The Hoffmann-Tinel Sign: Historical Background and Clinical Significance / Sinal de Hoffmann-Tinel: Contexto histórico e significado clínico

The Hoffmann-Tinel sign is well-known to professionals dealing with nerve lesions and is widely used as a provocative test. It was described by Paul Hoffman and Jules Tinel in the same year (1915), independently. In the present article, a biographical sketch of both authors is presented and the method for eliciting the sign and the sometimes controversial information of its results are discussed.

O sinal de Hoffmann-Tinel é bem conhecido pelos profissionais que lidam com lesões de nervos, sendo amplamente utilizado como um teste provocativo. Foi descrito por Paul Hoffmann e por Jules Tinel no mesmo ano (1915), de forma independente. No presente artigo, é apresentado um esboço biográfico de ambos autores e são discutidas a forma de obter o sinal e as informações, por vezes controversas, fornecidas por seus resultados.

A long-term clinical outcome of Hoffmann pocket four-point scleral fixated intraocular lens implantation combined with penetrating keratoplasty – A single corneal surgeon’s report

Purpose: To analyze retrospectively the outcomes of Hoffmann pocket scleral fixated intraocular lens implantation combined with penetrating keratoplasty at a tertiary institute by a single corneal surgeon. Methods: Forty?two eyes of 42 patients, aged between 11 and 84 years, had a mean follow?up of 2 ± 2.216 years. Overall, five (11.9%) had congenital and 37 had acquired pathology, 15 were pseudophakic, 23 were aphakic, and four were phakic. The commonest indication was trauma in 19 (45.2%), and 21 had previous multiple surgeries including five retinal procedures. Results: The grafts were clear in 20 (47.6%), they failed in 20, three had acute rejection, three were ectatic, two had infection, one had persistent edema, and one had endophthalmitis. The mean log of minimum angle of resolution (logMAR) best corrected visual acuity was 1.902 pre?op, 1.802 at the final follow?up, and 0.52 after excluding preexisting retinal pathologies. At the last follow?up, the vision improved in 18 (42.9%), maintained in 6, and worsened in 18, and three needed more than ?5.00 D and seven needed more than ?3.00 D cylinder correction. Five had glaucoma preoperatively, 10 developed the condition postoperatively, six needed cyclodestructive procedure, and three had valve surgery. Conclusion: Advantages of this surgery are avoidance of additional sections to insert the lens, direct positioning of the lens in the posterior chamber, rotational stability of the lens from four?point fixation, and untouched conjunctiva over the scleral pockets. The fact that 20 had clear grafts and 18 visually improved, though two needed lens removal and one developed retinal detachment postsurgery is encouraging. More cases with longer follow?ups will help understand the technique better

Revisión del intervalo de referencia del recuento plaquetario: ¿son adecuados los valores que estamos utilizando? / Review of the platelet count reference range: are the values we are using appropriate?

Los intervalos de referencia (IR) dependen de la población y de las características metrológicas del procedimiento de medida utilizado. A pesar de las recomendaciones internacionales, son pocos los laboratorios que establecen sus propios IR para cada magnitud por la dificultad para conseguir voluntarios de referencia y el elevado costo económico asociado. La International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) acepta la adopción de IR bibliográficos o su cálculo por métodos indirectos dado su bajo costo y fácil obtención. Existen varias fuentes confiables de IR bibliográficos para el hemograma. No obstante, para el recuento plaquetario, es una práctica común de los laboratorios emplear el rango de valores de 150-450.109 /L independiente de la metodología utilizada y grupo etario. El objetivo de este trabajo fue revisar los IR bibliográficos disponibles para el recuento plaquetario y estimarlo empleando el método indirecto de Hoffmann a partir de nuestra población. Los métodos indirectos se basan en aplicar criterios de exclusión y cálculos matemáticos sobre los resultados de una base de datos de laboratorio. Nuestros IR para el recuento plaquetario se comparan con los bibliográficos, que han sido establecidos por técnicas de muestreo directo. Por este motivo y dado que no existen estudios poblacionales que lo avalen, sería apropiado reemplazar el rango de 150-450.109 / L. Estos límites podrían seguir empleándose como puntos de corte o niveles de decisión médica para definir, según la clínica y otros resultados de laboratorio, los pacientes que ameritan un seguimiento posterior (AU)

