The clinical value of CT in the diagnosis of pelvic bone fractures is being explored. Conventional radiographic projections, including internal and external oblique views, although very helpful, often cannot provide sufficent jnformation to give a true sense of the fractures. CT conversely displays the anatomy in an axial plane, thereby providing the missing pieces of information and fascilitating classification of these fractures. From January 1983 to June 1986, 34 patients with pelvic bone fractures, admitted to Department of Orthopedic Surgery, Severance Hospital, were given both CT and conventional radiographs. Comparing the conventional radiographic findings with those of CT, the following conclusions were obtained. 1. For patients with multiple trauma who necessitate position changes during conventional radiography, no further change in position was required during CT. 2. CT clearly showed intraarticular loose bodies, anterior wall fractures of the acetabulum, and separations of the saicroiliac joint which were hardly detected on conventional radiographs. 3. CT permitted a better evaluation of the shape, extent, and degree of separation of fracture fragment, so it was very helpful in formulating the treatment plan. 4. Follow-up CT was helpful in evaluating the effectiveness of treatment.
Acetabulum ; Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Joints ; Multiple Trauma ; Orthopedics ; Pelvic Bones ; Radiography

Isolated fractures of the greater trochanter are unusual injuries. Because of their relative rarity and the unsettled controversy regarding their etiology and pathogenesis, several methods of treatment have been advocated. Furthermore, the reports on this particular type of injury are not plentiful and the average textook coverage afforded to this entiry is limited. These fractures are seen as two distinctly different types which occur in different age groups. The first type are epiphyseal separations which are found in the adolescent population, ususlly from seven to seventeen years of age. In this type, the mechanism of injury is muscle contraction that results in avulsion of the entire trochanteric apophysis and it can be displaced up to 6 cm. The second type is a comminuted fracture of the greater trochanter seen in adults. In this type, the mechanism of injury is usually a direct blow to the greater trochanter that results in a comminuted fracture, and only a part of the greater trochanter is generally involved.
Adult ; Aged ; Case Report ; Female ; Follow-Up Studies ; Hip Fractures/*radiography ; Human ; Male ; Multiple Trauma/radiography ; Wound Healing

PURPOSE: Traumatic diaphragmatic rupture resulting from blunt trauma is usually severe. However, it is often overlooked during initial evaluation because there are no characteristic signs and symptoms. Thus, this study aimed to determine the clinical characteristics of diaphragmatic rupture caused by blunt trauma and investigate the diagnostic usefulness of diaphragmatic height index (DHI) measured using chest radiographs. METHODS: The cohort comprised patients who were admitted due to diaphragmatic rupture from blunt trauma. Patients were divided into 2 groups; the control group comprised patients with blunt trauma who were matched for age, sex, and Injury Severity Score, while the DHI group comprised patients with diaphragmatic rupture from blunt trauma. Receiver operating characteristic curve was used to determine the cutoff value of DHI for diaphragmatic injury. The sensitivity, specificity, predictability, accuracy, and likelihood ratio of the cutoff were then determined. RESULTS: A total of 60 patients were confirmed to have diaphragmatic rupture. The mean DHI in patients with diaphragmatic rupture on the right and left side were both significantly different compared to that in the control group. A DHI cutoff value of >1.31 showed 71% sensitivity and 87% specificity for diagnosing right diaphragmatic rupture, while a cutoff value of <0.43 showed 87% sensitivity and 76% specificity for diagnosing left diaphragmatic rupture. CONCLUSION: DHI can be useful in the diagnosis of diaphragmatic rupture. DHI as determined using chest radiographs in patients with blunt abdominal trauma, particularly in those ineligible for diagnostic work-up, may help in the diagnosis of diaphragmatic rupture.
Abdominal Injuries ; Cohort Studies ; Diagnosis ; Diaphragm ; Humans ; Injury Severity Score ; Multiple Trauma ; Radiography, Thoracic ; ROC Curve ; Rupture ; Sensitivity and Specificity

