• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.71-75
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• 2004

Purpose: The purpose of this study was to evaluate retrospectively the clinical results of closed reduction and percutaneous screw fixation for unstable injuries on stress radiographs in subtle injuries of Lisfranc joint. Materials and Methods: From June 1997 to March 2003, 6 cases of unstable injuries on stress radiograph in subtle injuries of Lisfranc joint were treated by percutaneous cannulated screw fixation after closed reduction. All cases were injuried by indirect force (twisting injury). The average diastasis between the 1st and 2nd metatarsal base was 3 mm (2-4 mm) on initial nonweight bearing AP radiograph. The average follow-up period was 20 months. Clinical evaluation was assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score. Results: The AOFAS midfoot score was average 86 (80-90) points. The average diastasis between 1st and 2nd metatarsal base was 2 mm (1-3 mm) on weight bearing AP radiograph in final follow up. The final diastasis was increased slightly than diastasis in initial postoperative radiographs. But the clinical results were good. There was no correlation between the degree of diastasis and the clinical results. On weight bearing lateral radiograph, the average difference with normal foot in the distance between plantar aspect of 5th metatarsus and medial cuneiform was 2 mm (0-3 mm). One case had mild arthritic change on the radiographs. Conclusion: When the Lisfranc injuries, especially in the subtle injuries were suspicious, the stress views are helpful to assess stability of the Lisfranc injuries and planning of treatment. For unstable injuries on stress radiographs in subtle injuries of Lisfranc joint, closed reduction and percutaneous screw fixation is useful method to expect good clinical results.

• Korean Journal of Radiology
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• v.24 no.5
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• pp.406-423
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• 2023

Diagnosing bowel and mesenteric trauma poses a significant challenge to radiologists. Although these injuries are relatively rare, immediate laparotomy may be indicated when they occur. Delayed diagnosis and treatment are associated with increased morbidity and mortality; therefore, timely and accurate management is essential. Additionally, employing strategies to differentiate between major injuries requiring surgical intervention and minor injuries considered manageable via non-operative management is important. Bowel and mesenteric injuries are among the most frequently overlooked injuries on trauma abdominal computed tomography (CT), with up to 40% of confirmed surgical bowel and mesenteric injuries not reported prior to operative treatment. This high percentage of falsely negative preoperative diagnoses may be due to several factors, including the relative rarity of these injuries, subtle and non-specific appearances on CT, and limited awareness of the injuries among radiologists. To improve the awareness and diagnosis of bowel and mesenteric injuries, this article provides an overview of the injuries most often encountered, imaging evaluation, CT appearances, and diagnostic pearls and pitfalls. Enhanced diagnostic imaging awareness will improve the preoperative diagnostic yield, which will save time, money, and lives.

• Journal of Yeungnam Medical Science
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• v.38 no.4
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• pp.289-307
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• 2021

Avulsion injuries result from the application of a tensile force to a musculoskeletal unit or ligament. Although injuries tend to occur more commonly in skeletally immature populations due to the weakness of their apophysis, adults may also be subject to avulsion fractures, particularly those with osteoporotic bones. The most common sites of avulsion injuries in adolescents and children are apophyses of the pelvis and knee. In adults, avulsion injuries commonly occur within the tendon due to underlying degeneration or tendinosis. However, any location can be involved in avulsion injuries. Radiography is the first imaging modality to diagnose avulsion injury, although advanced imaging modalities are occasionally required to identify subtle lesions or to fully delineate the extent of the injury. Ultrasonography has a high spatial resolution with a dynamic assessment potential and allows the comparison of a bone avulsion with the opposite side. Computed tomography is more sensitive for depicting a tiny osseous fragment located adjacent to the expected attachment site of a ligament, tendon, or capsule. Moreover, magnetic resonance imaging is the best imaging modality for the evaluation of soft tissue abnormalities, especially the affected muscles, tendons, and ligaments. Acute avulsion injuries usually manifest as avulsed bone fragments. In contrast, chronic injuries can easily mimic other disease processes, such as infections or neoplasms. Therefore, recognizing the vulnerable sites and characteristic imaging features of avulsion fractures would be helpful in ensuring accurate diagnosis and appropriate patient management. To this end, familiarity with musculoskeletal anatomy and mechanism of injury is necessary.

• Journal of Trauma and Injury
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• v.37 no.3
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• pp.243-246
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• 2024

Traumatic ureteral injuries account for fewer than 1% of traumatic urologic injuries, and those caused by blunt trauma are even rarer than those caused by penetrating trauma. The symptoms associated with ureteral injury may be subtle, with or without hematuria, making it difficult to diagnose. We report the case of a 31-year-old man with a delayed diagnosis of proximal ureter injury after abdominal blunt trauma sustained in a motorcycle traffic accident. The patient underwent emergency laparotomy on admission for liver injury, mesenteric injury, and resultant hemoperitoneum. On postoperative day 6, he underwent angioembolization for suspected remnant intra-abdominal bleeding. Persistent symptoms of flank pain and leukocytosis led to follow-up imaging studies that revealed proximal ureter injury, and the patient underwent unilateral nephrectomy. This case stresses the importance of clinical suspicion for genitourinary injuries in the presence of abdominal trauma.

