Objectives: Conservative treatment for distal radius fractures typically involves closed reduction and immobilization with a plaster cast. However, no consensus exists regarding the best method and duration for immobilization. This study investigated the functional outcomes associated with different plaster cast application techniques in the treatment of stable distal radius fractures.

Methods: A systematic search was performed in accordance with PRISMA guidelines for studies in the last 5 years. The inclusion criteria were randomized controlled trials that investigated non-operative treatments for distal radius fractures. We excluded studies with short-term follow-up (less than 3 months), ongoing trials, those that did not directly address fractures, and studies involving the use of sugar-tong splints or non-circular immobilization. The outcomes evaluated included subjective measures (Disabilities of the Arm, Shoulder and Hand score; Patient-Rated Wrist Evaluation score; Mayo Wrist Score; and visual analog scale) and objective outcomes (complication rate and radiological parameters).

Results: We included seven articles from 2017 to 2022. These studies reported a total of 542 fractures, predominantly in women, with a mean age of over 50 years. Both short and long arm casts demonstrated similar functional and radiological outcomes. A longer immobilization period (>3 weeks) should be considered to prevent re-displacement.

Conclusion: In stable fractures treated conservatively, the use of both short and long arm casts resulted in comparable functional outcomes in older patients. Immobilization for at least 3 weeks is recommended, as it provided similar clinical and radiological outcomes compared to longer periods of immobilization (level of evidence: 2A).

Objectives: Accurately targeting distal nail holes and placing distal interlocking screws pose challenges during intramedullary nailing. This study proposes a straightforward technique for distal locking screw insertion using a Steinmann pin, eliminating the need to reposition the pin or drill bit.

Methods: We utilized 18 Sawbones femur models and intramedullary femur nails. A first-year resident created two distal locking holes on each model, employing both the conventional freehand technique and a novel method involving a Steinmann pin and hammer under image intensification. These techniques were evaluated based on three parameters: (1) the time required to create distal locking holes, measured from the moment the pin was positioned at the center of the hole until the far cortex was drilled through the interlocking hole; (2) the radiation dose (in mrem/h), as estimated with a personal gamma radiation dosimeter; and (3) the number of failures, defined as the creation of more than one hole in the near and far cortex.

Results: The new technique was associated with a lower radiation dose (P=0.0268) and fewer failures (P=0.0367) than the conventional approach. Additionally, the time required to establish distal holes was shorter using the new technique compared to the conventional method (P=0.0217).

Conclusion: The creation of distal interlocking holes with a Steinmann pin and hammer is accurate, efficient, and cost-effective.

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• Unresolved policy on the new placement of 2,000 entrants at Korean medical schools and this issue of Ewha Medical Journal
  Sun Huh
  The Ewha Medical Journal.2024;[Epub]     CrossRef

An 84-year-old woman visited our pain clinic with complaints of low back pain and severe radiating pain in the right lower extremity during walking. The patient demonstrated subacute compression fracture of L3 with vacuum change in lumbar spine plain radiographs and MRI which suggest Kummell’s disease. Despite our conservative treatments, she had little back pain relief. Therefore, we planned a percutaneous vertebroplasty. Manual compression could help perform percutaneous vertebroplasty more effectively by expanding the vertebral body. In addition, the spontaneous recovery of vacuum cleft width using negative pressure could help perform the technique more effectively. We successfully performed percutaneous vertebroplasty using these combination therapies for our patient.

While odontoid fractures are common injuries, disagreement exists regarding treatment. Because of the high risk of nonunion in type II odontoid fractures, surgical fusion should be considered in the initial treatment of odontoid fractures, surgical fusion should be considered in the initial treatment of odontoid fractures.

Surgical fusion of odontoid fractures has usually been carried out by posterior C1-2 arthrodesis rather than fracture fixation. The former approach has been associated with significant mortality and morbidity. In addition, it results in a decreased range of motion, particularly lateral rotation and requires postoperative external immobilization. Recently several authors aors have advocated anterior scrow fixation of the fracture as an alternative to posterior cervical fusion.

This paper presents a descuddion of different fusion methods and a limmited experience of screw fixation method.

Direct anterior odentoid screw fixation can be used for the successful treatment of selected odontoid fractures and nonunions.

It has been known that the hemiarthroplasty of the hip with bipolar prosthesis is the one of primary treatment methods for management of unstable intertrochanteric hip fracture, especially in severe osteoprotic patients. Additionally this operative treatment allows early full weight bearing and has many merits for the patient to return to the preinjury functional level. But we think that this operative method has several considerable points for the more effective treatment technique in unstable osteoporotic intertrochanteric fractures. We review the nine interochanteric comminuted fractture patients treated with bipolar prostheses at the Department of Orthopedie Surgery of Ewha Womans University Mok-Dong Hospital from September, 1993 to June, 1994. The considered points are as follows:

1) The difficult problem is to judge the intraoperative head-neck length. which is reduced by the tension of the fascia between gluteus medius and vastus lateralis fascia, preoperative measuring the head-neck length with transparent template, level of the tip of greater trochanter and prosthetic femoral head, and range of motion of hip of greater trochanter and prosthetic femoral head, and range of motion of hip joint under the tr1al reduction.

