• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.146-150
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• 2010

Purpose: Pilon fracture has several serious complications such as joint stiffness, arthrosis and delayed angular deformity. We report short-term results of new treatment modality using distracted dynamic external fixators and early controlled ankle motion. Materials and Methods: Eight cases of severe pilon fractures for which we tried small plate fixation and additional distracted dynamic external fixators from July 2007 to June 2009 were included. Half passive continuous ankle joint motion was allowed under free hinged ring fixators after the operation. The external fixators were removed after two or three months from the surgery. We investigated joint space by radiograph, joint pain, range of motion, patient's satisfaction of treatment protocol. Results: Joints were distracted when external fixators were applied and mean 28% of space loss developed after removal of external fixators. In most of cases, satisfactory alignments were maintained. Regarding range of joint motion, mean dorsiflexion angle was 15 degrees and mean plantarflexion angle was 32 degree in the condition of wearing external fixators. There was mean 8% reduction of range of motion but no further progression of ankle stiffness after removal of external fixators. Dorsiflexion was not improved after that, but plantarflexion angle was improved 10% even after removal of external fixators. Patients were generally in compliance with the treatment protocols with high level of satisfaction. Conclusion: We got good results with distracted dynamic external fixators and early continuous half-passive joint motion for pilon fractures in terms of joint pain and range of motion. Therefore we suggest this new protocol as an alternative modality for severe pilon fractures.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.255-261
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• 2019

Cross-leg flaps are a useful reconstructive option for complex lower limb defects when free flaps cannot be performed owing to vessel damage. We describe the use of the extended distally based sural artery flap in a cross-leg fashion for lower extremity coverage in three patients. To maximise the viability of these extended flaps, a delay was performed by raising them in a bipedicled fashion before gradual division of the tip over 5 to 7 days for cross-leg transfer. Rigid coupling of the lower limbs with external fixators was critical in preventing flap avulsion and to promote neovascular takeover. The pedicle was gradually divided over the ensuing 7 to 14 days before full flap inset and removal of the external fixators. In all three patients, the flaps survived with no complications and successful coverage of the critical defect was achieved. One patient developed a grade 2 pressure injury on his heel that resolved with conservative dressings. The donor sites and external fixator pin wounds healed well, with no functional morbidity. The cross-leg extended distally based sural artery flap is a reliable reconstructive option in challenging scenarios. Adequate flap delay, manoeuvres to reduce congestion, and postoperative rigid immobilization are key to a successful outcome.

• Journal of Veterinary Clinics
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• v.18 no.2
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• pp.164-166
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• 2001

An eight-month old female mixed breed dog was presented to the at Gyeongsang National University Animal Hospital, for tarsocrural arthrodesis. Previously the dog had been presented to a local animal clinic. Orthopedic and blood examinations were conducted. There was absent response of conscious proprioception on the right tarsocrural articulation. The dog stood knuckled onto the digits and had hock dropped but showed normal values in WBC, RBC, Hb, PCV, BUN, creatine, glucose, cholesterol, AST and ALT analyses. The dog was anesthetized and prepared for aseptic surgery. Steinmann pin and Joshi external fixators were applied(bilaterally). 11 weeks after the operation, the external fixators were removed from the bones. The hock dropped was well stabilized, but mild knuckling of distal metatarsopharangeal joint was remained.

• Proceedings of the KOSOMBE Conference
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• v.1991 no.11
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• pp.109-112
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• 1991

• Transactions of the Korean Society of Mechanical Engineers
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• v.15 no.2
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• pp.436-444
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• 1991

A computational method has been developed to analyze the bone-remodeling induced by external fixator. The method was based on the Finite Element Method (FEM) in combination with numerical formulation of adaptive bone-remodeling theories. As a feed-back control variable, compressive strain and effective stress were used to determine the surface remodeling and internal (density) remodeling respectively. Surface remodeling and internal remodeling were combined at each time step to predict the rel situation. A noticeable shape and density change were detected at the region between two pins and density change was decreased with time increment. At final time step, the shape and density distribution were converged closely to its original intact bone model. Similar change was detected in stress distribution. The altered stress distribution due to the pin and external fixator converged to the intact stress distribution with time.

