• Clinics in Shoulder and Elbow
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• 제24권3호
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• pp.183-188
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• 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.

• Clinics in Shoulder and Elbow
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• 제11권2호
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• pp.137-142
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• 2008

목적: 잠김 압박 금속판(LCP)을 이용한 상완골 근위부 골절의 수술적 치료에 대한 임상적, 방사선적 치료 결과를 평가해보고자 하였다. 대상 및 방법: 2005년 1월부터 2007년 4월까지 상완골 근위부 골절에 대해 LCP를 이용해 치료받고 12개월 이상 추시가 가능했던 24예를 대상으로 하였으며, 남자는 8예, 여자는 16예이었다. 평균 연령은 68.9세(33~90)이었다. 임상적 결과는 Neer의 기능적 평가 방법을, 방사선적 결과는 골 유합 시기 및 경간각을 이용한 Paavolainen의 방법으로 평가하였다. 결과: 평균 골 유합 기간은 11.9주(8~15)이었다. Neer의 기능적 평가상, 만족 이상의 결과를 보인 경우는 21예(87%)이었고, Paavolainen의 방법에 의한 방사선적 결과가 양호 이상인 경우는 22예(91%)이었다. 3예(13%)에서 금속 실패, 무혈성 골 두 괴사, 관절 강직의 합병증이 각각 발생하였다. 결론: 상완골 근위부 골절에 대해 LCP를 이용한 내고정술은 비교적 양호한 임상적, 방사선적 결과 및 적은 합병증을 보여, 상완골 근위부 골절의 수술적 치료에 유용한 방법 중 하나로 판단된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권5호
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• pp.217-223
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• 2013

Objectives: Buccal fracture of the mandibular proximal bone segment during bilateral sagittal split ramus osteotomy (SSRO) reduces the postoperative stability. The primary aim of this study is to evaluate the effect of this type of fracture on bone healing and postoperative stability after mandibular setback surgery. Materials and Methods: Ten patients who experienced buccal fracture during SSRO for mandibular setback movement were evaluated. We measured the amount of bone generation on a computed tomography scan, using an image analysis program, and compared the buccal fracture side to the opposite side in each patient. To investigate the effect on postoperative stability, we measured the postoperative relapse in lateral cephalograms, immediately following and six months after the surgery. The control group consisted of ten randomly-selected patients having a similar amount of set-back without buccal fracture. Results: Less bone generation was observed on the buccal fracture side compared with the opposite side (P<0.05). However, there was no significant difference in anterior-posterior postoperative relapse between the group with buccal fracture and the control group. The increased mandibular plane angle and anterior facial height after the surgery in the group with buccal fracture manifested as a postoperative clockwise rotation of the mandible. Conclusion: Bone generation was delayed compared to the opposite side. However, postoperative stability in the anterior-posterior direction could be maintained with rigid fixation.

• 대한치과보철학회지
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• 제39권1호
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• pp.14-24
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• 2001

The purpose of this study was to compare the fracture strengths and the fracture patterns of several hybrid-ceramic crowns and metal-ceramic crown. Ten crowns were constructed for each group according to the manufacturer's instruction. Removable template of silicone rubber impression material was used for standardization of each crowns. Each crown was cemented on a metal die with hybrid glass ionomer cement. All crowns cemented were stored in distilled water, $36^{\circ}C$ for 24 hours prior to loading in an universal testing machine. The load was directed at 130 degrees the long axis of metal die. The fracture strengths were measured and the fracture patterns were observed. The following results were obtained from this study 1. The mean fracture strengths of $Artglass^{(R)}$, $Sculpture^{(R)}$ and $Targis^{(R)}$ were $57.5{\pm}9.5Kgf,\;62.7{\pm}12.2Kgf$ and $60.2{\pm}10.1Kgf$ respectively. There was no significant difference among each hybrid ceramic crown group. 2. The toad required to fracture hybrid-ceramic crowns was significantly smaller than metal-ceramic crowns($131.7{\pm}22.0Kgf$). 3. In the metal-ceramic crowns, labial porcelain detached partially from porcelain-metal junction of proximal side by load. 4. Hybrid-ceramic crowns showed a simple fracture pattern that fracture line began at the loading area and extended through proximal surface, perpendicular to the margin. The crown was separated into two parts of labial side and lingual side. Above results revealed that three kinds of the hybrid-ceramic crowns used in this study must have careful application in clinical use since the strength of hybrid-ceramic crown was lower(about 1/2) than that of metal-ceramic crown.

• Clinics in Shoulder and Elbow
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• 제24권2호
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• pp.106-109
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• 2021

Displaced fracture of the distal third of the clavicle usually occurs after direct trauma to the shoulder and typically results in superior displacement of the proximal fragment. We report a previously undescribed case of downward displacement of the clavicle caused by a fall on an outstretched hand, and we suggest the mechanism of injury.

