Delayed Onset of the Popliteal Artery Pseudoaneurysm Following Medial Opening Wedge High Tibial Osteotomy / 대한정형외과학회잡지

High tibial osteotomy is an established method in treatment of medial knee osteoarthritis with varus deformity in younger patients. The popliteal artery is vulnerable to injury during surgeries performed around the knee joint. Pseudoaneurysm of the popliteal artery following medial opening wedge high tibial osteotomy is rare. A femoral angiogram revealed a pseudoaneurysm arising from the popliteal artery near the osteotomy site. Careful placement of retractors around the osteotomy site during sawing and flexing the knee to displace the popliteal artery away are recommended to prevent this complication. We report on the case of a pseudoaneurysm of the popliteal artery complicating medial opening wedge high tibial osteotomy that was treated clinically and radio-graphically with literature reviews.

Hemangioma of the Flexor Digitorum Superficialis Tendon Sheath in the Hand

Hemangioma is a common tumor which can occur in any part of the body. It can develop in any area the hand. Hemangioma of the hand usually presents with swelling, pressure pain, accompanied by motion restriction. Rarely it has throbbing pain. We report the case of a 21-year-old woman who had a hemangioma of flexor digitorum superficialis tendon sheath in second finger with restriction of motion and were treated by surgical intervention.

Venous Thromboembolism and Superficial Femoral Artery Obstruction after Femur Intertrochanteric Fracture: A Case Report / 대한고관절학회지

As the elderly population increases, occurrence of hip fractures has shown a rapid increase, and posttraumatic and postoperative venous thromboembolism can lead to fatal complications. Current prophylactic management includes mechanical and chemical prophylaxis. A 76-year-oldfemale, who was lost to follow-up after diagnosis of pulmonary thromboembolism four years ago, was admitted to our emergency room for a right intertrochanteric fracture. Before the operation, the thromboembolism recurred and was treated with anticoagulation medication. Bipolar hemiarthroplasty and fixation of the greater trochanter with a hook plate were performed 18 days after the trauma. Superficial femoral artery obstruction and venous thromboembolism occurred on the first day after the operation.

Dimensional change of the healed periosteum on surgically created defects

PURPOSE: The final goal of regenerative periodontal therapy is to restore the structure and function of the periodontium destroyed or lost due to periodontitis. However, the role of periosteum in periodontal regeneration was relatively neglected while bone repair in the skeleton occurs as a result of a significant contribution from the periosteum. The aim of this study is to understand the histological characteristics of periosteum and compare the native periosteum with the repaired periosteum after elevating flap or after surgical intervention with flap elevation. METHODS: Buccal and lingual mucoperiosteal flaps were reflected to surgically create critical-size, "box-type" (4 mm width, 5 mm depth), one-wall, intrabony defects at the distal aspect of the 2nd and the mesial aspect of the 4th mandibular premolars in the right and left jaw quadrants. Animals were sacrificed after 24 weeks. RESULTS: The results from this study are as follows: 1) thickness of periosteum showed difference as follows (Pflap-elevation group (0.36+/-0.07 mm)>defect formation group (0.26+/-0.03 mm), 2) thickness of gingival tissue showed difference as follows (Pflap-elevation group (2.02+/-0.25 mm)>control group (1.88+/-0.27 mm), 3) higher cellular activity was observed in defect formation group and flap-elevation groups than control group, 4) the number of blood vessles was higher in defect formation group than control group. CONCLUSIONS: In conclusion, prolonged operation with increased surgical trauma seems to decrease the thickness of repaired periosteum and increase the thickness of gingiva. More blood vessles and high cellular activity were observed in defect formation group.

