• Journal of Korean Foot and Ankle Society
• /
• v.15 no.2
• /
• pp.51-57
• /
• 2011

Pilon fractures involving distal tibia remain one of the most difficult therapeutic challenges that confront the orthopedic surgeons because of associated soft tissue injury is common. To introduce and describe the diagnosis, current treatment, results and complications of the pilon fractures. In initial assessment, the correct evaluation of the fracture type through radiographic checkup and examination of the soft tissue envelope is needed to decide appropriate treatment planning of pilon fractures. Even though Ruedi and Allgower reported 74% good and excellent results with primary open reduction and internal fixation, recently the second staged treatment of pilon fractures is preferred to orthopedic traumatologist because of the soft tissue problem is common after primary open reduction and internal fixation. The components of the first stage are focused primarily on stabilization of the soft tissue envelope. If fibula is fractured, fibular open reduction and internal fixation is integral part of initial management for reducing the majority of tibial deformities. Ankle-spanning temporary external fixator is used to restore limb alignment and displaced intraarticular fragments through ligamentotaxis and distraction. And the second stage, definitive open reduction and internal fixation of the tibial component, is undertaken when the soft tissue injury has resolved and no infection sign is seen on pin site of external fixator. The goals of definitive internal fixation should include absolute stability and interfragmentary compression of reduced articular segments, stable fixation of the articular segment to the tibial diaphysis, and restoration of coronal, transverse, and sagittal plane alignments. The location, rigidity, and kinds of the implants are based on each individual fractures. The conventional plate fixation has more advantages in anatomical reduction of intraarticular fractures than locking compression plate. But it has more complications as infection, delayed union and nonunion. The locking compression plate fixation provides greater stability and lesser wound problem than conventional implants. But the locking compression plate remains poorly defined for intraarticular fractures of the distal tibia. Active, active assisted, passive range of motion of the ankle is recommended when postoperative rehabilitation is started. Splinting with the foot in neutral is continued until suture is removed at the 2~3 weeks and weight bearing is delayed for approximately 12 weeks. The recognition of the soft tissue injury has evolved as a critical component of the management of pilon fractures. At this point, the second staged treatment of pilon fractures is good treatment option because of it is designed to promote recovery of the soft tissue envelope in first stage operation and get a good result in definitive reduction and stabilization of the articular surface and axial alignment in second stage operation.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.13 no.4
• /
• pp.412-420
• /
• 1991

Seventeen rigid screw fixation and sixteen nonrigid wire fixation cases of mandibular sagittal slit ramus osteotomy were selected to compare postoperative dental and skeletal changes. A constructed horizontal plane was drawn seven degrees under sella-nasion plane and detailed cephalometirc assessment was applied to serial radiographic films taken before surgery($T_0$), immediately after surgery($T_1$), and at least six months after surgery($T_2$). Linear and angular positional changes were measured and analyzed statistically using paired t-test method and percent of positional changes(amount of post-op change/amount of intra-op change)${\times}100$. The results were as follows; 1. It was 29.4% in rigid fixation cases and 37.5% in nonrigid fixation cases comparing the postoperative positional change of more than 2mm at point B. So rigid fixation method was slightly more stable. 2. In nonrigid fixation cases, the positional change might be caused by incomplete bony union at the osteotomy site and soft tissue tension acting on this site. 3. In rigid fixation cases, the positional change might be caused by interaction between relapse tendency of protracted condyle-proximal segment and neighboring soft tissue tension.

• Transactions of the Korean Society of Mechanical Engineers A
• /
• v.33 no.4
• /
• pp.430-439
• /
• 2009

Posterior Cruciate Ligament (PCL) plays an important role in knee extension. Rotational instability due to injured PCL can be restored by various PCL reconstruction methods. In this study, the initial lengthening affected by fixation device and location was demonstrated, and furthermore, the slippage and the relationship between lengthening ratio and slippage ratio in the calcaneus and soft tissue fixation methods was newly suggested. Eight specimens of proximal tibia and Achilles tendon grafts were harvested from four cadavers and divided into four groups in regard to the four different types of transtibial fixation techniques. The cyclic load ranged from 50 N to 250 N applied to each graft fixed to proximal tibia in 55 degrees. The initial lengthening ratio to the total elongation has been approximately constant regardless of the fixation methods. The soft tissue fixation method with an interference screw showed about 56.4% slippage ratio to the total elongation and the same method with a double cross-pin presented about 45.4% slippage ratio. The soft tissue fixation method with an interference screw demonstrated approximately 2 mm less total elongation and about 13% more slippage than lengthening because of poor fixation compared to the same method with a double cross-pin.

