OBJECTIVES To establish the precise diagnosis of a comminuted pertrochanteric fracture with femoral neck fracture in a senile osteoporotic patient and report of a preliminary clinical results of early bipolar hemiarthroplasty.
MATERIAL & METHODS: Consecutive seven cases of comminuted pertrochanteric fractures who were suspicious to have combination with femoral neck fracture were evaluated. All cases had routine radiographs and CT scans of proximal femur and performed with bipolar hemiarthroplasties. Observation of the retrieved femoral head to evaluate a fracture and recorded with photograph. Postoperative evaluation was done with Daubine & Postel clinical grading with medical recording and personal telephone. The clinical evaluation was focused on the recovery for preinjured walking distance. RESULTS All patients were proved to have combination with pertrochanteric fractures and femoral neck fractures. In addition, all patients were recovered to more than good in clinical grading and pre-injured walking distance. CONCLUSION To make a precise diagnosis of pertrochanteric fractures with femoral neck fracture it is recommended to perform the CT scan with prompt reading of the simple radiographs in suspicious case. An early bipolar hemiarthroplasty was also recommended to treat this kind of senile difficult fracture.
PURPOSE This study was performed to analyze the significant factors that may affect failure of fixation in trochanteric fractures of the femur treated with the compression hip screw. MATERIALS AND METHODS From May 1995 to July 2000, the authors analyzed 97 cases of trochanteric fracture of the femur treated with the compression hip screw and followed more than one year. We classified the fracture type by Jensen 's method. We used Singh index for the degree of osteoporosis. In the post-operative radiograph, we checked neck-shaft angle, state of reduction, position of the lag screw within the femoral head, tip-apex distance, and sliding distance of the lag screw. The relationship between these factors and failure of fixation was statistically analyzed. RESULTS There were 17 cases (17.5%) of failure of fixation ; 15 cases (15.4%) of excessive sliding of the lag screw, 1 case (1%) of cutting out of the lag screw, and 1 case (1%) of valgus malunion. There were significant relationships between failure of fixation and old age over 80, unstable fracture, telescoping reduction, anterior or medial displacement of the distal fragment, and anterior placement of the lag screw within the femoral head. CONCLUSION Accurate reduction and avoidance of the placement of the lag screw in the anterior part of the femoral head were important factors to prevent failure of fixation in trochanteric fractures of the femur treated with the compression hip screw.
PURPOSE This study evaluates the effectiveness of the condylar blade plate for internal fixation of unstable trochanteric fractures of the femur. MATERIALS AND METHODS Twenty six unstable trochanteric fractures of the femur (AO classification, 9 type A2 and 17 type A3) were treated by condylar blade plate fixation. Osteoporosis was found in 14 cases. Fractures were operated on the average 7th day after trauma and cancellous bone graft was performed in 3 fractures with severe comminution. Results were evaluated by operating time, time of fracture healing, complications, and function of the hip and walking ability at the final follow-up assessment. RESULTS Operating time was 123 minutes on average. All fractures were united in an average of 14.0 weeks. Complications at the fracture site were a heterotopic ossification and a refracture. Motion of the hip was limited moderately in a case with heterotopic ossification and mildly in 5 cases. Two patients used a cane and 2 patients revealed a mild limp. CONCLUSION Although the condylar blade plate is technically difficult to apply, it provides stable fixation to obtain good results with less complications for unstable trochanteric fractures of the femur, especially even in the presence of osteoporosis.
