• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.267-269
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• 2012

Traumatic brachial plexus injuries can be devastating, causing partial to total denervation of the muscles of the upper extremities. Surgical reconstruction can restore motor and/or sensory function following nerve injuries. Direct nerve-to-nerve transfers can provide a closer nerve source to the target muscle, thereby enhancing the quality and rate of recovery. Restoration of elbow flexion is the primary goal for patients with brachial plexus injuries. A 4-year-old right-hand-dominant male sustained a fracture of the left scapula in a car accident. He was treated conservatively. After the accident, he presented with motor weakness of the left upper extremity. Shoulder abduction was grade 3 and elbow flexor was grade 0. Hand function was intact. Nerve conduction studies and an electromyogram were performed, which revealed left lateral and posterior cord brachial plexopathy with axonotmesis. He was admitted to Rehabilitation Medicine and treated. However, marked neurological dysfunction in the left upper extremity was still observed. Six months after trauma, under general anesthesia with the patient in the supine position, the brachial plexus was explored through infraclavicular and supraclavicular incisions. Each terminal branch was confirmed by electrophysiology. Avulsion of the C5 roots and absence of usable stump proximally were confirmed intraoperatively. Under a microscope, neurotization from the musculocutaneous nerve to two medial pectoral nerves was performed with nylon 8-0. Physical treatment and electrostimulation started 2 weeks postoperatively. At a 3-month postoperative visit, evidence of reinnervation of the elbow flexors was observed. At his last follow-up, 2 years following trauma, the patient had recovered Medical Research Council (MRC) grade 4+ elbow flexors. We propose that neurotization from medial pectoral nerves to musculocutaneous nerve can be used successfully to restore elbow flexion in patients with brachial plexus injuries.

• Journal of the Korean Arthroscopy Society
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• v.13 no.3
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• pp.254-258
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• 2009

Tibial eminence fracture is caused by distortion, excessive flexion and extension, varus and valgus injury of the knee joint in the form of avulsion fracture. A failure over the exact anatomical reduction of fragment can lead to instability and limitation of joint motion. Recently, a variety of arthroscopic assisted reduction and fixation technique have been used. In the tibial eminence fracture, we created an arthroscopic pull-out wire fixation technique using a cannulated screw that is easy and more convenient than in the conventional technique. So we report this technique with a review of current literatures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.50 no.3
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• pp.123-133
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• 2024

Dentoalveolar (DA) trauma, which can involve tooth, alveolar bone, and surrounding soft tissues, is a significant dentofacial emergency. In emergency settings, physicians might lack comprehensive knowledge of timely procedures, causing delays for specialist referral. This systematic review assesses the literature on isolated DA fractures, emphasizing intervention timing and splinting techniques and duration in both children and adults. This systematic review adhered to PRISMA guidelines and involved a thorough search across PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library from January 1980 to December 2022. Inclusion and exclusion criteria guided study selection, with data extraction and analysis centered on demographics, etiology, injury site, diagnostics, treatment timelines, and outcomes in pediatric (2-12 years) and adult (>12 years) populations. This review analyzed 26 studies, categorized by age into pediatrics (2-12 years) and adults (>12 years). Falls were a common etiology, primarily affecting the anterior maxilla. Immediate management involved replantation, repositioning, and splinting within 24 hours (pediatric) or 48 hours (adult). Composite resin-bonded splints were common. Endodontic treatment was done within a timeframe of 3 days to 12 weeks for children and 2-12 weeks for adults. Tailored management based on patient age, tooth development stage, time elapsed, and resource availability is essential.

• Journal of the Korean Arthroscopy Society
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• v.5 no.2
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• pp.124-130
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• 2001

Purpose : To identify occult intra-articular pathologies in the acute ankle fracture using arthroscopy and to investigate the factors to predict its possibility of occult injuries that could be occurred. Materials and Methods : This prospective study included fifty patients who got operation for the ankle fractures. Ankle arthroscopy was performed to document the type and anatomical location of occult lesion. We investigated the correlation between incidence of occult injuries and specific fracture type. Results : Of fifty ankles, 37 ankles had occult lesion. Twenty five loose bodies including displaced fragments were found and various cartilage lesions were found in 31 ankles. Tibial avulsion fragment by anterior inferior tibiofibular ligament was occurred in 6 cases. There was no correlation between the incidence of occult lesion and various factors including age, sex, injury mechanism and fracture type(p>0.05). Conclusion : The ankle arthroscopy had an effective role for the detection and treatment of occult injuries and it was difficult to predict the occurrence or associated accurately in all of th ankle fractures.

