Journal of Musculoskeletal Trauma

Bone Union Time of Simple Distal Femur Fractures in the Elderly according to Fracture Gap after Treated with Minimally Invasive Plate Osteosynthesis: Young Ho Cho, Sangwoo Kim, Jaewook Koo; J Korean Fract Soc 2023;36(4):133-138. Published online October 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.4.133

Abstract PDF: Purpose
This study examined the difference in bone union time according to the fracture gap after minimally invasive plate osteosynthesis (MIPO) for simple distal femoral fractures in elderly patients.
Materials and Methods
From January 2010 to December 2019, patients aged 60 years or older who underwent surgical treatment for distal femoral fractures due to a low-energy injury were investigated retrospectively. Forty patients were enrolled in the study. The patients were divided into two groups according to the fracture gap after reduction: no more than 2 mm (Group A) and more than 2 mm (Group B) in the anteroposterior and lateral plane. The demographic, operation time, presence or absence of cerclage wiring, plate screw density, plate span ratio, plate length, bone union period, non-union, and complications were evaluated.
Results
No statistical differences in operation time, cerclage wiring, plate screw density, plate span ratio, and plate length were observed between the two groups, and the bone union was achieved in all patients without complication. The bone union period was 17.24±1.48 weeks in Group A and 24.53± 5.20 weeks in Group B, which was statistically significant (p<0.001).
Conclusion
The bone union time in treating geriatric simple distal femur fractures using the MIPO tech-nique was significantly shorter in the 2 mm or less fracture gap than in the greater than 2 mm group.

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Usefulness of Reduction and Internal Fixation Using a 2.4 mm Hand Plating System in Type AO 33-A3 Distal Femur Fracture - Technical Note -: Bong-Ju Lee, Ja-Yeong Yoon, Seungha Woo; J Korean Fract Soc 2023;36(1):25-28. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.25

Abstract PDF: Open reduction in an AO 33-A3 class distal femur transverse and comminuted fracture is often difficult due to frequent reduction loss during surgery, leading to longer operative time and increased blood loss intra-operation. In this study, the authors report a case in which the use of an offset grid plate (OsteoMed, USA) using 2.4 mm HPS (hand plating system) eased the process of fracture reduction and achieved a stable internal fixation, ultimately leading to successful osteosynthesis. The authors experienced no need for temporary fixation devices such as K-wires or screws, which are otherwise required to stabilize the reduction. The fracture reduction was stable throughout the primary fixation of the fracture using a locking plate and screws. The authors report that the advantage of the HPS plate is fitting into the cortical contour and providing stable maintenance of fracture reduction intra-operation, which would be beneficial in certain distal femoral fracture patterns.

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Distal Femur Fractures Treated with Distal Femoral Locking Plate Fixation: A Retrospective Study of One Year Mortality and Risk Factors: Kwang-Hwan Jung, Yoon-Seok Youm, Seung-Hyun Jung, Jae-Min Oh, Ki Bong Park; J Korean Fract Soc 2023;36(1):10-16. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.10

Abstract PDF: Purpose
This study examined the one-year mortality after locking plate fixation for distal femur fractures and the risk factors related to death.
Materials and Methods
From July 2011 to June 2020, 128 patients who underwent locking plate fixation for distal femur fractures were analyzed retrospectively. Epidemiologic information of the patients, characteristics related to fracture and surgery, and death were investigated. The risk factors related to death were investigated using Cox analysis, and a subgroup analysis was also performed based on the age of 65 years.
Results
The one-year mortality rate after locking plate fixation for distal femur fractures was 3.9%, and the mortality rates in patients younger than 65 years and older than 65 years were 0% and 6.7%, respectively. There were no significant risk factors related to death in the total population. On the other hand, in patients aged 65 years or older, however, high-energy fracture and high comorbidity index increased the risk of death after surgery by 6.9-fold and 1.9-fold, respectively.
Conclusion
The one-year mortality rate for the total patients was 3.9%, but the mortality rate for patients over 65 years of age increased to 6.7%. High-energy fractures and high comorbidity index were risk factors related to death after surgery for distal femur fractures in patients aged 65 years or older.

