Kim, Sug Won;Lee, Won Jai;Seo, Dong Wan;Chung, Yoon Kyu;Tark, Kwan Chul
Archives of Reconstructive Microsurgery
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v.9
no.2
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pp.114-119
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2000
The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.
Purpose: The purpose of this study was to evaluate the results of eight cases of coronoid process fractures that were fixed with a plate. Materials and Methods: Eight coronoid process fractures were treated by plating and these cases were reviewed retrospectively. Six patients were men and two were women. The average age was 41 years (range: 22-79) at the time of injury. According to Regan's classification, there were five type 2 and three type 3. According to O'Driscoll's classification, there were five anteromedial type and three base type. Open reduction and internal fixation with a plate were performed through a medial approach by splitting of the two heads of the flexor carpi ulnaris. The patients were follow-up for a mean of 15.8 months (range: 6-25). We evaluated the clinical outcomes with using the Mayo Elbow Performance Score. Results: The average active motion of the elbow joint was $120^{\circ}$. The average Mayo Elbow Performance Score was 86.9. There were 5 excellent results, 1 good result and 2 fair results. Summary: Plating through a medial approach of the elbow provided stable fixation and satisfactory union for treating displaced coronoid process fractures with the unstable elbow.
Scaled model tests were performed to evaluate the reinforcement effect of rock bolts in anisotropic rock mass. For this purpose, two tunnel cases were experimented which had different tunnel sizes, rock strengths, anisotropic angles and coefficients of lateral pressure. The fully grouted rock bolts of the D25 deformed bar were modeled as the basting pins with bead and were systematically installed at the roof and the side wall of the model tunnel. As results of the first case experimentations, the unsupported model showed initial crack at the roof of tunnel, but the supported model with rock bolts showed initial crack at the floor of tunnel where rock bolts were not installed. The crack initiating pressure and the maximum pressure of the supported model with rock bolts were 11% and 7% larger than those of the unsupported model, respectively. Moreover, the effect of the existing discontinuities in anisotropic rock mass on the fracture behavior of tunnel was reduced in the supported model, and so the reinforcement effect of rock bolt turned out to be experimentally verified. As results of the second case experimentations considering different support patterns, the crack initiating pressures of models were larger and the reduction ratios of tunnel area according to applied load were smaller as the length and the quantity of rock bolts were larger. Therefore, it was found that the performance of the rock bolts turned out to be improved as they were larger.
Objective : The objective of this study is to investigate the safety, surgical efficacy, and advantages of a polyaxial screw-rod system for posterior occipitocervicothoracic arthrodesis. Methods : Charts and radiographs of 32 patients who underwent posterior cervical fixation between October 2004 and February 2006 were retrospectively reviewed. Posterior cervical polyaxial screw-rod fixation was applied on the cervical spine and/or upper thoracic spine. The surgical indication was fracture or dislocation in 18, C1-2 ligamentous injury with trauma in 5, atlantoaxial instability by rheumatoid arthritis (RA) or diffuse idiopathic skeletal hyperostosis (DISH) in 4, cervical spondylosis with myelopathy in 4, and spinal metastatic tumor in 1. The patients were followed up and evaluated based on their clinical status and radiographs at 1, 3, 6 months and 1 year after surgery. Results : A total of 189 screws were implanted in 32 patients. Fixation was carried out over an average of 3.3 spinal segment (range, 2 to 7). The mean follow-up interval was 20.2 months. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-7 lateral masses, as well as the lower cervical and upper thoracic pedicles. Satisfactory bony fusion and reduction were achieved and confirmed in postoperative flexion-extension lateral radiographs and computed tomography (CT) scans in all cases. Revision surgery was required in two cases due to deep wound infection. One case needed a skin graft due to necrotic change. There was one case of kyphotic change due to adjacent segmental degeneration. There were no other complications, such as cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, or implant failure, and there were no cases of postoperative radiculopathy due to foraminal stenosis. Conclusion : Posterior cervical stabilization with a polyaxial screw-rod system is a safe and reliable technique that appears to offer several advantages over existing methods. Further biomechanical testings and clinical experiences are needed in order to determine the true benefits of this procedure.
