Between June 1996 and July 1997, 29 tibial fracture patients were treated using the Ilizarov method and apparatus. The mean follow-up petiod was 18 months. Among 29 cases, 11 were closed fractures with comminution and 18 were open fractures. There were 2 Gustilo-Anderson type I, 5 type II, and 11 type III open tibial fractures. Complications included 4 pin tract average time from application of the device to complete fracture healing was 26.3 weeks. According to Tucker's functional criteria, the results were 14 excellent, 9 good, 4 fair, 2 poor. No practical contraindications to the use of the Ilizarov device in the management of tibial fractures were encountered. We concluded that Ilizarov method is indeed a useful adjunct for the treatment of either open or closed tibial fractures.
The lateral condyle fracture of humerus in children is the second most common fracture among the elbow fractures. In dealing with this fracture, we have frequently encountered the various complications due to physeal plate and intraarticular involvement. Change of the carrying angle is one of the common complications, but many authors reported different results about the change of carrying angle. Also, it is too difficult to measure the carrying angle during the early stage of the treatment because of cast immobilization, motion limitation of elbow, and wide variations of radiologic carrying angle according to elbow position changes.
We performed this study to find the more stable and predictable new radiologic measuring method about the carrying angle, and then analysed the factors affecting the changes of canying angle of the 23 patients of the lateral condyle fractures of the humerus in children who were treated and followed up more than twelve months at the Department of Orhopaedic Surgery, Dong-A University Hospital from May 1990 to April 1993.
The results were as follows.
1. Carrying angles by Beals method showed variable values according to the elbow positions, but A-angles by the new measuring method were relatively stable regardless of the elbow positons.
2. Increase of clinical carrying angle was 3 cases, decrease was 9 cases, and ranges of clinical carrying angle change were from -7 degress to 14 degrees. Increase of A-angle was 7 cases, decrease was 4 cases, and ranges of A-angle change were from -10 degrees to +10 degrees.
3. The change of canying angle showed no correlation with Jacob stage, follow up duration, metaphyseal height and interval between injury and treatment. But the incidence and the amount of carrying angle change were increased according to the increased age at injury(r=0.62, P<0.01).
4. There were statistical significant correlation(r=-0.65, p<0.01) and regression between the change of canying angle and A-angle : Y=-0.99X+0.56(Y:change of clinical canying angle,X; A-angle change), (r2=0.42, P<0.01).
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Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture Yoon Hae Kwak, Dong Jou Shin, Kun Bo Park Journal of the Korean Fracture Society.2010; 23(1): 90. CrossRef
The tibial condylar fracture which involves articular surface of the proximal tibia is common in traffic accident and often produces some disability of the knee joint because it is frequently accompanied by injuries to ligaments and menisci.
There are much controversies in the method of treatment in the fractures of the tibial condyle. Although the anatomical reduction and rigid internal fixation with early knee motion are reconmanded to obtain good results, unsatisfactory results have been reported as 20-40% of cases.
The authors analyzed 36 cases of tibial condylar fractures that treated at the Department of Orthropaedic Surgery, College of Medicine, Dong-A University from March 1990 to March 1993.
The results were as follows: 1. The sex ratio was 2.3: 1 in male to female and most common age group was 4th decade.
2. The most common cause of injury was traffic accident in 25 cases(69.4%).
3, According to Schatzkers classification, the most common type was type II in 10 cases(27.8%).
4. The most common associated injuries were ligament injury in 10 cases(27.8%) and fibular fracture in 30 cases(27.8%).
5. By Porters criteria, 8 cases(80%) among 10 conservative cases and 18 cases(69.2%) among 26 operative cases had acceptable results.
6. The complications were most common in type II(5 cases) and type IV(5 cases).
7. The factors of poor results were as follows : displaced comminuted fracture, fracture associated with severe soft tissue injury or with ligamentous and meniscal injury.
A pilon fracture, which is defined as a comminuted intraarticular fracture of distal involve the articular surface and metaphysis with occasional extension in the diaphysis.
The management has been notoriously difficult due to the associated injury, intraarticular fracture, severe communition of distal tibia, joint incongruity and soft tissue trauma.
Most authors has reported good results after a surgical treatment by a principle of AO group treatment.
Rescently, Bone et all reports that ROM and outcomes of the severly comminuted or open fractures of the distal intraarticular tibia were very good in using the external fixator.
The result of treatment of 22 cases were analysed at the Department of Orthopedic Surgery, Dong-A University hospital from Mar. 1990 to Feb. 1993.
The results were as follows; 1. The incidence of pilon fracture is 8.3% of all ankle fracture treated during same period.
2. The most common cause of injury is fall down(63.3%).
3. The most frequent type is type 3 (54.6%).(by Rudei & Allgower) 4. The most common associated injury is compression fracture of spine and calcaneal fracture(4 cases).
5. There are eight cases open Pilon fracture(36.3%) 6. We had treated severe communited fracture and open fracture by using external fixator, we achived good ROM and outcomes.
7. The more accurate reduction, the better clinical result.
8. Complication of the Pilon fracutre were traumatic arthritis, non-union, malunion, wound int, etc.