Journal of Musculoskeletal Trauma

The Operative Treatment of the Intertrochanteric Fracture of the Femur in Elderly Patients over 70 years old: Comparison between Survivor group and Non-survivor group: Sang Won Park, Young Soo Byun, Dong Hoon Suh, Jae Hyo Jung; J Korean Soc Fract 1998;11(4):725-731. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.725

Abstract PDF: The intertrochanteric fractures of the femur are common in elderly. recently better implants and surgical techniques have improved the clinical results. But intertrochanteric fractures are still a major source of morbidity and mortality in elderly because of poor general condition and high incidence of osteoporosis. The primary goal of the treatment have been union of the fracture, but it is important to reduce the mortality rate and to return the patients to a prefracture ambulatory status. The authors analyzed the 63 intertrochanteric fractures of the femur in the elderly patients over 70 years old who had been treated at Korea University Hospital from January 1990 to December 1995 in order to determine the mortality rate and the prognostic factors associated with mortality. Also we analyzed the 44 patients in survivor group about their prefracture ambulatory ability and opst-operative ambulatory ability. The results were as follows; 1. There were 44 cases(69.8%) in survivor group and 19 cases(30.2%) in non survivor group. The mortlity rate was 20.6% at 1 year after operation. 2. Mortality was associated with the number of medical problems and interval between injury and peration. 3. The recovery of ambulatory ability was associated with the age at injury, associated medical problems, and preinjury ambulatory ability.

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Metal failure after compression plate fixation in femoral shaft fracture: Sung Ho Han, Bo Kyu Yang, Chi Hong Kim, Tae Won Ahn, Dong Hyun Kim; J Korean Soc Fract 1998;11(4):732-737. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.732

Abstract PDF: Intramedullary nailing is one of the most available method in the treatment of femoral shaft fracture. Recemtly compression plate is not widly used. Inapproriate technique using compression plate lead to metal failure. The purpose of this study is to analyz the clinical feature, cause and treatment of metal ailure in femoral shaft fracture. We analyzed 6 cases of metal failure from Jan. 1990. to Dec. 1996 and obtained the following results. 1. Type of fracture were Winquist-Hansen Type I in 1 case, Type-II 3 cases, Type III 2 cases. 2. The interval between initial poeration and metal failure was 11 months on average, ranging from one to twenty months. 3. Metal failure occurred as plate breakage in 4 cases, plate bending and loosening in 2 cases. 4. Cause of metal failure after compression plate fixation presumed to be comminuted fracture in 5 cases, early weight bearing in 3 cases, remaining bone defect in 4 cases, inadequate surgical technique in 4 cases and empty plate hole in 4 cases. 5. Treatment of metal failure after compression plate fixation were intramedullary nailing with bone graft in all cases. Accturate preoperative evaluation of fracture site, fracture pattern, and appropiate selection of metal device necessary for the prevention of metal failure.

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Ipsilateral Fracture of the Femoral Neck and Shaft: Chong Kwan Kim, Jeong Hwan Kim, Dae Young Kim; J Korean Soc Fract 1998;11(4):738-744. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.738

Abstract PDF: Ipsilateral femoral neck and shaft fractures are uncommon and have difficulty in diagnosis. The injury results from high energy trauma. From January, 1990 to March, 1995, 10 cases of ipsilateral femur neck and shaft fractures had been treated. Follow up period varied from 10 months to 3 years (average 1 year 10 month). The purpose of this study is to evaluate the fracture pattern of neck, complications due to delayed operation, and efficient methods of fixation. The neck fractures were minimally displaced or not displaced in 8 cases. The femur shaft fractures were usually comminuted and located at midshaft. The timing of operation was often determined by the patient's status as a multiple trauma victim, but a delay of days to cases, diagnosis was delayed, but there was no complication, like as avascular necrosis and nonunion. There was one case of nonunion of femur shaft, and which was treated with bone graft. We could not find the difference in complication rate among the fixation methods. Anatomic reduction and stable fixation seem to be more important than the method of fixation and timing of operation.

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Ender nailing For Intertrochanteric Fracture of the Femur in the Elderly patients: Hak Yeong Jeong, Seung Wook Yang, Seung Joon Shin, Hyeong Joon Seung; J Korean Soc Fract 1998;11(4):745-753. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.745

Abstract PDF: The principle of treatment of intertrochanteric fracture is early operation and early rehabilitation. The morbidity and mortality associated with intertrochanteric fracture are remained high because the elderly patient generally have a reduced tolerance for prolonged bed rest, lengthy operation and blood loss. Since Ender introduced the concepts of multiple flexible intramedullary nailing in 1970, Ender nailing has been mostly used in intertrochanteric fracture of the elderly patient, but it has been rarely used for unstable fracture. The authors analysed 87 cases of intertrochanteric fractures of femur over 60 years old, treated with Ender nailing during period from July, 1998 to October, 1996. The results were as follows : 1. Among 87 cases, 70 cases were female and average age was 75.3 years old. 2. The common complications were knee pain and LOM(10%) and distal migration of nails(3%). 3. These complications were reduced by careful bending of nails, fanning of nails in femoral head, stacking of medullary canal and accurate placement of portal hole. 4. 10 patients died within 1 year(Mortality rate : 11%). 5. Thirty-six(47%) patients maintained their prefracture ambulatory ability at a postoperative 1 year ; Fourty-one(53%) patients lost some degree of ambulatory ability. 6. In unstable intertrochanteric fracture, we can achieved good results by Ender nailing in valgus reduction.

