Factors Related to Failure of Conservative Treatment in Volar Plate Avulsion Fractures of the Proximal Interphalangeal Joint

Sanglim Lee,Seung Jin Jang,Suk Ha Jeon 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.3

Background: Volar plate avulsion fractures of the proximal interphalangeal (PIP) joint are a common hand injury and have been treated conservatively with favorable results. We assumed that conservative treatment of volar plate avulsion fractures of the PIP joint would be unsuccessful if the fracture fragment, even if small, was much displaced or rotated and that delayed excision of the avulsion fractures would result in good outcomes. We report clinical and radiological outcomes of conservative treatment of volar plate avulsion fractures of the PIP joint and risk factors for failure of conservative treatment. Methods: We retrospectively reviewed the clinical and radiological outcomes of 88 volar plate avulsion fractures (85 patients) treated conservatively at first. In 18 of these fractures, delayed excision of the fracture fragment was required after an average of 75 days of conservative treatment for limited motion or pain of the joint. We compared parameters between failed cases and successful cases after conservative treatment. Results: Compared to the successful cases, the failed cases had a higher prevalence of joint dislocation at the time of injury and greater pain, larger flexion contracture, and less further flexion after conservative treatment. The shape, comminution, and size of the fracture fragments were not related with the need for operation, but the operative cases had greater displacement and rotation of the fracture fragments than the conservative cases. After fragment excision, postoperative protection of the joint was not necessary, pain was reduced, and the mean range of motion increased. Conclusions: The presence of joint dislocation and greater displacement and rotation of the fragments may be associated with the failure of conservative treatment of volar plate avulsion fractures. Failed cases after conservative treatment could be resolved by delayed fragment excision with favorable results. Therefore, it might be appropriate to consider conservative treatment at first in almost all volar plate avulsion fractures of stable PIP joints.

