• Archives of Plastic Surgery
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• v.39 no.4
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• pp.284-290
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• 2012

Open reduction and anatomic reduction can create better function for the temporomandibular joint, compared with closed treatment in mandible fracture surgery. Therefore, the double miniplate fixation technique via mini-retromandibular incision was used in order to make the most stable fixation when performing subcondylar fracture surgery. Those approaches provide good visualization of the subcondyle from the posterior edge of the ramus, allow the surgeon to work perpendicularly to the fracture, and enable direct fracture management. Understanding the biomechanical load in the fixation of subcondylar fractures is also necessary in order to optimize fixation methods. Therefore, we measured the biomechanical loads of four different plate fixation techniques in the experimental model regarding mandibular subcondylar fractures. It was found that the loads measured in the two-plate fixation group with one dynamic compression plate (DCP) and one adaption plate showed the highest deformation and failure loads among the four fixation groups. The loads measured in the one DCP plate fixation group showed higher deformation and failure loads than the loads measured in the two adaption plate fixation group. Therefore, we conclude that the selection of the high profile plate (DCP) is also important in order to create a stable load in the subcondylar fracture.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.201-206
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• 2006

Purpose: To evaluate the advantages of the antiglide plate fixation procedure for Danis-Weber type B lateral malleolar fractures of ankle compared to other methods of lateral plate fixation. Materials and Methods: We reviewed 70 cases that antiglide plate fixation and lateral plate fixation procedures were performed from Mar. 2001 through Mar. 2006. Of the total 70 cases, they were divided into two groups ; 22 cases were treated with the antiglide plate procedure (Group I) and 48 cases were treated with the lateral plate procedure (Group II). The results of the two groups were analyzed both radiographically and clinically using Ankle-Hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS). Results: All fractures were healed at average of 8 weeks both radiographically and clinically. According to the Ankle-Hindfoot scale, all cases of Group I and 48 cases of Group II were above 80 points. 2 cases (9%) in Group I complained of peroneal tendinitis, while 19 cases (39%) in Group II showed skin irritation resulting from the screw or the plate. A total of 6 cases (27%) in Group I and 27 cases (55%) in Group II complained cosmetic problems. Conclusion: we concluded that the antiglide plate fixation for Danis-Weber type B lateral malleolar fractures is one of the good methods. But, further analysis will be need to find a solution for the peroneal tendinitis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.38 no.6
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• pp.332-336
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• 2012

Objectives: This study sought to evaluate fixation methods and determine the best method for the postoperative stabilization of maxillary osteotomy. For our analysis we performed a three-dimensional finite element analysis of stress distribution on the plate, screw, and surrounding bone, as well as displacement onto the plate. Materials and Methods: We generated a model using synthetic skull scan data; an initital surface model was changed to a solid model using software. Modified anterior segmental osteotomy (using Park's method) was made using the program, and four different types of fixation methods were used. An anterior load of 100 N was applied on the palatal surface of two central incisors. Results: The Type 1 (L-shaped) fixation method gave stresses of 187.8 MPa at the plate, 45.8 MPa at the screw, and 15.4 MPa at the bone around the plate. The Type 2 (I-shaped) fixation method gave stresses of 186.6 MPa at the plate, 75.7 MPa at the screw, and 13.8 MPa at the bone around the plate. The Type 3 (inverted L-shaped) fixation method gave stresses of 28.6 MPa at the plate, 29.9 MPa at the screw, and 15.3 MPa at the bone around the plate. The Type 4 (I-shaped) fixation method gave stresses of 34.8 MPa at the plate, 36.9 MPa at the screw, and 14.9 MPa at the bone around the plate. The deflection of the plates for the four fixation methods was 0.014 mm, 0.022 mm, 0.017 mm, and 0.018 mm, respectively. Conclusion: The Type 3 (inverted L-shaped) fixation method offers more stability than the other fixation methods. We therefore recommend this method for the postoperative stabilization of maxillary osteotomy.

