PURPOSE The purpose of this study is to evaluate the results of operative treatment using a reconstruction nail after temporary K-wire fixation of the femoral neck for ipsilateral femoral neck and shaft fractures. MATERIALS AND METHODS A total of 11 cases were treated, which were followed-up for more than two years, between August 2007 and July 2012. The average age was 51 years (29-69 years) and men were dominant counting eight cases. All cases were operated with a reconstruction nail after temporary K-wire fixation of the femoral neck. Bone union periods, alignment, etc. were evaluated by radiological methods and accompanying damage and complications were also investigated. Functional evaluation was performed in accordance with Friedman and Wyman criteria at the last follow-up. RESULTS The average time for union of the femoral shaft was 22.5 weeks (12-32 weeks), and femoral neck was 13.1 weeks (8-20 weeks). There was no nonunion, and four femoral shaft fractures resulted in delayed union. There was one case of leg length discrepancy more than 2 cm long, but malalignment of more than 10 degrees was not observed. Avascular necrosis of the femoral head did not occur. Functional results were good in eight cases, fair in two cases, and poor in one case. CONCLUSION Treatment with reconstruction nailing after temporary K-wire fixation of the femoral neck is thought to be a good method which prevents neck displacement and has low complication rates.
PURPOSE To compare treatment results obtained using the trochanteric (Sirus nail) entry portal with those obtained using the Piriformis fossa (M/DN) entry portal during intramedullary (IM) nailing of femur shaft fractures. MATERIALS AND METHODS Four hundreds and thirty-two patients treated for femur shaft fracture using IM nails from February, 2001 to May, 2010 were divided into two groups. group 1 was composed of 180 patients treated through the trochanteric (Sirus nail; n=180) entry portal, while group 2 contained 170 patients treated through the piriformis fossa (M/DN nail; n=170) entry portal. We compared the clinical and radiographic findings of both groups to evaluate the treatment results. RESULTS Functional result, range of motion and union time (18, 20 weeks) were similar in both groups. The operation time of patients in the over-weighted group was 90 minutes in group 1 and 120 minutes in group 2 (p<0.05). Additionally, the blood loss was 280 ml in group 1 and 335 ml in group 2, and in case of over-weight patients, group 2 showed more blood loss (p<0.05). The duration of exposure to fluoroscopy differed slightly, with group 1 being less exposed than group 2; however, this difference was not significant (p>0.05). There were 18 iatrogenic fractures in group 1 and 4 in group 2 (p<0.05). CONCLUSION There was not much difference in complications based on clinical and radiographic findings of both groups. For groups using the trochanteric entry portal, the operation time was shorter and blood loss was lower than in groups using the piriformis entry portal. Iatrogenic fracture occurred more often in the group using the trochanteric entry portal than in the group using the piriformis entry portal.
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Failure to Remove a Trochanteric Entry Femoral Nail and Its Cause in Adolescent Patients: Two Cases Report Ji-Hwan Kim, Seung-Oh Nam, Young-Soo Byun, Han-Sang Kim Journal of the Korean Fracture Society.2015; 28(1): 71. CrossRef
Treatment of the Femoral Fracture Using Sirus® Nail: A Comparison of Complication according to the Entry Potal Young-Yool Chung, Dong-Hyuk Choi, Dae-Hyun Yoon, Jung-Ho Lee, Ji-Hun Park Journal of the Korean Fracture Society.2015; 28(2): 103. CrossRef
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PURPOSE The purpose of this study was to analyze the results of treating subtrochanteric femoral fractures with proximal femoral nail antirotation (PFNA). MATERIALS AND METHODS Twenty five consecutive patients diagnosed with subtrochanteric femoral fractures underwent intramedullary fixation using PFNA and followed-up for over 12 months. According to the Seinsheimer's classification, there were 2 type IIA, 9 type IIB, 2 type IIIA, 3 type IV and 9 type V. According to the AO classification, there were 10 type A, 9 type B and 6 type C. There were 16 cases of closed reduction group and 9 cases of limited open reduction group. Retrospectively, radiological outcomes were assessed at the union period, change of neck shaft angle, tip-apex distance, Cleveland index, sliding of lag screw and complication. RESULTS Union was achieved in 23 of 25 cases, over an average of 17 weeks. Limb length shortening below 2 cm occurred in 7 patients. The Cleveland index was shown in 80% of 5, 6, 8 and 9 zone; the tip apex distance was 19.6 mm; the mean sliding distance was 4.4 mm; and the mean change of femur neck and shaft angle was varus 3 degree at the final follow-up. Complications included 3 cases of delayed union and 2 cases of nonunion. CONCLUSION With its early bony union, ambulation, rehabilitation and low complication, PFNA is a useful and reliable choice for the treatment of subtrochanteric fractures of the femur. Limited open reduction and additional fixation such as cable grip are recommended if it is difficult to obtain anatomical reduction by closed reduction.
