Journal of Musculoskeletal Trauma

Posterior Plating in Distal Fibular Fracture: Choong Hyeok Choi, Young A Cho, Jae Hoon Kim, Il Hoon Sung; J Korean Fract Soc 2007;20(2):161-165. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.161

PURPOSE
To report the technical experience of posterior plating for the distal fibular fracture.
MATERIALS AND METHODS
20 Weber type-B fibular fractures were included in this study, which were treated with the posterior plating. 1/3 semitubular plate was used and orientation of all screws were intended to be perpendicular to the plate as possible. Fixation stability and maintenance of reduction after plating was assessed manually in the operating field. Clinical results were evaluated at least 1 year after operation, using American Orthopaedic Foot and Ankle Society (AFOAS) Ankle-Hindfoot score.
RESULTS
5 cases were firmly stabilized without using any lag screw or fixation of distal fragment. For improving stability or achieving proper reduction, a lag screw was placed posteroanteriorly through the plate in 14 cases. Anteroposterior interfragmentary fixation in 1 case before plating, and contouring of the plate in 3 cases were needed in cases of which the posterior plating impeded reduction of distal fibular fracture. In all cases, fracture was stabilized without fixation through the most distal hole. There were no major postoperative complications. AFOAS score was 95.5Â±5.2.
CONCLUSION
The posterior plating technique for distal fibular fracture is regarded as a recommendable option. Additional fixation with interfragmentary screw or contouring of the plate, however, would be needed in some cases to achieve anatomical reduction or sufficient stability.

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A Specialized Fibular Locking Plate for Lateral Malleolar Fractures
Eui Dong Yeo, Hak Jun Kim, Woo In Cho, Young Koo Lee
The Journal of Foot and Ankle Surgery.2015; 54(6): 1067. CrossRef

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Relevancy of Posterior Column Injury and Dural Tear in Unstable Burst Fracture: Ye Soo Park, Kee Hun Son, Ki Chul Park, Il Hoon Sung, Jae Lim Cho; J Korean Fract Soc 2005;18(1):65-68. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.65

Abstract PDF

PURPOSE
To analyze the pattern of posterior column injury in unstable burst fractures and to predict the possibility of dural injury.
MATERIALS AND METHODS
Retrospective review was carried out on 22 patients of unstable burst fracture from Nov. 1996 to Sep. 2003. The pattern posterior column injury was analyzed by simple x-ray, CT and MRI findings. In simple x-ray, authors analyzed laminar fracture, posterior facet injury, inter-spinous widening and inter-spinous malalignment, posterior bony injury by CT, posterior inter-spinous ligament injury and dural tear by MRI. The statistical analysis was performed using Mann-Whitney test and Chi-square test.
RESULTS
There were 13 men and 9 women, and mean age was 41 years-old (18~65). The level of injury showed 15 cases in T12-L2, 6 in L3, 3 L4. In simple x-ray, findings were showed 13 cases (59.1%) in laminar fracture, 7 (31.8%) in posterior facet injury, 16 (72.7%) in inter-spinous widening and 8 (36.4%) in inter-spinous malalignment. In CT, findings were showed 13 (59.1%) in laminar fracture, 10 (45.5%) in posterior facet injury, 9 (40.9%) in transverse process fracture. In MRI, findings were showed 18 (81.8%) in posterior inter-spinous ligament injury and were not showed dural tear. The combined cases of posterior bony and ligamentous injury was 6 (27%) and 5 of 6 showed dural tear and the analysis of dural tear and radiologic findings was showed positive correlation (p=0.004).
CONCLUSION
Posterior ligament injury was more frequent than bony injury in unstable burst fracture. Among the posterior bony injuries, dural tear was more frequent in facet injury. Authors confirmed all dural tear with operation. In cases of posterior bony injury combined with ligamentous injuries, the possibility of dural tear was significantly higher than that of single structural injury (p=0.004).

