• Title/Summary/Keyword: Neck fracture

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Clinical and Radiological Comparison of Femur and Fibular Allografts for the Treatment of Cervical Degenerative Disc Diseases

  • Oh, Hyeong-Seok;Shim, Chan Shik;Kim, Jin-Sung;Lee, Sang-Ho
    • Journal of Korean Neurosurgical Society
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    • v.53 no.1
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    • pp.6-12
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    • 2013
  • Objective : This consecutive retrospective study was designed to analyze and to compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using a fibular and femur allograft with anterior cervical plating. Methods : A total of 88 consecutive patients suffering from cervical degenerative disc disease (DDD) who were treated with ACDF from September 2007 to August 2010 were enrolled in this study. Thirty-seven patients (58 segments) underwent anterior interbody fusion with a femur allograft, and 51 patients (64 segments) were treated with a fibular allograft. The mean follow-up period was 16.0 (range, 12-25) months in the femur group and 19.5 (range, 14-39) months in the fibular group. Cage fracture and breakage, subsidence rate, fusion rate, segmental angle and height and disc height were assessed by using radiography. Clinical outcomes were assessed using a visual analog scale and neck disability index. Results : At 12 months postoperatively, cage fracture and breakage had occurred in 3.4% (2/58) and 7.4% (4/58) of the patients in the femur group, respectively, and 21.9% (14/64) and 31.3% (20/64) of the patients in the fibular group, respectively (p<0.05). Subsidence was noted in 43.1% (25/58) of the femur group and in 50.5% (32/64) of the fibular group. No difference in improvements in the clinical outcome between the two groups was observed. Conclusion : The femur allograft showed good results in subsidence and radiologic parameters, and sustained the original cage shape more effectively than the fibular allograft. The present study suggests that the femur allograft may be a good choice as a fusion substitute for the treatment of cervical DDD.

A CLINICAL STUDY ON SOFT TISSUE INJURIES OF ORAL & MAXILLOFACIAL REGION (구강 및 악안면 영역의 연조직 손상에 관한 임상적 연구)

  • You, Jun-Young;Kim, Yong-Kwan;Bae, June-soo;Chang, Hyun-Seok
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.19 no.4
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    • pp.407-413
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    • 1997
  • The soft tissue injuries of Oral & Maxillofacial region include abrasion, contusion, simple laceration, laceration of skin with underlying tissue, soft tissue injuries combined with facial bone fracture and involving functional structures such as facial nerve and vessel, orbit, lacrimal duct and salivary gland and so on. The results obtained were as follows ; 1. The age range was 1 to 97, and the highest incidence occured in the 3rd decade(23.4%), followed by the 1st decade(20.2%), 4th decade(18.1%), 4th decade(18.1), and 5th decade(14.3%) 2. The sexual ration was 4 : 1(M : F). 3. The most common cause of facial laceration was a accident(54.5), followed by blow(17.8%), traffic accident(15.9%) and unknown(10.8%). 4. The most frequently occurred site of injury was a forehead(24), followed by oral cavity(16.9%), lip(15%), eyebrow(14.5%), cheek(14%), chin(11.8%), nose(2%), scalp(1.4%) and neck(0.9%). 5. Most of wound size was less than 3cm in length. 6. 28 patients suffered facial bone fracture, representing 7%. 7. The major complications following facial laceration were infection and facial paralysis caused by facial nerve injuries, representing 4.5% and 1.9%.

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A Comparative Review on Carthmi-Flos Pharmacopuncture Treatment - Focused on Clinical Study (홍화약침 시술에 관한 임상논문 비교연구)

  • Lee, Soo-Hwan;Yoon, Jeong-Won;Kim, Soon-Joong
    • Journal of Korean Medicine Rehabilitation
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    • v.27 no.4
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    • pp.55-65
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    • 2017
  • Objectives The purpose of this review is to analyze results of case studies and controlled studies about Carthmi-Flos pharmacopuncture. Based on the review, authors desire to suggest the study model including precise information and evident the effect of Carthmi-Flos pharmacopuncture objectively in treating clinical disorders. Methods We search 44 studies about Carthmi-Flos pharmacopuncture from 6 Korean web databases, using words 'Carthmi-Flos pharmacopuncture' in Korean alphabet. This study had been conducted throughout 1 month (July, 2017). We selected case studies and controlled trials in investigated 44 thesis, excluding experimental research and thesis not using the Carthmi-Flos pharmacopuncture for major treatment. Results We analyze 13 case reports and 7 controlled trials. As a result, Carthmi-Flos Pharmacopuncture was used mostly in musculoskeletal, neurological diseases. But this can be applied to internal diseases. Disorders reported effectively were carpal tunnel syndrome, degenerative knee joint arthritis, posterior neck pain, low back pain, radial nerve palsy, shoulder pain, lumbar compression fracture, alopecia areata, chronic daily headache, duverney fracture, oligomenorrhea, cervical disc herniation, rheumatoid arthritis and cervical headache. Conclusions As we analyzed, Carthmi-Flos pharmacopuncture is specifically effective in musculoskeletal and neurologic diseases. But there are various problems in study design. To design accurately, the study design should include much more specific information. And the result can be more precise by excluding other methods.

