Regardless of the efforts of several treatments after pelvic bone fracture, as many as 5% of all pelvic fractures result in malunion or nonunion of the pelvis. These complications can cause disabling symptoms, including pain, instability, and gait disturbance, which can decrease life quality of patients and increase socioeconomic problems. Therefore concerns regarding the treatment of malunion and nonunion after pelvic bone fracture are increasing. We report our experience and surgical management for pelvic malunion and nonunion.
PURPOSE The aim of this study was to analyze the use of a compression hip screw with a trochanter stabilizing plate for treatment of reverse oblique intertrochanteric fractures. MATERIALS AND METHODS We reviewed the results of 33 cases of reverse oblique intertrochanteric fracture treated with a compression hip screw with a trochanter stabilizing plate from January 2000 to December 2012 which were followed-up for more than one year. We evaluated postoperative bone union period, change of neck-shaft angle, sliding of hip screw, and other complications. RESULTS Of 33 patients, satisfactory reduction was achieved in 28 patients. Five patients had an unsatisfactory reduction, with two cases of excessive screw sliding, one of broken metal, one of varus deformity, and one of internal rotation deformity. We performed corrective osteotomy in varus and internal rotation deformity and partial hip replacement in a case of excessive screw sliding. Bone union was achieved in 29 patients, and the average bone union period was 19.2 weeks. CONCLUSION We consider that a compression hip screw with a trochanteric stabilized plate is a good option for treatment of reverse oblique intertrochanteric femoral fractures. However, adequate fracture reduction and ideal implant placement are a basic necessity for successful treatment.
Simultaneous Surgery on Jejunum perforation with Pelvic Ring Fracture: A Case Report HoeJeong Chung, Keum-Seok Bae, Seong-yup Kim, Doosup Kim Journal of Trauma and Injury.2016; 29(2): 56. CrossRef
PURPOSE The purpose of this study is to evaluate the clinical and radiological result in patients who got salvage re-fixation for the failed fixation of pertrochanteric fracture retrospectively. MATERIALS AND METHODS Between 1992 and 2009, 21 patients who could be followed-up for more than 1 year after salvage re-fixation for the failed fixation of pertrochanteric fracture were enrolled in this study. There were 16 men and 5 women. The mean age was 53 years (19-84 years) at the index surgery and the mean follow-up was 6.4 years. We evaluated the clinical and radiographic results and postoperative complications. RESULTS Walking ability and pain were improved in all cases and the mean leg length discrepancy was improved from 2.5 cm (0-10 cm) preoperatively to 1 cm (0-4 cm) at the latest follow-up. Nineteen patients (90.5%) out of 21 patients achieved bony union at the final evaluation and the mean union time was 4 months (3-7 months). There were 2 cases of non-union who had not received bone graft as a complication. CONCLUSION The clinical and radiological results of the salvage re-fixation for the failed fixation of pertrchanteric fracture were satisfactory in our study. Secure component fixation for the mechanical stability and proper bone graft for the improvement of bone biology are mandatory to improve the result.
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The Role of Beta-Tricalcium Phosphate Graft in the Dynamic Hip Screw Fixation of Unstable Intertrochanter Fracture Chul-Ho Kim, Ji Wan Kim, Eic Ju Lim, Jae Suk Chang Journal of the Korean Fracture Society.2016; 29(4): 250. CrossRef
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Comparative Results of Acetabular Both Column Fracture According to the Fixation Method Kyung-Jae Lee, Byung-Woo Min, Eun-Seok Son, Hyuk-Jun Seo, Jin-Hyun Park Hip & Pelvis.2011; 23(2): 131. CrossRef
PURPOSE To emphasis an effectiveness of the Ilizarov circular external fixator in treatment of the complicated segmental fractures of the tibia MATERIALS AND METHODS: We had analyzed 15 cases in 14 persons, treated from November 1993 to March 2000. We analyzed several considering factors including age, etiology, type of fracture, number of the segmentation, associated injuries, open or closed fracture, healing time, additional bone graft, clinical results and complications. RESULTS The mean period of follow up was 22 months. The mean age was 45 years. The etiology was traffic accident in 13 persons. Open fracture were 11 cases (73%). Associated injuries were noted in 8 persons (53%). The number of segmentation were three segments in 9 cases (60%) and four segments in 6 cases (40%). Additional manipulations after first application were needed in 10 cases (67%). Bone graft were performed in 5 fracture site (9.8%), proximal fracture site in two and distal in two, middle in one. Mean period of application of external fixator for healing was 8.1 Months. Procedures for soft tissue injuries performed in 3 cases including two split thickness skin graft and distant flap surgery. The results were graded as excellent in 5 cases, good in 2 cases, fair in 1 cases, poor in 7 cases. Limitation of motion in ankle joint was major cause of poor results CONCLUSION: We considered that ilizarov circular external fixator is one of effective treatment modality in treatment of the complicated segmental tibia fractures.
