• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.92-98
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• 2007

Introduction: The treatment of proximal humeral fracture is traditionally determined by Neer's classification system. The severely displaced three-part or four-part fracture is an indication for primary hemiarthroplasty. The current authors report the clinical results of 10 patients who received hemiarthroplasty for proximal comminuted fractures. The minimum follow-up period was 12 months. Materials and Methods: The current authors studied 10 patients who, between July 1999 and March 2005, each received hemiarthroplasty for a proximal humeral fracture of one shoulder. According to Neer's classification system, 5 of the patients had three-part fractures, and 5 of the patients had 4-part fractures. The mean interval between trauma and hemiarthroplasty was 6.1 days. The mean age of the 6 female and 4 male patients was 67.4 years(range: 56 to 76). Shoulder function was evaluated using the Constant score, the Simple Shoulder Test, and the modified UCLA score. Results: The mean Constant score was 51.4(range: 34 to 60). The mean modified SST score was 7.8 out of 12 tasks. Excluding the one patient who had also sustained an axillary artery rupture and a brachial plexus injury after the initial trauma, the mean Constant score for the remaining 9 patients was 53.5(range: 44 to 60), and the mean SST score was 7.2 tasks. The modified UCLA score averages for pain, function, and active forward flexion and strength were, respectively, 8.2($6{\sim}10$), 6.6($2{\sim}8$), and 6.9($4{\sim}8$). The total UCLA score was an average of 21.7($12{\sim}26$). Patients' the modified UCLA ratings were as follows: Excellent: 3, Good: 6, and Poor: 1. The patient with the poor outcome was the one who had also sustained the neurovascular injury. Patient's subjective satisfaction rating were as follows: Excellent: 2, Good: 7, and Poor: 1. Conclusion: Based on short term follow-up results, this study indicates that hemiarthroplasty is the treatment of choice for proximal humeral fractures on which it would be difficult to perform open reduction and internal fixation. Hemiarthroplasty is a useful treatment modality to prevent shoulder stiffness and to allow daily living tasks in elderly patients. However, restoration of muscle power and range of joint motion were not recovered satisfactorily.

• Journal of Korean Orthopaedic Sports Medicine
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• v.2 no.2
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• pp.168-175
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• 2003

Fracture about proximal humerus may be classified as the articular segment or the anatomical neck, the greater tuberosity, the lesser tuberosity, and the shaft or surgical neck. Now, usually used, Neer's classification is based on the number of segments displaced, over 1cm of displaced or more than 45 degrees of angulation , rather than the number of fracture line . Absolute indication of a operative treatment a open fracture, the fracture with vascular injury or nerve injury , and unreductable fracture-dislocation . Inversely, the case that are severe osteoporosis, and eldly patient who can't be operated by strong internal fixation is better than arthroplasty used by primary prosthetic replacement and early rehabilitation program than open reduction and internal fixation. The operator make a decision for the patient who should be taken the open reduction and internal fixation, because it's different that anatomical morphology, bone density, condition of patient. The operator decide operation procedure. For example, percutaneous pinning, open reduction, plate & screws, wire tension bands combined with some intramedullary device are operation procedure that operator can decide . The poor health condition for other health problem, fracture with unstable vital sign and severe osteoporosis , are the relative contraindication. The stable fracture without dislocation is not the operative indication . The radiologic film of the prokimal humerus before the operation can not predict for fracture evaluation. It's necessary to good radiologic film for evaluation of fracture form. The trauma serise is better than the other radiologic film for evaluation. The accessary radiologic exam is able to help for evaluation of bone fragment and anatomy. The CT can be helpful in evaluating these injury, especially if the extract fracture type cannot be determined from plain roenterogram of the proximal humerus, bone of humerus head. If the dislocation is severe anatomically , we could consider to do three dimentional remodelling. The MRI doing for observing of bony morphology before the operation is not better than CT If we were suspicious of vascular injury, we could consider the angiography.

