PURPOSE To compare the radiological and clinical results between intramedullary nailing and plate fixation in the treatment of distal tibial fractures. MATERIALS AND METHODS 19 cases of distal tibial metaphyseal fractures within 4 cm of the ankle joint line were enrolled. Ten patients were treated with interlocking intramedullary nail and the others with plate and screws. RESULTS The mean union time was 14 weeks in nailing group and 16 weeks in plate group. The average angulation in AP view was 4.1 degrees in nailing group and 3.1 degrees in plate group. The average angulation in lateral view was 1.7 degrees in nailing group and 2.7 degrees in plate group. The rotational deformity was 2.8 degrees in nailing group and 1.7 degrees in plate group in average. There was no implant failure and soft tissue problem. CONCLUSION There was no difference in clinical and radiological results between intramedullary nailing and plate in the treatment of the distal tibial fractures and, considering the preservation of the soft tissue, the intramedullary nails are a reliable method for managing distal metaphyseal fractures of the tibia.
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Does a Customized 3D Printing Plate Based on Virtual Reduction Facilitate the Restoration of Original Anatomy in Fractures? Seung-Han Shin, Moo-Sub Kim, Do-Kun Yoon, Jae-Jin Lee, Yang-Guk Chung Journal of Personalized Medicine.2022; 12(6): 927. CrossRef
A Comparison of the Results between Intramedullary Nailing and Minimally Invasive Plate Osteosynthesis in Distal Tibia Fractures Chul-Hyun Park, Chi-Bum Choi, Bum-Jin Shim, Dong-Chul Lee, Oog-Jin Shon Journal of the Korean Orthopaedic Association.2014; 49(4): 285. CrossRef
PURPOSE To evaluate the configuration of vertebral body fractures in flexion-distraction injuries of thoracolumbar spine. MATERIALS AND METHODS We investigated the location of fractures, anterior or posterior vertebral body height, kyphotic angle of injured segments, canal encroachment and severity of comminution on radiologic examinations of 21 cases. RESULTS There were 11 compression fractures and 9 burst fractures. 85% of fractures were located in the inferior vertebrae of injured segments. Anterior vertebral height decreased by 27% on average with decrease of 18% in compression fractures and 40% in burst fractures. Posterior height decreased by 1% on average with increase of 1% in compression fractures and decrease of 4% in burst fractures. The average kyphotic angle of injured segments was 19.5 degrees with 15.4degrees in compression fractures and 26.8 degrees in burst fractures. The canal encroachment in 9 burst fractures was 27% on average, and the comminution of vertebral body was mild in 74%. CONCLUSION The fracture of vertebral body in flexion-distraction injuries of thoracolumbar spine was very common, and located on the inferior vertebrae of injured segment. The decrease of vertebral height, canal encroachment and severity of comminution was relatively less than the estimated from mechanism of injury, with offset effect of distraction force.
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Differences in Thoracolumbar Burst Fractures by Falls from Height with Associated Foot and Ankle Fractures Chung-Shik Shin, Eea-Sub Chung, Chang-Eon Yu, Byeong-Yeol Choi Journal of Korean Society of Spine Surgery.2012; 19(2): 47. CrossRef
PURPOSE To evaluate the relationship between fracture stability and functional results, and analyze the correlation between stability factors and the outcome in intertrochanteric fractures of the elderly. MATERIALS AND METHODS Of the 231 patients, 84 patients with age above 60 were able to follow up for minimum 6 months. We measured the sliding length of the lag screw, varus degree, position of lag screw, reduction status and medialization of distal fragment radiologically. The functional outcome of the treatment was evaluated with the Clawson's result classification and we evaluated the correlation between the radiological results of measurement and the functional recovery depending on the Evans fracture classification. RESULTS There were good results in 40 cases out of 51 stable fractures, and in 10 cases out of 33 unstable fractures (p<0.001). In case of sliding of lag screw more than 10 mm, good results were obtained in 4 cases, and poor in 21. And in case of sliding less than 10 mm, good results were obtained in 46, and poor in 13 (p<0.001). But there was no relationship between other radiologic factors and clinical results. In unstable type, there were 12 cases with lag screw sliding more than 10 mm and 10 cases with less than 10 mm. In comminuted type, there were 11 cases with lag screw sliding more than 10 mm and 2 cases with less than 10 mm (p<0.001). CONCLUSION The sliding of lag screw more than 10 mm may result in poor outcome. As in comminuted unstable pattern, sliding of lag screw might be excessive, the use of compression hip screw alone is not a good treatment option.
