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.

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Avulsion Fracture of the Posterior Cruciate Ligament from Femoral Insertion Occurred in a Patient with Residual Poliomyelitis: A Case Report: Wonchul Choi, Taesup Kim; J Korean Fract Soc 2018;31(4):149-153. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.149

Abstract PDF: Avulsion fracture of the posterior cruciate ligament from its femoral insertion is quite rare, particularly in adults, and the treatment guidelines have not been established. A 68-year-old female patient with residual poliomyelitis presented with an avulsion fracture of the femoral insertion of the posterior cruciate ligament after a falling accident and was treated with arthroscopic headless compression screw fixation and pull-out suture of the avulsed ligament. We report this case with a relevant discussion of this type of injury.

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Arthroscopic Assisted Intra-Articular Reduction and Internal Fixation of Tibia Plateau Fracture: Dong Hwi Kim, Gwang Chul Lee, Kwi Youn Choi, Sung Won Cho, Sang Ho Ha; J Korean Fract Soc 2013;26(3):191-198. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.191

PURPOSE
We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts.
MATERIALS AND METHODS
From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system.
RESULTS
The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases.
CONCLUSION
We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.

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Current Concepts in Management of Tibia Plateau Fracture
Sang Hak Lee, Kang-Il Kim
Journal of the Korean Fracture Society.2014; 27(3): 245. CrossRef

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TFCC Injury Associated with the Triquetral Dorsal Chip Fracture: Seoung Joon Lee, Jin Ho Hwang, Min Seok Kang, Jong Woong Park; J Korean Fract Soc 2009;22(3):179-184. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.179

Abstract PDF: PURPOSE
To evaluate the usefulness of wrist arthroscopic examination in patient with persistent pain after the triquetral dorsal chip fracture and also to determine its relationship with TFCC injury in the triquetral dorsal chip fracture patient manifesting persistent pain.
MATERIALS AND METHODS
This study is based on six cases presenting persistent pain in the ulnar aspect after the triqeutral posterior cord fracture that were treated conservatively. Wrist arthroscopy was carried out for all six cases. All were preoperatively and postoperatively evaluated using VAS pain scale, grip power, ulnar grind test, Kleinman shearing test and lunotriquetral ballottment test.
RESULTS
Preoperatively, ulnar grind test yielded positive results in all six cases, Kleiman shearing test proved positive in three cases and lunotriquetral ballottment test yielded positive result in one case. In the arthroscopic findings, synovitis and TFCC injury were detected in all cases, and based on Palmer classification of TFCC injury, type IA was determined in five cases and type ID in one case. Arthroscopic TFCC partial resection and synovectomy were carried out. VAS pain scale improved from an average 8 points preoperatively to 3 points postoperatively. The difference of grip power between the normal and the other side improved from average of 15 lb preoperatively to 5 lb postoperatively. Based on postoperatively physical examination at 6 weeks, all cases yielded negative results in the ulnar grind test and Kleiman shearing test.
CONCLUSION
We think that TFCC injury is one of the causes of persistent pain after triquetral dorsal chip fracture. We recommend an arthroscopic TFCC partial resection as a valuable treatment option.

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Arthroscopic-Assisted Reduction and Internal Fixation of Patella Fractures: Sang Hun Ko, Sung Do Cho, Hwa Yeop Na, Woo Suk Kim, You Young Jeong, Chang Yeul Kwag, Bum Soo Kim; J Korean Soc Fract 2003;16(4):482-489. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.482

Abstract PDF

PURPOSE
The aim of this study is to report the clinical effectiveness of arthroscopic-assisted reduction and internal fixation of patella fractures.
MATERIALS AND METHODS
We analyzed fifteen patella fractures, which had been operated by using an arthroscopic-assisted technique from January, 2000 to April, 2003 at our hospital. After clinical follow-ups for at least 1 year, clinical analyses had been done by using the Cincinnati Knee Rating System Score, Lysholm Score Scale, and radiological findings.
RESULTS
In our study group, the Cincinnati Knee Rating System scores were from 80 to 100, with a mean of 89.9. The Lysholm Scoring Scale scores ranged from 81 to 100 with a mean of 90.8 for the same group. Radiologically, we obtained complete anatomical reduction of articular surfaces in 80 percent of cases. Arthroscopic-assisted reduction for patella fractures brought clinically satisfactory results that are accurate articular surface reduction, early recovery of motion range, knee joint stability and minimal soft tissue damage, etc.
CONCLUSION
The operative treatment for patella fractures using arthroscopic-assisted reduction is an effective alternative method to open reduction.