The operative treatment of displaced acetabular fracture has become the preferred method than conservative treatment. Displaced acetabular fracture occurs primarily in young adult involved in high energy trauma and it can lead to some degree of permanent disability. The aim of treatment must be the restoration of hip function which require accurate anatomical reduction and firm fixation followed by early exercise.
The complicated anatomy of the region, and unsatisfactory fixation to cancellous bone, and unnecessary wide dissection of the soft tissue for plate and screw fixation contribute to clinical end results of varying success.
The wire loop which was previously reported by our department as a successful method of fixation has now been developed to cable fixation that can be easily adjusted to the irregular surface of acetabulum and get more firm fixation.
A clinical analysis was performed on 14 patients with displaced unstable acetabular fracture who had been fixed by cable and followed for minimum 1 year period at our department from June 1993 to June 1994.
The results were follows; 1. According to Letournels classification, there were most common(9 cases:64.4%) in both column fracture, 3 cases(21.4%) in T shaped fracture, 1 case(7.1%) in transverse fracture, and 1 case(7.1%) in transverse and posterior wall fracture.
2. The satisfactory result was achieved in 12 cases(85.7%) on clinical grade and 12 cases(85.7%) on radiographic grade according to Epstein criteria.
3. The complication were developed in 3 cases(21.4%) out of 14 cases, such as posttraumatic arthritis in 2 cases and transient sciatic nerve palsy in 1 case.
4. Cable fixation provides a more secure and easy fixation and require a narrower exposure than a plate fixation.
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Cerclage Clamping Using Cerclage Passer for Reduction of Anterior and Posterior Column Fracture Ki Chul Park, Hyun Joong Cho, Hun Chul Kim, Kyung-Sik Min, Hae Won Jeong Journal of the Korean Orthopaedic Association.2016; 51(6): 486. CrossRef
Cerclage Wiring in Internal Fixation of Displaced Acetabular Fractures Chong-Kwan Kim, Jin-Woo Jin, Jong-Ho Yoon, Sung-Won Jung, Jung-Wook Peang Journal of the Korean Fracture Society.2008; 21(2): 95. CrossRef
Unstable pelvic bone fracture caused by high-energy trauma that can result in life-threatening situations in which intrapelvic hemorrhage and neurovascular injury.
Long-term complications are frequently present, such as leg length discrepancy, gait disturbance and chronic low-back pain. Recently it is principle that it is mandatory to restore the anatomy of pelvic ring structure and to fixistably by means of internal fixation or extemal fixation for successful outcome after unstable pelvicring injury.
26 cases of unstable pelvic bone fracture were treated operatively at the authors hospital between 1992 and 1994. We analyse the clinical and the radiological result. The following results were obtained.
1. The incidence of the unstable pelvic bone fracture was 26 cases(18.4%) of all pelvic bone fractures(141 cases).
2. By the classification of modified Tile, type B1 were 8 cases, type B2(3 cases). type C1(7 cases) and type C3(8 cases).
3. Associated organ injury were found most commonly in the acetabular fracture(8 cases), and other extremity fracture(8 cases), genitourinary system(6 cases) and hemopenitoneum(4 cases).
4. The specific fracture pattern was classified according to various anatomical locations such as transsymphysis(7 cases), transpubic(7 cases), combination of the trassymphysis and traspubic(1 cases), trassacroiliac(7 cases), transiliac(9 cases), transsacral(1 case) and sacroiliac fracture dis location(1 case).
5. According to the fracture location, following methods of stabilization were applied. For the ante rior portion of pelvic ring, plates(13 cases), external fixators(3 cases) and wirings(3 cases) were used. For the posterior portion of pelvic ring, plates(9 cases), percutaneous iliosacral screws(3 cases) and lag screw(1 case) were used.
6. The results revealed as excellent in 20 cases, good in 5 case and fair in 1 case.
7. Postoperative complications were fixation failure(2 cases), metal failure(1 case) and nerve injury(1 case).
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Surgical Treatment of Malunion and Nonunion after Pelvic Bone Fracture Byung-Woo Min, Kyung-Jae Lee Journal of the Korean Fracture Society.2015; 28(4): 266. CrossRef
Clinical Results of Surgical Treatment of Acetabular Fractures according to Quality of Reduction Sang-Hong Lee, Min-Kyu Shin, Sueng-Hwan Jo The Journal of the Korean Orthopaedic Association.2007; 42(2): 153. CrossRef
The shoulder is especially susceptible to stiffness following injury because of the formation of adhesions. Early mobilization prior to maturation of adhesions around the joint gliding surface is, therefore, an essential step in the management of the proximal humerus comminuted fractures. Our aims were accurate reduction and stable fixation to allow early mobilization and to achieve full functional recovery. During the eight-year period from January 1986 to June 1994,51 cases patients were treated surgically for comminuted fractures of the proximal part of the humerus by T-plate at our hospital.
