A case of variceal bleeding from the jejunum in liver cirrhosis

While esophagogastric varices are common manifestations of portal hypertension, variceal bleeding from the jejunum is a rare complication of liver cirrhosis. In addition, ectopic variceal bleeding occurs in the duodenum and at sites of previous bowel surgery in most cases, including of stomas. We report a case of obscure overt gastrointestinal bleeding from jejunal varices in a 55-year-old woman who had not previously undergone abdominal surgery, who had liver cirrhosis induced by the hepatitis C virus. Emergency endoscopy revealed the presence of esophageal varices without stigmata of recent bleeding, and no bleeding focus was found at colonoscopy. She continued to produce recurrent melena with hematochezia and received up to 21 units of packed red blood cells. CT angiography revealed the presence of jejunal varices, but no active bleeding was found. Capsule endoscopy revealed fresh blood in the jejunum. The patient submitted to embolization of the jejunal varices via the portal vein, after which she had a stable hemoglobin level and no recurrence of the melena. This is a case of variceal bleeding from the jejunum in a liver cirrhosis patient without a prior history of abdominal surgery.

Operative Risk Assessment of Degenerative Spinal Disorder Comparing with Total Hip Replacement

STUDY DESIGN: Retrospective study. OBJECTIVES: To assess the operative risks and complications of posterior decompression and fusion for degenerative spine disorders, we compared single level posterior decompression and posterolateral fusion of lumbar spine with total hip arthroplasty which have been evaluated in many reports and articles on complications and operative risks. SUMMARY OF LITERATURE REVIEW: There has been no study comparing the relative risks of spinal surgery with total hip arthroplasty. MATERIALS AND METHODS: One hundred and thirty-six subjects (mean age 69.6 years) who received single level posterior decompression and posterolateral fusion for degenerative lumbar disorders from February 2000 to May 2010 were selected as group A, and 136 subjects (mean age 67.2 years) who received total hip arthroplasty during the same period were selected as group B. A comparative analysis was performed according to age, gender, pre-operative ASA status based on their underlying medical conditions, total operative time, blood loss, hospitalization period, incidence of major and minor complications and functional recovery at the time of final follow up using retrospective and statistical manners from medical records and radiologic evaluations. RESULTS: The total operative time and blood loss were longer in group A with statistical significance (P<0.01). Major complications were frequent in group B with 16 cases and in group A with 6 cases (P<0.05). There were no significant differences in the total hospitalization period, incidence of minor complications and post-operative functional recovery. CONCLUSIONS: The present study revealed no increased operative risks for surgery for degenerative lumbar disorders compared with total hip arthroplasty in similar age groups.

Effectiveness of Initial Extracorporeal Shock Wave Therapy on the Newly Diagnosed Lateral or Medial Epicondylitis

OBJECTIVE: To evaluate the effectiveness of initial extracorporeal shock wave therapy (ESWT) for patients newly diagnosed with lateral or medial epicondylitis, compared to local steroid injection. METHOD: An analysis was conducted of twenty-two patients who were newly confirmed as lateral or medial epicondylitis through medical history and physical examination. The ESWT group (n=12) was treated once a week for 3 weeks using low energy (0.06-0.12 mJ/mm2, 2,000 shocks), while the local steroid injection group (n=10) was treated once with triamcinolone 10 mg mixed with 1% lidocaine solution. Nirschl score and 100 point score were assessed before and after the treatments of 1st, 2nd, 4th and 8th week. And Roles and Maudsley score was assessed one and eight weeks after the treatments. RESULTS: Both groups showed significant improvement in Nirschl score and 100 point score during the entire period. The local steroid injection group improved more in Nirschl score at the first week and in 100 point score at the first 2 weeks, compared to those of the ESWT group. But the proportion of excellent and good grades of Roles and Maudsley score in the ESWT group increased more than that of local steroid injection group by the final 8th week. CONCLUSION: The ESWT group improved as much as the local steroid injection group as treatment for medial and lateral epicondylitis. Therefore, ESWT can be a useful treatment option in patients for whom local steroid injection is difficult.

