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 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 To investigate the bone union time of patients treated with interlocking intramedullary nailing in wedged tibial shaft fracture and to evaluate the factors that influence this result. MATERIALS AND METHODS 32 patients treated with interlocking intramedullary nailing for wedge tibial shaft fracture were reviewed with a follow-up period of more than 1 year. Radiographic results were assessed with diameter (%) and length (mm) of wedge fragment, pre and postoperative displacement (mm) of wedge fragment. We also checked the bone union time of the main fragment and the wedge fragment (paired t-test). We investigated the bone union time acocording to the diameter, length of wedge fragment, pre and postopertvie displacement (correlation analysis). RESULTS Bone union time of the main fragments averaged 15.3 weeks (6~53 weeks) and that of wedge fragment averaged 24.2 weeks (8~64 weeks) (p=0.005). There was no correspondence between wedge fragment diameter and bone union time (p=0.681), but the bone union time of wedge fragment increased in proportion to its diameter (r2=0.747, p=0.031). There was no correspondence between preoperative displacement of wedge fragment and bone union time (p=0.574), but the bone union time increased in proportion to postoperative displacement of wedge fragment (r2=0.730, p=0.001). CONCLUSION Wedge fragments need longer time for bone union than main fragments in interlocking intramedullary nailing for wedge tibial shaft fractures. We need to pay attention to the displacemet of fragments in treating tibial shaft fractures with large wedge fragment.
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
Pseudoaneurysm is defined as the aneurysmal cyst resulted from partial or total rupture of vessel membrane, and it can be caused by fracture, operation, laceration, blunt trauma, osteochondroma and so on. When the displaced pelvic bone fracture is diagnosed, the traumatic pseudoaneurysm, which is frequently related by the direct injury of vessel, is one of the common complications, and it can result the massive hemorrhage even death. In case of the displaced pelvic bone fracture, surgeon should check the hemoglobin level and vital sign carefully for the possibility of vascular injury. Authors report the rare case of superior gluteal artery pseudoaneurysm without pelvic bone fractrure.
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
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 functional changes, postop delirium and complications after cemented bipolar hemiarthroplasty for the femur neck fractures in patients aged around ninety. MATERIALS AND METHODS Between May 1995 and April 2002, of the twenty seven patients, 17 who follow-up for at least one year were included in this study. Walking ability, activity of daily living, mental status, chronic illness, postoperative delirium and complications were evaluated retrospectively using Yoon's walking class, ADL scale, MMSE-K score, ASA classification, DSM IV respectively. RESULTS The walking ability was decreased to 2.4 from 3.3 tendency of reliance in ADL scale was increased to 8.3 from 4.5, MMSE-K score was decreased to 15.9 from 21.7. There was no significant change in status of chronic illness. Postoperative delirium occurred in eight (47%) cases and all of them recovered completely. complications included bladder problem in eleven (66%) cases, temporary respiratory distress in two (12%) cases, hip dislocation in two (12%) cases, infection in one (6%) case. Overall thirteen (78%) cases were able to walk with supports. CONCLUSION This study indicates that physicians treation femur neck fractures in patients aged around ninety must anticipate worsening of the functional changes more especially in regard to walking level, activity of daily living and mental status, little changes of chronic disease status, complete recovery of postop delirium and high complication rate
PURPOSE Although the majority of children's forearm diaphyseal fractures may be treated conservatively with closed reduction and cast immobilization, unstable or irreducible fractures are usually treated by surgical management. Authors performed percutaneous pin leverage reduction technique for irreducible displaced diaphyseal fractures. The aim of this study is to determine the efficacy of pin leverage technique in pediatric forearm diaphyseal fractures MATERIALS AND METHODS: In this retrospective study, we reviewed 22 cases of forearm diaphyseal fractures reduced by percutaneous pin leverage technique between 1997 and 2002. We analyzed radiographs, operation time, hospital stay and immobilization period, range of motion, postoperative complications and functional results by Thomas. RESULTS Average length of follow up was 28 months with mean age of 10.5 years. All fractures in this series healed less than 2 degrees of diaphyseal angulation. Average operation time including anesthesia was 42 minutes and hospital stay was 4.6 days. Time to union was 49.6 days in average and range of motion and functional results were satisfactory in all cases except one case of congenital radioulnar synostosis. There was one case of superficial pin track infection as complication. CONCLUSION In operative treatment of children's diaphyseal fractures of forearm bones, percutaneous pin leverage reduction technique is a good alternative method prior to open reduction in case of difficult closed reduction.
