PURPOSE Patient age significantly influences the rate of fracture healing. The rate of healing declines with increasing age. The authors compared the aging effect on fracture healing in the callus of rat femur by the light microscopy. MATERIALS AND METHODS In this study the unilateral, closed fractures were created in the femur of 18 Sprague-Dawley rats. The rats were killed in three age group(8 weeks:7, 32weeks:6, 70weeks:5) at 2 weeks after fracture. The composition of fracture callus(new bone, cartilage, mesenchymal layer) was measured by image analyzer with H-E stain. Immunohistochemical stain (PCNA, TUNEL, TRAP) positive cells were counted for the comparing of cellular activity according to the aging. RESULTS The percent of intramembranous new bone in the younger rat(8 week:22.32%) was higher than the older ones(30 week:7.09%, 70 week:5.37%). The percent of PCNA positive osteoblast in the newbone decreased according to the aging(8 week:64.25%, 30 week:57.40%, 70 week:29.54%). The number of osteoclast in the osteochondral junction at the 8 week(43) was more than that of 30 week(25.57) and 72 week(29.87). The number of TRAP positive osteoclast was not different as aging, but the number of osteoclast in the osteochondral junction(5.89) was more than that in the metapyseal area(2.08). CONCLUSIONS More new bone was found in younger rat. There was a strong correlation (p<0.05) between age and PCNA activity. More number of active osteoblast and osteoclast was found in younger rat femoral fracture callus, which indicated rapid fracture healing in younger age.
PURPOSE The goal of our study was to evaluate diagnosis and management of stress fracture in long bones using MRI findings.
MATERIAL & METHOD: Between May 1995 to May 1999, 40 patients( 45 cases ) were confirmed to have a stress fracture by clinical and radiological findings. All patients were evaluated with clinical, X-ray, bone scan, and MRI findings. The patient was 21 years in average( range from 18 to 23 years ). All were males and soldiers. The evaluation was made by comparison of MRI and plain radiograph, and duration of symptom was evaluated with MRI grading by Fredericson et al. RESULT The locations of stress fracture of long bones were tibia(n=25), fibula(n=14), and femur(n=6). MRI findings were bone marrow edema in 38(84.4%)cases, intramedullary low signal intensity band in 19(42.2%)cases which was continuous with cortex and cortical fracture line. Periosteal reaction was seen in 45(100%)cases and surrounding soft tissue edema in 20(44.4%)cases. Plain X-ray findings were peristeal reaction in 31( 68.9%)cases, medullary sclerosis in 10(22.2%)cases, and cortical fracture line in 8(17.8%) cases. Duration of symptom was longer in higher MRI grade. CONCLUSION MRI was more useful in early diagnosis and differential diagnosis of stress fracture, showing various findings than plain radiograph. MRI grading was helpful in planning tlhe therapy of stress fracture.
PURPOSE This retrospective study was performed to know the difficulties and efficient methods of treatment after several types of operations for ipsilateral femoral neck and shaft fracture. MATERIALS AND METHODS Thirteen cases (12 patients) with ipsilateral femoral neck and shaft fracture at the mean age of 36.6(range 21-51), have been followed up over the minimum of one year. All the patients suffered from motor vehicle accidents(11 in dash-board injury), and most of patients associated with multiple injuries including other fractures. All of femoral neck fracture were same type in basicervical area and 4 of them were missed initially. According to the classification of femoral shaft fractures, middle 1/3 fracture was most common in 10 cases and type C in 8 cases. In neck fractures, all cases were treated with multiple pinning, but in shaft fractures, 6 were treated by open plating, 5 by closed antegrade nailing, and 2 by retrograde nailing. RESULTS The mean union period was 12.1 weeks in neck fractures and 9.9 months in shaft fractures. In complications, there were 1 case of nonunion and 1 case of avascular necrosis in neck fractures, and 8 of delayed union, 3 of nonunion, and 2 of malunion, in shaft fractures. The methods of treatment had no influence on the results of this injury, but we had 1 failure in antegrade nailing prior to operation of neck fracture. CONCLUSION After operation of ipsilateral femoral neck and shaft fracture, the shaft fracture needed longer time of union and had many problems in spite of different methods. We suppose that many problems in shaft are affected not only by characteristic mechanism of injury, but also by multiple associated injury.
