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Comparison between Ender Nail and Interlocking Nail in The Treatment of Infra-isthmic Tibial Shaft Fracture
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Seung Wook Yang, Moo Ho Song, Hyung Taek Park, Sun Jin Choi
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J Korean Soc Fract 2001;14(4):651-659. Published online October 31, 2001
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DOI: https://doi.org/10.12671/jksf.2001.14.4.651
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 Abstract
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- PURPOSE
To compare the clinical results between Ender nail and interlocking nail in the treatment of infra-isthmic tibial shaft fracture.
MATERIALS AND METHODS
The authors analyzed 44 cases of infra-isthmic tibial shaft fracture treated with Ender nail(23 cases) as a group 1 or interlocking nail(21 cases) as a group 2 from 1994 to 1998. Fracture type was divided by AO classification, and measured the fracture level, the time of bone union and angular deformity was checked with roentgenograms. The functional results were compared using the criteria by Klemm and Borner.
RESULTS
Distal end of fracture line from ankle joint shows no difference between two groups(P>0.05). Mean operation time was 96 minutes in group 1 and 140 minutes in group 2(P<0.05). Mean intraoperative blood loss was 103cc in group 1 and 254cc in group 2(P<0.05). Mean bone union time was 19.26 weeks in group 1 and 24.81 weeks in group 2. There was no significant difference between two groups in the angulation(P>0.05) and the functional results by Klemm and Borner.
CONCLUSION
Ender nail is a good method of treatment in infra-isthmic tibial fracture when isthmic portion of tibia is too narrow, or insertion of distal interlocking screws were too difficult to insert because of the severe soft tissue injury. The stability of fixation can be strengthened with a three point fixation as fanning of the nails in the distal fragments using more than 3 nails selecting a 1cm longer nail than the ordinary nail length for diaphyseal fracture.
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Malalignment of Tibial Fracture Following Interlocking Intramedullary Nailing
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Seung Wook Yang, Hyung Taek Park, Kuen Tak Suh
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J Korean Soc Fract 2000;13(2):236-243. Published online April 30, 2000
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DOI: https://doi.org/10.12671/jksf.2000.13.2.236
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Abstract
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- PURPOSE
: The purpose of this study was to evaluate the incidence and the factors that influence on malalignment following interlocking nailing for tibial fracture.
MATERIALS AND METHODS
: The authors analysed 59 patients, 60 cases tibial fracture treated with interlocking intramedullary nailing from 1993 to 1997 about nail insertion site, nail entrance angle and fracture type with roentegenogram. Malalignment was defined as 5 degree or more angular deformity in varus-valgus, 10 degree or more angular deformity in anterior-posterior plane.
RESULTS
: Malalignment was found in 15 cases out of 60(25%). We found malalaignment in 7 cases out of 11(64%)in proximal fracture, 6 cases out of 29(21%) in middle fracture, 2 cases out of 20(10%) in distal fracture(p<0.001). Correlation between nail insertion site or medial entrance angle and angular deformity was higher in proximal fractures. In midshaft wedge fractures, direction of main fragment influenced on the axial alignment.
CONCLUSION
: Centromedullary nail orientation is required to prevent malalignment after interlocking intramedullary nailing. Precise selection of nail insertion site and nail entrance angle under the C-arm control in proximal tibial fracture is necessary. Fracture type and fragment direction must be considered during tibial nailing in comminuted tibial fracture.
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Ender nailing For Intertrochanteric Fracture of the Femur in the Elderly patients
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Hak Yeong Jeong, Seung Wook Yang, Seung Joon Shin, Hyeong Joon Seung
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J Korean Soc Fract 1998;11(4):745-753. Published online October 31, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.4.745
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- The principle of treatment of intertrochanteric fracture is early operation and early rehabilitation. The morbidity and mortality associated with intertrochanteric fracture are remained high because the elderly patient generally have a reduced tolerance for prolonged bed rest, lengthy operation and blood loss. Since Ender introduced the concepts of multiple flexible intramedullary nailing in 1970, Ender nailing has been mostly used in intertrochanteric fracture of the elderly patient, but it has been rarely used for unstable fracture. The authors analysed 87 cases of intertrochanteric fractures of femur over 60 years old, treated with Ender nailing during period from July, 1998 to October, 1996. The results were as follows : 1. Among 87 cases, 70 cases were female and average age was 75.3 years old. 2. The common complications were knee pain and LOM(10%) and distal migration of nails(3%). 3. These complications were reduced by careful bending of nails, fanning of nails in femoral head, stacking of medullary canal and accurate placement of portal hole. 4. 10 patients died within 1 year(Mortality rate : 11%). 5. Thirty-six(47%) patients maintained their prefracture ambulatory ability at a postoperative 1 year ; Fourty-one(53%) patients lost some degree of ambulatory ability. 6. In unstable intertrochanteric fracture, we can achieved good results by Ender nailing in valgus reduction.
