• Clinics in Shoulder and Elbow
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• v.23 no.3
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• pp.152-155
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• 2020

Periprosthetic fracture after total elbow replacement surgery is a difficult complication to manage, especially when it comes together with implant loosening. If stem revision and internal fixation of the periprosthetic fracture are performed simultaneously, this would be a very challenging procedure. Most of total elbow replacement implants are cemented type. Cement usage at periprosthetic fracture site may interfere healing of fractured site. Authors underwent internal fixation with use of locking plate and cerclage wire for periprosthetic fracture, allogenous fibular strut bone inserted into the humerus intramedullary canal allowing the fractured site to be more stable without cement usage. At 10-month follow-up, the complete union and good clinical outcome was achieved. We present a novel technique for treating periprosthetic fracture with implant loosening after total elbow replacement surgery, using intramedullary allogenous fibula strut bone graft.

• Archives of Plastic Surgery
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• v.46 no.4
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• pp.336-343
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• 2019

Background Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database. Methods Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications. Results There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P<0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P<0.001). Conclusions Sternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation >48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF's purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.

• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.1
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• pp.58-62
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• 2006

Purpose: To evaluate the result of operative treatment with plate and wire fixation for fractures of the distal clavicle. Materials and Methods: We assessed 9 cases of fractures of the distal clavicle that were treated by plate and wire fixation from March 2001 to July 2003 and followed up over 1year. We used the reconstruction plate as a buttress and performed cerclage wiring to fix comminuted fracture site. The functional result of shoulder was evaluated by the scoring system of Rowe. Results: The average periods of bony union was 9 weeks in all cases. According to Rowe scoring system, the functional result was exellent in 7 cases and good in 2 cases. There was no LOM of shoulder and traumatic arthritis in AC joint. But there was skin irritation in 1 case. Conclusion : The operative method by reconstruction plate and wire fixation for distal clavicular fracture was useful when there were comminuted fracture. This method seems to be simple and satisfactory in terms of improvement of range of motion of shoulder, restoration of function and rare complication.

• Journal of Veterinary Clinics
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• v.25 no.6
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• pp.545-548
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• 2008

A 3-year-old castrated male Siberian husky was presented for evaluation after being hit by a car. On physical examination, the dog showed open-mouth, displacement of mandible and hypersalivation with blood ting. The base of tongue was transected almost 80% on the bias from right dorsal side to the left ventral side. Radiography demonstrated separation of mandible symphysis, and fracture of right condyle and vertical ramus. After debridement of the necrotic tissue, tongue apposition with simple interrupted suture was performed. Mandibular symphysis, condyle and mandibular vertical ramus fractures were fixed using pin, cerclage wire, T-plate, and K-wires. The mouth was irrigated daily using chlorhexidine after surgery. The sutures that were loose here or untied at tongue were re-sutured under sedation. The transected tongue was healed and recovered its normal movement after 6 weeks.

• Journal of Veterinary Clinics
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• v.24 no.4
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• pp.658-662
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• 2007

The simple and easy treatment with cast or splint has been applied to stabilize long bone fractures in farm animals. Applying cast or splint is relatively easier than surgical fixation and may temporarily stabilize fracture site. However, the internal fixation provides strong stabilization and early recovery of limb function. In this report, we describe six cases of limb fractures in calves repaired by internal fixation. Fracture sites are various and affected ages are between 1 day and several months old. In some cases, patients were treated with cast or splint before admitting to Veterinary Medical Center. In these patients, regardless of initial treatment fractures were not immobilized. Consequently we decided to treat these patients with open reduction and internal fixation. The fracture repair with implants(bone plate, screw, cerclage wire, and intramedullary pin) were effective and satisfactory in calves which had been failed by application of cast. Although the cost of orthopedic treatment in farm animal is one of the most important considerations from the practical point of view, internal fixation has many benefits in newborn and young calves. And simplicity of postoperative management is also practically significant benefit expected from infernal fixation In conclusion, we suggest that internal fixation will produce better result than external coaptation in calve.

• Clinics in Shoulder and Elbow
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• v.15 no.1
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• pp.25-31
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• 2012

Purpose: The clinical and radiographic outcomes of the internal fixation, which were executed on patients over the age of 65 with proximal humerus fracture by using a polyaxial angular stable locking compression plate (Non-Contact-Bridging proximal humerus plate, Zimmer, Switzerland, NCB), were evaluated. Materials and Methods: Thirty two patients over the age of 65 among the proximal humerus fracture treated with NCB plate, between August 2007 and January 2011, were chosen as the subjects. The average age of patients was 71 years, and the average postoperative follow-up period was 11.5 months. The fractures included 14 two-part and 18 three-part fractures. The clinical results were evaluated, using the visual analog scale (VAS) score and the Constant score. The radiological results were evaluated by time to union and Paavolainen method, which measures the neck shaft angle. Results: At the last follow-up examination, the mean VAS score was 3 points and the mean Constant score was 64.5 points, with bone union achieved after the average of 16.2 weeks following the surgery in all the cases. The mean neck shaft angle was 125.9 and 24 cases had good results, while 8 cases had fair results by Paavolainen method, at the last follow-up. There were 1 case of delayed union and cerclage wire failure, and 3 cases of subacromial impingement. There were no complications, such as loss of reduction, nonunion, screw loosening, or avascular necrosis of the humeral head. Conclusion: Internal fixation, using a NCB plate, was considered to be an effective surgical method in treating proximal humerus fracture in the elderly patients, on whom the fixation of the fracture and maintenance of reduction are difficult.