• Title/Summary/Keyword: open fracture

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Mini-open Treatment Using Plate of Clavicle Mid-shaft Fractures

  • Park, Yong-Geun;Kang, Hyunseong;Kim, Shinil;Bae, Jong-Hwan;Choi, Sungwook
    • Clinics in Shoulder and Elbow
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    • v.20 no.1
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    • pp.37-41
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    • 2017
  • Background: Increased frequency of comminuted clavicle mid-shaft fractures and importance of functional satisfaction through early joint exercise has resulted in higher emphasis on surgical treatments. This study aimed to evaluate the clinical radiological results of treatment of clavicle mid-shaft fractures by open reduction and internal fixation using a plate with a small incision. Methods: The subjects of this study were 80 clavicle mid-shaft fracture cases treated with internal fixation using a plate from October 2010 to July 2014. Clavicle mid-shaft fractures were internally fixated using anatomical plates or locking compression plates. Achievement of bone union, union period, and clavicle length shortening were evaluated radiologically, and clinical assessment was done by using Constant and University of California at Los Angeles (UCLA) scores. Results: All 80 cases were confirmed to have achieved bone union through radiographs with an average union period of 10.9 weeks (range: 7-18 weeks). The average clavicle length of shortening in the affected side was 1.8 mm (range: 0-17 mm). The average UCLA score and Constant score were 33.6 (range: 25-35) and 92.5 (range: 65-100), respectively. Regarding complications, four cases reported skin irritation by metal plates, and one case reported a screw insertion site fracture due to minor trauma history. Conclusions: We were able to induce successful bone union and obtain clinically satisfactory results in displaced mid-shaft fractures of the clavicle without major complications such as nonunion through treatment of internal fixation using a plate.

Open Reduction and Internal Fixation for Vancouver B1 and B2 Periprosthetic Femoral Fractures: A Proportional Meta-Analysis

  • Byung-Ho Yoon;Seong Gyun Park;Young Hak Roh
    • Hip & pelvis
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    • v.35 no.4
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    • pp.217-227
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    • 2023
  • Purpose: Periprosthetic femoral fracture (PFF) is a common complication after total hip arthroplasty, and open reduction and internal fixation (ORIF) is a common surgical treatment. We conducted a meta-analysis to compare the outcomes of ORIF in patients with different fracture patterns (Vancouver B1 and B2). Materials and Methods: We conducted a systematic search of PubMed, Embase, Cochrane Library and KoreaMed from inception to August 2022. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the 10 comparative studies and a proportional meta-analysis on the data from the 39 articles to determine a consensus. The outcomes were the incidence of reoperations that included osteosynthesis, irrigation/debridement and revision arthroplasty. Results: The pair-wise meta-analysis showed similar outcomes between two groups; the risk of reoperation (odds ratio [OR]=0.82, confidence interval [CI] 0.43-1.55, P=0.542), nonunion (OR=0.49; CI 0.22-1.10, P=0.085) and deep infection (OR=1.89, CI 0.48-7.46, P=0.361). In proportion meta-analysis, pooled prevalence of reoperation was 9% (95% CI, 6-12) in B1 and 8% (95% CI, 2-15) in B2 (heterogeneity between two groups (Q), P=0.772). The pooled prevalence of nonunion was same as of 4% in B1 and B2 (Q, P=0.678), and deep infection was 2% (95% CI, 1-3) in B1 and 4% (95% CI, 2-7) in B2 (Q, P=0.130). Conclusion: ORIF is a feasible treatment for B1 and B2 periprosthetic femoral fractures, with acceptable outcomes in terms of, nonunion and infection. The results of this study would help clinicians and provide baseline data for further studies validating PFF.

Correction of post-traumatic anterior open bite by injection of botulinum toxin type A into the anterior belly of the digastric muscle: case report

  • Seok, Hyun;Park, Yong-Tae;Kim, Seong-Gon;Park, Young-Wook
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.39 no.4
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    • pp.188-192
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    • 2013
  • Post-traumatic anterior open bite can occur as a result of broken balance among the masticatory muscles. The superior hyoid muscle group retracts the mandible downward and contributes to the anterior open bite. Denervation of the digastric muscle by injection of botulinum toxin type A (BTX-A) can reduce the power of the digastric muscle and help to resolve the post-traumatic anterior open bite. A patient with a bilateral angle fracture had an anterior open bite even after undergoing three operations under general anesthesia and rubber traction. Although the open bite showed some improvement by the repeated operation, the occlusion was still unstable six weeks after the initial treatment. To eliminate the residual anterior open bite, BTX-A was injected into the anterior belly of the digastric muscle. Following injection of BTX-A, the anterior open bite showed immediate improvement. Complication and relapse were not observed during follow-up. Long-standing post-traumatic open bite could be successfully corrected by injection of BTX-A into the anterior belly of the digastric muscle without complication.

