• Title/Summary/Keyword: Fracture Site

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When do we use the Recycling Autograft in Limb Salvage Surgery? (사지구제술에서 언제 재활용 자가골 이식술이 유용한가?)

  • Kim, Jae-Do;Jang, Jae-Ho;Cho, Yool;Kim, Ji-Youn;Chung, So-Hak
    • The Journal of the Korean bone and joint tumor society
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    • v.14 no.2
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    • pp.95-105
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    • 2008
  • Purpose: To identify which is the best procedure in recycling autograft according to the resection & reconstruction type and recycling methods, and so when the recycling autograft is used in limb salvage surgery. Materials and Methods: We have treated fifty-eight patients (34 male, 24 female; age range 5 to 74 years, mean age 36.5 years), who had the malignant musculoskeletal tumors, with recycling autograft (47 patients with extracoporeal irradiation, 11 patients with pasteurization) from December 1995 to February 2006. The resection and reconstruction type was 3 cases with fragmentary, 8 intercalary, 23 rAPC (recycling-Autograft-Prosthesis composite), 18 osteoarticular, 5 total joint and 1 soft tissue (achilles tendon). The result was evaluated by the radiologic union at junctional site, the functional score by musculoskeletal tumor society score and complications according to the resection & reconstruction type and recycling methods. Results: The junctional union was obtained at 15.0 months in extracoporeal irradiation and 12.6 months in pasteurization. Also the mean radiologic union was shown at 6.0 months in fragmentary, 12.8 months in intercalary, 10 months in rAPC, 23.3 months in osteoarticular and 15.6 months in total joint. The functional score was 65.5% in fragmentary, 60.8% in intercalary, 62.8% in APC (except pelvis), 66.0% in osteoarticular and 66.6% in total joint. We have experienced 1 infection, 1 prutrusio acetabuli in pasteurization (18.1%) and other 22 complications (3 deep infections, 8 nonunions, 2 fractures, 2 epiphyseal problems, 5 joint instabilities, 2 local recurrence) in extracoporeal irradiation (46.8%). Also we have experienced 3 complications (3 nonunions) in intercalary (37.5%), 9 complications (4 nonunions, 1 deep infection, 1 periprosthetic fracture, 1 epiphyseal problem, 1 local recurrence, 1 protrusio acetabuli) in rAPC (50.0%), 6 complications (2 deep infections, 2 nonunions, 1 epiphyseal problem, 1 pathologic fracture) in osteoarticular (33.3%), 5 complications (5 joint instabilities) in total joint (100%) and 1 complication(1 local recurrence) in soft tissue (100%). Conclusion: In our experience, according to the resection & reconstruction type fragmentary and intercalary may have several advantages such as good radiologic and functional result and low rate of complication. And it seems that rAPC was available in case which have no sufficient residual bone stock. Also the pasteurization may have more advantages than that of the extracorporeal irradiation.

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Effects of Thermal and Mechanical Fatigue Stress on Bond Strength in Bracket Base Configurations (열적, 기계적 피로응력이 교정용 브라켓의 결합강도에 미치는 영향)

  • Kim, Jong-Ghee;Kim, Sang-Cheol
    • The korean journal of orthodontics
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    • v.30 no.5 s.82
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    • pp.625-642
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    • 2000
  • The purpose of this study is to evaluate the effects of mechanical and thermal fatigue stress on the shear, tensile and shear-tensile combined bond strengths(SBS, TBS, CBS) in various orthodontic brackets bonded to human premolars with chemically cured adhesive(Ortho-one, Bisco, USA). Five types of commercially available metal brackets with various bracket base configurations of Photoetched base(Tomy, Japan), Non-Etched Foil Mesh base(Dentaurum, Germany), Micro-Etched Foil Mesh base(Ortho Organizers, USA), Chessboard base(Daesung, Korea), and Integral base(3M Unitek, USA) were used. Samples were divided into 3 groups, the first group was acted with shear-tensile combined loads($45^{\circ}$) of 200g for 4 weeks(mechanical fatigue stress), the second group was subjected to the 5,000 thermocycles of 15 second dwell time each in $5^{\circ}C\;and\;55^{\circ}C$ baths(thermal fatigue stress), and the third group was the control. Bond strengths were measured at the crosshead speed of 0.5mm/min. The cross-section of bracket base/adhesive interface and the fracture surface were examined with the stereoscope and the scanning electron microscope. The resin remnant on bracket base surface was assessed by ART(Adhesive Remnant Index). The obtained results were summarized as follows, 1. In static bond strength, Photoetched base bracket showed the maximum bond strength and Integral base bracket showed the minimum bond strength(p<0.05). In all brackets, shear bond strength(SBS) was in the greatest value and shear-tensile combined strength(CBS) was in the least value(p<0.05). 2. After mechanical fatigue test, Photoetched base bracket showed the maximum bond strength and Integral base bracket showed the minimum bond strength(p<0.05). In Photoetched base bracket and Micro-Etched Foil Mesh base bracket, shear bond strength(SBS), tensile bond strength(TBS) and shear-tensile combined strength(CBS) were decreased after mechanical fatigue test(p

