Journal of Musculoskeletal Trauma

Operative Treatment for Acromiclavicular Joint Dislocation: Bum Soo Kim, Sung Do Cho, Ki Bong Kim; J Korean Soc Fract 1998;11(1):1-7. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.1

Abstract PDF: Acoromioclavicular dislocation occurs frequently in young athletes and recently in automobile accident victims and laborers, and there are various kinds of operative methods for this injury. Authors performed operative treatment for 45 cases of acromioclavicular dislocation: 30 cases of modified Phemister operation and 15 cases of modified Bosworth operation from March 1992 to June 1996. Authors analysed the result of the treatment and the results obtained were as follows. 1. The clinical results evaluated by Weitzman criteria were all satisfactory in both modified Phemister method and modified Bosworth method. 2. The radiologic results were evaluated by the difference of the distance from the coracoid process to the clavicle between the normal and the injured site. And the result was more satisfactory in modified Bosworth method. 3. There were less complications in modified Bosworth method.

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Results Following The Surgical Treatment of Acromioclavicular Joint dislocations; A Comparison of Phemister With Bosworth Operation: Jin young Park, Suk Joo Lyu, Ki Hyuk Moon, Myung Ho Kim; J Korean Soc Fract 1998;11(1):8-15. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.8

Abstract PDF: To compare the results the Bosworth with Phemister operation, we performed the Bosworth operation in 7 case and then Phemister operation in 9 case serially from 1994 to 1997 and followed them up postoperatively. The average follow-up was 19.2 months, with the longest being 32 months, and the shortest being 12 months. The extraarticular coracoclavicular fixation was done with a cancellous screw in Bosworth operation, the transarticular fixation with two or three Kirschner wires in Phemister operation and the coracoclavicular ligaments were sutured to all patient in phemister operation group. The average immobilization period 6.8 weeks(S.D.:1.0 weeks) in Bosworth operation, 6.5 weeks(S.D.:1.4 weeks) in Phemister operation. The cancellous screw or the Kirschner wires were removed in 12.6 weeks(S.D.:1.6 weeks) postoperatively in Bosworth operation, 11.8 weeks(S.D.:1.7 weeks) in Phemister operation and physiotheraphy was progressed to obtain the full range of motion. All of the patients were evaluated on a subjective(pain, night pain, medication. instability, activities of daily living), objective(range of motion) and roentgenographic(degree of displacement) basis at last follow-up. Shoulder function was assessed according to the shoulder score devised by the American Shoulder and Elbow Surgeons. The pain of Shoulder persisted remained in 1 case of Bosworth operation and in 3 cases of Phemister operation. The night pain around acromioclavicular joint was remained in 2 cases of Phemister operation. Average shoulder function index in Bosworth operation was 95 points and in Phemister operation 87 points. Average range of motion of Bosworth operation was 176degree (S.D.:9degree in forward elevation, 68degree(S.D.:11degree in external rotation, 88.6degree(S.D.:12degree in cross-rotation at 90degreeabduction, 22cm (S.D.:11cm) in cross-body adduction and T9 in internal rotation and Phemister operation 147degree(S.D. 18degree in forward elevation, 72degree S.D.:12degree in external body adduction and T8 in internal ratation. All of the patients were satisfied for results of operation. After surgery, loss of reduction was found in 3 of 7 in Bosworth operation and all of the patients were over 40 years and then conversions to Phemister operation was needed. According to short-term follow-up we prefer the transarticular Phemister method and Bosworth operation may be avoided in patients over 40 yeras old.

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Seidel Interlocking Intramedullary Nailing for Humerus Fractures: Woo Nam Moon, Jae Yong Ahn; J Korean Soc Fract 1998;11(1):16-21. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.16

Abstract PDF: From retrospective review of 26 humerus fractures treated by Seidel interlocking intramedullary nailing, 17 complications in nine patients(35%) were occurred: two delayed unions, three malunions, two infections, one distraction of fracture gap, two additional fragmentations, two failures in proximal interlocking screw insertion, three distal locking mechanism failures and two proximal protrusions of nail. Functional assessment was carried out an all patients at a mean follow up 13 months(9-23 months). The results were ten excellent, twelve good, two fair and two poor. These results show that there are considerable problems at present in the use of the seidel interlocking nail.

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Brachial Plexus Injury of Whole Arm Type Developed after Surgical Treatment of Infectious Mid-Shaft Clavicular Nonunion: Byung Chang Lee, Sang Soo Kim, Hyeoung Jun Kim; J Korean Soc Fract 1998;11(1):22-27. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.22

