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Anatomical Direct Reduction of Bony Mallet Finger Using Modified-Intrafocal Pinning Technique (변형-내초점 핀 고정술을 이용한 골성 망치 수지의 해부학적 직접 정복)

  • Kang, Sang-Woo;Park, Ji-Kang;Jung, Ho-Seung;Cha, Jung-Kwon;Kim, Kook-Jong
    • Archives of Hand and Microsurgery
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    • v.23 no.4
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    • pp.248-253
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    • 2018
  • Purpose: The purpose of this study was to evaluate the clinical results of anatomic reduction of bony mallet finger using modified-intrafocal pinning technique. Methods: From March 2014 to October 2017, 18 patients with bony mallet finger were treated with modified-intrafocal pinning technique. Kirschner-wire was used to directly reduction the bony fragment, and extension block pinning and distal interphalangeal joint fixation were additionally performed to minimize the loss of reduction. Postoperative pain, range of motion, and radiological evaluation were performed. Duration of bone healing, functional recovery and complication rate were evaluated and Crawford's criteria was used to determine functional outcome after surgery. Results: Bone union was achieved in all cases after a postoperative mean of 6 weeks (5-7 weeks). An average of $2.8^{\circ}$ ($0^{\circ}-10^{\circ}$) extension loss occurred in all patients. All patients showed satisfactory joint congruency and reformation of the joint surface, the mean flexion angle of the distal interphalangeal joint at the final follow-up was $72.2^{\circ}$ ($70^{\circ}-75^{\circ}$). According to Crawford's classification, 12 patients (66.7%) were excellent and 6 patients (33.3%) were good. Conclusion: Modified-intrafocal pinning technique is a method of obtaining anatomical bone healing by directly reduction and fixation of the bony fragment. Combined with other conventional percutaneous pinning procedures, it is expected that good results can be obtained if applied to appropriate indications.

Arthroscopic Reduction and Internal Fixation of Intra-articular Fractures of Lateral Tibial Plateau (관절면을 침범한 경골 외과 골절의 관절경적 정복 및 내고정술)

  • Lee, Kwang-Won;Lee, Hang-Ho;Yang, Dong-Hyun;Choy, Won-Sik
    • Journal of the Korean Arthroscopy Society
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    • v.10 no.1
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    • pp.53-60
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    • 2006
  • Purpose: This study is to analyze the clinical and radiological results after arthroscopic reduction and internal fixation of intra-articular fractures of lateral tibial plateau. Materials and Methods: The subject of the study are the 13 cases of the patients visited orthopedics surgery during March year 2000 to August year 2004 because of intra-articular fractures of lateral tibial plateau and were treated with arthroscopic reduction and internal fixation. X-rays and CT or MRI were both carried out to identify the precise pattern of fracture and the degree of depression which showed out to be all type 2 by Schatzker fracture classification. And in 9 of the cases, autogenous and allogenous bone grafts were given as bone loss were severe. The average age was 48, age group between 31 and 66, and average follow up period of about 38 months ($13{\sim}65months$). Radiological ratings were given by comparing the X-rays of degree of joint congruency before and after the operation, functional ratings by analyzing IKDC score and Lysholm score. Combined injuries observed after arthroscopy were posterior cruciate ligament injury in 1 case, meniscus injury in 4 cases and medial collateral ligament in 2 cases. Results: During follow up, X-rays showed well-maintained reduction of articular surface in all cases and no complications such as joint depression, fracture reduction loss, angular deformity or malunion were found. Average Lysholm score at last follow up was 87 points ranging from 65 to 97, in 8 of the cases excellent, 3 good, 1 fair and 1 poor according to Lynsholm classification. Average IKDC score was 92 (from 82 to 99). Conclusion: Not only does arthroscopic reduction of lateral tibial plateau fracture bring exact reduction of articular surface, but also, is considered to be a good way of operation to diagnose and treat combined injuries of knee joint using arthroscopy.

