Journal of Musculoskeletal Trauma

Operative Treatment for AO Type C Supracondylar Fractures of the Distal Femur: Ho Rim Choi, Joon Min Song, Hee Kwon, Youm Gyu Ko, Jang Geun Lee, Chang Hun Yoon; J Korean Soc Fract 2002;15(2):166-172. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.166

PURPOSE
Treatment of supracondylar fracture of the distal femur is challenging because of its characteristic anatomy and common occurrence of severe comminution. We evaluated the clinical results of 15 cases of AO type C supracondylar fracture.
MATERIALS AND METHODS
From December 1990 to November 1999, fifteen of 27 cases of AO type C supracondylar fracture of the distal femur were treated operatively. Mean follow-up period was one year and 5 months (range, 1 year-3 years and 3 months). The mean age of patients was 43.6 years. Eleven cases were treated by internal fixation and four cases by Ilizarov. Clinical results were evaluated by Schatzker and Lambert criteria.
RESULT
There were 5 excellent, 4 good, 1 fair and 1 poor results (81% satisfactory) in 11 cases treated by internal fixation and 1 excellent, 2 good, 1 fair results (75% satisfactory) in 4 cases treated by external fixation. COCLUSION: To get satisfactory results, AO type C supracondylar fracture of the distal femur need to be reduced anatomically and require rigid internal fixation. External fixation using Ilizarov can be an effective method of treatment in cases of open fracture and severe comminution with osteoporosis.

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Surgical Treatment of AO Type C Distal Femoral Fractures Using Locking Compression Plate (LCP-DF, Synthes®)
Kap-Jung Kim, Sang Ki Lee, Won-Sik Choy, Won-Cho Kwon, Do Hyun Lee
Journal of the Korean Fracture Society.2010; 23(1): 20. CrossRef

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Comparison of Intramedullary Nailing and Plate Fixation for the Treatment of Nonunion of the Long Bone Fracture on Lower Extermities: Jong Seok Park, Jae Hoon Lee, Hee Kwon, Jae Eung Yoo, Joon Min Song, Yeon Il Kim, Chang Uk Choi; J Korean Soc Fract 2000;13(2):327-333. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.327

Abstract PDF: PURPOSE
: Under the principle of rigid fixation and bone graft, we analyzed and compared the clinical results in the treatment of nonunion of long bone fractures using plate fixation and intramedullary nailing with or without bone graft.
MATERIALS AND METHODS
: We used 19 cases of plate fixation and 19cases of intramedullary nailing with or without bone graft for the treatment of the nonunion of long bone from Mar. 1994 through Feb. 1997. We analyzed and compared the clinical results of plate fixation and intramedullary nailing with bone graft in the treatment of nonunion of fracture.
RESULTS
: The mean bone union time according to nonunion type in case of plate fixation was 22.6 weeks in the hypertrophic type and 16.4 weeks in the atropic type(p<0.005). In case of intramedullary nailing was 20.4 weeks in the hypertrophic type and 15.3 weeks in the atropic type(p<0.05). According to the bone graft in case of plate fixation, 20.8 weeks in the autogenous bone graft and 19.3 weeks in the combination of autogenous bone graft and allo-bone graft(p>0.05). In case of intramedullary nailing, 16.9 weeks in the autogenous bone graft and 22.7 weeks that dosen't bone graft. According to the radioligical bone union time was 20.1 weeks in the plate fixation and 18.7 weeks in the intramedullary nailing(p>0.05).
CONCLUSION
: There was on significant difference according to the method of fixation, but the treatment of nonunion of long bone in lower extremities using intramedullary nailing will be good because of early ROM exercise and weight bearing ambulation than plate fixation. Although the type of nonunion is hypertrophic in the case of intramedullary nailing, bone graft is helpful to promote bony union.

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Checkrein deformity of the lesser toes following comminuted fracture of calcaneus : A Case Report: Hee Kwon, Dong Wook Kim, Dong Jin Kim, Chi Soo Sohn, Joon Min Song, Soo Kyoon Rah; J Korean Soc Fract 1998;11(4):806-810. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.806

Abstract PDF

Checkrein deformity of the great toe may occur after fracture of the distal third of tibia. It is due to adhesion of flexor hallucis longus muscle to callus. Charachteristic finding is shaply flexed great toe at ankle dorsiflexion and complete interphalangeal joint extension at ankle plantar flexion. We experienced a patient who had severe flexion deformity on the 2nd, 3rd, 4th toe and diagnosed as checkrein deformity of the lesser toes arised from calcaneal fracture. We can't find any report of checkrein deformity after fracture of calcaneus and we think this is very rare case. In operative field, we found fibrous contracture of quadratus plantae muscle which was adhered to flexor digitorum longus tendon. And we performed tenolysis, adhesiolysis and flexor digitorum longus tendon lengthening. 11 months after operation the patient showed excellent result with correction of the deformity.

