Tibialis anterior muscle hernia is the most common hernia among lower extremity muscles. This condition can be diagnosed by physical examination and radiologic findings, especially by dynamic ultrasonography. There are surgical methods of treatment for muscle hernia, including direct repair, fasciotomy, fascial patch grafting using autologous fascia lata or synthetic mesh. We report a case of tibialis anterior muscle hernia treated with local periosteal rotational flap. Because there are several advantages to the local periosteal rotational flap, such as lack of donor site morbidity, lack of skin irritation, low cost, simplicity, and an easy approach, this technique could be an option for tibialis anterior muscle hernia.
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Muscle hernias of the leg: A case report and comprehensive review of the literature Jesse T Nguyen, Jenny L Nguyen, Michael J Wheatley, Tuan A Nguyen Canadian Journal of Plastic Surgery.2013; 21(4): 243. CrossRef
PURPOSE To compare and analyze length change of patella tendon after intramedullary nailing of tibial shaft fracture using transtendinous approach. MATERIALS AND METHODS Thirty-two cases were analyzed from December, 1999 to December, 2005. Insall Salvati ratios were estimated. Severity of initial trauma, duration of nail retension, knee function and pain on change of length of patellar tendon was evaluated. RESULTS Mean duration of nail retention was twenty-two months. The shortening of patella tendon was observed in 25 cases (p<0.001). The effect of AO type and the duration of nail retension on the decrease of Insall Salvati ratio was not significant (p>0.05, p=0.778). Lysholom score decrease to 89.5. There was no significant difference between the shortening of patellar tendon length and knee pain (p=0.058). CONCLUSION After intramedullary nailing for closed tibia fracture, shortening of patellar tendon length is observed. That is irrelevant to the fracture type and the duration of nail retension. The shortening of patella tendon length may contribute to decreasing of knee function, but it was no significance of knee pain after intramedullary nailing.
PURPOSE To evaluate the anatomic and functional outcome of retrograde intramedullary single wire fixation for metacarpal shaft fractures of the little finger. MATERIALS AND METHODS hirty one consecutive patients with closed metacarpal shaft fractures of the little finger who have been treated with retrograde intramedullary single wire fixation were evaluated. Fracture union and angulation were analyzed radiologically, and clinical evaluations were performed including range of motion, DASH score and complications. RESULTS Fracture union was achieved in all cases and callus formation was obvious at postoperative 41 days. Average angulation of fracture site was 3degrees in the coronal plane and 1.2degrees in the sagittal plane at the last follow up and no measurable metacarpal shortening was observed. Mean TAM was 253degrees and DASH score was 2.6. There were two cases of pin migration as intermediate complications. CONCLUSION Closed reduction with subsequent percutaneous retrograde K-wire fixation produced good radiological and functional results. We recommend this minimally invasive technique which provides adequate fixation of displaced little finger metacarpal shaft fractures with good functional results and low morbidity.
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The Treatment Outcomes of the Metacarpal Shaft and Neck Comminuted Fractures Using Modified Percutaneous Retrograde Intramedullary Kirschner Wire Fixation Seok Woo Hong, Young Ho Lee, Min Bom Kim, Goo Hyun Baek Archives of Hand and Microsurgery.2018; 23(3): 175. CrossRef
PURPOSE This study evaluated the shortening and rotational deformity after closed intramedullary nailing of femur shaft fracture according to Winquist-Hansen classification type. MATERIALS AND METHODS This study was based on 98 cases who received cloased intramedullary fixation about their femur shaft fractures between January 2000 and October 2005 with minimum 12 months follow up. The rotational deformity was analysed by Yang's method (45 cases) preoperatively and postoperatively, and the shortening by orthoradiogram (55 cases). Furthermore we analysed other complications, for example nonunion, infection, and metal failure. RESULTS We found more than 15 degrees anteversion difference of both femurs in 10 cases. Among them, 9 cases were classified to type 3, 4. According to Winquist-Hansen classification, rotational deformity ranged from 3.7° (Type 1) to 8.9° (Type 4). More than 2 cm leg length discrepancy (LLD) was found in 9 cases, all of them were classified as Winquist-Hansen classification type 3, 4. In the type 1, LLD was checked as 3.2 mm and type 4, 14.2 mm. CONCLUSION To prevent the shortening and rotational deformity after intramedullary fixation of Winquist-Hansen classification type 3, 4 femur shaft fracture, intraoperatively the exact contralateral femoral anteversion and length should be checked.