급성 동통성 골다공증 추체 압박 골절에서 경피적 추체 성형술과 보존적 치료의 결과 비교

나화엽,이영상,박태훈,김태환,서강원 대한척추외과학회 2014 대한척추외과학회지 Vol.21 No.2

Study Design: A retrospective comparative study. Objectives: To compare the outcome of percutaneous vertebroplasty (VP) and conservative treatment for the treatment of acute painfulosteoporotic vertebral compression fractures (VCF). Summary of Literature Review: Vertebroplasty is a common procedure for the treatment of acute painful osteoporotic VCF. However,controversy still exists regarding clinical outcomes of the procedure compared with more conservative treatment. Material and Methods: A consecutive group of patients, undergoing VP and conservative treatment at our hospital, between July 2005and October 2008, were reviewed retrospectively. All patients were reviewed with at least 1 year of follow up. A total of 58 patientsunderwent 59 VP procedures under local anesthesia at post injury 2 weeks; a total of 31 underwent conservative treatment. These twogroups were compared by the kyphotic angle and loss of vertebral body height at immediate post-injury, post-injury 6weeks and 1y ear,radiologically. And they were compared by the visual analog scale(VAS) score and ambulatory status at the same time, clinically. Results: At the time of immediate post-injury, six weeks after post-injury, one year after injury, height loss was 29.73%, 19.81%, 22.59%in the VP group, respectively, and 31.20%, 36.80%, 40.60% in the conservative treatment group, respectively. The Kyphotic angles were13.44°, 9.10°, 11.31° in VP group, respectively, and 10.29°, 15.83°, 19.00° in the conservative treatment group, respectively. There was a statistically significant reduction of height loss and kyphotic angle in VP group at post-injury of 6 weeks and 1 year(p<0.05). At the same time, VAS scores were 9.41, 4.32, 2.47 in the VP group, respectively, and 9.50, 6.25, 2.71 in conservative treatment group,respectively. Ambulation status was 3.61, 1.46, 1.22 in the VP group, respectively, and 3.65, 2.45, 1.32 in the conservative treatmentgroup, respectively. There was a statistically significant reduction of VAS score and improved ambulation status in VP group at post-6weeks, but no difference between two groups at post 1 year. There was no significant difference in new fractures of adjacent vertebraebetween the two groups (p>0.05). Conclusions: VP prevents further collapse and kyphosis relieves pain quickly and allows early ambulation, but in post-injury 1 yearfollow up, there was no significant difference in clinical outcomes. Proper treatment should be done with respect to patient’s age, generalcondition, economic status and complication. Key Words: Vertebral compression fracture, Osteoporosis, Vertebroplasty, Conservative treatment 연구계획: 후향적 비교 연구목적: 골다공증성 추체 압박 골절에 대한 경피적 추체 성형술과 보존적 치료의 결과를 비교하고자 한다. 선행 문헌의 요약: 수술 직후 경피적 추체성형술은 보존적 치료에 비해 통증 완화와 신체 기능 개선에 있어 우수한 결과를 보인다. 그러나, 장기 추시 결과에 대해서는 논란이 있다. 대상 및 방법: 2005년 7월부터 2008년 10월까지 골다공증성 추체 압박 골절로 본원에서 경피적 추체 성형술과 보존적 치료를 시행한 환자들을 후향적으로 비교하였다. 58명의 환자에서 경피적 추체 성형술을 시행하였고, 31명의 환자에서 보존적 치료를 시행하였다. 후만의 증가와 추체 높이의 소실,Visual analog scale (VAS) score, 보행단계를 수상 직후, 수상 후 6주와 1년에 비교하였다. 결과: 추체 높이의 소실은 추체 성형술 군에서 수상 직후, 수상 후 6주, 수상 후 1년에 29.73%, 19.81%, 22.59%이었고, 보존적 치료군에서 각각31.20%, 36.80%, 40.60%이었다. 후만각은 추체 성형술군에서 13.44도, 9.10도, 11.31도이었고, 보존적 치료군에서 각각 10.29도, 15.83도, 19.00도이었다. 추체 성형술 군에서 수상 후 6주와 1년에 추체높이 소실의 감소 및 후만각 증가가 유의하게 적었다(p<0.05). VAS score는 추체 성형술 군에서9.41점, 4.32점, 2.47점이었고, 보존적 치료 군에서 각각 9.50점, 6.25점, 2.71점이었다. 보행단계는 추체 성형술군에서 3.61점, 1.46점, 1.22점이었고,보존적 치료군에서 3.65점, 2.45점, 1.32점이었다. 추체 성형술군에서 수상 후 6주에 유의한 통증의 감소 및 보행단계의 호전을 보였으나, 수상 후 1년에 두 군간에 유의한 차이는 없었다(p<0.05). 추시 기간 중 인접추체의 골절은 두 군간 유의한 차이를 보이지 않았다. 결론: 추체 성형술은 보존적 치료에 비하여 추체의 붕괴 및 후만곡의 증가를 막아주며, 조기에 통증을 완화시키고 보행을 가능하게 하나 수상 후 1년째임상적 결과에서 유의한 차이를 보이지 않았다. 골다공증성 압박 골절 환자의 치료시 환자의 통증이나 경제적 사정 및 합병증을 고려하여 환자에게 적합한 치료를 선택해야 할 것으로 사료된다. 색인단어: 추체 압박 골절, 골다공증, 추체 성형술, 보존적 치료약칭제목: 추체 성형술과 보존적 치료의 비교

소아 대퇴골 간부 골절의 치료 결과 분석 : 보존적 치료와 역행성 유연성 골수정 삽입술의 비교 Comparison between conservative treatment and retrograde flexible intramedullary nailing

