The flexion type, supracondylar fracture of the humerus is a rare injury of the elbow in children. It is known as difficult fracture to achieve and maintain reduction and is associated with relative high incidence of complications such as ulnar nerve injury, varus deformity and limited range of motion of the elbow. We have experienced 6 cases of flexion type sapracondylar fracture of the humerus in children. We performed closed reduction and percutaneous piniiing in type II fracture and in type III fracture, open reduction and internal fixation was performed because closed reduction was failed. The resuli were generally excellent. Full range of motion of the elbow and under 5 degree varus or valgus deformity resulted in. We become to believe that the aggressive approaches-even open reduction in type III fracture-provide good results and decrease the complications mentioned previously.
Clavicular shaft fracture is one of the most common fractures, which had been managed via conservative methods with some exceptions such as nonunion. Open treatment had been regarded even as important cause of nonunion and poor outcomes. Nowadays, however, the goal of fracture treatment has become anatomical reduction, rigid fixation and early rehabilitation for better final results.
According to this principle, we managed 21 clavicular shaft fractures with open reduction and internal fixation(12; plate fixation. 9; intramedullary pinning) since 1991 to 1993. All the fractures united within postoperative 10 weeks(mean 6.4) without any remarkabte complications such as nonunion, infection, and limited shoulder motion. In some intramedullary pinning cases. skin irritation at pin site was troublesome, but disappeared after removal of the pin.
Likewise other long bone fractures, open reduction and internal fixation seemed to be one of the useful method in the treatment of clavicular shaft fractures. especially in displaced, and comminuted ones.
Fractures with displaced articular facet of subtalar joint occupies 60-75% of whole calcaneal fractures. Nowadays, general principle of treatment for displaced intraarticular fracture has become anatomical reduction of joint surface and rigid fixation of the fracture. However, it had been difficult to apply this principle in cases of calcaneus due to various obstacles such as anatomical characteristics, therefore outcomes were not satisfactory in many cases. Extended lateral approach, which was designed by Letournel and Benirschke, contributed greatly in overcoming those obstacles.
From August 1992 to April 1994, the author managed fifteen displaced intraarticular fractures of the calcaneus in fourteen patients with open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate. The fractures were examined preoperatively with Brodens view and classified according to Eastwood(1992) with 2-plane CT. All the fractures united within postoperative 20 weeks(average 10.9 weeks). Final results were assessed by the clinical criteria for calcaneal fracture designed in Greighton Nebraska Health Foundation. Among the 15 cases, excellent results were obtained in eight cases, good in six, fair in one. There were no remarkable complications at the latest follow-up.
In managing displaced intraarticular fractures of calcaneus, open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate seemed to be very useful and harmless method.
In the management of fractures in patients with cererbral palsy, pre-existing contracture of joint and muscles, difficulty in maintenance of reduction partly because of involuntary motion of muscles are obstacles to the orthopaedic surgeons. Furthermore, disuse osteopenia in long term bed-ridden patients may be a Predisposing factor of refracture. Failures such as refracture were reported to occur 19 times more in cerebral palsy patients. Those failures usually result in malunion, which may be a cause of severely deformed extremities.
Among various types of cerebral palsy, rigid type is rare and involuntary muscle contraction is rigid. Therefore, fractures in these patients may be more difficult to manage and be accompanied by more complications, such as refracture compared even to spastic type. We experienced fractures in two patients with rigid cerebral palsy. An 11 year-old boy(proximal femoral shaft fracture) and a 45 year-old man(humerus shaft fracture) were treated with open reduction and internal fixation using plate and screws. Initial fixation was thought to be enoughly stable, but within 3 weeks postoperatively, maintenance of reduction in both fractures failed eventually. Because of the rarity of cases and difficulty in maintenance of reduction, we report these two cases after reviewing of the literatures.
Intramuscular hematoma in inner pelvic wall may not be a common problem for orthopaedic surgeons. It may be associated with fractures of pelvic bone, or bleeding tendency from various reasons.Usually these hematomae are managed conservatively because they have no harmful effect to the patient, their position makes it difficult to approach. Furthermore, the diagnosis of the hematomae is not simple, so suspicion is important for its diagnosis.
We experienced one case of delayed intramuscular hematoma in iliacus muscle in a 16-year old boy who had suffered blunt trauma to the pelvic area five weeks before. MRI had a significant role in the diagnosis of the hematoma. After evacuation of the hematoma, the patient recovered to normal status. Concerning about its unusual course and diagnostic significances of MRI, we report this case after reviewing of the Iiteratures.
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Muscular Injury of Iliacus and Gluteus Maximus after Mountain Climbing Ho Seung Jeon, Young Kyun Woo, Suk Ha Hwang, Seung Pyo Suh, Joon Kyung Lee The Korean Journal of Sports Medicine.2014; 32(1): 65. CrossRef
Dislocation of first metatarsophalangeal joint is a rare condition. Anatomically, the head of first metatarsal is stabilized by various soft tissue structures associated with the sesamoid bones. When the metatarsal head was entrapped underneath the sesamoid complex, it might be impossible to gain reduction via closed method.
We experienced a case of dorsal dislocation of first metatarsophalangeal joint and associated dislocation of larsornetatarsal joint in a 32 year old man who was injured by ftll from height. Closed reduction fEiled even under spinal anesthesia. Open reduction via medial approach revealedbuttonholingof the metatarsal head under the sesamoid complex, which had made colsed reduction impossible. Concerning about the rarity and anatomical characteristic of these injuries, we report this case with reviewing of the literatures.
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Lateral Dislocation of the First Metatarsophalangeal Joint: A Case Report Yeong-Sik Yun, Young-Mo Kim, Kyung-Cheon Kim, Pil-Sung Kim Journal of the Korean Fracture Society.2008; 21(4): 312. CrossRef