PURPOSE The purpose of this study was to review the clinical results of 23 cases of subtrochanteric fractures which were treated with compression hip screw fixation and evaluation of the advantage of lateral position. MATERIALS AND METHODS From December 1993 to October 1999, 23 cases(l4 male, 9 female) of subtrochanteric fractures were treated with open reduction and internal fixation using compression hip screw. The mean age was 51.3 years(range, 18-89 years). All operations were done on the standard surgical table in lateral position, and additional fixation was done by supplementary screw fixation or cerclage wiring in 19 cases. RESULTS All patients (100%) went on to union on the average of 15 weeks (range l2-28 weeks). There were no complications, such as nonunion, malunion, or fixation loss. There was one delayed union which revealed radiographical bony union at postoperative 7 months. CONCLUSION Fixation with compression hip screw with or without additional fixation was thought to be a recommendable method of treatment for subtrochanteric fracture. The surgical procedure with the patient on lateral position enabled the surgeon to do interfragmentory fixation more safely and effectively with less disturbance of soft tissues attached to the fractured fragment.
PURPOSE To evaluate the result and efficacy of nonunion of the femur shaft treated with interlocking compression nail without bone graft. MATERIALS AND METHODS From November, 1993 to January, 1999, l2 cases(11 patients) which have been diagnosed as nonunion of femur shaft fracture were treated with interlocking compression nail. Authors followed up and evaluated them about the clinical results, radiologic finding and complications at least 1 year. RESULTS All cases of nonunion occurred clinical and radiological complete bone union. The mean fracture union period was 25 weeks(19~36 weeks) and the mean interfragmental gap was improved from preoperative 6 mm(4~11 mm) to postoperative 1 mm(0.8~1.5 mm). Postoperative complication was the leg length discrepancy of 3 cases. Their average length is 1.1 cm. We thought that the length discrepancy came from initial severe communited fracture and could not find out any functional problems. CONCLUSION Interlocking compression nail for nonunion of the femur shaft seems to promote the fracture healing process without bone graft.
PURPOSE To determine more useful method by comparing the functional recovery and postoperative complications according to operative methods in treatment of unstable trochanteric fracture of the femur with osteoporotic bone. MATERIALS AND METHODS Of 45 cases with unstable femoral trochanteric fracture with osteoporosis who had been able to ambulate before injury, we compared postoperative functional recovery and complications between 25 cases treated by cemented bipolar hemiarthroplasty and 20 cases treated by dynamic compression hip screw. RESULTS Of 45 cases who had been treated by cemented bipolar hemiarthroplasty and dynamic compression hip screw, the functional results, according to the rating scale of Merle d Aubigne were rated as above good in 23 cases and 14 cases, respectively and postoperative mechanical complications were found in 2 cases and 7 cases, respectively. There was statistically significant difference(P<0.05). CONCLUSION Unstable trochanteric fracture of the femur with osteoporotic bone treated by cemented bipolar hemiarthroplasty showed good functional results and few mechanical complications for short term follow-up.
PURPOSE This study was designed to assess the necessity of additional supporting fixation to the traditional internal fixation for unstable intertrochanteric fractures of femur. MATERIALS AND METHODS Seventy two cases of unstable intertrochanteric fractures (modified Boyd-Anderson type III, IV) in the elderly were reviewed, which were internally fixed with Dynamic Hip Screw. 48 cases were treated with Dynamic Hip Screw only(Group I) and 24 cases with Dynamic Hip Screw and additional trochanteric supporting plate(Group II). In 13 cases with weak femoral cortx, we added wiring to the side plate. We measured neck-shaft angle, degrees of displacement of greater trochanteric fragment, slippage of hip screw on plain radiographs. RESULTS Varus change in neck-shaft angle, displacement of greater trochanteric fragment and slippage of hip screw revealed 7.3°, 5.4 mm, and 10.7 mm respectively in group I, while 2.1°, 0.1 mm and 3.8 mm respectively in group II. There were no pullout of cortical screws. CONCLUSION Internal fixation with additional trochanteric supporting plate to the conventional Dynamic Hip Screw was effective in unstable intertrochanteric fractures of the femur in the elderly. Added wiring to the side plate was also helpful in weak femoral cortex.
PURPOSE The purpose of this study is to analyze the surgical results of 11 patients who underwent posterior instrumentation and anterior interbody fusion using titanium mesh vertebral ring(MOSS) in osteoporotic vertebral fracture.
