• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.212-220
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• 1998

Concomitant ipsilateral fractures of the humerus, radius and ulna are uncommon combined injury and are also called "floating elbow". It was found that this injury was usually a result of rather severe trauma and frequently associated injuries to other organ systems. It is controversial in the treatment of the "floating elbow", but the current treatment recommendations are open reduction and internal fixation of both the humerus and the forearm fracture with early initiation of range of motion exercises. The authors reviewed thirteen cases of ipsilateral fractures of the humerus, radius and ulna treated in our clinic from January 1992 to March 1997, and average follow-up period was over 18 months(range, 12 to 36 months). The results obtained were as follows; 1. The most common cause of injury was traffic accident and most common location of fractures was mid-third in both humerus and forearm. 2. The shape of fractures was transverse or comminuted in most cases. 3. The good clinical results were obtained by open reduction and internal fixation of both the humerus and the forearm fracture with early initiation of range of motion exercises. 4. The recovery was affected by the severity of the initial trauma and method of the treatment. 5. According to the Lange and Foster method, the functional result was good in 8 cases, fair in 4 cases and poor in 1 cases.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.41-49
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• 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 Korean Neurosurgical Society
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• 제46권3호
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• pp.273-276
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• 2009

A 54-year-old man experienced injury to the second finger of his left hand due to damage from a paintball gun shot 8 years prior, and the metacarpo-phalangeal joint was amputated. He gradually developed mechanical allodynia and burning pain, and there were trophic changes of the thenar muscle and he reported coldness on his left hand and forearm. A neuroma was found on the left second common digital nerve and was removed, but his symptoms continued despite various conservative treatments including a morphine infusion pump on his left arm. We therefore attempted median nerve stimulation to treat the chronic pain. The procedure was performed in two stages. The first procedure involved exposure of the median nerve on the mid-humerus level and placing of the electrode. The trial stimulation lasted for 7 days and the patient's symptoms improved. The second procedure involved implantation of a pulse generator on the left subclavian area. The mechanical allodynia and pain relief score, based on the visual analogue scale, decreased from 9 before surgery to 4 after surgery. The patient's activity improved markedly, but trophic changes and vasomotor symptom recovered only moderately. In conclusion, median nerve stimulation can improve chronic pain from complex regional pain syndrome type II.

• Archives of Reconstructive Microsurgery
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• 제15권1호
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• pp.26-32
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• 2006

Purpose: The purpose of this study was to evaluate the effectiveness of limb reconstruction and functional recovery using vascularized fibular graft in the treatment of extensive bone defect of long bone caused by various diseases. Materials and Methods: From september 1995 to March 2005, 21 patients with segmental bone defects were managed with vascularized fibular graft: 13 males and 8 females, aged 39 years on average (range, $8{\sim}65\;years$). The reconstructed site was the humerus in 9 patients, the femur in 5, the tibia in 4 and the forearm bone in 3. The length of bone defect ranged from $8{\sim}17\;cm$. Results: Twenty grafts were successful. The mean period to obtain radiographic bone union was 5.7 months on average. Conclusion: Fibular grafts allow the use of a segment of diaphyseal bone and of sufficient length to reconstruct most skeletal defects of the long bone. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects.

• 한국방사선학회논문지
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• 제17권4호
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• pp.607-614
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• 2023