Reference ranges (RR) depend on the population and the metrological characteristics of the measurement procedure used. Despite international recommendations, few laboratories establish their own RRs for each magnitude because of the difficulty in obtaining reference volunteers and the associated high economic cost. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) accepts the use of literaturebased RRs or RRs calculated by indirect methods because of their low cost and easy collection. There are several reliable sources of literature-based RRs for the Cell Blood Count. However, for platelet count, it is common laboratory practice to use the range of 150-450,109 /L regardless of the methodology used and age group. The aim of this study was to review the available literature regarding RRs for platelet count and to establish it using the indirect Hoffmann method in our population. Indirect methods are based on applying exclusion criteria and mathematical calculations on the results of a laboratory database. Our RRs for platelet counts are compared with those in the literature, which have been established by direct sampling techniques. Therefore, and given that there are no population studies to support these findings, it would be appropriate to replace the 150-450,109 /L range. These limits may continue to be used as cut-off points or medical decision levels to define, according to clinical manifestations and other laboratory results, patients who warrant further follow-up (AU)

Intervalos de referencia en pediatría. Una guía de sus formas de cálculo ordenadas según su fortaleza metodológica / Pediatrics reference intervals. A guide of its calculation forms ordered according to their methodological strength

Resumen El objetivo de esta comunicación es proponer una guía de las formas decálculo de los intervalos de referencia (IR) en la población pediátrica ordenándolassegún su fortaleza metodológica. En primer lugar, el proceso recomendadopara definir un IR es el enfoque "directo", en el que se evalúanmuestras de sujetos considerados sanos. En segundo lugar, la convocatoria"indirecta", en la que a los resultados de las muestras de una base dedatos, se aplican criterios de exclusión y procesamientos estadísticos (métodosde Hoffmann y de Bhattacharya). Estos IR presentan poca diferenciacon los obtenidos por datos directos y se pueden considerar equivalentes,con la ventaja de su facilidad y sus costos más bajos. En tercer lugar, estánlos IR obtenidos de la bibliografía. La validación de los datos informadospor el fabricante es la última opción a tener en cuenta. Se reafirma laimportancia de contar con IR adecuados por sus aspectos clínicos y por laseguridad de los pacientes.

Abstract The aim of this communication is to propose a guide on the ways of calculating reference intervals (RI) in the pediatric population, ordering them according to their methodological strength. First, the recommended process to define an RI is the "direct" approach, in which samples of subjects considered healthy are evaluated. Secondly, the "indirect" approach, in which exclusion criteria and statistical processing are applied to the results ofthe samples in a database (Hoffmann and Bhattacharya methods). These RIs show little differences with those obtained by direct data and they can be considered equivalent, with the advantage of their ease and with lower costs. Thirdly, there are RIs that can be obtained from the bibliography. The validation of the data reported by the manufacturer is the last option to consider. The importance of having adequate RIs for their clinical aspects and for the safety of patients is reaffirmed.

Resumo O objetivo desta comunicação é propor um guia sobre as formas de cálculo dos intervalos de referência (IR) na população pediátrica, ordenando os mesmos de acordo com sua fortaleza metodológica. Emprimeiro lugar, o processo recomendado para definir um IR é a abordagem "direta", na qual sãoavaliadas amostras de indivíduos considerados saudáveis. Em segundo lugar, a abordagem "indireta",na qual critérios de exclusão e processamento estatístico (métodos de Hoffmann e Bhattacharya)são aplicados aos resultados das amostras em um banco de dados. Esses IR apresentam poucadiferença com os obtidos por dados diretos, podendo ser considerados equivalentes, com a vantagem de apresentarem facilidade e menor custo. Em terceiro lugar, os IR obtidos da bibliografia. A validadedos dados informados pelo fabricante é a última opção a ser considerada. A importância de termos IRadequados pelos seus aspectos clínicos e pela segurança dos pacientes é reafirmada.

