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Minimally Invasive Plate Osteosynthesis Using a Screw Compression Method for Treatment of Humeral Shaft Fractures

  • Ko, Sang-Hun;Cha, Jae-Ryong;Lee, Chae Chil;Joo, Yong Tae;Eom, Kyeong Su
    • Clinics in Orthopedic Surgery
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    • v.9 no.4
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    • pp.506-513
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    • 2017
  • Background: This study aims to compare the surgical outcomes of open reduction and internal fixation (ORIF) and minimally invasive plate osteosynthesis (MIPO) using a screw compression method in simple humeral shaft fractures. Methods: This retrospective study was performed with 50 patients who had surgical interventions for the treatment of simple humeral shaft fractures and had follow-ups of at least 12 months in Ulsan University Hospital between August 2008 and June 2015. Group 1 included 23 patients treated with ORIF and group 2 included 27 patients treated with the MIPO technique using a locking screw plate. The time to clinical/radiographic union, the joint range of motion (ROM), and function were evaluated. Results: The average time to clinical/radiographic bone union was shorter in group 2 ($12.0{\pm}3.7weeks/14.8{\pm}2.0weeks$ in group 1 and $9.4{\pm}1.3 weeks/12.0{\pm}3.3$ weeks in group 2; p = 0.022/p = 0.034). Shoulder and elbow joint function evaluated by joint ROM and visual analogue scale (VAS), Korean Shoulder Elbow Society (KSS), American Shoulder and Elbow Surgeons (ASES), and the University of California at Los Angeles (UCLA) scores was excellent in both groups. On the average shoulder ROM at 12 months after the operation, group 1 had forward elevation of $160^{\circ}$, external rotation of $30^{\circ}$ in adduction and lumbar vertebra 10 level in internal rotation and group 2 had forward elevation of $170^{\circ}$, external rotation of $35^{\circ}$ in adduction and lumbar vertebra 9 level in internal rotation. The mean VAS, KSS, ASES, and UCLA scores were 2.8, $87.0{\pm}0.9$, $89.4{\pm}0.9$, and $31.0{\pm}1.4$, respectively, in group 1 and 1.7, $89.1{\pm}2.7$, $91.0{\pm}1.6$, and $32.4{\pm}3.2$, respectively, in group 2. There were statistically significant intergroup differences in VAS score (p = 0.011). There were significantly less postoperative infections in group 2 (three cases, 10.7% in group 1 and 0 case in group 2; p = 0.041) although all of them were superficial infections and well-treated by an average 4-week course of antibiotics (range, 2 to 6 weeks). Conclusions: MIPO using a screw compression method in simple humeral shaft fractures demonstrated superior efficacy to ORIF in terms of the time to clinical/radiographic union, pain score, and postoperative infection rate.

The prospective preliminary clinical study of open reduction and internal fixation of mandibular angle fractures using 2 miniplates (하악 우각부 골절 시 2개의 miniplate를 이용한 관혈적 정복술에 대한 전향적 예비 임상연구)

  • Yang, Seung-Bin;Jang, Chang-Su;Kim, Ju-Won;Yim, Jin-Hyuk;Kim, Jwa-Young;Yang, Byoung-Eun
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.36 no.4
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    • pp.320-324
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    • 2010
  • Introduction: The placement of a single miniplate is not sufficient to achieve rigid fixation in mandibular angle fractures. It often causes difficulties in reducing the intermaxillary fixation (IMF) period. Consequently, the placement of 2 miniplates is preferable. The intraoral approach in an open reduction and internal fixation (ORIF) of a mandibular angle fracture with 2 miniplates is often challenging. Accordingly, an alternative of transbuccal approach is performed. However, this method leaves a scar on the face and can result in facial nerve injury. This clinical study suggests a protocol that can maintain rigid fixation without a transbuccal approach in mandibular angle fractures. Materials and Methods: The subjects were 7 patients who sustained fractures of the mandibular angle and treated at Department of Oral and maxillofacial surgery, Sacred Heart Hospital, Hallym University. ORIF under general anesthesia was done using the intraoral approach. One miniplate was inserted on external oblique ridge of the mandible, and the other was placed on lateral surface of the mandibular body with contra-angle drill and driver. A radiographic assessment and occlusal contact point examination was carried out before surgery, and 2, 4 and 6 weeks after surgery. Results: The mean operation time was 80 minutes. Regarding the occlusion state, the number of contact points increased after surgery. Paresthesia and infection were reported to be complications before surgery. Conclusion: The placement of 2 miniplates using contra-angle drill for ORIF of mandibular angle fractures allows early movement of the mandible without IMF. We propose this approach to reduce the patients’discomfort and simplify the surgical procedure.