Treatment of Osteoporotic Vertebral Fracture / 대한골다공증학회지

As the society became more aging, prevalence of senile spinal diseases such as osteoporotic spinal fracture, spinal sprain, myofascial pain, degenerative intervertebral disc disease, spondylitis, metastatic spinal disease, and infectious disease has increased. If spinal pain occurs in old age, complication of osteoporotic fracture must be considered. Before treating osteoporotic spinal fracture, degree of pain, fracture characteristics, presence of neurologic symptom, degree of kyphotic deformity, and general condition of the patient should be considered in order to choose the appropriate treatment method. Conservative treatment for osteoporotic fracture includes pain control, medication for osteoporosis, spinal brace and exercise treatment, and diverse surgical treatment methods such as vertebroplasty, kyphoplasty, or anterior and posterior instrumentation are preformed nowadays. We will investigate the definition of osteoporotic spinal fracture and several treatments and the indications and methods of which by reviewing references.

Hallux Valgus and Cartilage Erosion in First Metatarsal Head: Correlation between Intraoperative Cartilage Erosion and Preoperative Parameters / 대한족부족관절학회지

PURPOSE: To analyze relation between age or parameters measured before operation and cartilage erosion of the first metatarsal head measured during operation. MATERIALS AND METHODS: The study was targeted at 56 patients and 79 feet, who underwent Scarf osteotomy or Scarf and Akin osteotomy from November 2009 through November 2010, and whose cartilage lesion of the first metatarsal head referred to the cartilage grade III or IV of the International Cartilage Repair Society. The measurement parameters were age, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle. The cartilage erosion of the first metatarsal head was measured by one surgeon using cellophane. Occupancy rate and frequent involved sites of the cartilage erosion were recorded using AutoCAD(R) and adobe Illustrator CS4 program. SPSS correlation test and T-test were used for statistical analysis of the parameters and the cartilage erosion. RESULTS: The cartilage erosion was incurred frequently in the sagittal groove and the site where subluxation or dislocation of the tibial sesamoild bone occurred but frequent involved sites had no statistical significance with cartilage erosion. The age showed a statistical significance with the cartilage erosion in the correlation test (p=0.003). Especially, the group of over 51 year old patients was turned out to have association with the cartilage erosion, compared to the group of below 51 (p=0.007). But, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle were no statistical significance with the cartilage erosion. CONCLUSION: We found the more the age of patients increased (especially above 51), the more cartilage erosion increased. And it is thought that we pay attention to reduce tibial sesamoid bone.

Clinical Outcome Based Cauda Equina Syndrome Scoring System for Prediction of Prognosis

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We made a scoring system using the symptoms of cauda equina syndrome(CES) and we studied the efficacy of the scoring system. SUMMARY OF THE LITERATURE REVIEW: There has been no definite scoring system with clear factors that can predict the clinical results of cauda equine syndrome. MATERIALS AND METHODS: Between 1998 and 2006, 21 patients who were diagnosed with CES and who were followed for more than 2 years were enrolled in this study. There were 6 cases of HIVD, 6 cases of degenerative spondylosis, 7 cases of vertebral fracture and 2 cases of metastatic spinal tumor. We made a scoring system for CES (SSCES) using 8 symptoms among the general clinical manifestations that accompany CES, which are low back pain, sciatic neuropathy, sensory and motor disorder of the lower extremities, loss of a saddle sensation, voiding difficulty, disorder of the anal sphincter tone and deep tendon reflex disorder. RESULTS: The last clinical outcomes were 3 excellent patients, 5 good patients, 5 fair patients and 8 poor patients. The mean preoperative SSCES was 11.7+/-2.8(7-16) and the mean final follow up score was 7.6+/-3.4(2-13). Eight cases that had a mean preoperative SSCES score of 6 or below showed good clinical results with a mean SSCES of 3.9+/-11(2-5) on the final follow up, and 13 cases with a mean preoperative SSCES score of 7 or above showed bad clinical results with a mean SSCES of 9.9+/-1.9(7-13) on the final follow up. CONCLUSIONS: The prognosis was better on the final follow up for the patients with a lowere preoperative SSCES. So, for the treatment of CES, preoperative evaluation using the SSCES is thought to be very useful for predicting the prognosis.

Cardiac tamponade in a patient with lupus nephritis / 대한내과학회지

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that involves many different organ systems, and this illness exhibits a wide spectrum of clinical manifestations. The renal involvement in SLE is called lupus nephritis and 50~80% of patients with SLE suffer from lupus nephritis. Although pericarditis or pericardial effusion is a common cardiac manifestation of SLE, cardiac tamponade is rare. Cardiac tamponade may be fatal if it is not recognized quickly and treated promptly. We report a case of cardiac tamponade associated with lupus nephritis. Treatment consisted of pericardiocentesis and high-dose corticosteroid.

