Journal of Musculoskeletal Trauma

Radiological Findings and Classification of the Acetabular Fractures: Woo Shin Cho; J Korean Soc Fract 1997;10(3):458-464. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.458

Abstract PDF: Correct classification based on the accurate radiological evaluation is the keypoint in proper management of the acetabular fracture. Interpretation of the radiologic features of the acetabular fracture requires understanding of the relationship between radiologic landmarks and anatomic structures composing acetabulum. The standard radiographic views include acetabular A-P, iliac oblique and obturator oblique views. CT is mandatory for evaluation and provides more accurate informations, such as size and location of the fragment, joint impaction, intraarticular fragment, comminution, dislocation of the femoral head and sacroiliac joint involvement. Combined interpretation of the standard radiographic views and CT is essential. Tomography and 3-D CT provide additional information. Two representative classification systems of the acetabular fracture are Judet and Leteurnal classification and comprehensive classification of AO. Judet and Letpurnal focused on anatomic two columns and two walls, and devided the acetabular fracture into five elementary and five associated fracture types. The elementary fracture types are basically two part and the associated fractures are combination of at least two elementary types and so, they are three or four part fractures. Comprehensive classification system is based on Judet and Letournal classification and follows skeletal AO classification system. It is apprehensive, logic, universal and easy to computerize. Besides, it shows fracture personality which is important prognostic factors. Type A represnets single wall or column fractures, type B tran,iverse oriented fractures, and type C complete articular fracture, namely floating acetaoulum. The sequence in groups under the type is correlated with the prognosis but not always in types.

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Fracture - Dislocation of the Talus: Jeung Tak Suh, Yong Ho Suh, Chong Il Yoo; J Korean Soc Fract 1997;10(3):470-479. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.470

Abstract PDF: The talus is one of the most important bones of the foot because it supports and distributes body weight above it and allows motion between the tibia and the foot. And it has unique biomechanical feature and vascular supply. Fractures and dislocations of talus are uncommon. However, once those happen, there is no single method of treatment and, all the more, there are several severe complications and are subsequent disabililies. Authors analyzed 15 cases of fracture-dislocation of the talus, which had been treated at Pusan National University Hospital from May 1988 to December 1994. 1. Among the 15 cases, there were 13 male and 2 female and the average age was 28.4 ranged from 6 to 48. 2. The causes were traffic accidents in 11, failing down in 4 cases. A violent hyperdorsiflexion of the ankle was common mechanism of the fracture. 3. According to the classification by Hawkins, there were 9 cases in talar neck fracture(2 cases in type I, 3 in type II, 4 in type III), 1 was head fracture and 5 were body fractures. 4. Two cases of talar neck fracture type I were treated conservatively, and other types were treated operatively. 5. Final results, evaluated by the criteria of Hawkins, were as follows : excellent in 3 cases, good in 7, fair in 4 and poor in one. 6. Complications were avascular necrosis in 4 cases and traumatic arthritis in 3 cases. According to the results, talar neck fracture associated with marked displacement, comminution of subtalar joint and dislocation increased the rate of occurrence of complications despite of early open reduction and internal fixation.

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Ankle Arthrodesis by Internal Fixation with Cancellous Screws and Fibula Strut Graft: Report of Two Cases: Jin Man Wang, Kwon Jae Roh, Yeo Hon Yun, Dong Jun Kim, Joo Seok Eom; J Korean Soc Fract 1997;10(3):480-484. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.480

Abstract PDF: We present two cases of ankle arthrodesis in which tibiotalar fixation was achieved by two cancellous-bone screws across the ankle joint and a lateral fibular strut graft fixed with a proximal and a distal screw. This operation is a technique described by Thordarson and his associates, who performed only an in vitro biomechanical study using fresh-frozen cadaver. Through the recent clinical trial, we could get excellent results in both of our cases. We feel the fibular strut graft provides additional stability to tibiotalar internal fixation. This technique may have a special value for those cases with poor bone quality or osteoporosis.

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Limited Internal Fixation of Pilon Fractures: Sung Ho Han, Bo Kyu Yang, Chi Hong Kim, Tae Won Ahn, Wu Jun Chu; J Korean Soc Fract 1997;10(3):485-491. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.485

Abstract PDF: Pilon fracture is relatively an uncommon fracture involving the distal tibial articular surface. As usually being combined with many complications, it is difficult to manage. Among many treatment options limited internal fixation of the tibia with long screws and multiple pins augmented with external fixation or casting provide adequate stabilization without soft tissue compromise. Fractures were defined as type II in 10 fractures and type III in 16 by Ruedi-Allgowers classification. 16 fractures, 6 type II and 10 type III, had limited internal fixation and cast application. 1 type III fracture had limited internal and external fixation. 9 fractures, 4 type II and 5 type III, were treated by rigid tibial plating during a period of 5 years(Mar. 1990- Fed. 1995). By Burwells and Charnleys radiological criteria and clinical grading system, limited internal fixation showed 67% satisfactory results in type II and 64% in type III fractures while rigid tibial plating showed 75% satisfactory results in type II and 60% in type III fractures. 4(44%) patients with rigid tibial plating, and 2(12%) patients with limited internal fixation had complications. Pilon fractures are high energy injuries with significant associated soft tissue damage. limited internal fixation offers good solution to this difficult fracture problem.

