• Archives of Plastic Surgery
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• v.36 no.3
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• pp.318-321
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• 2009

Purpose: The bony mallet finger injury is generally managed by conservative treatments, but operative treatments are needed especially when the fractures involve above 30% of articular surface or distal phalanx is accompanied by subluxation in the volar side. This is the reason they often result in chronic instability, articular subluxation and unsatisfactory cosmetic. In this report, We describe new method using the hook plate as an operative treatment of Mallet finger deformity. Methods: Among 13 patients with Mallet finger deformity who came from February 2006 to February 2008, six patient were included in surgical indication. Under local anesthesia, H or Y type incision was made at the DIP joint area. After the DIP joint extension, the hook plate was put on the fracture line, and one self tapping screw was used for fixation. 2 hole plate which was one of the holes in 1.5 mm diameter was cut in almost half and bended through approximately $100^{\circ}$. Results: In all six cases which applied the hook plate, complications such as loss of reduction or nail deformity were not seen. In only one patient, hook pate was removed due to inflammatory reaction after surgery. At 2 weeks after operation, active motion of DIP joint was performed. The result was satisfactory not only cosmetically but also functionally. At 6 weeks after operation, the range of motion of DIP joint was average $64^{\circ}$. Conclusion: The purpose of the operative treatment for mallet finger deformity using the hook plate is to provide anatomical reduction with rigid fixation and to prevent contracture at the DIP joint. While other operations take 6 weeks, the operation using the hook plate begins an active motion at 2 weeks after operation. Complication rate was low and the method is rather simple. Thus, the operation using the hook plate is recommended as a good alternative method of the mallet finger deformity treatment.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.311-316
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• 2007

Objective : The objective of this study is to investigate the safety, surgical efficacy, and advantages of a polyaxial screw-rod system for posterior occipitocervicothoracic arthrodesis. Methods : Charts and radiographs of 32 patients who underwent posterior cervical fixation between October 2004 and February 2006 were retrospectively reviewed. Posterior cervical polyaxial screw-rod fixation was applied on the cervical spine and/or upper thoracic spine. The surgical indication was fracture or dislocation in 18, C1-2 ligamentous injury with trauma in 5, atlantoaxial instability by rheumatoid arthritis (RA) or diffuse idiopathic skeletal hyperostosis (DISH) in 4, cervical spondylosis with myelopathy in 4, and spinal metastatic tumor in 1. The patients were followed up and evaluated based on their clinical status and radiographs at 1, 3, 6 months and 1 year after surgery. Results : A total of 189 screws were implanted in 32 patients. Fixation was carried out over an average of 3.3 spinal segment (range, 2 to 7). The mean follow-up interval was 20.2 months. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-7 lateral masses, as well as the lower cervical and upper thoracic pedicles. Satisfactory bony fusion and reduction were achieved and confirmed in postoperative flexion-extension lateral radiographs and computed tomography (CT) scans in all cases. Revision surgery was required in two cases due to deep wound infection. One case needed a skin graft due to necrotic change. There was one case of kyphotic change due to adjacent segmental degeneration. There were no other complications, such as cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, or implant failure, and there were no cases of postoperative radiculopathy due to foraminal stenosis. Conclusion : Posterior cervical stabilization with a polyaxial screw-rod system is a safe and reliable technique that appears to offer several advantages over existing methods. Further biomechanical testings and clinical experiences are needed in order to determine the true benefits of this procedure.

• Journal of Veterinary Clinics
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• v.16 no.2
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• pp.309-320
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• 1999

