• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.79-83
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• 2009

Purpose: Avulsion injuries of digits have been presented for a long time as complex management problems. Despite of microsurgical advances, it is difficult to achieve good functional results and their management remains somewhat controversial. However, in a finger there are three transverse digital palmar arches. The middle and distal transverse digital palmar arches are consistently large(almost 1 mm) and may be used for arterial vessel repairs either proximally or distally, depending on the length and direction needed. 39-year-old man presented with avulsion amputation of the ulnar three digits, was operated using only arterial anastomosis with rerouting the transverse digital palmar arches. Methods: Replantation was performed using the artery-only technique. Because the digital arteries had been damaged, we did that the transverse digital palmar arches were transposed in an inverted Y to I configuration and were lengthened with rerouting them for the purpose of direct anastomosis of the digital artery. Venous drainage was provided by an external bleeding method with partial nail excision and external heparin irrigation. Results: The authors conclude that complete avulsion amputations with only soft tissue at the distal to insertion of the flexor digitorum superficialis tendon were salvageable with acceptable functional results. All three fingers survived. Conclusion: With technical advancements, the transverse digital palmar arches play an important role for finger amputation. Three digital palmar arches give us additional treatment option for the finger amputation. In this case, replantation with only-arterial anastomosis was successful and we obtained good aesthetic and functional outcome.

• Archives of Reconstructive Microsurgery
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• v.22 no.1
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• pp.24-28
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• 2013

Purpose: Soft tissue defect of the hand, which cannot be covered with skin graft or local flap, is usually reconstructed using a free flap. Temporoparietal fascial free flap is one of the best alternatives for functional reconstruction of the hand with exposed tendons, bones, and joints. Materials and Methods: We have experienced four cases of reconstruction using a temporoparietal fascial flap with a skin graft and followed up for 20 years. We conducted a retrospective review of the patients' clinical charts and photos. Results: At the time of initial injury, the average age of patients was 50.3 (39~62) years. The radial artery was used for reconstruction of the dorsal side of the hand, whereas the ulnar artery was used for that of the volar side of the wrist. Short term complication such as skin graft loss and donor site alopecia occurred. However, during the long term follow-up period, no change of flap volume was noted, and full range of motion in the adjacent joint was maintained. In addition, hyperpigmentation of the grafted skin on the flap disappeared gradually. Conclusion: Selection of the optimal flap is important for reconstruction of the hand without functional limitation. We obtained satisfactory soft tissue coverage and functional outcomes using a temporoparietal fascial free flap and followed up for 20 years.

• Archives of Plastic Surgery
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• v.47 no.2
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• pp.187-193
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• 2020

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.

• The korean journal of orthodontics
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• v.15 no.2
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• pp.197-209
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• 1985

To investigate the relationship between the pubertal spurt in body height and bone maturity of the hand-and-wrist in normal occlusion, the author X-rayed the hand-and-wrists of 1,141 students (male 614, female 527) and assessed their bone maturity. In this study, eleven skeletal stages were selected. The bones used to determine skeletal maturity were the ulnar sesamoid of the metacarpophalangeal joint of the first finger, the epiphyses of the proximal, middle, distal phalanges of the third finger, and middle phalanx of the fifth finger, and distal epiphysis of the radius. From the longitudinal data for height, an assessment was made of the change in growth velocity. The pubertal growth stage was divided into onset and peak height velocity phases. The results were as follows; 1. The onset of the pubertal growth was between the $PP_3=\;and\;MP_3=$ stage for boys, and between the $MP_3=\;and\;MP_5=$ stage for girls; the mean age of onset was 10.6 years for boys and 9.0 years for girls. 2. The peak height velocity was between the S and $MP_{3_{cap}}$ stage for boys, and between the $MP_{3_{cap}}$ and $MP_{5_{cap}}$ stage for girls; the mom age of peak height velocity was 12.5 years for boys and 10.9 years for girls. 3. As the stages of bone maturity progressed from $DP_{3u},\;to\;PP_{3u},\;MP_{3u}$, Ru, the peak height velocity had been reached, and the growth rate retarded, therefore the approach to full physical maturity was attained. 4. The evidence for the period of onset, peak height velocity and bone maturation suggested that girls were in advance of boys. During the latter part of pubertal growth, the rate of boys' bone maturation was faster than that of girls'.

