• Title/Summary/Keyword: Rigid fixation

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Elbow Arthrodesis with bone Autograft for the Management of Gunshot Fracture in a Dog (총상 골절 개에서 자가골 이식과 주관절 고정술)

  • Lee Jong Il;Alam Md. Rafiqul;Kim Nam soo
    • Journal of Veterinary Clinics
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    • v.22 no.1
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    • pp.60-64
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    • 2005
  • A 6year-old intact male hound cross dog, weighing 23 kg, was presented to the Teaching Animal Hospital, Chonbuk National University with the history of gunshot wound at the left elbow joint. Survey radiographs of the affected elbow revealed the presence of a metallic bullet caudal to the olecranon processes and comminuted fracture of the proximal radius and ulna. The first treatment strategy included removal of the bullet and fixation of the radius and ulna using separate bone plates, bone screw, K-wire and surgical wire, was failed. The second treatment strategy included olecranon osteotomy and rigid immobilization of the elbow joint with a bone plate applied to the caudal aspect of the humerus and ulna along with autogenous bone grafts collected from the 13th rib. The optimal angle of the joint following arthrodesis of this case appeared to be 130°. This resulted in improving the case but after 60 weeks the plate was bent and there was exudation from the wound. The third treatment strategy was the same with the second except for that the bone autografts were collected from the proximal metaphyses of the ipsilateral humerus. This resulted in a successful arthrodesis 6 weeks after the surgery. Elbow arthrodesis with bone autograft resulted in acceptable function, but abnormal gait remained in the dog due to mechanical interference with the movement of the joint.

Operative Treatment of Terrible Triad in Elbow of Adults (성인 주관절의 요골두와 구상돌기 골절을 동반한 탈구의 수술 적 치료 (성인 주관절에 발생한 위험3증주의 수술적 치료))

  • Kim, Byung-Heum;Park, Jong-Seok;Choi, Ho-Rim;Lee, Sang-Sun;Rah, Soo-Kyun;Lee, Hyun-Wook
    • Clinics in Shoulder and Elbow
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    • v.9 no.1
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    • pp.50-59
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    • 2006
  • Purpose: The nonoperative outcome of elbow dislocations with associated radial head and coronoid fractures are often unsatisfactory because of chronic instability and stiffness from proloned immobilization, Therefore we managed these injuries with well programed surgical appproaches. Method: Ten patients with this injury were evaluated retrospectively from May 1998 to June 2004 after a minimum of 12 months. These injuries include elbow dislocation and associated fractures of both the radial head and the coronoid process. All ten patients were treated by one clinic operatively with similar scheduled surgical methods which started on the lateral side and terminated on the medial side of the elbow. Radial head and neck fractures were classified Mason types, as two and three types respectively with six and four cases and six cases were fixated. Coronoid process were fixated with screws anteroposterior directly or anchor suture in all cases, each type was classified one, two and three. where were three type one, four type two, and three type three were according to Regan and Morrey classification. Results: The outcome was three resulting in excellent, four good, two normaland and the remaining case was one poor according to the Mayo Elbow Performance score. At a terminal follow up, the range of motion of the elbow averaged flection contracture, $6^{\circ}(0{\sim}20^{\circ})$ and further flection, $129^{\circ}(115{\sim}140^{\circ})$. Two patients had complications requiring additional care. One, displaced coronoid process which was repaired with capsule and the other patient experienced, palsy of ulnar nerve and contracted elbow joint. Conclusions: Usage of early operation as the minimum injury of medial ligaments complex and the rigid fixation of fractures to prompt motion with our scheduled management for elbow dislocations with associated radial head and coracoid fractures provided excellent results.

