Fractures of the femoral shaft with marked bowing face some obstacles in fixation of the fracture such as difficulty in insertion of the intramedullary nail (IM nail) or exact contouring plate. Locking compression plates (LCP) are an option to manage this problem. However, we experienced consecutive breakage of LCP twice and IM nail once in an 80-year-old female. Finally, union of the fracture was achieved after fixation of the IM nail and additional plate together. Fractures of the femur shaft with marked bowing are thought to have different biomechanical properties; therefore, we present this case with a review of the literature.
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Comparative analysis of operation time and intraoperative fluoroscopy time in intramedullary and extramedullary fixation of trochanteric fractures Milan Mitkovic, Sasa Milenkovic, Ivan Micic, Predrag Stojiljkovic, Igor Kostic, Milorad Mitkovic Vojnosanitetski pregled.2022; 79(2): 177. CrossRef
Pre-operative planning for fracture fixation using locking plates: device configuration and other considerations Alisdair R. MacLeod, Pankaj Pankaj Injury.2018; 49: S12. CrossRef
Letter: Repeated Metal Breakage in a Femoral Shaft Fracture with Lateral Bowing - A Case Report - Hae Seok Koh Journal of the Korean Fracture Society.2012; 25(3): 240. CrossRef
PURPOSE To evaluate the clinical outcomes of operative treatment using a transolecranon approach with a dual locking plate for unstable intercondylar fractures of the distal humerus. MATERIALS AND METHODS Eighteen patients were followed for more than 1 year after surgical treatment for unstable intercondylar fractures of the humerus. Anterior transpositioning of the ulnar nerve and an early rehabilitation program to allow range of motion (ROM) exercise from postoperative week 1 were used for all cases. The clinical and functional evaluation was performed according to the Mayo Elbow Performance Index and Cassebaum's classification of ROM. RESULTS The range of elbow joint motion was a flexion contracture mean of 12.8 degrees to a further flexion mean of 119.3 degrees at the final follow-up. The Mayo Elbow Performance Index was an average of 88.5 points. Among the results, 6 were excellent, 9 good, 2 fair, and 1 poor. Therefore, 15 cases (83.3%) achieved satisfactory results. Fourteen cases (77.7%) achieved a satisfactory ROM according to Cassebaum's classification. All cases achieved bone union, and the interval to union was an average of 14.2 weeks. CONCLUSION Dual locking plate fixation through the transolecranon approach seems to be one of the effective treatment methods for unstable intercondylar fractures of the humerus because it enables the anatomical reduction and rigid fixation of articulation, and early rehabilitation exercise.
PURPOSE To evaluate the clinical and radiologic results of the arthroscopic treatment using TightRope(R) (Arthrex, Inc, Naples, FL) for management of acute acromioclavicular dislocation. MATERIALS AND METHODS Twelve patients with acromioclavicular joint dislocation Rockwood type V are underwent the arthroscopic acromioclavicular joint reconstruction using TightRope(R) between March, 2008 and March, 2009. The average age was 40.4 years (range 25~63 years) and mean follow-up was 10 months (range 8~16 months). The shoulders were evaluated using parameters include radiologic measurements by comparing the clavicle posteroanterior and lateral radiographs with the contralateral one. Clinical evaluation was made for pain, function, and range of joint motion by Constant score and KSS (Korean Shoulder Score). RESULTS All twelve patients returned to their work without pain in 3 months after operation. The average Constant score and KSS score was 98.4 (range 97~100) and 97.8 (range 97~100) at the last follow-up. Because of technical error and indication error, two patients showed failures of TightRope(R) fixation on the coracoid side and the acromioclavicular joint was redislocated, so these cases were excluded. 10 patients were satisfied with functional results and cosmetic appearance. CONCLUSION Considering its less morbidity, less hospitalization, excellent cosmesis, early rehabilitation, this new technique offers an attractive alternative in acromioclavicular joint stabilization if the early technical error would be overcome.
