Journal of Musculoskeletal Trauma

Restoration of Lateral Tibial Plateau Widening and Articular Depression Is Necessary to Prevent Valgus Deformities after Arthroscopic Reduction and Internal Fixation in AO/OTA 41.B2 or B3 Fractures: Jun-Ho Kim, Kang-Il Kim, Sang-Hak Lee, Gwankyu Son, Myung-Seo Kim; J Korean Fract Soc 2024;37(3):125-136. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.125

Abstract PDF: Purpose
This study examined the factors affecting valgus deformities after arthroscopic reduction and internal fixation (ARIF) in lateral joint-depression tibial plateau fractures.
Materials and Methods
Patients with lateral joint-depression tibial plateau fractures treated with ARIF were assessed retrospectively. The radiological evaluations included the articular depression distance (ADD) and the lateral plateau widening distance (LPWD) on preoperative and postoperative computed tomography. A postoperative valgus deformity was defined as valgus malalignment (mechanical axis ≥3°) and valgus deviation (Δmechanical axis of the operated knee from the healthy knee of ≥5°). Subgroup analyses based on a postoperative valgus deformity were performed to compare the clinical outcomes, including the range of motion, patient-reported outcomes measures, and failure and osteoarthritis progression. Furthermore, factors affecting the postoperative mechanical and Δmechanical axes were assessed.
Results
Thirty-nine patients were included with a mean follow-up of 44.6 months (range, 24-106 months). Valgus malalignment and valgus deviation were observed after ARIF in 10 patients (25.6%) and five patients (12.8%), respectively. The clinical outcomes were similar in patients with and without a postoperative valgus deformity. On the other hand, lateral compartment osteoarthritis progression was significantly higher in the valgus deformity group than in the non-valgus deformity group (valgus malalignment group: 50.0% vs 6.9%, p=0.007; valgus deviation group: 60.0% vs 11.8%, p=0.032). One patient with valgus deformity underwent realignment surgery at postoperative five years. The preoperative ADD and postoperative LPWD were significantly associated with the postoperative mechanical (both, p<0.001) and Δmechanical (ADD, p=0.001; LPWD, p=0.025) axes. Moreover, the lateral meniscectomized status during ARIF was significantly associated with the Δmechanical axis (p=0.019).
Conclusion
Osteoarthritis progression was highly prevalent in patients with postoperative valgus deformity. Thus, the restoration of lateral plateau widening and articular depression and preservation of the meniscus are necessary to prevent a valgus deformity after ARIF in lateral joint-depression tibial plateau fractures.

276 View
11 Download

Does the Operator’s Experience Affect the Occurrence of Complications after Distal Radius Fracture Volar Locking Plate Fixation? A Comparative Study of the First Four Years and Thereafter: Kee-Bum Hong, Chi-Hoon Oh, Chae Kwang Lim, Sungwoo Lee, Soo-Hong Han, Jun-Ku Lee; J Musculoskelet Trauma 2024;37(4):175-183. Published online October 25, 2024; DOI: https://doi.org/10.12671/jmt.2024.37.4.175; Correction in: J Musculoskelet Trauma 2025;38(1):40

Purpose
The management of distal radius fractures (DRFs) has evolved with the introduction of volar locking plate (VLP) fixation, offering stable fixation and better outcomes. Nevertheless, the impact of the surgeon’s experience on the complication rates in VLP fixation remains to be determined, particularly for less-experienced surgeons. This study compared the complication rates during the initial four years and subsequent two years of a hand surgeon’s practice of VLP fixation for DRFs.
Materials and Methods
The data between March 2016 and December 2022 were analyzed retrospectively under the Institutional Review Board approval. A single surgeon performed all VLP fixation surgeries after finishing regular hand surgery training, with the first four years representing the less experienced phase (Group 1) and the following two years indicating the experienced phase (Group 2). The patients’ characteristics, operation-related factors, and postoperative complications, including tendon injuries, nerve-related complications, fixation and instrument-related issues, osteosynthesis-related problems, and infections, were compared. In addition, the authors compared the data with a large multicenter study conducted by experienced hand surgeons.
Results
Three hundred and nineteen patients (321 wrists) were included. The mean age was 63.3 years, and 26.3% were male and 73.7% were female. The operation time was 53.7±14.5 minutes and 74.4±26.5 minutes in groups 1 and 2, respectively, which was statistically significantly shorter (p<0.001). The complication rates between the two groups were similar, except for the higher implant removal rates in Group 1. A comparison with a previous multicenter study revealed higher reduction losses and carpal tunnel syndrome in this study, but the overall complication rate was low.
Conclusion
In DRF management, when the operating surgeon has completed an accredited training course, VLP fixation is a good treatment method that can be performed effectively even by less experienced surgeons with low complication rates.

