PURPOSE To assess the result of staged minimally invasive plate osteosynthesis (MIPO) for distal tibial fracture with an open wound or injured soft tissue. MATERIALS AND METHODS In 20 patients (mean age, 47.8 year-old) with distal tibial fractures, there were 4 type A fractures and 16 type C fractures based on the AO classification system. Eight of the 20 patients had open fractures. MIPO was performed on average 23.9 days after bridging external fixation. At the final follow-up, we assessed the radiological results of bone union and alignment. Functional results were also evaluated by measuring the degrees of ankle motion and the American Orthopedic Foot & Ankle Society (AOFAS) scores. RESULTS Seventeen of 20 cases (85%) achieved primary union at an average of 21.3 weeks. There were 3 cases of nonunion requiring a bone graft. The mean AOFAS score was 88.5 (range, 67~92) and the average range of ankle motion was 49.2degrees (plantarflexion: 37.4degrees, dorsiflexion: 11.8degrees). Complication included 2 cases of minor mal-alignment, 1 case of claw toe and 1 case of peroneal neuropathy. Patients over the age of 60 had lower functional results. Additional factors did not affect the final results. CONCLUSION Staged MIPO may achieve satisfactory results in distal tibial fractures with soft tissue compromise, decreasing deep infections and soft tissue complications.
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Anterolateral Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures Using an Anterolateral Locking Plate Dongwhan Suh, Hwan Hee Lee, Young Hoon Han, Jae Jung Jeong Journal of Korean Foot and Ankle Society.2020; 24(1): 19. CrossRef
Minimally Invasive Osteosynthesis with Locking Compression Plate for Distal Tibia Fractures Sung-Kyu Kim, Keun-Bae Lee, Keun-Young Lim, Eun-Sun Moon Journal of the Korean Fracture Society.2011; 24(1): 33. CrossRef
PURPOSE To review the clinical results of eight cases of typeIII coronoid process fractures which were treated operatively. MATERIALS AND METHODS Eight patients with coronoid type III fracture were reviewed retrospectively. All were men with an average age of 33. There were three isolated fractures, two elbow dislocations, two radial head and neck fractures, and one medial collateral ligament rupture. Open reduction and internal fixation through anterior approach with canulated screws was used. The patients were followed up for a mean of 31 months (24 to 60). RESULTS Average active elbow joint motion at the most recent follow up was 105degrees. The average Mayo Elbow Performance Score was 76.9 (50 to 95). There was one excellent result, four good, two fair, and one poor. CONCLUSION Early open reduction and stable internal fixation provided a reliable method for the treatment of type III coronoid process fractures. Any associated ligament injuries to the elbow and fracture comminution were considered as important prognostic factors.
PURPOSE Despite of various treatment methods, proximal tibial fractures are common injuries that may be associated with poor outcomes and high rates of complications. To improve this, percutaneous plating technique was performed in the proximal tibial fractures. MATERIALS AND METHODS Twenty-four proximal tibial fractures (AO 41A; 5, AO 41C; 12, AO 42; 7) were treated by percutaneous plating with either or both sides without bone graft. One was open fracture. RESULTS All fractures were healed. The average time for fracture healing was 16.5 weeks (range, 8~24 weeks). Complications included a 1cm shortened case and two mal-alignments; a 6 degree valgus case and 5 degree varus case. There was one case of superficial infection, which healed after plate removal. But, there was no deep infection. Results were evaluated by modified Rasmussen score system, all patients had excellent or good result. CONCLUSION Minimally invasive percutaneous plating technique can provide favorable results in the treatment of proximal tibial fractures.
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MINIMALLY INVASIVE OSTEOSYNTHESIS WITH PLATE OR NAIL FOR META-DIAPHYSEAL TIBIAL FRACTURES - WHAT IS BETTER? B. Makelov Trakia Journal of Sciences.2023; 21(4): 357. CrossRef
Medial Minimally Invasive Percutaneous Plate Osteosynthesis in Proximal Tibial Comminuted Fractures Jae-Ang Sim, Kwang-Hui Kim, Yong-Seuk Lee, Sang-Jin Lee, Beom-Koo Lee Journal of the Korean Orthopaedic Association.2014; 49(4): 278. CrossRef
Minimally Invasive Percutaneous Plate Stabilization Using a Medial Locking Plate for Proximal Tibial Fractures - Technical Note - Jae Ang Sim, Beom Koo Lee, Kwang Hui Kim, Yong Seuk Lee Journal of the Korean Fracture Society.2013; 26(4): 327. CrossRef
Clinical Outcomes of Locking Compression Plate Fixation through Minimally Invasive Percutaneous Plate Osteosynthesis in the Treatment of Distal Tibia Fracture Jae-Sung Yoo, Hyun-Woo Park Journal of the Korean Fracture Society.2012; 25(2): 117. CrossRef
Minimally Invasive Plate Osteosynthesis for Proximal Tibial Shaft Fracture Young-Soo Byun, Ki-Chul Park, Hyun-Jong Bong, Chang-Hoon Lee Journal of the Korean Fracture Society.2011; 24(1): 23. CrossRef
Minimally Invasive Plate Osteosynthesis for the Upper Extremity Fracture Using a Lumbar Spreader - Surgical Technique - Gu-Hee Jung, Chyul-Hyun Cho, Jae-Do Kim Journal of the Korean Fracture Society.2011; 24(1): 83. CrossRef
