• Clinics in Shoulder and Elbow
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• 제23권2호
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• pp.94-99
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• 2020

Background: Intra-articular distal humeral fractures can be surgically challenging. It remains under discussion whether open reduction and internal fixation (ORIF) or total elbow arthroplasty (TEA) is more beneficial for treatment of the elderly. This study aimed to compare the clinical and functional outcomes of ORIF and TEA for managing intra-articular distal humerus fractures in patients aged 65 years or older. Methods: Patients who underwent ORIF (n=28) or TEA (n=43) for in intra-articular distal humerus fracture between May 2008 and December 2018 were reviewed. Range of motion, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiologic outcomes, and surgical complications were evaluated at the final follow-up visit. Results: The ORIF and TEA groups showed a mean arc of flexion-extension of 97°±21° and 101°±12°, respectively. The mean MEPS and DASH scores were 94±15 and 27±12 points, respectively, in the ORIF group and 81±27 and 47±28 points in the TEA group. This difference was statistically significant. The incidence of total complications was similar between the groups. Conclusions: In patients older than 65 years with intra-articular distal humerus fracture, ORIF had better outcomes than TEA.

• 항공우주시스템공학회지
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• 제12권2호
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• pp.66-75
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• 2018

본 논문에서는 2MW급 풍력 블레이드의 스파캡을 탄소복합재료, 두께축소율(PRR) 및 상쇄연구(Trade-off study)를 이용해서 경량화 설계를 수행했다. 블레이드 스파캡은 블레이드의 기계적 건전성을 결정하는 가장 핵심적인 요소이다. 가벼우면서도 기계적 신뢰성을 확보할 수 있는 블레이드 스파캡의 형상을 도출하기 위해 주어진 설계하중으로 스파캡의 두께를 변화시키면서 반복적인 구조해석을 실시한다. 파손여부를 판정하기 위해서 Tsai-Wu 및 Puck 파손이론을 사용하였으며, 그 결과 GFRP 복합재료보다 CFRP 복합재료가 동일한 조건에서 약 30% 무게를 경량화 할 수 있었다. 해석 결과를 바탕으로 복합재료 적층두께의 최적값을 도출하여 구조적 성능 향상 및 경량화 된 설계 결과를 제시한다.

• Clinics in Shoulder and Elbow
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• 제18권2호
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• pp.75-79
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• 2015

Background: This retrospective comparative study aims to evaluate the surgical outcomes and complications of two surgical methods for simple fractures of the humeral shaft; minimally invasive anterior plating and open reduction combined with internal fixation. Methods: A total of 26 patients with humeral shaft simple fractures, who had surgery between June 2009 and September 2013 and were followed-up at least 12 months, were included in our analysis. They were divided into two groups; group 1 comprised of 12 patients who underwent minimally invasive anterior plating and group 2 comprised of 14 patients who underwent an open reduction and internal fixation. The clinical outcomes, radiological results, and complications were compared and analyzed. Results: We found that bone union was achieved in all patients, and the mean union periods were $20.7{\pm}3.34$ and $20.3{\pm}3.91$ weeks for groups 1 and 2, respectively. In most patients, we found that shoulder and elbow functions were recovered. At 12 months post-operation, we found that the Korean Shoulder Scoring system, the University of California at Los Angeles score and Mayo elbow performance score were $91.4{\pm}7.97$, $33.4{\pm}1.15$, and $90.8{\pm}2.23$ for group 1, and $95.2{\pm}1.53$, $33.3{\pm}1.43$, and $90.17{\pm}1.85$ for group 2. In terms of complications, we found that 2 patients had radial nerve palsy after open reduction and internal fixation, but all cases spontaneously resolved within 6 months. Complications such as infection and loss of fixation were not reported. Conclusions: Both minimally invasive anterior plating and open reduction with internal fixation produced satisfactory outcomes in the treatment of simple fractures of the humeral shaft.

• 한국기계가공학회지
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• 제15권1호
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• pp.95-102
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• 2016

Wrinkle, spring-back, and fracture are major defects frequently found in the sheet metal forming process, and the reduction of such defects is difficult as they are affected by uncontrollable factors, such as variations in properties of the incoming material and process parameters. Without any countermeasures against these issues, attempts to reduce defects through optimal design methods often lead to failure. In this research, a new multi-attribute robust design methodology, based on the Mahalanobis Taguchi System (MTS), is presented for reducing the possibilities of wrinkle, spring-back, and fracture. MTS performs experimentation, based on the orthogonal array under various noise conditions, uses the SN ratio of the Mahalanobis distance as a performance metric. The proposed method is illustrated through a robust design of the sheet metal forming process of a cross member of automotive body.

