Journal of Musculoskeletal Trauma

Problems of compression Hip Screw for the Treatment of Intertrochanteric Fracture in Elderly Patients: Kwon Jae Roh, Jong Oh Kim, Hyung Ho Kim; J Korean Soc Fract 1999;12(3):502-508. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.502

The principle in the treatment of an elderly patient with an intertrochanteric fracture has swung from traction to internal fixation due to complication such as pneumonia, skin ulcer, and thromboernbolic disease, etc. Many surgeons have used sliding compression screw for trochanteric fracture fixation which was regarded as a most effective device to manage the fracture. but, they have reported several risk factors to cause fixation failure such as screw impaction or loosening, because of osteoporosis, large defect on posteromedial aspect of neck, eccentric fixation of lag screw. The aim of the present investigation was to study the relationships between the type of fracture, the trabecular bone grading of proximal femur, reduction status, the implant position and the extent of impaction or loosening of the comression screw. We studied 47 elderly patients(age>60) who were managed using of compression hip screw as operative management and followed more than 6 months after operative treatment at Department of orthopaedic surgery, Ewha womens university Mokdong hospital from 1994 to 1998. The results were as follows 1. Screw impaction or loosening was developed in 7 cases of 47 cases after internal fixation. 2. Of 7 cases, 2 cases were stable fracture(modified Evans type I, II) and 5 cases unstable (modified Evans type III, IV, V). 3. Of 7 cases, 3 cases were high trabecula grade(grade VI, V, IV), 4 cases were low trabecula grade(grade I, II, III). 4. No siginificant diffierence of impaction or loosening development was in screw position. 5. Of 7 cases, 2 cases were anatomical reduction and 5 cases medial reduction.

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Treatment of Senile Osteoporotic Intertrochanteric Fracture using Proximal Femoral Nail
Dong-Hui Kim, Sang-Hong Lee, Young-Lae Moon, Jun-Young Lee, Kun-Sang Song
Journal of the Korean Fracture Society.2007; 20(3): 215. CrossRef

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The Clinical Resuts of Bipolar Hemiarthroplasty in Old Age-Femoral Neck Fracture vs. Intertrochanteric Fracture-: Dong Heon Kim, Kyu Cheol Shin, Byeong Chun Chang, Dae Sul Kang; J Korean Soc Fract 1999;12(3):509-515. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.509

Abstract PDF: The peritrochanteric fracture remains one of the most common and potentially devastating injuries in the geriatric population. The goal of treatment is early ambulation to prevent the complications such as pressure sore, pneumonia, deep vein thrombosis, pulmonary embolism and long time hospitalization by open reduction and internal fixation or closed reduction and internal rotation. In femoral neck fracture, many surgeons agree on the bipolar hemiarthroplasty but there is controversy about that treatment in intertrochanteric fracture. We have tried to assess the clinical outcome of bipolar hemiarthroplasty for the intertrochanteric fracture as compared with femoral neck fracture in old age. Ninty-five bipolar hemiarthroplasties were performed at our hospital, between January 1991 and February 1996. We selected 65 patients who had been followed for at least one year. Forty of sixty-five patients had femoral neck fractures and twenty-five of them intertrochanteric fractures. The results were as follows: 1. Regardless of using the cement, the partial weight bearing ambulation time after operation was 10.3 days in femoral neck fracture, 19.5 days in intertrichanteric fracture. 2. At one year follow-up the average Modified Harris Hip Score was 88.9 in femoral neck fracture, and 87.5 in intertrochanteric fracture. 3. Postoperative complications in case of femoral neck fracture included thigh pain in 4 patients, heterotopic ossification in 1, intraoperative fractures of the femoral shaft in 2, leg length inequality in 1 and dislocations after bipolar hemiarthroplasties in 3. And those in case of intertrochanteric fractures were thigh pain in 2 patients, heterotopic ossifications in 2, intraoperative fractures of the femoral shaft in 2 and dislocation after bipolar hemiarthroplasty in 1. 4. There were no statistically significant differences in the clinical functional score and complications between intertrochanteric and femoral neck fracture groups, therefore bipolar hemiarthroplasty can be recommended as one of the treatment of intertrochanteric fracture as well as femoral neck fracture in the elderly patient.

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Treatment of communited & Segmental Femoral shaft Fracture by using Interlocking nailing: Comparison between Closed and Open techniques: Chang Hyuk Choi, Koing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Ho Sun Chang; J Korean Soc Fract 1999;12(3):516-522. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.516

Abstract PDF: When femoral shaft fracture with severe communition and segmentation result from violent force, they are frequently associated with severe soft tissue damage. Treatment of this unstable fracture need the rigid fixation in order to prevent shorting and rotational loading. In terms of this advantages, interlocking nailing technique was widely used with open and closed methods. In the cases of fractures that having large fragments and wide displacement, closed technique has disadvantage of difficulties in anatomic reduction and its maintenance. Nineteen femoral shaft fractures had been treated by these techniques alternatively at our hospital between Feburary 1994 and Feburary 1997 and had been followed for more than 12 months. Among the 19 cases, closed techniques were 11 cases and open 8 cases. We evaluated the results of two treatment methods in terms of the bone union time, complications and functional results. Mean duration of the bone union time was 24.2 weeks in closed interlocking nailing, 24.5 weeks in open. There was no difference between the bone union time and the operation techniques(p-value>0.05). And complications were delayed union in two cases. In conclusion, in the cases of severe comminuted and segmental femoral shaft fractures especially with posteromedial fragment, open technique was more useful than closed technique, in terms of anatomic restoration and getting functional recovery afford to preinjury level of work.

