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Two-Stage Reconstruction of Infected Nonunion of Long Bones using Antibiotics-Impregnated Cement Beads
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Se Hyun Cho, Soon Taek Jeong, Hyung Bin Park, Sun Chul Hwang, Yong Chan Ha, In Hwan Hwang
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J Korean Fract Soc 2004;17(4):395-400. Published online October 31, 2004
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DOI: https://doi.org/10.12671/jkfs.2004.17.4.395
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 Abstract
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- PURPOSE
To evaluate treatment results between internal and external fixation groups in two-stage reconstruction of infected nonunion of long bones using antibiotics-impregnated cement beads.
MATERIALS AND METHODS
In the first stage, preexisting hardwares were removed and radical debridement was done. The dead space was filled with antibiotics -impregnated cement beads and the nonunion site was immobilized by external fixation, cast or skeletal traction. In the second stage, all cases were divided into two groups; the nonunion was fixed by internal fixation in group I versus external fixation in group II. The intervening period between the first and second stage was average 8.7 weeks (range, 3~23 weeks).
RESULTS
The follow-up period was average 45 months (range, 16~71 months). Infection control and bone union were achieved in all 13 cases of group I. Infection recurred in two of 28 cases in group II, one underwent above-knee amputation and the other case was lost in follow-up. The mean number of supportive operations including repeated curettage, augmentation and change of infected pins, angular correction, and soft tissue flap was average 2 and 6.2 times respectively in group I and group II. Bony union period was average 19.3 and 23.1 weeks in each group. According to Paley's classification, group I was similar to group II in bony and functional result (p>0.05).
CONCLUSION
Antibiotics-impregnated cement beads provided positive effect on infection control. Internal fixation group showed less number of additional operations and earlier bony union than external fixation group.
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Citations
Citations to this article as recorded by  - Treatment of Infected Nonunion
Sang-Ho Ha
Journal of the Korean Fracture Society.2007; 20(2): 206. CrossRef
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Screw breakage in tibial interlocking nailing
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Hyung Bin Park, Bun Jung Kang, Hae Ryong Song, Kyong Hoi Koo, Soon Taek Jeong, Se Hyun Cho
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J Korean Soc Fract 2002;15(4):483-488. Published online October 31, 2002
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DOI: https://doi.org/10.12671/jksf.2002.15.4.483
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Abstract
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The aims of this study were to investigate the prevalence and the causes of screw breakage in tibia nailing.
MATERIALS AND METHODS
Between 1995 and 2000, eighty-two tibial diaphyseal fractures were treated with interlocking nails. The loss of follow-up was 7 cases. We retrospectively reviewed seventy-five cases. We investigated the rate and location of metal failure and evaluated the fracture pattern, the presence of distraction after nailing and union abnormality.
RESULTS
Screw breakage was identified in seven cases (9.3%) and most frequently occurred on the second proximal locking screw. Screw breakage occurred in AO type B or C type fractures, fracture site distraction after nailing, open fracture, delayed union and nonunion.
CONCLUSION
The main cause of screw breakage is unstable bone to bone contact on the fracture site caused by comminution or distraction. The open fracture, delayed union, and nonunion also contributing factors for screw breakage. For preventing screw breakage, it is necessary to avoid fracture site distraction and delay full weight bearing in cases having unstable fracture site contact.
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Citations
Citations to this article as recorded by - Clinical Outcomes of the Tibia Segmental Fractures Treated by Intramedullary Nail Using Various Reduction Techniques
Oog-Jin Shon, Ji-Hoon Shin, Chul-Wung Ha
Journal of the Korean Fracture Society.2013; 26(1): 50. CrossRef
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The Effect of Low Intensity Ultrasound on Distraction Osteogenesis in the Rabbit Femur
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Hyung Bin Park, Hae Ryoung Song, Kyung Hoi Koo, Soon Taek Jeong, Bun Jung Kang, Se Hyun Cho
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J Korean Soc Fract 2002;15(2):159-165. Published online April 30, 2002
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DOI: https://doi.org/10.12671/jksf.2002.15.2.159
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Abstract
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The effects of ultrasound on mechanical properties of the callus in distraction osteogenesis was assessed in this study.
