• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권5호
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• pp.442-446
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• 2001

Purpose : This study evaluated clinical and radiographic results after open reduction and lag-screw fixation of mandibular condyle fractures. Patients and Methods : 26 patients had been treated by lag-screw fixation for madibular condyle fracures via submandibular approach and follow up for over 6 months. The lag-screw used in this study was designed by Eckelt. Results : Radiographically, resorption of the condyle head found in 4 cases (15%) and minimal displacement of the condyle head was found in 3 cases (12%). Post-operative infection were not found in all cases. Clinically, All patiens had a stable occlusion and normal mouth opening (over 40mm). TMD problems with crepitus or some discomfort encountered in 4 patients but tolerable to the patients. Conclusion : Lag screw fixation can be a good option especially high level condylar fractures, however this procedure must be used in cautiously because of slipping of the fragments and possible to resorption of the fragments.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권2호
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• pp.157-166
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• 1997

Treatment of condylar fracture is still controversial, but the indication of surgical mangement is increased due to improved fixation methods and surgical techniques. In this article, we report our clinical and radiological results with the use of lag screw osteosynthesis for fixation of fractured mandibular condyle. 12 case of condyle fracture treated by open reduction and fixation with lag screw were monitored for an average of 10 months (range from 6 months to 19 months) postoperatively. The obtained results are as follows : 1. Postoperative maximum mouth opening is achieved over 40mm except one patient. 2. Although slight crepitus and deviation of mandible during mouth opening were found, Temporomandibular joint problem is satisfactory in all but one patient. 3. Distal migration of screw and resorption of fractured fragment were found in each 2 patients, but good functional recovery was achieved in all. According to the above results, we think that lag screw osteosynthesis is relatively indicated in level III or IV condylar fracture.

• 한국임상수의학회지
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• 제37권4호
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• pp.217-222
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• 2020

A 3-year-old male Thoroughbred serving as a Korean racehorse named RAON PORTEOUS presented with acute lameness concomitant with edema and fever in the right carpal joint after completing a horse race. Through radiological examination using lateromedial oblique, flexed lateromedial oblique and dorsopromixal-dorsodistal oblique views, the horse was diagnosed with a slab fracture in the 3^rd carpal bone of right forelimb. The fracture was surgically approached and corrected by applying 4.5 mm leg screw fixation during surgery. At eight months post-surgery, the horse was able to return to racing and has had successful racing performances with two wins and several prizes in the last 8 months. This is the first reported case of the successful use of lag screw fixation surgery in Korea with the horse showing complete recovery from a severe injury that is often considered fatal in a racehorse.

• 대한족부족관절학회지
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• 제10권2호
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• pp.207-212
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• 2006

Purpose: To evaluate the results of ankle lateral malleolar fractures classified as Danis-Weber type B accompanying osteoporosis that were treated with lag screw. Materials and Methods: 15 cases of Danis-Weber type B ankle lateral malleolar fractures that had T score of less than -2.5 in BMD(bone mineral density) test were selected from June 2003 to December 2005. 10 cases were males and 5 cases were females with mean age of 59 years. The main injury mechanism was supination and external rotation. Mean follow-up period was 16 months. Clinical and radiologic evaluation was done according to Meyer and Kumler's criteria. Results: All cases showed satisfying result and mean radiologic bone union period was 3 months. Anatomic reduction and bone union was acquired in all cases without complications including wound infection, skin necrosis, delayed union and nonunion Conclusions: Lag screw fixation seem to be excellent treatment of Danis-Weber type B lateral malleolar fractures with osteoporosis as it can minimize soft tissue injury and enable anatomic reduction with firm fixation.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.498-503
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• 2017

