• Clinics in Shoulder and Elbow
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• 제25권1호
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• pp.49-56
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• 2022

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

• 대한한의학회지
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• 제16권2호
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• pp.62-78
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• 1995

In industrialized countries, low back pam is very common, with up to 60 to 80% of the population being affected at some time in their lives. Herniated lumbar intervertebral disc is one of principal cause of low back pain and radiculopathy. The therapy of the disease is classified into conservative treatment or surgical intervention. The majority of these cases successfully heal with conservative managemant, even though it was claimed that the henirated disc material would not resolved spontaneously without surgical removal. It was reported that there was no significant difference in outcome and cost effectiveness between conservative and surgical therapy group. Also after conservative therapy the resorption of herniated disc with satisfactory improvement of symptom was reported. Conservative treatment includes bed rest, heat, drug therapy, therapeutic exercises, physical therapy such as traction and manipulation, and acupuncture. These managements show favorable outcome in the patients with herniated lumbar intervertebral disc. So conservative management should be applied in the therapy of herniated intervertebral disc, unless there exist aggravation during the first 3 weeks of treatment or apparent surgical care indication. And further investigation to improve effectiveness of conservative therapy should be ensued.

• 대한족부족관절학회지
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• 제23권1호
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• pp.6-11
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• 2019

As a result of the increased participation in recreational and competitive sports activity, the incidence of chronic lateral instability has risen. Because chronic ankle instability can cause significant comorbidity and increase the social cost, the interest in this issue is growing. Although there are well-documented and effective surgical treatments for managing this condition, conservative treatments are a viable first option in selected patients. Through conservative treatment, surgical treatments can be reduced or delayed without necessarily affecting the overall outcome, but the failure of conservative treatment results in the need for surgical treatment to reduce the long term complications. Appropriate postoperative rehabilitation is essential for adequate functional recovery, even when surgical treatment is required.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.309-315
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• 2015

Objective : An advantage of surgical treatment over conservative treatment of spontaneous intracerebral hemorrhage (ICH) is controversial. Recent reports suggest that contrast extravasations on CT angiography (CTA) might serve as a crucial predictor of hematoma expansion and mortality. The purpose of this study was aimed at investigating the efficacy of surgical treatment in patients with spot sign positive ICH. Methods : We used our institutional medical data search system to identify all adult patients who admitted for treatment of ICH between January 1, 2007 and January 31, 2012. Patients were classified two groups into a surgical group (n=27) and a conservative treatment group (n=28). Admission criteria were the following: age 20-79 years, spontaneous supratentorial ICH, Glasgow Coma Score Ranging from 9 to 14, ICH volume ${\geq}20mL$, and treatment within 24 hours. Results : Fifty-five patients were analyzed. There was no significant difference in the ICU stay between the conservative treatment group ($7.36{\pm}3.66days$) and the surgical treatment group ($6.93{\pm}2.20days$; p=0.950). There was a significant difference in the in-hospital stay between the conservative treatment group ($13.93{\pm}8.87days$) and the surgical treatment group ($20.33{\pm}6.37days$; p=0.001). Overall mortality at day 90 after ICH was 36.4%; this included 16 of 28 patients (57.1%) in the conservative group and 4 of 27 patients (14.8%) in the surgical group. In univariate analysis, there was a positive effect of the surgical treatment in reducing mortality at 90 days (p=0.002), Glasgow Outcome Scale (GOS) at 90-day (p=0.006), and modified Rankin Scale (mRS) at 90-day (p=0.023). In multivariate logistic analysis, there was a significant difference in mortality (odds ratio, 0.211; 95% confidence interval, 0.049-0.906; p=0.036) between the groups at 90-day follow-up. However, there was no significant difference in GOS (odds ratio, 0.371; 95% confidence interval, 0.031-4.446; p=0.434) and mRS (odds ratio, 1.041; 95% confidence interval, 0.086-12.637; p=0.975) between the groups at 90-day follow-up. Conclusion : In this study of surgical treatment of supratentorial ICH in patients with spot sign positive in CTA was associated with less mortality despite of long duration of in-hospital stay. We failed to show that clinical outcome benefit of surgical treatment compared with conservative treatment in patients with spot sign positive ICH.

• 대한족부족관절학회지
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• 제27권3호
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• pp.87-92
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• 2023

Purpose: Concomitant ankle injuries associated with tibial shaft fractures can affect postoperative ankle joint pain and various postoperative ankle complications. This study compared the clinical outcomes between surgical treatment and conservative treatment of concomitant ankle injuries associated with tibial shaft fractures. Materials and Methods: From January 2015 to June 2020, a retrospective study was conducted on 118 tibia shaft fractures at the orthopedics department of the hospital. Associated ankle injuries were analyzed using plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative stress exams. The clinical outcomes were compared using the pain visual analog scale (pain VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score (AOFAS score), and Karlsson-Peterson ankle score (KP score). Results: Seventy-two (61.02%) of the 118 cases were diagnosed with associated ankle injuries. Fifty-six cases underwent surgery for the ankle injury, and 16 cases underwent conservative treatment. The clinical results (according to the pain VAS score, AOFAS score, the KP score) were 1.79±1.26, 94.48±4.03, and 94.57±3.60, respectively, in the surgical treatment group, and 3.00±1.03, 91.06±3.02, and 91.25±3.31, respectively, in the conservative treatment group. Conclusion: Surgical treatment showed better clinical outcomes than conservative treatment in concomitant ankle injury in tibia fractures. Therefore, surgical treatment produces better clinical outcomes than conservative treatment in concomitant ankle injuries in tibia fractures. Hence to improve the clinical outcomes, more attention is needed on ankle joint injury in tibial shaft fractures for selecting suitable surgical treatments for those patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권5호
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• pp.242-247
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• 2018