Citations

Citations to this article as recorded by

Author correction: “Does the operator's experience affect the occurrence of complications after distal radius fracture volar locking plate fixation? A comparative study of the first four years and thereafter”
Kee-Bum Hong, Chi-Hoon Oh, Chae Kwang Lim, Sungwoo Lee, Soo-Hong Han, Jun-Ku Lee
Journal of Musculoskeletal Trauma.2025; 38(1): 40. CrossRef

250 View
38 Download
1 Crossref

Acute Compartment Syndrome of Thigh: Ten-Year Experiences from a Level I Trauma Center: Hyung Keun Song, Won-Tae Cho, Wan-Sun Choi, Seung-Yeob Sakong, Sumin Im; J Musculoskelet Trauma 2024;37(4):171-174. Published online October 25, 2024; DOI: https://doi.org/10.12671/jmt.2024.37.4.171

Abstract PDF: Purpose
To assess the demographics, injury mechanisms, treatments, and outcomes of traumatic acute compartment syndrome in the thigh.
Materials and Methods
Patients diagnosed with thigh compartment syndrome were analyzed retrospectively at the authors’ level I trauma center from March 2012 to February 2022. Data were collected from medical and radiological records, focusing on demographics, injury details, treatment timelines, and clinical outcomes.
Results
The cohort included 13 patients (11 males and 2 females) with a mean age of 46 years. Injuries primarily resulted from falls (6 patients) and vehicle accidents (5 patients). Fractures were noted in 11 patients, with seven involving the lower extremities and seven having open fractures; three of these were severe enough to be classified as Gustilo–Anderson type IIIc with associated femoral artery injuries. Time from the injury to fasciotomy ranged from within six hours to more than 24 hours. Fasciotomies were mainly single-sided (10 patients), targeting primarily the anterior compartments, and bilateral in three cases. Wound closures were performed using delayed primary closure (four patients) and partial- thickness skin grafts (five patients). Two patients died from multi-organ failure; other complications included infections (three patients), amputations (three patients), and long-term disabilities like drop foot (two patients), sensory deficits, joint stiffness (eight patients), and fracture non-unions requiring additional surgery (two patients).
Conclusion
Thigh-compartment syndrome, though infrequent, poses significant risks of mortality and chronic disability. This underscores the importance of prompt diagnosis and intervention.

249 View
27 Download

Fragility Fractures of the Pelvis and Sacrum: Se-Won Lee, Ju-Yeong Kim; J Korean Fract Soc 2023;36(1):29-38. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.29

Abstract PDF: The incidence of fragility fractures of the pelvis (FFP) has increased significantly due to the aging popu-lation and improved diagnostic modalities. The evaluation and treatment of these patients differ from that of high-energy pelvic ring injuries typically seen in younger patients. Therefore, it is important to classify the FFP by patterns of the classification system to standardize optimal treatment criteria and appropriate treatment strategy. However, some cases are not classifiable according to the FFP classifi-cation. A newly proposed classification that can be verified by comparing existing FFP classifications is needed to overcome the weak points. Non-operative treatment is usually considered first and should focus on early mobilization. Operative fixation should focus on stabilizing the minimally invasive pelvic ring than the reduction of fractures to facilitate early mobilization and avoid complications that can arise from comorbidities associated with immobility.

180 View
1 Download

A new milestone: launching the Journal of Musculoskeletal Trauma to foster global orthopaedic trauma collaboration: Kang-il Kim; J Musculoskelet Trauma 2025;38(1):1-2. Published online December 27, 2024; DOI: https://doi.org/10.12671/jmt.2025.00001

PDF

153 View
15 Download

Effect of Coincident Hip Fracture on Distal Radius Fracture in Patients Treated with a Volar Locking Plate: A Matched-Pair Analysis of Elderly Patients: Hyoung-Seok Jung, Min-Su Chu, Jae-Sung Lee; J Korean Fract Soc 2024;37(3):137-143. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.137

Abstract PDF: Purpose
Although the incidence of simultaneous distal radius and hip fractures in older patients is minimal, patients with these coincident types of fractures exhibit unique features. This study analyzed the outcomes associated with operative treatment involving volar-locking plates in patients who sustained distal radius fractures and hip fractures and compared them with those in matched control patients who had undergone treatment for isolated distal radius fractures.
Materials and Methods
Between 2010 and 2015, 34 patients, who met the criteria for hip and distal radius fractures, were retrospectively reviewed. Thirty-four matched patients who underwent volarlocking plate fixation for isolated distal radius fractures during the same period were also reviewed. The clinical outcomes between the groups were compared using postoperative radiological parameters.
Results
The radiological assessment revealed a better radial length and inclination in the control group than in the study group at the final follow-up. In other words, patients with coincident hip fractures showed a higher tendency for loss of reduction. Despite the differences in radiological parameters, no significant differences in clinical outcomes were observed, except for grip strength.
Conclusion
Although volar-locking plating provides greater stabilization, a loss of reduction occurred in patients with coincident hip fractures.

145 View
8 Download

Introducing the Journal of Musculoskeletal Trauma: Jae Ang Sim; J Musculoskelet Trauma 2025;38(1):3-4. Published online December 27, 2024; DOI: https://doi.org/10.12671/jmt.2025.00002

PDF

128 View
9 Download

Outcomes of open reduction and internal fixation using 2.0/2.4 mm locking compression plate in isolated greater tuberosity fractures of humerus: Sung Choi, Dongju Shin, Sangwoo Kim, Byung Hoon Kwack; J Musculoskelet Trauma 2025;38(1):32-39. Published online January 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00005

