• Clinics in Shoulder and Elbow
• /
• 제21권4호
• /
• pp.177-178
• /
• 2018

• 대한족부족관절학회지
• /
• 제16권2호
• /
• pp.94-100
• /
• 2012

Purpose: The purpose of this study is to analyze the clinical features of distal tibia fractures and to evaluate the treatment outcomes of minimally invasive plate osteosynthesis (MIPO). Materials and Methods: From January 2004 to December 2009, 84 cases of 81 patients treated with plate fixation for distal tibia fracture were enrolled in this retrospective review. We investigated age, sex, injury mechanism, fracture patterns, and complications, and the clinical features were analyzed. To evaluate the treatment outcomes of MIPO, we divided into two groups. MIPO group consisted of 55 patients were treated with MIPO technique and conventional group consisted of 18 patients were treated with open reduction and internal fixation with conventional anterolateral plating. The results were compared between two groups by assessing bony union time, operation time, amount of blood loss, range of ankle motion, clinical score by American Orthopaedic Foot and Ankle Society (AOFAS) score, and post-operative complications. Results: The mean age of 81 patients with distal tibia fracture was 54.8 years. According to AO classification, A1:2:3 were 16, 20, 16 patients, B1:2:3 were 2, 8, 7, C1:2:3 were 1, 3, 11 patients. According to injury mechanism, slip down injury was patients, traffic accident was 26, fall from height injury was 14 patients respectively. The type A fractures were lower energy trauma and more older patients. The type C fractures were higher energy trauma and younger patients. MIPO group was better than conventional group in operative time, blood loss, bony union time, and ankle joint motion. In complications, MIPO group showed no nonunion and infection, one malunion, one skin necrosis, nine skin irritations, and one screw breakage. Conventional group showed two nonunion, four infections, two skin necrosis, and one metal failure. Conclusion: Distal tibial fractures caused by low energy trauma were on the increase. Minimal invasive plate osteosynthesis was shorter bony union time and operation time, less blood loss, and larger ankle motions than conventional open reduction and plate fixation.

• Clinics in Shoulder and Elbow
• /
• 제13권2호
• /
• pp.202-208
• /
• 2010

목적: 상완골 근위부 골절에 대하여 최소 침습적 금속판 술식을 시행하고, 임상 결과를 분석하여 유용성을 알아보고자 하였다. 대상 및 방법: 상완골 근위부 골절에 대하여 최소 침습적 금속판 술식을 시행한 27명을 대상으로 하였다. 골절 분류는 2분 골절 16예, 3분 골절 10예였으며, 4분 골절 1예가 포함되었다. 임상적 평가는 UCLA 점수와 KSS 점수 및 운동 범위 회복 정도와 합병증 발생 여부를 조사하였으며, 방사선학적으로는 골유합 기간과 경간각 회복 정도를 평가하였다. 평균 추시 기간은 19개월이었다. 결과: 최종 추시에서 UCLA 점수는 우수가 15예, 양호가 12예였으며 KSS 점수는 평균 91.4점이었다. 또한 최종 견관절 운동 범위는 전방 거상이 평균 $167.2^{\circ}$로 측정되었다. 모든 환자에서 수술 후 평균 14.1주에 골유합을 얻었으며, 경간각 회복 정도는 우수가 24예였으며 보통이 3예였다. 액와 신경 마비나 심부 감염, 금속판의 충돌 증후군 등의 합병증은 발생하지 않았다. 결론: 상완골 근위부 골절에 대한 최소 침습적 금속판 술식은 충분한 해부학적 지식을 숙지하고 시행하면 주변 연부 조직 박리를 최소화하여 합병증 발생을 감소시키고 조기 관절 운동을 가능하게 하므로 상완골 근위부 골절 치료의 효과적인 수술 방법의 하나로 사료된다.

