• Title/Summary/Keyword: Buttress

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One-Stage Treatment of Chronic Calcaneal Osteomyelitis with Bone Morphogenetic Protein 2 and Local Antibiotic Delivery in a Cat

  • Kim, Hyungkyoo;Jeong, Heejun;Park, Chul;So, Kyung-Min;Park, Jiyoung;Jeong, Seong Mok;Lee, Haebeom
    • Journal of Veterinary Clinics
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    • v.33 no.5
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    • pp.300-303
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    • 2016
  • An age-unknown, 4.8 kg, male, wild, domestic short-hair cat was presented for left hindlimb lameness. A physical examination revealed a draining tract which was suspected of bite on left calcaneal bone. The left tarsal joint was markedly swollen and exudates were observed around the draining tract. Sequestrum at left calcaneus bone, and osteolysis were identified by radiography. The sequestrum and its surrounding exudative tissue were debrided during surgery and the tissue was submitted for bacterial culture and sensitivity test. The debridement caused a bone defect ($1.5cm{\times}0.5cm{\times}0.5cm$) on the medial left calcaneal bone. Plate and screw fixation was performed to the calcaneus bone as buttress plate. Recombinant human bone morphogenetic protein-2 (rhBMP-2) loaded hydroxyapatite was implanted in the bone defect. Furthermore, Amikacin-impregnated collagen sponges were also placed around bone plate to deliver local antibiotics. A systemic antibiotic treatment regimen based on bacterial culture and sensitivity test results was administered for 4 weeks. The wound properly healed without any signs of infection, and the bone healing was confirmed by radiography. The patient showed normal weight bearing ambulation at 18 weeks after surgery. The use of rhBMP-2 and local antibiotic delivery system is a good surgical option for the one-stage treatment of chronic osteomyelitis.

Orbital wall restoring surgery with resorbable mesh plate

  • Joo, Jae Doo;Kang, Dong Hee;Kim, Hyon Surk
    • Archives of Craniofacial Surgery
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    • v.19 no.4
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    • pp.264-269
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    • 2018
  • Background: Orbital resorbable mesh plates are adequate to use for isolated floor and medial wall fractures with an intact bony buttress, but are not recommended to use for large orbital wall fractures that need load bearing support. The author previously reported an orbital wall restoring surgery that restored the orbital floor to its prior position through the transnasal approach and maintained temporary extraorbital support with a balloon in the maxillary sinus. Extraorbital support could reduce the load applied on the orbital implants in orbital wall restoring surgery and the use of resorbable implants was considered appropriate for the author's orbital wall restoring technique. Methods: A retrospective review was conducted of 31 patients with pure unilateral orbital floor fractures between May 2014 and May 2018. The patients underwent transnasal restoration of the orbital floor through insertion of a resorbable mesh plate and maintenance of temporary balloon support. The surgical results were evaluated by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values. Results: The OVR decreased significantly, by an average of 6.01% (p<0.05) and the preoperative and postoperative Hertel scale measurements decreased by an average of 0.34 mm with statistical significance (p<0.05). No complications such as buckling or sagging of the implant occurred among the 31 patients. Conclusion: The use of resorbable mesh plate in orbital floor restoration surgery is an effective and safe technique that can reduce implant deformation or complications deriving from the residual permanent implant.

Stress dissipation characteristics of four implant thread designs evaluated by 3D finite element modeling (4종 임플란트 나사산 디자인의 응력분산 특성에 대한 3차원 유한요소해석 연구)

