Journal of Musculoskeletal Trauma

Anatomical Study of Symphysis Pubis Using 3 Dimensional Computed Tomography in Koreans: Ji Wan Kim, Jung Min Park, Jae Suk Chang; J Korean Fract Soc 2013;26(1):32-36. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.32

Abstract PDF: PURPOSE
To acquire anatomical data for the normal pelvic bone structure using three-dimensional computed tomography (3D CT) and to propose the most appropriate angle and screw length for safe screw insertion during symphysis pubis plating.
MATERIALS AND METHODS
We performed 3D CT analysis in 52 patients who required plating and selected a medial and lateral insertion point between the symphysis pubis and the pubic tubercle. Using a three-dimensional medical image analysis program, we evaluated the appropriate screw length, sagittal angle, and oblique angle at each point in this cohort.
RESULTS
At the medial point, the sagittal angle was determined to be 49.1degrees with an average screw length of 49.4 mm. At the lateral point, we calculated an average screw length of 49.1 mm, oblique angle of 23.2degrees, and sagittal angle of 45.7degrees. The screw length was longer in men than in women (4.6 mm and 7.3 mm, respectively) at the medial and lateral point.
CONCLUSION
At the symphysis pubis diastasis, we can insert the screw caudally at 49degrees with a minimal length of 37 mm at the medial point. We can insert the screw caudally at 46degrees, medially at 23degrees, with a minimal 34 mm length at the lateral point.

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Treatement of Diastasis of the Distal Tibiofibular Syndesmosis: Woo Chun Lee, Han Suk Ko, Cheol Lee, Ki Heon Nam, Kang Hoon Ko, Jong Deuk Rha; J Korean Soc Fract 2001;14(4):677-684. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.677

Abstract PDF: PURPOSE
To investigate the indication of transfixation of distal tibiofibular syndesmosis.
MATERIALS AND METHODS
Twenty-two patients were surgically treated for diastasis of the distal tibiofibular syndesmosis and followed for more than one year. The decision to transfix the syndesmosis was made according to the result of intraoperative stress test.
RESULTS
In patients with bimalleolar fracture, good or excellent clinical results were obtained in all patients, and no widening of the medial clear space and I mm or no widening of the tibiofibular clear space was observed. In patients with deltoid ligament tear, good or excellent results were obtained in five patients, and the medial clear space was widened more than 1mm in three patients and tibiofibular clear space was widened 2mm or more in four patients.
CONCLUSION
We believe that transyndesmotic fixation is not required if anatomical bimalleolar fracture fixation is achieved, and in patients who have deltoid ligament rupture, it may be better to transfix the syndesmosis regardless of the level of fibular fracture.

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Diastasis of the Symphysis Pubis During Vaginal Delivery: Woo Nam Moon, Kwan Young Joo, Seung Woo Suh; J Korean Soc Fract 2001;14(1):37-43. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.37

Abstract PDF: PURPOSE
The objectives of this study are to observe the clinical characteristics and incidence of diastasis of symphysis pubis during vaginal delivery and to evaluate the risk factors of the lesion.
METHODS
AND MATERIALS: 16,000 vaginal delivery cases of our center from 1997 to 1999 were reviewed. The severe pain in symphysis pubis and walking difficulty after delivery were used as a diagnostic criterion. Several factors that increase the risk of this lesion during delivery were reviewed and analyzed by t-test between diastasis group (n=55) and normal group (n=100).
RESULTS
Fifty-five diastasis of symphysis pubis were diagnosed out of 16,000 normal vaginal delivery cases during that period. The widening of the joint ranged from 4mm to 34mm. Sixteen cases accompanied vertical mobility. No factor was proved to increase the risk of the lesion. Initial body weight of infant had suggestive significance (P=0.051).
CONCLUSION
We couldn't prove any risk factors that increased the risk of diastasis of symphysis pubis during vaginal delivery in this study. Further prospective studies with more cases would be needed to disclose the risk factors.