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Treatment of Ipsilateral Femur and Tibia Fractures: Yong Bum Park, sang Ho Moon, Chung Su Hwang, Soon Hyun; J Korean Soc Fract 1998;11(4):754-760. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.754

Abstract PDF

Ipsilateral femur and tibia fractures - so called "floating knee" are caused by high energy trauma and frequently associated with many problems such as hemorrhagic shock, higher morbidity, delayed union, knee stiffness, etc. To get a satisfactory functional result, rigid internal fixation and early mobilization are regarded as treatment priciples at present. Authors analyzed the functional outcomes of floatinhg knee injuries according to the fracture type and methods of surgical treatments. Twenty-eight patients were diagnosed as ipsilateral femur and tibia shaft fractures and treated surgically at the Dongguk University Hospital between June 1990 and May 1996. Average age was 34.5 years, and males were predominant. Majority of cases (27 out of 28) were caused by traffic accident. According to the classification of Blake and McBryde, type I injuries were observed in 17 cases and type II in 11 cases. Average follow up period was 1.3 years. All patients were treated by surgical methods which were selected appropriately with concideration of fracture types. 14 of 17 type I injuries were treated with intramedullary nailing for both femur and tibia fractures. Among these cases, 9 were excellent and 4 were good results. But in type II injuries, only 3 of 4 cases which were fixed with intramedullary nailing for femur and plate for tibia fractures were good results. Conclusively, Intramedullar nailing is an excellent method for ipsilateral femur and tibia fracture and type II injuries which have intra-articular fracture lines meet with worse results than type I.

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Efficacy of Integrated Korean Medicine Treatment Including Motion-Style Acupuncture Treatment for L1 Burst Fracture and Bilateral Femoral Condyle, Proximal Tibial, and Proximal Fibular Comminuted Fractures: A Case Report
Da Dam Kim, Seong Hyeon Jeon, Woo Young Kim
Journal of Acupuncture Research.2024;[Epub] CrossRef
Comparison of Floating Knee according to Presence of Knee Joint Injury
Eau-Sup Chung, Jong Hyuk Park, Hee Rack Choi, Joo Hong Lee, Kwang-Bok Lee
Journal of the Korean Fracture Society.2012; 25(4): 277. CrossRef

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Use of Interlocking Intramedullary Nail in Treatment of Delayed Union or Nonunion of the Long Bone Fractures: Suk Kyu Choo, Byung Jik Kim, Han Suk Ko, Jeong Gook Seo, Jin Gu Kim, Jun Woo Chang; J Korean Soc Fract 1998;11(4):761-768. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.761

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Of the several nonoperative and operative options described for the treatment of delayed union and nonunion of the long bone, interlocking nailing with reaming offect of internal splint, autogenous bone graft and early return to a normal way of life. The purpose of this study is to evaluate the usefulness and complication of intramedullary(IM) naling with reaming by retrospective method. We treated 34 patients with delayed union or nonunion of the tibia, femur, and humerus by interlocking nailing with reaming between January 1992 and December 1996. The results were as follows ; 1. Of the 34 cases, there were 13 tibia fracture, 17 femur fracture, 4 humerus fracture. Half of them were ununited and another half were delayed in fracture healing. 2. Previous methods of treatment were conservative treatment in 2 cases, external fixator in 2, plate & screws fixation in 8, Ender nail in 2, Kuntscher nail in 2 and interlocking nail in 7 among 24 cases of cloed fracture and external fixator in 8 and interlocking nail in 2 among 10 cases of open fracture. 3. Twenty-five patients were treated with closed nailing and 9 were treated with open nailing. Iliac bone graft was performed at 3 cases and fibulotomy was performed at 1 case. 4. Union was obtained in 33 cases and 1 case needed additional bone grafting to achieve union. 5. Postoperative complications were one nonunion, two evtry site pain, one screw breakage, one heterotopic ossification, and one postoperative infection. Interlocking nailing with reaming was associated with a high union rate(97%) in our eries. The authors believe that IM nailing with reaming is a useful option for treatment of delayed or nonunion of the long bone fracture.

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Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef

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Treatment of High-Energy Tibial Plateau Fracture: A comparison of External Fixation with Limited Internal Fixation to Plate and Screw Fixation: Suk Woong Yoon, Tae Sung Hwang, Byoung Gue Park; J Korean Soc Fract 1998;11(4):769-777. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.769

Abstract PDF: High energy tibial plateau fractures are associated with wevere articular depression, separation of both condyles, diaphyseal comminution and dissociation & loss of integrity of the soft tissue envelop. Thus it is very difficult to treat these fractures satisfactorily and severe complications may be developed. Authors carried out plate and screw fixation in 11 patients and external fixation(Ilizarov external fixator) with limited internal fixation in 8 patientsl who sustained high-energy tibial plateau fracture between Jan. 1992 and Feb. 1996. We compared the operative results of plate and screw fixation and external fixation with limited internal fixation in high-energy tibial plateau fractures which was follow up from 12months to 28months. The results were as follows; 1. The complications such as limitation of knee motion(3 cases), traumatic arthritis(1 case), angular deformity(2 cases), superficial infection(2 cases), deep infection(1 case), instability(1 case) were observed in plate fixation group. Limitation of knee motion(1 case), traumatic arthritis(1 case), delayed union(1 case) were developed in external fixation group. 2. According to Blokker's criteria, 6 cases(55%) among 11cases of plate and screw fixation group and 5 cases(63%) among 8 cases of Ilizarov external fixator group had satisfactory results. Ilizarov external fixation with limited internal fixation is useful method of treatment for high-energy tibial plateau fractures when extensive dissection and internal fixation are contraindicated due to comminution at the fracture site and compromise of the soft tissue.

