비골 골절 환자에서 치료 결과 만족에 영향을 미치는 인자

강일규,차흥억,정주현,윤진호,김미주,김선태 대한비과학회 2008 Journal of rhinology Vol.15 No.1

Background and Objectives:There are many factors affecting the satisfactory results of nasal bone fracture, such as age, sex, severity of nasal bone fracture and the time from the onset of injury to the beginning of treatment etc. The aim of this study is to evaluate the predictable factors of satisfaction for nasal bone fracture treatment. Materials and Methods:The authors retrospectively reviewed the medical records of 85 patients with nasal bone fracture to examine and analyze according to sex and age distribution, cause of injury and the time from the onset of injury to the beginning of treatment. Result:In this study, age, sex and severity of nasal bone fracture were found to be unrelated to the satisfactory result. The time from the onset of injury to the beginning of treatment is statistically related to the satisfactory result of nasal bone fracture (p<0.05). Conclusion:Early intervention of nasal bone fracture is necessary to obtain satisfactory results. Background and Objectives:There are many factors affecting the satisfactory results of nasal bone fracture, such as age, sex, severity of nasal bone fracture and the time from the onset of injury to the beginning of treatment etc. The aim of this study is to evaluate the predictable factors of satisfaction for nasal bone fracture treatment. Materials and Methods:The authors retrospectively reviewed the medical records of 85 patients with nasal bone fracture to examine and analyze according to sex and age distribution, cause of injury and the time from the onset of injury to the beginning of treatment. Result:In this study, age, sex and severity of nasal bone fracture were found to be unrelated to the satisfactory result. The time from the onset of injury to the beginning of treatment is statistically related to the satisfactory result of nasal bone fracture (p<0.05). Conclusion:Early intervention of nasal bone fracture is necessary to obtain satisfactory results.

골반 골절에 한방재활치료를 적용한 증례 보고 및 보존적 치료에 대한 국내 문헌 분석

하현주 ( Hyun Ju Ha ),구지향 ( Ji Hyang Gu ),최봉석 ( Bong Seok Choi ),오태영 ( Tae Young Oh ),오은미 ( Eun Mi Oh ),이옥진 ( Yu-chen Li ),오민석 ( Min-seok Oh ) 대한한의학회 한방재활의학과학회 2018 한방재활의학과학회지 Vol.28 No.2

The objective of this study is to investigate conservative treatment of pelvic fracture, and report that Korean rehabilitation treatment is effective for pelvic fracture. We reported a case about pelvic fracture treated with Korean rehabilitation treatment. We searched 10 domestic electronic databases to find reports on conservative treatment of pelvic fracture. We selected and analyzed 12 studies. In this case, pain, range of motion, and Oswestry Disability Index of patient were improved by Korean rehabilitation treatment. In analysis, traction, pelvic sling, hip spica cast, pelvic belt, medication are used in western medical treatment. Acupuncture, herbal medicine, cupping, moxibustion, physical therapy, manual therapy are used in Korean medical treatment. Most of conservative treatments are effective for pain, bone union, osteoporosis, dysfunction. In this study, we expect further study of Korean rehabilitation treatment program for pelvic fracture to compensate existing conservative treatment. (J Korean Med Rehabil 2018;28(2):135-148)

Operative Versus Nonoperative Management of Pediatric Proximal Humerus Fractures: A Meta-Analysis and Systematic Review

Hae-Ryong Song,Mi Hyun Song 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.6

Background: Proximal humerus fractures account for 2% of all pediatric fractures. A nonoperative approach is the treatment of choice for most of these fractures; however, debates continue regarding the treatment of displaced fractures, especially in adolescents. In this study, we aimed to examine demographic data and treatment strategies for proximal humerus fractures in the pediatric population by conducting a meta-analysis. Additionally, we investigated the preferred surgical technique for operative treatment. Methods: A systematic online search of databases, including Embase, Medline, PubMed, and Cochrane Library, was conducted to identify studies that matched our search criteria. Data collection was completed on May 1, 2022. Age, sex, degree of angulation, Neer-Horwitz classification, Salter-Harris classification, treatment method (operative vs. nonoperative), and instrument used for internal fixation were classified and documented. Effect size analysis was performed using odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs), based on data types. Results: Eight studies met our inclusion criteria. Overall, 33% of the patients (n = 195) underwent operative treatment, whereas 67% of them (n = 392) received nonoperative treatment. Among the demographic risk factors, severely displaced fracture type (OR, 10.00; 95% CI, 1.56−64.22; p = 0.020) and older age (WMD, 3.26; 95% CI, 2.29−4.23; p < 0.001) were significantly associated with operative treatment. There was no significant difference in the preference for percutaneous pinning or intramedullary nailing, the most frequently employed surgical techniques (OR, 5.09; 95% CI, 0.65−39.58; p = 0.120). Conclusions: The operative treatment rate in pediatric proximal humerus fractures was 33%, which increased to 60% in severely displaced fractures (Neer-Horwitz grade III/IV). Severely displaced fractures and older age significantly contributed to the establishment of a treatment strategy for operative treatment. The choice of surgical technique may seem to be based on the anatomical location of the fracture rather than the surgeon’s preference.

