• Title/Summary/Keyword: bony union

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Treatment of Fifth Metatarsal Base Fracture Using Tension Band Wiring (인장대 강선 고정술을 이용한 제5 중족골 기저부 골절의 수술적 치료)

  • Ahn, Jong-Kuk;Chung, Hyung-Jin;Bae, Su-Young;Park, Ji-Yong
    • Journal of Korean Foot and Ankle Society
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    • v.15 no.1
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    • pp.18-21
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    • 2011
  • Purpose: To evaluate the clinical and radiological results of internal fixation with tension band wiring for the fracture at the base of fifth metatarsal bone. Materials and Methods: From January 2008 to December 2009, 15 cases with displaced fracture at the base of fifth metatarsal were analyzed and average follow up period was 13.8 months. Lawrence classification was used to classify fracture type. We evaluated clinical results by American Orthopedic Foot Ankle Society (AOFAS) midfoot score and radiological results by union time. Complications was also checked. Results: According to classification, zone I fracture were 11 cases and zone II fracture were 4 cases. Bony union was achieved in all cases after 7 weeks. In the final follow-up, average AOFAS score was 94. There were no complications except hardware irritation. Conclusion: Satisfactory results were obtained after tension band wiring for the fifth Metatarsal base fracture in zone I fracture or comminuted zone II fracture for which it is not easy to be fixed with screw.

HISTOLOGICAL CHANGES IN THE ELONGATED BONE AFFECTED BY OSTEODISTRACTION OF THE MANDIBLE IN THE DOG (성견 하악골 절단 후 기계적 골 견인에 의해 형성된 골 신장부에 대한 시기별 조직학적 변화)

  • Baek, Sun-Ho;Ahn, Byoung-Keun;Park, Young-Ju;Park, Hee-Geon;Park, Jun-Woo;Rhee, Gun-Joo;Lee, Yong-Chan;Cho, Byoung-Ouck
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.27 no.5
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    • pp.404-416
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    • 2001
  • Purpose : Traditionally, the treatement of choice has been a bone grafting procedure to increase the length of bone in case of actual length discrepancy. But, bone grafting procedure has many disadvantages, for example, graft resorption, donor site morbidity, and so on. So, many trials have been performed to avert the use of autogenous bone graft via introducing new materials or methods. And, one of those trials has been realized by the development of a technique inducing bone lengthening by osteotomy (or corticotomy) and slow gradual distraction of the osteotomized segments. This new technique of bone lengthening dates back to the early 20th century. But, the majority of information concerning the biology of new bone formation during bone lengthening and technical details of the procedure were produced by extensive clinical and experimental studies performed by Ilizarov, a Russian surgeon. According to Ilizarov, with adequate blood supply, preservation of periosteum, rigid fixation of the osteotomized segments, and proper rate and rhythm of distraction, intramembranous bone rapidly develops within the distraction gap in the limb lengthening procedure. In the limb lengthening, many orthopedic surgeons try to observe the biologic and clinical principles recommended by Ilizarov. In the oral and maxillofacial region, however, not a few studies must be performed to apply this surgical technique in the clinical cases. Besides, the mechanism of bone formation in the distraction gap is not clear, yet. The purpose of this experiment was to scrutinize serially the histological changes in the elongated bone affected by osteodistraction of the mandibular body in an adult canine model. In addition, it was performed to confirm the presence of specific region(s) which was important in the bone formation in the gap through the observation of the expression pattern of osteocalcin and osteonectin with the immunohistochemical examination. Materials and Methods : The experimental and control specimens were obtained from seven adult male mongrel dogs weighing over 20kg. The distractors were custom-made linear extraoral devices and bicortical fixation screws were 2.3mm in diameter, 50mm in total length, 15mm in screw length. The distractors were devised to produce a linear gap of 0.75mm between two bony segments every $360^{\circ}$ turn of the rotation rod of the device. The mandibular body of the right side of each animal was corticotomized perpendicular to the occlusal plane and then two bony segments were separated completely by careful manipulation of the segments with bone forceps. The left side of each animal was left intact. This side was served as control. At sixth day after osteotomy and fixation of the segments were performed, distraction of the segments was commenced with a rate of 1.1mm/day and a rhythm of two/day for ensuing 7 days. The animals were euthanized at the 16th. 29th, and 44th day after the osteotomy. The bony specimens were decalcified, embedded in paraffin, sectioned $5{\mu}m$ thick and stained with H&E. The prepared specimens were examined under the light microscope. And, immunohistochemical examinations using anti-osteocalcin antibody (OC1, Biodesign, USA) and anti-osteonectin antibody (Haematologic Technologies Inc., Essex, VT) to locate the expressions of osteocalcin and osteonectin, respectively, were performed. Results : 1. New bone was observed already at the 16th. day after osteotomy. This suggests that new bone formation in osteodistraction was commenced at an early stage of the regenerative process. But, radiologically and microscopically, bony union was not completed in the distraction gap at the 44th. day after osteotomy. Therefore, rigid fixation must be maintained between the bony fragments till the complete bony union is confirmed clinically rather than one month or so after the completion of distraction.

