Soft tissue defect combined with an open fracture is a very challenging problem to the orthopaedic surgeon. Many complicated open fractures remain with soft tissue defect, chronic osteomyelitis, and sometimes terminate with major limb amputation. Soft tissue defect should be reconstructed as soon as possible, particularly when the bone, tendon, or neurovascular structures are exposed. Exposure for longer than a week significantly increases the risk of secondary infection and tissue necrosis. For the simple soft tissue defect, negative pressure wound closure technology has been introduced and many superficial wounds have been treated successfully using this method. For the more complicated wounds, many kinds of local flaps, pedicled flaps, muscle and fascisocutaneous flaps can be indicated according to the characteristics of the wounds. The free flaps including free vascularized bone graft can be considered as a final choice for the most difficult wound problems. In this article, various reconstruction strategies for soft tissue defect after traumatic open fracture are reviewed.
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PURPOSE To evaluate the usefulness of wrist arthroscopic examination in patient with persistent pain after the triquetral dorsal chip fracture and also to determine its relationship with TFCC injury in the triquetral dorsal chip fracture patient manifesting persistent pain. MATERIALS AND METHODS This study is based on six cases presenting persistent pain in the ulnar aspect after the triqeutral posterior cord fracture that were treated conservatively. Wrist arthroscopy was carried out for all six cases. All were preoperatively and postoperatively evaluated using VAS pain scale, grip power, ulnar grind test, Kleinman shearing test and lunotriquetral ballottment test. RESULTS Preoperatively, ulnar grind test yielded positive results in all six cases, Kleiman shearing test proved positive in three cases and lunotriquetral ballottment test yielded positive result in one case. In the arthroscopic findings, synovitis and TFCC injury were detected in all cases, and based on Palmer classification of TFCC injury, type IA was determined in five cases and type ID in one case. Arthroscopic TFCC partial resection and synovectomy were carried out. VAS pain scale improved from an average 8 points preoperatively to 3 points postoperatively. The difference of grip power between the normal and the other side improved from average of 15 lb preoperatively to 5 lb postoperatively. Based on postoperatively physical examination at 6 weeks, all cases yielded negative results in the ulnar grind test and Kleiman shearing test. CONCLUSION We think that TFCC injury is one of the causes of persistent pain after triquetral dorsal chip fracture. We recommend an arthroscopic TFCC partial resection as a valuable treatment option.
PURPOSE To evaluate the results of fracture fixation between using Proximal Femoral Nail and using Proximal Femoral Nail A and to analyze the effectiveness of proximal femoral nail A. MATERIALS AND METHODS We reviewed 32 patients who suffered from intertrochanteric fracture in our hospital, which were 19 cases of PFN and 13 cases of PFNA. Retrospectively we evaluated mean operation time, amount of bleeding, beginning of ambulation, average union period, changes of neck shaft angle and complication on set of telephone interview and OPD. We also evaluated postoperative capability of function and mobility using 'Social function score' and 'Mobility score'. RESULTS PFNA showed shorter mean operation time, less bleeding, shorter average union period, earlier ambulation and less change of neck shaft angle than PFN. Although they didn't show statistical difference, postoperative capability of function and mobility showed statistical and mathematical difference on each group. CONCLUSION PFNA showed better results of postoperative function and mobility and less complications than PFN. So treatment using PFNA is better method than that of PFN.
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Comparative Study of Proximal Femoral Nail Antirotation and Zimmer Natural Nail for the Treatment of Stable Intertrochanteric Fractures Jee-Hoon Kim, Oog-Jin Shon Journal of the Korean Fracture Society.2013; 26(4): 305. CrossRef
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PURPOSE To evaluate prospectively the results of early active exercise after open Bankart repair of traumatic anterior shoulder instability. MATERIALS AND METHODS From January, 2001 to June, 2003, 26 patients who were followed up at least 1 year after open Bankart repair for traumatic anterior shoulder instability were evaluated. Average age was 23.9 years old (range, 19~43) with 24 males and 2 females. We evaluated them using the functional shoulder scores (modified Rowe score, ASES score), range of motion, VAS pain scale, patient's subjective satisfaction and return to unlimited daily living activity. RESULTS The shoulder functional scores increased significantly. At last follow up, the final range of motion were flexion in average 5° deficit in comparison to normal side, external rotation in average 10o deficit, and internal rotation in T9. The patient's subjective satisfaction was good in 2l patients (81%). Return to unlimited daily activity was possible in 23 patients (88.5%), and 19 patients (73%) rejoined to sports activity before injury. There were complications including anterior recurrent subluxation in 1 case, weakness of subscapularis muscle in 1 case. CONCLUSION In traumatic anterior shoulder instability, early active range of motion exercise after open Bankart repair does not decrease shoulder stability. Early exercise can be useful for returning to previous level of sports activity in young active patients.
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We report an unusual case of Kirschner wire migration from the proximal humerus into the thoracic cavity and diaphragm which induced pneumothorax and hemoperitoneum. An 81-year-old woman admitted to the emergency room due to sudden onset of dyspnea. X-rays showed pneumothorax and old proximal humerus fracture fixed with rush pins and K-wires. One of K-wires was seen on the diaphragm level at posterior gutter of chest wall. Through the abdomen, K-wire was removed from the diaphragm and a chest tube was inserted. The potential for K-wires to migrate must be recognized, and frequent postoperative radiographic studies have to be performed for the early detection of loosening and migration. It appears that if K-wires are used for fixation of proximal humerus, the lateral ends must be bent to prevent medial migration, and when the desired therapeutic goals have been achieved, these pins have to be susbsequently removed as soon as possible.
