Journal of Musculoskeletal Trauma

Stress fractures in calcaneus and juxtatectal region of the acetabulum : case report: Soon Man Hong, Hong Tae Kim, Young Soo Byun, Sang Chul Shin, Kyoung Hoon Hyun, Soo Yeol Jeon; J Korean Soc Fract 1999;12(4):749-753. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.749

Abstract PDF: We have experienced a fatigue fracture occurred in the calcaneus of 49-year-old man and an insufficiency fracture occurred in the juxtatectal region of acetabulum in 70 -year-old woman. Both cases healed successively after rest. We suggest these fractures must be considered in differential diagnosis.

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Results of Treatment for Acetabular Fracture involving Posterior Wall: Choong Hee Won, Yong Min Kim, Kyoung Jin Park, Kyoung Il Jeong, Sin No Lee; J Korean Soc Fract 1999;12(4):754-760. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.754

The purpose of this study is to analyze the results of treatment of posterior wall fracture of acetabulum, which were treated at our hospital from September 1994 to December 1996. Among 24 posterior wall fractures, 15 cases were confirmed as isolated posterior wall fractures and nine fractures were associated with other acetabular fracture(4 transverse fracture, 3 both column fracture, and 2 posterior column fracture). Clinical follow-up was performed for a minimum of 2 years. The posterior wall fracture was classified according to fracture size(type 1<25%, type 2: 25-50%, type 3: 50-75%, type 4: >75%) and comminution (A: without comminution, B: with comminution, C: impacted) on standard roentgenogram and CT scan. Fourteen among 24 posterior wall fractures were followed for a minimum of 2 years, and the mean Harrif hip score was 91.2. Dislocation of hip occurred in 12 hips(50%). There was no definite difference of Harris hip score in regard to fracture size and comminution of posterior wall. Fractures with posterior hip dislocation had poor result compared with fractures without posterior hip dislocation. Anatomical reduction showed better clinical result than imperfect and poor reductions.

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Surgical Treatment of Posterior Wall Fractures of the Acetabulum
Young-Soo Byun, Se-Ang Chang, Young-Ho Cho, Dae-Hee Hwang, Sung-Rak Lee, Sang-Hee Kim
Journal of the Korean Fracture Society.2007; 20(2): 123. CrossRef

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Fixation of Complex Acetabular Fractures Using Cerclage Cable Grip System(DALL-MILES): Poong Taek Kim, Joo Chul Ihn, Gun Wook Park, Yung Ook Choi, Chan Sig Park; J Korean Soc Fract 1999;12(4):761-766. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.761

Abstract PDF: From 1996, in the 13 fractures of the acetabulum surgically treated in Kyung Pook National Hospital and Sae-Myung Orthopedics, cerclage grip system(DALL-MILES) have been used as reduction and fixation tool. Cerclage cable inferted through the greater sciatic notch to a point just cephalad to the anterior inferior spine was greatly helpful for both reduction and internal fixation of thirteen complex acetabular fractures. This technique is especially useful when the fracture line extend into the greater sciatic notch. This is true of high posterior column fractures that extend up into the upper part of the notch, transverse fractures that have an anterior or posterior limb that is high, and both column fractures through ilioinguinal approach with T- extension. Reduction was achieved to within 3mm in 11 cases and 6mm in 2 cases. This reduction was maintained until nuion. The technique may contribute to fracture stabilization, but supplementary fixation was added in 12 patients with curved reconstruction plate over pelvic brim and posterior column in 1 patient.

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The Treatment of the Hip fracture in the Dementia Patients: Ui Seoung Yoon, Keun Woo Kim, Yong Hoon Kim, Hak Jin Min, Kook Hyoung Cho, Sang Lim Kim, Hyong Tack Choi; J Korean Soc Fract 1999;12(4):767-772. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.767

Abstract PDF

PURPOSE
: The goal of treatment in elderly patients with hip fractures is restoration of function to preoperative ambulatory statuf as early as possible. The dementia patients who live in the asylum for the old need longer rehabilitation program for restoration of function, especially walking ability. The authors compare the modalities of the treatment for the hip fracture in the view point of walking ability.
MATERIALS and METHODS
: The twenty-eight dementia patients were operated due to hip fracture. Femur neck fractures were 7 cases, and femur intertrochanteric fractures were 21 cases. The authors analyze these patient on the recovery of walking ability. One patient who died immediately after operation was excluded in thil study. The patients were divided into two groups. Of 27 patients, 13 patients were treated with osteosynthesis(Group I), and remaining 14 patients were treated with hemidrthroplasy(Group II).
RESULTS
Fixation loss was treated with hemiarthroplasty in two case of osteosynthesis. The dislocation was treated with open reduction in one cafe of hemiarthioplasty. In the group I, the walking abilities were significantly different between the preoperative(3.85) and the postoperative at 2 weeks(2.46), at 2 months(2.73) and at the final follow-up(2.55)(P<0.05). In the group II, the walking abilities were not significantly different between the preoperative (2.57) and the postoperative at 2 weeks(2.14), at 2 months(2.36) and at the final follow- up(2.29)(P>0.05).
CONCLUSION
: Although there is no difference between two groups in final walking ability, The group treated with endoprosthesis showed earlier recovery of safting ability.

