• Clinics in Shoulder and Elbow
• /
• v.3 no.1
• /
• pp.26-32
• /
• 2000

Purpose : The aim of this study is the assessment of the clinical outcomes after percutanous pinning of unstable two-parts fracture of surgical neck in humerus. Materials and Methods: This study was based on thirteen cases of non-comminuted unstable surgical neck fracture of humerus among 19 cases, which followed-up more than one year. Follow-up averaged 29 months. We treated with percutaneous pinning techniques and assessed clinical outcomes. Functional evaluation was performed using the standard method of research committee of American Shoulder and Elbow Surgeons(ASES). Results: Last follow-up ROM of shoulder joint were 142 degrees of forward elevation, 57 degrees of external rotation, 72 degrees of external rotation in 90 degrees abduction, and T8 of internal rotation. Pain scale was l(range : 0∼3). ASES scores was 86.2(range : 63.3~98.3). Patient satisfaction based on ASES were excellent in 6 cases, good in 5 cases, fair in 1 case, poor in 1 case. A case of fair result was caused by limitation of motion in shoulder joint and poor case was paraplegia patient after traffic accident. Conclusion : Percutaneous pinning is recommended for non-comminuted unstable fracture of surgical neck in humerus.

• Journal of Yeungnam Medical Science
• /
• v.10 no.2
• /
• pp.400-408
• /
• 1993

During the period from March 1990 to November 1993, 22 children with diplaced supracondylar fracture of humerus were treated by closed reduction and percutaneous K-wire fixation at department of Orthopaedic surgery in Yeungnam University. All fracture were treated with closed reduction under the general anesthesia and percutaneous pinning. After the fracture was internally fixed, intraoperative anteroposterior reontgenograms of each distal humerus were compared. Only anatomical reduction ensured good result, because the main cause of late cubitus varus was medial tilting of distal fragment. We could follow up 10 patients more than one year. By Flynn's criteria, satisfactory result were obtained in 9 of the 10. Unsatisfactory one had a limitation in flexion of elbow joint, but had no problem in cosmetic feature. In short term follow up of 7 patients, 5 patients had a satisfactory result, too. There were no neurovascular complication and hospitalization was shortened to 11.4 days. Closed reduction and percutaneous pinning provided stabillity, vascular safety, simplified management, reduced hospital stay. This is safe and reliable technique for obtaining and maintaining an excellent reduction.

• Journal of Chest Surgery
• /
• v.31 no.6
• /
• pp.615-618
• /
• 1998

Systemic arteriovenous(AV) fistulas are a rare but well-recognized cause of hyperkinetic circulation that, if undetected, may lead to congestive heart failure. We experienced a very rare case of acquired arteriovenous fistula. A 61-year-old female patient presented with congestive heart failure symptoms after percutaneous pinning for right sternoclavicular joint dislocation. We surgically obliterated the fistula between aorta and innominate vein and performed tricuspid annuloplasty for severe tricupid insufficiency simultaneously. She was discharged with complete relief of her symptoms and has been well during 2 years and 6 months follow up.

• Clinics in Shoulder and Elbow
• /
• v.9 no.1
• /
• pp.96-104
• /
• 2006

Purpose: To evaluate and compare the results of children with displaced supracondylar fractures of humerus treated with open reduction and pinning with closed reduction and pinning. Materials and Methods: From March 2002, we treated 17 patients with completely displaced supracondylar fractures under the age of 7 with a minimal follow up period of 6 months. 9 patients were treated with closed reduction and pinning and 8 patients were treated with open reduction and pinning. The clinical results were evaluated with Flynn's criteria. Time to bone union was also analyzed for these two set of patients. Results: The group treated with open reduction had 6 excellent and 2 good results for change in carrying angles, 5 excellent, 2 good and 1 fair results for motion loss evaluated by Flynn's criteria. The average time to bony union for this group was 5.8 weeks. The group treated with closed reduction had 6 excellent, 2 good, and 1 fair results for change in carrying angles and 7 excellent, 1 good and 1 fair results for motion loss. The average time to bony uinon for this group was 3.7 weeks. Conclusion: In treating completely displaced supracondylar fractures of humerus in children, the closed reduction method and open reduction method all showed good results. But the operation time, duration of hospital stay and time to union was somewhat shorter for the patients treated with closed redution and pinning.

