• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.29-41
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• 1993

Recent advances in microsurgery have made it possible to provide a continued circulation of blood to the grafted bone so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. We reviewed 34 cases of vascularized osteocutaneous fibular transfers to the infected tibial defect complicated with skin defect, which were performed from May, 1982 to January, 1992, and the following results were obtained: 1. Despite of uncontrolled bone infection with skin defect, the vascularized osteocutaneous fibular flap transfer could be performed. 2. In the vascularized osteocutaneous fibula transfer, the patency of anastomoses could be indirectly monitored by observing the color of the skin flap. 3. The vascularized fibula had been hypertrophied with bony union during the follow-up period of 13 months to 6 years and 4 months(average, 30 months) and there was no resorption of the grafted fibula. 4. There was no fracture of the grafted fibula in parti resection of involved tibia. 5. The hypertrophic potentiality of grafted fibula could be inhibited by the infection status as operation site.

• The Journal of Korean Academy of Prosthodontics
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• v.44 no.6
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• pp.722-733
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• 2006

Statement of problem. The use of small diameter implants having less than 3 mm in diameter were restricted because of lack of bonding strength to bone. Purpose. The purpose of this study was to observe how much resorbable blast media pin implants increase the binding force to the bone compared to machined transitional pin implants by measuring removal torque, and whether they can be used as final implants for replacement of small diameter teeth. Material and method. Fifteen rabbits were used in this study. Two kinds of implants (resorbable blast media pin implants and machined transitional pin implants) were inserted in each tibia bicortically. After healing time of 2, 4 and 8 weeks, the removal torque values were recorded and the rabbits were sacrificed for histological analysis. Linear finite element method analyses were conducted to compare bicortical fixation with monocortical fixation. Result and conclusion. Within the limitation of this in vivo study, the following conclusions were drawn: 1) The removal torque value of RBM pin implants showed statistically significant increase compared to machined pin implants at 2, 4, and 8 weeks respectively (p<0.05). 2) The removal torque value of RBM pin implants at 2, 4, and 8 weeks was increased statistically significantly with time (p<0.05). 3) Bicortical fixation showed better stress distribution compared with monocortical fixation in a linear finite element method analysis. 4) RBM pin implants are not recommended as transitional implants because they showed a lot of bone fracture in histologic specimens.

• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.37-41
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• 2005

Purpose: The purpose of this study was to evaluate the effectiveness of internal transport using Ilizarov apparatus with free flap surgery for infected tibial nonunion. Materials and Methods: We reviewed 8 patients of infected tibial nonunion treated with internal transport using Ilizarov apparatus and free flap surgery. Seven of eight patients were available for at least 1 year follow-up. All patients were male. The mean age at the time of the surgery was All fractures were Gustilo's type III B open fracture. The mean length of the bone defect was 8.5 cm. All used flaps for covering the soft tissue defect were free rectus abdominis muscle flap. We evaluated bone and functional results with use of the Paley and Catagni's classification. And we classified the complication with use of the Paley's classification. Results: Acceptable length and solid union of bone was achieved in all cases. The mean size of the bone length was 7.2 cm. The mean healing index was 69.5 days/cm. All but one case needed bone graft at docking site. All flaps were survived. There was no recurrence of infection. According to Paley and Catagni's classification, all cases showed excellent or good results. Complications were pin tract infection in 3 cases, persistent pain in 2 cases and limitation of joint motion in 2 cases. Conclusion: Simultaneous free-tissue transfer and Ilizarov distraction osteogenesis was thought to be an attractive treatment modality for infected nonunion of the tibia.

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.125-132
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• 2007

