• Title/Summary/Keyword: rigid fixation

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INTRAORAL OPEN REDUCTION OF MANDIBULAR SUBCONDYLAR FRACTURES USING KIRSCHNER WIRE (Kirschner wire를 사용한 과두하 골절의 구강내 접근법)

  • Kim, Seong-Il;Kim, Seung-Ryong;Baik, Jin-Ah;Ko, Seung-O;Shin, Hyo-Keun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.23 no.3
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    • pp.270-276
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    • 2001
  • The treatment of mandibular subcondylar fractures is a matter of controversy. The majority of mandibular subcondylar fracture are treated by closed reduction, but the displaced or dislocated mandibular subcondylar fractures may be treated by open reduction. The characteristics of open reduction are the anatomical reduction, the functional restoration, the rapid function, the maintenance of vertical ramus dimension, the better appearance and the less resultant TMJ problem etc. When an open reduction is considered, the wire, miniplate, lag screw and Kirschner wire are available with internal fixation. Of these, Kirschner wire is a simple method relatively and correct positioning of the wire achieves rigid fixation. But many open reduction methods for mandibular subcondylar fractures require extraoral approach. The extraoral approach has some problems, the facial scar and the risk of facial nerve injury. On the other hand, the intraoral approach eliminates the potency of the facial scar and the facial nerve injury, but is difficult to access the operation site. Since the intraoral approach was first described by Silverman (1925), the intraoral approach to the mandibular condyle has been developed with modifications. The purpose of this article is to describe the intraoral technique with the Kirschner wire on mandibular subcondylar fractures. Conclusion : The intraoral reduction with Kirschner wire on mandubular subcondylar fractures avoids the facial scar and facial nerve injury and is simple method to the extraoral approach. And it has minimal morbidity and better esthetics.

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An in vitro comparison between two different designs of sagittal split ramus osteotomy

  • Andrade, Valdir Cabral;Luthi, Leonardo Flores;Sato, Fabio Loureiro;Pozzer, Leandro;Olate, Sergio;Albergaria-Barbosa, Jose Ricardo
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.41 no.3
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    • pp.133-138
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    • 2015
  • Objectives: To evaluate the influence of the type of osteotomy in the inferior aspect of the mandible on the mechanical performance. Materials and Methods: The study was performed on 20 polyurethane hemimandibles. A sagittal split ramus osteotomy (SSRO) was designed in 10 hemimandibles (group 1) with a vertical osteotomy in the buccal side (second molar level) and final osteotomy was performed horizontally on the lingual aspect, while the mandible body osteotomy was finalized as a straight osteotomy in the basilar area, perpendicular to the body. For group 2, the same osteotomy technique was used, but an oblique osteotomy was done in the basilar aspect of the mandibular body, forming continuity with the sagittal cut in the basilar area. Using a surgical guide, osteosynthesis was performed with bicortical screws using an inverted L scheme. In both groups vertical compression tests were performed with a linear load of 1 mm/min on the central fossa of the first molar and tests were done with models made from photoelastic resin. Data were analyzed using Student's t-test, establishing a statistical significance when P<0.05. Results: A statistical difference was not observed in the maximum displacements obtained in the two osteotomies (P<0.05). In the extensiometric analysis, statistically significant differences were identified only in the middle screw of the fixation. The photoelastic resin models showed force dissipation towards the inferior aspect of the mandible in both SSRO models. Conclusion: We found that osteotomy of the inferior aspect did not influence the mechanical performance for osteosynthesis with an inverted L system.

