Journal of Musculoskeletal Trauma

The Significance of Calcaneal Posterior Tuberosity Fragment Reduction When Treated with Open Reduction in Displaced Intra-Articular Calcaneal Fractures: Hong Ki Park, Jong Ryoon Baek, Jang Seok Choi, Sang Jin Lee, Je Won Paik; J Korean Fract Soc 2016;29(4):233-241. Published online October 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.4.233

Abstract PDF: PURPOSE
We attempt to evaluate the significance of calcaneal posterior tuberosity fragment reduction when treated with surgical open reduction in displaced intra-articular calcaneal fractures.
MATERIALS AND METHODS
A total of 90 patients with displaced intra-articular calcaneal fracture, between January 2010 and December 2015, treated with open reduction and internal fixation were enrolled in this study. At postoperative 3 months, we evaluated the reduction state of calcaneal posterior tuberosity fragment by measuring the degree of lateral displacement of the posterior tuberosity fragment on the calcaneal axial view. Moreover, we also evaluated the difference in the calcaneal length and height with the uninjured side on the lateral view of both sides. In addition, we estimated the reduction state of the posterior facet by measuring the degree of gap and step-off on the semi-coronal view of postoperative computed tomography and estimated the restoration of calcaneal angle by measuring the difference in BÃ¶hler's and Gissane angle with the uninjured side on the lateral view of both sides.
RESULTS
The correlation coefficient with 3 components for evaluating the reduction state of posterior tuberosity fragment and gap and step-off of posterior facet was r=0.538, 0.467, r=0.505, 0.456, r=0.518, and 0.493, respectively, and restoration of BÃ¶hler's and Gissane angle was r=0.647, 0.579, r=0.684, 0.630, r=0.670, and 0.628, respectively. The relationship of each component shows a significant correlation as all p-values were <0.01.
CONCLUSION
The precise reduction of calcaneal posterior tuberosity fragment developed by the primary fracture line was considered as an important process of anatomical reduction of calcaneal body, including the posterior facet and calcaneal angle restoration.

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Treatment of Tibial Plateau Fractures Using a Locking Plate and Minimally Invasive Percutaneous Osteosynthesis Technique: Hee Gon Park, Dae Hee Lee, Kyung Joon Lee; J Korean Fract Soc 2012;25(2):110-116. Published online April 30, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.2.110

Abstract PDF: PURPOSE
To acknowledge the importance of precise reduction of articular surface of tibial plateau fractures and to make a guideline of treatment by evaluating outcomes and effectiveness of using locking plate and minimally invasive percutaneous osteosynthesis technique.
MATERIALS AND METHODS
Twenty-nine patients who underwent surgery for tibial plateau fracture from November 2005 to March 2010 were enrolled with 12 months follow-up in a retrograde manner. The Shatzker classification was used to classify fractures, and we used lateral submeniscal approach to make a precise reduction of articular surface. Radiologic evaluation was determined by presence of bone union, malalignment, and reduction loss or joint depression of articular surface. Post-operative infection, time of active movement of the knee joint, time of partial weight loading, and range of motion (ROM) of knee joint were evaluated. Lysholm Knee Score was used for functional evaluation.
RESULTS
Bone union took place in all but one case that developed osteomyelitis. Angulation deformity of more than 10degrees and reduction loss or joint depression of more than 5 mm were not observed. There was one case of osteomyelitis and one case of superficial surgical site infection. There were satisfactory clinical results, with an average time of active knee joint movement and weight loading of 6 weeks. The average ROM of knee joint was 125degrees in the last follow up. As for functional evaluation using Lysholm Knee Score, cases showed an average Lysholm Knee Score of 94 which was a satisfactory result.
CONCLUSION
In cases of tibial plateau fractures, if a surgeon accurately reduces the articular surface of joint and use minimally invasive locking plate it will help in bone union biologically, reducing the incidence of soft tissue injuries, and biomechanically maintaining the articular surface of the joint, proving itself to be a useful method of treatment.

