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Ender nailing For Intertrochanteric Fracture of the Femur in the Elderly patients
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Hak Yeong Jeong, Seung Wook Yang, Seung Joon Shin, Hyeong Joon Seung
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J Korean Soc Fract 1998;11(4):745-753. Published online October 31, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.4.745
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- The principle of treatment of intertrochanteric fracture is early operation and early rehabilitation. The morbidity and mortality associated with intertrochanteric fracture are remained high because the elderly patient generally have a reduced tolerance for prolonged bed rest, lengthy operation and blood loss. Since Ender introduced the concepts of multiple flexible intramedullary nailing in 1970, Ender nailing has been mostly used in intertrochanteric fracture of the elderly patient, but it has been rarely used for unstable fracture. The authors analysed 87 cases of intertrochanteric fractures of femur over 60 years old, treated with Ender nailing during period from July, 1998 to October, 1996. The results were as follows : 1. Among 87 cases, 70 cases were female and average age was 75.3 years old. 2. The common complications were knee pain and LOM(10%) and distal migration of nails(3%). 3. These complications were reduced by careful bending of nails, fanning of nails in femoral head, stacking of medullary canal and accurate placement of portal hole. 4. 10 patients died within 1 year(Mortality rate : 11%). 5. Thirty-six(47%) patients maintained their prefracture ambulatory ability at a postoperative 1 year ; Fourty-one(53%) patients lost some degree of ambulatory ability. 6. In unstable intertrochanteric fracture, we can achieved good results by Ender nailing in valgus reduction.
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Fracture-Separation of The Distal Humeral Epiphysis
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Hak Yeong Jeong, Seung Wook Yang, Jae Woong Shim, Seung Joon Shin, Jeong Tae Kim
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J Korean Soc Fract 1998;11(3):650-657. Published online July 31, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.3.650
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- A fracture-separation of the distal humeral epiphysis in children is an extremely rare injury and presents problems in diagnosis, radiographic interpretation and management. From June 1992 to December 1996, Authors experienced the 5 cases of Salter - Harris type II injury of the distal humeral epiphysis at Department of Orthopedic Surgery, Pusan Maryknoll General Hospital. The patient were followed up from one year nine months to three years four months. The two cases were treated by closed reduction and percutaneous K-wire fixation and the three cases by open reduction and internal fixation with K-wires.
There were 4 cases of complication seldom reported following fracture-separation of the distal humeral epiphysis. This complications consist of 4 dissolutions of trochlea, which is one, frank avascular necrosis of trochlea. In 3 cases with open reduction developed the cubitus varus & dissolution of trochlea. We speculate that this complications results from avascular necrosis of distal end of humerus. Attention to change of carrying angle and radiographic change of distal humeral end are important in detection of complication & evaluation of etiology of dissolution of distal humeral end.
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Fracture of Olecranon Treated by K-wire and Tension Band Wiring Technique in Adults
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Hak Yeong Jeong, Seung Wook Yang, Jae Woong Shim, Beyong Seon Kong
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J Korean Soc Fract 1997;10(3):651-657. Published online July 31, 1997
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DOI: https://doi.org/10.12671/jksf.1997.10.3.651
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- Displaced fractures of olecranon in adults require operative treatment. The goal of treatment is to rigidly fix the fracture fragment, to anatomically restore the joint surface and to allow range of motioin early.
Authors treated fractures of olecranon by open reduction and internal fixation using K-wire and tension band wiring technique in 38 adult patients from April 1989 to October 1995 at the Department of Orthopedic Surgery, Maryknoll Hospital. This article documents the study of relationship between the treatment result and involvement of articular surface, articular step-off and gap of articular surface.
The results were as follows ; 1. The clinical results were good or fair in 31 cases(82%) according to the criteria by Helm et al.
2. Involvement of articular surface, step-off and gap of articular surface affected the results.
3. The clinical results were satisfactory in patients with postoperative step-off less than 2mm and postoperative gap of articular surface less than 2mm.