MATERIAL AND METHODS: From May 1997 to July 1999, we checked plain radiographs every 3 months and evaluated the change of kyphotic angle, fusion rate, change of clinical, neurologic symptoms and complications of these patients. RESULTS There were only average 0.2 degree correction of preoperative kyphotic angle at last follow-up X-ray. However, we confirmed successful bony fusion at nine of eleven patients(82%) and ten of eleven patients(90.9%) got satisfactory clinical results. Four patients with neurologic symptoms have recovered from their original neurologic status. Only one patient reoperated her back because of displacement of surgical device used in previous operation. CONCLUSION Among the surgical treatment methods in osteoporotic vertebral fractures, posterior instrumentation and anterior interbody fusion using titanium mesh vertebral ring(MOSS) is recommended as one of the effective surgical methods in severe osteoporotic patients.
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Kümmell's Disease Treated with Percutaneous Vertebroplasty: Minimum 1 Year Follow-Up Jae Won Park, Jong-Hwa Park, Hong Jun Jeon, Jong Young Lee, Byung Moon Cho, Se-Hyuck Park Korean Journal of Neurotrauma.2017; 13(2): 119. CrossRef
Peculiarities of Treatment of Patients with Complicated Compression Fractures of Thoracic and Lumbar Spine Vertebral Bodies on the Background of Osteoporosis S T Vetrile, Aleksandr Alekseevich Kuleshov, L Yu Darchiya, S T Vetrile, A A Kuleshov, L Yu Darchiya N.N. Priorov Journal of Traumatology and Orthopedics.2009; 16(2): 34. CrossRef
Delayed vertebral collapse with neurological deficits secondary to osteoporosis K-T Kim, K-S Suk, J-M Kim, S-H Lee International Orthopaedics.2003; 27(2): 65. CrossRef
Surgical Treatment of Kümmell Disease with Neurologic Deficits - Posterolateral Decompression and Posterior Reconstruction - Ki-Tack Kim, Kyung-Soo Suk, Jin-Moon Kim Journal of Korean Society of Spine Surgery.2001; 8(2): 136. CrossRef
PURPOSE The objectives of this study are to observe the clinical characteristics and incidence of diastasis of symphysis pubis during vaginal delivery and to evaluate the risk factors of the lesion. METHODS AND MATERIALS: 16,000 vaginal delivery cases of our center from 1997 to 1999 were reviewed. The severe pain in symphysis pubis and walking difficulty after delivery were used as a diagnostic criterion. Several factors that increase the risk of this lesion during delivery were reviewed and analyzed by t-test between diastasis group (n=55) and normal group (n=100). RESULTS Fifty-five diastasis of symphysis pubis were diagnosed out of 16,000 normal vaginal delivery cases during that period. The widening of the joint ranged from 4mm to 34mm. Sixteen cases accompanied vertical mobility. No factor was proved to increase the risk of the lesion. Initial body weight of infant had suggestive significance (P=0.051). CONCLUSION We couldn't prove any risk factors that increased the risk of diastasis of symphysis pubis during vaginal delivery in this study. Further prospective studies with more cases would be needed to disclose the risk factors.
PURPOSE To analyze the clinical outcomes of the hybrid external fixation which is more comfortable and simply appliable than Ilizarov fixator MATERIAL AND METHOD: 28-patients of periarticular or segmental tibia fracture from may 1998 to october 1999 were treated with hybrid external fixator (AnyFix®)that was invented by authors. It consists of two rings at epiphysis(full or 2/3 ring), 3 or 4 rods connecting 2 rings, K-wires, half pins, and specially designed push pins and crane pins which can be used as a reduction device and fixation pins. And it was used as a definitive modality. Joint exercise was started immediately after operation and partial weight bearing was permitted 4 weeks after initial application. RESULT The average time of bone union was 4.7 months, articular step-off of all cases were less than 1 mm. As a complication, there was no limitation of range of motion except one case of 10° dorsiflexion limitation of the ankle, and 1 case of deep wound infection. Clinical assesments of knee and ankle joint showed 14 cases of excellent, 9 cases of good, 3 cases of fair in total 26 cases of proximal or distal tibia fracture except 2 infected non-union. CONCLUSION Hybrid external fixation is effective method for periarticular or segmental tibia fracture and it gives simple applicability, firm stability and much less discomfort.