Abstract PDF: Background
The purpose of this study was to retrospectively evaluate the radiographic and clinical results of a small single or double low-profile plate fixation of 2.0/2.4 mm locking compression plate (LCP) in treating isolated greater tuberosity (GT) fractures of the humerus. Methods: From June 2015 to October 2022, patients who underwent LCP in treating isolated GT fractures of the humerus were included in this study. The radiological and clinical results were analyzed in 15 patients who underwent open reduction and internal fixation used 2.0/2.4 mm LCP. Results: Bone union was achieved in 14 patients (93.3%) and one failed case was treated with a 2.4 mm single LCP fixation. Radiological union was achieved within 10–20 weeks. Complications occurred in two patients (13.3%), including the reduction failure and shoulder stiffness. At the final follow-up, the average clinical scores were as follows: a visual analog scale for pain of 2.1 (range, 0–5) and a University of California, Los Angeles score of 27.2 (range, 18–31). Regarding range of motion (ROM), the average active ROMs were 142° for forward flexion (range, 120°–150°), 147.1° for abduction (range, 120°– 180°), and 59.3° for external rotation (range, 45°–80°). For internal rotation, the average was observed to reach the 10th thoracic vertebra (range, 1st lumbar vertebra–7th thoracic vertebra). Conclusions: The clinical and radiologic outcomes of treating isolated GT fracture using 2.0/2.4 mm LCP were favorable, and double low-profile plate fixation may be beneficial for sufficient fracture stability if possible. Level of evidence: Level IV, case series.

121 View
13 Download

Easily missed nondisplaced fractures accompanying complete fractures in the lower extremity and pelvis: a narrative review: Young-Chang Park; J Musculoskelet Trauma 2025;38(1):5-12. Published online January 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00017

Abstract PDF: Nondisplaced fractures accompanying complete fractures are often difficult to detect on plain radiographs or computed tomography scans, posing a diagnostic challenge. The diagnosis of these frequently overlooked injuries can be delayed, potentially leading to suboptimal patient outcomes. This review discusses four commonly missed fracture patterns in the lower extremity and pelvis, including posterior involvement in fragility fractures of the pelvis, intertrochanteric extensions in isolated greater trochanter fractures, ipsilateral femoral neck fractures in high energy femoral shaft fractures, and posterior malleolar fractures in distal spiral tibial shaft fractures. An accurate diagnosis of these accompanying nondisplaced fractures is critical for optimizing surgical outcomes. Surgeons should incorporate thorough preoperative evaluations into their clinical practice to facilitate early detection and appropriate treatment strategies. Prompt identification and comprehensive management remain essential for improving patient outcomes.

118 View
19 Download

The clinical outcome of treating elderly distal radius fractures by long volar locking plate with the elimination of irreducible metaphyseal comminuted volar cortical fragments: a retrospective case series: Soo Min Cha; J Musculoskelet Trauma 2025;38(1):13-22. Published online January 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00003

Abstract PDF: Background
In severe comminuted metaphyseal distal radius fracture (DRF) of elderly patients, after maintaining only radiological parameters of the radius using long volar locking plates (VLPs), we inevitably eliminated a few volar cortical fragments of metaphysis. Here, we report the final radiological and clinical outcomes of our method. Methods: For the patients who were treated between 2014 and 2018, the demographic factors, the preoperative radiologic factors, area of the eliminated volar cortical fragment, and final radiologic parameter, were evaluated. Clinical outcomes and ranges of active motion were evaluated. Results: In total, 31 patients were included. The mean patient age was 77.3 years and the mean eliminated cortical area was 3.30 cm2. At the final follow-up, the mean volar tilt, radial inclination, articular step-off, and ulnar variance were 10.35°, 20.00°, 0.58 mm, and 0.71 mm, respectively. There were no definitive correlations between bone mineral density, fragment area, the largest cortical fragment diameter ratio and differences in final and immediate postoperative measurements of these radiological parameters, respectively. Visual analog scale and disabilities of the arm, shoulder, and hand (DASH) scores were satisfactory, and the mean arcs of flexion-extension and pronation-supination were 124.35° and 133.23°. Clinical outcomes were not significantly different according to the AO system category. Conclusions: For maintenance of radiological parameters of the radius, long VLPs are useful in older patients with DRFs who exhibit volar metaphyseal comminution, despite concurrent ulnar fractures. Inevitable elimination of irreducible free comminuted cortical fragments when filling the defect does not affect final radiological and clinical outcomes. Level of evidence: Level IV, case series.

115 View
15 Download

Biomechanical Investigation to Establish Stable Fixation Strategies for Distal Tibial Fractures in Various Situations: Finite Element Analysis Studies: Sung Hun Yang, Jun Young Lee, Gu-Hee Jung, Hyoung Tae Kim, Ba Woo Ko; J Korean Fract Soc 2024;37(2):71-81. Published online April 30, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.2.71

Abstract PDF: Purpose
This study examined the structural and mechanical stability as well as the clinical significance of various fixation constructs for distal tibial fractures using finite element analysis.
Materials and Methods
Fracture models with 20 mm and 120 mm defects were produced, and implants of an intramedullary nail and anatomical plate model were applied. An axial load of 800 N with 60% distribution in the medial compartment and 40% in the lateral compartment was applied and analyzed using Ansys^® software.
Results
In the intramedullary nail model, the maximum von Mises stress occurred at the primary lag screw hole and adjacent medial cortex, while in the plate model, it occurred at the locking holes around the fracture. The maximum shear stress on the bone and metal implant in the fracture model with a 20 mm defect was highest in the plate assembly model, and in the fracture model with a 120 mm defect, it was highest in the two-lag screw assembly model.
Conclusion
Based on an analysis of the maximum shear stress distribution, securing the fixation strength of the primary lag screw hole is crucial, and the assembly model of the intramedullary nail with two lag screws and a blocking screw applied was the model that best withstood the optimal load. Securing the locking hole directly above the fracture is believed to provide the maximum fixation strength because the maximum pressure in the plate model is concentrated in the proximal locking hole and the surrounding cortex.

