• Archives of Reconstructive Microsurgery
• /
• 제24권2호
• /
• pp.41-49
• /
• 2015

Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.

• Journal of Chest Surgery
• /
• 제12권4호
• /
• pp.411-417
• /
• 1979

During the period of 4 years from August 1, 1975 to August 1, 1979, authors have experienced 100 cases of multiple rib fractures by nonpenetrating injury at Department of Thoracic Surgery, Paik Foundation Hospital in Seoul, Korea. 1. The ratio of male to female patients with multiple rib fracture was 2.6:1 with male predominance and 84% of the total cases were between 20 and 50 years of age. 2. The most common cause of multiple rib fracture was traffic accident and falls accounted for the next largest group. 3. The most common site of rib fracture was 4th rib to 7th rib level on both hemithorax [52%]. 4. Associated injuries were cerebral contusion in 26%, clavicular fracture in 22%, long bone fracture in 22%, pelvic bone fracture in 10%, and scapular fracture in 8%. 5. Early complications and/or result of the multiple rib fractures were lung contusion in 23 cases, subcutaneous emphysema in 21 cases, hemothorax in 21 cases, hemopneumothorax in 6 cases, and flail chest in 12 cases. 6. The flail chests were managed by strapping the chest with adhesive plaster, external traction of flail segment with towel clip, ventilatory assistance for marginal clinical indications, and in cases of complicated with intrathoracic hemorrhage, wire fixation of flail segment through open thoraco-tomy. 7. The principles of therapy for hemothorax and/or pneumothorax were rapid reexpansion of the lungs by thoracentesis [11%] and closed thoracostomy [22%], but open thoracotomy had to be done on 3 cases because of massive bleeding or intrapleural hematoma and diaphragmatic rupture. 8. The over all mortality was 4% [4 among 100 cases] and the cause of all deaths was head injury.

• 대한치과교정학회지
• /
• 제44권4호
• /
• pp.217-225
• /
• 2014

Single-tooth implantation has become a common treatment solution for replacement of a root-fractured maxillary incisor in adults, but the long-term esthetic results can be unfavorable due to progressive marginal bone loss, resulting in gingival recession. In this case report, a maxillary central incisor with a root fracture in its apical one-third was orthodontically extruded and extracted in a 21-year-old female. Implant surgery was performed after a 3-month healing period, and the final crown was placed about 12 months after extraction. After 12 years, favorable osseous and gingival architectures were visible with adequate bone height and thickness at the buccal cortical plate, and no gingival recession was seen around the implant-supported crown. Although modern dentistry has been shifting toward simplified, clinical procedures and shorter treatment times, both general dentists and orthodontists should be aware of the possible long-term esthetic advantages of orthodontic extrusion of hopelessly fractured teeth for highly esthetically demanding areas and should educate and motivate patients regarding the choice of this treatment solution, if necessary.

• Archives of Plastic Surgery
• /
• 제39권3호
• /
• pp.209-215
• /
• 2012

Background : Among all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR) for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR) through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone. Methods : A retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty. Results : According to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P<0.05). Mucosal injury with nasal bleeding occurred much less in the IOR group (5.3%) than the CR group (12.9%). Dorsal augmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them (31/34) showed satisfaction with the outcomes. Conclusions : IOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone.

• 대한골관절종양학회지
• /
• 제3권2호
• /
• pp.112-118
• /
• 1997

Multicentric chondrosarcoma other than the mesenchymal subtype is rare separate entity. We experienced a case with nonmonomelic synchronous multicentric chondrosarcoma without any preexisting lesions of Oilier's disease or Maffucci's syndrome. To our knowledge, there was no report of synchronous nonmonomelic multicentric chondrosarcoma. A thirty-three year old man had right distal thigh pain of one and half year. Bone scan showed hot lesions on medial condyle of right femur and shaft of left femur. Plain X-ray showed osteolytic lesion on right femur and slight cortical thickening and calcific lesion was observed on left femoral shaft. Curettage and bone cement filling was done on both lesions. The pathology reports were grade I chondrosarcoma on both side of femur. At one month from operation, pathologic fracture of left femur occurred on bone cement-host bone junction. Conservative treatment and radiotherapy of 60Gy was done. At 8 months from operation, nonunion was evident. Segmental resection of left femur with contralateral fibula graft and second look operation on right condyle lesion were done. At 6 months from revision, fracture occurred at host-graft bone junction. We removed previous hardware and applied long DCP and massive autogenous bone graft. Afterwards, the patient looks good and union was progressing. But at 4 years from last operation, hypertrophic nonunion occurred. Another revision was done with condylar plate and bone graft and now he is well without any sign of local recurrence or metastasis.

• Archives of Plastic Surgery
• /
• 제48권6호
• /
• pp.699-702
• /
• 2021

Extensive bone loss associated with severe vascular injury remains a challenge for lower extremity reconstruction. The fibular free flap has been utilized for many decades to reconstruct long-segment tibial defects. We present an unusual scenario of unilateral weight-bearing, wherein we salvaged the sole lower extremity by transfer of the fractured ipsilateral fibula and a bipedicled skin flap. A 38-year-old man sustained a severe crush injury in the right leg with loss of circulation. His left lower leg had a soft tissue defect measuring 20×15 cm with an exposed comminuted fracture and a 17-cm tibial defect, along with a segmental fracture of the fibula. Subsequently, we reconstructed the tibial defect by transferring a 17-cm-long section of the ipsilateral fibula. We covered the soft tissue defect with a bipedicled skin flap. The patient eventually began to ambulate independently after surgery.