Abstract PDF: Neurologic complications after surgical treatment of clavicular nonunion were rare, and they were usually types of incomplete paralysis of one or more branches of brachial plexus. We experienced a complete brachial plexus paralysis of whole arm type developed after compression plating and bone grafting for infectious clavicular nonunion. This 44 years old male patient, sustained infectious clavicular nonunion of mid-shaft, complains postoperatively complete paralysis of right upper extremity and severe burning pain around the clavlcle. We performed exploration after 1 day of operation. The operative findings are no gross damage of brachial plexus, direct compression with cancellous bone graft, narrowing of costoclavicular space and fibrotic adhesion with surrounding soft tissue. For decompression of brachial plexus, we perform adhesiolysis and neurolysis, and refixed the clavicle after plate bending along anterosuperior curvature and removal of inferiorly grafted bone to restore costoclavicular space. Eletrodiagnostic study in two weeks reveal severe brachial plexopathy of whole arm type. After three months of operation, he regain the nearly complete function of upper extremity and radiologic study show a evidence of bony union. The obtained results from the evaluation of this patient were as follows: 1. Direct compression by cancellous bone graft and a spike of bone is a major contributing factor. 2. Fibrous adhesion with surrounding soft tissue due to previous infection is another important factor of reducing the costoclavicular space. 3. Motor function is more profoundly affected than sensory function, and the order of motor return is radial, median, musculocutaneous, axillary and ulnar nerve. 4. When brachial plexopathy follow immediately operation of clavicle, early exploration is indicated for diagnostic and therapeutic purpose.

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The Treatment of Comminuted Fractures of Distal Humerus with Rigid Internal Fixation and Early Motion: Seung Rim Park, Hyoung Soo Kim, Joon Soon Kang, Woo Hyeong Lee, Joo Hyung Lee, Seung Jun Park; J Korean Soc Fract 1998;11(1):28-33. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.28

Abstract PDF

Comminuted fractures of distal humerus are difficult fracures to treat because of their rarity and associated significant comminution. The results of managing theses fractures non-operatively are limited by failure to get anantomical reduction and early mobilization, which often results in painful stiff elbow and/or pseudoarthrosis. The goals of open reduction are to preserve articular surface and restore elbow function. Hence an operative management with anatomical reduction of fragments becomes the treatment of choice for these fractures. Authors analyzed 17 patients, with 30 months follow-up on an average, who were treated with open reduction and rigid internal fixation followed early mobilization during the period from jan. 1991 to Dec. 1996. Following results were obtained. 1. According to the Muller's classification, type A was 4 cases(23.5%), type B was 4 (23.5%), and type C was 9(53%) 2. Excellent or good results were obtained in 12 cases(71%) by the criteria of Aitken and Rorabeck. 3. There were limitation of full extension over 5degreein all cases and no other severe complications causing disability of elbow.

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Treatment for the Supracondylar Fractures of the Distal Humerus with Cannulated Screw
Jin Soo Park, Young Khee Chung, Jung Han Yoo, Kyu Cheol Noh, Kook Jin Chung, Dong Nyoung Lee
Journal of the Korean Fracture Society.2007; 20(1): 58. CrossRef

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Analysis of the Operative Treatment of Ipsilateral diaphyseal Fractures of the Humerus and Forearm: Jung Ryul Kim, Kyung Jin Song, Sung Jin Kim, Jun Mo Lee, Byung Yun Hwang; J Korean Soc Fract 1998;11(1):34-40. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.34

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Twenty-six adults who had concomitant ipsilateral shaft fracture of the humerus and forearm were managed with operative treatment. The mean age was 41 years (range 20 to 55 years), and the mean follow-up was 3.3 years (range 1.5 to 6 years). We reviewed initial soft tissue injury, presence of open fracture, and evaluted radiologic bone union. The functional outcome assessed with rating system of Lange and Foster, which is based on terms of fracture healing and functional restoration of the upper extremity. Overall rate of union for the humerus was 88.4 per cent, for the radius was 82.6 per cent and for the ulna 84.2 percent. We found no difference in average time to union between the treatment group with regard to open reduction and plate fixation or intramedullary nailing in the humerus and forearm bones (P>0.1, Wilcoxon signed rank test). But radiologic evaluation revealed a significant correlation between presence of open fracture and average time to union. The functional result was good in 12 cases (46%), fair in 6 cases(23%), and poor in 8 cases (31 %) according to Lange and Foster criteria. There were four nonunions of the humerus, three of the radius, and three of the ulna. Infection occurred three patients. Other complications were high radial nerve palsy in one case and above elbow amputation in one case. The results following injury were affected both by the severity of the initial trauma and by the treatment given. Best chance for a functional outcome will result from stable fixation of both the humeral and the forearm components.

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Classic Floating Elbow in Adults: A Case Series
Chul-Hyun Cho, Kyung-Keun Min
Clinics in Shoulder and Elbow.2015; 18(1): 8. CrossRef

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The Operative Treatment of Scapula Fracture: Joo Tae Park, Gil Yeong Ahn, Young Shik Shin, dong Keun Kim; J Korean Soc Fract 1998;11(1):41-46. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.41

Abstract PDF: Fractures of the scapula are rare and those were treated conservatively, in general. But, some instances, conservative care cases remain limitation of range of motion, long standing pain and insufficiency of the muscle power. The purpose of his study is to evaluate the clinical results of the operative treatment on the scapular fracture. From May 1989 to December 1994, we treated 17 scapular fractures by the open reduction and internal fixation. We were able to follow up 14 cases, of which 11 cases(79%) had complete functional recovery. The other 3 cases (21%) had varying degree of pain, loss of mobility and weakness. Overall, however, 13 cases (93%) patients had good to excellent results.

