Journal of Musculoskeletal Trauma

The Treatment of Trochanteric Fractures in old Aged Persons: Overview: Kwon Ick Ha, Jai Gon Seo, Joong Han Bae, Jae Un Jeong; J Korean Soc Fract 1994;7(2):219-222. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.219

Abstract PDF: In cases of unstable thoracolumbar burst fractures, recently the operative treatments such as The population of the old aged person in Korea has been increasing rapidly since 1960s, The proportion of over 65-aged person was 2.9% of total population in 1960s, but which has been increased rapidly to 5% in 1990 and is expected to 6.8% in 2000s. Therefore, according to the increasing number of osteoporosis, trochanteric fractures in old-aged group will be expected to increase rapidly. So we should give more attention to the further comprehensive treatment and classification of trochanteric fractures.

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PERIOPERATIVE CARE (Including Anesthesia) for ELDERLY INTERTROCHANTERIC Fx: Yong Lak Kim; J Korean Soc Fract 1994;7(2):223-226. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.223

Abstract PDF: No abstract available.

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Elderly trochanteric fractures: principles of treatment: Keun Woo Kim, Seong Hong Ahn; J Korean Soc Fract 1994;7(2):227-234. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.227

The goal of treatment in elderly patients with trochanteric fractures is restoration of function to preoperative ambulatory status at the earliest possible time. For this purpose operative treatment is generally recommended. The success of operative treatment depends on the stable reduction and secure fixation. But osteoporosis and comminution of the fracture geometry which are common in this aged group result in various complications and preclude satisfactory results. Because of these factors many surgeons are tempteed to develop new implant designs and new modifications of the reduction. Stable reduction by either anatomic or nonanatomic means is preferred by most surgeons to lessen complications. Various sliding nail-plate devices and intramedullary nails are mainly used for fixation. Prosthetic replacement of the hip may be an altemative for osteoporotic risky patients.

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Outcomes of Cephalomedullary Nailing in Basicervical Fracture
Seok Hyun Kweon, Sung Hyun Lee, Seng Hwan Kook, Young Chae Choi
Hip & Pelvis.2017; 29(4): 270. CrossRef
Bipolar Hemiarthroplasty Using Calcar Replacement Stem for Unstable Intertrochanteric Femoral Fracture in Elderly Patients
Dukhwan Kho, Kyoungmo Nam, Daemyung Kang, Hyeungjune Kim
Hip & Pelvis.2013; 25(3): 203. CrossRef
Bipolar Hemiarthroplasty for Femoral Basicervical Fractures in the Elderly
Duk-Hwan Kho, Ki-Hwan Kim, Hyeung-Jun Kim, Dong-Heon Kim
Journal of the Korean Fracture Society.2009; 22(4): 239. CrossRef
Bipolar Hemiarthroplasty Using Calcar Replacement Stem for Hip Fractures in the Elderly
Duk-Hwan Kho, Ki-Hwan Kim, Hyeung-June Kim, Dong-Heon Kim
Journal of the Korean Fracture Society.2008; 21(3): 232. CrossRef
Trochanteric Management for Unstable Intertrochanteric Femoral Fracture in the Elderly Patients
Duk-Hwan Kho, Ju-Yong Shin, Ki-Hwan Kim, Jun-Hyuck Lee, Dong-Heon Kim
Journal of the Korean Fracture Society.2007; 20(2): 129. CrossRef

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The Radiographic Analysis of Unstable Intertrochanteric Fractures Treated with Compression Hip Screw: Chang Dong HAN, Kang Soo CHANG, Ick Hwan YANG, Jun Sub JABNG; J Korean Soc Fract 1994;7(2):235-241. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.235

Abstract PDF: We have treated 30 cases of unstable intertrochanteric fractures of the femur with hip compression screw and side plate from Jan. 1990 to Dec. 1992. We compared the collapse amount of facture site between anatomic reduction and medial displacement(medialization), and analysed the site of lag screw in femoral head and rediographic result. 1. The degree of fracture site collapse was measured as 3.83mm(mean) in anatomic reduction cases and 5.13mm(mean) in medial displacement cases. 2. The lag screws position in femoral head was as followed 6 cases(20%) in cranial position, 16 cases(53%) in central position, 8 cases(27%) in caudal position on anteroposterior view ; 3 cases(10%) in anterior position, 15 cases(50%) in central position, 12 cases(40%) in posterior position on lateral view. 3. The union rate was 100 percent. But the penetration of lag screw into the joint occured in three cases, in which the lag screw was located in cranial position on anteroposterior view. There was no difference in union rate and degree of fracture site collapse between anatomic reduction and medial displacement cases. But the best result was obtaned by central positioning of lag screw and firm internal fixation.

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Rehabilitation: No authors listed,; J Korean Soc Fract 1994;7(2):242-245. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.242

Abstract PDF: No abstract available.

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Ipsilateral Fracture of the Femoral Neck and Shaft: Ho Jung Kang, Dae Yong Han, Dong Eun Shin; J Korean Soc Fract 1994;7(2):246-255. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.246

Abstract PDF: Ipsilateral fractures of the femoral neck and shaft are relatively uncommon infuries and usually the result of high-energy trauma in young adults. Frequently, the severe trauma responsible for this injury combination is also productive of associated injuries indeed life threatening. Several unique features of this injury have been recognized, including the high incidence of associated knee injuries, particulary fractures of the patella. This is thought to be due to a mechanism of injury in which the femur is longitudinally loaded at the flexed knee while positioned in neutral abduction. Also, this combination of injuries pose a difficult problem in management. The authors reviewed 14 cases of ipsilateral fracture of the femoral neck and shaft for the evaluation of the associated injury and method of ueatment from October 1986 to Febraury 1991 and the average follow-up period was 1.8 years. The results were as follows. 1. The site of the femoral neck and shaft fracture were mainly, basicervical and midshaft. 2. In two cases, the femoral neck fracture was not diagnosed initially. 3. Most of the associated fractures were patella and tibial fractures and PCL ruptures. 4. Complications Included three stiffness of the knee, two delayed union of the femoral shaft, one superficial wound infection and one delayed union with coxa vara deformity of the femoral neck.