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Operative Treatment of the Condylnr Fractures of the Femur: Moon Gu Choi, Youn Soo Kim, Kee Haeng Lee, Chang Hoon Chung, Hyoung Min Kim, Joong Hyuk Kwon; J Korean Soc Fract 1999;12(3):523-528. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.523

Abstract PDF: PURPOSE
To evaluate the results of the the condylar fracture of the femur treated by open reduction and cancellous screw fixation. METERIALS AND METHODS: From April, 1994 to October, 1998, 9 cases of the condylar fracture of the femur were open reduced and internally fixed with cancellous screw. According to AO classification, B2 type, B3 type and C2 type were all three cases each. All intraarticular fragment of the 9 cases were fixed with cancellous screws fixation after open reduction. Additionally 2 cases were fixed with dynamic condylar screw and 1 case was fixed with supracondylar nail. Authors followed up from shortest one year one month to longist three year four month(average 2 years) and evaluated them by using the method of Schatzker and Lamberts.
RESULTS
Seven of 9 cases had reduced anatomically, and remained 2 case which were delayed to operation cannot reduced anatomically. In all case stable fixation of the intraarticular fragment was obtained by cancellous screw fixation without perioperative complication. Schatzker and Lamberts assesment shows excellent in four, good in one, fair in three and failure in one case. CONCLUSTION: In case of the condylar fracture of the femur, early and relatively simple screw fixation can obtain anotomical reduction and prevent complication caused by incongruent joint surface.

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Treatment of comminuted supracondylar fractures of the femur using Ilizarov method: Myung Chul Yoo, Yoon Je Cho, Ki Tack Kim, Young Soo Chun, Na Sil Pyo, Sung Gun Kim; J Korean Soc Fract 1999;12(3):529-537. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.529

Abstract PDF: PURPOSE
To evaluate the effectiveness of the Ilizarov method as a treatment of open or comminuted supracondylar fractures which are uncommon, and difficult to manage because of the wide range of potential complications.
MATERIALS and METHODS
Between 1992 and 1999, we treated open or comminuted supracondylar fractures of the femur by Ilizarov method in whole period or conversion to OR/IF with or without bone graft after transient Ilizarov fixation. There were 13 cases in 11 patients. Open comminuted fractures were seven cases and closed comminuted fracutres were six cases. We compared Ilizarov method in all procedures and temporary mode followed by internal fixation for definite care.
RESULTS
According to Schatzker and Lamberts assessment the results were good or excellent in ten cases(77%). And the results were rated as good or excellent in 67% of case of Ilizarov method in all procedures, and 86% of cases changed to OR/IF.
CONCLUSION
Ilizarov technique is an useful method in cases of open and/or comminuted supracondylar fractures of the femur. And after initial stabilization of fracture, conversion to OR/IF is advisable to prevent pin site infection and allow ROM excercise of the knee joint.

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Intraoperative Fracture of the Tibia Associated with Removal of the Interlocking Intramedullary Nail: Report of 5 cases: Chan Hoon Yoo, Young Soo Byun, Hong Tae Kim, Hyun Min Kim, Yeon Min Park, Soo Yeol Jeon; J Korean Soc Fract 1999;12(3):538-542. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.538

Abstract PDF

We have experienced five cases of intraoperative fracture of the tibia assoicated with removal of ACE interlocking tibial nail. All fractures occured in young patients whose ages ranged from eighteen to twenty-nine years(mean, 24 years). We think the main reason of the fracture was characteristic design of ACE nail such as prominent distal angulation and posterior longitudinal slot. The other factors were age of the patient, material of the nail and timing of removal of the nail. In conclusion, we advise caution in the removal of the ACE reamed interlocking intramedullary tibial nail in young patient.

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Failure to Remove a Trochanteric Entry Femoral Nail and Its Cause in Adolescent Patients: Two Cases Report
Ji-Hwan Kim, Seung-Oh Nam, Young-Soo Byun, Han-Sang Kim
Journal of the Korean Fracture Society.2015; 28(1): 71. CrossRef

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Treatment of conuninuted Segmental Fracture of the Proximal Tibial Shaft with Retrograde Ender Nails: Jung Geun Choi, Geun Sun Choi, Soo Jae Yim, Syung Ryul Yoon; J Korean Soc Fract 1999;12(3):543-548. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.543

Abstract PDF: PURPOSE
To present the result of retrograde Ender pinning technique for treatment of comminuted segmental fracture of the proximal tibial shaft.
MATERIALS and METHODS
From 1994 to 1998, we treated twenty-one cases of the comminuted segmental proximal tibial shaft fracture with the retrograde Ender pinning technique. We have followed up the clinical results.
RESULTS
The clinical bone union time was average eleven weeks, and the radiologic bone union time was average nineteen weeks.
CONCLUSIONS
In the treatment of comminuted segmental proximal tibial shaft fracture, the retrograde Ender pinning technique is useful. The method improves fixation of the proximal fragment, is simple and effective, provides good fixation of the tibia in patients in whom stabilization of several fractures is required, and can be used for fixation of tibial shaft fracture with soft tissue damage.