Suicidio mediante el uso de un arma de fuego, con presencia de doble Signo de Hoffmann: reporte de un caso / Firearm suicide with the presence of a double Hoffmann sign: case report

Resumen El presente artículo expone el caso de un suicidio de un masculino, el cual presentó dos orificios de entrada en la cabeza con características propias de un orificio de contacto, específicamente dos signos de boca de mina, también conocido como signo de Hoffmann.

Abstract This article presents the case of a suicide of a male, which presented two entry holes with characteristics of a contact hole in his head, two mine mouth signs, also known as Hoffman´s sign.

Manejo respiratorio en atrofia muscular espinal: cambio de paradigma en la era de las nuevas terapias específicas / Respiratory care in spinal muscular atrophy in the new therapeutic era

Resumen: La atrofia muscular espinal (AME) es la enfermedad genética mortal más frecuente en lactantes, con severidad variable. Se clasifica en cuatro subtipos: tipo 0 de inicio prenatal y recién nacido ya afecta do, con ausencia de esfuerzo respiratorio y ningún desarrollo motor, tipo 1 de inicio en menores de 3 meses que no logran sentarse, tipo 2 que logran sentarse, pero no caminar y tipo 3 que consiguen caminar. La causa más seria de morbimortalidad es la neumonía y la insuficiencia respiratoria. La información a los cuidadores debe contemplarse desde el diagnóstico, para la toma de decisiones anticipadas. Los objetivos del manejo incluyen el estímulo de la tos, evitar la deformación de la caja torácica, la hipoventilación, y tratar oportunamente las infecciones respiratorias, el trastorno de de glución, el reflujo gastroesofágico y la malnutrición. El objetivo de esta actualización es discutir los nuevos desafíos en cuidados respiratorios con un enfoque preventivo, considerando la reciente dis ponibilidad de tratamientos específicos -oligonucleótidos antisentido nusinersen- y otros que están en desarrollo, incluída la terapia génica.

Abstract: Spinal muscular atrophy (SMA) is the first inherited cause of mortality in infants, with four subtypes: SMA0 prenatal onset, SMA1 babies less than 3 months non sitters, SMA2 sitters and SMA3 walkers. Pneumonia and respiratory insufficiency are the most severe complications. Informed parental de cisions are relevant. Respiratory management includes cough assistance, prevention of lung under development due to chest deformity, prompt treatment of respiratory infections, hypoventilation, swallow problems, gastro esophageal reflux and malnutrition. In view of the FDA and EMA approval of the nonsense oligonucleotides nusinersen, the first specific treatment for SMA and the future with gene therapy and others under development, we need to optimize preventive respiratory manage ment with the new standard of care.

Síndrome de Werdnig-Hoffmann / Werdnig-Hoffmann disease

Introducción: El síndrome de Werdnig-Hoffmann o atrofia espinal tipo I forma parte de las atrofias musculares espinales y es la más grave de las tres formas clínicas existentes. Tiene carácter hereditario autosómico recesivo, no tiene tratamiento, es de carácter progresivo y por lo general culmina con la muerte del paciente entre el primero y segundo año de vida. Objetivo: Describir la conducta de la vía respiratoria anatómicamente difícil conocida en un paciente con síndrome de Werdnig-Hoffmann operado de litiasis renal derecha. Caso clínico: Paciente masculino de 39 años de edad, nivel de escolaridad superior, con diagnóstico de litiasis obstructiva en riñón derecho, propuesto para realizar una nefrolitotomía percutánea. Los exámenes en la consulta de anestesia diagnosticaron una vía respiratoria anatómicamente difícil. Pese a contar con la colaboración del paciente, personal entrenado, equipamiento necesario y proceder según los algoritmos recomendados en la literatura, se necesitó una vía quirúrgica para realizar la operación. Se efectúo el proceder quirúrgico propuesto sin complicación y el paciente salió del quirófano despierto y consiente. Conclusión: De requerirse otra intervención quirúrgica, sería necesario iniciar la intubación mediante fibroscopía óptica para evitar el edema de las vías respiratorias. De no obtenerse una vía respiratoria segura por este método, el paciente precisaría una vía aérea quirúrgica(AU)