• Archives of Hand and Microsurgery
• /
• v.23 no.4
• /
• pp.248-253
• /
• 2018

Purpose: The purpose of this study was to evaluate the clinical results of anatomic reduction of bony mallet finger using modified-intrafocal pinning technique. Methods: From March 2014 to October 2017, 18 patients with bony mallet finger were treated with modified-intrafocal pinning technique. Kirschner-wire was used to directly reduction the bony fragment, and extension block pinning and distal interphalangeal joint fixation were additionally performed to minimize the loss of reduction. Postoperative pain, range of motion, and radiological evaluation were performed. Duration of bone healing, functional recovery and complication rate were evaluated and Crawford's criteria was used to determine functional outcome after surgery. Results: Bone union was achieved in all cases after a postoperative mean of 6 weeks (5-7 weeks). An average of $2.8^{\circ}$ ($0^{\circ}-10^{\circ}$) extension loss occurred in all patients. All patients showed satisfactory joint congruency and reformation of the joint surface, the mean flexion angle of the distal interphalangeal joint at the final follow-up was $72.2^{\circ}$ ($70^{\circ}-75^{\circ}$). According to Crawford's classification, 12 patients (66.7%) were excellent and 6 patients (33.3%) were good. Conclusion: Modified-intrafocal pinning technique is a method of obtaining anatomical bone healing by directly reduction and fixation of the bony fragment. Combined with other conventional percutaneous pinning procedures, it is expected that good results can be obtained if applied to appropriate indications.

• Archives of Plastic Surgery
• /
• v.34 no.3
• /
• pp.409-412
• /
• 2007

Purpose: Percutaneous Kirschner wire fixation is common method for hand fracture. It is simple but has risk of ascending infection through the pin and bony injury by multiple drilling. Ascending infection through pin tract is mostly superficial and can be treated with antibiotics and aseptic dressing. This is a case review of subacute osteomyelitis on phalangeal bones after Kirschner wire fixation with literature review. Methods: A 40-years-old man with distal phalangeal fracture on right second finger is presented. He went to a local clinic and had percutaneous Kirschner wire fixation under local anesthesia. He was transferred to our hospital for ulcerative wound on DIP joint at 4 weeks after operation. Radiography showed osteolytic change around medulla of middle and distal phalanges, leading to diagnosis of a subacute osteomyelitis. We treated it with amputation at the level of shaft of middle phalanx. Results: The postoperative course was uneventful. We thought several possible reasons for osteomyelitis in our case. First, it could resulted from ascending infection through the wire. Second, it could be resulted from a bony burn by repeated drilling. And bony necrosis could be a consequence of arterial insufficiency caused by 2 pin insertion. Conclusion: We suggest that a precise pinning based on accurate anatomical understanding is required for a percutaneous Kirschner wire fixation. The frequency of drilling should be minimized. Careful observation and patient education for pin site care are essential.