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A Clinical Study of the Tibia Pilon Fractures: Jung Yoon Lee, Sung Keun Sohn, Kyung Taek Kim, Kyu Yeol Lee, Dong Man Park; J Korean Soc Fract 1994;7(2):256-268. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.256

Abstract PDF: A pilon fracture, which is defined as a comminuted intraarticular fracture of distal involve the articular surface and metaphysis with occasional extension in the diaphysis. The management has been notoriously difficult due to the associated injury, intraarticular fracture, severe communition of distal tibia, joint incongruity and soft tissue trauma. Most authors has reported good results after a surgical treatment by a principle of AO group treatment. Rescently, Bone et all reports that ROM and outcomes of the severly comminuted or open fractures of the distal intraarticular tibia were very good in using the external fixator. The result of treatment of 22 cases were analysed at the Department of Orthopedic Surgery, Dong-A University hospital from Mar. 1990 to Feb. 1993. The results were as follows; 1. The incidence of pilon fracture is 8.3% of all ankle fracture treated during same period. 2. The most common cause of injury is fall down(63.3%). 3. The most frequent type is type 3 (54.6%).(by Rudei & Allgower) 4. The most common associated injury is compression fracture of spine and calcaneal fracture(4 cases). 5. There are eight cases open Pilon fracture(36.3%) 6. We had treated severe communited fracture and open fracture by using external fixator, we achived good ROM and outcomes. 7. The more accurate reduction, the better clinical result. 8. Complication of the Pilon fracutre were traumatic arthritis, non-union, malunion, wound int, etc.

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A Clinical study of the Tibial Condylar Fractures: Jung Yoon Lee, Sung Keun Sohn, Kyung Taek Kim, Kyu Yeol Lee, Byeong Hwan Kim; J Korean Soc Fract 1994;7(2):269-278. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.269

Abstract PDF: The tibial condylar fracture which involves articular surface of the proximal tibia is common in traffic accident and often produces some disability of the knee joint because it is frequently accompanied by injuries to ligaments and menisci. There are much controversies in the method of treatment in the fractures of the tibial condyle. Although the anatomical reduction and rigid internal fixation with early knee motion are reconmanded to obtain good results, unsatisfactory results have been reported as 20-40% of cases. The authors analyzed 36 cases of tibial condylar fractures that treated at the Department of Orthropaedic Surgery, College of Medicine, Dong-A University from March 1990 to March 1993. The results were as follows: 1. The sex ratio was 2.3: 1 in male to female and most common age group was 4th decade. 2. The most common cause of injury was traffic accident in 25 cases(69.4%). 3, According to Schatzkers classification, the most common type was type II in 10 cases(27.8%). 4. The most common associated injuries were ligament injury in 10 cases(27.8%) and fibular fracture in 30 cases(27.8%). 5. By Porters criteria, 8 cases(80%) among 10 conservative cases and 18 cases(69.2%) among 26 operative cases had acceptable results. 6. The complications were most common in type II(5 cases) and type IV(5 cases). 7. The factors of poor results were as follows : displaced comminuted fracture, fracture associated with severe soft tissue injury or with ligamentous and meniscal injury.

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Traumatic Rupture of the Extensor Pollicis Longus Tendon Associated with Smiths Fracture: A case report: Keun Woo Kim, Yeng Boon Kim, Pil Gu Yi, Rak Jin Min, Ui Seoung Yoon, Yeng Ryeog Kang; J Korean Soc Fract 1994;7(2):279-283. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.279

Abstract PDF: As a complication of Smiths fracture, traumatic entrapment and closed rupture of the extensor pollicis longus tendon may occur rarely at the fracture site and cause loss of thumb extenion. Traumatic entrapment of the extensor pollicis longus tendon in Smiths fracture which was anatomic barrier of successful closed reduction was first described by Hunt in 1969. Since then, several authors reported another few cases. The mechanism of tendon rupture in Smiths fracture is thought that the sharp dorsal edge of the proximal fragment may tear the stretched muscular tendon unit during extreme wrist flexion. We experienced a case of traumatic rupture of the extensor pollicis longus tendon associated with a closed Smiths fracture and report this case with our treatment method.

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A Clinical Comparison between DCP Fixation and Brooker-Wills IM Nailing in the Treatment of Tibial Shaft Fracture: Hyung Seok Kim, Ki Do Hong, Sung Sik Ha, Young Ki Ko, Dong Seok Kang, Jae Hyun Lim; J Korean Soc Fract 1994;7(2):284-292. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.284

Abstract PDF: The tibia is the most commonly fractured bone in the long bones. There are many controversy concerning the method of treatments because of many complications, such as non-union, delayed union and infection. We comparatively analyzed 21 cases of Brooker-Wills IM nailing and 35 cases of DCP fixation in the treatment of tibial shaft fractures from Jan. 1988 to Dec. 1992. The results were as follow: 1. The averge bone union time was 12.1 weeks in Brooker-Wills IM nailing group and 13.9 weeks in DCP fixation group. There were significant different between two groups of the bone union time especially, the age from 20s to 40s and type B fracture in according to A-O classification but no different of the bone union time in open fractures. 2. There was more complications in DCP fixation than in Blocker IM nailing to treat the tibia shaft fractures. 3. In according to the above results to treat the tibia shaft fracture, we meet the conclusion that it will be a benifit to treat the tibia shaft fracture with IM nails than with DCP fixation especilly, young ages and type B fractures in A-O classification. Also we need further study for advantage between the IM nails which flexible and hard one, reamed and unlearned one.