Effect of seeding using an avidin-biotin binding system on the attachment of periodontal ligament fibroblasts to nanohydroxyapatite scaffolds: three-dimensional culture

PURPOSE: For periodontal tissue engineering, it is a primary requisite and a challenge to select the optimum types of cells, properties of scaffold, and growth factor combination to reconstruct a specific tissue in its natural form and with the appropriate function. Owing to fundamental disadvantages associated with using a two-dimensional substrate, several methods of seeding cells into three-dimensional scaffolds have been reported and the authors have asserted its usefulness and effectiveness. In this study, we explore the cell attachment of periodontal ligament fibroblasts on nanohydroxyapatite (n-HA) scaffold using avidin biotin binding system (ABBS). METHODS: Human periodontal ligament fibroblasts were isolated from the health tooth extracted for the purpose of orthodontic procedure. HA nanoparticles were prepared and Ca(NO3)2-4H2O and (OC2H5)3P were selected as precursors of HA sol. The final scaffold was 8 mm in diameter and 3 mm in height disk with porosity value of 81.55%. 1x10(5) periodontal ligament fibroblasts were applied to each scaffold. The cells were seeded into scaffolds by static, agitating and ABBS seeding method. RESULTS: The number of periodontal ligament fibroblasts attached was greater for ABBS seeding method than for static or agitating method (P<0.05). No meaningful difference has been observed among seeding methods with scanning electron microscopy images. However, increased strength of cell attachment of ABBS could be deduced from the high affinity between avidin and biotin (Kd=10(-15) M). CONCLUSIONS: The high-affinity ABBS enhances the ability of periodontal ligament fibroblasts to attach to three-dimensionally constructed n-HA scaffolds.

Tardy Ulnar Nerve Palsy due to Recurrent Dislocation of the Ulnar Nerve after Medial Epicondylar Fracture of the Humerus: A Case Report

Tardy ulnar nerve palsy might develop secondary to nonunion, malunion, or elbow deformity after medial epicondylar fracture of the humerus. We report a case of tardy ulnar nerve palsy following medial epicondylar fracture, treated with excision of bony fragment, neurolysis and relocation of the ulnar nerve.

Histological characteristics of newly formed cementum in surgically created one-wall intrabony defects in a canine model

PURPOSE: Periodontal regenerative therapies for defects created by severe periodontitis are mainly focused on bone regeneration. Although cementum regeneration needs to be better understood, it is believed to play an important role in periodontal regeneration. The first step toward a full understanding of cementum regeneration is to compare repaired cementum to pristine cementum. This study, which used histological techniques, was designed to focus on cementum regeneration and to compare pristine cementum to repaired cementum after surgical procedures with 8 and 24 week healing periods in a canine model. METHODS: Buccal and lingual mucoperiosteal flaps of 10 beagle dogs were surgically reflected to create critical-sized defects. Intrabony one-wall defects, of which dimension is 4 mm width and 5 mm depth, were made at the distal aspect of mandibular second premolars and the mesial aspect of mandibular fourth premolars in the right and left jaw quadrants. Animals were sacrificed after 8 and 24 weeks post-surgery for histological specimen preparation and histometric analysis. RESULTS: The repaired cementum was composed mostly of acellular cementum and cellular mixed fiber cementum and was thicker in the apical area than in the coronal area. The acellular cementum of the supracrestal area appeared to be amorphous. The newly formed cellular cementum was partially detached from the underlying circumpulpal dentin, which implied a weak attachment between new cementum and dentin, and this split was observed to a lesser extent in the 24 week group than in the 8 week group. The vertical height of the repaired cementum was greater in the 24 week group than in the 8 week group. CONCLUSIONS: Within the limitations of this study, we can conclude that repaired cementum after root planing was mainly acellular cementum and cementum tissue that matured to a shape similar to pristine cementum as the healing progressed from 8 to 24 weeks.