Free Vascularized Osteocutaneous Fibular Graft to the Tibia (경골에 시행한 유리 생 비골 및 피부편 이식)

  • Lee, Kwang-Suk;Park, Jong-Woong;Ha, Kyoung-Hwan;Han, Sang-Seok
    • Archives of Reconstructive Microsurgery
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    • v.6 no.1
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    • pp.63-72
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    • 1997
  • We have evaluated the clinical results following the 46 cases of free vascularized osteocutaneous fibular flap transfer to the tibial defect combined with skin and soft tissue defect, which were performed from May 1982 to January 1997. Regarding to the operation, flap size, length of the grafted fibula, anastomosed vessels, ischemic time of the flap and total operation time were measured. After the operation, time to union of grafted fibula and the amount of hypertrophy of grafted fibula were periodically measured through the serial X-ray follow-up and also the complications and results of treatment were evaluated. In the 46 consecutive procedures of free vascularized osteocutaneous fibular flap transfer, initial bony union were obtained in the 43 grafted fibulas at average 3.75 months after the operation. There were 2 cases in delayed unions and 1 in nonunion. 44 cutaneous flaps among the 46 cases were survived but 2 cases were necrotized due to deep infection and venous insufficiency. One necrotized flap was treated with latissimus dorsi free flap transfer and the other was treated with soleus muscle rotational flap. Grafted fibulas have been hypertrophied during the follow-up periods. The fracture of grafted fibula(15 cases) was the most common complication and occurred at average 9.7 months after the operation. The fractured fibulas were treated with the cast immobilization or internal fixation with conventional cancellous bone graft. In the cases of tibia and fibula fracture at recipient site, the initial rigid fixation for the fibula fracture at recipient site could prevent the fracture of grafted fibula to the tibia.

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Autogenous Low Heat Treated Bone Graft for Bone Reconstruction in Bone and Soft Tissue Tumors (골연부 종양에서 저온 열처리한 자가골을 이용한 재건술)

  • Jeon, Dae-Geun;Lee, Jong-Seok;Kim, Sug-Jun;Cho, Wan-Hyeong;Kwag, Bong-Jun;Lee, Soo-Yong
    • The Journal of the Korean bone and joint tumor society
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    • v.4 no.2
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    • pp.81-87
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    • 1998
  • Although autoclaved autogenous bone reconstruction is one of the established procedures, it may have some problems in bone regeneration and mechanical property. The purpose of this study is to evaluate the efficacy of more biologic and anatomical reconstruction where allograft is not readily available. From Aug.1991 to Feb. 1996 the authors analyzed 32 cases of reconstruction with autogenous low heat treated bone. Autogenous graft sites were humerus 4, tibia 4, pelvis 9, and 15 femur. Average follow-up period was 23(range;12-51) months. There were 49 graft-host junctional sites. Diaphysis was 22, metaphysis 10, and flat bone 17. Average duration of healing for the 38 united sites was 7 months. Average union time for each anatomical area 8 months in 19 diaphysis, 12 months in 7 metaphysis, and 12.7 months in 12 flat bone(pelvis). Eleven nonunion sites consisted of 3 diaphysis(3/22), 3 metaphysis(3/10), and 5 flat bone(5/17). Complications other than nonunion were local recurrence(4), bone resorption(3), graft fracture(2), osteomyelitis(1), metal failure(2), and wound infection(1). Initial bone quality and stable fixation technique was important for union rate. Plate and screw is a good method for diaphyseal lesion. Metaphyseal and flat bone are weak area for rigid fixation and one stage augmentation with iliac bone graft can be a salvage procedure.

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THE EFFECTS OF RESORBABLE PLATE IN THE HEALING PROCESS OF MANDIBULAR FRACTURE OF THE RABBITS (흡수성 고정판이 가토의 악골골절 치유에 미치는 영향)

  • Park, Hyun-Wook;Ryu, Dong-Mok;Lee, Han-Joo;Huh, Won-Shil
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.21 no.2
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    • pp.131-138
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    • 1999
  • The purpose of this study is to evaluate the effects of resorbable plate in the healing process of mandibular fracture. Reduction and rigid fixation was carried out on the artificial mandibular fracture site of the rabbits, using a resorbable screw, 1.5mm in diameter and 4.0mm in length, and an absorbable plate 1.5mm in thickness(Lactosorb$^{(R)}$). En block tissue specimens with plate were taken from the rabbits at 4, 6, 8, and 10 weeks intervals and specimen were observed with light microscope under the hematoxylin-eosin staining, to observe the inflammatory reaction and tissue healing process. The following conclusions were drawn: 1. The subject displayed good healing with no signs of detachment of the fixation plate. 2. At 4 weeks, the plate was covered by the connective tissue. Then at 6 weeks, bone regeneration was discovered around the plate. 3. During the period of healing, no inflammatory reaction or foreign body reaction, as a result of using resorbable plate, were observed. 4. At 8 weeks, the initial phase of the absorption of the plate was observed. Then at 10 weeks, macrophage were observed around the plate, indicating the absorption phase was in process. From the above results, it can be determined that when the resorbable plate is applied to rabbit, full recuperation occurs naturally in the absence of inflammatory reaction and foreign body reaction. The selected study is clinically valuable in proving this procedure.