• Journal of Trauma and Injury
• /
• 제29권3호
• /
• pp.76-81
• /
• 2016

Purpose: The purpose of this study was to compare the data comprehensively including not only the clinical and radiographic outcomes but some parameters related to operation between the minimally invasive plate osteosynthesis (MIPO) technique and intramedullary nailing (IMN) for treatment of segmental tibia shaft fractures. Methods: We conducted a retrospective study of 31 patients (mean age, 49.3 years, range, 27-74 years), with a mean follow-up of 14.1 months (range, 12-19 months) with acute segmental tibial fractures (AO 42-C2) who underwent either surgical treatment of MIPO or IMN. In accordance with the Gustilo-Anderson classification, 11 were type I, 5 were type II, and 15 were type III. Initial compartment syndrome was confirmed in 2 cases. Results: There were no statistically significant differences in terms of the patient demographic data between the two groups. The time to definitive fixation was longer in the MIPO group (mean $13.7{\pm}10.9days$; range, 2-27) than in the intramedullary group (mean $5.4{\pm}9.6days$; range, 0-35) with statistically significant difference (p=0.002). Bony union was observed in most of cases but except 5 cases of nonunion were diagnosed (3 in the MIPO vs 2 in IMN, p=0.188). The average bone healing time was 27.1 weeks (10 to 56 weeks) in MIPO group and 23.2 weeks (13 to 66 weeks) in IMN group, respectively (p=0.056). Overall complications were 5 cases in MIPO group and 2 cases in the IMN group. Difference in LEFS was not statistically significant between both groups (p=0.824). Conclusion: This study showed that segmental tibia shaft fractures treated with both MIPO and intramadullary nailing was challenging with relatively high complication rate. A well planned sequential strategy with keeping the soft tissue and personality of fracture in mind is utmost significant as much as the choice of surgical modalities.

• 대한족부족관절학회지
• /
• 제13권2호
• /
• 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.

• 대한정형외과학회지
• /
• 제52권1호
• /
• pp.1-6
• /
• 2017

목적: 쇄골 간부 골절의 최소 침습적 경피적 금속판 고정술과 관혈적 고정술에 대한 후향적 분석을 통해 수술 결과를 비교하고자 한다. 대상 및 방법: 2011년 11월부터 2014년 5월까지 쇄골 간부 골절로 수술을 시행한 최소 1년 이상의 추시가 가능하였던 40예에서 최소 침습적 금속판고정술 20예를 A군, 관혈적 고정술 20예를 B군으로 나누어 두 군 간의 수술시간, 골유합, 기능적 평가(American Shoulder and Elbow Society score), 수술 반흔의 길이, 술 후 통증 완화(visual analogue scale) 및 합병증에 대해 비교 분석하였다. 결과: 모든 예에서 골유합이 이루어졌으며, 양 군에서 모두 양호한 결과를 보였다(p>0.05). 평균 수술 시간은 A군에서 47.5분, B군에서 58.7분이었고, 평균 절개의 길이는 A군에서 6.2 cm, B군 10.7 cm로 유의한 차이를 보였으며, 술 후 통증의 완화에서도 A군에서 초기 빠른 회복을 보였다. 합병증으로 A군에서 부정유합 1예, 피부 감각이상 2예를 보였으며, B군에서 피부 감각이상 6예 및 수술 반흔에 대한 미용상의 문제가 2예 있었다. 결론: 쇄골 간부 골절에서 A와 B 양 군에서 대체적으로 양호한 결과를 보였으나 A군이 B군에 비해 짧은 수술시간과 수술 절개, 초기 통증 완화 항목들에서 더 좋은 결과를 보였다. 하지만 부정유합, 방사선 노출 등의 합병증 및 장기 추시 결과에 대한 연구가 더 이루어져야 할 것으로 보인다.

• 대한족부족관절학회지
• /
• 제8권2호
• /
• pp.166-170
• /
• 2004

Purpose: To evaluate the results of MIPPO (minimal invasive percutaneous plate osteosynthesis) technique for distal tibial metaphyseal fractures. Materials and Methods: It is a retrospective study of 13 patients who were treated by MIPPO technique for distal tibial metaphyseal fractures from Jan. 2001 to Jan. 2003. The average age was 46.7 years and mean follow-up period was 13.3 months. According to AO classification, there were 8 cases of A1, 3 cases of A2, 1 case of B1 and 1 case of C2. One case of A1 was a Gustilo-Anderson type I open fracture and fibular fractures were combined in 12 cases. We applied anatomical reduction and internal fixation for the fibular fractures and internal fixation on the medial side of the tibia by MIPPO technique for distal tibial metaphyseal fractures. Clinical results were evaluated using radiographic results, Neer score, the starting time of postoperative exercise and clinical complications. Results: According to the Neer score, all cases showed satisfactory results. Active ankle ROM was started at average 2.4 weeks ($2{\sim}4$ weeks) and full weight bearing ambulation at average 5.2 weeks ($4{\sim}8$ weeks) postoperatively. Union of fractures was obtained by average 14.4 weeks ($8{\sim}18$ weeks) postoperatively. Two cases showed $5^{\circ}$ limitation of motion without functional deficits and other cases showed satisfactory ROM results. One case had $6^{\circ}$ valgus deformity without functional deficits. There were not any other complications like soft tissue problems and delayed-or non-union. Conclusion: MIPPO technique for the treatment of distal tibial metaphyseal fractures is a feasible technique with a good clinical outcomes.