Management of Fractures of Distal Tibia by Minimally Invasive Plate Osteosynthesis through an Anterior Approach Gu-Hee Jung, Jae-Do Kim, Jae-Ho Jang, Sung-Keun Heo, Dong-won Lee Journal of the Korean Orthopaedic Association.2010; 45(6): 473. CrossRef
The Comparison of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Proximal and Distal Tibia Fracture Joon Soon Kang, Seung Rim Park, Sang Rim Kim, Yong Geun Park, Jae Ho Jung, Sung Wook Choi Journal of the Korean Fracture Society.2010; 23(2): 172. CrossRef
Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture Joon-Woo Kim, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Woo-Kie Min, Byung-Chul Park, Kyung-Hoon Kim, Hee-Joon Kim Journal of the Korean Fracture Society.2009; 22(1): 6. CrossRef
Proximal Tibia Fracture: Plating Ki-Chul Park Journal of the Korean Fracture Society.2009; 22(3): 206. CrossRef
PURPOSE This is a retrospective study to analyze the results of unreamed intramedullary nailing in grade III tibial open fracture. MATERIALS AND METHODS Twenty-nine Gustilo-Anderson grade III tibial open fractures fixed with unreamed tibial nail were followed more than one year. Primary union rate, union time, infection, conversion to external fixation, ankle and knee function according to different grade of open, fracture level, AO classification, and muscle flap were evaluated. RESULTS Primary union was achieved at sixteen fractures. There were three delayed union that achieved union twenty week after primary operation. And eight undergone secondary bone grafts which were done after inflammation sign subcided. Complications about infection were in five cases. Two cases were unable to maintain internal fixation due to deep infection, and three of superficial infection were treated with repeated debridement and antibiotics use. CONCLUSION In grade III tibial open fracture, unreamed nailing with early soft tissue reconstruction and early prophylactic bone graft can be a good treatment.
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Management of Open Fracture Gu-Hee Jung Journal of the Korean Fracture Society.2010; 23(2): 236. CrossRef
Management of Open Tibial Fractures: Role of Internal Fixation Yerl-Bo Sung Journal of the Korean Fracture Society.2007; 20(4): 349. CrossRef
PURPOSE This was a retrospective study to evaluate the results of intramedullary nailing in proximal shaft fracture of tibia. We analyzed those results according to AO classification and Poller screw. MATERIALS AND METHODS Thirty-three proximal tibial shaft fractures (32 patients) were followed for more than one year. In AO classification, there were 6 cases of type A, 14 cases of type B, and 13 cases of type C. We used Poller screws in 14 operations. We evaluated translation, angulation and nonunion after surgeries. RESULTS Twenty-eight cases (85%) were united primarily, but nonunions occurred in 5 cases. Malalignment (angulation>5degree or translation>5 mm) was found in 14 cases (42%). In Poller screw used and non-used groups, the malalignment was respectively showed in 2 cases (14%) and 12 cases (63%). According to AO classification, nonunion was found in only type B with 5 cases (36%). CONCLUSION Intramedullary nailing of proximal shaft fracture of tibia showed relatively lower rate of primary union. Especially, when initial fractures have a butterfly fragment, it showed the higher rate of nonunion. Moreover, the malalignment rate was relatively higher, yet it is possible to reduce the rate of malalignment by using Poller screw.
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Open Source-Based Surgical Navigation for Fracture Reduction of Lower Limb Sanghyun Joung, Jaeyeong Park, Chul-Woo Park, Chang-Wug Oh, Il Hyung Park Transactions of the Korean Society of Mechanical Engineers A.2014; 38(5): 497. CrossRef
PURPOSE We retrospectively reviewed the outcomes and advantages of minimal invasive plating osteosynthesis (MIPO) technique as a new treatment of distal femoral fractures. MATERIALS AND METHODS Sixteen supracondylar femoral fractures (15 patients) were treated by MIPO technique and evaluated radiologically and functionally after minimal 1 year follow-up (average; 22 months, range; 13~42 months). There were 9 women and 6 men with a mean age of 46 years old (range 35 to 64 years). Seven fractures were extended into knee joints (AO/OTA type C), and 9 were extraarticular (AO/OTA type A). Five cases were open fractures (type I; 2, type II; 3) according to the Gustilo-Anderson classification. After minimal lateral parapatellar incision and accurate reduction of intra-articular fractures, the supracondylar fractures were fixed by percuatneous plating method without exposure of fracture area. Neer scoring was used for functional evaluation of knee. RESULT At a mean of 17 weeks (range 14 to 22), most fractures united without secondary procedures. One case of nonunion had the procedure of bone graft, but there were no other complications including shortening over 1 cm, mal-alignment over 10 degrees, or deep infections. All the cases had good or excellent knee function, and the average range of knee motion was 120.6 degrees. CONCLUSION MIPO technique is a worthwhile method of managing distal femoral fractures with good unions and functional recovery.