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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
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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Intraarticular Soft Tissue Injuries in Fractures of the Distal Radius: A Descriptive Arthroscopic Study: Seok Beom Lee, Chang Beom Lee; J Korean Soc Fract 2001;14(4):726-732. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.726

Abstract PDF

PURPOSE
The aim of this study was to determine prevalence of the associated intraarticular soft tissue lesions with fractures of the distal radius by arthroscopic evaluation of the wrist joint and thus to avoid poor outcome after the conventional treatment. MATERIAL AND METHOD: Medical records, radiographs and arthroscopic findings of 27 patients with fractures of the distal radius that underwent arthroscopic procedures were reviewed . Relationships between fracture pattern and associated lesions of the triangular fibrocartilage complex (TFCC), scapholunate and lunotriquetral ligaments were investigated.
RESULTS
71% of fractures of the distal radius were associated with soft tissue lesions. Among those, tear of the triangular fibrocartilage complex was the most prevalent (47%). Associated lesions such as TFCC, scapholaunate and lunotriquetral lesion were more common with inraarticular fracture, while severe nature of the lesion that neccessiated pinning and/or arthroscopic repair was more common with extraarticular fractures of the distal radius.
CONCLUSION
Incidence of the associated soft tissue lesions in this study were comparably high with the latest publications. The authors suggest strongly that wrist arthroscopy should accompay any procedure for fractures of the distal radius, if it is to be done under anesthetic control, to get more favorable outcome.

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Arthroscopic Repair for Traumatic Peripheral Tear of Triangular Fibrocartilage Complex
Seung-Ju Jeon, Chan-Sam Moon, Ho-Seung Jeon, Haeng-Kee Noh, Sung-Hwan Kim
Journal of the Korean Fracture Society.2007; 20(4): 330. CrossRef

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Treatments of the Tibial Condylar Fractures: Taik Seon Kim, Jae Ik Shim, Sung Jong Lee, Suk Ha Lee, Dong Ki Lee, Yeon Sik Yu, Hong Man Cho; J Korean Soc Fract 2000;13(2):311-319. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.311

Abstract PDF: PURPOSE
: In the proximal tibial condylar fractures, the authors analyzed the treatment results clinically and radiologically, after arthroscopically assisted accurate anatomical reduction of articular surface and rigid internal fixation with early mobilization.
MATERIALS AND METHODS
: We reviewed 56 cases of tibial condylar fracture that were treated at our the orthopaedic department between January 1990 and December 1996 and the follow-up period was 1 year above. According to Schatzker's classifications, we classified the type of fracture and we analyzed the results by average union time and Porter's criteria after accurate anatomical reduction of articular surface and rigid assisted redcution of articular surface and internal fixation.
RESULTS
: According to Schatzker's classification, Type I 15cases, TypeII 14cases, TypeIII 6 cases, TypeIV 7cases, TypeV 3cases, TypeVI 11cases, Associated soft tissue injuries were total 22cases the were MCL injuries 12 cases, lateral meniscal injuries 6 cases. The average union time was 15.5 weeks and by Porter's criteria, 56 cases, of which 39 cases(71%) had an good result.
CONCLUSION
: we considered that good results can be obtained by assistant use of arthroscopy and rigid internal fixation with early mobilization, that accurate diagnosis and appropriate treatments of accampaning injuries according to the type of fractures, and accurate anatomical reduction of articualr surface.

