Journal of Musculoskeletal Trauma

Risk Factors for Knee Stiffness in Distal Femoral Fractures: Dong Wook Son, Hyoung Soo Kim, Woo Young Choi; J Korean Fract Soc 2018;31(4):123-131. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.123

PURPOSE
The aims of this study were to evaluate risk factors for knee stiffness after the fixation of distal femoral fractures, and to analyze the clinical and radiologic outcomes.
MATERIALS AND METHODS
This is a retrospective case control study of 104 consecutive patients who have a distal femoral fracture and were treated with a submuscular locking plate. The case group comprised of patients with 12-month postoperative range of motion (ROM) â‰¤90Â° or a history of manipulation under anesthesia. The case group was compared with the control group of patients with a 12-month postoperative ROM >90Â°. The possible risk factors were evaluated by univariate and logistic regression analysis. The postoperative ROM and Knee Society clinical rating system was evaluated for the clinical assessment and the distal femoral angle on a whole-extremity scanogram was measured for radiologic assessments.
RESULTS
Fifty-four patients were included in the study (14 in the case group, 40 in the control group). Univariate analysis showed that comminuted fracture, intra-articular fracture, open fracture, temporary external fixation, severe osteoarthritis, and prolonged immobilization placed patients at an increased risk for knee stiffness. On the other hand, multivariate logistic regression showed that an extensor mechanism injury was the only significant predictor (p=0.001; odds ratio, 42.0; 95% confidence interval, 5.0â€“350.7). The ROM and Knee Society score were significantly lower in the case group; however, the coronal alignment was similar in the case and control group.
CONCLUSION
Various factors that delay postoperative knee motion place patients at increased risk of knee stiffness. Understanding these risk factors may help surgeons prevent postoperative knee stiffness after distal femoral fractures. In particular, extensor mechanism injury, such as patella fracture or open quadriceps injury, was found to be an independent predictable factor associated with knee stiffness.

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Staged Management for Distal Femur Fractures: Impacts on Reoperation, Stiffness, and Overall Outcomes
Matthew T. Yeager, Robert W. Rutz, Alex Roszman, Gerald McGwin, James E. Darnley, Joseph P. Johnson, Clay A. Spitler
Journal of Orthopaedic Trauma.2024; 38(11): 577. CrossRef
Outcome of the Masquelet Technique for Complex Bilateral Distal Femoral Bone Defects
Ziad A Aljaafri, Abdullah Alzahrani, Ali Alshehri, Ahmed AlHussain, Faisal Alzahrani, Khalid Alsheikh
Cureus.2023;[Epub] CrossRef
Efficacy of non-operative treatment of patients with knee arthrofibrosis using high-intensity home mechanical therapy: a retrospective review of 11,000+ patients
Shaun K. Stinton, Samantha J. Beckley, Thomas P. Branch
Journal of Orthopaedic Surgery and Research.2022;[Epub] CrossRef
Distal Femoral Replacement and Extensor Mechanism Repair Reinforced With Synthetic Mesh for Distal Femur Fracture With Patellar Ligament Avulsion
Charles Powell, Kristopher Sanders, Neal Huang, Luis Felipe Colón, Colton Norton
Arthroplasty Today.2022; 16: 31. CrossRef
The fragility of statistical significance in distal femur fractures: systematic review of randomized controlled trials
Michael Megafu, Hassan Mian, Emmanuel Megafu, Sulabh Singhal, Alexander Lee, Richawna Cassie, Paul Tornetta, Robert Parisien
European Journal of Orthopaedic Surgery & Traumatology.2022; 33(6): 2411. CrossRef
Association Between Femoral “Spike” Size After Intramedullary Nailing and Subsequent Knee Motion Surgery
Michael G. Schloss, Nathan N. O'Hara, Syed M. R. Zaidi, Zachary D. Hannan, Dimitrius Marinos, Jared Atchison, Alexandra Mulliken, Jason W. Nascone, Robert V. O'Toole
Journal of Orthopaedic Trauma.2021; 35(2): 100. CrossRef
Distal Femur Replacement Versus Surgical Fixation for the Treatment of Geriatric Distal Femur Fractures: A Systematic Review
Brett P. Salazar, Aaron R. Babian, Malcolm R. DeBaun, Michael F. Githens, Gustavo A. Chavez, L. Henry Goodnough, Michael J. Gardner, Julius A. Bishop
Journal of Orthopaedic Trauma.2021; 35(1): 2. CrossRef