• The Journal of the Korea Contents Association
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• v.12 no.4
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• pp.380-389
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• 2012

This study aims to argue fundamental issues on factors associated with revenues of hand injury patients to effectively manage hospitals specialized in hand injuries. The study employes 2,461 patients who entered S hospital from 2008 to 2010 with hand injuries. The followings are the results of the study. First, there is significant difference among occurrence of hand injuries with regard to demographics of patients. That is, it is likely to have longer average length of stay(ALOS) of male over female, of the elderly over infants and toddlers, and vice versa on average daily patient revenues. Also, compared to patients with traffic and labor insurance, patients with health insurance is likely to stay longer at lower daily cost. Fifth, demographics and incidence of hand injuries were significantly associated with average length of stay(ALOS) and average daily patient revenues. That is, male over female, age over 60 over any other age categories, patients with traffic and labor insurances over one with health insurance, cases with laceration, avulsion and bone transplantation over any other types of hand injury patients were factors significantly related to ALOS and average daily patient revenues. In sum, it is needed to focus on education and campaign to raise attentions on preventing various hand injuries. Also, managers at hospitals specialized in hand injuries should pay attention on issues such as reducing ALOS to run the organization effectively.

• Journal of Trauma and Injury
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• v.37 no.1
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• pp.20-27
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• 2024

Purpose: Severe abdominal injuries often require immediate clinical assessment and surgical intervention to prevent life-threatening complications. In Jeju Regional Trauma Center, we have instituted a protocol for emergency department (ED) laparotomy at the trauma bay. We investigated the mortality and time taken from admission to ED laparotomy. Methods: We reviewed the data recorded in our center's trauma database between January 2020 and December 2022 and identified patients who underwent laparotomy because of abdominal trauma. Laparotomies that were performed at the trauma bay or the ED were classified as ED laparotomy, whereas those performed in the operating room (OR) were referred to as OR laparotomy. In cases that required expeditious hemostasis, ED laparotomy was performed appropriately. Results: From January 2020 to December 2022, 105 trauma patients admitted to our hospital underwent emergency laparotomy. Of these patients, six (5.7%) underwent ED laparotomy. ED laparotomy was associated with a mortality rate of 66.7% (four of six patients), which was significantly higher than that of OR laparotomy (17.1%, 18 of 99 patients, P=0.006). All the patients who received ED laparotomy also underwent damage control laparotomy. The time between admission to the first laparotomy was significantly shorter in the ED laparotomy group (28.5 minutes; interquartile range [IQR], 14-59 minutes) when compared with the OR laparotomy group (104 minutes; IQR, 88-151 minutes; P<0.001). The two patients who survived after ED laparotomy had massive mesenteric bleeding, which was successfully ligated. The other four patients, who had liver laceration, kidney rupture, spleen injury, and pancreas avulsion, succumbed to the injuries. Conclusions: Although ED laparotomy was associated with a higher mortality rate, the time between admission and ED laparotomy was markedly shorter than for OR laparotomy. Notably, major mesenteric hemorrhages were effectively controlled through ED laparotomy.

• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.1
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• pp.36-42
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• 2007

To compare the survival rate of periodontal ligament cells preserved in storage media with good availability at the time of an avulsion injury, periodontal ligament cells were incubated in ${\alpha}-MEM$ culture medium containing 10% FBS in condition of $37^{\circ}C$, 5% $CO_2$. These cells were then cultured in HBSS, ${\alpha}-MEM$, milk(S co., P. co.) and tap water at the temperature of 4, 25, $37^{\circ}C$ each in 60 min. The groups were measured by MTT assay. The results were as follows : 1. Among the storage media at $4^{\circ}C$, ${\alpha}-MEM$ and P-milk had the highest preserving ability of periodontal ligament cells, while that of HBSS S-milk and tap was low in order. 2. Among the storage media at $25^{\circ}C$, ${\alpha}-MEM$ had the highest preserving ability of periodontal ligament cells, while that of P-milk, HBSS, S-milk, tap water was low in order. 3. Among the storage media at $37^{\circ}C$, the preserving ability of periodontal ligament cells was very high in ${\alpha}-MEM$, P-milk, HBSS and S-milk, it's lowest in tap water. 4. The preserving ability of periodontal ligament cells in ${\alpha}-MEM$ was high at $4^{\circ}C$ and it's low in order of $25^{\circ}C$, $37^{\circ}C$, but in HBSS was high at $4^{\circ}C$ and it's low at $25^{\circ}C$, $37^{\circ}C$ 5. The preserving ability of periodontal ligament cells in S-milk and P-milk was high at $4^{\circ}C$, $25^{\circ}C$ and it s low at $37^{\circ}C$. In conclusion, HBSS is the storage medium of choice in an avulsion, but in this study it is preferable to choose milk at $4^{\circ}C$ for tooth since it is easy to get and affect cell viability.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.504-509
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• 2003

