Journal of Musculoskeletal Trauma

Vertically Unstable Fracture of the Pelvis Combined with Anterior Dislocation of the Hip Joint: A Case Report: Kap Jung Kim, Ha Yong Kim, Dae Suk Yang, Won Sik Choy; J Korean Fract Soc 2007;20(3):272-276. Published online July 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.3.272

Abstract PDF: Pelvic fractures result from high energy trauma and often associated with concomitant injuries. But, vertically unstable pelvic fractures combined with anterior dislocation of the hip is far less common. The traumatic dislocation of the hip is a true orthopedic emergency and it should be considered that a femoral head can be exposed to deteriorized vascularity. We report a case of vertically unstable pelvic fractures combined with traumatic anterior dislocation of the hip joint with the review of the literature.

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Hip Fracture-dislocation with Sciatic Nerve Palsy and Ipsilateral Femoral Shaft Open Fracture: A Case Report: Kap Jung Kim, Ha Yong Kim, Sung Il Kang, Won Sik Choy; J Korean Fract Soc 2007;20(1):94-98. Published online January 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.1.94

Abstract PDF: The posterior dislocation of the hip accounts for about 85~90% of traumatic hip dislocations and high energy mechanisms such as traffic accidents may cause them. The traumatic dislocation and fracture-dislocation of the hip are true orthopedic emergencies and it should be considered that a femoral head has poor vascularity and the sciatic nerve is closely located to it. We report on one patient who went through the surgical treatment of the concomitant ipsilateral open fracture of the femoral shaft and hip fracture-dislocation accompanying sciatic nerve injury with the review of the literatures.

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Development of a Computer-assisted Surgery System for Screw Fixation of the Sacro-iliac Joint: Jin Sup Yeom, Won Sik Choy, Ha Yong Kim, Whoan Jeang Kim, Jong Won Kang, Yeongho Kim, Hyungmin Kim, Donghyun Seo, Seok Lee, Jae Bum Lee, Namkug Kim, Cheol Young Kim; J Korean Soc Fract 2003;16(1):1-7. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.1

Abstract PDF: PURPOSE
The purposes of this study were to develop a computer-assisted surgery system for percutaneous screw fixation of the sacro-iliac joint and to evaluate its accuracy.
MATERIALS AND METHODS
We have developed a navigation system composed of an optical tracking device (Polaris, Northern Digital, Canada) and a personal computer. The registration error and target localization error at hybrid registration were measured using a phantom. The errors were measured 30 times for each. Sixteen 6.5 mm cannulated screws were inserted into four plastic bone models (Sawbones, USA), and the accuracy was evaluated.
RESULTS
The registration error was 0.76 +/-0.33 mm, and the target localization error was 1.43 +/-0.42 mm. All of the 16 screws were inserted well across the sacro-iliac joint, and there was neither penetration of the cortical bones nor collision between screws or washers.
CONCLUSION
The accuracy of the developed system was similar to existing ones, and its usefulness and helpfulness was proven with screw insertion into plastic bone models.

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Treatment of Femoral Shaft Fractures with External Fixators in Children: Ha Yong Kim, Jong Hyun Park, Seung Hun Lee, Kap Jung Kim, Kwang Won Lee, Byung Sung Kim, Won Sik Choy; J Korean Soc Fract 2002;15(1):36-44. Published online January 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.1.36

Abstract PDF

PURPOSE
This study was to assess the amount of overgrowth and convenience after external fixation of pediatric femoral fracture.
MATERIALS AND METHODS
Followed-up more than 18 months were 20 childrens treated with external fixator for femoral fracture(mean follow-up periods: 25.5 months). Mean age was 7.15 years(range: 4-11 years). End to end apposition was done on the closed reduction. Evaluation of the result was done with five parameters; clinical results, radiological results, parents`satisfaction with questionnaire, hospital fee and complications.
RESULTS
Clincal results were not any disability in all cases. No angulation deformity was estimated in all cases, and overgrowth was estimated average 4.8mm (range: -1 ~ 13mm). Answer for questionnaire was revealed satisfactory result. Total hospital fee was average 831 thousand won in external fixator group, and average 289 thousand won in treated group with cast.
CONCLUSION
We propose that external fixation in closed femoral shaft fractures of children could be a rational alternative mode of therapy, because it has excellent clinical & radiological results and parents were satisfied with its convenience & final results. Total hospital fee was statistically higher in external fixator group.