• Biomedical Science Letters
• /
• v.13 no.4
• /
• pp.361-368
• /
• 2007

Biological samples can be fixed either by chemical method by using chemical solution or physical methods by using heat treatment. The problem in traditional heat fixation is unsatisfactory quality due to uneven heat conduction in specimen and loss of inner cell contents. Chemical fixation method also bears several intrinsic problems like the limit in specimen size, time consumption in fixative impregnation, and loss of low molecular weight cell components. These factors deteriorate the quality of fixed specimen, thus limit the magnification and contrast of tissue pictures. Microwave heat has been reported to be a good alternative to current chemical methods to overcome these problem. In this study, we tried to introduce the microwave energy method to routine fixation work in hospital. We replaced chemical fixative with saline to provide moderate reaction condition, and used frozen section to reduce time for sample preparation. Temperature was measured at each experiment. The fixation of rat kidney tissue with 2.45 GHz electromagnetic wave and saline showed similar result to the control group fixed with traditional chemical method. Human tumor tissue fixed with 2.45 GHz electromagnetic in frozen section was improved in terms of histochemistry of PAS and immunohistochemistry of tumor marker like cytokeratin. Total turnaround time was reduced from $24\sim38$ h to to $2\sim4$ h. In conclusion, the quality of samples prepared by microwave heating method was at least as good as that of traditional method. If the condition for the fixation of different specimens is standardized, this new method could be applied to routine work in hospital, and could save working time as well.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.20 no.8
• /
• pp.417-424
• /
• 2019

Despite its superior ability to show distinct cellular morphology and for long-term storage, conventional tissue fixation by formalin has many drawback, including slower fixation, the exposure to harmful chemicals and extensive protein modification. Herein, we assessed the effects of rapid microwave-assisted tissue fixation on histological examination and on protein integrity by comparing these microwave irradiation fixated tissues with the formalin-fixed tissues. One of the paired mouse tissues (liver and kidney) was fixed in formalin and the other was fixed by using microwave irradiation in phosphate buffered saline. Each slide from the paraffin-embedded tissues was examined by H & E staining for the adequacy of fixation and by immunohistochemical staining for antigenicity in a blinded fashion. Evaluation of protein recovery and the protein quality from the fixed tissues were analyzed by the BCA method and Western blotting, respectively. The results from H & E staining and immunohistochemical staining showed that the sections obtained from microwave-fixed tissues under our experimental conditions were comparable to those of the formalin-fixed tissues except for the integrity of RBCs. Furthermore, proteins were effectively extracted from the microwave-fixed tissues with acceptable preservation of the proteins' quality. Taken together, this microwave-assisted tissue processing yields a quick fixation and better protein recovery in higher amounts, as well as the adequacy of fixation and the antigenicity being comparable to formalin-fixed tissues, and this all suggests that this new fixation technique can be applied in an environment where rapid tissue fixation is required.

• Journal of Korean Foot and Ankle Society
• /
• v.7 no.2
• /
• pp.250-257
• /
• 2003

Purpose: Pilon fracture is caused by high energy and axial compression forces, and it is often associated with severe comminution and soft tissue injury. Recently, limited internal fixation of this fracture may avoid the soft tissue complications associated with formal open reduction and internal fixation and avoid incongruity of joint margin associated with conservative treatment. We have treated Ovadia and Beals type II or III pilon fracture with limited internal fixation and the results were satisfactory. Materials and Methods: We analyzed 15 cases of Ovadia and Beals type II or III fractures who were treated by limited internal fixation(K-wire or screw fixation) from January 1995 to December 2000. The average follow up period was 20 months(range, 12 to 38 months). According to the Ovadia and Beals classification, seven cases were type II, and eight cases were type III. Radiographic results were assessed by Ovadia and Beals criteria. We also assessed the functional results by Mast and Teipner criteria. Results: Radiographic results showed good in 67% and fair in 33% of cases. Clinical results showed good in 73% and fair in 27% of cases. There were no complications such as wound infection and skin necrosis, but traumatic arthritis were 2 cases. Conclusion: Pilon fractures are high energy injuries with significantly associated soft tissue damage and traumatic arthritis. Limited internal fixation offers good solution to Ovadia and Beals type II or III fracture.

