Journal of Musculoskeletal Trauma

Comparison of a Novel Box-Frame External Fixator and Conventional Delta-Frame External Fixator in the Staged Treatment of Distal Tibia Fractures: Yong-Cheol Yoon, MinKyu Shin, Chang-Wug Oh, Jong-Keon Oh; J Korean Fract Soc 2020;33(3):125-133. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.125

Purpose
Distal tibia fractures with severe soft-tissue edema or intra-articular fractures are treated by staged operations using external fixators. Definitive surgery that maintains ligamentotaxis has been difficult using existing fixators. This study introduced a novel ‘box-frame’ external fixator and evaluated its clinical usefulness.
Materials and Methods
This study included 45 patients (32 males, 13 females) diagnosed with distal tibia fractures who underwent staged operations between March 2012 and March 2016, with a follow-up of at least one year. The patients were divided into two groups. In one group, fixation was performed with a box-frame external fixator (Group A). In the other group, fixation was performed with a delta-frame external fixator (Group B). The following outcomes were evaluated: the time until definitive surgery, operative time of the definitive surgery, radiation exposure time, bone union, time to achieve bone union, postsurgical complications, American Orthopaedic Foot & Ankle Society anklehindfoot score, and ankle range of motion.
Results
Compared to the delta-frame, the box-frame showed a statistically significant reduction in the mean radiation-exposure time and operative time during the definitive surgery by 58 seconds and 25 minutes, respectively. The differences in the time until definitive surgery, bone union, time to achieve bone union, postsurgical complications, and functional scores were not significant.
Conclusion
The box-frame external fixator can be a useful treatment method in the staged surgery of distal tibia fractures.

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Temporary Circular External Fixation for Spanning the Traumatized Ankle Joint
Nando Ferreira, Niel Bruwer, Adriaan Jansen van Rensburg, Ernest Muserere, Shao-Ting Jerry Tsang
JBJS Essential Surgical Techniques.2024;[Epub] CrossRef
Temporary circular external fixation for spanning the traumatised ankle joint: A cohort comparison study
William D. Harrison, Franklin Fortuin, Matthieu Durand-Hill, Etienne Joubert, Nando Ferreira
Injury.2022; 53(10): 3525. CrossRef

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Treatment of Neglected Proximal Interphalangeal Fracture Dislocation Using a Traction Device: A Case Report: Yongun Cho, Jai Hyung Park, Se Jin Park, Ingyu Lee, Eugene Kim; J Korean Fract Soc 2019;32(4):222-226. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.222

Abstract PDF: This paper reports the use of a traction device for the treatment of neglected proximal interphalangeal fracture dislocations. A 44-year-old man with a fracture dislocation of a right ring finger proximal interphalangeal joint was admitted 17 days after the injury. Closed reduction and external fixation were performed using a dynamic traction device and C-arm under a brachial plexus block. Passive range of motion exercise was started after two weeks postoperatively and active range of motion exercise was started after three weeks. The traction device was removed after five weeks. No infection occurred during the traction period. No subluxation or displacement was observed on the X-ray taken two months postoperatively. The active range of motion of the proximal interphalangeal joint was 90Â°. The patient was satisfied with the functional result of the treatment with the traction device. The dynamic traction device is an effective treatment for neglected fracture dislocations of the proximal interphalangeal joint of a finger.

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Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures: Sang Woo Kim, Chae Chil Lee, Sang Hun Ko, Il Yeong Hwang, Min Seok Kim, Woo Young Jin; J Korean Fract Soc 2019;32(1):1-5. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.1

Abstract PDF

PURPOSE
This paper suggests the use of distraction dynamic external fixators (DDEF) for the treatment of proximal middle phalanx fractures.
MATERIALS AND METHODS
Seven patients, who were diagnosed with comminuted intra-articular fractures at the base of the middle phalanx from February 2014 to November 2016, were enrolled in this study (volar aspect 6 cases, dorsal aspect 1 case). They underwent a closed reduction under a C-arm image intensifier, and DDEF was applied with general anesthesia. Range of motion (ROM) exercise was encouraged after 3 to 5 days postoperatively, and DDEF was removed after 5 weeks. Subluxation, angulation and displacement were evaluated 6 weeks postoperatively.
RESULTS
The patients who were treated with DDEF showed a normal proximal interphalangeal joint ROM (100Â°), and there was no subluxation or displacement on the X-ray film 6 weeks postoperatively. In addition, there were no signs of infection, such as local heat, redness, and pus-like discharge.
CONCLUSION
DDEF helps maintain the reduction and reducing forces through the ligamentotaxis. The joint stiffness is reduced, which it makes early return to daily life easier.

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Treatment of Neglected Proximal Interphalangeal Fracture Dislocation Using a Traction Device: A Case Report
Yongun Cho, Jai Hyung Park, Se-Jin Park, Ingyu Lee, Eugene Kim
Journal of the Korean Fracture Society.2019; 32(4): 222. CrossRef

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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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Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect: Soo Kyung Lee, Jung Ryul Kim, Jong Han Lim, Jun Mo Lee; J Korean Fract Soc 2010;23(1):57-63. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.57

Abstract PDF: PURPOSE
To study clinical results and complications in the treatment of infected nonunion of the tibia according to location of nonunion and reconstruction for soft tissue defect.
MATERIALS AND METHODS
36 cases of tibia infected nonunion which were treated with the llizarov included in this study. There were proximal 1/3 in 14, middle 1/3 in 10, and distal 1/3 in 11 cases. Coverage of the soft tissue were treated with the free flap in 8 cases as classified group A and non-free flap in 17 cases classified group B. We evaluated the healing index, complications and comparing the results of each treatment by the Paley method.
RESULTS
Bone union was achieved in all cases. The proximal nonunion showed better results than those in the middle and distal area; average healing index: 35.6 days/cm (p=0.038), bone results: 92.9% (p=0.025), functional result: 90.5% (p=0.03). Group B showed significantly better results as it showed average healing index: 30.3 days/cm (p=0.015), bone results: 85.7% (p=0.025), functional results: 90.5% (p=0.015).
CONCLUSION
The nonunion of proximal 1/3 showed better results than other sites. Soft tissue reconstruction with free flap that control infection more effectively, could be improved the treatment outcomes.

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Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage: Seung Ryul Lee, Jae Hoon Yang, June Kyu Lee, Hyun Dae Shin, Kyung Cheon Kim, Kyu Woong Yeon, Young Mo Kim; J Korean Fract Soc 2009;22(3):152-158. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.152

Abstract PDF: PURPOSE
To find out the efficiency of two staged operation of patients with high energy proximal tibia fracture with severe soft tissue damage, the first step being external fixation, and the second, internal fixation with plates.
MATERIALS AND METHODS
The study group was the 42 patients who had followed for one year out of a group of 56, performed the first step external fixation and the second step internal fixation with plates retrospectively, from March 2003 to March 2007. The average age of the study group was 51.4, 26 men, and 16 women participating in this study. The average time of follow up was 32 months. In the final follow up, investigations of the radiological assessments and functional abilities of the bony fusion were carried out along with the complications of the soft tissue.
RESULTS
The duration after the first step external fixation until second step internal fixation to be performed was 14.9 (6~40) days in average. The final bone fusion took about 15 weeks, and according to the final follow up, the range of motion of the knee was around 110.8 degrees (6.2~117 degrees). In 31 cases, only the internal fixation was performed, while in 11 cases, soft tissue reconstruction was carried out with the internal fixations. As for the complications there were 2 cases of deep soft tissue infection, 2 cases of nonunion, 1 case of malunion and 1 case of knee joint stiffness.
CONCLUSION
In cases of proximal tibia fracture with severe soft tissue damage, external fixation was important to secure the safety of the fracture, carry forward the anatomical alignment, plan the soft tissue safety and manage the wound to decrease the number of microbial in the next operation, which is the internal fixation with plates.

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Comparison of Outcomes for Unstable Distal Radius Intraarticular Fractures: T-locking Compression Plate versus External Fixator: Chul Hyun Cho, Su Won Jung, Sung Won Sohn, Chul Hyung Kang, Ki Cheor Bae, Kyung Jae Lee; J Korean Fract Soc 2008;21(1):51-56. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.51

Abstract PDF

PURPOSE
To compare the outcomes between T-locking compression plate (T-LCP) and external fixator (EF) for unstable distal radius intraarticular fractures.
MATERIALS AND METHODS
We retrospectively analysed the results in 22 cases with T-LCP, 20 cases with EF. We evaluated the clinical results according to the Mayo Wrist Scoring System, radiographic results.
RESULTS
The mean score was 84.6 in the T-LCP group and 80.5 in the EF group respectively. Final radiographic measurements for the T-LCP group averaged 10.5 mm radial length, 21.7degrees radial inclination, 9.8degrees volar tilt and 0.25 mm intraarticular step-off. The EF group averaged 10.1 mm radial length, 20.3 degrees radial inclination, 6.3 degrees volar tilt and 0.73 mm intraarticular step-off.
CONCLUSION
Both groups showed satisfactory final clinical outcomes. But T-LCP group allowed return to daily living, resulting in early postsurgical wrist motion. By the anatomical reduction, final volar tilt, intraarticular step-off were statistically better in the T-LCP group.