Early Stage Legg-Calve-Perthes Disease in a Dog: Clinical, Surgical, Radiological, Computed Tomography and Histological Findings (초기 허혈성 대퇴골두 괴사증을 보이는 개에서 임상학적, 수술적, 방사선학적, 컴퓨터단층촬영, 조직학적 소견)

  • Thak, Min-Ae;Yoon, Hun-Young;Jeong, Soon-Wuk
    • Journal of Veterinary Clinics
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    • v.30 no.5
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    • pp.366-370
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    • 2013
  • A 7-month-old Pomeranian presented with non-weight bearing lameness on the right pelvic limb. Physical examination revealed pain on extension of the right hip joint, and serum chemistry results showed an increased concentration of creatine kinase. Radiographic findings at admission included a weak radiolucent line on the right femoral head and widening of the right hip joint space, and mild displacement of the right capital femoral epiphysis was additionally identified on day 14. Computed tomography (CT) showed a decreased Hounsfield Unit measurement and a fracture line on the right femoral head. Early stage Legg-Calve-Perthes disease (LCPD) was diagnosed and femoral head and neck ostectomy was performed on the right femur. A fracture fissure and osteophytes at the epiphyseal plate of the femoral head were identified surgically. Necrosis in the femoral metaphysis and epiphysis was observed histologically. This case report describes the radiography, CT images, and surgical and histological findings in a dog with early stage LCPD.

The Clinical Study on 34 Admission Patients to Oriental Medical Hospital due to Traffic Accident (한방병원에 입원한 교통사고 환자 34명에 대한 임상적 고찰)

  • Cho, Sung-Woo;Go, Kyung-Hoon;Nam, Jung-Hun;Kim, Bong-Hyun;Lee, In-Seon
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.1 no.2
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    • pp.101-109
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    • 2006
  • Objective: The purpose of this study is finding tendencies admission patients to orient medical hospital due to Traffic Accident. Method: We studied 34 cases who were admitted in Dong-eui University Oriental Hospital from 1st, December, 2003 to the 30st, May, 2005. And we came to some conclusion about clinical tendencies as follows. Results and Conclusions: 1. Women had occupied more than men, And 10 persons in 30th were the most distribution of age. 2. Most patients used western medical hospital as primary hospital and after several days they started to search for orient medical treatments. 3. In the diagnosis through radiological test, cervical spine sprain was most(19 cases, 55.6%). The others were lumbar spine sprain(14 cases, 41.2%), fracture of other bone{4 cases, 11.8%), fracture of spine(3 cases, 8.8%), Intercranial hemorrhage(3 cases, 8.8%). 4. In chief complaint, low back pain was most(19 cases, 55.9%), The others were neck stiffness(17 cases, 50.0%), headache(13 cases, 38.2%), lower limb pain(9 cases, 26.5%). 5. Simple Disease had higher than complex disese at effective rate. 6. Both $43{\sim}60$ days admission and $15{\sim}21$ days admission were the best effective. $8{\sim}14$ days admission was next effective. 7. Early visit made more effective.

