• 대한족부족관절학회지
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• 제13권2호
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• pp.179-183
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• 2009

The triplane fracture has been described as a fracture of the distal tibial epiphysis occurring across three planes-sagittal, transverse and coronal. The characteristic pattern of fusion of distal tibial epiphysis explains the special configuration of the fragments in the triplane fracture. According to Dias-Tachdjian classification, triplane fracture is classified two part fracture, three part fracture, four part fracture and two part fracture with extension to the medial malleolus. Among four types, two part triplane fracture with extension to the medial malleolus is a relatively rare injury and generally is not treated by closed reduction. Such fractures should have an anatomic reduction and adequate fixation to restore the joint congruity and obtain an anatomic reduction of the growth plate to prevent a future growth deformity. This is usually best accomplished with an open reduction and screw fixation or k-wire fixation. We experienced two part triplane fracture with extension to medial malleolus and check the CT to define the extent of the injury completely. And then we underwent open reduction and screw fixation for the fracture. As a result, we present four cases of two part triplane fracture with extension with review of related literatures.

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.198-204
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• 1998

Unstable fractures of the proximal humerus continue to be difficult problems for orthopaedic surgeons. The optimum treatment of these fractures has remained a matter of controversy. We analyzed the clinical results of open reduction and plate fixation underwent for patients of unstable fractures of proximal humerus after minimum 12 months follow up. The purpose of this study is to evaluate the efficacy of open reduction and rigid plate fixation. Twenty-two patients were managed with open reduction and plate fixation. Mean follow up duration was 20.6 months(range, 12 to 28 mon.). Because the age of patient as a maker of degree of osteoporosis was considered the key factor in the success of anatomic reconstruction, we divided into two groups according to age. Group A was comprised of 12 cases with younger than 50 yrs of age. Ten cases of older than 50 yrs of age were Group B. According to Neer's classification, five cases(22%) were two part fracture, 12 cases(64%) were three part fracture, and three cases(14%) were four part fracture. We used the Neer rating system for evaluating the results. In Group A, overall scores were 79.1. In Group B, overall scores were 76.8. Overall scores in two part fracture were 85, overall scores in three part fracture 78.4 and overall scores in three part fracture 68.3. We achieved excellent or good results in nine cases(75%) of Group A and seven cases(70%) of Group B. Also, we obtained excellent or good results in all cases of two part fracture, ten cases(71%) of three fracture and one case(33%) of four part fracture. The complications were three metal loosening, one avascular necrosis of humeral head, one severe stiff shoulder, one superficial wound infection and one ectopic ossification. The results were excellent or good in 16 cases(73%) out of 22 cases. In conclusion, rigid fixation and supervised early exercise would be a good option for unstable fracture of the proximal humerus.

• Clinics in Shoulder and Elbow
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• 제3권1호
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• pp.20-25
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• 2000

Purpose : To evaluate functional results and study factors influencing results after humeral hemiarthroplasty for comminuted fractures of the proximal humerus. Materials and Methods: We reviewed 12 patients with average follow-up period of 23 months(12 to 42). The proximal humeral fractures consisted of one anatomical neck fracture, five three-part and six four-part fractures or fracture-dislocations. Constant score and Compito et al' evaluation system were used for clinical assessment. Statistical analysis was done with the Wilcoxon test. Results: Six cases of anatomical neck, three-part fractures or fracture-dislocations showed 61 points on the average Constant score and three unsatisfactory results on the Compito et al' evaluation; Six of four-part fractures or fracture-dislocations showed 51 points and three unsatisfactory results. There were 59(two unsatisfactory) for five non-associated dislocation and 53(four unsatistactory) for seven associated dislocation; 66(one unsatisfactory) for three under 60 years and 41(five unsatisfactory) for nine over 60 years; 67(two unsatisfactory) for seven tuberosity union and 41(four unsatisfactory) for five tuberosity non-union or resorption; 58(four unsatisfactory) for ten early operation within two weeks and 43(all unsatisfactory) for two delayed operation; and 18(unsatisfactory) for one case of a accompanied rotator cuff tear. Conclusion: We concluded that tuberosity union was important factor influencing the results. Also, we thought that age, timing of operation and accompanied rotator cuff tear could be influenced to results.