  • Nam, Ok-Hyun;Yu, Won-Jae;Kyung, Hee-Moon
    • The Journal of Korean Academy of Prosthodontics
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    • v.53 no.2
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    • pp.120-127
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    • 2015
  • Purpose: The aim was to investigate the effect of implant thread designs on the stress dissipation of the implant. Materials and methods: The threads evaluated in this study included the V-shaped, buttress, reverse buttress, and square-shaped threads, which were of the same size (depth). Building four different implant/bone complexes each consisting of an implant with one of the 4 different threads on its cylindrical body ($4.1mm{\times}10mm$), a force of 100 N was applied onto the top of implant abutment at $30^{\circ}$ with the implant axis. In order to simulate different osseointegration stages at the implant/bone interfaces, a nonlinear contact condition was used to simulate immature osseointegration and a bonding condition for mature osseointegration states. Results: Stress distribution pattern around the implant differed depending on the osseointegration states. Stress levels as well as the differences in the stress between the analysis models (with different threads) were higher in the case of the immature osseointegration state. Both the stress levels and the differences between analysis models became lower at the completely osseointegrated state. Stress dissipation characteristics of the V-shape thread was in the middle of the four threads in both the immature and mature states of osseointegration. These results indicated that implant thread design may have biomechanical impact on the implant bed bone until the osseointegration process has been finished. Conclusion: The stress dissipation characteristics of V-shape thread was in the middle of the four threads in both the immature and mature states of osseointegration.

Effect of thread design on the marginal bone stresses around dental implant (임플란트 나사산 디자인이 변연골 응력에 미치는 영향)

  • Lee, Sang-Hyun;Jo, Kwang-Heon;Lee, Kyu-Bok
    • The Journal of Korean Academy of Prosthodontics
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    • v.49 no.4
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    • pp.316-323
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    • 2011
  • Purpose: The purpose of this study was to investigate the effect of different thread designs on the marginal bone stresses around dental implant. Materials and methods: Standard ITI implant(ITI Dental Implant System; Straumann AG, Waldenburg, Switzerland), 4.1 mm in diameter and 10 mm in length, was selected as control. Test implants of four different thread patterns were created based on control implant, i.e. maintaining all geometrical design of control implant except thread pattern. Four thread designs used in test implants include (1) small V-shape screw (model A), (2) large V-shape screw (model B), (3) buttress screw (model C), and (4) trapezoid screw (model D). Surface area for unit length of implant was 14.4 $mm^2$ (control), 21.7 (small V-shape screw), 20.6 (large V-shape screw), 17.0 (buttress screw) and 28.7 $mm^2$ (trapezoid screw). Finite element models of implant/bone complex were created using an axisymmetric scheme with the use of NISA II/DISPLAY III (Engineering Mechanics Research Corporation, Troy, MI, USA). A load of 100 N applied to the central node on the crown top either in parallel direction or at 30 degree to the implant axis (in order to apply non-axial load to the implant NKTP type 34 element was employed). Quantification and comparison of the peak stress in the marginal bone of each implant model was made using a series of regression analyses based on the stress data calculated at the 5 reference points which were set at 0.2, 0.4, 0.6, 0.8 and 1.0 mm from implant wall on the marginal bone surface. Results: Results showed that although severe stress concentration on the marginal bone cannot be avoided a substantial reduction in the peak stress is achievable using different thread design. The peak marginal bone stresses under vertical loading condition were 7.84, 6.45, 5.96, 6.85, 5.39 MPa for control and model A, B, C and D, respectively. And 29.18, 26.45, 25.12, 27.37, 23.58 MPa when subject to inclined loading. Conclusion: It was concluded that the thread design is an important influential factor to the marginal bone stresses.

Seismic Performance of Precast Infill Walls with Strain-Hardening Cementitious Composites (변형경화형 시멘트 복합체를 사용한 프리캐스트 끼움벽의 내진성능)

  • Kim, Sun-Woo;Yun, Hyun-Do;Jang, Gwang-Soo;Yun, Yeo-Jin
    • Journal of the Korea Concrete Institute
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    • v.21 no.3
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    • pp.327-335
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    • 2009
  • In the seismic region, non-ductile structures often form soft story and exhibit brittle collapse. However, structure demolition and new structure construction strategies have serious problems, as construction waste, environmental pollution and popular complain. And these methods can be uneconomical. Therefore, to satisfy seismic performance, so many seismic retrofit methods have been investigated. There are some retrofit methods as infill walls, steel brace, continuous walls, buttress, wing walls, jacketing of column or beam. Among them, the infilled frames exhibit complex behavior as follows: flexible frames experiment large deflection and rotations at the joints, and infilled shear walls fail mainly in shear at relatively small displacements. Therefore, the combined action of the composite system differs significantly from that of the frame or wall alone. Purpose of research is evaluation on the seismic performance of infill walls, and improvement concept of this paper is use of SHCCs (strain-hardening cementitious composites) to absorb damage energy effectively. The experimental investigation consisted of cyclic loading tests on 1/3-scale models of infill walls. The experimental results, as expected, show that the multiple crack pattern, strength, and energy dissipation capacity are superior for SHCC infill wall due to bridging of fibers and stress redistribution in cement matrix.

