Purpose This study examined the effect of lag screw insertion on proximal fragments by separating the right and left sides of intertrochanteric fractures in elderly patients that underwent intramedullary nailing. Materials and Methods Patients aged ≥65 years that underwent intramedullary nailing after a diag-nosis of intertrochanteric fractures during the period February 2012 to May 2016 were included in the study. The subjects were divided into right and left side groups. The effect of the clockwise rotational force generated when a lag screw was inserted on the proximal fragment was evaluated in both groups. Results In the right and left groups, most proximal fragments were located in the intramedullary canal after surgery (45 cases [75.0%] and 67 cases [73.6%], respectively). Clockwise rotation due to lag screw placement in the right group occurred in two cases (3.3%), which both showed internal rotation, and in four cases (4.4%) in the left group, all of which showed external rotation. Conclusion After intramedullary nailing of intertrochanteric fractures in elderly patients, proximal fragments were mostly located in the intramedullary cavity. The results obtained confirmed that the clockwise rotational force generated by lag screw insertion did not affect left or right sides.
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Which side should be taken care of when positioning a lag screw in intertrochanteric femoral fracture: right or left? Min Uk Do, Kyeong Baek Kim, Sang-Min Lee, Hyun Tae Koo, Won Chul Shin European Journal of Trauma and Emergency Surgery.2025;[Epub] CrossRef
Midterm Outcomes of Intramedullary Fixation of Intertrochanteric Femoral Fractures Using Compression Hip Nails: Radiologic and Clinical Results You-Sung Suh, Jae-Hwi Nho, Min Gon Song, Dong Woo Lee, Byung-Woong Jang Clinics in Orthopedic Surgery.2023; 15(3): 373. CrossRef
Purpose This study compared the clinical and radiographic results of two proximal femoral nail antirotation II (PFNA-II) angled by 125° and 130° in patients with intertrochanteric fractures. Materials and Methods From March in 2015 to September in 2016, 65 patients who underwent a closed reduction and internal fixation with PFNA-II for a femoral intertrochanteric fracture were evaluated retrospectively. The minimum follow-up period was two years. Of those, 30 and 35 patients underwent 125° angled PFNA-II and 130° angled PFNA-II, respectively. The clinical performance was evaluated using the Harris hip score, WOMAC (Western Ontario and McMaster Universities Osteoarthrtis Index), and UCLA (University of California Los Angeles) score. Radiographic analyses were performed using standardized anteroposterior and lateral radiographs to assess the implant position and quality of reduction. The blade length, distance between the blade tip and the tip of the greater trochanter, and distance between the blade tip and the most lateral protrusion point of the greater trochanter in the two groups were measured and compared. Results The clinical results, including the Harris hip score, WOMAC, and UCLA, were similar in the two groups at the last follow-up postoperatively. In the radiography evaluation, the implant position, quality of reduction, and the blade length were similar in the two groups. The distances between the blade tip and the tip of the greater trochanter were 52.60±3.53 mm and 58.07±5.54 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The distance between the blade tip and the most lateral protrusion point of greater trochanter were 16.48±2.54 mm and 21.19±4.43 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively.
The differences were significant (p=0.031, p=0.012). Conclusion The operation with the 125° angled PFNA-II showed a more superior and lateral position of the blade than that with the 130° angled PFNA-II. Nevertheless, lateral thigh pain can occur when the blade is positioned superolaterally.
This paper reports the use of a traction device for the treatment of neglected proximal interphalangeal fracture dislocations. A 44-year-old man with a fracture dislocation of a right ring finger proximal interphalangeal joint was admitted 17 days after the injury. Closed reduction and external fixation were performed using a dynamic traction device and C-arm under a brachial plexus block. Passive range of motion exercise was started after two weeks postoperatively and active range of motion exercise was started after three weeks. The traction device was removed after five weeks. No infection occurred during the traction period. No subluxation or displacement was observed on the X-ray taken two months postoperatively. The active range of motion of the proximal interphalangeal joint was 90°. The patient was satisfied with the functional result of the treatment with the traction device. The dynamic traction device is an effective treatment for neglected fracture dislocations of the proximal interphalangeal joint of a finger.
Min Jung Park, Su Jin Lee, Jin Hwa Kam, Yun Tae Lee, Ju Hyung Yoo, Hyun Cheol Oh, Joong Won Ha, Yung Park, Sang Hoon Park, Seong Hoon Kim, Han Kook Yoon
J Korean Fract Soc 2017;30(3):137-141. Published online July 31, 2017
Atypical femoral fracture related to a long-term bisphosphonate therapy has commonly been reported; however, a fracture at the site other than the femur has rarely been reported to date. Herein, we report a case of a patient on long-term bisphosphonate therapy who presented atypical tibial insufficiency fracture at the anterolateral aspect of diaphysis, without trauma. We, for the first time in Korea, present this case with a literature review.
