PURPOSE We retrospectively analysed the result of retrograde supracondylar nail fixation in femur supracondylar fractures and evaluate the clinical effectiveness of this method. MATERIALS AND METHODS Since October 1998 we have treated 14 supracondylar fractures (AO type: A2-6, A3-1, C1-3 and C2-4) by retrograde intramedullary nailing technique through trans-patellar tendon approach from October 1998 to June 2001 and followed more than 1 year. RESULTS Among 14 cases, 5 cases were excellent, 6 good, 3 fair according to Schatzker functional result. The complications were 1 distal locking screw loosening, 1 delayed union and 1 fracture around proximal locking site. CONCLUSION Even though the retrograde nailing may damage the knee joint because it is inserted by opening up the joint, it provided the necessary stable fixation with short operation time, low blood loss, minimal soft tissue injury. Thus we believe that retrograde nailing is useful operative technique for the management of supracondylar fracture in osteoporotic, communited fractures, or open fractures.
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Retrograde Nailing for Supracondylar Fracture after Total Knee Replacement: The Compatibility of Femoral Implant with Supracondylar Nail Moon-Jib Yoo, You-Jin Kim, Jin-Won Lee Journal of the Korean Fracture Society.2008; 21(1): 19. CrossRef
PURPOSE The purpose of this study is to evaluate the effectiveness of Kirschner wire and additional wire fixation in clavicle lateral end fractures. MATERIALS AND METHODS We reviewed 14 cases that were treated by Kirschner wire and wire fixation from January 1997 to May 1999 and followed up for more than 1 year. Average age was 42 years old(male 6, female 8). The fractures were classified according to Jager and Breitner classification : 2 cases of type 1, 5 of type 2a, 5 of type 2b, 2 of type 3. We used 3 types of fixation method : First, interfragment Kirschner wire and wire fixation in simple fracture. Second, first method was reinforced with transacromial Kirschner wire fixation in simple, but osteoporotic bone. Third, fracture was fixed by transacromial Kirschner wire and wire fixation in intraarticular or comminuted fracture. RESULTS Bony union was obtained in all cases with average duration of 10 weeks. The functional result of shoulder was evaluated by the scoring system of Rowe : exellent 8, good 5, fair 1 case. The complications were pin migration 2, pin infection 1, shoulder LOM 3, traumatic acromioclavicular joint arthritis 2 cases. CONCLUSION Appropriate use of three types of Kirschner wire and wire fixation technique according to location of fracture, degree of comminution can improve bony union rate and shoulder function.
PURPOSE The purpose of this study is to evaluate the effect of dynamization which was done for the treatment of delayed union or persisting fracture gap after interlocking intramedullary nailing, by radiographic and physical examination. MATERIALS AND METHODS We analyzed 22 cases these were treated with dynamization from 247 cases of tibia shaft fracture treated initially with static interlocking intramedullary nailing from February l990 to May 2000 and were followed up more than lyear. The result of dynamization was classified as 3 groups and we divided each results 3 categories that is effective result, uncertain result and ineffective result. Group A is cases that achived ultimate union with shortening of fracture gap and was 10 cases. Group B is that achieved ultimate union but fracture gap did not reduced and was 10 cases. Group C is that showed ultimate non-union and was 2 cases. RESULTS The result is that dynamization was effective only 4 cases of group A. 6 cases of group A and 4 cases of group B showed instability(radiolucent halo around nail, hypertrophied callus and leg pain), and 6 cases of group B showed no shortening of fracture gap, thus these were classified as uncertain result. Group C(2 cases) showed non-union, classified as ineffective. CONCLUSION Dynamization caused instability in most tibia fractures except simple mid-shaft fracture. So in the comminuted fractures and distal or proximal l/3 oblique fractures, other procedures such as bone graft, refixation should be considered rather than dynamization.
Spiral fractures of the middle or distal shaft of the humerus that occur during attempts to throw a variety of objects are not common. Many authors have reported that the cause of fracture was the results of uncoordinated muscle violence. We experienced two cases of throwing fractures of humerus, one is baseball player(catcher) preceded by arm pain during throwing motion, the other is recreational hand grenade player without prodromal arm pain.