Citations
Citations to this article as recorded by
Helical Blade Locking Sleeve Disassembly Following Failed Femur Intertrochanter Fracture - A Case Report - Soon Ho Huh, Hong-Man Cho, Ji-Yeon Park Journal of the Korean Fracture Society.2021; 34(3): 112. CrossRef
Excessive Sliding of the Helical Blade and the Femoral Neck Fracture after Insertion of Proximal Femoral Nail Anti-Rotation for Type A2 Intertrochanteric Fractures - A Case Report - Bong-Ju Park, Hong-Man Cho, Ju-Han Kim, Woo-Jin Sin Journal of the Korean Fracture Society.2013; 26(2): 151. CrossRef
A Case Report of Unique Complications of PFNA Penetration of the Blade into the Hip Joint Se-Ang Jang, Young-Ho Cho, Young-Soo Byun, Hun-Sik Cho, Sung Choi, Hyun-Seong Yoo Hip & Pelvis.2011; 23(4): 318. CrossRef
PURPOSE This prospective study was performed to evaluate the usefulness and the risk of the Proximal Femoral Nail(PFN) for internal fixation of the femur intertrochanteric fracture. MATERIALS AND METHOD We operated 26 consecutive intertrochanteric fracture patients with PFN from June 2000 to May 2001 and analysed the operation time, bleeding loss, union rate, union time, failure of fixation and complications. We also evaluated the clinical result with the recovery of ambulatory function and functional recovery score. RESULTS Mean operation time was 72 minutes and mean transfusion amount was 0.54 unit. 24 cases progressed to union until 4 months uneventfully and remaining 2 cases also progressed to union within 6months without further operation. There was no failure of fixation. Mean fracture site impaction was 4.4mm and among the 11 unstably reduced cases 3 showed overimpaction(> 10mm). Clinically mean loss of ambulation ability was 1.4 grade. Last follow Skovoron functional recovery score was 72.2. We removed laterally protruded hip pin and femur neck screws in two cases because of irritation on the lateral trochanteric area skin. But there was no significant complications such as intraoperative or postoperative fractures and femoral head cut out. CONCLUSION The findings from this study indicate that, compared with other methods, PFN is useful and reliable choice for the femur intertrochanteric fracture treatment in the terms of less complications and equal or better results.
Citations
Citations to this article as recorded by
GS Hip Nail versus Affixus Hip Fracture Nail for the Intramedullary Nailing of Intertrochanteric Fractures Seungcheol Kwon, Minjae Lee, Heeyeon Lee, Jihyo Hwang Journal of Clinical Medicine.2023; 12(21): 6720. CrossRef
Treatment of the Proximal Femoral Fracture Using the New Design Cephalomedullary Nail: Prospective Outcomes Study Young Ho Roh, Joseph Rho, Kwang Woo Nam Journal of the Korean Fracture Society.2019; 32(1): 35. CrossRef
Treatment of Intertrochanteric Fractures Using the Compression Hip Nail Je-Min Yi, Kye Young Han, Keun Woo Kim, Chang Hyun Ryu Hip & Pelvis.2014; 26(3): 166. CrossRef
Unstable Intertrochanteric Fracture Treated with ITST: A Comparative Study between Groups with and without Comminution of Greater Trochanter Kyung-Sub Song, Sang-Ho Lee, Seong-Hun Jeong, Su-Keon Lee, Sung-Ha Hong Journal of the Korean Fracture Society.2014; 27(1): 36. CrossRef
Treatment of Unstable Pertrochanteric Fractures with a Long Intramedullary Nail Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Dae Jung Huh Hip & Pelvis.2013; 25(1): 51. CrossRef
Comparative Study of Proximal Femoral Nail Antirotation and Zimmer Natural Nail for the Treatment of Stable Intertrochanteric Fractures Jee-Hoon Kim, Oog-Jin Shon Journal of the Korean Fracture Society.2013; 26(4): 305. CrossRef
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
Operative Treatment with Gamma 3 Nail in Femur Intertrochanteric Fracture Ki-Do Hong, Jae-Chun Sim, Sung-Sik Ha, Tae-Ho Kim, Yoon-Ho Choi, Jong-Hyun Kim Journal of the Korean Fracture Society.2011; 24(1): 7. CrossRef
The Comparison between ITSTâ„¢ (Intertrochanteric/Subtrochanteric) & DHS (Dynamic Hip Screw) in Unstable Femur Intertrochanteric Fracture Ho-Seung Jeon, Byung-Mun Park, Kyung-Sub Song, Hyung-Gyu Kim, Jong-Ju Yun Journal of the Korean Fracture Society.2009; 22(3): 131. CrossRef
Complications of Femoral Pertrochanteric Fractures Treated with Proximal Femoral Nail (PFN) Kee-Byoung Lee, Byung-Taek Lee Journal of the Korean Fracture Society.2007; 20(1): 33. CrossRef