• PNF and Movement
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• v.17 no.3
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• pp.379-389
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• 2019

Purpose: This study examined the effects of wheelchair handle directions on the trunk muscle activity of adult males when climbing ramps. It also evaluated the wheelchair attendant's physical discomfort during tasks. Methods: Healthy males aged over 20 years were chosen and the direction of wheelchair handle grip was randomly selected. The grips included a general grip with ulnar deviation, a medial grip with wrist pronation, and a neutral grip with a neutral wrist. The trunk muscle activity was measured using surface electromyography. Furthermore, the physical discomfort of wheelchair attendants was subjectively evaluated using the Borg CR-10 Scale, which rates the perceived exertion. In addition, the SPSS 18.0 program was used perform repeated measure ANOVA to compare muscle activity and subjective discomfort during the interventions. The contrast test was also conducted with a significance level (α) of 0.05. Results: There was significant difference between the general grip and the medial grip in the rhomboid major muscle and the lumbar erector spinae muscle (p<0.05). In addition, there was significant difference between the general grip and the neutral grip in the rhomboid major muscle and the lumbar erector spinae muscle (p<0.05). Further, there was significant difference between the general grip and the neutral grip in subjective discomfort (p<0.05). Conclusion: In this study, adult male trunk muscle activity and subjective discomfort were lowest when using the neutral grip while climbing ramps. Accordingly, we suggest that neutral grips will help improve the function of the musculoskeletal system and reduce the subjective discomfort by putting less strain on the trunk muscles and maximizing efficiency with less force.

• Annals of Clinical Neurophysiology
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• v.16 no.1
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• pp.8-14
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• 2014

Background: Early detection of neuropathy may prevent further progression of this complication in the diabetic patients. The purpose of this study was to evaluate the prevalence of early neuropathic complication in patients with newly diagnosed type 1 and type 2 diabetes. Methods: Nerve conduction studies (median, ulnar, posterior tibial, peroneal, and sural nerves) were performed for 49 type 1 (27 males, mean $14.1{\pm}7.5$ years) and 40 type 2 (27 males, $42.0{\pm}14.1$ years) diabetic patients at onset of diabetes. Children with age at onset under 4 years and adults over 55 years were excluded to eliminate the aging effect and the influence of obstructive arteriosclerosis. Neuropathy was defined as abnormal nerve conduction findings in two or more nerves including the sural nerve. Results: Mean HbA1c level was $12.6{\pm}3.3%$ for type 1 and $10.5{\pm}2.9%$ for type 2 diabetes. The prevalence of neuropathy was 12.2% for type 1, and 35.0% for type 2 diabetes, respectively. There were significant trends in the prevalence of neuropathy with increasing age (p<0.05). The effect of the mean level of glycosylated hemoglobin on the prevalence of polyneuropathy at onset of diabetes was borderline (p=0.0532). Neither sex of the patients nor the type of diabetes affected the neurophysiologic abnormalities at the diagnosis. Conclusions: Even in a population with diabetes at the diagnosis, the prevalence of subclinical neuropathy was not low. Neuropathy has been significantly associated with increasing age indicating the possibility of longer duration of undetected diabetes among them, especially in type 2 diabetes.

• Journal of the Korean Society of Clothing and Textiles
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• v.31 no.7
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• pp.1008-1019
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• 2007

The purpose of this study was to develop an appropriate jacket pattern for elderly women over sixty years old, providing a good fit and appearance. Results were as follows: The length of the jacket was made long enough to cover the area 22.0cm below the waistline. The waist back length was made 1.7cm longer than the actual size of the waist back length. The armhole length was made 0.5cm longer than B/4, enhacing the appearance and functionality while allowing freer movement of the arms. As for the front and back interscye breadths, the front interscye breadth was made 1.7cm larger than the actual size while the back interscye breadth was only 1.0cm larger, providing the front interscye breadth more space. The bust breadth was made 10.0cm larger than the bust circumference measure(B/4+2.5cm), the waist breadth was made 6.0cm larger than the waist circumference measure(W/4+1.5cm), The hip breadth was made 12.0cm larger than the him circumference measure(H/4+3.0cm). The sleeve length was made 3.0cm larger than the arm length measure, as the sleeve length of a jacket is usually long enough to cover the ulnar styloid. The sleeve width was made 5.0cm larger than the upper arm circumference measure, as the upper arm circumference measure of the model pattern was too large than necessary, worsening the overall appearance. The sleeve cap height was set at AH/4+4.7cm. The wrist circumference of 27.0cm was set, allowing 2/3 and 1/3 for the large sleeve and small sleeve respectively.