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Surgical Treatment of the Pilon Fractures: Jung Jae Kim, Jong Hi Park, Woo Shin Cho, Key Yong Kim; J Korean Soc Fract 1997;10(3):492-500. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.492

Abstract PDF: The intraarticular fractures of the distal tibia. so-called pilon fractures have been difficult in management due to the severe comminution of articular surface and frequent soft tissue problems. So there have been many controversies in the method of treatment. Although historically the results of various type of treatment of these fractures have been less than optimal, there has been a recent trend that suggests success in the majority of cases through operative treatment following the principles outlined by the AO/ASIF group. Among the patients of pilon fracture admitted to our hospital from October 1989 to August 1995 who were treated by open reduction and internal fixation, 32 patients(34 cases) were included who could be follow up for more than 2 years. According to AO/ASIF classification, type B1 5 cases, type B2 7 cases, type B3 5 cases, type C1 3 cases, type C2 4 cases, type C3 10 cases. The authors analyaed the clinical and radiological results of tibial pilon fractures exclusively treated by internal fixation. The results as follow : 1. Among 34 cases, 12 cases(35.3%) were not associated with of fibula fracture. There was no stastical relationship between the severity of pilon fracture and the presence of flbula fracture. 2. Good results in fracture reduction was obtained at 26 cases(76.5%) and good functional reults was obtained at 26 cases(76.5%). 3. The most commom postoperative complication was infection combined with skin problem(6 cases), which were treated by antibiotics and flap surgery. 4. Anatomical reduction and stable internal fixation of articular surface, careful manipulation of soft tissues and early range of motion exercise yielded good results of surgical treatment of pilon fracture.

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Surgical Treatment of the Clavicular Nonunion: Chang Hyuk Choi, Kyung Ho Kim; J Korean Soc Fract 1997;10(3):501-508. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.501

Abstract PDF: Ten patients who had a clavicular nonunion were treated operatively at the Catholic University of Taegu Hyosung, with semitubular plate and small LC-DCP from 1987 to 1996. The most common mechanism of the initial fracture was direct injury in eight cases and the most prevalent location of the nonunion was in the middle third in eight cases also. The purpose of this study is to evaluate the functional and radiological results of the treatment of the clavicular nonunion with the technique of semitubular plate and small LC-DCP and to verify the anatomical configuration and mechanism of the clavicular fracture. The results were as follows: 1. According to the comprehensive classification system, initial fracture type consisted of 8 cases of III-B, and 1 case in II-B and I-B alternatively. 2. Initial treatment was conservative in 8 cases, operative in 2 cases and the treatment of the nonunion was an operative technique with semitubular plate and LC-DCP in 5 cases alternatively. 3. Iliac bone graft was done in all cases and radiological union was achieved by 7.5 weeks with STP group, by 8 weeks with LC-DCP group. 4. The functional result by Weitzman classification was excellent in 4 cases, fair in 1 case with STP group and excellent in 3 cases, good in 1, and fair in 1 case with LC-DCP group. 5. LC-DCP was considered as a recommendable device because it could afford sufficient strength and reduce local osteoporosis of the bone.

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Bipolar Hemiarthroplasty Inserted with Cement for the femoral Neck Fractures in Elderly Patients: Sang Won Park, Young Soo Byun, Gyou Hyouk Lee, Jong Won Kim; J Korean Soc Fract 1997;10(3):509-515. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.509

Abstract PDF: Elderly patients with femoral neck fracture often have other medical diseases, poor bone quality and poor compliance which make it more difficult to obtain satisfactory results after internal fixation. Therefore, prosthetic replacement is accepted as an appropriate treatment for elderly patients. The purpose of this study was to analize clinical results of cemented bipolar hemiarthroplasty in the femoral neck fractures of elderly patients. The authors analyzed thrity-seven patients with 38 fractures of the femoral neck older than 65 years of age who were treated with cemented bipolar hemiarthroplasty from Jan. 1991 to Dec. 1995. The average follow-up period was three years, ranged from one to five years. The functional results were evaluated according to the criteria of the Harris hip score The results obtained were as follows : 1. The average Harris hip score was 84.6 points, ranged from 61 to 97 points. 2. The average pain score was 40.3 points. Twelve cases did not complain of pain, slight pain in 26 cases and mild pain in 2 cases. 3. The average limping gait score was 8.9 points. Twelve cases had no limping gait, slight limping in 25 cases and moderate limping in one case. 4. The average support score was 8.4 points. Seventeen cases could be walked without support, sixteen cases did use cane for long walk, two cases did use cane at full time, and three cases did use crutch. 5. Intraoperative complications were partial fracture of greater trochanter in 2 cases and one non-displaced calcar fracture. 6. Postoperative complications were heterotopic ossification in 2 cases, dislocatioin of bipolar cup with proximal migration in 1 case and ipsilateral femur fracture below the tip of femoral stem in 1 case. Above results suggest that the cemented bipolar hemiarthroplasty for femoral neck fracture in elderly patients appears to be a method of treatment better than internal fixation for early ambulation and functioinal recovery.