PURPOSE To evaluate the correlation of the safe zone of percutaneous iliosacral screw fixation with sacral dysmorphism and sacral alar slope variation. MATERIALS AND METHODS We studied the plain radiographs and the pelvic bone CT images of 52 patients. We reviewed each cases in terms of Routt 's dysmorphism and sacral alar slope variation(anterior, coplanar and posterior to inter-ICD line). We divided each cases into narrow and wide groups by the width of safe zone for the transverse 6.5mm cannulated cancellous screw. The data were analysed by McNemar x2-test and Cochran Q-test(p<0.05). RESULTS Typical sacral dysmorphism was found in five cases(9%). Four cases with dysmorphism(80%) and eighteen non-dysmorphic cases(38.2%) revealed narrow safe zones. The sacral slopes were anterior in 16 cases, coplanar in 25 cases, and posterior in 11 cases. The safe zone was significantly narrow in the group with anterior slope variation. CONCLUSION We could not found definite correlation between sacral dysmorphism and a narrow safe zone because the incidence of dysmorphism was too low in our study which differed from Routt 's report. An anterior sacral alar slope on CT can be a significant risk indicator for potential narrow safe zone and the risk of screw malposition.
Citations
Citations to this article as recorded by
Measurement of Optimal Insertion Angle for Iliosacral Screw Fixation Using Three-Dimensional Computed Tomography Scans Jung-Jae Kim, Chul-Young Jung, Jonathan G. Eastman, Hyoung-Keun Oh Clinics in Orthopedic Surgery.2016; 8(2): 133. CrossRef
Operative Treatment of Unstable Pelvic Ring Injury Sang Hong Lee, Sang Ho Ha, Young Kwan Lee, Sung Won Cho, Sang Soo Park Journal of the Korean Fracture Society.2012; 25(4): 243. CrossRef
Upper Sacral Morphology Related to Iliosacral Screw Fixation in Korean Jung-Jae Kim, Chul-Young Jung, Hyoung-Keun Oh, Byoung-Se Yang, Jae-Suck Chang Journal of the Korean Fracture Society.2007; 20(2): 115. CrossRef
PURPOSE To review the clinical and radiographic results of operative treatment of acetabular fractures for which there were minimum five-year follow-up. MATERIALS AND METHODS We reviewed 22 acetabular fracture cases that had been treated operatively from March 1993 to July 1996. Each of the patients had been followed for a minimum five-year. The radiographic results were classified by Matta 's criteria and the clinical results were analyzed according to d 'Aubigne and Postel 's criteria. RESULTS Satisfactory reduction were obtained in 18 hips (81.8%), 14 and 13 hips of which were included in good or excellent categories of roentgenographic and clinical results respectively. Overall radiographic results for 17 hips (77.3%) at the one-year follow-up and 14 hips (63.6%) at the minimum five-year follow-up were excellent or good. According to clinical criteria, 16 hips (72.7%) at the one-year follow-up and 13 hips (59.1%) at the minimum five-year follow-up were classified as excellent or good. CONCLUSION Folow-up roentgenographic and clinical results were good or excellent in satisfactory reduction group. Threrefore the accuracy of reduction is an important prognostic factor in acetabular fracture. The results were worse at the minimum five-year follow-up than at the one-year follow-up. Late-postoperative complication is expected to increase as time passes.
PURPOSE To evaluate the causative factors of metal failure after internal fixation, and to suggest more rational treatment guideline that can prevent metal failure in the mid-shaft femur fractures. MATERIALS AND METHODS A retrospective review of 17 cases, who were treated with internal fixation for the femur mid-shaft fracture was analyzed. We evaluated the cause of injury, fracture type and site, associated injury, used instruments, duration to metal failure, and complications. RESULTS The metal failure occurred on average 14.8 months after internal fixation. As extrinsic factors, early exercise and weight-bearing in 7 cases, slip down during ambulation in 4 cases, improper physical therapy in 3 cases and unknown cause in 3 cases were related to metal failure. Most metal failure were occurred at the initial fracture site in 12 cases. Other metal failure site were empty holes in 1 case and proximal area of fracture site in 1 case, and screw breakage in 3 cases. CONCLUSION Accurate preoperative evaluation of fracture site, fracture type and proper selection of instrument, and precise surgical technique will be essential for the prevention of metal failure.
