Journal of Musculoskeletal Trauma

Treatment of the Femur Shaft Fractures using Interlocking Nail: Jong Keon Oh, Soon Hyuck Lee, Seung Woo Suh, Young Soo Byun; J Korean Soc Fract 1997;10(2):289-294. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.289

Abstract PDF: A series of forty patients who had forty femoral shaft fractures that were treated with static interlocking nailing were analyzed to determine the incidence of union of the fracture without planed conversion from static to dynamic intramedullary fixation as a technique to stimulate healing of the fracture. All of the forty cases were nailed using closed method under the guide of a image intensifier. The time to full weight was individualized for each patient and depend on the degree of comminution, the postoperative cortical contact between the major fragments, the presence of bridging callus as seen on follow up x-rays, and the patients mobility according to the associated injuries. Healing occurred in thirty nine(97%) of the forty fractures of the femoral shaft that had been treated with static interlocking nailing without dynamizaton. Only one patient needed conversion from static to dynamic interlocking fixation to promote fracture healing. This patient had a delayed union after closed interlocking nailing of Gustilo type I open midshaft fracture associated with Winquist type II comminution. We concluded that static interlocking nailing for femoral shaft fractures does not seem to inhibit the fracture healing process, and that conversion to dynamic intramedullary fixation is needed only for exceptional cases of delayed union.

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A Comparison of Unlearned IM-nailing with Reamed IM-nailing in Tibial Shaft Fracture: Su Chan Lee, Bum Gu Lee, Do Hyun Moon, Jin Hong Ko, Hong Ki Park, Ki Dong Kang, Sang Kyoo Choi; J Korean Soc Fract 1997;10(2):295-302. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.295

Abstract PDF: Recently, there is seen frequently the tibial fracture due to the increased traffic accident and the high industry. Rigid intramedullary nailing is the method of choice in tibial shaft fracture, early weight bearing and joint motion. Between Jan.1993 and Dec. 1994, we treated 93 tibial shaft fractures with reamed intramedullary nails(55 cases) & unlearned intramedullary nails(38 cases). We analyzed the effects of these two methods, and the following results were obtained. 1. Of 93 fractures, 32 fractures were open and 61 fractures were closed. 2. The most common cause was traffic addicent. Among the 93 cases, 60 cases were male and 33 cases were female, the most common age were ranged from 30-39 year, involving 36 cases. 3. The mean durations of the bone union were 19.7 weeks in closed fracture with treated by reamed nail and 22.1 weeks in closed fracture with unlearned. The mean duration of the bone union were 24.5 weeks in open fracture with reamed and 22.4 weeks in open fracture with unlearned. The complications of intramedullary nail are angular deformity, infection, delayed and nonunion, and screw breakage.

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A Prospective Study of Fractures of the Tibial Shaft Treated with Intramedullary Interlocking Nail : Comparing One versus Two Distal Screws: Eun Woo Lee, Ki Ser Kang, Soo Yong Kang, Eui Chan Jang, Jin Woo Lee; J Korean Soc Fract 1997;10(2):303-308. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.303

Abstract PDF: In non-randomized prospective study, 67 tibial fractures were treated with intramedullary inter-locking nail. Patients were divided into 2 groups based on the number of distal locking screw. Group I was consisted of 33 fractures treated with one distal locking screw Group II was consisted of 34 fractures treated with two distal locking screws. The patients were followed up for an average of 12 months. There was no statistically significant difference between group I and II with regard to total operation time, fracture union time. However fluoroscopic time was significantly longer at group II than group I. Serial radiographs of patients in both group were analyzed for change of hardware and fracture healing postoperatively. No significant difference was found between two groups in fracture union time, hardware failure and complications in proximal and middle tibial fracture. But the angulation and locking screw breakage were significant in group I in distal tibia fracture. We concluded that fracture of the proximal and middle third of the tibia that require interlocking nail can be successfully treated with a single distal locking screw. However, in fractures of the distal one third, two distal locking screws should be required to prevent of angular deformity in sagittal plane and for stablefixaton. The use of a single distal locking screw reduces operation time, radiation exposure, local soft tissue discomfort and cost without compromizing fracture union.