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Treatment of Supracondylar Fracture of the Femur using the Supracondylar intramedullary Nail under the Arthroscopy(Preliminary Report): Suk Woong Yoon, Dong Ha Kang, Tae Sung Hwang, Jeong Il An; J Korean Soc Fract 1998;11(4):778-783. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.778

Abstract PDF: Supracondylar nailing is one of the treatment methods for supracondylar fractures of the femur but it needs arthrotomy. We introduce a mew technique of supracondylar nailing under the arthroscopy without arthrotomy. It is closed reduction and intramedullary supracondylar nailing under the arthroscopic control. The potential benefits of this method are decreased unnecessary soft tissue dissection, excellent intraarticular visualization and reduction, decreased blood loss and shortened operative time and postoperative rcovery. We performed this new technique on 4 cases of supracondylar fractures of the femur. Theresults were as follows; 1. Among the 4 cases, 3 cases were AO type A and 1 case was AO type C. 2. All cases showed bony union and average range of knee motion was 110 degrees. 3. The operation time ranged from 60 minutes to 170 minutes and averaging 110 minutes.

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Femoral Stress Fractures in Civilians who are not military recruits and athlethes :Two cases report: Myung Ku Kim, Suk Myun Ko, Kyung Ho Mun; J Korean Soc Fract 1998;11(4):784-789. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.784

Abstract PDF: We reports two cases of femoral stress fractures, one at femoral neck, the other at distal femur. Femoral stress fracture is not uncommon in reported literature, but most of reported cases limited in military recruits and athlethes. There are few reports about femoral stress fractures of civilians. Early dignosis is difficult because complaints are vague and poorly localized, so displacement occurs and misdiagnosis is made. The purpose of this report is to call attention to the importance of early diagnosis of stress fracture of the femur so that displacement and misdiagnosis, which may lead to prolonged in capacitation or to the necessity for surgical intervention, may be prevented.

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Treatments of Tibial Condylar Fractures: Yong Bum Park, Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Dong Ju Chae, Han Chul Kim, Sang ho Moon, Seung Hun Lee, Tae Young Kim, Sun Hyun Yun; J Korean Soc Fract 1998;11(4):790-797. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.790

Abstract PDF: The tibial condylar fractures are characterized by intra-articular extension of fracture line and associated soft tissue injuries, and could affect knee alignment, stability, adn range of motion after treatments. Therefore, anatomical reduction and rigid internal fixation is mandatory to get satisfactory results. But this method of treatment can not be always possible due to technical dimend of surgical sklls and high risk of postoperative infection. The authors analyzed 43 cases of tibial condylar fractures, which were treated at the orthopaedic department of the Dongguk University Hospital from March 1990 to May 1996. Males were 34, and females were 9. Average age of patients was 41.4 years, and average follow up period was 18 months. The most common causes of injuries were traffic accidents (36 cases), and most common type of fracture was Schatzker type I. associated soft tissue injuries were observed in 21 cases. Treatment methods were chosen by degree of displacement of fracture fragment and associated soft tissue injuries. Conservative treatments were done in 23 cases and operative treatments in 20 cases. Satisfactory results were obtained in overall 32 cases(74%) regardless of the methods of treatment. Unsatisfactory results were observed in patients who had associated soft injuries and significant displacement of fracture. Conclusively, satisfactory results could be obtained in patients with tibial condylar fractures by appropriate selection of treatments according to displacement of fracture and associated soft tissue injuries.

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Treatment of Pilon Fracture, limited ORIF with External Fixation by Ilizarov Method: Bu Hwan Kim, Jong In Im, Yong Kyun Yim, Deog Jeong Kang, Uk Nam; J Korean Soc Fract 1998;11(4):798-805. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.798

Abstract PDF: The authors retrospectively reviewed 22 pilon fractures in 22 patients treated with limited ORIF with external fixation by Ilizarov method. Clinical follow up averaged 28 months (range, 16-45 months). Interfragmental screw fixation of key fragments were done in fifteen cases and bone-grafting was done in thirteen cases. The average duration of external fixation was fourteen weeks. All of the fractures healed (one after delayed bone-grafting). The subjective and objective results were classified according to Ovadia and Beals. Sixteen patients (72%) had good and excellent results at final follow up. On the basis of these early results, the prevalence of complications asociated with pilon fractures and their treatments can be decreased by external fixation of Ilizarov method and limited internal fixation. We conclude that this method is good treatment modality on tibial pilon frature.

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Checkrein deformity of the lesser toes following comminuted fracture of calcaneus : A Case Report: Hee Kwon, Dong Wook Kim, Dong Jin Kim, Chi Soo Sohn, Joon Min Song, Soo Kyoon Rah; J Korean Soc Fract 1998;11(4):806-810. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.806

Abstract PDF

Checkrein deformity of the great toe may occur after fracture of the distal third of tibia. It is due to adhesion of flexor hallucis longus muscle to callus. Charachteristic finding is shaply flexed great toe at ankle dorsiflexion and complete interphalangeal joint extension at ankle plantar flexion. We experienced a patient who had severe flexion deformity on the 2nd, 3rd, 4th toe and diagnosed as checkrein deformity of the lesser toes arised from calcaneal fracture. We can't find any report of checkrein deformity after fracture of calcaneus and we think this is very rare case. In operative field, we found fibrous contracture of quadratus plantae muscle which was adhered to flexor digitorum longus tendon. And we performed tenolysis, adhesiolysis and flexor digitorum longus tendon lengthening. 11 months after operation the patient showed excellent result with correction of the deformity.