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Outcomes following Treatment of Geriatric Distal Femur Fractures with Analyzing Risk Factors for the Nonunion: Soo young Jeong, Jae Ho Lee, Ki Chul Park; J Korean Fract Soc 2019;32(4):188-195. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.188; Correction in: J Musculoskelet Trauma 2020;33(1):62

Abstract PDF

PURPOSE
Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (ageâ‰¥60) and to determine the risk factors related witht he occurrence of nonunion.
MATERIALS AND METHODS
This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients' underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion.
RESULTS
The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045).
CONCLUSION
The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors.

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Comparison of Clinical Outcomes for Femoral Neck System and Cannulated Compression Screws in the Treatment of Femoral Neck Fracture
Jae Kwang Hwang, KiWon Lee, Dong-Kyo Seo, Joo-Yul Bae, Myeong-Geun Song, Hansuk Choi
Journal of the Korean Fracture Society.2023; 36(3): 77. CrossRef

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The Mid-Term Result after Osteosynthesis of Intra-Articular Fractures of Distal Femur: Sam Guk Park, Jeong Jae Moon, Oog Jin Shon; J Korean Fract Soc 2016;29(4):242-249. Published online October 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.4.242

Abstract PDF

PURPOSE
This study was to evaluate the radiological and clinical mid-term results and the presence of post-traumatic osteoarthritis after osteosynthesis in patients under the age of 50 years undergoing osteosynthesis for distal femur intra-articular fractures (AO/OTA 33-B & C) from high-energy trauma.
MATERIALS AND METHODS
Between January 2008 and January 2013, a total of twenty-one patients with more than three years of follow-up were enrolled. Recovery of the alignment of the lower extremity, union period, and the presence of post-traumatic osteoarthritis were confirmed by follow-up radiographs. Clinically, the range of motion, pain on fracture lesion, and Knee Society score (KSS) were evaluated.
RESULTS
The average duration of union was 18.2 weeks (10-28 weeks), and the alignment of the lower extremity was within normal range in all patients. Seven patients showed post-traumatic osteoarthritis at the final follow-up after more than three years. The presence of post-traumatic osteoarthritis was associated with the classification of fractures, coronal plane fracture, and age. The average range of motion, knee score among KSS, and function score at the last follow-up were 128.7Â°, 86.1, and 85.1, all showing a greater improvement when compared with the one-year follow-up scores.
CONCLUSION
The mid-term result was radiologically and clinically satisfactory. Furthermore, only 33.3% of patients showed a slight progress of post-traumatic osteoarthritis, which critically effects the prognosis.

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Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef

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Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture: Sung Won Cho, Sang Ho Ha, Gwang Chul Lee, Woong Hee Kim; J Korean Fract Soc 2013;26(3):205-211. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.205

Abstract PDF

PURPOSE
To analyze the clinical and radiologic results of minimally invasive plate osteosynthesis (MIPO) for distal femur fractures using a locking compression plate (LCP) and to evaluate its usefulness.
MATERIALS AND METHODS
From May 2006 to April 2011, 23 patients (24 cases) with distal femur fracture were treated by MIPO with a LCP and followed-up for at least 12 months. Mean age was 61.6 years (35-80 years). Union time and post-operative alignment were measured on radiograph, and clinical function was evaluated by range of motion (ROM), Knee Society Score and complications.
RESULTS
In 22 patients (23 cases) except for 1 case, bony union was obtained after an average of 18 weeks (12-26 weeks). The mean ROM was 124 degrees (80-135 degrees). According to the Knee Society Score, there were 12 excellent, 8 good, 1 fair and 2 poor results and the mean score was 87.5 (60-98). Postoperative complications were nonunion in 1 case, ankylosis in 1 case, malunion in 2 cases and superficial wound infection in 2 cases.
CONCLUSION
The treatment of distal femoral fracture with MIPO using a LCP was considered a useful method which can result in satisfactory clinical and radiologic outcomes if there is accurate understanding about the surgical techniques and appropriate procedures involved.

