• Clinics in Shoulder and Elbow
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• 제25권1호
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• pp.49-56
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• 2022

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

• Clinics in Shoulder and Elbow
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• 제15권2호
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• pp.143-147
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• 2012

상부 견갑 현수 복합체(Superior shoulder suspensory complex)의 3중 붕괴는 몇몇 저자들에 의해서만 보고된 극히 드문 손상이다. 저자들은 오구돌기, 견갑극 골절 및 견봉-쇄골 관절의 탈구가 동반된 상부 견갑 현수 복합체의 3중 붕괴 환자를 경험하였기에 보고하고자 한다. 본 환자의 경우 견봉-상완 및 오구-상완 간격을 유지하기 위하여 관혈적 정복 및 내고정을 시행하여 상부 견갑 현수 복합체의 3중 붕괴 모두를 해부학적으로 복원하여 치료하였다. 술 후 6개월에 증상 없이 관절운동범위를 모두 회복하였다. 최종 추시인 5년에는 상부 견갑 현수 복합체의 기능이 완전히 회복된 것을 확인할 수 있었으며, 환자는 수술 결과에 대하여 크게 만족하였다.

• Clinics in Shoulder and Elbow
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• 제11권2호
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• pp.150-157
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• 2008

목적: 견갑골 체부 골절의 수술적 치료 결과를 분석하고자 하고자 한다. 대상 및 방법: 7명의 환자를 대상으로 수술적 치료를 시행하였다. 견갑골 외측 경계가 100% 전위된 경우, 관절와가 $25^{\circ}$ 각변형 되거나 1 cm 이상 내측 전위된 경우, 견갑골 체부와 쇄골 골절이 동반된 경우를 수술적 치료의 대상으로 삼았다. 남자가 5명 여자가 2명, 평균 나이는 49(40~58)세, 평균 추시는 11(6~24)개월 이였다. 두 명은 다발성 늑골 골절과 척추 골절을 동반하였다. 기능적 평가를 위해 UCLA score 와 Korean shoulder score, 술 후 주관적인 만족도를 이용하였다. 결과: UCLA score는 평균29(17~33)점 이었고 평균 Korean shoulder score는 86(63~94)점이었다. 환자의 주관적인 만족도는 10점 만점에 7.7(4~9)이었다. 합병증으로 정복된 골절의 소실 없는 나사못 이완이 1예에서 관찰되었으며 관절와로 돌출된 나사못으로 1예에서는 교환하여야 하였다. 결론: 심하게 전위된 견갑골 체부골절에서는 견관절 및 견갑흉곽관절의 생역학적 이상으로 인한 견관절의 운동 장애를 예방하기 위해 수술적 치료가 도움이 될 것으로 판단된다.

• Clinics in Shoulder and Elbow
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• 제17권2호
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• pp.68-76
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• 2014

Background: Recently, reverse total shoulder arthroplasty (RTSA) has been accepted as a main treatment option in irreparable massive rotator cuff tear with cuff arthropathy. The purpose of this study was to evaluate the early complication incidence and the preliminary clinical results of RTSAs performed in single institute. Methods: Fifty-seven RTSAs (56 patients) were performed between April 2011 and March 2013. The indications for RTSA were cuff tear arthropathy and irreparable massive rotator cuff tear with or without pseudoparalysis. Exclusion criteria were revision, preoperative infections and fractures. At final follow-up, 45 shoulders were enrolled. Mean follow-up duration was 12.5 months (range, 6-27 months). The mean age at the time of surgery was 73.6 years (range, 58-87 years). All the patients were functionally accessed via Constant score, American Shoulder and Elbow Surgeons (ASES) score, pain and functional visual analogue scale (VAS) scores and active range of motion. Complications were documented as major and minor. Major complications include fractures, infections, dislocations, nerve palsies, aseptic loosening of humeral or glenoid components, or glenoid screw problems. Minor complications include radiographic scapular notching, hematomas, heterotopic ossification, algodystrophy, intraoperative dislocations, intraoperative cement extravasation, or radiographic lucent lines of the glenoid. Results: The mean Constant score increased from 31.4 to 53.8 (p < 0.001). The pain and functional VAS scores improved (5.2 to 2.7, p < 0.001, 4.0 to 6.7, p < 0.001) and active forward flexion improved from $96.9^{\circ}$ to $125.6^{\circ}$ (p = 0.011). One or more complications occurred in 16 (35.6%) of 45 shoulders, with one failure (2.2%) resulting in the removal of implants by late infection. The single most common complication was scapular notching (9 [20%]). There were 4 (8.9%) axillary nerve palsies postoperatively (n=3: transient n. palsy, n=1: Symptom existed at 11 months postoperatively but improving). Conclusions: In a sort term follow-up, RTSA provided substantial gain in overall function. Most common early complications were scapular notching and postoperative neuropathy. Although overall early complication rate was as high as reported by several authors, most of the complications can be observable without compromise to patients' clinical outcome. Long term follow-up is required to clarify the clinical result and overall complication rate.