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Swanson Prosthesis Replacement of the Comminuted Radial Head Fracture Associated with Posterior Dislocation of the Elbow: 3 Cases Experienced: Soo Kyoon Rah, Jin Il Kim, Chi Soo Sohn, Yon Il KIm, Chang Uk Choi; J Korean Soc Fract 1998;11(1):47-55. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.47

Abstract PDF: Radial head resection is the accepted treatment of comminuted radial head fractures in adults, but the results are not always satisfactory. a number of well-known problems can ensue. These include chronic elbow and wrist pain, limited of motion, cubitus valgus, proximal radial migration, and new bone formation at the site of excision. Prosthetic replacement of radial head after excision offers theoretical advantages in the prevention of these problems. We are reporting three cases of patients, who had treated Swanson silastic prosthesis after comminuted radial head fracture associated posterior dislocation of the elbow.

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Operative Treatment of Intraarticular Fractures of the Distal Radius: Chung Nam Kang, Jin Man Wang, Kwon Jae Roh, Jong Oh Kim, Dong Jun Kim, Jong Keon Oh, Han Cheon Bang; J Korean Soc Fract 1998;11(1):56-62. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.56

Abstract PDF: Intraarticular fractures of the distal part of the radius comprise a distinct subgroup of fractures that are difficult to manage and are associated with a high frequency of complication and represent one of the greatest challenges to the orthopaedic surgeon. We reviewed 30 cases(28 patients) of intraarticular fractures of the distal radius treated surgically in orthopaedic department of Ewha medical center between January 1993 to May 1996 and analyzed the correlation between the clinical end results and radiographic parameters. The clinical end results were significantly worse when radia inclination didn't exceed 15, or radial length was less than 10mm or dorsal tilt exceeded 0. Ulna styloid fractre did adversely affect the clinical results. In our study 2mm articular step off did not show any difference in clinical results. But this is thought to be the result of relatively short period of follow up. Therefore we need to analyse this factor with long term follow up data.

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The Operative Treatment of the shaft Fractures of the Forearm Bone: Operative Comparison in Intramedullary Fixation to Plate Fixation on Treatment of the Both Forearm Bone Fracture: Chung Nam Kang, Jong Ho Kim, Dong Wook Kim, Young Do Gho, Jae Doo You, Jong Keon Oh, Jin Chang; J Korean Soc Fract 1998;11(1):63-69. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.63

Abstract PDF

Diaphyseal fractures of the radius and ulna present high incidence of malunion and nonunion because of difficulty in reduction and maintenence of two mobile, parallel ones in the presence of the pronating and supinating muscles which exert angulatory as well as well as rotational forces. The author divided the traceable patients into two groups, the one was the group treated with AO compression plates and the other one was the roup treated with Rush pin in radius and AO compression plate in ulna, and compared the results in the aspect of healing time and functional results. The results were as follows; 1.Those two groups were demographically similar. 2.The immobilization period and the radiologic bone union time did not differentiate two groups significantly. 3.In plate group, one nonunion, one nerve injury and two superficial wound infection were occurred. 4.Between the two operative methods selected alternatively, immobilization period, radiologic bone union and fuctional results were not different significantly, but the Rush pinning method was preferred due to simple operation technique, small operation scar, short operation time, a little blood loss, a few complication.

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Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing
Sang Bum Kim, Youn Moo Heo, Jin Woong Yi, Jung Bum Lee, Byoung Gu Lim
Clinics in Orthopedic Surgery.2015; 7(3): 282. CrossRef
Interlocking Intramedullary Nailing of Forearm Shaft Fractures in Adults
Sanglim Lee, Hee-Sung Lee, Yerl-Bo Sung, Jae-Kwang Yum
Journal of the Korean Fracture Society.2009; 22(1): 30. CrossRef

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Bioresorbable Implant Fixation for the Treatment of Radial Head and Neck Fractures: Coo Hyun Baek, Young Jin Sohn, Choon ki Lee, Moon Sang Chung; J Korean Soc Fract 1998;11(1):70-77. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.70

Abstract PDF: Between March 1988 and March 1995, 10 patients with displaced Mason type II, type III, or type IV fracture of the radial head or neck were treated by open reduction and internal fixation using bioresorbable pins. The average age of the patients was 38 years (22 to 70), and average follow-up period eas 14 months (12 to 18). There were 4 type II, 4 type III, and 2 type IV fractures. According to the functional rating system of Broberg and Morrey, the clinical results were reviewed at an average follow-up of 14 months. The functional results were 4 excellent, 5 good, and 1 fair. Fixation of displaced radial head or neck fracture using bioresorbable pins, was considered as one of the good methods.

