• Clinics in Shoulder and Elbow
• /
• v.27 no.1
• /
• pp.72-78
• /
• 2024

Background: Clinical outcomes after fixation of distal humerus intraarticular fractures are directly related to the quality of reduction. The use of three-dimensional (3D)-printed fracture models can benefit preoperative planning to ensure good reduction. This review aims to determine if surgery performed with 3D printing assistance are faster and result in fewer complications and improved clinical outcomes than conventional methods. We also outline the benefits and drawbacks of this novel technique in surgical management of distal humerus fractures. Methods: A systematic literature search was carried out in various electronic databases. Search results were screened based on title and abstract. Data from eligible studies were extracted into spreadsheets. Meta-analysis was performed using appropriate computer software. Results: Three randomized controlled trials with 144 cases were included in the final analysis. The 3D-printed group had significantly shorter mean operating time (mean difference, 16.25 minutes; 95% confidence interval [CI], 12.74-19.76 minutes; P<0.001) and mean intraoperative blood loss (30.40 mL; 95% CI, 10.45-60.36 mL; P=0.005) compared with the conventional group. The 3D-printed group also tended to have fewer complications and a better likelihood of good or excellent outcomes as per the Mayo elbow performance score, but this did not reach statistical significance. Conclusions: Three-dimensional-printing-assisted surgery in distal humerus fractures has several benefits in reduced operating time and lower blood loss, indirectly decreasing other complications such as infection and anemia-related issues. Future good-quality studies are required to conclusively demonstrate the benefits of 3D printing in improving clinical outcomes.

• The Korean Journal of Pain
• /
• v.37 no.1
• /
• pp.51-58
• /
• 2024

Background: The rise in national health care costs has emerged as a global problem given the ever-aging population and rapid development of medical technology. The utilization of interventional pain management has, similarly, shown a continued rise worldwide. This study evaluates the differences in the medical costs in the field of interventional pain treatment (IPT) between two countries: Korea and Japan. Methods: Korean medical insurance costs for 2019 related to pain management focused on IPT were compared to those of Japan. Purchasing power parity (PPP) was used to adjust the exchange rate differences and to compare prices in consideration of the respective societies' economic power. Results: The cost of trigger point injections in Japan was 1.06 times higher than that of Korea, whereas the perineural and intraarticular injection prices were lower in Japan. The cost of epidural blocks was higher in Japan compared to Korea in both cervical/thoracic and lumbar regions. As for blocks of peripheral branches of spinal nerves, the cost of scapular nerve blocks in Japan was lower than that in Korea, given a PPP ratio 0.09. For nerve blocks in which fluoroscopy guidance is mandatory, the costs of epidurography in Japan were greater than those in Korea, given a PPP ratio 1.04. Conclusions: This is the first comparative study focusing on the medical costs related to IPT between Korea and Japan, which reveals that the costs differed along various categories. Further comparisons reflecting more diverse countries and socio-economic aspects will be required.

• Journal of the Korean Arthroscopy Society
• /
• v.4 no.1
• /
• pp.42-48
• /
• 2000

We retrospectively reviewed the results of arthroscopic adhesiolysis on postoperative knee stiffness in order to observe the clinical improvement and to evaluate the prognostic factors. Arthroscopic adhesiolysis without extraarticular procedure was performed in 31 knees displaying persistent flexion or extension loss. The causes of arthrofobrosis were previous ligament surgeries in 17 knees, surgery for a fracture involving the articular surface of the knee in 10 cases and other causes in four cases. The average range of motion was $60^{\circ}(range,\;14^{\circ}-74^{\circ})$ preoperatively, and improved by $120^{\circ}(range,\;7^{\circ}-127^{\circ})$ immediately following the procedure. The range of motion at the final follow-up (average 34 months) was $129^{\circ}(range,\;3^{\circ}-132^{\circ})$. In the 17 patients with arthrofibrosis fellowing ligament surgery, the range of motion was improved from $65^{\circ}$ preoperatively to $135^{\circ}$ at final follow-up. The improvement in function and motion was achieved during the first postoperative year. In the 10 patients with arthrofibosis following intraarticular fractures, the range of motion was improved from $60^{\circ}$ preoperatively to $125^{\circ}$ at the final follow-up, and most of the increase in motion was achieved within the first 6 months. Patients who suffered from a limitation of motion for less than 7 months gained an average $70^{\circ}$ improvement in total range of motion following arthroscopic surgery. However, the total range of motion in patients with a duration of symptoms greater than 7 months improved by an average $49^{\circ}$ postoperatively. In conclusion, arthroscopic adhesiolysis without incisional procedure is an effective therapeutic modality in arthrofibrosis of intraarticular origin. Improved outcomes can be expected in stiffness after ligament surgery and a symptom duration of arthrofibrosis less than 7 months.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.32 no.6
• /
• pp.497-503
• /
• 2010

