Surgical Techniques for Percutaneous Intramedullary Fixation with Steinmann Pins for Clavicle Shaft Fractures / 대한정형외과학회잡지

PURPOSE: To report the clinical results from surgical treatment for clavicle shaft fracture by percutaneous intramedullary fixation with Steinmann pins. MATERIALS AND METHODS: Between January 2004 and June 2014, the medical records of 135 patients who underwent percutaneous intramedullary fixation with Steinmann pins were reviewed. The mean follow-up periods were 15 months. The functional results were evaluated with The Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant score. The clinical results were evaluated with the shortened length of the clavicle, length of surgical wound, operation time and Kang's criteria. RESULTS: The mean bone union period was 11.6 weeks (8–16 weeks). The mean DASH score was 11.8. The mean Constant score was 91.2. The mean shortened length of the clavicle was less than 20 mm. The mean length of surgical wound was 1.2 cm (0.7–1.5 cm). The mean operation time was 18 minutes (10–35 minutes). Using Kang's criteria, 131 out of 135 patients (97.0%) showed good results. Complications included were 3 pin migrations and 2 non-unions. CONCLUSION: Percutaneous intramedullary fixation with Steinmann pins showed good results for treating clavicle shaft fracture.

Isolated Avulsion Fracture of the Lesser Tuberosity of the Humerus: A Case Report

Isolated avulsion of the lesser tuberosity of the humerus is a rare injury. The mechanism of injury is the avulsion of the lesser tuberosity from forced contractions of the subscapularis muscle when the arm is forced into an externally rotated position on shoulder abduction. Authors report a case for isolated avulsion of the lesser tuberosity of the humerus which was treated with open reduction and transosseous suture fixation, as well as a view of the literature.

Circumferential Wiring Combined with Tension Band Wiring in the Operative Treatment of Patella Fracture

PURPOSE: The purpose of this study is to evaluate the radiographic and clinical results of patella fractures using a circumferential wiring combined with tension band wiring. MATERIALS AND METHODS: Between January 2005 and June 2012, 22 (male 14, female 8) patients with patella fracture treated with circumferential wiring combined with tension band wiring were analyzed retrospectively. The mean age of patients was 51 years (range, 28 to 72 years). Controlled passive range of motion exercise was started at three weeks from the postoperative day. The patients were evaluated using radiographs, clinical examination, and Levack's scoring system. RESULTS: All fractures healed and mean time elapsed for union was 11.5 weeks (range, 10 to 14 weeks). Complete union without displacement and full range of motion was achieved in all cases. Clinical results according to Levack's scoring system were excellent in 20 cases and good in two cases. We found broken wire in one case. In this case, results of clinical evaluation after reoperation were good. CONCLUSION: Circumferential wiring combined with tension band wiring is appropriate for patella fractures.

Surgical Techniques for Percutaneous Reduction by Towel Clips and Percutaneous Intramedullary Fixation with Steinmann Pins for Clavicle Shaft Fractures

PURPOSE: To report the clinical results of surgical treatment of clavicle shaft fracture by percutaneous reduction with towel clips and percutaneous intramedullary pin fixation. MATERIALS AND METHODS: This study reviewed the results of 80 cases of clavicle shaft fracture treated by percutaneous reduction with towel clips and percutaneous intramedullary pin fixation with Steinmann pins from January 2002 to August 2010, after follow-up for 12 months or more. We evaluated the clinical results, such as union time and complications. RESULTS: Bone union was evident in all cases and the mean time for bone union to appear on radiological findings was 10.3 weeks. Using Kang's criteria, 78 of the 80 patients (97.5%) showed good results and there were no severe complications. CONCLUSION: Percutaneous reduction with towel clips and the percutaneous intramedullary pin fixation method showed good results for treating clavicle shaft fracture.