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Operative Treatment of fracture with Osteopetrosis: Jeung Tak Suh, Jin Heon Song; J Korean Soc Fract 1998;11(1):78-84. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.78

Abstract PDF: Osteopetrosis is a rare skeletal disorder characterized by increased bone radiodensity with diminished bone resorption due to malfunction of the osteoclasts. Orthopaedic problems in the intermediate and autosomal dominant form include increased fracture, coxa vara, long bone bowing, hip and knee degenerative arthritis, and mandibular and long bone osteomyelitis. Healing of osteopetrotic bone is slow, and surgical treatment may be complicated by unusual technical problems of internal fixation due to bony hardness. The authors have experienced three cases of fracture with osteopetrosis and those cases are to be reported with exhaustive review of reference.

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Consumptive Coagulopathy Secondary to a Traumatic False Aneurysm of Deep Femoral Artery: Duke Whan Chung, Hwi Joong Yoon, Chang Moo Yim, Young Soo Chun, Hyun Ju Park; J Korean Soc Fract 1998;11(1):85-90. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.85

Abstract PDF: A case of consumptive coagulopathy due to pseudoaneurysm, which occured as a complication of intramedullary nailing, was rarely reported. Pseudoaneurysm of peripheral artery is presented with pulsating mass and may show extrinsic indentations of the adjacent bone. The coagulopathy and bleeding responded to surgical elimination of the fistula and aneurysm. Diffuse intravascular coagulopathy or consumptive coagulopathy is infrequently associated with pseudoaneurysm of deep femoral artery. Laceration of major arteries are more common in open than in closed fractures. They usually occur only when a major artery is in close proximity to bone as complications to frractures. Diffuse intravascular coagulopathy or consumptive coagulopathy is characterized clinically by excessive bleeding, ecchymosis and petechiae and by laboratory evidence of a disease in the numbers of platelets and amount of fibrinogen and an increase of fibrin degradation products with prolonged prothrombin and partial thromboplastin times. When the two coexist, they create a difficult clinical problem that reuires optimal medical and surgical treatments. If the appropriate treatment was delayed, serious complication such as sepsis or death could be occured. Prompt recongnition through appropriate laboratory tests and early surgical intervention was indicated essentially. We are reporting one case of coagulopathy associated with pseudoaneurysm of deep femoral artery that presented to the broad clinical picture.

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Treatment of Infected Nonunion with Bone Defect with Ilizarov Lenthening apparatus: Joo Chul Ihn, Byung Chul Park, Il Hyung Park, Hee Soo Kyung, Chang Wug Oh, Jin Hum Cho; J Korean Soc Fract 1998;11(1):91-99. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.91

Abstract PDF: From June 1993 to May 1997, 12 patients aged from 13 to 41 years were treated for infected nonunion with bone defect by the Ilizarov technique. Of 12 cases, 9 cases were tibia and 3 cases were femur. The cuases of nonunion were open comminuted fractures with initial bone loss and bone defect after removal of sequestrum. Infection was managed by radical resection of the infected necrotic bone and insertion of antibiotics mixed cement beads. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length inequality was achieved by means of external lenghthening technique. Corticotomies were performed at the proximal level(7), at the distal level(5). The average optained length averaged 4.8cm in length and healing index averaged 67.4days/cm According to paley and Catagni's callification bony and functional results were either excellent or good execpt I case (nonunion, poor bony result). The complications (devided by paley to 3 categories: problems, obstacles, complications) were pin tract infecton(8), pain(5), mild flexion contracture of joint(1), delayed consolidation(3), soft tissue impingement(2), joint stiffness(3) and nonunion(1). We concluded that Ilizarov techinque was very effective for treatment of infected nonunion with bone defect and soft tissue defect.

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Metacarpal Shaft Fracture Treated by Closed Reduction and Percutaneous Intramedullary K-wire Fixationv: Soo Joong Choi, Chang Kyun Lim, Ho Guen Chang, Jun Dong Chang, Chang Ju Lee; J Korean Soc Fract 1998;11(1):100-106. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.100

Abstract PDF: The metacarpal shaft fracture has been reported as a stable fracture relatively, but operative treatment is indicated when there happens reduction loss, or is in need of early exercise. Intramedullary K-wire fixation has been used for unstable transverse or long oblique diaphyseal fracture of the metacarpal bone. The fracture site is not opened and the K-wires are introduced under X-ray control. The techniques can stablize the fracture site and allow immediate exercise postoperatively. We experienced 9 cases of 4th metacarpal shaft fracture treated by percutaneous intramedullary K-wire frxation with modified technique. The K-wire was used one or two ezch metacarpal fracture. The types of fracture were 4cases of transverse, 3 of oblique, 2 of comminuted. The average clinical union period were 5 weeks. There were not severe complications in all cases.

