• Journal of the Korean Orthopaedic Association
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• v.54 no.3
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• pp.227-236
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• 2019

Purpose: To evaluate the results of tibial lateral plateau fractures using arthroscopic-assisted reduction and internal fixation without cortical window or bone grafts. Materials and Methods: From March 2009 to March 2017, 27 patients with Schatzker type II tibial plateau fractures with articular depression and displacement over 5 mm on a computed tomography (CT) scan, who were treated with arthroscopic reduction and internal fixation and followed-up for at least 18 months, were enrolled in this study. Under arthroscopic guidance, the depressed fracture fragment was reduced using a freer and fixed with 5.0 or 6.5 mm cannulated screws through the inframeniscal portal without a cortical window or bone graft. The clinical and radiological results were evaluated using a Rasmussen system. Second look arthroscopy was performed in thirteen patients during the implant removal operation. Results: All fractures healed completely with a mean union time of 8.7 weeks (range from 8 to 12 weeks). Twenty four patients had good to excellent clinical results and 25 patients had good to excellent radiological results according to the Rasmussen classification. A well-healed articular surface with fibrocartilage was also found in 13 cases with second look arthroscopy. The 8 cases on CT scan at outpatient department follow-up showed bone union without bone grafting. Conclusion: Arthroscopic-assisted fixation of tibial lateral plateau fractures is a useful method without a cortical window or bone graft that produces good clinical results.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.112-123
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• 2007

Purpose: Evaluate the clinical results of humerus neck nonunion treated with Polarus intramedullary nail. Materials and Methods: 8 patients who underwent surgery for nonunion of humerus surgical neck fracture were included. All patients were female, the average age was 65 years. 5 out the total 8 cases initially received surgery, open reduction and internal fixation with metal plate in 1 case, Ender nail insertion in 2 cases, external fixator in 1 case and closed reduction and percutaneous pinning in 1 case. The other 3 non union cases initial received conservative managemnent. The average period of nonunion was 9 months in the operated group and 6.2 months in the conservative group. All 8 cases received closed reduction with intrameedullary Polarus nail and auto iliac bone graft. Union was confirmed radiologically, and functional evaluation was done with the UCLA functional criteria. Results: All 8 cases showed union on radiologic evaluation. Average time to union was 3.5 months, average follow up period was 27 months. Average UCLA shoulder evaluation score was 7.6 points preoperatively which improved to 26.3 points after surgery. Active shoulder flexion was 40.7 degrees preoperatiely which increased to 104 degrees after surgery. Shoulder abduction improved from 32.9 degrees preoperatively to 96.3 degrees after surgery. UCLA functional criteria was good in 5 cases and fair in 3 cases, which no poor cases. Conclusion: Polarus IM nailing and AIBG is a useful method for treating nonunion of humerus neck fracture with improvement in union and function.

• Journal of the Korean Orthopaedic Association
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• v.56 no.1
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• pp.26-33
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• 2021

Purpose: This study evaluated the results of dual plate fixation for periprosthetic femur fracture after total knee arthroplasty (TKA). Materials and Methods: From October 2007 to February 2013, 23 cases of periprosthetic femur fracture after TKA were treated at the author's hospital. There were 13 cases of fixation using a medial and lateral dual plate when the stability of the fracture site could not be achieved by one side fixation with a follow-up of more than one year. The cases included no loosening of the femoral component in fractures that were categorized as Lewis-Rorabeck classification II and supracondylar comminuted fractures and elongation of the fracture line to the lateral epicondyle of the femur or stem in the medullary canal. The mean age was 72 years (65-82 years), and 11 cases were female. Three cases had a stem due to revision. The mean bone marrow density was -3.2 (-1.7 to -4.4), and the mean period from primary TKA to periprosthetic fractures was 28 months (1-108 months). The mean follow-up period was 23 months (12-65 months). The medial fracture site was first exposed via the subvastus approach. Second, the supplementary plate was fixed on the lateral side of the fracture using a minimally invasive plate osteosynthesis technique. The average union time, complications, and Hospital for Special Surgery Knee Score (HSS) at the last follow-up were evaluated. Results: The mean union time was 17.4 weeks (7-40 weeks). Two cases showed delayed bone union and nonunion occurred in one case, in whom bone union was achieved three months later after re-fixation using a dual plate with an autogenous bone graft. The mean varusvalgus angulation was 1.67 degrees (-1.2-4.9 degrees), and the mean anterior-posterior angulation was 2.86 degrees (0-4.9 degrees) at the last follow-up. The mean knee range of motion was 90 degrees, and the HSS score was 85 points (70-95 points) at the last follow-up. Conclusion: Dual plate fixation for periprosthetic femur fractures that had not achieved stability by one side plate fixation after TKA showed a good clinical result that allowed early rehabilitation.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.129-138
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• 2016

