Journal of Musculoskeletal Trauma

Retrospective Comparative Study of the Intraoperative Fracture Gap Compression in the Treatment of Intertrochanteric Fracture Using Proximal Femoral Nail Antirotation: Se Jin Kim, Hong Man Cho, Jiyeon Park, Ki Yong An, Young Woo Chung, Woojin Shin; J Korean Fract Soc 2020;33(4):179-188. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.179

Purpose
Intertrochanteric fractures can be treated using proximal femoral nail antirotation (PFNA). This study examined the clinical and radiological results of the intraoperative fracture compression.
Materials and Methods
Ninety-four patients underwent intraoperative compression (Group I), and 88 patients underwent natural sliding only (Group II). The patients were followed-up for more than two years. All patients met the following seven conditions: (1) AO/OTA 31-A1, A2 type intertrochanter fracture, (2) availability of compression of more than one cortical bone in the anterior or medial region of the fracture site under the preoperative imaging test, (3) Singh index grade ≥3, (4) blade position: center-center, center-inferior, (5) tip-apex distance <25 mm, (6) reduction status of good or very good, and (7) positive or neutral medial cortical support position with slightly valgus reduction.
Results
A slight tendency toward significant differences in acute phase pain between the two groups was observed at six weeks postoperatively (p=0.073). Twenty-four months after surgery, lateral extension of the PFNA helical blade between the two groups showed significant differences (p=0.017). Fracture gaps measured immediately after surgery showed significant differences (p=0.001), and a clear tendency for a significant difference in the average fracture union time was found (p=0.065).
Conclusion
Intraoperative fracture compression, intraoperative fracture compression appears beneficial to achieve a successful union of trochanteric fractures provided that all conditions are met to apply the method safely.

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Benefits of a Demineralized Bone Matrix in Osteoporotic Intertrochanteric Femoral Fracture Patients
Se Jin Kim, Hong-Man Cho, Myung Cheol Jung
Journal of the Korean Fracture Society.2022; 35(4): 151. CrossRef

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Treatment of Proximal Femur Fracture with a Newly Designed Nail: Trochanteric Fixation Nail-Advanced (TFNA): Jae Youn Yoon, Ji Wan Kim; J Korean Fract Soc 2020;33(4):189-195. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.189

Abstract PDF

Purpose
This study evaluated the clinical results and implant safety of a newly developed implant, Trochanteric Fixation Nail-Advanced (TFNA; DePuy Synthes), in the treatment of proximal femur fractures.
Materials and Methods
This was a retrospective cohort study of 26 patients diagnosed with proximal femur fracture and treated surgically with TFNA. The patients’ demographic data, surgical data, radiologic findings, and functional outcomes, including complications, were evaluated.
Results
The mean age of the patients was 71.2 years (95% confidence interval [CI], 68.2-74.2); 65.4% were female. The mean Carlson comorbidity index score was 5.4, and the mean Koval grade before fracture was 2.1. Fracture classification included four cases of AO/OTA 31.A1, nine cases of A2, six cases of A3, and seven cases of 32A including six cases of atypical femoral fractures. The mean operating time was 53.3 minutes (95% CI, 43.6-63.1). There were no early postoperative complications, such as postoperative infection, deep vein thrombosis, pulmonary embolism, or in-hospital death, except one case of pneumonia. The mean Koval score at the postoperative six-month follow-up was 2.9. EuroQol-5 Dimension (EQ-5D) increased from 0.05 to 0.54 after three months and 0.72 at six months postoperatively. Bone union was observed in all cases with a mean union time of 12.9 weeks. No implant failure occurred, and no cases required secondary revision surgery.
Conclusion
A new intramedullary nail system, TFNA, showed excellent outcomes and safety in the surgical treatment of proximal femur fractures.

