Journal of Musculoskeletal Trauma

The Determination of Optimal Entry Point for Proximal Femoral Nail Antirotation-II by Fluoroscopic Simulation: A Cadaveric Study: Jin Hoon Jeong, Gu Hee Jung; J Korean Fract Soc 2017;30(4):173-179. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.173

PURPOSE
This study seeks to determine the anatomically optimal entry point of proximal femoral nail antirotation-II (PFNA-IIÂ®) according to geographic features of Korean cadaveric femoral trochanters for successful reduction of osteoporotic proximal femoral fractures.
MATERIALS AND METHODS
Forty-three adult cadaveric femurs without previous fractures or surgeries were included. Anteroposterior (AP) and lateral images of all femurs and PFNA-IIÂ® were taken with an image intensifier. Using the image synthesis process via the image editing program (Adobe Photoshop CS6), the optimal entry point was verified and compared with the tip of the greater trochanter (GT) and the cervicotro-chanteric junction on AP images, as well as the width of the trochanter and the neck on lateral images.
RESULTS
The optimal entry point of PFNA-IIÂ® was an average distance of 9.1 mm (range, 7â€“15 mm) medially from the tip of GT on AP images. The center of the nail was located at an average of 30% (range, 21%â€“44%) area from the posterior margin of the middle neck, which is an average area of 38% (range, 26%â€“48%) from the posterior cortex of the trochanter on lateral images. Furthermore, the ideal entry point was at the extended line of the cervico-trochanteric junction.
CONCLUSION
The optimal entry point, which was found to be medial to the tip of the GT and posterior to the center of the middle femoral neck and the trochanter, was at on the extended line of the cervicotrochanteric junction.

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Clinical Research through Computational Anatomy and Virtual Fixation
Ju Yeong Kim, Dong-Geun Kang, Gu-Hee Jung
Journal of the Korean Orthopaedic Association.2023; 58(4): 299. CrossRef
Does the Entry Point of Proximal Femoral Nail Antirotation Affect the Malalignment of Intertrochanteric Fracture? A Cadaveric Study
Chittawee Jiamton, Nonpawit Nimmankiatkul, Pongsakorn Rungchamrassopa, Wichan Kanchanatawan, Pariyut Chiarapatanakom, Wirat Kongcharoensombat
Journal of Southeast Asian Orthopaedics.2022;[Epub] CrossRef

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Evaluation of the Wearing Characteristics of Hip Protectors Based on Draping Pattern Design and Body Shape in Korean Elderly People: Eunjin Jeon, Heeeun Kim, Heecheon You, Seunghoon Lee, Giwook Kim, Sunjung Yoon; J Korean Fract Soc 2017;30(4):180-185. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.180

Abstract PDF

PURPOSE
The purpose of this study was to verify the new hip protector design with respect to the comfort and mobility. The new hip protector was developed based on a pattern of draping and body shape of Korean elderly individuals.
MATERIALS AND METHODS
An wearing characteristics evaluation was conducted on 101 elderly women wearing hip protector using a questionnaire of preference and ease of wearing. Hip protectors, with existing and newly developed belt and underwear types, which were previously preferred by the Korean elderly, were evaluated.
RESULTS
The newly developed belt type (65.0%) and newly developed underwear type (30.1%) hip protectors were preferred to the existing type (3.9%) and existing underwear type (1.0%) ones. The convenience of the newly developed belt type was greater than 4 out of 5 points (1 for strongly disagree and 5 for strongly agree) for all nine measures, including fit, allowance, mobility, pad placement, pad thickness, pad size, material, design, ease of dressing, and ease of undressing. The newly developed hip protectors showed less discomfort than the existing ones. In particular, the newly developed belt type and developed underwear type improved sitting convenience by 31.1% and 26.1%, respectively, compared with the existing ones.
CONCLUSION
The hip protectors developed in the present study is expected to provide better fit for the body shape of Korean elderly individuals and prevent hip fracture due to fall.