Purpose: Due to recent advances in internal fixation techniques, instrumentation and orthopedic implants there is an increasing number of humeral shaft fracture treated operatively. As a consequence, an increased number nonunion after operative fixation are being referred to our center. The aim of this study is to report the common error during osteosynthesis that may have led to nonunion and present a systematic analytical approach for the management of aseptic humeral shaft nonunion. Methods: In between January 2007 to December 2013, 20 patients with humeral shaft nonunion after operative procedure were treated according to our treatment algorithm. We could analysis x-rays of 12 patients from initial treatment to nonunion. In a subgroup of 12 patients the initial operative procedure were analyzed to determine the error that may have caused nonunion. The following questions were used to examine the cases: 1) Was the fracture biology preserved during the procedure? 2) Does the implant construct have enough stability to allow fracture healing? Results: In 19 out of 20 patients have showed radiographic evidence of union on follow up. One patient has to undergo reoperation because of the technical error with bone graft placement but eventually healed. There were 2 cases wherein the treatment algorithm was not followed. All patients had problems with mechanical stability, and in 13 patients had biologic problems. In the analysis of the initial operative fixation, only one of 12 patients had biologic problems. Conclusion: In our analysis, the common preventable error made during operative fixation of humeral shaft fracture is failure to provide adequate stability for bony union to occur. And with these cases we have demonstrated a systematic analytic management approach that may be used to prevent surgeons from reproducing the same fault and reduce the need for bone grafting.

• Journal of Korean Neurosurgical Society
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• v.65 no.6
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• pp.825-833
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• 2022

Objective : ABM/P-15 (anorganic bone matrix/15-amino acid peptide fragment) is a commercially available synthetically manufactured P-15 collagen peptide fragment, that is adsorbed on ABM. This study was done to investigate the efficacy of ABM/P-15 in achieving fusion in the lumbar spine and comparing it with that of recombinant bone morphogenic protein-2 (rhBMP-2) and demineralized bone matrix (DBM). Methods : A retrospective observational study of prospectively collected data of 140 patients who underwent lumbar spinal fusion surgeries in a single specialty spine hospital between 2016 and 2020, with a minimum 6-month follow-up was conducted. Based on the material used for the augmentation of the bone graft at the fusion site, the patients were divided into three categories namely ABM/P-15, rhBMP-2, and DBM group. Results : ABM/P-15, rhBMP-2, and DBM were used in 46, 44, and 50 patients, respectively. Patient characteristics like age, gender, bone mineral density, smoking history, and presence of diabetes mellitus were comparable amongst the three groups. Average follow-up was 16.0±5.2, 17.9±9.8, and 26.2±14.9 months, respectively in ABM/P-15, rhBMP-2, and DBM groups. The fusion was achieved in 97.9%, 93.2%, and 98% patients while the average time-to-union was 4.05±2.01, 10±4.28, and 9.44±3.49 months (p<0.001), respectively for ABM/P-15, rhBMP-2, and DBM groups. The average pre-operative Visual analogue scale score was 6.93±2.42, 7.14±1.97, 7.01±2.14 (p=0.900) for ABM/P-15, rhBMP-2 and DBM groups, respectively, which reduced to 1.02±0.80, 1.21±0.96, and 0.54±0.70 (p=0.112), respectively at the last follow up. Pre-operative Oswestry disability index scores were 52.7±18.02, 55.4±16.8, and 53.56±19.6 (p=0.751) in ABM/P-15, rhBMP-2, and DBM groups, which post-operatively reduced to 33.77±15.52, 39.42±16.47, and 38.3±15.89 (p=0.412) and further to 15.74±8.3, 17.41±10.45, and 16.76±9.81 (p=0.603), respectively at the last follow-up. Conclusion : ABM/P-15 appears to achieve union significantly earlier than rhBMP-2 and DBM in lumbar spinal fusion cases while maintaining a comparable clinical and complication profile.

• Journal of Periodontal and Implant Science
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• v.26 no.3
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• pp.735-751
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• 1996

An ultimate goal of periodontal therapy is to stop the disease process and to regenerate a functionally-oriented periodontium destroyed as a result of periodontal disease. The purpose of this study was to observe the effect of grafting granulation tissue obtained from extraction socket on the regeneration of horizontal furcation defect. Six dogs were used in this study. All mandibular first and third premolars were extracted. At 2, 3, and 5 days after extraction, tissues were obtained from extraction socket of 1 mongrel dog and examined by light microscope. Granulation tissue obtained at 5 days after extraction was chosen as the graft material. Five days later, horizontal furcation defects were created surgically at mandibular second and fourth premolars in the right and left side of the 5 beagle dogs. The entrance area of the artificially prepared "key hole" defects were about $3\;4mm^2$. By random selections, 2 exposed furcation defects were grafted with granulation tissue obtained from extraction socket as experimental group and 1 furcation defect was as control. The flaps were replaced to their original position and sutured with 4-0 chromic cat-gut. Three dogs were sacrificed 4 weeks and two dogs 8 weeks after surgery, and the prepared specimens were examined by light microscope. At 4 weeks, furcations were filled with epithelial lining and fibrous connective tissue infiltrated with chronic inflammatory cells. New bone formation was observed in all groups. Only experimental group showed new cementum formation. At 8 weeks, new cementum, functional arrangement of new PDL fiber, root resorption, and some ankylotic union of newly formed alveolar bone and root surface were observed in all groups. Experimental group showed that epithelial downgrowth was inhibited and new bone formation was more active compared to control. The success rate of the furcation defect healing was higher in experimental group than control. These results suggested that grafting of granulation tissue obtained from extraction socket which combined with reconstructive periodontal flap surgery may promote periodontal regeneration of horizontal furcation defect.

