Journal of Musculoskeletal Trauma

Effect of Insertion of Bone Graft Substitutes on Consolidation of Distracted Callus: Changes of Radiography & Bone Mineral Density in the Tibia of Rabbits: Chang Wug Oh, Poong Taek Kim, Byung Chul Park, Hae Ryong Song, Il Hyung Park, Jun Ho Baek, Hyung Jin Park; J Korean Soc Fract 2000;13(4):687-695. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.687

Abstract PDF: PURPOSE
This study was designed to know the effect of calcium-sulfate and xenograft on the distracted callus after lengthening.
MATERIALS AND METHODS
We had operation of subperiosteal osteotomy and external fixation on the tibial diaphysis of young New Zealand White rabbits(2.0-2.5kg); after 5 days of latency period, 7 mm(1mm/day, 2 times/day) of tibial lengthening was reached in a week. At 1 week after lengthening, the 1st experimental group of 7 rabbits received a pellet of calcium sulfate(Osteoset , Wright medical, USA) in the distraction gap, and the 2nd experimental group of 7 rabbits received 5mm2 of xenogrfat(Lubboc ) in the distraction gap. But, the control group of 7 rabbits did not receive any of above materials. We compared three groups with the changes of radiographic findings at every week and bone mineral ratio(DEXA) at every two weeks.
RESULTS
The time to complete consolidation of distraction callus of both experimental group(calcium sulfate;14 weeks, xenograft; 15.4 weeks) was shorter than that of control group(16.9 weeks) in radiographic findings. Maximum value of bone mineral ratio of distraction callus was higher and the time to reach the highest value was also shortened in the both experimental group compared to control group.
CONCLUSION
By use of bone substitutes as like calcium sulfate or xenograft in the distraction callus with external fixator, it may be possible to shorten the consolidation period and the fixator-wearing period.

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The biomechanical Study on the Extraction Strengths of Iliosacral Lag Screws: Poong Taek Kim, Chang Wug Oh, Joo Chul Ihn, Jun Dae Kwun; J Korean Soc Fract 2000;13(4):696-701. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.696

PURPOSE
The purpose of this study is for the rigid fixation of the pelvic ring by quantifying and comparing the extraction strength of cancellous screws in the sacral ala and body.
MATERIALS AND METHODS
Six cadaveric human pelvis were obtained for test of the extraction strengths of three groups of 7.0mm cannulated cancellous screws: shortthreaded in the sacral ala, short-threaded in the sacral body, long-threaded in the sacral body. The extraction strengths of these groups were compared with each other.
RESULTS
The mean extraction strengths of short-threaded screws in the sacral ala, short-threaded screws in the sacral body and long-threaded screws in the sacral body were 10.26N, 25.85N and 48.37N respectively. The mean extraction strength of the long-threaded screws in the body was significantly greater than that of the shortthreaded screws in the ala and body. The mean extraction strength of the short-threaded screws in the body was greater than that of the short-threaded screws in the ala, but insignificant statistically.
CONCLUSION
In choosing iliosacral lag screws to stabilize the posterior pelvic ring disruption, superior fixation is achieved by inserting the long-threaded screw in the sacral body.

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Crescent Fracture-dislocation of Sacroiliac Joint: Affecting Factors of Operative Results
Hee-Soo Kim, Chang-Wug Oh, Poong-Taek Kim, Young-Soo Byun, Joo-Woo Kim, Byung-Chul Park, Woo-Kie Min, Hyun-Joo Lee
Journal of the Korean Fracture Society.2009; 22(2): 71. CrossRef

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The Relationship between the Variation of the femoral neckshaft angle according to Age and the Fracture of the Hip: Jun Seop Jahng, Seong Hwan Moon, Jin Ho Che; J Korean Soc Fract 2000;13(4):702-708. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.702

Abstract PDF: PURPOSE
Femur neck-shaft angles were obtained from plain radiographs of the pelvis and their changes according to age were assessed along with their correlations to hip fracture incidence.
MATERIALS AND METHODS
Forty-four patients who have received surgical treatments for femur neck or intertrochanteric fractures and 171 patients who performed bone densitometry at out patient clinic without any history of hip fractures were included in the study. All patients were older than 50 years. Standard value of 0.725 g/cm2 w a s used to separate the osteoporosis and non-osteoporosis groups. Femur neck-shaft angle was measured from standardized radiograph.
RESULTS
In the non-osteoporosis group, varization of femur neck-shaft angle was observed as age increased. No significant difference of the neck-shaft angle was proven between osteoporosis and non-osteoporosis group, and no correlation existed between the femoral neck bone mineral density and neck-shaft angle. Furthermore, fracture group and no fracture group showed no significant difference in neck-shaft angle.
CONCLUSION
The decrease in the neck-shaft angle with age increments has no effects on incidence of hip fracuture and factor most closely associated with fractures is bone mineral density.

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Segmental Breakage of Distal Interlocking Screw Complicating removal of broken nail: A Case Report: Kyu Hyun Yang, Seong Jin Park, Hyung Jung Kim; J Korean Soc Fract 2000;13(4):709-712. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.709

Abstract PDF: Metal failure (nail breakage) after locked intramedullary nailing results from delayed union or nonunion, which necessitates removal of nail and interlocking screws. Breakage of interlocking screw(s) can be associated with failure of the intramedullary nail. It usually breaks into two parts. Proximal part, which contains the screw head, can be removed by screwdriver without difficulties. Distal part can be removed from the far cortex or be left in place if it does not hinder further procedures. We experienced a case of segmental breakage of distal interlocking screw, which was associated with failure of the femoral nail and nonunion. Middle part of the broken screw obstructed the hollow of the nail and complicated the removal of the broken nail.

