Journal of Musculoskeletal Trauma

Clinical Study on Operative Technique and Management of Tibial condylar Fractures: Su Chan Lee, Beom Koo Lee, Do Hyun Moon, Jin Hong Ko, Young Kyu Kim, Hong Ki Park, Jun MO Jung, Hyun Park; J Korean Soc Fract 1998;11(3):533-539. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.533

Abstract PDF: We reviewed fifteen cases of tibial condylar fractures, especially, Schatzker type VI treated with hybrid method from January 1995 to May 1997. We attained satisfactory bony union in all cases. There were not serious complications such as deep wound infection and severe angular deformity, but partial ankylosis. After operation, the patients could do knee motion exercise immediately and had no difficulty in getting maintenance of reduction and fracture healing. In conclusions, the hybrid method is an excellent treatment in soft tissue care, maintenance of reduction, and early ambulation and fracture healing in the cases of tibial condylar fractures.

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Treatment of Unstable Intertrochanteric Fractures of the Femur - Comparative analysis of the postero-medial fixation with or without additional screw -: Jin Hong Ko, Bum Gu Lee, Do Hyun Moon, Young Sung Kim; J Korean Soc Fract 1998;11(3):487-494. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.487

Abstract PDF: An unstable intertrochanteric fracture lacks continuity of the bone cortex on the opposing surfaces of the proximal and distal fragments. This cortical deficit is due to either comminuti- On on the medial aspect of the neck(calcar-region) or a large and separate posterior trochan-teric fragment. Treatment of unstable intertochanteric fracture have taken method to restore bony contact medially and posteriorly by anatomical reduction or displacement osteotomy. The authors analyzed the 60 unstable intertrochanteric fractures treated by anatomic reduction and internal fixation with a compression hip screw from January 1990 to December 1995. We made a comparative analysis of the postero-medial fixation with additional screw(Group I) and no fixation group(Group II). We tried to find the difference of operation time, blood loss, union time, weight bearing time, neck-shaft angle, sliding length of lag screw and complication rate in two groups. The results were obtained as follows: 1. The mean union time was 11.5 weeks in the Group I and 12.7 weeks in the Group II (p>0.05). 2. The mean weight bearing time was 6.1 weeks in the Group I and 8.3 weeks in the Group II (p<0.05). 3. The decrease of neck-shaft angle was 2.3 degree in the Group I and 5.2 degree in the Group II(p<0.05). 4. The sliding length of lag screw was 5.8mm in the group I and 11.2mm in the group II(p< 0.05). 5. The lower complication rate was obtained in the group I than in the Group II, but two groups showed no significance by statistical analysis. In conclusion, the postero-medial fixation with additional screw in the treatment of unstable intertrochanteric fracture of the femur are suggested that medial cortical stability can be gained and early weight-bearing can be allowed.

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Application & Use of an Ilizarov Technique for the Pilon Fracture: Jin Hong Ko, Beom Koo Lee, Do Hyun Moon, Sung We; J Korean Soc Fract 1997;10(4):879-885. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.879

Abstract PDF: A pilon fracture, which is defined as a comminuted intraarticular fracture of distal tibia, violates the articular region and the metaphysis with occasional extension into the diaphysis, and renders the bone difficult to restore to its anatomic shape. The best known treatment of the pilon fracture is, as recommended by A-O group. In the treatments of the fractures with severe comminution or with significant open soft tissue injury aggressive tries for internal fixation with plate and screws in the distal tibia will result in inevitable stripping of the soft tissue and the periosteum. Therefore, dangers of the delayed union, nonunion, soft tissue necrosis and infection will be increased. The authors treated 14 cases by the Ilizarov external fixation technique for treatment of pilon fracture of the tibia. The average duration of external fixation was thirteen weeks. The results were as follows. v1. Such techniques are especially useful in those injuries with extensive aricular communition and in the open pilon fracture with significant soft tissue compromise. 2. The average duration of external fixation was 13 weeks and the time to clinical union averaged 16.4 weeks. 3. In case of accurate reduction, the better clinical result was obtained.

