• Clinics in Shoulder and Elbow
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• 제21권4호
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• pp.227-233
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• 2018

Background: The purpose of this study was to compare the radiologic results of patients who underwent surgery with a hook plate and a locking plate in distal clavicle fractures. Methods: Sixty patients underwent surgical treatment for Neer type IIa, IIb, III, and V distal clavicle fracture. Twenty-eight patients underwent fracture fixation with a hook plate and 32 with a locking plate. Coracoclavicular distance was measured on standard anteroposterior radiographs before and after the surgery, and union was confirmed by radiograph or computed tomography taken at 6 months postoperatively. Other radiologic complications like osteolysis was also checked. Results: Bony union was confirmed in 59 patients out of 60 patients, and 1 patient in the hook plate group showed delayed union. Coracoclavicular distance was decreased more in the hook plate group after surgery (p<0.01). After 6 weeks of the hook plate removal, the coracoclavicular distance was increased a little compared to before metal removal, but there was no difference compared to the contralateral shoulder. Eleven out of 28 patients (39.3%) showed osteolysis on the acromial undersurface in the hook plate group. Conclusions: Both the hook plate group and the locking plate group showed satisfactory radiologic results in distal clavicle fractures. Both hook plate and locking plate could be a good treatment option if it is used in proper indication in distal clavicle fracture with acromioclavicular subluxation or dislocation.

• Clinics in Shoulder and Elbow
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• 제24권2호
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• pp.72-79
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• 2021

Background: A midshaft clavicle fracture is a common fracture that typically responds well to open reduction and internal fixation (ORIF). However, refracture can occur after implant removal (IR). This study aimed to analyze the rate of refracture and related factors after removal of the locking compression plate (LCP) for displaced midshaft clavicle fractures. Methods: We retrospectively reviewed the medical records of 201 patients who had undergone ORIF with LCP for midshaft clavicle fractures after IR after bony union from January 2011 to May 2018 at our institute. We evaluated basic demographic characteristics and radiographic parameters. All patients were treated with an LCP for primary fracture. The patients were divided into two groups: a refracture group that experienced a second fracture within 1 year after IR and a no-fracture group. Results: There were four cases (1.99%) of refracture; three were treated conservatively, while one was treated surgically. All patients achieved bony union. The average interval between refracture and IR was 64 days (range, 6-210 days). There was a significant difference in classification of fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] classification) between the two groups. However, other patient demographics and radiographic measurements between refracture and IR, such as bone diameter, showed no significant difference between the two groups. Conclusions: This study showed that one in 50 patients suffered from refracture after removal of the LCP. Thus, if patients desire IR, the surgeon should explain that there is a relatively higher possibility of refracture for cases with simple or segmental fractures than for other types of fracture.

• 대한골관절종양학회지
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• 제11권2호
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• pp.111-117
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• 2005

목적: 15세 이하의 소아에서 골종양에 2차적으로 발생한 대퇴골의 병적 골절의 치료 결과에 대해 알아보고자 하였다. 대상 및 방법: 1995년 1월부터 2004년 6월까지 골종양에 2차적으로 발생한 대퇴골의 병적 골절로 치료받았던 환자 중 1년 이상 추시가 가능하였던 18명, 20예를 대상으로 하였다. 평균 연령은 10.2세였고 평균 추시 기간은 42.5개월이었다. 결과: 골절 부위는 대퇴 근위부 14예, 간부 3예, 원위부 3예였으며, 원인 골종양은 섬유성 이형성증 9예, 단순 골낭종 4예, 동맥류성 골낭종 4예, 비골화성 섬유종 2예, 호산구성 육아종 1예였다. 치료 방법으로 골절에 대해서는 11예에서 석고고정을 이용한 보존적 치료를, 8예에 대해서는 내고정을 1예에서는 외고정을 시행하였다. 원발 종양에 대해서는 관찰만 시행한 경우가 11예, 소파술 및 골이식이 8예, 절제술이 1예에서 시행되었다. 다발성 섬유성 이형성증에서 모든 예에서 변형이 발생하여 변형 교정술 및 골수정 내고정술로 더 이상의 변형이나 재골절을 예방할 수 있었다. 결론: 골종양에 2차적으로 발생한 소아 대퇴골의 병적 골절은 그 치료가 어려우나 원발 골종양의 종류 및 그 특성에 따른 적절한 치료 방법을 선택하면 우수한 결과를 얻을 수 있을 것으로 생각된다.

