Journal of Musculoskeletal Trauma

Treatment of Unstable Intertrochanteric Fractures of the Femur - Comparative analysis of the postero-medial fixation with or without additional screw -: Jin Hong Ko, Bum Gu Lee, Do Hyun Moon, Young Sung Kim; J Korean Soc Fract 1998;11(3):487-494. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.487

Abstract PDF: An unstable intertrochanteric fracture lacks continuity of the bone cortex on the opposing surfaces of the proximal and distal fragments. This cortical deficit is due to either comminuti- On on the medial aspect of the neck(calcar-region) or a large and separate posterior trochan-teric fragment. Treatment of unstable intertochanteric fracture have taken method to restore bony contact medially and posteriorly by anatomical reduction or displacement osteotomy. The authors analyzed the 60 unstable intertrochanteric fractures treated by anatomic reduction and internal fixation with a compression hip screw from January 1990 to December 1995. We made a comparative analysis of the postero-medial fixation with additional screw(Group I) and no fixation group(Group II). We tried to find the difference of operation time, blood loss, union time, weight bearing time, neck-shaft angle, sliding length of lag screw and complication rate in two groups. The results were obtained as follows: 1. The mean union time was 11.5 weeks in the Group I and 12.7 weeks in the Group II (p>0.05). 2. The mean weight bearing time was 6.1 weeks in the Group I and 8.3 weeks in the Group II (p<0.05). 3. The decrease of neck-shaft angle was 2.3 degree in the Group I and 5.2 degree in the Group II(p<0.05). 4. The sliding length of lag screw was 5.8mm in the group I and 11.2mm in the group II(p< 0.05). 5. The lower complication rate was obtained in the group I than in the Group II, but two groups showed no significance by statistical analysis. In conclusion, the postero-medial fixation with additional screw in the treatment of unstable intertrochanteric fracture of the femur are suggested that medial cortical stability can be gained and early weight-bearing can be allowed.

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Delayed Intramedullary Nailing after Failed External fixation for Open Tibial Fractures: Jin Hong Ko, Bum Gu Lee, Do Hyun Moon, Hong Gi Park, Cheol Won Park; J Korean Soc Fract 1997;10(3):694-701. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.694

Abstract PDF: Recently, extemal fxation and unreamed intramedullary nailing are largely used for operative treatment for open long bone fractures. Extemal fixation, especially in cases of unstable fractures, blamed for complications, for example, malunion, delayed union, loss of reduction, refracture, pin tract infection. In addition, there are some problems such as long hospital stay and delayed returning to work. Some surgeons tried to treat such problems by secondary intramedullary nailing, but they came to different retults. The purpose of the current study is to evaluate our experience with secondary intramedullary nailing after failed external fixation of 4 cases of open Grade II, 8 cases of open Grade III a, and 4 cases of open Grade III b tibial fractures. The results are as follows ; 1. The external fixation had been maintained for 123 days in average. 2. The mean interval between removal of the external fixation and intramedullary nailing was 16 days except 5 immediate operation. 3. Reamed intramedullary nailing with static interlocking were done in all 16 cases. 4. In 12 cases of 16, bone union was obtained without complications, and the mean union time after intramedullary nailing was 21.7 weeks radiollogically. 5. Deep infections developed in 2 cases, which had in fracture site, and local infections in 2 cases, which had been in previous pin site of external fixator. In conclusion, delayed intramedullary nailing was a method for treatment of problematic external fixation, such as delayed union, nonunion, loss of fixation, and pin site infection, for open fractures of the tibia.

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Treatment of Subtochanteric Fractures of the Femur by Interlocking Nailing: Do Hyun Moon, Bum Gu Lee, Jin Hong Ko, Young Kab Shin; J Korean Soc Fract 1997;10(3):548-555. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.548

Abstract PDF: Subtrochanteric fracture of the femur are difficult to treat successfully. Although performing operative treatment, the incidence of mechanical complication is higher than other sites of long bones. During the period of January. 1990 to June. 1995, twe nty-four cases of subtrochanteric fracture of femur were treated by Interlocking intramedullary nail at the Department of Orthopedic Surgery, Gil Hospital, Incheon, and the results were obtained as follows : 1. Associated injuries, which were common in lower limb(7 cases), pelvic bone(3 cases) and upper limb(4 cases) made a fracture more difficult to treat. 2. Fieldings type III(12 cases) fracture and Seinsheimers type II(18 cases) fracture and Russel-T aylors Type I A(19 cases) fracture and Winqist-Hansen Type II(13 cases) fracture were most common. 3. The average union time was 19.3 weeks. 4. The complications were three cases. : delayed union(1 case), infection(1 cases), angular deformity(1 case). 5. Interlocking nail is one of the good implant for rigid fixation of subtrochanteric fracture, especially mechanical characteristics of interlocking nail have eliminated the requirement of surgically reconstituting the medial femoral cortex.

