• Clinics in Shoulder and Elbow
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• v.27 no.1
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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.

• Parasites, Hosts and Diseases
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• v.62 no.1
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• pp.131-138
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• 2024

Halicephalobus gingivalis is a free-living nematode that occasionally causes infections in horses. We report a rare case of limb fracture of horse caused by infection with H. gingivalis. An 8-year-old mare was referred to the Veterinary Hospital of the Federal University of Lavras with claudication grade 5 of the right hind limb, that had been started 3 months ago. The patient had aseptic arthritis in the tarsal joint and edema that extended to the quartile. The radiographic examination showed punctate osteolysis with exacerbation of bone trabeculation along the calcaneus, talus, proximal epiphysis of the third metatarsal and distal epiphysis of the tibia. Treatment for arthritis was initiated, and the animal showed a slight improvement in limb function. However, 21 days after hospitalization, due to a comminuted fracture of the tibia, it was euthanized. At necropsy, yellowish masses were found from the metatarsal to the tibia, and around the tarsal bones and joint. Similar masses were also found in the left kidney. Numerous nematodes compatible with H. gingivalis were identified. This is the first description of a pathological fracture caused by H. gingivalis infection in an equine limb.

• Journal of Welding and Joining
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• v.34 no.6
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• pp.28-34
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• 2016

Galvannealed(GA) steels are now generally used in car body manufacturing for corrosion resistance. In this study, the weldability and joint mechanical behavior of a newly developed 1.2GPa grade GA ultra high strength TRIP(transformation induced plasticity) steel was investigated for three joining processes, such as adhesive bonding, resistance spot welding and weldbonding. Under both shear and peel stress conditions, the failure mode of the adhesive joints were the mixture of the adhesive cohesive failure, adhesive interface failure and coating layer failure. It means that the adhesion strength of GA coating onto the base metal was similar to that of adhesive bonding onto the GA coating. Under the shear stress condition, the weldbonding exerted to expand the optimal spot welding condition of 1.2GPa GA TRIP steel because the strength of adhesive bond overwhelmed that of the resistance spot weld. Under the peel stress condition, the weldbonding also exerted to expand the optimal spot welding condition of 1.2GPa GA TRIP steel by inducing the tear fracture mode rather than the partial plug fracture mode.

• Clinics in Shoulder and Elbow
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• v.27 no.2
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• pp.183-195
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• 2024

Background: Reverse total shoulder arthroplasty (rTSA) has gained popularity in recent years and is indicated for a wide variety of shoulder pathologies. However, use of rTSA in patients with "weight-bearing" shoulders that support wheelchair use or crutches has higher risk. The aim of this study was to assess the results of rTSA in such patients. Methods: Between 2005 and 2014, 24 patients (30 shoulders) with weight-bearing shoulders were treated with rTSA at our unit. Patients had cuff arthropathy (n=21), rheumatoid arthritis (n=3), osteoarthritis (n=1), acute fracture (n=3), or fracture sequela (n=2). Postoperatively, patients were advised not to push themselves up and out of their wheelchair for 6 weeks. This study was performed in 2016, and 21 patients (27 shoulders) were available for a mean follow-up of 5.6 years (range, 2-10 years). The mean age at surgery was 78 years (range, 54-90 years). Results: Constant-Murley score improved from 9.4 preoperatively to 59.8 at the final follow-up (P=0.001). Pain score improved from 2/15 to 13.8/15 (P=0.001). Patient satisfaction (Subjective Shoulder Value) improved from 0.6/10 to 8.7/10 (P=0.001). Significant improvement in mean range of motion from 46° to 130° of elevation, 14° to 35° of external rotation, and 29° to 78° internal rotation was recorded (P=0.001). Final mean Activities of Daily Living External and Internal Rotation was 32.4/36. Only three patients showed Sirveaux-Nerot grade-1 (10%) glenoid notching and three grade 2 (10%). Conclusions: rTSA can be used for treatment of patients with weight-bearing shoulders. Such patients reported pain free movement, resumed daily activities, and high satisfaction rates.

