• Title/Summary/Keyword: Early fixation

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Thoracic Epidural Anesthesia and Analgesia (TEA) in Patients with Rib Fractures

  • Kim, Young-Jin;Cho, Hyun-Min;Yoon, Chee-Soon;Lee, Chan-Kyu;Lee, Tae-Yeon;Seok, June-Pill
    • Journal of Chest Surgery
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    • v.44 no.2
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    • pp.178-182
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    • 2011
  • Background: We analyzed the results of surgical reduction and fixation of ribs under thoracic epidural anesthesia and analgesia (TEA) in patients who had no more than 3 consecutive rib fractures with severe displacement to examine the clinical usefulness of this method. Materials and Methods: From May 2008 to March 2010, 35 patients underwent surgical reduction and fixation of ribs under TEA. We reviewed the indications for this technique, number of fixed ribs, combined surgical procedures for thoracic trauma, intraoperative cardiopulmonary events, postoperative complications, reestablishment of enteral nutrition, and ambulation. Results: The indications of TEA were malunion or nonunion of fractured ribs in 29 (82.9%; first operation) and incompletely ribs under previous general anesthesia in 6 (17.1%; second operation). The average number of fixed ribs per patient was 1.7 (range: 1~3). As a combined operation for thoracic trauma, 17 patients (48.6%) underwent removal of intrathoracic hematomas, and we performed repair of lung parenchyma (2), wedge resection of lung (1) for accompanying lung injury and pericardiostomy (1) for delayed hemopericardium. No patient had any intraoperative cardiopulmonary event nor did any need to switch to general anesthesia. We experienced 3 postoperative complications (8.6%): 2 extrapleural hematomas that spontaneously resolved without treatment and 1 wound infection treated with secondary closure of the wound. All patients reestablished oral feeding immediately after awakening and resumed walking ambulation the day after operation. Conclusion: Thoracic epidural anesthesia and analgesia (TEA) may positively affect cardiopulmonary function in the perioperative period. Moreover, this technique leads to an earlier return of gastrointestinal function and early ambulation without severe postoperative complications, resulting in a shortened hospital stay and lowered costs.

PHOTOELASTIC STRESS ANALYSIS OF LOAD TRANSFER TO SATELLITE ABUTMENT AS AN IMMEDIATE ABUTMENT (인공치아의 즉시부하를 위해 새로이 개발된 인공치아 지대주(Satellite Abutment)의 광탄성 응력 분석)

  • Park, Sang-Kyu;Lee, Baek-Soo;Engelke, W;Kim, Boo-Dong
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.28 no.6
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    • pp.472-479
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    • 2002
  • Since $Br^{\circ}anemark$ introduced the osseointegrated implants, they have been granted for useful methods for the restoration of oral function. The original $Br^{\circ}anemark$ protocol recommended long stress-free healing periods to achieve the osseointegration of dental implants. However, many clinical and experimental studies have shown that the osseointegration is no wonder in almost cases and that early and immediate loading may lead to predictable osseointegration. So we are willing to introduce the Satellite Abutment newly invented for immediate loading. We think that it will make the occlusal forces dispersed to surrounding bone and that we can restore the oral function immediately after implant installation not disturbing osseointegration. In case of using Satellite abutment, stress concentrated to bone contact area of implant was distributed not only fixation plate and screws but also superior, middle portion of implant and cortical layer of jaw bone. It was clearly decreased on the bone contact surfaces around dental implants. 1. Stress was decreased more than 76.5% when satellite straight abutment was used. 2. Stress was decreased more than 50% when satellite angled abutment was used. 3. The stress around dental implant was well distributed along the cortical bone surface and the fixation plate and screw. This study concludes that satellite abutment can be used as all immediate loading implant prothesis because it was possible to distribute periimplant occlusal stress through implant contact bone surface and cortical layer of jaw bone.

Evaluation of Osseointegration around Tibial Implants in Rats by Ibandronate-Treated Nanotubular Ti-32Nb-5Zr Alloy

