• Title/Summary/Keyword: Bone screw

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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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Technical Note of Arthroscopic Subtalar Arthrodesis Using Posterior Portals - Operative Technique - (후방 삽입구를 이용한 관절경적 거골하 관절 유합술- 수술 방법-)

  • Lee, Keun-Bae;Choi, Jin;Park, Yu-Bok;Seo, Hyeong-Yeon;Suh, Jin-Soo
    • Journal of Korean Foot and Ankle Society
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    • v.9 no.2
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    • pp.193-196
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    • 2005
  • A posterior 3-portal arthroscopic approach with the patient in the prone position provides a novel and optimal approach for isolated subtalar arthrodesis. This approach facilitates access to the posterior talocalcaneal facet and facilitates safe access with regard to the posteromedial neuromuscular bundle. The technique involves prone positioning, establishment of two posterolateral portals and one posteromedial portal, arthroscopic posterior talocalcaneal facet debridement, percutaneous morcellized bone grafting and internal screw fixation. Preliminary results have shown high patient satisfaction, an excellent fusion rate and less postoperative morbidity than open subtalar arthrodesis.

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Open Reduction of Coxofemoral Luxation with a Toggle Pin & Synthetic Capsule Technique in a Rottweiler (Rottweiler에서 발생한 고관절 탈구의 개방적 정복)

  • 장광호;채형규;권영삼;임재현;김영홍;장인호
    • Journal of Veterinary Clinics
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    • v.17 no.1
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    • pp.134-137
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    • 2000
  • 체중 43kg의 10개월령 암컷 로토와일러가 약 2개월전부터 점진적으로 진행된 좌측후지의 심한 파행 병력으로내원하였다. 신체검사와 고관절 탈구를 진단하였으며 골반의 외측 및 복배측 방사선 사진 촬영으로 확진할 수 있었다. 전배측 접근 후 골수내정으로 제작한 한 개의 toggle pin 및 두 개의 bone screw를 병용 적용하여 대퇴골두를 고정하였다. 일차교정은 술후 7일의 재탈구로 실패하였으며 동일 방법으로 이차 시술한 후 Ehner sling을 적용하고 운동을 제한하였다. 술후 20일에 환축은 거의 정상보행을 회복하였다.

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Spondylolisthesis Accompanying Bilateral Pedicle Stress Fracture at Two Vertebrae

  • Kim, Hyeun-Sung;Kim, Seok-Won;Lee, Won-Tae
    • Journal of Korean Neurosurgical Society
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    • v.51 no.6
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    • pp.388-390
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    • 2012
  • There has been no report of bilateral pedicle stress fractures involving two vertebrae. The authors describe a unique case of spondylolisthesis accompanying a bilateral pedicle stress fracture involving two vertebrae. De novo development of spondylolisthesis at the L5-S1 vertebrae accompanying a bilateral pedicle stress fracture at L4 and L5 was observed in a 70-year-old woman. The patient's medical history was unremarkable and she did not have any predisposing factors except severe osteoporosis. Interbody fusion with bone cement augmented screw fixation was performed. Surgical treatment resulted in good pain management and improved functional recovery.

TAnkle Arthrodesis Using Cannulated Screws under Arthroscopy -Three cases report- (관절경하 유관 나사를 이용한 족관절 관절 고정술 (3례 보고))

  • Kim, Myung Ku
    • Journal of the Korean Arthroscopy Society
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    • v.2 no.1
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    • pp.59-63
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    • 1998
  • There have been numerous methods to obtain a stable arthrodesis of the tibiotalar joint. However, a controvercy has arisen over the most successful and reproducible method to obtain an arthrodesis. The objective of this report is to show that an ankle arthrodesis can be performed successfully and advantageously by using cannulated screws under arthroscopic control and that our csaes will be a part of the multicentric study of arthroscopic ankle arthrodesis in korea. Between May 1996 and May 1997, we perfomed 3 ankle arthrodesis under arthroscopy using cannulated screws. Two patients had post-traumatic osteoarthritis and one had rheumatoid arthritis. Clinical ankylosis in one case and radiological union in two cases were obtained in 12 weeks postoperatively. We propose that arthroscopic ankle arthrodesis is effective procedure in patient who has minimal deformity and bone loss, advantages like small incision, minimal morbidity, low infection rate and rapid return to normal daily activity, but more cases and comparision with open tecnique will be needed.

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Screw Fixation without Fusion for Low Lumbar Burst Fracture : A Severe Canal Compromise But Neurologically Intact Case

  • Jang, Kun-Soo;Ju, Chang-Il;Kim, Seok-Won;Lee, Sung-Myung
    • Journal of Korean Neurosurgical Society
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    • v.49 no.2
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    • pp.128-130
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    • 2011
  • The low lumbar spine is deeply located in flexible segments, and has a physiologic lordosis. Therefore, burst fractures of the low lumbar spine are uncommon injuries. The treatment for such injuries may either be conservative or surgical management according to canal compromise and the neurological status. However, there are no general guidelines or consensus for the treatment of low lumbar burst fractures especially in neurologically intact cases with severe canal compromise. We report a patient with a burst fracture of the fourth lumbar vertebra, who was treated surgically but without fusion because of the neurologically intact status in spite of severe canal compromise of more than 85%. It was possible to preserve motion segments by removal of screws at one year later. We also discuss why bone fusion was not necessary with review of the relevant literature.

