Journal of Musculoskeletal Trauma

Patellar Fracture: Duck Yun Cho; J Korean Soc Fract 1996;9(4):835-840. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.835

Abstract PDF: Patellar fractures constitute approximately 1 percent of skeletal injuries in the literature and 3.4 percent in the authors institution. The goals of treatment are restoration of the entensor mechanism and perfect restoration of the articulating surface. In contrast to most other intraarticular fractures, the selection of treatment must take into consitleration tensile suess of the bone, as were as compressive stress. The basic schema for treatment of patellar fracture is as follows: 1. To determine therapy, patellar fractures must be classified in 3 models;The mechanism of injury. amount of displacement, and configuration of fracture. 2. Nonoperative treatment is indicated if the extensor retinaculum is intact and if displacement of fragment is minimal. 3. The success of operative treatment depends on the exact reduction of fracture, secure fixation, and the amount of articular cartilage damage. 4. Recent biomechanical studies on the efficiency of various forms of fixation for patellar fractures showed that fixation with modified tension band wiring with or without circumferentiat wiring was superior to tension band wiring or circumferential wiring. 5. Partial patellectomy should be selected in preference to total patellectomy if at all possible because partial patellectomy offers better function.

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Anatomy and Classification: Eun Kyoo Song; J Korean Soc Fract 1996;9(4):841-845. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.841

Abstract PDF: No abstract available.

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No title in English: Byung Chul Park; J Korean Soc Fract 1996;9(4):846-849. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.846

Abstract PDF

No abstract available.

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Clinical Effectiveness of Korean Medical Rehabilitation Treatment after Patellar Fracture: A Report of 4 Cases
Ji-Hye Geum, Hyeon-Jun Woo, Jong-gyu Kim, Jung-Han Lee
Journal of Korean Medicine Rehabilitation.2020; 30(4): 203. CrossRef

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Patellectomy and Rehabilitation: Kuen Tak Suh, Seung Wook Kim; J Korean Soc Fract 1996;9(4):850-858. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.850

Abstract PDF: No abstract available.

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Multiple Knowles Pin Fixations of the Femoral Neck Fractures in Adults under 60 Years of Age: Sang Won Park, Kwang Suk Lee, Dae Gon Wie; J Korean Soc Fract 1996;9(4):859-868. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.859

Abstract PDF: Femoral neck fracture is more common in elderly even by minor trauma because of osteoporosis. In young adults, though the incidence is low, have a poor prognosis because of high incidence of non-union and aseptic necrosis. The treatment method of the femur neck fracture is widely divided into internal fination and replacelnent arthroplasty But there is still contrversies present in the treatment methods. The object of this study is to observe the relationships between the clinical outcomes and the age, the degree of displacement. the type of reduction, the time of operation and the bone density in the femoral neck fractures treated with mulliple Knowles pin fitation. The authors analyzed 29 cases of femoral neck fractures in adults under 60 years of age, who were treated with multiple pih (ixation and followed up more than 1 yearduration The results obtained were as follows; 1. The union of femoral neck fracture occured in 19 cases(65.5%) among the 19 cases and the mean duration of union was 4.8 months. 2. The complications were 8 cases(21.6%) of avascular necrosis, 2 cases(6.9%) of non-union, 2 cases of malunion and 1 case of post-traumatic arthritis. 3. The functional results by Lunceford criteria were satisfactory in 17 cases (58.6%). 4. In the patient group which were no avascular necrosis and non-union showed 89.5% of satisfactory functional end result. 5. There was a relationship between the complications such as avascular necrosis and non-union, and age of the patient, bone density, degree of initial displacement and type of reduction. But the duration between the injury and operation did not influence the complication rate. According to the above results, we concluded that multiple Knowles pin fination in femoral neck fracture is simple and safe method, and one of salvaging method of femoral head in adults under 60 years of age.

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Evaluation of Quality of Life after Treatment of Femoral Neek Fracture in Elderly Patieno: Kweon Jae Roh, Jae Doo Yoo; J Korean Soc Fract 1996;9(4):869-875. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.869

Abstract PDF: In the elderly patients, we evaluated the results of treatments for the femoral neck fractures in the respect of quality of life. We used the Rosser index to generate quality of life score(QoL). Rosser index composed of two dimensions with distress and disability. Seventy-nine patients aged over 65 years with femoral neck fracture have been evaluated. Forty-nine cases were treated with bipolar hemiarthroplasty and thirty cases were treated with internal fixation such as compression hip screw. Knowles pin, cannulated hip screws. At one-year after operation, the median score of quality of life was 0.990 in bipolar hemiarthroplasty patients and 0.988 in the internal fixation patients. There was significant difference between the two groups(P<0.05). Patients treated with bipolar hemiarthrol)lasty had better QoL score than the patients treated with internal fixation. The elderly patients treated with bipolar hemiarthroplasty has lesser diability and was able to get early weight bearing.

