Purpose To report the surgical results of the parapatellar approach for AO/OTA 33-C distal femoral intra-articular fractures. Materials and Methods Twenty-one patients with AO/OTA 33-C distal femoral intra-articular fracture were included. There were 11 cases of C2 and 10 cases of C3 fractures. The time of union and the coronal alignment were radiographically investigated. The complications related to surgery were clinically investigated, and a functional evaluation using the range of motion and Oxford knee score was performed to compare the surgical results according to fracture classification. Results In all cases, sufficient articular exposure and anatomical reduction were achieved with the parapatellar approach. No cases of coronal malalignment, loss of reduction, and plate failure were noted. On the other hand, in four cases (19.0%), an autogenous bone graft was performed due to delayed union on the meta-diaphyseal fracture site. There were no differences in the radiological and clinical outcomes of the C2 and C3 fractures. The knee joint pain and Oxford knee score were poorer in the delayed union group than the normal union group. Conclusion The parapatellar approach is useful for achieving an anatomical reduction of the articular surface of the distal femur and minimally invasive plating technique. Although satisfactory surgical results could be obtained regardless of the degree of articular comminution, a study of the risk factors of delayed metaphyseal fusion may be necessary.
Purpose This study examined the results of internal fixation using an intramedullary nail in the treatment of distal metaphyseal fractures involving the articular surface. Materials and Methods From November 2009 to November 2018, distal tibia fractures involving the articular surface were treated with intramedullary nailing only for fractures corresponding to AO type 43 B and 43 C1, twenty-four cases were studied retrospectively. The tibial alignment was measured preoperatively and postoperatively, and the bone union time and nonunion were assessed. In addition, the clinical evaluation of ankle joint function was assessed using the Olerud and Molander ankle score (OMAS). Results Complete bone union was obtained in all cases, and the mean union time was 17.7±1.87 weeks (range, 15-20 weeks). The average preoperative coronal alignment was 6.4°±1.0° (range, 5.2°-8.4°), and sagittal alignment was 2.7°±0.6° (range, 1.9°-3.8°). The average postoperative coronal alignment was 2.5°±0.13° (range, 2.2°-2.6°) and sagittal alignment was 0.4°±0.25° (range, 0.09°-0.95°). There was no nonunion. The OMAS had an average of 85±7.9 points (range, 70-95 points). Conclusion In the treatment of distal metaphyseal fractures involving the articular surface, internal fixation using an intramedullary nail reduces complications and achieves satisfactory reduction and union.
This method is considered an excellent treatment to obtain good clinical results.
PURPOSE Pediatric intra-articularproximal phalangeal head fractures of the big toe are very rare and few studies on this have been published. The purpose of this study is to present the diagnostic approach and surgical management of these extremely rare fractures, which might be easily underestimated or misdiagnosed. MATERIALS AND METHODS The study retrospectively reviewed all the patients who were diagnosed as intra-articular proximal phalangeal head fracture of the big toe and who underwent surgical intervention in our institution. The size of the bony fragment and hallux valgus interphalangeus angle were measured on the preoperative X-rays. The size and rotation of the osteochondral fragment, the presence of avascular necrosis, ligamentous injury and soft tissue entrapment were assessed on the preoperative magnetic resonance images (MRIs). The radiologic and functional evaluation were performed at 1 year postoperatively. RESULTS The average size of the bony fragments measured on the X-rays was 4.1 mm in width and 2.3 mm in length. Two cases showed hallux valgus interphalangeus. Preoperative MRI was performed in four cases and the average size of any osteochondral lesion was 5.3 mm in width, 3.9 mm in length, and 4.7 mm in height. Rotation of the osteochondral fragment was observed in one patient, and soft tissue entrapment was noted in two patients. Postoperatively, successful bony union was achieved in all the patients and the average time to union was 74.4 days. CONCLUSION Intra-articular proximal phalangeal head fractures of the big toe are very rare and often neglected due to incomplete ossification in the pediatric population. It is important to suspect the presence of this intra-articular fracture and to appropriately implement further evaluation. Nonunion of chronic cases as well as acute fractures can be successfully treated through open reduction and internal fixation using multiple K-wires.
PURPOSE Twenty early surgical management cases of distal humerus type-C fractures were analyzed. MATERIALS AND METHODS This study analyzed 20 early patients, who received surgical management of distal humerus type-C fractures, and could be followed-ups for more than one year between March of 2013 and May of 2015. The operative time, bone union time, and elbow range of motion were analyzed. The Mayo's functional score was used to evaluate their postoperative function. The primary and secondary complications of each patient immediately after each of their surgery were also reviewed. RESULTS All patient groups achieved bone union within an average period of 16.4 weeks. Based on the Mayo functional score, 6, 10, and 4 patients scored excellent, good, and fair, respectively. The average range of motion was a flexion contracture of 14.5° with a follow-up improvement averaging 120.7°. Six patients received nine revision operations due to major and minor complications. Two patients received revision fixation from an inadequate fixating power, and another patient received an ulnar nerve transposition. Other complications included olecranon osteotomy site displacement, superficial operational site infection, and pin loosening. CONCLUSION Distal humerus fractures of the AO-C type can cause a range of complications and has a very high rate of revision due to its difficult nature of surgical manageability. Therefore, it is imperative for a surgeon to expect various complications beforehand and a careful approach to their postoperative rehabilitation is essential.
