Treatment of the Tibial Plafond Fractures Using the Ilizarov Method / 대한정형외과학회잡지

An intra-articular fracture of the distal tibia or a fracture of the tibial plafond is a relatively uncommon but the most difficult fracture to manage. There are many treatment options and many authors have reported good results after open reduction and rigid internal fixation to restore the length with articular surface and bone-graft followed by early motion and prolonged non-weight bearing. But in the fractures with severe comminution or with severe soft tissue injury, tries for internal fixation with plate and screws in the distal tibia will result in extensive soft tissue stripping of the wound with precarious blood supply, high rates of wound breakdown, superficial and deep infection, and osteomyelitis. The purpose of this study is to evaluate the results of treatment of severely open (open type III-A and more by Gustilo and Anderson) or comminuted plafond fractures (fracture type III and more by Ovadia and Beals) with an Ilizarov method with a minimum follow up of one year (average: 27.9 months) and we have reviewed 12 cases from December 1990 to October 1995. The results were as follows. 1. The average time of bone union were 17.5 weeks (range: 6-42weeks). 2. The radiological results of the treatment were excellent in 4 patients (33.3%), good in 4 patients (33.3%) and poor in 4 patients (33.3%) by radiological assessment of Crutchfield and the clinical results of the treatment were excellent in 4 patients (33.3%), good in 5 patients (41.7%) and poor in 3 patients (25.0%) by functional rating scaie of Crutchfield. 3. It seems that prognosis depends on severity of comminution at the time of injury. 4. The complications were bony collapse of the distal tibia in 2 patients, nonunion in 1 patient, degenerative arthritis of the ankle joint in 2 patients and chronic osteomyelitis in 2 patients. 5. Ilizarov technique is an useful method in the management of severely open or comminuted plafond fracture of the tibia and it would be preferable to apply buttress plate or bone graft after improvement of skin condition to prevent the late collapse.

Surgical Treatment of Lower Lumbar Burst Fractures / 대한정형외과학회잡지

Burst fractures of lower lumbar spine are rare and have not been well delineated in the literature. Treatment and management considerations for lower lumbar burst fractures are somewhat different from the rest of spine because this area only has the cauda equina and nerve roots. The purpose of this study was to analyse the clinical and radiological results and to determine operative approach. The authors analysed the 16 patients who had been treated with spinal instrumentation (Cotrel- Dubousset, Danek, Kaneda) from Dec. 1990 to Dec. 1994, and following results were obtained. 1. The classification of fracture by Francis-Denis method was B type in 7 cases, A type in 6 cases, E type in 2 cases, and D type in 1 case. 2. By the load-sharing classification, six points or less in 11 patients (first group) and seven or more in 5 patients (second group). In first group lordosis was corrected from 20.4degreespreoperatively to 32.6degrees postoperatively and 24.1degrees at the end of follow-up. In second group lordosis was corrected from 14.8degrees preoperatively to 21.3degrees postoperatively and 0.8degrees at the end of follow-up. 3. The short segmental fixation through posterior approach yielded good result in the first group, but poor result in the second group with complications including two cases of loss of reduction and one case of screw breakage. As a result, posterior approach might be more perferable in first group and anterior approach in the second group.

Ipsilateral Fractures of the Femoral Neck and Shaft / 대한정형외과학회잡지

The management of ipsilateral fractures of the femoral neck and shaft has proved to be a challenge to the orthopedist. Most major institutions have treatment protocols that emphasize early rigid stabilization of the femoral neck fracture to minimize the incidence of avascular necrosis of the femoral head and the shaft fractures were fixed prior to definitive neck stabilization. Whenever possible, patients should be followed for a minimum of three years to rule out aseptic necrosis of the femoral head. These dual fractures are usually encountered in the young, associated with high-velocity accidents and usually accompanied by multiple system trauma. At the department of orthopedic surgery, Eul Gi General Hospital, from June, 1986 to August, 1993, 21 cases of the concomitant ipsilateral femoral neck and shaft fractures had been treated. The mean follow-up was 2.8 years(ranging from 1.6 to 5.8 years). The diagnosis of femoral neck fracture was delayed in two patients. Seventeen of the 21 cases underwent surgery had a relatively satisfactory functional outcome without complication of femoral head. In two patient, a symptomatic varus nonunion and varus malunion developed. In two cases, osteonecrosis of femoral head developed and one case of these patients was treated with Meyer techniqe of muscle pedicle graft. Our series emphasize that the recommended treatment consists of a closed intramedullary fixation of the femoral shaft fracture followed by ASNI screw fixation of the femoral neck fracture, with good long term functional results and minimum complication. And approaches to the treatment of concomitant femoral neck and femoral shaft fractures should be selected according to the skill and experience of the surgeon and the availability of equipment.

Management of Tibia Fracture by Closed Intramedullary Nailing / 대한정형외과학회잡지

161 patients with tibia fracture were treated by closed intramedullary nailing at the department of Orthopedic Surgery, Eul-Ji General hospital, Dae Jeon, during 5 years from January, 1988 to April, 1993. 134 of these patients were performed with Kiintscher IM nailing and 27 patients with Ender nailing. Rigid IM nailing is the method of choice in tibia shaft fracture with rigid fixation, low complication, wide indication and early weight bearing, but the treatment of segmental fracture of the tibia will have many difficulties because of severe displacement, severe comminution, massive soft tissue damage and lack of blood supply at fracture site. Either antegrade or retrograde Ender nailing was of value for the management of segmental fracture which was too proximally or too dixtally located to insert interlocking screws, open fracture and soft tissue injury around Kiintscher insertion site. The result as fllows; 1. 43 fractures were open and 118 were closed. 69 fractures involved the distal portion, 55 fractures the middle portion, 13 fractures the proximal portion of the tibia and 24 fractures were segmental. 2. Among the 161 eases, 114 cases were male and 47 cases were female, the most common ages were ranged from 21 year to 30 year, involving 44 cases. 3. The most common cause was traffic accident. 4. Average intervals from injury to operation were 6.34 days(closed fracture) and 9.84 days(open fracture). 5. The mean durations of the bone union were 18.90 weeks(closed fracture) and 16.46 weeks(open fracture). 6. Complication included 7 cases delayed union, 3 cases nonunion, 8 cases superficial infection, 4 cases joint stiffness, 3 cases nail migration, 2 cases angular deformity, 2 cases rotational deformity, 1 cases osteomyelitis.

The Treatment of Tibial Shaft Fractures by Closed Kuntscher I / 대한정형외과학회잡지

Frature of the tibial shaft is the most common fracture of the long bone and the treatment has become one of the most controversial subjects in orthopedic surgery. 61 cases of tibial shaft fracture in adults were treated by closed Kuntscher I-M nailing at the department of Orthopedic Surgery, Dae-Jeon Eul-Ji Hospital during 5 years from January, 1983 to December, 1987. In this paper we are reporting our result of 52 selected cases which we could follow up more than 6 months. The results were as follows. 1. The mean duration of clinical bone union was 9.6 weeks and that of radiological bone union was 15.6 weeks. 2. 6 cases of complication were noted with a little impairment of function finally. The complication were ankle joint stiffness(2), superficial infection(1), irritation of protruded nail(2) and bursting fracture(1). 3. Closed Kuntscher and occasionally combined interlocking I-M nailing are relatively short operative procedure with rigid fixation, low complication, wide indication and early weight bearing. So we consider them to be good methods of treatment for tibial shaft fractures.