Three-Dimensional Approaches in Histopathological Tissue Clearing System (조직투명화 기술을 통한 3차원적 접근)

  • Lee, Tae Bok;Lee, Jaewang;Jun, Jin Hyun
    • Korean Journal of Clinical Laboratory Science
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    • v.52 no.1
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    • pp.1-17
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    • 2020
  • Three-dimensional microscopic approaches in histopathology display multiplex properties that present puzzling questions for specimens as related to their comprehensive volumetric information. This information includes spatial distribution of molecules, three-dimensional co-localization, structural formation and whole data set that cannot be determined by two-dimensional section slides due to the inevitable loss of spatial information. Advancement of optical instruments such as two-photon microscopy and high performance objectives with motorized correction collars have narrowed the gap between optical theories and the actual reality of deep tissue imaging. However, the benefits gained by a prolonged working distance, two-photon laser and optimized beam alignment are inevitably diminished because of the light scattering phenomenon that is deeply related to the refractive index mismatch between each cellular component and the surrounding medium. From the first approaches with simple crude refractive index matching techniques to the recent cutting-edge integrated tissue clearing methods, an achievement of transparency without morphological denaturation and eradication of natural and fixation-induced nonspecific autofluorescence out of real signal are key factors to determine the perfection of tissue clearing and the immunofluorescent staining for high contrast images. When performing integrated laboratory workflow of tissue for processing frozen and formalin-fixed tissues, clear lipid-exchanged acrylamide-hybridized rigid imaging/immunostaining/in situ hybridization-compatible tissue hydrogel (CLARITY), an equipment-based tissue clearing method, is compatible with routine procedures in a histopathology laboratory.

A comparative study on the change of postoperative facial hard tissue profile after maxillary rotational surgery (하악전돌증 환자의 양악 수술 시 상악골 후상방 회전이동 여부에 따른 안면부 경조직 변화량에 대한 비교 연구)

  • Kim, Uk-Kyu;Lee, Sung-Tak;Kim, Tae-Hoon;Song, Jae-Min;Hwang, Dae-Seok;Chung, In-Kyo
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.37 no.4
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    • pp.264-271
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    • 2011
  • Purpose: This study evaluated retrospectively the postsurgical facial hard tissue profile of a Le Fort I osteotomy with/without posterior impaction and rigid internal fixation to correct mandibular prognathism. After observing a difference between the two groups, this measurement was used to prepare a treatment plan for 2-jaw surgery. Patients and Methods: Thirty patients who had undergone orthognathic surgery in Pusan National University Dental Hospital were enrolled in this study. Fifteen patients were treated using a Le Fort I osteotomy with posterior impaction and mandibular setback bilateral sagittal split ramus osteotomy, and the other fifteen patients were treated without posterior impaction. The preoperative (T0), immediate postoperative (T1) and six-month follow-up period (T2) cephalograms were taken and difference between T1-T0 and T2-T2 was analyzed. Results: Both groups was FH-ABp, SNB and ANB showed significant changes in the measurement, whereas only the posterior impaction group showed a change in the SN-U1, occlusal plane, posterior facial height, surgical movement difference from the L1 and B-point. There was no significant statistical change between the immediate postoperative (T1) and six-month follow-up (T2) hard tissue analysis in the two groups. Conclusion: A Le Fort I osteotomy with posterior impaction is considerable for patients with a flat occlusal plane angle, large posterior facial height, prominent B-point, pogonion and labioversed incisal inclination if the indications are well chosen.

MORPHOLOGIC AND POSITIONAL CHANGE OF THE PROXIMAL SEGMENTS AFTER INTRAORALVERTICAL RAMUS OSTEOTOMY OF THE MANDIBULAR PROGNATHISM ON SUBMENTOVERTEX CEPHALOGRAM (하악골 전돌증환자의 구내 하악골상행지 수직골절단술후 이하두정 계측방사선사진상에서의 근심골편의 형태 및 위치 변화)