PURPOSE This study was to evaluate the radiological and clinical mid-term results and the presence of post-traumatic osteoarthritis after osteosynthesis in patients under the age of 50 years undergoing osteosynthesis for distal femur intra-articular fractures (AO/OTA 33-B & C) from high-energy trauma. MATERIALS AND METHODS Between January 2008 and January 2013, a total of twenty-one patients with more than three years of follow-up were enrolled. Recovery of the alignment of the lower extremity, union period, and the presence of post-traumatic osteoarthritis were confirmed by follow-up radiographs. Clinically, the range of motion, pain on fracture lesion, and Knee Society score (KSS) were evaluated. RESULTS The average duration of union was 18.2 weeks (10-28 weeks), and the alignment of the lower extremity was within normal range in all patients. Seven patients showed post-traumatic osteoarthritis at the final follow-up after more than three years. The presence of post-traumatic osteoarthritis was associated with the classification of fractures, coronal plane fracture, and age. The average range of motion, knee score among KSS, and function score at the last follow-up were 128.7°, 86.1, and 85.1, all showing a greater improvement when compared with the one-year follow-up scores. CONCLUSION The mid-term result was radiologically and clinically satisfactory. Furthermore, only 33.3% of patients showed a slight progress of post-traumatic osteoarthritis, which critically effects the prognosis.
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Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef
PURPOSE We attempt to evaluate the significance of calcaneal posterior tuberosity fragment reduction when treated with surgical open reduction in displaced intra-articular calcaneal fractures. MATERIALS AND METHODS A total of 90 patients with displaced intra-articular calcaneal fracture, between January 2010 and December 2015, treated with open reduction and internal fixation were enrolled in this study. At postoperative 3 months, we evaluated the reduction state of calcaneal posterior tuberosity fragment by measuring the degree of lateral displacement of the posterior tuberosity fragment on the calcaneal axial view. Moreover, we also evaluated the difference in the calcaneal length and height with the uninjured side on the lateral view of both sides. In addition, we estimated the reduction state of the posterior facet by measuring the degree of gap and step-off on the semi-coronal view of postoperative computed tomography and estimated the restoration of calcaneal angle by measuring the difference in Böhler's and Gissane angle with the uninjured side on the lateral view of both sides. RESULTS The correlation coefficient with 3 components for evaluating the reduction state of posterior tuberosity fragment and gap and step-off of posterior facet was r=0.538, 0.467, r=0.505, 0.456, r=0.518, and 0.493, respectively, and restoration of Böhler's and Gissane angle was r=0.647, 0.579, r=0.684, 0.630, r=0.670, and 0.628, respectively. The relationship of each component shows a significant correlation as all p-values were <0.01. CONCLUSION The precise reduction of calcaneal posterior tuberosity fragment developed by the primary fracture line was considered as an important process of anatomical reduction of calcaneal body, including the posterior facet and calcaneal angle restoration.
PURPOSE The purpose of this study is to evaluate the usefulness of computed tomography (CT) for spiral tibia shaft fracture by analyzing associated distal tibia intra-articular fractures diagnosed by CT only which met the indication of surgical fixation and were fixed. MATERIALS AND METHODS Ninety-five spiral tibia shaft fractures with preoperative ankle plain radiographs and CT were analyzed retrospectively. The incidence and type of associated distal tibia articular fractures were evaluated by reviewing ankle plain radiography and CT. The number of fractures diagnosed by CT that correspond with the indication of fixation and that were actually fixed were analyzed. RESULTS Among 95 spiral tibia shaft fractures, 62 cases (65.3%) were associated with distal tibia intra-articular fracture. There were 37 cases of posterior malleolar fracture, 5 cases of avulsion fracture of the distal anterior tibiofibular ligament, 5 cases of medial malleolar fracture, and 15 cases of complex fracture. Among 52 posterior malleolar fractures including complex fracture, 20 cases were diagnosed by ankle plain radiograph. Of these 20 cases, 16 posterior malleolar fractures (80.0%) met the indication of surgical fixation, and 14 cases were actually fixed with a screw. Among 32 posterior malleolar fractures diagnosed by CT only, 26 cases (81.3%) met the indication of surgical fixation and 18 cases (56.3%) were fixed by screw. CONCLUSION Approximately 50% of associated fractures were diagnosed by CT only and more than 80% of associated posterior malleolar fractures met the indication of surgical fixation and among these fractures, 18 cases (56.3%) were actually fixed by screw. This result suggests that CT is useful in diagnosis and treatment of distal tibia intra-articular fracture associated with spiral tibia shaft fracture.