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CORR Insights®: What Are the Risk Factors for Dislocation of Hip Bipolar Hemiarthroplasty Through the Anterolateral Approach? A Nested Case-control Study
Eckart Mayr
Clinical Orthopaedics & Related Research.2016; 474(12): 2630. CrossRef
Risk Factors Associated with Dislocation after Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture
Yeesuk Kim, Joon-Kuk Kim, Il-Han Joo, Kyu-Tae Hwang, Young-Ho Kim
Hip & Pelvis.2016; 28(2): 104. CrossRef

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Cemented Hemiarthroplasty in Femoral Neck Fractures over 70 Years : A Matched-Pair Analysis of unipolar and Bipolar Hemiarthroplasty: Kang Sup Yoon, Seung Baik Kang, Ji Ho Lee, Jin Soo Tark, Hyeok Rhyou; J Korean Soc Fract 1999;12(4):773-779. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.773

Abstract PDF

PURPOSE
: The goal of treatment in elderly patients with hip fractures is restoration of function We analysed the clinical efficacy of the cemented unipolar hemiarthroplasty and bipolar hemiarthroplalty for the treatment of femoral neck fractures in elderly patients over 70 years. Twenty-four pairs of patients who had a cemented hemiarthroplasty were studied with a retrospective and matched-pair analysis. Half of the patients had received a cemented bipolar hemiarthroplasty and the other half, a cemented unipolar hemiarthroplasty The patients were matched for age, sex, femoral head size, physical status and the ability to walk. At one year follow-up, the frequency of the pain and the limp were 41.7% and 54.2%, respectively, in the unipolar group and 45.8% and 45.8%, respertively, in the bipolar group. The ability to live independently was 66.7% in the unipolar group and 79.2% in the bipolar group. None of these differences were statistically significant. The frequency of the return to the level of function before injury was 37.5% in unipolar group and 45.8% in the bipolar group, which was also not significantly different. Flexion of the hip joint was 96.7+/-6.9 in unipolar group and 101.5+/-7.3 in the bipolar group(p=0.02). Abduction and rotational motion was not significantly different in two groups. There were no revisions in either group. Cemented bipolar hemiarthroplasty did not show better clinical results than cemented unipolar group.

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Bipolar Hemiarthroplasty for the Femoral Neck Fractures in Elderly Patients
Woong-Kyo Jeong, Sang-Won Park, Soon-Hyuck Lee, Jong-Hoon Park, Suk-Ha Lee, Ji-Hoon Kang, Gi-Won Choi, Won Noh
Journal of the Korean Fracture Society.2008; 21(1): 8. CrossRef

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Treatment of femur neck fracture : Attributing factor of postoperative collapse & avascular necrosis: Do Hyun Moon, Kee Chul Ko; J Korean Soc Fract 1999;12(4):780-785. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.780

Abstract PDF

We have experienced some difficulties in anatomical reduction and osteosynthesis of femoral neck fracture due to its specific anatomical structuret. The purpose of this study are to analyse attribilting factors of postoperative collapse and aseptic necrosis in femoral neck fractures. We studied 62 cases of femoral neck fracture treated with the internal fixation from February 1995 to August 1997 at Gil General Hospital. Average follow up period was 1.6years. We analyzed age, sex, operation interval, Garden stage, Pauwel angle, Singh index, fracture site and the fixation method. The results obtained were as follows : Increased incidence of collapse and aseptic necrosis was noted with higher Garden stage(Garden stage 4), wider Pauwel angle(over type 2), under 40 year or over 60 year old age, woman and larger operative interval.

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Hidden osteonecrosis of the femoral head after healed femoral neck fractures: magnetic resonance imaging study of 58 consecutive patients
Chul-Ho Kim, Minkyu Shin, Dongkeun Lee, Se Jin Choi, Dou Hyun Moon
Archives of Orthopaedic and Trauma Surgery.2022; 142(7): 1443. CrossRef

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Use of Gamma Nail in Peritrochanteric Fractures of the femur : A comparative study of Asian-Pacific type with Standard-European type: Koing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Chang Hyuk Choi, Dong Kyu Shin, Young Joon Youn; J Korean Soc Fract 1999;12(4):786-791. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.786

Abstract PDF: PURPOSE
: The mismatch of the Standard Gammd nail(SU) in oriental people led to the modification of the delign of its femoral shaft component and use of the Asian-Pacific type(AP). We compared the clinical results of 2 groups of femoral peritrochanteric fractures treated with each type of Gamma nail.
MATERIALS and METHODS
: 65 cases of peritrochanteric fractures of the femur(AP 24 cases, SU 42 cases) were studied with regard to operation time, union time and complications. The cases in each group were similar in fracture pattern, degree of osteoporosis and time interval between trauma and operation.
RESULTS
There were no significant differencef between two groups in operation time, intraoperative blood loss, and union time. Lateral cortical fracture and nail breakage were not observed in AP group but lag screw cutout was more frequent in AP group(8%) than in SU group(2%), but other complications were similar in type and frequency between two groups.
CONCLUSION
: AP Camma nail showed somewhat improved matching with the configuration of Korean femora, but further modification of the design might be needed to solve remained problems such as nail protrusion above trochanter.

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Comparison between results of treatment of the Femoral Neck and Intertrochanteric Fractures : Focused on Mortality rate and Complications: Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Tae Hoon Kim, Han Chul Kim, Yong Soon Kim; J Korean Soc Fract 1999;12(4):792-802. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.792

Abstract PDF

The incidence of femoral neck and intertrochanteric fractures has steadily increased with lengthening of the life span. It is well known that anatomical characteristics of femoral neck may evoke complications such as nonunion and avascular necrosis. And there are many problems in the treatment of femoral intertrochanteric fractures due to osteoporosis, unstable pattern of fracture and poor general condition in elderly patients. The author analyzed 56 cases(56 patients) of femoral neck fractures and 63 cases(61 patients) of femoral intertrochanteric fractures which we have been able to follow up more than 1 year from March 1991 to March 1997. The purpose of this study is 1) to analyze results of treatment, predisposing factors, complications and mortality rates, and so 2) to reduce the mortality rate and complication in these fractures. The results were as follows , 1. The difference in union time between both type of fractures was not significant. 2. The mortality rate during admission was 1.8% in femoral neck fractures and 6.3% in intertrochanteric fractures. 3. The mortality rate during 1 years was 3.6% in femoral neck fractures and 9.5% in femoral intertrochanteric fractures. 4. The predisposing factors associated with postoperative mortality rate were malnutrition. chronic obstructive pulmonary disease, previous contralateral hip fracture, and operation within 3 days.

