PURPOSE : Under the principle of rigid fixation and bone graft, we analyzed and compared the clinical results in the treatment of nonunion of long bone fractures using plate fixation and intramedullary nailing with or without bone graft. MATERIALS AND METHODS : We used 19 cases of plate fixation and 19cases of intramedullary nailing with or without bone graft for the treatment of the nonunion of long bone from Mar. 1994 through Feb. 1997. We analyzed and compared the clinical results of plate fixation and intramedullary nailing with bone graft in the treatment of nonunion of fracture. RESULTS : The mean bone union time according to nonunion type in case of plate fixation was 22.6 weeks in the hypertrophic type and 16.4 weeks in the atropic type(p<0.005). In case of intramedullary nailing was 20.4 weeks in the hypertrophic type and 15.3 weeks in the atropic type(p<0.05). According to the bone graft in case of plate fixation, 20.8 weeks in the autogenous bone graft and 19.3 weeks in the combination of autogenous bone graft and allo-bone graft(p>0.05). In case of intramedullary nailing, 16.9 weeks in the autogenous bone graft and 22.7 weeks that dosen't bone graft. According to the radioligical bone union time was 20.1 weeks in the plate fixation and 18.7 weeks in the intramedullary nailing(p>0.05). CONCLUSION : There was on significant difference according to the method of fixation, but the treatment of nonunion of long bone in lower extremities using intramedullary nailing will be good because of early ROM exercise and weight bearing ambulation than plate fixation. Although the type of nonunion is hypertrophic in the case of intramedullary nailing, bone graft is helpful to promote bony union.
An uncommon fracture of the proximal tibial epophysis can be classified into 5 types based in the mechanism of injury and the relationship of the fracture line to the physeal plate. The separation extends along the physeal plate and then through a portion of the metaphysis, Salter-Harris type II is the most common physeal fracture. We experienced a very rare case of bilateral flexion type Salter-Harris type II fracture of the proximal tibia, which was treated by long leg cast. At six weeks fusion is complete at the proximal tibial epiphyses of both knees, and the range of motion is full at follow-up six months
PURPOSE : The purpose of this paper was to present the clinical and roentgenographic results were obtained with bipolar hemiarthroplasty as a primary treatment for comminuted unstable intertrochanteric fracture in elderly patients with severe osteoporosis. The goal of this treatment is early ambulation with early weight bearing to prevent the complications such as a deep vein thrombosis, pulmonary embolism, pneumonia or atelectasis, and pressure sore. MATERIALS AND METHODS : Twenty consecutive patients who were more than seventy years old with severe osteopotosis and had an comminuted unstable intertrochanteric fractures were treated by primary bipolar hemiarthtoplasty from January 1995 through January 1998 at the Department of Orthopaedic Surgery of Soonchunhyang University Hospital. If there were fractured at the lesser or the greater, a circlage wire or Dall-Miles system (trochanter cable grip system) was passed through the lesser and the greater trochnater to permit its subsequent fixation to the medial and the lateral side of the femoral component. The functional results were judged according to the hip rating scale of Merle d' Aubigne. RESULTS : The mean age at operation was 79.8(70 to 92) years old. The most common type according to the Evans classification system was I -d(10 cases, 50%). Singh index was case(5%) of Grade I , 7 cases(35%) of Grade II, 10 cases(50%) of Grade III and 2 cases(10%) of Grade IV. The mean bone mineral density(BMD) was -4.24(-6.95 - -3.17). The functional results in 75% of the patients were rated as excellent, very good, or good and in 25% as fair, poor, or bad. CONCLUSION : Primary bipolar hemiarthroplasty for the treatment of comminuted unstable intertrochanteric fractures in elderly patients with severe osteoporosis could return these patients to their pre-injury level of activity quickly, thus obviating the postoperative complications caused by immobilization.