A Case of Thoracic Vertebral Chondroblastoma, Treated with 3-D Image Guided Resection and Reconstruction

  • Lee, Yoon-Ho;Shin, Dong-Ah;Kim, Keung-Nyun;Yoon, Do-Heum
    • Journal of Korean Neurosurgical Society
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    • v.37 no.2
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    • pp.154-156
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    • 2005
  • We present a case of chondroblastoma in the thoracic vertebra. A 40-year-old patient with upper back pain and lower extremity weakness was admitted to our clinic. On neurological examination, the patient exhibited lower extremity spastic paraparesis. Magnetic resonance imaging revealed a mass infiltrating the 7th thoracic vertebra and its adjacent structures with concomitant compression of the epidural space. After right upper lung tuberculoma was resected through the transthoracic approach, T7 total corpectomy was done with anterior stabilization using a MESH cage and T7 rib bone graft. Two weeks after the first operation, remained part of vertebra was removed and posterior stabilization was performed using a pedicle screw fixation and cross linkage bar with the assistance of the navigation system. The final pathologic diagnosis of the vertebral lesion was benign chondroblastoma.

Isolated Dorsal Dislocation of Intermediate Cuneiform: A Case Report (중간 설상골의 단독 배측 탈구 골절: 증례 보고)

  • Lee, Dong Joo;Choi, Jun Young;Suh, Jin Soo
    • Journal of Korean Foot and Ankle Society
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    • v.23 no.1
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    • pp.39-41
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    • 2019
  • An isolated dislocation of the intermediate cuneiform bone is a rare midfoot injury. This paper reports a case of a 60 year old man who fell from a height with his foot in the plantar flexed position. An isolated dorsal dislocation of the intermediated cuneiform was confirmed. Good results were obtained after an open reduction and internal fixation with a Lisfranc screw and Kirschner wire.

Pre-contoured reconstruction plate fabricated via three-dimensional printed bending support

  • Song, In-Seok;Ryu, Jae-Jun;Choi, Young-Jun;Lee, Ui-Lyong
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.47 no.3
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    • pp.233-236
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    • 2021
  • A mandibular continuity defect can be repaired using either a prosthetic device or autogenous bone. A titanium reconstruction plate can be used with a localized or vascularized flap over the defect of the mandible. Unfortunately, the plate may fail due to plate exposure, screw loosening, fracture, or infection, and will need to be removed. Plate exposure though the skin or mucosa is one of the main reasons for failure. In the present work, the authors introduced a lingually positioned reconstruction plate fabricated via three-dimensional printed bending support. This custom reconstruction plate can avoid plate re-exposure as well as reduce surgical errors and operation time.

Long-term Effects on the Cervical Spine after Anterior Locking Plate Fixation (경추 전방 잠금식 금속판이 장기적으로 경추에 미치는 영향)

  • Kim, Keun Su
    • Journal of Korean Neurosurgical Society
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    • v.30 no.4
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    • pp.493-500
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    • 2001
  • Objective : Anterior cervical locking plates are the devices for achieving anterior cervical spinal fusion. This study was conducted to evaluate the locking plate system regarding its long-term advantages and disadvantages in the view of interbody fusion rate, hardware-related failures, vertebral change close to the fusion segment and postoperative complications. Method : Eight-six patients, operated from Jan., 1996 to Jun. 1998, were followed-up for more than two years. All of the cases were fused with iliac bone graft and ORION locking plate(Sofamor Danek USA, Inc., Memphis, TN) fixation. The patients were discharged or transferred to rehabilitation department 2-7 days after operation. A comprehensive evaluation of the interbody fusion state, instrument failure, vertebral change and postoperative complications were made by direct interview and cervical flexion-extension lateral plain films. Results : There were 55 male and 31 female with a mean age of 45 years(18-75 years). The mean follow-up period was 29 months(24-43 months). Various disorders that were operated were 40 cervical discs, 6 cervical stenosis including OPLL, 2 infections, and 38 traumas. Fusion level was single in 59 cases, two levels of each disc space in 15 cases, and two levels after one corpectomy in 12 cases. There was no instrument failure. Pseudoarthrosis was observed in two cases(2%) without radiological instability. The other patients(98%) showed complete cervical fusion with stable instrument. Mild settling of interbody graft with upward migration of screws was found in 12 cases(14%). Anterior bony growth at the upper segment was found in 5 cases(6%). Postoperative foreign body sensation or dysphagia was observed in 12 cases(4%), and disappeared within one month in 7 cases and within six months in 4 cases. One patient complained for more than six months and required reoperation to remove paraesophageal granulation tissue. Conclusion : The results show that Orion cervical locking plate has some disadvantages of upward migration of screws, anterior bony growth at the upper segment, or possibility of esophageal compression even though it has advantages of high interbody fusion rate or low instrument failure. Author believe that anterior cervical locking plate in the future should be thinner, and should have short end from the screw hole, and movable screw with adequate stability.

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