• 한국임상수의학회지
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• 제39권6호
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• pp.378-383
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• 2022

A 3-year-old, 24-kg intact female Border Collie was referred for a toe-touch weight-bearing stance, intermittent weight-bearing lameness, and moderate pain reaction of the right forelimb on physical examination and right humerus olecranon avulsion fracture on diagnostic imaging examination. Surgical repair was performed using tension band wiring to re-attach the triceps tendon and distal olecranon. Migration of the distal olecranon fragment was observed due to comminuted fracture of the fragment 5-days after surgery, and revision surgery was performed. The tension-relieving sutures were passed through the pre-drilled hole in the olecranon, and the polyester mesh was augmented to the suture region, covering the triceps tendon and olecranon drilling hole using the Krackow suture pattern. The elbow joint was immobilized using a type IA transarticular external fixator, which was removed 8 weeks after surgery. Fourteen weeks after surgery, no lameness was observed on gait evaluation. At follow-up after 7 months, the distal olecranon fragment had stabilized, and no lameness was observed.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.1-6
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• 2010

목적: 상완골 간부 골절에서의 전향적 교합성 골수강내 금속정 고정술의 치료 결과 및 합병증에 대하여 알아 보고자 한다. 대상 및 방법: 2002년부터 2008년까지 상완골 간부 골절로 전향적 교합성 골수강내 금속정 고정술을 시행하고 골유합 기간까지 추시 관찰이 가능하였던 47예를 대상으로 임상적, 방사선학적 결과 및 술 후 합병증을 분석하였다. 술 후 추시 단순 방사선 검사로 골유합을 확인하였고, ASES 점수 평가법을 이용하여 임상적 평가를 시행하였다. 결과: 총 47예 중 41예 (87.2%)에서 골유합을 보였고, 평균 유합 시기는 14.5주였다. 주요 합병증으로 불유합이 6예, 지연 유합이 3예, 술 중 원위 상완골 후방 피질 골절이 2예, 견관절 유착성 관절막염이 1예를 포함한 영구적 견관절 동통이 2예 있었다. 임상적 결과는 우수가 29예, 양호가 11예, 보통이 4예, 불량이 3예로, 40예 (85.1%)에서 만족할 만한 결과를 보였다. 결론: 상완골 간부 골절에서의 전향적 교합성 골수강내 금속정 고정술은 만족할만한 골유합율 및 임상적 결과를 나타내었으며, 특히 다발성 골절 등의 동반 손상이 있는 경우 또는 분절 골절에서 유용한 하나의 치료 방법이라 사료된다.

• Journal of Trauma and Injury
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• 제36권1호
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• pp.65-69
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• 2023

The surgical approach for humeral implant failure can be challenging due to neurovascular anatomy and the possible necessity of osteosynthesis removal. We present a rare case of humeral nail bending after secondary trauma in a patient with preexistent nonunion of the humerus after intramedullary nailing. During revision surgery, the nail was sawed in half and the distal part was removed, followed by plate osteosynthesis with cable fixation to achieve absolute stability. The patient regained a full range of motion 1 year after surgery, and complete healing of the fracture was seen on imaging.

• Clinics in Shoulder and Elbow
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• 제16권1호
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• pp.33-39
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• 2013

목적: 고령 환자의 상완골 원위부 골절에서 이중 강선 장력대 고정술을 이용한 수술의 임상적 결과를 분석하여 그 유용성을 알아보고자 한다. 대상 및 방법: 상완골 원위부 골절 환자 중 AO 분류상 C형 골절과 골다공증을 가진 65세 이상의 고령 환자에서 이중 강선 장력대 고정술을 이용해 관혈적 정복과 내고정을 시행 받은 10예를 대상으로 하였다. 남자가 1명, 여자가 9명이었으며 평균 연령은 74.6(66~84)세였다. 평균 추시 기간은 39.2(20~74)개월이었다. 골유합 유무, 시기와 주관절의 운동 범위를 측정하였고, Mayo 주관절 수행 점수, Jupiter 등에 의한 평가법을 이용하여 기능 상태를 평가하였다. 결과: 골유합은 10명에서 2차적인 전위 없이 이루어졌고, 평균 골유합 기간은 16.6(13~22)주였다. 최종 추시시 측정한 평균 주관절 운동범위는 굴곡 구축은 8.5 (0~15)도, 후속 굴곡 119(100~140)도, Mayo 주관절 수행 점수는 82(70~90)점으로 각각 우수 2예(20%), 양호 7예(70%), 보통 1예(10%)였다. Jupiter 등에 의한 평가법을 따르면 각각 우수 7예(70%), 양호 1예(10%), 보통 2예(20%)였다. 1예에서 이소성 골화가 있었으나 그에 따른 증상은 동반되지 않아 추시 관찰하기로 하였으며, 1예에서 강선에 대한 피부 자극 증상이 발생하여 장력대 강선 교체 수술을 시행하였다. 결론: 골다공증을 가진 고령 환자의 상완골 원위부 C형 골절의 수술적 치료에서 이중 강선 장력대 고정술은 견고한 고정과 동시에 조기 관절 운동을 가능하게 하여 효과적이며 우수한 치료법으로 사료된다.

