• 대한족부족관절학회지
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• 제1권1호
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• pp.51-58
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• 1997

The purpose of this study is to evalute the efficacy af the Ilizarov external fixation for the surgical treatment. of the tibial plafond fractures. We reviewed retrospectively fourteen cases of tibial plafond fractures with moderate to severe soft. tissue damage, which were fixed with Ilizarov external fixator. Using the AO Muler classification, there were four Type C1 fractures, six Type C2 and four Type C3. In most, of the cases, the ankles were operated on with other associated fractures within a few days after injury. We reduced the fracture indirectly by soft issue taxis and fixed externally across the ankle joint. using the circular external fixator with tensioned wires and ankle hinge. In cases of inadequate closed reduction, we applied limited open reduction and internal fixation. Range of motion exercise began immediately. Postoperative follow-up averaged fourteen months (ranges, 8-30 months). Overall clinical results rated good or excellent in 7 cases, fair in 4 and poor in 3. There were three cases of pin tract infection which were resolved with short-term antibiotics and local care; one delayed wound closure in a patient. whose fracture was associated with Type III open wound; one wound slough in a patient associated with Type II open wound, which was closed later by skin graft; and one osteoarthritis. From this review, we concluded that cross-ankle circular external fixation with tensioned wires with or without. limited open reduction is a reasonable alternative for the treatment of the tibial plafond fractures with severe soft tissue damage.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.58-64
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• 2006

Purpose: Management of soft-tissue defect after open tibial fractures includes immediate and repeated debridement, skeletal stabilization, and early soft-tissue coverage with muscle flaps. The purpose of this study was to evaluate the outcome of the free rectus abdominis muscle flap (RA flap) for treatment of open fractures of the tibia and to discuss its advantages compared with the latissimus dorsi muscle flap (LD flap) in poly trauma patients. Materials and Methods: We performed a retrospective review of 5 patients who had a severe (Gustilo IIIb or IIIc) open fracture of the tibia treated with RA flap from May 2003 to March 2006. All were men, and the mean age was 46.6 years (range, $28{\sim}68$). Three patients had combined injuries such as pelvic bone fractures, multiple rib fractures with hemothorax, and contralateral tibial fracture. All patients received RA flap within 7 days after trauma except two with established chronic osteomyelitis. Results: All flaps survived, and there was no marginal flap necrosis. During the follow-up period, there was no evidence of persistent or recurrent osteomyelitis. The size of RA flap ranged from $8{\sim}20\;cm$ in length and $6{\sim}10\;cm$ in width. The average time required for RA flap elevation was 32 minutes, which is shorter than LD flap. Flap elevation could be done in supine position which is essential in poly trauma patients. Conclusion: Although a wide variety of options are available, RA flap is regarded as an optimal method for coverage of soft-tissue defect of the open tibial fracture in poly trauma patients. LD flap is reserved for large sized soft-tissue defect which cannot be covered by RA flap.

• 지질공학
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• 제27권4호
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• pp.463-474
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• 2017

본 연구는 화강암과 퇴적암지역에 위치하는 중저준위 경주방폐장의 불균질 배경 단열의 방향성, 밀도, 크기를 정량적으로 분석하였다. 불균질 배경 단열을 분석하기 위하여 지표지질조사, 전기비저항탐사, 공내 초음파주사검층 자료를 이용하였다. 연구지역 배경 단열의 정량화 분석을 위해서 부트스트랩 방법을 적용하였으며, 이에 의하여 위치에 따라 다양한 방향성을 가지는 단열들의 이방성을 합리적으로 특성화할 수 있었다. 단열 밀도는 단층 연장성을 고려한 단층거리의 역산값 및 전기비저항 평균값과 상관성을 보였으며, 평균 부피 단열 밀도($P_{32}$)는 $3.1m^2/m^3$로 나타났다. 중저준위 방폐물 처분 지하 사일로에서 측정된 단열과 지표 단층 정보에 의하면, 단열크기는 단열의 프랙탈 성질에 기초한 멱함수 법칙 분포에 따르며, 배경 단열의 반경은 1.5~86 m로 산정되었다.