오창욱,박병철,인주철,소형태,백승훈 대한골절학회 2002 대한골절학회지 Vol.15 No.2

목 적 : 소아 대퇴골 간부 골절환자에서 보존적 치료와 역행성 유연성 골수정 삽입술 시행후 동통 및 파행 등의 임상증상, 회복기간, 각형성 및 하지부동 등의 합병증을 비교하였다. 대상 및 방법 : 1992년 1월부터 2000년 6월까지 4~11세의 대퇴골 간부 골절 환자 46명 51례를 대상으로 하였고, 수상시 연령은 보족적 치료군이 평균 6세11개월, 수술적 치료군이 평균 7세였다. 보존적 치료군이 24례, 수술적 치료군이 27례로, 보존적 치료군은 견인술후 3~6주에 고수상 석고고정을 하였고, 수술적 치료군은 자체제작한 3.0 mm 스테인레스 강선으로 대퇴원위부에서 폐쇄적 정복 삽입술을 시행하였다. 결 과 : 두 치료군에서 동통 및 주변관절의 운동장애, 불유합이 나타난 예는 없었다. 방사선적 평가에서 보존적 치료군은 10도이상의 각형성이 4례 있었으나, 수술적 치료군에서는 없었다. 10mm이상의 심각한 하지부동은 수술적 치료군은 없었으나, 보존적 치료군에서 4례 발생하였고, 그중 파행이 보존적 치료군에서 2례 있었다. 부분 체중 부하시기는 수술적 치료군이 평균 7.5주로 보존적 치료군의 10.8주보다 빨랐다. 결 론 : 소아의 대퇴골 간부 골절에서 역행성 유연성 골수정 삽입술은 보존적 치료에 비해 각형성 및 하지부동 등의 합병증이 비교적 적고, 조기재활이 가능한 치료방법으로 사료된다. Purpose : To compare clinical outcomes and complications between pediatric patients with femoral shaft fracture who had undergone conservative treatment and retrograde flexible intramedullary nailing. Materials and Methods : 51 cases of 46 pediatric patients who had femoral shaft fracture were retrospectively studied. Hip spica cast was applied 3∼6 weeks after traction in 24 cases of conservative treatment group and closed reduction and internal fixation with flexible nails were performed in 27 cases. Results : Neither pain, limitation of joint motion, nor nonunion was reported in both groups. In radiologic evaluation, 4 cases of angulation more than 10 degrees were observed in conservative treatment group and none of surgical treatment group. In leg length discrepancy(LLD) over 10 mm, there was none in surgical treatment group, but 4 cases were seen in the conservative group. Two cases of limping were observed only in the conservative group. Mean time to weight bearing was earlier in surgical treatment group(7.5 weeks) than that in the conservative group(l0.8 weeks). Conclusion : As treatment of pediatric femoral shaft fracture, retrograde flexible intramedullary nailing had less complications such as LLD and angulation and enabled earlier rehabilitation than conservative treatment.

척추 측만증의 보존적 치료에 관한 최신 지견 - PubMed 검색을 위주로 2008년 이후 -

조성우,이승연,Cho, Sung Woo,Lee, Seung Yeon 대한한방소아과학회 2013 대한한방소아과학회지 Vol.27 No.1

Objectives Scoliosis is that spine's arrangement was changed to be curved. Mostly scoliosis was found at childhood and recently rate of scoliosis is increasing. Causes of scoliosis were very various, but the patients are due to idiopathic reasons. Scoliosis was treated by conservative treatment or surgery treatment. If scoliosis is diagnosed early enough, it can be treated with conservative treatment. Methods We are searching PubMed by keywords and found 47 theses complied with requirements. Results Studies of conservative treatment of Scoliosis were active. Conservative treatments are considered before surgery treatment and there was a set guideline of conservative treatment. Also, there were several studies about effectiveness of conservative treatment and quality of life, mental stress. Studies about various kinds of conservative treatment were found as well. There were brief studies about introduction of new brace, effectiveness of several braces, and case studies. Conclusions Conservative treatment is very effective choice before surgery treatment at Scoliosis patient.

골반 골절에 한방재활치료를 적용한 증례 보고 및 보존적 치료에 대한 국내 문헌 분석

하현주 ( Hyun Ju Ha ),구지향 ( Ji Hyang Gu ),최봉석 ( Bong Seok Choi ),오태영 ( Tae Young Oh ),오은미 ( Eun Mi Oh ),이옥진 ( Yu-chen Li ),오민석 ( Min-seok Oh ) 대한한의학회 한방재활의학과학회 2018 한방재활의학과학회지 Vol.28 No.2

