Journal of Musculoskeletal Trauma

Posterior stabilization of the Unstable Pelvic Ring Fracture: Soon Taek Jeong, Ji Yeon Kim, Se Hyun Cho; J Korean Soc Fract 1996;9(3):513-517. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.513

Abstract PDF: Stable pelvis fracture is easily treated by conservative treatment with little complication. Unstable pelvic ring fracture, however, is difficult to manage due to various problems. Conservative treatment is rarely indicated because prolonged traction and immobilization often lead to life-threatening complications. The malunion produces pain, limb length discrepancy and eventually poor life quality, Surgical stabilization can help easy care of patients, early mobilization and diminish the morbidity. This study is to present the clinical results of two kinds of metal fixations using seven transiliac bars and four percutaneous sacral screws for the surgical stabilization of the unstable pelvic ring fractures. Total eleven cases had been operated by the authors at Geyong-Sang national hospital from August 1991 to April 1994. They were eight male and three female patients of average forty one years in age(range, eighteen to sixty two years). The average duration of follow-up was thirty one months(range, twenty to fifty three months). All cases of sacral screw fixations revealed satisfactory results both at clinical and radiological aspects. Out of seven cases of transiliac bar fixation, there were two cases of minor infection and three cases of painful and palpable hardware requiring removal, especially in thin patients. The results confirm that sacral screw is better tolerated by thin patients in spite of risk of temporary entrapment of sacral cutaneous nerves.

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Operative treatment of the Unstable Pelvic Bone Fracture: Byung Woo Min, Kwang Soon Song, Chul Hyung Kang, Young Soo Kim; J Korean Soc Fract 1996;9(3):518-524. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.518

Unstable pelvic bone fracture caused by high-energy trauma that can result in life-threatening situations in which intrapelvic hemorrhage and neurovascular injury. Long-term complications are frequently present, such as leg length discrepancy, gait disturbance and chronic low-back pain. Recently it is principle that it is mandatory to restore the anatomy of pelvic ring structure and to fixistably by means of internal fixation or extemal fixation for successful outcome after unstable pelvicring injury. 26 cases of unstable pelvic bone fracture were treated operatively at the authors hospital between 1992 and 1994. We analyse the clinical and the radiological result. The following results were obtained. 1. The incidence of the unstable pelvic bone fracture was 26 cases(18.4%) of all pelvic bone fractures(141 cases). 2. By the classification of modified Tile, type B1 were 8 cases, type B2(3 cases). type C1(7 cases) and type C3(8 cases). 3. Associated organ injury were found most commonly in the acetabular fracture(8 cases), and other extremity fracture(8 cases), genitourinary system(6 cases) and hemopenitoneum(4 cases). 4. The specific fracture pattern was classified according to various anatomical locations such as transsymphysis(7 cases), transpubic(7 cases), combination of the trassymphysis and traspubic(1 cases), trassacroiliac(7 cases), transiliac(9 cases), transsacral(1 case) and sacroiliac fracture dis location(1 case). 5. According to the fracture location, following methods of stabilization were applied. For the ante rior portion of pelvic ring, plates(13 cases), external fixators(3 cases) and wirings(3 cases) were used. For the posterior portion of pelvic ring, plates(9 cases), percutaneous iliosacral screws(3 cases) and lag screw(1 case) were used. 6. The results revealed as excellent in 20 cases, good in 5 case and fair in 1 case. 7. Postoperative complications were fixation failure(2 cases), metal failure(1 case) and nerve injury(1 case).

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Surgical Treatment of Malunion and Nonunion after Pelvic Bone Fracture
Byung-Woo Min, Kyung-Jae Lee
Journal of the Korean Fracture Society.2015; 28(4): 266. CrossRef
Clinical Results of Surgical Treatment of Acetabular Fractures according to Quality of Reduction
Sang-Hong Lee, Min-Kyu Shin, Sueng-Hwan Jo
The Journal of the Korean Orthopaedic Association.2007; 42(2): 153. CrossRef

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Surgical Treatment of the Posterior wall Fracture of Acetabulum with Posterior Hip Dislocation: Eu Seup Chung, Kyung Soo Choi, Min Kee Kim, Yong Il Son; J Korean Soc Fract 1996;9(3):525-532. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.525

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The Posterior wall and column fracture of the acetabulum is clinically important because of its range of motion and weight bearing portion, and in majority cases, they accompany with posterior dislocation of the hip. When the fractures were not treateci well, they may give rise to disabling symptoms such as traumatic arthritis and avascular necrosis of the femoral head. So, accurate reduction is more important than other fractures. The purpose of this study is to know the clinical results and complications when reduced surgically the posterior wall fractures of acetabulum with posterior hip dislocation. Sixteen cases of posterior wall fracture of acetabulum with posterior hip dislocation were treated surgically in the presbyterian medical center during the period 1981 to 1995. The short summary of observations were following as; 1. According to Letoumels classification, simple posterior wall fracture was 10 cases, comminuted posterior wall fracture in 4 cases, and posterior wall and column in 2 cases, and relatively good clinical result was seen at the simple posterior wall fracture. 2. The complications were traumatic osteoarthritis in 4 cases(25%), and heterotopic ossification in 2 cases(12.5%). 3. The clinical result above Good was 14 cases(88%), the roentgenographic result above Good was 11 cases(69%), and they were correlations in each others(P<0.05).