• Investigative Magnetic Resonance Imaging
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• v.13 no.2
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• pp.177-182
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• 2009

Purpose : To compare the subchondral fracture on plain radiography and MR image as a method for assessing osteonecrosis in Legg-Calve-Perthes(LCP) pateients. Materials and methods: We retrospetively reviewed 15 hip joint MR images and plain radiography which visualized subchondral fracture. With basis of the Salter-Thompson classification, extent of necrosis was graded group A to B, as follows; Group A = < 50%, B = > 50%. On PACS workstation, necrotic area of each MR image was measured to calculate the volume of necrotic portion: volume = necrotic area $\times$ slice thickness. Necrotic areas on MR images were graded group A to B and results were compared with that measured in Salter-Thompson classification. On follow up, bone resorption was measured and the extent was compared with subchondral fracture representing necrotic area and that on MR volume method respectively. Results : In 9 joints of 15 hip joints (60%), the degree of necrosis in Salter-Thompson classification on plain radiographs was different from that on MR volume method. Based on plain radiographs by Salter-Thompson classification, the degree of necrosis was overestimated in 6(67%) joints, and underestimated in 3(33%) joints compared with MR volume method. On follow up study, bone resorption was not correlated with necrotic extent of subchondral fracture and MR volume method. Conclusion : The extent of femoral head necrosis measured by subchondral fracture was different from that measured by MR and was not correlated with bone resorption on follow up. Therefore, usefulness of subchondral fracture as a prognostic factor may be limited.

• Journal of the Korea institute for structural maintenance and inspection
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• v.19 no.4
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• pp.92-100
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• 2015

The aim of this study is to evaluate the fracture characteristics of ductile fiber reinforced cement based composites with 1.5 volume ratio of polyvinyl alcohol and steel fiber by high velocity impact of steel projectile. We used gunpowder impact facility to evaluate the fracture characteristics of ductile fiber reinforced cement based composites by collision of steel projectile, and the impact velocity was from about 150 to 1,000m/s. The results of evaluation on the fracture characteristics of ductile fiber reinforced cement based composites were penetration grade, which is the kinetic energy more than three times of no-fiber reinforced specimen (Plain). In addition, ductile fiber reinforced cement based composites did not occurred critical damage other than the debris. In the case of mass loss, Plain specimen was proportional to kinetic energy of steel projectile, while ductile fiber reinforced cement based composites was not significantly affected by kinetic energy of steel projectile. In particular, this tendency had a close relationship with the fracture characteristics of back side of specimens, and the scabbing inhibiting efficiency of PVA specimen was higher than S specimen. In the results of verifying relationship between front and back side calculated by local damage, scabbing occurred at the region close to the back side in the ductile fiber reinforced cement based composites unlike Plain specimen. Thus, in this study, we examined principal fracture behaviors of ductile fiber reinforced cement based composites under collision of steel projectile, and verified that impact resistance performance was improved as compared to Plain specimen.

• Journal of Korean Foot and Ankle Society
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• v.11 no.2
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• pp.130-134
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• 2007

Purpose: To investigate the relationship between classification based on simple radiographic findings and arthroscopic findings of the cartilage lesions in medial degenerative arthritis of the ankle joint. Materials and Methods: We studied 41 ankles of 36 patients with asymmetrical narrowing of the medial joint space. Degenerative arthritis following fracture and those with generalized arthritic disease were excluded, but those with a history of ankle sprain were included. Standing radiographs of all patients were graded according to the Takakura classification and the Kellgren-Lawrence (K/L) classification. Arthroscopic findings were classified according to the depth, width, and anteroposterior dimension of articular cartilage damage. Results: According to the Takakura classification, 29 ankles were classified as stage II, 7 cases as stage IIIA and 2 cases as stage IIIB. According to our classification of arthroscopic findings of 29 ankles in stage II, 1 ankle was graded as Grade I, 3 ankles as grade II, 10 ankles as grade III, and 15 ankles as grade IV. Spearman correlation coefficient between Takakura classification and arthroscopic classification was 0.342 (P=0.028), and coefficient between K/L classification and arthroscopic classification was 0.480 (P=0.001). Conclusion: Degenerative changes of the articular cartilage are more advanced than radiographic findings in many patients with ankle degenerative arthritis with asymmetrical narrowing of medial joint space. Therefore, we conclude that more aggressive effort should be made for correct diagnosis and treatment of degenerative arthritis.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.1
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• pp.70-75
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• 1999

