구개골절의 유형에 따른 치료방법

박상훈,옥재진 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

The palatal fracture results in deformity of the midface, as well as change in occlusion. However, no report was found on the incidence, treatment and results of palatal fracture in Korea. A retrospective review was done over 6 years and 11 patients(6.5%) with palatal fracture were determind out of 168 patients who had midfacial bone fractures without nasal bone fracture. According to the Hendrickson's classification, the number of patients with specific types of palatal fracture was described as follows; sagittal(2 cases), parasagittal(2 cases), para-alveolar(3 cases), transverse(3 cases) and complex(1 case). Le Fort Ⅰ(6 cases), Le Fort Ⅱ(7 cases) and mandible(6 cases) fractures were also associated. Open reduction and internal fixation was applied to all patients. Internal fixation consisted of pyriform or alveolar ridge stabilization and maxillary buttress stabilization. The rigid palatal vault stabilization was applied in one patient with midline split of the palate. The duration of intermaxillary fixation was shortened to less than 3 weeks from 4 to 6 weeks with rigid fixation. The palatal splint was used temporarily before internal fixation. All the patients showed good bony union and satisfactoryocclusion postoperatively. Open reduction and internal fixation showed satisfactory results from the aspects of stability, occlusion, patient convenience and final aesthetics. The following treatment model for palatal fracture according to the fracture type is proposed; 1) Alveolar type - close reduction or open reduction and selective alveolar ridge fixation and selective application of palatal splint, 2) Sagittal type - open reduction and internal fixation of the alveolar ridge, maxillary buttress and palatal vault. 3) Parasagittal type - open reduction and internal fixation of the pyriform aperture and maxillary buttress, as well as selective fixation of the palatal vault. 4) Para-alveolar type - open reduction and internal fixation of the alveolar ridge and maxillary buttress. 5) Complex type - open reduction and internal fixation of the alveolar ridge, maxillary buttress, pyriform aperture and continuous use of a palatal splint to bony union. 6) Transverse type - open reduction and internal fixation of the alveolar ridge and maxillary buttress.

다발성 외상 환자의 대퇴골 간부 골절에서 임시 외고정술 후 내고정술로의 전환

주석규 ( Suk Kyu Choo ),강경운 ( Kyung Woon Kang ),김영우 ( Young Woo Kim ),오형근 ( Hyoung Keun Oh ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.4

Purpose: We report the surgical outcomes for femoral shaft fractures in polytrauma patients who were temporarily treated with external fixation and subsequently converted to internal fixation. Methods: From August 2008 to April 2012, we enrolled 13 patients with multiple traumas due to high-energy injuries and concurrent femoral shaft fractures in which temporary external fixation was carried out. The mean age was 39 years, with a range from 18 to 55 years. Ten were men and 3 were women. According to the AO/OTA classification of fractures, type A was found in 5 patients, type B in 6, and type C in 2, with open fractures being found in 6 patients and femoral artery rupture occurring in 2. For internal fixation, intramedullary nailing was performed in 7 patients, and minimally-invasive fixation of locking compression plates was used in 6. Results: Of the 7 patients converted to intramedullary nailing, 1 experienced delayed union. Of the 6 patients treated with minimally-invasive plate fixation, delayed union occurred in 5, and an auto-bone graft was performed within, on average, 8 months (range: 5~10 months), leading to bone union in all cases in the final follow-up. None of the patients experienced infections or complications involving other organs after having been converted to internal fixation. During the mean follow-up of 19 months, patients achieved satisfactory functional outcomes. Conclusion: In polytrauma patients with a femoral shaft fracture who have been treated with temporary external fixation and who may need internal fixation due to the occurrence of delayed union, an appropriate internal fixation method needs to be selected based on the patient’s physical status, and the fracture type. [ J Trauma Inj 2014; 27: 151-7 ]

불안정성 골반환 손상시 전방 골반환의 고정방법

김원유(Weon-Yoo Kim),지종훈(Jong-Hun Ji),김영율(Young-Yul Kim),양영준(Young-Jun Yang),이동엽(Dong-Youb Lee) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.1

