Journal of Musculoskeletal Trauma

Posterior Hip Dislocation with Femoral Head and Neck Fracture: You Sung Suh, Jae Hoon Lee, Soo Jae Yim, Yon Il Kim; J Korean Soc Fract 2000;13(3):423-431. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.423

Abstract PDF: PURPOSE
In the femoral head fracture associated with posterior dislocation of hip, we analyzed the clinical results according to the fracture types and treatment methods to promoting the guide of treatment.
MATERIALS AND METHODS
We used 20 cases of fractured femoral head with posterior dislocation of hip from January 1990 to December 1997, and analyzed the treatment methods and clinical results according to the Pipkin classification.
RESULTS
Among the 20 cases, male was 19 cases(95%), motor vehicle accident contributed 15 cases(75%), and the case of type II and IV of Pipkin classification were 7(35%) and 9(45%) cases. Closed reduction performed within 12 hours after injury with good results was conducted in 9 cases(60%) among the 15 cases. According to the treatment methods after closed reduction, good result was showed only 3 of 8 cases(37.5%) in the conservative treatment, whereas 8 of 12 cases(66.7%) in the operative treatment. According to the type of Pipkin classification, good result was showed 3 of 6 cases(50%) in conservative treatment and all of 3 cases in operative treatment among the 9 cases of type I and II, whereas none of 2 cases in conservative treatment and 5 of 9 cases(56%) in operative treatment among the 11 cases of type III and IV. The following complications were encounted; 2 cases of avascular necrosis, 1 case of traumatic arthritis, 1 case of peroneal nerve palsy and 1 case of nonunion CONCLUSION: Good results were obtained in patients with early, stable, and accurate reduction. The Computed Tomogram was helpful to find the small fragment and check the accurate reduction. Open method that restoration joint congruity seemed to be the better procedure than closed method.

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Treatment of Acetabular Fracture with Wire: Chang Soo Kang, Dong Hwa Woo, Doo Hwan Oh; J Korean Soc Fract 2000;13(3):432-439. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.432

Abstract PDF: PURPOSE
To evaluate the clinical and radiological results of wire fixation for acetabular fracture and its merits.
MATERIALS AND METHODS
From 1996 Jan. to 1998 Dec., 18 cases of being fixed by wire among 42 cases who being treated by surgical method were analyzed. We evaluated these cases after a mean follow up of 2.1 years. The fixation was done by wires in 11 cases, wires with plate in 3 cases and wires with screw in 4 cases.
RESULTS
According to Epstein's criteria, favorable results were achieved in 15 cases(83.3%) on clinical grade and 14 cases(77.7%) on radiographic grade.
CONCLUSION
The results of this study suggest that open reduction and internal fixation with wire is preferable method that can permit early ambulation, decrease postoperative complication and achieve firm fixation, comparing with open reduction and internal fixation with plate and screws, in treatment of displaced acetabular fractures.

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Subtrochanteric Fracture in Osteopetrosis: Yerl Bo Sung, Kook Jin Chung, Sung Wook Won, Jin Ho Kim, Hyung Jin Chung, Jae Kwang Hwang, Jae Kwang Yum, Jong Guk Ahn; J Korean Soc Fract 2000;13(3):440-444. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.440

Abstract PDF: Osteopetrosis is a rare inheritable skeletal disorder caused by a defective remodeling mechanism. The resultant bone of these children is dense, brittle and susceptible to fracture. We report a case of the subtrochanteric fracutre in osteopetrosis.

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Treatment of Femoral Neck Fractures with Cannulated Screws: Chan Hoon Yoo, Hong Tae Kim, Young Soo Byun, Sang Chul Shin, Byung Doo Jang, Kyoung Hoon Hyun; J Korean Soc Fract 2000;13(3):445-453. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.445

Abstract PDF: PURPOSE
This study was performed to evaluate the results of femoral neck fractures in adult treated with cannulated screws and the factors that may affect results.
MATERIALS AND METHODS
From April 1992 to December 1998, the authors analysed 53 cases of femoral neck fracture treated with cannulated screws and followed more than one year. According to Garden's classification and anatomic location, we classified the fracture type. We used Garden alignment index for the accuracy of reduction and Singh index for the degree of osteoporosis. The clinical results were analysed by Lunceford's assessment.
RESULTS
According to Lunceford's assessment, the results were good or excellent in 40 cases(75%). Mean bony union time was 16.3 weeks. There were 10 cases(19%) of avascular necrosis of the femoral head, 6 cases(11%) of nonunion and 2 cases(4%) of malunion. There were significant relationship between complication rate and accuracy of reduction(P<0.01), operative delay more than 7 days(P<0.05).
CONCLUSION
The important factors that may affect the results are accuracy of reduction and interval between injury and time of operation, the others were degree of displacement, anatomic site, degree of osteoporosis. The results of this study indicate that cannulated screw fixation is an effective method for femoral neck fractures in adult.

