Journal of Musculoskeletal Trauma

Comparison of outcomes of reinforced tension band wiring and precontoured plate and screw fixation in the management of Mayo type IIIB olecranon fractures: Hyun Goo Kang, Tong Joo Lee, Samuel Jaeyoon Won; Received January 13, 2025 Accepted February 19, 2025 Published online February 28, 2025; DOI: https://doi.org/10.12671/jmt.2025.00059 [Epub ahead of print]

Abstract PDF: Background
Mayo type IIIB olecranon fractures are characterized by significant displacement and comminution, presenting a challenge in selecting the appropriate fixation technique. This study compared the clinical and radiographic outcomes, complications, and reoperation rates of reinforced tension band wiring (TBW) and precontoured plate and screw fixation (PF) in the surgical treatment of Mayo type IIIB olecranon fractures.
Methods
This retrospective review analyzed 24 patients diagnosed with Mayo type IIIB olecranon fractures, who were treated between 2005 and 2023. Of these, 11 patients underwent reinforced TBW, and 13 received precontoured PF. Clinical outcomes were assessed using Disabilities of the Arm, Shoulder, and Hand (DASH) scores and the Mayo Elbow Performance Score (MEPS). Radiographic outcomes focused on fracture union. Operative times, complication rates, and reoperation rates were compared between the groups.
Results
Both the reinforced TBW and PF groups achieved satisfactory clinical outcomes, with no significant between-group differences in DASH and MEPS scores (P>0.05). Radiographic union was achieved in all patients. The reinforced TBW group demonstrated a significantly shorter operative time than the PF group (93.6±7.4 min vs. 132.3±13.7 min; P<0.001). Complication rates were similar between the two groups (reinforced TBW, 38.4%; PF, 36.3%), but hardware-related irritation occurred more frequently in the reinforced TBW group. Reoperations were required in 15.8% of the reinforced TBW group due to hardware irritation, whereas no reoperations were necessary in the PF group.
Conclusions
Reinforced TBW and PF are both effective surgical options for managing Mayo type IIIB olecranon fractures, yielding comparable clinical and radiographic outcomes. While reinforced TBW offers shorter operative times and lower costs, PF is associated with fewer hardware-related complications. Further prospective studies are needed to optimize treatment strategies for these complex fractures. Level of Evidence: Level III.

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Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty: Hyunseok Seo, Jin-Hyung Im, Joo-Yup Lee; J Korean Fract Soc 2020;33(2):110-117. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.110

The indications for total elbow replacement arthroplasty (TERA) include rheumatoid arthritis, degenerative arthritis, acute fracture, nonunion, malunion, posttraumatic arthritis, tumor, and chronic instability. With the development of designs and the increasing use of TERA, more periprosthetic fractures are occurring. On the other hand, there is less data on periprosthetic fractures after TERA because TERA is a relatively rare procedure. Thus, a careful review of the previous literature and appropriate selection of surgical indications are essential for achieving a satisfactory outcome, which should be accompanied by precise surgery as planned. This article presents the causes, risk factors, classification, and principles of treatment of periprosthetic fractures after TERA.

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Intramedullary fibula strut bone allograft in a periprosthetic humeral shaft fracture with implant loosening after total elbow arthroplasty
Young-Hoon Jo, Seung Gun Lee, Incheol Kook, Bong Gun Lee
Clinics in Shoulder and Elbow.2020; 23(3): 152. CrossRef

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Distal Humerus Fracture: How to Choose the Approach, Implant, Fixation and Rehabilitation: Min Ho Lee, Young Ho Lee; J Korean Fract Soc 2019;32(1):72-81. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.72

Abstract PDF: Distal humerus fractures require stable fixation and early joint motion, similar to other intra-articular fractures, but are difficult to treat adequately because of the anatomical complexity, severe comminution, and accompanying osteoporosis. In most cases, surgical treatment is performed using two supporting plates. Plate fixation can be divided into right angle plate fixation and parallel plate fixation. In addition, depending on the type of fracture, surgical procedures can be performed differently, and autologous bone grafting can be required in the case of severe bone loss. The elbow joint is vulnerable to stiffness, so it is important to start joint movement early after surgery. Postoperative complications, such as nonunion, ulnar nerve compression, and heterotopic ossification, can occur. Therefore, accurate and rigid fixation and meticulous manipulation of soft tissues are required during surgery.

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New Injury Mechanism and Treatment Algorithm of Posterior Elbow Dislocation: In Hyeok Rhyou; J Korean Fract Soc 2019;32(1):61-71. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.61

Abstract PDF: Although the concept of a single elbow dislocation mechanism, in which all dislocations start from the lateral side of the elbow joint and progress to the medial side, has never been able to explain the various conflicting experimental and clinical observations thus far, new studies and proposals for a valid mechanism have not been reported. The new proposal for posteromedial and posterolateral dislocation of the elbow joint according to the authors' study and the new treatment algorithm based on this new study can explain the various clinical and experimental results that have been difficult to explain, and provide a reasonable approach to the treatment of elbow dislocations.