Treatment of Distal Clavicular Fracture by Reconstruction Plate and Wire Fixation (쇄골 원위부 골절에 대한 재건 금속판과 강선 고정술을 이용한 치료)

  • Suh, Mu-Sam;Kim, Sang-Hyo;Park, Hyeong-Taek
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.5 no.1
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    • pp.58-62
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    • 2006
  • Purpose: To evaluate the result of operative treatment with plate and wire fixation for fractures of the distal clavicle. Materials and Methods: We assessed 9 cases of fractures of the distal clavicle that were treated by plate and wire fixation from March 2001 to July 2003 and followed up over 1year. We used the reconstruction plate as a buttress and performed cerclage wiring to fix comminuted fracture site. The functional result of shoulder was evaluated by the scoring system of Rowe. Results: The average periods of bony union was 9 weeks in all cases. According to Rowe scoring system, the functional result was exellent in 7 cases and good in 2 cases. There was no LOM of shoulder and traumatic arthritis in AC joint. But there was skin irritation in 1 case. Conclusion : The operative method by reconstruction plate and wire fixation for distal clavicular fracture was useful when there were comminuted fracture. This method seems to be simple and satisfactory in terms of improvement of range of motion of shoulder, restoration of function and rare complication.

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Stress Analysis on the Splinted Conditions of the Two Implant Crowns with the Different Vertical Bone Level (치조골 높이가 다른 2개 임플란트 금관의 고정연결 조건에 따른 응력분석)

  • Jeon, Chang-Sik;Jeong, Sin-Young;Kang, Dong-Wan
    • Journal of Dental Rehabilitation and Applied Science
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    • v.21 no.2
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    • pp.169-182
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    • 2005
  • The purpose of this study was to compare the stress distribution around the surrounding bone according to the splinted and non-splinted conditions on the finite element models of the two implant crowns with the different vertical bone level. The finite element model was designed with the parallel placement of the two fixtures ($4.0mm{\times}11.5mm$) with reverse buttress thread on the mandibular 1st and 2nd molars. As the bone quality, the inner cancellous bone and the outer 2 mm cortical bone were designed, and the cortical and cancellous bone were assumed to be perfectly bonded to the implant fixture. The splinted model(Model 1) had 2 mm contact surface and the non-splinted model(Model 2) had $8{\mu}m$ gap between two implant crowns. Two group (Splinted and non-splinted) was loaded with 200 N magnitude in the vertical and oblique directions on the loading point position on the central position of the crown, the 2 mm and 4 mm buccal offset point from the central position. Von Mises stress value was recorded and compared in the fixture-bone interface in the bucco-lingual and mesio-distal sections. The results were as follows; 1. In the vertical loading condition of central position, the stress was distributed on the cortical bone and the cancellous bone around the thread of the fixture in the splinted and non-splinted models. In the oblique loading condition, the stress was concentrated toward the cortical bone of the fixture neck, and the neck portion of 2nd molar in the non-splinted model was concentrated higher than that of 1st molar compared to the splinted model. 2. In the 2 mm buccal offset position of the vertical loading compared to the central vertical loading, stress pattern was shifted from apical third portion of the fixture to upper third portion of that. In the oblique loading condition, the stress was distributed over the fixture-bone interface. 3. In the 4 mm buccal offset position of the vertical loading, stress pattern was concentrated on the cortical bone around the buccal side of the fixture thread and shifted from apical third portion of the fixture to upper third portion of that in the splinted and non-splinted models. In the oblique loading, stresses pattern was distributed to the outer position of the neck portion of the fixture thread on the mesio-distal section in the splinted and non-splinted models. Above the results, it was concluded that the direction of loading condition was a key factor to effect the pattern and magnitude of stress over the surrounding bone of the fixture under the vertical and oblique loading conditions, although the type with or without proximal contact did not effect to the stress distribution.