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The Surgical Treatment of displaced Acetabular Fracture: Sang Hong Lee, Kyung Ho Kim, Pyong Ju; J Korean Soc Fract 2000;13(3):454-462. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.454

Abstract PDF: PURPOSE
To analysis clinical and radiological results of operative treatment of displaced acetabular fractures and establish the guideline for the operative treatment of displaced acetabular fracture with the analysis of the clinical and radiological results.
MATERIALS AND METHODS
A clinical analysis was performed on 36 patients with displaced acetabular fractures who had been operated on and followed for minimum 1 year period from January 1993 to December 1998. Clinical outcome was analyzed clinically by Harris hip scoring system and radiologically by Matta's roentgenographic grading system.
RESULTS
According to Letournel's classification, we had 25 elementary fractures(69%) and 12 associated fracture(31%). Among the elementary fractures, the posterior wall fracture was the most common type(17 cases, 47%) and both column fracture was the most common type among associated fractures(5 cases, 11%). Surgical approaches were 22 Kocher-Langenbeck, 8 extended iliofemoral, 3 triradiate transtrochanteric, 3 ilioinguinal. The mean duration of follow up after the operation was 2.2 years (range, 1 to 7 years). Among thirty six patients who had followed up more than one year, the satisfactory results were achieved in 27 cases (75%) on clinical grade and 26 cases (72%) on radiographic grade. The complications were developed in 20 cases out of 36 cases including posttraumatic arthritis 7 cases, heterotopic ossification 4 cases.
CONCLUSION
In the majority of the displaced acetabular fractures, accurate open reduction and internal fixation was recommended. It seems that the satisfactory operative reduction of the fracture is the factor that correlates with a satisfactory clinical result according to our study. Therefore in the surgical treatment of the acetabuluar fractures, it is essential to achieve an anatomical reduction and firm fixation by fully understanding the pathologic anatomy and by choosing an appropriate approach and fixation device.

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Breakage of Interlocking Screw after Intramedullary Nailing of Femoral Shaft Fracture: Gun Il Im, Cheol Won Hyun, Joo Ho Shin, Do Young Kim, Won Ho Cho; J Korean Soc Fract 2000;13(3):463-469. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.463

Abstract PDF: PURPOSE
We analysed risk factors for failure of interlocking screws after femoral intramedullary nailing, and introduce tips for removing broken screw.
MATERIALS AND METHODS
Seventy-two closed femoral shaft fractures were treated with interlocking nail. We compared 7 patients in whom interlocking screw breakage occurred (Group I) with 65 patients without breakage of interlocking screw (Group II). Analytic parameters were age, weight, level of fracture, degree of comminution, nail diameter. We used Mann-Whitney U test & Chi-sqare test for statistical analysis.
RESULT
Upper one of distal interlocking screws was broken in 6 patients, both of distal screws were broken in one patient. All of the patients with broken screws had associated delayed union. The mean age of patients were 20 years in group I, 31 years in group II. The mean weight were 69.6 Kg in group I, 62.02kg in group II. Three patients had fractures in proximal half and four patients had fractures in distal half in group I. In group II, there were 25 proximal fractures and 40 distal fractures. There were 2 type I, 2 type II, 1 type III, 2 type IV fractures in group I, and 16 type I, 31 type II, 17 type III, 1 type IV fractures according to Winquist and Hansen classification. Nail diameters were 10mm in 4 patients, 11mm in 2 patients, 12mm in 1 patient for group I and 10mm in 8 patients, 11mm in 13 patients, 12mm in 25 patients, 13mm in 13 patients, and 14mm in 6 patients for group II. Age, weight, degree of comminution, nail diameter had statistically significant relation to the breakage of interlocking screw(p<0.05), but the level of fracture didn't(p>0.05). Broken screws were easily removed by advancing screw to medial compartment with S-pin and making short medial incision.
CONCLUSION
It is suggested from our study that combination of parameters may have contributed to the failure of interlocking screw ; narrower diameter nail for comminuted fracture in young, active patients with more body weight. Inserting two screws have advantage over one screw.

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Two stage Operative Treatment of Supracondylar Open Comminuted Fracture of Femur: Temporary fixation with Transarticular Ender nails: Song Lee, Dong Ki Ahn, Seung Hwan Kim, Sung Wook Chun; J Korean Soc Fract 2000;13(3):470-478. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.470

Abstract PDF: PURPOSE
In many cases of open comminuted supracondylar fracture, it is very hard to apply traditional methods. So we have used Ender nails for temporary transarticular fixation. We thought that it could provide enough stability to control the wound and didn't promote further soft tissue damage or infection. We performed 2nd stage rigid fixation and bone graft after soft tissue healing. We have studied to prove this staged operation valuable to treat the very severe open comminuted supracondylar fracture of femur.
MATERIALS AND METHODS
We analysed 16 cases which have been treated with such staged operation method from April 1992 to April 1996 about complication, union time and functional result in retrospective method.
RESULTS
We could prevent severe wound infection in all cases. We performed 2nd stage rigid fixation and bone graft average 6 weeks after first stage temporary fixation. The average union time was 8 months and average range of motion was 10degrees flexion contracture and 100degrees further flexion.
CONCLUSION
In patients with very severe open comminuted supracondylar fracture of femur, the temporary fixation with transarticular Ender nails allowed the successful initial management for the secondary rigid fixation and bone graft and time could be saved for management of concomitant injuries. So this new staged operation is considered as a good method for safety, union time and functional result.