PURPOSE We analysed risk factors for failure of interlocking screws after femoral intramedullary nailing, and introduce tips for removing broken screw. MATERIALS AND METHODS Seventy-two closed femoral shaft fractures were treated with interlocking nail. We compared 7 patients in whom interlocking screw breakage occurred (Group I) with 65 patients without breakage of interlocking screw (Group II). Analytic parameters were age, weight, level of fracture, degree of comminution, nail diameter. We used Mann-Whitney U test & Chi-sqare test for statistical analysis. RESULT Upper one of distal interlocking screws was broken in 6 patients, both of distal screws were broken in one patient. All of the patients with broken screws had associated delayed union. The mean age of patients were 20 years in group I, 31 years in group II. The mean weight were 69.6 Kg in group I, 62.02kg in group II. Three patients had fractures in proximal half and four patients had fractures in distal half in group I. In group II, there were 25 proximal fractures and 40 distal fractures. There were 2 type I, 2 type II, 1 type III, 2 type IV fractures in group I, and 16 type I, 31 type II, 17 type III, 1 type IV fractures according to Winquist and Hansen classification. Nail diameters were 10mm in 4 patients, 11mm in 2 patients, 12mm in 1 patient for group I and 10mm in 8 patients, 11mm in 13 patients, 12mm in 25 patients, 13mm in 13 patients, and 14mm in 6 patients for group II. Age, weight, degree of comminution, nail diameter had statistically significant relation to the breakage of interlocking screw(p<0.05), but the level of fracture didn't(p>0.05). Broken screws were easily removed by advancing screw to medial compartment with S-pin and making short medial incision. CONCLUSION It is suggested from our study that combination of parameters may have contributed to the failure of interlocking screw ; narrower diameter nail for comminuted fracture in young, active patients with more body weight. Inserting two screws have advantage over one screw.
PURPOSE : The trochlear secondary ossification center may be variable in number, shape and size, thus it can be considered as fracture. The purpose of this study is to evaluate radiographic analysis of normal trochlear secondary ossification center. METHOD AND MATERIAL : We reviewed the 100 cases of normal elbow radiographs and classified the numbers and shapes of trochlear sencondary ossification center. RESULT : The number of trochear secondary ossification center was that one was 72 cases(72%), two 19 cases(19%), three 9 cases(9%). The shape of trochlear ossification center which has only one ossification center was classified as round was 11cases(15.3%), elliptical 24 cases(33.3%), irregular37(51.4%). CONCLUSION : The radiographic finding of trochlear secondary ossification center is variable in number, size and shape, thus authors concluded that fragmentation or bizzare shape of trochlea in painless elbow must be considered as secondary ossification center.
PURPOSE : The purpose of this study is to evaluate the seg length discrepancy after Ender nail fixation in children's femoral shaft fracture. MATERIALS AND METHODS : We reviewed 18 femoral shaft fracture that were treated with Ender nail and studied the relationship between the initial site of fracture, type of fracture and overgrowth. The age of children in this study ranged 6 to 13 years old and the average period of follow-up was 32 months. RESULTS : The range of leg length discrepancy was from 6 mm shortening to 16mm lengthening and average 3.4 mm lengthening. Only one patient had shortening, nine patients had limbs of equal length(less than 2 mm) and eight patients had lengthening.
The average overgrowth was 1.3 mm in proximal 1/3, 7.0 mm in middle 1/3, 3.0 mm in distal 3/1 fractures. The average overgrowth was 7.3 mm in transverse, 1.3 mm in oblique and 2.3 mm in comminuted fractures. Conclusions : We consider closed Ender nailing in children femoral shaft fractures as a good treatment modality in the matter of leg length discrepancy.
We studied 39 patients with distal tibial shaft fracture. Seventeen fractures(10 closed fractures and 7 open fractures: 5 type-I and 2 type II fractures, according to the classification of Gustilo et al.) were treated with interlocking nail, and 22 fractures(19 closed and 3 open fractures: 1 type I and 2 type II fractures) were treated with anatomical plate.
The clinical results were analyzed according to treatment modality. All of the patients were followed up for more than 1 year. The average time to union was 18.1 weeks in the patients treated with interlocking nail and 23.7 weeks in the patients treated with anatomical plate. In the functional outcome(according to Klemm and Borner), twelve patients(70.6%) treated with interlocking nail showed excellent results and 10 patients(45.5%) treated with anatomical plate had excellent results.
We concluded that more satisfactory results could be obtained with interlocking nail compared with anatomical plate in the treatment of the distal tibial fracture.