Although arterial grafts are widely used due to the advantage of long-term patency in coronary bypass surgery, greater saphenous vein is still an important additional conduit. It was reported that preservation of the adventitia of vein graft and the adjacent tissues may bring the improved long-term graft patency. The aim of this study is to look for a harvest technique that can reduce vein injury and wound complications. Material and Method: In thirty-four patients that vein grafts were used for coronary bypass surgery, 50 harvest sites were included for the study. In 25 harvest sites in calf below knee (group 1), vein was exposed through a long incision and then clearly dissected from the adjacent tissue. Ten endoscopic vein harvests were performed in the thighs (group 2). Fifteen other vein grafts that were bluntly dissected were harvested from the thighs through three separate incisions (group 3). Result: Vein harvest time was longest in endoscopic harvest group (44.7$\pm$9.8 minutes) and shortest in group 3 (24.2$\pm$5.9 minutes) (p＝0.000). Most avulsion injuries of vein branches happened in the endoscopic group. Sequential grafting numbers per vein were 1.72$\pm$0.98 with thigh vein graft and 1.16$\pm$0.37 with calf vein (p＝0.02). Swelling of foot and/or leg, which was the most common wound complication after vein harvest, was most commonly presented in group 1 (20/25 sites; p＝0.000). Tingling, the most common neurologic complication, was also most prevalent in group 1 (7/25 sites; p＝0.013). The risk factor of the wound complication was vein harvest from calf, and the vein harvest technique was not a risk for wound complication. Conclusion: Vein harvest technique through three separate incisions from thigh presented shorter harvest time and less vein injury and wound complication compared with the endoscopic harvest technique from thigh or the harvest through a long incision from calf.

• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.499-502
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• 2013

An eight-year-old, castrated male, Poodle dog was presented with a bite wound in the neck region. Clinical examination revealed non-ambulatory signs of tetraparesis with deep pain, and upper motor neuron changes in all limbs. Fractures of the transverse process of C1 and the dorsal spinous process of C2 were observed on the radiographs and the computed tomography (CT). Conservative therapy was performed for 1 week. However the neurological problems were not alleviated until 7 days after injury. The owners agreed to perform surgical stabilization. The surgical stabilization was performed 7 days after presentation. Ventral stabilization was performed with screws, K-wires and bone cement. The dog stood up independently after 4 weeks and was able to walk 6 weeks postoperatively. In this report we suggest that using combined stabilization techniques are effective for this type of cervical fracture in which the dorsal and ventral structures of the vertebra are severely disrupted.

• Journal of Chest Surgery
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• v.35 no.10
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• pp.730-735
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• 2002

Diaphragm is innervated by phrenic nerve and lower intercostal nerves. For patients with avulsion injury of brachial plexus, an in situ graft of phrenic nerve is frequently used to neurotize a branch of the brachial plexus. We studied short-term and mid-term changes of diaphragmatic level and movement in patients with dissection of phrenic nerve for neurotization. Material and Method : Thirteen patients with division of either-side phrenic nerve for neurotization of musculocutaneous nerve were included in this study. With endoscopic surgical procedure, the intrathoracic phrenic nerve was entirely dissected and divided just above the diaphragm. The dissected phrenic nerve was taken out through thoracic inlet and neck wound and then anastomosed to the musculocutaneous nerve through a subcutaneous tunnel. With chest films and fluoroscopy, levels and movements of diaphragm were measured before and after operation. Result : There was no specific technical difficulty or even minor postoperative complications following endoscopic division of phrenic nerve. After division of phrenic nerve, diaphragm was soon elevated about 1.7 intercostal spaces compared with the preoperative level, but it did not show paradoxical motion in fluoroscopy. More than 1.5 months later, diaphragm returned downward close to the preoperative level (average level difference was 0.9 intercostal spaces; p＝NS). Movement of diaphragm was not significantly decreased compared with the preoperative one. Conclusion : After division of phrenic nerve, the affected diaphragm did not show a significant decrease in movement, and the elevated diaphragm returned downward with time. However, the decreased lung volumes in the last spirometry suggest the decreased inspiratory force following partial paralysis of diaphragm.