PURPOSE Antegrade intramedullary nailing of the femur is effective method of treatment for patients with femoral shaft fractures. But retrograde IM nailing is another effective method, especially in femoral shaft fractures concomitant with ipsilateral femoral neck, intertrochanteric fractures, acetabular fracture, multiple fracture and obesity, pregnancy, traumatic arthrotomy of the knee joint, bilateral femur fractures, and floating knee injuries are also indicated. The purpose of this study is to verify the effectiveness of retrograde IM nailing after long-term follow-up by retrospective evaluation. MATERIALS AND METHODS A retrospective review of the medical charts and X-rays about 37 patients who were operated by retrograde nailing and all patients were minimally followed up about 2 years. Results were evaluated radiologically for screw breakage, nail migration, nonunion and clinically for knee ROM limitation, infection. RESULTS The results were as follows; 1) union was achieved at on average of 17 weeks. 2) Full range of knee motion was gained in 33/37 cases. Knee-stiffness occurred in 4 cases, Severity of initial trauma might affect such results but not, retrograde nailing 3) 2 complications were found nonunion and delayed union. 4) There were not postoperative infection and femoral shortening. There were distal screw breakage in 4 cases but, the others were not migrated. CONCLUSION Retrograde IM nailing of femoral fracture is an effective method in selected cases such as ipsilateral femoral neck fractures, floating knees, post-TKRA femoral fracture and so on. If retrograde IM nailing is operated by skillful surgeon and appled to absolute indication, the result is no significant difference of antegrade IM nail such as bone union, nonunion and postoperative infection. Nevertheless, operation time is shorter and blood loss lesser. Significant knee problems related to this technique could not be identified for 2 years followed up.
Citations
Citations to this article as recorded by
Factors Affecting the Period of Bone Union When Treating Femoral Fractures with a Retrograde Intramedullary Nail Bum-Soo Kim, Seong-Tae Kim, Seungyup Shin, Seong Man Jeon Journal of the Korean Orthopaedic Association.2021; 56(4): 326. CrossRef
Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult Yong-Woon Shin, Yerl-Bo Sung, Jeong Yoon Choi, Minkyu Kim Journal of the Korean Fracture Society.2011; 24(4): 313. CrossRef
PURPOSE We analyze the clinical causes and precautions of nail breakage followed by femoral intramedullary nailing MATERIALS AND METHODS: We reviewed 12 cases of nail breakage followed by the femoral intramedullary nailing from Jan. 1993 to Feb. 2001 and for each cases, we analyzed used nail diameter, patient weight and used nail, time to nail breakage and configuration of non-union. We classified fracture site at the time of trauma as proximal 1/3, middle 1/3, distal 1/3, and evaluated gap of fracture site, displacement of fragment after surgery, location and treatment of broken nail on each part, and analyzed the causes of nail breakage RESULTS: The average time of nail breakage was 8.1 months and distal 1/3 fracture were major as 6 cases. Those were mainly comminuted fracture of Winquist-Hansen type II. After surgery, gap of fracture site and displacement of fragment were mostly observed in middle 1/3 fracture and, in the part of middle 1/3, the site of nail breakage took place in fracture site. Especially in the distal 1/3 fracture, nail breakage happened usually in distal first locking screw hole. The causes of nail breakage were inadequately small diameter of nail inserted into the isthmic portion of medullary canal in proximal fracture, inaccurate reduction of fracture site in middle fracture, and the use of short length of nail and its mechanical damage caused by inaccurate insertion of distal locking screw in distal fracture. CONCLUSION To prevent nail breakage while femoral intramedullary nailing, in proximal fracture, adequate diameter of nail has to be inserted into the isthmic portion of medullary canal. In middle fracture, the accurate reduction of fracture site will be necessary, and the case of distal fracture, enough length of nail has to be used and especially it is important not to cause mechanical injury with the accurate insertion of distal locking screw in nail
