• Clinics in Shoulder and Elbow
• /
• 제9권1호
• /
• pp.96-104
• /
• 2006

Purpose: To evaluate and compare the results of children with displaced supracondylar fractures of humerus treated with open reduction and pinning with closed reduction and pinning. Materials and Methods: From March 2002, we treated 17 patients with completely displaced supracondylar fractures under the age of 7 with a minimal follow up period of 6 months. 9 patients were treated with closed reduction and pinning and 8 patients were treated with open reduction and pinning. The clinical results were evaluated with Flynn's criteria. Time to bone union was also analyzed for these two set of patients. Results: The group treated with open reduction had 6 excellent and 2 good results for change in carrying angles, 5 excellent, 2 good and 1 fair results for motion loss evaluated by Flynn's criteria. The average time to bony union for this group was 5.8 weeks. The group treated with closed reduction had 6 excellent, 2 good, and 1 fair results for change in carrying angles and 7 excellent, 1 good and 1 fair results for motion loss. The average time to bony uinon for this group was 3.7 weeks. Conclusion: In treating completely displaced supracondylar fractures of humerus in children, the closed reduction method and open reduction method all showed good results. But the operation time, duration of hospital stay and time to union was somewhat shorter for the patients treated with closed redution and pinning.

• 대한정형외과스포츠의학회지
• /
• 제2권2호
• /
• pp.168-175
• /
• 2003

근위 상완골 골절은 골절의 형태에 따라 크게 관절편 또는 해부학적 경부, 대 결절, 소 결절, 상완골 간부 또는 외과적 경부의 4개의 골절편으로 나눌 수 있다. 현재 널리 사용되고 있는 Neer의 근위 상완골 골절의 분류는 골절선에 의해 골절편을 나누는 분류가 아니며, 1 cm이상전이나 45$^{\circ}$ 이상의 각형성 이 있는 경 우를 전 이 골절편으로 생각하였다. 골절에 대한 관혈적 정 복 및 내고정술의 일차적 적응증은 골다공증이 없는 젊은 환자에서 발생된 튼튼한 내고정물을 시행할 수 있는 삼분 골절로 만족할 만한 결과를 위해 술후 오랜 기간동안 시행할 재활치료에 잘견딜수 있는 활동력 이 좋은 환자여야 한다. 수술적 치료의 절대적 적응증은 개방성 골절 ,혈관이 나 신경 손상이 동반될 때 , 정복이 불가능한 골절 탈구등이다. 반대로 환자가 골다공증이 심하거나, 근위 상완 골절편의 분쇄정도가 심하며 , 튼튼한 내고정을 시행할 가능성 이 희박한 나이가 많은 경 우에는 관혈적 정복 및 내고정술보다 일차적 인공삽입물을 이 용한 관절성형 술을 시행한 후 조기 재활 치료를 시행하는 것을 고려할 수 있다. 상완골 근위부 골절의 수술적 요법에는 다양한 수술 기법과 이에 따른 여러 합병증이 발생할 수 있으며 지속적 이고 체계적 인 재활 치 료가 꼭 필요하다. 여러 수술 기 법 중 관혈적 정복 및 장력 대 강선 기법을 시행할 때 만족할 만한 결과를 얻 을 수 있다. 이 방법 은 수술적 기법이 어렵지 않고, 골에 대한 고정과 함께 회전근 개의 건부착 부위에 대한 봉합을 추가할 수 있으나 역시 여러 가지 합병증이 있으므로 골절의 양상이 나 환자의 상태 ,환자의 활동력 등을 고려하여 치료 방법을 결정하여야 할것으로 사료된다.EX>46N으로, 슬개건-티타늄 간섭나사군이평균 1067.4$\pm$145N에서평균 601.8$\pm$134N으로, 슬개건-생체흡수성간섭나사군이평균 987.1$\pm$168N에서588.7$\pm$124N으로각각40$\%$, 39$\%$, 50$\%$, 24$\%$, 44$\%$, 40$\%$가감소하였다. 결론: 수술후초기고정력은슬괵건을LA나사(R) 또는Semifix(R)로고정하는방법과슬개건을티타늄및생체흡수성간섭나사로고정하는방법등이우수하였으며, 슬괵건을생체흡수성간섭나사나Endobutton(R)으로 고정하는 방법 등은고정력이 상대적으로매우약함을 알수있었다. 최대인장력은단순인장검사로는이상의대퇴골측고정방법의고정력이초기부하를견뎌내는데충분하다고생각되었으나주기성부하실험후현저히감소되어충분한초기안정성을제공하지못함을알수있었다.를 나타내었다. 또한 3m깊이에서의 측방 선량분포에서 Spoiler의 거리변화(6, 10cm)는 심부선량의 변화에 영향을 주지 않는 것으로 확인할 수 있었다. 그리고 위의 실험측정치를 치료계획 시스템에 입력하여 선량분포를 확인한 결과 Spoiler를 사용하는 경우 OPEN에 비해 선량분포 영역을 표면으로 끌어 올릴 수 있으며 Bolus 보다 피부 보호효과는 어느 정도 유지가 되는 것을 보여주었다. 4.결론 이와 같이 Spoiler는 Bolus와 비교하여 6MV 광자선의 build up 영역을 표면으로 증가시키는 동시에 Skin Sparing(피부보호)효과를 유지할 수 있으며 두경부암의 치료에서 Spoiler의 사용이 가능한 조건으로는 조사면이