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Nonunion after Interlocking Intramedullay Nailing in Tibia Segmental Fractures: Jin Hong Rhee, Jeong Woung Lee, Jae Yong Cho, Sang Won Bae, Seog Hyun Yoon, Ju Youn Lee; J Korean Soc Fract 1997;10(2):309-315. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.309

Abstract PDF

Tibial segmetnal fracture, usually caused by strong external force has recently been increased in frequency because of increased traffic accident. This type of fracture has been well known to be very difficult to manage on reduction and maintenance of reduction, and also that it has high rate of complications such as delayed union, nonunion, infection and etc., because of high incidence of open fracture and association with other injury. For the management of this type fracture there are various methods from conservative care to operative treatment such as internal or external fixation. We analyzed nonunion of 8 cases who underwent interlocking intramedullary nailing for tibia segmental fracture. The results were as follows ; 1. Interlocking intramedullary nailing for the treatment of tibia segmental fractures were done in 29 cases(76.31%) out of total 38 tibia segmental fractures. 2. Nonunion occurred in 8 out of 29 cases(27.6%). 3. Nonunion occurred at the distal fracture site in 7 cases and both proximal and distal fracture site in 1 case. 4. Nonunion occurred in 4 cases of open fractures, 3 cases of closed fractures with compartment syndrome. 5. Nonunion occurred in 5 cases of Melis type IV, fracture, 2 cases of type I and 1 case of type II fracture. Although the interlocking intramedullary nailing is thought to be good method for the tibia segmental fracture, our study showed relatively high rate of nonunion especially, at the distal fracture site, in case of open fracture, associated with compartment syndrome and Melis Type IV fracture. On the basis of this study we recommend that closer attention should be paid to the method of treatment, fracture type, severity of comminution, open or closed fracture, degree of soft tissue injury, and fracture site.

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Funciones entre dendroides (abanicos) que (no) preservan (no)contractibilidad
José G. Anaya, Félix Capulín, Mónica Sánchez Garrido
Revista Integración.2021;[Epub] CrossRef
Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures
Sang Soo Park, Jun-Young Lee, Sang-Ho Ha, Sung-Hae Park
Journal of the Korean Fracture Society.2013; 26(4): 275. CrossRef

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Treatment of Distal Tibial Fractures by Interlocking Intramedullary Nailing: Bu Hwan Kim, Joung In Yim, Hee Yeong Chung, Jung Ju Kim; J Korean Soc Fract 1997;10(2):316-323. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.316

Abstract PDF: Intramedullary rigid nailing has been used to treat diaphyseal fracture of tibia, but with improvement of practical technical ideas, especially development of interlocking transverse screw, the indication of intramedullary nailing for tibial fracture became expanded to the fractures occurred 3cm proximal to the ankle joint. We treated 34 distal tibial fractures from Mar. 1992 to Feb. 1995 and followed up at least more than one year. The results of treatment were as follows ; 1. Time for union was 11.3 weeks in closed fracture group and 19 weeks in open group. 2. According to the functional classification of Klemm and Borner, excellent and good results were obtained in 30 cases(94.1%). 3. Complications developed in 7 cases which include ankle motion limitation, angular deformity, delayed union.

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Arthroscopic Management of the Tibial Condylar Fractures: Do Hyun Moon, Beom Koo Lee, Jin Hong Ko, Ki Dong Kang, In Seok Oh, Young Kab Shin; J Korean Soc Fract 1997;10(2):324-331. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.324

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The tibial condylar fracture is a fracture of the proximal end of the tibia, involving as they do weight-bearing articular sufaces and frequently accompanied by soft tissue injuries and menisci present a variety of problems in the treatment and prognosis. We performed reduction of the depressed articular fragment under mornitoring of arthroscopy and under the control of image intensifier and fixed with cannulated cancellous screws and accompanied by bone graft in 7 cases of the 11 cases. The results were satisfactory Arthroscopy bridges the advantage of accurate reduction and fixation without extensive operative exposure. In addition, arthroscopy allows through lavage, removal of loose fragment and accurate of associated intraarticular pathology. Since extensive exposure is avoided, rapid recovery with reduced pain and early full ROM us achieved in patients managed arthroscopically.

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Arthroscopically Assisted Reduction and Internal Fixation of Intra-Articular Fractures of Tibial Plateau
Jeung Tak Suh, Jae Min Ahn, Tae Wan Kim, He Myung Cho
Journal of the Korean Orthopaedic Association.2012; 47(2): 96. CrossRef

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Management of Unstable Proximal Tibial Fractures Using the Ilizarov: Hong Gee Park, Beom Goo Lee, Soo Chan Lee, Do Hyun Moon, Jin Hong Ko, Ki Dong Kang, Hyun Park; J Korean Soc Fract 1997;10(2):332-337. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.332

Abstract PDF: We reviewed fifteen cases of unstable tibial fractures treated with Ilizarov method from May 1995 to May 1996. We attained satisfactory bony union in all cases without bone graft(Average time 19 weeks). There were numbers of complications, such as pin tract infection, angular deformity and joint ankylosis but its were soluble and careful management & numbers of minor surgery were needed to prevent & solve such complications. Post-op immediate weight bearing and ROM exercise were possible and showed no difficulty in getting mainteance of reduction & fracture healing, and serious joint ankylosis waa not developed. In conclusions, Ilizarov method is an excellent treatment in getting reduction, maintenance of reduction, early ambulation and fracture healing in the cases of unstable tibia fractures.

