It is very rare that the bone scan after 72 hours from the trauma doesn't exhibit the increased radio-nuclide uptake in the patient with fracture. The purpose of this study is to report the case that indicate the false negative finding in the bone scan performed after 78 hours from the trauma in the 56-year-old man with L2 compression fracture, including a review of the relevant literatures.
PURPOSE To evaluate the relationship between the level of screw fixation and the stability of the segment of endplate fracture after posterior pedicle screw instrumentation for thoracic and lumbar burst fractures. MATERIALS AND METHODS The 41 patients of burst fractures who had been operated with pedicle screw instrumentation were retrospectively evaluated. The patients were divided into two groups by the levels of screw fixation. One group was treated with screws fixed by one-level to the direction of fractured endplate (One-level group, 16 cases). The other group was treated with screws fixed by two-level to the direction of endplate fracture (Two-level group, 25 cases). The two groups were compared by the radiographic changes of kyphotic angle between the day of surgery and 6 months after surgery. RESULTS At the 6 months, one-level group showed the change of kyphotic angle of 17.5+/-2.4 degrees, which was different from two-level group of 5.2+/-0.8 degrees (p=0.000). CONCLUSION In posterior pedicle screws fixation for thoracic and lumbar burst fractures, 2 vertebrae to the direction of the endplate fracture should be included to prevent the postoperative kyphotic change.
PURPOSE To evaluate whether progression of compression correlates with bone densiometry index in patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine. MATERIALS AND METHODS Using the results of bone densiometry, 30 patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine between March 2002 to March 2005 were categorized into 4 groups; above 80%, 70 to 80%, 60 to 70%, and below 60%. We compared the measurements of sagittal index and anterior vertebral height from the plain radiographs taken at the time of injury and following three consecutive months after the injury. RESULTS Patients with lower bone densiometry index had greater amount of compression at the time of injury and more rapid progression of compression. We also found that progression of compression was lowest during the first month after injury in all groups. CONCLUSION Patients with low bone densiometry index in osteoporotic thoracolumbar compression fracture are susceptible to more rapid progression of compression and should have early brace application and longer duration of treatment for osteoporosis.
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Comparison of Outcomes of Conservative Treatment, Early Vertebroplasty, and Delayed Vertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures Se-Hyuk Im, Young-Joon Ahn, Bo-Kyu Yang, Seung-Rim Yi, Ye-Hyun Lee, Ji-Eun Kwon, Jong-Min Kim Journal of Korean Society of Spine Surgery.2016; 23(3): 139. CrossRef
Progression of Compression and Related Factors in Conservative Management of Osteoporotic Vertebral Compression Fractures Young Do Koh, Jeong Soo Park Journal of the Korean Fracture Society.2015; 28(2): 132. CrossRef
Of the several nonoperative and operative options described for the treatment of delayed union and nonunion of the long bone, interlocking nailing with reaming offect of internal splint, autogenous bone graft and early return to a normal way of life. The purpose of this study is to evaluate the usefulness and complication of intramedullary(IM) naling with reaming by retrospective method. We treated 34 patients with delayed union or nonunion of the tibia, femur, and humerus by interlocking nailing with reaming between January 1992 and December 1996. The results were as follows ; 1. Of the 34 cases, there were 13 tibia fracture, 17 femur fracture, 4 humerus fracture. Half of them were ununited and another half were delayed in fracture healing. 2. Previous methods of treatment were conservative treatment in 2 cases, external fixator in 2, plate & screws fixation in 8, Ender nail in 2, Kuntscher nail in 2 and interlocking nail in 7 among 24 cases of cloed fracture and external fixator in 8 and interlocking nail in 2 among 10 cases of open fracture. 3. Twenty-five patients were treated with closed nailing and 9 were treated with open nailing. Iliac bone graft was performed at 3 cases and fibulotomy was performed at 1 case. 4. Union was obtained in 33 cases and 1 case needed additional bone grafting to achieve union.
5. Postoperative complications were one nonunion, two evtry site pain, one screw breakage, one heterotopic ossification, and one postoperative infection. Interlocking nailing with reaming was associated with a high union rate(97%) in our eries.
The authors believe that IM nailing with reaming is a useful option for treatment of delayed or nonunion of the long bone fracture.
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Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef
Infected nonunion of long bone frequently accompanies with bone loss, because of the outcome of initial trauma or iatrogenic result from sequestra resection. In this study, infected and ununited long bone fracture was treated with internal bone transport technique which was first discribed by G.A. Ilizarov. There were eleven tibial and two femural nonunion. The mean number of admission was 2.8 times; mean number of operation was 8 times; mean duration of average healing index was 1.95 month/cm. All infections were cured and all nonunions were united. Functional result was excellent in 5 cases (of 13 cases), good in 5, fair in 2, and 1 had poor result. Many complication had been observed. All had infection of pin site and pain at least one time, 5 had stiff knee, 9 had stiff ankle, early consolidation(1), delay consolidation(3), tibiofibular synostosis(5), nerve injury(1), refracture after union(1), angular deformity over 5 degree(7), rotational deformity over 10 degree(2).
We have reviewed 15 cases of tibial pilon fractures who have been treated operatively from May, 1990 to May, 1995 at our hospital.
1. The fractures were classifed into Type I, I and III according to the system of Mast, Spiegel and Pappas and Type III were subdivided into Type A, B and C according to the system of Ruedi-Allgewer, Type I was 1 case(6.7%), Type II were 8(53.3%), Type IIIA were 2(13.3%), Type IIIB were 3(20%) and Type IIIC was 1 case(6.7%).
2. Type I, II and IIIA were treated with open reduction and internal fixation using screw or plate. 2 cases of Type IIIB were treated with open reduction and external fixation and 1 case was treated with plate. Type IIIC was treated with open reduction and external fixation.
3. Conclusively. we had good results with open reduction and internal fixation in Type I, II and IIIA. In Type IIIB, IIIC, if it was difficult to maintain of reduction with internal fixation due to severe bone loss, comminution and soft tissue injury, we could have good results with open reduction, bone graft and external fixation including ankle joint.
Comminuted fractures of distal radius are usually unstable and complex injuries, which require prolonged treatment and often result in some degree of permanent disability. Previous treatment was mainly closed reuction and cast immobilization, and operative treatment of accurate open reduction, internal fixation and bone graft when needed. But recently ligamentotaxis of the fracture using external fixation device has been widely employed.
Which could be followed up for 12 cases of comminuted fractured of distal radius operated with external fixators, more than 1 year, during the period of September 1990 to September 1994 at Seoul Paik Hospital was reviewed. According to Frykmalls classification, the most common type was type VIII (7 cases, 58.3%).
There was 1 open fracture, and 7 combined injuries of ipsilateral upper extremity.
According to AO classification, 9 cases(75%) were type C2 and C3. The most common cause was failing down from a height(6 cases). Additional limited internal fixation was done in 5 cases, all 12 cases were treated external fixators. Results were defined with modified Gartland & Werleys demerit pointing system, exellent was 6 cases(50fr), good wa,i 4 cases(33.3F)), poor was 2 cases. Surgical treatment using external fixators and/or limited open reduction was good Inethod for comminuted distal radius.