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The Comparison of Minimally Invasive Percutaneous Plate Osteosynthesis versus Open Plate Fixation in the Treatment of in the Distal Femur Fracture Seong-Jun Ahn, Suk-Woong Kang, Bu-Hwan Kim, Moo-Ho Song, Seong-Ho Yoo, Kwan-Taek Oh Journal of the Korean Fracture Society.2013; 26(4): 314. CrossRef
Treatment of Distal Femur Fracture with Minimally Invasive Locking Compression Plate Osteosynthesis Ki-Chul Park, Kyu-Sung Chung, Joon-Ki Moon Journal of the Korean Fracture Society.2012; 25(1): 13. CrossRef
Axial Malalignment after Minimally Invasive Plate Osteosynthesis in Distal Femur Fractures with Metaphyseal Comminution Jae-Ho Jang, Gu-Hee Jung, Jae-Do Kim, Cheung-Kue Kim Journal of the Korean Orthopaedic Association.2011; 46(4): 326. CrossRef
Surgical Treatment of AO Type C Distal Femoral Fractures Using Locking Compression Plate (LCP-DF, Synthes®) Kap-Jung Kim, Sang Ki Lee, Won-Sik Choy, Won-Cho Kwon, Do Hyun Lee Journal of the Korean Fracture Society.2010; 23(1): 20. CrossRef
What is an Ideal Treatment? Chang-Wug Oh Journal of the Korean Fracture Society.2008; 21(4): 347. CrossRef
PURPOSE Low-intensity, pulsed ultrasound (LIPUS) has demonstrated a stimulation and acceleration of the normal fracture-repair process in cellular bases as well in animal and human models. In this study, the adjunctive effect of LIPUS and LASER was investigated in established nonunion of the long bones. MATERIALS AND METHODS Study group consisted of eight patients to whom conventional bone graft and adjunctive LIPUS and LASER was applied. On the other hand, eight patients in the control group underwent bone graft only. Eleven men and five women were included in this study and the average age of the patients was 41.7 years (range, 19~62 years). Six of the tibias and ten of the femurs met the criteria for established nonunion. The average fracture age, the post-fracture period before the start of LIPUS/LASER treatment, was 502 days. RESULTS Seven of the ten nonunions who were treated by LIPUS and LASER healed completely in an average treatment time of 141 days (range, 101~202 days) and otherwise, in control group, five of the eight nonunions healed completely, in 240 days (range, 183~283 days). CONCLUSION This clinical study showed a positive effect of LIPUS and LASER on the rate of osseous repair, especially accelerated time to initial callus cortical bridging compared to that of conventional treatment.
PURPOSE This is a retrospective study to analyze the results after retrograde intramedullary(IM) nailing in femoral shaft fractures with limited indications. MATERIALS AND METHODS Twenty-four femoral shaft fractures(21 patients) were operated with unreamed IM nail(Unreamed femoral nail, SynthesR) in a retrograde method and were followed for more than 1 years. There were 16 men and 5 women, and the mean age at index operation was 41 years (range 18-76 years). In Winquist-Hansen classifications, there were 10 of type I, five of type II, three of type III, and six of type IV. All the patients had associated fractures or injuries, and there were eight ipsilateral tibia fractures, five ipsilateral proximal femoral fractures(including neck and trochanter), four ipsilateral pelvic or acetabular fracture, three bilateral femoral fractures, and one ipsilateral knee injury according to the used indications. In radiological study, we evaluated the time for union, non-unions and malunion, and clinical evaluation with Neer 's criteria was done. RESULTS Most fractures(87.5%) were primarily united cases, and the mean time for union was 15.8 weeks(range 12-20 weeks). Three cases of delayed union or nonunion were developed, but a shortening over 1cm or malunion over 10 degrees angular deformity were not found. Evaluating the knee functions, the Neer score was 86.9 in average and all the cases were above satisfactory grade. The average range of knee motion was 120.2 degrees, and the mild knee pain was developed in three cases. CONCLUSION The retrograde IM nailing can be a useful option for femoral shaft fractures with limited indications, including ipsilateral fractures of other areas or multiple fractures.
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Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture Chang-Wug Oh, Jong-Keon Oh, Woo-Kie Min, Shin-Yoon Kim, Seung-Hoon Baek, Byung-Chul Park, Hyung-Soo Ahn, Tae-Gong Kim Journal of the Korean Fracture Society.2007; 20(2): 135. CrossRef
Retrograde Intramedullary Nailing for the Treatment of Ipsilateral Femoral Shaft and Neck Fracture Chang-Wug Oh, Jong-Keon Oh, Shin-Yoon Kim, Ki-Bong Cha, In-Ho Jeon, Byung-Chul Park, Woo-Kie Min, Tae-Gong Kim The Journal of the Korean Orthopaedic Association.2007; 42(3): 380. CrossRef
PURPOSE To compare clinical outcomes and complications between pediatric patients with femoral shaft fracture who had undergone conservative treatment and retrograde flexible intramedullary nailing. MATERIALS AND METHODS 51 cases of 46 pediatric patients who had femoral shaft fracture were retrospectively studied. Hip spica cast was applied 3~6 weeks after traction in 24 cases of conservative treatment group and closed reduction and internal fixation with flexible nails were performed in 27 cases. RESULT Neither pain, limitation of joint motion, nor nonunion was reported in both groups. In radiologic evaluation, 4 cases of angulation more than 10 degrees were observed in conservative treatment group and none of surgical treatment group. In leg length discrepancy(LLD) over 10 mm, there was none in surgical treatment group, but 4 cases were seen in the conservative group. Two cases of limping were observed only in the conservative group. Mean time to weight bearing was earlier in surgical treatment group(7.5 weeks) than that in the conservative group(10.8 weeks). CONCLUSION As treatment of pediatric femoral shaft fracture, retrograde flexible intramedullary nailing had less complications such as LLD and angulation and enabled earlier rehabilitation than conservative treatment.
