• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.244-252
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• 2020

Purpose: Total femoral replacement (TFR) is an extreme form of limb salvage. Considering the rarity of this procedure, reports have focused on the complications and a proper indication is unclear. This study analyzed 36 patients with TFR who were asked the following: 1) prognostic factors related to survival in patients who underwent TFR with a tumoral cause; 2) overall implant and limb survival; 3) complications, functional outcome, and limb status for patients surviving for more than 3 years. Materials and Methods: According to the causes for TFR, 36 patients were categorized into three groups: extensive primary tumoral involvement (group 1, 15 cases), tumoral contamination by an inadvertent procedure or local recurrence (group 2, 16 cases), and salvage of a failed reconstruction (group 3, 5 cases). The factors that may affect the survival of patients included age, sex, cause of TFR, and tumor volume change after chemotherapy. Results: The overall five-year survival of the 36 patients was 31.5%±16.2%. The five-year survival of 31 patients with tumoral causes was 21.1%±15.6%. The five-year survival of 50.0%±31.0% in patients with a decreased tumor volume after chemotherapy was higher than that of increased tumor volume (p=0.02). The five-year survival of 12 cases with a wide margin was 41.7%±27.9%, whereas that of the marginal margin was 0.0%±0.0% (p=0.03). The ten-year overall implant survival of 36 patients was 85.9%±14.1%. The five-year revision-free survival was 16.6%±18.2%. At the final follow-up, 12 maintained tumor prosthesis, three underwent amputation (rotationplasty, 2; above knee amputation, 1), and the remaining one had knee fusion. Among 16 patients with a follow-up of more than three years, 14 patients underwent surgical intervention and two patients had conservative management. Complications included infection in 10 cases, local recurrences in two cases, and one case each of hip dislocation, bushing fracture, and femoral artery occlusion. Conclusion: Patients showing an increased tumor volume after chemotherapy and having an inadequate surgical margin showed a high chance of early death. In the long-term follow-up, TFR showed a high infection rate and the functional outcome was unsatisfactory. Nevertheless, this procedure is an inevitable option of limb preservation in selected patients.

• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.110-119
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• 2019

Proximal humerus fracture can be defined as a fracture that occurs in the surgical neck or proximal part of the humerus. Despite the appropriate treatment, however, various complications and sequelae can occur, and the treatment is quite difficult often requiring surgical treatment, such as a shoulder replacement. The classification of sequelae after a proximal humerus fracture is most commonly used by Boileau and can be divided into two categories and four types. Category I is an intracapsular impacted fracture that is not accompanied by important distortions between the tuberosities and humeral head. An anatomic prosthesis can be used without greater tuberosity osteotomy. In category I, there are type 1 with cephalic collapse or necrosis with minimal tuberosity malunion and type 2 related to locked dislocation or fracture-dislocation. Category II is an extracapsular dis-impacted fracture with gross distortion between the tuberosities and the humeral head. To perform an anatomic prosthesis, a tuberosity osteotomy should be performed. In category II, there are type 3 with nonunion of the surgical neck and type 4 with severe tuberosity malunion. In type 1, non-constrained arthroplasty (NCA) without a tuberosity osteotomy should be considered as a treatment. On the other hand, reverse shoulder arthroplasty (RSA) should be considered if types 1C or 1D accompanied by valgus or varus deformity or severe fatty degeneration of the rotator cuff. In general, the results are satisfactory when NCA is performed in type 2 sequelae. On the other hand, RSA can be considered as an option when there is no bony defect of the glenoid and a defect of the rotator cuff is accompanied. In type 3, it would be effective to perform internal fixation with a bone wedge graft rather than shoulder replacement arthroplasty. Recent reports on the results of RSA are also increasing. On the other hand, recent reports suggest that good results are obtained with RSA in type 3. In type 4, RSA should be considered as a first option.

• 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 Dental Rehabilitation and Applied Science
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• v.25 no.2
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• pp.139-155
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• 2009

Objective : To assess the biological stability of immediate transmucosal placement of tapered implants into tooth extraction sockets. Material and methods : Following tooth extraction, tapered implants were immediately placed into the sockets. Teeth with evidence of acute periapical pathology were excluded. After implant placement, sutured allowing a non-submerged, transmucosal healing. Standardized radiographs were obtained every visiting from baseline to 32 weeks after implant placment. Changes in depth of the distance from the implant shoulder (IS) and from the alveolar crest (AC) to the bottom of the defect (BD) were assessed. Results : Thirteen patients (10 males and 3 females) were enrolled and followed. They contributed with 15 tapered implants. extraction iste displayed sufficient residual bone volume to allow primary stability of all implants. The mean surgery time was $41{\pm}10.0$ mins. All implants healed uneventfully yielding a survival rate of 100%. Mean ISQ values were relatively stable. Interproximal crestal bone decreased $1.69{\pm}1.2mm$ (mesial), $1.65{\pm}1.2mm$ (distal) from baseline to 32-week follow-up. No statistically significant changes with respect to FMPS, FMBS, PPD and width of KG were observed. Conclusions: Immediate transmucosal implant placement represented a predictable treatment option for the replacement of teeth lost due to reasons including fractures, endodontic failures and caries.

