Journal of Musculoskeletal Trauma

Articles in E-pub version are posted online ahead of regular printed publication.

Review Articles

Current concepts and applications of internal fixation for forearm diaphyseal fractures: Sung Yoon Jung, Min Kyun Cho, Dong-hee Kim, Sang Hyun Lee; Received January 30, 2026 Accepted May 11, 2026 Published online July 3, 2026; DOI: https://doi.org/10.12671/jmt.2026.00087 [Epub ahead of print]

Abstract PDF: Adult diaphyseal fractures of the forearm functionally behave as intra-articular injuries because forearm rotation depends on accurate restoration of length, axial alignment, rotation, and the native radial bow. This narrative review summarizes contemporary surgical options for adult forearm shaft fractures, including 3.5-mm plate osteosynthesis, dual mini-plate fixation, interlocking intramedullary nailing, and minimally invasive plate osteosynthesis (MIPO). Compression plating with 3.5-mm plates remains the reference standard for most fracture patterns, whereas other techniques should be regarded as selective, emerging, or salvage options according to their indication spectrum and evidence base. Mini-fragment dual plating may be useful for short segments or thin soft-tissue envelopes, although the supporting clinical evidence remains limited and meticulous biomechanical execution is essential. Interlocking intramedullary nailing is a viable alternative for carefully selected simple fracture patterns or soft-tissue-compromised situations, offering less invasive exposure but a narrower indication spectrum. MIPO may be considered for selected comminuted or soft-tissue-compromised diaphyseal fractures; however, its use in adult forearm fractures remains constrained by the high functional requirement for precise restoration of length, rotation, and the radial bow. To improve transparency, this review explicitly distinguishes established, evidence-supported methods from techniques supported mainly by limited retrospective data or institutional experience. A pattern-based pragmatic algorithm and expanded comparison table are provided to guide fixation selection according to the bone involved, fracture location, fracture morphology, soft-tissue condition, and evidence tier while minimizing complications such as nonunion, infection, nerve injury, refracture after plate removal, and radioulnar synostosis.

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How do we know a fracture has healed? A narrative review of radiographic bone union definitions and assessment methods: Jeong-Hyun Koh, Seungyeob Sakong; Received April 2, 2026 Accepted April 20, 2026 Published online May 20, 2026; DOI: https://doi.org/10.12671/jmt.2026.00150 [Epub ahead of print]

Abstract PDF Supplementary Material: Bone union is the most commonly reported primary outcome in fracture treatment trials, yet no universally accepted radiographic definition exists. The widely taught criterion of “bridging callus on 3 of 4 cortices on anteroposterior and lateral radiographs” has no clearly identifiable primary source in the indexed literature. This narrative review traces the historical origins of radiographic bone union assessment, documents the heterogeneity of definitions used in clinical studies, and provides a comparative analysis of the standardized scoring systems developed to address this problem. A systematic PubMed search using six prespecified strategies, from database inception to March 2026, supplemented by hand-searching and citation tracking, identified 2,380 records. After screening, 359 articles on long-bone fractures were included. The “3 of 4 cortices” criterion appears most plausibly to derive from Panjabi’s 1985 finding that cortical continuity was the strongest radiographic predictor of fracture strength (r=0.80), but no traceable validation study was identified despite citation tracking through successive Cochrane reviews (CD008579, pub2‒pub4). In their 2008 study, Corrales and colleagues documented 11 different radiographic criteria across 123 studies, finding that ‘3 cortices’ was used in only 27%. Five standardized scoring systems (Radiographic Union Score for Tibial fractures [RUST], modified RUST [mRUST], Radiographic Union Score for Hip [RUSH], Radiographic Union Score for Humeral fractures [RUSHU], and Radiographic Humerus Union Measurement [RHUM]) have improved interobserver reliability within specific anatomical settings but remain fragmented by site and limited to secondary bone healing. A 2024 analysis by Bax and his team further illustrated that this inconsistency is not limited to fractures, documenting 13 different criteria and nine classification systems within the osteotomy literature. The most widely used radiographic union criterion likely emerged through clinical teaching rather than formal validation. A minimum reporting framework is proposed to improve standardization in future studies. Consensus definitions, cross-site validation, and more objective assessment strategies are needed to resolve this four-decade-old problem.

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Case report

Radiocarpal subluxation after volar plating due to an insufficiently supported dorsal key fragment: a case report: Yeongyoon Koh, Kanghun Yu, Jong Woong Park, In Cheul Choi; Received April 28, 2026 Accepted May 13, 2026 Published online July 3, 2026; DOI: https://doi.org/10.12671/jmt.2026.00185 [Epub ahead of print]

Abstract PDF: Distal radius fractures are commonly managed using volar locking plate fixation, which provides stable fixation in most cases. However, certain fracture patterns involving dorsal key fragments may not be adequately stabilized with a volar approach alone, even when intraoperative reduction appears satisfactory. We report the case of a 58-year-old male patient with a complex intra-articular distal radius fracture involving a dorsoulnar corner (DUC) fragment. Preoperative computed tomography revealed a dorsal fragment associated with subtle dorsal radiocarpal subluxation. Despite this finding, the fragment was considered amenable to fixation through a volar approach because it was relatively large. Although satisfactory reduction was achieved intraoperatively, early postoperative imaging demonstrated progressive dorsal radiocarpal subluxation due to displacement of the DUC fragment, while overall alignment parameters remained preserved. Revision surgery with additional dorsal buttress fixation successfully restored stability. This case highlights the critical importance of recognizing dorsal key fragments and achieving adequate dorsal support during fixation, as failure to provide sufficient support may result in delayed instability despite acceptable initial reduction.

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Case Report

Successful reconstruction and functional recovery of a pediatric medial malleolus defect in an 8-year-old girl using autologous iliac crest bone grafting in Korea: a case report: Sung Yoon Jung, Dong-hee Kim, Sang-Hyun Lee, Ki-Hun Kim; Received January 15, 2026 Accepted March 4, 2026 Published online April 8, 2026; DOI: https://doi.org/10.12671/jmt.2026.00059 [Epub ahead of print]

Abstract PDF: An 8-year-old girl presented after a traffic accident with a severe crush and degloving injury of the medial right ankle and foot, a distal tibiofibular fracture, and medial midfoot bone defects. After staged irrigation and debridement with temporary external fixation, definitive reconstruction was performed on August 6, 2016. The medial malleolar defect (2.5×2.0 cm) was reconstructed using a contoured autologous iliac crest bone graft secured with internal fixation, and medial stability was augmented using harvested gluteal fascia as a deltoid ligament substitute fixed with suture anchors. A bone-cement spacer was placed adjacent to the injured physis to mitigate physeal bridging, and the extensive soft-tissue defect was covered with a free anterolateral thigh flap and skin graft. During follow-up, progressive varus deformity and contracture were managed with corrective osteotomy and plating, Achilles tendon lengthening, Z-plasty, and Ilizarov fixation. At the final follow-up (March 6, 2025), the limb-length discrepancy was 5 mm, active ankle dorsiflexion was 0° (passive dorsiflexion 5°), and the patient was pain-free with full participation in daily activities, including hiking and dancing. This case emphasizes the value of an integrated staged strategy that combines bony reconstruction, medial stabilization, physeal management, and durable soft-tissue coverage during skeletal growth. Level of evidence: IV.

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