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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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 Abstract
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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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Abstract
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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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Abstract
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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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