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A Clinical Study of Trochanteric Fractures of the Femur in the Elderly over 70 years in the age: Jeung Tak Suh, Won Bum Chung, Chong Il Yoo; J Korean Soc Fract 1994;7(2):293-301. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.293

Abstract PDF

The primary goal in the treatment of the trochanteric fracture in the elderly with osteoporosis and poor general condition is to do early ambulation by rigid fixation of fracture and to decrease threatened postoperative complication. But these fractures have thirty-nine always represented a particularly difficult problem of treatment for orthopaedic surgeon. The 39 cases of intertrochanteric fracture of the femur in the elderly over 70 year in the age had operative procedures at the Department of Orthopaedic Surgery of Pusan National University Hospital and all cases were divided into compression hip screw fixation group, Jewett nail fixation group and Ender nailing group and were followed from 1 year to 3 year 8 months. The results were as follows; 1. By the Tronzo classifiaction, ihe most common type was type III (74.3%), type II(66.7%) by Boyd-Griffin classification, and unstable fracture(76.9%) by Evans classification. 2. The average bone union was about 14 weeks in compression hip screw fxation group, 15 weeks in Jewett nail fixation group 13 weeks in Ender nailing group. 3. For all patients, radiographic measurement for osteoporosis using the singh index were preformed ; 35 cases(89.7%) of these patients had poor bone quality below grade III, and the rate of loss of reduction was no statistical difference in the each group(p>0.05). 4. Ender nailing allows immediate mobilization without restriction of weight bearing after operation. 5. The modified technique to have the distal end of nails within the medullary cavity gave satisfactory result to prevent the distal migration of nails.

Citations

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Changes in Tip-Apex Distance by Position and Film Distance Measured by Picture Archiving and Communication System (PACS)
Kyu Yeol Lee, Sung Soo Kim, Hyeon Jun Kim, Dong Ho Ha, Hyung Min Yoon, Hyun Su Do
Hip & Pelvis.2015; 27(1): 36. CrossRef
Comparison of the Dyna Locking Trochanteric Nail, Proximal Femoral Nail Antirotation and Gamma 3 Nail in Treatment of Intertrochanteric Fracture of the Femur
Sung Soo Kim, Kyu Yeol Lee, Chul Hong Kim, Myung Jin Lee, Lih Wang, Hyeon Jun Kim, Sun Hyo Kim
Hip & Pelvis.2013; 25(3): 211. CrossRef
Operative Treatment with Gamma 3 Nail in Femur Intertrochanteric Fracture
Ki-Do Hong, Jae-Chun Sim, Sung-Sik Ha, Tae-Ho Kim, Yoon-Ho Choi, Jong-Hyun Kim
Journal of the Korean Fracture Society.2011; 24(1): 7. CrossRef

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Posterior Fracture Dislocation of the Hip with Fracture of the Femoral Head: Choong Gil Lee, Jin Woo Kwon, Jun Wan Park, Young Dae Park, Sung Ho Shin; J Korean Soc Fract 1994;7(2):302-307. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.302

Abstract PDF: The femoral head rarely is fractured in fracture-dislocation of the hip and probably result from forces transmitted axially along the femoral shaft with the hip flexed 60 degrees or less in neutral abduction and adduction. Pipkin subclassified Epstein-Thompson type 5 fracture-dislocations into four additional subtypes according to head fragment location and presence of neck, acetabulum fracture. Hougaard and Thomsen reviewed 203 posterior hip dislocations and found that 13 patients with a fracture of the femoral head(Pipkin type 1,2). 1 with fractures of femoral head and neck(Pipkin type 3), 2 with fractures of femoral had and acetabulum(Pipkin type 4). Epstein, Wiss, and Cozen reported that 11 cases of Pipkin type 1,26 of type 2,8 of type 3, and 10 of type 4. We experienced 2 cases of Pipkin type 3 and 3 of type 4 from January, 1990 and the results obtained were as follows. 1. By Pipkin classification, type 3 was 2 cases and type 4 was 3 cases. 2. In 2 cases of type 3, was treated by primary bipolar endoprosthesis due to comminution of head, neck and the other was by emergency open reduction of dislocation, multiple Knowles pinning of neck fracture, screw fixation of large head fragmnt, multiple knowles pinning of neck fracture, screw fixation of large head fragment, and quardratus femoris pedicled bone graft. 3. In 3 cases of type 4, one was reduced successfully by manipulation and treated conservatively. Two cases were initially treated by closed reduction and delayed open screws fixation of large acetabular rim fragments, during which head fragments were not removed. 4. There had been no clinical or radiological evidence of avascular necrosis of femoral head at 17 months follow up, but increased isotope uptake on bone scanning in type 3 patient. 5. All type 4 patients had not complained of hip pain and no evidence of radiological avascular necrosis of femoral heads at average 29 months follow up.

