Journal of Musculoskeletal Trauma

Comparison of a Novel Box-Frame External Fixator and Conventional Delta-Frame External Fixator in the Staged Treatment of Distal Tibia Fractures: Yong-Cheol Yoon, MinKyu Shin, Chang-Wug Oh, Jong-Keon Oh; J Korean Fract Soc 2020;33(3):125-133. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.125

Purpose
Distal tibia fractures with severe soft-tissue edema or intra-articular fractures are treated by staged operations using external fixators. Definitive surgery that maintains ligamentotaxis has been difficult using existing fixators. This study introduced a novel ‘box-frame’ external fixator and evaluated its clinical usefulness.
Materials and Methods
This study included 45 patients (32 males, 13 females) diagnosed with distal tibia fractures who underwent staged operations between March 2012 and March 2016, with a follow-up of at least one year. The patients were divided into two groups. In one group, fixation was performed with a box-frame external fixator (Group A). In the other group, fixation was performed with a delta-frame external fixator (Group B). The following outcomes were evaluated: the time until definitive surgery, operative time of the definitive surgery, radiation exposure time, bone union, time to achieve bone union, postsurgical complications, American Orthopaedic Foot & Ankle Society anklehindfoot score, and ankle range of motion.
Results
Compared to the delta-frame, the box-frame showed a statistically significant reduction in the mean radiation-exposure time and operative time during the definitive surgery by 58 seconds and 25 minutes, respectively. The differences in the time until definitive surgery, bone union, time to achieve bone union, postsurgical complications, and functional scores were not significant.
Conclusion
The box-frame external fixator can be a useful treatment method in the staged surgery of distal tibia fractures.

Citations

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Temporary Circular External Fixation for Spanning the Traumatized Ankle Joint
Nando Ferreira, Niel Bruwer, Adriaan Jansen van Rensburg, Ernest Muserere, Shao-Ting Jerry Tsang
JBJS Essential Surgical Techniques.2024;[Epub] CrossRef
Temporary circular external fixation for spanning the traumatised ankle joint: A cohort comparison study
William D. Harrison, Franklin Fortuin, Matthieu Durand-Hill, Etienne Joubert, Nando Ferreira
Injury.2022; 53(10): 3525. CrossRef

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Clinical and Radiological Outcomes of Polished Cemented Bipolar Hemiarthroplasty for Intertrochanteric Fractures in Elderly Patients: Suc-Hyun Kweon, Chang-Hyun Shin, Yeong-Chang Lee, Min-Woo Kim, Tae-Ho Kim; J Korean Fract Soc 2020;33(3):134-141. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.134

Abstract PDF: Purpose
To evaluate the clinical and radiological outcomes of bipolar hemiarthroplasty using a polished cemented femoral stem for intertrochanteric fractures in elderly patients.
Materials and Methods
From July 2005 to May 2015, 48 patients diagnosed with intertrochanteric fractures underwent bipolar hemiarthroplasty. The mean age and follow-up period were 80.5 years and 30.5 months, respectively. The postoperative results were evaluated clinically and radiologically.
Results
The mean operation time was 100 minutes (range, 90-120 minutes), and the mean amount of blood loss was 334 ml (range, 170-500 ml). At the last follow-up, the mean Harris hip score (HHS), visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were 82.2 (range, 76-90), 0.8 (range, 1-3), and 36 (range, 30-40), respectively. Walking was initiated using a walker for partial weight-bearing, and the mean walking time was 5.8 days (range, 3-14 days). Ambulatory ability was restored to a walking state before the injury in 36 cases (75.0%), and wheelchair ambulation was possible in 12 cases (25.0%). The instrumental activities of daily living (IADLs) were 17 patients (35.4%), and the basic activities of daily living (BADLs) were 31 patients (64.6%).
Conclusion
Polished cemented bipolar hemiarthroplasty can achieve secure fixation with no postoperative thigh pain. Restoring the preoperative walking ability will be more helpful for intertrochanteric fractures in elderly patients.