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Treatment for Concurrent Ipsilateral Femoral Neck and Shaft Fractures Using Reconstruction Nail with Temporary K-Wires Sang-Joon Lee, Sang Hong Lee, Sang Ho Ha, Gwang-Chul Lee Journal of the Korean Fracture Society.2015; 28(1): 23. CrossRef
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 The aim of this study was to analyze frequencies, types, and treatment results of the undisplaced abduction fracture of the neck of the femur for the prediction of the prognosis.
MATERIALS & METHODS: From February 1984 to February 1999, the population was selected from those who were admitted in our hospital with the diagnosis of the fracture of the neck of the femur(96 cases). Among them 34 cases of undisplaced abduction fracture who could be followed minimum 2 years were chosen. The types of initial injury, the degrees of the rotation into valgus, union and the incidences of avascular necrosis of the femur head were analyzed by plain radiographs and medical records. RESULTS The undisplaced abduction fracture of the neck of the femur were 34 cases(35%) of the whole 96 cases and 33 cases of them had been operated. In all the 34 cases we were able to see the bone union, however in 7 cases(20.6%) the avascular necrosis of the femur head were happened. The incidences of the avascular necrosis is related with the degrees of the rotation into valgus(p=0.004). CONCLUSION The undisplaced abduction fracture of the neck of the femur is known to the result in good prognosis. According to this study, not a few avascular necrosis of the femur head happened. As a results, although undisplaced abduction fracture regained to be paid intention to the incidences of the avascular necrosis and careful follow-up should be accompanied.
PURPOSE To compare and analyze the operative results of compression hip screw with those of gamma nail in the treatment of intertrochanteric fracture of femur. MATERIALS AND METHODS We performed retrospective analysis of intertrochanteric fracture of femur using the compression hip screws on 16 cases(stable 8 cases, unstable 8 cases) and compared the results with those of 21 cases(stable 5 cases, unstable 16 cases) of Gamma nail fixation. All the 37 cases were operated between April 1992 and May 1997 and followed for minimal 12 months. We permitted earlier weight bearing for the Gamma nail inserted group(1 week vs 3 weeks). We evaluated the operation time, bleeding amount, intraoperative and postoperative complications, bone union time, neck-shaft angle, and functional assessment by follow up radiographs and clinical results. RESULTS The average operation time was shorter in the Gamma nail group than in the compression hip screw group (97+/-23.3 compared with 117+/-35.9 minutes; p<0.05). The average amount of bleeding was lesser in the Gamma nail group than in the compression hip screw group (592 compared with 712 ml: p<0.05). The fracture union time and clinical function of two groups showed no statistically significant difference(p>0.05). During Gamma nail insertion, crack was developed in one femoral shaft which was united after bed rest and delayed weight bearing. Postoperative complications were coxa vara in 3 cases(1 case on Gamma nail, 2 cases on CHS) and cutting out of lag screw in 3 cases(1 case on Gamma nail, 2 cases on CHS), but showed no statistically significant difference between two groups(p=0.781). CONCLUSION Early weight bearing can be encouraged for the Gamma nail group and this seemed to be beneficial for the old patients. The Gamma nail fixation is considered as a useful method for the patients with intertrochanteric fracture if it is managed with proper technique.