• The korean journal of orthodontics
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• v.41 no.3
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• pp.164-173
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• 2011

Objective: The purpose of this study was to perform gender-wise analysis of the related cephalometric factors affecting Korean patients with obstructive sleep apnea (OSA). Methods: We examined 118 adults who had visited the Sleep Disorder Clinic Center in Keimyung university, Daegu, Korea, and evaluated them by using poly-somnography (PSG) and lateral cephalograms. The patients were divided into 4 groups (male simple snorers, male OSA patients, female simple snorers, and female OSA patients) according to AHI (apnea-hypopnea index) and sex. Results: The position of the hyoid bone in the female OSA group was inferior to that in the female simple snorer group. Multiple regression analysis showed that tongue length and soft palate width were significant determinants for the severity of AHI in male OSA patients. However, inferior position of the hyoid was a significant determinant only in women. Conclusions: From a cephalometric point of view, OSA in male and female adult patients may be characterized by different pathogeneses. In particular, in female OSA patients, they might be managed by individualized treatments such as hormone replacement therapy in addition to conventional treatment.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.3
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• pp.270-275
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• 2011

Fibrous dysplasia is a developmental tumor-like condition that is characterized by replacement of normal bone by an excessive proliferation of cellular fibrous connective tissue intermixed with irregular bony trabeculae. Craniofacial lesions may cause facial pain, headache, cranial asymmetry, facial deformity, tooth displacement and visual or auditory impairment. In this case, a 2-year-9-month old boy who was diagnosed as the fibrous dysplasia showed delayed eruption on affected area. Teeth of left lateral dentition group have erupted completely but teeth of right lateral dentition group are erupting slowly. Eruption and maturation of affected teeth are in progress, so continuous observation is required presently. If the eruption state stops, surgical opening or forced eruption of the impacted teeth will be considered.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.4
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• pp.591-596
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• 2009

In the case of the impacted teeth, the clinician has to consider development of tooth, site of impaction, eruption path, and cooperation of patient. Treatment options for the management of impacted teeth are separated into four categories: observation, intervention, orthodontic or surgical relocation and extraction. Autotransplantation may be defined as the transplantation of embedded, impacted or erupted teeth, from one site to another in the same individual into extraction site or surgically prepared sockets. Autotransplantation ensures preservation of natural tooth, induction of alveolar bone growth and root development, offers one of the fastest and most economically feasible means in the replacement of young patients' missing teeth. This case presents a malpositioned impacted mandibular premolar of an 11-year-old girl. It was thought that orthodontic traction was difficult because of its unfavorable impacted position. Therefore the tooth was treated by autotransplantation, we can observe good healing pattern during 12 months.

• Archives of Reconstructive Microsurgery
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• v.3 no.1
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• pp.32-39
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• 1994

One hundred and sixty patients had reconstructive surgery of the lower extremity with the microsurgical technique at the department of orthopaedic surgery, Yonsei University College of Medicine from 1982 to 1989. There were ninty-six cases of men and sixty-four cases of women, in which the mean age was 23.8 years. These patients were followed for 21.4 months. The causes were 114 cases from traffic accidents, 18 cases from tumors, 12 cases from machinery injuries, 5 cases from burns, 2 cases from explosive injuries, and 9 cases from other reasons. There were 55 cases of scapular flap, 35 cases of groin flap, 23 cases of free vascularized osteocutaneous flap, 18 cases of parascapular flap, 9 cases of combined scapular and latissimus dorsi flaps, and 8 cases of segmental resection and rotationplasty. Success in reconstructive surgery with the microsurgical technique was achieved in one hundred and thirty four cases, and function and cosmetic results were excellent. Free vascularized flap with development of the microsurgical technique has taken an important role in reconstruction of large extremity defects where skin graft and distant flap were not applicable. Reconstruction of the lower extremity with the microsurgical technique is indicated with free vascularized osteocutaneous flap when there is a large defect of bone, a need for injured nerve replacement, and in the case of needed multiple staged operations. In these instences, this technique is regarded as simple one-staged reconstructive surgery.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.1
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• pp.66-72
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• 2012

Autogenous tooth transplantation can be defined as the surgical movement of a tooth from one position in the mouth to another in the same individual. The most common reasons for tooth transplantation include replacement of a missing first molar, transplantation of impacted canines to their normal positions in the arch, and transplantation of premolars in areas of missing teeth, especially in the anterior area of the mouth. The key to successful tooth transplantation is proper selection of graft with adequate root development as well as the design of surgical operation. Root development stage with half to three-quarter-developed roots increase the success rate of autotransplantation. We report the cases of successful autotransplantation which resulted in ideal healing of periodontal ligament, gingiva and alveolar bone. All transplanted teeth presented immature root formation at the moment of the procedure. After surgical procedure, we can observe good healing pattern without endodontic problem.

• Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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• 2015.10a
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• pp.582-585
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• 2015

In the aging society, TKRA is steadily increased because of joint diseases. Artificial joint used in TKRA generates metal artifacts in the MRI. Metal artifact may affect diagnosis. In study, We are going to minimize the effect of metal artifact to improve the value of diagnosis by changing the sequence and the type of artificial joint(Co-Cr, Ni-Ti). 1.5T AVANTO, plastic containers and each of the artificial joint (Normal, Co-Cr, NiTi) were used. After the artificial joints fixed in a paper cup was inserted in a plastic container of cylindrical, Signal intensity was measured. To obtain strong and uniform signal intensity, the plastic container was filled with water. We changed Sequences(T1 TSE, T2 TSE, PD TSE) and obtained an Axial image. After excepting the maximum and minimum values, We calculated the average of SNR, CNR and PSNR. Consequently, The SNR, CNR value of PD TSE are measured higher than these of T1 TSE, T2 TSE and The PSNR of Co-Cr is higher than this of Ni-Ti. The SNR of Co-Cr is similar to the SNR of normal comparing this of Ni-Ti. As a result, Using sequence of PD Tse and Co-Cr alloy is considered to be useful.