Journal of Musculoskeletal Trauma

Volume 31(3); July 2018

Original Articles

The Effects of Extramedullary Reduction in Unstable Intertrochanteric Fracture: A Biomechanical Study Using Cadaver Bone: Young Chang Park, Soon Phil Yoon, Kyu Hyun Yang; J Korean Fract Soc 2018;31(3):79-86. Published online July 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.3.79

PURPOSE
To prevent excessive sliding and subsequent fixation failures in unstable intertrochanteric fractures with posteromedial comminution, extramedullary reduction through overlapping of the anteromedial cortices of both proximal and distal fragments as a buttress has been introduced. The purpose of this study was to compare the biomechanical properties between two reduction methods-intramedullary reduction and extramedullary reduction-in treating unstable intertrochanteric fractures with posteromedial comminution (AO/OTA classification 31-A2.2).
MATERIALS AND METHODS
Eight pairs of frozen human cadaveric femora were used. The femora of each pair were randomly assigned to one of two groups: the intramedullary reduction group or the extramedullary reduction group. A single axial load-destruction test was conducted after cephalomedullary nailing. Axial stiffness, maximum load to failure, and energy absorbed to failure were compared between the two groups. Moreover, the pattern of mechanical failure was identified.
RESULTS
The mean axial stiffness in the extramedullary reduction group was 27.3% higher than that in the intramedullary reduction group (422.7 N/mm vs. 332.0 N/mm, p=0.017). Additionally, compared with the intramedullary reduction group, the mean maximum load to failure and mean energy absorbed to failure in the extramedullary group were 44.9% and 89.6% higher, respectively (2,848.7 N vs. 1,966.5 N, p=0.012 and 27,969.9 NÂ·mm vs. 14,751.0 NÂ·mm, p=0.012, respectively). In the intramedullary reduction group, the mechanical failure patterns were all sliding and varus deformities. In the extramedullary reduction group, sliding and varus deformities after external rotation were noted in 3 specimens, sliding and varus deformities after internal rotation were noted in 3 specimens, and medial slippage was noted in 2 specimens.
CONCLUSION
In unstable intertrochanteric fractures with posteromedial comminution, the biomechanical properties of extramedullary reduction are superior to those of intramedullary reduction. Anteromedial cortex could be the proper buttress, despite a comminuted posteromedial cortex. It could help enhance the stability of the bone-nail construct.