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Dynamic Positional Deformity of the Hallux
Byung-Ki Cho, Yong-Min Kim, Dong-Soo Kim, Eui-Sung Choi, Ji-Kang Park, Jung-Wook Oh
The Journal of Foot and Ankle Surgery.2014; 53(6): 791. CrossRef
Checkrein Deformity by Incarcerated Posterior Tibial Tendon and Displaced Flexor Hallucis Longus Tendon following Ankle Dislocation - A Case Report -
Su-Young Bae, Hyung-Jin Chung, Man-Young Kim
Journal of the Korean Fracture Society.2011; 24(3): 271. CrossRef

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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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A Clinical Study of rmmediate Internal Fixation(within 24 Hrs) in Open Fractures of The Long Bones: Yoon Sik Kim, Jae Eung Yoo, Chi Soo Sohn, Jong Seouk Park, Hee Kwon, Joon Min Song, Soo Kyun Rah; J Korean Soc Fract 1996;9(3):593-604. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.593

Abstract PDF: The major goals in the treatment of open fractures of the long bones are to prevent infection, avoid malunion or nonunion, achieve bone union, and restore limb and patient function as soon and as fully as possible. The treatment modalities adopted in open fractures still remains controversial, especially in Gustilo-Anderson Type III. It has been the fear of infection that has lead to the traditionally accepted opinion that immediate internal fixation of open fractures is contraindicated but, nowadays, it is no longer tabooed. Owing to the early meticulous wound debridment and irrigation, and the use of bactericidal antibiotics, the infection rate reduced remarkably. Fifty-five cases of open long bone fractures treated by immediate internal fixation within 24 hours from inury were reviewed, which were treated at the Department of Orthopedic Surgery, Soonchunhyang University hospital for nine and half years from June, 1985 to January, 1995. The results were as follow: 1, There were 20 Type II , 19 Type III A, 10 Type IIIB and 5 Type IIIC open fractures treated by immediate internal fixation within 24 hours following to Gustilo-Andersons classification. 2. The most common causes of open fractures were traffic accident(84%). 3. The associated injuries of the patients treated by immediate infernal fixation were in sequence.:26 multitraumatized patient, 5 arterial injuries, 5 musculotendinous injuries, 3 major joint dislocations and so forth. 4. Normal bony union was achieved in 41 patients(73.2%), Delayed bony union was in 7 patient(12.5%) and nonunion in 8 patients(14.5%). 5. Primary wound healing was achieved in 40 patients(71.4%), superficial to moderate infection were in 5 patients(9%), deep to osteomyelitis in 11 patients(19.6%). 6. According to the subtypes of open fractures, deep to osteomyelitis were 80% in Type IIIC, 30% in Type IIIB, 10.6% in Type IIIA and 10% in Type II.

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Treatment of the Ipsilateral fracture of Femur and Tibia in Children: Jong Seok Park, Yoon Sik Kim, Hee Kwon, Jun Min Song, Soo Kyun Rah, Chang Uk Choi; J Korean Soc Fract 1996;9(1):129-136. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.129

Abstract PDF: Sixteen cases of fracture of the femur and tibia on the same leg in children below 16 year age were treated in Soonchunyang Univ. Hospital during the period 1988-1993. We studied all of these patients, classified by LettsNew classification of pediatric floating knee, retrospectively with analysis of treatment and results. The results were as follows; 1. Among the 16 cases,14 cases were male(88%), and 10 cases(63%) were at their first decade and 6 cases(37%) were at second decades. 2. The main cause of injury was traffic accident;15 cases(94%). 3. The most common concomitant injury was fracture in other site;5 cases(31%). 4. Among the 9 cases of conservative treatment, limping and leg length inequality were occurred in 6 cases(61%), and malunion in 5 cases(56fo). 5. Among the 7 cases of operative treatment, limping was occurred in 1 cases(14%), leg length inequality was in 2 cases(29%), and malunion in 3 cases(43%). 6. Among the 10 cases at first decade, limping was occurred in the 6 cases(75%) out of 8 cases of conservative treatment, but it was not occurred in 2 cases of operative treatment. According to the results, we suggest that at least one fracture should be rigidly fixed in all cases.

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Application of Unlearned Interlocking Nailing for Tibial Shaft Fractures: Hee Kwon, Kyoung Dae Min, Jong Suk Park, Jae Uk Kwon, Soo Byoon Rah, Chang Uk Choi; J Korean Soc Fract 1995;8(1):292-299. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.292

Abstract PDF: Intramedullary nails may be divided into two categories: unlearned and reamed. reaming effectively lengthens the isthmus of the tibia and thereby extends the number of fractures amenable to this technique, but other studies showed that union impairement and infection rates were relatively high because of reaming destroyed the endosteal blood supply, especially open fractures. Unlearned interlocking nails in open fractures offer the advantage of less damage to the intramedullary blood supply Also lower infection rates have been reported in open fracture when compared with reamed nails. We analysed 22 cases of tibial shaft fractures managed with interlocking nailing without reaming and experienced treatment of complications since September 1992. Average follow-up period was 13 months ranged 5 to 17 months and results were as follows: 1) We used an unlearned interlocking nails for tibial open fractures, 14 cases(Gustilo-Anderson type: I.3 cases, II.5 cases, III a 4 cases, III b.2 cases)and closed fractures asscciated with combined injuries, 8 cases. 2) Union occurred an average of 5.2 months postoperatively with a range from three to 14 months. 3) The complications were 2 cases of superficial infection and 5 cases of nonunion(3 cases among the 8 cases of closed fracture and 2 cases among the 14 cases of open fracture. 4) The treatment of nonunion was successful with bone graft, additional screw fixation and reinsertion of reamed nail. 5) We concluded that unlearned interlocking nailing was useful method to treat the open tibial shaft fractures in the selected cases, but undesirable to treat closed tibial shaft fractures because considered less mechanical stability.

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