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Lumbar Spine Fracture
Seung-Wook Back, Hyun-Joong Cho, Ye-Soo Park
Journal of the Korean Fracture Society.2011; 24(3): 277. CrossRef
Relationship between Lamina Fractures and Dural Tear in Low Lumbar Burst Fractures
Ki-Chan An, Dae Hyun Park, Yong-Wook Kwon
Journal of the Korean Fracture Society.2011; 24(3): 256. CrossRef

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Penetration of Joints by Screws on Anterior Process of Calcaenus: Choong Hyeok Choi, Il Hoon Sung, Bong Geun Lee, Doo Jin Paik, Dong Won Kim; J Korean Fract Soc 2004;17(3):257-260. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.257

Abstract PDF: PURPOSE
This study was performed to determine the involvement of joints by screws, inserted on the anterior process of the calcaneus, using cadaveric specimens.
MATERIALS AND METHODS
An L-shaped lateral incision was performed on 32 embalmed feet (16 cadavers). An H-plate was applied on lateral wall of the calcaneus and it's anterior margin was located at 4 mm posterior to the lateral margin of the calcaneocuboidal joint. 3.5 mm cortical screws were inserted perpendicularly to the lateral calcaneal wall through the plate. Each calcaneus was dissected and taken out from the foot, and whether the tips of screws penetrated joints on the anterior process was evaluated.
RESULTS
11 (17.2%) of 64 screws, inserted on the anterior process, penetrated joints. Among them, seven screws involved the calcaneocuboidal joint and four screws penetrated the anterior facet of the subtalar joint. In two cases, both joints were penetrated by screws.
CONCLUSION
This study shows that joint surfaces could be penetrated by screws inserted from the lateral surface on the anterior process of the calcaneus. Care should be given to selecting the length and insertional angle of screws. Intraoperative radiography would be needed to observe the articular surface on the anterior process, when screws were inserted to the anterior process close to the calcaneocuboidal joint.

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Radiological Assessment for Distal Fibular Length: Il Hoon Sung, Jong Min Lee; J Korean Soc Fract 2003;16(2):208-214. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.208

Abstract PDF: PURPOSE
This study was performed to reevaluate the radiological parameters for assessing the length of the distal fibula in the mortise view of the ankle and to introduce a more reliable method to lessen measurement error.
MATERIALS AND METHODS
Mortise view radiographs of 36 normal ankles from 18 healthy volunteers were obtained. The talocrural angle and bimalleolar angle were measured two times and compared bilaterally by two independent observers. Also, The lateral malleolar angle, newly devised in our department was measured and compared bilaterally.
RESULTS
The average of the talocrural angle, bimalleolar angle, and lateral malleolar angle was 78.4 degrees (range 74 to 83), 78.3 degrees (range 73 to 86), and 36.7 degrees (range 30 to 41), respectively. The difference of the talocrural angle, bimalleolar angle, and lateral malleolar angle between right and left was 2.1 degrees, 3.0 degrees, and 1.2 degrees (95% confidence limit), respectively. Intraobsever difference of the talocrural angle, bimalleolar angle, and lateral malleolar angle was 1.5 degrees, 1.6 degrees, and 0.4 degrees, respectively. Interobsever difference of the talocrural angle, bimalleolar angle, and lateral malleolar angle was 1.3 degrees, 2.4 degrees, and 1.0 degrees, respectively.
CONCLUSION
When using various measurement methods to judge the length of the distal fibula, the measurement error should be considered. The proposed method, lateral malleolar angle, would be a good method for assessing the length of distal fibula in the mortise view of ankle.

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Intramedullary Nailing in Distal Tibial Meta-Diaphyseal Fracture: Kee Cheol Park, Young A Cho, Young Ho Kim, Tae Soo Park, Ye Soo Park, Il Hoon Sung, Kuhn Sung Whang; J Korean Soc Fract 2003;16(2):201-207. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.201

Abstract PDF: PURPOSE
This study was undertaken in order to evaluate the efficiency of the closed intramedullary nailing in 18 cases of distal tibial fractures.
MATERIALS AND METHODS
From May 1999 to June 2001, eighteen patients were treated by closed intramedullary nailing for distal tibial meta-diaphyseal fracture. According to Robinson classification, there were 7 type 1 fractures, 7 type 2A fractures, 1 type 2B fractures, and 2C type fractures. The mean distance between distal end of fracture and tibial plafond was 2.6+/-1.1 cm (0~5 cm). We evaluated both clinical and radiographic parameters.
RESULTS
Plate fixation of distal fibular fracture was performed in 7 cases. Poller screw was used in 4 cases which showed malalignment after insertion of nail. The mean score was 92.5 point by Blaird ankle scoring system. All patients got the bone union at average of 20 weeks (12~40 weeks). One patient had a antecurvatum deformity of 9 degrees.
CONCLUSION
Intramedullary nailing for distal tibial fractures is one of the safe and reliable method for managing these injuries.