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Distal Radius Fracture treated with Distraction Plate Technique: Ho Jung Kang, Dae Yong Han, Tae Yong Koo; J Korean Soc Fract 1994;7(2):308-315. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.308

Abstract PDF: The comminuted intraarticular fracture of the distal radius requires early, accurate reduction of the articular surfaces and sustained restoration of anatomic position. The most commonly employed methods are pins and plaster, external fixation, percutaneous pinning and open reduction and internal fixation. There are pitfalls, advantages and disadvantages inherent in each method. Open reduction and internal fixation has been condemned for some time without any controlled series documention its ineffectiveness. Anatomic open reduction and internal fixation with early mobilization, however, are recommanded for nearly every other intraarticular fracture. Two cases of displaced intraarticular fracture of distal radius was managed with distraction plating technique. We will present these cases in detail.

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Surgical Treatment of Concomitant Ipsilateral Humerus and Forearm Fractures: Jeung Tak Suh, Sung Hun Kim, Chong Il Yoo; J Korean Soc Fract 1994;7(2):316-321. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.316

Abstract PDF: The term "floating elbow" refers to concomitant ipsilateral humeral and forearm bone fractures. This type of fractures is relatively rare and has few guidelines for treatment. Author reviewed 14 cases of these fractures which were treated by open reduction and rigid internal fixation in Pusan National University Hospital from January 1983 to January 1993. In follow up study, Author obtained that good results in 10 cases(71%) of patient, and fair results in 3 cases of patient. Author advocate the patient with concomitant ipsilateral humerus and forearm bone fractures should requires open reduction and stable internal fixation of the both humerus and forearm bone, as soon as possible.

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A Comparison study of the Gamma Nail the Dynamic Hip Screw for Peritrochanteric Fractures: Jong In Im, Bu Hwan Kim, Gi Deug Lee; J Korean Soc Fract 1994;7(2):322-330. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.322

Abstract PDF: Early operative treatment of peritrochanteric fracture in geriatric patients is now accepted practice and numerous versions of a sliding nail-plate system are the most widely used implants. The Gamma nail was introduced for the treatment of peritrochanteric component and minimizing the surgical trauma. We have operated 46 cases and studied 30 cases were followed up over 1 year. At follow-up, all patients continued to ambulate and all fractures healed. and clinical results was satisfactory. But we experienced some technical problems and complications. Intraoperative complications included difficulty in securely placing the distal screws(1 patient) and small fracture of the base of the greater trochanter(2 patients). Postoperative complications included gluteal bursitis(3 patients), progressive varus deformity(3 patients), progressive varus deformity(3 patients), thigh & knee pain(2 patients), cutting out of the femoral head (1 patient), and a femoral shaft fracture through the distal locking screws following a fall. We had no cases of infection or nonunion. To minimize technical problems and complications, the following considerations are important. 1. Accurate preoperative templating is necessary. 2. Exact placement of the guide wire. It must enter the greater trochanter at the junction of its anterior third and posterior two-thirds, just lateral to its tip. 3. Selection of a nail 2mm narrower than the reamer was recommended. 4. Nail must be inserted by hand, not by hammering, along the medulla canal. 5. Lag screw must be inserted into femoral head deeply and avokd into superior part of head especially in severe porotic bone. 6. Subtrochanteric fractures extending to distal locking site are inapproprocate indication for standard Gamma-nailing. a spiral subtrochanteric fracture which cannot be reduced by a closed technique is managed with circumferential wiring with nimimal incision before nail is inserted. 7. Repeated check of device loosening is important, especially before distal locking screw insertion. Initial insertion of proximal part of distal screw is preferred and routine use of distal locking screws is prohibited. 8. Weighted bearing must be delayed when abnormal sliding of lag screw is noted before weight bearing and in severe osteoporosis with comminution.

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Epidemiology of Senile Fractures of the Proximal femur, 1983-1992: Chang Ju Lee, Won Ho Cho, Ho Guen Jang, Soo Jung Choi, Jong Oh Ha; J Korean Soc Fract 1994;7(2):331-340. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.331

Abstract PDF: The risk of fracture of the proximal femur is high for individuals with metabolic bone disease, or with low bone mass associated with advanced age. The menopause is generally believed to be an important factor in bone loss in women. In these group, even minor trauma(low energy injury) may result in fractures, while much greater force is needed to produce a fracture in people with higher bone mass. This study is aimed at ascertaining the age, sex and type-specific incidences in the hip fracture, the difference of frequency between the neck and trochanteric fracture and the change in the averse age of the hip fracture patient. All patient from this hospital with a diagnosis of fracture of the neck and trochanteric region of the femur during the period 1983 to 1992 were reviewed for this study. Patients with fracture resulting from metastatic lesions were excluded. The original medical records were reviewed for each patient, data were entered on protocol disinged for the study. The data included basic demographic informations such as patients age and sex, type of fracture of the femur neck or trochanter, type of the low/high energy injury, immediate cause of accidents, presence of the cormorbid diseases, and safety factors inducing fall accidents in home or outside. During the years 1983-1992, a total 240 patients with fractures of the proximal femur were identified from the operating recordings. Among them, data of 201 patients could be entered on protocol through the retrieved records. 1. Of 201 patients, 65 years or older are 117. 39 are men and 78 are women, 103 are low energy injury and 14 are high,57 are sustained by fractures on the neck of the femur and 60 are sustained on the trochanter. 2. Mean age of the 117 patients over 65 years old is 76 years. Those of men and women are equaly 76 years old. 3. Of 57 patients sustained with the fractures on the neck of the femur, their mean age is 71 years. Men are 18 patients, their mean age is 76 years. Women are 39 patients, their mean age is 75 years. 4. Of 60 patients sustained with the fractures on the trochanter of the femur, mean age is 76 years. Men are 22 patients, their mean age is 75 years. Women are 38 patients, their mean age is 77 years. 5. The cormorbid common diseases are the hypertension, cataract, diabetes mellitus(DM), celebre-vascular accidents(CVA), pulmonary tuberculosis, asthma, chronic obstrutive polmonary disease(COPD), mitral insuficiency(Ml), chronic heart failure(CHF), and chronic renal failure(CRF) in order of.