• Clinics in Shoulder and Elbow
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• 제19권4호
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• pp.229-236
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• 2016

Background: Cubitus varus and cubitus valgus deformities are common complications of distal humeral fractures in children. We evaluated the usefulness of supracondylar dome osteotomy as a treatment option for adults with cubitus varus or valgus deformity developed during childhood. Methods: Ten patients who had received supracondylar dome osteotomy and stabilization with plates to treat cubitus varus or valgus deformity between July 2006 and August 2013 were included in this study. Their mean age at the time of surgery was $36.50{\pm}10.22years$. The mean follow-up duration was $54.80{\pm}32.50months$. We evaluated humerus-elbow-wrist angles (HEWA), improvements in the lateral prominence index (LPI) or medial prominence index (MPI), Mayo elbow performance scores (MEPS), and overall results in accordance with the Banerjee criteria. Results: For the six patients with cubitus varus, the mean postoperative HEWA, mean correction angle, and mean improvement in LPI were $9.72^{\circ}{\pm}3.95^{\circ}$, $27.67^{\circ}{\pm}10.75^{\circ}$, and $6.92%{\pm}3.40%$, respectively. For the four patients with cubitus valgus, the mean postoperative HEWA, mean correction angle, and mean improvement in MPI were $14.73^{\circ}{\pm}2.97^{\circ}$, $11.55^{\circ}{\pm}3.26^{\circ}$, and $11.33%{\pm}6.39%$, respectively. There was no significant difference between postoperative and preoperative mean MEPS. The subjective ulnar nerve symptoms were alleviated in all patients. The overall results were excellent in six and good in four patients. Conclusions: This study suggests that supracondylar dome osteotomy with secure fixation using double plates may be useful in correcting cubitus varus or cubitus valgus deformity, yielding good functional outcomes in adults.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.163-169
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• 2013

Purpose: This study was conducted to confirm the anatomic conformity of the new periarticular locking plates designed by Zimmer on Korean adult bones and to identify the structures at risk during the application of these implants. Methods: The study was performed on the humerus, radius, and tibia of 10 adult cadavers(6 males and 4 females) procured from the cadaveric lab of our hospital. Anteroposterior (AP) and lateral X-rays were taken to confirm that the cadavers were free of any unusual lesions or anatomic variations. We used the 3.5-mm proximal humerus plate, 2.7-mm distal radius plate, 3.5- and 5.0-mm proximal tibia plates, and 3.5-mm distal tibia plate developed by Zimmer, Inc. (Zimmer periarticular locking plate). The longest plate from each group was used to confirm anatomical conformity. Standard approaches were used for each area, and soft tissue was retracted in order to pass the plate beneath the muscle. The position of the plate was confirmed using standard AP and lateral view X-rays. After this procedure had been completed, the region was dissected along the length of the implant to determine the conformity of the implant to bone and the penetrations of screws into the articular surface or violations of any vital structures, such as nerves, blood vessels, or tendons. Results: Excellent anatomical conformity was observed with Zimmer periarticular locking plates for Korean adults. The tibial nerve and the posterior tibial artery were found to be structures at risk when applying a distal tibial plate. Conclusion: Additional posterolateral fixation is recommended when dealing with cases of tibial plateau fracture when the fracture line extends to the posterolateral cortex. We recommend taking proper views using 10~15 degrees of internal rotation to ensure correct screw length and, thus, avoid penetration of vital structures and tendons.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.41-49
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• 2015

Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.

• Archives of Reconstructive Microsurgery
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• 제19권2호
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• pp.93-96
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• 2010

We report a case of 44 years old male patient with neuroma-in-continuity of ulna nerve. In the patient's past history, he had received operative treatment for the open supracondylar fracture of right distal humerus and ulnar nerve injury at 10 years ago, and neurolysis was tried 2 times due to severe neuropathic pain. Despite of these operations, the symptom was not improved. In operative field, we noticed neuroma-in-continuity and decided to resect the neuroma until normal nerve fascicle was noted. The nerve cable graft was done with auto sural nerve on the defect site and the nerve was wrapped with small saphenous vein. At post operative 7 months, pain was markedly decreased and sensory recovery was slightly improved and patient was satisfied with the result.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.3-10
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• 2024

Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.

• Clinics in Shoulder and Elbow
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• 제14권1호
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• pp.146-152
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• 2011

목적: 주관절 전지환 성형술의 최근 수술 결과와 합병증에 대하여 문헌을 토대로 기술하고자 한다. 대상 및 방법: 주관절 전치환술의 적응증은 다른 수술 방법으로 관절 기능의 회복이 불가능한 류마토이드 관절염, 외상후 관절염, 관절 강직, 종양 제거 후 상태, 그리고 고령의 원위 상완골 분쇄 골절 등이 있다. 합병증으로는 가장 심각한 합병증인 감염을 비롯하여 삽입물 이완, 삽입물 골절, 삽입물 주위 골절, 척골 신경병증, 이소성 골화, 상완 삼두근 손상, 탈구를 포함한 불안정, bushing의 마모 등이 있다. 결과 및 결론: 재치환술을 기준으로 한 주관절 치환술의 수명은 10년을 기준으로 85% 정도인 것으로 알려져 있다. 염증성 관절염이 가장 예후가 좋으며 외상후 관절염의 이완율이 비교적 높다. 합병증은 다른 관절의 치환술에 비해 많이 발생하는 경향이 있으며 특히 심부 감염은 3~5% 정도로 높은 편이다. 주관절 치환술은 재건술로 관절 기능을 회복할 가능성이 없는 활동력이 높지 않은 환자에 대해 신중하고 적절하게 시행한다면 만족스러운 기능 회복을 기대할 수 있다.