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Anesthetic considerations for surgical treatment of geriatric hip fracture
Dong Kyu Lee, Seunguk Bang, Sangseok Lee
Anesthesia and Pain Medicine.2019; 14(1): 8. CrossRef
A Comparison of Clinical Results between Compression Hip Screw and Proximal Femoral Nail as the Treatment of AO/OTA 31-A2.2 Intertrochanteric Femoral Fractures
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, In Hwa Back, Kyeong Soo Eom
Journal of the Korean Orthopaedic Association.2016; 51(6): 493. CrossRef
Postoperative Mortality and the Associated Factors in Elderly Patients with Hip Fracture
You-Sung Suh, Yong-Beom Kim, Hyung-Suk Choi, Hong-Kee Yoon, Gi-Won Seo, Byung-Ill Lee
Journal of the Korean Orthopaedic Association.2012; 47(6): 445. CrossRef
One-Year Mortality Rate of Patients over 65 Years Old with a Hip Fracture
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Young Hwa Choi
Hip & Pelvis.2011; 23(2): 137. CrossRef

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The Results of Surgical Treatment of Intertrochanteric Fractures in the Elderly Patients Aged over 65 years : Comparative Study between Compression Hip Screw and Ender Nail Fixationt: Byeong Yeon Seong, Chang Min Lee, Dong Sung Park; J Korean Soc Fract 1999;12(4):802-811. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.802

Abstract PDF: OBJECTIVES
: To analyse the comparative results of surgical treatment with compressive hip screw or Ender nail for intertrochanteric fracture in aged over 65 years. MATERIALS & METHODS : From June 1990 to December 1997, 39 of 55 patients who were operated with compression hip screw or Ender nailing and followed up for more than 1 year. A retrospective survey was completed for 39 intertrochanteric fractures which were operated with compressive hip screw(22 patients, Group 1) or Ender nail(17 patients, Group 2). There was an average follow up of 48 months, with a range of 12 to 84 months. Radiographic measurements were performed in aspects of osteoporosis and fracture classification. Clinical evaluation of follow up was measured as Clawsons evaluation according to the fracture claffification and types of fixation. 23 of 39 cases(59%) were unstable and 26 of 39 cases(66.6%) showed below grade III in osteoporosis. Age, cause of fracture, fracture classification, accompanying diseases and Singhs index were identical to both group.
RESULTS
The mean radiologic bone union period was 16.4 weeks. The rate of complication was 7 cases(31.8%) in group I and 8 cases(47.0%) in group II. The rate of mortality was 3 cases(13.6%) in group I and 3 cases(17.6%) in group II. Satisfactory rate was 20 of 22cases(90.9%) in group I and 14 of 17 cases(82.3%) in group II.
CONCLUSION
: We suppose that compressive hip screw fixation for the elderly over 65 years who had intertrochanteric fracture and medical problem, produced good results as comparing to Ender nail fixation. The clinical satisfactory rate were superior in the compressive hip screw group comparing to Ender nail group. Cement fixation for eldly could help to fixate more in compression hip screw.

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Analysis of cause of collapse and Non-union After Internal Fixation of Intertrochanteric Fracture: Seung Woo Suh, Chang Ryong Hur, Jung Ho Park, Jun Seok Hong, Woo Nam Moon; J Korean Soc Fract 1999;12(4):812-817. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.812

Abstract PDF: Sixty-five Intertrochanteric hip fractures were analyzed radiologically to study the factors affecting postoperati ye stability. Fractures were evaluated by measuring shortening and angulation, collapse of telescoping device when utilized, and migration of the fixation device within the femoral head. Fractures were classified according to their stability preoperatively and the reduction of lessor trochanteric fracture fragment postoperatively. The failure rate and postoperative stability were then compared on terms of severity of osteoporosis, type of fracture, existence of reduction of lestor trochanter fragment.
Results
indicated that the severity of osteoporosis was not related to the group of fracture, which determines stability of fracture. Regarding the rate of bone union, anatomically reduced groups showed similar rates of bone union(73.8% in average) and degree of sliding of lag screw (4.13mm in average) regardless of fixation of lesser trochanter fragment. On the other hand, malreduced group which failed to obtain anatomical reduction had 26.1% of bone union rates and 10.95mm of sliding of lag screw representing importance of anatomical reduction rather than fixation of lesser trochanteric fracture. In conclusion, there was no correlationthip between severity of oLteoporosis and type of fracture. And it is suggested that unstabae intertrochanteric fractures accompanied by large lesser trochanteric fracture fragment can be provided stability avoiding major complications such as loosening of implant or collapse of fracture fragment if it is fixed with anatomical reduction of fracture even without the fixation of lesser trochanteric fragment.

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The Operative Treatment of Subtrochanteric Fractures of the Femur: Sang Won Park, Young Soo Byun, Dang Jae Lim; J Korean Soc Fract 1999;12(4):818-823. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.818

Abstract PDF: PURPOSE
: The authort have investigated the subtrochanteric fractures, which were treated operatively using variable internal fixation devices to determine the clinical results according to the fracture types and internal fixation devices.
MATERIALS and METHODS
: We have reported 18 cases of subtrochanteric fractures, which were treated operatively using variable internal fixation devices from October, 1992 to December, 1997. fourteen cases were male and 4 cases were female. Eight cases were type I, 5 cases were type II and 5 cases were type III by Fieldings classification. Of fixation devices, 13 cases were DHS, and 5 cases were interlocking intramedullary nail. The mean duration of follow up was 1 year and 6 months.
RESULTS
The mean duration of bony union was 20.3 weeks, and there was no significant difference between fracture types or between internal fixation devices. Of the 18 cases, 4 complications(22%) were occured ; delayed union(1 case), nonunion(1 case), and varus deformity(2 cases).
CONCLUSION
: The internal fixation devices should be chosen adequately according to the fracture type in subtrochanteric fracture of the femur. Also, additional bone graft was necessary for posteromedial cortical defect to decrease complications, in cases of nail-plate devices especially.