The effects of newly formed synthetic peptide on bone regeneration in rat calvarial defects

PURPOSE: Significant interest has emerged in the design of cell scaffolds that incorporate peptide sequences that correspond to known signaling domains in extracellular matrix and bone morphogenetic protein. The purpose of this study was to evaluate the bone regenerative effects of the synthetic peptide in a critical-size rat calvarial defect model. METHODS: Eight millimeter diameter standardized, circular, transosseus defects created on the cranium of forty rats were implanted with synthetic peptide, collagen, or both synthetic peptide and collagen. No material was was implanted the control group. The healing of each group was evaluated histologically and histomorphometrically after 2- and 8-week healing intervals. RESULTS: Surgical implantation of the synthetic peptide and collagen resulted in enhanced local bone formation at both 2 and 8 weeks compared to the control group. When the experimental groups were compared to each other, they showed a similar pattern of bone formation. The defect closure and new bone area were significantly different in synthetic peptide and collagen group at 8 weeks. CONCLUSIONS: Concerning the advantages of biomaterials, synthetic peptide can be an effective biomaterial for damaged periodontal regeneration.

Evaluating intra- and inter-examiner reproducibility in histometric measurement: one-wall intrabony periodontal defects in beagle dogs

PURPOSE: Accurate and exact measurement is an important factor for generating meaningful results in any properly designed study. If all the participating examiners are able to yield similar results, it will be possible to evaluate the objective results of the study more easily and quickly. The purpose of this study was to evaluate the intra- and inter-examiner reproducibility of histometric measurements in the intrabony periodontal defect model. METHODS: One wall intrabony defects were surgically created at the distal aspect of the second and the medial aspect of the fourth mandibular premolars in the right and left jaw quadrants in twenty beagle dogs and the defect sites received the following beta-tri calcium phosphate, growth differentiation factor-0, growth differentiation factor-100 and sham surgery. Histometric analysis was performed after 8 weeks. Histometric parameters were recorded and repeated at three months interval by three examiners. Intra- and inter-examiner reproducibility was assessed. RESULTS: Most parameters of all the groups showed high intra- and inter-examiner reproducibility. Parameters including defect height, bone regeneration height, cementum regeneration height, and formation of junctional epithelium yielded inter-examiner correlation > or = 0.9. The intra-examiner reproducibility showed a high result, over 0.9. CONCLUSIONS: Histometric evaluation of the one-wall intra-alveolar periodontal defect model showed high reproducibility not only for a single given examiner but also among the three examiners.

A simple approach to preserve keratinized mucosa around implants using a pre-fabricated implant-retained stent: a report of two cases

PURPOSE: There is no consensus regarding the relationship between the width of keratinized mucosa and the health of peri-implant tissues, but clinicians prefer to provide enough keratinized mucosa around dental implants for long-term implant maintenance. An apically positioned flap during second stage implant surgery is the chosen method of widening the keratinized zone in simple procedures. However, the routine suture techniques used with this method tend to apply tension over the provisional abutments and decrease pre-existing keratinized mucosa. To overcome this shortcoming, a pre-fabricated implant-retained stent was designed to apply vertical pressure on the labial flap and stabilize it in a bucco-apical direction to create a wide keratinized mucous zone. METHODS: During second stage implant surgery, an apically displaced, partial thickness flap with a lingualized incision was retracted. A pre-fabricated stent was clipped over the abutments after connecting to the provisional abutment. Vertical pressure was applied to displace the labial flap. No suture was required and the stent was removed after 10 days. RESULTS: A clinically relevant amount of keratinized mucosa was achieved around the dental implants. Buccally displaced keratinized mucosa was firmly attached to the underlying periosteum. A slight shrinkage of the keratinized zone was noted after the healing period in one patient, but no discomfort during oral hygiene was reported. Clinically healthy gingiva with enough keratinized mucosa was achieved in both patients. CONCLUSIONS: The proposed technique is a simple and time-effective technique for preserving and providing keratinized tissue around dental implants

Osteochondroma of the Metacarpal Head in a Child: A Case Report

The osteochondroma is the most common benign bone tumor which occurs in the metaphyseal portion of long bone. The osteochondroma is rare in hand and extremely rare in the intraarticular location of the hand. We present a case of intraarticular osteochondroma which occurred at the fourth metacarpal head of the hand in a child patient.

