• 대한정형외과스포츠의학회지
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• 제5권1호
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• pp.63-68
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• 2006

목적: 전위성 쇄골 간부 골절의 치료로 관혈적 정복술 후 LCP를 사용하여 내고정을 시행한 환자를 대상으로 방사선학적, 임상적 결과를 분석하여 전위성 쇄골 간부 골절의 치료에 있어서 LCP의 유용성을 알아보고자 하였다. 대상 및 방법: 2003년 5월부터 2004년 11월까지 본원에서 쇄골 간부 골절에 대해 LCP를 이용한 관혈적 정복, 금속내 고정술을 시행하고 6개월 이상 추시가 가능하였던 26례를 대상으로 하였다. 수술 후 최종 평가는 방사선 결과와 fang s criteria를 이용한 임상적 결과로 분석하였다. 결과: 수술 후 평균 9.3주에 모든 예에서 지연유합 없이 골유합 되었으며 임상적으로 Kangs criteria에 따라 구분한 결과, 우수 이 상이 22례로 나타났다. 특히, 견관절 운동은 상완골 골절이 동반된 두 경우를 제외한 24례에서 2.9주내에 정상 범위로 빠른 회복을 보였다. 합병증으로는 견관절 운동 장애 2례, 수술 절개 부위의 켈로이드 형성 1례였으며 그 이외에 다른 주요 합병증은 없었다. 결론: 전위성 쇄골 간부 골절에서 LCP를 이용한 관혈적 정복 및 금속내 고정술은 기존의 금속판에 비해 수술 후 합병증을 줄이고 효과적인 골유합과 조기 견관절 운동에 도움을 줄 수 있는 좋은 치료 방법 중 하나라고 사료된다.

• 대한족부족관절학회지
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• 제17권2호
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• pp.130-135
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• 2013

Purpose: Preshaped Locking compression plate(LCP) has holes with fixed angle between screw and plate and have advantage firm fixation because it has stability of angular and axial deformity. We evaluated usefulness of LCP after open reduction and internal fixation in distal fibular fracture. Materials and Methods: Between December 2011 and May 2012, 23 patients with fracture of distal fibula were followed up at least 12 months underwent open reduction and internal fixation with LCP. There were 15 males and 8 females with a mean age 39.8(20~69) years. According to Danis-Weber classification, there were 20 cases of type B and 3 cases of type C. There were 13 cases of isolated lateral malleolus fractures, 1 case of bimalleolar fracture, 6 cases of trimalleolar fractures and 3 cases of distal tibia fractures with proximal fibula fracture. Intraoperatively, we assessed whether preshaped LCP fit lateral margin of distal fibula or not and evaluated quality of reduction and postoperative complications. The cases were analyzed by radiological bone union time and clinical results according to the criteria of Meyer Results: Of all cases, complete bone union was achieved and average radiological bone union time was 7.3(6~12) weeks. The clinical results were excellent in 18 cases(78%), good in 5 cases(22%). There were 5 cases of plate with 3 holes, 13 cases of plate with 4 holes, 2 cases of plate with 5 holes, 1 case of plate with 6 holes and 2 cases of plate with 7 holes. The average number of screws at proximal fragement was 2.5 and at distal fragment was 3.5. In 14 cases (60.8 %), we needed re-bending of plate because the distance between plate and lateral cortical margin of distal fibula was more than 5 mm at anteroposterior X-ray after reduction. All cases have anatomical reduction and there were no complications of wound infections. There were no complaint about hardware irritation. Conclusion: At fractures of distal fibula,preshaped LCP had a excellent stability although far cortex was not fixed with screw and bending of plate. And there are less complications of hardware irritation and wound problems. But, Some complement would be needed because there were no complete fitting between precontour of LCP and lateral cortical margin of distal fibula.

• 한국임상수의학회지
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• 제24권4호
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• pp.658-662
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• 2007

The simple and easy treatment with cast or splint has been applied to stabilize long bone fractures in farm animals. Applying cast or splint is relatively easier than surgical fixation and may temporarily stabilize fracture site. However, the internal fixation provides strong stabilization and early recovery of limb function. In this report, we describe six cases of limb fractures in calves repaired by internal fixation. Fracture sites are various and affected ages are between 1 day and several months old. In some cases, patients were treated with cast or splint before admitting to Veterinary Medical Center. In these patients, regardless of initial treatment fractures were not immobilized. Consequently we decided to treat these patients with open reduction and internal fixation. The fracture repair with implants(bone plate, screw, cerclage wire, and intramedullary pin) were effective and satisfactory in calves which had been failed by application of cast. Although the cost of orthopedic treatment in farm animal is one of the most important considerations from the practical point of view, internal fixation has many benefits in newborn and young calves. And simplicity of postoperative management is also practically significant benefit expected from infernal fixation In conclusion, we suggest that internal fixation will produce better result than external coaptation in calve.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.305-310
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• 2007