Introduction: Werdnig-Hoffmann disease or spinal atrophy type I is part of the spinal muscular atrophies and the most serious of the three clinical forms in existence. It is an autosomal recessive hereditary condition, with no treatment, progressive in nature and usually culminates with the death of the patient between the first and second year of life. Objective: To describe the behavior of the anatomically difficult airway identified in a patient with Werdnig-Hoffmann disease operated for right renal lithiasis. Clinical case: Male patient at age 39, higher education level, with a diagnosis of obstructive lithiasis in the right kidney, proposed to be performed a percutaneous nephrolithotomy. The exams in the anesthesia consultation provided diagnosis of an anatomically difficult airway. Despite having the cooperation of the patient, trained personnel, necessary equipment and proceeding according to the algorithms recommended in the literature, a surgical approach was needed to perform the operation. The proposed surgical procedure was carried out without complications and the patient left the operating room awake and conscious. Conclusion: In case that another surgical intervention is required, it would be necessary to initiate intubation by optical fibroscopy in order to avoid edema of the respiratory tract. In case a safe airway is not obtained by this method, the patient would need a surgical airway(AU)

Application of Hoffmann II metal external fixation in treatment of open tibiofibular fracture / 局解手术学杂志

Objective To observe the effect and complications of Hoffmann Ⅱ metal external fixator in the treatment of open fractures of tibia and fibula. Methods 40 patients with open fractures of fibula received fracture reduction and fixation with HoffmannⅡmetal exter-nal fixing frame by C arm X-ray machine,who were followed up for 12 months,and the efficacy and the incidence rate were observed. Results Among the 40 cases,27 cases (67. 5%) were recovered,11 cases(27. 5%) were delayed healing,2 cases(5%) did not heal. 11 cases (27. 5%) with the pin loosening,8 cases (20%) with pin tract infection,7 cases (17. 5%) with the pin tract aseptic,1 cases (2. 5%) with infection of bone,1 cases (2. 5%) with knee flexion and extension slight abnormality. Conclusion Hoffmann Ⅱ metal external fixator in the treatment of open fractures of tibia and fibula has certain advantages,and the curative effect is exact,but there are still complications,we should pay attention to prevention to avoid adverse consequences.

Atrofia muscular espinal tipo 1: enfermedad de Werdnig-Hoffmann / Type I spinal muscular atrophy: Werdnig-Hoffmann disease

Introducción. Las atrofias musculares espinales de la infancia son enfermedades neuromusculares hereditarias, autosómicas, recesivas, caracterizadas por la degeneración de las neuronas motoras del asta anterior de la médula espinal. La atrofia muscular espinal tipo I (enfermedad de Werdnig-Hoffmann) es la forma más severa. Se inicia in útero o durante los primeros meses de vida. La muerte suele ocurrir antes de los dos años de edad. Caso clínico. Lactante de 6 meses de edad que ingresa al Servicio de Urgencias por dificultad respiratoria severa. Presenta marcada hipotonía muscular, debilidad de musculatura intercostal y fasciculaciones de la lengua. La electromiografía es compatible con polineuropatía motora con daño mielínico y axonal. El análisis molecular reportó un estado homocigoto para la deleción de los exones 7 y 8 del gen SMN-1 . Con estos dos estudios se integra el diagnóstico de atrofia muscular espinal tipo 1 (enfermedad de Werdnig-Hoffmann). Conclusiones. Es importante conocer y diagnosticar esta entidad para brindar consejo genético a la familia, así como asesoramiento y apoyo en el manejo del paciente.

