No abstract available.
Fractures, Comminuted* ; Radius*

Two cases of acquired absence of forearm bone secondary to compound comminuted fractures were treated by reconstructive surgery, which consist of surgical construction of one-bone forearm. The results of treatment were referred and the review of the literature was done concerning about surgical reconstruction of one-bone forearm.
Forearm ; Fractures, Comminuted

Sometimes serious tension occurs in the radial nerve when doing internal fixation for distal humerus shaft fracture or neurorrhaphy for radial nerve injury. Medial transposition of radial nerve on fracture site can avoid direct radial nerve injury by fracture fragment, radial nerve tension by plating for distal humerus shaft fracture, and also safe from neural tension during neurorrhaphy of damaged radial nerve. We reported here total 6 cases of backward transposition of radial nerve including 2 cases of radial nerve injury associated with humerus fracture and 4 cases of comminuted fracture of humerus shaft.
Fractures, Comminuted ; Humerus ; Radial Nerve

The authors clinically analysed the causes of metallic failure in 21 cases after treatment of comminuted fracture of femur at Department of Orthopaedic Surgery, Kang-Nam St. Marys Hospital during 5 year period from May 1981 to December 1986. In this series, the nature of metallic property was not studied which may influence the result of failure. 1. Metallic failure occurred in seventeen self-compression plates, one Kuntscher nail, one I-beam nail, one Ender nail, and one Angle blade-plate. 2. Seventeen patients had fractures in the middle or distal one third of femur. 3. Metallic failure occurred from 3 to 19 months following open reduction and internal fixation. The time interval between internal fixation and failure was 9.6 months on an average. 4. Metallic failure of the self-compression plate was observe in the empty hole over the fracture site in 14 out of 17 patients. In the Kiintscher, failure developed at the interlocking hole corresponding with the fracture level. In the Ender nail and Angle blade-plate, failure developed at the fracture site, and in the I-beam nail plating, failure developed at the neck of the fixation screw, and not at the plate. 5. The cause of metallic failure in 17 self-compression plate-treated cases was improper plating such as varus plating in 4, absence of medial buttress due to cortical comminution in 10. Above mentioned two conditions were combined in 4 cases, in which one case of Angle blade-plate was included. Incorrect position of I-beam nail, inadequate postoperative management following Ender nailing and incorrect selection of implant in one case of Kiintscher nailing were the other possible causes of metallic failure.
Femur ; Fractures, Comminuted ; Humans ; Neck

PURPOSE: During interlocking nailing the displaced butterfly fragments can be left in situ or reduced by opening the fracture site. The purpose of this study is to investigate the fate of the displaced comminuted butterfly fragments when left unreduced and factors that influences fracture union in comminuted femoral fracture after closed interlocking nailing. MATERIALS AND METHODS: Out of 95 closed interlocking nailings done for fractured femur from July 1990 to July 1993, 43 femoral fractures that had comminuted fragments larger than 1 cm were followed for more than 18 months postoperatively, The correlations between the size of the comminuted fragments, its distance from the femoral shaft, the angulation of the fragment, the gap of the main fracture sites and bone union were analyzed. RESULTS: The distance between the fragment and the femoral shaft and angulation spontaneously decreased gradually, even the fractures having inverted fragments were united uneventfully, and the union rate of the fractures with gap less than 3 mm was higher than those with gap greater than 3 mm. CONCLUSIONS: The displaced fragment need not be reduced by open method and minimizing the fracture gap is recommended in increasing the union rate.
Butterflies ; Femoral Fractures* ; Femur ; Fractures, Comminuted

PURPOSE: To introduce the technique of reducing displaced or comminuted clavicle shaft fracture using composite wiring and report the clinical results. MATERIALS AND METHODS: Between March 2006 and December 2013, 31 consecutive displaced clavicle fractures (Edinburgh classification 2B) treated by anatomic reduction and internal fixation using composite wiring and plates were retrospectively evaluated. The fracture fragments were anatomically reduced and fixed with composite-wiring. An additional plate was applied. Radiographic assessments for the numbers of fragments, size of each fragment and amount of shortening and displacement were performed. The duration for fracture union and complications were investigated retrospectively. The mean fallow-up duration was 15.9 months. RESULTS: The mean number of fragments was 1.7 (1-3) and the mean width of fracture fragment was 7.1 mm (4.5-10.6 mm). The mean shortening of the clavicle was 20.5 mm (10.3-36.2 mm). The mean number of composite wires used in fixation was 1.9 (1-3). Radiographic union was achieved in all patients with a mean time to union of 11.6 weeks. There were no complications including metal failure, pin migration, nonunion, or infection. CONCLUSION: The composite wiring was suitable for fixation of small fracture fragment and did not interfere with the union, indicating that it is useful for treatment of clavicle shaft fracture.
Classification ; Clavicle* ; Fractures, Comminuted ; Humans ; Retrospective Studies