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Surgical Treatment of Complex Acetabular Fracture: Dae Yong Han, Chong Hyuk Choi, Yong Jin Yoon; J Korean Soc Fract 1994;7(2):337-344. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.337

Abstract PDF: The principle of operation for Acetabular fracture is, as for any other intraarticular fracture, required anatomical reduction followed by stable internal fixtion. But it is difficult to make good anatomical recuction with firm fixation, because of complicated anatomy and difficulty with surgical exposure. Traumatic arthitis and avascular necrosis of femoral head could be followed by operation. We reviewed 17 cases of complex acetabular fracture treated operatively from January 1984 to December 1991 The prevalent age group was the fourth decade. There were 7 cases of dislocation of the hip, 5 fracture of femur as associated injury. According to the Letournels classification, there were 2 cases of T-shaped fracture, 4 posterior column & posterior wall fracture, 2 anterior column & posterior hemitransverse fracture, 9 both column fracture. Surgical approach was extended iliofemoral method in all cases. The fractuer was fixed internally with only screws in 3 cases and with plate and screws in 14 cases. Treatment results was analyzed by Harriss hip scoring system and Mattas reontgenographic grading system. Among 12 patients who had followed up more than ony year, the satisfactory results were achieved in 76% and the poor results were achieved in 16%. The complications were post traumatic arthritis in 2 cases, avscular necrosis of femoral head 1 cases and skin necrosis 1 case. Anatomical reduction and firm fixation is essential for good result and extended iliofemoral approach is one of the good methods for surgical exposure of complex acetabular fracture.

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Treatment of Comminuted Subtrochanteric Fractures of the Femur with Ender Nails: Kwon Ick Ha, Sung Ho Hahn, Min Yeong Chung, Bo Kyu Yang, Jae Hoon Ryu; J Korean Soc Fract 1994;7(2):345-351. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.345

Abstract PDF: The subtrochanteric fracture of the femur is often comminuted because the bone here is mainly cortical and high velocity trauma and hiornechanically and adjacent power muscles. Therefore, it is difficult to maintain accurate reduction and rigid fixation and delayed or nonunion, limb shortening, varus deformity, mechanical failure, and many other problems can be encountered. We studied 6 comminuted subtrochanteric fractures treated with Ender nails from Sept. 1991 to Oct. 1992. 3 weeks of skin or skeletal traction followed by partial weight bearing postoperatively showed excellent outconles.

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Comparison between Intramedullary and Plate Fixation for Subtrochanteric Fracture of the Femur: Han Suk Ko, Byung Jik Kim, Suk Kyu Choo, Jae Sung Choi; J Korean Soc Fract 1994;7(2):352-363. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.352

Abstract PDF: Management of subtrochanteric fractures of the femur is difficult because it occurs in bone that is predominantly cortical and high stress concentrates in this region. The subtrochanteric fracture is difficult for the accurate reduction and maintenance because many of these fractures are cmminuted from high velocity trauma and its proximal fragment is severely displaced by adjacent strong muscles pooling. Therefore, as a rule we prefer to treat subtrochanteric fractures by operative means if possible. Many internal fixation devices have been recomended for use in subtrochanteric fractures and their selection should be based on the individual fracture anatomy. In recent years, generally accepted two methods are intramedullary nailing and plate fixation. We have reviewed our experience using the intramedullary fixation on 14 cases of subtrochanteric femur fracture and compared the result with those of 14 cases of plate fixation. All the 28 cases were treated at the Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University in the period from March 1988 to March 1993. Intramedullary fixation were implanted with shorter operating time, smaller incisions, and less intraoperative bleeding. The intramedullary fixation group had a shorter covalescence and earlier full weight-bearing but no significant difference in fracture union rate with plate fixation group. We conclude that with careful surgical technique, the intramedullary fixation was a more suitable method for the treatment of the subtrochanteric femoral fractures.

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Conservative Treatment of Scapular Fractures: Jae Won You, Hyun Jung Yoon; J Korean Soc Fract 1994;7(2):364-370. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.364

Abstract PDF

Fracture of the scapula is relatively uncommon injuries. It is often caused by violent direct trauma and associated injuries of the shoulder and thorax are very common. The purpose of this study is to evaluate the clinical results and the complications of the conservative treatment on the scapular fracture. We reviewed 42 cases of the scapular fracture treated conseuatively from 1987 to 1993. The follow up period ranged 14 to 30 months. The results were as follows. 1. The most common cause was traffic accident(30 out of 42 cases), especially pedestrian(15 cases). 2. Mostly associated injuries were ipsilateral clavicle fractures(25%), rib fractures(22.5%), humerus fractures(20%), hemopneumothorax(20%), brachial plexus injuries(20%), and head trauma(20%). 3. According to the classification by Ada and Miller, the neck fracture was most common(36.5%). 4. According to the criteria of functional result by Hardegger et al, excellent and good results are 80.9%(34 out of 42 cases). 5. The complications were the limited range of motion(3 cases), shoulder pain(2 cases), brachial plexus injury(2 cases), and malunion(2 cases). 6. In most cases of conservative treatment, we obtained satisfactory results but we think that the more active surgical treatment will be necessary in the cases of the intraarticular glenoid fracture, the combined fractures, the floating shoulder, and the double disruption of superior suspensory shoulder complex, especially in the active age.

