Journal of Musculoskeletal Trauma

Stimulation of fracture Healing by Low-Intensity Pulsing Ultrasound: Kyu Hyun Yang, Chong Hyuk Choi, Jae Ho Cho; J Korean Soc Fract 1998;11(2):247-253. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.247

We performed a preliminary study to evaluate the effect of ultrasound in canine osteotomy model. Both ulna shafts were osteotomized and one side was irradiated with low-energy pulsing ultrasound, 50mW/cm2, 1 MHz, 200 microsecond bursting sine wave for 15 minutes, 6 days a week. Effect on the fracture healing was evaluated by radiologic scoring system, amount of uptake of radioactive isotope, and time to union. Results were as follows : At postoperative 2 months, means of the radiologic healing score were 4.5 in the irradiated side and 2.5 on the control side (p=0.019). Mean isotope uptake in the irradiated side was 44.4 count and 33.8 count in the control side (p=0.028). Two nonunion developed on the control side. Mean time to union of eight dogs was 2.6 months in the irradiated side and 3.1 months on the control side. Based on the cumulative union rate curve, fracture healing was stimulated and union was obtained one month faster in the irradiated side than the control side.

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Alterations in Serum Levels of Receptor Activator of Nuclear Factor-κB Ligand and Osteoprotegerin in Patients with Head Injury and Fracture
Shin Young Park, Kuen Tak Suh, Chang Hoon Ryu, Seung Hun Woo, Jung Sub Lee, Seong-Gang Kim
Journal of the Korean Fracture Society.2008; 21(2): 145. CrossRef

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Complications of Interlocking Intramedullary Nailing for the Humeral Shaft Fractures: Choong Gil Lee, Jin Woo Kwon, Kyoung Tae sohn, Seung Ho Shin, Jong Cheon Park; J Korean Soc Fract 1998;11(2):254-261. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.254

Abstract PDF: Locked intramedullary nailing has been used as a popular method in treating humeral shaft fracture because of relatively less invasive procedure, good stability and allowing early rehabilitation. However many problems such as rotator cuff injury, iatrogenic fracture, difficult distal locking at operation and painful limitation of shoulder motion due to protrusion of the nail above the greater tuberosity, frequent delayed or nonunion were reported. We reviewed our experience with 26 cases of humeral shaft fractures that were treated by interlocking intramedullary nailing to evaluate the pitfalls and the complications of this technique. the results were as follows. 1. In five cases(19.2%) iatrogenic fractures occured during nail insertion. Three were in the site of inlet and two were in the original fracture site. 2. In four cases(15.4%) painful limitation of shoulder motion was persisted for 2 months. Two were caused by subacromial impingement due to nail protrusion and two were by intraoperative rotator cuff injury. 3. Nonunion occured in two cases(7.7%) which were middle one third transverse fractures and were not fixed with distal locking screws. 4. Intraoperative and postoperative complication rate was 42.3%.

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The Effect of Dynamization After Static Intelocking Intramedullary Nailing: Kyoo Seog shin, Jong Soon Kim, Kong Wha Lee, Jin Hwan Seo; J Korean Soc Fract 1998;11(2):262-268. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.262

Abstract PDF: We had investigated the effect of dynamization in static interlocking intramedullary nailing for the long bone fracture of the femur and tibia treated in Bongseng Memorial Hospital for last 3 years (from Jan. 1994 to Jan. 1997) Total 62 patients (37 tibia, 28 femur) were treated, 35 cases were reamed at operaion and 27 cases not reamed. following results were obtained; 1. In all except 24 fractures, the static interlocking intramedullary nail was preserved without dynamization and got to mean union time of 17.2 weeks (femur) and 6.4 weeks (tibia). 2. The 24 patients (14 femur, 10 tibia) did not show callus formation and complained of vague pain in fracture site at 20 weeks after static mode. In those cases, we tried dynamization as a initial treatment modality. 3. The success rate after dynamization was about 87%. 4. The interval between nailing and dynamization did not affect the success rate. 5. Dynamization could be done day surgery.

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Operative Treatment of the Displaced Clavicle Shaft Fracture in Adult: Ig Gon Kim, Jae Hyek Kim, Chul Hyun Kim, Ryong Hwang; J Korean Soc Fract 1998;11(2):273-280. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.273

Abstract PDF: Clavicle fracture is one of the most common fracture, which had been managed via conservative methods with some exceptions such as nonunion. Operative treatment had been regarded as an important cause of nonunion and poor outcome. Nowadays, however, the goal of fracture treatment has become anatomical reduction, rigid fixation and early rehabilitation for better final results. We managed 43 clavicular shaft fracture which was displaced above 11mm, with conservative treatment (23 cases) and operative treatment (20 cases) since 1990 to 1995. All patients achieved good union in both group, except 5 nonunions of conservative treatment and no significant difference in union time. By functional evaluation of shoulder by Weitzman, final results were excellent in 17, good in 2 cases, fair in 1 case with operative treatment and excellent in 12, good in 4, fair in 3 and poor in 4 cases with conservative treatment. It was concluded that early operative treatment of clavicular shaft fracture showed better result than conservative treatment, especially in displaced and comminuted ones.

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Treatment of the Femoral Shaft Fractures with Interlocking Compression Nail: Sung Taek Jung, Taek Rim Yoon, Jong Keun Seon; J Korean Soc Fract 1998;11(2):281-287. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.281

Abstract PDF

The results of treatment of femoral shaft fractures with interlocking compression nail, the third generation nail, were evaluated to determine the incidence of union of the fracture & clinical usefulness. Fifty-three femoral fractures that had been treated by interlocking compression nailing between February 1994 and March 1996 and had been followed for more than twelve months were included in this study. forty-eight cases were fresh closed fracture and five, fresh open fracture. The results were as follows 1. According to Winquist-Hansen classification, 25 cases were type I, 13 type II, 7 type III, 5 type IV, 3 type V. 2. Union occurred in 52(97%) of 53 femoral shaft fractures. The mean fracture union period was 18.1 weeks with a range of 10 to 32 weeks. 3. Postoperative complication were delayed union(5 cases), leg length discrepancy(2 cases) and nonunion(1 case). We concluded that interlocking compression nailing for femoral shaft fracture seems to promote the fracture healing process without conversion to dynamic intramedullary fixation.