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HISTOLOGICAL CHANGES IN THE ELONGATED BONE AFFECTED BY OSTEODISTRACTION OF THE MANDIBLE IN THE DOG (성견 하악골 절단 후 기계적 골 견인에 의해 형성된 골 신장부에 대한 시기별 조직학적 변화)

  • Baek, Sun-Ho;Ahn, Byoung-Keun;Park, Young-Ju;Park, Hee-Geon;Park, Jun-Woo;Rhee, Gun-Joo;Lee, Yong-Chan;Cho, Byoung-Ouck
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.27 no.5
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    • pp.404-416
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    • 2001
  • Purpose : Traditionally, the treatement of choice has been a bone grafting procedure to increase the length of bone in case of actual length discrepancy. But, bone grafting procedure has many disadvantages, for example, graft resorption, donor site morbidity, and so on. So, many trials have been performed to avert the use of autogenous bone graft via introducing new materials or methods. And, one of those trials has been realized by the development of a technique inducing bone lengthening by osteotomy (or corticotomy) and slow gradual distraction of the osteotomized segments. This new technique of bone lengthening dates back to the early 20th century. But, the majority of information concerning the biology of new bone formation during bone lengthening and technical details of the procedure were produced by extensive clinical and experimental studies performed by Ilizarov, a Russian surgeon. According to Ilizarov, with adequate blood supply, preservation of periosteum, rigid fixation of the osteotomized segments, and proper rate and rhythm of distraction, intramembranous bone rapidly develops within the distraction gap in the limb lengthening procedure. In the limb lengthening, many orthopedic surgeons try to observe the biologic and clinical principles recommended by Ilizarov. In the oral and maxillofacial region, however, not a few studies must be performed to apply this surgical technique in the clinical cases. Besides, the mechanism of bone formation in the distraction gap is not clear, yet. The purpose of this experiment was to scrutinize serially the histological changes in the elongated bone affected by osteodistraction of the mandibular body in an adult canine model. In addition, it was performed to confirm the presence of specific region(s) which was important in the bone formation in the gap through the observation of the expression pattern of osteocalcin and osteonectin with the immunohistochemical examination. Materials and Methods : The experimental and control specimens were obtained from seven adult male mongrel dogs weighing over 20kg. The distractors were custom-made linear extraoral devices and bicortical fixation screws were 2.3mm in diameter, 50mm in total length, 15mm in screw length. The distractors were devised to produce a linear gap of 0.75mm between two bony segments every $360^{\circ}$ turn of the rotation rod of the device. The mandibular body of the right side of each animal was corticotomized perpendicular to the occlusal plane and then two bony segments were separated completely by careful manipulation of the segments with bone forceps. The left side of each animal was left intact. This side was served as control. At sixth day after osteotomy and fixation of the segments were performed, distraction of the segments was commenced with a rate of 1.1mm/day and a rhythm of two/day for ensuing 7 days. The animals were euthanized at the 16th. 29th, and 44th day after the osteotomy. The bony specimens were decalcified, embedded in paraffin, sectioned $5{\mu}m$ thick and stained with H&E. The prepared specimens were examined under the light microscope. And, immunohistochemical examinations using anti-osteocalcin antibody (OC1, Biodesign, USA) and anti-osteonectin antibody (Haematologic Technologies Inc., Essex, VT) to locate the expressions of osteocalcin and osteonectin, respectively, were performed. Results : 1. New bone was observed already at the 16th. day after osteotomy. This suggests that new bone formation in osteodistraction was commenced at an early stage of the regenerative process. But, radiologically and microscopically, bony union was not completed in the distraction gap at the 44th. day after osteotomy. Therefore, rigid fixation must be maintained between the bony fragments till the complete bony union is confirmed clinically rather than one month or so after the completion of distraction.