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Pediatric Forearm Bone Fractures Treated with Flexible Intramedullary Nail Suk Kyu Choo, Jin Hwan Kim, Hyung Keun Oh, Dong Hyun Kim Journal of the Korean Fracture Society.2007; 20(2): 190. CrossRef
PURPOSE Even though emergent percutaneous pinning after closed reduction is the popularized treatment of the displaced type II and type III pediatric supracondylar fractures of the humerus, the timing of pinning still presents controversy. The purpose of this study is to suggest an appropriate surgical time without significant perioperative complications. MATERIALS AND METHODS From April 1995 to January 2002, 179 consecutive patients who had undergone surgical treatment were selected. They were divided to 5 groups [A group: 8 hours or less following injury (24 cases), B group: from 9 to 16 hours (63 cases), C group: from17 hours to 24 hours (63 cases), D group: from 25 hours to 48 hours (18 cases), and E group: from 49 hours to 72 hours (11 cases)] and reviewed retrospectively to analyze perioperative complications and operation time. RESULTS There was no significant difference between each group with respect to surgical wound infection, iatrogenic ulnar nerve injury, VIC, operation time and the necessity of reoperation (p>0.05). CONCLUSION Within the parameters outlined in our study, we could not find the any meaningful correlation between surgical timing and occurrence of perioperative complications and also, we think that the timing of percutaneous pinning can be delayed to the time when a surgeon considers it appropriate.
The purpose of this study was to evaluate the common modes of fixation failure in unstable intertrochanteric fractures , related risk factors and the prevention of fixation failure. Between 1995 and 2001, 44 patients who had sustained an unstable intertrochanteric fractures were assigned to be treated with a sliding hip screw. Men in 14 cases ( 32% ), women in 30 cases ( 68% ) , the average age at the operation was 65(22-90) years and the average duration of follow up was 12(8-22) months. We classified the fracture patterns with Evans system and used Singh 's index for osteoporosis. And we examined the common modes of fixation failure with postoperative X-ray. The fixation failure in unstable intertrochanteric fracture was 8 cases (18.2 % ); varus collapse of the proximal fragment with cutout of the lag screw was 3 cases (6.8%), varus collapse of the proximal fragment with excessive sliding of the lag screw was 4 cases (9.1%) and loss of fixation of the plate-holding screws was 1 case (2.3%). The authors think that inadequate anatomical reduction of comminuted posteromedial fragment and severity of osteoporosis are main causes of fixation failure. During operation for unstable intertrochanteric fractures, the most important point is accurate reduction of posteromedial fragment and the intramedullary hip screw like proximal femoral nail ( PFN ) may be considered to avoid fracture of lateral cortex that enter the lag screw, causing fixation failure.
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The Antero-medial Cortex Overlapped Reduction of Unstable Intertrochanteric Fractures Chae-Geun Kim, Suc-Hyun Kweon, Hong-Jun Han, Jae-Seon Hwang Hip & Pelvis.2013; 25(4): 280. CrossRef
PURPOSE To assess the relationship between the type of hip fracture-dislocation and nerve injury, the relationship between the treatment of hip fracture-dislocation and nerve recovery and the effectiveness of electromyography(EMG)-nerve conduction study(NCV) for the diagnosis of nerve injury and clinical result. MATERIALS AND METHODS We reviewed 8 cases associated with nerve injury of 52 cases which were diagnosed and treated for hip fracture-dislocation from March 1993 to December 1999 with an average follow up period 18.1 months. Mean age was 36.1 years. We assessed the diagnosis of nerve injury through physical exam at emergency room and follow up EMG-NCV. The clinical results of nerve recovery were evaluated according to the Clawson-Seddon classification. RESULT The cause of injury was motor vehicle accident in all cases. The outcome of the nerve injury was analyzed as 4 complete recovery, 3 partial recovery, 1 no recovery for 31 months follow up. The clinical result was analyzed as 7 satisfactory and 1 unsatisfactory. The latter was complete sciatic nerve injury, seemed to be recovered at follow up EMG-NCV but unsatisfactory for clinical result. CONCLUSION The nerve injury of the posterior hip fracture-dislocation was not rare and the rate of nerve injury was relatively good. The limitation as a clinical outcome was revealed in the EMG-NCV because one case which seemed to be recovered at follow up EMG-NCV was unsatisfactory for clinical result. In future, we think to require non-invasive, more reliable method for the diagnosis and follow up of the nerve injury and the study of the factor, can improve the nerve recovery.
