• 한국임상수의학회지
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• 제29권5호
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• pp.412-415
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• 2012

1년령의 중성화된 수컷 요크셔테리어와 7년령의 암컷 푸들이 골절의 지연유합으로 내원하였다. 요크셔테리어의 경우 오른쪽 요골과 척골의 원위부가 골절되었고, 푸들의 경우 왼쪽 경골과 비골의 원위부가 골절되었다. 두 환자에서 신체검사 및 방사선검사를 통해 골절의 유합이 지연되고 있음을 확인하였다. 골절부는 금속판 및 나사못으로 고정시키고 자가해면질골을 골절 틈새에 이식하였다. 또한 빠른 골유합을 위해 $20{\mu}g$의 rh-BMP 2 가 포함된 matrigel을 골절부에 주입하였다. 수술 후 방사선검사를 통해 골절부의 치유 상태를 확인하였다. 장기간의 방사선검사에서 두 마리 모두 빠른 골유합을 보였다. 첫 증례에서는 방사선사진상에서 2주째에 요골과 척골 골절 틈새에 골밀도가 증가하였다. 20주째에는 골절선이 더 이상 관찰되지 않았으며, 정상 외관을 회복하였다. 두 번째 증례에서는 방사선사진상에서 11주째에 골절 치유가 진행되고 있음이 확인되었다. 이 두 증례 모두 예상한 것보다 골절의 치유가 빠르게 일어났다. 따라서 rh-BMP 2와 matrigel은 지연유합된 골절의 치유를 촉진하는데 효과가 있다고 생각된다.

• Archives of Reconstructive Microsurgery
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• 제16권2호
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• pp.125-132
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• 2007

Introduction: Ulna is nearly equal to radius in function and bony architecture and strength in forearm. But in lower extremity, fibula is 1/5 of tibia in anatomic and functional point so we can find fibula transposition is commonly used in defect of tibia. We cannot find other article about segmental forearm bone transposition in man. The purpose of this study was to report our clinical and functional result of undergoing segmented transposition of ipsilateral ulna with its own vascular supply in defect of radius in 6 cases. Material and method: From June 1994 to October 2007, 7 segmented bone transpositional grafts in forearm were performed in Kyung Hee Medical Center. The distribution of age was from 20 years old to 73 years old. There was male in 6 cases and female in 1 case. The causes of operation were giant cell tumor in 1 case and traumatic origin in 6 cases; it was nonunion in 2 cases and fracture with severe comminution in 4 cases. Ipsilaterally segmented ulna keeping its own vascular supply was transported to defect of radius in severe traumatic patients and one patient whose tumor in radius had been excised. Transported ulna was fixed to proximal and distal radius remnants by plate and screw. In one case with giant cell tumor, transported ulna was connected to radius across wrist joint as wrist joint fusion. Joint preserving procedures were performed in 6 cases with crushing injury of radius. Results: We could obtain solid bony union in all cases and good functional results. The disadvantage was relative shortening of forearm, but we could overcome this problem. Conclusion: We think that ipsilateral segmented ulna transposition keeping its own vascular supply to radius can be perfomed with one of procedures in cases with wide defect in radius.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.163-169
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• 2013

Purpose: This study was conducted to confirm the anatomic conformity of the new periarticular locking plates designed by Zimmer on Korean adult bones and to identify the structures at risk during the application of these implants. Methods: The study was performed on the humerus, radius, and tibia of 10 adult cadavers(6 males and 4 females) procured from the cadaveric lab of our hospital. Anteroposterior (AP) and lateral X-rays were taken to confirm that the cadavers were free of any unusual lesions or anatomic variations. We used the 3.5-mm proximal humerus plate, 2.7-mm distal radius plate, 3.5- and 5.0-mm proximal tibia plates, and 3.5-mm distal tibia plate developed by Zimmer, Inc. (Zimmer periarticular locking plate). The longest plate from each group was used to confirm anatomical conformity. Standard approaches were used for each area, and soft tissue was retracted in order to pass the plate beneath the muscle. The position of the plate was confirmed using standard AP and lateral view X-rays. After this procedure had been completed, the region was dissected along the length of the implant to determine the conformity of the implant to bone and the penetrations of screws into the articular surface or violations of any vital structures, such as nerves, blood vessels, or tendons. Results: Excellent anatomical conformity was observed with Zimmer periarticular locking plates for Korean adults. The tibial nerve and the posterior tibial artery were found to be structures at risk when applying a distal tibial plate. Conclusion: Additional posterolateral fixation is recommended when dealing with cases of tibial plateau fracture when the fracture line extends to the posterolateral cortex. We recommend taking proper views using 10~15 degrees of internal rotation to ensure correct screw length and, thus, avoid penetration of vital structures and tendons.

• 대한근관절건강학회:학술대회논문집
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• 대한근관절건강학회 1996년도 제4회 춘계학술대회
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• pp.110-121
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• 1996