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Additive Manufacturing of Patient-specific Femur Via 3D Printer Using Computed Tomography Images
Wang Kyun Oh, Ki Seon Lim, Tea Soo Lee
Journal of the Korean Society of Radiology.2013; 7(5): 359. CrossRef

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Treatment of Acetabular Fractures -Comparison of Conservative Treatment and Surgical Treatment According to AO Comprehensive Classification-: Chang Hyuk choi, Koing Woo Kwun, shin Kun Kim, Sang Wook Lee, seung Hee Kim; J Korean Soc Fract 1998;11(2):288-295. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.288

Abstract PDF: Acetabular fracture is a severe injury associated with other body injuries. they result in permanent disability due to management difficulty and its complications such as traumatic arthritis, avascular necrosis of femoral head, etc.. In order to restore excellent function of hip joint, anatomic reduction and secure internal fixation followed by early mobilization are neccessary. We analysed 21 patients who were diagnosed as type A1 acetabular fracture from Jan. of 1991 to Dec. of 1996, and compared the functional results of conservative treatment method with that of surgical treatment method. The results were as follows. 1. Conservative management was done at 8 cases, and surgical management was done at 13 cases with open reduction and internal fixation. 2. The functional result by Goodwin criteria was all satisfactory in conservative reatment method and 12 cases(92%) in surgical treatment method. 3. Associated injuries were found in 18 cases, among them pelvic bone fracture was the most common fractured site and knee ligament injury was the most common soft tissue injury. 4. In the cases of larger acetabular fragment or in the presence of associated injury and instability after closed reduction, faster rehabilitation was achieved by starting early range of motion exercise and weight-bearing after surgical treatment than classical conservative treatment.

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Recovery of Walking Ability After Operation for Unstable Intertrochanteric fractures of the Femur in Elderly. -Timing on weight Bearing-: Deuk Soo Hwang, Hyun Tae Jung, Sang Beom Kim, Jin soo Kim; J Korean Soc Fract 1998;11(2):296-303. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.296

Abstract PDF

Intertrochanteric fracture of the femur frequently occurs in elderly patients with osteoporosis, represent as unstable and comminuted fracture, is the major cause of the morbidity and mortality in old ages. In the past, the goal of treatment of a fracture was to obtain union with little regard early ambulation is thought to be the best treatment modality. Fifty-three patients with unstable intertrochanteric fracture of the femur treated by possible anatomic reduction and internal fixation with compression hip screw were divided two groups and reviewed. In group A, 25 patients were began to bearing partial weight during six to eight weeks after operation. In group B, 28 patients were began to bearing partial weight as soon as possible(during first to third week after operation). The results were as follows; 1. According to Koval's classification, 6 cases(24.0%) in group A and 12 cases(42.9%) in group B maintained their prefracture ambulatory ability at more than 1 year postoperatively. 12 cases(48.0%) in group A, 8 cases(28.6%) in group B lost more than two grade of ambulatory ability. 2. Average loss of neck-shaft angle was 5.87degree in group A and 9.41degree in group B. Also average shortening was 5.2mm in group A and 12.7mm in group B at more than 1 year postoperatively. 3. The complications were two cases of nonunion in group A, two cases of femur fracture around compression hip screw in group B. There was no evidence of nail penetration or metal failure in both group. We concluded that better results are obtained in the respect of recovery of walking ability when partial weight bearing was started in early, even if more malunion was occurred, which is not seemed to be a severe problem for ordinary daily living in elderly.

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A Comparative Study of Bipolar Hemiarthroplasty for Intertrochanteric Fracture: Direct Anterior Approach versus Conventional Posterolateral Approach
Young Yool Chung, Seung-Woo Shim, Min Young Kim, Young-Jae Kim
Hip & Pelvis.2023; 35(4): 246. CrossRef
Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases
Ji-Hun Park, Young-Yool Chung, Sung-Nyun Baek, Tae-Gue Park
Hip & Pelvis.2022; 34(2): 79. CrossRef
The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures
Yee-Suk Kim, Jae-Seung Hur, Kyu-Tae Hwang, Il-Yong Choi, Young-Ho Kim
Hip & Pelvis.2014; 26(2): 99. CrossRef
Changes in Patient Pattern and Operation Methods for Intertrochanteric Fractures
Dong-Hui Kim, Sang-Hong Lee, Sang-Ho Ha, Jae-Won You
Journal of the Korean Orthopaedic Association.2011; 46(1): 49. CrossRef
Cementless Bipolar Hemiarthroplasty for Treating Intertrochanteric Fracture in Elderly Patients
Han-Jun Lee, Jong Won Kim, Jae-Sung Lee, Jae June Yang, Woo-Young Hwang
Journal of the Korean Fracture Society.2010; 23(3): 276. CrossRef
Comparison between Results of Internal Fixation and Hemiarthroplasty in Unstable Intertrochanter Fracture of Osteoporotic Bone
Haw Jae Jung, Jae Yeol Choi, Hun Kyu Shin, Eugene Kim, Se-Jin Park, Yong Taek Lee, Gwang-Sin Kim, Jong-Min Kim
Journal of the Korean Fracture Society.2007; 20(4): 291. CrossRef