BACKGROUND: This study evaluated the outcomes of surgical management of ipsilateral femoral and tibial fractures in adults. METHODS: Fifteen patients (13 men, 2 women; mean age, 34.8 years; range, 18 to 65 years) were enrolled in this study. The fractures types were classified according to the classification by Fraser et al. as follows: type I (5), type IIa (3), IIb (4), IIc (3). Femur fractures were treated using locked intramedullary nails, plate-screws, or dynamic condylar screws, and tibia fractures were treated with an external fixator (in open fractures), or plate-screws, and locked intramedullary nailing. The mean follow-up duration was 2.2 years (range, 1.3 to 4 years). RESULTS: The extent of bony union according to the Karlstrom criteria was as follows: excellent, 8; good, 4; acceptable, 2; poor, 1. CONCLUSIONS: The associated injuries and type of fracture (open, intra-articular, comminution) are prognostic factors in a floating knee. The best management of the associated injuries for good final outcome involves intramedullary nailing of both the fractures and postoperative rehabilitation.
Adolescent ; Adult ; Aged ; Female ; Femoral Fractures/radiography/*surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary/instrumentation/*methods ; Humans ; Male ; Middle Aged ; Multiple Trauma/radiography/*surgery ; Orthopedic Fixation Devices ; Prognosis ; Tibial Fractures/radiography/*surgery ; Treatment Outcome ; Young Adult

PURPOSE: The study was designed to identify the necessity of radiographs and to decrease overutilization of radiographs in uncommunicable children who do not move their arms. This study provides clinical guidelines on radiographic evaluation and treatment of children with limited motion in the upper extremity. METHODS: The cases of one hundred thirteen pediatric patients under 36 months of age, who had visited the Emergency Center of Korea University Ansan Hospital from January 2000 to December 2001, were retrospectively reviewed. Pediatric patients with upper extremity injuries due to multiple trauma, laceration or motor vehicle accident were excluded. Parameters analyzed were age, sex, mechanism of injury, physical findings, radiographic finding, and injuried upper extremity region. We described focal tenderness and regional edema as physical finding. Each patient without regional edema was classified into an improved or a not-improved group depending on the outcomes after manual reduction. All statistical tests were conducted with twotailed levels of 0.05. RESULTS: Of the 113 patients, the mean age was 18.6+/-0.89 months. The most common injury mechanisms were unknown and traction. Minimal edema in the elbow joint was seen in 5 cases, and supracondylar fractures due to short falls were seen in 4 (80%) of those cases (p<0.05). The improved group was finally confined to radial head subluxation in 88 patients. Although all the not-improved-group patients had received radiographs, no abnormal findings were seen in the elbow. However, clavicle fracture due to fall above or from a level surface were seen in 4 cases (20%) of the not-improved group (p<0.05). No difference of injury mechanism existed between the improved and the not-improved groups. CONCLUSION: Recommand Radiographic evaluations in Children not-used arm with regional edema before manual reduction. But without regional edema, manual reduction of elbow is first. If children without regional edema do not improve after manual reduction of elbow and they are injuried due to fall, children should be assessed for fractures of clavicle.
Arm* ; Child* ; Clavicle ; Edema ; Elbow ; Elbow Joint ; Emergencies ; Gyeonggi-do ; Head ; Humans ; Korea ; Lacerations ; Motor Vehicles ; Multiple Trauma ; Radiography ; Retrospective Studies ; Traction ; Upper Extremity

Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation.
Accidental Falls ; *Bone Wires ; Child ; Fracture Fixation ; Humans ; *Humeral Fractures ; Male ; Multiple Trauma ; Radiography ; *Radius Fractures ; *Upper Extremity/diagnostic imaging/injuries/surgery

OBJECTIVETo investigate a new classification and treatment of zygomatic complex fractures (ZCF) by clinical and radiographic studies.

METHODSStandard radiographs with Waters, submental vertex views had been obtained before and after operation in 206 patients (212 sides) with ZCF. Patients with complicated fractures underwent two and three dimensional CT. Computer-assisted measuring system was used to measure the degree of displacement.

RESULTSZCF were classified into 3 types and 6 subtypes according to the degree of displacement of segments and facial deformities. Treatment principles were proposed. The results were satisfied through clinical application and measurement of post-operative images.