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Atypical Femoral Fracture Occurring at a Proximal Screw Insertion Site after Plate Removal in a Distal Femoral Fracture Jin Woo Jin, Sung Jin Shin, Jong Min Jeon Journal of the Korean Orthopaedic Association.2024; 59(4): 314. CrossRef
PURPOSE We compared visible blood loss and calculated blood loss after intramedullary fixation in intertrochanteric fracture, and evaluated correlation between blood loss and its risk factors. MATERIALS AND METHODS A total of 256 patients who underwent closed reduction and intramedullary fixation in femoral intertrochanteric fracture between 2004 and 2013 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including fracture pattern (according to Evans classification), gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score and use of antithrombotic agents. RESULTS Total calculated blood loss (2,100+/-1,632 ml) differed significantly from visible blood loss (564+/-319 ml). In addition, the blood loss of unstable fracture patient was 2,496+/-1,395 ml and multivariate analysis showed a significant relationship between blood loss and fracture pattern (p<0.01). However, other factors showed no statistically significant difference. CONCLUSION Total calculated blood loss was much greater than visible blood loss. Patients with unstable intertrochanteric fracture should be treated with care in order to reduce blood loss.
PURPOSE To compare the outcomes of distal radius fractures in a fixed-angle volar locking plate group and variable-angle volar locking plate group. MATERIALS AND METHODS Forty-one patients observed at least 6 months after surgery were included in this retrospective study. We used the range of motion, visual analogue scale score, Disabilities of the Arm, Shoulder and Hand Questionnaire score, and radiologic findings to measure the clinical results. RESULTS No differences in clinical results or radiologic results were noted between the fixed-angle volar locking plate group and variable-angle volar locking plate group. CONCLUSION We believe that it is important to minimize complications by using appropriate screws and plates according to the fracture type, though no differences in the surgical outcome were noted between the fixed-angle volar locking plate group and variable-angle volar locking plate group with distal radius fracture.
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Volar locking plate fixation for distal radius fractures: did variable-angle plates make difference? Mohamed Abdel-Wahed, Ahmed Abdel-Zaher Khater, Mahmoud Ahmed El-Desouky International Orthopaedics.2022; 46(9): 2165. CrossRef
Treatment of Fractures of the Distal Radius Using Variable-Angle Volar Locking Plate Jae-Cheon Sim, Sung-Sik Ha, Ki-Do Hong, Tae-Ho Kim, Min-Chul Sung Journal of the Korean Fracture Society.2015; 28(1): 46. CrossRef
Functional Outcomes of Percutaneous K-Wire Fixation for Distal Radius Fractures with or without Osteoporosis Ki-Chan An, Gyu-Min Kong, Jang-Seok Choi, Hi-Chul Gwak, Joo-Yong Kim, Sung-Yub Jin Journal of the Korean Fracture Society.2013; 26(4): 248. CrossRef
High-energy injury, as traffic accident or fall down, can cause fracture of femur head and posterior dislocation of hip joint which is accompanied with ipsilateral acetabulum fracture or femur neck fracture. But the case that femur head fracture and posterior dislocation of the hip joint coincide with ipsilateral intertrochanteric fracture of proximal femur is so uncommon that reports of the case is very rare. We hereby are to report the experienced and treated-cases of femur head fracture and posterior dislocation of the hip joint that is accompanied with ipsilateral intertrochanteric fracture.
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Decoding the behaviour of extracapsular proximal femur fracture- dislocation - A systematic review of a rare fracture pattern Keyur B. Desai Journal of Clinical Orthopaedics and Trauma.2021; 18: 157. CrossRef
We described an unusual case of a 16-year-old Taekwondo athlete who injured the left wrist when she compete with other athlete. She described a mechanism of axial loading, with the wrist in radial deviation. This unusual combined lunate and triquetrum fracture was not associated with the perilunar dislocation. We present this case with a review of the literature. In this case, internal fixation and early range of motion result in a good functional outcome.
OBJECTIVES To evaluate the results and its efficacy of double plating for proximal tibial fractures using minimally invasive percutaneous osteosynthesis (MIPO) technique.