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Clinical Analysis of Avascular Necrosis of the Femoral Head following femoral Neck Fracture: You Sung Suh, Kyung Dae Min, Byung Joon Shin, Byung Ill Lee, Yeon Ill Kim, Soo Kyun Rah, Chang Uk Choi; J Korean Soc Fract 1998;11(2):304-312. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.304

Abstract PDF: Post-traumatic avascular necrosis is a notorious complication of intracapsular fractures of the femoral neck, whether or not the fracture unites. The incidence of avascular necrosis of the femoral head following femoral neck fractures has been reported variably ranged from 7% to 84%. The purposes of this study are to analysis the clinical features of avascular necrosis of the femoral head following femoral neck fractures and to define causative factors of posttraumatic avascular necrosis. From May 1986 to May 1995, sixty-eight patients with intracapsular femoral neck fracture were operated on osteosynthesis in soonchunhyang University Hospital; we analysed retrospectively with follow-up more than two years, post-traumatic avascular necrosis(AVN) was developed in 13 patients(AVN group) and united forty-six patients were included non-avascular necrosis group, nine patients were excluded due to nonunion. Comparative study was performed between these two groups. The results were as follows: 1. The avascular necrosis of the femoral head following femoral neck fractures treated with osteosynthesis was noted in 13 cases (19%) 2. The eleven cases of 13 cases showed segmental collapse of the femoral head within 2 years. 3. Among the causative factors, age and sex, delay before operation and fixation device have no statistical significance(p>0.05) but type of fracture, initial displacement and quality of reduction showed to be statistical correlation(p<0.05). In conclusion, adequate reuction and internal fixation for the femoral neck fracture may essential to minimize avascular necrosis following osteosynthesis.

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Clinical Results of Cemented Bipolar Arthroplasty in Femur Neck Fractures over 70 Years: Hyung Ku Yoon, Ho Seung Jeon, Kye Nam Cho, Jong Wha Yi; J Korean Soc Fract 1998;11(2):313-320. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.313

Abstract PDF: There have been much controversy about prosthetic replacement or internal fixation for patients over 70 years old. Authors reviewed and analyzed 45 cases of cemented bipolar hemiarthroplasty in patient over 70 years treated at the Department of Orthopedic Surgery, Sung-Ae General hospital from January 1988 to July 1995. The purpose of this study was to analyse the clinical and radiological results and to detect the motion study of bipolar cup. Follow up period was average 26.1 months, ranged from 24 months to 37 months. The following results were obtained. 1. In clinical evaluation, excellent & good result were in 31 cases(68.6%). 2. In radiologic evaluation, acetabular erosion were in 2 cases and loosening of the femoral component was in 1 case. 3. With time elapsed, the amount of the inner bearing motion was decreasing with preservation of the total joint motion. 4. Complications were idiopathic pain 7 cases, nerve paresis 2 cases, superficial infection 2 cases, intraoperative fracture 1 case, dislocation 1 case, losening 1 case.

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A Clinical Comparision of Multiple Pinning With Bipolar Endoprosthesis of the Femoral Neck Fractures in the Elderly Patients: Jae Ik Lee, Myung Hwan Son, Jae Hong Park, Kang Hoon Kim; J Korean Soc Fract 1998;11(2):321-327. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.321

Abstract PDF: The goal of the treatment of femoral neck fractures is early ambulation to prevent the complications such as pneumoniae or atelectasis, deep vein thrombosis, pulmonary embolism, bed sore, general weakness. The authors have tried to asess the outcome and complication of multiple pinning (28 cases) and biploar endoprosthesis (35 cases) for femoral neck fractures in average 18 momths with the range of 12 months to 5 years from May 1990 to May 1996. The results were asessed by interval from injury to operation, post operative complication and mortality rate, weight bearing time, Lunceford hip grading method. The results were as folllows: 1. Post operative complications rate were 43% in multiple pinning, and 26% in bipolar group. 2. The mortality rate was 14.2% in multiple pinning group and 11.4% in bipolar endoprosthesis group. 3. The functional results evaluated by Lunceford's methods were satisfactory in 64% of multiple pinning group and 71% in bipolar endoprosthesis group. We concluded that displaced fractures, subcapital fracture, severe osteoporosis, old fracture over 3 weeks in elderly patients, bipolar endoprosthesis gave a more reliable results.

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Treatment of Femoral Shaft Fracture by Interlocking Intramedullary Nailing - Relative Analysis Between Closed Nailing and Open Nailing -: Jong Oh kim, Young Do Koh; J Korean Soc Fract 1998;11(2):328-336. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.328

Abstract PDF: The closed intramedullary nailing is the best method of treatment in femur shaft fracture, but it is not available in some fracture patten or fracture level, and also need specific technique under specific equipment. conventional closed intramedullary nailing dose not provide adequate fixation if cortical contact of the major fragments is lost due to severe comminution. Open intramedullary nailing with aditional wire fixation or bone graft do not always produce good result and involved and increased risk of infection, delayed union, and also need additional operation. We analysed 80 cases of interlocking intramedullary nailing from September 1994 to September 1997. closed intramedullary nailing was used in 47 cases and open intramedullary nailing in 33 cases. The results were as follows; 1. The average union time was 17.58 weeks in closed Im nailing group, and 27.32weeks in open IM nailing group. 2. In open IM nailing group, complications incluled 10 delayed union, 3 nonunion, two infections, shortening of more than two centimeters, which occurred in 3patients. In closed IM nailing group only one complication is transient peroneal nerve palsy.

