• Title/Summary/Keyword: Open fracture

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Comparative Study of Open Reduction and Internal Fixation and Primary Subtalar Arthrodesis for Sanders Type 4 Intra-Articular Calcaneal Fractures (Sanders 4형 종골 골절에 대한 관혈적 정복술 및 내고정술과 일차성 거골하 관절 유합술의 치료 결과 비교)

  • Woo, Seung Hun;Chung, Hyung-Jin;Bae, Su-Young;Kim, Sun-Kyu
    • Journal of the Korean Orthopaedic Association
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    • v.52 no.1
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    • pp.49-58
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    • 2017
  • Purpose: To compare clinical outcome of Sanders type IV intra-articular calcaneal fracture treated with open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis (PSTA). Materials and Methods: Between March 2003 and November 2013, 22 patients with 22 Sanders type 4 intra-articular calcaneal fractures were included in this study. Of these, 11 were treated with ORIF (ORIF group), and 11 were treated with ORIF and PSTA (PSTA group). The mean follow-up period was 34.6 months (range, 18-72 months). Clinical outcomes were assessed along with the American Orthopedic Foot and Ankle Society's ankle-hindfoot scale (AOFAS score), and the visual analogue scale pain score (VAS score) at 6-month, 12-month, and last follow-up. Patient satisfaction, return to previous occupation and postoperative complications were also investigated. Results: The results for ORIF did not differ from those for PSTA based on the last follow-up AOFAS scores or the VAS scores (p>0.05). However, patient satisfaction was significantly higher in the PSTA group (p=0.008). Secondary subtalar arthrodesis was conducted in five patients (45.5%) of the ORIF group within 2 years postoperatively. Conclusion: We were unable to demonstrate a significant difference in clinical outcomes between ORIF and PSTA; however, the patient satisfaction was higher in the PSTA group. PSTA may be a suitable choice for patients who need fast recovery to daily activity and to prevent the need for secondary subtalar arthrodesis.

Polarus Intramedullary Nail for Nonunion of Humerus neck (Polarus 골수정을 이용한 상완골 경부 불유합의 수술적 치료)

  • Kang, Ho-Jung;Kim, Sul-Gee;Yoon, Hong-Kee;Hahn, Soo-Bong;Kim, Sung-Jae
    • Clinics in Shoulder and Elbow
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    • v.10 no.1
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    • pp.112-123
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    • 2007
  • Purpose: Evaluate the clinical results of humerus neck nonunion treated with Polarus intramedullary nail. Materials and Methods: 8 patients who underwent surgery for nonunion of humerus surgical neck fracture were included. All patients were female, the average age was 65 years. 5 out the total 8 cases initially received surgery, open reduction and internal fixation with metal plate in 1 case, Ender nail insertion in 2 cases, external fixator in 1 case and closed reduction and percutaneous pinning in 1 case. The other 3 non union cases initial received conservative managemnent. The average period of nonunion was 9 months in the operated group and 6.2 months in the conservative group. All 8 cases received closed reduction with intrameedullary Polarus nail and auto iliac bone graft. Union was confirmed radiologically, and functional evaluation was done with the UCLA functional criteria. Results: All 8 cases showed union on radiologic evaluation. Average time to union was 3.5 months, average follow up period was 27 months. Average UCLA shoulder evaluation score was 7.6 points preoperatively which improved to 26.3 points after surgery. Active shoulder flexion was 40.7 degrees preoperatiely which increased to 104 degrees after surgery. Shoulder abduction improved from 32.9 degrees preoperatively to 96.3 degrees after surgery. UCLA functional criteria was good in 5 cases and fair in 3 cases, which no poor cases. Conclusion: Polarus IM nailing and AIBG is a useful method for treating nonunion of humerus neck fracture with improvement in union and function.

A Clinicostatistical Study of 677 Mandibular Fractures (하악골 골절 667 증례의 임상통계학적 분석)

  • Lee, Sang-Han;Lee, Seoung-Ho
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.11 no.1
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    • pp.50-62
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    • 1989
  • This is clinicostatistical study of mandibular fractures. This study was based on a series of 677 patients with mandibular fracture during the period of 1982 to 1987. This results obtained were as follows : 1. In respect of incidence, there were high frequency in May and September, and in large city(63%). 2. The age frequency was the highest in the 20s-year old group (38.7%), and the ratio of male to female was 4.64 : 1. 3. The most common etiologic factor was blow(31.5%), but in children that was traffic accident followed by fall down. 4. The most common site of bone fractures was symphysis, followed by angle, condyle. In comparison of right and left sides, left side was more frequently involved(364 cases) than right side(257 cases). 5. The patients arrived in hospital immediately within 24 hours after accident were 62.9% of all, and 42.4% was arrived via private medical and dental clinic. 6. In respect of treatment, open reduction was 55.5% of all, closed reduction was 37.2%. In children, closed reduction was done in 50.6%.