MATERIAL & METHODS: Twenty-three fractures, followed-up more than 1 year, were included in this retrospective study. There were 18 men and 5 women, and the mean age was 53.5 years-old. According to the AO-OTA classification, five were 41A, 13 were 41C, and 5 were 42. There were four open fractures (grade I- three, grade III A-one case). The plates were fixed on the medial and lateral sides of tibia with MIPO technique. Functional and radiographic results were evaluated by the modified Rasmussen system. RESULTS All fractures healed without bone graft, and the mean period for fracture healing was 19.3 weeks (range, 10~32 weeks). All other patients had excellent or good clinical or radiological results, except for two patients of a fair clinical result after a combined injury. Complications included one case of shortening (1 cm) and two cases of mal-alignments (varus less than 10 degrees). There was one case of superficial infection, but no patient showed deep infection. CONCLUSION Double plating using MIPO technique can provide favorable results in the treatment of proximal tibial fractures.
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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
Minimally Invasive Plate Osteosynthesis for Proximal Tibial Shaft Fracture Young-Soo Byun, Ki-Chul Park, Hyun-Jong Bong, Chang-Hoon Lee Journal of the Korean Fracture Society.2011; 24(1): 23. CrossRef
Treatment of Proximal Tibia Fractures Using LCP by MIPO Technique Sang-Ho Ha, Dong-Hui Kim, Jun-Young Lee Journal of the Korean Fracture Society.2010; 23(1): 34. CrossRef
Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture Joon-Woo Kim, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Woo-Kie Min, Byung-Chul Park, Kyung-Hoon Kim, Hee-Joon Kim Journal of the Korean Fracture Society.2009; 22(1): 6. CrossRef
PURPOSE To retrospectively review the results of internal bone transport in the management of tibial bone defect using ilizarov fixator. MATERIALS AND METHODS We treated 39 cases of tibial bone defect (16 of traumatic bone loss, 23 after treatment of osteomyelitis). The mean age of index procedure was 33.8 years (range, 13~66 years), and all of them had follow-up study for a mean of 3.5 years (range, 1.6~8 years). The mean transported amount was 6.3 cm (range, 2.7~20 cm), and the external fixator was removed after 345 days (range, 120~700 days). The mean external fixation index was 60.3 days/cm (range, 13.1~121.3 days/cm). RESULTS Primary union of distraction and docking site was achieved in all, but two patients had failure in union of docking site. Functional results showed 6 excellent, 19 good, 10 fair, and 4 fair. The patients under age 20 showed better functional outcomes than the others. Among 73 complications (incidence, 1.87 cases/ patient), 27 of major complications with residual sequelae occurred in 20 patients. The residual sequelae were more common in the patients who had the concomitant injuries in the same leg. CONCLUSION Internal bone transport can solve the large amount of tibial bone defect. However, the complications are not uncommon, which might be related to the concomitant injures in the same leg.
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Bone Transport Over the Intramedullary Nail for Defects of Long Bone Jae-Young Roh, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Byung-Chul Park, Woo-Kie Min, Joon-Woo Kim, Chang-Hyun Cho Journal of the Korean Fracture Society.2008; 21(1): 37. CrossRef
Minimally Invasive Plate Osteosynthesis to Prevent or Treat the Deformity after Distraction Osteogenesis Chang-Wug Oh, Byung-Chul Park, Il-Hyung Park, Hee-Soo Kyung, Woo-Kie Min, Seung-Hoon Baek, Seung-Kil Baek The Journal of the Korean Orthopaedic Association.2007; 42(6): 764. CrossRef
PURPOSE Despite of various treatment methods, proximal tibial fractures are common injuries that may be associated with poor outcomes and high rates of complications. To improve this, percutaneous plating technique was performed in the proximal tibial fractures. MATERIALS AND METHODS Twenty-four proximal tibial fractures (AO 41A; 5, AO 41C; 12, AO 42; 7) were treated by percutaneous plating with either or both sides without bone graft. One was open fracture. RESULTS All fractures were healed. The average time for fracture healing was 16.5 weeks (range, 8~24 weeks). Complications included a 1cm shortened case and two mal-alignments; a 6 degree valgus case and 5 degree varus case. There was one case of superficial infection, which healed after plate removal. But, there was no deep infection. Results were evaluated by modified Rasmussen score system, all patients had excellent or good result. CONCLUSION Minimally invasive percutaneous plating technique can provide favorable results in the treatment of proximal tibial fractures.
