PURPOSE: To evaluate the osseointegration of titanium alloy cortical screws with the passage of time. MATERIALS AND METHODS: Fifty four titanium alloy cortical screws (24 mm in length, 3.5 mm in diameter) were implanted bilaterally in the tibial diaphysis of adult mongrel male dogs of similar size and weight (30 +/-5 kg). The insertion torques, radiographs, undecalcified histology, histomorphometric analysis and extraction torques were evaluated at 2, 4 and 8 weeks after surgery. RESULTS: The extraction torque at 2 weeks (1.14+/-0.470 cN. m) was significantly lower than the insertion torque (1.76+/-0.609 cN. m) (p=0.0071), the extraction torque at 4 weeks (2.57+/-1.36 cN. m) was slightly improved and the extraction torque at 8 weeks (3.18+/-0.499 cN. m) was significantly higher than insertion torque (p=0.0005). Direct bony contact in the early phase was poor and intervening fibrous tissue was observed at the bone-screw interface. However, the fixation between the bone and the screws improved with time. The percentage of bone-screw contact at 8 weeks (33.1+/-18.5%) was higher than that of 2 weeks (22.4+/-12.9%), but not statistically significant. CONCLUSION: Because of thermal injury or pressure necrosis, the fixation strength of titanium alloy cortical screws at 2 weeks after implantation is significantly lower than that at the insertion time. So, we should keep in mind the initial phase weakness of screw fixation when we allow the patients the range of motion exercise or weight bearing and the improvement of the initial phase fixation is very important in clinical results.
Adult ; Alloys* ; Animals ; Diaphyses ; Dogs ; Humans ; Male ; Necrosis ; Osseointegration* ; Range of Motion, Articular ; Titanium* ; Torque ; Weight-Bearing

PURPOSE: To evaluate treatment results between internal and external fixation groups in two-stage reconstruction of infected nonunion of long bones using antibiotics-impregnated cement beads. MATERIALS AND METHODS: In the first stage, preexisting hardwares were removed and radical debridement was done. The dead space was filled with antibiotics -impregnated cement beads and the nonunion site was immobilized by external fixation, cast or skeletal traction. In the second stage, all cases were divided into two groups; the nonunion was fixed by internal fixation in group I versus external fixation in group II. The intervening period between the first and second stage was average 8.7 weeks (range, 3~23 weeks). RESULTS: The follow-up period was average 45 months (range, 16~71 months). Infection control and bone union were achieved in all 13 cases of group I. Infection recurred in two of 28 cases in group II, one underwent above-knee amputation and the other case was lost in follow-up. The mean number of supportive operations including repeated curettage, augmentation and change of infected pins, angular correction, and soft tissue flap was average 2 and 6.2 times respectively in group I and group II. Bony union period was average 19.3 and 23.1 weeks in each group. According to Paley's classification, group I was similar to group II in bony and functional result (p>0.05). CONCLUSION: Antibiotics-impregnated cement beads provided positive effect on infection control. Internal fixation group showed less number of additional operations and earlier bony union than external fixation group.
Amputation ; Anti-Bacterial Agents ; Classification ; Curettage ; Debridement ; Follow-Up Studies ; Infection Control ; Traction

PURPOSE: To investigate the etiologic factors related to refractures of the upper extremity in children MATERIALS AND METHODS: 18 refractures of the upper extremity were divided into three groups according to the location of initial fractures: Supracondyle fractures of the humerus, lateral condyle fracture of the humerus, and the forearm bone fractures. They were analyzed in terms of the type of refractures (early refracture occurring at the immature callus and late refracture occurring at the remodeled bone), fracture patterns, and the existence of underlying deformity. RESULTS: Nine supracondyle fractures had refractures at the supracondyle (2 cases) and the lateral condyle (7 cases), in which underlying cubitus varus were present in 6 cases. Three lateral condyle fractures had refractures at the supracondyle (1 case) and the lateral condyle (2 cases), in which one case had underlying cubitus varus. All but one case in the group of humerus fractures were late refractures and treated operatively except one. Of 6 refractures of forearm, 5 were early refractures and occurred within 9 weeks at the original site: 4 at the diaphysis of both bones of forearm and 1 at the diaphysis of ulna. All cases in the group of forearm fractures had volar angulation before the refracture, and treated conservatively except one CONCLUSION: In the humerus, underlying cubitus varus was the most important predisposing factor to refractures and the lateral condyle fractures were common. In the forearm, volar angulation of the diaphysis were related to refractures, and complete and circular consolidation of the primary fracture of forearm was thought to be important to prevent refracture.
Bony Callus ; Causality ; Child* ; Congenital Abnormalities ; Diaphyses ; Forearm ; Fractures, Bone ; Humans ; Humerus ; Ulna ; Upper Extremity*