  • Chung, Jae-Hyung;Park, Hyung-Sik;Hwang, Chung-Ju
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.29 no.1
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    • pp.26-34
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    • 2003
  • Intraoral Vertical Ramus Osteotomy,along with Sagittal Split Ramus Osteotomy,is an popular surgical technique performed on mandibular prognathism. However Intraoral Vertical Ramus Osteotomy has been suspected for an initial mobilization at the healing phase of segment because it does not employ the rigid fixation between segments. To execute a study on the healing phase of segment after Intraoral Vertical Ramus Osteotomy on the horizontal plane, 102 patients (204 parts) who were diagnosed mandibular prognathism and took Intraoral Vertical Ramus Osteotomy at the Yonsei University dental hospital were observed during the period of before operation, immediately postoperation, 1 month, 3 months, 6 months, and 12 months. The change in the width of segment and horizontal angle of proximal segment and condylar head on the Submentovertex Cephalogram taken from those patients represented following results. 1. The width of proximal and distal segment decreased with the lapse of time. It decreased into 84.5% between immediate postoperative and 6M and even continued to decrease till 12M. 2. The horizontal angle of the proximal segment did medial rotation according as the lapse of time and rigorously continued till 3M. The rotation angle of condylar head indicated its tendency of recurrence to the original position but the entire recurrence was not allowed. The bigger an initial angle was, the higher was the tendency of recurrence after the operation while the rotation angle remained still bigger. 3. After grouping into group 1, group 2,and group 3 based on the extent of the variation of rotation angle of condylar head at immediate postoperative, the variation of rotation angle was measures in each group. The result presented that the initial rotation angle of condylar head had correlation with that of proximal segment but had no relation with the extent of setback of the mandible. However a quantitative analysis alone is not a sufficient method for analyzing the healing phase of segment on the horizontal plane.Therefore a multilateral analysis using 3 dimensional data such as CT is recommendable for the future study.

Factors influencing primary stability of miniplate anchorage: a three-dimensional finite element analysis (미니플레이트의 골내 고정원 적용 시 초기 안정성에 영향을 주는 요인에 대한 3차원 유한요소법적 연구)

  • Lee, Nam-Ki;Choi, Dong-Soon;Jang, In-San;Cha, Bong-Kuen
    • The korean journal of orthodontics
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    • v.38 no.5
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    • pp.304-313
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    • 2008
  • Objective: The purpose of this study was to evaluate the stress distribution in bone and displacement distribution of the miniscrew according to the length and number of the miniscrews used for the fixation of miniplate, and the direction of orthodontic force. Methods: Four types of finite element models were designed to show various lengths (6 mm, 4 mm) and number (3, 2) of 2 mm diameter miniscrew used for the fixation of six holes for a curvilinear miniplate. A traction force of 4 N was applied at $0^{\circ}$, $30^{\circ}$, $60^{\circ}$ and $90^{\circ}$ to an imaginary axis connecting the two most distal unfixed holes of the miniplate. Results: The smaller the number of the miniscrew and the shorter the length of the miniscrew, the more the maximum von Mises stress in the bone and maximum displacement of the miniscrew increased. Most von Mises stress in the bone was absorbed in the cortical portion rather than in the cancellous portion. The more the angle of the applied force to the imaginary axis increased, the more the maximum von Mises stress in the bone and maximum displacement of the miniscrew increased. The maximum von Mises stress in the bone and maximum displacement of the miniscrew were measured around the most distal screw-fixed area. Condusions: The results suggest that the miniplate system should be positioned in the rigid cortical bone with 3 miniscrews of 2 mm diameter and 6 mm length, and its imaginary axis placed as parallel as possible to the direction of orthodontic force to obtain good primary stability.

Comparison of Results of ACL Reconstruction According to the Fixation Materials (Metal & Bioabsorbable Interference Screw and RIGIDfix) (금속, 흡수성 간섭 나사못 및 RIGIDfix를 이용한 전방 십자 인대 재건술의 결과 비교)

  • Lim Hong Chul;Wang Joon Ho;Rho Young Jin;Hwang Jin Ho
    • Journal of the Korean Arthroscopy Society
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    • v.7 no.2
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    • pp.206-214
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    • 2003
  • Purpose : To analysis each clinical results after arthroscopic ACL reconstruction with using variable fixatives which are metallic and bioabsorbable interference screw, and RIGIDfix. Therefore, We reported the clinical reliability and safty of ACL reconstruction using RIGIDfix. Materials and Methods : We evaluated the results of arthroscopic ACL resconstruction with patellar tendon autograft among three groups, of which group 1 is used metal interference screw for 44 patients, group 2 used bioabsorbable interference screw for 47 patients, group 3 used RIGIDfix for 42 patients. We compared the clinical results by physical examination (anterior drawer test, Lachman test and pivot shift test), Lysholm score and KT-2000 arthrometer and compared the radiological results by measurement of tunnel and fixatives position and widening and by MRI findings. We analyzed the results by SAS 8.2 Ducan. Tukey and paired t-test Results : Physical instability was in 5 cases, which group 2 had 4 cases and group 3 had 1 case. Lysholm score improved from 59.8. 64.4, 61 to 90.1, 92.3. 92. KT-2000 arthrometer instability improved from 9.20, 10.2, 9.5 to 1.43. 1.62. 2.00 (p=0.478). Radiologically, all cases had excellent tunnel position and cyst change was observed the 8 cases in the group 2, but, all 20 cases 2nd MRI had signal change of peri-fixatives. But, no correlation of clinical results. Conclusion : No statistical difference of clinical instability was found among three groups. And femoral tunnel changes were much observed in group I, II than III. We considered the RIGIDfix has much advantages because the short operation time, better fixation position and much bone contact surface. But, further long term follow up study was needed.

