Complications of Fracture: Acute Compartment Syndrome

Acute compartment syndrome occurs when the pressure in the closed bone-myofascial muscle compartment rises above a critical level, and venous perfusion through the capillaries is blocked, resulting in microcirculation disorders. Tissue ischemia in the compartment causes irreversible damage to the muscles, nerves, and even bones, and can cause functional disorders, muscle contractures, nerve damage, and nonunion. In addition to trauma, phlebitis after injection, pseudoaneurysm due to blood vessel damage, anticoagulants (e.g., warfarin), and exercise are all known causes of acute compartment syndrome. On the other hand, it commonly occurs after a fracture, leading to serious complications if not treated appropriately. Therefore, when a fracture occurs, care must be taken to determine if acute compartment syndrome has occurred, and capillary circulation must be quickly restored through early diagnosis and decompression.

The Current Status of Bacterial Identification by Wound Culture for Diabetic Foot Lesions in a Single Tertiary Hospital in South Korea / 대한족부족관절학회지

Purpose@#The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investigating bacterial isolates. @*Materials and Methods@#This study included 223 DFU patients that visited a single tertiary hospital and underwent bacterial culture between January 2016 and February 2020. The study was conducted in two parts: 1) to compare bacterial isolates and wound healing according to comorbidities such as chronic kidney disease (CKD) and peripheral artery disease (PAD), and 2) to compare bacterial isolates according to wound depth using the Wagner classification. @*Results@#Of the 223 patients, 43 had CKD (group A), 56 had PAD (group B), 30 had CKD and PAD (group C), and 94 had none of these comorbidities (group D). The isolation rate for multidrug-resistant gram-negative bacteria (MRGNB) and gram-negative to grampositive bacteria ratio were highest in group C (p=0.018, p=0.038), and the proportion that achieved wound healing was lowest in group C (p<0.001). In the second part of the study, subjects were classified into 5 grades by wound depth using the Wagner classification; 13 grade I, 62 grade II, 60 grade III, 70 grade IV, and 17 grade V. No significant difference was observed between these grades in terms of isolation rates or gram-negative to gram-positive bacteria ratios. @*Conclusion@#This study suggests antibiotics that cover gram-negative bacteria including MRGNB produces better results in the presence of CKD and PAD and that initial antibiotic choice should be based on the presence of CKD and PAD rather than wound depth.

The Current Status of Bacterial Identification by Wound Culture for Diabetic Foot Lesions in a Single Tertiary Hospital in South Korea / 대한족부족관절학회지

Purpose@#The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investigating bacterial isolates. @*Materials and Methods@#This study included 223 DFU patients that visited a single tertiary hospital and underwent bacterial culture between January 2016 and February 2020. The study was conducted in two parts: 1) to compare bacterial isolates and wound healing according to comorbidities such as chronic kidney disease (CKD) and peripheral artery disease (PAD), and 2) to compare bacterial isolates according to wound depth using the Wagner classification. @*Results@#Of the 223 patients, 43 had CKD (group A), 56 had PAD (group B), 30 had CKD and PAD (group C), and 94 had none of these comorbidities (group D). The isolation rate for multidrug-resistant gram-negative bacteria (MRGNB) and gram-negative to grampositive bacteria ratio were highest in group C (p=0.018, p=0.038), and the proportion that achieved wound healing was lowest in group C (p<0.001). In the second part of the study, subjects were classified into 5 grades by wound depth using the Wagner classification; 13 grade I, 62 grade II, 60 grade III, 70 grade IV, and 17 grade V. No significant difference was observed between these grades in terms of isolation rates or gram-negative to gram-positive bacteria ratios. @*Conclusion@#This study suggests antibiotics that cover gram-negative bacteria including MRGNB produces better results in the presence of CKD and PAD and that initial antibiotic choice should be based on the presence of CKD and PAD rather than wound depth.

