• Journal of Korean Neurosurgical Society
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• 제50권6호
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• pp.528-531
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• 2011

Although posterior segmental fixation technique is becoming increasingly popular, surgical treatment of craniovertebral junctional disorders is still challenging because of its complex anatomy and surrounding critical neurovascular structures. Basilar invagination is major pathology of craniovertebral junction that has been a subject of clinical interest because of its various clinical presentations and difficulty of treatment. Most authors recommend a posterior occipitocervical fixation following transoral decompression or posterior decompression and occipitocervical fixation. However, both surgical modalities inadvertently sacrifice C0-1 and C1-2 joint motion. We report two cases of basilar invagination reduced by the vertical distraction between C1-2 facet joint. We reduced the C1-2 joint in an anatomical position and fused the joint with iliac bone graft and C1-2 segmental fixation using the polyaxial screws and rods C-1 lateral mass and the C-2 pedicle.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.95-100
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• 2000

Objective : Posterior transarticular screw fixation is known to be one of the best surgical method for the atlantoaxial instability. We assessed the complication and operative risk in 15 patients. Patients and Methods : Between January 1997 and April 1998, 15 patients suffering from this condition were admitted to our institution. Atlantoaxial instability was caused by C1 or C2 fractures in 11, rheumatoid arthritis in 2, and os odontoideum in 2. This technique was used in the treatment of 13 patients and 2 patients was used in sublaminar wire fixation only. Bilateral C1-C2 screws were placed in 11 patients ; 2 patients had only one screw placed becauce of an anomalous vertebral artery and axial destruction. Follow-up period ranged from 5 to 20 months. Results : Most screws were positioned satisfactorily. One screw was malpositioned. No patients had neurological complications. Conclusion : Rigidly fixating C1-C2 instability with transarticular screws showed a significantly higher fusion rate than that achieved using wired grafts alone. The risk of screw malpositioning and catastrophic vascular or neural injury is small and can be minimized by assessing the position of the transverse foramen on preoperative computed tomographic scans and by correctly using intraoperative fluoroscopy and surgeon's precaution.

• The Korean Journal of Pain
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• 제1권2호
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• pp.199-202
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• 1988

Secure fixation is essential for continous epidural catheterization on a long-term-basis. Adhesive tape or surgical knots were commonly used for those patients, but the surgical knot method has a tendency to cause strangulation of catheter. Another invasive technique, subcutaneous tissue tunnelling is more safe than other methods but requires sophisticated technique and time. We employed a simple device using a blood transfusion set for patients who have epidural catheters placed safely un their backs. In 120 patients treated for postoperative and chronic pain by means of this technique, the results were as follows: 1) Five of 120 patients (4.2%) developed backache and pruritus, but there were no instances of respiratory depression, local infection and headache. 2) Nine of 120 patients (7.5%) failed booster-injections, but two cases were due to be non-technical errors. 3) The duration of fixation was 1~3 days in most cases (85%), the longest being for 21 days.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권6호
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• pp.393-402
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• 2020

Objectives: Here, we present cases of mandibular fracture that were managed with the cortical lag screw fixation technique (CLSFT) in order to critically evaluate technique indications and limitations of application at various fracture sites. Materials and Methods: This was a retrospective cohort study. The study sample was composed of patients suffering from mandibular fractures that were treated by the CLSFT. The outcome variables were fracture type, duration of surgery, number of screws, and pattern of application. Other study categories included patient demographics and causes of injury. Chi-square tests were used to assess descriptive and inferential statistical differences, and the P-value was set at 0.05. Results: Thirty-three patients were included in the study sample, with a mean age of 30.9±11.5 years and a male predominance of 81.8%. The technique was applied more frequently in the anterior mandibular region (51.5%) than in other sites. Double CLSFT screws were required at the symphysis and parasymphysis, while single screws were used for body and angle regions. No intraoperative and postoperative variables were significantly different except for surgical duration, which was significantly different between the sites studied (P=0.035). Conclusion: We found that CLSFT is a rapid, cost-effective technique for the fixation of mandibular fractures yielding good treatment results and very limited complications. However, this technique is sensitive and requires surgical expertise to be applied to mandibular fractures that have specialized characteristics.

• 대한족부족관절학회지
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• 제24권1호
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• pp.25-30
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• 2020