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One-Stage Achilles Tendon Reconstruction Using the Free Composite Dorsalis Pedis Flap in Complex Wound (족배부 복합 피부-건 유리피판을 이용한 Achilles건의 일단계 재건술)

  • 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.

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Plate Fixation for Fractures of the Coronoid Process of the Ulna (금속판을 이용한 구상돌기 골절의 치료)

  • Shin, Dong-Ju;Byun, Young-Soo;Cho, Young-Ho;Park, Ho-Won;Youn, Hee-Min;Han, Jae-Hui
    • Clinics in Shoulder and Elbow
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    • v.11 no.2
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    • pp.177-184
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    • 2008
  • 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.

Detection of inflow permeable zones using fluid conductivity logging in coastal aquifer (공내수 치환기법을 이용한 연안지역 대수층의 수리특성 평가)

  • Hwang Seho;Park Yunsung;Shim Jehyun;Park Kwon Gp;Choi Sun Young;Lee Sang Kyu
    • 한국지구물리탐사학회:학술대회논문집
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    • 2005.09a
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    • pp.83-92
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    • 2005
  • Fluid conductivity logging has been applied in the boreholes to identify the permeable fi:actures and estimate the origin of saline groundwater in coast area. Fluid replacement technique measures the fluid electrical conductivity with depth at different times in a well after the borehole is first washed out with different water by passing a tube to the borehole bottom. Then formation water flows into the borehole through aquifer such as permeable fractures or porous formation during ambient or pumping condition. Measured conductivity profiles with times therefore indicate the locations of permeable zone or fractures within the open hole or the fully slotted casing hole. As a result of fluid conductivity logging for three boreholes in the study area, it is interpreted that saline groundwater is caused by seawater intrusion through fractured rock, although the effect by land reclamation partially remains. We are planning the quantitative analysis to estimate the hydraulic characteristics using fluid replacement technique, and this approach might be usefully utilized for assessing the characteristics of seawater intrusion, the design of optimal pumping, and estimating the hydraulic properties in coastal aquifer.

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Surgical treatment of Mallet finger deformity with Hook plate (고리 금속판을 이용한 망치 손가락의 수술적 치료법)

  • Choi, Seok Min;Jung, Sung Gyun;Shin, Ho Seong;Park, Eun Soo;Kim, Yong Bae
    • Archives of Plastic Surgery
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    • v.36 no.3
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    • pp.318-321
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    • 2009
  • Purpose: The bony mallet finger injury is generally managed by conservative treatments, but operative treatments are needed especially when the fractures involve above 30% of articular surface or distal phalanx is accompanied by subluxation in the volar side. This is the reason they often result in chronic instability, articular subluxation and unsatisfactory cosmetic. In this report, We describe new method using the hook plate as an operative treatment of Mallet finger deformity. Methods: Among 13 patients with Mallet finger deformity who came from February 2006 to February 2008, six patient were included in surgical indication. Under local anesthesia, H or Y type incision was made at the DIP joint area. After the DIP joint extension, the hook plate was put on the fracture line, and one self tapping screw was used for fixation. 2 hole plate which was one of the holes in 1.5 mm diameter was cut in almost half and bended through approximately $100^{\circ}$. Results: In all six cases which applied the hook plate, complications such as loss of reduction or nail deformity were not seen. In only one patient, hook pate was removed due to inflammatory reaction after surgery. At 2 weeks after operation, active motion of DIP joint was performed. The result was satisfactory not only cosmetically but also functionally. At 6 weeks after operation, the range of motion of DIP joint was average $64^{\circ}$. Conclusion: The purpose of the operative treatment for mallet finger deformity using the hook plate is to provide anatomical reduction with rigid fixation and to prevent contracture at the DIP joint. While other operations take 6 weeks, the operation using the hook plate begins an active motion at 2 weeks after operation. Complication rate was low and the method is rather simple. Thus, the operation using the hook plate is recommended as a good alternative method of the mallet finger deformity treatment.

