Journal of Musculoskeletal Trauma

Anatomy and Kinematics of the Scaphoid: M S Chung, Y B Park; J Korean Soc Fract 1996;9(2):241-247. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.241

Abstract PDF: No abstract available.

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Scaphoid Fractures Mechanism of Injury and Diagnosis: P T Kim; J Korean Soc Fract 1996;9(2):248-251. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.248

Abstract PDF: No abstract available.

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Treatment of Acute Scaphoid Fracture: C S Kwon; J Korean Soc Fract 1996;9(2):252-254. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.252

Abstract PDF: No abstract available.

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Treatment of Scaphoid Nonunion: E S Kang; J Korean Soc Fract 1996;9(2):255-256. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.255

Abstract PDF: No abstract available.

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Scaphoid nonunion Ireated by Bone Graft and Internal Fixation: Jae Sung Seo, Myun Whan Ahn, Woo Seok Jang; J Korean Soc Fract 1996;9(2):257-263. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.257

Abstract PDF: There is difficuity in the treatment of scaphoid nonunion, because of it is not easy to diagnosis scaphoid fracture after affecting the damage, and also of inadequate treatment. We have performed wedge bone Graft and internal fixation in treatment of 52scaphoid nonunions from April, 1986 to June, 1994. We got result as below by analysis of 27 cases which could follow up more than one year. 1. The most frequent age of fracture is the 3rd decade and the fracthre is more frequent in men (26 cases)than in woman (1 case). 2. The X-ray fingings of nonunion are bony sclerosis (13 cases), cystic change(3 cases), and absorption of fracture line (11 cases). 3. The mean period of bony union is 14.7 weeks. 4. In 8 cases there has been dorsal intercalated segmental instability(DISI) on preoperative X-ray finding and which is corrected after operation. 5. In evaluatory system by Herbert and Fischer about degree of patients satisfaction, the grade 0 is 15 cases, grade 1 is 11 cases and grade 2 is 1 case, in clinical results, grade 0 is 15 cases, grade lis 9 cases and grade 2 is 3 cases, in radiographic result, grade 0 is 22 cases, grade 1 is 4 cases, grado 2 is 1 case.

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The Treatnent of Fracture and Nonunion of the Carpal Scaphoid: Sung Keun Sohn, Sung Soo Kim, Myung Soo Lee; J Korean Soc Fract 1996;9(2):264-273. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.264

Abstract PDF: The scaphoid fracture is the most common fracture in carpal bones and its incidence of nonunion, avascular necrosis and ostoarthritis is high because of its precarious blood supply and diffculties of diagnosis and treatment. Authors analyzed 14 cases of carpal scaphoid fractures that treated at the Department of Orthopaedic Surgery College of Medicine, Dong-A University from March 1991 to February 1994 The results were obtained as follows 1. The results of treatment were evaluated by Maudsley method. Excellent or good results were 7 of 8 cases in the Herbert screw fixation, 1 of 2 cases in the K-wire fixation and all cases in the conservative treatment and the bone graft. 2. The mean duration of immobilization was no significant difference regardless of the treatment method in fractures. But in nonunions,there was a decreased immbilization time with the Herbert screw fixation as comparing with the K-wire fixation. 3. In fractures, Herbert screw fixation showed early bone union comparing to other treatments. And there was no significant difference of bone union regardless of the treatment method in nonunion.

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Treatment of Carpal Scaphoid Fracture: Byoung Ho Lee, Dong Min Shin, Sang Ho Ha; J Korean Soc Fract 1996;9(2):274-282. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.274

Abstract PDF: We reviewed 32 cases of scaphoid fracture, treated from June, 1989 to June, 1994. The average follow up period from operation was 13 months. We analyed clinical result according to fracture classification and method of treatment. Nonsurgical treatment of displaced fracture generall gave poor result. In scaphoid fracture associated with complex injury open anatomic reduction and ligament repair was significantly better than conservative treatment. In the treasradial-styloid scaphoid fracture, anatomic reuduction and fixation of radial stloid is neccessory. To protect the misplacenlent of hardware, procisional K-wirc fixation and radiological confirmation will be indispellsable.