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Cement Augmentation of Dynamic Hip Screw to Prevent Screw Cut Out in Osteoporotic Patients with Intertrochanteric Fractures: A Case Series

  • Rai, Avinash Kumar;Goel, Rajesh;Bhatia, Chirag;Singh, Sumer;Thalanki, Srikiran;Gondane, Ashwin
    • Hip & pelvis
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    • v.30 no.4
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    • pp.269-275
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    • 2018
  • Purpose: The purpose of this study is to describe a method of inserting cement in the femoral head before fixation with dynamic hip screw to prevent screw cut out due to osteoporosis and to evaluate its clinical outcome in these patients. Materials and Methods: In this prospective study, 30 patients aged 60 years and older with intertrochanteric fracture were included. Bone mineral density was measured. After reaming of the femoral head and neck with a triple reamer and polymethyl methacrylate, bone cement was introduced into the femoral head using a customized nozzle and a barrel fitted on a cement gun. A Richard screw was inserted and the plate was fixed over the femoral shaft. Patients were mobilized and clinical outcomes were rated using the Salvati and Wilson's scoring system. Results: More patients included in this study were between 66 and 70 years old than any other age group. The most common fracture according to the Orthopaedic Trauma Association classification was type 31A2.2 (46.7%). The T-score was found to be $-2.506{\pm}0.22$ (mean${\pm}$standard deviation); all patients were within the range of -2.0 to -2.8. The duration of radiological union was $13.67{\pm}1.77$ weeks. Salvati and Wilson's scoring at 12 months of follow up was $30.96{\pm}4.97$. The majority of patients were able to perform their normal routine activities; none experienced implant failure or screw cut out. Conclusion: Bone cement augmentation may effectively prevent osteoporosis-related hardware complications like screw cut out in elderly patients experiencing intertrochanteric fractures.

Cut-Through versus Cut-Out: No Easy Way to Predict How Single Lag Screw Design Cephalomedullary Nails Used for Intertrochanteric Hip Fractures Will Fail?

  • Garrett W. Esper;Nina D. Fisher;Utkarsh Anil;Abhishek Ganta;Sanjit R. Konda;Kenneth A. Egol
    • Hip & pelvis
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    • v.35 no.3
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    • pp.175-182
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    • 2023
  • Purpose: This study aims to compare patients in whom fixation failure occurred via cut-out (CO) or cut-through (CT) in order to determine patient factors and radiographic parameters that may be predictive of each mechanism. Materials and Methods: This retrospective cohort study includes 18 patients with intertrochanteric (IT) hip fractures (AO/OTA classification 31A1.3) who underwent treatment using a single lag screw design intramedullary nail in whom fixation failure occurred within one year. All patients were reviewed for demographics and radiographic parameters including tip-to-apex distance (TAD), posteromedial calcar continuity, neck-shaft angle, lateral wall thickness, and others. Patients were grouped into cohorts based on the mechanism of failure, either lag screw CO or CT, and a comparison was performed. Results: No differences in demographics, injury details, fracture classifications, or radiographic parameters were observed between CO/CT cohorts. Of note, a similar rate of post-reduction TAD>25 mm (P=0.936) was observed between groups. A higher rate of DEXA (dual energy X-ray absorptiometry) confirmed osteoporosis (25.0% vs. 60.0%) was observed in the CT group, but without significance. Conclusion: The mechanism of CT failure during intramedullary nail fixation of an IT fracture did not show an association with clinical data including patient demographics, reduction accuracy, or radiographic parameters. As reported in previous biomechanical studies, the main predictive factor for patients in whom early failure might occur via the CT effect mechanism may be related to bone quality; however, conduct of larger studies will be required in order to determine whether there is a difference in bone quality.

Comparative Analysis of Preoperative and Postoperative Muscle Mass around Hip Joint by Computed Tomography in Patients with Hip Fracture

  • Sung Yoon Jung;Hyeon Jun Kim;Kyu Taek Oh
    • Hip & pelvis
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    • v.34 no.1
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    • pp.10-17
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    • 2022
  • Purpose: This study was conducted in order to assess changes in hip muscles by comparing results of preoperative and postoperative computed tomography (CT) in older patients who underwent surgery for treatment of hip fracture. Materials and Methods: A total of 50 patients (aged ≥65 years) who underwent surgery for treatment of intertrochanteric fractures (25 patients) and femoral neck fractures (25 patients) between February 2013 and February 2019 and underwent preoperative and postoperative pelvic CT were enrolled in the study. The cross-sectional area, attenuation and estimates of muscle mass of the gluteus medius, gluteus minimus, iliopsoas, and rectus femoris on the uninjured side were measured. Basic patient data (sex, age, height, weight, body mass index [BMI], bone mineral density [BMD], Harris hip score [HHS], and length of follow-up) were collected from medical records. Results: No significant differences in sex, age, height, weight, BMI, BMD, HHS, and length of follow-up were observed between the two groups. No significant difference in the cross-sectional areas and attenuations of gluteus medius and gluteus minimus was observed after surgery; however, a statistically significant decrease was observed in those of iliopsoas and rectus femoris after surgery. Lower estimates with statistical significance of muscle mass of the iliopsoas and rectus femoris were observed on postoperative CT. Conclusion: Muscle mass of the hip flexor (iliopsoas, rectus femoris) showed significant decreases on postoperative CT compared with preoperative CT. Based on these findings, selective strengthening exercise for hip flexor should be beneficial in rehabilitation of hip fractures.