• Structural Engineering and Mechanics
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• 제50권4호
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• pp.525-539
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• 2014

Bonded composite-patch repair has been widely used to restore or extend the service life of damaged structures due to its effectiveness as a mechanical repair technique. In this paper using extended finite element method (XFEM), three-dimensional crack models are developed to examine the fracture behavior of centrally cracked aluminum plates repaired with single and double sided composite patches. Stress intensity factor (SIF) at the crack tip is used as the fracture criterion. In this regard, the effects of the crack lengths, patch materials, orientation of plies, adhesive and patch thickness are examined to estimate the SIF of the repaired plate and the repair performance. The obtained results show that composite patches have significant effect on reduction of the SIF at the crack tip. It is also proved that using double symmetric repair, in comparison to single one, reduces considerably SIF at the crack tip. Hence, the residual strength can be improved significantly as well as fatigue life of the structure. Investigation of ply orientation effects shows SIF increase as the ply orientation is changed from $0^{\circ}$ (perpendicular to the advancing crack) to $90^{\circ}$ (parallel to the crack line). However, the effectiveness of the ply orientation depends on the loading direction and the crack direction.

• Steel and Composite Structures
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• 제26권4호
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• pp.439-452
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• 2018

This paper presents experimental and numerical study on buckling behaviors and hysteretic performance of Class 1 H-shaped steel beam subjected to cyclic pure bending within the scope of ultra-low cycle fatigue (ULCF). A loading device was designed to achieve the pure bending loading condition and 4 H-shaped specimens with a small width-to-thickness ratio were tested under 4 different loading histories. The emphasis of this work is on the impacts induced by local buckling and subsequent ductile fracture. The experimental and numerical results indicate that the specimen failure is mainly induced by elasto-plastic local buckling, and is closely correlated with the plastic straining history. Compared with monotonic loading, the elasto-plastic local buckling can occur at a much smaller displacement amplitude due to a number of preceding plastic reversals with relative small strain amplitudes, which is mainly correlated with decreasing tangent modulus of the material under cyclic straining. Ductile fracture is found to be a secondary factor leading to deterioration of the load-carrying capacity. In addition, a new ULCF life evaluation method is proposed for the specimens using the concept of energy decomposition, where the cumulative plastic energy is classified into two categories as isotropic hardening and kinematic hardening correlated. A linear correlation between the two energies is found and formulated, which compares well with the experimental results.

• Computers and Concrete
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• 제33권5호
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• pp.605-619
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• 2024

The increase of reclaimed asphalt pavement (RAP) content in recycled asphalt concrete (RAC) is accompanied by the degradation of low-temperature cracking resistance, which has become an obstacle to the development of RAC. This paper aims to reveal the meso-scale mechanisms of the low-temperature fracture behavior of RAC and provide a theoretical basis for the economical recycling of RAP. For this purpose, micromechanical heterogeneous peridynamic model of RAC was established and validated by comparing three-point bending (TPB) test results against corresponding numerical simulation results of RAC with 50% RAP content. Furthermore, the models with different aggregate shapes (i.e., average aggregates circularity (${\bar{C_r}}=1.00$, 0.75, and 0.50) and RAP content (i.e., 0%, 15%, 30%, 50%, 75%, and 100%) were constructed to investigate the effect of aggregate shape and RAP content on the low-temperature cracking resistance. The results show that peridynamic models can accurately simulate the low-temperature fracture behavior of RAC, with only 2.9% and 13.9% differences from the TPB test in flexural strength and failure strain, respectively. On the meso-scale, the damage in the RAC is mainly controlled by horizontal tensile stress and the stress concentration appears in the interface transition zone (ITZ). Aggregate shape has a significant effect on the low-temperature fracture resistance, i.e., higher aggregate circularity leads to better low-temperature performance. The large number of microcracks generated during the damage evolution process for the peridynamic model with circular aggregates contributes to slowing down the fracture, whereas the severe stress concentration at the corners leads to the fracture of the aggregates with low circularity under lower stress levels. The effect of RAP content below 30% or above 50% is not significant, but a substantial reduction (16.9% in flexural strength and 16.4% in failure strain) is observed between the RAP content of 30% and 50%. This reduction is mainly attributed to the fact that the damage in the ITZ region transfers significantly to the aggregates, especially the RAP aggregates, when the RAP content ranges from 30% to 50%.