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Dynamic Positional Deformity of the Hallux
Byung-Ki Cho, Yong-Min Kim, Dong-Soo Kim, Eui-Sung Choi, Ji-Kang Park, Jung-Wook Oh
The Journal of Foot and Ankle Surgery.2014; 53(6): 791. CrossRef
Checkrein Deformity by Incarcerated Posterior Tibial Tendon and Displaced Flexor Hallucis Longus Tendon following Ankle Dislocation - A Case Report -
Su-Young Bae, Hyung-Jin Chung, Man-Young Kim
Journal of the Korean Fracture Society.2011; 24(3): 271. CrossRef

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Availability of Supplementary Circumferential Wire Loop in Treatment of Complicated Patellar Fracture: Ju Hong Lee; J Korean Soc Fract 1998;11(4):811-816. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.811

Abstract PDF: We have treated 22 patients of complicated patellar fracture with generally proposed fixation methods and supplementary circumferential wire loop as a checkrein or load sharing cable from Mar. 1995 to Feb. 1997 and then compared its surgical results with 15 patients of patellar fracture treated with modified tension band wiring alone in terms of functional recovery of the injured knee. The pattern of fracture was mostly comminuted(Bostman Type II), usually accompanying ipsilateral fractures with or without open wound, ligamentous injuries, or others. Although obtainning more satisfactory functional results in supplementary circumferential wire loop (68%) than control group(46.6%) in according to Lysholm and Gillquist scoring system and statistically significant difference in duration of regaining the functional arc of knee motion between two groups(p=0.007, Wilcoxon rank sum test) at 6 months postoperatively, we have found similar clinical results in two groups at 12 months follow-up(82% vs 80% in good results). Nevertheless, we thought that supplementary circumferential wire loop is one of the effective methods to improve the early surgical results of the complicated patellar fracture in respect of prompt regaining in knee motion.

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Treatment of Open Fractures of the Tibial Shaft by Sequential Compression technique in Ilizarov device: Suk Ku Han, In Ju Lee, Nam Yong Choi, Sung Jin Park, Gyeol Yoo, Hyo Seng Ahn; J Korean Soc Fract 1998;11(4):817-824. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.817

Abstract PDF: External skeletal fixation is used widely in the management of open or closed tibial fractures, but delayed healing is common. There is concern that this might be due not only due to the severity of injury but also to the mechanical conditions imposed at the fracture site by the fixator. Since fractures treated by external skeletal fixation can rarely be reduced to perception nor held with absolute stability, union occurs by indirect healing, which is acutely sensitive to both the charactericstics and timing of mechanical stimulation. So, the achivevment of the optimum mechanical environment is particularly important where delay in bone healing is likely. Ilizarov external fixator is useful in treating open fractures of the tibial shaft because it permits axial micromotion which enhances bridging callus formation with stable fixation as well as its complications such as infected nonunion or limb length discrepancy. The impared healing with external fixation is often caused by wrong surgical technique, such as distraction of fracture fragments by fixation device. Sequential compression at fracture site may overcome any fracture gap in external skeletal fixation and also enhance endosteal bone formation. We applied sequential compression forces at the fracture site in 18 open fractures of the tibial shaft, trated by Ilizarov external fixator with or without autogenous bone grafting. Sequential compression technique is composed of initial compression with 1 mm/wk for 4 weeks and then compression 1 mm/10 days until adequate apposition of cortex and callus formation in radiograph. We acquired successful bony union in all cases except one which had additional bone grafting in open fractures of the tibial shaft by sequential compression technique using Ilizarov device.

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Surgical Treatment of Ipsilateral Fracture of the Femur and Tibia("Floating Knee"): Eu Sub Chung, Ki Sik Hong, Seung Soo Hwang; J Korean Soc Fract 1998;11(4):825-832. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.825

Abstract PDF: Ipsilateral fractures of the femur and tibia is also called "Floating knee", It is the term applied to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur and tibia. The principles of the treatment is focussed to the rigid fixation and early restoration of the knee function. Authors reviewed 24 patient in which were treated surgical management from January 1991 to June 1998. The results were as following : 1. The patient who had both diaphyseal fractures had better clinical result than metaphyseal fractures. And the metaphyseal fractures associated with intraarticular fractures were worse than other metaphyseal fractures. 2. At the last follow up, the excellent and good results were achieved in 71% of the patients treated with internal fixation of both fractures and 60% of the patient with external fixation of the tibia, but all of the patient with wxternal fixation of the femur were poor result by Karlstrom and Olerud criteria.

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Treatment of Tibial Fractures with the Ilizarov External Fixator: Suk Myun Ko, Myung Ku Kim, Jung Yoon Lee, In Suk Oh, Sang Eun Kim; J Korean Soc Fract 1998;11(4):833-840. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.833

Abstract PDF: Between June 1996 and July 1997, 29 tibial fracture patients were treated using the Ilizarov method and apparatus. The mean follow-up petiod was 18 months. Among 29 cases, 11 were closed fractures with comminution and 18 were open fractures. There were 2 Gustilo-Anderson type I, 5 type II, and 11 type III open tibial fractures. Complications included 4 pin tract average time from application of the device to complete fracture healing was 26.3 weeks. According to Tucker's functional criteria, the results were 14 excellent, 9 good, 4 fair, 2 poor. No practical contraindications to the use of the Ilizarov device in the management of tibial fractures were encountered. We concluded that Ilizarov method is indeed a useful adjunct for the treatment of either open or closed tibial fractures.

