PURPOSE Because the prognosis of the mid 1/3 clavicle fracture is good, the conservative treatment with a figure of 8 bandage is the gold standard and the nonunions are rare.However, recently surgical treatment is recommended when the shortening and displacement is severe because of the high nonunion rate and the poor clinical result. This study was undertaken to evaluate that the shortening and displacement at fracture site are associated with the development of nonunion. MATERIALS AND METHODS We analysed the 194 fractures of mid 1/3 clavicle in adults which had been treated conservatively from February 1993 to January 2002 and did the retrospective study. Of these, 78cases were originally in the middle third of the clavicle and had been completely displaced. We reviewed 63 of these cases. The shortening and displacement at the fracture site was measured on the initial roentgenogram. And the analysis of the patients 'chart was done for another predisposing nonunion factors. Nonunion and delayed union are considered to be present when there has been little or no progression of clinical or radiographic healing at a minimum of 4 months after injury. RESULTS 15 of the 63cases had developed nonunion.. The average 8.6mm(2mm-17mm) shortening and average 9.7mm(2-22mm) in the union patients. The average 14.5mm(3mm-37mm) shortening and average 17.3mm(4-25mm) in the nonunion patients. We found that initial shortening > or =1 8 m m ( Fisher's exact test, p <0.01) and initial displacement > or =16mm(Chi-square test, p <0.01) at the fracture site were siinificantly associated with the development of nonunion. CONCLUSION The conservative treatment with figure-8-bandage is the gold standard in the clavicle middle one third fracture. However, the nonunion is commonly occurs in the cases of more of severely shortened and displaced fractures. If there are no signs of callus formation and the patient complains of pain after several weeks, osteosynthesis should be considered.
PURPOSE The purpose of this study is to analyze the clinical and radiological result of surgical treatment for femoral shaft nonunion. MATERIALS AND METHODS From January 1993 to December 1999, 21 cases of femoral shaft nonunion were treated surgically and followed for an average of 15 months. We analyzed initial cause of injuries, classification of fractures, and cause of nonunion in clinically and radiologically. The authors analyzed the average time to union and results after surgical treatment by rigid internal fixation with interlocking intramedullary nail and autogenous bone graft. RESULTS The mean duration of bony union was 22 weeks and bony union achieved in 18 cases(85.7%) of 21 cases. The complications were shortening of leg length and limping gait in 2 cases, partial limitation of knee joint in 2 cases, superficial infection in 2 cases. CONCLUSION Rigid internal fixation with interlocking intrameduallary nail and bone graft is useful method of treatment for femoral shaft nonunion according to cause and type of nonunion.
PURPOSE The malunited diaphyseal tibia fractures result in tibial shortening, angular deformities, gait disturbance, development of joint pain, etc. The authors analyzed the results of treatment consist of corrective osteotomy for diaphyseal malunion with internal or external fixation. MATERIALS AND METHODS The authors reviewed 18 cases of tibial diaphyseal malunion treated in Korea Veterans Hospital between January 1992 and December 1998. Mean follow-up period was 4.2 years. The preoperative deformities were varus, anterior or posterior bowing and shortening. The preoperative symptoms were knee joint pain, ankle joint pain, and gait disturbance. Corrective osteotomy was done on the site of malunion in all cases. Fixation were done with IM nailings(13 cases), plates(3 cases) and Ilizarov external fixator. We analyzed the unions radiologically and the knee pains with HSS score. RESULTS All malunions were successfully corrected. Mean duration of union was 4.5 month. In the coronal plane, preoperative varus deformity(mean 16.5degrees varus) was corrected to 3degrees of valgus. In the saggital plane, anterior and posterior bowing was corrected to neutral. In 15 cases of the patient with knee joint pain, the mean HSS score was improved from 69 preopertively to 82 postoperatively. CONCLUSION The correction of tibia diaphyseal malunion had good results by osteotomy at the malunited site and firm internal or external fixation. And it also improved knee joint pain significantly.