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Pelvic Bone Fractures in Children: Byoung Suck Kim, Ye Yeon Won, Weon Ik Lee, Myeong Ryeol Song, Jae In Ahn; J Korean Soc Fract 1998;11(1):107-114. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.107

Abstract PDF: The pelvic bone fractures in children were uncommon, except for avulsion injuries in the literature and authors had 21 cases of children's pelvic bone fracture, ranging from 1 to 15 years. The mode of injury, type of fracture, associated injuries, morbidity and mortality, and out-come were retrospectively analyzed. The majority of injuries were from automobile-pedestrian collisions (81.0%). the Torode and Zieg type IV injury had the greatest morbidity, mortality, and complications. sixteen patients had non-orthopedic, associated injuries and fourteen required blood transfusions within initial 48 hours after injury. Two of them passed away due to hematologic unstableness. Twenty patients were managed by conservative method, except for one operative case by using of an external fixation device. This study included only 13 cases had average 1 year of follow-up. One acetabular dysplasia of 5 acetabular fractures was found at 12 months after injury. The nonoperative approach for the pelvic bone injury has had a satisfactory outcome in our hospital. so, authors think that if conservative methods will be properly applied, it may be one of the methods of treatment for the children's pelvic bone fracture. Even though there is no symptoms, long-term follow-up will be inevitable for checking more severe acetabular dysplasia and leg length discrepancy.

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Remodelling of Angular DeforMity after Femoral Shaft Fractures in Children: Young Bae Pyo, Sang Ho Ha, Hong Moon Sohn; J Korean Soc Fract 1998;11(1):116-122. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.116

Abstract PDF: The common sequelae after femoral shaft fractures in children are leg-length discrepancy, angular deformity and rotational deformity. Overgrowth after the conservative management of fractures has been clearly defined, and it has been reported that rotational deformities can remodel. The importance of angular deformity after fracture is less clear although it has been reported as many as 40% of cases. So, authors reviewed 15 children (16 cases) with unilaterral femoral shaft fractures who had more than 10 degrees angular deformity after conservative treatment and observed the remodelling of deformity both at the fracture site and the physes. after average follow up of 34 months, the results were as follows 1. The average correction was 84% of the initial angular deformity; the physes contributed more than the fracture site. 2. The anterior angulation remodelled better than the varus angulation. 3. Younger children remodelled better and the magnitude of the angulation influenced the degree of remodelling.

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Correction Angular Deformity & Evaluation of Overgrowth for Femoral Shaft Fractures in Children: Chung Nam Kang, Jong Oh Kim, Dong Wook Kim, Young Do Koh, Jae Doo You, Seong Man Kim; J Korean Soc Fract 1998;11(1):123-128. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.123

Abstract PDF: We reviewed 40 cases of femoral shaft fractures in children treated with Russel traction. The treatment of femoral shaft fractures in children is various according to age. Satisfactory result have been reported with russel traction. At an average follow-up of 30 months, We obtained following results. 1. The average time of traction was 18 days, and hip spica cast was applied for 28 days. 2. Malunion exceeding 25degree in flexion & valgus & varus was not developed. 3. Remodeling of angulation deformities occurred slowly over the duration of the follow-up period in our patients. At the last evaluation no patient was aware that he had any residual angulation but many did have X-ray evidence of an abnormal contour of the femur, that is average rate of spontaneous correction is 83% in anterior angulation, 87% in varus deformities, 88% in valgus deformities. 4. Fracture occurred most commonly in the middle third of the femoral shaft, but overgrowth was the greatest in proximal one third fracture. The average overgrowth was 1.2 cm in length and, growth acceleration was the greatest in oblique fracture and, among the children 4 to 9 years of age, significant overgrth(average 1.2 cm) was seen. 5. Skeletal Russel traction is easy, safe and convenient to treat all femoral shaft fractures of the children between four and ten years old.

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Treatment of the Humeral Shaft Fracture with the Intramedullary Nail: Byung Chang Lee, Chul Hong Chun, Soo Uk Chae; J Korean Soc Fract 1998;11(1):129-135. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.129

Abstract PDF: Interlocking nailing has been increasingly used to treat humeral shaft fractures with the improvement in intramedullary device design and surgical technique. We reviewed the clinical results in twenty nine patients who had intramedullary nailing for the treatment of humeral shaft fractures from May, 1992 to July, 1995 in wonkwang university hospital. there were 8 polytrauma patients; 6 were osteoporotic elderly patients; 10 were comminuted fractures; 2 were segmental fractures; 1 was nonunion; 1 was pathologic fracture; 1 was bilateral humeral fractrure. Trueflex, Seidel and Uniflex nail were selected 13, 8 and 8 cases respectively. According to AO classification, simple, wedge and complex fractures were 14, 7 and 8 cases respectively. The result of this study were as follows : sound bony union were observed in twenty three cases, but six nonunions treated by additional operations such as bone graft, modified dual onlay bone graft or OR/IF with bone graft were occurred. Nonunion was occurred mainly in simple and wedge type of AO classification. Distraction of fracture site occurred mainly in simple type of AO classification was related with nonunion. Chronic shoulder symptoms were observed in six cases, and proximal nail protrusion and injury to rotator cuff were considered as its possible cause. Other omplications were one postoperative radial nerve palsy and metal breakage.