Citations

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Which side should be taken care of when positioning a lag screw in intertrochanteric femoral fracture: right or left?
Min Uk Do, Kyeong Baek Kim, Sang-Min Lee, Hyun Tae Koo, Won Chul Shin
European Journal of Trauma and Emergency Surgery.2025;[Epub] CrossRef
The effect of anterior support screw (AS2) in unstable femoral trochanteric fractures: A multicenter randomized controlled trial
Takashi Maehara, Takashi Hayakawa, Shunsuke Mukoyama, Yoshihisa Anraku, Takahiro Hamada, Hiroyuki Suzuki, Takeshi Doi, Tomohiko Shimizu, Masanori Yorimitsu, Hidefumi Teramoto, Takao Mae, Yasunori Okamoto, Jun Hara, Kazushi Mihara, Koichi Kanekasu
Injury.2024; 55(10): 111725. CrossRef
Anteromedial cortical support reduction of intertrochanteric fractures–A review
Wenjun Xie, Liu Shi, Cheng Zhang, Xueliang Cui, Xiangxu Chen, Tian Xie, Sheng Zhang, Hui Chen, Yunfeng Rui
Injury.2024; 55(12): 111926. CrossRef
Anteromedial Cortical Support in Reduction of Trochanteric Hip Fractures
Wei Mao, Chen-Dong Liu, Shi-Min Chang, Ao-Lei Yang, Choon Chiet Hong
Journal of Bone and Joint Surgery.2024; 106(11): 1008. CrossRef
Five states of reduction in OTA/AO A1.3 intertrochanteric fractures of the femur a biomechanical study
Shu Li, Yong-Gang Bao, Rong-Hua Tian, Chun-Yang Meng, Hai-Bin Wang, Bin Wu, Xian-Min Bu
BMC Musculoskeletal Disorders.2024;[Epub] CrossRef
Intramedullary Impaction of the Basicervical Component is Determinant of Fixation Failure in a Simple Two-Part Pertrochanteric Fracture
Seok Ha Hong, Kang Hun Yu, Seung Beom Han
Journal of Orthopaedic Trauma.2024;[Epub] CrossRef
Flexible reamer use to overcome entry point errors in proximal femoral nail application in severe obese intertrochanteric fracture patients
Levent Horoz, Ali Ihsan Kilic, Cihan Kircil, Mehmet Fevzi Cakmak
BMC Musculoskeletal Disorders.2024;[Epub] CrossRef
Risk Factors Associated with Fixation Failure in Intertrochanteric Fracture Treated with Cephalomedullary Nail
Hyung-Gon Ryu, Dae Won Shin, Beom Su Han, Sang-Min Kim
Hip & Pelvis.2023; 35(3): 193. CrossRef
Positive or negative anteromedial cortical support of unstable pertrochanteric femoral fractures: A finite element analysis study
Qin Shao, Yue Zhang, Gui-Xin Sun, Chen-Song Yang, Na Liu, Da-Wei Chen, Biao Cheng
Biomedicine & Pharmacotherapy.2021; 138: 111473. CrossRef
Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced)
Hyeon Joon Lee, Hyun Bai Choi, Ba Rom Kim, Seung Hwan Jo, Sang Hong Lee
Journal of the Korean Fracture Society.2021; 34(3): 105. CrossRef
Factors Associated with Mechanical Complications in Intertrochanteric Fracture Treated with Proximal Femoral Nail Antirotation
Oog-Jin Shon, Chang Hyun Choi, Chan Ho Park
Hip & Pelvis.2021; 33(3): 154. CrossRef
Additional Reduction Screw Fixation Technique for Pertrochanteric Hip Fractures: A Novel Method to Prevent Excessive Sliding in Cephalomedullary Nail Surgery
Chul-Ho Kim, Han Soul Kim, Dou Hyun Moon
Hip & Pelvis.2021; 33(3): 162. CrossRef
Comparison of sliding distance of lag screw and nonunion rate according to anteromedial cortical support in intertrochanteric fracture fixation: A systematic review and meta-analysis
Eic Ju Lim, Seungyeob Sakong, Whee Sung Son, Jae-Woo Cho, Jong-Keon Oh, Chul-Ho Kim
Injury.2021; 52(10): 2787. CrossRef
A new fluoroscopic view for evaluation of anteromedial cortex reduction quality during cephalomedullary nailing for intertrochanteric femur fractures: the 30° oblique tangential projection
Shi-Yi Chen, Shi-Min Chang, Rujan Tuladhar, Zhen Wei, Wen-Feng Xiong, Sun-Jun Hu, Shou-Chao Du
BMC Musculoskeletal Disorders.2020;[Epub] CrossRef
New Approach in the Treatment of Intertrochanteric Fracture Using a Cephalomedullary Nail
Junyoung Kim, Kihong Choi, Kyu Hyun Yang
Journal of the Korean Orthopaedic Association.2020; 55(3): 193. CrossRef
Effect of a synthetic osteoconductive bone graft substitute with zeta potential control (geneX®ds) in the treatment of intertrochanteric fracture: A single center experience of 115 consecutive proximal femoral nail antirotations
Won Chul Shin, Jae Hoon Jang, Jae Yoon Jeong, Kuen Tak Suh, Nam Hoon Moon
Journal of Orthopaedic Science.2019; 24(5): 842. CrossRef

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A Comparison of the Results between Internal Fixation and External Fixation in AO C Type Distal Radius Fractures: Yoon min Lee, Hwa Sung Lee, Seok Whan Song, Jae Hoon Choi, Jong Tae Park; J Korean Fract Soc 2018;31(3):87-93. Published online July 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.3.87

Abstract PDF

PURPOSE
The purpose of this study was to evaluate the radiological and clinical results of plate fixation and external fixation with additional devices for treating distal radius fracture in AO type C subtypes, and propose a treatment method according to the subtypes.
MATERIALS AND METHODS
Two hundred and one AO type C distal radius fracture patients were retrospectively reviewed. Eighty-five patients in group 1 were treated with volar or dorsal plate, and 116 patients in group 2, were treated with external fixation with additional fixation devices. Clinical (range of mtion, Green and O'Brien's score) and radiological outcomes were evaluated.
RESULTS
At the 12-month follow-up, group 1 showed flexion of 64.4Â°, extension of 68.3Â°, ulnar deviation of 30.6Â°, radial deviation of 20.8Â°, supination of 76.1Â°, and pronation of 79.4Â° in average; group 2 showed flexion of 60.5Â°, extension of 66.9Â°, ulnar deviation of 25.5Â°, radial deviation of 18.6Â°, supination of 73.5Â°, and pronation of 75.0Â° in average. The mean Green and O'Brien score was 92.2 in group 1 and 88.6 in group 2. The radial height of group 1 and group 2 was 11.6/11.4 mm; radial inclination was 23.2Â°/22.5Â°; volar tilt was 11.6Â°/8.7Â°; and the ulnar displacement was 1.27/0.93 mm.
CONCLUSION
Judicious surgical techniques during device application and tips for postoperative management during external fixation can produce similar clinical results compared with internal fixation patients.