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A Comparison of Unlearned IM-nailing with Reamed IM-nailing in Tibial Shaft Fracture: Su Chan Lee, Bum Gu Lee, Do Hyun Moon, Jin Hong Ko, Hong Ki Park, Ki Dong Kang, Sang Kyoo Choi; J Korean Soc Fract 1997;10(2):295-302. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.295

Abstract PDF: Recently, there is seen frequently the tibial fracture due to the increased traffic accident and the high industry. Rigid intramedullary nailing is the method of choice in tibial shaft fracture, early weight bearing and joint motion. Between Jan.1993 and Dec. 1994, we treated 93 tibial shaft fractures with reamed intramedullary nails(55 cases) & unlearned intramedullary nails(38 cases). We analyzed the effects of these two methods, and the following results were obtained. 1. Of 93 fractures, 32 fractures were open and 61 fractures were closed. 2. The most common cause was traffic addicent. Among the 93 cases, 60 cases were male and 33 cases were female, the most common age were ranged from 30-39 year, involving 36 cases. 3. The mean durations of the bone union were 19.7 weeks in closed fracture with treated by reamed nail and 22.1 weeks in closed fracture with unlearned. The mean duration of the bone union were 24.5 weeks in open fracture with reamed and 22.4 weeks in open fracture with unlearned. The complications of intramedullary nail are angular deformity, infection, delayed and nonunion, and screw breakage.

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

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

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Operative Tleatment of the Lateral Condyle Fractures of the Humerus in Children: Bum Gu Lee, Do Heun Moon, Jin Hong Ko, Su Chan Lee, Hong Ki Park, Ki Dong Kang, Young Kim; J Korean Soc Fract 1996;9(4):1096-1103. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1096

Abstract PDF: Fracture of the lateral humeral condyle is a relatively common injury in children. The standard treatment of Jakobs type II and III fractures is open reduction and internal fixation The treatment of Jakobs type I fractures is more controversial. Authors performed clinical and radiological analysed of fifty-two patients of lateral condylar fracture of the humerus who have been treated with open reduction and internal fixation. They were followed up from one year to five years and two months. The results were as follows; 1. The age incidence was confined from 3 years to 12 years. 2. There were 14 cases(26.9%) of Milch type I, 38 cases(73.8%) of Milch type II and according to Jakobs stage, 20 cases were stage I, 23 cases were stage II, 9 cases were stage III. 3. All cases were treated by open reduction and Internal fixation. 4. In 5 cases were lateral condyle overgrowth of the humerus, 2 cases were limited ROM of elbow joint. and 2 cases pin site loosening and superficial wound infections observed. And this complications did not resutt in significant clinical disabilites. 5. Respectively, according to the criteria of Hardacre 41 cases(78.8%) were excellent, 11 cases (21.1%) were good, and there was no poor case. 6. The fracture type and stage of displacement did not effect the flnal results. the complications, the complications are due to inaccurate reduction or insecure fixation. Therefore, open anatomical reduction and stable internal fixation is required to avoid complications, even in stage I displaced fractures.

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Surgical Treatment of Intra-articular Fracture of the Os Calcis: Soo Kil Kim, Young Gyu Kim, Bum Gu Lee, Jin Hong Ko, Su Chan Lee, Young Kim; J Korean Soc Fract 1996;9(2):354-365. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.354

Abstract PDF: Intra-articular fractures involving the posterior facet of the subtalar joint are associated with significant and prolonged disability. But, the treatment of choice for displaced intra-articular calcaneal fractures remains controversial. We treated 30 displaced intra-articular fractures of the calcaneus by open 1eduction and internal fixation through the lateral approach with autogenous bone graft at the Department of Orthopaedic Surgery, Choong-ang Gil and Dong Inchon Gil Ceneral Hospital from January 1990 to October 1994 The clinical and radiographic analyses were as follows. 1. Of 26 patients, 20 patients were male and 6 patients were female. 2. The main cause fractures of calcaneus was a fall from a height in 23 cases(88%) and most of associ ated fractures were spine injury in 6 patients. 3. Fracture was classified according to Essex-Lopresti classification. 13 cases were tongue type, 17 cases were joint depression type. 4. Alt Open reduction and internal fixation through the laterl approach with bone graft was performed in joint depression type and tongue type. 5. The preoperative ayerage Bohlers angle was - 5. The postoperative avereage Bohlers angle was -24, Which was increased significantly. 6. Complications were 12 cases ; included heel pad pain in 8 caLes, osteomyelitis and superficial wound infection in 2 cases, transient sensory hypesthesia on the lateral side of the foot in 2 cases. 7. Based on assessement of Salama, the results were excellent in 5 cases, good in 1 Teases, fair in 6 cases, poor in 2 cases.

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