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Surgical Outcomes of the Monteggia Type 2 Fracture Dislocation in Adults: Sung Choi, Daegeun Jeong, Youngsoo Byun, Taehoe Gu, Sungsoo Ha, Dongju Shin; J Korean Fract Soc 2019;32(1):6-13. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.6

Abstract PDF: PURPOSE
This study examined clinical outcomes of Monteggia fracture type 2, which is the most common in adults with a high rate of accompanied injuries.
MATERIALS AND METHODS
From June 2004 to November 2015, a retrospective study was performed on 12 patients diagnosed with Monteggia fracture type 2 with a follow-up period of at least 6 months after surgery. The clinical outcomes were evaluated using the Mayo elbow performance score (MEPS), and the existence of accompanied injures, radiological result, and complications were analyzed.
RESULTS
Posterior instability was confirmed in all patients and accompanied fractures were detected in 9 patients (75.0%) on the radial head, whereas 10 patients (83.3%) were found on the coronoid process. The average arc of motion was 107Â° (70Â°â€“130Â°) and the mean MEPS was 89 (45â€“100). Additional re-operation due to re-dislocation, radioulnar synostosis, elbow instability, ulna nonunion, and radial head nonunion were performed in 4 cases (33.3%).
CONCLUSION
The Monteggia fracture type 2 is more commonly associated with radial head fractures and coronoid process fractures rather than other types, which causes elbow instability. Because the rate of additional surgery due to complications is high, the treatment of Monteggia fracture type 2 requires careful assessments.

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Capitellar Osteochondral Impacted Fracture of the Humerus in an Adult Female: A Case Report: Jaekwang Yum, Minkyu Seong, Kyungil Kim; J Korean Fract Soc 2018;31(4):154-158. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.154

Abstract PDF: Capitellar osteochondral impaction fractures of the humerus are an uncommon injury and not encompassed by commonly used classification systems, such as that of Bryan and Morrey. Only a few cases of capitellar osteochondral impaction fractures have been reported. We report a case of a 53-year-old female with a capitellar osteochondral impaction fracture. The osteochondral fracture fragment of the capitellum was impacted and there was a step-off on the articular surface. Recovery of congruence in the capitellar articular surface was necessary. Satisfactory clinical and radiological results were obtained through the â€˜lever armâ€™ reduction of the fracture fragment with a small osteotome and fixation with â€˜raftâ€™ K-wire.

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Additional Hinged External Fixation in Complex Elbow Injury: Tong Joo Lee, Taek Ho Hong, Nak Chul Kim; J Korean Fract Soc 2015;28(3):169-177. Published online July 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.3.169

Abstract PDF: PURPOSE
The purpose of this study was to evaluate the use of hinged external fixation in management of complex elbow injury.
MATERIALS AND METHODS
We retrospectively reviewed clinical outcomes in 10 patients with elbow dislocation and associated fractures of both the radial head and the coronoid process from January 2007 to December 2013. All ten patients were treated by hinged external fixation after open reduction and internal fixation. The indication for use of a hinged external fixator was persistent instability after fixation of the fractures. Early mobilization was started at 1 week (6.5 days) after surgery. The external fixator was removed at 6 weeks after surgery. Cassebaum classification and Mayo elbow performance score were used for clinical and functional evaluation. The follow-up period was at least 1 year.
RESULTS
At the last follow-up, the average further flexion was 127degrees, and the average flexion contracture was 16degrees. The average pronation was 83degrees and the average supination was 78degrees. By the Cassebaum classification after 1 year follow-up, patients were classified as 4 excellent, 4 good, and 2 poor. According to the Mayo elbow performance score, the average score was 87 points (65-100 points) with 3 excellent, 6 good, and 1 fair. Stability was restored in all patients at the last follow-up. There was no case of nonunion and the average union period was 11.5 weeks.
CONCLUSION
This study advocated the additional use of a hinged external fixator in the treatment of complex elbow instability, especially when fixation of fractures and repair of soft tissues were not sufficient. Providing adequate stability and allowing early motion, additional external fixation could improve the functional outcome.

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The Short Term Results of Radial Head Arthroplasty with Unipolar Loose Fit Stem: Su Keon Lee, Kyeong Seop Song, Seung Hwan Lee, Sang Pil Yoon, Sang Youn Lim; J Korean Fract Soc 2015;28(2):125-131. Published online April 30, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.2.125

Abstract PDF: PURPOSE
We report short-term results of radial head prosthesis using a unipolar loose fit stem in ten patients.
MATERIALS AND METHODS
Ten patients with Mason type three radial head fracture, who received unipolar radial head arthroplasty from February 2010 to June 2011, were evaluated (mean follow-up: 22 months, range: 18-30 months). Subjects consisted of five men and five women. Range of elbow motion was measured. Mayo elbow performance index (MEPI) score was used for functional evaluation and periodic radiological imaging was performed to evaluate the stability of implant.
RESULTS
After an average follow-up of 22 months, elbow stability was maintained in all cases, and the average range of motion of elbow flexion and extension was 6 to 130 degrees. Average range of pronation and supination was 66 and 74 degrees, respectively. MEPI score was evaluated as excellent in seven cases, and good in three cases. On final follow-up, radiological assessment showed implant stability in all cases without evidence of dislocation, subluxation, arthritis, periprosthetic osteolysis or heterotopic ossification.
CONCLUSION
Based on our short-term follow-up, radial head arthroplasty with unipolar loose fit stem is a useful method for obtaining satisfactory outcome for unreducible comminuted radial head fractures.