A Clinical and Statistical Study on Maxillofacial Fractures. (악안면골(顎顔面骨) 골절환자(骨折患者)의 임상(臨床) 통계적(統計的) 연구(硏究))

  • Kim, Seung-Lyong;Jin, Woo-Jeong;Shin, Hyo-Keun;Kim, Oh-Hwan
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.11 no.1
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    • pp.1-11
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    • 1989
  • This is a retrospective study on maxillofacial fractures. This study was based on a series of 442 patients with maxillofacial fractures treated at Dept, of oral and Maxillofacial Surgery, College of Dentistry, Chon Buk National University from Jan, 1984 to Sep. 1988. The results obtained were as follows: 1. The ratio of Male/Female was 4.8 : 1, and 3rd decade (43.9%) was the highest age group in incidence. 2. Monthly incidence was the highest in Oct,(10.6%). 3. The most frequent maxillofacial fracture site was mandible (70.0%), and zygoma & zygomatic arch (13.6%), maxilla(11.7%) and nasal bone (4.7%) were next in order of frequency. 4. Traffic accidents (47.5%), fight(24.8%) were the most common causes of maxillofacial fractures. 5. The most frequent chief complaint was painful swelling(40.7%). 6. In mandibular fractures, the most frequent fracture site was symphyseal area(28.9%) and simple fracture was the most frequent in type of fracture (71.2%). 7. In maxillary fractures, fracture with other facial bones (64.5%) was more frequent than fracture of maxilla only. The most common type of fracture was unilateral fractures(37.1%). 8. In fracture of zygoma complex, zygoma fracture was the most frequent fracture type(40.3%), zygoma and zygomatic arch fx, (30.6%), zygomatic arch fx, (29.1%) were next in order 9. Open reduction was major method of treatment in maxillofacial fractures : Mandible (77.5%), Maxilla (61.3%), Zygoma complex(43.1%). 10. Maxillofacial fractures were most frequently combined with head injury(39.3%), and lower extremities(17.0%), upper extremities(13.6%) were next in order.

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THE CHANGES OF C-REACTIVE PROTEIN IN THE PATIENTS ASSOCIATED WITH MANDIBULAR FRACTURE (하악골 골절 환자에서의 C-Reactive Protein의 변화)

  • Gwak, Jong-Min;Kim, Chul-Hwan;Kim, Kyung-Wook
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.28 no.1
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    • pp.35-41
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    • 2006
  • It is well known that concentration of C-reactive protein(CRP) in the serum increase as nonspecific reaction of the various tissue injury. The CRP, synthesized in the hepatocyte, is one of 'acute phase proteins' in the serum. The main signal patterns of this protein are regulated by synthesis of interleukin-I secreted from macrophage in the area of tissue injury. Many studies were performed for quantitative analysis for CRP according to various surgical operation, but the study for fracture patients associated with trauma, especially in mandible, are rare. The mandible fracture have intrinsic danger for infection in oral bacteria associated with open wound in oral cavity, and, are difficult for detection of tissue reaction between surgical swelling and infection by facial swelling. In this study, quantitative analysis for CRP associated tissue injury in mandibular fracture and surgical intervention was done, the results were as follows: 1. After initial mandibular trauma, the value of serum CRP diminished sequentially, most high value was presented in post-traumatic 2 days. 2. The CRP was diminished significantly 2 days after surgical intervention, and maintained normal value in 5 days after surgery. 3. The change of CRP are higher value in surgical intervention than initial trauma, it suggested that tissue injury from surgery was severe than trauma. 4. The high value of CRP was obtained in mandibular fracture combined soft tissue injury than no associated soft tissue injury. 5. In measurement of CRP according to surgical approach, highest serum value in patients of combined intra-oral and extra-oral approach was showed, and intra-oral approach, extra-oral approach, in sequential orders. 6. The CRP value are more higher in patient of 2 fracture site than only one fracture site. From the results obtained in this study, CRP has showed different values in mandibular fracture associated with severity of tissue injury and surgical intervention, and quantitative analysis of CRP value in serum can be applied to the clinical management of mandibular fracture.