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Surgical Treatment of AO/OTA 33-C Intra-Articular Distal Femoral Fractures through Parapatellar Approach
Suk Kyu Choo, Sung Tan Cho, Hyoung Keun Oh
Journal of the Korean Fracture Society.2022; 35(1): 1. CrossRef
Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef

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The Daily Life Functions of Elderly Peritrochanteric Fracture Patients after Surgical Treatment: Dae Moo Shim, Tae Kyun Kim, Jong Yun Kim, Duk Hwa Choi, Joung Suk Lee, Seong In Lee; J Korean Fract Soc 2012;25(1):8-12. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.8

Abstract PDF: PURPOSE
Although most peritrochanteric fractures in old age necessitates surgical treatment, daily life functions are still impaired after discharge. We assessed the types of peritrochanteric fracture, risk factors, and functional recovery in elderly patients who were over 65 years old. We also tried to determine factors for recovery to daily life.
MATERIALS AND METHODS
From January 2006 to December 2007, among 61 patients who were over 65 years old with the possibility of 1 year follow-up, 50 patients were selected through interviews. After verifying age, sex, mode, types of fracture, and method, we analyzed daily living activities with a functional recovery index and estimated recovery of daily life functions after surgery, assuming a score increase if functional recovery was good.
RESULTS
The mean age was 75.8 years, and females (31 patients, 62%) exceeded males. Slipping (27 patients, 54%) was the most common cause of fracture, and the intertrochanteric femur fracture was the most common fracture type (34, 68%). The average functional recovery index decreased 16.24% compared with the pre-operation value, having a tendency to decrease more in old age and female patients. Subtrochanteric femur fracture showed a 17.6% decrease in functional recovery index among the fracture types.
CONCLUSION
In elderly patients over 65 years, the functional recovery index after peritrochanteric fracture decreased 16.24% on average compared with the preoperation state. The largest decrease was in basic life ability. The functional recovery index decreased more in old age, females, and subtrochanteric femur fracture, which indicates these factors influence functional recovery.

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Treatment of Distal Femur Fracture with Minimally Invasive Locking Compression Plate Osteosynthesis: Ki Chul Park, Kyu Sung Chung, Joon Ki Moon; J Korean Fract Soc 2012;25(1):13-19. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.13

Abstract PDF

PURPOSE
To analyze the result of distal femur fracture treatment with minimally invasive plate osteosynthesis (MIPO) using a locking compression plate (LCP).
MATERIALS AND METHODS
From December 2004 to April 2010, 33 patients with distal femur fractures were treated by MIPO with a locking compression plate. The reduction state and bone union time was checked radiologically. The clinical outcome was evaluated by the Schatzker and Lambert criteria.
RESULTS
The mean bone union time was 16.3 weeks (10~22 weeks). There were 3 nonunions, 2 broken plates, 1 superficial infection, 7degrees of valgus angulation in 1 case, and 1.5 cm limb shortening in 1 case. Except for the 3 nonunion cases, according to the Schatzker and Lambert criteria, results were graded as excellent in 11 cases, good in 14 cases, and moderate in 5 cases.
CONCLUSION
The treatment of distal femoral fracture by MIPO with a locking compression plate resulted in good functional and radiological outcomes, but it has problems, such as broken plates and nonunion. Accurate surgical technique and appropriate treatment will be needed according to fracture type.

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Surgical Treatment of AO/OTA 33-C Intra-Articular Distal Femoral Fractures through Parapatellar Approach
Suk Kyu Choo, Sung Tan Cho, Hyoung Keun Oh
Journal of the Korean Fracture Society.2022; 35(1): 1. CrossRef
Comparing Outcomes of Retrograde Intramedullary Nail and Locking Plate Fixation in Distal Femoral Fractures
Byung-Ho Yoon, Bo Kwon Hwang, Hyoung-Keun Oh, Suk Kyu Choo, Jong Min Sohn, Yerl-Bo Sung
Journal of the Korean Fracture Society.2021; 34(4): 131. CrossRef
Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef
Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture
Sung Won Cho, Sang Ho Ha, Gwang Chul Lee, Woong Hee Kim
Journal of the Korean Fracture Society.2013; 26(3): 205. CrossRef

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Clinical Outcome of Surgical Treatment for Fracture of the Femoral Shaft with Ipsilateral Fracture of the Proximal Femur: Hee Gon Park, Jae Sung Yoo; J Korean Fract Soc 2011;24(4):307-312. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.307

