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Acute on Chronic Stress Fracture of a Varus Deformed Distal Tibia - A Case Report -
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Seong Kee Shin, Ki Chun Kim, Eli Schmidt, Seung Yeon Cho, Ki Chul Park
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J Musculoskelet Trauma 2024;37(4):184-189. Published online October 25, 2024
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DOI: https://doi.org/10.12671/jmt.2024.37.4.184
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 Abstract
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- A severe post-traumatic distal tibia vara deformity is an uncommon condition in orthopedics. Typical symptoms include intractable recurrent pain, fragility related to stress fractures over the tensile area, and a limping gait caused by leg length discrepancy. Surgical management should be performed on acute fractures extending from a stress fracture gap. For successful surgical results, deformity correction is important for sustaining axial load bearing for standing and walking. Procedures to manage this condition have been proposed, but there is a high risk of complications, including metal failure, nonunion, and weakness caused by a long period of rehabilitation. In this case, the authors report a successful result using a modified clamshell osteotomy combined with a proximal and distal wedge bone resection in a single stage.
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Demographic and Radiographic Parameters as Predictors of Reduction Loss after Conservative Treatment of Distal Radius Fractures in Adults
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Kyu Jin Kim, Dae Won Shin, Seong Kee Shin
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J Korean Fract Soc 2023;36(2):45-51. Published online April 30, 2023
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DOI: https://doi.org/10.12671/jkfs.2023.36.2.45
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- Purpose
This study examined the demographic and radiological risk factors for later reduction loss of distal radius fractures treated conservatively.
Materials and Methods This study enrolled patients treated for distal radius fractures between January 2017 and December 2019. Seventy-eight patients were included in the analysis and divided into two groups. The patients who showed minimal reduction loss within an acceptable radiologic angle after initial manual reduction were classified as Group A. The patients who showed reduction loss out of an acceptable radiologic angle and finally malunited or converted to surgical treatments were classified as Group B. The patient’s age and bone marrow density were used as demographic data. The initial X-ray images were evaluated to determine the fracture type. Various radiological parameters were measured.
Results The 78-patient study cohort consisted of nine men and 69 women with a mean age of 67 years. Forty-eight cases were sorted into Group A, and 30 cases into Group B. On logistic regression analysis, the age of 80 or older was a risk factor for later fracture displacement among the demographic factors (p=0.037, odds ratio=4.937). Among the radiographic factors, the presence of distal ulnar fracture and dorsal cortical comminution were disclosed as risk factors of later displacement (p=0.049, 0.003, odds ratio=3.429, 7.196).
Conclusion When conservative management for distal radius fracture is decided in patients more than 80 years of age or accompanied by a distal ulnar fracture or with dorsal cortical comminution, the possibility of later displacement of the distal radius should be considered.
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Insufficiency Fracture of Simultaneously Bilateral Femur Neck in Patient Treated with Long-Term Bisphosphonate Treatment - A Case Report -
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Seong Kee Shin, Hyung Gon Ryu, Dae Won Shin, Beom Su Han
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J Korean Fract Soc 2022;35(3):109-113. Published online July 31, 2022
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DOI: https://doi.org/10.12671/jkfs.2022.35.3.109
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- Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary.
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Cement Leakage into Disc after Kyphoplasty: Does It Increases the Risk of New Adjacent Vertebral Fractures?
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Hoon Sang Sohn, Seong Kee Shin, Eun Seok Seo, Kang Seob Chang
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J Korean Fract Soc 2011;24(4):361-366. Published online October 31, 2011
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DOI: https://doi.org/10.12671/jkfs.2011.24.4.361
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Abstract
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- PURPOSE
This study aims to investigate the relationship between cement leakage into the disc during percutaneous balloon kyphoplasty and subsequent compression fractures in adjacent vertebrae during treatment of osteoporotic vertebral compression fracture.
MATERIALS AND METHODS
103 patients (118 vertebrae) who have been treated with balloon kyphoplasty due to osteoporotic compression fracture from June 2007 to July 2010 were retrospectively analyzed. The group was composed of 13 males and 90 females. The mean age was 75 years (57~95 years). The mean follow-up period was 10 months (6~30 months). Patients were divided into two groups; one with cement leakage into the disc and the other without cement leakage into the disc. The study was performed to determine whether subsequent compression fractures in adjacent vertebrae were related to several factors.
RESULTS
The cement leakages into the disc occurred in 16 of 118 vertebrae. Of the 16 vertebrae with cement leakage into the disc, 5 (31%) had subsequent adjacent vertebral compression fractures; however, of the 102 vertebrae in which cement leakage did not occur, only 11 (11%) had subsequent adjacent vertebral compression fractures (p<0.05). Of the 16 vertebrae with cement leakage into the disc, subsequent adjacent vertebral compression fractures occurred 1 vertebrae of 10 vertebrae with definite trauma history. Out of the 6 vertebrae with cement leakage and no definite trauma history, 4 vertebrae (67%) had subsequent adjacent vertebral compression fractures (p<0.05).
CONCLUSION
The cement leakage into the disc significantly increases the incidence of subsequent adjacent vertebral compression fractures. Most of the subsequent fractures occurred in the early post-operative period. When cement leakage into the disc occurred in patients with no definite trauma history such as slip down, the incidence of subsequent adjacent vertebral compression fracture increased significantly.
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