3D imaging of fracture aperture density distribution for the design and assessment of grouting works (절리 암반내 그라우팅 설계 및 성과 판단을 위한 절리틈새 밀도 분포의 3차원 영상화 연구)

  • Kim, Jung-Yul;Kim, Yoo-Sung;Nam, Ji-Yeon
    • Proceedings of the Korean Geotechical Society Conference
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    • 2004.03b
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    • pp.113-120
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    • 2004
  • Grouting works in fractured rocks have been performed to reinforce the underground and/or to block ground water flow at the foundation site of dam, bridge and so on. For the efficient grouting design, a prior knowledge of the fracture pattern of underground area to be grouted in very important. For the practical use, aperture sizes of open fractures that will be filled up with grouting materials will be kind of valuable information. Thus, the main purpose of this study is to develop a new technique (so called "GenFT") enable to form a three dimensional image of fracture aperture density distribution from Televiewer data. For this, the study is to focus on dealing with (1) estimating aperture size of each fracture automatically from Televiewer time image, (2) mapping extension of fracture planes on a given section, (3) evaluating aperture density distribution on the section by using both aperture size and fracture face mapping result of each fracture, (4) developing an algorithm that can transfer the previous results to any arbitrary(vertical and/or horizontal) section around the borehole. Since 3D imaging means "a strategy used to form an image of arbitrarily subdivided 2D sections with aperture density distribution", it will help avoid ambiguities of fracture pattern interpretation and hence will be of practical use not only for the design and assessment of grouting works but also for various engineering works. Examples of fields experiments are illustrated. It would seem that this technique might lead to reflecting future trend in underground survey.

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Treatment of Intra-articular Calcaneal Fracture with Open Reduction and Internal Fixation (관혈적 정복 및 내고정을 이용한 관절내 종골 골절의 치료)

  • Choi, Jun-Won;Choi, Joon-Cheol;Lee, Young-Sang;Na, Hwa-Yeop;Kim, Woo-Sung;Han, Sang-Ho
    • Journal of Korean Foot and Ankle Society
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    • v.11 no.2
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    • pp.226-231
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    • 2007
  • Purpose: To evaluate the clinical outcomes and radiographic results of open reduction and internal fixation for intraarticular calcaneal fractures. Materials and Methods: We reviewed 20 cases of calcaneal fractures managed with open reduction and internal fixation from March 2003 to January 2005. We used the computed tomographic classification system proposed by Sanders et al to classify these fractures. Preoperative and postoperative Bohler's angle, heel height (calcaneal facet height) and calcaneal length, calcaneal width were measured. The Creighton-Nebraska Health Foundation Assessment score was used for clinical evaluation. Results: There were 12 cases of type II fractures, 5 of type III fractures and 3 of type IV fractures. The mean clinical score was 84.3 for type II, 82.6 for type III and 56.1 for type IV. The mean preoperative $B{\ddot{o}}hler$ angle was $6.1^{\circ}$ and final was $22.8^{\circ}$. The mean preoperative calcaneal facet height was 76.6 mm and final was 80.3 mm (The mean calcaneal facet height was changed from preop 76.6 mm to postop 80.3 mm). The mean preoperative calcaneal length was 88.2 mm and final was 92.6 mm. The mean preoperative width was 38.1 mm and final was 35.6 mm. Conclusion: Open reduction and internal fixation showed good results for type II and III fractures, but for type IV fractures the clinical result was significantly worse than the other types. However, type IV fractures still had restoration of (should be restored in) $B{\ddot{o}}hler's$ angle, calcaneal facet height, calcaneal length and width which may be helpful in later subtalar fusion.