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Comparison of Compression Hip Screw, Captured Hip Screw and Gamma-Locking Nail in Intertrochanteric Fracture of Femur: Eu Seup Chung, Kyung Seo Choi, Min Ki Kim, Jong Bong Lee; J Korean Soc Fract 1996;9(4):876-883. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.876

Abstract PDF: It is well known that most of the intertrochanteric fractures of femur occur in elderly patients with osteoporosis and poor general conditions. So, there are many problems in the treatment of intertrochanteric fractures of femur due to osteoporosis and unstable patterns of fracture and poor general conditions in clderly patients. Various devices have been developed and the results of treatment have been improved, but the morbidity and the mortality still remain high. The authors analysed 33 cases of compression hip screw(group 1), 19 cases of captured hip screw(group 2), and 13 cases of Camma-locking nail(group 3) amomg 65 cases of intectrochanteric fracture of femul operated at Presbyterian Medical Center from Jan.1990 to Aug.1994. We compared the intraoperative and postoperative complications amomg the three devices, and obtained the following results; 1. The incidences of fixation failure were not sigmificant among the three groups. 2. The lag screw penetration of femoral head and angulation were higher in Gamma-locking nail group(23%) among the three groups. 3. Most of anterior displacement of distal fragment and severe impaction of fracture site were occured in unstable fracture and higher in captured hip screw group(16%), and none in Camma locking nail group. 4. In Gamma-locking nail group, severe impaction at fractuie site was not found but the lag screw penetration of femoral head and angulation were higher. In the other two groups, the results were reverse.

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The Treatment of Traumntic Posterior Fracture-Dislocation of the Hip: Won Sik Choy, Kwang Won Lee, Yoo In Kim, Moon Ho Sohn; J Korean Soc Fract 1996;9(4):884-890. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.884

Abstract PDF: Traumatic posterior dislocation of the hip is a serious injury and must be treated as emergency. Every effort must be made to recognize the dislocation. particularly in patients with other lower extremity trauma. We perfornted computed tomography as soon as possible after closed reduction in all patients. The purpose of this study was to compare the results posterior fractvre-dislocation of the hip treated by closed reduction and closed reduction followed by an open procedure. We reviewed 27 patients out of total 29 patients with traumatic posterior dislocation of the hip between January, 1989 and October, 1993. 1. According to Thompson and Epstein classification, six patients were type 1 injury. five patients type 2 injury, five patients type 3 injury, three patients type 4 injury and eight patients type 5 injury. In the classification of fractures by the Pipkin type, there were two cases in Pipkin type 1, three cases in Pipkin type 2, one case in Pipkin type 3 and two cases in Pipkin type 4. 2. Open reduction with various internal fixation were done in twenty patients and primary bipolar endoprosthesis in two patients and total hip arthroplasty in one patient. Also. four patients were treated by closed reduction, followed by gentle traction for 6 weeks & progressive weight bearing over twelve weeks. 3. There were one case of avascular necrosis in Thompson and Epstein type 4 and two cases of posttraumatic arthritis in type 3 and 4. One case of post-traumatic arthritic patients was performed total hip arthroplasty. 4. We found that 33.3% of the cases had a exellent result by both clinical and radiological criteria, 44.4% were graded good and 11.1% were graded poor.

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Complications in Femur Shaft Fracture treated with Interlocking Intramedullary Nailing: Ho Geun Chang, Woon Hwa Jeong, Ung Joo Lee, Seo Joong Choi, Jun Dong Chang, Won Ho Cho, Chang Ju Lee; J Korean Soc Fract 1996;9(4):891-898. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.891

Abstract PDF: The interlocking IM nailing is one of the most commonly used treatment method of the femoral shaft fracture. Althrough it has many advantages, but various complications is reported including delayed union, nonunion, malunion, interlocking nail or screw breakage, joint stiffness and infection. In order to evaluate the complications we reviewed 38 cases in treated with interlocking IM nailing in femoral shaft fracture from january, 1991 to december, 1995 in Hangang Sacred-Heart hospital. The average follow up duration was 14 months (range ; 6 months to 38 months). The following results are obtained 1. There were 1 cases of nonunion. Nonunion was of no analytic significance in sex, age, the fracture site and associated fracture (P=0.186), but significant in segmental fracture (P=0.02). Because of the small number group, we considered that it would be necessary more clinical expenence. 2. There were 3 cases interlocking screw breakage, all of which were occured in proximal screw. Partial weight bearing was permitted average postoperation 4.3 months. Average duration between operation and screw breakage was 1.3 months, between operation and bone union was 11.7 months. 3. There was 1 case of interlocking nail breakage. we considered that it was resulted from usage of relatively small nail(11 mm) and postoperative early weight bearing(8 weeks).