• Journal of Biomedical Engineering Research
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• v.25 no.6
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• pp.531-536
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• 2004

In fracture treatment with external fixators, the inter-fragmentary movements at the fracture site affect the fracture healing process, and these movements are highly related to the stiffness of external fixation systems. Therefore, in order to provide the optimal fracture healing at the fracture site, it is essential to understand the relationship between the stiffness and the system configurations in external fixation system. In this study we investigated the influences of system configuration parameters on the stiffness in the finite element analysis of an external fixation system of a long bone. The system alignment, the geometric and the material non-linearity of the pin, the joint stiffness and the callus formation were considered in the finite element model. In the first, the system stiffness of the developed finite element model was compared with the experiment data for model validation. The consideration of the joint stiffness and nonlinearity of the model improved the system stiffness results. The joint stiffness, the non-alignment of the system decreased the system stiffness while the callus formation increased the system stiffness. The present results provided the biomechanical basis of rational guidelines for design improvements of external fixators and pre-op. planning to maximize the system stiffness in fracture surgery.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.298-303
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• 2023

Unstable pelvic ring injuries are potentially life-threatening and associated with high mortality and complication rates in polytrauma patients. The most common cause of death in patients with pelvic ring injuries is massive bleeding. With resuscitation, external fixation can be performed as a temporary stabilization procedure for hemostasis in unstable pelvic fractures. Internal fixation following temporary external fixation of the pelvic ring yields superior and more reliable stabilization. However, a time-consuming extended approach to open reduction and internal fixation of the pelvic ring is frequently precluded by an unacceptable physiologic condition and/or concomitant injuries in patients with multiple injuries. Conservative treatment may lead to pelvic ring deformity, which is associated with various functional disabilities such as limb length discrepancy, gait disturbance, and sitting intolerance. Therefore, if the patient is not expected to be suitable for additional surgery due to a poor expected physiologic condition, definitive external fixation in combination with various percutaneous screw fixations to restore the pelvic ring should be considered in the acute phase. Herein, we report a case of unstable pelvic ring injury successfully treated with definitive external fixation and percutaneous screw fixation in the acute phase in a severely injured polytrauma patient.

• Journal of the Korean Orthopaedic Association
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• v.54 no.5
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• pp.457-462
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• 2019

The treatment of a brachymetacarpia using conventional distraction osteogenesis requires holding an external fixator following distraction for stability, which causes prolonged discomfort that adversely affects the patient's daily activities. This paper reports a case of a 20-year-old male of brachymetacarpia treated with distraction osteogenesis combined with a plate reducing the period of an external fixator, allowing rapid return to the daily activities, and presenting good clinical results.

• Journal of Veterinary Clinics
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• v.31 no.6
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• pp.523-526
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• 2014

Three dogs were admitted for repair of bone fracture. Case 1 (Maltese, 1.8 kg, intact female, 5-month-old) and case 2 (poodle, 3.0 kg, intact female, 6-month-old) had non-weight bearing lameness in the left pelvic limb, and case 3 (mixed, 3.3 kg, intact female, age unknown) had non-weight-bearing lameness in the left thoracic limb. On orthopedic examination, there was pain, crepitus, palpable instability and substantial soft tissue swelling on the affected side. No neurological deficits were identified. Radiographs revealed left proximal metaphyseal tibial and fibular fractures in cases 1 and 2, and left proximal metaphyseal radial and ulnar fractures in case 3. All cases had closed long-bone fractures with short juxta-articular fracture segments. Under fluoroscopic guidance, proper placement of the ring fixation elements was confirmed during surgery. Two or three rings were used to stabilize fractures with traditional circular external skeletal fixators (CESF). Postoperative radiographs showed acceptable alignment and apposition of the previously identified fracture. Time to radiographic union ranged from 5 to 14 weeks and there were no signs of implant failure or pin tract infection. Functional outcomes were excellent in all cases. CESF can be successfully used to reduce short juxta-articular fractures in which bone plates or external skeletal fixation cannot be applied.

• Archives of Craniofacial Surgery
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• v.15 no.2
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• pp.53-58
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• 2014

Background: Maxillomandibular fixation (MMF) is usually used to treat double mandibular fractures. However, advancements in reduction and fixation techniques may allow recovery of the premorbid dental arch and occlusion without the use of MMF. We investigated whether anatomical reduction and microplate fixation without MMF could provide secure immobilization and correct occlusion in double mandibular fractures. Methods: Thirty-four patients with double mandibular fractures were treated with open reduction and internal fixation without MMF. Both fracture sites were surgically treated. For bony fixations, we used microplates with or without wire. After reduction, each fracture site was fixed at two or three points to maintain anatomical alignment of the mandible. Interdental wiring was used to reduce the fracture at the superior border and to enhance stability for 6 weeks. Mouth opening was permitted immediately. Results: No major complications were observed, including infection, plate exposure, non-union, or significant malocclusion. Five patients experienced minor complications, among whom the only one patient experienced a persistant but mild malocclusion with no need for additional management. Conclusion: This study showed that double mandibular fractures correction with two-or three-point fixation without MMF simplified the surgical procedure, increased patient comfort, and reduced complications, due to good stability and excellent adaptation.