• Title/Summary/Keyword: complex fracture

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Correction of Malunited Fracture of Zygoma Through Limited Incisions (제한적 접근을 통한 부정유합된 관골골절의 교정)

  • Kim, Yong-Ha;Kim, Sung-Ho;Seul, Jeung-Hyun;Lee, Kyung-Ho
    • Journal of Yeungnam Medical Science
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    • v.13 no.1
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    • pp.22-31
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    • 1996
  • It is difficult to get a satisfactory result for the correction of malunited fracture of zygoma. Triple osteotomy and reposition of malunited zygoma is accepted as the better surgical method than camouflage surgery by means of onlays, if the orbital floor is to be reconstructed. The surgical approach can be divided into bicoronal, periorbital, intraoral and old scar. In 7 patients with malunited fracture of zygoma, the authors used a limited approach through extension of periorbital incision and intraoral incision instead of wide exposure including bicoronal incision. And we performed triple osteotomy and advancement of zygoma complex. The patients were followed for 4.5 months with acceptable result, and this approach was an effective method for the relatively simple tripod type-malunited fracture of zygoma. The authors obtained following conclusions: 1. Preoperative evaluation through thorough measurement of X-rays, investigation of photographs and detail communication with the patients was an important process. 2. Through lateral extension of subciliary incision, lateral eyebrow and intraoral incision, we could obtain adequate exposure for triple osteotomy and advancement of zygoma. 3. The zygoma should be reduced and fixed in an overcorrected superior and medial direction. 4. Return of zygoma to its anatomical position was possible only when it is completely freed from the surrounding soft tissue including masseter. 5. We could not find any different results between autogenous calvareal bone graft and $Medpor^{(R)}$ insertion on the floor of orbit.

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TREATMENT OF COMPLICATED CROWN FRACTURE BY PARTIAL PULPOTOMY : CASE REPORTS (부분 치수절단술을 이용한 복잡 치관파절의 치료 : 증례보고)

  • Ahn, Byung-Duk;Kim, Young-Jae;Jang, Ki-Taeg;Lee, Sang-Hoon;Kim, Chong-Chul;Hahn, Se-Hyun;Kim, Jung-Wook
    • Journal of the korean academy of Pediatric Dentistry
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    • v.35 no.2
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    • pp.324-332
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    • 2008
  • Traumatic crown fracture in mixed dentition or early permanent dentition is relatively common. Crown fracture is classified into simple or complicated crown fracture by the presence of pulp exposure. The condition of pulp must be considered in treatment of crown fractures with pulp exposure. Treatment of immature crown-fractured incisor with pulp exposure is more complex because of its incomplete root formation. Pulp capping, partial pulpotomy, cervical pulpotomy can be used for continuous root development in immature crown-fractured incisor with pulp exposure. The success rate of partial pulpotomy is very high and there are several advantages of partial pulpotomy because the cell-rich coronal pulp tissue is preserved. This paper reports 2 cases of crown-fractured permanent incisors with pulp exposure that had been treated by partial pulpotomy successfully.

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Postoperative malocclusion after maxillofacial fracture management: a retrospective case study

  • Kim, Sang-Yun;Choi, Yong-Hoon;Kim, Young-Kyun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.40
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    • pp.27.1-27.8
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    • 2018
  • Purpose: Various complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture. Materials and methods: In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors' department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery. Results: One patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration. Conclusions: Considering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem.

Fracture patterns in the maxillofacial region: a four-year retrospective study

  • Park, Kyung-Pil;Lim, Seong-Un;Kim, Jeong-Hwan;Chun, Won-Bae;Shin, Dong-Whan;Kim, Jun-Young;Lee, Ho
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.41 no.6
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    • pp.306-316
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    • 2015
  • Objectives: The facial bones are the most noticeable area in the human body, and facial injuries can cause significant functional, aesthetic, and psychological complications. Continuous study of the patterns of facial bone fractures and changes in trends is helpful in the prevention and treatment of maxillofacial fractures. The purpose of the current clinico-statistical study is to investigate the pattern of facial fractures over a 4-year period. Materials and Methods: A retrospective analysis of 1,824 fracture sites was carried out in 1,284 patients admitted to SMG-SNU Boramae Medical Center for facial bone fracture from January 2010 to December 2013. We evaluated the distributions of age/gender/season, fracture site, cause of injury, duration from injury to treatment, hospitalization period, and postoperative complications. Results: The ratio of men to women was 3.2:1. Most fractures occurred in individuals aged between teens to 40s and were most prevalent at the middle and end of the month. Fractures occurred in the nasal bone (65.0%), orbital wall (29.2%), maxillary wall (15.3%), zygomatic arch (13.2%), zygomaticomaxillary complex (9.8%), mandibular symphysis (6.5%), mandibular angle (5.9%), mandibular condyle (4.9%), and mandibular body (1.9%). The most common etiologies were fall (32.5%) and assault (26.0%). The average duration of injury to treatment was 6 days, and the average hospitalization period was 5 days. Eighteen postoperative complications were observed in 17 patients, mainly infection and malocclusion in the mandible. Conclusion: This study reflects the tendency for trauma in the Seoul metropolitan region because it analyzes all facial fracture patients who visited our hospital regardless of the specific department. Distinctively, in this study, midfacial fractures had a much higher incidence than mandible fractures.