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Treatment of Infected Nonunion of the Femur Using the Ilizarov Apparatus: Duck Yun Cho, Eun Sung Koh, Suk Cho Kong; J Korean Soc Fract 1996;9(4):899-906. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.899

Abstract PDF: Infected nonunion is serious complication in the long bone fractures and it is sometimes resulted in significant disability. From December 1990 to February 1994, we reviewed 11 cases who were treated for infected nonunion of the femur by using the Ilizarov apparatus at National Hedical Center, Active infection was controlled by radical resection of the infected necrotic bone and soft tissue and continuos irrigarion with antibiotics mixed saline for 3 weeks. After sequrstrectomy, bone deject was ranged from 2.5cm to 12.5cm(average, 7.2cm) in 11 cases. Preoperative leg length discrepancy(LLD) was ranged from 2.0cm to 8.Ocm(average, 3.9cm) in 7 of 11 cases. Bone defects were gradually treated by internal bone transport technique and solid bone union was achived by internal fixation and bone graft. The average of transporation was 8.9cm(range, 2.5-15.5cm). The average of healing index was 1.6menths/cm(range, 1.0-3.6months/cm). The percentage of increment was ranged from 5% to 32%(average, 19.6%). According to Paleys classification, bony results was poor in 11 cases and functional results was good in four, fair in three, poor in four. We concluded that the application of Illizarov technique to infected nonunion of the femur with large bone defect was useful method but internal fixation and bone graft was necessary for nonunion of doicking site.

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Femoral Fatigue Fracture in Soldier: Jae Hyung Lee, Sung Ku Kang, Chul Joen Kim, Nok Soo Kim, Byung Chul Moon, Jong Oh Kim; J Korean Soc Fract 1996;9(4):907-913. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.907

Abstract PDF: Fatigue fracture are commonly seen in military personnel, especially at basic training c enter, and have been noted in athletes, ballet dancers, laborers, and even pregnant woman. This type of injury is usually encountered in the metatarsal shaft. however in rare cases. fatigue fracture in the femoral shaft was reporied. The purpose of this article is to call attention to the impouanre of early diagnosis of fatigue fracture of the shaft of the femur so that displacement, which may lead to the necessity for surgical intervention, may be prevented. The following clinical results were obtained by analysis of 6 cases of femoral fatigue fractures experienced in the departmert of orthopedic surgery, Capital Armed Forces General Hospital from January 1993 to April 1996. 1. A series off femoral fatigue fractures are reported in the miliiary recruits. 2. The average age was 21 years and all patients sex were male. 3. All the patients were peculiarly army recruits, whose average body heights were 170.3 centimeters and body weights were 61.6 Kilograms. 4. All the patients had previously led a sedentary life styie, with very little physical activity of any kind, including walking. 5. The site of predilection in the femoral shaft was distal one-third, occuring in 5(83.3%) of the cases. The site of other one case was middle one-third of the shaft. 6. The main cause of the fatigue fractures was marching on hard roads, and other cause was playing football. 7. Most of femoral fatigue fractures were classified as grade II, showing periosteal readion on both cortices. 8. All soldiers were treated by immediate stoppage of physical activity, with no plaster immobilization except a displaced fatigue fracture.

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Interlocking Intramedullary Nailing of Femoral Shaft Fractures in Adolescents: Chil Soo Kwon, Jong Kuk Ahn, Jin Hyok Kim, Byung Hyun Jung, Yerl Bo Sung, Hyung Jin Jung, Jong Deuk Rha, Woo Chun Lee, Hyun Soo Park, Myung Ho Lee, Bu Maan Kim; J Korean Soc Fract 1996;9(4):914-920. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.914

Abstract PDF: Although treatment of femoral shaft fractures by traction and casting satisfactory in young children, it is less useful in obtaining and maintaining satisfactory alignment in adolescent patients. Residual angulation, malrotation. and leg length inequality is well documented. The options for surgical treatment of femoral shaft fractures in adolescents include extemal fixation, plate fixation, and intramedullary nailing. Surgical treatments carry the-risks of growth plate damage and infection, but these risks are very low. Recently, it is generally anepted that adolescent femoral shaft fractures are preferably treated by intramedullary nailing with care taken to avoid damaging the distal femoral physis. The authors experienced 9 femoral shaft fractures in 8 patients treated with interlocking intramedullary nails from August 1989 to May 1994, and followed up for more than 18 months(range from 18 to 45 months). The results were as follows: 1. There were 6 cases in male, 2 cases in female. Average age at the time of injury was 13 years(range, 11-14). 2. All fractures were united, and the nails were removed at an average 13.3 months after operation: no refracture or femoral neck fracture has since occured. 3. None had angular or rotational malunions, infection and avascular necrosis of femoral head. The average leg-length discrepancy at the last follow-up was 0.5cm(range, 0-1.0cm) and all were clinically acceptable. Coxa valga due to premature closure of trochanteric apophysis was not found. The average femoral neck-shaft angle was 133(130~138) at the last follow-up. So, interlocking intramedullary nailing is a reasonable alternative for the treatment of femoral shaft fracture in adolescents.