PURPOSE To investigate the relationship between the complications of intracapsular femoral neck fractures treated by multiple pinning and several affecting factors. MATERIALS AND METHODS Sixty-eight patients with intracapsular femoral neck fractures were treated by multiple pinning from March 1993 to January 2000 and followed at more than one year. Relationship between the complications such as failure of union, collapse of femoral head due to osteonecrosis of femoral head and several affecting factors including displacement of fracture according to Garden stage, state of reduction, position of screws, time interval from injury to operation, and fracture level were analyzed. The Fisher exact test, chi-square test, and multivariate logistic regression analysis were used to find the relevant factors influencing incidence of complications. Statistical significance was set at p < 0.05. RESULTS Position of screw was the most important single factor affecting the results of treatment of intracapsular femoral neck fracture (p=0.046). Moreover, the Garden stage and position of screw were revealed affecting the incidence of complications together with other factors (each p value was 0.028 and 0.027). CONCLUSION We considered that satisfactory position of screw was important to reduce complications after multiple pinning for intracapsular femoral neck fracture. And the results of operation also seemed to closely relate with multiple factors including Garden stage and status of reduction.
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Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures Tae-Ho Kim, Jong-Oh Kim, Sung-Sik Kang Journal of the Korean Fracture Society.2009; 22(2): 79. CrossRef
PURPOSE This retrospective study was performed to know the difficulties and efficient methods of treatment after several types of operations for ipsilateral femoral neck and shaft fracture. MATERIALS AND METHODS Thirteen cases (12 patients) with ipsilateral femoral neck and shaft fracture at the mean age of 36.6(range 21-51), have been followed up over the minimum of one year. All the patients suffered from motor vehicle accidents(11 in dash-board injury), and most of patients associated with multiple injuries including other fractures. All of femoral neck fracture were same type in basicervical area and 4 of them were missed initially. According to the classification of femoral shaft fractures, middle 1/3 fracture was most common in 10 cases and type C in 8 cases. In neck fractures, all cases were treated with multiple pinning, but in shaft fractures, 6 were treated by open plating, 5 by closed antegrade nailing, and 2 by retrograde nailing. RESULTS The mean union period was 12.1 weeks in neck fractures and 9.9 months in shaft fractures. In complications, there were 1 case of nonunion and 1 case of avascular necrosis in neck fractures, and 8 of delayed union, 3 of nonunion, and 2 of malunion, in shaft fractures. The methods of treatment had no influence on the results of this injury, but we had 1 failure in antegrade nailing prior to operation of neck fracture. CONCLUSION After operation of ipsilateral femoral neck and shaft fracture, the shaft fracture needed longer time of union and had many problems in spite of different methods. We suppose that many problems in shaft are affected not only by characteristic mechanism of injury, but also by multiple associated injury.
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Treatment for Concurrent Ipsilateral Femoral Neck and Shaft Fractures Using Reconstruction Nail with Temporary K-Wires Sang-Joon Lee, Sang Hong Lee, Sang Ho Ha, Gwang-Chul Lee Journal of the Korean Fracture Society.2015; 28(1): 23. CrossRef
Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture Chang-Wug Oh, Jong-Keon Oh, Woo-Kie Min, Shin-Yoon Kim, Seung-Hoon Baek, Byung-Chul Park, Hyung-Soo Ahn, Tae-Gong Kim Journal of the Korean Fracture Society.2007; 20(2): 135. CrossRef
Retrograde Intramedullary Nailing for the Treatment of Ipsilateral Femoral Shaft and Neck Fracture Chang-Wug Oh, Jong-Keon Oh, Shin-Yoon Kim, Ki-Bong Cha, In-Ho Jeon, Byung-Chul Park, Woo-Kie Min, Tae-Gong Kim The Journal of the Korean Orthopaedic Association.2007; 42(3): 380. CrossRef
PURPOSE This study was designed to evaluate the indirect reduction or limited internal fixation with hybrid external fixation for bicondylar fractures of proximal tibia.
MATERIALS & METHODS: Twenty-two cases (mean age; 49) proximal tibial fractures have been treated, including 7, type V and 15, type VI. After reconstruction of articular surface, the hybrid fixation was applied at the condyle and shaft with or without limited internal fixation by cannulated screw or one-third plate. We permitted early ROM exercise of knee and partial weight-bearing about 4 weeks after operation. RESULTS Time to union averaged 15.6 weeeks(range ; 11-20 weeks). There were 4 cases of nonunion including three cases of early bone graft for severe comminution and one infection. Functional scoring revealed 5 excellent, 12 good, 3 fair and 2 poor results. 18 out of 22 cases had good or excellent result in anatomical grading. The mean range of knee motion was 116 degrees(from 4.1 to 120 degrees). In complications, there were two cases of malunion, one deep infection, and one pin-site infection, but soft tissue compromise such as skin necrosis was not happened. CONCLUSION The indirect reduction or limited internal fixation with hybrid external fixation for bicondylar fractures of proximal tibia have advantages of anatomic, stable fixation, early mobilization and less soft tissue dissection, so good results of knee function can be accomplished.
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Dual Plate Fixation Compared with Hybrid External Fixator Application for Complex Tibial Plateau Fractures Jae-Sung Lee, Yong-Beom Park, Han-Jun Lee Journal of the Korean Fracture Society.2008; 21(2): 124. CrossRef
PURPOSE To evaluate the usefulness of unreamed nailing inthe treatment of femoral shaft fractures. MATERIALS AND METHODS Between March 1996 and June 1998, unreamed nailing with closed method was done for 74 patients with 82 femoral shaft fractures. The main indications for this treatment were multiple injury or isolated femoral fracture above Winquist type II. The influence of Winquist- Hansen classification, anatomical location, and open injury over bone union and the influence of injury severity score over general complication including fat embolism were investigated. RESULTS Primary union occurred in 76 cases(93%) with 6 cases of nonunion and 10(12%) of delayed union, and mean time to union was 27 weeks. In open fractures, the union time was delayed(32 weeks) rather than closed fracture. In Winquist classification, there was no stastical importance on time to union, but nonunion was most common in Winquist type IV. Anatomical location has no influence on time to union. In the view point of multiple injury, the group above 18 points(31 patients) in injury severity score had none of fat embolism, but the group below 18 points(43 patients) had 2 patients. CONCLUSION The treatment of femoral shaft fractures by unreamed nailing had longer time to union with higher rate of delayed union, and we think that the theoretical advantage of decreasing pulmonary complications is controversial.