일측성 하악과 골절치료의 수술적 방법과 비수술적 방법에 대한 임상적 고찰

김양우,차진한 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.2

Mandibular condyle fracture, as common as it may be still has many controversies in its treatment. Other mandibular fractures are usually treated by surgical procedures, however unilateral mandibular condyle fracture is frequently treated by intermaxillary fixation. However, with such conservative method about 30% have reported failure in mandibular functions. Recently, surgical methods have reported good results for normal anatomical reconstruction of mandibular condyle fracture. We treated 56 unilateral mandibular fracture patients from March, 1988 to August, 1995, of these 41 were treated conservatively and the remaining 15 were treated by open reduction. Their pre- & post-treatment X-rays and physical findings were analyzed and followed up to obtain the following data. 1. Of 56 patients, 39 were male and 17 were female. All five patients with intracapsular fracture were all conservatively treated, 17 of the 21 patients with condylar neck fracture were treated conservatively and the remaining 4 were surgically treated. Eleven of the 30 patients with subcondylar fracture were treated surgically. 2. Under radiological examination, 41 patients who underwent conservative treatment showed no significant improvement in displacement angulation. However, in 15 patients who were surgically treated showed significant decrease in displacement angulation from 67˚pretreated to 7˚post-treated. 3. Under radiological examination, nonsurgical group showed no significant improvement in reduction of mandibular height. Surgical group showed statistically significant improvement from 16mm to 2mm. 4. Condylar neck fracture showed improvement in displacement from 29˚ to 25˚with conservative treatment alone, however subcondylar fracture failed to show improvement with conservative treatment alone. On the other hand, in the surgical group both condylar neck and subcondylar fracture showed significant improvement in displacement angulation. 5. In condylar neck fracture, both nonsurgical and surgical group showed similar mouth opening state. In subcondylar fracture only the surgical group showed similar mouth opening state. In subcondylar fracture only the surgical group showed significant improvement of mouth opening state. 6. Nonsurgical group showed higher incidence of malocclusion, mandibular asymmetry, pain, and clicking sounds in the joints compared to surgical group. On the other hand, surgical group developed a transient facial paralysis which was recovered about 3 weeks post-surgery. In conclusion, even with severe malocclsion, displacement angulation or reduction in mandibular height surgical group showed better improvement as compared to nonsurgical group. Also other subjective symptoms that the patients feel or the objective clinical evaluations show that surgical group had better results than the nonsurgical group. Especially, in the case with subcondylar fracture surgical group showed better improvement in many ways compared to the nonsurgical group.

Effect of core surface treatment on the fracture resistance of zirconia restoration

Su-Ha Jeoung(정수하),Jeong-mi Kim(김정미),Da-Ryeong Park(박다령),Ji-Young Park(박지영),Ji-Myung Bae(배지명),Seung-Han Oh(오승한) 대한치과재료학회 2014 대한치과재료학회지 Vol.41 No.3

