• Clinics in Shoulder and Elbow
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• v.22 no.1
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• pp.29-36
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• 2019

Background: The execution of fibular allograft augmentation in unstable proximal humerus fractures (PHFs) was technically demanding. In this study, the authors evaluated the clinical and radiographic outcomes after tricortical iliac allograft (TIA) augmentation in PHFs. Methods: We retrospectively assessed 38 PHF patients treated with locking-plate fixation and TIA augmentation. Insertion of a TIA was indicated when an unstable PHF showed a large cavitary defect and poor medial column support after open reduction, regardless of the presence of medial cortical comminution in preoperative images. Radiographic imaging parameters (humeral head height, HHH; humeral neck-shaft angle, HNSA; head mediolateral offset, HMLO; and status of the union), Constant score, and range of motion were evaluated. Patients were grouped according to whether the medial column support after open reduction was poor or not (groups A and B, respectively); clinical outcomes were compared for all parameters. Results: All fractures healed radiologically (average duration to complete union, 5.8 months). At final evaluation, the average Constant score was 73 points and the mean active forward flexion was $148^{\circ}$. Based on the Paavolainen assessment method, 33 patients had good results and 5 patients showed fair results. The mean loss of reduction was 1.32 mm in HHH and 5.02% in HMLO. None of the parameters evaluated showed a statistically significant difference between the two groups (poor and not poor medial column support). Conclusions: In unstable PHFs, TIA augmentation can provide good clinical and radiological results when there are poor medial column support and a large cavitary defect after open reduction.

• Journal of the Korea institute for structural maintenance and inspection
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• v.28 no.3
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• pp.91-99
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• 2024

Piping systems are crucial facilities used in various industries, particularly in areas related to daily life and safety. Piping systems are fixed to the main structures of buildings and facilities but do not support external loads and serve as non-structural elements performing specific functions. Piping systems are affected by relative displacements owing to phase differences arising from different behaviors between two support points under seismic loads; this can cause damage owing to the displacement-dominant cyclic behavior. Fittings and joints in piping systems are representative elements that are vulnerable to seismic loads. To evaluate the seismic performance and limit states of fittings and joints in piping systems, a high-stroke actuator is required to simulate relative displacements. However, this is challenging because only few facilities can conduct these experiments. Therefore, element-level experiments are required to evaluate the seismic performance and limit states of piping systems connected by fittings and joints. This study proposed a method to evaluate the seismic performance of an elbow specimen that includes fittings and joints that are vulnerable to seismic loads in vertical piping systems. The elbow specimen was created by connecting straight pipes to both ends of a 90° pipe elbow using flexible groove joints. The seismic performance of the elbow specimen was evaluated using a cyclic loading protocol based on deformation angles. To determine the margin of the evaluated seismic performance, the limit states were assessed by applying cyclic loading with a constant amplitude.

• Clinics in Shoulder and Elbow
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• v.23 no.3
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• pp.156-158
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• 2020

PHILOS plate fixation in osteoporotic proximal humerus fracture of old age is well-known for high complication rate, especially metal failure, providing various augmentation techniques, such as calcium phosphate cement, allogenous or autologous bone graft. We report a case of polymethyl methacrylate augmentation to provide appropriate reduction with a significant mechanical support. This can be a treatment option for displaced unstable osteoporotic proximal humerus fracture with marked bony defect.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.87-92
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• 2023

Six months after undergoing reverse shoulder arthroplasty (RSA) a 73-year-old woman sustained a periprosthetic scapular spine fracture following a fall. She was treated with open reduction and internal fixation (ORIF), followed by botulinum toxin injection into the deltoid muscle to temporarily minimize strain at the fracture. Fracture union was achieved by 3 months, with excellent clinical function more than 1 year following fracture fixation and full resolution of deltoid function. Scapular spine fracture following RSA can be treated with ORIF and temporary deltoid paralysis using botulinum toxin in the immediate postoperative period to safely support fracture healing.

• Clinics in Shoulder and Elbow
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• v.19 no.4
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• pp.216-222
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• 2016

Background: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. Methods: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. Results: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was $3.09^{\circ}$. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. Conclusions: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.

• Clinics in Shoulder and Elbow
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• v.17 no.1
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• pp.10-17
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• 2014

Background: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes. Methods: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications. Results: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient). Conclusions: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support.