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The Fate of Butterfly Fragments in Extremity Shaft Comminuted Fractures Treated with Closed Interlocking Intramedullary Nailing Ki-Chan An, Yoon-Jun Kim, Jang-Suk Choi, Seung Suk Seo, Hi-Chul Gwak, Dae-Won Jung, Dong-Woo Jeong Journal of the Korean Fracture Society.2012; 25(1): 46. CrossRef
Limited Open Reduction and Intramedullary Nailing of Proximal Femoral Shaft Fracture Sang Ho Ha, Jun Young Lee, Sang Hong Lee, Sung Hwan Jo, Jae Cheul Yu Journal of the Korean Fracture Society.2009; 22(4): 225. CrossRef
PURPOSE To evaluate the functional results after internal fixation with two low profile plates in fractures of the distal tibia. MATERIALS AND METHODS From March 1998 to October 2002, twelve patients with fractures of the distal tibia were treated with internal fixation using two low profile plates and followed for at least one year. Fractures according to AO/OTA classification were one Type A1, four Type A2, two Type C1, two Type C2 and three Type C3. We analyzed the functional results by the Olerud and Molander ankle scoring system and the postoperative complications. RESULTS The average functional score was 81.2 points and the results were three excellent, six good, one fair and two poor. Bony union was achieved in all cases. There was 1 case of superficial wound infection as a complication. CONCLUSION Internal fixation with two low profile plates in fractures of the distal tibia may minimize the incidence of soft tissue complications and provide good bony union and functional results. Therefore, we consider internal fixation with two low profile plates as a good alternative treatment of the distal tibial fracture.
PURPOSE To evaluate the clinical distribution of bilateral non-contemporary hip fractures regarding to fractures type, risk factors and fractures interval in elderly patients. MATERIALS AND METHODS 24 bilateral non-contemporary cases among 621 hip fractures from Sep. 1997 to Dec. 2004 were evaluated regarding to gender, age, incidence, Singh index, causes, interval, fracture pattern, operative methods and underlying diseases between the two fractures retrospectively. RESULTS The distribution is as follows: males to females (5:19), incidence (3.86%), mean age (76.9 years and 78.9 years), average Singh index 2.5 degree (2~4) and 2.1 degree (1~3) respectively. 21 cases (87.5%) in both fractures suffered from minor slips and 19 cases (79.1%) occured within 3 years of the first fracture and 17 (68.1%) cases were same type fractures. Bipolar hemiarthroplasty was performed in 12 cases. All but one patient had underlying cardiovascular diseases and CVA sequales. CONCLUSION To prevent the bilateral non-contemporary hip fractures, surgeons must bear in mind that osteoporosis treatment, control of underlying cardiovascular diseases and CVA sequales, and the effective rehabilitation is very important.
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Does the Time of Postoperative Bisphosphonate Administration Affect the Bone Union in Osteoporotic Intertrochanteric Fracture of Femur? Yoon Je Cho, Young Soo Chun, Kee Hyung Rhyu, Joon Soon Kang, Gwang Young Jung, Jun Hee Lee Hip & Pelvis.2015; 27(4): 258. CrossRef
Sequential Hip Fractures in Elderly Osteoporotic Patients Soojae Yim, Yuseok Seo, Sanghyok Lee, Joonghyun Ahn Hip & Pelvis.2012; 24(4): 309. CrossRef
Effect of Intravenous Administration of Bisphosphonate for Patients Operatively Treated for Osteoporotic Hip Fracture Sang Hong Lee, Woong Chae Na, Yi Kyu Park Hip & Pelvis.2012; 24(2): 133. CrossRef
PURPOSE To evaluate the clinical and radiographic results of interlocking intramedullary nailing for the distal metaphyseal fractures of the tibia and to identify the usefulness of the interlocking intramedullary nailing. MATERIALS AND METHODS Thirty four patients who underwent interlocking intramedullary nailing for distal metaphyseal fractures of the tibia were reviewed with a follow-up period of more than 2 years. Clinical result was assessed using the Olerud score and this score was marked as percentage of prefracture state. Radiographic results were assessed with varus-valgus angle, anterior-posterior angle, and bone union time. We checked the cases of complication and need for additional surgery after interlocking intramedullary nailing. RESULTS Clinically, Olerud score averaged 92.1% (76~100%). Radiographically, average varus-valgus angle was 1.6+/-2.9 degrees and average antero-posterior angle was 0.8+/-3.3 degrees. Bone union time averaged 18.7 weeks. As complications, there were one deep infection and two breakages of distal interlocking screw. In additional surgery, there were 1 debridement and soft tissue flap, and one dynamization of nail at postoperative 12 weeks. CONCLUSION Interlocking intramedullary nailing is one of safe and reliable method for distal metaphyseal fractures of the tibia, considering less soft tissue injury, possibility of early range of motion exercise, high bone union rate, and low complications rate.