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Treatment of Distal Tibial Spiral Fractures Combined with Posterior Malleolar Fractures Young Sung Kim, Ho Min Lee, Jong Pil Kim, Phil Hyun Chung, Soon Young Park Journal of the Korean Orthopaedic Association.2021; 56(4): 317. CrossRef
PURPOSE The olecranon osteotomy in intra-articular comminuted distal humerus fractures is a suggested technique for excellent exposure of articular fractures. However, complications including delayed union, nonunion of osteotomy site have been reported. Authors have applied predrilling for cannulated screw before osteotomy for achievement of rapid and accurate reposition of separation part and added wire fixation for secure stability. The purpose of this study is to evaluate the efficacy of this fixation procedure following the olecranon osteotomy during the internal fixation of intra-articular fracture of the distal humerus. MATERIALS AND METHODS This study retrospectively analyzed 14 cases (9 women and 5 men) of intra-articular distal humerus fractures in which the olecranon osteotomy was applied. The mean age of patients was 53.4 years (range, 25 to 83 years), and the average follow-up period was 15.9 months. Eleven cases were classified as AO 13-C3, and the other 3 cases were AO 13-C2. Reduction accuracy, union period of osteotomy site on follow-up radiographs and postoperative complications related to olecranon osteotomy were evaluated. RESULTS All osteotomized parts showed no position change and solid union with normal alignment at the last follow-up. The mean period of bony union was 3.5 months (range, 2 to 5 months). There were no complications related to olecranon osteotomy except one case of non-displaced fracture of the proximal ulnar shaft at the level of cannulated screw tip caused by forceful passive physical therapy. It was managed by conservative treatment without further problem. CONCLUSION Predrilled cannulated screw and wire fixation following the olecranon osteotomy during internal fixation of intra-articular comminuted distal humerus fractures showed satisfactory results in the union of osteotomy site and it could be a recommendable procedure when fractures require olecranon osteotomy.
PURPOSE To analyze the clinical result of a conventional reconstruction plate (CRP) fixation and locking compressive plate (LCP) fixation on the surgical treatment of an adult's displaced intercondylar fracture of humerus. MATERIALS AND METHODS A total of 40 patients enrolled in the study were treated between August 2002 and May 2012. Fixation with a CRP was performed in 20 patients (group A) and anatomical locking compression plate fixation was performed in 20 patients (group B). The clinical and functional evaluation was performed according to the Mayo elbow performance score and Cassebaum classification of elbow range of motion (ROM), disabilities of the arm, shoulder and hand score. RESULTS The Mayo elbow functional evaluation scores, eight cases were excellent, 10 cases were good, and two cases were fair in group A, and 12 cases were excellent, seven cases good, and one case fair in group B; both groups showed satisfactory results. The durations of attaining 90 to 120 degrees of the ROM of joints postoperatively were 8.3 days on average (6 to 15 days) in group A and 5.5 days on average (5 to 9 days) in group B, demonstrating a significant difference between the two groups (p=0.04). Although the correlations of clinical results according to the difference of bone mineral densities (BMDs) were not statistically significant between the two groups (p=0.35), loss of fixation occurred due to loosening of screws in two patients with low BMDs in whose operations reconstruction plates were used. CONCLUSION The use of locking compressive plate on the surgical treatment of an diaplaced intercondylar fracture of humerus have a good clinical results because that permits early rehabilitation through good fixation and reduces the complications such as loosening of screws.
PURPOSE To evaluate the short term follow-up results of minimally invasive technique in the management of Sanders type II, III, and IV joint depressive calcaneal fracture. MATERIALS AND METHODS Between May 2008 and May 2011, we studied 17 cases undergoing treatment with minimally invasive technique with modified sinus tarsi approach for Sanders II, III, and IV joint depressive intra-articular calcaneal fracture and were followed up for more than 1 year. We evaluated the treatment result by assessing the radiologic parameters (Bohler angle, Gissane angle, and calcaneal height/width/length) and clinical outcomes (American Orthopaedic Foot and Ankle Society [AOFAS] score and visual analog scale [VAS]) and investigating the complication. RESULTS Radiological results improved from 7.9degrees to 19.8degrees in the Bohler angle after the operation. Satisfactory results were obtained in clinical assessment with average AOFAS score of 82.45 and the average VAS score of 3.94. We experienced 3 cases of complications, 1 case of superficial wound infection and radiologic findings of subtalar arthritis in 2 cases. CONCLUSION Minimally invasive technique may be a useful alternative surgical method in the management of Sanders type II, III, and IV joint depressive calcaneal fracture that cannot adopt extensile approach, which enable to obtain good radiological and clinical results.