Medial patellar luxation in dogs is one of the most common patellar problems presented to the veterinary practitioner. It is observed in toy and miniature breed and the majority of cases is a congenital form. Because of extensor mechanism's instability, it causes deformity and disorder in the growth of the affected limb when the luxation is left without treatment As lameness is not easily detectable in puppies, early diagnosis and correction are essential for therapy. Up to now, there has not been any reports refering to the diagnostic methods and the optimal age for correction in young dogs. Thirteen 45-90 days old puppies, have grade I and/or II medial patellar luxation. Only by palpation, all 13 dogs were diagnosed of patelar luxation. Skyline radiographic view was useful to interpret patellar morphology and depth of trochlear groove only above 60 days old. However, it was difficult to make definite diagnosis patellar luxation. The caudocranial and lateral radiographic view as well as ultrasonographic skyline view were not showed of patellar luxation. 2 puppies had unilateral patellar luxation and 11 puppies had bilateral patellar luxation which more serious on the left than on the right. Only 3 puppies among 11 puppies with bilateral patellar luxation were observed of lameness degree 1. Regardless of grade of patellar luxation and lameness, we performed trochlear chondroplasty using a U-shape sculpture blade to minimize cartilage injury, transposition of tibia tuberosity with No. 1 Supramid to align extensor mechanism and lateral imbrication. After surgery, we examined the operated animal daily for 10 days and on 15, 30 and 60 days after surgery respectively. After operation, pain and fever became normal on 7 days, swelling on 10 days, respectively. On 10 days after surgery, dogs showed normal standing position, and normal walking was observed in 15 days after surgery. In force plate analysis, the operated legs were normal weight bearing at 30 days after operation. After surgery, not only patellar luxation and clinical signs have been gradually reduced but also bone growth have become normal without showing growth physeal plate injury. The survival rate of puppies over 62 days old was 100%, while 42-45 days old 37.5%. The above results suggest that optimal age for surgical correction of congenital medial patellar luxation is recommended over 60 days old. In conclusion, combination of trochlear chondroplasty, transposition of tibia tuberosity, and lateral retinacular imbrication is appropriate for over 60 days old puppies to efficiently correct patellar luxation.

• 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.

• Journal of the Korean Orthopaedic Association
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• v.54 no.6
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• pp.574-578
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• 2019

For the treatment of a bony Bankart lesion accompanied by an acute traumatic shoulder dislocation, anatomical reduction and stable fixation of the bone fragment and glenohumeral ligament are essential to avoid chronic instability or degenerative changes. If the Bankart lesion has large bony pieces or comminuted fragments, it can be difficult to perform precise and secure fixation of the big intraarticular fragment to the fracture site because of the limited visualization of the arthroscopic procedure. In addition, in the case of the open procedure, it requires an extensive surgical dissection to access the fractured fragment, which may cause surgical approach-related morbidity, such as neurovascular complications, delayed subscapularis healing, and increased risk of stiffness. This paper describes an alternative open suture anchor technique for a large bony Bankart lesion, which was secured anatomically with squared knots after a shuttle relay through bony tunnels and adjacent soft tissue and labrum. This technique can achieve anatomical and firm fixation under direct vision, and reduce the number of surgery related morbidities.

• Tuberculosis and Respiratory Diseases
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• v.63 no.4
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• pp.372-377
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• 2007

Tuberculous spondylitis is the most common manifestation of musculoskeletal tuberculosis (TB). The progression of the disease is usually slow and insidious. The main symptom, back pain, is not specific, which frequently results in a delayed diagnosis resulting in neurologic deficits and more advanced vertebral destruction. It is more difficult to diagnose the disease if the involved area is an uncommon sites, such as the upper thoracic, cervical or sacral region. It is important to make an early diagnosis and treatment to achieve a better treatment outcome. We reported a 29 year old female with upper thoracic TB spondylitis(T2-8) and pulmonary TB complaining of back pain that persisted for 5 months and fever. TB spondylitis was not suspected to be due to upper thoracic involvement despite her pulmonary tuberculosis. Chest CT for the evaluation of pulmonary TB found T5 destruction and the paravertebral abscess that was consistent with TB spondylitis. Her spine was examined by MRI, which made an early diagnosis before the neurologic deficit had developed. She was treated with surgical intervention due to the spinal instability and anti-TB medication for 1 year with excellent results.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.1-8
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• 2008