THE LITERACTURE REVIEW AND CLINICAL EVALUATION OF INTRAORAL APPROACH FOR SUBCONDYLAR FRACTURE (하악 과두하 골절시 구강내 접근의 문헌 고찰과 임상 연구)

  • Seo, Hyun-Soo;Hong, Soon-Min;Yoo, Seung-Eun;Park, Jun-Woo
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.34 no.6
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    • pp.644-648
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    • 2008
  • Purpose: The aim of this study was to investigate the clinical cases of subcondylar fracture with intraoral approach. Material and Method: Fifteen patients with unilateral subcondylar fracture were treated in the department of oral and maxillofacial surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University between 2006 and 2007. Each patients was examined by computed tomography(CT) and panorama. 3D-CT taken when fractured segment was displaced and comminuted. Patients was done intermaxillary fixation to occlusal stability and prevent displacement of fractured segment before general operation. Open reduction and internal fixation(ORIF) accomplished under general anesthesia and used to intraoral approach. We examinated the state of occlusion, maximum opening. Evaluation of the state of occlusion was divided in patient`s subjective evaluation that compare pre-traumatic occlusion with postoperative occlusion, and estimator`s objective evaluation that use articulating paper. Examination was done at 2 weeks, 1, 3, 6 month postoperative by follow up. Result: The ORIF through intraoral approach was good in all patients. In the state of occlusion, all patients recovered pre-traumatic occlusion in 6 month postoperation. Maximum opening was gradually increased. In 3 month postoperative, maximum opening was excessed 40mm. Conclusion: Our study indicate that the intraoral approach is a good technique for subcondylar fracture. Intraoral approach prevent complication that facial nerve damage, scar formation caused by extraoral approach. So, we recommend intraoral approach when subcondylar fracture.

POST OPERATIVE EVALUATION FOR RETROMANDIBULAR APPROACH OF SUBCONDYLAR FRACTURES (하악골 과두하 골절 시 후하악접근법 통해 ORIF 시행한 환자들의 술 후 추적조사)

  • Lee, Seul-Ki;Song, Kyoung-Ho;Kim, Jwa-Young;Song, Sang-Hoon;Yang, Byoung-Eun;Choi, Won-Cheul;Kim, Seong-Gon
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.33 no.6
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    • pp.631-635
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    • 2007
  • Purpose: The classic technique for open reduction of subcondylar fractures is the submandibular approach. The aim of this study was to evaluate clinical result of retromandibular approach to displaced subcondylar fractures. Material and methods: During a period of 24months we perfomed a prospective study with a retromandibular approach in 23 patients with displaced subcondylar fractures. In this article we describe clinical result in 23 patients with follow ups for 3 months after surgery. Preoperatively all patients had malocclusion and radiology demonstrated displacement. Result: The retromandibularl approach for ORIF was good in all case. Mouth opening(M/O) was 49mm. Occlusion was good too. Permanent facial nerve palsy was not detected. Conclusion: Our findings indicate that the retromandibular approach is a safe technique for subcondylar fractures.

Malunion of the Jaw Fractures Complicated Following the Primary Managements (악골절 치료후 부정유합에 관한 임상적 연구)

