• Journal of Chest Surgery
• /
• 제49권5호
• /
• pp.361-365
• /
• 2016

Background: Sternal fractures are relatively rare, and caused mainly by blunt anterior chest wall trauma. In most cases, sternal fractures are treated conservatively. However, if the patient exhibits problematic symptoms such as intractable chest wall pain or bony crepitus due to sternal instability, surgical correction is indicated. But no consensus exists regarding the most appropriate surgical method. We analyzed the results of surgical fixation in cases of sternal fracture in order to identify which surgical method led to the best outcomes. Methods: We retrospectively reviewed the medical records of patients with sternal fractures from December 2008 to December 2011, and found 19 patients who underwent open reduction and internal fixation of the sternum with a longitudinal plate (L-group) or a T-shaped plate (T-group). We investigated patients' characteristics, clinical details regarding each case of chest trauma, the presence of other associated injuries, the type of open reduction and fixation, whether a combined operation was performed, and postoperative complications. Results: Of the 19 patients, 10 patients (52.6%) were male, and their average age was 56.8 years (range, 32 to 82 years). Seven patients (36.8%) had isolated sternal fractures, while 12 (63.2%) had other associated injuries. Seven patients (36.8%) were in the L-group and 12 patients (63.2%) were in the T-group. Three patients in the L-group (42.9%) showed a loosening of the fixation. In all patients in the T-group, the fracture exhibited stable alignment. Conclusion: Open reduction and internal fixation with a T-shaped plate in sternal fractures is a safer and more efficient treatment method than treatment with a longitudinal plate, especially in patients with a severely displaced sternum or anterior flail chest, than a longitudinal plate.

• Archives of Plastic Surgery
• /
• 제44권1호
• /
• pp.53-58
• /
• 2017

Background Adequate fixation of replanted digits is essential not only for short-term healing but for long-term function. Various bony fixation methods using Kirschner (K-) and intraosseous wire are available in replantation. We examined clinical and radiographic outcomes of fixation methods on bone union after digital replantation. Methods A single institutional retrospective review identified 992 patients who had undergone 1,247 successful replantations between July 2009 and September 2015. Exclusion criteria included amputations of the distal phalanx, comminuted fractures, and intra-articular fractures. Patients were classified according to 5 categories of fixation methods: single K-wire, double longitudinal K-wires, cross K-wires, wire with, and wire without K-wire support. Bone union was evaluated by 5-month postoperative X-ray and fixation outcomes were compared across the 5 groups. Results The exclusion criteria were applied, and 88 patients with 103 replanted digits remained for analysis. Single K-wire fixation was used in 40 digits, double longitudinal K-wires in 30, and cross fixation in 14. Wire with and without K-wire support was required in 15 and 4 digits. Nonunion was observed in 32 digits (31.1%), of which 13 required additional operations such as bone graft or corrective osteotomy. The highest percent of nonunion was observed after cross fixation (35.7%) and the lowest after wire alone (25.0%). Conclusions In this study, contrary to general knowledge, we found that single K-wire fixation was not associated with poorer outcomes. Successful bone union outcomes may be achieved by careful selection of bone fixation methods. This study provides useful information for planning bone fixation in digital replantation.

• 대한족부족관절학회지
• /
• 제10권2호
• /
• pp.223-229
• /
• 2006

Purpose: The purpose of this study was to analyze the results of the treatment of hallux valgus with metatarsal double osteotomy and longitudinal pin fixation. Materials and Methods: We reviewed 19 patients (21 feet) who had been treated by metatarsal double osteotomy and longitudinal pin fixation for the moderate or severe hallux valgus with increased distal metatarsal articular angle (DMAA), between 1999 and 2004. They were followed prospectively for a minimum of 20 months. Functional outcomes were measured via Hallux metatarsophalangeal-Interphalangeal (HMI) scale and Mayo clinic forefoot scoring system (FFSS). Radiographically, we assessed pre, postoperative and at the last follow-up, the hallux valgus angle (HVA), 1st and 2nd intermetararsal angle (IMA), DMAA. Results: The average preoperative HVA, IMA, DMAA measured $36.76^{\circ}$, $13.62^{\circ}$, $26.00^{\circ}$, respectively. At the last follow-up, HVA, IMA, DMAA measured $9.57^{\circ}$, $7.14^{\circ}$, $9.33^{\circ}$. The correction of HVA, IMA, DMAA were $27.19^{\circ}$, $6.48^{\circ}$, $6.67^{\circ}$. At the last follow-up, there were no recurrences and complications, except two patients complained of unsatisfactory stiffness in the 1st metatarsophalangeal joint and subjectively rated their results as fair. The others rated that as excellent or good. At the last follow-up, statistically, the mean HMI scale and FFSS improved significantly from pre-operative score. Conclusions: In the treatment of moderate or severe hallux valgus with increased DMAA by metatarsal double osteotomy and longitudinal pin fixation, we had good functional and radiological results without recurrences and significant complications. But the stiffness in the 1st metatarsophalangeal joint warrants further study.