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A Traumatic Anterior Hip Dislocation Associated Ipsilateral Femoral Shaft Segmental Fracture : Case Report: Chang Soo Kang, Young Rae Cho; J Korean Soc Fract 1997;10(3):516-521. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.516

Abstract PDF: Traumatic hip dislocation associated with ipsilateral femur shaft fracture is a very rare injury and often results from high velocity injury such as traffic accidents or fall from a height. This combined injury was first documented by Sir Ashley Cooper in 1823. Wiltberger, Mitchell and Hedrick estimated its incidence at one out of 100,000 cases of fractured femoral shaft. Until 1978 there have been only 3 cases were reported of anterior hip dislocation with ipsilateral femoral shaft fracture in the literature. We have recently had the opportunity to manage the patient with anterior hip dislocation with ipsilateral femoral shaft segmental fracture and contralateral acetabular fracture.

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Fatigue Fracture of the Interlocking Nail in the Treatment of the Distal Part of the femoral Shaft Fractures: Won Sik Choy, Hwan Jung Kim, Kwag Won Lee, Young Sik Min, Ha Yong Kim, Moon Ho Shon; J Korean Soc Fract 1997;10(3):522-528. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.522

Abstract PDF: Closed intramedullary nailing with or without interlocking screws has been a widely accepted method for the fixation of fractures of the femoral shaft. The design of the interlocking nail introduces the potiential for high stress concentrations at the proximal and distal holes. The authors experienced six cases of metal failure of the interlocking nail in the treatment of fractures of the distal part of the femoral shaft from February 1992 to March 1995. The predisposing factors to fatigue fracture of the interlocking nail were studied. In all patients, the fracture of femur was five centimeters or less from the more proximal of the two distal screw-holes. The risk of fatigue failure may be minimized by using nails that have a larger diameter, by using nails long enough to be driven down to the subchondral area of the knee joint and by avoiding early weight-bearing.

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Effect of Unreduced Lesser Trochanteric Fracture on Stability in Intertrochanteric Fracture of Femur: Seung Woo Suh, Jeong Ho Park, Jong Kun Oh, Kyung Wook Nah, Tae Hyeon Kim, Woo Nam Moon; J Korean Soc Fract 1997;10(3):529-533. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.529

Abstract PDF: Unstable intertrochanteric hip fractures are characterized by comminution of the posteromedial cortex, resulting in a fragment of variable size containing the lesser trochanter. Stability can be provided by transfixion of the lesser trochanteric fracture fragment with a screw. However, fixation of lesser trochanteric fragment is difficult, time-consuming, and often unsuccessful. Controversy exists as to whether it is necessary to perform reduction and fixation of this fragment. A radiological review of 61 intertrochanteric fractures treated with compression screw was made to study the effect of unreduced lesser trochanteric fracture on fracture healing and stability in unstable intertrochanteric fractures accompanied by lessor trochanteric fracture. Analysis were made on terms of rate of bone union, maintenance of reduction by comparing between anatomically reduced group with/without lesser trochanteric fracture and malreduced group with lesser trochanteric fracture. Anatomically reduced groups with/without lessel trochanteric fracture showed similar rates of bone union(88.3% in average) and degree of sliding of lag screw(3.74mm in average) regardless of fixation of lesser trochanter. On the other hand, unreduced group had 33.3% of bone union rates and 9.80mm of sliding of lag screw representing importance of anatomical reduction rather than fixation of lesser trochanteric fracture. In conclusion, it is suggested that unstable intertrochanteric fractures accompanied by large lesser trochanteric fracture fragment can be treated without fixation of lesser trochanteric fragment avoiding major complicatioins such as loosening of implant or collapse of fracture fragment.

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Tibial Segmental Fracture Treated with Interlocking Intramedullary Nail: Churl Hong Chun, Byung Chang Lee, Gyu Taec Hwang, Soon Gu Kwon, Han Sol Lee; J Korean Soc Fract 1997;10(3):534-540. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.534

Abstract PDF

The orthopaedic surgeon experiences the difficulties of treating segmental tibial fractures by internal fixation and accompanying complications. OBJECT : The purpose of this study has been to review the useful treatment of 21 interlocking nails in the tibial segmental fracture, to investigate the union rate related to fracture types and to analyze the complications related to it. METERIAL and METHOD : Between November 1988 and August 1995, the authors treated tibial segmental fractures with interlocking intramedullary nail and analyzed 21 cases with followed up of more than 1 year. Injury mechanism were caused by traffic accident in which high velocity accounted for 17 cases. 11 cases of segmental tibial fracture were closed, and 10 cases were open. 6 cases of open fracture were open type 1, and 4 cases were open type II. We treated 21 fractures with unlearned intramedullary nail of 7 cases and limited reamed intramedullary nail of 14 cases.
RESULT
: Callus formation and consolidation were faster at the posterolateral aspect of the tibia than in anteromedial aspect. Radiologically complete union was faster in proximal portion at average 26.8 weeks than distal portion of segmental fracture at average 35.6 weeks. Complications included 2 cases of nonunion, 1 infection, 2 screw breakage and 2 ankle joint stiffness.
CONCLUSION
: We achieved excellent results using interlocking intramedullary nail by limited reaming or unlearned methoo in the tibial segmental fracture even though the injury was caused by high-velocity external force.