Purpose: The purpose of this study is to induce artificial arthritis on rabbit TMJ by injecting collagenase. Materials and Methods: An experimental animal model of arthritis induced by surgical method or intraarticular injection of chemical agent like LDH, papain, ketorolac. Surgical method is complex and needs a long time in inducing arthritis. Intra-articular injection of chemical agent like LDH, papain, ketorolac is simple. But chemical agent like LDH, papain, ketololac needs multiple injections to induce arthritis and mechanism inducing arthritis was known. Collagenase destroys helical domain of type II collagen in extracellular matrix produced by chondrocyte and then induces arthritis. We injected collagenase (0.5, 1.0, 2.0 mg) into the temporomandibular joint of rabbit. In the control group saline was intra-articularly injected. The condylar cartilage, disk and synovia were histologically examined at 1, 2, 4, 6 weeks after the initiation of collagenase injections. Results: Four weeks after injection of 2.0 mg collagenase, we could see histologic change like arthritis. In other groups, we couldn't see arthritis-like change. Conclusion: In our study, we produce arthritis on temporomandibular joint of rabbit by using injection of collagenase in temporomandibular joint of rabbit. And this experimental osteoarthritis is a useful animal model.

• Journal of the Korean Arthroscopy Society
• /
• v.9 no.2
• /
• pp.232-237
• /
• 2005

Purpose: To evaluate the effectiveness of arthroscopic direct cystic removal of popliteal cyst using 70 degree arthroscopy and posteromedial portal. Materials and Methods: From January 2003 to January 2004, 21 patients(23 cases) with popliteal cyst have been treated by direct cystic decompression with arthroscopy. The average age of the 21 patients was 54 years(range 35 to 78 years). There were 5 males and 16 females. Of the 23 cases,8 cases were occured in right side and 11 cases were occured in left side. 4 cases were both sides. In all cases, preoperative MRI were performed to detect combined intraarticular pathology. At 6 months and 1 year postoperatively, follow-up ultrasonography were performed to detect recurrence of cyst. We used Rauschning and Lindgren criteria for clinical evaluation. Results: All cases had no recurrence and no complaints of pain, swelling, or functional impairment at 1 year after surgery. At ultrasonography, no recurrence were founded. One complication was occurred. Postoperatively, Rauschning and Lindgren criteria were more than grade 1. Conclusion: Arthroscopic direct cystic removal using arthroscopy and posteromedial portal is an effective method in popliteal cyst surgery.

• Clinics in Shoulder and Elbow
• /
• v.7 no.1
• /
• pp.5-9
• /
• 2004

Purpose: To identify associated findings in glenohumeral joint in rotator cuff tear and evaluate its clinical significance, we examined minor and major changes during arthroscopic or mini open repair. Materials & Methods: We reviewed 66 patients of rotator cuff tear treated from March, 2001 to January, 2004. Of 38 cases of small to medium tear, average age was 53 years old and involved in dominant arm in 27 cases. Of 28 cases of large to massive tear, average age was 58 years old and involved in dominant arm in 26 cases. Minor and major associated changes of the glenohumeral joint were evaluated in the tendon of biceps long head, biceps pulley, cartilage of the glenoid and humeral head, labrum and synovium. Results: Minor changes in biceps tendon were in 35% of cases, biceps pulley in 18%, cartilage of humeral head in 27%, cartilage of glenoid in 18%, labrum in 38%, and synovium in 42%. Major changes in biceps tendon were in 6% of cases, biceps pulley in 35%, arthritis of humeral head in 3%, arthritis of glenoid in 2%, labrum in 6%, and synovium in 21 %. Major changes in biceps tendon were 5% in Group I and 7% in Group Ⅱ(p>0.05) and in biceps pulley, 18% and 57% in each (P<0.05). Minor changes of arthritis were prevalent in glenoid cartilage and major changes were more prevalent in humeral head. There were no differences in minor changes of labrum and synovium, but major changes were more prevalent in Group Ⅱ. Conclusion: The prevalence of intraarticular associated changes of rotator cuff tear were 63% in synovium, 54% in labrum, 53% in biceps pulley, 41% in biceps tendon, 30% in humeral head and 20% in glenoid cartilage in order. Major changes of biceps pulley, humeral head, labrum and synovium were more prevalent in Group Ⅱ.

• The Journal of the Korean bone and joint tumor society
• /
• v.1 no.2
• /
• pp.133-144
• /
• 1995

After resection of intraarticular, periacetabulum(P2) and pubic rami(P23) and extraarticular, proximal femur(P2-H12) by Enneking classification, reconstruction is very difficult. We experienced three cases of saddle prostheses for reconstruction after P2, P23, and P2-H12 resection in pelvic malignancies. Case 1 was a high grade chondrosarcoma in 36 year-old-man and P2 resection was done. But he died of disease 19 months after operation. Case 2 was a malignant giant cell tumor in 32 year-old-woman. P23 resection was given and she is disease-free 32 months after operation. Case 3 was an osteosarcoma of 27-year-old-man and P2-H12 resection was performed and he is disease-free postoperative 12 months now. According to MSTS functional evaluatin system, all three patients showed no pain(5), intermediate function(2), emotinally satisfied(3), one cane or crutch supported(1), limited walking(3), and minor cosmetic gait(3). There was no significant complication and no dislocation except intermittent inguinal hernia in case 2. All patients started crutch walking 3 weeks after operation. Around 6 months postoperatively, the preserved iliac wing(P1 component) was hypertrophied enough to endure the full weight bearing. All could have squating and kneeling positions. In conclusion, saddle prosthesis would be a very useful method of reconstruction after P2, P23, and/or H1-2 resection to shorten the operation time and to reduce the infection rate without significant loss of function.