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Ambulatory Ability & Mortality Study after Intertrochanteric Fractures of the Femur in Geriatric Patients: Bong Gee Park, Beom Koo Lee, Do Hyun Moon, Jin Hong Ko, Young Gue Go; J Korean Soc Fract 1997;10(4):755-760. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.755

Abstract PDF: Intertrochanteric fractures are common in older age group. But still many patients suffer from high morbidity and mortality and decreased ambulation levels, because of accompanying general weak- ness and various senile diseases. From January 1991 to February 1995, we treated 46 patients older than 65 years with intertrochanteric fractures of femur. A retrospective study was performed to determine which Pre- and postinjury factors were predictive of mortality and ambulatory capacity 1 year after operation. Potential causative factors included age, gender, prefracture ambulatory ability, postoperative ambulatory ability, associated medical problem, fracture type, degree of osteoporosis, American. Society of Anesthesiologists rating of operative risk, interval between injury and operatiorl. This retrospective study were analyEed with following results ; 1. Mortality was releated to prefracture ambulatory ability, postoperative ambulatory ability, ASA risk, interval between injury and operation, which were statistically significant. 2. Eighteen(39%) patients maintained their prerfacture ambulatory ability at a poslinjury 1 year ; Twenty-eight(61%) patients lost some degree of ambulatory ability.

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Delayed Intramedullary Nailing after Failed External fixation for Open Tibial Fractures: Jin Hong Ko, Bum Gu Lee, Do Hyun Moon, Hong Gi Park, Cheol Won Park; J Korean Soc Fract 1997;10(3):694-701. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.694

Abstract PDF: Recently, extemal fxation and unreamed intramedullary nailing are largely used for operative treatment for open long bone fractures. Extemal fixation, especially in cases of unstable fractures, blamed for complications, for example, malunion, delayed union, loss of reduction, refracture, pin tract infection. In addition, there are some problems such as long hospital stay and delayed returning to work. Some surgeons tried to treat such problems by secondary intramedullary nailing, but they came to different retults. The purpose of the current study is to evaluate our experience with secondary intramedullary nailing after failed external fixation of 4 cases of open Grade II, 8 cases of open Grade III a, and 4 cases of open Grade III b tibial fractures. The results are as follows ; 1. The external fixation had been maintained for 123 days in average. 2. The mean interval between removal of the external fixation and intramedullary nailing was 16 days except 5 immediate operation. 3. Reamed intramedullary nailing with static interlocking were done in all 16 cases. 4. In 12 cases of 16, bone union was obtained without complications, and the mean union time after intramedullary nailing was 21.7 weeks radiollogically. 5. Deep infections developed in 2 cases, which had in fracture site, and local infections in 2 cases, which had been in previous pin site of external fixator. In conclusion, delayed intramedullary nailing was a method for treatment of problematic external fixation, such as delayed union, nonunion, loss of fixation, and pin site infection, for open fractures of the tibia.

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Clinical Analysis Between Interlocking IM Nail and Plate Fixation in the Treatment of Humeral shaft Fractures: Soo Chan Lee, Beom Koo Lee, Do Hyun Moon, Jin Hong Ko, Hong Gi Park, Ki Dong Kang, Hyoung Il Kim; J Korean Soc Fract 1997;10(3):621-627. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.621