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Operative Treatment of Displaced Acetabular Fractures: Prognostic Significance of Accurate Reduction: Hong Geun Jung, Jong Bum Lim, Myung Ho Kim; J Korean Soc Fract 2000;13(4):713-723. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.713

Abstract PDF: PURPOSE
The purpose of this study was to clinically evaluate the series of displaced acetabular fractures and also to verify that the accuracy of reduction is one of the important prognostic factors for good clinical outcome. MATERIAL AND METHODS: The study is based on retrospective review on 23 patients with displaced acetabular fractures who had undertaken open reduction and internal fixation during the period of June 1st, 1994 to December 31st, 1997. Follow up evaluation of the patients was done for average 25.1 months(15-45 months). According to Letournel and Judet classification, 15 of 23 hips hips were classified as elementary types and 8 hips as complex types. Average age at operation was 43.4(22-66years) years old. Twenty one of 23 fractures were caused by traffic accidents. Twenty of 23 hips were combined with hip dislocation, 18 of which were posterior type. Twenty-one of 23 hips were operated on by single operative approach (Kocher-Langenbeck or iliofemoral approach), while 2 cases were approached by anterior and posterior approach in one stage. Functional evaluations and Radiographic evaluations for the postoperative status of 34 patients were done with the criteria by Matta.
RESULTS
Overall clinical results for 14(60.9%) hips of total 23 hips were excellent or good. According to radiographic criteria, 13(56.5%) hips were classified as excellent or good. Postoperative hip joint congruity was found in 13(56.5%) hips, 11(84.6%) of which were included in good or excellent categories of clinical as well as radiographic results.
CONCLUSION
These findings indicated that for most displaced acetabular fractures, the good results with patient satisfaction can be achieved, if the hip joint were congruous post-operatively. Therefore the accuracy of reduction was verified as very important prognostic factor for good clinical and radiographic results.

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Significance of Anatomic Reduction in Acetabular Fracture: Sung Kon Kim, Jung Ho Park, Jong Wung Park, Joon Seok Hong, Jae Hun Kim; J Korean Soc Fract 2000;13(4):724-732. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.724

Abstract PDF

PURPOSE
The purpose of operative treatment in acetabular fracture is to restore anatomically the disrupted joint surface and prevent post-traumatic arthritis. We analysed the relationship between the types of the fracture, its location, reduction state with the development of post-traumatic arthritis and hip joint function in postoperative period.
METHOD
& MATERIAL: A clinical analysis was performed on 14 patients, excluding patients with anterior & posterior wall fracture, with displaced acetabular fracture who had been treated by open reduction and internal fixation. All patients had been followed for minimum 1 year in our department from May 1989, to February 1999.
RESULTS
The type of acetabular fracture was not correlated statistically with posttraumatic arthritis and Harris hip score. The reduction state of acetabular fracture was significantly correlated with post-traumatic arthritis and Harris hip score. The antomic location of acetabular fracture was not correlated statistically with post-traumatic arthritis but correlated with Harris hip score.
CONCLUSION
Anatomic reduction is more significant factor in postoperative outcome of acetabular fracture than the type of fracture and the anatomic location of fracture.

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Comparative Results of Acetabular Both Column Fracture According to the Fixation Method
Kyung-Jae Lee, Byung-Woo Min, Eun-Seok Son, Hyuk-Jun Seo, Jin-Hyun Park
Hip & Pelvis.2011; 23(2): 131. CrossRef
Cerclage Wiring in Internal Fixation of Displaced Acetabular Fractures
Chong-Kwan Kim, Jin-Woo Jin, Jong-Ho Yoon, Sung-Won Jung, Jung-Wook Peang
Journal of the Korean Fracture Society.2008; 21(2): 95. CrossRef
Treatment of Acetabular Column Fractures with Limited Open Reduction and Screw Fixation
Jung-Jae Kim, Hyoung Keun Oh, Sung-Yoon Kim
Journal of the Korean Fracture Society.2007; 20(1): 26. CrossRef

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Internal fixation with pelvic plate for displaced Acetabular Fracture: Taek Rim Yoon, Sung Nam Jung, Sang Jin Park, Eun Kyoo Song; J Korean Soc Fract 2000;13(4):733-740. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.733

Abstract PDF

PURPOSE
The purpose of this study was to review the clinical and radiographic results after plate fixation for displaced acetabular fracture.
MATERIALS AND METHODS
A clinical analysis was performed on 47 cases of displaced unstable acetabular fracture which had been fixed with plates and screws. Clinical and radiographical results were analyzed according to Epstein criteria.
RESULTS
In 44 cases, internal fixation was performed using only plate and screws. In three cases, the fixation was augmented with cerclage wiring. The fracture type included posterior wall or posterior column fracture in 37 cases(78.7%). Satisfactory results were achieved in 39 cases(86.7%) on clinical grade and 40 cases(88.9%) on radiographic grade. The complications were deep wound infection in two cases, avascular necrosis of femoral head in one case, post traumatic arthritis in 2 cases, and malunion with partial ankylosis in one case. Total hip arthroplasty were needed in two cases with avascular necrosis and infection.
CONCLUSION
Early surgical treatment including accurate anatomical reduction and stable internal fixation is emphasized for better clinical and radiographic results. The plate and screw fixation is well indicated for posterior wall and/or posterior column fracture of acetabulum.

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Cerclage Clamping Using Cerclage Passer for Reduction of Anterior and Posterior Column Fracture
Ki Chul Park, Hyun Joong Cho, Hun Chul Kim, Kyung-Sik Min, Hae Won Jeong
Journal of the Korean Orthopaedic Association.2016; 51(6): 486. CrossRef
Comparative Results of Acetabular Both Column Fracture According to the Fixation Method
Kyung-Jae Lee, Byung-Woo Min, Eun-Seok Son, Hyuk-Jun Seo, Jin-Hyun Park
Hip & Pelvis.2011; 23(2): 131. CrossRef
Treatment of Acetabular Column Fractures with Limited Open Reduction and Screw Fixation
Jung-Jae Kim, Hyoung Keun Oh, Sung-Yoon Kim
Journal of the Korean Fracture Society.2007; 20(1): 26. CrossRef

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Prognosis of early internal fixation in unstable pelvic fractures: Jang Yeol Lee, Do Hun Moon, Gun Beom Kim; J Korean Soc Fract 2000;13(4):741-748. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.741