• 터널과지하공간
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• 제12권4호
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• pp.312-320
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• 2002

암반 내 존재하는 절리는 전단응력에 의해 미끄러지는 전단변형 거동을 하며, 역학적 경계조건 및 절리면의 거칠기에 영향을 받는다. 이러한 경우, 절리의 전단변형과 거칠기에 의해 발생된 팽창으로 인해 간극분포가 변화한다. 또한, 절리는 유체 흐름의 경로가 되며, 간극분포 특성에 영향을 받는 것으로 알려져 있다. 따라서 본 연구에서는 절리의 전단변형 거동에 미치는 거 칠기의 영향 및 간극분포의 변화를 정량적으로 분석하여 절리의 수리학적 거동을 해석하고자 시도하였다. 이러한 절리의 수리-역학적 거동에 대한 이해를 향상시키기 위하여 절리면의 거칠기 변화가 절리의 전단변형 및 수리 지동에 미치는 영향을 분석하고자 하였다. 이를 위하여, 통계적 방법을 이용하여 절리를 발생하고, 이를 전단변형 거동과 수리학적 모델에 적용한 수치해석을 실시하였다 본 연구의 주요 결과로는, 절리의 거칠기가 감소하고 수직응력이 증가할수록 전단응력이 연성 거동으로 변하는 것으로 나타났다. 또한, 전단변형 후 절리의 간극분포는 절리면의 거칠기에 큰 영향을 받아 절리의 투수성 변화에 거칠기가 중요한 역할을 하는 것으로 나타났다. 마지막으로, 절리면의 거칠기가 증가할수록 전단변형에 의한 채널 현상의 붕괴가 조기에 발생하는 것으로 나타났다.

• 대한두개안면성형외과학회지
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• 제18권1호
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• pp.25-29
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• 2017

Background: Many authors have evaluated the post-reduction result of nasal bone fracture through patient satisfaction or postoperative complications. However, these results are limited because they are subjective. The aim of this study was to correlate an objective operation result with patient satisfaction and postoperative complications according to the type of nasal bone fractures. Methods: Our study included 313 patients who had isolated nasal bone fractures and had undergone a closed reduction. Postoperative outcomes were evaluated objectively using computed tomographic (CT) images, while patient satisfaction was evaluated one month after the operation. The correlation of the operation result with patient satisfaction was then evaluated. Results: The correlation between the operation result and patient satisfaction was highest for the lateral impact group type I (LI) type of fracture and lowest for the comminuted fracture group (C) type of fracture. However, there were no statistically significant differences in correlation between the overall result and patient satisfaction by fracture type. The complication rate of lateral impact group type II (LII), C, and frontal impact group type I (FI) fractures were statistically significantly higher than that of frontal impact group type II (FII) and LI fractures. There were no statistically significant relationships between the prevalence of complications and septal fracture or deviation according to the fracture type. In the total group, however, there was a statistically significant difference in complication rate by septal fracture. Conclusion: We found that the CT outcomes correlated with patient satisfaction. The complication rate of LII, C, and FI fractures were statistically significantly higher than that of FII and LI fractures. Septal fracture/deviation increased the postoperative complication in the total group.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권3호
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• pp.270-276
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• 2001

The treatment of mandibular subcondylar fractures is a matter of controversy. The majority of mandibular subcondylar fracture are treated by closed reduction, but the displaced or dislocated mandibular subcondylar fractures may be treated by open reduction. The characteristics of open reduction are the anatomical reduction, the functional restoration, the rapid function, the maintenance of vertical ramus dimension, the better appearance and the less resultant TMJ problem etc. When an open reduction is considered, the wire, miniplate, lag screw and Kirschner wire are available with internal fixation. Of these, Kirschner wire is a simple method relatively and correct positioning of the wire achieves rigid fixation. But many open reduction methods for mandibular subcondylar fractures require extraoral approach. The extraoral approach has some problems, the facial scar and the risk of facial nerve injury. On the other hand, the intraoral approach eliminates the potency of the facial scar and the facial nerve injury, but is difficult to access the operation site. Since the intraoral approach was first described by Silverman (1925), the intraoral approach to the mandibular condyle has been developed with modifications. The purpose of this article is to describe the intraoral technique with the Kirschner wire on mandibular subcondylar fractures. Conclusion : The intraoral reduction with Kirschner wire on mandubular subcondylar fractures avoids the facial scar and facial nerve injury and is simple method to the extraoral approach. And it has minimal morbidity and better esthetics.