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A Comparison between Minimally Invasive Plate Osteosynthesis & Interlocking Intramedullary Nailing in Distal Tibia Fractures Kee-Byung Lee, Si-Young Song, Duek-Joo Kwon, Yong-Beom Lee, Nam-Kyou Rhee, Jun-Ha Choi Journal of the Korean Fracture Society.2008; 21(4): 286. CrossRef
PURPOSE To evaluate the accuracy of X-ray evaluation in classification, displacement and size of posterior malleolar fragment, comparing with three dimensional computed tomography (3D CT) in trimallelar ankle fractures. MATERIALS AND METHODS 20 cases of trimalleolar ankle fractures evaluated with preoperative 3D CT, and followed up periods were at least 2 years. All cases were classified according to the Danis-Weber and Lauge-Hansen classification. Displacement and size of posterior malleolar fragment were measured using PACS. The reliability between simple X-ray and 3D CT was evaluated in the Danis-Weber and Lauge-Hansen classification (kappa analysis). The correlation between simple X-ray and 3D CT was evaluated in displacement and size of posterior malleolar fragment (correlation analysis). RESULTS Degree of agreement of Danis-Weber classification in simple X-ray and 3D CT was 0.700 kappa value, and that of Lauge-Hansen was 0.605 kappa value. Measurement of simple X-ray and 3D CT about displaced status of posterior malleolar fragment showed statistically significant positive linear correlation (p= 0.000), but correlation of measurement of size in simple X-ray and CT was not statistically significant (p=0.102). CONCLUSION CT or operative field will be more accurate than simple X-ray to select the method of treatment and operation, especially when the displacement and size of posterior malleolar fragment are important to decide.
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Comparison of the Size of the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures Measured Using Lateral Plain Radiography and Three-Dimensional Computed Tomography Gun-Woo Lee, Dong-Min Jung, Woo Kyoung Kwak, Keun-Bae Lee Journal of the Korean Fracture Society.2022; 35(3): 91. CrossRef
PURPOSE To evaluate clinical outcome and functional result after cemented bipolar hemiarthroplasty of displaced neck fracture in parkinsonism patients. MATERIALS AND METHODS 12 parkinsonism patients treated by cemented bipolar hemiarthroplasty of displaced femur neck fracture from August 1994 to October 2002 were evaluated. Posterolateral approach was performed. Preoperative and postoperative walking ability, activity of daily life and severity of parkinsonism were compared. The effects of parkinsonism on clinical outcome were analyzed retrospectively. RESULTS The median difference of walking ability was 1 (p=0.001) and that of ADL scale was -3 (p=0.0005). There was no significant change in the severity of parkinsonism (p=0.5), and the severity and duration of parkinsonism were not correlated with postoperative functional status. 7 cases of voiding difficulty, 5 of temporary delirium, and 2 of temporary respiratory insufficiency were noted as general complications. 2 cases of dislocation and 1 of infection were noted as orthopaedic complications. CONCLUSION In parkinsonism patient, walking ability was worsened, activity was more independent, but severity of parkinsonism was not changed after hemiarthroplasty of displaced femur neck fracture. Orthopaedic surgeons should bear in mind that functional outcome is poor and orthopaedic complication rate high in parkinsonism.
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Failure of Long Spinal Construct and Pseudarthrosis in a Patient with Parkinson Disease for the Treatment of Degenerative Lumbar Spinal Disorder: Case Report Hong Kyun Kim, Hyun Woo Na, Kook Jin Chung Journal of Korean Society of Spine Surgery.2014; 21(4): 174. CrossRef
PURPOSE To investigate the effect of fibular malreduction on ankle joint after tibia interlocking IM nailing of tibial and fibular fractures according to type of fibular fractures at preoperation. MATERIALS AND METHODS Thirty-nine patients who had ipsilateral tibiofibular fracture were analyzed clinically and radiographically. The talocrural angle and the distance from joint line to the tip of fibular were measured on both ankle standing AP view. The difference of angle and distance of both ankle were analyzed by paired t-test and correlation between defference and AOFAS score by Spearman correlation coefficients. RESULTS The difference of The talocrural angle and the distance from joint line to the tip of fibular of both ankle was statistically significant (p<0.05). The correlation between this difference and AOFAS score was statistically insignificant (p>0.05). CONCLUSION In tibia interlocking IM nailing of tibia and fibula fracture, malreduction of fibula could cause the change of ankle joint.
