High energy tibial plateau fractures are associated with wevere articular depression, separation of both condyles, diaphyseal comminution and dissociation & loss of integrity of the soft tissue envelop. Thus it is very difficult to treat these fractures satisfactorily and severe complications may be developed. Authors carried out plate and screw fixation in 11 patients and external fixation(Ilizarov external fixator) with limited internal fixation in 8 patientsl who sustained high-energy tibial plateau fracture between Jan. 1992 and Feb. 1996. We compared the operative results of plate and screw fixation and external fixation with limited internal fixation in high-energy tibial plateau fractures which was follow up from 12months to 28months. The results were as follows; 1. The complications such as limitation of knee motion(3 cases), traumatic arthritis(1 case), angular deformity(2 cases), superficial infection(2 cases), deep infection(1 case), instability(1 case) were observed in plate fixation group. Limitation of knee motion(1 case), traumatic arthritis(1 case), delayed union(1 case) were developed in external fixation group. 2. According to Blokker's criteria, 6 cases(55%) among 11cases of plate and screw fixation group and 5 cases(63%) among 8 cases of Ilizarov external fixator group had satisfactory results.
Ilizarov external fixation with limited internal fixation is useful method of treatment for high-energy tibial plateau fractures when extensive dissection and internal fixation are contraindicated due to comminution at the fracture site and compromise of the soft tissue.
The reduction and maintenance of the disphyseal fractures of the forearm bone are difficult due to the special rotational movement between two bones. Over the years various methods of operative treatment have been advocated, and good method must be selected as the fracture level, the fracture type, and the patients general condition.
From May 1988 to August 1993, the authors have reviewed 50 patients of the forearm shaft fracture except the solitary radius or ulna fracture with minimum 1 year follow up which were treated in Department of Orthopedic Surgery, Korea University Hospital.
The results obtained were as follows, 1. The most common cause of injury was the traffic accident(38%) and the next was the fall down(24%). The most frequent level of the fracture was middle one-third(54%) and the most common type of the fracture was transverse fracture(64%). The treatment methods were 32 cases of the compression plate and screw fuation in the radius and ulna, and 18 cases of the compression plate and screw fixation in radius and the intramedullary nailing in ulna.
2. The average duration of the radiological union of compression plate and screw fixation of radius and ulna was 12.5 weeks in radius and 12.1 weeks in ulna, and 12.8 weeks of radius and 15.2 weeks of ulna in cases of compression plate and screw fixation of radius and intramedullary nailing of ulna.
3. According to Grace and Eversmanns evaluation, satisfactory results (Excellent and Good) were 81.5% of compression plate and screw fixation and 83.3.To of compression plate and screw fixation of radius and intramedullary nailing of ulna.
4. Postoperative complication were 2 cases of superFicial wound infection and each 1 case of transient posterior interosseous nerve injury, non-union and non-union with metal failure in compression plate and screw fixation of both radius and ulna, and 1 case of non-union in intramedullary nailing of the ulna.
Citations
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Comparison of Locking versus Dynamic Compression Plates for Treatment of Diaphyseal Forearm Fracture Yong Chan Lee, Hong Je Kang Journal of the Korean Society for Surgery of the Hand.2015; 20(4): 168. CrossRef