PURPOSE To compare of results between open interlocking intramedullary nailing combined with cerclage wiring and closed interlocking intramedullary nailing in treatment of femoral shaft comminuted fracture, we reviewed retrospectively 62 femoral shaft fractures. MATERIALS AND METHODS We reviewed retrospectively 62 femoral shaft comminuted fractures, who had been followed up for a minimum one year including Winquist-Hansen classification II, III, IV from January 1996 to December 2002. The group I include the patients who treated with closed interlocking intramedullary nailing. The group II include the patients who treated with open interlocking intramedullary nailing combined with cerclage wiring. RESULTS The average bone union time was 18.6 weeks in group I, 27.6 weeks in group II. The complication included 3 delayed unions, 1 nonunion and shortening of more than two centimeters in 1 patents in group I. In group II, The complication included 2 infections, 7 delayed unions and 3 nonunions. CONCLUSION We can use open interlocking intramedullary nailing with cerclage wiring in some femur shaft comminuted fractures, but there are many problems and complications. So we must consider it carefully before using this method.
PURPOSE To analyze the results of surgical treatment of the displaced distal radius fractures in elderly patients over 65 years old who were treated with percutaneous K-wire fixation only and percutaneous K-wire fixation with external fixation.
MATERIAL AND METHOD: We evaluated 24 cases of the distal radius fracture in patients older than 65 years from January 1998 to December 2001. The patients were followed up at least 12 months postoperatively. We compared the surgical results of 14 cases, treated with percutaneous K-wire fixation only with the surgical results of 10 cases, treated with percutaneous K-wire fixation with external fixation. We evaluated the functional results according to demerit point system and the radiographic results (radial length, radial inclination, volar tilt). RESULTS According to demerit point system, the mean score of demerit point was 9.9 in the group of percutaneous K-wire fixation and 5.3 in the group of percutaneous K-wire with external fixation respectively (p<0.05). In radiographic results, the percent of the mean loss of radial length, radial inclination and volar tilt were 23.2%, 12% and 41.7% in the group of percutaneous K-wire fixation and 11%, 5.9% and 27.4% in the group of percutaneous K-wire with external fixation respectively (p<0.05). CONCLUSION Percutaneous K-wire with external fixation showed better functional and radiographic results than percutaneous K-wire fixation only for the treatment of the displaced distal radius fractures in elderly patients older than 65 years and percutaneous K-wire with external fixation is thought to be a one of the most effective treatment of the displaced distal radius fractures in elderly patients.
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Osteoporotic Distal Radius Fracture-conservative Treatment Seok-Whan Song Journal of the Korean Fracture Society.2008; 21(1): 81. CrossRef
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.
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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 usefulness of early posterior internal fixation(I/F) by cannulated cancellous screw(CCS) in unstable pelvic bone fractures involving the sacrum and sacroiliac joint. MATERIALS AND METHODS Sixteen cases were evaluated retrospectively. Classification according to the injury mechanism, using Young's criteria, was as follows: 7 anteroposterior compression, 4 lateral compression, 4 vertical shear and 1 combined mechanism. With respect to treatment, 9 cases were treated by combined anterior external fixation(E/F) and posterior I/F with CCS(7 cases) and transiliac rod(2 cases). Five cases were treated by anterior E/F only, and 2 cases were treated without surgery. We analyzed clinical results using Matta's criteria, and radiologic abnormalities. RESULTS The management by posterior I/F with CCS and transiliac rod including anterior E/F has shown superior clinical results(7 satisfactory, 2 unsatisfactory) over the management by only anterior E/F(1 satisfactory, 4 unsatisfactory) or conservative methods(2 unsatisfactory). The rate of malunion and nonunion was also low in the former method in the radiographic analysis. CONCLUSION Posterior I/F using CCS is an excellent surgical procedure in the treatment of unstable pelvic bone fracture due to its lessened invasiveness, early applicability, simple surgical technique and its direct effects on the prevention of several complications.
