• Journal of Trauma and Injury
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• v.20 no.1
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• pp.26-32
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• 2007

Purpose: Hemorrhagic shock is the leading cause of death in patients with pelvic bone fractures. The majority of blood loss is due to injured pelvic arteries and retroperitoneal veins and to bleeding from the fracture site itself. Pelvic angiography and embolization of injured vessels is an effective way to control continuous bleeding. However, identifying the bleeding focus in hemodynamically unstable patients before diagnostic intervention is difficult. The purpose of this study was to determine the correlation between fracture patterns in hemodynamically unstable patients with pelvic fractures and later pelvic angiography findings. Methods: We performed a retrospective study of 21 hemodynamically unstable patients with pelvic fractures admitted to our emergency department between April 2001 to April 2006. All 21 patients underwent pelvic angiography. Pelvic fractures were assessed according to the Tile's classification and the degree of injury was assessed using the Injury Severity Score (ISS) and Revised Trauma Score (RTS). The hemodynamic status of the patients was defined using vital signs, base excess, and blood lactate. Fracture patterns were compared with hemodynamic status and angiography findings. Results: In the 5year study period, 21 hemodynamically unstable pelvic bone fracture patients were admitted; ten were men (47.6%), and 11 were women (52.4%). The mean age was 41.1 years (range: ${\pm}20.1$). Of the 21 embolization was performed in 6 patient (28.6%): 1 patient of the 5 unstable pelvic bone fracture patients (20%), and 5 patients of 16 the stable pelvic bone fracture patients (31.3%). There were no significant differences between the RTS (p=0.587) and embolization rate (p=0.774) for either the stable patients or the unstable patients. Patients with arterial injury on angiography had a lower RTS compared with patients without arterial injury but there was no significant difference in ISS between the two groups. The angiographic injured sites were five internal femoral arteries and one external femoral artery. Conclusion: The findings in this study suggest that the pelvic fracture pattern in hemodynamically unstable patients with pelvic fractures does not correlate with pelvic angiography findings.

• Journal of Trauma and Injury
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• v.24 no.2
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• pp.159-163
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• 2011

Massive bleeding due to traumatic pelvic bone fracture is a leading cause of death. Thus, several methods to control bleeding have been attempted, but none of these has yet been clearly established. After an automobile accident, a 34-year-old motorist was admitted to the Emergency Department for right hip,leg and abdominal pain. Because the patient's pressure remained consistently low and pelvic bone fracture and abdominal bleeding were found on radiologic examination, an explorative laparotomy was performed. After pelvic packing and bleeding control, bleeding still continued, so Angiography was performed, and arterial embolization for bleeding was performed.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.139-144
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• 2012

Purpose: Hypovolemic shock is the leading cause of death in multiple trauma patients with pelvic bone fracures. The purpose of this study was to develop a simple prediction method for injury severity and amount of hemorrhage via an analysis of the correlation between the site of pelvic bone fracture and the amount of transfusion and to verify the usefulness of the such a simple scoring system. Methods: We analyzed retrospectively the medical records and radiologic examination of 102 patients who had been diagnosed as having a pelvic bone fracture and who had visited the Emergency Department between January 2007 and December 2011. Fracture sites in the pelvis were confirmed and re-classified anatomically as pubis, ilium or sacrum. A multiple linear regression analysis was performed on the amount of transfusion, and a simplified scoring system was developed. The predictive value of the amount of transfusion for the scoring system as verified by using the receiver operating characteristics (ROC). The area under the curve of the ROC was compared with the injury severity score (ISS). Results: From among the 102 patients, 97 patients (M:F=68:29, mean $age=46.7{\pm}16.6years$) were enrolled for analysis. The average ISS of the patients was $16.2{\pm}7.9$, and the average amount of packed RBC transfusion for 24 hr was $3.9{\pm}4.6units$. The regression equation resulting from the multiple linear regression analysis was 'packed RBC units=1.40${\times}$(sacrum fracture)+1.72${\times}$(pubis fracture)+1.67${\times}$(ilium fracture)+0.36' and was found to be suitable (p=0.005). We simplified the regression equation to 'Pelvic Bleeding Score=sacrum+pubis+ilium.' Each fractured site was scored as 0(no fracture) point, 1(right or left) point, or 2(both) points. Sacrum had only 0 or 1 point. The score ranged from 0 to 5. The area under the curve (AUC) of the ROC was 0.718 (95% CI: 0.588-0.848, p=0.009). For an upper Pelvis Bleeding Score of 3 points, the sensitivity of the prediction for a massive transfusion was 71.4%, and the specificity was 69.9%. Conclusion: We developed a simplified scoring system for the anatomical fracture sites in the pelvis to predict the requirement for a transfusion (Pelvis Bleeding Score (PBS)). The PBS, compared with the ISS, is considered a useful predictor of the need for a transfusion during initial management.