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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
WDM-PON upstream transmission using Fabry–Perot laser diodes externally injected by polarization-insensitive spectrum-sliced supercontinuum pulses
Yang Jing Wen, Chang-Joon Chae
Optics Communications.2006; 260(2): 691. CrossRef

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Knee Pain Analysis After Tibia Intramedullary Nailing: Kwang Won Lee, Jong Won Kang, Seung Hun Lee, Ha Yong Kim, Won Sik Choy; J Korean Soc Fract 2001;14(2):278-284. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.278

Abstract PDF

PURPOSE
To analyze the incidence and clinical and radiological results of anterior knee pain following tibial intramedullary nailing.
MATERIALS AND METHODS
From January 1995 to April 1999, we retrospectively analyzed in 122 patients with tibial fracture who were treated by closed intramedullary nailing. All of 125 cases analyzed the age and sex distribution, mechanism of injury, fracture morphology, relationship of nail position on radiographs to knee pain and relationship of knee pain to the incision methods of patella tendon. Anterior knee pain was assessed with a 10-point analogue scale. Statistical analysis was performed using paired T-test.
RESULTS
At a mean follow-up period of thirty-eight months(12-64 months), sixtynine( 56%) patients(70 of 125 knees) had developed anterior knee pain. Insertion of the nail through the patella tendon splitting incision was associated with a higher incidence of knee pain compared to the paratendon site of nail insertion(62% and 35% respectively). According to the radiological analysis, the mean extent of nail protrusion of 122 patients was -1.4mm and the average nail protrusion of 69 patients with knee pain was 1.3mm respectively. Nail removal resolved or improved the symptoms in 69%.
CONCLUSION
Based on these data, we would recommend a parapatella tendon incision for nail insertion, and nail removal for those patients with a painful knee after bony union.

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Alteration of the Patella Tendon Length after Intramedullary Nail in Tibial Shaft Fractures
Dong-Eun Shin, Ki-Shik Nam, Jin-Young Bang, Ji-Hoon Chang
Journal of the Korean Fracture Society.2012; 25(4): 283. CrossRef
Anterior Knee Pain after Intramedullary Nailing for Tibial Shaft Fractures
Suk-Kyu Choo, Hyoung-Keun Oh, Hyun-Woo Choi, Jae-Gwang Song
Journal of the Korean Fracture Society.2011; 24(1): 28. CrossRef

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Musculo-skeletal trauma of the children: Ha Yong Kim, Kun Young Park, Kwang Won Lee, Jae Hoon Ahn, Jin Sup Yeom, Won Sik Choy; J Korean Soc Fract 2001;14(1):128-134. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.128

Abstract PDF

PURPOSE
The aim of study was to analyze the patterns of musculo-skeletal trauma of the children.
MATERIALS AND METHODS
From 1997 to 1999, the included for the study were 108 children, who had been admitted for the orthopedic treatment and followed-up. The analysis were done as for 1) children s biological characteristics, 2) the situations of trauma, 3) causes of trauma, 4) types of trauma and 5) locations of fractures.
RESULTS
The average age was 8.5 years at the time of trauma. Sixty cases (56%) were between 5 and 9 years old. Boys were 3 times more common than girls. Second children (61cases, 57%) were more prone to trauma. Half of trauma took place between July and October, and one third of trauma (36 cases, 33%) happened on the street. Ninety eight children (91%) were admitted due to fracture, and supracondyle fracture of humerus was the most common cause(48 cases).
CONCLUSION
Many of accidents could be attributed to children's mischievous play resulted from curiosity and freedom of thought. For the prevention of these accidents, therefore, environment should be restructured from the point of child's view, and not only the design of facility itself but also proper management and education on the facilities should be taken.

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The Pattern of Occurrence of Fractures in Children and Adolescents and Its Managements Based on the Database of the Health Insurance Review and Assessment Service
Yong-Wook Kwon, Soon-Hyuck Lee, Hyun-Woo Kim, Jin-Ho Hwang
Journal of the Korean Fracture Society.2014; 27(4): 308. CrossRef

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Factors Affecting the Functional Result of Monteggia Fractures in Adults: Yong Bum Park, Byeong Ki Lee, Kwang Won Lee, Whoan Jeang Kim, Ha Yong Kim, Jae Hoon Ahn, Won Sik Choy; J Korean Soc Fract 2000;13(3):597-604. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.597

