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
The authors analyzed 34 cases of humeral shaft fractures in patients who were treated by the Seidel intramedullary nailing from March 1994 to August 1996. Average follow-up period was 18 months(12 months - 26 months). We experienced nonunions of 5 cases(14.7%). The nonunions were found mostly at the comminuted midshaft fractures. The probable cause of nonunion was distraction of fracture ends due to intramedullary endosteal lysis and failure of fanning within postoperative 3 months.
These 4 cases of nonunion were treated with rigin internal fixation and additional bone graft, and 1 case with refanning only. So we concluded that the eidel system ws insufficient fixation technique because of the distal spreading-fin loosening. Distal screw-locked nailing seemed to be nn more useful technique unless there are major modifications to the Seidel nail itself.
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.
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%).
The elbow is highly constrained and stable joints in the body, but dislocation is not uncommon due to trauma such as traffic accident and sports injury. The relative incidence of associated fractures in previously reported series of elbow dislocations has ranged from 12% to 62%. Post-traumatic sequelae of the elbow fractures and dislocations are joint stiffness, nerve injury, non-union and heteroDopic ossification. Operative procedures for repair and reconstruction of the injured elbow are technically demanding and require careful planning. Because of the proximity of crucial neurovascular structures, a thorough knowledge of the anatomy and extensile exposure is essential. Thirteen adult patients with elbow dislocation associated with fractures about the elbow from June 1990 to June 1995 who had taken operative treatment were studied. The results were as follows ; 1. Most common direction of dislocation is posterior(8 cases) and most common associated fracture is radial head & neck fracture(7 cases).
2. Most common and disabling complication is limitation of motion(7 cases).
3. By the Mehlhoffs criteria, with regard to limitation of motion, pain, instability and neurovascular deficit, relatively good results are obtained at 9 cases(69%).
4. For better functional results, early reduction of dislocation, stable fixation of fracture and early motion is essential option in the management of elbow fractures and dislocations.
It has been known that early recognition and prompt decompression is critical in acute compartment syndrome with tibial fracture because inappropriate treatment lead to signincant functional disabilities.
We treated 567 cases of tibial fracture and experienced 21 cases of acute compartment syndrome between September 1988 and June 1994.
The purpose of this study is to analysis the initial degree of intracompartmental pressure and duration between the diagnosis and decompression, to evaluate the functional results and to discuss the complications.
The result obtained were as follows 1. Anterior intracompartmental pressure was ranged from 25mnHg to 81mmHg (average 43.4mmHg), and deep posterior intracompartmental pressure ranged from 19mmHg to 61mmHg (average 32.7mmHg).
2. Among the 21 cases, common peroneal neuropathy were developed in 19 cases. We experienced complete recovery in 5 cases, incomplete recovery in 13 cases and 1 case of no change. We found posterior tibial neuropathy in 8 cases, and experienced complete recovery in 2 cases, incomplete recovery in 5 cases and 1 case of no change.
3. As an complications, clawing of toe developed in 3 cases, equinovarus deformity of ankle in 2 cases, superficial wound infection, osteomyelitis and nonunion in 1 case.
4. We obtained good or excellent results in 16 cases(76.1%).
5. We thought that the most important factor to decide the prognosis seems to be duration of high level of tissue pressure and also it is neccessary early diagnosis and early treatments to obtain good results.
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Is CT Angiography a Reliable Tool for Diagnosis of Traumatic Vessel Injury in the Lower Extremities? Jong-Hyuk Park, Kwang-Bok Lee, Hyuk Park, Jun-Mo Lee Journal of the Korean Fracture Society.2012; 25(1): 26. CrossRef
Fracture of the distal radius is one of the most common injuries Met in the orthopaedic field. Once it was thought that good function comes despite poor anatomic restoration in distal radius fractures.
But now maximum recovery of wrist function is dependent on accurate and stable reduction of the radial articular surface.
We reviewed thirty-nine cases of distal radius fracture that were treated with closed reduction under C-arm field and then the wrist was immobilized by a sugar tong cast splint and then a long arm cast, from Aug. 1992 to Aug. 1995 at the Department of Orthopaedic Surgery of Chosun University Hospital.
The results of this study were as follows; 1. The main causes of these injuries were from slipping(51.3%) and falling down(28.2%).
2. Among the 39 cases of distal radius fracture, 12 cases(30.8% ) had unstable fractures.
3. In the 39 case, satisfactory results were shown in 25 cases but, in the unstable fracture group, 10 cases out of 12 cases showed unsatisfactory results.
4. When the articular surface of the radius was severely comminuted and the fracture site was severely displaced, the result of this study was poor.
5. Accurate and stable reduction of the radial articular surface & radial length was significantly correlated with the clinical results.
The reduction and maintenance of subtrochanteric fractures are difficult because most of these fractures are comminuted due to high velocity trauma.
Although various devices of internal fixation have been developed to solve these problems, selecting the appropriate fixation device for different fracture types is difficult.
Subtrochanteric fractures were treated operatively and analysed at Chosun University hospital from Jan.1985 to Dec.1991 and the following results were obtained.
The most common type of fracture was type II a by Seinsheimer classification(11 cases,28.9%) The bone union rate was 81.8% in plate fixation group and 87.5% in intramedullary group. Of the 38 cases, 9 complications occured.
From this study, it was concluded that intramedullary nailing is beneficial in subtrochanteric fractures associated with medial cortical comminution. Also, when plating was performed massive bone grafting & external support were required.
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On the role of the pre-ionization mechanism in the optical breakdown of molecular oxygen induced by CO2 laser: Numerical investigation Yosr E. E.-D. Gamal, O. Aied Nassef, A. S. Salama Physics of Plasmas.2019;[Epub] CrossRef
Interlocking nailing is the best method available in treatment of femoral shaft fracture dui to its many advantages compared with other method. However, we have encountered many problems during the operative procedure and postoperative periods due to technical complexities. After we have evaluated problems during and after the procedure of interlocking nailing for the femoral fractures in 56 cases, we suggest the means to avoid these errors and complications.
1. Among the 54 patients,39 complications and technical errors have been reported in 19 patients.
2. Intraoperative complications and technical errors were encountered in ; 9 cases of improper portal of entry, 3 cases of new fragmentation,3 cases of angulation,2 cases of new fracture line,2 cases of failure of distal locking screw insertion,2 cases of distraction of fracture site, 1 case of proximal protrusion of nail and 1 case of rotation of nail.
3. Postoperative complications were encountered ,6 cases of delayed union,2 cases of nonunion,2 cases of limb shortening,2 cases of deep infection,2 cases of loosening of distal locking screw, 1 case of breakage of distal locking screw and 1 case of failure of nail.
The authors report a clinical experience of 25 patients having patellar fracture who were treated with tension band wiring or modified tension band wiring from January 1984 to December 1988, at the Department of Orthopedic Surgery, Cho-Sun University Hospital.
The results were as follows.
1. Out of 25 cases were treated by modified tension band wiring and remaining 5 cases were treated by tension band wiring.
2. The mean fracture healing period was 5.8 weeks in cases of modified tension band wiring and 6.8 weeks in tension band wiring.
3. Fixation by tesion band priciple has given acceptable results in comminuted fractures and transverse fractures both.