The treatment of distal tibial fractures with compromised soft tissue poses many problems that usually occurs from the high-energy trauma, and the results are often unsatisfactory following lots of complications like loss of reduction, malunion, and inlection. We studied to evaluate the treatment results of Brooker intramedually nailing for the distal 1/3 tibial fractures with compromised soft tissue.
Twenty-three cases of distal tibial fractures with comprolnised soft tissue were reviewed and we analyzed the results of surgical treatment in the viewpoint of union time, loss of reduction, malunion, complication and its final outcome. The range of follow-up was 24 months to 38 months with mean 29 months follow-up. Most of patients were between twenty and sixty years, and average age was 43.2 years.
Acording to Gustilo and Andersons classification, 3 were Type I, 2 were Type II of 5 open fractures. According to Tschernes classification, 13 were Grade I, 5 were Grade II of 18 closed fractures.
The average to union was 15 weeks with range 11 to 20 weeks. The healing was slowest in Tschernes Type II and fastest in Tschernes Type I fracture.
There were 3 cases of malunion, more than 5 degrees. All of the 3 cases were posterior angulation.
Only 1 case was the loss of reduction. This case was 3 to 10 degrees of varus angulation.
There were 3 cases of superficial infection. The infection was controlled with antibiotic therapy.
Only 1 case was acceptable of the final outcome. This case waf limping gait because of pain and loss of ankle dorsiflexion to 15 degrees. But, the limitation of ordinary work was not seen.
And 18 cases were excellent and 4 cases were good.
We recommand that wherever possible, Brooker intramedually nailing can be used for distal tibial fractures with compromised soft tissue. And a high rate of union and a low rate of complication can be expected with thit treatment modality.
The intramedullary nailing is one of the most available methods in treatment of femoral shaft fracture. The closed intramedullary nailing is known to be the best method of treatment of femur shaft fracture, but it is not always available in cases of deficit of equipment, severe associated injury, and some fracture pattern. The open intramedullary nailing has advantage of easily obtaining anatomical reduction but it increases the risk of infection, the incidence of delayed union and additional operations inevitably. We reviewed 33 cases of open intramedullary nailing in femur shaft fracture from September 1994 to September 1997. The results were as follows : 1. The average union time was 27.3 weeks. 2. Location of fractures was middle one-thirds in most cases, and Winquist-Hansen classification type II was the most common. 3. The complication included 8 delayed unions, 3 nonunions, 2 infections, shortening of more than two centimeters in 3 patients.
4. In 4 cases, we did open intramedullary nailing with bone graft initially, but all of them has complication as delayed union and nonunion. We can use open intramedullary nailing method in some femur shaft fractures, but there are many problems and complications. So we must consider it carefully before using this method.
In general, severe open fractures of the tibial shaft have been treated initially with external fixation. However, despite many refinements in this technique, it has been associated with numerous complications, including problems at the sites of pins, non-union, delayed union, malunion, and infection. The purpose of this retrospective study is to analyze the results in a consecutive series of patients. There were 8 males and 2 females with an average age of the 44.9 years(range, 26-64 years). The mean follow up period was 23.2 nibtgs(range, 34-120 days). Free flap procedures were performed on all patients. The average time between removal of the fixator and intramedullary nailing was 16.5 days(range, 11-26 days). Indication of conversion to nailing was abscence of any serous discharge, reddness or local heating around pin-sites and normal renge of laboratory data. All 10 fractures had united with additional bone graft in 7 cases. The most frequent complications were delayed union in 7 cases and infection(superficial infection: 6 cases, osteomyelitis: 1 case) after IM nailing. We concluded that pin-tract infection is the major cause of infection after IM nail, but duration of external fixation and time interval(between removal of external fixator and nailing) are not isolated factors.
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Treatment of Type IIIb Open Tibial Fractures Seong Yeon Lim, Il Jae Lee, Jae Ho Joe, Hyung Keun Song Journal of the Korean Fracture Society.2014; 27(4): 267. CrossRef
Management of displaced fractures of the acetabulum represents one of the greatest challenges in fracture surgery. The results had been proved to be successful after anatomical reduction and stable internal fixation. The purpose of this study is to analyze the clinical results and complications of open reduction of the displaced acetabular fractures to minimize the complications, and to present suggestions for the treatment of these fractures. We reviewed our experience with 23 displaced acetabular fractures which had been treated by open reduction to evaluate the clinical results and complications.
