Hee Soo Kyung

Retrograde nailing with subsequent screw fixation for ipsilateral femoral shaft and neck fractures

IntroductionAlthough ipsilateral femoral shaft and neck fractures are difficult to treat, there is still no consensus on the optimal treatment of this complex injury. We report the results of treating the 17 fractures with a standard protocol of retrograde nailing for diaphyseal fractures and subsequent screw fixation for the femoral neck fractures.Materials and methodsSeventeen injuries (16 patients) sustained femoral shaft fractures, which were treated with retrograde intramedullary nails and subsequent screw fixation. Femoral neck fracture was noted before the operation in all patients except one. A femoral shaft fracture was always addressed first with unreamed retrograde nailing. Then, the femoral neck fracture was treated by cannulated screws or dynamic hip screw according to the level of fracture.ResultsThe average time for union of femoral shaft fractures was 27.3 (14–60) weeks. Nonunion occurred in five patients, who required bone grafts or changes of fixation. The average time for union of femoral neck fractures was 11 (8–12) weeks. All united, except for one case of nonunion with avascuar necrosis, which was a Garden stage IV fracture. Functional results using Friedman–Wyman criteria were good in 16 cases, and fair in one. The only fair result was nonunion of the femoral neck, which had the joint arthroplasty.ConclusionRetrograde nailing of femoral shaft fractures can provide an easy fixation and a favorable result for ipsilateral femoral neck fractures.

Double plating of unstable proximal tibial fractures using minimally invasive percutaneous osteosynthesis technique

Background Double plating of proximal tibial fractures with traditional open osteosynthesis gives a stable fixation, but may be complicated by wound healing problems. Minimally invasive methods have been recommended to decrease the wound complication rates. We report the efficacy of double plating of proximal tibial fractures using a minimally invasive percutaneous technique. Patients and methods 23 proximal tibial fractures in 23 patients (mean age 54 (36–78) years) were treated with double plating using a minimally invasive percutaneous technique. Functional and radiographic results were evaluated by a modified Rasmussen scoring system. Results All fractures healed. The average time for fracture healing was 19 (10–32) weeks. 21 patients had excellent or good clinical and radiographic results. 2 patients had a fair clinical result because of associated knee injuries. Complications included 1 case of shortening (1 cm) and 2 cases of mild malalignments (varus less than 10°). There was 1 case of superficial infection that healed after removal of the plate. No deep infections occurred. Interpretation Double plating using minimally invasive percutaneous technique can provide favorable results in the treatment of proximal tibial fractures.

Intramedullary nailing versus submuscular plating in adolescent femoral fracture

BACKGROUND Femoral fractures in adolescents usually need operative treatment, but the optimal method is unclear. The purpose of this study is to compare intramedullary nailing (IN) and submuscular plating (SP) in adolescent femoral fractures. MATERIALS AND METHODS We performed the prospective, comparison study of IN and SP in adolescent femoral shaft fractures at a mean age of 13.9 years (11-17.4). Twenty-two cases of IN and 23 cases of SP were followed for a minimum of 1 year. We compared radiological and clinical results, surgical parameters, and complications of two techniques. RESULTS Bony union was achieved in all cases except one case of IN. Time to union was similar in both groups. None showed mal-union over 10° or limb length discrepancy over 1 cm. None of SP group and 2 in IN group experienced re-operation; one patient had deep infection with nonunion. The other patient sustained mal-rotation. Both patients healed after revision procedure. All patients showed excellent or satisfactory results of Flynns criteria. The time to full-weight bearing was shorter in IN (IN: 57.3 days, SP: 89.2 days, p<0.05). In surgical parameters, operative time seemed shorter in IN (IN: 94.7 min, SP: 104 min, p=0.095), and fluoroscopy time was shorter in IN (IN: 58s, SP: 109s, p<0.05) than SP group. CONCLUSION Although both IN and SP yield good results and minimal complication in adolescent femoral fractures, IN may be advantageous in less need of fluoroscopy, technical easiness in reduction and early weight bearing.