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Anterior Cruciate Ligament Double Bundle Reconstruction with Hamstring Tendon Autografts - Technical Notes (자가 슬괵건을 이용한 전방 십자 인대 이준 다발 재건술 - 수술 술기 -)

  • Ahn, Jin-Hwan;Lee, Sang-Hak;Ahn, Hyung-Kwon;Kang, Hong-Jae
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.2
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    • pp.222-231
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    • 2005
  • Purpose: This article describes a double-bundle ACL reconstruction technique using a five-strand hamstring tendon autograft with conventional anteromedial bundle reconstruction and additional posterolateral bundle reconstruction. Operative technique: For the tibial tunnel, the conventional single tunnel technique is performed and for the femoral tunnel, the double tunnel technique is performed with the anteromedial and posterolateral bundle. After minimal notchplasty, the anteromedial femoral tunnel is prepared with leaving one milimeter of posterior femoral cortex within the over-the-top, which if positioned at the 11-o'clock orientation for the right knee or at the 1-o'clock position for the left knee. The posterolateral femoral tunnel that is located 5 to 7 mm superior to the inner margin of the lateral meniscus anterior horn at $90^{\circ}$ of flexion is prepared with tile outside-in technique using a 4.5 cannulated reamer. The graft material for the double bundle reconstruction is made of the conventional four-strand hamstring autograft in the anteromedial bundle and of a single-strand semitendinosus tendon in the posterolateral bundle. The anteromedial bundle is fixed with using a rigid fix system on the femoral side and the posterolateral bundle is fixed to tie with the miniplate from the outside femur. Then, with the knee in $10^{\circ}\;to\;20^{\circ}$ of flexion, a bioabsorbable screw is simultaneously applied to achieve tibial fixation with tensioning of both bundles. Conclusion: A double bundle reconstruction with five-strand hamstring autograft, which is designed with a favorable conventional anteromedial bundle and an additional posterolateral bundle to restore rotation stability, seems to be a very effective method for the treatment for ACL instabilities.

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Nose Changes after Maxillary Advancement Surgery in Skeletal Class III Malocclusion (골격성 III급 부정교합자에서 상악골 전방 이동술 후 코의 변화에 관한 연구)

  • Kang, Eun-Hee;Park, Soo-Byung;Kim, Jong-Ryoul
    • The korean journal of orthodontics
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    • v.30 no.5 s.82
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    • pp.657-668
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    • 2000
  • The purpose of this study was to evaluate the amount and interrelationship of the soft tissue of nose and maxillary changes and to identify the nasal morphologic features that indicate susceptibility to nasal deflection in such a manner that they would be useful in presurgical prediction of nasal changes after maxillary advancement surgery in skeletal Class III malocclusion. The sample consisted of 25 adult patients (13 males and 12 females) who had severe anteroposterior skeletal discrepancy. The patients had received presurgical orthodontic treatment. They underwent a Le Fort I advancement osteotomy, rigid internal fixation, alar cinch suture and V-Y advancement lip closure. The presurgical and postsurgical lateral cephalograms and lateral and frontal facial photographs were evaluated. The computerized statistical analysis was carried out. Soft tissue of nose change to h point change ratios were calculated by regression equations. The results were as follows 1. The correlation of maxillary hard tissue horizontal changes and nasal soft tissue vortical changes were high and the ${\beta}_0$ for soft tissue to ADV were 0.228 at ANt, 0.257 at SNt. 2. The correlation of maxillary hard tissue and nasal soft tissue horizontal changes were high and the ${\beta}_0$ for soft tissue to ADV were 0.484 at ANt, 0.431 at SNt, 0.806 at Sn. 3. The correlation of maxillary hard tissue horizontal changes and width changes of ala of nose were high and the ${\beta}_0$ lot alar base width ratio to ADV were 0.002. 4. The DRI, Prominence of nose, Pre-Op CA is not a quantitative measure that can be used clinically to improve the predictability of vertical and horizontal nasal tip deflection. In this study, increases in nasal tip projection and anterosuperior rotation occur when there is an anterior vector of maxillary movement. These nasal changes were Quantitatively correlated to magnitude of maxillary(A point) movement.

