• Archives of Craniofacial Surgery
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• v.19 no.2
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• pp.114-119
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• 2018

Background: The ideal absorbable plating system should provide sufficient rigidity and then be absorbed within a timely manner. The Resorb-X has been recently developed as a plating system with a mixture ratio of 50:50 poly(D, L-lactide). Methods: We present seven of 121 patients who experienced delayed degradation with this absorbable plate. One hundred twenty-one patients with facial bone fracture underwent surgical treatment from March 2011 to March 2015, and rigid fixation was achieved with the Resorb-X. Results: Of 121 patients, seven (5.8%) developed complications at the surgical sites. Six of 102 cases underwent fixation of the infraorbital rim and one of 73 underwent fixation of the frontozygomatic buttress; the other sites of fixation did not develop delayed degradation. Foreign body granuloma developed at the earliest by postoperative 20 months and at the latest by postoperative 28 months (average, 23.5 months). Conclusion: We observed that the use of absorbable plates in incision sites or areas with thin skin can increase the possibility of delayed degradation. When performing surgery in these areas, the normal skin above the fixed location should be covered sufficiently.

• Clinics in Shoulder and Elbow
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• v.19 no.1
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• pp.43-47
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• 2016

Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months followup, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.175-179
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• 2010

Purpose: Sternal fractures after blunt thoracic trauma can cause significant pain and disability. They are relatively uncommon as a result of direct trauma to the sternum and open reduction is reserved for those with debilitating pain and fracture displacement. We reviewed consecutive 11 cases of open reduction and fixation of sternum and tried to find standard approach to the traumatic sternal fractures with severe displacement. Methods: From December 2008 to August 2010, the medical records of 11 patients who underwent surgical reduction and fixation of sternum for sternal fractures with severe displacement were reviewed. We investigated patients' characteristics, chest trauma, associated other injuries, type of open reduction and fixation, combined operations, preoerative ventilator support and postoperative complications. Results: The mean patient age was 59.3years (range, 41~79). The group comprised 6 male and 5 female subjects. Among 11 patients who underwent open reduction and fixation for sternal fracture with severe displacement, 6 cases had isolated sternal fractures and the other 5 patients had associated other injuries. Sternal fractures were caused by car accidents (9/11, 81.8%), falling down (1/11, 9.1%) and direct blunt trauma to the sternum (1/11, 9.1%), respectively. 3 of the 7 patients (42.9%) who underwent sternal plating with longitudinal plates showed loosening of fixation. Otherwise, none of the 4 patients who underwent surgical fixation using T-shaped plate had stable alignment of the fracture. Conclusion: Sternal fractures with severe displacement need to be repaired to prevent chronic pain, instability of the anterior chest wall, deformity of the sternum, and even kyphosis. In the present study, a T-shaped plate with a compression-tension mechanism constitutes the treatment of choice for displaced sternal fractures.

• Journal of Korean Foot and Ankle Society
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• v.5 no.1
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• pp.18-22
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• 2001

Most of Danis-Weber type B fracture has an oblique fracture plane proximal posteriorly to distal anteriorly. In these cases, the lateral plate has become widely accepted. However some limitation to the use of the lateral plate exist. The plate must be bent accurately and the screws in the distal fragment must be unicortical to avoid penetration into the joint, predisposing it to poor fixation in the osteoporotic bone. In 1982, Brunner and Weber introduced the antiglide plate for fixation of the shaft oblique fracture of the distal fibula, but it has not widely used. The author reviewed 21 cases treated by antiglide plate fixation from March, 1995 to March, 1999 which could be follow-up more than 1 year. We analysed the result radiographically and clinically using Ankle-Hindfoot scale(100 % total) of the American Orthopedic Foot and Ankle Society. The results obrained were as follows: 1. All fracture were united at average 8 weeks clinically and radiographically. 2. According to the Ankle- Hindfoot scale, 8 cases were above 90 points, 11 cases were beet ween 80 and 89 points and two cases were below 80 points. 3. One case had an injury to intermediate dorsal cutaneous nerve.

• Anatomy and Cell Biology
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• v.56 no.4
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• pp.456-462
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• 2023

Plate fixation has become the preferred approach for treating displaced midshaft clavicle fractures. However, plate fixation of the clavicle presents several unique challenges, including its complex bony architecture and its immediate subcutaneous location. In many cases, we have observed that precontoured implants do not conform to the clavicular anatomy, and many patients complain of postoperative implant-related discomfort. A total of 111 clavicles, both left and right sides, were examined to match two commonly used designs of anatomical pre-contoured superior anterior clavicle plates, with and without lateral extension. The anteroposterior (AP) plane congruence of the plate to the underlying bone, the vertical gap between the bone and plate, and the length of the plate that was off the bone either anteriorly and/or posteriorly at both ends of the clavicle were measured. The scoring system was used to determine the fit of the implant on the clavicle as anatomic, good, or poor. We found that the maximum superior bow of the clavicle was lateral to the midline by 30.75 mm and 30.5 mm on the right and left sides, respectively. The magnitude of the bow was 4.28 mm and 4.46 mm on the right and left sides, respectively. We also found that the plate was a poor fit in 75.86% of cases on the left side and 73.5% of cases on the right side. Manipulating the plates during surgery was very difficult in the AP plane.

• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.397-405
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• 2023

Background: A precontoured plate rarely fits properly within the patient's clavicle and must be bent intraoperatively. This study aimed to determine whether anatomical reduction could be achieved using a plate bent before surgery. Methods: This study included 87 consecutive patients with displaced mid-shaft clavicle fractures who underwent plate fixation and were followed-up for a minimum of 1 year. After exclusions, 39 consecutive patients underwent fixation with a precontoured plate bent intraoperatively (intraoperative bending group), and 28 underwent fixation with the plate bent preoperatively (preoperative bending group). Using free software and a three-dimensional (3D) printer, ipsilateral clavicle 3D-printed models were constructed. Using plain radiographs, the distance between the edge of the lateral inferior cortex and the medial inferior cortex was measured. The angle between the line connecting the inferior cortex edge and the line passing through the flat portion of the superior cortex of the distal clavicle was measured. Results: Mean length differences between the ipsilateral and contralateral clavicle were smaller on both anteroposterior (AP; P=0.032) and axial images (P=0.029) in the preoperative bending group. The mean angular differences on both AP (P=0.045) and axial images (P=0.008) were smaller in the preoperative bending group. No significant differences were observed between the two groups in functional scores at the last follow-up. Conclusions: Smaller differences in length and angle between the ipsilateral and contralateral clavicle, indicative of reduction, were observed in the preoperative bending group. Using the precontoured technique with low expense, the operation was performed more effectively as reflected by a shorter operation time. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• v.21 no.2
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• pp.95-100
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• 2018

Background: The purpose of this study was to evaluate the clinical outcomes and complications of hook plate fixation in acromioclavicular (AC) joint dislocations and distal clavicle fractures. Methods: We retrospectively reviewed a series of 60 consecutive patients with hook plate fixation for AC joint dislocation (group I) and distal clavicle fracture (group II). Groups I and II had 39 and 21 patients, respectively. Clinical results were evaluated using the pain visual analogue scale (VAS), simple shoulder test, and Constant-Murley scores. In addition, subacromial erosion and stiffness were evaluated as complications. Results: At the removal, the pain VAS was $2.69{\pm}1.30$ and $4.10{\pm}2.14$ in groups I and II, respectively, which were significantly different (p=0.003). The simple shoulder test score was $9.59{\pm}1.60$ and $7.81{\pm}2.67$ in groups I and II, respectively, which were also significantly different (p=0.002). Subacromial erosion was significantly more frequent in group II (14/21 patients, 66.7%) than in group I (15/39 patients, 38.5%) (p=0.037), and stiffness was also higher in group II (17/21 patients, 81.0%) than in group I (22/39 patients, 56.4%), but it was not significant. Conclusions: Hook plate fixation showed good clinical and functional results for the treatment of acute unstable AC joint dislocation and distal clavicle fracture. But, in distal clavicle fractures, there are more subacromial erosion and stiffness compare with acute unstable AC joint dislocation.

• Clinics in Shoulder and Elbow
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• v.17 no.4
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• pp.175-180
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• 2014

Background: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. Methods: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. Results: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder ($8.2{\pm}7.9mm$ versus $7.3{\pm}3.4mm$, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. Conclusions: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.

• Journal of Korean Foot and Ankle Society
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• v.19 no.3
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• pp.86-90
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• 2015

Purpose: We analyzed and compared the clinical and radiologic results between minimally invasive plate osteosynthesis and internal fixation using intramedullary (IM) nail in the treatment of distal tibia fractures. Materials and Methods: From March 2005 to June 2013, 65 cases of distal tibia fractures treated with either plate fixation or IM nail fixation were analyzed retrospectively by clinical and radiologic evaluations. The clinical results were compared using the American Orthopaedic Foot and Ankle Society (AOFAS) score, Olerud-Molander ankle score (OMAS), and visual analogue scale (VAS) score at the last follow-up. The radiologic results were compared by time to bone union, complications such as nonunion, delayed union, and malunion. Results: The clinical results (according to OMAS, AOFAS score, and VAS score) were 77.47, 84.76, and 1.75, respectively, in the plating group, and 90.21, 91.00, and 1.25, respectively, in the nailing group, and there was no statistically significant difference. Plating group showed earlier union than the nailing group and the nailing group showed higher frequency of non-union and delayed union than plating group. Conclusion: In treatment of distal tibia fractures, two methods showed appropriate results. Therefore, thorough investigation of the types of fracture, state of soft tissues, and advantages and disadvantages of the two methods should be conducted in the treatment of distal tibia fractures.

• Journal of Korean Foot and Ankle Society
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• v.17 no.2
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• pp.136-142
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• 2013

Purpose: To analyze the outcome of distal tibia fracture treated with the Distal Tibia LCP with combination of interfragmentary screw. Materials and Methods: Between January 2008 and March 2012, data of 34 patients with fracture of distal tibia treated with the Distal Tibia LCP with or without combination of interfragmentary screws were reviewed. There were 17 males and 17 females with an average age of 51.8 years (range, 18~77 years). Radiographic union time and time from surgery until ability to full weight bearing were measured and compared. Callus index was measured as quotient of callus thickness and diameter of corticalis both in AP and sagittal direction. Results: 12 fractures were treated with interfragmentary screws and 22 fractures were treated with bridging plate alone. In interfragmentary fixation group, time to full weight bearing was 14 weeks versus 15.75 weeks without screw. Callus index at bearing was not significantly lesser in patients with screw compated with those without, but callus index difference at posterative 4weeks was sigficant. Radiologic union time was 11.3 weeks in interfragmentary fixation group and 12.58 weeks without screw. Conclusion: The osteosynthesis with the Distal tibia LCP with combination of interfragmentary screw seems to be more stable in postoperative 4weeks than Distal tibia LCP alone, expecting to earlier ROM exercise and rehabilitation.