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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
Management of sacral fractures associated with spinal or pelvic ring injury Ye-Soo Park, Seung-Wook Baek, Hong-Sik Kim, Ki-Chul Park Journal of Trauma and Acute Care Surgery.2012; 73(1): 239. 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 The purpose of the current study is that CT can predict peroneal tenosynovitis in the intraarticular calcaneal fracture. MATERIALS AND METHOD Sixty five calcaneal fractures in 55 patients were evaluated with CT scan. The follow-up period after operation was averaged 19 months (ranging from 4 to 79 months). A classification for peroneal tendon injury was developed, based on CT scan. RESULTS Of the 65 intraarticular calcaneal fractures, the incidence of peroneal tenosynovitis were 14 cases(26%)[open reduction and internal fixation group 7/43(16%), Essex-Lopresti group 7/22(32%)]. According to the author's classification, the incidence of peroneal tenosynovitis among open reduction and internal fixation subgroup was followed ; type I was none(0/4), type II 11%(2/19), type III 20%(3/15) and type IV 40%(2/5) respectively(p=0.074). The incidence of peroneal tenosynovitis among Essex-Lopresti subgroup was followed ; type I was none(0/4), type II 16%(1/6), type III 33%(3/9) and type IV 100%(3/3) respectively(p=0.009). CONCLUSION CT can be used to evaluate the status of the peroneal tendon as well as to predict the development of peroneal tenosynovitis. The open reduction and internal fixation in type III and IV is preferable to achieve a alignment of peroneal tendon and a accurate reduction of subtalar joint.
PURPOSE : We evaluated the result of tibial fracture with butterfly fragment treated with interlocking intramedullary nailing and union of butterfly fragment.
Material and Method : The thirty tibial fractures with butterfly fragment treated with interlocking intramedullary nailing from 1994 February to 1997 January were followed up more than 12 months. They were clastified by Henleys classification based on the size of fragment and Johner and Wruhs classification cased on the comnlinution and accident mechanism. We evaluated the bone union of tibial fracture and butterfly fragment itself. RESULTS The time for bone union was Bl-14.5, B2-16.2, B3-18.8 weeks and Type I-15.2, Type II-17.1 Type III-18.3 weeks. In proximal and distal part of butterfly fragment, the time for bone union was 8.6 and 7.2 weeks in type I, 10.5 and 9.3 weeks in type II, and 11.8 and 10.2 weeks in type III. As the displacement of fragment were classified into 0-5, 5-10, and more than 10mm, the time for bone union was 15.3, 15.0 weeks in type I(no case in more than 10mm), 16.4, 17.5, 18.2 weeks in type II, and 17.7, 18.4, 20.3 weeks in type III. CONCLUSION : As the size and comminution of butterfly fragment increased, bony union was delayed. The union of spiral fracture in distal tibia was earlier than others, unrelated to the size of butterfly fragment. For the union of butterfly fragment, the distal part had earlier union than the proximal part. As the displacement of fragment was increased bone union was delayed.
Severe open fracture of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilization was by external fixation, but the advent of small diameter interlocking intramedullary nails has introduced a new option. From the June 1992 to December 1997, 55 cases of open tibial shaft fracture were treated with unreamed interlocking intramedullary nailing at the department of orthopedic surgery, Pusan National University Hospital. The purpose of this study is to evaluate its result and complications. Mean age was 31, mostly male. The main cause of trauma was traffic accidents(30 cases, 55%) and fracture sites consisted of mid 1/3 portion over 75%. According to the Gustilo & Anderson classification 8 type I(15%), 22 type II(40%), 15 type IIIA(27%) and 10 type IIIB(18%) were shown. Union time was 28.3 weeks on an average and union rate was 98%. There were 5 cases(9%) of delayed union, 2 cases(4%) of deep infection and 1 case(2%) of chronic osteomyelitis. In conclusion unreamed interlocking intramedullary nailing can be the first choice treatment in the treatment of open tibia shaft fractures with low postoperative infection.