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Radiological Comparison between $60^{\circ}$ Distal Chevron Osteotomy and $40^{\circ}$ Distal Chevron Osteotomy in Hallux Valgus (족무지 외반증에서 $60^{\circ}$ 원위부 갈매기형 절골술과 $40^{\circ}$ 원위부 갈매기형 절골술 간의 방사선학적 비교)

  • Rha, Jong-Deuk;Park, Hyun-Soo;Lim, Chang-Suk;Jang, Young-Soo;Jeon, Yong-Soo;Jin, Hyun-Bae;Kim, Kyung-Hun
    • Journal of Korean Foot and Ankle Society
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    • v.9 no.2
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    • pp.146-150
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    • 2005
  • Purpose: We made a radiological comparison between $60^{\circ}$ distal Chevron osteotomy with short armed two parts and $40^{\circ}$ distal Chevron osteotomy with long armed one part performing operation in cases of hallux valgus angle of less than $40^{\circ}$, intermetatarsal angle of less than $15^{\circ}$. Materials and Methods: 12 cases with $60^{\circ}$ distal Chevron osteotomy and 12 cases with $40^{\circ}$ distal Chevron osteotomy were selected from October 2000 to March 2005. We have analysed the hallux valgus angle, 1-2 intermetatarsal angle, metatarsal length, distal metartarsal articular angle and angulation at osteotomy site on lateral view in each radiological films taken at preoperative, postoperative and 3 months after operation presuming bone union. All cases were women, both sides were 9 cases and average age was 52.3 years old. Results: Data taken at preoperative, postoperative and 3 months follow up films in $60^{\circ}$ distal Chevron osteotomy were as follows; the hallux valgus angles were $32.1^{\circ}$, $10.9^{\circ}$, $13.8^{\circ}$, the 1-2 intermetatarsal angles were $13.6^{\circ}$, $8.5^{\circ}$, $8.4^{\circ}$, the metatarsal length were 60.6 mm, 58.8 mm, 58 mm, the distal metartarsal articular angles were $13^{\circ}$, $6^{\circ}$, $6.6^{\circ}$ and 3 cases were over $3^{\circ}$ angulation at lateral view. In $40^{\circ}$ distal Chevron osteotomy, the hallux valgus angles were $34.5^{\circ}$, $11.6^{\circ}$, $15.3^{\circ}$, the 1-2 intermetatarsal angles were $12.7^{\circ}$, $8.2^{\circ}$, $7.8^{\circ}$, the metatarsal length were 59.2 mm, 56.9 mm, 55.9 mm, the distal metartarsal articular angles were $12^{\circ}$, $7.3^{\circ}$, $7.3^{\circ}$ and there were no case with angulation over $3^{\circ}$ at lateral view. Conclusion: In comparison between $60^{\circ}$ distal Chevron osteotomy and $40^{\circ}$ distal Chevron osteotomy measuring at postoperative and follow up, most of all data were similar, but 3 cases over $3^{\circ}$ angulation at lateral view happened in $60^{\circ}$ Chevron osteotomy. This result showed that $40^{\circ}$ distal Chevron osteotomy fixing with screws through long armed one part may have benefit than $60^{\circ}$ distal Chevron osteotomy fixing with K-wires through short armed two parts in making rigid fixation, even though there is a personal difference of technigue.

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