Abstract PDF

PURPOSE
This study was conducted to analyze the clinical prognosis of early internal fixation in unstable pelvic fracture. MATERIAL AND METHOD: We analyzed the sixteen patients. The average age of the patients was 34 years(range, 21-64 years). They were followed up for average 21 months. The sixteen pelves were classified by Tile ; Type B 3 cases, Type C 13 cases. Nine patients(56%) had the associated injuries. In 13 patients(81%), internal fixation were performed within 3 weeks after the injury. Fixation was accomplished by the plates and screws. We assessed the functional, radiological results and postoperative complications.
RESULTS
Fourteen(88%) patients were fully ambulatory, had no limp, did not need assistive devices. Fifty percents of the patients had returned to the previous jobs and 31% had to change the jobs. On radiolograph, there were 14 excellent and 2 good reduction. Three postoperative complications happened ; two superficial infections and one lumbar neuropathy, which resolved spontaneously. Three patients with associated injuries, who had delayed fixation, appealed gait disturbance and chronic pain.
CONCLUSION
early internal fixation of unstable pelvic ring fractures may be expected to yield satisfactory functional success and radiologic results in the majority of patients

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Intrapelvic Anterior Plate Fixation for Crescent Fracture-Dislocation of Sacroiliac Joint
Kwang-Jun Oh, Jin-Ho Choi
Journal of the Korean Fracture Society.2013; 26(3): 184. CrossRef
Surgical Fixation of Sacroiliac Joint Complex in Unstable Pelvic Ring Injuries
Kwang-Jun Oh, Seok-Min Hwang
Hip & Pelvis.2012; 24(2): 139. CrossRef
Operative Treatment of Unstable Pelvic Ring Injury
Sang Hong Lee, Sang Ho Ha, Young Kwan Lee, Sung Won Cho, Sang Soo Park
Journal of the Korean Fracture Society.2012; 25(4): 243. CrossRef
Crescent Fracture-dislocation of Sacroiliac Joint: Affecting Factors of Operative Results
Hee-Soo Kim, Chang-Wug Oh, Poong-Taek Kim, Young-Soo Byun, Joo-Woo Kim, Byung-Chul Park, Woo-Kie Min, Hyun-Joo Lee
Journal of the Korean Fracture Society.2009; 22(2): 71. CrossRef

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Insufficiency Fracture of the Sacrum: Report of two cases: Young Kil Han, Young Su Jang; J Korean Soc Fract 2000;13(4):749-753. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.749

Abstract PDF: Insufficiency fractures of the sacrum are rare but a distinct subgroup of pathologic fractures characterized by reduced osseous elastic resistance due to structural alterations of the bone. Stress fractures occurring in the settings have been defined as insufficiency fractures. Insufficiency fracture of the sacrum are difficult to diagnose, as plain radiographic findings are either unhelpful or misleadining. Bone scan is very sensitive and shows moderate to high uptake but the characteristic of H-shaped pattern of increased uptake of sacroiliac joint, specific for an insufficiency fracture, is only rarely seen. M.R.I is clearly the examination of choice, as it reveals early medullary edema and frequently a fracture line in a typical location. M.R.I helps in distinguishing tumoral disease from an insufficiency fracture. In this report, two cases of insufficiency fracture of the sacrum are discribed and compared with those previous studies.

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Anatomical Results According to Fracture Pattern after Surgical Treatment of Acetabular Fractures: Kyu Hyun Yang, Dae Yong Han, Seong Jin Park, Jae Min Jung; J Korean Soc Fract 2000;13(4):754-760. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.754

Abstract PDF

PURPOSE
We analyzed the anatomical results of operative treatment in acetabular fractures according to fracture pattern and surgeon's experience. MATERIAL AND METHODS: From December, 1993 to December, 1999, 100 cases of acetabular fractures operated by single surgeon were analyzed. Fracture configuration was classified by Letournel's method. The anatomical results were classified by Matt' s criteria and Claude Martimeau score.
RESULTS
There were 36 elementary fractures(anterior column type: 4 cases, posterior wall type: 29 cases, transverse type: 3 cases) and 64 complex fractures(posterior wall and posterior column type: 4 cases, anterior and posterior hemitransverse type: 8 cases, transverse and posterior wall type: 16 cases, T type: 6 cases, both column type: 30 cases). According to Matta's criteria, all elementary fractures were seen anatomic or satisfactory results however, eleven cases of combined fracture were seen unsatisfactory results. Mean Claude Martimbeau's score was 6.1 point. Elementary fracture was 7.5 point and combined fracture was 5.4 point. Both column fracture was 4.4 point and it was the lowest point among the fractures. In both column fracture, the improvement of surgeon's skill made more good anatomical results. There were four cases of infection and 2 cases of nerve injury.
CONCLUSION
In operative treatment of acetabular fractures, complexity of fracture demands more appropriate surgical approach and skillful surgeon,

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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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Operative Treatment of Acetabular Fractures: Jong Oh Kim, Yo Hun Yun, Dong Wook Kim, Young Do Koh, Jae Doo Yoo, Hyoung Jin Jeong, Yi Kyoung Shin; J Korean Soc Fract 2000;13(4):761-770. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.761

Abstract PDF: PURPOSE
We reviewed 47 cases of acetabular fractures which was treated operatively, to review the clinical results of operative treatment of acetabular fractures considering the experience of a surgeon, to assess the relationship between the quality of the operative reduction and the clinical results.
MATERIALS AND METHODS
We reviewed 47 cases of acetabular fractures which was treated operatively from September 1993 to December 1999 and follow up more than 1 year. And we analyzed retrospectively the data in the aspect of the relationships between the radiologic evaluation of the reduction and the clinical results, and we reviewed the initial 20 cases as a group I and the later 27 cases as a group II to compare the differences of clinical results of the two groups.
RESULTS
In the accuracy of reduction, anatomical reductions were 4 hips in the group I and 13 in the group II, satisfactory 7 hips in the group I and 9 hips in the group II, unsatisfactory 9 hips in the group I and 5 hips in the group II. We assess the over-all clinical result with the criteria of Merle d'Aubigne and Postel. In the group I, 20 hips, the clinical result was excellent for 3 hips(15%), good for 6 hips(30%), fair for 5 hips(25%), and poor for 6(30%) hips. In the group II, 27 hips, the clinical result was excellent for 11 hips(41%), good for 8 hips(30%), fair for 5 hips(18%), and poor for 3(11%).
CONCLUSION
The accuracy of reduction was closely related to the clinical results. And the more a surgeon getting experienced, the better accurate reduction and clinical results were possible.