Abstract PDF

PURPOSE
Monteggia fracture is a combination of ulnar fracture and radial head dislocation. Despite of low incidence, Monteggia fracture has a problem in the treatment. So satisfactory results could not be achieved easily. The purpose of this study was to analyze factors affecting functional results in Monteggia fracture.
MATERIALS AND METHODS
From January 1990 to June 1998, we retrospectively reviewed 24 patients out of 40 patients who had been treated for Monteggia fracture. The functional assessment was performed with Broberg and Morrey system10).
RESULTS
Excellent and good results were achieved in 16 cases(66.6%), whereas fair and poor results in 8 cases(33.4%). Satisfactory results were obtained in 66.6% overall. According to the Bado classification, functional results were not different significantly between types. According to the mechanisms of injury, unsatisfactory results were obtained in 8 of 17 patients with high energy injury. Monteggia fractures with ulnar fracture at the diaphyseal level showed satisfactory results significantly compared to others. In terms of the methods of internal fixation, the plate and screw fixation showed satisfactory results in 14 of 16 patients whereas tension band wiring or intramedullary nailing showed unsatisfactory results in 6 of 8 patients.
CONCLUSION
In Monteggia fractures, factors affecting functional result may be the mechanism of injury, the level of ulnar fracture and the method of internal fixation.

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Incomplete Anterior Interosseous Nerve Palsy That Accompanied a Monteggia Fracture
Bo-Kyu Yang, Seong-Wan Kim, Seung-Rim Yi, Young-Jun Ahn, Jung-Ho Noh, Young-Hak Roh, Seung-Won Lee, Min-Soo Je, Seok-Jin Kim
Journal of the Korean Orthopaedic Association.2011; 46(1): 78. CrossRef

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Functional Results of Olecranon Fracture-Dislocation According to the Methods of Internal Fixation: Won Sik Choy, Yong Bum Park, Kwang Won Lee, Whoan Jeang Kim, Ha Yong Kim, Jae Hun An, Chang Soo Ryu; J Korean Soc Fract 2000;13(2):414-420. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.414

Abstract PDF: PURPOSE
: This study was performed to compare the functional results according to the methods of internal fixation in olecranon fracture-dislocation.
MATERIALS AND METHODS
: Authors retrospectively analyzed in 13 adult patients with olecranon fracture-dislocation (Colton II D) who were treated by internal fixation from January 1991 to June 1998. Functional results were assessed by Broberg and Morrey system and radiographic results were analyzed in terms of articular step-off, articular gap and reduction loss.
RESULTS
: In regard to functional assessment, all oblique fractures treated with plate and screw showed 100% of satisfactory result whereas those treated with tension bands showed 33.4% of satisfactory result. Comminuted fractures treated with plate and screw showed 40% of satisfactory result whereas all two treated with tesion bands resulted in unsatisfactory result. In regard to radiologic assessment, three oblique fractures treated with plate and screw result whereas those treated with tension bands resulted in fair result. Comminuted fractures treated with plate and screw resulted in three fair, two poor radiologic results whereas those treated with tension bands resulted in one fair, one poor result.
CONCLUSION
: Plate and screw fixation can obtain more satisfactory functional and radiologic results than tension bands in oblique and comminuted olecranon fracture-dislocation

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Treatment of Humeral Shaft Nonunion after Primary Internal Fixat: Kwang Won Lee, Kyou Hyeun Kim, Whoan Jeang Kim, Ha Yong Kim, Jae Hoon Ahn, Yong Bum Park, Won Sik Choy; J Korean Soc Fract 1999;12(3):704-711. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.704

Abstract PDF: We retrospectively reviewed one hundred fifty-two patients who were treated for humeral shaft fractures at Eul-Ji Medical College hospital from Jan 1991 to June 1997. We experienced twenty one cases of nonunion among them after primary internal fixation. The purpose of this study was to evaluate possible causes of nonunion and to find out adequate treatments. The main cause of nonunion was an inadequate fixation (57%). The most common fracture pattern was simple transverse type(22%), and it occurred most frequently at the middle one third area of humeral shaft(22%). For the treatment of nonunion, the plate fixation was done in ten cases, interlocking intramedullary nailing in three cases, bone graft only in six cases, and external fixation using monofixator(Orthofix) in two cases. We obtained complete bony union from all cases, and the average union time was 17.5 weeks. Our study showed that higher incidence of nonunion was found in primary intramedullary nailing cases(19%) than in primary plate fixation cases(4%). In conclusion, close attention should be paid when choose the primary fixation method, and plate fixation and bone graft was considered as one of the useful treatment method of nonunion.