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Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures
Sang Soo Park, Jun-Young Lee, Sang-Ho Ha, Sung-Hae Park
Journal of the Korean Fracture Society.2013; 26(4): 275. CrossRef

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Treatment of Tibial Shaft Fractures with Ender Nailing and Postoperative Functional Bracing: Young Soo Byun, Hong Tae Kim, Won Ho Cho, Se Ang Chang, In Hak Choi, Jin Wook Jung; J Korean Soc Fract 1997;10(3):541-547. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.541

Abstract PDF: Ender nailing is an alternative method of treatment of selected unstable tibial shaft fractures. The purpose of this study is to evaluate the result of functional treatment with Ender nailing and postoperative functional bracing. We treated 31 tibial shaft fractures(16 closed, 15 open) with closed Ender nailing and postoperative functional bracing between August 1990 and September 1994 and followed up the patients from minimum 10 months to 74 months. Clinical analyses were as follows; 1. According to AO classification, 10 cases were Type A simple fractures(32%), 14 Type B wedge fractures(45%), and 7 Type C complex fractures(23%). 2. Ninety four percent of the fractures united in an average time of 17.3 weeks. The average time to union of complex fractures was longer than that of simple and wedge fractures(P<0.05). 3. There were two nonunions(6.5%), two delayed unions(6.5%), and three angulatory malunions(9.7%) between 6 and 10 , but there was no putient of significant shortening, joint stiffness, or infection. The Ender nails provide sufficient stability at the fracture site of the tibial shaft to permit carly weight-bearing in a functional brace, and this treatment provides early fracture union with less complicatioins and facilitates functional recovery.

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Treatment of Subtochanteric Fractures of the Femur by Interlocking Nailing: Do Hyun Moon, Bum Gu Lee, Jin Hong Ko, Young Kab Shin; J Korean Soc Fract 1997;10(3):548-555. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.548

Abstract PDF: Subtrochanteric fracture of the femur are difficult to treat successfully. Although performing operative treatment, the incidence of mechanical complication is higher than other sites of long bones. During the period of January. 1990 to June. 1995, twe nty-four cases of subtrochanteric fracture of femur were treated by Interlocking intramedullary nail at the Department of Orthopedic Surgery, Gil Hospital, Incheon, and the results were obtained as follows : 1. Associated injuries, which were common in lower limb(7 cases), pelvic bone(3 cases) and upper limb(4 cases) made a fracture more difficult to treat. 2. Fieldings type III(12 cases) fracture and Seinsheimers type II(18 cases) fracture and Russel-T aylors Type I A(19 cases) fracture and Winqist-Hansen Type II(13 cases) fracture were most common. 3. The average union time was 19.3 weeks. 4. The complications were three cases. : delayed union(1 case), infection(1 cases), angular deformity(1 case). 5. Interlocking nail is one of the good implant for rigid fixation of subtrochanteric fracture, especially mechanical characteristics of interlocking nail have eliminated the requirement of surgically reconstituting the medial femoral cortex.

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The Treatment and Complications of Ipsilateral Fracture of the Femur and tibia: Kyu Min Kong, Ki Chan Ahn, Sung Seok Seo, Young Chang Kim, Jang Seok Choi, Young Goo Lee; J Korean Soc Fract 1997;10(3):556-561. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.556

Abstract PDF: Ipsilateral fracture of the femur and tibia is difficult to treat because it is often comminuted and combined with severe soft tissue injury. And The result of treatment is poor in most cases. The thirty-four cases were treated at Pusan Paik Hospital from March, 1992 to February, 1995. The result were as follows; 1. The bony union time was shorter in the intramedullary nailing than other methods. 2. There were less complications in the group of used intramedullary nailing than other methods. 3. The intramedullary nailing was relatively good treatment method for ipsilateral fracture of the femur and tibia.

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Treatment of Tibial Shaft Fractures Using Interlocking Intramedullary Comparison of Reamed and Unlearned Methods: Woo Nam Moon; J Korean Soc Fract 1997;10(3):562-568. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.562

Abstract PDF: Sixty-four closed or Gustilo type I open fractures of the tibial shaft were treated with interlocking intramedullary nailing with(n=38) or without(n=26) reaming and were followed for an average of 13 months. The time to bony union ranged from twelve to twenty-five weeks with an average of 16.4 weeks in reamed method and from thirteen to twenty-seven weeks with an average of 15.9 weeks in unlearned method. The complications of reamed method were seen in 4 cases(11%) (two stiffness of ankle joint, one malunion and one distal screw breakage) whereas complications of unlearned method were seen in 7 cases(27%) (one stiffness of ankle joint, two malunions and four distal screw breakages). There was no significant difference in the union time of reamed and unlearned interlocking intramedullary nailing. But complications of fracture healing were less frequently seen on reamed interlocking intramedullary nailing.

