Journal of Musculoskeletal Trauma

Original Articles

Operative Treaeent of Hohl II, III Plateau Fracture by Small Incision and Bone Window: Jin Woo Kwon, Kyoung Tae Sohn, Sung Ho Shin, Woo Se Lee, Won Ho Jo, Jae Il Kim; J Korean Soc Fract 1999;12(3):593-600. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.593

Abstract PDF: Severely depressed plateau fractures, especially Hohl I, III, can not be reduced by ligamentotaxis and require elevation through a cortical window, bone grafting, and fixation with either cancellous screws or a buttress plate. But traditional long lateral parapatellar incision and plate fixation method caused frequent wound dehiscence and deep infection. Thus to reduce the soft tissue problem we treated Hohl II, III plateau fractures by small anterolateral L-shaped incision, submeniscal exposure, reduction of depressed plateau and bone graft through bone window, and then cancellous screws fixation beneath the subchondral bone of elevated plateau. We anayzes 22 cases with Hohl II, III plateau fractures, which were treated by these method from February 1990 to December 1997 and followed more than 1 year. Males were 17, and females were 5. Average age of patients was 44.7 years. The most common cause of injury was traffic accidents(17 cases), and fracture type according to the Hohl classification was 14 cases of type II, 8 of type III. The associated injuries were 18 cases of meniscus tear, 13 of ligament injury(6 ACL, 7 MCL). The clinical results by Blokkers criteria were satisfactory 19 cases(86.3%) and unsatisfactory 3 cases(13.7%). We concluded that this method has following advantages; relatively firm fracture fixation, short operation time, low soft tissue problem.

The Problems of Locked Intramedullary Nailing in the Proximal Shaft Fractures of the Tibia: Jin Woo Kwon, Kyoung Tae Sohn, Seung Ho Shin, Jae Il Kim; J Korean Soc Fract 1999;12(1):76-82. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.76

Abstract PDF: Proximal shaft fractures of the tibia have a high incidence of complication and often result in poor outcomes. Plate fixation and locked intramedullary nailing are the most common methods of treatment, but now the latter is more popular because of soft tissue problem, osteomyelitis etc.. The purpose of this study is to evaluate the results of locked intramedullary nailing in the treatment of proximal shaft fractures of the tibia and to draw a conclusion that what type of fracture patterns are the appropriate indication of nailing. We analyzed 18 proximal shaft fractures of the tibia which were treated by locked intramedullary nailing from October 1991 to March 1997 and followed more than 12 months. The results were as follows ; The complications were occurred in 12 cases(66.6%); 4 cases of delayed or non-union, 8 of angular deformity, 1 of leg length discrepancy. Delayed or non-unions were caused by fracture site comminution and bone defect. 5 anterior angular deformities were due to the pulling of the knee extensor mechanism and 3 valgus deformities were due to medially located entry portal. In conclusion, since locked intramedullary nailing in proximal tibial fractures causes a high incidence of complications, it is recommended in transverse or undisplaced fractures. And plate fixation and bone graft will be recommended in comminuted or displaced oblique fractures, if soft tissue condition is permitted.

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