We present a case of parosteal osteosarcoma of the femur with secondary dedifferentiation. This 57-year-old woman was radiologically diagnosed as a parosteal osteosarcoma in 1987. In 1992, excisional biopsy revealed a classical parosteal osteosarcoma with diploidy DNA pattern. In 1998, she revisited due to a recurrent tumor with pathologic fracture. The resected specimen showed a classic parosteal osteosarcoma with area of dedifferentiation, showing high-grade spindle cell sarcoma. This dedifferentiated area revealed aneuploidy cell population on DNA flow cytometry. This case reminds us that not all parosteal osteosarcomas are low-grade lesions. Some low-grade lesions may dedifferentiate to become high-grade tumors after inadequate excision.

• Journal of Korean Neurosurgical Society
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• v.41 no.1
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• pp.1-6
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• 2007

Objective : The purpose of this study is to determine the factors that have effects on the neurological deficit in the patients with thoracolumbar fracture. Methods : Forty-eight patients were included. Cause of injury, type of injury, time interval, combined injury, kyphotic angle, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, transverse diameter, the most narrow transverse diameter, and remained height of vertebra body were concerned as the factors. The patients with American Spinal Injury Association[ASIA] impairment scale grade A to D were considered as having neurology while others with ASIA grade E were considered to be without neurology. The patients with ASIA grade A were classified to paraplegia group and the patients with ASIA grade B to E were not thought to be paraplegia. Statistical analysis for these groups were performed. Results : Spinal canal compromise [P<0.001] have correlation with neurological deficit. The most narrow sagittal diameter was smaller in the group with deficit than that in the group without deficit [P<0.004]. Also, combined injury have correlation with neurology [P=0.028]. Spinal canal compromise [P<0.001], sagittal diameter [P=0.032], the most narrow sagittal diameter [P=0.025], and Denis type [P<0.001] also have correlation with paraplegia. Conclusion : The factors of percentage of spinal canal compromise, the most narrow sagittal diameter, and combined injury are predictive of neurological deficit. The patients with paraplegia may be predicted by the factors such as type of injury, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, and Denis type.

• Journal of the Korean Ceramic Society
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• v.38 no.11
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• pp.987-992
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• 2001

A refractory grade low-cost silicon nitride powder was chemically analyzed, purified, and gas pressure sintered with the sintering additives. As-received powder contained a significant amount of free-Si, 0.72 wt% of Fe, 0.5 wt% of al and 0.31 wt% of Ca. Oxygen and carbon contents of the powder were 3.3 wt% and 0.4 wt%, respectively, and it consisted of 96% of $\beta$-phase and 4% of $\alpha$-phase. After lowering the Fe content and nitriding treatment, the powder was sintered with 6 wt% yttria and 2 wt% alumina for 1 h between 1823 K and 2123 K in order to examine the sintering behavior. Fully dense samples were obtained by sintering at 2123k for 2h. For comparison, a commercially available high-grade powder was also sintered at the same time. The low-cost powder showed much slower densification rate than the high-grade powder. Fully dense sample prepared from the low-cost powder contained a number of coarse grains with a low aspect ratio, and its hardness, fracture toughness, flexural strength and thermal shock resistance were not as good as those of the sample prepared with the high-grade powder.