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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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Effects of Yuhan Bone Connecting Powder on the Repair of Fractures in Rats: Il Yong Choi, Tai Seung Kim, Il Hoon Sung, Won Kyu Kim, Yun Young Choi, Kwan Hyoung Lee, Kyu Sung Hwang; J Korean Soc Fract 2000;13(4):1067-1079. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.1067

Abstract PDF: OBJECTIVES
We have studied the effects of Yuhan bone connecting powder on the healing process of the frauture at the osteotomized bones in rat, using bone densitometer, X-ray and morphological studies after administration of Yuhan bone connecting powder which has been reported in China as enhancing the processes of the fracture healing.
MATERIALS AND METHODS
90 Sprague-Dawley male rats were divided into the rib and tibia osteotomy groups. Each group was subdivided into the control, low dosage and high dosage groups. Rib and tibia were osteotomized under the general anesthesia with ketamin. From the next day after operation, Yuhan bone connecting powder diluted with distilled water was administrated to low(0.68g/kg) and high(1.36g/kg) dosage groups per se. Same amount of the distilled water was used to the control group. 1.5cm long rib including the osteotomy site and whole tibia were excised. Bone densitometer using dual energy X-ray absorptiometry, radiological and morphological studies with HE stain and alcian blue(pH 2.5)-PAS stain were performed.
RESULTS
BMD showed statistically significant difference between control group, low dose group and high dose group at 2weeks after treatment(p=0.035), but did not show such a good result at 1week(p=ns) and 4weeks(p=0.091) after treatment. Radiologically, after treatment for 2 weeks, the low and high dose groups showed more active callus formation than control group. Morphologically, dilated numerous blood vessels adjacent the bony trabeculae and well developed cartilagenous callus were observed in the experimental group at the 1st week. At the 2nd week, many newly formed bony trabeculae were formed from the cartilagenous callus, and at the 4th week relatively thick compact bone and bony trabeculae were connecting the both osteotomy ends.
CONCLUSION
BMD at the osteotomy site seemed to be increased after administration with Yuhan bone connecting powder to rats, and this finding was supported radiologically at 2weeks after treatment. Morphologically, at the early stage of the fracture healing, numerous dilated blood vessels were distributed and many bony trabeculae were formed from the cartilagenous callus. At the remodelling stage relatively thick compact bone was connecting the both ends of the osteotomy site. So it is suggested that Yuhan bone connecting powder would induce enhancing the healing process of the osteotomized bone in rat through active vascularization, mineralization of the cartilage matrix, endochondral ossification and remodelling.

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Treatment of Peterson classification Type VI of Physeal Injury in Ankle Joint: 2 cases report: Byung Il Lim, Tai Seung Kim, Kuhn sung Whang, Il Hoon Sung; J Korean Soc Fract 2000;13(4):1061-1066. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.1061

Abstract PDF

Peterson classification type VI, which has been reported newly on physeal injury classification, is defined as partial missing of the metaphysis and epiphysis with a portion of the physis. It has not been reported in the Republic of Korea to our knowledge. Because this is an open fracture, immediate surgery is needed in all cases. Angular deformity and leg length discrepancy occurs as a result of the formation of the physeal bar. Additional reconstuctive operation, therefore, should be necessary. We report two cases of Peterson classification type VI, both cases were open fracture at the level of ankle joint owing to pedestrian traffic accident. In our experience, Peterson classification type VI required multiple operations because progression of angular deformity with growth, and must be followed up until maturity.

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Changes in Oxygen Saturation and Walk in Relation to Smoking and Types of Shoes
Jea-Cheol Park, Jong-Man Han, Woon-Soo Cho, Yong-Nam Kim
The Journal of Korean Physical Therapy.2015; 27(1): 55. CrossRef

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