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A STUDY OF PRIMARY CEMENTED BIPOLAR HEMIARTHROPLASTY OF HIP IN ELDERLY PATIENTS WITH OSTEOPOROTIC, UNSTABLE INTERTROCHANTERIC FRACTURE Maheshwar Lakkireddy, Radhakrishna Rapaka, Naveen Gouru, Shivaprasad Rapur Journal of Evidence Based Medicine and Healthcare.2015; 2(35): 5447. CrossRef
Post-traumatic avascular necrosis is a notorious complication of intracapsular fractures of the femoral neck, whether or not the fracture unites. The incidence of avascular necrosis of the femoral head following femoral neck fractures has been reported variably ranged from 7% to 84%. The purposes of this study are to analysis the clinical features of avascular necrosis of the femoral head following femoral neck fractures and to define causative factors of posttraumatic avascular necrosis. From May 1986 to May 1995, sixty-eight patients with intracapsular femoral neck fracture were operated on osteosynthesis in soonchunhyang University Hospital; we analysed retrospectively with follow-up more than two years, post-traumatic avascular necrosis(AVN) was developed in 13 patients(AVN group) and united forty-six patients were included non-avascular necrosis group, nine patients were excluded due to nonunion. Comparative study was performed between these two groups. The results were as follows: 1. The avascular necrosis of the femoral head following femoral neck fractures treated with osteosynthesis was noted in 13 cases (19%) 2. The eleven cases of 13 cases showed segmental collapse of the femoral head within 2 years. 3. Among the causative factors, age and sex, delay before operation and fixation device have no statistical significance(p>0.05) but type of fracture, initial displacement and quality of reduction showed to be statistical correlation(p<0.05). In conclusion, adequate reuction and internal fixation for the femoral neck fracture may essential to minimize avascular necrosis following osteosynthesis.
Radial head resection is the accepted treatment of comminuted radial head fractures in adults, but the results are not always satisfactory. a number of well-known problems can ensue. These include chronic elbow and wrist pain, limited of motion, cubitus valgus, proximal radial migration, and new bone formation at the site of excision. Prosthetic replacement of radial head after excision offers theoretical advantages in the prevention of these problems. We are reporting three cases of patients, who had treated Swanson silastic prosthesis after comminuted radial head fracture associated posterior dislocation of the elbow.
STUDY DESIGN: Seventy femoral neck fractures in the elderly patients aged over 60 years treated with osteosynthesis or primary biploar arthroplasty were assessed on complication and functional outcome at final follow up.
OBJECTIVE: To compare the results of femoral neck fractures in the elderly patients aged over 60 years treated with osteosynthesis or primary bipolar arthroplasty retrospectively. To know the indications of each method.
SUMMARY OF BACKGROUND DATA: Althrough the osteosynthesis method had preservation of hip joint, primary osteosynthesis method had possibility of major complications as nonunion and avascular necrosis of femoral head. METHODS Seventy patients with intra-articular femoral neck fracture were treated with osteosynthesis in 33 patients(group 1) and primary biploar arthroplasty in 37 patients(group 2). A comparartive analysis of age, sex, type of fracture, initial displacement of fracture, method of treatment, fixation device type, quality of reduction, operative time, blood loss at operation, complication and functional outcome at final follow up were performed. RESULTS The female was more three times than male. The mean ages were 70.1 years old in group 1 and 73.3 years old in group 2. In group 1, complications such as non-union and avascular necrosis of femoral head were significantly greater in the subcapital fractures and Garden's stage 3,4 than the transcapital fractures and Garden's stage 1,2. In operative method, blood loss and operative time were significantly greater in the group 2 than in the group 1. Seven major complications (avascular necrosis: 6 cases, non-union: 1 case) occurred in group 1, two major complications(death: 2 cases) occurred in group 2. The functional outcomes were superior to the group 2, but it may be due to high complication rates in group 1. CONCLUSIONS This study suggests that the important factors that influenced the clinical results were type of fracture, initial displacement of fracture, quality of reduction. So in relatively poor arthroplasty.
