Biomechanical study of fixation techniques for the fixation of comminuted fractures of the inferior pole of the patella - separate vertical wiring v.s. circumferential wiring with separate vertical wiring

의학과/석사슬개골 하극 분쇄 골절에서 고정 술기에 따른 인장력 비교목 적 : 슬개골 하극 분쇄골절에서 수직 강선 고정술 단독 수술법과 환상 강선 고정술을 병행한 수술법 간의 술 후 슬개골의 길이와 인장력의 차이를 사체 슬개골을 이용하여 비교하였다.대상 및 방법 : 5구의 사체에서 좌우 10개의 슬개골을 적출한 후 하극이 사등분 되도록 절골술을 시행하고 한쪽은 수직 강선 고정술을, 반대쪽은 수직 강선 고정술 후 환상 강선 고정술을 병행하여 내고정 하였다. 슬개골의 최장 종축 길이를 절골술 시행 전과 각각의 시술 후 측정하여 길이의 변화를 측정하였다. 검체를 Intron기기(Instron model 6022; Instron Co., Canton, Massachusetts, U.S.A.)에 연결하여 절골부의 해리가 발생할 때까지 인장력을 가하여 최대 인장력을 측정하였다. 각각의 고정 방법에서 슬개골 길이 변화 및 최대 인장력, 강성도를 구한 후 이를 Wilcoxon signed rank test를 시행하여 유의수준 0.05에서 검증하였다.결 과 : 절골술 전 슬개골의 길이는 수직 강선 고정군에서 평균 5.27cm (범위 4.72-5.87cm), 환상 강선 고정술 병행군에서 평균 5.27cm (범위 4.75-5.82cm)였으며, 시술 후 수직 강선 고정군에서는 평균 4.8cm (범위 4.24-5.36cm), 환상 강선 고정술 병행군에서 평균 4.72cm (범위 4.08-5.3cm)으로 환상 강선 고정술 병행군에서 길이 변화가 의미 있게 많았다(p<0.05). 최대 인장 강도 및 강성도는 수직 강선 고정군에서는 평균 223N (범위 131.6-365.2N) 및 249.5N/mm (범위 186.5-376.1N/mm) 였으며, 환상 강선 고정술 병행군에서 평균 324.7N (범위 264.8-423.8N) 및 342.9N/mm (범위 295.2-426.1N/mm)로 두 군간의 의미 있는 차이를 나타내었다(p<0.05).결 론 : 수직 강선 고정술과 환상 강선 고정술을 병행하여 시행하면 수직 강선 고정술 단독 고정에 비하여 고정력이 우수하며 조기 재활이 가능하여 대퇴 신전 기능 유지에 더 좋은 효과가 있는 치료 방법으로 사료된다.ope

Intermittent Parathyroid Hormone Treatment for Stimulation of Callus Formation on Distal Femoral Fracture in Elderly Patients: Case Report

Fracture healing is the ongoing process but it is often delayed in elderly patients. Because the fractures in elderly patients with osteoporosis are severely comminuted and their quality of bone is poor, the associated delay of fracture healing is likely to lead to surgical failure. Recently, as a way to promote healing fractures, intermittent systemic parathyroid hormone treatment has been actively researched. Although the effect of parathyroid hormone, which is demonstrated by animal experiments, is well known, there are not many clinical applications. The authors report 2 cases which had the time-shortened callus formation by intermittent parathyroid hormone (teriparatide) administration after surgical treatment, maximum preservation of periosteum as possible, in elderly patients who have supracondylar fracture on distal femur.ope

Clinical outcomes of autogenous cancellous bone grafts obtained through the portal for tibial nailing.

BACKGROUND: The purpose of this study is to introduce and review the clinical outcomes of a new technique for harvesting autogenous cancellous bone grafts in association with tibial intramedullary (IM) nailing. MATERIALS AND METHODS: We retrospectively reviewed 21 patients who received autogenous cancellous bone grafts obtained from the entry portal of a tibial IM nail for fracture gaps, malalignment or nonunion in the lower extremities. All patients were scheduled to receive IM nailing or had already received IM nailing for the fixation of an ipsilateral tibia shaft fracture. A total of 33 patients who received only tibial IM nailing were selected as a control group. Through the follow-up, postoperative complications related to the bone harvest were monitored. Further by taking serial X-rays, radiographic changes of the donor site and the knee joint were closely observed. Knee pain (visual analogue scale (VAS)) and function (Lysholm knee score) were compared between the study group and the control group. RESULTS: At the last follow-up, the average VAS in the study group was 1.28 (0-5), which was not significantly different from the control group (VAS: 1.36, range 0-7) (P=0.985). The range of motion of the knee joint was similar in both groups, averaging 130.23° (range: 115-135°) and 131.36° (range: 115-135°), respectively. There was no significant difference in the Lysholm knee score between the study and control groups (P=0.610). All patients exhibited complete fracture healing at an average of 6 months and no complications associated with the bone donor site were observed. CONCLUSIONS: By using the new technique, autogenous cancellous bone grafting can be performed conveniently and safely to treat fracture gaps, malalignment or nonunion in the lower extremities without additional morbidity at the donor site.ope

Atypical Subtrochanteric and Diaphyseal Femoral Fractures

Increasing numbers of atypical subtrochanteric fractures have been reported among long-term bisphosphonate users. However, the nature and extent of the problem are unknown despite recent investigations. The task force of American Society for Bone and Mineral Research (ASBMR) defined major and minor features of complete and incomplete atypical femoral fractures; transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including bisphosphonate, glucocorticoids, and proton pump inhibitors. Based on published data, the incidence of atypical femoral fractures associated with bisphosphonate therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by bisphosphonate. Physicians and patients should be aware of the possibility of atypical femoral fractures and of the potential for bilateralityope

T Plate Fixation for Unstable Fracture of Distal Clavicle

Purpose: To review clinical and radiological results after open reduction and internal fixation with T plate for unstable distal clavicle fractures. Materials and Methods: From July. 1999 to December 2002, nine patients with distal clavicle Neer type II fractures were treated by open reduction and internal fixation with T plate. The bony union was confirmed by plain radiography. The clinical results were analyzed according to the classification by Kona et al. Results: Average time to fracture union was 8 weeks in all cases. The functional results were as follows: excellent in 7 cases and good in 2 cases. Screw loosening occurred in one case, but bony union was achieved. Conclusion: We recommend T plate fixation as another treatment method for unstable distal clavicle fractures.ope