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Clinical Experiences of the Femoral Unicondylar Fractures: Ryuh Sup Kim, Suk Myun Ko, Kyu Jung Cho, Dong Hun Choi, Hyun Woo Park; J Korean Soc Fract 2000;13(3):479-487. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.479

Abstract PDF: PURPOSE
The femoral unicondylar fractures occur less frequently than the supracondylar or intercondylar femoral fractures. We document the problems and results in the treatment of these fractures.
MATERIALS AND METHODS
Eleven patients with minimal follow-up peroid of 12 months were included. In the methods of treatment, the operation with by closed or open reduction and internal fixation with screws was used for 7 cases, the conservative treatment for 4 cases. The therapeutic outcomes were rated by the Lysholm knee scoring scale.
RESULTS
The concomitant injuries including neurovascular, collateral or cruciate ligaments and capsular structures of knee to ipsilateral extremity were frequent events. The therapeutic outcomes were significantly affected by associated injuries. The only 5 cases had satisfactory result by the Lysholm knee scoring scale.
CONCLUSION
These injuries have been considered to be the result of high-energy trauma on flexed knee. The open reduction and internal screw fixation of the femoral unicondylar fractures are necessary for good results because those are unstable and easily displaced. The associated disruption of the cruciate ligament was frequently associated injury and, significantly affected to the therapeutic outcome.

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Arthroscopic Treatment of The Tibial Intercondylar Eminence Fractures: Han Chul Kim, Beom Kim; J Korean Soc Fract 2000;13(3):488-493. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.488

Abstract PDF: PURPOSE
To compare operative results between pull-out wiring and retrograde screw fixation for displaced tibial intercondylar eminence fracture.
MATERIALS AND METHODS
From March 1997 to February 1999, authors carried out pull-out wiring in 3 patients and retrograde screw fixation in 5 patients who sustained typeII and typeIII displaced tibial intercondylar eminence fractures follow up for 16 months(mean).
RESULTS
The Union time was mean 7 wk in pull-out wiring and 6.5 wk in retrograde screw fixation. Limitation of knee motion(1 case) developed in retrograde screw fixation group and reoperated for adhesiolysis. Pull-out wiring group were all full motion recovered. Anterior instability(1 case) developed in retrograde screw fixation group and pull-out wiring group had no instability. Operation time for retrograde screw fixation group was mean 98min and pull-out wiring group was 105 min.
CONCLUSION
The outcome of pull-out wiring group were superior to retrograde screw fixation group. It can be stably fixed and allow early motion exercise. Besides, in case of small bony fragment, it is difficult for fixation with screw. And even impossible. In child cases, the multiple percutaneous pinning can lead to good result. So authors believe that pull-out wiring is worthy for tibial intercondylar eminence fracture.

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Popliteal Artery Injury Associated with Fracture and/or Dislocation of the Knee: Jun Young Yang, Kwang Jin Rhee, June Kyu Lee, Deuk Soo Hwang, Ki Yong Byun, Taek Soo Jeon; J Korean Soc Fract 2000;13(3):494-500. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.494

Abstract PDF: PURPOSE
To compare the outcome in patients who have popliteal artery injury associated with fracture and/or dislocation around the knee according to treatment option.
MATERIALS AND METHODS
We have reviewed fourteen cases of popliteal artery injury patients associated with fracture and/or dislocation injury around the knee who had visited at Chungnam National University Hospital from April 1997 to July 1999.
RESULTS
Combined skeletal injuries included fracture of distal femur, fracture of proximal tibia, and dislocation of the knee. Internal or external fixation was applied for skeletal injuries. We repaired the injured popliteal artery using end-to-end anastomosis (3 cases), interposed saphenous vein graft (9 cases), prosthetic vein graft (1 case), or thrombectomy alone (1 case). The amputation rate was 21 % (3 out of 14 patients). In limb salvage cases, we evaluated the function of knee joint, and the results were as follows : good 5 cases, fair 3 cases, and poor 3 cases.
CONCLUSION
Early diagnosis and prompt management for injuries of the popliteal artery is the most important factor to save the limb. Also, complete resection of all injured portion of vessel and reconstruction of patency through interposed saphenous vein graft are most useful method.