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Development and Evaluation of Fall Impact Protective Clothing for the Elderly Women
Jung Hyun Park, Jin Suk Lee, Jeong Ran Lee
Fashion & Textile Research Journal.2018; 20(5): 569. CrossRef
Development and Evaluation of Fall Impact Protection Pad
Jung Hyun Park, Jin Suk Lee, Jeong Ran Lee
Fashion & Textile Research Journal.2018; 20(4): 422. CrossRef

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Clinical Features and Outcomes of Pelvic Insufficiency Fractures: Yong Min Seo, Young Chang Kim, Ji Wan Kim; J Korean Fract Soc 2017;30(4):186-191. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.186

Abstract PDF: PURPOSE
The purpose of this study was to investigate the radiological and epidemiological characteristics, as well as the clinical course of pelvic insufficiency fractures in the elderly population.
MATERIALS AND METHODS
At a Haeundae Paik Hospital, we retrospectively reviewed patients with pelvic insufficiency fractures between March 2010 and May 2017. The demographic data of patients were analyzed, and bone mineral density and bone turnover markers were evaluated to estimate the metabolic status of the bone. The radiological characteristics were evaluated by comparing the simple x-ray images with the computed tomography images, and the types of fractures were classified via computed tomography images. For clinical course evaluation, we investigated comorbid complications, and compared the walking ability scale before and 6 months after the fracture.
RESULTS
A total of 42 patients were included, with an average age of 76.5 years. All were female except one case. In 5 cases where the initial medical examination was from another institution, the fracture was not found in 3 cases. All cases received conservative treatment. After the diagnosis of pelvic bone fracture using a simple x-ray imaging, additional fractures were found in 81.0% of the study population using a computed tomography. Initiation of gait occurred at an average of 2.8 weeks, and every case except 1 (97.6%) fully recovered their gait ability.
CONCLUSION
We concluded that there was a limitation with diagnosing pelvic insufficiency fracture using only a simple x-ray imaging technique. In general, cases in this study showed conservative treatment yielded favorable clinical outcome with relatively less critical complications.

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Comparison of the Treatment Results between Reduction with Percutaneous Wiring and Reduction without Percutaneous Wiring in Reverse Oblique Trochanteric Fractures (AO Classification 31-A3.3): Jae Woo Park, Oog Jin Shon, Seung Wan Lim; J Korean Fract Soc 2017;30(4):192-197. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.192

Abstract PDF: PURPOSE
The aim of this study was to investigate the utility of percutaneous wiring in the reduction of reverse oblique trochanteric fractures (AO classification 31-A3.3) by analyzing the treatment results with or without the use of percutaneous wiring.
MATERIALS AND METHODS
Thirty-five cases from January 2008 to August 2014 that could be followed-up for at least one year were selected among patients with unstable trochanteric fractures who underwent either internal fixation or open reduction. Seventeen patients underwent surgery with percutaneous wire fixation but another 18 patients underwent surgery without it. All patients received a closed reduction and internal fixation with an intramedullary nail. The factors evaluated were as follows: the length of operation, loss of blood, length of in-hospital stay, lower limb function scale, return to preinjury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, time taken for bone attachment, quality of post-operative reduction, and complications.
RESULTS
No significant difference in the mean operative time, loss of blood, length of in hospital stay, lower limb function scale, return to pre-injury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, and quality of postoperative reduction was observed between the two groups. A significant difference was noted in the time taken for bone attachment (p=0.032). Bone attachment took 13.3 weeks (9â€“17 weeks) on average when fixed with percutaneous wiring and no patient was found to have any complications. When treated without percutaneous wiring, however, bone attachment took 17.8 weeks (12.5â€“28.0 weeks) on average and three cases resulted in delayed union.
CONCLUSION
Percutaneous wiring is a recommended treatment option for patients with an unstable trochanteric fracture.

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Delayed Sciatic Nerve Palsy due to Hematoma Related with Anticoagulants Prophylaxis in the Femur Intramedullary Nailing: A Case Report: Young Mo Kim, Yong Bum Joo, Seok Hwan Song; J Korean Fract Soc 2017;30(4):198-202. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.198

Abstract PDF

Femur intramedullary nailing can be one of the most predictable procedures in orthopedic traumatology. The advantage of this method is that the fracture site does not have to be widely exposed for reduction, which can minimize soft tissue damage. For this reason, the incidence of complications related to hematoma has been rare. We experienced only one case of sciatic nerve palsy due to hematoma after intramedullary nailing; the patient was receiving an anticoagulant therapy. Therefore, we report this case with literature review.