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Clinical Results of Surgical Treatment of Acetabular Fractures according to Quality of Reduction
Sang-Hong Lee, Min-Kyu Shin, Sueng-Hwan Jo
The Journal of the Korean Orthopaedic Association.2007; 42(2): 153. CrossRef

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Treatment of Intertrochanteric Fracture with Gamma Nail: Jung Dae Oh, Young Shik Lee, Shin Kang Cho, Jin Tae Choi; J Korean Soc Fract 1996;9(3):533-540. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.533

Abstract PDF: There are many problems in the treatment of the intertrochanteric fracture due to osteoporosis and unstable patten of fracture in elderly patients, which are also determined by quality of the bone, geometry and reduction of the fragments, and type and placements of the implant. The Gamma nail has recently become available for the treatment of intertrochanteric femur fracture. The authors analysed the intertrochanteric fracture of the 33 patients who were operatively treated with Gamma nail and followed up more than 3 years from May, 1991 to June, 1994 to evaluate the results and prognostic factors. The results obtained were as follws; 1. Type III in TronBo classification was the most common(58%). 2. Among the 33 cases, the patients with osteoporosis below grade III of Singh index were 26 cases(78.8%). In osteoporotic group(Singh index I-III), unstable type fracture was more common(85%). 3. The complication was developed in 8 cases(24.2%), of which cutting out from the femoral head was found in 4 cases. 4. The complication rate statistically had significant correlation with severity of osteoporosis.

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Treatment with an Interlocking Nail for Ipsilateral Fracture of the Femur and Tibia: Sang Soo Kim, Churl Hong Chun, Dong Churl Kim, Sang Hoon Cha; J Korean Soc Fract 1996;9(3):541-546. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.541

Abstract PDF: Concomitant ipsilateral femoral and tibial fractures present a challenging therapeutic problem. They are generally caused by high-energy trauma, primarily motor-vehicle accidents, and the associated injuries frequently develop. Also the complications much as delayed union, non-union, malunion and stiffness of the knee are more prevalent in patients with this combination of fractures than in patients with an isolated femoral or tibial fractures. The interlocking nail system has many advantages about among the many treatment methods of isolated long bone fractures, but the surgical technique is very difficult at the concomitant ipsilateral femoral and tibial fractures. The purpose of this study has been to review the surgical technique and to grasp an easy reduction method at that fractures. We routinely perform the interlocking nail for the ipsilateral femoral and tibial fractures in order to promote early motion of the knee in 14 patients from 1989 to 1995. Local complications included 1 case of femoral metal failure, and 2 cases of nonunion treated by bone graft. At the last follow up examination, at an average of 13 months after injury, the mean range of motion of the knee was 130 degrees. Over-all, a good or excellent functional result was achieved in about 93% of the patients according to the criteria suggested by Karlstr m and Olerud. In conclusion, the best results were achieved when both fractures were stabilized surgically with the interlocking nail system.

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Problems and complication after Interlocking Intramedullar Nailing for Femoral Shaft Fracture: In Suk Oh, Do Hyun Moon, Jin Hong Ko, Ki Dong Kang, Si Hwan Kim; J Korean Soc Fract 1996;9(3):547-556. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.547

Abstract PDF

Fracture of the femoral shaft, is among most common fractures in orthopaedics, with its aspect becomming more complex. Since the introduction of Kuncher Nail, closed rodding techinque and locking nail system were followed with additional feature of preventing shortening and rotation as well as allowing early weight bearing and joint motion. With their wide application, we met many problems during the operative procedure due to delicient concept and technique. We have checked the possible problems during and after the procedure of interlocking nailing for the femoral fractures in 65 cases. 1. With poor selection of implant, long, short and small nail were used in 5, 3 & 2 cases, respectively. 2. In the process of operation, inlet error, angular & rotational deformity, femoral neck fracture, failure (or loossening) of distal screws were 2,10, 1, and 4 cases, respectively. 3. A New fragment was made in 7 cases(11%) durinbg surgery, especially medial side and distal to the fracture line. 4. Post-operative deep infection were developed in 2 cases. 5. Post-operative metal failure and delayed(or non) union was 1 and 7(11%) cases, delayed union (or nonunion) occured in 3 cases(20%) after open reduction while following closed reduction in 4 cases(8%).

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Iatrogenic Femur Proximal Shaft Fracture during Nailing Using Lateral Entry Portal on Femur Shaft Fracture
Hong Moon Sohn, Gwang Chul Lee, Chae Won Lim
Journal of the Korean Orthopaedic Association.2014; 49(4): 272. CrossRef

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Clinical Result of Surgical Treatment in Distal Femur Fractures using Dynamic Compression Screw and Blade Plate: Seung Baik Kang, Joong Hee Won, Bong Soon Chang, Eui Seong Choi, Jin Seon Yoo, Hee Joong Kim; J Korean Soc Fract 1996;9(3):557-566. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.557

Abstract PDF: The fracture of distal femur, which include the supracondylar region, intercondylar region and knee joint, have many problems by nature. It is almost all comminuted fracture and has a some difficulty in approach. Early attempts at internal fixation frequently gave unacceptably high rates of malunion, nonunion, and infection. Traditionally, nonsurgical treatment has been favored. Over the past 15 years, improved and meticulous techniques of internal fixation has been shown to yield good to excellent results. Also a number of excellent devices are now available. We reviewed the patients who were admitted for fractures of the distal femur and were treated by the surgical treatments at department of Orthopaedic Surgery, Chungbuk National University Hospital from July 1993 through Augrst 1994. Fourteen cases were followed for more than one year. An average age at operation was 54 years (range, 18-74 years). The analysis group consisted of 9 males and 5 females. The cause of injuries were motor cycle injury in 8 cases, in-car accident in 2 cases, pedestrian injury in 2 cases and fall down in 2 cases. According to the classifications of AO, 4 cases were type Al, 2 were type A2, 2 were type A3, Cl was 1 case, C2 were 2 cases and C3 were 3 cases. Open fractures were 2 cases. Blade plate was used in 10 cases and DCS(dynamic compression screw) in 4 cases. With serial follow-up X-ray, ROM of knee and Neers scoring system, evaluation was performed. Excellent or good results were obtained in 13 cases (93%). Deep infection was developed in one case. At last follow-up, ROM was satisfactory. Blad plate was very useful for severe osteoporotic patient. For comminuted, displaced intra-articular fractures such as Type C, extensile surgical approach was most useful.

