Jung Jae Kim

Plating of humeral shaft fractures: comparison of standard conventional plating versus minimally invasive plating.

PURPOSE This study compared clinical outcomes and complications in patients with humeral shaft fractures treated using two methods of fixation by plating. METHODS Minimally invasive plate osteosynthesis (MIPO, n=29) was prospectively performed from around the middle of the study period, while open reduction and plate osteosynthesis (ORPO, n=30) had been the original standard method. Locking compression plate was used in these two groups. Major characteristics of the two groups were similar in terms of fracture type, fracture location, age, associated injuries and numbers of open fractures. RESULTS Primary union was achieved in 28 of 29 in the MIPO and in 27 of 30 in the ORPO. Mean time to union was similar in the two groups. Mean operation time in the MIPO (110min) was shorter than in the ORPO (169min) (P<0.05). Bone grafting was performed in five patients of in the ORPO, but in no patient in the MIPO (P<0.0001). There was one case of deep infection in the ORPO. Functional outcome was satisfactory in both groups. CONCLUSIONS Minimally invasive plate osteosynthesis may achieve comparable results with the open plate osteosynthesis method in simple as well as complex fractures of humeral shaft. Although MIPO potentially has the radiation hazard, it may reduce the perioperative complications with a shortened operation time. LEVEL OF EVIDENCE Level III. Case-control study.

Predicting the rotationally neutral state of the femur by comparing the shape of the contralateral lesser trochanter

The rotationally neutral state of the femur was measured by comparing the shape of the contralateral lesser trochanter in 100 adults. Three observers predicted a position presumed to be neutral by comparing the shape of the neutrally positioned contralateral lesser trochanter previously recorded by C-arm image intensification. The mean (SD) angular discrepancy between the neutral point and the predicted angle was 3.4 degrees (+/- 2.4) without interobserver variation (P = .87). Seventy-seven percent indicated the value within 4 degrees, and none of the observations exceeded 15 degrees. These findings suggest the outline of the contralateral lesser trochanter may be a useful reference during surgical treatment of femoral fractures to minimize rotational deformity.

Factors affecting fracture location in atypical femoral fractures: A cross-sectional study with 147 patients

INTRODUCTION Many studies have tried to determine the characteristics of atypical femoral fractures (AFFs) through age-, sex-, and ethnicity-matched comparison with non-AFFs. However, we hypothesized that diaphyseal AFFs would have characteristics different from those of subtrochanteric AFFs. The aim of this study was to evaluate the clinical features of diaphyseal/subtrochanteric AFFs and determine the factors related to fracture location. PATIENTS AND METHODS One hundred forty-seven patients with AFF were enrolled, 114 patients (78%) had a history of bisphosphonate use. Forty-nine patients (33%) had bilateral lesion, and 35% of patients had thigh pain. Patients were divided into two groups according to fracture location: 52 patients (35.4%) with subtrochanteric AFF and 95 patients (64.6%) with diaphyseal AFF. The patient demographics and fracture characteristics of the two groups were compared. Multivariate logistic regression analysis was used to adjust for variables related to fracture location. RESULTS The patients in the diaphyseal AFFs group were older and had lower BMI, lower BMD, and larger lateral and anterior bowing. Multivariate analysis revealed that age greater than 65 years and low BMD were related with diaphyseal location. With greater lateral bowing angle, the AFF location was moved from the subtrochanteric area to the diaphyseal area. CONCLUSION This study demonstrated that patients with diaphyseal AFFs had different characteristics compared with those with subtrochanteric AFFs.