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PURPOSE To evaluate the radiological results and complications of interlocking intramedullary nailing for segmental tibia fractures. MATERIALS AND METHODS Twenty-six patients (26 cases) who underwent interlocking intramedullary nailing for segmental tibia fractures between January 2003 and May 2011 were followed for more than one year. We evaluated the complications and statistically analyzed the factors influencing bone union, including open fracture, fracture site, reaming, postoperative angulation, and postoperative fracture gap. RESULTS Nineteen cases (73%) achieved bone union with one operation at an average of 7 months (range, 5 to 11). Seven cases had secondary procedures before achieving union. Complications included 7 cases of nonunion, 3 cases of incomplete peroneal nerve injury, 2 cases of superficial infection, 1 case of compartment syndrome. Factors showing statistically significant differences were open fracture, postoperative angulation, and postoperative fracture gap. Factors showing no statistically significant difference were fracture site and reaming. CONCLUSION Nonunion is the most common complication in interlocking intramedullary nailing for segmental tibia fractures. To minimize this complication, comprehension of surgical techniques to reduce anatomically and careful evaluation of the fracture are required.
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PURPOSE To analyze the clinical and radiologic results of minimally invasive plate osteosynthesis (MIPO) for distal femur fractures using a locking compression plate (LCP) and to evaluate its usefulness. MATERIALS AND METHODS From May 2006 to April 2011, 23 patients (24 cases) with distal femur fracture were treated by MIPO with a LCP and followed-up for at least 12 months. Mean age was 61.6 years (35-80 years). Union time and post-operative alignment were measured on radiograph, and clinical function was evaluated by range of motion (ROM), Knee Society Score and complications. RESULTS In 22 patients (23 cases) except for 1 case, bony union was obtained after an average of 18 weeks (12-26 weeks). The mean ROM was 124 degrees (80-135 degrees). According to the Knee Society Score, there were 12 excellent, 8 good, 1 fair and 2 poor results and the mean score was 87.5 (60-98). Postoperative complications were nonunion in 1 case, ankylosis in 1 case, malunion in 2 cases and superficial wound infection in 2 cases. CONCLUSION The treatment of distal femoral fracture with MIPO using a LCP was considered a useful method which can result in satisfactory clinical and radiologic outcomes if there is accurate understanding about the surgical techniques and appropriate procedures involved.
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PURPOSE We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts. MATERIALS AND METHODS From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system. RESULTS The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases. CONCLUSION We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.
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Current Concepts in Management of Tibia Plateau Fracture Sang Hak Lee, Kang-Il Kim Journal of the Korean Fracture Society.2014; 27(3): 245. CrossRef
PURPOSE To evaluate the short term follow-up results of minimally invasive technique in the management of Sanders type II, III, and IV joint depressive calcaneal fracture. MATERIALS AND METHODS Between May 2008 and May 2011, we studied 17 cases undergoing treatment with minimally invasive technique with modified sinus tarsi approach for Sanders II, III, and IV joint depressive intra-articular calcaneal fracture and were followed up for more than 1 year. We evaluated the treatment result by assessing the radiologic parameters (Bohler angle, Gissane angle, and calcaneal height/width/length) and clinical outcomes (American Orthopaedic Foot and Ankle Society [AOFAS] score and visual analog scale [VAS]) and investigating the complication. RESULTS Radiological results improved from 7.9degrees to 19.8degrees in the Bohler angle after the operation. Satisfactory results were obtained in clinical assessment with average AOFAS score of 82.45 and the average VAS score of 3.94. We experienced 3 cases of complications, 1 case of superficial wound infection and radiologic findings of subtalar arthritis in 2 cases. CONCLUSION Minimally invasive technique may be a useful alternative surgical method in the management of Sanders type II, III, and IV joint depressive calcaneal fracture that cannot adopt extensile approach, which enable to obtain good radiological and clinical results.
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Towards uniformity in communication and a tailor-made treatment for displaced intra-articular calcaneal fractures Tim Schepers International Orthopaedics.2014; 38(3): 663. CrossRef
PURPOSE To evaluate the clinical and radiological results of minimally invasive plate, osteosynthesis, using either a locking compression plate-distal tibia (LCP-DT) or Zimmer periarticular locking plate (ZPLP) for distal tibia fractures. MATERIALS AND METHODS Fifty one patients (51 cases), who underwent minimally invasive osteosynthesis using locking compression plate for distal tibia fractures between October 2008 and August 2011, were followed for more than six months. Eighteen patients were treated with LCP-DT and 33 patients with ZPLP. Time to bony union and anatomic alignment were evaluated radiologically. Clinically, American Orthopedic Foot & Ankle Society ankle-hindfoot scales (AOFAS score) and range of ankle motion were assessed and compared between two groups. RESULTS All patients achieved bony union at an average of 18 weeks on LCP-DT group and 16weeks on ZPLP group. The average American Orthopedic Foot & Ankle Society ankle-hindfoot scales was 83.3 points on the LCP-DT group, 84.6 points on the ZPLP group, and range of ankle motion averaged at 45 degrees, 48 degrees, respectively. CONCLUSION Both types of locking compression plates were effective when performing minimally invasive osteosynthesis for distal tibia fractures.