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Treatment of Fractures of the Lateral Malleolus using Locking Compression Plate (Locking Compression Plate를 이용한 족근 관절 외과 골절의 치료)

  • Ha, Sung-Sik;Hong, Ki-Do;Chung, Nam-Sik;Sim, Jae-Cheon;Ahn, Sang-Cheon
    • Journal of Korean Foot and Ankle Society
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    • v.9 no.1
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    • pp.99-104
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    • 2005
  • Purpose: The purpose of this study was to investigate usefulness of locking compression plate (LCP) as an open reduction technique by evaluating clinical results obtained from the patients with lateral malleolar fracture treated by internal fixation using LCP after open reduction. Materials and Methods: Among the patients with lateral malleolar fracture, the 28 patients who were treated by internal fixation using Locking compression plate after an open reduction and were able to be followed up for more than 6 months were included in this study. Final postoperative evaluation was done based on the Meyer's clinical and radiologic evaluation system. Results: All cases achieved anatomical reduction and fixation of the reduction postoperatively. 28 minutes were taken meaningly from the incision to the fixation of LCP plate after the anatomical reduction. Everage bony union time was 8.2 weaks, and the result was excellent in 23 cases (82%), good in 5 cases (17%) and poor result was abscent according to the criteria of Meyer et al. One case of post traumatic arthritis and one case of superficial infection on the operation site were found, but non-union, delayed union and malunion were not occurred. Conclusion: The internal fixation after open reduction using LCP is an effective treatment method in treating lateral malleolar fracture of the ankle since it offers advantages including easy application and a greater stability due to its capability of maintaining exact anatomical reduction even though the screw does not penetrate the medial cortex of fibular to add the stability and rigidity of the fixation.

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Analysis of Bone Fixation Methods in Digital Replantation

  • Lee, Seung Woo;Lee, Dong Chul;Kim, Jin Soo;Roh, Si Young;Lee, Kyung Jin
    • Archives of Plastic Surgery
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    • v.44 no.1
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    • pp.53-58
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    • 2017
  • Background Adequate fixation of replanted digits is essential not only for short-term healing but for long-term function. Various bony fixation methods using Kirschner (K-) and intraosseous wire are available in replantation. We examined clinical and radiographic outcomes of fixation methods on bone union after digital replantation. Methods A single institutional retrospective review identified 992 patients who had undergone 1,247 successful replantations between July 2009 and September 2015. Exclusion criteria included amputations of the distal phalanx, comminuted fractures, and intra-articular fractures. Patients were classified according to 5 categories of fixation methods: single K-wire, double longitudinal K-wires, cross K-wires, wire with, and wire without K-wire support. Bone union was evaluated by 5-month postoperative X-ray and fixation outcomes were compared across the 5 groups. Results The exclusion criteria were applied, and 88 patients with 103 replanted digits remained for analysis. Single K-wire fixation was used in 40 digits, double longitudinal K-wires in 30, and cross fixation in 14. Wire with and without K-wire support was required in 15 and 4 digits. Nonunion was observed in 32 digits (31.1%), of which 13 required additional operations such as bone graft or corrective osteotomy. The highest percent of nonunion was observed after cross fixation (35.7%) and the lowest after wire alone (25.0%). Conclusions In this study, contrary to general knowledge, we found that single K-wire fixation was not associated with poorer outcomes. Successful bone union outcomes may be achieved by careful selection of bone fixation methods. This study provides useful information for planning bone fixation in digital replantation.

Indirect Reduction Technique in Proximal Humeral Fractures Stabilized by Locking Plates

  • Rhee, Yong Girl;Cho, Nam Su;Cha, Sang Won;Moon, Seong Cheol;Hwang, Sang Phil
    • Clinics in Shoulder and Elbow
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    • v.17 no.1
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    • pp.2-9
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    • 2014
  • Background: Indirect reduction technique offers a valid option in the treatment of proximal humerus fracture. The purpose of this study is to evaluate the functional outcome and the complication rate after indirect reduction and internal fixation of unstable proximal humeral fractures with use of a locking plate. Methods: Twenty four patients with acute proximal humerus fracture were managed with indirect reduction and internal fixation with a locking plate. The mean follow-up period was 15.5 months. Results: The anatomical reduction of the medial cortex buttress was seen in 16 patients (66%) of the Group A and the non-anatomical reduction was seen in 8 patients (33%) of the Group B. Mean union time was $3.2{\pm}1.9$ months; it was $2.2{\pm}0.6$ months in the Group A and $5.3{\pm}2.2$ months in the Group B (p < 0.05). In our series, there were 6 cases of complications and these include 2 cases of varus malunion, 2 cases of shoulder stiffness, 1 case of heterotrophic ossification, 2 cases of screw perforation and 1 case of impingement. Conclusions: We conclude from our studies that indirect reduction and internal fixation using locking plate for acute proximal humerus fracture can give good results with bony union and predictable good overall functional outcome. If the medial cortex buttress is well maintained, a better anatomical reduction would be achieved, the union would be prompted, the pain would be further reduced and the range of the motion would be recovered more promptly.

