• Journal of Audiology & Otology
• /
• v.25 no.3
• /
• pp.159-162
• /
• 2021

Temporal bone trauma can cause hearing loss and in case of prolonged conductive hearing loss, traumatic ossicular injury should be considered. Separation of the incudostapedial joint is the most common lesion, and stapediovestibular dislocation is relatively rare but can easily cause perilymphatic fistula. Here, we report a very rare case of external stapediovestibular dislocation after trauma, ending up with successful surgical outcome. A 27-year-old man with non-progressive hearing loss on the right side since childhood visited the clinic. Audiogram showed a conductive hearing loss with air-bone gap of 55 dB on the right side. Temporal bone CT revealed the disruption of ossicular chain. An exploratory tympanotomy identified multiple ossicular disruptions including external stapediovestibular dislocation with shiny fibrous membrane sealing the oval window. Ossicular chain reconstruction was performed using the total ossicular replacement prosthesis of titanium. A postoperative audiogram showed a recovery of air-bone gap less than 10 dB. To the best of our knowledge, this is the first case of external long-standing stapediovestibular dislocation, with oval window completely sealed with fibrous membrane, ending up with successful hearing recovery by surgery. This case would help dealing with such condition which can be encountered in the clinic.

• Korean Journal of Audiology
• /
• v.25 no.3
• /
• pp.159-162
• /
• 2021

Temporal bone trauma can cause hearing loss and in case of prolonged conductive hearing loss, traumatic ossicular injury should be considered. Separation of the incudostapedial joint is the most common lesion, and stapediovestibular dislocation is relatively rare but can easily cause perilymphatic fistula. Here, we report a very rare case of external stapediovestibular dislocation after trauma, ending up with successful surgical outcome. A 27-year-old man with non-progressive hearing loss on the right side since childhood visited the clinic. Audiogram showed a conductive hearing loss with air-bone gap of 55 dB on the right side. Temporal bone CT revealed the disruption of ossicular chain. An exploratory tympanotomy identified multiple ossicular disruptions including external stapediovestibular dislocation with shiny fibrous membrane sealing the oval window. Ossicular chain reconstruction was performed using the total ossicular replacement prosthesis of titanium. A postoperative audiogram showed a recovery of air-bone gap less than 10 dB. To the best of our knowledge, this is the first case of external long-standing stapediovestibular dislocation, with oval window completely sealed with fibrous membrane, ending up with successful hearing recovery by surgery. This case would help dealing with such condition which can be encountered in the clinic.

• Clinical Pain
• /
• v.20 no.2
• /
• pp.131-134
• /
• 2021

We report a rare case of anti-viral agent induced hypophosphatemic osteomalacia presented with localized and radicular pain. A 51-year-old man, who had been taking adefovir for chronic hepatitis, had experienced low back pain radiating to his right thigh for 2 years. With impression of lumbar disc herniation, he underwent magnetic resonance imaging and found multi-level disc herniation with facet joint synovial cysts. He received transforaminal epidural steroid injections, however, symptoms did not improve. To find other possible causes, additional tests were performed. Blood tests revealed hypophosphatemia and increased serum alkaline phosphatase, and osteoporosis was noted in dual-energy X-ray absorptiometry with multiple hot uptakes in bone scan. After replacement of adefovir to entecavir and supplement of phosphate and vitamin D, phosphate level and the clinical symptoms were improved. This is the first to report the presentation of osteomalacia due to anti-viral agent as radicular low back pain with facet synovial cysts.

• Clinics in Shoulder and Elbow
• /
• v.24 no.3
• /
• pp.183-188
• /
• 2021

We report a case of a 69-year-old right-dominant man who had an open Monteggia-like lesion of the right elbow (Gustilo-Andersen IIIA) with severe proximal ulna bone loss associated with an ipsilateral ulnar shaft fracture due to a motorcycle accident. The patient underwent two-stage surgery. Wound debridement and bridging external fixation were performed at first. Three months later, a frozen massive osteochondral ulnar allograft was implanted and fixed with a locking compression plate. A superficial wound infection appeared 5 weeks after the second surgery. Superficial wound debridement, negative pressure therapy, and antibiotics were administered for 3 months, achieving infection healing. At 3 years post-surgery, the elbow range of motion was satisfactory with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 16.7. Radiographs and computed tomography scans showed good allograft-bone integration without allograft reabsorption or hardware loosening. Although not complication-free, massive ulna osteochondral allograft implantation can be considered a valid option in cases of open Monteggia-like lesions associated with ulnar shaft fracture and severe bone loss in active patients, whenever osteosynthesis or joint replacement is not a proper solution. This type of bone stock restoration allows for future surgery, if needed.