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Clinical Results of Lateral-Posterior Internal Fixation for the Treatment of Scapular Body Fractures
Yoon-Min Lee, Joo-Dong Yeo, Seok-Whan Song
Journal of the Korean Orthopaedic Association.2020; 55(1): 46. CrossRef

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A Diagnosis and Treatment of Carpal Scaphoid Fractures: Ig Gon Kim, Soo Gon Kim; J Korean Soc Fract 1994;7(2):371-378. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.371

Abstract PDF: The scaphoid fracture is the most common fracture in carpal bones. Its diagnosis is very difficult because of less symptoms and swelling. But unfortunately its complications such as nonunion, avascular necrosis, and osteoarthritis were severe. We reviewed 27 cases of the carpal scaphoid fractures treated from March 1989 to March 1993 in Hae-Dong hospital and obtained following results. 1. The highest peak was third and forth decades. 24 cases were male among 27 cases. The most common cause of fracture was outstretched hand injury. 2. The middle third was the most common location(60%) and transverse type fractures were 12 cases(75%) among these fractures. 3. We gained 75% bone union at average 15.4 weeks in proximal 1/3 carpal scaphoid fractures, 93% union at average 12.9 weeks in middle 1/3 fractures, and 100% union at average 11.2 weeks in distal 1/3 fractures. 4. The results of treatments were evaluated by Maudsley method. Excellent and good results were 10 of 11 cases in conservative treatment, 13 of 16 cases in operative treatment. According to fracture sites excellent, and good results were 1 of 4 cases in proximal fracture, 14 of 16 cases in middle fracture and all of 7 cases in distal. 5. The complications were 2 cases of nonunion,3 cases of avascular necrosis and 2 cases of osteoarthritis. 6. In case of delayed diagnosis, the longer duration of treatments were needed, We obtained better results in fresh, undisplaced fractures with thumb spica cast than old displaced fractures. We gained better results in displaced fractures with open reduction and bone graft than conservative methods.

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Surgical Treatment of Calcaneal Fractures: Koon Soon Kang, Jun Seop Jahng, Bui Wan Park, Ho Jung Kang, Dong Eun Shin; J Korean Soc Fract 1994;7(2):379-387. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.379

Abstract PDF: The Os Calcis is the largest bone of the tarsal bones. The incidence of fracture of the calcaneus is more frequent than that of any other tarsal bones. Farctures involving subtalar joint can usually cause serious and persistent disabilities and badly influence the patients psychologically, socially and economically. But, there was no standardized treatment method for these fractures. The purpose of this article is to describe the surgical technique and the results obtained in 33 consecutive cases of calcaneal fractures involving the subtalar joint. The results were as follows, 1. Of 33 patients, 24 patients were male and 9 patients were female. 2. The main cause of fracture of calcaneus was a fall from a height in 79% of cases. Most of the associated fractures were the spinal and tibial fractures. 3. Of these intra-articular fractures, 19 fractures were joint depression type and 14 cases were tongue type by Essex-Lopresti classification. 4. Open reduction and internal fixation was performed in 18 cases of joint depression type and 6 cases of tongue type, and closed reduction and axial pinning was performed in 8 cases of tongue type and 1 case of joint depression type. 5. After average twenty-two months follow-up, the over all results of open reduction and internal fixation were excellent and good in 71%, and that of closed reduction and axial pinning were excellent and good in 67% by Salama creteria. 6. Complications included four superficial wound infection and one subluxation of peroneal tendon.

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A Clinical Study of Ankle Diastasis with Fracture of flbula: Koon Soon Kang, Jun Seop Jahng, Hui Wan Park, Ho Jung Kang, Young Chul Cho; J Korean Soc Fract 1994;7(2):388-396. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.388

Abstract PDF: Ankle joint is important as a weight-bearing joint and ankle diastasis requires accurate diagnosis and treatment. The authors analysed 82 cases of ankle diastasis with fibular fracture during the year 1986 through 1992 at YoungDong Severance Hospital. The results obtained are as follows. 1. The most common cause of injury was slip down, and traffic accident and fall down in order. 2. By Weber classification, 42 cases were type BS(+) and 40 cases were type C. By Lauge-Hansen classification, supination-external rotation was most common (35 cases). 3. Open reduction was done in all cases for fracture of fibula. 45 cases of ankle diastasis were treated with one transfixation screw and 37 cases without transfixation after confirmation by Cotton test. 4. The result according to Cottons criteria, 39 cases(86.7%) were were good or fair in transfixation group, and 34 cases(91.9%) in nontransfixation group. In conclusion, the transfixation screw was not necessary in cases of ankle diastasis which was considered as stable by Cotton test after internal fixation for the fracture of fibula.

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Minimal Arthrotomy for Postoperative Knee Arthrofibrosis in Patella Fracture: Report of 3 Cases: Koon Soon Kang, Jun Seop Jahng, Young Chul Cho; J Korean Soc Fract 1994;7(2):397-403. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.397

Abstract PDF: Significant and Permanent loss of knee flexion or extension is a recognized and disabling complication of either operative procedures or trauma about the knee. We have experienced 3 cases of the postoperative ankylosis of the knee after the patella fracture, in which the range of motion of the knee was not satisfactory after the trial of the arthroscopic Iysis of adhesion with manipulation of the knee, so minimal arthrotomy, limited lateral arthrotomy combined with medial arthrotomy, were performed and revealed the satisfactory results.