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Arthroscopically-assisted Reduction and Fixation for the Lateral Tibial Condyle Fractures: Jeong Hwan Oh, Seon Nam Kim; J Korean Soc Fract 1999;12(3):614-621. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.614

Abstract PDF: PURPOSE
Retrospective study was performed about arthroscopically-assisted reduction and internal fixation for the lateral tibial condyle fractures to evaluate the usefulness of arthroscopy. MATERIAL AND METHODS: From January 1993 through December 1996, 36 patients with tibial plateau fractures were evaluated. After reviewing the records and radiologic studies, 22 patients were included in the study based on fracture patterns. Average follow up were 26 months, with a range of 12 to 45 months. Among the 22 cases, 16(72.7%) were male and 6 (27.3%) were female. Fourteen(72.6%) were caused by traffic accident(9 pedestrians, 5 passengers) and 7 were fall from a height. According to Schatzker classification, 9 cases (40.1%) were classified as cleavage with depression(type II), 5 cases(22.4%) of pure central depression(type III) and 8 cases(36.5%) of pure cleavage(type I). There were 24 cases of associated injuries in 16 patients, among which lateral meniscus tears was most common (37.5%). We used Porters criteria for the clinical evaluation and Blotters criteria.
RESULTS
By Porters criteria for the clinical evaluation, acceptable results were obtained in 20 cases (90.9%) in symptom, 21 cases(95.5%) in functional aspect and 22 cases(100%) in appearance and radiologic appearance. By Blotters criteria, satisfactory results were in 20 cases (90.9%).
CONCLUSION
Arthroscopically-assisted reduction and internal fixation should be considered one of the treatment of choice in selected tibial plateau fractures from many advantages.

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Arthroscopically-Assisted Reduction and Fixation in Fractures of the Tibial Condyle: Jung Su Hwang, Han Chul Kim, Yong Soon Kim; J Korean Soc Fract 1999;12(1):90-97. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.90

Abstract PDF: Fractures of the tibial condyle are characterized that often involve the articular surfaces and frequently associated with soft tissue injuries such as collateral ligament, cruciate ligament and menisci of the knee. The author analyzed 12 cases of tibial condyle fractures, which were surgically treated by reduction of depressed articular surface under assist of arthroscopy and then fixed with cannulated cancellous screws and accompanied by bone graft under the control of image intensifier in 9 cases of the 12 cases. The purpose of this study are (1) obtaining accurate reduction of the depressed articular surface, (2) preventing knee joint from the surgical wide dissection, (3) not only bony problems but also combined menisci and ligament injuries were diagnosis and management. We can obtain more anatomical reduction and excellent or good functional knee score since extensive exposure is avoided. There is no complication with regard to arthroscopic surgery and rapid recovery with reduced pain and early full ROM are obtained after follow-up study of a mean of 1 year.

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Arthroscopically assisted technique on ankle Fx: Beom Goo Lee, Hong Kee Park, Jae Jin Oh; J Korean Soc Fract 1998;11(4):886-893. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.886

Abstract PDF: In literatures, osteochondral fragment could be founded in 68% of acute displaced ankle fractures that could not be founded on plain X-ray. And skin necrosis following open reducion and internal fixation of ankle fractures are reported to be 3% that could result in serious problem. Above 2 problems could be handled with arthroscopic assisted fixation. We did arthroscopically assisted internal fixation on 6 cases of acute displaced ankle fractures. The results were as follows ; 1. No patients suffered from soft tissue problem. 2. Osteochondral fragment were founded in 3 cases and was debrided 3. According to Evanski and Waugh, mean functional score was 42 points, pain score was 36 points and R.O.M score was 7 points respectively. The results were excellent in all cases. 4. In roentgenographic study, nearly anatomic reduction was noted in all medial malleus fractures. In conclusion, better evaluation and management of osteochondral fragment, shorter hospitalization and quicker recovery were advantages of the arthroscopically assisted treatment of ankle fractures.