PURPOSE: To report the effectiveness of Kirschner wire fixation for the treatment of unstable tibial shaft fractures in children. MATERIALS AND METHODS: We analyzed 15 cases of pediatric tibial shaft fractures treated at our hospital with fixation using K-wire and followed up for more than 1 year from July 1998 to January 2002. The subjects included 11 boys and 4 girls. The ages ranged from 3 to 10 years at the time of injury, with the average age being 7.9 years. We examined the presence of angulation, leg length discrepancy, joint motion limitation, and complications. RESULTS: Bony fusion was obtained in all patients by an average of postoperative 9.5 weeks. At the time of last follow-up (by an average of postoperative 1 year and 4 months), anterior and posterior radiographs showed an average of 4.2degree angulation, and lateral radiographs showed an average of 4.4degree angulation. The affected leg was extended by an average of 3.7 mm compared to the opposite leg according to Bell-Thompson's radiographs. As for complications, infection was developed around the pin in 3 cases but treated with the administration of oral antibiotics and sterilization around the site without progressing to deep infection. We could not observe joint motion limitation, pain and difficulties related with discrepancy in leg length. CONCLUSION: We concluded that fixation using K-wire for children with tibial shaft fractures was a safe and effective method of surgery that could be performed easily, did not require secondary surgery to remove the wire, and showed sufficient stability after fixation.
Anti-Bacterial Agents ; Child* ; Female ; Follow-Up Studies ; Humans ; Joints ; Leg ; Sterilization

Intercondylar fractures of the distal humerus are very rare in children. The pattern of the fracture would suggest that the mechanism of injury involves a fall directly on the flexed elbow. Most agree that the undisplaced fracture can be managed conservatively. With increasing displacement and comminution, the opinions tend to differ. We suggest that closed reduction with percutaneous K wire pinning and open reduction with percutaneous K wire pinning offer a satisfactory methods by which to treat displaced intercondylar fracture in children.
Child* ; Elbow ; Humans ; Humerus*

PURPOSE: To compare clinical and radiological results between vertebroplasty and conservative treatment in osteoporotic compression fractures of thoracolumbar spine. MATERIALS AND METHODS: 34 patients were reviewed with at least 1 year follow up. Vertebroplasty was used in 14 and conservative treatment was done in 20 fractures. These groups were compared by clinical results which were evaluated by the scoring system according to pain, mobility and analgesic usage at preoperative, postoperative 1 month and postoperative 1 year. And also compared by the increment of kyphosis and loss of vertebral body height in lateral films at the same time. We compared duration of hospitalization between two groups. RESULTS: Vertebroplasty group showed statistically significant less pain and mobility than conservative treatment (p<0.05), but there was no differences in analgesic usage at postoperative 1 year while significant difference at 1 month. In radiological comparison, vertebroplasty showed less increment of kyphosis and loss of body height significantly (p<0.05). Also vertebroplasty group had shorter hospitalization stay significantly (p<0.05). CONCLUSION: Our retrospective analysis demonstrated that vertebroplasty provided significant pain relief, improvement of motion and reduction of analgesic usage and also provided considerable spinal stabilization that prevented further kyphosis and collapse.
Body Height ; Follow-Up Studies ; Fractures, Compression* ; Hospitalization ; Humans ; Kyphosis ; Osteoporosis ; Retrospective Studies ; Spine ; Vertebroplasty*