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AMRI Study of Associated Soft Tissue Injury in Tibial Plateau Fractures: Jang Suk Choi, Young Chang Kim, Sung Suk Seo, Ki Chan Ahn, Chang Sub Lee, Jae Sang Choi; J Korean Soc Fract 2000;13(3):501-506. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.501

Abstract PDF: Tibial plateau fractures can occur concomitent with injuries to the collateral, cruciate ligament and mensci. The purpose of this article is to demonstrate the frequency of soft tissue injuries associated with tibial plateau fractures and analyze the pattern of fracture more accurately by magnetic resonance imaging(MRI). Thirty one plateau fractures were evaluated in this study. MRI was more accurate in determining the classification of the fracture and measuring the displacement and depression of fragment. There was a 71%(22 of 31) frequency of associated soft tissue injuries in this series of tibial plateau fractures. The medial collateral ligaments were injured in 32.3%(10 of 31), the anterior cruciate ligaments in 29%(9 of 31), the posterior cruciated ligament in 22.5%(7 of 31), the lateral collateral ligament in 19.4%(6 of 31), and the menisci in 39%(12of 31). Schatzker type II and IV fracture patterns were associated with the highest frequency of soft tissure injuries. Medial collateral ligament injuries were most commonly associated with Schatzker type II fracture patterns. Menisci were most commonly injured with Schazker type IV fracture patterns. Most of the patients with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatement plan.

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Blade Plate Fixation of Proximal Tibial Fractures: Young Soo Byun, Hong Tae Kim, Soon Man Hong, Sang Chul Shin, Soo Yeol Jeon, Byung Doo Jang; J Korean Soc Fract 2000;13(3):507-514. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.507

Abstract PDF: PURPOSE
This study demonstrates the effectiveness of the blade plate as an implant for the operative management of proximal tibial fractures.
MATERIALS AND METHODS
Twelve proximal tibial fractures (AO classification, 10 type A and 2 type C) were treated by direct or indirect reduction and condylar blade plate fixation. The condylar blade plate was fixed on the anteromedial surface of the proximal tibia and cancellous bone graft was performed in 4 fractures with severe cortical comminution or bone defect in early cases. At the final follow-up assessment, the patients were evaluated as to subjective symptoms, objective findings, and radiographic findings.
RESULTS
All fractures were healed in an average of 13.2 weeks (range, 9.0 to 25.0 weeks). There were 3 major complications of a delayed union, a 6-degree varus malunion, and a reduced range of motion of the knee related with associated multiple fractures of the ipsilateral lower limb, but there were no soft tissue problems, loss of fixation, infection, nonunion, and traumatic arthritis. A few patients complained a prominence of the plate on the anteromedial side of the proximal tibia.
CONCLUSION
Blade plate fixation is a reliable method of stable fixation to obtain good results for proximal tibial fractures by early rehabilitation and good fracture healing, particularly in patients with osteoporosis and cortical comminution.

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A Comparison of Reamed and Unreamed Interlocking Intramedullary Nailing for Closed Fractures of the Tibia Shaft: Keun Bae Lee, Sung Taek Jung, Dae Chang Joo, Jae Joon Lee; J Korean Soc Fract 2000;13(3):515-521. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.515

Abstract PDF

PURPOSE
To get a reliable clinical data of interlocking IM nailing, the authors compared the results of the reamed interlocking IM nailing(Reamed) with unreamed interlocking IM nailing(Unreamed) in only closed fractures of tibial shaft. MATERIAL AND METHODS: Each Reamed(n=40) and Unreamed group(n=31) was followed by twenty-nine(13-53) months and twenty-one(13-55) months. We analyzed the results and complications of the each group.
RESULTS
The average total duration of the procedures performed without reaming was 13 minutes shorter than that of the procedures done with reaming(p>0.05). Twenty-nine fractures(73%) that were treated with reaming and eighteen(58.1%) that were treated without reaming united at postoperative 4 months. But, thirty-eight(95%) and twenty-nine(93.5%) fractures united at postoperative 6 months respectively. There was only one nonunion, which developed without reaming. Delayed union occurred after two nailing procedures with reaming and after one without reaming. Malunion occurred after one nailing with reaming and after two without reaming. There were two superficial infection, which developed after nailing with reaming.
CONCLUSION
There was no significant differences in the clinical and radiological result between reamed and unreamed nailing for the treatment of closed tibial shaft fracture. But, the bone union rate was significantly higher in reamed group than unreamed group at postoperative 4 months.