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Treatment of Intertrochanteric Fractures of femur in Elderly Patient with Osteoporosis: Chung Nam Kang, Jin Man Wang, Kwon Jae Roh, Jong Oh Kim, Yeo Hon Yun, Seok Beom Lee, Dong Jun Kim, Chung Hyok Choi, Dong Wook Kim, Seok Woo Kim; J Korean Soc Fract 1994;7(2):404-411. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.404

Abstract PDF: With the age of our population advancing, the number of elderly osteoporotic patients with comminuted intertrochanteric fractures of the femur has increased dramatically. Intertrochanteric fractures of the femur usually occur in a more elderly age group than femoral neck fractures of the femur usually occur in a more elderly age group than femoral neck fractures. Intertrochanteric fractures are best treated by intenal fixation, since this mehod provides satisfactory positioning of the fragments and obviates the hazards of recumbency. However, in some caces with severe osteoporosis, arthroplasty is an excellent altemative to the internal fixation. From 1987 to 1992, thirty-six intertrochanteric fractures of femur in the elderly patients(over 60 years of age) were treated by operation at the department of orthopaedic surgery in the Ewha Womans University Hospital. Thirty-three caces were internally fixated with the sliding-compression hip screws-plates(30), the Gamma interlocking intramedullary nails(2), the Rohs plate(1), and in three caces endoprosthetic or total hip replacement arthroplaties were performed.

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Treatment of Femur Neck and Intertrochanteric Fractures in the Elderly with primary Hemiarthroplasty: Myung Chul Yoo, Ki Tack Kim, Yoon Je Cho, Seung Duk Sun, Gyoung Chean Park; J Korean Soc Fract 1994;7(2):412-421. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.412

Abstract PDF

From January 1982 through December 1992, 102 hips in 100 patients had a primary hemiarthroplasty for the treatment of femur neck and intertrochanteric fractures in the elderly who had severe comminuted fractures or poor bone quality and poor genenral condition. Of these, we reviewed 62 hips in 62 patients with a minimum follow-up over one year. 1. The average age at operation was 71.7 years(50-96 years). 2. The most common cause of injury was slip down in 56 cases(90.4%). 3. Bone quality was evaluated with Singh index radiologically and 42 cases(67.8%) were classified to below grade III. 4. Most patients were possible to sit and start wheel chair ambulation within a week and the average period of time from operation to partial weight bearing was 12.9 days. 5. In clinical evaluation, the average Harris hip score was 75.9 in the femoral neck fractures and 71.9 in intertrochanteric fractures and 73.2 in the unipolar endoprosthesis group and 69.5 in the bipolar endoprosthesis at the final follow up. 6. Postoperatively, 13 hips(21%) had only mild discomfort, 6 hips(10%) had moderate pain, one hip(1.6%) had severe pain on the ipsilateral hip or thigh, or knee. 7. The most common early postoperative complications were superficial wound infection(3 cases, 6.4%). 8. In the radiological evaluation, the most common late postoperative complications were leg length discrepancy(L.L.D) in 6 cases(9.7%) and acetabular erosion in 5 cases(8.1%). 9. In the analysis of the relationship between prosthetic head size compared to acetabular size and acetabular erosion, more proper size of prosthetic head raised less acetabular erosion, 1 case(2.5%), and large size of prosthetic head raised more acetabular erosion, 2 cases(28%). There was no significant difference in the incidence of the acetabular erosion between the unipolar and bipolar endoprosthesis group. In this study, most of the patients had relatively good results and lower incidence of local or general complictions. Therefore, hemiarthroplasty can be suggested for one of primary treatment method of intertrochanteric fractures and femur neck fractures in elderly patients who had fevere comminuted fractures or poor bone quality and poor general condition.

Citations

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The Efficacy of Suture Fixation of the Greater Trochanter in Unstable Intertrochanteric Fractures
Ki-Choul Kim, Hee-Gon Park, Jae-Wook Park
Clinics in Orthopedic Surgery.2021; 13(4): 468. 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

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Surgical Treatment of Acetabular Fracture: Sung Kon Kim, Seung Woo Suh; J Korean Soc Fract 1994;7(2):422-430. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.422

Abstract PDF

Acetabular fracture results from high-enegy trauma that cause considerable displacement of the fracture fragments as well as to articular surface of the acetabulum. The goal of surgical treatment is to prevent post-traumatic arthritis and avascular necrosis of femoral head by reconstructing the articular surface accurately and restoring the contact areas between the acetabular and femoral head. We analyzed 15 patients who were treated with surgical method at Korea University Ansan Hospital from May 1989 to July, 1992 and followed up more than 1 year. The results were as follows: 1. The most common type was posterior wall fracture in 5 cases(33.3%), transverse fracture in 4 cases(26.7%), both column fracture in 4 cases(26.7), anterior column fracture in 2 cases(13.3%) in sequeuce according to Letournel classification. 2. The most common cause of injury was traffic accident in 13 cases(86.6%), and 2 cases(13.4%) were passengers. 3. There were 9 cases(60.0%)operated within 7th day after injury, 4 cases(26.7%) between the 7th day and 14th day, 2 cases(13.3fo)at the 21st day. 4. The employed surgical approaches were the extended ilio-femoral approach in 7cases(46.7%), the Hocker-Langenbeck approach in 6 cases(40.0%), the ilioinguinal approach in 2 cases(13.3%). 5. The result of treatment was satisfactory in 13 cases(87.7%) and the complications were post traumatic arthritis in 2 cases(15.4%), ectopic ossification in 1 case(6.7%), and avascular necros of femoral head in 0 case.