PURPOSE The purpose of this study is for the rigid fixation of the pelvic ring by quantifying and comparing the extraction strength of cancellous screws in the sacral ala and body. MATERIALS AND METHODS Six cadaveric human pelvis were obtained for test of the extraction strengths of three groups of 7.0mm cannulated cancellous screws: shortthreaded in the sacral ala, short-threaded in the sacral body, long-threaded in the sacral body. The extraction strengths of these groups were compared with each other. RESULTS The mean extraction strengths of short-threaded screws in the sacral ala, short-threaded screws in the sacral body and long-threaded screws in the sacral body were 10.26N, 25.85N and 48.37N respectively. The mean extraction strength of the long-threaded screws in the body was significantly greater than that of the shortthreaded screws in the ala and body. The mean extraction strength of the short-threaded screws in the body was greater than that of the short-threaded screws in the ala, but insignificant statistically. CONCLUSION In choosing iliosacral lag screws to stabilize the posterior pelvic ring disruption, superior fixation is achieved by inserting the long-threaded screw in the sacral body.
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Crescent Fracture-dislocation of Sacroiliac Joint: Affecting Factors of Operative Results Hee-Soo Kim, Chang-Wug Oh, Poong-Taek Kim, Young-Soo Byun, Joo-Woo Kim, Byung-Chul Park, Woo-Kie Min, Hyun-Joo Lee Journal of the Korean Fracture Society.2009; 22(2): 71. CrossRef
PURPOSE This study was designed to investigate whether intramedullary pressure is different in reamed compared with unreamed femoral nailing in cadeveric femoral bones.
MATERIALS & METHODS: Eight pairs of fresh-frozen cadaveric femoral bones were studied. The diameter of isthmus was checked from 10mm to 14mm and the length of femur was checked from 35cm to 44cm. Intramedullary pressure was measured in the distal femoral shaft at the supracondylar region. Data were monitored in femoral nailing procedures. We utilized the AO universal nail(reamed) and AO unreamed femoral nail. RESULTS Intramedullary pressure increased in the reamed group to 423.8 mmHg(mean pressure) during reaming by starting reamer(9 mm) and in the unreamed group to 290 mmHg(mean pressure) during insertion of nails(p=0.001). In the unreamed groups, the next high intramedullary pressure is 136.6 mmHg during proximal reaming. A statistiscally significant difference in intramedullary pressure was found during the first reaming process in the reamed group compared with the proximal reaming process in the unreamed group(p=0.005). CONCLUSION The data indicate that the intramedullary pressure during unreamed nailing process is lower than reamed nailing process. So we can consider that the unreamed nailing in multiple fracture or pulmonary injured patients is a good modalities.
PURPOSE : this paper was to evaluate the treatment results in the viewpoint of bone union, union time, and complications including infection of unreamed nailing of pen tibial fractures. MATERIALS AND METHODS : We reviewed 46 open tibial shaft fractures that were treated with unreamed tibial nail. AO unreamed tibial nail was inserted after reduction under image intensifier control, Considering factors were severity of open wound, type and location of fractures. RESULTS : Average union time of open fractures was 21.3 weeks, nonunion rate was 2/46(4%). Average union tiome were 24.1, 19.7, 24, 24, 20 weeks in open grade I , II, IIIa, IIIb, IIIc fractures. According to the type of fractures, average union time were 20.4, 23.6, 25.7 weeks and nonunion rate were 0/22, 1/18, 1/6 in type A, B, C fractures. According to the level of fractures, average union time were 24.0, 20.0, 24.1 weeks in proximal, middle, and distal fractures. There was no signficant differences in average period of radiologic union, infection rate and nonunion rate according to fracture level, open grade, but longer union time and higher nonunion rate were observed in complex and comminuted fractures(p<0.05). CONCLUSION : With adequate soft tissue treatment, the unreamed intramedullary nailing can be a good treatment modality for open tibial shaft fractures, even to grade IIIB.
PURPOSE : To evaluate the results of the treatment of distal tibial fracture using ring or hybrid ring external fixator and to compare the results according to the influencing factors. MATERIALS AND METHODS : The authors analized 30 patients, 31 cases of distal tibial fracture who were treated by Ilizarov ring external fixator or hybrid ring external fixator at our hospital from May 1996 to August 1998 and were followed up over 1 year. The type of distal tibial fractrue were classified according to AO group, type A was 7 cases, and type C was 24(C1:5, C2:4, C3:15)cases. Restoration of articular surface of the distal tibia was performed through closed method or minimal invasive technique by minimal internal fixation with K-wire or screw. Then fixation of th distal tibia was done by ring external with multiple transfixing wire. Connection to the tibial shaft was done by Ilizarov ring external fixator(15 cases), or mono-external fixator(Dyna-Extor, 16 cases). RESULTS : By Tornetta's assessment of functional results, excellent was 5, good 19, fair 4 and poor 3cases. According to AO classification, the functional results of type A, 7cases were all above good results, among 24 cases of type C, 4cases of C1, 2 cases of C2, and 11 cases of C3 were above good results and there was no statistical difference between the results and the fracture type(P=0.024). One of 3 cases of poor functional results was open type C3 fracture and was complicated with osteomyelitis and refracture, and others two cases type C2 fracture which were complicated with malunion. CONCLUSION : The authors had a good results without soft tissue complication after the treatment of distal tibial fracture patients by Ilizarov ring external fixator or hybrid ring external fixator.
