• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.99-105
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• 2007

Purpose: The morphological study and dynamic stability of the ulnar nerve around the elbow joint was investigated in asymptomatic normal population using ultrasonography. The purpose of this study is to provide fundamental data for ultrasonographic diagnosis of ulnar neuropathy in cubital tunnel syndrome. Materials and Methods: Fifty cases of 25 healthy male volunteers, aged between 20 to 30 years, included in this study. High resolution 7.5 MHz linear probe was used to examine the ulnar nerve in axial and longitudinal views. In a longitudinal view, the course, position and the thickness of nerve were monitored, the diameter of ulnar nerve and dynamic stability at elbow flexion and extension were measured in an axial view at four different points; 1cm proximal to medial epicondyle, behind the medial epicondyle, entrance to Osborne ligament, and 1cm distal to Osborne ligament. Results: The short diameters of ulnar nerve at elbow extension at four anatomic points were 2.66 mm, 2.97 mm, 2.64 mm, and 2.69 mm and the long diameters were 4.61 mm, 4.56 mm, 4.36 mm, and 4.37 mm, which showed no significant change at each point. However, at elbow flexion, the short diameters were changed to 2.72 mm, 2.34 mm, 2.65 mm, and 2.41 mm and the long diameters into 4.49 mm, 5.40 mm, 4.16 mm, and 4.66 mm. At elbow flexion, significant morphologic change was observed in the medial epicondyle area, and the diameter of the ulnar nerve was shortest at the entrance of Osborne ligament both at flexion and extension. In terms of dynamic stability, nine subluxations and seven dislocations were observed. Conclusion: This study shows dynamic instability and a morphological change of long and short diameters of ulnar nerve at flexion and extension in a normal person, which should be considered in the ultrasonographic diagnosis of ulnar neuropathy.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.2
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• pp.69-74
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• 2012

Purpose: By confirm the change of popliteal arterial position when extension or flexion of the knee and estimate the change of popliteal arterial position after posterior capsular release, we tried to know the position can minimize injury of popliteal artery during arthroscopic surgery and usefulness of posterior capsular release. Materials and Methods: Total of two middle-aged man and woman, fresh frozen cadavers as systemic, all four cases of the knee were included in this study. After the knee was flexed to 0 degrees, 30 degrees, 60 degrees, 90 degrees angle, we estimated distance from posterior tibial cortex to popliteal artery at articular surface, the distal 1 cm and 2 cm from articular surface. We performed posterior capsular release by arthroscopy, and estimated distance between posterior tibial cortex and popliteal artery in the same way. Results: Mean distance between popliteal artery and posterior tibial cortex was 6.3 mm (4.5~7), 4.6 mm (3.6~6), 4.9 mm (3.9~5.8) when knee flexion to 0 degrees at articular surface, distal 1 cm and 2 cm from articular surface each. When knee flexion to 30 degrees, it was 7.4 mm (5.2~9), 4.9 mm (3.6~7.2), 5.3 mm (3.8~6.6). When knee flexion to 60 degrees, it was 8.7 mm (5.4~11), 5.2 mm (4.9~7.3), 6.2 mm (5.4~9.6). When knee flexion to 90 degrees, it was 9.8 mm (5.8~12.1), 5.5 mm (5.1~7.4), 6.5 mm (5.4~10.7). After posterior capsule release, the distance was 6.5 mm (5.5~7.5), 5.8 mm (3.9~7.2), 5.2 mm (3.8~7.0) when knee flexion to 0 degrees, 7.7 mm (5.5~9,1), 7.1 mm (4.6~7.6), 5.5 mm (4.1~6.9) when knee flexion to 30 degrees, 8.9 mm (5.7~11.2), 8.5 mm (5.5~9.2), 6.4 mm (5.3~10.1) when knee flexion to 60 degrees and 10.2 mm (6.3~13.6), 9.5 mm (6.5~11), 6.6 mm (5.9~9.8) when knee flexion to 90 degrees. Conclusion: As knee joint is flexed, the distance from posterial tibial cortex to popliteal artery are increased beween knee joint articular surface and distal 2 cm from knee joint. So popliteal artery injury will be reduced at knee joint surgery. Posterior capsular release could also reduce popliteal artery injury by increasing distance between posterior tibial cortex and popliteal artery.