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Treatment of Infected Nonunion in Supracondylar and Intercondylar Fractures of the Femur after Open Reduction and Internal Fixations: Ho Geun Chang, Eung Joo Lee, Sang Chun Ahn; J Korean Soc Fract 1996;9(4):921-929. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.921

Abstract PDF: The postoperative complications in open reduction and internal fination of supracondylar and intercondylar fractures of the femur include leg length discrepanfy, infection, skin necrosis, irritation by implants, valgus or varus deformity, bony destruction associated with vascular disturbance, instability of thr knee joint and translation of the frartured surface. The most vulnerable complication among them may be infection. Then infected nonunion is dangerous to the patients and its treatment is very difficult. Authors evaluated 25 cases of 25 patients who were treated and followed up evaluation over one year in the department of Orthopaedic Surgery, College of Medicine, Hallym University from January, 1988 to June, 1995. All cases were treated by open reduction & internal fixations. Four cases of them had developed infected nonunion. After we treated these cases wr could reach following results: 1. The cause of infection was primarily staphylococcus aureus in all cases. 2. Among 4 cases of infected nonunion, external fixator was preformed in 3 patients and interlocking IM nailing in remainder. 3. The infection was managed with intravenous antibiotics, frequent irrigation. insertion of antibiotic impregnated beads and daily dressing. 4. Erythrocyte sedimentation rate was normalized at average 8.5 months(range, from 1.5 to 26 months). 5. The union was accomplished at mean 5.4 months in 21 cases without infection and at mean 17.7 months(range, from 10 to 35 months) in 4 cases with infued nonuion after infection developed. 6. The main complications were limitated range of motion of the knee(30 to 100 degree flexion) and shortening of affected extremity. 7. In conclusion, we suggest that early removal of implant in situ, external fination and bone graft after infection controlled is an adequate plan for the treatment of infected nonunion in supracondylar and intracondylar fractures of the femur.

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Arthroscopieally Assisted Insertion of a Supracondylar Intramedullary Nail for Distal and Supracondylar Femoral Fracture: Technique Report: Sin Kang Cho, Jin Tae Choi, Sung Jae Kim; J Korean Soc Fract 1996;9(4):930-935. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.930

Abstract PDF: The retrograde supracondylar interlocking nail has been selectively used for the treatment of the supracondylar fracture of the femur. The open method using open medial arthrotomy increases the morbidity of the knee joint while the blind technique using minimal incision can cause the intra-articular complications owing to its blindness of procedure. In this article, we sought the safe method of insefion to reduce the complications of knee joint by minimal incision and also, using the auhroscopic guide. According to our method using arthrposcopic technique we concluded it has the potential benifits over the open or blind methods as early knee enercise, early soft tissue healing, decreased risk of damage to the intra-articular stiuctures, earlier convalescence with reduced hospitalization time, and better cosmesis.

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Femur Neck Fracture during Closed Nailing of Femur Shaft Fracture: Keun Woe Kim, Ui Seong Yoon, Yong Hoon Kim, Hak Jin Min, Jin Sup Yeom, Young Ho Lee; J Korean Soc Fract 1996;9(4):936-942. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.936

Abstract PDF

Closed intramedullary nailing has become increasingly popular in the management of fractures of the femur because of a high rate of union, a low rate of infection, and excellent return of function. But it requires good availability of equipment and surgeons skill and experience. Iatrogenic femur neck fracture can occur as a complication of closed intramedullary nailing of femur shaft fracture. The authors report five cases of this complication and analyze these five cases in the viewpoint of causal technical errors and suggest some technical points to avoid this complication.

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Some Series of Honey-Comb Spaces
Elena Barbieri, Alberto Cavicchioli, Fulvia Spaggiari
Rocky Mountain Journal of Mathematics.2009;[Epub] CrossRef

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Treatment of the Difficult Supracondylar Fracture of the Femur with the Intramedullary Supracondylar Nail: Bum Gu Lee, Yong Ju Kim, Suk Woong Yoon, Shin Young Kang, Jae Hee Cho, Myong Se Jang; J Korean Soc Fract 1996;9(4):943-950. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.943

Abstract PDF: Open reduction and internal fixation should be considered for the AO classification type C supracondylar fracture of the femur. However serious complications such as infection and nonunion can occur after extensive stripping of the soft tissue. We will analyze the usefulness of the intramedullary supracondylar nail for treatment of the 1 cases of the difficult supracondylar fracture such as AO type C fracture, nonunion and supracondylar fracture associated with ipsilateral hip fracture. Follow up period of 7 cases was at least 18 months. 1. 5 cases of 7 were AO type C and 2 cases of 7 were associated with ipsilateral hip fracture. 2. 2 cases of 1 rere nonunion and 2 cases of 7 were grade III open fracture in Gustilo classification. 3. 5 cases of 7 had bone union and average range of motion of the knee was 90 degree. 4. There was no infection, but t case was complicated with the femoral shaft fracture near the proximal nail tip, and 2 cases were complicated with the metal failure at the fracture site resulting nonunion. 5. Intramedullary supracondylar nail was very useful tool for the very difficult supracondylar fracture of the femur due to minimal incision, minimal soft tissue dissection and rigid fixation. But this nail was not available for the proximally extended fracture of the femoral shaft.