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Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator Suk Kyu Choo, Kyung Wook Nha, Hyoung Keun Oh, Dong Bong Lee Journal of the Korean Fracture Society.2007; 20(4): 323. CrossRef
PURPOSE In the evaluation of acetebular fractures, conventional radiography is limited by distortion, magnification, and overlap of fracture fragments. Computed tomography(CT) has already been shown to be superior in this field. The purpose of this paper was to use 3D reformations for classification of acetabular fractures and planning of operation. MATERIALS AND METHODS From July 1994 to December 1998, we reviewed 40 acetabular fractures. We evaluated fractures as plain X-ray(inlet & outlet view, AP view, obturator foramen & illiac wing view), axial CT with 3 mm slices, and 3D reformations. We classified fractures by classification of Letournel. RESULTS 32 cases of 40 cases were displaced fractures, We recognized fracture easily in 3D reformations. 12 cases were posteior wall fracture. 9 cases were both column frctures. We interpretated both column fractures difficultly in plain X-ray, but we had many informations about rotation & displacement of fracture fragment by 3D reformations. Undisplaced fracture was 8 cases. We interpretated undisplaced fracture difficultly in 3D reformations and distinguished difficultly from normall 3D reformations. CONCLUSION 3D reformations were useful for analysis of complex displaced fracture but not useful for analysis of undisplaced fracture. Acetabular internal oblique view was useful for analysis of quadrilateral space & posterior wall fractures. Acetabular external view was useful for decision of surgical approach.
The purpose of this article is to delineate factors important in successful management and subsequent extremity function of the patient with arterial injury associated with fractures or dislocations around the knee.
We reviewed 25 cases of arterial injury associated with fractures or dislocations around the knee which were treated at our hospital between 1994 and 1998.
As long term results, the salvage rate of the lower limb was related to the extent of the soft tissue damage and the severity of infection, but there was no statistical difference according to the method of vascular surgery(p=0.645). Compared with the salvage rate of the lower limb according to the length of time from injury to vascular reanastomosis, there was no statistical difference between two groups of the patients who were operated within 12 hours and were operated during the time between 12 hours and 24 hours(p=0.084). In view of whether open or closed fractures were combined, 1 I cases(58%) among 19 cases of open fractures and 5 cases(83%) among S cases of close(1 fractures were able to salvage the lower limb, so it could contributes to the sdlvdge rate of the limb. Finally 16 cases(64%) among total 25 cases were able to salvage the lower limb, and its functional outcome was like followings : excellent results were found in 6 cases, fair results in 8 cases, poor results in 2 cases, and amputation in 9 cases(36%).
In case of amputation, 3 cases were primarily amputated and 6 cases were amputated secondary to vascular surgery .
As long term results, whether open or closed fractures were combined, the teverity of the infection and the extent of the soft tissue necrosis were the factors influencing on the falvage rate of the lower limb. Other factors, such as the difference of ischemic time within 24 hours interval, the site and the method of management of the fractures and the vascular injuries and whether fasciotomy was performed or not were not important factors influencing on the salvage rate of the lower limb.
The purpose of this paper was to evaluate the results of the femoral shaft fractures by reamed Russell-Taylor intramedullary nailing in the viewpoint of union time and complications. We reviewed 59 femoral shaft fractures. According to the type of fractures(Winquist-Hansen classification), average union time were 20.1 and 23.5 weeks in type 1, 2 and 3, 4, and nonunion rates were 12.5% and 10.5% in type 1, 2 and 3, 4. According to the level of fractures, average union time were 19.9, 20.3, 23.4 weeks in proximal, middle and distal fractures, and nonunion rates were 6.7%, 8.8%, 30% in proximal, middle and distal fractures. According to the reduction techniques, average union time were 20.0 and 21.5 weeks in closed and open reduction, and nonunion rates were 5.9% and 20.O% in closed and open reduction. According to the Methods of interlocking screw fixation, average union time were 19.3 and 20.7 weeks in dynamic and static fixation, and nonunion rates were 25% and 9.8% in dynamic and static fixation. There was no significant differences in averdge union time between closed and open fracture group, closed and open reduction group, and dynamic and static fixation group. There was significant differences in union time between simple and complex, comminuted fractures(P<0.05), and between distal and proximal, middle fractures(P<0.05). Also there was significant differences in nonunion rate between fracture reduced with closed and open technique(P<0.05). In conclusion, reamed Rustell-Taylor intramedullary nailing can be a uheful treatment modality in femoral shaft fracture if closed reduction is available. However, there was high complication rate including failure of screw, varut deformity, delayed union time in distal femoral shaft fractures.
In this situation, we should consider other treatment method.