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Traumatic Bilateral Anterior Hip Dislocation: A Case Report Sung-Taek Jung, Hyun-Jong Kim, Myung-Sun Kim, Young-Jin Kim, Sang-Kwan Cho Journal of the Korean Fracture Society.2008; 21(1): 62. CrossRef
PURPOSE This is a retrospective study to analyze the functional results of closed reduction and percutaneous fixation of displaced unstable proximal humerus fractures. MATERIALS AND METHODS We report 23 patients, 20 with 2-part and 3 with 3-part proximal humerus fractures that can be reduced closed but remain unstable in which percutaneous fixation was performed. The fixation methods were multiple pinning in 10, multiple cannulated screw fixation in 8, Rush pin fixation in 3 and Rush pin combined with other methods in 2. The functional rusults were analyzed with Neer,scriteria. RESULTS The functional rusults were excellent in 14, satisfactory in 4 and unsatisfactory in 5. No significant difference was not noted in the long term follow-up results according to the fixation methods but Rush pin resulted in impingement and displacement of greater tuberosity. CONCLUSION Closed reduction and percutaneous fixation is a useful alternative to open reduction and internal fixation for the displaced 2-part or 3-part proximal humerus fractures that can be reduced closed but remain unstable.
PURPOSE To evaluate the efficacy of dynamization of static interlocking intramedullary nailing as a trial leading to bony union of femur shaft fracture, delayed union of femur shaft fracture underwent dynamization were investigated.
MATERIALS & METHODS: Between april 1995 and December 2000, 162 patients were treated static interlocking intramedullary nailing, 14 patients were selected who had underwent dynamization. The average age was 39 years old (range 24 to 61), they were 11 men and 3 women. The type of fractures were two communited, seven segmental and five simple fractures. Dynamization were done by removal of proximal or distal interlocking screw. We defined complete bony union as radiological and clinical bony union. Also we measured leg length discrepancy and angulation by radiologic parameters. RESULTS Of the 14 patients who showed delayed union, 7 patients were noted successful bony union by dynamization, and of the 7 patients who failed union by dynamization, 6 patients were noted bony union by supportive operative treatments(bone graft : 4 patients, nail exchanging : 1 patient, both method 1 patient). One patient was seen nonunion state because of patient's refusal of treatment. 7 patients who were noted successful bony union by dynamization had 2 degrees~6 degrees(average 4.14 degrees) varus-valgus angulation and 4 degrees~9 degrees(average 6 degrees) AP angulation, and 3 of the 7 patients showed leg length discrepancy(LLD) greater than 2 cm. The other 7 patients had 2 degrees~5 degrees(average 3.57 degrees) varus-valgus angulation and 3 degrees~7 degrees(average 5 degrees) AP angulation, and 2 of the 7 patients showed LLD greater than 2cm. Of the 14 patients, 5 patients showed limping. CONCLUSION Dynamization of intramedullary nainling is a simple and valuable method for improving bony union of femur shaft fracture in the case of delayed union. But if the delayed unions are seen due to large bone defect, supportive operative treatments (bone graft, nail exchanging etc.) to avoid significant complica-tion(shortening and angulation) is needed.
PURPOSE The results of treatment of tibial plateau fractures by extensive soft tissue exposure were less satisfactory even if anatomical reduction was achieved. The purpose of this study is to assess the functional and radiological results of the treatment of tibial plateau fractures by cannulated screw fixation to decrease soft tissue injury and operation time. MATERIALS AND METHODS From January 1996 to February 2000, 19 patients were treated by limited open reduction and internal fixation by cannulated screw. According to scoring of Rasmussen, the functional results were rated. RESULTS In all cases, Bony union was obtained and according to scoring of Rasmussen, excellent in 1 case, good in 14, fair in 4 cases. There were 2 cases of limitation of joint motion and 2 cases of persistant pain as sequale. CONCLUSION We considered that if accurate preoperative evaluation was done, Cannulated screw fixaction was easier and faster method than other methods for treatment of tibial plateau fractures.