Citations

Citations to this article as recorded by

Intra-articular fracture distal end radius external fixation versus locking volar radius plate: A comparative study
S.P.S Gill, Manish Raj, Santosh Singh, Ajay Rajpoot, Ankit Mittal, Nitin Yadav
Journal of Orthopedics, Traumatology and Rehabilitation.2019; 11(1): 31. CrossRef

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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; J Korean Fract Soc 2018;31(3):94-101. Published online July 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.3.94

Abstract PDF

PURPOSE
This study compared the radiological and clinical results of minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) of distal tibial fractures, which were classified as the simple intra-articular group and extra-articular group.
MATERIALS AND METHODS
Fifty patients with distal tibial fractures, who could be followed-up more than 12 months, were evaluated. Group A consisted of 19 patients treated with MIPO and group B consisted of 31 patients treated with IMN. The results of each group were analyzed by radiological and clinical assessments.
RESULTS
The mean operation times in groups A and B were 72.4 minutes and 65.7 minutes, respectively. The mean bone union times in groups A and B were 16.4 weeks and 15.7 weeks, respectively. The bone union rate in groups A and B were 100% and 93%, respectively. The ranges of ankle motion were similar in the two groups at the last follow-up. The mean American Orthopaedic Foot and Ankle Society score was similar: 90.1 in group A and 90.5 in group B. The radiological and clinical results were similar in the intra and extra-articular groups. In groups A and B, two cases of posterior angulation and five cases of valgus deformity of more than 5Â° were encountered.
CONCLUSION
Both MIPO and IMN achieved satisfactory results in extra-articular AO type A and simple articular extension type C1 and C2 distal tibia fractures.

Citations

Citations to this article as recorded by

Intramedullary Nailing versus Minimally Invasive Plate Osteosynthesis for Distal Tibia Shaft Fractures: Retrospective Comparison of Functional and Cosmetic Outcomes
Kahyun Kim, In Hee Kim, Geon Jung Kim, SungJoon Lim, Ji Young Yoon, Jong Won Kim, Yong Min Kim
Journal of Korean Foot and Ankle Society.2023; 27(3): 93. CrossRef

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Review Articles

Pelvis/Acetabular Fractures in the Elderly: When and How to Fix?: Kyeong Hyeon Park, Chang Wug Oh, Joon Woo Kim; J Korean Fract Soc 2018;31(3):102-113. Published online July 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.3.102

Abstract PDF

Owing to the increase in life expectancy, the incidence of osteoporotic fracture of the pelvis and acetabulum is increasing. Fractures in the elderly population is different from those in younger patients. Pelvic ring and acetabular fractures in geriatric patients are more likely the result of low-energy trauma, but the outcomes are generally poorer than those of the younger population. Multiple management options are available, but no intervention has become the standard of care for these fractures in the elderly. A treatment strategy should be established depending on the state of the individual patient. Regardless of whether nonsurgical or surgical treatment is selected, early ambulation should be considered to avoid the complications associated with prolonged immobilization.

Citations

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Effect of Korean Medicine Treatments for Pain Reduction in Patients with Hip Fracture : A Retrospective Observational Study
Nam Hoon Kim, Min Seok Oh
Journal of Physiology & Pathology in Korean Medicine.2020; 34(5): 263. CrossRef

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Treatment Options of Osteoporotic Vertebral Compression Fractures: Yu Mi Kim, Tae Kyun Kim, Dae Moo Shim, Kyeong Hoon Lim; J Korean Fract Soc 2018;31(3):114-121. Published online July 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.3.114

Abstract PDF

This paper reviews previous studies on the treatment of osteoporotic vertebral compression fractures in elderly patients to determine what factors should be considered for successful treatment. In osteoporotic vertebral compression fractures, the primary treatment is conservative treatments. Other treatments include osteoporosis treatment, pain control, orthosis, and physical therapy. Recently, percutaneous catheterization or balloon plasty is performed for rapid pain recovery and early ambulation. Percutaneous catheterization or balloon posterior plasty is effective in reducing pain and improving the activity ability. Surgical treatment should be considered in cases of nonunion or osteonecrosis, dent, deformation, and spinal cord compression after conservative treatment has failed. In surgical treatment, posterior spinal fixation and vertebroplasty are more advantageous in terms of the amount of bleeding, operation time compared to the anterior approach, but the most appropriate method should be selected through the patient's condition and understanding of each surgical method.

Citations

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Effects of Herbal Medicines on Bone Mineral Density Score in Osteoporosis or Osteopenia: Study Protocol for a Systematic Review and Meta-Analysis
Su Min Hong, Eun Jung Lee
Journal of Korean Medicine Rehabilitation.2021; 31(2): 49. CrossRef
Spinal Stability Evaluation According to the Change in the Spinal Fixation Segment Based on Finite Element Analysis
Cheol-Jeong Kim, Seung Min Son, Jin-Young Heo, Chi-Seung Lee
Journal of the Computational Structural Engineering Institute of Korea.2020; 33(3): 145. CrossRef

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