Citations

Citations to this article as recorded by

Comparative Results of Acetabular Both Column Fracture According to the Fixation Method
Kyung-Jae Lee, Byung-Woo Min, Eun-Seok Son, Hyuk-Jun Seo, Jin-Hyun Park
Hip & Pelvis.2011; 23(2): 131. CrossRef

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Treatment of Tibial Shaft Fractures by Intramedullary Nailing: Sung Kon Kim, Sung Woo Suh, Hyung Suk Kim; J Korean Soc Fract 1994;7(2):431-437. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.431

Abstract PDF: From March, 1989 to Sept. 1992, total of 31 cases of tibial shaft fracture have been admitted treated with intramedullary nailing at the Department of Orthopaedic Surgery, Ansan Hospital, Korea University. Among them, 13 cases which had been followed-up than 2years were analyzed and the results were as follows; 1. Among the 13 patients, 9 of them(69.2%) were male, the rest of 4(30.8%)were female. 2. Eight cases out of 13 were open fractures with Gustilo type I-4 cases, type II-2 cases, type III-2 cases and the remaining 5 were closed type. 3. Treatment offered were either interlocking intramedullary nailing(10 cases, 76.9%) or insertion of flexble nails(3 cases, 23.1%). 4. There were no cases with non-union and the average period of bone union was 21.6 weeks. 5. Delayed union and superficial infection occured in each three cases as a complication. 6. Intramedullary nailing could be used carefully in tibial shaft fracture even in the communicated & open fractures.

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Treatment of Tibial Shaft Fractures by Intramedullary Nailing: Sung Kon Kim, Sung Woo Suh, Hyung Suk Kim; J Korean Soc Fract 1994;7(2):438-443. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.438

Abstract PDF: The incidence of the intertrochanteric fracture of the femur is increasing due to increased geriatric population. The primary goal in the treatment of an order patients with an intertrochanteric fracture is to obtain anatomical reduction and rigid fixation for the rapid mobilization, decreased mortality and restoration of function. Many devices were developed for this purpose, especially of compression hip screw had gained considerable acceptance. A retrospective study of clinical results of the 50 cases intertrochanteric fracture from March 1990 to January 1993 was performed. The result were as follows; 1. Average age is 58 years and sex distribution is 31 cases of male, 19 cases of female. 2. Common cause of injury are slip down and traffic accident. Affected side is Rt 32 cases and Lt 18 cases. 3. According to the classification (of Boyd-Graffin), there are 14 case of Type I, 31 cases of Type II 2 cases of type III,3 cases of Type IV. 4. Among 50 cases, complication is encountered in 8 cases angular deformity (4 cases), limitation of motion(3 cases), infection(1 case). 5. After treatment of intertrochanteric fracture ; Neck-shaft angle of non-displaced fracture and comminuted fracture was an average 2 degree varus angular deformity. Vertical displacement of non-displaced fracture was an average 4.5mm and comminuted fracture was 5.0 mm. Medial displacement of non-displaced fracture was an average 3.5mm and comminuted fracture was 4.5mm. 6. Satifactory results could be obtained by open reduction and internal fixation with compression hip screw.

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Surgical treatment of Unstable Acetabular Fracture Clinical analysis of 28 cases with consideration of surgical problems and complications: I Kim, Y K Woo, Y S Kim, S W Song, S Y Kwon, S A Park; J Korean Soc Fract 1994;7(2):444-456. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.444

Abstract PDF: Authors reviewed total 28 cases of acetabular fracture with operative management followed up over 1 year. The clinical results were retrospectively analyzed with consideration of surgical problems and complications. The overall results were as follows: 1. According to the classification by Judet and Letoumel(1974), 20 cases were elementary fractures and 8 cases were associated fractures. The posterior wall fractures were most common in 9 case. 2. Kocher-Langenbeck approach in 18 cases, ilioinguinal in 4 cases, iliofemoral in 4 cases and triradiate transtrochanteric approach in 2 cases were used. 3. The devices for internal fixation were as follows screw only in 8 cases. plate and screw in 14 cases, plate and screw with circumferential wiring In 4 cases, wire and staple only in 1 each case. 4. The early and late complications occurred postoperatively as follows : incomplete sciatic nerve palsy 2 cases, wound infection 2 cases as early complications and posttraumatic arthritis 6 cases. avascular necrofis of femoral head 2 cases, heterotropic ossification 1 case as late complications. Two cases of sciatic nerve palsy were spontaneously recovered and 2 cases of wound infection were controlled by adequate drainage and antibiotic therapy. And then, the total hip arthroflasty were carried out for 2 cases of avascular necrosis of femoral head, and 6 cases of posttaumatic arthritis and 1 case of heterotopic ossification were under observation. 5. Postoperatively, the causes of inadequate reduction and insufficient fixation were radiographically analyzed with immediate]y and lastly checked plain films, of which causes in 9 cases were as follows : inappropriate approach for exposure in 4 cases, delayed operation due to major associated injury over 3 weeks in 3 cases and severe comminution in 2 cases. As a result, we reached to put an emphasis on an importatnce of preoperative planning, including the evaluation of individual fracture personality, the choice of surgical approach and the method of internal fixation.

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