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Biomechanical analysis and clinical effects of bridge combined fixation system for femoral fractures Da-xing Wang, Ying Xiong, Hong Deng, Fu Jia, Shao Gu, Bai-lian Liu, Qun-hui Li, Qi Pu, Zhong-zi Zhang Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine.2014; 228(9): 899. CrossRef
PURPOSE To analyze the clinical and radiological results of the different fixation methods according to the type and displacement of unstable pelvic ring injuries. MATERIALS AND METHODS Twenty-three patients with unstable pelvic ring injuries from January 2005 to December 2009 were classified according to the AO/OTA classification system. When patients had been diagnosed with unstable pelvic ring injuries with partial instability, they were treated by anterior fixation with a plate and posterior percutaneous iliosacral screw fixation. When patients had been diagnosed with unstable pelvic ring injuries with complete instability, they were treated by open reduction and anterior to posterior fixation with a plate through the ilioinguinal approach. The radiological results were evaluated using Matta and Saucedo's method, and the clinical results were evaluated using Rommens and Hessmann's method. RESULTS The outcomes from the radiological evaluation were that the displacement of the posterior pelvic ring were improved by about 6.65 mm in unstable pelvic ring injuries with partial instability. The displacement of the posterior pelvic ring were improved by about 7.8 mm in unstable pelvic ring injuries with complete instability. The clinical results were excellent in 13 cases and good in 6 cases on latest follow-up. CONCLUSION Good results can be achieved by selecting the treatment method according to the type of unstable pelvic ring injurie and displacement.
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Outcome of Surgical Treatment of AO Type C Pelvic Ring Injury Do Hyeon Moon, Nam Ki Kim, Jun Sung Won, Jang Seok Choi, Dong Hyun Kim Hip & Pelvis.2014; 26(4): 269. CrossRef
Minimally Invasive Plate Osteosynthesis for Humeral Proximal or Distal Shaft Fractures Using a 3.5/5.0 Metaphyseal Locking Plate Hyoung Keun Oh, Suk Kyu Choo, Jung Il Lee, Dong Hyun Seo Journal of the Korean Fracture Society.2012; 25(4): 305. CrossRef
PURPOSE To report the good results of two-stage treatment in pilon fractures. MATERIALS AND METHODS A retrospective study of 23 patients among 30 patients with pilon fractures from March 2006 to November 2008, who underwent two-stage treatment of pilon fractures with a minimum of 24 months follow-up. The mean follow-up period was 28 months (24~41 months). In the first stage of the operation, open reduction of the articular surface and external fixation were performed after minimal incision. As the soft tissue healed, locking compression plate fixation was performed with the Minimally invasive plate osteosynthesis. Radiographic evaluation was graded by the criteria of Burwell and Charnley, and functional assessment of the ankle was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. RESULTS The fractures were united within 16 weeks (12~30 weeks). The radiologic results showed anatomical reduction in 18 cases and a mean AOFAS score of 81. The mean range of ankle motion was 44 degrees. There were four complications: 1 case of wound infection and 3 cases of ankle osteoarthritis. CONCLUSION Two-stage treatment of pilon fractures is a good treatment method because it is designed to obtain early anatomical reduction, definitive stable fixation, low rates of soft tissue complication, and good range of ankle motion.
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Current Concepts in Management of Pilon Fracture Jun-Young Lee, Sang-Joon Lee Journal of the Korean Fracture Society.2014; 27(2): 173. CrossRef
PURPOSE To compare results between minimally invasive plate osteosynthesis using a periarticular plate and intramedullary nailing in distal tibial metaphyseal fractures in two treatment groups. MATERIALS AND METHODS Sixty-one cases of distal tibial metaphyseal fractures from December 2008 to December 2009 were evaluated. The minimal follow-up period was 12 months. Thirty patients treated by minimally invasive plate osteosynthesis using a periarticular plate were Group A; 31 patients treated by intramedullary nailing were Group B. We compared and analyzed the results of each group by radiological and clinical assessments. RESULTS The mean bony union time was 16.4 weeks in Group A and 17.2 weeks in Group B. The mean operation time was 45 minutes in Group A and 48 minutes in Group B. The mean radiation exposure times were 4.2 minutes and 4.8 minutes, respectively. VAS scores were 0.7 points and 0.5 points in each respective group. In Group A, the VAS score was 1.7 points when we applied pressure on the skin around the plate. The mean Olerud and Molander Ankle Score was 87.4 points and 86.3 points, respectively. A superficial wound infection occurred in 1 case in each group, and angular deformities more than 5 degrees occurred in 2 Group B cases. CONCLUSION No significant differences in results were observed between the two groups. However, a higher incidence of angular deformity was seen in the intramedullary nailing group. Therefore, we must be careful during surgery.