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Experience with Bipolar Hemiarthroplasty in Femoral Neck Fracture in the Elderly Patients: Correlation Between Preoperative Medical Conditions and Postoperative Functional Results of Hip: Kwang Hee Lee, Se Dong Kim, Dong Chul Lee, Duk Seop Shin; J Korean Soc Fract 1998;11(1):143-152. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.143

Abstract PDF

The displaced femoral neck fracture remains a major challenge to orthopedic surgeons, as the elderly population is increasing. Elderly patients with femoral neck fractures often have other medical conditions, fragile bones, and poor compliance. Thus, for elderly patients who need early ambulation and funtional recovery, bipolar prosthesis is accepted as an appropriate treatment. We report a study of 58 cases of bipolar hemiarthroplasty with a femoral neck fracture and a physiologic age older than 65 years from January 1991 to May 1996. The purpose of this study is to evaluate the functional outcome of bipolar hemiarthroplasty and correlation between preoperative medical conditions and Harris hip score in femoral neck fractures in the elderly patients. The results obtained were as followings. 1. 90% of patients had uncontrolled medical conditions. Cardiovascular and pulmonary disease were main preexisting medical conditions. 2. The preoperative medical conditions were important deteminants for the functional results after bipolar hemiarthroplasty. 3. Dislocated bipolar prosthesis needed open reduction or revision to total hip arthroplast due to disassembly of the prosthesis caused by attempted closed reduction.

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Usefulness of the Cementless Stem for the Treatment of Hip Fracture in Elderly Patients with Osteoporosis - Comparative Analysis between Cementless Stem and Cemented Stem -
Joon Soon Kang, Kyoung Ho Moon, Rhu Seop Kim, Sang Ho Lee, Jong Min Choi
Journal of the Korean Fracture Society.2011; 24(1): 16. CrossRef

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Treatment of Femoral Neck Fractures in the Elderly Patients Aged over 60 years: Comparative Study between Osteosynthesis and Bipola Arthroplasty: You Sung Suh, Byung Woo Kim, Kyung Dae Min, Chi Soo Son, Soo Kyoon Rah, Chang Uk Choi; J Korean Soc Fract 1998;11(1):153-158. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.153

Abstract PDF: STUDY DESIGN: Seventy femoral neck fractures in the elderly patients aged over 60 years treated with osteosynthesis or primary biploar arthroplasty were assessed on complication and functional outcome at final follow up. OBJECTIVE: To compare the results of femoral neck fractures in the elderly patients aged over 60 years treated with osteosynthesis or primary bipolar arthroplasty retrospectively. To know the indications of each method. SUMMARY OF BACKGROUND DATA: Althrough the osteosynthesis method had preservation of hip joint, primary osteosynthesis method had possibility of major complications as nonunion and avascular necrosis of femoral head.
METHODS
Seventy patients with intra-articular femoral neck fracture were treated with osteosynthesis in 33 patients(group 1) and primary biploar arthroplasty in 37 patients(group 2). A comparartive analysis of age, sex, type of fracture, initial displacement of fracture, method of treatment, fixation device type, quality of reduction, operative time, blood loss at operation, complication and functional outcome at final follow up were performed.
RESULTS
The female was more three times than male. The mean ages were 70.1 years old in group 1 and 73.3 years old in group 2. In group 1, complications such as non-union and avascular necrosis of femoral head were significantly greater in the subcapital fractures and Garden's stage 3,4 than the transcapital fractures and Garden's stage 1,2. In operative method, blood loss and operative time were significantly greater in the group 2 than in the group 1. Seven major complications (avascular necrosis: 6 cases, non-union: 1 case) occurred in group 1, two major complications(death: 2 cases) occurred in group 2. The functional outcomes were superior to the group 2, but it may be due to high complication rates in group 1.
CONCLUSIONS
This study suggests that the important factors that influenced the clinical results were type of fracture, initial displacement of fracture, quality of reduction. So in relatively poor arthroplasty.

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The Gamma Mail for Subtrochanteric Fractures of the Femur: Suk Kang, Jung Soo Hwang, Phil Hyun Chung, Dong Ju Chae, Yong Bum Park, Han Chul Kim, Kyu Hwang Um, Jeong Yong Hong; J Korean Soc Fract 1998;11(1):159-167. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.159

Abstract PDF: The aubtrochanteric area is cortical bone which has a decreased blood supply and a serious communition after trauma. Large biomechanical stresses in the subtrochanteric area can lead to failure of fixation devices. Many fixation devices have been used to treat the fractures of subtochanter of the femur. The Gamma nail was introduced for the treatment of peritrochanteric fractures with the theoretical advantage of a load-shearing femoral component. We reviewed 15 patients of subtrochanteric fractures who were treated by use of the Gamma nail at Dongguk university hospital since March 1993. Results showed satisfactory fracture union with little loss of position, even in comminuted fractures. The patients had shorter convalescence and earlier weight bearing. Perioperative complications were few. We conclude that Gamma nail is effective in achieving good stabilization of the unstable fractures of the subtrochanteric region and is an advance in the treatment of subtrochanteric fractures of the femur.