Purpose: To evaluate the value and limitation of modified Mau osteotomy through the review of 30 feet treated by this procedure. Materials and Methods: We retrospectively analyzed 30 cases treated with modified Mau osteotomy since 2002. The mean duration of follow-up was 10 months. We reviewed medical records to describe each case and select several clinical factors which related with surgical procedure and could influence on final results. We measured radiographic parameters such as hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position and also assessed clinical outcomes by AOFAS score and satisfaction degrees. Results: The mean preoperative HVA and IMA were $40.4^{\circ}$, $17.4^{\circ}$ and the mean amounts of correction were $31.2^{\circ}$ and $11.5^{\circ}$. Amounts of delayed loss of correction were 16.8% in HVA and 19.2% in IMA. Initial HVA, rotational angle and translation distance of the distal fragment, stability of fixation, first ray instability were revealed as significant factors for the final result from this procedure. DMAA was increased by rotation of the distal fragment and decreased by adding translation on the rotation. Conclusion: Modified Mau osteotomy is an effective procedure to get enough correction. But, it is important to try to avoid excessive rotation of the distal fragment because it may worse joint congruity. It may be worthwhile to pay close attention to the direction of saw and stability of fixation.

• Journal of Korean Neurosurgical Society
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• v.41 no.3
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• pp.166-170
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• 2007

Objective : The purpose of this study is to evaluate the clinical outcome of the two-stage operation for thoracic tuberculous spondylitis. Methods : Eleven patients [4 male, 7 female] with thoracic tuberculous spondylitis were treated with two-stage operation. First stage consisted of anterior debridement and interbody fusion using rib graft and second with posterior instrumentation with fusion. Mean age was 46 years, and mean follow-up period was 18 months. All patients were treated with 12 months of antituberculotic medication postoperatively, and evaluated before and after surgery with respect to pain level, neurological status, associated lesions, hematological parameters and change of kyphotic angle. Results : The associated lesions were pulmonary tuberculosis in 4 cases. There were no recurrences of infection and bone union was obtained within 6 months of the operation in all cases. Changes in the pain severity, neurological status, and hematological parameters demonstrated significant clinical improvement in all patients. The mean kyphotic angle was corrected from $17.8^{\circ}$ to $9.8^{\circ}$ after surgery. The most recent follow-up of the mean kyphotic angle was $12.3^{\circ}$, with a loss of correction of $2.5^{\circ}$. The preoperative VAS averaged to be 7.18 [range, 4-10]. It decreased significantly an average of 1.45 [p <0001]. Conclusion : These results indicate that two-stage surgical treatment for thoracic tuberculous spondylitis provid safe and satisfactory results. Spine instability and kyphosis can be also prevented by two-stage operation.

• Journal of Korean Neurosurgical Society
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• v.46 no.6
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• pp.515-521
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• 2009

Objective : The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation. Methods : Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging. Results : Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups. Conclusion : Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.637-642
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• 2006

Purpose: Incidence of chronic osteomyelitis in femur is lower than that of tibia due to abundantsurrounding soft tissue like muscles and subcutaneous fat. However, if the femur is infected, surgical approach would be very difficult because of surrounding soft tissue and bony defects would be getting larger due to the late detection. Chronic osteomyelitis of femur is an intractable disease with frequent recurrence and remained bone instability in spite of multiple classical operations. Methods: From August 1998 to October 2005, we had 7 cases of fibular osteocutaneous free flap to reconstruct the femur. Those were followed-up for 23 months. All 7 cases were male. 4 cases were in midshaft and the others are distal part of femur. Results: The 7 cases that had not been healed in spite of average 9.1 times previous operations were reconstructed successfully without the recurrence of chronic osteomyelitis. Continuous rehabilitation therapy and brace were very helpful for the ambulation. It took 5.6 months for complete union of bone, and 9.8 months for the ambulation. Conclusion: After wide resection, reconstruction of the femur using fibular osteocutaneous free flap guaranteed bone stability and prevented recurrence of osteomyelitis through rich blood supplying fibula and muscle. Double barrel graft of fibula would be needed in case of the sufficient strength and thickness of femur. We report the successful results of reconstruction of femur with fibular osteocutaneous free flap for chronic osteomyelitis of femur.