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Prediction of Concomitant Lateral Meniscus Injury with a Tibia Plateau Fracture Based on Computed Tomography Assessment: Wonchul Choi, Yunseong Choi, Go Tak Kim; J Korean Fract Soc 2018;31(4):132-138. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.132

Abstract PDF

PURPOSE
This study examined whether any fracture pattern shown in computed tomography (CT) scan is associated with the presence of lateral meniscus (LM) injury in a tibia plateau fracture.
MATERIALS AND METHODS
Fifty-three tibia plateau fractures with both preoperative CT and magnetic resonance imagings (MRI) available were reviewed. The patient demographics, including age, sex, body mass index, and energy level of injury were recorded. The fracture type according to the Schatzker classification, patterns including the lateral plateau depression (LPD), lateral plateau widening (LPW), fracture fragment location, and the number of columns involved were assessed from the CT scans. The presence of a LM injury was determined from the MRI. The differences in the factors between the patients with (Group 1) and without (Group 2) LM injuries were compared and the correlation between the factors and the presence of LM injury was analyzed.
RESULTS
The LM was injured in 23 cases (Group 1, 43.4%) and intact in 30 cases (Group 2, 56.6%). The LPD in Group 1 (average, 8.2 mm; range, 3.0â€“20.0 mm) and Group 2 (average, 3.8 mm; range, 1.4â€“12.1 mm) was significantly different (p < 0.001). The difference in LPW of Group 1 (average, 6.9 mm; range, 1.2â€“15.3 mm) and Group 2 (average, 4.8 mm; range, 1.4â€“9.4 mm) was not significant (p=0.097). The other fracture patterns or demographics were similar between in the two groups. Regression analysis revealed that an increased LPD (p=0.003, odds ratio [OR]=2.12) and LPW (p=0.048, OR=1.23) were significantly related to the presence of a LM tear.
CONCLUSION
LPD and LPW measured from the CT scans were associated with an increased risk of concomitant LM injury in tibia plateau fractures. If such fracture patterns exist, concomitant LM injury should be considered and an MRI may be beneficial for an accurate diagnosis and effective treatment.

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The value of magnetic resonance imaging in the preoperative diagnosis of tibial plateau fractures: a systematic literature review
Gregoire Thürig, Alexander Korthaus, Karl-Heinz Frosch, Matthias Krause
European Journal of Trauma and Emergency Surgery.2023; 49(2): 661. CrossRef

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Clinical Features and Characteristics of Greater Tuberosity Fractures with or without Shoulder Dislocation: Dong Wan Kim, Young Jae Lim, Ki Cheor Bae, Beom Soo Kim, Yong Ho Lee, Chul Hyun Cho; J Korean Fract Soc 2018;31(4):139-144. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.139

Abstract PDF: PURPOSE
The purpose of this study was to compare the characteristics and clinical features of greater tuberosity fractures with or without a shoulder dislocation.
MATERIALS AND METHODS
A total of 108 cases of greater tuberosity fractures (56 cases with shoulder dislocation, 52 cases without shoulder dislocation) were reviewed retrospectively. Age, sex, side, injury mechanism, fracture displacement, fracture morphology, number of fracture fragments, main fragment size, treatment, and combined injuries were investigated.
RESULTS
The age, sex, side, injury mechanism, treatment, and combined injuries were similar in both groups (p>0.05). A statistically significant difference in fracture displacement, fracture morphology, number of fracture fragment, and main fragment size was observed between the two groups (p < 0.05).
CONCLUSION
In greater tuberosity fractures with a shoulder dislocation, the prevalence of fracture displacement was high and the depression type of fractures occurred frequently. In addition, the number and size of the fracture fragment increased. Therefore, an understanding of these fracture patterns will be helpful for deciding treatment and prognosis.

