Treatment of OTA type A2 Intertrochanteric Fractures of the Femur Using Sliding Hip Screw: An Analysis of Risk Factors

PURPOSE: This study was performed to evaluate the risk factors affecting the failure of fixation and to analyze the clinical and radiologic results after operation with using a sliding hip screw for treating OTA type A2 intertrochanteric fractures of the femur. MATERIALS AND METHODS: From January 2001 to June 2005, we reviewed the clinical records and the serial radiographs of 53 patients (OTA type A2 intertrochanteric fractures of the femur) who were treated with a 135-degree angled sliding hip screw. We analyzed the change in the neck-shaft angle, the sliding distance and failure of the sliding screw, according to the reduction of the lesser trochanteric fragment and the stability of the lateral buttress. RESULTS: Among 53 patients, there were 15 cases (28.3%) of failures to reduce the lesser trochanteric fragment. Losses of the lateral buttress were observed in 35 cases (66.0%). There were 8 cases (15.1%, 8/15) that failed radiologically, including cutting out of the sliding hip screw from a femoral head (3 cases), metal failure (1 case) and excessive sliding (4 cases). There were significantly differences for the changes of the angle of the neck-shaft, the distance of sliding and the length of penetration of the sliding hip screw, according to the reduction of the lesser trochanteric fragment and the stability of the lateral buttress. CONCLUSION: It is important to consider the reduction of the lesser trochanteric fragment and the stability of lateral buttress when treating OTA type A2 intertrochanteric fractures with using a sliding hip screw.

Comparison of the Results after the Surgical Treatments of the Trimalleolar Ankle Fractures / 대한족부족관절학회지

PURPOSE: To evaluate the methods and results of the surgical treatment in the trimalleolar fracture of the ankle. MATERIALS AND METHODS: We analysed the results of the ankle trimalleolar fracture which were treated with open reduction and internal fixation from January 1999 till September 2003. There were 45 patients who had at least six months follow up, 16 men, and 29 women. We have analysed the mechanism of injury, methods of operation and postoperative complications. RESULTS: The results were assessed on ankle AP, lateral and mortise X-rays and retrospective chart review. There were 30 supination-external rotation, 13 pronation-external rotation, 2 pronation-abduction in the mechanism of injury by Lauge-Hansen classification. Cases of the posterior malleolar fracture which involved more than 25% of the weight bearing surface were 7 (15.6%). Medial malleolar mono-fixation was done in 5 cases, fibular mono-fixation in 2 cases, bimalleolar fixation in 32 cases, trimalleolar fixation in 6 cases. 38 cases (84.4%) were good or excellent in clincal assessment and 39 cases (86.7%) were good or excellent in radiological assessment according to the criteria of the Meyer. There was no difference of results among the surgical treatment methods. CONCLUSION: The results of our study indicate that the rigid fixation with early ankle motion and weight bearing is needed in ankle trimalleolar fracture. But minimal fixation is not bad in slight displaced fracture. Both anterior approach and posterior approach were useful methods to stabilization the posterior malleolar fracture. And pre-operative evaluation to detect the hidden soft tissue injuries and fracture mechanism is very important to avoid the failure.

Operative Treatment of Intraarticular Calcaneal Fracture According to the Fracture Type / 대한족부족관절학회지

PURPOSE: We evaluated the clinical results of operative treatment of the intraarticular calcaneal fracture according to fracture classification. MATERIALS AND METHODS: There were 25 cases (24 patients) which had at least one year follow up, 17 men and 7 women who were treated from June 1997 to March 2003. We have analysed the Bohler's angle, cruciate angle, width and posttraumatic osteoarthritis in radiological evaluation, and evaluated clinical results according to the Creighton-Nebraska health foundation score. RESULTS: Excellent results were noted in 7 cases, good results in 6 cases, fair results in 4 cases and poor results in 8 cases. Radiological changes showed as follows: Bohler angle 17 degrees, Crucial angle 0.1 degrees, Width 6mm. CONCLUSION: Type II showed satisfactory results and type IV showed unsatisfactory results in Sanders classification. Proper evaluation of the intraarticular calcaneal fracture by X-ray and CT scan is necessory to predict prognosis and decise method of operative treatment.

Respiratory and Cardiovascular Effects in Relation to Single Intravenous Dose of Fentanyl / 대한마취과학회지

BACKGROUND: Fentanyl is a narcotic analgesic with rapid onset and brief duration of action, so we can use it for analgesia in painful condition. But respiratory depression due to high dose is one of the major complications. We studied the respiratory and cardiovascular effects in relation to single dose of fentanyl. METHODS: We selected forty-two adults who had clear conciousness and received spinal anesthesia without premedication. After the fixation of level of anesthesia, we measured respiratory rate(RR), PaCO2, mean arterial pressure(MAP), and heart rate(HR) as a control value. We allocated patients randomly to 4 groups and administrated a bolus of fentanyl(1, 2, 3, 4 mcg/kg) intravenously. The changes of RR, PaCO2, MAP, and HR were observed. RESULTS: In all groups, RR decreased and PaCO2 increased after injection of fentanyl. The change was peak at 5min, and then maintained until 20min. MAP was not changed in all groups and HR decreased with higher dose than 2 mcg/kg. CONCLUSION: Intravenous injection of fentanyl depress the ventilatory function but has not clinically significant depressant effect up to 4 mcg/kg in normal patients.