• Clinics in Shoulder and Elbow
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• 제15권2호
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• pp.130-137
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• 2012

목적: 골다공증이 있는 노인환자에서 상완골 원위부 관절부위 골절로 관혈적 정복술 및 내고정술과 주관절 전치환술 시행 후 기능적 결과에 대해서 평가 보고하였다. 대상 및 방법: 2007년1월부터 2009년 10월까지 상완골 원위부 관절내 골절을 주소로 내원한 65세 이상의 환자 24명을 대상으로 하였으며 18명은 후방 도달법을 이용하여 관혈적 정복술 및 내고정술을 시행하고 (Fig. 1), 6명은 주관절 전치환술을 시행하였다 (Fig. 2). 평균 추시 기간은 16.3 개월 이였으며 골절형태는 AO 분류로 8명이 C2, 16명이 C3 형태의 골절이였다. 추시 시 모든 환자들은 방사선촬영 및 신체검사를 시행하였고, Mayo 주관절 수행점수, 및 DASH 점수를 이용하여 임상적 결과를 측정하였다. 결과: Group I 18예 모두 골유합 되었으며 골절부터 골유합까지 평균 기간은 14주였다. 합병증으로 2예에서 주두골 절골부위에 불유합이 관찰되었으며 척골신경증상을 보였던 2예 중 1예는 전방이전술에도 불구하고 개선되지 않았다. Mayo 주관절 수행점수는 평균 87.0점이였으며, DASH 점수는 평균 32.4점이였다. 마지막 추시 시에 시행한 이학적 검사에서 굴곡은 평균 121.0도 (95~145도), 굴곡구축은 평균 12도 (0~35)이였다. Group II 6예 모두 추시 기간내 합병증은 없었으며, Mayo 주관절 수행점수는 평균 89.1점 이였으며, DASH 점수는 평균 44.3점이었다. 마지막 추시 시에 시행한 이학적 검사에서 굴곡은 평균 125.1도 (100~145도), 굴곡 구축은 평균 12.6도 (0~30)이였다. 결론: 골다공증을 동반한 고령의 상완골 원위부 관절내 골절 환자에서 적절한 환자 선택시 내고정술 뿐만 아니라 전치환술에서도 단기 추시 시 만족할만한 결과를 보임을 확인할 수 있었다.

• Clinics in Shoulder and Elbow
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• 제23권1호
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• pp.20-26
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• 2020

Background: High complication rate after open reduction and internal fixation can lead to use of primary total elbow replacement (TER) in treatment of complex distal humerus fractures in elderly patients. The purpose of this study was to investigate the short-term outcomes and complications after primary TER in patients with complex distal humerus fracture. Methods: Nine patients with acute complex distal humerus fracture were treated by primary TER using the semiconstrained Coonrad-Morrey prosthesis. The mean age of patients was 72.7 years (range, 63-85 years). Clinical and radiographic outcomes were evaluated over a mean follow-up of 29.0 months (range, 12-65 months) using visual analog scale (VAS) score for pain; Mayo elbow performance score (MEPS); 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, mean VAS, MEPS, and Quick-DASH scores were 1.2, 80.5, and 20, respectively. The mean range of motion was 127.7° of flexion, 13.8° of extension, 73.3° of pronation, and 74.4° of supination. There was no evidence of bushing wear or high-grade implant loosening on serial plain radiographs. Three complications (33.3%) comprising two periprosthetic fractures and one ulnar neuropathy were observed. Conclusions: Primary TER for treatment of complex distal humerus fractures in elderly patients yielded satisfactory short-term outcomes. However, surgeons should consider the high complication rate after primary TER.

• Clinics in Shoulder and Elbow
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• 제21권3호
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• pp.120-126
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• 2018

Background: Treatment of distal humerus fractures in osteoporotic elderly patients is often challenging. For non-reconstructible fractures with open reduction and internal fixation, total elbow arthroplasty (TEA) is an acceptable alternative. However, the relatively high complication rates and lifelong activity restrictions make TEA less ideal for elderly or low-demand patients. Efforts to identify or develop alternate procedures that benefit relatively young, high-demand patients have resulted in increased interest in hemiarthroplasty. This systematic review reports the clinical outcomes of hemiarthroplasty for distal humeral fractures. Methods: We systematically reviewed the databases of PubMed, Ovid MEDLINE, and Cochrane Library. All English-language studies published before June 2017 were considered for possible inclusion. Search terms included 'distal humerus fracture' and 'hemiarthroplasty'. Studies reporting outcomes (and a minimum of 1 year clinical follow-up) in human subjects after hemiarthroplasty (Latitude system) for distal humeral fractures were assessed for inclusion. Patient demographics, clinical and radiographic outcomes, and complications were recorded, and homogenous outcome measures were analyzed. Results: Nine studies with a total of 115 patients met the inclusion criteria. Among the included studies, the weighted mean follow-up time was 35.4 months. Furthermore, the weighted mean of the postoperative range of motion ($107.6^{\circ}$ flexion-extension, $157.5^{\circ}$ for pronation-supination) and functional outcomes (Mayo elbow performance scores: 85.8, Disabilities of the Arm, Shoulder and Hand score: 19.6) were within the acceptable range. Conclusions: Our study indicates that hemiarthroplasty is a viable option for comminuted distal humerus fracture. Satisfactory functional outcomes were observed in most patients.