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Coracoclavicular Ligament Augmentation Using Tight-Rope®for Acute Acromioclavicular Joint Dislocation - Preliminary Report - Seok Hyun Kweon, Sang Su Choi, Seong In Lee, Jeong Woo Kim, Kwang Mee Kim The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 115. CrossRef
Coracoclavicular Ligament Augmentation Using Endobutton for Unstable Distal Clavicle Fractures - Preliminary Report - Chul-Hyun Cho, Gu-Hee Jung, Hong-Kwan Sin, Young-Kuk Lee, Jin-Hyun Park The Journal of the Korean Shoulder and Elbow Society.2011; 14(1): 1. CrossRef
PURPOSE To compare the results of open fixation and closed percutaneous pinning in managing Jakob stage II lateral condylar fractures of children's elbow. MATERIALS AND METHODS Since Febuary 2000, We operated 21 children with Jakob stage II lateral condylar fractures of elbow. Eleven of the 21 were treated with closed percutaneous pinning, open fixation was done to the other 10 children. Each patient was evaluated about range of motion, carrying angle, scar satisfaction and radiologic findings for comparison between closed pinning and open fixation groups. RESULTS Open fixation group showed 3.8 degrees decrease of elbow motion while closed pinning group showed no significant decrease. Carrying angle and radiologic findings were not different between the two groups. Open fixation group expressed dissatisfaction to their scars (average 5.2 cm) whereas all the patients of closed pinning group were satisfied with their functional and cosmetic outcomes. CONCLUSION In managing Jakob stage II lateral condyle fractures of children's elbow, closed percutaneous pinning was thought to be superior to open fixation because of the same functional outcome and much better cosmetic results.
Traumatic posterior hip dislocation should be reduced emergently, but diagnosis could be delayed in a patient with head trauma or in developing countries. We have experienced neglected posterior hip dislocation for three months in a crutch-walking patient who had ipsilateral tibia fracture and alert mentality. Open reduction followed by six-weeks skeletal traction was performed. At one year follow-up, the reduced hip showed good range of motion with no evidence of avascular necrosis.
Fat embolism is a rare complication of multiple long bone fracture or extensive soft tissue injury. The pathogenesis of fat embolism has been poorly understood and definite pathogenesis and treatment were not fully established. Respiratory failure associated with fat embolism is a major cause of death, but is usually self-limited, and is responsive to intensive treatment. We have experienced fat embolism in cancellous bone fracture which occurred in spine, distal radius and talus. Patient's fractures were treated with conservative management. The patient was recovered from fat embolism with supportive treatment.
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A case of fat embolism syndrome in juvenile rheumatoid arthritis patient Kyung Hoon Kim, Ju Kyung Lee, Young Hun Choi, Woo Sun Kim, June Dong Park, Young Yull Koh, Dong In Suh Allergy Asthma & Respiratory Disease.2013; 1(1): 94. CrossRef
PURPOSE To evaluate the differences of associated factors in thoracolumbar fractures according to the mechanism of injury, level and type of the fracture, associated injuries were investigated for comparison between injuries by fall from height and by in-car accident injury. MATERIALS AND METHODS Medical records and X-ray findings of 249 patients with fractures of thoracolumbar spine were reviewed retrospectively. Among them, 169 patients were injured by the two main causes. McAfee classification was adopted to determine the type of fracture. Associated injuries were classified as head and neck, chest and abdomen, pelvis, proximal and distal extremity, and neurologic deficit. Statistical analysis using Chi-square method was used for comparison between the two groups. RESULTS In overall patients, the most common cause of thoracolumbar fracture was fall from height (44.6%) followed by in-car accident (23.3%) and fall down (16.9%). In fall-from height gruoup, burst fracture was the most common (44.1%) while flexion-distraction injury was the most popular (39.7%) in in-car accident group (p=0.05). Comparison according to height of fall showed significant increase of multiple fractures (p=0.0326). Associated injuries of distal lower and upper extremities and pelvis were common in fall-from-height group, while injuries of head and neck, proximal part of upper extremity, chest and abdomen were common in in-car accident patients. CONCLUSION Type of fracture and distribution of associated injuries were significantly different between the two main causes of thoracolumbar injury, which seemed to be useful for understanding the mechanical events of injury and detecting associated injuries in each victim.