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Management of open Supracondylar Fractures of Femur using the Ilizarov Method: Bum Ku Lee, Do Hyun Moon, Jin Hong Ko, Soo Chan Lee, Ki Dong Kang, Jong Seob Park; J Korean Soc Fract 1996;9(3):567-573. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.567

Abstract PDF: It is extremely difficult to treat to the comminuted open fractures of supracondyle of femur Internal fixation with plates and screw or intramedullary nailing of open fracture is high risk of infection and circulatory compromising at the fracture site. External fixation reduces the risk of infection and permits easy access for wound care, early mobilizatioll of joints and weight bearing. We reviewed nine cases of open supracondylar fractures of femur treated with Ilizarov method from February 1993 to December 1995 and obtained the following results. 1. The average time of bony union was 2 weeks. According to AO classification, the average time of bony union was 22.7 weeks in type A and 29.3 weeks in type C. According to classification of Gustilo and Anderson, the average time of bony union was 21 weeks in type II,27.3 weeks in type Illa and 30 weeks in type IIIb. 2. The Neers criteria was based on the final functional and anatomical rating for supracondylar fracture of femur. According to this criteria, excellent was 1 case, satisfactory in 7 cases and unsatisfactory in 1 case. 3. The complications were divided into problem, obstacle and complication;Problem in 9 cases, bstacle in 5 cases and complication in 3 cases. We conculded the Ilizarov technique is a useful method in management of the severe comminuted fractures and extensive soft tissue injury of the supracondylar fractures of femur.

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Cable Fixation Method for Displaced Acetabular Fracture: Chang Soo Kang, Byung Woo Min, Kwang Soon Song, Chul Hyung Kang, Jong Wan Park; J Korean Soc Fract 1996;9(3):574-582. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.574

Abstract PDF

The operative treatment of displaced acetabular fracture has become the preferred method than conservative treatment. Displaced acetabular fracture occurs primarily in young adult involved in high energy trauma and it can lead to some degree of permanent disability. The aim of treatment must be the restoration of hip function which require accurate anatomical reduction and firm fixation followed by early exercise. The complicated anatomy of the region, and unsatisfactory fixation to cancellous bone, and unnecessary wide dissection of the soft tissue for plate and screw fixation contribute to clinical end results of varying success. The wire loop which was previously reported by our department as a successful method of fixation has now been developed to cable fixation that can be easily adjusted to the irregular surface of acetabulum and get more firm fixation. A clinical analysis was performed on 14 patients with displaced unstable acetabular fracture who had been fixed by cable and followed for minimum 1 year period at our department from June 1993 to June 1994. The results were follows; 1. According to Letournels classification, there were most common(9 cases:64.4%) in both column fracture, 3 cases(21.4%) in T shaped fracture, 1 case(7.1%) in transverse fracture, and 1 case(7.1%) in transverse and posterior wall fracture. 2. The satisfactory result was achieved in 12 cases(85.7%) on clinical grade and 12 cases(85.7%) on radiographic grade according to Epstein criteria. 3. The complication were developed in 3 cases(21.4%) out of 14 cases, such as posttraumatic arthritis in 2 cases and transient sciatic nerve palsy in 1 case. 4. Cable fixation provides a more secure and easy fixation and require a narrower exposure than a plate fixation.

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Cerclage Clamping Using Cerclage Passer for Reduction of Anterior and Posterior Column Fracture
Ki Chul Park, Hyun Joong Cho, Hun Chul Kim, Kyung-Sik Min, Hae Won Jeong
Journal of the Korean Orthopaedic Association.2016; 51(6): 486. CrossRef
Cerclage Wiring in Internal Fixation of Displaced Acetabular Fractures
Chong-Kwan Kim, Jin-Woo Jin, Jong-Ho Yoon, Sung-Won Jung, Jung-Wook Peang
Journal of the Korean Fracture Society.2008; 21(2): 95. CrossRef

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Treatment using Intramedullary Fixation for Open Tibial Diaphyseal Fractures: Young Goo Lee, Jnng Seok Choi, Young Chang Kim, Hyun Duck Yoo, Seung Seok Seo, Sang Hun Ha; J Korean Soc Fract 1996;9(3):583-592. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.583

Abstract PDF: This fractures of tibial shaft are common and open injuries are frequently accompanied due to its anatomical characteristics. External fixation was widely used for treatment of open fractures of tibia, but recently internal fixation combined with appropriate debridement and antibiotics has been reported, with more comfortness and less secondary operations. We analysed 33 cases of open tibial diaphyseal fractures treated using intramedullary fixation devices. The results were as follows. 1. The methods of fixation were Ender nail, 15 cases, and interlocking nail, 18 cases. And 17 cases out of 18 interlocking nail were unlearned one. 2. The Ender nail was used in 5 cases for open type I fracture, 7 type II, 2 type III-a and 1 type III-b, And the interlocking nail was used in 9 cases for type 1, 7 type II, 1 type IIIa and 1 type III-b. The average operation time was 55 minutes for Ender nail, while 14 minutes for interlocking nail. 3. The Ender nailing group has 6 complications;one case superficial infection, one deep infection, one delayed union, one nonunion and two angulation deformities. The interlocking nailing group has also 6 complications;one case superficial infection, two deep infections, one delayed union, one nonunion and one peroneal nerve palsy. 4. The average union period was 18.4 weeks in Ender nail and 19.1 weeks in interlocking nail.