PURPOSE : The purpose of our study in to determine the incidence of spontaneous recovery from neural injuries associated with supracondylar fractures of the humerus and to assess the results of electromyographic study and nerve conduction velocity.
Material & methods : The 160 displaced supracondylar fractures of the humerus which had operation at the Sung Ae general hospital between April 1994 and 1998 were reviewed. Twelve(7.5%) were associated with complete neural injuries involving 16 nerves ; 9 radial, 5 ulnar and 2 median nerves. The mean age was 7.8 years old and boys outnumbered girls by 9 to 3. The follow-up period ranged from 1 year to 5 yeras 2 months. 11 fractures were managed with closed reduction and one with open means.
All of the neural injuries were initially managed only by closed observation. At recent follow-up examination, we assessed the motor and sensory neurological status with Seddon's modification, grip strength and two-point discrimination in the autonomous zone. Electromyography(EMG) and nerve conduction velocity(NCV) were performed in 13 nerves of 10 patients who were assessed as complete recovered clinically. Result : Spontaneous neurological recovery occurred in 11 patients(15 nerves) at a mean of 2.4 months(range, 2 to 3.5 months.) Clinically, these nerves were assessed as normal. In the EMG and NCVs, 4 of 13 nerves resulted in adnormal findings. 2 radial and 1 ulnar nerve showed mild sensory neuropathy and 1 ulnar nerve showed mild denervation potentials in EMG and slow motor and sensory NCVs. CONCLUSION : We think that neural injuries associated with the displaced supracondylar fractures of the humerus tend towards spontaneous recovery within 4 months. And even though the neurologic recoveries are clinically complete, these are not always completely recovered in electromyographic study and nerve conduction velocity.
PURPOSE : The nonunion after mid-shaft clavicular fracture is predisposed by refracture, interposition of the soft tissue, complete displacement of the fracture fragment and bony defect with comminuted fracture by the high-energy trauma. Symptomatic nonuions may need surgical treatment. The purpose of this study is to assess the functional and radiological results of the surgical treatment of the symptomatic nonunion of the clavicle. MATERIALS AND METHODS : We reviewed 10 cases of symptomatic clavicular nonunions managed with surgical treatment from January, 1994 to May, 1997. The age at operation ranged from 26 to 60 years old( average 46.5 years ). The average length of follow-up was 1.7 years( range, 1 to 3 years ). According to the scoring system of Rowe, the function of the shoulder was evaluated. RESULTS : All cases were united and radiologic union was obtained at 10.2 weeks on average after surgery. On functional result. average score on pain was 9.9 (3-12), average score on stability was 24.5 (20-25), average score on function was 21.0 (10-25).
In motion, average score on abduction and forward flexion was 11.0 (7-15), average score on internal and external rotation were 3.8 (3-5), 3.3 (0-5). According to the scoring system of Rowe, excellent in 6 cases, good in 3 cases, fair in 1 case and the average of the total score were 83.8. CONCLUSION : We concluded that open reduction and internal fixation by plate or intramedullary device with autogenous bone graft could provide the relief of symptom and effective results of shoulder of shoulder function in the symptomatic nonunion of the clavicle
Fracture-Dislocations of the ulnar carpometacarpal joints is an uncommon injury. The priorities of management of other more extensive injuries often delay definitive treatment. If such a dislocation is diagnosed early, it can be reduced easily by closed means. We reviewed one case of fracture-dislocation of carpometacarpal joints excluding thumb with stable and pain free carpometacarpal joints in one year after closed reduction and internal fixation.