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Comparative Analysis of the Results of Fixed-angle versus Variable-angle Volar Locking Plate for Distal Radius Fracture Fixation
Seung-Do Cha, Jai-Hyung Park, Hyung-Soo Kim, Soo-Tae Chung, Jeong-Hyun Yoo, Joo-Hak Kim, Jung-Hwan Park
Journal of the Korean Fracture Society.2012; 25(3): 197. CrossRef
Treatment for Unstable Distal Radius Fracture with Osteoporosis -Internal Fixation versus External Fixation-
Jin Rok Oh, Tae Yean Cho, Sung Min Kwan
Journal of the Korean Fracture Society.2010; 23(1): 76. CrossRef

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Bone Transport Over the Intramedullary Nail for Defects of Long Bone: Jae Young Roh, Chang Wug Oh, Jong Keon Oh, Hee Soo Kyung, Byung Chul Park, Woo Kie Min, Joon Woo Kim, Chang Hyun Cho; J Korean Fract Soc 2008;21(1):37-44. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.37

Abstract PDF

PURPOSE
To evaluate the results of bone transport using external fixator over an intramedullary nail for defects of long bone.
MATERIALS AND METHODS
We treated 14 cases of bone defect after chronic osteomyelitis or trauma of tibia (12 cases) and femur (2 cases) using this method. The mean age of index procedure was 46.9 years, and all of them had follow-up study for a mean of 3 years. After the corticotomy and insertion of intramedullary nail, bone transport was done by external fixators. Then, the segment was moved and bone graft was done at docking site.
RESULTS
The mean transported amount was 5.8 cm, and the external fixator was removed after 141 days. The mean external fixation index was 25.6 days/cm. Primary union of distraction and docking site was achieved in all, but one had failure in union of docking site. According to the Mekhail's functional criteria, there were 5 excellent, 6 good, and 3 fair results. Among 15 complications, there were 2 major complications with residual sequelae, and they were 1 recurred osteomyelitis and 1 flexion contracture of knee.
CONCLUSION
Bone transport using external fixator over an intramedullary nail, can successfully solve defects of long bone. Since this method can remove external fixators earlier than the conventional method, it has fewer complications and makes patients to return to daily life earlier.

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Treatment for Bone Defect of Open Tibial Fractures by Using Intramedullary Nail Fixation with Autogenous Iliac Bone Graft
Hyub Sakong, Ki Cheor Bae, Chul Hyun Cho, Kyung Jae Lee, Eun Seok Son, Du Han Kim
Journal of the Korean Fracture Society.2012; 25(4): 288. CrossRef

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Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator: Suk Kyu Choo, Kyung Wook Nha, Hyoung Keun Oh, Dong Bong Lee; J Korean Fract Soc 2007;20(4):323-329. Published online October 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.4.323

Abstract PDF: PURPOSE
We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern.
MATERIALS AND METHODS
We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern.
RESULTS
Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%).
CONCLUSION
The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.

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Radiologic Reduction Loss after Surgical Treatment of Distal Radius Fracture: Heun Guyn Jung, Jin Bae Choi, Seung Yong Seo, Yong Soo Choi; J Korean Fract Soc 2006;19(4):454-459. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.454

Abstract: PURPOSE
To compare and analyse radiologic reduction loss between fixation with K-wire only group and fixation with K-wire and external fixator group for surgical treatment of distal radial fracture.
MATERIALS AND METHOD
We analysed 60 patients who received the operative treatment with K-wire fixation only or K-wire and external fixator and also were in regular follow up at least one year. We compared radiologic reduction loss of radial length, radial inclination and volar tilt between immediate post-operative radiograph and latest follow up radiograph according to operative methods, fracture patterns and age groups.
RESULTS
Reduction loss of volar tilt was greater in fixation with K-wire only group than fixation with K-wire and external fixator group (p<0.05). Reduction losses of radial length and radial inclination were more in intra-articular subgroup than extra-articular subgroup in fixation with K-wire only group (p<0.05). No significant difference of reduction loss was noted between intra-articular and extra-articular subgroups in fixation with K-wire and external fixator group.
CONCLUSION
More radiologic reduction loss can be expected in fixation with K-wire only group for intra-articular distal radius fracture compared with extra-articular distal radius fracture. Additional external fixation should be added in intra-articular distal radius fracture to reduce radiologic reduction loss.

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Treatment of Distal Radius Fractures Using the Percutaneous K-wire Reduction-Fixation and External Fixator: Sang Jin Cheon, Ja Gyung Ku, Dong Ho Lee, Hui Taek Kim, Jeung Tak Suh; J Korean Fract Soc 2006;19(2):228-235. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.228

Abstract

PURPOSE
To analyse the results of treatment of unstable intra-articular distal radius fractures using the percutaneous K-wire reduction-fixation and external fixator.
MATERIALS AND METHODS
A retrospective follow-up study of 22 cases was carried out. With use of the system of AO classification 9 cases were in C1 and 7 in C2, and 6 in C3. The average duration of follow-up for all fractures was 35 months. We evaluated the radiologic results, the functional results according to clinical evaluation scoring system by Green and O'Brien and osteoarthritis grade according to arthritic grading system by Knirk and Jupiter.
RESULTS
Excellent and good results were rated in 17 cases (77%) of all cases. At last follow-up the mean loss of radial length, radial inclination and volar tilt were 1.4 mm, 1.0o, and 1.4o respectively. Also 7 patients had grade I, 1 patient grade II, and 1 patient grade III arthritis.
CONCLUSION
We think that percutaneous K-wire reduction-fixation and external fixation is useful treatment method for the unstable intra-articular distal radius fracture. But severely comminuted AO type C3 fractures would need additional treatments such as open reduction and bone graft to acquire and maintain the articular reduction for better results.

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Management of Comminuted Intra-articular Fractures of the Distal Radius: Arthroscopically Assisted Reduction and Pin Fixation Supplemented with External Fixation
Jong-Pil Kim, Hyun-Jin Yu
The Journal of the Korean Orthopaedic Association.2009; 44(2): 233. CrossRef
Comparison of Outcomes for Unstable Distal Radius Intraarticular Fractures - T-locking Compression Plate versus External Fixator -
Chul-Hyun Cho, Su-Won Jung, Sung-Won Sohn, Chul Hyung Kang, Ki-Cheor Bae, Kyung-Jae Lee
Journal of the Korean Fracture Society.2008; 21(1): 51. CrossRef
Volar T-Locking Compression Plate for Treatment of Unstable Distal Radius Fractures
Chul Hyun Cho, Ki Choer Bae, Doo Hyun Kwon
Journal of the Korean Fracture Society.2008; 21(3): 220. CrossRef

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Problems of Anterior External Fixation in Unstable Pelvic Ring Injury: Jun Dong Chang, Young Jin Seo, Yong Hyuck Choi; J Korean Fract Soc 2005;18(4):394-398. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.394

Abstract PDF

PURPOSE
To determine the problems of anterior external fixators in unstable pelvic ring injuries.
MATERIALS AND METHODS
We reviewed 25 patients with an unstable pelvic ring injuries who had been treated with only anterior external fixator over one year follow-up. By Tile's classification, type B 14, type C 11 and the radiological results were evaluated preoperation, postoperation and bone union state. The clinical evaluation was done in termas of the residual pain, discrepency in limb length, rotational deformities, gait disturbance, neurologic deficiency.
RESULTS
In 25 patients with an unstable pelvic ring injuries, 18 (72%) patients were reducted and 3 (17%) patients of 25 were reduction failure at last follow up, they were all Tile type C. The residual pain was graded normal 3, mild 11, moderate 10, severe 1 respectively. The cases with discrepency in limb length and gait disturbance were 6 (all type C), 10 (type B 3, type C 7) respectively. The complication were 4 pin site infection, 3 pressure sore and 1 pyogenic hip arthritis.
CONCLUSION
Our results indicate that anterior external fixator should be limited to vitally unstable patients in acute resuscitative phase and cases without vertical displacement.

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Outcome of Surgical Treatment of AO Type C Pelvic Ring Injury
Do Hyeon Moon, Nam Ki Kim, Jun Sung Won, Jang Seok Choi, Dong Hyun Kim
Hip & Pelvis.2014; 26(4): 269. CrossRef
General Assessment and Initial Management of Polytrauma Patients
Hyoung Keun Oh
Journal of the Korean Fracture Society.2013; 26(3): 230. CrossRef
Damage Control and Provisional Fixation
Hyoung Keun Oh
Journal of the Korean Fracture Society.2010; 23(3): 346. CrossRef

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A Biomechanical Advantage of the Lengthening with an External Fixator Over an Intramedullary Nail: An Experimental Study in Saw Bones and Cadeveric Bones: Chang Wug Oh, Poong Taek Kim, Hae Ryong Song, Jong Keon Oh, Hyung Soo Ahn, Byung Chul Park, Byung Guk Min, Sung Ki Park, Young Heon Sohn; J Korean Fract Soc 2005;18(3):335-340. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.335

Abstract PDF: PURPOSE
To know biomechanical differences in methods of limb lengthening between using monolateral external fixator and using external fixator over an intramedullary nail.
MATERIALS AND METHODS
In acryl rods, saw-bone, and cadeveric bone, we created two lengthening models of using monolateral external fixator and using external fixator over an intramedullary nail. The axial compression test was done on the site of osteotomy for lengthening. To fix the models, half pins of 5 mm in diameter and nails of 9 mm in diameter were used. Using MTS (Material Test System) machine, we evaluated the differences of axial stiffness according to the presence of an intramedullary nail or the numbers of half-pins which were fixed at each side of osteotomy.
RESULTS
Lengthening over an intramedullary nail, comparing to monolateral external fixator only, increased the axial stiffness by 1.1~1.2 times in acryl rods, 1.2~1.6 times in saw bones, and 15.6~15.9 times in cadeveric bones when the same numbers of half-pins were used. In saw bone and cadaveric bone, the group of two half pins in lengthening over an intramedullary nail was stiffer than the group of three pins in lengthening with monolateral external fixator.
CONCLUSION
In the distraction of the limb, the addition of an intramedullary nail may increase the axial stiffness of the frame of monolateral external fixator. In lengthening over an intramedullary nail, it is enough to distract the bone with fixing two half pins at each sides of osteotomy.