CONCLUSIONSThe treatment for ZCF should be selected according to the fracture types. The key of operation is to recover the malar prominence. Remodeling the length and radian of zygomatic arch guarantee the recovery of malar prominence. Zygomatic-sphenoid and zygomatic-maxillary fissures are very important reference marks for reduction and fixation.

Adolescent ; Adult ; Child ; Female ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Male ; Maxillary Fractures ; surgery ; Middle Aged ; Multiple Trauma ; surgery ; Radiography ; Zygomatic Fractures ; classification ; diagnostic imaging ; surgery

OBJECTIVE: To table a proposal for select using the medical imaging methods to evaluate pelvic injury in forensic field, by studying the structure of pelvis and radiological methods in common use. METHODS: A study of several cases of pelvic injury was done, in which biomechanics and classification of pelvic injury were analyzed, moreover imaging methods were compared with each other, such as fluoroscopy, X-ray photography, computerized tomography (CT) and so on. RESULTS: Four cases of pelvic injury are all multiple injuries, confirmed by X-ray photography and CT examination approvingly. CONCLUSIONS Authors advocate that pelvic injury mechanism and biomechanics should be considered accordingly, multiple injuries should be attracted notice, so as to select suitable imaging methods to evaluate pelvic injury exactly.
Adult ; Biomechanical Phenomena ; Female ; Forensic Medicine ; Fractures, Bone/diagnostic imaging* ; Humans ; Magnetic Resonance Imaging ; Male ; Multiple Trauma/diagnostic imaging* ; Pelvic Bones/injuries* ; Radiography/methods* ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsilateral hip and femoral shaft fractures.

METHODSFrom August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsilateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture.

RESULTSThe follow-up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varus malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed.

CONCLUSIONSThe reconstructive intramedullary interlocking nail, with less trauma, reliable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.

Adolescent ; Adult ; Bone Nails ; Female ; Femoral Fractures ; diagnostic imaging ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; methods ; Fracture Healing ; physiology ; Hip Fractures ; diagnostic imaging ; surgery ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Multiple Trauma ; diagnostic imaging ; surgery ; Prognosis ; Radiography ; Recovery of Function ; Retrospective Studies ; Risk Assessment ; Sampling Studies ; Treatment Outcome

OBJECTIVETo investigate the influence of hip and pelvic fracture, especially acetabular fracture complicated by sciatic nerve injury on clinical features and prognosis of sciatic nerve injury.

METHODSFrom January 1987 to January 2000, 17 patients (14 male and 3 female) who had hip and pelvic fractures complicated by sciatic nerve injury were treated with operative reduction and internal fixation and followed up from 10 months to 5 years. The average age was 38 years (ranging 23-56 years). The left extremities were involved in 11 patients and the right in 6. Twelve patients underwent primary exploration and neurolysis and 5 patients underwent secondary operation.

RESULTSPreoperatively, 8 patients were treated with large doses of oral narcotics to control their severe sciatic pain. Three of the 8 patients underwent patient-controlled analgesia and epidural analgesia. After operation, excellent and good rates of reduction and functional recovery of sciatic nerve were 94.1% and 88% respectively. Four patients still had sciatic pain and 2 patients failed to recover. Sciatic nerve function improved within 3-6 months after surgery in 11 patients.

CONCLUSIONSHip and pelvic fractures can result in sciatic nerve injury, especially common peroneal nerve injury and prognosis is poor. Open reduction and internal fixation combined with nerve exploration and neurolysis should be used as early as possible for severe sciatic pain.

Adult ; Analgesics ; therapeutic use ; Cohort Studies ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; rehabilitation ; Hip Fractures ; complications ; diagnostic imaging ; surgery ; Humans ; Intraoperative Complications ; Joint Dislocations ; complications ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Multiple Trauma ; diagnostic imaging ; rehabilitation ; surgery ; Pain Measurement ; Pelvic Bones ; injuries ; surgery ; Radiography ; Range of Motion, Articular ; Recovery of Function ; Retrospective Studies ; Risk Assessment ; Sciatic Nerve ; injuries ; Sciatic Neuropathy ; complications ; diagnosis ; drug therapy ; Treatment Outcome