2) The operative approach is the other considerable point for the exposure of medial cortical buttress and lesser trochanter in reducing and maintaining principal fragments, and for the accurate anteversion angle of femur.

3) Bipolar hemiathroplasty technique is not effective in reducing the operative time and the blood loss amount in operative field, wspecially in comminuted interochanteric fracture treatment.

The olecranon fracture is intra-articular fracture anatomically. So the fracture should be reduced completely. We experienced 46 cases of olecranon fracture from January. 1985 to December. 1989.

The results were as follows ;

1) The fracture was more in adult than child.

2) The most common cause was fall down from height.

3) The undisplaced type I fractures were treated with conservative management. the results were satisfactory.

4) The displaced fractures should he treated with operative method for stability of elbow and prevention of limitation of motion.

5) The tension band wiring technique was not difficult and widely used method in treatment of displaced fracture. The most common complication was protrusion of K-wire, but careful technique would prevent the complication.

Experience with the use of the surgibone graft in anterior cervical interbody fusion employing the Cloward technique in 15 cases of the fracture-dislocation is reported.

The surgibone, manufactured from the bone of young calves, is heterogenous material that consists only of fibrils and crystallites.

With use of surgibone, iliac osteotomy is unnecessary, and this procedure is no problem of donor site pain and infection which can be possible in interbody fusion with iliac bone and rib graft and the aims of the operations are achieved, namely removal of the disc, fixation of the spine to prevent compression of the neurak tissues and stability of the spine.

The operative procedure is simplified and the time required for the operation is diminished, comparing to autogenous bone graft.

The aid of treatment in patellar fracture is the restoration of knee joint function and quadriceps muscle power. In this series, we experienced 37 cases of patellar fractures from March 1981 to March 1987 which were treated with operative care and followed-up at least 2 years at Department of the Orthopedic Surgery, College of Medicine, Ewha Womans University.

The results were as follow :

1) Most fractures were encountered in man from twenties to thirties.

2) The traffic accident was the most prevalent cause(17 cases, 47%) and 24 cases(65%) of fracture were induced by direct injury.

3) The most frequent configration of fractures was comminuted.

4) Among the operative methods, the result of the tension band wiring was superior to other operative methods, but not significantly.

5) The long-term result of patellar fracture with operative management following trauma may be directly related to this initial damage, involvement of articular surface, duration of immobilization and operative method.

The tibial condylar fractures involving the articular surface can produce disability of knee joint bacause of its incongrousity and accompanied soft tissue injuries such as ligaments & menisci.

Accurate anatomical reduction and rigid internal fixation followed by early motion is known to get a best result and minimize the complications.

The author analyzed the 57 cases of the tibial condylar fractures treated at the Department of Orthopaedic Surgery, Ewha Womans Medical College and following results were obtained.

1) The highest incidence was in 4th decade(28%) and the most frequent cause was traffic accident (74%).

2) The most common fracture site was lateral condyle(77%).

3) The most common type of fracture was total condylar depression(25%). and next common type was split compression(13%) by hohl & Luck classification.

4) According to Porter's criteria, the satisfactory result was obtained in 31 cases(77%) out of 40 by the operated treatment and above all satisfactory result was 47 cases(83%) out of 57.

5) The most important factor in the end result was the accurate anatomical reduction, rigid fixation and the early joint motion.

Clinical studies have indicated that the non-operative treatment is the best method for clavicle fracture and the operative treatment may contribute to the development of non-union. But some clavicle fractures may be difficult to treat only by non-operative method.

From March, 1980 to May, 1989, 42 patients with clavicle fractures were treated by open reduction and internal fixation with threaded steinmann pin and plate & screws at Department of Orthopaedic Surgery of Ewha Womans University Hospital.

The results were as follows;

1) The avarage duration of union of fracture was 6.7 weeks.

2) By open reduction & internal fixation, gross deformity such as large bone hypertrophy, joint stiffness and shortening was minimized.

3) The plate & screws fixation is more satisfactory result than threaded steinmann pin fixation.

The intramedullary nailing of long bone fractures, particularly, fractures of the shaft of femur in adults, is a satisfactory technique as it fulfills the objectives of fracture management. Malunion is, however, a significant problem with intramedullary nailing of the Kuntscher type, the major problem is malrotation which occurs either at the time of the operation or as a result of rotatory instability. Another from of malunion that occurs is shortening of the fracture site especially in the presence of comminution. Klemm & Schellmann(1972), and King(1980) has shown, however, by using interlocking cross-pinning technique that stable fixation can be achieved with no significant shortening and this development has extended the indications of intramedullary nailing. Four cases of femoral shaft fractures were treated by interlocking intramedullary nailing and good results were obtained at Ewha Womans University Hospital, Department of Orthopedic Surgery, Since February, 1985.

The authors experienced three cases of posterior hip dislocations associated with femoral head fractures which are very rare condition. One of them was treated with closed method and the others were treated with surgical method. The result of treatment in three cases was good.

