• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.46-53
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• 2020

Purpose: Scapular body fractures have generally been treated with non-surgical methods. This study reports the clinical and radiological outcomes after lateral-posterior internal fixation for treating displaced scapular body fractures. Materials and Methods: From March 2007 to May 2017, out of 40 patients who underwent internal fixation for scapular fractures, 13 cases of lateral plate fixation of a scapular body fracture were reviewed retrospectively. Preoperative and postoperative displacement, angulation and glenopolar angle (GPA) were measured. The range of shoulder motion, visual analogue scale (VAS), and disabilities of the arm, shoulder, and hand (DASH), and Constant score were assessed at the last follow-up. Results: The mean follow-up period was 17.7 months (range, 6-45 months). The mean preoperative GPA was 23.3°±3.96° (range, 17.8°-28.1°) and the postoperative GPA was 31.1°±4.75° (range, 22.5°-40.1°). Injury to the suprascapular nerve, nonunion, fracture redisplacement, metallic failure, or infection did not occur. At the last follow-up, the mean range of motion was 150.5°±19.3° in forward flexion, 146.6°±2.34° in lateral abduction, 66.6°±19.1° in external rotation, and 61.6°±18.9° in internal rotation. The VAS, DASH, and Constant scores were 1.7±1.3, 6.2±2.4, and 86±7.9 points, respectively. Conclusion: A scapular body fracture with severe displacement, angulation and marked decreased GPA can be stabilized by lateralposterior plate fixation using the appropriate surgical technique with good functional and radiological results.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.42 no.4
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• pp.182-186
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• 2016

Objectives: The purpose of this study was to analyze the incidence of indications for the removal of mini-plates over a five-year period in maxillofacial trauma patients. Materials and Methods: The medical records of 530 patients who underwent treatment with mini-plate fixation after maxillofacial trauma were reviewed for a five-year period (May 2007 to May 2012). Patients were evaluated concerning the number of mini-plates removed, age and gender distributions, time between insertion and removal, indication for removal, and site of removal. Results: The plates of 120 patients were removed (26 females and 94 males). The removal rate was 22.6%. The most frequent indication for removal was patient demand (81.7%), followed by tooth extraction (7.5%), and pain (3.3%). The most frequent removal site was the mandible (95.0%). Conclusion: The number of mini-plates removed was small, and the most common indication for removal was patient demand. There is no evidence to support a recommendation for the routine removal of titanium mini-plates.

• Clinics in Shoulder and Elbow
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• v.25 no.3
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• pp.230-235
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• 2022

Background: Unstable distal clavicles experience high non-union rates, prompting surgeons to recommend surgery for more predictable outcomes. There is a lack of consensus on the optimal method of surgical fixation, with an array of techniques described in the literature. We describe an alternative method of fixation involving the use of a distal clavicular anatomical locking plate with Fibertape cerclage augmentation in our series of patients. Methods: Nine patients (8 males and 1 female), with a mean age of 36 years, who sustained unstable fracture of the distal clavicle in our institution were treated with our described technique. Postoperative range of motion, functional and pain scores, and time to radiographic union were measured over a mean follow-up period of 10 months. Incidences of postoperative complications were also recorded. Results: At the last patient consult, the mean visual analog scale score was 0.88±0.35, with a mean Disabilities of the Arm, Shoulder, and Hand (DASH) score of 1.46±0.87 and American Shoulder and Elbow Surgeons (ASES) score of 94.1±3.57. The mean range of motion achieved was forward flexion at 173°±10.6°, abduction at 173°±10.6°, and external rotation at 74.4°±10.5°. All patients achieved internal rotation at a vertebral height of at least L2 with radiographical union at a mean of 10 weeks. No removal of implants was required. Conclusions: Our described technique of augmented fixation of the distal clavicle is effective, produces good clinical outcomes, and has minimal complications.

