PURPOSE The purpose of this study was to evaluate the surgical outcomes of isolated greater tuberosity fractures of the proximal humerus fixed with the spring plates. MATERIALS AND METHODS Fourteen patients who could be followed up at least 1 year after the surgical treatment of isolated greater tuberosity fracture were evaluated. Their mean age was 51 years (range, 25~73 years). The deltopectoral approach and fixation with the spring plate were performed in all cases. The spring plate was used in all cases. In some circumstances, sutures incorporating the rotator cuff, interfragmentary screw or tension band wire were added. We evaluated the clinical outcomes using UCLA scoring system and KSS (Korean Shoulder Score). RESULTS The mean UCLA score was 29.8 and the mean KSS was 89.4. The average time of bony union was 10.2 weeks (range, 7~14 weeks) after the surgery, including 1 case that was performed the secondary operation due to metal failure. The shoulder stiffness were observed in 4 cases and one case of infection was treated well without operation. CONCLUSION In the treatment of isolated greater tuberosity fractures of the proximal humerus, the spring plates fixation can be a good surgical option providing reliable functional results.
Recent advances in the understnading of the biomechanics of the ankle have given rise to the clinical uncertainty about the indications for the operative treament of isolated fractures of the lateral malleolus. If deltoid ligament injury is associated, it may be unstable and operation may be indicated. This study was done to determine if we are able to assess the stability of the isolated lateral malleolus fracture based on the fracture patterns seen on radiographs and clinical findings. 37 patients with malleolar fracture of the ankle were treated at Hanil General Hospital by open reduction and internal fixation from Dec. 1996 to Jan. 1998. Lauge-Hansen classification was tried in all cases to determine if it could be applied. Stress test under anesthesia on 10 isolated lateral malleolar fracture patients with clinical findings of injury on the deltoid ligament area, whose medial clear space were normal or widened less than 2 mm on initial film. Exploration of the deltoid ligament was performed in 6 of above 10 patients There were 21 supination-external rotation type injuries, 2 supination-adduction injuries, 1 pronation-abduction injury and 13 fractures could not be clearly categorized into specific group. In 6 among 13 unclear cases, there were short oblique fracture lime indicating pronation injury, but direction of the fracture line could not be clearly determined. In 4 cases, direction of the fracture lime indicated pronation injury, but the length of the fracture line was too long. In 3 cases, both the direction and length of the fracture line was indeterminate. The stress test on 10 isolated lateral malleolar fraactures with clinical findings of deltoid injury revealed less than 2 mm widening in 7 cases, more than 2 mm widening in 3 cases. In 3 cases with less than 2 mm widening, tearing of anterior third of superficial deltoid was confirmed by exploration. In 3 cases with more than 3 mm widening, partial rupture of the deep deltoid was observed in 2 cases and anterior third of superficial deltoid was torn in 1 case.
We suggest that we cannot clearly assess the stability of isolated lateral malleolar fracture either by fracture patterns or clinical findings, so stress test can be considered in determining the stability.
Isolated fracture dislocation of the tarsal navicular bone is a very rare injury. The mechanism of injury of this fracture dislocation is known as a horiBontal or axial load in plantar flexed foot. Anatomical reduction using closed or open methods is recommended for displaced navicular fractures to achieve a satisfactory result and early mobilization of the foot is required to get a good range of motion at the tarsal joint. Authors report one case of isolated fracture dislocation of the tarsal navicular which was treated with closed reduction and percutaneous K-wire fixation.
Citations
Citations to this article as recorded by
Fractures of the Tarsal Bone Young Hwan Park, Hak Jun Kim, Soo Hyun Kim Journal of the Korean Fracture Society.2016; 29(4): 276. CrossRef
Isolated dislocation of the tarsal navicular is very rare and its mechanism of injury and treatment is not well established.
In our case, the naricular is dislocated plantomedially resulting from hyperplantar flexion, abduction injury with longitudial axial load.
Open reduction and internal fixation was required because of pulling by tibialis posterior tender There was no traumatic arthritis at talo-navicular joint and naviculo-cuneiform joint and no evidenc of avascular necrosis of the tarsal navicular at postoperative 15 months follow-up.
Citations
Citations to this article as recorded by
Fractures of the Tarsal Bone Young Hwan Park, Hak Jun Kim, Soo Hyun Kim Journal of the Korean Fracture Society.2016; 29(4): 276. CrossRef
Dislocation and fracture-dislocation fo the Tarsometatarsal joint were rare injuries, but an increase of motor vehicle accidents, industrial and athletic injuries seems to be responsible for an incresing incidence of these injuries. Because of the basic inherent stabilith of the bony architecture and the structures on the sole of the foot including the plantar fascia, the intrinsic foot muscles, peroneus, tibialis posterior tendon and the stronger plantar pligaments most dislocations occur in dorsal and lateral direction.
We report a case of 32 year-old male patient who had an isolated fracture and disloction of the first Tarsometatarsal joint with laterai and plantarward displacement. This developed by in-car accident and which did not fit to any proposed classification systems. The diagnosis was delayed because of the combined injuries, but with open reduction and internal fixation with 2 smooth K-wires, satisfactory results could at 12 moonths follow-up study.