• Journal of Veterinary Clinics
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• v.39 no.2
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• pp.59-64
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• 2022

A dog aged two years and seven months and a cat aged seven years were referred owing to fractures of long bones. Preoperative radiographs revealed comminuted bone fractures close to joints. Conventionally, long-bone fractures are treated using intramedullary pins, plate and screw systems, or an external fixator system. In cases of non-reducible fractures, various graft materials have been used in fracture treatments to stimulate bone repair. Here, recombinant human bone morphogenetic protein-2 (rhBMP-2) and a collagen membrane were applied. Four weeks after surgery, fractured bone fragments began to unite and the bone union was observed using radiography four months after surgery. No complications occurred related to grafted materials. We successfully applied rhBMP-2 and collagen membranes in two different species to support the healing process of comminuted fractures, according to the concept of guided bone regeneration.

• Journal of Veterinary Clinics
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• v.25 no.3
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• pp.215-217
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• 2008

Medical records from the Veterinary Medical Teaching Hospital of the University of Missouri-Columbia from 2004 to 2007 were available for 28 raptors that underwent long bone fracture repair. There were 14 owls, 10 hawks, 2 vultures, 1 eagle, and 1 falcon. Mean body weight was 780 g (ranged from 150 to 1400 g) for 14 owls; 650 g (ranged from 150 to 1270 g) for 10 hawks; 1760 g (ranged from 1520 to 2000 g) for 2 vultures; 5000 g for 1 eagle; and 130 g for 1 falcon. Of all 28 fracture cases, 11 cases (39%) and 1 case (3%) were related to hit-by-car and shooting respectively. Physical examination revealed dehydration in 18 raptors (64%) and lethargy in 12 raptors (42%). Forty one long bone fractures were included in 28 cases. The radiographs revealed 13 ulnar fractures (32%), 12 humeral fractures (30%), 10 radial fractures (25%), 4 tibiotarsal fractures (9%), 1 femoral fracture (2%), and 1 fibular fracture (2%). External skeletal fixation using polymethylmethacrylate (PMMA) combined with intramedullary fixation was used in 19 long bone fractures (46%). Intramedullary fixation using intramedullary Kirschner pin was used in 16 long bone fractures (39%). No surgical treatment was performed in 6 long bone fractures (15%). This study reported that many of raptors presented dehydration and lethargy when admitted for treatment. Therefore, proper hydration and nutrition are critical pre-surgical requirements. In addition, combination of internal fixation and external skeletal fixation using PMMA might be better option to treat raptors with comminuted fracture that results from mostly trauma of hit-by-car.

• Proceedings of the Korea Society of Information Technology Applications Conference
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• 2005.11a
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• pp.91-97
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• 2005

Bones are dynamic structures, being supported by muscles, tendons, and ligaments. When some or all the structures are disturbed i.e. in fractures, the alignment of the bone in respect to the rest of the body is deranged. This gives rise to axial as well as rotational deformity in three dimensional planes. The correct alignment and position of the long bones are to be maintained to heal the bone in the best possible anatomical and functional position. The objective of this research is to address the problems in the current practice involving surgeon, assistant, fluoroscopy and crude mechanical means and to see if a robotic solution exists to solve the problems of manipulating and reducing long bone fractures. This paper presents various design aspects of the proposed surgeon-instructed, image-guided and robotic system including the system design specification, robot design and analysis, motion control and implementation, and x-ray image processing and incorporation in CAD environment.

• Clinical and Experimental Pediatrics
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• v.56 no.2
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• pp.60-67
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• 2013

As chemotherapy and other sophisticated treatment strategies evolve and the number of survivors of long-term childhood cancer grows, the long-term complications of treatment and the cancer itself are becoming ever more important. One of the most important but often neglected complications is osteoporosis and increased risk of fracture during and after cancer treatment. Acquisition of optimal peak bone mass and strength during childhood and adolescence is critical to preventing osteoporosis later in life. However, most childhood cancer patients have multiple risk factors for bone mineral loss. Cancer itself, malnutrition, decreased physical activity during treatment, chemotherapeutic agents such as steroids, and radiotherapy cause bone mineral deficit. Furthermore, complications such as growth hormone deficiency and musculoskeletal deformity have negative effects on bone metabolism. Low bone mineral density is associated with fractures, skeletal deformity, pain, and substantial financial burden not only for childhood cancer survivors but also for public health care systems. Thus, it is important to monitor bone health in these patients and minimize their risk of developing osteoporosis and fragility fractures later in life.