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Ambulatory Recovery after Fixation of Intertrochanteric Fracture with Gamma nail in the Elderly: Dong Kyu Shin, Koing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Chang Hyuk Choi, Sang Bong Go; J Korean Soc Fract 2000;13(4):771-778. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.771

Abstract PDF

PURPOSE
This study was performed to evaluate the ambulatory recovery after fixation of intertrochanteric fracture of elderly patients with Gamma nail and to analyze the factors to affect the recovery.
MATERIALS AND METHODS
we evaluated the ambulatory result of 64 cases of intertrochanteric fracure which were fixed with gamma nail and rehabilitated with early weight bearing protocol regardless of reduction state. We analysed the result with statisical method and tried to find the important factor for better ambulatory recovery.
RESULTS
Only 21 patients were able to recover to preinjured level of ambulation and mean loss of ambulation ability was 1.31 according to our evaluation protocol. Stastically the age and early weight bearing walking exercise was affecting factor for better recovery of ambulation and the rate of complication caused by early weight bearing was not significant.
CONCLUSION
Fixation with Gamma nail and early weight bearing rehabilitation protocol was good choice for elderly intertrochanteric fracture without the risk of major complication.

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Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents
Hong Man Cho, Kyujung Lee, Woongbae Min, Yong Suk Choi, Hyun Suk Lee, Hyoung Jin Mun, Hye Young Shim, Da Geon Lee, Mi Joung Yoo
Journal of Korean Medical Science.2016; 31(1): 89. CrossRef

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Effect of Trochanter Stabilizing Plate in Unstable Intertrochanteric Fracture: Youn Soo Park, Kye Young Han, Hyung Gun Kim; J Korean Soc Fract 2000;13(4):779-787. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.779

Abstract PDF

PURPOSE
The purpose of this study is to investigate the effectiveness of trochanter stabilizing plate (TSP) with compression hip screw(CHS) on the reduction stability, fracture union and sliding of lag screw in unstable intertrochanteric fracture. MATERIAL AND METHOD: From October 1997 to March 1999, 32 cases(group 1) and 20 cases(group 2) who could be followed for more than 1 year were treated with TSP (group 2) and CHS only (group 1) due to unstable intertrochanteric fractures. And two groups were compared clinically and radiologically.
RESULTS
Operation time was longer in group 2 and hospital stay was longer in group 1. Preoperative functions were better in group 1(7.00 points) than in group 2(6.47 points). When postop. function was compared with preop. function, group 1 showed differences on the three months follow-up and six months follow-up. Whereas group 2 only showed difference on the three months follow-up but not on the six months follow-up. There was no difference in the incidence of lag screw sliding. However, there were differences in the extent of sliding between group 1(ave.4.88mm) and group 2(ave.2.88mm) with three months follow-up and six months follow-up (group 1: ave 5.42mm and group 2: ave. 3.03mm). There was a significant difference between group 1(12cases) and group 2(0 case) in greater trochanter lateralization, but shaft medialization between group 1(17cases) and group 2(10cases) showed no difference. Loss of neck-shaft angles between group 1(9cases) and group 2(3cases) were not significantly different. Due to loss of reduction, one case in group 1 was reoperated.
CONCLUSION
Application of TSP is not a difficult procedure and reduce excessive sliding of lag screw. And early fuctional recovery without adverse effect of bone healing is possible. So in unstable intertrochanteric fracture, additional use of TSP is effective.

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Surgical Treatment of Femoral Unstable Intertrochanteric Fractures in Elderly Patients -Comparative Study between Compressive Hip Screws and Additional Trochanteric Stabilizing Plates-
Kap Jung Kim, Dae Suk Yang, Sang Ki Lee, Won Sik Choy, Kyoung Wan Bae
Journal of the Korean Fracture Society.2011; 24(4): 295. CrossRef
Proximal Femoral Nail Antirotation versus Compression Hip Screw with Trochanter Stabilizing Plate for Unstable Intertrochanteric Hip Fractures
Jae-Young Rho, Sang-Bum Kim, Youn-Moo Heo, Seong-Jin Cho, Dong-Sik Chae, Woo-Suk Lee
Journal of the Korean Fracture Society.2010; 23(2): 161. CrossRef

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Morbidity and Mortality of Bilateral Hip Fractures in Elderly Patients: Suk Ku Han, Nam Yong Choi, Seong Jin Park, Seong Keun Lee, Chan Woong Moon; J Korean Soc Fract 2000;13(4):788-794. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.788

Abstract PDF

PURPOSE
The purpose of this study was to estimate the morbidity and mortality rate of bilateral hip fractures in elderly patients compared to that in unilateral hip fractures and to evaluate it's related risk factors.
MATERIALS AND METHODS
Twenty-two cases of bilateral hip fractures in patients who were older than 70 years with at least two year follow-up were included in our study. We analysed the risk factors of bilateral hip fractures by comparing with age, sex and diagnosis matched 22 cases of ipsilateral hip fractures including onset of secondary fracture, injury mechanism and the rate of morbidity and mortality, respectively.
RESULTS
The onset of secondary fracture and death were mostly within 1 year after operation for the first hip fracture. Comorbidity of cardiovascular, neurologic, urologic or history of previous fracture and decreased ambulation ability were related with the occurrence of bilateral hip fractures. The rate of morbidity and mortality of bilateral hip fractures were about two- fold than that of ipsilateral hip fractures. High mortality rate was noted in patients who had operation delay from injury. But no significant relationship between nutrition, body weight or bone mineral density and the development of secondary hip fractures.
CONCLUSION
To prevent the occurence of bilateral hip fractures which had more serious results than that of ipsilateral hip fractures, more aggressive rehabilitation to improve walking ability and appropriate environmental circumstances to avoid falls were important, especially in older patients.