Brachial Plexus Injury as a Complication of Arthroscopic Bankart Repair: A Case Report / 대한정형외과학회잡지

Shoulder arthroscopy is widely used through the development of arthroscopic technique and equipment but some complications have been reported that are related to the complexity of technique and the long duration time of operation. Brachial plexus injury, as a complication of arthroscopic Bankart repair, is rare, but remains a serious sequelae. We performed the neurorrhaphy and neurolysis of brachial plexus and showed relatively good functional outcome after 2 years.

Mechanism, prevention, risk assessment and treatment in bisphosphonates induced osteonecrosis of the jaw / 대한치주과학회지

PURPOSE: Bisphophonates are drugs used to suppress osteoclastic activity and to treat osteoporosis, Paget's disease of bone and bone metastasis. The purpose of this report is to review the literatures on bisphopsphonates use that could affect bone healing and cause osteonecrosis of the jaws. MATERIALS AND METHODS: Medline research was carried out to find relevant articles on bisphophonates and osteonecrosis of the jaw. RESULTS: Oral administration of bisphopsphonates is reported to decrease the risk of adverse bone outcomes. On the contrary, IV bisphopsphonates is known to significantly increase the risk. Prevention of the osteonecrosis of the jaw is primary concern before usage. If the adverse bone reaction takes place, proper management and treatments are required to alleviate pain of patients and prevent further progression of necrosis. CONCLUSION: Case reports of bisphosphonates induced osteonecrosis of the jaw are increasing. Dentists and physicians should be aware of the higher frequency of osteonecrosis of the jaw in patients receiving IV bisphopsphonates and be prepared to prevent and cope with adverse bone reaction.

Retrograde Intramedullary Nailing or the Treatment of Segmental Femoral Shaft Fracture Including Distal Part

PURPOSE: To evaluate the usefulness of the retrograde intramedullary nailing for the treatment of segmental femoral shaft fracture including distal part. MATERIALS AND METHODS: We reviewed 15 patients of segmental femoral fracture, who had treated with retrograde intramedullary nailing and followed-up more than 1 year from January 2003 to October 2007. There were 10 men, 5 women, and the mean age was 45 years old. There were associated fracture in 10 cases. We evaluate the time for union, non-union and malunion by radiologic finding and functional assessment by Sanders' criteria. RESULTS: The mean time of union was 21 weeks. There was one delayed union in proximal fracture site. There was no shortening more than 1.5 cm, no angular deformity more than 10 degrees, no postoperative infection or instability. According to Sanders' criteria, there were excellent clinical results in 9 cases, good results in 5 cases and fair result in 1 case. CONCLUSION: The retrograde intramedullary nailing can be a useful method for treatment of segmental femoral shaft fracture including distal part.

Cauda Equina Syndrome due to Epidural Hematoma After Lumbar Epidural Block : A Case Report / 대한척추외과학회지

Cauda equina syndrome after epidural block is a rare complication, but it requires emergency surgery when it is diagnosed. A 65-year-old man who underwent epidural block at a local clinic was admitted with right lower leg weakness and decreased leg sensation, severe lower radiating pain, dysuria and decreasing sensation in the perianal region. Magnetic resonance image showed protruded disc material between L4-L5 and a hematoma that occupied most of the spinal canal and this was compressing the spinal cord. These findings were diagnostic for cauda equina syndrome after epidural block and so laminectomy, excision of the herniated disc and removal of the hematoma were done. At 6 months follow-up, the neurologic symptoms were resolved except for the dorsiflextion of the ankle and the big toe. We report here on a case of cauda equina syndrome as a rare complication after epidural anesthesia.