• Clinics in Shoulder and Elbow
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• 제9권2호
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• pp.169-175
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• 2006

Purpose: The purpose of this study was to evaluate the usefullness of polarus nailing in the treatment of proximal humerus fractures including 2 part, 3 part and proximal comminuted fractures. Materials and methods: Fifteen cases of proximal humerus fracture treated with Polarus nailing from March, 2002 to March, 2004 were selected. Man was 3 cases, and woman was 11 cases. There were one case of follow up loss due to decease. Average age was 60 years old (range, 23 to 84), and there were 6 cases of 2 part fracture, 3 cases of proximal segmental fracture, 5 cases of 3 part fracture. We analyzed the outcom results between 2 part fracture and 3 part fracture. The average follow up period after the operation was 1.5(range, 1 to 2) years. Range of motion (ROM), pain and functional outcome were evaluated by visual analogue scale(VAS) and american shoulder and elbow surgery (ASES) activity of daily living (ADL) functional scoring system. Results: All cases showed union on radiologic evaluation, with 2.3 months follow up. In 5 cases of 3 part fracture, average union time was 1.9 months regardless of proximal screw loosening in 4 cases. In 2 part fracture union time was 2.2 months (P>0.05). VAS pain score was 1.3, ROM was $160^{\circ}$ in forward flexion, $40^{\circ}$ in external rotation, L3 level in internal rotation, and ASES, ADL functional score was 21 in 2 part fracture. VAS pain score was 1.25, ROM was $160^{\circ}$, $43^{\circ}$ and L1 level, and ASES, ADL functional score was 21 in 3 part fracture. There were no statistically significant difference between two groups (P>0.05) VAS pain score was 1.6, ROM was $170^{\circ}$, $47^{\circ}$ and L3 level, and ASES, ADL functional score was 23 in proximal comminuted fracture. Conclusion: Polarus nailing could be used as an effective modality in certain cases of proximal humeral fracture including 2 part, proximal segmental and in cases of 3 part fractures with large greater tuberosity fragment.

• Clinics in Shoulder and Elbow
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• 제6권2호
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• pp.149-160
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• 2003

Purpose: to determine the results after open intramedullary nailing and tension band suture technique in proximal humerus fracture for improving the stability and decreasing the complications. Materials and Method: Authors reviewed 27 patients treated by open intramedullary nailing and tension band suture technique. Mean follow-up period was 39 months (24-59months). Surgical neck fracture were 6 cases, surgical neck fracture with shaft fracture were 3 cases, three part fracture with greater tuberosity fracture were 17 cases, four part fracture was 1 case and fracture and dislocation were 2 cases Results: We got the bony union in 26 cases. Average pain scale was 1 point (0-6), Neer score was 86 point(45-99) and ASES score was 85 point(40-100). We separate all cases in two groups based on age (65 years), L-spine t-score (-2.5) and Neer classification (2 and 3 part). There is no significance in pain scale, Neer score and ASES score between each group. Conclusion: As a method of surgical treatment on severe proximal humeral fractures, we recommend intramedullary nailing and tension band suture technique and it may have particular advantages in early exercise and satisfactory functional outcome.

• 대한기계학회:학술대회논문집
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• 대한기계학회 2004년도 추계학술대회
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• pp.262-267
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• 2004

The unloading compliance method is the most commonly used method to evaluate the fracture resistance characteristics of a material. In dynamic loading condition, the direct current potential drop(DCPD) method has been used because the unloading compliance method can not be applied due to the discontinuity of loading. However, even in the dynamic test using DCPD method, there is a problem that the voltage drops sharply on the initiation of crack. For the reason metioned above, the normalization method was suggested on ASTM E 1820 which is revised recently, as a new method to evaluate the dynamic fracture resistance characteristic. The nomalization method can be used to obtain a fracture resistance curve directly from a load-load line displacement. In this study, we obtained two fracture resistance curves from static test of welding part of nuclear piping both by unloading compliance and nomalization method. The two curves were almost same each other, so the adaptability of the nomalization method has been proved. We conducted a dynamic fracture resistance test for the same material. The fracture resistance curve from the dynamic test was obtained by normalization method and compared to that of the static test result.