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Assessment of the Clinical Features of Bilateral Sequential Hip Fractures in the Elderly
Duk-Hwan Kho, Ju-Yong Shin, Hyeung-June Kim, Dong-Heon Kim
The Journal of the Korean Orthopaedic Association.2009; 44(3): 369. CrossRef

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The Result Of Surgical Treatment Of The Femur Unstable Intertrochanteric Fracture Using Compression Hip Screw: Analysis Of Effect Of Degree Of Force On Trauma And Degree Of Osteoporosis: Ki Do Hong, Sung Sik Ha, Sang Weon Park; J Korean Soc Fract 2000;13(4):795-803. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.795

Abstract PDF: PURPOSE
To analyise the effect of degree of force on trauma and degree of osteoporosis in femoral unstable intertrochanteric fracture's result of treatment using compression hip screw.
MATERIALS AND METHODS
From January 1993 to December 1997, 55 patients who were operated with compression hip screw and followed up for more than 1 year were devided into high and low energy injured group by the mechanism of the trauma and also devided low(gradeIV,V,VI) and high grade osteoporosis group(gradeI,II,III) by Singh's index. We analize and compare the result of treatment in each groups.
RESULTS
The averrage rate of mechanincal complication was 24%. The mechanical complication rate of the high grade osteoporosis group(34%) was higher than low grade osteoporosis group(9%)(p<0.05). The average subsidence of compression screw was 9.9mm and it shows significant difference between low(7.8mm ) and high grade osteoporosis group(11.5mm )(p<0.05). The average increased varus deformity of neckshaft angel during follow up was 3.8degrees and it shows singnificant defference between high energy injuried group(4.6degrees ) and low energy injuried group(2.7degrees)(p<0.05). No difference was seen in each groups for time of bone union(p>0.05). In view of functional recovery by Clawson's method, no difference between pre-injury and postoperative state was seen in 7 cases(22%) in high grade osteoporosis group and 13 cases(57%) in low grade osteoporosis group, thus worse functional recovery was seen in high grade osteoporosis group.
CONCLUSIONS
We observed higher mechanical complication rate, more compression screw subsidence and worse functional recovery in high grade osteoporosis group and more varus deformity in high energy injured group. Thus we need more attension to treatment and follow up in high energy injured, severe osteoporotic unstable intertrochanteric fracture.

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Osteopetrosis combined with Subtrochanteric Fracture of Femur: A Case Report: Ok Gyun An, Jong Ho Jang, Young Kyu Lim; J Korean Soc Fract 2000;13(4):804-808. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.804

Abstract PDF: Osteopetrosis (Albers-Schonberg's disease, Marble bones, and chalk bones) is a rare genetic disorder in which the bony structure throughout the body becomes dense and brittle. Because of the fragility of the pathologic bone, fractures are common and insufficient development of the bone marrow, optic atrophy, deafness, and facial paralysis can be developed to complications. We report a case of 35-year-old female with the autosomal dominant form of osteopetrosis combined with subtrochanteric fracture of femur that underwent surgical treatment.

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Treatment of Femoral Neck Fracture (Comparison of Knowles Pin and Cannulated Screw Fixation): Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suk Ha Lee, Young Bae Kim, Shin Pyo Kang; J Korean Soc Fract 2000;13(4):809-816. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.809

Abstract PDF: PURPOSE
The authors have analyzed clinical and radiological results of the femoral neck fractures to evaluate the difference Knowles pin and cannulated screw fixation group.
MATERIALS AND METHODS
The patients were devided into two group retrospectively, Group I included 35 cases that were treated with Knowles pin fixation for femoral neck fracture and Group II included 30 cases that were treated with cannuled screw fixation for femoral neck fracture. Clinical information included operation time, total blood loss and functional outcome. Postoperative X-ray information included Garden alignment index, duration of union and complication(P>0.05).
RESULTS
There was no difference between the two fixation group regarding duration of union, functional outcome by Lanceford's method and complication(P>0.05).
CONCLUSION
Knowles pin fixation and cannulated screw fixation were considered to be proper as a fixaton method in a fracture of the femur neck.

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Two Stage Treatment of Infected Nonunion of Femur with Antibiotics Impregnated Cement Beads and External Fixator: Hyung Bin Park, Yeon Chen Jung, Hae Ryong Song; J Korean Soc Fract 2000;13(4):817-824. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.817

Abstract PDF: PURPOSE
The purpose of this study was to find out the treatment efficiency of two stage osteosynthesis with antibiotic cement beads and external skeletal fixation for infected nonunion of femur.
MATERIALS AND METHODS
In the first stage, radical debridement was performed. The soft tissue and bony defects were filled with antibiotics impregnated cement beads and the nonunion site was stabilized with external skeletal fixation. In the second stage, the debrided nonunion site was repaired with bone grafting. The intervening time between the first and second stages of treatment was 4 to 6 weeks (average 5.4 weeks). The bone defects ranged from 0.5 to 14cm, Autogeneous iliac cancellous bone grafting was performed in 17 patients and microvascularized fibular graft was performed in 5 patients.
RESULTS
The follow-up period was average 45 months (range, 27-62 months). Infection control and bone union were achieved in all 22 cases. Postoperative infection after the second-staged bone grafting occurred in one patient. This recurred case was treated with repeated two staged operation. Even though aggressive physical theraphy was done, all patients had relevant knee flexion deficits. 14 patients were achieved more than 100 degrees of knee flexion, but 8 patients had less than 80 degrees of range of motion.
CONCLUSION
We have found that two-stage treatment with antibiotic beads local therapy, external skeletal fixation, and staged bone grafting is an acceptable treatment modality for the management of infected femoral nonunion. It results in rapid recovery from osteomyelitis and a predictable recovery from nonunion.