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Treatment of Intertrochanteric Fractures Using Targon Proximal Femoral Nails Il Ho Park, Jong Kyoung Won, Kye Young Han Hip & Pelvis.2012; 24(2): 117. CrossRef
PURPOSE To compare the timing of ambulation, complications and functional results between the autogenous femoral head graft and the calcar replacement type stem in the severe comminuted fracture of the elderly patients with unstability. MATERIALS AND METHODS 25 intertrochanteric femoral fracture patients who had bipolar hemiarthroplasty were followed for more than 1 year. 17 patients had autogenous femoral head graft and 8 patients had calcar replacement type stem. RESULT The mean operating time for autogenous femoral head graft was 1.7 hours, and calcar replacement type stem was 1.3 hours. Postoperative Harris functional score was 84.1 for the autogenous femoral head graft group and 82.2 for the calcar replacement type stem group. Discussion : Both autogenous femoral head graft augmentation and fixation using the calcar replacement type stem result in rigid fixation, which enables the patients to ambulate early and to have low complication rate. Both techniques seem to be effective for the treatment of intertrochanteric fractures.
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Analysis of Missed Fractures by Bone Scan in Elderly Hip Fracture Patients with Osteoporosis Tae Hun Lee, Yeong Hyun Lee, Seo Won Kang Journal of the Korean Fracture Society.2024; 37(3): 144. CrossRef
Hemiarthroplasty for Hip Fractures in Elderly Patients over 80 Years Old - Comparative Analysis between Femoral Neck Fracture and Intertrochanteric Fracture - Chae-Hyun Lim, Young-Yool Chung, Jeong-Seok Kim, Chung-Young Kim Hip & Pelvis.2013; 25(1): 44. CrossRef
Bipolar Hemiarthroplasty for Hip Fractures in Patients Aged over 90 Years - The Factors Influencing the Postoperative Mortality - Jun-Dong Chang, Je-Hyun Yoo, Sang-Soo Lee, Tae-Young Kim, Kyu-Hak Jung, Yong-Kuk Kim Hip & Pelvis.2010; 22(4): 283. CrossRef
PURPOSE This study was performed to analyze the weight-bearing ambulation time, bony union time and complications after fixation of comminuted subtrochanteric fractures of the femur with compression hip screw and evaluate its effectiveness.
MATERIAL & METHODS: From January 1993 to January 2000, 21 cases of S e i n s h e i m e r's Type IV and Type V comminuted subtrochanteric fractures of femur which were treated by compression hip screw and followed for more than 1 year were analyzed by weight-bearing ambulation time, bony union time and complications. RESULTS We recommended partial weight bearing ambulation from 6 weeks after operation and full weight bearing ambulation from 12 weeks after operation. All of 21 cases, primary bony union was achieved and mean time was 16 weeks(range 13 to 25 weeks). 2 cases of mechanical complications were occurred. Also 4 cases of malunion of lesser trochanter and 2 cases of nonunion of lesser trochanter were occurred, but none of them result in limitation of motion, limping nor pain. CONCLUSIONS We thought compression hip screw is a good implant for rigid fixation of comminuted subtrochanteric fractures, especially involve intertrochanteric region like Seinsheimer's Type IV and Type V.
PURPOSE The purpose of this study was to compare the clinical results of subtrochanteric fractures which were treated with compression hip screw, intramedullary nailing and Rowe plate. MATERIALS AND METHODS From 1991 to 1999, 84 cases of subtrochanteric fractures were treated in Chonnam national university hospital. Among them, 25 cases were treated with compression hip screw, 18 cases with interlocking IM nailing and 32 cases with Rowe plate. Excluding pathologic fracture, there were 24 cases(group A), 16 cases(group B) and 30 cases(group C) of subtrochanteric fractures which were followed over 1 year. Mean follow up period was 18, 21, 24 months each. We compared the fracture pattern, operation time, operation method, additional fixation, bone union and complications among the groups. RESULTS We devided subtrochanteric fracture into below class II and above class III based on Seinsheimer classification. The overall clinical results were 1 case below class II, 22 above III in group A, 12 below II, 6 above II in group B, and 4 below II, 26 above III in group C. The average operation time was 153 minutes in group A, 166 in group B, and 150 in group C. Additional wiring was performed in 15 cases in group A, 1 in group B and 6 in group C. Interfragmentary screw fixation was performed only in group A(12 cases). Bone graft was performed in 6 cases in group A, 6 cases in group B and 11 cases in group C. The complications were as follows; delayed union 1 case in group A, 2 cases in group B and 6 cases in group C.; Nonunion only 1 case in group B; varus deformity 4 cases in group B and 2 cases in group C; metal failure 1 case in group B and 1 case in group C. CONCLUSIONS In treatment of subtrochanteric fractures, compression hip screw was applied to more communited fractures than intramedullary nail, but with additional fixation safe union and excellent clinical outcomes obtained. For intramedullary nailing, great care should be taken not to produce varus malalignment. In plate fixation, we should keep in mind the possibility of metal failure and varus malalignment. Weight bearing should be delayed.
