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Minimally invasive plate osteosynthesis of the periarticular tibial fracture
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Jae Duk Ryu, Weon Yoo Kim, Jin Hyung Sung, Jin Il Park, Jin Young Kim
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J Korean Soc Fract 2001;14(1):66-72. Published online January 31, 2001
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DOI: https://doi.org/10.12671/jksf.2001.14.1.66
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- PURPOSE
To investigate the effective surgical method for the periarticular tibial fracture.
MATERIALS AND METHODS
A retrospective review was done on 27 cases with the periarticular tibial fracture who were treated by minimally invasive plate osteosynthesis(MIPO) between March, 1995 and December, 1998. The mean follow up period was 20.3 months(range: 14-42 months). Raiological bony union and clinical complications were analysed. Nineteen cases(70%) were proximal and remained 8 were distal. Five were open fractures and 15(56%) were communited.
RESULTS
Postoperatively if clinical(12.3 weeks) and radiolographic(14.7 weeks) signs of healing were present, and their concurrent injuries allowed, full weight bearing was initiated. In functional evaluation, proximal tibia fractures were excellent and good in 17 cases, fair in 2 cases and distal tibia fractures were good in 6 cases, fair in 1 case, poor in I case. Complications were occurred in 5 cases(19%)as superficial infection, rotational malunion, nonunion and knee joint stiffness.
CONCLUSION
It seems that the MIPO on patients with periarticular tibial fracture allows early motion of adjacent joint, shorten the interval of radiographic and clinical union and decrease the complications and it has excellent cosmetic effect. As a conclusion, we recommend that the MIPO should be considered as an appropriate operative treatment regimen in treating peritalar tibial fracture. But we have to pay attention to prebending a plate before application.
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Nerve injuries complicating Monteggia lesion
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Jae Duk Ryu, Chang Hwan Han, Weon Yoo Kim, Jin Hyung Sung, Jin Ho Jung, Jin Young Kim
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J Korean Soc Fract 2000;13(3):591-596. Published online July 31, 2000
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DOI: https://doi.org/10.12671/jksf.2000.13.3.591
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Abstract
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Concerns on the Monteggia lesion was concentrated on the injuries to the bone parts and largely ignores the soft tissues and the nerves in particular. We reviewed injured nerve, treatment and prognosis in the Monteggia lesion associated with nerve injury.
MATERIALS AND METHODS
From January 1990 through November 1999, 26 patients with Monteggia lesions have been treated: six of these patients had associated with nerve injuries. The age of injured patients ranged from 9 to 67 years with an average of 25.5 years.
RESULTS
All could be classified as Type 1 of Bado(anterior dislocation of the radial head), and four injuries were open and two were closed. two patients had radial-nerve palsy and four patients had posterior interosseous-nerve palsy, one of them with associated ulnar-nerve palsy. The fifth patient demonstrated complete spontaneous recovery. One patient with posterior interosseous nerve injury was absence of spontaneous return of function within 12 weeks after injury, exploration and neurolysis was performed. Complete recovery of posterior interosseous nerve function occurred in 14 weeks after exploration.
CONCLUSION
Monteggia lesions can be reduced early with ease under general anesthesia and, if necessary, even under local anesthesia. Spontaneous recovery of nerve function may occur within 12 weeks; in the absence of electromyographic or clinical evidence of return of nerve function within 12 weeks, exploration and neurolysis is indicated.
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Autogenous bone marrow injection for the treatment of delayed union of the long bone
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Jin Hyung Sung, Jae Duk Ryu, Weon Yoo Kim, Chang Hwan Han, Eui Young Ohm, Jin Young Kim
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J Korean Soc Fract 1999;12(4):1071-1076. Published online October 31, 1999
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DOI: https://doi.org/10.12671/jksf.1999.12.4.1071
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- It is known that the Salter-Harris type I and II fractures of the distal tibial epiphysis usually For resolving problems of delayed union and non-union of long bones, many efforts was made such as autogenous graft, allogenic or artificial bone graft and electrical stimulation, but there were many complications and not sufncient fracture healing process. The purpose of this study was to investigate the effect of autograft with bone marrow on the repair or bone formation of delayed union by the serial radiogram and clinical examination. We evaluated thirty nine patients which had been treated for long bone fracture, to whom bone marrow injection was made between 3 months and 13 months after adequate fixation(average.4.8months). After bone marrow injection, clinical follow up period was from 15 months to 35 months(average 26.7months). The age distribution was from 18 years to 84 years(average 42). A total of 100- 150cc of marrow was injected at the nonunion site immediately after aspiration under the C-arm.
Of 39 cases, there were improved bone healing process of 30 cases(77%) by radiographically and clinically, Of 9 cases without improvement, 5 cases were due to loosening of external fixator, 2 cases was due to chronic osteomyelitis and other 2 cases was unknown origin. No serious complications were observed other than no improvement. Although percutaneous bone marrow injection does not promote healing more rapidly than would standard operative bone grafting, it has many distinct advantages over the latter. It is safe, easy, and time saving. It is economical and involves minimal trauma. It can be done under local anesthesia and avoids the risks of general anesthesia, infection and surgery. It can be done in cases which are not fit for open bone grafting because of poor condition of the skin.