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Ilizarov External Fixation for Severe Open Tibial Shaft fractures in Adults: Jeung Tak Suh, Tae Wook Nam, Chong Il Yoo; J Korean Soc Fract 1999;12(3):549-556. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.549

Abstract PDF: PURPOSE
It is to evaluate and discuss the result of severe open tibial shaft fractures treated by Ilizarov external fixation.
MATERIALS and METHODS
From the January 1992 to July 1997, 34 cases of severe open tibial shaft fracture in adults were treated with Ilizarov external fixator. 20 males and 14 females were followed for at least 1 year.
RESULTS
Fractures were evenly distributed through proximal 1/3 to distal 1/3 and its pattern was mostly comminuted one. According to Gustilo-Anderson classification, it mainly consisted of type IIIa &IIIb(28 cases: 82%). Mean bony union time was 40.2 months. There were 5 cases(15%) of delayed union, 2 cases(6%) of nonunion, 5 cases(15%) of deep infection including 3 cases(9%) of osteomyelitis, 10 cases(29%) of pin tract infection, 4 cases(12%) of malunion and 11 cases(32%) of ankle stiffness.
CONCLUSION
Conclusively, in the first place, for the successful treatment with Ilizarov external fixator, determining appropriate indications is the most important. Secondly, active reconstruction of soft tissue environment and early prophylactic bone graft, if necessary, are also essential to shorten union time. Thirdly, meticulous care of pin site and ankle motion is needed for the prevention of the two most common complications even though they are considered to be minor.

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Clamp external fixator for IIIb open tibial shaft fracture: Jeung Tak Suh, Byung Guk Park, Chong Il Yoo; J Korean Soc Fract 1999;12(3):557-567. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.557

Abstract PDF: As the saftest and simplest method of immobilization treatment, external fixation is indicated in IIIb open tibial shaft fractures with extensive damage to soft tissue and bone. This enables better wound treatment, patient transport and performace of surgical treatment such as plastic and reconstructive surgery, orthopedic surgery. From the march 1994 to september 1997 14 cases of IIIb open tibial shaft fractures were treated with clamp external fixator either Orthofix or DynaExtor. The purpose of this study is to determine indication of clamp external fixator and investigate its outcome as well as complications and solutions. 11 males and 3 females were followed for 29.3 months on an average. Fractures mainly occurred at mid 1/3 of tibial shaft and its pattern was most frequently comminuted one. Mean bony union time was 46 months. There were 1 case(7%) of delayed union, 2 cases(14%) of nonunion, 6 cases(42%) of reduction loss, 4 cases(28%) of deep infection including 2 cases(14%) of osteomyelitis, 6 cases(42%) of pin tract infection, 2 cases(14%) of malunion and 3 cases(21%) of ankle stiffness. Conclusively for the creation of a suitable environment of fracture healing and prevention of complications such as delayed union, nonunion and deep infection, thorough debridement and irrigation followed by adequate stabilization of bone, early soft tissue coverage and early prophylactic bone graft is paramount important in the treatment of IIIb open tibial shaft fracture since it is high energy trauma. In addition, initial firm fixation for the prevention of reduction loss and active and passive exercise for the prevention of ankle stiffness and pin tract infection or loosening should be taken into careful consideration.

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Treatment of open Tibial Shaft Fractures with Unreamed Interlocking Intramedullary Nailing: Jeung Tak Suh, Byung Guk Park, Chong Il Yoo; J Korean Soc Fract 1999;12(3):568-576. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.568

Abstract PDF: Severe open fracture of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilization was by external fixation, but the advent of small diameter interlocking intramedullary nails has introduced a new option. From the June 1992 to December 1997, 55 cases of open tibial shaft fracture were treated with unreamed interlocking intramedullary nailing at the department of orthopedic surgery, Pusan National University Hospital. The purpose of this study is to evaluate its result and complications. Mean age was 31, mostly male. The main cause of trauma was traffic accidents(30 cases, 55%) and fracture sites consisted of mid 1/3 portion over 75%. According to the Gustilo & Anderson classification 8 type I(15%), 22 type II(40%), 15 type IIIA(27%) and 10 type IIIB(18%) were shown. Union time was 28.3 weeks on an average and union rate was 98%. There were 5 cases(9%) of delayed union, 2 cases(4%) of deep infection and 1 case(2%) of chronic osteomyelitis. In conclusion unreamed interlocking intramedullary nailing can be the first choice treatment in the treatment of open tibia shaft fractures with low postoperative infection.

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Nonunion after Intramedullary Nailing of Femoral Shaft Fracture: Woo Suk Lee, Kyoo Ho Shin, Kyung Su Lim; J Korean Soc Fract 1999;12(3):577-593. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.577

Abstract PDF

From January 1992 to June 1997, we reviewed retrospectively eighteen femoral shaft nonunions after intramedullary nailing and followed for an average of 31(18-53)months. We investigated causes of nonunion and analyzed the results according to operative method. Nonunion was divided into infected(4 cases) or noninfected types(14 cases). The causes of noninfected nonunion were insufficient stability(7 cases) and bone defects(4 cases). In insufficient stability, there were loosening of locked screw in four, absence of locked screw in two, and breakage of locked screw in one. There was a correlation between severe comminuted fracture with an early weight bearing and screw failure(p<0.05). Seven cases of nonunion were treated with compression plate and cancellous bone grafting, four cases only bone grafting, three cases Ilizarov external fixations, three cases dynamization, and one case renailing. The clinical and roentgenographic healing processes were recorded. All achieved solid unions within an average period of 11.7(2.5-41)months. An average time to union was 5.2(3-7)months after dynamization, 7.3(7-8)months after bone grafting, 12 months after renailing, 12.9(4-25)months after compression plate and cancellous bone grafting, and 21.3(11-41)months after Ilizarov external fixation. The union period with noninfected nonunion was significantly shorter than infected nonunion(9.2 months vs. 20.3 months; p<0.05).