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Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices Jung-Yoon Choi, Yerl-Bo Sung, Jin-Hee Yoo, Sung-Jae Chung Hip & Pelvis.2014; 26(2): 107. CrossRef
Efficacy of Percutaneous Cerclage Wiring in Intramedullary Nailing of Subtrochanteric Femur Fracture - Technical Note - Ki-Chul Park, Hee-Soo Kim Journal of the Korean Fracture Society.2013; 26(3): 212. CrossRef
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PURPOSE This study was evaluated to find the aspect of the femoral shaft stress fracture.
MATERIAL AND METHOD: From Jan. 1990 to May. 1999, this study included 8 cases diagnosed as stress fracture of the femoral shaft that were proved by clinical & radiologic findings in our hospital. Patients with undisplaced femoral shaft stress fracture were treated conservatively and patients with displaced ones were treated with open reduction and internal fixation. RESULT 5 of 8 fractures were located in the distal shaft and 3 were in the middle shaft. 5 of 8 fractures were undisplaced and 3 were displaced. These 3 displaced fractures were located in the distal shaft. CONCLUSION According to our experience, femoral distal shaft stress fracture which is rare, has a high tendency to displace. Therefore, the early diagnosis and prevention of femoral distal shaft fracture is important to prevent progression to displaced fracture.
PURPOSE To evaluate the effectiveness between reamed and unreamed nailing in the treatment of femoral shaft fracture. MATERIALS AND METHODS Among the patients of femoral shaft fracture who were treated with reamed and unreamed nail, we reviewed 49 patients whose follow-up was possible for more than 1 year. The patients were divided into two groups: the reamed and the unreamed group. We reviewed union time, nonunion rate, complication and operation time and compared the effectiveness. RESULTS The average union time was 30.6 weeks in unreamed group and 27.8 weeks in reamed group, which was not different statistically. There were 5 cases of nonunion in 22 unreamed cases and 3 cases in 27 reamed cases, which meant no statistical difference. There was no significant difference of complications between the two groups. The mean operation time was 141 minutes in reamed group and 110 minutes in unreamed group, which meant statistical difference. CONCLUSION There was no significant difference in union time, nonunion rate and comlication between reamed and unremed group. The operation time was shorter in unreamed group, so unreamed nailing can be preferred in the treatment of multiply injured patient.
PURPOSE The purpose of this study is to evaluate the effectiveness of Kirschner wire and additional wire fixation in clavicle lateral end fractures. MATERIALS AND METHODS We reviewed 14 cases that were treated by Kirschner wire and wire fixation from January 1997 to May 1999 and followed up for more than 1 year. Average age was 42 years old(male 6, female 8). The fractures were classified according to Jager and Breitner classification : 2 cases of type 1, 5 of type 2a, 5 of type 2b, 2 of type 3. We used 3 types of fixation method : First, interfragment Kirschner wire and wire fixation in simple fracture. Second, first method was reinforced with transacromial Kirschner wire fixation in simple, but osteoporotic bone. Third, fracture was fixed by transacromial Kirschner wire and wire fixation in intraarticular or comminuted fracture. RESULTS Bony union was obtained in all cases with average duration of 10 weeks. The functional result of shoulder was evaluated by the scoring system of Rowe : exellent 8, good 5, fair 1 case. The complications were pin migration 2, pin infection 1, shoulder LOM 3, traumatic acromioclavicular joint arthritis 2 cases. CONCLUSION Appropriate use of three types of Kirschner wire and wire fixation technique according to location of fracture, degree of comminution can improve bony union rate and shoulder function.
