• Journal of Veterinary Clinics
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• v.23 no.3
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• pp.291-299
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• 2006

During long bone lengthening, there are many disadvantages including axial deviation, malalignment and re-fracture which are commonly encountered inspite of its proven abilities. To study the effects of intramedullary K-wire application on the lengthening of long bone, ten skeletally mature mongrel dogs were separated into two groups(Group I, II). Right femurs of group I(5 dogs) were fixed with only monolateral external fixator after subperiosteal osteotomy. Right femurs of group II(5 dogs) were fixed with mono lateral external fixator and intramedullary K-wire after subperiosteal osteotomy. Lengthening was started at 7 days after the surgery with the rate of 0.5 mm per day for 5 weeks and the dogs were sacrificed after 15 weeks postoperatively to examine histologic differences and evaluate bone mineral density. Radiographic examination at an interval of two weeks was done to evaluate the type of callus formed and to analyze complications including instability of external skeletal fixation and axial deviation. Bone mineral density at the lengthened area and contralateral nonlengthened area were measured using quantitative computerized tomography. Histological examination of regenerated bone was performed using Masson's trichrome stain method. The radiographs demonstrated poor callus formation, higher incidence of axial deviation and screw loosening in the group I compared to the group II. The bone mineral density at the lengthened area in the group II was higher than that of the group I(P<0.05). Histological examination showed that the new bone trabeculae in the group II were greater than that of the group I. In conclusion, the combination of monolateral external fixator and intramedullary K-wire can prevent pin loosening, axial deviation and reduce healing period in dogs.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.156-160
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• 2002

Purpose : To evaluate the results and usefulness of meniscal repair using meniscal arrows with ACL reconstruction. Material and Methods : Among cases of the simultaneous meniscal arrow fixation and ACL recontruction performed between May, 1997 and September, 2000, 17 cases could be evaluated. The average follow-up were 18.5 months. Twelve cases were medial meniscus, 5 cases, lateral meniscus. All cases were longitudinal tear. Meniscal tear were seen at red-red zone in 13 cases, red-white zone in 5 cases. The results were analyzed by pain, joint line tenderness, locking, McMurray test, the Marshall knee scoring scale and complications. Results : Postoperatively two patients had mild joint line tenderness without pain on joint motion or weight bearing. No patient had locking or positive McMurray test. At last follow-up, 15 cases $(88\%)$ were 'excellent' or 'good' according to the Marshall knee score scale. There were two complications which are soft tissue irritation sign on active knee motion and a femoral chondral injury due to protruded T-shaped head of meniscus arrow. Conclusion : Meniscus arrow can be one of the options in repairing the associated meniscus tear, especially the posterior horn of medial meniscus, during ACL reconstruction. However, surgeons using meniscus arrow should be aware of its potential complications such as pain due to soft tissue irritation and chondral damage of the femoral condyle.

• Journal of Veterinary Clinics
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• v.28 no.3
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• pp.323-327
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• 2011

A Jindo dog (8-month-old, intact male) was referred for hind limb lameness on the right side. The dog was diagnosed with a simple femoral fracture by radiological examination. After surgical fixation of the femoral fracture, tramadol: a narcotic-like synthetic analgesic was intravenously administrated for post-operative analgesia. After injection of the tramadol, generalized tonic clonic seizure was immediately occurred in the dog. Seventeen hours later, the dog died despite intensive care. We suspected that tramadol might induce the seizurogenic effect resulted in death. A necropsy was performed to examine the cause of the death. In consequence, the dog was diagnosed as necrotizing meningoencephalitis (NME) based on histopathological examination. We would be concerned that tramadol may be related to seizure activity in the NME patient. From this case, it is known that although tramadol has been proven to be a safe and effective agent for the control of pain in veterinary medicine, it would be carefully used to patient with history of neurological diseases including meningoencephalitis, hydrocephalus, and encephalopathy.

• Journal of Biomedical Engineering Research
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• v.31 no.3
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• pp.199-209
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• 2010