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Ipsilateral Foot Drop After Leg Traction on Fracture Table for Mid-Shaft Femur Fracture Nailing: A Rare Case Report
Jehad A Alzahrani, Ahmed A Alabdali, Mohammed O Albariqi
Cureus.2023;[Epub] CrossRef

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Intrapelvic Penetration of Lag Screw in Proximal Femoral Nailing: A Case Report: Jung Woo Lee, Hong Man Cho, Jae Woong Seo; J Korean Fract Soc 2017;30(4):203-208. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.203

Abstract PDF

Hip fractures are common among elderly individuals. Internal fixation with the intramedullary system has been widely used to treat intertrochanteric femur fractures. The Gamma 3 nail is a useful device for fixating trochanteric fractures of the proximal femur. We report a rare complication of medial pelvic penetration of the lag screw of a Gamma 3 nail two months after surgery. There was a complete separation between the nail body and lag screw, and the lag screw penetrated through the acetabulum into the pelvis. We report a case of unstable intertrochanteric fracture with intrapelvic penetration after surgical treatment with proximal femoral nailing and a case followed by fatal results.

Citations

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Medial lag screw migration in an intramedullary nail combination
Zac Dragan, Ryan J Campbell, Terence R Moopanar
BMJ Case Reports.2025; 18(3): e262436. CrossRef
Endovascular assisted removal of intrapelvic lag screw after intramedullary proximal femoral nail: A case report and literature review
Zakaria Mousati, Mathias Van Den Broek, Joren Callaert, Jan Gielis, Kris Govaers
Trauma Case Reports.2023; 46: 100873. CrossRef
Intrapelvic migration of the lag screw in intramedullary nailing after intertrochanteric fracture fixation: A case report
Aymen Ben Fredj, Hedi Rbai, Fourat Farhat, Marouen Berriri
Clinical Case Reports.2022;[Epub] CrossRef
Intramedullary nailing confers an increased risk of medial migration compared to dynamic hip screw fixation in unstable intertrochanteric hip fractures
Gin Way LAW, Yoke Rung WONG, Antony GARDNER, Yau Hong NG
Injury.2021; 52(11): 3440. CrossRef
Medial migration in cephalomedullary nail fixation of pertrochanteric hip fractures
G. W. Law, Y. R. Wong, A. K-S. Yew, A. C. T. Choh, J. S. B. Koh, T. S. Howe
Bone & Joint Research.2019; 8(7): 313. CrossRef
Intrapelvic Migration of the Lag Screw with Wedge Wing from Dyna Locking Trochanteric Nail: A Case Report and Literature Review
Yong-Woo Kim, Weon-Yoo Kim, Kyong-Jun Kim, Se-Won Lee
Hip & Pelvis.2019; 31(2): 110. CrossRef

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Malunion: Deformity Correction of the Upper Extremity: Soo Min Cha, Hyun Dae Shin; J Korean Fract Soc 2017;30(4):209-218. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.209

Abstract PDF: Malunions after fractures are classified as shortened, angulated, torsion, or rotational deformities that is outside the acceptable range, regardless of the location, whether upper or lower extremity. The distinct feature of a malunion in the upper extremity is that it is free from weight bearing; thus, some degree of shortening is allowed compared with the contralateral normal side in long bones, such as the humerus, radius, or ulna. However, malunions associated with functional impairment, especially angulated or rotational deformities, are more likely to develop instability, degenerative lesions, or rarely, compressive neuropathy. Hence, malunions with such association may occasionally require correction.

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A Correction of Malunion or Deformity in the Lower Extremity: Kyeong Hyeon Park, Joon Woo Kim, Chang Wug Oh; J Korean Fract Soc 2017;30(4):219-227. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.219

Abstract PDF: The incidence of malunion in the long bone with has been reduced because of the advancements in surgical technique. However, nonunion or malunion are still observed in mechanical axis deformation of the lower limb, resulting in the overload of cartilage and instability of the joint, requiring surgical correction. Preoperative planning for malunion is very important, and accurate evaluation of the deformity is essential. Herein, we describe the indications of corrective osteotomy, choice of patients, and various surgical methods for the treatment of malunion of the long bone.

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