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Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult
Yong-Woon Shin, Yerl-Bo Sung, Jeong Yoon Choi, Minkyu Kim
Journal of the Korean Fracture Society.2011; 24(4): 313. CrossRef
Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef

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Surgical Treatment of Comminuted Interior Patellar Pole Fractures by Separate Vertical Wirings: A New Method of Internal Fixation: Young Soo Byun, Hong Tae Kim, Chan Hoon Yoo, Hyun MiH Kim, Yeon Min Park, Sang Chul Shin; J Korean Soc Fract 1999;12(3):584-592. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.584

Abstract PDF: The inferior pole fragments of patellar fractures should be reduced anatomically whenever possible because any resection of the inferior pole fragments results in patella baja and abnormal patellofemoral biomechanics. However, there are still no effective methods of stable fixation for comminuted inferior patellar pole fractures. The purpose of this study is to introduce a new method of internal fixation of separate vertical wirings for comminuted inferior patellar pole fractures and to present the results of the wirings. Thirteen patients with comminuted inferior patellar pole fracture were treated with 2 to 4 separate vertical wirings, which provided the sufficient strength to allow early motion without loss of reduction during fracture healing. All the fractures were healed in anatomical position and all the patients regained full range of motion of the knee. Loss of fixation occurred in a patient by foiling on the ground, but the fracture was healed by the wirings again. There were no patients with radiographic evidence of posttraumatic osteoarthritis at the final follow-up. Overall result was rated as excellent in all the patients. The results of this study indicate that separate vertical wirings are an effective method of stable fixation enough to allow early motion without loss of reduction during fracture healing for comminuted inferior patellar pole fractures.

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Operative Treaeent of Hohl II, III Plateau Fracture by Small Incision and Bone Window: Jin Woo Kwon, Kyoung Tae Sohn, Sung Ho Shin, Woo Se Lee, Won Ho Jo, Jae Il Kim; J Korean Soc Fract 1999;12(3):593-600. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.593

Abstract PDF: Severely depressed plateau fractures, especially Hohl I, III, can not be reduced by ligamentotaxis and require elevation through a cortical window, bone grafting, and fixation with either cancellous screws or a buttress plate. But traditional long lateral parapatellar incision and plate fixation method caused frequent wound dehiscence and deep infection. Thus to reduce the soft tissue problem we treated Hohl II, III plateau fractures by small anterolateral L-shaped incision, submeniscal exposure, reduction of depressed plateau and bone graft through bone window, and then cancellous screws fixation beneath the subchondral bone of elevated plateau. We anayzes 22 cases with Hohl II, III plateau fractures, which were treated by these method from February 1990 to December 1997 and followed more than 1 year. Males were 17, and females were 5. Average age of patients was 44.7 years. The most common cause of injury was traffic accidents(17 cases), and fracture type according to the Hohl classification was 14 cases of type II, 8 of type III. The associated injuries were 18 cases of meniscus tear, 13 of ligament injury(6 ACL, 7 MCL). The clinical results by Blokkers criteria were satisfactory 19 cases(86.3%) and unsatisfactory 3 cases(13.7%). We concluded that this method has following advantages; relatively firm fracture fixation, short operation time, low soft tissue problem.

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Risk Group of Lateral Meniscus Injury in Fracture of Lateral Tibial Condyle: Jung Man Kim, Cheong Ho Chang, Doo Hoon Sun, Jeong Tae Seo, Seok Joong Kim; J Korean Soc Fract 1999;12(3):601-606. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.601

Abstract PDF: PURPOSE
Untreated meniscus injuries accompanied with fractures of lateral tibial condyle may cause prolonged pain and post-traumatic arthritis. Lateral displacement of fractured fragment of lateral tibial condyle was found to be related to the incidence of lateral meniscus tear. We established the risk groups for lateral meniscus injuries on the basis of the degree of the lateral displacement of lateral tibial condyle.
MATERIALS and METHODS
Risk groups for lateral meniscus injury in fractures of lateral tibial condyle were evaluated in 39 knees, retrospectively, using plain roentgenograms and arthroscopic findings. On the knee anteroposterior radiography, displacement of lateral tibia condyle were classified into three groups according to the probability of lateral meniscus INJURY: high risk group for above 8mm of lateral displacement; moderate risk group for 4-8mm; low risk group for less than 4mm.
RESULTS
High risk group has ten meniscus injuries among 13 knees(76.9%) and moderate risk group had the seven meniscus injuries of 18 knees(38.9%). Low risk group of eight knees had no meniscus injury(0%). These different incidences among groups were statistically significant(p<0.05).
CONCLUSIONS
The authors suggest that the incidence of lateral meniscus injury was related to the degree of lateral displacement of lateral tibial condyle, and our definition of risk groups are useful for prediction of lateral meniscus injury in fracture of lateral tibial condyle.