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Cannulated Screw and Wire Fixation with Predrilling for Olecranon Osteotomy in Intra-articular Comminuted Distal Humerus Fractures: Soo Hong Han, Ho Jae Lee, Woo Hyun Kim, Yong Gil Jo, Won Tae Song; J Korean Fract Soc 2015;28(2):118-124. Published online April 30, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.2.118

Abstract PDF: PURPOSE
The olecranon osteotomy in intra-articular comminuted distal humerus fractures is a suggested technique for excellent exposure of articular fractures. However, complications including delayed union, nonunion of osteotomy site have been reported. Authors have applied predrilling for cannulated screw before osteotomy for achievement of rapid and accurate reposition of separation part and added wire fixation for secure stability. The purpose of this study is to evaluate the efficacy of this fixation procedure following the olecranon osteotomy during the internal fixation of intra-articular fracture of the distal humerus.
MATERIALS AND METHODS
This study retrospectively analyzed 14 cases (9 women and 5 men) of intra-articular distal humerus fractures in which the olecranon osteotomy was applied. The mean age of patients was 53.4 years (range, 25 to 83 years), and the average follow-up period was 15.9 months. Eleven cases were classified as AO 13-C3, and the other 3 cases were AO 13-C2. Reduction accuracy, union period of osteotomy site on follow-up radiographs and postoperative complications related to olecranon osteotomy were evaluated.
RESULTS
All osteotomized parts showed no position change and solid union with normal alignment at the last follow-up. The mean period of bony union was 3.5 months (range, 2 to 5 months). There were no complications related to olecranon osteotomy except one case of non-displaced fracture of the proximal ulnar shaft at the level of cannulated screw tip caused by forceful passive physical therapy. It was managed by conservative treatment without further problem.
CONCLUSION
Predrilled cannulated screw and wire fixation following the olecranon osteotomy during internal fixation of intra-articular comminuted distal humerus fractures showed satisfactory results in the union of osteotomy site and it could be a recommendable procedure when fractures require olecranon osteotomy.

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Combined Anterolateral and Lateral Approaches in Treatment of Extra-articular Fracture of the Distal Humerus: Dae Gyu Kwon, Kyoung Ho Moon, Suk In Na, Byung Ki Shin, Tong Joo Lee; J Korean Fract Soc 2012;25(3):185-190. Published online July 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.3.185

Abstract PDF

PURPOSE
The purpose of this study was to analyze the clinical effectiveness of open reduction in the treatment of distal humeral fracture using a newly designed combined approach of anterolateral and lateral approaches to protect the radial nerve.
MATERIALS AND METHODS
We investigated 24 consecutive cases of distal humeral fracture who received open reduction and internal fixation with a plate and screws with a minimum follow-up period of 1 year. We analyzed the patients' age, sex, fracture pattern, timing of the union, range of motion of the elbow joint, and complications. The Mayo elbow performance index (MEPI) was employed for the assessment of elbow joint function.
RESULTS
Clinical union was observed at 10.8 weeks (6~20 weeks) on average. Pre-operatively, there were 3 cases of incomplete radial nerve palsy. All of the cases recovered, and there was no additional radial nerve palsy due to surgery. According to the MEPI, 13 cases were "excellent" and 10 cases were "good" or better, comprising 95.83% of the cases. The range of motion at the elbow was 5.5 degrees (0~15 degrees) of extension, and 131.5 degrees (120~145 degrees) of flexion, suggesting no functional disability. The duration of return to work was 11.2 weeks (5~32 weeks) on average. There were no nonunion, malunion, or infection complications.
CONCLUSION
The combined anterolateral and lateral approach we designed is a clinically effective approach due to facilitation of protection of the radial nerve and attainment of adequate fixation space.

Citations

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Posterior Dual Plating for Distal Shaft Fractures of the Humerus
Chul-Hyun Cho, Kwang-Yeung Jeong, Beom-Soo Kim
Journal of the Korean Fracture Society.2017; 30(3): 117. CrossRef
Modified Combined Approach for Distal Humerus Shaft Fracture: Anterolateral and Lateral Bimodal Approach
Tong Joo Lee, Dae Gyu Kwon, Suk In Na, Seung Do Cha
Clinics in Orthopedic Surgery.2013; 5(3): 209. CrossRef

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Ipsilateral Distal Radius and Scaphoid Fractures Associated with Posteromedial Dislocation of the Elbow Joint: A Case Report: Jin Wan Kim, Young Chul Ko, Chul Young Jung, Il Soo Eun, Young Jun Kim, Chang Kyu Kim; J Korean Fract Soc 2012;25(2):150-154. Published online April 30, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.2.150

Abstract PDF: Arm injuries occurring from high energy injuries such as falls or traffic accidents can be accompanied by wrist and elbow injuries. Monteggia fracture, Galeazzi fracture, and Essex-Lopresti fracture-dislocation are known some examples of such injuries. However, there are no reports on the dislocation of the elbow occurring from a distal radius fracture accompanied by scaphoid fracture, and there is nothing published about its prognosis. The authors report on the treatment and outcomes of a case of a 42-year-old male who had a distal radius and scaphoid fracture associated with posteromedial dislocation of the elbow on the same side of his arm along with a literature review.