Abstract PDF: PURPOSE
To analyze diagnostic process and clinical data in cases of fracture of the femoral shaft with fracture of the proximal femur.
MATERIALS AND METHODS
We reviewed 24 cases of patient who undergone surgery for fracture of the femoral shaft with ipsilateral fracture of the proximal femur and more than 1 year of examination of follow up was available. Age, sex.location and classification of the fracture, the time of diagnosis and operation, the method of operation, the associated injuries, the time of bony union and complication were investigated, postoperative function was evaluated on Friedman and Wyman criteria.
RESULTS
Bony union showed significant difference in the displacement and comminution of fracture, postoperative function revealed significant difference according to the associated injuries. The 6 cases (25%) out of 24 cases are failed early diagnosis, 4 cases out of 6 cases was detected during operation and 2cases was found after surgery. 21 cases out of 24 cases of femoral shaft fractures showed union, 23 cases out of 24 cases of femoral neck fractures showed union. There were eleven good, eleven fair, and two poor functional result according to Friedman and Wyman criteria.
CONCLUSION
Precious clinical and radiologic examination is needed not to miss the diagnosis of proximal femur fractures in ipsilateral femoral shaft fractures with proximal femur fractures. Anatomical reduction and rigid fixation of proximal femur are important to reduce avascular necrosis of femoral head and nonunion of proximal femoral fractures.

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Stiff Knee by Entrapment of Quadriceps Femoris Tendon at Fracture Site in Paediatric Distal Femur Shaft Fracture: Suk Kang, Jong Pil Kim, Chung Soo Hwang, Phil Hyun Chung, Young Sung Kim, Sang Ho Lee, Jin Wook Chung; J Korean Fract Soc 2007;20(4):339-344. Published online October 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.4.339

Abstract PDF: The complications following paediatric femur fracture are leg length discrepancy, angulation deformity, rotational deformity, ischemic limb. But, stiff knee is rarely expressed after trauma like paediatric femur fracture. We report a case of stiff knee due to entrapment of quadriceps femoris tendon at displaced fracture site after conservative treatment by Russel traction and hip spica cast in paediatric femur fracture. We treated successfully by resection of distal end of proximal segment of femur and release of quadriceps femoris tendon for flexion contracture of the knee.

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Treatment of the Distal Femur Fracture with Retrograde Intramedullary Nailing: Moon Jib Yoo, Myung Ho Kim, Hee Gon Park, Woo Sup Byun, Ki Choul Kim; J Korean Fract Soc 2005;18(3):238-243. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.238

Abstract PDF

PURPOSE
To evaluate the results and complications of the retrograde intramedullary nailing for the treatment of distal femur fracture.
MATERIALS AND METHODS
Thirty three patients who received retrograde IM nailing for fractures of the distal femur between October 1998 to December 2003. Average age was 53.8+/-17 (17~86) years. The average follow up period was 19.4 (12~36) months. Clinical information included age, sex distribution, associated fracture and fracture was classified by AO classification. Functional result was evaluated by Schatzker's criteria.
RESULTS
The most common cause of injury was traffic accident (60%). The type of fracture were 6 A1 cases, 5 A2 cases, 11 A3 cases, 5 C2 cases, 6 C3 cases by AO classification. Among the 33 cases, 15 cases were excellent, 9 good, 6 fair and 1 failure according to Schatzker's criteria. Average union time was 9.7+/-3.5 months.
CONCLUSION
Treatment of distal femur fracture with retrograde intramedullary nailing was useful due to its minimal invasiveness and early range of motion, more rigid fixation.

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Retrograde Intramedullary Nailing for Periprosthetic Supracondylar Fractures of the Femur after Total Knee Arthroplasty
Hyuk-Soo Han, Kyu-Won Oh, Seung-Baik Kang
Clinics in Orthopedic Surgery.2009; 1(4): 201. CrossRef
Retrograde Nailing for Supracondylar Fracture after Total Knee Replacement: The Compatibility of Femoral Implant with Supracondylar Nail
Moon-Jib Yoo, You-Jin Kim, Jin-Won Lee
Journal of the Korean Fracture Society.2008; 21(1): 19. CrossRef
Midterm Results of Treatment with a Retrograde Nail for Periprosthetic Fractures of the Femur Following Total Knee Arthroplasty
Kyung-Taek Kim, Jin-Hun Kang, Lih Wang, Jae-Sung Hwang
Journal of the Korean Fracture Society.2007; 20(4): 309. CrossRef

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Treatment of Distal Femoral Shaft and Supracondylar Fracture with aRetrograde Intramedullary Nailing: Sang Hong Lee, Jun Young Lee, Sang Ho Ha, Hong Moon Sohn, Kwang Chul Lee; J Korean Fract Soc 2004;17(2):103-109. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.103