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Anatomically Percutaneous Wiring Reduction in Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: Young Mo Kim, Chan Kang, Deuk Soo Hwang, Yong Bum Joo, Woo Yong Lee, Jung Mo Hwang; J Korean Fract Soc 2011;24(3):230-236. Published online July 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.3.230

Abstract PDF: PURPOSE
To report the method of anatomical reduction and its maintenance by percutaneous wiring reduction in minimally invasive plate osteosynthesis for distal tibial fractures.
MATERIALS AND METHODS
17 cases that were diagnosed oblique, spiral or transverse fracture of distal tibia from August 2007 to February 2010 and were able to anatomically reduce by the method of percutanous wiring reduction in minimally invasive plate osteosynthesis were included in this study. Mean age was 50, and mean follow up period was 18 months. We investigated the period until bone union was achieved, degree of angulation angle, and complications. For postoperative evaluation, Olerud and Molander ankle score and VAS pain score in daily living were checked.
RESULTS
The mean varus/valgus angulation after bone union on AP radiograph was 0.9 degrees and the mean anterior/posterior angulation on lateral radiograph was 2.0 degrees The mean Olerud and Molander ankle score was 89.4, and mean pain score due to walk adjacent to metal plate was 0 points.
CONCLUSION
By the method of percutaneous wiring reduction in distal tibial fracture, anatomical reduction is easily acquired, and only by wire itself, reduction could be maintained, so that without additional manual reduction, plate could be easily fixed.

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Treatment of Comminuted Subtrochanteric Fractures of the Femur by High-Energy Trauma: Taek Soo Jeon, Woo Sik Kim, Sang Bume Kim, Cheol Mog Hwang, Kyu Tae Kim, Sun Hong Kim; J Korean Fract Soc 2006;19(2):135-140. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.135

Abstract

PURPOSE
The purpose is to evaluate the effectiveness of open reduction and internal fixation in comminuted subtrochanteric fractures caused by high energy trauma at a non-osteoporotic young age.
MATERIALS AND METHODS
Of all cases of subtrochanteric fractures caused by high energy trauma under 60 years old from February 2000 to February 2004, we analyzed 16 patients who had severe comminuted fractures (Seinsheimer classification type IV, V). The mean age is 43.5 (31~54) years old. Mean follow-up period was 22 (14~38) months. We tried to reduce anatomically as much as possible and fixed firmly using a compression hip screw in all cases. Additional procedures such as interfragmentary screw fixation, cerclage wiring or lateral stabilization plating were performed in 13 cases. Bone grafting was performed in 8 cases. We evaluated bony union rate, time to union, status of reduction, varus deformity and rate of implant failure using a simple X-ray. We also analyzed the clinical result using the Harris hip score including range of motion, pain and limping gait, so on.
RESULTS
In all 16 cases, bony union was achieved and the mean time to union was 24 (20~32) weeks. There was no intra-operative complication. Postoperative complications such as loss of reduction, varus deformity, implant failure or infection did not occur. Clinically, the Harris hip score was 98.9 (97~100) points.
CONCLUSION
Optimal open reduction and firm internal fixation with or without additional fixation was thought to be a recommendable method of treatment for comminuted subtrochanteric fractures of the femur caused by high energy trauma at a young age.

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Treatment of Subtrochanteric Femur Fractures Using Intramedullary Devices
Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Chong Suk Park, Sang Ho Lee
Journal of the Korean Fracture Society.2008; 21(1): 13. CrossRef

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Treatment of the Intertrochanteric Fractures of the Femur in Elderly Patients: Comparision of Wayne-County Reduction and Anatomical Reduction: Nam Yong Choi, Kee Ho Nah, Hyun Seok Song, Sang Il Seo, Jung Keun Choi, Suk Ku Han; J Korean Fract Soc 2004;17(4):301-307. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.301