Citations
Citations to this article as recorded by
Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures Bailian Liu, Ying Xiong, Hong Deng, Shao Gu, Fu Jia, Qunhui Li, Daxing Wang, Xuewen Gan, Wei Liu Journal of Orthopaedic Surgery and Research.2014;[Epub] CrossRef
Limited Open Reduction and Intramedullary Nailing of Proximal Femoral Shaft Fracture Sang Ho Ha, Jun Young Lee, Sang Hong Lee, Sung Hwan Jo, Jae Cheul Yu Journal of the Korean Fracture Society.2009; 22(4): 225. CrossRef
PURPOSE The purpose of this study was to compare the results between open reduction and internal fixation with plate and screws and closed reduction and external fixation with Ilizarov device for the fracture of disatal metaphyseal fracture of tibia. MATERIALS AND METHODS In this study, the results in treatment of the 19 distal metaphyseal fractures of tibia with closed reduction and external fixation with Ilizarov device were compared with those in treatment of the 23 fractures with open reduction and internal fixation with a plate and screws. The cases were the patients who had been treated for the fractures at the Department of Orthopaedic Surgery, Dankook University Hospital from May 1997 to December 2000. The results of treatment were analysed using functional evaluation by Mast and Teipner and radiological evaluation by Ovadia and Beals. RESULTS The results were as follows: 1. The major causes of injury were motor vehecle accidents, fall-downs, and falls from a height in order.
2. Treatment of the fractures with closed reduction and external fixation with Ilizarov device showed comparable results to that with open reduction and internal fixation with a plate and screws.
3. Complications in treatment were a little more frequent in open reduction and internal fixation with a plate and screws than in closed reduction and external fixation with Ilizarov device. CONCLUSION Considering the results, closed reduction and external fixation with Ilizarov device is thought to be one of recommendable options in treatment of the distal metaphyseal fractures of tibia with the advantages in wound management, prevention of stiffness of ankle joint, and convenience in removal of the device.
Citations
Citations to this article as recorded by
Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator Suk Kyu Choo, Kyung Wook Nha, Hyoung Keun Oh, Dong Bong Lee Journal of the Korean Fracture Society.2007; 20(4): 323. CrossRef
PURPOSE Proximal humerus fractures are relatively frequent and have variable treatment mothods. It is important to resolve union of the fracture site, good range of motion and function through the early ambulation in treatment results. We will know whether it is recommendable treatment or not and analyze the results of treatment on the effectiveness of the external fixator in two or three part fractures of the proximal humerus fractures. MATERIALS AND METHODS From May, 1999 to April, 2001, 8 cases in 8 patients were treated by external fixator on the proximal humerus fractures. Mean age was 44.7yrs(11 to 68 yrs), two part fracture 6 cases, three part fracture 2 cases in fracture classification by Neer. We treated 3 cases with ring external fixator, 4 cases with monoplane external fixator. We referred chart and radiographics to patients and assessed the results by Neer 's shoulder function table through final follow-up or phone call. RESULTS In all cases, we obtained bone union without neuroparalysis, neurovascular injury, avascular necrosis and other complications. Mean bone-union time was 7 weeks(5 to 12 weeks). Final functional assessments are excellent or good in 7 cases, poor in 1 case. CONCLUSION We obtained comfortable results after we performed external fixation on proximal humerus fracture and bone union was acquired and removed external fixator at 7 weeks through early ambulation. We think procedure has brief, low soft tissue damage, high stability and motily. Thus we think it is recommendable treatment on the displaced proximal humerus fractures.
