The Journal of the Korean bone and joint tumor society
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v.1
no.1
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pp.45-51
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1995
The incidence of metastatic bony lesion has been increased recently, with the advanced therapeutic modalities of malignant tumors. The purpose of this study was to evaluate the effectiveness of surgical treatment in impending or established pathologic fractures due to metastasis in extremity. From 1981 to 1992, thirty two patients who had established or impending pathologic fractures in extremity had been treated surgically. The locations of metastasis, were lower extremity in 24 cases(femsral head and neck;5, intertrochanteric;7, subtrochanteric;8, femoral shaft;4) and upper extremity in 8 cases(proximal humerus;2, humoral shaft;6). The method of surgery was excision of tumor mass and rigid internal fixation to allow immediate mobilization, except 2 cases of amputation. The results were analysed by two criteria. The first was the grade of performance status that was made by modification of Functional Classification of New York Heart Association. The second was the degree of pain relief. The performance status was improved at least one grade in all patients and the mean improvement was 1.7 grades. The satisfactory pain relief was achieved in 81% of patients. Postoperatively, most of the patients had only slight to moderate limitation of physical activities and they became comfortable at rest and ordinary activities. The solitary metastatic lesions showed better pain relief(92%) than multiple metastasis(75%). The curative surgery was done in 3 cases, and they showed more than 24 months of disease-free survival.
Judet's rib struts which are designed for osteosynthesis are made of stainless steel This report describes clinical analysis of our experiences of 30 cases with the operative stabilization of multiple rib fractures with Judet's rib struts from December, 1995, to December, 1996 in Chungmoo Hospital, Chounan. Our indications for operative stabilization were as follows: 14 cases in flail chest, 8 cases in severe displacement of rib including segmental fractures, 7 cases in additional procedures during intrathoracic operation, and 1 case in other cause. Postoperative artificial ventilation is needed in only 1 case for 5 days and postoperative complications were few: 2 cases of hemopneumothorax, 2 cases of alcohol withdrawal delirium, and 1 case of postoperative hepatitis. Average duration of hospital admission who have limited thoracic injuries was 10.5 days. Though more comparative studies is necessary, we find this technique to be better than previously published m thods, since it provides better stabilization and immobilization of the ribs and shortening the duration of hospital admission.
The $12^{th}$ rib syndrome is a disease that causes pain between the upper abdomen and the lower chest. It is assumed that the impinging on the nerves between the ribs causes pain in the lower chest, upper abdomen, and flank. A 74-year-old female patient visited a pain clinic complaining of pain in her back, and left chest wall at a 7 on the 0-10 Numeric Rating scale (NRS). She had a lateral fixation at T12-L2, 6 years earlier. After the operation, she had multiple osteoporotic compression fractures. When the spine was bent, the patient complained about a sharp pain in the left mid-axillary line and radiating pain toward the abdomen. On physical examination, the $10^{th}$ rib was not felt, and an image of the rib-cage confirmed that the left $10^{th}$ rib was severed. When applying pressure from the legs to the $9^{th}$ rib of the patient, pain was reproduced. Therefore, the patient was diagnosed with $9^{th}$ rib syndrome, and ultrasound-guided $9^{th}$ and $10^{th}$ intercostal nerve blocks were performed around the tips of the severed $10^{th}$ rib. In addition, local anesthetics with triamcinolone were administered into the muscles beneath the $9^{th}$ rib at the point of the greatest tenderness. The patient's pain was reduced to NRS 2 point. In this case, it is suspected that the patient had a partial resection of the left $10^{th}$ rib in the past, and subsequent compression fractures at T8 and T9 led to the deformation of the rib cage, causing the tip of the remaining $10^{th}$ rib to impinge on the $9^{th}$ intercostal nerves, causing pain.