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Elbow Function and Complications after Internal Fixation for Fractures of the Distal Humerus: Hyug Soo Ahn, Young Ho Cho, Young Soo Byun, Do Yop Kwon, Seung Oh Nam, Dong Young Kim; J Korean Fract Soc 2006;19(1):56-61. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.56

Abstract

PURPOSE
To evaluate the functional results of the elbow and the complications after internal fixation for distal humeral fractures.
MATERIALS AND METHODS
We reviewed 38 distal humeral fractures; 12 type A, 7 type B and 19 type C by AO classification. There were six low columnar fractures in type A and nine in type C. Six type C fractures were open. The fracture healing and complications were assessed and the functional result was evaluated by rating system of Jupiter et al.
RESULTS
Type A fractures were healed in an average of 10.6 weeks, type B 7.7 weeks and type C 11.5 weeks. Ulnar neuropathy occurred in six cases, loss of fixation in two cases, nonunion in one case, heterotopic ossification in one case and traumatic arthritis in one case. The functional result showed excellent or good in 34 cases (89%) and fair or poor in 4 cases (11%). Open fractures showed significantly worse result than closed fractures.
CONCLUSION
To obtain the satisfactory results, stable fixation followed by early motion is required in most distal humeral fractures. Ulnar neuropathy occurs postoperatively in high incidence and the result of open fractures is worse than that of closed fractures.

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Comparison of Shoulder Range of Motion, Pain, Function, Scapular Position Between Breast Cancer Surgery and Shoulder Surgery Female Patients
Min-ji Lee, Suhn-yeop Kim, Jae-kwang Shim
Physical Therapy Korea.2015; 22(1): 9. CrossRef
Minimally Invasive Plate Osteosynthesis for Humeral Proximal or Distal Shaft Fractures Using a 3.5/5.0 Metaphyseal Locking Plate
Hyoung Keun Oh, Suk Kyu Choo, Jung Il Lee, Dong Hyun Seo
Journal of the Korean Fracture Society.2012; 25(4): 305. CrossRef
Nonunion of Humeral Intercondylar Comminuted Fracture Treated with Fibular Graft - A Case Report -
Jin Rok Oh, Chang Ho Lee, Ki Yeon Kwon, Hoi Jeong Chung
Journal of the Korean Fracture Society.2010; 23(1): 118. CrossRef
Double Parallel Plates Fixation for Distal Humerus Fractures
Young Hak Roh, Moon Sang Chung, Goo Hyun Baek, Young Ho Lee, Hyuk-Jin Lee, Joon Oh Lee, Kyu-Won Oh, Hyun Sik Gong
Journal of the Korean Fracture Society.2010; 23(2): 194. CrossRef

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Elbow Dislocation Combined with Coronoid Process and Radial Head Fracture: Sung Tae Lee, Jin Hyung Choi, Joong Bae Seo, Jin Young Park; J Korean Fract Soc 2005;18(4):437-442. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.437

Abstract PDF: PURPOSE
To evaluate the clinical outcome for terrible triad injury of the elbow joint. MATERIAL AND METHODS: We reviewed consecutive 10 cases retrospectively among 12 terrible triad injuries, which had been followed up for a minimum 1 year. The average age at the time of injury was 45 years (range, 32~72). All cases were dislocated posteriorly. The 3 cases had fracture of olecranon. Combined medial and lateral approach was performed in 3 cases, medial and lateral approach after extensile posterior approach in 4 cases, transolecranon approach using existed olecranon fracture in 2 cases, and transolecranon approach in 1 case were done.
RESULTS
The average Mayo elbow performance score was 87, with 5 excellent, 4 good, and 1 poor results. Results by Riseborough and Radin's rating criteria include 9 good and 1 fair. The 8 cases were stable. But 2 cases were classified with moderate and severe instability; these cases had been performed by radial head allograft and excision respectively.
CONCLUSION
A stable, functional elbow can be restored in terrible triad injury by early active rehabilitation after anatomic reduction and firm internal fixation.

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Treatment of Periarticular Fracture of Elbow with Hinged External Fixator: Hyun Dae Shin, Kwang Jin Rhee, Kyung Cheon Kim, Chang Hwa Hong, Yong Bum Joo; J Korean Fract Soc 2005;18(3):299-303. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.299

Abstract PDF: PURPOSE
To evaluate the result of the treatment with external fixator and early ROM exercise to prevent the stiffness and contracture of the elbow in unstable elbow injury.
MATERIALS AND METHODS
From Jan. 1997 to Dec. 2001, ten patients of unstable elbow injury treated with hinged external fixator and early ROM exercise were evaluated. The age was average 37 years. The patients were followed at least 1 years and motorcycle injury (4 cases) was most common. Nine cases were comminuted fractures and one case was fractures with dislocation. We estimated the result of the treatment with Mayo elbow performance index.
RESULTS
ROM exercise started in average 2 days after operation. Two cases were treated by ilizarov and eight cases treated by elbow distracter modified by the author. The result of the treatment was estimated as following: excellent in two, good in three cases, fair in eight cases, and poor in two case.
CONCLUSION
There were satisfactory results in patients treated with external fixation with early ROM exercise, whose injuries had difficulty in being fixed internally. The authors recommend hinged external fixation and early ROM exercise to prevent postoperative stiffness & contracture of elbow joint in this circumference.

