Journal of Musculoskeletal Trauma

Major Limb Replantation of Lower Leg Amputation with Ipsilateral Distal Femoral Comminuted Fracture in Old Age: A Case Report: Tae Young Ahn, Seung Joon Rhee, Sang Ho Kwak, Hyo Seok Jang, Sang Hyun Lee; J Korean Fract Soc 2019;32(4):227-231. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.227

Abstract PDF: The development of microsurgical techniques has also increased the success rate of replantation surgery. This paper reports the results of limb replantation performed on a lower extremity amputation that was associated with crush amputation and an ipsilateral comminuted fracture in and elderly patient. A 68-year-old female presented with a right distal tibia amputation due to a traffic accident. At that time, with a comminuted fracture in the distal femoral condyle, simple wound repair was recommended, but the caregivers strongly wanted replantation. Three years after surgery, normal walking was possible without a cane and the patient was satisfied with the function and aesthetics. What used to be contraindicated in limb replantation in the past are now indications due to the development of microsurgical techniques, surgical experience, and postoperative rehabilitation treatment. If the patient is willing to be treated, good results in contraindications can be obtained.

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Results of the Kapandji Procedure in the AO Type C Distal Radius Fracture in Patients over Age 60: Chul Hong Kim, Sung Soo Kim, Myung Jin Lee, Hyeon Jun Kim, Bo Kun Kim, Young Hoon Lim; J Korean Fract Soc 2012;25(3):191-196. Published online July 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.3.191

Abstract PDF: PURPOSE
To evaluate the clinical and radiologic results of the Kapandji procedure in AO classification type C distal radius fracture patients over 60 years old.
MATERIALS AND METHODS
Twenty-one type C distal radius fracture patients over the age of 60 years who were treated with the Kapandji procedure from June 2004 to June 2009 in our hospital and had a post-operative follow-up period of more than 1 year were enrolled. The volar tilt, radial inclination, and radial length were measured for the radiographic analysis using the modified Lidstrom scoring system about post-operative reduction loss in every follow-up radiogram. The clinical result was assessed with a visual analogue scale (VAS) and Korean Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) score at the last follow-up.
RESULTS
The mean radiologic loss of volar tilt was 1.1degrees and the mean loss of radial length was 2.6 mm and the mean radial inclination loss was 2.7degrees compared with the immediate post-operative period and last follow-up period. The average VAS and DASH scores were 1.4 and 15.9.
CONCLUSION
The radiologic results of closed reduction and percutaneous pinning using the Kapandji technique for distal radius AO type C fracture patients over 60 years of age was not satisfactory. Nevertheless, the clinical results were satisfactory.

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Treatment for Intractable Infected Nonunion of Lower Extremity in Elderly People using External Fixator: Seung Jun Park, Jong Sup Shim, Sung Kee Shin; J Korean Fract Soc 2004;17(2):177-183. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.177

PURPOSE
To introduce and report the results of treatment of old patients' infected nonunion using external fixator.
MATERIALS AND METHODS
Nine patients more than 60 years old were included in the study. Four cases had combined medical problems of diabetes, hypertension, and vascular disorder. We used Ilizarov fixator in eight cases and uni-lateral external fixator in one. All patients were treated with debridement, broad sequestrectomy, segmental resection, bone graft and compression of fracture site about 1~1.5 cm. We evaluated the final results by functional result and complication according to the criteria of Paley.
RESULTS
Average length discrepancy was 1.7 cm before operation by initial bone loss and final follow-up shortening was average 2.6 cm. Mean duration of fixtor removal was 5.2 months. We acquired bony union lastly in 8 cases. Final functional result was 3 excellent, 2 good, 2 fair and 2 poor. Among them, 2 good, 1 fair and 1 poor cases had medical problem.
CONCLUSION
In old patients, compression of nonunion site and early joint motion using external fixator seemed to be very useful in the treatment of intractable infected nonunion of lower extremity and in minimizing duration of treatment.