The objective of this study is to investigate conservative treatment of pelvic fracture, and report that Korean rehabilitation treatment is effective for pelvic fracture. We reported a case about pelvic fracture treated with Korean rehabilitation treatment. We searched 10 domestic electronic databases to find reports on conservative treatment of pelvic fracture. We selected and analyzed 12 studies. In this case, pain, range of motion, and Oswestry Disability Index of patient were improved by Korean rehabilitation treatment. In analysis, traction, pelvic sling, hip spica cast, pelvic belt, medication are used in western medical treatment. Acupuncture, herbal medicine, cupping, moxibustion, physical therapy, manual therapy are used in Korean medical treatment. Most of conservative treatments are effective for pain, bone union, osteoporosis, dysfunction. In this study, we expect further study of Korean rehabilitation treatment program for pelvic fracture to compensate existing conservative treatment. (J Korean Med Rehabil 2018;28(2):135-148)

법랑모세포종 139증례의 임상소견에 따른 치료방법의 임상 통계학적 분석

신영민(Young-Min Shin),박지훈(Ji-Hoon Park),김진욱(Jin-Wook Kim),권대근(Tae-Geon Kwon),이상한(Sang-Han Lee),김진수(Chin-Soo Kim) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.4

Introduction: Ameloblastoma is a benign but locally invasive tumor with a high recurrence rate. The aim of this study was to make an easier diagnosis and treatment planning of ameloblastoma. Materials and Methods: From January 1993 to October 2009, 139 cases from 123 patients, who had been diagnosed with ameloblastoma through radiologic and biopsy in the department of oral and maxillofacial surgery of Kyunpook National University, were selected as the subjects in this study. According to the medical charts, 9 factors (age, gender, location, chief complaints, duration, radiographic findings, size and recurrence) concerned in deciding the treatment method and the relevance between each factor and the treatment methods were examined.(Conservative treatments were marsupialization, enucleation, curettage and lateral decortication. Radical treatments included block excision, resection and hemisection) Results: In the patients under the age of 20, 77.14% had conservative treatments, whereas 22.86% underwent radical treatments. In the patients over the age of 20, 44.23% were treated conservatively treatments, and 55.77% underwent radical treatments. For unilocular types, 28.57% had conservative treatments, whereas 71.43% had radical treatments. For the multilocular types, 66.67% underwent conservative treatments, and 33.33% had radical treatments. For the primary cases, 58.68% were treated conservatively and 41.32% had radical treatments. For the recurrent cases, 16.67% and 83.33% underwent conservative and radical treatments, respectively. Conclusion: There was statistical significance in the factors affecting the treatment methods, such as age, radiographic findings and recurrence.

요추부 추간판 탈출증의 보존적 치료 결과 - 척추관의 1/3이상을 침범한 추간판 탈출증에 대한 전향적 연구 -

신병준,이재철,이호형,장해동 대한척추외과학회 2011 대한척추외과학회지 Vol.18 No.3

Study Design: Prospective study. Objectives: To investigate the clinical results of conservative treatment for mid-to-large lumbar disc herniation diagnosed via magnetic resonance imaging (MRI) and the factors influencing treatment. Summary of Literature Review: There is limited information regarding the clinical results of conservative treatment for lumbar disc herniation. The recent studies using MRI have suggested favorable treatment results. Materials and Methods: The study subjects were 39 cases of herniated disc patients with over a 1/3 spinal canal encroachment -- based on MRI -- that were followed up for at least 1 year. The average age was 42.6-years-old (range of 12-76 years-old), and the average follow-up period was 28 months. The neurological deficit and the visual analogue scale (VAS) of back pain and radiating pain at the time of initial diagnoses and final follow-ups were compared, and the clinical results were evaluated based Kim & Kim’s criteria. Results: Although 4 of the 39 patients needed to undergo surgery during the follow-up period, 33 of the remaining 35 patients showed satisfactory (excellent and good ratings) results: 27 excellent, 6 good, 2 fair, i.e., a 85% (33 out of 39) satisfactory results. Of the 14 cases that had neurological defect at the initial diagnosis, only 1 case needed surgery, thereby resulting in a 93% (13 out of 14) satisfactory result. There were no statistically significant correlations among the degree of spinal canal encroachment and other factors such as age, sex, herniation type, and neurological deficit at initial diagnosis, and the clinical results at the final follow-up, conversion to surgery during follow-up, and remaining pains. Conclusions: The clinical results of conservative treatment in lumbar disc herniation were satisfactory even in cases of high degree of spinal canal encroachment. Therefore, conservative treatment of lumbar disc herniation should be considered first before resorting to surgical treatment. Key Words: Lumbar Disc Herniation, Conservative Treatment, MRI, Spinal Canal Encroachment