A Case of Immune Reconstitution Inflammatory Syndrome in AIDS-related Progressive Multifocal Leukoencephalopathy after Antiretroviral Therapy / 감염과화학요법

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to JC virus. In acquired immunodeficiency syndrome (AIDS) patients, JC virus infects myelin-producing oligodendrocytes causing a non-inflammatory lytic reaction leading to demyelination and brain death. We herein report a case of a 56-years-old AIDS man who developed immune reconstitution inflammatory syndrome and died while undergoing highly active antiretroviral therapy. In this patient, the PML involved the brainstem, causing mental confusion followed by recurrent aspiration, adult respiratory distress syndrome, and eventually to early death.

Evaluation of the Factors Affecting Root Tears of the Posterior Horn of the Medial Meniscus as Confirmed during Total Knee Arthroplasty

PURPOSE: We examined the incidence of root tear of the medial meniscus posterior horn among patients who had undergone total knee replacement and we analyzed the factors that cause this tear. MATERIALS AND METHODS: We enrolled 258 knees of 173 patients who had undergone total knee replacement from January 2008 to June 2009. The mean age was 68.8 (range: 50~87). There were 23 men (28 cases) and 150 women (230 cases). We performed statistical correlation analysis between the assumed causes of meniscal tears (age, gender, grade of osteoarthritis, the predisposition site, BMI and varus deformity) and root tears. RESULTS: Meniscal tears were observed in 182 cases (70.5%), and there were 18 cases (64.2%) of 28 cases and 164 cases (71.3%) of 230 cases in the men and women, respectively. Root tear had correlation with the severity of osteoarthritis (p=0.040) and varus deformity (p=0.030), but other underlying factors didn't show significant correlation (p>0.05). CONCLUSION: Root tears of the medial meniscus posterior horn in total knee arthroplasty were related to the severity of osteoarthritis and varus deformity, but active interventions are required whether or not there are predisposing factors that cause osteoarthritis.

Correlation Between Clinical Result and Adjacent Segment Degeneration After Lumbar Spinal Fusion / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: To determine the relationship between clinical outcome and adjacent segment degeneration (ASD) after lumbar fusion. SUMMARY OF LITERATURE REVIEW: Few studies have analyzed the correlation between clinical outcomes and ASD. MATERIALS AND METHODS: Between January 2000 and December 2004, 217 patients who underwent lumbar spinal fusion (>2 years of follow-up) were evaluated. The patients were divided into 2 groups: one-segment (A) and two-segment (B). The UCLA grading scale was used to evaluate the prevalence of ASD on radiography. The association between clinical outcome and ASD was evaluated by Spearman's correlation. RESULTS: ASD occurred in 11.6% (13/112) of patients in group A and 15.2% (16/105) of patients in group B. The number of cases which progressed to more than 2 levels of the degenerative grade were 0 cases in group A and 13 cases (81.3%) in group B. In A, 5 out of 13 ASD cases downgraded one level in their clinical outcomes. In B, all 16 ASD cases downgraded more than one level in their clinical outcomes. Worsening in degenerative grade, was correlated with worse clinical outcome (Spearman's rho = 0.829, P <0.05). CONCLUSIONS: The association of clinical outcomes with ASD after fusion showed a significant correlation, especially association with ASD after multiple segment fusion.

The Effect of Methylprednisolone and Riluzole on Axonal Growth after Acute Spinal Cord Injury in Rats / 대한정형외과학회잡지

PURPOSE: To determine the effect of methylprednisolone (MP) and riluzole administration on axonal growth after spinal cord injury (SCI) in rats. MATERIALS AND METHODS: Three Sprague Dawley rats (SD rat) served as controls (average 24 weeks of age) and 24 SCI SD rats scoring below 7 points on on Basso, Beattie, and Bresnahan open field test served as test subjects (total 27 SD rats; mean weight 581 g, range=427-613 g). Test subjects were divided into two groups of 12 subjects each. Group I was injected with saline (1 ml/kg) and group II was injected with MP (300 mg/kg) and riluzole (5 mg/kg) intraperitoneally. Four SD rats were sacrificed in each group at the following time points after SCI: days 1, 4, and 7. We completed behavioral testing, immunohistochemical staining and RT-PCR for chondroitin sulfate proteoglycans (CSPG), and microarrays for c-JUN, ATF-2, p53, and Elk-1. RESULTS: On behavioral testing, group II showed superior results at only day 4 after SCI (p<0.05). On RT-PCR for CSPG, optical densities were 2.06 (ratio=Group I/Group II) and 2.11 at days 4 and 7, respectively. Microarray showed that lower expression of c-JUN in group II during the entire period (p< 0.05). ATF-2 showed lower expression in group II at days 4 and 7 (p<0.05). p53 showed lower expression in group I at day 1 (p<0.05). Elk-1 showed lower expression in group I at day 1 (p<0.05) and in group II at day 7 (p<0.05). CONCLUSION: Simultaneous administration of MP and riluzole led to various changes in the MAPK pathway, and decreased CSPG. Therefore, this method has a protective effect on axonal regeneration after SCI in an SD rat model.