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Surgical Treatment for Metastatic Spinal Tumor (전이성 척추 종양의 수술적 치료)

  • Han, Chung-Soo;Kim, Ki-Tack;Soh, Jae-Ho;Lee, Jung-Hee;Shin, Dong-Jun
    • The Journal of the Korean bone and joint tumor society
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    • v.6 no.1
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    • pp.1-9
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    • 2000
  • Purpose : Spine is one of the most common sites of the metastatic bone tumors. Conservative management such as chemotherapy or radiotherapy has been preferred in most cases. However, the neurologic deficit has not been usually improved, and the quality of life was poor. The purpose of this study was to show the efficacy of the surgical treatments for metastatic spinal tumors in terms of postoperative improvements of neurologic deficit and survival time. Materials and Methods : Authors have reviewed the literatures and analyzed 14 patients of metastatic spinal tumors who were received operative treatments between August 1991 and June 1999 at the our department of orthopaedic surgery. Results : The most frequent primary tumor was breast cancer in women and lung cancer in men. The thoracic region was the most common site. There was a preponderance of females over males, and the age ranged between 4th and 8th decade. The indications of surgical treatment comprised instability, progressive neurologic findings, resistance to radiotherapy, pathological fracture, long life expectancy( >6weeks), isolated metastasis and need for pathological diagnosis. The degree of preoperative neurological deficit might influence on the improvement of clinical symptoms after surgery. Conclusion : The surgical treatment reduced the neurological deficit and pain regardless of the operative methods. In the early stage of neurological deficit, the surgical treatment was important for better prognosis. Recently early active operative treatment was performed for metastatic spinal tumor to minimize the intractable pain and to prevent the progression of the neurologic deficit. Early intervention can improve the quality of life and long term survival.

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Limb Salvage Operation with Recycled Autogenous Bone Graft (자가골 재이식술을 이용한 사지 구제술)

  • Rhee, Seung-Koo;Kang, Yong-Koo;Suh, Yoo-Joon;Yoo, Jong-Min;Jung, In-Ho
    • The Journal of the Korean bone and joint tumor society
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    • v.10 no.2
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    • pp.96-106
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    • 2004
  • Purpose: To determine the usefulness of limb salvage operation with recycled autogenous bone graft in musculoskeletal malignant tumors. Materials and Methods: Twenty nine cases, who underwent limb salvage operation with recycled autogenous bone graft for the treatment of musculoskeletal malignant tumor between February 1990 and January 2003, were included. There were 18 males and 11 females and the mean age was 33 years (range, 10 to 65 years). The mean follow-up period was 51.8 months (range, 18 to 117 months). The Enneking stage was IIA in 10 cases and IIB in 19 cases. The recycling method of autogenous bone was deep freezing in 6 cases, autoclaving in 11 cases, pasteurization in 7 cases and the composite of autoclaving and vascularized fibular graft in 5 cases. The union of junctional site was evaluated radiologically and the functional results was analyzed by the grading systems of the International Symposium On Limb Salvages (ISOLS). Results: The mean union time was 7.2 months (range, 3 to 15 months). The union took 5.8 months (range, 4 to 8 months) in deep freezing, 9.7 months (range, 6 to 15 months) in autoclaving, 5.9 months (range, 4 to 8 months) in pasteurization, and 5 months (range, 4 to 8 months) in the composite of autoclaving and vascularized fibular graft. The mean functional evaluation percentage was 76.8% (range, 40 to 90%). It was 65.8% (range, 40 to 85%) in deep freezing, 76.6% (range, 40 to 90%) in autoclaving, 81.6% (range, 70 to 90%) in pasteurization, and 83.4% (range, 75 to 90%) in the composite of autoclaving and vascularized fibular graft. There were 6 cases of complications including 1 case of local recurrence, lung metastasis, infection, fracture, respectively and 2 cases of nonunion. Conclusion: The limb salvage operation with recycled autogenous bone graft is a useful treatment method for the musculoskeletal malignant tumors. Particularly, autoclaving is the most reliable sterilization method. The vascularized fibular graft can compensate decreased osteoinductivity and mechanical strength of recycled bone. So, the composite of autoclaving and vascularized bone graft seems to be a favorable treatment method for high grade malignant musculoskeletal tumors.