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Delayed Management of Supracondylar and Intercondylar Fracture of the Femur Using the Composite Graft(Autograft+Processing Allograft): Young Kyun Woo, Seung Koo Rhee, Soen Yong Kwon, Hwa Sung Lee, Joo Yup Lee; J Korean Soc Fract 1996;9(4):951-957. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.951

Abstract PDF: There are many difficuties and problems to get anatomical reduction and rigid internal fixation in treatment of supracondylar and intercondylar fracture of the fumur. Authors reviewed and clinically analysed 7 patients w.ith svpracondylar and intercondylar fracture of the femur treated by delayed reconstruction from August 1993 to Decfmber 1995. Of 1 cases, there were 5 cases of open and 2 cases of closed fracture. According to AO classification, 7 cases were classified as followed; A3 type-l case, C2 type-4 cases, and C3 type-2 cases. They underwent surgical treatment at average 35 days after injury(range from 25 days to 58 days). Main causes of delay in surgical treatment were poor preoperative condition associated with mulliple injuries in 3 cases, wound problems at the site of open fracture in 3 cases and the combined state in 1 case. For internal fixation of fractures, a supracondylar nail in 4 cases and a dynamic condylar screw in 3 cases were used, and the bony defective area of fracture site in all 1 cases was replaced by the composite graft made of the autogenous cancellous bone and the processing allograft(Tutoplast). The period of follow up was from 8 months to 30 months(average time 14.8 months). There were no infection or allograft-rejection postoperatively. Clinical union was achieved from 6 months to 10 months in 6 cases, and nonunion associated with incomplete incorporation of graft bone was developed in 1 case. In 6 cases of clinical union, clinical assessment estimated by Schatzker and Lamberts criteria was fair in 1 case and failure in 5 cases, and change of tibiofemoral alignment occurred in 2 cases. The above poor clinical results could be considered to be derived from the delayed operative intervention resulting in joint stiffness due to soft tissue contracture, arthritis and large bony defect. In conclusion, even if it showed poor clinical results, the composite graft made of the autogenous cancellous bone and the pmcessing allograft could serve as a possible alternative for restoration of large bony defect in delayed management of supracondylar and intercondylar fracture of the fumur.

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A clinical study of tibial condylar fracture: Kyu Yeol Lee, Myung Soo Lee, Sung Keun Sohn; J Korean Soc Fract 1996;9(4):958-969. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.958

Abstract PDF: The tibial condyle fracture was descirbed first by Cooper in 1825, which involves articular surface of the proximal tibial and often pnduces disabilities of the knee joint due to accompanied by injuries to ligaments and menisci, frequently. There are much controversies in the method of the treatment in the fracture of the tibia condyle, but todays, the anatomical reduction and firm internal fixation is recommanded with early knee motion for good results. The authors analyzed 43 cases of tibia condylar fractures that treated at Department of Orthopaedic Surgery, College of Medicine, Dong-A University from March 1990 to May 1995. The results were obtained as follows: 1. The most common age group was 4th decade. 2. The most common cause of injury was motor vehicle accident in 28 cases(65.1%) and others were slip down, fall down and sports injury, etc. 3. According to Schatzkers classification, thr most common type was type II and VI in 10 cases(23.3%) individually. 4. The most common soft tissue injury was ligament injury in 16 cases(37.2%), and the most common associated fracture was fibular fractures(13 cases). 5. By Porters criteria, 16 cases(76.2%) among 21 conservative cases and 16 cases(12.7%) among 22 operative cases had acceptable results. 6. The most common complication was limit of motion of knee joint(8 cases) and then, traumatic arthritis, angular deformity, infection, joint instability were seen. 7. There was no different result between conseHative and operation method in our study, but we think the simple comparision was meaningless because of the degrees of injury to the objects of the two treatment methods were different. 8. The factors to effect the prognosis were as fellows; the depression, displacement of the fracture, soft tissue injury, anatomical reduction and early knee exercise, etc.

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Operative Treatment of Comminuted Fraeture of the Patella: Yung Khee Chung, Jung Han Yoo, Yong Wook Park, Gyu Cheol Roh; J Korean Soc Fract 1996;9(4):970-976. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.970

Abstract PDF

The patella, lying within the quadriceps tendon mechanism and subcutaneous in position, is susceptible to the effects of both direct and indirect trauma. Patella fractures are intra-articular injuries and have a significant effect on knee function. The tension band wiring technique is widely used for treating fractures of the patella and is often the treatment of choice. We reviewed tweenty nine cases of cemminuted fracture of the patella treated with surgical methods from Jan. 1989 to Mar. 1995 and fellowed up more than one year, from the department of of hopedic surgiry, Kangnam Sacred Heart Hospital, Hallym University. The results were as follows: 1. According to the classincation of Bostman, there were 6 cases(20.7%) of type 1.16(55.2%) of II A, 5(17.2%) of II B and 2(6.9%) of III. 2. Of tweenty nine cases, tweenty six(89.7%) were treated by modified tension band wiring with cerclage wiring (MTBW with CW) and three(10.3%) by partial patellectomy with cerclage wiring(PP with CW). 3. Among tweenty six cases treated with MTBW with CW. tweenty one cases(76.9%) revealed a good or exellent result according to the Cincinnati rating system. 4. Especially, among 5 cases of type II B & 2 cases of type III comminuted fracture treated with MTBW with CW, 5 cases(73.4%) revealed good result. We concluded that the use of modified tension band wiring with cerclage wiring for the comminuted fracture of patella has been shown to be a satisfactory method.

