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The Importance of Position of the Distal Fragment in Intertrochanteric Fracture of the Femur using Compression Hip Screw
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Jong Deuk Rha, Hyun Soo Park, Young Bong Park, Chang Suk Lim, Seung Woo Kim
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J Korean Soc Fract 2003;16(4):447-455. Published online October 31, 2003
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DOI: https://doi.org/10.12671/jksf.2003.16.4.447
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- PURPOSE
We reviewed the amount of impaction and the change of neck shaft angle of intertrochanteric fracture of the femur which were treated with compression hip screw according to the fracture type and the displaced state of the distal fragment.
MATERIALS AND METHODS
There were 50 patients who had at least six months follow up, 13 men, and 37 women who were treated from January 1995 to December 2000. We have analysed the amount of impaction (measurement of the ratio between screw length and screw outside barrel length) and the change of neck shaft angle according to the fracture type and the displaced state of the distal fragment. The results were assessed statistically.
RESULTS
The fracture healing was achieved in about 13 weeks. There were 36 stable fracture types and 14 unstable fracture types by Evans classification. The most common osteoporotic singh index was grade II. The mean impaction amount of the fracture site was 5.4 mm and the mean neck shaft angle change was 1.5degrees of varus angulation. The mean tip apex distance was 32 mm. There was no case of lag screw penetration into the joint. There was significant difference in result according to the displaced state of the distal fragment. The amount of impaction was less in cases that anatomically reduced or got the posterolateralization of the distal fragment.
CONCLUSION
The results of our study indicate that the anatomical reduction and posterolateralization of the distal fragment could reduce the amount of impaction and the change of neck shaft angle. We advise that the position of the distal fragment in intertrochanteric fracture of the femur is very important to reduce the failure.
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Citations
Citations to this article as recorded by  - Comparison of Bone Mineral Density in Elderly Patients according to Presence of Intertrochanteric Fracture
Sang Ho Moon, Byoung Ho Suh, Dong Joon Kim, Gyu Min Kong, Hyeon Guk Cho
Journal of the Korean Fracture Society.2007; 20(3): 222. CrossRef
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Treatement of Diastasis of the Distal Tibiofibular Syndesmosis
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Woo Chun Lee, Han Suk Ko, Cheol Lee, Ki Heon Nam, Kang Hoon Ko, Jong Deuk Rha
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J Korean Soc Fract 2001;14(4):677-684. Published online October 31, 2001
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DOI: https://doi.org/10.12671/jksf.2001.14.4.677
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Abstract
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- PURPOSE
To investigate the indication of transfixation of distal tibiofibular syndesmosis.
MATERIALS AND METHODS
Twenty-two patients were surgically treated for diastasis of the distal tibiofibular syndesmosis and followed for more than one year. The decision to transfix the syndesmosis was made according to the result of intraoperative stress test.
RESULTS
In patients with bimalleolar fracture, good or excellent clinical results were obtained in all patients, and no widening of the medial clear space and I mm or no widening of the tibiofibular clear space was observed. In patients with deltoid ligament tear, good or excellent results were obtained in five patients, and the medial clear space was widened more than 1mm in three patients and tibiofibular clear space was widened 2mm or more in four patients.
CONCLUSION
We believe that transyndesmotic fixation is not required if anatomical bimalleolar fracture fixation is achieved, and in patients who have deltoid ligament rupture, it may be better to transfix the syndesmosis regardless of the level of fibular fracture.
