• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1469-1475
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• 2000

Objective : The goal of this study was to evaluate the clinical outcome of the posterior C1-2 transarticular screw fixation without C1-2 sublaminar wiring in atlantoaxial instability. Methods : Between Apr. 1995 and Feb. 2000, we used this technique in treat randomly selected 17 patients (11 men, 6 women) who had atlantoaxial instability. The causes of instability were : type II-A odontoid process fracture(10 cases) ; type II-P odontoid process fracture(1 case) ; Os odontoideum(2 cases) ; transverse ligament laxity due to rheumatoid disease(1 case) ; and, transverse ligament injury without bone fracture(3 cases). All cases were operated with posterior C1-2 transarticular screw fixation with 3.5mm cortical screw and interlaminar iliac graft without sublaminar wire fixation. The mean follow-up period was 28 months(5 to 58 months) and the mean age at the time of operation was 41 years(15 to 68 years). All Patients were allowed to ambulate with Philadelphia neck collar on the first post-operation day. Results : Bony fusion was successfully achieved in all cases demonstrated at 3-month follow-up studies. There was no operative mortality or morbidity. Conclusion : The authors conclude that the posterior transarticular screw fixation without C1-2 sublaminar wiring provide adequate stability with high bony union rate in atlantoaxial instability of various causes.

• 대한족부족관절학회지
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• 제17권1호
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• pp.34-39
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• 2013

Purpose: To evaluate the effectiveness of intraoperative stress test for diagnosis of occult Lisfranc injury. Materials and Methods: Between April 2009 and October 2012, 21 patients with occult Lisfranc injuries underwent intraoperative stress test and internal fixation. There were 11 males and 10 females with an average age of 45.3 years (range, 23~79 years). Injuries were caused by traffic accident in 10 cases, indirect force (twisting injury) in 8 cases, and crush in 2 cases, falling from a height in 1 case. Unstable injuries on stress radiograph in occult injury of Lisfranc joint were treated by open reduction or closed reduction and fixation with cannulated screw or K-wire. Radiological evaluation was assessed according to preoperative and postoperative diastasis between $1^{st}$ and $2^{nd}$ metatarsal base. Results: Assoicated injuries were 9 cases of metatarsal fractures, 6 cases of cuneiform fractures and 6 cases of both metatarsal and cuneiform fractures. Medial and middle column fixation was in 13 cases, and three columns fixation was in 8 cases. Initial diastasis between $1^{st}$ and $2^{nd}$ metatarsal base was 2.8 mm (1.3~4.7 mm) on AP radiograph and postoperative diastasis between $1^{st}$ and $2^{nd}$ metatarsal base was 1.2 mm (0.5~2.4 mm) on AP radiograph. Conclusion: Even there is no sign of clear Lisfranc injury, it is necessary to pay attention and give evaluation on circumstances of occult Lisfranc injuries with metatarsal or cuneiform fractures. Intraoperative stress test is helpful to diagnose an occult Lisfranc injury. For unstable injuries on stress radiographs of occult Lisfranc joint injury, operative treatment with open or closed reduction and internal fixation is useful method.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권6호
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• pp.332-338
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• 2023

Objectives: This study aimed to compare the effectiveness of a hybrid arch bar (hAB) with the conventional Erich arch bar (EAB) for the management of jaw fractures, focusing on their use for temporary fixation in patients undergoing open reduction and internal fixation (ORIF). Materials and Methods: Patients presenting with maxillary and mandibular fractures at our institution were included in this prospective, comparative study. Placement time and ease of occlusal reproducibility were recorded intraoperatively for Group A (hAB patients) and Group B (EAB patients). The primary outcome was comparison of the postoperative stability of the two arch bars. Postoperative measurements also included mucosal overgrowth, screw loosening or wire retightening, and replacement rates. The data were tabulated and computed with a P<0.05 considered statistically significant. Results: The study included 41 patients. A statistically significant difference was observed in postoperative stability scores (3) between Group A and Group B (85.0% vs 9.5%, P=0.001). The mean placement time in Group A (23.3 minutes) significantly differed from that in Group B (86.4 minutes) (P<0.001). The ease of intraoperative occlusion was not different between the two groups (P=0.413). Mucosal overgrowth was observed in 75.0% of patients (15 of 20) in Group A. Conclusion: The hAB was superior to EAB in clinical efficiency, maxillomandibular fixation time reduction, stability, versatility, and safety. Despite temporary mucosal overgrowth, the benefits of hAB outweigh the disadvantages. The choice between hAB and EAB should be based on specific clinical requirements.