The Radiologic Comparison of Operative Treatment Using a Hook Plate versus a Distal Clavicle Locking Plate of Distal Clavicle Fracture

  • Yoon, Byungil;Kim, Jae Yoon;Lee, Jae-Sung;Jung, Hyoung Seok
    • Clinics in Shoulder and Elbow
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    • v.21 no.4
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    • pp.227-233
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    • 2018
  • Background: The purpose of this study was to compare the radiologic results of patients who underwent surgery with a hook plate and a locking plate in distal clavicle fractures. Methods: Sixty patients underwent surgical treatment for Neer type IIa, IIb, III, and V distal clavicle fracture. Twenty-eight patients underwent fracture fixation with a hook plate and 32 with a locking plate. Coracoclavicular distance was measured on standard anteroposterior radiographs before and after the surgery, and union was confirmed by radiograph or computed tomography taken at 6 months postoperatively. Other radiologic complications like osteolysis was also checked. Results: Bony union was confirmed in 59 patients out of 60 patients, and 1 patient in the hook plate group showed delayed union. Coracoclavicular distance was decreased more in the hook plate group after surgery (p<0.01). After 6 weeks of the hook plate removal, the coracoclavicular distance was increased a little compared to before metal removal, but there was no difference compared to the contralateral shoulder. Eleven out of 28 patients (39.3%) showed osteolysis on the acromial undersurface in the hook plate group. Conclusions: Both the hook plate group and the locking plate group showed satisfactory radiologic results in distal clavicle fractures. Both hook plate and locking plate could be a good treatment option if it is used in proper indication in distal clavicle fracture with acromioclavicular subluxation or dislocation.

Replantation of a Distal Lower Leg in an Elderly Patient After Retrieval of the Limb from Seawater Immersion (바다에서 건진 절단된 하지 원위부의 재접합)

  • Woo, Sang Hyun;Oh, Kyoung Sok
    • Archives of Reconstructive Microsurgery
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    • v.9 no.2
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    • pp.186-189
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    • 2000
  • A case of distal lower leg replantation, in an elderly patient, was successfully performed after retrieval of the amputated limb from 3 hours of immersion in seawater. Due to the patient's age, bony union was delayed and functional nerve recovery was unsatisfactory. After massive saline irrigation of the amputated part, employing a catheter through the main artery, as well as, prophylactic antibiotics to prevent infection by Aeromonas, there were no postoperative complications. Despite the issue of age, immersion of an amputated part into seawater is not a contraindication of replantation.

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Ankle Arthrodesis (족관절 유합술)

  • Chun, Dong-Il;Won, Sung Hun
    • Journal of Korean Foot and Ankle Society
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    • v.22 no.1
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    • pp.1-7
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    • 2018
  • Ankle arthrodesis is a common and standard treatment for patients with end-stage ankle arthritis. The surgical goals of ankle arthrodesis are to obtain bony union between the tibia and talus with adequate alignment, and provide a pain-free plantigrade foot for weightbearing activities. To achieve successful fusion, the surgeon should closely examine the patient's factors before surgery, particularly the following: adjacent arthritis and deformity, infection, avascular necrosis of talus, Charcot arthropathy, and rheumatoid arthritis. Recently, ankle arthroplasty has been reported to provide satisfactory clinical results. On the other hand, long-term follow-up results are still lacking, and considering the various complications of arthroplasty, ankle arthrodesis is still the primary surgical treatment for advanced arthritis of the ankle joint.

Case Report of Squamous-cell Carcinoma of the Mandibular Gingiva with Invasion of The Bone, Treated by Resection and Tibial Bone Graft (악골결손부에 경골이식술로 성형한 치험예)

  • Kim, Kwang-Hyun;Kim, Hong-Ki;Choi, Mock-Kyun
    • The Journal of the Korean dental association
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    • v.11 no.3
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    • pp.195-198
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    • 1973
  • The authors have treated a squamous-cell carcinoma occurred in molar region of the right mandible in 52-year old woman by means of bony resection and banked tibial bone graft, and made the normal appearance of her face. The result as follow: 1) The healing of a graft is similar to the healing of an uninfected fracture except that it will take considerably longer. It is of the utmost importance that it should be well immobilized, otherwsie there is danger of absorption of bone and fibrous union. 2) Until the graft acquires a blood supply it is easily infected, for it has no defence against organisms, so it is most important to prevent wound infection set in.

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Uni and Bilateral Dual Calcaneonavicular and Talocalcaneal Coalitions (일측과 양측 발에 동시에 발생한 거종 및 종주상 결합)

  • Park, Yong-Wook;Kim, Do-Young;Lee, Sang-Soo;Yoon, Tae-Kyung;Noh, Kyu-Cheol;Son, Hyun-Il
    • Journal of Korean Foot and Ankle Society
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    • v.7 no.2
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    • pp.263-268
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    • 2003
  • Tarsal coalition is a congenital failure of segmentation resulting in fibrous, cartilaginous, or bony union between tarsal bones. Although single tarsal coalitions are common, dual tarsal coalitions are a rare occurrence. We repport of unilateral and bilateral dual calcaneonavicular and talocalcaneal coalitions.

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