PURPOSE The authors have analyzed clinical and radiological results of the femoral neck fractures to evaluate the difference Knowles pin and cannulated screw fixation group. MATERIALS AND METHODS The patients were devided into two group retrospectively, Group I included 35 cases that were treated with Knowles pin fixation for femoral neck fracture and Group II included 30 cases that were treated with cannuled screw fixation for femoral neck fracture. Clinical information included operation time, total blood loss and functional outcome. Postoperative X-ray information included Garden alignment index, duration of union and complication(P>0.05). RESULTS There was no difference between the two fixation group regarding duration of union, functional outcome by Lanceford's method and complication(P>0.05). CONCLUSION Knowles pin fixation and cannulated screw fixation were considered to be proper as a fixaton method in a fracture of the femur neck.
PURPOSE To analyze the clinical and radiological result of diaphyseal fractures of the forearm both bones treated by plate fixation and plate fixation with intramedullary nailing. MATERIALS AND METHODS We reviewed 52 cases of diaphyseal fractures of the forearm both bones in adults that were treated and the follow-up period was 1 year above. The first group(I), 25 cases(48.1%) were treated with plate fixation in radius and ulna, the second group(II), 27 cases(51.9%) were treated with plate fixation in radius and threaded Steinman pin fixation in ulna. we analyzed the results by average union time and functional result according to Anderson's criteria. RESULTS The mean duration of union was in the first group, 12.3 weeks in the second group, 13.2 weeks. By Anderson's criteria, in the first group, 21 cases(84%) and in the second group, 22 cases(81.5%) had a good result. As complications in the first group, non-union 2 case, angulation deformity 1 case, rotational deformity 1 case and in the second group, non-union 4 cases, angulation deformity 2 cases. CONCLUSION We considered that satisfactory results can be obtained by rigid internal fixation with plates in radius & ulna and early mobilization in fractures of forearm both bones in adults and according to the type of fracture, Fixation with plate in radius and threaded Steinman pin in ulna was one of the proper methods.
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Treatment of a Segmental Ulnar Shaft Fracture and an Olecranon Fracture Myoung Soo Kim, Kyu Pill Moon, Hyung Joon Cho, Jung Yun Bae, Kuen Tak Suh Journal of the Korean Orthopaedic Association.2010; 45(6): 496. CrossRef
Treatment of Forearm Shaft Fracture with Modified Interlocking Intramedullary Nail Kwang-Yul Kim, Moon-Sup Lim, Shin-Kwon Choi, Hyeong-Jo Yoon Journal of the Korean Fracture Society.2008; 21(2): 157. CrossRef
PURPOSE : To analyze the clinical and radiological result of femoral trochanteric fractures treated by using Ender nails in elderly patients.
MATERIAL AND METHODS :Sixty seven patients of femoral trochanteric fractures treated at Korean Veterans Hospital from 1993 to 1997 were included in this study. Under the C-arm guided, closed reduction and internal fixation with Ender nails was done within one week. According to Kyle classification, we classfied type I in 12case, type II in 20cases, type III in 25cases, typeIV in 20 cases and analyzed duration of bone union, ambulatory ability and postoperative complication. RESULT : The duration of union was from 14 weeks to 17 weeks and the mean was about 15.5 weeks. Thirty seven(60.7%) patients maintained their prefracture ambulatory ability at a postoperative 1 year and twenty four(39.3%) patient lost some degree of ambulatory ability. Postoperative complications were the knee pain and the limitation of the motion of the knee in 10 cases(14.9%), external rotation deformity in 7 cases(10.4%), distal migration of nails in 4 cases(5.9%), proximal migration of nails in 2 cases(2.(%), nonunion in 2 cases(2.9%). CONCLUSION : We conclude that the treatment by using Ender nails is one of the proper methods in elderly femoral trochanteric fracture with associated medical complication.
