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Volume 4(2); December 1991
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Treatment of Intertrochanteric Fracture with Compression Hip Screw - A clinical analysis of causative factors in loss of fixation-
Hee Joong Kim, Young Min Kim, Sang Hoon Lee, Ji Ho Lee, Seung Baik Kang
J Korean Soc Traumatol. 1991;4(2):57-124.
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Among the many devices available for internal fixation of intertrochanteric fractures of the femur, the compression hip screw (CHS) has gained considerable acceptance. But some reports indicated that the loss of fixation was not infrequent in cases using the compression hip screw. A clinical analysis of causative factors in loss of fixation was performed. Of ninety four intertrochanteric fracture patients treated with CHS from 1985 to 1990, forty four patients (14 males and 30 females) were reviewed, whose follow-up period was more than three months. The average age at surgery was 72 years (range, 25 years to 92 years). As the index of loss of fixation, sliding of lag screw, migration toward acetabulum (including penetration), varus tilting of proximal fragment, metal failure and separation of plate from femur shaft were considered. Osteoporosis, fracture stability, initial reduction state and location of lag screw in head were considered as causative factors. Of 44 cases, sliding (max. 5.6 pitch, average 1.41 pitch) in 33 cases, migration toward acetabulum (max. 4.3 pitch, average 0.23 pitch) in 12 cases and varus tilting in 4 cases were noted. Neither metal failure nor separation case was observed. In causative factors, osteoporosis, fracture stability and Dimon-Hughston tendency reduction and nonanatomic reduction at initial reduction were significant factors in loss of fixation. Placement of lag screw more than 1cm from subchondral bone is considered to be safe. Using a short barrel plate is recommended for the cases in which large amount of sliding is expected.
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Emergency Treatment of Acute Abdominal Pain
Whan Bong Lee, Jin Cheon Kim, Suk Koo Kim
J Korean Soc Traumatol. 1991;4(2):69-142.
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377 patients complaining abdominal pain who were treated by surgical department in emergency room from 1989 June to 1990 June were analyzeed and disease prevalence were obtained as follows; acute appendicitis 163 cases (43.1 %), non-specific abdominal pain (NSAPs) 61 cases (16.1 %), cholelithiasis 33 cases (8.7%), perforated peptic ulcer 23 cases (6.1 %), intestinal abhesion 21 cases (5.6%), gynecologic problems 18 cases (4.8%), intraabdominal malignancy 17 cases (4.5%), abdominal trauma 14 cases (3.7%) and others 28 cases (7.4%). The most frequent problem in the age group 0-15 were non-specific abdominal pain, and cholelithiasis in the age group over 60. But not a single case of non-specific abdominal pain was found in the age group over 60. The overall morbidity was 16.2%, whereas mortality 2.7%. Increasing tendency of morbidity found in the age group over all 60 were due to respiratory complications, and cholelithiasis. Trauma was the most frequent cause of death. Among surgical interventions of 291 cases (79.3%), 31 cases (10.6%) showed negative laparotomies which were explored under the impression of acute appendicitis. Because only a few study about the acute abdomen in general review has been tried, we have tried initial analysis of acute abdominal pain patients in Emergency room treated by surgical department.
Summary
Surgical Treatment of the Flail Chest Using CMW plate 1 Case
Hae Kyoon Kim, Doo Yun Lee, Mal Soon Song
J Korean Soc Traumatol. 1991;4(2):75-151.
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Mal Soon Song RN M.S. Department of Nursing Offzce, Yongdong Severance Hospital, Yomei University College of Nursing Multiple rib fracture patient with flail chest who was complicated by pneumonia had been treated by CMW plate. Operative stabilization permits the avoidance of the op. Pain and reduction in the duration of respiratory care.
Summary
A Clinical Review of 50 Burn Patients
Jae Cheon Yoon, Seong Rae Kang, Sang Ho Lee, Tae Ii Hyun, Sang Hyun Rho
J Korean Soc Traumatol. 1991;4(2):78-162.
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This is a review of clinical analysis with 50 burn patients which treated at the our hospital between january, 1990 to November, 1991. The results were as follows: 1) Most abundant group of age was between 40 to 49 years old (24%), Male was affected more frequently than female. The ratio of male to female was 2.31 : 1. 2) Seasonal distribution showed that winter was the highest incidence; 15 cases (30%), but no significant seasonal difference was observed. 3) Flame burn was 48% and Scalding burn was 46%. 4) Most of patient (80%) were lesser affected than 20% extent of burn. 5) The most frequent hematocrit level (Hemoglobin concentration) was 36-40% (1l.0-13.9gm%); 16 cases (32%). 6) The most frequent duration of treatment was within 10 days (38%). 7) Skin graft was performed in 10 cases and most frequent period of grafting was above 6 weeks (50%). 8) The main complications were wound infection (58.3%), sepsis (12.5%), pulmonary complication (8.3%), etc, in order. 9) In 14 cases of burn wound culture, the main organisms were Pseudomonas aeroginosa 12 cases (54%), Staphylococus aureus 3 cases (13%), E.coli ; 2 cases (9%), etc, in order. 10) The over all mortality rate was 8% (4/50) and the most frequent cause of death was sepsis 75% (3/4). 11) The highest mortality rate was in flame burn (100%).
Summary
A Role of Oxygen Free Radical in Myoglobin-induced Acute Renal Failure
Joo Seop Kim, Dae Yune Jung, Jang Man Kim, Hong Rae Cho, Soo Tong Pai, Gu Kang, Hyung Sik Shin
J Korean Soc Traumatol. 1991;4(2):86-177.
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Highly reactive oxygen metabolites have been known to have a role in several models of acute renal failure. Especially hydroxyl radicals have been proved to be important mediators by some previous authors. This study was aimed to determine the role of superoxide radical as well as hydroxyl radical and to compare the protective effects of both scavengers in myoglobinuric renal failure. Acute renal failure was induced by intramuscular injection of hypertonic glycerol (6mg/kg, half-dose in each hindlimb muscles) in rats. Rats treated with glycerol and hydroxyl radical scavenger, dimethylsulfoxide (DMSO), showed lower serum blood urea nitrogen (BUN) and creatinine level than rats with glycerol alone. And also significant protection was noticed histologically. Superoxide radical scavenger, superoxide dismutase (SOD), had a similar protective effects. In contrast, allopurinol, an inhibitor of xanthine oxidase, was not protective at all. The present study may suggest that both superoxide and hydoxyl radical playa role of tissue injury in myoglobin-induced renal failure. Beside xanthine oxidase, other souces of oxygen free radical may exist.
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