Bones are important parts in sustaining the shape of the body, but they are also metabolic organs which undergo bone remodeling by constant bone resorption and formation. Osteoporosis, the typical metabolic bone disease, is characterized by a reduction in bone mineral density (BMD). Women more than men are at risk fir osteoporosis-related fractures, especially in the lumbar spine, wrist, and hip region. Risk of fracture depends on one's BMD, which open determined by the peak bone mass value achieved at skeletal maturity and followed by subsequent age-and menopause-related bone loss. Genetic and environmental factors are known to play a key role in bone metabolism and diet is considered as one of the important environmental factors. The purpose of the present study was to assess the status of BMD and bone mineral content(BMC) to clarify the relationships between dietary intakes and the risk of osteoporosis in adult women in Taegu. Subjects were 130 healthy females in between 20 and 69 years of age. BMD and BMC of the lumbar spine(venebrae L2-4) of the subjects were measured by dual energy X-ray absorptiometry. The average age of the subjects was 47.4${\pm}$11.7 years old, the average weight was 57.2${\pm}$8.4kg, the average age of menarche was 16.6${\pm}$1.9 years old and the average age of menopause was 48.4${\pm}$5.3 years old. The nutrient intakes of the subjects measured by the convenient method were generally lower than the level of RDA. The result of nutrient intake assessed has shown that the average energy intake was 1701${\pm}$316kca1 which is 85.1% of the RDA and the average calcium intake was 485.4${\pm}$172.3mg which is 69.3% of the RDA. The intakes of protein, vitamin A, vitamin B$_1$, niacin were greater than the RDA, whereas the remaining nutrient intakes were lower than the RDA. The average BMD of the subjects was shown to be 1.06${\pm}$1.09g/$\textrm{cm}^2$. The highest BMD of 1.24${\pm}$0.14g/$\textrm{cm}^2$ was noticed in the subjects of 30s compared to 20s, 40s, 50s, 60s. The BMD values were compared by the relative body weight(R3W) of the menopause subjects, and it was found that the underweight group had significant lower BMB while the rest of the groups did not have any differences in BMD. The most strongly correlated nutrient with BMD among the menopause subjects appeared to be calcium. The women whose Ca intakes were higher than 500mg showed the significantly higher BMD than those with Ca intakes lower than 500mg. This study suggests that the most effective way to prevent osteoporosis and to reduce the incidences of fractures seems to be minimizing bone loss through the adequate intake of calcium as well as avoiding underweight, especially in menopausal women. (Korean J Nutrition 31(9) . 1446-1456, 1998)
Recent research has indicated that the current ACI shear provision provides unconservative predictions for large slender beams and beams with low level of longitudinal reinforcement, and conservative results for deep beams. To modify some problems of ACI shear provision, ultimate shear strength equation considering size effect and arch action to compute shear strength in high-strength concrete beams without stirrups is presented in this research. Three basic equations, namely size reduction factor, rho factor, and arch action factor, are derived from crack band model of fracture mechanics, analysis of previous some shear equations for longitudinal reinforcement ratio, and concrete strut described as linear prism in strut-tie model deep beams. Constants of basic equations are determined using statistical analysis of previous shear testing data. To verify proposed shear equation for each variable, effective depth, longitudinal reinforcement ratio, concrete compressive strength and shear span-to-depth ratio, about 300 experimental data are used and proposed shear equation is compared with ACI 318-99 code, CEB-FIP Model code, Kim &Park's equation and Zsutty's equation. The proposed shear equation is not only simpler than other shear equations, it is but also shown to be economical predictions and reasonable safety margin. Hence proposed shear strength equation is expected to be applied to practical shear design.
Ground magnetic surveys were conducted at four areas where the Yangsan fault, the most prominent lineament in the Kyeongsang basin, appears to be passed through. For data processing, IGRF correction, upward continuation and reduction-to-the-pole were performed. The automatic inversion by using a matrix computation method, which takes the depth to bottom layer of the horizontal two layer structure as the model parameter, has been attempted to delineate the subsurface structure. Upward continuation of the surface magnetic map to the same level of the aeromagnetic survey (KIER, 1989) resulted in very similiar patterns to those of aeromagnetic data. Subsurface modeling of eight profile data show that the strike and dip of the Yangsan fault in study areas are $N6^{\circ}-15^{\circ}E$, and near vertical to somewhat eastward, repectively, despite of the local lithological contrast of each study area. It seems that the magnetic effect of faulting in the study area 1, which locates in the most northern part of the survey areas, is disturbed by that of igneous intrusion. At study area 2, the possibility of volcanic or igneous intrusion, which is 200-300 meters wide along the fault plane was presented. At study area 3, unlike other study areas, distinct fracture zone of 500-700 meters in width was revealed along the surface fault line. The andesitic rocks of the study area 4 have very high susceptibilities and the fault line on surface of this area was shifted about 500 meter eastward, as compared with the inferred fault line by the previous study.