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Anterior Knee Pain after Intramedullary Nailing for Tibial Shaft Fractures
Suk-Kyu Choo, Hyoung-Keun Oh, Hyun-Woo Choi, Jae-Gwang Song
Journal of the Korean Fracture Society.2011; 24(1): 28. CrossRef

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PROPER SCREW LENGTH FOR FIXATION OF THE MEDIAL MALLEOLAR FRACTURE OF ANKLE: Dong Bae Shin, Soo Hong Han, Seung Soo Jeon; J Korean Soc Fract 2000;13(3):522-528. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.522

Abstract PDF: PURPOSE
There is rare report about screw length in ankle fracture in spite of the anatomical characteristic that distal densest area can give enough purchase of screw threads for fixation of medial malleolar fragment. Purpose of the current study is to evaluate the results of screw fixation and to estimate proper screw length in medial malleolar fracture.
MATERIALS AND METHODS
Authors retrospectively reviewed 136 cases of medial malleolar fracture which had been performed from Janurary 1985 to December 1997. The patients were divided into 3 groups according to screw length ; under 34mm screw length (9 cases), between 35mm and 45mm (76 cases), over 46mm (50 cases). Each group was evaluated bone union time, clinical outcomes and radiological results by Meyer and Kumler.
RESULTS
Good and excellent results were achieved 121 cases (89%) on clinical result and 125 cases (91.9%) on radiological result by Meyer criteria. There were no statistical differences between three group, but the 35mm-45mm screw length group showed slightly faster union tendency.
CONCLUSION
In the treatment of medial malleolar fracture, around 40mm length screw is sufficient for fixation and it doesn,t need to use the screw over 45mm length for more rigid fixation.

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The Treatment of Danis-Weber Type B Fractures of the Distal Fibula by Multiple Kirschner Wires Fixation: Ho Yoon Kwak, Baik Young Song, Sang Wook Bae, Nam Hong Choi, Jin Young Kim; J Korean Soc Fract 2000;13(3):529-536. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.529

Abstract PDF

PURPOSE
To evaluate the accuracy of reduction and stability of fixation according to different methods of internal fixation for the Danis-Weber classification type B fractures of the distal fibula. MATERIAL AND METHODS: Seventy-three cases with follow up of average 13 months were divided into three groups: plate fixation(Group I, 36), more than two lag screws fixation (Group II, 13) and multiple K wires fixation with less than one lag screw(Group III, 24). We measured the bimalleolar angle and axial displacement of the fracture ends for radiographic evaluation, and used the Meyer's classification for clinical evaluation.
RESULTS
There was significant difference of postoperative fibular shortening between group I(0.44mm) and III(0.17mm) on the anteroposterior view(p=0.003), but no difference of it on the lateral view. The changes of bimalleolar angle and the increment of fibular shortening showed no significant difference among three groups.
CONCLUSION
Multiple K wires fixation combined with less than one lag screw for Danis-Weber type B fractures of distal fibula demonstrated that it provides accurate reduction and stable internal fixation.

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Posterior Plating in Distal Fibular Fracture
Choong-Hyeok Choi, Young-A Cho, Jae-Hoon Kim, Il-Hoon Sung
Journal of the Korean Fracture Society.2007; 20(2): 161. CrossRef

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Prediction of Peroneal Tenosynovitis in the Intraarticular Calcaneal Fractures Using Computed Tomography: Jeung Tak Suh, Ju Young Jung, Hui Tak Kim, Chong Il Yoo, Seong Ho Hwang, Heung Tae Chung; J Korean Soc Fract 2000;13(3):537-543. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.537

Abstract PDF: PURPOSE
The purpose of the current study is that CT can predict peroneal tenosynovitis in the intraarticular calcaneal fracture.
MATERIALS AND METHOD
Sixty five calcaneal fractures in 55 patients were evaluated with CT scan. The follow-up period after operation was averaged 19 months (ranging from 4 to 79 months). A classification for peroneal tendon injury was developed, based on CT scan.
RESULTS
Of the 65 intraarticular calcaneal fractures, the incidence of peroneal tenosynovitis were 14 cases(26%)[open reduction and internal fixation group 7/43(16%), Essex-Lopresti group 7/22(32%)]. According to the author's classification, the incidence of peroneal tenosynovitis among open reduction and internal fixation subgroup was followed ; type I was none(0/4), type II 11%(2/19), type III 20%(3/15) and type IV 40%(2/5) respectively(p=0.074). The incidence of peroneal tenosynovitis among Essex-Lopresti subgroup was followed ; type I was none(0/4), type II 16%(1/6), type III 33%(3/9) and type IV 100%(3/3) respectively(p=0.009).
CONCLUSION
CT can be used to evaluate the status of the peroneal tendon as well as to predict the development of peroneal tenosynovitis. The open reduction and internal fixation in type III and IV is preferable to achieve a alignment of peroneal tendon and a accurate reduction of subtalar joint.