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Evaluation of soft tissue asymmetry using cone-beam computed tomography after open reduction and internal fixation of zygomaticomaxillary complex fracture

  • Kim, Dong Hyuck;Kim, Rae Hyong;Lee, Jun;Chee, Young Deok;Kwon, Kyoung-Hwan
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.40 no.3
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    • pp.103-110
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    • 2014
  • Objectives: In this study, we assessed soft tissue asymmetry that occurred after open reduction of unilateral zygomaticomaxillary complex (ZMC) fractures. We proposed a simple method to assess soft tissue asymmetry after reduction surgery by evaluating the symmetry between the affected and the unaffected sides. The factors affecting soft tissue contour after surgery were also analyzed. Materials and Methods: Subjects included patients admitted to Wonkwang University Dental Hospital from 2008 to 2013. Cone-beam computed tomography (CBCT) images of asymmetric patients who underwent open reduction at least 3 months prior were compared with healthy patients. Results: The degree of asymmetry was measured in both the open reduction and control groups. Landmarks that showed a statistically significant difference between the two groups were zygion ($1.73{\pm}0.24mm$), bucclae ($1.08{\pm}0.26mm$), point of cheek ($2.05{\pm}0.33mm$) and frontozygomatic point ($1.30{\pm}0.31mm$). Conclusion: When compared with the normal group, asymmetry can occur in the affected side, which usually shows depression of overlying soft tissue and is statistically significantly different. Evaluation of soft tissue asymmetry with CBCT images after open reduction of ZMC fracture is useful.

Comparative Analysis of the Result of Minimally Invasive Anterior Plating and Open Reduction and Internal Fixation in Humerus Shaft Simple Fracture

  • Ko, Sang-Hun;Choe, Chang-Gyu;Lee, Ju-Hyung
    • Clinics in Shoulder and Elbow
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    • v.18 no.2
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    • pp.75-79
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    • 2015
  • Background: This retrospective comparative study aims to evaluate the surgical outcomes and complications of two surgical methods for simple fractures of the humeral shaft; minimally invasive anterior plating and open reduction combined with internal fixation. Methods: A total of 26 patients with humeral shaft simple fractures, who had surgery between June 2009 and September 2013 and were followed-up at least 12 months, were included in our analysis. They were divided into two groups; group 1 comprised of 12 patients who underwent minimally invasive anterior plating and group 2 comprised of 14 patients who underwent an open reduction and internal fixation. The clinical outcomes, radiological results, and complications were compared and analyzed. Results: We found that bone union was achieved in all patients, and the mean union periods were $20.7{\pm}3.34$ and $20.3{\pm}3.91$ weeks for groups 1 and 2, respectively. In most patients, we found that shoulder and elbow functions were recovered. At 12 months post-operation, we found that the Korean Shoulder Scoring system, the University of California at Los Angeles score and Mayo elbow performance score were $91.4{\pm}7.97$, $33.4{\pm}1.15$, and $90.8{\pm}2.23$ for group 1, and $95.2{\pm}1.53$, $33.3{\pm}1.43$, and $90.17{\pm}1.85$ for group 2. In terms of complications, we found that 2 patients had radial nerve palsy after open reduction and internal fixation, but all cases spontaneously resolved within 6 months. Complications such as infection and loss of fixation were not reported. Conclusions: Both minimally invasive anterior plating and open reduction with internal fixation produced satisfactory outcomes in the treatment of simple fractures of the humeral shaft.

Operative Treatment of Fractures of the Midshaft Clavicle using Locking Compression Plate (Locking Compression Plate를 이용한 전위성 쇄골 간부 골절의 수술적 치료)

  • Chung, Nam-Sik;Hong, Ki-Do;Ha, Sung-Sik;Park, Sung-Joon;Kang, Jung-Ho;Sim, Jae-Cheon
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.5 no.1
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    • pp.63-68
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    • 2006
  • Purpose: To assess the effectiveness of the Locking compression plate (LCP) after open reduction for the treatment of the displaced clavicular shaft fracture, the clinical and radiologic outcome of the patients who were managed with the LCP for internal fixation after open reduction has been analyzed. Materials and Methods: We reviewed 26 cases with a displaced clavicular shaft fracture treated by internal fixation using Locking compression plate after open reduction between May 2003 and November 2004. The patients were followed up for at least six months period, and final postoperative outcome was evaluated using clinical results based on Kang's criteria, radiologic signs of fusion. Results: All fractures united by an average of 9.3 weeks without delayed union and showed fast recovery of motion fraction and shoulder function. In addition,24 cases without the fractures of proximal humerus recovered to normal range of shoulder notion within 2.9 weeks. Clinically, according to Kang's criteria, the outcome was good or better in 22 patients. The complications included shoulder joint dysfunction in two cases and keloid formation in one case, and no other complications were observed. Conclusion: The internal fixation using LCP for the treatment of displaced clavicular shaft fracture is a safe, reliable method of treatment, with few complications, and offers rapid recovery of shoulder joint function and bone union.

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