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A Clinical Study of the Tibial Pilon Fractures: Chil Soo Kwon, Jong Kuk Ahn, Jin Hyok Kim, Yerl Bo Sung, Hyung Jin Chung; J Korean Soc Fract 1997;10(2):338-345. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.338

Abstract PDF: The pilon fracture result from axial compression and rotational forces causing variable degrees of metaphyseal disruption, articular damage, and malleolar displacement. It is managements are closed reduction and plaster immobilization, skeletal traction, fibular stabilization alone, limited open reduction and extemal fixation, primary arthrodesis, and even immediate amputation. Recently limited open reduction and external fixation has been proved to provide good clinical results for the severely comminuted or open pilon fractures. Authors reviewed 20 cases of the pilon fractures. Among them 10 cases were treated with limited open reduction and external fixation from October 1989 to January 1994. The results were as follows : 1. Age distribution was from 14 years to 77 years(mean ; 47 years). 2. Of the 20 cases, male were 14, and female were 6. 3. The cause of injury were tracffic accident in 10 cases, slip down in 6 and fall from a height in 4. 4. The most frequent type of fractures was type III(12 cases : 60%) according to Ruedi and Allgower classification. 5. Limited open reduction and external fixation(10 cases) has shown better results than classic open recduction and internal fixation for severely comminuted or open pilon fractures.

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A Operative Treatment of the Tibial Pilon Fractures : For minimize soft tissue injury: Jae Do Kang, Kwang Yul Kim, Hyung Chun Kim, Moon Sub Yim, Sang Hoon Ko; J Korean Soc Fract 1997;10(2):346-355. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.346

Abstract PDF: The tibial Pilon fracture is difficult to manage because high energy axial compression and rotational forces which make severe injuries to the ankle joint, which result in impaction, severe comminution, metaphyseal disruption and soft tissue trauma. Though there are variable methods of treatment including manipulation and cast, calcaneal traction and cast, external fixation, pin and plaster, limited open reduction and external fixation, open reduction and internal fixation and arthrodesis, most of authors reported better result after a surgical treatment than that of conservative treatment. While there is no doubt that the treatment of ankle joint injuries is much improved today, complications are still very common for many reasons. We have reviewed the 19 cases of the tibial plafond fractures on 18 patients which were treated at orthopedic department, Walles Memorial Baptist Hospital, from March 1991 to February 1995. The results were as follows . 1. There were so much combined injuries that physician must evaluate other injury such as spinal compression fracture. 2. The most frequent type of pilon fracture was type 3, the 2nd was type 5 by Ovadia and Beals classification. 3. Regardless of the treatment method, type 1 and 2 were excellent subjective result by Ovadia and Beals subjective evaluation classificatioin, but in case of type 3, 4 we could get a good and excellent result by anatomical open reduction and internal fixation. 4. We could reduce complications of the postoperative wound infection and skin necrosis by posteromedial and posterolateral approach after skeletal traction and manual reduction for more than one week.

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Treatment Using Arthroscopic Reduction and Fixation in Tibial Intercondylar Eminence Fracture: Chung Nam Kang, Dong Wook Kim, Sang Hoon Ko; J Korean Soc Fract 1997;10(2):356-364. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.356

Abstract PDF: Meyers and Mckeever proposed a classification of intercondylar eminence fractures based on the degree of displacement. Zaricznyj added type IV comminuted avulsion fracture. Type III and IV of tibial spine fractures are considered an indication for surgery. The purpose of this study is to evaluate the result of arthroscopic treatment for displaced intercondylar eminence fractures. In all of the cases, the displaced fragments were reduced arthroscopically in effective, and fixed by K-wires, pull-out sutures or pull out wiring. At last follow-up above 12 months, all 22 cases(100%) were evaluated as above good by Meyers and Mckeever criteria.