Abstract PDF

PURPOSE
Retrograde intramedullary nailing has been recommended as one of the treatment options for the distal femoral fracture, particularly in patients who are obese, are pregnant, has sustained ipsilateral femoral neck fracture, have multiple injuries. However there are some disadvantage such as post-arthrotomy infection, knee joint stiffness. This paper is to evaluate the result and complication of treatment of distal femoral fracture with a retrograde intramedullary nailing.
MATERIALS AND METHODS
We reviewed 13 cases (distal femoral shaft fracture: 6 cases, supracondylar fracture: 7 cases) of the distal femoral fracture who had been treated with retrograde intramedullary nailing and follow up for more than 12 months from January 1999 to December 2001. The rate of bony union, range of motion of the knee, complications were evaluated.
RESULTS
The mean duration of bony union was 20 weeks (range, 16~25 weeks). A case of delayed union was developed. In 4 cases of 13 cases showed posterior angulation below 6 degree, which did not need further treatment. According to Saunder's criteria, excellent result was achieved in 8 patients, good result in 5 patients, respectively.
CONCLUSION
This study showed good clinical and radiological results of union with retrograde intramedullary nailing at the distal femoral fracture and ipsilateral multiple fracture

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Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult
Yong-Woon Shin, Yerl-Bo Sung, Jeong Yoon Choi, Minkyu Kim
Journal of the Korean Fracture Society.2011; 24(4): 313. CrossRef
Axial Malalignment after Minimally Invasive Plate Osteosynthesis in Distal Femur Fractures with Metaphyseal Comminution
Jae-Ho Jang, Gu-Hee Jung, Jae-Do Kim, Cheung-Kue Kim
Journal of the Korean Orthopaedic Association.2011; 46(4): 326. CrossRef

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Nancy Nail Fixation for Femur Shaft Fracture in Children: Ki Do Hong, Sung Sik Ha, Nam Sik Chung, Jae Cheon Sim, Jae Young Kim; J Korean Soc Fract 2003;16(4):592-599. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.592

Abstract PDF

PURPOSE
To investigate, the radiologically, the duration of bone union, angular formation, leg length discrepancy, other complications and mean hospital stay after Nancy nail fixation has been performed in children with femoral shaft fracture, and also to inquire into the clinical validity of such procedure. MATERIAL AND METHOD: Included in this study were 12 patients who had been treated with the Nancy nail fixation for the femoral shaft fracture and then followed up for a year or more. The age distribution ranged from 4 to 12 years with mean age 7.2 years. After the fracture was reduced under an imaging intensifier, 2 or 3 Nancy nails were pinned onto the medial and lateral femur distally.
RESULTS
The average duration for complete union was 9.9 weeks. Any angular formation over 5 degrees was notfound. Leg length discrepancy ranged from 2 mm shortening to 12 mm overgrowth with a mean value of 2.8 cm. In one case, with overgrowth over 10 mm or more, there was no gait disturbance. In all cases, There was neither infection, delayed union, nor any motion disturbance. A nail was moved distally in one case and skin irritation was evident in another case. The mean hospital stay was 17.3 days.
CONCLUSION
Nancy nail fixation in pediatric femoral shaft fracture relatively has less complications and is a safe surgical procedure. In addition, it helps in reducing hospital stay.

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Comparison of Flexible Intramedullary Nailing with External Fixation in Pediatric Femoral Shaft Fractures
Do-Young Kim, Sung-Ryong Shin, Un-Seob Jeong, Yong-Wook Park, Sang-Soo Lee, Keun-Min Park
The Journal of the Korean Orthopaedic Association.2008; 43(1): 30. CrossRef

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Retrograde Flexible Intramedullary Nailing of Pediatric Femur Fractures: Chang Wug Oh, Byung Chul Park, Hyung Jin Park; J Korean Soc Fract 2001;14(2):272-277. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.272

Abstract PDF

PURPOSE
This study was designed to evaluate the clinical effectiveness including bone union, leg length discrepancy, after retrograde flexible intramedullary nailing for pediatric femoral fractures. MATERIAL AND METHOD: Nineteen cases (18 patients) with femur fracture at the age of 4 to 10 years (mean age 6.7) have been followed up over the minimum of one year. Under imaging intensifier, the fracture was temporarily reduced with manual traction, and 1 or 2 flexible nails were inserted at medial and lateral side of distal femur above the distal epiphysis. After two weeks of immobilization with long leg splint, joint motion was permitted. At 6-8 weeks, partial weight bearing was permitted, and at 10- 12 weeks, full weight bearing was permitted.
RESULTS
Time to radiologic union averaged 10.9 weeks. Limb length discrepancy ranged from 7mm of shortening to 6mm of overgrowth(mean ; 1.1mm of overgrowth), but there was no severe limb length discrepancy over 10mm. As another complications, there were one case of limited motion of knee joint and one case of broken nail.
CONCLUSION
We found that retrograde flexible intramedullary nailing is a safe, effective treatment for acute femoral shaft fractures in skeletally immature patients.