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Augmentative Plate Fixation for Femoral Nonunion after Intramedullary Nailing: Hyoun Oh Cho, Kyoung Duck Kwak, Jong Jin Kim, Soo Min Sohn, Cheol Ho Kang, Hong Ju Lee; J Korean Soc Fract 2000;13(4):825-831. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.825

Abstract PDF

The purpose of this study is to evaluate the efficacy of augmentative plate fixation for the femoral nonunion after intramedullary nailing. We reviewed eleven femoral nonunion after intramedullary nailing, which were treated with augmentative plate internal fixation. All cases were initially managed with interlocking intramedullary nailing. Five were hypervascular and six were avascular. Leaving the intramedullay nail in situ, an augmentative plate fixation was applied to the fracture site to counter the rotational instability. A simultaneous bone grafting was performed in six avascular nonunion to repair the bony defect. The union time was 8.2 months in average( 7.8 months in hypervascular and 8.5 months in avascular). In conclusion, augmentative plating leaving the intramedullary nail in situ is an useful alternative for the treatment of femoral nonunion after intramedullary nailing. The technique is simple and does not require any special instruments. It facilitates an early weight bearing and gives a quick recovery from nonunion.

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The Comparison of LC-DCP versus LCP Fixation in the Plate Augmentation for the Nonunion of Femur Shaft Fractures after Intramedullary Nail Fixation
Se Dong Kim, Oog Jin Sohn, Byung Hoon Kwack
Journal of the Korean Fracture Society.2008; 21(2): 117. CrossRef

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Treatment of the Femoral Shaft FracturesUsing Unreamed Interlocking Intramedullary Nail: Chang Wook Oh, Joo Chul Ihn, Poong Taek Kim, Shin Yoon Kim, Hee Soo Kyung, Chung Hyun Lee; J Korean Soc Fract 2000;13(4):832-836. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.832

Abstract PDF: PURPOSE
To evaluate the usefulness of unreamed nailing inthe treatment of femoral shaft fractures.
MATERIALS AND METHODS
Between March 1996 and June 1998, unreamed nailing with closed method was done for 74 patients with 82 femoral shaft fractures. The main indications for this treatment were multiple injury or isolated femoral fracture above Winquist type II. The influence of Winquist- Hansen classification, anatomical location, and open injury over bone union and the influence of injury severity score over general complication including fat embolism were investigated.
RESULTS
Primary union occurred in 76 cases(93%) with 6 cases of nonunion and 10(12%) of delayed union, and mean time to union was 27 weeks. In open fractures, the union time was delayed(32 weeks) rather than closed fracture. In Winquist classification, there was no stastical importance on time to union, but nonunion was most common in Winquist type IV. Anatomical location has no influence on time to union. In the view point of multiple injury, the group above 18 points(31 patients) in injury severity score had none of fat embolism, but the group below 18 points(43 patients) had 2 patients.
CONCLUSION
The treatment of femoral shaft fractures by unreamed nailing had longer time to union with higher rate of delayed union, and we think that the theoretical advantage of decreasing pulmonary complications is controversial.

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Treatment of Ipsilateral Femur and Tibia Fractures: Sung Keun Sohn, Kyung Taek Kim, Byeong Hwan Kim, Bum Ho Jung, Kyung Sik Hwang; J Korean Soc Fract 2000;13(4):837-846. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.837

Abstract PDF

PURPOSE
Searching for the most excellent outcome of ipsilateral fractures of femur and tibia according to the treatment methods and the combined injuries which occasionally neglected.
MATERIALS AND METHODS
We reviewed thirty cases of ipsilateral fractures of the femur and tibia, treated at the orthopaedic department of the Dong-A university hospital between February 1991 and May 1999. Children under 10 years old, treated by conservative methods were excluded in this study. Average follow-up period was 23.2 months(range, 5 to 44 months) and mean age was 34.7 years old(range, 16 to 58 years).
RESULTS
According to the measurement of the Karlstrom and Olerud, range of motion of the ipsilateral knee joint and bony union time, intramedullary nailing was the treatment of choice for both femur and tibia fracures except limited by open wound and fracture level and types(14 cases, 47%). The ipsilateral knee ligaments injury was the most common combined injury which neglected at initial trauma(8 cases, 27%).
CONCLUSION
By intramedullary nailing, the patients with ipsilateral fractures of femur and tibia could achieve early weight bearing ambulation and ipsilateral knee joint excercise, and showed the most excellent outcome. After fixation of both femur and tibia fractures, by physical examination and arthroscopic examination of ipsilateral knee joint we could detect and treat the ipsilateral knee ligaments injuries, which occasionally neglected.

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Ipsilateral Femoral Segmental and Tibial Fractures: A Case Report
Oog Jin Sohn, Chul Hyun Park, Sang Keun Bae
Journal of the Korean Fracture Society.2009; 22(3): 193. CrossRef

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The Results Of Femoral Shaft Fracture By Difference Of Operative Method: Ki Do Hong, Sung Sik Ha, Jae Cheon Shim; J Korean Soc Fract 2000;13(4):847-854. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.847

Abstract PDF: PURPOSE
To evaluate and compare the bone union period, complications and functional assessments between compression plate and intramedullary nailing which are operative methods of the femoral shaft fracture. MATERIAL AND METHOD: We evaluate the bone union period, complications and functional assessments of the 65 cases(63 patients). 30 cases were treated with compression plate and another 35 cases were treated with intramedullary nailing, who were diagnosed to have femoral shaft fracture. And they were treated in our hospital from January 1995 to August 1999, whose follow up was available more than 1 year.
RESULTS
Mean bone union period of compression plate fixations was 14.6 weeks and intramedullary nailing was 16.2 weeks. Complications in compression plate fixations group was deep infection in one case, metal failure in one case, refracture in one case, nonunion in one case, and there were 5 complications in intramedullary nailing fixations group which were nonunion in 2 cases, limb shortening in 2 cases and angular deformity of nail in one case. By using functional assessment according to Magerl et al16) among 30 cases of compression plate fixations, 25 were excellent, 3 were good, 2 were fair, and among 35 cases of intramedullary nailing, 29 were excellent, 4 were good, 2 were fair, so we achieved excellent results in both techniques as 83.3% and 82.9% cases each.
CONCLUSION
In operative management of femoral shaft fracture, compression plate fixations and intramedullary nailing shows average difference of 1.6weeks of bone union period, but both method didn't show significant difference in bone union period. Both methods achieved excellent results in functional assessments, so if we manage by knowing thoroughly the advantage and disadvantage of both technique, we can get a excellent results with reduced complications.