Hip Resurfacing Arthroplasty after Failure of Tantalum Rod Insertion in Patients with Osteonecrosis of the Femoral Head

  • Yoon Je Cho;Kee Hyung Rhyu;Young Soo Chun;Hyun Gon Gwak
    • Hip & pelvis
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    • v.34 no.4
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    • pp.219-226
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    • 2022
  • Purpose: The purpose of this study was to examine the clinical outcomes and efficacy of hip resurfacing arthroplasty (HRA) in patients with osteonecrosis of the femoral head after the failure of porous tantalum rod insertion without rod removal. Materials and Methods: Conversion to hip resurfacing arthroplasty was performed in 10 patients (11 hips) with a mean period of 14.9 months after the primary surgery. The mean follow-up period was 73.7 months. Analysis of pre and postoperative range of motion (ROM), University of California at Los Angeles (UCLA) activity score, modified Harris hip score, and visual analog scale (VAS) pain score was performed. Radiographic analysis of component loosening and osteolysis was performed. Results: The postoperative ROM showed significant improvement (P<0.05), excluding flexion contracture. The modified Harris hip score showed improvement from 65.82 to 96.18, the UCLA score showed improvement from 4.18 to 8.00, and the VAS pain score was reduced from 6.09 to 1.80. All scores showed statistically significant improvement (P<0.05). No component loosening or osteolysis was detected by radiographic analysis. Conclusion: Satisfactory results were obtained from conversion hip resurfacing arthroplasty after failure of porous tantalum rod insertion without rod removal. The findings of this study demonstrate the advantages of HRA, including no risk of trochanteric fracture and no bone loss around the tantalum rod. In addition, the remaining porous tantalum rod provided mechanical support, which reduced the potential risk of femoral neck fracture or loosening. This technique can be regarded as a favorable treatment option.

A THREE DIMENSIONAL FINITE ELEMENT STRESS ANALYSIS OF SINGLE IMPLANT PROSTHESES ACCORDING TO THE HEX-LOCK TYPE (단일 임플랜트 보철물의 Hex-lock 형태에 따른 3차원 유한요소법적 응력분석)

  • Hwang, Young-Pil;Kay, Kee-Sung;Cho, Kyu-Zong
    • The Journal of Korean Academy of Prosthodontics
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    • v.34 no.2
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    • pp.385-402
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    • 1996
  • The purpose of this study was to analyze how the stability of the implant prostheses and the loosening of the fastening screw was affected when the various types of Hex structure provided for the effect of anti-rotation of the single prostheses were given. Three dimensional finite element model was designed with which the implants with the external hex type of 0.75mm, 1.5mm and the implant with the internal hex type of 0.75mm, 1.5mm and the implant with the external hex type of $15^{\circ}$ tapered shape of 0.75mm were supposed to completely osseointegrate to the mandible. After fininshing the finite element model, the preload of 10N at the fastening screw was applied and then the vertical and $30^{\circ}$ lateral load of 200N was applied respectively at the cusp tips of the prostheses. The following results were obtained : 1. In case of displacement, the amount of displacement was increased at the internal hex type(model C, D) than at the external hex type(model A, B, E) when the vertical and lateral load was applied. 2. Less equivalent stress was represented at the model B with increased external hex height than at the model A when the vertical and lateral load was applied. 3. Much stress was represented at the model E with increased hex angle than at the model A in case of the stress happened to the implant body and the fastening screw when the vertical and lateral load was applied. 4. Much equivalent stress was represented at the model D with deepened internal hex height than at the model C when vertical and lateral load was applied. 5. The least stress was taken at the model B and the most stress was taken at the model D in case of the stress happened to the implant when the vertical and lateral load was applied. 6. The least stress was taken at the model C at the vertical load. And the least stress was taken at the model B at lateral load in case of the stress happened to the fastening screw. As a results of this study, the good lateral stability of prostheses and less stress of the component of implant was taken when the external hex height was increased, and the risk of neck fracture of implant and fastening screw was increased when the internal hex height was deepned because of long screw neck portion and thin implant neck portion.

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