4. The clinical results were satisfactory in patients with articular involvement less than 60%.
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The Treatment of Infected Fracture of Long Bones
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Hak Yeong Jeong, Seung Wook Yang, Young Cheol Shin, Jae Woong Shim
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J Korean Soc Fract 1995;8(3):678-687. Published online July 31, 1995
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DOI: https://doi.org/10.12671/jksf.1995.8.3.678
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- The increase in incidence and severity of open injury to bone and surrounding soft tisseues from vehicular and industrial accidents, and the aggressive surgical approach of open reduction and internal fixation of closed fractures contribute to a definite rise in acute wound infection in fracture management.
The main objectives are twofold in the treatment of infected fractures, the first to diagnose infection early and the second to treat it effectively and to prevent it from spreading into bone. To solve these problems, we used some principles of treatment, those are meticulous debridement of infected tissue, management of soft tissue and bony defect and maintenance of fracture stability.
From Jan. 1988 to Dec. 1993, we treated 23 infected fractures of long bone and the result were as follows.
1. The infected fractures were femur in 9 and tibia in 14 cases.
2. There were 14 open fractures and 9 closed fractures.
3. In closed fracture, the first infection sign was developed average 7.8 days after open reduction, and average 9 days after trauma in open fracture.
4. The most common causative organism was staphylococcus aureus.
5. Infection was controlled from 3 months to a year and 8 months.
6. The number of soft tissue and bone debridement was one to four times.
7. Bony union was achieved from 6 months to 2 years in tibia and 6 months to 2 years and 1 month in femur.
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Surgical Treatment of the Patellar Fractures
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Hak Yeong Jeong, Seung Wook Yang, Young Cheol Shin, Han Sung Park, Tae Ho Joo
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J Korean Soc Fract 1995;8(3):578-585. Published online July 31, 1995
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DOI: https://doi.org/10.12671/jksf.1995.8.3.578
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- Recently the incidence of the patellar fracture has been increasing because of frequent traffic accidents and industrial accidents, and its treatment is considered very important due to the involvement of the articular suface occurs in most of the cases. Comminuted displaced fractures of the patella which are difficult to reduce accurately and to get stable internal fixation, may lead to traumatic osteoarthritis, chondromalacia, extension lag and limited ROM of the knee joint.
The retrospective review was undertaken of 49 patients with patellar fractures treated by surgical methods and a follow up of more than 1 year at the Department of Orthopaedic Surgery at Maryknoll Hospital between Aug. 1987 and Jan. 1994.
The findings were as follows: 1. Most fractures were encountered in man from twenties to forties.
2. The most common cause of fractures was traffic accident, followed by slip down or fall down.
3. Comminuted fracture was the most common type in this series.
4. Large separated fragments of the patella should be accurately reduced with rigid fixation in the rationale of the intraarticular fracture.
5. The most favorable results were obtained by Modified Tension Band Wiring with supplementary oircurnferential wiring for comminuted fractures and the result was superior to other operative methods.
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Operative Treatment with Plate Screw Devices for Distal Femoral Fracture
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Hak Yeong Jeong, Seung Wook Yang, Young Cheol Shin, Han Sung Park
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J Korean Soc Fract 1994;7(2):512-521. Published online November 30, 1994
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DOI: https://doi.org/10.12671/jksf.1994.7.2.512
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Abstract
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- Until 1960, conservative managemant was considered superior to operative treatment of distal femoral fracture. But with advancement of new fixation divices and techniques, open reduction and internal fixation is recent trend.
From May, 1986, to May, 1993, at Pusan Maryknoll hospital, the results of 39 cases of distal femoral fracture treated operatively with plate screw devices were analyzed after minimum follow up of 1 year according to the rating system of Schatzker and lambert.
The results were as follows: 1. Average radiologic union time was 16.3 weeks.
2. According to Schatzker and Lamberts criteria, excellent was 17 cases, good in 13 cases, fair in 5 cases and failure in 4 cases.
3. For fixation of distal femoral fracture with severe comminution at metaphyseal portion, the condylar blade plate and dynamic condylar screw showed better result than anatomical plate.
4. With extensile approach, the dynamic condylar screw showed excellent result for distal femoral fracture with intraarticular comminution.
We concluded that wide exposure enough for accurate reduction of fracture fragments aud joint surface and rigid internal fixation were the cornerstone for treatment of the distal femoral fracture.
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