It is well defined that osteoporosis is an age related disorder and associated with decreased bone mass. It is one of the most important disease lacing the aging population because of its association with fracture of the hip, vertebrae and distal radius. The disease provoke a significant economic burden and major public health problem of an elderly. The life-time risk of hip fracture in white women is approximately 15% which is equal to the combined risk of breast, uterine, and ovarian cancer. Despite its deleterious effect on women's health, knowledge of the epidemiology of osteoporosis in Korea is only beginning. 1970 in Korea has non as the crossover period between the chronic and an Infectious diseases. As the result, the infant mortality declined and an elderly population in Korea increased significantly in the past decade, The average life expectancy of women in Korea is now about 75 years. Thus, the majority of Korean women will spend approximately one-third of their life in the postmenopause state. Therefore, better understanding of bone metabolism and fracture incidence in Korean population is a great interest for the medical community as well as for public health. Currently, no population based epidemiologic data are available to support the incidence of osteoporotic fractures in Korea. However, available data suggest that significant declining of bone mineral density (BMD [g/$cm^2$]) has been occurring in Korean women after menopause. In same population, peak BMD was observed around 33-39 years of age and continue to decline thereafter. An accelerated bone losses occur after the menopause and the average loss is approximately 13% within 15 years from the menopause. The incidence of fracture was highly correlated with an age and bone mineral density. The mean age of menopause in Korean women was 47 years and this age appears to getting younger when analyzed by the birth cohort. An earlier menopausal age and increase life expectancy place Korean women at increase risk for osteoporosis and bone fracture. Korean or Asian women are no longer protected from the risk of bone fracture. Therefore, an early prevention or intervention schemes are essential before the outbreak of osteoporosis and/or fracture occurs in Korean or Asian women.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.41-49
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• 2015

Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.

• Advances in biomechanics and applications
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• 제1권3호
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• pp.143-158
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• 2014

Forearm fractures in children are very common among all pediatric fractures. However, biomechanical investigations on the pediatric forearm are rather scarce, partially due to the complex anatomy, closely situated, interrelated structures, highly dynamic movement patterns, and lack of appropriate tools. The purpose of this study is to develop a computational tool for child forearm investigation and characterize the mechanical responses of a backward fall using the computational model. A three-dimensional 10-year-old child forearm finite element (FE) model, which includes the ulna, radius, carpal bones, metacarpals, phalanges, cartilages and ligaments, was developed. The high-quality hexahedral FE meshes were created using a multi-block approach to ensure computational accuracy. The material properties of the FE model were obtained by scaling reported adult experimental data. The design of computational experiments was performed to investigate material sensitivity and the effects of relevant parameters in backward fall. Numerical results provided a spectrum of child forearm responses with various effective masses and forearm angles. In addition, a conceptual L-shape wrist guard design was simulated and found to be able to reduce child distal radius fracture.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권2호
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• pp.115-117
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• 2018

Lingual nerve injury is a rare complication of general anesthesia. The causes of lingual nerve injury following general anesthesia are multifactorial; possible mechanisms may include difficult laryngoscopy, prolonged anterior mandibular displacement, improper placement of the oropharyngeal airway, macroglossia and tongue compression. In this report, we have described a case of bilateral lingual nerve injury that was associated with orotracheal intubation for open reduction and internal fixation of the left distal radius fracture in a 61-year-old woman. In this case, early treatment with dexamethasone effectively aided the recovery of the injured lingual nerve.

• Clinics in Shoulder and Elbow
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• 제17권1호
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• pp.25-30
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• 2014

Background: Normal elbow joint kinematics has been widely studied in cadaver, whilst in vivo study, especially of the forearm, is rare. Our study analyses, in vivo, the kinematics of normal forearm and of malunited forearm using a three-dimensional computerized simulation system. Methods: We examined 8 patients with malunited Monteggia fracture and 4 controls with normal elbow joint. The ulna and radius were reconstructed from CT data placing the forearm in three different positions; full pronation, neutral, and full supination using computer bone models. We analyzed the axis of rotation 3-dimentionally based on the axes during forearm rotation from full pronation to full supination. Results: Axis of rotation of normal forearm was pitch line, with a mean range of 2 mm, from full pronation to full supination, connecting the radial head center proximally and ulnar fovea distally. In normal forearm, the mean range was 1.32 mm at the proximal radioulnar joint and 1.51 mm at the distal radioulnar joint. However in Monteggia fracture patients, this range changed to 7.65 mm at proximal and 4.99 mm at distal radoulnar joint. Conclusions: During forearm rotation, the axis of rotation was constant in normal elbow joint but unstable in malunited Monteggia fracture patients as seen with radial head instability. Therefore, consideration should be given not only to correcting deformity but also to restoring AOR by 3D kinematics analysis before surgical treatment of such fractures.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.3-10
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• 2024

Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.

• 대한방사선기술학회지:방사선기술과학
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• 제22권2호
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• pp.41-46
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• 1999

Osteoporosis, which causes mainly fracture of the spine, proximal femur and distal radius by minimal trauma, is a major public health problem and its prevalence is steadily increasing in Korea according to the development of public health care. There are reliable methods for diagnosis based on bone densitometry. Early detection and intervention are important for reducing the incidence of fractures. A consensus definition of osteoporosis, based on bone density measurement, has been developed by the World Health Organization(WHO). In this study, bone mineral density(RMD) was measured by dual energy x-ray absorptiometry(DEXA) at the proximal femur and lumbar spine in 132 post-menopausal women. The purpose of this study is to find influential factors on the BMD of the proximal femur and the lumbar spine and to analyze correlation between BMD and the problematic factors. We obtained the following results : 1. Mean BMD score, T-score and Z-score of the proximal femur were $0.81(g/cm^2)$, -2.45(S.D.) and -2.09(S.D.) respectively and in the lumbar spine were $0.83(g/cm^2)$, -2.02(S.D.), -2.43(S.D.) respectively. 2. In correlation analysis between BMD and many factors, correlation coefficients were -0.467, 0.212, -0.321 and 0.241 in age, height, duration after menopause respectively. BMI and the residuals were comparatively small. 3. Correlation coefficients to age matched BMD, in height and body weight were 0.222 and 0.241, in age and duration after menopause were -0.268, -0.282. 4. The fracture threshold of proximal femur BMD to the 90th percentile was $0.845(g/cm^2)$. 5. At the result of multiple regression analysis, age, body weight, $BMI(kg/m^2)$ and duration after menopause described as significant variables.