Abstract PDF: Most of the humeral shaft fractures have been treated conservatively. If operation is indicated, most surgeons used to perform an open reduction and internal fixation with plate &Treatment of the Humeral Shaft Fracture in Adult screws. But, when open reduction and internal fixation is carried out, the periosteum and soft tissue attachments must be stripped off from the bone and operative time becomes longer. Interlocking IM nailing is an attractive procedure which does not disrupt or strip off periosteum and soft tissue at the fracture site, decrease the chance of infection and allow early exercise. Authors compare the clinical result of humerus shaft fracture which were treated by plate fixation in 25 patients and interlocking IM nailing in 16 patients who were treated at the orthopedic depaunent, Joong Ang Gil Hospital from Feb. 1992 to Jan. 1995. 1. The average time of operation in interlocking IM nail was 65 minutes and that of plate fixation was 95 minutes. 2. The average time for bone union was about 14.4 weeks in interlocking IM nail and 14.2 weeks in plate fixation. 3. The complications of interlocking IM nail were 1 case of postoperative radial nerve palsy, 1 case of delayed union, 1 case of nonunion and 3 cases of pain and stiffness of shoulder. 4. the complications of plate fixation were 1 case of infectioin, 1 case of delayed union, 3 cases of nonunion, 1 case of metal failure, 2 cases of postoperative radial nerve palsy and 2 cases of pain and stiffness of elbow. In conclusion, the interlocking IM nailing is an attractive procedure or the treatment of the humeral shaft fractures.

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Treatment of Subtochanteric Fractures of the Femur by Interlocking Nailing: Do Hyun Moon, Bum Gu Lee, Jin Hong Ko, Young Kab Shin; J Korean Soc Fract 1997;10(3):548-555. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.548

Abstract PDF: Subtrochanteric fracture of the femur are difficult to treat successfully. Although performing operative treatment, the incidence of mechanical complication is higher than other sites of long bones. During the period of January. 1990 to June. 1995, twe nty-four cases of subtrochanteric fracture of femur were treated by Interlocking intramedullary nail at the Department of Orthopedic Surgery, Gil Hospital, Incheon, and the results were obtained as follows : 1. Associated injuries, which were common in lower limb(7 cases), pelvic bone(3 cases) and upper limb(4 cases) made a fracture more difficult to treat. 2. Fieldings type III(12 cases) fracture and Seinsheimers type II(18 cases) fracture and Russel-T aylors Type I A(19 cases) fracture and Winqist-Hansen Type II(13 cases) fracture were most common. 3. The average union time was 19.3 weeks. 4. The complications were three cases. : delayed union(1 case), infection(1 cases), angular deformity(1 case). 5. Interlocking nail is one of the good implant for rigid fixation of subtrochanteric fracture, especially mechanical characteristics of interlocking nail have eliminated the requirement of surgically reconstituting the medial femoral cortex.

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Management of Unstable Proximal Tibial Fractures Using the Ilizarov: Hong Gee Park, Beom Goo Lee, Soo Chan Lee, Do Hyun Moon, Jin Hong Ko, Ki Dong Kang, Hyun Park; J Korean Soc Fract 1997;10(2):332-337. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.332

Abstract PDF: We reviewed fifteen cases of unstable tibial fractures treated with Ilizarov method from May 1995 to May 1996. We attained satisfactory bony union in all cases without bone graft(Average time 19 weeks). There were numbers of complications, such as pin tract infection, angular deformity and joint ankylosis but its were soluble and careful management & numbers of minor surgery were needed to prevent & solve such complications. Post-op immediate weight bearing and ROM exercise were possible and showed no difficulty in getting mainteance of reduction & fracture healing, and serious joint ankylosis waa not developed. In conclusions, Ilizarov method is an excellent treatment in getting reduction, maintenance of reduction, early ambulation and fracture healing in the cases of unstable tibia fractures.

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Arthroscopic Management of the Tibial Condylar Fractures: Do Hyun Moon, Beom Koo Lee, Jin Hong Ko, Ki Dong Kang, In Seok Oh, Young Kab Shin; J Korean Soc Fract 1997;10(2):324-331. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.324

Abstract PDF

The tibial condylar fracture is a fracture of the proximal end of the tibia, involving as they do weight-bearing articular sufaces and frequently accompanied by soft tissue injuries and menisci present a variety of problems in the treatment and prognosis. We performed reduction of the depressed articular fragment under mornitoring of arthroscopy and under the control of image intensifier and fixed with cannulated cancellous screws and accompanied by bone graft in 7 cases of the 11 cases. The results were satisfactory Arthroscopy bridges the advantage of accurate reduction and fixation without extensive operative exposure. In addition, arthroscopy allows through lavage, removal of loose fragment and accurate of associated intraarticular pathology. Since extensive exposure is avoided, rapid recovery with reduced pain and early full ROM us achieved in patients managed arthroscopically.

