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The Treatment of the Proximal Tibia Fracture -Comparison of the Variable Method of Fixation-
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Dong Heon Kim, Kyu cheol Shin, Kyeong Soon Kim, Byeong Chun Chang, Dae Sul Kang
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J Korean Soc Fract 1998;11(2):442-448. Published online April 30, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.2.442
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- The treatment of proximal tibial fracture is an area of great controversy. Because open and comminuted fractures are common, selection of fixation method of the proximal tibial fracture is more difficult than any other fractures. Many authors reported high rate of malunion and loss of reduction. The purpose of this study is to compare the results of the proximal tibial fractures depending on the fixation method. We evaluated the records of 35 patients (36 fractures) who had been treated with intramedullary nailing, plate and screws and external fixation from January 1989 to January 1996. The mean period of follow-up was 12months. Of the 36 fractures, 8 fractures were with intramedullary nailing, 12 fractures with plate and screws, 16 fractures with external fixator. In intramedullary nailing groupp, the average time of bony union was nineteen weeks (16-27), in plate and screws fixation group twenty three weeks (18-31) and in external fixation group 22 weeks (19-29). The complications of intramedullary nailing group were 3 nonunions, 1 delayed union, 1 varus deformity, 2 anterior angulations and 2 cases of deep wound infection. The complications of plate and screws group were 1 nonunion, 3 delayed union, 1 deep wound infection, 2 superficial infections and in most fractures partial stiffiness of knee joint. The complications of external fixator group were 1 nonunion, 1 delayed union, 1 deep wound infection, 6 pin tract infections and 3 cases of knee joint stiffness. In our cases, if there is open wound higher than Gustilo grade III-B and severe comminuted fracture initially, the external fixation is more preferred for wound management and also more advantageous method for the patients who got a multiple trauma in abdomen, chest and head injuries. In closed fractures and Gustilo grade I, II open fractures, intramedullary nailing is considered to be more preferable method. But the anatomy of proximal tibia made nailing these fractures technically difficult. In conclusion, we consider each method of fixation is useful fixation method of the proximal tibial fractures, but each method should be selected advertently depending on the severity of soft tissue injury and the degree of comminution of the fractures.
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Treatment of Open Segmental Fracture of the Tibia
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Kyeong Soon Kim, Kyu Chul Shin, Dong Hyeuk Kim, Dong Heon Kim
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J Korean Soc Fract 1998;11(1):205-213. Published online January 31, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.1.205
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Abstract
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- Tibial segmental fractures are considered special type of lesion and pose many problems and the results often are unsatisfactory. We performed retrospective study of the 17 cases of open tibial segmental fracture which were treated from January 1990 to December 1995 and evaluated the efficacy of the external fixation and intramedullary nailing. The segmental fracture were classified according to the Melis classification and open fracture were classified according to the Gustilo-Anderson classification. After average follow-up of 16 months (range, 12 to 24 months), all of the fractures had healded except one. The results were as follows: 1. The average time of union was 22.5 weeks in the case of intramedullary nailing (Endernail; 26 weeks, Interlocking IM nailing; 21 weeks) and 31 weeks in the case of external fixation (Monofixator; 28 weeks, Ilizarov external fixator; 34 weeks).
2. Nonunion and osteomyelitis was developed in one case of Ilizarov external fixation and 5 cases of pin tract infection were also developed. Among 8 cases of external fixation group, 4 cases of delayed union and one case of malunion were developed.
3. In intramedullary nailing, delayed union was developed in 4 cases.
4. The functional results by Tile rating system were showed good in 6 cases, acceptable in 8 and poor 3. In concla\usion, intramedullary nailing provided better ressults thanexternal fixator in open segmantal tibial fractures, but we consider fixation device should be selected depending on the fracture type, degree of comminution and condition of the soft tissue.
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Ender Nailing of Humeral Shaft Fractures
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DONG HEON KIM, KYU CHUL SHIN, KYEONG SOON KIM, SANG HAK LEE
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J Korean Soc Fract 1997;10(3):614-620. Published online July 31, 1997
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DOI: https://doi.org/10.12671/jksf.1997.10.3.614
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- Most humeral shaft fractures are treated conservatively. However, in the event of failure of closed reduction, pathologic fractures, multiple fracture, multiple associated injury and severe neurologic disorder, operative treatment may be indicated. The purpose of this article is to evaluate the effectiveness of Ender nailing for the humeral shaft fracture of the patients who have multiple fracture, multiple associated injury and pathologic fractures. Authors treated 56 patients with humeral shaft fractures by flexible intramedu-llary stabilization- Ender nail or Ender nail with Rush pin 47 cases were treated closed method, 9 cases were treated by open method. Period of follow-up was average 16 weeks. Fractures were united by an average 12 weeks(range : 9 to 20 weeks). There were no non-union, infection and malunion. No backing out of nails occured. In conclusion, Ender nailing is effective treatment for the humeral shaft fracture to decrease hospital stay, to permit early range of motion of the shoulder and elbow joint.
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Citations
Citations to this article as recorded by  - Contributing Factors of Radial Nerve Palsy Associated with Humeral Shaft Fracture
Tae-Soo Park, Joon-Hwan Lee, Tai-Seung Kim, Kwang-Hyun Lee, Ki-Chul Park
Journal of the Korean Fracture Society.2008; 21(4): 292. CrossRef
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Comparision of Ender Nailing with Sliding Screw Plate Fixation in Intertrochanteric Fracture
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Dong Heon Kim, Young Roon Kim, Kyeong Soon Kim
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J Korean Soc Fract 1994;7(2):545-552. Published online November 30, 1994
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DOI: https://doi.org/10.12671/jksf.1994.7.2.545
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- A sliding screw plate is the most commonly used device for the fixation of intertrochanteric hip fractures, providing secure fxation and controlled impaction but several complications, such as penentration of lag screw, back out of lag screw, wide skin incision and relatively long operation time, have been reported. An intramedullary device has been introduced as an alternative method. Ender nailng for intertrochanteric fracture of femur has many advantages such as minimal operative trauma and blood loss, short operation time, low incidence of infection, good stability of fracture and early ambulation.
The authors have treated 45 cases of intertrochateric fracture from March 1988 to July 1994 with sliding screw plate(25 cases) or Ender nailing(20 cases).
The results are as follows : 1. The ratio between men and women was 1 : 1.5 and the average age was 69 years old.
2. The most common causes were slip down injury followed by traffic accident and fall down injury.
3. Follow-up period was 16 to 34 monthes(average 23 monthes).
4. The most common type of fractures was Tronzo type III.
5. The average bony union time was about 14.2 weeks in sliding screw plate group and 15.1 weeks in Ender nailing group.
6. The most common complications were progressive varus deformity in SSP group and pain & limited ROM of knee joint in Ender nailing group.
7. The outcome was satisfactory in both group.
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