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Treatment of Supracondylar Fracture of the Femur using the Supracondylar intramedullary Nail under the Arthroscopy(Preliminary Report): Suk Woong Yoon, Dong Ha Kang, Tae Sung Hwang, Jeong Il An; J Korean Soc Fract 1998;11(4):778-783. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.778

Abstract PDF: Supracondylar nailing is one of the treatment methods for supracondylar fractures of the femur but it needs arthrotomy. We introduce a mew technique of supracondylar nailing under the arthroscopy without arthrotomy. It is closed reduction and intramedullary supracondylar nailing under the arthroscopic control. The potential benefits of this method are decreased unnecessary soft tissue dissection, excellent intraarticular visualization and reduction, decreased blood loss and shortened operative time and postoperative rcovery. We performed this new technique on 4 cases of supracondylar fractures of the femur. Theresults were as follows; 1. Among the 4 cases, 3 cases were AO type A and 1 case was AO type C. 2. All cases showed bony union and average range of knee motion was 110 degrees. 3. The operation time ranged from 60 minutes to 170 minutes and averaging 110 minutes.

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Surgical Treatment of Tibial Plateau Fracture: Validity of Arthroscopy: Shin Kang Cho, Jung Dae Oh, Young Sik Lee, Jin Tae Choi, Gyeong Hin Lim; J Korean Soc Fract 1997;10(4):832-842. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.832

Abstract PDF

Twenty tibial plateau fractures were surgically treated by means of the double images of the arthroscopy and the image intensifier. The purpose of this attempt was (1) obtaining more anatomical reduction of articular margin, (2) preventing knee joint from the surgical dissection and (3) simultaneous diagnosis & management of the combined meniscus and ligament injuries. Three aims of this study are searching for (1) the indications of the arthroscopic surgery for the libial plateau fractures, (2) the techniques of the arthroscopic surgery for reduction and fixation and (3) the techniques for reducing the risk of the arthroscopic surgery. As a result, we can obtain more anatomical reduction and excellent or good functional knee score after follow-up study of a mean of 1 year and 9 months. There is no complication with regard to arthroscopic surgery. But anatomical reduction of the bicondyle fractures with severe articular and metaphyseal comminution was technically difficult. So, the other technique as if open reduction will be needed.

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Arthroscopically-Assisted Reduction and Internal Fixation of Intra-Articular Fractures of the Lateral Tibial Plateau
Juhan Kim, Dong Hwi Kim, Jae-Hwan Lim, Hyunwoong Jang, Young Wook Kim
Journal of the Korean Orthopaedic Association.2019; 54(3): 227. CrossRef
Treatment of Shatzker Type VI Tibia Plateau Fracture Using Lateral and Posteromedial Dual Incision Approach and Dual Plating
In-Jung Chae, Sang-Won Park, Soon-Hyuck Lee, Won Noh, Ho-Joong Kim, Seung-Beom Hahn
Journal of the Korean Fracture Society.2009; 22(4): 252. CrossRef

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Arthroscopic Management of the Tibial Condylar Fractures: Do Hyun Moon, Beom Koo Lee, Jin Hong Ko, Ki Dong Kang, In Seok Oh, Young Kab Shin; J Korean Soc Fract 1997;10(2):324-331. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.324

Abstract PDF

The tibial condylar fracture is a fracture of the proximal end of the tibia, involving as they do weight-bearing articular sufaces and frequently accompanied by soft tissue injuries and menisci present a variety of problems in the treatment and prognosis. We performed reduction of the depressed articular fragment under mornitoring of arthroscopy and under the control of image intensifier and fixed with cannulated cancellous screws and accompanied by bone graft in 7 cases of the 11 cases. The results were satisfactory Arthroscopy bridges the advantage of accurate reduction and fixation without extensive operative exposure. In addition, arthroscopy allows through lavage, removal of loose fragment and accurate of associated intraarticular pathology. Since extensive exposure is avoided, rapid recovery with reduced pain and early full ROM us achieved in patients managed arthroscopically.

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Arthroscopically Assisted Reduction and Internal Fixation of Intra-Articular Fractures of Tibial Plateau
Jeung Tak Suh, Jae Min Ahn, Tae Wan Kim, He Myung Cho
Journal of the Korean Orthopaedic Association.2012; 47(2): 96. CrossRef

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