Treatment of Humeral Shaft Fractures with Seidel Nail / 대한정형외과학회잡지

Seidel nail provides more advantages for treatment of humeral shaft fracture than other treatment modalities. It enables patients to get high bone union rate, makes surgical technigne less invasive, and allows early mobilization mobilization so that the patients is subjected to more comfortable treatment. But, Seidel nail is apt to injure the rotator cuff and has relatively weak holding power of distal fragment of fracture so that it may result in distraction and rotatory instability, and make nonunion and impaired shoulder function. Thus, in order to the functional and radiological results, complications and technical problems, we evaluated the efficacy of Seidel nail in treatment of 20 cases of hurneral shaft fractures from March l994 to March 1996, retrospectively. The results were as follows. 1. 18 cases(90%) achieved radiological union. 2. The time of union was 12.5 weeks in average. 3. 17 cases achieved satisfactory results according to Neers functional score. 4. The complications included proximal protrusion of nail from the entry site(10%), fracture of greater tuberosity of proximal humerus(5%), loosening of distal spreading screw(10%), and nonunion( l 0%). In conclusion, Seidel nailing is one of good treatment modalities for humeral shaft fracture, but skillful operative technique is needed to obtain the satisfactory functional result. And also, it is necessory to modify the distal locking system of Seidel nail to reinforce the rotational stahility of the fracture site.

Lumbar Spinal Epidural Abscess Combined with Cauda Equina Syndrome: A Case Report / 대한정형외과학회잡지

Spinal epidural abscess is an uncommon, but a significant disease due to its high morbidity and mortality rate if not diagnosed in time. Although early diagnosis and prompt surgical intervention is needed for better prognosis of this disease, the diagnosis of spinal epidural abscess is often elusive despite modern medical advances, and depends on a high index of suspicion. we report a case of lumbar spinal epidural abscess of unknown origin complicated by cauda equina syndrome.

Treatment of the Open Tibial Pilon Fractures - Using Limited Internal Fixation and External Fixation / 대한정형외과학회잡지

Open tibial pilon fractures present extensive soft tissue disruption and common complications such as sepsis or skin slough, and deserve special cosideration in addition to the challenging reconstructive problems. The purpose of this study is to assess the effectiveness of limited internal fixation and external fixation for the treatment of the open tibial pilon fractures, and to introduce some idea in Ilizarov device use. We reviewed 27 open tibial pilon fractures treated with limited internal fixation and external fixation from Feb. 1992 to Mar. 1996(follow-up range, 1 to 5 years). Fracture classification(Ruedi and Allgower) was type I in 5, type II in 10 and type III in 12, open wound type(Gustilo-Anderson) was II in 8, IIIA in 17 and IIIB in two. Secondary procedures were 16 soft tissue procedures, 13 bone graftings and 2 limb lengthening. Mean time for removal of the external fixators was 3.5 months(range, 6 to 21 weeks), and clinical union averaged 4.3 months(range, 12 to 25 weeks). At the time of last follow-up, radiologic grading(Burwell and Charnley) showed 13 good(48%), 10 fair(37%) and 4 poor results(15%). Objective functional grading(Ovadia and Beals) showed 5 excellent(19%), 15 good(56%), 6 fair(22%) and 1 poor(4%), and subjective grading 2 excellent(7%), 16 good(59%), 7 fair(26%) and 2 poor(7%). Common complications included 10 wound sepsis(37%), 6 posttraumatic arthritis(22%) and 5 malunions(19%). In conclusion, we cosider limited internal fixation and external fixation is an effective treatment modality till bone union for open tibial pilon fractures, and Ilizarov method using tension wires crossed only through the fracture fragments can provide a sufficient early and late stability.

Surgical Treatment of Post - traumatic Kyphosis / 대한정형외과학회잡지

Post-traumatic kyphosis is generally recognized as the result of failure of initial treatment in injured spine. The purposes of this study are to find out the surgical indications in residual post-traumatic kyphosis and to analysis the result of operative correction in post-traumatic kyphosis. The authors analyzed 14 cases of post-traumatic kyphosis, operated from Jan. 1992 to Mar. 1996. Their injuries were estimated initially compression fracture in 12 cases, hurst fracture in 2 cases. Their initial treatments were conservative method in 12 cases, anterior fusion in 1case & laminectomy in 1 case. The results of this study are as follows: 1) By standard Cobb lateral measurement, the mean preoperative kyphosis of 32.9degrees was reduced to 14.2 degrees(56.8% correction ratio). 2) Symptomatic improvement was definite, stooping with fatigue pain, mid back pain and accompanied claudication were improved in all cases. And low hack pain due to compensatory lordosis was improved in 5 of 6 cases. 3) We acquired bone union in all cases. We concluded that some thoraco-lumhar fractures could be underestimated in supine X-ray and needed more meticulous evaluation and follow-up. In addition, preexisting symptomatic lumhar degeneration below fracture should be considered in initial surgical decision making of post-traumatic kyphosis.

Thoracolumbar Epidural Hematoma Complicated by Cauda Equina Syndrome : Complication of Systemic Heparinization Following Epidural Anesthesia: A case report / 대한정형외과학회잡지

Spinal epidural hematoma is a rare complication of epidural anesthesia and most commonly associated with intraoperative or postoperative anticoagulant administration. We describe the case of an acute thoracolumbar epidural hematoma at the T12-L4 level complicated by cauda equina syndrome, which occurred after placement of spinal epidural catheter for anesthesia and anticoagulant therapy for acute myocardial infarction developed postoperatively. In our experience, the spinal epidural catheterization and anticoagulant therapy may potentially increase the risk of epidural hematoma formation.