PURPOSE The purpose of this study is to evaluate the correlation between the amount of displacement of the greater tuberosity of the humerus and the that of the radiographic displacement. MATERIALS AND METHODS Dry bones of the scapula, humerus were fixed to the board. After cutting the greater tuberosity, the center of the lesser tuberosity, the anterior and inferior margin of the greater tuberosity fragment, the anterior edge of the bone defect at the greater tuberosity were marked with wire. The humerus were placed in the neutral position, 60 degree internal rotation, 15 degree external rotation, 45 degree abduction, 90 degree abduction. The radiographs were taken in the position of the 5, 10, 15, 20, 25mm posterior superior displacement of the fragment respectively. RESULTS The correlation coefficient between the amount of displacement of the greater tuberosity of the humerus and the that of the radiographic displacement were followings; 0.599(p=0.285) in the neutral anterior posterior view, 0.790(p=0.112) in the 60 degree internal rotation view, 0.522(p=0.367) in the 15 degree external rotation view, 0.290(p=0.635) in the 45 degree abduction axillary view, 90 degree abduction axillary view. CONCLUSION The 90 abduction axillary view was the most appropriate radiograph to evaluate the amount of displacement of the greater tuberosity of the humerus.
PURPOSE To assess postoperative functional outcomes among plates, intramedullary nails and external fixators in adult humeral shaft fractures, including limitation of motion in shoulder and elbow, pain in activities of daily living.
MATERIAL AND METHODS: 24 cases treated with plates and screws, 19 cases with antegrade intramedullary nails and 13 cases with external fixators were analyzed in terms of limitation of motion, postoperative pain and activities in daily living. RESULTS There was no statistical difference in the range of motion of shoulder and elbow among three groups. VAS(visual analogue scale) which expressed postoperative pain in the affected site was lowest in the group treated with plates and screws. ASES score(American shoulder and elbow surgeons'score) which expressed the activities of daily living was investigated the highest in the group treated with plates and screws, and the differences of VAS and ASES score among three groups have statistical significances. CONCLUSION The most satisfactory results were obtained in the group treated with plates and screws.
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A Separate Approach and Cephalo-Diaphyseal Plate Fixation for the Comminuted Metadiaphyseal Fractures of the Proximal Humerus Sung-Weon Jung Journal of the Korean Fracture Society.2013; 26(1): 8. CrossRef
Surgical Treatment of Pathologic Humeral Fracture Ho Jung Kang, Byoung Yoon Hwang, Jae Jeong Lee, Kyu Ho Shin, Soo Bong Hahn, Sung Jae Kim Journal of the Korean Fracture Society.2010; 23(2): 187. CrossRef
Result of Interlocking Intramedullary Nailing for Humeral Shaft Fracture Evaluation of Post-operative Shoulder Function Seung Rim Park, Tong Joo Lee, Ryuh Sub Kim, Kyoung Ho Moon, Dong Seok You Journal of the Korean Fracture Society.2007; 20(2): 166. CrossRef
PURPOSE To evaluate the methods of treatment to obtain rigid fixation for nonunion of humerus shaft fractures developed after operative treatment. MATERIALS AND METHODS From January 1993 to January 2000, twenty-one patients of nonunion of humerus shaft after primary internal fixation were reviewed and the results were analyzed. Three cases who have loss of follow-up were excluded. RESULTS In twenty-one cases, nineteen had union but, two cases have failed. In the group of compression plate fixation and bone graft, bone union was completed at mean 4.4 months, in the group of IM nailing and bone graft at 4.9 months, in case of bone graft only with state of IM nailing at 5.5 months. Mean time until bone union was 4.6 months. CONCLUSION Distraction should be avoided during IM nailing at primary internal fixation. Secondly, To obtain rigid fixation in nonunion of humerus shaft after primary internal fixation, use larger and more broad plate, dual plate or IM nail.