  • Nepal, Manoj;Li, Liang;Bae, Tae Sung;Kim, Byung Il;Soh, Yunjo
    • Biomolecules & Therapeutics
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    • v.22 no.6
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    • pp.563-569
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    • 2014
  • Materials with differing surfaces have been developed for clinical implant therapy in dentistry and orthopedics. This study was designed to evaluate bone response to titanium alloy containing Ti-32Nb-5Zr with nanostructure, anodic oxidation, heat treatment, and ibandronate coating. Rats were randomly assigned to two groups for implantation of titanium alloy (untreated) as the control group and titanium alloy group coated with ibandronate as the experimental group. Then, the implants were inserted in both tibiae of the rats for four weeks. After implantation, bone implant interface, trabecular microstructure, mechanical fixation was evaluated by histology, micro-computed tomography (${\mu}CT$) and the push-out test, respectively. We found that the anodized, heat-treated and ibandronate-coated titanium alloy triggered pronounced bone implant integration and early bone formation. Ibandronate-coated implants showed elevated values for removal torque and a higher level of BV/TV, trabecular thickness and separation upon analysis with ${\mu}CT$ and mechanical testing. Similarly, higher bone contact and a larger percentage bone area were observed via histology compared to untreated alloy. Furthermore, well coating of ibandronate with alloy was observed by vitro releasing experiment. Our study provided evidences that the coating of bisphosphonate onto the anodized and heat-treated nanostructure of titanium alloy had a positive effect on implant fixation.

Management of gunshot wounds near the elbow: experiences at a high-volume level I trauma center

  • Umar Ghilzai;Abdullah Ghali;Aaron Singh;Thomas Wesley Mitchell;Scott A. Mitchell
    • Clinics in Shoulder and Elbow
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    • v.27 no.1
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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.

Medium Depths and Fixation Dates of 'Seolhyang' Strawberry Runner Plantlets in Nursery Field Influence the Seedling Quality and Early Growth after Transplanting (차근육묘를 위한 배지의 깊이 및 착근 시기가 '설향' 딸기 자묘 소질과 정식 후 초기 생장에 미치는 영향)

  • Park, Gab Soon;Choi, Jong Myung
    • Horticultural Science & Technology
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    • v.33 no.4
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    • pp.518-524
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    • 2015
  • The objective of this research was to investigate the influence of various depths of expanded rice hull (ERH) medium and fixation dates of runner plantlets of 'Seolhyang' strawberry on the growths in nursery field and in plastic house soil after transplanting. The five treatments in medium depths (30, 50, 70, 90, and 110 mm) and four treatments in fixation dates (1st and 15th July and 1st and 15th August) were tested. The growths of runner plantlets were investigated before transplanting to plastic house soil. The early growth and inflorescence rates of crops after transplant to plastic house soil were also investigated. The plant height and fresh weight of runner plantlets were the highest in the medium depths of 50, 70, and 90 mm. The medium depth of 30 mm had higher numbers of first roots, but lower root fresh weight compared to those of 70, 90, and 110 mm. The treatment of 30 mm in medium depth showed poorer growth in all indexes except root length and root weight compared to those of 70, 90, and 110 mm. The runner plantlets fixed on July 1 and July 15 showed good root growth and the weights of ERH adhered to form root balls were 18.3 g and 13.9 g, respectively. The detached amount of ERH was less than 40% in the two treatments when root balls were shaken by a vibratory sieve shaker. The plant growth at 45 days after transplanting to plastic house soil were not significantly different when the runner plantlets were fixed in the period from July 1 to Aug. 1. The inflorescence rates of the first cluster were 93 to 100% when runner plantlets were fixed in the period from July 1 to Aug. 1. By contrast the runner plantlets fixed on the Aug. 15 had a 67% in florescence rate for the first cluster. These results indicate that optimum depth of ERH medium was 7 cm and the ranges of optimum fixation dates are from July 20 to 25.

HISTOLOGICAL CHANGES IN THE ELONGATED BONE AFFECTED BY OSTEODISTRACTION OF THE MANDIBLE IN THE DOG (성견 하악골 절단 후 기계적 골 견인에 의해 형성된 골 신장부에 대한 시기별 조직학적 변화)