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Treatment of Unstable Intraarticular Fracture of Distal Radius with External Fixator and Minimal open Reduction: Jae Sung Seo, Jin Myeung Dan, Dong Chul Lee, Se Dong Kim; J Korean Soc Fract 1996;9(2):283-289. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.283

Abstract PDF: The distal radius fracture is one of the most common fracture in orthopedics, but their optimal treatment has not been delineated, especially in unstable intraarticular fracture. The unstable intraarticular fracture is increasig due to high energy injury following industrialization and increasing traffic accidents. The unstable intraarticular facture of the distal radius comprises distince subgroups that are difficult to manage and are associated with a high frequency of posttraumatic arthritis. Authors treated 6 cases of unstable intraarticular fracture of distal radius using external fixator and minimal open reduction to improve anatomical and functional results. Six patient were followed up more than one year (mean 19.3 month) and the patients were assessed functional results by Green and 0Briens score and anatomical results by Stewarts scale. Using the external firator and minimal open reduction, is thought to be a useful method for treatment of unstable intraarticular fracture of the distal radius.

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Treatment for the Malunion of the Distal Radius: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Cheol Soo Ryoo, Woo Keun Jung; J Korean Soc Fract 1996;9(2):290-294. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.290

Abstract PDF: Malunited fractures of the distal radius may result in adequate function of the wrist with absence of pain in elderly patients. However, posttraumatic dedormity in younger, active patients is less well toterated, especially in those engaged in heavy manual work or who require a normal range of motion of the wrist. surgical correction of the malunion of the distal radius should be considered for this group of patients. Operation for the malunited fractures of the distal radius was performed in ten cases during the periods between January, 1990 and December, 1993, who were followed for an average of 15 months.The procedures included radial osteotomy(RO) in four malunions of short duration, radial osteotomy with ulnar shortening (RO & US) in these malunions of long duration and ulnar shortening(US) in three cases. We reviewed these cases retrospectively with respect to the clinical findings(pain, grip strength, range of motion of the wrist) and radiograpic changes(volar tilt, radial articular inclination and radiul shortening). Symptoms(radioulnar or radiocarpal pain) were improved in all cases. By compairing with the opposite sides, resedual loss of grip strength was 35% in RO group, 40% in RO & US and 31% in & US group. Residual loss of motion in flexion and extension or in deviation was similar in all groups, whill loss in rotation was less in RO or RO & US group than in US group. Inclination of the radial articular surface (radial inclination and volar tilt) was restored up to the degree similar to the opposite wrist in RO or US group, while was not in US group. Radial length was restored up to the dgegrees similar to the opposite wrist in all groups. The overall results were good or very good in five among the seven cases of RO group(with or without ulnar shortening), while good only in one among the cases of US group.

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T-Plate Fixation of Unstable Fractures of the Distal Radins: Churl Hong Chun, Sang Soo Kim, Hak Sun Kim, Jeong Hyu Lee; J Korean Soc Fract 1996;9(2):295-302. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.295

Abstract PDF: In the treatment of Unstable fractures of the Distal Radius, selecting a right method of treatment that can give the best result is very difficult. Many complications can be developed if improper mothods are chosen o treat these fractures. We analyzed 25 patients with unstable fractures of the distal raduis, being treated with open reduction and internal fixation with T-plate from May 1986 to December in 1994 and, being followed for more than 12 months. The results were as follows; 1. In twenty-five patients, 17 cases were Cellosfractures, 2 cases Smith fractures and 6 cases Bartons fractures. 2. In follow-up roentgenogram, the mean values of the radial length, radial deviation, volar tilt and step-off are 18.8 mm,20.3 ,8 ,0.2mm respectively. 3. Recovery of wrist function was correlated with the degree of correction of volar tilt angle in the postoperative roentgenogram . 4. In 25 patients treated with open reduction and internal fixation using the T-plate, satisfactory result was obtained in 88% (22 cases) of patients, We concluded that this is the effective method for treating unstable fractures of the distal radius because this method permits early motion of the wrist by firm and stable fixation.

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Surgical Treatment of Comminuted Distal Radius Fracture using External Fixators: Suk Kyu Choo, Byung Jik Kim, Han Suk Ko, Young Lim, Jeong Gook Seo, Jae Kie Shin; J Korean Soc Fract 1996;9(2):303-310. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.303

Abstract PDF: Comminuted fractures of distal radius are usually unstable and complex injuries, which require prolonged treatment and often result in some degree of permanent disability. Previous treatment was mainly closed reuction and cast immobilization, and operative treatment of accurate open reduction, internal fixation and bone graft when needed. But recently ligamentotaxis of the fracture using external fixation device has been widely employed. Which could be followed up for 12 cases of comminuted fractured of distal radius operated with external fixators, more than 1 year, during the period of September 1990 to September 1994 at Seoul Paik Hospital was reviewed. According to Frykmalls classification, the most common type was type VIII (7 cases, 58.3%). There was 1 open fracture, and 7 combined injuries of ipsilateral upper extremity. According to AO classification, 9 cases(75%) were type C2 and C3. The most common cause was failing down from a height(6 cases). Additional limited internal fixation was done in 5 cases, all 12 cases were treated external fixators. Results were defined with modified Gartland & Werleys demerit pointing system, exellent was 6 cases(50fr), good wa,i 4 cases(33.3F)), poor was 2 cases. Surgical treatment using external fixators and/or limited open reduction was good Inethod for comminuted distal radius.