The locking compression plates-distal femur(LCP-DF) are being widely used for surgical management of the extra-articular complex fractures of the distal femur. They feature locking mechanism between the screws and the screw holes of the plate to provide stronger fixation force with less number of screws than conventional compression bone plate. However, their biomechanical efficacies are not fully understood, especially regarding the number of the screws inserted and their optimal configurations. In this study, we investigated effects of various screw configurations in the shaft and the condylar regions of the femur in relation to structural stability of LCP-DF system. For this purpose, a baseline 3-D finite element (FE) model of the femur was constructed from CT-scan images of a normal healthy male and was validated. The extra-articular complex fracture of the distal femur was made with a 4-cm defect. Surgical reduction with LCP-DF and bone screws were added laterally. To simulate various cases of post-op screw configurations, screws were inserted in the shaft (3~5 screws) and the condylar (4~6 screws) regions. Particular attention was paid at the shaft region where screws were inserted either in clustered or evenly-spaced fashion. Tied-contact conditions were assigned at the bone screws-plate whereas general contact condition was assumed at the interfaces between LCP-DF and bone screws. Axial compressive load of 1,610N(2.3 BW) was applied on the femoral head to reflect joint reaction force. An average of 5% increase in stiffness was found with increase in screw numbers (from 4 to 6) in the condylar region, as compared to negligible increase (less than 1%) at the shaft regardless of the number of screws inserted or its distribution, whether clustered or evenly-spaced. At the condylar region, screw insertion at the holes near the fracture interface and posterior locations contributed greater increase in stiffness (9~13%) than any other locations. Our results suggested that the screw insertion at the condylar region can be more effective than at the shaft during surgical treatment of fracture of the distal femur with LCP-DF. In addition, screw insertion at the holes close to the fracture interface should be accompanied to ensure better fracture healing.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.141-147
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• 2006

Purpose: To compare the clinical and radiological results of anterior cruciate ligament(ACL) reconstruction using hamstring autograft and tibialis tendon allograft. Materials and Methods: Twenty four ACL reconstructions using hamstring autograft and 30 using tibialis anterior tendon altograft were followed up at least 1 year. We performed femoral tunnel fixation with Ligament Anchor(LA) screw and tibial tunnel fixation with biodegradable interference screw. Evaluations included Lysholm knee(LK) score, Tegner activity scale, Lachman test, Pivot-Shift test, Quardriceps atrophy, incision site numbness, anterior knee pain and instrumented anterior laxity with $Telos^{(R)}$ device. Results: Preoperativ mean LK score was $60.3(18{\sim}82)$ in autograft group and 61.2(25-80) in allograft group. Mean LK score improved to $91.6(68{\sim}100)\;and\;92.6(77{\sim}100)$ respectively. Activity level, using Tegner activity scale, slightly decreased compared with that of Preinjury state in both groups. Lachman test, pivot-shift test, Quadriceps atrophy, anterior knee pain, incision site numbness, and anterior drawer test using $Telos^{(R)}$ device showed no significant difference between two groups (p>0.05). Conclusion: In performing the ACL reconstruction, there was no statistically significant difference between hamstring autograft group and tibilis anterior allograft group in clinical or in radiological results.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.165-172
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• 2006

Purpose: The purpose of this study is to evaluate the effects of intratunnel fixation in the tibial side on the arthroscopic ACL reconstruction with quadruple hamstring tendon at the second look arthroscopy. Materials and Method: From Dec 1999 to May 2005, we arthroscopically reexamined 32 cases who had been done arthroscopic ACL reconstruction with quadruple hamstring tendons. Hamstring tendons of all cases were fixed at femoral side with RigidfixTM. At the tibial side hamstring tendons were fixed only Post-tie (Group I) or Post-tie combined with IntrafixTM (Group II). At the time of second look arthroscopy mean age of cases was 30 years and mean duration for second look arthroscopy was 21.3 months. We analyzed the results with IKDC score, KT-1000 arthrometer under anesthesia, Telos stress radiography, tibial tunnel widening on the radiography and second look arthroscopic findings. Results: Group II had more superior than group I at side to side differences with KT-1000 and Telos stress radiograph, IKDC score, but the differences were insignificant. At arthroscopic evaluation, Group ll also had more superior than group I at graft tension and graft appearance, graft synovialization, but the differences were insignificant. Tibial tunnel widening in the knee AP radiograph was 2.3 mm in Group I and 1.7 mm in Group II and the difference was significant. (P=0.042) Conclusions: Additional procedure of tibial intratunnel fixation in arthroscopic ACL reconstruction with autogenous hamstring tendon significantly prohibited from tibial tunnel widening but clinical results, radiologic joint stability, findings in second look arthroscopy were insignificantly different. We concluded that Post-tie itself induced satisfactory clinical results, joint stability and graft maturation and that tibial tunnel widening did not affect the results.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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• pp.45-51
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• 1995