From 1996, in the 13 fractures of the acetabulum surgically treated in Kyung Pook National Hospital and Sae-Myung Orthopedics, cerclage grip system(DALL-MILES) have been used as reduction and fixation tool. Cerclage cable inferted through the greater sciatic notch to a point just cephalad to the anterior inferior spine was greatly helpful for both reduction and internal fixation of thirteen complex acetabular fractures. This technique is especially useful when the fracture line extend into the greater sciatic notch. This is true of high posterior column fractures that extend up into the upper part of the notch, transverse fractures that have an anterior or posterior limb that is high, and both column fractures through ilioinguinal approach with T- extension. Reduction was achieved to within 3mm in 11 cases and 6mm in 2 cases. This reduction was maintained until nuion. The technique may contribute to fracture stabilization, but supplementary fixation was added in 12 patients with curved reconstruction plate over pelvic brim and posterior column in 1 patient.
Infected nonunion developed after open reduction and internal fixation is one of the serious complications among the treatments of fracture of long bone. It is very difficult to eliminate the infection, to correct the deformity and defect at the same time obtaining union. All six cases were male, the average of age was 34 years old from 21 to 49. Five cases were closed fracture and one was open fracture. For the primary internal implant, five cases were plate and one was intramedullary nail. About the 6 cases of infected nonunion of femur from June, 1994 to October, 1996, we performed the following procedure : after removal of internal fixation, extensive debridememt, complete sequestrectomy, firm fixation with Ilizarov external fixator, compression at fracture site and early autogenous cancellous bone graft. We obtained following results : 1. The average duration of infection was 7.8 months, average duration of bone union was 5.8 months. Average duration of follow-up was 17.5 months. 2. The average shortening of leg was 1.4cm. 3. According to classification of Paley and Catagni, the bone results were excellent in all cases, functional results were excellent in 4 cases and fair in 2 cases.
4. In conclusion, firm fixation with Ilizarov fixator, sequestrectomy, early autogenous cancellous bone graft and compression is one of the good treatment modalities of infected nonunion of the femur.
From June 1993 to May 1997, 12 patients aged from 13 to 41 years were treated for infected nonunion with bone defect by the Ilizarov technique. Of 12 cases, 9 cases were tibia and 3 cases were femur. The cuases of nonunion were open comminuted fractures with initial bone loss and bone defect after removal of sequestrum. Infection was managed by radical resection of the infected necrotic bone and insertion of antibiotics mixed cement beads. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length inequality was achieved by means of external lenghthening technique. Corticotomies were performed at the proximal level(7), at the distal level(5). The average optained length averaged 4.8cm in length and healing index averaged 67.4days/cm According to paley and Catagni's callification bony and functional results were either excellent or good execpt I case (nonunion, poor bony result). The complications (devided by paley to 3 categories: problems, obstacles, complications) were pin tract infecton(8), pain(5), mild flexion contracture of joint(1), delayed consolidation(3), soft tissue impingement(2), joint stiffness(3) and nonunion(1). We concluded that Ilizarov techinque was very effective for treatment of infected nonunion with bone defect and soft tissue defect.
The treatment of supracondylar fracture of humerus in children has so many pitfalls as to be once called - supracondylar dilemma -.
The authors analyzed the follow up results of 53 displaced extension type supracondylar fractures treated by closed reduction and cast, closed reduction and percutaneous pinning, skeletal traction and open reduction from 1993 to 1995.
The following results were obtained : 1. Closed reduction and percutaneous pinning produced the best radiographic and clinical result by Flynns criteria when compared to other methods.
2. No difference in radiographical stability was found between percutaneous pinning with one medial and one lateral pin as opposed to two lateral pins.
3. There was a strong correlation between the change in Baumanns angle and the carrying angle(p=0.03).
The management of supracondylar and interconylar fractures of the femur is fraught with a wide range of potential complications. Particularly, the type C3 fracture of AO classincation easily result in catastrophe in the form of traumatic arthritis, angular deformity, shortening, infection, post- operative joint stiffness and nonunion. During recent years. new concept and techniques of surgical treatment has been developed which permit more accurate anatomical reduction and stable internal fixation. We reports five cases of type C3 supra-interconylar fractures of the femur managed by modiHed extensile approach technique of Schatzker.
The significant risk to life associated with the hip fracture has long been recognized, and the reports of poor prognosis are well known with wide range of mortality rates. We retrospectively studied 164 patients(older than 60 years) who had a hip fracture to determine the effects of the age, treatment methods, pre-existing medical condition, operative delay after injury, type of fracture, and others on patient mortality.
The summarized results were as follows ; 1. One hundred twenty three patients survived and forty one patients died(overall mortality rate; 25.0%).
2. Twenty one patients died within one year(one-year mortality rate, 12.8%).
3. Mortality was related to age of patient at injury, ASA classification, absense or presence of operative treatment, operation-related complication, which were statistically ignificant (P<0.05).
4. The operative delay after injury did not influence mortality, but we think that it is not signifcant because this study was done retrospectively.