The Effect of Screw Apophysiodesis of Greater Trochanter in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: To evaluate the interstitial and appositional growth of greater trochanter post-screw apophysiodesis in Legg-Calve-Perthes (LCP) disease. MATERIALS AND METHODS: A total of 17 patients, who were diagnosed with LCP and underwent greater trochanter screw apophysiodesis and metal removal between December 2003 and December 2012, and were followed-up for at least 4 years, were selected. Anterioposterior radiologic images were taken in each process of apophysiodesis, metal removal, and last follow-up. From such images, articulotrochanter tip distance (ATD), trochanter tip-screw distance (TSD), trochanter tip-trochanter lower margin distance (TLD), and screw-trochanter lower margin distance (SLD) were measured. Appositional growth and greater trochanter growth rates were compared using paired t-test, independent t-test, and correlation analysis. RESULTS: The average ATD of the affected and unaffected sides was 14.2 and 16.8 mm, respectively at apophysiodesis and 9.2 and 14.8 mm at the last follow-up, with a significantly greater decrease observed on the affected side the unaffected side (p=0.030). TLD of the affected side during the follow-up increased 11.0 mm, from an average of 30.8 to 41.8 mm, while the un-affected side increased 14.3 mm, from an average of 26.7 to 41.0 mm. The growth of greater trochanter after the operation in the affected side was 76.7% of that in unaffected side. The ratio of TLD of the affected side to the unaffected side was significantly reduced, from 1.15 to 1.02 (p=0.014) at the final follow-up. TSD was significantly increased from 4.5 to 14.4 mm at metal removal (p < 0.001) and increased to 17.0 mm at the last follow-up. Moreover, the ratio of TSD to SLD was significantly increased from 0.20 to 0.74 at metal removal (p < 0.001) and increased to 0.84 at the final follow-up. CONCLUSION: The results of this study showed that screw apophysiodesis can suppress the overall growth, but not the appositional growth of the greater trochanter. Therefore, screw apophysiodesis may not be a good procedure to inhibit the growth of greater trochanter.

Breakage of the Femoral Cross-Pin with Impending Rupture of the Popliteal Vessels after Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

Breakage of the femoral cross-pin with impending rupture of the popliteal vessels is a rare complication for femoral tunneling in anterior cruciate ligament (ACL) reconstruction. The authors experienced a case of impending rupture of the popliteal vessels following breakage of the cross-pin 16 days after primary ACL reconstruction. Impending rupture of the popliteal vessels was detected with ultrasonography following breakage of the cross-pins which caused popliteal discomfort and irritation. After removal of the broken cross-pins, previous ACL graft and interference screw with subsequent re-reconstruction of the ACL using a new allograft and interference screw, the patient showed satisfactory results and resolution of symptoms. Therefore we report on this case with a review of literature.

Two-Year Follow-up Results of Anteroposterior Cannulated Screw Fixation of Posterior Malleolar Fragment in the Trimalleolar Fracture / 대한족부족관절학회지