The purpose of this study is to verify the clinical efficacy of unreamed nails compared to reamed nails. The cases of 31 parients in whom 32 fractures of the femoral shaft had been treated by intramedullary nailing with reamed or unreamed nails were prospectively reviewed. Reamed nailing was done for 17 cases, and unreamed nailing was done for 15 cases. The following results were obtained. 1. According to Winquist-Hansen classification, type 1 was 9 cases, type 2,3,4 were 4,2,2 cases 2. The average operation time was 70.5 minutes in reamed group, and 62.5 minutes in unreamed group(p-value=0.638). the average bleeding amount was 450ml in reamed group, and 218ml in unreamed group(p-value=0.000). 3. The mean times to partial weight bearing and full weight bearing were 4.4 weeks, 7.7 weeks in reamed group retrospectively, and 7.2 weeks, 13.7 weeks in unreamed group(p-walue=0.039,0.002). 4. The mean union time was 15.2 weeks in reamed group, and 17.7 weeks in unreamed group(p-value=0.237). 5. According to Denker's functional classification, 15 cases were excellent, 1 case was satisfactory, 1 case was very poor in reamed group, and 13 cases were wxcellent, 1 case was satisfactory, 1 case was poor in unreamed group(p-value=0.545).
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Bursting Fracture of the Proximal Femur during Insertion of Unreamed Femoral Nail for Femur Shaft Fracture - A Case Report - Ji Wan Kim, Seong-Eun Byun, Won-Hyuk Oh, Jung Jae Kim Journal of the Korean Fracture Society.2010; 23(2): 227. CrossRef
There have been much controversy about prosthetic replacement or internal fixation for patients over 70 years old. Authors reviewed and analyzed 45 cases of cemented bipolar hemiarthroplasty in patient over 70 years treated at the Department of Orthopedic Surgery, Sung-Ae General hospital from January 1988 to July 1995. The purpose of this study was to analyse the clinical and radiological results and to detect the motion study of bipolar cup. Follow up period was average 26.1 months, ranged from 24 months to 37 months. The following results were obtained. 1. In clinical evaluation, excellent & good result were in 31 cases(68.6%). 2. In radiologic evaluation, acetabular erosion were in 2 cases and loosening of the femoral component was in 1 case. 3. With time elapsed, the amount of the inner bearing motion was decreasing with preservation of the total joint motion. 4. Complications were idiopathic pain 7 cases, nerve paresis 2 cases, superficial infection 2 cases, intraoperative fracture 1 case, dislocation 1 case, losening 1 case.
Fracture of radial head and neck in children is a relatively rare injury and comprises 5 to 10 percent of fractures of the elbow in children. Its prognosis has been considered relatively good, but prognosis is poor in severely displaced fractures of the radial head and neck, especially types II and III by OBriens classification and have a high risk of complication.
We retrospectively reviewed 8 cases of radial head and neck fractures in 1 patients, who were treated from Jan.1992 to June 1994 at Kwang Myung Sung Ae Hospital.
They were followed up for more than 1 year.
The results were as follows; 1. There were 4 male and 3 female patients. One patient had bilateral involvement 2. The most common cause was fall down injury (6 cases).
3. According to O'Briens classification, 3 cases were type I and 5 cases were type II Treatments included simple immobilization(3 cases), closed reduction and plaster cast (4 cases), percutaneous K-wire leverage method(1 case).
4. According to the criteria of Tibone, the clinical result was excellent in 7 cases and good in 1 case. Primary angulation was the most important factor affecting the result and early closed reduction was important to obtain the satisfactory clinical result.
Recently intramedullary nailing has become the most common method treating tibial fractures.
Reamed intramedullaiy nailing technique leaves the problem of destorying the endosteal blood supply, which associated with delayed union and postoperative infection. Recent reports have shown excellent rate of union and low rate of intection with unlearned interlocking intramedullary nail.
Author reviewed 58 cases of tibia shaft fractures that were treated with unrealned interlocking nail from Feb. 1992 to Feb. 1994.
1. Furty nine fractures were closed and 9 were open (Gustilo-Andersonl;3,II;5, IIIa;1). Thrity one fractures involved the distal portion, 19 fractures the middle portion, 6 fractures tile proximal portion and 2 fractures were segmental.