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Treatment of Femoral Shaft Fracture with Interlocking Humeral Nail in Older Children and Adolescent
Kun-Bo Park, Hoon Park, Hyun-Woo Kim, Hui-Wan Park, Jae Young Roh
Journal of the Korean Fracture Society.2010; 23(2): 206. CrossRef

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The Treatment of Femur Fractures in Neonates with a Pavlik Harness: Two Cases Report: Bon Seop Koo, Kyung Chul Kim, Ji Hyo Hwang; J Korean Soc Fract 2000;13(4):1033-1037. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.1033

Abstract PDF: Femur fractures during birth are very rare and the treatment of the fractures is variable. Pavlik harness is available in the treatment of the femur fractures in infants but any literature on the treatment of the birth fractures of femurs can not be found as far as we know. We experienced two cases of femur fractures in neonates treated with Pavlik harness and present them with a review of the literature.

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Periprosthetic Femur Fracture due to Unrecognized Surgical Instrument Left in the Medullary Canal : A case report: Ui Seoung Yoon, Keun Woo Kim, Yong Hoon Kim, Hak Jin Min, Kook Hyeung Cho, Min Sup Lee, Sang Rim Kim; J Korean Soc Fract 2000;13(2):334-337. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.334

Abstract PDF: Postoperative periprosthetic fracture of the femur after hip arthroplasty is a serious complication that can be difficult to treat. Moreover, it has become more common in recent years, as the cases of hip arthroplasty and revisonal hip arthroplasty increase. We have experienced a postoperative periprosthetic fracture of th femur probably caused by a surgical instrument left in the medullary canal during hip arthroplasty. We report this case with reference to other related articles.

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Leg Length Discrepancy after Ender Nail Fixation in Children Femoral Shaft Fracture: Jin Woo Kwon, Seung Ho Shin, Won Ho Cho, Woo Se Lee, Jin Ho Park; J Korean Soc Fract 2000;13(1):172-177. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.172

Abstract PDF: PURPOSE
: The purpose of this study is to evaluate the seg length discrepancy after Ender nail fixation in children's femoral shaft fracture.
MATERIALS AND METHODS
: We reviewed 18 femoral shaft fracture that were treated with Ender nail and studied the relationship between the initial site of fracture, type of fracture and overgrowth. The age of children in this study ranged 6 to 13 years old and the average period of follow-up was 32 months.
RESULTS
: The range of leg length discrepancy was from 6 mm shortening to 16mm lengthening and average 3.4 mm lengthening. Only one patient had shortening, nine patients had limbs of equal length(less than 2 mm) and eight patients had lengthening. The average overgrowth was 1.3 mm in proximal 1/3, 7.0 mm in middle 1/3, 3.0 mm in distal 3/1 fractures. The average overgrowth was 7.3 mm in transverse, 1.3 mm in oblique and 2.3 mm in comminuted fractures.
Conclusions
: We consider closed Ender nailing in children femoral shaft fractures as a good treatment modality in the matter of leg length discrepancy.

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Flexible Intramedullary Nailing for Femoral Shaft Fracture in Children: Kwang Pyo Jeon, Kyung Hoon Kang, Jin Il Kim, Dong Soo Kim, Hyung Koo Yoon, Chul Weon Kang; J Korean Soc Fract 1999;12(4):1051-1057. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1051

Abstract PDF: PURPOSE
: In children, fractures of the femoral shaft have been traditionally treated by immobilization in a spica cast, either immediately or after a period in traction except open fracture or for patient with head injuries. More recently, there has been a growing trend towards surgical treatment with widening of the indications including isolated femoral fractures. To evaluate the clinical, radiological results of surgical treatment for femoral shaft fractures in children, we reviewed 13 cases of femoral shaft fractures in children treated with flexible intramedullary nailing and followed for more than 12 months. MATERIALS & METHODS : The average age of the patients was 11 years and 4 months(range 10- 14 years). The average follow-up period was 1 years and 3 months(range 1 years-1 years and 8 months)after surgery. 10 cases and 3 cases were inserted through antegrade and retrograde entry, RESULTS: No major complications were found except 1 intraoperative iatrogenic fracture and 2 postoperative bursitis ;all fractures were united and radiologic union was obtained at 9.5 weeks after surgery.
CONCLUSION
: The clinical results obtained using flexible intramedullary nails for the stabilization of femoral shaft fracture in children are comparable to non-operative treatment, but with less disruption to family life and a shorter hospitalization while achieving near anatomic alingment, maintaining lengh, and allowing early active motion at the hip and knee.