The purpose of this study was to evaluate the effects of different bases of ceramic brackets on shear bond strength and to observe failure patterns of bracket bondings. Lower bicuspid brackets whose bases designed for the macromechanical and silane treated chemical bonding those for silane treated chemical bonding, those for micromechanical bonding, and those for macromechanical bonding were tested as experimental groups, and foil mesh-backed metal brackets as a control group. All the brackets were bonded with $Mono-Lok\;2^{(TM)}$ on the labial surface of extracted human lower bicuspids after etching the enamel with $38\%$ phosphoric acid solution for 60 seconds. The shear bond strengths were measured on the universal test machine after 24 hours passed in the $37^{\circ}C$ water bath. The gathered data were evaluated and tested by ANOVA and Duncan's multiple range test, and those results were as follows. The shear bond strengths of brackets for macromechanical and chemical bonding, those for chemical bonding, and those for micromechanical bonding were not different (p>0.05), but showed statistically higher than those of metal bracket and those of ceramic bracket for micromechanical bonding(p<0.05). The shear bond strengths of ceramic bracket for micromechanical bonding showed statistically lower than those of metal bracket(p<0.05). The enamel fractures and/or ceramic bracket fractures were observed in the cases of higher bond strength than that of metal bracket. These results supported that silane treated base of ceramic bracket show higher shear bond strength than that of metal bracket, and suggested that micromechanical form of ceramic bracket bases show higher shear bond strength than that of macromechanical form.
Injury of the musculocutanous nerve can be associated with a proximal humeral fracture or shoulder dislocation, and injury of the brachial plexus. However, injury of this nerve associated with a humeral shaft fracture has rarely been reported. Diagnosis of the musculocutaneous nerve injury is difficult because its sensory loss is ill-defined, and examination of elbow flexion is difficult when it is associated with fractures. We report an unusual case of musculocutaneous nerve injury in a 27 years old woman who had multiple injuries including a humerus shaft fracture, an ipsilateral radius shaft fracture, and an associated radial nerve laceration. Diagnosis of the musculocutaneous nerve injury was delayed because combined fractures of the humerus and radius prevented proper examination of the elbow motion and nerve grafting of the radial nerve delayed early elbow motion exercise. Delayed exploration of the musculocutaneous nerve 6 months after trauma showed complete rupture of the nerve at its entry into the coracobrachialis muscle and the defect was successfully managed by sural nerve graft.
Diagnostic radiology and conservative management for S75 patient with L1 lumbar fracture by traffic accidents were discussed with references, and then the obtained results were as follows ; 1. Wedging compression fractures with 10% deformity was confirmed at anterior vertebral body of L1 lumbar spine through lateral plain X-ray film. 2. Irregular bony fractures were observed at anterior vertebral body of L1 lumbar spine by CT scans, anatomically T12-L1 sites showed highly frequency of injuries, Denis's fracture type was classified as multiple compression fracture at anterior column without abnormal middle and posterior column, also no Cobb's angle, and then Frankel's neurological classification was E grade. 3. Orthopaedic treatments were performed with conservative methods. With rest on the bed, anti-in-flammatory medication, electrolyte and nutritional solution, the pain diminished. 4. After 3 weeks, rehabilitation was worked with putting on polyethylene back corset, although pains remained slightly until after 8 weeks, thereafter the spine showed gradually stability.
The iridium disc, generally used in industrial radiography, is examined to find the fracture morphology and fine particles remaining on the shear blank surface. Randomly selected 1,200 discs were observed under a scanning electron microscope tilted more than $45^{\circ}$. Fracture surfaces are classified into three groups: (1) surface fall-out, (2) fracture on the edge and (3) multi-step brittle fracture, which shows the mutual relationship between the fracture morphology and remaining particles. Fracture particles were removed by cleaning the discs in a ultrasonic bath with acetone and collected at the bottom. Removed number of the particles were counted for each different group of fracture surfaces. Followings are conclusions: (1) About 80.5% of discs (966/1,200), have sound plastic shear surfaces with particles remained. (2) About 2% discs accompany surface fall-out's having large particles tens of ${\mu}m$, which is stable not to be pulled out even after the considerably long time of ultrasonic cleaning. (3) About 5% discs contain the fractures on the edge and the particles are removed thoroughly within 30 minutes. (4) 234 discs out of 1,200 discs have multi-step fracture surfaces whose particles never removed in a short period of time but come out very slowly. Such a disc having multiple-step fracture is attributed to the promate cause to the 'leaker'. It is noted here that the discs having mutiple-step fractures should be treated separately with special care, and it is need to study how to treat them.
