호
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• pp.242-246
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• 2000

Radiofrequency medial branch neurotomy is an effective way of controlling pain in the posterior compartment of the spine such as the facet joint, and the interspinous ligament. However, it is difficult to determine the exact location of the medial branch. Up until now we have relied on sensory response provoked by 50 Hz stimulation. The responses elicited using this method are quite subjective and can originate from sources other than the medial branch such as the periosteum, the intermediate or lateral branch. We need a confirmed indicator to locate the medial branch reliably. We applied 2 Hz stimulation under 0.4 volts to locate the medial branch and elicited a motor response. Twitching of multifidus and muscles around the SI joint was observed. The observation of these muscles provides a much more reliable method for confirmation of the medial branch. We have treated 45 chronic nonspecific low back pain patients using radiofrequency medial branch neurotomy with this method of confirming the medial branch.

• Journal of Korean Neurosurgical Society
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• 제37권3호
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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.

• Clinics in Shoulder and Elbow
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• 제10권1호
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• pp.131-135
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• 2007

23세 남환에서 발생한 요골 두 급성 전방 탈구를 경험하였기에 이를 보고하고자 한다. 수상 당시 전완부는 회내전, 주관절은 약간 굴곡되어 있었고, 손이 지면에 닿아 체중이 실리면서 주관절의 갑작스런 과도한 회내전이 발생하였다. 요골 두는 상완근의 외측 근육 다발에 의해 감돈 되었고, 윤상인대가 척골의 후방 부착부에서 견열되어 요골 두와 소두 사이에 끼어 정복을 방해하였다. 관혈적 정복을 시행하였다. 12개월간 추시 관찰을 하였으며 요골 두의 정복은 잘 유지되고 있었고 주관절의 운동제한은 없었다.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.105-108
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• 2011

Purpose: An extensive knowledge of the arterial anatomy of the upper extremity and its variations is indispensable to the hand surgeon. We report a patient with anomalous radial artery, superficial course of two radial arteries, encountered during the excision of volar wrist ganglion. Methods: The patient was a 53-year-old man who had a painful mass on the left volar wrist for 1 year. Under general anesthesia, a curved incision was made around the mass. With the skin flaps retracted, the dome of the cyst was identified. Particular care was taken to identify and protect the radial artery, which was intimately attached to the wall of the ganglion. Two radial arteries completely encircled the ganglion. The pedicle was traced to the volar joint capsule, radiocarpal ligament. The joint was open and the capsular attachments were excised. Results: The patient made an uneventful recovery. There were two arterial pulsations at the volar side of the wrist joint. Compressing this site revealed that the major arterial contributor to blood supply in the hand was the ulnar artery. At angioCT, an anomaly of the radial artery was found with a duplication. The pathway of this aberrant artery was superficial to the original radial artery. It changed its course subcutaneously at the level of the tendon of the brachioradialis muscle, and crossing the wrist lateral to the original radial artery and ending in the deep palmar arch. Conclusion: Authors experienced a case of bifurcating radial artery encountered during the excision of ganglion on the volar of the wrist. Because these duplicated radial arteries make strong contributions to the thumb and index finger as well as to the deep palmar arch, when they are present there may be probably less blood supply to the hand from the ulnar artery. If the radial artery is palpated superficially on the brachioradialis muscle, it is important to remember the kind of anomaly.

• 한국임상수의학회지
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• 제11권1호
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• pp.369-376
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• 1994

The purpose of this report Is to discribe the radiological findings of traumatic elbow luxation and subluxation of carpal joint which were caused by being hit by a wild animal and forced hyperextension of carpus in two hunting dogs. In case 1, carniocaudal and mediolateral radiographic examination of the elbow joint revealed that the radius that the radius and ulna were completely luxated laterally. The lateral projection showed the humeral condyles overlying the radial head with an absent joint space, but displacement is apparent on the craniocaudal projection. Incidence of collateral ligament rupture in conjunction with elbow luxation was not recognized on physical examination of the limb after closed reduction. Radiographic examination of the elbow made 5 months after closed reduction revealed only mild degenerative joint disease. Radiographic examination of the carpus in case 2 demonstrated palmar subluxation of most carpal joints including antebrachiocarpal, mediocarpal carpometacarpal joints, and some intercarpal joints, and avulsion fracture of the palmar surface of the accessory carpal bone. However, the mediocarpal and carpometacarpal joints were most severely affected by tensile forces of hyperextension, and it was concluded that the ligaments of the middle ca,pal joints and carpometacarpal joints as well as the palmar fibrocartilage were ruptured based on clinical and radiographic findings. In elbow luxation and subluxation of carpal Joints of the dog, differentiation of the joint or joints involved, and ligamentous structures damaged is important in determining whether surgery Is necessary and which procedure is most appropriate. And the radiographic findings of these conditions would be of help to practitioners.