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Treatment of the Femoral Shaft Fractures Using Reamed Russell-Taylor Intramedullary Nail: Shin Yoon Kim, Jun Dae Kwun, Hak Su Kim, Byung Gook Kim, Chang Wug Oh, Byung Chul Park, Joo Chul Ihn; J Korean Soc Fract 1999;12(4):824-832. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.824

Abstract PDF: The purpose of this paper was to evaluate the results of the femoral shaft fractures by reamed Russell-Taylor intramedullary nailing in the viewpoint of union time and complications. We reviewed 59 femoral shaft fractures. According to the type of fractures(Winquist-Hansen classification), average union time were 20.1 and 23.5 weeks in type 1, 2 and 3, 4, and nonunion rates were 12.5% and 10.5% in type 1, 2 and 3, 4. According to the level of fractures, average union time were 19.9, 20.3, 23.4 weeks in proximal, middle and distal fractures, and nonunion rates were 6.7%, 8.8%, 30% in proximal, middle and distal fractures. According to the reduction techniques, average union time were 20.0 and 21.5 weeks in closed and open reduction, and nonunion rates were 5.9% and 20.O% in closed and open reduction. According to the Methods of interlocking screw fixation, average union time were 19.3 and 20.7 weeks in dynamic and static fixation, and nonunion rates were 25% and 9.8% in dynamic and static fixation. There was no significant differences in averdge union time between closed and open fracture group, closed and open reduction group, and dynamic and static fixation group. There was significant differences in union time between simple and complex, comminuted fractures(P<0.05), and between distal and proximal, middle fractures(P<0.05). Also there was significant differences in nonunion rate between fracture reduced with closed and open technique(P<0.05). In conclusion, reamed Rustell-Taylor intramedullary nailing can be a uheful treatment modality in femoral shaft fracture if closed reduction is available. However, there was high complication rate including failure of screw, varut deformity, delayed union time in distal femoral shaft fractures. In this situation, we should consider other treatment method.

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Treatment of rotational malalignment after interlocking intramedullary nailing of femur : Report of a case: Suk Kyu Choo, Byung Jik Kim, Byung Hee Min; J Korean Soc Fract 1999;12(4):833-836. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.833

Abstract PDF: Rotational malalignment after IM nail of femur is a common problem and if the deformity is great, may cause pain, limitation of motion, even require corrective osteotolny later. The rotational malalignment of femur is not easy to find out during operation because prominant landmarks is lack. We experienced 25 years old male patient with 45 of internal malalignment of femur after IM nail at other hospital. The patient was treated by corrective osteotomy at the fracture site and exchange nailing, but we confronted the obstacle that was remained rotatonal unstability after slotted nailing, and we have to use additional plate fixation. This problem can be prevented by using rigid unslotted nail.

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Fractures of the Femur associated with the Hip Arthroplasty: Sung Kwan Hwang, Young Sang Lee, Jin Soo Park; J Korean Soc Fract 1999;12(4):837-843. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.837

Abstract PDF: Periprosthetic fractures as a complication of hip arthroplasty are uncommon. However, the incidence has been increafed recently especially in cementless or press-fit arthroplasties. The need to achieve a tight fit of the prosthesis in the bone when using cementless component has led to increased risk of periprosthetic fractures. We have experienced periprosthetic fractures occurred in 52 cases(51 patients) among 814 hip arthroplastic from January 1990 to December 1997. Among the 52 cases of periprosthetic fractures, 5 cases were occurred in cemented femoral stem(5 cases among the total 236 cases of cemented femoral stem : 2.1%), and 47 cases were occurred in the cementless type of femoral stem(47 cases among the total 578 cases of cementless type of femoral stem : 8.1%). There were 43 cases of intraoperative fracture and the rest was occurred postoperatively. According to the Johannson classification, type I fractures were 28 cases, type II fractures were 20 cases, and type III fractures were 4 cases. In postoperative periprosthetic fractures, according to the Vancouver classification, type A fracture was 1 case, typeB 1 fractures were 4 cases, typeB2 fractures were 2 cases, and type C fractures were 2 cases. The accurate preoperative templating and prophylactic managemnet of the risk factors are important for reducing the incidence of periprosthetic fractures.

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Treatment of Nonunion in Femoral Supracondylar and Intercondylar Fracture: Duk Yong Lee, Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suk Ha Lee, Dong Ki Lee, Yeon Sik Yu, Eun No Lee, Yoon Yeup Kim; J Korean Soc Fract 1999;12(4):844-850. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.844

Abstract PDF: The femoral supracondylar and intercondylar fractures are difficult to be treated due to severe soft tissue damage, comminution, intraarticular extension of fracture and injury to the quadriceps mechanism frequently. The causes of nonunion are inadequate anatomical reduction, fixation failure, bone defect and infection occasionally, which is difficult to be treated. The authors analyzed 16 cases with nonunion of femoral supracondylar and intercondylar fracture who had been treated surgicdlly from January 1990 to December 1991 According to AO/ASIF classification in the initial fracture patterns, type A were 8 cases, type B was 1 case and type C were 7 cases. The duration between initial treatment and surgical treatment of nonunion was 6 months in average. The causes of nonunion were fixation failure due to inadequate device selection in 9 cases, inadequate anatomical reduction or surgical technique in 4 cases and infection in 3 cases. The treatmentt were internal fixation with Dynamic condylar screw(DCS) in 9 cases, internal fixation with condylar blade plate in 4 cases, monofocal lenghtening with Ilizarov in 1 case and bifocal lenghtening with Ilizarov in 2 cases. According to Schatzker classification, the good result was obtained in 11 cases(68.8%). The complications were 3 knee joint ankyloses, 2 superficial wound infections, 1 delayed union and 1 deep vein thrombosis. In conclusion, the requirement for the good result in treatment of nonunion are exact anatomical reduction, rigid fixation and autogenous bone graft.