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Treatment for Intractable Infected Nonunion of Lower Extremity in Elderly People using External Fixator: Seung Jun Park, Jong Sup Shim, Sung Kee Shin; J Korean Fract Soc 2004;17(2):177-183. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.177

Abstract PDF

PURPOSE
To introduce and report the results of treatment of old patients' infected nonunion using external fixator.
MATERIALS AND METHODS
Nine patients more than 60 years old were included in the study. Four cases had combined medical problems of diabetes, hypertension, and vascular disorder. We used Ilizarov fixator in eight cases and uni-lateral external fixator in one. All patients were treated with debridement, broad sequestrectomy, segmental resection, bone graft and compression of fracture site about 1~1.5 cm. We evaluated the final results by functional result and complication according to the criteria of Paley.
RESULTS
Average length discrepancy was 1.7 cm before operation by initial bone loss and final follow-up shortening was average 2.6 cm. Mean duration of fixtor removal was 5.2 months. We acquired bony union lastly in 8 cases. Final functional result was 3 excellent, 2 good, 2 fair and 2 poor. Among them, 2 good, 1 fair and 1 poor cases had medical problem.
CONCLUSION
In old patients, compression of nonunion site and early joint motion using external fixator seemed to be very useful in the treatment of intractable infected nonunion of lower extremity and in minimizing duration of treatment.

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Manufacturing Techniques of Ancient Forged High-tin Bronze Wares from Archaeological Sites in Bagan, Myanmar
Jae Sung Lee, Yee Yee Win, Bonnie Lee, Jae Eun Yu
Journal of Conservation Science.2023; 39(5): 673. CrossRef
Treatment of Infected Nonunion
Sang-Ho Ha
Journal of the Korean Fracture Society.2007; 20(2): 206. CrossRef

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Biomechanical Analysis of Hybrid External Fixation for the Distal Tibial Fractures: A FEM Study: Duk Young Jung, Boug Ju Kim, Seok Bae Ryu, Jong Keon Oh; J Korean Fract Soc 2004;17(2):160-166. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.160

Abstract PDF: PURPOSE
To analyze the biomechanical effects of different frame configurations of the hybrid external fixators for distal tibial fractures on the frame stiffness and stress distribution with a finite element method (FEM).
MATERIALS AND METHODS
Five configurations were simulated: Group I: two wires with convergence angle of 60degrees, Group II: 3rd wire on a bisector axis of the group I. Group III: two wires with 30degrees. Group IV: 3rd wire on a bisector axis. Group V: two wires with 30degree and a half pin on the distal articular fragment. Each group was simulated under compression, torsion, anterior-posterior and lateral-medial bending load. Stiffness, stress and deformation values were calculated.
RESULTS
The overall stiffness was increased by 15~30% with the addition of a third wire, and by 150~400% with a anteromedial half pin on the articular fragment. The half pin decreased the stress level of the frame by about 43% and the deformation of the 5/8 ring by about 30%.
CONCLUSION
The addition of a half pin on the articular fragment is not only a method of increasing the stiffness but also a way of decreasing the stress concentration and the deformation of the frame.

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Treatment of Fractures of Distal Radius using External Fixator: Sung Tae Lee, Seok Ha Lee, Kwang Jun Oh, Jong In Na, Ji Sung Jun, In Rok Yu; J Korean Soc Fract 2003;16(3):407-415. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.407

Abstract PDF: PURPOSE
To assess the clinical and radiological results from the treatment of the intraarticular distal radius fracture by using the external fixator and confirm the usefulness of the external fixator from this study. MATERIALS & METHODS: We selected 20 cases of the distal radius fracture patients, who were treated with external fixator, among the patients from March, 1998 to March, 2001 and they could be followed for 1 year. There were 12 males and 8 females with a mean age of 53.4. According to AO classification, there were 2 cases for type A (10%), 2 cases for type B (10%), 5 cases for type C1 (25%), 9 cases for type C2 (45%), and 2 cases for type C3 (10%). In the 16 cases, the external fixator was used alone and in the other 2 cases, the external fixator was used with K-wires fixation. In the last 2 cases, K-wires fixation and autogenous iliac bone graft were combined.
RESULTS
In more severe form of distal radius fracture such as complete intraarticular fracture (type C2, C3 of AO classification), the better outcome in clinical and radiologic results was showed when additional K-wires fixation and/or autogenous iliac bone graft were combined rather than using the external fixator only. Particularly, in the cases of type C2, the poorest outcomes of radial length loss 2.7 mm (4.0%), radial inclination loss 1.4 (4.9%), volar tilting loss 2.4 (6.9%) were showed when the external fixator was used alone. The three worst results were from the cases of using external fixator alone in type C2. In the two cases of combination with K-wire fixation, the result of type C2 was excellent and that of type C3 was good. The results of the last two cases (type C2, C3) of combination with K-wire fixation and autogenous iliac bone graft were all excellent.
CONCLUSION
In this study, we confirmed that the better result could be achieved when the treatment were performed with combination with K-wire and/or autogenous iliac bone graft rather than using the external fixator alone.

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Anterior Approach and Volar T-plate fixation of Distal Radius Fracture: Woo Sung Choi, Weon Yoo Kim, Dong Won Choi, Yun Hack Shin, Jin Young Kim; J Korean Soc Fract 2003;16(2):244-252. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.244

Abstract PDF

PURPOSE
To analyze the radiologic and clinical results of open reduction and volar plating through anterior approach for distal radius fracture.
MATERIALS AND METHODS
We retrospectively analysed that 19 distal radius fracture, which would not be reduced by closed reduction or too comminuted to maintain reduction or articular surface incongruency, were treated by open reduction and volar plating through anterior approach. The results were evaluated by preoperative and immediate postoperative radiographics and clinical results were analysed using Green and O'Brien scoring system at final follow up.
RESULTS
All cases achieved anatomical articular surface reduction postoperatively. In terms of radiologic analysis, mean radial length (8.8 mm +/-4.8 mm vs. 11 mm +/-3 mm), radial inclination (15 degrees+/-5.7 degreesvs. 20degrees+/-5degrees), volar tilt (-11 degrees+/-13 degrees vs. 7 degrees+/-4 degrees) and ulnar plus variant (4 mm+/-3 mm vs. 0 mm+/-1 mm) were improved. The clinical evaluation revealed 9 excellent cases, 7 good cases, 2 fair cases and 1 poor case. The reduction loss and flexor pollicis longus rupture was occurred in one patient, who had severely displaced comminute fracture in initial injury.
CONCLUSION
Using volar plating, authors gain good radiologic and clinical results. But, additional external fixation is recommended to prevent further collapse in severly comminuted fractures.

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Is dorsal cortex drilling necessary for distal radius fractures treated with a volar locking plate? A comparative study of near-cortex-only and far-cortex drilling
Chul Hong Kim, Sung Yoon Jung, Hyeon Jun Kim, Si-Hyun Park
Journal of Trauma and Injury.2025; 38(3): 248. CrossRef
Treatment of Fractures of the Distal Radius Using Variable-Angle Volar Locking Plate
Jae-Cheon Sim, Sung-Sik Ha, Ki-Do Hong, Tae-Ho Kim, Min-Chul Sung
Journal of the Korean Fracture Society.2015; 28(1): 46. CrossRef

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Surgical treatment using external fixator for unstable intra-articular fracture of distal radius: Chul Hong Kim, Byeong Hwan Kim, Sung Won Lee, Wook Kim; J Korean Soc Fract 2003;16(1):83-90. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.83

Abstract PDF: PURPOSE
To analyze the results of surgical treatment using external fixator for unstable intra-articular fracture of distal radius. MATERIAL AND METHODS: We investigated 38 cases of distal radius fracture from Mar. 1990 to Dec. 2000. The patients were followed up for average 18 months postoperatively. We compared the results of 22 cases, treated with open reduction and internal fixation(ORIF) to the results of 16 cases, treated with ORIF and external fixation. We evaluated the results of the mean loss of radial length, radial inclination, volar tilt and traumatic arthritis according to demerit point rating system above the Fernandez classification IV.
RESULTS
According to demerit point rating system, excellent to good results were obtained in 72.7% at ORIF and external fixator, compared to 43.8% at case of ORIF only. In the last follow up, the mean loss of radial length was 0.6mm in case of ORIF, but 0.4 mm in case of ORIF and external fixator, the mean loss of radial inclination was 2.3 and 1.5 degrees, the mean loss of volar tilt was 2.5 and 2.2 degrees, respectively (p < 0.05). Postoperative complications were developed in 9 cases. Malunion was in 4 cases of ORIF and external fixator, in 2 cases of ORIF. Metacarpal bone fracture was in 1 case of ORIF and external fixation. Traumatic arthritis was in 2 cases of ORIF.
CONCLUSION
Open reduction and internal fixation combined with external fixation was thought to be a better method than open reduction and internal fixation for the treatment of unstable intra-articular fractures of the distal radius of the Fernandez classification IV and IV, because that was more comfortable and convenient to patients and was useful to prevent late displacement.