As the saftest and simplest method of immobilization treatment, external fixation is indicated in IIIb open tibial shaft fractures with extensive damage to soft tissue and bone. This enables better wound treatment, patient transport and performace of surgical treatment such as plastic and reconstructive surgery, orthopedic surgery. From the march 1994 to september 1997 14 cases of IIIb open tibial shaft fractures were treated with clamp external fixator either Orthofix or DynaExtor. The purpose of this study is to determine indication of clamp external fixator and investigate its outcome as well as complications and solutions. 11 males and 3 females were followed for 29.3 months on an average. Fractures mainly occurred at mid 1/3 of tibial shaft and its pattern was most frequently comminuted one. Mean bony union time was 46 months. There were 1 case(7%) of delayed union, 2 cases(14%) of nonunion, 6 cases(42%) of reduction loss, 4 cases(28%) of deep infection including 2 cases(14%) of osteomyelitis, 6 cases(42%) of pin tract infection, 2 cases(14%) of malunion and 3 cases(21%) of ankle stiffness. Conclusively for the creation of a suitable environment of fracture healing and prevention of complications such as delayed union, nonunion and deep infection, thorough debridement and irrigation followed by adequate stabilization of bone, early soft tissue coverage and early prophylactic bone graft is paramount important in the treatment of IIIb open tibial shaft fracture since it is high energy trauma. In addition, initial firm fixation for the prevention of reduction loss and active and passive exercise for the prevention of ankle stiffness and pin tract infection or loosening should be taken into careful consideration.
PURPOSE It is to evaluate and discuss the result of severe open tibial shaft fractures treated by Ilizarov external fixation. MATERIALS and METHODS From the January 1992 to July 1997, 34 cases of severe open tibial shaft fracture in adults were treated with Ilizarov external fixator. 20 males and 14 females were followed for at least 1 year. RESULTS Fractures were evenly distributed through proximal 1/3 to distal 1/3 and its pattern was mostly comminuted one. According to Gustilo-Anderson classification, it mainly consisted of type IIIa &IIIb(28 cases: 82%). Mean bony union time was 40.2 months. There were 5 cases(15%) of delayed union, 2 cases(6%) of nonunion, 5 cases(15%) of deep infection including 3 cases(9%) of osteomyelitis, 10 cases(29%) of pin tract infection, 4 cases(12%) of malunion and 11 cases(32%) of ankle stiffness. CONCLUSION Conclusively, in the first place, for the successful treatment with Ilizarov external fixator, determining appropriate indications is the most important. Secondly, active reconstruction of soft tissue environment and early prophylactic bone graft, if necessary, are also essential to shorten union time. Thirdly, meticulous care of pin site and ankle motion is needed for the prevention of the two most common complications even though they are considered to be minor.
The results of partial and total patellectomy as a treatment for severe comminuted and displaced patellar fracture were assessed retrospectively with the use of clinical criteria and radiologic findings. Sixteen patients treated with patellectomy(four total and twelve partial patellectomies) were followed up for an average of 3 years 4 months and valuated. According to the Bostmans fracture classification, there were type I In 5 cases(31%), type II in 7 cases(44%), and type III in 4 cases(25%). The results of the patellectomy were relatively good since excellent result was shown in 11(69%) among 16 cases. The comparison between partial and total patellectomy was difficult because the fracture patterns treated by these techniques were different. In this study, the result of the partial patellectomy was better than that of the total patellectomy, but their difference was not statisticaliy significant(P>0.05). The results of the study indicated that partial or total patellectomy could be one of the effective treatment methods for severe comminuted and displaced patellar fracture. However total patellectomy should be recommended only when the entire patella was too severely comminuted to function as a part of the extensor mechanism of the knee.
The talus is one of the most important bones of the foot because it supports and distributes body weight above it and allows motion between the tibia and the foot. And it has unique biomechanical feature and vascular supply. Fractures and dislocations of talus are uncommon. However, once those happen, there is no single method of treatment and, all the more, there are several severe complications and are subsequent disabililies. Authors analyzed 15 cases of fracture-dislocation of the talus, which had been treated at Pusan National University Hospital from May 1988 to December 1994.
1. Among the 15 cases, there were 13 male and 2 female and the average age was 28.4 ranged from 6 to 48.
2. The causes were traffic accidents in 11, failing down in 4 cases. A violent hyperdorsiflexion of the ankle was common mechanism of the fracture.
3. According to the classification by Hawkins, there were 9 cases in talar neck fracture(2 cases in type I, 3 in type II, 4 in type III), 1 was head fracture and 5 were body fractures.
4. Two cases of talar neck fracture type I were treated conservatively, and other types were treated operatively.
5. Final results, evaluated by the criteria of Hawkins, were as follows : excellent in 3 cases, good in 7, fair in 4 and poor in one.
6. Complications were avascular necrosis in 4 cases and traumatic arthritis in 3 cases.
According to the results, talar neck fracture associated with marked displacement, comminution of subtalar joint and dislocation increased the rate of occurrence of complications despite of early open reduction and internal fixation.