Background. Childhood spinal muscular atrophy is an autosomal recessive neuromuscular disease characterized by degeneration of the anterior horn cells of the spinal cord. SMA type I, the most severe form (Werdnig-Hoffmann disease) can be detected in utero or during the first months of life. Death typically occurs within the first 2 years of life. Case report. A 6-month-old female was admitted to the emergency room for severe respiratory distress. She had muscular hypotonia, intercostal muscle weakness and tongue fasciculations. Electromyography was compatible with motor polyneuropathy with axonal and myelin damage. Molecular analysis of SMN-1 gene reported homozygous for deletion of exons 7 and 8 of SMN-1 gene. Conclusions. It is imperative to recognize and diagnose this entity in order to provide genetic counseling to the family as well as to offer support and advice in the care of the patient.

Nevo lipomatoso cutáneo superficial: presentación de dos casos / Superficial cutaneous lipomatous nevus: report of two cases

El nevo lipomatoso cutáneo superficial (NLCS) es una anomalía del desarrollo infrecuente, caracterizada por la presencia de tejido adiposo maduro ectópico en la dermis. Puede estar presente al nacer o aparecer en la infancia o adolescencia. Describimos dos casos de NLCS: el primero, un niño de 4 años con una placa hipertricótica en la nalga izquierda, presente desde el nacimiento y el segundo, una niña de 9 años con una placa de aspecto esclerodermiforme en el muslo izquierdo, de aparición en etapa preescolar.

Nevus lipomatosus cutaneous superficialis (NLCS) is a rare developmental anomally characterized by the presence of ectopic mature adipose tissue in the dermis. It may be present at birth, or appear at chilhood or adolescence. We describe two cases of NLCS: the firs one, a 4-year-old child that presented with an hypertrychotic plaque on his left buttock, present from birth and, the second one, a 9-year-old girl with a plaque of sclerodermiform appearance on her left leg, that arise before school time.

Effect of Neiguan (PC6) electro acupuncture (EA) on pain threshold and Hoffmann reflex in normal subjects

Experiments were undertaken on normal subjects at the age of 19-44 years. Pain threshold were measured by Analgesymeter (Made in Ugobasile-Italy) in 60 subjects before and after 30 minutes of PC6 EA. Amplitude and latency of Hoffman wave of 30 males was investigated before and after 30 minutes of PC6 EA. EA parameters were set in 2Hz, 4-5 volts. The following results were shown: (1) PC6 EA could elevate pain threshold in most subjects (p< 0.01); After acupuncture, pain threshold is more increase in women comparing to men (p<0.05). Electric acupunture at Neiguan inhibit H reflex by reduce its amplitude and last the latency of this wave (p<0.05). thse results suggested that pain reduce mechanism of electric accupunture could ralate to the role of nervous system.

Dynamic Hoffmann's sign and early diagnosis of cervical spondylotic myelopathy / 第二军医大学学报

Objective:To study the relationship between dynamic Hoffmann's sign(DHS) and the early diagnosis of cervical spondylotic myelopathy. Methods:Patients with neck, shoulder and back pain (218 cases) were employed in this investigation. Among them, 96 cases had positive reaction to DHS test and they received 3 7 years follow up as study group. The other 122 cases negative to DHS test were taken as control group. The clinical data included the patient's symptoms and signs, sagittal diameter of cervical spinal canal, Pavlov rate, angular displacement and horizontal displacement between cervical vertebral, etc . Results:There were 72 cases in study group developed cervical spondylotic myelopathy and needed operation during follow up. Meanwhile, 11 cases in control group received surgical treatment. The incidence of stenosis of cervical spinal canal, herniation of cervical intervertebral disc and instability of cervical spine in DHS group were significantly higher than that of the control group. Conclusion:DHS is closely related to the onset of cervical spondylotic myelopathy. The patients should be followed up closely if they present positive reaction to DHS, and should be operated on early when their neurological symptom is progressing.