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Outcomes of Minimally Invasive Surgery in Intra-Articular Calcaneal Fractures: Sanders Type III, Joint Depressive Type Calcaneal Fracture Je Hong Ryu, Jun Young Lee, Kang Yeol Ko, Sung Min Jo, Hyoung Tae Kim Journal of the Korean Fracture Society.2023; 36(3): 85. CrossRef
Towards uniformity in communication and a tailor-made treatment for displaced intra-articular calcaneal fractures Tim Schepers International Orthopaedics.2014; 38(3): 663. CrossRef
PURPOSE To evaluate the surgical outcomes of open reduction and internal fixation of AO calcaneal plate in displaced intra-articular fractures of the calcaneus. MATERIALS AND METHODS From January 2004 to July 2007, 25 patients with 27 displaced intra-articular calcaneal fractures were treated by open reduction and internal fixation using the AO calcaneal plate. Preoperative, postoperative evaluations and a follow-up after 1 year were done radiologically by the Bohler angle, Gissane angle, heel height and width among all patients. Their functional status was assessed by means of the Maryland foot score. RESULTS The mean Bohler angle, Gissane angle, heel height and width were restored comparing with preoperative data. However, in Sanders type IV, some losses of reduction occurred at 1 year follow-up (p<0.05). The mean Maryland foot scores were 85 points in type II, 82 points in type III and 63 points in type IV. Sanders types significantly affected the clinical results (p<0.05). CONCLUSION The AO calcaneal plate fixation using extensile L-shpaed lateral approach shows satisfactory radiologic and clinical results in the treatment of displaced intra-articular calcaneal fractures.
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Surgical Treatment of Calcaneal Fractures of Sanders Type II and III by A Minimally Invasive Technique with 6.5 mm Cancellous Screw Yong Seung Oh, Kyung Ho Lee, Jung Ho Kim, Myoung Jin Lee Journal of Korean Foot and Ankle Society.2019; 23(3): 116. CrossRef
Usefulness of Treatment with 6.5 mm Cancellous Screw and Steinmann Pin Fixation for Calcaneal Joint Depression Fracture Gi-Soo Lee, Chan Kang, Deuk-Soo Hwang, Chang-Kyun Noh, Gi-Young Lee Journal of Korean Foot and Ankle Society.2015; 19(1): 11. CrossRef
PURPOSE To evaluate functions of the elbow joint according to surgical approach, time to exercise, and type of fracture after surgical treatment for the intra-articular comminuted fracture of the distal humerus. MATERIALS AND METHODS 27 patients with the intra-articular comminuted fractures of the distal humerus underwent surgery from March, 2000 to January, 2007. We investigated the surgical approach, time for union, time to exercise and age. We also evaluated postoperative functions of the elbow joint according to the flexion contracture, the range of motion and the Mayo elbow performance score. RESULTS The average follow-up period was 37 months and the average time for union was 14 weeks. The average range of flexion was 115 degrees, the average flexion contracture was 10 degrees, and the Mayo elbow performance score with average value of 85 point showed good clinical results. There were no statistically significant differences in functions of the elbow joint according to the operative method and age. However, patients with early postoperative exercise within 6 days showed statistically better outcomes than patients with postoperative exercise after 7 days. Type C1, 2 fractures showed statistically better results than the type C3 fracture. CONCLUSION Stable fixation and early exercise are required to prevent postoperative complications and restore functions of the elbow joint with an intra-articular comminuted fracture of the distal humerus.
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Surgical Treatment Using a Transolecranon Approach with a Dual Locking Plate for Unstable Intercondylar Fractures of the Humerus Ji-Kang Park, Yong-Min Kim, Dong-Soo Kim, Eui-Sung Choi, Hyun-Chul Shon, Kyoung-Jin Park, Byung-Ki Cho Journal of the Korean Fracture Society.2012; 25(2): 129. CrossRef
PURPOSE This study compares the clinical results of open reduction and internal fixation with and without bone graft for the treatment of intra-articular calcaneal fractures. MATERIALS AND METHODS Twenty-five patients who had open reduction and internal fixation for intra-articular calcaneal fractures and available for at least 1 year of follow-up were included in this study. Fifteen cases were operated with bone graft. Period to bone union and functional evaluation score were compared between both groups with analysis of complications. RESULTS Bone union was achieved in all cases with average bone union time of 11.6 weeks and 12.8 weeks in group with and without bone graft respectively. Creighton-Nebraska Health Foundation (CNHF) functional score was 86.5 points and 80.3 points respectively. The period to bone union and the CNHF score in the comparison of two groups were statistically insignificant. Complications were observed in four cases of group without bone graft and 5 cases of group with bone graft. CONCLUSION This study indicates that bone graft does not play a significant role in bone union and functional outcome when intra-articular calcaneal fractures are treated with open reduction and internal fixation.
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Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures Chul Hyun Park, Oog Jin Shon Journal of the Korean Fracture Society.2016; 29(3): 221. CrossRef
PURPOSE To evaluate the clinical efficacy of F-plate in displaced intra-articular fractures of calcaneus. MATERIALS AND METHODS Total 43 cases treated with F-plate and followed up at least six months postoperatively were reviewed. Radiographically, Böhler angle was measured and all cases were subdivided by Sanders classification. Each case was reviewed for the presence of local infection, traumatic arthritis, nonunion, and any breakage of plate or screw. Maryland foot score was used for clinical assessment and factors influencing on clinical results were determined. RESULTS The mean Böhler angle was improved from 0.5° (range: -24.7~35.5°) preoperatively to 25.8° (range: 14.2~38.6°) postoperatively and the angle at last follow-up was 23.5° (range: 10.2~37.5°), showing about 2.3 degree decline compared to postoperative Böhler angle. There were two cases of F-plate breakage and two cases of screw breakage but the metal breakage did not affect any change in Böhler angle. Other complications were; five cases of traumatic arthritis, one case of varus malunion and one case of deep wound infection. According to Maryland foot score, there were 10 excellent, 22 good, 10 fair and 1 poor result. Furthermore, Age, pre-operative Böhler angle and the patient's expectation on financial compensation had significant influences upon the clinical result. CONCLUSION F-plate fixation seems to yield firm fixation and satisfactory clinical results in the treatment of displaced intra-articular fractures of calcaneus.