• 대한수의학회지
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• 제63권3호
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• pp.24.1-24.6
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• 2023

This study compared the biomechanical properties of bone-stapling techniques with those of other fixation methods used for stabilizing tibial tuberosity fractures using 3-dimensionally (3D)-printed canine bone models. Twenty-eight 3D-printed bone models made from computed tomography scan files were used. Tibial tuberosity fractures were simulated using osteotomy. All samples were divided into 4 groups. Group 1 was stabilized with a pin and tension-band wire; group 2, with a pin and an 8 mm-wide bone staple; group 3, with 2 horizontally aligned pins and an 8 mm-wide bone staple; and group 4 with a 10 mm-wide bone staple. Tensile force was applied with vertical distraction until failure occurred. The load and displacement were recorded during the tests. The groups were compared based on the load required to cause displacements of 1, 2, and 3 mm. The maximum failure loads and modes were recorded. The loads at all displacements in group 4 were greater than those in groups 1, 2, and 3. The loads at 1, 2, and 3 mm displacements were similar in groups 1 and 3. There was no significant difference between groups 1 and 3. Groups 1 and 4 provided greater maximum failure loads than groups 2 and 3. Failure occurred because of tearing of the nylon rope, tibial fracture, wire breakage, pin bending, and fracture around the bone staple insertion. In conclusion, these results demonstrate that the bone-stapling technique is an acceptable alternative to tension-band wire fixation for the stabilization of tibial tuberosity fractures in canine bone models.

• Clinics in Shoulder and Elbow
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• 제9권2호
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• pp.196-201
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• 2006

We report two cases of migration of K-wires from the acromioclavicular joint to the neck. A 73-year-old man complained of right shoulder pain for one month and had undergone orthopedic surgery because of acromioclavicular joint dislocation about 27 years earlier. Another 56-year-old man complained of left shoulder pain and neck pain for 5 years and had undergone orthopedic surgery because of acromioclavicular joint dislocation about 25 years earlier. In both cases, we took X-rays to look for the cause of shoulder pain and discovered broken and migrated K-wires in the neck. We removed the K-wires from the trapezius muscle and the paraspinal muscle respectively. K-wire fixation technique is simple and effective but should be followed up with X-rays periodically. In addition, we should warn patients of the possibility of migration of K-wire. And it is desirable for us to avoid using K-wire near major neurovascular structures like the sternoclavicular joint and the clavicle.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제11권2호
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• pp.47-52
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• 1989

현대문명의 발달과 더불어 안면골 골절의 형태는 다양해지고 그 손상 정도와 치료개념도 새로운 변천을 하게 되었다. 안면골 골절의 치료개념은 점차 소강판 또는 압박골판과 나사 고정등의 안정된 고정들의 수술방법으로 발전되고 있는 추세에 있다. 본 증례보고는 최소한 8개소 이상의 골절선을 가진 다발성 안면골 골절을 Miniplate osteosynthesis을 주로 이용한 치험례로, 필요시 Craniofacial suspension wire등의 겸용으로 아주 양호한 결과를 얻었기에 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권2호
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• pp.9-20
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• 1990

