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Current Treatment of Tibial Pilon Fractures (경골 천정(pilon) 골절의 최신 치료)

  • Lee, Jun-Young
    • Journal of Korean Foot and Ankle Society
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    • v.15 no.2
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    • pp.51-57
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    • 2011
  • Pilon fractures involving distal tibia remain one of the most difficult therapeutic challenges that confront the orthopedic surgeons because of associated soft tissue injury is common. To introduce and describe the diagnosis, current treatment, results and complications of the pilon fractures. In initial assessment, the correct evaluation of the fracture type through radiographic checkup and examination of the soft tissue envelope is needed to decide appropriate treatment planning of pilon fractures. Even though Ruedi and Allgower reported 74% good and excellent results with primary open reduction and internal fixation, recently the second staged treatment of pilon fractures is preferred to orthopedic traumatologist because of the soft tissue problem is common after primary open reduction and internal fixation. The components of the first stage are focused primarily on stabilization of the soft tissue envelope. If fibula is fractured, fibular open reduction and internal fixation is integral part of initial management for reducing the majority of tibial deformities. Ankle-spanning temporary external fixator is used to restore limb alignment and displaced intraarticular fragments through ligamentotaxis and distraction. And the second stage, definitive open reduction and internal fixation of the tibial component, is undertaken when the soft tissue injury has resolved and no infection sign is seen on pin site of external fixator. The goals of definitive internal fixation should include absolute stability and interfragmentary compression of reduced articular segments, stable fixation of the articular segment to the tibial diaphysis, and restoration of coronal, transverse, and sagittal plane alignments. The location, rigidity, and kinds of the implants are based on each individual fractures. The conventional plate fixation has more advantages in anatomical reduction of intraarticular fractures than locking compression plate. But it has more complications as infection, delayed union and nonunion. The locking compression plate fixation provides greater stability and lesser wound problem than conventional implants. But the locking compression plate remains poorly defined for intraarticular fractures of the distal tibia. Active, active assisted, passive range of motion of the ankle is recommended when postoperative rehabilitation is started. Splinting with the foot in neutral is continued until suture is removed at the 2~3 weeks and weight bearing is delayed for approximately 12 weeks. The recognition of the soft tissue injury has evolved as a critical component of the management of pilon fractures. At this point, the second staged treatment of pilon fractures is good treatment option because of it is designed to promote recovery of the soft tissue envelope in first stage operation and get a good result in definitive reduction and stabilization of the articular surface and axial alignment in second stage operation.

STRESS DISTRIBUTION OF ENDODONTICALLY TREATED MAXILLARY SECOND PREMOLARS RESTORED WITH DIFFERENT METHODS: THREE-DIMENSIONAL FINITE ELEMENT ANALYSIS (상이한 방법으로 수복한 근관치료된 상악 제2소구치의 응력분포: 3차원 유한요소법적 분석)

  • Lim, Dong-Yeol;Kim, Hyeon-Cheol;Hur, Bock;Kim, Kwang-Hoon;Son, Kwon;Park, Jeong-Kil
    • Restorative Dentistry and Endodontics
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    • v.34 no.1
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    • pp.69-79
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    • 2009
  • The purpose of this study was to evaluate the influence of elastic modulus of restorative materials and the number of interfaces of post and core systems on the stress distribution of three differently restored endodontically treated maxillary second premolars using 3D FE analysis. Model 1, 2 was restored with a stainless steel or glass fiber post and direct composite resin. A PFG or a sintered alumina crown was considered. Model 3 was restored by EndoCrown. An oblique 500 N was applied on the buccal (Load A) and palatal (Load B) cusp. The von Mises stresses in the coronal and root structure of each model were analyzed using ANSYS. The elastic modulus of the definitive restorations rather than the type of post and core system was the primary factor that influenced the stress distribution of endodontically treated maxillary premolars. The stress concentration at the coronal structure could be lowered through the use of definitive restoration of high elastic modulus. The stress concentration at the root structure could be lowered through the use of definitive restoration of low elastic modulus.

Fabrication of complete denture using 3D printing: a case report (3D 프린팅을 이용한 양악 총의치 제작 증례)

  • Lee, Eunsu;Park, Chan;Yun, Kwidug;Lim, Hyun-Pil;Park, Sangwon
    • The Journal of Korean Academy of Prosthodontics
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    • v.60 no.2
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    • pp.202-210
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    • 2022
  • Recently with the advance in digital dentistry, the fabrication of dentures using computer-aided design and computer-aided manufacturing (CAD-CAM) is on the rise. The denture designed through a CAD software can be produced in a 3-dimensional manufacturing process. This process includes a subtractive processing method such as milling and an additive processing method such as 3D printing and in which it can be applied efficiently in more complex structures. In this case, complete dentures were fabricated using Stereolithography (SLA)-based 3D printing to shorten the production time and interval of visits in patient with physical disabilities due to cerebral infarction. For definitive impression, the existing interim denture was digitally replicated and used as an individual tray. The definitive impression obtained with polyvinyl siloxane impression material was including information about the inclination and length of the maxillary anterior teeth, vertical dimension, and centric relation. In addition, facial scan data with interim denture was obtained so that it can be used as a reference in determination of the occlusal plane and in arrangement of artificial teeth during laboratory work. Artificial teeth were arranged through a CAD program, and a gingival festooning was performed. The definitive dentures were printed by SLA-based 3D printer using a FDA-approved liquid photocurable resin. The denture showed adequate retention, support, and stability, and results were satisfied functionally and aesthetically.