PURPOSE : In the proximal tibial condylar fractures, the authors analyzed the treatment results clinically and radiologically, after arthroscopically assisted accurate anatomical reduction of articular surface and rigid internal fixation with early mobilization. MATERIALS AND METHODS : We reviewed 56 cases of tibial condylar fracture that were treated at our the orthopaedic department between January 1990 and December 1996 and the follow-up period was 1 year above. According to Schatzker's classifications, we classified the type of fracture and we analyzed the results by average union time and Porter's criteria after accurate anatomical reduction of articular surface and rigid assisted redcution of articular surface and internal fixation. RESULTS : According to Schatzker's classification, Type I 15cases, TypeII 14cases, TypeIII 6 cases, TypeIV 7cases, TypeV 3cases, TypeVI 11cases, Associated soft tissue injuries were total 22cases the were MCL injuries 12 cases, lateral meniscal injuries 6 cases. The average union time was 15.5 weeks and by Porter's criteria, 56 cases, of which 39 cases(71%) had an good result. CONCLUSION : we considered that good results can be obtained by assistant use of arthroscopy and rigid internal fixation with early mobilization, that accurate diagnosis and appropriate treatments of accampaning injuries according to the type of fractures, and accurate anatomical reduction of articualr surface.
The femoral supracondylar and intercondylar fractures are difficult to be treated due to severe soft tissue damage, comminution, intraarticular extension of fracture and injury to the quadriceps mechanism frequently. The causes of nonunion are inadequate anatomical reduction, fixation failure, bone defect and infection occasionally, which is difficult to be treated.
The authors analyzed 16 cases with nonunion of femoral supracondylar and intercondylar fracture who had been treated surgicdlly from January 1990 to December 1991 According to AO/ASIF classification in the initial fracture patterns, type A were 8 cases, type B was 1 case and type C were 7 cases. The duration between initial treatment and surgical treatment of nonunion was 6 months in average. The causes of nonunion were fixation failure due to inadequate device selection in 9 cases, inadequate anatomical reduction or surgical technique in 4 cases and infection in 3 cases. The treatmentt were internal fixation with Dynamic condylar screw(DCS) in 9 cases, internal fixation with condylar blade plate in 4 cases, monofocal lenghtening with Ilizarov in 1 case and bifocal lenghtening with Ilizarov in 2 cases. According to Schatzker classification, the good result was obtained in 11 cases(68.8%). The complications were 3 knee joint ankyloses, 2 superficial wound infections, 1 delayed union and 1 deep vein thrombosis.
In conclusion, the requirement for the good result in treatment of nonunion are exact anatomical reduction, rigid fixation and autogenous bone graft.
Non-union of patella fracture was rare reported. We reported our experience with four cases of non-union of patella fracture treated by surgical intervention. Surgical management by skeletal traction and tension band wiring achieved union of the fracture in all four cases. The patients also recovered an excellent range of movement and strength in the affected knees.
The authors analysed the 40 patients of the lateral condyle fracture of the humerus in children who were admitted in Korea Veterans Hospital in Seoul from Jan. 1990 to Dec. 1997. The fracture type and the displacement was classified according to Milch type and Jakob stage. Clinical analysis was performed on 40 patients with lateral condyle fracture of humerus, who could be followed up. The patients were followed up from 12 months to 63 months with an average of 23 months. Average duration of bone union was 6 weeks after operation. The significant differences in outcome were notified from open reduction and internal fixation in comparison to closed reduction and percutaneous pinning. According to the criteria of Hardacre, we obtained excellent result in 16 cases(40%), good result in 22 cases(55%) and poor results in 2 cases(5%).