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Spinal Canal Migration of a K-Wire Used for Fixation of a Distal Clavicular Fracture Byung-Ill Lee, Yong-Beom Kim, Hyung-Suk Choi, Chang-Hyun Kim, Jung-Woo Ji Journal of the Korean Orthopaedic Association.2013; 48(3): 231. CrossRef
Early Intrathoracic Migration of K-wire Used for Fixation of Proximal Humerus Fracture Sang Jin Cheon, Ji Min Lee Journal of the Korean Orthopaedic Association.2011; 46(2): 167. CrossRef
PURPOSE The purpose of this report is to describe the pattern of elbow injuries and the incidence of the different fracture types in children. MATERIALS AND METHODS The records of 445 in-patient children treated for the elbow injuries for 5 years were reviewed and analyzed statistically. RESULTS The average age of 445 children was 6.7 years. The average age of boys(6.9 years) was about 1 year older than girls(5.9 years). The age group of 4 - 7 years is the majority(50%), followed by the age group of 8 - 11 years(22%). The boy to girl ratio was approximately 2:1. The male predominance changed with the age and appeared dramatically in the age group of 12-16 years( 6.7:1 ). Left elbow was injured more frequently(60%). Left side predominance was accentuated in girls compared to boys(69% vs 55%), especially in the age group of 8 - 16 years (80% vs 50%). Thirty percent of the fractures occurred during the summer, followed by 27% the autumn, 26% the spring months and 17% the winter. The most common fracture was the supracondylar fractures of the humerus(52.3%), followed by lateral condylar fractures(25.4%), olecranon fractures(5.3%), radial head fractures(4.8%), medial epicondyle fractures(4.6%), transphyseal fractures(2.8%) and Monteggia fractures(2.2%). Medial condylar fractures(1.1%) and elbow dislocation(0.8%) were rare injuries. The average age was higher in radial head fracture(10.6 years) and medial epicondylar fracture(12.4years). Closed reduction and percutaneous pinning was the method of treatment in more than half(52%). Open reduction was performed in 32%. Sixteen percent was treated by closed reduction and cast immobilization. CONCLUSION The incidence and pattern of elbow injuries in children, which needed operative treatment in the majority, occured closely correlated with the amount of injury prone play and the pattern of behavior during the causative accidents.
PURPOSE To know the functional and radiologic results of the operative treatment for the type I and II tibial plateau fractures according to the methods of internal fixations. MATERIALS AND METHODS Twenty-six patients, who had been treated with open reduction and internal fixation for the type 1 or 2 tibial plateau fractures were evaluated. Twelve cases of type 1 fractures were fixated with 1 lag screw in 5, 2 lag screws in 4 and buttress plate in 3. Fourteen cases of type 2 fractures were fixated with 1 lag screw in 4, 2 lag screws in 6 and buttress plate in 4. The criteria of Hohl and Porter was used for the evaluation of the clinical and radiological results. RESULTS There was no significant difference in the clinical result in type 1 and 2 tibial plateau fractures according to the methods of fixations. And the radiological results were not significantly different in both of type 1 and 2 fractures. CONCLUSION If the anatomical reduction of the articular surface can be achieved, the methods of fixation for the type 1 and 2 tibial plateau fractures do not affect the final clinical and radiological results.
PURPOSE : We evaluated the results after the lag screw fixations using A.O. 2.0mm mini screws for the unstable multiple spiral metacarpal fractures. MATERIALS AND METHODS : thirteen cases of multiple spiral metacarpal fractures were treated with the lag screw fixations using 2.0mm mini cortical screws by the recommended technique of AOASIF. TAM of each digit was measured at the time of last follow up and the result was compared with the contralateral normal digits. We also evaluated the amount of shortening, angulation or rotation at the fracture sites on the last follow-up radiographs. RESULTS : Complete radiological unions were obtained in all of the cases. TAM of the operated digits were above 90% compared with those of the contralateral normal digits except 1 case, which had an another fracture and deep laceration at the distal phalanx and proximal interphalangeal joint during the period of follow up. We could not find any shortening, angulation or rotation at the fracture sites on the last follow-up radiographs. CONCLUSION : When we consider that the goal of treatment of the metacarpal fracture is to obtain full motion of the digit through the early mobilization after injury, we think that the lag screw fixation using 2.0mm mini screw is a good treatment modality in the cases of unstable multiple spiral metacarpal fractures.
The ankle is a complex, weight bearing joint and its injury results in a severe functional disturbance of complex anatomical characteristics. It is very important to understand the mechanism of the trauma in order to make defenite diagnosis and proper treatment. The authors analysed 92 cases(92 patients) of the ankle fractures which were operated in Orthopedic Department, Korea University Hospital from Sept. 1980 to Dec. 1991. The results obtained were as follows ; 1. Of the 92 cases, male was 61 cases(66.3%), female was 31 cases(33.7%) and average age of the patients was 39.9 years.
2. The causes of the injury were slipping down, traffic accident, sports injuries and falling down in orders.
3. Open fractures were 12 cases(13.0%) and closed fractures were 80 cases(87%).
4. The most common type of the ankle fracture was supination-external rotation type(32 cases, 34.8%) and next was pronation-external rotation type(26 cases, 28.3%), according to the classification of Lauge-Hansen.
5. The associated fractures with ankle fracture were 26 cases (28.3%).
6. The best result was supination-adduction type and the worst result was pronation dorsiflexion type, when assessed according to the criteria of Meyer.
7. There were 11 cases of complications(12.0%), in which 6 cases of traumatic arthritis, 4 cases of malunlon and 1 case of nonunion.
8. The accurate reduction and rigid internal fixation to the fracture of lateral malleolus of dlstal fibula and tibiofibular diastasis was important in the treatment of the ankle fractures.