Comparison of Operative Management in Distal Radius Fractures Using 3.5 mm Versus 2.4 mm Volar Locking Compression Plates

PURPOSE: To evaluate clinical and radiological results using 3.5 mm & 2.4 mm volar locking compression plate (LCP) in distal radius fractures. MATERIALS AND METHODS: This study reviewed the results of 115 cases of distal radius fractures treated with 3.5 mm volar LCP (73 cases) & 2.4 mm volar LCP (42 cases) from September 2003 to June 2009. The radiographic results were evaluated by radiographic assessment, and the clinical results were evaluated by Knirk and Jupiter's criteria, Modified Mayo wrist scoring system and DASH score. RESULTS: Radiological evaluation of the radial length, radial inclination, volar tilt and intraarticular step off were improved both 3.5 mm volar LCP and 2.4 mm volar LCP. Nine cases of arthritis occured in 3.5 mm volar LCP and 7 cases in 2.4 mm volar by using the Knirk and Jupiter's criteria. The mean score evaluated by Modified Mayo was 86.7 in 3.5 mm volar LCP and 84.8 in 2.4 mm volar LCP. DASH score was 11.2 point in 3.5 mm volar LCP, 10.9 point in 2.4 mm volar LCP. All cases showed bone union showing no evidence of malunion, nounion, nor metal failure. CONCLUSION: Distal radius fractures treated with 3.5 mm volar LCP and 2.4 mm volar LCP show satisfying radiological and clinical outcome.

Operative Treatment with Gamma 3 Nail in Femur Intertrochanteric Fracture

PURPOSE: To evaluate clinical and radiological results of surgical treatment of femur intertrochantenric fracture using Gamma 3 nail. MATERIALS AND METHODS: With clinical study, 22 patients who were treated surgically by Gamma 3 nail were retrospectively evaluated. By postoperative radiograph and last follow up radiograph we measured Tip-apex distance, Cleveland index, Neck-shaft angle change Lag screw slippage and Union time. And By medical record review, the clinical results were evaluated with the operation time, intraperative estimated blood loss, amount of transfusion, change of mobility and complication. RESULTS: The mean change of femur neck shaft angle was 5.18 degrees. The mean lag screw sliding was 5.43 mm. The mean bone union time was 11.8 weeks. From all of these examples shows bone union. The mean operative time was 41 min, blood loss was 161 ml and the transfusion amount was 0.3 pint. In Ceder et al mobility score, it showed 0.2 point decreased and in Jensen social function score, it showed 0.6 point increased. Comparing the results before and after operation, the results were satisfactory. CONCLUSION: Using the Gamma 3 nail, the treatment of fermur intertrochanteric fractures showed good results both radiologically and clinically.

The Surgical Treatment of Distal Femur Medial Condyle Fracture Using Lateral Anatomical Plate of Opposite Side through Medial Approach

PURPOSE: To evaluate clinical and radiological results of surgical treatment of distal femur medial condyle fracture using lateral anatomical plate of opposite side through medial approach. MATERIALS AND METHODS: This study reviewed the results of 9 cases of distal femur medial condyle fracture treated with lateral anatomical plate of opposite side through medial approach from December 2005 to June 2007, after a follow up of more than 12 months. There were 2 males and 7 females with a mean age of 63.1 (57~72) years. The clinical results were evaluated using the Schatzker's criteria, and the radiographic results were evaluated using the bone union time. RESULTS: Using the Schatzker's criteria, 7 cases of the 9 patients (78%) showed exellent results. The mean time for bone union was 13.4 (11~15) weeks. There were 3 cases of pain on full weight bearing same as previous operative state by degenerative osteoarthritis. There weren't complications as joint stiffness, infection, varus & rotational deformity, malunion, nonunion, and metal failure. CONCLUSION: Plate fixation using medial approach provides the proper anatomical reduction and stronger fixation, and outcome good results.

Operative Treatment with ITST in Femur Trochanteric Fracture

PURPOSE: To evaluate the clinical and radiographic results of treatment of trochanteric fracture with ITST (Intertrochanteric/ Subtrochanteric) nail. MATERIALS AND METHODS: We reviewed the results of 40 cases of trochanteric fracture treated with ITST from January 2006 to May 2007, which could be followed up for more than 12 months. The cases include 13 males and 27 females, and the mean age is 75.6 years old. The clinical results were evaluated by Ceder mobility assessment, and the radiographic results were evaluated by the change of femoral neck-shaft angle and sliding of lag screw. RESULTS: The mean bone union time is 13.5 weeks. Thirty four cases (85%) were recovered to pre-injury state of walking ability. The change of neck-shaft angle was an average of 5.21degrees and the sliding distance of lag screw was an average of 5.78 mm. Complications were occurred in 4 patients (10%). CONCLUSION: The ITST nail were seen good results in treatment of trochanteric fracture and has relatively less complications than other internal fixator.