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Comparative Analysis of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Distal Tibia Fractures Ho-Min Lee, Young-Sung Kim, Jong-Pil Kim, Phil-Hyun Chung, Suk Kang, Kaung Suk Jo Journal of the Korean Fracture Society.2018; 31(3): 94. CrossRef
A Comparison of the Results between Intramedullary Nailing and Minimally Invasive Plate Osteosynthesis in Distal Tibia Fractures Chul-Hyun Park, Chi-Bum Choi, Bum-Jin Shim, Dong-Chul Lee, Oog-Jin Shon Journal of the Korean Orthopaedic Association.2014; 49(4): 285. CrossRef
PURPOSE To analyze the long term follow up results of treatment with posterolateral approach and to investigate its usefulness in the patients of trimalleolar fracture with posterior fragment which is above 25% of articular involvement. MATERIALS AND METHODS There were 34 cases of trimalleolar fracture in our hospital from May 2004 to April 2008. We investigated 20 patients who underwent operation with the posterolateral approach and over-2 years follow up cases. The mean follow up period was 34 (24~58) months. Preoperative posterior malleolar fragment involved above 25% of articular surface in all cases and displaced more than 2 mm in 11 cases. We analyzed the radiologic type of posterior malleolar fragments and evaluated the function and pain through AOFAS score and complications. RESULTS All cases showed primary union at mean 13.1 weeks. The complications are that partial ankylosis result of soft tissue contracture is seen in 2 cases (10%) and post-traumatic arthritis is seen in 1 cases (5%) and 17 cases (85%) of all patients are showed excellent AOFAS score. CONCLUSION The posterolateral approach is a valuable method because that it enables us to easily reduction and internal fixation of the posterior malleolus and lateral malleolus at one time and the results are satisfied for a long time follow up.
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Outcomes of Immediate Operative Treatment of Ankle Trimalleolar Open Fractures Jun-Young Lee, Yong-Jin Cho, Sin-Wook Kang, Yung-Min Cho, Hyun-Bai Choi Journal of Korean Foot and Ankle Society.2020; 24(1): 25. CrossRef
PURPOSE This study compares the clinical results of open reduction and internal fixation with and without bone graft for the treatment of intra-articular calcaneal fractures. MATERIALS AND METHODS Twenty-five patients who had open reduction and internal fixation for intra-articular calcaneal fractures and available for at least 1 year of follow-up were included in this study. Fifteen cases were operated with bone graft. Period to bone union and functional evaluation score were compared between both groups with analysis of complications. RESULTS Bone union was achieved in all cases with average bone union time of 11.6 weeks and 12.8 weeks in group with and without bone graft respectively. Creighton-Nebraska Health Foundation (CNHF) functional score was 86.5 points and 80.3 points respectively. The period to bone union and the CNHF score in the comparison of two groups were statistically insignificant. Complications were observed in four cases of group without bone graft and 5 cases of group with bone graft. CONCLUSION This study indicates that bone graft does not play a significant role in bone union and functional outcome when intra-articular calcaneal fractures are treated with open reduction and internal fixation.
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Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures Chul Hyun Park, Oog Jin Shon Journal of the Korean Fracture Society.2016; 29(3): 221. CrossRef
PURPOSE We wanted to evaluate the efficacy of MIPO (minimal invasive plate osteosynthesis) technique by LCP (locking compression plate) for treating proximal tibia fractures. MATERIALS AND METHODS Twenty-three patients, who had operation due to proximal tibia fracture and available for follow up for more than 1 year were included in this study. Cause of injury and accompanied injuries were checked. Operation time, period to bone union, range of joint motion and alignment were evaluated with complications. RESULTS Mean bone union time was 13.7 weeks (10~20). Twenty-one cases of the patients showed angulation of less than 5 degrees and 17 cases had normal range of motion. Five cases showed skin irritation by the plate and 2 cases had superficial infection. CONCLUSION LCP by MIPO technique for treating proximal tibia fracture showed excellent results. Delicate technique is required for the proper adjustment of LCP and the alignment of the lower leg.
