• 제목/요약/키워드: Unstable fracture

검색결과 181건 처리시간 0.026초

원위경비인대결합의 손상 (Syndesmotic Injury)

  • 안정태;박문수;정비오
    • 대한족부족관절학회지
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    • 제26권1호
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    • pp.9-15
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    • 2022
  • Syndesmotic injuries are found frequently in clinical practice, and they remain controversial because of the variety of diagnostic techniques and management options. Bony avulsions or malleolar fractures are commonly associated with syndesmotic disruptions. Even unstable isolated syndesmosis injuries are associated with a latent or frank tibiofibular diastasis and should not be ignored in the early phase. A relevant instability of the syndesmosis with diastasis results from collateral ligaments tears and requires operative stabilization. The treatment involves an anatomic reduction of the distal tibiofibular articulations followed by stable fixation. Syndesmotic transfixation screws or suture button implants are being proposed as a means of fixation. Recently, suture button fixation has shown more favorable outcomes, but the outcomes can still be controversial. Syndesmotic malreduction can lead to hardware failure, adhesions, heterotopic ossification, tibiofibular synostosis, chronic instability, and posttraumatic arthritis. In particular, the correct diagnosis and evidence-based treatment options for unstable syndesmotic injury should be considered.

PHILOS plate fixation with polymethyl methacrylate cement augmentation of an osteoporotic proximal humerus fracture

  • Kim, Do-Young;Kim, Tae-Yeong;Hwang, Jung-Taek
    • Clinics in Shoulder and Elbow
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    • 제23권3호
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    • pp.156-158
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    • 2020
  • PHILOS plate fixation in osteoporotic proximal humerus fracture of old age is well-known for high complication rate, especially metal failure, providing various augmentation techniques, such as calcium phosphate cement, allogenous or autologous bone graft. We report a case of polymethyl methacrylate augmentation to provide appropriate reduction with a significant mechanical support. This can be a treatment option for displaced unstable osteoporotic proximal humerus fracture with marked bony defect.

종골 부정 유합에 동반된 거주상 관절 아탈구의 치료 (1예 보고) (Treatment of Talonavicular Subluxation Accompanied by Calcaneal Malunion (A Case Report))

  • 차성무;장보훈;서진수
    • 대한족부족관절학회지
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    • 제16권4호
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    • pp.270-275
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    • 2012
  • There may be complications after comminuted or intraarticular calcaneal fracture regardless of the initial treatment. Transcalcaneal talonavicular dislocation is rarely reported severe form of calcaneal fracture. We experienced a neglected transcalcaneal talonavicular subluxation case, who had been treated for intraarticular calcaneal fracture conservatively. Subtalar distraction bone block fusion was done for calcaneal malunion with talonavicular subluxation. Inspite of successful subtalar fusion, pain was persisted because of talonavicular re-subluxation with arthritis and calcaneocuboid arthritis. So, second operation, the talonavicular and calcaneocuboid fusion, was done. After union achieved, the patient's foot pain was improved. Calcaneal malunion combined with talonavicular subluxation and unstable transverse tarsal joint, such as this case, initial triple arthrodesis could be considered.

Hemorrhagic Shock in a Patient with a Morel-Lavallée Lesion Combined with Active Arterial Bleeding without Fracture

  • Lim, Eic Ju;Oh, Jong-Keon;Cho, Jae-Woo;Sakong, Seungyeob;Cho, Jun-Min
    • Journal of Trauma and Injury
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    • 제34권1호
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    • pp.61-65
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    • 2021
  • A Morel-Lavallée lesion is a closed degloving injury caused by traumatic separation of the skin and subcutaneous tissue from the underlying fascia. However, since physicians tend to focus on treating the bone fracture, hemodynamic instability accompanying a Morel-Lavallée lesion can sometimes be overlooked. We report the case of a hemodynamically unstable 73-year-old man who had a Morel-Lavallée lesion of the thigh, but no femur fracture. Angiography showed active bleeding from the muscular branch of the right deep femoral artery, which was then successfully embolized.