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Treatment of Developmental Dislocation of the Hip in Walking Age (보행기의 발달성 고관절 탈구의 치료)

  • Kim, Se-Dong;Jang, Jae-Hyuk;Lee, Dong-Chul;Shin, Duk-Seop
    • Journal of Yeungnam Medical Science
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    • v.13 no.2
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    • pp.211-224
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    • 1996
  • The patients of developmental dislocation of the hip(DDH) are almost found after walking age because of early diagnosis of DDH in younger children is not easy. A controversy still exists as to the relative value of closed and operative management in the treatment of a child who has reached walking age. This study is a report of the results of 16 patients(17 cases) in developmental dislocation of the hip who have visited our hospital at the age of 9 months to 3 years old, and have been followed more than 12 months (12-112 months) on review of plain radiographs and arthrograms. The results were as follows : 1. The age at diagnosis was 16.4 months(9-31 months) in average. The methods of treatment were conservative for 8 cases, and operation for 4 cases and secondary operation for 5 cases who were failed with conservative therapy. 2. By Severin's radiologic grade, the result was good in 4 cases, fair in 3 cases and poor in 1 case in conservative treatment. In operative treatment, fair was in 2 cases and poor in 2 cases. In secondary operative patients who were failed with conservative therapy, good was in 2 cases, fair in 2 cases and poor in 1 case. 3. Avascular necrosis of femoral head was developed in 3 cases. 4. In the good reduction as determined by arthrogram according to Race and Herring, we can get a favorable result in conservative treatment, and in the poor reduction as determined by arthrogram, the better result in operative treatment can be expected.

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A Clinical Analysis of Femur Neck Fracture in Elderly Patients (노년층에서 대퇴경부 골절의 치료)

  • Ihin, Joo-Choul;Ahn, Myun-Whan;Seo, Jae-Sung
    • Journal of Yeungnam Medical Science
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    • v.2 no.1
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    • pp.11-22
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    • 1985
  • Femur neck fracture is well known as one of the major death cause after trauma in elderly patients, and unsolved fracture due to its frequent association with complications such as avascular necrosis and nonunion. Through meticulous evaluation of the patient, hip and surgeon's experiences, reduction of mortality and morbidity as well as rapid recovery of the patient to the preinjury social and ambulatory status without local complications and revision after treatment is urgently needed. Many factors about this fracture In itself were noted, but we have analyzed 18 femur neck fractures of the patients older than 50 years preliminarily according to age, fracture pattern, osteoporosis, etiology and method of treatment with its delay in association with major complications especially avascular necrosis and nonunion. The results are as follows; 1. Of these 18 fractures, 11 were in females, 8 were caused by minor trauma such as slip-down accident and 4 were associated with definite osteoporosis according to the Sing's classification. 2. Fracture pattern of these 18 are undisplaced in 4, displaced subcapital in 11, displaced transcervical in 3. 11 fractures in the patients older than 60 year are composed of 3 undisplaced or impacted fractures and 8 displaced subcapital fractures. 3. These 18 fractures were treated by closed reduction and Internal fixation with multiple pins in 13, and hemiarthroplasty in 4, but one was not treated to die after discharge from hospital. 4. 4 undisplaced or impacted fractures and 3 displaced transcervical fractures were not associated with any complications such as avascular necrosis or nonunion. But 4 of 6 displaced subcapital fractures were complicated by avascular necrosis, 3 of which were reduced in the varus position within 1 week, and the other was reduced in the good position on 1 week after trauma. There was no complication in 2 displaced subcapital fractures reduced in valgus position within 3 days after trauma. According to the above results, the prognosis of the femur neck fracture is dependent upon the fracture pattern and delay in its treatment. So it is inevitable to reduce the fracture in anatomical or valgus position as early as possible. But the arthroplasty may be needed in displaced subcapital fractures delayed for several days, with its reluction in extreme varus position or impossible and with pre-existing disease in the same hip Joint (total hip replacement).