PURPOSE The purpose of this study is to document the result of the interlocking intramedullary nailing of the proximal humerus fracture in eldery patients over 65 years old. MATERIALS AND METHODS We performed a clinical and radiographic assessment after a follow up period exceeding 12months of 14cases of interlocking intramedullary nailing of proximal humerus fracture. RESULTS By Kronberg 's radiogrphic evaluation, 9 cases were good, 4 cases were acceptable, 1 case was poor. The average pain index was 3.2 point by Howkins guide line. All patients complained about final range of motion, especially in abduction and flexion movement. CONCLUSION Though the interlocking intramedullary nailing was an attractive alternative for the proximal humerus fracture stabilization for early rehabilitation in eldery patients over 65 years old, but should be consideration for postoperative shouder pain and loss of motion
PURPOSE We have followed up the patients of the humeral shaft fracture who had been treated with dynamic compression plate or locked intramedullary nail, which are common therapeutic options, compared them and analyzed results and complications. MATERIALS AND METHODS We analyse the clinical results, radiological results and complications of 50 cases of the humeral shaft fracture who were treated with dynamic compression plate(DCP) or intramedullary nail(IMN) at the Pusan National University Hospital from March in 1996 to February in 2001. RESULTS We find the no significant difference in range of motion of the shoulder, infection, operation time, operative bleeding loss and second radial nerve palsy but 4 cases of shoulder pain and 1 case of shoulder impingement in IMN group. We find the no significant difference in mean bone union time in both groups but 2 cases of nonunion in DCP group and 4 cases of nonunion in IMN group. Complications happened in 4 case of DCP group (total 26 cases) and 2nd surgery was needed in 3 cases(11.5%). However complications happened in 10 cases of IMN group (total 24 cases) and second surgery was needed in 6 cases(25%). CONCLUSION The treatment results of the humeral shaft fracture with dynamic compression plate is much better than intramedullary nail except specific pathologic or segmental fracture pattern.
Citations
Citations to this article as recorded by
COMPARATIVE STUDY OF COMPRESSION PLATING VS. INTERLOCKING NAIL IN FRACTURE SHAFT OF HUMERUS Rajeev Kumar Roy, Mahesh Prasad Journal of Evidence Based Medicine and Healthcare.2017; 4(41): 2481. CrossRef
Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107. CrossRef
PURPOSE To evaluate the results of the treatment of humeral shaft fractures using retrograde AO Unreamed Humeral Nail(UHN). MATERIALS AND METHOD From Apr. 1998 and Aug. 2001, 18 humeral shaft fractures were treated with retrograde AO UHN. All fractures were classified according to the AO classification. The results were analyzed by bony union time, range of motion and complication. RESULTS There were eleven cases of A3, two B2, one B3, four A2 humeral middle shaft fractures according to the AO classification. The mean bony union time was 12.2 weeks(range;9-16 weeks). All patients regained full range of motion of the shoulder joint and the elbow joint but 2 patients with intraopenatively ruptured capsule had transient elbow motion limitation. Complications were iatrogenic fractures at the entry portal in 2 patients(15%), transient shoulder pain in 4 patients(30.7%), nonunion in 1 patient(7.6%), required bone graft and internal fixation after removal of the nail at 13 months postoperatively. CONCLUSION The treatment of humeral shaft fracture with retrograde AO unreamed humeral nail is one of the good options to reduce the rate of non-union or delayed union by compression effect if the intraoperative errors is prevented.
PURPOSE This is a retrospective study to analyze the clinical results of the usefulness of the lateral J plate fixations in distal humeral shaft and metaphyseal fractures. MATERIALS AND METHODS From October 1996 to May 2000, eleven patients with distal humeral shaft and metaphyseal fracture were treated by open reduction and internal fixations with lateral J plate fixations. The clinical results were analyzed according to Morrey 's functional rating scale. Radiological unions, complication, and range of motion of the elbow were assessed. RESULTS All fractures were united at 12 weeks (range, 10 ~18) in average. Finally, average range of motion of the elbow joint was flexion contracture 6 degrees in average(range, 0 ~20) to further flexion 126 degrees in average (range, 90 ~1 5 0 ) . Morrey 's functional rating scale were as follows; excellent 4, good 6, and fair 1. CONCLUSION Lateral J plate fixations can be a good treatment method for the transitional zone of distal humeral shaft and metaphyseal fractures.