• Clinics in Shoulder and Elbow
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• v.2 no.1
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• pp.14-20
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• 1999

Purpose: Despite of the popular use of the reconstruction plate for the fixation of clavicular shaft fractures, some disadventages have been raised such as long period of immobilization, long skin incision, loosening of plate and screws, and increased chance of nonunion due to severe periosteal injury. Thus, the authors have performed intramedullary multiple Steinmann pins fixation that could reduce the disadvantages of plate fixation in order to compare the treatment results between the two groups. Materials & Methods: From 1994. Jan. to 1997. Dec. the department of orthopaedic surgery of the Kwak's hospital treated operatively for 56 cases of the clavicular shaft fractures in adult. 39 cases of them were treated with the plate fixation and 17 cases with the intramedullary multiple Steinmann pins fixation(SP group). Reconstruction plates(Plate group) were used for 26 out of 39 patients treated with plate fixation. Among the Plate group and SP group, each 15 cases were selected by age and sex and compared each other according to the bone union time, union rate, complication, and functional results. The follow-up period was 12 months at the shortest and 48 months at the longest and the average was 16 months. Results: The Plate group showed that the bone union time was 7 weeks and the bone union rate was 93%. The SP group showed 6.5 weeks and 100% respectively. In complication, the Plate group had 1 case of loosening of plate and screws and delayed union; SP group had 1 case of pin migration. The functional results according to Kang's criteria, 87% of the Plate group and 93% of the SP group showed good or excellent. Conclusion : The SP group showed very comparable results in terms of the bone union time, bone union rate, complication, and functional results comparing to the Plate group. The intramedullary multiple Steinmann pins fixation showed several advantages over the reconstruction plate fixation, which were simple operative technique, easy removal of pins, being able to perform immediate postoperative full range of motion exercise. Therefore, the intramedullary multiple Steinmann pins fixation is thought to be one of the useful operative techniques in treatment of the clavicular shaft fractures in adult.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.691-700
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• 2017

Objective : The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes. Methods : A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs : subsidence, C2-C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain. Results : In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups : however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425) ; fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31). Conclusion : Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

• Clinics in Shoulder and Elbow
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• v.5 no.1
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• pp.23-28
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• 2002

Purpose Displaced lateral end fracture of clavicle and acromioclavicular dislocation type Ⅲ∼Ⅵ may be required surgical treatment. Material and Methods : From May 1998 to March 2001, we operated with Welter plate with minimal incision by one surgeon. Immediately, pendulum and passive exercise was initiated after surgery. The shoulder function was evaluated using UCLA score. Average follow up was on 28(12∼45) months. Results : All 11 patients were regained satisfactory function. Average UCLA score was 31.9(29~35) at last follow up. Conclusion . The merit of Welter plate fixation with minimal incision is simple technique, reduced surgical time, smaller scar than large plate, strong fixation, early exercise, reduced implant failure. The disadvantage is expensive, skin irritatatation by long hook. But Welter plate fixation with minimal incision is a good method of internal fixation and excellent clinical result in surgical treatment of type H displaced lateral end fracture of the clavicle and type Ⅲ∼Ⅵ acromioclavicular dislocation.

• Journal of Chest Surgery
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• v.49 no.1
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• pp.1-8
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• 2016

More than a century ago, the first scientific report was published about fracture fixation with plates. During the 1950's, open reduction and plate fixation for fractures were standardized by the founders of Arbeitsgemeinschaft $f{\ddot{u}}r$ osteosynthesefragen/Association for the Study of Internal Fixation. Since the introduction of plate fixation for fractures, several plates and screws have been developed, all with their own characteristics. To accomplice more fracture stability, it was thought the bigger the plate, the better. The counter side was a compromised blood supply of the bone, often resulting in bone necrosis and ultimately delayed or non-union. With the search and development of new materials and techniques for fracture fixation, less invasive procedures have become increasingly popular. This resulted in the minimally invasive plate osteosynthesis (MIPO) technique for fracture fixation. With the MIPO technique, procedures could be performed with smaller incisions and thus with less soft tissue damage and a better preserved blood supply. The last 5 years rib fixation has become increasingly popular, rising evidence has becomeavailable suggesting that surgical rib fixation improves outcome of patients with a flail chest or isolated rib fractures. Many surgical approaches for rib fixation have been described in the old literature, however, most of these techniques are obscure nowadays. Currently mostly large incisions with considerable surgical insult are used to stabilize rib fractures. We think that MIPO deserves a place in the surgical treatment of rib fractures. We present the aspects of diagnosis, preoperative planning and operative techniques in regard to MIPO rib fixation.

