Effect of Preoperative Bisphosphonate Treatment on Fracture Healing after Internal Fixation Treatment of Intertrochanteric Femoral Fractures

( Eic Ju Lim ),( Jung-taek Kim ),( Chul-ho Kim ),( Ji Wan Kim ),( Jae Suk Chang ),( Pil Whan Yoon ) 대한고관절학회 2019 Hip and Pelvis Vol.31 No.2

Purpose: There are concerns that administration of bisphosphonate (BP) can substantially suppress bone turnover, potentially interfering with fracture healing. We investigated the effects of preoperative BP administration before internal fixation of intertrochanteric femoral fractures using fracture healing and clinical outcomes. Materials and Methods: We retrospectively analyzed data from 130 patients who underwent internal fixation for osteoporotic intertrochanteric femoral fractures between March 2012 and July 2016. Patients previously treated with BPs for at least 3 months (BP group; n=29) were compared with the remaining patients (BP-naïve group; n=101). Radiographs were used to assess and compare fracture healing 3 months and 1 year postsurgery. The primary clinical outcome measure assessed was change in Koval score. Results: Fracture union at 3 months after surgery was verified in 72.4% of patients (21/29) in the BP group and 90.1% of patients (91/101) in the BP-naïve group (P=0.027). Fracture union at 1 year postsurgery (BP group, 93.1% [27/29] vs. BP-naïve group, 97.0% [98/101], P=0.310) and change in Koval score (1.1 vs. 1.0, P=0.694) were not significantly different between the groups. Multivariable logistic regression analysis revealed that a history of BP administration was associated with an increased risk of delayed union at 3 months postsurgery (P=0.014). Conclusion: Preoperative administration of BP was associated with a decreased fracture healing rate 3 months after internal fixation, compared with BP-naïve patients. Therefore, patients previously treated with a BP should be carefully allowed to wean off walking aids and transition to full weight-bearing in the early postoperative period.

Hemorrhagic Shock in a Patient with a Morel-Lavallée Lesion Combined with Active Arterial Bleeding without Fracture

( Eic Ju Lim ),( Jong-keon Oh ),( Jae-woo Cho ),( Seungyeob Sakong ),( Jun-min Cho ) 대한외상학회 2021 大韓外傷學會誌 Vol.34 No.1

A Morel-Lavallée lesion is a closed degloving injury caused by traumatic separation of the skin and subcutaneous tissue from the underlying fascia. However, since physicians tend to focus on treating the bone fracture, hemodynamic instability accompanying a Morel-Lavallée lesion can sometimes be overlooked. We report the case of a hemodynamically unstable 73-year-old man who had a Morel-Lavallée lesion of the thigh, but no femur fracture. Angiography showed active bleeding from the muscular branch of the right deep femoral artery, which was then successfully embolized.

The Effects of a Trauma Team Approach on the Management of Open Extremity Fractures in Polytrauma Patients: A Retrospective Comparative Study

( Seungyeob Sakong ),( Eic Ju Lim ),( Jun-min Cho ),( Nak-jun Choi ),( Jae-woo Cho ),( Jong-keon Oh ) 대한외상학회 2021 大韓外傷學會誌 Vol.34 No.2

Purpose: Open extremity fractures require prompt antibiotic medication and initial debridement surgery to reduce the infection rate and restore functional stabilization. We aimed to report the effects and positive outcomes of a trauma team approach on the management of open extremity fractures in polytrauma patients. Methods: This retrospective review included all polytrauma patients with open extremity fractures admitted between March 2009 and December 2019. Patients were divided into two groups according to whether they were treated before or after the implementation of the trauma team approach (March 2014). We analyzed the outcomes in each group with respect to the time interval until the doctor’s arrival, total length of stay in the emergency department, the time interval until initial antibiotic treatment and operation, whether the initial operation was performed within 24 hours, and the rate of deep infections. Results: A total of 123 patients met the inclusion criteria. There were no statistically significant differences in demographic characteristics. The time interval until the doctor’s arrival (64.12±49.2 minutes vs. 19.82±15.23 minutes; p=0.035) and initial antibiotic treatment (115.47±72.12 minutes vs. 48.78±30.12 minutes; p=0.023) significantly improved after implementing the trauma team approach. The union rate was not significantly different. However, the time interval until initial debridement, opportunity for initial debridement within 24 hours, and the rate of deep infections demonstrated better results. Conclusions: The reduced time interval until initial antibiotic treatment and debridement could be attributed to the positive effect of the trauma team approach on the management of open extremity fractures in polytrauma patients.