• 대한관절경학회지
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• 제7권1호
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• pp.92-95
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• 2003

34세 남자 환자로 등산중 실족으로 발생한 전방십자인대의 완전파열로 자가 슬괵건을 이용한 경핀 고정법으로 전방십자인대 재건술을 시행하였다. 술후 경과는 양호하였으나 술후 3개월째 굴신 신전 운동 시 슬부 후측면의 동통과 지속적인 관절내 부종 소견을 보였으며 수차례의 관절천자와 약물투여에도 반응이 없었다. 컴퓨터 단층 촬영 상후방 피질 골의 천공이 관찰되어 술후 6개월째 이차관절내시경 수술을 시행하였다. 내시경 소견상 경핀고정물의 전방부 1/3에 일치되는 투명한 이물질과 대퇴경골관절면의 연골의 손상이 관찰되었으며 이물 제거 후 증세는 호전되었다. 경핀 터널의 잘못된 위치가 실패의 원인이라고 생각되었으며 경핀고정법을 이용한 전방십자인대 재건술시, 슬관절 과굴곡 상태에서 예각의 대퇴 터널을 만들어 후방 피질 골을 두껍게 남기고, 핀 홀을 만들 때 경핀가이드를 횡상과축보다 $10\~20$도 외회전시켜야 대퇴골 후방피질골의 천공을 방지할 수 있어 조기 실패를 예방할 수 있다고 생각된다.

• 대한관절경학회지
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• 제11권1호
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• pp.45-49
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• 2007

11세 여환의 증상을 유발하는 내측 반월상 연골판의 비정상적 소견을 보고하고자 한다. 환자는 내원 4개월 전부터 지속된 좌측 슬관절의 동통을 주소로 보존적 치료를 시행 받았으나, 치료에 반응이 없어 관절경 술식을 시행받았다. 관절경 소견상 환자의 내측 반월상 연골판 전각에서 기시하는 비정상적인 띠를 발견 할 수 있었으며, 이 띠는 전방십자인대 옆을 지나 대퇴골 과간 절흔으로 뻗어나가 대퇴골 내과의 외측면에 부착되는 비정상적인 소견을 보였다. 이 비정상적인 띠는 수술 전 시행한 슬관절 자기 공명 영상에서는 확인되지 않았으며, 관절경 시행시 발견되어 절제술을 시행하였다. 절제술 시행 후 술 전 호소하던 증상은 완전히 소실되었다.

• Clinics in Shoulder and Elbow
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• 제13권2호
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• pp.266-269
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• 2010

목적: 3년이 경과된 진구성 주관절 탈구 증례를 경험하였기에 보고하고자 한다. 대상 및 방법: 45세 여자가 3년이 경과된 진구성 주관절 탈구로 수술적 소견상 주관절 외측 및 내측 측부 인대는 구축되어 있어 박리술을 시행하였다. 후방 관절낭을 완전히 유리시키고 전방 관절낭을 절개한 이후 수동적 조작을 가하여 요상완 및 척상완 관절을 정복시켰다. 변형된 Morrey형의 경첩형 외고정 장치를 주관절부에 장착하고 조기 주관절 운동을 시행하였다. 결과 및 결론: 저자들은 3년이 경과된 진구성 주관절 탈구에서 개방적 정복과 경첩형 외고정 장치를 이용한 고정술의 만족스런 결과를 경험하여 문헌고찰과 함께 보고하는 바이다.

• Archives of Plastic Surgery
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• 제38권5호
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• pp.655-662
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• 2011

Purpose: The anterolateral thigh flap is versatile flap for soft-tissue reconstruction for defects located at various sites of the body. This useful flap offers a thick and vascular fascia lata component with large amounts that can be soft tissue coverage for different reconstructive purposes. We present our clinical experience with the use of vascular fascia lata, combined with anterolateral thigh flap for various reconstructive goals. Methods: From April 2008 to February 2011, we transferred anterolateral thigh flaps with fascia lata component to reconstruct soft-tissue defects for different purposes in 11 patients. The fascia lata component of the flap was used for tendon gliding surface in hand/forearm reconstruction in 4 patients, for reconstruction medial and lateral patellar synovial membrane and retinaculum in 2 patients, for reconstruction of plantar aponeurosis in the foot in 2 patients, for reconstruction of fascial and peritoneal defect in the abdominal wall in 2 patient, and for dural defect reconstruction in the scalp in the remaining one. Results: Complete loss of the flap was not seen in all cases. Partial flap necrosis occurred in 2 patients. These complications were treated successfully with minimal surgical debridement and dressing. Infection occurred in 1 patient. In this case, intravenous antibiotics treatment was effective. Conclusion: Anterolateral thigh flap has thick vascular fascia with large amounts. This fascial component of the flap is useful for different reconstructive aims, such as for tendon, ligament, aponeurosis defects, abdominal wall or dura reconstruction. It should be considerated as an important advantage of the flap, together with other well-known advantages.