• Archives of Plastic Surgery
• /
• v.50 no.5
• /
• pp.523-528
• /
• 2023

The Gustilo IIIB tibiofibular fractures often result in long bone loss and extensive soft tissue defects. Reconstruction of these complex wounds is very challenging, especially when it includes long bone grafts, because the donor site is limited. We describe our experience using a set of chimeric ipsilateral vascularized fibula grafts with a thoracodorsal artery perforator free flap to reconstruct the traumatic tibia defects. A 66-year-old male suffered a severe comminuted tibia fracture and segmented fibula fracture with large soft tissue defects as a result of a traffic accident. He also had an open calcaneal fracture with soft tissue defects on the ipsilateral side. All the main vessels of the lower extremity were intact, and the cortical bone defect of the tibia was almost as large as the fractured fibula segment. We used an ipsilateral vascularized fibula graft to reconstruct the tibia and a thoracodorsal artery perforator flap to resurface the soft tissue, using the distal ends of peroneal vessels as named into sequential chimeric flaps. After 3 weeks, the calcaneal defect was reconstructed with second thoracodorsal artery perforator free flap. Reconstruction was successful and allowed rapid rehabilitation because of reduced donor site morbidity.

• Steel and Composite Structures
• /
• v.50 no.2
• /
• pp.237-247
• /
• 2024

Research on interfacial crack formation in orthotropic bi-materials has experienced a notable increase in recent years, driven by growing concerns about structural integrity and reliability. The existence of a crack at the interface of bi-materials has a substantial impact on mechanical strength and can ultimately lead to fracture. The primary objective of this article is to introduce a comprehensive analytical model and establish stress relationships for investigating interfacial crack between two non-identical orthotropic materials with desired crack-fiber angles. In this paper, we present the application of the Interfacial Maximum Tangential Stress (IMTS) criterion, in combination with the Reinforcement Isotropic Solid (RIS) model, to investigate the behavior of interfacial cracks in orthotropic bi-materials under mixed-mode I/II loading conditions. We analytically characterize the stress state at the interfacial crack tip using both Stress Intensity Factors (SIFs) and the T-stress term. Orthotropic materials, due to their anisotropic nature, can exhibit complex crack tip stress fields, making it challenging to predict crack initiation behavior. The secondary objective of this study is to employ the IMTS criterion to predict the crack initiation angle and explore the notable impact of the T-stress term on fracture behavior. Furthermore, we validate the effectiveness of our approach in evaluating Fracture Limit Curves (FLCs) for interfacial cracks in orthotropic bi-materials by comparing our FLCs with relevant experimental data from existing literature.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.19 no.4
• /
• pp.435-446
• /
• 1997

Overall study was carried out for the patients visiting Department of Oral & Maxillofacial Surgery through Emergency Room in Chonnam University Hospital, from Jan. 1, 1992 to Dec. 31, 1996. Result obtained were as follows ; Male predilection was shown, the male to female ratio being 2.5 to 1. The frequently developing age group were the first 3rd and 4th decade and under the age of 9 was followed. The number of patients for emergency was peak in September and October to 11%. About the causes for emergency, traffic accident was the most, and fall down injury and assault were followed. About the injury lists, facial laceration was preceded and the next facial bone fracture and the tooth injury followed. In the facial bone fracture, fracture in the mandible only was the most, and zygomaticomaxillary complex fracture, and mandible-maxilla complex fracture were followed. when the case of the mandible fracture, symphysis, condyle, angle were marked in succession. 57% was predomunatly ranged in the timea of 18 : 00 to 03 : 00 for the emergency. From injury onset to visiting emergency room, the range of 8 hours to 12 hours was predominant. Above results suggest that urgent patients of oral and maxillofacial area were relatively so high that division of oral and maxillofacial surgery should be established immediately.

