Frequency of Multiple Consecutive Rib Fractures After Blunt Chest Trauma

Ah, Kyung,Kim, Young Joo,Shinn, Kyung Sub,Park, Seog Hee,Son, Young Bo,Kim, Sung Hoon THE CATHOLIC UNIVERSITY OF KOREA 1997 Bulletin of The Catholic Research Institutes of Me Vol.25 No.-

Rib fractures often are not seen on initial radiographs. This study was undertaken to determine the frequency of the multiple consecutive rib fractures after blunt chest trauma. We retrospectively reviewed all the radiographs and medical charts of 87 patients with rib fractures after blunt chest trauma. Rib fractures were divided into single and multiple. The multiple rib fractures were subclassified as consecutive, interrupted continuous, or random. Thirteen cases of single and 83 cases of multiple rib fractures were present. Among the 83 cases of multiple factures, there were 73 cases(88%) of consecutive fractures, 5 cases(6%) of interrupted continuous fractures and 5 cases(6%) of random fractures. Among the multiple rib fractures consecutive rib fractures are much more common than noncontiguous rib fractures. We recommend that if one find an apparently nonfractured rib between contiguously fractured upper and lower ribs, one should meticulously search for possible fracture of an apparently normal rib with high-index of suspicion.

Prevalence of Diplopia and Extraocular Movement Limitation according to the Location of Isolated Pure Blowout Fractures

Min Seok Park,Young Joon Kim,김훈,Sang Hyun Nam,최영웅 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.3

Background Isolated pure blowout fractures are clinically important because they are the main cause of serious complications such as diplopia and limitation of extraocular movement. Many reports have described the incidence of blowout fractures associated with diplopia and limitation of extraocular movement; however, no studies have statistically analyzed this relationship. The purpose of this study was to demonstrate the correlation between the location of isolated pure blowout fractures and orbital symptoms such as diplopia and limitation of extraocular movement. /Methods We enrolled a total of 354 patients who had been diagnosed with isolated pure blowout fractures, based on computed tomography, from June 2008 to November 2011. Medical records were reviewed, and the prevalence of extraocular movement limitations and diplopia were determined. /Results There were 14 patients with extraocular movement limitation and 58 patients complained of diplopia. Extraocular movement limitation was associated with the following findings, in decreasing order of frequency: floor fracture (7.1%), extended fracture (3.6%),and medial wall (1.7%). However, there was no significant difference among the types of fractures (P=0.60). Diplopia was more commonly associated with floor fractures (21.4%)and extended type fractures (23.6%) than medial wall fractures (10.4%). The difference was statistically significant (Bonferroni-corrected chi-squared test P<0.016). /Conclusions Data indicate that extended type fractures and orbital floor fractures tend to cause diplopia more commonly than medial wall fractures. However, extraocular movement limitation was not found to be dependent on the location of the orbital wall fracture.

Are Intertrochanteric Fractures Evolving? Trends in the Elderly Population over a 10-Year Period

Jegathesan T,Ernest Beng Kee Kwek 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.1

Background: Intramedullary devices for the fixation of intertrochanteric fractures are increasing in usage and popularity. This reflects either a shift in adoption of new technology or intertrochanteric fractures becoming more complex or unstable. This trend was observed in our institution, hence we set out to investigate if this was concordant with an associated change in the demographics of the patients or in the morphology of the intertrochanteric fracture pattern over a 10-year period. Methods: This is a retrospective cross-sectional comparison undertaken for the first 100 consecutive elderly patients with intertrochanteric fractures admitted to our tertiary institution over 3 yearly intervals, in each of the years 2004, 2007, 2010, and 2013. Fractures were radiologically classified via the Evans and AO classifications. Patient demographics such as age, ethnicity, and comorbidities and surgical data including time, type of fixation, time to surgery, and length of stay were collected via case note reviews to identify possible trends. Results: The overall mean age was 80.5 years, with no statistically significant trend among age, sex, ethnicity, and comorbidities over the 10-year period. The main finding was a rise in the proportion of unstable intertrochanteric fractures. The proportion of such fractures was 30% in 2004, 42% in 2007, 47% in 2010, and 62% in 2013 (p < 0.001). Patients admitted for intertrochanteric fractures also experienced a shorter hospital length of stay and an increasing trend towards early fracture fixation (p < 0.001), with a greater usage of intramedullary nails in the treatment of such fractures (p < 0.001). Conclusions: Intertrochanteric fractures in elderly patients have evolved into more complex fractures over the past ten years, despite there being no change in the age of the patients over the same duration. This increasing proportion of unstable intertrochanteric fractures has brought about a greater tendency to fix these fractures with intramedullary implants.