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Clinical and Radiological Outcomes of ‘Blocking Kirschner Wire Technique’ in Displaced Intra-Articular Calcaneal Fractures via the Extended Sinus Tarsi Approach Jeong-Kil Lee, Chan Kang, Sang-Bum Kim, Gi-Soo Lee, Jung-Mo Hwang, Byung-Kuk An Journal of the Korean Orthopaedic Association.2021; 56(3): 224. CrossRef
Open Reduction and Internal Fixation with AO Calcaneal Plate for Displaced Intra-articular Calcaneal Fracture Myung Jin Lee, Sung Keun Sohn, Kyu Yeol Lee, Sung Soo Kim, Min Soo Kang, Hyeon Jun Kim, Sang Kyu Sun Journal of the Korean Fracture Society.2010; 23(3): 303. CrossRef
Intra-articular Calcaneal Fractures Treated with Open Reduction and Internal Fixation -A Comparative Study between Groups with and without Bone Graft- Hong Moon Sohn, Sang Ho Ha, Jun Young Lee, Sung Hwan Jo, Hoon Yang Journal of the Korean Fracture Society.2010; 23(2): 180. CrossRef
PURPOSE To analyse the results of treatment of unstable intra-articular distal radius fractures using the percutaneous K-wire reduction-fixation and external fixator. MATERIALS AND METHODS A retrospective follow-up study of 22 cases was carried out. With use of the system of AO classification 9 cases were in C1 and 7 in C2, and 6 in C3. The average duration of follow-up for all fractures was 35 months. We evaluated the radiologic results, the functional results according to clinical evaluation scoring system by Green and O'Brien and osteoarthritis grade according to arthritic grading system by Knirk and Jupiter. RESULTS Excellent and good results were rated in 17 cases (77%) of all cases. At last follow-up the mean loss of radial length, radial inclination and volar tilt were 1.4 mm, 1.0o, and 1.4o respectively. Also 7 patients had grade I, 1 patient grade II, and 1 patient grade III arthritis. CONCLUSION We think that percutaneous K-wire reduction-fixation and external fixation is useful treatment method for the unstable intra-articular distal radius fracture. But severely comminuted AO type C3 fractures would need additional treatments such as open reduction and bone graft to acquire and maintain the articular reduction for better results.
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Management of Comminuted Intra-articular Fractures of the Distal Radius: Arthroscopically Assisted Reduction and Pin Fixation Supplemented with External Fixation Jong-Pil Kim, Hyun-Jin Yu The Journal of the Korean Orthopaedic Association.2009; 44(2): 233. CrossRef
Comparison of Outcomes for Unstable Distal Radius Intraarticular Fractures - T-locking Compression Plate versus External Fixator - Chul-Hyun Cho, Su-Won Jung, Sung-Won Sohn, Chul Hyung Kang, Ki-Cheor Bae, Kyung-Jae Lee Journal of the Korean Fracture Society.2008; 21(1): 51. CrossRef
Volar T-Locking Compression Plate for Treatment of Unstable Distal Radius Fractures Chul Hyun Cho, Ki Choer Bae, Doo Hyun Kwon Journal of the Korean Fracture Society.2008; 21(3): 220. CrossRef
PURPOSE To evaluate the overall clinical features and postoperative functional results of the intra-articular calcaneal fractures at more than 2 years follow-up, and also to compare the results at postoperative 1 year with the results at more than 2-year follow-up. MATERIALS AND METHODS The study is based on 39 intra-articular calcaneal fractures (34 patients) that underwent surgical treatment from March 1997 to May 2002 with at least 2 years follow-up. The overall postoperative results were evaluated with Creighton-Nebraska functional scale. The comparison of results at postoperative 1 year was also performed with results at more than 2-year follow-up. RESULTS By Sanders classifications, there were 13 type II fractures (33.3%), 20 type III (51.3%), and 6 type IV fractures (15.4%). Average follow-up period was 35 months (range: 24~87 months) and at final follow-up of more than 2 years, Creighton-Nebraska score was average 76.0 (range: 30~100) which significantly improved from postoperative 1-year results of 67.1 (range: 22~95) (p<0.05). CONCLUSION The clinical outcome at more than 2 years after surgical treatment of intra-articular calcaneal fractures was quite promising, which significantly improved compared to 1-year results. Therefore, we concluded that functional results of calcaneal fractures should be evaluated at least 2 years after the treatment.
