Efficacy of Intra-Articular Injection of Thrombin-Based Hemostatic Agent in the Control of Bleeding after Primary Total Knee Arthroplasty

( Ki Cheor Bae ),( Chul Hyun Cho ),( Kyung Jae Lee ),( Eun Seok Son ),( Si Wook Lee ),( Suk Joong Lee ),( Kyung Hwan Lim ) 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.4

purpose: To evaluate the hemostatic effect of intraarticular injection of a thrombin-based hemostatic agent in total knee arthroplasty (TKA). materials and methods: We performed a prospective randomized controlled trial on the use of a thrombin-based hemostatic agent in patients undergoing unilateral TKA. A total of 100 TKA patients were enrolled, with 50 patients randomized into the study group and the other 50 patients into the controlled group. Drain output, hemoglobin level, total red blood cell loss for 24 hours after surgery, transfusion rates, and complications were assessed. results: Postoperative drain output was 525 mL in the study group and 667 mL in the control group (p=0.01). Nine patients in the study group and eighteen in the control group received blood transfusion (p=0.043). But, there was no significant difference between two groups in terms of hemoglobin level change and total red blood cell loss (p>0.05). conclusions: The thrombin-based hemostatic agent demonstrated efficacy in reducing drain output and blood transfusion rates. Thus, we believe the use of a thrombin-based hemostatic agent should be considered as an option in orthopedic surgery that involves massive bleeding.

Surgical Treatment of Late Presented Displaced Lateral Condylar Fracture of the Humerus in Children

Ki Cheor Bae(배기철),Kwang Soon Song(송광순),Chul Hyung Kang(강철형),Byung Woo Min(민병우),Chul Hyun Cho(조철현),Hyub Sa-Kong(사공협) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.1

목적: 3주 이상 지연 발현된 전위된 소아 상완골 외과 골절에 대해 관혈적 정복 및 내고정술이 가능한지 그리고 최대 언제까지 치료가 지연되어도 골 이식 없이 관혈적 정복 및 내고정이 가능한지를 알아보고자 한다. 대상 및 방법: 3주 이상 지연 발현되었고 2.5 ㎜ 이상 전위된 소아 상완골 외과 골절에 대해 관혈적 정복 및 내고정술을 시행한 8예를 대상으로 하였다. 결과: 임상적 치료 결과는 우수가 6예, 양호가 2예였다. 수술 후 불유합이나 무혈성 괴사 같은 심한 합병증은 전 예에서 관찰되지 않았으나 2예에서 경도의 물고기-꼬리 변형과 외과 골편의 과성장으로 인한 경도의 운반각 소실이 있었다. 결론: 지연 발현된 소아 상완골 외과 골절에서 무혈성 괴사의 위험성 없이 관혈적 정복을 시행할 수 있는 허용 기간으로 3주는 너무 짧다고 생각되며, 최대 5주 혹은 그이상도 수술적 치료를 통하여 양호한 결과를 얻을 수 있을 것으로 생각된다. Purpose: To determine whether late open reduction and internal fixation (ORIF) of a lateral condylar fracture (LCF) after 3 weeks is possible, and to determine the latest time for ORIF without a bone graft. Materials and Methods: Eight children underwent late ORIF (>3 weeks) of a displaced LCF (>2.5 ㎜) of the humerus between 3 weeks and 5 weeks after injury. Results: Clinically, results were excellent in 6 cases and good in 2 cases. There was no serious complication, including nonunion and avascular necrosis (AVN), though 2 cases had a slight fishtail deformity and mild carrying angle loss due to overgrowth of the lateral condyle fragment. Conclusion: We believe that 3 weeks is too short to deny open reduction and anatomic reduction for fear of AVN of a late presented lateral condyle fracture of the humerus. The latest time for ORIF in late presented LCF in children is around 5 weeks, and surgical treatment may even be possible after greater delays.

Case Report : Bilateral Medial Tibial Plateau Fracture after Arthroscopic Anterior Cruciate Ligament Reconstruction

( Ki Cheor Bae ),( Chul Hyun Cho ),( Kyung Jae Lee ),( Jong Hyuk Jeon ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.2

Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures.

동종 아킬레스건을 이용한 전방십자인대 재건술

배기철 ( Ki Cheor Bae ),손승원 ( Sung Won Sohn ),조철현 ( Chul Hyun Cho ),이경재 ( Kyung Jae Lee ),오건명 ( Geon Myeong Oh ) 대한스포츠의학회 2008 대한스포츠의학회지 Vol.26 No.2

The purpose of this study was to evaluate the clinical and radiologic result of arthroscopic anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft. Fifty three patients out of 66 patients, who were performed arthroscopic ACL reconstruction between January 2004 and May 2006 at our institute, were followed up at least more than 1 year 6 months. Among them, sixteen patients underwent second look arthroscopy. The average Lysholm score was improved from preoperative 51.2 to postoperative 84.9. On Lachman test, 45 cases were converted to negative. On Pivot shift test, 46 cases were converted to negative. The anterior laxity test with Telos(R) on 30 lb was 10.3 mm in average at preoperative stage and was decreased to 2.9 mm in average at postoperative stage. In conclusion, ACL reconstruction using Achilles allograft can be one of effective grafts for the ACL reconstruction.