• Clinics in Shoulder and Elbow
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• v.22 no.2
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• pp.106-109
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• 2019

Acromial fractures are well-documented complications subsequent to reverse shoulder arthroplasty (RSA), and most appear as stress fractures with no history of single trauma. To date, no study has reported the occurrence of acute displaced acromial fracture due to sudden strong deltoid contraction during heavy work. Displacement of the fracture results in a challenging surgery since it is difficult to obtain adequate fixation in thin and osteoporotic bones. We report a rare case of acute displaced acromial fracture after successful RSA treatment, using a novel technique of open reduction and internal fixation, applying two 4.5 mm cannulated screws and lateral clavicle precontoured plate.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.105-115
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• 2016

Purpose: While all midshaft clavicle fractures have traditionally been treated with conservative measures, recent operative treatment of displaced, communited midshaft clavicle fractures has become more common. Though a recent increase in operative treatment for midshaft clavicle fractures, we have done the operative methods in limited cases. The aim of this study is to present indications, operative techniques and outcomes of the experienced cases that have applied to this limited group over the previous 10 years. Methods: This study consists of a retrospective review of radiological and clinical data from January of 2005 to July of 2015. Operative criteria for midshaft clavicle fractures having considerable risk of bone healing process were 4 groups - a floating shoulder, an open fracture, an associated neurovascular injury, and a nonunion case after previous treatment. Results: The study consisted of 18 patients who had operative treatment for midshaft clavicle fractures in adults. The most common surgical indication was a floating shoulder (10 cases, 55.6%), followed by nonunion (5 cases, 27.8%), an associated neurovascular injury (4 cases, 22.2%), and open fracture (3 cases, 16.7%). All cases were treated by open reduction and internal fixation in anterosuperior position with reconstruction plate or locking compression plate. Bone union was achieved in all cases except 1 case which was done bone resection due to infected nonunion. Mean bone union period was 19.5 weeks. There were no postoperative complications, but still sequelae in 4 cases of brachial plexus injury. Conclusion: We have conducted an open reduction and internal fixation by anterosuperior position for midshaft clavicle fractures in very limited surgical indications for last 10 years. Our treatment strategy for midshaft clavicle fractures showed favorable radiological results and low postoperative complications.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.86-90
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• 2007

Purpose: We evaluated the results of operative treatment with F or H plates and screws using extensile lateral approach in intraarticular calcaneal fractures. Materials and Methods: From August 2003 to July 2006, twenty intraarticular calcaneal fractures which were operated with open reduction and internal fixation with F or H plates and screws were evaluated retrospectively. According to the Essex-Lopresti classification, 3 cases were tongue type and 16 were joint depression type. With the Sanders classification, 2 cases were IIA type, 7 were IIB, 5 were IIIAB, 2 were IIIAC and 3 were IV. We have analysed the $B{\ddot{o}}hler$ angle, Gissane angle, and calcaneal width in radiologic evaluation, and evaluated clinical result according to the Creighton-Nebraska Health Foundation Score. Results: Radiologic changes showed as follows: $B{\ddot{o}}hler$ angle improved from $5.8^{\circ}$ to $25.9^{\circ}$, Gissane angle from $119.0^{\circ}$ to $113.3^{\circ}$, and calcaneal width from 50.4 mm to 37.8 mm. In the clinical results, excellent cases were noted in 8 cases, good in 8 cases, fair in 2 cases, poor in 1 case. Conclusion: Operative treatment with F or H plates and screws using extensile lateral approach in intraarticular calcaneal fractures was thought to be a useful operative method allowing anatomical reduction.

• Journal of Korean Foot and Ankle Society
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• v.7 no.2
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• pp.238-249
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• 2003

Purpose: To report the clinical result of the intraarticular calcaneus fracture after open reduction and internal fixation with plate by lateral approach. Materials and Methods: Thirty-six calcaneal fractures of 33 patients(29 men and 4 women) were treated by open reduction and internal fixation using an lateral approach from March, 1997 to May, 2002 and were followed more than one year. The autogenous iliac bone graft was done in 2 cases but the others didn't. Radiographically B?hler angle and Gissane angle on simple lateral radiograph were measured and in the 15 cases, the step-off(gap) of posterior facet joint on post-operative CT images were followed. The Salama method was used for evaluation of clinical results. Results: According to Sanders classification, 19 cases of the 36 cases were classified as type II. Type III fracture were found in 12 cases and type IV in 5 cases. The following results were obtained: twenty-two cases(61.1%) out of 36 cases were estimated as good or excellent. The good results or more were obtained in 15 cases(78.9%) in type II and 7 cases(58.3%) in type ill, but no case in type IV. B?hler angles were improved from preoperative average 1.6?to postoperative average 23.4?, Gissane angle was improved from preoperative 107.2?to postoperative 122.8?, respectively. Among 36 cases, Computed tomography was carried out in 15 cases. The postoperative step-off (gap) of posterior facet joint on computed tomography was filled with cancellous bone. Satifactory results was obtained in 7 cases with 2mm gap or less and in 6 cases of 2-5mm. There were no satifactory results in 2 cases with 5mm gap or more. Conclusion: Open reduction and internal fixation for intra-articular fracture of calcaneus was thought to be a good treatment modality. It is thought that the lateral approach is one of the good one for surgical treatment, and that accurate reduction of the posterior facet, acceptable recovery of B?hler angle are more important to obtain best results.