The effect of acid environment and thawing and freezing cycles on the mechanical behavior of fiber-reinforced concrete

  • A.R. Rahimi Chakdel;S.M. Mirhosseini;A.H. Joshagani;M.R.M. Aliha
    • Structural Engineering and Mechanics
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    • 제90권5호
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    • pp.481-492
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    • 2024
  • This research examined the mechanical behavior of fiber-reinforced concrete at unstable environmental conditions. Concrete composites with varying percentages of steel and glass fibers were analyzed. Compressive, indirect tensile, and fracture toughness properties were evaluated using the Edge Notched Disc Bend (ENDB) test under freezing-thawing and acidic environments and the results were compared with normal conditions. Steel fibers decreased the strength in the specified cycles, while glass fibers showed a normal strength trend. The compressive, tensile and fracture toughness of the samples containing 1.5 vol.% fibers showed a 1.28-, 2.13- and 4.5-fold enhancement compared to samples without fibers, after 300 freezing-thawing cycles, respectively.

콘크리트 삼점휨 시험편의 동적 파괴거동 (Dynamic Fracture Behaviors of Concrete Three-Point Bend Specimens)

  • 연정흠
    • 콘크리트학회논문집
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    • 제14권5호
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    • pp.689-697
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    • 2002
  • 콘크리트 삼점휨 시험편의 변위제어에 의한 동적 파괴실험으로 하중과 하중점-변위가 측정되었다. 변형률 게이지를 사용하여 균열의 성장길이가 측정되었으며, 균열이 성장되는 동안의 평균속도는 0.16 ~ 66 m/sec이었다. 균열성장에 대한 파괴에너지는 측정된 외부일에 대한 하중점-변위에 대한 운동에너지와 영구변형이 고려되지 않은 탄성에너지의 차이로부터 계산되었다. 모든 균열속도에 대해 23mm의 균열성장 동안 미소균열이 성장되며, 51 mm의 최대 탄성0에너지까지 안정 균열성장과 이후의 불안정 균열성장을 보였다. 균열속도가 66msec인 경우를 제외하고 80mm의 균열성장에서 균열성장의 구속이 관측되었다. 균열속도에 대한 파괴에너지와 파괴에너지율의 분석은 13mm/sec보다 느린 경우에 정적 거동을 그리고 1.9m/sec보다 빠른 속도에서 동적 거동을 보였다. 동적 실험에서 측정된 하중과 하중점-변위 관계의 큰 차이에도 불구하고 관성력과 균열성장길이 그리고 탄성에너지의 차이로 불안정 균열성장 이전의 균열속도에 대한 파괴저항은 균열속도에 영향을 받지 않았다. 안정 균열성장 동안의 최대 파괴저항은 최대하중 이후 최대 탄성에너지에서 발생되며, 동적 실험이 정적 실험보다 147% 큰 값이었다.

전복막출혈이 동반된 골반골절 (Pelvic Bone Fracture with Preperitoneal Hemorrhage)

  • 김중석;설영훈;고승제;예진봉;박상순;구관우;김영철
    • Journal of Trauma and Injury
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    • 제28권4호
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    • pp.272-275
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    • 2015
  • Pelvic bone fracture with unstable vital signs is a life-threatening condition demanding proper diagnosis and immediate treatment. Unlike long bones, the pelvic bone is a three dimensional structure with complex holes and grooves for vessels and nerves. Because of this complexity, a pelvic bone fracture can lead to complicated and serious bleeding. We report a case of a fifty-year-old male suffering from a pelvic bone fracture due to a fall. An imaging study showed fractures of both the superior and the inferior ramus of the pubic bone, with contrast extravasation underneath them, resulting in a large preperitoneal hematoma. He was sent for angiography, which revealed a hemorrhage from a branch of the left obturator artery. Embolization was done with a glue and lipiodol mixture. The patient recovered without complication, and was discharged at four weeks after admission.