Full mouth rehabilitation with fixed implant-supported prosthesis using temporary denture and double digital scanning technique: a case report (임시 의치와 이중 디지털 스캐닝 기법을 활용한 전악 고정성 임플란트 수복 증례)

  • Seok-Hyun Shin;Chan-Ik Park;Se-Ha Kang;Ji-Eun Moon;Min-Seok Oh;Chul-Min Park;Woo-Jin Jeon;Seong-Gu Han;Sun-Jae Kim;Su-Jin Choi
    • The Journal of Korean Academy of Prosthodontics
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    • v.61 no.3
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    • pp.245-256
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    • 2023
  • When restoring with a dental digital system for implant-supported prosthesis, a double digital scanning technique is required: an intraoral scan of the three-dimensional implant location and intraoral scan after placement of temporary denture or provisional prosthesis. During the intraoral scan, the use of scan body as a stable landmark can improve the accuracy of digital impression and simplify laboratory process. In this case, a full-digital system was used to plan and fabricate a custom abutment, provisional prosthesis, and definitive prosthesis. After implant placement, the scan area of the intraoral scan body connected with implant and the intraoral scan body marked on the inside of temporary denture were superimposed. Out of the superimposed files, a custom abutment and provisional prosthesis were fabricated which match the vertical dimension of temporary denture, and definitive prosthesis was fabricated based on provisional prosthesis. We report this case because result has been functionally and esthetically satisfactory by using vertical dimension and central relation set during the fabrication of temporary denture to the definitive prosthesis.

치아, 구강 및 악안면외상의 1차적 처치

  • Kim, Myeong-Rae
    • The Journal of the Korean dental association
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    • v.22 no.5 s.180
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    • pp.387-392
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    • 1984
  • 외상의 처치는 일반적으로 응급처치기(emergency 혹은 initial phase), 중간처치기 (intermidiate 혹은 planning phase) 그리고 항구치료기 (definitive phase)로 구분되며 응급처치의 범주내에서는 우선 환자의 생명유지를 고려하고 다음엔 창의 생활력(vitality)을 유지하여 장차의 조직결손과 기능적 결합을 예방하는 데 목적이 있다. 그러므로 구강 및 악안면의 광범한 외상은 기도확보, 대량실혈의 방지, shock의 예방 (수액보충 등) 및 감염대책 등의 순으로 응급대처하게 된다. 그러나 일반 개원임상의들이 자주 접하는 비교적 작은 외상에서는 위의 대원칙에 더하여 창상의 효과적인 1차적 처치에 더욱 관심을 갖어 조직의 괴사나 결손 및 변형으로 인한 기능적 심미적 장애를 최솔 하는 것이 중요하다.

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Hamartoma of the Lung -One case Report- (페에 발생한 Hamartoma -1예 보고-)

  • Kim, Yong-Gil;Kim, Gong-Su
    • Journal of Chest Surgery
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    • v.13 no.3
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    • pp.298-300
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    • 1980
  • The hamartoma is the most common benign tumor of the lung, but the incidence is very low. Most of hamartomas are revealed accidentally as coin lesion of routine chest X-ray because of no symptoms usually. The differential diagnosis should include tuberculoma, bronchogenic carcinoma, and other forms of tumor. Definitive diagnosis usually is established at exploratory thoracotomy. In this report, we present one case of a 42-year-old female having hamartoma of the left lower lobe of the lung that removed successfully and confirmed histopathologically. Her postoperative course was uneventful. She was discharged in good condition.

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Diagnostic Approach of Hepatic Mass using Ultrasound Guided Fine Needle Aspiration in a Dog (개에서 초음파를 이용한 간 종괴의 세침흡인술 증례)

  • 최호정;이기창;최민철;윤정희
    • Journal of Veterinary Clinics
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    • v.21 no.2
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    • pp.181-183
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    • 2004
  • Hepatic mass was aspirated under the guidance with ultrasound in 9-year old female maltese with signs of anorexia, hematochezia, vomiting, depression, and abdominal distension. Radiographic and abdominal ultrasonographic examinations were performed, which revealed enlarged tubular shaped uterine mass and solitary, small round hyperechoic hepatic mass dorsal to gall bladder as an incidental finding. Ultrasound-guided fine needle aspiration was completed, but histologic confirmation should be made for definitive diagnosis by tissue core or wedge biopsy.

Clinical Experience of the Mediastinal Tumors - Report of 40 Cases - (종격동 종양의 임상적 경험 - 40례 보고 -)

  • 송진천
    • Journal of Chest Surgery
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    • v.23 no.1
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    • pp.137-140
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    • 1990
  • This report is an review of 40 cases of mediastinal tumors which were treated surgically in the Department of Thoracic and Cardiovascular Surgery, Chonnam University Hospital from January, 1985 to September, 1989. In this series, male to female sex distribution was 1.35:1 with the male predominant. The main clinical manifestations were chest pain and dyspnea, and there was no definitive symptom in 5 cases [12.5 %]. The most common mediastinal tumor was thymoma, 11 cases [27.5 %], and next common mass was germ cell tumor, 9 cases [22.5 %]. The half of these were malignant. In operating, all of the benign masses were removed.

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Nephronophthisis

  • Kang, Hee Gyung;Cheong, Hae Il
    • Childhood Kidney Diseases
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    • v.19 no.1
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    • pp.23-30
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    • 2015
  • NPHP is the most common monogenic cause of CKD in children or adolescents. Extra-renal symptoms often accompany, therefore examination of retina, hearing, and skeleton is necessary in patients with CKD with insidious onset. Genes involved in NPHP-RC are mostly related in primary cilia. While genetic diagnosis is necessary for definitive diagnosis, there is no curative treatment.