• Journal of Korean Foot and Ankle Society
• /
• v.13 no.2
• /
• pp.162-168
• /
• 2009

Purpose: To evaluate the efficiency of the minimally invasive percutaneous plate osteosynthesis (MIPPO) with locking compression plate (LCP) for distal tibial metaphyseal intra-articular fracture compared with extra-articular fracture. Materials and Methods: From February 2006 to June 2008, 21 patients with distal tibia metaphyseal intra-articular fracture and 20 patients with extra-articular fracture were treated operatively by MIPPO technique with LCP and followed for at least one year. In the group with intra-articular fracture, mean age was 48.85 years old and a mean follow-up was 15 months. In the other group with extra-articular fracture, mean age was 52.35 years old and a mean follow-up was 14.5 months. The type of fracture was evaluated using the AO/OTA classification and open-fractures were according to the Gustilo-And gron classification. Radiologic evaluation with fracture healing and tibial alignment, clinical evaluation with Olerud and Molander ankle score and restriction of motion were done for treatment. Results: According to AO/OTA classification, There were 21 type A, 15 type B, 5 type C. Average union time of the intra-articular fracture (type B, C) was 18.7 weeks. Average union time of the extra-articular fracture (type A) was 17.1 weeks. All fractures were healed without malunion. There were no difference of mean restriction angle between intra-articular fracture (ankle dorsiflexion was 3.57 degree, plantar-flexion was 5.95 degree) and extra-articular fracture (ankle dorsiflexion was 3 degree, plantar-flexion was 3.75 degree). There were no difference of Olerud and Molander ankle score between them as a mean score of intra-articular and extra-articular was 89.25, 91.25 each other. As a complication, there were 3 case of skin necrosis, 8 case of discomfortable skin tenting by plate and 1 superficial infection, but could be healed by conservative care. Conclusion: MIPPO technique, combined articular reduction, with LCP of distal tibial metaphyseal fracture was a good method with high functional recovery.

• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.2 no.2
• /
• pp.62-67
• /
• 2009

Purpose: The purpose of this study is to find out the accuracy and usability of the three dimensional ultrasonography in measuring the size of the rotator cuff tear, especially before and after the injection of normal saline into the glenohumeral joint. Materials and Methods: 14 patients of rotator cuff tear who were diagnosed and operated from August 2007 to September 2008 were included in this study and authors compared the size of rotator cuff tear measured with three dimensional ultrasonography with the real size measured intraoperatively. In preoperative ultrasonographic evaluation, horizontal and longitudinal length of rotator cuff tear before and after injection of normal saline intraarticularly. During the arthroscopic operation the size of tear was measured by passing a Kirschner wire through a spinal needle and direct measure was performed in open surgery. Results: The average difference was 8 mm in horizontal and 1.9 mm in longitudinal length of tear without saline injection between ultrasonographic and intraoperative measure. The average difference was 4.1 mm in horizontal and 1.6 mm in longitudinal length of tear after the normal saline injection. Conclusion: In three dimensional ultrasonographic evaluation in rotator cuff tear, intraarticular normal saline injection would produce more accurate results.

• Journal of the Korean Arthroscopy Society
• /
• v.12 no.1
• /
• pp.53-57
• /
• 2008

Purpose: We analyzed the clinical results after arthroscopic treatment in acute pyogenic arthritis of the knee. Materials and Methods: From July 2000 to January 2005, we reviewed 16 cases(15 patients) of acute pyogenic arthritis of the knee on which arthroscopic treatment was done. The mean age was 61.9 years and the mean follow-up period was 30.5 months. There were 8 cases with diabetes or degenerative osteoarthritis and 14 cases with acupuncture or intraarticular injection history. Results: Causative organisms were identified in 7 cases. The average postoperative antibiotics were used intravenously for 25.5 days and per orally for 22.5 days. There were 11 complications; 5 cases of partial ankylosis, 2 cases of secondary arthritis, 1 case of chronic osteomyelitis and 3 cases of death. Patients with over 3 week immobilization had higher rate of stiffness of knee joint(p=0.032) but there was no significant difference between the symptom to treatment duration and the incidence rate of complications(p=0.293). The cases of which the causative organism was detected had higher incidences of complications(p=0.034). Conclusion: The incidence of joint stiffness was higher in the patients of longer immobilization. More complications were detected in the cases of which the causative organism is detected.