PURPOSE The purpose of this study is to evaluate the effect of dynamization which was done for the treatment of delayed union or persisting fracture gap after interlocking intramedullary nailing, by radiographic and physical examination. MATERIALS AND METHODS We analyzed 22 cases these were treated with dynamization from 247 cases of tibia shaft fracture treated initially with static interlocking intramedullary nailing from February l990 to May 2000 and were followed up more than lyear. The result of dynamization was classified as 3 groups and we divided each results 3 categories that is effective result, uncertain result and ineffective result. Group A is cases that achived ultimate union with shortening of fracture gap and was 10 cases. Group B is that achieved ultimate union but fracture gap did not reduced and was 10 cases. Group C is that showed ultimate non-union and was 2 cases. RESULTS The result is that dynamization was effective only 4 cases of group A. 6 cases of group A and 4 cases of group B showed instability(radiolucent halo around nail, hypertrophied callus and leg pain), and 6 cases of group B showed no shortening of fracture gap, thus these were classified as uncertain result. Group C(2 cases) showed non-union, classified as ineffective. CONCLUSION Dynamization caused instability in most tibia fractures except simple mid-shaft fracture. So in the comminuted fractures and distal or proximal l/3 oblique fractures, other procedures such as bone graft, refixation should be considered rather than dynamization.
PURPOSE To analyse the frequency of soft tissue injuries associated with tibial plateau fracture through arthoscopy and demonstrate the pattern and treatment of lateral meniscal tear which is the most frequently concomitant injury.
MATERIAL AND METHOD: We evaluated the charts, X-rays and arthoscopic records of the 27 patients who had been diagnosed as tibial plateau fracture and received the arthoscopic examination or arthoscopic assisted operative management and analysed the injury pattern, association of schatzker classification and treatment of the 9 patients who had been concomitant with lateral meniscal tear. RESULT In our cases, lateral meniscus tear was the most common among the soft tissue injury it was revealed that a longitudinal tear at the peripheral area was shown in 8 cases, which were treated with meniscal repair and a radial tear of the central area in l cases, treated with partial menisectomy. CONCLUSION Lateral meniscus injury is one of the most frequently concomitant with tibial plateau fracture, In those cases, arthroscopic meniscal repair would be helpful for better prognosis.
PURPOSE To investigate the effective surgical method for the periarticular tibial fracture. MATERIALS AND METHODS A retrospective review was done on 27 cases with the periarticular tibial fracture who were treated by minimally invasive plate osteosynthesis(MIPO) between March, 1995 and December, 1998. The mean follow up period was 20.3 months(range: 14-42 months). Raiological bony union and clinical complications were analysed. Nineteen cases(70%) were proximal and remained 8 were distal. Five were open fractures and 15(56%) were communited. RESULTS Postoperatively if clinical(12.3 weeks) and radiolographic(14.7 weeks) signs of healing were present, and their concurrent injuries allowed, full weight bearing was initiated. In functional evaluation, proximal tibia fractures were excellent and good in 17 cases, fair in 2 cases and distal tibia fractures were good in 6 cases, fair in 1 case, poor in I case. Complications were occurred in 5 cases(19%)as superficial infection, rotational malunion, nonunion and knee joint stiffness. CONCLUSION It seems that the MIPO on patients with periarticular tibial fracture allows early motion of adjacent joint, shorten the interval of radiographic and clinical union and decrease the complications and it has excellent cosmetic effect. As a conclusion, we recommend that the MIPO should be considered as an appropriate operative treatment regimen in treating peritalar tibial fracture. But we have to pay attention to prebending a plate before application.
PURPOSE The results of treatment of tibial plateau fractures by extensive soft tissue exposure were less satisfactory even if anatomical reduction was achieved. The purpose of this study is to assess the functional and radiological results of the treatment of tibial plateau fractures by cannulated screw fixation to decrease soft tissue injury and operation time. MATERIALS AND METHODS From January 1996 to February 2000, 19 patients were treated by limited open reduction and internal fixation by cannulated screw. According to scoring of Rasmussen, the functional results were rated. RESULTS In all cases, Bony union was obtained and according to scoring of Rasmussen, excellent in 1 case, good in 14, fair in 4 cases. There were 2 cases of limitation of joint motion and 2 cases of persistant pain as sequale. CONCLUSION We considered that if accurate preoperative evaluation was done, Cannulated screw fixaction was easier and faster method than other methods for treatment of tibial plateau fractures.
