A Comparative Study of Tensile Strength of Three Operative Fixation Techniques for Metacarpal Shaft Fractures in Adults: A Cadaver Study

BACKGROUND: We sought to estimate the ultimate tensile strength after metacarpal shaft fracture repair in adults using three operative fixation methods: plate fixation, Kirschner wire (K-wire) fixation, and intramedullary headless compression screw fixation. We also compared the advantages and disadvantages of each operative technique. METHODS: We acquired 30 metacarpal bones from four Korean adult cadavers without trauma, operative history, or deformities. The 30 metacarpal bones were divided into ten groups consisting of three metacarpal bones each with matching sizes and lengths. They were fractured, reduced, and fixed with plate and screws, K-wires, or headless compression screws. We performed force testing, collected ultimate tensile strength data, and created a stress-strain graph. RESULTS: The ultimate tensile strength of ten groups according to the fixation method was as follows: late and screw fixation, 246.1 N (range, 175.3 to 452.4 N); K-wire fixation, 134.6 N (62.7 to 175.0 N); and intramedullary headless compression screw fixation, 181.2 N (119.2 to 211.7 N). The median tensile strength of each fixation method was significantly different. In addition, the post-hoc test showed significant difference between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation. CONCLUSIONS: The tensile strength median values decreased in the following order showing significant differences among the fixation methods: plate and screw fixation, headless compression screw fixation, K-wire fixation. Significant differences were also observed between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation.

The Outcomes of Proximal Humerus Fractures with Medial Metaphyseal Disruption Treated with Fibular Allograft Augmentation and Locking Plate

BACKGROUND: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. METHODS: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. RESULTS: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. CONCLUSIONS: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

A Comparison between Arthroscopic Biceps Tenodesis and Arthroscopic Repair in Isolated Type 2 Superior Labrum Anterior and Posterior Lesions

BACKGROUND: The purpose of this study was to compare the clinical outcome in patients aged less than 55 years who underwent arthroscopic tenodesis and arthroscopic repair for type 2 superior labrum anterior and posterior (SLAP) lesions. METHODS: Between April 2008 and December 2014, surgery was performed on a total of 45 patients with isolated type 2 SLAP lesions. Arthroscopic repair was performed in 22 patients and arthroscopic tenodesis was performed in 23 patients. In both groups, the clinical outcomes at follow-ups were evaluated using the University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and visual analogue scale (VAS) score. RESULTS: In both groups, the VAS scores for pain had improved significantly throughout the postoperative follow-up period. The VAS score showed a statistically significant difference at postoperative 3 and 6 months (p0.05). In both groups, the functional outcome was statistically improved postoperatively. In a comparison of the UCLA and ASES scores between the two groups, there was a statistically significant difference at postoperative 3 and 6 months (p0.05). CONCLUSIONS: Based on the results of this and other studies, patients with isolated type 2 SLAP lesions showed better short-term clinical outcome with tenodesis than with repair. However, there was no difference between the two groups at the final follow-up.

The Outcomes of Proximal Humerus Fractures with Medial Metaphyseal Disruption Treated with Fibular Allograft Augmentation and Locking Plate

BACKGROUND: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. METHODS: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. RESULTS: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. CONCLUSIONS: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

A Comparison between Arthroscopic Biceps Tenodesis and Arthroscopic Repair in Isolated Type 2 Superior Labrum Anterior and Posterior Lesions

BACKGROUND: The purpose of this study was to compare the clinical outcome in patients aged less than 55 years who underwent arthroscopic tenodesis and arthroscopic repair for type 2 superior labrum anterior and posterior (SLAP) lesions. METHODS: Between April 2008 and December 2014, surgery was performed on a total of 45 patients with isolated type 2 SLAP lesions. Arthroscopic repair was performed in 22 patients and arthroscopic tenodesis was performed in 23 patients. In both groups, the clinical outcomes at follow-ups were evaluated using the University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and visual analogue scale (VAS) score. RESULTS: In both groups, the VAS scores for pain had improved significantly throughout the postoperative follow-up period. The VAS score showed a statistically significant difference at postoperative 3 and 6 months (p0.05). In both groups, the functional outcome was statistically improved postoperatively. In a comparison of the UCLA and ASES scores between the two groups, there was a statistically significant difference at postoperative 3 and 6 months (p0.05). CONCLUSIONS: Based on the results of this and other studies, patients with isolated type 2 SLAP lesions showed better short-term clinical outcome with tenodesis than with repair. However, there was no difference between the two groups at the final follow-up.