Development of the Hardware and Software for the Selective Dorsal Rhizotomy Using Hoffmann Reflex: A Study on the EMG Patterns Generated by Stimulation of the Spinal Nerve Roots

This experimental study was designed to develop an electromyography(EMG) machine and a program to be used during the selective dorsal rhizotomy, and to investigate the patterns of EMG waves generated by stimulation of the normal spinal nerve roots in cat. The developed machine, consisting of nerve stimulator, EMG amplifier, analogue-digital converter and computer program, functioned well during experiment without any mechanical or electrical problems. We were able to record pure H-wave(Hoffmann wave) in EMG by stimulating posterior root in most cases, although components of motor and directly conducted waves were observed only in few cases. The peak latency of H-wave, which was about half of that of the motor wave by the mean value, was consistent as a whole. H2/H1 ratio (the ratio of the second and the first H-wave), peak amplitude and the pattern of changes of the peak amplitudes with continuous sitmulation, however, varied greatly from case to case. In conclusion, the results of this experiment suggest that EMG wave patterns, generated by the stimulation of the posterior nerve roots, may not be appropriate for the determination of the nerve roots to be cut during the selective dorsal rhizotomy.

Clinical Study for External Fixators of Open Tibial Fractures / 대한정형외과학회잡지

From August, 1981 to November, 19S5, the Hoffmann and Monofixateur apparatus were employed in the treatment of thirty five open tibial fractures that we considered to have a poor prognosis with more conventional forms of treatment. The results were obtained as follows; l. Application of Monofixateur was minimum iatrogenic soft tissue injuries and easier, simpler than Hoffmann and two external fixators were favorable device with rigidity in wound management. 2. Two external fixators could obtained sufficient stability when 3 or more pins were applied at each fragment of fracture in Hoffmann and 2 or more pins in Monofixateur. Monofixateur could obtained high stability with small number of fixation components and more stronger against anterior-posterior bending and in Hoffmann more stronger against lateral bending. 3. External components of Monofixteur was located in anterior surface, therefore dynamization converted tensile force of anterior surface of tibia to compression force and then bone union was activated. 4. After operation, in Hoffmann correction of compression, distraction and angular, rotational deformity were possible and in Monofixateur correction of compression distraction, and anterior or posterior angulation was possible. 5. Because of rigid stability of two external Bxators, these allowed early movement, avoiding joint stiffness and duration ambulation unilateral assembly of device in position biomechanically favorable. 6. The lateral view of fracture site could not be confirmed accurately due to overlapping of Hoffmann's adjustable connecting rod and bony shadow. In Monofixateur A-P and lateral view of Fx. site could be confirmed. 7. Accurate reduction and compression played a important role in bone union. 8. The time to fixation for all of the fractures averaged 20 weeks in Hoffmann and 16 weeks in Monofixateur. The time to union averaged 24 weeks in Hoffmann and 20 weeks in Monofixateur.

Hoffmann External Fixation in the Treatment of the Fractures of the Tibia / 대한정형외과학회잡지

External fixation was improved in its devices and techniques as a specific method of fracture treatment. It was possible to immobilize the fractures firmly with the use of Vidal modified Hoffmann external fixation and could be used effectively in difficult fractures with severe soft tissue injury. From October 1981 to December 1983, 28 patients of tibial fracture who had been treated with Hoffman external fixation at Severence Hospital, Yonsei University College of Medicine were studied. The results are summerized as follows: 1. The age of patients varied from 14 to 66 years old, the majority (53.6%) being between 20 to 39 years old and males comprized 89.3%. 2. Traffic accidents and machinary injuries comprized 96.4%. 3. Average duration with Hoffmann frame was 16.6 weeks and average time of bone union was30.1 weeks. 4. Many complications were noticed but majority were related to personalities of the fractures, not due to Hoffmann external fixation itself. 5. Hoffmann device was relatively easy and quick to apply: sufficient stability was obtained: reasonable anatomic reduction of major fragments was possible: facilitated treatment and care of polytr- aumatized patients. 6. Secondary operations, e,g., bone grafting and even plastic surgery, had been possible without necessitating removal of the device. 7. It was useful in open fractures with severe soft tissue tissue injury and also in taking care of further necessary managements.

