Problems in the Classification and Treatment of Tibial Eminence Frature / 대한정형외과학회잡지

The studies about tibial spine fracture were less frequently reported, especially in its sdult type, had different opinions according to authors. Meyers and McKeever described it had frequedntly occured as isolated injury without associated ligamentous injury of the same knee in children and mainly caused by bicycle accident. They had classified it by three different types according to the shape of it, managed conservatively type I, II,IIIA, and recommanded simple suturing with absorbable materials as operative method. But, in our cases it had frequently occured in adult and combined with ligamentous injury at the same knee including ACL and MCL. Also, it had frequently been caused by major trauma such as traffic accident. Previous method of management including simple stainless steel wiring had scored poor results in these complicated fractures. The author reviewed 24 cases of the tibial spine fracture treated at the Department of Orthopaedic Surgery, National Medical Center from June, 1980, to June, 1988, and the following results were obtained. 1. The most common causes of the injury were traffic accident (12 cases) and associated with rupture of medial collateral ligament in 7 cases. 2. The fracture was classified as four different types according to its pattern and comminution and most commen types were III and IV, scored 8 cases and 7 cases irrespectively. 3. Initially, closed sreduction and cast immobilization was performed in 15 cases, of which 8 cases had poor results with non-union of the fracture and instability. 4. Simple stainless steel wiring in 2 cases scored poor results and distal advancement of ACL with double wiring revealed good results in these cases. 5. One case of type II fracture had persistently positive anterior drawer sign and subjective instability and needed distal advancement of ACL and double wiring. 6. Distal advancement of ACL and double wiring was performed in 6 cases of which 4 cases revealed excellent results and 2 cases did good ones.

Treatment of Segmental Tibial Fracture / 대한정형외과학회잡지

In addition to general charceteristics of tibial fracture, segmental tibial fracture is commonly combined with extensive soft tissue injury, comminution and displacement with poor blood supply in its middle segment. According to recent reports, intramedullary nailing was regarded as the excellent method in the management of this kind of fracture. Twenty-one cases were treated at the department of Orthopaedic Surgery, National Medical Center from January 1980 to December 1987 and following results were obtained; 1. Most common type of fracture was Type I (38.1%). Almost all the fractures were accompanied by open wounds(85.7%) and GIIIB open wounds were 12 cases(57.1%). 2. A verage union time was 31.8 weeks(union rate, 76.2%) and showed marked difference between closed fracture(20.2 weeks) and GIIIB open one(38.6 weeks). 3. Better results were seen in 8 cases of intramedullary nailing(average union time, 24.2 weeks), while all the plating method showed non-union in 3 cases of open wound.