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Treatment of Coronal Split Fracture of the Femoral Condyle: Yong In, Seung Key Kim, Won Jong Bark, Jong Beom Park, Gun Chang, Han Chang; J Korean Soc Fract 2000;13(4):855-860. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.855

Abstract PDF: PURPOSE
To evaluate the results of treatment in 6 cases of coronal split fractures of the femoral condyle MATERIALS AND METHODS: Six cases of coronal split fractures of the femoral condyle were treated and followed up 16 to 36 months. Five cases were treated operatively. We used anteromedial approach for 3 cases, posteromedial approach for 1 case and posterolateral approach for other 1 case. Non-displaced case was treated conservatively with cast. We compared the results of each case using Letenneur assessment system.
RESULTS
All 3 cases approached anteromedially and the case approached posterolaterally showed good results. But the case approached posteromedially showed fair result with mild limitation of motion and pain. Non-displaced case treated with cast resulted in poor result with nonunion.
CONCLUSION
We propose operative treatment for coronal split fracture of the femoral condyle even though there is no displacement. Anteromedial approach and headless screw fixation could be the best method for reduction and fixation of fracture.

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Comparision of Operative Treatment Methods of AO type C2-C3 Fractures of the Distal Femur: Beom Koo Lee, In Ho Seong, Min Ho Song; J Korean Soc Fract 2000;13(4):861-867. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.861

Abstract PDF: PURPOSE
To evaluate the advantages of transarticular reconstruction and fixation of metaphysis by MIPO technique for AO type C2-C3 fractures of the distal femur. MATERIAL AND METHODS: In a retrospective study conducted from January 1996 to December 1997, AO type C2-C3 fractures of the distal femur were treated using three techniques; 1) A group-MIPO technique and medial parapatellar arthrotomy for the direct reduction of the condylar block(10 cases), 2) B group-conventional AO technique(8 cases) 3) C group-closed supracondylar nailing(4 cases). Minimal followup time was 12 months.
RESULTS
Time to bone healing was 15 weeks in A group, 20 weeks in B group, and 16 weeks in C group. complication rate was 0% in A group, 50% in B group, and 50% in C group. normal alignment between 0 & valgus 9 degrees was 100% in A group, 75% in B group, and 50% in C group. Neer score was 90% excellent or satisfactory in A group, 75% in B group, and 50% in C group respectively. The results of A group was better than those of B and C group.
CONCLUSION
Transarticular joint reconstruction and MIPO technique for AO type C2-C3 fractures of the distal femur is an excellent technique to obtain more rapid bony union with less complications.

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Tibial Condyle Fracture Treated by Osteosynthesis with a Buttress Plate: Duck Yun Cho, Sung Jin Kim, Gun Yeon, Young Yoo Kim, Sung Joon Im, Chun Hee Won; J Korean Soc Fract 2000;13(4):868-876. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.868

Abstract PDF: PURPOSE
We analyzed the anatomical results of operative treatment in acetabular fractures according to fracture pattern and surgeon's experience. MATERIAL AND METHODS: From December, 1993 to December, 1999, 100 cases of acetabular fractures operated by single surgeon were analyzed. Fracture configuration was classified by Letournel's method. The anatomical results were classified by Matt' s criteria and Claude Martimeau score.
RESULTS
There were 36 elementary fractures(anterior column type: 4 cases, posterior wall type: 29 cases, transverse type: 3 cases) and 64 complex fractures(posterior wall and posterior column type: 4 cases, anterior and posterior hemitransverse type: 8 cases, transverse and posterior wall type: 16 cases, T type: 6 cases, both column type: 30 cases). According to Matta's criteria, all elementary fractures were seen anatomic or satisfactory results however, eleven cases of combined fracture were seen unsatisfactory results. Mean Claude Martimbeau's score was 6.1 point. Elementary fracture was 7.5 point and combined fracture was 5.4 point. Both column fracture was 4.4 point and it was the lowest point among the fractures. In both column fracture, the improvement of surgeon's skill made more good anatomical results. There were four cases of infection and 2 cases of nerve injury.
CONCLUSION
In operative treatment of acetabular fractures, complexity of fracture demands more appropriate surgical approach and skillful surgeon,

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Bicondylar Tibial Plateau Fractures Treated with Hybrid-Ring External Fixator: Chang Wug Oh, Hee Soo Kyung, Joo Chul Ihn, Byung Chul Park, Young Chul Choi; J Korean Soc Fract 2000;13(4):877-883. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.877

Abstract PDF

PURPOSE
This study was designed to evaluate the indirect reduction or limited internal fixation with hybrid external fixation for bicondylar fractures of proximal tibia. MATERIALS & METHODS: Twenty-two cases (mean age; 49) proximal tibial fractures have been treated, including 7, type V and 15, type VI. After reconstruction of articular surface, the hybrid fixation was applied at the condyle and shaft with or without limited internal fixation by cannulated screw or one-third plate. We permitted early ROM exercise of knee and partial weight-bearing about 4 weeks after operation.
RESULTS
Time to union averaged 15.6 weeeks(range ; 11-20 weeks). There were 4 cases of nonunion including three cases of early bone graft for severe comminution and one infection. Functional scoring revealed 5 excellent, 12 good, 3 fair and 2 poor results. 18 out of 22 cases had good or excellent result in anatomical grading. The mean range of knee motion was 116 degrees(from 4.1 to 120 degrees). In complications, there were two cases of malunion, one deep infection, and one pin-site infection, but soft tissue compromise such as skin necrosis was not happened.
CONCLUSION
The indirect reduction or limited internal fixation with hybrid external fixation for bicondylar fractures of proximal tibia have advantages of anatomic, stable fixation, early mobilization and less soft tissue dissection, so good results of knee function can be accomplished.