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Treatment of Avulsion Fracture of posterior Cruciate Ligament from Tibial Attachment: Retrospective Study: Moon Jib Yoo, Suk Joo Lyu, Kwang Ho Jin, Myung Ho Kim; J Korean Soc Fract 1999;12(3):607-613. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.607

Abstract PDF: PURPOSE
If PCL injury is not treated properly, it may result in progressive instability and functional disability, ultimately degenerative changes of the knee joint. So, we classified fracture type according to extent of displacement and comminution. We will investigate the result and prognosis of operative treatment, and fracture type, associated injuries, and fixation device affect the result. Finally we will ascertain the effectiveness of MRI. MATERIAL AND METHODS: 15 patients were treated in our hospital during the period september 1995 to july 1998. All of them were male. 14 of the 15 patients were treated operatively and 1 patient conservatively. The follow-up period after operative treatment varied from 9 to 30 months.
RESULTS
The roentgenograms showed union in all patients. There was subjective satisfaction in 11 of 15 patients. According to the measurement using objective device(KT-2000), in 12 patients, posterior displacement of tibia was less than 2mm, and in 3 patients, less than 4mm. According to Lysholm and Gillquist scoring scale, 11 patients were excellent, 3 patients were good, and 1 patient was fair. The fracture type and fixation device exerts no effect on the results, while associated injury around the knee joint had significant effect on the results.
CONCLUSION
Firstly, In avulsion fracture of PCL from tibial attachment, we were able to obtain satisfactory result by operative treatment using the small curvilinear posterior incision. Secondly, By using MRI, we were able to classify the fracture type more exactly and also find associated soft tissue injuries on the traumatized knee joint. As a result, MRI was quite helpful in determining the treatment and prospection of prognosis. Thirdly, The type of device had no effects on the results, no need of removal of fixation devices. Finally, Fixation was made possible by small curvilinear skin incision.

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Arthroscopically-assisted Reduction and Fixation for the Lateral Tibial Condyle Fractures: Jeong Hwan Oh, Seon Nam Kim; J Korean Soc Fract 1999;12(3):614-621. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.614

Abstract PDF: PURPOSE
Retrospective study was performed about arthroscopically-assisted reduction and internal fixation for the lateral tibial condyle fractures to evaluate the usefulness of arthroscopy. MATERIAL AND METHODS: From January 1993 through December 1996, 36 patients with tibial plateau fractures were evaluated. After reviewing the records and radiologic studies, 22 patients were included in the study based on fracture patterns. Average follow up were 26 months, with a range of 12 to 45 months. Among the 22 cases, 16(72.7%) were male and 6 (27.3%) were female. Fourteen(72.6%) were caused by traffic accident(9 pedestrians, 5 passengers) and 7 were fall from a height. According to Schatzker classification, 9 cases (40.1%) were classified as cleavage with depression(type II), 5 cases(22.4%) of pure central depression(type III) and 8 cases(36.5%) of pure cleavage(type I). There were 24 cases of associated injuries in 16 patients, among which lateral meniscus tears was most common (37.5%). We used Porters criteria for the clinical evaluation and Blotters criteria.
RESULTS
By Porters criteria for the clinical evaluation, acceptable results were obtained in 20 cases (90.9%) in symptom, 21 cases(95.5%) in functional aspect and 22 cases(100%) in appearance and radiologic appearance. By Blotters criteria, satisfactory results were in 20 cases (90.9%).
CONCLUSION
Arthroscopically-assisted reduction and internal fixation should be considered one of the treatment of choice in selected tibial plateau fractures from many advantages.

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Operative Treatment of the Tibial Pilon Fractures: Suk Woong Yoon, Tae Sung Hwang, Byung Gue Park, Sang Deog Kim; J Korean Soc Fract 1999;12(3):622-631. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.622

Abstract PDF: Pilon fracture which is defined as a comminuted intraarticular fracture of distal tibia has been known to be difficult to manage because high axial compression and rotational forces to the ankle joint result in impaction, severe comminution, metaphyseal disruption, and soft tissue trauma. Several authors have reported good results using an AO group treatment principle. However, others have documented less favorable results such as skin slough, wound infection, and osteomyelitis. Recently, satisfactory results were obtained by the treatment with open reduction and fixation using Ilizarov method. We reviewed and analyzed 22 cases of the pilon fracture treated by the two methods O.R.I.F. and fixation by Ilizarov method) and compared the results to find out the usefulness of fixation by Ilizarov method, from Feb. 1993 to Mar. 1997 at the Department of Orthopedic Surgery, Seoul Red Cross Hospital. Fixation by Ilizarov method using ligamentotaxis and occasional minimal open reduction was effective for fracture reduction. It also decreased complications such as wound infection, skin necrosis, and osteomyelitis because it did not need extensive soft tissue dissection. And, it was also useful for severe comminuted fracture, open fracture, and fracture with extensive diaphyseal extension to proximal metaphysis.

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Comparative Analysis of Interlocking Nail and Anatomical Plate in the Treatment of Distal Tibial Fracture: Gun Il Im, Do Young Kim, Joo Ho Shin, Kang Seob Youn, Won Ho Cho; J Korean Soc Fract 1999;12(3):632-637. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.632

Abstract PDF

We studied 39 patients with distal tibial shaft fracture. Seventeen fractures(10 closed fractures and 7 open fractures: 5 type-I and 2 type II fractures, according to the classification of Gustilo et al.) were treated with interlocking nail, and 22 fractures(19 closed and 3 open fractures: 1 type I and 2 type II fractures) were treated with anatomical plate. The clinical results were analyzed according to treatment modality. All of the patients were followed up for more than 1 year. The average time to union was 18.1 weeks in the patients treated with interlocking nail and 23.7 weeks in the patients treated with anatomical plate. In the functional outcome(according to Klemm and Borner), twelve patients(70.6%) treated with interlocking nail showed excellent results and 10 patients(45.5%) treated with anatomical plate had excellent results. We concluded that more satisfactory results could be obtained with interlocking nail compared with anatomical plate in the treatment of the distal tibial fracture.