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Treatment of Intertrochanteric Fractures of the Femur using Compression Hip Screw in the Senile Osteoporosis: Eui Hwan Ahn, In Whan Chung, Jeong Hwan Oh, Hyuck Jun Lee; J Korean Soc Fract 1998;11(1):168-174. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.168

Abstract PDF: The intertrochanteric fracture of the femur are seen in elderly patients who are highly vulnerable to generalized osteoporosis and various senile disease. Firm internal fixation and early ambulation is a goal of treatment. The morbidity and mortality after fracture remain high despite of the development of various devices. For this purpose, compression hip screw becomes popular recently. The purpose of this report is to assess the availability of compression hip screw in the intertrochanteric fracture in the senile osteoporosis by the review of 107 cases from Jan. 1990 to Jan. 1996. The result were as follows : 1. Eighty-three cases(77.6%) were unstable fractures. 2. The lag screw position in the femoral head of 76 cases(71%) were centerd 3. The average length of sliding of the lag screw was 9.9mm. 4. Satisfactory results were obtained in 91% of patients by the functional class of Clawson.

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Structural Study of Proximal femur in the Elderly Femoral Neck & Trochanteric Fracture: Byung Chul Park, Chang Wug Oh, Seung Hoon Oh; J Korean Soc Fract 1998;11(1):175-180. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.175

Abstract PDF: The factors that determine whether a proximal femoral fracture is neck or trochanteric area are a matter of controversy. So we studied the BMD(bone mineral density) and the morphology of the contralateral femur in subcapital fracture and intertrochanteric fracture(Boyd - Griffin Type I,II). The bone density of femoral neck, Ward's triangle and trochanteric region was measured by dual energy X-ray absortiometry(DEXA) in 41 patients with femoral neck fracture value and fracture type in same patients, we calculate the femoral neck length from the plain X-ray film. The results were as follows. 1. The ratio of BMD in the neck and trochanter area was higher in the trochanter fracture group. 2. The level of BMD of the trochanter fracture group was lower than the neck fracture group in all opints of measurement. 3. In the measurement of femoral neck length at plain X-ray film, the neck length of trochanter fracture group was longer than the neck fracture group. It may be that difference in BMD and femoral neck length is related to the site at which a proximal femoral fracture occurs.

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Treatment of the Femoral Shaft Fracture by Interlocking Intramedullary Nailing: Sung Joon Im, Sung Jin Kim, Dae Sang Yoo, Ho Sik Sung; J Korean Soc Fract 1998;11(1):181-190. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.181

Abstract PDF: Femoral shaft fractures result from high energy trauma such as traffic accident or falls, and it is frequently accompanied by multiple fractures and several other organ injuries. Intramedullary nail is the effective device available for patient with appropriate fracture of the femoral shaft, and it may also prevent several complications, such as infections and delayed union that can be caused by periosteum and soft tissue injury. Rigid internal fixaton of the femoral shaft fracture with interlocking intramedullary nails presents a significant advance in the management of unst-able fractures and provides longitudinal and rotational stability as well as early joint motion and weight bearing. This procedure has been used with wide popularity because it is possible simultaneously to preserve the range of motion and to obtain the bone union. The purpose of this sutdy is to evaluate the differences of the functional results and duration of the bone union based on Winquist-Hansen classification. Also we analyzed the causes of the complications and results of the treatment. Forty one cases of the femoral shaft fractures were treated with interlocking intramedullary nailing during the period from January 1993 to June 1995 over 12 months follow up. The results were as follows: 1. Among 41 cases of the femoral shaft fractures, static nailings were used in 34 cases and 7 cases with dynamic nailings, then bone union was achieved at 18 weeks for static mode and 15 weeks for dynamic mode respectively. 2. Intraoperative complications were new fractures near the original fracture site(2 cases) and femur neck(1 case). 3. Postoperative complications were delayed union(4 cases), metal failre(1 case), limb shortening(1 case) and distal screw breakage(1 case). 4. Delayed union developed in 4 cases with static mode, but bone union was achieved at average of 22 weeks after changing to dynamic mode at 15 weeks. 5. Functional results were assessed by Karlstrom and Olerud criteria and 80% of the patients were in excellent and goood results.

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Treatment of Open Type-III Tibial Shaft Fractures -Comparison Between Ilizarov External Fixation and Secondary Intramedullary Nailing-: Hoon Kim, Woo Dong Nam, Ki Chan Ahn, Seung Seok Seo, Young Chang Kim, Jang Seok Choi, Young Goo Lee; J Korean Soc Fract 1998;11(1):191-197. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.191

Abstract PDF: Open type III tibial shaft fractures have a high incidence of complication and a poor outcome. The most usual method of stabilization is by external fixation, but there are several complications as infection, delayed union and nonunion. We tried to compare the results of Ilizarov external fixation cases with the case of secondary intramedullary nailing after temporary Ilizarov fixation. There was no significant difference in the union time of Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. But the patients were more comfortable in the secondary intramedullary nailing. In conclusions, secondary intramedullary nailing after temporary Ilizarov fixation is the useful method in the treatment of open type III tibial shaft fractures.