• Radiation Oncology Journal
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• v.19 no.3
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• pp.211-215
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• 2001

Purpose : This study was done to evaluate the efficacy of low-dose radiation in reduction of thoracic vertebral metastases in patients with breast cancer. Materials and Methods : 109 patients who were treated for bone metastasis from breast cancer from June, 1988 to June, 1998 in the Department of Therapeutic Radiology, Seoul National University were included. Of the 109 patients, 40 patients had been previously treated by postoperative radiotherapy and 69 had not. Postoperative radiotherapy had been given using Co-60 teletherapy device in 30 patients or 6 MV linear accelerator in 10. Thoracic spines from 1 to 10 were usually irradiated except in 1 patient and cervical vertebrae 6 and/or 7 were partially included in ,: patients. A total of 50.4 Gy was given with 1.8 Gy fraction. Metastatic bone diseases were scored in 11 regions, i. e., skull, conical spine, thoracic spine from 1 to 4, from 5 to 8, 9 and 10, 11 and 12, lumbar spine, pelvis, femur, ribs and others. Results : In no postoperative parasternal irradiation group, lumbar vertebrae were the most common metastatic sites $(55.1\%)$ followed by pelvis $(44.9\%)$, ribs $(40.6\%)$, thoracic vertebrae 11 and 12 $(37.7\%)$, thoracic vertebrae between 5 and 8 $(36.2\%)$, thoracic vertebrae 9 and 10 $(34.8\%)$, and thoracic vertebrae between 1 and 4 $(26.1\%)$. In postoperative parasternal irradiation group, lumbar vertebrae and pelvis were also the most common sites of metastases ($55.0\%$, respectively) followed by ribs $(37.5\%)$, and thoracic vertebrae 11 and 12 $(32.5\%)$. But significant less metastases were seen at thoracic vertebrae from 1 to 10. Conclusion : We can find that the were significantly less bony metastases at thoracic vertebrae which had been previously irradiated postoperatively.

• The Journal of the Korean bone and joint tumor society
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• v.16 no.1
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• pp.1-7
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• 2010

Purpose: With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications. Materials and Methods: We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. Results: The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%. Conclusion: Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.4
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• pp.706-711
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• 1996

다발성 골수증은 다양한 증세를 보이는 형질세포로부터 기원하는 악성종양으로 40세이상의 남성에서 호발되며 alkylating agent 단독, 혹은 corticosteroid와 병용하는 항암제 치료로 생존율이 크게 증가되기는 하였지만 치료후 평균생존기간의 20개월 내외로 완치율이 그다지 높지않은 형편이다. 악골에서의 발생은 극히 드물고 대개 늑골, 편평골, 척추, 골반, 두개골등에 광범위한 patchy destruction의 형태로 나타나는데 악골에 발생할 경우 임상증상은 장기적인 무통성 종창이 가장 흔하며 때로는 동통, 악골의 팽창, 감각이상, 치아의 동요, 악골골절등을 보이기도 한다. 전신적증상으로 무력감, 체중감소, 빈혈, 신부전, hypercalcemia, hyperiviscosity syndrome을 나타내기도 하는데 약 10%의 환자에서 전신적인 amyloidosis를 보인다. 진단은 골수생검상 골수의 plasmacytosis가 10% 이상이면서 혈장이나 뇨전기영동법에서 monoclonal globulin peak이 있을 때 가능하다. 여러 학자들은 처음에는 독립적인 고립성병소로 나타났다가 장기적으로 다발성골수종으로 이행됨을 주장하면서 장기적인 추적을 권하고 있지만 골내 고립성 형질세포종(solitary plasmacytoma in bone), 수질외 형질세포종(extramedullary plasmacytoma) 등은 다발성골수종과는 다른 질환이라 주장하는 등 아직 많은 논란이 있는 형편이다. 치료는 $4000{\sim}6000$ rad의 방사선치료와 여러 가지 약제의 복합적인 항암요법이 사용되고 있으며 국소적인 병소의 경우 외과적 절제술이 추천되기도 한다. 저자들은 59세 여자환자에서 하악골에 발생된 다발성골수종을 치험하였기에 문헌고찰과 함께 보고하는 바이다.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.95-105
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• 2008