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Proximal Row Carpectomy for Disease of the Proximal Carpal Bone: Seung Koo Rhee, Hyoung Min Kim, Soon Young Kwon, Hwa Sung Lee, Hang Kyu Lee; J Korean Soc Fract 1996;9(2):311-318. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.311

Abstract PDF: The management of pain, stiffness and weakness of the wrist following unsuccessful conservative treatment of fractures of the scaphoid or of Kienbocks disease and so on is a difficult problem. Despite the recommendation by Cotton in 1924 and subsequently by others that the proximal row of carpal bones should be removed in the presence of disease, arthrodesis or various stabilizing procedures continue to be recommended. But, although a radiocarpal fusion, when successful, leads to a painless, stable wrist, the loss of the normal motion of the wrist inevitably results in some loss of function of the hand. The purpose of this study is to evaluate the efficacy of the proximal-row carpectomy. Since 1987, five patients were studied following proximal-row carpectomy. The lesions for which the operation was done included two Kienbocks disease, one crushing injury, one transscaphoid volar lunar dislocation, and one scapholunate dissociation. Their end results after average 74 months of follow-up showed less pain than before operation and a reasonable range of flexion/extension which varied between 65% and 85% of normal, the average being 74%, Postoperative grip strength was from 70 to 90% fo normal, the average being 78%. In conclusion, excision of the proximal row of tile carpus is a useful procedure, with a limited application in patients with Kienbocks disease, dislocation of the lunate bone, scapholunate dissociation and similar injuries which do not respond to conservative management.

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Conservative Treatment for Distal Radius Fractures: Sang Ho Ha, Sang Hong Lee, Dong Min Shin, Young Bae Pyo, Hyun Sik Mun; J Korean Soc Fract 1996;9(2):319-325. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.319

Abstract PDF: Fracture of the distal radius is one of the most common injuries Met in the orthopaedic field. Once it was thought that good function comes despite poor anatomic restoration in distal radius fractures. But now maximum recovery of wrist function is dependent on accurate and stable reduction of the radial articular surface. We reviewed thirty-nine cases of distal radius fracture that were treated with closed reduction under C-arm field and then the wrist was immobilized by a sugar tong cast splint and then a long arm cast, from Aug. 1992 to Aug. 1995 at the Department of Orthopaedic Surgery of Chosun University Hospital. The results of this study were as follows; 1. The main causes of these injuries were from slipping(51.3%) and falling down(28.2%). 2. Among the 39 cases of distal radius fracture, 12 cases(30.8% ) had unstable fractures. 3. In the 39 case, satisfactory results were shown in 25 cases but, in the unstable fracture group, 10 cases out of 12 cases showed unsatisfactory results. 4. When the articular surface of the radius was severely comminuted and the fracture site was severely displaced, the result of this study was poor. 5. Accurate and stable reduction of the radial articular surface & radial length was significantly correlated with the clinical results.

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K-wire Migration into the Thoracic Cavity after Surgery of Scapular Fracture: A Case Report: In Ju Lee, Nam Yong Choi, Young Chae Lee, Hyun Seok Song; J Korean Soc Fract 1996;9(2):326-329. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.326

Abstract PDF: The use of smooth and threaded pins for internal fixation is often complicated by component migration to a part of the body especially when employed about the acromioclavicuiar Joint. A case report of K-wire migration into the thoracic cavity following surgery of scapular fracture is presented. This phoenomenon occurred despite efforts to bend the lateral ends of the pins to prevent medial migration. If pins or wires are employed even bent at the lateral ends, chinidcal and x-ray follow up should be frequent. The pins should be removed immediately on obtaining the desired therapy.