The results were as follows; 1. The most common type of elementary fractures was posterior wall fractures according to Letournel's classification. 2. Excellent or good results were obtained in 88% among the satisfactory reduction group, and it means that accurate reduction was the most reliable factors contributing to successful clinical outcomes. 3. Complications were 1 deep infection, 2 ectopic bone formation, 1 intraarticular hardware, and 1 chondrolysis. 4. In the treatment of displaced acetabular fractures, careful initial assessment using radiograph, angiogram and 3-D CT, appropriate selection of surgical approach and accurate surgical clinical outcome and minimize the complication rate.
We describe the results of treatment and complication of open tibial fractures in 44 children. There were 30 males and 14 females with an average age of the 6.7 years(range 3~2 years). The mean follow up period was 15 months(range 1.4~28month). According to the classification of Gustilo et al, Type I were 17 cases, Type II were 13 cases, Type IIIA were 9 cases and Type IIIB were 5 cases. All patient received tetanus prophylaxis, and systemic thirty-four with minimal soft tissue injury were closed primarily. The other 10 were initially left open; of these, 7 wounds were allowed to heal secondarily and 3 larger wounds required split skin grafts. The average time to healing of the fracture was 12.9weeks(range 6.9~22.4weeks).
The complication included superficial infection(7%), malunion(5%), delayed union(2%), synostosis(2%), and leg length discrepancy(5%): these incidences are similar to those reported in adult. The osteomyelitis, compartment syndrome, and vascular injury didn't developed at any case. The K-wire fixation of open tibia fractures of the childrens is very useful to prevent the displacement and to care for the openwound without the risk of deep infection.
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Analysis of Treatment Outcomes for Open Fractures of the Tibia in Children Jong-Hyuk Park, Jung Ryul Kim, Dong Hun Ham, Hyung Suk Lee, Sung Jin Shin Journal of the Korean Orthopaedic Association.2010; 45(6): 440. CrossRef
Diaphyseal fractures of the radius and ulna present high incidence of malunion and nonunion because of difficulty in reduction and maintenence of two mobile, parallel ones in the presence of the pronating and supinating muscles which exert angulatory as well as well as rotational forces. The author divided the traceable patients into two groups, the one was the group treated with AO compression plates and the other one was the roup treated with Rush pin in radius and AO compression plate in ulna, and compared the results in the aspect of healing time and functional results. The results were as follows; 1.Those two groups were demographically similar.
2.The immobilization period and the radiologic bone union time did not differentiate two groups significantly.
3.In plate group, one nonunion, one nerve injury and two superficial wound infection were occurred.
4.Between the two operative methods selected alternatively, immobilization period, radiologic bone union and fuctional results were not different significantly, but the Rush pinning method was preferred due to simple operation technique, small operation scar, short operation time, a little blood loss, a few complication.
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Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing Sang Bum Kim, Youn Moo Heo, Jin Woong Yi, Jung Bum Lee, Byoung Gu Lim Clinics in Orthopedic Surgery.2015; 7(3): 282. CrossRef
Interlocking Intramedullary Nailing of Forearm Shaft Fractures in Adults Sanglim Lee, Hee-Sung Lee, Yerl-Bo Sung, Jae-Kwang Yum Journal of the Korean Fracture Society.2009; 22(1): 30. CrossRef
Intraarticular fractures of the distal part of the radius comprise a distinct subgroup of fractures that are difficult to manage and are associated with a high frequency of complication and represent one of the greatest challenges to the orthopaedic surgeon. We reviewed 30 cases(28 patients) of intraarticular fractures of the distal radius treated surgically in orthopaedic department of Ewha medical center between January 1993 to May 1996 and analyzed the correlation between the clinical end results and radiographic parameters. The clinical end results were significantly worse when radia inclination didn't exceed 15, or radial length was less than 10mm or dorsal tilt exceeded 0. Ulna styloid fractre did adversely affect the clinical results. In our study 2mm articular step off did not show any difference in clinical results. But this is thought to be the result of relatively short period of follow up. Therefore we need to analyse this factor with long term follow up data.