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A Clinical Study of rmmediate Internal Fixation(within 24 Hrs) in Open Fractures of The Long Bones: Yoon Sik Kim, Jae Eung Yoo, Chi Soo Sohn, Jong Seouk Park, Hee Kwon, Joon Min Song, Soo Kyun Rah; J Korean Soc Fract 1996;9(3):593-604. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.593

Abstract PDF: The major goals in the treatment of open fractures of the long bones are to prevent infection, avoid malunion or nonunion, achieve bone union, and restore limb and patient function as soon and as fully as possible. The treatment modalities adopted in open fractures still remains controversial, especially in Gustilo-Anderson Type III. It has been the fear of infection that has lead to the traditionally accepted opinion that immediate internal fixation of open fractures is contraindicated but, nowadays, it is no longer tabooed. Owing to the early meticulous wound debridment and irrigation, and the use of bactericidal antibiotics, the infection rate reduced remarkably. Fifty-five cases of open long bone fractures treated by immediate internal fixation within 24 hours from inury were reviewed, which were treated at the Department of Orthopedic Surgery, Soonchunhyang University hospital for nine and half years from June, 1985 to January, 1995. The results were as follow: 1, There were 20 Type II , 19 Type III A, 10 Type IIIB and 5 Type IIIC open fractures treated by immediate internal fixation within 24 hours following to Gustilo-Andersons classification. 2. The most common causes of open fractures were traffic accident(84%). 3. The associated injuries of the patients treated by immediate infernal fixation were in sequence.:26 multitraumatized patient, 5 arterial injuries, 5 musculotendinous injuries, 3 major joint dislocations and so forth. 4. Normal bony union was achieved in 41 patients(73.2%), Delayed bony union was in 7 patient(12.5%) and nonunion in 8 patients(14.5%). 5. Primary wound healing was achieved in 40 patients(71.4%), superficial to moderate infection were in 5 patients(9%), deep to osteomyelitis in 11 patients(19.6%). 6. According to the subtypes of open fractures, deep to osteomyelitis were 80% in Type IIIC, 30% in Type IIIB, 10.6% in Type IIIA and 10% in Type II.

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Treatment of Open Tibial Fracture with Enternal Fixator: Byung Chang Lee, Sang Soo Kim, Sang Do Cha; J Korean Soc Fract 1996;9(3):605-613. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.605

Abstract PDF: In a retrospective study from 1987 to 1993, we reviewed 191 patients with 203 open tibial fractures which were treated with external fixator and had adequate clinical and radiological follow up evaluation over 1 year. The configuration of fractures was classified using AO classification, and to extent of soft tissue damage was graded using to Gustilo classification of open fracture. There were 108 Grade I ;36 Grade II and 59 were Grade III. We used mainly unilateral two plane type(simple conventional type) and unilateral one plane type. To stabilize supplementarily large bony fragment, screw, K-wire or wire were used in 11, 41 and 6 cases respectively. 117(51.6%) open fracture wounds healed by delayed primary or secondary intentien, whereas 40(19.1%) patients received a split thickness skin graft, 31(15.3%) patients had a rotation of a myncutaneous flap, and 15(7.4%) patients received a free flap surgery for soft tissue coverage. The average time to union was 25.1 weeks. To obtain bone healing, we performed additionally bone graft in 89 cases(43.8%), fixator change only in 8 cases(3.9%), and fixator change with bone graft in 20 cases(9.9%). All cases except 28 open tibial fractures, which was performed fixator change, were treated by primary external fixation without a change of fixator. Major complications were delayed union, nonunion and pin tract infection, and superficial infection, chronic osteomyelitis, pin loosening and partial ankylosis of joint were developed. In conclusion, we think the external fixator is a routine device for open tibial fractures. The configuration of fracture and degree of soft tissue damage had influence on healing of open tibial fracrures. Supplementary fixation in combination with external fixation does not offer important advantages. We should pay attention to bone healing more than soft tissue healing in Crade I & II injury and to soft tissue healing more than bone healing in Grade III injury.

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Treatment of Acute Compartment Syndrome with Tibial fracture: Young Bae Pyoi, Dong Min Shin, Pan Ok Kim; J Korean Soc Fract 1996;9(3):614-621. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.614

Abstract PDF

It has been known that early recognition and prompt decompression is critical in acute compartment syndrome with tibial fracture because inappropriate treatment lead to signincant functional disabilities. We treated 567 cases of tibial fracture and experienced 21 cases of acute compartment syndrome between September 1988 and June 1994. The purpose of this study is to analysis the initial degree of intracompartmental pressure and duration between the diagnosis and decompression, to evaluate the functional results and to discuss the complications. The result obtained were as follows 1. Anterior intracompartmental pressure was ranged from 25mnHg to 81mmHg (average 43.4mmHg), and deep posterior intracompartmental pressure ranged from 19mmHg to 61mmHg (average 32.7mmHg). 2. Among the 21 cases, common peroneal neuropathy were developed in 19 cases. We experienced complete recovery in 5 cases, incomplete recovery in 13 cases and 1 case of no change. We found posterior tibial neuropathy in 8 cases, and experienced complete recovery in 2 cases, incomplete recovery in 5 cases and 1 case of no change. 3. As an complications, clawing of toe developed in 3 cases, equinovarus deformity of ankle in 2 cases, superficial wound infection, osteomyelitis and nonunion in 1 case. 4. We obtained good or excellent results in 16 cases(76.1%). 5. We thought that the most important factor to decide the prognosis seems to be duration of high level of tissue pressure and also it is neccessary early diagnosis and early treatments to obtain good results.