• 대한인간공학회지
• /
• 제27권2호
• /
• pp.83-89
• /
• 2008

Study was developed the metallic plate for fixation in the femur fracture and plates has a firm place in fracture treatment. This plates can be stabilized for fracture fixation as well as biological and dynamical device. The device's designation and sizing has a optimization with bending structural stiffness and strength, known meaning that is reliable regardless of the plate by the short type and long type. The bending strength of the curved metallic long plate has to evaluate a 11,000N and the bending strength of the curved metallic short plate has to evaluate a 6,525N. This see the X-ray image of bending angle made certain of 15$^{\circ}$ at number 2 and same 82.87$^{\circ}$ at number 2, 4, 5, 7, 8, 9, 10 by outside angle, and confirmed 25.26$^{\circ}$ at number 3, 3.68$^{\circ}$ at number 6, 15.64$^{\circ}$ at number 9 by inside angle. This study shows that keep up the metallic plate for fixation in the femur fracture through X-ray Image and the device can be used to support Revision case of Hip Implant and to use a case of Hip screw compression of Hip Neck Fracture. Short plate have a wrapping of femur and long plate have to preserve a pole of femur.

• Journal of Chest Surgery
• /
• 제14권2호
• /
• pp.123-126
• /
• 1981

190 cases of the thoracic injuries experienced at the department of chest surgery, Chungnam National University Hospital, for 5 years from Jan. 1976 till Dec 1980, were analysed. The results are as follows; 1. The incidence rate of male to female was 5.1:1. The common age groups were 3rd, 4th and 5th decades, and the most common age group in the penetrating injury was 3rd decade. 2. The most common mode of the nonpenetrating injuries was a traffic accident [63.0%], and the most commonly used tool in the penetrating injuries is a knife [66.7%]. 3. The most common nonpenetrating injury was rib fracture [73.9%], and the common fracture sites were 5th, 6th, 7th and 8th ribs [especially, 7th rib]. The incidence rate of flail chest was 15% of the cases of the rib fractures. 4. The common associated injuries of the nonpenetrating were long bone fracture [18.3%], brain contusion [15.9%], and clavicle fracture etc.. 5. The common method of surgical treatment were closed thoracostomy [46.7%], thoracentesis, and open thoracotomy [7.4%] etc.. 6. The overall mortality was 2.8%. [Nonpenetrating; 0.8%, Penetrating; 6.3%]

• 한국컴퓨터정보학회논문지
• /
• 제12권5호
• /
• pp.285-292
• /
• 2007

본 논문은 정형외과영역인 대퇴부에 고정하여 사용하는 금속판으로 골 고정 골절치료의 유합술 골절치료를 할 수 있도록 구성하였는데, 사용되는 치료방법은 견고하고, 안정적이며, 역동적인 생물학적 금속판으로 고정 골수강 내 고정술을 적용되도록 견고한 골접촉 곡선형 시스템을 분석하였다. 금속판은 두 가지 유형으로 장형과 단형으로 구성되고, 금속판의 굴곡이 구조적이고 기하학적으로 경성 및 강도가 고루 분포하도록 최적화 하였다. 장 플레이트의 골접촉에 따른 곡선형으로 굽힙강도는 11,000N 이고, 단 플레이트의 골접촉에 따른 곡선형으로 굽힙강도는 6,525N 이며, 금속판에 골편간 압박을 주는 인장강도는 $1573N/m^2,\;1539N/m^2$정도이다. 금속판은 곡선부와 금속판부의 두 가지 부분으로 나뉘어져 있는데, 곡선부만 있는 단형과 밑 부분의 금속판이 달려있는 장형으로 진행되며, 곡선부의 단형은 전체적인 Profile이 낮고, 금속판이 달려있는 장형은 슬리브의 일체형으로 Profile보다 약간 높아져서 있다. 본 논문의 결과로 제공되는 것은 Hip Implant의 Revision case에 있어 보완뿐만 아니라 Hip Neck Fracture 경우에 사용되었던 Compression Hip Screw의 사용이 가능할 것으로 예상된다.

• Investigative Magnetic Resonance Imaging
• /
• 제21권3호
• /
• pp.177-182
• /
• 2017

Schwannomas are benign nerve sheath tumors that are typically located in soft tissue. Occasionally, schwannomas involve osseous structures. These intraosseous schwannomas are generally benign neoplasms that account for less than 0.2% of primary bone tumors. Schwannomas are very rarely observed in long bones. We present a case of a schwannoma affecting the proximal femur with a coincident subchondral fracture of the femoral head. A 38-year-old-male presented with left hip pain without deteriorating locomotor function. Plain film radiographs displayed a lobulating contoured lesion within the intertrochanteric portion of the femur. The magnetic resonance imaging (MRI) scans showed a tumor occupying the intertrochanteric region. Diffuse bone marrow edema, especially in the subchondral and head portions of the femur that was possibly due to the subchondral insufficiency fracture was also noted. The lesion was surgically excised and bone grafting was performed. Histologically, there was diffuse infiltrative growth of the elongated, wavy, and tapered cells with collagen fibers, which are findings that are characteristic of intraosseous schwannoma. Although very rare, intraosseous schwannoma should be included in the differential diagnosis of radiographically benign-appearing, non-aggressive lesions arising in the femur. The concomitant subchondral fracture of the femoral head confounded the correct diagnosis of intraosseous schwannoma in this case.