Purpose: To identify which is the best procedure in recycling autograft according to the resection & reconstruction type and recycling methods, and so when the recycling autograft is used in limb salvage surgery. Materials and Methods: We have treated fifty-eight patients (34 male, 24 female; age range 5 to 74 years, mean age 36.5 years), who had the malignant musculoskeletal tumors, with recycling autograft (47 patients with extracoporeal irradiation, 11 patients with pasteurization) from December 1995 to February 2006. The resection and reconstruction type was 3 cases with fragmentary, 8 intercalary, 23 rAPC (recycling-Autograft-Prosthesis composite), 18 osteoarticular, 5 total joint and 1 soft tissue (achilles tendon). The result was evaluated by the radiologic union at junctional site, the functional score by musculoskeletal tumor society score and complications according to the resection & reconstruction type and recycling methods. Results: The junctional union was obtained at 15.0 months in extracoporeal irradiation and 12.6 months in pasteurization. Also the mean radiologic union was shown at 6.0 months in fragmentary, 12.8 months in intercalary, 10 months in rAPC, 23.3 months in osteoarticular and 15.6 months in total joint. The functional score was 65.5% in fragmentary, 60.8% in intercalary, 62.8% in APC (except pelvis), 66.0% in osteoarticular and 66.6% in total joint. We have experienced 1 infection, 1 prutrusio acetabuli in pasteurization (18.1%) and other 22 complications (3 deep infections, 8 nonunions, 2 fractures, 2 epiphyseal problems, 5 joint instabilities, 2 local recurrence) in extracoporeal irradiation (46.8%). Also we have experienced 3 complications (3 nonunions) in intercalary (37.5%), 9 complications (4 nonunions, 1 deep infection, 1 periprosthetic fracture, 1 epiphyseal problem, 1 local recurrence, 1 protrusio acetabuli) in rAPC (50.0%), 6 complications (2 deep infections, 2 nonunions, 1 epiphyseal problem, 1 pathologic fracture) in osteoarticular (33.3%), 5 complications (5 joint instabilities) in total joint (100%) and 1 complication(1 local recurrence) in soft tissue (100%). Conclusion: In our experience, according to the resection & reconstruction type fragmentary and intercalary may have several advantages such as good radiologic and functional result and low rate of complication. And it seems that rAPC was available in case which have no sufficient residual bone stock. Also the pasteurization may have more advantages than that of the extracorporeal irradiation.

• The Korean Journal of Nuclear Medicine
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• v.31 no.4
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• pp.452-458
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• 1997

