PURPOSE To assess the affecting factors of results after the operation of Crescent fracture-dislocation in sacro-iliac joint. MATERIALS AND METHODS In 19 patients (mean age, 47.4 year-old) of open reduction and internal fixation for Crescent fracture-dislocation, there were seven type I, 9 type II, and 3 type III fractures according to Day's classification. We assessed affecting factors of radiological and functional results, such as patients' ages, surgical approaches, the fixation extent of pelvic ring, and fracture patterns. RESULTS Seventeen of 19 cases united at 14.5 weeks in average, and 2 non-unions occurred with the fixation failure of posterior ring. Satisfactory results were 14 and 15 in radiological and functional evaluation, respectively. In complications, three cases of leg length discrepancy were from an imperfect reduction and two fixation failures. Surgical approach did not show any difference of results, but all cases of unsatisfactory reduction occurred from posterior ring fixation through the anterior approach. Fixation of both rings seemed to have satisfactory results, comparing to posterior ring only. Older patients over 60 year-old had more complications and a tendency to show an unsatisfactory result. CONCLUSION In operative treatment of Crescent fracture-dislocation of sacro-iliac joint, it is better to fix both anterior and posterior rings. But, caution is needed to prevent complications in old-aged patients.
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PURPOSE To evaluate the factors predicting complications after internal fixation using multiple cannulated screws in the patients with femoral neck fracture, the authors performed a comparative study of a success group and a failure group and reviewed the literature. MATERIALS AND METHODS Sixty-eight patients with intracapsular femoral neck fractures were treated by multiple pinning from January 2000 to July 2007 and followed up more than one year. Relationships between the complications such as failure of union, collapse of femoral head due to osteonecrosis of femoral head and several affecting factors including the degree of displacement by Garden stage, state of reduction, position of screws, patient's age, time interval from injury to operation, anatomical fracture site and two weeks postoperative (99m)Tc-MDP bone scan were analyzed. RESULTS Statistically significant factors were the degree of displacement by Garden stage (p<0.001), reduction state (p<0.001) and postoperative two weeks (99m)Tc-MDP bone scan (p<0.001). CONCLUSION An accurate anatomical reduction is needed to decrease complications with multiple cannulated screws fixation of femoral neck fracture. Displacement of fracture by Garden stage and (99m)Tc-MDP bone scan are major factors predicting complications.
PURPOSE We analyzed the complications of femoral peritrochanteric fractures treated with the Gamma nail to reduce its complications. MATERIALS AND METHODS We evaluated the complications among the 96 patients who were treated with the Gamma nail from January 2000 to May 2005. Mean follow-up period was 17.8 months and mean age was 75.2 years. We analysed the relationship between the complication and the fracture pattern, postoperative reduction status, position of the lag screw, bone density, displacement and tip-apex index (TAD). RESULTS The complications were presented in 12 cases (12.5%). Cut-out of lag screw were in 5 cases, varus deformity with short lag screw in 2 cases, metal breakage of distal screw in 1 case, breakage of drill bit intraoperatively in 1 case, superficial infection in 2 cases and deep infection in 1 case. 5 cases (4.2%) were required reoperation. All of the cut-out of lag screw showed increased TAD (tip apex distance) above 25 mm. CONCLUSION To reduce the complications of the Gamma nail, we need exact surgical technique, good positioning of the lag screw and choice of appropriate length for the lag screw.
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Effectiveness of the Valgus Reduction Technique in Treatment of Intertrochanteric Fractures Using Proximal Femoral Nail Antirotation Ji-Kang Park, Hyun-Chul Shon, Yong-Min Kim, Eui-Sung Choi, Dong-Soo Kim, Kyoung-Jin Park, Byung-Ki Cho, Jung-Kwon Cha, Sang-Woo Kang Journal of the Korean Orthopaedic Association.2013; 48(6): 441. CrossRef
PURPOSE To analyze the clinical and radiologic results of treatments in proximal femoral fracture with Proximal Femoral Nail-Antirotation (PFNA). MATERIALS AND METHODS We retrospectively reviewed the results of 21 cases of proximal femoral fracture treated with PFNA from September 2006 to October 2007 which could be followed up for minimum of more than a year. The mean age was 61.5 (20~88) years old. Male were involved in 12 cases, female in 9 cases. The mean follow up was 14.3 (12~18) months. The Garden alignment index, Cleveland index, tip apex distance were evaluated by post-operative radiologic evaluation and complications of bone union, failure of internal fixation and deformity were evaluated by follow up radiologic findings. Clinical results were assessed by social function score of Jensen and mobility score of Parker and Palmer at last follow up. RESULTS All fractures were united and the mean time to bone union was 15.7 (13~18) weeks. Garden alignment index showed good results of above 'good' in 15 cases (71.4%), Cleveland index showed 14 cases (66.4%) positioning in zone 5 and tip apex distance showed 17.81 (+/-5.65~27.52) mm in radiologic findings. The mean sliding of blade was 1.32 (0.34~2.94) mm in follow up radiologic findings and fracture of distal locking screw area was found in 1 case as a complication. Among 21 cases, the function before injury was completely recovered in 15 cases (71.4%) which were assessed by social function score of Jensen and 13 cases (61.9%) by mobility score of Parker and Palmer. CONCLUSION We think that PFNA is effective osteosynthetic device for proximal femur fracture with satisfactory radiologic and clinical outcomes.
Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail Jae-Cheon Sim, Tae-Ho Kim, Ki-Do Hong, Sung-Sik Ha, Jong-Seong Lee Journal of the Korean Fracture Society.2013; 26(1): 37. CrossRef
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Cementless Bipolar Hemiarthroplasty Using a Rectangular Cross-section Stem for Type A2 or above Intertrochanteric Fractures Bong-Ju Park, Hong-Man Cho, Cheol Park, Hwang-Se Bong Hip & Pelvis.2012; 24(3): 222. CrossRef
Hip Arthroplasty for Failed Internal Fixation of Intertrochanteric Fractures Ju-Oh Kim, Hong-Man Cho, Cheol Park, Ju-Hyun Sim Hip & Pelvis.2012; 24(2): 94. CrossRef
Anatomical Measurement of Normal Korean Proximal Femur Using Plain Radiography: A Problem when using Proximal Femoral Nail Anti-rotation Jong-Seok Park, Woo-Jong Kim, Jae-Wan Soh, Byung-Woong Jang, Tae-Heon Kim, You-Sung Suh Hip & Pelvis.2011; 23(4): 303. CrossRef
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Proximal Femoral Nail Antirotation versus Compression Hip Screw with Trochanter Stabilizing Plate for Unstable Intertrochanteric Hip Fractures Jae-Young Rho, Sang-Bum Kim, Youn-Moo Heo, Seong-Jin Cho, Dong-Sik Chae, Woo-Suk Lee Journal of the Korean Fracture Society.2010; 23(2): 161. CrossRef
Treatment of the Unstable Intertrochanteric Fracture with Proximal Femoral Nail Antirotation: Comparison with Compression Hip Screw with Trochanteric Stabilizing Plate Tae-Ho Kim, Jong-Oh Kim, Seung-Yup Lee, Geon-Ung Yun Journal of the Korean Fracture Society.2010; 23(4): 353. CrossRef
PURPOSE The purpose of this study was to classify posterior malleolar fractures according to the position of fragments and to analyze radiologic features of each type. MATERIALS AND METHODS We analyzed forty-six patients of ankle fractures involving a posterior malleolus who were treated between January 2004 and December 2007. The posterior malleolar fractures were categorized into three types (posterolateral, posteromedial, shell) based on the major fracture line. In each type, we analyzed amount of displacement, involvement of articular surface, existence of subluxation and osteochondral impacted fragments. RESULTS The forty-six patients were categorized into three types: Posterolateral (PL) type (33 cases, 72%), Posteromedial (PM) type (8 cases, 17%), shell type (5 cases, 11%). Of the 8 cases with PM type, 7 cases showed displacement more than Grade II, 4 cases showed subluxation of ankle joint, and 3 cases showed osteochondral impacted fragment. Average involvement of articular surface of PM type is 35% (15~65%). CONCLUSION Posterior malleolar fractures with medial extension tended to have adverse effect on ankle stability and Preoperative CT scan is essential for evaluation of fracture type and determination of appropriate surgical approach.
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PURPOSE To report the surgical results of volar percutaneous cannulated compression screw fixation in subacute scaphoid fracture. MATERIALS AND METHODS Between January 2004 and January 2007, eight consecutive patients with subacute scaphoid waist fracture, who sought medical attention between 4 weeks to 6 months after injury, were included in this study. All patients were male of an average age 29.2 years (range, 19 to 44). Mean duration of injury was 10.3+/-4.1 weeks. An acutrak cannulated screw (Acumed, Hillsboro, OR) was introduced volarly under image intensifier guidance in all patients. We performed radiological evaluation preoperatively and postoperatively. And we performed 12 months postoperatively using grip strength, range of motion (ROM) of the wrist, Mayo Modified Wrist Score (MMWS) and Disabilities of the Arm, Shoulder and the Hand (DASH) score for functional evaluation. RESULTS Preoperative radiography showed minimal sclerosis line in three patients and a bone resorption around fracture sites in two patients. However, no patient had dorsal intercalated segment instability or more than 35 degrees of lateral intrascaphoid angle. Fractures united successfully at 11.6+/-2.1 weeks postoperatively without any requirement for a further procedure. At 12 months follow-up evaluations, ROM of the injured wrist was 93% of the uninjured wrist and grip strength of the injured wrist was 95% of the injured wrist. The mean MMWS was 93+/-6.6 and the mean DASH score was 4.8+/-1.2. CONCLUSION We believe that volar percutaneous cannulated screw fixation is a reliable method in case of subacute scaphoid waist fracture without scaphoid deformity or carpal instability.
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Dislocations of the interphalangeal joint of the great toe that are irreducible are very rare. Invagination of the plantar plate or the sesamoid bone into the IP joint, which prevents reduction. To our knowledge, however, dislocations of the IP joint of the great toe that were irreducible because of lateral collateral ligament entrapment, not invagination of the plantar plate or the sesamoid bone, have not been reported by any English literature. We report a 29-year-old ballet dancer who sustained an irreducible dislocation of the interphalangeal joint of the great toe owing to lateral collateral ligament entrapment.
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