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Fracture-Separation of The Distal Humeral Epiphysis
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Hak Yeong Jeong, Seung Wook Yang, Jae Woong Shim, Seung Joon Shin, Jeong Tae Kim
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J Korean Soc Fract 1998;11(3):650-657. Published online July 31, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.3.650
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- A fracture-separation of the distal humeral epiphysis in children is an extremely rare injury and presents problems in diagnosis, radiographic interpretation and management. From June 1992 to December 1996, Authors experienced the 5 cases of Salter - Harris type II injury of the distal humeral epiphysis at Department of Orthopedic Surgery, Pusan Maryknoll General Hospital. The patient were followed up from one year nine months to three years four months. The two cases were treated by closed reduction and percutaneous K-wire fixation and the three cases by open reduction and internal fixation with K-wires.
There were 4 cases of complication seldom reported following fracture-separation of the distal humeral epiphysis. This complications consist of 4 dissolutions of trochlea, which is one, frank avascular necrosis of trochlea. In 3 cases with open reduction developed the cubitus varus & dissolution of trochlea. We speculate that this complications results from avascular necrosis of distal end of humerus. Attention to change of carrying angle and radiographic change of distal humeral end are important in detection of complication & evaluation of etiology of dissolution of distal humeral end.
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Fracture of Olecranon Treated by K-wire and Tension Band Wiring Technique in Adults
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Hak Yeong Jeong, Seung Wook Yang, Jae Woong Shim, Beyong Seon Kong
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J Korean Soc Fract 1997;10(3):651-657. Published online July 31, 1997
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DOI: https://doi.org/10.12671/jksf.1997.10.3.651
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Abstract
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- Displaced fractures of olecranon in adults require operative treatment. The goal of treatment is to rigidly fix the fracture fragment, to anatomically restore the joint surface and to allow range of motioin early.
Authors treated fractures of olecranon by open reduction and internal fixation using K-wire and tension band wiring technique in 38 adult patients from April 1989 to October 1995 at the Department of Orthopedic Surgery, Maryknoll Hospital. This article documents the study of relationship between the treatment result and involvement of articular surface, articular step-off and gap of articular surface.
The results were as follows ; 1. The clinical results were good or fair in 31 cases(82%) according to the criteria by Helm et al.
2. Involvement of articular surface, step-off and gap of articular surface affected the results.
3. The clinical results were satisfactory in patients with postoperative step-off less than 2mm and postoperative gap of articular surface less than 2mm.
4. The clinical results were satisfactory in patients with articular involvement less than 60%.
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The Treatment of Infected Fracture of Long Bones
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Hak Yeong Jeong, Seung Wook Yang, Young Cheol Shin, Jae Woong Shim
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J Korean Soc Fract 1995;8(3):678-687. Published online July 31, 1995
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DOI: https://doi.org/10.12671/jksf.1995.8.3.678
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- The increase in incidence and severity of open injury to bone and surrounding soft tisseues from vehicular and industrial accidents, and the aggressive surgical approach of open reduction and internal fixation of closed fractures contribute to a definite rise in acute wound infection in fracture management.
The main objectives are twofold in the treatment of infected fractures, the first to diagnose infection early and the second to treat it effectively and to prevent it from spreading into bone. To solve these problems, we used some principles of treatment, those are meticulous debridement of infected tissue, management of soft tissue and bony defect and maintenance of fracture stability.
From Jan. 1988 to Dec. 1993, we treated 23 infected fractures of long bone and the result were as follows.
1. The infected fractures were femur in 9 and tibia in 14 cases.
2. There were 14 open fractures and 9 closed fractures.
3. In closed fracture, the first infection sign was developed average 7.8 days after open reduction, and average 9 days after trauma in open fracture.