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A CLINICAL STUDY OF BIODEGRADABLE PLATES AND SCREWS IN ORAL AND MAXILLOFACIAL SURGERY (구강 악안면 영역의 생체 흡수성 고정판 사용에 관한 임상 연구)

  • Kim, Il-Kyu;Park, Seung-Hoon;Jang, Keum-Soo;Yang, Jung-Eun;Jang, Jae-Won;Sasikala, Balaraman
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.35 no.6
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    • pp.451-458
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    • 2009
  • Metallic bone plates and screws have been commonly used in oral and maxillofacial surgery for internal fixation. However, there are several disadvantages such as atrophy of cortical bone inherent to excessive rigid fixation systems, growth disturbance in growing individual, allergy reaction, interference with radiographic imaging, palpability, thermal sensitibity and the need for subsequent removal. To overcome these disadvantages and avoid additional surgery of removal of plates and screws, there have been many studies of biodegradable plates and screws. But, It also has complication such as foreign body reactions. We have undertaken a clinical and retrospective study on 140 patients in Dept. of Oral and Maxillofacial Surgery, Inha University Hospital from February 2006 to March 2009. The purpose of this study is to report the clinical cases and review of the literatures with biodegradable plates and screws. And we concluded following results. 1. 6 cases(3.4%) of the 177 operation sites(140 patients) experienced complications. 1 case(0.6%) was a failure of initial fixation, 1 case(0.6%) was a postoperative infection, 4 cases(2.3%) were inflammations or foreign body reaction. 2. Postoperative infections, inflammations and foreign body reactions were completely recovered with incision and drainage, supporative care with antibiotic coverage and removal of biodegradable plates. 3. Biodegradable plates and screws provide acceptable rigidity and stability clinically. But, long-term observation is required for the tissue reactions around the biodegradable plates and screws because of long resorption periods of the biodegradable materials.

Treatment of Carpal Scaphoid Fracture (주상골 골절의 수술적 치험례)

  • Beck, Won-Jin;Seo, Jae-Sung;Ahn, Jong-Chul;Ihn, Joo-Chul
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.361-366
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    • 1986
  • Fracture of the carpal scaphoid bone is the most common fracture of the carpus. Unfortunately. nonunion are common since the symptoms do not alert patients to seek early medical treatment and the diagnosis is easily missed. Fracture of the scaphoid is a common condition whose management remains controversial. The conservative treatment has many complications, these include inability to work while in plaster, stiffness of the wrist afterwards, muscle wasting, weakness and malunion. So various operative treatments of scaphoid fracture have been developed. Open reduction by use of screws suggested by Maclaughlin first in 1954. In 1984 a new and simple operative technique has been developed to provide rigid internal fixation for all types of fractures of the scaphoid by T.J. Herbert. This involves the use of a double-treaded bone screw which provides good fixation that, after operation, a plaster cast is rarely required and most patients are able to return to work within a few weeks. Authors have experienced 10 cases of scaphoid fracture and accomplished good result in all cases by internal fixation using Herbert screw. The results are as follows : Of these 10 fractures, 2 were fresh fractures and 8 were non unions of scaphoid fracture. In nonunion cases, the time interval between fracture and operation was from 5 months to 5 years. The postoperative immobilization period was average of 4 weeks. Short period of immobilization achieved early functional recovery of the wrist. The bony unions in roentgenogram were seen from 3 months to 9 months after operation. In 2 cases the fracture gap was seen after 9 months. But in these cases the symptoms such as pain and range of motion of wrist were improved.