팔꿉관절 측방향 일반촬영 검사 시 위팔뼈 양측 위관절융기의 정확한 겹침과 팔꿉관절의 적절한 분리는 매우 중요하다. 그러나 팔꿉관절의 복잡한 해부학적인 구조로 인해서 최적의 영상을 획득하기 어려워 반복적인 검사가 시행되고 있다. 따라서 본 연구는 팔꿉관절 측방향 일반촬영 검사 시 정확한 영상을 획득할 수 있는 환자의 각도를 조사하고자 하였다. 연구 대상은 20명의 환자로 정해진 연구 절차에 따라 시행되었다. 먼저 아래팔과 테이블 사이의 0°의 각도에서 X선을 수직 입사하여 영상을 획득하였다(대조군). 그 후, 팔꿉관절의 측방향 영상이 부적절하다고 판단될 경우 5° 및 10°의 기울기를 가진 스티로폼 지지대를 이용하여 아래팔의 각도를 조정하여 영상을 획득하였다(실험군). 평가 방법으로는 두 명의 평가자가 리커트 5점 척도를 통해 영상을 평가했고, 평가에 대한 신뢰성은 크론바흐 알파 값을 제시하였다. 결과적으로 처음 검사(대조군)에서 양측 위관절융기의 겹침과 팔꿉관절의 분리가 적절하지 않은 환자들은 아래팔뼈와 테이블 사이에 10° 각도를 설정하였을 때 가장 좋은 영상을 획득할 수 있었다. 이에 대한 정성적 평가 점수는 0°에서 1.6±0.8점, 5°에서 2.7 ± 0.8점, 10°에서 4.4 ± 1.3점이었고, 0°, 5°, 10° 각도에 대한 신뢰도 분석 결과 크론바흐 알파 값은 각각 0.867, 0.697 및 0.922였다. 결론적으로 기존의 검사 자세와 X선 입사 방식을 사용하여 정확한 영상을 얻을 수 없는 경우에는 아래팔과 테이블 사이의 각도를 10°로 설정한 후 우선적으로 영상을 획득하고 차츰 각도를 줄여가면서 영상을 획득한다면 반복 검사의 횟수를 줄이면서 최적의 영상을 얻을 수 있을 것으로 판단된다.

• 한국방사선학회논문지
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• 제18권2호
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• pp.127-133
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• 2024

팔꿉관절은 3개의 뼈대가 조합하여 관절을 이루고 있으며 신체적 활동 및 외력에 의한 이상 시 X-선 등, 방사선 검사로 영상진단을 한다. 팔꿉 관절 선행연구에 의하면 전완부(forearm)의 Z축 거상에 의한 기울기 자세에서 영상평가 기준에 부합하는 새로운 검사법이 발표되어 이에 최적화된 기구를 설계하고 다른 상지 검사에서도 활용 가능한 보조기구를 개발하고자 하였다. 2D 도면 및 3D 모델링 설계로 디자인 후 4부분의 파트로 구분 된 디자인을 ABS 소재의 3D 프린팅 방법으로 출력 후 조립 단계를 거쳐 제품을 완성하였다. 개발된 보조기구는 Z축 거상 기울기 4단계 각도(0, 5, 10, 15도) 기능과 1도 단위로 360도 회전되어 고정하는 기능으로 구성하였다. 개발된 보조기구는 사용 빈도의 누적 및 신체적 활용에 의한 하중 문제에 대해 구조해석을 통하여 최대 등가응력(equivalent stress) 56.107 Pa, 변위(displacement) 1.6548e-5 mm 의 안전한 물성치 범위로 개발되었다. 또한 개발된 보조기구는 팔꿉관절의 X-선 검사뿐만 아니라 위팔뼈 회전에 의한 어깨 기능검사에서도 활용할 수 있으며 비금속 소재로 MRI, CT 검사에서도 적용이 가능하도록 개발되었다. 개발된 보조기구는 향후 다양한 장치 및 의료영상 검사의 임상 적용을 통하여 검사의 정확성 및 효율화에 기여하리라 판단한다.

• PNF and Movement
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• 제21권1호
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• pp.47-52
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• 2023

Purpose: This study aims to examine the functional difference in the long and short heads of the biceps brachii by investigating the onset time of muscle contractions in the biceps brachii in the supination motion according to whether the flexor of the elbow joint is excluded. Methods: This study was conducted with 21 healthy men aged in their 20s. While performing forearm pronation at an elbow flexion angle of 90 degrees, the onset time of muscle contractions in the long and short heads of the biceps brachii was measured and compared in a posture where the humerus is placed on a table and the posture is lifted against gravity. Using an independent samples t-test, the difference in the onset time of muscle contractions in the long and short heads of the biceps brachii was analyzed. Results: The onset time of the long head was shorter if the flexor activity of the elbow joint was excluded, while that of the short head of the biceps brachii was shorter if it was not excluded. Conclusion: It is noted that the long head of the biceps brachii mainly functions as a supinator muscle, while the short head of the biceps brachii plays a role in stabilizing and maintaining flexion of the elbow joint.