인공 슬관절 전치환술을 시행한 환자에서 수술 전 비경구적 철 수크로스 투여의 효과

배기철 ( Ki Cheor Bae ),조철현 ( Chul Hyun Cho ),이경재 ( Kyung Jae Lee ),이성윤 ( Sung Yun Lee ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.2

Purpose: The purpose of this study was to evaluate the efficacy of preoperative parenteral iron sucrose therapy in patients with postoperative anemia following total knee arthroplasty. Materials and Methods: We retrospectively reviewed 30 patients who had postoperative anemia and who had undergone total knee arthroplasty from March 2008 to November 2008. Those patients agreed on treatment with preoperative parenteral iron sucrose therapy. The other 30 patients without iron sucrose administration were selected as a control group from January 2007 to February 2008. In this study, age, gender, the preoperative and postoperative values of hemoglobin, the operation time, the amount of bleeding, the amount of transfusion, the frequency of transfusion, postoperative infection and the length of the hospital stay were evaluated and statistically compared. Postoperative complications were also assessed. Results: Ant complications due to the administration of iron sucrose were not observed. At 48 hours postoperatively, the mean hemoglobin of iron sucrose administration group was 9.4g/dL and that of the control group was 8.7g/dL (p=0.008). Homogenous transfusion was done for 17 cases in the iron sucrose administration group and for 22 cases in the non-iron sucrose administration group, but among these groups, the results were statistically insignificant. The amount of homogenous transfusion for each patient who underwent iron sucrose administration is 1.3 units and this was 1.7 units for each patient who underwent non-iron sucrose administration. No statistical differences were observed between the groups in this study. Conclusion: Parenteral iron sucrose administration in patients following total knee arthroplasty was not efficacious for preventing immediate postoperative anemia.

골결손을 동반한 경골골절에서 금속정 고정 및 자가골 이식을 이용한 치료

사공협 ( Hyub Sakong ),배기철 ( Ki Cheor Bae ),조철현 ( Chul Hyun Cho ),이경재 ( Kyung Jae Lee ),손은석 ( Eun Seok Son ),김두한 ( Du Han Kim ) 대한골절학회 2012 대한골절학회지 Vol.25 No.4

목 적: 경골골절에 발생한 골결손에 대해 금속정 고정술 및 자가장골 이식술을 시행하고 결과를 평가하였다. 대상 및 방법: 2005년 5월부터 2008년 9월까지 경골 골결손에 대해 금속정 고정술 및 자가장골 이식술을 시행 받았던 환자 중 1년이상 추시가 가능하였던 10예를 대상으로 하였다. 남자가 8예, 여자가 2예였으며 평균연령은 50.2세(29∼76세)였다. 사고 원인은 교통사고 9예, 추락사고 1예였으며 평균 추시기간은 21.9개월(12∼42개월)이었다. 방사선학적 결과는 결손 부위의 유합 유무로 판단하였고 임상적 결과는 Mekhali의 평가법으로 분석하였다. 결 과: 전 예에서 골유합을 보였으며 평균 골유합 기간은 8.4개월(5∼18개월)이었다. Mekhali의 평가법상 9예에서 우수(excellent)의 결과를 보였고 1예에서 족관절에 운동장애가 있어 보통(fair)의 결과를 보였다. 수술적 처치로 인한 합병증은 관찰되지 않았다. 결 론: 경골골절에 발생한 골결손 치료에 있어 금속정 고정 및 자가장골 이식술은 외고정장치를 일찍 제거할 수 있어 합병증을 줄일 수 있으며 골전도 및 골유도, 골형성 능력이 뛰어난 자가골을 이식함으로써 우수한 골유합을 얻을 수 있다는 장점이 있어 유용한 술기로 생각한다. Purpose: This study was conducted to evaluate the results of intramedullary nail fixation with autogenous iliac bone graft for defects of bone after tibial fractures. Materials and Methods: Ten patients with bone defects in tibial fractures who had been treated with intramedullary nail fixation with autogenous iliac bone graft between May 2005 and September 2008 with more than 12 month follow-up were subject to study. Of the 10 patients, 8 were male and 2 were female, and the mean age was 50.2 years (29∼76 years). By cause of accident, motor vehicle accidents caused 9 cases, a crush caused 1 case, and the average follow-up period was 21.9 months (12∼42 months). Radiologically, we analyzed the union of the bone defect on simple x-ray and clinical evaluation was performed using the estimate method of Mekhali. Results: This study reveals that there was radiological union in all 10 cases and the mean time to union was 8.4 months (5∼18 months). By clinical evaluation according to Mekhali`s estimate method, 9 patients had excellent outcomes and 1 patient had limitation of motion in the ankle joint rated as a fair clinical result. None of patients developed complications post-operatively. Conclusion: Our study demonstrated that the intramedullary nail fixation with autogenous iliac bone graft can be a useful operative method because it can remove external fixators early and reduce complications, and autogenous bones have exceptional osteoconduction, osteoinduction, and bone-forming ability resulting in excellent union of bones.

