Femoral Neck Fractures in Young Adults / 대한정형외과학회잡지

A fracture of the femoral neck in a young adult differs from the same fracture in an older patient in the following respects; 1. A relatively uncommon injury. 2. A significant difference in the severity of trauma. 3. A less satisfactory result. At the point of view, we studied the femoral neck fcartures in 15, 20- to 50-year-old patients. The aims were to analyze why these fractures occur in young adults, and what results can be expected after internal fixation. The results were as follows; 1. Common in men (3:1). 2. 80% (12/15 cases) of the fractures were caused by severe trauma. 3. The 3 cases (20%) were associated with the other fractures. 4. The factors infuencing the clinical results and complications in our study; a. Severity of trauma. b. Degree of displacement. c. Existence of posterior comminution. d. Time interval between accident and operation. 5. The multiple pinning got the more rigid fixation and diminished the rate of fixation failure. 6. All cases were achieved good to acceptable reduction. 7. Satisfactory functional results were achieved in 93.3%. 8. The rate of avascular necrosis was 15.4% (2/13 cases). It is concluded that the most of femoral neck fractures in younger patients occur because of the significant trauma. In our study, the incidence of avascular necrosis was not greater than in order patients. Therefore, to get as good a result as possible it seems important to perform the anatomical tion and rigid internal fixation with or without bone graft.

Observation of Fracture Load Index in Tibia Fracture Treated with Patella Tendon Bearing Cast / 대한정형외과학회잡지

The finger flexor injuries are very difficult to treat satisfactorily. It is usually said that the earlier the treatment performed, the better result obtained. But the delicasy of the hand anatomy and its function as well as the absence of the hand surgeon in the first aid care make the problem more complex. Even if we made the primary treatment to the flexor tendon injuries, some disabilities are often remained. We have treated fifty eight cases of old flexor tendon injuries in forty eight patients, the results can be summarized as follows. 1. The cause of the tendon damage is due to the laceration injury in the majorities of the cases. T,he tendon injuries are especially common between the late second and the early third decade. 2. In the injury of the Zone II with pulley distortion, the pulley reconstruction using palmaris longus or fascia from other sites will prevent bowstring and help the tendon function. 3. The Zone II can be subdivided into two subspecific areas. The proximal area is from the distal palmar crease to the midoprtion of porximal phalanx and the distal one is from the midportion of the proximal phalanx to the insertion of the sublimis tendon. In the proximal area one can repair the injured tendon directly after removal of the A1 and about proximal half of the A2 pulley without any subsequent bowstring if the tendon and its tunnel is relatively well preserved. Thus one can convert this proximal portion of Zone II to Zone III. So the proximal area of the Zone II should be differentiated from the remaining distal part of the Zone II. 4. At six months after the operation the result of the operation was analyzed by the percentage of the recovery, which was calculated by the postoperative active range of the interphalangeal joints divided by one hundred seventy five degrees that means the available total range of motion of normal interphalangeal joints. Excluding the cases with the tenodesis or arthrodesis, the total result revealed good or excellent in about ninty percentages with this method. 5. There were two fingers that showed a postoperative lumbrical plus state in Zone II, which were recovered spontaneously within three to four months postoperatively. So it is considered that the relative shortening of the lumbrical muscles can be treated and overcome conservatively by the active use of the fingers, and there is no need to perform an lumbrical tenotomy to correct this kind of muscle imbalance.