• The Academic Congress of Korean Shoulder and Elbow Society
• /
• 2005.03a
• /
• pp.70-70
• /
• 2005

• Journal of Korean Neurosurgical Society
• /
• v.64 no.6
• /
• pp.944-949
• /
• 2021

Objective : The stability is an important factor to decide the treatment plan in thoracolumbar burst fracture patients. Patients with an unstable burst fracture generally need operative management. Decrease in vertebral body height, local kyphosis, involvement of posterior column, and/or canal compromise are considered important factors to determine the treatment plan. On the other hand, in thoracolumbar injury classification system (TLICS), surgery is recommended in patients with TLICS of more than 5 points. The purpose of this study was to apply the TLICS score in patients with thoracolumbar burst fractures and to distinguish the differences of treatment plan on burst fracture. Methods : All patients, diagnosed as a thoracolumbar burst fracture between January 2006 and February 2019 were included in this study. Unstable thoracolumbar burst fracture was defined as burst fracture with neurologic deficit, three-column injury, kyphosis over 30 degrees, decrease of anterior body height over 40 percent and canal comprise more than 50%. TLICS score was measured with morphology, neurological involvement and posterior ligamentous complex integrity. The existence of instability was compared with TLICS score. Results : Total 233 patients (131 men, 102 women) were included in this study. In Denis classification, 51 patients (21.9%) diagnosed as stable burst fracture while 182 patients (78.1%) had unstable burst fracture. According to TLICS, 72 patients (30.9%) scored less than 4, while 161 patients (69.1%) scored 4 or more. All the patients with stable burst fracture scored 2 in TLICS. Twenty-one patients (9.0) scored 2 in TLICS but diagnosed as unstable burst fracture. Thirteen patients had over 40% of vertebra body compression, four patients had more than 50% of canal compromise, three patients had both body compression over 40% and kyphosis over 30 degrees, one patients had both body compression and canal compromise. Fifteen patients presented kyphosis over 30 degrees, and three (20%) of them scored 2 in TLICS. Seventy-three patients presented vertebral body compression over 40% and 17 (23.3%) of them scored 2 in TLICS. Fifty-three patients presented spinal canal compromise more than 50%, and five (9.4%) of them scored 2 in TLICS. Conclusion : Although the instability of thoracolumbar burst fracture was regarded as a critical factor for operability, therapeutic strategies by TLICS do not exactly match with the concept of instability. According to the concept of TLICS, it should be reconsidered whether the unstable burst fracture truly unstable to do operation.

• Economic and Environmental Geology
• /
• v.54 no.6
• /
• pp.615-627
• /
• 2021

The Baekildo fault, a dextral strike-slip fault developed in Baekil Island, Goheung-gun, controls the distribution of tuffaceous sandstone and lapilli tuff and shows a complex fracture system around it. In this study, we examined the spatial variation in the geometry and connectivity of the fracture system by using circular sampling and topological analysis based on a detailed fracture trace map. As a result, both intensity and connectivity of the fracture system are higher in tuffaceous sandstone than in lapilli tuff. Furthermore, the degree of the orientation dispersion, intensity, and average length of fracture sets vary depending on the along-strike variation in structural position in the tuffaceous sandstone. Notably, curved fractures abutting the fault at a high angle occur at a fault bend. Based on the detailed observation and analyses of the fracture system, we conclude as follows: (1) the high intensity of the fracture system in the tuffaceous sandstone is caused by the higher content of brittle minerals such as quartz and feldspar. (2) the connectivity of the fracture system gets higher with the increase in the diversity and average length of the fracture sets. Finally, (3) the fault bend with geometric irregularity is interpreted to concentrate and disturb the local stress leading to the curved fractures abutting the fault at a high angle. This contribution will provide important insight into various geologic and structural factors that control the development of fracture systems around faults.