We reviewed 40 cases of femoral shaft fractures in children treated with Russel traction. The treatment of femoral shaft fractures in children is various according to age. Satisfactory result have been reported with russel traction. At an average follow-up of 30 months, We obtained following results.
1. The average time of traction was 18 days, and hip spica cast was applied for 28 days.
2. Malunion exceeding 25degree in flexion & valgus & varus was not developed.
3. Remodeling of angulation deformities occurred slowly over the duration of the follow-up period in our patients. At the last evaluation no patient was aware that he had any residual angulation but many did have X-ray evidence of an abnormal contour of the femur, that is average rate of spontaneous correction is 83% in anterior angulation, 87% in varus deformities, 88% in valgus deformities.
4. Fracture occurred most commonly in the middle third of the femoral shaft, but overgrowth was the greatest in proximal one third fracture. The average overgrowth was 1.2 cm in length and, growth acceleration was the greatest in oblique fracture and, among the children 4 to 9 years of age, significant overgrth(average 1.2 cm) was seen.
5. Skeletal Russel traction is easy, safe and convenient to treat all femoral shaft fractures of the children between four and ten years old.
Traumatic dislocation or fracture-dislocation of the hip is relatively uncommon, but high velocity accidents have increased its incidence in recent years. The purpose of this study was to review the result of the treatment and to evaluate the prognostic factor. We retroprospectively reviewed 28 patients with traumatic fracture-dislocation of the hip between October, 1993 and March, 1996. 21 were males and 7 females. The mean age was 33.5 years(range, 11 to 67 years). Average follow-up was 18 months(range, 13 to 28 months). Exellent or good results were obtained in 19 patients(68%) by the criteria of Epstein. The complications were followings 2 cases of avascular necrosis and 1 case of osteoarthritis. Factors associated with a good prognosis included an early reduction, low level of initial trauma, abscence of associated injury.
Intertrochanteric fractures of the femur usually occur in the elderly and osteoporotic patients. These appear to be increasing in frefuence and are usually unstable. Sixthy two cases were treated ai our hospital from September 1993 through October 1995. 29 elderly patients underwent bipolar hemiarthroplasty and 33 patients underwent internal fixation with compression hip screw(C.H.S). The results were as follows ; 1. Functional results according to hip rating scale of Merle D,Aubiigne was superior in bipolar group.
2. The incidence of postoperative complications was much fewer in bipolar group than in compression hip screw group.
3. In casees of definite osteoporosis with Singhs index below 3 and Evans unstable type frartures, the incidence of mechanical complications was increased, especially in compression hip screw group.
4. There was no siginificant difference between 2 groups in operative time and blood loss.
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Fixation of Greater Trochanter Using an AO Trochanteric Reattachment Device (AO TRD) in Arthroplasty for Intertrochanteric Femur Fracture of Elderly Patients Weon-Yoo Kim, Young-Yul Kim, Jae-Jung Jeong, Do-Joon Kang Hip & Pelvis.2013; 25(4): 274. CrossRef
Hemiarthroplasty for Hip Fractures in Elderly Patients over 80 Years Old - Comparative Analysis between Femoral Neck Fracture and Intertrochanteric Fracture - Chae-Hyun Lim, Young-Yool Chung, Jeong-Seok Kim, Chung-Young Kim Hip & Pelvis.2013; 25(1): 44. CrossRef
Hip Arthroplasty Using Collarless Polished Tapered Stem -Minimum 2 Years Follow-up Results- Yerl-Bo Sung, Jung-Yun Choi, Su-Chan Oh Hip & Pelvis.2012; 24(1): 18. CrossRef
Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients Sung-Hwan Kim, Soo-Won Lee, Gyu-Min Kong, Mid-Um JeaGal Hip & Pelvis.2012; 24(1): 45. CrossRef
Cemented Bipolar Hemiarthroplasty for Intertrochanter Fracture in Elderly Patients - Minimum 2-Years Follow-up Results - Sung Kwan Hwang, Dong Hyun Kang, Tae Yeon Cho, Chang Ho Yi Hip & Pelvis.2010; 22(3): 209. CrossRef
From 1993 to 1996, we have used hemiarthroplasty on shoulder for comminuted fracture and fracture-dislocation of proximal humerus. The study reviewed 8 patients with on average age 62.1 years. The hemiarthroplasty was performed at average 5 days following injury. The purpose of this study was to evaluate pain, function, range of motion, strength, patients satisfaction. All cases was performed using cement and surgical approach was deltopectoral. Average follow up was 33 months after operation(range, 24 to 45 months). According to UCLA shoulder rating scale, 5 patients(63%) were satisfactory and 3 patients(37%) were unsatisfactory. Average active flexion was 110, and average abduction was 97 and average external rotation was 39, average internal rotation to the first lumbar vertabrae. Average humeral offset on fractured shoulder was 20.5 and average humeral offset on normal uninjured shoulder was 30.8. For functional improvement of shoulder hemiarthroplasty, We concluded humeral length restoration and humeral offset preservation is very crucial factors.