PURPOSE To evaluation of usefulness of low-intensity ultrasound for nonunion and delayed union. MATERIALS AND METHODS For 5 months, we treated 7 delayed union and 8 nonunion using low-intensity ultrasound. After 5 months, in checked X-ray AP and Lateral view, when cortical bridge formation was done, we through union. RESULTS In 7 delayed union, 5 cases-2 femur, tibia, humerus, radius were healed. In 8 nonunion, 3 femur nonunion were healed. Union rate was 71% in delayed union 37.5% in nonunion. CONCLUSION we thought that the low-intensity ultrasound has capacity of induction of union and was considered as the method of treatment for delayed union.
PURPOSE To evaluate optimal placement of the Herbert/Whipple screw in scaphoid fracture. MATERIALS AND METHODS Forty eight models molded from four cadaver scaphoids were used for this study. Using the Herbert/Whipple jig, the guide wire was placed distal to proximal into each scaphoid with twelve method which were four entry points and three target points. Guide wire placement was then evaluated with three planes in the proximal, middle, distal planes and distance from the nearest cortex. RESULTS The most concentric position in the proximal plane was D5, in the middle plane C10. As distal entry point, the most concentric position in proximal plane was C. There were no statistical concentric, as middle, distal plane, and proximal entry point, CONCLUSION: The most ideal placement were D5 in proximal fractures of the scaphoid, C5 in distal fractures. In waist fractures of the scaphoid, there were relatively safe, except A0 and D0. The position of entry points was more important than that of target points for ideal screw placement.
PURPOSE We studied the co-relation on the causes of the hip fracture through the analysis of a relevance on the etiological factors as increased incidence according increasing old ages. MATERIALS AND METHODS Total 158 cases that treated on the hip fracture from 2001 Jan. to 2002 May were studied. The parameters were age, gender, smoking, obesity, type of fracture, place of fracture, other comorbidity, activity of daily living, bone marrow densitometry, hardness of floor, orientation, injury energy. And then, we analysis of difference between femur neck fracture and femur intretrochanter fracture and between stable femur intertrochanter fracture and unstable femur intertrochanter fracture. RESULTS The incidence of the femoral intertrochanteric fracture was larger significantly than that of the femoral neck fracture in the older than 80(p < 0.001). On the comparison of the pre-fractural activity of daily living, the group revealed lower activity had larger incidence of femoral intertrochateric fracture(p < 0.001). Also, the femoral intertrochanteric fracture was more larger in osteoporosis patient group(p < 0.005), and lower energy trauma(P<0.05). In a unstable femoral intertrochanteric fracture, 21 cases(77.7%) of total 27 cases were belong to the group of the activity of daily living scale below C(p < 0.05), 24 cases of 27 cases were belong to the osteoporosis patient who was estimated below -3.0 on T-score(p < 0.001). CONCLUSION In the hip fracture of the elderly patients, the femoral intertrochanteric fracture is more prevalance rather than the femoral neck fracture on the cases of older patient more than 80 year-old, lower activity of daily living scale, lower T-score less than -3.0 on BMD, lower energy trauma. Also, in femur intertrochanter fracture, unstable fracture is more common in low daily activity and osteoporosis
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The Daily Life Functions of Elderly Peritrochanteric Fracture Patients after Surgical Treatment Dae Moo Shim, Tae Kyun Kim, Jong Yun Kim, Duk Hwa Choi, Joung Suk Lee, Seong In Lee Journal of the Korean Fracture Society.2012; 25(1): 8. CrossRef
The Usefulness of Hip to Thigh Ratio as an Anthropometric Indicator for the Incidence of Hip Fracture Jin Park, Kyu Hyun Yang, Seong Hwan Moon Journal of the Korean Fracture Society.2009; 22(1): 1. CrossRef
Minimally Invasive Two-Incision Total Hip Arthroplasty for Treating Acute Displaced Femoral Neck Fractures in Active Elderly Patients Chang-Ich Hur, Taek-Rim Yoon, Kyung-Soon Park, Sang-Gwon Cho, Ji-Hyeon Yim The Journal of the Korean Orthopaedic Association.2008; 43(5): 643. CrossRef