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Intermediate Length Cephalomedullary Nails in Proximal Femoral Fractures: Review of Indications and Outcomes
Daniel Scott Horwitz, Ahmed Nageeb Mahmoud, Michael Suk
Journal of the American Academy of Orthopaedic Surgeons.2025;[Epub] CrossRef
Clinical and Radiological Outcomes of Unstable Intertrochanteric Fractures Treated with Trochanteric Fixation Nail-Advanced and Proximal Femoral Nail Antirotation-II: Correlation between Lateral Sliding of the Helical Blade and Lateral Trochanteric Pain
Sung Yoon Jung, Myoung Jin Lee, Lih Wang, Hyeon Jun Kim, Dong Hoon Sung, Jun Ha Park
Journal of the Korean Orthopaedic Association.2024; 59(3): 208. CrossRef
Prospective randomized multicenter noninferiority clinical trial evaluating the use of TFN-advancedTM proximal femoral nailing system (TFNA) for the treatment of proximal femur fracture in a Chinese population
Lidan Zhang, Zhijun Pan, Xiaohui Zheng, Qiugen Wang, Peifu Tang, Fang Zhou, Fan Liu, Bin Yu, Frankie K. L. Leung, Alex Wu, Suzanne Hughson, Zhuo Chen, Michael Blauth, Anthony Rosner, Charisse Sparks, Manyi Wang
European Journal of Trauma and Emergency Surgery.2023; 49(3): 1561. CrossRef
Risk of shortening in operatively treated proximal femur fractures with cephalomedullary nails with dynamically versus statically locked helical blades
Nathan Cherian, Lasun Oladeji, Cole Ohnoutka, Dan Touhey, Madeline Sauer, Kyle A. Schweser, Mauricio Kfuri, James L. Cook, Gregory J. Della Rocca, Brett D. Crist
Injury.2023; 54(2): 669. CrossRef
GS Hip Nail versus Affixus Hip Fracture Nail for the Intramedullary Nailing of Intertrochanteric Fractures
Seungcheol Kwon, Minjae Lee, Heeyeon Lee, Jihyo Hwang
Journal of Clinical Medicine.2023; 12(21): 6720. CrossRef
Comparison of the Clinical and Radiological Outcomes of TFNA (Trochanteric Fixation Nail-Advanced) and PFNA-II (Proximal Femoral Nail Antirotation-II) Treatment in Elderly Patients with Intertrochanteric Fractures
Min Sung Kwon, Young Bok Kim, Gyu Min Kong
Journal of the Korean Fracture Society.2022; 35(4): 162. CrossRef
Analysis of Clinical and Functional Outcomes according to the Blood Sugar Control Status at the Time of Ankle Fractures Resulting from Rotational Injuries
Jun Young Lee, Dong Seop Lim, Seung Hyun Lee, Seo Jin Park
Journal of the Korean Fracture Society.2022; 35(4): 135. CrossRef
Conventional versus helical blade screw insertion following the removal of the femoral head screw: a biomechanical evaluation using trochanteric gamma 3 locking nail versus PFN antirotation
Hong Man Cho, Kwang Min Park, Tae Gon Jung, Ji Yeon Park, Young Lee
BMC Musculoskeletal Disorders.2021;[Epub] CrossRef
Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced)
Hyeon Joon Lee, Hyun Bai Choi, Ba Rom Kim, Seung Hwan Jo, Sang Hong Lee
Journal of the Korean Fracture Society.2021; 34(3): 105. CrossRef

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Results of Intramedullary Nailing for Distal Metaphyseal Intra-Articular Fractures of Tibia: Jun Young Lee, Yongjin Cho, Hyung Seok Park, Se Woong Jang; J Korean Fract Soc 2020;33(4):196-203. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.196

Abstract PDF: Purpose
This study examined the results of internal fixation using an intramedullary nail in the treatment of distal metaphyseal fractures involving the articular surface.
Materials and Methods
From November 2009 to November 2018, distal tibia fractures involving the articular surface were treated with intramedullary nailing only for fractures corresponding to AO type 43 B and 43 C1, twenty-four cases were studied retrospectively. The tibial alignment was measured preoperatively and postoperatively, and the bone union time and nonunion were assessed. In addition, the clinical evaluation of ankle joint function was assessed using the Olerud and Molander ankle score (OMAS).
Results
Complete bone union was obtained in all cases, and the mean union time was 17.7±1.87 weeks (range, 15-20 weeks). The average preoperative coronal alignment was 6.4°±1.0° (range, 5.2°-8.4°), and sagittal alignment was 2.7°±0.6° (range, 1.9°-3.8°). The average postoperative coronal alignment was 2.5°±0.13° (range, 2.2°-2.6°) and sagittal alignment was 0.4°±0.25° (range, 0.09°-0.95°). There was no nonunion. The OMAS had an average of 85±7.9 points (range, 70-95 points).
Conclusion
In the treatment of distal metaphyseal fractures involving the articular surface, internal fixation using an intramedullary nail reduces complications and achieves satisfactory reduction and union. This method is considered an excellent treatment to obtain good clinical results.