Ameloblastoma treatment varies based on the clinical, histopathologic, and radiographic characteristics. Aggressive surgical treatments, such as marginal or segmental resection, have traditionally been implemented, but some conservative surgical methods are also being introduced, including decompression, enucleation, or curettage. The aim of the present study was to evaluate the possibility of applying these conservative surgical treatments to ameloblastoma and to analyze the prognosis of the procedures and their healing aspects. Among all patients who visited our clinic (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong) from 2009 to 2017, three who had undergone conservative surgery were recruited. One of these three patients underwent both excision of the lesion and an iliac bone graft during the same procedure. In the other two patients, due to the size of the lesion, decompression was performed to reduce the size of the lesion, and then conservative surgical treatments followed. As shown in the cases of this study, patients were only treated with conservative surgical methods, such as decompression or enucleation. During the follow-up period, there were no recurrences. In conclusion, the use of conservative surgical treatment in ameloblastoma can be a reliable, safe, and successful method.

• Restorative Dentistry and Endodontics
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• 제40권1호
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• pp.79-84
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• 2015

This case report presents surgical endodontic management outcomes of maxillary incisors that were infected via the lateral canals. Two cases are presented in which endodontically-treated maxillary central incisors had sustained lateral canal infections. A surgical endodontic treatment was performed on both teeth. Flap elevation revealed vertical bone destruction along the root surface and infected lateral canals, and microscopy revealed that the lateral canals were the origin of the lesions. After the infected lateral canals were surgically managed, both teeth were asymptomatic and labial fistulas were resolved. There were no clinical or radiographic signs of surgical endodontic management failure at follow-up visits. This case report highlights the clinical significance and surgical endodontic management of infected lateral canal of maxillary incisor. It is important to be aware of root canal anatomy variability in maxillary incisors. Maxillary central incisors infected via the lateral canal can be successfully managed by surgical endodontic treatment.

• Journal of Korean Dental Science
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• 제16권2호
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• pp.211-217
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• 2023

Fibrous dysplasia (FD) accompanying osteomyelitis (OM) has been reported to result in recurrent, refractory pain and swelling. Although radical resection of the lesions has been suggested, effective surgical treatment strategies have not yet been established due to the limited number of studies on this pathological condition. In this report, we present the conservative surgical management of FD accompanying OM in two patients who exhibited recurrent signs and symptoms. The present report suggests that OM occurring in patients with FD can be successfully managed with conservative surgical treatment and following removal of the odontogenic origin although bone defect in which inflammatory fibro-osseous lesions is removed through decompression surgery may exhibit regeneration of dysplastic bone. In addition, for the prevention of OM in patients with FD, careful clinical examination and thorough management of dental-related pathologies are necessary with regular follow-up examinations to screen for the possibility of malignant changes.

• 대한소아치과학회지
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• 제40권4호
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• pp.328-334
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• 2013

각화낭성 치성종양은 국소적으로 공격적이고, 높은 재발률을 가지며 뚜렷한 조직학적 특성이 있는 낭성 병소로 다양한 치료 방법이 사용되고 있다. 몇몇 학자들은 공격적인 형태의 치료방법을 주장하지만, 또 다른 학자들은 보존적인 치료를 선호한다. 본 증례들은 미맹출 치아를 가진 소아 환자들에게 보존적 외과적 방법인 조대술과 낭종 적출술을 이용하여 각화낭성치성종양을 치료하였고, 주기적인 검진을 시행중에 있다. 보존적 외과적 치료를 이용하여 각화낭성 치성종양을 치료하는 경우 치아와 해부학적 구조를 보호할 수 있어 소아 청소년 환자의 경우에게 좋은 치료 선택이 될 수 있다.

• 대한기관식도과학회지
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• 제9권2호
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• pp.49-55
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• 2003

Background and Objectives : Traditionally incision and drainage is considered to be standard treatment of deep neck infection. But antibiotics and diagnostic technique are developed recently, there are reports that conservative therapy could be as successful as open surgical drainage. The purposes of this study has been to assess clinical feature between surgical therapy group and conservative therapy group through statistical analysis. Materials and Methods : A retrospective study was performed on 46 cases of deep neck space abscess, which were confirmed CT, in patients admitted from January 1999 to June 2002. Result : About 80% of all are treated with conservative therapy. Erythrocyte sediment rate, volume of abscess and duration of hospitalization of conservative therapy group are decreased than those of surgical therapy group. Conclusions : Conservative therapy is expected to be effective on treatment of early stage, small sized deep neck infection. But its complication can lead to serious condition of patient it should be done under meticulous observation.