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Treatment of Commiuted Fractures of the Proximal Tibia Using Ilizarov External Fixator: Jae Ik Lee, Myung Hwan Son, Jae Hong Park, Kang Hoon Kim; J Korean Soc Fract 1998;11(1):198-204. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.198

Abstract PDF: Twenty one comminuted fractures of the proximal tibia in 21 patients were treated with Ilizarov external fixator from May 1990 to May 1996 in Pusan City Medical Center. The average duration of external fixation was 17weeks, and all of the fractures healed without bone graft. The mean time to union was 18weeks in closed comminuted fractures, and 21 weeks in Gustilo type I, II open fractures. The complications with this technique were pin tract infection 3 cases, pin loosening 6 cases, septic arthritis 1 case, post-traumatic osteoathritis 1 case, and joint ankylosis 1 case. The average duration of follow up was 18 months. The range of knee motion of 19 cases of the the 21 patients was at least 115-degrees arc. Post-operative immediate exercise was possible, and partial weight bearing with crutch was also possible after post-operative 4 weeks. We concluded that Ilizarov external fixation is a satisfactory technique for the treatment of selected comminuted fractures of the proximal tibia.

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Treatment of Open Segmental Fracture of the Tibia: Kyeong Soon Kim, Kyu Chul Shin, Dong Hyeuk Kim, Dong Heon Kim; J Korean Soc Fract 1998;11(1):205-213. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.205

Abstract PDF: Tibial segmental fractures are considered special type of lesion and pose many problems and the results often are unsatisfactory. We performed retrospective study of the 17 cases of open tibial segmental fracture which were treated from January 1990 to December 1995 and evaluated the efficacy of the external fixation and intramedullary nailing. The segmental fracture were classified according to the Melis classification and open fracture were classified according to the Gustilo-Anderson classification. After average follow-up of 16 months (range, 12 to 24 months), all of the fractures had healded except one. The results were as follows: 1. The average time of union was 22.5 weeks in the case of intramedullary nailing (Endernail; 26 weeks, Interlocking IM nailing; 21 weeks) and 31 weeks in the case of external fixation (Monofixator; 28 weeks, Ilizarov external fixator; 34 weeks). 2. Nonunion and osteomyelitis was developed in one case of Ilizarov external fixation and 5 cases of pin tract infection were also developed. Among 8 cases of external fixation group, 4 cases of delayed union and one case of malunion were developed. 3. In intramedullary nailing, delayed union was developed in 4 cases. 4. The functional results by Tile rating system were showed good in 6 cases, acceptable in 8 and poor 3. In concla\usion, intramedullary nailing provided better ressults thanexternal fixator in open segmantal tibial fractures, but we consider fixation device should be selected depending on the fracture type, degree of comminution and condition of the soft tissue.

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Treatment of the Tibial Condyle Fracture: Sung Ho Han, Bo Gyu Yang, Chi Hong Kim, Tae Won Ahn, Sun Tae Jeong; J Korean Soc Fract 1998;11(1):214-225. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.214

Abstract PDF

A fracture of the tibial condyle is an intra-articular fracture of a major weight bearing joint and loss of function result in high percentage disability of the extremity. The goal of tibial condyle fracture management is a stable, well-aligned, congruent joint, with a painless range of motion and function. The management of tibial condyle fractures remains controversal. Many authors have stated that anatomical restoration of the articular surface and stable internal fixation are essential for these goals to be attained, but good results have also been reported after the conservative treatment. So the method of treatment has to be selected in each individual cases. We evaluated the 35 tibial plateau fractures, 17 treated by conservative method and 18 treated by surgery, at an average follow up of 17 months. The results were obtained as follows; 1. The most common cause of injury was motor vehicle accident in 25 cases(71.5%). 2. According to Schatzker classification, the most common type was typeII in 12 3. Associated soft tissue injuries were in 19 cases(54.3%). Among these, meniscal injuries were most common(in 13 cases). 4. According to Hohl and Luck criteria, the clinical results were acceptable in 11 to 17 cases (64.7%) after non-operative methods and 14 of 18 cases(78%) after operative methods.

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Evaluation of the Patterns of Fractures and the Soft Tissue Injury Using MRI in Tibial Plateau Fractures
Ji-Yong Chun, Hee-Gon Park, Sung-Su Hwang
Journal of the Korean Fracture Society.2007; 20(4): 302. CrossRef

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Isolated Plantar Midtarsal Dislocation: A case Report: Seung Key Kim, Jong Beom Park, Jong Hun Lee, Han Chang; J Korean Soc Fract 1998;11(1):226-229. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.226

Abstract PDF

Isolated plantar midtarsal dislocation is extremely rare injury. Only few cases have been reported previously in the literature. We experienced 1 case, a 16-year-old man. And we report a case with review of the literatue.

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Citations to this article as recorded by

Combined Ipsilateral Fracture and Dislocation of Hip, Knee and Foot Joints - A Case Report -
Hyoung-Soo Kim, Ju-Hak Kim, Sang-Joon Park, Jae-Won Hyung
Journal of the Korean Fracture Society.2012; 25(1): 73. CrossRef

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