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Analysis of Elbow Injuries 'pattern in Children: Soon Hyuck Lee, Jong Woong Park, Sang Won Park, Kwang Suk Lee, Dang Jae Im, Tae Ha Kim, Sang Won Lee; J Korean Soc Fract 2003;16(1):98-103. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.98

Abstract PDF: PURPOSE
The purpose of this report is to describe the pattern of elbow injuries and the incidence of the different fracture types in children.
MATERIALS AND METHODS
The records of 445 in-patient children treated for the elbow injuries for 5 years were reviewed and analyzed statistically.
RESULTS
The average age of 445 children was 6.7 years. The average age of boys(6.9 years) was about 1 year older than girls(5.9 years). The age group of 4 - 7 years is the majority(50%), followed by the age group of 8 - 11 years(22%). The boy to girl ratio was approximately 2:1. The male predominance changed with the age and appeared dramatically in the age group of 12-16 years( 6.7:1 ). Left elbow was injured more frequently(60%). Left side predominance was accentuated in girls compared to boys(69% vs 55%), especially in the age group of 8 - 16 years (80% vs 50%). Thirty percent of the fractures occurred during the summer, followed by 27% the autumn, 26% the spring months and 17% the winter. The most common fracture was the supracondylar fractures of the humerus(52.3%), followed by lateral condylar fractures(25.4%), olecranon fractures(5.3%), radial head fractures(4.8%), medial epicondyle fractures(4.6%), transphyseal fractures(2.8%) and Monteggia fractures(2.2%). Medial condylar fractures(1.1%) and elbow dislocation(0.8%) were rare injuries. The average age was higher in radial head fracture(10.6 years) and medial epicondylar fracture(12.4years). Closed reduction and percutaneous pinning was the method of treatment in more than half(52%). Open reduction was performed in 32%. Sixteen percent was treated by closed reduction and cast immobilization.
CONCLUSION
The incidence and pattern of elbow injuries in children, which needed operative treatment in the majority, occured closely correlated with the amount of injury prone play and the pattern of behavior during the causative accidents.

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Neurologic Complications of Elbow Fractures in Children: Suk Kyu Choo, Gyu Won Park; J Korean Soc Fract 2002;15(4):595-600. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.595

Abstract PDF: PURPOSE
We analyzed neurologic complications of the elbow fractures in children and evaluated clinical results of type of fractures, frequency of nerve injuries and displacement of fracture fragments and spontaneous recovery of each nerve injuries.
MATERIALS AND METHODS
We analyzed 17 child-patients (20cases) with nerve injuries who were treated conservatively and follewed up for at least 1 year since December 1999. and we analyzed type of fractures, differences between fracture type and nerve injuries, frequency of each nerve injuries and periods of spontaneous recovery of each nerves.
RESULTS
There were all 148 elbow fractures in children. Children with neurologic complications were 17(20 nerves) and 14 in supracondylar and 3 in medial epicondylar fractures. There were 6 in radial nerve, 8 in ulnar nerve, 3 in median nerve and 3 in anterior interosseous nerve. Both ulnar and median nerve injuries were 3 patients. They were recovered spontaneously and mean periods of recovery was 7.3 weeks, 6.5 weeks in radial nerves, 7.0 in median nerves, 7.6 in anterior interosseous nerves, 7.8 in ulnar nerves and radial nerve recovery was most fast than any others. One patient with ulnar nerve injury who was diagnosed medial epicondylar fracture recovered 2 weeks after excision of nonuioned fragment. Among 14 supracondylar fractures, there was 11 posteromedial displacement, 1 posterolateral and 2 posterior. Most of them was displaced posteromedially.
CONCLUSION
All nerve injuries happened in supracondylar and medial condylar fractures and almost recovered. Nerve injuries in the supracondylar fractures was displaced fractures than nondisplaced simple fractures and displacement of fracture fragment and nerve injuries was not agreed with previous published books or papers. We recommand that observation is the appropriate way to manage these nerve injuries in most cases than immediate operation for excision.

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Reconstruction of the coronoid process using a graft from the olecranon of the same side for chronic posterior dislocation of the elbow: Jin Ho Kim, Seung Taek Song, Young Jin Sohn; J Korean Soc Fract 2002;15(3):410-413. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.410

Abstract PDF: It is reported when posterior dislocation of the elbow with the fracture of the coronoid process is occurred, if they can 't achieve the reduction of coronoid process, the patient would have the elbow instability. That is required to open reduction of coronoid process. Limitation of the elbow motion and persistent posterior dislocation of the elbow result from failure of reduction of coronoid process in acute injury. That patients have been treated by distraction arthroplasty, total elbow replacement, arthrodesis, and coronoid process reconstruction. We experienced one case that had a excellent result from reconstruction of the coronoid process using a graft from the olecranon of same side in 28 years old man.

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The role of the coronoid process fracture in the elbow dislocation: Yong Girl Rhee, Jae Ryong Cha; J Korean Soc Fract 2001;14(3):491-498. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.491

Abstract PDF

PURPOSE
To evaluate whether the size of the coronoid process fracture influence on elbow instability, to recognize the requirement of surgery and to report the final results after operation.
MATERIALS AND METHODS
We performed the operative treatment for 10 cases among 17 coronoid process fractures with elbow dislocation from December 1995 to January 1999, and evaluated operative cases. According to Reagan & Morrey classification, 3 cases(30%) belong to type I, 4 cases(40%) type II and 3 cases(30%) type III. The major mode of injury was fall down accident(70%) and most common associated injury was radial head fracture(70%). In all case, the elbow was inevitably subluxated when flexed beyond 45degreesregardless the size of the fragment segment. This lead us to performed the fixation of coronoid process fracture and the reconstruction of the ruptured articular capsule. Two patients who had had recurrent posterolateral instability due to severe capsular damage at initial injury and previous excision of the radial head underwent the total elbow replacement.
RESULTS
According to Mayo elbow performance index, results were graded as excellent in 7 cases(70%), good in 1 cases(10%), and at two case of radial head excision had been performed previously, the results had been graded as poor, but after total elbow replacement they were good. At final results, all of them resulted in more than good. Postoperative range of motion averaged 6 degrees in extension and 128 degrees in forward flexion and there was significantly a tendency for less motion of a forward flexion with more involvement of coronoid fragment.
CONCLUSION
In cases of the elbow dislocation, instability of the elbow is correlated with the severity of the damaged articular capsule and ligament regardless of the size of the coronoid process fracture. The early excision of the fractured radial head should be avoided not to run into total elbow replacement.