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Limited Internal Fixation for the Treatment of the Pilon Fracture: Phil Hyun Chung, Suk Kang, Sang Ho Mun, Won Suk Chae; J Korean Soc Fract 1998;11(4):841-848. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.841

Abstract PDF: The intraarticular fractures of the distal tibia-so called pilon fracture or plafond fracture- were caused by high energy and axial compression forces arising from motor vehicle accidents or falls from a height, and it is frequently associated with severe vomminution and soft tissue injury. Expecially soft tissue injury has been considered as a difficult problems to treat these fractures and there has been many controversies in the methods of treatment. We analized 30 cases of pilon fracture who were treated by limited internal fixation from March 1992 to March 1997. the average follow up period was 26 months(from 15 to 50 months). The results as follow: 1. According to Ruedi and Allgower classification, Type I were 4(13%), Type II were 14(46%) and Type III were 12(40%) cases. 2. By using Ovadia and Beals' radiologic assessment, limited internal fixation showed good and fair results in about 80% of cases. 3. By using Mast and Teipner's clinical functional assessment, limited internal fixation showed good and fair reults in about 80% of cases. 4. Complications after operation were traumatic arthritis(17%) and nonunion(3.3%). But there were no complications such as wound infection and skin necrosis. Limited internal fixation with casting provides good result to treat pilon fractures and it reduces the complications of soft tissues problem.

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Malailgnment Following Intramedullary Nailing of Tibial Shaft Fracture - s comparison between medial parapatellar approachand patellar tendon spltting approach -: Dong Ju Chae, Phil Hyun Chung, Tae Young Kim; J Korean Soc Fract 1998;11(4):849-857. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.849

Abstract PDF: Intramedullary nailing is often the treatment of choice in the management of fractures in the tibial diaphysis. One of the most frequent complications of tibial nailing is fracture malalignment leading to angulatory or rotational deformities. Access to the proximal tibia for intramedullary nailing of the tibial shaft fractures may be via a patallar tendon splitting or paratendinous exposure. Although the tendon splitting approach is more direct, the incidence of knee pain is significantly higher when this technique is used. In addition, several cases of heterotopic ossification have been reported following tendon splitting approaches. For these reasons an incision medial to the tendon is generally chosen. We reviewed 140 cases(131 patients) of tibial shaft fractures who were treated by use of the intramedullary nailing from 1994 to 1997 and made a comparison between the medial parapatellar approach and the patellar tendon splitting approach about degree of malalignment. We have noticed that there was significant difference in the number of tibias that were malaligned after tibial nailing with the medial parapatellar access and the tendon splitting approach. With the medial parapatellar approach, malalignment was seen in 13/42 tibiae(31.0%) of the fractures of tibial shaft, 11/12 tibiae of the proximal third fractures and 2/10 tibiae of the distal third fractures respectively. With the patellar tendon splitting approach, malalignment was seen in 8/98 tibiae(8.2%) of the fractures of the tibial shaft, 4/15 tibiae of the proximal third fractures, 1/45 of the middle third fractures and 3/38 tibiae of the distal third fractures respectively. We conclude that the tendon splitting approach may be better for intramedullary nailing of the proximal fractures of the tibia and the medial parapatellar approach may be chosen for the treatment of the middle and distal shaft fractures of the tibia.

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Treatment of Patella Fracture Using Modified Transverse Tension Band Wiring Method: Jung Dae Oh, Cyeong Rim Lim, Yu Jin Joung, Gyu Sung Lee; J Korean Soc Fract 1998;11(4):858-864. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.858

Abstract PDF: Recently the fracture of patella has increasing tendency due to frequent traffic and industrial accidents. In this series, we treated fractures of patella by open reduction and internal fixation with modified transverse tension band wiring method. Early post operative continuous passive motion and early weight bearing exercise were followed. This method was excellent for treatment of the patella fractures. The surgical results were evaluted by Leveck scoring systems, 12 out of 14 cases had satisfactory results. This technique have some advantage in terms of decreasing pain and maintenance of circulation on the patella, because of the small incision and minimize dissection. It can prevent post operative complications such as limitation of motion and post traumatic arthritis of the knee joint.

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Intra-articular Fracture of the Calcaneus: Analysis of Result of Operative Treatment and Prognostic Factor: Sung Soo Chung, Jai Gon Seo, Youn Soo Park, Chong Suh Lee, Tae Kyu Hwang; J Korean Soc Fract 1998;11(4):865-872. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.865

Abstract PDF: The calcaneus is the most commonly fractured tarsal bone, but the appropriate care of calcaneal fracture continue to be an unsolved dilemma. As technology in imaging has improved, operative treatment is more suggested. The purpose of this study is to evaluate the results of operative treatment in intra-articular calcaneal frcture and to analyse the results in accordance with various prognostic factors. We analysed retrospectively 13 patients, 17 intra-articular calcaneal fractures undergone operative treatment. Mean follow-up period was 27 months (range:13 ~ 44 months). There were 11 males and 2 females with 41 year old mean age (range:18 ~ 63 years old). Clinical assessment used the modified Creighton-Nebraska health foundation assessment sheet for fracture of the calcaneus. We obtained excellent result in 7 cases (41.2%), good in 2 cases (11.8%), fair in 7 cases (41.2%) and poor in 1 case (5.8%). Clinically age and body weight, radiologically Bohler angle, fibulo-calcaneal distance and subtalar joint discrepancy are related to the prognosis of intra-articular calcaneal fracture following operative treatment. Postoperative complications are limping (2 case), heel pain (3 cases), hump bump of calcaneus (1 case) and subtalar arthritis (1case). In conclusion, on the basis of our results, there is a relationship between anatomical abnormalities of the heel and a poor clinical outcome. Therefore, in operative treatment of intra-articular fracture of calcaneus, we recommend anatomical reduction, if possible, not only of the subtalar joint but also of the Bohler angle and fibulo-calcaneal distance.