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Treatment of Two-part, Displaced Surgical Neck Fracture of the Proximal Humerus with Modified Ender Nail and Tension Band Technique: Kwang Won Lee, In Sung Hwang, Seung Hun Lee, Tae Gyoo Ahn, Ha Yong Kim, Whoan Jeang Kim, Won Sik Choy; J Korean Soc Fract 1999;12(2):395-401. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.395

Abstract PDF

Operative treatment of two-part, displaced surgical neck fractures of the proximal humerus is used when satisfactory closed reduction cannot be achieved or maintained. Recently, we modified the Ender nails by making an additional hole above the slot for wire incorporation. The purpose of this study was to assess the effects of stabilization of displaced and unstable surgical neck fractures of the humerus by Ender nailing and tension band technique. We reviewed the data of fourteen consecutive patients (10 women and 4 men) who had been treated with Ender nailing and tension band wiring between from Aug 1996 and Oct 1997 at Eulji Medical College Hospital. The average age of patients was 54 years (range, 38 to 79 years), and the average follow-up period was 18 months (range, 12 to 24 months). Bone union was observed at 6.3 weeks (range, 5.5 to 10 weeks), except one case of delayed union. There were no infections and nonunions. The average ranges of shoulder elevation and abduction were 140 degrees(100 degrees to 170 degrees) and 126 degrees(100 degrees to 160 degrees), respectively. The median value of the thumb to vertebral distance was L1, with a range of T6 to L5 for internal rotation, external rotation was 48 degrees (30 degrees to 70 degrees) . Radiography revealed one case of medial shift greater than 5mm, and 4 cases of lateral shift greater than 5mm of the humeral shaft. The average varus angulation of the humeral neck was 8.5o(0 degree to 34 degrees). Four patients (28.6%) were excellent (34 to 35), six patients (42.8%) were good (28 to 33), four patients (28.6%) were fair (21 to 27) in UCLA shoulder rating scale. In conclusion, Ender nailing and incorporation of the tension band wire loops provided additionally rotational and longitudinal stability in two-part displaced surgical neck fracture of the proximal humerus associated with osteoporosis.

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Treatment with Modified Steinmann Pins and Tension Band Wiring Technique in Proximal Humeral Comminuted Fractures with Osteoporosis
Soo-Tai Chung, Joo-Hak Kim, Hyung-Soo Kim, Sang-Joon Park
Journal of the Korean Fracture Society.2007; 20(2): 184. CrossRef

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Injuries of the Knee Associated with Fractures of the Tibial Shaft: Kwang Won Lee, In Sung Hwang, Seung Hun Lee, Tae Gyoo Ahn, Ha Yong Kim, Whoan Jeang Kim, Won Sik Choy; J Korean Soc Fract 1999;12(2):277-283. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.277

Abstract PDF: Two hundred and seventeen consecutive patients with two hundred and twenty five diaphyseal tibia fractures were retrospectively reviewed to evaluate the frequencies, types and the results of treatments for the associated ipsilateral knee ligaments and menisci injuries from May 1993 to Feb 1997 at Eulji Medical College Hospital. Average follow-up period was 41 months(20~65 months). Thirteen patients with knee injuries(5.8%) were diagnosed by stress X-ray & MRI evaluation and confirmed by arthroscopic examination. Eleven patients(84.6%) were diagnosed as having a ligament or meniscus injury at the time of initial management. The posterior cruciate ligament(PCL) was injured in eight patients(50%); the anterior cruciate ligament(ACL), in three; the medial collateral ligament, in three; the lateral collateral ligament, in two: the medial meniscus, in two; and the lateral meniscus, in two. There was no relationship between specific ligament damage and the cause of the injury or level of fracture. Collateral ligament injuries, two ACL, and four PCL injuries were treated conservatively and one PCL injuries were treated with pull-out suture technique and another four PCL injuries were treated with reconstruction using bone-patella tendon-bone. One ACL injury was treated with reconstruction using semitendinosus tendon. As evaluated by the method of HSS knee score, there were seven(53.9%) excellent, four(30.8%) good, and two fair(15.3%). On the basis of the results of this study, we believe that, after stabilization of a fracture of the tibial shaft, it is essential to examine the knee throughly to identify any associated ligamentous injuries.