• Journal of Korean Foot and Ankle Society
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• v.18 no.3
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• pp.119-123
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• 2014

Purpose: This study was designed to evaluate the clinical efficacy of temporary K-wire fixation in F-plate fixation for displaced intra-articular calcaneal fractures. Materials and Methods: Two groups (group 1 with F-plate fixation only and group 2 with temporary K-wire fixation and F-plate fixation) of patients were included in this study. The temporary K-wire was removed six weeks after the operation. Each group consisted of 33 cases. Rotational axis angles were measured radiographically and the foot and ankle outcome score (FAOS) was used for clinical assessment. Results: In group 1, the mean rotational axis angle was reduced from $27^{\circ}$ preoperatively to $5.59^{\circ}$ postoperatively and the angle at last follow-up was $9.94^{\circ}$. There was an increase in angle of $4.35^{\circ}$ between postoperative and the last follow-up measurement. In group 2, the mean rotational axis angle was reduced from $21.2^{\circ}$ preoperatively to $4.39^{\circ}$ postoperatively and the angle at last follow-up was $5.91^{\circ}$. There was an increase in angle of $1.52^{\circ}$ between postoperative and the last follow-up measurement. Significant difference in the changes of rotational axis angle was observed between the two groups. However, no significant difference in FAOS was observed between the two groups. Conclusion: Temporary K-wire fixation can prevent reduction loss when treating displaced intra-articular calcaneal fractures with an F-plate.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.12-16
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• 2011

Purpose: This study examined the biomechanical stability of four different plating techniques in the experimental model of mandibular subcondyle fracture. Methods: Twenty standardized bovine tibia bone samples ($7{\times}1.5{\times}1.0cm$) were used for this study. Each of the four sets of tibia bone was cut to mimic a perpendicular subcondyle fracture in the center area. The osteotomized tibia bone was fixed using one of four different fixation groups (A,B,C,D). The fixation systems included single 2.0 mm 4 hole mini adaption plate (A), single 2.0 mm 4 hole dynamic compression miniplate (B), double fixation with 2.0 mm 4 hole mini adaption plate (C), double fixation with a 2.0 mm 4 hole mini adaption plate and 2.0 mm 4 hole dynamic compression miniplate (D). A bending force was applied to the experimental model using a pressure machine (858 table top system, $MTS^{(R)}$) until failure occurred. The load for permanent deformation, maximum load of failure were measured in the load displacement curve with the chart recorder. Results: Double fixation with a 2.0 mm 4 hole mini adaption plate and a 2.0 mm 4 hole dynamic compression miniplate (D) applied to the anterior and posterior regions of the subcondyle experimental model showed the highest load to failure. Conclusion: From this study, double fixation with an adaption plate and dynamic compression miniplate fixation technique produced the greatest biomechanical stability. This technique may be considered a useful means of fixation to reduce the postoperative internal maxillary fixation period and achieve early mobility of the jaw.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.1
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• pp.32-38
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• 2005

The efficacy of bioresorbable fixation has recently been described in the osseosynthesis of the oral & maxillofacial region. However, a liitle data exist regarding the use of biodegradable plates and screws for the internal fixation of human mandible fractures. The purpose of this study is to analyze and compare the treatment of mandibular fractures by using a bioresorbable fixation system with conventional titanium system in human mandible fractures. eighteen patients constituted the bioresorbable fixation group and twenty-five patients constituted the titanium fixation group. Both groups underwent open reduction and internal fixation by use of a bioresorbable system or a titanium fixation system. Panoramic radiograph were obtained preoperatively, immediately postoperatively after reduction, at 6 months and at 12 months postoperatively. In the bioresorbable fixation group, complication(infection) occurred in 1 patient(5.6%) and was resolved by incision & drainage, plate removal and antibiotics without untoward sequelae. 2 patients(8.0%) experienced complications in the titanium fixation group and were treated using conservative treatment. There was no statistical difference in complication rates between two groups. Our data supported the use of bioresorbale plate fixation in mandibular fractures as a means of avoiding the potential and well documented problems with rigid titanium fixation systems. In conclusion, the bioresorbable fixation system provide a reliable and sufficient alternative to conventional titanium plate system.