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MINIMALLY INVASIVE OSTEOSYNTHESIS WITH PLATE OR NAIL FOR META-DIAPHYSEAL TIBIAL FRACTURES - WHAT IS BETTER? B. Makelov Trakia Journal of Sciences.2023; 21(4): 357. 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
Minimally Invasive Percutaneous Plate Stabilization Using a Medial Locking Plate for Proximal Tibial Fractures - Technical Note - Jae Ang Sim, Beom Koo Lee, Kwang Hui Kim, Yong Seuk Lee Journal of the Korean Fracture Society.2013; 26(4): 327. CrossRef
Clinical Outcomes of Locking Compression Plate Fixation through Minimally Invasive Percutaneous Plate Osteosynthesis in the Treatment of Distal Tibia Fracture Jae-Sung Yoo, Hyun-Woo Park Journal of the Korean Fracture Society.2012; 25(2): 117. CrossRef
Minimally Invasive Plate Osteosynthesis for Proximal Tibial Shaft Fracture Young-Soo Byun, Ki-Chul Park, Hyun-Jong Bong, Chang-Hoon Lee Journal of the Korean Fracture Society.2011; 24(1): 23. CrossRef
Minimally Invasive Plate Osteosynthesis for the Upper Extremity Fracture Using a Lumbar Spreader - Surgical Technique - Gu-Hee Jung, Chyul-Hyun Cho, Jae-Do Kim Journal of the Korean Fracture Society.2011; 24(1): 83. CrossRef
Management of Fractures of Distal Tibia by Minimally Invasive Plate Osteosynthesis through an Anterior Approach Gu-Hee Jung, Jae-Do Kim, Jae-Ho Jang, Sung-Keun Heo, Dong-won Lee Journal of the Korean Orthopaedic Association.2010; 45(6): 473. 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
Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture Joon-Woo Kim, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Woo-Kie Min, Byung-Chul Park, Kyung-Hoon Kim, Hee-Joon Kim Journal of the Korean Fracture Society.2009; 22(1): 6. CrossRef
Proximal Tibia Fracture: Plating Ki-Chul Park Journal of the Korean Fracture Society.2009; 22(3): 206. CrossRef
PURPOSE This is a retrospective study to analyze the results of unreamed intramedullary nailing in grade III tibial open fracture. MATERIALS AND METHODS Twenty-nine Gustilo-Anderson grade III tibial open fractures fixed with unreamed tibial nail were followed more than one year. Primary union rate, union time, infection, conversion to external fixation, ankle and knee function according to different grade of open, fracture level, AO classification, and muscle flap were evaluated. RESULTS Primary union was achieved at sixteen fractures. There were three delayed union that achieved union twenty week after primary operation. And eight undergone secondary bone grafts which were done after inflammation sign subcided. Complications about infection were in five cases. Two cases were unable to maintain internal fixation due to deep infection, and three of superficial infection were treated with repeated debridement and antibiotics use. CONCLUSION In grade III tibial open fracture, unreamed nailing with early soft tissue reconstruction and early prophylactic bone graft can be a good treatment.
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Management of Open Fracture Gu-Hee Jung Journal of the Korean Fracture Society.2010; 23(2): 236. CrossRef
Management of Open Tibial Fractures: Role of Internal Fixation Yerl-Bo Sung Journal of the Korean Fracture Society.2007; 20(4): 349. CrossRef
PURPOSE Low-intensity, pulsed ultrasound (LIPUS) has demonstrated a stimulation and acceleration of the normal fracture-repair process in cellular bases as well in animal and human models. In this study, the adjunctive effect of LIPUS and LASER was investigated in established nonunion of the long bones. MATERIALS AND METHODS Study group consisted of eight patients to whom conventional bone graft and adjunctive LIPUS and LASER was applied. On the other hand, eight patients in the control group underwent bone graft only. Eleven men and five women were included in this study and the average age of the patients was 41.7 years (range, 19~62 years). Six of the tibias and ten of the femurs met the criteria for established nonunion. The average fracture age, the post-fracture period before the start of LIPUS/LASER treatment, was 502 days. RESULTS Seven of the ten nonunions who were treated by LIPUS and LASER healed completely in an average treatment time of 141 days (range, 101~202 days) and otherwise, in control group, five of the eight nonunions healed completely, in 240 days (range, 183~283 days). CONCLUSION This clinical study showed a positive effect of LIPUS and LASER on the rate of osseous repair, especially accelerated time to initial callus cortical bridging compared to that of conventional treatment.