No abstract available.
Bankart Lesions ; Suture Techniques ; Fractures, Comminuted

Spinal fixation using pedicle screws has recently been the focus of increased attention, but the adequate size of pedicle screw and maximum percentage fill as related to the pedicle diameter and are not well known. The objects of this study were to determine the ideal ratio among pedicle, drill and screw diameter, and to determine the maximum percentage fill of the screw without significant decrease of pull-out strength. The materials used for the experiments were 376 thoracic pedicles obtained from the 38 young pigs, and the diameters of pedicles ranged from 3.0 to 8.5mm. After 40% to 100% drilling as compared to pedicle diameter, screws were inserted carefully, and measurements were taken of the outer pedicle changes and pull-out strengths, and adequate drill and screw sizes as related to the diameters of given pedicles were determined. It was found that pull-out strength was the strongest after 60% drill, and the larger the drill diameter, the smaller the holding power, and the larger the screw diameter, the greater the holding power. Maximum pull-out strength was seen at 80-90% fill with 60% drill. After sequentially drilling each pedicle with increasingly larger drill bits, larger screws could be inserted with pedicle changes such as expansion, cutout, split fracture, and comminuted fracture. after larger drilling up to 100%, pedicle screws with diameters smaller than 115% of measured pedicle diameters could be safly inserted without fracture and significant decrease of pull-out strength. It is concluded that effective percentages of drill and screw diameters to the pedicle diameter are 60% and 80-90% respectively, and pedicle screw up to 115% of measured pedicle diameter can be safely inserted into pedicle without significant decrease of pull-out strength. It is thought that fresh pedicle has elasticity and larger screw can be inserted to the pedicle with strong holding after larger drilling.
Elasticity ; Fractures, Comminuted ; Pedicle Screws ; Swine

PURPOSE: The purpose of this study was to know whether ultrasonography is proper diagnostic tool for decision of treatment method or not, as compared the efficacy of US in allowing identifying fracture patterns of nasal bone with that of CT. MATERIALS AND METHODS: Fifty patients with nasal trauma were investigated prospectively by CT and US. According to CT and ultrasonographic findings, each case of nasal bone injury were rated as grade 1 (nasal injury but not fracture), grade 2 (simple fracture without displacement), grade 3 (unilateral simple fracture with displacement), grade 4 (bilateral simple fractures with displacement), and grade 5 (bilateral comminuted fractures with depression). Assessment for ultrasonographic method were defined as overestimations or underestimation according to whether the nasal fracture had been assigned a higher or lower grade at the review of the findings of CT. The correlation between the results of CT and ultrasonography were measured. RESULTS: In ultrasonographic estimation of grade of 50 cases of nasal bone injuries, there were correctly graded in 42 cases, overestimated in 5 cases, underestimated in 3 cases. In allowing accurate grading of nasal bone injury, images of nasal ultrasonography correlated closely with those of CT (r = 0.796). CONCLUSION: Nasal ultrasonography is a reliable method that allows appropriate grading of nasal bone injury and would be a useful first line imaging method in providing the detail necessary for proper management of patients with mild simple nasal bone injury.
Fractures, Comminuted ; Humans ; Nasal Bone ; Prospective Studies

PURPOSE: To compare the mechanical effectiveness between performing conventional partial patellectomy and the separate vertical wiring technique for a comminuted fracture of the inferior pole of the patella. MATERIALS AND METHODS: Twenty patellae from cadavers (ten pairs) were used to model acute comminuted fractures of the inferior pole of the patella. Comminuted fractures of the inferior pole of the patellae were made by an oscillating saw. Then they were fixed with separating vertical wiring on one side and the other side received a partial patellectomy by the pull-out suture technique. We measured the maximal lengths between the superior and inferior poles of the normal patella and after fixation. A biomechanical test was then performed to compare the strength of fixation in the two group. RESULTS: The lengths of patella in the separate vertical wiring group (mean: 5.63 cm) were longer than those in the partial patellectomy group (5.24 cm). The maximal strengths of fixation in the separate vertical wiring (mean: 250.1 Newtons) were higher than in the partial patellectomy (mean: 69.7 Newtons). CONCLUSION: A separate vertical wiring is an effective method for fixation of the comminuted fracture of the inferior pole of the patella.
Cadaver ; Fractures, Comminuted* ; Knee ; Patella* ; Suture Techniques