Several advantages of intramedullary nails over plates and external fixators have led to an anpansion of the surgical indications for humeral shaft tractures. But, various morbidities due to proximity of several important structures, such as rotator cuff and radial nerve, follwed the operation. We reviewed our experience with 23 cases of humeral shaft fractures that were treated by interlocking intramedullary nailing to evaluate the pitfalls and the complications of this technique. Fifteen men and 8 women were followed for average 19.5 months. Twenty one (91.3%) of them had midshaft fractures. According to AO/ASIF classification, type A was most common(60.9%), and followed by type B(26.1%) and type C(13.O%). Eighteen of them had associated injuries - 5 radial nerve palsies, 1 Volkmans ischemic contracture, and 14 had fracture of other sites. Indications for interlocking intramedullary nailing were unsatisfactory reduction after closed reduction, fracture of the ipsilateral upper extremity, segmental fractures, and multiple injuries. The operation was performed average 6.7 days after injury. The final results were evaluated with radiographs for quality of union and with physical examination for functional status of the shoulder. There were four cases of complication associated with increase morbidity. A post operative radial verve palsy, associated with the distal interlocking screw fixation was developed due to inappropriately short nail insertion. And in one case, fracture healing was delayed due to distraction of the fracture gap after nailing. In another case subacromial impingement was developed secondary to protruded nail tip because the length was thought be the common underlying causative factor. Finally there was a case of iatrogenic fracture at the site of distal interlocking screw fixation and it was thought to be a technical problem. The results gave us the conclusion that inappropriate nail length was the common underlying causative factor of the complications. Therefore in the interlocking IM nailing for the humeral shaft fractures, accurate measurment of nail length is one of the most cirtical factor for the good final result.
Supracondylar fracture of distal humerus is up to 60% of all fractures around the elbow in children. Complications of this fracture include nerve injury, arterial injury, skin slough, Volkmanns ischemic contracuture, and changes in carrying angle. Many different treatment methods to minimize these complications have been devised. Recently, closed reduction and percutaneous pinning with K-wire is most widely used in treating supracondylar fractures in children exept in some rare cases such as unreducible fracture by closed reduction. However, troublesome changes in the carrying angle which do not interfere with function but the appearance of the arm is unsatisfactory, continue in approximately 30% of most series. We reviewed 59 cases which were treated by closed reduction and percutaneous pinning in supracondylar fracuture of the humerus. The purpose of our study is to evaluate the cosmetic and functional results and complications and to analysis the relationship between the stability of reduction and method of pinning.
The results are as follows; 1) There were many cosmetic problems, actually. Change over 10 degrees in carrying angle compared to the normal site was as high as 10 cases(17%) of 59 cases.
2) There was no functional problem such as limitatioin of motion.
3) There was no significant complication.
4) The cross pinning fixation was more stable than lateral pinning fixation only.
5) Accurate anatomical reduction is required to prevent unsatisfactory result regardless the treatment method.