MATERIAL AND METHOD: Forty mature New Zealand white rabbits were divided into two groups (ultrasound group and control group). A midshaft femoral osteotomy was made and fixed with a small external fixator. After a latent period of a week, lengthening was performed at the rate of 1mm a day for 2 weeks. Low intensity ultrasound (EXOGEN inc, Piscataway, NJ U.S.A) was applied to the operated limb for 20 minutes a day in the ultrasound group, while the control group waited for natural maturation of the callus. The bone mineral density and mechanical properties such as ultimate load, ultimate stress, deflection at ultimate load, ultimate stiffness and energy absorption at ultimate load were measured and analyzed.
RESULT
The bone mineral density, the area of the callus, ultimate load, ultimate stress and energy absorption at ultimate load were not significantly different between the two groups (p>0.05). The ultimate stiffness in the ultrasound group was significantly higher than those of the control group (p<0.01). The deflection at ultimate load in the ultrasound group was significantly lower than those of the control group (p<0.01).
CONCLUSION
The low density ultrasound has a positive effect on the mechanical properties of the distracted callus in the rabbit femoral model in terms of the ultimate stiffness and the deflection at ultimate load.
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Triradiate Approach in Surgical Treatment of Complex Fracture of Acetabulum
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Kang Il Kim, Kyung Hoi Koo, Bun Joong Kang, Hyung Bin Park, Sun Chul Hwang, Soon Taek Jeong, Hae Ryong Song, Se Hyun Cho
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J Korean Soc Fract 2001;14(4):616-622. Published online October 31, 2001
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DOI: https://doi.org/10.12671/jksf.2001.14.4.616
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Abstract
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To determine the advantages of triradiate approach in complex acetabular fractures, the results were reviewed for 24 patients who had open reduction and internal fixation of complex acetabular fractures with a triradiate approach.
MATERIALS AND METHODS
Twenty four patients were followed for a mean of 3 years after the operation. All patients with complex fractures of the acetabulum were treated with open reduction and internal fixation using Y-shaped triradiate incision, osteotomy of the greater trochanter, and arthrotomy of the hip joint. In 13 patients the fracture was fixed with reconstruction plates and in I 1 patients the fracture was fixed with the plates and wires.
RESULTS
All fractures united and no patient required subsequent total hip replacement arthroplasty. Four patients had heterotopic ossification without serious limitation of motion of the hip and one patient had grade IV lesion as defined by Brooker et al, which limited motion of the hip enough to impair function. Six patients showed posttraumatic arthritis at the latest radiograph. The overall clinical result was excellent for 7 hips, good for 13, and fair for 4 as defined by d' Aubigne and Postel. The radiological result was excellent for 13 hips, and good for 6 as defined by Matta. One femoral head necrosis was observed at the latest follow-up.
CONCLUSION
A triradiate approach provides a good extra and intraarticular access to complex fracture of the acetabulum, which facilitates an accurate reduction, rigid fixation, removal of loose osteochondral fragments and management of labial injury, without increased morbidity of the hip joint.
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Posterior stabilization of the Unstable Pelvic Ring Fracture
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Soon Taek Jeong, Ji Yeon Kim, Se Hyun Cho
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J Korean Soc Fract 1996;9(3):513-517. Published online July 31, 1996
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DOI: https://doi.org/10.12671/jksf.1996.9.3.513
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Abstract
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- Stable pelvis fracture is easily treated by conservative treatment with little complication. Unstable pelvic ring fracture, however, is difficult to manage due to various problems. Conservative treatment is rarely indicated because prolonged traction and immobilization often lead to life-threatening complications. The malunion produces pain, limb length discrepancy and eventually poor life quality, Surgical stabilization can help easy care of patients, early mobilization and diminish the morbidity.
This study is to present the clinical results of two kinds of metal fixations using seven transiliac bars and four percutaneous sacral screws for the surgical stabilization of the unstable pelvic ring fractures. Total eleven cases had been operated by the authors at Geyong-Sang national hospital from August 1991 to April 1994. They were eight male and three female patients of average forty one years in age(range, eighteen to sixty two years). The average duration of follow-up was thirty one months(range, twenty to fifty three months).
All cases of sacral screw fixations revealed satisfactory results both at clinical and radiological aspects. Out of seven cases of transiliac bar fixation, there were two cases of minor infection and three cases of painful and palpable hardware requiring removal, especially in thin patients. The results confirm that sacral screw is better tolerated by thin patients in spite of risk of temporary entrapment of sacral cutaneous nerves.
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