견갑부 골절의 치료

이한구 ( Han Koo Lee ),이상훈 ( Sang Hoon Lee ),정필현 ( Phil Hyun Chung ),유석주 ( Suk Joo Lyu ),박민종 ( Min Jong Park ) 대한외상학회 1989 大韓外傷學會誌 Vol.2 No.1

Sixty-two patients with fractures of the shoulder (22 clavicular fractures, 36 proximal humeral fractures and 4 scapular fractures) were treated at Department of Orthopedic Surgery, College of Medicine, Seoul National University between January, 1978 and October 1988. They were followed up between six months and three and half years with the aver-age of 1.2 years. Mean ages were 34.8 years in clavicular fractures, 52.9 years in proximal humeral fractures and 37.6 years in scapular fractures. Traffic accident was the most common cause of injury in all the shoulder fractures. In clavicular fractures, twelve were middle third and ten were lateral third fractures (four type I and six type II). Proximal humeral fractures were classified according to Neer``s classification, there were seven one-part(20%), seventeen two-part(41%), eight three-part(22%) and four four-part(11%) fractures or fracture-dislocations. In scapular fractures, there were two body fractures, one neck and one complex fractures involving the glenoid. Treatment and its results were as follows; 1. In clavicular fractures, middle third fractures were treated conservatively except two, which was unable to manually reduced. Type I lateral fractures were treated by closed method and type II by open method. 2. Complications of clavicular fractures were one nonunion, two malunion, one delayed union and one stiff joint in middle third fractures, and one broken pin, one loss of fix-ation in type II lateral third fractures. 3. In proximal humeral fractures, one-part and two-part fractures were treated conserva-tively except two old two-part fracture-dislocations. Three-part fractures were treated by open method except two with closed method and four-part fractures by two open method and two prosthesis. 4. Clinically, thirty-two(89%) proximal humeral fractures showed excellent or satisfac-tory tory results. 5. In scapular fractures, one glenoid fracture were treated by open method and others conservatively. All showed satisfactory union of fractures.

비중격 성형술을 동반한 비골절 치료의 임상적 고찰

성일용(Iel-Yong Sung),조영철(Yeong-Cheol Cho),변기정(Gi-Jeong Byun) 대한구강악안면외과학회 2007 대한구강악안면외과학회지 Vol.33 No.5

Nasal fractures are the most common type of facial fractures. Nowdays computed tomography is found to be very helpful in diagnosing nasal fracture, especially in findings the nasal septal fractures. From August 2004 to July 2005, 36 cases of nasal fracture were admited and reviewed to oral and maxillofacial surgery of Ulsan University Hospital, not including other facial bone fracture. Out of 223 cases of facial bone fractures, we treated 47 cases of nasal fractures. We reviewed and examined the 36 patients of nasal fractures 2months postoperative. The results were 28cases of male and 8cases of female. The highest age frequency was in the fourth decades group. The most frequent causes of injury were falling down and fist trauma. The 25(69%) patients were found to have septal fractures, after computed tomography findings. The treatment methods of nasal fracture were closed reduction(13cases), open reduction(20cases), ORIF(1case), non operation(2cases). Complications of nasal deformity were found in 2patients. Septoplasty was performed on 21 patients. Septal fractures in combination with nasal fracture are usually unrecognized and untreated at the time of injury, usually ended in nasal deformities. It is important to find out the exact type of nasal fractures. We will report the results of treatment of nasal fractures with a literature review.