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Spino-Pelvic Fixation in Unstable Sacral Fracture: A Case Report: Jung Hwan Choi, Kyu Tae Hwang, Seung Gun Lee, Chang Nam Kang; J Korean Fract Soc 2018;31(4):145-148. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.145

Abstract PDF: A 22-year-old female patient visited the emergency room (ER) after a pedestrian traffic accident in a drunken state. An examination at the ER revealed fractures at the right side of the sacral ala, sacral foramina, left anterior acetabulum, right inferior ramus, and right superior articular process of S1. She underwent spino-pelvic fixation and iliosacral (IS) screw fixation. One year later, bone union was completed and implant removal was performed and the treatment was completed without complications. The authors recommend spino-pelvic fixation and IS screw fixation for unstable sacral fractures as one of the excellent methods for obtaining posterior stability of the pelvis among the various treatments of unstable sacral fractures.

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Avulsion Fracture of the Posterior Cruciate Ligament from Femoral Insertion Occurred in a Patient with Residual Poliomyelitis: A Case Report: Wonchul Choi, Taesup Kim; J Korean Fract Soc 2018;31(4):149-153. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.149

Abstract PDF: Avulsion fracture of the posterior cruciate ligament from its femoral insertion is quite rare, particularly in adults, and the treatment guidelines have not been established. A 68-year-old female patient with residual poliomyelitis presented with an avulsion fracture of the femoral insertion of the posterior cruciate ligament after a falling accident and was treated with arthroscopic headless compression screw fixation and pull-out suture of the avulsed ligament. We report this case with a relevant discussion of this type of injury.

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Capitellar Osteochondral Impacted Fracture of the Humerus in an Adult Female: A Case Report: Jaekwang Yum, Minkyu Seong, Kyungil Kim; J Korean Fract Soc 2018;31(4):154-158. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.154

Abstract PDF: Capitellar osteochondral impaction fractures of the humerus are an uncommon injury and not encompassed by commonly used classification systems, such as that of Bryan and Morrey. Only a few cases of capitellar osteochondral impaction fractures have been reported. We report a case of a 53-year-old female with a capitellar osteochondral impaction fracture. The osteochondral fracture fragment of the capitellum was impacted and there was a step-off on the articular surface. Recovery of congruence in the capitellar articular surface was necessary. Satisfactory clinical and radiological results were obtained through the â€˜lever armâ€™ reduction of the fracture fragment with a small osteotome and fixation with â€˜raftâ€™ K-wire.

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Atypical Femoral Fractures: What Do We Know about Them?: Beom Seok Lee, Young Kyun Lee, Heejae Won, Hyungkook Kim, Kyung Hoi Koo; J Korean Fract Soc 2018;31(4):159-164. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.159

Abstract PDF

Recently, atypical femoral fractures (AFFs) have been found in patients who were prescribed bisphosphonate to prevent osteoporotic fractures. Although the occurrence of AFF is rare, there are some concerns, such as a higher risk of delayed or non-union of AFF. This paper reviews the treatment of AFF and suggests some considerations during surgery.

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Atypical Femoral Fracture Occurring at a Proximal Screw Insertion Site after Plate Removal in a Distal Femoral Fracture
Jin Woo Jin, Sung Jin Shin, Jong Min Jeon
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Position Statement: Atypical Femoral Fracture from the Korean Society for Bone and Mineral Research in 2023
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Journal of Bone Metabolism.2023; 30(3): 209. CrossRef

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Medical Treatment of Osteoporosis/Prevention of Falls: Hyoung Keun Oh; J Korean Fract Soc 2018;31(4):165-171. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.165

Abstract PDF

The prevention and treatment of fragility fractures is evolving continuously. Adequate fracture care should involve treating the fracture itself as well as the underlying bone disease. Although effective treatments of osteoporosis are available, a large proportion of patients with fragility fractures are not prescribed anti-osteoporotic medications after their injury. Recent advances in diagnostic tools and medications allow for a more effective and comprehensive treatment of fragility fractures.

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