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EVALUATION OF FUNCTIONAL OUTCOME OF SURGICAL TREATMENT FOR FRACTURE AROUND KNEE WITH LOCKING PLATE VIKAS KUNTWAD, AMOL WAGH, SATYAJEET A HORE Asian Journal of Pharmaceutical and Clinical Research.2023; : 213. CrossRef
Medial Minimally Invasive Percutaneous Plate Osteosynthesis in Proximal Tibial Comminuted Fractures Jae-Ang Sim, Kwang-Hui Kim, Yong-Seuk Lee, Sang-Jin Lee, Beom-Koo Lee Journal of the Korean Orthopaedic Association.2014; 49(4): 278. CrossRef
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PURPOSE To evaluate the result of treatment of proximal femoral shaft fracture with limited open reduction and intramedullary nailing. MATERIALS AND METHODS: Fifteen patients who had limited open reduction and intramedullary nailing due to proximal femoral shaft fracture for follow-up for more than 12 months were selected between March 2001 and December 2005. The clinical and radiologic results were analyzed. Winquist-Hansen classification and OTA/AO classification were used. RESULTS: Thirteen cases achieved bone union and 2 cases showed delayed union. The mean bone union period was 21.3 weeks (14~32). There was no postoperative infection. Nonunion was observed in 2 cases of which bone union was acquired with the exchange of intramedullary nail and bone graft in one case and with the additional plate fixation and bone graft in the other case. CONCLUSION: Treating proximal femoral shaft fracture with limited open reduction and intramedullary nailing seems to be a technique to manage proximal femoral shaft fracture that has combined fracture or ipsilateral femoral fracture or is unable to acquire acceptable reduction with closed reduction.
PURPOSE Wound problems occur in 5~30% of intra-articular calcaneal fractures following operation. Diabetes mellitus, large incisions and abundant dissection can increase the risk of wound problems that may require skin graft or other additional care. The authors used minimally invasive technique to treat intra-articular calcaneal fractures in diabetic patients and evaluated the results and complications of this method. MATERIALS AND METHODS: Between January 2002 and July 2005, 12 patients with intra-articular calcaneal fractures who had underlying diabetes mellitus were treated using minimally invasive technique with a modified sinus tarsi approach. The patients had an average age of 47 years (39~67) and were followed an average of 19 months (13~32). The mean period between injury and operation was 8 days (5~14). Crutch assisted partial weight bearing was advised for an average of 7.3 weeks (6~9) and full weight bearing was allowed after average of 9.3 weeks (7~11). RESULTS According to AOFAS scale for ankle and hindfoot, patients had the following results: excellent - 1 patient (8%), good - 9 patients (75%), fair - 1 patient (8%), unsatisfied - 1 patient (8%). Bone union was achieved in all cases and there were no events of deep infection or skin necrosis. CONCLUSION Treating intra-articular calcaneal fractures by minimally invasive technique is an excellent operative method for patients with diabetes mellitus, as this method can minimize soft tissue incision and resulting deep infection and skin necrosis.
PURPOSE To evaluate the relationship between radiographic parameters and clinical results after operative treatment of the displaced intra-articular calcaneal fractures. MATERIALS AND METHODS We analyzed 35 patients of unilateral displaced intraarticular calcaneal fractures who had operative treatment with minimum follow up of 1 year. At the last follow up, we measured the radiographic parameters including Bohler angle, Gissane angle, heel height, calcaneal length, talocalcaneal angle, talar declination angle, subtalar incongruity between normal and affected site. Clinical results were measured by Creighton-Nebraska Health Foundation Assessment Score (CNH). The correlation between the radiographic parameters and the clinical results were analysed by Pearson correlation method. RESULTS Among the all radiographic parameters we analyzed, only subtalar incongruity shows strong negative linear correlation with clinical results. The average difference of subtalar incongruity between normal and affected site was 0.54 mm (0~2.5) and the correlation coefficients with CNH score was -0.784 (p=0.002). CONCLUSION We suggest that the subtalar incongruity is significantly correlated with the clinical results after operative treatment of the displaced intraarticular calcaneal fractures.
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PURPOSE To evaluate the short-term results of two-staged delayed minimal invasive plate osteosynthesis in high-energy intraarticular fractures of the distal tibia. MATERIALS AND METHODS Thirteen patients, who underwent two-staged delayed minimal invasive plate osteosynthesis for intraarticular fractures of the distal tibia between January 2002 and July 2004, were followed for more than one year. The mean interval time between first stage and second stage of the procedures was 28.6 days (range, 14~34 days). By Ruedi-Allgower classification, there were two cases in type I, three cases in type II, and eight cases in type III. There were six cases in type B and seven cases in type C patients according to AO/OTA classification. Radiographs were graded by the criteria of Burwell and Charnley and ankle functions were graded by the criteria of Mast and Teipner. Union time and postoperative complications were also analysed. RESULTS Average union time was 16.9 weeks (range, 14~20 weeks) in twelve of the thirteen fractures, but there was one fracture resulting in soft tissue complication and infected nonunion. At the latest follow-up, review of the radiographic results showed that ten cases of fractures (77%) achieved an anatomic reduction, two cases (15%) achieved fair reduction and one case (8%) achieved a poor reduction. And clinical functional assessment showed that nine cases (69%) were good results, three cases were (23%) fair results and one case (8%) was poor result. CONCLUSION Two-staged delayed minimal invasive plate osteosynthesis is an excellent option for the treatment of high-energy intraarticular fractures of the distal tibia.