Abstract PDF

PURPOSE
To compare the radiological and clinical results of Wayne-County reduction with anatomical reduction in treatment of the intertrochanteric fractures of the femur in elderly patients.
MATERIALS AND METHODS
Among one hundred-three of intertrochanteric fractures treated with 135- degree angled compression hip scresw, eighty three cases treated by Wayne-County reduction (Group 1, 42 cases) and anatomical reduction (Group 2, 41 cases) with at least 1 year follow-up were reviewed. The average pateint ages were 72.4 (65~92) in group 1, 71.6 (65~89) in group 2, respectively. 33 cases (75.2%) in group 1 and 31 cases (77.5%) displayed unstable fractures by Jensen classification. The radiological observation was included neck-shaft angle, penetrating length of lag screw into head, sliding length of lag screw and time of bony union. The clinical results were evaluated by Koval criteria, Kyle's functional evaluation, leg length inequality and complications.
RESULTS
There were no significant changes between group 1 and group 2 in stable fractures in the radiological and clinical results. In unstable fractures, the neck-shaft angle averaged 132.2 degree in group 1 and 129.4 degree in group 2 in the final follow-up films. The penetrating length of lag screw into head were 2.2 mm in group 1 and 3.1 mm in group 2 (p<005). But there were little differences in the sliding length of lag screw, the time of bony union and complication rates between groups. In post- operative evaluation of walking abilility by Koval, 31 patients (73.8%) in group 1 and 28 (68.3%) recovered the activity level before injury by the postoperative 1 year follow-up. Leg length discrepancy at final follow-up was 4.1+/-6 mm shortening in group 1 and 6.5+/-8 mm in group 2, respectively.
CONCLUSION
Both Wayne-County reduction and anatomical reduction had a favorable results after treatment of stable intertrochanteric fractures of the femur, but Wayne-County reduction may be a better method in treatment of unstable fractures, especially in elderly patients, in which it is difficult to obtain anatomical reduction.

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New Approach in the Treatment of Intertrochanteric Fracture Using a Cephalomedullary Nail
Junyoung Kim, Kihong Choi, Kyu Hyun Yang
Journal of the Korean Orthopaedic Association.2020; 55(3): 193. CrossRef
The Effect of Valgus Reduction on the Position of the Blade of the Proximal Femoral Nail Antirotation in Intertrochanteric Hip Fractures
Eui Yub Jung, In Taek Oh, Sang Yeup Shim, Byung Ho Yoon, Yerl Bo Sung
Clinics in Orthopedic Surgery.2019; 11(1): 36. CrossRef
Effectiveness of the Valgus Reduction Technique in Treatment of Intertrochanteric Fractures Using Proximal Femoral Nail Antirotation
Ji-Kang Park, Hyun-Chul Shon, Yong-Min Kim, Eui-Sung Choi, Dong-Soo Kim, Kyoung-Jin Park, Byung-Ki Cho, Jung-Kwon Cha, Sang-Woo Kang
Journal of the Korean Orthopaedic Association.2013; 48(6): 441. CrossRef

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Results of Surgical Treatment in Schatzker Type VI Tibial Plateau Fracture: Kyung Jin Song, Kwang Bok Lee, Seung Jin Moon, Joo Hong Lee; J Korean Fract Soc 2004;17(1):32-37. Published online January 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.1.32

Abstract PDF: PURPOSE
The purpose of this study was to evaluate the factors influencing the results for the treatment of the Schatzker type VI tibial plateau fractures.
MATERIALS AND METHODS
Twenty-two cases of the 21 patients in Schatzker type VI tibial plateau fractures were analyzed. Treatment results were analyzed according to the type of fracture (open vs closed), method of operative treatment, angulation more than 5 degree and status of infection. The functional results was evaluated by Hohl's functional criteria. Student t-test was used for the statistical analysis.
RESULTS
Functional outcome demonstrated 5 excellent, 8 good, 6 fair and 3 poor results. There was no significant difference in the treatment results between type of fracture, method of operative treatment and status of infection. Among 9 cases with angular deformity of more than 5 degree, 2 showed excellent or good result and 7 showed fair or poor result (p<0.05). There was no significant difference between rate of postoperative infection and the mean period of the clinical bone union (p=0.66).
CONCLUSION
Accurate anatomical reduction and rigid fixation is essential for the treatment of Schatzker type VI tibial plateau fractures for the prevention of the angular deformity. And early weight bearing exercise should be controlled for the prevention of loss of reduction and loss of alignment leading to angular deformity.