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Biomechanical Evaluation on Hooks Pattern of the Posterior Constructs in an Unstable Burst Fracture Model: Jae Won You, Tae Hong Lim; J Korean Soc Fract 1998;11(2):337-344. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.337

Abstract PDF: We prefer the posterior instrumentation system for the surgical treatment of the unstable burst fractures of the thoracolumbar spine. We are usually using a hooks pattern with posterior instrumentation, when we can not use a pedicle screw instrumentation in the case of an one stage operation of anterior decompression and posterior stabilization or injury of osteoporotic spine. The purpose of this study was designed to compare biomechanical flexibilities of posterior instrumentation constructs provided by hooks pattern in an unstable calf spine model. Ten fresh frozen calf spines (T10-L4) were used for this study with an anterior and middle column defect and loaded with pure unconstrained moments in flexion, extension, axial rotation, and lateral bending directions. Testing was performed on intact specimens first and then each specimens after laminar hooks insertion and ISOLA posterior implants and any kind of graft materials or transfixation devices were not used to make the worst possible case of instability of an injured spine. Three different fixation methods were instrumented. These included: (1) 2 hooks 2 levels above and 2 levels below corpectomy site in distraction modes bilaterally, (2) 2 levels above and 2 levels below hooks with one rod in distraction and the another rod in compression modes, (3) 2 levels above and 2 levels below hooks with claw hook configuration bilaterally. The results were as follows; 1. At the level of corpectomy site, the group I significantly reduced the motion in flexion and lateral bending (p<0.001), but not in extension as compared to the intact specimen. The group I provided significantly less stabilization than other fixation methods in all motions (p<0.01). The group II and III significantly reduced the motions in flexion, extension, and lateral bending as compared to the intact specimen (p<0.001). Axial rotational motions of all fixation constructs were significantly larger than the intact specimens (p<0.001), and the group I showed greater axial rotational motion than the groups II and III (p<0.001). 2. At the level below corpectomy site, all fixation methods showed the reduced motion significantly in all loading modes and the stabilization was similar with each other. 3. At the level above corpectomy site, all tested fixation methods did not improve the axial rotational stability beyond the intact case, but reduced flexion, extension, and lateral bending motions significantly(p<0.001). In conclusion, the hooks pattern construct in distraction modes is least stable at the corpectomy and above corpectomy sites. It was showed similar stabilizing effect between the claw and compression-distraction configuration. when using hooks, the hooks should be placed in either the claw or compression-distraction configuration.

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Operative Treatment of the Intercondyle of the Humerus in adults: Hyun Dae Shin, Kwang Jin Rhee, June Kyu Lee, Won Sok Lee, Seung Jin Lee; J Korean Soc Fract 1998;11(2):345-353. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.345

Abstract PDF: We had studied the results of operative treatments in twenty-seven interconylar fractures of the distal end of the humerus over a ten-year period retrospectively. From march 1989 to February 1996, 27 patients were included in this study. The fracture patterns were classified according to the system of Muller et al. and evaluated the results of the involved elbow by Jupiter's scale. The mean follow-up was 47.8 months. The operation method was open reduction by wide exposure and transolecranon approach and internal fixation between two condyles by cancellous screw or Hebert screw and two reconstruction plate rectangularly each other. Among 27, 17 were men and left elbow were 15. The mean average age was 50.2 (23- 72)years old. The most common injury mechanism was direct trauma in 18 cases(62.9%). By Muller classification C3 type were 12 cases(44.4%), while C1 were 5 cases and C2 were 5 cases and C2 were 10 cases. At last follow-up the elow ROM was average flexion angle 107 degrees(18 to 125 degrees). Except intolerable pain and partial stiffness of elbow, the postoperative complications were 4 cases ; dsyesthia of ulnar nerve were 2, infection were 1, and heterotopic ossification was 1 case. The results of excellent and good were 20 cases(74.1%). In 7 cases of fair and poor results, C3 were 4 cases and C2 were 2 cases. It was concluded that the transolecranon approach and dual-plate fixation on humerus for fractures of the intercondyle of the humerus was satisfactory and necessary to effort of rigid fixation and a early rehabilitation after operation as possible.

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A critical Analysis of Long-Term Result and Prognostic Factors of Fractures of the Calcaneus: Ig Gon Kim, Jae Hyek Kim, Chul Hyun Kim, Jong Suck Kim; J Korean Soc Fract 1998;11(2):354-361. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.354

Abstract

Forty-six patients who had had forty-nine calcaneal fractures were managed with closed reduction and a cast, closed reduction and axial pin fixation, and open reduction and internal fixation. The results were reviewed retrospectively, between twelve months and twenty-six months after the treatment, with criteria usued in assesssment of result by Salama30) and with plain radiographs. The purpose of this study were to analyze the relationship between the prognostic factors and post-treatment results. The results of treatment and prognostic factors obtained from this study were as follows. 1. The negative prognostic factors that were associated with an unsatisfactory out come were an age of more than fifty years, a greater body weight, work involving strenuous labor, subtalar incongruity, a decreased fibulocalcaneal space, and a decreased B hler-angle ratio of the fractured to the normal side. 2. Patients who had had a tongue-type fracture had a better result than those who had had a central depression fracture, while those who had had a central depression fracture had a better outcome than those who had had a comminuted fracture. 3. The length of the Achilles-tendon fulcrum, which is directly related to the calcaneal length, was not related to the outcome.