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Staged Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures Sung-Ki Park, Chang-Wug Oh, Jong-Keon Oh, Kyung-Hoon Kim, Woo-Kie Min, Byung-Chul Park, Won-Ju Jeong, Joo-Chul Ihn Journal of the Korean Fracture Society.2010; 23(3): 289. CrossRef
The Comparison of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Proximal and Distal Tibia Fracture Joon Soon Kang, Seung Rim Park, Sang Rim Kim, Yong Geun Park, Jae Ho Jung, Sung Wook Choi Journal of the Korean Fracture Society.2010; 23(2): 172. CrossRef
Two-staged Delayed Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Open Fractures Jung Hwan Yang, Seok Hyun Kweon, Jeung Woo Kim, Jin Young Park, Hyun Jun Kim, Chul Min Lim Journal of the Korean Fracture Society.2008; 21(1): 24. CrossRef
PURPOSE To evaluate the safety and usefulness of the short-segment posterior instrumentation and fusion in the treatment of thoracolumbar spine fractures. MATERIALS AND METHODS Forty-two patients were treated by short-segment pedicle screw instrumentation and fusion between Oct. 1998. and Jan. 2004 by single surgeon. All patients were treated posteriorly and all the pedicle screws are monoaxial. Intraoperative rod bending and fixation technique was used to reduce the collapsed vertebral body and correct the kyphotic angle. The follow up duration is mean 2.1 year (1~6 year). The mean age is 40.2 year (18~60 year) old. The fractures were classified by Denis' classification and Load-Sharing Classification. Preoperative and postoperative changes of kyphotic angle and vertebral body height were measured. Denis' Pain Score and Work scales, Frankel neurologic grade were obtained during follow-up evaluation for patients. RESULTS All the cases got solid bony union. Mean Load-Sharing Score was 7.3. Clinical results were good. The mean kyphotic angle was preoperatively 14.5 degree, immediate postoperatively 7.5 degree, and last follow up 9.2 degree. The mean anterior vertebral heights s were 60.8% preoperatively, 83.4% immediate postoperatively, and 79.5% last follow up. There was only one case of screw breakage but no revision operation due to loss of reduction. All the cases showed satisfactory clinical results. CONCLUSION This study suggest that short-segment instrumentation and fusion using pedicle screw system for thoracolumbar spine fractures could lead to good results, if comminution of vertebral body is considered in the selection of approach.
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Comparison of Percutaneous versus Open Pedicle Screw Fixation for Treating Unstable Thoracolumbar Fractures Jin Young Han, Ki Youn Kwon Journal of the Korean Fracture Society.2020; 33(1): 1. CrossRef
PURPOSE To evaluate the postoperative progress and outcomes of bone injured patients with long bone fracture showing callus formation and deformity due to delayed surgical treatment. MATERIALS AND METHODS 10 cases with more than 1 year follow up were chosen from 12 patients with long bone fracture whose surgical treatment was delayed due to brain injury. Exuberant callus formation and deformations were observed. Average delayed period was 6.7 weeks (4~10 weeks). Preoperative callus formation, shortening and angulation were evaluated using plain radiographs. Total operation time and transfusion amount were compared with that from operations done within 2 weeks following accident. Postoperative bone union was checked. RESULTS In all cases, preformed angulation and hypertrophic ossification made reduction difficult and this increased total operation time and transfusion amount but had no statistical importance. In patients with humerus and femur fractures accompanying brain injury, massive hypertrophic ossification was observed both in preoperative period and in postoperative period. Average bone union period was 13.5 weeks in humerus fractures, 17.9 weeks in femur fractures. The bone union period was shorter in subject group but had no statistical importance. CONCLUSION Early surgical treatment is essential to patients with long bone fracture accompanying brain injury but if early surgical treatment can not be done, proper immobilization to fracture site should be done.