From January 1991 to August 1996, we experienced 17 cases of metal failure among 150 cases of plate fixation of femur fracture.
We analyzed the cases and obtained the following results: 1. Among 17 cases, 15 cases were closed fracture and 2 cases were open fracture. In 11 cases, the fractures were located on the midshaft of femur and most of them was segmental or comminuted. According to AO classification, 14 cases(82%) were type B(B1:1, B2:4) and C(C1:7, C3:2).
2. The interval between initial operation and metal failure was 8 months on average.
3. The cause of metal failure were bone defect remaining after initial operation, fragment necrosis due to periosteal denuding of large free bone fragments, early weight bearing, selection of inappropriate implants and improper operation technique.
4. Plate breakages were occured in 11 cases and screw fractures and screw loosening in 6 cases. Most of plate breakage was due to remaining bone defects, and most of screw fractures and loosening was due to inappropriate implants and improper operation techinque.
In conclusion, accurate preoperative evaluation on the fracture site, fracture pattern and appropriate selection of internal fixative are important for proper bone healing. Based upon our result, we suggest semiopen technique with minimal soft tissue injury and initial early bone graft for bone defect.
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The Surgical Treatment of Distal Femur Medial Condyle Fracture Using Lateral Anatomical Plate of Opposite Side through Medial Approach Sung-Sik Ha, Jae-Chun Sim, Ki-Do Hong, Jae-Young Kim, Kwang-Hee Park, Yoon-Ho Choi Journal of the Korean Fracture Society.2009; 22(4): 246. CrossRef
The comminuted iniercondyiar fractvre of the distal humeruf is rather uncommon injury. Because of anatomic complexity of the distal humerus, any incongrousness makes loss of function of the elbow joint. Hence, for the complete restoration of the articular surface and joint nlotion, wide exposure is necessary, while stable internal fixation and early post operative exercise should be conducted. With the frefuency of comminution and displacement, this intraarticular fracture is difficult to treat. But the fabrication of new implants and development of surgical approach method has increased the reliability of operative stabilization. The authors compared 36 patients of distal humeral fracture treated with transolecranon approach and Campbells posterior approach at the Department of Orthopaedic Surgery. College of Medicine, Soonchunhyang University from Dec. 1991 to Oct. 1994 and following results were obtained.
In transolecranon approach, the operation time was slightly longer with technical difficulties. However, we had excellent exposure of posterior aspect of lower end of the humerus and had a good range of motion, especially in flexion contracture compared with posterior approach. Also, we hardly observed complications of fracture of the olecranon in transolecranon approach.
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Clinical Outcome of Surgical Treatment for Intra-articular Distal Humerus Fracture Myung Jin Lee, Hyeon Jun Kim, Sung Keun Sohn, Kyu Yeol Lee, Sung Soo Kim, Chul Hong Kim, Lib Wang, Hyun Woo Sung Journal of the Korean Fracture Society.2010; 23(2): 201. CrossRef
Hip dislocation represents 2 to 5% of all joint dislocations. Bilaterat dislocation of the hip joints is reported about 1.25% of all cases fo hip dislocations and therefore 0.025 to 0.050% of all joint dislocations. Dislocations in which one hip dislocates anteriorly and the other posteriorly are even rarer. Of all traumatic bilateral hip dislocations, bilateral simultaneous anterior and posterior dislocations in 40% of cases. This paper is a case report of a traumatic bilateral anterior and posterior dislocation of hips in a 24 year-old man injured by motor vehicle accident as a passenger. The patient was treated by means of closed reduction, traction and physical therapy. We report such a case.
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Traumatic Bilateral Anterior Hip Dislocation: A Case Report Sung-Taek Jung, Hyun-Jong Kim, Myung-Sun Kim, Young-Jin Kim, Sang-Kwan Cho Journal of the Korean Fracture Society.2008; 21(1): 62. CrossRef
Sixteen cases of fracture of the femur and tibia on the same leg in children below 16 year age were treated in Soonchunyang Univ. Hospital during the period 1988-1993. We studied all of these patients, classified by LettsNew classification of pediatric floating knee, retrospectively with analysis of treatment and results.