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Comparative Analysis of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Distal Tibia Fractures Ho-Min Lee, Young-Sung Kim, Jong-Pil Kim, Phil-Hyun Chung, Suk Kang, Kaung Suk Jo Journal of the Korean Fracture Society.2018; 31(3): 94. CrossRef
Comparative Analysis of Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Intramedullary Nailing in Distal Tibial Metaphyseal Fractures Gwang Chul Lee, Jun Young Lee, Sang Ho Ha, Hong Moon Sohn, Yi Kyu Park Journal of the Korean Fracture Society.2012; 25(1): 20. CrossRef
Comparative Study Using of Treatment with Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Interlocking Intramedullary Nailing in Distal Tibia Fractures Chang Hwa Hong, Jong Seok Park, Sang Seon Lee, Soo Ik Awe, Woo Jong Kim, Ki Jin Jung Journal of the Korean Fracture Society.2010; 23(3): 296. CrossRef
A Comparison between Minimally Invasive Plate Osteosynthesis & Interlocking Intramedullary Nailing in Distal Tibia Fractures Kee-Byung Lee, Si-Young Song, Duek-Joo Kwon, Yong-Beom Lee, Nam-Kyou Rhee, Jun-Ha Choi Journal of the Korean Fracture Society.2008; 21(4): 286. CrossRef
Ender nailing is an alternative method of treatment of selected unstable tibial shaft fractures. The purpose of this study is to evaluate the result of functional treatment with Ender nailing and postoperative functional bracing. We treated 31 tibial shaft fractures(16 closed, 15 open) with closed Ender nailing and postoperative functional bracing between August 1990 and September 1994 and followed up the patients from minimum 10 months to 74 months. Clinical analyses were as follows; 1. According to AO classification, 10 cases were Type A simple fractures(32%), 14 Type B wedge fractures(45%), and 7 Type C complex fractures(23%).
2. Ninety four percent of the fractures united in an average time of 17.3 weeks. The average time to union of complex fractures was longer than that of simple and wedge fractures(P<0.05).
3. There were two nonunions(6.5%), two delayed unions(6.5%), and three angulatory malunions(9.7%) between 6 and 10 , but there was no putient of significant shortening, joint stiffness, or infection.
The Ender nails provide sufficient stability at the fracture site of the tibial shaft to permit carly weight-bearing in a functional brace, and this treatment provides early fracture union with less complicatioins and facilitates functional recovery.
The interlocking IM nailing is one of the most commonly used treatment method of the femoral shaft fracture. Althrough it has many advantages, but various complications is reported including delayed union, nonunion, malunion, interlocking nail or screw breakage, joint stiffness and infection.
In order to evaluate the complications we reviewed 38 cases in treated with interlocking IM nailing in femoral shaft fracture from january, 1991 to december, 1995 in Hangang Sacred-Heart hospital. The average follow up duration was 14 months (range ; 6 months to 38 months).
The following results are obtained 1. There were 1 cases of nonunion. Nonunion was of no analytic significance in sex, age, the fracture site and associated fracture (P=0.186), but significant in segmental fracture (P=0.02). Because of the small number group, we considered that it would be necessary more clinical expenence.
2. There were 3 cases interlocking screw breakage, all of which were occured in proximal screw. Partial weight bearing was permitted average postoperation 4.3 months. Average duration between operation and screw breakage was 1.3 months, between operation and bone union was 11.7 months.
3. There was 1 case of interlocking nail breakage. we considered that it was resulted from usage of relatively small nail(11 mm) and postoperative early weight bearing(8 weeks).
Iniercondylar fractures of the distal humerus in adults are rare and notoriously difficult to treat. We treated 8 patients by open reduction and internal fixation using Y-plate with extraarticular olecranon osteotomy in posterior approach. L-shaped osteotomy was performed at the extraarticular portion of olecranon with triceps tendon insertian remained to proximal portion of it, using air-saw. The follow-up period ranged from 12 to 30 months with average of 19.7 months. The fractures were dassified according to AO classification. The results were evaluated using Jupiter et al grading system.
1) There was no loosening of fixation Cevice of humeral condyle and olecranon.
2) Niether delayed union nor nonunion of olecranon and humeral condyle were found.
3) Exellent grade was achieved in 4 patients(50%), three(38%) had good, and one(12%) poor. Flexion-extension arc ranged from 60 degree to 120 degree with mean of 98.8 degree.
