• Journal of Trauma and Injury
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• 제26권3호
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• pp.163-169
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• 2013

Purpose: This study was conducted to confirm the anatomic conformity of the new periarticular locking plates designed by Zimmer on Korean adult bones and to identify the structures at risk during the application of these implants. Methods: The study was performed on the humerus, radius, and tibia of 10 adult cadavers(6 males and 4 females) procured from the cadaveric lab of our hospital. Anteroposterior (AP) and lateral X-rays were taken to confirm that the cadavers were free of any unusual lesions or anatomic variations. We used the 3.5-mm proximal humerus plate, 2.7-mm distal radius plate, 3.5- and 5.0-mm proximal tibia plates, and 3.5-mm distal tibia plate developed by Zimmer, Inc. (Zimmer periarticular locking plate). The longest plate from each group was used to confirm anatomical conformity. Standard approaches were used for each area, and soft tissue was retracted in order to pass the plate beneath the muscle. The position of the plate was confirmed using standard AP and lateral view X-rays. After this procedure had been completed, the region was dissected along the length of the implant to determine the conformity of the implant to bone and the penetrations of screws into the articular surface or violations of any vital structures, such as nerves, blood vessels, or tendons. Results: Excellent anatomical conformity was observed with Zimmer periarticular locking plates for Korean adults. The tibial nerve and the posterior tibial artery were found to be structures at risk when applying a distal tibial plate. Conclusion: Additional posterolateral fixation is recommended when dealing with cases of tibial plateau fracture when the fracture line extends to the posterolateral cortex. We recommend taking proper views using 10~15 degrees of internal rotation to ensure correct screw length and, thus, avoid penetration of vital structures and tendons.

• 한국임상수의학회지
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• 제22권1호
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• pp.60-64
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• 2005

체중 23kg, 나이 6세된 수캐 잡종 사냥개가 왼쪽 주관절에 총상을 입어 전북대학교 수의과대학 동물병원에 내원하였다. 방사선 사진에서 요골 척골 근위부에 복잡골절과 주관절 돌기 후방에 금속성 탄환이 발견되었다. 첫 번째 외과처치는 탄환을 제거하고 bone plate, bone screw, K-wire등을 이용하여 정복 고정하였으나 실패하였다. 두 번째 시도는 주관철 고정술과 13번째 늑골로부터 얻은 자가골을 이용하여 결손부를 충진 하였다. 결과가 만족스럽지 못하여 자가골 재이식과 3번째 수술을 실시하여 주관절의 안정된 고정상태를 유지 할 수 있었다. 60주가 지난 현재 평상시 활동에는 커다란 문제점이 없지만 속보 혹은 뛰는 경우 관절 고정술을 실시한 다리를 들고 세 다리만 사용하는 아쉬움이 있다.

• 한국임상수의학회지
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• 제28권3호
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• pp.328-331
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• 2011

간헐적 전지 파행을 보이는 두 마리 개가 내원하였다. 신체 검사에서 약 $90^{\circ}$ 외측 회전을 동반한 전완 기형을 두 마리 모두에서 확인 하였다. 일반 방사선 사진에서 척골 원위부 아탈구, 요골 앞쪽 휨 현상, 짧아진 요골 척골, 및 앞발의 외측 회전을 확인하였다. 외측 회전을 동반한 전완 기형의 교정을 위해 척골 원위부 골절제와 요골 원위부 쐐기형 절골술 및 요골 원위부 내측 회전을 실시 하였다. 관절 부조화를 예방하기 위해 척골 근위부 절골술을 첫 번째 개에서 실시 하였다. 수술 후 정기 검진은 수의사의 신체 검사를 통해 실시 되었으며 두 마리 모두에서 수술과 관련한 합병 증상 및 파행이 없음을 확인하였다.

• 한국정밀공학회지
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• 제29권7호
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• pp.705-710
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• 2012

Research involving discomfort or pain related to haptic vibratory stimulation the for prosthesis users of myoelectrical hand is very lacking. Our objective of this study was to evaluate the displeasure and sensitivity of areas in forearm using vibration stimulation system between upper limb amputees and non-amputees. Twenty transradial amputees and forty non-amputees (20 youth, 20 elderly) were involved. We set up custom-made vibration stimulation system including eight actuators (4 medial parts and 4 lateral parts) and GUI-based acquisition system, to investigate changes of residual somatosensory sensibility and displeasure at proximal 25% of forearm. Eight vibration actuators were attached to the circumference of proximal 25% point of forearm at regular intervals. Sensitivity tests were used to stimulate the 120Hz and discomfort experiment was used to 37 ~ 223Hz. The subjective responses were evaluated by 10 point scale. The results showed that both groups were similar in sensitive areas. Response at around of radius was most sensitive than other areas in all subjects. Elderly group do not appear discomfort of vibrotactile; however, youth group and amputee presented discomfort of vibrotactile. Prosthesis with a vibrotactile feedback system should be developed considering the sensitivity. Furthermore, Future studies should investigate the scope of application of that principle.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.3-10
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• 2024

Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.50-55
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• 2010

Injury of the musculocutanous nerve can be associated with a proximal humeral fracture or shoulder dislocation, and injury of the brachial plexus. However, injury of this nerve associated with a humeral shaft fracture has rarely been reported. Diagnosis of the musculocutaneous nerve injury is difficult because its sensory loss is ill-defined, and examination of elbow flexion is difficult when it is associated with fractures. We report an unusual case of musculocutaneous nerve injury in a 27 years old woman who had multiple injuries including a humerus shaft fracture, an ipsilateral radius shaft fracture, and an associated radial nerve laceration. Diagnosis of the musculocutaneous nerve injury was delayed because combined fractures of the humerus and radius prevented proper examination of the elbow motion and nerve grafting of the radial nerve delayed early elbow motion exercise. Delayed exploration of the musculocutaneous nerve 6 months after trauma showed complete rupture of the nerve at its entry into the coracobrachialis muscle and the defect was successfully managed by sural nerve graft.

• Clinics in Shoulder and Elbow
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• 제22권4호
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• pp.216-219
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• 2019

Background: Progression of the tear size and erosion of the greater tuberosity (femoralization) in the supraspinatus tear makes it difficult to repair or increases the risk of a re-tear. This study examined the proximal articular surface and greater tuberosity of the humeral head in plain radiography. Methods: Two-hundred forty-seven cases, whose anteroposterior (AP) radiographs were taken correctly, were included from 288 cases, in whom the status of the supraspinatus had been confirmed by surgery. After downloading the plain AP radiograph as DICOM, the radius of the circle apposed at the superior half of the articular surface of the head, and the distance between the circle and the farthest point of the greater tuberosity ('height' of the greater tuberosity) were calculated using the software (TechHime, Korea). MRI checked the number of torn tendons and degree of muscular atrophy. Results: The following were encountered: 93 intact supraspinatus, 50 partial-thickness tears, and 104 full-thickness tears. In the analysis using the 93 intact cases, the average radius of the rotation center was 25.3 mm in male and 22.3 mm in female. The average height of the greater tuberosity from the circle with the same rotation center was 4.3 mm in male and 4.2 mm in female with no statistical significance. The correlation between the reparability of supraspinatus and height of the greater tuberosity, fatty infiltration, and muscular atrophy was confirmed. Conclusions: The height of the greater tuberosity from the circle with the same rotation center was 4.3 mm in male and 4.2 mm in female. This height was strongly correlated with muscular atrophy and fatty infiltration of the supraspinatus tendon.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.41-49
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• 2015

Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.

• 대한골관절종양학회지
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• 제1권1호
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• pp.60-67
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• 1995

It is difficult to manage the growing deformity of forearm bone caused by hereditary osteochondromatosis in children, because deformity and discrepancy of limb length is progressive. The are many treatment methods of these problems including excisio of osteochondroma, lengthening of ulna, shortening of radius, corrective osteotomy with or without lengthening apparatus. Among many treatment methods, we tried free vascularized epiphyseal transplantation with the proximal fibular epiphysis in 3 patients of hereditary osteochondromatosis for inducement of continuous bone growth and deformity correction. The average duration of follow up was 7 years and 1 month, the shortest duration being to 4 years and 5 months and the longest 10 years and 8 months. Serial radiologic and clinical evaluation were carried out during follow up and there were satisfactory length gain, deformity correction and improvement of adjacent joint motion in 2 cases. According to our follow up evaluation, free vascularized epiphyseal transplantation is valuable procedure in forearm deformity of hereditary osteochondromatosis although it needs skillful and experienced operative technique.

• Clinical Pain
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• 제19권2호
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• pp.129-132
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• 2020

Fracture is uncommon cause of lymphedema. The mechanism of lymphedema progression is still unknown, but disruption of the lymphatic system during and after fracture might be involved. In contrast, breast cancer surgery is a common cause of lymphedema and is usually caused by the removal of axillary lymph nodes. Sentinel node biopsy (SNB) has been adopted in early breast cancer to reduce the risk of lymphedema. Thus, the incidence of lymphedema in SNB was lowered. However, less than 10% of SNB patients are still diagnosed with lymphedema, but it is known that it took years to diagnose. Recently, we encountered atypical lymphedema occurred after breast cancer surgery with SNB. Symptoms started earlier than usual and were more severe. Interestingly, she has a history of a proximal radial fracture on the same side of SNB. We thought there could be a relationship between the acceleration of breast cancer-related lymphedema and fracture.