Calculation of Expected Life of Hydrogen Pressure Vessels by Fracture and Fatigue Mechanics assuming Semi-elliptical Cracks and Analysis of the Effect of Thickness and Radius (반타원형 균열을 가정한 파괴 및 피로역학에 의한 수소 압력용기의 예상 수명 계산과 두께와 내경이 미치는 영향 분석)

  • Kim, Jeong Hwan;Lee, Hwa Young;Lee, Min-Kyung;Lee, Jae-Hun;Lyu, Geunjun
    • Journal of the Korean Institute of Gas
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    • v.25 no.6
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    • pp.53-65
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    • 2021
  • While the hydrogen refueling station is rapidly expanded and installed, the safety inspection of the hydrogen pressure vessel in the station should be very important. Of these, according to ASME, hydrogen embrittlement tests must be performed for hydrogen vessel that store hydrogen above a certain pressure. The main test method for hydrogen embrittlement inspection is to carry out fracture tests and fatigue fracture tests in a high pressure hydrogen atmosphere, which allows the durability limit of the pressure vessel to be measured and the endurable limit to be determined in the hydrogen atmosphere. In detail, the critical crack depth can be calculated by the stress intensity factor(K), and the service life can be determined by da/dN (fatigue growth rate). API579-1/ ASME FFS-1 part 9 exemplifies the calculation method according to the mode of crack-like flaws, but for various shapes such as plates and cylinders, there are about 55 modes according to the shape and location of the crack. Due to the fairly complex formula, it is not easily accessible. In this study, we will show you how to calculate fracture mechanics numerically via Excel and VBA. In addition, this was applied to analyze the effects of the thickness and inner diameter of the pressure vessel on the service life.

NSM00158 Specifically Disrupts the CtBP2-p300 Interaction to Reverse CtBP2-Mediated Transrepression and Prevent the Occurrence of Nonunion

  • Chen, Xun;Zhang, Wentao;Zhang, Qian;Song, Tao;Yu, Zirui;Li, Zhong;Duan, Ning;Dang, Xiaoqian
    • Molecules and Cells
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    • v.43 no.6
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    • pp.517-529
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    • 2020
  • Carboxyl-terminal binding proteins (CtBPs) are transcription regulators that control gene expression in multiple cellular processes. Our recent findings indicated that overexpression of CtBP2 caused the repression of multiple bone development and differentiation genes, resulting in atrophic nonunion. Therefore, disrupting the CtBP2-associated transcriptional complex with small molecules may be an effective strategy to prevent nonunion. In the present study, we developed an in vitro screening system in yeast cells to identify small molecules capable of disrupting the CtBP2-p300 interaction. Herein, we focus our studies on revealing the in vitro and in vivo effects of a small molecule NSM00158, which showed the strongest inhibition of the CtBP2-p300 interaction in vitro. Our results indicated that NSM00158 could specifically disrupt CtBP2 function and cause the disassociation of the CtBP2-p300-Runx2 complex. The impairment of this complex led to failed binding of Runx2 to its downstream targets, causing their upregulation. Using a mouse fracture model, we evaluated the in vivo effect of NSM00158 on preventing nonunion. Consistent with the in vitro results, the NSM00158 treatment resulted in the upregulation of Runx2 downstream targets. Importantly, we found that the administration of NSM00158 could prevent the occurrence of nonunion. Our results suggest that NSM00158 represents a new potential compound to prevent the occurrence of nonunion by disrupting CtBP2 function and impairing the assembly of the CtBP2-p300-Runx2 transcriptional complex.