Citations
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Analysis of the Risk Factors and Clinical Outcomes of Femoral Intertrochanteric Fractures in Patients over 65 Years Old Chul Hong Kim, Kyu Yeol Lee, Sung Soo Kim, Myung Jin Lee, Lih Wang, Hyeon Jun Kim, Jung Mo Kang Hip & Pelvis.2013; 25(2): 127. CrossRef
The Analysis of Postoperative Mortality after Bipolar Hemiarthroplasty for Hip Fractures in the Elderly Dukhwan Kho, Kyoungmo Nam, Sunghak Oh, Hyeungjune Kim Hip & Pelvis.2013; 25(4): 267. CrossRef
Postoperative Mortality and the Associated Factors in Elderly Patients with Hip Fracture You-Sung Suh, Yong-Beom Kim, Hyung-Suk Choi, Hong-Kee Yoon, Gi-Won Seo, Byung-Ill Lee Journal of the Korean Orthopaedic Association.2012; 47(6): 445. CrossRef
One-Year Mortality Rate of Patients over 65 Years Old with a Hip Fracture Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Young Hwa Choi Hip & Pelvis.2011; 23(2): 137. CrossRef
Postoperative Mortality and the Associated Factors for Senile Hip Fracture Patients Dong-Soo Kim, Hyun-Chul Shon, Yong-Min Kim, Eui-Sung Choi, Kyoung-Jin Park, Se-Hyuk Im The Journal of the Korean Orthopaedic Association.2008; 43(4): 488. CrossRef
The treatment of the tibial piateau fractures has been under discussion for several decades, but no final answer has been reached. But many surgeons today believe that open reduction and internal fixation of commninuted, severly depressed, or displaced fractures are indicated The goal of the surgery is anatomic reduction of joint surface, rigid fixation, and early range of motion. This retrospective study evaluated 40 cases of tibial condylar fractures that treated surgically at the Department of Orthopaedic Surgery Kyungpook National University Hospital from February, 1991 to August, 1995. The minimum follow up period was 13 months and average follow up period of the patients was 33 months.
The obtained result were as follows: 1. There were forty patients treated by surgically, the mean age was forty-six, and thirty patients were male, ten patients were female., thirty-one patients involved in motor vehicle accidents.
2. The most common type of the fracture was SchatBker type II in 10 patients., the most common associated soft tissue injury was rupture of the ipsilateral medial collateral ligament.
3. The most common method of the treatment was minimal screw fixation and bone graft in 20 cases.
4. The thirty-one cases (77.5%) had satisfactory result according to the Blokkers criteria among 40 cases. There were 2 superficial infections and 1 deep infection for post operative complications.
5. We had good result by anatomical reduction of the articular surfaces and early knee motion and delayed weight bearing for the treatment of the displaced, comminuted tibial condylar fracture.
There are many procedures described for the treatment of complete acromio-clavicular dislocationn but there are still controversies concerning the best management of these injuries. Surgical treatment modalities for complete acromio-clavicular dislocation are variable and usually successful. The fiftheen cases were treated at the Department of Orthopedic Surgery, Kyungpook National University Hospital, from January 1990 to July 1993. And they had been followed for average 22 months. The following results were obtained.
1. According to classification by Rockwood and Green. Grade li[ were 7 cases and Grade V 8 cases.
2. Of the 15 cases,2 cases were treated by conservative method, and 13 cases by operative mothods.
3. The clinical results according to Weitzmans criteria were excellent in 9 cases(60%), good in 4 cases(26.7%) and fair in w cases(13.3%).
4. The complications were pin migration, breakage, loosening, calcification of coraco-clavicular joint in 1 case respectively and recurrent dislocation after pin removal in 2 cases.
5. We thought that the operative procedures are indicated in the treatment of type III & V complete dislocation of acromio-clavicular joint.
For fixation of small osteochondral fracture fragment which was difficult to fix with ordinary fixation device in comminuted acetabular posterior wall fracture, we employed a modified 3.5mm one thired tubular plate that was shaped into so-called hooked spring plate. During operation, one end of a plate with two to five hole is flattened for a lenght of 1cm. The flattened end is fashioned into two spikes by trimming the end to the adjacent screw holes with a wire cutter. The resultant spikes are bent to 90 with respect to the plate. The residual proteion of the plates is contoured with convex bow with respect to the surface of the bone. The hooks are placed either through the capsule and around the edge of the fragment or they are embedded into the fragment itself. Six consecutive patients undergoing Kocher-Langenbeck approach for open reduction with internal fixation of posterior wall acetabular fracture(7/91-1.93) were reviewed.
There were five simple type and one associated type, as transverse and posterior wall. In two cases application of spring plate in isolation was done.
In four cases application of spring plate as part of a reconstruction plate assembly was done All six fractures progressed to union without any loss of the reduction of fixation.
In conclusion, the application of spring plate is mechanically sound, valuable for fixation of difficult small osteochondral fractures with avoidance of intaarticular penetration of metal. This method eliminates the need to employ screws in the immediate juxta-articular portion of the plate and promotes early rehabilitation.
Citations
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The Surgical Outcomes of Isolated Greater Tuberosity Fractures of the Proximal Humerus Fixed with the Spring Plate Dong-Ju Shin, Young-Soo Byun, Se-Ang Chang, Hee-Min Yun, Ho-Won Park, Jae-Young Park Journal of the Korean Fracture Society.2009; 22(3): 159. CrossRef
We analyzed Twenty eight cases of femoral head fracture associated with posterior hip dislocation managed in Kyungpoek National University Hospital between 1984 march and 1993 June. Classification was made by Pipkin and we added impaction fracture as another classification by post reduction CT finding.
The results were as follows 1. Most common type of fracture was impaction of femoral head by CT, Which is not included by pipkin classification.
2. Excellent, or Good result according to Epstein criteria, 7 of 8 cases in Pipkin type I, 1 of 3 cases in type II ,0 off 4 cases in type III , 1 off 4 cases in type IV, 6 off 9 cases in impaction racture.
3. There were no significant difference between the results of operative treatment and conservative treatment.
4. Post reduction CT was useful to determine the method of the further treatment.
5. Complications were avascular necrosis in 5 cases, posttrumatic arthritis in 3 cases, sciatic nerve paresis in 2 cases, heterotropic ossification in 1 case.