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Current Trends in the Treatment of Syndesmotic Injury: Analysis of the Korean Foot and Ankle Society (KFAS) Member Survey (원위경비골인대 손상의 치료 동향: 대한족부족관절학회 회원 설문조사 분석)

  • Cho, Jaeho;Cho, Byung-Ki;Jeong, Bi O;Chung, Jin-Wha;Bae, Su-Young;The Academic Committee of Korean Foot and Ankle Society,
    • Journal of Korean Foot and Ankle Society
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    • v.26 no.2
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    • pp.95-102
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    • 2022
  • Purpose: This study was based on the Korean Foot and Ankle Society (KFAS) member survey and aimed to report the current trends in the management of syndesmotic injuries over the last few decades. Materials and Methods: A web-based questionnaire containing 36 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experiences in the treatment of patients with syndesmotic injuries. Answers with a prevalence ≥50% of respondents were considered a tendency. Results: Seventy-six (13.8%) of the 550 members responded to the survey. The results showed that the most preferred method to diagnose a syndesmotic injury was magnetic resonance imaging (MRI). Intraoperatively, the external rotation stress test and the Cotton test were most frequently used to confirm syndesmotic diastasis. The reduction was usually done by a reduction clamp. One 3.5-mm screw was used most frequently over three cortices at 2~4 cm above the ankle joint. The preferred ankle position during fixation was 0° dorsiflexion. Removal of the syndesmotic screw was routinely done by most surgeons, mainly because of the limitation of movement and risk of screw breakage. Factors that affect suture button selection included non-rigid fixation which enables adequate fixation, early weight-bearing, and an infrequent need to remove the hardware. Inadequate reduction was considered the main factor that affects poor prognosis. Conclusion: This study proposes updated information about the current trends in the management of syndesmotic injuries in Korea. Consensuses in both the diagnostic and therapeutic approach to patients with syndesmotic injury were identified in this survey study. This study may raise the awareness of the various possible approaches toward the injury and should be used to further establish a standard protocol for the management of syndesmotic injuries.

Limited Open Reduction and Internal Fixation of the Tibial Pilon Fractures (제한 절개를 통한 관혈적 정복 및 내고정술을 이용한 경골 Pilon 골절의 치료)

  • Kang, Chung-Nam;Kim, Jong-Oh;Kim, Dong-Wook;Koh, Young-Do;Ko, Sang-Hun;Yoo, Jae-Doo;Hwang, Jun-Ho
    • Journal of Korean Foot and Ankle Society
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    • v.1 no.2
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    • pp.102-111
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    • 1997
  • The tibial Pilon fracture, which is defined as a comminuted intraarticular fracture of the distal tibia, is difficult to manage because high axial compression and rotational forces to the ankle joint result in impaction, severe comminution, metaphyseal disruption and soft tissue damage. There are variable methods of treatment such as manipulation and cast, calcaneal traction and cast, external fixation, pin and plaster, limited open reduction and external fixation, and open reduction and rigid internal fixation. Though most of authors reported better result after a surgical treatment. than that of conservative treatment, many complications such as posttraumatic arthritis and soft tissue problem still remain troublesome. We have reviewed 19 cases of the tibial Pilon fractures in 18 patients which were treated with limited open reduction and internal fixation from September 1993 to May 1996. The results were as follows: 1. The fractures were classified into five types according to the system of Ovadia and Beals, and the most frequent type was type 3 (53%). The most common cause of injury was traffic accident (47%). 2. All of the cases of type 1 and 2, in which the injury of the ankle joint was less severe, revealed good or excellent clinical results. But in type 4 and 5, because the injury is much severe and accurate reduction is difficult, the clinical results were unsatisfaetory. 3. The most frequent complication was posttraumatic osteoarthritis, and which developed in second frequent complication, was developed m the three cases of type 3 in which the radiographic results were less than fair, but there were no correlation with the clinical results. 4. We could markedly reduce the complications related to the soft tissue problem of Pilon fracture by treatment with limited open reduction and internal fixation, and consider that this is a good method of treatment of Pilon fracture when the injury is less severe and accurate reduction is possible.

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