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The Risk Factors Associated with Nonunion after Surgical Treatment for Distal Fibular Fractures Jun Young Lee, Kwi Youn Choi, Sinwook Kang, Kang Yeol Ko Journal of Korean Foot and Ankle Society.2018; 22(3): 95. CrossRef
Pseudoaneurysm of the femoral artery is a rare complication following the fixation of the fracture of proximal femur or protruded bony fragment and reports injuring on superficial femoral artery is very rare compared to deep femoral artery complicated by the insertion of distal interlocking screw. The chance of injuring superficial femoral artery may increase by deep insertion of drill bit or the repetitive arterial pulsation on prominent distal interlocking screw tip during the perioperative period. Authors experienced one case of injury on the superficial femoral artery postoperative 42 hours followed by the use of proximal femoral nail advocated by the AO group recently and would like to call attention upon the possibilities of vessel injury complicated with the use of the distal interlocking screw.
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Huge Pseudoaneurysm of Popliteal Artery Following Conservative Treatment of a Distal Femur Fracture: A Case Report Won-Chul Cho, Chong Bin Park, Young-Jun Choi, Hyun-Il Lee, Hee-Jae Won, Jae-Kwang Hwang Journal of the Korean Fracture Society.2016; 29(2): 137. CrossRef
Proximal femoral fractures and vascular injuries in adults: Incidence, aetiology and outcomes Antonio Barquet, Andrés Gelink, Peter V. Giannoudis Injury.2015; 46(12): 2297. CrossRef
Delayed Pseudoaneurysm of the Femoral Artery after Intramedullary Nailing of a Femur Shaft Fracture Hyun Cheol Oh, Jae Wan Suh, Dae Kyung Kwak, Han Kook Yoon Journal of the Korean Orthopaedic Association.2013; 48(3): 240. CrossRef
Diagnosis and Treatment for Delayed Pseudoaneurysm of Deep Femoral Artery - A Case Report - Seok-Hyun Lee, Ji-Hyun Ahn The Journal of the Korean Orthopaedic Association.2008; 43(1): 118. CrossRef
PURPOSE To evaluate the prognostic factors associated with the clinical outcome, which analysed with use of the Pearson correlation method in AOFAS score and radiographic measurement between normal and the affected site after operative treatment of the calcaneal fractures. MATERIALS AND METHODS We evaluated 13 patients(13 cases) who had unilateral calcaneal fractures. At the latest follow-up, we calculated the mean differences of the Bohler angle, gissane angle, heel height, calcaneal width, calcaneal length, talocalcaneal angle, talar declination angle, subtalar incongruity between normal and affected site on the lateral view of ankle and tangential view of the calcaneus. And then the correlation between radiographic measurement and the clinical outcome analysed by Pearson correlation method. RESULTS Heel height(correlation coefficient = 0.827, p-value<005) and subtalar incongruity(correlation coeffidient = -0.764, p-value<0.05) were closely correlated with the clinical outcome and the B hler angle showed lower correlation coefficiency(correlation coefficiency = 0.470, p-value : 0.104) compare to the heel height. CONCLUSION We suggested that restoration of the heel height and subtalar incongruity was significantly correlated to the clinical outcome after operative treatment of the calcaneal fractures.
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The Comparison of Radiographic Parameters and Clinical Results after Operative Treatment of Displaced Intraarticular Calcaneal Fractures Hong Moon Sohn, Jun Young Lee, Sang Ho Ha, Sueng Hwan Jo Journal of the Korean Fracture Society.2007; 20(3): 227. CrossRef
The purpose of this study was to evaluate the results of distal femoral physeal injury in adolescence after various treatment 5 which had been performed for the last 4 years. This study consisted of 9 distal femoral physeal fractures from August 1993 to May 1996. Average length of follow up was 21 months. We evaluated the functional status such as range of motion, instability, pain and sports activity. They showed no abnormalities. We also assessed the lateral distal femoral angle, mechanical axis deviation, femorotibial angle and leg length discrepancy using orthoradiogram. 4 Cases showed the lateral distal femoral angle differences(more than 5), 7 cases showed the mechanical axis differences(average : 11.8mm), 6 cases showed the remorotibial angle differences(average : 5.8) and 6 cases showed the leg length discrepancy(average : 4.6mm). So we carefully concluded that the adequacy of the reduction is the most important prognostic factor and there are some problems in radiological angle difference despite the anatomical reduction.