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Clinical and Radiological Results of Treating Unstable Distal Radial Fractures with a Domestically Developed Volar Locking Plate That Has the Characteristic of Double-Tiered Subchondral Support (불안정성 원위 요골 골절의 치료에 있어 한국형 이중 연골하지지고정 전방 금속판의 임상적 및 방사선학적 결과)

  • Lee, Chul-Hyung;Jung, Deukhee;An, Chung-Han;Jeong, Uitak
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.6
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    • pp.495-502
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    • 2020
  • Purpose: The aim of this study was to assess the effectiveness of domestically developed volar locking plate which has the concept of double-tiered subchondral support (DSS) in maintaining the reduction after distal radial fracture surgery. Materials and Methods: From July 2017 to December 2018, 54 patients were assessed. Plain radiographs were obtained immediately after surgery and at the last follow-up, and the radiographic parameters were measured in those images: radial length, radial inclination, volar tilt, ulnar variance, and distal dorsal cortical distance. The patients were subdivided into their age, type of fracture, and the position of the plate to evaluate the influence of each factors on the reduction maintenance. Results: Distal dorsal cortical distance in radiographs after the surgery was 5.91 mm (standard deviation, ±1.95 mm) on average. Significant differences in the radial length (p=0.038) and ulnar variance (p=0.001) were observed between immediately after surgery and at the last follow-up. When the parameters were evaluated by dividing the patients into subgroups according to the three specific factors, the ulnar variance showed a significant increase at the last follow-up when the patients were included 65-years-old or older. AO/OTA type C3 fracture, and Soong classification grade 0 plate position (p=0.007, p=0.012, p=0.046, respectively). Conclusion: Using the domestically developed DSS-type volar locking plate, significant reduction after distal radial fracture surgery could be maintained successfully. On the other hand, further study will be needed to determine about the reduction loss of the lunate facet identified in special cases that deal with fractures in elderly patients, unstable AO/OTA type C3 distal radial fractures, and Soong classification grade 0 plate position.

Effect of Temporary Anterior Positioning Splint Using Putty Impression Material on Acute Closed Lock (급성 과두 걸림의 치료에서 퍼티 고무 인상재로 제작한 임시 전방위치장치의 적용)

  • Song, Ji-Hee;Kim, Ji-Hyun;Kwon, Jeong-Seung;Ahn, Hyung-Joon
    • Journal of Oral Medicine and Pain
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    • v.37 no.4
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    • pp.221-225
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    • 2012
  • Disc dislocation without reduction, as known as closed lock, is a clinical condition in which the disc is dislocated from the condyle and does not return to normal position during condylar movement When the condition of disc dislocation without reduction is acute, the initial therapy should include an attempt to reduce or recapture the disc by manual manipulation. When patients report a history of being locked for 1 week or less, manual manipulation is usually successful. In patients with a longer history, success rate tends to decrease rapidly. If the disc has been successfully recaptured, placing an anterior positioning appliance is recommended to prevent clenching on the posterior teeth, which would likely redislocated the disc. But it is hard to make an appliance immediately in the clinic because it takes too much time. And making an appliance using self-curing acrylic resin is not very popular because of its discomfort by odor and working time. Also, if the patient has resin allergy or is under orthodontic treatment, or if it is impossible to control behavior of the patient, it has been restricted to make an appliance immediately. Therefore, to supplement this disadvantages, we tried to confirm about successful short term use of temporary anterior positioning splint made by using putty impression material after manual manipulation in this study.

SECONDARY RHINOPLASTY IN MID-FACIAL TRAUMA PATIENTS (중앙안면골 골절 환자에서의 이차 비성형술)

  • Jeong, Jong-Cheol;Kim, Keon-Jung;Lee, Jeong-Sam;Min, Heung-Ki;Choi, Jae-Sun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.18 no.4
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    • pp.607-614
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    • 1996
  • Nasal bone fracture is common in mid-facial trauma patients. In these patients, facial bone and nasal bone fracture are reducted at same time, but definite nasal reduction is difficulty in these patients because of nasotracheal intubation during general anesthesia and facial swelling in early facial trauma patients. If nasal packing and MMF are needed, there are difficult to maintain the reducted nasal bone because of some difficulty in airway maintenance after nasal packing and increasing the patient discomfort. So postoperative nasal deformity is more common in these combined patients. Secondary rhinoplasty is necessary in these patients who have deformed nasal bone, and there are many methods and materials for secondary rhinoplasty. But if primary nasal bone was reducted symmetrically, it is easy in secondary rhinoplasty. We present 7 cases of secondary rhinoplasty in mid-facial trauma patients who had combined nasal bone fracture. In these patients, primary nasal bone reduction carried with closed reduction method during primary facial bone reduction. About 6 months later, we performed secondary rhinoplasty with iliac bone and alloplastic materials. So we report these cases with literatures.

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