Clinical Experiences of Facial Asymmetries in Zygomaticomaxillary Complex Bone Fracture Patients (관골상악골 복합체 골절 환자에서의 안면 비대칭에 대한 임상경험)

  • Kang, Nak-Heon;Choi, Sang-Mun;Kim, Joo-Hak;Song, Seung-Han;Oh, Sang-Ha
    • Archives of Plastic Surgery
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    • v.38 no.2
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    • pp.161-165
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    • 2011
  • Purpose: Zygomaticomaxillary complex (ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum. Methods: 369 patients, treated for fractures of the ZMC were included in the study. After the operation, such as open reduction and internal fixation (ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3-dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re-evaluated. Gross photographs were obtained at outpatient clinic. Results: Total of 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch (n=2), lateral displaced comminuted fracture of arch (n=6), comminuted arch fracture combined posterior root fracture (n=9), and communited arch and body fracture (n=12), severely contused soft tissue (n=9). After the manipulations outcomes were acceptable. Conclusion: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.

Characteristic Analysis of Dredging and Sedimentation Debris Control Facilities in Inje, Gangwon (강원 인제지역 토석류 사방시설의 준설 및 퇴적 특성)

  • Park, Byungsoo;Jun, Sanghyun;Um, Jaekyung;Cho, Kwangjun;Yoo, Namjae
    • Journal of the Korean GEO-environmental Society
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    • v.14 no.1
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    • pp.15-22
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    • 2013
  • 5 each permeable and impermeable debris dams were selected to analyze the characteristics of dredging and sedimentation according to facility type in Inje, Gangwon. Field tests for the ground water table and sedimentation characteristics of the selected dams were performed. Furthermore, data of the dredging amount, storage capacity, and drainage area were analyzed for the 51 more debris control facilities. From the results of field tests, it was found that the storage capacity of impermeable debris dam could be not enough when the large debris flow is produced since sediments are accumulated even if large debris flow was not occurred. Drainage can be a problem since the ground water table of impermeable debris dam was reached to the surface of ground. However, it was found that the ground saturation should not occur at heavy rain since ground water table of permeable debris dam was located in lower part of buttress. Furthermore, from the analysis results of relation among the dredging amount, basin area, and capacity of debris control facility, it was found that size of debris control facility was not reflected by the basin area. Effective planning and construction should be accomplished for the future since the real sedimentation amount was not significant even though large debris dams were constructed.

Finite Element Stress Analysis of Bone Tissue According to the Implant Connection Type (2종의 임플란트 내부결합구조체에 따른 치조골상 유한요소응력 분석)

  • Byun, Ook;Jung, Da-Un;Han, In-Hae;Kim, Seong-Ryang;Lee, Chang-Hee
    • Journal of Dental Rehabilitation and Applied Science
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    • v.29 no.3
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    • pp.259-271
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    • 2013
  • The purpose of this study was to make the stress distribution produced by simulated different load under two types of internal connection implant system (stepped and tapered type) by means of 3D finite element analysis, The finite element model was designed with the parallel placement of the one fixtures ($4.0mm{\times}11.5mm$) with reverse buttress thread on the mandibular 1st molar. Two models were loaded with 200 N magnitude in the vertical direction on the central position of the crown, the 1.5 mm and 3 mm buccal offset point from the central position of the fixture. The oblique load was applied at the angle of $30^{\circ}$ on the crown surface. Von Mises stress value was recorded and compared in the fixture-bone interface in the bucco-lingual dimension. The results were as follows; 1. The loading conditions of two internal connection implant systems (stepped and tapered type) were the main factor affecting the equivalent bone strain, followed by the type of internal connections. 2. The stepped model had more mechanical stability with the reduced max. stress compared to $11^{\circ}$ tapered models under the distributed oblique loading. 3. The more the contact of implant-abutment interface to the inner wall of implant fixture, the less stress concentration was reduced.