• Journal of Trauma and Injury
• /
• v.34 no.4
• /
• pp.305-308
• /
• 2021

Comminuted fractures of the patella mostly occur at the inferior pole and require appropriate reduction and fixation to restore the extensor mechanism. Conventional methods such as tension-band wiring are not enough to gain proper fixation strength. Numerous methods have been reported, including circumferential cerclage wiring, osteosynthesis, and suture anchors depending on the fracture pattern. Herein, the author reports a relatively rare case of a comminuted fracture of the upper pole of the patella, for which we used augmented Krackow sutures in the quadriceps and fixation with tying of the suture limbs through patellar bone tunnels. Satisfactory results were obtained in terms of reduction and extensor mechanism recovery.

• Journal of Chest Surgery
• /
• v.54 no.6
• /
• pp.539-542
• /
• 2021

Resection and reconstruction of the chest wall for the radical surgical treatment of malignant soft tissue tumors are currently considered a substantial challenge for thoracic surgeons. We present an unusual case of infantile fibrosarcoma with tropomyosin 3-neurotrophic receptor tyrosine kinase 1 fusion in a 13-year-old patient. The surgical treatment consisted of radical resection of the right posterior chest wall and reconstruction with the use of the STRATOS (Strasbourg Thoracic Osteosynthesis System) titanium rib bridge system. The patient had a favorable postoperative course and received respiratory-ventilatory rehabilitation, adjuvant therapy with chemotherapeutic agents, immunotherapy, and radiotherapy.

• Journal of the Korean Orthopaedic Association
• /
• v.56 no.4
• /
• pp.317-325
• /
• 2021

Purpose: This study compared the functional and radiologic outcomes of intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) for tibia fractures in distal tibial spiral fractures combined with posterior malleolar fractures, as well as the functional and radiologic outcomes with and without fixation for posterior malleolar fractures. Materials and Methods: From January 2010 to December 2018 the radiological and clinical outcomes of 30 skeletally mature patients with tibial spiral fractures (AO Foundation/Orthopaedic Trauma Association classification 42-A1, B1, C1) combined with posterior malleolar fractures were analyzed. Sixteen patients were treated with IMN, and 14 patients were treated with MIPO. Depending on the surgical methods, the radiologic and clinical outcomes were compared by evaluating the bone union time, postoperative alignment, postoperative displacement of the posterior malleolar fragment, and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, the functional and clinical outcomes with and without fixation for posterior malleolar fractures were compared. Results: The mean bone union time was 21.8 weeks in the IMN group and 23.1 weeks in the MIPO group (p=0.500). At the final follow up, the mean alignment was coronal angulation of 1.8°, sagittal angulation of 1.6° in the IMN group and coronal angulation of 1.2° and sagittal angulation of 1.7° in the MIPO group (conoral angulation: p=0.131, sagittal angulation: p=0.850). The postoperative and final radiologic evaluation showed no displacement of the posterior malleolar fragment and excellent joint congruity in all cases. At the final follow-up, the mean AOFAS score was 88.0 on average in the IMN group and 87.6 on average in the MIPO group (p=0.905). The ankle range of motion and AOFAS score were similar in the fixation group and no fixation group for posterior malleolar fractures. Conclusion: Both IMN and MIPO for tibial spiral fractures combined with posterior malleolar fractures result in satisfactory radiological and clinical outcomes.

• Journal of the Korean Orthopaedic Association
• /
• v.52 no.1
• /
• pp.1-6
• /
• 2017

Purpose: To retrospectively compare minimally invasive percutaneous plate osteosynthesis (MIPPO) with open plate fixation for the treatment of clavicle midshaft fracture. Materials and Methods: Between November 2011 to May 2014, 40 cases that were followed for more than 1 year-among all cases of MIPPO and open plate fixation-were analyzed. The study population was divided into two groups: group A included 20 cases of MIPPO and group B included 20 open plate fixation cases. The comparative analysis between the two groups was based on the operative time, bone union, functional evaluation (American Shoulder and Elbow Society score), incision length, pain relief (visual analogue scale, VAS), and complication. Results: The bone union was successful for all the cases, and the functional evaluation scores of the shoulder joint were satisfactory for both groups (p>0.05). The operative time was 47.5 minutes and 58.7 minutes for group A and B, respectively (p<0.05). The incision length for group A was 6.2 cm and that for group B was 10.7 cm with statistical significance (p<0.05). Pain relief (VAS) after surgery for group A showed a quick recuperation in the early stages. For complications, there were 2 cases of dysesthesia and 1 case of malunion due to metal fixation failure in group A. There were 6 cases of dysesthesia and 2 cases of cosmetic problem due to hypertrophic scar in group B. Conclusion: Surgical results of clavicle shaft fracture were satisfactory for both groups, but group A had advantages of shorter operative time, minimal incision length, and better pain relief in the early stages compared with group B. However, we need further evaluations with long-term follow-up results and complications, such as malunion and exposure on radiation.