PURPOSE To evaluate the therapeutic results of intra-articular fracture of distal humerus treated through triceps sparing posterior approach. MATERIALS AND METHODS From February 2001 to December 2003, we reviewed total 9 cases of intra-articular fracture of distal humerus, which were treated by surgical treatment and were followed more than for 12 months. According to the OTA classification, nine cases were classified as type A; two, as type C1; five, as type C2; two. Triceps sparing posterior approach was used in all nine patients. An extensile posterior incision was used over the olecranon without triceps muscle injury. Exposure of the fracture site was done by obtaining medial-lateral mobility through dissection of medial and lateral edge of triceps muscle. Therapeutic results were assessed by bone union, duration for fracture union, complication. and for functional estimation, Mayo elbow performance score was checked and analysed. RESULTS The range of the elbow joint motion was flexion contracture 5.2 degree to further flexion 135.5 degree on average. Clinical results using Mayo elbow performance score were as follows; six excellent, three good. Compressive neuropathy of ulnar nerve which has been done anterior transposition was observed in one patient. CONCLUSION Triceps sparing posterior approach is useful surgical technique that provides sufficient exposure of medial and lateral condyle without injury of triceps muscle in intra-articular fracture of distal humerus to the extent of OTA type C2.
PURPOSE To evaluate the clinical and radiologic results of percutaneous surgical treatment of the intra-articular fractures of the distal radius, we have compared the results of percutaneous pinning and the combination of percutaneous pinning with external fixation after closed reduction. MATERIALS AND METHODS We analysed the results of 52 patients with intra-articular fracture who received the operative treatment with closed reduction in the period of June, 1995 to June, 2001 and also were in regular follow-up at least one year. We used the subjective analysis by Cole & Obletz and the objective analysis by Scheck. RESULTS We have found the outcome that 83.3% of percutaneous pinning were graded above "Good" in type B and C1 and 82.2% of the combination treatment of percutaneous pinning with external fixation were graded above "Good" in type C2 and C3. CONCLUSION The percutaneous pinning and external fixator after closed reduction in intra-articular fractures of the distal radius are considered useful to restore the articular congruity and make good clinical results.
PURPOSE This study was designed to investigate the usefulness of lateral approach for accurate reduction and rigid internal fixation in comminuted intra-articular fractures of calcaneus. MATERIALS AND METHOD Twenty patients(21 cases) who had intra-articular fracture of calcaneus and underwent an open reduction and internal fixation using lateral approach were enrolled. Using Essex-Lopresti classification, all cases were intra-articular fracture, which joint depression type was 17 cases and 4 of severe comminuted tongue type. We compared the preoperative and postoperative change of B o h l e r 's angle and clinical results were analyzed using Paley and Halls evaluation protocol and scoring system. RESULTS The average B ohler 's angle was restored from 2.8 to 25.1 after operations and clinical results classified 4 well, 12 good, 4 fair, 1 poor cases. Postoperative complications were 2 cases of wound dehiscence, 1 of infection and one had sural nerve injury. Late complications included 3 cases of limitation of motion of ankle that disturb usual activity, 3 of sustained pain and 2 of traumatic arthritis and 2 cases had 2 complications at the same patients. CONCLUSION The lateral approach is valuable for the comminuted intra-articular fractures of calcaneus that enables accurate anatomical reduction and rigid internal fixation by providing direct exposure of subtalar joint, and also with little morbidity of neurovascular injury.
PURPOSE To investigate the results of surgical treatment of displaced intra-articular fracture of the calcaneus using a Y-plate. MATERIALS AND METHOD We have studied 22 patients who underwent surgical treatment of displaced intra-articular fracture of the calcaneus in our hospital from March, 1998 to August, 2000. The fractures were identified according to Eastwood classification, there were 8 cases of type I, 10 cases of type II and 4 cases of type III. The axial and Bohler angle of lateral views were compared preoperative and postoperative period. Functional evaluation was measured by Carr 's method. RESULT The average Bohler angle before the operation was 5 degrees and after the operation it has been up to 28 degrees. In functional evaluation, 3 cases were excellent, 15 cases were good, and 4 cases were fair. CONCLUSION Fixation using a Y-plate can be used easily for restoration of anatomical dimension of the calcaneus in the operative treatment of displaced intra-articular fracture. It could be helpful for firmer fixation of the posterior facet.
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Joint-Sparing Surgical Management of Sanders IV Displaced Intra-Articular Calcaneal Fractures Thomas S. Roukis Clinics in Podiatric Medicine and Surgery.2019; 36(2): 251. CrossRef
Open Reduction and Internal Fixation with AO Calcaneal Plate for Displaced Intra-articular Calcaneal Fracture Myung Jin Lee, Sung Keun Sohn, Kyu Yeol Lee, Sung Soo Kim, Min Soo Kang, Hyeon Jun Kim, Sang Kyu Sun Journal of the Korean Fracture Society.2010; 23(3): 303. CrossRef
Treatment of Displaced Intra-articular Calcaneal Fractures Using a F-plate Kyu Hyun Yang, Jae Bong Chung, Han Kook Yoon, Si Young Park, Hang Seob Yoon Journal of the Korean Fracture Society.2007; 20(1): 1. CrossRef
PURPOSE : To evaluate the role of the additional external fixator in maintenance of reduction with was known as an important prognostic factor for the treatment of intra-articular distal radius frctures.