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Displaced Supracondylar Fractures of the Humerus in Children: Comparative Analysis between Percutaneous Pinning & Open Reduction: Won Sik Choy, Hyun Dae Shin, Hwan Jeung Kim, Kwang Won Lee, Hyung Sun Baik, Nam Hun Kim; J Korean Soc Fract 1996;9(2):330-340. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.330

Abstract PDF: Supracondylar fracture of the humerus is the Inost common fracture of the elbow in children and it can aiso be one of the most difficult fractures to be treated. The authors periormed retrospective study of 85 patients who were treated by percutaneous pinning, and by open reduction from 1989 to 1993. 1. The mean age 7.4 years, ranging from 2 years to 13 years and the male and female ralio was 2.1:1 2. The left side was more frequently involved(66%). 3. Treatment methods were PP 52% & OR 48% 4. According to tile Flynns criteria, the results of the treatment by PP wear excellent 80%, Good 4%. Fair 9%, Poor 7% and OR were 54%, 12%, 15%, 19%, respectively. 5. No stastisfically significant differences regarding maintenance of reduction were found when comparing crossd-pin and lateral-pin fixation.

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Treatment of the Pediatric Ankle Fracture: Kyung Chul Kim, Jae Yeul Choi, Joon Sik Kim, Young Soo Jhe, Beoung Chul Yun; J Korean Soc Fract 1996;9(2):341-348. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.341

Abstract PDF

The objectives of this study is to evaluate the incidence and the complicated results of pediatric ankle fracture. The injuries of the ankle in children occur mostly at physis rather than ligamentous structure, and the injuries of the physis may result in arrest of the growth of physis and these may lead to angular deformity, joint incongruity, and growth disturbance, which are frequently reported in the literatures. Accurate treatment under the clear understanding of mechanism of injury in very important for preventing this complications. We reviewed 17 cases of pediatric ankle fracture, from June 1990 to June 1994 and followed up for more than 1 year at department of orthopaedic surgery Kangbuk Samsung Hospital. We could obtain results as follows; 1. The mean age was 1 1 years old, and predominant in male. 2. Sports injury was the most common cause. 3. According to modified Dias and Tachdjan classification, supination inversion type was the most common and according to Salter Harris classification, type II was. 4. Eight cases were treated by closed reduction and immobilizatior in a plaster cast, and other nine by open reduction and internal fixation, among them, three cases had complications, such as angular deformity, Joint incongruity, and premature closure of physis.

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Interposition of Periosteum in Distal Tibial Physeal Fractures of Children
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Jae Woo Cho
Journal of the Korean Fracture Society.2011; 24(1): 73. CrossRef

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Unusual Isolated lateroplantar Dislocation of the First Tarsometatarsal Joint: A case Report: Joo Hong Lee, Jae Hoon Lee, Hak Ji Kim, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 1996;9(2):349-353. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.349

Abstract PDF: Dislocation and fracture-dislocation fo the Tarsometatarsal joint were rare injuries, but an increase of motor vehicle accidents, industrial and athletic injuries seems to be responsible for an incresing incidence of these injuries. Because of the basic inherent stabilith of the bony architecture and the structures on the sole of the foot including the plantar fascia, the intrinsic foot muscles, peroneus, tibialis posterior tendon and the stronger plantar pligaments most dislocations occur in dorsal and lateral direction. We report a case of 32 year-old male patient who had an isolated fracture and disloction of the first Tarsometatarsal joint with laterai and plantarward displacement. This developed by in-car accident and which did not fit to any proposed classification systems. The diagnosis was delayed because of the combined injuries, but with open reduction and internal fixation with 2 smooth K-wires, satisfactory results could at 12 moonths follow-up study.

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Surgical Treatment of Intra-articular Fracture of the Os Calcis: Soo Kil Kim, Young Gyu Kim, Bum Gu Lee, Jin Hong Ko, Su Chan Lee, Young Kim; J Korean Soc Fract 1996;9(2):354-365. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.354

Abstract PDF: Intra-articular fractures involving the posterior facet of the subtalar joint are associated with significant and prolonged disability. But, the treatment of choice for displaced intra-articular calcaneal fractures remains controversial. We treated 30 displaced intra-articular fractures of the calcaneus by open 1eduction and internal fixation through the lateral approach with autogenous bone graft at the Department of Orthopaedic Surgery, Choong-ang Gil and Dong Inchon Gil Ceneral Hospital from January 1990 to October 1994 The clinical and radiographic analyses were as follows. 1. Of 26 patients, 20 patients were male and 6 patients were female. 2. The main cause fractures of calcaneus was a fall from a height in 23 cases(88%) and most of associ ated fractures were spine injury in 6 patients. 3. Fracture was classified according to Essex-Lopresti classification. 13 cases were tongue type, 17 cases were joint depression type. 4. Alt Open reduction and internal fixation through the laterl approach with bone graft was performed in joint depression type and tongue type. 5. The preoperative ayerage Bohlers angle was - 5. The postoperative avereage Bohlers angle was -24, Which was increased significantly. 6. Complications were 12 cases ; included heel pad pain in 8 caLes, osteomyelitis and superficial wound infection in 2 cases, transient sensory hypesthesia on the lateral side of the foot in 2 cases. 7. Based on assessement of Salama, the results were excellent in 5 cases, good in 1 Teases, fair in 6 cases, poor in 2 cases.