• 한국해양공학회지
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• 제29권6호
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• pp.454-462
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• 2015

An extended study was conducted on the fracture criterion by Choung et al. (2011; 2012) and Choung and Nam (2013), and the results are presented in two parts. The theoretical background of the fracture and the results of new experimental studies were reported in Part I, and three-dimensional fracture surface formulations and verifications are reported in Part II. How the corrected true stress can be processed from the extrapolated true stress is first introduced. Numerical simulations using the corrected true stress were conducted for pure shear, shear-tension, and pure compression tests. The numerical results perfectly coincided with test results, except for the pure shear simulations, where volume locking appeared to prevent a load reduction. The average stress triaxialities, average normalized lode parameters, and equivalent plastic strain at fracture initiation were extracted from numerical simulations to formulate a new three-dimensional fracture strain surface. A series of extra tests with asymmetric notch specimens was performed to check the validity of the newly developed fracture strain surface. Then, a new user-subroutine was developed to calculate and transfer the two fracture parameters to commercial finite element code. Simulation results based on the user-subroutine were in good agreement with the test results.

• 대한기계학회논문집A
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• 제31권2호
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• pp.166-173
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• 2007

Fatigue fracture behavior of a hybrid bolted joint was evaluated in comparison to the case of static fracture. Two kinds of specimens were fabricated for the mechanical tests; a hybrid bolted joint specimen for the shear test and a hybrid joint part specimen applied in the real tilting car body for the bending test. Characteristic fracture behaviors of those specimens under cyclic toads were obviously different from the case under static loads. For the hybrid bolted joint specimen, static shear loading caused the fracture of the bolt body itself in a pure shear mode, whereas cyclic shear loading brought about the fracture at the site of local tensile stress concentration. For the hybrid joint part specimen, static bend loading caused the shear deformation and fracture in the honeycomb core region, while cyclic bend loading did the delamination along the interface between composite skin and honeycomb core layers as well as the fracture of welded joint part. Experimental results obtained by static and fatigue tests were reflected in modifications of design parameters of the hybrid joint structure in the real tilting car body.

• 한국전산구조공학회:학술대회논문집
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• 한국전산구조공학회 1995년도 봄 학술발표회 논문집
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• pp.35-41
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• 1995

Fracture Mechanics does work for concrete, provided that a finite nonlinear zone at fracture front is being considered. The development of model for fracture process zone is most important to describe fracture phenomena in concrete. The fracture process zone is a region ahead of a traction-free crack, in which two major mechanisms, microcracking and bridging, play important rules. The toughness due to bridging is dominant compared to toughness induced by microcracking, so that the bridging is dominant mechanism governing the fracture process of concrete. In this paper the bridging zone, which is a part of extended macrocrack with stresses transmitted by aggregates in concrete, is model led by a Dugdale-Barenblatt type model with linear tension-softening curve. Two finite element techniques are shown for the model of fracture process zone in concrete.

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.205-211
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• 1998

저자들은 상완골 근위부의 골절탈구로 일차성 견관절 반치환술로 치료받은 환자 25례중 14례를 대상으로 치료결과를 분석하여 다음과 같은 결론을 얻었다. 1. 전례에서 동통은 소실되거나 완화되었으나 Neer의 평가에 따라 총 14례중 5례에서만 만족할만 한 결과를 믿었으며 나머지 9례에서는 불만족한 결과를 보였다. 2. 수상시 상완곤두의 분쇄상이 심하거나, 수술이 지연되어 골편치 연화가 심한 경우 상완골 길이와 humeral offset의 유지가 힘들었으며, 견관절 반치환술 시팽한 측이 정상측보다 1cm 이상 단축을 보인 경우가 5례였으며 이 경우 능동적 견관절 운동범위가 정상측보다 감소되었다. 3. 견관절 반치환술은 분쇄상 상완골 근위부 골절에서 사용되어지며 동통의 감소와 기능의 호전은 있으나 완전한 회복은 어려우며 수술시 연부조직 손상이 적고 적당한 후염각, 결절의 재건 과 회전근개의 수복은 필수적이다. humeral offset과 길이의 유지는 술 후 능동적 견관절 운동 범위의 향상에 영향을 미치며 아울러 환자의 협조하에 체계적인 재활운동이 필요할 것으로 사료된다.