Helical Plating for Fractures of the Proximal Humeral Shaft / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of internal fixation with a helical plate for displaced proximal humeral shaft fractures by analyzing the clinical outcomes of patients. MATERIALS AND METHODS: Fourteen displaced fractures of the proximal humeral shaft were treated by open reduction and internal fixation (ORIF) or by minimally invasive plate osteosynthesis (MIPO) with the use of helical locking compression plates. We evaluated the adequacy of reduction, time-to-fracture healing, range of motion of the shoulder, and postoperative complications. The functional outcome of the shoulder was evaluated using a Constant-Murley shoulder score. RESULTS: Anatomical reduction of the fracture was obtained in nine cases treated by ORIF, and anatomical alignment was obtained in five cases treated by MIPO. All fractures were healed in an average of 14.9 weeks. The active range of motion of the shoulder was fully recovered in five cases, and restricted in nine cases, at around 12 months after surgery. The mean Constant-Murley shoulder score was 87.4 points, at around 12 months after surgery. There were no major complications, such as neurovascular injury, infection, loss of fixation, and nonunion. CONCLUSION: Helical locking compression plating for proximal humeral shaft fractures is a safe and effective surgical method in obtaining satisfactory fracture healing and functional outcome because it provides stable fixation and avoids complications related with lateral plating.

Limited Open Reduction and Intramedullary Nailing of Proximal Femoral Shaft Fracture

PURPOSE: To evaluate the result of treatment of proximal femoral shaft fracture with limited open reduction and intramedullary nailing. MATERIALS AND METHODS: Fifteen patients who had limited open reduction and intramedullary nailing due to proximal femoral shaft fracture for follow-up for more than 12 months were selected between March 2001 and December 2005. The clinical and radiologic results were analyzed. Winquist-Hansen classification and OTA/AO classification were used. RESULTS: Thirteen cases achieved bone union and 2 cases showed delayed union. The mean bone union period was 21.3 weeks (14~32). There was no postoperative infection. Nonunion was observed in 2 cases of which bone union was acquired with the exchange of intramedullary nail and bone graft in one case and with the additional plate fixation and bone graft in the other case. CONCLUSION: Treating proximal femoral shaft fracture with limited open reduction and intramedullary nailing seems to be a technique to manage proximal femoral shaft fracture that has combined fracture or ipsilateral femoral fracture or is unable to acquire acceptable reduction with closed reduction.

The Usefulness of Blocking Screw in Intramedullary Nail on Proximal Tibial Fracture

PURPOSE: To evaluate the effectiveness of a blocking screw in intramedullary nailing at the tibia proximal shaft fracture. MATERIALS AND METHODS: 63 tibia proximal shaft fractures from January 2000 to December 2002 treated with only intramedullary nailing were referred to as group I, and 8 fractures from January 2003 to December 2003 treated with both intramedullary nailing and the blocking screw were referred to as group II. Retrospective studies were done for group I and II. The incidence of nonunion and the postoperative angular alignments were compared. Malalignment was defined as an angle of 5 degrees anteroposteriorly or mediolaterally. RESULTS: There were 7 nonunion (11%) in group I in compare with none in group II. There were 21 angular malalignments (33%) in group I and 1 in group II (12%) and most of them had valgus deformity or anterior anglulation. No complications were directly due to the use of the Blocking screw. CONCLUSION: The technique of the blocking screw used to be one of the option for proximal tibial nailing at tibial proximal shaft fracture helps to overcome angular malalignments of bones.

Treatment of Proximal Shaft Fracture of Tibia with Intramedullary Nail: Analysis According to AO Classification and the Poller Screw

PURPOSE: This was a retrospective study to evaluate the results of intramedullary nailing in proximal shaft fracture of tibia. We analyzed those results according to AO classification and Poller screw. MATERIALS AND METHODS: Thirty-three proximal tibial shaft fractures (32 patients) were followed for more than one year. In AO classification, there were 6 cases of type A, 14 cases of type B, and 13 cases of type C. We used Poller screws in 14 operations. We evaluated translation, angulation and nonunion after surgeries. RESULTS: Twenty-eight cases (85%) were united primarily, but nonunions occurred in 5 cases. Malalignment (angulation>5degree or translation>5 mm) was found in 14 cases (42%). In Poller screw used and non-used groups, the malalignment was respectively showed in 2 cases (14%) and 12 cases (63%). According to AO classification, nonunion was found in only type B with 5 cases (36%). CONCLUSION: Intramedullary nailing of proximal shaft fracture of tibia showed relatively lower rate of primary union. Especially, when initial fractures have a butterfly fragment, it showed the higher rate of nonunion. Moreover, the malalignment rate was relatively higher, yet it is possible to reduce the rate of malalignment by using Poller screw.

Spiral Plate Fixation For Treatment of Proximal Humerus Fracture / 대한정형외과학회잡지

PURPOSE: When open reduction and internal fixation with plate and screws are indicated in comminuted proximal shaft of humerus, the ideal plate position at proximal end of the humerus is the lateral surface of the greater tuberosity. At midshaft of the humerus, however, insertion of the deltoid muscle limits the application of the plate on the lateral aspect. To overcome this discordance, open reduction and internal fixation for the treatment of comminuted fracture in the proximal humerus with precontoured spiral plate was performed to preserve deltoid insertion. MATERIAL AND METHOD: We performed open reduction and internal fixation with spiral plate in five patients. Two out of five required tricortical autogenous iliac bone graft due to severe comminution at the surgical neck. All patients were folllowed up for 20.5 months in average. The radiographic study for bony union and shoulder function ( Neer's criteria ) were evaluated. RESULT: All five fractures healed. Comminuted fracture at proximal humerus consolidated at 5 months in average. Comminuted fracture at the surgical neck needed an extra 2 months for healing. Shoulder function was classified as one excellent, two good and two fair. Two fair patients, who had severe comminution at the surgical neck, resulted in moderate loss of abduction and external rotation of the involved shoulder. But, the patients were satisfied with their shoulder function at final follow-up. There was no infection or metal failure. CONCLUSION: We recommend spiral plate as a worthwhile treatment for comminuted fracture of proximal humerus. Preservation of deltoid insertion seems to be helpful in the recovery of shoulder function.

The Clinical Study of the Proximal Shaft Fracture of the Femur in Children / 대한정형외과학회잡지

In general, satisfactory results can be obtained by nonoperative means in the management of proximal femoral shaft fracture in children. Howerver, it is sometimes difficult to maintain the fracture alignment by the nonoperative means because of different muscle pulls in the thigh. The proximal fragment tend to be displaced and roentgenograms are difficult to be taken during traction. These problems have led some authors to advocate open reduction and internal fixation which facilitate overall care. We report our experiences on nonoperative and.operative treatment for proximal femoral fracture at the Chon-ju Presbyterian Medical Center from February 1987 to January 1991. The results are as follows ; 1. There were 20 cases in male, 7 cases in female. Average age at injury was 6.9 years (range, 6 months to 12 years and 8 months). Traffic accident was the most common cause (70.3%). 2. Average immobillization time was 9.2 weeks (range, 6.0 weeks to 12.1 weeks) in the nonoperative treatment group(17 cases), while 8.1 weeks(range, 6.1 weeks to 11.4 weeks) in the operative treatment group (10 cases). 3. Average bony union time was 9.6 weeks (range, 6.3 weeks to 12.5 weeks) in the nonoperative treatment group(17. cases) and 11.2 weeks (range, 9.0 weeks to 13.4 weeks) in the operative treatment group (P < 0.05). 4. Average overgrowth of femur was 3.3mm(range,