It is reported when posterior dislocation of the elbow with the fracture of the coronoid process is occurred, if they can 't achieve the reduction of coronoid process, the patient would have the elbow instability. That is required to open reduction of coronoid process. Limitation of the elbow motion and persistent posterior dislocation of the elbow result from failure of reduction of coronoid process in acute injury. That patients have been treated by distraction arthroplasty, total elbow replacement, arthrodesis, and coronoid process reconstruction. We experienced one case that had a excellent result from reconstruction of the coronoid process using a graft from the olecranon of same side in 28 years old man.
PURPOSE We report complications occurred from 6 patients among 14 patients who received the operation for their radial head and neck fractures by using the absorbable rod made by poly-glycolic acid(PGA). MATERIALS AND METHODS We analyze the postoperative results of 14 patients who recieved fixation by absorbable rod for the radial head and neck fractures from March 1991 to March 2000. All of the fractures were are reducible and modified Mason 's type II. RESULTS After average 15 months follow up, flexion contracture was average 20 degrees and full flexion was average 130 degrees. Complications were occurred in 6 cases. Osteolysis was occurred in 3 cases and in 2 cases among theses 3 cases, radial head excision was performed. Synovitis was occured in other 3 cases and in one case joint fluid was drainaged from operation wound for 2 weeks and in other 2 cases, synovitis was progressed to arthritis. CONCLUSION The absorbable rod made of PGA in radial head and neck fracture have relatively high rate of adverse tissue responses. So surgeon should consider adverse tissue response of PGA. Development of more biocompatible absorbable and slow degrading material should be needed.
PURPOSE Children with femoral shaft fractures in association with other injuries such as head injuries, abdominal injuries, open fractures, multiple fractures, or unstable displaced fractures require operative treatment rather than being treated in conservative methods. In this study, we compare the surgical result of femoral shaft fracture using external fixator in children, and evaluate the complications and the related factors as well as the advantage over the other management described in the literature. MATERIALS AND METHODS We reviewed 15 cases of femoral shaft fractures in children admitted between May, 1995 and May, 2000. The mean age was 8 years and 2months old (range: 6-12 year-old, 9 boys, 6 girls). All the evaluations were based on the postoperative radiologic studying and clinical findings. In the radiologic evaluations, bony union time, angular deformity, and leg length discrepancy in both sagittal and coronal plane were evaluated, and in the clinical evaluations, we analyzed the duration of external fixation, hospital day, range of motion in both hip and knee joint, and post-operative complications. RESULTS The average bony union time based on the radiologic studying was 10.9 weeks (ranging from 7 to 24 weeks). Angular deformity at the fracture site was less than 5 degrees and no rotational deformity was found in all 15 cases. The average length of overriding fracture fragment was 11.7 mm (ranging from 10 to 15 mm) and average leg length discrepancy was 2.1 mm (ranging from -3 to +10mm). Duration of external fixation averaged 12.1 weeks (ranging from 9 to 24 weeks) and average hospital day was 29.4 day (ranging from 21 to 48 day). None of the patient had limitation in hip or knee joint movement. There were 1 case of refracture (case of pathologic fracture) and 4 cases of pin tract infection(superficial infection). CONCLUSION At our institution, we observed average overgrowth of 2.1 mm and no severe complications excepts in 1 case of refracture due to pathologic fracture. Thus we concluded that closed reduction and external fixation is effective in treating open, or unstable displaced fracture of femoral shaft with other associated injuries in pediatric population, and it is also believed to be effective means in treating closed femoral fractures.
Cystic change on femoral head and neck in neurofbromatosis patient is rare case. Scoliosis is the most common bony lesion. Others are appeared at changes of out feature in long bone shaft. Bone cyst with bone fracture are treated with non operation or external fixation, osteotomy, curettage, partial and complete excision of cyst capsule, steroid injection therapy, bone graft, internal fixation, arthroplasty. We have experienced a case of bone cystic change on femoral head and neck with femoral head fracture and acetabular lesion in neurofibromatosis patient treated with total hip arthroplasty who was acceptable result.