• 제목/요약/키워드: Early fixation

검색결과 212건 처리시간 0.027초

Open Reduction of Proximal Interphalangeal Fracture-Dislocation through a Midlateral Incision Using Absorbable Suture Materials

  • Lee, Jae Jun;Park, Hyoung Joon;Choi, Hyun Gon;Shin, Dong Hyeok;Uhm, Ki Il
    • Archives of Plastic Surgery
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    • 제40권4호
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    • pp.397-402
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    • 2013
  • Background Fracture-dislocation of the proximal interphalangeal (PIP) joint is a relatively common injury. Various treatments for fracture-dislocation of the PIP joint have been reported. In the present study, we performed open reduction through a midlateral incision using absorbable sutures to reduce the small bone fragments and performed volar plate repair. Methods We treated nine patients with fracture-dislocation of the PIP joint with small fractured bone fragments too small for pinning or screw fixation. Patients with volar plate injury were treated with open reduction and volar plate repair at the periosteum of the middle phalangeal bone base by the modified Kessler method using absorbable sutures. All patients were placed in a dorsal aluminum extension block splint, which maintained the PIP joint in approximately 30 degrees of flexion to avoid excessive tension on the sutured volar plate. Results At a mean final follow-up of postoperative 9 months, all patients were evaluated radiographically and had adequate alignment of the PIP joint and reduction of the displaced bone fragments. Range of motion was improved and there were no complications. Conclusions This technique is an excellent alternative to the current method of treating patients with fracture-dislocations that include small fragments that are too small for pinning or screw fixation. It is a less invasive surgical method and enables stable reduction and early exercise without noticeable complications.

견봉쇄골 관절 탈구에서 Modified Phemister와 Modified Weaver-Dunn 술식을 이용한 수술적 치료 (The Surgical Treatment of Acromioclavicular Joint Dislocation using Modified Phemister and Modified Weaver-Dunn Operation)

  • 전철홍;이성호;이병창;조용우
    • Clinics in Shoulder and Elbow
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    • 제1권2호
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    • pp.180-185
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    • 1998
  • There has been considerable controversy as to the treatment method of dislocation of the acromioclavicular joint, so various operative treatment modalities have been suggested. We analyzed the results of 40 patients with acromio­clavicular dislocation, in whom twenty patients were treated by modified Phemister method and 20 patients by modified Weaver-Dunn method above follow-up two years. The purpose of this study was to compare the clinical results of two operative methods. According to Weitzman criteriae for clinical results, 12 cases were excellent, six cases good and two cases fair in modified Phemister method. But in modified Weaver-Dunn method, ten cases were excellent, eight cases good, one case fair and one case poor. In radiological result, coracoclavicular distance was measured at preoperative, postoperative and last follow-up period. The modified Phemister method was 6.lmm, 1.5mm and 2.4mm respectively, and the modified Weaver-Dunn method 7.8mm, 2.lmm and 2.5mm respectively. The complications were two cases of heterotopic ossification, one case of inadequate fixation and one case of K-wire breakage in modified Phemister method, and two cases of early fixation loss and one case of heterotopic ossification in modified Weaver-Dunn method. We obtained that the clinical, functional and radiological results showed no significant difference in two methods. The modified Phemister method was effective treatment for old patients in acute injuries due to short operation time and simple technique. The modified Weaver-Dunn method, as a reconstructive operation that reduces various complications for young and active male patients, was also good for getting the stability of coraco­clavicular ligament through clavicular bony union.

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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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    • 제44권2호
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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.

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

  • 박상규;이백수;;김부동
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제28권6호
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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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    • 제22권6호
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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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    • 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.

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

  • 박갑순;최종명
    • 원예과학기술지
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    • 제33권4호
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    • pp.518-524
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    • 2015
  • '설향' 딸기 차근육묘에서 팽연왕겨 배지의 깊이 및 착근시기가 자묘의 생장과 본포 정식 후 초기 생장에 미치는 영향을 구명하고자 본 연구를 수행하였다. 배지 깊이에 따른 자묘 생장에서 초장은 50, 70, 및 90mm 처리가 컸고, 엽수, 관부 직경, 및 1차 근수는 처리별 차이가 인정되지 않았다. 뿌리 생체중은 배지 깊이를 70, 90, 및 110mm로 조절한 처리가 30 또는 50mm로 조절한 처리들 보다 뚜렷하게 무거웠고, 근장은 90과 110mm 처리가 가장 길었다. 지상부 생체중은 70mm 처리에서 가장 무거웠고 이 보다 얕거나 깊은 배지 깊이 처리들에서 생장량이 적어졌다. 착근시기에 영향을 받은 자묘의 생장에서 착근 시기가 빠를수록 초장, 엽면적, 관부 직경 및 생체중 등 생장이 우수하였다. 그러나 1차 근수 및 뿌리 생체중은 7월 1일, 7월 15일 및 8월 1일의 세 처리간 통계적인 차이가 인정되지 않았다. 착근시기가 빠를수록 근권의 왕겨 부착량이 많았으며, 체 진동기를 사용하여 왕겨의 제거율을 조사한 결과 7월 1일과 7월 15일 처리는 40% 미만, 8월 1일 및 8월 15 처리는 각각 64% 및 70%로써 정식 시 왕겨 제거를 위한 노동력 요구도가 높았다. 착근시기가 다른 자묘를 본포에 정식하고 45일 후 생육을 조사한 결과 7월 1일 및 15일 그리고 8월 1일 착근한 처리의 1화방 출뢰율은 93-100%, 8월 15일 처리는 67% 였다. 본 실험 결과 팽연왕겨 차근육묘의 적절한 배지 깊이는 70mm, 그리고 착근시기는 7월 20-25일이며, 이상의 결과를 활용하여 육묘농가의 시행착오가 감소하고 양질묘가 생산될 수 있다고 예상한다.

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

  • 백선호;안병근;박영주;박희건;박준우;이건주;이용찬;조병욱
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제27권5호
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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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전방십자인대 재건술 환자의 운동프로그램 참여 시기에 따른 등척성 근기능 비교 (Comparison of the Isometric Myofunction on Anterior Cruciate Ligament Reconstruction Patients according to the Time of Participation in Exercise Program)

  • 배창환;조성현;황보각
    • 대한물리의학회지
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    • 제6권4호
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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.

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

  • 홍지석
    • 조형예술학연구
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    • 제5권
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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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