Fracture of tibial intercondylar eminence has a clinical importance in aspect of associated ligament injury, limited range of motion and joint instability The purpose of this study is to evaluate the intercondylar eminence fracture and to compare the results of treatment by method of arthroscopic reduction and pull-out suture with results of conservative treatment. The results were evaluated with Mayers and Mckeevers criteria of result and instability. 23 cases of avulsion fracture of tibial intercondylar eminence were reviewed. Most common type was type II Most common cause was traffic accident. Closed reduction and cast immobilization was performed in 12 cases, of which 10 cases had above good result initially, reduction with pull-out suture by arthroscopy was performed in 11 cases, of which 10 cases had above good refult. Type III B fracture were reduction with minimal arthrotomy because of the arthroscopic reduction was difficult. 2 cases of instability were in type III A and type III B. An instability case of type III A was treated non-operatively and the other of type III B was treated pull-out suture. 1 case of extension limitation was in type II which waf treated non-operatively because of multiple injury.
The supracondylar fracture of the humerus is the most common fracture of the elbow in children and is occasionally associated with significant residual complications such as cubitus varus deformity. Clincal analysis was performed on 32 patients with displaced supracondylar fractures of humerus, who were treated either by closed reduction and percutaneous pinning or by open reduction and internal fixation. The results were as follows : 1. The average age of the children was 6.8 years old in both sexes, and male to female was 21 : 11. 2. The extension type was 26 cases(82%), flexion type was 6 cases(18%) and the left side was more frequently involved. 3. According to Pirone classification, type II was 14 cases, type III 18 cases. 4. There was no significant difference in the mean duration of bony union between the percutaneous group and the open reduction group. 5. Cubitus varus deformity and limitation of elbow motion were more common complications in open reduction group.
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The Effect of Rotational Deformities on Cubitus Varus for Supracondylar Humerus Fractures in Children Hyun Dae Shin, Kyung Cheon Kim, Dong Kyu Kim, Woo Yong Lee Journal of the Korean Orthopaedic Association.2010; 45(5): 373. CrossRef
Authors report 42 cases of humeral shaft fractures, which were treated with plate fixation in 19 cases and intramedullary(IM) nailing in 23 cases, from January 1992 to December 1996. The average time of operation in plate fixation was 100 minutes and that in Im nailing was 65 minutes. The nonunion in plate fixation was 2(10.5%)cases and that in IM nailing was 4(17.4%)cases. Other complications of plate fixation were 2 cases of wound infection and 2 cases of radial nerve palsy. Those of IM nailing were 1 case of limited motion of the shoulder and 1 case of wound infection. After reviewing above reslts, we concluded that there were no marked difference between the two operative method in bone union of humeral shaft fracture cxcept diversity of complication.
The ankle fracture with diastasis of distal tibiofibular jointis caused by an axial loading force with concomitant external rotation or other force. Many surgeons have treated this injuries by rigid fixation medial and lateral malleoli with syndesmotic fixation. But recently, syndesmotic fixation is not required to maintain the syndesmotic fixation on ankle fracture. seventy-five patients of ankle fracture with syndesmotic injury treated at Korea veterans Hospital from Jan. 1990 to Dec. 1996 were analysed in clinical and radiological aspect. The syndesmotic fixation was not necessary if the both medial and lateral injury was rigidly stabilized by fixation or ligament repair.
Treatment of tibial pilon fractures is difficult to manage because of its comminuted pattern of the intra-articular fracture of the ankle, the articular incongruity, associated with soft tissue injury and its complication. The modern concept of fracture mordality are the open anatomical reduction, stable internal fixation with correct length of fibula and functional aftercare. We analyzed 17 cases which underwent open reduction and internal fixation for the tibial pilon fracture at the Korea Veterans Hospital from March 1990 to September 1996. 1. The most common type was type III according to Ruedi and Allgower's classification. 2. The treatment was open reduction and internal fixation in all cases and the results were above fair by Ovadia and Beals criteria in 16 cases. 3. The union of fracture was taken in all cases and the duration of union was average 14 weeks. 4. The most common complication was the limitation of ROM in the ankle joint.