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Risk Factors Affecting the Early Complications of Femoral Head Fractures: HoeJeong Chung, Jin-Woo Lee, Dong Woo Lee, Hoon-Sang Sohn; J Korean Fract Soc 2020;33(4):204-209. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.204

Abstract PDF: Purpose
This study analyzed the prognostic factors in patients with femoral head fractures by comparing two groups with and without complications.
Materials and Methods
A retrospective study was performed on femoral head fracture patients who visited two different level-1 trauma centers from January 1, 2014 to June 30, 2018. Thirty-three patients with a follow-up period of more than one year were included. Early complications were defined as fair or poor in the Thompson–Epstein clinical evaluation criteria and grades 3 or 4 in the Kellgren– Lawrence classification within one year after the fracture. The patients were divided into two groups, with and without early complications. Statistical analysis was performed for the nominal variables with a Fisher’s exact test and continuous variables using a Mann–Whitney U test.
Results
Nine patients (27.3%) had early complications, and there were no significant differences according to age, sex, treatment method, combined fractures, Pipkin classification, and AO/OTA classification between the two groups.
Conclusion
The prognosis in femoral head fractures is difficult to predict. Therefore, the validation of existing classifications or a new classification is necessary.

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Comparison of the Clinical and Radiographic Results between 125° and 130° Caput-Collum-Diaphyseal Angle Proximal Femoral Nail Anti-Rotation II in Patients with Intertrochanteric Fracture: Soo Jae Yim, Yong Bok Park, Hyun Kwon Kim, Sin Hyung Park; J Korean Fract Soc 2020;33(4):210-216. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.210

Abstract PDF: Purpose
This study compared the clinical and radiographic results of two proximal femoral nail antirotation II (PFNA-II) angled by 125° and 130° in patients with intertrochanteric fractures.
Materials and Methods
From March in 2015 to September in 2016, 65 patients who underwent a closed reduction and internal fixation with PFNA-II for a femoral intertrochanteric fracture were evaluated retrospectively. The minimum follow-up period was two years. Of those, 30 and 35 patients underwent 125° angled PFNA-II and 130° angled PFNA-II, respectively. The clinical performance was evaluated using the Harris hip score, WOMAC (Western Ontario and McMaster Universities Osteoarthrtis Index), and UCLA (University of California Los Angeles) score. Radiographic analyses were performed using standardized anteroposterior and lateral radiographs to assess the implant position and quality of reduction. The blade length, distance between the blade tip and the tip of the greater trochanter, and distance between the blade tip and the most lateral protrusion point of the greater trochanter in the two groups were measured and compared.
Results
The clinical results, including the Harris hip score, WOMAC, and UCLA, were similar in the two groups at the last follow-up postoperatively. In the radiography evaluation, the implant position, quality of reduction, and the blade length were similar in the two groups. The distances between the blade tip and the tip of the greater trochanter were 52.60±3.53 mm and 58.07±5.54 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The distance between the blade tip and the most lateral protrusion point of greater trochanter were 16.48±2.54 mm and 21.19±4.43 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The differences were significant (p=0.031, p=0.012).
Conclusion
The operation with the 125° angled PFNA-II showed a more superior and lateral position of the blade than that with the 130° angled PFNA-II. Nevertheless, lateral thigh pain can occur when the blade is positioned superolaterally.

