The Outcome of Primary Rigid Internal Fixation of Displaced Fracture Neck Of the Femur with Muscle Pedicle Bone Graft in Young Adult

Objective: In this study our main aim to evaluate the outcomeof primary rigid internal fixation of displaced fracture neck ofthe femur with muscle pedicle bone graft in young adult.Methodology: This prospective observational study wasconducted at National institute of traumatology and orthopaedicrehabilitation (NITOR), Dhaka from July 2003 to June 2005.During the study, recent neck femur fracture 12 cases, inbetween age 20-55 years irrespective of gender were taken asa sample.Results: In the experiment, 75% were male patient and 25%were female patients. 66.67 % patients with type 1V fractureand 33.33% patients were with type III fracture. Also, after thetreatment. 83.33 % patients obtained satisfactory result and16.67% was unsatisfactory.Conclusion: From our study we can conclude that thistechnique is especially applicable in early days of fracture toachieve union and revisualization of the proximal fracturefragment and prevent non-union or avascular necrosis. Thefollow up period of this initial study is short, long-term follow upand evolution of the viability of this procedure should provideadditional useful result.

The Result of Open Reduction and Mini-Plate Fixation for Displaced Talar Neck Fracture

PURPOSE: We evaluated the complications, radiological and clinical results after operative treatment using a mini-plate for fixation of displaced talar neck fractures. MATERIALS AND METHODS: There were 20 cases of displaced talar neck fractures from May 2006 to December 2011; we performed a retrospective chart review of 15 patients treated by open reduction and internal fixation using a mini-plate who had more than 2 years of follow-up. According to Hawkin's classification, there were 7 cases of type II fractures and 8 cases of type III fractures. During postoperative 12-16 weeks we checked magnetic resonance imaging. The assessment of clinical results was based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. RESULTS: Mean union period was 11.6 weeks (10-15 weeks). Nonunion and malunion did not occur in all cases. The mean AOFAS score was 88.2 points (80-97 points). There were 5 cases of avascular necrosis. Of these, there were 3 cases of body collapse and 4 cases of post-traumatic arthritis. In the statistical analysis, there was no correlation between the elements including gender, Hawkin's classification and union rates and clinical results. CONCLUSION: Mini-plate fixation of a displaced talar neck fracture is thought to be a good technique, with a low rate of malunion and also showed satisfactory results in radiological and clinical assessment.

Arthroscopy Assisted Percutaneous Reduction and Screw Fixation of a Displaced Intra-articular Glenoid Fracture: A Case Report

PURPOSE: The authors used arthroscopy-assisted percutaneous reduction and cannulated screw fixation rather? than conventional arthrotomy for displaced glenoid fracture. MATERIALS AND METHODS: We used arthroscopy assisted reduction and screw fixation for a 66 year old man who had a clavicle fracture, a displaced glenoid fracture and a scapula fracture. RESULTS: At 9 months postoperatively, the patient had recovered full range of motion and was not inconvenienced by the surgery. Removal of the implant was done 12 months post-operatively under general anesthesia. CONCLUSION: The advantages of arthroscopy-assisted percutaneous screw fixation are less pain and less bleeding, shorter hospital stay and earlier rehabilitation. Arthroscopic percutaneous screw fixation for a displaced glenoid fracture seems to be a good alternative treatment method.

Comparison of Influenceon Displaced Femoral Neck Fractures in Young Adults : Fracture Level and Comminution, Time to Operation and Reduction / 대한정형외과학회잡지

PURPOSE: To analyze the influences of fracture level and comminution, time to operation and reduction quality on the results of displaced femoral neck fractures in young adults. MATERIALS AND METHODS: From January 1996 to January 2003, 39 of 51 cases of displaced femoral neck fractures that were treated with closed reduction and percutaneous internal fixation using cannulated screws, were evaluated after at least two years of follow-up with respect to the fracture level, comminution, time to operation, and reduction quality. RESULTS: The incidence of AVN and non-union were 6/39 (15.4%) and 3/39 (7.7%), respectively. The differences in the incidences of complications among subcapital, transcapital, and subcapital fractures was not significant (p=1 & p=1). There was a higher incidence of AVN (p=0.0066) and non-union (p=0.0219) with posterior comminutions than anterior ones. The time to operation was not an important factor in influencing the development of complications (p=0.4984 & p=1). Between acceptable and poor reductions, the differences in the incidences of AVN was significant (p=0.0105), but not in the incidences of non-unions (p=0.1011). CONCLUSION: We concluded that good quality of reduction is more important than the time to operation for achieving good results, and that comminution is a more important prognostic factor than is the fracture level.

Intramedullary K-wire Fixation for Displaced Fracture of Distal Radius

PURPOSE: To evaluate indications and effectiveness of intramedullary K-wire fixation for distal radial fractures. MATERIALS AND METHODS: Twenty one fractures of distal radius treated with intramedullary K-wire fixation from April 2001 to September 2002 were evaluated. The mean age was 67.8(range 46~82). Severely comminuted intra-articular fractures and Barton's fractures were excluded. One or two K-wires were added percutaneously. To assess the functional result, we used Green and O'Brien score system. The radiographic assessment included a scoring system based on measurements of radial length, radial inclination, volar tilt and step-off of the radial articular surface. RESULTS: Average follow up period was 13.5 months. In functional result, excellent and good result were obtained in 18 cases (86%). In radiologic result, mean loss of radial length, radial inclination and volar tilt were 0.9 mm, 1.4degrees, 0.9degrees, respectively. CONCLUSION: The advantages of intramedullary K-wire fixation were relatively simple procedure, low occurrence of soft tissue complications and early wrist motion. Intramedullary K-wire fixation was good to maintaining reduction in osteoporotic bone.

Open Reduction and Internal Fixation of the Displaced Fractures of the Acetabulum / 대한정형외과학회잡지

Authors reviewed 28 cases of displaced acetabular fracture treated operatively from Februay 1991 to January 1996 and followed up more than 1 year. The clinical results were retrospectively analyzed with consideration of surgical problems and complications. The results were as follows; 1. According to Letournels classification, we had 16 elementary fractures(57%) and 12 associated fractures(43%). 2. Kocher-Langenbeck approach in 16 cases, ilioinguinal in 9 cases, extended iliofemoral 2 cases and combined approach in 1 case were used. 3. The devices for internal fixation were as follows: screw only in 12 cases(elementary fracture 9cases, associated fracture 3 cases), plate and screw in 16 cases(elementary fracture 7 cases, as-sociated fracture 9 cases). 4. There were complications such as 3 degenerative arthritis, 2 superficial wound infection, 1 iatrog-enic sciatic nerve palsy and 1 avascular necrosis of femoral head and no postoperative heterotro-phic ossification. 5. Satisfactory reduction by radiologic criteria was gained in 23 cases(82%). Satisfactory results by clinical criteria(by dAubigne & Postels) was gained in 21 cases(75%). Only 2 patient with a satisfactory radiologic reduction was clinically unsatisfactory. It seems that the satisfactory operative reduction of the fracture is the factor that correlates best with a satisfact-ory clinical result.

Hip Joint Pressure in Displaced Fracture of the Femoral Neck / 대한정형외과학회잡지

We studied 16 cases intracapsular pressure in displaced fracture of femoral neck(Garden stage III, IV), the pressures were measured range between 12-62 mmHg(mean, 23.4 mmHg). Aspirated blood amount from hip joint did not exceed 3cc, this amount not correlate with intracaspsular pressure. Of 10 cases examined scintimetry, 2 had incressed uptake after aspiraton, it is suggested that early decompression of hemarthrosis in femur neck fracture regaredless of displacement may be considered.