Motor Evoked Potential and Continuous Electromyography Monitoring during Spinal Surgery / 대한정형외과학회잡지

PURPOSE: A prospective study to determine the usefulness of the spinal cord monitoring (SCM) for predicting and preventing iatrogenic nerve injury during spinal surgery. MATERIALS AND METHODS: We studied 27 cases with adolescent idiopathic scoliosis (AIS, 7), degenerative spinal deformity (DSD, 13), and spinal stenosis (7) who received decompression and SCM including MEP and EMG. Intravenous anesthesia was performed using propofol. We initially could not measure SCM because of the presence of muscle relaxants. But later could check SCM in 24 cases. We evaluated the success rate of SCM, the degree of electrical stimulus, and abnormal signals. RESULTS: The success rate of SCM was 88.9%. MEP showed an increased stimulus indicating a normal neurologic response in: AIS (26.6%), DSD (24.3%), and spinal stenosis (15.7%). EMG showed abnormal signals in 4 cases. but 3 cases had no significant nerve damage. In one case, we reinserted the pedicle screw because we found nerve irritation by the probe. None of theses cases had neural deficits after the operation. CONCLUSION: MEP and EMG allow for correction and decompression without spinal cord or nerve root injury with appropriate anesthesia technique and interpretation of abnormal signals required for SCM.

Classification and Treatment of Degenerative Lumbar Spinal Deformity / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVE: To categorize and analyze clinical results of degenerative lumbar deformity patients according to the degree of scoliosis and kyphosis. SUMMARY AND LITERATURE REVIEW: A degenerative spinal deformity is classified into a coronal and sagittal deformity. There are some reports about treatment according to each classification but the classification is sometimes inappropriate and the treatment can vary. MATERIALS AND METHODS: From June 1998 to June 2003, 79 patients, who were diagnosed with a degenerative lumbar deformity and underwent conservative or operative treatment, were studied retrospectively. Group I had scoliosis ranging from 10 to 20degrees , and group II had scoliosis > 20degrees Each group was subdivided into A, B, and C according to the lordosis, group A > 30degrees , group B between 20 to 30degrees , and group C 20degrees or lordosis < 20degrees are expected to show more improvement in symptom after surgery than after conservative treatment.

Thoracic Myelopathy in Elderly Patients with Degenerative Lumbar Scoliosis / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical findings and effective management of thoracic myelopathy combined with degenerative lumbar scoliosis. MATERIAL AND METHODS: Seven cases with degenerative lumbar scoliosis of more than 10 degrees and underwent surgery on the thoracic spine were retrospectively studied through a chart review and the radiological findings. The mean follow-up period was 32.3 months. The average age was 65.3 years (range, 61-82 years), and there were 4 males and 3 females. 5 cases underwent a lumbar laminectomy with or without fusion prior to admission. The patients were evaluated through their history, physical examination, period of symptoms, MRI findings and surgical methods. A clinical evaluation was carried out using the Oswestry Disability Index (ODI). RESULTS: All cases had decreased hip flexion and a spastic gait, along with various degrees of radiating pain and buttock pain. No case had pathological reflexes but various degrees of motor and sensory disturbances were observed. The preoperative MRI findings showed herniated discs at the level of T5-6 (1 case), T6-7 (1 case), T8-9 (2 cases), T9-10 (1 case), T9-12 (1 case) and T10-12 (1 case). Decompression through the anterior approach was carried out on 4 cases, and decompression and posterior fusion was carried out on 3 cases. The average preoperative ODI was 28.6 points (range, 25-34) and improved to 12.3 points (range, 10-15), respectively at the final follow-up. CONCLUSION: Although thoracic myelopathy combined with degenerative lumbar scoliosis is a rare disease, pathognomonic symptoms such as gait disturbances highlight the need for considering the appropriate management and surgical level through a differential diagnosis with simple degenerative lumbar scoliosis.

