• Journal of Korean Orthopaedic Sports Medicine
• /
• v.7 no.2
• /
• pp.128-134
• /
• 2008

Purpose: We prospectively evaluated the clinical usefulness of the patellar inferior pole (PIP) as a landmark of the anteromedial (AM) portal for the arthroscopic surgery of the medial mensiscus posterior horn (MMPH). Materials and Methods: Group 1 (50 normal left knees of adults), Group 2 (10 normal knees under anesthesia), and Group 3 (50 consecutive knees undergoing elective arthroscopic surgery for relatively simple intraarticular pathologies, or diagnostic arthroscopy) were included. In Group 1 and 2, the true lateral (A) and valgus stress lateral radiographs (B) on $30^{\circ}$ flexion were obtained, and the lines (AM portal line) passing through the PIP and distal-most medial femoral condyle (MFC) were drawn under the condition without considering the thickness of articular cartilage of MFC (1, 2-A, B group), and considering it as 2.5mm on B (1, 2-C group). Then, we investigated the meeting point of the AM portal line with medial tibial plateau (C-D percentage), and measured the distance between the PIP and the anterior joint line (E-length), and medial tibial-femoral joint space (F-length). In Group 3, the AM portal was made at the PIP level and clinical usefulness of the approach to the MMPH and body of the lateral meniscus (LM) was analyzed. Results: The average C-D percentage came out as 85.8, 101.3, 69.1% for each Group 1-A, B, C, and 102.4, 144.6, 116.8% for each Group 2-A, B, C. Measured E-length was an average of 15.1 (Group 1-A), 15.5 (Group 1-B, C), 13.1 (Group 2-A), and 12.9 mm (Group 2-B, C) and the change by valgus stress had no statistical significance. The F-length increased about 1.2 (Group 1) and 3.6 mm (Group 2) when valgus stress was applied, which had statistical significance (p<0.001, p<0.001). In Group 3, 49, 48 knees were classified as good for the MMPH, and the body of LM in aspect of the clinical usefulness of AM portal made on the PIP level. Conclusion: We identified the clinical usefulness of the PIP as a skin landmark of AM portal for the arthroscopic surgery of the MMPH.

• Clinics in Shoulder and Elbow
• /
• v.11 no.2
• /
• pp.177-184
• /
• 2008

Purpose: The purpose of this study was to evaluate the results of eight cases of coronoid process fractures that were fixed with a plate. Materials and Methods: Eight coronoid process fractures were treated by plating and these cases were reviewed retrospectively. Six patients were men and two were women. The average age was 41 years (range: 22-79) at the time of injury. According to Regan's classification, there were five type 2 and three type 3. According to O'Driscoll's classification, there were five anteromedial type and three base type. Open reduction and internal fixation with a plate were performed through a medial approach by splitting of the two heads of the flexor carpi ulnaris. The patients were follow-up for a mean of 15.8 months (range: 6-25). We evaluated the clinical outcomes with using the Mayo Elbow Performance Score. Results: The average active motion of the elbow joint was $120^{\circ}$. The average Mayo Elbow Performance Score was 86.9. There were 5 excellent results, 1 good result and 2 fair results. Summary: Plating through a medial approach of the elbow provided stable fixation and satisfactory union for treating displaced coronoid process fractures with the unstable elbow.

• Archives of Plastic Surgery
• /
• v.41 no.6
• /
• pp.686-692
• /
• 2014

Background Restoring orbital volume in large blowout fractures is still a technically challenge to the orbital surgeon. In this study, we restored the orbital wall using the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses, and we compared the surgical outcome to that of a conventional transorbital method. Methods A retrospective review of all patients with pure unilateral blowout fractures between March 2007 and March 2013 was conducted. 150 patients were classified into two groups according to the surgical method: conventional transorbital method (group A, 75 patients, control group), and the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses (group B, 75 patients, experimental group). Each group was subdivided depending on fracture location: group I (inferior wall), group IM (inferomedial wall), and group M (medial wall). The surgical results were assessed by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values. Results In the volumetric analysis, the OVR decreased more by the experimental groups than each corresponding control groups (P<0.05). Upon ophthalmic examination, neither the differences among the groups in the perioperative Hertel scale nor the preoperative and postoperative Hertel scales were statistically significant (P>0.05). Conclusions Our surgical results suggest that orbital volume was more effectively restored by the combination of transorbital and transnasal approach with additional supports from the paranasal sinuses than the conventional method, regardless of the type of fracture.