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Alterations in Serum Levels of Receptor Activator of Nuclear Factor-κB Ligand and Osteoprotegerin in Patients with Head Injury and Fracture Shin Young Park, Kuen Tak Suh, Chang Hoon Ryu, Seung Hun Woo, Jung Sub Lee, Seong-Gang Kim Journal of the Korean Fracture Society.2008; 21(2): 145. CrossRef
PURPOSE To evaluate the clinical result of ender nailing under local anesthesis was done to patient with tibia shaft fracture who had high risk for general anesthesia or spinal anesthesia. MATERIALS AND METHODS 10 cases with ender nailing procedure under local anesthesia due to high anesthetic risk were selected from total of 20 cases with tibia shaft fracture operated with ender nailing. In each patient, hepatic, diabetic, cadiopulmonary complication and thromboembolism which can be initiated or aggravated by general or spinal anesthesia, were evaluated. Radiologic and clinical evaluation were used to check bone union. RESULTS There were no complication of local anesthesia. Bone union were acquired in all cases with average bone union period of 18 weeks. There were no evidence of flexion deformity, limb shortening or joint contracture. CONCLUSION Ender nail fixations under local anesthesia enable close reduction and intramedullary nailing and is effective in patient care but has no problem with bone union. For this reason, ender nail fixation under local anesthesia seem to be effective method if general of spinal anesthesia is difficult.
PURPOSE Retrograde intramedullary nailing has been recommended as one of the treatment options for the distal femoral fracture, particularly in patients who are obese, are pregnant, has sustained ipsilateral femoral neck fracture, have multiple injuries. However there are some disadvantage such as post-arthrotomy infection, knee joint stiffness. This paper is to evaluate the result and complication of treatment of distal femoral fracture with a retrograde intramedullary nailing. MATERIALS AND METHODS We reviewed 13 cases (distal femoral shaft fracture: 6 cases, supracondylar fracture: 7 cases) of the distal femoral fracture who had been treated with retrograde intramedullary nailing and follow up for more than 12 months from January 1999 to December 2001. The rate of bony union, range of motion of the knee, complications were evaluated. RESULTS The mean duration of bony union was 20 weeks (range, 16~25 weeks). A case of delayed union was developed. In 4 cases of 13 cases showed posterior angulation below 6 degree, which did not need further treatment. According to Saunder's criteria, excellent result was achieved in 8 patients, good result in 5 patients, respectively. CONCLUSION This study showed good clinical and radiological results of union with retrograde intramedullary nailing at the distal femoral fracture and ipsilateral multiple fracture
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Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult Yong-Woon Shin, Yerl-Bo Sung, Jeong Yoon Choi, Minkyu Kim Journal of the Korean Fracture Society.2011; 24(4): 313. CrossRef
Axial Malalignment after Minimally Invasive Plate Osteosynthesis in Distal Femur Fractures with Metaphyseal Comminution Jae-Ho Jang, Gu-Hee Jung, Jae-Do Kim, Cheung-Kue Kim Journal of the Korean Orthopaedic Association.2011; 46(4): 326. CrossRef
PURPOSE To evaluate the clinical results of the surgical treatment for established nonunion of lateral humeral condyle fracture using closing wedge osteotomy and bone graft. MATERIALS AND METHODS Six patients diagnosed as symptomatic established nonunion of lateral humeral condyle fracture and cubitus valgus deformity were reviewed retrospectively. The average age was 23 years old and mean follow up period was 32 months. We investigate the changes of the symptoms and radiographic findings, and determine the results by Oppenheim's criteria. RESULTS According to Oppenheim's criteria, 3 patients showed excellent, 2 good, 1 poor. Carrying angle is improved to 10.2 degrees and range of motion was decreased by mean 9 degrees. All of the patients' muscle weakness and pain were improved, and was achieved solid union at the last follow up. CONCLUSION In the treatment of symptomatic established lateral humeral fracture and cubitus valgus deformity, better functional and cosmetic results are anticipated by a closing wedge osteotomy and bone graft.
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In SituLate Metaphyseal Osteosynthesis for the Fractures of the Lateral Humeral Condyle in Children Kun Bo Park, Seung Whan Lee, Hyun Woo Kim, Hui Wan Park, Ki Seok Lee Journal of the Korean Fracture Society.2008; 21(2): 151. CrossRef
PURPOSE Examine a humeral shaft fracture which had been treated with a plate and screw fixation or intramedullary nailing and compare these two methods with each other according to clinical and radiologic results and access the clinical avaliablity. MATERIALS AND METHODS Take 116 cases of humeral shaft fracture which had been treated with plate and screw fixation(73 cases) or intramedullary nailing(43 cases) and compare these two methods with each other according to bone union time, average operation time and nonunion rate. RESULTS Bony union in plate fixation was achieved 1.2 weeks earlier than intramedullary nailing(P>0.05). The average time of operation in intramedullary nailing was 58 minutes, which was shorter than that in plate fixation(P<0.05). The prevalence of nonunion was higher in intramedullary nailing than that in plate fixation, which was thought due to the fanning relaxation, fracture site distraction and/or inappropriate operative technique. Limitation of shoulder motion occasionally occurred in intramedullary nailing, so approriate device selection and surgical technique should be considered. CONCLUSIONS We concluded that the results of interlocking IM nailing were not superior to the results of plate fixation. But it is an attractive technique for the rapid closed stabilization of polytrauma patients and segmental and communited fractures.