Clinical Findings of the CompleteRadial Rupture of the Meniscal Root Ligament of the Medial Meniscus Posterior Horn: Preliminary Report / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical findings of a complete radial rupture of the meniscal root ligament of the medial meniscus posterior horn. MATERIALS AND METHODS: From April, 2004 to December, 2004, nineteen patients (mean age, 56.5 years old) who were diagnosed with a medial root ligament rupture of the medial meniscus posterior horn during an arthroscopic treatment were enrolled in this study. The clinical findings, physical examinations, and the radiological and arthroscopic findings were analyzed retrospectively. RESULTS: Thirteen out of the nineteen cases had tenderness of the knee without specific trauma. The preoperative physical examination revealed posteromedial joint line tenderness in fifteen cases. A medial joint line protrusion with direct tenderness was observed in six cases (31.5%) and a positive McMurray test was observed in seventeen cases (89.5%). MRI was carried out in sixteen patients. All sixteen patients were diagnosed with a rupture of the meniscal root ligament using the author's diagnostic MRI criteria. CONCLUSION: Non-traumatic pain and posteromedial joint line tenderness in patients in their sixth decade are indications of a rupture of the meniscal root ligament of the medial meniscus posterior horn. Confirmation using MRI and arthroscopy is important for making a diagnosis.

Usefulness of Nutrient Foramen of Lamina for Insertion of Thoracic Pedicle Screw / 대한정형외과학회잡지

PURPOSE: To determine the utility of the nutrient foramen on the lamina in thoracic pedicle screw fixation. MATERIALS AND METHODS: This study investigated the nutrient foramina on the lamina from 4th to 8th thoracic vertebra after partial laminectomy of 7 cadaveric spines. A 2 mm steinmann pin was inserted as follows: Vertical insertion on the right nutrient foramen and a 10 degree caudad on the left nutrient foramen. Radiographs and CT were obtained and the relationships between steinmann pin and pedicle were analyzed. RESULTS: There were 44 nutrient foramens (63%). Among them, 31 nutrient foramens (70%, 31/44) were on the right. On the lateral radiograph, the right pins were inserted to the upper end plate and the left pins were inserted within the vertebral body in T4 and T5. In T6, 7 and 8, the right pins were inserted lower than the upper end plate, and the left pins were inserted to the lower portion of the vertebral body. On the CT axial scan, medialization to 17 degrees from T4 to T7 and 5 degrees in T8 from the nutrient foramen was possible when the size of pedicle screw for humans is considered. CONCLUSION: The nutrient foramens on the lamina of thoracic vertebra are useful for inserting the thoracic pedicle screw.

Arthroscopic Bankart Repair and Rotator Interval Plication by Transglenoid Technique: Preliminary Report / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of arthroscopic Bankart repair and rotator interval plication by the transglenoid technique on Traumatic Unidirectional Bankart Surgery (TUBS) with concomitant rotator interval widening. MATERIALS AND METHODS: From May 2002 to May 2003, 13 cases who underwent arthroscopic Bankart repair and rotator interval plication by the transglenoid technique were studied, out of the 14 cases that were diagnosed as TUBS with concomitant rotator interval widening. Follow up period was at least 1 year. Results were evaluated by Rowe score before and after surgery. RESULTS: All the cases were male. Nine cases were on the right shoulder and 4 on the left. The mean age was 22 years old (range, 14-26 years old). The mean duration from injury to operation was 4.3 (range, 1.3-10) years. The Rowe score was improved from 58.3 to 86.4 (p=0.00). Overall outcomes were excellent in 10 cases, good in 2 and fair in 1 at final follow up. There was no sulcus sign in any of the cases at the last follow up, and redislocation did not appear in any of the cases during the follow up period. CONCLUSION: In the treatment of TUBS with concomitant rotator interval widening, arthroscopic Bankart repair and rotator interval plication by the transglenoid technique have made good results.