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Hybrid External Fixation and Limited Internal Fixation for Severe Open Tibial Shaft Fractures: Hong Jun Han, Soo Uk Chae, Ul Oh Jeung; J Korean Soc Fract 2003;16(1):52-58. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.52

Abstract PDF: PURPOSE
To evaluate the radiographic and clinical results of severe open tibial shaft fracture treated by hybrid external fixation and limited internal fixation.
MATERIALS AND METHODS
We reviewed 25 patients open tibial shaft fracture(> or =Gustillo classification type II) which were treated with hybrid external fixation(AnyFixR) that was invented by authors and limited internal fixation between June 1998 to June 2001. 20 males and 5 females were minimum follow up period of 12 months(12-27 months). The mean age was 45 old years(11-72 old years). The results were based on the assessment radiographical analysis with duration of bony union, delayed union including of states of nonunion and malunion, clinical analysis with pain, joint range of motion, wound infection and skin & soft tissue coverage. All fractures were classified according to the Gustilo classification, there were 6 cases of type II, 9 cases of type IIIa and 10 cases of type IIIb. The cause of injury, there were 18 cases of motor vehicle accident, 5 cases of direct trauma and 2 cases of fall from height.
RESULTS
In twenty-five cases, fifteen had union, the average time of bone union was 6.8 months and additional bone graft without change of external fixator performed in ten cases, but one case have failed and then change of intramedullary nail with bone graft. In the group of bone graft, bone union was completed at mean 8.7 months. According to the clinical analysis, no pain in the fracture site, in complications, there were 2 cases of mild joint range of motion that has acceptable result and 2 cases of wound infection were treated with effective antibiotics theraphy and wound dressing. Five cases need to coverage of the open wound, 3 cases were flap operation and each case were muscle transfer, skin graft without change of external fixator.
CONCLUSION
The use of hybrid external fixation and limited internal fixation in severe open tibial shaft fracture to be successful for the stabilization of fracture and subsequent plastic and/or orthopaedic procedure for muscle and skin coverage, bone grafting are more easily accomplished without change of external fixator.

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Treatment of Femoral Shaft Fracture with External Fixator in Children: Phil Hyun Chung, Suk Gang, Dong Ju Chae, Jong Pil Kim, Sung Pock Park; J Korean Soc Fract 2002;15(3):421-426. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.421

Abstract PDF: PURPOSE
Children with femoral shaft fractures in association with other injuries such as head injuries, abdominal injuries, open fractures, multiple fractures, or unstable displaced fractures require operative treatment rather than being treated in conservative methods. In this study, we compare the surgical result of femoral shaft fracture using external fixator in children, and evaluate the complications and the related factors as well as the advantage over the other management described in the literature.
MATERIALS AND METHODS
We reviewed 15 cases of femoral shaft fractures in children admitted between May, 1995 and May, 2000. The mean age was 8 years and 2months old (range: 6-12 year-old, 9 boys, 6 girls). All the evaluations were based on the postoperative radiologic studying and clinical findings. In the radiologic evaluations, bony union time, angular deformity, and leg length discrepancy in both sagittal and coronal plane were evaluated, and in the clinical evaluations, we analyzed the duration of external fixation, hospital day, range of motion in both hip and knee joint, and post-operative complications.
RESULTS
The average bony union time based on the radiologic studying was 10.9 weeks (ranging from 7 to 24 weeks). Angular deformity at the fracture site was less than 5 degrees and no rotational deformity was found in all 15 cases. The average length of overriding fracture fragment was 11.7 mm (ranging from 10 to 15 mm) and average leg length discrepancy was 2.1 mm (ranging from -3 to +10mm). Duration of external fixation averaged 12.1 weeks (ranging from 9 to 24 weeks) and average hospital day was 29.4 day (ranging from 21 to 48 day). None of the patient had limitation in hip or knee joint movement. There were 1 case of refracture (case of pathologic fracture) and 4 cases of pin tract infection(superficial infection).
CONCLUSION
At our institution, we observed average overgrowth of 2.1 mm and no severe complications excepts in 1 case of refracture due to pathologic fracture. Thus we concluded that closed reduction and external fixation is effective in treating open, or unstable displaced fracture of femoral shaft with other associated injuries in pediatric population, and it is also believed to be effective means in treating closed femoral fractures.

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External Fixation of Displaced Proximal Humeral Fracture: Suk Kyu Choo, Byung Jik Kim, Jin Hwan Kim, Seung Yeub Suk, In Hwan Hwang; J Korean Soc Fract 2002;15(3):379-384. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.379

Abstract PDF: PURPOSE
Proximal humerus fractures are relatively frequent and have variable treatment mothods. It is important to resolve union of the fracture site, good range of motion and function through the early ambulation in treatment results. We will know whether it is recommendable treatment or not and analyze the results of treatment on the effectiveness of the external fixator in two or three part fractures of the proximal humerus fractures.
MATERIALS AND METHODS
From May, 1999 to April, 2001, 8 cases in 8 patients were treated by external fixator on the proximal humerus fractures. Mean age was 44.7yrs(11 to 68 yrs), two part fracture 6 cases, three part fracture 2 cases in fracture classification by Neer. We treated 3 cases with ring external fixator, 4 cases with monoplane external fixator. We referred chart and radiographics to patients and assessed the results by Neer 's shoulder function table through final follow-up or phone call.
RESULTS
In all cases, we obtained bone union without neuroparalysis, neurovascular injury, avascular necrosis and other complications. Mean bone-union time was 7 weeks(5 to 12 weeks). Final functional assessments are excellent or good in 7 cases, poor in 1 case.
CONCLUSION
We obtained comfortable results after we performed external fixation on proximal humerus fracture and bone union was acquired and removed external fixator at 7 weeks through early ambulation. We think procedure has brief, low soft tissue damage, high stability and motily. Thus we think it is recommendable treatment on the displaced proximal humerus fractures.

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Treatment of nonunion of proximal tibia: Treatment using external fixator: Kuhn Sung Whang, Il Hoon Sung, Jun Sic Park; J Korean Soc Fract 2002;15(2):129-137. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.129

Abstract PDF: PURPOSE
To evaluate causes, treatment methods, outcomes and usefulness of external fixator after we have treated patients with proximal tibial nonunion successfully using external fixator.
MATERIALS AND METHODS
We treated the 10 patients with proximal tibial nonunion between December, 1991 and December, 2000. Mean follow-up period was 18.5 months. We analyzed numbers of operations, operative methods and causes of nonunion, and rated bony and functional results according to Paley's classification.
RESULTS
The causes of nonunion were infection in 6 cases, insecure fixation in 4 cases. Bony union was achieved in all 10 cases. The mean time of union was 12.9 months. Complications were developed in 8 cases. Pin site infection occurred in 7 cases, pain in 8 cases, joint stiffness in 2 cases, angular deformity in 2 cases. Functional results were excellent in one, good in four, fair in three, poor in two.
CONCLUSIONS
We concluded that external fixation method using external fixator such as Ilizarov in treating nonunion of proximal tibia was very useful because of offering advantages of bony shortening and compression, bony lengthening, bone grafting and early weight bearing in patient with infected nonunion and bone defect with many complications

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The Biomechanics of Hybrid External Fixator: The Effect of Periarticular Half Pin on Frame Stiffness: Jong Keon Oh, Duk Young Jung, In Su Kim; J Korean Soc Fract 2002;15(2):114-122. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.114

Abstract PDF: OBJECTIVES
The purpose of this study was to identify the biomechanical effect of periarticular half pin in the hybrid external fixator.
METHODS
Simulated tibial plateau fractures were created using a polyvinylchloride pipe. Seven frame configurations were tested : a four-ring Ilizarov frame, a hybrid frame with three wires on peri-articular fragment, hybrid frames with wires and half pins on peri-articular fragment by four different configurations, a hybrid frame constructed with multiple levels of fixation in the periarticular fragment. A materials testing machine was used to apply pure compression, anterior and posterior bending, medial and lateral bending, and torsion. Stiffness values were calculated from the load deformation and torque angle curves RESULTS: The overall stiffness of the hybrid frame was increased up to 30% by replacing a coronal tension wire with a half pin placed on the sagittal plane. The hybrid frame constructed with two wires and a half pin on the sagittal plane of the periarticular fragment showed overall stiffness compatible with that of multi-level peri-articular fixation frame.
CONCLUSION
Our results show that the half pin placed on the periarticular fragment can be a effective tool to increase the stiffness of hybrid external fixators in this periarticular tibia fracture model.

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The Biomechanics of Hybrid External Fixator: Effectiveness of Bar to Ring Connection: Jong Keon Oh, Duk Young Jung, Seong Yong Yoon; J Korean Soc Fract 2001;14(4):783-791. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.783

Abstract PDF: OBJECTIVES
The biomechanical effects of bar to ring connection in a hybrid external fixator have not yet been clearly identified. The purpose of this study was to identify the biomechanical effects of bar to ring augmentation in the hybrid external fixator.
METHODS
Simulated tibial plateau fractures were created using a polyvinylchloride pipe. Groups of simulated periarticular tibia fractures were stabilized with one of six different external fixation constructs with components from one manufacturer. Six frame configurations were tested: a four-ring Ilizarov frame, a hybrid frame without bar to ring augmentation, hybrid frames with three different bar to ring augmentations, a hybrid frame constructed with multiple levels of fixation in the periarticular fragment. A material testing machine was used to apply pure compression, anterior and posterior bending, medial and lateral bending, and torsion. Stiffness values were calculated from the load deformation and torque angle curves RESULTS: The four-ring Ilizarov fixator was the stiffest in all modes of testing. Frame augmentation with three different types of bar-to-ring connection did increase stiffness in all modes of testing. No statistical difference was found between the stiffness of the frames with three different types of bar to ring augmentations. The stiffness of a hybrid frame constructed with multiple levels of fixation in the periarticular fragment was comparable to that of the fixators with bar to ring augmentation.
CONCLUSION
Our results show that the bar to ring augmentation increases the overall stiffness of hybrid external fixators in this periarticular tibia fracture model by 27-76%.