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Results of Tension Band Wiring and Additional Circumferential Wiring in Treatment of Comminuted Patella Fracture
Young Min Lee, Kook Jin Chung, Ji Hyo Hwang, Hong Kyun Kim, Yong Hyun Yoon
Journal of the Korean Fracture Society.2014; 27(3): 206. CrossRef

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Clinical Study of Prognostic Factors in Patellar Fractures: Duck Yun Cho, Hee Chun Kim, Chung Hwan Kim; J Korean Soc Fract 1996;9(4):977-983. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.977

Abstract PDF: Most authors report 70% to 80% good to excellent results following open reduction and internal fixation of fractures of the patella. As with most intraarticular fractures, the prognosis for healing and restoration of function in fractures of the patella is dependent on the amount of articular cartilage damage and exact reduction of fracture. In order to document clinical results and describe any prognostic factors, we evaluated the results of 69 patellar fractures treated in 66 patients who had been treated with open reduction and internal fixation at the Department of Orthopaedic Surgery, Nationanl Medical Center, from January 1990 to December 1994. The average age at the time of surgery was 41.2 years(16 years-75 years) and the average follow-up time was 38.7 months(14 months-74 months). The results were as fellows: 1. The mechanism of injury(traffic accident), concomittant inury of ipsilateral lower extremity, fracture morphology, immgbilization period less than two weeks and accuracy of reduction were significant prognostic factors. 2. Age and method of fixation were not significant prognostic factors. 3. The brisement of knee under general anesthesia was helpful, that had been performed following bony union.

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Treatment of Tibial Plateau Fracture Comparison of Functional and Radiologic End Result: Chang Hyuk Choi, Soo Il Han, Seung Hee Kim; J Korean Soc Fract 1996;9(4):984-992. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.984

Abstract PDF: The aim of treating a tibial plateau fracture is to gain a stable, pain free knee motion, and to repair all associated lesion. Recently a preferred treatment is the open reduction and internal fixation of all displaced and unstable tibial plateau fracture in order to gain anatomic reduction and early knee motion. But functional recovery is relatively impaired in complex knee trauma, despite various treatment modalities. Observations based on long-term radiologicexaminations frequently did not correlate with the functional end results. When choosing the treatment modalities, there are many factors to consider which will influence the final results. Forty-seven cases of tibial plateau fractures were treated from August 1988 to March 1995 and the average follow up period was fouty-eight months. The results were as follows: 1. Of the 47 patients, there were 34 male and 13 female patients, and the mean age was 49 years. 2. Causes of injury were traffic accidents(36 cases), falling down(7 cases), crushing injury(1 case), and others(3 cases), and the left side was more predominant(28 cases) than the right side (39 cases). 3. Treatment modalities were conservative treatment(16 cases), Illizarov external fixators(8 cases), tibial bolt(11 cases) and screw & wire(12 cases). 4. The range of motion of the knee joint averaged 116 degrees and the average start time of the range of motion exercise was 7.8 weeks. In the good to excellent clinical end results groups, there were meaningful statistical differences. 5. There were statiscal differences between type I(88%), II(80%) fractures and type IV(56%), VI(33%) fractures for the clinical end results. 6. We gained better results after treatment of closed fracture and isolated injury cases than open fracture or associated injury cases, but there were no statistical differences. 7. There were no statistical differences on treatment modalities.

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Interlocking Intramedullary Nailing in the Treatment of the Tibial Shaft Fractures: Comparative Study between Reamed and Unreamed Nailing: Jae Hoon Lee, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 1996;9(4):993-1001. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.993

Abstract PDF: Interlocking intramedullary nailing has been popularized by its many advantages in the fracture treatment of long bone compared with the other fixatives. The purpose of this paper was to evaluate the treatment results in the viewpoint of bone union, complication and functional outcomes of the interlocking intramedullary nailing between reamed and unlearned technique in the treatment of tibial shaft fractures. We reviewed 64 tibial shaft fracture that were treated at our hospital from May 1990 to February 1995 with interlorking intramedullary nailing that composed 36 reamed, and 28 unlearned cases. These included 33 open fractures and 34 closed fractures. There was no significant di florences in average prriod of radiologic union, complications and in the functional outcomes between the two treatment grovps(P<0.05). Unlearned interlocking intramedullary nailing in the tibial shaft fractures must be a goof treatment modality by its simplicity, shorter operation time, less probability in pulmonary and throrrlboembolic complications and less comprormised medullary blood supply, especially in patients with multiple trauma or open fractures.

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Angulation Deformity Following Interlocking Nailing for Treaeent of Tibia Fracture: Hong Jun Han, Jae Hoon Shin, Jeong Hyu Lee; J Korean Soc Fract 1996;9(4):1002-1008. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1002

Abstract PDF: Intramedullary nailing is often the treatment of choice in the management of fractures in the tibial diaphysis. With the advent of interlocking nailing, the indication for nailing have expanded, recently. One of the most frequent but little discussed complication of tibial nailing is fracture malalignment leading to angular or rotational deformities. This retrospective study was undertaken to access the incidence of aneular malalignment after interlocking nailing for 210 tibiae(208 patients). The results obtained were as follows; 1. The incidence of angular malalignment was 12.4% 2. The incidence of angular malalignment was 15.8% in proximal one third, 4.1% in middle one third,20.7% in distal one third fractures. 3. The most frequent deformity was valgus angulation in distal one third fractures. 4. Angular deformity was developed more frequently in cases of unlearned nailing(18.9%) than reamed nailing(8.4%). 5. Angular deformity was developed more frequently in cases of double level fracture(22.2%) than single level fracture(11.5%).