PURPOSE The purpose of this study is to evaluate the effectiveness of operative methods for diaphyseal fractures of both forearm bones in adults. MATERIALS AND METHODS Forty five cases with diaphyseal fractures of both forearm bones over 18 year old that are treated by operative methods from January 1994 to December 1998 were followed and analyzed. The most common age group was 3rd and 4th decade(each, 24.4%). Traffic accident was the most common cause of injuries(31.2%). Among both the radius and ulna, middle 1/3 was the most common level of fractures(60%, 57.8%). In operative methods, open redeuction and internal fixation with dynamic compression plate(D.C.P.) and screws were performed in 39 cases, closed reduction and internal fixation with Rush pin were performed in 5 cases, And another 1 case was performed with D.C.P. and Rush pin simultaneously. RESULTS According to simple X-ray and physical examinations, The average of bone union periods was 12.7 weeks in radius, 13.5 weeks in ulna. The range of bone union periods according to the level of fractures was from 12.4 weeks to 14.1 weeks. For the functional results assessed by Grace and Eversmann method, excellent was 48.9%, good was 35.6%, acceptable was 11.1% and unacceptable was 4.4%. CONCLUSION The functional result was satisfactory in 84.5%. So the operative method of diaphyseal fractures of both forearm bones, if proper operative method had been selected and meticulous surgical technique had been performed, was considered as recommendable method.
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The trochlear fracture of the distal humerus known as a Laugier fracture is extremely rare in occurrence because this articulating unit has no capsule, muscle, or ligamentous attachment and is cradled by the olecranon. Isolated, displaced fracture of the trochlea presented with review of the literature
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PURPOSE The purpose of this study was to show how bone mineral densities of the lumbar spine decrease with aging, to investigate the relationship between the bone mineral densities of the control and fracture group, and to obtain fracture threshold values. MATERIALS AND METHOD From January 1995 to December 1999, we measured and evaluated BMD of L3 by DXA in 239 normal volunteers(96 men and 143 women), and in 218 patients with lumbar spine fracture(91 men and 127 women) above 50 years. The Chi-Square test was used for statistical analysis. RESULTS 1. The average BMD of L3 in control group and lumbar spine fracture group were 0.772+/-0.030 g/cm2 in male and 0.732+/-0 . 0 8 9 g / c m2 i n female and 0.720+/-0 . 0 3 1 g / c m2 in male and 0.692+/-0 . 0 0 2 g / c m2 i n female, respectively. RESULTS 2. The BMD of the control group and fracture group decreased with aging(p<0.05) and were higher in men than in women. There were statistically significant difference(p<0.001). RESULTS 3. There were statistically significant difference between BMD of the control group and BMD of the lumbar spine fracture group(p<0.05). The BMD were higher in the control group than fracture group. RESULTS 4. Fracture threshold of the lumbar spine fracture group were 0.867g/cm2( male: 0.898g /cm2, female:0.836g/cm2) according to 90 percentile.