MATERIAL AND METHOD : Thirty cases of unstalbe intra-articular fractures of the distal radius, which were treated by operative method, were classified by Frykman's method and grouped in two(group A and B). The group A was treated by closed reduction and percutaneous K-wire fixation and long arm cast immobilization. The group B was treated by treated by closed reduction and percutaneous K-wire fixation with use of additional external fixator. The end results were evaluated by the Demerit Point Rating System(by Sarmiento) & radiologic evaluation(radiologic index : radial length, radial tilt, volar tilt) RESULTS : By the Demerit point rating system, excellent and good results were rated by 45.5% in group A and 75% in group B and poor results were found in 3 cases which were Frykman type VII or VIII in group A. Radiologically, radial length loss was rated by 11%, radial tilt loss by 10.8% and volar tilt loss by 47% in group A and 3.1%, 6.8%, 29% each in group B(p<0.05). CONCLUSION : We think that additional use of external fixator, after percutaneous K-wire fixation, may have an important role in maintenance of reduction and group prognosis for the treament of intra-articular distal radius fractures.
There has been many treatment modalities in the distal radius fracture. Although there is no doubt that external fixators have a role in the treatment of some highly displaced distal radius fractures, many unstable distal radius fractures may be treated adequately with far less complicated and intrusive percutaneous pinning technique. The purpose of this study was to evaluate indication and effectiveness of Rayhack's transulnar percutaneous pinning technique. Authors reviewed the unstable intra-articular fracture of the distal radius of 15 cases treated with Rayhack's transulnar percutaneous pinning technique between March 1994 and February 1997. At the final follow-up examination, the mean loss of radial length, radial inclination and volar tilt was respectively 0.4mm (3.9%), 2.0 (10.6%), 2.1 (14.7%). Posttraumatic arthritis was occurred in 1 case (11.1%) of less than 1mm residual articular step-off, 2 cases (40%) of more than 1mm and less than 3mm residual articular step-off, 1 case (100%) of more than 3mm residual articular step-off. Distal radioulnar joint synostosis by percutaneous pinning was not found. According to Demerit point rating system, excellent to good results were obtained in 73.3%. Authors suggest that Rayhack's pinning technique can be applied in terms of simple procedure, cost-effectiveness and functional outcome.
The calcaneus is the most commonly fractured tarsal bone, but the appropriate care of calcaneal fracture continue to be an unsolved dilemma. As technology in imaging has improved, operative treatment is more suggested. The purpose of this study is to evaluate the results of operative treatment in intra-articular calcaneal frcture and to analyse the results in accordance with various prognostic factors. We analysed retrospectively 13 patients, 17 intra-articular calcaneal fractures undergone operative treatment. Mean follow-up period was 27 months (range:13 ~ 44 months). There were 11 males and 2 females with 41 year old mean age (range:18 ~ 63 years old). Clinical assessment used the modified Creighton-Nebraska health foundation assessment sheet for fracture of the calcaneus. We obtained excellent result in 7 cases (41.2%), good in 2 cases (11.8%), fair in 7 cases (41.2%) and poor in 1 case (5.8%). Clinically age and body weight, radiologically Bohler angle, fibulo-calcaneal distance and subtalar joint discrepancy are related to the prognosis of intra-articular calcaneal fracture following operative treatment. Postoperative complications are limping (2 case), heel pain (3 cases), hump bump of calcaneus (1 case) and subtalar arthritis (1case). In conclusion, on the basis of our results, there is a relationship between anatomical abnormalities of the heel and a poor clinical outcome. Therefore, in operative treatment of intra-articular fracture of calcaneus, we recommend anatomical reduction, if possible, not only of the subtalar joint but also of the Bohler angle and fibulo-calcaneal distance.
Computed tomography was used in the evaluation of intra-articular fractures of the calcaneus to develop and reasonable treatment program and predict prognosis. Seventeen fractures of the calcaneus in the sixteen patients were shown to involve the posterior facet and classified by the images of coronal CT scan; Type I(non-displaced), Type II(displaced) and Type III(comminuted). There were one Type I, ten Type II, and six type III fractures. All of which were treated with open reduction and internal fixation, with or without bone graft. The length of follow-up period ranged from thirteen to fourty-five months(mean : 24 months). The results were graded by a predetermined point system. The one type I had an excellent result. Of the ten type 2 fractures ; three had excellent result, four good result, two fair result, and one poor result. Ofthe six type 3 fracture, one had good result, three fair result, two poor result. On the basis a our study, we believed that open reduction and internal fixation was a good method of treatment for the displaced or mildly comminuted intraarticular fracture of the calcaneus
The intra-anicular fracture of the elbow joint can render the elbow joint unstable. In this situation. it is desired to reduce and fix the bone fragment internally. The goal of treatment of the intra-aficular fracture of the elbow joint is a painless, stable elbow to provide a favorable range of motion.