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Iigament Injuries of the Knee Joint Combined with Ipsilateral Femoral Shaft Fracture
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Jin Hyung Sung, Choang Whan Han, Jae Duk Ryu, Weon Jin Cha, Jin Young Kim
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J Korean Soc Fract 1998;11(3):509-513. Published online July 31, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.3.509
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- Most fractures of the shaft of the femur are caused by high-energy trauma. It would be expected that in many cases the ipsilateral knee ligaments are subjected to severe stress. In these days, early diagnosis and proper treatment of combined ligament injury in ipsilateral femoral shaft fracture become to be important and are possible by arthroscope and MRI. We retrospectively reviewed a series of 97 patients with 97 fractures of the femoral shaft from March 1995 to December 1997. demonstrable ipsilateral knee ligament laxity was present in 10(11.3 per cent) of these patients. There were 7 males and 8 left femur fractures. Eight of them were injured by traffic accident. Ten patients were followed for an average months. PCL injuries were five cases and ACL and MCL injuries were two cases each and posterolateral instability was one case. Early diagnosis was possible in MCL and ACL cases but diagnosis was dilayed to average 10 months post-accidentally in PCL injuries. MCL injuries and one ACL injuries were treated conservatively and one ACL and one PCL avulsion fracture were treated with pull-out suture technique and another 4 PCL injuries were treated with reconstruction using bone patella tendon bone, From this study, we advocate careful asessment of the knee, especially PCL injury in all cases of fracture of the femur caused by high-energy trauma.
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A Clinical Study of Fracture of Distal Radius: Pitfall of Treatment of Intraarticularly comminuted fracture
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Chong Hoon Park, Won Yoo Kim, Jin Hyung Sung, Kyong Ho Yoo, Jin Yiung Kim
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J Korean Soc Fract 1996;9(1):33-41. Published online January 31, 1996
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DOI: https://doi.org/10.12671/jksf.1996.9.1.33
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Abstract
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- The fracture of the distal radius was first described as the fracture of the radius with dorsally eisplaced fragment within distal 1.5 inch at 1814 by Abraham Calles.since that, according to feature of fractures, many classifications have been introduced. Although there are many kinds of msthod in treatment of fracture of the distal radius, we find difficulty in selecting adequate method of treatment of intraarticularly comminuted fracture of the distal radius.And recently the intraarticularly comminuted fracture is occasionally recognized as nit a simple fracture but a complicated fracture because of postraumtic arthritrs, malunion, nonunion,and stiff hand after treatment.So,we retrospectively reviewed thirty-eight cases which were treated by several methods for 5 year from Jan.1990 to Dec. 1994 at the our hospital. The results were as follows.
1.In general, the incidence was mare higher in male, but the older in age, the more incidence in female.
2.The most common catse as a single cause of injury was a traffic accident.
3.By the point system for subjective evaluation and objective evaouation of Gartland and Werley, the excellent or good result were represented at the extraarticular fractures or undisplaced inraarticaular fracture among Collesfracture, Bartons Chauffeurs, Smiths, and lunste load fracture, which had been treated by sugar-tongs splint or percutaneous pinnongs after the closed reduction. And the excellent result was especially showed at the volar Bartons jractures which had been managed by the plate fixation after the open reduction. But the poor result was represented at the intraarticularly comminuted fractures of the distal radius, which had been treated by percutaneoys pinning(2 cases)or only external fixation without an additional fixation(4 cases) after the closed reduction.
In conclusiln, the investigatir thought that the anatomical reduction, more secure fixation, and sometimes bone grafting in treating the intraarticylarlycomminuted fracture of the distal radiuw were essential fir having satisfactory clinical result.
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Result of 29 consecutive patients with the distal femiral fracture: Analysis of the result treated with AO DCS(dynamic condylar Screw) Supracondylar nail, May anatomical plate
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Weon Yoo Kim, Jin Hyung Sung, Chong Hoon Park, Jeong Soo Park, Jin Yong Kim
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J Korean Soc Fract 1996;9(1):68-75. Published online January 31, 1996
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DOI: https://doi.org/10.12671/jksf.1996.9.1.68
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- Twenty-nine cases of the surgically treated distal femoral fracture were analyzed to compare internal fixatorw (AO DCS,Supracondylar nail, May anatomical plate),who were treated at Department of orthopaedic surgery, Taejon Saint Marys hospital from Jan. 1992 to Jun. 1994. The cases were classified according to AO classification and minmum 12 months(average:22.4 monthw) follow up.
Following results were obtained: 1.Male was more common than female, age distrbution was between 16 and 77 years old(average 40.4), abd the most common cause of the fracture was traffic accident.
2.The most comon type C by AO classification(type A 11 cases, type B 1 case, type C 17 cases).
3.According to Schatzkers criteria in the clincal result, type A,B were better resykt than type C, and severe soft tissue damage, comminution and joint involvement lead to unsatisfactory results.
4.Supracondylar nail was inadequate implant due to inferior clinical result(1 excellent, 2 good and 3 poor).
5.DCS had more sateafactory result than other internal fixators(supracondylar nail, May anatomical plate).
Based on the observations, the better results depend on the amount of initial trauma, early anatomical reduction, rigid internal fixation and exercise of the knee joint.
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