4) Complications included postoperatile neuritis in one, myositis ossificance in one, and heterotopic bone in one patient.
Authors would introduce the method and result of extraarticular olecranon osteotomy in posterior approach for the intercondylar fracture of distal humerus, as a new technique.
The fractures in the burned patients is more complicated mechanism. There are controversies in the treatment of the fractures in the burned patients.
We analysed the fracture incidence, the type of burn, the mode of injury, the mean burn percentage, the fracture site and the results of treatment of the if fractures in 44 patients selected from 3300 burned patients in Hangang sacred-heart hospital during recent 5 years.
The incidence of the fractures in the burned patients was 1.3%, the predominant type of the burn was flame burn(72.7%), the mean burn percentage was 28.7% of the total body surface. The mode of injury mainly consisted of fall down after burn(50%). The most common fracture site was thoracolumbar spine(11 cases).
In 12 long bonr fractures, 5 cases(Tibia:3 case, Femur:2 case) were treated with operative method. But, the osteomyelitis was not developed in ail cases. We concluded that the operative treatment is recommended in severe burned fracture patients for pain relief, comfortable wound manage, rigid fixation and early exercise.
The fifth metacarpal neck fractures are unstable and often heals with angulation and deformity. So, after closed reduction and immobilization with splint or cast, they have often been lost reduction and healed with posterior angulation and cosmetic deformity. We conducted a prospective study of 11 patients who underwent percutaneous retrograde intramedullay K-wire fixation for a fracture of the neck of the fifth metacarpal during four years period.
We used a closed reduction technique derived from Jahss maneuver or three point fixation maneuver. And, the fracture was maintained with two cross or parallel smooth intramedullary K-wire. The proximal side of K-wire was placed back wound side near the wrist joint. The last follow up (postoperative 14±2 weeks) radiographic results were dorsal angualtion 7±4 , corresponded to preoperative 48±7 , and immediately postoperative 6±4 The complications such as limitation of movement, increase of dorsal angulation, rotational malalignment, shortening, and depression of the head of metacarpal were not occurred. Rotational deformity was always well controlled. Correction of angulation was good and K-wire insertion and fixation technique were easy. We recommend this technique in case of over 40 dorsal angulation of fracture site due to absence of contact between the palmar fractured ends, and patients who dont accept the cosmetic deformity or want early exercise.
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Comparative Evaluation of the Efficacy of Combined Intramedullary Pinning with K-Wires Pinning in the Treatment of Fifth Metacarpal Neck Fractures versus Conventional Techniques—K-Wires Pinning and Intramedullary Pinning Dong-Eun Kim, Tong-Joo Lee, Yeop Na, Ye-Geon Noh Medicina.2023; 59(11): 1944. CrossRef
Modified Bouquet Technique for Treatment of Metacarpal Neck Fractures Yong-Gyu Sung, Seok-Whan Song, Yoon-Min Lee Journal of the Korean Society for Surgery of the Hand.2016; 21(3): 137. CrossRef
Treatment of 5th Metacarpal Neck Fracture Using Percutaneous Transverse Fixation with K-Wires Jae-Hak Jung, Kwan-Hee Lee, Yong-Ju Kim, Woo-Jin Lee, Sung-Hyun Choi Journal of the Korean Fracture Society.2012; 25(4): 317. CrossRef
Treatment of Metacarpal Fractures using Transverse Kirschner-wire Fixation Nam Yong Choi, Hyun Seok Song The Journal of the Korean Orthopaedic Association.2007; 42(5): 608. CrossRef
Bouquet Pin Intramedullary Nail Technique of the 5th Metacarpal Neck Fractures Myung-Ho Kim, Moon-Jib Yoo, Jong-Pil Kim, Ju-Hong Lee, Jin-Won Lee Journal of the Korean Fracture Society.2007; 20(1): 64. CrossRef
The risk of fracture of the proximal femur is high for individuals with metabolic bone disease, or with low bone mass associated with advanced age. The menopause is generally believed to be an important factor in bone loss in women.
In these group, even minor trauma(low energy injury) may result in fractures, while much greater force is needed to produce a fracture in people with higher bone mass.
This study is aimed at ascertaining the age, sex and type-specific incidences in the hip fracture, the difference of frequency between the neck and trochanteric fracture and the change in the averse age of the hip fracture patient.