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Injury Severity and Patterns of Accompanying Injury in Spinal Fracture Hun Park, Kyung-Jin Song, Kwang-Bok Lee, Joo-Hyun Sim Journal of the Korean Fracture Society.2012; 25(3): 203. CrossRef
Differences in Thoracolumbar Burst Fractures by Falls from Height with Associated Foot and Ankle Fractures Chung-Shik Shin, Eea-Sub Chung, Chang-Eon Yu, Byeong-Yeol Choi Journal of Korean Society of Spine Surgery.2012; 19(2): 47. CrossRef
PURPOSE To assess diagnostic efficacy of the MRI in thoracolumbar fractures, especially in changes of bone and soft tissue which cannot be documented by other diagnostic tools. MATERIALS AND METHODS Among 85 patients managed for thoracolumbar fractures between January 1997 and June 2003, MRI was performed in 30 patients to get more informations. Plain X-ray, CT and MRI of these cases were reviewed retrospectively by two orthopaedic spine surgeons and one radiologist to investigate the informations which only MRI could afford. RESULTS 14 (46.7%) among 30 patients had occult fractures of vertebrae other than main fracture which had not been diagnosed as fractured. Besides 6 patients who showed distraction of posterior structure on plain X-ray, injury of posterior ligament complex was confirmed by MRI in 12(40%) patients. Additionally, MRI visualized other soft tissue injuries such as intramuscular and subcutaneous hematoma, changes of the spinal cord and intervertebral disc. In 16 among 30 patients, informations achieved from MRI were the most important factors in deciding treatment modality. CONCLUSION MRI seems to be efficient in visualizing not only soft tissue injury such as ligament but also occult fractures of additional vertebra in thoracolumbar fractures, therefore MRI seems to be an important diagnostic tool in decision of treatment modalities, especially in cases of uncertain stability.
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Measurement Discrepancy of Sagittal Parameters between Plain Radiography and 3D Computed Tomography in Thoracolumbar and Lumbar Fractures Dong-Soo Kim, Yong-Min Kim, Eui-Sung Choi, Hyun-Chul Shon, Kyoung-Jin Park, Byung-Ki Cho, Ji-Kang Park, Hyun-Cheol Lee Journal of the Korean Orthopaedic Association.2012; 47(3): 198. CrossRef
Relationship between Lamina Fractures and Dural Tear in Low Lumbar Burst Fractures Ki-Chan An, Dae Hyun Park, Yong-Wook Kwon Journal of the Korean Fracture Society.2011; 24(3): 256. CrossRef
PURPOSE To evaluate the availability of the mangled extremity severity score(MESS) in deciding the early treatment modality for the patients with open lower extremity fractures and severe soft tissue injury. MATERIALS AND METHODS Analyzed 27 patients for the lower extremity open fractures with extensive soft tissue injury. A comparative study using a MESS, a cause of injury, vascular injury and a fracture pattern, average hospital stay and average hospital charges were analyzed, and daily living ability and subjective self-evaluation were assessed. RESULTS There was statistically significant correlation applying MESS to patient group that had been operated by early amputation because of severe soft tissue and vascular injury. But there was no significant difference in the subjective self-assessment score, admission period and total cost during admission between each treatment method. CONCLUSION MESS can be used as an objective assessment criteria in deciding the proper treatment modality for the cases of lower limbs fracture with extensive soft tissues and vascular injury.
Lateral femoral insufficiency fracture in total hip arthroplasty occur due to osteopenia and varus positioning of the femoral component. The presentation of these fractures usually involves the insidious onset of unexplained thigh or groin pain. The insufficiency fracture generally occur at the level of the femoral stem tip on the lateral cortex of the femur. Recommended treatment involves revision to a long stem femoral component. This is the first report of lateral femoral insufficiency fracture simply regarded as periprosthetic fracture of the femur.
The purpose of this study is to analyze the results of treatment of posterior wall fracture of acetabulum, which were treated at our hospital from September 1994 to December 1996. Among 24 posterior wall fractures, 15 cases were confirmed as isolated posterior wall fractures and nine fractures were associated with other acetabular fracture(4 transverse fracture, 3 both column fracture, and 2 posterior column fracture). Clinical follow-up was performed for a minimum of 2 years. The posterior wall fracture was classified according to fracture size(type 1<25%, type 2: 25-50%, type 3: 50-75%, type 4: >75%) and comminution (A: without comminution, B: with comminution, C: impacted) on standard roentgenogram and CT scan. Fourteen among 24 posterior wall fractures were followed for a minimum of 2 years, and the mean Harrif hip score was 91.2. Dislocation of hip occurred in 12 hips(50%). There was no definite difference of Harris hip score in regard to fracture size and comminution of posterior wall. Fractures with posterior hip dislocation had poor result compared with fractures without posterior hip dislocation. Anatomical reduction showed better clinical result than imperfect and poor reductions.