• Journal of Chest Surgery
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• 제47권4호
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• pp.406-408
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• 2014

A 66-year-old male patient arrived at the emergency room with a crush injury to his chest. Multiple rib fractures, hemothorax on both sides, left scapular fracture, liver laceration, and retroperitoneal hematoma were found upon the radiologic examination. After closed thoracostomy, the patient had been initially admitted to the intensive care unit, but he was transferred to the general ward on the next day. On the 4th post-trauma day, the patient complained of severe pain and there was bloody drainage through the chest tube. This case is an exploration with the consideration of the possibility of major bleeding and the subsequent repair of the descending thoracic aorta. This case is regarded as a case in which the aorta wall was damaged as the sharp margin of the fractured ribs caused continuous irritation.

• Journal of Chest Surgery
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• 제12권4호
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• pp.418-423
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• 1979

Chest injuries due to blunt trauma often result in severe derangements that lead to death. And we have to diagnose and treat the patients who have blunt chest trauma immediately and appropriately. A clinical analysis was made on 324 cases of chest injury due to blunt trauma experienced at department of Thoracic and Cardiovascular Surgery, College of Medicine, Kyung Hee University during 8-year period from 1972 to 1979. Of 324 patients of blunt chest injuries, there were 189 cases of rib fracture, 121 of hemothorax or/and pneumothorax, 108 of soft tissue injury of the chest wall only, 41 of lung contusion, 24 of flail chest, 13 of scapular fracture, 7 of diaphragmatic rupture and others. The majority of blunt chest injury patients were traffic accident victims and falls accounted for the next largest group of accidents. Chest injuries were frequently encountered in the age group between 3rd decade and 4th decade [60%] and 238 patients were male comparing to 86 of female [Male: Female = 3:1 ]. In the patients who have the more number of fractured ribs, the more incidence of intrathoracic injury and intraabdominal organ damage were found. The principal associated injuries were head injury on 58 cases, long bone fractures on 37, skull fractures on 12, pelvic fractures on 10, renal injuries on 6 and intraabdominal organ injuries on 5 patients. The principle of early treatment of chest injury due to blunt trauma were rapid reexpansion of the lung by closed thoracotomy which was indicated on 96 cases, but open thoractomy was necessary on 14 cases because massive bleeding, intrapleural hematoma and/or fibrothorax, or diaphragmatic laceration-On 15 cases who were young and have multiple rib fracture with severe dislocation delayed elective open reduction of the fractured ribs with wire was done on the purpose of preserving normal active life. The over all mortality was 2.8% [9 of 324 cases] due to head injury on 3 cases, massive bleeding on 2,wet lung syndrome, acute renal failure on 1 and septicemia on 1 patient.

• Archives of Plastic Surgery
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• 제45권6호
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• pp.495-503
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• 2018

With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.

• Journal of Chest Surgery
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• 제12권4호
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• pp.411-417
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• 1979