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Treatment of Open Tibial Fracture with Repofix External Fixator: Ho Choi, Hoon Kim, Neung cheol Shin, Sang Ho Shin, Dong Soo Han; J Korean Soc Fract 2001;14(3):412-418. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.412

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the results of treatment of open tibial fracture with Repofix external fixator by clinical and radiological assessement. MATERIAL AND METHODS: 24 cases of open tibial fracture, who had been treated with Repofix external fixator from Oct. 1995 to June 1999, were evaluated about distribution of gender, age, cause of injury, fracture site and pattern, and assessed bony union time and complication.
RESULTS
The mean period of application of external fixator was 12.3 weeks and we kept PTB cast until bony union for average 11.5 weeks. According to Gustilo-Anderson's classification, the mean bony union time was 21.7 w e e k s ( type I ), 36 weeks(type II) and 39 weeks(type III), simple fracture was 22 weeks, comminuted fracture was 32 weeks(p<0.05). Complications were pin site infection(9 cases), delayed union(3 cases), nonunion(1 cases) and focal skin necrosis(1 case). There was no loss of motion about joint.
CONCLUSION
Repofix external fixator, which has the advantages of accurate reduction without extension of wound and decreases motion limitation of neighboring joint, is alternative useful appratus for open tibial fracture.

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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

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Treatment of Tibial Condylar Fractures Using the Ilizarov External Fixator: Dong Wha Lee, Kyoo Seog Shin, Jong Soon Kim, Yong Whee Kim, Jin Ho Seok; J Korean Soc Fract 2001;14(3):404-411. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.404

Abstract PDF: PURPOSE
The aim of this study is to report results of treatment of tibial condylar fracture using the Ilizarov external fixator. MATERIALS & METHOD: 21 Cases of tibial condylar fracture, which were operatively treated with Ilizarov external fixator were evaluated clinically & radiographically. All patients were followed for at least 1 years.
RESULTS
Primary bony union was achieved in 15 cases(71.4%) and bony union after secondary operative procedure was obtained in 6 cases(28.6%). The fracture was united within 6 months except 2 cases. As complications, pin irritation was observed in 6 cases and Joint stiffness in 1 case, delayed union in 1 cases, nonunion in 1case CONCLUSION: We could obtain satisfactory clinical results with using of Ilizarov external fixator in treating of tibial condylar fractures. The good indications for the use of Ilizarov external fixator seems to be high energy tibial condylar fracture difficult to fixation with other method. In cases of bony defect or severe comminuted fractures, we shall obtain better outcome when bone graft is performed.

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TREATMENT OF PROXIMAL TIBIA FRACTURE WITH HYBRID EXTERNAL FIXATOR: Tae Woo Park, Sung Do Cho, Youg Sun Cho, Bum Soo Kim, Sogu Lew, Su Yeon Hwang; J Korean Soc Fract 2001;14(2):285-290. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.285

Abstract PDF

PURPOSE
To evaluate the results and usefulness of hybrid external fixator in the treatment of proximal tibia fracture. MATERIAL AND METHOD: From Jan. 1997 to Jan. 2000, 19 proximal tibia fracture were treated with hybrid external fixator with or without limited internal fixation to stabilize the articular surface. All fractures were classified according to the AO classification. The results were analyzed by ROM(range of motion), bony union time, fracture reduction with MPTA(medial proximal tibial angle) and joint congruency.
RESULT
There were 1 A2, 7 A3, 1 C1, 8 C2, 2 C3 proximal tibial fractures according to the AO classification. Open fractures were 10 patients. The mean bony union time was 13 wks(range 8-36wks) and the mean length of time in the external fixator was 14wks(range 8-36wks). At last follow up, the MPTA of the proximal tibia was 87.9 degree. 2 patients developed varus(82 degree) and valgus(92 degree) deformity respectively. Complications were intermittent pin drainage in 6 patients(31.6%), deep infection in 1 patient(5.3%) and nonunion in 4 patients(21%) required bone graft and internal fixation with plate at 6 months postoperatively. Four nonunions were 3 C2 and 1 C3 according to the AO classification and three were open fracture(1 type I, 1 type IIIb, 1 type IIIc : Gustilo type) CONCLUSION: Hybrid external fixation is a good treatment option for proximal tibial fractures. However, nonunion and angular deformity would occur in severe metaphyseal comminution and soft tissue injury. Accurate fracture reduction and careful soft tissue management is prerequisite and if necessory early bone graft should be considered in such cases.

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Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage
Seung-Ryul Lee, Jae-Hoon Yang, June-Kyu Lee, Hyun-Dae Shin, Kyung-Cheon Kim, Kyu-Woong Yeon, Young-Mo Kim
Journal of the Korean Fracture Society.2009; 22(3): 152. CrossRef

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Hybrid External Fixation for Periarticular or Segmental Fractures of Tibia: Hong Jun Han, Yeung Jin Kim, Jae Myoung Kim; J Korean Soc Fract 2001;14(1):44-51. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.44

Abstract PDF: PURPOSE
To analyze the clinical outcomes of the hybrid external fixation which is more comfortable and simply appliable than Ilizarov fixator MATERIAL AND METHOD: 28-patients of periarticular or segmental tibia fracture from may 1998 to october 1999 were treated with hybrid external fixator (AnyFixÂ®)that was invented by authors. It consists of two rings at epiphysis(full or 2/3 ring), 3 or 4 rods connecting 2 rings, K-wires, half pins, and specially designed push pins and crane pins which can be used as a reduction device and fixation pins. And it was used as a definitive modality. Joint exercise was started immediately after operation and partial weight bearing was permitted 4 weeks after initial application.
RESULT
The average time of bone union was 4.7 months, articular step-off of all cases were less than 1 mm. As a complication, there was no limitation of range of motion except one case of 10Â° dorsiflexion limitation of the ankle, and 1 case of deep wound infection. Clinical assesments of knee and ankle joint showed 14 cases of excellent, 9 cases of good, 3 cases of fair in total 26 cases of proximal or distal tibia fracture except 2 infected non-union.
CONCLUSION
Hybrid external fixation is effective method for periarticular or segmental tibia fracture and it gives simple applicability, firm stability and much less discomfort.

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Treatment of Infected Nonunion of the Tibia by Ilizarov External Fixator: Jung Ryul Kim, Keun Ho Yang, Byung Yun Hwang; J Korean Soc Fract 2000;13(4):921-927. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.921

Abstract PDF: PURPOSE
To analyze the clinical results and complications of the Ilizarov technique in the treatment of the tibial nonunion.
MATERIALS AND METHODS
Twenty-seven patients who had infected nonunion of the tibia were managed with Ilizarov external fixator form January 1992 to January 1997. Types of nonunion were classified according to Paley and status of infection were divided into AO classification. We evaluated clinical outcomes and complications which were assessed with rating system of Paley.
RESULTS
All cases obtained bony union. The mean time to union was 11.5 months. On average, healing index was 51.4 days/cm(range 28-72 days/cm) and percentage of increment was 18.5 %(range, 13-31.5 %). According to Paley criteria, bone results were good to excellent in 22 cases(81.5 %), and functional results were good to excellent in 24 cases(88.9 %). Total thirty five complications were occurred, which were classified by Paley criteria, problems in 15 cases, obstacles in 17 cases, and complication in 3 case.
CONCLUSION
Ilizarov technique is a useful method in management of the tibial nonunion, but we have to consider the complications and endeavor to reduce them.

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Effect of Insertion of Bone Graft Substitutes on Consolidation of Distracted Callus: Changes of Radiography & Bone Mineral Density in the Tibia of Rabbits: Chang Wug Oh, Poong Taek Kim, Byung Chul Park, Hae Ryong Song, Il Hyung Park, Jun Ho Baek, Hyung Jin Park; J Korean Soc Fract 2000;13(4):687-695. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.687

Abstract PDF: PURPOSE
This study was designed to know the effect of calcium-sulfate and xenograft on the distracted callus after lengthening.
MATERIALS AND METHODS
We had operation of subperiosteal osteotomy and external fixation on the tibial diaphysis of young New Zealand White rabbits(2.0-2.5kg); after 5 days of latency period, 7 mm(1mm/day, 2 times/day) of tibial lengthening was reached in a week. At 1 week after lengthening, the 1st experimental group of 7 rabbits received a pellet of calcium sulfate(Osteoset , Wright medical, USA) in the distraction gap, and the 2nd experimental group of 7 rabbits received 5mm2 of xenogrfat(Lubboc ) in the distraction gap. But, the control group of 7 rabbits did not receive any of above materials. We compared three groups with the changes of radiographic findings at every week and bone mineral ratio(DEXA) at every two weeks.
RESULTS
The time to complete consolidation of distraction callus of both experimental group(calcium sulfate;14 weeks, xenograft; 15.4 weeks) was shorter than that of control group(16.9 weeks) in radiographic findings. Maximum value of bone mineral ratio of distraction callus was higher and the time to reach the highest value was also shortened in the both experimental group compared to control group.
CONCLUSION
By use of bone substitutes as like calcium sulfate or xenograft in the distraction callus with external fixator, it may be possible to shorten the consolidation period and the fixator-wearing period.

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Ilizarov/Hybrid-Ring External Fixation in the Management of Tibial Plafond Fractures: Chang Wug Oh, Byung Chul Park, Joo Chul Ihn, Sung Jung Kim, Hee Soo Kim, Saeng Guk Lee; J Korean Soc Fract 2000;13(2):244-251. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.244

Abstract PDF

PURPOSE
: To evaluate the results of the treatment of distal tibial fracture using ring or hybrid ring external fixator and to compare the results according to the influencing factors.
MATERIALS AND METHODS
: The authors analized 30 patients, 31 cases of distal tibial fracture who were treated by Ilizarov ring external fixator or hybrid ring external fixator at our hospital from May 1996 to August 1998 and were followed up over 1 year. The type of distal tibial fractrue were classified according to AO group, type A was 7 cases, and type C was 24(C1:5, C2:4, C3:15)cases. Restoration of articular surface of the distal tibia was performed through closed method or minimal invasive technique by minimal internal fixation with K-wire or screw. Then fixation of th distal tibia was done by ring external with multiple transfixing wire. Connection to the tibial shaft was done by Ilizarov ring external fixator(15 cases), or mono-external fixator(Dyna-Extor, 16 cases).
RESULTS
: By Tornetta's assessment of functional results, excellent was 5, good 19, fair 4 and poor 3cases. According to AO classification, the functional results of type A, 7cases were all above good results, among 24 cases of type C, 4cases of C1, 2 cases of C2, and 11 cases of C3 were above good results and there was no statistical difference between the results and the fracture type(P=0.024). One of 3 cases of poor functional results was open type C3 fracture and was complicated with osteomyelitis and refracture, and others two cases type C2 fracture which were complicated with malunion.
CONCLUSION
: The authors had a good results without soft tissue complication after the treatment of distal tibial fracture patients by Ilizarov ring external fixator or hybrid ring external fixator.