The Treatment of the Pelvic Bone Fractures by Means of Hoffmann's External Skeletal Fixation Devices / 대한정형외과학회잡지

We have exprierienced 10 cases of pelvic bone fractures that were treated by Hoffmann's external fixation devices from June, 1979 to June, 1982. As a result, following advantages were noted; 1. Rapid recuction of pain, prevention of serious early complication, and easiness of nursing care were possible. 2. Late complications such as lumbosacral pain and gait disturbance could be preventable in majority of the patients, as well as shortening the duration of the hospitalization.

The Treatment of Fractures by the External Skeletal Fixation Devices (Hoffmann Apparatus, Pin and Resin Fixation) / 대한정형외과학회잡지

We have employed the external akeletal fixation devices, that is Hoffmann apparatus and Pin and Resin fixation method, for the treatment of 44 cases of long bone fractures from Dec. 1978 to Dec. 1981. The following are our impressins. 1. Hoffmann apparatus and Pin and Resin fixation method proved to be effective and useful measure for the management of fractures of long bones, particulary in cases of the open tibial fractures. 2. Employing the Hoffmann apparatus to the tibial model, the possible limit of correction of the fracture alignment was calculated. It was found that the average angle of correction of deformity can be managed up to 20 degrees in varus and valgus deformity, 70 degrees in anterior angulation, 40 degrees in posterior angulation and 70 degrees in rotation. 3. Pin and Resin fixation method is one of effective means in immobilization of long bones. It is simple to apply, easy to manipulate and inexpensive while offering fair fixation without much complications and therefore we recommend the method as the best alternative to expensive Hoffmann apparatus. 4. The complications of Hoffmann apparatus and Pin and Resin fixation method were pin tract infections and ankle stiffness which were generally minor and prevented by more careful aseptic technique and encouraging early joint motion.

Clinical Consideration on the Treatment of Fractures by Hoffmann's Transfixation Method / 대한정형외과학회잡지

Open long bone fracture is frequently difficult to reduce and maintain, especilly when there is extensive soft tissue damage. Infection, instability, malalignment and soft tissue complication often result in prolonged mobidity or failure. The Hoffmann's apparatus have merits, that can easily correct distracted, angular or rotational deformity of fracture site during early post-operative period, and stable fixation facilitates easily to the care of soft tissue injury. In addition, the affected limb can be elevated with balanced suspension, possible early exercise of neighboring joints. But we have exerienced some problems during treatment of fracture with Hoffmann's transfixation method. From February 1980 to December 1981, Hoffmann's transfixation method was employed in treatment of twenty-one patients that considered to have a poor prognosis with conversional forms of treatment. The results were obtained as follows; 1. For correction of distracted, angular, or rotational deformity, the fracture site should be reduced accurately. 2. Hoffmann pins should be transfixed as one plane and parrallel to each other. 3. Rigidity of fixation can be increased by increasing number of pins, actually three or more pins should be applied at each fragment of fracture. 4. Hoffmann's apparatus is more complex for management, more expensive and requires skillful technique compared with other external fixation apparatus. 5. The lateral view of fracture site could not be confirmed accurately due to overlapping of Hoffmann's adjustable connecting rod and bony shadow. 6. The main cause of injuries was due to traffic accidents in 17 cases (81%), involving tibia in 18 cases, femur in 2 cases and humerus in 1 case. 7. In the sixteen cases which could be assessed, the average times for external transfixation was 13.9 weeks and then followed by early weight bearing with P.T.B. cast or brace. The average time of bony union was 26.4 weeks. 8. The final result was excellent in 7 cases, good in 5 cases, acceptable in 3 cases, poor in 1 case.