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Is CT Angiography a Reliable Tool for Diagnosis of Traumatic Vessel Injury in the Lower Extremities?
Jong-Hyuk Park, Kwang-Bok Lee, Hyuk Park, Jun-Mo Lee
Journal of the Korean Fracture Society.2012; 25(1): 26. CrossRef

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Operative Treatment of the Fracture of Patella: Kyu Yeol Lee, Hyung Hwan Lee, Sung Soo Kim, Sung Keun Sohn; J Korean Soc Fract 1996;9(3):622-630. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.622

Abstract PDF: The patella, the largest human sesamoid bone, is important functional component of the knee extensor mechanism and its treatment is considered to be very important because the fracture involvement to the articular surface occures in most of the cases. We report 40 cases of fractures of patella treated with operative methods from January 1990 to June 1995 at the department of orthopaedic surgery, Dong-A university hospital. The results are as follows. 1. Among 40 cases, 29 cases were male and 24 cases were belong to 3rd decade and 4th decade. 2. The most common cause of injury was slip down or fall down. 3. The pattenrs of fracture were transeverse in 21 cases, vertical in 2 and comminuted in 17. 4. The methods of surgical treatment were modified tension band wiring in 33 cases, circumferential wiring in 2, partial patellectomy in 4 and total patellectomy in 1. 5. In patient treated with modified tension band wiring, range of motion of the knee was 128 and mean duration of bone union was 9.2 weeks. 6. Complications were limitation of range of motion in 3 cases, refracture by slip down in 1 case and wire migration in 1 case.

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A Clinical Study of the Comminuted Fracture of Patella: Il Yong Choi, Sung Joon Kim, Tai Seung Kim, In Mool Lee; J Korean Soc Fract 1996;9(3):631-639. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.631

Abstract PDF: Recently the fracture of patella especially comminuted fracture has increasing tendency due to frequent traffic accident. Because of the patella is an important functional component of the knee extensor mechanism, and proximal three-quarters of the posterior surface of the patella are covered with articular cartilage. accurate reduction and rigid fixation are important in treatment of the comminuted fracture of the patella. Some fractures were treated successfully by immobilization in a cylinder or an above-knee cast, but most patellar fractures should be treated surgically. Various techniques of internal fixation have been recommended for comminuted fractures of the patella, but best way should be selected out of various methiods case by case. In this series, 48 comminuted patella fractures between January, 1990 and April, 1995 have been reviewed at least 9 months after injury and obtained following results. 1. Peak age was third to fifth decade and predominant in men. 2. The major causes of the comminuted patella fractures were traffic accident in over-all, and slip down in sixth and seventh decades. 3. Most fractures were accompainied by other fractures. 4. fourteen patients had postoperative complications, six had patellofemoral osteoarthritis, three metal failure, two loss of reduction, two superficial infections and one malunion. 5. In long-term follow up, the factors that related to the range of motion of the affected knee were though to not the operative method but initial severity of the comminution and accampanied injury.

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Operative Treatment of Patellar Fracutres: Eun Kyoo Song, Dae Ik Kim, Hyung Seog Kim; J Korean Soc Fract 1996;9(3):640-646. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.640

Abstract PDF: Patella has important roles to enhance extensor mechanism of knee, therefore patellar fractures should be treated correctly according to the type and displacement of fractures for the preservation of patellar function. The purpose of study is to analyse the clinical results of operative treatment for patellar fractures. 77 cases of patellar fracture which were treated at Chonnam University Hospital between June 1985 and March 1995 were reveiwed. Among them, 32 cases with open reduction and internal fixation were included in this study. The mean follow-up period was 21.5 months(range twelve to eighty two months). Oircurnferential wiring, modified tension band wiring, malleolar screws and combination of circlage and tension band wiring were used as a fixatives. The clinical results were compared according to Reileys clinical evaluation criteria mainly by range of motions, mid-thigh circumferential difference. The most favorable results could be obtained with the combination of circlage and tension band wiring.

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Arthroscopic and Conventional Treatment of Lateral Tibial Plateau Fractures: Jung Man Kim, Chang Whan Han, Han Seok Son; J Korean Soc Fract 1996;9(3):647-655. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.647

Abstract PDF: The goals in the treatment of a tibial plateau fracture are to obtain a stable, aligned, mobile and painless joint and to minimize the risk of post-traumatic osteoarthritis. Most recently the management of tibial plateau fractures has been via arthroscopy. Proponents of arthroscopic techniques advocate their use not only to better visualize the surface of the tibia but also to evaluate the rest of the joint. This retrospective study compared the results of arthroscopic and conventional treatment of tibial plateau fractures from January 1988 through April 1995. Forty-seven knees of tibial plateau fractures were involved in this study. Sixteen of these patients were treated with arthroscopic reduction and autogenous bone graft with or without internal fixation, while the remaining 31 underwent open reduction, bone graft and internal fixation. The results are as follows: 1. The average time to full weight bearing was 10.2 weeks (range 7-14 weeks) in the arthroscopic group and 13.5 weeks(7.2-18 weeks) in the open reduction group. 2. The incidence of lateral meniscus tear was 56%(9/16) in the arthroscopic reduction group and 29%(9/31) in the open reduction group. 3. Flexion of at least 130 was obtained in 81%(13/16) of arthroscopic reduction group, while only Tabl 58%(16/31) in the open reduction group. Full extension was obtained in 93%(15/16) of arthroscopic reduction group, and in 83%(26/31) in the open reduction group. 4. Complications occurred more frequently in the open reduction group than in the arthroscopic reduction group.

