• Journal of Yeungnam Medical Science
• /
• v.10 no.2
• /
• pp.388-399
• /
• 1993

The adequate treatment of tibia fracture is one of the most difficult due to severe commiuntion, open wound, delayed union, angulation deformity and infection. We treated 38 fractures of the tibia by Interlocking intramedullary nail from Feb. 1983 to Mar. 1993, 35 cases of the tibia fracture were fresh, 13 cases of fracture were open. The other 3 cases were delayed union and nonunion. The Mean follow-up was 14.0 months. The results were as followings. 1. Of the 38 fractures, 37 fractures united and the mean union time was 18.7 weeks. 2. Interlocking intramedullary nail could be used to the majority of fractures of the proximal & distal tibia shaft fractures. 3. The Interlocking nail had rigid rotational stability and was appropriate for the treatment in severe unstable fractures, commninution and open with bone loss. 4. Delayed union or nonunion was a good indication for intramedullary nailling. 5. The major complication were valgus deformity of 2 cases, varus deformity of 1 case, 1 case deep infection. 6. Interlocking intramedullary nailing provided rigid fixation of fracture and then made early joint motion exercise and ambulation.

• Journal of Trauma and Injury
• /
• v.31 no.2
• /
• pp.96-102
• /
• 2018

Ipsilateral fractures of proximal femur with shaft and condylar region are very rare. Current concept of management is based on fixation of each fracture as independent entity using separate fixation modalities for proximal and distal parts of femur. However, we considered that antegrade femoral nailing with cephalomedullary screw fixation is a good option for ipsilateral multi-level femoral fractures. Here, we present an experience of satisfactory treatment for ipsilateral femoral neck fracture, subtrochanteric fracture, comminuted shaft fracture with supracondylar fracture following road traffic accident.

• Clinics in Shoulder and Elbow
• /
• v.22 no.2
• /
• pp.87-92
• /
• 2019

Background: This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types. Methods: From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft $f{\ddot{u}}r$ Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20-87 years), and mean follow-up period was 2.3 years (range, 1.0-6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed. Results: Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352). Conclusions: Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.

• Journal of Trauma and Injury
• /
• v.33 no.2
• /
• pp.104-111
• /
• 2020

Purpose: Although exchange nailing is a standard method of treating femoral shaft nonunion, various rates of healing, ranging from 72% to 100%, have been reported. The purpose of this study was to evaluate the efficacy of exchange nailing in femoral shaft nonunion. Methods: We retrospectively reviewed 30 cases of aseptic femoral shaft nonunion after intramedullary nailing. The mean postsurgical period of nonunion was 66.8 weeks. A nail at least 2 mm larger in diameter was selected to replace the previous nail after reaming. Distal fixation was performed using at least two interlocking screws. The success of the procedure was determined by the finding of union on simple radiographs. Possible reasons for failure were analyzed, including the location of nonunion, the type of nonunion, and the number of screws used for distal fixation. Results: Of the 30 cases, 27 achieved primary healing with the technique of exchange nailing. The average time to achieve union was 23.1 weeks (range, 13.7-36.9 weeks). The three failures involved nonunion at the isthmic level (three of 15 cases), not at the infraisthmic level (zero of 15 cases). Of eight cases of oligotrophic nonunion, two (25%) failed to heal, and of 22 cases of hypertrophic nonunion, one (4.5%) failed to heal. Of 11 cases involving two screws at the distal fixation, two (18.2%) failed to heal, and of 19 cases involving three or more screws, one (5.3%) failed to heal. None of these findings was statistically significant. Conclusions: Exchange nailing may enable successful healing in cases of aseptic nonunion of the femoral shaft. Although nonunion at the isthmic level, oligotrophic nonunion, and weaker distal fixation seemed to be associated with a higher chance of failure, further study is needed to confirm those findings.

• Proceedings of the Korean Society of Precision Engineering Conference
• /
• 1997.10a
• /
• pp.816-819
• /
• 1997

The operation of femoral non-union after IM(Intramedullary) nailing in distally femoral fractures is considered. Augmentive plate fixation is the management of femoral non-union after IM nailing. The purpose of this study is to compare the bending, torsional stiffness and stress distribution of the two operations by the FEM(Finite Element Method). Augmentive plate fixation is better than IM nail fixation. These results conclude that plate augmentation is a useful method for the unstable femoral non-union after interlocking IM nailing.

• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.6 no.1
• /
• pp.1-9
• /
• 2013

Purpose: The purpose is to perform objective evaluation for rotator cuff using ultrasonography and validate factors influencing cuff integrity as well as efficacy of follow-up ultrasonography after unreamed antegrade intramedullary nailing for humerus fracture. Materials and Methods: Seventeen patients with an average age of $55.7{\pm}18.6$ years underwent antegrade intramedullary nailing for humerus fracture and follow-up ultrasonography of shoulder joint. Mean follow-up period was $43.5{\pm}32.2$ months. Intraoperative evaluation for preoperative cuff tear was performed, of which four cuffs were repaired by single row repair technique. Clinical evaluation included visual analogue scale (VAS), range of motion, Korean Shoulder Scoring System (KSS) and American Shoulder and Elbow Society (ASES) score. Ultrasonographic evaluation was performed on cuff integrity and protrusion of proximal nail tip as well. Radiographic evaluation included time to union, protrusion of proximal nail tip and migration of proximal interlocking screw which could affect shoulder joint function. Results: Mean VAS at last follow-up was $1.65{\pm}1.84$ points. Range of motion showed forward flexion of $137.0{\pm}33.5^{\circ}$, external rotation of $43.5{\pm}12.7^{\circ}$ and internal rotation of $16.4{\pm}2.0^{\circ}$ while KSS score and ASES score were $79.6{\pm}20.7$ and $83.7{\pm}17.0$ points, respectively. Bone union was demonstrated in all cases and average time to union was $3.4{\pm}1.3$ months. Migration of proximal interlocking screw was shown in 6 cases (35%). On ultrasonographic evaluation, there were normal in 8 (47%), weaving in 4 (24%), partial tear in 5 cases (29%), but no complete tear. Protrusion of proximal nail tip was demonstrated in 8 cases (47%) on plain radiographs whereas in 11 cases (65%) on ultrasonography and was associated with increasing age (p=0.038). Ultrasonographic weaving and partial tear was associated with protrusion of proximal nail tip (p=006), but not with repair of preoperative tear (p>0.05). Conclusion: Because weaving and partial tear on ultrasonography originated from protrusion of proximal nail tip, careful insertion of nail and meticulous repair of cuff during operation lead to stable fixation with satisfactory recovery of shoulder function follow-up ultrasonography can be a useful tool for evaluating protrusion of nail tip and rotator cuff tear, of which diagnosis is difficult on plain X-ray after antegrade intramedullary nailing for humerus fracture.

• Journal of the Korean Orthopaedic Association
• /
• v.56 no.6
• /
• pp.535-539
• /
• 2021

Vascular complications following a femoral fracture are rare but can result in serious issues. Several case studies have reported pseudoaneurysms occurring after direct trauma or the insertion of a proximal femoral nail in the case of a proximal femoral fracture. The authors encountered an 85-year-old patient treated with retrograde intramedullary nail fixation for a distal femur fracture and suffered a decrease in the hemoglobin level, swelling, and pain on the 9^th day after surgery. The authors initially attributed the temporary hematoma and pain to ordinary postoperative processes. On the 16^th day after surgery, a pseudoaneurysm originating from the descending branch of the lateral femoral convolutional artery was diagnosed and treated by percutaneous vascular embolization. After the procedure, the hemoglobin level increased, and the swelling and pain decreased.

