Résumé
PURPOSE: To evaluate the results of five-pin external fixation, with the fifth pin stabilizing the distal radius articular fragment, for unstable distal radial fractures. MATERIALS AND METHODS: Twenty cases of unstable distal radial fractures were treated with five-pin external fixation (5-pin group). The fifth pin was inserted into the distal articular fragment and attached to the external fixation frame. Metacarpal pins were removed at sixth week in 12 cases and at third in 8 cases, and radial pins were removed at eighth or ninth week. The radiographic results of 5-pin group were compared with those of 20 cases of traditional four-pin external fixation (4-pin group). RESULTS: The postoperative radial inclination was 23.1 degrees in 5-pin group and 22.2 degrees in 4-pin group; while at last follow-up 21.8o and 15.1 degrees respectively. Postoperative volar tilt was 8.5 degrees and 7.3o; while at last follow-up 6.3 degrees and 0.1 degrees respectively. Postoperative radial shortening was 0.3 mm, 0.4 mm; while at last follow-up 1.1 mm and 2.1 mm respectively. In 5-pin group, there were no significant differences in results whether the metacarpal pins were removed at sixth or third week. CONCLUSION: Five-pin external fixation, with the fifth pin stabilizing the distal articular fragment, enhanced early motion of the wrist maintaining fracture stability in unstable fractures of the distal radius.
Sujets)
Études de suivi , Radius , PoignetRésumé
PURPOSE: To prepare the appropriate guideline in choosing the internal fixatives for the intertrochanteric fractures of the femur in the elderly. MATERIALS AND METHODS: We reviewed 95 cases of intertrochanteric fractures of the femur from January, 1999 to December, 2003. We fixed the fracture with Proximal Femoral Nail in 37 cases (PFN group), Dynamic Hip Screw in 56 (DHS group), Dynamic Condylar Screw in 2 cases (DHS group). We reviewed operation time, blood loss during operation, changes in neck-shaft angle and sliding of lag screw. RESULTS: There were no significant differences in the parameters between the 2 groups in stable fracture. In unstable fractures, operation time in PFN group and DHS group revealed 103.9 and 128.2 minutes respectively; mean amount of blood loss during operation revealed 523.2 and 573.1 ml respectively. Mean changes in the neck-shaft angle at final follow-up in PFN group and DHS group revealed 4.6 degrees and 4.1 degrees; sliding of lag screw averaged 3.4 and 6.5 mm respectively. Among the DHS group, cases of additional fixation with trochanteric supporting plate revealed 3.1 degrees of changes in neck-shaft angle and 4.2 mm of lag screw sliding. CONCLUSION: In cases of stable fractures, any fixative might suffice. In cases of unstable fractures, there were no significant differences in results of treatment between these two groups, however, PFN group revealed shoter operation time and less blood loss during operation. It seemed to be necessary to apply additional fixation with trochanteric supporting plate when using DHS in unstable cases.
Sujets)
Sujet âgé , Humains , Fémur , Fixateurs , Études de suivi , Hanche , Fractures de la hancheRésumé
Neuromuscular choristoma is a rare benign tumor of the peripheral nerves. To the best of our knowledge, 21 cases have been reported to date. We describe here a 20-day-old female infant who presented with a buttock mass (4.5 x 4.1 x 3.2 cm on MRI) arising from the left sciatic nerve. Microscopically, it was characterized by an intimately disorganized mixture of nerve fibers and striated muscle fibers that were occasionally surrounded by the perineurium and separated by fibrous bands of varying thickness. In some areas, there appeared to be some cells in transitional forms between nerve fibers and muscle fibers, revealing variously positive expressions for S-100 protein in the muscular components. These findings are consistent with the hypothesis that neuroectodermal-derived Schwann cells can give rise to mature skeletal muscle. It appears that the fibrosis may be related to the degeneration of the neural components. The size of the mass on MRI has been unchanged during the 3-year follow-up period.
Sujets)
Femelle , Humains , Nourrisson , Fesses , Choristome , Fibrose , Études de suivi , Imagerie par résonance magnétique , Muscles squelettiques , Muscle strié , Neurofibres , Nerfs périphériques , Protéines S100 , Cellules de Schwann , Nerf ischiatiqueRésumé
PURPOSE: To analysis the efficacy of MRI in assessing fracture configuration and frequency of associated soft tissue injuries in tibial plateau fractures. MATERIALS AND METHODS: In the plain films and MRI of 47 cases with tibial plateau fractures,every fracture was classified by findings on plain film and MRI respectively according to the Schatzker system and they were compared with each other. The degree of displacement and depression of the fracture fragments were measured on plain film and MRI. RESULTS: MRI was more accurate in determining the classification of the fracture and measuring the displacement and depression of fragments. Fracture classifications were changed in 12 cases. Especially in Schatzker VI cases, articular step off over 2 mm and articular fragments over 2X2 cm were revealed in detail by MRI. Evidence of internal derangement of the knee was found in 38 (80.8%) cases. CONCLUSION: Most of the cases with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatment plan.
Sujets)
Classification , Dépression , Genou , Ligaments , Imagerie par résonance magnétique , Traumatismes des tissus mousRésumé
The function of the meniscus and subsequently the importance of meniscus preservation are well known. Thirty-two patients who underwent arthroscopic meniscus repair between 1993 and 1995 were studied retrospectively. Twenty menisci were repaired using modified Henning inside-out technique and the remaining twelve meaisci, outside-in technique. The average delay in surgery was two hundred days. Follow-up was done from 1 year to 3 years (average 22.4 months). The medial meniscus was repaired in 22 cases and the lateral meniscus including two saucerized discoid meniscus in 10 cases. Fourteen patients had anterior cruciate ligament (ACL) tear and other associated knee injuries were lateral condyle fra'cture of femur in one case and lateral condyle &acture of tibia in one case. Assessment of the result was based on the evaluation form of the International Knee Documentation CommitteegKDC). Twenty-seven patients (84.3%) were normal to nearly normal. Abnormal and severely abnormal results were mainly affected by the result of treatment of ACL tear.
Sujets)
Humains , Ligament croisé antérieur , Fémur , Études de suivi , Genou , Traumatismes du genou , Ménisques de l'articulation du genou , Études rétrospectives , TibiaRésumé
The purpose of this study is to make an emphasis the necessity of the dynamization after interlocking intramedullary nailing. We reviewed 75 cases of the fractures of the shaft of femur or tibia fixed with static interlocking intramedullary nailing. We excluded the cases in whom the locking screws were removed for the purpose of the relief of pain from the irriataion by those screws. The parameter we reviewed were the type of fracture, postoperative gap between the major fragments. Early callus formation, the union time, postoperative dynamization and controlled weight bearing. In those cases in which the contact surface between the major fragments was more than 50% and there noticed no early callus within 6 weeks after operation, the union time was shortened after dynamization, when the contact surface was less than 50% and there noticed no early callus, the union time was shortened after bone graft and dynamization which resulted in some shortening in the length in acceptable ranges. In cases with a major gap of more than 2mm, the union time was shortened after dynamization. The rate of early callus formation was a little higher in cases with postoperative controlled weight bearing than those to whom we did not permit a controlled weight bearing.