• Journal of Korean Foot and Ankle Society
• /
• v.7 no.1
• /
• pp.68-77
• /
• 2003

Purpose: The treatment of calcaneal fractures remains a controversy in orthopaedic field because of its complications. The purpose of this study is to evaluate the efficacy of the treatment of calcaneal fractures and its complications. Materials and Methods: Clinical and radiological results were retrospectively analyzed in 28 patients, 34 cases with fractures of calcaneus which were treated in our department from September 1998 to march 2003. Results: According to the Creighton-Nebraska Foundation Assessment score, there were 3 excellent, 11 good, and 12 fair 6 poor results. Bohler angle was corrected from $8.3^{\circ}$ to $18.3^{\circ}$, Gissane angle was corrected from $121^{\circ}$ to $135^{\circ}$, and calcaneal width was corrected from 46.8mm to 37mm. Conclusion: Open reduction and internal fixation for joint depression type calcaneal fractures thought to be a good method of treatment. Closed reduction and percutaneous axial pinning should be chosed in selected cases of tongue type fractures. In treatment of complicated calcaneal fractures as malunion, subtalar distraction arthrodesis and lateral wall exostectomy will reduce disability of the disease.

• Clinics in Shoulder and Elbow
• /
• v.10 no.1
• /
• pp.112-123
• /
• 2007

Purpose: Evaluate the clinical results of humerus neck nonunion treated with Polarus intramedullary nail. Materials and Methods: 8 patients who underwent surgery for nonunion of humerus surgical neck fracture were included. All patients were female, the average age was 65 years. 5 out the total 8 cases initially received surgery, open reduction and internal fixation with metal plate in 1 case, Ender nail insertion in 2 cases, external fixator in 1 case and closed reduction and percutaneous pinning in 1 case. The other 3 non union cases initial received conservative managemnent. The average period of nonunion was 9 months in the operated group and 6.2 months in the conservative group. All 8 cases received closed reduction with intrameedullary Polarus nail and auto iliac bone graft. Union was confirmed radiologically, and functional evaluation was done with the UCLA functional criteria. Results: All 8 cases showed union on radiologic evaluation. Average time to union was 3.5 months, average follow up period was 27 months. Average UCLA shoulder evaluation score was 7.6 points preoperatively which improved to 26.3 points after surgery. Active shoulder flexion was 40.7 degrees preoperatiely which increased to 104 degrees after surgery. Shoulder abduction improved from 32.9 degrees preoperatively to 96.3 degrees after surgery. UCLA functional criteria was good in 5 cases and fair in 3 cases, which no poor cases. Conclusion: Polarus IM nailing and AIBG is a useful method for treating nonunion of humerus neck fracture with improvement in union and function.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.2 no.2
• /
• pp.168-175
• /
• 2003

Fracture about proximal humerus may be classified as the articular segment or the anatomical neck, the greater tuberosity, the lesser tuberosity, and the shaft or surgical neck. Now, usually used, Neer's classification is based on the number of segments displaced, over 1cm of displaced or more than 45 degrees of angulation , rather than the number of fracture line . Absolute indication of a operative treatment a open fracture, the fracture with vascular injury or nerve injury , and unreductable fracture-dislocation . Inversely, the case that are severe osteoporosis, and eldly patient who can't be operated by strong internal fixation is better than arthroplasty used by primary prosthetic replacement and early rehabilitation program than open reduction and internal fixation. The operator make a decision for the patient who should be taken the open reduction and internal fixation, because it's different that anatomical morphology, bone density, condition of patient. The operator decide operation procedure. For example, percutaneous pinning, open reduction, plate & screws, wire tension bands combined with some intramedullary device are operation procedure that operator can decide . The poor health condition for other health problem, fracture with unstable vital sign and severe osteoporosis , are the relative contraindication. The stable fracture without dislocation is not the operative indication . The radiologic film of the prokimal humerus before the operation can not predict for fracture evaluation. It's necessary to good radiologic film for evaluation of fracture form. The trauma serise is better than the other radiologic film for evaluation. The accessary radiologic exam is able to help for evaluation of bone fragment and anatomy. The CT can be helpful in evaluating these injury, especially if the extract fracture type cannot be determined from plain roenterogram of the proximal humerus, bone of humerus head. If the dislocation is severe anatomically , we could consider to do three dimentional remodelling. The MRI doing for observing of bony morphology before the operation is not better than CT If we were suspicious of vascular injury, we could consider the angiography.