PURPOSE This is a retrospective study to analyze the results after retrograde intramedullary(IM) nailing in femoral shaft fractures with limited indications. MATERIALS AND METHODS Twenty-four femoral shaft fractures(21 patients) were operated with unreamed IM nail(Unreamed femoral nail, SynthesR) in a retrograde method and were followed for more than 1 years. There were 16 men and 5 women, and the mean age at index operation was 41 years (range 18-76 years). In Winquist-Hansen classifications, there were 10 of type I, five of type II, three of type III, and six of type IV. All the patients had associated fractures or injuries, and there were eight ipsilateral tibia fractures, five ipsilateral proximal femoral fractures(including neck and trochanter), four ipsilateral pelvic or acetabular fracture, three bilateral femoral fractures, and one ipsilateral knee injury according to the used indications. In radiological study, we evaluated the time for union, non-unions and malunion, and clinical evaluation with Neer 's criteria was done. RESULTS Most fractures(87.5%) were primarily united cases, and the mean time for union was 15.8 weeks(range 12-20 weeks). Three cases of delayed union or nonunion were developed, but a shortening over 1cm or malunion over 10 degrees angular deformity were not found. Evaluating the knee functions, the Neer score was 86.9 in average and all the cases were above satisfactory grade. The average range of knee motion was 120.2 degrees, and the mild knee pain was developed in three cases. CONCLUSION The retrograde IM nailing can be a useful option for femoral shaft fractures with limited indications, including ipsilateral fractures of other areas or multiple fractures.
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Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture Chang-Wug Oh, Jong-Keon Oh, Woo-Kie Min, Shin-Yoon Kim, Seung-Hoon Baek, Byung-Chul Park, Hyung-Soo Ahn, Tae-Gong Kim Journal of the Korean Fracture Society.2007; 20(2): 135. CrossRef
Retrograde Intramedullary Nailing for the Treatment of Ipsilateral Femoral Shaft and Neck Fracture Chang-Wug Oh, Jong-Keon Oh, Shin-Yoon Kim, Ki-Bong Cha, In-Ho Jeon, Byung-Chul Park, Woo-Kie Min, Tae-Gong Kim The Journal of the Korean Orthopaedic Association.2007; 42(3): 380. CrossRef
PURPOSE To investigate whether injection of calcium sulfate salt powder could be used to facilitate consolidation of early & fast distraction osteogenesis. MATERIALS AND METHODS Group I was experimental group and Groups II and III were controls. After 3 days of latency period, a small distractor was distracted for a total of 8 mm for 4 days. Calcium sulfate salt powder suspended in carboxymethylcellulose(CMC) solution was injected, whereas CMC media alone was injected in one control group and without intervention in the other control group. Plain radiographs were taken on every weeks. We assesed the bone mineral density(BMD) at 3 and 6 weeks and %BMD was calculated. The rabbits were sacrificed at 6 weeks for histologic examination. RESULTS In radiography, the distracted area was consolidated in the experimental group but not in control groups. The % BMD of the experimental group was significantly greater than that of control groups at 6 weeks(p<0.01). In histologic examination, greater amount of newly formed bone was noted in the distraction zone of the experimental group, compared to two control groups. CONCLUSION Implantation of calcium sulfate powder can accelerate consolidation in distraction osteogenesis in rabbits.
PURPOSE To investigate the relationship between the complications of intracapsular femoral neck fractures treated by multiple pinning and several affecting factors. MATERIALS AND METHODS Sixty-eight patients with intracapsular femoral neck fractures were treated by multiple pinning from March 1993 to January 2000 and followed at more than one year. Relationship between the complications such as failure of union, collapse of femoral head due to osteonecrosis of femoral head and several affecting factors including displacement of fracture according to Garden stage, state of reduction, position of screws, time interval from injury to operation, and fracture level were analyzed. The Fisher exact test, chi-square test, and multivariate logistic regression analysis were used to find the relevant factors influencing incidence of complications. Statistical significance was set at p < 0.05. RESULTS Position of screw was the most important single factor affecting the results of treatment of intracapsular femoral neck fracture (p=0.046). Moreover, the Garden stage and position of screw were revealed affecting the incidence of complications together with other factors (each p value was 0.028 and 0.027). CONCLUSION We considered that satisfactory position of screw was important to reduce complications after multiple pinning for intracapsular femoral neck fracture. And the results of operation also seemed to closely relate with multiple factors including Garden stage and status of reduction.
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Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures Tae-Ho Kim, Jong-Oh Kim, Sung-Sik Kang Journal of the Korean Fracture Society.2009; 22(2): 79. CrossRef
PURPOSE To evaluate the clinical results after modified Phemister operation for complete dislocation of acromioclavicular joint. MATERIALS AND METHODS Thirty-seven cases of Fifty-three cases complete dislocation of acromioclavicular joint which were treated modified Phemister operation, follow up for at least one year, were evaluated. After operation, applied Kenny-Howard brace for six weeks and removed the inserted pins at ten to twelve weeks postoperatively. The ROM exercise was started at postoperative six weeks and meticulous ROM exercise was begun at pin removal. The clinical results were evaluated with range of movement, comparision of the coracoclavicular distance after surgery with that of follow up, and complications. RESULTS The range of motion were forward elevation 150 degree, external rotation 71 degree, external rotation at 90 degree abduction 77 degree, and internal rotation T8. The comparision of coracoclavicular distance after surgery(0,6mm) with that of follow up(1.0mm) showed no significant ligament laxity. The complication were subluxation in 2 cases, heterotrophic calcification in 3cases, broken K-wire in 2cases, pin site infection in 7cases and distal clavicle osteolysis in 3cases, which were healed at follow up radiographically. CONCLUSION To prevent of redislocation of acromioclavicular joint, we tried to insert the pin during relatively long period for sufficient healing of ruptured coracoclavicular ligament. Although immobilization period was relatively long period, clinical results were good.
