Comparison between Screw Fixation and Tension Band Wiring for the Treatment of Medial Malleolar Fractures / 대한정형외과학회잡지

In the treatment of malleolar fracture, anatomical reduction and rigid internal fixation are essential to prevent the complications such as infection, malunion or nonunion, traumatic arthritis, skin necrosis and joint contracture. But it is often difficult to obtain rigid fixation for medial malleolar fracture because of its comminution or thin cortex with osteoporosis. Generally, two operative methods are available for medial malleolar fracture, which are malleolar lag screw fixation and tension band wiring. The purpose of this paper is to analyze which operative method is better for anatomical reduction and rigid fixation and has less postoperative complications for medial malleolar fractures. From March 1992 through March 1995, 88 patients had undergone surgical intervention for medial malleolar fractures. The patients were divided into 2 groups according to operative method for medial malleolar fracture. For one group, malleolar lag screw together with or without a K-wire was used in 48 patients, and for the other group, tension band wiring was used in 40 patients. The average follow-up periods were 14 months in screw fixation group and 13 months in tension band wiring group. The average union time were 15.4 weeks (8-17 weeks) in screw fixation group and 12.2 weeks (6-15 weeks) in tension band wiring group. 27 cases (56%) showed excellent result in screw fixation group and 30 cases (75%) in tension band wiring group. In the patient over 50 years old, 2 (15%) in 13 cases showed excellent result of screw fixation group, while 5 (45%) in 11 cases of tension band wiring group. We concluded that tension band wiring is a better method for medial malleolar fracture to obtain early union and to prevent postoperative complications, especially in the elderly patient.

Passive Release of Pulley with Needle for Trigger Finger / 대한정형외과학회잡지

The purpose of this study was to assess the results of passive release of the pulley with needle under local anesthesia performed at the out patient department. There were 68 fingers of 54 patients. Fifteen patients(27.8 %) were male and 39 patients(72.2 %) were female. Involved fingers were 28 thumbs(41.2 %), 7(10.3 %) index fingers, 14(20.6 %) middle fingers, and 19(27.9 %) ring fingers. Ages were varied-between 41 years and 61 years old. Rheumatoid fingers were 12(17.6 %). The others had no underlying disease. An 18 gauge needle was introduced distal to the palpable nodule. The pulley was released passively when the PIP joint was extended. The follow-up period was 4.5 years on average(range; 1-8 years). At final follow-up local recurrence was noted in 1-2 weeks in 7 cases(10.3 %), which was due to technical fault in early trial cases. The patients complained of pain for a few days and mild tenderness for less than 2 weeks. In three cases adhesion occurred, which was resolved in a week by maniqulation. There was no difference between rheumatoid arthritis and the other underlying diseases as far as rate of recurrence was concerned. From these results it would be suggested that the passive release of pulley with needle is an effective method for the treatment of adult trigger finger.