Jo, Si-Hoon;Jeong, Su-Yang;Nam, Hyun-Seok;Song, Kwang-Yeob;Park, Ju-Mi;Ahn, Seung-Geun
Journal of Dental Rehabilitation and Applied Science
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v.26
no.4
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pp.477-482
/
2010
In a case of multiple posterior teeth loss, antagonistic teeth extrude to the edentulous space and compensatory occlusion on the remained anterior teeth leads to occlusal trauma. Extrusion of antagonistic teeth breaks down occlusion plane and loss of posterior support bring about severe wear of remained teeth. In this situation, it is needed to restore remained teeth and edentulous space by increasing vertical dimension to obtain prosthodontic rehabilitation space and to correct occlusion plane. In this case report, the patient had a masticatory problem with loss of posterior teeth support and an esthetic problem of shortened anterior teeth. Before the tooth preparation for the prosthodontic restoration, the patient used removable device for 2 months to increase vertical dimension reversibly. After that, he got provisional fixed restoration with irreversible tooth reduction and used it for 3 months. It had spent 5 month to evaluate the adaptation state on final restoration with incresed vertical dimension. The increasing amount was 3 mm, which was relatively in less degree and masticatory system adapted to the increased vertical dimension without any pathologic changes. Final restoration was made to have equal-intensity contacts on all teeth in a verifiable centric relations and immediate disclusion of all posterior contacts the moment the mandible moves in any direction from centric relation. In addition, metal occlusion surface on posterior teeth was applied to prevent excessive muscle activation, occlusal trauma and the porcelain fracture.
Nha Koung Wook;Jung Byung Hyun;Suh Jin Soo;Suk Seung Yeub;Park Gyu Won;Chae Dong Ju
Journal of the Korean Arthroscopy Society
/
v.6
no.1
/
pp.25-30
/
2002
Purpose : To evaluate the clinical results of displaced tibial intercondylar eminence fractures which were treated with transpatellar cannulated screw fixation. Materials and Methods : Ten patients with displaced tibial intercondylar eminence fractures were treated between December 1998 and May 2001 and then followed up for more than one year. They were treated arthroscopic reduction and fixation of fracture site by cannulated screw through the hole of nonarticular surface of inferior patella. They were prospectively evaluated with regard to their clinical and radiologic results. Results : Radiologic unions occurred at an average of 9.2 weeks. Average anterior displacements were 1.8 mm in stress x-rays and 1.1 mm in KT-2000 arthrometer. Average loss of extension was $4.1^{\circ}$. Functional results were excellent in 7 cases and good in 3 cases. Conclusion : Arthroscopic transpatellar cannulated screw fixation is one of the useful methods for the treatment of displaced tibial intercondylar eminence fractures.
Fracture mode and carbide reactions of cast alloy 738LC during thermal exposure and creep at 816$^{\circ}C$/440MPa and 982$^{\circ}C$/152MPa were investigated. Crystallographic transgranular failure was observed in the specimen crept at 816$^{\circ}C$ due to shearing on the slip plane. Because selective oxidation at the grainboundaries which was exposed at the surface leads reduction in surface energy, however, early initiation of crack at the grainboundaries and intergranular failure were observed in the specimen crept at 982$^{\circ}C$/152MPa. As a result of decomposition of MC carbide at the tested temperatures, M(sub)23C(sub)6 carbide precipitated either on the grainboundaries or on the deformation band. The applied stress enhanced decomposition of MC. $\sigma$phase nucleated from Cr(sub)23C(sub)6 then grew to the ${\gamma}$+${\gamma}$\\` matrix. Precipitation of $\sigma$was accelerated by increasing temperature and applied stress.
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