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- Treatment of Open Tibial Fracture with Enternal Fixator
- Byung Chang Lee, Sang Soo Kim, Sang Do Cha
- J Korean Soc Fract 1996;9(3):605-613. Published online July 31, 1996
- DOI: https://doi.org/10.12671/jksf.1996.9.3.605
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Abstract
PDF - In a retrospective study from 1987 to 1993, we reviewed 191 patients with 203 open tibial fractures which were treated with external fixator and had adequate clinical and radiological follow up evaluation over 1 year. The configuration of fractures was classified using AO classification, and to extent of soft tissue damage was graded using to Gustilo classification of open fracture. There were 108 Grade I ;36 Grade II and 59 were Grade III. We used mainly unilateral two plane type(simple conventional type) and unilateral one plane type. To stabilize supplementarily large bony fragment, screw, K-wire or wire were used in 11, 41 and 6 cases respectively. 117(51.6%) open fracture wounds healed by delayed primary or secondary intentien, whereas 40(19.1%) patients received a split thickness skin graft, 31(15.3%) patients had a rotation of a myncutaneous flap, and 15(7.4%) patients received a free flap surgery for soft tissue coverage. The average time to union was 25.1 weeks. To obtain bone healing, we performed additionally bone graft in 89 cases(43.8%), fixator change only in 8 cases(3.9%), and fixator change with bone graft in 20 cases(9.9%). All cases except 28 open tibial fractures, which was performed fixator change, were treated by primary external fixation without a change of fixator. Major complications were delayed union, nonunion and pin tract infection, and superficial infection, chronic osteomyelitis, pin loosening and partial ankylosis of joint were developed. In conclusion, we think the external fixator is a routine device for open tibial fractures. The configuration of fracture and degree of soft tissue damage had influence on healing of open tibial fracrures. Supplementary fixation in combination with external fixation does not offer important advantages. We should pay attention to bone healing more than soft tissue healing in Crade I & II injury and to soft tissue healing more than bone healing in Grade III injury.
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- Treatment with bone block transfer of coracoacromial ligment in acromioclayicular injury
- Byung Chang Lee, Sang Soo Kim, Dae Moo Shim, Sang Do Cha
- J Korean Soc Fract 1996;9(1):146-153. Published online January 31, 1996
- DOI: https://doi.org/10.12671/jksf.1996.9.1.146
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Abstract
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- Several studies have shown the effectiveness of reconstruction of acromioclavicular ligament with coracoacromial ligament in treating the Grade III acromioclavicular joint injury. One of these is a bone block transfer of coracoacromial ligament into the medullary canal of the clavicle to prevent occasional pullout of the transfered ligament. Eleven cases with complete acromioclavicular dislocation(acute 3, chronic 8) were treated by this method. We modified slightly the original method described by Shoji et at. to increase the success rate. Failure of coracoclavicular reconstruction occurred in two cases. All except one patient regained nearly painlefs range of shoulder motion. One patient showed severe restriction of shoulder abduction and definite deformity. In functional evaluation by the Weitzman criteria, five were excellent, four good, one fair, and one poor. Radiologic results for restoration of coracoclavicular interval showed marked improvement but were not consistent with clinical results. Main technical problems were harvesting bone block and fixation of ligament. To obtain good osseus healing without pull out of transferred ligament, we found that preservation of bone ligament junction and careful harvest of full thickness acromiai bone block was important.
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