Citations

Citations to this article as recorded by

Arthroscopically Assisted Reduction and Internal Fixation of Intra-Articular Fractures of Tibial Plateau
Jeung Tak Suh, Jae Min Ahn, Tae Wan Kim, He Myung Cho
Journal of the Korean Orthopaedic Association.2012; 47(2): 96. CrossRef

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A Comparison of Unlearned IM-nailing with Reamed IM-nailing in Tibial Shaft Fracture: Su Chan Lee, Bum Gu Lee, Do Hyun Moon, Jin Hong Ko, Hong Ki Park, Ki Dong Kang, Sang Kyoo Choi; J Korean Soc Fract 1997;10(2):295-302. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.295

Abstract PDF: Recently, there is seen frequently the tibial fracture due to the increased traffic accident and the high industry. Rigid intramedullary nailing is the method of choice in tibial shaft fracture, early weight bearing and joint motion. Between Jan.1993 and Dec. 1994, we treated 93 tibial shaft fractures with reamed intramedullary nails(55 cases) & unlearned intramedullary nails(38 cases). We analyzed the effects of these two methods, and the following results were obtained. 1. Of 93 fractures, 32 fractures were open and 61 fractures were closed. 2. The most common cause was traffic addicent. Among the 93 cases, 60 cases were male and 33 cases were female, the most common age were ranged from 30-39 year, involving 36 cases. 3. The mean durations of the bone union were 19.7 weeks in closed fracture with treated by reamed nail and 22.1 weeks in closed fracture with unlearned. The mean duration of the bone union were 24.5 weeks in open fracture with reamed and 22.4 weeks in open fracture with unlearned. The complications of intramedullary nail are angular deformity, infection, delayed and nonunion, and screw breakage.

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Operative Tleatment of the Lateral Condyle Fractures of the Humerus in Children: Bum Gu Lee, Do Heun Moon, Jin Hong Ko, Su Chan Lee, Hong Ki Park, Ki Dong Kang, Young Kim; J Korean Soc Fract 1996;9(4):1096-1103. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1096

Abstract PDF: Fracture of the lateral humeral condyle is a relatively common injury in children. The standard treatment of Jakobs type II and III fractures is open reduction and internal fixation The treatment of Jakobs type I fractures is more controversial. Authors performed clinical and radiological analysed of fifty-two patients of lateral condylar fracture of the humerus who have been treated with open reduction and internal fixation. They were followed up from one year to five years and two months. The results were as follows; 1. The age incidence was confined from 3 years to 12 years. 2. There were 14 cases(26.9%) of Milch type I, 38 cases(73.8%) of Milch type II and according to Jakobs stage, 20 cases were stage I, 23 cases were stage II, 9 cases were stage III. 3. All cases were treated by open reduction and Internal fixation. 4. In 5 cases were lateral condyle overgrowth of the humerus, 2 cases were limited ROM of elbow joint. and 2 cases pin site loosening and superficial wound infections observed. And this complications did not resutt in significant clinical disabilites. 5. Respectively, according to the criteria of Hardacre 41 cases(78.8%) were excellent, 11 cases (21.1%) were good, and there was no poor case. 6. The fracture type and stage of displacement did not effect the flnal results. the complications, the complications are due to inaccurate reduction or insecure fixation. Therefore, open anatomical reduction and stable internal fixation is required to avoid complications, even in stage I displaced fractures.