Concomitant ipsilateral fractures of the femoral neck and shaft are rare, and present diagnostic difficulties and complex choices as to treatment.
At the Department of Orthopedic surgery, Pusan National University Hospital, from April 1987 to June 1998, 18 cases of the concomitant ipsilateral fractures of the femoral neck and shaft had been treeated and followed up for 48.7 months in average (ranging from 12 months to 89 months). Initially one case of the femoral neck fracture was missed, which was a non-displaced fracture. Femoral reck fractures were treated with multiple screws or pins in all cases except two cases treated with recon struction nail. For the femoral shaft fractures, plate and screws were applied in 12 cases, Ender nails in three cases, reconstruction nail in two cases and skeletal traction in one case. Nonunion of femoral shaft fracture was developed in one case treated with skeletal fraction, metal loosening in one case treated with Ender nails, and limited motion of the knee in three cases which had knee injuries. But in our cases, avascular necrosis of femoral head and nonunion of the femoral neck and metal failure were not developed. The key factors of successful treatment for concomitant ipsilateral fractures of the femoral neck and shaft seemed to be careful evaluation of the associated hip injures in felnoral shaft fracture and early anatomical reduction and rigid fixation of fractures with early motion of joints.
Fractures of the distal femur which include supracondylar and intercondylar injuries are difficult to manage. Usually combined with high energy trauma, there are severe soft tissue damage, comminu tion, intra-articular fracture, and injury to the quadriceps mechanism lead to unsatisfactory results in many cases, regardless of the treatment. The goals of treatment are to achieve fracture union and to restore early knee motion.
Before 1960, preferred method of menagment was primarily traction alone or combination with a cast. During the last two decades, as technology and implants have been improved, most traumatologists have advocated some form of internal fixation in the managment of distal femur fractures. Surfaces, restorative treatment requires achieving the following goals;anatomic reduction of joint surfaces, restoration of limb length and alignment, rigid fixation, and eatly knee range of motion.
Author reviewed and clinically analysed 42 cases of the fractures which were followed more than one year at the orthoedic department of Pusan National Universty Hospital during the period from January 1987 to December 1993.
The results were as follows; 1.The incidence was higher in active young age group.
2.The most common cause of the injury was traffic accident with high energy rauma(59.5%) and the most frequent injury type by Mullwes classification was C type(59.5%) 3.Overall result estimsted by schatzkers criteria was excellent in 10 cases(28.6%), good in 4 cases(40.0%), faur in 6 cases(17.1%) and poor in 5 cases(14.3%).
4.The causes of poor resulted cases were open fractures, fracture with articular comminution and inadequate anatomical reduction.
5.Rigid internal fixation permits early functional rehabilitation of the patient and decrease the incidence of malunion, nonunion and loss of fixation.
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Fractures of the distal femur in elderly patients: retrospective analysis of a case series treated with single or double plate Dae Jin Nam, Min Seok Kim, Tae Ho Kim, Min Woo Kim, Suc Hyun Kweon Journal of Orthopaedic Surgery and Research.2022;[Epub] CrossRef
The term "floating elbow" refers to concomitant ipsilateral humeral and forearm bone fractures. This type of fractures is relatively rare and has few guidelines for treatment.
Author reviewed 14 cases of these fractures which were treated by open reduction and rigid internal fixation in Pusan National University Hospital from January 1983 to January 1993.
In follow up study, Author obtained that good results in 10 cases(71%) of patient, and fair results in 3 cases of patient.
Author advocate the patient with concomitant ipsilateral humerus and forearm bone fractures should requires open reduction and stable internal fixation of the both humerus and forearm bone, as soon as possible.
The primary goal in the treatment of the trochanteric fracture in the elderly with osteoporosis and poor general condition is to do early ambulation by rigid fixation of fracture and to decrease threatened postoperative complication. But these fractures have thirty-nine always represented a particularly difficult problem of treatment for orthopaedic surgeon. The 39 cases of intertrochanteric fracture of the femur in the elderly over 70 year in the age had operative procedures at the Department of Orthopaedic Surgery of Pusan National University Hospital and all cases were divided into compression hip screw fixation group, Jewett nail fixation group and Ender nailing group and were followed from 1 year to 3 year 8 months.