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A Clinical Comparative Study for the Results of the Tibial Intercondylar Eminence Fracture: Hyun Kee Chung, Choong Hyeok Choi, Chang Ho Rho, Jae Lim Cho; J Korean Soc Fract 1996;9(3):656-664. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.656

Abstract PDF: The management of fractures of the tibial intercondylar eminence is uncomplicated when the fracture has minimal displacement(Type I) or when only one-third or a half of the eminence is elevated(Type II). However, the treatment of complete separation(Type III) has been controversial. Authors reviewed 35 cases in 35 patients of the tibial intercondylar eminence fracture at the Department of Orthopedic Surgery of Hanyang University Hospital from Jan. 1988 to Dec. 1994. The results were as follows: 1) There was a predisposition for male and prevalent age distribution was 2nd to 4th decade. 2) The most common cause of injury was traffic accident in 22 cases(62.9%). 3) The most common associated injury was rupture of MCL on the ipsilateral knee in 11 cases (37%). 4) According to the Meyers and Mckeevers classification, type III was most common in 24 cases(69%), type II was 7 cases(20%) and type I was 4 cases(11%). 5) The excellent or good result was 82% in conservative treatment group, 83% in screw fixation group and 92% in pull out suture group. 6) In case of small size and comminution of the fragment, it was difficult to fix the fragment with screw fixation. So, we recommend the method of fixation with pull out suture technique for small or comminuted type III fracture.

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Treatment of Infected Nonunion of the Tibia Using the Ilizarov Apparatus: Duck Yun Cho, Eun Sung Koh, Suk Cho Kong; J Korean Soc Fract 1996;9(3):665-673. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.665

Abstract PDF: Infected nonunion of the tibia was most serious complication in the tibial fracture and it have had many obstacles in treatment. Various treatment methods for infected nonunion have been performed to achieve bony union and restore bony defects after sequestrectomy. From Febrary 1991 to June 1993, the authors reviewed 12 cases who were treated for infected nonunion of the tibia with bone defect by the Ilizarov technique at National Medical Center to achieve union. to correct deformity, to eradicate infection, to reestablish limb length, and to eliminate bone defect. These infected nonunions were treated by on bloc resection of the diaphyseal shaft and internal bone transport. Final equalization of leg length inequality was achieved by external lengthening technique. Preoperative shortening was present in 1 of 12 cases and ranged from 1cm to 4cm (average,2.0cm). Bone defects size was ranged from 2cm to 7cm(average 4.5cm). Tibial corticotomies were performed at the proximal level in 8 cases and at the distal level in 4 cases. Regnerated new bone was ranged from fun to 9cm(average, 5.8cm). The average healing index was 2.54 months/cm. At an average 18 months follow up, according to Paley and Catagnis classification, bony results were excellent in five, good in six, poor in one and functional result were excellent in one, good in five, fair in five. poor in one. We concluded that the application of Ilizarov technique to resistant infected nonunion of the tibia with bone defect was very encouraging and useful method.

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Fracture-SeFaration Involving the Entire Distal Humeral Epiphysis in a Young Child(Salter-Harris type I injury): A Case Report: Jong Ho Jang, Seung Gyun Cha, Kyoung Hoon Kim, Jeon Oh Kang; J Korean Soc Fract 1996;9(3):674-677. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.674

Abstract PDF: Fracture-separation of the distal humeral epiphysis is a rare injury, frequently misdiagnosed as a fracture of the lateral humeral condyle, a supracondylar fracture of the humerus or a dislocation of the elbow. Roentgenographic evaluation reveals posteromedial displacement of the distal epiphysis. Single contrast arthrography is performed in order to confirm diagnosis. Treatment is first directed toward prompt recognition of the injury. A manipulative closed reduction is usually recommended. We experienced a case of fracture-separation involving the entire distal humeral physis treated by closed reduction and percutaneous pinning. The result was excellent.

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Clinical Analysis of the Lateral Humeral Condyle Fracture in Children: Jong Oh Kim; J Korean Soc Fract 1996;9(3):678-687. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.678

Abstract PDF: The author have analyzed clinical and radiological materials of foully-five patients of lateral condylar fracture of the humerus who have been treated with close reduction and percutaneous pinning after arthrogram, open reduction and internal fixation and followed up for more than 6 month since September, 1993. If the fracture is incomplete will not be displaced after varus and valgus stress. Also We have checking arthrogram of reduction state. we have treated with close reduction and percutaneous pinning. If the fracture is complete the fragment may be displaced and open reduction with internal fixation is mandatory, the following results were obtained: 1. Age at diagnosis was 5.7 years in average ranging from two years to twelves years. thirty-three out of fourty-five children(73.3%) were male to reveal definite male prepoderance. 2. As for Milch type classification, three cases(5%) were of type I and foully two cases(95%) were of type II. According to Jakobs staging of displacement, 7 cases were of stage I, 25 cases were of stage II , and 13 cases were of stage III. 3. The open reduction were indicated as follows: Jak obs stage II unreduced, postinjury 48 hours relapsed, Jakob stage III. The closed reduction were indicated as follows: Jakobs stage I, II Badelon type I, II and undisplaced and reduceable with supination-valgus stress view, arthrogram. 4. The average period of postoperative cast immobilization was 4 weeks, active and gentle passive motion exercises were instituted thereafter. 5. The range of change in carrying angle was not influenced by degree of fragment displacement and method of treatment. 6. The complications were lateral condylar overgrowth(6 cases) and avascular necrosis(1 case). 7. The result of the treatment classified according to Hardacre assessement, were excellent in thirty one cases(69%), good in thirteen cases(29%), poor in one case(2%). In conclusion, the closed reduction and internal fixation with arthrogram, is considered as the treatment of choice for the minimally displaced lateral condylar fractures of the humerus in children.

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Treatment of Radial Head and Neck Fracture in Children: Hyung Ku Yoon, Kuk Hwan Oh, Kyung Hoon Kang, J I Kim, Jong Hwa Yi; J Korean Soc Fract 1996;9(3):688-694. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.688

Abstract PDF: Fracture of radial head and neck in children is a relatively rare injury and comprises 5 to 10 percent of fractures of the elbow in children. Its prognosis has been considered relatively good, but prognosis is poor in severely displaced fractures of the radial head and neck, especially types II and III by OBriens classification and have a high risk of complication. We retrospectively reviewed 8 cases of radial head and neck fractures in 1 patients, who were treated from Jan.1992 to June 1994 at Kwang Myung Sung Ae Hospital. They were followed up for more than 1 year. The results were as follows; 1. There were 4 male and 3 female patients. One patient had bilateral involvement 2. The most common cause was fall down injury (6 cases). 3. According to O'Briens classification, 3 cases were type I and 5 cases were type II Treatments included simple immobilization(3 cases), closed reduction and plaster cast (4 cases), percutaneous K-wire leverage method(1 case). 4. According to the criteria of Tibone, the clinical result was excellent in 7 cases and good in 1 case. Primary angulation was the most important factor affecting the result and early closed reduction was important to obtain the satisfactory clinical result.