The purpose of this study was to examine the effect of acid-base surface treatment on the fracture resistance, which is one of main mechanical property, of zirconia restoration in order to improve the bonding characterization between zirconia core and ceramic veneer in bi-layered all ceramic restoration system. 10% hydrofluoric acid (HF) and 1 M sodium hydroxide (NaOH) were used as acid and base chemical solutions for surface treatment, respectively. Fracture-resistance tests were performed to investigate the effects of acid and liner treatment on the improvement of the bonding strength between veneer ceramics and zirconia. Specimens were divided into five groups (n = 4) according to the type of surface treatment: (1) Group A, no treatment (control); (2) Group B, liner treatment; (3) Group C, 10% HF etching for 60 s; (4) Group D, 10% HF etching for 60 s and liner treatment. All results of fracture resistance test showed that there were no significant differences between surface treatment types. Failure mode observation indicated that most specimens of Cerasys, Zmatch, and ICE groups showed cohesive failure mode regardless of the method of surface treatment. From the results of study, the short (1 min) treatment of zirconia in HF solution is supposed to be suitable for improving bond strength of zirconia restoration, but long (more than 30 min) treatment of zirconia in HF solution is expected to deteriorate the zirconia structure. Also, several factors such as liner and acid treatment, which improve the fracture resistance of zirconia restoration, seemed to depend on the type of zirconia materials.

Effect of core surface treatment on the fracture resistance of zirconia restoration

정수하,김정미,박다령,박지영,배지명,오승한 대한치과재료학회 2014 대한치과재료학회지 Vol.41 No.3

The purpose of this study was to examine the effect of acid-base surface treatment on the fracture resistance, which is one of main mechanical property, of zirconia restoration in order to improve the bonding characterization between zirconia core and ceramic veneer in bi-layered all ceramic restoration system. 10% hydrofluoric acid (HF) and 1 M sodium hydroxide (NaOH) were used as acid and base chemical solutions for surface treatment, respectively. Fracture-resistance tests were performed to investigate the effects of acid and liner treatment on the improvement of the bonding strength between veneer ceramics and zirconia. Specimens were divided into five groups (n = 4) according to the type of surface treatment: (1) Group A, no treatment (control); (2) Group B, liner treatment; (3) Group C, 10% HF etching for 60 s; (4) Group D, 10% HF etching for 60 s and liner treatment. All results of fracture resistance test showed that there were no significant differences between surface treatment types. Failure mode observation indicated that most specimens of Cerasys, Zmatch, and ICE groups showed cohesive failure mode regardless of the method of surface treatment. From the results of study, the short (1 min) treatment of zirconia in HF solution is supposed to be suitable for improving bond strength of zirconia restoration, but long (more than 30 min) treatment of zirconia in HF solution is expected to deteriorate the zirconia structure. Also, several factors such as liner and acid treatment, which improve the fracture resistance of zirconia restoration, seemed to depend on the type of zirconia materials.

상완골 근위부의 삼분 및 사분골절과 골절탈구의 수술적 치료

이용수,김민기 예수병원 1998 예수병원학술지 Vol.19 No.-

Factors Related to Failure of Conservative Treatment in Volar Plate Avulsion Fractures of the Proximal Interphalangeal Joint

Sanglim Lee,Seung Jin Jang,Suk Ha Jeon 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.3

Background: Volar plate avulsion fractures of the proximal interphalangeal (PIP) joint are a common hand injury and have been treated conservatively with favorable results. We assumed that conservative treatment of volar plate avulsion fractures of the PIP joint would be unsuccessful if the fracture fragment, even if small, was much displaced or rotated and that delayed excision of the avulsion fractures would result in good outcomes. We report clinical and radiological outcomes of conservative treatment of volar plate avulsion fractures of the PIP joint and risk factors for failure of conservative treatment. Methods: We retrospectively reviewed the clinical and radiological outcomes of 88 volar plate avulsion fractures (85 patients) treated conservatively at first. In 18 of these fractures, delayed excision of the fracture fragment was required after an average of 75 days of conservative treatment for limited motion or pain of the joint. We compared parameters between failed cases and successful cases after conservative treatment. Results: Compared to the successful cases, the failed cases had a higher prevalence of joint dislocation at the time of injury and greater pain, larger flexion contracture, and less further flexion after conservative treatment. The shape, comminution, and size of the fracture fragments were not related with the need for operation, but the operative cases had greater displacement and rotation of the fracture fragments than the conservative cases. After fragment excision, postoperative protection of the joint was not necessary, pain was reduced, and the mean range of motion increased. Conclusions: The presence of joint dislocation and greater displacement and rotation of the fragments may be associated with the failure of conservative treatment of volar plate avulsion fractures. Failed cases after conservative treatment could be resolved by delayed fragment excision with favorable results. Therefore, it might be appropriate to consider conservative treatment at first in almost all volar plate avulsion fractures of stable PIP joints.