108 View
6 Download

Fluid Management of Trauma Patients: Yo Huh, Jaeri Yoo; J Korean Fract Soc 2023;36(2):69-76. Published online April 30, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.2.69

Abstract PDF

Fluid therapy is one of the fundamental treatments for the management of trauma patients. Apart from supplementary hydration, fluid therapy is also applied for resuscitation. Especially in cases of hypovolemic shock due to bleeding, fluid therapy needs to be carefully adjusted to correct the shock. The importance of fluid therapy is increasing not only in resuscitation and treatment after hospitalization but also in pre-hospital care. Fluid therapy needs to be adjusted based depending each patient’s volume status. The various classifications of fluids include crystalloid solutions, glucose solutions, and colloid solutions. Although not included as a fluid therapy, blood transfusion is increasingly gaining more importance than fluid therapy in unstable trauma patients. Early appropriate fluid therapy is crucial in the treatment of hemodynamically unstable patients such as multiple trauma and massive bleeding, whereas comprehensive fluid therapy should be applied by considering the characteristics of specific injuries such as fractures, vascular damage, and cerebral hemorrhage, as well as the age groups (children, the elderly, and pregnant women).

Citations

Citations to this article as recorded by

Effectiveness of the Eye Care Protocol in the Intensive Care Unit Patients: A Randomized Controlled Trial
Kyu Won Lim, Shin Young Ha, In Soon Kang
Journal of Korean Academy of Nursing.2024; 54(3): 432. CrossRef

100 View
5 Download
1 Crossref

Prediction of Syndesmotic Instability according to the Lateral Malleolus Fracture Pattern in Supination-External Rotation Type Ankle Fractures: Short Oblique versus Long Oblique Fracture: Chan-Jin Park, Min-Su Lee, Keun-Bae Lee; J Korean Fract Soc 2024;37(1):39-45. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.39

Abstract PDF: Purpose
This study examined whether preoperative radiological evaluations can predict syndesmotic instability according to the lateral malleolus fracture pattern in supination-external rotation-type ankle fractures.
Materials and Methods
This study enrolled 132 patients (132 ankles) with supination-external rotation stage 3 and 4 ankle fractures. Three-dimensional computed tomography was used for the morphological classification of the lateral malleolus fractures. A long oblique fracture was defined when the posterior cortical bone height of the fracture was 4.5 cm or more from the plafond of the distal tibial articular surface. A short oblique fracture was defined when the height was less than 4.5 cm. The demographic characteristics and syndesmotic instability of the two groups were evaluated.
Results
Short oblique fractures were confirmed in 102 cases, and long oblique fractures were confirmed in 30 cases. Long oblique fractures occurred at a statistically significantly higher incidence in younger ages and among males compared to short oblique fractures. Syndesmotic instability was more common in long oblique fractures.
Conclusion
In supination-external rotation-type ankle fractures, syndesmotic instability was observed in approximately 13%. Specifically, when the fracture pattern of the lateral malleolus is long oblique, the incidence of syndesmotic instability is approximately three times higher than in short oblique fractures. Therefore, meticulous evaluations of the lateral malleolus fracture pattern and establishing an appropriate treatment plan before surgery are crucial.

93 View
3 Download

Crush Syndrome: Traumatic Rhabdomyolysis, Reperfusion Injury: Yong-Cheol Yoon; J Korean Fract Soc 2023;36(2):62-68. Published online April 30, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.2.62

Abstract PDF: A crush injury causes damage to bones, muscles, blood vessels, nerves, and other tissues caused due to pressure. Crush syndrome is a reperfusion injury that occurs throughout the body after a crush injury and leads to traumatic rhabdomyolysis, in which muscle fibers are broken down. Owing to the decreased blood supply, inflammation, and changes in metabolic activity, fluids and electrolytes in the blood can move into tissues, causing hypovolemic shock. In addition, toxic substances resulting from cell destruction can circulate through the bloodstream, causing electrolyte imbalances, renal failure, arrhythmias, and cardiac arrest, with approximately 15% of patients with acute renal failure dying. The treatment for crush syndrome involves aggressive fluid therapy and correction of the electrolyte imbalances, while patients with acute renal failure may require dialysis. Surgical treatment may include debridement and irrigation of necrotic tissue, and fasciotomy is necessary to address compartment syndrome, a complication that may arise.

93 View
3 Download

Avulsion Fractures around the Hip Joint and Pelvis: Ha-Yong Kim, Hajun Jang, Jung-Taek Kim, Jin-Woo Kim, Jun-Il Yoo, Won-Sik Choy, Yonghan Cha; J Korean Fract Soc 2024;37(3):150-157. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.150

Abstract PDF: Avulsion fractures occur when tendons or ligaments are subjected to forces greater than they can withstand at the apophysis or enthesis, regardless of the fusion status. Given the diverse muscular structures around the pelvis and hip joint, which serve as origins for multiple muscles leading to the lower extremities, these areas are vulnerable to such injuries. Pelvic avulsion fractures commonly af-fect young athletes, but they can also occur in adults. Diagnosis typically involves assessing the trauma history, clinical examination, and radiographic imaging. In cases of unclear diagnosis, additional tests, such as computed tomography or magnetic resonance imaging, may assist in treatment decisions and diagnosis. Although most avulsion fractures respond well to conservative treatment, surgical interven-tion may be preferred in severe displacements, significant retraction in active athletes, or when a faster recovery is necessary. Chronic or neglected injuries may lead to excessive osseous formation around the pelvis, causing impingement syndromes. Recognizing the characteristic radiological findings based on the pelvic anatomy aids in accurate diagnosis because chronic injuries might mimic tumors or infectious conditions, necessitating a careful differential diagnosis.