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The Evaluation of Clinical and Radiographic Prognostic Factors for the Surgically Treated Unstable Ankle Fractures: Hong Geun Jung, Hee Kon Park, Moon Jib Yoo, Tai Won Kim; J Korean Soc Fract 2002;15(2):216-225. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.216

Abstract PDF

PURPOSE
The purpose of this study is to analyze the clinical and radiographic prognostic factors which may affect the postoperative clinical results of the unstable ankle fractures.
MATERIALS AND METHODS
This study is based on 75 unstable ankle fractures treated by open reduction and internal fixation from May 1994 to August 2000, with a minimum follow-up period of 12 months(range : 13 months-7 years 3 months). The 75 patients were average 40.5 years old with male: female ratio of 52:23. Based on Lauge-Hansen classification, the supination-external rotation type was the most common with 42 (56.0%) cases. The clinical results was assessed by American Orthopaedic Foot and Ankle Society(AOFAS) functional scale. The sex, age, side of injury, body weight, trauma-operation interval, operation time, cause of injury as the possible postoperative clinical prognostic factors and fracture type, anatomical reduction of fracture, preoperative medial clear space, postoperative medial clear space, talo-crural angle, talar tilt, tibio-fibular clear space, tibio-fibular overlap space as the possible radiographic prognostic factor were statistically analyzed RESULT: Postoperative AOFAS functional scale was average 81.0 points with 23(30.7%) cases excellent, 17(22.7%) good, 18(24.0%) fair and 17(22.7%) cases poor results. The age, the operation time(p<0.001) and the anatomical reduction of fracture(p<0.005) were found to be statistically significant factors affecting the prognosis. The other clinical and radiographic factors did not significantly affect the clinical results.
CONCLUSION
The surgically treated unstable ankle fractures in patients whose age was above 41 years old or operation time exceeding 90 minutes or unsatisfied anatomical reduction of fractures showed significantly poor clinical results.

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Analysis of Bone Mineral Density of Ankle Fracture Patients
Tae Hyung Kim, Jae Hyung Lee, Seung-Hwan Park
Journal of the Korean Orthopaedic Association.2021; 56(4): 334. CrossRef

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The Surgical Treatment of displaced Acetabular Fracture: Sang Hong Lee, Kyung Ho Kim, Pyong Ju; J Korean Soc Fract 2000;13(3):454-462. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.454

Abstract PDF: PURPOSE
To analysis clinical and radiological results of operative treatment of displaced acetabular fractures and establish the guideline for the operative treatment of displaced acetabular fracture with the analysis of the clinical and radiological results.
MATERIALS AND METHODS
A clinical analysis was performed on 36 patients with displaced acetabular fractures who had been operated on and followed for minimum 1 year period from January 1993 to December 1998. Clinical outcome was analyzed clinically by Harris hip scoring system and radiologically by Matta's roentgenographic grading system.
RESULTS
According to Letournel's classification, we had 25 elementary fractures(69%) and 12 associated fracture(31%). Among the elementary fractures, the posterior wall fracture was the most common type(17 cases, 47%) and both column fracture was the most common type among associated fractures(5 cases, 11%). Surgical approaches were 22 Kocher-Langenbeck, 8 extended iliofemoral, 3 triradiate transtrochanteric, 3 ilioinguinal. The mean duration of follow up after the operation was 2.2 years (range, 1 to 7 years). Among thirty six patients who had followed up more than one year, the satisfactory results were achieved in 27 cases (75%) on clinical grade and 26 cases (72%) on radiographic grade. The complications were developed in 20 cases out of 36 cases including posttraumatic arthritis 7 cases, heterotopic ossification 4 cases.
CONCLUSION
In the majority of the displaced acetabular fractures, accurate open reduction and internal fixation was recommended. It seems that the satisfactory operative reduction of the fracture is the factor that correlates with a satisfactory clinical result according to our study. Therefore in the surgical treatment of the acetabuluar fractures, it is essential to achieve an anatomical reduction and firm fixation by fully understanding the pathologic anatomy and by choosing an appropriate approach and fixation device.

