The efficacy of intramedullary nailing in treating patients who have fractures of the tibial shaft has been well estabilished. Forty-five fractures of the shaft of the tibia(forty-five patients) were randomized to treat with interlocking nail with either the Blocker-Wills nail(nineteen fractures) or the Russell-Taylor nail(twenty-six fractures), who were treated at Department of Orthopaedic Surgery, Seoul Adventist Hospital from January, 1993 to December, 1997. Forty-five patients had acute traumatic fractures of the shaft of tibia with no other significant injuries, patients with other injuries which would intefere with functional evaluation were excluded, We analyzed the result of treatment clinically and radilogically.
The results obtained were as follows ; 1. The average operating time was 114.7 minutes in Blocker-Wills nailing and 141.7 minutes in Russell-Taylor nailing.
2. The average time to fracture union healing was 16.7 weeks for Brooker-Wills nailing and 18.6 weeks for Russell-Taylor nailing.
3. The complications including delayed union and superficial infection were greater in Russell-Taylor ndiling than in Blocker-Wills nailing.
4. In functional results accourding to Klemm and Bormer were above good in 16 cases(84.2%) of Brooker-Wills group, and 22 cases(84.6%) in Russell-Taylor nailing group.
Fracture of the lateral humeral condyle is a relatively common injury in children. It is an itraarticular fracture involving the growth plate so, the treatment should be done very carefully to reduce aditional damage and complication. The authors analyzed 34 fractures of the lateral humeral condyle in children who were treated from Mar. 1993 to Feb. 1998, to know the releationship between the factors affecting the development of complications and the results. The results were summerized as follows ; 1. There were 1 case (2.9 %) of Milch type I and 33 cases (97.1 %) of Milch ype II, and according to Jakob' stage, 9 case (26.5 %) of stage I, 19 cases (55.9 %) of stage II, and 6 cases (17.6 %) of stage III. 2. They were treated with cast immobilization in 5 cases (14.7 %), with closed rduction and percutaneous K-wire pinning in 8 cases (23.5%), and with open reduction and K-wire fixation in 21 cases (61.8%). 3. According to the criteria of Hardacre, the result of 5 cases of cast immobilization were excellent, 8 cases of closed reduction and percutaneous K-wire pinning were 3 excellent, 4 good, 1 poor, and 22 cases of open reduction and K-wire fixation were 19 excellent, 2 good, so there were 22 cases (64.7%) excellent, 11 cases (32.4%) good, and 1 case (2.9%)poor. 4. The complications were 11 cases (32.4%) of bony spur, 6 cases (17.6%) of overgrowth of the lateral condylar or capitellum, 1 case (2.9%) of premature epiphyseal fusion, and 2 cases (5.9%) of pinning site infection.
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The tibial plateau fracture often produce some disabilities of the knee joint because it is the intraarticular fracture and often associated with soft tissue, ligament and meniscal injury. The authors analyzed 42 cases of the Tibial Plateau fractures, which were treated at the department of orthopaedic surgery, Seoul Adventist Hospital from 1992 to 1997, to know the releationship between the type of fracture, the methods of treatment, and the results. The results were summerized as follows; 1. The most common fracture type by Schatzker classification was type I(18 case 42.9%). 2. Sixteen cases among of 42 cases were treated with conservative treatment, and 26 cases were treated with operative method 3. The clinical result according to Blokker method, acceptable were 34 cases (81.0%) and unacceptable were 8 cases (19.0%) 4. The complications were limitation of range of motion(4 case), peroneal nerve palsy(2 case), posttraumatic arthritis(1 case), wound infection(1 case).
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Supracondylar fracture of the humerus is the most common elbow fracture in children. It can be complicated by Volkmanns ischemic contracture, nerve injury, deformity of elbow, joint stiffness, and myositis ossificans, etc. even after the treatment. Various methods of treating displaced supracondylar rracture have been described, and the indications for open reduction and internal fixation are relatively established well. The surgeon, however, might be in trouble with making decision for closed reduction, whether to maintain by casting or by percutaneous pinning. From fan. 1990 to May 1990, 117 patients of supracondylar tracture had been treated in Seoul Adventist Hospital, and 82 patients of them were challenged initially by closed reduction and casting. Among them, 51 cases have been followed more than 1 year, and they are reviewed.