Purpose: Generally, the treatment of ankle trimalleolar open fractures is divided into two stages: external fixation and debridement; and secondary internal fixation. On the other hand, this two-stage operation takes considerable treatment time and is challenging in procedures requiring reduction. The purpose of this study was to evaluate the radiologic and clinical results of an immediate one-stage internal fixation operation considering the wound conditions to overcome two stage operation disadvantages. Materials and Methods: From September 2009 to January 2018, 24 cases of ankle trimalleolar open fractures, who underwent immediate internal fixation and were followed up for at least one year, were studied retrospectively. The open wound was divided into the Gustilo-Anderson classification. Open reduction and internal fixation were performed on every medial and lateral malleolar fracture. On the other hand, with posterior malleolar fractures, surgical or conservative treatment was performed depending on the fragment size. The radiologic outcome was evaluated using the Burwell and Charnley criteria and American Orthopaedic Foot and Ankle Society (AOFAS) scores, and complications, such as infection and posttraumatic arthritis, were used for the clinical evaluation. Results: The wound was classified into eight cases (33.3%) of type I, 11 cases (45.8%) of type II, and five cases (20.8%) of type IIIa. The degree of reduction was anatomical, fair, and poor in 16 cases (66.7%), six cases (25.0%), and two cases (8.3%), respectively. The mean AOFAS score was 79 points, and there were complications, such as infection in three cases (12.5%) and post-traumatic arthritis in two cases (8.3%). Conclusion: Satisfactory results were obtained through immediate surgical treatment in ankle trimalleolar open fractures of types I, II, and IIIa.

• Hip & pelvis
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• 제30권4호
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• pp.202-209
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• 2018

Atypical femoral fractures differ from ordinary femoral diaphyseal or subtrochanteric fractures in several aspects. Although several authors have reported the results of surgical treatment for atypical femoral fractures, the rate of complications (e.g., delayed union, nonunion, fixation failure, and reoperation) is still high. Therefore, we reviewed principles of surgical treatment and describe useful methods for overcoming femoral bowing in these high-risk patients.

• Archives of Plastic Surgery
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• 제43권1호
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• pp.40-45
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• 2016

Background Bioabsorbable plates and screws are commonly used to reduce maxillofacial bones, particularly in pediatric patients because they degrade completely without complications after bone healing. In this study, we encountered eight cases of a delayed foreign body reaction after surgical fixation with bioabsorbable plates and screws. Methods A total of 234 patients with a maxillofacial fracture underwent surgical treatment from March 2006 to October 2013, in which rigid fixation was achieved with the Inion CPS (Inion, Tampere, Finland) plating system in 173 patients and Rapidsorb (Synthes, West Chester, PA, USA) in 61 patients. Their mean age was 35.2 years (range, 15-84 years). Most patients were stabilized with two- or three-point fixation at the frontozygomatic suture, infraorbital rim, and anterior wall of the maxilla. Results Complications occurred in eight (3.4%) of 234 patients, including palpable, fixed masses in six patients and focal swelling in two patients. The period from surgical fixation to the onset of symptoms was 9-23 months. Six patients with a mass underwent secondary surgery for mass removal. The masses contained fibrous tissue with a yellow, grainy, cloudy fluid and remnants of an incompletely degraded bioabsorbable plate and screws. Their histological findings demonstrated a foreign body reaction. Conclusions Inadequate degradation of bioabsorbable plates caused a delayed inflammatory foreign body reaction requiring secondary surgery. Therefore, it is prudent to consider the possibility of delayed complications when using bioabsorbable plates and surgeons must conduct longer and closer follow-up observations.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.755-762
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• 2017

Objective : The purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease. Methods : The medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. Results : The median follow-up period was 13 months (range, 3-48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved (p<0.05). In the radiological analysis, both the segmental angle at the operated segment and anterior disc height were significantly increased. At 6 months postoperatively, solid bony fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients. Conclusion : This study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.

• Clinics in Shoulder and Elbow
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• 제22권2호
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• pp.113-117
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• 2019

Treating distal humerus fractures, especially those involving intra-articular lesions, is complex and often technically demanding. Although there still exist many controversial issues, the goal of treatment is to establish anatomical stable fixation by restoring the two columns and the articular surface. Universally, a posterior midline incision is applied, and the approach varies according to the further management of the triceps or olecranon. Evidence supports dual plate fixation as the optimal fixation method, and debates regarding appropriate plating configuration are still ongoing. As multiple clinical studies comparing results of parallel and perpendicular plate fixation have shown no actual difference, it is important to place the plates according to the fracture configuration.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.298-303
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• 2023

Unstable pelvic ring injuries are potentially life-threatening and associated with high mortality and complication rates in polytrauma patients. The most common cause of death in patients with pelvic ring injuries is massive bleeding. With resuscitation, external fixation can be performed as a temporary stabilization procedure for hemostasis in unstable pelvic fractures. Internal fixation following temporary external fixation of the pelvic ring yields superior and more reliable stabilization. However, a time-consuming extended approach to open reduction and internal fixation of the pelvic ring is frequently precluded by an unacceptable physiologic condition and/or concomitant injuries in patients with multiple injuries. Conservative treatment may lead to pelvic ring deformity, which is associated with various functional disabilities such as limb length discrepancy, gait disturbance, and sitting intolerance. Therefore, if the patient is not expected to be suitable for additional surgery due to a poor expected physiologic condition, definitive external fixation in combination with various percutaneous screw fixations to restore the pelvic ring should be considered in the acute phase. Herein, we report a case of unstable pelvic ring injury successfully treated with definitive external fixation and percutaneous screw fixation in the acute phase in a severely injured polytrauma patient.