• Proceedings of the Korean Institute of Information and Commucation Sciences Conference
• /
• 2021.05a
• /
• pp.470-473
• /
• 2021

In this study, we developed the biometric ultrasound transducer, residual thickness measurement algorithm and optimized ultrasound operation methods to diagnose precise conditions of implanted medical prosthetic material inserted during total hip artificial joint replacement. In detail, ultrasound transducers having 8 MHz and 20 MHz center frequencies with similar sensitivity and bandwidth were fabricated to measure various thicknesses of commercial polyethylene-based artificial hip liners, resulting in a comparative analysis of signal-to-noise ratio and axial resolution to conduct an optimization study of ultrasound operations in vivo.

• Structural Engineering and Mechanics
• /
• v.88 no.6
• /
• pp.583-588
• /
• 2023

Total hip replacement is a crucial intervention for patients with fractured hips who face challenges in natural recovery. The design of durable prostheses requires a comprehensive understanding of the natural processes occurring in bone. This article focuses on static loading analysis, specifically during stumbling activity, aiming to enhance the longevity of prosthetic implants. Three distinct implants, Charnley, Osteal, and Thompson, were selected for a detailed study to determine the most appropriate model. The results revealed critical insights into the distribution of Von Mises stresses on the components of femoral arthroplasty, including the cement, implant, and cortical bone. Furthermore, the examination of shear stress within the cement emerged as a pivotal aspect for all three implants, playing a crucial role in evaluating the performance and durability of hip prostheses. The conclusions drawn from this study strongly suggest that the Thompson model stands out as the most suitable choice for hip joint implants.

• The Journal of the Korean bone and joint tumor society
• /
• v.13 no.1
• /
• pp.48-54
• /
• 2007

Purpose: To evaluate clinical results of the tumor prosthetic replacement for pathologic fracture of the proximal femur with extensive bony destruction due to metastatic bone tumors. Materials and Methods: From 2005 October to 2006 October, resection of proximal femur and tumor prosthesis replacement was performed for metastatic bone tumors extensively involving trochanteric area in 6 patients. The mean age of overall patients was 61(range, 48~77). Mean clinical follow up was 10.5 months (range, 6~16). Primary tumor consisted with multiple myeloma in 2 patients, lung cancer in 1, breast cancer in 1, transitional cell carcinoma of the renal pelvis in 1, unknown origin in 1 patient. $MUTARS^{(R)}$ proximal femur (Implantcast, Munster, Germany) were used in all cases. The functional evaluation in the lower extremities was performed with Musculoskeletal Tumor Society 1993 scores. The degree of pain relief after surgical treatment was assessed with Visual Analogue Scale (VAS). Results: At the final follow up, all of the patients survived. The mean lower extremities functional score of Musculoskeletal Tumor Society 1993 was 17.8(59.3%)(range, 12~25). VAS was improved to 2.5 from 8.5 after the surgical treatment. Ambulation was encouraged as soon as possible and mean duration after surgery for ambulation was 7.3(range, 3~16) days. Post-operatively, there was no surgical infection, periprosthetic fracture or loosening. Dislocation occurred in one out of six cases. Conclusion: Resection of proximal femur and tumor prosthesis replacement for metastatic bone tumors around proximal femur extensively involving trochanteric area seems to be safe procedure in view of post-operative complication, and effective for functional restoration as well as pain relief. Thus, it is accordant to the treatment principle of the metastatic bone tumors.

• The Journal of the Korean bone and joint tumor society
• /
• v.1 no.2
• /
• pp.154-163
• /
• 1995