Prevalence of Diplopia and Extraocular Movement Limitation according to the Location of Isolated Pure Blowout Fractures

Park, Min-Seok,Kim, Young-Joon,Kim, Hoon,Nam, Sang-Hyun,Choi, Young-Woong Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.3

Background : Isolated pure blowout fractures are clinically important because they are the main cause of serious complications such as diplopia and limitation of extraocular movement. Many reports have described the incidence of blowout fractures associated with diplopia and limitation of extraocular movement; however, no studies have statistically analyzed this relationship. The purpose of this study was to demonstrate the correlation between the location of isolated pure blowout fractures and orbital symptoms such as diplopia and limitation of extraocular movement. Methods : We enrolled a total of 354 patients who had been diagnosed with isolated pure blowout fractures, based on computed tomography, from June 2008 to November 2011. Medical records were reviewed, and the prevalence of extraocular movement limitations and diplopia were determined. Results : There were 14 patients with extraocular movement limitation and 58 patients complained of diplopia. Extraocular movement limitation was associated with the following findings, in decreasing order of frequency: floor fracture (7.1%), extended fracture (3.6%), and medial wall (1.7%). However, there was no significant difference among the types of fractures (P=0.60). Diplopia was more commonly associated with floor fractures (21.4%) and extended type fractures (23.6%) than medial wall fractures (10.4%). The difference was statistically significant (Bonferroni-corrected chi-squared test P<0.016). Conclusions : Data indicate that extended type fractures and orbital floor fractures tend to cause diplopia more commonly than medial wall fractures. However, extraocular movement limitation was not found to be dependent on the location of the orbital wall fracture.

Sensory change and recovery of infraorbital area after zygomaticomaxillary and orbital floor fractures

Sang Woo Han,Jeong Ho Kim,Sug Won Kim,Sung Hwa Kim,Dae Ryong Kang,Jiye Kim 대한두개안면성형외과학회 2022 Archives of Craniofacial Surgery Vol.23 No.6

Background: To compare the sensory change and recovery of infraorbital area associated with zygomaticomaxillary and orbital floor fractures and their recoveries and investigate the factors that affect them. Methods: We retrospectively reviewed 652 patients diagnosed with zygomaticomaxillary (n= 430) or orbital floor (n= 222) fractures in a single center between January 2016 and January 2021. Patient data, including age, sex, medical history, injury mechanism, Knight and North classification (in zygomaticomaxillary fracture cases), injury indication for surgery (in orbital floor cases), combined injury, sensory change, and recovery period, were reviewed. The chi-square test was used for statistical analysis. Results: Orbital floor fractures occurred more frequently in younger patients than zygomaticomaxillary fractures (p< 0.001). High-energy injuries were more likely to be associated with zygomaticomaxillary fractures (p< 0.001), whereas low-energy injuries were more likely to be associated with orbital floor fractures (p< 0.001). The sensory changes associated with orbital floor and zygomaticomaxillary fractures were not significantly different (p= 0.773). Sensory recovery was more rapid and better after orbital floor than after zygomaticomaxillary fractures; however, the difference was not significantly different. Additionally, the low-energy group showed a higher incidence of sensory changes than the high-energy group, but the difference was not statistically significant (p= 0.512). Permanent sensory changes were more frequent in the high-energy group, the difference was statistically significant (p= 0.043). Conclusion: The study found no significant difference in the incidence of sensory changes associated with orbital floor and zygomaticomaxillary fractures. In case of orbital floor fractures and high-energy injuries, the risk of permanent sensory impairment should be considered.

The Frequency of Occult Intertrochanteric Fractures among Individuals with Isolated Greater Trochanteric Fractures

( Jongho Noh ),( Kee Haeng Lee ),( Sehoon Jung ),( Sunwook Hwang ) 대한고관절학회 2019 Hip and Pelvis Vol.31 No.1

Purpose: Isolated greater trochanteric (GT) fractures are often identified using plain radiography of patients with post-traumatic hip pain. In many cases, the fracture extends to form an occult intertrochanteric fracture. We conducted a study to determine the frequency of occult intertrochanteric fractures in patients diagnosed with isolated GT fractures using plain radiographs. Materials and Methods: Among 3,017 individuals who visited our emergency department with a trauma-induced pertrochanteric femur fracture between July 2004 and March 2018, 100 patients diagnosed with isolated GT fractures using plain radiographs were retrospectively analyzed. Patients were divided into two groups, those with: i) isolated GT fractures (group A) and ii) occult intertrochanteric fractures (group B). In addition, plain radiographs, magnetic resonance imaging results, and treatment methods were further analyzed in each group. If surgery treatment was needed, it was performed by one surgeon, and in all cases, a 2-hole dynamic hip screw was used. Results: Among the 100 cases of isolated GT fractures diagnosed using plain radiograph, additional examinations revealed that 10 (10.0%) were suffering from isolated GT fractures alone, while the remaining 90 (90.0%) were further diagnosed with occult intertrochanteric fracture. Gender, age, mechanism of injury, and bone mineral density did not correlate with fracture type. Conclusion: In our analysis, 90% of injuries initially diagnosed as isolated GT fractures were found to extend into occult intertrochanteric fractures upon further examination with additional imaging modalities. Therefore, additional evaluation should be performed to test for the potential presence of occult intertrochanteric fractures and to establish appropriate treatment plans.