소아 대퇴골 간부 골절의 치료 결과 분석 : 보존적 치료와 역행성 유연성 골수정 삽입술의 비교 Comparison between conservative treatment and retrograde flexible intramedullary nailing

오창욱,박병철,인주철,소형태,백승훈 대한골절학회 2002 대한골절학회지 Vol.15 No.2

목 적 : 소아 대퇴골 간부 골절환자에서 보존적 치료와 역행성 유연성 골수정 삽입술 시행후 동통 및 파행 등의 임상증상, 회복기간, 각형성 및 하지부동 등의 합병증을 비교하였다. 대상 및 방법 : 1992년 1월부터 2000년 6월까지 4~11세의 대퇴골 간부 골절 환자 46명 51례를 대상으로 하였고, 수상시 연령은 보족적 치료군이 평균 6세11개월, 수술적 치료군이 평균 7세였다. 보존적 치료군이 24례, 수술적 치료군이 27례로, 보존적 치료군은 견인술후 3~6주에 고수상 석고고정을 하였고, 수술적 치료군은 자체제작한 3.0 mm 스테인레스 강선으로 대퇴원위부에서 폐쇄적 정복 삽입술을 시행하였다. 결 과 : 두 치료군에서 동통 및 주변관절의 운동장애, 불유합이 나타난 예는 없었다. 방사선적 평가에서 보존적 치료군은 10도이상의 각형성이 4례 있었으나, 수술적 치료군에서는 없었다. 10mm이상의 심각한 하지부동은 수술적 치료군은 없었으나, 보존적 치료군에서 4례 발생하였고, 그중 파행이 보존적 치료군에서 2례 있었다. 부분 체중 부하시기는 수술적 치료군이 평균 7.5주로 보존적 치료군의 10.8주보다 빨랐다. 결 론 : 소아의 대퇴골 간부 골절에서 역행성 유연성 골수정 삽입술은 보존적 치료에 비해 각형성 및 하지부동 등의 합병증이 비교적 적고, 조기재활이 가능한 치료방법으로 사료된다. Purpose : To compare clinical outcomes and complications between pediatric patients with femoral shaft fracture who had undergone conservative treatment and retrograde flexible intramedullary nailing. Materials and Methods : 51 cases of 46 pediatric patients who had femoral shaft fracture were retrospectively studied. Hip spica cast was applied 3∼6 weeks after traction in 24 cases of conservative treatment group and closed reduction and internal fixation with flexible nails were performed in 27 cases. Results : Neither pain, limitation of joint motion, nor nonunion was reported in both groups. In radiologic evaluation, 4 cases of angulation more than 10 degrees were observed in conservative treatment group and none of surgical treatment group. In leg length discrepancy(LLD) over 10 mm, there was none in surgical treatment group, but 4 cases were seen in the conservative group. Two cases of limping were observed only in the conservative group. Mean time to weight bearing was earlier in surgical treatment group(7.5 weeks) than that in the conservative group(l0.8 weeks). Conclusion : As treatment of pediatric femoral shaft fracture, retrograde flexible intramedullary nailing had less complications such as LLD and angulation and enabled earlier rehabilitation than conservative treatment.

Treatment of Thoracolumbar Fracture

김병국,단진명,신동은 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.1

The most common fractures of the spine are associated with the thoracolumbar junction. The goals of treatment of thoracolumbar fracture are leading to early mobilization and rehabilitation by restoring mechanical stability of fracture and inducing neurologic recovery, thereby enabling patients to return to the workplace. However, it is still debatable about the treatment methods. Neurologic injury should be identified by thorough physical examination for motor and sensory nerve system in order to determine the appropriate treatment. The mechanical stability of fracture also should be evaluated by plain radiographs and computed tomography. In some cases, magnetic resonance imaging is required to evaluate soft tissue injury involving neurologic structure or posterior ligament complex. Based on these physical examinations and imaging studies, fracture stability is evaluated and it is determined whether to use the conservative or operative treatment. The development of instruments have led to more interests on the operative treatment which saves mobile segments without fusion and on instrumentation through minimal invasive approach in recent years. It is still controversial for the use of these treatments because there have not been verified evidences yet. However, the morbidity of patients can be decreased and good clinical and radiologic outcomes can be achieved if the recent operative treatments are used carefully considering the fracture pattern and the injury severity.