• Journal of Trauma and Injury
• /
• v.29 no.3
• /
• pp.76-81
• /
• 2016

Purpose: The purpose of this study was to compare the data comprehensively including not only the clinical and radiographic outcomes but some parameters related to operation between the minimally invasive plate osteosynthesis (MIPO) technique and intramedullary nailing (IMN) for treatment of segmental tibia shaft fractures. Methods: We conducted a retrospective study of 31 patients (mean age, 49.3 years, range, 27-74 years), with a mean follow-up of 14.1 months (range, 12-19 months) with acute segmental tibial fractures (AO 42-C2) who underwent either surgical treatment of MIPO or IMN. In accordance with the Gustilo-Anderson classification, 11 were type I, 5 were type II, and 15 were type III. Initial compartment syndrome was confirmed in 2 cases. Results: There were no statistically significant differences in terms of the patient demographic data between the two groups. The time to definitive fixation was longer in the MIPO group (mean $13.7{\pm}10.9days$; range, 2-27) than in the intramedullary group (mean $5.4{\pm}9.6days$; range, 0-35) with statistically significant difference (p=0.002). Bony union was observed in most of cases but except 5 cases of nonunion were diagnosed (3 in the MIPO vs 2 in IMN, p=0.188). The average bone healing time was 27.1 weeks (10 to 56 weeks) in MIPO group and 23.2 weeks (13 to 66 weeks) in IMN group, respectively (p=0.056). Overall complications were 5 cases in MIPO group and 2 cases in the IMN group. Difference in LEFS was not statistically significant between both groups (p=0.824). Conclusion: This study showed that segmental tibia shaft fractures treated with both MIPO and intramadullary nailing was challenging with relatively high complication rate. A well planned sequential strategy with keeping the soft tissue and personality of fracture in mind is utmost significant as much as the choice of surgical modalities.

• Journal of the Korean Orthopaedic Association
• /
• v.52 no.1
• /
• pp.25-32
• /
• 2017

Purpose: The purpose of this study was to analyze the radiological and clinical outcomes in elderly patients with unstable intertrochanteric femur fractures in accordance with the length of intramedullary nail. Materials and Methods: Between August 2009 and December 2014, a total of 139 patients-older than 65 years of age with AO/OTA classification of 31-A2 unstable intertrochanteric femur fracture-who has been followed-up for at least 1 year after the treatment with internal fixation by using an intramedullary nail were enrolled for this retrospective control study. The subjects were classified into two groups according to the length of intramedullary nail: 106 patients in the short group (group I) and 33 patients in the long group (group II). For radiological assessments, the reduction state, time to union, and implant related complications were examined. The clinical outcomes were assessed by preoperative hemoglobin, operating time, intraoperative bleeding amount, blood transfusion rate, hospitalization period, and Charnley hip pain scoring system at the final follow-up. Results: The postoperative radiographs showed good or acceptable reduction in all cases. The mean time of radiologic bone union was 4.8 months, and there was no difference between the two groups. With respect to surgical time, the group II was found to take longer (57.87 minutes) than the group I (45.65 minutes) (p=0.003). The bleeding amount during surgery of the group II was greater (288.78 ml) than that of the group I (209.90 ml) (p=0.046). The clinical results at the final follow-up were found to be satisfactory in both groups. Conclusion: In cases of good reduction of the fracture from the treatment of unstable intertrochanteric femur fracture accompanying the posteromedial fragment in elderly patients, both groups-long and short intramedullary nails-showed satisfactory radiological and clinical outcomes.

• Clinics in Shoulder and Elbow
• /
• v.16 no.2
• /
• pp.107-114
• /
• 2013

Purpose: This study is designed to evaluate the clinical and radiographical results for the displacement of fracture fragments after interlocking intramedullary nailing in humeral shaft fractures. Materials and Methods: We retrospectively reviewed the results of 8 cases of humeral shaft fractures that have displacements of over 10 mm and under 20 mm after interlocking intramedullary nailing between July 2004 and August 2011. The mean age was 54.1 years (range, 43 to 70 years) and there were 3 male and 5 female patients. Radiographically, the time to bony union, change of displacement and angulation of the fracture site, and degree of improvement of these two factors were measured. Clinically, the range of motion of shoulder and elbow joints, postoperative pain and complications were evaluated. Results: All cases showed complete bony union in last follow-up. The mean time to bony union was 16.1 weeks. At the last follow-up, almost all cases had normal range of motion of shoulder and elbow joints. But, one case had stiffness of shoulder joint. Therefore, arthroscopic capsular release and manipulation was performed. One case had transient shoulder pain and the other case had transient elbow pain. In the two cases, pull-out of proximal interlocking screw were noted, but they finally had bony union. Conclusion: Although considerable displacement of fracture fragments after interlocking intramedullary nailing in humeral shaft fractures was present, we had excellent radiographical and clinical outcomes. Therefore, an additional procedure, such as open reduction or another fixation for the fracture site, was not necessary.