Meyers and Mckeever proposed a classification of intercondylar eminence fractures based on the degree of displacement. Zaricznyj added type IV comminuted avulsion fracture. Type III and IV of tibial spine fractures are considered an indication for surgery. The purpose of this study is to evaluate the result of arthroscopic treatment for displaced intercondylar eminence fractures. In all of the cases, the displaced fragments were reduced arthroscopically in effective, and fixed by K-wires, pull-out sutures or pull out wiring. At last follow-up above 12 months, all 22 cases(100%) were evaluated as above good by Meyers and Mckeever criteria.
Treatment of lateral condyle fracture has been traditionally divided to closed and open treatment. Minimal displaced fracture of lateral humeral condyle can be appropriately treated with closed reduction and percutaneous K-wire fixation. Adherence to these guidelines is likely to prevent malunion, nonunion, premature epiphyseal closure, ulnar neue palsy, and cubitus valgus deformity, all possible complications of this fracture.
Since September 1993, we managed 20 children with lateral condyle fracture of elbow using closed reduction and percutaneous pinning. And intraoperative arthrogram was done to confirm the reduction status. Pins were removed 6 weeks postoperatively. The average period of follow-up was 24 months. There was no significant difference in carrying angle, range of motion and physical activity compared to contralateral elbow. Valgus - varus stress view is a useful method in evaluating fracture stability and rupture of cartilage hinges and valgus - supination stress view is very useful for confirming the reduction. Arthrogram was considered to be useful in evaluating the reduction state and deciding the treatment plan.
The tarsometatarsal fracture-dislocation are unusual freguency. Lesion in this area are generally the result of a high energy traulna and difficult to recognize on standard radiographs. Twenty-one casei of fracture and dislocation of the tarsometatarsal joint were treated by open or closed reduction from January 1991 to April 1996. We assessed clnical result & treatment result and the following results were obtained.
1. Anatomical reduction is likely to lead nearly normal function & little complications.
2. Due to soft tissue interposition, espicially interposition of tibialis anterior, and marked articular comminution, early closed reduction was failed in 3 cases. If the closed reduction is tossed, then open reduction and internal fixation was performed.
3. In cases of nearly anatomical reduction, good prognosis was obtained.
4. Accurate accessment of AP & oblique & lateral projection of radiographs were very adventa geous & important.
5. Open anatomical reduction was superior to closed reduction & percataneous pining & cast immobilization alone.
Internal fixation with dynamic compression plate is an accepted method of treating diaphyseal The treatment of stable bursting fracture of thoracolumbar spine has long been controversal and middle column theory has been known important factor to determine fracture stability, following to "Three column theroy" by Denis & McAfee in 1983.
We have analyBed kyphotic angle and compression degree, each 7 cases of thoracolumbar stable bursting fracture, treated consertive or operative, from Oct. 1993 to Dec. 1994.
We obtained following results; 1. The correction of kyphotic angle was more increased in the average 12 in conservative treatment and decreased in the average 8.3 in operative treatment than admission date.
2. The correction of compression degree was more increased in the average 30% in conservative treatment and decreased in the average 18% in operative treatment.
3. More severe deformity was noted in the active young adult rather than old age.
4. MRI study and bending stress view are needed in the detect of the posterior column injury.
In summary, more severe deformity was noted not only in the adult, but in the conservative treatment. Thus, we must consider the operative treatment in active young adult in cases of stable bursting fracture.
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The primary goal of treatment of the posterior lip fracture is to effect the returning of normal function that is accomplished by the early institution of motion.
A variety of both open and closed treatment have been recommended, but many authors have advocated internal fixation of large fragments that compromise 25 per cent or more of the articular surface on the lateral radiography Open reduction with internal fixation of the posterior lip fragment has been associated with technical problems. VisualiBation of the articular surface is obscure by overhanging of the posterior tibial margin and talus. And than efforts at open reduction of posterior lip fragments are frequently unsuccessful. We used the posteromedial approach to this lesion.
The results obtained from this study were as follows; 1. Of the 17 cases, male was 9 cases(53%), female was 8 cases(47%) the most common victim was twentieth and thirtieth decades.