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A Clinical Study of Ankle Diastasis with Fracture of flbula: Koon Soon Kang, Jun Seop Jahng, Hui Wan Park, Ho Jung Kang, Young Chul Cho; J Korean Soc Fract 1994;7(2):388-396. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.388

Abstract PDF: Ankle joint is important as a weight-bearing joint and ankle diastasis requires accurate diagnosis and treatment. The authors analysed 82 cases of ankle diastasis with fibular fracture during the year 1986 through 1992 at YoungDong Severance Hospital. The results obtained are as follows. 1. The most common cause of injury was slip down, and traffic accident and fall down in order. 2. By Weber classification, 42 cases were type BS(+) and 40 cases were type C. By Lauge-Hansen classification, supination-external rotation was most common (35 cases). 3. Open reduction was done in all cases for fracture of fibula. 45 cases of ankle diastasis were treated with one transfixation screw and 37 cases without transfixation after confirmation by Cotton test. 4. The result according to Cottons criteria, 39 cases(86.7%) were were good or fair in transfixation group, and 34 cases(91.9%) in nontransfixation group. In conclusion, the transfixation screw was not necessary in cases of ankle diastasis which was considered as stable by Cotton test after internal fixation for the fracture of fibula.

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A Clinical Study of the Ankle Fracture with Diastnsis: Ik Dong Kim, Jo Chul Ihn, Pong Tnk Kim, Byung Chul Park, Young Goo Lyu, Il Hyung Park, Chang Hyuk Choi; J Korean Soc Fract 1992;5(2):253-259. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.253

Abstract PDF: The ankle fracture with diastasls of distal tibiofibular joint is caused by an axial loading force with concomitant external rotation and associated with severe ankle fracture in addition to talai subluxation due to rupture of the distal tibiofibular syndesmosis. In order to restore the normal ankle mortise, operative anatomical reduction and temporary stabilization of the syndesmosis is mostily required until early ligament healing is present. Twelve cases among ninety-six cases of the ankle fracture were associated with diastasis and treated in the Department of Orthopedic Surgery, Kyungpook National University Hospital during the period from January, 1988 to May, 1991. We analysed these cases according to injury mechanism, radiographic criterion, the patterns of associated medial and lateral injury and treatment result. The results obtained were as follows; 1. The incidence of trauma was most frequent in 5th decade(5 cases). 2. Diastasls was produced by 3 mechanism according to Lauge-Hansen classification : (pronalion-external rotation : 7, Suplnatlon-external rotation : 3, pronation-Abduction;2). 3. All were associated with fibular fracture : proximal fibular fracture was most common (7cases). 4. All had disruption of the medial structures (medial ligament rupture 3, medial malleolusfracture 9). 5. Although the cases were small, there seems no significant differences between transfixation group and unfixation group when accurate anatomical restoration of the distal tibiofibular syndesmosis was achieved.

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A clinical study of ankle fractures: In Hwan Jeong, Jeong Hwan Oh, Eui Hwan Ahn, Kyung Jong Ham; J Korean Soc Fract 1991;4(2):347-355. Published online November 30, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.2.347

Abstract PDF: No abstract available.

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A clinical investigation of ankle fractures associated withdiastasis: Chang Ju Lee, Won Ho Cho, Ho Geun Chang, Hyun Cheol Yang; J Korean Soc Fract 1991;4(1):75-84. Published online May 31, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.1.75

Abstract PDF: No abstract available.

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A Study of Classification of Ankle Fractures: Se Il Suk, Choon Ki Lee, Soo Ho Lee, Suk Kee Tae, Song Choi; J Korean Soc Fract 1989;2(2):155-163. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.155

Abstract PDF: Lauge-Hansens classification system and Webers classification system are the two most commonly used systems in ankle fractures. both are based on causative mechanism but both have some deficiencies. Authors intended to decide which is easily applicable in clinical practice and shwich provides more information about treatement, especially that of diastasis. So we analysed 143 cases of ankle fractures in Seoul National University Hospital, Kang-nam General Hospital and Namseoul Hospital from January 1983 to December 1988. The results obtained are as follows. 1. Webers type A fractures correspond not only supination-adduction but also to pronation-abduction and pronation-dorsiflexion. Type B fractures correspond most closely to supination-external rotation and possibly to pronation abduction and pronation external rotation. Type C fractures show the nearest equivalence to pronation-external rotation and occasionally correspond to supination-external roation or pronation-abduction. 2. Diastasis was noted in 16 cases(28%) of type B and in 18 cases(74%) of type C and this lower incidence was seemed to be due to neglect of diastasis at physical examination or during operation. 3. It seemed to be more reasonable to fix the diastasis with tibiofibular fixation screw especially in type C. 4. Webers simpler classification system, which can explain the hidden ligamentous injury such as diastasis, was more easily applicable in daily use than Lauge-Hansen classification.

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