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Treatment of Infected Nonunion of the Femur: Jung Ryul Kim, Byung Yun Hwang; J Korean Soc Fract 1999;12(4):851-857. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.851

Abstract PDF: The pupose of this study was to analyze influences on the bony union, to evaluate results and to consider effective methods of the treatment of infected nonunited fracture of the femur Seventeen patients who had infected nonunited fracture of the femur were managed from January 1989 to January 1996. We reviewed the results according to the method of treatment. Fixation were judged to be unstable in all of patients who had undergone primary internal fixation so that we treated them with radical debridement of soft tissue and necrotic bone. The bacterial cultures usually revealed a mixed infection and the organisms cultured from the infected fracture site were, in order of frequency , Staphylococcus aureus, Escherichia coli, Streptococcus, Pseudomonas, and Enterococcus. At the time of final evaluation, functional results according to criteria of Sanders-Swiontkowski-Helfet were excellent in three, good in five, fair in four, and poor in five. The average motion of the knee joint ranged from 6.7(0-20) of extension to 75.5(50-130) of flexion. The five patients had shortening of affected limb (mean 1.8+/-.2cm). Effective treatment of the infected non-union should be achieved not only bony union but also bacteriological and clinical remission of infection with subsequent closure of the wound and physical rehabilitation of the patient. Rigid internal fixation at the site of non-union can provide fracture healing as well as eradicate infection by improving the biologic environment.

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Operative Treatment of patellar Fractures: Chang Kwan Kim, Jeong Hwan Kim, Sang Yup Lee, Young Hwan Kim, Chae Ik Chung, Jeong Gee Hong; J Korean Soc Fract 1999;12(4):858-864. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.858

Abstract PDF: We studied 45 patients of patella fracture who were treated by surgical method from March 1990 to December 1991. The results were analysed to evaluate the functional results of the knee according to methods of fixation and severity of comminution. The results were as follows. 1. Out of 45 cases, 11 cases were tredted by tension band wiring, 19 cases by modified tension band wiring, 5 cases by tension band wiring by circumferential wiring, 8 cases by circumferential wiring, and 2 cases by screw fixation. 2. The mean fracture healing period was 6.9 weeks in cases of tension band wiring, 6.5 weeks in cases of modified tension band wiring, 5.2 weeks in cases of tension band wiring with circumferential wiring, and 7.3 weeks in cases of circumferential wiring. 3. The most favorable result was obtained in cases which were fixed with tension band wiring and circumferential wiring. 4. Modified tension band wiring seems to be a good method for displaced transverse fracture and comminuted fracture with large fragments and tension band wiring with circumferential wiring is for severely comminuted fracture with small fragments.

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Arterial Injuries associated with Fractures or Dislocations around the Knee: Chang Wug Oh, Joo Chul Ihn, Byung Chul Park, Il Hyung Park, Shin Yoon Kim, Hee Soo Kim; J Korean Soc Fract 1999;12(4):865-871. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.865

Abstract PDF: The purpose of this article is to delineate factors important in successful management and subsequent extremity function of the patient with arterial injury associated with fractures or dislocations around the knee. We reviewed 25 cases of arterial injury associated with fractures or dislocations around the knee which were treated at our hospital between 1994 and 1998. As long term results, the salvage rate of the lower limb was related to the extent of the soft tissue damage and the severity of infection, but there was no statistical difference according to the method of vascular surgery(p=0.645). Compared with the salvage rate of the lower limb according to the length of time from injury to vascular reanastomosis, there was no statistical difference between two groups of the patients who were operated within 12 hours and were operated during the time between 12 hours and 24 hours(p=0.084). In view of whether open or closed fractures were combined, 1 I cases(58%) among 19 cases of open fractures and 5 cases(83%) among S cases of close(1 fractures were able to salvage the lower limb, so it could contributes to the sdlvdge rate of the limb. Finally 16 cases(64%) among total 25 cases were able to salvage the lower limb, and its functional outcome was like followings : excellent results were found in 6 cases, fair results in 8 cases, poor results in 2 cases, and amputation in 9 cases(36%). In case of amputation, 3 cases were primarily amputated and 6 cases were amputated secondary to vascular surgery . As long term results, whether open or closed fractures were combined, the teverity of the infection and the extent of the soft tissue necrosis were the factors influencing on the falvage rate of the lower limb. Other factors, such as the difference of ischemic time within 24 hours interval, the site and the method of management of the fractures and the vascular injuries and whether fasciotomy was performed or not were not important factors influencing on the salvage rate of the lower limb.

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Treatment of patellar Fractures with Modified Tension Band Wiring: Myung Hwan Son, Byung Chul Kim, Nam Wook Kang, Tae Young Choi; J Korean Soc Fract 1999;12(4):872-878. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.872

Abstract PDF

The aim of treatment of patellar fracture is the restoration of knee joint function and quadriceps muscle power. Comminuted and displaced fracture of the patella, which are difficult to reduce accurately and to get stable internal fixation, may lead to traumatic osteoarthritis, chondromalacia, limited ROM of the knee joint. In this series, we treated 29 cases of displaced transverse and comminuted fractures with modified tension band wiring. In severely comminuted fractures, the fragments were indirectly reduced by cerclage wire and then fixed with modified tension band wiring. We could obtain stable fixation and early ROM of the knee joint. There were 5 complications including wire breakage and wire loosening. In this respect, we concluded that modified tension band wiring was a good method for displaced transverse and comminuted patellar fracture.