• 대한족부족관절학회지
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• 제3권1호
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• pp.40-48
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• 1999

The neck of the talus is its most vulnerable and fragile segment, because of narrow diameter, devoid of hyaline padding and honeycombed internally by vascular channels etc. Talar neck fractures comprise 50% of all major to the talus. The majority occurs as a result of high-energy injuries, such as motor vehicle accidents or fall from a height. Anatomically, talar surface is covered mainly with articular cartilage and blood supply to the talus is very poor. So, complications, such as non-union, avascular necrosis and post traumatic arthritis, are frequent. The authors reviewed fourteen cases of talar neck fractures treated in our clinics from Jan. 1992 to Mar. 1997, and average follow-up period was over 15 months. The results obtained were as follows; 1. Patients' average age was 31.2 years. 2. The most common cause was traffic accident(9/14, 64%), and hyperdorsiflexion injury of the ankle was common mechanism of the fractures. 3. According to the modified Hawkins classification, type I was four cases, type II was nine cases, type III was one case and type IV was no case. 4. Hawkins sign of subcortical radiolucency was found in 64% (9/14) of the fractures. 5. Avascular necrosis was occurred in 21% (3/14) of the fractures(in two cases of type II fractures, and in one of type III). 6. According to the Hawkins criteria, four cases in type I, five in type II were an excellent result. Two cases, one in type II and one in type III were good result, and two in type II were fair. One in type II was poor result.

• 대한족부족관절학회지
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• 제12권2호
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• pp.185-188
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• 2008

Purpose: Zone I fractures of the fifth metatarsal bone can generally be treated by conservative methods while both surgical and conservative methods are used for zone II fractures. However, the clinical results of conservative treatment have been rarely reported. The purpose of this study is to report the clinical results of conservative treatment for zone I and II nondisplaced fractures. Materials and Methods: Between July 2007 and August 2008, consecutive thirty seven patients (38 fractures) with zone I and II fractures of the fifth metatarsal bone were treated with tolerable weight bearing and minimum duration of immobilization based on pain on weight bearing. We evaluated the duration of immobilization, time to clinical and radiographic union, and time to pre-injury activity level. Results: Clinical and radiological union were achieved in all patients without any complications including malunion or nonunion. The mean duration of immobilization was 28.7 days. The mean 33.1 days and 48.9 days were required for clinical union and radiographic union respectively, after the initial injury. The mean time to pre-injury activity level was 4.8 months. Conclusion: Our study shows that the acute nondisplaced zone I, II fracture of fifth metatarsal bone can be treated effectively using tolerable weight bearing and minimum duration of immobilization, which is based on the pain on weight bearing.

• Archives of Plastic Surgery
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• 제45권4호
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• pp.325-332
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• 2018

Background Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. Methods A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctival incision and an elevator through the intraoral incision. Results The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. Conclusions The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

• 한국지반공학회논문집
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• 제21권6호
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• pp.93-100
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• 2005

수압파쇄시 다중으로 분할된 균열의 생성은 자주 발생되는 현상이며 이러한 균열군은 단균열과는 달리 상당히 다른 거동을 나타낸다. 그러나 대부분의 수치기법으로는 이러한 균열군 거동의 모사는 계산량의 증가로 결코 쉽지 않다. 따라서 본 논문에서는 수압파쇄시 생성되는 다수의 균열 변위를 경계병치법을 사용하여 효과적으로 계산하기 위한 방법을 제시하였다. 우선 평행하면서 아주 가깝게 위치한 다중 분할 균열의 점근적 해를 구하고 경계병치법의 균열에 사용된 병치점의 수를 변화시켜 점근적 해와 비교하였다. 그 결과 기존의 기준에 비해 병치점의 수를 10배정도 줄이더라도 얻어지는 결과에는 별 차이가 없음을 밝혀냈다. 따라서 이보다 더욱 복잡한 균열이 존재하는 실제의 경우 병치점의 수를 줄여 적용하여도 경계병치법에 의한 계산은 유효하다는 결론을 얻었다.