• Journal of the Korean Society of Physical Medicine
• /
• v.15 no.1
• /
• pp.19-24
• /
• 2020

PURPOSE: This paper describes the effects of the myofascial release (MFR) approach in a 20-year-old female patient with neuroforaminal encroachment and regional kyphosis in the cervical area, who also had neck pain. METHODS: A 20-year-old female presented with the chief complaint of neck pain while studying with a level of seven on the rating analogue scale (RAS) and was not taking any drugs or undergoing treatment for the control of neck pain prior to visiting. The cervical radiograph demonstrated neuroforaminal encroachment from C4-5. The patient showed 3.5° kyphosis at C4-5 and 22.9° lordosis at C2-7 according to the Harrison posterior tangent method. The anterior head translation (AHT) was 13.9mm. She reported pain of RAS 5 at the scapular medial border while rotating her neck in the left direction and flexing forward. The patient was treated a total 16 times, three times/week for six weeks using the MFR approach. RESULTS: After the treatment sessions, studying without pain was possible for approximately two hours, but after approximately two hours of studying, she experienced pain of RAS 6 and a stiff feeling in front of the neck. Neuroforaminal encroachment was not detected in the radiographs taken after applying MFR. Improvement of C4-5 kyphosis was noted (from 3.5° kyphosis to 3.8° lordosis). AHT was decreased by 13.6 mm (from 13.9 mm to 0.3 mm). The pain with motion had disappeared. CONCLUSION: The MFR approach in this patient with neuroforaminal encroachment could reduce the pain related to motion and restore the regional cervical lordosis.

• Archives of Plastic Surgery
• /
• v.45 no.4
• /
• pp.325-332
• /
• 2018

Background Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. Methods A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctival incision and an elevator through the intraoral incision. Results The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. Conclusions The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

• Archives of Plastic Surgery
• /
• v.48 no.1
• /
• pp.69-74
• /
• 2021

Background In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. Methods Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. Results Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

• Journal of Korean Foot and Ankle Society
• /
• v.27 no.4
• /
• pp.148-153
• /
• 2023

Traditionally, arthroscopic microfracture and autologous osteochondral autograft transplantation have been the primary surgical treatments for osteochondral lesions of the talus. On the other hand, recent advancements have introduced alternative approaches, such as autologous chondrocyte transplantation, matrix-derived autologous chondrocyte transplantation, intra-articular injection of concentrated bone marrow aspirate concentrate, and the use of fibrin glue to address chondral defects. Furthermore, some studies have explored a combination of bone marrow aspirate and matrix-derived chondrogenesis. In light of these developments, this report presents a case study of a young male patient in his early twenties with a relatively large osteochondral lesion exceeding 1.5 cm² on the medial talar dome. Instead of removing the osteochondral lesion, a surgical approach was employed to retain the lesion while addressing the unstable cartilage in the affected area. This approach involved a combination of bone marrow aspirate concentrate and matrix-derived chondrogenesis. The treatment yielded favorable clinical outcomes and ultimately successfully induced the bony union of osteochondral lesions. This paper reports the author's experience with this innovative approach with a review of the relevant literature.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.33 no.6
• /
• pp.497-504
• /
• 2011