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Circumferential Wiring Combined with Tension Band Wiring in the Operative Treatment of Patella Fracture
Jae-Chun Sim, Sung-Sik Ha, Ki-Do Hong, Tae-Ho Kim, Min-Chul Sung
Journal of the Korean Fracture Society.2014; 27(1): 65. CrossRef

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Predictors for saving the limb after popliteal artery injury: Byoung Suck Kim, Woo Sig Kim, Byoung Hynn Min, Chang Hoon Jeon, Ye Yeon Won, Dae Woong Kim, Jae In Ahn; J Korean Soc Fract 1999;12(4):879-884. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.879

Abstract PDF: PURPOSE
: This study had been performed to evaluate the factors affecting either saving the limb or amputation after popliteal artery injury associated with fractures or dislocation around the knee.
MATERIALS and METHODS
: Twelve patients of popliteal artery injury were included. Authors had analysed nine probable factors as follows - age, sex, injury mechanisms, injury types, interval between injury and time to arrive at the hospital, interval between injury and time of operation, surgical methods for revascularization, severity of extremity injuries and fasciotomy, for discrimination between the limb-saving group and the amputation.
RESULTS
Ten patients were arrived at the hospital within 48 hours after the injury. Each patient was managed by end-to-end anastomosis in 6 cases and autogenous vein graft in 4 cases and among them, 2 cases needed additional amputation for vascular compromise. All limbs could be saved in which cases operate within 6 hours after the injury. However, the limb was lost in one of 6 cases(16.7%) between 6 and 20 hours, in one of two cases(50%) over 20 hours. One of 7 cases(14.3%) with the Mangled Extremity Severity Score(MESS) of 2 to 4 points, two of 4 cases(50%) with MESS of 5 to 6 points and one(100%) with MESS of 7 points were amputated. All 4 patients associated with fasciotomy could save their limbs, however, two of 6 patients not associated with fasciotomy lost. SUMMARY : Authors thought the most reliable predictors for saving the limbs after the popliteal artery injury might include the MESS and fasciotomy, however, ischemic time more than 6 hours might not be an absolute indication for amputation.

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Proximal Tibiosbular Fracture associated with Popliteal Artery Injury: Sang Soo Kim, Hong Jun Han, Dong Churl Kim, Dae Ho Ha, Hee Jun Yoo, Suk Kyun Park; J Korean Soc Fract 1999;12(4):885-893. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.885

Abstract PDF: Injury to the popliteal artery results in amputation more frequently than any other arterial injury. The major factor in the amputated limbs was a delay in diagnosis and therapy of the arterial injury associated with blunt trauma. The proximal tibial fractures produced the highest percentage of vascular complications and indicated immediate application of therapeutic measures. The purpose of this study is to investigate the long-term results and factors that influences the results of surgical treatment in patients with combined proximal tibial fracture and popliteal artery injury. Authors reviewed the records of 24 cases treated for this injury between January 1984 and May 1997. The age of the patients ranged from 17 to 70 years(average 45 years). Nine patients presented with life threatening injuries and classical signs of acute limb ischemia. Prolonged ischemic time ranged from 3 to 6 hours 30 minutes(average 4 hours 50 minutes). The most common cause of thoses injury was traffic accident in 16 cases. Five cases had neurologic deficit ; significant soft tissue injury was present in 14 extremities. Vascular procedures included saphenous vein interposition, end-to-end anastomosis, etc. Bony procedures were accomplished by external means in 14 cases and the others treated by immediate internal fixation in 5 cases. Intraoperative fasciotomy was performed in 5 patients with lower limb ischemia. The results suggested that limb salvage was possible in 63 percent of patients with combined proximal tibial fracture and popliteal artery injuries, but a history of life-threatening condition and severe associated injury with vascular compromise was an unfavorable prognostic factor. So a well organized multidisciplinary approach is necessary to ensure life and functional limb salvage.

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Treatment of Tibial Shaft Fracture with Butterfly Fragment using Interlocking Intramedullary Nailing: Chong Il Yoo, Jeung Tak Suh, Tae Wook Nam; J Korean Soc Fract 1999;12(4):894-900. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.894

Abstract PDF: PURPOSE
: We evaluated the result of tibial fracture with butterfly fragment treated with interlocking intramedullary nailing and union of butterfly fragment. Material and Method : The thirty tibial fractures with butterfly fragment treated with interlocking intramedullary nailing from 1994 February to 1997 January were followed up more than 12 months. They were clastified by Henleys classification based on the size of fragment and Johner and Wruhs classification cased on the comnlinution and accident mechanism. We evaluated the bone union of tibial fracture and butterfly fragment itself.
RESULTS
The time for bone union was Bl-14.5, B2-16.2, B3-18.8 weeks and Type I-15.2, Type II-17.1 Type III-18.3 weeks. In proximal and distal part of butterfly fragment, the time for bone union was 8.6 and 7.2 weeks in type I, 10.5 and 9.3 weeks in type II, and 11.8 and 10.2 weeks in type III. As the displacement of fragment were classified into 0-5, 5-10, and more than 10mm, the time for bone union was 15.3, 15.0 weeks in type I(no case in more than 10mm), 16.4, 17.5, 18.2 weeks in type II, and 17.7, 18.4, 20.3 weeks in type III.
CONCLUSION
: As the size and comminution of butterfly fragment increased, bony union was delayed. The union of spiral fracture in distal tibia was earlier than others, unrelated to the size of butterfly fragment. For the union of butterfly fragment, the distal part had earlier union than the proximal part. As the displacement of fragment was increased bone union was delayed.

