Journal of Musculoskeletal Trauma

Original Articles

Posttraumatic avascular necrosis of talus: Soo Bong Hahn, Hong Jun Park, Kee Hong Song; J Korean Soc Fract 2000;13(2):368-374. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.368

Abstract PDF: PURPOSE
: We performed this study in order to analyze the clinical results and complications of posttraumatic avascular necrosis of talus MATERIALS AND METHODS : We performed a retrospective review of 19 patients undertaken treatment of talus fracture from September 1996 to September 1998. There were 11 males and 8 females with an a mean age of 21.4 years(range, 10-52years).
RESULTS
: In one case, there was soft tissue defect and bone maceration on dorsum of left foot due to crushing injury by traffic accident. The patient was treated with debridement and skin graft. In trauma 5 months, equinus deformity and stiffness of ankle was noted. Posttraumatic avascular necrosis of talus was noted at magnetic resonance imaging. But, there was neither collapse of talar dome nor pain. Therefore, heel cord lengthening and correction of equinus by hinged Ilizarov with distraction was done. In follow-up(1 year 3 months), avascular necrosis was improved and good ambulation without pain was possible. In another case, open reduction and internal fixation for talar neck fracture(Hawkins typeIII)was performed. In trauma 9 months, there were severe degenerative arthritis of peritalar joint, severe ankle pain, and severe avascular necrosis with collapse of talus. Therefore, dead bone resection and ankle arthrodesis with autoiliac bone graft were performed using Ilizarov external fixator. In follow-up(trauma day 1 year 11 months), good ambulation in 90degreesankle fusion state without pain was possible.
CONCLUSION
: In the treatment of talus fracture, periodic physical and radiologic examination is important for early detection of posttraumatic avascular necrosis and early management.

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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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Ilizarov Treatment of Nonunions with Bone Defect in the Tibia: Soo Bong Hahn, Hong Jun Park, Kee Hong Song; J Korean Soc Fract 2000;13(1):13-19. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.13

Abstract PDF: PURPOSE
To analyze the clinical results and complications of internal transport by Ilizarov for defect nonunion of tibia MATERIALS AND METHODS: We performed a retrospective review of 24 patients undertaken internal transport by Ilizarov for defect nonunion of tibia from January 1991 to December 1997. There were 21 males and 3 females with a mean age of 33.4 years(range, 17-64 years). On average, the size of bone defect measured 7.9 cm(range, 2-17 cm). Bone defects were gradually closed by progressive internal transport. After internal transport, bone grafts on 14 docking sites were performed because of delayed union. Soft tissue defects were treated with secondary closures(6 cases), skin grafts(4 cases), and flaps(4 cases).
RESULTS
According to Paley and Catagni's classification, bone results were excellent in 19 cases, good in 4 cases, and poor in 1 case. Functional results were excellent in 2 cases, good in 21 cases, and poor in 1 case. According to Paley's classification, the complications were developed as follows; Problems were pin site infections(12 cases), joint contractures(9 cases), and distraction gap delayed consolidations(3 cases). Obstacle was absent. Complication was refracture(1 case). The average distraction consolidation index was 39.4 days/cm. The average percentage transport was 139.7 %.
CONCLUSION
The application of Ilizarov to defect nonunion of the tibia is effective, but correct technique and careful follow-up is required.

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Clinical Evaluation of Antibiotics Prophylaxis Against Infection in Clean Orthopaedic Surgery: Nam Hyun Kim, Soo Bong Hahn, Hong Jun Park; J Korean Soc Fract 1995;8(4):815-822. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.815

Abstract PDF: Prophylactic antibiotic treatment to prevent postoperative wound infection is an appealing routine to the orthopaedic surgeon. But, there has been no adequate guideline of prophylactic antibiotics in the field of ctean orthopaedic surgery. The purpose of this study was to investigate the method of effective administration of antibiotics and the factors affecting the postoperative infection in clean orthopaedic surgery. Two hundred and forty one patients were included in a prospective randomized double-blind trial comparing the efficacy of three days(group 1,42 patients) versus that of five days cefotiam(group II, 199 patients) injection for prophylaxis against wound infection in patients who had an operation using bone plate, Ender of Kiintscher nails, or other internal fixation devides. The two groups were similar in terms of mean age, sex ratio, duration of preoperative hospital stay, underlying risk factors and type of surgical procedure. A wound infection developed in one of the forty-two patients in group I(2.3%) and in nine of 199 patients in group II(4.5%). This difference of infection rate is not stati stically significant(p>O.05). Staphylococcus aureus, Staphylococcus epidermidis , Klebsiella pneumoniae and Enterobacter aerogenes were the common infecting organisms. And the infection rate in lower extremity operations was higher than that of other regions in the group II (p In conclusion. the recommended method of administration of prophylactic antibiotics in clean orthopaedic surgery to prevent postoperative wound infection is a high dosage injection of antibiotics one hour before surgery, intraoperative infusion of one dosage when the operation lasts more than one hour and then postoperatively within 72 hours. This will reduce the adverse effects of medication and will also reduce the costs.

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