Objective : The purpose of the present study was to compare inter-fragmentary compression pressures after fixation of a simulated type II odontoid fracture with the headless compression Herbert screw and a half threaded cannulated lag screw. Methods : We compared inter-fragmentary compression pressures between 40- and 45-mm long 4.5-mm Herbert screws (n=8 and n=9, respectively) and 40- and 45-mm long 4.0-mm cannulated lag screws (n=7 and n=10, respectively) after insertion into rigid polyurethane foam test blocks (Sawbones, Vashon, WA, USA). A washer load cell was placed between the two segments of test blocks to measure the compression force. Because the total length of each foam block was 42 mm, the 40-mm screws were embedded in the cancellous foam, while the 45-mm screws penetrated the denser cortical foam at the bottom. This enabled us to compare inter-fragmentary compression pressures as they are affected by the penetration of the apical dens tip by the screws. Results : The mean compression pressures of the 40- and 45-mm long cannulated lag screws were $50.48{\pm}1.20N$ and $53.88{\pm}1.02N$, respectively, which was not statistically significant (p=0.0551). The mean compression pressures of the 40-mm long Herbert screw was $52.82{\pm}2.17N$, and was not statistically significant compared with the 40-mm long cannulated lag screw (p=0.3679). However, 45-mm Herbert screw had significantly higher mean compression pressure ($60.68{\pm}2.03N$) than both the 45-mm cannulated lag screw and the 40-mm Herbert screw (p=0.0049 and p=0.0246, respectively). Conclusion : Our results showed that inter-fragmentary compression pressures of the Herbert screw were significantly increased when the screw tip penetrated the opposite dens cortical foam. This can support the generally recommended surgical technique that, in order to facilitate maximal reduction of the fracture gap using anterior odontoid screws, it is essential to penetrate the apical dens tip with the screw.

• Hip & pelvis
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• 제30권4호
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• pp.254-259
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• 2018

Purpose: Internal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ${\geq}45$ years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed. Materials and Methods: Between March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated. Results: Clinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0-5; P<0.05); HHS was 85 (range, 72-90); and mean bone union time was 5.0 (range, 2.0-8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27-14.63) mm; lateral average TAD was 7.26 (range, 1.20-18.43) mm; total average TAD was 14.21 (range, 2.47-28.66) mm; average lag screw sliding was 4.63 (range, 0-44.81) mm; and average angulation was varus $0.72^{\circ}$(range, $-7.6^{\circ}-12.7^{\circ}$). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than $5^{\circ}$. Conclusion: CHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권6호
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• pp.393-402
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• 2020

Objectives: Here, we present cases of mandibular fracture that were managed with the cortical lag screw fixation technique (CLSFT) in order to critically evaluate technique indications and limitations of application at various fracture sites. Materials and Methods: This was a retrospective cohort study. The study sample was composed of patients suffering from mandibular fractures that were treated by the CLSFT. The outcome variables were fracture type, duration of surgery, number of screws, and pattern of application. Other study categories included patient demographics and causes of injury. Chi-square tests were used to assess descriptive and inferential statistical differences, and the P-value was set at 0.05. Results: Thirty-three patients were included in the study sample, with a mean age of 30.9±11.5 years and a male predominance of 81.8%. The technique was applied more frequently in the anterior mandibular region (51.5%) than in other sites. Double CLSFT screws were required at the symphysis and parasymphysis, while single screws were used for body and angle regions. No intraoperative and postoperative variables were significantly different except for surgical duration, which was significantly different between the sites studied (P=0.035). Conclusion: We found that CLSFT is a rapid, cost-effective technique for the fixation of mandibular fractures yielding good treatment results and very limited complications. However, this technique is sensitive and requires surgical expertise to be applied to mandibular fractures that have specialized characteristics.

• Hip & pelvis
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• 제35권3호
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• pp.175-182
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• 2023

Purpose: This study aims to compare patients in whom fixation failure occurred via cut-out (CO) or cut-through (CT) in order to determine patient factors and radiographic parameters that may be predictive of each mechanism. Materials and Methods: This retrospective cohort study includes 18 patients with intertrochanteric (IT) hip fractures (AO/OTA classification 31A1.3) who underwent treatment using a single lag screw design intramedullary nail in whom fixation failure occurred within one year. All patients were reviewed for demographics and radiographic parameters including tip-to-apex distance (TAD), posteromedial calcar continuity, neck-shaft angle, lateral wall thickness, and others. Patients were grouped into cohorts based on the mechanism of failure, either lag screw CO or CT, and a comparison was performed. Results: No differences in demographics, injury details, fracture classifications, or radiographic parameters were observed between CO/CT cohorts. Of note, a similar rate of post-reduction TAD>25 mm (P=0.936) was observed between groups. A higher rate of DEXA (dual energy X-ray absorptiometry) confirmed osteoporosis (25.0% vs. 60.0%) was observed in the CT group, but without significance. Conclusion: The mechanism of CT failure during intramedullary nail fixation of an IT fracture did not show an association with clinical data including patient demographics, reduction accuracy, or radiographic parameters. As reported in previous biomechanical studies, the main predictive factor for patients in whom early failure might occur via the CT effect mechanism may be related to bone quality; however, conduct of larger studies will be required in order to determine whether there is a difference in bone quality.

• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.503-508
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• 2018

Objective : Anterior odontoid screw fixation is a safe and effective method for the treatment of odontoid fractures. The surgical technique is recommended for perforation of the apical cortex of the dens by the lag screw. However, overpenetration of the apical cortex may lead to potentially serious complications such as damages of adjacent vascular and neural structures. The purpose of this study was to assess the role of three-dimensional computed tomography (CT) scan to evaluate the safe margin beyond dens tip to ventral dura for anterior odontoid screw fixation. Methods : We retrospectively analyzed the three-dimensional CT scans of the cervical spines in 55 consecutive patients at our trauma center. The patients included 38 males and 17 females aged between 22 and 73 years (mean age${\pm}$standard deviation, $45.8{\pm}14.2years$). Using sagittal images of 3-dimensional CT scan, the safe margins beyond dens tip to ventral dura as well as the appropriate screw length were measured. Results : The mean width of the apical dens tip was $9.6{\pm}1.1mm$. The mean lengths from the screw entry point to the apical dens tip and posterior end of dens tip were $39.2{\pm}2.6mm$ and $36.6{\pm}2.4mm$. The safe margin beyond apical dens tip to ventral dura was $7.7{\pm}1.7mm$. However, the safe margin beyond the posterior end of dens tip to ventral dura was decreased to $2.1{\pm}3.2mm$, which was statistically significant (p<0.01). There were no significant differences of safe margins beyond dens tip to ventral dura with patient gender and age. Conclusion : Extension by several millimeters beyond the dens tip is safe, if the trajectory of anterior odontoid screw is targeted at the apical dens tip. However, if the trajectory of the screw is targeted to the posterior end of dens tip, extension beyond dens tip may lead to damage immediately adjacent to the vental dura mater.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권2호
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• pp.167-180
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• 1997

1993년 1월부터 1995년 12월까지 원광 대학교 치과대학 구강악안면외과에 하악 과두 골절을 주소로 내원한 환자중 관혈적 정복술 적응증에 해당되는 79명의 환자에 대하여 관혈적 정복술을 시행하였다(이 중 25명은 Dr. 남씨법을 행한 환자임). 평균 환자 나이는 32.5세(8-65세)이었으며 환자 관찰기간은 약 18.4개월(3-28개월)이었다. 62명(81%)에서 편측 과두 골절 양상이었으며, 57명(72%) 환자가 하악골내 다른 부위와 연관되어 골절되었고 이중 47명(59%)에서 정중부와 관련되어 골절되었다. 환자 나이, 골절된 과두의 심한 정도, 임상 증상, 방사선 사진상 등을 통하여 수술 방법을 선택하였으며 과두부 골절이 아닌 경우 대개 골절 부위의 견고 고정 및 근심쪽 과두 골편 제거, 관절 성형술 및 관절원판 정복술, lag screw고정 등을 시행하였다. 술 후 악간 고정은 약 2주 정도 하였으며 이후 수동적 개구 운동 및 능동적 개구 운동을 2에서 4주, 4주이상에서 시행하였다. 술후 방사선학적 관찰시 과두 흡수 및 후방 부위로 근심 과두부 변위 등, 약 21.5%에서 술 후 방사선학적 변화를 가져왔으며 특히 Dr. 남씨법에서 더 많이 나타났다(Dr. 남씨법(32%), 다른 정복술(16%)). 술 후 임상 증상은 19%의 일시적 안면신경 마비, 개구시 하악 변위(16.4%), 악관절 동통(15.2%), 35mm 이하에서의 개구제한(10%), 기타 부정교합, 관절잡음, 가성 관절 강직 등의 합병증을 나타냈으며 이중 Dr. 남씨법에서 더 많은 합병증을 나타냈다. 과두 골절의 와괴적 처치는 가능한 견고 고정을 시행하는 것이 좋으며 이중 Dr. 남씨법은 그 사용에 있어 고려 해 보는 것이 좋다고 사료된다. 특히 과두 골절 처치에 있어 무엇보다도 술 후 계속적인 환자 관리 및 장기간 예후 관찰이 필수적이라 사료된다.