Citations

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Treatment of Infected Nonunion
Sang-Ho Ha
Journal of the Korean Fracture Society.2007; 20(2): 206. CrossRef

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A comparison of fixation with Ender nail and sliding screw plate in intertrochanteric fractures of elderly patients: Joo Hyoun Song, Yong Koo Kang, Han Yong Lee, Hae Seok Koh, Kee Won Rhyu, Kwang Won Lee; J Korean Soc Fract 1999;12(2):203-211. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.203

Abstract PDF: In order to investigate the correlation between morbidity of the elderly patients and method of fixation, we analyzed 39 elderly patients had undergone internal fixation with Ender nail or sliding screw plate for the intertrochanteric fractures of the femur from January 1992 through December 1995. Among the 39 patients, 20 patients and 20 fractures were treated with Ender nail. Mean follow-up period was 26 months and average in age was 76.2 years Remaining 19 patients, 19 fractures were treated with sliding screw plate Mean follow-up period was 25 months and average in age was 75.4 years. The results obtained were as follows : 1. In the cases where Ender nails were used, the average operation time took in the average of 45 minutes and whereby, in the cases where sliding screw plates were used, took in the average of 110 minutes. 2. During the operation time, the amount of hemorrhage in the cases of Ender nail was about 100ml and the sliding screw plate resulted in about 350 ml. And the average amount of transfusion was 0.9 pints in cases of Ender nail and 2.3 pints in cases of sliding screw plate. 3. Among 20 patients fixed with Ender nail, only 2 patients had to be cared at ICU, but 9 of 19 patients had to be cared at ICU in the cases of sliding screw plates. 4. In the cases of Ender nail, the radiologic bony union time was about 13.4 weeks and they could walk with supports with in a week. But, in the cases of sliding screw plate the radiologic bony union time was about 16.2 weeks and they could walk with orthrosis at 28.4 days postoperatively. 5. Most patients treated with Ender nail were suffered from the problem at knee and protrusion of Ender nail into the hip joint, backing out of nail through the entry, coxa valga deformity were major complications after the operation. In the cases of sliding screw plates, loosening of sliding screw with coxa vara deformity, wound infection and delayed union were major complications. 6. Despite of many complications, if the indication is chosen well, the fixation with Ender nail will result in a benefical treatment method in the elderly patients for its advantages in general condition of the patients.

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Analysis of Rick Fractors of HiP fractures after the eighth Decade of Life: Seung Ho Yune, Sang Rho Ahn, Chan Hee Park, Jun Young Yang; J Korean Soc Fract 1994;7(1):131-136. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.131

Abstract PDF: In Order to evaluate to the risk factors of hip fracture, we reviewed 34 patients, who were over 70 years old, from Jan. 1991 to Dec. 1993. The patients who have preexisting desease such as chronic illness, or in case of traffic accident, and fall down injury were excluded. We measured the singhs index and femoral neck-shaft angle on simple X-ray, bone mineral density for quantitative measurement of mineral on dual photon absorptiometry, and calcium, phosphate, and alkaline phosphatase on serologic study. We compared the results with control group who have not orthopaedic problems in 20 old aged person, and the results obtained were as follows. 1. The male to female ratio is 11:23, a high rate in female, and the mean age of patients is 74.3 years old, ragne from 70 to 89 years. 2. Femoral neck-shaft angle of patient group is 141.67Â±5.3 compared to 143.40Â±4.8 of control, showed statistical significance. 3. Bony trabeculae index of proximal femur of patient group is 1.83Â±0.83 compared to 2.91 Â± 0.86 of control, showed statistical significance. 4. In patient group, about 30% decreased in bone mineral density compared control. This result must be requisite to reinvestigation and statlstical analysis were not carried due to numbers of members of control. 5. There is no significant difference between two groups regard to serologic study. In summary, risk factors of hip fractures are aged female with decreased femoral neck-shaft angle, below third degree in singhs index and lower bone mineral density compared with same age. According to the our data, in case of hip fractures in old aged, for prevent the postoperative complication and refracture, prophylactic theraphy to collectible causes are required, in addllion to operative internal fixation.

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