PURPOSE To evaluate the clinical results between the posterior and lateral plate for distal fibular fixation in the bimalleolar, trimalleolar fracture and isolated lateral malleolar fractures with more than 3 mm of displacement. MATERIALS AND METHODS We reviewed 69 cases treated by open reduction and internal fixation with the posterior or lateral plate for distal fibular fractures in the bimalleolar, trimalleolar fractures and isolated lateral malleolar fractures with more than 3mm of displacement. The follow up period was more than 12 months. RESULTS In the posterior plate group, radiographically there were no intraarticular screw, loss of fixation, nonunion and malunion, but 2 cases of distal tibiofibular synostosis were developed. In physical examination, there were no wound complication, palpable screws, peroneal tendinitis and limitation of motion, but 2 patients who had distal tibiofibular synostosis complained of mild discomfort after walking. CONCLUSION The posterior plate for distal fibular fixation is thought to be a favorable method and can be recommended as the fixation modality of choice regardless of level of fracture, because of increased biomechanical stability and few complication.
Atraumatic calcaneal fractures associated with neurological abnormalities have been reported by several authors, and most of them are associated with diabetes. Chronic alcoholism is also a cause of neurological abnormality and neuropathic arthropathies associated with chronic alcoholism were reported. However we could not find any report of atraumatic calcaneal avulsion fracture associated with chronic alcoholism. We have treated a calcaneal avulsion fracture in a chronic alcoholic patient with open reduction and internal fixation, and the result was not satisfactory. We suggest that conservative treatment is better for the atraumatic calcaneal avulsion fracture in a chronic alcoholic patient with severe osteoporosis and neurological abnormalities.
PURPOSE The causes and risk factors of complications following operative treatment of fracuture of neck of humerus were analysis.
MATERIALS & METHODS: From 1995 to 1998, 32 cases of fracture of neck of humerus on which operative treatment have been taken were reviewed. The average age was 48.3 years. There were 13 cases of two part fracture, 11 cases of three part fracture and 8 cases of four part fracture, with 4 cases associated with comminution. Closed reduction and pinning was performed in 11 cases. An external fixator was applied in 1 case. Other 18 cases underwent open reduction using various fixation method including 4 K-wires, 2 cannulated screws, 5 plates, 1 Ender nail and 6 tension band wirings combined with screws each. 2 cases were underwent hemiarthroplasty. RESULTS Thirteen patients (41%) had postoperative complications. There were 3 nonunion, 2 pin site infection, 2 inferior subluxation of humeral head, 3 impingement syndrome, 1 hardware failure, 1 avascular necrosis of humeral head and 1 glenoid rim erosion. The incidence of postoperative complication was high in ages older than 40 years and the four part and comminuted fractures. The insufficient fixation due to osteoporosis, incomplete reduction, surgical technique and use of inappropriate implant were considered as related causative factures. CONCLUSION The patient's age, the quality of bone, severity of fracture and methods of fixation are all important contributing factors for postoperative complications.
PURPOSE We conducted this study to discriminate transolecranon fracture-dislocation of the elbow from the anterior Monteggia lesion and to validate the differences of method of treatment. MATERIALS AND METHOD From March, 1998 to May, 1999, 3 cases of the transolecranon fracture-dislocation of the elbow were treated by open reduction and internal fixation.One of the three patients had simple oblique fracture of the olecranon combined with capitellum fracture and two had complex comminuted fracture of the olecranon. Functional outcome was assessed with elbow performance rating system of Broberg and Morrey. RESULTS At a minimum follow-up of 12 months, overall outcome was rated as exellent in two patients, fair in one. Average bone union peoriod was three months. CONCLUSION Stable restoration of the accurate contour and dimension of the trochlear notch of the olecranon and early ROM exercise will lead to good result in transolecranon fracture-dislocation cases.
PURPOSE The goals of the present study were to compare of radial head excision and open reduction k internal fixation for comminuted radial head & neck fracture. MATERIALS AND METHODS From march 1993 to February 1999, Patients with fracture of radial head (Mason type III) who were treated at Dae-Jeon Sun General hospital were enrolled in the study. The average duration of follow up was 3 years and 3 months. Six patients(Group A) were treated with radial head excision and fourteen patients(Group B) were treated with open reduction and internal fixation. RESULTS By functional rating index(modified After B.F. Morrey et al), in Group A, the results were classified as excellent(1 patient), good(No patient), fair(2 patients), and poor(3 patients), and in Group B, excellent(4 patients), good(5 patients), fair(3 patients), and poor(2 patients). CONCLUSION We concluded clinically to obtain better outcome in group which were treated with open reduction and internal fixation than radial head excision. Therefore, though the treatment of choice for Mason type III radial head fracture was total excision, in consideration of complication, procedure to preserve radial head was desirable. We must give careful consideration to possibility of open reduction and decision of radial head excision.