• Journal of Korean Neurosurgical Society
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• v.38 no.5
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• pp.350-354
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• 2005

Objective : The aim of this study is to assess the immediate and long-term efficacy of percutaneous vertebroplasty for treating painful vertebral osteoporotic fractures. Methods : A retrospective review of 149patients who had undergone 167 vertebroplasty procedures for osteoporotic fractures was performed. Clinical, radiologic, and procedural datas were analyzed as parameters of prognostic significance, including age, sex, bone marrow density score, symptom duration, bone cement filling grade, number of fractured vertebrae, compression grade of vertebrae, leakage of bone cement, volume of bone cement injected and complications. Results : In 158 of the 167 procedures assessed, immediate pain relief was obtained [94.6%]. The extent of collapse of the vertebral body was assessed as a parameter for prognostic significance [p=0.015]. Three months postoperatively, no improvement of the pain was observed in four of the 167 procedures that had undergone the vertebroplasty [2%]. At long-term follow-up, the improvement of pain was not correlated with the compression grade of vertebrae [p=0.420]. Conclusion : The immediate outcome of vertebroplasty are less effective in vertebrae more collapsed.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.37-43
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• 2009

Purpose: A missed fracture is a very common occurrence in the Emergency Department (ED) and can have serious results because of delays in treatment, resulting in long-term disability. It is also one of the most common causes leading to medical legal issues. We analyzed the causes of missed fractures by using a bone scan which is known to be an effective tool for diagnosing bony lesions. Methods: We reviewed the medical records of trauma patients who underwent a bone scan after being discharged the ED from September 2006 to March 2008. Cases of missed fractures were identified by using electronic medical records to review each diagnosis. Definition of missed fracture was read after bone scan by radiologist. We decided that there was no fracture if we read 'trauma-related lesion' or 'cannot rule out fracture' on a bone scan read by a radiologist. Enrolled patients were analyzed by age, sex, time until bone scan and Injury Severity Score (ISS). Patients were divided into two groups, alert mentality and not-alert mentality, so there were split between a diagnosis group and a missed fracture group. ISS was also used in determining the severity of the patient's injury upon discharge from the ED. Results: A total of 532 patients were enrolled in this study. Of those, 487 patients were in the diagnosis group, and 45 patients (8.4%) were discovered to have had a fracture. Of the 45 missed fracture patients, 34 patients (6.4%) had one-site fractures, 8 patients (1.5%) had two-site fractures, and 3 patients (0.6%) had three-site fractures. The most commonly missed fracture was multiple rib fractures (18 patients, 30.5%), followed by lumbosacral (LS) spine fractures (10 patients, 16.9%), thoracic spine fractures (8 patients, 13.6%), and clavicle fractures (6 patients, 10.2%). Mean age was $50.12{\pm}18.54$ years in the diagnosis group and $57.38{\pm}16.88$ years in the missed fracture group. For the diagnosis group, the mean ISS was $9.03{\pm}8.26$, but in the missed fracture group it was $17.53{\pm}9.69$. Missed fractures were much more frequent in the not-alert mentality (p<0.01) and in the high (ISS$ ISS{\geq}16$) group (p<0.01). Conclusion: Missed fractures occur most frequent in patients of old age, not-alert mentality, and high ISS. Multiple rib and spine fractures were found to be the most frequent missed fractures, regardless of trauma severity. This study also shows a high possibility of clavicle and scapula fractures in patients with severe trauma.