Operative Treatment with Locking Compression Plate (LCP) in Proximal Humerus Fracture

PURPOSE: To evaluate the clinical and radiographic results of the treatment of a proximal humerus fracture with a locking compression plate(LCP). MATERIALS AND METHODS: This study reviewed the results of 24 cases of a proximal humerus fracture treated with a LCP from January 2005 to April 2007, after a follow up of more than 12 months. There were 8 males and 16 females with a mean age of 68.9(33-90) years. The clinical results were evaluated using the Neer's evaluation criteria, and the radiographic results were evaluated using the bone union time and Paavoleinen method. RESULTS: The mean time for bone union was 11.9 weeks. Using the Neer's functional evaluation, 21 cases of the 24 patients (87%) showed excellent or satisfactory results. Twenty two cases (91%) showed good results according to the Paavoleinen method. The complications encountered were metal failure (1 patient), AVN of the humeral head (1 patient) and joint stiffness (1 patient). CONCLUSION: The LCP demonstrated good results in the treatment of a proximal humerus fracture and has relatively fewer complications than other internal fixators.

Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann

PURPOSE: To evaluate the results between open reduction and internal fixation with the plate and percutaneous reduction by towel clip and intramedullary fixation with Steinmann pin for clavicle shaft fractures in adult. MATERIALS AND METHODS: We have studied the results in 33 cases with the plate, 35 cases with the Steinmann pin among total 68 cases of clavicle shaft fracture. The patients were followed up over a period of at least 12 months. The final postoperative outcome was analyzed with the clinical outcomes using Kang's criteria, radiological union time and operation time. RESULTS: The clinical outcome that was good or excellent according to the Kang's criteria showed a distribution of 88% in the group using the plate with 29 cases out of total 33 cases, 91% in the group using the Steinmann pin with 32 cases out of total 35 cases. The mean radiological union time was 8.9 weeks in the group using the plate, 9.1 weeks in the group using Steinmann pin. The mean operation time was 72 minutes in the group using the plate, whereas was 18 minutes in the group using Steinmann pin. CONCLUSION: In the treatment of adult clavicle shaft fracture, two groups did not show a significant statistical difference in clinical and radiological outcomes. However, the operation time and postoperative functional recovery was significantly shorter and faster in the group using Steinmann pin. Additionally economic and cosmetic aspect was more satisfactory in the group using Steinmann pin.

Operative Treatment with the Plate Fixation in Intraarticular Calcaneal Fractures / 대한족부족관절학회지

PURPOSE: We evaluated the results of operative treatment with F or H plates and screws using extensile lateral approach in intraarticular calcaneal fractures. MATERIALS AND METHODS: From August 2003 to July 2006, twenty intraarticular calcaneal fractures which were operated with open reduction and internal fixation with F or H plates and screws were evaluated retrospectively. According to the Essex-Lopresti classification, 3 cases were tongue type and 16 were joint depression type. With the Sanders classification, 2 cases were II A type, 7 were II B, 5 were III AB, 2 were III AC and 3 were IV. We have analysed the Bohler angle, Gissane angle, and calcaneal width in radiologic evaluation, and evaluated clinical result according to the Creighton-Nebraska Health Foundation Score. RESULTS: Radiologic changes showed as follows: Bohler angle improved from 5.8 degrees to 25.9 degrees, Gissane angle from 119.0 degrees to 113.3 degrees, and calcaneal width from 50.4 mm to 37.8 mm. In the clinical results, excellent cases were noted in 8 cases, good in 8 cases, fair in 2 cases, poor in 1 case. CONCLUSION: Operative treatment with F or H plates and screws using extensile lateral approach in intraarticular calcaneal fractures was thought to be a useful operative method allowing anatomical reduction.