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Treatment of Supracondylar Fracture of Humerus in Children: Conservative vs Operative Treatment: Jong Min Sohn, Ju Hai Chang, Dong Heon An, Seung Pyo Eun, Han Seok Son; J Korean Soc Fract 1996;9(3):695-705. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.695

Abstract PDF: Supracondylar fracture of the humerus is the most common fracture around the elbow joint in children, especially in the age from 4 to 9. 97% of the fractures are extension type and there are many problems in management such as the method of reduction and maintenance of reduction, Volkmanns ischemia, neurovascular injuries, cubitus varus or valgus deformity, and myositis ossificans etc. Currently the methods of treatment of supracondylar fracture include open reduction and pin fixation, closed reduction and percutaneous pin fixation, and closed reduction and immobilization by splint. 134 children with supracondylar fracture of humerus, conservatively 49 cases and operative 85 cases, were treated from January 1991 to October 1995 and were followed up for at least 6 months. We analyBed the type of fracture, method of treatment and results and concluded that accurate reduction, minimizing soft tissue injury and maintenance of reduction are important factors for gaining good results.

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Supracondylar Closing Wedge Osteotomy for Posttraumatic Angular Deformity of Distal Humerus: Methods for Reducing Secondary Deformity: Sung Soo Kim, Sung Keun Sohn, Chul Hong Kim; J Korean Soc Fract 1996;9(3):706-714. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.706

Abstract PDF: The angular deformity of distal humerus is one of the most frequent complication of supracondylar fracture in growing children. The deformity rarely limits function, but corrected by patients request due to cosmetic problem. Many orthopedic surgeons have suggested various operation methods but with high incidence of complications related to these operations, also we often experience secondary deformity after inaccurate osteotomy. Therefore to identify desirable operative method to reduce secondary deformity, a retrospective study of 17 patients operated with angular deformity following distal humerus fracture was carried out in which replanning with isosceles triangle method was done in all cases. The following results were obtained. 1. The complications were two cases of metal failure and one of non union. 2. The basic requirement of closing wedge osteotomy without secondary deformity was that:the center line of isosceles triangle whose apex angle should be identical to the deformity angle and be placed on the concave apex of deformity, should overlap the transverse bisector of hurnerusforearm axes. In inevitable cases, the disparity should be minimized to alleviate secondary deformity. 3. The translation was calculated by the equation of T=Dxsin Î±(T:translation, D:proximal or distal migration of the point of contact of humerus-forearm axes, Î±:angle of the deformity). In conclusion, we think that the deformity may be corrected safely and easily using minute preoperative planning with application of above principle.

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Treatment of Fracture-Dislocation of Tarsometatarsal Joint: Chung Nam Kang, Jong Oh Kim, Sang Hun Ko; J Korean Soc Fract 1996;9(3):715-724. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.715

Abstract PDF: The tarsometatarsal fracture-dislocation are unusual freguency. Lesion in this area are generally the result of a high energy traulna and difficult to recognize on standard radiographs. Twenty-one casei of fracture and dislocation of the tarsometatarsal joint were treated by open or closed reduction from January 1991 to April 1996. We assessed clnical result & treatment result and the following results were obtained. 1. Anatomical reduction is likely to lead nearly normal function & little complications. 2. Due to soft tissue interposition, espicially interposition of tibialis anterior, and marked articular comminution, early closed reduction was failed in 3 cases. If the closed reduction is tossed, then open reduction and internal fixation was performed. 3. In cases of nearly anatomical reduction, good prognosis was obtained. 4. Accurate accessment of AP & oblique & lateral projection of radiographs were very adventa geous & important. 5. Open anatomical reduction was superior to closed reduction & percataneous pining & cast immobilization alone.

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Treatment of the Tarsometatarsal Joint Fracture-Dislocation: Kun Yung Lee, Young Kee Lee, Yong Man Cho, Heung Sik Kang; J Korean Soc Fract 1996;9(3):725-732. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.725

Abstract PDF: Traumatic dislocation and fracture-dislocation of the tarsometatarsal joint rare injuries. These injuries often missed because radiographs of this joint is difficult to be interpreted, so delay to be diagnosed and treated. These injuries often leads to arthritic change with significant residual symptoms and deformities. Tarsometatarsal joint injuries are generally managed by accurate repositioning of the displaced metatarsals and stabilization with instruments(K-wire, screws etc.). The purpose of this study is to review the anatomical, radiological and functional results. The authors analysed the 25 cases with injuries of the tarsometatarsal joint treated of the department of Orthopaedic Surgery, Lee-Rha general hospital from March 1989 to September 1994, which showed the following results. 1. The most common cause of the injury was traffic accident(76%). 2. According to the Hardcastles classification, the injuries were classified as follows:partial incongruity in 16 cases(64%), total incongruity in 6 cases(24%), and divergent congruity in 3 cases(12%). 3. Three cases were treated with closed reduction and case immobilization, thirteen cases were treated with closed reduction and percutaneous K-wire fixation. Nine cases were treated with open reduction and K-wire fixation as follows:reduction failure in 3 cases, entrapment of anterior tibial tendon in 2 cases, severe soft tissue injury in 4 cases. 4. The anatomic reduction and its maintenance were considered as most important factor of prognosis.