Osteoporotic Fractures of the Spine, Hip, and Other Locations after Adjuvant Endocrine Therapy with Aromatase Inhibitors in Breast Cancer Patients: a Meta-analysis

이영균,이은경,김하영,이유진,이승미,서동철,유준일,이시연 대한의학회 2020 Journal of Korean medical science Vol.35 No.46

Background: Aromatase inhibitors (AIs) play an important role in the endocrine therapy of postmenopausal breast cancer patients, with a recent tendency to extend the duration of their use. However, AIs may increase the risk of osteoporotic bone fractures. This meta-analysis evaluated the risk of osteoporotic fractures of the hip, spine, and other locations in breast cancer patients using AIs. Methods: We performed a systematic search to identify randomized controlled clinical trials that investigated osteoporotic fractures in breast cancer patients on AI therapy. The main outcomes were the incidence and risk of osteoporotic fractures in general and of hip, vertebral, and non-vertebral fractures in AI users and controls. Results: The systematic review found a total of 30 randomized controlled trials including 117,974 participants. The meta-analysis showed a higher incidence of osteoporotic fracture in AI users: The crude risk ratio for all osteoporotic fractures was 1.35 (95% confidence interval [CI], 1.29–1.42; P < 0.001), for hip fractures 1.18 (95% CI, 1.02–1.35; P < 0.001), for vertebral fractures 1.84 (95% CI, 1.36–2.49; P < 0.001), and for non-vertebral fractures 1.18 (95% CI, 1.02–1.35; P < 0.001), respectively, compared to the controls. Conclusion: Our meta-analysis suggested an increased risk of osteoporotic fractures for AI therapy in patients with breast cancer that was most expressed for vertebral fractures. Breast cancer patients on AIs need to be monitored for osteoporosis and osteoporotic fractures, and active prevention measures should be implemented.

The Frequency of Occult Intertrochanteric Fractures among Individuals with Isolated Greater Trochanteric Fractures

노정호,이기행,정세훈,황선욱 대한고관절학회 2019 Hip and Pelvis Vol.31 No.1

Purpose: Isolated greater trochanteric (GT) fractures are often identified using plain radiography of patients with post-traumatic hip pain. In many cases, the fracture extends to form an occult intertrochanteric fracture. We conducted a study to determine the frequency of occult intertrochanteric fractures in patients diagnosed with isolated GT fractures using plain radiographs. Materials and Methods: Among 3,017 individuals who visited our emergency department with a trauma-induced pertrochanteric femur fracture between July 2004 and March 2018, 100 patients diagnosed with isolated GT fractures using plain radiographs were retrospectively analyzed. Patients were divided into two groups, those with: i) isolated GT fractures (group A) and ii) occult intertrochanteric fractures (group B). In addition, plain radiographs, magnetic resonance imaging results, and treatment methods were further analyzed in each group. If surgery treatment was needed, it was performed by one surgeon, and in all cases, a 2-hole dynamic hip screw was used. Results: Among the 100 cases of isolated GT fractures diagnosed using plain radiograph, additional examinations revealed that 10 (10.0%) were suffering from isolated GT fractures alone, while the remaining 90 (90.0%) were further diagnosed with occult intertrochanteric fracture. Gender, age, mechanism of injury, and bone mineral density did not correlate with fracture type. Conclusion: In our analysis, 90% of injuries initially diagnosed as isolated GT fractures were found to extend into occult intertrochanteric fractures upon further examination with additional imaging modalities. Therefore, additional evaluation should be performed to test for the potential presence of occult intertrochanteric fractures and to establish appropriate treatment plans.