Clinical Outcomes of Conservative Treatment and Arthroscopic Repair of Rotator Cuff Tears: A Retrospective Observational Study

Woo Hyung Lee,Hyun Kyung Do, Joong Hoon Lee,Bo Ram Kim,Jee Hyun Noh,Soo Hyun Choi,Sun Gun Chung,Shi-Uk Lee,최지은,Seihee Kim,Min Jee Kim,Jae-Young Lim 대한재활의학회 2016 Annals of Rehabilitation Medicine Vol.40 No.2

Objective To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear.Methods In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments.Results A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p<0.001) and the ROM in forward flexion (p<0.001) were significantly improved in both groups. The ROM in internal rotation did not significantly change after conservative treatment and arthroscopic repair. The pain assessment score and ROM were not significantly different between the two groups. Retear was observed in 9.6% of patients who had an arthroscopic repair and tear progression was found in 6.7% of those who underwent conservative treatment. The proportion of aggravation for pain and ROM did not significantly differ between the two groups.Conclusion The effectiveness of conservative treatment is not inferior to arthroscopic repair for patients >50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear.

척추수술 실패 증후군 환자의 보존적 치료에대한 치험 1례

이정훈 ( Jeong Hun Lee ),김용 ( Yong Kim ),박종민 ( Jong Min Park ),박상길 ( Sang Gil Park ),심우진 ( Woo Jin Sim ),김성용 ( Sung Yong Kim ),신준식 ( Jun Sik Shin ) 한방재활의학과학회 2004 한방재활의학과학회지 Vol.14 No.4

Objectives: By this time, there are many studies on surgical treatment for failed back surgery syndrome, but few on oriental conservative treatment. So this study is designed to report the effect of oriental conservative treatment to the patient with failed back surgery syndrome. Methods: The patient of 55 year-old received treatment in hospital of oriental medicine for 20 days(from Jan 26, 2004 to Feb 14, 2004). We used Herbal Medication, Accupuncture, Bee Venom Therapy, Chuna and Physical Therapy for this patient. We observed the change between before and after treatment through VAS, ODI and physical examination. Results: Patient`s chief complain is L.B.P & Rt. side sciatica after walking over 100m and standing up more than 10 minutes. This symptom improved. VAS score changed from 10 to 2 and ODI score changed from 18 to 38. Conclusions: Oriental conservative treatment had an effect on improvement of symptom from aggravated L.B.P & Rt. side sciatica after operation more than one time. We concluded that conservative treatment is required first for treatment of failed back surgery syndrome, except for the case of surgical indication. We think that it need the further study about each significance of oriental conservative treatments and comparison of its effect in the future.

파열형(破裂型) 요추간판탈출증(腰椎間板脫出症)에 대한임상적(臨床的) 연구(硏究)

신민섭,노정두,최석우,이동호,송범룡,육태한,Sin Min-Seop,Roh Jeong-Du,Choi Seok-Woo,Lee Dong-Ho,Song Bum-Yong,Yook Tae-Han 대한침구의학회 2001 대한침구의학회지 Vol.18 No.6

Objectives : We defined that the ruptured disc is extruded trans ligamentous through the posterior longitudinal ligament or sequestrated. The authors have experienced 12 cases of ruptured disc that underwent the conservative treatment. We studied the effect and possibility of the conservative treatment for the ruptured disc. Methods : The patients with ruptured disc have underwent the conservative treatment. After the treatment, we compare pre-treatment with post treatment in the view of state of patients' ambulation and physical conditions. Results : In this study, 12 cases of ruptured disc have underwent the conservative oriental treatment. After the treatment, 75% of the cases were improved above good state Conclusion : The ruptured disc has been operated universally. Except the emergency state, the conservative treatment is helpful to improve the symptoms of the patients with ruptured disc.