• Archives of Reconstructive Microsurgery
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• 제2권1호
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• pp.20-28
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• 1993

From 1981 to 1991, twenty one vascularized bone grafts had been performed for the treatment of large bone defects of the extremities, with average follow-up of 65.4 months. Fibulae were used in 15 patients Including two cases of osteocutaneous flap, iliums in 5 including two of osteocutaneous flap, and osteocutneous rib in one. Ten of these patients were treated for segmental defects derived from trauma or infection sequelae of long bones, while eight for locally aggressive benign or malignant bone tumors ; and three for congenital pseudarthrosis of tibia. The location of the lesions were 8 cases in tibia; 7 in humerus ; 3 in forearm bone ; 2 in foot ; and 1 in femur. The length of bone defects were averaged as 10 cm, ranging from 3 to 17.5. In eighteen patients(85.7%), the operation was successful. The duration from operation to bony union was average 5.1 months on successful cases, and three of them needed additional procedures, such as bone graft and electrical stimulation to promote bony union. Local recurrence was found in one case of chondrosarcoma, resulting in AK amputation. Wound infections were noted each one case on donor or recipient site. In five cases, the fracture of grafted bone, which united with cast immobilization in four, occurred average 16.7 months after operation.

• The Journal of Korean Physical Therapy
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• 제15권4호
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• pp.331-372
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• 2003

The purpose of study was to evaluate effects of low-intensity ultrasound and laser on healing of bone fracture. Twenty fracture patient were selected for this study(fourteen males, six females. mean aged 44.8) fracture area was humerus, tibia, forearm bones. The obtain result are as follows. 1. The result of this study were following that pain score was significantly reduced pre intervention compared with post intervention in male(P<.001). 2. The result of this study were following that pain score was significantly reduced pre intervention compared with post intervention in female(P<.001). 1. The result of this study were following that pain score was not appeared reduced pre intervention compared with post intervention in male and female(P<.001). 4. The result of this study were following that pain score was not appeared pre intervention compared with post intervention in male between age(P<.001). 5. The result of this study were following that pain score was not appeared pre intervention compared with post intervention in female between age (P<.001). 6. The result of this study were following that radiologic score was significantly reduced pre intervention compared with post intervention in male(P<.001). 7. The result of this study were following that radiologic score was significantly reduced pre intervention compared with post intervention in female(P<.001). 8. The result of this study were following that radiologic score was not appeared reduced pre intervention compared with post intervention in male and female(P<.001). 9. The result of this study were following that radiologic score was not appeared pre intervention compared with post intervention in male between ages(P<.001). 10. The result of this study were following that radiologic score was not appeared pre intervention compared with post intervention in female between ages(P<.001). 11. The result of this study were following that healing on fracture area was observed that reduced pre intervention compared with post intervention

• 대한골관절종양학회지
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• 제1권2호
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• pp.154-163
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• 1995

1986년 3월부터 1993년 12월까지 연세대학교 의과대학 정형외과학 교실에서 상지에 발생한 악성 및 침윤성 양성 골종양에 대하여 사지구제술을 시행하여 다음과 같은 결과를 얻었다. 1. 총 13명의 상지에 발생한 악성 및 침윤성 양성골종양 환자에 대해 사지 구제술을 시술 하였다. 2. 사지 구제 술의 내용은 8 례가 Tikhoff -Linberg 수술, 2 례가 분절절제 및 재접합술, 2 례가 종양삽입물 치환술 그리고 1 례가 분절절제술 및 유리혈관부착 생비골이식술이었다. 3. 13 례중 3 례가 골육종, 4 례가 연골육종, 3 례가 거대세포종, 1 례가 병적 골절을 동반한 유잉육종, 1 례가 연골아세포종, 1 례가 전완부 건 및 근육과 원위요골 및 척골을 동시에 침범한 평활근 육종이었다. 4. 추시기간은 술수 1년에서부터 7년 5개월로 평균 4년 5개월이었다. 5. 총 13명의 환자 중 1 례의 상완골에 발생한 병적 골절을 동반한 유잉 육종의 환자에서 국소재발 및 다발성 골전이가 나타나 수술 후 4년 4개월만에 사망하였고 나머지 12 례의 환자는 국소재발이나 원격전이의 소견은 없었다. 6. 상지에 발생한 악성 및 침윤성 양성 골종양의 치료로 여러방법의 사지구제술은 병의 치료 면이나 기능적인 면에서 만족스런 결과를 가져왔다.