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Operative Treatment of Calcaneal Fracture: Jeong Ho Park, Young Min Yoon, Young Gi Hong, Jeong Whan Son, Jae Do Kim; J Korean Soc Fract 1996;9(2):363-368. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.363

Abstract PDF: In the past, the treatment of calcaneal fracture was mainly non-operative, because of its unique shape, difficulties arose in understanding the pathoanantomy of the fractures. Following to advancement in imaging techinique including CT scan, which became to evaluate fracture patterns of the calcaneal fracture more accurately, the operative treatment has been popularized. The extensive lateral approach for intra-articular calcaneal fracture which was reported by Letournel in 1988, provides sufficent exposure of calcaneus and allows the easier reduction, rigid fixation and early mobilization. The 11 tases of 10 patients of intra-articular fractures of calcaneus were treated with open reduction and internal fixation through extensive laterai approach form Jan.1992 to Dec. 1994. The satisfactory result were observed in 8 cases(73%) by Stephenson criteria. It was concluded that operativa treatment will be better to the intra-articula fracture of the calcaneus than the conservative treatment.

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A Treatment of Fracture of the Neck of the Talus: In Suk Oh, Do Hyun Moon, Jin Hong Ko, Ki Dong Kang, Si Hwan Kim; J Korean Soc Fract 1996;9(2):369-375. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.369

Abstract PDF: A fracture of the tatar nock if relatively rare, but it is generally regarded as a serious traumatic lesion of the ankle, because of the poor outcome after treatment. The talus has a special anatomical, functional and vascular characteristics. So the complications with avascular necrosis and nonunion and degenerative joint diseases are frequent. We reviewed 19 cases who treated at ChungAng Gil General Hospitai from January, 1990 to August, 1994 and studied the incidence of complications and important factors in achieving good results. The follow up period was at least 12 months. The results were as follows; 1. Of the 18 cases, there were 18 males and 2 females, and most were third and fourth decades(67%). 2. The main cause were a fall down injury(44%), with sudden hyperextension as its mechanism. 3. According to Hawkins classification, type I, type II & type III were 6,8 & 4 cases, respectively. 4. The accompanying ipsilateral peri-ankle involvement were observed in 44%. 5. As for the method of treatment, C/R with cast immobilization were performed in 6 cases of type I while O/R and I/F with screw & Steinmann pin done on others. 6. As for the complications, AVN, skin necrosis, traumatic arthritis and infection were 3, 1,2 and 1 cases, respectively. : Excellent in 9 cases, good in 6, fair in 1, poor in 2. Consequently we think, in the treatment of displaced neck fracture and dislocation of talus, it is important to decompress the soft tissue early with concomitant anatomical reduction & internal fixation to get a satisfactory results.

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Treatment of Unstable Intertrochanteric fracture of the femur in Elderly Patients: Deuk Soo Hwang, Cheol Se Ahn, Sang Yong Lee; J Korean Soc Fract 1996;9(2):376-383. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.376

Abstract PDF: Intertrochanteric fractrures in elderly are a frequent problem and are becoming more common as the population of elderly people in the population increase. The treatment of unstable intertrochanteric fracture present a challenging problem. Severe comminution in elderly osteoporotic patients renders internal fixation difficult and precipitate varus malpositioning after internal fixation. We analysed 48 unstable intertrochanteric fractures in 48 elderly patient (58 to 91 yeared, mean age : 78 years) with advanced osteoporosis (grade III or more by Singh et al., and by BMD) between May, 1990 to March, 1995 ; Nineteen had been treated with an anatomical reduction with dynamic hip screw(DHS). In addition to DHS fixation, additional circumferential wiring was done in 1 cases, adjunctive methylmethacrylate bone cement fixation in head and neck was done 2 cases. We classified lag screw fixation alone group as DHS , lag screw fixation and additional oircurnferential wire reinforcement group as DHS II. Twenty had been treated with an anatomical reduction with gamma nail. Another nine that had severe comminuted fracture had been treated with bipolar hemiarthroplasty. In DHS II and gamma nailing group, operation time was longer and amount of transfusion after postoperative period was much than DHS I group. In DHS fixation group, lag screw fixation and additional tircurnferential wire reinforcement of posteromedial fracture fragment group was more favor result than lag screw fixation alone. Nonunion developed in two cases of adjunctive methylmethacrylate fixation with DHS, and malunion(external rotation) developed in two cases of DHS fixation group. We concluded that better result are obtained when posteromedial fracture fragment reduced with circumferential wiring with DHS. In addition to anatomical reduction of fragment, encouraging early postoperative ambulation also contribute to good prognosis. A number of the patients who had fear for weight bearing after 3 month postoperatively compromise ambulation on further follow up. In severely commented fracture that was not able to get stable reduction or in patient necessary for early weight bearing, hemiarthroplasty permit to early ambulation, but it also have many disadvantage.