• Clinics in Shoulder and Elbow
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• v.14 no.1
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• pp.6-12
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• 2011

Purpose: We wanted to analyze and report on the radiologic and clinical results of prospective Hook plate fixation for unstable distal clavicle fractures after a minimum of 2 years follow up. Materials and Methods: We followed up 17 out of 20 cases that underwent prospective Hook plate fixation from 2008 to 2009. We performed radiologic follow up at 2 weeks, 6 weeks, 3 months, 6 months, 18 months and 24 months postoperatively. The clinical results were evaluated at 12 months and 24 months postoperatively. Results: The mean period for bony fusion was 14.5 weeks and the plate was removed after an average of 20.2 weeks. The VAS pain scores were 0.7 and 0.8, the UCLA scores were 33.5 and 33.3, the ASES scores were 92.8 and 92.5, the Constant-Murley scores were 81.5 and 77.0, the KSS scores were 92.5 and 94.3 and the ranges of motion were $173.3^{\circ}$ and $173.7^{\circ}$ of flexion, $56.0^{\circ}$ and $54.5^{\circ}$ of external rotation, $62.3^{\circ}$ and $63.5^{\circ}$ of the internal rotation, $172.0^{\circ}$ and $172.6^{\circ}$ of abduction and $43.3^{\circ}$, and $42.9^{\circ}$ of extension at 1 and 2 years follow-up, respectively. There was no statistically significant difference of clinical outcomes and the range of motion at 1 year and 2 year postoperatively (p>0.05). There was no other complication except 1 case of delayed union. Conclusion: For Hook plate fixation at 2 years postoperatively, the complications will be decreased and excellent clinical results should occur.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.37-44
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• 2019

Purpose: Tumor infiltration around the knee joint or skip metastasis, repeated infection sequelae after tumor prosthesis implantation, regional recurrence, and mechanical failure of the megaprosthesis might require combined distal femur and proximal tibia replacement (CFTR). Among the aforementioned situations, there are few reports on the indication, complications, and implant survival of CFTR in temporarily arthrodesed patients who had a massive bony defect on either side of the knee joint to control infection. Materials and Methods: Thirty-four CFTR patients were reviewed retrospectively and 13 temporary arthrodesed cases switched to CFTR were extracted. All 13 cases had undergone a massive bony resection on either side of the knee joint and temporary arthrodesis state to control the repeated infection. This paper describes the diagnosis, tumor location, number of operations until CFTR, duration from the index operation to CFTR, survival of CFTR, complications, and Musculoskeletal Tumor Society (MSTS) score. Results: According to Kaplan-Meier plot, the 5- and 10-year survival of CFTR was 69.0%±12.8%, 46.0%±20.7%, respectively. Six (46.2%) of the 13 cases had major complications. Three cases underwent removal of the prosthesis and were converted to arthrodesis due to infection. Two cases underwent partial change of the implant due to loosening and periprosthetic fracture. The remaining case with a deep infection was resolved after extensive debridement. At the final follow-up, the average MSTS score of 10 cases with CFTR was 24.6 (21-27). In contrast, the MSTS score of 3 arthrodesis cases with failed CFTR was 12.3 (12-13). The average range of motion of the 10 CFTR cases was 67° (0°-100°). The mean extension lag of 10 cases was 48° (20°-80°). Conclusion: Although the complication rates is substantial, conversion of an arthrodesed knee to a mobile joint using CFTR in a patient who had a massive bony defect on either side of the knee joint to control infection should be considered. The patient's functional outcome was different from the arthrodesed one. For successful conversion to a mobile joint, thorough the eradication of scar tissue and creating sufficient space for the tumor prosthesis to flex the knee joint up to 60° to 70° without soft tissue tension.

• The Journal of Korean Academy of Prosthodontics
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• v.53 no.1
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• pp.58-65
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• 2015

For the rehabilitation of fully edentulous patients, implant-supported removable partial dentures can be considered as one of the treatment options with complete dentures or implant-supported overdentures. If removable partial dentures are used in combination with a small number of implants placed in strategically important positions, it can offer additional stability, retention and support through implants and reduce a burden of surgical procedures compared with fixed implant-supported prostheses with extensive implant placement. Moreover, the economical benefit can be expected as well. The purpose of this case report is to present a treatment in which an implant-supported removable partial denture was fabricated considering residual alveolar bone status and demands after teeth loss in a patient who had been using a distal extension removable partial denture for a long period of time. In anterior area, fixed prostheses were fabricated with implant placement and in posterior area, short implants provide only support for the removable partial denture. In addition, denture base and clasp were made of thermoplastic acrylic resin. Finally, functionally and aesthetically satisfying treatment results can be achieved.

• The Journal of Korean Academy of Prosthodontics
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• v.31 no.1
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• pp.87-99
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• 1993