The results were as follows; 1. Among the 16 cases,14 cases were male(88%), and 10 cases(63%) were at their first decade and 6 cases(37%) were at second decades.
2. The main cause of injury was traffic accident;15 cases(94%).
3. The most common concomitant injury was fracture in other site;5 cases(31%).
4. Among the 9 cases of conservative treatment, limping and leg length inequality were occurred in 6 cases(61%), and malunion in 5 cases(56fo).
5. Among the 7 cases of operative treatment, limping was occurred in 1 cases(14%), leg length inequality was in 2 cases(29%), and malunion in 3 cases(43%).
6. Among the 10 cases at first decade, limping was occurred in the 6 cases(75%) out of 8 cases of conservative treatment, but it was not occurred in 2 cases of operative treatment.
According to the results, we suggest that at least one fracture should be rigidly fixed in all cases.
The diaphyseal fractures of radius and ulnar have many problems like nonunion, malunion and functional disturbance with conservative treatment. Therefore, open anatomical reduction and rigid internal fixation have been widely used. The plate fixation has been employed in most both forearm bone fractures and the intramedullary pinning usually used in cases of the open fractures, comminuted types, multiple fractures or poor general conditions. Seventeen patients were treated with semitubular plate and eighteen cases by the closed or open reduction and intramedullary fixation with Rush pin(the operation methods were decised alternatively) were followed up more than one year at Soonchunhyang Gumi Hospital from June 1988 to Nov. 1992 and the results were compared and analyzed clinically.
1. Those two groups were demographically similar.
2. The operation time was 65 minites in Rush pin group, 85.6 minutes in plate group and the blood loss was 37.1cc in Rush pin group,85.3cc in plate group.
3. The immobilization period and the radiologic bone union time did not differentiate two groups significantly.
4. In plated group, one nonunion and one radius refracture after union(plate removed state) were occurred.
5. Between the two operatio methods selected alternatively, immobilization period, radiologic bone union and functional results were not different significantly, but the Rush pinning method was preferred due to simple operation technique, small operation scars, short operation time, a little blood ioss, a few complications.
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Comparison of Locking versus Dynamic Compression Plates for Treatment of Diaphyseal Forearm Fracture Yong Chan Lee, Hong Je Kang Journal of the Korean Society for Surgery of the Hand.2015; 20(4): 168. CrossRef
Pediatric Forearm Bone Fractures Treated with Flexible Intramedullary Nail Suk Kyu Choo, Jin Hwan Kim, Hyung Keun Oh, Dong Hyun Kim Journal of the Korean Fracture Society.2007; 20(2): 190. CrossRef
Posterior hip dislocation with femoral head and neck fracture(Pipkin type III) was considered as a rare injury, However, the advance of high speed motor vehicle accidental injury has contributed to its increased incidence and the choice of treatment is still controversial.
Mechanism of injury was considered as a kind of secondary trauma of inversion or internal rotation force with hip joint was flexed position state. Three cases of posterior hip dislocation with femoral head and neck fracture(Pipkin type III)have been experienced and follow up still now at Soon Chun Hyang University hospital. The results were evaluated by Thomson Epsteins clinicoradiologic criteria and Harris hip score and follow up radiologic findings.
As a results of this study, we are more prefer primary open reduction and rigid internal fixation than primary joint replacement arthroplasty due to be occured in young age group. And futher evaluation should be needed.
Since Malgaigne described a external fixators in 1853, it were widely used for open and communited fractures. Modern external fixators such as modified Hoffman, Denham and of hofix external fixators are commonly applied because it could obtain rigid fixation and compression of fracture site.
