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Surgical Treatment of Pediatric Intra-Articular Proximal Phalangeal Head Fracture of the Big Toe
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Yeun Soo Kim, Geunwu Gimm, Il ung Hwang, Goo Hyun Baek, Jihyeung Kim
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J Korean Fract Soc 2020;33(1):9-15. Published online January 31, 2020
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DOI: https://doi.org/10.12671/jkfs.2020.33.1.9
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 Abstract
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- PURPOSE
Pediatric intra-articularproximal phalangeal head fractures of the big toe are very rare and few studies on this have been published. The purpose of this study is to present the diagnostic approach and surgical management of these extremely rare fractures, which might be easily underestimated or misdiagnosed.
MATERIALS AND METHODS
The study retrospectively reviewed all the patients who were diagnosed as intra-articular proximal phalangeal head fracture of the big toe and who underwent surgical intervention in our institution. The size of the bony fragment and hallux valgus interphalangeus angle were measured on the preoperative X-rays. The size and rotation of the osteochondral fragment, the presence of avascular necrosis, ligamentous injury and soft tissue entrapment were assessed on the preoperative magnetic resonance images (MRIs). The radiologic and functional evaluation were performed at 1 year postoperatively.
RESULTS
The average size of the bony fragments measured on the X-rays was 4.1 mm in width and 2.3 mm in length. Two cases showed hallux valgus interphalangeus. Preoperative MRI was performed in four cases and the average size of any osteochondral lesion was 5.3 mm in width, 3.9 mm in length, and 4.7 mm in height. Rotation of the osteochondral fragment was observed in one patient, and soft tissue entrapment was noted in two patients. Postoperatively, successful bony union was achieved in all the patients and the average time to union was 74.4 days.
CONCLUSION
Intra-articular proximal phalangeal head fractures of the big toe are very rare and often neglected due to incomplete ossification in the pediatric population. It is important to suspect the presence of this intra-articular fracture and to appropriately implement further evaluation. Nonunion of chronic cases as well as acute fractures can be successfully treated through open reduction and internal fixation using multiple K-wires.
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Double Parallel Plates Fixation for Distal Humerus Fractures
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Young Hak Roh, Moon Sang Chung, Goo Hyun Baek, Young Ho Lee, Hyuk Jin Lee, Joon Oh Lee, Kyu Won Oh, Hyun Sik Gong
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J Korean Fract Soc 2010;23(2):194-200. Published online April 30, 2010
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DOI: https://doi.org/10.12671/jkfs.2010.23.2.194
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Abstract
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- PURPOSE
The purpose of this study was to review the outcome of fixation of distal humerus fractures using recently-introduced double parallel plate system in sagittal plane.
MATERIALS AND METHODS
From May 2004 to June 2008, seventeen patients with distal humerus fractures underwent primary open reduction and internal fixation with double parallel plates. According to the AO classification, there were 2 A3, 2 C1, 7 C2, and 6 C3 type fractures. Outcome assessment was performed by using the Mayo Elbow Performance index (MEPI).
RESULTS
At a mean follow up of 18 (range, 12 to 32) months, 4 patients were rated as excellent, 8 as good, and 5 as fair in terms of MEPI. The average arc of elbow flexion after primary operation was 116 (range, 90~140) degrees with a mean flexion contracture of 13 (range, 0 to 30) degrees. One patient required reoperation due to fixation failure and six patients underwent capsulolysis and three patients underwent ulnar nerve neurolysis. The time to begin elbow motion exercise had negative correlation with total elbow range of motion and multiple trauma patients had significantly lower MEPI functional score compared to those without combined injury.
CONCLUSION
Double parallel plating allowed adequate fixation for distal humerus fractures regardless of patient age and fracture pattern. Partial ankylosis and unlar nerve compression symptoms were the main causes of reoperation.
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Surgical Treatment of Femoral Nonunion
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Hyun Sik Gong, Hee Joong Kim, Han Soo Kim, Goo Hyun Baek, Sang Hoon Lee, Sang Rim Kim, Moon Sang Chung, Young Min Kim
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J Korean Soc Fract 1999;12(1):1-5. Published online January 31, 1999
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DOI: https://doi.org/10.12671/jksf.1999.12.1.1
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Abstract
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- Femur is one of the most frequent sites of nonunion and femoral nonunion imposes many complications secondary to repeated surgical procedures and immobilizations. Many kinds of treatment options have been used and studied for comparison, but still the classical principle is rigid fixation, bone grafting, and adequate postoperative immobilization. In this study, the results of surgical treatment for femoral nonunion were analyzed. From July 1995 to August 1997, a total of 14 cases of femoral nonunion were treated surgically at the department of Orthopedic Surgery of the Seoul National University Hospital. All cases were treated by autogenous bone graft and internal fixation. For internal fixation, plate and screws were used in 10 cases and intramedullary nail in 3 cases and compression hip screw in 1 case. Postoperatively, hip spica cast was applied in 8 cases, cast brace in 2 cases and long leg splint in 1 case. In the other 3 cases, no additional support was adopted. In all cases, clinical union was achieved at postoperative 5 months in average. There was no significant complication except one case of marked limited motion in knee followed by hip spica cast.
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Citations
Citations to this article as recorded by  - Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef
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