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Treatment of Clavicle Fracture : Operative vs Non-operative: Seok Whan Song, Hwa Sung Lee, Young Kyun Woo, Seung Koo Rhee, Young Yul Kim; J Korean Soc Fract 2000;13(3):544-549. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.544

Abstract PDF

INTRODUCTION: The purpose of this study was to compare the final results of the patients of the clavicle fractures, treated with the conservative or surgical techniques.
MATERIALS AND METHODS
125 patients (over 15 years old, follow-up over 6 months) were reviewed. To measure the amount of shortening of the fractured clavicle, the length of clavicle was measured from the mid-point of the medial end to the lateral. Range of motion of shoulder, evaluation of functional results and subjective satisfaction, and complications were assessed.
RESULTS
In the surgical treatment group, the period of bony union was short and the shortening of the final length of the fractured clavicle, although there was no statistical significance, was rare. Overall satisfaction for the final result and range of motion of the shoulder were not significantly different between the groups. Complication rates were higher in the conservative treatment than in the surgical.
CONCLUSIONS
In most cases of the clavicle fracture, the operative treatment is recommended to decrease the complications, to shorten the treatment period, to satisfy the patients, and probably to decrease the economical burden.

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Progressive Brachial Plexus Palsy after Fixation of Clavicle Shaft Nonunion: A Case Report
Hong-Ki Jin, Ki Bong Park, Hyung Lae Cho, Jung-Il Kang, Wan Seok Lee
Journal of the Korean Fracture Society.2019; 32(2): 97. CrossRef

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The combined qudriple lesion : fracture of acromion, distal end of clavicle, distal coracoid and glenoid rim associated with anterior shoulder dislocation: A Case Report: Ryup Sub Kim, Suk Myun Ko, Kyu jung Cho, Hyeok Chae Jeong, Dong Hun Choi; J Korean Soc Fract 2000;13(3):550-554. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.550

Abstract PDF: A distal clavicle fracture, as a single fracture, has been reported frequently in the literature. However, combined anterior shoulder dislocations with fracture of the coracoid or acromion is very rare. Fracture of the coracoid or the acromion are even uncommon, represent 3-5% and 9-12% of scapular fractures respectively, which account for 1 perecnt of all fractures. Combined anterior shoulder dislocations with distal end clavicle or glenoid rim fractures are also rare. We observed the concurrent quadruple lesion: fracture of acromion, distal end of clavicle, distal coracoid and glenoid rim associated with anterior shoulder dislocation. To our knowledge, this combined injury has not been reported previously in the literature. Therefore, We presented the proposed mechanism of injury, course of treatment, and its clinical outcome with brief review of literature.

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A Comparison of Interlocking Nail with Wiring versus Plate Fixation in Long Oblique or Spiral Fractures of Humeral Shaft: Phil Hyun Chung, Sang Ho Moon; J Korean Soc Fract 2000;13(3):555-561. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.555

Abstract PDF: PURPOSE
To compare functional results between interlocking intramedullary nail with wiring and plate for treating long oblique or spiral diaphyseal fractures of humerus.
MATERIALS AND METHODS
From April 1996 to February 1999, 9 long oblique or spiral fractures were treated with antegrade humeral locked nails and wiring after minimal open reduction, and another 9 fractures were fixed with plate and screws. Average age of patients was 45.8 years and average follow-up was 13.5 months.
RESULTS
Nail group showed earlier clinical and radiologic union than plate and screw group. All patients with plate and screw group(plate fixation) had clinical union within 5.8+/-2.5 weeks and radiologic union within 8.5+/-2.1 weeks. But, all patients with wiring had clinical union within 2.8+/-0.6 weeks and radiologic union within 5.5 +/-1.6 weeks. At last follow-up, average range of shoulder motion in plate group was larger than nailing group, but that was stastically insignificant. Plate fixations had more complications than nailing, for example, deep infection, non-union, implant failure and radial nerve injury.
CONCLUSION
Interlocking intramedullary nail with wiring has the advantages of minimal tissue trauma and scar formation, sufficient reduction and fixation, early union and fewer complication. So it can be a worthy alternative for the treatment of long oblique or spiral fractures of humerus.

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Treatment of Humerus Shaft Fracture with Intramedullary Nail: Dong Kyu Shin, Kwoing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Chang Hyuk Choi, Sang Bong Ko; J Korean Soc Fract 2000;13(3):562-569. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.562

Abstract PDF: PURPOSE
This study was performed to evaluate the results of treatment of the humerus shaft fracture with interlocking IM nail.
MATERIALS AND METHODS
The result of IM nailing for 29 patients with humerus shaft fracture were evaluated radiologically and clinically. We tried to compare the result of Seidel nail and that of interlocking nail.
RESULTS
The results were as follows ; 1. Nonunion rate was 50% in Seidel nail group and 27% in interlocking nail group(p=0.264). 2. Operation time was shorter in Seidel nail group(67.8min) than in interlocking nail group(115.4min)(p=0.002). 3. Fracture site distraction was present in 9 cases and resulted in nonunion in 8 cases. 4. Union time except the nonunion cases was 10.4weeks in Seidel nail group and 11.9weeks in interlocking nail group but was not considered to be significant due to many nonunion cases. 5. Proximal protrusion was present in 6 cases but resulted in shoulder LOM and pain in only 2 ). cases.
CONCLUSION
Although the operation time in Seidel nail group was shorter than in interlocking nail group, we couldn't find any other difference between the two nails. The results of treatment of humeral shaft fracture with interlocking nail was unsatisfactory in terms of union rate, complications, union time and functional result.