Management of ipsilateral femoral and tibial fractures

This is a retrospective study of 18 patients who had ipsilateral femoral and tibial fractures. They were treated by the retrograde femoral and antegrade tibial intramedullary nail from a single incision in the knee. The average time for union of femoral shaft fractures was 27.6 (18–40) weeks. One patient required antegrade nailing with a bone graft due to metal failure after using the short nail. Two tibial fractures required bone grafting due to bone loss, with an initial open fracture. The average time for union of tibial fractures was 24.5 (18–30) weeks. Functional results using the Karlstrom–Olerud criteria were excellent in 14, good in three, and acceptable in one. The only acceptable result was in a supra- and inter-condylar femoral fracture, with protrusion of the nail tip into the knee joint, which created moderate limitation of knee motion. Simultaneous retrograde femoral and antegrade tibial nailing with a single incision in the knee can achieve satisfactory results in the management of these types of fracture.RésuméEtude rétrospective de 18 patients qui avaient une fracture fémorale et tibiale ipsilatérales. Ils ont été traités par enclouage centromédullaire rétrograde fémoral et enclouage antérograde tibial, en utilisant une seule incision sur le genou. Le temps moyen de consolidation des fractures diaphysaires fémorales était de 27,6 (18–40) semaines. Un malade a nécessité un enclouage antérograde avec greffe osseuse à cause de l’échec dû à l’utilisation d’un clou trop court. Deux fractures tibiales ont nécessité une greffe osseuse à cause de la perte de substance dûe à une fracture ouverte initiale. Le temps moyen de consolidation des fractures tibiales était de 24,5 (18–30) semaines. Les résultats fonctionnels, avec les critères de Karlstrom–Olerud étaient excellents dans 14 cas, bon dans trois et médiocre dans un cas. Le seul résultat médiocre était aprés une fracture sus et intercondylienne fémorale, avec issue de l’extrémité du clou dans l’articulation du genou, créant une limitation modéré de la mobilité. L’enclouage simultané rétrograde fémoral et antérograde tibial avec une seule incision sur le genou peut donner des résultats satisfaisants dans la gestion de ces fractures.

Injected calcium sulfate for consolidation of distraction osteogenesis in rabbit tibia.

This study investigated the effects of calcium sulfate powder injection in a rabbit tibial distraction model. There was one experimental group and two control groups. The calcium sulfate powder, suspended in carboxymethylcellulose (CMC) medium, was injected into the distracted tissue in the experimental rabbit group, whereas only CMC medium was injected into the one control group. The other control group did not undergo any intervention. On radiography and bone mineral density tests, the amount of newly formed bone was greater in the distracted zone of the experimental group than in the two control groups, which showed incomplete bone deposition and calcification. The application of calcium sulfate to distracted tissue increased the rate of osteogenesis and calcification.

Percutaneous plating for comminuted midshaft fractures of the clavicle: A surgical technique to aid the reduction with nail assistance

INTRODUCTION Due to the complex anatomy of the clavicle, percutaneous plating with indirect reduction for comminuted midshaft fracture of the clavicle is challenging. The aim of this series was to report on a novel technique of nail-assisted percutaneous plating and to evaluate the radiographic and clinical outcomes in comminuted midshaft fractures of the clavicle. MATERIALS AND METHODS Between 2009 and 2010, with nail assistance for the reduction and its maintenance, percutaneous plating was performed in 14 patients with comminuted midshaft fracture of the clavicle. The mean follow-up period was 17.6 months (range, 15-31 months). A retrospective review of the clinical and radiologic results for these patients was conducted. RESULTS All fractures healed within a mean period of 15.6 weeks (range, 11-18 weeks) without loss of reduction. Regarding complications, there was no occurrence of implant failure or infection. All patients showed excellent shoulder function, with a mean Constant shoulder score of 99, and a mean Disabilities of the Arm, Shoulder and Hand (DASH) score of 4.2 (range, 0-22) at the latest follow-up. No significant difference in mean proportional length was observed between injured and uninjured clavicles, with a mean of 0.4% (range, -1.5% to 2.4%). CONCLUSIONS Minimally invasive percutaneous plating for comminuted midshaft fractures of the clavicle, combining the advantages of elastic intramedullary nailing and percutaneous plating, may be a good option.