2. The mean afticular surface involvement of the posterior lip fragments in the sagittal plane were 28 percent.
3. The location of posterior lip fragment was central(2 cases), posteromedial(6 cases), posterolateral(9 cases).
4. The posteromedial approach affords the most predictable way to cary out an absolutely anatomic reduction of posterior lip fractures and a low complication rate.
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Treatment of the Posterior Malleolar Fracture Using Posterior Approach Hyun Wook Chung, Dong Hwan Kim, Si Hoon Yoo, Jin Soo Suh Journal of the Korean Fracture Society.2010; 23(1): 50. CrossRef
Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle Jae Sung Lee, Soo Yong Kang, Han Jun Lee, Young Bong Ko Journal of the Korean Fracture Society.2009; 22(2): 98. CrossRef
We analyzed 41 femoral neck fractures in 40 elderly patients aged over 65 years. All of them were treated by surgery and followed for average 22 months (range, 14 to 52 months) at the Ewha Womans University Hospital from 1988 to 1992. Of these, 15 cases were treated with internal fixation and 26 cases with endoprosthetic or total hip replacement arthroplasty For the level of fractures the most common features were subcapital, that were moderately to severely (Gardens stage III or IV) displaced. In the internal fuation group the results were unsatisfactory in the cases of subcapital type, moderate to severe (Gardens stage III or IV) displacement, Pauwels type III and those with osteoporosis (below stage III in Singh index). Our short term follow-up results showed that the prosthetic replacement group were generally superior in that they were not affected by the types of fractures and the degree of osteoporosis.
With the age of our population advancing, the number of elderly osteoporotic patients with comminuted intertrochanteric fractures of the femur has increased dramatically. Intertrochanteric fractures of the femur usually occur in a more elderly age group than femoral neck fractures of the femur usually occur in a more elderly age group than femoral neck fractures. Intertrochanteric fractures are best treated by intenal fixation, since this mehod provides satisfactory positioning of the fragments and obviates the hazards of recumbency. However, in some caces with severe osteoporosis, arthroplasty is an excellent altemative to the internal fixation.
From 1987 to 1992, thirty-six intertrochanteric fractures of femur in the elderly patients(over 60 years of age) were treated by operation at the department of orthopaedic surgery in the Ewha Womans University Hospital. Thirty-three caces were internally fixated with the sliding-compression hip screws-plates(30), the Gamma interlocking intramedullary nails(2), the Rohs plate(1), and in three caces endoprosthetic or total hip replacement arthroplaties were performed.
The clavicle plays very important role in the motion of the shoulder girdle and maintenance of power and stability of the arm. The most clavicular shaft fractures can be treated by conservative methcds with a high rate of union and low rate of complications. The operative treatment in clavicular fracture is limited in such as wide separation of the fragments with soft tissue interposition, nonunion, or neurovascular involvements. From 1989 to 1991, eighty six consecutive patients with clavicular shaft fractures were treated at Ewha Womans University Hospital. Fifty eight patients were treated conservatively(Group I) and twenty eight patients operatively(Group II) Authors compared both groups and obtained the following results; 1. The most common cause of injuries was the traffic accident and the most common associated skeletal injury around the shoulder was the rib fracture.
2. The degree of comminution and displacement of the clavicular shaft fracture were more severe in Group II.
3. The average time to union was 8.7 weeks in Group I and 10.3 weeks in Group II.
4. The average rate of union at 4 months was 93.1% in Group I and 96.4% in Group II 5. The functional result was good or excellent in over 90% in both Groups according to the Kangs criteria.
6. The rate of complication was 8.0% in Group I (one nonunion, three delayed unions and one malunlon) and 3.6% in Group II(only one case of nonunion) 7. The immobilization period was between 6 to 8 weeks In Group I and within 4 weeks in Group II in most cases.