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The Clinical Results of Unreamed Interlocking Intramedullary Nailing for Tibial Fractures: Young Ho Kwon, Hyun Mok Yang; J Korean Soc Fract 1997;10(3):569-574. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.569

Abstract PDF: Recently interlocking intramedullary nailing is used widely for the management of tibial shaft fractures. We evaluated any differences in healing time and complications associated with reamed and unlearned tibial interlocking intramedullary nailing. Between January 1991 and February 1996 we performed a retrospective trial on 62 patients with tibial shaft fractures comparing the reamed with unlearned interlocking nailing. The mean time to union for patients with unlearned intramedullary nail was 18.5 weeks(13 to 32 weeks) which was significantly less(P<0.05) than the 21.7 weeks(16 to 36 weeks) for reamed group. The complications of the reamed interlocking intramedullary nailing were three delayed unions (9.3%), three superficial infections(9.3%), and two cases of knee joint or ankle joint LOM(6.2%). The complications of the unlearned interlocking intramedullary nailing were four delayed unions(13.9%), three angular deformities(10.3%), three screw breakages(10.3%), and one superficial infection(3.4%). Unlearned interlocking intramedullary nailing is better for the tibial shaft comminuted fractures with small diameter, unstable tibial isthmus fractures, pelytraurnatized patient and some type of open fractures.

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Clinical Results of Locked Unreamed Nailing in Tibial Shaft Fractures: Duck Yun Cho, Hee Chun Kim, Kyung Chul Kim; J Korean Soc Fract 1997;10(3):575-582. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.575

Abstract PDF: We reviewed the results of the treatment of 23 tibial shaft fractures in 22 patients by primary unlearned locked intramedullary nailing. The duration of follow-up was average 10.1 months (range, from 6 to 27 months). The results were as follows : 1. There were 11 open and 12 closed fractures. 2. All fractures united clinically in an average time of 17.9 weeks(range 10 to 26 weeks), and radiologically in an average time of 19.4 weeks (range, 10 to 31 weeks). 3. Complications included 1(4.3%) case with delayed union and 3(13.0%) cases with malunion. 4. No patient had deep infection and there were no broken nails or screws in this series. 5. No fracture refuired an additional procedure before union, such as dynamization or bone graft.

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Disseminated Intravascular Coagulation Following Septic Shock in Multiple Open Fractures : a Case Report: Tai Seung Kim, Jae Lim Cho, Choong Hyeok Choi, Sung Hee Oh, Do Hyeung Kim, Kuhn Sung Whang; J Korean Soc Fract 1997;10(3):583-587. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.583

Abstract PDF: Disseminated intravascular coagulation is known to be a syndrome which can evoke compound derangement in the cascade mechanism of normal hemostasis, which causes depletion of coagulation factors, secondary fibrinolysis, and eventually massive and uncontrollable bleeding. Even though there still are not absolute criteria for diagnosis, some laboratory findings - platelet count, plasma fibrinogen, fibrinogen degradation product, plasma protamine test, etc - can suggest the possibility to diaglose. The basic principle in management is to eliminate the triggering mechanism as soon as possible and to cure the initial disease entities. In orthopedic point of view, disseminated intravascular coagulation can occur in the case of malignancy, massive trauma, infection, sepsis and so on. Authors report a case of disseminated intravascular coagulation occured in a 12 year 2 month old male patient who visited Hanyang university hospital in septic condition after emergency operations following multiple open fractures on his left femur. tibia and fibula in a motor-cycle accident.

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Clinical Evaluation for the Ankle Fractures by Treatment: Jae Ick Lee, Myung Hwan Son, Jae Won Lee, Seong Hyeoun Namgung; J Korean Soc Fract 1997;10(3):588-596. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.588

Abstract PDF

The ankle joint plays important role in weight bearing, walking and standing, which consist of medial and lateral malleolus, tibial plafond, talus,ligament and soft tissue structure. Hence, the ankle injuries not only fracture of bone but often also the rupture of ligament and soft tissue. The purpose of this study is to reduce the complications and to early return to work by anatomical reduction of ankle mortise. The authers analysed 78 cases(76 patients) of the ankle fractures which were treated in department of orthopaedic surgery, Busan City Medical Center from March 1991 to february 1994 and average follow up period was 21 months(from 14 to 38 months). The results obtained from this study were as follows ; 1. The most common type of the ankle fractures, according to the classification of Lauge-Hansen, was supination-external rotation type(37%). 2. 62 cases (79%) were treated by open reduction and internal fixation and 16 cases(21%) were treated with closed reduction. The result of patients who were treated by open reduction and internal fixation were better than those by closed reduction, according to the criterion of Meyer. 3. The incidence of complication, such as traumatic arthritis and nonunion occured higher in the cases treated with closed method.