Many studies have been reported on the successful replacement of missing teeth with osseointegrated dental Implants. However, little research has been carried out on the bio-mechanical aspect of the stress on the surrounding bone of the free-standing type of dental implant prostheses. This experimental study was aimed to analyze the stress distribution pattern on the supporting tissues depending upon the position of osseointegrated implants supporting fixed bridges. In the cases of unilateral partially edentulous mandible (the 2nd premolar and the 1st and 2nd molars missing), two osseointegrated implants were placed at the 2nd premolar and 2nd molar sites (Model A) , the 1st and 2nd molar sites (Model B, Anterior cantilevered type), the 2nd premolar and 1st molar sites (Model C, Posterior cantilevered type). Chewing forces of dentate patients and denture wearer were applied vertically on the 2nd premolar, the 1st molar, and the 2nd molar of each model. A 3-Unit fixed partial denture was constructed at each model and cantilevered extension parts were involved in Model B and Model C. Two dimensional finite element analysis was undertaken. The commercial software (Super SAP) for IBM 16 bit personal computer was utilized. The results were as follows : 1. The magnitude of applied load influenced on the total value of stresses, but did not in-fluence on the pattern of stress distribution. 2. The magnitude of stress developed from the supporting tissues were in order of Model C,Model A,Model B. 3. High stresses were concentrated on the cervical and apical portion of the implant/bone interface. 4. A difference of the stress magnitude on the implant/bone interface between mesial and distal implant was most prominant in Model C and in order of Model A and Model B. 5. The stresses developed in Model A were evenly distributed throughout both implants. 6. The stresses concentrated on the cervical portion of cantilevered side were higher in the posterior cantilevered type than in the anterior cantilevered type.

• The Journal of Korean Academy of Prosthodontics
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• v.56 no.4
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• pp.323-329
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• 2018

Traditional options for posterior edentulous treatment include removable partial dentures and implant fixed prostheses. Recently, the concept of implant assisted removable partial denture, in which two treatments are fused, has been introduced in consideration of systemic health and patient's needs, costs, residual alveolar bone status and so on. Implant assisted removable partial denture has the advantage of increasing the retention and stability of the denture and improving its esthetics in cases of large bone defects or biomechanical disadvantages. In addition, it is possible to strategically place the implants in a site where the alveolar bone is relatively sufficient, thereby overcome the limit of the conventional removable partial denture design as well as reducing the burden on a wide range of implant surgery. Cost reduction is also expected. In this case, the patient was treated by placing the implant in both premolar sites of the mandible and fabricating the distal extension removable partial denture with the implant fixed prosthesis as an abutment. After delivering the definitive prosthesis, the patient showed satisfaction with the masticatory function and esthetics. and has been regularly followed-up for more than one year. The following 20-months follow-up case report describes the design of an implant-assisted-removable partial denture (IARPD) in which two cementretained implant crowns used to provide support and stability.

• 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 the Korean Arthroscopy Society
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• v.14 no.1
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• pp.49-52
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• 2010

Purpose: We introduce arthroscopically assisted mini-open rotator cuff repair using anterolateral approach. Operative Technique: Placing lateral decubitus position on general anesthesia, a standard arthroscopic glenohumeral examination is performed to evaluate lesions of shoulder joint through posterior and anterior portal. And then arthroscope is placed in the subacromial space and we evaluate the size of the torn tendon and perform arthroscopic acromioplasty through lateral portal. A 3 to 4 cm skin incision is performed from anterolateral edge of acromion to distal and dissected along to raphe between anterior and middle deltoid. A deltoid retractor is then placed, allowing direct visualization of the rotator cuff and humeral head. As torn tendon is tagged by traction suture, we try to anatomical reduction on the footprint and then perform single row or double row repair of the rotator cuff using suture anchors. To prevent avulsion of the deltoid from the acromion, additional sutures by bone tunnel with acromion and deltoid is performed. Conclusion: This technique is useful procedure to get direct approach to anterior portion of supraspinatus tendon and to need lesser deltoid retraction than portal extension approach due to dividing along to raphe between anterior and middle deltoid. Also it provide better visualization of the superior portion of subscapularis and infraspinatus.

• Journal of Veterinary Clinics
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• v.32 no.3
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• pp.251-254
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• 2015

A 3-year-old castrated male Spitz dog (8.4 kg) was referred for hindlimb lameness. The dog had undergone corrective surgery for bilateral medial patellar luxation 6 weeks prior to presentation. Intermittent lameness of both hind limbs was evident on general inspection. Physical examination revealed moderate pain and crepitus upon flexion and extension of the stifle joints. Radiography revealed features consistent with distal deviation of the cartilage flaps and effusion in both stifle joints. Detachment and deviation of both osteochondral blocks were suspected based on the physical and radiographic findings. Arthroscopy confirmed failed osteochondral blocks (right $1.5cm{\times}0.9cm{\times}0.2cm$, left $1.3cm{\times}0.9cm{\times}0.1cm$), which were removed. After removal of the osteochondral blocks, the stepped trochlear grooves were located and debrided using an arthroscopic burr, to prevent patellar tracking disorder. The dog resumed normal ambulation without medial patellar luxation 2 weeks postoperatively, and there were no complications. Arthroscopy is an effective surgical modality for the diagnosis and treatment of canine joint disorders. It offers a magnified view of the joint, which allows accurate evaluation of intra-articular structures. In addition, arthroscopic surgery can reduce the postoperative complications associated with surgical wound.