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Assessment of the Stability of the Isolated Lateral Malleolar Fracture: Woo Chun Lee, Hyun Soo Park, Young Kil Han, Jang Woon Rim, Jong Deuk Rha; J Korean Soc Fract 1998;11(4):873-879. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.873

Abstract PDF: Recent advances in the understnading of the biomechanics of the ankle have given rise to the clinical uncertainty about the indications for the operative treament of isolated fractures of the lateral malleolus. If deltoid ligament injury is associated, it may be unstable and operation may be indicated. This study was done to determine if we are able to assess the stability of the isolated lateral malleolus fracture based on the fracture patterns seen on radiographs and clinical findings. 37 patients with malleolar fracture of the ankle were treated at Hanil General Hospital by open reduction and internal fixation from Dec. 1996 to Jan. 1998. Lauge-Hansen classification was tried in all cases to determine if it could be applied. Stress test under anesthesia on 10 isolated lateral malleolar fracture patients with clinical findings of injury on the deltoid ligament area, whose medial clear space were normal or widened less than 2 mm on initial film. Exploration of the deltoid ligament was performed in 6 of above 10 patients There were 21 supination-external rotation type injuries, 2 supination-adduction injuries, 1 pronation-abduction injury and 13 fractures could not be clearly categorized into specific group. In 6 among 13 unclear cases, there were short oblique fracture lime indicating pronation injury, but direction of the fracture line could not be clearly determined. In 4 cases, direction of the fracture lime indicated pronation injury, but the length of the fracture line was too long. In 3 cases, both the direction and length of the fracture line was indeterminate. The stress test on 10 isolated lateral malleolar fraactures with clinical findings of deltoid injury revealed less than 2 mm widening in 7 cases, more than 2 mm widening in 3 cases. In 3 cases with less than 2 mm widening, tearing of anterior third of superficial deltoid was confirmed by exploration. In 3 cases with more than 3 mm widening, partial rupture of the deep deltoid was observed in 2 cases and anterior third of superficial deltoid was torn in 1 case. We suggest that we cannot clearly assess the stability of isolated lateral malleolar fracture either by fracture patterns or clinical findings, so stress test can be considered in determining the stability.

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Radiologic Evaluation of the Ankle Joint: Comparison of Different criteria & its A vailability of Clinical Practice: Deuk Soo Hwang, Seung Ho Yune, Kwang Jin Rhee, June Kyu Lee, Je Taek Jeong; J Korean Soc Fract 1998;11(4):880-885. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.880

Abstract PDF: Generally it is Known that the best clinical results in treatment of injuries of the ankle are obtained by anatomical restoration of the joint. For objective measurements of tibiotalar joint, some investigators ued different criteria and defined the specific reference points under variable angle of internally rotated anteroposterior projection. But, occasionally we didn't acquire the accurate roentgenographic finding that was suggested by investigators. So, we check the variable angle of internal rotation film in addition to angle suggested by investigators and compare the criteria between them. The purpose of this study is to evaluate availability of internally rotated mortise view and its criteria in clinical practice. Following results was acquired. First, there was no significant difference in measuring the medical clear space on depand on variability of rotation angle. Second, the overlapping distance of tibiofibular syndesmosis decreased by increasing internal rotation angle, but was not under 1mm (ie, index of injury). A third, to measure the Weber's 3 criteria, we need to check the variable internal rotation angle, if necessary. Finally, we acquired the normal range of measurement about Tile's 2 criteria by variable internal rotation angle.

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Arthroscopically assisted technique on ankle Fx: Beom Goo Lee, Hong Kee Park, Jae Jin Oh; J Korean Soc Fract 1998;11(4):886-893. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.886

Abstract PDF: In literatures, osteochondral fragment could be founded in 68% of acute displaced ankle fractures that could not be founded on plain X-ray. And skin necrosis following open reducion and internal fixation of ankle fractures are reported to be 3% that could result in serious problem. Above 2 problems could be handled with arthroscopic assisted fixation. We did arthroscopically assisted internal fixation on 6 cases of acute displaced ankle fractures. The results were as follows ; 1. No patients suffered from soft tissue problem. 2. Osteochondral fragment were founded in 3 cases and was debrided 3. According to Evanski and Waugh, mean functional score was 42 points, pain score was 36 points and R.O.M score was 7 points respectively. The results were excellent in all cases. 4. In roentgenographic study, nearly anatomic reduction was noted in all medial malleus fractures. In conclusion, better evaluation and management of osteochondral fragment, shorter hospitalization and quicker recovery were advantages of the arthroscopically assisted treatment of ankle fractures.

