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Treatment of Failed Intertrochanteric Fractures to Maintain the Reduction in Elderly Patients
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Soon Yong Kwon, Hyun Woo Park, Sang Uk Lee, Soo Hwan Kang, Jae Young Kwon, Jung Hoon Do, Seung Koo Rhee
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J Korean Fract Soc 2008;21(4):267-273. Published online October 31, 2008
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DOI: https://doi.org/10.12671/jkfs.2008.21.4.267
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- PURPOSE
The aim of this study was to evaluate and report the new method with a cement augmented screw fixation again to treat the failed intertrochanteric fracture in elderly which were treated with ordinary compression hip screw initially.
MATERIALS AND METHODS
From Mar. 1988 to May 2007, 10 patients (mean age 69 years) with the failed intertrochanteric fracture which were treated with initial hip screw, were treated with a cement augmented compression hip screw again. The mean follow-up after surgery was over 18 months. The cause of failure, the period upto the reoperation, the neck-shaft angle after the reoperation, the position of lag screw in the femoral head, and the degree of union at last follow-up were analyzed. The change in the functional hip capacity were evaluated by the classification of Clawson.
RESULTS
Causes of failure were superior cutting-out in 6 cases, cortical anchorage failure in 3, and nonunion in one case. The period upto the reoperation was average 7.8 months. Valgus reduction of average 5.7degrees was achieved, and the positions of lag screw were postero-inferior in 6 cases, center in 3, infero-center in one case. We obtained complete union in 9 cases. The functional outcome showed moderate in 6 cases, good in 3 and poor degree in one case.
CONCLUSION
Cement augmented compression hip screw treatment will possibly reduce cutting-out of screw and bring more stability in fixation for intertrochanteric fractures in old osteoporotic patients, as well, even in failed cases treated with initial compression hip screw, but proper selection of patients is important.
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Citations
Citations to this article as recorded by  - Safety and Effectiveness of the Anchor Augmentation with Bone Cement on Osteoporotic Femoral Fracture: A Systematic Reviews
So Young Kim
Journal of the Korean Fracture Society.2019; 32(2): 89. CrossRef
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Traumatic Bladder Rupture in Pelvic Fracture - Case Report
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Soon yong Kwon, Woung Kyun Woo, Hwa Sung Lee, Jong Chul Kim, Yong Sik Kim
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J Korean Soc Fract 2002;15(1):77-81. Published online January 31, 2002
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DOI: https://doi.org/10.12671/jksf.2002.15.1.77
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- Pelvic fracture and bladder rupture resulted in bladder wall entrapment in the fracture site of a patient involved in a fall down accident. Although hematuria and bladder rupture are known to occur after fracture of the pelvis, our literature review showed no reports of this type injury or management. Abscess was drainaged and sepsis was managed with fluid and antibiotics treatment. Bladder extravasation was managed with primary repair and surgical extraction of catheter drainage. We report a case of a patient who presented with traumatic bladder rupture in pelvic fracture.
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Impacted Cancellous Allograft and Valgus Fixation of Intertrochanteric Fracture Nonunion
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Soon Yong Kwon, Young Kyun Woo, Jong Min Sohn, Jin Hwa Chung, Jung Ho Lee, Yong Sik Kim
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J Korean Soc Fract 2002;15(1):65-71. Published online January 31, 2002
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DOI: https://doi.org/10.12671/jksf.2002.15.1.65
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Abstract
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- PURPOSE
The aim of this study was attempted to evaluate the effects of impacted cancellous allograft and valgus fixation in the management of nonunion of intertrochanteric fracture of the femur.
MATERIALS AND METHODS
Between June 1995 and October 1999, 5 patients, ranging from 38 to 75 years of age, with nonunion of femoral intertrochanteric fracture, whose primary treatment had been done with compression hip screws, were treated with impacted cancellous allograft and valgus fixation RESULTS: After follow-up from 13 months to 24 months, among the 5 cases, 4 cases resulted in the union in a mean time of 16 weeks, improvement of LLD in a mean length of 0.8cm and good function of abduction, but 1 case resulted in nonunion, followed by total hip arthroplasty.
