-
Management of the Intraarticular and Periarticular Fracture Using a Herbert bone screw: Clinical analysis of Technical Probleus of Surgery and Complications
-
In Kim, Young Kyun Woo, Ju Hae Chang, Yong Sik Kim, Seok Whan Song, Soon Yong Kwon, Whan Kun Yoo
-
J Korean Soc Fract 1995;8(1):216-227. Published online January 31, 1995
-
DOI: https://doi.org/10.12671/jksf.1995.8.1.216
-
-
 Abstract
 PDF
- 32 cases of intraarticular and periarticular fractures treated with the Herbert bone screw were analyzed retrospectively by radiographic and functional assessment in the department of orthopaedic surgery of Catholic University Medical College from 1989 to 1994.
1. According to the anatomical distribution, there were various fracture sites as follows: 11 cases of carpal scaphoid, 7 cases of distal humerus, 4 cases of proximal radius, 3 cases of proximal humerus, 3 cases of femoral head,2 cases of distal radius, metacarpal head and medial malleolus in each 1 case.
2. Early and late radiographic assessment showed some complications as follows: 1) Through early radiographic assessment, there were 2 cases of inaccurate reduction of fracture fragment,2 cases of inappropriate fixation (out of bone) and 1 cases of insecure fixation followed by displacement of fracture fragment.
2) Through late radiographic assessment, there were 3 cases of posttraumatic arthritis, 2 cases of avascular necrosis of the osteochondral fracture fragment ; Of 3 cases of posttraumatic arthritis, 2 cases were related to the progressive protrusion of screw head resulting from degenerative thinning of the articular cartilage. Through this study, it was stressed that 1. Fracture personality must be evaluated for the appropriate use of Herbert screw, considering the fracture pattern and sites.
2. The head including a trailing thread must be inserted into the subchondral bone to prevent the protrusion of screw head, being aware of the progressive thinning of cartilage resulting from the inevitable posttraumatic arhritis or avasculsr necrosis of fracture fragment.
3. In the cases of osteochondral fracture deserving the shear force by musculotendinous pulling and joint motion, Herbert screw seems to be undesirable.
4. The Herbert screw is effective method, but needs skill and experience if errors are to be avoided.
-
Surgical Treatment of the Unstable Fractures of the Proximal Humerus: Consideration of Surgery-related Problems and Complications
-
In Kim, Young Kyun Woo, Ju Hae Chang, Hyung Min Kim, Yong Sik Kim, Soon Yong Kwon, Yang Su Kim
-
J Korean Soc Fract 1995;8(1):126-139. Published online January 31, 1995
-
DOI: https://doi.org/10.12671/jksf.1995.8.1.126
-
-
Abstract
PDF
- Authors reviewed and analyzed the 96 cases of the unstable proximal humerus fracture surgically managed in the department of orthopaedic surgery of Catholic University Medical College from 1981 to 1993. Analysis dealt with the fracture classification, the clinical assessment, surgical method and related complication, operative result. The overall results were as follows 1. According to the classification by Neer (1970),46 cases were 2 part fracture, 16 cases 3 part fracture,24 cases 4 part fracture,8 cases fracture -dislocation and 2 cases head splitting fracture; of 8 cases of fracture-dislocation,2 cases(3part-1/4part-1) were the iatrogenic displaced cases during manual reduction of 2 part fracture-dislocation.
2. The surgical methods were as follows; for fracture fixation of 80 cases, buttress T-plate in 48 cases, Rush pin and wire in 9 cases, cancellous screw and wire in 8 cases, Steinmann pin and wire 8 cases, Seidle nail in 3 cases, Herbert screw and wire in 1 case and Steinmann pin in 1 case were used respectively. Herbert screw was used in 6 cases for major or supplementary fixation. And joint replacement in 16 cases(14 hemiarthroplasty/2 total arthroplasty ) were performed.
3. The Operative results were analyzed with postoperative radiograph 1) Of 80 cases of open reduction; adequate reduction in 51 cases, inadequate reduction in 21 cases(varus-9, valgus-4, malreduction of greater tuberosity-4, highly located implant-3, excessive shortening-1), insufacient fixation in 5 cases, joint penetration of screw in 2 cases, iatrogenic shaft fracture in 1 case.
2) Of 16 cases joint replacement; adequate replacement in 12 cases, improper fixation or management of greater tuberosity in 3 cases, inappropriate retrotorsion of humeral component in 1 case.
4. Functional assessment by Neers method was done as follows: Of 80 cases open reduction group, excellent and satisfactory results in 59 cases, unsatisfactory and failure results in 21 cases. of 16 cases joint replacement group, satisfactory results in 10 cases and unsatisfactory results in 6 cases.
5. Complications occurred as follows: 1) Of 80 cases of open reduction; malunion with joint stiffness 26 cases, impingement in 4 cases, fixation loss in 3 cases, axillary nerve palsy, distant pin migration and avascular necrosis of humeral head in each 1 case.
2) Of 16 cases of joint replacement; joint stiffness in 7 cases, loosening of humeral component in 4 cases, nonunion of greater tuberosity and axillary nerve in each 1 case.
|
E-submission
KFS