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Management of open Supracondylar Fractures of Femur using the Ilizarov Method: Bum Ku Lee, Do Hyun Moon, Jin Hong Ko, Soo Chan Lee, Ki Dong Kang, Jong Seob Park; J Korean Soc Fract 1996;9(3):567-573. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.567

Abstract PDF: It is extremely difficult to treat to the comminuted open fractures of supracondyle of femur Internal fixation with plates and screw or intramedullary nailing of open fracture is high risk of infection and circulatory compromising at the fracture site. External fixation reduces the risk of infection and permits easy access for wound care, early mobilizatioll of joints and weight bearing. We reviewed nine cases of open supracondylar fractures of femur treated with Ilizarov method from February 1993 to December 1995 and obtained the following results. 1. The average time of bony union was 2 weeks. According to AO classification, the average time of bony union was 22.7 weeks in type A and 29.3 weeks in type C. According to classification of Gustilo and Anderson, the average time of bony union was 21 weeks in type II,27.3 weeks in type Illa and 30 weeks in type IIIb. 2. The Neers criteria was based on the final functional and anatomical rating for supracondylar fracture of femur. According to this criteria, excellent was 1 case, satisfactory in 7 cases and unsatisfactory in 1 case. 3. The complications were divided into problem, obstacle and complication;Problem in 9 cases, bstacle in 5 cases and complication in 3 cases. We conculded the Ilizarov technique is a useful method in management of the severe comminuted fractures and extensive soft tissue injury of the supracondylar fractures of femur.

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Problems and complication after Interlocking Intramedullar Nailing for Femoral Shaft Fracture: In Suk Oh, Do Hyun Moon, Jin Hong Ko, Ki Dong Kang, Si Hwan Kim; J Korean Soc Fract 1996;9(3):547-556. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.547

Abstract PDF

Fracture of the femoral shaft, is among most common fractures in orthopaedics, with its aspect becomming more complex. Since the introduction of Kuncher Nail, closed rodding techinque and locking nail system were followed with additional feature of preventing shortening and rotation as well as allowing early weight bearing and joint motion. With their wide application, we met many problems during the operative procedure due to delicient concept and technique. We have checked the possible problems during and after the procedure of interlocking nailing for the femoral fractures in 65 cases. 1. With poor selection of implant, long, short and small nail were used in 5, 3 & 2 cases, respectively. 2. In the process of operation, inlet error, angular & rotational deformity, femoral neck fracture, failure (or loossening) of distal screws were 2,10, 1, and 4 cases, respectively. 3. A New fragment was made in 7 cases(11%) durinbg surgery, especially medial side and distal to the fracture line. 4. Post-operative deep infection were developed in 2 cases. 5. Post-operative metal failure and delayed(or non) union was 1 and 7(11%) cases, delayed union (or nonunion) occured in 3 cases(20%) after open reduction while following closed reduction in 4 cases(8%).

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Iatrogenic Femur Proximal Shaft Fracture during Nailing Using Lateral Entry Portal on Femur Shaft Fracture
Hong Moon Sohn, Gwang Chul Lee, Chae Won Lim
Journal of the Korean Orthopaedic Association.2014; 49(4): 272. CrossRef

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A Treatment of Fracture of the Neck of the Talus: In Suk Oh, Do Hyun Moon, Jin Hong Ko, Ki Dong Kang, Si Hwan Kim; J Korean Soc Fract 1996;9(2):369-375. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.369

Abstract PDF: A fracture of the tatar nock if relatively rare, but it is generally regarded as a serious traumatic lesion of the ankle, because of the poor outcome after treatment. The talus has a special anatomical, functional and vascular characteristics. So the complications with avascular necrosis and nonunion and degenerative joint diseases are frequent. We reviewed 19 cases who treated at ChungAng Gil General Hospitai from January, 1990 to August, 1994 and studied the incidence of complications and important factors in achieving good results. The follow up period was at least 12 months. The results were as follows; 1. Of the 18 cases, there were 18 males and 2 females, and most were third and fourth decades(67%). 2. The main cause were a fall down injury(44%), with sudden hyperextension as its mechanism. 3. According to Hawkins classification, type I, type II & type III were 6,8 & 4 cases, respectively. 4. The accompanying ipsilateral peri-ankle involvement were observed in 44%. 5. As for the method of treatment, C/R with cast immobilization were performed in 6 cases of type I while O/R and I/F with screw & Steinmann pin done on others. 6. As for the complications, AVN, skin necrosis, traumatic arthritis and infection were 3, 1,2 and 1 cases, respectively. : Excellent in 9 cases, good in 6, fair in 1, poor in 2. Consequently we think, in the treatment of displaced neck fracture and dislocation of talus, it is important to decompress the soft tissue early with concomitant anatomical reduction & internal fixation to get a satisfactory results.