PURPOSE This study was designed to know the effect of calcium-sulfate and xenograft on the distracted callus after lengthening. MATERIALS AND METHODS We had operation of subperiosteal osteotomy and external fixation on the tibial diaphysis of young New Zealand White rabbits(2.0-2.5kg); after 5 days of latency period, 7 mm(1mm/day, 2 times/day) of tibial lengthening was reached in a week. At 1 week after lengthening, the 1st experimental group of 7 rabbits received a pellet of calcium sulfate(Osteoset , Wright medical, USA) in the distraction gap, and the 2nd experimental group of 7 rabbits received 5mm2 of xenogrfat(Lubboc ) in the distraction gap. But, the control group of 7 rabbits did not receive any of above materials. We compared three groups with the changes of radiographic findings at every week and bone mineral ratio(DEXA) at every two weeks. RESULTS The time to complete consolidation of distraction callus of both experimental group(calcium sulfate;14 weeks, xenograft; 15.4 weeks) was shorter than that of control group(16.9 weeks) in radiographic findings. Maximum value of bone mineral ratio of distraction callus was higher and the time to reach the highest value was also shortened in the both experimental group compared to control group. CONCLUSION By use of bone substitutes as like calcium sulfate or xenograft in the distraction callus with external fixator, it may be possible to shorten the consolidation period and the fixator-wearing period.
PURPOSE This study was designed to investigate whether intramedullary pressure is different in reamed compared with unreamed femoral nailing in cadeveric femoral bones.
MATERIALS & METHODS: Eight pairs of fresh-frozen cadaveric femoral bones were studied. The diameter of isthmus was checked from 10mm to 14mm and the length of femur was checked from 35cm to 44cm. Intramedullary pressure was measured in the distal femoral shaft at the supracondylar region. Data were monitored in femoral nailing procedures. We utilized the AO universal nail(reamed) and AO unreamed femoral nail. RESULTS Intramedullary pressure increased in the reamed group to 423.8 mmHg(mean pressure) during reaming by starting reamer(9 mm) and in the unreamed group to 290 mmHg(mean pressure) during insertion of nails(p=0.001). In the unreamed groups, the next high intramedullary pressure is 136.6 mmHg during proximal reaming. A statistiscally significant difference in intramedullary pressure was found during the first reaming process in the reamed group compared with the proximal reaming process in the unreamed group(p=0.005). CONCLUSION The data indicate that the intramedullary pressure during unreamed nailing process is lower than reamed nailing process. So we can consider that the unreamed nailing in multiple fracture or pulmonary injured patients is a good modalities.
PURPOSE : The purpose of this pater was to evaluate results of double plate osteosynthesis in distal humerus fractures.
MATERIAL AND METHOD : From June1995 to August 1998, we reviewed 22 distal humerus fractures. According to the type of fractures(AO classification), 6 and 16 cases were type A and C respectively. According to surgical approach, transolecranon approach was done in 12 cases and triceps split approach in 10 cases. We fixed intercondylar fracture with lag screw and supracondylar fracture with dual plate(2 reconstruction plates or 1 reconstruction plate + 1/3 tubular plate) as right angle. Rehabilitation was started just after postoperative 24 hours with posterior splint, and then increase activity and frequency. RESULTS : Average union time was 11.5 weeks. Overall functional results according to the classification of Jupiter and Cassebaum were excellent, good, fair, poor in 8, 10, 3, 1 cases, respectively. According to the age, patients under 50-year-old group revealed slightly superior functional. According to the type of fracture, surgical approach, interval between injury and approach, there were no statistically significant difference between group(p>0.05). There were 5 cases with complications. 1 case was mental failure, 3 cases were ulnar palsy, and 1 case was transient radial nerve palsy. CONCLUSION : We consider dual plate osteosynthesis in distal humerus fractures as a good treatment modality, even in type C fractures and old age patients.
The purpose of this article is to delineate factors important in successful management and subsequent extremity function of the patient with arterial injury associated with fractures or dislocations around the knee.