CONCLUSION
For patients with nonunion of femoral intertrochanteric fracture, impacted cancellous allograft and valgus fixation provide a good result of union.
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Complications and Its Treatment of Ankle Fractures
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In Kim, Seung Ko Rhee, Soon Yong Kwon, Ki Won Kim, Yong Keun Cho, Han Chang, Won Jong Bahk, Nam Kee Lee, Seung Ki Kim
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J Korean Soc Fract 1995;8(4):736-746. Published online October 31, 1995
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DOI: https://doi.org/10.12671/jksf.1995.8.4.736
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- We have investigated total 294 cases of ankle fractures, which were treated and followed for average 17 months after treatment at St. Marys hospital since 1980, to detect the complications and to define their provoking factors. The results were as follows; 1. Twenty-six cases out of total 294 cases of ankle fracture(8.8%) were complicated clinically and radiologically.
2. Their complications are osteoarthritis(8/26, 31%), diastasis of distal tibio-fibular syndesmosis(9/26, 34.6%), varus ankle deformity(5/26, 19.2%), malunion(6/26, 23%), non-union and ankle instability(each 2/26, 7.7%) in its order, but 14 cases of the 26 cases complained painful limited ankle motion and limp. So, clinical symptoms are not closely related with radiologic changes in complications of ankle fracture.
3. The complications are common in elderly patients over 50 of their ages(12.26, 46%) and in younger patients under 16 of their ages(5/26, 20%).
4. The complications are frequently found in pronation-external rotation injuries(6/61, 1O%), pronation-dorsiflexion(9/14, 64%) and supination-external rotation injuries(8/165, 4.8%) in orders.
5. Malpractice with misuse of instrument(12/26, 46%), mistakes in preoperative evaluation and neglect any ankle fracture or diastasis of syndesmosis(8/26, 30.7%) and severity of injuries(6.26, 23%) are common causes of complications of ankle fractures.
6. Varus ankle deformity due to early epiphyseal closure are shown in 5 cases(5/28, 20%) and three of them are treated with supramalleolar corrective osteotomies and Langenskiolds physolysis In conclusion, the complications of ankle fracture could be reduced by accurate pre-operative evaluation to detect the hidden soft tissue injuries or fracture mechanism and by also anatomic reduction, rigid internal fixation and early ankle motions. childrens ankle fracture will induce angular deformity and limb length discrepancy due to frequent epjphyseal damage, so long-term follow up should be kept in mind until their skeletal growth are ceased.
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Management of the Intraarticular and Periarticular Fracture Using a Herbert bone screw: Clinical analysis of Technical Probleus of Surgery and Complications
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In Kim, Young Kyun Woo, Ju Hae Chang, Yong Sik Kim, Seok Whan Song, Soon Yong Kwon, Whan Kun Yoo
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J Korean Soc Fract 1995;8(1):216-227. Published online January 31, 1995
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DOI: https://doi.org/10.12671/jksf.1995.8.1.216
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- 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.
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Surgical Treatment of the Unstable Fractures of the Proximal Humerus: Consideration of Surgery-related Problems and Complications
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In Kim, Young Kyun Woo, Ju Hae Chang, Hyung Min Kim, Yong Sik Kim, Soon Yong Kwon, Yang Su Kim
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J Korean Soc Fract 1995;8(1):126-139. Published online January 31, 1995
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DOI: https://doi.org/10.12671/jksf.1995.8.1.126
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- 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.
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The role of lateral malleolus in normal growth and biomechanics of ankle clinical long term study in growing children
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In Rhee Kim, Yong Sik Kim, Soon Yong Kwon, Kee Won Ryu, Seong Jin Park, Ko Seung
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J Korean Soc Fract 1992;5(1):138-149. Published online May 31, 1992
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DOI: https://doi.org/10.12671/jksf.1992.5.1.138
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- No abstract available.
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