Bone density around the fixture after function of implant molar prosthesis using CBCT / 대한구강악안면방사선학회지

PURPOSE: The purpose of this study was to examine the significance of increased bone density according to whether bone grafts were applied using demographic data with Cone Beam Computed Tomography (CBCT) and to compare the bone densities between before and after implant prosthesis using the Hounsfield index. MATERIALS AND METHODS: Thirty-six randomly selected computed tomography (CT) scans were used for the analysis. The same sites were evaluated digitally using the Hounsfield scale with V-Implant 2.0(TM), and the results were compared with maxillary posterior bone graft. Statistical data analysis was carried out to determine the correlation between the recorded Hounsfield unit (HU) of the bone graft and implant prosthesis using a Mann-Whitney U test and Wilcoxon Matched-pairs test. RESULTS: The bone grafted maxillary posterior teeth showed an increase in the mean values from-157 HU to 387 HU, whereas non-grafted maxillary posterior teeth showed an increase from 62 HU to 342 HU. After implantation, the grafted and non-grafted groups showed significantly higher bone density than before implantation. However, the grafted group showed significantly more changes than the non-grafted group. CONCLUSION: Bone density measurements using CBCT might provide an objective assessment of the bone quality as well as the correlation between bone density (Hounsfield scale) and bone grafts in the maxillary molar area.

Dorsal Closing Wedge Osteotomy in Freiberg's Disease / 대한정형외과학회잡지

This etiology of Freiberg's disease, an idiopathic avascular necrosis of the second metatarsal head, has not been clarified. In 1979, Gauthier and Elbaz treated 53 cases of the advanced Freiberg's disease by a new technique, that is, dorsal closing wedge osteotomy, and their result was successful. Recently, in 1989, Zollinger identified that the load per surface area is concentrated at the dorsal rather than plantar surface of the second metatarsal head during walking by an experimental dynamic study, and this theory explained why the lesion of the disease is confined to the dorsal surface of the second metatarsal head, and provided a basic concept on the dorsal closing wedge osteotomy. The authors reviewed 5 cases of Freiberg's disease treated by dorsal closing wedge osteotomy from September 1989 to February 1994, and the average follow-up period was 2 years and 5 months(range, 12 to 50 months). The results were as follows; 1. All were female, and the average age at the time of operation was 29.4 years(range, 22 to 43 years). 2. All were pain-free at the last follow-up. 3. The range of motion(ROM) of the metatarsophalangeal joint was increased postoperatively; average ROM: preoperative, 33°/ postoperative 77°; mean gain of ROM, 44° So, dorsal closing wedge osteotomy is a recommendable procedure for the treatment of advanced Freiberg's disease.

Supracondylar Extension osteotomy for Knee Flexion Contracture by the Ilizarov Technique / 대한정형외과학회잡지

In patients with the sequele of poliomyelitis, pyogenic or tuberculous arthritis, or trauma, flexion contracture of the knee could be developed and many difficult problems would be met in treating them. Ilizarov suggested the method of gradual correction of deformities of bone after corticotomy-osteo- clasis, combined with gradual elongation of the shortened soft tissues, and the flexion contracture of knee & limb length discrepancy could be corrected simultaneously or sequentially following a sigle operative procedure. The authors have treated 25 patients with flexion contracture of the knee joint by the principle of Ilizarov treatment at the Sang Gye Paik Hospital between September 1991 and March 1994, The average preoperative flexion contracture of the knee joint, 25° (range, 10°

Biologic Arthroplasty of the Elbow Joint / 대한정형외과학회잡지

The stiffness of the elbow joint is caused by trauma, infection, and ect. The conventional arthrop lasty and arthrodesis of this joint has been used but the indication is very limited because of unsati sfactory result. The Oganesyan external fixator, which was invented by Mstislav V. Volkov and Oganes V. Oganesyan in 1971, generally employes tne hinged-distraction apparatus to treat joint stiffness and flexion contracture. According to them, regeneration of both cartilage and underlying subchondral bony tissue is possible. These authors consider the main factor for regeneration of the cartilage af a destroyed joint surface to be early restitution of joint functions including unloaded motion and elimination of increased friction between the joint surfaces. From Jan. 1992 to Jan. 1994, We have experienced the 6 cases of stiff elbow who had been undergone biologic arthroplasty. The results were as follows; The gain of the average range of motion of the joint at final follow-up was 50.5°. The complications were mild pain in 2 cases, mild instability on exertion in 2 cases, recurrence of contracture in two cases and ulnar nerve irritation in one case. The complications affected no significant long term results except recurrence.