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Study of Mobility for Radionuclides in Nuclear Facility Sites (원자력 시설물 주변에서의 방사성 오염물 거동 특성 연구)

  • Chang, Seeun;Park, JongKul;Um, Wooyong
    • Economic and Environmental Geology
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    • v.51 no.2
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    • pp.99-111
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    • 2018
  • In this study three target radionuclides ($^{60}Co$, $^{137}Cs$, and $^{125}Sb$) were reacted with solid samples collected from the nuclear facility sites to investigate their sorption and mobility behaviors for preparing unexpected nuclear accidents. The highest sorption distribution coefficients ($K_{ds}$) of target radionuclides ($^{60}Co=947mL/g$, $^{137}Cs=2105mL/g$, $^{125}Sb=81.3mL/g$) were found in topsoil layer under groundwater condition, and the $K_d$ values of three radionuclides decreased in the order of fractured rock and bedrock samples under the same groundwater condition. High $K_d$ values of $^{60}Co$ in topsoil layer and fracture rock resulted from the clay minerals present, and the $K_d$ values decreased 58-69 % under seawater condition due to high ionic strength. $^{137}Cs$ sorption was controlled by the ion exchange reaction with $K^+$ on flayed edge sites (FES) of mica. The $^{137}Cs$ sorption was the most affected by seawater (89-97 % decrease), while $^{125}Sb$ sorption was not much affected by seawater. As the results of column and batch experiments, the retardation factors (R) of $^{137}Cs$, $^{60}Co$, and $^{125}Sb$ were determined about 5400-7400, 2000-2500, and 250-415, respectively, indicating no significant transport for these radionuclides even in fractured zone with groundwater. These results suggest that even in the case of severe nuclear accident at the nuclear facilities the mobility of released radionuclides ($^{60}Co$, $^{137}Cs$, and $^{125}Sb$) can be significantly retarded by the topsoil layer and fractured rock. In addition, the results of this study will be used for the safety and environmental performance assessment of nuclear facilities.

Postoperative Complications After Arthroscopic Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft (자가 슬개건을 이용한 전방 십자 인대 재건술의 수술 후 합병증)

  • Zhu, Fang Zhen;Yoo, Moon-Jib;Kim, Myung-Ho;Park, Hee-Gon;Bahng, Seung-Chul
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.7 no.2
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    • pp.122-127
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    • 2008
  • Purpose: Evaluation and analysis of the incidence of postoperative complications after arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. Materials and Methods: We reviewed 172 cases of arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft in anterior cruciate ligament tear without meniscal injury. We performed Lysholm knee score and KT-2000 testing, simple radiograph, physical examination as evaluation factor. Also, around knee pain, swelling, limitation of motion, patellofemoral crepitation, paresthesia and pain on kneeling were evaluated. Results: The average follow up period was 49.8 months. In 172 patients, 148 males and 26 femlaes were evaluated. The average age was 34.4 years. The Lysholm knee score improved from 51.9 points preoperatively to 90.8 points at final follow up. Clinical outcome was excellent in 83%, good in 11%, fair in 4% and poor in 2%. There were many cases of complications, 24 cases (14%) of around knee pain, 12 cases (7%) of swelling, 45 cases (26.2%) of patellofemoral crepitation, 52 cases (30%) of donor site paresthesia, 65 cases (38%) of pain on kneeling, 10 cases (5.8%) of limitation of motion at extension, 13 cases (8%) of limitation of motion at flexion and 2cases (1.2%) of patellar fracture. Conclusion: Although arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone had good clinical results, many complications were noted. Some factors in surgical technique were suspected to be related to the complications and long term follow up will be necessary to further evaluated.