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Surgical Fixation with Biodegradable Plate for the Treatment of Ankle Fractures
Jae-Young Cho, Jin-Whan Kim, Sang-Eun Kim, Kyung-Chil Jung, Seung-Hyun Choi
Journal of the Korean Fracture Society.2008; 21(1): 31. CrossRef

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Surgical Treatment of Avulsion Fracture of the Fibular Head Associated with Lateral Instability of the Knee: Min Young Chung, Won Suck Lee, Soo Myung Lee, Won Cheul Song, Chang Woo Kim, Kwang Min Jung; J Korean Soc Fract 1997;10(3):597-603. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.597

Abstract PDF

Though avulsion fracture of the fibular head rarely occurs, it frequently associates with lateral compartment injury of the knee which resulls in lateral instability. Some authors preferred to internally fixing avulsion fracture of the fibular head to prevent and restore lateral instability of the knee. Our purpose was to suggest that lateral instability of the knee be restored by internal fixation of the fibular head in these cases. We reviewed 6 cases of avulsion fracture of the fibular head associated with lateral instability of the knee which were treated surgically from January, 1993 to December, 1994 with average 2-year-over follow-up. We evaluated each cases using the Knee Ligament Standard Evaluation Form proposed by International Knee Documentation Committee. The results were as follows. The average displacement of the fibular head was 8.4mm. The activity level and overall grade were A(normal) in 4 cases, B(nearly normal) in 1 case, D(severe abnormal) in 1 case. Lateral instability of the knee was satisfactorily restored by internal fixation of the fibular head and repair of ligamentous injuries in cases of avulsion fracture of the fibular head associated with lateral instability of the knee.

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Establishment of Classification of Tibial Plateau Fracture Associated with Proximal Fibular Fracture
Zhan‐le Zheng, Yi‐yang Yu, Heng‐rui Chang, Huan Liu, Hui‐lin Zhou, Ying‐ze Zhang
Orthopaedic Surgery.2019; 11(1): 97. CrossRef

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The Clinical Result of Operative Treatment of the Comminuted Patellar Fractures : A Comparison of Clinical Results According to the Operative Methods and the Postoperative Cares: Byeong Yoen Seong, Jong Hoon Lee, Seung Jun Park; J Korean Soc Fract 1997;10(3):604-613. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.604

Abstract PDF: Approximately one third of patellar fractures require surgery and stellate and comminuted frachres of the patella has been increased. Operative treatment of the patella should be achieved to ensure continuity of the extensor mechanism, to preserve patellar function and reduce the incidence of complications related to articular fracture. Various techniques of internal fixation have been recommended for comminuted fracture of De patella, but there are some complications including loss of fragment position, reoperation, nonunion, loss of range of motion and loss of extensor mechanism strength. The evaluation of the clinical results in rigid fixation group which was made postoperative excercise from postoperative 2 weeks without cylinder cast application, was needed for the purpose whether or not to decrease those complications. We reported 46 cases of comminuted patellar fracture who were operated various methods with or without cylinder cast as postoperative care, from Jun 1990 to Dec 1995 at the department of orthopaedic surgery, Dongrae Bongsaeng hospital. In conculsions, rigid fixation as using Kirschner wires with modified anterior tension band and a circumferential wiring and early motion without cylinder cast for the comminuted patellar could be increased the fusion rate and range of motion and recovered function of the knee joint.

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Ender Nailing of Humeral Shaft Fractures: DONG HEON KIM, KYU CHUL SHIN, KYEONG SOON KIM, SANG HAK LEE; J Korean Soc Fract 1997;10(3):614-620. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.614

Abstract PDF

Most humeral shaft fractures are treated conservatively. However, in the event of failure of closed reduction, pathologic fractures, multiple fracture, multiple associated injury and severe neurologic disorder, operative treatment may be indicated. The purpose of this article is to evaluate the effectiveness of Ender nailing for the humeral shaft fracture of the patients who have multiple fracture, multiple associated injury and pathologic fractures. Authors treated 56 patients with humeral shaft fractures by flexible intramedu-llary stabilization- Ender nail or Ender nail with Rush pin 47 cases were treated closed method, 9 cases were treated by open method. Period of follow-up was average 16 weeks. Fractures were united by an average 12 weeks(range : 9 to 20 weeks). There were no non-union, infection and malunion. No backing out of nails occured. In conclusion, Ender nailing is effective treatment for the humeral shaft fracture to decrease hospital stay, to permit early range of motion of the shoulder and elbow joint.

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Contributing Factors of Radial Nerve Palsy Associated with Humeral Shaft Fracture
Tae-Soo Park, Joon-Hwan Lee, Tai-Seung Kim, Kwang-Hyun Lee, Ki-Chul Park
Journal of the Korean Fracture Society.2008; 21(4): 292. CrossRef

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Clinical Analysis Between Interlocking IM Nail and Plate Fixation in the Treatment of Humeral shaft Fractures: Soo Chan Lee, Beom Koo Lee, Do Hyun Moon, Jin Hong Ko, Hong Gi Park, Ki Dong Kang, Hyoung Il Kim; J Korean Soc Fract 1997;10(3):621-627. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.621