• Journal of Trauma and Injury
• /
• 제23권2호
• /
• pp.175-179
• /
• 2010

Purpose: Sternal fractures after blunt thoracic trauma can cause significant pain and disability. They are relatively uncommon as a result of direct trauma to the sternum and open reduction is reserved for those with debilitating pain and fracture displacement. We reviewed consecutive 11 cases of open reduction and fixation of sternum and tried to find standard approach to the traumatic sternal fractures with severe displacement. Methods: From December 2008 to August 2010, the medical records of 11 patients who underwent surgical reduction and fixation of sternum for sternal fractures with severe displacement were reviewed. We investigated patients' characteristics, chest trauma, associated other injuries, type of open reduction and fixation, combined operations, preoerative ventilator support and postoperative complications. Results: The mean patient age was 59.3years (range, 41~79). The group comprised 6 male and 5 female subjects. Among 11 patients who underwent open reduction and fixation for sternal fracture with severe displacement, 6 cases had isolated sternal fractures and the other 5 patients had associated other injuries. Sternal fractures were caused by car accidents (9/11, 81.8%), falling down (1/11, 9.1%) and direct blunt trauma to the sternum (1/11, 9.1%), respectively. 3 of the 7 patients (42.9%) who underwent sternal plating with longitudinal plates showed loosening of fixation. Otherwise, none of the 4 patients who underwent surgical fixation using T-shaped plate had stable alignment of the fracture. Conclusion: Sternal fractures with severe displacement need to be repaired to prevent chronic pain, instability of the anterior chest wall, deformity of the sternum, and even kyphosis. In the present study, a T-shaped plate with a compression-tension mechanism constitutes the treatment of choice for displaced sternal fractures.

• 대한정형외과스포츠의학회지
• /
• 제10권2호
• /
• pp.109-112
• /
• 2011

전위성 슬개골 골절에 있어서 해부학적 정복 및 견고한 고정은 슬관절 기능과 강도, 그리고 조기 관절 운동 범위의 회복을 위해서 필요하다. 골절의 형태와 다양한 수술 기법에 따라서, 수술 후 많은 합병증들이 보고 되어져 왔다. 본 저자들은 운동 선수들에게서 발생한 종골절 1예와 이분성 슬개골의 골편 전위 골절 1예에서 유관 나사못 횡 고정술을 시행한 뒤 새로운 횡골절이 발생한 증례를 경험하여 보고하고자 한다.

• 대한족부족관절학회지
• /
• 제15권3호
• /
• pp.124-131
• /
• 2011

Ankle arthrodesis has been considered to be the standard operative treatment for end-stage ankle arthritis, nevertheless currently increasing arthroplasty. Indication for arthrodesis is painful ankle from global arthrosis regardless of the etiology. But it is hard to be carried out in the several circumstance such as infection states, poor vascularity, severe diabetes, prematurity, etc. So thorough evaluation should be done before the surgery, including adjacent joints status. The ideal position for fusion is neutral in flexion, functional valgus, and slightly external rotation. Methods of arthrodesis would be largely divided into two categories as in situ fixation and realignment procedure. The lateral and anterior longitudinal approaches are two common procedures, and fixation modalities are also variable. The long-term results of arthrodesis have been reported. Even the close follow-up have shown subsequent degeneration of adjacent joints, benefits such as reliable pain loss, easy correctability for deformity, and improved functional status with considerable durability can be expected in the most patients.

• 한국의학물리학회지:의학물리
• /
• 제13권3호
• /
• pp.135-138
• /
• 2002

치료대상 병소에 분할 방사선수술을 시술할 경우 회전중심(isocenter)은 정확하고 재현성 이 있어야 한다. 본 연구는 노발리스 방사선 수술장비와 정위 마스크 시스템을 사용한 분할방사선 수술에서 회전중심의 재현성을 측정하고 평가 하였다. 마스크는 열가소성 재질의 상용을 사용하였고 회전중심의 재현성을 측정하기 위해 고안된 머리 모양의 아크릴 팬텀에 맞도록 제작하였다. 팬텀의 내부에는 직경 5 mm의 아크릴봉을 수직으로 세우고 그 끝단을 회전중심으로 선택하였으며 예상되는 회전중심점에 pin hole을 낸 monochromic 필름을 설치하여 방사선 조사 후 회전중심의 재현성을 측정할 수 있도록 하였다. 측정 결과 회전중심은 공간오차가 평균 1 mm 이내이고 표준편차 또한 2 mm 이내여서 이미 보고된 타 문헌에서의 측정값과 비교해 볼 때 모든 측정값이 제시된 오차범위 내에 있었다. 결론적으로 분할방사선수술에 사용하는 정위 마스크 시스템은 매우 정확하고 재현성이 우수하였으며, 실제로 방사선 수술대상의 병소의 직경이 10 mm 정도 이상이라면 일반적인 한번의 고선량 방사선 수술에 정위 마스크 시스템의 사용이 가능할 것으로 사료된다.