89 View
3 Download

Triplane Fracture Management: Prediction of Periosteal Entrapment and the Need for Open Reduction by Measurements of the Physeal Fracture Gap in Preoperative Computed Tomography Scans: Dae Hee Lee, Joo Han Kwon, Jae Uk Jung; J Korean Fract Soc 2024;37(1):1-7. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.1

Abstract PDF: Purpose
This study measured the physeal fracture gap on preoperative ankle computed tomography (CT) to predict the periosteal entrapment that requires an open reduction in distal tibia triplane fractures.
Materials and Methods
This study retrospectively reviewed patients who had undergone internal fixation for a triplane fracture from April 2004 to September 2022. The demographic data, including age,body mass index, and past medical history, were analyzed. In the radiographic evaluations, ankle CT and ankle simple radiographs, including anteroposterior (AP), lateral, and mortise views, were taken preoperatively. Postoperatively, simple ankle radiographs were obtained periodically, including AP, mortise, and lateral views. The physeal fracture gap was measured on ankle CT, and the larger gap between the coronal and sagittal view of CT was selected. The residual physeal gap <2 mm was considered an adequate reduction.
Results
Of 17 cases, three demonstrated successful reduction using closed reduction techniques. Periosteal entrapment was observed in 14 cases open reduction cases. In all three closed reduction cases, the physeal gap estimated on preoperative ankle CT was under 3 mm with a mean gap of 2.4±0.2 mm (range, 2.1-2.5 mm). In the remaining 14 open reduction cases, the measured physeal gap was over 3 mm, averaging 5.0±2.7 mm (range, 3.1-12.2 mm). There was a significant difference in the preoperative physeal gap between the two groups (p<0.01). Overall, good reduction was achieved in all 17 cases; the postoperative physeal gap was under 2 mm with a mean of 1.0±0.5 mm (closed reduction group, 0.5±0.2 mm; open reduction group, 1.1±0.5 mm).
Conclusion
Open reduction is strongly recommended for triplane fractures with a physeal fracture gap of 3 mm or more in preoperative ankle CT, suggesting the possibility of an entrapped periosteum in the fracture gap.

88 View
4 Download

Avulsion Fractures of around the Hand: Dong Whan Kim, Jung Il Lee; J Korean Fract Soc 2024;37(3):158-168. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.158

Abstract PDF: An avulsion fracture occurs when soft tissues, including the tendons and ligaments, are forcibly detached from the main bone by an external force. The hand contains numerous anatomical structures, such as ligaments, tendons, and volar plates, which are essential for maintaining multidirectional motion and joint stability. Excessive force applied in a specific direction can damage these structures, leading to avulsion fractures around the joint. These fractures can result in severe complications if left untreated or improperly managed, including joint deformity, contracture, nonunion or malunion of the fracture, secondary osteoarthritis, and limited range of motion. Therefore, an accurate examination, diagnosis, and appropriate treatment are crucial for preventing these adverse outcomes. An avulsion fracture can be managed conservatively when the avulsed fragment does not compromise joint stability or motion. Nevertheless, surgical intervention is required to stabilize the fragment if it affects joint stability or motion. The use of internal fixation has become more prevalent because of recent advances in small implants for fixation.

88 View
4 Download

The Efficiency of Radiation Shielding Sheet to Reduce Radiation Exposure during C-arm Fluoroscopy: Hosang Jeon, Won Chul Shin, Hee Yun Seol, Yongkan Ki, Kyeong Baek Kim, Ki Seok Choo, Sang Don Lee, Suk-Woong Kang; J Korean Fract Soc 2023;36(4):111-117. Published online October 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.4.111

Abstract PDF: Purpose
This study evaluates the radiation shielding performance of a new lead-free tungsten-based sheet to reduce the radiation exposure of operators and patients under C-arm fluoroscopy.
Materials and Methods
A non-lead radiation shielding sheet (ROO201128; Pentas, Korea) was fabri-cated using tungsten and bismuth. The dose measurements were conducted using a C-arm fluoroscopy machine at 64 kVp and 1.5 mA, assuming two possible scenarios according to the position of the sheet. In each scenario, measurements were conducted at three distances (30, 60, and 90 cm) away from the beam center and in three directions (cephal, caudal, and operator’s direction).
Results
In the area within a radius of 60 cm from the beam center, the measured doses were reduced by 66.3% on mean, and the doses measured at distances more than 60 cm were less than 0.1 mSv/h in both scenarios. The most beneficial utilization of the lead-free shielding sheet was verified during C-arm fluoroscopy by placing the sheet on the X-ray tube. The operator’s radiation exposure was reduced by 56.6% when the sheet was placed under the phantom, and by 81.0% when the sheet was placed on the X-ray tube.
Conclusion
The use of lead-free radiation shielding sheets under C-arm fluoroscopy was effective in reducing radiation exposure, and the most beneficial scenario in which the sheet can be utilized was verified when the sheet was placed on the X-ray tube.