PURPOSE To analyzed the degree of pain relief of 40 patients with osteoporotic thoracolumbar compression fracture treated by percutaneous vertebroplasty with bone cement. MATERIALS AND METHODS We studied 40 cases of the osteoporotic thoracolumbar compression fracture from January 2000 to June 2000. It was evaluated with simple Xray, bone scan, bone mineral density and CT for the patients 1)who had the compressed wedge fracture of vertebral body on simple X-ray, 2)who had increased bony uptakes of fracture site on bone scan, 3)who were under -2.5 in T-score on bone mineral density, 4)who were not relieved the pain to analgesic drug medication for more than 3 month with no radiating pain, 5)who had no fracture of posterior wall of vertebral body on CT in the case of acute fracture. We performed percutaneous vertebroplasty with bone cement and observed the degree of pain relief using pain scale pre-/ postoperation. RESULTS The average pain point decreased from 6.17 points to 1.06 points at postoperative 1 day, total decreased points were 5.11 points. The average pain point was 1.05 at postoperative 6 months in the patients followed up for more than 6 months. CONCLUSION Percutaneous vertebroplasty with bone cement is valuable method in the treatment of osteoporotic thoracolumbar compression fracture, providing pain relief, prevention of complication originated from long term traction and bed rest, unwearing brace and early ambulation
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PURPOSE This study was designed to evaluate the clinical effectiveness including bone union, leg length discrepancy, after retrograde flexible intramedullary nailing for pediatric femoral fractures.
MATERIAL AND METHOD: Nineteen cases (18 patients) with femur fracture at the age of 4 to 10 years (mean age 6.7) have been followed up over the minimum of one year. Under imaging intensifier, the fracture was temporarily reduced with manual traction, and 1 or 2 flexible nails were inserted at medial and lateral side of distal femur above the distal epiphysis. After two weeks of immobilization with long leg splint, joint motion was permitted. At 6-8 weeks, partial weight bearing was permitted, and at 10- 12 weeks, full weight bearing was permitted. RESULTS Time to radiologic union averaged 10.9 weeks. Limb length discrepancy ranged from 7mm of shortening to 6mm of overgrowth(mean ; 1.1mm of overgrowth), but there was no severe limb length discrepancy over 10mm. As another complications, there were one case of limited motion of knee joint and one case of broken nail. CONCLUSION We found that retrograde flexible intramedullary nailing is a safe, effective treatment for acute femoral shaft fractures in skeletally immature patients.
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Treatment of Femoral Shaft Fracture with Interlocking Humeral Nail in Older Children and Adolescent Kun-Bo Park, Hoon Park, Hyun-Woo Kim, Hui-Wan Park, Jae Young Roh Journal of the Korean Fracture Society.2010; 23(2): 206. CrossRef
PURPOSE To analyze the incidence and clinical and radiological results of anterior knee pain following tibial intramedullary nailing. MATERIALS AND METHODS From January 1995 to April 1999, we retrospectively analyzed in 122 patients with tibial fracture who were treated by closed intramedullary nailing. All of 125 cases analyzed the age and sex distribution, mechanism of injury, fracture morphology, relationship of nail position on radiographs to knee pain and relationship of knee pain to the incision methods of patella tendon. Anterior knee pain was assessed with a 10-point analogue scale. Statistical analysis was performed using paired T-test. RESULTS At a mean follow-up period of thirty-eight months(12-64 months), sixtynine( 56%) patients(70 of 125 knees) had developed anterior knee pain. Insertion of the nail through the patella tendon splitting incision was associated with a higher incidence of knee pain compared to the paratendon site of nail insertion(62% and 35% respectively). According to the radiological analysis, the mean extent of nail protrusion of 122 patients was -1.4mm and the average nail protrusion of 69 patients with knee pain was 1.3mm respectively. Nail removal resolved or improved the symptoms in 69%. CONCLUSION Based on these data, we would recommend a parapatella tendon incision for nail insertion, and nail removal for those patients with a painful knee after bony union.
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Alteration of the Patella Tendon Length after Intramedullary Nail in Tibial Shaft Fractures Dong-Eun Shin, Ki-Shik Nam, Jin-Young Bang, Ji-Hoon Chang Journal of the Korean Fracture Society.2012; 25(4): 283. CrossRef
Anterior Knee Pain after Intramedullary Nailing for Tibial Shaft Fractures Suk-Kyu Choo, Hyoung-Keun Oh, Hyun-Woo Choi, Jae-Gwang Song Journal of the Korean Fracture Society.2011; 24(1): 28. CrossRef
PURPOSE To evaluate the results and usefulness of hybrid external fixator in the treatment of proximal tibia fracture.