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Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator
Suk Kyu Choo, Kyung Wook Nha, Hyoung Keun Oh, Dong Bong Lee
Journal of the Korean Fracture Society.2007; 20(4): 323. CrossRef

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Mechanical Properties of External Fixator according to Its Arrangement and Structure: Hong Jun Han, Byung Chang Lee, Yeung Jin Kim, Byung Soo Jin, Gun Hyee Lee; J Korean Soc Fract 2000;13(1):38-45. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.38

Abstract PDF: PURPOSE
To obtain the accurate knowledge of the fundamental mechanical properties of the external fixator affected by variations in arrangements and structures. We used newly developed external fixator, Anyfix, universal testing machine and plastic padding bone model which had similar structural properties to human tibia. The measured performance for seven different configurations of external fixators was its ability to control the motion of the bone fragment at the fracture site. Based on a unit of applied load, the corresponding displacement measured at the fracture site was used to described the stiffness of the fixation device for each load. Three stiffness moduli can be determined as axial stiffness, anterior posterior bending stiffness and lateral bending stiffness.
RESULTS
In basic configuration, all three stiffnesses for unilateral two plane external fixator showed marked increase than those for unilateral one plane model. Axial compression stiffness and bending stiffness were increased when ring component were located far from the fracture site. In modified configuration, all three stiffnesses were increased when the number of pin was increased and small sized ring was used.
CONCLUSION
The stiffness of the external fixator can be substantially increased by using unilateral two plane, locating the ring at far portion from the fracture site, using a small sized ring and increasing the number of pins.

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Treatment of Humerus Fracture using Ilizarov External Fixator: Suk Myun Ko, Myung Gu Kim, Ryuh Sup Kim, In Suk Oh, Joung Yoon Lee, Hyeok Chae Jeong; J Korean Soc Fract 2000;13(1):30-37. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.30

Abstract PDF

PURPOSE
Recently, the incidence of humerus fracture not allowing open reduction and internal fixation has been increased with increment of traffic accident and industrial accident. But, there have been a few reports in the use of Ilizarov external fixator. The purpose of this study is to report the authors'experience with Ilizarov external fixation for the treatment of the patients with fractures of the humerus.
MATERIALS AND METHODS
From June 1996 to July 1998, we reviewed sixteen patients with humeral fracture who were treated by the Ilizarov external fixator. Three fractures were in the middle third of the shaft; two, in the proximal third; two, in the distal third; seven, in the proximalmiddle; two, in the middle-distal. The fractures that were located within the joint of the shoulder or the elbow were excluded. Five fractures had been open and six had been associated with multiple trauma. Two had been initially treated by open reduction and internal fixation but failed : one, because of infection; the other, because of loss of fixation. We performed the Ilizarov external fixator procedure in the case of soft tissue trauma so severe that internal fixation was impossible, and in the case of the comminution too extensive and severe for internal fixation.
RESULTS
The average time to radiologic union was 12.7 weeks. According to Stewart and Hundley's functional assessment system, excellent or good results were obtained in 14 cases. There was no poor result.
CONCLUSION
Although the Ilizarov external fixator was a technically demanding procedure, it was a good method comparing with any other operative methods for the treatment of fractures of the humerus not allowing the open reduction and internal fixation.

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Contributing Factors of Radial Nerve Palsy Associated with Humeral Shaft Fracture
Tae-Soo Park, Joon-Hwan Lee, Tai-Seung Kim, Kwang-Hyun Lee, Ki-Chul Park
Journal of the Korean Fracture Society.2008; 21(4): 292. CrossRef

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Treatment of Comminuted Fractures of Femur & Tibia with Ilizarov Apparatus: Soo Bong Hahn, Hong Jun Park, Hui Wan Park, Sung Hun Kim; J Korean Soc Fract 2000;13(1):20-29. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.20

Abstract PDF: PURPOSE
To evaluate the effectiveness of Ilizarov external fixator for the treatment of unstable closed or open comminuted femoral and tibial fractures, especially those with severe soft tissue injury by clinical and radiological analysis.
MATERIALS AND METHODS
Fifty six consecutive femoral or tibial fractures were treated using Ilizarov external fixator between May 1991 and August 1998 and followed up for minimum 12 months upto 36 months with the average of 16 months. All of them consisted of comminuted or segmental fractures. And thirty five cases of them were open fractures. There were nine Type I, seventeen Type II, five Type IIIA, and four Type IIIB fractures. Primary closure was performed for Type I and II fractures. Split-thickness skin graft (5 cases) and free vascularized flap (3 cases) were used for severe soft tissue defects.
RESULTS
All fractures healed within the average of 7.7 months (from minimum 3 months to maximum 24 months). Bone grafts were performed in 39 cases. Bony union was obtained in all the cases with Ilizarov method. The most common complication, the adjacent joint contracture was developed in 21 cases (37.5%). Pin site infection in 12 cases (21.4%), delayed union in 3 cases (5.4%), angulation deformity in 2 cases (3.6%) were developed.
CONCLUSION
The Ilizarov external fixation technique is one of the effective methods in the management of unstable closed or open comminuted femoral or tibial fractures.

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Treatment of fractures of the Distal Radius with External Fixator: C Y Huh, J R Yoon, H S Ha; J Korean Soc Fract 1999;12(4):995-1002. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.995

Abstract PDF

PURPOSE
: Recently, intraarticular fractures or unstable fractures with severe comminution of the distal radius are increasing in younger ages, which are known to be difficult to treat. We designed this study to evaluate the clinical results and the prognosis of the external fixators for the treatment of the fractures of the distal radius. Material and Method : We reviewed 16 cases of the distal radius fractures, which were treated surgically with the external fixdtors since January 1995 to December 1997. We applied the external fixator with closed reduction and Kirschner-wire fixation in 8 cases, and in the rest of the cases we did minimal open reduction before the application of the exteranl fixator, because it was not enough to reduce the articular fragments in those cases with closed reduction For the analysis of the clinincal results, we used the Demerit point rating system, and for the analysis of the radiologic parameter, we measured radial height, radial inclination, and volar tilting in comparison with the uninjured side from the anteroposterior and the lateral X-ray films which were taken at preoperative, postoperative, and last follow-up period.
RESULTS
In clinical results by Demerit rating point system, 2 cases were excellent, 10 cases were good, 4 cases were fair, and none of the cases was poor. In radiologic results, the average of the radial height was 8.43mm, the average of the radial inclination was 17.68o, and the average of the volar tilting was 3.870.
CONCLUSION
: It is suggested that external fixator is one of the useful modalities in the treatment of the unstable fractures of the distal radius, and we can also improve the results of the intraarticular fractures by using the minimal open reduction technique.

Citations

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Volar T-Locking Compression Plate for Treatment of Unstable Distal Radius Fractures
Chul Hyun Cho, Ki Choer Bae, Doo Hyun Kwon
Journal of the Korean Fracture Society.2008; 21(3): 220. CrossRef
Comparison of Outcomes for Unstable Distal Radius Intraarticular Fractures - T-locking Compression Plate versus External Fixator -
Chul-Hyun Cho, Su-Won Jung, Sung-Won Sohn, Chul Hyung Kang, Ki-Cheor Bae, Kyung-Jae Lee
Journal of the Korean Fracture Society.2008; 21(1): 51. CrossRef

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Clamp external fixator for IIIb open tibial shaft fracture: Jeung Tak Suh, Byung Guk Park, Chong Il Yoo; J Korean Soc Fract 1999;12(3):557-567. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.557

Abstract PDF: As the saftest and simplest method of immobilization treatment, external fixation is indicated in IIIb open tibial shaft fractures with extensive damage to soft tissue and bone. This enables better wound treatment, patient transport and performace of surgical treatment such as plastic and reconstructive surgery, orthopedic surgery. From the march 1994 to september 1997 14 cases of IIIb open tibial shaft fractures were treated with clamp external fixator either Orthofix or DynaExtor. The purpose of this study is to determine indication of clamp external fixator and investigate its outcome as well as complications and solutions. 11 males and 3 females were followed for 29.3 months on an average. Fractures mainly occurred at mid 1/3 of tibial shaft and its pattern was most frequently comminuted one. Mean bony union time was 46 months. There were 1 case(7%) of delayed union, 2 cases(14%) of nonunion, 6 cases(42%) of reduction loss, 4 cases(28%) of deep infection including 2 cases(14%) of osteomyelitis, 6 cases(42%) of pin tract infection, 2 cases(14%) of malunion and 3 cases(21%) of ankle stiffness. Conclusively for the creation of a suitable environment of fracture healing and prevention of complications such as delayed union, nonunion and deep infection, thorough debridement and irrigation followed by adequate stabilization of bone, early soft tissue coverage and early prophylactic bone graft is paramount important in the treatment of IIIb open tibial shaft fracture since it is high energy trauma. In addition, initial firm fixation for the prevention of reduction loss and active and passive exercise for the prevention of ankle stiffness and pin tract infection or loosening should be taken into careful consideration.