• Clinics in Shoulder and Elbow
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• 제16권1호
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• pp.27-32
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• 2013

목적: 상완골 간부 단순 골절의 수술적 치료에서 잠김 압박 금속판을 이용한 최소 침습적 금속판 골유합술의 임상적 및 방사선학적 결과를 분석하였다. 대상 및 방법: 2010년 8월부터 2011년 5월까지 상완골 간부 단순 골절 골절에 대해 최소 침습적 금속판 골 유합술을 통해 수술을 시행하고 전향적으로 12개월 이상 추시한 6례의 환자를 대상으로 하였으며, 임상적 및 방사선학적 골유합 기간 및 술 후 관절 운동 범위와 기능을 확인하였다. 결과: 임상적 및 방사선학적 평균 골유합 기간은 각각 7.2주, 8주였다. 술 후 골 정렬에서 전후상 평균 2.8도, 측면상 내반 2도의 변형을 보였다. 술 후 12개월째 견관절 운동 범위는 전방거상 167도, 외회전 50도, 내회전 수위는 흉추 11번이었고, 평균 VAS는 1.2점, KSS는 91.3점, ASES는 26.5점, UCLA 점수는 31.5점이었다. 결론: 상완골 간부 단순 골절의 수술적 치료에서 최소 침습적 금속판 골유합술은 방사선학적 및 기능적으로 우수한 결과를 보였으며 상완골 간부 단순 골절에서 고려해 볼 수 있는 유용한 치료 방법 중 하나라고 생각된다.

• Journal of Yeungnam Medical Science
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• 제9권1호
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• pp.130-136
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• 1992

본 영남대학교 의과대학 부속병원 정형외과에서는 1986년 12월에서 1991년 11월까지 경부 간부 골절 31례에 대하여 Ender nail을 시행하여 다음과 같은 결과를 얻었다. 1. 환자의 평균연령은 37.3세였고, 남자에게서 3배가 많았으며, 교통사고가 가장 많은 원인이었다(67%). 2. 폐쇄성 골절이 20례, 개방성 골절이 11례였으며, 분쇄골절과 분절골절이 18례(57.7%)였고, 중간부 골절이 16례로 가장 많았다. 3. 동반손상이 19례에서 있었고, 수상후 수술까지의 기간은 평균 7.6일이었다. 4. 평균 골유합 기간은 18.9주였으며, 2례에서 지연유합을 보였다. 5. 합병증으로 하지 단축이 2례, 각형성 변형이 3례, 관절 운동 제한 2례, 감염이 연부조직에 1례 있었다. 이상 경골 간부골절 치료에 사용한 Ender nail은 시술의 간편성, 적절한 고정성과 운동성, 비교적 폭넓은 적용 범위등으로 좋은 치료 결과를 기대할 수 있는 방법으로 사료된다.

• 대한족부족관절학회지
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• 제14권2호
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• pp.135-139
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• 2010

Purpose: We analyse and report the result of transfibular ankle arthrodesis using lateral malleolar saving procedureversus lateral malleolar sacrificing procedure. Materials and Methods: Eighteen cases of transfibular ankle arthrodesis which were performed since 2001 were included. We devided them into lateral malleolar saving and lateral malleolar sacrificing groups. We reattached and fixed lateral malleolus in 10 cases and sacrificed malleolus for morcelized bone graft in 8 cases. We evaluated clinical results by AOFAS ankle-hindfoot score, visual analogue scale (VAS) and radiological results by union time. Complications and subjective satisfaction degrees were also recorded and compared between two groups. Results: Preoperative mean AOFAS score was 32 points (16~41) and VAS was 7.5 points (7~8) and they were changed into 68.6 points (61~77) and 2.8 points (2~4) postoperatively. There was no significant difference in clinical results between the two groups even though lateral malleolar saving group showed higher AOFAS score (69.4) than lateral malleolar sacrificing group (67.7). Duration of getting union was 11.3 weeks in lateral malleolar saving group and 10.6 weeks in lateral malleolar sacrificing group. There was no difference in subjective satisfaction level. There were one delayed union and one nonunion in lateral malleolar sacrificing group and one nonunion in lateral malleolar saving group. Conclusion: There was no difference in clinical and radiological results between lateral malleolar saving group and lateral malleolar sacrificing group of transfibular ankle arthrodesis. Therefore it may not necessary to sacrifice lateral malleolus for bone graft except very selective case for which heavy graft is needed.

• 대한족부족관절학회지
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• 제17권2호
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• pp.106-114
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• 2013

Purpose: Posteroanterior screw fixation is biomechanically stronger than anteroposterior screw fixation. However, there are few literature about the correlation between clinical results and more strength by posteroanterior fixation. This study was performed to evaluate the clinical outcomes of the accelerated rehabilitation following anterior open reduction and posterior percutaneous screw fixation for displaced talar neck fractures. Materials and Methods: Eighteen cases were followed up for more than 1 year after posteroanterior fixation using headless compression screw for talar neck fractures. The clinical evaluation was performed according to American Orthopaedic Foot and Ankle Society (AOFAS) score and Hawkins criteria. As radiographic evaluation, the degree of fracture displacement, period to union, and occurrence rate of complications such as avascular necrosis through MRI were measured. Results: The AOFAS score was average 90.4 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the Hawkins criteria. Therefore, 16 cases(88.8%) achieved satisfactory results. The degree of fracture displacement had improved significantly from preoperative average 5.6 mm to 1.2 mm immediate postoperatively, and maintained to 1.1mm at the last follow-up. All cases achieved bone union, and the period to union was average 12.4 weeks. There were 3 cases of avascular necrosis of talar body and 2 cases of post-traumatic arthritis. Conclusion: Anterior open reduction and posterior percutaneous headless screw fixation seems to be an effective surgical method for displaced talar neck fractures, because of the possibility of accurate restoration of articular surface, fixation strength enough to early rehabilitation, and needlessness of hardware removal.