PURPOSE: The purpose of this study was to assess the 2-year follow-up results of patients with a trimalleolar fracture, who had undergone an anterior incision cannulated screw fixation of the posterior malleolar fragment, which had more than 25% of articular involvement or had no cortical continuity with the distal tibia. MATERIALS AND METHODS: Among 28 patients with a trimalleolar fracture who had undergone fixation of the posterior malleolar fragment between February 2005 and February 2010, 14 patients, who underwent an anterior incision cannulated screw fixation of posterior malleolar fragment and were followed-up for more than 2 years, were selected. The postoperative clinical and radiological findings immediately and at the 1- and 2-year follow-up were compared. The clinical findings were evaluated as American Orthopaedic Foot and Ankle Society (AOFAS) score. The radiological assessment was evaluated as the maintenance of reduction, period to bone union, and the presence of nonunion, malunion, and complications. RESULTS: The clinical outcome by mean AOFAS score revealed 83.0 points in the group with preoperative displacement below 2 mm and 80.7 points in the group with preoperative displacement above 2 mm postoperatively. The mean AOFAS score was 91.7 and 93.1 points in the group with preoperative displacement below 2 mm on 1- and 2-year follow-up, respectively, and 89.8 and 91.7 points in group with the preoperative displacement above 2 mm on 1- and 2-year follow-up, respectively. After a 2-year follow-up among 14 cases selected for this study, 13 cases showed an excellent reduction state and only 1 case (7.1%) showed a displacement of more than 2 mm. No complication were encountered in the group with preoperative displacement below 2 mm. On the other hand, among 8 patients in the group with preoperative displacement above 2 mm, there were 3 with limitations of the range of motion of the ankle joint (37.5%) and 1 post-traumatic arthritis (12.5%) at the 2-year follow-up. CONCLUSION: Anterior incision cannulated screw fixation of the posterior malleolar fragment could be a valuable method for the treatment of trimalleolar fractures that provides satisfactory results.

The Changes in Patient Pattern for Pediatric Supracondylar and Lateral Condylar Humeral Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the changes in patients pattern retrospectively for pediatric supracondylar and lateral condylar humeral fractures. MATERIALS AND METHODS: We retrospectively studied 335 pediatrics treated operatively for supracondylar and lateral condylar fracture from March 1993 to February 2013. The pediatrics were divided depending on the 10-year time period: those who received treatment from March 1993 to February 2003 as group I, and those who received treatment from March 2003 to February 2013 as group II. By each group, the differences in age, gender, cause, season of incidence, whether the time of incidence was a weekend, and education level of the parents were compared and analyzed. RESULTS: Fractures in group I were mainly due to slip down and fall down, but sports injury was the main cause of fractures in group II. There were 112 cases and 121 cases of supracondylar fractures, and 65 cases and 37 cases of lateral condylar fracture in groups I and II. Significant differences were found in the incidence of lateral condylar facture (p=0.009). In terms of the education level of the parents, the number with high school or under decreased significantly from group I to group II, from 71 cases to 45 cases (p=0.040). CONCLUSION: The supracondylar fracture does not show any significant difference according to the time lapse in the age and cause of incidence. However, the incidence of lateral condylar fracture shows a decreasing trend which may be related to the decrease of the incidence of slipping and falling, and the improvement in the parent's education level.

Comparisons of Vertebroplasty and Kyphoplasty for Thoracolumbar Osteoporotic Vertebral Fractures / 대한골다공증학회지

OBJECTIVES: To examine and compare the effects of vertebroplasty or kyphoplasty on change in the vertebral height and kyphotic angle and presence of new vertebral fracture of adjacent level. MATERIALS AND METHODS: A total of 60 patients with vertebral compression fractures or stable burst fractures underwent vertebroplasty or kyphoplasty from Jan, 2007 to April, 2014 were included in the study. Preoperative, postoperative and last follow-up radiographs were analyzed to quantify presence of new vertebral fractures and preoperative and postoperative vertebral height and kyphotic angle at fracture levels were also measured. Changes in the vertebral body height and kyphotic angle at fracture levels were compared for vertebroplasty and kyphoplasty to determine if there was a significant differences. RESULTS: Measurements revealed that vertebroplasty increased vertebral body height at fracture level by an average 5.5mm or or by 33% of preoperative height and reduced local kyphotic angle by an average 3.5 degrees and kyphoplasty increased vertebral body height at fracture level by an average 5.8mm or by 36% of preoperative height and reduced local kyphotic angel by an average 3.6 degrees. New vertebral fractures occurred in 8 patients (24%) after vertebroplasty and 4 patients (14%) after kyphoplasty. CONCLUSION: There was no significant statistically greater improvement of changes in the vertebral body height at fracture level and kyphotic angle found with vertebroplasty and kyphoplasty. But the vertebroplasty has statistically greater risk of new fracture than kyphoplasty.