• Journal of the Korean Society of Radiology
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• v.17 no.4
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• pp.607-614
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• 2023

Clear overlapping of the bilateral epicondyle and proper separation of the elbow joint are crucial for obtaining accurate lateral general radiographs of the elbow. However, due to the complex anatomical structure of the elbow, achieving optimal positioning is challenging, leading to the need for repeated x-ray examinations. Therefore, the purpose of this study was to investigate the angle of the forearm in patients where accurate lateral images of the elbow joint can't be obtained after vertical incidence using a styrofoam device during elbow joint lateral x-ray imaging. Twenty patients were enrolled in our study following the established protocol. First, a vertical x-ray at an angle of 0° between the forearm and the table was taken (control group). Here, if the lateral image of the elbow joint was deemed inadequate, the forearm angle was adjusted using custom-made styrofoam supports with 5° and 10° inclinations (experimental groups). For the evaluation method, two assessors utilized a 5-point Likert scale to assess the images. The reliability of the assessments was analyzed using Cronbach's alpha coefficient. As a result, patients with inadequate overlap of the bilateral epicondyle and separation of the elbow joint in the initial examination (control group) were able to obtain the best images when setting a 10° angle between the forearm and the table. The subjective evaluation was 1.6 ± 0.8 points at 0°, 2.7 ± 0.8 points at 5°, and 4.4 ± 1.3 points at 10°, respectively. The reliability analysis for the angles of 0°, 5°, and 10° yielded Cronbach's alpha values of 0.867, 0.697, and 0.922, respectively. In conclusion, when it is not possible to obtain accurate images using the conventional position and X-ray beam direction, it is considered that by initially acquiring images with an angle of 10° between the forearm and the table, and gradually decreasing the angle while obtaining images, it would be possible to achieve the optimal image while reducing the number of repeat examinations.

• Proceedings of the Korean Society for Noise and Vibration Engineering Conference
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• 1997.10a
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• pp.58-63
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• 1997

The natural frequencies of the support system for a vertical pump, which are a key factor affecting the dynamic stability of the pump support system, are not easily predictable with analytical approaches only, due to the difficulties estimating the effective stiffness of the connections between the concrete base, the motor structure, the discharge elbow and the suction column of the pump system. This paper presents the results of a finite element analysis and an experimental study performed to identify and modify the characteristics of the pumping structure. The difficulties of modelling the effective stiffness were overcome by utilizing experimental results in the analysis. Based on analytical and experimental results, appropriate structural modifications are taken to reduce excessive vibration of the pump system to a satisfactory level.

• Clinics in Shoulder and Elbow
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• v.20 no.4
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• pp.208-216
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• 2017

Background: This study compared the clinical and radiological outcomes of the single calcar screw plate and Polarus nail techniques for the treatment of the proximal humerus fractures. Methods: Seventy-two patients diagnosed with displaced proximal humerus fracture were enrolled for the study. Of these, 50 patients underwent the locking plate surgery with a single calcar screw (plate group), whereas 22 patients underwent the Polarus nail surgery (nail group). The plate group was further divided into plate 1 group (with medial support), and plate 2 group (without medial support). The radiological and functional results of both groups were compared to the nail group. Results: The ${\alpha}$ angle 1 year after surgery was significantly different between plate 1 and plate 2, and plate 2 and nail groups (p=0.041, p=0.043, respectively). The ratio that does not satisfy the reference value of ${\gamma}$ angle was 2.8% in plate 1, 7.1% in plate 2 and 22.7% in nail group (p=0.007); there was a significant difference between plate 1 and nail group, and plate 2 and nail group (p=0.014, p=0.033, respectively). Conclusions: No significant differences were observed in the clinical results between locking plate and Polarus nail. However, in the plate 2 group and nail group, the rate of failure to maintain reduction during the 1-year period after surgery was statistically and significantly higher than the plate 1 group (level of evidence: level IV, case series, treatment study).

• Journal of the Korean Society of Radiology
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• v.18 no.1
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• pp.11-20
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• 2024

As the importance of intervention has recently increased, interest in the health of medical staff performing the procedure is increasing. Existing radiation shielding devices have limited the operator's movement and have not been properly used due to the risk of infection, and adequate radiation shielding of the operator's gonads and furthermore, the entire area of the procedure room has not been achieved. An auxiliary shielding device was manufactured by attaching a Bismuth to the elbow support used in the procedure, and the radiation shielding effect was measured. As a result of the measurement, the average spatial dose rate decreased by about 64.8%, and the independent sample t-test analysis showed statistically significant below the significance probability (p<0.05). The use of an auxiliary shielding device is considered to be an effective shielding method that can shield the operator's gonads and reduce the radiation spatial dose rate of the entire area of the procedure room.