Journal of Musculoskeletal Trauma

The Result of Treatment in Fracture of the Proximal Humerus: Man Je Park, Byeong Yeun Seong, Seung Ki Lee, Taek Gun Lee, Sang Yol Shin, Hyung Su Kim; J Korean Soc Fract 2002;15(2):299-306. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.299

PURPOSE
To evalute the anatomical and functional outcome after treatment for proximal humerus fracture according to surgical and conservative treatment and assess the final results according to treatment methods.
MATERIALS AND METHODS
Forty-two cases with follow-up over 12 months were divided into three groups: conservative treatment (Group 1, 20 cases), closed reduction with Rush or percutaneous pin fixation (Group 2, 11 cases), proximal intramedullary interlocking nailing(Group 3, 11 cases). The functional outcome was obtained by modified neer method using self-assessed score paper and the anatomical outcome was obtained by paavolainen method using radiologic film score. Statistics in comparing with the result of each group was analized by variance analysis using Generalized Liner Model and Fisher?s exact test.
RESULT
Anatomical reduction was best obtained in group 3 (p< 0.05) and mean duration of bone union was 10.33 weeks. Functional score was also best obtained in group 3 (p<0.05). Complication was noted in 9 cases. There was only 1 case in group 3. In studing of overall outcome, the group 3 has good result than other groups.
CONCLUSION
Proximal intramedullary interlocking nailing in displaced proximal humerus fracture can be demonstrated as better method for anatomical reduction(p<0.05) than other methods because it can make insertion of locking screw ease with multiple direction for anatomical reduction and can provides a sufficient fixation for early rehabilitation and union , while minimizing complication.

Citations

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Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?
Woo-Bin Jung, Eun-Sun Moon, Sung-Kyu Kim, David Kovacevic, Myung-Sun Kim
BMC Musculoskeletal Disorders.2013;[Epub] CrossRef
Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture
Doo-Sup Kim, Dong-Kyu Lee, Chang-Ho Yi, Jang-Hee Park, Jung-Ho Rah
Journal of the Korean Fracture Society.2011; 24(2): 144. CrossRef

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A Treatment of Unreamed Intramedullary Nailing of Open Fracture of the Tibia: Keun Kwon Kang, Jang Jung Kim, Kun Yung Lee, Myung Kon Nam, Myung Sik Park; J Korean Soc Fract 1995;8(3):551-556. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.551

Abstract PDF: The tibial fracture was the most common fracture of the long bone fractures, especially there were many controversies in the treatment of open fracture by high energy injury. The authors analyzed retrospectively 32 patients of tibial open fracture who underwent unlearned intramedullary nailing at the Department of Orthopedic Surgery, Lee-Rha general hospital from September 1992 to August 1994 with minimal 1 year follow up. In 32 cases, the average age was 37.5 years old and the most common injury was traffic accident(25 cases,78%). Twenty seven cases were male(84.4%) and 5 cases female(15.5%). There were 17 cases of Type A fracture(53%),12 cases Type B(37.5%) and 3 cases Type C(19.5%) by A-O classification, and 11 cases were Type I open fracture(34%) by Gustilo - Anderson classification, 15 cases, Type B (47%) and 6 cases, Type III (19%). The average bone union time was 14.8 weeks except one case of infected non-union. We concluded that unlearned intramedullary nailing is recommended for the compatible treatment metnod of tibial open fractures.

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A Treatment of Humeral Shaft Fracture with Closed Interlocking Nailing: Kun Yung Lee, Myung Sik Park, Keun Kwon Kang; J Korean Soc Fract 1995;8(1):159-166. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.159

Abstract PDF: The ideal treatment of acute fractures of the humeral shaft remains controversial. It is generally accepted that conservative treatment is best for isolated closed fractures of the humerus shaft. But recently, in case of surgical management, intramedullary nailing treatment has reported good results. Authors have analysed 20 cases of the humeral shaft fractures treated with closed intramedullary nailing at the department of orthopedic surgery, Lee-Rha general hospital from June 1991 to December 1993 with minimal 1 year follow up. The results were as follows 1. In the 20 cases, the age between 20 and 40 years old was taken place 60% and the most common cause of injury was traffic accident (75%) 2. It was worthwhile to define the relationship between union time and Winquist-Hansen classification which used in femoral shaft fracture. And the average bone union time was 8 weeks except 3 cases, especially delayed union was found in type 3 of Winquist-Hansen classification. But 2 cases were united after 9 monthes follow up without secondary procedure. 3. Problem in Seidel nailing was flilure of expansion of distal portion and in Russel-Taylor nailing was impairement of internal rotation of shoulder and delayed union due to iatrogenic distraction at the fracture level during operation. In according to the above results to treat the humeral shaft fracture, closed intramedullary inter-locking nailing was satisfactory enough to obtain bone union and early recovery of shoulder motion. Also, the Winquist-Hansen classification is useful guide to find the bone union time in the treatment of humeral shaft fracture with interlocking nail.

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Proximal Femral Fracture During Closed Intramedullary Interlocking Delta Nailing: Phil Hyun Chung, Moon Jib Yoo, Suk Kang, Eung Nam Cha, Yong Min Kim, Jong Won Kim; J Korean Soc Fract 1992;5(2):378-382. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.378

Abstract PDF: Closed intramedullary nailing is a complex technique which usually requires fracture table and image intensifier, so that the patient and surgeon are exposed to the radiation. But this technique affords considerable advantages such as high rate of union, less infection rate and early weight bearing, etc. The main causes of failure or complication of this procedure are inapproprisate entry point and inadequate nail size. These are especially important problems in the patient who is femoral canal diameter is very small (8 or 9mm). The Delta femoral interlocking nails (diameter 10mm and 11mm)were devised for the femurs with narrow canal diameter. However, proximal portion of the Delta nail (about 7cm from the proximal end)is thick (diameter 13mm)to gain strength enough for holding the insertion device and fixation of the interlocking screws. If the insertion point is not correct or proximal reaming is inadequate, iatrogenic proximal femoral fracture may occur during final insertion of the nail. We experienced 2 cases of this complication during fixation of femoral shaft fractures using the Delta nails. We managed thls problem with hip spica cast immobilization in one case, and multiple pinning of femur neck in the other.

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