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A Treatment for Fracture of the Talar Neck: Kun Yung Lee, Young Kee Lee, Yong Mann Cho, Cheon Dong Lee; J Korean Soc Fract 1996;9(4):1009-1015. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1009

Abstract PDF: The talus has some important anatomic features. Approximately 60% of its surface is cartilage and the talus often has problems with circulation. Talar neck fracture have a high association with osteonecosis and osteoarthritis. Authors have analysed 16 cases of the talar neck fractures treated at Lee-Rha General Hospital from January 1990 to December 1995 with minimal 1 year follow up. The results were as follows; 1. In the 16 cases, there were 14 males and 2 females, the age between 20 and 40 years old was 10 cases(63%). 2. The most common rause of injury was traffic accident(63%), with sudden hyperextension as its mechanism. 3. Associated injuries were 4 malleolar fracutres, 3 calcaneous fractures, 3 spine fractures, 3 tibiofibular fractures and 2 femur fractures. 4. According to the Hawkins classification ; 3 cases in type 1, 4 cases in type II, 5 cases in typeIII, 4 case in type IV fractures were observed. 5. The method of treatment, all 3 cases of Hawkins type I fractures were treated by closed reduction and cast immobilization, 3 cases of Hawkins type II and 1 case of Hawtins type III fracture were treated by closed reduction and internal fixation, other 9 cases were treated by open reduction and internal fixation. 6. Excellent results were observed in 8 cases, good in 5 cases, fair in 2 cases, poor in 1 case with the Hawkinstherapeutic criteria. 7. Complications were observed 3 avascular necrosis, 2 post-traumatic arthritis, 2 ankle stiffness and 1 skin necrosis. From the above results, authors believe that early anatomical reduction & internal fixation is importent to get a satisfactory result in the treatment of tatar neck fracture.

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A treatment for the Fracture-Dislocation of the Talus: Sung Kwan Hwang, Kwang Jong Yoo; J Korean Soc Fract 1996;9(4):1016-1025. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1016

Abstract PDF: Fractures of the talus are uncommon injuries. Because of the unique blood supply and biomechanical features. the complication of the displaced fractures are frequent and long term disabilities are so severe that the importance of proper treatment is emphasized. A clinicaT evaluation of 25 patients with fracture of the talus has been made from January, 1985 to December, 1994 and followed them more than 12 months for each. The result were as follows; 1. There are 20 men and 5 women and the average age was 31.2 years. 2. The common causes of fracture were traffic accidents in 13 cases(52%) and fall from height in 9 cases(32%). 3. According to the classification by Hawkins, four of the fractures were included in type I, eight in type II, six in type III, one in type IV and six in body and process. 4. All 4 cases in type I. 1 case in type II and 4 cases in body and process fractures were treated conservatively, 7 cases in type II, 6 cases in type III, 1 case in type IV and 2 cases in body and process fractures were treated operatively. 5. According to the Hawkins criteria, final result were as follows; excellent in 10 cases, good in 7 cases, fair in 5 cases, poor in 3 cases. 6. Among the operatively treated type II, III, IV, delayed operations wrre performed in type II(2 cases). type III(3 cases). The final results of the delayed operations were good in one case, fair in one cases, poor in three cases. In conclusion, the results of the delayed operation were worse than those of the early operation, so we think that the early operation of talar fracture and dislocation will give good results.

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Clinical Study of the Surgically Treated Fracture-Dislocation of the Talus: Soo Jae Yim, Won Kee Choi, Seung Ryul Yoon, Seok Young Jung, Soo Kyun Rha; J Korean Soc Fract 1996;9(4):1026-1033. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1026

Abstract PDF: Fracture of the talus are relatively uncommon injury, when they occur, however, they are of major importance, because of the relativily heigh frequency of complications and long term disability. Complications such as non-union, avascular necmsis, traumatic arthritis are frequently developed as a late sequele in fracture or fracture-dislocation of the talus because of talar surface is covered mainly with articular ratilage and poor blood supply. Authors have reviewed 19 cases of the talus fracture & fracture-dislocation surgically treated at Soonchunhyang University Kumi Hospital from January 1987 to October 1995 with minimal 1 year follow up period. The result were as follows 1. Of 19 cases, 16 male and 3 female with their average age of 29.8 years. 2. The rause of injury were traffic accident(motor veiheicle accident)-lO/l9 cases (53%), direct trauma-2/l9 cases(11%), sport injury-l/l9 cases(5%) and fall from height-6/l9 cases(32%). 3. The most common concomittant injury was the ipsilateral fracture of the tibiofibular (including medial malleolar fracture)-9/19 cases(47%). 4. According to the hawkinsclassification, 5 cases in type I, 8 cases in type II, 5 cases in type III and 3 cases in type IV. 5. According to the Hawkinstherapeutic criteria, excellent results in 8 cases, good in 1 cases, fair in 3 cases but poor in 1 case. 6. Avascular necrosis was occured in 7 cases(37%) and ankle stiffness in 4 cases(21%) but nonunion was not observed.