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Open Reduction and Internal Fixation with AO Calcaneal Plate for Displaced Intra-articular Calcaneal Fracture
Myung Jin Lee, Sung Keun Sohn, Kyu Yeol Lee, Sung Soo Kim, Min Soo Kang, Hyeon Jun Kim, Sang Kyu Sun
Journal of the Korean Fracture Society.2010; 23(3): 303. CrossRef

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The Results of Blair Ankle Fusion in Trauma and Disease Around the Ankle: Duke Whan Chung, Kang Il Kim, Byung Joo Park; J Korean Soc Fract 1998;11(2):362-370. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.362

Abstract PDF: Blair introduced talotibial fusion via tibial sliding graft, rectangular bone block donated from distal tibia, to the neck of talus to settle the problems, shortening of lower extremity and deformity of foot, which had been produced by talectomy or subtalar fusion in the treatment of the comminuted fracture-dislocation of the body of the talus. The purpose of this study was to report the excellent results of Blair ankle fusion in treatments of various diseases of ankle as well as fracture and avascular necrosis of talus, and to announce the effect of Blair ankle fusion. The ten cases were reviewed, which had undergone Blair ankle arthrodesis, from January 1989 to December 1996 in Kyung Hee Medical Center. There were 4 men and 6 women. Mean age was 4.7(18-75) years old. Preoperative diagnosis were 2 posttraumatic osteoarthritis, 2 avascular necrosis of talus, 2 degenerative osteoarthritis, 1 chronic osteomyelitis of calcaneus with myelopathy, 1 Charcot joint due to diabetes mellitus, 1 secondary osteoarthritis due to infection sequelae and 1 old crushing injury of ankle and foot. We used Boston children's Hospital ankle-scoring system as clinical assessment criteria and tibiopedal motion as functional assessment in gait. Time to union was average 14.6(8-23) weeks. Postoperative complications were pin tract infection in two cases and deep infection(chronic osteomyelitis) in one case. Pain was observed in three cases. Delayed union, nonunion or pseudoarthrosis were not observed. The average leg length discrepancy was 0.64cm(0-1.27). On the clinical criteria for Boston children's Hospital ankle-scoring system, we observed seven excellent and three good cases. The results in tibiopedal motion using cineroentgenography were 6 good and 4 fair cases. By using Blair fusion, we expect early bony union, near normal shape of foot, no shortening, and normal walking by preserving the enough range of tibiopedal motion.

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Essex-Lopresti Axial Fixation for Intra-articular Calcaneal Fractures: Young Do Koh, Jong Oh Kim; J Korean Soc Fract 1998;11(2):371-377. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.371

Abstract PDF: Fracture of the calcaneus is quite common, and displace intraarticular fractures can be associated with serious and prolonged disability. However, there still a great deal of controversy regarding the treatment of intraarticular fractures of calcaneus. Authors had treated 41 cases of 32 patients with displaced intraarticular calcaneal fractures using Essex-Lopresti axial fixation at Ewha Woman's University Mokdong Hospital from September, 1993 to February, 1996, and analyzed the functional results after the minimum 2 year follow-up. The results as follows; 1. Of 41 intraarticular calcaneal fractures, 27 fractures were tongue type and 14 fractures were joint depression type according to Essex-Lopresti classification. 2. Postoperatively Bohler angle was restored to mean 24.5degree intongue type, and to mean 13.8degree in joint depression type. 3. The reduction loss of Bohler angle was 7% in tongue type and 18.8% in joint depression type at the final follow-up. 4. The satisfactory results were obtained in 77.7% of tongue type and in 49.9% of joint depression type.

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Treatment of the Supracondylar and Intercondylar Fracture of the Humerus in Adults: Sang Won Park, Young Soo Byun, Ki Hoon Kang, Sang Won Han; J Korean Soc Fract 1998;11(2):378-383. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.378

Abstract PDF: Supracondylar and intercondylar fracture of the adult humerus is uncommon and present a difficult management problem. The purpose of this study is to analyse the clinical results according to types of the fracture and methods of the treatment. The authors reviewed twenty-eight patients treated for supracondylar and intercondlar fracture of the adult humerus at the Department of Orthopaedic Surgery, Korea University Hospital from January 1990 to August 1996. The mean follow up period was 41 months (12months to 79months). The results were as follows: 1. According to AO classification, there were 9 cases(32%) of Type A, and 19 cases(68%) of Type C. 2. The Methods of treatment were closed reduction and cast immobilization in 4 cases, closed reduction and fixation with K-wire or screw in 11 cases, open reduction and fixation with K-wire or screw in 7 cases and open reduction and plate fixation in 6 cases. 3. Poor results can be expected after closed reduction and cast immobilization, open fracture, above 60 years old, and Type C according to AO classification.

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Operative Treatments of the Tibial Pilon Fractures: Duk Yong Lee, Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suck Ha Lee, Dong Ki Lee, Yong Chan Lim, Jae Joon Shin; J Korean Soc Fract 1998;11(2):390-397. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.390

Abstract PDF

Treatment of tibial pilon fractures is difficult to manage because of its comminuted pattern of the intra-articular fracture of the ankle, the articular incongruity, associated with soft tissue injury and its complication. The modern concept of fracture mordality are the open anatomical reduction, stable internal fixation with correct length of fibula and functional aftercare. We analyzed 17 cases which underwent open reduction and internal fixation for the tibial pilon fracture at the Korea Veterans Hospital from March 1990 to September 1996. 1. The most common type was type III according to Ruedi and Allgower's classification. 2. The treatment was open reduction and internal fixation in all cases and the results were above fair by Ovadia and Beals criteria in 16 cases. 3. The union of fracture was taken in all cases and the duration of union was average 14 weeks. 4. The most common complication was the limitation of ROM in the ankle joint.