목적: 골반환의 전방 고정을 외고정 또는 내고정술로 치료하고 그 결과를 비교하고자하였다. 대상 및 방법: 33예를 대상으로 후향적 연구방법으로 환자의 만족도를 평가하였다. 평균 추시 기간은 29개월(범위; 12-54) 이었고 type B는 도수정복 후 외고정기 고정술 또는 관혈적 정복 후 금속판 내고정술로 전방 고정을 시행하였으며 type C는 공통적으로 경피적 천장나사못을 이용한 후방 고정술을 시행 후 전방은 고정술을 시행하였다. 외고정군은 16예, 내고정군은 17예였으며 각 군의 만족도는 Postel score를 이용해 평가하였다. 결과: 외고정군은 장기간 착용하는 불편함과 핀삽입부의 염증으로 인한 과다한 흉터 및 반흔조직 등 뿐 아니라 부정유합으로 인하여 환자가 느끼는 통증 및 보행의 장애가 가장 큰 불편함으로 평가되었으며(Postel score 9.9; range, 8-11), 내고정군은 모든 환자가 양호 이상이었다(Postel score 11.6; range, 10-12). 결론: 불안정성 골반환 손상의 경우 전방 고정 시는 외고정 장치를 이용한 방법보다는 관혈적 방법으로 해부학적 정복을 이룬후 견고한 내고정을 시행하는 것이 치료결과가 더 양호할 것으로 판단된다. Purpose: We reviewed the clinical result of two techniques of anterior fixation method for unstable pelvic ring injuries, which are external and internal fixation. Materials and Methods: A retrospective clinical analysis was performed on 33 cases which had been operated from September 1998 to February 2003. Mean follow-up period is 29 months (range, 12-54 months). Previous to anterior fixation percutaneous iliosacral screw fixation was applied on iliosacral joint in Type C injury. After then plate and screw fixation were done in 17 cases and external fixation in 16 cases as an anterior fixation method. The patient's functional outcome was evaluated by Postel score and comparison between two groups was performed. Results: In external fixator group the complaints are long duration of application of external fixator, excessive scar formation due to pin tract infection, pain and discomfort (Postel score 9.9; range, 8-11) due to malunion. In internal fixation group all of them showed more than good result and satisfactory to the postoperative condition and clinically (Postel score 11.6; range, 10-12). Conclusion: An open reduction and internal fixation technique is better than external fixation for the treatment of injured anterior pelvic ring in unstable pelvis fracture.

골다공증을 동반한 불안정 원위 요골 골절의 치료 -금속판 내고정술과 외고정술의 비교

오진록 ( Jin Rok Oh ),조태연 ( Tae Yean Cho ),권성민 ( Sung Min Kwan ) 대한골절학회 2010 대한골절학회지 Vol.23 No.1

목적: 골다공증을 동반한 불안정 요골 원위부 골절의 치료로서 요측 굴곡 금속판을 이용한 내고정술과 경피적 핀고정술 및 외고정술의 기능적, 방사선적 결과를 비교 분석하였다. 대상 및 방법: 2006년 3월부터 2008년 3월까지 본원에서 불안정 원위요골 골절로 치료받은 60세 이상 골다공증을 동반한 환자 36명을 대상으로 내고정술(1군) 혹은 외고정술(2군)을 시행한 군으로 나누어 후향적 분석을 하였으며 임상적 결과 및 방사선적 결과를 분석하였다. 결과: 운동범위, DASH 점수, BMD 점수는 두 군에서 통계학적으로 유의한 차이는 보이지 않았으나, 악력 및 PRWE 점수는 2군에서 높았다(p<0.05). 방사선학적 평가에서는 요측 기울기, 수장굴곡은 1군에서 높은 결과를 보였다(p<0.05). 결론: 골다공증을 동반한 60세 이상의 불안정 원위 요골 골절의 치료에서 요측 굴곡 금속판을 이용한 내고정술은 관절면에 대한 정확한 해부학적 정복과 안정적인 고정을 가능하게 해주어, 수술 후 완관절의 운동을 조기에 허용하며, 핀 주변 감염, 관절 강직 등의 술후 합병증이 낮아 골다공증을 동반한 불안정성 원위 요골 골절에 유리한 치료법이 될 수 있다. Purpose: To compare the functional and radiological outcomes of volar plating to that of external fixation for treating unstable osteoporotic distal radius fracture. Materials and Methods: From March 2006 to March 2008, 36 patients with osteoporosis over 60-year old were selected for this study. They were divided into two groups; group I (open reduction and internal fixation with volar fixed angle plate) and group II (closed reduction and external fixation). Clinical outcomes and radiologic outcomes were evaluated. Results: There was no statistical difference between group I and group II in range of motion and DASH score, BMD score. However, the grip strength and PRWE score were found to be higher in group II (p<0.05). In radiologic evaluation, group I showed higher radial inclination, volar tilting angle (p<0.05). Conclusion: Internal fixation using Volar-fixed Angle Plate seems to give more stable fixation for distal articular fragments compared to external fixation. it could allow early postoperative exercise and could result in low incidence of postoperative complication such as pin track infections and joint stiffness. Therefore, the internal fixation could be more desirable treatment method to manage unstable distal radius fracture.