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Surgical Outcomes after Olecranon Plating with Retrograde Coronoid Process Screw Fixation through the Plate Hole in the Bifocal Fracture of the Proximal Ulna
Seong-Eun Byun, Ho-Jae Lee, Junhyun Kim, Sang-June Lee, Uk Kim, Soo-Hong Han
Journal of the Korean Orthopaedic Association.2016; 51(5): 403. CrossRef

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Isolated trochlear fracture of the distal humerus: A case report: Sogu Lew, Joon O Yoon, Soo Sung Park, Eugene Kim, Seung Jun Shin; J Korean Soc Fract 2001;14(2):253-256. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.253

Abstract PDF

The trochlear fracture of the distal humerus known as a Laugier fracture is extremely rare in occurrence because this articulating unit has no capsule, muscle, or ligamentous attachment and is cradled by the olecranon. Isolated, displaced fracture of the trochlea presented with review of the literature

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Fractures of the humeral trochlea: case presentations and review
Lucas B.J. Gonçalves, David C. Ring
Journal of Shoulder and Elbow Surgery.2016; 25(6): e151. CrossRef

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Treatment of Transolecranon Fracture-Dislocation of the Elbow: Soo Yong Kang, Han Jun Lee, Jung Nam Han, Kyoung Hwan Kim; J Korean Soc Fract 2001;14(1):99-105. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.99

Abstract PDF: PURPOSE
We conducted this study to discriminate transolecranon fracture-dislocation of the elbow from the anterior Monteggia lesion and to validate the differences of method of treatment.
MATERIALS AND METHOD
From March, 1998 to May, 1999, 3 cases of the transolecranon fracture-dislocation of the elbow were treated by open reduction and internal fixation.One of the three patients had simple oblique fracture of the olecranon combined with capitellum fracture and two had complex comminuted fracture of the olecranon. Functional outcome was assessed with elbow performance rating system of Broberg and Morrey.
RESULTS
At a minimum follow-up of 12 months, overall outcome was rated as exellent in two patients, fair in one. Average bone union peoriod was three months.
CONCLUSION
Stable restoration of the accurate contour and dimension of the trochlear notch of the olecranon and early ROM exercise will lead to good result in transolecranon fracture-dislocation cases.

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Posterior Dislocation of Elbow Joint with Fracture of Radial Head and Coronoid Process (Terrible triad of Elbow Fracture and Dislocation): case report: Eui Hwan Ahn, Sung Tae Lee, Hyun Sik Ahn; J Korean Soc Fract 2000;13(4):1011-1015. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.1011

Abstract PDF: Dislocation of the elbow with fracture of the radial head and the coronoid process is a complex injury that includes severe damage to both soft tissue and bone. The above injury is named as 'terrible triad of elbow fracture and dislocation'. This injury is very rare and difficult to treat and this combined lesion has been reported to have a worse prognosis than either of the single injury. The complications of ectopic ossification, recurrent dislocation, and loss of motion are recognized as a source of considerable concern to the treating orthopaedic surgeon. Many authors emphasized the importance of fixation of coronoid process. The proper management of radial head fracture is controversial. Whatever method used, the elbow must be stable enough to permit early motion. We treated 2 patients who sustained posterior dislocation of elbow with fracture of radial head and coronoid process. First case was treated by closed reduction for dislocation of elbow immediately. After 2 days, radial head was excised and coronoid process was fixed with pulled-out technique. Second case was treated by closed reduction for dislocation of elbow immediately. After 3 days, radial head was treated with open reduction and internal fixation with K-wire and teared anular ligament was repaired. Clinical result of both cases was good

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Reconstruction of Medial Collateral Ligament in Old Posterior Dislocation of the Elbow: Sang Soo Lee, Ho Yeun Hwang, Dong Hee Lee, Il Hyun Nam, Sang Un Lee; J Korean Soc Fract 2000;13(3):576-583. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.576

Abstract PDF: PURPOSE
To evaluate and analyse the operative results of reconstruction of medial collateral ligament(MCL) in old posterior dislocation of the elbow.
MATERIALS AND METHODS
Nine patients (from 1989 to 1999) with old posterior dislocation of the elbow treated by operation were reviewed. We analysed the pattern of dislocation, associated injury, method of operation, complication and functional results. All patients were treated with open reduction. Reconstruction of MCL was undertaken in three patients of nine.
RESULTS
All nine patients who had underwent open reduction were improved in the flexion-extension motion of elbow. Three patients of nine underwent reconstructive surgery of MCL were much improved in the flexion-extension motion. But there is no differences in improving the pronation-supination motion between of them(P>0.05, ttest).
CONCLUSION
Precise understanding of MCL anatomy and appropriate intraoperative technique are mandatory. We achieved much more range of motion in the cases of reconstruction and early motion rather than those of immobilization for 3 weeks with K-wire. We believe reconstruction of MCL is a useful addition to treatment options for old elbow dislocation of elbow.