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Towards the synthesis of amphidinolide B. An intramolecular Stille coupling approach
M.Belén Cid, Gerald Pattenden
Tetrahedron Letters.2000; 41(38): 7373. CrossRef

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Use of the Ilizarov Technique for Treatment of Infected Non-Union: Sung Taek Jung, eun Kyoo song, Bong suk Bae; J Korean Soc Fract 1998;11(2):398-404. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.398

Abstract PDF: We reviewed infected non-union of tibia and femur which had been treated by radical resection of the necrotic bone and Ilizarov method in thirty-nine patients. All patients had either one-segment or two segment lengthening of bone with a technique of bone transport. The size of the bone defect that was bridged averaged 5.7cm (range, 2 to 16cm). All cases attained bone union and the infection was eradicated in all pattints before the fixator was removed. The mean duration of external fixator was 14 months(range, 4-28months). The mean external fixation index was 1.6 months/cm and the mean distraction index was 23.2 days/cm. The functional results were exellent in 3 patients, good in 19, fair in 9, poor in 8. The bone results were excellent in 5 patients, good in 20, fair in 10, poor in 4. Complication were pin tract infection in 15 patients, equinus contracture of ankle in 2, knee flexion contracture in 1, transient sensory change in 1, axial deviation in 2, premature consolidation in 2, delayed union in 2, and leg length discrepancy in 2, and refracture in 1. In conclusion, the Ilizarov method is very effective for treatment of infected non-union with bone loss, limb shortening and soft tissue defect.

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Humeral Fractures Associated by Forearm Fractures: Ho Jung Kang, Kae Yong Han, Kyu Jyun Yang, Jin Oh Park; J Korean Soc Fract 1998;11(2):405-412. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.405

Abstract PDF: We reviewed fractured patients in Yongdong Severance Hospital for 10 years(1987-96), and collected 42 fractured patients who had concomittent ipsilateral humeral fractures and forearm fractures. The causes of injury were falling down in 21, slipping down in 2, motor vehicle accident in 15, machinery injuries in 2, crushing injury in 1 and ski injury in 1. among them 13 patients were under 15 years old. Nine cases of supracondylar fractures, three cases of lateral condylar fractures and one case of proximal humeral fractures were included. Patterns of combined forearm fractures were diverse. Twenty-three cases were occurred in the age between 16 and 59 years. Fracture patterns were very complicated in both humerus and forearm in this age. Most common humeral fracture was midshaft fracture and forearm was both forearm bone fracture. The fractures were resulted from relatively more severe traumatic event in this age than other ages. Number of patients over 60 years was six. four of them had proximal humeral fractures, one of them distal humeral fracture and one of them humeral medial comdylar fracture. Forearm fracture patterns were various but the olecranon fracture was the most common forearm fracture(4/6) in the aged. We treated fractures by many combinations of operative and conservative means. Generally K-wires were applied to the children when internal fixation was indicated. The shaft of long bones were fixated usually by dynamic compression plate and comminuted articular fractures by Egyre plate or K-wires. The average follow up period was 15 months(5-35 months). 17 complications were resulted. There were 4 nonunions, 3 elbow ankylosises, 1 Volkmann's ischemic contracture, 7 nerve paralysises(4 ulna nerve, 3 radial nerve) and 2 infections.

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Surgical Treatment of Acute acromioclavicular Dislocation: Hyoun Oh Cho, Kyoung Duck Kwak, Byeung Yong Kim, su Min Sohn, Jin Kyoung Moon; J Korean Soc Fract 1998;11(2):413-419. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.413

Abstract PDF: We have reviewed 40 patients of acute acromioclavicular dislocation all treated by several operative procedure from January 1990 to July 1996. After about 12 months follow up period, we analyzed the relationship between the type of operation and the clinical results. Several operative mothods were demonstrated till now, but 4 techniques or their combinations are commonly used. Those are fixation of acromioclavicular joint, fixation of coracoclavicular ligament, resection of distal end of clavicle and dynamic muscle transfer. Modified Phemister technique, modified phemister technique with coracoclavicular fixation and modified Bosworth technique were used with or without repairment of coracoclavicular ligament at our hospital. Modified Phemister technique showed less good results than those of other techniques especially when repair of the coracoclavicular ligamentwas not made, and the repair of the coracoclavicular ligaments or fixation of the coracoclavicular joint is an important factor affecting the final results.

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Tardy Ulnar Nerve Palsy Caused by Post-Traumatic Elbow deformities: Seung koo Rhee, seok Whan Song, Hwa Sung Lee, Ho Tae Kim; J Korean Soc Fract 1998;11(2):420-426. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.420

Abstract PDF: Thirty-five patients with tardy ulnar nerve palsy caused by cubitus valgus (33 cases0 and varus (2 cases) deformities were retrospectively studied. All patients had a history of old fracture on the distal humerus during childhood. The mean interval between the previous fractures and the onset of ulnar neuropathy was 19 years. The severity of nerve palsy was classified as McGowan's grade I in 24 patients, grade II in 8 patients, and grade III in 3 patients. The mean carrying angle was average 29 degrees in 33 cases with cubitus valgus and it was decreased to average 11 degrees postoperatively, but the angle was average -23 degrees preoperatively in 2 cases with cubitus varus and it was corrected to average 9 degrees postoperatively. the cause of palsy was analysed by mechanical stetching in 11 cases, compression by a fibrous band between the two heads of flexor carpi ulnaris in 8 cases, and diffuse fibrous adhesion around the ulnar tunnel in 5 cases. All patients was treated with supracondylar closing wedge osteotomy accompanied with anterior ulnar nerve transposition in 13 patients, corrective osteotomy only in 12 patients, and anterior ulnar nerve transposition only in 10 patients. Their end results were analysed as good in 24 cases, fair in 8 cases, and poor in 3 cases within average 6 months after the operations (4 to 13 months). The poor results was obtained in 3 cases out of 9 cases with corrective osteotomy group (33.3%). Conclusively, a tardy ulnar nerve palsy caused by post-traumatic elbow deformities should be corredcted with anterior ulnar nerve transposition with or without corrective closing wedge osteotomy but not by corrective osteotomy only, because of compressive neuropathy by diffuse fibrous adhesion or bands of two heads of FCU around the ulnar tunnel in elbow.