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Dual Plate Fixation Compared with Hybrid External Fixator Application for Complex Tibial Plateau Fractures
Jae-Sung Lee, Yong-Beom Park, Han-Jun Lee
Journal of the Korean Fracture Society.2008; 21(2): 124. CrossRef

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Two-Stage Treatment of Infected Nonunion of the Tibia using Antibiotics Impregnated Cement Beads and External Fixator: Yeon Cheon Jeong; J Korean Soc Fract 2000;13(4):884-890. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.884

Abstract PDF: PURPOSE
To evaluate the results of two-stage treatment for infected nonunion of the tibia using antibiotics impregnated cement beads(AICB) and external skeletal fixation.
MATERIALS AND METHODS
We analyzed 25 infected tibial nonuinon that were treated with AICB and external skeletal fixation from July 1995 to April 1998. The average follow-up was 25 months. In the first stage, sequestrectomy and radical debridement was performed. and then the soft tissue and bony defects were filled with AICB and was stabilized with external skeletal fixation. In the second stage, after removal of AICB and the nonunion site was either grafted with autogenous cancellous bone graft(17 patients) or internal bone transport(8 patients) was performed according to the bone defect size.
RESULTS
The average bony union time was 36.8 weeks. The intervening time between the first and second stages of treatment was 4 to 6 weeks (average 5.4 weeks). There were 8 pin tract infections, 1 Postoperative infection after the second-stage bone grafting. According to Paley's functional assessment system, excellent or good results were obtained in 20 cases. There was no poor result.
CONCLUSION
In our opinion, the above advocated two-stage treatment is an acceptable treatment modality for the management of infected tibial nonunion.

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Supracondylar Intramedullary Nail for Femoral Supracondylar Fracture following TKA: 3 Cases Report: Jun Dong Chang, Hyun Min Han, Suck Woo Kim, Won Ik Lee, Soo Joong Choi, Chang Ju Lee; J Korean Soc Fract 2000;13(4):891-896. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.891

Abstract PDF: A periprosthetic supracondylar femoral fracture is one of the complications of the total knee arthroplasty(TKA). The periprosthetic supracondylar femoral fracture after TKA occurs approximately 0.3% to 2.5% and various methods have been introduced to treat this fracture. We report three cases of supracondylar femoral fractures following TKA, with brief review of pertinent literatures, in which retrograde supracondylar intramedullary nail provided satisfactory results. In severe osteoporotic patient, firm fixation of the nail was obtained by using cement and early motion of the knee joint was possible. In addition, we found that the supracondylar intramedullary nail could be used without insertion difficulty in all PCL retaining TKA systems which were available in use in our country.

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Treatments of the Malunited Tibial Shaft Fracture: Taik Seon Kim, Jae Ik Shim, Sung Jong Lee, Suk Ha Lee, Yeon Sik Yu, Young Bae Kim, Kwang Yeol Park; J Korean Soc Fract 2000;13(4):897-904. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.897

Abstract PDF: PURPOSE
The malunited diaphyseal tibia fractures result in tibial shortening, angular deformities, gait disturbance, development of joint pain, etc. The authors analyzed the results of treatment consist of corrective osteotomy for diaphyseal malunion with internal or external fixation.
MATERIALS AND METHODS
The authors reviewed 18 cases of tibial diaphyseal malunion treated in Korea Veterans Hospital between January 1992 and December 1998. Mean follow-up period was 4.2 years. The preoperative deformities were varus, anterior or posterior bowing and shortening. The preoperative symptoms were knee joint pain, ankle joint pain, and gait disturbance. Corrective osteotomy was done on the site of malunion in all cases. Fixation were done with IM nailings(13 cases), plates(3 cases) and Ilizarov external fixator. We analyzed the unions radiologically and the knee pains with HSS score.
RESULTS
All malunions were successfully corrected. Mean duration of union was 4.5 month. In the coronal plane, preoperative varus deformity(mean 16.5degrees varus) was corrected to 3degrees of valgus. In the saggital plane, anterior and posterior bowing was corrected to neutral. In 15 cases of the patient with knee joint pain, the mean HSS score was improved from 69 preopertively to 82 postoperatively.
CONCLUSION
The correction of tibia diaphyseal malunion had good results by osteotomy at the malunited site and firm internal or external fixation. And it also improved knee joint pain significantly.

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The Angular Deformity of Interlocking Nailing in Tibial Fractures: Hwa Jae Jeong, Kyung Chul Kim, Jae Yeul Choi, Bon Seop Koo, Jung Hee Oh; J Korean Soc Fract 2000;13(4):905-911. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.905

Abstract PDF: PURPOSE
We studied the relationship between angular deformity and possibly contributing factors in the treatment of tibial fractures with interlocking nailing.
MATERIALS AND METHODS
Intramedullary nailing of the tibia was performed on 49 cases and were followed for the minimum of 12 months. We analyzed relationship between angular deformity and postoperative tibial alignment, operative technique and other factors.
RESULTS
Of the 49 cases, 19(38%) were angulated. Angular deformity was seen in 60%, 51.8% and 11.8% in the proximal, distal and middle third of tibial fractures respectively. With AO classification, Group A,B,C were angulated in 32.4%, 55.6%, 66.7%. In group A, 43.8% of spiral fractures, 28.6% of oblique fractures and 14.3% of transverse fractures were angulated. The cases combined with fibular fracture showed higher incidence of angular deformity than the cases with intact fibula. The opening of fracture and the nail insertion site were not significant to angular deformity.
CONCLUSION
Angular deformity of interlocking nailing in tibial fractures were more common in proximal, comminuted and spiral fractures. Precise attentions to operative technique i. e. accurate anatomical reduction and centromedullary nail orientation are recommended to prevent angular deformity. In proximal third tibial shaft fractures where muscles and patellar tendon has deforming force on fracture fragment, authors believe that use of interlocking nailing must be limited with fracture pattern.

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