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Axillary Artery Rupture after Shoulder Dislocation That Was Treated with a Self-Expanding Stent - A Case Report -: HaengJin OHE, Daehyun Hwang, Inkeun Park, Minki Lee, Jun-Ku Lee; J Korean Fract Soc 2020;33(4):217-221. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.217

Abstract PDF: raumatic shoulder dislocations are one of the most common major dislocations in the general population. Injury to major vessels is rarely reported as a complication of shoulder dislocations. This case report presents the traumatic dissection of the axillary artery after a simple shoulder dislocation that was managed successfully with the placement of a self-expanding stent. With the clinical manifestations of a brachial plexus injury and progressive vascular compromise in the affected arm, a major vascular injury was detected on an angiogram, and a self-expanding stent was deployed. Through immediate diagnosis and prompt intervention, serious complications, such as hypovolemic shock and even death, were averted, ultimately achieving a favorable patient outcome.

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Sclerotherapy Using Abnobaviscum for the Extensive Recurrent Chronic Morel-Lavallée Lesions - A Case Report -: Joon-Kuk Kim, Ji-Won Jung, Ki-Chul Park; J Korean Fract Soc 2020;33(4):222-226. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.222

Abstract PDF

The Morel-Lavallée lesion (MLL) is a closed soft-tissue degloving injury, resulting in characteristic hemo-lymphatic fluid collection between the fascia and subcutaneous layers. The MLL was managed routinely with drainage and compression bandages, but sclerotherapy can be used in patients with chronic lesions refractory to first-line therapy. This paper presents a case of extensive recurrent chronic MLL treated with sclerotherapy using Abnobaviscum, which has been used to treat adhesion in malignant pleural effusion.

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Seroma prevention with topical Abnobaviscum sclerotherapy following excision of giant cervical lipoma
Jun Ho Choi, Seung Yeon Choi, Jae Ha Hwang, Kwang Seog Kim, Sam Yong Lee
Archives of Craniofacial Surgery.2023; 24(1): 10. CrossRef

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Tendon Healing: A Review of Basic Science and Current Progress: Young Woo Kwon, Pei Wei Wang, Jun-Ku Lee; J Korean Fract Soc 2020;33(4):227-237. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.227

Abstract PDF: The tendon connects the muscles to the bones and transmits the loads generated by the muscles to the bones to move the joints, support the joints, and provide stability to the joints. Approximately 30% of patients complaining of musculoskeletal pain are associated with tendon disease, and approximately 50% of musculoskeletal injuries are caused by a tendon injury. Despite this frequent treatment of tendon damage, studies on the basic biology that provide scientific evidence for treatment, such as development, tendon injury, and healing, are still very limited. This review first summarizes the classification and composition of the tendon identified so far, the surrounding tissue, and the blood supply to the tendon. The limitations of the tendon recovery process after a tendon injury are also discussed. Finally, this review examines ways to improve tendon recovery and the biological approaches and tissue engineering that have been currently studied. In conclusion, innovative progress in promoting tendon healing has not been achieved despite the many advances in the basic structure of the tendon, and the cell and regulatory molecular factors involved in tendon recovery. Biological approaches and tissue engineering, which have become a recent issue, have shown many possibilities for the recovery of damaged cases, but further research will be needed until clinical application.

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Bone Substitutes: From Basic to Current Update: Jong Seong Han, Hyung Keun Song; J Korean Fract Soc 2020;33(4):238-244. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.238

Abstract PDF

Bone substitutes are being used increasingly in bony surgery as more than two million bone grafts are performed worldwide per year. Autobone grafts represent the gold standard for bone grafting, but morbidity and limited availability are the main problems. Allobone grafts are osteoconductive, but there are still concerns regarding the infection risks, costs, and donor availability issues. As an alternative, widely used ceramic-based synthetic bone substitutes are based alternatively on calcium (hydroxyapatite, tricalcium phosphate, calcium sulfate, calcium phosphate). Ceramic-based bone substitutes are osteoconductive, but they are weaker than cortical bone and are not osteoinductive. Bone morphogenic protein, demineralized bone matrix, and platelet-rich plasma are used to obtain an osteoinductive function. Recently, cell-based and gen-based bone substitutes were developed and studied. This paper reviews the basic information and the latest concepts on bone grafts and bone substitutes.

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Tannic acid-modified magnesium oxychloride bone cement with high water resistance and osteogenic properties
Junying Chen, Yijia Guan, Yue Yang, Tingting Ma, Jinlun Feng, Wenjie Guo, Qifang Wang, Yanru Zhang, Jianguo Liao
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Surface and Coatings Technology.2022; 433: 128078. CrossRef

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