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Brachial Plexus Injury Secondary to Exuberant Callus Formation of Fracture of Clavicle : Two Cases Report: Song Eon Lee, Young shik Shin, Jeong Ho Yang, Joon Ho Lee; J Korean Soc Fract 1998;11(2):427-434. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.427

Abstract PDF: Brachial plexus neuropraxia is a rare complication of the fractured clavicle although neurovascular injury following clavicular fracture is significant problem. The clavicular midshaft fracture can almost always be treated by conservative methods with a high rate of healing. There are some operative indication for clavicular fracture, which contains severe angulation or comminution of clavicle fracture, neurovascular compromise that is progressive, open fracture and closed method of immobilization are immpossible. Nearly all fracture was healed without complications such as infection, neurovascular compromise and nonunion. The authors describe two cases of brachial plexus injury secondary to exuberant callus formation of the clavicular fracture.

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Comparison of Results According to the Type and Procedure in Unstable Fracture of the Distal Radius: Jin Young Park, Hong Geun Jung, Moon Jib Yoo, Jeong Wan Kim; J Korean Soc Fract 1998;11(2):435-441. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.435

Abstract PDF

In the treatment of an unstable fracture of the distal radius, the anatomical reduction of articular surface and the maintenance of radial length are essential. Recently, more extensive therapeutic method was introdced for reduction and maintenance of distal radius fracture. To compare the results between type C2 and C3 that were treated with pinning and the results between pinning and pinning with external fixation in type C3 according to AO classification, we analysed anatomical and functional results of unstable fracture of the distal radius from June, 1994 to september, 1996 at DanKook University Hospital. There were 12 cases of C2 type with pinning, 17 cases of C3 type with pinning and 14 cases C3 type with external fixation and pinning. Among the 43 cases, the most commom type was C3 (31cases), and open fractures were 6 (14%)cases. The following results were obtained; 1. For comparison of C2 type with C3 type that were treated with pinning, the results of C2 type were better anatomically and functionally. 2. For comparison of percutaneous pinning with percutaneous pinning and external fixation in C3 type, the results of C3 type that were treated by pinning and external fixation were better anatomically and functionally.

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Treatment for Unstable Distal Radius Fracture with Osteoporosis -Internal Fixation versus External Fixation-
Jin Rok Oh, Tae Yean Cho, Sung Min Kwan
Journal of the Korean Fracture Society.2010; 23(1): 76. CrossRef

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The Treatment of the Proximal Tibia Fracture -Comparison of the Variable Method of Fixation-: Dong Heon Kim, Kyu cheol Shin, Kyeong Soon Kim, Byeong Chun Chang, Dae Sul Kang; J Korean Soc Fract 1998;11(2):442-448. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.442

Abstract PDF: The treatment of proximal tibial fracture is an area of great controversy. Because open and comminuted fractures are common, selection of fixation method of the proximal tibial fracture is more difficult than any other fractures. Many authors reported high rate of malunion and loss of reduction. The purpose of this study is to compare the results of the proximal tibial fractures depending on the fixation method. We evaluated the records of 35 patients (36 fractures) who had been treated with intramedullary nailing, plate and screws and external fixation from January 1989 to January 1996. The mean period of follow-up was 12months. Of the 36 fractures, 8 fractures were with intramedullary nailing, 12 fractures with plate and screws, 16 fractures with external fixator. In intramedullary nailing groupp, the average time of bony union was nineteen weeks (16-27), in plate and screws fixation group twenty three weeks (18-31) and in external fixation group 22 weeks (19-29). The complications of intramedullary nailing group were 3 nonunions, 1 delayed union, 1 varus deformity, 2 anterior angulations and 2 cases of deep wound infection. The complications of plate and screws group were 1 nonunion, 3 delayed union, 1 deep wound infection, 2 superficial infections and in most fractures partial stiffiness of knee joint. The complications of external fixator group were 1 nonunion, 1 delayed union, 1 deep wound infection, 6 pin tract infections and 3 cases of knee joint stiffness. In our cases, if there is open wound higher than Gustilo grade III-B and severe comminuted fracture initially, the external fixation is more preferred for wound management and also more advantageous method for the patients who got a multiple trauma in abdomen, chest and head injuries. In closed fractures and Gustilo grade I, II open fractures, intramedullary nailing is considered to be more preferable method. But the anatomy of proximal tibia made nailing these fractures technically difficult. In conclusion, we consider each method of fixation is useful fixation method of the proximal tibial fractures, but each method should be selected advertently depending on the severity of soft tissue injury and the degree of comminution of the fractures.

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Clinical Results of Unreamed Static Interlocking Intramedullary Nailing In Clsed Tibial Shaft Fractures: Sang Yeon Lee, Young Shik Shin, Jeong Ho Yang, Heun Young Park; J Korean Soc Fract 1998;11(2):449-455. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.449

Abstract PDF: For the treatment of tibial shaft fracures interlocking intramedullary nailing has been used widely. Recently choosing between reamed or unreamed interlocking nailing for closed tibial shaft fracture is still controversial. The purpose of this study is to evaluate the results and complications of unreamed interlocking nailing for closed tibial shaft fractures. We reviewed 28 closed tibial shaft fractures that were treated with unreamed static medullary nailing from May 1993 to December 1996 at the Deparment of Orthopaedic surgery, Pohang St. Mary's Hospital. The results were as follows 1. In all 28 cases, union of the fracture was achieved at average 19.6 weeks and tere was no malunion. 2. We performed additional procedures in 4 cases(14.3%) for union : autogenous iliac bone graft in 1 case(3.5%) that was unstable segmental fracture and dynamization in 3 cases(10.7%) 3. There was breakage of distal locking screw in 1 case but no breakage of intramedullary nail.