• Transactions of Materials Processing
• /
• v.28 no.6
• /
• pp.321-327
• /
• 2019

In this study, a hot and cold forging process was investigated to produce a complex-shaped hub of dual clutch transmission with low material loss and high productivity. The process was designed by the commercial finite element (FE) analysis program, DEFORM-2D (hot forging) and 3D (cold forging). And, the material flow and ductile fracture characteristics were studied to check the surface crack initiation of the specimen. The simulation results indicated that the proposed process could manufacture the complex-shaped hub with no surface crack and high-efficiency compared to the conventional machining process. For verification the numerical results, the hub of the SCM440 was fabricated by the proposed process and the mechanical properties and microstructure evolution were studied. It was demonstrated that the suggested hot and cold forging process might be useful in producing the key components of the automobile industry as a high-efficiency and environmentally friendly process.

• Archives of Craniofacial Surgery
• /
• v.19 no.2
• /
• pp.143-147
• /
• 2018

We present a patient who showed a sterile abscess after facial bone fixation with bioabsorbable plates and screws. He had zygomaticomaxillary complex and periorbital fracture due to falling down. The displaced bones were treated by open reduction and internal fixation successfully using bioabsorbable plate system. However, at postoperative 11 months, abrupt painless swelling was noted on the previous operation sites, left lateral eyebrow and lower eyelid. By surgical exploration, pus-like discharge and degraded materials were observed and debrided. The pathologic analysis revealed foreign body reaction with sterile abscess. This complication followed by bioabsorbable device implantation on maxillofacial bone surgery has been rarely reported in which we call attention to the maxillofacial plastic surgeons.

• Journal of Trauma and Injury
• /
• v.35 no.4
• /
• pp.268-276
• /
• 2022

Purpose: Rib fractures are common injuries that can lead to morbidity and mortality. Methods: Data on all patients with rib fractures admitted to a single trauma center between January 1, 2008 and December 31, 2018 were reviewed. Results: A total of 1,671 admissions for rib fracture were examined. Patients' median age was 57 years, the median Injury Severity Score (ISS) was 14, and the median number of fractured ribs was three. The in-hospital mortality rate was 4%. Age, the number of rib fractures, and Charlson Comorbidity Index scores were poor predictors of mortality, while the ISS was a slightly better predictor, with area under the receiver operating characteristic curve values of 0.60, 0.55, 0.58, and 0.74, respectively. Multivariate regression showed that age, ISS, and Charlson Comorbidity Index score, but not the number of rib fractures, were associated with significantly elevated adjusted odds ratios for mortality (1.03, 1.14, and 1.28, respectively). Conclusions: Age, ISS, and comorbidities were independently associated with the risk of mortality; however, they were not accurate predictors of death. The factors associated with rib fracture mortality are complex and cannot be explained by a single variable. Interventions to improve outcomes must be multifaceted.

• Archives of Plastic Surgery
• /
• v.40 no.6
• /
• pp.721-727
• /
• 2013

Background One of the main concerns in orbital blowout fracture repair is a narrow operation field, due mainly to the innate complex three dimensions of the orbit; however, a deep location and extensive area of the fracture and soft tissue edema can also cause concern. Swelling of the orbital contents progresses as the operation continues. Mannitol has been used empirically in glaucoma, cerebral hemorrhage, and orbital compartment syndrome for decompression. The authors adopted mannitol for the control of intraorbital edema and pressure in orbital blowout fracture repair. Methods This prospective study included 108 consecutive patients who were treated for a pure blowout fracture from January 2007 to October 2012. For group I, mannitol was administered during the operation. Under general anesthesia, all patients underwent surgery by open reduction and insertion of an absorbable mesh implant. The authors compared postoperative complications, the reoperation rate, operation time, and surgical field improvement between the two groups. Results In patients who received intraoperative administration of mannitol, the reoperation rate and operation time were decreased; however, the difference was not statistically significant. The total postoperative complication rates did not differ. Panel assessment for the intraoperative surgical field video recordings showed significantly improved vision in group I. Conclusions For six years, mannitol proved itself an effective, reliable, and safe adjunctive drug in the repair of orbital blowout fractures. With its rapid onset and short duration of action, mannitol could be one of the best methods for obtaining a wider surgical field in blowout fracture defects.