Osteochondroma of the Distal Clavicle

Dong-Wan Kim,Ki-Cheor Bae,Eun-Seok Son,Chung-Sin Baek,Chul-Hyun Cho 대한견주관절의학회 2018 대한견주관절의학회지 Vol.21 No.3

Hereditary multiple exostosis (HME) is an autosomal dominant disorder manifested by the presence of multiple osteochondromas. Although the lesions are benign in nature, exostoses are often associated with characteristic progressive skeletal deformity and displaying clinical symptoms such as mechanical irritation or impingement. We present the successful arthroscopic resection in a 24-year-old HME male with impingement syndrome and long head tendon tear of the biceps caused by osteochondroma arising from the distal clavicle.

Two-stage revision anterior cruciate ligament reconstruction

( Du-han Kim ),( Ki-cheor Bae ),( Dong-wan Kim ),( Byung-chan Choi ) 대한슬관절학회 2019 대한슬관절학회지 Vol.31 No.1

With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. When performing a revision reconstruction, the surgeon decides between a single-stage or a two-stage revision. Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active infection, and concomitant knee pathology (e.g., malalignment, other ligamentous injuries, meniscal or chondral lesions). Among these potential scenarios requiring a two-stage revision, tunnel-widening is the most common cause; the first stage involves graft removal, tunnel curettage, and bone grafting, followed by revision ACL reconstruction in the second stage. The purpose of this article is to review the preoperative planning, surgical considerations, rehabilitation, and outcomes of two-stage revision ACL reconstructions and summarize the recent literature outlining treatment results.

Hook Plate Fixation for Isolated Greater Tuberosity Fractures of the Humerus

Kyoung-Rak Lee,Ki-Cheor Bae,Chang-Jin Yon,Chul-Hyun Cho 대한견주관절의학회 2017 대한견주관절학회지 Vol.20 No.4

Background: The purpose of this study was to investigate the outcomes after fixation using a 3.5-mm locking compression plate (LCP) hook plate for isolated greater tuberosity (GT) fractures of the proximal humerus. Methods: We evaluated the postoperative radiological and clinical outcomes in nine patients who were followed up at least 1 year with isolated GT fractures. Using the deltopectoral approach, we fixed the displaced GT fragments with a 3.5-mm LCP hook plate (Synthes, West Chester, PA, USA). Depending on the fracture patterns, the hook plate was fixed with or without augmentation using either tension suture or suture anchor fixation. Results: All the patient showed successful bone union. The mean time-to-union was 11 weeks. The radiological and clinical outcomes at the final follow-up were generally satisfactory. The mean visual analogue scale for pain, the University of California at Los Angeles score, the American Shoulder and Elbow Surgeons score, and the subjective shoulder value were 1.4, 30.3, 84.3, and 82.2%, respectively. The mean active forward flexion, abduction, external rotation, and internal rotation of the shoulder were 156.7°, 152.2°, 61.1°, and the 10th thoracic vertebral level, respectively. Only one patient presented with a postoperative complication of shoulder stiffness. The patient was treated through arthroscopic capsular release on the 5th postoperative month. Conclusions: We conclude that fixation using 3.5-mm LCP hook plates for isolated GT fractures of the proximal humerus is a useful treatment method that provides satisfactory clinical and radiological outcomes.

Avulsion fracture of the tibial eminence associated with Stener-like lesion of the medial collateral ligament in an adult: a case report and review of the literature

Du-Han Kim,Ki-Cheor Bae,Beom-Soo Kim,임경환 대한정형외과 스포츠의학회 2021 Arthroscopy and Orthopedic Sports Medicine Vol.8 No.1

Avulsion fractures of tibial eminence are not infrequent in the pediatric population but rare in the adult population. Moreover, displaced distal medial collateral ligament, known as Stener-like lesion, was also reported as rare. Each entity is well-documented when occurring in isolation. However, avulsion fracture of tibial eminence and displaced distal medial collateral ligament rupture in the same patient is rare. This paper reports a case of a 20-year-old female with such an injury. Moreover, avulsion fractures of tibial eminence were treated with arthroscopic pullout technique and suture tie. The medial collateral ligament was treated as an anatomical repair using suture anchors. A 4.1-mm side-to-side difference in valgus stress test was noted 6 months after surgery, and the clinical outcome was satisfactory and showed an uneventful magnetic resonance imaging scan at 1-year follow-up.