We reviewed 25 cases of arterial injury associated with fractures or dislocations around the knee which were treated at our hospital between 1994 and 1998.
As long term results, the salvage rate of the lower limb was related to the extent of the soft tissue damage and the severity of infection, but there was no statistical difference according to the method of vascular surgery(p=0.645). Compared with the salvage rate of the lower limb according to the length of time from injury to vascular reanastomosis, there was no statistical difference between two groups of the patients who were operated within 12 hours and were operated during the time between 12 hours and 24 hours(p=0.084). In view of whether open or closed fractures were combined, 1 I cases(58%) among 19 cases of open fractures and 5 cases(83%) among S cases of close(1 fractures were able to salvage the lower limb, so it could contributes to the sdlvdge rate of the limb. Finally 16 cases(64%) among total 25 cases were able to salvage the lower limb, and its functional outcome was like followings : excellent results were found in 6 cases, fair results in 8 cases, poor results in 2 cases, and amputation in 9 cases(36%).
In case of amputation, 3 cases were primarily amputated and 6 cases were amputated secondary to vascular surgery .
As long term results, whether open or closed fractures were combined, the teverity of the infection and the extent of the soft tissue necrosis were the factors influencing on the falvage rate of the lower limb. Other factors, such as the difference of ischemic time within 24 hours interval, the site and the method of management of the fractures and the vascular injuries and whether fasciotomy was performed or not were not important factors influencing on the salvage rate of the lower limb.
From June 1993 to May 1997, 12 patients aged from 13 to 41 years were treated for infected nonunion with bone defect by the Ilizarov technique. Of 12 cases, 9 cases were tibia and 3 cases were femur. The cuases of nonunion were open comminuted fractures with initial bone loss and bone defect after removal of sequestrum. Infection was managed by radical resection of the infected necrotic bone and insertion of antibiotics mixed cement beads. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length inequality was achieved by means of external lenghthening technique. Corticotomies were performed at the proximal level(7), at the distal level(5). The average optained length averaged 4.8cm in length and healing index averaged 67.4days/cm According to paley and Catagni's callification bony and functional results were either excellent or good execpt I case (nonunion, poor bony result). The complications (devided by paley to 3 categories: problems, obstacles, complications) were pin tract infecton(8), pain(5), mild flexion contracture of joint(1), delayed consolidation(3), soft tissue impingement(2), joint stiffness(3) and nonunion(1). We concluded that Ilizarov techinque was very effective for treatment of infected nonunion with bone defect and soft tissue defect.
Cubitus valgus may arise as the sequele of a number of different condition for example, a premature epiphysiodesis of the lateral condylar physis, nonunion or malunion of the lateral condylar fracture, rarely supracondylar fracture of the humerus. Cubitus valgus has more functional loss of extension and possibly the late development of a tardy ulnar nerve paralysis and less significant cosmetic effect. Authors treated the 7 patients who had cubitus valgus developing as a sequele of nonunion of the lateral condyle of the humerus, by the medial closed wedge osteotomy and internal fixation with the lateral arm cut anatomical Y-plate through posterior approach. Five males and two females were followed average 19 months(range 5 to 37 months). A mean age at the time of the operation was 17.1 years(range 13 to 25 years). Symptoms of tardy ulnar nerve palsy was shown in 5 patients. Two patients were treated due to disappearing cosmetic problem. The carrying angle was mean valgus 31 (range 22~50) preoperatively. The carrying angle was changed from mean valgus 9.6(range 3-15) immediate postoperatively to valgus 9(range 3-14) followed state. The duration of external immobilization after operation was mean 4.1 weeks(range 3-5 weeks). Range of motion of the elbow was fully recovered in 6 cases. The neurologic deficit of the tardy ulnar nerve palsy was fully recovered in all five patients. The result of supracondlar osteotomy was excellent in 4 cases(57.1%), good in 2 cases(28.6%) and poor in 1 case(14.3%). In conlusion, internal fixation with the lateral arm cut anatomical Y-plate after medial closed wedge osteotomy through the posterior approach can be recommanded as a method of treatment for the cubitus valgus.
Fractures of the distal radius represent the most common fractures of upper extremity and treatment remains challenging. Recently, more extensive therapeutic method is represented for reduction and maintenance of distal radius unstable fracture.