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Operative treatment of displaced intraarticular fractures of the calcaneus: Ki Soo Kim, Yong Soo Choi, seung Chae Han, Kwang Soo Shon; J Korean Soc Fract 1998;11(4):894-899. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.894

Abstract PDF

As technology in imaging has improved, we have learned more of the anatomical features of these fractures, and onw several objective studies in the literature with sufficient follow up recommend surgical treatment for some displaced intraarticular fractures of the calcaneu. The purpose of this study is to report the results of the open reduction with rigid internal fixation for displaced intraarticular fractures of the calcaneus. from March 1994 to December 1996, the author managed twenty-nine displaced intraarticular fractures of the calcaneus in twenty-three patients with open reduction via extended lateral approach and internal fixation using the plate. The fractures were classified according to Essex-Lopresti with the lateral radiograph and according to Sanders with the computed tomograph. Clinical results were assessed the pain, activity, return to work, range of motion, change in shoe size and swelling from creighton-Nebraska health foundation assessment. Among the 29 cases, satisfactory results were obtained in 24 cases(82.9%). We assessed the radioolgic objective parameters such as Bohler angle, crucial angle, height and width of the calcaneus, and the arthritis of the subtalar joint. Radiologically, we showed satisfactory restoration of the calcaneal morphology and severe subtalar arthritis in 4 cases. We found the negative correation between the clinical results and the radiological subtalar arthritis(P=0.038). In managing displaced intraarticular fractures of the calcaneus, open reduction via extended lateral approach and rigid internal fixation seemed to be useful method.

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Correlation Analysis of Reduction for Intra-Articular Calcaneal Fracture and Clinical Outcomes Using Postoperative Computed Tomography
Joon-Sang Eom, Young-Deuk Joo, Seong-Jun Kim, Min-Ho Shin, Dong-Oh Lee, Hong-Geun Jung
Journal of Korean Foot and Ankle Society.2014; 18(4): 165. CrossRef

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Pitfalls in Treatment of Lateral Malleolar Frcture with Plate and Screws: Jong Min Sohn, Ju Hae Jahng, Nan Kyung Ha, Dae Hyun Baek, Hyoung Gwan Kim, Bong Heon Hyun; J Korean Soc Fract 1998;11(4):900-905. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.900

Abstract PDF

The goal in treatment of ankle fracture is the restoration of normal ankle function. Although controversy still exists over the best method of treatment, recent ariticles emphasize importance of the anatomic reduction of fibula and the benefits of early mobilization when adequate fixation is accomplished. When we fix fracture of lateral alleolus with plte and screws, the distal screws should engage the medial cortex of the fibula but not protrude into the talofibular joint. Because the penetration of screws into ankle joint may be the cause of postoperative pain and opst-traumatic arthritis. This article has reviewed a series of 36 ankle fractures, treated from March 1993 to January 1997, using plate and screws. In order to analyse the influence of the penetration of screws into the ankle joint, all fractures were classified according to the penetrating length of screw from medial cortex of lateral malleolus. Thse with the end of the screw protnided more than 2mm into joint were clssified group I, those with less than 2mm groupp II, those with no engagement group III. The results obtained from this study were as follows: 1. According to clinical and radiolgraphic assessment of the results of the treatment, open reduction and internal fixation using plate and screws in treatment of lateral malleous was a satisfactory method. The excellent or good results were achieved in 28 patients among the 36 patients (77.8%). 2. Average time of bony union was not different significally among the three groups. 3. The gain of full range of motion was delayed in group I. 4. Patients of group I complained persistent pain and discomfort more frequently than the other groups. 5. In the treatment of lateral malleolar fracture, the distal screws should engage the medial cortex of fibula to gain firm fixation,but should not protrude more than 2mm into the ankle joint.

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Features of Lateral Malleolar Fractures in Elderly Patients and Clinical Outcome of Locking Compression Plate Fixation
Seok-Min Hwang, Hong-Geun Jung, Hyung-Jin Chung, Joon-Sang Eom, Dong-Oh Lee, Jung-Hyun Cho, Jong-Tae Park
Journal of the Korean Orthopaedic Association.2016; 51(1): 77. CrossRef

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Surgical Treatment for Displaced Talus Fracture-Dislocation: Kwang Soon Song, Chul Hyung Kang, Seong Ryeol Kim; J Korean Soc Fract 1998;11(4):906-911. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.906

Abstract PDF: Talus fracture is an uncommon fracture and frequently accompanied with serious complications such as avascular necrosis, nonunion and osteoarthritis. The purpose of this paper is to assess the effectiveness of open reduction and internal fixation in treatment of displaced talus fracture. Fourteen patients with severely displaced talus fracture-dislocation, classified as more severe than Hawkins type III and comminuted body fracture were evaluated. They were treated at Keimyung University Dongsan Medical Center during the period of July 1989 to August 1996. The average period for follow up was 53 months, ranging from 18 months to 8 years. All patients were treated by open reduction and internal fixation using screws except 2 cases of severe talar body fractures, which were treated by Blair fusion. according to Hawkins scoring system. the end results were excellent only in 4 cases, good in 2, fair in 5, poor in 3. Avascular necrosis developed in 3 cases and traumatic arthritis in 5 cases. In conclusion, displaced talus fracture-dislocation had a high incidence of postoperative complications(57%) in spite of early sugical treatment. It is essential to consider about possible complications and sequelae before operation is performed.