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Surgical Treatment of Posterior Wall Fractures of the Acetabulum Young-Soo Byun, Se-Ang Chang, Young-Ho Cho, Dae-Hee Hwang, Sung-Rak Lee, Sang-Hee Kim Journal of the Korean Fracture Society.2007; 20(2): 123. CrossRef
Clavicular shaft fracture is one of the most common fractures, which had been managed via conservative methods with some exceptions such as nonunion. Open treatment had been regarded even as important cause of nonunion and poor outcomes. Nowadays, however, the goal of fracture treatment has become anatomical reduction, rigid fixation and early rehabilitation for better final results.
According to this principle, we managed 21 clavicular shaft fractures with open reduction and internal fixation(12; plate fixation. 9; intramedullary pinning) since 1991 to 1993. All the fractures united within postoperative 10 weeks(mean 6.4) without any remarkabte complications such as nonunion, infection, and limited shoulder motion. In some intramedullary pinning cases. skin irritation at pin site was troublesome, but disappeared after removal of the pin.
Likewise other long bone fractures, open reduction and internal fixation seemed to be one of the useful method in the treatment of clavicular shaft fractures. especially in displaced, and comminuted ones.
Fractures with displaced articular facet of subtalar joint occupies 60-75% of whole calcaneal fractures. Nowadays, general principle of treatment for displaced intraarticular fracture has become anatomical reduction of joint surface and rigid fixation of the fracture. However, it had been difficult to apply this principle in cases of calcaneus due to various obstacles such as anatomical characteristics, therefore outcomes were not satisfactory in many cases. Extended lateral approach, which was designed by Letournel and Benirschke, contributed greatly in overcoming those obstacles.
From August 1992 to April 1994, the author managed fifteen displaced intraarticular fractures of the calcaneus in fourteen patients with open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate. The fractures were examined preoperatively with Brodens view and classified according to Eastwood(1992) with 2-plane CT. All the fractures united within postoperative 20 weeks(average 10.9 weeks). Final results were assessed by the clinical criteria for calcaneal fracture designed in Greighton Nebraska Health Foundation. Among the 15 cases, excellent results were obtained in eight cases, good in six, fair in one. There were no remarkable complications at the latest follow-up.
In managing displaced intraarticular fractures of calcaneus, open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate seemed to be very useful and harmless method.
In the management of fractures in patients with cererbral palsy, pre-existing contracture of joint and muscles, difficulty in maintenance of reduction partly because of involuntary motion of muscles are obstacles to the orthopaedic surgeons. Furthermore, disuse osteopenia in long term bed-ridden patients may be a Predisposing factor of refracture. Failures such as refracture were reported to occur 19 times more in cerebral palsy patients. Those failures usually result in malunion, which may be a cause of severely deformed extremities.
Among various types of cerebral palsy, rigid type is rare and involuntary muscle contraction is rigid. Therefore, fractures in these patients may be more difficult to manage and be accompanied by more complications, such as refracture compared even to spastic type. We experienced fractures in two patients with rigid cerebral palsy. An 11 year-old boy(proximal femoral shaft fracture) and a 45 year-old man(humerus shaft fracture) were treated with open reduction and internal fixation using plate and screws. Initial fixation was thought to be enoughly stable, but within 3 weeks postoperatively, maintenance of reduction in both fractures failed eventually. Because of the rarity of cases and difficulty in maintenance of reduction, we report these two cases after reviewing of the literatures.
Intramuscular hematoma in inner pelvic wall may not be a common problem for orthopaedic surgeons. It may be associated with fractures of pelvic bone, or bleeding tendency from various reasons.Usually these hematomae are managed conservatively because they have no harmful effect to the patient, their position makes it difficult to approach. Furthermore, the diagnosis of the hematomae is not simple, so suspicion is important for its diagnosis.
We experienced one case of delayed intramuscular hematoma in iliacus muscle in a 16-year old boy who had suffered blunt trauma to the pelvic area five weeks before. MRI had a significant role in the diagnosis of the hematoma. After evacuation of the hematoma, the patient recovered to normal status. Concerning about its unusual course and diagnostic significances of MRI, we report this case after reviewing of the Iiteratures.