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Radial Head Dislocation With Ipsilateral Radial Shaft Fracture: A Case Report: Keun Woo Kim, Yong Hoon Kim, Hak Jin Min, Ui Seoung Yoon, Hee Oh Kim, Jae Hee Kim; J Korean Soc Fract 2000;13(3):570-575. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.570

Abstract PDF

Radial head dislocation with ipsilateral radial shaft fracture is one of the reportable trauma case with very low incidence. Only 4 cases of this type injury have been reported worldwide. In 3 cases of them, good results were achieved after early closed reduction of the radial head, followed by internal fixation of the radial shaft. In the a u t h o r s'case, the patient received the same method of treatment mentioned at the previous successful 3 cases. But after that, he suffered from repeated dislocations and finally nonunion of the fracture. At last, the authors could obtain bony union and stable elbow joint after radial head resection and osteosynthesis using autologous cancellous bone graft, but resulted in limitation of motion. We report the case and the experience of treatment.

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Delayed radial head dislocation after radial shaft fracture fixation: a case report and review of the literature
Jiyong Yang, Jie Zhang, Zhengzhong Yang
BMC Surgery.2022;[Epub] CrossRef

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Reconstruction of Medial Collateral Ligament in Old Posterior Dislocation of the Elbow: Sang Soo Lee, Ho Yeun Hwang, Dong Hee Lee, Il Hyun Nam, Sang Un Lee; J Korean Soc Fract 2000;13(3):576-583. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.576

Abstract PDF: PURPOSE
To evaluate and analyse the operative results of reconstruction of medial collateral ligament(MCL) in old posterior dislocation of the elbow.
MATERIALS AND METHODS
Nine patients (from 1989 to 1999) with old posterior dislocation of the elbow treated by operation were reviewed. We analysed the pattern of dislocation, associated injury, method of operation, complication and functional results. All patients were treated with open reduction. Reconstruction of MCL was undertaken in three patients of nine.
RESULTS
All nine patients who had underwent open reduction were improved in the flexion-extension motion of elbow. Three patients of nine underwent reconstructive surgery of MCL were much improved in the flexion-extension motion. But there is no differences in improving the pronation-supination motion between of them(P>0.05, ttest).
CONCLUSION
Precise understanding of MCL anatomy and appropriate intraoperative technique are mandatory. We achieved much more range of motion in the cases of reconstruction and early motion rather than those of immobilization for 3 weeks with K-wire. We believe reconstruction of MCL is a useful addition to treatment options for old elbow dislocation of elbow.

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Operative Treatment of the Capitellar Fracture of the Humerus: Ho Jung Kang, Sang Jin Shin, Hyoung Sik Kim, Eung Shick Kang; J Korean Soc Fract 2000;13(3):584-590. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.584

Abstract PDF: PURPOSE
The capitellar fractures of the humerus are rare. Furthermore, the treatment of the fracture has been controversial. This study presents the experience in the operative treatment of capitellar fractures of the humerus.
MATERIALS AND METHODS
Eleven patients with an average age of 41.0 years (range, 15-76 years) were included in this study. The average length of follow-up was 13.6 months (range, 12-17 months). Type I fracture was noticed in ten patients and type III in one patient. Herbert screws, Kirschner wires, cancellous screw and miniscrew were used for internal fixation. The postoperative immobilization period averaged 6.7 days (range, 3-10 days).
RESULTS
Flexion of the elbow averaged 135 degrees (range, 100-150 degrees), with an average flexion contracture of 17 degrees (range, 5-45 degrees). Supination averaged 83 degrees (range, 20-90 degrees) and pronation averaged 87 degrees (range, 80-90 degrees). Seven patients had an excellent functional results, two good and two fair according to Broberg and Morrey elbow-rating scale. The complications included loosening of Kirschner's wires in two patients, osteochondral loose body in one, nonunion and heterotopic ossification in one and severe limitation of motion in one.
CONCLUSION
The early motion of the elbow joint after anatomical reduction and internal fixation for the displaced capitellar fracture is an effective treatment in restoring normal elbow function.