• Journal of Korean Foot and Ankle Society
• /
• v.28 no.1
• /
• pp.8-14
• /
• 2024

Purpose: Ankle fracture fixation is the gold standard of treatment but it does have its own complications. There is inadequate data regarding the comparative effectiveness of early vs. delayed fixation for open ankle fracture outcomes. This study compares the clinical and functional outcomes of open ankle fractures treated by early or delayed definitive fixation and identifies the limitations of both methods. Materials and Methods: All 73 patients enrolled in the study underwent surgical intervention within 24 hours of injury. The early fixation group (group A) consisting of 39 patients underwent definitive fixation as an index procedure, while the delayed fixation group (group B) consisted of 34 patients who underwent debridement and external fixator application as an index procedure and definitive fixation when soft tissue condition was conducive. All patients were evaluated at 2, 6, and 12 weeks postoperatively and then three monthly for a year. Results: Enneking and American Orthopaedic Foot and Ankle Society scores were markedly higher in the early fixation group at 6 months postoperatively (p-values <0.001 and 0.011, respectively). However, no discernible intergroup difference was evident at 12 months postoperatively. Between 6 and 12 months, group functional outcome scores were significantly different. At 6 months, there was a substantial difference in dorsiflexion between the two groups (p-values 0.001 and <0.001, respectively), but no difference was observed at 12 months postoperatively. At 6 and 12 months, group average plantar flexions were non-significantly different. Conclusion: Early definitive fixation of complex ankle fractures using a targeted approach produced promising results for lower grade open fractures (grades 1 and 2), and delayed definitive fixation, after initial external fixation to allow for soft tissue stabilization, produced promising results for higher grade open fractures (grades 3A and 3B). At 12-month follow-ups, clinical and functional outcomes achieved using these strategies were equivalent.

• Journal of Korean Foot and Ankle Society
• /
• v.21 no.4
• /
• pp.165-169
• /
• 2017

Secondary soft tissue injuries can occur from the pressure of the displaced fragment of posterior calcaneal tuberosity in calcaneal tongue-type fractures and calcaneal tuberosity avulsion fractures. The soft tissue injury can be prevented by immediate reduction of the displaced fragments. Various techniques can be used to fix the fracture fragments, but the stability of fixation and minimal invasiveness to soft tissue should be considered. This paper reports the successful outcomes of patients with soft tissue compromises in calcaneal tongue-type fractures and calcaneal tuberosity avulsion fractures. The fixation technique of a large cannulated screw and simple cerclage wiring is believed to be a useful surgical option for the treatment of secondary soft tissue compromised calcaneal fractures.

• Applied Microscopy
• /
• v.50
• /
• pp.10.1-10.6
• /
• 2020

Plant specimens for scanning electron microscopy (SEM) are commonly treated using standard protocols. Conventional fixatives consist of toxic chemicals such as glutaraldehyde, paraformaldehyde, and osmium tetroxide. In 1996, methanol fixation was reported as a rapid alternative to the standard protocols. If specimens are immersed in methanol for 30 s or longer and critical-point dried, they appear to be comparable in preservation quality to those treated with the chemical fixatives. A modified version that consists of methanol fixation and ethanol dehydration was effective at preserving the tissue morphology and dimensions. These solvent-based fixation and dehydration protocols are regarded as rapid and simple alternatives to standard protocols for SEM of plants.

• Korean Journal of Environmental Biology
• /
• v.38 no.2
• /
• pp.248-253
• /
• 2020

The level at which analyses of DNA content might contribute more significantly to the genetic mechanisms of evolution lies in the events of speciation. The object of this study was to investigate the DNA content of abalone (Haliotis discus hannai) and determine the optimal tissue samples for measuring the DNA content of abalone by flowcytometry without fixation. The DNA content (pg/nucleus) of gill tissue (2.5±0.08), which was contaminated with protozoa, was significantly lower than that of muscle tissue (3.2±0.02), mantle tissue (3.2±0.02) (p<0.05), and a standard reference standard, while the DNA contents of muscle tissue and mantle tissue were higher than that of the standard reference. Considering the results of this study, DNA content analysis with flowcytometry is an acute and rapid method by which muscle tissue and mantle tissue are the most appropriate sample for measuring the DNA content of abalone without fixation.