To evaluate the pinhole scintigraphic findings and its significance, authors retrospectively compared the pinhole bone scintigrams and corresponding radiograms of 16 lesions in 14 patients with fibrous dysplasia. They were diagnosed pathologically in 10 lesions and radiologically in 6 lesions. The mean age of patients was 41.1 years. The mean interval between two studies was 1.1 days. Locations were ribs 7, pelvic bone 4, clavicle 1, long bones 4(femur 2, tibia 1, humerus 1). The radiographic findings were as follows : the central portions were radiolucent(n=9), ground-glass opacities(n=5) or sclerotic(n=2) and the peripheral appearance were sclerotic rim(n=5), septation(n=7), cortical perforation (n=10) and invisible cortical thinning(n=9). Pinhole scintigraphic findings were as follows; Central portions showed normal 1+ uptake in 6 cases(radiolucent 5, ground-glass opacity 1), slightly increased 2+ upta- ke in 7 cases(radiolucent 4, ground-glass opacity 3), and marked 3+ uptake in 3 cases(ground-glass opacity 1, sclerotic 2). The 15 of 16 lesions showed more intense uptake in the peripheral portion: slightly increased 2+ uptake corresponding to the sclerotic rim(5/5) and unvisible cortical thinning(1/9), and irregular foci of marked 3 + uptake corresponding to septation(7/7), cortical perforation(10/10) and invisible cortical thinning (8/9). One of 16 lesions showed homogeneous 2+ uptake. In conclusion, pinhole scintigram provides information on regional activity of the fibrous dysplasia, which would be helpful in diagnosis, prediction of prognosis and determination of treatment plan.

• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.164-171
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• 2019

Purpose: A dedifferentiated chondrosarcoma is a rare lethal tumor characterized by a low grade chondrosarcoma juxtaposed with a high grade dedifferentiated sarcoma, such as osteosarcoma, fibrosarcoma. The aim of our study was to document the clinical manifestation and oncologic outcomes of a dedifferentiated chondrosarcoma. Materials and Methods: This study identified 11 patients who were diagnosed and treated for dedifferentiated chondrosarcoma between January 2007 and December 2016. The identified cohort was then reviewed regarding age, sex, symptom onset, tumor location, magnetic resonance imagings (MRIs), surgical margin, and pathologic diagnosis. The time to local recurrence and/or metastasis, follow-up duration, and the patients' final status were analyzed. Results: The patients were comprised of 7 males and 4 females with a mean age of 54 years (range, 33-80 years). The location of the tumor was in the femur in 6 cases, pelvis in 4 cases, and metatarsal in 1 case. The average tumor diameter was 12.7 cm (range, 6.0-26.1 cm). At the time of diagnosis, 2 patients showed pathologic fracture; 1 patient was Enecking stage IIA, 9 patients were stage IIB, and 1 patient was stage III. Eight patients were classified as a primary dedifferentiated chondrosarcoma and 3 patients were secondary. One of the primary lesions was misinterpreted initially as a low grade chondroid lesion by MRI and underwent curettage. Local recurrence occurred in 8 cases and distant metastasis occurred in 10 cases with a mean duration of 8 months (range, 2-23 months) and 7 months (range, 1-32 months), respectively. The three-year overall survival of patients with dedifferentiated chondrosarcoma was 18%, and 10 patients died due to disease progression. Conclusion: Dedifferentiated chondrosarcoma developed lung metastases in the early period of the clinical courses and the prognosis was dismal.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.206-211
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• 2009

Purpose: Abdominal CT (computed tomography) is a principal diagnostic imaging modality for torso trauma at the Emergency Department (ED). When acute osseous pelvic injuries are detected by abdominal CT, additional three-dimensional (3D) reconstruction pelvic CT is often performed. We compared abdominal CT with pelvic CT to provide information about acute osseous pelvic injuries. Methods: A retrospective investigation of patients'electronic medical records during the five year period between January 1, 2004 and December 31, 2008 among Korean soldiers who underwent pelvic CT after abdominal CT at the ED was conducted. Axial images of abdominal CT were compared with axial images and 3D reconstruction images of pelvic CT. Results: Sixteen patients underwent subsequent pelvic CT after abdominal CT. Axial images of abdominal CT showed the same results in terms of fracture detection and classification when compared to axial images and 3D reconstruction images of pelvic CT. Pelvic CT (including 3D reconstruction images) followed by abdominal CT neither detected additional fracture nor changed the fracture type. Conclusion: This study has failed to show any superiority of pelvic CT (including 3D reconstruction images) over abdominal CT in detecting acute osseous pelvic injury. When 3D information is deemed be mandatory, 3D reconstructions of abdominal CT can be requested rather than obtaining an additional pelvic CT for 3D reconstruction.