From march 1980 to August 1983, fourteen patients with fractures of the clavicle were treated by open reduction and internal fixation with threaded steinman pin at department of orthopadic surgery of Ehwa university hospital. The results were as followings; 1) Average duration of union of the fractures was 8.9 weeks. 2) Non-union was occured in one case, which was united by autogenous bone graft. 3) By open reduction and internal fixation, abnormal external appearance, such as bony protrusion and shortening was not noted and with early motion of the shoulder joint, disturbance of the joint function was minimized. 4) Open reduction and internal fixation in fractures of the clavicle was recommended in severe comminuted fracture, clinical non-union and heavy worker.

Fractures of the distal third of the femur proved to be very difficult to treat regardless of selection of treatment method whether surgical or nonsurgical. There are too many difficulties in both accurate reduction with traction and subsquent maintenance of reduction with cast when nonsurgical methods were used, as compared with the problems encountered with accurate internal fixation. Also, there are too many complications when nonoperative methods were used. Recent development of more efficient metallic devices for internal fixation and cast brace, and traction methods will improve the results of the treatments. Forty one cases of supracondylar, intercondylar, and condylar fractures of the femur, which were treated at the department of orthopaedic surgery, college of medicne, Ewha Womans Univeristy during the period from March 1970 to December 1982 has been analysed clinically, and following results were obtained:1) Among 41 cases, 27 cases(65.9%) were male. The most common cause was traffic accident with 25 cases(61.0%) and next was slipping with 7 cases(17.1%). 2) By the Neer's classification, intercondylar fractures of the femur were observed in 27 cases(65.9%), and the most commcn was type III with 11 cases. 3) By the evaluation of Schatzker and Lambert, the results of treatment were satisfactory in 72.7% of the patient with operative method, and only in 37.5% of the patient with conservative method. 4) The results, in the cases of inadequate initial management, severe comminuted supracondylar and intercondylar fractures of the femur, open fractures, prolonged immobilization of the knee joint for 13 weeks, and delayed operative internal fixation of more than 4 weeks were usually fair to good. 5) The results, in the cases of mobilization of the knee joint at 6 weeks from injuries and at 1 week from operative internal fixation were usually excellent to good. 6) Author's methods which consist of making the Z-incision of tensor fascia lata for wide exposure of the operative field, using bone hooks, and temporary fixation by two K-wires were satisfactory for easy reduction of the distal fragment-

The ankle, which at times bears up to five times the body weights, is the most congruous joint of lower extremity, but its complex articulations are as not yet understood completely. The injuries to the ankle joint include not only injuries that cause distruption of the bony architecture of ankle but often injuries of significant syndesmotic ligamentous. One hundred and sixty two cases of ankle fractures in adult which were treated at the Department of Orthopedic Surgery, College of Medicine, Ewha Womans University, during the period from March, 1982, were analysed clinically and the following results were obtained ; 1) In 162 cases of ankle fractures, 122 cases(77.2%) were male, and the most common cause was traffic accident. The most common type, according to the Lauge-Hansen's classification, was pronation-external rotation with 58 cases(35.8%). 2) According to the Colton's criteria, the result of treatment with open reduction and internal fixation was not comparable to that with closed reduction. 3) Good functional result in ankle fracture and associated ligamentous injuries were depend on three factors such as, anatomic restoration of articular surface, early range of motion, and early weight bearing. 4) For the satisfactory function of the mortise, the fibular must be restored to normal length, correctly positioned in the groove of the tibia, and effectivey anchored to the tibia through the syndesmosis.

The sequelae of unstable fracture of the cervical spine were tragic. The first objective of treatment is protection of the spinalcord during reduction and stabulization. Since 1933, skeletal traction which was introduced by Crutchfield and modified by Vinke, Barton and others, has been used for reduction of fracture-dislocation of the cervical spine. 4 cases of fracture and dislocation of the cervical spine were treated at this department. 2 cases of them, one was quadriplegic and the other revealed nerve root irritation sign, were performed posterior spine fusion and recovered. The third who had fracture-dislocation between C5 and C6 with ankylosing spondylitis was died in the early course. The 4th who hadfracture-dislocation between C5 and C6 with transsection of the spinal cord was also died at home 7 weeks after trauma.

To dilrectly coimpare the rigid and flexible jlltrarnedullary nails for the treatment of tibialfractiires, we restrospectively reviewed the clinical result of 108 tibial fractures treated at theEwha Womans University Hospital between January 1987 to June 1993. Twenty-one cases werebelonged to the flexible nail(FN) group, while 87 fractures were included to the rigid(non-locking or interlocking) nail(RN) group.

Average period between the injury and fracture union was overall 17.5 weeks(range, 11-67)and it was much shorter in the RN group(15.2 weeks) than the FN group(29.0). Complicationsduring and after treatment in terms of malunion as well as delayed or non-union, were alsomore common in the FN group. However. deep wound infecctions were only found after rigidnailing.

In conclusion, in view of the fracture union time and comptication rate, rigid nailing showedbetter results than the flexible one. But the flexible nails had several inherent advantages especially ill the technical aspects of their use.