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Treatment of Tibial Fractures with the Ilizarov External Fixator: Suk Myun Ko, Myung Ku Kim, Jung Yoon Lee, In Suk Oh, Sang Eun Kim; J Korean Soc Fract 1998;11(4):833-840. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.833

Abstract PDF: Between June 1996 and July 1997, 29 tibial fracture patients were treated using the Ilizarov method and apparatus. The mean follow-up petiod was 18 months. Among 29 cases, 11 were closed fractures with comminution and 18 were open fractures. There were 2 Gustilo-Anderson type I, 5 type II, and 11 type III open tibial fractures. Complications included 4 pin tract average time from application of the device to complete fracture healing was 26.3 weeks. According to Tucker's functional criteria, the results were 14 excellent, 9 good, 4 fair, 2 poor. No practical contraindications to the use of the Ilizarov device in the management of tibial fractures were encountered. We concluded that Ilizarov method is indeed a useful adjunct for the treatment of either open or closed tibial fractures.

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Treatment of Open Fractures of the Tibial Shaft by Sequential Compression technique in Ilizarov device: Suk Ku Han, In Ju Lee, Nam Yong Choi, Sung Jin Park, Gyeol Yoo, Hyo Seng Ahn; J Korean Soc Fract 1998;11(4):817-824. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.817

Abstract PDF: External skeletal fixation is used widely in the management of open or closed tibial fractures, but delayed healing is common. There is concern that this might be due not only due to the severity of injury but also to the mechanical conditions imposed at the fracture site by the fixator. Since fractures treated by external skeletal fixation can rarely be reduced to perception nor held with absolute stability, union occurs by indirect healing, which is acutely sensitive to both the charactericstics and timing of mechanical stimulation. So, the achivevment of the optimum mechanical environment is particularly important where delay in bone healing is likely. Ilizarov external fixator is useful in treating open fractures of the tibial shaft because it permits axial micromotion which enhances bridging callus formation with stable fixation as well as its complications such as infected nonunion or limb length discrepancy. The impared healing with external fixation is often caused by wrong surgical technique, such as distraction of fracture fragments by fixation device. Sequential compression at fracture site may overcome any fracture gap in external skeletal fixation and also enhance endosteal bone formation. We applied sequential compression forces at the fracture site in 18 open fractures of the tibial shaft, trated by Ilizarov external fixator with or without autogenous bone grafting. Sequential compression technique is composed of initial compression with 1 mm/wk for 4 weeks and then compression 1 mm/10 days until adequate apposition of cortex and callus formation in radiograph. We acquired successful bony union in all cases except one which had additional bone grafting in open fractures of the tibial shaft by sequential compression technique using Ilizarov device.

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The Treatment of the Proximal Tibia Fracture -Comparison of the Variable Method of Fixation-: Dong Heon Kim, Kyu cheol Shin, Kyeong Soon Kim, Byeong Chun Chang, Dae Sul Kang; J Korean Soc Fract 1998;11(2):442-448. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.442

Abstract PDF: The treatment of proximal tibial fracture is an area of great controversy. Because open and comminuted fractures are common, selection of fixation method of the proximal tibial fracture is more difficult than any other fractures. Many authors reported high rate of malunion and loss of reduction. The purpose of this study is to compare the results of the proximal tibial fractures depending on the fixation method. We evaluated the records of 35 patients (36 fractures) who had been treated with intramedullary nailing, plate and screws and external fixation from January 1989 to January 1996. The mean period of follow-up was 12months. Of the 36 fractures, 8 fractures were with intramedullary nailing, 12 fractures with plate and screws, 16 fractures with external fixator. In intramedullary nailing groupp, the average time of bony union was nineteen weeks (16-27), in plate and screws fixation group twenty three weeks (18-31) and in external fixation group 22 weeks (19-29). The complications of intramedullary nailing group were 3 nonunions, 1 delayed union, 1 varus deformity, 2 anterior angulations and 2 cases of deep wound infection. The complications of plate and screws group were 1 nonunion, 3 delayed union, 1 deep wound infection, 2 superficial infections and in most fractures partial stiffiness of knee joint. The complications of external fixator group were 1 nonunion, 1 delayed union, 1 deep wound infection, 6 pin tract infections and 3 cases of knee joint stiffness. In our cases, if there is open wound higher than Gustilo grade III-B and severe comminuted fracture initially, the external fixation is more preferred for wound management and also more advantageous method for the patients who got a multiple trauma in abdomen, chest and head injuries. In closed fractures and Gustilo grade I, II open fractures, intramedullary nailing is considered to be more preferable method. But the anatomy of proximal tibia made nailing these fractures technically difficult. In conclusion, we consider each method of fixation is useful fixation method of the proximal tibial fractures, but each method should be selected advertently depending on the severity of soft tissue injury and the degree of comminution of the fractures.

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Treatment of Commiuted Fractures of the Proximal Tibia Using Ilizarov External Fixator: Jae Ik Lee, Myung Hwan Son, Jae Hong Park, Kang Hoon Kim; J Korean Soc Fract 1998;11(1):198-204. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.198

Abstract PDF: Twenty one comminuted fractures of the proximal tibia in 21 patients were treated with Ilizarov external fixator from May 1990 to May 1996 in Pusan City Medical Center. The average duration of external fixation was 17weeks, and all of the fractures healed without bone graft. The mean time to union was 18weeks in closed comminuted fractures, and 21 weeks in Gustilo type I, II open fractures. The complications with this technique were pin tract infection 3 cases, pin loosening 6 cases, septic arthritis 1 case, post-traumatic osteoathritis 1 case, and joint ankylosis 1 case. The average duration of follow up was 18 months. The range of knee motion of 19 cases of the the 21 patients was at least 115-degrees arc. Post-operative immediate exercise was possible, and partial weight bearing with crutch was also possible after post-operative 4 weeks. We concluded that Ilizarov external fixation is a satisfactory technique for the treatment of selected comminuted fractures of the proximal tibia.

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Treatment of Pediatric Femoral Fractures Using External Fixator: Sung Kwan Hwang, Seung Tae Jeong; J Korean Soc Fract 1997;10(1):25-30. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.25

Abstract PDF: Seven patients with femur fractures were treated with external fixators. The average age at fracture was 8 years 4 months ranging from 6 years to 10 years. Of 7 fractures, 5 were closed fractures and 2 were open fractures. The average time to healing of fractures was 7.3 weeks(ranging from 4 to 20 weeks). Duration of extemal Dxation averaged 12 weeks. There were 2 cases of pin tract infection; none resulted in osteomyelitis. Of all cases, angulation at the fracture site was less than 5 degrees. Two patients had leg length discrepancy less than 10mm. Conclusion ; External fxation is a well-proven technique for managing femoral fractures in the child with multiple injuries. It is also an effective means of treating isolated femoral fractures in the podiatric population.

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Management of open Supracondylar Fractures of Femur using the Ilizarov Method: Bum Ku Lee, Do Hyun Moon, Jin Hong Ko, Soo Chan Lee, Ki Dong Kang, Jong Seob Park; J Korean Soc Fract 1996;9(3):567-573. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.567

Abstract PDF: It is extremely difficult to treat to the comminuted open fractures of supracondyle of femur Internal fixation with plates and screw or intramedullary nailing of open fracture is high risk of infection and circulatory compromising at the fracture site. External fixation reduces the risk of infection and permits easy access for wound care, early mobilizatioll of joints and weight bearing. We reviewed nine cases of open supracondylar fractures of femur treated with Ilizarov method from February 1993 to December 1995 and obtained the following results. 1. The average time of bony union was 2 weeks. According to AO classification, the average time of bony union was 22.7 weeks in type A and 29.3 weeks in type C. According to classification of Gustilo and Anderson, the average time of bony union was 21 weeks in type II,27.3 weeks in type Illa and 30 weeks in type IIIb. 2. The Neers criteria was based on the final functional and anatomical rating for supracondylar fracture of femur. According to this criteria, excellent was 1 case, satisfactory in 7 cases and unsatisfactory in 1 case. 3. The complications were divided into problem, obstacle and complication;Problem in 9 cases, bstacle in 5 cases and complication in 3 cases. We conculded the Ilizarov technique is a useful method in management of the severe comminuted fractures and extensive soft tissue injury of the supracondylar fractures of femur.

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The Results of the Treatment with Circular External Fixator for Severely Comminuted Intraarticular Fractures involving the Knee: Gang Wook Lee, Je Hoon Lee, Byung Yun Hwang; J Korean Soc Fract 1996;9(2):424-430. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.424

Abstract PDF: In treating the patients having the intraarticular condylar fractures of the distal femur and the proximal tibia, many aulhors have recommended accurate anatomical reduction and rigid internal fixaion with early mobiliEation of the thee. But we cant often reduce the displaced bony fragments into the anatomical position and also fix them rigidly in severely comminuted and displaced fractures in proctice. Furthermore open wound makes surgeons face with some difficulties in using internal fixatives due to postoperative osteomyelitis. We treated 16 cases of severely comminuted intraarticular fractures involving the knee with circular fikator from March, 1992 to October 1994. Those were composed of 8 intraarticular femoral condylar fractures in which 7 cases were classified as C3 by AO classification and 6 cases had open wound, and 8 intraarticular tibil condylar fractures in which 8 cases were classified as type VI by Schatzkers classification and 6 cases showed open fractures. We could get bony union in all cases but we were not satisfied with the functional results of the treatment. So, we recommend the circular external fixation as a method for the treatment of these severely comminuted fractures involving the knee, and we think that further study for improving the functional results will be needed.