PURPOSE: To assess the clinical and functional outcome of the patients who underwent percutaneous vertebroplasty with bone cement for the osteoporotic compression fracture and who had been followed up for minimum 1 year. MATERIALS AND METHODS: Among 110 patients who had been undergone percutaneous vertebroplasty with bone cement for osteoporotic compression fracture in Gangneung Asan Hospital from January 2001 to August 2002, 75 patients who had been followed up for more than 1 year were selected. And retrospectively, we analyzed the clinical and radiographic finding of 1 year, 2 year and 3 year follow-up. The patients were divided into 3 groups, the first group who have follow-up period of the from 1 to 2 years had 75 patients, the second group who the from 2 to 3 years, 49 patients, and the third group who the more than 3 years, 20 patients. We graded the clinical results to excellent, good, normal, fair and poor. Also, we assessed the height of vertebral body, the adjacent vertebral body fracture and the leakage of bone cement. RESULTS: 74 patients (98.6%) had the excellent or good results postoperatively. 69 patients (92%) of the first group, 46 patients (93.8%) of the second group and 16 patients (80%) of the third group had excellent or good results at last follow-up. There was no statistical correlation of each groups (p>0.05). In first group, the average height of body was 71.1% preoperatively, 73.5% postoperatively and 73.5% at follow-up. In second group, 71.5%, 75.5%, and 73.1%. In third group, 71.2%, 78.0% and 77.8%. There was no significant statistical correlation of each groups (p>0.05). 47cases (38.8%) had some leakage of cement immediate postoperatively. In 4 cases (7 vertebra), there were adjacent vertebral body fractures. CONCLUSION: Based on the results of our study, percutaneous vertebroplasty is a useful method in the treatment for the osteoporotic compression fracture of vertebra body.
Chungcheongnam-do ; Follow-Up Studies* ; Fractures, Compression* ; Gangwon-do ; Humans ; Retrospective Studies ; Spine ; Vertebroplasty*

PURPOSE: To review the result of bony mallet finger treated with a closed reduction using extension block K-wire MATERIALS AND METHODS: Between January 2001 and November 2002, among the patients with bony mallet finger underwent closed reduction using extension block K-wire, we retrospectively reviewed 14 patients with 14 fractures who had a minimum follow-up of 12 months. RESULTS: There were 10 men and 4 women, with an average follow-up for all cases 15.7 months (range, 12 months~18 months). According to Crawford's evaluation criteria, we obtained 7 excellent, 5 good, 2 fair. We obtained bony union in all patients, with no remained pain. The average ROM was 67 degrees at postoperative 12 months. Postoperative complications occurred in two cases, which were nail deformity and mild osteoarthritis at the distal interphalangeal joint. There was no pin site infection. CONCLUSION: This technique is not only easier but also less invasive than other techniques for reduction of mallet finger. Also, it shows excellent result with lower complication rate. So, it seems a reliable treatment for bony mallet finger.
Congenital Abnormalities ; Female ; Fingers* ; Follow-Up Studies ; Humans ; Joints ; Male ; Osteoarthritis ; Postoperative Complications ; Retrospective Studies

We report one case of snapping metacarpo-phalangeal joint after depressed fracture of metacarpal neck which could be diagnosed by exploration for the snapping during extension in spite of conservative treatments.
Joints* ; Neck*

PURPOSE: To review the result of fractures of distal radius treated with the T-plate fixation and to recommend guideline for treatment of fracture of distal radius. MATERIALS AND METHODS: Between January 1999 and December 2002, among the patients with fractures of distal radius underwent T-plate fixation, we retrospectively reviewed 52 cases that had a minimum follow-up of 12 months. According to the Fernandez classification of distal radius fractures, 18 cases were type I, 4 cases were type II, 22 cases were type III, 2 cases were type IV and 6 cases were type V. To assess the clinical result, we used the Demerit Point System and for the radiologic result, we used the Point system by Scheck. We Compare the result of treatment in fractures of distal radius by T-plate fixation and K-wire fixation in Type I and III. RESULTS: Excellent to good results were obtained in 38 cases (73%) in clinical result and 39 cases (75%) in radiological results. Radiologic evidence of arthritis was presented 6 cases at follow-up examination. There was no evidence of statistical difference between Type I using T-plate and K-wire fixation (p>0.05). However in type III, result in the group of T-plate fixation were better than in pinning group (p<0.05). CONCLUSION: We obtained good result for type III with T-plate but only T-plate fiaxtion for type V was not satisfactory
Arthritis ; Classification ; Follow-Up Studies ; Humans ; Radius Fractures ; Radius* ; Retrospective Studies