  • Kim, Dae-Sung;Kim, Myung-Rae;Choi, Jang-Woo
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.25 no.4
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    • pp.356-360
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    • 1999
  • PURPOSE : This is to review the complicated jaw fractures that had been referred for revision of the unsatisfactory results, and to provide proper managements for the easily complicated jaw fractures. MATERIALS & METHODS : Twenty-nine patients who had been revised due to malunion or complicated fractures of facial bones for last 3 years were reviewed. The main problems required for revision, type of fractures complicated, the primary managements to be reclaimed, the specialties to be involved, the management to be reclaimed, time elapsed to seek reoperation, type of revision surgeries, residual complication were analysed with medical records, radiographs and final examinations. RESULTS: The major complaints were malocclusion(79.3%), facial disfigurement(41.3%), TMJ problems (13.7%), neurologic problems(10.3%), non-union(10.3%), and infection(6.8%). Unsatisfactory results were occurred most frequently after improper management of the multiple fractures of the mandible (62.2%), combined fractures of maxilla and mandible (20.6%), fracture of zygomatico-maxillary complex and midpalate (17.2%). The complications to be corrected were widened or collapsed dental arches (79.3%), improperly reduced condyles (41.3%), painful TMJ (34.4%), limited jaw excursion (31.0%), over-reduction of zygoma (13.7%), and nonunion with infection(13.7%). and dysesthesia (10.3%). The primary managements were nendereet by plastic surgeons in 82.7%(24/29) and by oral surgeons in 7.6%(2/29). Main causes of malunion are inadequate ORIF in 76%, unawareness & delay in 17%, and delayed due to systemic cares in 17%. 76% of 29 patients had been in state of intermaxillary fixation for over 4 weeks. Revision were done by means of "refracture and ORIF"in 48.2%(14/29), orthognathic osteotomies with bone grafts in 55.1%(16/29), and camouflage countering & alloplastic implantations in 37.9%(11/29), TMJ surgeries in 17.2%, micro-neurosurgeries in 11.6%. Residual complications were limited mouth opening in 24.1% (7/29), paresthesia in 13.7%, resorption of reduced condyle in 10.3%. CONCLUSIONS : Failure of initial treatment of jaw fractures is due to improper diagnosis and inadequate treatment with lack of sufficient knowledge of stomatognathic system. It is crucial to judge jaw fracture and patients accurately, moreover, the best way of treatments has to be selected. Consideration of these factors in treatment could minimize the complication of jaw fractures.

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Clinical Experiences of Facial Asymmetries in Zygomaticomaxillary Complex Bone Fracture Patients (관골상악골 복합체 골절 환자에서의 안면 비대칭에 대한 임상경험)

  • Kang, Nak-Heon;Choi, Sang-Mun;Kim, Joo-Hak;Song, Seung-Han;Oh, Sang-Ha
    • Archives of Plastic Surgery
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    • v.38 no.2
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    • pp.161-165
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    • 2011
  • Purpose: Zygomaticomaxillary complex (ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum. Methods: 369 patients, treated for fractures of the ZMC were included in the study. After the operation, such as open reduction and internal fixation (ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3-dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re-evaluated. Gross photographs were obtained at outpatient clinic. Results: Total of 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch (n=2), lateral displaced comminuted fracture of arch (n=6), comminuted arch fracture combined posterior root fracture (n=9), and communited arch and body fracture (n=12), severely contused soft tissue (n=9). After the manipulations outcomes were acceptable. Conclusion: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.

A Comparative Study of Intermaxillary Fixation and Manual Reduction at Open Reduction and Internal Fixation of Mandibular Fractures

  • Jin, Soo-Young;Kim, Su-Gwan;Oh, Ji-Su;Kim, Jeong-Sun;Jeong, Mi-Ae
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.35 no.1
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    • pp.51-54
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    • 2013
  • Purpose: The purpose of this study is to evaluate the difference between open reduction and internal fixation (ORIF) and intermaxillary fixation (IMF) of mandibular fractures. Methods: A total of one hundred twenty-seven patients who were treated for mandibular fractures at Chosun University Dental Hospital, from January 2008 to December 2010, and analyzed their prognoses based on the use of IMF at the time of fracture reduction. The patients were divided into two groups; the manual reduction group without IMF and IMF group. Results: After reduction of the mandibular fracture, good results were obtained with majority patients. Nonetheless, seven patients (13.0%) in manual reduction method without arch bars or IMF, developed complications after surgery. Three patients underwent IMF due to occlusal instability after surgery, while one patient underwent re-operation. Thus, a significant difference was not observed between the IMF and manual reduction groups. Conclusion: Manual reduction and IMF at mandibular simple fracture could produce good results. In case of mandibular simple fracture, it was recommended with only manual reduction without IMF or IMF during a short period.