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Surgical Treatment of the Bimalleolar Ankle Fractures: Kyung Jin Song, Keun Ho Yang, Kyung Rae Lee, Ju Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1999;12(4):956-960. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.956

Abstract PDF

We designed this study to evaluate the functional outcome and to suggest the guidelines in the treatment of bilnalleolar ankle fractures with clinical and radiological analysis after operative treatment. We analyzed 35 patients with bimalleolar fractures among 90 ankle fractures and followed up for more than 1 year. All 36 fractures were classified according to Lauge-Hansen system and the Meyer criteria was used for the clinical and radiological assessment. Seventeen cases(47%) were supination-external rotation(47%), 9 cases(21%) were supination- adduction: 6 cases(17%) were pronation-abduction and 4 cases(11%) were pronation-external rotation type. Satisfactory results was obtained in 32 cases(89%) according to the criteria of Meyer in the viewpoint of clinical and radiological analysis. Satisfactory results could be obtained with early anatomical reduction and rigid internal fixation for the treatment of bimalleolar ankle fractures. Distal tibiofibular syndesmosis disruption could be spontaneously reduced without trans-syndesmotic screw fixation by early open reduction and rigid internal fixation for the bimalleolar ankle fractures. Early and more accurate anatomical reduction can reduce the post-traumatic arthritis in cases with moderate talar displacement and open fractures.

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MANAGEMENT OF FRACTURES AROUND ANKLE JOINT
Pagidimarri Manasa, Devarasetty Shanmukha Sreenivas, B. Someswara Reddy
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2021; : 14. CrossRef

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Treatment of the Tarsometatarsal Joint Fracture-Dislocation: Kun Yung Lee, Young Kee Lee, Yong Man Cho, Heung Sik Kang; J Korean Soc Fract 1996;9(3):725-732. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.725

Abstract PDF: Traumatic dislocation and fracture-dislocation of the tarsometatarsal joint rare injuries. These injuries often missed because radiographs of this joint is difficult to be interpreted, so delay to be diagnosed and treated. These injuries often leads to arthritic change with significant residual symptoms and deformities. Tarsometatarsal joint injuries are generally managed by accurate repositioning of the displaced metatarsals and stabilization with instruments(K-wire, screws etc.). The purpose of this study is to review the anatomical, radiological and functional results. The authors analysed the 25 cases with injuries of the tarsometatarsal joint treated of the department of Orthopaedic Surgery, Lee-Rha general hospital from March 1989 to September 1994, which showed the following results. 1. The most common cause of the injury was traffic accident(76%). 2. According to the Hardcastles classification, the injuries were classified as follows:partial incongruity in 16 cases(64%), total incongruity in 6 cases(24%), and divergent congruity in 3 cases(12%). 3. Three cases were treated with closed reduction and case immobilization, thirteen cases were treated with closed reduction and percutaneous K-wire fixation. Nine cases were treated with open reduction and K-wire fixation as follows:reduction failure in 3 cases, entrapment of anterior tibial tendon in 2 cases, severe soft tissue injury in 4 cases. 4. The anatomic reduction and its maintenance were considered as most important factor of prognosis.

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Lateral Condyle Fracture of Tibia Treated by Open Reduction and Internal Fixation: Jong Min Sohn, Ju Hai Chang, Dong Heon An, Soo An Park; J Korean Soc Fract 1996;9(1):137-145. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.137

Abstract PDF: Tibial condyle fracture involving articular surface can produce some disabilities of the knee because they are usually accompanied with the injuries of the ligaments and menisci. Though recent studies suggest that anatomical reduction and rigid fixation of the fracture followed by early knee mobilization have improved clinical end results, the results were not always successful. The lateral condyle fracture is more often in the incidence than the medial one. This is due to the physiologic valgus of the knee, the weaker trabeculation under the lateral tibial plateau, and the increased frequency of valses injuries as the knee is protected medially by the contralateral side. Eighteen lateral condyle fractures of the tibia treated by open reduction and internal fixation at the Our Lady of Mercy Hospital from June 1991 through February 1995 were analized. The results are as follows. 1. The patients were 13 males and 5 females, mean age was 39.2 years and mean follow up-period was 19.2 months. 2. The most common cause was motor vehicle accident(8 cases,44.4%). 3. The most frequent type of fracture was split(8 cases,44.4%) by Rasmussens lateral condyle fracture classification and the next was split-compression(6 cases,33.3%). 4. According to Blokkers criteria,15 cases(83.3%) had satisfactory results. Among 3 cases of unsatisfactory results, 1 developed secondary degenerative change, 1 had valgus instability and 1 secondary degenerative change and mild valgus instability. It is thought that the most important factor influencing results was the anatomical reduction of the articular surface, rigid fixation and early joint mobilization.

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