Fourteen patients of the intra-articular fraciure of the elbow joint who were treated with Herbert screw in Eul Ji General Hospital, Taejon from October, 1993 to December, 1994. were analyzed in clinical and radiologic aspects.
The results obiained from this study were as follows; 1. Among 74 patients, male were 11 cases(78.5%) and female were 3 cases(21.5%).
2. The average age of patients were 31.8 years with range from 15 years to 11 years and the follow-up period ranged from 16 months to 33 months with average 19.6 months.
3. The most common cause of injury was fall down(50.0%) followed by slip down(28.5%) and traffic acrident(21.5%).
4. The most common intra-articular frarture of the elbow joint was capitellum fracture(50.0%) rollowed by radial head fracture(35.6%).
5. Through late radiologic assessment, there was 1 case of post-traumatic arthritis.
6. The result of treatment were excellent in 6 patients(42.8%), good in 1 patients(50.0%) fair in 1 patient(7.2%) by functional rating index of Morrey.
Intra-articular fractures involving the posterior facet of the subtalar joint are associated with significant and prolonged disability.
But, the treatment of choice for displaced intra-articular calcaneal fractures remains controversial.
We treated 30 displaced intra-articular fractures of the calcaneus by open 1eduction and internal fixation through the lateral approach with autogenous bone graft at the Department of Orthopaedic Surgery, Choong-ang Gil and Dong Inchon Gil Ceneral Hospital from January 1990 to October 1994 The clinical and radiographic analyses were as follows.
1. Of 26 patients, 20 patients were male and 6 patients were female.
2. The main cause fractures of calcaneus was a fall from a height in 23 cases(88%) and most of associ ated fractures were spine injury in 6 patients.
3. Fracture was classified according to Essex-Lopresti classification. 13 cases were tongue type, 17 cases were joint depression type.
4. Alt Open reduction and internal fixation through the laterl approach with bone graft was performed in joint depression type and tongue type.
5. The preoperative ayerage Bohlers angle was - 5. The postoperative avereage Bohlers angle was -24, Which was increased significantly.
6. Complications were 12 cases ; included heel pad pain in 8 caLes, osteomyelitis and superficial wound infection in 2 cases, transient sensory hypesthesia on the lateral side of the foot in 2 cases.
7. Based on assessement of Salama, the results were excellent in 5 cases, good in 1 Teases, fair in 6 cases, poor in 2 cases.
The os calcis is the most frequently fractured than any other tarsal bone and the displaced intraarticular fracture account for 60-75% of them. Because of complex contour of calcaneus, it is difficult to evaluate the pattern of fracture exactuly by conventional roentgenograms. But recently, computed tomography clearly defines fracture patterns of subtalar joint and calcaneocuboid joint. From Feb. 1992 to Jan. 1994. we analyzed 18 feet in 16 patients of intraarticular calcaneal fractures after routine preoperative CT scan and Sandersclassification. All cases were operated through extensile lateral approach and internally fixed with plate and screws. The clinical and radiographic analysis were as follows: 1. Sanders classification of 18 cases were type I in 3, type I in 8, type III in 4 and type IV in 3.
2. As the fracture line moves medially, intraoperative visualization of joint, reduction becomes more difficult and the prognosis worsens in type II and IIIBC.
3. By SandersCT classification of calcaneal fracture, it help us in understanding fracture pattern more detail and in deciding of the method of treatment and in the predicting of the prognosis.
Treatment of displaced or comminuted intra-articular fractures of distal radius is often difficult and demanding. Emphasis has been on achieving and maintaining an anatomical reduction of the fragments by open reduction and internal fixation.
We analyzed twenty nve cases of intra-articular fracture of distal radius treated with open reduction and internal fixation from January 1989 to December 1993 by the method of Gartland and Werley (clinical) and Lidstrom(radiologic) The results of this study were as follows.
1. 84% of the patients had satisfactory results on the basis of the subjective criteria of minimal deformity, absence of pain, and good strength.
2. 88% of the patients had satisfactory results on the basis of radiologic and clinical evaluation.
3. When the intra-articular step-off exceeded 2mm, the results were only fair.
4. If one cannot achieve and maintain a articular step-off of 2mm or less, open reduction of the fracture should be considered.
The os calcis is one of the most commonly injured tarsal bone and fractures involving the subtalar joint may cause serious and persistent disabilities.
We treated 12 intra-artlcular calcaneal fractures in 11 patients from June, 1998 to April, 1992 by plate fixation after lateral approach. The Sanders fracture classification system was applied to out study which classify the fractures according to the number of the fractured segments and direction of the fracture lines after computerized axial tomography of the posterior facetal joint. The follow-up evaluation included questioning the patient about pain during activity and rest, the ability to walk and stand, range of subtalar motion and ability to return to work according to the assessment sheet for calcaneal fractures of Creighton Nebraska Health Foundationl We experienced 8 excellent and 2 good results among 12 cases and there was little complication.