A series of 19 cases with maxillary hyperplasia and mandibular retrognathia were operated on by simultaneous superior repositioning of the maxilla after Le Fort I osteotomy and anterior repositioning of the mandible after bilateral sagittal split ramus osteotomies with or without osteotomy of the inferior border of the mandible. These were evaluated by retrospective cephalometric and computer analysis for the longitudinal skeletal and dental changes for an average of 17.1 months after surgery. For stabilization of the osteotomized segments, the authors used wire osteosynthesis by means of bilateral infraorbital and zygomatic buttress suspension wire at the maxilla, and direct interosseous wire at the split segments of the mandibular rami. Results show generally good stability after simultaneous maxillary and mandibular surgery with wire osteosynthesis, and a minimal to moderate tendency toward skeletal and dental relapse. This article is a preliminary study to defy the efficiency of the wire osteosynthesis (wo)compared with rigid internal fixation (RIF) for simultaneous maxillary and mandibular surgery. 1. The vertical relapse rate of the A point after superior repositioning of the maxilla is 2.2%. 2. The horizontal relapse rate of the B point after advancement of the mandible is 18.3%. 3. The condyle is distracted inferiorly and slightly posteriorly at the immediate postoperative period. 4. At the long term follow up examination, the condyle presents tendency of return to the preoperative position. 5. Condylar segment angle is decreased at the immediate postoperative period, and at the long term follow up evaluation, the angle is increased. 6. Gonial angle is increased at the immediate postoperative period, and then is decreased at the long term follow up evaluation. 7. The dentition is satisfactory with acceptable movement at the long term follow up evaluation. 8. At the mandibular free body analysis, genioplasty shows good stability. 9. Wire osteosynthesis provides excellent stabilization for the simultaneous maxillary and mandibular surgery.

• Archives of Plastic Surgery
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• 제48권1호
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• pp.69-74
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• 2021

Background In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. Methods Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. Results Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

• 대한족부족관절학회지
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• 제9권2호
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• pp.151-157
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• 2005

Purpose: To present our experience of distal chevron osteotomy utilizing one BOLD $screw^{(R)}$ as an alternative fixation method which has advantages over the Kirschner (K)-wire fixation. Materials and Methods: Between January 2001 and June 2003, 19 patients with a symptomatic hallux valgus deformity underwent 20 distal metatarsal chevron osteotomies with one BOLD $screw^{(R)}$ fixation. The mean age was 55.6 years with a minimum follow up period 12 months. For radiographical evaluation, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were used. For clinical evaluation, we used AOFAS hallux metatarsophalangeal interphalangeal scale and overall satisfaction of the patients. Results: The AOFAS scores improved from mean 47.5 points to mean 68.1 points at postoperative 3 months and mean 86.0 points at last follow-up. The average HVA corrected from 25.3 degrees to 12.7 degrees. The IMA was corrected from 11.6 degrees to 7.6 degrees. The overall satisfaction of the patients was 85%. There was no major complication. Conclusion: We demonstrated that distal chevron osteotomy with one BOLD $screw^{(R)}$ fixation has advantages such as no additional procedure, no loss of correction, early rehabilitation, no prominent hardware and skin irritation. This method also showed excellent bone union, correction and patient satisfaction.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권1호
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• pp.95-99
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• 1991

악안면 기형에 대한 활발한 치료가 행해지고 있는 가운데 악교정술 후에 발생하는 회귀현상(Relapse)에 대해서는 아직도 많은 연구가 진행되고 있다. 특히 하악골 전돌증으로 후방이동술을 시술받은 환자의 경우에 회귀의 원인으로 Schendel, Epker, Lake, Worms, Ive, Poulton과 Ware등 많은 학자들이 하악과두의 부적합한 위치를 강조하였다. 하악골 시상골절단술시에는 이미 Leonard(1976), Zecha 등 (1978)이 상악의 선부자에 acrylic과 wire 또는 retainer 등을 이용하여 하악근심 골편의 보존을 시도하였다. 이에 저자는 하악골 전돌증의 후방 이동량이 큰 경우나 심한 안면 기형이 있는 19명의 환자에 대해 하악지 수직골절단술을 시술한 경우에 주로 정형외과에서 사용하는 External Skeletal Pin Fixation인 Mini-Hoffmann Sets을 이용하여 하악과두의 중심교합위 보존에 도움을 주었기에 보고하는 바이다.