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Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107. CrossRef
From January 1992 to December 1996, authors analyzed 26 cases of fracture-dislocation of talar neck or body, treated at Chosun University Hospital retrospectively. There were 20 males and 6 females and the average age was 34 years old. The follow up period was at least 14 months. There were 19 neck fracture-dislocations, 6 body fractures and total dislocation of talus. Three type I talar neck fractures were treated conservertively. In six cases, in which either three cases of severe open type III talar neck fracture or three cases of severly comminuted talar body fracture, primary fusion was performed. Other seventeen cases of fracture-dislocation were treated by open reduction and internal fixation. Excellent results were observed in 6 cases, good in 7 cases, fair in 11 cases and poor in 2 cases. The result of primary arthrodesis for severe injury of talus was relatively good. Complications were avascular necrosis in 7 cases, posttraumatic arthritis in 5 cases, skinnecrosis in 3 cases, wound infection in 2 cases and malunion in 2 cases.
Distal humerus fracture, particularty those that involve the articular surface, in adult has remained one of the most difficult of all fractures to manage. The goal of this study is to analyze clinical result according to fracture pattern and method of treatments and to recognize complicating factor affecting prognosis. Nonoperatively managed intraarticular fractures are likely to have compromised functional outcome. Open anatomic reduction and stable fixation secure enough to permit early functional, pain-free motion of the elbow showed best result. Stable fixation of fracutre is achieved with use of single or dual plates with additional lag screws depending on the fracture pattern. When there is segmental articular fragments, interfragmentary bipolar threaded screw(Herbert screw) may be useful. autogenous cancellous bone grafting is sometimes advisable when the diaphyseal portion of the fracture is comminuted. Transolecranon approach affords excellent surgical exposure of the joint surface for fracture with comminuted intra-articular component and there was no postoperative complication.
The common sequelae after femoral shaft fractures in children are leg-length discrepancy, angular deformity and rotational deformity. Overgrowth after the conservative management of fractures has been clearly defined, and it has been reported that rotational deformities can remodel. The importance of angular deformity after fracture is less clear although it has been reported as many as 40% of cases. So, authors reviewed 15 children (16 cases) with unilaterral femoral shaft fractures who had more than 10 degrees angular deformity after conservative treatment and observed the remodelling of deformity both at the fracture site and the physes. after average follow up of 34 months, the results were as follows 1. The average correction was 84% of the initial angular deformity; the physes contributed more than the fracture site.
2. The anterior angulation remodelled better than the varus angulation.
3. Younger children remodelled better and the magnitude of the angulation influenced the degree of remodelling.
LC-DCP is the latest plate and screw system developed by AO-ASIF group. There are many merits of LC-DCP with its unique contour and material. : Reduction of surface contact between plate and bone result in preserved vascularization and then improved bone consolidation. Compression can be achieved in either longitudinal direction and a lag screw can be inserted at greater inclination. In addition, pure titanium as an LC-DCP material display optimal biocompatibility and reduce the spread of bacteria and increase resistance against infection. Between June 1994 and September 1995, 39 patients with 40 long bone fractures were treated using LC-DCP.(24 femur, 13 humerus, 3 tibia) Follow-up averaged 12 months : Bone union was achieved in 32 cases(80%) The complications were 7 cases of metal failure, 7 cases of limited joint motion, 2 cases of nonunion,2 cases of delayed union and 2 cases of deep infection.
In dealing with lateral humeral condylar injuries, the chance of having a poor functional result with inappropriate management is much greater.
Therefore, careful attention in treatment is required in order to reduce additional damage caused by excessive manipulation and firm internal fixation with accurate anatomical reduction is recommended for the prevention of complications even if displacement is not severe.
The authors analyzed 29 fractures of the lateral condyle of humerus in children who were treated from Jan. 1990 to Dec. 1994.
The results were as follows ; 1. All of fractures were Milch type II and Jakobs stage II was most common in 14 cases(48.3%).
2. They were treated with cast immobilization in 5 cases(17.2%), with percutaneous K-wires pinning in 5 cases(17.2%) and with open reduction and internal fixation in 19 cases(65.5%).
3. The complications were 12 cases of bony spur, 8 cases of bony overgrowth. 2 cases of premature epiphyseal fusion, 1 case of cubitus valgus with extension limitation, 1 case of pin site infection.
4. According to the criteria of Hardacre, we obtained excellent result in 10 cases(34.5%), good result in 17 cases(58.6%) and poor result in 2 case(6.9%).