Introduction: Ulna is nearly equal to radius in function and bony architecture and strength in forearm. But in lower extremity, fibula is 1/5 of tibia in anatomic and functional point so we can find fibula transposition is commonly used in defect of tibia. We cannot find other article about segmental forearm bone transposition in man. The purpose of this study was to report our clinical and functional result of undergoing segmented transposition of ipsilateral ulna with its own vascular supply in defect of radius in 6 cases. Material and method: From June 1994 to October 2007, 7 segmented bone transpositional grafts in forearm were performed in Kyung Hee Medical Center. The distribution of age was from 20 years old to 73 years old. There was male in 6 cases and female in 1 case. The causes of operation were giant cell tumor in 1 case and traumatic origin in 6 cases; it was nonunion in 2 cases and fracture with severe comminution in 4 cases. Ipsilaterally segmented ulna keeping its own vascular supply was transported to defect of radius in severe traumatic patients and one patient whose tumor in radius had been excised. Transported ulna was fixed to proximal and distal radius remnants by plate and screw. In one case with giant cell tumor, transported ulna was connected to radius across wrist joint as wrist joint fusion. Joint preserving procedures were performed in 6 cases with crushing injury of radius. Results: We could obtain solid bony union in all cases and good functional results. The disadvantage was relative shortening of forearm, but we could overcome this problem. Conclusion: We think that ipsilateral segmented ulna transposition keeping its own vascular supply to radius can be perfomed with one of procedures in cases with wide defect in radius.

• Archives of Plastic Surgery
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• v.50 no.5
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• pp.501-506
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• 2023

This article portrays the authors' experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of "spare parts" in reconstructive microsurgery. This case describes the successful use of the osteocutaneous distal tibia turn-up fillet flap that allowed "lowering the level of the amputation" from a through knee to a below-knee amputation (BKA) to preserve the knee joint function. We comprehensibly review reports of turn-up flaps which effectively lower the level of amputation, also applying "spare-parts" surgery principles and explore how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-up fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.

• Journal of Korean Foot and Ankle Society
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• v.17 no.2
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• pp.130-135
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• 2013

Purpose: Preshaped Locking compression plate(LCP) has holes with fixed angle between screw and plate and have advantage firm fixation because it has stability of angular and axial deformity. We evaluated usefulness of LCP after open reduction and internal fixation in distal fibular fracture. Materials and Methods: Between December 2011 and May 2012, 23 patients with fracture of distal fibula were followed up at least 12 months underwent open reduction and internal fixation with LCP. There were 15 males and 8 females with a mean age 39.8(20~69) years. According to Danis-Weber classification, there were 20 cases of type B and 3 cases of type C. There were 13 cases of isolated lateral malleolus fractures, 1 case of bimalleolar fracture, 6 cases of trimalleolar fractures and 3 cases of distal tibia fractures with proximal fibula fracture. Intraoperatively, we assessed whether preshaped LCP fit lateral margin of distal fibula or not and evaluated quality of reduction and postoperative complications. The cases were analyzed by radiological bone union time and clinical results according to the criteria of Meyer Results: Of all cases, complete bone union was achieved and average radiological bone union time was 7.3(6~12) weeks. The clinical results were excellent in 18 cases(78%), good in 5 cases(22%). There were 5 cases of plate with 3 holes, 13 cases of plate with 4 holes, 2 cases of plate with 5 holes, 1 case of plate with 6 holes and 2 cases of plate with 7 holes. The average number of screws at proximal fragement was 2.5 and at distal fragment was 3.5. In 14 cases (60.8 %), we needed re-bending of plate because the distance between plate and lateral cortical margin of distal fibula was more than 5 mm at anteroposterior X-ray after reduction. All cases have anatomical reduction and there were no complications of wound infections. There were no complaint about hardware irritation. Conclusion: At fractures of distal fibula,preshaped LCP had a excellent stability although far cortex was not fixed with screw and bending of plate. And there are less complications of hardware irritation and wound problems. But, Some complement would be needed because there were no complete fitting between precontour of LCP and lateral cortical margin of distal fibula.

• Journal of Veterinary Clinics
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• v.29 no.5
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• pp.412-415
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• 2012

A 1-year-old, castrated male Yorkshire terrier (case 1) and a 7-year-old female Poodle (case 2) presented with delayed union fractures. In case 1, the dog had a fractured right distal radius and ulna. In case 2, the dog had a fractured left distal tibia and fibula. A physical examination and radiographs performed in both dogs revealed delayed union fractures with large gaps. The fracture sites were fixed by bone plate and screws. Autogenous cancellous bone graft was applied into the fracture gap. To encourage rapid bone union, we used matrigel containing $20{\mu}g$ of recombinant human bone morphogenetic protein-2 (rhBMP-2) in the fracture site. Radiographs were taken postoperatively to monitor healing. Rapid bone union was noted in both dogs in long-term radiographs. In case 1, the radiographs revealed that the fracture gaps of the radius and ulna were bridged at 2 weeks. Fracture lines were not observed and normal appearance was restored at 20 weeks. In case 2, the radiographs showed that fracture repair had progressed at 11 weeks. The fractures healed faster than expected in these two cases. The results indicate that rhBMP-2 and matrigel may be effective and useful materials to enhance healing of delayed fractures.