Short- to mid-term outcomes of radial head replacement for complex radial head fractures

  • Baek, Chung-Sin;Kim, Beom-Soo;Kim, Du-Han;Cho, Chul-Hyun
    • Clinics in Shoulder and Elbow
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    • v.23 no.4
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    • pp.183-189
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    • 2020
  • Background: The purpose of the current study was to investigate short- to mid-term outcomes and complications following radial head replacement (RHR) for complex radial head fractures and to identify factors associated with clinical outcomes. Methods: Twenty-four patients with complex radial head fractures were treated by RHR. The mean age of the patients was 49.8 years (range, 19-73 years). Clinical and radiographic outcomes were evaluated for a mean follow-up period of 58.9 months (range, 27-163 months) using the visual analog scale (VAS) score for pain, the Mayo elbow performance score (MEPS), the quick disabilities of the arm, shoulder and hand (Quick-DASH) score, and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, the mean VAS score, MEPS, and Quick-DASH score were 0.6±1.1, 88.7±11.5, and 19.4±7.8, respectively. The mean range of motion was 132.7° of flexion, 4.7° of extension, 76.2° of pronation, and 77.5° of supination. Periprosthetic lucency was observed in six patients (25%). Heterotopic ossification was observed in four patients (16.7%). Arthritic change of the elbow joint developed in seven patients (29.2%). Capitellar wear was found in five patients (20.8%). Arthritic change of the elbow joint was significantly correlated with MEPS (P=0.047). Four cases of complications (16.6%) were observed, including two cases of major complications (one stiffness with heterotopic ossification and progressive ulnar neuropathy and one stiffness) and two cases of minor complications (two transient ulnar neuropathy). Conclusions: RHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high.

Stress Analysis of Composite Plate with an Elliptical Hole or a Crack Using Complex Potentials (복소퍼텐셜을 이용한 타원공 또는 균열을 가진 복합재 평판 응력해석)

  • Kwon, Jung-Ho;Hwang, Kyung-Jung
    • Composites Research
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    • v.20 no.5
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    • pp.56-63
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    • 2007
  • An approach using complex potentials is presented for analysis of composite plate with an elliptical hole or a rectilinear crack. Composite structure is susceptible to encounter impact damages, which lead to considerable decrease in its residual strength. Such impact damages could be modeled as an equivalent elliptical hole or notch-like crack. Even though finite element method is widely used to analyze stresses or fracture mechanics parameters around such damage, it is tedious to make successive FE-modeling for damage tolerance assessment under fatigue loadings. In this point of view, the solutions based on complex potentials are very simple and easy to use. The computed results are also compared and discussed with those from FEA.

A CASE REPORT OF THE HUGE COMPLEX ODONTOMA TREATED WITH THE SAGITTAL SPLITTING OF BUCCAL BONE PLATE AND ILIAC BONE GRAFT IN LEFT MANDIBLE ANGLE (하악 협측골 시상분절술 및 장골 이식술을 이용한 거대치아종의 치험례)

  • Kim, Ho-Seok;Song, Jae-Chul;Kim, Chin-Soo
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.15 no.4
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    • pp.269-274
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    • 1993
  • This is the case report of huge complex odontoma treated with sagittal splitting of buccal bone plate and iliac bone graft in left mandible angle. The 22 years old patient was admitted to the department of Oral and Maxillofacial Surgery of Kyungpook National University Hospital with the chief complaint of swelling on the left mandible angle area. We used extra oral Risdon incision and splitted the buccal cortical bone after making the horizontal bone cut buccally. The tumor mass was removed with cutting into the pieces with surgical bur to prevent mandibular fracture. The dead space was grafted with autogenous iliac bone graft and the splitted buccal cortical bone was fixed with two L-type miniplate. After 12months follow up check, we noticed good process of bone healing and satisfactory aesthetic result. In this case, my operative approach provided the excellent surgical access to the hard tissue mass and minimized post operative complication comparing with the conventional surgical approaches.

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Physical Therapy and Rehabilitation of Complex Regional Pain Syndrome in Shoulder Prosthesis

  • Celik, Derya;Demirhan, Mehmet
    • The Korean Journal of Pain
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    • v.23 no.4
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    • pp.258-261
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    • 2010
  • We report a 66-year-old woman with complex regional pain syndrome (CRPS) 1 treated with combined medical and active physical therapy. She was diagnosed with CRPS 1 following partial shoulder prosthesis due to proximal humerus fracture. Despite continuous medication and physical therapy, there was no improvement in her pain and functional outcome. Her overall pain was decreased by stellate ganglion block 3 times in two weeks conducted during the second month of the follow-up period. Following the ganglion blockades, pain and the other symptoms were decreased intermittently but range of motion (ROM) and functional status were not satisfied as much as expected. After the third month of follow-up, her passive and active ROM of the shoulder joint was increased after application of manipulation under general anesthesia. In conclusion, because CRPS 1 remains one of the most difficult pain syndromes, early diagnosis and treatment are important to have adequate functional results from physical therapy. Manipulation under general anesthesia may be an additional effective treatment tool to obtain functional improvement in some patients diagnosed with CRPS 1.