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Intramedullary Nailing in Distal Tibial Fracture: Kyu Hyun Yang, Dae Yong Han, Seong Jin Park, Hwan Wook Yoo, Ki Won Yang; J Korean Soc Fract 1999;12(4):901-908. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.901

Abstract PDF: PURPOSE
: We evaluated the efficacy of intramedullary nailing in distal tibial fractures. Material and Method : Twenty-six patients with distal tibial fracture were treated with intramedullary nailing between Jan. 1996 and May 1998. Operation was done on the fracture table under skeletal traction. We evaluated the causes of trauma, type of fracture, location of fracture, time to union, malunion, nonunion, range of motion of knee and ankle, and degree of pain.
RESULTS
: There were 4 cases of open fracture and 4 cases of closed soft tissue injury at fracture site. The time to fracture union was 19 weeks on average. One case(3.8%) did not heal by 10 months and was classified as nonunion. The union rate was 96.2 % and the complication rate was 7.7%(one case of nonunion and one case of malunion). There was no infection and soft tissue disruption. The range of motion of knee was reduced in 1 case(3.8%) and 2 patients(7.7%) complained of mild pain at the knee joint. The range of motion of the ankle joint was reduced in 4 cases(15.5%), averaging 15.5 degrees in dorsiflexion and 9 cases(34.6%), averaging 21 degress in plantarflexion. Two patients complained of mild pain at the ankle joint.
CONCLUSION
: We had relatively good clinical and radiological results and concluded that closed intramedullary nailing is a safe and effective method of managing distal tibial fracture.

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A comparative study of the Brooker-Wills and Russell-Taylor Nailing for fractures of the tibial shaft: Hyung Seok Kim, Ki Do Hong, Sung Sik Ha, Young Wha Lee; J Korean Soc Fract 1999;12(4):909-915. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.909

Abstract PDF: The efficacy of intramedullary nailing in treating patients who have fractures of the tibial shaft has been well estabilished. Forty-five fractures of the shaft of the tibia(forty-five patients) were randomized to treat with interlocking nail with either the Blocker-Wills nail(nineteen fractures) or the Russell-Taylor nail(twenty-six fractures), who were treated at Department of Orthopaedic Surgery, Seoul Adventist Hospital from January, 1993 to December, 1997. Forty-five patients had acute traumatic fractures of the shaft of tibia with no other significant injuries, patients with other injuries which would intefere with functional evaluation were excluded, We analyzed the result of treatment clinically and radilogically. The results obtained were as follows ; 1. The average operating time was 114.7 minutes in Blocker-Wills nailing and 141.7 minutes in Russell-Taylor nailing. 2. The average time to fracture union healing was 16.7 weeks for Brooker-Wills nailing and 18.6 weeks for Russell-Taylor nailing. 3. The complications including delayed union and superficial infection were greater in Russell-Taylor ndiling than in Blocker-Wills nailing. 4. In functional results accourding to Klemm and Bormer were above good in 16 cases(84.2%) of Brooker-Wills group, and 22 cases(84.6%) in Russell-Taylor nailing group.

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Treatment of comminuted Tibial Fractures using Ilizarov Method: Eui Hwan Ahn, Sung Tae Lee, Hyeon Seok Kang; J Korean Soc Fract 1999;12(4):916-923. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.916

Abstract PDF: From March 1996 to March 1999, thirty two cases of comminuted tibial fractures were treated with Ilizarov external fixator. 13 cases were closed fractures and 19 cases open fractures. Among 19 open fractures, there were 3 cases of Gustilo type I, 10 cases of type II and 6 cases of type III fractures. All the cases could not be initially treated by open reduction and internal fixation because of open wound or severe comminution. Among 32 cases, 4 were tibial condyles, 22 were tibial shafts, 6 were tibial plafonds. All the cases were followed up from a minimum 12 months up to 35 months with an dverage of 22 months. We obtained satisfactory bony union in ail cases with the average duration of 18.1 weeks. Bone graft was done initially in two cases. Numerous complications were encountered, most commonly, joint stiffness and pin tract infection were developed but they were treated well. To avoid such complications, careful management was needed. According to Tuckers clafsification, the result was graded as excellent in 8, good in 18, fair in 4 and poor in 2 cases. We conclude that Ilizarov external fixatior is a very useful method for initial treatment in getting reduction, maintenance of reduction, early ambulation and fracture healing in cases of communited tibial fractures whether open or closed.

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Brooker Intramedually Nailing for the Treatment of Distal 1/3 Tibial Fractures with Compromised Soft Tissue: Chung Nam Kang, Jong Oh Kim, Yeo Hon Yun, Dong Wook Kim, Young Do Koh, Jae Doo Yoo, Jong Keon Oh, Ki Woong Lee; J Korean Soc Fract 1999;12(4):924-931. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.924

Abstract PDF: The treatment of distal tibial fractures with compromised soft tissue poses many problems that usually occurs from the high-energy trauma, and the results are often unsatisfactory following lots of complications like loss of reduction, malunion, and inlection. We studied to evaluate the treatment results of Brooker intramedually nailing for the distal 1/3 tibial fractures with compromised soft tissue. Twenty-three cases of distal tibial fractures with comprolnised soft tissue were reviewed and we analyzed the results of surgical treatment in the viewpoint of union time, loss of reduction, malunion, complication and its final outcome. The range of follow-up was 24 months to 38 months with mean 29 months follow-up. Most of patients were between twenty and sixty years, and average age was 43.2 years. Acording to Gustilo and Andersons classification, 3 were Type I, 2 were Type II of 5 open fractures. According to Tschernes classification, 13 were Grade I, 5 were Grade II of 18 closed fractures. The average to union was 15 weeks with range 11 to 20 weeks. The healing was slowest in Tschernes Type II and fastest in Tschernes Type I fracture. There were 3 cases of malunion, more than 5 degrees. All of the 3 cases were posterior angulation. Only 1 case was the loss of reduction. This case was 3 to 10 degrees of varus angulation. There were 3 cases of superficial infection. The infection was controlled with antibiotic therapy. Only 1 case was acceptable of the final outcome. This case waf limping gait because of pain and loss of ankle dorsiflexion to 15 degrees. But, the limitation of ordinary work was not seen. And 18 cases were excellent and 4 cases were good. We recommand that wherever possible, Brooker intramedually nailing can be used for distal tibial fractures with compromised soft tissue. And a high rate of union and a low rate of complication can be expected with thit treatment modality.