• Clinics in Shoulder and Elbow
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• v.8 no.2
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• pp.97-104
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• 2005

Purpose: To report the results of surgical treatment of comminuted fractures of distal humerus and to identify factors that affect the results. Materials and Methods: Thirty-two patients who were treated with open reduction and internal fixation for comminuted fracture of distal humerus were enrolled. According to the AO classification, A2.3 was 1 case, A3.2, 2 cases, A3.3, 8 cases, B1.3, 1 case, B2.3, 1 case, C2.2, 5 cases, C2.3, 4 cases, C3.2, 3 cases and C3.3, 7 cases. As fixation technique, 17 cases were fixed by double plates, 4 cases by only K-wires, 4 cases by only screws, 3 cases by K-wires and screws and 4 cases by one plate and screws. The mean age at the time of the operation was 49 years(range, $19{\sim}77$ years). The mean follow-up period was 16 months(range, $8{\sim}51$ months). Results: At the last follow-up, the mean maximum flexion was $116.4^{\circ}\;(range,\;85{\sim}140^{\circ})$ and the mean loss of terminal extension was $11.8^{\circ}\;(range,\;0{\sim}40^{\circ})$. The average Mayo elbow performance score was $91.4^{\circ}\;(range,\;55{\sim}100^{\circ})$. Overall 29 cases(91%) showed good to excellent results. The mean range of motion of extraarticular and intraarticular fracture group was $105.5^{\circ}\;(range,\;65{\sim}140^{\circ})$ and $104^{\circ}\;(range,\;55{\sim}140^{\circ})$, respectively. The average elbow score of both groups was$93^{\circ}\;(range,\;70{\sim}100^{\circ})$ and $90.7^{\circ}\;(range,\;55{\sim}100^{\circ})$. Over 90% showed more than good results. 30 cases(94%) showed complete bony union but two cases, nonunion. One case of the nonunion cases underwent replating with bone graft as revision surgery and total elbow arthroplasty was performed in the other case. At the last follow-up, 27 patients(84.4%) showed subjective satisfaction. Conclusion: Open reduction and internal fixation with appropriate surgical technique for comminuted fractures of distal humerus showed good results, which were not affected by age at the time of operation, fixation methods and anterior transposition of the ulnar nerve. Transolecranon approach may be considered as good choice for intraarticular comminuted fractures of distal humerus.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.5
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• pp.474-481
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• 2006

The endoscopic assisted approach for the treatment of condylar fracture is a less invasive alternative treatment modality and is considered to be able to overcome the limited access to the operation field to obtain an accurate reduction and fixation. Six patients with condylar neck and subcondylar fracture underwent the endoscopic assisted open reduction and internal fixation through the transoral approach at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. The endoscope was inserted through an intraoral incision and the reduction of fracture fragment was performed via a transbuccal approach with two transcutaneous stab incisions. Five patients showed anatomic reduction without any complications. One patient, whose fracture site was fixed with a single plate, showed displacement of fractured condylar segment during the follow up period. No patient had any facial nerve damage.

• Korean Journal of Cleft Lip And Palate
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• v.12 no.2
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• pp.85-94
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• 2009

Cleft lip and palate patients show midface hypoplasia, maxillary hypoplasia due to scar of previous surgery, and manifest as a class III malocclusion, retruded midface and shallow palate. These deformities have been treated with traditional orthognathic surgery. Although conventional Le Fort I osteotomy was performed on most cleft patinets with midface hypoplasia, it showed limited amount of maxillary advancement and high relapse tendency. Recently, when great amount of advancement are required in severe maxillary hypoplasia, distraction osteogenesis using RED system is widely used. But, several months of consolidation period is needed after distraction osteogenesis, occlusal relationship is not stable until mandibular setback surgery has done in mandibular hyperplasia cases and during these period, patients may feel discomfort. We present clinical cases of immediate rigid internal fixation after completion of maxillary distraction using RED system and simultaneous mandibular setback procedure in adult cleft and lip patients who show both maxillary hypoplasia and mandibular prognathism.