The Effects of Hydroxyapatite-Chitosan Membrane on Bone Regeneration in Rat Calvarial Defects / 대한치주과학회지

PURPOSE: Recently, interest in chitosan has increased due to its excellent biological properties such as biocompatibility, antibacterial effect, and rapid healing capacity. On the other hand, hydroxyapatite is used as a bone substitute in the fields of orthopedics and dentistry. The hydroxyapatite-chitosan (HA-CS) complex containing hydroxyapatite nanoparticles was developed for synergy of both biomaterials. The objective of this study was to evaluate the effect of hydroxyapatite (HA)-chitosan (CS) membrane on bone regeneration in the rat calvarial defect. METHODS: Eight-millimeter critical-sized calvarial defects were created in 70 male Sprague-Dawley rats. The animals were divided into 7 groups of 10 animals and received either 1) chitosan (CS) 100% membrane, 2) hydroxyapatite (HA) 30%/ CS 70% membrane, 3) HA 30% / CS 70%, pressed membrane, 4) HA 40%/ CS 60% membrane, 5) HA 50%/ CS 50% membrane, 6) HA 50%/ CS 50%, pressed membrane, or 7) a sham - surgery control. The amount of newly formed bone from the surface of the rat calvarial defects was measured using histomorphometry, following 2- or 8- week healing intervals. RESULTS: Surgical implantation of the HA - CS membrane resulted in enhanced local bone formation at both 2 and 8 weeks compared to the control group. The HA - CS membrane would be significantly more effective than the chitosan membrane in early bone formation. CONCLUSIONS: Concerning the advantages of biomaterials, the HA-CS membrane would be an effective biomaterial for regeneration of periodontal bone. Further studies will be required to improve the mechanical properties to develop a more rigid scaffold for the HA-CS membrane.

Bone regeneration capacity of two different macroporous biphasic calcium materials in rabbit calvarial defect / 대한치주과학회지

ABSTRACT PURPOSE: Synthetic bone products such as biphasic calcium phosphate (BCP) are mixtures of hydroxyapatite (HA) and a- tricalcium phosphate (a- TCP). In periodontal therapies and implant treatments, BCP provides to be a good bone reconstructive material since it has a similar chemical composition to biological bone apatites. The purpose of this study was to compare bone regeneration capacity of two commercially available BCP. METHODS: Calvarial defects were prepared in sixteen 9-20 months old New Zealand White male rabbits. BCP with HA and a- TCP (70:30) and BCP with Silicon-substituted hydroxyapatite (Si-HA) and a-TCP (60:40) particles were filled in each defect. Control defects were filled with only blood clots. Animals were sacrificed at 4 and 8 week postoperatively. Histomorphometric analysis was performed. RESULTS: BCP with HAand a- TCP 8 weeks group and BCP with Si-HA and a- TCP 4 and 8 weeks groups showed statistically significant in crease (P<0.05) in augmented area than control group. Newly formed bone area after 4 and 8 weeks was similar among all the groups. Residual materials were slightly more evident in BCP with HA and a- TCP 8 weeks group. CONCLUSIONS: Based on histological results, BCP with HA and a- TCP and BCP with Si-HA and a- TCP appears to demonstrate acceptable space maintaining capacity and elicit significant new bone formation when compared to natural bone healing in 4 and 8 week periods.

Effect of Hydroxyapatite containing dentifrice on teeth hypersensitivity after periodontal therapy / 대한치주과학회지