Purpose: Patients who had a subcondylar fracture with a displaced or deviated condylar segment were treated with a retromandibular approach (RMA) or an endoscope-assisted transoral approach (EATA) in our department of oral and maxillofacial surgery. The clinical results of the approaches were compared. A comparative study of specific approaches for subcondylar fractures has not been published before in Korea. Methods: Twenty-one patients with subcondylar fractures of the mandible were included. Ten patients were treated with the retromandibular approach and 11 were treated with an endoscope-assisted transoral approach. We examined patient age, gender, fracture sites, classifications, period of maxillomandibular fixation, facial nerve (FN) or greater auricular nerve (GAN) injuries, maximal mouth opening, deflection, occlusal changes, number of plates, follow-up period, and other complications. Preoperative computed tomography and pre-operative, post-operative, and follow-up panoramic views were taken of each patient. Results: Mean maximal mouth openings were similar between the two approaches. FN and GAN injuries were more frequent in the RMA group but the deflective rate with mouth opening was higher in the EATA than that in RMA group. Two cases of post-operative infection occurred in the EATA group, and occlusal changes were observed in one case for both approaches. Conclusion: The RMA offers more direct access and visualization of the surgical field but it can cause scars and retractive injuries of the FN and GAN. But, EATA did not result in consequent nerve injuries or scars postoperatively, but unfavorable fractures such as $medial$ $override$ condyles were more difficult to reduce endoscopically. Except cases of an expected difficult reduction, the treatment of choice for a displaced subcondylar fracture may be an EATA.

• Clinics in Shoulder and Elbow
• /
• v.12 no.1
• /
• pp.67-75
• /
• 2009

Purpose: This study evaluated the clinical outcomes of debridement arthroplasty using the posteromedial approach in elbow joints with pain and bony limitation of motion. Materials and Methods: This study involved 16 elbows in 16 patients with pain and bony limitation of motion, which were treated by debridement arthroplasty using the posteromedial approach from March 2005 to March 2008. The mean follow up period was 27.6 (13~52) months. The clinical outcomes were analyzed using the Visual Analogue Scale(VAS) for pain scale, the preoperative and postoperative range of motion and the Mayo Elbow Performance Scores(MEPS). Results: The VAS was decreased significantly from a preoperative mean of 4.5 to a postoperative mean 1.1 (p<0.001). The average arc of motion improved significantly from $61.6 (0~90)^{\circ}$ preoperatively to $109.4 (80-120)^{\circ}$ postoperatively (p<0.001). The MEPS also improved significantly from 59.4 to 85.6 postoperatively (p<0.001). There were no complications, such as hematoma and elbow instability. Conclusion: Debridement arthroplasty using the posteromedial approach is a useful surgical procedure in the elbow joint with pain and bony limitation of motion, where all compartments can be debrided, the ulnar nerve can be manipulated easily and damage to the medial collateral ligament can be minimized.

• Journal of Korean Library and Information Science Society
• /
• v.5
• /
• pp.1-31
• /
• 1978

This thesis is to discuss and prove the identity of the acts of the library and the character of the library which regards these as its objects. And this study is analyzed in view of per ceptual problems and scientific problems and scientific problems, in order to make clear the character of the acts of the library. In these processes, some basic propositions are extracted. First, culture can be found in arranged order. Second, human being can create culture by the acquisition of accmulated culture. Third, an individual is purposely related with culture. Fourth, culture is antonomous to mankind. And in this thesis, library science is defined as the systematic formation of mankind's pursuing acts, and to identify this definition, some theoretical models of library science have been offered as follows : Model I 1. Theory of making culture assets informative. 2. Theory of making culture assets empirical; that of imformation treatment. 3. Theory of medial acts of librarians. Model II 4. Theory of organic systems of libraries. Model III 5. Theory of guiding school activities. 6. Theory of extending the inhabitants' interests of communities. 7. Theory of a kind of resources in social improvement. Model IV 8. Theory of a means of principal approach to the succession of culture. In conclusion, this study is to prove that acts of libraries are the universal ones of those human being that are gualified to be the unique means to the creation of culture and, library science is a science that shapes concepts and rules to describe, to make explanation and to foretell these acts.