PURPOSE This study is to evaluate the radiologic results after close reduction for the distal radius fractures that were reduced.
MATERIAL AND METHOD: From March 1996 to Feburary 1999, thirty-four patients with distal radius fracture were treated with close reduction and cast immobilizationat at Ewha Womans University Hospital. The radiograph were taken after reduction and at 3days, 2 weeks, 4 weeks, 6 weeks. Three parametersof the radiograph were measured.; radial inclination, palmar angulation and radial shortening. The radiological results were estimated by the criteria of Sarmiento. RESULTS In 34 patients, type I were 10 cases, type II were 15 cases, type III were 6 cases, type IV-A were 3 cases by the Universal classification. The average value of the radiologic parameters after reduction were followings s; radial inclination(RI) 18.2°, palmar angulation(PA) 9.3° and radial shortening(RS) 1.8mm in type I. RA 17.2°. PA 8.4° and RS 2.0mm in type II. RI 16.5°, PA 8.0°, RS 2.5mm in type III. RI 14.9°, PA 7.7°, RS 3.5mm in type IV. At 6weeks after reduction, RI 17.8°, PA 9.2° and RS 2.1mm in type I. RA 16.7°, PA 7.6° and RS 2.6mm in type II, RI 15.4°, PA 7.0°, RS 4.0mm in type III. RI 13.3°, PA 6.2°, RS 5.2mm in type IV. CONCLUSION Loss of reduction after close reduction with cast immobilization for type III and IV were occurred more frequtently than type I and II.
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Redisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic Factors Ho-Wook Jung, Hanpyo Hong, Hong Jun Jung, Jin Sam Kim, Ho Youn Park, Kun Hyung Bae, In-Ho Jeon Clinics in Orthopedic Surgery.2015; 7(3): 377. CrossRef
PURPOSE This study summarizes the satisfactory results obtained using a composite fixation method for the surgical treatment of long bone fractures in elderly patients with osteoporosis. MATERIALS AND METHODS We reviewed 10 cases of long bone fractures, that were treated by composite fixation, involving patients over 60 years of age that presented with radiological osteoporosis. Composite fixation was applied incorporating, traditional plate and screw fixation in conjunction with bone graft, plate or intramedullary bone cement at four cases of humeral shaft fractures, three cases of femur supracondylar fractures, two cases of femur shaft fractures, and one case of tibia shaft fracture. Results were evaluated in methods of ambulation, range of motion, bony union and complications. RESULTS Satisfactory ambulation and range of motion was observed in all cases, which showed bony union without early implant failure. No re-operation were necessary due to nonunion. No medical complication was noted. CONCLUSION The results shows that the composite fixation method provided a stable reduction and a rigid fixation, which facilitated bony union, and allowed elderly patients with osteoporosis an early range of motion and mobility after the surgical treatment of long bone fractures.
PURPOSE The aim of study was to analyze the patterns of musculo-skeletal trauma of the children. MATERIALS AND METHODS From 1997 to 1999, the included for the study were 108 children, who had been admitted for the orthopedic treatment and followed-up. The analysis were done as for 1) children s biological characteristics, 2) the situations of trauma, 3) causes of trauma, 4) types of trauma and 5) locations of fractures. RESULTS The average age was 8.5 years at the time of trauma. Sixty cases (56%) were between 5 and 9 years old. Boys were 3 times more common than girls. Second children (61cases, 57%) were more prone to trauma. Half of trauma took place between July and October, and one third of trauma (36 cases, 33%) happened on the street. Ninety eight children (91%) were admitted due to fracture, and supracondyle fracture of humerus was the most common cause(48 cases). CONCLUSION Many of accidents could be attributed to children's mischievous play resulted from curiosity and freedom of thought. For the prevention of these accidents, therefore, environment should be restructured from the point of child's view, and not only the design of facility itself but also proper management and education on the facilities should be taken.
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The Pattern of Occurrence of Fractures in Children and Adolescents and Its Managements Based on the Database of the Health Insurance Review and Assessment Service Yong-Wook Kwon, Soon-Hyuck Lee, Hyun-Woo Kim, Jin-Ho Hwang Journal of the Korean Fracture Society.2014; 27(4): 308. CrossRef