Citations

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Comparative Analysis of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Distal Tibia Fractures
Ho-Min Lee, Young-Sung Kim, Jong-Pil Kim, Phil-Hyun Chung, Suk Kang, Kaung Suk Jo
Journal of the Korean Fracture Society.2018; 31(3): 94. CrossRef
Comparative Analysis of Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Intramedullary Nailing in Distal Tibial Metaphyseal Fractures
Gwang Chul Lee, Jun Young Lee, Sang Ho Ha, Hong Moon Sohn, Yi Kyu Park
Journal of the Korean Fracture Society.2012; 25(1): 20. CrossRef
Comparative Study Using of Treatment with Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Interlocking Intramedullary Nailing in Distal Tibia Fractures
Chang Hwa Hong, Jong Seok Park, Sang Seon Lee, Soo Ik Awe, Woo Jong Kim, Ki Jin Jung
Journal of the Korean Fracture Society.2010; 23(3): 296. CrossRef
A Comparison between Minimally Invasive Plate Osteosynthesis & Interlocking Intramedullary Nailing in Distal Tibia Fractures
Kee-Byung Lee, Si-Young Song, Duek-Joo Kwon, Yong-Beom Lee, Nam-Kyou Rhee, Jun-Ha Choi
Journal of the Korean Fracture Society.2008; 21(4): 286. CrossRef

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HERBERT SCREW FIXATION FOR NON-COMMINUTED CLOSED MEDIAL MALLEOLAR FRACTURE: Dong Man Park, Yong Jin Kim, Jea Won Chang, Jin Cheul Park; J Korean Soc Fract 1999;12(3):638-644. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.638

Abstract PDF: It is known that the Salter-Harris type I and II fractures of the distal tibial epiphysis usually Non-comminuted closed displaced medial malleolar fracture has been treated by open reduction and internal fixation. Since fracture fragment of medial malleolar is usually thiner and smaller than that of lateral malleolar, it is more difficult to fix firmly than that of lateral malleolar. In the treatment of medial malleolar fracture, although various fixation methods in the treatment of medial malleolar fracture have been reported, several complications have been reported. And then authors have been tried to find fixation methods and firm fixation material for medial malleolar fracture to minimize complications. The purpose of this paper is to compare operation time, duration of bone union, the presence of complication, and results by Meyer and Kumler criteria between Herbert and malleolar screw and to introduce percutaneous Herbert screw fixation technique. Since March 1996, forty-four patients had undergone surgical intervention for medial malleolar fractures. Twenty-three Herbert screw and twenty-one malleolar screws were used. The results were as follows; The operation time was shorter in Herbert screw fixation group. There were no complications such as pain and tenderness due to hardware protrusion and metal lossening in Herbert screw fixation group. We come to the coonclusion that the Herbert screw fixation method was a little better than the malleolar screw fixation method according to comparison by Meyer and Kumler ctireria. We concluded that Herbert screw fixation was a better method for non-comminuted closed displaced medial malleolar fracture to obtain early union and to prevent postoperative complications.

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The Comparative Study of Treatment between the IM nailing and the Plate fuation of the Humerus Shaft Fracture: Eu Sub Chung, Il Yup Jeon; J Korean Soc Fract 1999;12(3):645-651. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.645

Abstract PDF: The ideal treatment of acute fractures of the humeral shaft remains controversial. Recently, tendency of surgical treatment has been increased. Authors reviewed and analyzed plate fixation in 40 patients and intramedullary nailing in 26 patients having humeral shaft fractures. These patients were treated at the department of orthopaedic surgery, Chonju Presbyterian Medical Center from June 1994 to November 1997. There is no significant difference in union time, operation time, functional result. But, non-union rate of intramedullary nailing is superior to that of plate fixation. So, We concluded that plate fixation in humerus shaft fracture is more acceptable than intramedullary nailing, except severe osteoporosis, severe communited fracture, segmental fracture, pathologic fracture.

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Alterations of Biochemical Markers in Osteoporotic Fractures: Jae Sung Seo, Kwang Hee Lee, Woo Hyuk Jang; J Korean Soc Fract 1999;12(3):652-659. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.652

Abstract PDF: Hip fracture is one of the most severe consequence of osteoporosis affecting aged women. Biochemical markers of bone formation and bone resorption allow for a noninvasive assessment of the bone turnover alteration of the entire skeleton in osteoporosis. To evaluate the bone metabolic status of postmenopausal women who sustained hip fractures, we measured serum osteocalcin levels as a bone formation markers, and urinary deoxypyridinoline levels as a bone resorption markers. Comparison was made with-age-matched controls. At the time of admission, serum osteocalcin was 23% lower in the fractured patients compared to controls and urine deoxypyridinoline was 22% higher than in the controls(P<0.05). Hip fracture patients have biochemical evidence of decreased bone formation and increased bone resorrtion compared to controls. Increased bone resorrtion was considered more important factor than bone formation in the postmenopausal osteoporotic hip fracture. Since fracture pathogenesis is complex, various factors, such as osteoporosis and risk factors for injury, have been considered. We suggest that abnormal level of osteocalcin and deoxypyridinoline in Postmenopausal women could be contribute a factor of fracture pathogenesis.