Abstract PDF: Most of the humeral shaft fractures have been treated conservatively. If operation is indicated, most surgeons used to perform an open reduction and internal fixation with plate &Treatment of the Humeral Shaft Fracture in Adult screws. But, when open reduction and internal fixation is carried out, the periosteum and soft tissue attachments must be stripped off from the bone and operative time becomes longer. Interlocking IM nailing is an attractive procedure which does not disrupt or strip off periosteum and soft tissue at the fracture site, decrease the chance of infection and allow early exercise. Authors compare the clinical result of humerus shaft fracture which were treated by plate fixation in 25 patients and interlocking IM nailing in 16 patients who were treated at the orthopedic depaunent, Joong Ang Gil Hospital from Feb. 1992 to Jan. 1995. 1. The average time of operation in interlocking IM nail was 65 minutes and that of plate fixation was 95 minutes. 2. The average time for bone union was about 14.4 weeks in interlocking IM nail and 14.2 weeks in plate fixation. 3. The complications of interlocking IM nail were 1 case of postoperative radial nerve palsy, 1 case of delayed union, 1 case of nonunion and 3 cases of pain and stiffness of shoulder. 4. the complications of plate fixation were 1 case of infectioin, 1 case of delayed union, 3 cases of nonunion, 1 case of metal failure, 2 cases of postoperative radial nerve palsy and 2 cases of pain and stiffness of elbow. In conclusion, the interlocking IM nailing is an attractive procedure or the treatment of the humeral shaft fractures.

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Treatment of the Humeral Shaft Fracture in Adult: Sung Keun Sohn, Silng Soo Kim, Sung Wan Kim, Jin Gu Kim; J Korean Soc Fract 1997;10(3):628-633. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.628

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It has been generally agreed that most fractures of the humeral shaft are treated non-operatively, but recently the rate of operative treatment was increased due to high incidence of segmental fracture and combined injury. Authors analyzed 47 cases of the humeral shaft fracture in adults that treated from May 1990 to May 1994 at the Department of Orthopaedic Surgery, College of Medicine, Dong-A University. The results were as follows : 1) The mean age was 38.5 years and the most common cause of injury was traffic accident in 23 cases(48.9%). 2) The most common type of fracture was spiral or oblique fracture in 17 cases(36.2%). 3) Six cases were treated conservatively, 29 were treated operatively after failure of attempt to treat conservatively, and 12 were treated only operatively. 4) The mean time of the conversion from conservative treatment to operative treatment was 3.7 weeks after treatment, the causes of failure in conservative treatment were assumed incooperative on fracture care and muscular weakness in elderly patient, severe angular deformity and displacement after trauma. 5) In the conservative treatment group, clinical union was accomplished at 8.2weeks and the mean radiological union at 14.6 weeks, while in operative treatment group, the clinical union at 7.6 weeks and the radiological union at 13.5 weeks. 6) In radial verve palsy, complete or incomplete ruptures were found in 4 cases among 6 exploratioins, so we think that early exploration is considerable option.

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Result of Early Active Range of Motion Exercise after Bankart Repair of Traumatic Anterior Instability
Haeng Kee Noh, Jong Woong Park, Jung Il Lee, Jung Ho Park
Journal of the Korean Fracture Society.2007; 20(1): 53. CrossRef

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Treatment of the Proximal Humeral Fracture by Bent Semitubular Plate: Choong Gil Lee, Jin Woo Kwon, Jae Hyum Park, Sung Ho Shin, Wan Eub Kim; J Korean Soc Fract 1997;10(3):634-639. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.634

Abstract PDF: There is no consensus on the best way to treat complicated fractures of the proximal humerus. Open reduction and internal fixation with plate is one of the most popular method, but it has several disadvantages. Thus we used bent semitubular plates to fix the proximal humeral fractures, which were reported by Szabo and Sehr. Moda etc. This method provided relatively firm fixation and then early ROM exercise was possible even in case of osteoporotic or severely comminuted fractures. We treated 9 cases of proximal humerus fractures which were with bent semitubular plates from January 1992 to June 1996 and followed up more than 6 months. The following results were obtained. 1. The bent semitubular piate fixation was useful method even in treatment of comminuted or osteoporotic proximal humerus fractures. 2. The mean duration of radiologic bone union was postoperative 10 weeks. 3, Complications developed in 2 cases ; one case was plate failure and the other was humeral head penetration by blade portion. 4, According to Neer criteria 5 cases were excellent, 2 cases satisfactory, 1 case unsatisfactory and 1 case failure.

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Fracture of the Coracoid Process Associated with Acromioclavicular Dislocation: Ui Seoung Yoon, Yong Hoon Kim, Keun Woo Kim, Hak Jin Min, Kook Hyeung Cho, Ki Seung Kum, Il Myung Kim; J Korean Soc Fract 1997;10(3):640-644. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.640

Abstract PDF: Acromioclavicular dislocation with a concomitant coracoid process fracture occurs infrequently, as only several cases have been reported in the literature. This injury usually occurs in the second or third decade of life. The mechanism of injury were sports, motor vehicle and direct trauma. An axillary lateral radiograph of the shoulder often is needed to detect this fracture. The authors present two cases of coracoid process fracture associated with acromioclavicular dislocation. Satisfactory function with minimal residual cosmetic deformity may be achieved by nonoperative measures. Also surgical treatment can produce good result in complete third acromioclavicular separation combined with the significantly displaced coracoid fracture.