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Intraoperative and Postoperative Complications After Arthroscopic Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft (자가 골-슬개건-골을 이용한 관절경적 전방십자인대 재건술의 수술 중 및 수술 후 합병증)

  • Kim, Kyung-Tae;Lee, Song;Jeong, Soon-Young;Kim, Hyun-Soo;Park, Jun-Seong
    • Journal of the Korean Arthroscopy Society
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    • v.6 no.1
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    • pp.1-6
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    • 2002
  • Purpose : Evaluation and analysis of the incidence and causes of intraoperative and postoperative complications after arthoscopic anterior cruciate ligament(ACL) reconstruction using bone-patella. tendon-bone (BPTB) auto graft. Materials and Methods : We reviewed 85 cases of arthroscopic ACL reconstruction using BPTB autograft which had been followed up for more than 1 year. Intraoperative complications had been recorded and corrected during the operation. Postoperative complications were analyzed and compared between 3 groups which were classified by the last follow-up period after the operation. Results : There were a few intraoperative complications including patellar fracture(1 case), contamination of harvested graft(1 case), impingement of graft(2 cases), blow-out of tile posterior wall of the femoral tunnel(1 case) and intraarticular retraction of the screw(1 case). The result of the comparison of postoperative complications among the groups shows that the incidence of anterior knee pain, donor site pain and patellofemoral crepitation were significantly decreased after 2 years. But there was no significant decrease in these complications after 3 years. Conclusion : Intraoperative complications after arthroscopic ACL reconstruction using BPTB autograft were due to incorrect technique and carelessness of the operation team, and can be prevented by improvement of surgical technique and accumulation of experience. Postoperative complication were somewhat unavoidable but gradually improved with time; hence, we should consider it for the selection of graft donor.

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Cesium Sorption to Granite in An Anoxic Environment (무산소 환경에서의 화강암에 대한 세슘 수착 특성 연구)

  • Cho, Subin;Kwon, Kideok D.;Hyun, Sung Pil
    • Korean Journal of Mineralogy and Petrology
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    • v.35 no.2
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    • pp.101-109
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    • 2022
  • The mobility and transport of radioactive cesium are crucial factors to consider for the safety assessment of high-level radioactive waste disposal sites in granite. The retardation of radionuclides in the fractured crystalline rock is mainly controlled by the hydrochemical condition of groundwater and surface reactions with minerals present in the fractures. This paper reports the experimental results of cesium sorption to the Wonju Granite, a typical Mesozoic granite in Korea, performed in an anaerobic chamber that mimics the anoxic environment of a deep disposal site. We measured the rates and amounts of cesium (133Cs) removed by crushed granite samples in different electrolyte (NaCl, KCl, and CaCl2) solutions and a synthetic groundwater solution, with variations in the initial cesium concentration (10-5, 5×10-6, 10-6, 5×10-7 M). The cesium sorption kinetic and isotherm data were successfully simulated by the pseudo-second-order kinetic model (r2= 0.99) and the Freundlich isotherm model (r2= 0.99), respectively. The sorption distribution coefficient of granite increased almost linearly with increasing biotite content in granite samples, indicating that biotite is an effective cesium scavenger. The cesium removal was minimal in KCl solution compared to that in NaCl or CaCl2 solution, regardless of the ionic strength and initial cesium concentration that we examined, showing that K+ is the most competitive ion against cesium in sorption to granite. Because it is the main source mineral of K+ in fracture fluids, biotite may also hinder the sorption of cesium, which warrants further research.