• 대한족부족관절학회지
• /
• 제12권1호
• /
• pp.80-85
• /
• 2008

Purpose: To evaluate and compare the outcome between interlocking IM nailing and LCP fixation in the treatment of distal metaphyseal tibial fracture. Materials and Methods: From January 2000 to December 2007, 17 patient were treated by interlocking IM nail and 13 patient were treated by LCP fixation for distal metaphyseal tibial fracture. Results: According to AO classification, there were 2 type A1 fracture (12%), 6 type A2 fracture (36%), 3 type A3 fracture (18%), 4 type B1 fracture (24%), 1 type B3 fracture (6%), 1 type C1 fracture (6%) in interlocking IM nailing group and 1 type A2 fracture (7.7%), 2 type A3 fracture (15.4%), 3 type B1 fracture (23%), 3 type B2 fracture (23%), 3 type C1 fracture (23%), 1 type C2 fracture (7.7%) in LCP fixation group. The clinical functional outcome (according to AOFAS score) is 75.6 point in IM nailing group and 81.5 point in LCP fixation group. In IM nailing group, 65% of patient showed satisfactory result and In LCP fixation group, 77% of patient showed satisfactory result. Conclusion: There is no difference on clinical results between IM nailing and MIPPO (minimal invasive percutaneous plate osteosynthesis) group in the treatment of distal tibia fracture. But MIPPO group have higher subjective satisfactory score and less complication rate. The weakness of our study is a small case number and limited follow-up and we believe a better designed prospective study will be needed.

• 대한방사선기술학회지:방사선기술과학
• /
• 제37권3호
• /
• pp.203-209
• /
• 2014

쇄골 CT 영상을 이용하여 보급형 3D 프린터로 제작된 모델로 사전 수술계획을 실시하여 수술효율에 대한 유용성과 임상적 활용가능성을 평가하였다. CT 영상을 Open Source DICOM Viewer Osirix에서 STL 파일로 변환하여 FDM 와이어 척층가공방식의 보급형 3D 프린터로 환자 맞춤형 쇄골 골절 모델을 제작하였다. 또한, 인체의 좌우 대칭 특성을 이용하여 골절되지 않은 반대편 쇄골의 STL 파일을 Mirror 기법으로 손상되기 전 원형의 모델을 복원, 제작하였다. 모델은 골절의 위치와 크기, 정도가 동일하게 출력되었다. 영상의학과에서 적은 비용과 시간으로 직접 제작한 쇄골 모델을 활용하면 수술시 2차 손상을 줄이고, 최소 침습적 피하금속판 골유합술(MIPO)로 수술효율을 높일 수 있어 임상적으로 유용할 것으로 생각된다.

• Composites Research
• /
• 제25권5호
• /
• pp.136-140
• /
• 2012

본 논문에서는 복합재료 IM rod가 적용된 골절부의 세포 분화과정을 모사하기 위해 유한요소해석을 실시하였다. 세포의 골화과정을 해석하기 위해 편향 변형률을 이용한 메카노 규제 이론을 사용하였으며, 반복 계산을 위해 Python 코드를 이용하여 서브루틴을 구현하였다. 치료에 가장 적절한 복합재료 IM rod의 강성을 찾기 위해 직물 탄소섬유/에폭시 복합재료 (WSN3k)의 적층각도를 바꾸어 해석을 실시하였다. 골절부에 가해지는 기계적 자극에 따른 치료효율을 비교하기 위해 두 가지 초기 하중 조건을 적용하였다. 그 결과 치료효율은 강성의 차이보다 하중에 의해 큰 영향을 받았으며, 초기 하중이 몸무게의 10%이고, 적층순서가 $[{\pm}45]_{nT}$일 때 치료효율이 가장 높았다.