With the development of anticancer chemotherapy and improved radiographic imaging studies, limb salvage operation became possible in the treatment of malignant and aggressive benign tumors. High grade sarcomas of the shoulder or the upper extremity can be surgically treated with a forequarter amputation, shoulder disarticulation or limb salvage surgery such as Tikhoff-Linberg procedure, segmental resection and replacement with endoprosthesis, segmental resection and replantation, or segmental resection and free vascularized bone graft. Among them the limb salvage surgery showed not only preservation of the remained upper extremity but also the excellent functional results. When comparing amputation and limb salvage operation while performing anticancer chemotherapy in both cases, 5 year survival rate, local recurrence, and distant metastasis did not show much difference. We studied 13 cases of limb salvage for the malignant and aggressive benign bone tumor of the upper extremity from March 1986 to December 1993 at Severance hospital. The summarized results were as follows. 1. There were 21 cases of malignant bone tumors and 5 cases of benign aggressive ones. 2. Of the 26 cases of malignant and benign aggressive bone tumors, limb salvage procedures such as Tikhoff-Linberg operation(8 cases), endoprosthetic replacement(2 cases), segmental resection and replantation(2 cases), and segmental resection and free vascularized fibular graft(l case) were done in 13 cases. 3. In 13 patient on whom the limb salvage procedure was performed, there were 3 osteosarcomas, 4 chondrosarcomas, 3 giant cell tumors, 1 Ewing's sarcoma, 1 leiomyosarcoma and 1 chondroblastoma. 4. In 13 patients, there was no local recurrence nor distant metastasis except one who had a segmental resection of the entire humerus part including glenoid and then postoperative anticancer chemotherapy for the treatment of the Ewing's sarcoma of the entire shaft of the humerus with pathological fracture. Local recurrence occurred 2 years and 6 months postoperatively in this Ewing's sarcoma patient, so forequarter amputation was performed and the irradiation and the anticancer chemontherapy were performed, but multiple bony metastasis developed and died of the disease 22 months after local recurrence. 5. The patients were followed-up for I year to 7 years and 5 months(average 4 years 5 months). 6. In 8 cases in which Tikhoff-Linberg procedure was performed, the function of the hand was almost normal. 7. Segmental resection and endoprosthetic replacement was performed in 2 cases, and the function of the remained upper extremity was good with no evidence of aseptic loosening or nerve palsy. 8. In 1 case of segmental resection and free vascularized fibular graft for the patient of the chon drosarcoma in the humerus, the function of the shoulder, elbow and hand was nearly normal. 9. In I case of leiomyosarcoma which involved both forearm muscles and bone near wrist joint, segmental resection and replantation was performed, and the patient has useful hand function.

• Clinics in Shoulder and Elbow
• /
• v.14 no.1
• /
• pp.140-145
• /
• 2011

Purpose: Installing a radial head prosthesis has developed into a reliable procedure to replace the native radial head for treating unreconstructible radial head fracture when this is associated with an unstable elbow or forearm. A variety of implants have been developed and these are now commercially available. This article reviews the literature related to the indications, the available implants and the surgical techniques of radial head replacement arthroplasty. Materials and Methods: The main indication for a metallic radial head prosthesis is a comminuted fracture that is not amenable to reconstruction, and particularly if it is associated with complex elbow injuries. Excision of the radial head should be avoided in the presence of combined injured ligaments or interosseous membrane injury. Three different implants are available in Korea, including the bipolar, press fit monopolar and loose fit monopolar radial head prostheses. A primary technical goal of radial head arthroplasty is the insertion of an implant that closely replicates the native radial head. The major pitfall when using a metallic radial head prosthesis is the insertion of a longer implant, which results in overstuffing of the radiocapitellar joint. Results and Conclusion: Satisfactory clinical results can be anticipated when a radial head prosthesis is used for the correct indications and when a systemic approach is undertaken to ensure proper sizing. For the future studies, we need data regarding the long term outcomes and comparison of the various types of prostheses.

• Clinics in Shoulder and Elbow
• /
• v.13 no.2
• /
• pp.293-298
• /
• 2010

Purpose: Since an injured elbow joint can disturb the activity of daily life by limiting motion, especially if the motion is restricted over 40 degree of flexion contracture and under 105 degree of further flexion, it is imperative to select the best method and the timing of treatment of the elbow stiffness. Therefore this review will discuss open surgical techniques for stiff elbows based on the literature. Materials and Methods: It is important to take sufficient clinical examination of the patient, including history taking. And, a surgeon should select appropriate procedure after accurately understanding about the status and cause of the stiff elbow with radiographic methods. Surgical methods include arthroscopic release open release, distraction arthroplasty, total elbow replacement and there are four approachs in the open release - anterior approach, medial "over the top" approach, limited lateral approach: column procedure, posterior extensile approach-. Results and Conclusion: Although at present the arthroscopic technique is emphasized for the treatment of elbow stiffness, a surgeon should know conventional open techniques.