MATERIAL AND METHOD: From Jan. 1997 to Jan. 2000, 19 proximal tibia fracture were treated with hybrid external fixator with or without limited internal fixation to stabilize the articular surface. All fractures were classified according to the AO classification. The results were analyzed by ROM(range of motion), bony union time, fracture reduction with MPTA(medial proximal tibial angle) and joint congruency. RESULT There were 1 A2, 7 A3, 1 C1, 8 C2, 2 C3 proximal tibial fractures according to the AO classification. Open fractures were 10 patients. The mean bony union time was 13 wks(range 8-36wks) and the mean length of time in the external fixator was 14wks(range 8-36wks). At last follow up, the MPTA of the proximal tibia was 87.9 degree. 2 patients developed varus(82 degree) and valgus(92 degree) deformity respectively. Complications were intermittent pin drainage in 6 patients(31.6%), deep infection in 1 patient(5.3%) and nonunion in 4 patients(21%) required bone graft and internal fixation with plate at 6 months postoperatively. Four nonunions were 3 C2 and 1 C3 according to the AO classification and three were open fracture(1 type I, 1 type IIIb, 1 type IIIc : Gustilo type) CONCLUSION: Hybrid external fixation is a good treatment option for proximal tibial fractures. However, nonunion and angular deformity would occur in severe metaphyseal comminution and soft tissue injury. Accurate fracture reduction and careful soft tissue management is prerequisite and if necessory early bone graft should be considered in such cases.
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Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage Seung-Ryul Lee, Jae-Hoon Yang, June-Kyu Lee, Hyun-Dae Shin, Kyung-Cheon Kim, Kyu-Woong Yeon, Young-Mo Kim Journal of the Korean Fracture Society.2009; 22(3): 152. CrossRef
PURPOSE To evaluate the results of operative treatment for tibial condyle fracture of the proximal tibia.
MATERIAL AND METHODS: From March 1995 to June 1999, 15 patients with more than one year follow-up periods were treated by operative method at Sun General Hospital. 10 of them were treated by open reduction and internal fixation(plate & screw for 8, screw & K-wire for 2) and 5 of them by closed reduction and Ilizarov fixation. Preoperative prognostic factors were considered as the fracture type of Schatzker classification, associated injury, and closed or open fracture. Functional outcome was evaluated results by Blokker`s criteria. RESULTS According to Schatzker classification, type III were 4 cases, type IV were 6 cases, and type V were 5 cases. At last follow up, average range of motion was 115degrees (Internal fixation was 110degrees, External fixation was 130degrees) The results was according to Blokker`s criteria, 11 cases(73%) had satisfactory acceptable results, among 4 cases(27%) of non-acceptable criteria. CONCLUSION For treatment of tibia condyle complicated communited fracture, we are able to consider that rigid internal fixation with anatomical reduction and external fixation for early range of motion.
PURPOSE To know the functional and radiologic results of the operative treatment for the type I and II tibial plateau fractures according to the methods of internal fixations. MATERIALS AND METHODS Twenty-six patients, who had been treated with open reduction and internal fixation for the type 1 or 2 tibial plateau fractures were evaluated. Twelve cases of type 1 fractures were fixated with 1 lag screw in 5, 2 lag screws in 4 and buttress plate in 3. Fourteen cases of type 2 fractures were fixated with 1 lag screw in 4, 2 lag screws in 6 and buttress plate in 4. The criteria of Hohl and Porter was used for the evaluation of the clinical and radiological results. RESULTS There was no significant difference in the clinical result in type 1 and 2 tibial plateau fractures according to the methods of fixations. And the radiological results were not significantly different in both of type 1 and 2 fractures. CONCLUSION If the anatomical reduction of the articular surface can be achieved, the methods of fixation for the type 1 and 2 tibial plateau fractures do not affect the final clinical and radiological results.