A Retrospective Comparative Study of Internal Fixation with Reconstruction Plate Versus Anatomical Locking Compression Plate in Displaced Intercondylar Fractures of Humerus Tong-Joo Lee, Young-Tae Kim, Dae-Gyu Kwon, Ju-Yong Park Journal of the Korean Fracture Society.2014; 27(4): 294. CrossRef
Operative Treatment of Displaced Intercondylar Fracture of the Distal Humerus with Reconstruction Plate Ryuh Sup Kim, Tong Joo Lee, Kyoung Ho Moon, Seung Rim Park, Moon Lee Journal of the Korean Fracture Society.2007; 20(2): 172. CrossRef
Tibia is anatomically predisposed to an open fracture because of inadequate covering of soft tissue, and fracture of tibial shaft is more frequently complicated by nonunion than any oter fractures. Although the methods of treatment for nonunion are varied, tibial fractures failed to heal within expected time can constitute a major orthopedic problem. Twenty-six patients of the nonunion of tibia were treated at the Department of Orthopedic Surgery, Ewha Womans University Hospital from January 1983 to December 1990, and were analysed.
The results were as follows ; 1. Of twenty-six cases, 21 cases were injured by traffic accident.
2. Most common fracture site & type were middle 1/3 and comminuted fracture.
3. Among fifteen cases of open fracture, seven were Gustilo Type I injury 4. Seventeen cases were associated with injury of other part of the body.
5. Hypertrophic type nonunion were treated intramedullary nailing with fibular osteotomy and then early weight bearing, and these union and satisfactory results were obtained.
6. Atrophlc type nonunion were treated plate and screws with bone graft, and also satisfactory results were obtained.
The management of extra-articular proximal tibial fracture remains controversy. Many reporters recognized that the proximal tibial facture are best treated by closed reduction and long leg cast, however delayed union with this method have frequently been documented in spite of anatomical characteristics of proximal tibia. Thirty patients of the fracture of extra-articular Froximal tibia were treated and managed at the Department of Orthopaedic Surgery, Ewha University Hospital from January, 1583 to December 1989.
The following results were obtained: 1. According to Gerard classification, anterior long oblique & posterior long oblique fracture were 18 cases(60%) and 8 cases(27%) respectively. Delayed union developed in 9 cases(50%) of 18 cases anterior long oblique fracture and 2 cases(25%) of 8 cases posterior long oblique fracture.
2. All cases of deleyed union of tibia developed through or below the tuberosity.
3. Among 30 cases, the fractures were managed with closed method at 23 cases, open method at 7 cases, internal fixation at 12 cases without delayed union and external fixator at 10 cases. The all cases using external fixator resulted in delayed union.
4. Among 30 cases, 16 cases(53%) were open fracture, and the most common type was type IIIb. Delayed union developed in 8 cases(50%) of 9 cases(56%) type IIIb.
5. The 24 cases (80%) of fibular fracture were concurred with proximal tibial fracture, and delayed union developed in 10 cases (42% ) of 24 cases fibular fracture and one case of 6. cases without fibular fracture.
In conclusion, many delayed unions were frequent. In our experience, in case of GradeIII open comminuted fractures, we used external fixation methods mostly, so delayed unions were developed. But after management of soft tissue injury, healing time were short with bone graft as soon as possible, We consider that in cases in which internal fixation was possible according to soft tissue injury, delated unions are prevented by internal fixation using plate and screws or retrograde flexible nails.
The fracture of distal third of femoral shaft difficult to choose method of treatment and timing of wt. bearing because of increrment of communited fracture, anatomic characteristics and complication such as metal faulure, shortening and angulation. After analysis of 52 cases of fracture of distal third femoral shaft treated operatively in the Department of Orthopaedic Surgery, Ewha Womans University Hospital during 5.5yrs from. Jan. 1984 to June 1989 except pathologic fracture, the following results were obtained.
1. By Reis and Hirschberg classification, type I, II and III fracture wore seen in 16 patients (31%), 12 patients(23%) and 24 patients(46%) respectively.
2. The rate of complication was 29%(15 cases) with 46%(7 cases) of the complication related to the nature of the implant.
3. Among the 7 cases of metal faulure, four cases was caused by early wt. bearing and uncarefulness of patients in type III fracture.
Closed intramedullary nailing with or without interlocking screws has been a widely accepted method for the fixation of fracture of the femora shaft. Certain complex fractures in which now are commonly treated by dynamic or static locking of the nail by using screws. Interlocking nail introduces the potential for high concentration of stress at both its proximal and its distal end.
This paper describes a patient who had at fatigue fracture of the distal part of interlocking nail in the treament of fracture of the femoral shaft.