PURPOSE: The purpose of this study was to evaluate the effects of hydroxyapatite containing toothpaste for patients who received periodontal therapy and felt hypersensiptivity. MATERIAL AND METHODS: After application of toothpaste, patients were evaluated for VAS(Visual Analog scale) scores to a cold stimulate on baseline, 1 week, and 4 weeks. VAS scores were analyzed by statistical methods. RESULTS: The results of this study were as follows. 1. VAS scores in control group on baseline, 1 week, 4 weeks were 5.39+/-2.05, 4.75+/-2.00, 4.21+/-1.75. 2. VAS scores in experimental group on baseline, 1 week, 4 weeks were 5.61+/-2.37, 4.81+/-2.46, 4.08+/-2.54. 3. Decrease of VAS scores on hypersensitivity after 1week was 0.64+/-0.49(p<.0001) in control group, 0.80+/-1.65 (p<.0001) in experimental group. 4. Decrease of VAS scores on hypersensitivity after 4weeks was 1.18+/-1.60(p<.0001) in control group, 1.53+/-1.88 (p<.0001) in experimental group. 5. When compared, decrease of VAS scores after 1 week between 2 groups were not statistically different(p=0.2622). 6. When compared, decrease of VAS scores after 4 weeks between 2 groups were not statistically different(p=0.1219). CONCLUSION: It was confirmed that hydroxyapatite containing toothpaste have the similar effect with pre-existing proven dentifrice for relieving teeth hypersensitivity.

Study of chitosan's effects on periodontal tissue regeneration: a meta-analysis of the histomorphometry / 대한치주과학회지

PURPOSE: Chitosan & chitosan derivative(eg. membrane) have been studied in periodontal regeneration, and recently many studies of chitosan have reported good results. If chitosan's effects on periodontal regeneration are enhanced, we can use chitosan in many clinical and experimental fields. For this purpose, this study reviewed available literatures, evaluated comparable experimental models. MATERIALS AND METHODS: Ten in vivo studies reporting chitosan's effects on periodontal tissue regeneration have been selected by use of the 'Pubmed' and hand searching. RESULTS: 1. In Sprague Dawley rat calvarial defect models, amount of newly formed bone in defects showed significant differences between chitosan/chitosan-carrier/chitosan-membrane groups and control groups. 2. In beagle canine 1-wall intrabony defect models, amount of new cementum and new bone showed significant differences between chitosan/chitosan-membrane groups and control groups. The mean values of the above experimental groups were greater than the control groups. CONCLUSION: The results of this study have demonstrated that periodontal regeneration procedure using chitosan have beneficial effects, which will be substitute for various periodontal regenerative treatment area. One step forward in manufacturing process of chitosan membrane and in use in combination with other effective materials(eg. bone graft material or carrier) may bring us many chances of common use of chitosan in various periodontal area.

Histologic evaluation of various membranes on periodontal tissue regeneration of 1-wall intrabony defects in dogs / 대한치주과학회지

PURPOSE: In dental clinical fields, various periodontal membranes are currently used for periodontal regeneration. The periodontal membranes are categorized into two basic types: resorbable and non-resorbable. According to the case, clinician select which membrane is used. Comparing different membranes that are generally used in clinic is meaningful. For this purpose, this study evaluates histological effects of various membranes in canine one wall intrabony defect models and it suggest a valuation basis about study model. MATERIAL AND METHOD: The membranes were non-resorbable TefGen Plus(R), resorbable Gore Resolut XT(R) and resorbable Osteoguide(R). One wall intrabony defects were surgically created at the second and the mesial aspect of the fourth mandibular premolars in either right or left jaw quadrants in two dogs. The animals were euthanized 8 weeks post-surgery when block sections of the defect sites were collected and prepared for histological evaluation. RESULTS: 1. While infiltration of inflammatory cells were observed in control, TefGen Plus(R) and Gore Resolut XT(R), it was not observed in Osteoguide(R). 2. TefGen Plus(R) had higher integrity than others and Osteoguide(R) was absorbed with folding shape. Gore Resolut XT(R) was divided everal parts during resorbtion and it was also absorbed from inside. 3. Quantity of new bone and new cementum was not abundant in all membranes. 4. For histologic evaluation of membranes we should consider infiltration of inflammatory, migration of junctional epithelium, integrity of membrane, quantity of new bone and new cementum, connective tissue formation and aspect of resorption. CONCLUSION: This histologic evaluation suggests that Osteoguide(R) provides periodontal regenerative environment with less inflammatory state. It is meangful that this study model suggests a valuation basis about other study model.