The results were as follows; 1. By the Tronzo classifiaction, ihe most common type was type III (74.3%), type II(66.7%) by Boyd-Griffin classification, and unstable fracture(76.9%) by Evans classification.
2. The average bone union was about 14 weeks in compression hip screw fxation group, 15 weeks in Jewett nail fixation group 13 weeks in Ender nailing group.
3. For all patients, radiographic measurement for osteoporosis using the singh index were preformed ; 35 cases(89.7%) of these patients had poor bone quality below grade III, and the rate of loss of reduction was no statistical difference in the each group(p>0.05).
4. Ender nailing allows immediate mobilization without restriction of weight bearing after operation.
5. The modified technique to have the distal end of nails within the medullary cavity gave satisfactory result to prevent the distal migration of nails.
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Changes in Tip-Apex Distance by Position and Film Distance Measured by Picture Archiving and Communication System (PACS) Kyu Yeol Lee, Sung Soo Kim, Hyeon Jun Kim, Dong Ho Ha, Hyung Min Yoon, Hyun Su Do Hip & Pelvis.2015; 27(1): 36. CrossRef
Comparison of the Dyna Locking Trochanteric Nail, Proximal Femoral Nail Antirotation and Gamma 3 Nail in Treatment of Intertrochanteric Fracture of the Femur Sung Soo Kim, Kyu Yeol Lee, Chul Hong Kim, Myung Jin Lee, Lih Wang, Hyeon Jun Kim, Sun Hyo Kim Hip & Pelvis.2013; 25(3): 211. 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
Because of the anatomical configuration of the tarsornetatarsal joints with their strong ligmanet connections, the injries in this regicon are rare. But the injury is associated with a high potential for chronic disability.Authors reviewed and clinically analysed 18 cases of tarsometatarsal joint injuries which were followed more than one year at the orthopedic department of Pusan National University durging the period from January 1986 to December 1990. The results were as follows ; 1. The incidence was higher in male and young active age group. 2. The most common cause of the injury was traffic accident (50.0%). 3. Tarsal and metatarsal fractures were commonly combined (61.1%) 4. The most frequent injury type by Hardcastles classification was total inconjgrulty type (55.5%). 5. Overall result estimated by Hardcastles criteria was good in 5 cases (27.8%), fair in 8 cases (44.4%), and poor in 5 cases (27.8%). 6. The causes of poor resulted cases were severe crushing injury, inadequate anatomical reduction, delayed treatment due to combind injury and loss of medial longitudinal arch. 7. Late complications such as traumatir arthrltis, paln and foot deformity were seen more than half of the cases.
Outcomes of Treatment for Femoral Head Fractures with Hip Dislocation - Review of 20 Cases - Ji Wan Kim, Jae Suk Chang, Joo Yul Bae, Jung Jae Kim Hip & Pelvis.2010; 22(4): 298. CrossRef
A study was made of 39 cases of proximal humeral fractures and fracuture dislocations in adults who had been hospitalized and treated at the Department of Orthopedic Surgery, Pusan National University Hospital, from March 1983 to August 1988.
Analysis was based on the age, sex distribution, causes, classification of fracture, associated injuries, treatments, results of treatment and complications.
The results obtained were as follows; 1. the age of the patients ranged from 15 to 82 years with a mean of 46.8 years the highest incidence was in the fifth decades and male were affected more frequently than female.
2. The main cause of the fractures was traffic accident 20(51.3%) and the others were slip-down 10(25.6%), fall from a height 8(20.5%) and direct blow 1(2.6%) 3. According to Neers classification, 2-part fracture 28(71.8%) was the most common type and followed by 1-part fracture, head-splitting or head-fragmented fracture, 3-part fracture and 4-part fracture in the order of frequency.
4. Among the 39 cases, 25 cases(64.1%) were treated conservatively an 14 cases(35.9%) operatively.
5. The most common complication was joint stiffness.
6. The results of the cases were rated by the Neers numerical system. Of 39, 14 cases (35.9%) were excellent, 21 cases(53.8%) satisfactory, and 4 cases(10.3%) poor. Most of the poor results were the cases that were immobilized for a long time because of severe comminution, associated injury or poor general condition. It was thought important to allow early motion of joint to obtain a good functional result.