• Journal of the Korean Society for Precision Engineering
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• v.25 no.10
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• pp.137-143
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• 2008

The objective of this study was to characterize the role of synovial fluid and hyaluronan in the frictional response of bovine articular cartilage. Seven cylindrical cartilage specimens were harvested from three fresh bovine humoral heads (4-6 months old). Reciprocal sliding motion (1mm/s) was provided by a custom-made friction testing apparatus with a normal load of 22.3 N. From the measured time-dependent normal and frictional forces, the minimum and maximum frictional coefficients were calculated. Synovial fluid reduced the minimum frictional coefficient by ${\sim}75$ % and maximum frictional coefficient by ${\sim}11%$, while the reduction of the minimum and maximum frictional coefficients with hyaluronan was ${\sim}42%$ and ${\sim}24%$, respectively. To the best of our knowledge, this experimental study investigates the first such comparisons of frictional response of articular cartilage with and without synovial fluid and hyaluronan, and provides significant insights into their role in the articular cartilage friction and lubrication.

• Journal of the Korean Society for Precision Engineering
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• v.25 no.1
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• pp.145-150
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• 2008

One of the unresolved questions in articular cartilage biomechanics is the magnitude of the dynamic modulus and tissue compressive strains under physiological loading conditions. The objective of this study was to characterize the dynamic modulus and compressive strain magnitudes of bovine articular cartilage at physiological compressive stress level and loading frequency. Four bovine calf shoulder joints (ages 2-4 months) were loaded in Instron testing system under load control, with a load amplitude up to 800 N and loading frequency of 1 Hz, resulting in peak engineering stress amplitude of ${\sim}5.8\;MPa$. The corresponding peak deformation of the articular layer reached ${\sim}27%$ of its thickness. The effective dynamic modulus determined from the slope of stress versus strain curve was ${\sim}23\;MPa$, and the phase angle difference between the applied stress and measured strain which is equivalent to the area of the hystresis loop in the stress-strain response was ${\sim}8.3^{\circ}$. These results are representative of the functional properties of articular cartilage in a physiological loading environment. This study provides novel experimental findings on the physiological strain magnitudes and dynamic modulus achieved in intact articular layers under cyclical loading conditions.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.1
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• pp.30-41
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• 2007

Purpose: Bone metastasis in breast cancer patients are usually assessed by conventional Tc-99m methylene diphosphonate whole-body bone scan, which has a high sensitivity but a poor specificity. However, positron emission tomography with $^{18}F-2-deoxyglucose$ (FDG-PET) can offer superior spatial resolution and improved specificity. FDG-PET/CT can offer more information to assess bone metastasis than PET alone, by giving a anatomical information of non-enhanced CT image. We attempted to evaluate the usefulness of FDG-PET/CT for detecting bone metastasis in breast cancer and to compare FDG-PET/CT results with bone scan findings. Materials and Methods: The study group comprised 157 women patients (range: $28{\sim}78$ years old, $mean{\pm}SD=49.5{\pm}8.5$) with biopsy-proven breast cancer who underwent bone scan and FDG-PET/CT within 1 week interval. The final diagnosis of bone metastasis was established by histopathological findings, radiological correlation, or clinical follow-up. Bone scan was acquired over 4 hours after administration of 740 MBq Tc-99m MDP. Bone scan image was interpreted as normal, low, intermediate or high probability for osseous metastasis. FDG PET/CT was performed after 6 hours fasting. 370 MBq F-18 FDG was administered intravenously 1 hour before imaging. PET data was obtained by 3D mode and CT data, used as transmission correction database, was acquired during shallow respiration. PET images were evaluated by visual interpretation, and quantification of FDG accumulation in bone lesion was performed by maximal SUV(SUVmax) and relative SUV(SUVrel). Results: Six patients(4.4%) showed metastatic bone lesions. Four(66.6%) of 6 patients with osseous metastasis was detected by bone scan and all 6 patients(100%) were detected by PET/CT. A total of 135 bone lesions found on either FDG-PET or bone scan were consist of 108 osseous metastatic lesion and 27 benign bone lesions. Osseous metastatic lesion had higher SUVmax and SUVrel compared to benign bone lesion($4.79{\pm}3.32$ vs $1.45{\pm}0.44$, p=0.000, $3.08{\pm}2.85$ vs $0.30{\pm}0.43$, p=0.000). Among 108 osseous metastatic lesions, 76 lesions showed as abnormal uptake on bone scan, and 76 lesions also showed as increased FDG uptake on PET/CT scan. There was good agreement between FDG uptake and abnormal bone scan finding (Kendall tau-b : 0.689, p=0.000). Lesion showed increased bone tracer uptake had higher SUVmax and SUVrel compared to lesion showed no abnormal bone scan finding ($6.03{\pm}3.12$ vs $1.09{\pm}1.49$, p=0.000, $4.76{\pm}3.31$ vs $1.29{\pm}0.92$, p=0.000). The order of frequency of osseous metastatic site was vertebra, pelvis, rib, skull, sternum, scapula, femur, clavicle, and humerus. Metastatic lesion on skull had highest SUVmax and metastatic lesion on rib had highest SUVrel. Osteosclerotic metastatic lesion had lowest SUVmax and SUVrel. Conclusion: These results suggest that FDG-PET/CT is more sensitive to detect breast cancer patients with osseous metastasis. CT scan must be reviewed cautiously skeleton with bone window, because osteosclerotic metastatic lesion did not showed abnormal FDG accumulation frequently.