The authers reviewed 15 patients of open fracture of the tibial shaft who were treated by external fixation followed by intramedullary nailing. These fractures comprised two Type-I, two Type-II, four Type-IIIa, and seven Type-IIIb injuries. Ten patients were treated with unreamed intramedullary nailing and 5 patients were treated with reamed intramedullary nailing. The results were analyzed as followings: 1. All fractures had union at 5.2 months after intramedullary nailing and 4 true osteomyelitis were developed. 2. All osteomyelitis were developed for the patients who were treated with reamed intramedullary nailing. 3. There was no osteomyelitis who were treated with unreamed intramedullary nailing. 4. Delayed conversion to intramedullary nailing after control of pin tract infection had no effect for prevention of osteomyelitis.
Cubitus varus is the most common angular deformity that results from supracondylar fractures in children. Although this deformity rarely limit elbow function, the correction is frequently requested due to cosmetic problem. This paper was prepared to describe the operative method and to evaluate the clinical results of tension band wirinB after distal humeral supracondylar osteotomy for cubitus varus. The result was evaluated using Oppenheim criteria. Excellent or good cases were 94.4%. We concluded that tension band wiring is a satisfactory method of treatment for cubitus varus.
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Evaluation of tension-band osteosynthesis for cubitus varus deformity in pediatric patients: A retrospective review Man Duc Minh Phan, Terry Richard Light, Tiep Van Phan, Phi Duong Nguyen Journal of Hand and Microsurgery.2025; 17(2): 100213. CrossRef
The treatment of 16 intraarticular fractures at the base of the fifth metacarpal was studied.
Intraarticular fractures at the base of the fifth metacarpal resembled Bennetts and Rolandos fractures in their pattern and in their tendency to instability. The problem was usually not the reduction, but rather maintaining the reduction. A force hitting the head of the fifth metacarpal along the longitudinal axis of the metacarpal was the most common cause of injury, Five fractures were immobilized in a plaster cast after closed reduction. Six fractures were treated by closed reduction and percutaneous pinning, 4 by open reduction and pinning. 1 by open reduction and plating. At follow up after median 14.8 months, the result of 11 cases was satisfactory. Two cases nonoperated showed decreased grip power, limited motion, radiographical signs of osteoarthritis, and pain. Three cases operated showed decreased grip power.
We concluded that restoration of articular surface and internal fixation againt the muscular pull was mandatory for a satisfactory outcome.
The Os Calcis is the largest bone of the tarsal bones. The incidence of fracture of the calcaneus is more frequent than that of any other tarsal bones.
Farctures involving subtalar joint can usually cause serious and persistent disabilities and badly influence the patients psychologically, socially and economically.
But, there was no standardized treatment method for these fractures. The purpose of this article is to describe the surgical technique and the results obtained in 33 consecutive cases of calcaneal fractures involving the subtalar joint.
The results were as follows, 1. Of 33 patients, 24 patients were male and 9 patients were female.
2. The main cause of fracture of calcaneus was a fall from a height in 79% of cases. Most of the associated fractures were the spinal and tibial fractures.
3. Of these intra-articular fractures, 19 fractures were joint depression type and 14 cases were tongue type by Essex-Lopresti classification.
4. Open reduction and internal fixation was performed in 18 cases of joint depression type and 6 cases of tongue type, and closed reduction and axial pinning was performed in 8 cases of tongue type and 1 case of joint depression type.
5. After average twenty-two months follow-up, the over all results of open reduction and internal fixation were excellent and good in 71%, and that of closed reduction and axial pinning were excellent and good in 67% by Salama creteria.
6. Complications included four superficial wound infection and one subluxation of peroneal tendon.
Ipsilateral fractures of the femoral neck and shaft are relatively uncommon infuries and usually the result of high-energy trauma in young adults.
Frequently, the severe trauma responsible for this injury combination is also productive of associated injuries indeed life threatening. Several unique features of this injury have been recognized, including the high incidence of associated knee injuries, particulary fractures of the patella.
This is thought to be due to a mechanism of injury in which the femur is longitudinally loaded at the flexed knee while positioned in neutral abduction.
Also, this combination of injuries pose a difficult problem in management.
The authors reviewed 14 cases of ipsilateral fracture of the femoral neck and shaft for the evaluation of the associated injury and method of ueatment from October 1986 to Febraury 1991 and the average follow-up period was 1.8 years.
The results were as follows.
1. The site of the femoral neck and shaft fracture were mainly, basicervical and midshaft.
2. In two cases, the femoral neck fracture was not diagnosed initially.
3. Most of the associated fractures were patella and tibial fractures and PCL ruptures.
4. Complications Included three stiffness of the knee, two delayed union of the femoral shaft, one superficial wound infection and one delayed union with coxa vara deformity of the femoral neck.