• Clinics in Shoulder and Elbow
• /
• 제15권1호
• /
• pp.25-31
• /
• 2012

목적: 65세 이상의 상완골 근위부 골절 환자에 대하여 다축 각안정 잠김 압박 금속판 (Non-Contact-Bridging proximal humerus plate, Zimmer, Switzerland, NCB)을 이용하여 내고정술을 시행하고 그 임상적, 방사선적 결과를 알아보고자 하였다. 대상 및 방법: 2007년 8월부터 2011년 1월까지 65세 이상의 상완골 근위부 골절 환자 중 NCB 금속판을 이용하여 내고정술을 시행한 32명의 환자를 대상으로 하였다. 평균 연령은 71세 였으며 평균 추시 기간은 11.5개월이였다. 골절의 분류는 2분 골절이 14예, 3분 골절이 18예였다. 임상적 평가는 VAS 점수와 Constant 점수를 이용하였으며, 방사선학적 평가는 골유합 시기와 Paavolainen 방법으로 경간각을 평가하였다. 결과: 최종 추시 시 VAS 점수는 평균 3점, Constant 점수는 평균 64.5점이었으며 모든 예에서 수술 후 평균 16.2주에 골유합을 얻었다. 방사선학적 평가 결과 최종 추시 시 경간각은 평균 125.9도로 우수 24예, 양호 8예이었다. 강선 파열 1예 및 지연유합 1예, 경미한 금속판의 견봉하 충돌로 인한 통증 호소 3예 등의 합병증이 관찰되었으며 정복소실, 나사 이완, 불유합, 상완골 골두의 무혈성 괴사 등은 없었다. 결론: NCB 금속판을 이용한 내고정술은 골절의 고정 및 정복의 유지가 어려운 고령의 상완골 근위부 골절 환자의 치료에 효과적인 수술 방법 중 하나로 생각된다.

• Parasites, Hosts and Diseases
• /
• 제51권4호
• /
• pp.453-459
• /
• 2013

Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was $40.9{\pm}18.8$ years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn't develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive.

• 대한골관절종양학회지
• /
• 제1권1호
• /
• pp.52-59
• /
• 1995

Metastatic cancer is the most common tumor of the skeleton. The prevalence of pathologic fracture may increase as patient survival is prolonged by improved cancer therapy. With recent advances in orthopaedic procedure and medical management of terminal cancer patients, it is generally agreed that aggressive treatment should be undertaken for patient with pathologic fracture secondary to metastatic disease, and a team approach should be utilized. The authors have reviewed twenty cases of pathologic fracture of the long bone due to metastatic tumor treated in the Department of Orthopedic Surgery, Yonsei University College of Medicine, from April 1989 to April 1994 and the following results were obtained. 1. The mean age at surgery was 58.4 years (ranged from 24years to 86years) and among 20 cases, 10 cases were male and the others were female. 2. The most frequent site of pathologic fracture in long bone is femur(15 cases, 75%), and followed by humerus(4 cases, 20%), tibia(1 case). 3. The frequently encountered primary tumors that metastases to long bone are those of the lung(7 cases, 35%), breast(4 cases, 20%), and prostate(2 cases, 10%). 4. The operative procedure was performed by resection of the tumor mass extensively, and we used polymethylmetacrylate for filling the dead space after resection, in all cases. 5. The mean survival period after operation is 9.2 months(ranged from 1 month to 4 years and 9 month). 6. The results of postoperative pain relief status were graded as fair to excellent in 17 cases(85%).

