Comparison of Fixation Stability and Incidence of Extensor Tendon Injury according to the Screw Insertion Method in Volar Plate Fixation for Distal Radius Fractures / 대한정형외과학회잡지

PURPOSE: This retrospective study was aimed to analyze the differences in stability and extensor impairment after two different volar plating procedures to manage unstable distal radius fracture, which were the penetration of only near-cortex followed by screw fixation (Group 1) and perforation of dorsal cortex by drill-bit followed by fixation with the screws downsized after gauging (Group 2). MATERIALS AND METHODS: We reviewed the medical records of 491 patients with distal radius fracture treated with standard-sized, targeted distal radius plate in two institutions between April 2009 and May 2014. Finally, 341 patients with complete demographic data, records of AO classification of fractures, data on the lengths of inserted distal screws, radiologic parameters immediately and at 3 months after operation, as well as extensor impairments, were included in this study. There were 112 patients (98 women and 14 men) in Group 1, and 229 patients (171 women and 58 men) in Group 2. The mean age was 59.8 years for all the patients; 60.3 years in Group 1 and 59.5 years in Group 2. RESULTS: The mean length of the longest screws used in Group 2 was longer than that in Group 1; however, the mean length of the shortest screws used in Group 2 was shorter than that in Group 1. While the differences in changes for radial inclination measured immediately and at 3 months after the operation were statistically significant (p=0.019), the change of radial inclination in Group 2, which showed a greater change, was only 0.5 mm. There were two cases with extensor pollicis longus rupture in Group 1 and 2 respectively, and the difference in frequency according to each Group was not statistically significant (p=0.6). CONCLUSION: The superiority of one surgical procedure in terms of fracture stability on measured radiological parameters was not fully proven compared with the other one in this study. Therefore, it would be better to selectively use the surgical method of dorsal cortex perforation viadrill-bit followed by fixation only in limited circumstances.

Brachial plexus injuries in adults

As the number of survivors of motor vehicle accidents and extreme sporting accidents increases, more people must live with brachial plexus injuries. Brachial plexus injuries also occur in multiple trauma patients and can be debilitating. Although the injured limb will never return to normal, an improved understanding of the pathophysiology of nerve injury and repair, as well as advances in microsurgical techniques, have provided the upper extremity reconstructive surgeons with opportunities to improve function in patients with these life-altering injuries. The purpose of this review is to present in detail some of the current concepts in the treatment of adult brachial plexus injuries and to give the reader an understanding of the nuances of the timing of treatment, the available treatment options, and the outcomes of treatment.

Underestimated Sacroiliac Joint Lesion on Computed Tomography in Pelvic Open-book Injury: A Case Report / 대한고관절학회지

The classification of anteroposterior compression (APC) injury type is based on using static radiographs, stress radiographs are known as a useful adjunct in classifying type of APC pelvic injuries. According to a recent article, the intraoperative stress examination has led to a change in the treatment plan in more than 25% of patients on 22 patients presumed APC type I (symphyseal diastasis <2.5 cm) injuries. Here authors present a case demonstrating a necessity of intraoperative stress test for excluding concealed posterior ring disruption.