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Nerve injuries complicating Monteggia lesion: Jae Duk Ryu, Chang Hwan Han, Weon Yoo Kim, Jin Hyung Sung, Jin Ho Jung, Jin Young Kim; J Korean Soc Fract 2000;13(3):591-596. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.591

Abstract PDF: PURPOSE
Concerns on the Monteggia lesion was concentrated on the injuries to the bone parts and largely ignores the soft tissues and the nerves in particular. We reviewed injured nerve, treatment and prognosis in the Monteggia lesion associated with nerve injury.
MATERIALS AND METHODS
From January 1990 through November 1999, 26 patients with Monteggia lesions have been treated: six of these patients had associated with nerve injuries. The age of injured patients ranged from 9 to 67 years with an average of 25.5 years.
RESULTS
All could be classified as Type 1 of Bado(anterior dislocation of the radial head), and four injuries were open and two were closed. two patients had radial-nerve palsy and four patients had posterior interosseous-nerve palsy, one of them with associated ulnar-nerve palsy. The fifth patient demonstrated complete spontaneous recovery. One patient with posterior interosseous nerve injury was absence of spontaneous return of function within 12 weeks after injury, exploration and neurolysis was performed. Complete recovery of posterior interosseous nerve function occurred in 14 weeks after exploration.
CONCLUSION
Monteggia lesions can be reduced early with ease under general anesthesia and, if necessary, even under local anesthesia. Spontaneous recovery of nerve function may occur within 12 weeks; in the absence of electromyographic or clinical evidence of return of nerve function within 12 weeks, exploration and neurolysis is indicated.

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Factors Affecting the Functional Result of Monteggia Fractures in Adults: Yong Bum Park, Byeong Ki Lee, Kwang Won Lee, Whoan Jeang Kim, Ha Yong Kim, Jae Hoon Ahn, Won Sik Choy; J Korean Soc Fract 2000;13(3):597-604. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.597

Abstract PDF

PURPOSE
Monteggia fracture is a combination of ulnar fracture and radial head dislocation. Despite of low incidence, Monteggia fracture has a problem in the treatment. So satisfactory results could not be achieved easily. The purpose of this study was to analyze factors affecting functional results in Monteggia fracture.
MATERIALS AND METHODS
From January 1990 to June 1998, we retrospectively reviewed 24 patients out of 40 patients who had been treated for Monteggia fracture. The functional assessment was performed with Broberg and Morrey system10).
RESULTS
Excellent and good results were achieved in 16 cases(66.6%), whereas fair and poor results in 8 cases(33.4%). Satisfactory results were obtained in 66.6% overall. According to the Bado classification, functional results were not different significantly between types. According to the mechanisms of injury, unsatisfactory results were obtained in 8 of 17 patients with high energy injury. Monteggia fractures with ulnar fracture at the diaphyseal level showed satisfactory results significantly compared to others. In terms of the methods of internal fixation, the plate and screw fixation showed satisfactory results in 14 of 16 patients whereas tension band wiring or intramedullary nailing showed unsatisfactory results in 6 of 8 patients.
CONCLUSION
In Monteggia fractures, factors affecting functional result may be the mechanism of injury, the level of ulnar fracture and the method of internal fixation.

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Incomplete Anterior Interosseous Nerve Palsy That Accompanied a Monteggia Fracture
Bo-Kyu Yang, Seong-Wan Kim, Seung-Rim Yi, Young-Jun Ahn, Jung-Ho Noh, Young-Hak Roh, Seung-Won Lee, Min-Soo Je, Seok-Jin Kim
Journal of the Korean Orthopaedic Association.2011; 46(1): 78. CrossRef

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Intramedullary pressure changes in reamed and unreamed nailing systems: an experimental study in cadaveric femoral bones: Chang Wug Oh, Joo Chul Ihn, Poong Taek Kim, Il Hyung Park, Sung Jung Kim, Chung Hyun Lee; J Korean Soc Fract 2000;13(3):631-637. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.631

Abstract PDF: PURPOSE
This study was designed to investigate whether intramedullary pressure is different in reamed compared with unreamed femoral nailing in cadeveric femoral bones. MATERIALS & METHODS: Eight pairs of fresh-frozen cadaveric femoral bones were studied. The diameter of isthmus was checked from 10mm to 14mm and the length of femur was checked from 35cm to 44cm. Intramedullary pressure was measured in the distal femoral shaft at the supracondylar region. Data were monitored in femoral nailing procedures. We utilized the AO universal nail(reamed) and AO unreamed femoral nail.
RESULTS
Intramedullary pressure increased in the reamed group to 423.8 mmHg(mean pressure) during reaming by starting reamer(9 mm) and in the unreamed group to 290 mmHg(mean pressure) during insertion of nails(p=0.001). In the unreamed groups, the next high intramedullary pressure is 136.6 mmHg during proximal reaming. A statistiscally significant difference in intramedullary pressure was found during the first reaming process in the reamed group compared with the proximal reaming process in the unreamed group(p=0.005).
CONCLUSION
The data indicate that the intramedullary pressure during unreamed nailing process is lower than reamed nailing process. So we can consider that the unreamed nailing in multiple fracture or pulmonary injured patients is a good modalities.

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