  • Baek, Sun-Ho;Ahn, Byoung-Keun;Park, Young-Ju;Park, Hee-Geon;Park, Jun-Woo;Rhee, Gun-Joo;Lee, Yong-Chan;Cho, Byoung-Ouck
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.27 no.5
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    • pp.404-416
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    • 2001
  • Purpose : Traditionally, the treatement of choice has been a bone grafting procedure to increase the length of bone in case of actual length discrepancy. But, bone grafting procedure has many disadvantages, for example, graft resorption, donor site morbidity, and so on. So, many trials have been performed to avert the use of autogenous bone graft via introducing new materials or methods. And, one of those trials has been realized by the development of a technique inducing bone lengthening by osteotomy (or corticotomy) and slow gradual distraction of the osteotomized segments. This new technique of bone lengthening dates back to the early 20th century. But, the majority of information concerning the biology of new bone formation during bone lengthening and technical details of the procedure were produced by extensive clinical and experimental studies performed by Ilizarov, a Russian surgeon. According to Ilizarov, with adequate blood supply, preservation of periosteum, rigid fixation of the osteotomized segments, and proper rate and rhythm of distraction, intramembranous bone rapidly develops within the distraction gap in the limb lengthening procedure. In the limb lengthening, many orthopedic surgeons try to observe the biologic and clinical principles recommended by Ilizarov. In the oral and maxillofacial region, however, not a few studies must be performed to apply this surgical technique in the clinical cases. Besides, the mechanism of bone formation in the distraction gap is not clear, yet. The purpose of this experiment was to scrutinize serially the histological changes in the elongated bone affected by osteodistraction of the mandibular body in an adult canine model. In addition, it was performed to confirm the presence of specific region(s) which was important in the bone formation in the gap through the observation of the expression pattern of osteocalcin and osteonectin with the immunohistochemical examination. Materials and Methods : The experimental and control specimens were obtained from seven adult male mongrel dogs weighing over 20kg. The distractors were custom-made linear extraoral devices and bicortical fixation screws were 2.3mm in diameter, 50mm in total length, 15mm in screw length. The distractors were devised to produce a linear gap of 0.75mm between two bony segments every $360^{\circ}$ turn of the rotation rod of the device. The mandibular body of the right side of each animal was corticotomized perpendicular to the occlusal plane and then two bony segments were separated completely by careful manipulation of the segments with bone forceps. The left side of each animal was left intact. This side was served as control. At sixth day after osteotomy and fixation of the segments were performed, distraction of the segments was commenced with a rate of 1.1mm/day and a rhythm of two/day for ensuing 7 days. The animals were euthanized at the 16th. 29th, and 44th day after the osteotomy. The bony specimens were decalcified, embedded in paraffin, sectioned $5{\mu}m$ thick and stained with H&E. The prepared specimens were examined under the light microscope. And, immunohistochemical examinations using anti-osteocalcin antibody (OC1, Biodesign, USA) and anti-osteonectin antibody (Haematologic Technologies Inc., Essex, VT) to locate the expressions of osteocalcin and osteonectin, respectively, were performed. Results : 1. New bone was observed already at the 16th. day after osteotomy. This suggests that new bone formation in osteodistraction was commenced at an early stage of the regenerative process. But, radiologically and microscopically, bony union was not completed in the distraction gap at the 44th. day after osteotomy. Therefore, rigid fixation must be maintained between the bony fragments till the complete bony union is confirmed clinically rather than one month or so after the completion of distraction.

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Comparison of the Isometric Myofunction on Anterior Cruciate Ligament Reconstruction Patients according to the Time of Participation in Exercise Program (전방십자인대 재건술 환자의 운동프로그램 참여 시기에 따른 등척성 근기능 비교)

  • Bae, Chang-Hwan;Cho, Sung-Hyoun;HwangBo, Kak
    • Journal of the Korean Society of Physical Medicine
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    • v.6 no.4
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    • pp.455-464
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    • 2011
  • Purpose : This study is to investigate difference in the isometric muscular function of knee joints according to the time of participation in rehabilitation exercise in patients who had anterior cruciate ligament reconstruction. Methods : The subjects of this study were patients by sports injury or accident in the sports rehabilitation center of G hospital. The early exercise program group (n=7) started functional ability exercise from 2 weeks after the surgery and the late exercise program group (n=7) from 6 weeks after the surgery. Statistical analysis was used repeated measure ANOVA to test mean difference by using SPSS 18.0 for windows. Results : First, as to quadriceps femoris muscle according to the time of participation in exercise program, significant difference was observed according to interaction and time. Second, as to hamstring muscle according to the time of participation in exercise program, significant difference was observed in muscle strength according to time. Conclusion : This results suggest that if the effect of exercise program is similar between the early starting group and the late starting group, it is not necessary to have a long period of fixation as in the late exercise program group but is desirable to start functional ability exercise early in order to relieve pains in the knee joints.