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Vascularized Fibular Graft in the Treatment of Chronic Osteomyelitis of Long Tubular Bone: Kwang Suk Lee, Sang Won Park, Kyung Jo Woo, Jong Won Kim; J Korean Soc Fract 1997;10(2):365-370. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.365

Abstract PDF: Previous management of chronic osteomyelitis has included antibiotic therapy, radical debridement, skin-grafting, distant cross-leg flaps, and local muscle flaps. Each of these modalities of treatment has limitations. However, over the last 20 years, vascularized fibular bone grafts have proved to be a valuable method of reconstruction of skeletal defects in the extremities following both infected and uninfected skeletal nonunions unresponsive to conventional methodology. We evaluated the efficacy of vascularized fibular graft in the treatment of chronic osteomyelitis of long bone. From August 1988 to June 1995, fourteen cases of chronic osteomyelitis of long bone which were followed for an average of 3 years duration were treated by vascularized fibular graft at the Department of Orthopaedic Surgery, Korea University Hospital. The results were as follows; 1. Even if the long tubular bone infection was uncontrolled, vascularized fibular graft could be performed and it was highly resistent to local infection. 2. Twelve cases (85.7%) out of a fourteen cases had primarily obtained bony union. 3. Free vascularized fibular graft is significant and reliable porcedure of bone grafting for the treatment of chronic osteomyelitis of long tubular bones.

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Metal Failure after Plate Fixation for Femur Fracture: Hee Kwon, Dong Wook Kim, Chi Soo Sohn, Seung Ryeol Yoon, Joon Min Song, Soo Kyoon Rah, Chang Uk Choi; J Korean Soc Fract 1997;10(2):371-378. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.371

Abstract PDF

From January 1991 to August 1996, we experienced 17 cases of metal failure among 150 cases of plate fixation of femur fracture. We analyzed the cases and obtained the following results: 1. Among 17 cases, 15 cases were closed fracture and 2 cases were open fracture. In 11 cases, the fractures were located on the midshaft of femur and most of them was segmental or comminuted. According to AO classification, 14 cases(82%) were type B(B1:1, B2:4) and C(C1:7, C3:2). 2. The interval between initial operation and metal failure was 8 months on average. 3. The cause of metal failure were bone defect remaining after initial operation, fragment necrosis due to periosteal denuding of large free bone fragments, early weight bearing, selection of inappropriate implants and improper operation technique. 4. Plate breakages were occured in 11 cases and screw fractures and screw loosening in 6 cases. Most of plate breakage was due to remaining bone defects, and most of screw fractures and loosening was due to inappropriate implants and improper operation techinque. In conclusion, accurate preoperative evaluation on the fracture site, fracture pattern and appropriate selection of internal fixative are important for proper bone healing. Based upon our result, we suggest semiopen technique with minimal soft tissue injury and initial early bone graft for bone defect.

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The Surgical Treatment of Distal Femur Medial Condyle Fracture Using Lateral Anatomical Plate of Opposite Side through Medial Approach
Sung-Sik Ha, Jae-Chun Sim, Ki-Do Hong, Jae-Young Kim, Kwang-Hee Park, Yoon-Ho Choi
Journal of the Korean Fracture Society.2009; 22(4): 246. CrossRef

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Biomechanical Analysis of Translucent Hexagonal External Fixator: Duk Yong Lee, In Ho Choi, Chin Youb Chung, Tae Joon Cho, Yoon Keun Park; J Korean Soc Fract 1997;10(2):379-387. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.379

Abstract PDF: The mechanical stiffness of 4 configurations of the Translucent Hexagonal External Fixator(THEF) was analyzed and compared with conventional Ilizarov system in vitro. The advantage of the THEF was that it is less expensive, radio-translucent because it was made of carbon fiberepoxy. Stiffness in axial compression, torsion, A-P bending and lateral bending were measured in both fixators. The fixators were assembled into 90-90 and 45-135 configurations, respectively. In each configurations, two types of pin, smooth pins and olive pins, were used for transfixion. As compared with the Ilizarov fixator, the THEF was less stiff in axial compression when the two smooth pins were used for transfixion regardless of configuration, but was also less stiff in A-P and lateral bending except A-P bending when the smooth wires were assembled in 90-90 configuration, and lateral bending when the olive wires were assembled in 45-135 configuration. However, the THEF was more stiff in torsion regardless of configuration and type of wires used. When the olive wires were used, the THEF was more stiff than the Ilizarov fixator regardless of wire configuration in all loadiilg mode except AP bending. Changing the pin configuration from 90-90 to 45-135 decreased all stiffness of the Ilizarov fixator. However, lateral bending and axial compression stiffness with smooth wire and A-P bending stiffness regardless of types of wires were decreased in the THEF. Changing the smooth wires to olive wires increased the A-P and lateral bending stiffness in the Ilizarov fixator, while it increased all stiffnesses in the THEF. We believe that the results originated from the weakness of the material used. THEF may be an effective alternative for osteosynthesis, deformity correction in complex construct because of its radiolucency in spite of less favorable biomechanical properties in some loading mode.