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Clinical Outcome after Treatment of Tibia Segmental Fracture with Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis: Jun Young Lee, Hyung Seok Park, Dong Hyuk Cha; J Korean Fract Soc 2020;33(3):142-147. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.142

Abstract PDF: Purpose
This study examined the clinical outcomes after the treatment of a tibia segmental fracture with intramedullary nailing (IM nailing) and minimal invasive plate osteosynthesis (MIPO).
Materials and Methods
From July 2012 to December 2017, 14 out of 17 cases from a treatment cohort of 32 cases of AO type 42 C2 tibia segmental fractures with IM nailing and MIPO were studied retrospectively. Periodic radiographs were used to evaluate the presence of union, union time, and radiographic evaluation of bony union (varus-valgus deformity, anteroposterior angular deformity, shortening). To evaluate the postoperative clinical function, modified Rasmussen’s system was used for proximal fractures, and the American Orthopaedic Foot and Ankle Society functional score was used for distal fractures.
Results
Bony union was achieved in all 14 cases, and the average union time was 26 weeks. In one case of soil contamination, there were no other complications other than simple debridement after a soft tissue infection. The mean varus was two degrees; the mean anteroposterior angular deformity was three degrees of anterior oblique; the mean length shortening was 5 mm (2-9 mm). The mean functional score of the knee joint with the Modified Rasmussen’s system measured for the postoperative clinical function was relatively good (excellent 9, good 4, fair 1, and poor 0). The results of the Molander and Olerud Functional scores of the ankle joints were also good (excellent 8, good 3, fair 2, poor 0).
Conclusion
The treatment of tibia segmental fractures with IM nailing and MIPO can effectively reduce the gap of fracture sites. Hence, it is possible to increase the bony union probability and obtain relatively satisfactory alignment. Overall, the treatment of tibia segmental fractures with IM nailing and minimally invasive plate osteosynthesis appears to be a useful treatment, considering the preservation of the soft tissue and the alignment of the tibia.

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Does the Use of a Silicone Ring Tourniquet Help Reduce Bleeding in the Minimally Invasive Internal Fixation with Locking Plate for Distal Femoral Fractures?: Ki-Bong Park, Hong-Ki Jin, Il-Yeong Hwang, Sung-Who Chang, Sung-Cheon Na; J Korean Fract Soc 2020;33(3):148-153. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.148

Abstract PDF

Purpose
This study evaluated the usefulness of a silicone ring tourniquet by analyzing the changes in the perioperative hemoglobin (Hb) levels or amount of perioperative bleeding compared to those of a pneumatic tourniquet or no usage during minimally invasive plate fixation for distal femoral fractures.
Materials and Methods
From January 2017 to December 2019, 30 patients who underwent minimally invasive plate fixation using a locking compression plate for distal femoral fractures were evaluated and classified as a silicone ring tourniquet (Group 1), a pneumatic tourniquet (Group 2), and no usage (Group 3). The variables for analysis were age, sex, preoperative Hb (preHb), postoperative 72-hour Hb (postHb), differences between preHb and postHb (preHb-postHb), amount of intraoperative and overall transfusion, estimated unit of transfusion corrected by preHb-postHb and total transfusion (Hb-lost), amount of intraoperative and postoperative and total bleeding. One-way ANOVA was used to identify the differences between the groups.
Results
The age, sex, operation time, preHb, preHb-postHb, amount of intraoperative and overall transfusion and Hb-lost were similar in the two groups. The amount of intraoperative bleeding was significantly lower in Group 1 than Group 3 (p=0.004), but there was no difference in the amount of postoperative and total bleeding between the two groups.
Conclusion
The use of a silicone ring tourniquet in the minimally invasive plate fixation for distal femoral fractures decreased the amount of intraoperative bleeding compared to no use of a tourniquet.