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The Treatment of Trochanteric Fractures by Intramedullary Nail: Concerning Perioperative Complications: J H Wang, K J Roh, Y H Yun, D J Kim, D W Kim, S W Kim; J Korean Soc Fract 1996;9(2):384-391. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.384

Abstract PDF: Trochanteric fractures of the femur are usually seen in the elderly with osteoporosis and in young adult by high energy trauma. These fractures need firm internal fixation and early weight bearing, and Gamma interlocking nail or intramedullary hip screw is commonly used for this purpose at present. We analysed 23 patients with trochanteric fracture, who were treated with Gamma-locking nail or intramedullary hip screw from July 1992 to June 1994 with minimum 1 year follow-up. The mean age was 70 years-old. The intertrochanteric fracture was seen in 21 cases and subtrochanteric fracture in 2 cases. The final outcome was achieved with less surgical time, less blood loss and earlier rehabilitation. In addition, in biomechanical point of view, the advantages of using these nails are in short lever arm and in short lever arm and in lower bending moment. However, complications were developed in 10 patients. Intraoperative complications included the problem due to mismatching of the femoral component of the nail in 7 cases, problems of distal target screw in 2 cases, femoral shaft fracture in 1 case and cortical fractures in 2 cases. Bursitis in 2 cases, progressive coxa vara in 2 cases, thigh and knee pain in 1 case were developed postoperatively. Although using a smaller modified nail reduced these complications and obtained better result, we conclude that with careful surgjcal technique, choice of accurate indication and suitable modified femoral component, the Gamma nail and intramedullary hip screw are an advance in the treatment of peritrochanteric fractures.

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Operative Treatment of Intertrochanteric Fractures in Elderly Patients oyer 65 Years old: Ju Chul Chung, Jae Yul Koh, Sung Jun Lee, Eun Jun Lee; J Korean Soc Fract 1996;9(2):392-400. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.392

Abstract PDF: The incidence of intertrochanteric fracture of femur is much higher than past because of recent prolongation of average life span and increased activity. The goal of treatment of an intertrochanteric fracture must be restoration of the patient to his or her preoperative status at the earliest possible time. The authors analysed the 51 patients of the intertrochanteric fracture over 65 years old age who were operatively treated from Jan. 1989 to Dec. 1994. The results obtained were as follows 1. According to Tronzo classiffication, the most common type was type 3 in 3B cases (61%), and according to Evans classification, unstable fracture were more common (65%). 2. The degree of osteoporosis by Singh index were 27 cases (53%) in Grade III, 15 cases (29%) in Grade II, 7 cases (14%) in Grade IV, and 2 cases (4%) in Grade V. The osteoporotic group (Singh index I, II, III) had statistically significant correlation with unstable type fracture. 3. The patterns of reduction were anatomical reduction in 33 cases (66%), and valgus reduction (9 cases ; 18%), varus reduction (6 cases ; 12%), medialization (2 cases ,4%). 4. The mean union time was 14.1 weeks on compression hip screw group, and 15.7 weeks on Ender nail group, 15.4 weeks on Gamma nail group, 16.2 weeks on multiple pinning gloup. The authors couldnt find significant difference among the each groups. 5. Postoperative complications were occurred in 23 cases(45%) and more frequently in unstable type fracture(19 cases).

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Primary Bipolar Hemiarthroplasty Compared with Compression Hip Screw on Treatment of Elderly Unstable Intertrochanteric Fractures: Jae Ick Lee, Myung Hwan Son, Seong Geun Heo, Young Ho Gwun, Jae Hong Park; J Korean Soc Fract 1996;9(2):401-408. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.401

Abstract PDF

The incidence of intertrochanteric fracture of the femur appears to be increasing, Particularly the more unstable comminuted fracture types are increasing, paralleling increased longevity in the population. Fourteen cases were treated with primary bipolar hemiarthroplasty and eighteen cases were treated with compression hip screw at the Department of Orthopaedic Surgery of Pusan City Medical Center from June 1991. to June 1993. The results obtained were as follows; 1. In the bipolar hemiarthroplasty group, rehabilitation was easier and faster, and the incidences of pressure sore, pulmonary infection & atelectasis were significantly lower. 2. The early walking with full weight bearing that the bipolar hemiarthroplasty made possible is considered to be a major contributing factor to those results.