Objective : Combined antero-posterior fixation has been a standard method for bilateral interfacetal dislocation in cervical spine. The purpose of this study is to evaluate the efficacy and complication of anterior cervical stabilization in treatment of bilateral interfacetal dislocation. Methods : A total of 65 cases of traumatic bilateral interfacetal dislocation in cervical spine who were managed in our institution, from Mar. 1997 to Feb. 2006, were included in this study. Closed reduction was tried in all cases before operation. If closed reduction was accomplished successfully, only anterior cervical fixation was performed (Group I), and attempted to place screws bicortically as possible with unicortical screws. If failed, posterior open reduction with fixation was first tried, followed by anterior cervical fixation (Group II). All patients were evaluated for neurological outcome and radiological evidence of healing. Results : The Group I included 47 patients and the Group II, 18 patients. The improvement of Frankel grade and increase of mean cervical lordosis angles were not statistically different between two groups. Screw-plate system used did not influence the outcome. On follow up, solid bone fusion was evident and there were no cases of instability in both groups. Conclusion : Our study demonstrated that anterior cervical fixation on BID is safe and effective in comparison with combined antero-posterior cervical fixation.

• 대한두개안면성형외과학회지
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• 제10권1호
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• pp.33-36
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• 2009

Purpose: Fractures of the mandibular condylar area are common injuries that account for 29% to 40% of fractures of the facial bones and represent 20% to 62% of all mandibular fractures. Currently 3 main methods are being used in the treatment of mandibular subcondylar fractures: closed reduction; open reduction and internal fixation; Endoscopic reduction and internal fixation. Each method has its proponents and opponent as well as advantages and disadvantages, and indications for each vary among surgeons. There are six approaches of open reduction: submandibular, retromandibular, preaurilcular, postauricular, intraoral, transparotid approach. Among them, transparotid approach has been described for subcondylar exposure with dissection in the direction of facial nerve fibers to expose the bone through the parotid gland. This approach carries the risk of a parotid glandular fistula as well as facial nerve injury but has the advantage of being directly over the fracture site. We report safety and efficacy of surgical treatment using a transparotid approach for direct plating. Methods: A 43-year-old man sustained multiple facial bone fractures by driver traffic accident. Mandibular subcondyle was fractured and dislocated internally. We performed open reduction and internal fixation by transparotid approach. Fractured site was fixed by titanium mini plate & screw. We applicated arch bar for approximately 3 weeks. Results: Follow-up length was about 5months. Scar of surgical incision was indistinct, there was no symptoms and signs of facial nerve and parotid gland injury, and maximal mouth opening was measured 49.5 mm. Conclusion: Transparotid approach has high risks of facial nerve and parotid gland injury, but paradoxically it is the most effective technique in saving facial nerve. Open reduction and internal fixation of mandibular subcondylar fracture by transparotid approach with precise and versed procedure, best outcome can be expected.

• 대한족부족관절학회지
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• 제24권1호
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• pp.19-24
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• 2020

Purpose: Anterolateral minimally invasive plate osteosynthesis (MIPO) was performed to treat patients with distal tibial fractures associated with open fractures or extensive soft tissue injuries, which is limited medial MIPO. The treatment results of the anterolateral MIPO technique were evaluated and analyzed. Materials and Methods: Seventeen patients with distal tibial fractures associated with an open fracture or large bullae formation on the distal tibia medial side were treated with anterolateral MIPO using anterolateral locking plates. Within 24 hours of visiting the emergency room, external fixation was applied, and the medial side wound was managed. After damage control, the anterolateral locking plate was applied using an anterolateral MIPO technique. The union time, nonunion, or malunion were evaluated with regular postoperative radiographs. The ankle range of motion, operative time, blood loss, Iowa score, and wound complications were investigated. Results: Radiological evidence of bony union was obtained in all cases. The mean time to union was 16.7 weeks (12~25 weeks). The mean operation time was 44.0 minutes. Regarding the ankle range of motion, the mean dorsiflexion was 15°, and the mean plantarflexion was 35°. Satisfactory results were obtained in 15 out of 17 cases; five results were classified as excellent, four were good, and six were fair. The mean blood loss was 125.2 mL. Two complications were recorded. Conclusion: In distal tibial fractures with severe medial soft tissue damage caused by high-energy trauma, the staged anterolateral MIPO technique using anterolateral locking plates is a useful alternative treatment to achieving optimal wound care, rapid union with biological fixation, and intra-articular reduction.