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혈역학적으로 불안정한 골반 골절에서 진공 폐쇄 드레싱을 병용한 후복막 거즈 충전법 치료 (Retroperitoneal Gauze Packing with Vacuum-Associated Closure for Pelvic Fracture with Hemodynamic Instability)

  • 김성집;김지훈
    • Journal of Trauma and Injury
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    • 제27권2호
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    • pp.29-32
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    • 2014
  • Pelvic bone fracture with hemodynamic instability is fatal and the mortality rate can range up to 40%. Despite the big advances in the treatment of massive bleeding and hemorrhagic shock, the mortality associated with hemodynamically unstable pelvic bone fractures remains high. The gold standard of treatment for pelvic bone fracture with hemodynamic instability has not yet been determined and is an issue of main discussion among many doctors. Retroperitoneal packing is not yet wide spread in Korea, but is a good modality for managing of massive bleeding from pelvic bone fractures when an angiography suite or an expert surgeon is not available. A vacuum-assisted closure (VAC) system can also be applied with retroperitoneal packing in the manner of damage control surgery and open abdomen surgery. We present the case of a 51-year-old male who had a pelvic bone fracture with massive bleeding. We performed retroperitoneal gauze packing with a VAC system for the first time. The postoperative vital signs of patient were immediately stable, the massive bleeding was easily and quickly controlled, and the amount of transfusion of blood components was reduced.

전위된 하부 천골 횡골절에 대한 이중 금속판을 이용한 내고정술 (Dual Plate Fixation for Displaced Transverse Fracture of the Lower Sacrum)

  • 최동혁;박지훈;심승우;최용수
    • 대한정형외과학회지
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    • 제55권2호
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    • pp.178-182
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    • 2020
  • 하부 천골의 단독 골절은 일반적으로 저에너지 손상으로 안정된 골절이 많아 대부분의 경우에서 보존적 치료가 이루이지고 있고 그 결과도 좋은 것으로 보고되고 있다. 하지만 전위된 불안정 골절에서는 수술적 치료의 필요성이 요구되나 치료 방법이 정립되어 있지 않으며 증례보고마저 매우 드물다. 이에 저자들은 하부 천골의 전위된 횡골절에 대해 관혈적 정복 및 이중 금속판을 이용한 내고정술을 치험한 증례를 보고하고자 한다.

Biomechanical Study of Posterior Pelvic Fixations in Vertically Unstable Sacral Fractures: An Alternative to Triangular Osteosynthesis

  • Chaiyamongkol, Weera;Kritsaneephaiboon, Apipop;Bintachitt, Piyawat;Suwannaphisit, Sitthiphong;Tangtrakulwanich, Boonsin
    • Asian Spine Journal
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    • 제12권6호
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    • pp.967-972
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    • 2018
  • Study Design: Biomechanical study. Purpose: To investigate the relative stiffness of a new posterior pelvic fixation for unstable vertical fractures of the sacrum. Overview of Literature: The reported operative fixation techniques for vertical sacral fractures include iliosacral screw, sacral bar fixations, transiliac plating, and local plate osteosynthesis. Clinical as well as biomechanical studies have demonstrated that these conventional techniques are insufficient to stabilize the vertically unstable sacral fractures. Methods: To simulate a vertically unstable fractured sacrum, 12 synthetic pelvic models were prepared. In each model, a 5-mm gap was created through the left transforaminal zone (Denis zone II). The pubic symphysis was completely separated and then stabilized using a 3.5-mm reconstruction plate. Four each of the unstable pelvic models were then fixed with two iliosacral screws, a tension band plate, or a transiliac fixation plus one iliosacral screw. The left hemipelvis of these specimens was docked to a rigid base plate and loaded on an S1 endplate by using the Zwick Roell z010 material testing machine. Then, the vertical displacement and coronal tilt of the right hemipelves and the applied force were measured. Results: The transiliac fixation plus one iliosacral screw constructions could withstand a force at 5 mm of vertical displacement greater than the two iliosacral screw constructions (p=0.012) and the tension band plate constructions (p=0.003). The tension band plate constructions could withstand a force at $5^{\circ}$ of coronal tilt less than the two iliosacral screw constructions (p=0.027) and the transiliac fixation plus one iliosacral screw constructions (p=0.049). Conclusions: This study proposes the use of transiliac fixation in addition to an iliosacral screw to stabilize vertically unstable sacral fractures. Our biomechanical data demonstrated the superiority of adding transiliac fixation to withstand vertical displacement forces.