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Radiologic Pattern of Trochlear Ossification Center: Jin Woo Kwon, Seung Ho Shin, Won Ho Cho, Woo Se Lee, Chun Ho Kim; J Korean Soc Fract 2000;13(2):216-221. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.216

Abstract PDF: PURPOSE
: The trochlear secondary ossification center may be variable in number, shape and size, thus it can be considered as fracture. The purpose of this study is to evaluate radiographic analysis of normal trochlear secondary ossification center.
METHOD
AND MATERIAL : We reviewed the 100 cases of normal elbow radiographs and classified the numbers and shapes of trochlear sencondary ossification center.
RESULT
: The number of trochear secondary ossification center was that one was 72 cases(72%), two 19 cases(19%), three 9 cases(9%). The shape of trochlear ossification center which has only one ossification center was classified as round was 11cases(15.3%), elliptical 24 cases(33.3%), irregular37(51.4%).
CONCLUSION
: The radiographic finding of trochlear secondary ossification center is variable in number, size and shape, thus authors concluded that fragmentation or bizzare shape of trochlea in painless elbow must be considered as secondary ossification center.

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Treatment of Periprosthetic Fracture Following Total Elbow arthroplasty: Myung Chul Yoo, Yong Girl Rhee, Yoon Je Cho, Kang Il Kim, Young Lin Cho; J Korean Soc Fract 2000;13(1):193-199. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.193

Abstract PDF

PURPOSE
: To classify the pattern of periprosthetic fracture after total elbow replacement(TER) and introduce the principles of treatment in various fracture patterns.
MATERIALS AND METHODS
: Four patients(1 man and 3 women) were evaluated, who had periprosthetic fractures following total elbow arthroplasty, form July 1997 to October 1998. The incidence of fracture among TERs was 6%(4/62) and the average follow-up period was 1 year 6 months. The locations of periprosthetic fractures were classified according to Hanyu et al. The result were analyzed about the treatment modalities, the period to bony union, elbow motion and complication.
RESULTS
: Type2 and type 3 fractures were treated with closed reduction and hanging splint, whereas type 1 fracture showing loosening of humeral component was treated with revision arthroplasty. Type 4 fracture was treated with open reduction and internal fixation. The period to bone union was 5 months in average. The elbow motion ranged between 7.5degrees to 106.2degrees at the last follow-up. Type 3 showed anterior angulation deformity of 20degrees.
CONCLUSION
: Fracture pattern, stability, and loosing of component should be considered to select treatment modality. In transverse fracture proximal to the humeral stem tip(type 3), open reduction and internal fixation is recommended because of difficulties in maintaining alignment of fracture fragment. Postoperative rehabilitation program is very important to prevent limitation of elbow motion

Citations

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Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty
Hyunseok Seo, Jin-Hyung Im, Joo-Yup Lee
Journal of the Korean Fracture Society.2020; 33(2): 110. CrossRef

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Surgical Treatment of the Fracture and Dislocation of the Elbow and Early Controlled Mobilization: Young Kye Kim, Ki Young Kang; J Korean Soc Fract 2000;13(1):186-192. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.186

Abstract PDF: PURPOSE
: To assess the results according to the injury types of fracture-dislocation of the elbow and to evaluate the stability after early controlled mobilization.
MATERIALS AND METHODS
: Twenty-two patients were managed with open reduction and internal fixation, sometimes using the compass hinged external fixator. Most common direction of dislocation was posterior(46%) and most common associated fracture was radial head and neck fracture(36%). patients were treated with various methods regarding the types of fracture and immediate mobilization using the hinged functional brace.
RESULTS
: Of 11 cases associated with radial head fracture. 9 cases had excellent or good results and 2 cases combined with concomitant other fracture had fair results. Of 5 cases associated with olecranon fracture, 2 cases with severe comminuted fracture had fair or poor results. All of 6 cases associated with coronoid or medial condyle fracture had good results. Late instability was not observed in any of 22 cases.
CONCLUSION
: This study revealed that more combined lesion and comminution of the fracture had worse functional results. Late instability from immediate controlled mobilization was not observed.

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Results of Treatment of Fracture-Dislocations of Elbow: Dong Soo Kim, Soon Ho Hwang, Chil Soo Kwon, Jong Kuk Ahn, Byung Hyun Jung, Yerl Bo Sung, Jae Kwang Yum, Hyung Jin Chung; J Korean Soc Fract 2000;13(1):178-185. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.178

Abstract PDF: PURPOSE
: This study analyzed clinical and biomechanical data from patients with elbow fracture dislocation to correlate long-term objective result with the specific injury type and treatment rendered. This can provide a basis for the management of this difficult injuries.
MATERIALS AND METHODS
: Fifteen patients with elbow dislocation were studied from October, 1992 to October, 1997 in Sang-Gye Paik Hospital. The average duration of follow up was 4.2 years.
RESULTS
: On the basis of an objective functional grading score that included elements of pain, motion, strength, and stability, the results were excellent in five(33%), good in five(33%), fair in one(7%), poor in four(27%). Prolonged immobilization greater than four weeks was associated with poor results. The results were closely related to the combined injuries and duration of immobilization. In case of radial head fractures, the best result was obtained in patients with Mason type II fractures treated by open reduction and internal fixation using Herbert screw and early complete radial head excision. SUMMARY AND CONCLUSION : The most common combined injury is radial head fracture. Early complete radial head excision and encouraging early ROM had more satisfactory result than delayed radial head excision or internal Fixation for Mason type III fracture.