Most of external fixators used only as a fixator after reduction, however new extemal fixator(Ex-F-Re) by Osteo is consists of two units, which are the correction and fixation units. This device is possible to manipulate fracture fragments under the complete control of stability and to obtain more rigid fixation and compression of fracture site.
Among the 16 cases of tibial fractures treated with Ex-Fi-Re external fixator device from June 1992 to June 1993, 14 casrs had minimum 1 year follow up and the following results were obtained.
1. Among 14 cases,7 were open fractures,4 were closed periarticular communited fractures and 3 were infected nonunion of tibia.
2. Among 11 cases of fracture and 3 cases of infected nonunion, nonunion was happened in each one case.
3. Average bony union period was 24.4 weeks in fracture group and 44 weeks in infected nonunion group.
4. Ex-Fi-Re external fixator was very rigid fixator, easy to use, and possible to manipulate fracture fragments under the complete control of stability.
The ipsilateral femur fracture after hip arthroplasty is rare, but serious complication. And its treatment is difficult and controversial. We experienced 6 patients who had the hip arthroplasty complicated by an ipsilateral femur fracture in postoperative period at the Department of Orthopaedic Surgery, Soonchunhyang Univesity from February 1990 to December 1993.
The Type 1 fracture was 1 case, and 2 Type IV-A, and 1 Type IV-3, and 2 Type V according to AAOS classification. Bony union and satisfactory clinical results were achieved in all 6 cases.
Intramedullary nails may be divided into two categories: unlearned and reamed. reaming effectively lengthens the isthmus of the tibia and thereby extends the number of fractures amenable to this technique, but other studies showed that union impairement and infection rates were relatively high because of reaming destroyed the endosteal blood supply, especially open fractures. Unlearned interlocking nails in open fractures offer the advantage of less damage to the intramedullary blood supply Also lower infection rates have been reported in open fracture when compared with reamed nails.
We analysed 22 cases of tibial shaft fractures managed with interlocking nailing without reaming and experienced treatment of complications since September 1992. Average follow-up period was 13 months ranged 5 to 17 months and results were as follows: 1) We used an unlearned interlocking nails for tibial open fractures, 14 cases(Gustilo-Anderson type: I.3 cases, II.5 cases, III a 4 cases, III b.2 cases)and closed fractures asscciated with combined injuries, 8 cases.
2) Union occurred an average of 5.2 months postoperatively with a range from three to 14 months.
3) The complications were 2 cases of superficial infection and 5 cases of nonunion(3 cases among the 8 cases of closed fracture and 2 cases among the 14 cases of open fracture.
4) The treatment of nonunion was successful with bone graft, additional screw fixation and reinsertion of reamed nail.
5) We concluded that unlearned interlocking nailing was useful method to treat the open tibial shaft fractures in the selected cases, but undesirable to treat closed tibial shaft fractures because considered less mechanical stability.
Total dislocation of talus is a rare injury which induce high complication rate. The mechanism of this dislocation results from excessive inversion and eversion.
The authors experienced one case of open total dislocation of talus and treated by open reduction and followed by subsequent total talectomy due to infection. So We report this case with review of literature.
Complete dislocation of the acromioclavicular joint is not a common jnjury. But there are many methods of treating for complete separation of acromioclavicular joint.
From February, 1988 to March, 1989 at Soonshunyang university hospital, 14 pateints with complete acromioclavicular separation(Allmans type3) had been treated sugically by coraco-clavicular wiring.
The results are follows.
1) The most common cause of injury is fraffic accident.
2) Ages in peak incidence are 3rd and 4th decades.
3) The shoulder pain and the limitation of external rotation, which are well known problem of transacromioclavicular fixation cant be found and the functional result were excellent in 12 cases good in 1 case and fair 1 case 4) We consider that over reduction and anatomical reduction of acromioclavicular joint may be prevent complications and obtain excellent results.
5) We can Prevent the anterior displacement of clvicle from the acromion and bony erosion by passing the wire loop through the drill hole on the center of clavicle which direction is from superior to inferior portion.