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Comparison between the Results of Internal Fixation Using Proximal Femur Nail Anti-rotation and Bipolar Hemiarthroplasty in Treatment of Unstable Intertrochanteric Fractures of Elderly Patients
Sung-Hwan Kim, Soo-Won Lee, Gyu-Min Kong, Mid-Um JeaGal
Hip & Pelvis.2012; 24(1): 45. CrossRef

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Treatment of Femoral Shaft Fracture with Intramedullary Nailing: A Comparison of Ender Nailing with Interlocking Intramedullary Nailing: Sung Tae Lee, In whan Jeong, Dong Heon Kim, Kyu Cheol Shin, Moon Koo Lee; J Korean Soc Fract 1996;9(2):409-415. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.409

Abstract PDF: The rigid internal fixation of the femoral shaft fracture with intramedullary nailing enables early joint motion and reduces morbidity. The authors reviewed the results of 38 patients treated with Ender nailing(22 casses) and interlocking intramedullary nailing(16 cases) between March 1989 and March 1994. The resuls were as follows. 1. The average bony union time in Ender nailing(18.9 weeks) was similar to interlocking intramedullary nailing(18.7 weeks). 2. The average time to acHieve full range of motion of the knee was shorter in intramedullary nailing (10.2 weeks) than in Ender nailing(13.5 weeks). 3. Interlocking intramedullary nailing required shorter time to achieve full weight Ender nailing. 4. The average operation time was shorter in Ender nailing(55 mins.) than in interlocking intramedullary nailing(100 mins). Interlocking intramedullary nailing is thought to be a better option than Ender nailing in fixa lion of femur shaft fracture by our study. However, in elderly patients or multiple injured patieilts, Ender nailing can be used advantageously for shorter operation time and technical sim plicity.

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Ipsilateral Fractures of the Femur and Tibia: Hyoun Oh Cho, Kyeong Duck Kwak, Sung Do Cho, Cheol Soo Ryoo, Jang Ho Oh; J Korean Soc Fract 1996;9(2):416-423. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.416

Abstract PDF: Concomitant ipsilateral femoral and tibial fractures are generally caused by high energy trauma with high incidence of associated injuries and complications. Twenty-seven cases of ipsilateral fractures of the femur and tibia in 25 adults from 1990 through 1994 were reviewed and the patients were grouped according to the type of fracture and the method of treatment. Nine femoral fractures(33%) and 19 tibial fractures(70%) were open. All but one femoral fractures and 23 tibial fractures were treated operatively with plate and screws, intramedullary nail and external fixator. Local complications include 14 delayed or non-onions, 3 deep infections, 1 compartment syndrome and 2 below-the-knee amputations. Over-all, a good or excellent functional result was achieved in 20 cases(74%). More use or rigid external fixation is recommended in the management of the tibial fracture, combined with internal fixation of the femoral fracture. Examination of the ipsilateral knee suggested that with the "floating knee injuries", disruption of ligaments is a common occurance and should always by suspected.

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The Results of the Treatment with Circular External Fixator for Severely Comminuted Intraarticular Fractures involving the Knee: Gang Wook Lee, Je Hoon Lee, Byung Yun Hwang; J Korean Soc Fract 1996;9(2):424-430. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.424

Abstract PDF: In treating the patients having the intraarticular condylar fractures of the distal femur and the proximal tibia, many aulhors have recommended accurate anatomical reduction and rigid internal fixaion with early mobiliEation of the thee. But we cant often reduce the displaced bony fragments into the anatomical position and also fix them rigidly in severely comminuted and displaced fractures in proctice. Furthermore open wound makes surgeons face with some difficulties in using internal fixatives due to postoperative osteomyelitis. We treated 16 cases of severely comminuted intraarticular fractures involving the knee with circular fikator from March, 1992 to October 1994. Those were composed of 8 intraarticular femoral condylar fractures in which 7 cases were classified as C3 by AO classification and 6 cases had open wound, and 8 intraarticular tibil condylar fractures in which 8 cases were classified as type VI by Schatzkers classification and 6 cases showed open fractures. We could get bony union in all cases but we were not satisfied with the functional results of the treatment. So, we recommend the circular external fixation as a method for the treatment of these severely comminuted fractures involving the knee, and we think that further study for improving the functional results will be needed.

