PURPOSE : To analyze the clinical and radiological result of femoral trochanteric fractures treated by using Ender nails in elderly patients.
MATERIAL AND METHODS :Sixty seven patients of femoral trochanteric fractures treated at Korean Veterans Hospital from 1993 to 1997 were included in this study. Under the C-arm guided, closed reduction and internal fixation with Ender nails was done within one week. According to Kyle classification, we classfied type I in 12case, type II in 20cases, type III in 25cases, typeIV in 20 cases and analyzed duration of bone union, ambulatory ability and postoperative complication. RESULT : The duration of union was from 14 weeks to 17 weeks and the mean was about 15.5 weeks. Thirty seven(60.7%) patients maintained their prefracture ambulatory ability at a postoperative 1 year and twenty four(39.3%) patient lost some degree of ambulatory ability. Postoperative complications were the knee pain and the limitation of the motion of the knee in 10 cases(14.9%), external rotation deformity in 7 cases(10.4%), distal migration of nails in 4 cases(5.9%), proximal migration of nails in 2 cases(2.(%), nonunion in 2 cases(2.9%). CONCLUSION : We conclude that the treatment by using Ender nails is one of the proper methods in elderly femoral trochanteric fracture with associated medical complication.
PURPOSE : In the proximal tibial condylar fractures, the authors analyzed the treatment results clinically and radiologically, after arthroscopically assisted accurate anatomical reduction of articular surface and rigid internal fixation with early mobilization. MATERIALS AND METHODS : We reviewed 56 cases of tibial condylar fracture that were treated at our the orthopaedic department between January 1990 and December 1996 and the follow-up period was 1 year above. According to Schatzker's classifications, we classified the type of fracture and we analyzed the results by average union time and Porter's criteria after accurate anatomical reduction of articular surface and rigid assisted redcution of articular surface and internal fixation. RESULTS : According to Schatzker's classification, Type I 15cases, TypeII 14cases, TypeIII 6 cases, TypeIV 7cases, TypeV 3cases, TypeVI 11cases, Associated soft tissue injuries were total 22cases the were MCL injuries 12 cases, lateral meniscal injuries 6 cases. The average union time was 15.5 weeks and by Porter's criteria, 56 cases, of which 39 cases(71%) had an good result. CONCLUSION : we considered that good results can be obtained by assistant use of arthroscopy and rigid internal fixation with early mobilization, that accurate diagnosis and appropriate treatments of accampaning injuries according to the type of fractures, and accurate anatomical reduction of articualr surface.
The femoral supracondylar and intercondylar fractures are difficult to be treated due to severe soft tissue damage, comminution, intraarticular extension of fracture and injury to the quadriceps mechanism frequently. The causes of nonunion are inadequate anatomical reduction, fixation failure, bone defect and infection occasionally, which is difficult to be treated.
The authors analyzed 16 cases with nonunion of femoral supracondylar and intercondylar fracture who had been treated surgicdlly from January 1990 to December 1991 According to AO/ASIF classification in the initial fracture patterns, type A were 8 cases, type B was 1 case and type C were 7 cases. The duration between initial treatment and surgical treatment of nonunion was 6 months in average. The causes of nonunion were fixation failure due to inadequate device selection in 9 cases, inadequate anatomical reduction or surgical technique in 4 cases and infection in 3 cases. The treatmentt were internal fixation with Dynamic condylar screw(DCS) in 9 cases, internal fixation with condylar blade plate in 4 cases, monofocal lenghtening with Ilizarov in 1 case and bifocal lenghtening with Ilizarov in 2 cases. According to Schatzker classification, the good result was obtained in 11 cases(68.8%). The complications were 3 knee joint ankyloses, 2 superficial wound infections, 1 delayed union and 1 deep vein thrombosis.
In conclusion, the requirement for the good result in treatment of nonunion are exact anatomical reduction, rigid fixation and autogenous bone graft.
The authors analysed the 40 patients of the lateral condyle fracture of the humerus in children who were admitted in Korea Veterans Hospital in Seoul from Jan. 1990 to Dec. 1997. The fracture type and the displacement was classified according to Milch type and Jakob stage. Clinical analysis was performed on 40 patients with lateral condyle fracture of humerus, who could be followed up. The patients were followed up from 12 months to 63 months with an average of 23 months. Average duration of bone union was 6 weeks after operation. The significant differences in outcome were notified from open reduction and internal fixation in comparison to closed reduction and percutaneous pinning. According to the criteria of Hardacre, we obtained excellent result in 16 cases(40%), good result in 22 cases(55%) and poor results in 2 cases(5%).