We analysed three cases, repectively. The first case was chronic uncontrolled infected nonunion of femur due to open type III fracture which had been operated unsuccessfully at least 5 times. The second case was a infected nonunion and shortening of leg due to infecton of soft tissue surgery and then after knee arthrodesis. The third case was result from the total knee arthroplasty failure and then after knee arthrodesis. Ilizarov instrument was applied to this case for the knee joint arthrodesis. All cases showed bony union after average 14.6 months. The exact bony lengthening in the two cases after treatment was 11cm and 13cm and the healing index was 49.Odays/cm and 50.8days/cm The complications included the pin tract infection in all three cases and pin breakage in 2 of the cases. We achieved bony lengthening and bony union with relief of infection in 3 cases of chronic uncontrolled infected nonunion of femur treated with extensive saucerizaton and fixation using the Ilizarov instrument. These are the results of our treatment of chroic uncontrolled infected nonunion of femur using the Ilizarov instrument.
Displaced intraarticular fractures of the calaneus require operative intervention to restore the anatomy of the bone, which in turn is the requirement for recovery of subtalar joint mobility.
To evaluate the complex contour of calcaneal anatomy, a classification for intraarticular calcaneal fractures was used, based on standardized coronal and transverse computed tomography scans of os calsis.
From January 1993 to December 1994, intraarticular calcaneal fractures of 47 cases treated in Korea Veterans Hospital were analysed preoperatively with C.T. scan and classified by Sandersclassification system. And clinical evaluation of the patients was done by Maryland Foot Score postoperatively.
The result were as follows:Type I fractures were found in 10 cases. 25 cases of 47 cases were classified as type II and subdivided as II A in 13 cases, II B in 6 cases, II C in 6 cases. Type III fractures were found in 8 cases and subdivied as III AB in 4 cases, III BC in 3 cases, III AC in 1 case. Type IV fractures were found in 4 cases.
This classification aids a surgeon to make perioperative decision, because it has prognostic significance.
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Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft Eun Sun Moon, Myung Sun Kim, Il Kyu Kong, Min Sun Choi Journal of the Korean Fracture Society.2010; 23(1): 69. CrossRef
The Comparison of Radiographic Parameters and Clinical Results after Operative Treatment of Displaced Intraarticular Calcaneal Fractures Hong Moon Sohn, Jun Young Lee, Sang Ho Ha, Sueng Hwan Jo Journal of the Korean Fracture Society.2007; 20(3): 227. CrossRef
The scaphoid fracture is the most common fracture of the carpal bone in young men and has high incidence of nonunion. Many methods of treatment for nonunion of the carpal scaphoid have been described; bone grafting, screw fixation, pulsed electromagnetic field and cast, percutaneous pinning and Herbert screw fixation.
Two of the commonest methods of treatment are Matti-Russe procedure and Herbert screw fixation and this paper compares these two surgical treatments.
At the Department of Orthopaedic Surgery, Korea Veterans Hospital, from October 1988 to October 1994, 11 cases of the scaphoid nonunion had been treated by Matti-Russe procedure only (4 cases), Matti-Russe procedure with K-wire (2 cases) and Bone graft with Herbert screw fixation (5 cases) and followed up more than 1 year.
The results were as follows; 1. Among 11 cases, 10 cases were male and 1 case was female and the range of age was 19-46 years (Mean 26.2 years).
2. The sites of fracture were confined to the waist in 9 cases (82%) and prox 1/3 in 2 cases (18%).
3. The treatment methods were Matti-Russe only in 4 cases, Matti-Russe procedure with K-wire in 2 cases and Bone graft with Herbert screw fixation in 5 cases.
4. Postoperative cast immobilization was done for 16.5 weeks in the cases treated by Matti-Russe procedure and for 4 weeks in the cases treated by Bone graft with Herbert screw fixation.