• Korean Journal of Applied Biomechanics
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• v.28 no.1
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• pp.55-60
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• 2018

Objective: This study aimed to analyze the effects of computer game exposure on pathological musculoskeletal symptoms in adolescents. Method: This study included 10 male junior high school students who used computers less than 3 times a week for 1 hr per day. The subjects were asked to play computer games for 4 hr. Magnetic resonance imaging of the hand and wrist, from the distal radius and ulnar head to the distal phalanges, and radiography of the cervical vertebrae were performed before and after playing computer games. For each dependent variable, a paired t-test was performed to identify significant changes before and after a 4-hr active computer game (p<.05). Results: The horizontal diameters of the flexor tendons in the index and middle fingers were significantly reduced after playing computer games. The horizontal diameters of the flexor tendons of other fingers did not show any significant differences, but there was a tendency toward a decrease after playing computer games. There was no significant change in the cervical lordosis angle before and after playing computer games. However, the cervical lordosis angle was relatively decreased. Conclusion: The results of this study showed that computer game exposure had direct and indirect effects on morphological changes of flexor tendons. In addition, playing computer games for long periods of time can have a negative effect on normal functioning of the musculoskeletal system, with the possible development of abnormalities. However, computer game exposure in adolescents cannot be decisively identified as a factor causing pathological symptoms, based on the results of this study alone. Thus, longterm longitudinal studies on the overall musculoskeletal system are necessary.

• Journal of Trauma and Injury
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• v.27 no.3
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• pp.57-62
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• 2014

Purpose: A hamate body coronal fracture is well known as a very rare fracture in the carpal bones and is also hard to diagnose in initial stage due to the bone's architecture. We report our experience in treatment of such a fracture, and we present a review of the relevant literatures. Methods: Four patients who experienced hamate body coronal fractures from October 2006 to October 2013 were enrolled in this study. One patient also had an associated Capitate fracture, and two patients had associated dislocations of the $4^{th}$ metacarpal joint. We performed open reduction and mini-screw fixation on the four patients. In addition, a K-wire was fixed for the two patients with dislocations. Results: The average follow-up period was 24.5 months after surgery, and bone union was observed at the $8^{th}$ week after surgery. We confirmed that bone union had been completed for all the patients, and functional tests showed that joint motion was in the normal range without complications. Conclusion: When a patient has consistent pain on the ulnar side of the wrist, a hamate fracture should be suspected. Computer tomography is better than a simple X-ray scan for confirming the diagnosis of a hamate body coronal fracture. An open reduction and mini-screw fixation led to a good result.

• Journal of Physiology & Pathology in Korean Medicine
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• v.25 no.2
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• pp.217-226
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• 2011

The aim of this study is to identify central neural pathway of neurons following the projection to the large intestine and Hapgok(LI4) which is Won acupoint of the large intestine meridian of hand-yangmyeong. In this experiment, Bartha's strain of pseudorabies virus was used to trace central localization of neurons related with large intestine and acupoint(LI4) which has been known to be able to regulate intestinal function. The animals were divided into 3 groups: group 1, injected into the large intestine; group 2, injected into the acupoint(LI4); group 3, injected into the acupoint(LI4) after severing the radial, ulnar, median nerve. After four days survival of rats, PRV labeled neurons were identified in the spinal cord and brain by immunohistochemical method. First-order PRV labeled neurons following the projection to large intestine, acupoint(LI4) and acupoint(LI4) after cutting nerve were found in the cervical, thoracic, lumbar and sacral spinal cord. Commonly labeled neurons were labeled in the lumbosacral spinal cord and thoracic spinal cord. They were found in lamina V- X, intermediomedial nucleus and dorsal column area. The area of sensory neurons projecting was L5-S2 spinal ganglia and T12-L1 spinal ganglia, respectively. In the brainstem, the neurons were labeled most evidently and consistently in the nucleus tractus solitarius, area postrema, dorsal motor nucleus of vagus nerve, reticular nucleus, raphe nuclei(obscurus, magnus and pallidus), C3 adrenalin cells, parapyramidal area(lateral paragigantocellular nucleus), locus coeruleus, subcoeruleus nucleus, A5 cell group, periaqueductal gray matter. In the diencephalon, PRV labeled neurons were marked mostly in the arcuate nucleus and median eminence. These results suggest that overlapped CNS locations are related with autonomic nuclei which regulate the functions of large intestine-related organs and it was revealed by tracing PRV labeled neurons projecting large intestine and related acupoint(LI4).