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fracture and Dislocation of the Elbow Treated with Compass Elbow Hinge: Hyung Bin Park, Hae Ryong song; J Korean Soc Fract 1998;11(3):709-717. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.709

Abstract PDF: Post-traumatic elbow stiffness is a common and disastrous complication after acute elbow injury. prolonged immobilization universally leads to stiffness. Stable fixation and controlled, gradual increase in range of motion is prferred for the treatment of comminuted intraarticular fracture and acute unstable dislocation of elbow. In comminuted intraarticular fracture of elbow, the Compass Elbow Hinge provides additional stability for fixation devices used to fix intraarticular fractures and simultaneously permits measured and controlled joint mobilization. In instability after reduction of elbow dislocation, the Compass Elbow Hinge helps to protect the soft tissue from undesirable stresses during healing. The purpose of this study is to evaluate the results of the Compass Elbow Hinge in maintaining and restoring mobility in the acutely injured elbow. The authors reviewed 11 consecutive patients who had the Compass Elbow Hinge applied for acute elbow instability. The average duration of application was 7 weeks. Follow-up averaged 18 months, adn motion averaged 96 degrees in flexion/extension plane. Comcentric stability was restored in all but one case, one case of resubluxation required reconstruction of medial collateral ligament, following which, the elbow was stable. According to the Mayo elbow performance index there were 8 excellent, 2 good and 1 fair result. The Compass Elbow Hinge helps to facilitate management of complex osseo-ligamentous injuries of the elbow. It decreases the incidence of sequelae such as stiffness and instability by permitting early mobilization through a kinematically normal range of motion without jeopardizing soft tissue healing.

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Neural Injuries in Elbow Fracture in Children: Kyung Chul Kim, Bon Sub Koo, Hae Du Sung; J Korean Soc Fract 1997;10(2):388-392. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.388

Abstract PDF: Due to the unique anatomical characteristics of elbow, it is well known that fracture involving elbow joint, relatively common in children, frequently accompanies nerve injuries. In recent studies, most of these injury are reported to be resolved within average 2~3months spontaneously. The authors reviewed 91 elbow fractures revealing 9 neural injuries in children at Kangbuk Samsung Hospital from January 1990 to December 1995 retrospectively. These injuries occurred in 9 patient whose age ranged from 5~8 years. The overall incidence of neural injuries appeared to be around 9.8%. There were three radial, three ulnar, two interosseous, one median neuropathies detected. Two of the ulnar nerve injuries were iatrogenic, resulting from closed reduction and percutaneous pinning. All of the deficit, resolved spontaneously within a range 1~7 months(average 2.6months).

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Operative Treatment of Elbow Fractures and Dislocations in Adults: Sang Ho HA, Sang Hong Lee, Dong Min Shin, Young Bae Pyo, Pan Ok Kim; J Korean Soc Fract 1997;10(1):119-126. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.119

Abstract PDF: The elbow is highly constrained and stable joints in the body, but dislocation is not uncommon due to trauma such as traffic accident and sports injury. The relative incidence of associated fractures in previously reported series of elbow dislocations has ranged from 12% to 62%. Post-traumatic sequelae of the elbow fractures and dislocations are joint stiffness, nerve injury, non-union and heteroDopic ossification. Operative procedures for repair and reconstruction of the injured elbow are technically demanding and require careful planning. Because of the proximity of crucial neurovascular structures, a thorough knowledge of the anatomy and extensile exposure is essential. Thirteen adult patients with elbow dislocation associated with fractures about the elbow from June 1990 to June 1995 who had taken operative treatment were studied. The results were as follows ; 1. Most common direction of dislocation is posterior(8 cases) and most common associated fracture is radial head & neck fracture(7 cases). 2. Most common and disabling complication is limitation of motion(7 cases). 3. By the Mehlhoffs criteria, with regard to limitation of motion, pain, instability and neurovascular deficit, relatively good results are obtained at 9 cases(69%). 4. For better functional results, early reduction of dislocation, stable fixation of fracture and early motion is essential option in the management of elbow fractures and dislocations.

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A Clinical Study of the Intra-articular Fracture of the Elbow Joint Fixed with Herbert Sciew: Won Sik Choy, Hyun Dae Shin, Whan Jeung Kim, Kwang Won Lee, Hyun Jong Park, Yoo In Kim; J Korean Soc Fract 1996;9(4):1111-1117. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1111

Abstract PDF: The intra-anicular fracture of the elbow joint can render the elbow joint unstable. In this situation. it is desired to reduce and fix the bone fragment internally. The goal of treatment of the intra-aficular fracture of the elbow joint is a painless, stable elbow to provide a favorable range of motion. Fourteen patients of the intra-articular fraciure of the elbow joint who were treated with Herbert screw in Eul Ji General Hospital, Taejon from October, 1993 to December, 1994. were analyzed in clinical and radiologic aspects. The results obiained from this study were as follows; 1. Among 74 patients, male were 11 cases(78.5%) and female were 3 cases(21.5%). 2. The average age of patients were 31.8 years with range from 15 years to 11 years and the follow-up period ranged from 16 months to 33 months with average 19.6 months. 3. The most common cause of injury was fall down(50.0%) followed by slip down(28.5%) and traffic acrident(21.5%). 4. The most common intra-articular frarture of the elbow joint was capitellum fracture(50.0%) rollowed by radial head fracture(35.6%). 5. Through late radiologic assessment, there was 1 case of post-traumatic arthritis. 6. The result of treatment were excellent in 6 patients(42.8%), good in 1 patients(50.0%) fair in 1 patient(7.2%) by functional rating index of Morrey.

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