86 View
3 Download

Comparison of Results between Minimally Invasive Plate Fixation and Antegrade Intramedullary Nailing of Recon-Type in Low-Energy Injury Distal Femoral Shaft Fractures: Hong Moon Sohn, Gwangchul Lee, Ba Rom Kim, Jung Soo Oh; J Korean Fract Soc 2024;37(2):87-94. Published online April 30, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.2.87

Abstract PDF: Purpose
This study compared the outcomes of minimally invasive plate osteosynthesis and antegrade intramedullary nailing for low-energy fracture of the distal femoral shaft.
Materials and Methods
A study was conducted on 30 patients who underwent surgery for low-energy fractures of the distal femoral shaft between January 2016 and April 2022. The study compared 15patients who underwent minimally invasive plate osteosynthesis (Group P) with 15 patients who underwent recon-type antegrade intramedullary nailing (Group N). We evaluated intraoperative blood loss, operative time, C-arm exposure time, bone density, final union status, anatomical reduction, and clinical evaluation. The complications were also examined, and statistical analysis was conducted to compare the two groups.
Results
The blood loss, surgery time, and C-arm time were similar in the two groups. The radiographic assessments and clinical evaluations were also similar in the two groups. The clinical results showed no difference between the groups. Group N had one case of nonunion and one case of delayed union, while Group P had one case of nonunion and one case of peri-prosthetic fracture.
Conclusion
Antegrade intramedullary nailing of the recon-type demonstrated comparable results to minimally invasive plate osteosynthesis. Hence, antegrade intramedullary nailing of the recon-type, which enhances stability by fixing the entire femur and providing additional fixation in the distal portion, is deemed appropriate for treating distal femoral shaft fractures.

86 View
3 Download

Interpositional tricortical iliac bone graft in nonunion of midshaft clavicular fractures: Eun-Seok Son, Bum-Soon Park, Chang-Jin Yon, Chul-Hyun Cho; J Musculoskelet Trauma 2025;38(1):23-31. Published online January 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00004

Abstract PDF: Background
The purpose of this study was to investigate the radiological and clinical outcomes after interpositional tricortical iliac bone graft with plate fixation for the nonunion of clavicle midshaft fractures. Methods: Between 2007 and 2020, 17 cases who were treated by interpositional tricortical iliac bone graft with plate fixation for the clavicle midshaft nonunion combined with bone defect were investigated. The mean age was 53 years (range, 22–70 years). The mean follow-up period was 102.2 months (range, 18–193 months). Serial plain radiographs were used to evaluate radiological outcomes. The University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and Quick-disabilities of the arm, shoulder, and hand (DASH) score were used to evaluate clinical outcomes. Complications were also evaluated. Results: All cases achieved complete bony union with mean healing time of 17.6 weeks (range, 14–22 weeks). The mean clavicle length difference was significantly decreased from 9.1 mm preoperatively to 2.6 mm postoperatively (P<0.001). The mean UCLA and ASES scores were significantly improved from 18.1 and 52.2 before surgery to 30.6 and 88.6 after surgery (both P<0.001), respectively. The mean final Quick-DASH score was 18.0. Three cases (17.6%) developed postoperative complications including two cases of shoulder stiffness and one case of screw irritation. Conclusions: Interpositional tricortical iliac bone graft with plate fixation for the clavicle midshaft nonunion demonstrated excellent radiological and clinical outcomes. In cases of atrophic nonunion combined with bone defect, this technique is an effective option that can provide structural support and restore clavicle length. Level of evidence: Level IV, case series.

84 View
10 Download

Analysis of Missed Fractures by Bone Scan in Elderly Hip Fracture Patients with Osteoporosis: Tae Hun Lee, Yeong Hyun Lee, Seo Won Kang; J Korean Fract Soc 2024;37(3):144-149. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.144

Abstract PDF: Purpose
The incidence of hip fractures is increasing due to an increase in elderly populations because elderly patients often have accompanying diseases, such as cognitive impairment or dementia, which may lead to missed fractures. Therefore, this study assessed the utility of bone scans in detecting missed fractures in elderly patients.
Materials and Methods
This study analyzed the data from 178 patients treated from January 2014 to March 2023. The inclusion criteria were patients who had hip fractures with osteoporosis over 70 years old. Bone scans were performed on average 10 days after injury. The rate and trend of missed fractures not detected in the initial diagnosis were determined based on sex, age, dementia status, and the presence of osteoporosis.
Results
Among the 178 hip fracture patients over 70 years old, 37 patients had a history of being diagnosed with dementia, and 141 patients had never been diagnosed. Missed fractures were confirmed in 49 cases (42 patients) (23.6%). The dementia group had 13 missed fractures, and the non-dementia group had 36 missed fractures, but there was no significant difference. Rib fractures were most common, followed by vertebral fractures.
Conclusion
Missed diagnoses of fractures were common among elderly hip fracture patients. A whole body bone scan appeared to be effective in detecting missed fractures. Therefore, identifying accompanying fractures through bone scans and delivering appropriate treatment can play an important role in postoperative rehabilitation.