Clinical Outcome of a Precontoured Symphysis Pubis Plate with Tension Band Wiring for Traumatic Symphysis Pubis Rupture in Pelvic Fractures

  • Lee, Jeong Moon;Yoon, Sun Jung;Park, Myung Sik;Song, Kyung Jin
    • Journal of Trauma and Injury
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    • v.29 no.1
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    • pp.22-27
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    • 2016
  • Purpose: The optimal method of fixation of symphysis pubis (SP) diastasis in pelvic ring injuries is still controversial. In this study, we investigated the radiological and the clinical results of a precontoured 4.5-mm symphysis pubis (SP) plate with tension band wiring (TBW) after an anterior pelvic injury in pelvic fractures. Methods: We treated 25 patients with traumatic SP diastasis by open reduction and internal fixation with plates and wires. We used a four-hole 4.5-mm precontoured SP plate with a tension band wiring. Results: Patients with a SP with TBW fixation achieved excellent or good results at final follow-up. Post-operative complications included two (8%) patients with metal work movement. The mean symphyseal width was smaller in 4.5 mm SP plate with TBW during 1-year follow up period. Conclusion: A precontoured symphysis pubis plate (4.5 mm) with figure-of-eight fashion tension band wiring shows favorable radiological results, excellent or good clinical outcome, and a lower complication (hardware failure and revision surgery).

TREATMENT OF COMPOUND COMMINUTED MANDIBULAR FRACTURES (하악골 복합 분쇄 골절의 치험례)

  • Jeong, Jong-Cheol;Kim, Keon-Jung;Choi, Jae-Sun;Sung, Dae-Kyung;Kim, Ho-Sung;Lee, Gye-Hyeok
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.20 no.2
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    • pp.101-105
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    • 1998
  • Compound comminuted mandibular fracture is defined as the presence of multiple fracture lines with open wound resulting in many small pieces within the same area. The incidence of mandibular comminution is difficult to determine but reported as 2.7~18.6 % incidence among mandibular fractures. There are controversies in the treatment of mandibular comminuted fractures. Treatment of comminuted mandibular fracture has traditionally involved closed reduction in an effort to avoid stripping periostcum from the bony segments, but rigid internal rigid fixation is used more popular at present. The extent of comminution, displacement of bony fragments and patient general conditions are important factors in decision of the treatment methods. When significant bone displacement is present, it is necessary to reduce these comminuted fragments to an anatomic, pretraumatic relationship to restore facial form and function. In these cases, ORIF allows anantomic reduction of comminuted segments as well as pretraumatic occlusion. Gentle handling of the soft tissue, rigid fixation of bony fragments and adequate immobilization are essential for reducing the complications. This is the report the incidence, causes, complications and treatment of the patients who visited our department for compound comminuted mandibular fractures.

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Open Reduction and Internal Fixation (ORIF) of Trapdoor Orbital Floor Blowout Fracture with Absorbable Mesh Plate (뚜껑문 안와저 골절에 있어서 망상 흡수성 판을 이용한 관혈적 정복술 및 내고정술)

  • Kwon, Yu-Jin;Kim, Ji-Hoon;Hwang, Jae-Ha;Kim, Kwang-Seog;Lee, Sam-Yong
    • Archives of Plastic Surgery
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    • v.37 no.5
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    • pp.619-625
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    • 2010
  • Purpose: Trapdoor orbital blowout fracture is most common in orbital blowout fracture. Various materials have been used to reconstruct orbital floor blowout fracture. Absorbable alloplastic implants are needed because of disadvantages of nonabsorbable alloplastic materials and donor morbidity of autogenous tissue. The aim of the study is to evaluate usefulness of absorbable mesh plate as a reconstructive material for orbital blowout fractures. Methods: From December 2008 to October 2009, 18 trapdoor orbital floor blowout fracture patients were treated using elevator fixation, depressor fixation, or elevatordepressor fixation techniques with absorbable mesh plates and screw, depending on degree of orbital floor reduction, because absorbable mesh plates are less rigid than titanium plates and other artificial substitutes. Results: Among 18 patients, 5 elevator fixation, 4 depressor fixation, and 9 elevator and depressor fixation technique were performed. In all patients, postoperative computed tomographic (CT) scan showed complete reduction of orbital contents and orbital floor, and no displacement of bony fragment and mesh plate. Mean follow-up was 10 months. There were no significant intraoperative or postoperative complications. Conclusion: Three different techniques depending on the degree of orbital floor reduction are useful for open reduction and internal fixation of trapdoor orbital floor blowout fracture with absorbable mesh plates.