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Assessment of the Stability of the Isolated Lateral Malleolar Fracture
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Woo Chun Lee, Hyun Soo Park, Young Kil Han, Jang Woon Rim, Jong Deuk Rha
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J Korean Soc Fract 1998;11(4):873-879. Published online October 31, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.4.873
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Abstract
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- Recent advances in the understnading of the biomechanics of the ankle have given rise to the clinical uncertainty about the indications for the operative treament of isolated fractures of the lateral malleolus. If deltoid ligament injury is associated, it may be unstable and operation may be indicated. This study was done to determine if we are able to assess the stability of the isolated lateral malleolus fracture based on the fracture patterns seen on radiographs and clinical findings. 37 patients with malleolar fracture of the ankle were treated at Hanil General Hospital by open reduction and internal fixation from Dec. 1996 to Jan. 1998. Lauge-Hansen classification was tried in all cases to determine if it could be applied. Stress test under anesthesia on 10 isolated lateral malleolar fracture patients with clinical findings of injury on the deltoid ligament area, whose medial clear space were normal or widened less than 2 mm on initial film. Exploration of the deltoid ligament was performed in 6 of above 10 patients There were 21 supination-external rotation type injuries, 2 supination-adduction injuries, 1 pronation-abduction injury and 13 fractures could not be clearly categorized into specific group. In 6 among 13 unclear cases, there were short oblique fracture lime indicating pronation injury, but direction of the fracture line could not be clearly determined. In 4 cases, direction of the fracture lime indicated pronation injury, but the length of the fracture line was too long. In 3 cases, both the direction and length of the fracture line was indeterminate. The stress test on 10 isolated lateral malleolar fraactures with clinical findings of deltoid injury revealed less than 2 mm widening in 7 cases, more than 2 mm widening in 3 cases. In 3 cases with less than 2 mm widening, tearing of anterior third of superficial deltoid was confirmed by exploration. In 3 cases with more than 3 mm widening, partial rupture of the deep deltoid was observed in 2 cases and anterior third of superficial deltoid was torn in 1 case.
We suggest that we cannot clearly assess the stability of isolated lateral malleolar fracture either by fracture patterns or clinical findings, so stress test can be considered in determining the stability.
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Interlocking Intramedullary Nailing of Femoral Shaft Fractures in Adolescents
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Chil Soo Kwon, Jong Kuk Ahn, Jin Hyok Kim, Byung Hyun Jung, Yerl Bo Sung, Hyung Jin Jung, Jong Deuk Rha, Woo Chun Lee, Hyun Soo Park, Myung Ho Lee, Bu Maan Kim
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J Korean Soc Fract 1996;9(4):914-920. Published online October 31, 1996
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DOI: https://doi.org/10.12671/jksf.1996.9.4.914
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Abstract
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- Although treatment of femoral shaft fractures by traction and casting satisfactory in young children, it is less useful in obtaining and maintaining satisfactory alignment in adolescent patients. Residual angulation, malrotation. and leg length inequality is well documented. The options for surgical treatment of femoral shaft fractures in adolescents include extemal fixation, plate fixation, and intramedullary nailing. Surgical treatments carry the-risks of growth plate damage and infection, but these risks are very low. Recently, it is generally anepted that adolescent femoral shaft fractures are preferably treated by intramedullary nailing with care taken to avoid damaging the distal femoral physis.
The authors experienced 9 femoral shaft fractures in 8 patients treated with interlocking intramedullary nails from August 1989 to May 1994, and followed up for more than 18 months(range from 18 to 45 months). The results were as follows: 1. There were 6 cases in male, 2 cases in female. Average age at the time of injury was 13 years(range, 11-14).
2. All fractures were united, and the nails were removed at an average 13.3 months after operation: no refracture or femoral neck fracture has since occured.
3. None had angular or rotational malunions, infection and avascular necrosis of femoral head.
The average leg-length discrepancy at the last follow-up was 0.5cm(range, 0-1.0cm) and all were clinically acceptable.
Coxa valga due to premature closure of trochanteric apophysis was not found.
The average femoral neck-shaft angle was 133(130~138) at the last follow-up. So, interlocking intramedullary nailing is a reasonable alternative for the treatment of femoral shaft fracture in adolescents.
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Clinical analysis of fixation failure in the treatment of intertro chanteric fracture of the femur
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Jong Deuk Rha, Young Hoon Kim, Sung Il Yoon, Jun Soon Kang, Duck Hyun Park
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J Korean Soc Fract 1991;4(2):298-305. Published online November 30, 1991
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DOI: https://doi.org/10.12671/jksf.1991.4.2.298
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Abstract
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- No abstract available.
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