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Neural Injuries in Elbow Fracture in Children: Kyung Chul Kim, Bon Sub Koo, Hae Du Sung; J Korean Soc Fract 1997;10(2):388-392. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.388

Abstract PDF: Due to the unique anatomical characteristics of elbow, it is well known that fracture involving elbow joint, relatively common in children, frequently accompanies nerve injuries. In recent studies, most of these injury are reported to be resolved within average 2~3months spontaneously. The authors reviewed 91 elbow fractures revealing 9 neural injuries in children at Kangbuk Samsung Hospital from January 1990 to December 1995 retrospectively. These injuries occurred in 9 patient whose age ranged from 5~8 years. The overall incidence of neural injuries appeared to be around 9.8%. There were three radial, three ulnar, two interosseous, one median neuropathies detected. Two of the ulnar nerve injuries were iatrogenic, resulting from closed reduction and percutaneous pinning. All of the deficit, resolved spontaneously within a range 1~7 months(average 2.6months).

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The Treatment of Supracondylar Fracture of The Humerus in Children: Chung Nam Kang, Jong Oh Kim, Dong Wook Kim, Young Do Koh, Cheol Min Kim, Sang Hoon Ko, Seung Wook Jeong; J Korean Soc Fract 1997;10(2):393-400. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.393

Abstract PDF: Supracondylar fracture of distal humerus is up to 60% of all fractures around the elbow in children. Complications of this fracture include nerve injury, arterial injury, skin slough, Volkmanns ischemic contracuture, and changes in carrying angle. Many different treatment methods to minimize these complications have been devised. Recently, closed reduction and percutaneous pinning with K-wire is most widely used in treating supracondylar fractures in children exept in some rare cases such as unreducible fracture by closed reduction. However, troublesome changes in the carrying angle which do not interfere with function but the appearance of the arm is unsatisfactory, continue in approximately 30% of most series. We reviewed 59 cases which were treated by closed reduction and percutaneous pinning in supracondylar fracuture of the humerus. The purpose of our study is to evaluate the cosmetic and functional results and complications and to analysis the relationship between the stability of reduction and method of pinning. The results are as follows; 1) There were many cosmetic problems, actually. Change over 10 degrees in carrying angle compared to the normal site was as high as 10 cases(17%) of 59 cases. 2) There was no functional problem such as limitatioin of motion. 3) There was no significant complication. 4) The cross pinning fixation was more stable than lateral pinning fixation only. 5) Accurate anatomical reduction is required to prevent unsatisfactory result regardless the treatment method.

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Retrieval of a Broken Intramedullary Nail after Refracture of Femoral Shaft: A case report: Yung Khee Chung, Jung Han Yoo, Yong Wook Park, Ji Dong Lee; J Korean Soc Fract 1997;10(2):401-404. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.401

Abstract PDF: As the use of intramedullary nail fixation for the long bone fracture has been increased over recent years, so has the rate of reported complications involving intramedullary nail devices. One of the most common complication is fatigue fracture of an intramedullary nail itself if there is delayed union or nonunion of the fracture. The retrieval of the distal segment of broken intramedullary nail had proved to be particularly troublesome. The authors experienced one case of the retrieval of a broken intramedullary nail after refracture of femoral shaft, using the closed method and report this case with review of literatures.

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Treatment of Fracture of the Distal Radius by External Fixator: Eun Sun Moon, Inn Soo Rhym, Jae Hyung Park, Seung Gi Lee; J Korean Soc Fract 1997;10(2):405-411. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.405

Abstract PDF: Fractures of the distal radius represent the most common fractures of upper extremity and treatment remains challenging. Recently, more extensive therapeutic method is represented for reduction and maintenance of distal radius unstable fracture. Twenty patients, 21 cases of distal radius fracture treated by external fixator between June, 1991 and September, 1995 were followed by more than one year to evaluate the correlation between anatomical and functional results. To assess the functional results, we used Green and OBriens system which scores subjective and objective findings. Grip power ratio was checked with Jamar dynanometer. To assess the anatomical results, volar tilt, radial inclination and radial length were measured. Frykmann type VIII and Universal type IV C fractures are most common form(7 cases, 33%) in our study. The more severe form of fracture of distal radius, the less score in funtional results. There was a little loss of velar tilt, radial inclination and radial length on last follow-up radiographs. In radiographic parameters, radial length showed significant correlation with ulnar deviation(p=0.002). In complication, sudek atrophy(2 cases), ulnar nerve entrapment symptom(1 case), and writing problem(1 case) was seen, but not serious. We concluded that external fixation in distal radius fracture is one of the treatment method expecting good result without serious complication.

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