• Journal of the Korean Arthroscopy Society
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• v.13 no.2
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• pp.183-187
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• 2009

Purpose: We describe a new and simple technique for arthroscopic fixation of tibial intercondylar eminence avulsion fracture using bioabsorbable pins in skeletally immature patients. Operative Technique: Diagnostic knee arthroscopy is performed using anterolateral and anteromedial portals. Fracture debris and blood clot are debrided to expose the injured site well. The fragment is reduced with the probe and fixed temporarily with a 1.1-mm diameter K-wire that is inserted percutaneously from the anterosuperior aspect of the knee joint. The drill guide is introduced into the joint and the fragment is secured by bioabsorbable, poly-p-dioxanone 1.3-mm pins inserted from different angles. The pins are 40 mm in length. The knee is placed in a long leg cast in extension for 4 weeks to assure that full extension is obtained. Conclusion: Arthroscopic fixation of an tibial intercondylar eminence avulsion fracture using bioabsorbable pins is not a technically demanding, suitable method that ensures fracture healing and restores the stability of the joint.

• Journal of Yeungnam Medical Science
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• v.9 no.1
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• pp.130-136
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• 1992

Fractures of the tibial shaft are the most common among the long bone fractures, and have much difficulty in treatment due to their enumerous complications. Thirty patients with fractures of the tibial shaft were treated with Ender nails under the image intensifier at the Department of Orthopedic Surgery, Yeungnam University Hospital from December 1986 to November 1991. The following results were observed. 1. The average age was 37.3 years and the number of male was three times of the female. The most common cause was traffic accident. 2. Twenty cases out of thirty one were closed fractrure and the remaining 11 were open. The comminuted and segmental fractures were 18(57.7%) in number and the most common fracture site was the middle one third(53%). 3. Average interval from injury to operation was 7.6 days and 19 cases showed associated injuries. 4. The mean duration of the bone union was 18.9 weeks and 2 cases showed the delayed union. 5. Twelve complications were noted such as shortening, varus deformity, delayed union, ankle motion limitation, nail irritation, and soft tissue infection.

• The Journal of the Korean bone and joint tumor society
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• v.3 no.1
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• pp.32-38
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• 1997

PURPOSE : For the reconstruction of large bone defect after tumor resection, it is possible to reuse the bone involved by tumor with some treatment to it. Several bone-reusing methods have been reported such as autoclaving, low-heat treatment(pasteurization) and intraoperative radiotherapy. We have used extracorporeally radiated autogenous bone graft for reconstruction after tumor resection, and analyzed the periods for junctional union, functional results and complications to know the indications of this method. METHODS : From Dec. 1993 to Sept. 1995, nine patients had taken autogenous bone graft with extracorporeal irradiation. Eight cases were osteosarcoma and 1 giant cell tumor. The graft sites were 5 in femur, 3 proximal tibia and 1 femur and tibia. Stage 3 was 1 case(GCT), Stage IIB 3 and Stage IIIB 5. After wide resection, surrounding soft tissue and intramedullary and extramedullary portion of the tumor were removed. Radiation was done in 5000cGy to the resected bone. Ender nails and bone cement were inserted and filled into the medulla to prevent fracture. RESULTS : Average follow-up period was 12.3(4 to 21) months. Average junctional union period in simple X-ray was 6.5 months in 4 cases. Average functional score following Enneking's criteria was 19(12-27). Complications were as follows ; condylar fractures and femur neck fracture in 4 cases, subluxation of the knee joint 3 and infection 1. Although local recurrence was detected in 1 case, the site of recurrence was not in the radiated bone but surrounding soft tissue. At final follow-up, no recurrence was found in one case(GCT), CDF 2, AWD 2, DOD 3, and died of chemotherapy related sepsis 1. CONCLUSIONS : Extracorporeally radiated bone autograft is considered to be a method for reconstruction of the large bone defect made by tumor resection, especially in the reconstruction around the joint.