• 한국안전학회지
• /
• 제32권4호
• /
• pp.28-33
• /
• 2017

A sharp curved ballasted track on earthwork that was connected with a direct fixation slab track on steel box railway bridges have been deformed and damaged despite the frequently maintenance by a restoring force of sharp curved rail and track-bridge interaction forces such as axial forces and longitudinal displacement of continuous welded rail(CWR) owing to their structural characteristics, calling for alternatives to improve the structural safety and track irregularity. In this study, the authors aim to prove a cause of deformation for the sharp curved ballasted tracks to enhance the structural safety and track irregularity of ballasted track in service. A track-bridge interaction analysis and a finite-element method analysis for the sharp curved ballasted track were performed to consider the axial force and longitudinal displacement of CWR, the temperature and the effect of restoring force of sharp curved rail. From the results, the deformation of the sharp curved ballasted track with adjusted sleeper spacing from 833mm to 590mm were significantly reduced.

• 대한족부족관절학회지
• /
• 제21권4호
• /
• pp.144-150
• /
• 2017

Purpose: To assess the clinical and radiographic results and complications of arthroscopy-assisted reduction and percutaneous fixation for patients with tongue-type Sanders type II calcaneal fractures. Materials and Methods: Between August 2014 and December 2015, 10 patients who underwent surgery using subtalar arthroscopic assisted reduction and percutaneous fixation for tongue-type Sanders type II calcaneal fractures were reviewed. The mean age was 50.8 years (36~62 years), and the mean follow-up period was 24 months (12~40 months). The clinical results were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at the regular follow-ups, and the foot function index (FFI) at the last follow-up. The subtalar range of motion (ROM) was evaluated and compared with the uninjured limb at the last follow-up. The radiographic results were assessed using the Bohler's angle from the plain radiographs and the reduction of the posterior calcaneal facet using computed tomography (CT). The postoperative complications were assessed by a chart review. Results: The VAS and AOFAS ankle-hindfoot score improved until 12 months after surgery. The FFI was 15 (1.8~25.9) and subtalar ROM was 75.5% (60%~100%) compared to the uninjured limb at the last follow-up. The $B{\ddot{o}}hler^{\prime}s$ angle was increased significantly from $2^{\circ}$ ($-14^{\circ}{\sim}18^{\circ}$) preoperatively to $21.8^{\circ}$ ($20^{\circ}{\sim}28^{\circ}$) at the last follow-up. The reduction of the posterior facet was graded as excellent in five feet (50.0%) and good in five (50.0%) on CT obtained at 12 months after surgery. One foot (10.0%) had subfibular pain due to a prominent screw head. One foot (10.0%) had pain due to a longitudinal tear of the peroneal tendon that occurred during screw insertion. Conclusion: Subtalar arthroscopic-assisted reduction of the posterior calcaneal facet of the subtalar joint and percutaneous fixation is a useful surgical method for tongue-type Sanders type II calcaneal fractures.

• 문화기술의 융합
• /
• 제9권3호
• /
• pp.633-640
• /
• 2023

본 연구는 운행선 경전철 직결식 궤도 부설구간에서 발생한 도상블록의 변위거동 특성을 분석하여 적정 보강 방안을 도출하고자 현장조사를 바탕으로 한 수치해석을 수행하였다. 본 연구의 대상선로는 교량상 급곡선 직결식 콘크리트 궤도로서 교량바닥판에 부설된 도상블록이 종방향 및 횡방향으로 이동하는 문제가 발생하여 이에 대한 메커니즘을 분석하였다. 본 연구에서는 3D Solid요소를 이용한 궤도구조 모델링을 바탕으로 운행하중 조건에서 발생가능한 직결식 궤도의 거동을 분석하고 다양한 보강방안에 대한 보강효과를 해석적으로 분석하였다. 도상블럭의 보강 전, 후 횡변위 분석결과, 극한 횡압 작용 시 보강 후 최대 횡변위는 보강 전 대비 약 3% 수준(약 0.1mm)으로 크게 감소하는 것으로 분석되었다. 또한 채움 모르타르, 교량 바닥판, 보강철근의 발생응력 검토결과, 모두 2.6 이상의 충분한 안전율을 확보하는 것으로 분석되어 보강방안에 대한 최적 조건을 도출하였다. 따라서 본 연구에서 검토한 앵커링 보강 수량 및 대칭형 앵커배치는 도상블록 횡방향 변위 발생 제어 및 교량, 도상블록의 구조적 건전성 확보에 효과적일것으로 판단된다.