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Treatment of Unstable Open Tibial Fractures with Ilizarov System: Won Sik Choy, Kwang Won Lee, Ha Yong Kim, In Sung Hwang; J Korean Soc Fract 1998;11(3):567-575. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.567

Abstract PDF: The treatment of open comminuted tibial shaft fractures have a high incidence of complications and often result in poor outcomes. General principles of treatment are accepted throughout most surgeons, which include aggressive debricdement, antibiotics, early stabilization, early soft tissue coverage, and prophylactic bone graft. But, recently there is a controversy on the bony stabilization methods; one group of authors favors external fixator, and the other group favors unreamed interlocking intramedullary nail. In this paper, we carried out retrospective study of the 42 cases of open comminuted tibial shaft fractrues managed with Ilizarov external fixator (minimum follow up of one year(average: 2.8 years)). The purpose of this study is to evaluate the results of treatment with an Ilizarov method for the patients with open comminuted tibia fractures (open type III-A and more by Gustilo and Anderson classification and, type B and more by AO classification). The results were as follows; 1. It has taken 7.4 months to achieve bony union with relatively delayed healing time for the diaphyseal fractures and fractures with higher energy injury on AO classification). The results were as follows; 1. It has taken 7.4 months to achieve bony union with relatively delayed healing time for the diaphyseal fractures and fractures with higher energy injury on AO classification. 2. Forty eight additional operations were needed for 27 patients; 24 bone grafts for 19 atients, 1 case of bone marrow injection, 4 cases of corticotomy and bone transport, 4 cases of sequestrectomy, 3 cases of internal fixation with plate, 2 cases of IM nailings, and 2 cases of Ilizarov correction in operating room. 3. Following complications were resulted in; delayed union 14 cases, nonunion 1 case, superficial infection 2 cases, deep infection 8 cases, chronic osteomyelitis 3 cases, refracture 2 cases, knee stiffness 6 cases, ankle stiffness 5 cases, subtalar stiffness 8 cases, lateral angulation 4 cases, anteroposterior angulation 4 cases, and leg length discrepancy 5 cases. 4. Twenty patients, at the final follow-up, could walk without limping and live their life with no activity limitation. 5. At the final follow-up, 19 patients complained intermittent pain on fracture sites, knees or feet and ankles. We could conclude that the Ilizarov external fixator can be a stabilizer of choice for the open comminuted (Gustilo type III and more than AO type B) tibial shaft fractures of which fracture line extended over the proximal or distal metaphysis.

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A Comparison of Plate Fixation with Intramedullary Nailing in Humeral Shaft Fracture: Kwang Won Lee, Kyou Hyeun Kim, Ha Yong Kim, Young Sik Min, Hwan Jung Kim, Won Sik Choy; J Korean Soc Fract 1997;10(4):785-792. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.785

Abstract PDF: We evaluated prospectively ninety-two patients out of 130 humeral shaft fractures requiring surgical stabilization from January 1991 to December 1995. Among them, thirty-one patients received open reduction and internal fixation with plate & screws(PLT). Thirty-one patients received closed reduction & antegrade intramedullary nail fixation(IMN). Thirty patients received closed reduction & antegrade and retrograde endernail fixation(EN). Average follow-up period was 20.7 months. Eleven patients had primary radial nerve palsies. The higher incidence of nonunion was found on IMN(42%), and EN(20%), than PLT(8%). We concluded that the result of IMN was not superior to that of PLT or EN.

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Fatigue Fracture of the Interlocking Nail in the Treatment of the Distal Part of the femoral Shaft Fractures: Won Sik Choy, Hwan Jung Kim, Kwag Won Lee, Young Sik Min, Ha Yong Kim, Moon Ho Shon; J Korean Soc Fract 1997;10(3):522-528. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.522

Abstract PDF: Closed intramedullary nailing with or without interlocking screws has been a widely accepted method for the fixation of fractures of the femoral shaft. The design of the interlocking nail introduces the potiential for high stress concentrations at the proximal and distal holes. The authors experienced six cases of metal failure of the interlocking nail in the treatment of fractures of the distal part of the femoral shaft from February 1992 to March 1995. The predisposing factors to fatigue fracture of the interlocking nail were studied. In all patients, the fracture of femur was five centimeters or less from the more proximal of the two distal screw-holes. The risk of fatigue failure may be minimized by using nails that have a larger diameter, by using nails long enough to be driven down to the subchondral area of the knee joint and by avoiding early weight-bearing.

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