The results were summarized as follows; 1. There were 17 cases of the two-part fractures, 31 cases of the three-part fractures and 3 cases of the four-part fractures following to Neers classification.
2. The most common cause of injury was road traffic accident(34 cases).
3. The excellent or satisfactory results were seen 82% of the two-part fractures and 81% of the three-part fractures, whereas 67% of the four-part fractures.
4. The most frequent complication of comminuted fractures were motion limitation and pain(5 cases), delayed union(2 cases), plate bending(1 case) and infection(1 case) but avascular necrosis of the humeral head, non-union, myositis ossificans and plate breakage had not been developed in these cases.
5. T-plate was one of the good internal fixation devices for surgical treatment of the comminuted fractures of the proximal humerus.
Intramedullary nailing for the treatment of a fractured tibia has proven its value not only through rigid fixation but also early joint motion and weight bearing which promote more rapid bony union and functional recovery.
Recently reaming intramedullary nailing technique leaves the problems of destroying the endosteal blood supply, which associated with delayed union and postoperative infection.
The purpose of this study is to evaluate the results and the complications of nonreamed interlocking intramedullary nailing in the treatment of open tibial fractures.
The authors reviewed 20 cases of open fractures of tibial shaft that were treated with nonreamed interlocking intramedullary nailing from May 1993 to July 1994 The follow up period ranged from 12 to 26 months.
The results were summariBed as follows.
1. The average period of radiologic union was obtatined in 21.2 weeks.
2. Complications include 1 case of delayed union and 1 case of postoperative infection in Type III open tibial fracture. Locking screw broke in 1 case of Type I open tibial fracture.
3. According to the criteria of functional results by Klemm and Borner, 18 cases(90%) showed excellent results.
Although 90% of fresh carpal scaphoid fracture heals with adequate treatment, the rate of non-union is higher in untreated or misdiagnosed at the time of injury leading to carpal collapse and degenerative arthritis.
We have treated these non-unions by modified Matti-Russe technique and all cases showed uneventful healing, but range of motion of the wrist joint decreased in some cases. We studied 18 patients of non-union of the carpal scaphoid treated modified Matti-Russe technique from November,1988 to December, 1992 and the results were as follows: 1. Among the 18 patients, the ratio of male and female was 16:2, and mean age was 23.0 years old.
2. Dominant hand was involved in 14 cases.
3. The fracture was most commonly situated at the waist of the scaphoid.
4. Bony union was obtained in all cases and the average time to radiological union was 18.0 weeks.
5. According to Maudsleys assessment, the results revealed as 7 cases of excellent, 9 cases of good and 2 cases of fair.
Thirty-one posterior fracture-dislocations of hip with fracture of acetabulum were followed from 6 months to 84 months(average, 23.3 months). The patientsages ranged from 19 to 58 years(average, 35.4 years). All had primary attempt at closed reduction with subsequent open reduction. Satisfactory results were obtained in 87% of all patients. Complications included partial sciatic nerve palsy(1 case), myositis ossificans(2 cases), osteoarthritis(3 case), recurrent dislocation(1 case) and infections(2 cases).
This survey was undertaken to assess the results of a certain method of treament, and in the hope of contributing further information on this subject.
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Complications in Patients with Acetabular Fractures Treated Surgically Byung Woo Min, Kyung-Jae Lee Journal of the Korean Fracture Society.2008; 21(4): 341. CrossRef
Surgical Treatment of Posterior Wall Fractures of the Acetabulum Young-Soo Byun, Se-Ang Chang, Young-Ho Cho, Dae-Hee Hwang, Sung-Rak Lee, Sang-Hee Kim Journal of the Korean Fracture Society.2007; 20(2): 123. CrossRef
The best method of treatment for displaced comminuted fractures of the radial head is still controversial. Early excision of the fractured radial head has been favored by a number of authors. but problems such as chronic pain in the elbow, forearm or wrist, restricted movement of the elbow, late subluxation of the distal radio-ulnar joint can ensue. So prosthetic replacement of the radial head had been advocated either for acute treatment of a fracture or for delayed treatment, when conservative treatment has failed. We analyzed 10 patients with comminuted radial head fracture treated by silastic prosthesls replacement shortly after injury from Jan. 1988 to Dec. 1992.
The results were as follows.
1. Age distribution at operation was varied from 19 to 57 year with the average at 40.9 year.
2. The average time interval between initial radial head fracture and silastic prosthetic replacement was about 10 days(range 4 days to 18 days).
3. 6 patients(60%) were free of elbow, pain 2 patients(20%) had intermittent mild pain especially at night and 2 patients(20%) had mild pain only after heavy work.
4. All patients were free of wrist pain 5. There was no patient of breaking or tilting of prosthesis radiologically.
6. Overall assessment showed excellent in 4 patients(40%), good in 4 patients(40%) and poor in 2 patients(20%).