• Clinics in Shoulder and Elbow
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• 제17권4호
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• pp.175-180
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• 2014

Background: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. Methods: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. Results: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder ($8.2{\pm}7.9mm$ versus $7.3{\pm}3.4mm$, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. Conclusions: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권3호
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• pp.438-446
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• 1994

Eighty-nine patients with mandibular fracture were treated by open reduction and internal fixation using the monocortical titanium miniplate(Leibinger Co.). Postsurgical intermaxillary fixation was carried out for 2 to 18 days according to the patient's status. Seven patients developed infections postoperatively(7.9%). Five patients were favorably treated by incision and drainage and/or saucerization. But two patients were not controlled by early surgical intervention and should have been followed by plate removal, saucerization and secondary reconstruction including the bone graft. This article reports the postoperative infection associated with miniplate fixation of mandibular fractures and discuss the incidence, cause, treatment and prognosis with careful case analyses.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.32-38
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• 2024

Background: Open reduction and internal fixation (ORIF) with a locking plate is a popular surgical treatment for proximal humeral fractures (PHF). This study aimed to assess the occurrence of complications in elderly patients with PHF treated surgically using ORIF with a locking plate and to investigate the potential differences between patients treated by shoulder surgeons and non-shoulder surgeons. Methods: A retrospective study was conducted using a single-center database to identify patients aged ≥70 years who underwent ORIF for PHF between January 1, 2011, and December 31, 2021. Data on the Neer classification, follow-up, occurrence of avascular necrosis of the humeral head, implant failure, and revision surgery were also collected. Statistical analyses were performed to calculate the overall frequency of complications according to the Neer classification. Results: The rates of implant failure, avascular osteonecrosis, and revision surgery were 15.7%, 4.8%, and 15.7%, respectively. Complications were more common in patients with Neer three- and four-part fractures. Although the difference between surgeries performed by shoulder surgeons and non-shoulder surgeons did not reach statistical significance, the rate of complications and the need for revision surgery were nearly two-fold higher in the latter group. Conclusions: PHF are highly prevalent in the elderly population. However, the ORIF surgical approach, as demonstrated in this study, is associated with a considerable rate of complications. Surgeries performed by non-shoulder surgeons had a higher rate of complications and a more frequent need for revision surgery. Future studies comparing surgical treatments and their respective complication rates are crucial to determine the optimal therapeutic options. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• 제13권2호
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• pp.194-201
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• 2010

목적: 오구 쇄골 인대를 봉합하지 않고 견봉 쇄골 관절의 관혈적 정복만 시행한 환자군에서의 임상적, 방사선학적 추시 결과를 확인하고자 하였다. 대상 및 방법: 1998년부터 2007년까지 변형 Phemister 술식과 갈고리 금속판 (AO hook 금속판, Wolter 금속판)을 사용하여 견봉 쇄골 관절 탈구로 수술 받은 환자 중 삽입물 제거한 53예를 대상으로 하였다. 변형 Phemister 술식을 사용한 군이 21명, 갈고리 금속판을 사용한 군이 32명 이였다. 임상적 평가는 Constant score를 이용하였으며, 양측 쇄골과 오구돌기 사이의 수직 거리를 비교하여 방사선적 평가를 하였다. 결과: Constant score는 변형 Phemister 술식을 사용한 군에서는 $87.59{\pm}7.8$, 갈고리 금속판을 사용한 군에서는 $89.35{\pm}5.3$로 통계학적 차이는 없었다. 두 군에서 수술 전 손상 부위의 쇄골 오구돌기의 평균 거리는 15.9 mm이였으며, 건측 견관절은 평균 8.0 mm이였다. 갈고리 금속판 환자군에서 건측과 비교하여 평균 1.0 mm, 변형 Phemister 환자군에서는 평균 1.2 mm의 수직 전위가 관찰되었으며 통계학적 차이는 없었다. 결론: 오구쇄골 인대를 복원 하지 않은 견봉 쇄골 관절 탈구의 관혈적 정복술 및 내고정술은 양호한 임상적, 방사선학적 결과를 보였다.