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Operative Treatment of the Tibial Condylar Fracture: Kyung Chul Kim, Jae Yeul Choi, Joon Sik Kim, Young Soo Jhe, Sang Yuon Woo; J Korean Soc Fract 1996;9(2):431-438. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.431

Abstract PDF: The tibial condylar fractures often produce disabilities of the knee joint because it is frequently accompanied by injuries of the ligaments and the menisci. Schatzker had reported that the most common type of the tibial condylar fracture was pure central depression, but we have obtained the result that the most common one of these fractures is cleavage combined with depression and satisfactory outcome. We have analyzed 28 cases of the tibial condylar fractures treated by operative method at the department of the orthopaedic surgery, Kangbuk Samsung hospital from Jan. 1990 to May 1994. We obtained the results as follows; 1. Males were predominant and the patients mean age was 42 years. 2. The most common cause of injuries was pedestrian traffic accident. 3. The most common fracture type according to Schatzkers classification was type II, which was different from the result of Schatzker. 4. We have obtained 68% of acceptable results bu Porters criteria.

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The tibial condylar fractures treated by surgical method: Hee Soo Kyung, Joo Chul Ihn, Chang Ho Park; J Korean Soc Fract 1996;9(2):439-448. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.439

Abstract PDF: The treatment of the tibial piateau fractures has been under discussion for several decades, but no final answer has been reached. But many surgeons today believe that open reduction and internal fixation of commninuted, severly depressed, or displaced fractures are indicated The goal of the surgery is anatomic reduction of joint surface, rigid fixation, and early range of motion. This retrospective study evaluated 40 cases of tibial condylar fractures that treated surgically at the Department of Orthopaedic Surgery Kyungpook National University Hospital from February, 1991 to August, 1995. The minimum follow up period was 13 months and average follow up period of the patients was 33 months. The obtained result were as follows: 1. There were forty patients treated by surgically, the mean age was forty-six, and thirty patients were male, ten patients were female., thirty-one patients involved in motor vehicle accidents. 2. The most common type of the fracture was SchatBker type II in 10 patients., the most common associated soft tissue injury was rupture of the ipsilateral medial collateral ligament. 3. The most common method of the treatment was minimal screw fixation and bone graft in 20 cases. 4. The thirty-one cases (77.5%) had satisfactory result according to the Blokkers criteria among 40 cases. There were 2 superficial infections and 1 deep infection for post operative complications. 5. We had good result by anatomical reduction of the articular surfaces and early knee motion and delayed weight bearing for the treatment of the displaced, comminuted tibial condylar fracture.

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The Effect of fibular fractures in the healing of tibial shaft fractures treated with an interlocking nail: Ki Soo Kim, Yong Soo Choi, Jong Jun Park, Sun Young Chung; J Korean Soc Fract 1996;9(2):449-457. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.449

Abstract PDF: The effect of fibular fractures in the healing of tibial shaft fractures has controversial results. Its results are the greater part of the data for the conservative treatment of tibial shaft fractures. Recently closed interlocking nailing has been the most efficient treatment for displaced fractures of the tibial shaft. The purpose of this study was to evaluate the effect of fibular fractures in the healing of tibial shaft fractures treated with an interlocking nail and to determine whether the fibular fracture had a relation with other prognostic factors. From Mar. 1992 to Feb. 1995. the authors performed interlocking nailing for displaced fractures of the tibial shaft in 111 patients. We reviewed 98 patients with a minimal ten month follow up period. We divided the fractures into three groups; the intact fibula group which consisted of 15 patients had tibial shaft fractures with intact fibula, the same level fracture group had tibiofibular fractures at the same level in 56 patients and the different level fracture group had tibiofibular at different level in 27 patients. The results were as follows: 1. Clinically excellent and good results, according to Klemm and Horner criteria. were in 15 patients(100%) of the intact fibula group,49 patients(87.4%) in the same level fracture group and 21 patients(92.5%) in the different leyel fracture group. 2. Radiologically bone healing was obtained in 15 patients(100%) with a mean union time of 13.3 weeks in the intact fibula group, 42 patients(75.O%) with a mean union time of 17.9 weekf in the same level fracture goup and 2,1 patients(85.2%) with a mean union time of 15.3 weeks in the different level fracture group. 3. The same level fracture group had a tendency to cause a bending force while the different level fracture group tended to treat a torsional force. We found that the bending fractures had the worst prognosis. These results suggest that the treatment of tibial shaft fractures with an intact fibula by using an interlocking nail prevents significant complications and allows early weight bearing, thus permiiting early mobilization of the traumatized patient. The level of the fibular fracture associated with the tibial fracture may be a useful prognostic factors in the healing of tibial shaft fractures.

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