Heterotrophic ossification (HO) is a reactive disease presenting the formation of mature lamellar bone in soft tissues. It is known to occur following surgery, soft tissue injury, or central nervous system anomalies. However, a definite cause has not yet been clearly addressed. During the process of approach, reduction, and fixation while conducting surgeries, partial injury of soft tissue is inevitable. Additionally, secondary injuries may be caused during the active and passive range of motion exercises that should be done for the recovery of joint motion after surgery. The authors experienced cases of HO that may occur during surgery and rehabilitation after surgery. The authors recognized that special care is required for patients complaining of severe pain during the early stage of rehabilitation immediately after surgery. This study aimed to reaffirm the principles of fracture treatment by reviewing the cases and to investigate the occurrence of HO after fracture surgery.
PURPOSE To evaluate the adequate surgical methods and postoperative rehabilitation by analyzing the outcome of surgical treatment for isolated greater tuberosity fracture of proximal humerus. MATERIALS AND METHODS Ten patients who allowed at least 1 year follow up after the surgical treatment of isolated greater tuberosity fractures were evaluated. Their mean age was 52.3 years (range, 28~67) and mean follow up duration was 23.8 months (range, 12~36). We choosed the different approaches and fixation methods according to size, location and presence of comminution of the fragment, and combined injury. The rehabilitation programs were indivisualized and we evaluated the clinical outcomes using UCLA and Constant scoring system. RESULTS According to the UCLA scoring system, 5 cases were excellent, 3 cases were satisfactory, and 2 cases were unsatisfactory. By the Constant scoring system, 8 cases were excellent and 2 cases were good. The average bony union time was 7.6 weeks (range, 6~8) except the 2 cases of revision surgery. Two cases were operated using cannulated screws alone, 3 cases using only nonabsorbable sutures and 5 cases using cannulated screws and nonabsorbable sutures. One out of two revision cases was developed from the negligence of preoperative shoulder anterior dislocation with rupture of subscapularis, and the other was caused by improper immobilization of the fracture site postoperatively. CONCLUSION Not only the adequate surgical approaches and the fixation methods according to the size and comminution of fragment, but also the identification of combined injuries were very important in the surgical treatment for the isolated greater tuberosity fracture. And we considered that the adequate postoperative rehabilitation and proper protection based on the intraoperative fixation stability play an important role for the better clinical and radiological outcomes.
Citations
Citations to this article as recorded by
Clinical Features and Characteristics of Greater Tuberosity Fractures with or without Shoulder Dislocation Dong-Wan Kim, Young-Jae Lim, Ki-Cheor Bae, Beom-Soo Kim, Yong-Ho Lee, Chul-Hyun Cho Journal of the Korean Fracture Society.2018; 31(4): 139. CrossRef
The Surgical Outcomes of Isolated Greater Tuberosity Fractures of the Proximal Humerus Fixed with the Spring Plate Dong-Ju Shin, Young-Soo Byun, Se-Ang Chang, Hee-Min Yun, Ho-Won Park, Jae-Young Park Journal of the Korean Fracture Society.2009; 22(3): 159. CrossRef
PURPOSE To establish a general guide line in the treatment of the patellar fracture MATERIALS AND METHODS: Twenty three patellar fractures followed for 2.2 years in average, treated with internal fixation were evaluated retrospectively. The primary fixations were the metal screw fixation in 7, the Dall-Miles' cable circumferential fixation in 14 and combination of both methods in 2 cases. The additional fixations were the tension band wiring in 9, the load sharing cable fixation in 3 and combination of both methods in 5 cases. The initial postoperative immobilazation of the knee joint in flexion, preferably 90degrees, for 7 days was effective to gain full range of motion RESULTS: Complete union without displacement was achieved in all cases. Full ROM was achieved in all cases except one. CONCLUSION The choice of internal fixation need to be individualized according to the level of comminution, bone strength, fracture site and soft tissue damage. A strong internal fixation, initial immobilization in flexion followed by early ROM exercise were important factors to gain good result.
Citations
Citations to this article as recorded by
Clinical Effectiveness of Korean Medical Rehabilitation Treatment after Patellar Fracture: A Report of 4 Cases Ji-Hye Geum, Hyeon-Jun Woo, Jong-gyu Kim, Jung-Han Lee Journal of Korean Medicine Rehabilitation.2020; 30(4): 203. CrossRef
Treatment of Transverse Patellar Fracture with Cannulated Screws Jung-Man Kim, Ju-Seok Yoo, Yong-Jin Kwon, Jang-Ok Cheon Journal of the Korean Fracture Society.2007; 20(2): 149. CrossRef