Journal of Musculoskeletal Trauma

Surgical Treatment of AO/OTA 33-C Intra-Articular Distal Femoral Fractures through Parapatellar Approach: Suk Kyu Choo, Sung Tan Cho, Hyoung Keun Oh; J Korean Fract Soc 2022;35(1):1-8. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.1

Abstract PDF: Purpose
To report the surgical results of the parapatellar approach for AO/OTA 33-C distal femoral intra-articular fractures.
Materials and Methods
Twenty-one patients with AO/OTA 33-C distal femoral intra-articular fracture were included. There were 11 cases of C2 and 10 cases of C3 fractures. The time of union and the coronal alignment were radiographically investigated. The complications related to surgery were clinically investigated, and a functional evaluation using the range of motion and Oxford knee score was performed to compare the surgical results according to fracture classification.
Results
In all cases, sufficient articular exposure and anatomical reduction were achieved with the parapatellar approach. No cases of coronal malalignment, loss of reduction, and plate failure were noted. On the other hand, in four cases (19.0%), an autogenous bone graft was performed due to delayed union on the meta-diaphyseal fracture site. There were no differences in the radiological and clinical outcomes of the C2 and C3 fractures. The knee joint pain and Oxford knee score were poorer in the delayed union group than the normal union group.
Conclusion
The parapatellar approach is useful for achieving an anatomical reduction of the articular surface of the distal femur and minimally invasive plating technique. Although satisfactory surgical results could be obtained regardless of the degree of articular comminution, a study of the risk factors of delayed metaphyseal fusion may be necessary.

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Minimal Invasive Fixation Methods for the Metacarpal Fracture: Ki Youn Kwon, Jin Rok Oh, Ji Woong Kwak; J Korean Fract Soc 2022;35(1):9-15. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.9

Abstract PDF: Purpose
This study compared the radiologic and clinical outcomes of metacarpal fractures treated with two minimally invasive surgical techniques: Kirschner wire (K-wire) fixation and headless screw fixation.
Materials and Methods
This study included 52 patients (46 males and 6 females; age 18-55 years) with distal metacarpal fractures (middle and distal shaft, including the neck) who had undergone K-wire fixation or headless screw fixation. All subjects were followed up for at least six months. The radiologic assessments were performed to evaluate the angular deformity and shortenings. The total active motion (TAM), grip strength, and patients’ subjective functional assessment were measured to evaluate the hand function. The time taken to return to work (RTW) and adverse events were analyzed.
Results
Of the 52 cases, metacarpal fractures treated with headless screw fixation and K-wire fixation showed a significant difference associated with early RTW (p<0.05). There were no significant differences between the subjects treated with K-wire fixation and those with headless screw fixation in terms of the radiologic measurement, hand function examinations, complications, and adverse events (p>0.05).
Conclusion
After a six-month follow-up, minimally invasive K-wire fixation and headless screw fixation produced similar clinical and radiologic outcomes in subjects with metacarpal fractures. Compared to K-wire fixation, however, headless screw fixation led to earlier functional recovery and might be a better option for treating metacarpal fractures in this regard.

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Recurrent Treatment Failure in Vancouver Classification Type C Periprosthetic Fractures around a Well Fixed Short Femoral Stem: Byeong Yeol Choi, Hong-Man Cho, Jiyeon Park; J Korean Fract Soc 2022;35(1):16-20. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.16

Abstract PDF: A short femoral stem (type 1 cementless stem) is being increasingly used to perform total hip arthroplasty; however, various types of intra- or postoperative periprosthetic fractures have been reported in recent times. A 66-year-old woman with a history of bilateral total hip arthroplasties using a type 1B femoral stem was admitted 2 months post-operation for a Vancouver type C periprosthetic fracture. She underwent open reduction and internal fixation; however, we observed recurrent non-union and plate breakage at the same site. In this case report, we discuss the factors associated with treatment failure in patients with a Vancouver type C periprosthetic fracture following type 1 femoral stem im-plantation.

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Early Corrective Osteoclasis for Malunited Pediatric Medial Condylar Fracture of the Humerus: Hong Jun Jung, Ho Youn Park, Yuna Kim; J Korean Fract Soc 2022;35(1):21-25. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.21

Abstract PDF: Fractures of the medial condyle of the distal humerus in children are very rare, and the younger the age, the more difficult it is to diagnose. These fractures include an intra-articular fracture and a Salter–Harris type IV growth plate fracture. Therefore, the prognosis is poor if the fracture is neglected or misdiag-nosed because of the high incidence of complications such as nonunion, angular deformity, or joint contracture. This paper reports a case of a four-year-old child who presented with a malunion of the medial condyle of the humerus with good results after an early corrective osteoclasis.

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The Antibiotic Cement Coated Nail and Masquelet Technique for the Treatment of Infected Nonunion of Tibia with Bone Defect and Varus Deformity: Min Gu Jang, Jae Hwang Song, Dae Yeung Kim, Woo Jin Shin; J Korean Fract Soc 2022;35(1):26-30. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.26

Abstract PDF: Infective nonunion after fracture surgery can cause persistent pain and inflammatory exudate in patients, requiring long-term treatment. To treat infective nonunion, radical debridement of infective bone and soft tissue should be performed, followed by stable internal fixation and bone graft. Multiple treatment strategies need to be considered according to the classification of chronic osteomyelitis, size of the bone defect, degree of bone malalignment, and severity of the soft tissue injury. This paper reports a case of a patient treated with an antibiotic cement-coated nail and a Masquelet technique to treat the infected nonunion of the tibia with a bone defect and varus deformity.

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Current Management of Talar Fractures: Gun-Woo Lee, Keun-Bae Lee; J Korean Fract Soc 2022;35(1):31-37. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.31

Abstract PDF: Talar fracture management is one of the most challenging tasks for orthopedic surgeons. High complication rates and functional impairments after talar fractures have been well documented, and thus, surgical strategies capable of perfect anatomic reduction and stable fixation are important. The current review was undertaken to provide recommendations regarding updated surgical strategies that include surgical timing, approach, fixation methods, and the prevention and treatment of possible complications.

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Treatment of Ankle Fracture and Dislocation: Chan Kang; J Korean Fract Soc 2022;35(1):38-49. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.38

Abstract PDF: Ankle fractures are the most common type of foot and ankle fracture injury. Several types of fractures occur in the ankle structures (medial malleolus, lateral malleolus, posterior malleolus, and Chaput’s tubercle) with various mechanisms and extent of fracture force. Moreover, fractures can be accompanied by other injuries, such as distal tibiofibular syndesmotic injury, medial deltoid ligament rupture, and lateral ligament complex rupture. Ankle dislocation can be accompanied when an injury is caused by a greater fracture force. Non-surgical treatments or combined surgeries may be performed depending on the mechanism and fracture type. Generally, a stable fracture maintaining anatomical reduction is treated conservatively, but surgical treatment is performed when this is not the case. Furthermore, surgeries for stable fractures can be offered when the patients demand early weight bearing due to their occupation, age, and performance state. Restoring the ankle mortise in its anatomical shape before the injury and starting early rehabilitation for functional recovery simultaneously until a union is achieved is important. Traumatic arthritis can occur if the treatment focuses only on fractures and neglects ligament injuries, such as distal tibiofibular syndesmotic injury and medial deltoid ligament rupture. Shortening, angular deformation, and rotational deformation of the fibular promote the progression of traumatic ankle arthritis in the long term, which may further cause chronic ankle pain. An overlooked displaced posterior malleolus fracture also causes traumatic arthritis through anteroposterior instability of the ankle joint.

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