During the period of 4 years from August 1, 1975 to August 1, 1979, authors have experienced 100 cases of multiple rib fractures by nonpenetrating injury at Department of Thoracic Surgery, Paik Foundation Hospital in Seoul, Korea. 1. The ratio of male to female patients with multiple rib fracture was 2.6:1 with male predominance and 84% of the total cases were between 20 and 50 years of age. 2. The most common cause of multiple rib fracture was traffic accident and falls accounted for the next largest group. 3. The most common site of rib fracture was 4th rib to 7th rib level on both hemithorax [52%]. 4. Associated injuries were cerebral contusion in 26%, clavicular fracture in 22%, long bone fracture in 22%, pelvic bone fracture in 10%, and scapular fracture in 8%. 5. Early complications and/or result of the multiple rib fractures were lung contusion in 23 cases, subcutaneous emphysema in 21 cases, hemothorax in 21 cases, hemopneumothorax in 6 cases, and flail chest in 12 cases. 6. The flail chests were managed by strapping the chest with adhesive plaster, external traction of flail segment with towel clip, ventilatory assistance for marginal clinical indications, and in cases of complicated with intrathoracic hemorrhage, wire fixation of flail segment through open thoraco-tomy. 7. The principles of therapy for hemothorax and/or pneumothorax were rapid reexpansion of the lungs by thoracentesis [11%] and closed thoracostomy [22%], but open thoracotomy had to be done on 3 cases because of massive bleeding or intrapleural hematoma and diaphragmatic rupture. 8. The over all mortality was 4% [4 among 100 cases] and the cause of all deaths was head injury.

• 대한관절경학회지
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• 제12권3호
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• pp.217-221
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• 2008

오구 충돌 증후군은 상완골 전상방 면과 오구견봉 궁 후외측면의 비정상적 접촉에 의해 발생하며, 그 원인으로는 외상성, 특발성 및 의인성 인자가 있다. 그 중 외상에 의한 경우는 견갑골 경부, 오구 돌기, 또는 상완골 소결절 골절이 원인이 될 수 있다. 상완골 소결절 부정 유합에 의한 오구 충돌 증후군은 드문 질환으로 치료에 대해서는 주로 개방적 수술이 사용되어 왔으나 관절경적 오구 돌기 성형술과 함께 소결절의 경피적 고정술을 보고한 예는 없었다. 이에 저자들은 상완골 소결절 부정 유합으로 발생한 오구 충돌 증후군에 대하여 관절경적 수술로 치유된 1 예를 경험하였기에 문헌 고찰과 함께 보고하고자 한다.

• Journal of Chest Surgery
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• 제13권1호
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• pp.60-65
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• 1980

We have experienced 2 cases of the hunshot wound sof the chest involving cardiac injuries at department of the thoracic surgery, Capital Armed Forces General Hospital during I year from April I 1979 to Jan. 1980. In one case of two patients , he was a 22 years old man who was transported to this emergency room 4 hour 10 minutes after having gunshot wound of the left chest by helicopter. Physical examination showed small inlet in left 3rd ICS and left parasternal border, large outlet in left 8th ICS and left scapular line, no breath sound on left side and distant heart sound. chest roentgenography demonstrated marked pleural effusion in left side and mediastinum shifted to right. As soon as chest X-ray was taken, the bleeding through penetrating wound became profuse and cardiac arrest ensued. Closed chest cardiac massage was started and vigorous transfusion continued, but no effective cardiac activity could not be obtained. The patient was pronounced dead due to exsanguinating hemorrhage from wuwpected cardiac wounds. In this critically injured patient with evidence of intrathoracic hemorrhage and suspected cardiac penetration, only emergency thoracic exploration and immediate surgical control of bleeding points might offer the maximum possibility of survival. The other case was a 23 years old man who was transferred to the emergency room 4 hours 50 minutes after having kmultiple communicated fractures of sternum and linear fracture of right mandible by a missile. Examination revealed about 30% skin loss of the anterior chest wall, weak pulse of 96 beats/min., distant heart sound and decreased breath sounds bilaterally. finding on the chest X-ray films showed multiple sternal fractures, marked pericardial effusion indicating hemopericardium. So, the patient was moved immediately to the operation room where, after endotracheal tube inserted, a median sternotomy was performced. A hemorrhagic congestion of the right upper lobe and marked bulging pericardium were disclosed. The pericardium was opened anterior to right phrenic nerve and exsanguinating hemorrhage ensued from the 0.5cm lacerated wound in the auricle of right atrium. The rupture site of right atrium was occluded with non-crushing vascular clamps and then was over sewn with interrupted sutures. It was thought to be highly possible that he was alive long enough to have cardiorrhaphy because of cardiac tamponade, which prevented exsanguinating hemorrhage. He was taken closed reduction for linear fracture of right mandible 2 weeks after repair of ruptured right auricle in dental clinic. This patient's post-operative course was not eventful.