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Assessments of Reduction for Supracondylar Humerus fractures in Children: Comparison of Clinical carrying angle, Baumanns angle and Metaphyseal-diaphyseal angle: Seung Rim Park, Hyoung Soo Kim, Joon Soon Kang, Woo Hyeong Lee, Seong Hwan Kim; J Korean Soc Fract 1999;12(3):660-666. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.660

Abstract PDF

PURPOSE
The object of this retrospective study is to verify Baumanns angle as assessment methods of reduction for supracondylar fracture of the humerus in children and to confirm what is the more accurate assessment methods of supracondylar fracture of the humerus between Baumanns and metaphyseal-diaplyseal angle.
MATERIALS AND METHODS
34 cases of more than 1 years follow up after closed reduction and pinning were reviewed. Simple linear regression has been used for statistical analysis and Pearsons correlation coefficient(rho) has been used for comparison of Baumanns angle and metaphy seal-diaphyseat angle.
RESULTS
The results form simple linear regression, about a 10 change in Baumanns angle contributes to a change in the carrying angle of approximately 3.7 on the uninjured(=-0.372, r=-0.750, P<0.001) and injured( =-0.365, r=-0.759, P<0.001) arms. In comparison of Baumanns angle and metaphyseal-diaphyseal angle to predict final carrying angle, the correlation coefficient between Baumanns angle and carrying angle(r=-0.759) was higher than that between metaphyseal-diaphyseal angle and carying angle(r=-0.495) with statistical significant using Fishers rho(P<0.05).
CONCLUSION
The Baumannss angle after reduction can be reliably used to predict accurately the final carrying angle and is more accurate than the metaphyseal-diaphyseal angle to predict the final carrying angle.

Citations

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Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture
Yoon Hae Kwak, Dong Jou Shin, Kun Bo Park
Journal of the Korean Fracture Society.2010; 23(1): 90. CrossRef

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Treatment of the Lateral Condyle Fractures of the Humerus in Children: Duk Yong Lee, Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suk Ha Lee, Dong Ki Lee, Yoen Sik Yu, Eun No Lee, Nak Hoon Seong; J Korean Soc Fract 1999;12(3):667-673. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.667

Abstract PDF: The authors analysed the 40 patients of the lateral condyle fracture of the humerus in children who were admitted in Korea Veterans Hospital in Seoul from Jan. 1990 to Dec. 1997. The fracture type and the displacement was classified according to Milch type and Jakob stage. Clinical analysis was performed on 40 patients with lateral condyle fracture of humerus, who could be followed up. The patients were followed up from 12 months to 63 months with an average of 23 months. Average duration of bone union was 6 weeks after operation. The significant differences in outcome were notified from open reduction and internal fixation in comparison to closed reduction and percutaneous pinning. According to the criteria of Hardacre, we obtained excellent result in 16 cases(40%), good result in 22 cases(55%) and poor results in 2 cases(5%).

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Ulnar nerve palsy After Percutaneous Pinning in Childrens Supracondylar fracture: Tai Seung Kim, Jay Rim Choi, Kuhn Sung Whang; J Korean Soc Fract 1999;12(3):674-678. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.674

Abstract PDF: Many authors have described percutaneous pinning techniques as the treatment of choice for most supracondylar fractures. But little information is available concerning ulnar nerve injury resulting from pinning techniques. When the surgeon is faced with a postoperative ulnar nerve palsy, it can be the result of unrecognized preoperative palsy, manipulation during surgery, or damage to the nerve by one of the medial pin placements. The options for management include exploration, medial pin removal, or observation. We reviewed our hospital records on the 132 supracondylar elbow fractures that we treated in children from 1991 to 1998 There were 16 palsies found with normal preoperative and abnormal postoperative ulnar nerve function. Normal nerve function returned without exploration and early medial pin removal in all cases. We recommand that observation is the appropriate way to manage these postoperative ulnar nerve palsies in most cases.

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Immediate Quadriparesis after Posterior Sublaminar Wiring for Cervical Fracture Dislocation: A Case Report: Byeong Yeon Seong, Chan Ji Park, Dong Seong Park; J Korean Soc Fract 1999;12(3):679-685. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.679

Abstract PDF: Open reduction and internal fixation of the cervical spine is a commonly performed method of treatment for acute cervical fracture dislocation. A sudden or gradual worsening of the neurological status of a patient during reduction should alert the physician to the presence of high grade compression of the spinal canal. Loss of neurological function during or after manipulation or open reduction and internal fixation should raise the suspicion of compression of the spinal cord from a lesion occupying the canal, such as a herniated disc, buckling of the ligamentum flavum, an epidural hematoma or bone fragments. Magnetic resonance imaging or myelogram are the most helpful diagnostic means and should be used initially if suspected. Treatment is anterior decompression and autogenous strut bone graft. Causes of our case include ruptured disc, vertebral end plate and posterior longitudinal ligament. We experienced a case of immediate quadriparesis after posterior decompression and sublaminar wiring for cervical fracture dislocation which was resulted from ruptured disc, vertebral end plate and posterior longitudinal ligament.

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Treatment of Acute Acromioclavicular Dislocation with Modified Phemister Technique: Myung Hwan Son, Byung Chul Kim, Nam Wook Kang, Tae Young Choi; J Korean Soc Fract 1999;12(3):686-692. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.686

Abstract PDF: There are various kinds of operative methods for the treatment of acute acromioclavicular dislocation but many complications such as posttraumatic arthritis, limitation of shoulder motion, and recurrence of dislocation would be developed. We have experienced 23 cases of acute acromioclavicular dislocation treated by modified Phemister technique from January 1992 to January 1997 and followed-up at least 1 year at Department of Orthopaedic Surgery, Pusan City Medical Center. The results were as follows: 1. The clinical results were evaluated by Weaver and Dunn were good in 19 cases, fair in 3 cases, poor in 1 case. 2. The radiological results were evaluated by the difference of the distance from the coracoid process to the clavicle between normal and injured site. The comparison of coraco-clavicular distance after surgery(1.76 mm) with that of follow up(2.41 mm) showed no significant difference(P>0.05, by Student t-test). 3. There was no posttraumatic arthritis and limitation of shoulder motion in all cases. So we suggest that modified Phemister technique is a good method for aute acromioclavicular dislocation.