Treatment of Congenital Brachymetatarsia Lengthened by Callotasis / 대한정형외과학회잡지

Congenital brachymetatarsia causes minor disability in daily life. However, patients suffer cosmetically or psychologically and often demand correction of the deformity when they reach adolescence. Thirty-eight skeletal lengthenings were performed on twenty-three patients with congenital brachymetatarsia between March 1992 and July 1993. Short metatarsal bones were osteotomized subperiosteally, and held by a small external fixator and then subjected to slow axial distraction. All the patients were female with an average age of patients at the time of operation was twenty-one years. The average lengthenings was 15.8mm. The average healing index was 80.6(day/cm). The average lengthenings percentage was 35.2%. There was a metatarso-phalangeal joint subluxation with pain in one patient. We believe that the callotasis method was no need for bone grafting and permitted early weight bearing. The result was good cosmetically.

A Clinical analysis of the Fracture of the Humeral Shaft / 대한정형외과학회잡지

The humerus is anatomically and phyelologically unique, such as, firstly, it is a non weight bearing bone, secondly, it has greatest range of motion, thirdly, when at rest while the person is standing, the axis of bone hangs vertically and is influenced by gravity, and conservative methods usually used in treatment. However, in the event of closed reduction failure, open fracture, multiple fracture, and old age, operative method may be employed. Authors reviewed and analzed 84 humeral shaft fractures which had been treated at the Department Orthopedic Surgery, Paik Hospital from Dec. 1979 to May 1988. The results were as follows : l. Among the 84 patients, male were 63 and female were 21. 2. The major causes of injury were a traffic accident. 3. The most frequent type and site of fracture was comminuted and middle one third. 4. The incident of radial nerve injury was 17 cases. 5. Of 84 cases, 22 cases were treated conservatively and 62 cases operatively. 6. The most common complication was non-union of 14 cases, of which 10 cases were treated with plate and bone graft and 4 cases with only bone graft.

A Clinical Study of the Tibial Plafond Fractures / 대한정형외과학회잡지

The tibial plafond fractures result from an axial compression snd rotational forces causing variable degrees of metaphyseal disruption, articular damage, and malleolar displscement. It is relatively uncommon but a most difficult fracture to manage. It has been treated in a number of manners, but the best results have been occurred when stable internal fixation is accomplished using plates and screws. Basic steps in reconstruction are restoration of anatomic length of the fibula with plate fixation, reconstruction of the tibial articular surface, cancellous bone grafting of the metaphyseal defect and buttress plating of the distal tibia. The suthor analysed the 20 cases of the tibial plafond frsctures in 17 patients, which were trested at the Department of Orthopedic Surgery, Paik Hospital, Inje Medical College from Jsnuary 1983 to March 1987. The longest durstion of followup was 2 years and 4 months and shortest one was 6 months, and the aversge was one year. The results were as follows : 1. Among the 17 patients, male were 16 and female was one. 2. The major causes of injury were a fall from a height. 3. The most frequent type of fracture was type C by Ruedi and Allgower classification. 4. Regardless of the method of trestment the type A and B were in good and fair result, but the type C were fair in 4 cases and poor in 8 cases. There were 7 cases of snkle fusion in poor group. 5. It is important to remind the basic steps in reconstruction and applied in sn individual csse especially in type C. If anatomic reconstruction of the joint surface can be restored and stable fixation achieved, esrly motion of the ankle joint is made possible. This early motion reduces stiffness of the ankle and win yeild the most sstisfying result. But the anatomic reduction of ank1 joint is difficult to be obtained in each case especially in type C and may consider an ankle fusion.