Twenty patients, 21 cases of distal radius fracture treated by external fixator between June, 1991 and September, 1995 were followed by more than one year to evaluate the correlation between anatomical and functional results. To assess the functional results, we used Green and OBriens system which scores subjective and objective findings. Grip power ratio was checked with Jamar dynanometer. To assess the anatomical results, volar tilt, radial inclination and radial length were measured. Frykmann type VIII and Universal type IV C fractures are most common form(7 cases, 33%) in our study. The more severe form of fracture of distal radius, the less score in funtional results. There was a little loss of velar tilt, radial inclination and radial length on last follow-up radiographs. In radiographic parameters, radial length showed significant correlation with ulnar deviation(p=0.002). In complication, sudek atrophy(2 cases), ulnar nerve entrapment symptom(1 case), and writing problem(1 case) was seen, but not serious. We concluded that external fixation in distal radius fracture is one of the treatment method expecting good result without serious complication.
The significant risk to life associated with the hip fracture has long been recognized, and the reports of poor prognosis are well known with wide range of mortality rates. We retrospectively studied 164 patients(older than 60 years) who had a hip fracture to determine the effects of the age, treatment methods, pre-existing medical condition, operative delay after injury, type of fracture, and others on patient mortality.
The summarized results were as follows ; 1. One hundred twenty three patients survived and forty one patients died(overall mortality rate; 25.0%).
2. Twenty one patients died within one year(one-year mortality rate, 12.8%).
3. Mortality was related to age of patient at injury, ASA classification, absense or presence of operative treatment, operation-related complication, which were statistically ignificant (P<0.05).
4. The operative delay after injury did not influence mortality, but we think that it is not signifcant because this study was done retrospectively.
Citations
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Analysis of the Risk Factors and Clinical Outcomes of Femoral Intertrochanteric Fractures in Patients over 65 Years Old Chul Hong Kim, Kyu Yeol Lee, Sung Soo Kim, Myung Jin Lee, Lih Wang, Hyeon Jun Kim, Jung Mo Kang Hip & Pelvis.2013; 25(2): 127. CrossRef
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Postoperative Mortality and the Associated Factors in Elderly Patients with Hip Fracture You-Sung Suh, Yong-Beom Kim, Hyung-Suk Choi, Hong-Kee Yoon, Gi-Won Seo, Byung-Ill Lee Journal of the Korean Orthopaedic Association.2012; 47(6): 445. CrossRef
One-Year Mortality Rate of Patients over 65 Years Old with a Hip Fracture Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Young Hwa Choi Hip & Pelvis.2011; 23(2): 137. CrossRef
Postoperative Mortality and the Associated Factors for Senile Hip Fracture Patients Dong-Soo Kim, Hyun-Chul Shon, Yong-Min Kim, Eui-Sung Choi, Kyoung-Jin Park, Se-Hyuk Im The Journal of the Korean Orthopaedic Association.2008; 43(4): 488. CrossRef
The ankle fracture with diastasls of distal tibiofibular joint is caused by an axial loading force with concomitant external rotation and associated with severe ankle fracture in addition to talai subluxation due to rupture of the distal tibiofibular syndesmosis. In order to restore the normal ankle mortise, operative anatomical reduction and temporary stabilization of the syndesmosis is mostily required until early ligament healing is present. Twelve cases among ninety-six cases of the ankle fracture were associated with diastasis and treated in the Department of Orthopedic Surgery, Kyungpook National University Hospital during the period from January, 1988 to May, 1991. We analysed these cases according to injury mechanism, radiographic criterion, the patterns of associated medial and lateral injury and treatment result. The results obtained were as follows; 1. The incidence of trauma was most frequent in 5th decade(5 cases).
2. Diastasls was produced by 3 mechanism according to Lauge-Hansen classification : (pronalion-external rotation : 7, Suplnatlon-external rotation : 3, pronation-Abduction;2).
3. All were associated with fibular fracture : proximal fibular fracture was most common (7cases).
4. All had disruption of the medial structures (medial ligament rupture 3, medial malleolusfracture 9).
5. Although the cases were small, there seems no significant differences between transfixation group and unfixation group when accurate anatomical restoration of the distal tibiofibular syndesmosis was achieved.
The os calcis is one of the most commonly injured tarsal bone and fractures involving the subtalar joint may cause serious and persistent disabilities.
We treated 12 intra-artlcular calcaneal fractures in 11 patients from June, 1998 to April, 1992 by plate fixation after lateral approach. The Sanders fracture classification system was applied to out study which classify the fractures according to the number of the fractured segments and direction of the fracture lines after computerized axial tomography of the posterior facetal joint. The follow-up evaluation included questioning the patient about pain during activity and rest, the ability to walk and stand, range of subtalar motion and ability to return to work according to the assessment sheet for calcaneal fractures of Creighton Nebraska Health Foundationl We experienced 8 excellent and 2 good results among 12 cases and there was little complication.