Structural Behavior Evaluation of NRC Beam-Column Connections (NRC 보-기둥 접합부의 구조적 거동 평가)

  • Jeon, Ji-Hwan;Lee, Sang-Yun;Kim, Seung-Hun
    • Journal of the Korea institute for structural maintenance and inspection
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    • v.26 no.1
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    • pp.73-80
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    • 2022
  • In this study, details of NRC beam-column connections were developed in which beam and columns pre-assembled in factories using steel angles were bolted on site. The developed joint details are NRC-J type and NRC-JD type. NRC-J type is a method of tensile joining with TS bolts to the side and lower surfaces of the side plate of the NRC column and the end plate of the NRC beam. NRC-JD type has a rigid joint with high-strength bolts between the NRC beam and the side of the NRC column for shear, and with lap splices of reinforcing bar penetrating the joint and the beam main reinforcement for bending. For the seismic performance evaluation of the joint, three specimens were tested: an NRC-J specimen and NRC-JD specimen with NRC beam-column joint details, and an RC-J specimen with RC beam-column joint detail. As a result of the repeated lateral load test, the final failure mode of all specimens was the bending fracture of the beam at the beam-column interface. Compared to the RC-J specimen, the maximum strength of the specimen by the positive force was 10.1% and 29.6% higher in the NRC-J specimen and the NRC-JD specimen, respectively. Both NRC joint details were evaluated to secure ductility of 0.03 rad or more, the minimum total inter-story displacement angle required for the composite intermediate moment frame according to the KDS standard (KDS 41 31 00). At the slope by relative storey displacemet of 5.7%, the NRC-J specimen and the NRC-JD specimen had about 34.8% and 61.1% greater cumulative energy dissipation capacity than the RC specimen. The experimental strength of the NRC beam-column connection was evaluated to be 30% to 53% greater than the theoretical strength according to the KDS standard formula, and the standard formula evaluated the joint performance as a safety side.

Musculoskeletal Injuries by Weapons in Korean Soldiers: Four-Year Follow-Up (총기 및 폭발물에 의한 군인의 근골격계 손상: 최근 4년간 분석)

  • Yang, Hanbual;Hwang, Il-Ung;Song, Daeguen;Moon, Gi Ho;Lee, Na Rae;Kim, Kyoung-Nam
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.3
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    • pp.234-244
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    • 2021
  • Purpose: To date, studies of firearm and explosive injuries in the Korean military have been limited compared to its importance. To overcome this, this study examined the characteristics of musculoskeletal damages in soldiers who have suffered firearm and explosive injuries over the past four years. Materials and Methods: From January 2015 to July 2019, military forces who had suffered musculoskeletal injuries from firearms or explosive substances were included. The medical records and radiographs were reviewed retrospectively, and telephone surveys about Short Musculoskeletal Functional Assessment (SMFA) for this group were conducted. To compare the functional outcomes, statistical analysis was performed using a t-test for the types of weapons, and ANOVA for others. Results: Of the 61 patients treated for firearms and explosives injuries, 30 patients (49.2%) were included after undergoing orthopedic treatment due to musculoskeletal injury. The average age at injury was 26.4 years old (21-52 years old). The number of officers and soldiers was similar. Eleven were injured by gunshot and 19 by an explosive device. Sixteen were treated in the Armed Forces Capital Hospital and 10 at private hospitals. More than half of the 16 patients (53.3%) with a fracture had multiple fractures. The most common injury site was the hand (33.3%), followed by the lower leg (30.0%). There were 14 patients (46.7%) with Gustilo-Anderson classification 3B or higher who required a soft tissue reconstruction. Fifteen patients agreed to join the SMFA survey for the functional outcomes. Between officers and soldiers, officers had better scores in the Bother Index compared to soldiers (p=0.0045). Patients treated in the Armed Forces Capital Hospital had better scores in both the Dysfunction and Bother Index compared to private hospitals (p=0.0008, p=0.0149). Conclusion: This is the first study to analyze of weapons injuries in the Korean military. As a result of the study, the orthopedic burden was high in the treating patients with military weapon injuries. In addition, it is necessary to build a military trauma registry, including firearm and explosive injuries, for trauma treatment evaluation and development of military trauma system.