Delayed bladder perforation due to screw loosening after pelvic ring injury surgery: a case report

( Hyun-chul Shon ),( Ho-won Kang ),( Eic-ju Lim ),( Jae-young Yang ) 대한외상학회 2022 大韓外傷學會誌 Vol.35 No.1

Pelvic ring injuries have high mortality and morbidity rates, and they are difficult to treat because accompanying injuries to the pelvic organs, genitourinary organs, and neurovascular tissues are common. Genitourinary injuries are common comorbid injuries that have been reported to occur in 5% to 6% of all pelvic ring injuries. However, these injuries usually occur simultaneously with the pelvic ring injury, whereas relatively little research has dealt with genitourinary injuries that occur after treatment of a pelvic ring injury. To the best of our knowledge, only three cases of delayed bladder perforation due to screw loosening after symphyseal plate fixation in anterior pelvic ring injury have been reported worldwide, and no such cases have yet been reported in Korea. Since the authors experienced this very rare complication after pelvic ring surgery, we report this case along with a literature review.

불안정성 전자간부 골절의 활강 압박 고 나사 수술적 고정술에 있어 베타 3칼슘 인산염 이식의 역할

김철호 ( Chul Ho Kim ),김지완 ( Ji Wan Kim ),임익주 ( Eic Ju Lim ),장재석 ( Jae Suk Chang ) 대한골절학회 2016 대한골절학회지 Vol.29 No.4

목 적: 본 연구는 불안정성 대퇴 전자간 골절의 수술적 치료인 금속 활강 압박 고 나사 고정법에서 대퇴 대전자부와 소전자 부위 간 해면골 결손부에 베타 3칼슘 인산염(β-tricalcium phosphate, β-TCP) 과립을 이식하는 방법을 소개하고 그 임상 결과를 비교하고자 한다. 대상 및 방법: 2002년 3월부터 2016년 1월까지 불안정 대퇴 전자간 골절로 수술을 시행받은 환자를 대상으로 후향적 연구를 진행하였다. 60세 이상, 저 에너지성 골절, AO 골절 분류상 31-A2.2, A2.3인 환자와 3개월 이상 추시가 가능하였던 환자를 대상으로 하였다. 통상적인 술기로 압박 고 나사를 이용하여 전자간 골절을 치료한 군과 β-TCP 과립을 이식하여 치료를 시행한환자군 중 성별과 나이로 짝지은 각각 29예 간의 골유합률, 유합기간, 압박 고 나사의 활강 정도를 비교하였다. 결 과: 모든 예에서 골유합 진행의 증거가 관찰되었고, 소요된 기간은 β-TCP를 이식한 군에서는 평균 7.0주, 이식하지 않은 군에서는 8.8주였다. 지연나사의 활강은 각각 평균 3.6 mm, 5.5 mm로 측정되었으며, 모든 환자에서 고정 실패는 발생하지않았다. 결 론: 불안정성 전자간부 골절의 활강 압박 고 나사 수술적 고정술에 있어 β-TCP 이식은 만족할 만한 임상 결과를 얻었다. Purpose: The purpose of this study was to introduce our method of stabilizing unstable intertrochanteric fractures by using the dynamic hip screw (DHS) with a beta-tricalcium phosphate (β-TCP) graft and to compare the outcomes of this procedure with those of the conventional DHS without β-TCP. Materials and Methods: Patients who underwent surgery by using DHS between March 2002 and January 2016 were retrospectively reviewed for analysis of the outcomes. The inclusion criteria were: 1) age of 60 years and older; 2) low-energy fracture resulting from a fall from no greater than the standing height; 3) multifragmentary pertrochanteric fracture (AO classification 31-A2.2, 2.3); and 4) follow-up of over 3 months. We compared 29 patients (29 hips) who underwent surgery, using DHS without β-TCP, with 29 age-sex matched patients (29 hips) who underwent surgery using DHS with grafted β-TCP granules to empty the trochanter area after reaming. We investigated the fracture union rate, union time, and length of lag screw sliding. Results: Bone union was achieved in all cases. The mean union time was 7.0 weeks in the β TCP group and 8 .8 weeks in the non-β-TCP group. The length of lag screw sliding was 3.6 mm in the β-TCP group and 5 .5 mm in the non-β-TCP group. There were no implant failure cases in both groups. Conclusion: The β-TCP graft for reinforcement DHS acquired satisfactory clinical outcomes for treating unstable intertrochanteric fractures.