• 대한족부족관절학회지
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• 제20권3호
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• pp.126-130
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• 2016

Purpose: The aim of this study was to evaluate the result of extraarticular dorsal closing wedge osteotomy in Freiberg's disease. Materials and Methods: Between February 2012 and July 2014, total 10 patients who underwent dorsal closing wedge osteotomy and followed up more than 1 year were selected for inclusion. Average age was 16.3 years, and average follow-up period was 15.5 months. The diagnosis was made using magnetic resonance imaging of those with a limitation in walking or usual activity due to pain in the metatarsal head. During operation, we removed loose body, and synovectomy was done. Osteotomy at the metatarsal neck and fixation with Kirschner wire were performed. X-ray was taken to check shortening of 2nd metatarsal and bone union. Moreover, we checked the active range of motion of 2nd metatarsophalangeal joint before and after surgery. At the last follow-up, the shortening of metatarsal, American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), and patient's subjective satisfaction were evaluated. Results: According to the Smillie's stage, there were 3 cases of stage II, 4 cases of stage III, and 3 cases of stage IV. Average bone union time on the osteotomy site was 8 weeks. Average shortening of metatarsal was 2.53 mm. Average AOFAS score improved significantly from 56.9 to 82.8 points at final follow-up (p<0.05), and average VAS score also improved significantly from 6.4 to 1.4 points at final follow-up (p<0.05). Average active range of motion at metatarsophalangeal joint improved from $28.0^{\circ}$ preoperatively to $46.5^{\circ}$ at the final follow-up. Other complications, such as metatarsalgia and arthritis, were not found; however, there was 1 case of delayed union with no symptom. Conclusion: In Freiberg's disease, dorsal closing wedge osteotomy is recommended for the improvement of clinical symptoms and range of motion.

• Clinics in Shoulder and Elbow
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• 제10권2호
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• pp.220-226
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• 2007

목적: 원위 쇄골 골절은 근위부나 중간부 쇄골 골절과는 다른 생역학적 구조를 가져서 지연유합과 불유합이 많이 발생한다. 원위 쇄골 불유합 치료에 대한 연구보고는 거의 없는 상태이다. 저자들은 원위 쇄골 골절 불유합에 대한 관혈적 정복 및 골이식의 수술적 치료 후 좋은 결과를 얻었기에 문헌 고찰과 함께 보고하는 바이다. 대상 및 방법: 2003년 8월부터 2006년 5월까지 원위 쇄골 불유합으로 수술 치료받은 8예를 대상으로 하였으며, 평균 연령은 38.9($21{\sim}62$세)세였고, 지배 수지 6예였다. 수상 초기 수술적 치료 후 발생한 불유합이 4예, 보존적 치료 후 발생한 불유합이 4예였고, 불유합 기간은 수상 후 평균 1년 5개월이었다. 전 예에서 자가장골 이식술 및 내고정술을 시행하였고, 내고정물은 금속판이 7예, 긴장대 강선 고정술이 1예였다. 결과: 평균 추시 기간은 14개월이었고, 방사선학적 골유합은 전 예에서 평균 8주에 관찰할 수 있었다. 최종 추시상 견관절의 운동범위는 모두 정상 소견이었고, Kona 등의 평가표에 의한 기능적 평가에서 7예에서 우수한 결과를, 1예에서 양호한 결과를 얻었다. 결론: 원위 쇄골 골절 불유합에 대한 수술적 치료는 조기 재활이 가능하고 견고한 골유합을 얻을 수 있어 추천할 만한 치료 방법으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권8호
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• pp.3791-3794
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• 2012

CD44v, especially splice variants containing exon v6, has been shown to be related closely to development of different tumors. High levels of CD44v6/v7 have been reported to be associated with invasiveness and metastasis of many malignancies. The objective of this study was to detect expression of CD44v6-containing variants in patients with acute promyelocytic leukemia (APL) and evaluate the potential of CD44v6/v7 for risk stratification. Reverse transcription polymerase chain reaction (RT-PCR) followed by PCR product purification, ligation into T vectors and positive clone sequencing were used to detect CD44 v6-containing variant isoforms in 23 APL patients. Real-time quantitative PCR of the CD44v6/v7 gene was performed in patients with APL and in NB4 cells that were treated with all-trans retinoic acid (ATRA) or arsenic trioxide ($As_2O_3$). Sequencing results identified four isoforms (CD44v6/v7, CD44v6/v8/v10, CD44v6/v8/v9/v10, and CD44v6/v7/v8/v9/v10) in bone marrow mononuclear cells of 23 patients with APL. The level of CD44v6/v7 in high-risk cases was significantly higher than those with low-risk. Higher levels of CD44v6/v7 were found in three patients with central nervous system relapse than in other patients inthe same risk group. Furthermore, in contrast to ATRA, only $As_2O_3$ could significantly down-regulate CD44v6/v7 expression in NB4 cells. Our data suggest that CD44v6/v7 expression may be a prognostic indicator for APL.