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Treatment of Nonunion of the Femur Shaft with Intramedullary Compression Nail
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Churl Hong Chun, Ha Heon Song, Dae Ho Ha, Kyeong Jin Kim
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J Korean Soc Fract 2001;14(1):8-15. Published online January 31, 2001
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DOI: https://doi.org/10.12671/jksf.2001.14.1.8
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 Abstract
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- PURPOSE
To evaluate the result and efficacy of nonunion of the femur shaft treated with interlocking compression nail without bone graft.
MATERIALS AND METHODS
From November, 1993 to January, 1999, l2 cases(11 patients) which have been diagnosed as nonunion of femur shaft fracture were treated with interlocking compression nail. Authors followed up and evaluated them about the clinical results, radiologic finding and complications at least 1 year.
RESULTS
All cases of nonunion occurred clinical and radiological complete bone union. The mean fracture union period was 25 weeks(19~36 weeks) and the mean interfragmental gap was improved from preoperative 6 mm(4~11 mm) to postoperative 1 mm(0.8~1.5 mm). Postoperative complication was the leg length discrepancy of 3 cases. Their average length is 1.1 cm. We thought that the length discrepancy came from initial severe communited fracture and could not find out any functional problems.
CONCLUSION
Interlocking compression nail for nonunion of the femur shaft seems to promote the fracture healing process without bone graft.
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Proximal Tibiosbular Fracture associated with Popliteal Artery Injury
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Sang Soo Kim, Hong Jun Han, Dong Churl Kim, Dae Ho Ha, Hee Jun Yoo, Suk Kyun Park
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J Korean Soc Fract 1999;12(4):885-893. Published online October 31, 1999
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DOI: https://doi.org/10.12671/jksf.1999.12.4.885
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Abstract
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- Injury to the popliteal artery results in amputation more frequently than any other arterial injury. The major factor in the amputated limbs was a delay in diagnosis and therapy of the arterial injury associated with blunt trauma. The proximal tibial fractures produced the highest percentage of vascular complications and indicated immediate application of therapeutic measures. The purpose of this study is to investigate the long-term results and factors that influences the results of surgical treatment in patients with combined proximal tibial fracture and popliteal artery injury. Authors reviewed the records of 24 cases treated for this injury between January 1984 and May 1997. The age of the patients ranged from 17 to 70 years(average 45 years). Nine patients presented with life threatening injuries and classical signs of acute limb ischemia. Prolonged ischemic time ranged from 3 to 6 hours 30 minutes(average 4 hours 50 minutes). The most common cause of thoses injury was traffic accident in 16 cases. Five cases had neurologic deficit ; significant soft tissue injury was present in 14 extremities. Vascular procedures included saphenous vein interposition, end-to-end anastomosis, etc. Bony procedures were accomplished by external means in 14 cases and the others treated by immediate internal fixation in 5 cases. Intraoperative fasciotomy was performed in 5 patients with lower limb ischemia.
The results suggested that limb salvage was possible in 63 percent of patients with combined proximal tibial fracture and popliteal artery injuries, but a history of life-threatening condition and severe associated injury with vascular compromise was an unfavorable prognostic factor. So a well organized multidisciplinary approach is necessary to ensure life and functional limb salvage.
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Modified Dual Onlay Graft for Nonunion of the humeral Shaft
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Dae Ho Ha, Hong Jun Han, Jeong In Song
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J Korean Soc Fract 1998;11(3):703-708. Published online July 31, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.3.703
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Abstract
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- There have been some difficulties in treatment of nonunion of the humeral shaft with osteoporosis. We report here the results on the treatment of nonunion with osteoporosis by using modified dual onlay graft method. The six cases among 34 nonunions of humeral shaft were operated by modified dual onlay graft. Initial treatments were applied one hanging arm cast, two plate fixations, three intramedullary nailings. In the 3 cases of them, we performed plate fixation and bone graft as secondary treatment. However, nonunion occurred with loosening of fixation. Modified dual anlay graft was applied from 6 to 36 months )average 12 months) after fracture of humerus. The proximal and distal humeral nonunion surface was made decorticated and flattened, and then reduction was performed. On the lateral side of nonunion site, 6 holes plate was fixed and on the medial side, fixed with 5~9 cm cortical bone which was harvested from proximal tibia. Cancellous bone graft was performed around nonunion area. Long arm splint was done for 2~4 weeks after operation. The union period was in the range of 3.5~6 months (average 4.9 months) in all six cases. Quicker bone union was achieved as the bone block got longer and the number of the fixation screw increased. We conclude that modified dual onlay graft method is the one of effective methods to treat nonunion of humeral shaft fracture with osteoporosis.
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