A Study on the formation and dissolution of tautological structure in the Frank Stella's work (프랭크 스텔라(Frank Stella)에 있어서 토톨로지 구조(Tautological Structure)의 형성과 해체)

  • Hong Ji-Suk
    • Journal of Science of Art and Design
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    • v.5
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    • pp.35-66
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    • 2003
  • This article dealt with the formation and dissolution of tautological structure in the Frank Stella's work from 1959 to 1980 years by the analysis of signifier. A characteristic of Stella's work change is that it has the gradual progress which condensed into three periods -1) the formation and fixation period of tautological structure 2) the relaxation period of tautological structure and 3) the dissolution period of tautological structure. In other words, the early works of stella in the early 1960s has the structure which minimize differences in one hand, and maximize strictness, clearness, and identity on the other hand However, the stella's work from mid 1960s to mid 1970s extend differences gradually, while keeping a characteristic of prior work. And the stella's work after late 1970s has the decentered disintegration, namely anti-tautological structure which maximize differences. 'The formation and dissolution of tautological structure' in the Stella's work could be understood in relation to the fact that the Greenberg's modernist canon has loss the power gradually after late 1960s. That is to say, the dissolution of tautological structure in the late stella's work could be interpreted as the inevitable product which is produced in the searching for a new canon of painting. However, on the other hand, the structural change of stella's work in the late 20th Century is also understood in relation to the broader context, the social, and cultural context. Here, it is interpreted as the one of typical example which reflect a social and cultural convulsion designated as a 'Coming of Postmodernism'. In short, the late Stella's work which emphasize differences and unclearness, while diverging from early Stella's work which stress identity and rationality could be interpreted that it has the homology with the change of ways of thinking in the late 20th century Society.

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A Three-Dimensional Finite Element Study of Interface Micromotion in a Non-Cement Total Hip stem (FEM 3차원 모델을 이용한 인공관절 대퇴 Stem 경계면의 미세운동 분석)

  • Kim, Sung-Kon;Choi, Hyung-Yun;Chae, Soo-Won
    • Journal of Biomedical Engineering Research
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    • v.17 no.1
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    • pp.61-70
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    • 1996
  • In cementless total hip arthroplasty(THA), an initial stability of the femoral component is mandatory to achieve bony inyowth and secondary long term fixation. Primary stability of the femoral component can be obtained by minimizing the magnitude of relative micromotions at bone stem interface. An accurate evaluation of interf'ace micromotion and stress/strain fields in the bone-implant system may be relevant for better understanding of clinical situations and improving THA design. Recently finite element method(FEM) was introduced in'orthopaedic research field due to its unique capacity to evaluate stress in structure of complex shape, loading and material behavior. The authors developed the 3-dimensional finite element model of proximal femur with $Multilock^{TM}$ stem of 1179 blick elements to analyse the micromotions and mechanical behaviors at the bone-stem inteface in early post-operative period for the load simulating single leg stance. The results indicates that the values of relative motion for this well fit stem were $150{\mu}m$ in maximum $82{\mu}m$ in minimum and the largest relative motion was developed in medial region of Proximal femur and in anterior-posterior direction. The motion in the proximal bone was much greater than in the distal bone and the stress pattern showed high stress concentration on the cortex near the tip of the stem. These findings indicate that the loading on the hip joint in the early postoperative situation before achieving bony ingrowth could produce large micromotion of $150{\mu}m$ and clinicaly non-cemented THA patient should not be allowed weight bearing strictly early in the postoperative period.

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Operative Treatment of the Displaced Midshaft Clavicle Fracture Using Precontoured Locking Compression Plate (Precontoured Locking Compression Plate를 이용한 전위성 쇄골 간부 골절의 수술적 치료)

  • Kim, Jeong Woo;Kang, Hong Je;No, Sung Hyun
    • Clinics in Shoulder and Elbow
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    • v.15 no.2
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    • pp.117-122
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    • 2012
  • Purpose: To assess the effectiveness of internal fixation using a precontoured locking compression plate for the treatment of the displaced clavicle fracture by analyzing both radiological and clinical outcomes. Materials and Methods: We reviewed 34 cases of displaced clavicle shaft fracture treated by internal fixation using precontoured locking compression plates between May 2009 and February 2010. Radiological outcomes were analized on the basis of bone union and the differences between the time for bone union depending on sex and age. Clinical outcomes were analyzed on the basis of quick DASH Scores and the differences in the range of motion of the affected shoulder compared to the contralateral shoulder. Results: In the radiological evaluation, all fractures showed bone union, and the average time for bone union was 12.3 weeks, without delayed unions. Time for bone union did not differ significantly with respect to sex and age (p=0.87). In the clinical evaluation, the average final quick DASH Score was 23.5 (range, 12~42). At final follow up, the range of motion after bone union in the affected shoulder was not significantly different from that of the contralateral shoulder (p=0.69). Conclusion: The internal fixation achieved using precontoured locking compression plate in displaced clavicle shaft fracture showed effective bone union and can be considered as a reliable method with fine clinical results showing early range of motion at the shoulder joint.