• Journal of Veterinary Clinics
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• v.32 no.5
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• pp.410-416
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• 2015

Bone grafting is widely used to bridge major bone defects or to promote bone union. In the evaluation of bone defect regeneration, 5 mm-diameter defects were created in rabbit calvaria. Concerning biocompatibility, fibrous capsule thickness of CBHA (hydroxyapatite from cuttlebone) was significantly thinner than that of CB (cuttlebone) and CHA (hydroxyapatite from coral) (p < 0.05) at 2 and 4 weeks after implantation. Concerning 12-week total changes of radiologic gray-level histogram, CBHA was significantly higher than CHA (p < 0.05). In the evaluation of bone defect regeneration, bone formation of CHA was significantly higher than that of CB and CBHA (p < 0.05). Based on the clinical and histological results, CBHA would be a safe material for use inside the body and has more effective osteoconduction than CB. It is suggested that CBHA is a valuable bone graft material.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.157-162
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• 2008

Nowadays, most of the malignant bone tumor patient underwent limb salvage operation, however, reconstructive options for skeletally immature group are still controversial. There are three necessary conditions of most ideal reconstructive method in treating the skeletally immature children. As the epiphyseal plate sacrification is usually inevitable in malignant bone tumor around knee joint, ideal reconstructive technique would be as follows; 1)minimal or no damage to theadjacent epiphyseal plate, 2) maintaining mobile joint, 3) index procedure does not disturb subsequent operation such as lengthening. Segmental resection and reconstruction using autogenous pasteurized graft was done for 4 years old meta-diaphyseal osteosarcoma of femur. At 6 months from index operation, plain radiograph showed pasteurized bone resorption and loosening of fixation devise. To overcome the complication, we used allograft reconstruction by impacting the proximal host bone to the fluted portion of allobone. Three months later, proximal bone union was observed and patient showed good functional outcome.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.1
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• pp.117-127
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• 1991

When open reduction of maxilla fractures is postponed due to concurrent life-threatening injuries, delayed union may result with malunion or nonunion. If delayed malunion is occurred, significant facial deformity may result, including a dished-out face, irregular retromaxillism with Angle's class III malocclusion, open anterior bite, nasal collapse, telecanthus and malar flattening. The treatment planning for this problem includes cephalometric evaluation anterior and lateral tomograms, dental casts, orthodontic planning, dental planning and use of impression tray to rupture the fibrous tissue casts, orthodontic planning, dental planning and use of impression tray to rupture the fibrous tissue attachment at the fracture site. In this paper, one case presented a 58-year-old female patient with maxilla retrusion after comminuted fracture, who was treated with orthodontic methods of maxillary protraction headgear and Plaster headcap, whereas the other two cases were about male patients who were treated principally with surgically open reduction or Le Fort I-controlled transverse osteotomy with iliac bone graft.

• Horticultural Science & Technology
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• v.28 no.3
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• pp.456-461
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• 2010

A study was conducted to investigate the effect of topophysis, and uniting method of rootstock and scion on rooting and subsequent growth of stenting-propagated cut rose ($Rosa$ $hybrida$ Hort.) in an effort to develop an efficient stenting propagation method for domestic rose cultivars. Four cultivars used in this study were two standard type cultivars 'Sweet Yellow' and 'Hanmaum', and two spray type cultivars 'Chelsi' and 'May'. Scions were grafted on cuttings of a rootstock $Rosa$ $indica$ 'Major'. The stenting-propagated scion-rootstock unions were planted in rockwool cubes ($50{\times}50{\times}50mm$, Delta, Grodan, Denmark) and were placed in a graft-take chamber for five days before being placed on misted greenhouse beds. The rootstock was removed of all leaves and nodes. Both the base of scions and top of stocks were simultaneously cut at a $45^{\circ}$ angle for grafting. Scions were prepared as single node cuttings, each with a five-leaflet leaf. Three positions of topophysis used were 7-9th (top), 4-6th (middle), and 1st-3rd (bottom) nodes from the stem base. Four uniting materials used were tube, tube + parafilm wrap, tube + clothespin, and clothespin. Rooting and growth were affected by the topophysis and cultivar. The best topophysis for rooting was 7-9th (top) nodes in all cultivars. Topophysis affected percent rooting, and number of roots, length of the longest root, and but not weight, shoot length and graft-take. Rooting and growth were affected by the uniting method and cultivar. Tube uniting method generally showed higher percentage graft-take, percent rooting, and number of roots than other methods. However, rootstock and scion union was not complete in this treatment. On the whole, the greatest rooting and subsequent growth of stenting-propagated plants were found in the tube + clothespin method. Except 'Sweet Yellow', rooting and growth were not adequate in the clothespin method. The results suggested that a tube + clothespin method was the most effective, and this method may be used as a substitute to save labor compared to a tube + parafilm wrap method which is currently being used in commercial nurseries.