• 대한방사선기술학회지:방사선기술과학
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• 제22권2호
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• pp.41-46
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• 1999

Osteoporosis, which causes mainly fracture of the spine, proximal femur and distal radius by minimal trauma, is a major public health problem and its prevalence is steadily increasing in Korea according to the development of public health care. There are reliable methods for diagnosis based on bone densitometry. Early detection and intervention are important for reducing the incidence of fractures. A consensus definition of osteoporosis, based on bone density measurement, has been developed by the World Health Organization(WHO). In this study, bone mineral density(RMD) was measured by dual energy x-ray absorptiometry(DEXA) at the proximal femur and lumbar spine in 132 post-menopausal women. The purpose of this study is to find influential factors on the BMD of the proximal femur and the lumbar spine and to analyze correlation between BMD and the problematic factors. We obtained the following results : 1. Mean BMD score, T-score and Z-score of the proximal femur were $0.81(g/cm^2)$, -2.45(S.D.) and -2.09(S.D.) respectively and in the lumbar spine were $0.83(g/cm^2)$, -2.02(S.D.), -2.43(S.D.) respectively. 2. In correlation analysis between BMD and many factors, correlation coefficients were -0.467, 0.212, -0.321 and 0.241 in age, height, duration after menopause respectively. BMI and the residuals were comparatively small. 3. Correlation coefficients to age matched BMD, in height and body weight were 0.222 and 0.241, in age and duration after menopause were -0.268, -0.282. 4. The fracture threshold of proximal femur BMD to the 90th percentile was $0.845(g/cm^2)$. 5. At the result of multiple regression analysis, age, body weight, $BMI(kg/m^2)$ and duration after menopause described as significant variables.

• Clinics in Shoulder and Elbow
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• 제20권2호
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• pp.95-99
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• 2017

Background: The purpose of this study was to investigate the clinical and radiological outcomes of locking plate fixation with fibular strut allograft to manage unstable osteoporotic proximal humerus fractures. Methods: We retrospectively reviewed 15 patients who underwent open reduction and locking plate fixation with fibular strut allograft for osteoporotic proximal humerus fracture between July 2011 and June 2015. For functional evaluation, we evaluated visual analogue scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and active range of motion. For radiological evaluation, shoulder true anteroposterior (AP) and AP in $20^{\circ}$ external rotation, as well as the axillary view were taken at two weeks, six weeks, three months, six months, and one year. And the neck-shaft angle was measured on the AP view in $20^{\circ}$ external rotation view. Results: At the one-year follow-up, mean VAS pain score and all shoulder scores, including ASES score and UCLA shoulder score, exhibited satisfactory clinical outcomes. All patients obtained bone union between three and six months post-procedure. Moreover, the mean immediate postoperative neck-shaft angle was $138^{\circ}{\pm}4^{\circ}$, and at one-year follow-up, the neck shaft angle was $137^{\circ}{\pm}5^{\circ}$. There was no significant difference between the preoperative and postoperative values (p=0.105). Conclusions: For the unstable two-part and three-part osteoporotic proximal humerus fractures with medial calcar comminution, the use of fibular strut allograft with locking plate fixation was effective in maintaining the initial status of reduction and exhibiting the satisfactory functional and radiological outcomes.

• Clinics in Shoulder and Elbow
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• 제3권2호
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• pp.61-67
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• 2000

Purpose: Most proximal humeral fractures are minimally displaced and can be treated satisfactorily with a conservative method. But in many comminuted fractures, hemiarthroplasty is usually done as a primary treatment. The authors evaluated how much functional improvement was achieved after hemiarthroplasty and which factors influence on the final functional results. Materials and Methods: Eleven hemiarthroplasties were performed for three- and four-part fractures(including fracture-dislocation) between April 1992 and June 1999. There were eight women and three men, and the mean age was 65 years. According to Neer classification, six was three-part fracture and five was four-part fracture. Six patients were injured on their right shoulder and five on the left shoulder. Among the five four-part fractures, three had axillary nerve injury and among the six three-part fractures, only one patient had axillary nerve injury. The average follow-up period was 2.4 years(1 year-7 years) after operation. The functional results were evaluated with the UCLA scoring system(Modification for hemiarthroplasty). In addition to the overall results, we compared the results according to the classification of the fracture, the cause of injury, and whether the axillary nerve was injured. Results: At the last follow-up, average total UCLA score was 18.2. The mean score for pain was 7.0, mean muscle power and motion score was 5.5 and 5.7 respectively. The pain relief was more satisfactory than any other functional results. The average score for three-part fractures was 22, and the average for four-part fractures was 13.6. The average score for the patients fractured by vehicle accidents was 15.3, and 19.3 for the patients fractured by slip-down injury. In patients without axillary nerve injury, the average score was 20, and with axillary nerve injury, the score was 15. Conclusion: Shoulder hemiarthroplasty, for the treatment of proximal humeral fractures, cannot restore the shoulder function to normal, but can achieve the functional result to some degree, especially for the activity of daily living. And as for pain, we think that it is relatively effective measure. And we think that the severer the comminution, the more the chance of axillary nerve injury, and the poorer the functional results. In conclusion, the severity of initial injury seems to be the major prognostic factor.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2004년도 학술대회
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• pp.34-36
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• 2004

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2005년도 제3차 연수강좌
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• pp.103-109
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• 2005