• Journal of Veterinary Clinics
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• v.37 no.6
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• pp.363-366
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• 2020

A 2-month-old, 50 kg male Korean native calf was referred with bilateral mandibular fractures. The bilateral mandible was hanging loose, with inability to use the jaw, indicated by excessive salivation. Radiography revealed a long oblique fracture in the right mandible, and a short oblique fracture in the left mandible. Computerized Tomography, a different form of radiography, revealed the fracture in the left mandible to be a comminuted fracture. In order to stabilize the bilateral mandible fractures, a combination of bone plate and wiring was applied; in addition, resin was applied to enhance stabilization of the mandible. Six weeks after surgery, the calf was able to masticate and ruminate well. In this case, application of the plate and wiring with resin to bilateral mandibular fractures presented a successful functional recovery. Accordingly, the combination of bone plate and wiring with resin can be an effective technique for treating mandibular fractures.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.6
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• pp.544-549
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• 2009

Failure to use effective methods of reduction, fixation and immobilization may lead to osteomyelitis with the exposed necrotic bone, as the overzealous use of transosseous wires & plates that devascularizes bone segments in the compound comminuted fractures of mandible. Once osteomyelitis secondary to fractures has become established, intermaxillary fixation should be instituted as early as possible. Fixation enhances patient comfort and hinders ingress of microorganisms and debris by movement of bone fragments. Teeth and foreign materials that are in the line of fracture should be removed and initial debridement performed at the earliest possible time. Grossly necrotic bone should be excised as early as possible ; no attempt should be made to create soft tissue flaps to achieve closure over exposed bone. The key to treatment of chronic osteomyelitis of the mandible is adequate and prolonged soft tissue drainage. If good soft tissue drainage is provided over a long period, sequestration of infected bone followed by regeneration or fibrous tissue replacement will occur so that appearance and function are not seriously altered. Localization and sequestration of infected mandible are far better performed by natural mechanism of homeostasis than by cutting across involved bone with a cosmetic or functional defect. As natural host defenses and conservative therapy begin to be effective, the process may become chronic, inflammation regresses, granulation tissue is formed, and new blood vessels cause lysis of bone, thus separating fragments of necrotic bone(sequestra) from viable bone. The sequestra may be isolated by a bed of granulation tissue, encased in a sheath of new bone(involucrum), and removed easily with pincettes. This is a case report of the long-term conservative drainage care in osteomyelitis associated with mandibular fractures.

• Archives of Plastic Surgery
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• v.39 no.3
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• pp.209-215
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• 2012

Background : Among all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR) for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR) through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone. Methods : A retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty. Results : According to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P<0.05). Mucosal injury with nasal bleeding occurred much less in the IOR group (5.3%) than the CR group (12.9%). Dorsal augmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them (31/34) showed satisfaction with the outcomes. Conclusions : IOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone.

• Archives of Craniofacial Surgery
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• v.22 no.4
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• pp.193-198
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• 2021

Background: Nasal bone fractures are frequently encountered in clinical practice. Although fracture reduction is simple and correction requires a short operative time, low patient satisfaction and relatively high complication rates remain issues for many surgeons. These challenges may result from inaccuracies in fracture recognition and assessment or inappropriate surgical planning. Findings from immediate postoperative computed tomography (CT) scans and those performed at 4 to 6 weeks postoperatively were compared to evaluate the accuracy and outcomes of nasal fracture reduction. Methods: This retrospective study included patients diagnosed with nasal bone fractures at our department who underwent closed reduction surgery. Patients who did not undergo additional CT scans were excluded from the study. Clinical examinations, patient records, and radiographic images were evaluated in 20 patients with nasal bone fractures. Results: CT findings from immediately after surgery and a 1month follow-up were compared in 20 patients. Satisfactory nasal projection and aesthetically acceptable results were observed in patients with accurate correction or mild overcorrection, while undercorrection was associated with unfavorable results. Conclusion: Closed reduction surgery for correcting nasal bone fractures usually provides acceptable outcomes with relatively few complications. If available, immediate postoperative CT scans are recommended to guide surgeons in the choice of whether to perform secondary adjustments if the initial results are unsatisfactory. Based on photogrammetric data, nasal bone reduction with accurate correction or mild overcorrection achieved acceptable and stable outcomes at 1 month postoperatively. Therefore, when upward dislocation is observed on postoperative CT, one can simply observe without a subsequent intervention.