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Fracture around Hip Joint Combined with Ipsilateral Femoral Shaft Fracture: Sung Kwan Whang, Jung Ho Rha, Jin Rok Oh, Young Hyun Park; J Korean Soc Fract 1997;10(4):746-754. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.746

Abstract PDF: Fracture around hip joint combined with ipsilateral femoral shaft fracture is relatively uncommon injury and usually result from high-energy trauma. In many of cases, this fracture accompanies with multiple fractures and may be unrecognized the fracture around hip joint. The mechanism of this fracture is that the force on knee joint breaks femoral shaft, and then, when adductive position of femoral shaft, the remained force dislocates hip joint or breaks acetabulum, when abductive position of the shaft, the force breaks femoral neck or intertrochanter. The treatment methods of this fracture are many, but there is no choice of treatment. So, when we select method of treatment, we must consider patients all situations(patients age, pattern of fracture, qulality of bone, ability of surgeon, etc.). The purpose of this study is to make the algorithim of the selection of treatment method for rracture around hip joint combined with ipsilateral femoral shaft fracture. We reviewed 37 cases of fracture around hip joint combined with iplilateral femoral shaft fracture from Febrary 1978 to June 1996. The minimal follow-up period was 1 year. From the review, we made the algorithm of the selection of treatment method for fracture around hip joint combined with ipsilaterl femoral shaft fracture.

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Metal Failure after Plate Fixation for Femur Fracture: Hee Kwon, Dong Wook Kim, Chi Soo Sohn, Seung Ryeol Yoon, Joon Min Song, Soo Kyoon Rah, Chang Uk Choi; J Korean Soc Fract 1997;10(2):371-378. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.371

Abstract PDF

From January 1991 to August 1996, we experienced 17 cases of metal failure among 150 cases of plate fixation of femur fracture. We analyzed the cases and obtained the following results: 1. Among 17 cases, 15 cases were closed fracture and 2 cases were open fracture. In 11 cases, the fractures were located on the midshaft of femur and most of them was segmental or comminuted. According to AO classification, 14 cases(82%) were type B(B1:1, B2:4) and C(C1:7, C3:2). 2. The interval between initial operation and metal failure was 8 months on average. 3. The cause of metal failure were bone defect remaining after initial operation, fragment necrosis due to periosteal denuding of large free bone fragments, early weight bearing, selection of inappropriate implants and improper operation technique. 4. Plate breakages were occured in 11 cases and screw fractures and screw loosening in 6 cases. Most of plate breakage was due to remaining bone defects, and most of screw fractures and loosening was due to inappropriate implants and improper operation techinque. In conclusion, accurate preoperative evaluation on the fracture site, fracture pattern and appropriate selection of internal fixative are important for proper bone healing. Based upon our result, we suggest semiopen technique with minimal soft tissue injury and initial early bone graft for bone defect.

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The Surgical Treatment of Distal Femur Medial Condyle Fracture Using Lateral Anatomical Plate of Opposite Side through Medial Approach
Sung-Sik Ha, Jae-Chun Sim, Ki-Do Hong, Jae-Young Kim, Kwang-Hee Park, Yoon-Ho Choi
Journal of the Korean Fracture Society.2009; 22(4): 246. CrossRef

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Ender Nailing for Femoral Shaft Fracture in Children: Won Sik Choy, Cheun Hwan Yoo, Sang Suk Ong; J Korean Soc Fract 1997;10(1):180-187. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.180