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Intra-Articular Fractures of the Calcaneus: Open reduction and internal fixation via extended lateral transcalcaneal approach: Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Yong Min Kim, Hyung Ho Oh, Dong Joo Chae, Min Hyo Park, Jee Hong Kim, Yun Chul Cho; J Korean Soc Fract 1996;9(3):733-741. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.733

Abstract PDF: Fractures with displaced articular facet of subtalar joint occupies 60-75% of whole calcaneal fractures. Nowadays, general principle of treatment for displaced intraarticular fracture has become anatomical reduction of joint surface and rigid fixation of the fracture. However, it had been difficult to apply this principle in cases of calcaneus due to various obstacles such as anatomical characteristics, therefore outcomes were not satisfactory in many cases. Extended lateral approach, which was designed by Letournel and Benirschke, contributed greatly in overcoming those obstacles. From August 1992 to April 1994, the author managed fifteen displaced intraarticular fractures of the calcaneus in fourteen patients with open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate. The fractures were examined preoperatively with Brodens view and classified according to Eastwood(1992) with 2-plane CT. All the fractures united within postoperative 20 weeks(average 10.9 weeks). Final results were assessed by the clinical criteria for calcaneal fracture designed in Greighton Nebraska Health Foundation. Among the 15 cases, excellent results were obtained in eight cases, good in six, fair in one. There were no remarkable complications at the latest follow-up. In managing displaced intraarticular fractures of calcaneus, open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate seemed to be very useful and harmless method.

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The Classiflcation and Management of Intraarticular Calcaneal Fracture Based on Computed Tomography: Jae lk Shim, Taik Seon Kim, Sung Jong Lee, Suck Ha Lee, Chang Moo You, Young Bae Kim; J Korean Soc Fract 1996;9(3):742-749. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.742

Abstract PDF

Displaced intraarticular fractures of the calaneus require operative intervention to restore the anatomy of the bone, which in turn is the requirement for recovery of subtalar joint mobility. To evaluate the complex contour of calcaneal anatomy, a classification for intraarticular calcaneal fractures was used, based on standardized coronal and transverse computed tomography scans of os calsis. From January 1993 to December 1994, intraarticular calcaneal fractures of 47 cases treated in Korea Veterans Hospital were analysed preoperatively with C.T. scan and classified by Sandersclassification system. And clinical evaluation of the patients was done by Maryland Foot Score postoperatively. The result were as follows:Type I fractures were found in 10 cases. 25 cases of 47 cases were classified as type II and subdivided as II A in 13 cases, II B in 6 cases, II C in 6 cases. Type III fractures were found in 8 cases and subdivied as III AB in 4 cases, III BC in 3 cases, III AC in 1 case. Type IV fractures were found in 4 cases. This classification aids a surgeon to make perioperative decision, because it has prognostic significance.

Citations

Citations to this article as recorded by

Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft
Eun Sun Moon, Myung Sun Kim, Il Kyu Kong, Min Sun Choi
Journal of the Korean Fracture Society.2010; 23(1): 69. CrossRef
The Comparison of Radiographic Parameters and Clinical Results after Operative Treatment of Displaced Intraarticular Calcaneal Fractures
Hong Moon Sohn, Jun Young Lee, Sang Ho Ha, Sueng Hwan Jo
Journal of the Korean Fracture Society.2007; 20(3): 227. CrossRef

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Nonoperative Management of Stable Thoracolumbar Fracture with Bracing in Old Age: Jong Oh Kim; J Korean Soc Fract 1996;9(3):750-758. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.750

Abstract PDF: Fourteen neurologically intact patients with stable fractures at the thoracolumbar junction above 60yrs old age were treated with early ambulation in a total contact orthosis, Jewett Brace, Knight-Taylor Brace and had followed up greater than one year. Spinal orthosis have been traditionally used in the management of thoracolumbar junction treated with or without surgical stabilization However, the orthotic treatment modality in the management of spinal fractures remain subjective, especially old age. since few objective data are available on the effectiveness of orthosis in stabilizing injuried segments. At minimum follow up of one year, an overall outcome evaluation involved verbal numerical scale ( VNS ) and radilogical assessment. Approxiamately 80% of the patient had under 3 points in the verbal numerical scale, serial roentgenograms documented significant progressing in body collapse which averaged 9.6% compression,5.2 in Cobbs angle, not correlate with type of brace. Mainly body collapse and increasing Cobbs angle at the fracture site developed within posttraumatic 3 months. Degree of osteoporosis did not correlate with change in deformity. Initial radiographic severity of injury or residual deformity following closed management did not correlate with symptoms at follow-up. This pattern of results suggested comportable brace treatment such as Jewett and Knight-Taylor Brace, as the preferred treatment in stable thoracolumbar fracture in old age.

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Change of Canal Compromise After Ligamentotaxis in Thoracolumbar Burst Fracture: Kyu Jung Cho, Min Suk Yang; J Korean Soc Fract 1996;9(3):759-766. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.759

Abstract PDF: Twenty-one patients with burst fracture of the thoracolumbar spine were treated by posterior pedicle screw instrumentation and fusion. We assessed canal compromise using CT fcan preoperatively and its restoration shortly after instrunientation lot confirmation of effect of lisamentotafis. The amount of neurologic recovery in each patient was compared to the final area of the spinal canal. The mean initial canal compromise was 42.6% and this was reduced to 16.2% postoperatively. The mean sagittal diameter was 10.2mm preoperatively & 12.9mm postoperatively. We achieved a mean reduction of canal compromise of 62%. A significant correlation between preoperative canal compromise and amount of restoration, or severity of neurologic deficit could not be established. Ligamentotaxis by pedicle screw instrumentation could effectively decompress the canal in thoracolumbar burst fracture.

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