Carved Merocel^Ⓡ을 이용한 비골골절의 고정

공정식,강소라,김양우,전영우,정재아 대한두개안면성형외과학회 2011 Archives of Craniofacial Surgery Vol.12 No.2

Purpose: In most cases of nasal bone fracture, closed reduction with internal or external splint fixation approach is selected. However, because of indiscriminate insertion of the internal splint without considering of anatomical difference or deformity, insufficient fixation happens frequently that need additional fixation. Therefore, we suggest a new method for providing adequate support in reduced nasal bone by carving Merocel^Ⓡ that is fixed for the anatomical structure. Method: Closed reduction and internal fixation with carved Merocel^Ⓡ was performed in 15 nasal bone fracture patients from March, 2010 to July, 2010. Each patient was evaluated by physical examination, facial photographic check, simple X-ray, and computerized tomography. On the first day post-operation, location of packing and amount of reduction were checked by follow up X-ray and computerized tomography. In addition, patients’ symptoms were evaluated. During the 3-month post-op follow up at out-patient clinic, operator, 2 doctors in training and one assistant performed the objective evaluations by physical examination on nasal dorsal hump, nasal deviation, nasal depression, nasal breath difficulty, and nasal airway obstruction. A survey of subjective patients’ satisfaction in 4-stages was also performed. Results: The results of follow-up computerized tomography of the 15 patients revealed that 11 patients had good reduced state. Three patients with combined maxillary frontal process fracture had over reductions. A survey performed on the first day post-operation showed that 14 of 15 patients answered that their current symptoms were more than tolerable. At the 3-month follow-up physical exam, one case had a dorsal hump. However, there were no nasal deviations, nasal depressions, nasal breath difficulties, or nasal airway obstructions. Twelve of the 15 patients answered more than moderate on the 3-month survey. Conclusion: Intranasal packing after carving the Merocel^Ⓡ considering anatomical structure is a new effective method to promote proper-reduction, maintain stability, and minimize patients’ symptoms by addition of a simple procedure. (J Korean Cleft Palate Craniofac Assoc 12: 93, 2011)

Internal Fixation with a Locking T-Plate for Proximal Humeral Fractures in Patients Aged 65 Years and Older

Jae-Kwang Yum,Min-Kyu Seong,Chi-Woon Hong 대한견주관절의학회 2017 대한견주관절학회지 Vol.20 No.4

Background: The purpose of this study was to evaluate the clinical and radiographic outcomes of internal fixation with locking T-plates for osteoporotic fractures of the proximal humerus in patients aged 65 years and older. Methods: From January 2007 through to December 2015, we recruited 47 patients aged 65 years and older with osteoporotic fractures of the proximal humerus. All fractures had been treated using open reduction and internal fixation with a locking T-plate. We classified the fractures in accordance to the Neer classification system; At the final follow-up, the indicators of clinical outcome—the range of motion of the shoulder (flexion, internal rotation, and external rotation) and the presence of postoperative complications—and the indicators of radiographic outcome—the time-to-union and the neck-shaft angle of the proximal humerus—were evaluated. The Paavolainen method was used to grade the level of radiological outcome in the patients. Results: The mean flexion was 155.0° (range, 90°–180°), the mean internal rotation was T8 (range, T6–L2), and the mean external rotation was 66.8° (range, 30°–80°). Postoperative complications, such as plate impingement, screw loosening, and varus malunion were observed in five patient. We found that all patients achieved bone union, and the mean time-to-union was 13.5 weeks of the treatment. The mean neck-shaft angle was 131.4° at the 6-month follow-up. According to the Paavolainen method, “good” and “fair” radiographic results each accounted for 38 and 9 of the total patients, respectively. Conclusions: We concluded that locking T-plate fixation leads to satisfactory clinical and radiological outcomes in elderly patients with proximal humeral fractures by providing a larger surface area of contact with the fracture and a more rigid fixation.

Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing

김상범,허윤무,이진웅,이정범,임병구 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.3

Background: Plate fixation is the most commonly used technique for the treatment of shaft fractures of both forearm bones (SFBFBs). However, all fractures are difficult to treat with plate fixation because of soft tissue injuries, fracture patterns, or the patient’s condition. The purpose of this study is to compare the functional results of plate fixation only and combined plate and intramedullary (IM) nail fixation in SFBFBs. Methods: Fifty-nine cases of SFBFBs that were surgically treated from June 2007 to July 2012 were retrospectively reviewed. In this study, 47 cases that were followed up for more than 12 months were included. All SFBFBs were divided into two groups according to the methods used for internal fixation: plate fixation only (group A) and combined plate and IM nail fixation (group B). The fixation methods were determined intraoperatively. Plate fixation was considered as the first option in all cases, but combined plate and IM nail fixation was selected as the second option if it was difficult to be fixed with plate only. Groups A and B comprised of 31 and 16 cases, respectively. The functional results were evaluated by the Grace and Eversmann rating system and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: In groups A and B, a radiologic union was achieved in 30/31 and 14/16 cases and average union time was 11.1 and 17.8 weeks, respectively. According to the Grace and Eversmann rating system, group A had excellent results in 15 cases, good in 14, acceptable in one, and unacceptable in one. Group B had excellent results in three cases, good in nine, acceptable in two, and unacceptable in two. The average DASH score was 7.1 points (range, 0 to 19.2 points) in group A and 15.1 points (range, 0 to 29.6 points) in group B. Three cases of nonunion with unacceptable results achieved a bony union by additional procedures and the functional results of these cases improved to good or excellent. Conclusions: The functional results and the average union time were superior in group A than in group B. However, we think that combined fixation is a useful method for SFBFBs that cannot be treated with plate fixation only.

골다공증을 동반한 고령 환자에서 불안정성 대퇴 전자간 골절의 금속 내 고정술과 양극성 반치환술의 결과 비교

정화재 ( Haw Jae Jung ),최재열 ( Jae Yeol Choi ),신헌규 ( Hun Kyu Shin ),김유진 ( Eu Gene Kim ),박세진 ( Se Jin Park ),이용택 ( Yong Taek Lee ),김광신 ( Gwang Sin Kim ),김종민 ( Jong Min Kim ) 대한골절학회 2007 대한골절학회지 Vol.20 No.4

목적: 골다공증을 동반한 고령 환자에서 발생한 불안정성 대퇴 전자간부 골절의 치료에 있어서 금속 내 고정술을 시행한 집단과 양극성 반치환술을 시행한 집단의 술 후 임상 결과 및 방사선학 결과를 후향적으로 비교 분석하였다. 대상 및 방법: 2003년 2월부터 2006년 2월까지 대퇴골 전자간부 골절로 수술을 시행 받은 환자 중 1년 이상 추시 가능하였던 환자로, 골절 유형이 Evans분류로 불안정성 골절, 70세 이상, 골밀도 (BMD)상 T-score가 -3.0이하인 골다공증 환자 36예를 대상으로 하였다. 압박 고 나사 고정술 또는 골수강 내 금속정 삽입술을 시행한 23예를 A군, 양극성 반치환술을 시행한 13예를 B군으로 정하였다. 두 집단을 수술 전후와 최종 추시 시의 단순 방사선 사진의 비교 분석과 Clawson분류로 수술 후 고관절 기능에 대해 평가하였다. 결과: A군에서는 6예에서 고정 실패를 보였다. 이중 1예에서 지연 나사의 이완을 보였고, 5예에서 불유합을 보였다. B군에서는 13예에서 삽입물의 안정적인 유지를 보였다. 수술 전후 보행 능력 회복 정도는 B군에서의 결과가 더 양호하였다. 결론: 금속 내 고정술의 경우가 양극성 반치환술에 비하여 골절의 불유합 및 고정물의 고정 실패가 더 많은 빈도로 발생하였고, 고관절 기능 회복에서도 좋지 않은 결과를 보였다. 따라서, 골다공증을 갖는 불안정성 대퇴골 전자간부 골절에서는 금속 내 고정술보다는 양극성 반치환술이 수술적 치료로 더 유용할 것으로 생각한다. Purpose: To perform comparative analysis between the results of internal fixation and hemiarthroplasty in unstable intertrochanteric fracture of osteoporotic bone. Materials and Methods: From February 2003 to February 2006, 36 patients treated surgically for unstable intertrochanteric fractures were evaluated. The patient`s age was older than 70 year old; the T-score of preoperative bone mineral density (BMD) was lower than-3.0; they were followed up for more than 1 year. The patient were divided into two groups. One group was treated with dynamic hip screw or proximal femoral nail (Group A, 23 cases), and the other group was treated with bipolar hemiarlhroplasty (Group B, 13 cases). The two groups were compared in terms of hip joint function using Clawson classification and radiologically. Results: Nonunion and fixation failure happened in 6 cases (26%) of gruop A. However, all patients in group B showed stable maintenance of implant. Recovery of hip joint function was found in 13 cases (43%) of group A, whereas 12 cases (93%) of group B recovered. Conclusion: Nonunion and failure of fixation happened more frequently in internal fixation than bipolar hemiarthroplasty, and the postoperative hip joint function was better in bipolar hemiarthroplasty than internal fixation. Therefore, bipolar hemiarlhroplasty might be better operative treatment for unstable intertrochanteric fracture of osteoporotic bone.