The incidence of metastatic bony lesion has been increased recently, with the advanced therapeutic modalities of malignant tumors. The purpose of this study was to evaluate the effectiveness of surgical treatment in impending or established pathologic fractures due to metastasis in extremity. From 1981 to 1992, thirty two patients who had established or impending pathologic fractures in extremity had been treated surgically. The locations of metastasis, were lower extremity in 24 cases(femsral head and neck;5, intertrochanteric;7, subtrochanteric;8, femoral shaft;4) and upper extremity in 8 cases(proximal humerus;2, humoral shaft;6). The method of surgery was excision of tumor mass and rigid internal fixation to allow immediate mobilization, except 2 cases of amputation. The results were analysed by two criteria. The first was the grade of performance status that was made by modification of Functional Classification of New York Heart Association. The second was the degree of pain relief. The performance status was improved at least one grade in all patients and the mean improvement was 1.7 grades. The satisfactory pain relief was achieved in 81% of patients. Postoperatively, most of the patients had only slight to moderate limitation of physical activities and they became comfortable at rest and ordinary activities. The solitary metastatic lesions showed better pain relief(92%) than multiple metastasis(75%). The curative surgery was done in 3 cases, and they showed more than 24 months of disease-free survival.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.413-419
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• 2018

Background: We aimed to examine the factors that influence synovialization of the grafted tendon after double-bundle anterior cruciate ligament (ACL) reconstruction based on second-look arthroscopic findings. Methods: Out of 205 knees that were treated between August 2008 and May 2016 with double-bundle ACL reconstruction using bio-absorbable cross-pins and Endobuttons for femoral tunnel fixation, we enrolled 65 knees (64 patients) that underwent second-look arthroscopy with hardware removal at 1 year postoperatively. Measured clinical outcomes included the Lysholm score and Tegner activity score that were evaluated preoperatively and during the final follow-up. We analyzed the relationship between synovial coverage and patient age, length of the preserved remnant tissue on the tibial side, type of bundle (anteromedial or posterolateral), type of graft (autograft or allograft), and time from injury to surgery. Results: The area of synovial coverage showed a significant statistical correlation with patient age and the length of the preserved remnant tissue on the tibial side. The average synovial coverage was significantly better for the anteromedial bundle than for the posterolateral bundle, better for the autograft than for the allograft reconstruction, and better when treated in the acute stage than in the chronic stage. However, synovialization of grafted tendon did not correlate to clinical outcomes. Conclusions: While we were able to identify several factors influencing synovialization of the grafted tendon after double-bundle ACL reconstruction, including patient age, length of preserved remnant tissue of the torn ACL, type of bundle, type of graft, and time from injury to surgery, we found no evidence that increased synovialization improves clinical outcomes at 1 year postoperatively.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.193-199
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• 2020

A gamma nail has been used to treat intertrochanteric fractures since 1988. Although such cephalomedullary nails have mechanical advantages over extramedullary fixation devices, such as sliding hip screw, their beneficial effects on treating the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A1 and 31-A2 fractures are still controversial. During their 30-year history, many problems have been overcome, and new types of cephalomedullary nails have been introduced in clinical practice. New cephalomedullary nail systems facilitate nailing procedures and enhance the purchase capability of the femoral head by a lag screw. On the other hand, the failure rate still depends on the hands of the orthopedic surgeons. This review article focused on the basic principle of medial support and restoration of a medial buttress during the treatment of trochanteric fractures using a cephalomedullary nail.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1023-1030
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• 1998

Background: Calcific degeneration limits durabilities of the bioprosthetic tissues implanted in the human body. The direct coupling sulphonated polyethyleneoxide(PEO-SO3) to the bioprosthetic tissues after glutaraldehyde(GA) fixation and the removal of residual aldehyde groups from the tissues can augment the effect of calcification-resistance. Materials and methods: To study the anti-calcification effect by PEO-SO3 modification and the removal of the residual aldehyde groups of tissues, surface modified bovine pericardia(BP-PEO-SO3) were preserved in aseptic saline to wash out GA(saline group) and 0.65% GA solution(GA group). And then above two groups and PERIGUARD (Bio-vascular. Co.) (product group) were evaluated with respects to calcium contents and microscopic findings using in vivo implantation models at carotid and femoral artery and peritoneum of 8 adult dogs. Results: In the tissues retrieved from carotid artery, calcium content was significantly decreased in saline group than in other two groups(saline; 2.89±0.31 vs. GA; 6.14±1.08 vs. product; 22.82±5.00 mg/g of dried tissue; p<0.05). In the tissues retrieved from femoral artery and peritoneum, calcium amount was also decreased in saline group than in other two groups, but not reached the significant difference between groups. On the other hand, the pathologic findings of pericardial tissues showed marked destructuction in GA group compared to the other two groups. Conclusions: In this study, covalently PEO-SO3 bound to bovine pericardium decreased calcifications and the anti-calcification effect of BP-PEO-SO3 could be augmented by the washing out the residual aldehyde groups using saline after GA fixation. Conclusively, the PEO-SO3 modified bovine pericardium is highly resistant to calcification and can be useful for the development of calcification-resistant cardiovascular patches and valves.