A CASE REPORT OF CORRECTION OF MANDIBULAR PROGNATHISM BY INTRAORAL OBLIQUE SPLITTING OSTEOTOMY OF MANDIBULAR RAMI (구내 경사 분열 골절단술(Intraoral oblique splitting osteotomy)에 의한 하악 전돌증의 치험례)

  • Park, Hui-Dae;Doe, Kee-Yong;Bae, Yun-Ho;Byun, Sang-Kill;Chin, Byung-Rho;Lee, Hee-Keung
    • Journal of Yeungnam Medical Science
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    • v.6 no.2
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    • pp.183-194
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    • 1989
  • This is a report of 2-cases of mandibular prognathism corrected by Intraoral oblique splitting osteotomy of mandibular ramus. The Intraoral oblique splitting osteotomy is a modification of sagittal split osteotomy of ramus and it is documented by Yoshida, on 1985. By this method. authors obtained the following results. 1. The patients' esthetic, psychological and functional problems were dissolved by setback of mandibular prognathism. 2. The postoperative infection, splitted bone segments fracture, paresthesia of the face and T.M.J. dysfunction were not appeared. 3. Postoperative intermaxillary fixation was maintained for 8 weeks. The patients could open their mouths in normal range after a week of intermaxillary fixation removal. 4. The soft tissue changes of lower lip and chin were about 1:1 to the hard tissue changes. 5. During intermaxillary fixation period and postoperative orthodontic treatment, slight relapse was observed. Now, the patients are under postoperative orthodontic treatment.

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The Relationship between Food Habit, Nutrient Intakes and Bone Mineral Density and Bone Mineral Content in Adult Women (성인여성의 식습관과 영양섭취상태와 골밀도 및 골무기질함량과의 관계)

  • 최미자;정윤정
    • Journal of Nutrition and Health
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    • v.31 no.9
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    • pp.1446-1456
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    • 1998
  • 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)

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Two Dimensional Size Effect on the Compressive Strength of T300/924C Carbon/Epoxy Composite Plates Considering Influence of an Anti-buckling Device (T300/924C 탄소섬유/에폭시 복합재 적층판의 이차원 압축 강도의 크기효과 및 좌굴방지장치의 영향)

  • ;;;C. Soutis
    • Proceedings of the Korean Society For Composite Materials Conference
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    • 2002.10a
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    • pp.88-91
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    • 2002
  • The two dimensional size effect of specimen gauge section (length x width) was investigated on the compressive behavior of a T300/924 [45/-45/0/90]3s, carbon fiber-epoxy laminate. A modified ICSTM compression test fixture was used together with an anti-buckling device to test 3mm thick specimens with a 30$\times$30, 50$\times$50, 70$\times$70, and 90mm$\times$90mm gauge length by width section. In all cases failure was sudden and occurred mainly within the gauge length. Post failure examination suggests that $0^{\circ}$ fiber microbuckling is the critical damage mechanism that causes final failure. This is the matrix dominated failure mode and its triggering depends very much on initial fiber waviness. It is suggested that manufacturing process and quality may play a significant role in determining the compressive strength. When the anti-buckling device was used on specimens, it was showed that the compressive strength with the device was slightly greater than that without the device due to surface friction between the specimen and the device by pretoque in bolts of the device. In the analysis result on influence of the anti-buckling device using the finite element method, it was found that the compressive strength with the anti-buckling device by loaded bolts was about 7% higher than actual compressive strength. Additionally, compressive tests on specimen with an open hole were performed. The local stress concentration arising from the hole dominates the strength of the laminate rather than the stresses in the bulk of the material. It is observed that the remote failure stress decreases with increasing hole size and specimen width but is generally well above the value one might predict from the elastic stress concentration factor. This suggests that the material is not ideally brittle and some stress relief occurs around the hole. X-ray radiography reveals that damage in the form of fiber microbuckling and delamination initiates at the edge of the hole at approximately 80% of the failure load and extends stably under increasing load before becoming unstable at a critical length of 2-3mm (depends on specimen geometry). This damage growth and failure are analysed by a linear cohesive zone model. Using the independently measured laminate parameters of unnotched compressive strength and in-plane fracture toughness the model predicts successfully the notched strength as a function of hole size and width.

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