• Journal of the Korean Medical Association
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• v.61 no.12
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• pp.724-731
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• 2018

Our faces can express a remarkable range of subtle emotions and silent messages. Because the face is so essential for complex social interactions that are part of our everyday lives, aesthetic repair and restoration of function are an important tasks that we must not take lightly. Soft-tissue defects occur in trauma patients and require thorough evaluation, planning, and surgical treatment to achieve optimal functional and aesthetic outcomes, while minimizing the risk of complications. Recognizing the full nature of the injury and developing a logical treatment plan help determine whether there will be future aesthetic or functional deformities. Proper classification of the wound enables appropriate treatment, and helps predict the postoperative appearance and function. Comprehensive care of trauma patients requires a diverse breadth of skills, beginning with an initial evaluation, followed by resuscitation. Traditionally, facial defects have been managed with closure or grafting, and prosthetic obturators. Sometimes, however, large defects cannot be closed using simple methods. Such cases, which involve exposure of critical structures, bone, joint spaces, and neurovascular structures, requires more complex treatment. We reviewed and classified causes of significant trauma resulting in facial injuries that were reconstructed by microsurgical techniques without simple sutures or coverage with partial flaps. A local flap is a good choice for reconstruction, but large defects are hard to cover with a local flap alone. Early microsurgical reconstruction of a large facial defect is an excellent choice for aesthetic and functional outcomes.

• Journal of Korean Society for Atmospheric Environment
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• v.2 no.3
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• pp.1-10
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• 1986

Nowadays, air pollution by increasing consumption of fossil fuels resulting from rapidly growing population and industrialization has caused the adverse effects on terrestrial ecosystems and become one of the most serious problems causing environmental discriptions. Air pollution such as $SO_2, HF, NO_X,$ fly ash, ozone and PAN might influence plant growth, reproduction, nutrient cycling, photosynthesis and predisposition to entomological and pathological stresses on plants. Furthermore, accumulation of those toxic substances in forests might cause subtle or serious changes in the structure and function of forest ecosystems. Since 1970s, a number of large industrial complexes had been constructed as a part of industrialization plan in Korea. Accordingly, the forest exosystems around them has been under chronic influences of air pollution and effects of air pollution on plants became a matter of concern. In Yocheon Industrial Complex which consisted of lots of petrochemical plants and a phosphatic fertilizer manufacturing plant, forests has been exposed to chronic air pollution, mainly HF and $SO_2$ gas, Various reports were available to investigate the potential effects of air pollution on crops and forest trees in Yocheon. Kim and Kim surveyed vegetation by naked eye method and reported 71 families, 150 genera and 158 species were growing within a 2 km from air pollution sources in 1981. Needle injuries on Pinus spp. in the polluted area water reported by Kim, et al. and Kim, et al. Kim, et al. investigated the primary production of Pinus thunbergii forests in the polluted area and verified that growth inhibition of Pinus thunbergii was attributable to air pollution. Thus, previous reports suggested that forest ecosystems around Yocheon Industrial Complex were influenced adversely by air pollution. The objective of this study was to investigate the subtle ecological changes in forest community exposed to chronic air pollution in Yocheon.

• Safety and Health at Work
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• v.3 no.4
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• pp.278-286
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• 2012

Objectives: Authors investigated the pattern of the rate of occupational injuries and illnesses (ROII) at the level of enterprises in order to build a network for exchange of experience and knowledge, which would contribute to workers' safety and health through safety climate of workplace. Methods: Occupational accidents were analyzed at the manufacturing work site unit. A two step clustering process for the past patterns regarding the ROII from 2001 to 2009 was investigated. The ROII patterns were categorized based on regression analysis and the patterns were further divided according to the subtle changes with Mahalanobis distance and Ward's linkage. Results: The first clustering of ROII through regression analysis showed 5 different functions; 29 work sites of the linear function, 50 sites of the quadratic function, 95 sites of the logarithm function, 62 sites of the exponential function, and 54 sites of the sine function. Fourteen clusters were created in the second clustering. There were 3 clusters in each function categorized in the first clustering except for sine function. Each cluster consisted of the work sites with similar ROII patterns, which had unique characteristics. Conclusion: The five different patterns of ROII suggest that tailored management activities should be applied to every work site. Based on these differences, the authors selected exemplary work sites and built a network to help the work sites to share information on safety climate and accident prevention measures. The causes of different patterns of ROII, building network and evaluation of this management model should be evaluated as future researches.

• Korean Journal of Radiology
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• v.2 no.4
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• pp.216-221
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• 2001

Objective: To compare, in terms of their demonstration of tears of the anterior glenoid labrum, oblique axial MR arthrography obtained with the patient's shoulder in the abduction and external rotation (ABER) position, with conventional axial MR arthrography obtained with the patient's arm in the neutral position. Materials and Methods: MR arthrography of the shoulder, including additional oblique axial sequences with the patient in the ABER position, was performed in 30 patients with a clinical history of recurrent anterior shoulder dislocation. The degree of anterior glenoid labral tear or defect was evaluated in both the conventional axial and the ABER position by two radiologists. Decisions were reached by consensus, and a three-point scale was used: grade 1=normal; grade 2=probable tear, diagnosed when subtle increased signal intensity in the labrum was apparent; grade 3=definite tear/defect, when a contrast material-filled gap between the labrum and the glenoid rim or deficient labrum was present. The scores for each imaging sequence were averaged and to compare conventional axial and ABER position scans, Student's t test was performed. Results: In 21 (70%) of 30 patients, the same degree of anterior instability was revealed by both imaging sequences. Eight (27%) had a lower grade in the axial position than in the ABER position, while one (3%) had a higher grade in the axial position. Three whose axial scan was grade 1 showed only equivocal evidence of tearing, but their ABER-position scan, in which a contrast material-filled gap between the labrum and the glenoid rim was present, was grade 3. The average grade was 2.5 (SD=0.73) for axial scans and 2.8 (SD=0.46) for the ABER position. The difference between axial and ABER-position scans was statistically significant (p<0.05). Conclusion: MR arthrography with the patient's shoulder in the ABER position is more efficient than conventional axial scanning in revealing the degree of tear or defect of the anterior glenoid labrum. When equivocal features are seen at conventional axial MR arthrography, oblique axial imaging in the ABER position is helpful.