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Muscular Injury of Iliacus and Gluteus Maximus after Mountain Climbing Ho Seung Jeon, Young Kyun Woo, Suk Ha Hwang, Seung Pyo Suh, Joon Kyung Lee The Korean Journal of Sports Medicine.2014; 32(1): 65. CrossRef
Dislocation of first metatarsophalangeal joint is a rare condition. Anatomically, the head of first metatarsal is stabilized by various soft tissue structures associated with the sesamoid bones. When the metatarsal head was entrapped underneath the sesamoid complex, it might be impossible to gain reduction via closed method.
We experienced a case of dorsal dislocation of first metatarsophalangeal joint and associated dislocation of larsornetatarsal joint in a 32 year old man who was injured by ftll from height. Closed reduction fEiled even under spinal anesthesia. Open reduction via medial approach revealedbuttonholingof the metatarsal head under the sesamoid complex, which had made colsed reduction impossible. Concerning about the rarity and anatomical characteristic of these injuries, we report this case with reviewing of the literatures.
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Lateral Dislocation of the First Metatarsophalangeal Joint: A Case Report Yeong-Sik Yun, Young-Mo Kim, Kyung-Cheon Kim, Pil-Sung Kim Journal of the Korean Fracture Society.2008; 21(4): 312. CrossRef
Lateral condylar fracture of humerus is the secondly most common elbow injury in childhood. Compared to the most common supracondylar fracture which is fracture of metaphysis around olecranon fossa, lateral condylar fracture is intraarticular, epiphyseal injury and easily displaced by extensor muscle pull. Therefore, lateral condylar fractures are reduced and fixed more frequently by open method than supracondylar fractures are. In spite of affording more accurate reduction, however, open treatment of fracture can be complicated by infection, avasular necrosis, disfiguring scars, etc. So, it is more desirable that accurate reduction and rigid fixation can be achieved by closed method.
Sine July 1992, We manged 10 children with lateral condylar fractures of elbow using closed reduction, percutaneous K-wire fixation and intraoperative arthrogram for confirming the reduction status of articular margin. The fractures united and K-wires were removed within postop. 7 weeks(mean) in all cases. The patients were followed up for from 9 months to 2 years and 2 months postoperatively, revealed no great differences in carrying angle, range of motion and physical activity compared with contralateral elbow.
Radiologic evaluation showed no definite complications except mild spur formation. Closed reduction and fixation followed by intraoperative arthrogram seemed tobe one of the useful method in the management of lateral humeral condylar fractures in children, especially in mildly displaced cases.
Closed intramedullary nailing is a complex technique which usually requires fracture table and image intensifier, so that the patient and surgeon are exposed to the radiation. But this technique affords considerable advantages such as high rate of union, less infection rate and early weight bearing, etc. The main causes of failure or complication of this procedure are inapproprisate entry point and inadequate nail size. These are especially important problems in the patient who is femoral canal diameter is very small (8 or 9mm). The Delta femoral interlocking nails (diameter 10mm and 11mm)were devised for the femurs with narrow canal diameter. However, proximal portion of the Delta nail (about 7cm from the proximal end)is thick (diameter 13mm)to gain strength enough for holding the insertion device and fixation of the interlocking screws. If the insertion point is not correct or proximal reaming is inadequate, iatrogenic proximal femoral fracture may occur during final insertion of the nail. We experienced 2 cases of this complication during fixation of femoral shaft fractures using the Delta nails. We managed thls problem with hip spica cast immobilization in one case, and multiple pinning of femur neck in the other.
Negative electric charge is known to induce osteoblastic activity in bone. Therefore, electrical stimulation can be used clinically to promote more active new bone formation in the fracture site. Among many methods in the treatment of fracture nonunion, electrical stimulation can be emplyed as one of the useful methods, which is less of noninvasive and rather simple.
We experienced 10 cases of fracture nonunion managed with EST without surgery in the Department of Orthtopedic Surgery of Seoul National University Hospital from September 1980 to March 1987. Of these, 6 cases were managed with semiinvasive direct current method and resulted in union of all cases. 4 cases were managed with nonivasive capacitively coupled electric field method and resulted in union iin 3 cases but in1 case, nonunion persisted till 22 months follow-up. In the 9 cases of satisfactory results, union time varied from 2 months to 9 months with mean of 4 months.
No remarkable complication was found in these cases.
In conclusion, electrial sitmulation therapy is thought to be one of the useful and hopeful methods in the treatment of fracture nonunion cases in which surgery is not absolutely indicated.