• Korean Journal of Veterinary Research
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• v.14 no.2
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• pp.135-150
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• 1974

한국재내산양(韓國在來山羊) 11마리의 전지근(前肢筋)을 절개하여 관찰하였던 바 다음과 같은 결과를 얻었다. 1. 한국재내산양(韓國在來山羊)의 전지(前肢)에서는 다음과 같은 근(筋)들을 관찰할 수 있었다. 승모근(僧帽筋) M. trapezus, 릉형근(菱形筋) M. rhomboideus, 완두근(腕頭筋) M. brachiocephalicus, 쇄골하근(鎖骨下筋) M. subclavius, 견갑횡구근(肩甲橫究筋) M. omotransv-ersarius, 란배근(瀾背筋) M. latissimus dorsi, 천흉근(淺胸筋) M. pectoralis guperficialis, 탐흉근(探胸筋) M. pectorlis profundus, 복거근(腹鋸筋) M. serratus ventralis, 삼각근(三角筋) M. deltoideus, 극하근(棘下筋) M. infraspinatus, 극상근(棘上筋) M. supraspinatus, 견갑하근(肩甲下筋) M. subscapularis, 대원근(大圓筋) M. teres major, 소원근(小圓筋) M. theres minor, 전완근막장근(前腕筋膜張筋) M. tensor fascia antebrachii, 삼두완근(三頭腕筋) M. triceps brachii, 주근 M. anconeus, 이두완근(二頭腕筋) M. biceps brachii, 상완근(上腕筋) M. brachialis, 조훼완근(鳥喙腕筋) M. coracobrachialis, 요완신근(橈腕伸筋) M. extensor carpi radialis, 고유제삼지신근(固有第三指伸筋) M. extensor digiti tertii proprius, 총지신근(總指伸筋) M. extensor digitorum cemmunis 고유제사지신근(固有第四指伸筋) M. extensor digiti quartii proprius, 척완신근(尺腕伸筋) M. extensor carpi ulnaris, 장모지외전근(長母指外轉筋) M. abductor pollicis longus, 척완굴근(尺腕屈筋) M. flexor carpi ulnaris, 요완굴근(橈腕屈筋) M. flexor carpi radialis, 원회내근(圓回內筋) M. pronator teres, 천지굴근(淺指屈筋) M. flexor digitorum suprficialis, 탐지굴근(探指屈筋) M. flexor digitorum profundus, 골간근(骨間筋) M. interosseus medius. 2. 천흉근(淺胸筋)과 심흉근(深胸筋)은 각각 전부(前部)와 후부(後部)로 명확히 분리(分離)되어있으며 특히 심흉근(深胸筋)의 전부(前部)와 후부(後部)는 서로 떨어져서 기시(起始)를 하고있어 그 사이에는 흉골(胸骨)이 노출되어 있었다. 3. 쇄골하근(鎖骨下筋)은 전예(全例)에서 관찰할 수 있었다. 4. 조탁흉근(鳥啄胸筋)은 소나 양에 비하여 매우 발달하였으며 특히 3예(例)에서는 더욱 발달하여 3개의 부분(部分)으로 되어있어 상완골 내측면 거의 전체를 덮고 있었다. 5. 주근, 소원근(小圓筋) 등 소동물(小動物)에서는 작은 근(筋)들이 매우 발달하였으나 장모지외전근(長母指外轉筋)은 엷고 작았다. 6. 반추류(反芻類)에서 가끔 볼 수 있는 M. extensor pollicis는 관찰할 수 없었다.