83 View
2 Download

Computational Simulation of Femoral Neck System and Additional Cannulated Screws Fixation for Unstable Femoral Neck Fractures and the Biomechanical Features for Clinical Applications: Ju-Yeong Kim; J Korean Fract Soc 2023;36(1):1-9. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.1

Abstract PDF: Purpose
To identify the biomechanical features for clinical applications through a computational simulation of the fixation of the Femoral Neck System (FNS) with additional cannulated screws for a Pauwels type III femoral neck fractures.
Materials and Methods
Thirty cadaveric femurs underwent computed tomography, and the images were transferred to the Mimics^® program, resulting in three-dimensional proximal femur models. A three-dimensional scan of the FNS and 6.5 mm and 7.0 mm cannulated screws was performed to enable computerized virtual fixation of FNS with additional cannulated screws for unstable femoral neck fractures. Furthermore, the cannulated screw used for additional fixation was modeled and used as a cylinder within the Ansys program. The biomechanical characteristics of these models were investigated by applying a physiological load virtually.
Results
The maximum von Mises stress value at bone was 380.14 MPa in FNS and 297.87 MPa in FNS+7.0 mm full-thread cannulated screw. The maximum von Mises stress value at FNS was 786.83 MPa in FNS and 435.62 MPa in FNS+7.0 mm full-thread cannulated screw. The FNS group showed the highest maximum von Mises stress values at bone and FNS. For total deformation, the maximum deformation value was 10.0420 mm in FNS and 9.2769 mm in FNS+7.0 mm full-thread cannulated screws. The FNS group represented the highest maximum deformation compared to the other groups.
Conclusion
Considering the anatomical spatiality and biomechanical characteristics of the FNS in unstable femoral neck fractures, when one 7.0 mm full thread cannulated screw was also fixed to the anterosuperior portion of the FNS, significant biomechanical stability was demonstrated.

82 View
3 Download

Author correction: “Does the operator's experience affect the occurrence of complications after distal radius fracture volar locking plate fixation? A comparative study of the first four years and thereafter”: Kee-Bum Hong, Chi-Hoon Oh, Chae Kwang Lim, Sungwoo Lee, Soo-Hong Han, Jun-Ku Lee; J Musculoskelet Trauma 2025;38(1):40-40. Published online January 24, 2025; DOI: https://doi.org/10.12671/jmt.2024.37.4.175.e1; Corrects: J Musculoskelet Trauma 2024;37(4):175

PDF

81 View
7 Download

Treatment of Avulsion Fractures around the Knee: Sumin Lim; J Korean Fract Soc 2024;37(2):117-124. Published online April 30, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.2.117

Abstract PDF: Avulsion fractures are common in athletes and result from high-impact or sudden, forceful movements involving the separation of a bone fragment at the ligament or tendon attachment site. The key focus areas include the anterior and posterior cruciate ligaments, medial collateral ligament, anterolateral complex, arcuate complex, medial patellofemoral ligament, patellar tendon, and quadriceps tendon. Diagnostic approaches combine radiography with advanced imaging techniques, such as computed tomography and magnetic resonance imaging, to elucidate the extent of injury and guide treatment decisions. Treatment ranges from conservative management for non-displaced fractures to surgical intervention for displaced fractures, with strategies customized based on the specific ligament involved and the nature of the fracture.

81 View
0 Download

Complications of Hand Fractures and Its Prevention: Jong Woo Kang; J Korean Fract Soc 2024;37(1):46-51. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.46

Abstract PDF: Complications of hand fractures occur regardless of the methods used for their treatment. The treatment is also challenging. The most common and troublesome complications of hand fractures are malunion, finger stiffness, and consequent functional impairment. Early recognition and meticulous treatment of these complications is essential for improvement in hand function and satisfaction. Most of all, surgeons should clearly understand that prevention of complications is the easiest way to ensure a satisfactory outcome in hand fractures.

77 View
1 Download

Short-term Treatment Comparison of Teriparatide and Percutaneous Vertebroplasty in Patients with Acute Osteoporotic Vertebral Compression Fractures: Joonoh Seo, Ki Youn Kwon, Bumseok Lee, Hoon-Sang Sohn; J Korean Fract Soc 2024;37(1):15-21. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.15

Abstract PDF: Purpose
This study compared the 3-month treatment effects of teriparatide and percutaneous vertebroplasty for acute osteoporotic vertebral compression fractures.
Materials and Methods
A retrospective study was conducted on 76 patients diagnosed with acute osteoporotic vertebral compression fractures from January 1, 2020 to December 31, 2022. The patients were divided into the teriparatide group and the percutaneous vertebroplasty+alendronate group. The visual analog scale (VAS), Oswestry disability index (ODI), and height of the vertebrae anterior wall were measured before treatment and at 1 and 3 months after treatment.
Results
Of the 76 patients, 42 were treated with teriparatide, and 34 were treated with percutaneous vertebroplasty. The symptoms improved in both groups, with a decrease in the VAS and ODI scores at 1 and 3 months after treatment, respectively. On the other hand, there was no significant difference in the VAS, ODI score, and anterior vertebral body height between the two groups before treatment and at 1 and 3 months after treatment.
Conclusion
In the treatment of acute osteoporotic vertebral compression fractures, conservative treatment using teriparatide showed similar short-term (3 months) treatment results to percutaneous vertebroplasty in terms of improvement in back pain and function and degree of reduction in anterior vertebral body height.