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Ilizarov Method for Treatment of Tibia Nonunion Associated with Bone Defects: Sung Taek Jung, Keun Bae Lee, Eun Kyoo Song, Sung Nam Jung; J Korean Soc Fract 1999;12(4):932-939. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.932

Abstract PDF: PURPOSE
: This study was to evaluate the results and complications in gap nonunions of the tibia treated by Ilizarov method MATERIALS and METHODS : We reviewed 30 patients of tibial nonunions(23 atrophic, 7 hypertrophic) with bone loss(1-l3cm, mean 4.6cm) who were treated by Ilizarov technique. The causes of bone defect were open fracture with bone loss(15 cases) and infected nonunions(15 cases). Bone defects were closed by Ilizarov bone transport technique.
RESULTS
All patients had satisfactory union. The mean distraction-consolidation index (distraction-consolidation time/ distraction gap) was 1.3 months/cm. The younger patients and metaphyseal lengthening healed faster than the older patients and diaphyseal lengthening. Even though, we met with the numerous complicationt such as pain around the pin site, pin site infection and delayed union, we could successfully treat most of them.
CONCLUSION
: The application of Ilizarov techniques to nonunions of the tibia with bone defect was very effective, but correct technique and careful follow-up examination was required to avoid complications.

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Treatment of Tibial Defect by Fibular Transposition using Ilizarov: Chung Soo Han, Yong Girl Rhee, Chang Hyun Cho, Moo Song Park, Dong Jun Shin; J Korean Soc Fract 1999;12(4):943-947. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.943

Abstract: Treatment of large segmental defect of tibia is difficult because of associated infection, shortening of limb, nonunion and soft tissue reconstruction. There has been a few options for the reconstruction of segmental tibial defect including vascularized or nonvascularized fibular graft, vascularized iliac bone graft, compression-distraction osteosynthesis and allograft. Tibialization of the ipsilateral fibula for 5 patients who had large tibial defect was successfully achieved by fibular transposition using Ilizarov apparatus at our hosipital . The average defect of tibia was 10.4cm in length. The average time of Ilizarov fixation was 10.3 months. Although one patient required bone grafts, most of them achieved good bony union. The clinical and radiological features and their results were also addressed. Fibular transposition using Ilizarov may be a satisfactory method of treatment for the large segmental tibial defect associated with severe soft tissue injury or vascular compromise.

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Ankle Fracture with Syndesmosis Separation : Radiographic Landmark and Results of Trans-Syndesmotic Screw Fixation: Chong Kwan Kim, Byung Woo Ahn, Sang Guk Lee, Young Hwan Kim, Chae Ik Chung, Sik Hwang; J Korean Soc Fract 1999;12(4):948-955. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.948

Abstract PDF: In the treatment of ankle f1racture, anatomical reduction and restoration of ankle mortise is very important. But tranf-syndesmotic screw fixation for syndesmosis seperation is dependent on the condition in operation field. The purpose of this study is to analyse the radiographic and clinical relults. to evaluate the need for trans-syndesmotic screw fixaition, and to know the effectiveness of radiogrphic landmarks for diagnofis of the syndesmosis separation, retrospectively. The patients were divided into two groups. The Croup I(25cases) were treated with trant-syndetmotic screw and group II(42 cases) were treated without trans-syndesmotic screw fixation . The clinical results were excellent in 13, good 9 in group I and excellent in 19, good in 17 in group II. The radiographic results were excellent in 6, good in 8 in group I and excellent in 23, good 14 in group II. In the radiographic findings, the false negative result of tibiofibular overlap was 15.6%(M: 20.8%, F: 10.4%), tibiofibular clear space was 16.8%(M: 21.6%, F: 11.9%) and ratio of tibiofibular overlap to fibular width was 14.2%(M: 14.9%, F: 13.6%). There was no siginificant statsitical difference in the ratio of tibiofibular overlap to fibular width between male and female. We consider that the ratio of tibiofibular overlap to tibiofibular width are more reliable diagnostic criteria for syndemosis separation than the tibiofibular overlap and tibiofibular clear space. Trans-syndesmotic tcrew fixation is not alswaya required to maintain the integrity of the tibiofibular syndesmosis if the diastasis was satisfactorily reduced with rigid fixation.

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Surgical Treatment of the Bimalleolar Ankle Fractures: Kyung Jin Song, Keun Ho Yang, Kyung Rae Lee, Ju Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1999;12(4):956-960. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.956

Abstract PDF

We designed this study to evaluate the functional outcome and to suggest the guidelines in the treatment of bilnalleolar ankle fractures with clinical and radiological analysis after operative treatment. We analyzed 35 patients with bimalleolar fractures among 90 ankle fractures and followed up for more than 1 year. All 36 fractures were classified according to Lauge-Hansen system and the Meyer criteria was used for the clinical and radiological assessment. Seventeen cases(47%) were supination-external rotation(47%), 9 cases(21%) were supination- adduction: 6 cases(17%) were pronation-abduction and 4 cases(11%) were pronation-external rotation type. Satisfactory results was obtained in 32 cases(89%) according to the criteria of Meyer in the viewpoint of clinical and radiological analysis. Satisfactory results could be obtained with early anatomical reduction and rigid internal fixation for the treatment of bimalleolar ankle fractures. Distal tibiofibular syndesmosis disruption could be spontaneously reduced without trans-syndesmotic screw fixation by early open reduction and rigid internal fixation for the bimalleolar ankle fractures. Early and more accurate anatomical reduction can reduce the post-traumatic arthritis in cases with moderate talar displacement and open fractures.

Citations

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MANAGEMENT OF FRACTURES AROUND ANKLE JOINT
Pagidimarri Manasa, Devarasetty Shanmukha Sreenivas, B. Someswara Reddy
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2021; : 14. CrossRef

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