1. The average age was 7.2 years, and the patient population consisted of 33 boys and 18 girls. 2. 3 cases of nerve injuries, 2 cases of ipsilateral forearm bone fractures, 2 cases of impending Volkmanns ischemic contracture and 1 case of cerebral contusion were associated with supracondylar fracture. 3. Fracture pattern were classified as flexion type of 1 case and extension type of 50 cases. According to Gartland classification, type II was 16 cases(31.4%), type III-A was 27(52.9%) and III-B was 7(13.7%). Of all, 28 cases(54.9%) were comminuted and 23 were non-comminuted. On the other hand, 14 cases(27.5%) were oblique fracture and 37(72.5%) were transverse one, classified by pattern of fracture line. 4. Success rate of closed reduction and casting were 56.3% in Garland type II, 33.3% in type III-A, 42.9% in type III-B. In comminuted fracture, it was 21.4% and 65.2% in non-comminuted one. Success rate was 7.1% in oblique fracture, and 54.1% in transverse one. This suggests that comminuted fracture or oblique fracture should not be tried by closed reduction and casting but by percutaneous pinning. 87.5% of non-comminuted and transverse fractures were treated successfully by initial closed reduction and casting, and it also suggests that closed reduction and casting should be done only in this case selectively.
5. By Flynns criteria the results were excellent in 9 cases, good in 8, fair in 3 and poor in 1 with casting. Percutaneous pinning resulted in 15 excellent, 10 good, and 1 fair cases. Open reduction and internal fixation resulted in 2 excellent and 2 good cases.
The patella, the largest human sesamoid bone, lies within and is important functional component of the knee extensor mechanism, So the treatment of patellar fracture is considered very important.
In this series, we experiened 24 cases of ptellar fractures treated with modified tension band wiring and circumferential wiring from Jan. 1987 to Dec. 1992 at the department of orthopaedic surgery, Seoul Adventist Hospital.
The Results were as follows; 1. The mean fracture healing peroid was 9.6 weeks in cases of modified tension band wiring and 12.4 weeks in circumferential wiring.
2. circumferential wiring is a good method for severe comminuted, small fragmented fracture and modified tension band wiring is for displaced transeverse fracture and large fragmented comminuted feacture.
The tibia is the most commonly fractured bone in the long bones. There are many controversy concerning the method of treatments because of many complications, such as non-union, delayed union and infection.
We comparatively analyzed 21 cases of Brooker-Wills IM nailing and 35 cases of DCP fixation in the treatment of tibial shaft fractures from Jan. 1988 to Dec. 1992.
The results were as follow: 1. The averge bone union time was 12.1 weeks in Brooker-Wills IM nailing group and 13.9 weeks in DCP fixation group. There were significant different between two groups of the bone union time especially, the age from 20s to 40s and type B fracture in according to A-O classification but no different of the bone union time in open fractures.
2. There was more complications in DCP fixation than in Blocker IM nailing to treat the tibia shaft fractures.
3. In according to the above results to treat the tibia shaft fracture, we meet the conclusion that it will be a benifit to treat the tibia shaft fracture with IM nails than with DCP fixation especilly, young ages and type B fractures in A-O classification. Also we need further study for advantage between the IM nails which flexible and hard one, reamed and unlearned one.
The tibia plateau fractures are more common and severe than past decade because of increased traffic accident and industrial injury recently There are many argument about treatment of tibla plateau fractures, but the main goal of treatment Is to achived a stable, well-a-ligned, movable joint with minimum surface irregularities and with adequate soft tissue healing.
The authors analyzed the 38 cases of the tibia plateau fractures treated at the Department of Orthopedic Surgery, Seoul Adventist Hospital from 1987 to 1992, to know the relationship between the type of fracture, treatment, and the results. The fallowing results were obtained.
1. The incidence Is more frequent in male and fifth decade was the most popular.
2. The most common cause of injury was traffic accident.
3. The most affrected site was left(26 cases) and lateral condyle(25 cases).
4. The most common fracture type acording to the Hohls classification were undisplaced and communited type of fractures.
5. 14 cases were treated with conservative method and 24 cases were treated with surgical method and 75% of patient which were treated with conservative, 86% of patient which were treated with surgical method, obtained satisfactory result according to Brokkers evaluation 6. The factors of poor results were as follow, communited fracture in Hohls classification, associated with severe other part of fracture, with severe soft tissue injury, or with ligament and meniscal injury.