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옥재철,소재근,안진환 대한골절학회 1995 대한골절학회지 Vol.8 No.4
The triplane fracture of the distal end of the tibia in adolescents is considered uncommon injuries, but recently it has received considerable attention in the orthopaedic literature. We reviewed five patients who had been treated at Kyung Hee University Hospital for triplane fractures and followed- up at least one year. The purposes of this paper were to determine the configuration of the fracture and the results of treatment. The cause of injury was slip down in three patients, fall down in one patients and sports injury in one patient. The mechanism of injury was supination-external rotation in four patients and unknown in one patient. The plain x-ray and CT were evaluated in all patients, On radiological evaluation, the initial displacement more than 2mm observed in four patients, but displaced fractures were reduced less than 2mm after treatment. The two fragment fractures were seen in two patients, three fragments in three patients. At last follow-up, complete union with anatomical position occurred without degenerative change of ankle joint and any deformity. We treated operatively in two patients, one with arthroscopic reduction and percutaneous pinning, the other with open reduction and internal fixation. Also we treated conservatively in one minimal displaced fracture and two displaced fractures. The results were graded using a modification of the Weber protocol. Points were assigned for pain, walking, activity, radiographic findings, function of the ankle joint, and deformity. The results was classified as excellent in 5 patients and good, fair and poor results was none. The complications was not developed in all patients. The initial displacement, No. of fragments and treatment method were not significantly affect the results of treatment. Finally, we had excellent results in triplane fracture if the reduction less than 2mm regardless initial displacement can obtained.
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옥재철,배대경,정선욱,안동기 대한슬관절학회 1997 대한슬관절학회지 Vol.9 No.2
The PFC(Press Fit Condylar) knee was first implanted clinically in 1984 with retention of posterior cruciate ligament. Thereafter PFC modular version had been developed at 1988 with option of posterior cruciate ligament substitution and minor design changes. We classified the 170 patients, 252 knees which underwent the PFC total knee arthroplasty in the period from January 1988 to May 1995 into three groups. In group I, 62 patients had 93 total knee arthroplasties with insertion of the original PFC total knee prosthesis with retention of posterior cruciate ligament from January 1988 to October 1991. In group IIa, 51 patients had 74 total knee arthroplasties with insertion of the modular PFC total knee prosthesis with retention of posterior cruciate ligament from November 1991 to May 1995. In group III, 57 patients had 85 total knee arthroplasties with insertion of the modular PFC total knee prosthesis with substitution of posterior cruciate ligament from November 1991 to May 1995. Average follow-up periods were 7 years 5 months in group I and 3 years 2 months in group IIa and IIb. Clinical and radiographic results were similar among the group I, IIa and IIb except slight better scores in group IIa and IIb than group I, even though group IIa and IIb had short follow-up periods. Postoperative implant wear was developed at 5 knees in group I, 1 knee in group IIa and not developed in group IIb. Implant loosening was developed at 1 knee only in group I. Revisional arthroplasty was performed to 7 knees in group I, 1 knee in group IIa and not in group IIb. In conclusion, posterior cruciate ligament substitution group had no difference in functional results with the retention group. In the problem of implant wear, posterior cruciate ligament substitution group was superior to the retention group but similar in loosening.
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정덕환,한정수,옥재철,조창현,Chung, Duke-Whan,Han, Chung-Soo,Ok, Jae-Chul,Cho, Chang-Hyun 대한미세수술학회 1997 Archives of reconstructive microsurgery Vol.6 No.1
Complete denervation after severe brachial plexus injury make significant muscle atrophy with loss of proper function. It is much helpful to reconstruct the essential function of the elbow flexion movement in patient with total loss of elbow flexion motion after brachial plexus lesion which was not recovered with nerve surgery or long term conservative treatment from onset. In whole arm type brachial plexus injury, if there were no response to neurotization or neglected from injury, the volume of the denervated muscle is significantely reduced month by month. About 18 months most of the muscle fibers change to fibrous tissues and markedly atrophied irreversibly, further waiting is no more meaningful from that period. Authors performed 14 cases of functioning gracilis muscle transfer from 1981 to 1995 with microneurovascular technique, neuromusculocutaneous free flaps were performed for reconstruction of lost elbow flexion function. Average follow-up period was 5 years and 6 months. We used couple of intercostal nerves as a recipient nerve which were anastomosed to muscular nerve from obturator nerve in all cases. Recipient vessels were three deep brachial artery and eleven brachial artery which were anastomosed to medial femoral circumflex artery with end to end or end to side fashion. Average resting length of the transplanted gracilis were 24 cm. We can get average 54 degree flexion range of elbow with fair muscle power from flail elbow. There were one case of muscle necrosis with lately developed thrombosis of microvascular anastomosed site which comes from insufficient recipient arterial condition, 3 cases of partial marginal necrosis of distal skin of the transplanted part which were not significant problem with spontaneously solved with time goes by gracilis muscle has constant neurovascular pattern with relatively easy harvesting donor with minimal donor morbidity. Especially it has similar length and shape with biceps brachii muscle of upper arm and longer nerve pedicle which can neurorrhaphy with intercostal nerve without nerve graft if sufficient mobilization of the nerves from both sides of gracilis and intercostal region. Authors can propose gracilis muscle transplantation with intercostal nerves neurotization is helpful method with minimal donor morbidity for neglected brachial plexus palsy patients.
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