PURPOSE The aim of this study was to evaluate the radiation dose administered in orthopedic operative procedures and to determine whether all operation room personnel must use the lead protector. MATERIALS AND METHODS From March 2001 to May 2001, sixty six orthopedic operations were done with fluoroscopic intensifier(Series 9600TM, OEC Medical Systems Inc.). The accumulative exposure doses of operator, 1st assist, scrub nurse, circulating nurse and anesthesiologist were assessed by TLD(Thermo luminescence dosimeter) and compared with the dose limit set by the KINS(Korea Institute of Nuclear Safety). The exposure times and doses were evaluated in each cases and analyzed according to the each procedure. The exposure doses were assessed by the distance (Om, 0.5m, 1m, 2m) from the fluoroscopic generator. RESULTS Accumulative exposure doses(3 months) were checked 1.37mSv in operator, 1.73mSv in 1st assist, 0.17mSv in scrub nurse, 1.01mSv in circulating nurse, 0.01mSv in anesthesiologists and all doses were lower than dose limit set by the KINS(12.5mSv). Low exposure was checked in procedure of hand, ankle, cervical spine but high exposure was checked in IM nailing of femur(one way Anova with postHoc test, p<0.05). The exposure doses were decreased with the distance and exposure dose out of 1m was minimal. CONCLUSION Radiation is higher in IM nailing procedure but the total accumulative doses were safe especially in personnel who can fall apart from the operation field more than lm. So, we conclude that the lead protector is not essential to the all operation room personnel.
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Radiation exposure and fluoroscopically-guided interventional procedures among orthopedic surgeons in South Korea Seonghoon Kang, Eun Shil Cha, Ye Jin Bang, Teresa W. Na, Dalnim Lee, Sang Youn Song, Won Jin Lee Journal of Occupational Medicine and Toxicology.2020;[Epub] CrossRef
PURPOSE To evaluate the methods of treatment to obtain rigid fixation for nonunion of humerus shaft fractures developed after operative treatment. MATERIALS AND METHODS From January 1993 to January 2000, twenty-one patients of nonunion of humerus shaft after primary internal fixation were reviewed and the results were analyzed. Three cases who have loss of follow-up were excluded. RESULTS In twenty-one cases, nineteen had union but, two cases have failed. In the group of compression plate fixation and bone graft, bone union was completed at mean 4.4 months, in the group of IM nailing and bone graft at 4.9 months, in case of bone graft only with state of IM nailing at 5.5 months. Mean time until bone union was 4.6 months. CONCLUSION Distraction should be avoided during IM nailing at primary internal fixation. Secondly, To obtain rigid fixation in nonunion of humerus shaft after primary internal fixation, use larger and more broad plate, dual plate or IM nail.
PURPOSE This study is to evaluate the radiologic results after close reduction for the distal radius fractures that were reduced.
MATERIAL AND METHOD: From March 1996 to Feburary 1999, thirty-four patients with distal radius fracture were treated with close reduction and cast immobilizationat at Ewha Womans University Hospital. The radiograph were taken after reduction and at 3days, 2 weeks, 4 weeks, 6 weeks. Three parametersof the radiograph were measured.; radial inclination, palmar angulation and radial shortening. The radiological results were estimated by the criteria of Sarmiento. RESULTS In 34 patients, type I were 10 cases, type II were 15 cases, type III were 6 cases, type IV-A were 3 cases by the Universal classification. The average value of the radiologic parameters after reduction were followings s; radial inclination(RI) 18.2°, palmar angulation(PA) 9.3° and radial shortening(RS) 1.8mm in type I. RA 17.2°. PA 8.4° and RS 2.0mm in type II. RI 16.5°, PA 8.0°, RS 2.5mm in type III. RI 14.9°, PA 7.7°, RS 3.5mm in type IV. At 6weeks after reduction, RI 17.8°, PA 9.2° and RS 2.1mm in type I. RA 16.7°, PA 7.6° and RS 2.6mm in type II, RI 15.4°, PA 7.0°, RS 4.0mm in type III. RI 13.3°, PA 6.2°, RS 5.2mm in type IV. CONCLUSION Loss of reduction after close reduction with cast immobilization for type III and IV were occurred more frequtently than type I and II.