Incidence of Venous Thromboembolism Using 64 Channel Multidetector Row Computed Tomography-Indirect Venography and Anti-Coagulation Therapy after Total Knee Arthroplasty in Korea

Purpose This study evaluated the incidence of a venous thromboembolism (VTE) after total knee arthroplasty (TKA) using multidetector row computed tomography-indirect venography (MDCT-indirect venography) and assessed the efficacy of anti-coagulation therapy. Materials and Methods We enrolled 118 patients with 126 cases of TKA. The average age of the patients was 68.4 years. We used 64 channel MDCT-indirect venography for the detection of VTE. We treated selectively proximal deep vein thrombosis (DVT) or pulmonary thromboembolism (PTE) cases according to the results of MDCT-indirect venography. We re-evaluated the change in VTE using follow-up MDCT-indirect venography after 3 months. Results We identified VTE in 35.7%. DVT only was identified in 22.2% including 8 cases of proximal DVT and 20 cases of distal DVT. PTE without DVT was identified in 4.8%, and combined DVT and PTE in 8.7%. All patients with PTE were asymptomatic, but 4 DVT patients had signs of leg swelling. After anti-coagulation therapy, 20 patients showed complete resolution in 16 cases, improvement in 3 cases and one case showed a new distal DVT. Conclusions The incidence of VTE after primary TKA was 35.7% in Korea. Furthermore, anti-coagulation therapy for proximal DVT and PTE patients may be a useful method for preventing the occurrence of a fatal PTE.

Medial Patellofemoral Ligament Reconstruction: A Comprehensive Review.

It has been suggested that in the majority of patellar dislocation cases, the medial patellofemoral ligament (MPFL) is disrupted with a high recurrence rate especially in female patients. Although MPFL tear is not the primary cause of instability, MPFL reconstruction is effective for stabilizing the knee and may alone prevent lateral patellar dislocation. There is limited but growing evidence that MPFL reconstruction for patellofemoral instability leads to excellent functional outcomes. Growing awareness of the biomechanical contribution of the MPFL has led to an upsurge in the publication of techniques and trials dealing with reconstructive techniques, warranting a review that includes the most recent evidence. The aim of this article was to review and summarize the recent literatures concerning MPFL reconstruction and provide a comprehensive review of previous studies ranging from basic science to current surgical techniques and results.

Biplanar Open Wedge High Tibial Osteotomy in the Medial Compartment Osteoarthritis of the Knee Joint: Comparison between the Aescula and TomoFix Plate

Background The purpose of this study was to compare the results of Aescula and TomoFix plates used for biplanar open wedge high tibial osteotomy in medial osteoarthritis of the knee joint with varus deformity. Methods A consecutive series of 50 cases of biplanar open wedge high tibial osteotomy were evaluated retrospectively. Group A contained 25 cases treated by using the Aescula plate, and group T contained 25 cases treated by using the TomoFix plate. Full weight-bearing was permitted at 6 weeks after surgery in group A and at 2 weeks in group T. Clinical evaluations were performed at the final follow-up by using postoperative knee scores and functional scores. Radiographic analysis included postoperative mechanical femur-tibia angle, change in posterior tibial slope angle, and complications related to implants. The mean follow-up periods were 30 months in group A and 26 months in group T. Results The knee and functional scores were improved at the final follow-up in both groups (p < 0.05), but no differences were observed between the two groups (p > 0.05). An acceptable correction angle was obtained in 52% of group A and in 84% of group T (p = 0.015). Change in posterior tibial slope angle was larger in group A than in group T (p < 0.001), showing better maintenance of posterior tibial slope in group T. In group A, there were 3 cases of screw loosening and 4 cases of delayed union. In addition, there were residual varus deformities in 7 cases (6 in group A and 1 in group T). Conclusions This study shows that firm fixation using a TomoFix plate for open wedge high tibial osteotomy produces better radiologic results and a low complication rate than those of the Aescula spacer plate.

Biomechanical Analysis of Operative Methods in the Treatment of Extra-Articular Fracture of the Proximal Tibia

Background To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures. Methods Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure. Results Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8; p < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group. Conclusions During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.