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Coracoid Process Fracture Associated with Acromioclayicular Dislocation and Partial Rupture of Coracoclavicular Ligament: A Case Report: Seok Woong Yoon, Tae Sung Hwang, Byung Gue Park, Ki Hoon Kil; J Korean Soc Fract 1999;12(3):693-697. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.693

Abstract PDF: A coracoid process fracture associated with acromioclavicular dislocation has been reported infrequently. A coracoid process fracture associated with coracoclavicular ligament rupture has been reported only in two cases. Two separated injury mechanisms seem to be involved in this instance; one is direct trauma to the shoulder girdle causing dislocation of acromioclavicular joint, and the other is sudden avulsive pull on coracoid process by the conjoined tendons of short head of biceps brachialis and coracobrachialis, and pectoralis minor muscle causing fracture of the coracoid process. We reported one case of coracoid process fracture associated with acromioclavicular dislocation and partial rupture of coracoclavicular ligament. The lesion was treated by open reduction and interanl fixation using two Kirschner - wires for the acromioclavicular joint and a cortical screw for coracoid process, and the result was satisfactory without complication.

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Operative Treatment of Fracture of the Body of the Scapula: Moon Gu Choi, Hyoung Min Kim, Youn Soo Kim, Kee Haeng Lee, Chang Hoon Chung, Kwang Yeol Lee; J Korean Soc Fract 1999;12(3):698-703. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.698

Abstract PDF: PURPOSE
Although fracture of the body of the scapula have been treated successfully by conservative treatment but residual deformity was high and related to the residual symptom. Authors had done open reduction and internal fixation with wiring in the case of severe displacement of the fracture fragment of the body of scapula and analyzed that results. MATERIAL AND METHODS: Authors treated 18 cases of fracture of the body of the scapula in 17 patients from October, 1985 to June, 1996. Conservatively treated group was 12 cases which has less than 2cm displacement and operatively treated group was 6 cases which has more than 2cm displacement of the fracture fragment. Internal fixation was done with wiring. All cases was followed up average 1 year 9 months(from 13 months to 8 year 8 months) and evaluated by McGinnis assessment system.
RESULTS
All cases united within ten weeks. Five cases in the operatively treated six cases got anatomic reduction and stable fixation with wiring and had no operation related complication. Operatively treated group has average 2.83 associated injury and conservatively treated group has average 1.87 Neurovascular complication compromised the results.
CONCLUSION
Operative treatment of the fracture of the scapular body can reduce the residual deformity and residual symptom in the severely displaced case and facilitate early rehabilitation.

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Treatment of Humeral Shaft Nonunion after Primary Internal Fixat: Kwang Won Lee, Kyou Hyeun Kim, Whoan Jeang Kim, Ha Yong Kim, Jae Hoon Ahn, Yong Bum Park, Won Sik Choy; J Korean Soc Fract 1999;12(3):704-711. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.704

Abstract PDF: We retrospectively reviewed one hundred fifty-two patients who were treated for humeral shaft fractures at Eul-Ji Medical College hospital from Jan 1991 to June 1997. We experienced twenty one cases of nonunion among them after primary internal fixation. The purpose of this study was to evaluate possible causes of nonunion and to find out adequate treatments. The main cause of nonunion was an inadequate fixation (57%). The most common fracture pattern was simple transverse type(22%), and it occurred most frequently at the middle one third area of humeral shaft(22%). For the treatment of nonunion, the plate fixation was done in ten cases, interlocking intramedullary nailing in three cases, bone graft only in six cases, and external fixation using monofixator(Orthofix) in two cases. We obtained complete bony union from all cases, and the average union time was 17.5 weeks. Our study showed that higher incidence of nonunion was found in primary intramedullary nailing cases(19%) than in primary plate fixation cases(4%). In conclusion, close attention should be paid when choose the primary fixation method, and plate fixation and bone graft was considered as one of the useful treatment method of nonunion.

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Operative treatment of humeral shaft fracture: Comparision of plate fuation and intramedullary nailing: Sang Ho Ha, Jae Won You, Sang Hong Lee, Dong Min Shin, Young Bae Pyo, Byoung Ho Lee, Min Hyok Choi; J Korean Soc Fract 1999;12(3):712-719. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.712

Abstract PDF

PURPOSE
Examine a humeral shaft fracture which had been treated with a plate and screw fixation or intramedullary nailing and compare these two methods with each other according to clinical and radiologic results and access the clinical avaliablity.
MATERIALS AND METHODS
Take 116 cases of humeral shaft fracture which had been treated with plate and screw fixation(73 cases) or intramedullary nailing(43 cases) and compare these two methods with each other according to bone union time, average operation time and nonunion rate.
RESULTS
Bony union in plate fixation was achieved 1.2 weeks earlier than intramedullary nailing(P>0.05). The average time of operation in intramedullary nailing was 58 minutes, which was shorter than that in plate fixation(P<0.05). The prevalence of nonunion was higher in intramedullary nailing than that in plate fixation, which was thought due to the fanning relaxation, fracture site distraction and/or inappropriate operative technique. Limitation of shoulder motion occasionally occurred in intramedullary nailing, so approriate device selection and surgical technique should be considered.
CONCLUSIONS
We concluded that the results of interlocking IM nailing were not superior to the results of plate fixation. But it is an attractive technique for the rapid closed stabilization of polytrauma patients and segmental and communited fractures.

Citations

Citations to this article as recorded by

Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures
Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn
The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107. CrossRef

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