77 View
7 Download

Single Percutaneous Retrograde Anterior Column Screw Fixation in a Minimally Displaced Transverse Acetabular Fracture - A Case Report -: Seungyup Shin, Jinkyu Park, Sungho Lee; J Korean Fract Soc 2023;36(2):57-61. Published online April 30, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.2.57

Abstract PDF: According to the Letournel classification, a transverse fracture is the only elementary fracture pattern that breaks both the anterior and posterior border of the innominate bone. A transverse acetabular fracture separates the innominate bone into two segments: the iliac segment and the ischiopubic segment. Therefore, minimally displaced transverse fractures can be stabilized by purchasing both segments with a large-diameter single screw. Although it is not a stable internal fixation construct compared with plates and screws, it provides sufficient stability to promote early mobilization and early weight-bearing while minimizing the risk of secondary displacement and preventing secondary complications associated with prolonged bed rest and immobilization. The authors successfully treated a case of minimally displaced transverse acetabular fracture with percutaneous column fixation using a retrograde fashion of a single anterior column screw. This report discusses the case with a literature review and deliberates the usefulness of the procedure.

77 View
1 Download

Checkrein Deformity after Fracture: Jungtae Ahn, Gu-Hee Jung; J Korean Fract Soc 2024;37(1):60-68. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.60

Abstract PDF: Checkrein deformity has dynamic characteristics in which the degree of extension contracture of the metatarsophalangeal joint and flexion contracture of the interphalangeal joint change according to the movement of the ankle joint. Although the primary lesion is the flexor hallucis longus, several clinical features exist because of the accessory connection with the flexor tendon of other toes. After a physical diagnosis, a radiological examination should be performed to determine the cause and location of adhesion. Moreover, it is vital to determine if it is direct adhesion to the tendon tissue or muscle contracture due to ischemic muscle damage. Although there are no clear guidelines for surgical treatment, it can be divided broadly into two methods: soft tissue release and Z-plasty performed through direct access to the lesion site or indirect access through the tarsal tunnel or medial midfoot approach. Direct tendon tissue release surgery should be attempted if the tendon tissue is locally attached to the fracture callus or specific soft tissue. On the other hand, operation on the lesion site should be performed first if the checkrein deformity occurred due to an implant or bone fragments, followed by release surgery. If muscle contracture and movement are limited due to ischemic damage, surgery should be performed to remove adhesions and additional tendon connections around the flexor hallucis longus and digitorum longus by approaching through the tarsal canal and the medial side of the midfoot. The fixed contractures of the metatarsophalangeal and interphalangeal joints should be addressed if the limitations of tendon excursion are identified despite the release techniques.

76 View
5 Download

Fracture-Related Complication: Fat Embolism Syndrome: Beom-Soo Kim; J Korean Fract Soc 2023;36(3):95-102. Published online July 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.3.95

Abstract PDF: Fat embolization is a common occurrence after trauma or during orthopedic procedures involving intramedullary manipulation. Although uncommon, fat embolism syndrome (FES) with respiratory failure, neurologic dysfunction, and petechial rash can be fatal to patients. Two theories are proposed for the manifestation of FES: in the mechanical theory, FES occurs when fat tissue in the bone marrow enters the bloodstream and mechanically blocks it; the biochemical theory proposes that FES occurs due to an inflammatory reaction caused by free fatty acids. There are currently no clear diagnostic criteria for FES, and symptoms and signs are typically nonspecific. For the treatment of FES, conservative and supportive management is performed for the specific symptoms, and close monitoring of the respiratory and neurologic systems is required in high-risk groups. Early fracture fixation of long bones helps prevent and reduce the severity of fat embolism.

74 View
0 Download

Demographic and Radiographic Parameters as Predictors of Reduction Loss after Conservative Treatment of Distal Radius Fractures in Adults: Kyu Jin Kim, Dae Won Shin, Seong Kee Shin; J Korean Fract Soc 2023;36(2):45-51. Published online April 30, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.2.45

Abstract PDF: Purpose
This study examined the demographic and radiological risk factors for later reduction loss of distal radius fractures treated conservatively. Materials and Methods This study enrolled patients treated for distal radius fractures between January 2017 and December 2019. Seventy-eight patients were included in the analysis and divided into two groups. The patients who showed minimal reduction loss within an acceptable radiologic angle after initial manual reduction were classified as Group A. The patients who showed reduction loss out of an acceptable radiologic angle and finally malunited or converted to surgical treatments were classified as Group B. The patient’s age and bone marrow density were used as demographic data. The initial X-ray images were evaluated to determine the fracture type. Various radiological parameters were measured. Results The 78-patient study cohort consisted of nine men and 69 women with a mean age of 67 years. Forty-eight cases were sorted into Group A, and 30 cases into Group B. On logistic regression analysis, the age of 80 or older was a risk factor for later fracture displacement among the demographic factors (p=0.037, odds ratio=4.937). Among the radiographic factors, the presence of distal ulnar fracture and dorsal cortical comminution were disclosed as risk factors of later displacement (p=0.049, 0.003, odds ratio=3.429, 7.196). Conclusion When conservative management for distal radius fracture is decided in patients more than 80 years of age or accompanied by a distal ulnar fracture or with dorsal cortical comminution, the possibility of later displacement of the distal radius should be considered.

74 View
1 Download

Most read articles