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Silicone ring tourniquet could be a substitute for a conventional tourniquet in total knee arthroplasty with a longer surgical field: a prospective comparative study in simultaneous total knee arthroplasty
Tae sung Lee, Kwan Kyu Park, Byung Woo Cho, Woo-Suk Lee, Hyuck Min Kwon
BMC Musculoskeletal Disorders.2023;[Epub] CrossRef

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Rare Experience of Bilateral Femoral Neck and Shaft Fractures - A Case Report -: DaeHyun Choe, Jae-Ho Lee, Ki-Chul Park; J Korean Fract Soc 2020;33(3):154-158. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.154

Abstract PDF: Ipsilateral fractures of the femoral neck and shaft are relatively common injuries and accompany 2% to 9% of all femoral shaft fractures. On the other hand, it is extremely rare for these injuries to occur bilaterally. This paper reports the authors’ experience of a case with bilateral femoral neck and shaft fractures. The patient sustained multiple injuries, including liver laceration with hemoperitoneum, bilateral open fractures of the tibia, and bilateral femoral neck, and shaft fractures caused by a high-speed motor vehicle accident. Under the circumstances, damage-control orthopedic principles were applied, and external fixators were initially placed. After the patient’s general condition showed improvement, both femurs were fixed with a reconstruction nail. Fracture healing was achieved without complications, such as avascular necrosis of the femoral head. Despite the rare occurrence, this paper describes this case because these injuries must be managed with meticulous attention.

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Rendezvous Surgery for Peri-Implant Fractures around Locking Compression Plate on Anterolateral Bowed Femur - A Case Report -: Hong Man Cho, Jiyeon Park; J Korean Fract Soc 2020;33(3):159-163. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.159

Abstract PDF: An 84-year-old female visited with an intertrochanteric femoral fracture. The patient had undergone an open reduction and internal fixation with a compressive plate and elastic nail in an ipsilateral atypical diaphyseal femoral fracture in the past. Compressive plate and elastic nail remained, and anterolateral bowing was presented. To treat the periprosthetic trochanteric fracture, a proximal femoral nail was used without removing the previously inserted compressive plate. Under the “rendezvous” technique, using a combination of fixating intramedullary nail and compressive plate simultaneously, the distal screw was fixed, and a femoral head lag screw was inserted after reducing the fracture. Complete union of the fracture was achieved 16 months after the operation, and a decrease in mobility function was not found postoperatively. The authors report this case for the “rendezvous” technique as a treatment option for elderly patients with periprosthetic trochanteric fractures, who had previously undergone surgical treatment for ipsilateral atypical diaphyseal femoral fractures with anterolateral bowing.

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Current Concepts in the Articular Cartilage Repair: Eui Dong Yeo, Whi Je Cho, Young Koo Lee; J Korean Fract Soc 2020;33(3):164-170. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.164

Abstract PDF: Articular cartilage defects are common in orthopedic practice. Most clinical and research efforts focus on restoring the damaged cartilage in connection with osteoarthritis or trauma. This article explains the current clinical approaches for repairing cartilage, as well as the research approaches and those under translation into clinical practice. Tissue engineering techniques are being employed with aims of repopulating a cartilage defect with hyaline cartilage containing living chondrocytes with hopes of improving the clinical outcomes. Cartilage tissue engineering involves the cell source, biomaterial and membranes, and growth stimulators. Tissue engineering is being applied to clinical medicine by autologous chondrocyte implantation or similar techniques. While basic science has refined orthopedic treatment of chondral lesions, available evidence does not conclude the superiority of tissue engineering methods over other techniques in improving the clinical symptoms or restoring the native joint mechanics.

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Current Concepts of Bone Healing: Dong Hun Suh, Bong Mo Koo, Jong Woo Kang; J Korean Fract Soc 2020;33(3):171-177. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.171

Abstract PDF: Bone injuries induce an inflammatory response that promotes bone healing. On the other hand, an aberrant process, where inflammation becomes chronic, can inhibit the healing of injured bone. At the first stage of the bone healing process, inflammatory cells, such as neutrophils and macrophages, are assembled and secrete various cytokines, chemokines, and growth factors. During callus formation, cells differentiated from mesenchymal stem cells, such as osteoblasts and chondrocytes, play leading roles in bone healing. Currently, various treatment modalities have been developed through the known mechanism of bone healing, and the clinical outcomes of bone defect and fracture nonunion have been good.

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