Celiac artery compression is a rare condition in which the celiac artery is compressed by the median arcuate ligament. Case reports of compression after trauma are hard to find. Blunt traumatic pericardium rupture is also a rare condition. We report a single patient who experienced both rare conditions from a single blunt injury. An 18-year-old woman was brought to the trauma center after a fatal motorcycle accident, in which she was a passenger. The driver was found dead. Her vital signs were stable, but she complained of mild abdominal pain, chest wall pain, and severe back pain. There were no definite neurologic deficits. Her initial computed tomography (CT) scan revealed multiple rib fractures, moderate lung contusions with hemothorax, moderate liver injury, and severe lumbar spine fracture and dislocation. She was brought to the angiography room to check for active bleeding in the liver, which was not apparent. However, the guide wire was not able to pass through the celiac trunk. A review of the initial CT revealed kinking of the celiac trunk, which was assumed to be due to altered anatomy of the median arcuate ligament caused by spine fractures. Immediate fixation of the vertebrae was performed. During recovery, her hemothorax remained loculated. Suspecting empyema, thoracotomy was performed at 3 weeks after admission, revealing organized hematoma without pus formation, as well as rupture of the pericardium, which was immediately sutured, and decortication was carried out. Five weeks after admission, she had recovered without complications and was discharged home.
Background: Treating panfacial fractures (PFFs) can be extremely difficult even for experienced surgeons. Although several authors have attempted to systemize the surgical approach, performing surgery by applying a unidirectional sequence is much more difficult in practice. The purpose of this study was to review the literature on PFF surgery sequence and to understand how different surgical specialists-plastic reconstructive surgery (PRS) and oral maxillofacial surgery (OMS)-chose sequence and review PFFs fixation sequence in clinical cases. Methods: The PubMed and Google Scholar databases were scoured for publications published up until May 2020. Data extracted from the studies using standard templates included fracture part, fixation sequence, originating specialist, and the countries. Bibliographic details like author and year of publication were also extracted. Also, we reviewed the data for PFFs patients in the Trauma Registry System of Dankook University Hospital from 2011 to 2021. Results: In total, 240 articles were identified. This study comprised 22 studies after screening and full-text analysis. Sixteen studies (12 OMS specialists and 4 PRS specialists) used a "bottom-top" approach, whereas three studies (1 OMS specialist and 2 PRS specialists) used a "top-bottom" method. However, three studies (only OMS specialists) reported on both sequences. In our hospital, there were a total of 124 patients with PFF who were treated during 2011 to 2021; 64 (51.6%) were in upper-middle parts, 52 (41.9%) were in mid-lower parts, and eight (6.5%) were in three parts. Conclusion: Bottom-top sequencing was mainly used in OMS specialists, and top-bottom sequencing was used at a similar rate by two specialists in literature review. In our experience, however, it was hard to consistently implement unidirectional sequence suggested by a literature review. We realigned the reliable and stable buttresses first with tailoring individually for each patient, rather than proceeding in the unidirectional sequence like bottom-top or top-bottom.
Mi-Ji Kim;Gyeong-Ye Lee;Joo Hyun Sung;Seok Jin Hong;Ki-Soo Park
Journal of agricultural medicine and community health
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v.48
no.4
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pp.275-284
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2023
Objectives: This study aimed to assess hand grip strength and femoral neck bone mineral density levels among Korean fishery workers and investigate their association. Methods: Hand grip strength and femoral neck bone mineral density were measured in a survey and health examination conducted in 2021 among fishery workers in a southern region of South Korea. Covariates including gender, age, education level, income level, smoking behavior, drinking behavior, family history of hip fractures, use of calcium and vitamin D supplements, hypertension, diabetes, regular exercise, and body mass index were investigated. Multiple regression analysis was employed to assess the association between hand grip strength and femoral neck bone mineral density. Results: Among 147 fishery workers, 8.16% exhibited low hand grip strength levels indicative of possible sarcopenia, and a significant association was found between low hand grip strength and decreased femoral neck bone mineral density (β = -89.14, 95% CI = -160.50, -17.78). Additionally, factors such as women gender, advanced age, family history of hip fractures, and a body mass index below 25 kg/m2 were associated with decreased femoral neck bone mineral density. In the subgroup analysis by gender, a correlation between low hand grip strength and decreased femoral neck bone mineral density was observed only in men. Conclusions: Further research is needed to explore various determinants and intervention strategies to prevent musculoskeletal disorders among fishery workers, ultimately enhancing their quality of life and well-being.
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