All patient from this hospital with a diagnosis of fracture of the neck and trochanteric region of the femur during the period 1983 to 1992 were reviewed for this study. Patients with fracture resulting from metastatic lesions were excluded. The original medical records were reviewed for each patient, data were entered on protocol disinged for the study. The data included basic demographic informations such as patients age and sex, type of fracture of the femur neck or trochanter, type of the low/high energy injury, immediate cause of accidents, presence of the cormorbid diseases, and safety factors inducing fall accidents in home or outside.
During the years 1983-1992, a total 240 patients with fractures of the proximal femur were identified from the operating recordings. Among them, data of 201 patients could be entered on protocol through the retrieved records.
1. Of 201 patients, 65 years or older are 117. 39 are men and 78 are women, 103 are low energy injury and 14 are high,57 are sustained by fractures on the neck of the femur and 60 are sustained on the trochanter.
2. Mean age of the 117 patients over 65 years old is 76 years. Those of men and women are equaly 76 years old.
3. Of 57 patients sustained with the fractures on the neck of the femur, their mean age is 71 years. Men are 18 patients, their mean age is 76 years. Women are 39 patients, their mean age is 75 years.
4. Of 60 patients sustained with the fractures on the trochanter of the femur, mean age is 76 years. Men are 22 patients, their mean age is 75 years. Women are 38 patients, their mean age is 77 years.
5. The cormorbid common diseases are the hypertension, cataract, diabetes mellitus(DM), celebre-vascular accidents(CVA), pulmonary tuberculosis, asthma, chronic obstrutive polmonary disease(COPD), mitral insuficiency(Ml), chronic heart failure(CHF), and chronic renal failure(CRF) in order of.
Authors reviewed 8 cases of wrist fracture-dislocation treated with mini-external fixator and internal fixation form Septmeber 1989 to May 1992 with average 6 months follow up. The results were as follows ; 1. Mean ages were 47 years, most patients were young age. 2. We could achieve good results in intra-articular, communited, displaced fracture and open fracture of the wrist by using the mini-externall fixator and internal fixation. 3. Radial length and inclination was maintained mainly by the external fixator. Articular surface restoration and reconstruction was performed by bone graft and the limited internal fixation. We would like to recommend to use the mini-external fixator and limited internal fixation instead of plate and screws for the intraarticular fractue, displaced, communited farcture and open fracture of the wrist.
Proximal humerus fractures respond satisfactorily to conservative treatment, but in old age group, there are difficulties in managing it. So we analyzed 42 cases of proximal humerus fractures according to age and the method of treatment. The results were as follows; 1. Eighteen one part fractures were treated conservatively except one case and show satisfactory result except one.
2. Fifteen two-part fractures were treated by open reduction except one case and show satisfactory result except one. 3. Six three-part fractures were treated by open reduction in all cases and show satisfactory result except one. 4. Three four-part fractures were treated by open reduction or total shoulder arthroplastT 2. respectively in two ceses and show satisfactory result except one.
5. In old age group. loosenings of plate and screws were found in 2 cases. 6. In young age group, loosening of plate and screws was not found. 7. Tension band wire was not related loosening of wire in all cases.
The authors report a clinical experience of 12 cases having comminuted patellar fracture who were treated with modified tension band wiring or partial patellectomy from January 1985 to Oecember 1989 at the department of Orthopedic Surgery, Hallym University Hangang Sacred Heart Hospital.
The results were as follows 1. All cases caused by direct blow.
2. Mean immobilization period was 5 weeks in modified tension band wiring, mean immobilixation was 3.3 weeks in partial patellectomy.
3. Range of motion of knee joint was 3-123 in modified tension band wiring, range of motion of knee joint was 5" -110" in partial patellectomy.
4. Quadriceps muscle weakness was developed in all of 2 cases of partial fatellectomy.
5. Extension lag of knee joint was developed in 1 case of partial patellectomy.
6. The result of modified tension band wiring was much better than partial patellectomy in comminuted patellar fracture.
Avascular necrosis was a frequent complication of the fracture of the neck of the talus. Hawkins described a subchondral radiolucency visible in the body of the talus six to eight weeks after fracture.
This sign has proved to be a useful objective prognostic sign; the presence of this sign would not undergo avscular necrosis.
In eleven patients, serial roetgenograms were examined for this phenomenon. The results were as follows: 1. Six fractures that had the Hawkins sign did not undergo avascular necrosis.
2. Also, we experienced two cases of partial Hawkins sign which developed the partial avascular necrosis.