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Fractures at the Base of the Fifth Metacarpal: Ho Jung Kang, Han Sik Kim, Dong Eun Shin, Eung Shik Kang; J Korean Soc Fract 1997;10(3):645-650. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.645

Abstract PDF: The treatment of 16 intraarticular fractures at the base of the fifth metacarpal was studied. Intraarticular fractures at the base of the fifth metacarpal resembled Bennetts and Rolandos fractures in their pattern and in their tendency to instability. The problem was usually not the reduction, but rather maintaining the reduction. A force hitting the head of the fifth metacarpal along the longitudinal axis of the metacarpal was the most common cause of injury, Five fractures were immobilized in a plaster cast after closed reduction. Six fractures were treated by closed reduction and percutaneous pinning, 4 by open reduction and pinning. 1 by open reduction and plating. At follow up after median 14.8 months, the result of 11 cases was satisfactory. Two cases nonoperated showed decreased grip power, limited motion, radiographical signs of osteoarthritis, and pain. Three cases operated showed decreased grip power. We concluded that restoration of articular surface and internal fixation againt the muscular pull was mandatory for a satisfactory outcome.

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Fracture of Olecranon Treated by K-wire and Tension Band Wiring Technique in Adults: Hak Yeong Jeong, Seung Wook Yang, Jae Woong Shim, Beyong Seon Kong; J Korean Soc Fract 1997;10(3):651-657. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.651

Abstract PDF: Displaced fractures of olecranon in adults require operative treatment. The goal of treatment is to rigidly fix the fracture fragment, to anatomically restore the joint surface and to allow range of motioin early. Authors treated fractures of olecranon by open reduction and internal fixation using K-wire and tension band wiring technique in 38 adult patients from April 1989 to October 1995 at the Department of Orthopedic Surgery, Maryknoll Hospital. This article documents the study of relationship between the treatment result and involvement of articular surface, articular step-off and gap of articular surface. The results were as follows ; 1. The clinical results were good or fair in 31 cases(82%) according to the criteria by Helm et al. 2. Involvement of articular surface, step-off and gap of articular surface affected the results. 3. The clinical results were satisfactory in patients with postoperative step-off less than 2mm and postoperative gap of articular surface less than 2mm. 4. The clinical results were satisfactory in patients with articular involvement less than 60%.

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Operative Treatment of the Malunited Phalangeal Neck Fractures: Ho Jung Kang, Young Gon Koh, Joong Won Ha, Eung Shick Kang; J Korean Soc Fract 1997;10(3):658-664. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.658

Abstract PDF: It is generally accepted that malunited phalangeal neck fracture in hands not only limits range of motion but also accelerates the onset of degenerative changes, with increasing pain and stiffness of the affected joint. When displaced or rotated phalangeal neck fracture presents within the first or second weeks, properly performed closed or open reduction with percutaneous pinning or internal fixation is excellent options with predictable results. Malaligned fractures that present later frequently cannot be readily reduced. Once fully united, treatment options have included corrective osteotomy if function is significantly impaired or if appearance is objectionable. We have followed 9 patients, who had operations for malunited phalangeal neck fractures. The average length of follow up was 27 months. The interval between injury and operation ranged from 4 weeks to 6 years, with a mean of 21 months. Sites of operation include thumbs(3 cases), 2nd fingers(1 case), 3rd fingers(2 cases), 4th fingers(2 cases) and 5th finger(1 case). For those cases with less than 8 weeks elapsed since the injury, osteoclasis of the fracture with fixation using K-wire or pull-out was carried out. For those cases with more than 8 weeks elapsed, realignment osteotomy followed by fixation with K-wire or miniscrew was used. Parameters for the evaluation of result include range of motion to within 10 degree of full range in each joint, deviation of the fingers during active maximum flexion and extension, the minimum distance between the tip of the finger pulp and the palm, full bony union, relief of pain and the subjective cosmetlc result. Excellent and good results were noticed in 7 cases. The best results can be achieved only with near-anatomic restoration of the joint surface and early active motion exercise. In conclusion, with careful patient selection and close attention to operative detail, operative treatment of malunited phalangeal neck fracture can be effective.

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Avulsion Fracture of the Base of the Second Metacarpal by the Extensor Carpi Radialis Longes : a Case Report: Hong Gi Park, Cheol Won Park; J Korean Soc Fract 1997;10(3):665-668. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.665

Abstract PDF: Isolated intraarticular fractures of the base of the second metacarpals are rare because of the lack of motion in these joints. Also these injuries are an avulsion fractures of the base of second metacarpals that attached the extensor carpi radialis longus(ECRL) or brevis(ECRB). Most authors reporting these cases have recommanded opertive treatment, because the keys of treatment of this fracture are to restore the integrity of the joint margin and to restore the insertion of the extensor carpi radialis tendon. We report a single case of avulsion fracture of the ECRL, which included a fracture of the large metacarpal base.

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