5. The union rate was 91 % after postoperative 4 months (Mean 4.1 months).
6. The results of treatment were excellent in 7 cases (64%), good in 3 cases (27%) and fair in 1 case(9%). Therefore the Matti-Russe procedure and Bone graft with Herbert Screw fixation are good procedures in the treatment of scaphoid nonunion.
But, Bone graft with Herbert screw fixation is more useful in young men because of short periods of immobilization and early returning to work.
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Volar Percutaneous Cannulated Screw Fixation for Subacute Scaphoid Wasit Fracture Jae Kwang Kim, Jong Oh Kim, Seung Yup Lee, Nam Hoon Do Journal of the Korean Fracture Society.2009; 22(2): 104. CrossRef
Recently, there is seen frequently the tibial fracture due to the increased traffic accident and the high energy trauma, and this fracture has many problems in a treatment because of nonunion, malunion, angular deformity, shortening and infection.
In the treatment of distal 1/3 fracture of tibia. interlocking intramedullary nailing has been popularized because it enables preservation of the range of motion of the joint, early weight bearing and early bony union.
Between Jan. 1988 and Dec. 1993 intramedullary nailing of the tibial fracture has been perfomed in 41cases, of which 38 cases were acute fractures and 3 cases were nonunion with folow up of more than one year.
The results were as follows; 1. Closed nailing technique was accomplished in 38 cases and 3 were opened.
2. The mean fracture healing period was 18.6 weeks and each mean fracture healing time was 19 weeks in Brooker nail and 18.5 weeks in interlocking nail, and so there was no significant difference in bone union time between two devices.
3. According to the functional classification of Klemm and Borner, out of 41 cases,26 were excellent,8 were good,5 were fair and 2 were poor.
4. The complications were infection in 4 cases, delayed union in 2 cases, angular deformity in 1 case and partial ankylosis of knee in 1 case.
5. In the cases associated with soft tissue injury and comminuted fracture of distal 1/3 of lower leg, Blocker nail was considered an useful treatment when distal interlocking screw fixation was not appropnate.
The incidence of intertrochanteric fracture of femur is increasing because of increasing number of old-aged people.
The goal in the treatment of an elderly patient with an intertrochanteric fracture is to restore the patient to his prefracture activity as soon as possible.
The purpose of this report is to review of the difficulty of treating the intertrochanteric fracture of femur in elderly patients.
The authors treated 213 cases of intertrochanteric fracture from Jan,1980 to Dec.1993.
We analyzed the clinical result of 73 cases intertrochanteric fracture with minimum 1 year follow up retrospectively.
The results were as follows.
1. The degrees of osteoporosis by Singh index were 27 cases in Grade III, 22 Cases in Grade II,14 cases in grade IV,5 cases in Grade I and 5 cases in Grade V.
2. By Tronzo classification of fracture, the most common type was 38 cases in type III, 17 cases in type II and 8 casesintype V.
3. The operation method were compression hip screw(38 cases), Jewett nail (12 cases), Ender nail(17 cases), multiple pinning (5 cases), and primary kerniarthoplasty(3 cases).
4. Average bony union time was 13.2 weeks in compression hip screw group, 14.5 weeks in Jewett nail group,14.7 weeks in Ender nail group and 15.4 weeks in multiple pinning group.
It is reported that infected pathological fracture of distal femur has a difficulty in treatment The difficulties lie in; choosing a internal fixator, adequate sequestrectomy of infected lesion, limb shortening, long duration of immobilizatlon.
We uses the external fixator in treatment of distal femoral fracture because it needs less devices in fracture site than the internal fixator, and it could get a rigid fixation. we uses the Ilizarov apparatus. The merits of Ilizarov are, early weight bearing; limb lengthening and easy compression and distraction. The one case in which limb length discrepancy is occured, is peformed by limb lengthening.
In this study, we are going to argue about the two cases, of infected non-unlon of distal femoral fixation comparing with one another.