A meningomyelocele with normal intracranial signs on ultrasound and false-negative amniotic fluid alpha-fetoprotein and acetylcholinesterase

Neural tube defects are the major targets of prenatal diagnoses, along with Down syndrome. Prenatal diagnosis of spina bifida is possible at second trimester of gestation through alpha-fetoprotein and acetylcholinesterase biochemistry assays and ultrasound. In particular, the discovery of characteristic intracranial signs on ultrasound leads to a very high diagnosis rate. However, it is rare for spina bifida to present without intracranial signs while also showing normal values of maternal serum alpha-fetoprotein, amniotic fluid alpha-fetoprotein, and acetylcholinesterase. In our hospital, a fetus with spina bifida was delivered at 37+5 weeks' gestation by cesarean section, and was continually followed up over 2 years to date.

Clinical Experience of Radial Forearm and Anterolateral Thigh Perforator Faciocutaneous Free Flap for Hypopharyngeal Reconstruction

The reconstruction of hypopharynx after ablation of carcinoma is quite challengeable to plastic surgeons and requires the recovery of anatomic continuity and its own function such as swallowing and speech. Various surgical methods have been evolved through the years from local flap to microvascular free flap. The latter, obviously has improved the surgical outcome playing a main role in reconstruction of hypopharynx and universally been divided into visceral free transfer and fasciocutaneous free flap. Though lots of surgical options are reported depending on the shape and size of defect, patient's desires or surgeon's empirical background, no general agreement about the reconstruction of hypopharynx exists because the advantage of the one flap can be a disadvantage of the other and vice versa. The fasciocutaneous free flaps were used for reconstruction of hypopharynx in 18 patients, radial forearm free flap for 14 and anterolateral thigh perforator flap for 4 patients, respectively and indicated following that the first is the patients have partial defect that retain the remnant mucosa more than 50% of hypopharyngeal circumference. the second indication is the patient with previous abdominal operation and the third is the patient with risk of long ischemic time of transferred bowel. the last cases is the elderly patient with other comorbid condition even though the remnant mucosa are less than 50% of hypopharyngeal circumference. We have designed the flap to have a sufficient lumen of neohypopharyngeal diameter more than 4cm and the cephalic margin of hypopharynx be wider than caudal one, like a funnel shape, to eliminate the size discrepancy between the pharyngeal and esophageal lumen. The small triangular flap extension was designed in the caudal margin to prevent the distal enteric anastomosis site from the stricture, making the circumference of distal margin to be enlarged. In this paper, we contemplate our speculation for use of fasciocutaneous free flap for reconstruction of hypopharynx with surgical finesse to get a fine surgical outcome.

An Experimental Study of Fibroblast Suppression in Collagen Lattice

Fibroblasts are known as the key cells for wound contraction. In the plastic surgical field, wound contraction is one of the main concerns. Many drugs and treatment modalities have been tried to reduce the action of fibroblasts. To investigate the effects of minoxidil and griseofulvin on fibroblasts, fetal human fibroblasts were isolated from the anterior chest of normal fetus. Minoxidil, in addition to its effect on hypertension and hair growth and griseofulvin which has been used as antifungal agent were added on cultured fibroblasts. The morphological changes and numerical changes of the fibroblasts were observed by phase contrast microscopy. In low concentration, minoxidil does not inhibit the proliferation of fibroblasts but in high concentration, it inhibits the proliferation of fibroblasts and prevents the formation of proliferative cytoplasmic buds of fibroblasts. Griseofulvin inhibits the action of fibroblasts but not so significant as minoxidil. Also, they prevent the contraction of collagen lattice in high concentration. The importance of these findings is possible usage of these drugs to treat clinical fibrosis and hypertrophic scars. Further studies will be planned to learn more about a possible role of minoxidil and griseofulvin in prevention of wound contraction.

Clinical study on the oroantral fistula accompanied with odontogenic maxillary sinusitis

No abstract available.

Clinical study on the oroantral fistula accompanied with odontogenic maxillary sinusitis

No abstract available.

Open reduction of fractured mandibular condyles: overview

No abstract available.