• Clinics in Shoulder and Elbow
• /
• v.16 no.1
• /
• pp.27-32
• /
• 2013

Purpose: The purpose of this study is to evaluate the clinical and radiological outcomes of treatment of humerus shaft simple fracture by minimally invasive percutaneous osteosynthesis (MIPO) technique using locking compression plate (LCP). Materials and Methods: Six patients who were operated for humerus shaft simple fracture from August 2010 to May 2011 were enrolled for this study. We checked the cause of injury and the accompanying injuries and evaluated the operation time, the clinical and radiological period of union, postoperative range of motion of the shoulder and elbow joint, pain, activities in daily living, radiologic alignment, and other complications. Results: The clinical period of bone union was 7.2 weeks on average, and the radiologic period of bone union was 8 weeks on average. Follow-up period was more than 12 months in all cases. The angulation through postoperative alignment was 2.8 degrees in AP view and 2 degrees in lateral view. The postoperative range of motion was 167 degrees in forward flexion, 50 degrees in external rotation, and thoracic vertebra 12 level in internal rotation. The average value of visual analogue scale (VAS) was 1.2 and that of KSS was 91.3. The American Shoulder and Elbow Surgeons' score (ASES) was 26.5 and the UCLA score was 31.5. Conclusion: MIPO technique for the humerus shaft simple fracture showed good functional and radiological outcomes and may be considered as one of the treatment options for humerus shaft simple fracture.

• 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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.38 no.1
• /
• pp.50-54
• /
• 2012

According to Luhr's classification, a fracture in the mandible with a width of less than 15-20 mm is considered to be an atrophic mandibular fracture and its incidence is very rare. Because of the reduced cross-sectional area and smaller contact area of the fractured ends as well as the poorly vascularized bony structure and delayed bone healing, an atrophic mandibular fracture is a great challenge for oral and maxillofacial surgeons. Surgeons tend to perform closed reduction, because open reduction is considered a non-life-saving surgery among elderly patients. Thus, most of them have limited experience in surgical management. According to recent reports, open reduction yields a good result, and the Association for Osteosynthesis (AO) group has recommended open reduction. This is a case report of our two experiences of open reduction and rigid fixation of atrophic mandibular fractures by the AO principle. Articles were also reviewed here.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.11 no.1
• /
• pp.12-20
• /
• 1989

This is a retrospective study on 452 patients with maxillofacial bone fracture. The patients were treated at the Dept. of Oral and Maxillofacial Surgery, WON KWANG UNIV. HOSPITAL from Aug. 1, 1984 to Sept. 30, 1988. The results were as follows. 1. The facial bone fractures occured most frequently in the twenties (35.3%)and male were predominant(75%) than female. 2. The most frequent etiologic factor was traffic accident. 3. The most common location of facial bone fracture was mandible(57%). Zygomatic bone & arch(39.9%) were most common on middle 1/3 of the face and symphysis(37.1%) were most common on the mandible. 4. The time from injury to treatment was variable from under the 1 week (65%) to over the 1 week(35%). In most case of the patients were treated beyond the 3 days(51.5%). 5. The relationship of intermaxillary fixation period and treatment method was an intimate relationship. The IMF period was reduced by the use of plate and screw osteosynthesis. 6. The weight loss was proportioned to intermaxillary fixation period.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.11 no.1
• /
• pp.93-100
• /
• 1989

This is a report of comparison of condyle fracture treatment by functional treatment and surgical treatment. In cases of functional therapy, mode of action of Activator that we used; By fulcrum of posterior teeth, the mandibular elevators of the opposite side cause the gap in the dental arches to be reduced, while the mandible performs a rotational movement about the fulcrum during which the fracture surface of the large fragment moves downward. Condylar fractures are often seen in association with fractures of other regions of the mandible. In our department, such cases were treated by miniplate and intramaxillary fixation. Surgical treatment of fractures of the mandible condylar were treated by intraoral approach. The result were drawn as follows : 1. Lateral displacement of condyle ; functional therapy with activator. 2. Compound fracture ; miniplate osteosynthesis and physiotherapy. 3. Anteriormedially displacement ; surgical treatment.

• Archives of Reconstructive Microsurgery
• /
• v.10 no.2
• /
• pp.86-92
• /
• 2001

Failure of replantation is inevitable in finger replantation surgery, around 10% of failure rate are reported in many authors. Management of the failed finger replantation is one of big dilemma to microsurgeons. We report 5 cases of thumb reconstruction after failure of replantation. The reconstructive surgery composed with early debridement of soft tissue that are under gangrenous processing, extract the phalangeal bone without any soft tissues. Osteosynthesis of the extracted phalangeal bone with host phalangeal bone. The exposed bony portion covered with vascularized flaps such as revered radial forearm pedicled flap, free radial forearm flap and neurovascular island finger flap. This procedure underwent within a week after vascular insufficiency developed. All of the flaps are survived, bone union achieved within 3 months. The function and external appearance of the reconstructed thumb were encouraging; Pinch Power was average 1.2 Pounds. Early removal of necrotizing soft tissue followed by covering none vascular phalangeal bone which extracted from the dead phalanx with vascularized flap is one of the useful alterative solutions in failed replantation surgery in hand.