4. The most common causative organism was staphylococcus aureus.
5. Infection was controlled from 3 months to a year and 8 months.
6. The number of soft tissue and bone debridement was one to four times.
7. Bony union was achieved from 6 months to 2 years in tibia and 6 months to 2 years and 1 month in femur.
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Surgical Treatment of the Patellar Fractures
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Hak Yeong Jeong, Seung Wook Yang, Young Cheol Shin, Han Sung Park, Tae Ho Joo
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J Korean Soc Fract 1995;8(3):578-585. Published online July 31, 1995
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DOI: https://doi.org/10.12671/jksf.1995.8.3.578
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- Recently the incidence of the patellar fracture has been increasing because of frequent traffic accidents and industrial accidents, and its treatment is considered very important due to the involvement of the articular suface occurs in most of the cases. Comminuted displaced fractures of the patella which are difficult to reduce accurately and to get stable internal fixation, may lead to traumatic osteoarthritis, chondromalacia, extension lag and limited ROM of the knee joint.
The retrospective review was undertaken of 49 patients with patellar fractures treated by surgical methods and a follow up of more than 1 year at the Department of Orthopaedic Surgery at Maryknoll Hospital between Aug. 1987 and Jan. 1994.
The findings were as follows: 1. Most fractures were encountered in man from twenties to forties.
2. The most common cause of fractures was traffic accident, followed by slip down or fall down.
3. Comminuted fracture was the most common type in this series.
4. Large separated fragments of the patella should be accurately reduced with rigid fixation in the rationale of the intraarticular fracture.
5. The most favorable results were obtained by Modified Tension Band Wiring with supplementary oircurnferential wiring for comminuted fractures and the result was superior to other operative methods.
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Fracture of Distal Radius Treated with Open Reduction and Internal Fixation
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Bak Yeong Jeong, Seung Wook Yang, Young Cheol Shin, Young Ho Kim
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J Korean Soc Fract 1994;7(2):501-511. Published online November 30, 1994
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DOI: https://doi.org/10.12671/jksf.1994.7.2.501
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Abstract
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- Seventeen cases of unstable comminuted fractures of distal radius were treated with open reduction and internal fixation from Jul. 1988 to Apr. 1992 at the department of orthopaedic surgery at Maryknoll Hospital. Most of the fractures were the resutts of high-energy impact and the results of this study were as follows: 1. According to Fernandez classification, the type A 3.2 fracture was most common, and nine of 17 patients were classifled as C2 and C3 (intra-articular comminuted fracture) and eight as A3(extra-articular comminuted fracture).
2. The final result of wrist motion showed dorsiflexion/palmar flexion to be 77.6% of the opposite site and of the grip strength was 80.6% of the opposite site.
3. In the cases of extra-articular comminuted fracture, attention was focused on restoration of radial length, and in the cases of intra-articular fracture, better results were obtained with achieving congruent articular reduction.
4. The funtional end results were superior especially in young patients.
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Operative Treatment with Plate Screw Devices for Distal Femoral Fracture
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Hak Yeong Jeong, Seung Wook Yang, Young Cheol Shin, Han Sung Park
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J Korean Soc Fract 1994;7(2):512-521. Published online November 30, 1994
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DOI: https://doi.org/10.12671/jksf.1994.7.2.512
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- Until 1960, conservative managemant was considered superior to operative treatment of distal femoral fracture. But with advancement of new fixation divices and techniques, open reduction and internal fixation is recent trend.
From May, 1986, to May, 1993, at Pusan Maryknoll hospital, the results of 39 cases of distal femoral fracture treated operatively with plate screw devices were analyzed after minimum follow up of 1 year according to the rating system of Schatzker and lambert.
The results were as follows: 1. Average radiologic union time was 16.3 weeks.
2. According to Schatzker and Lamberts criteria, excellent was 17 cases, good in 13 cases, fair in 5 cases and failure in 4 cases.
3. For fixation of distal femoral fracture with severe comminution at metaphyseal portion, the condylar blade plate and dynamic condylar screw showed better result than anatomical plate.
4. With extensile approach, the dynamic condylar screw showed excellent result for distal femoral fracture with intraarticular comminution.
We concluded that wide exposure enough for accurate reduction of fracture fragments aud joint surface and rigid internal fixation were the cornerstone for treatment of the distal femoral fracture.
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