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A Technique for Intramedullary Nailing of Proximal Third Tibia Fractures: Jung Jae Kim, Kyung Min Noh, Woo Shin Cho, Yung Tae Kim, Key Yong Kim; J Korean Soc Fract 1998;11(2):456-463. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.456

Abstract PDF

INTRODUCTION : Recently, intramedullary nailing is the treatment of choice in the management of fractures in the tibial diaphysis. But fractures of the proximal third of the tibial shaft including segmental fractures do not appear to respond as favorably to intramedullaryu nailing as do fractures in the distal 2/3 of the tibia. One of the msot frequent complications of intramedullary nailing of proximal third tibia is fracture malalignment leading to anterior angulation, anterior displacement or valgus angulation. There are several factors combine to make these fractures difficult to reduce when nailing. 1) The pull of the patellar tendon and muscles around the proximal tibia on the shory proximal fracture fragment. 2) The traditional medial entrance point of nailing in the proximal tibia. The author`s objective is to introduce a new technique to neutralize these factors so that intramedullary nailing can be consistently used to treat poximal third ribia fractures.
MATERIALS AND METHODS
: Five of proximal third tibial shaft including one segmental fracture were treated with a new technique for intramedullary nailing of these fractures. The clinical summary was s belows. 1) Inserted two 0.125inch Steinmann pins at the proximal tibial fragment, which authors called as 'blocking pin'. These pins were crossed with 10-15degree angle at midpoint of the proximal tibia anteroposteriorly and mediolaterally. 3) Made the entrance hole using awl which was introduced just anterior to the cross point of two blocking pins. 4) The AO unreamed tibial nail was inserted anterior to two blocking pins, After then, continued the nail insertion with closed technique. 5) Performed proximal(3 screws) and distal(2 or 3 screws) locking. 6) Removed two blocking pins finally. Outcomes were evaluated immediately postoperatively and at follow-up visit by measurement of alignment in both the anteroposterior and lateral planes. All patient were evaluated clinically also.
RESULTS
: The average anterior angulation and anterior displacement immediately postoperatively were 3.0degree (range 1degree to 5degree) and 2.8mm (range 1mm to 4mm) respectively. The average coronal plane alignement was 3.2degree valgus(range 2degree to4degree valgus). There was no complication from the use of this technique either intraoperatively or postoperatively. Fracture alignment at the time of last follow-up was unchanged from immediate postoperative measurements. All 5 cases healed clinically and radiologically. In 3 casesm bone graft was performed at postoperative 6 weeks due to delayed union. The average time to radiologic healing was 21weeks(17-26 weeks).
CONCLUSIONS
: Intramedullary nailing of proximal third tibial fractures including segmental fractures is technically demending and has a problem of the high rate of malalignments. However, through a new technique above mentioned which neutralize deforming factors, reliable alignments and healing were achieved successfully in proximal third tibial fractures. The authors introduce and recommend a new technique in intramedullary nailing to treat the authors introduce and recommend a new technique in intramedullary nailing to treat the fractures of the proximal third of the tibial shaft(esp. segmental fractures).

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Fractures of the Middle Third of the Tibia Treated with a Functional Brace
Augusto Sarmiento, Loren L. Latta
Clinical Orthopaedics & Related Research.2008; 466(12): 3108. CrossRef

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The Results and Complications After Treatment of Open Tibia Fractures in Children: Chung Nam Kang, Jong Ho Kim, Dong Wook Kim, Young Do Gho, Jae Doo You, Jin Chang; J Korean Soc Fract 1998;11(2):464-470. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.464

Abstract PDF

We describe the results of treatment and complication of open tibial fractures in 44 children. There were 30 males and 14 females with an average age of the 6.7 years(range 3~2 years). The mean follow up period was 15 months(range 1.4~28month). According to the classification of Gustilo et al, Type I were 17 cases, Type II were 13 cases, Type IIIA were 9 cases and Type IIIB were 5 cases. All patient received tetanus prophylaxis, and systemic thirty-four with minimal soft tissue injury were closed primarily. The other 10 were initially left open; of these, 7 wounds were allowed to heal secondarily and 3 larger wounds required split skin grafts. The average time to healing of the fracture was 12.9weeks(range 6.9~22.4weeks). The complication included superficial infection(7%), malunion(5%), delayed union(2%), synostosis(2%), and leg length discrepancy(5%): these incidences are similar to those reported in adult. The osteomyelitis, compartment syndrome, and vascular injury didn't developed at any case. The K-wire fixation of open tibia fractures of the childrens is very useful to prevent the displacement and to care for the openwound without the risk of deep infection.

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Analysis of Treatment Outcomes for Open Fractures of the Tibia in Children
Jong-Hyuk Park, Jung Ryul Kim, Dong Hun Ham, Hyung Suk Lee, Sung Jin Shin
Journal of the Korean Orthopaedic Association.2010; 45(6): 440. CrossRef

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Treatment of the Femoral Shaft Fractures using Unreamed Interlocking Intramedullary Nail: Sung Taek Jung, Eun Sun Moon, Moon Lee; J Korean Soc Fract 1998;11(2):471-476. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.471

Abstract PDF: The current trend in the use of the unreamed intramedullary nail to avoid the increased damage to the intramedullary blood supply may be theoretically attractive for femoral shaft fracture stabilization but little clinical and radiological attention was reported. We have evaluated the results of treatment of femoral shaft fracture with unreamed interlocking intramedullary nail. Thirty-eight femoral fractures have been followed for more than twelve months were included in this study. Most of the fractures were the result of moderate to high-energy trauma. Thirty-three cases were fresh closed fracture and five were open fractures. Winquist-Hansen type I fracture (16 cases) were most common and healing period was shorter than other type. Healing occurred in 35 cases and mean healing period was 18.7 weeks with a range of 11 to 32 weeks. Postoperative complications were delayed union in 3 cases. We concluded that unreamed interlocking nailing for femoral shaft fracture seems to be a useful method with low complication rate.

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