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Redisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic Factors Ho-Wook Jung, Hanpyo Hong, Hong Jun Jung, Jin Sam Kim, Ho Youn Park, Kun Hyung Bae, In-Ho Jeon Clinics in Orthopedic Surgery.2015; 7(3): 377. CrossRef
PURPOSE We reviewed 47 cases of acetabular fractures which was treated operatively, to review the clinical results of operative treatment of acetabular fractures considering the experience of a surgeon, to assess the relationship between the quality of the operative reduction and the clinical results. MATERIALS AND METHODS We reviewed 47 cases of acetabular fractures which was treated operatively from September 1993 to December 1999 and follow up more than 1 year. And we analyzed retrospectively the data in the aspect of the relationships between the radiologic evaluation of the reduction and the clinical results, and we reviewed the initial 20 cases as a group I and the later 27 cases as a group II to compare the differences of clinical results of the two groups. RESULTS In the accuracy of reduction, anatomical reductions were 4 hips in the group I and 13 in the group II, satisfactory 7 hips in the group I and 9 hips in the group II, unsatisfactory 9 hips in the group I and 5 hips in the group II. We assess the over-all clinical result with the criteria of Merle d'Aubigne and Postel. In the group I, 20 hips, the clinical result was excellent for 3 hips(15%), good for 6 hips(30%), fair for 5 hips(25%), and poor for 6(30%) hips. In the group II, 27 hips, the clinical result was excellent for 11 hips(41%), good for 8 hips(30%), fair for 5 hips(18%), and poor for 3(11%). CONCLUSION The accuracy of reduction was closely related to the clinical results. And the more a surgeon getting experienced, the better accurate reduction and clinical results were possible.
External fixation for severe fractures of the distal radius is accepted treatment offering the potential advantages of controlled distraction, accurate positioning of fracture fragments, and avoidance of extensive open procedures. One of the limitation of external fixation for distal radius fractures is excessive distraction, which affect the outcome. This study was conducted to evaluate the changes of the distraction of the intercarpal and radiocarpal joint, developed after treatment of distal radius fractures with external fixator. Restrospective study was done for 28 paitents, who were evaluated by chart review, questionnaire, radiograph, and physical examination. The carpal height ratio, radial inclination, velar tilt, radial length were measured in the postoperative and follow-up radiographs. The carpal height ratio was used to quantify the distraction. Functional evaluation was performed with Demerit-Point system described by Garthland and Werley. Five fractures had an excellent results, 16 had a good results, 4 had a fair results, and 3 had poor results. After union, average radial inclination was 21.3 degree, average dorsal angulation was -0.5 degree, and radial shortening was 1mm. Increased carpal height ratio of the 9 cases did not decrease to less than 0.56 at one year after operation. The over-distraction of intercarpal and radiocarpal joint developed after external fixation of the distal radius fracture, did not have decreased in the one year follow-up radiographs after operation. The over- distraction should be avoided intraoperativly.
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.
There is a great difference in opinion regarding the treatment of intraarticular fractures of the calcaneus. In Essex-Lopresti method, a heavy Steinmann pin is introduced into the cancellous part of tongue fragment and the fracture is reduced by lifting the fragment by the level effect of the Steinmann pin. The authors had treated 38 cases in 36 patients with displaced intraarticular tongue shaped fractures using Essex-Lopresti axial fixation at our hospital from 1993 to 1997. We obtained the following results. 1. Of 36 patients, 31 patients were male and 5 female 2. The main cause of fractures were fall from height in 86 percent of cases and spine injury was associated in 8 cases(22%). 3. The favorable result was obtained in 29 cases(76%). 4. The poor prognostic factors in functional outcome were old age, comminution of fracture, osteoporosis and the loss of correction in B.. ohler angle at postoperative and follow up Xrays.
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.
In the elderly patients, we evaluated the results of treatments for the femoral neck fractures in the respect of quality of life. We used the Rosser index to generate quality of life score(QoL). Rosser index composed of two dimensions with distress and disability. Seventy-nine patients aged over 65 years with femoral neck fracture have been evaluated. Forty-nine cases were treated with bipolar hemiarthroplasty and thirty cases were treated with internal fixation such as compression hip screw. Knowles pin, cannulated hip screws. At one-year after operation, the median score of quality of life was 0.990 in bipolar hemiarthroplasty patients and 0.988 in the internal fixation patients. There was significant difference between the two groups(P<0.05). Patients treated with bipolar hemiarthrol)lasty had better QoL score than the patients treated with internal fixation. The elderly patients treated with bipolar hemiarthroplasty has lesser diability and was able to get early weight bearing.