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Intramedullary Nailing Treatment for Segmental TibialFractures
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In Heon Park, Kee Byoung Lee, Kyung Won Song, Jin Young Lee, Eung Joo Lee, Byung Koo Jooe
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J Korean Soc Fract 1998;11(3):546-551. Published online July 31, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.3.546
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 Abstract
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- Fracture of the tibia is the most common fracture of the long bone and due to its anatomical property, significantly high rate of complication has been reported during and after treatment. Various ways of surgical treatment have been tried with reasonable satisfaction. Recently, closed intramedullary nailing under the image intensifier has been widely performed with good results. However, segmental tibial fractures are more difficult than ordinary tibial shaft fracture in terms of reduction and fixation. Its treatment has been rather challenging for average orthopedic trauma surgeons. Particularly, segmental tibial fractures are commonly combined with extensive soft tissue injury, comminution as well as displacement resulted in poor blood supply especially in its middle segment. In this paper we are reporting our experience with intramedullary nailing treatment for 13 segmental tibial fractures in 13 patients. 13 cases with segmental fracture of tibia were reviewed, which were treated at the Deparment of Orthopaedic Surgery, Kang-Dong Sacred Hospital of Hallym University for 6 years from January 1990 to December 1996 with more than 1 year follow up period. All cases were caused by traffic accident and four were open fractures. Patients were 19-60 years of age (average 44) with male to female ratio of 1.6:1. The fractures were closely reduced and intramedullary nailed under the image intensifier control. Two cases were added with limited skin opening of the displaced fragments for reduction. Seven cases were reenforced an additional immobilization such as long leg splint or cast or externl fixator postoperatively. Melis type I fractures were most frequent in our series. All fractures were healed within a 1 year and average union period was 167 days (proximal fracture-144 days, distal fracture-190 days). Complications were a case of chronic osteomyelitis and one deep vein thrombosis and 4 case of delayed union, which were treated by reoperation with bone grafts. Displacing most proximal fragment was most troublesome to manage during and after operation. We tried intracortical screws fixation between proximal and middle segments with satisfactory bony union without displacement for a case. Carefully planned intramedullary nailing with or without some modification of the most proximal and shoryt segment seems to be recommendable way of treatment for the most segmental fractures of the tibia.
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Treatment of Infected Nonunion in Supracondylar and Intercondylar Fractures of the Femur after Open Reduction and Internal Fixations
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Ho Geun Chang, Eung Joo Lee, Sang Chun Ahn
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J Korean Soc Fract 1996;9(4):921-929. Published online October 31, 1996
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DOI: https://doi.org/10.12671/jksf.1996.9.4.921
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Abstract
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- The postoperative complications in open reduction and internal fination of supracondylar and intercondylar fractures of the femur include leg length discrepanfy, infection, skin necrosis, irritation by implants, valgus or varus deformity, bony destruction associated with vascular disturbance, instability of thr knee joint and translation of the frartured surface. The most vulnerable complication among them may be infection. Then infected nonunion is dangerous to the patients and its treatment is very difficult.
Authors evaluated 25 cases of 25 patients who were treated and followed up evaluation over one year in the department of Orthopaedic Surgery, College of Medicine, Hallym University from January, 1988 to June, 1995. All cases were treated by open reduction & internal fixations. Four cases of them had developed infected nonunion. After we treated these cases wr could reach following results: 1. The cause of infection was primarily staphylococcus aureus in all cases.
2. Among 4 cases of infected nonunion, external fixator was preformed in 3 patients and interlocking IM nailing in remainder.
3. The infection was managed with intravenous antibiotics, frequent irrigation. insertion of antibiotic impregnated beads and daily dressing.
4. Erythrocyte sedimentation rate was normalized at average 8.5 months(range, from 1.5 to 26 months).
5. The union was accomplished at mean 5.4 months in 21 cases without infection and at mean 17.7 months(range, from 10 to 35 months) in 4 cases with infued nonuion after infection developed.
6. The main complications were limitated range of motion of the knee(30 to 100 degree flexion) and shortening of affected extremity.
7. In conclusion, we suggest that early removal of implant in situ, external fination and bone graft after infection controlled is an adequate plan for the treatment of infected nonunion in supracondylar and intracondylar fractures of the femur.
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