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Measurement of Angulation after Treatment of Fractures of the Tibia: Comparison of Conventional Methods and New Method Using Mechanical Axis: Chul Yong Chung, Chan Young Son, Sun Bon Koo, Sang Eun Kim; J Korean Soc Fract 1998;11(4):912-917. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.912

Abstract PDF: The importance of residual angular deformity after tibial fracture is still uncertain. but it is generally assumed that osteoarthritis of the ankle and the knee will result when the deformity is severe. Therefore accurate measurement of the alignment of the tibia is important clinically and in research. We compared the results of conventional methods (method 1,2) of measuring the angulation deformity after a fracture of the shaft of the tibia, with a new method using mechanical axis reported by Milner11) (method 3). Sixty-seven patients of tibial fractures with angulation deformity treated at sei Gang General Hospital from January 1995 to December 1996 were evaluated. Samples of 20 sets of standard AP and lateral radiographs of both tibia were measured. The results obtained were as follows. 1. The difference between the angles obtained by Milner's new method (method 3) and conventional methods (method 1,2) was significant in all planes. 2. Both the mean intra-& interobserver difference were minimal in new method, compared with conventional methods, t all planes. 3. There is no statistically significant difference using by paired T-test between angles obtained by new method and conventional methods (p>0.05). From these results, an angulation of measuring the new method was accurate and has good inter- and intraoesrver reliability.

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ankle and Tibitalocalcaneal Arthrodesis using Lateral Malleolus as Bone Graft: Yung Khee Chung, Jung Han Uoo, Yong Wook Park, Kang Il Lee; J Korean Soc Fract 1998;11(4):918-923. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.918

Abstract PDF: A variety of surgical approaches and bone grafting techniques for ankle and tibiotalocalcaneal arthrodesis have been described. Wed used transfibular approach and lateral malleolus was used for bone graft. This permitted excellent visualization of the ankle and subtalar joint so that the fusion can readily be achieved under th direct visualization. And also we didn't need to prepare the additional bone graft from another site. Ten ankle fusions and two tibiotalocalcaneal fusions were carried out and reviewed. The average age of the patients was 43 years(range, 27 - 58 years). The average follow-up was 27.8 months(range, 24 - 34 months). We evaluated the clinical and radiological results, and complications. All cases were satisfied and fused. But we experienced one minor complication that was posteroplantar heel pain caused by prominence of cannulated screw head. So, we suggest that this procedure has benefit for ankle or tibiotalocalcaneal fusion.

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Treatment of the Posterior Malleolar Fracture: Hwa Jae Jeong, Kyung Chul Kim, Seoung Woo Chung; J Korean Soc Fract 1998;11(4):924-931. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.924

Abstract PDF

Posterior malleolar fractures are usually caused by an abduction or external rotation injury. indications for open reduction of the posterior malleolar fracture depend on its size and the amount of displacement. If the fragment of the posterior malleolus involves more than 25% to 30% of the articular surface, it should be treated by anatomical reduction and internal fixation. Authors analysed twenty-three patients of ankle fractures with the posterior malleolar fractures who were treated in Kangbuk Samsung Hospital between March 1993 and March 1997. Thirteen patients whose posterior malleolar fracture involved less than 30% of articular surface were treated conservatively (Group 1), while ten patients with involvement of more than 30% of articular surface were treated by open reduction and internal fixation. Among the ten patients treateed by open reduction, the five patients were indirectly fixed through anterior approach (Group 2), another five patients were directly fixed through posterior approach (Group 3). In group 1, the patients whose opsterior malleolus involved more than 25% of articular surface have unsatisfactory results compared to patients whose posterior malleolus involved less than 25% of articular surface(P<0.04). The results of the treatment were better in those directly fixed through posterior appproach than in those indirectly fixed through anterior approach regardless of size of the fragment(P<0.05).

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Treatment of the Trimalleolar Fracture Using Posterolateral Approach: Minimum 2-year Follow Up Results
Gwang Chul Lee, Jun-Young Lee, Sang-Ho Ha, Jae-Won You, Sang-Hong Lee, Hong-Moon Sohn, Ki-Young Nam, Kwang-Hyo Seo
Journal of the Korean Fracture Society.2011; 24(4): 328. CrossRef
The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique
Jae-Sung Lee, Han-Jun Lee, Jae-Hyun Yoo, Hee-Chun Kim
Journal of the Korean Fracture Society.2009; 22(1): 19. CrossRef
Treatment of the Posterior Malleolar Fragment of Trimalleolar Fracture Using Posterolateral Approach - Preliminary Report -
Jun-Young Lee, Sang-Ho Ha, Kyung-Hwan Noh, Sang-Jun Lee
The Journal of the Korean Orthopaedic Association.2009; 44(4): 422. CrossRef
Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle
Jae Sung Lee, Soo Yong Kang, Han Jun Lee, Young Bong Ko
Journal of the Korean Fracture Society.2009; 22(2): 98. CrossRef

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Sbuchondral Curettage & Bone Peg Fixation in Osteochondral Fracture of The Talus: Myung Chul Yoo, Yoon Je Cho, Hyun Sub Kwon, Jae Young Park; J Korean Soc Fract 1998;11(4):932-940. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.932

Abstract PDF: Osteochondral fracture is an attached fragment of subchondral bone become partially or completely separated from the underlying bone. Accurate diagnosis of osteochondral fracture of the talus,mainly caused by trauma, is difficult because osteochondral lesion is not detected easily on the roentgenographic examination. Osteochondal fracture is intraarticular fracture, thus operative approach and fixation is technically difficult and requires talus, with subchondral bone curettage through percutaneous extraarticular transtalar approact under the C-arm guide without arthrotomy in three cases of minimally detached or elevated osteochondral fragment. And two cases of partially detached osteochondral fragment treated by bone peg fixation with arthrotomy. We obtained good functional results at the follow-up of a mean of 1 year and 5 months. We believe that the subchondral curettage and bone peg fixation are excellent treatment methods for osteochondral fracture of the talus.

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