2. Thirty six cases were male and 22 were female. The most common age was 3rd decade (25.8%).
3. The most common caute was traffic accident.
4. Average interval from injury to operation were 5.7 days in close fracture and 11.3 days in open fracture.
5. The mean duration of bone union were 15.7 weeks in closed fracture and 19.5 wreks in open fracture.
6. Complications include 1 case of delayed union, 1 case of joint stiffness and 1 case of screw failure.
7. According to the functional results by Klemm and Borner, 42 cases were excellent, 15 cases were good and 1 was fair.
Fractures of the tibia are one of the most common injury encountered by orthopaedic surgeons and their treatments are considered to be difficult due to serious complications. Many treatment modalities were introduced. Among them, Ender nailing is considered one of the useful modality because it is a relatively simple and, 3ess invasive procedure Authors analized 123 tibial fractures treated with Endr nails from Feb. 1986 to Feb. 1992 to solve the problems during Ender nailing. The follow up ranged from 12months to 51 months with an average of 11 months.
The results are as follows; 1. Among 123 patients,93 cases are male and 30 cases are female. Traffic accident is the most common cause of injury.
2. Average interval from injury to operation is 9 days and average 2.1 Ender nails are used. The mean duration of the bone union is 19.1 weeks.
3. To prevent knee joint pain, more distal medial and lateral portal of entry and more posteriorly located lateral portal of entry were used.
4. To provide stability of distal 1/3 fracture,3 or more nails are introduced with fanning in AP and lateral plane.
5. to provide stability of the comminuted fractures, convexities of at least 2 nails are located at the comminuted site.
6. To prevent rotation of the middle fragments of segmental fractures, technique of temporary Steinmann pin fixation for handling the middle fragment during operation were used.
The intercondylar fracture of distal humerus in adult is difficult to treat. Because it is difficult to obtain accurate anatomical reduction atd rigid internal fixation due to comminution and intraarticular components.
The authors review the 13 cases of intercondylar fracture of the distal humerus in adult that were treated at the orthopaedic department of Sung Ae Hospital, from JAN 1988 to JUN 1992, and the result are as follows: 1. It was frequently occured in 3rd and 4th decades active male and old female over 60 years old.
2. We think that cast hinge elbow brace is recommendable method for improvement of elbow ROM through early active motion.
3. For accurate anatomical reduction and rigid internal fixation, transolecranon approach is recommended for the suffcient exposure of the articular surface.
In 1814, Monteggia first desHribed a fracture of proximal third of the ulna with dislocation of radial head, and Bado classified and included all fracture of ulna at any level with a dislocation of radial head under the name of Monteggla lesion In 1967.
In adults, the prognosis Is poor due to many complications such as nerve injury, unreduced radial head, heterotrophic ossification, nonunion and malunion. The most important factors In achieving good results in adult Monteggia lesions are early accurate diagnosis, rigid internal fixation of the ulna and complete reduction of the radial head as soon as possible.
The authors reviewed 12 cases of Monteggia fracture In adults who were treatod at department of orthopaedic surgery, Sung-Ae General hospital from 1989 jan. to 1991 Dec. with 17 months mean follow-up.
The results obtained were as follows: 1. Male was 10 cases and female 2 cases.
2. The causes of injury were traffic accident In 9 cases, machinery injury in 2, fall down in 1 3. Location of ulna fracture was as follows; metaphysis was 4, proximal 1/3 in 6 cases, proximal 1/3 junction in 1, metaphysls and proximal 1/3 in 1.
4. According to Bado classificatlon, type I was 58%. type II 25%, tyre III 17%, type IV 0%.
5. Treatments of dislocated radial head were closed reduction in 9 Gases open reduction in 1 case, and excision in 2 cases.
6. Fractures of ulna were all treated with open reduction and internal fixation with plate in 9 cases. IM nailing in 1 case, tension band wiring in 2 cases.
7. Palsy of posterior interosseous nerve was in 2 cases with complete recovery within 6 months.
8. The results(Bruce, et. at) 17 month follow-up in average were 2 excellent, 5 good, 2 fair and 3 poor.
Analysis of Treatment Outcomes for Open Fractures of the Tibia in Children Jong-Hyuk Park, Jung Ryul Kim, Dong Hun Ham, Hyung Suk Lee, Sung Jin Shin Journal of the Korean Orthopaedic Association.2010; 45(6): 440. CrossRef