Operative Treatment of Traumatic Humeral Shaft Fracture: Comparision of Interlocking IM Nailing and Plate Fixation by Posterior Approach

PURPOSE: To compare the results and complications of interlocking IM nailing and plate fixation by posterior approach in the treatment of traumatic humeral shaft fracture MATERIALS AND METHODS: From March 1997 to March 2003, 49 patients undergone operation due to traumatic humeral shaft fracture. Follow-up was over one year. 28 patients operated with interlocking IM nailing initially and 21 operated with plate fixation by posterior approach prospectively. Statistics were compared using clinical and radiological outcomes and complications. RESULTS: Radiologically, bone union was observed after an average of 14.3 weeks in IM nailing, and 11.7 weeks in plate fixation. So plate fixation showed earlier bone union (p=0.012). Nonunion occurred in 4 cases (14.3%) operated with IM nailing, and 1 case (4.8%), that was open shaft fracture, with plate fixation. Nonunion occurred more frequently when operated by IM nailing. 6 cases showed limitation of shoulder movement due to damage of the rotator cuff by IM nail entry site. 1 case showed radial nerve palsy, and 1 case showed axillary nerve palsy in the case of IM nailing. Also, secondary surgery due to complications was operated in 9 cases (32.1%) in IM nailing and 1 case (4.8%) in plate fixation (p=0.03). CONCLUSION: In the case of traumatic humeral shaft fracture plate fixation by posterior approach was more useful than IM nailing in the decrease of complications and bone union. Such approach is thought to be an excellent method for anatomic reduction and nerve exploration in the case of open and comminuted fracture which accompany nerve injuries

Operative Treatment of Metacarpal Shaft Fracture>: Comparision of Low-Profile Miniplating System and Kirschner Wire Fixation

PURPOSE: To compare Kirschner wire fixation and low profile miniplating system in metacarpal shaft fracture. MATERIALS AND METHODS: Patients, available at least 1 year, who received the operative treatment after being diagnosed as metacarpal shaft fracture from 1997 May to 2003 May were the subjects with the exclusion of thumb fracture and intraarticular metacarpal bone fracture and also cases involving Kirschner wire fixation on severe laceration or open fracture. On the last follow up total action motion (TAM) and plain radiographes was checked. RESULTS: In 7 cases (38.9%) where closed reduction and Kirschner wire fixation were carried out, 8 cases (61.5%) where open reduction and Kirschner wire fixation were carried out and 24 cases (88.9%) where open reduction using miniplate and screw showed either excellent or good results on TAM. 5 cases of dorsal angulation occured in closed reduction and Kirschner wire fixation group and 4 cases of dorsal angulation in open reduction and Kirschner wire fixation group however no cases of dorsal angulation occured in open reduction and miniplate and screw fixation group, and in all cases no rotational deformity, complications through ulnar or radial angulation occured. Internal fixation was carried out on 2 cases of nonunion which had closed reduction and Kirschner wire fixation carried out, while the rest all showed bony union. CONCLUSION: Selective use of low profile miniplate and screw fixation in the metacarpal shaft fracture is more effective than in cases of comminuted fracture which can not be achieved firm fixation by Kirschner wire fixation. Low profile miniplate and screw fixation can get more precise anatomical reduction and firm fixation so it allow early return to daily living activity and show low complication rate.

Conservative Treatment of the Displaced Clavicular Shaft Fracture in Multiple Injury

PURPOSE: To analyse the comparative clinical results between adults with multiple injury including the clavicular shaft fracture and only clavicular shaft fracture who had supportive care through retrospective aspect. MATERIALS AND METHODS: We had 48 adult patients in this hospital with simple fracture and multiple injury including the clavicular shaft whom we were able to evaluate at least more than a year. 12 of 48 patients were with only clavicular shaft fracture and the rest of them were with multiple injury. We classified patients into two groups those who had fracture with displacement for group A (A1 for the cases with over 50% of fracture surface contact rate and A2 for less than 50% from the images of simple X-ray) and those who had comminuted fracture for B. We compared the time of bone union, nonunion rate of only clavicular fractures and multiple injury, clinical results for patients who had supportive care with retrospective aspect. RESULTS: A1 (7 cases), A2 (4 cases), B (1 case) were prevalent in the group of only clavicular shaft fracture and A1 (8 cases) and A2 (16 cases) and B (12 cases) were prevalent in the group of multiple injury. For the cases with supportive care, we could find 1 nonunion case (8%) and 11 union cases on average 2.91 months in the group of only clavicular shaft fracture and 7 nonunion cases (19%) and 29 union cases on average 3.58 months in the group of multiple injury. The best clinical results had occurred in 8 cases (67%) of only clavicular shaft fracture group and 19 cases (53%) of multiple injury group. We could find out the union from all 8 nonunion cases that took operation afterward. CONCLUSION: Although the choice of treatment of clavicular fracture is supportive care, but multiple injury including the clavicular fracture is a high-energy injury, so the possibility of comminuted and displacement is high, so that nonunion rate is high. The possibility of early surgery must be considered seriously.