Abstract PDF: The indications for surgical stabilization of a pediatric diaphyseal femur fracture are expanding Children with multiple systemic injury, a head injury, and/or with multiple fractures have fewer local and distant complications if the femur fracture is treated operatively. Other indications include a frac- ture in a child with a preexisting condition that prevents the application of a spica cast, a child older than 10 years of age, or a child less than 10 years of age who cannot be kept adequately aligned using conventional(traction/casting) methods of fracture management. Here closed intramedullary Ender nailing of 15 femoral fractures in 15 children, 7-13 years of age, was studied retrospectively. Seven patients had associated injuries. The average operation time was 40 minutes and hospitalization time averaged 16 days. There were no infections, nonunions, or malunions. On follow-up, average 27 months, no patient had deformity of over 8 degree in any plane. No patient had clinical loss of motion, leg length discrepancy, or radiographic evidence of growth disturbance. Here, authors Concluded that closed Ender nailing is very useful method in the management of femoral shaft fracture in children over 10 years old or when there is associated head injury or multiple fractures regardless of patients age.

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Clinical Result of Surgical Treatment in Distal Femur Fractures using Dynamic Compression Screw and Blade Plate: Seung Baik Kang, Joong Hee Won, Bong Soon Chang, Eui Seong Choi, Jin Seon Yoo, Hee Joong Kim; J Korean Soc Fract 1996;9(3):557-566. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.557

Abstract PDF: The fracture of distal femur, which include the supracondylar region, intercondylar region and knee joint, have many problems by nature. It is almost all comminuted fracture and has a some difficulty in approach. Early attempts at internal fixation frequently gave unacceptably high rates of malunion, nonunion, and infection. Traditionally, nonsurgical treatment has been favored. Over the past 15 years, improved and meticulous techniques of internal fixation has been shown to yield good to excellent results. Also a number of excellent devices are now available. We reviewed the patients who were admitted for fractures of the distal femur and were treated by the surgical treatments at department of Orthopaedic Surgery, Chungbuk National University Hospital from July 1993 through Augrst 1994. Fourteen cases were followed for more than one year. An average age at operation was 54 years (range, 18-74 years). The analysis group consisted of 9 males and 5 females. The cause of injuries were motor cycle injury in 8 cases, in-car accident in 2 cases, pedestrian injury in 2 cases and fall down in 2 cases. According to the classifications of AO, 4 cases were type Al, 2 were type A2, 2 were type A3, Cl was 1 case, C2 were 2 cases and C3 were 3 cases. Open fractures were 2 cases. Blade plate was used in 10 cases and DCS(dynamic compression screw) in 4 cases. With serial follow-up X-ray, ROM of knee and Neers scoring system, evaluation was performed. Excellent or good results were obtained in 13 cases (93%). Deep infection was developed in one case. At last follow-up, ROM was satisfactory. Blad plate was very useful for severe osteoporotic patient. For comminuted, displaced intra-articular fractures such as Type C, extensile surgical approach was most useful.

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Treatment of Intertrochanteric Fractures of Femur in Elderly Patients over 65 Years Old: Yoo Seong Seo, Hyung Suk Choi, Sang Gi Kim, Byung Joon Shin, Soo Kyun Rah, Chang Uk Choi; J Korean Soc Fract 1995;8(1):54-60. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.54

Abstract PDF: The ipsilateral femur fracture after hip arthroplasty is rare, but serious complication. And its treatment is difficult and controversial. We experienced 6 patients who had the hip arthroplasty complicated by an ipsilateral femur fracture in postoperative period at the Department of Orthopaedic Surgery, Soonchunhyang Univesity from February 1990 to December 1993. The Type 1 fracture was 1 case, and 2 Type IV-A, and 1 Type IV-3, and 2 Type V according to AAOS classification. Bony union and satisfactory clinical results were achieved in all 6 cases.

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Idiopathic Fever following Childrens femur Fractures: Hong Jun Han, Hyun Lee, Sang Soo Kim; J Korean Soc Fract 1990;3(2):280-283. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.280

Abstract PDF: Not infrequently, Orthopaedic surgeons notice that fever following childrens femur fractures does not coincide with the laboratory findings. The authors agree that knowledge of the frequency, time of onset, duration, and magnitude would be helpful in accessing the significance of fever in the postinjury period. The authors reviewed 65 childrens femur fractures without infection under the 15 years old from March 1984 to December 1989 and following observations were made. 1. Fever developed in 32 patients(49%), but only in 7 patients(11%) significant fever elevation was found. 2. The mean onset of fever was 4 days after trauma, and the mean duration was 3 days. 3. The rate of fever occurrence increased In accordance with age. 4. Fever was least common in patients having oblique fracture. 5. Associated injuries were found more commonly in the febrile group.

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