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Epidemiology and treatment of The Fractures in Burned Patients: Ho Guen Chang, Woon Hwa Jeong, Ung Joo Lee, Jun Dong Chang, Won Ho Cho, Chang Ju Lee; J Korean Soc Fract 1996;9(4):1034-1038. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1034

Abstract PDF: The fractures in the burned patients is more complicated mechanism. There are controversies in the treatment of the fractures in the burned patients. We analysed the fracture incidence, the type of burn, the mode of injury, the mean burn percentage, the fracture site and the results of treatment of the if fractures in 44 patients selected from 3300 burned patients in Hangang sacred-heart hospital during recent 5 years. The incidence of the fractures in the burned patients was 1.3%, the predominant type of the burn was flame burn(72.7%), the mean burn percentage was 28.7% of the total body surface. The mode of injury mainly consisted of fall down after burn(50%). The most common fracture site was thoracolumbar spine(11 cases). In 12 long bonr fractures, 5 cases(Tibia:3 case, Femur:2 case) were treated with operative method. But, the osteomyelitis was not developed in ail cases. We concluded that the operative treatment is recommended in severe burned fracture patients for pain relief, comfortable wound manage, rigid fixation and early exercise.

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Treatment of Acromioclavieular Dislocation: Comparative Study between Conservative Treatment and Two Operative Method: Chang Hyuk Choi, Chang Jin Kang; J Korean Soc Fract 1996;9(4):1039-1046. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1039

Abstract PDF: We treated 43 cases of the complete dislocation of the acromioclavicular dislocation with the modified Weaber and Dvnn method(22 cases), Phemister method(12 cases) and conservative method(9 cases) from April 1987 to February 1995. The purpose of this study is to compare the clinical and radiological results of two operative method and conservative treatment. The average follow up period was fifty sit months and the results were as follows: 1. Of the 43 patients, there was 34 male and 9 femaie patients, and peak incidence was in 3rd and 4th decades(4775). 2. Cause of injury was fall down (20 cases), traffic accident(12 cases), and slip down(11 cases) and left side was predominent with 26 cases(60%). 3. The functional result by the Weitzmann criteria was Excellent in 15 cases(68%), Good in 5 cases(23%), and Fair in 2 cases(9%) with Modified Weaber and Dunn method, and 8 cases(66%), 2cases(17%),and 2cases(17%) with Phemister method, and 5 cases(55%), 2 cases(23%), and 2cases(23%) with conservative treatment. 4. There were no maior complications that could affect the end results. 5. The functional results were similiar to all treatment modalities, and coracoclavicular interval ratio was well maintained regardless of two operative method, but less complication and more patient satisfaction were after Modifid Weaber and Dunn method.

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Management of Clavicular Shaft Fracture with Open Reduction and Internal Fixation: Hyung Ho Oh, Yoon Chul Cho, Yong Min Kim; J Korean Soc Fract 1996;9(4):1047-1053. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1047

Abstract PDF: Clavicular shaft fracture is one of the most common fractures, which had been managed via conservative methods with some exceptions such as nonunion. Open treatment had been regarded even as important cause of nonunion and poor outcomes. Nowadays, however, the goal of fracture treatment has become anatomical reduction, rigid fixation and early rehabilitation for better final results. According to this principle, we managed 21 clavicular shaft fractures with open reduction and internal fixation(12; plate fixation. 9; intramedullary pinning) since 1991 to 1993. All the fractures united within postoperative 10 weeks(mean 6.4) without any remarkabte complications such as nonunion, infection, and limited shoulder motion. In some intramedullary pinning cases. skin irritation at pin site was troublesome, but disappeared after removal of the pin. Likewise other long bone fractures, open reduction and internal fixation seemed to be one of the useful method in the treatment of clavicular shaft fractures. especially in displaced, and comminuted ones.

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Impaction and Tension-Band Wiring Technique in Proximal Humerus Fractures Accompanying Severe Comminution of Surgical Neck: Sung Il Bin, Sung Jin Cho, Key Yong Kim; J Korean Soc Fract 1996;9(4):1054-1060. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1054

Abstract PDF: Proximal humerus frartures occur most commonly in elderly people, especially with osteoporotic bone. But recently these fractures are also common in younger people due to the increased incidence of trafnc accidents or sports injuries. It is reported that displacement of major fracture fragments can be observed in about 20 percents of proximal humerus fractures and they need some form of surgical treatment. But when there is a sevfre comminution in the area of surgical neck which precludes anatomical reduction, it is almost impossible to obtain rigid fixation and to start an early motion. We reported ten cases of unstable proximal humerus fractures with severe comminution of surgical neck which preclude anatomical reduction and stable rxation and require impaction of the shaft fragment into the head and fixation with multiple pins and tension band wiring. After an arevage follow-up period of 30 months, we obtained the following results: 1. Nine cases out of 10 showed satisfactory results, excellent in 2 cases and good in 7 cases. But there was 1 case in poor. 2. In complications, 2 cases showed transient postoperative subluxation and 3 case showed moderate joint stiffness. But there was no avascular necrosis of humeral head.

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