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Surgical Treatment of Intra-articular Fracture of the Os Calcis: Soo Kil Kim, Young Gyu Kim, Bum Gu Lee, Jin Hong Ko, Su Chan Lee, Young Kim; J Korean Soc Fract 1996;9(2):354-365. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.354

Abstract PDF: Intra-articular fractures involving the posterior facet of the subtalar joint are associated with significant and prolonged disability. But, the treatment of choice for displaced intra-articular calcaneal fractures remains controversial. We treated 30 displaced intra-articular fractures of the calcaneus by open 1eduction and internal fixation through the lateral approach with autogenous bone graft at the Department of Orthopaedic Surgery, Choong-ang Gil and Dong Inchon Gil Ceneral Hospital from January 1990 to October 1994 The clinical and radiographic analyses were as follows. 1. Of 26 patients, 20 patients were male and 6 patients were female. 2. The main cause fractures of calcaneus was a fall from a height in 23 cases(88%) and most of associ ated fractures were spine injury in 6 patients. 3. Fracture was classified according to Essex-Lopresti classification. 13 cases were tongue type, 17 cases were joint depression type. 4. Alt Open reduction and internal fixation through the laterl approach with bone graft was performed in joint depression type and tongue type. 5. The preoperative ayerage Bohlers angle was - 5. The postoperative avereage Bohlers angle was -24, Which was increased significantly. 6. Complications were 12 cases ; included heel pad pain in 8 caLes, osteomyelitis and superficial wound infection in 2 cases, transient sensory hypesthesia on the lateral side of the foot in 2 cases. 7. Based on assessement of Salama, the results were excellent in 5 cases, good in 1 Teases, fair in 6 cases, poor in 2 cases.

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Treatment of Unstable Tibial Fracture Using Interlocking Intramedullary Nailing: In Suk Oh, Do Hyun Moon, Jin Hong Ko, Su Chan Lee, Yeoung Hun Jang; J Korean Soc Fract 1995;8(1):269-277. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.269

Abstract PDF: With increasing industrial and traffic accident, tibia fractures by high energy has been increased and their treatment is difficult. There are many controversy concerning the method of treatment, because of many complications, such as malunion, delayed union, nonunion, infection and joint contracture. The use of an intramedullary nail with interlocking bolts, either closed or open thchnique has became an attractive alternative method of treatment for unstable fracture of tibia. From Januaiy, 1987 to December,1992 we treated 63 fractures of the tibia by minipulative reduction and fixation of the fracture fragments with rigid intramedullary nail at Department of Ouhopaedic Surgery Choong-ang Gil Hospital. The following result was obtained. 1) The average time from injury to operation is in closed and open fracture, 6 and 21 days respectively. 2) Of 63 fractures, 60 fractures united and the union rate was 95.2% 3) The average time of bone union was the 19.3 wks : the 17.8 wks in closed fracture ; the 21.6 wks in open fracture ; the 22.3 wks in Non-union. 4) Regardless of amount of comminution, we treated tibial fractures extending from 3 CM distal to the tibial tuberosity to 5 CM above the ankle joint. 5) Static and dynamic interlocking nailing were done 44 and 19 cases respectively. 6) We permitted weight bearing within 2 weeks in butterfly or oblique fracture within 6 weeks in communited or segmental fracture. 7) According to the functional classification of Klemm and 3,orner, among 63 cases, 35 were excellent,20 good,5 fEir and 3 poor.

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