Fracture of tibial intercondylar eminence has a clinical importance in aspect of associated ligament injury, limited range of motion and joint instability The purpose of this study is to evaluate the intercondylar eminence fracture and to compare the results of treatment by method of arthroscopic reduction and pull-out suture with results of conservative treatment. The results were evaluated with Mayers and Mckeevers criteria of result and instability. 23 cases of avulsion fracture of tibial intercondylar eminence were reviewed. Most common type was type II Most common cause was traffic accident. Closed reduction and cast immobilization was performed in 12 cases, of which 10 cases had above good result initially, reduction with pull-out suture by arthroscopy was performed in 11 cases, of which 10 cases had above good refult. Type III B fracture were reduction with minimal arthrotomy because of the arthroscopic reduction was difficult. 2 cases of instability were in type III A and type III B. An instability case of type III A was treated non-operatively and the other of type III B was treated pull-out suture. 1 case of extension limitation was in type II which waf treated non-operatively because of multiple injury.
The supracondylar fracture of the humerus is the most common fracture of the elbow in children and is occasionally associated with significant residual complications such as cubitus varus deformity. Clincal analysis was performed on 32 patients with displaced supracondylar fractures of humerus, who were treated either by closed reduction and percutaneous pinning or by open reduction and internal fixation. The results were as follows : 1. The average age of the children was 6.8 years old in both sexes, and male to female was 21 : 11. 2. The extension type was 26 cases(82%), flexion type was 6 cases(18%) and the left side was more frequently involved. 3. According to Pirone classification, type II was 14 cases, type III 18 cases. 4. There was no significant difference in the mean duration of bony union between the percutaneous group and the open reduction group. 5. Cubitus varus deformity and limitation of elbow motion were more common complications in open reduction group.
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The Effect of Rotational Deformities on Cubitus Varus for Supracondylar Humerus Fractures in Children Hyun Dae Shin, Kyung Cheon Kim, Dong Kyu Kim, Woo Yong Lee Journal of the Korean Orthopaedic Association.2010; 45(5): 373. CrossRef
Authors report 42 cases of humeral shaft fractures, which were treated with plate fixation in 19 cases and intramedullary(IM) nailing in 23 cases, from January 1992 to December 1996. The average time of operation in plate fixation was 100 minutes and that in Im nailing was 65 minutes. The nonunion in plate fixation was 2(10.5%)cases and that in IM nailing was 4(17.4%)cases. Other complications of plate fixation were 2 cases of wound infection and 2 cases of radial nerve palsy. Those of IM nailing were 1 case of limited motion of the shoulder and 1 case of wound infection. After reviewing above reslts, we concluded that there were no marked difference between the two operative method in bone union of humeral shaft fracture cxcept diversity of complication.
The ankle fracture with diastasis of distal tibiofibular jointis caused by an axial loading force with concomitant external rotation or other force. Many surgeons have treated this injuries by rigid fixation medial and lateral malleoli with syndesmotic fixation. But recently, syndesmotic fixation is not required to maintain the syndesmotic fixation on ankle fracture. seventy-five patients of ankle fracture with syndesmotic injury treated at Korea veterans Hospital from Jan. 1990 to Dec. 1996 were analysed in clinical and radiological aspect. The syndesmotic fixation was not necessary if the both medial and lateral injury was rigidly stabilized by fixation or ligament repair.
Treatment of tibial pilon fractures is difficult to manage because of its comminuted pattern of the intra-articular fracture of the ankle, the articular incongruity, associated with soft tissue injury and its complication. The modern concept of fracture mordality are the open anatomical reduction, stable internal fixation with correct length of fibula and functional aftercare. We analyzed 17 cases which underwent open reduction and internal fixation for the tibial pilon fracture at the Korea Veterans Hospital from March 1990 to September 1996. 1. The most common type was type III according to Ruedi and Allgower's classification. 2. The treatment was open reduction and internal fixation in all cases and the results were above fair by Ovadia and Beals criteria in 16 cases. 3. The union of fracture was taken in all cases and the duration of union was average 14 weeks. 4. The most common complication was the limitation of ROM in the ankle joint.