Comparative Analysis of the Result of Minimally Invasive Anterior Plating and Open Reduction and Internal Fixation in Humerus Shaft Simple Fracture

Sang-Hun Ko,Chang-Gyu Choe,Ju-Hyung Lee 대한견주관절의학회 2015 대한견주관절학회지 Vol.18 No.2

Background: This retrospective comparative study aims to evaluate the surgical outcomes and complications of two surgical methods for simple fractures of the humeral shaft; minimally invasive anterior plating and open reduction combined with internal fixation. Methods: A total of 26 patients with humeral shaft simple fractures, who had surgery between June 2009 and September 2013 and were followed-up at least 12 months, were included in our analysis. They were divided into two groups; group 1 comprised of 12 patients who underwent minimally invasive anterior plating and group 2 comprised of 14 patients who underwent an open reduction and internal fixation. The clinical outcomes, radiological results, and complications were compared and analyzed. Results: We found that bone union was achieved in all patients, and the mean union periods were 20.7 ± 3.34 and 20.3 ± 3.91 weeks for groups 1 and 2, respectively. In most patients, we found that shoulder and elbow functions were recovered. At 12 months post-operation, we found that the Korean Shoulder Scoring system, the University of California at Los Angeles score and Mayo elbow performance score were 91.4 ± 7.97, 33.4 ± 1.15, and 90.8 ± 2.23 for group 1, and 95.2 ± 1.53, 33.3 ± 1.43, and 90.17 ± 1.85 for group 2. In terms of complications, we found that 2 patients had radial nerve palsy after open reduction and internal fixation, but all cases spontaneously resolved within 6 months. Complications such as infection and loss of fixation were not reported. Conclusions: Both minimally invasive anterior plating and open reduction with internal fixation produced satisfactory outcomes in the treatment of simple fractures of the humeral shaft.

족관절 골절과 동반된 전하 경비 인대 견열 골절의 치료

정형진,배서영,김만영,Chung, Hyung-Jin,Bae, Su-Young,Kim, Man-Young 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.1

Purpose: To evaluate the clinical results of anteroinferior tibiofibular ligament avulsion fracture accompanied ankle fractures treated with anatomical reduction and internal fixation. Materials and Methods: From January 2007 to April 2010, 30 cases with anteroinferior tibiofibular ligament avulsion fracture that treated with anatomical reduction and internal fixation were analyzed. The average follow-up period was 26 months (minimum 6 months). We have reviewed the bony union, complication and subjective satisfaction according to the fracture classification and method of internal fixation. Results: Among 30 cases, 28 cases were occurred in Lauge-Hansen classification supination-external rotation type, one case was fracture-dislocation and one case was Maisonneuve fracture. We have performed internal fixation with Mini screw in 11 cases, K-wire in 10 cases, repair in six cases and Mini screw & K-wire in three cases. In all cases bony union was completed. two cases in Mini screw, one case in K-wire, two cases in repair and one case in Mini screw & K-wire revealed LOM of ankle joint. Skin irritation and superficial peroneal nerve irritation happened in one case each. Other cases show good subjective satisfaction. Conclusion: Anteroinferior tibiofibular ligament avulsion fracture accompanied with ankle fracture is a good clinical outcome with internal fixation. So we should not miss out the anteroinferior tibiofibular ligament avulsion fracture in radiologic evaluation or operation room.