A Clinical Study of Fat Embolism / 대한정형외과학회잡지

The fat embolism is a complication which occurs rarely in cases of long bone of lower extremity and pelvic bone fractures or after severe injury of soft tissue, and may result in an embolism in the lungs, brain, heart, kidneys and other important vessels when fat globules flow from bone marrow into such areas. There has been much adverse criticism about the pathogenesis of fat embolism including the incidence, diagnosis and treatment of it, and studies on this subject have been prevalent in recent years. The following results have been obtained through the study of 9 cases of fat embolism at the Department of Orthopaedic Surgery, Dong San Medical Center, Keimyung University during the period from 1973 to 1984. 1. By sex and age distribution, most of the patients were under the age of 40 and there were more male than female patients. 2. Seven cases were caused by traffic accidents and two were caused by falls accompanied by multiple fractures of the femur and pelvic bone. 3. Symptoms generally occured within 48 houres after trauma, however some cases were within 12 houres, some were 5 days and others 12 days. Clinical symptoms which were present at the time admission revealed increased erythrocyte sedimentation tates and decreased hemoglobin and platelete in most cases. Bilateral infiltrates and cotton ball appearances were found in all cases on thoracic radiology, but no fat globules were found in the urine or in frozen sections of clotted blood. 4. Blood gas analysis was performed in 4 cases and Pa02 under 60mmHg found in all cases increased gradually after treatment. 5. Of the 9 cases with fat embolism 6 cases completely recovered and three cases expired.

The Clinical Study of Subtrochanteric Fracture of the Femur / 대한정형외과학회잡지

The Subtrochanteric fracture requires long period healing time and is difficult for treatment because it occurs in bone that is predominantly cortical and high stress concentrates in this region. The Subtrochanteric fracture is difficult for the reduction and maintenance because many of these fractures are comminuted from high velocity trauma and the angulation rotation occurs by the influence of the surrounding large and powerful muscles. During the period of February, 1980 to April, 1985, 62 cases of Subtrochanteric fractures were admitted and treated at the Department of Orthopedic Surgery, School of Medicine, Keimyung University, and results were obtained as follows: 1. Of 62 cases, 42 in man and 20 in woman and diffuse in ages. 2. Causes of Subtrochanteric fractures were 32 cases of traffic accidents, 21 cases of fall or slip down, 5 cases of others, and 3 cases of pathologic fractures. 3. Of 62 cases, Type I by Zickel classification was predominant (33 cases), and Type III-A, “three-part spiral fracture“ by Seinsheimer was predominant (24 cases). 4. The better results can be achieved through the bone graft in severe comminuted fracture and through the provision of good cortical load-bearing medially between the fragment during the reduction and fixation. 5. Earlier bone union and low complication of metallic failure and nonunion were achieved with Compression Hip Screw rather than Jewett nail. 6. The causes for the 6 metallic failure cases were comminuted fracture of medial cortical bone, failure in contact and fixation of medial free fragment, and weight bearing before complete union was achieved. 7. There was a breakage in nail-plate junction when Vitalium jewett nail was used. Also there were breakage and loosening of screws when Stainless steel Jewett nail was used. 8. Further studies in the advantages and disadvantages of Zickel nail, Ender nail, Compression Hip Screw, and Kuntscher nail treatment of subtrochanteric fracture are needed.