• Clinics in Shoulder and Elbow
• /
• 제18권2호
• /
• pp.86-90
• /
• 2015

Background: Although there are several methods for evaluating bone quality, Hounsfield units (HU), a standardized computed tomography (CT) attenuation coefficient, provide a useful tool for estimating focal bone mineral density (BMD). The aim of this study is to investigate the HU for evaluating the degree of osteoporosis in greater tuberosity with regard to anchor positioning. Methods: Forty patients diagnosed as normal on shoulder CT were included and categorized according to age and gender. Axially sectioned CT images were processed to 3-dimensional models containing information about bone quality using Mimics (14.11 platform v14.1.1.1 Materialise). Three-dimensional anchors were simulated and positioned according to 6 regions of interest (ROI) in the greater tuberosity classified using Tingart's system. Mean HU of intra-anchor volumes in the 6 regions was measured. Results: A significant decrease in HU was observed with increasing age (p=0.0001) and menopause (p<0.001). A significant difference in HU was found between male and female groups with males showing the higher values (p=0.0001). HU of proximal areas of ROI was higher than those of distal areas (p<0.005). However, although mean HU of distal posterior ROI showed the lowest values, no statistically significant difference was found between anterior, middle, and posterior regions (p=0.087). Conclusions: Mean HU of ROIs provides a tool for preoperative assessment of focal BMD, which is a factor of suture anchor stability and can be used to aid decision-making regarding secure anchor positioning for rotator cuff repair. Our data support that the most secure point is the proximal regions of ROI.

• 한국정밀공학회지
• /
• 제28권8호
• /
• pp.984-991
• /
• 2011

The aim of this study is to develop a humeral Intramedullary fixation nail (HIFN) suitable for Korean people. In this study, CT images were obtained from 72 Korean cadaveric humeral bones and 3D Korean humeral bone models were reconstructed based on the CT images to investigate anatomical characteristics. Major design parameters of HIFN were selected using the morphological measurement information of the Korean humeral bone models. Through finite element analysis and mechanical tests, the developed HIFN prototype was compared with the Polarus HIFN ($ACUMED^{(R)}$, USA), and it was found that the HIFN prototype showed similar and/or superior mechanical performance compared to the Polarus HIFN. Also, clinical validation for the HIFN prototype was carried out to check predictable troubles in surgical operations. Finally, optimal design modification was proposed to prevent the possible axillary nerve injury due to the locking screw system of the HIFN prototype.

• 한국임상수의학회지
• /
• 제33권5호
• /
• pp.261-265
• /
• 2016

The purpose of this study was to perform retrospective data collection of the sites and types of fracture in raptors in order to enable wildlife veterinarians to manage cases of fracture more effectively. This study included raptors with fracture, rescued between January 2013 and August 2015 in the Daegu-Gyeongbuk region in Republic of Korea. The data were collected from the medical reports and radiographic findings acquired from designated animal hospitals for wild animals, the Dongin Animal Hospital and the Kyungpook wildlife rescue center. The distribution, sites, and types of fracture, and outcomes of rescue and fracture management of the raptors included in this study were analyzed. Among the 31 birds included in this study, Falco tinnunculus was the most common species. Of the 42 sites of fracture, the diaphysis of the humerus was the most common site of fracture, and comminuted fracture was the most common type. Of the 31 birds, 13 were treated surgically. Intramedullary pinning with bandaging was the most common method of surgical treatment. While 7 of the 13 birds died, 2 were reintroduced into the wild, and 4 were kept captive. This study presents the evaluation of the data on the species, sites, and types of fracture, and treatment procedures and outcomes in raptors with fractures, rescued in the Daegu-Gyeongbuk region. The findings of this study could serve as a basic database for the treatment of fracture in raptors.

• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
• /
• 제55권3호
• /
• pp.173-176
• /
• 2012

Oncocytic neoplasm of the head and neck region accounts for approximately 1% of all salivary gland tumors, but only 5% of oncocytic neoplasm is malignant. Oncocytic carcinoma arising in the submandibular gland is exceedingly rare. We encountered a sixty seven-year-old male patient who presented with multiple mass in the right neck. Fine needle aspiration biopsy revealed a salivary gland tumor of predominantly oncocytic form, and a differential diagnosis included oncocytic adenoma or mucoepidermoid carcinoma. A right submandibular gland resection and modified radical neck dissection were performed. Histologically, the tumor cells showed nuclear pleomorphism, and stromal invasion, which were compatible with oncocytic carcinoma. After surgery, the entire neck region was irradiated. Seventeen months after the initial surgery, multiple metastases to the bone and lung were detected from the incidental pathologic bone fracture of the right humerus; palliative chemotherapy was performed to resolve this. We report a case of oncocytic carcinoma in the submandibular gland with a review of literature.

• 대한족부족관절학회지
• /
• 제5권2호
• /
• pp.156-159
• /
• 2001

Unicameral bone cysts are benign solitary lesions that occur in the first two decades of life and with a greater frequency in the humerus and femur. The cyst is usually asymptomatic unless a fracture or impending fracture is present. The traditional method of treating unicameral cysts has been curettage with bone graft or steroid injection. Also, pathologic fractures in the calcaneus, unlike in other bones, are reported especially in the children to be nonexistent. In general, closed treatment was recommended for most of the calcaneal fractures in children, but suggested open reduction when joint displacement was severe. We report a case of displaced intraarticular fracture of the calcaneus with unicameral bone cyst in a child treated by classic curettage, allograft and open reduction with screw fixation.