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Surgical Treatment of Comminuted Distal Radius Fracture using External Fixators: Suk Kyu Choo, Byung Jik Kim, Han Suk Ko, Young Lim, Jeong Gook Seo, Jae Kie Shin; J Korean Soc Fract 1996;9(2):303-310. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.303

Abstract PDF: Comminuted fractures of distal radius are usually unstable and complex injuries, which require prolonged treatment and often result in some degree of permanent disability. Previous treatment was mainly closed reuction and cast immobilization, and operative treatment of accurate open reduction, internal fixation and bone graft when needed. But recently ligamentotaxis of the fracture using external fixation device has been widely employed. Which could be followed up for 12 cases of comminuted fractured of distal radius operated with external fixators, more than 1 year, during the period of September 1990 to September 1994 at Seoul Paik Hospital was reviewed. According to Frykmalls classification, the most common type was type VIII (7 cases, 58.3%). There was 1 open fracture, and 7 combined injuries of ipsilateral upper extremity. According to AO classification, 9 cases(75%) were type C2 and C3. The most common cause was failing down from a height(6 cases). Additional limited internal fixation was done in 5 cases, all 12 cases were treated external fixators. Results were defined with modified Gartland & Werleys demerit pointing system, exellent was 6 cases(50fr), good wa,i 4 cases(33.3F)), poor was 2 cases. Surgical treatment using external fixators and/or limited open reduction was good Inethod for comminuted distal radius.

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Treatment of Nonunion of the Tibia Fracture: Dong Heon Kim, Kyu Cheol Shin, Hee Cheol Park, Ju Yong Shin; J Korean Soc Fract 1996;9(1):112-118. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.112

Abstract PDF: Nonunion after tibia fracture is a relatively common problem. The cases of nonunion have been known open and comunited fracture, extensive soft tissue injury, interposition of the soft tissue, distarbance of the blood supply and inadequate fixation. A number of methods stimulating union have born described. These include fibular osteotomy followed by weight-bearing in a cast, autogenous boone graft with or without additional stabilization, internal or external fixation with compression, open or closed IM nailing and even electromagetic stimulation. In this paper we carried out retrospective study of the 24 nonunion of the tibia fracture which were treated at the Department of Orthopeadic Surgery, Kon-Kuk University Hospital from March 1990 to March 1995. The results were as follows: 1. Among 24 cases of monunions, 16cases(66.6%) were communited fractures and 18cases(75%) were open fractures. 2. Hypervascular nonunion were 12cases and avascular nonunion were 12cases. Previous methods of treatinent were conservative treatment in 6cases of closed fracture and were treated with Ender nailing, multiple K-wire fixation, Ilizarolr external fixation, monofixator external fixation in 1 Bcases of open fractures. 3. The average duration from injury to dignosis of nonunion was 7 months tweets.(Range 5 months to 24months) 4. Tibial nonunion were treated with plate and screw with bone graft(Bcases), Interlocking IM nail ing(14cases), and nizarov external fixation with bone graft(teases). 5. The average time of union was 23weeks in all patients: 24 weeks in the case of plate and screw with bone graft. 20 weeks in the case of interlocking IM nailing. 28 weeks in the case Ilizarov external fixation with bone graft. 6. The main complications were joint stiffness due to long-term cast irnrnobiliBation in the case of plate and screw with bone graft, LROM of joint contracture and external pin site in the case of Ilizarov external fixation with bone graft, deep infection Icase and knee joint pain teases due to proximal nail protrusion in the case of Interlocking IM nailing.

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Treatment of Intraarticular Fractures of the Distal Radius with Dynamic External Fixator: Myung Ku Kim, Nam Hong Choi, Jun Seop Jahng, Hyoung Kook Ahn; J Korean Soc Fract 1995;8(3):688-695. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.688

Abstract PDF: The treatment of intra articular fractures of distal radius is difRcult and has various problems. Over the past few years, the importance of alignment correction, preservation of normal radial length and reconstruction of congruity of both radiocarpal and radioulna joints have been emphasized. The end redults of closed reduction and rigid fixation with dynamic external flxator include 13 cases(86.6%) with excellent and good results. Roentgenograms of 15 of these patient show accurate alignment of the healed fractures. One patient had a poor functional result although roentgenograms demonstrated good alignment of the healed fractures. The dynamic external fixator is both a useful and convenient method for the reconstruction and treatment of comminuted intraaricular fractures of the distal radius.

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A Clinical Analysis on Treatment of Tibial Fractures Using Ex-Fi-Re External Fixator: Soo Kyun Rah, Dae Ik Kim, Chang Uk Choi; J Korean Soc Fract 1995;8(2):354-360. Published online April 30, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.2.354

Abstract PDF: Since Malgaigne described a external fixators in 1853, it were widely used for open and communited fractures. Modern external fixators such as modified Hoffman, Denham and of hofix external fixators are commonly applied because it could obtain rigid fixation and compression of fracture site. Most of external fixators used only as a fixator after reduction, however new extemal fixator(Ex-F-Re) by Osteo is consists of two units, which are the correction and fixation units. This device is possible to manipulate fracture fragments under the complete control of stability and to obtain more rigid fixation and compression of fracture site. Among the 16 cases of tibial fractures treated with Ex-Fi-Re external fixator device from June 1992 to June 1993, 14 casrs had minimum 1 year follow up and the following results were obtained. 1. Among 14 cases,7 were open fractures,4 were closed periarticular communited fractures and 3 were infected nonunion of tibia. 2. Among 11 cases of fracture and 3 cases of infected nonunion, nonunion was happened in each one case. 3. Average bony union period was 24.4 weeks in fracture group and 44 weeks in infected nonunion group. 4. Ex-Fi-Re external fixator was very rigid fixator, easy to use, and possible to manipulate fracture fragments under the complete control of stability.

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Treatment of Infected Nonunion of Femoral Fracture: Chil Soo Kwon, Young Uck Kim, Byung Hyun Jung, Kyeong Seog Kong; J Korean Soc Fract 1995;8(1):13-21. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.13

Abstract PDF: There are many difficult problems in the treatment of inferted nonunions of the femur, e.g, eradication of infection and osseous union even in the presence of devastating infection. To solve these diffcult problems, various methods were tried including thorugh debridement and rigid internal nxation or external fixation, and bone graft. Recently, large bone defect due to resection of infected bone was treated excellently using llizarov external fixator. Authors treated 13 cases of infected nonunions of femur with Ilizarov external fixator from september 1989 to July 1994. The results were as follows. 1. Among 13 cases of infected nonunion of femoral fracture, 1 case was treated with internal fixation and others with external fixation, and obtaned bone union in all cases. 2. Mean number of previous surgery in other hospital was 3.2(1-5) times and mean number of surgery in our hospital was 2.5(1-5) times. 3. Lengthening(including length of internal bone transport) was performed from 2.5cm to 22cm. 4. Duration of treatment was from 4 months to 27 months(Mean : 11 months). In conclusion, infected femoral nonunion in very selective cases could be treated with retention of internal fixation (Exchange of nail, or plate and screws). But converison to external fixator should be well prepared in most cases. Infected nonunion could be managed in staged surgery with use of modular external fixator like llizarov external fixator. Management of infection, malposition, and shortening could be controlled more safely and more definitely with the ring external fixator.

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Extensively Comminuted Type III Open Fracture of Tibial Shaft: 4 Case Treated by Ilizarov External Fixator: Ju Hai Chang; J Korean Soc Fract 1994;7(2):480-489. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.480

Abstract PDF: It is extremely difficult to treat to the type III open fractures of the tibial shaft which have been severely comminuted and splitted in the long length. Early internal fixation with plates and screws or intramedullary nailing of type III open fracture is contraindicated because of high infection rate and circulatory compromising at the fracture site. External fixation is the method of choice for the treatment of type III open fracture of the tibia. It reduces the risk of infection and permits easy access for wound care, early mobilization of joints and weight bearing. Four type III open fractures of the tibial shaft that were very unstable had entered this hospital from November 1990 to June 1992. The patients were all young males. The causes of injury were one explosion and three motor vehicle accidents. The open fractures were three type III A and one type III B according to Gustilos classification. These fractures were stabilized with Ilizarov external fixator. Parenteral antibiotic therapy was started from the emergency room to prevent infection. Illzarov fixator was applied 17 to 63 days(av. 37 days) after injury and maintained for 6 to 12 months(av. 8 months). Subsequent autogenous bone grafting and internal fixation were done in three patients 7 to 8 months after external fixation because of delayed union. Follow-up period ranged from 1 year and 11 months to 2 years and 6 months(av. 2 years and 2 months). Solid union was obtained in all patients between 1 year 1 month and 1 year and 7 months(av, 1 year and 3 months) without active osteomyelitis. At last follow-up, there were mild limitation of ankle joint motion in all patients and tibial shortening of 18 to 34mm(av. 25 mm)on the roentgenograms of three patients. No significant working disability or malalignment of the leg was noted in all patients. The final results were very good compared to the severity of their injuries.

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The Treatment in Infected Nonunion of Distal Femoral Fracture: Report of two cases: Jong Oh Kim, Yon Sik Yoo, Suk Ha Lee, Sung Jong Lee, Taek Sun Kim, Jae Ik Sim; J Korean Soc Fract 1994;7(1):161-166. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.161

Abstract PDF: It is reported that infected pathological fracture of distal femur has a difficulty in treatment The difficulties lie in; choosing a internal fixator, adequate sequestrectomy of infected lesion, limb shortening, long duration of immobilizatlon. We uses the external fixator in treatment of distal femoral fracture because it needs less devices in fracture site than the internal fixator, and it could get a rigid fixation. we uses the Ilizarov apparatus. The merits of Ilizarov are, early weight bearing; limb lengthening and easy compression and distraction. The one case in which limb length discrepancy is occured, is peformed by limb lengthening. In this study, we are going to argue about the two cases, of infected non-unlon of distal femoral fixation comparing with one another.

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