Journal of Musculoskeletal Trauma

Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect: Soo Kyung Lee, Jung Ryul Kim, Jong Han Lim, Jun Mo Lee; J Korean Fract Soc 2010;23(1):57-63. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.57

Abstract PDF: PURPOSE
To study clinical results and complications in the treatment of infected nonunion of the tibia according to location of nonunion and reconstruction for soft tissue defect.
MATERIALS AND METHODS
36 cases of tibia infected nonunion which were treated with the llizarov included in this study. There were proximal 1/3 in 14, middle 1/3 in 10, and distal 1/3 in 11 cases. Coverage of the soft tissue were treated with the free flap in 8 cases as classified group A and non-free flap in 17 cases classified group B. We evaluated the healing index, complications and comparing the results of each treatment by the Paley method.
RESULTS
Bone union was achieved in all cases. The proximal nonunion showed better results than those in the middle and distal area; average healing index: 35.6 days/cm (p=0.038), bone results: 92.9% (p=0.025), functional result: 90.5% (p=0.03). Group B showed significantly better results as it showed average healing index: 30.3 days/cm (p=0.015), bone results: 85.7% (p=0.025), functional results: 90.5% (p=0.015).
CONCLUSION
The nonunion of proximal 1/3 showed better results than other sites. Soft tissue reconstruction with free flap that control infection more effectively, could be improved the treatment outcomes.

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Treatment of Segmental Fractures Associated with Periarticular Fracture of the Tibia by Ilizarov External Fixator: Jung Ryul Kim, Moon Ki Choi, Kwang Bok Lee, Jong Hyuk Park, Ju Hong Lee, Jun Mo Lee, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 2003;16(4):504-510. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.504

Abstract PDF: PURPOSE
We analyzed the results and complications of the treatment of segmental fractures of the tibia associated with periarticular fracture by using Ilizarov external fixator.
MATERIALS AND METHODS
We reviewed 17 patients of segmental fractures of the tibia were treated by Ilizarov external fixator and were followed for a minimum one year. There were twelve closed fractures, three type 3A, and two type 3B open fractures. According to Melis classification, there were five type I, four type II, and eight type III. All closed fractures were reduced and fixed with Ilizarov external fixator within seven days. Open fractures were performed immediate wound irrigation and radical debridement and fixed with Ilizarov external fixator. Autogenous iliac bone graft was done in five severe comminuted fractures. Average time in bone graft was 7.5 weeks after operation. We analyzed bony union time according to configuration and site of the fractures, results of the treatment, and complications. The functional outome was assessed with rating system of Tucker.
RESULTS
In all cases, bony union was obtained, and average union time was 20.5 weeks. According to modified Melis classification, our results showed no difference between each criteria with respect to bony union and there was no difference bony union time between proximal and distal fracture site. There were two leg-length discrepancy less than 2 cm, one partial ankylosis of the knee joint, and ten pin tract infections. The functional results was excellent in 11 cases, good in 5 cases, and fair in one case.
CONCLUSION
Ilizarov external fixator can be useful method for the treatment of segmental fractures of the tibia associated with juxtaarticular fracture in respect of bony union and functional results.

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Treatment of Distal Tibial Fractures by Interlocking Intramedullary Nailing: Jung Ryul Kim, Hyung Suk Lee, Moon Ki Choi, Kwang Bok Lee, Jong Hyuk Park, Jun Mo Lee; J Korean Soc Fract 2003;16(3):348-355. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.348

PURPOSE
To analyze the result of treatment for distal tibial fractures by interlocking intramedullary nailing.
MATERIALS AND METHODS
Eighteen patients who underwent interlocking intramedullary nailing for distal tibial fracture were followed up for more than one year. We analyzed the fracture configuration, presence of fibular fracture, angular deformity and bone union by follow-up radiograph, and complications. The functional results were assessed by Baird's ankle scoring system.
RESULTS
According to Robinson classification, there were 4 type I fractures, 12 type IIA fractures, and 2 type IIB fractures. All cases were combined with fibular fracture. The mean union period of 18 cases were 21.9 weeks. There were three complications with 3 cases of valgus deformity. In functional outcome according to Baird's ankle scoring system, 15 patients (83%) showed satisfactory results.
CONCLUSION
We concluded that interlocking intramedullary nailing is effective method for the treatment of the distal tibial fractures. However, to avoid valgus deformity of the distal tibia when combined distal fibular fracture, fibular reduction and rigid fixation should be needed.

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Clinical Outcomes of the Tibia Segmental Fractures Treated by Intramedullary Nail Using Various Reduction Techniques
Oog-Jin Shon, Ji-Hoon Shin, Chul-Wung Ha
Journal of the Korean Fracture Society.2013; 26(1): 50. CrossRef
Interlocking Intramedullary Nail in Distal Tibia Fracture
Oog Jin Shon, Sung Min Chung
Journal of the Korean Fracture Society.2007; 20(1): 13. CrossRef

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Treatment of Ipsilateral Femoral Neck and Shaft Fractures: Jung Ryul Kim, Hyung Suk Lee, Myung Sik Park, Hee Chul Yu, Doo Hyun Yang; J Korean Soc Fract 2003;16(3):327-333. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.327

Abstract PDF: PURPOSE
To analyse the result of the treatment of ipsilateral femoral neck and shaft fractures and to consider effective method of the treatment.
MATERIALS AND METHODS
Seventeen patients with ipsilateral femoral neck and shaft fractures were treated from January 1992 to January 1999 and followed up more than 2 years. Radiologic bony union between each treatment method, complication were analysed. The functional results assessed with Iowa hip rating system and Swiontkowski system.
RESULTS
In femoral neck fractures, bony union was obtained in all cases, average 12 weeks. In femoral shaft fractures, bony union was obtained in all but one case. There was no statistical association bony union time between each treatment method (p>0.05). By Iowa hip rating system, nine hips had an excellent result; eight, a good result. According to rating system of Swiontkowski, the result was excellent in nine, good in six, fair in one, and poor in one.
CONCLUSION
We concluded that early diagnosis of all injuries was needed. To avoid further vascular damage of femoral head, early anatomical reduction of the femoral neck fracture should be performed. And then, shaft fracture was fixed with implants which were most appropriate for that combination of fractures.

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Fatigue Fracture of the Interlocking Nail in the Treatment of Femoral Shaft Fractures: Jung Ryul Kim, Jin Ho Yoon; J Korean Soc Fract 2003;16(2):163-168. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.163

Abstract PDF: PURPOSE
To analyze clinical and mechanical factors of the fatigue fracture of the intramedullary nail in the treatment of the femoral shaft fractures and to consider preventive methods of fatigue fracture.
MATERIALS AND METHODS
We reviewed 12 patients of fatigue fractures of the intramedullary and were followed for a minimum one year. The site of fatigue fracture of the intramedullary nail was at fracture site in 10 cases, just proximal to proximal locking hole in one, and the most proximal of two distal locking holes in one. We analyzed type and diameter of broken nail, time from injury to fatigue fracture, causes of metal failure, and treatment results.
RESULTS
Intramedullary nails which had fatigue fracture were reamed AO nail in four cases, Grosse-Kempf nail in four, Russel-Taylor nail in three, and long Gamma nail in one. Time to fracture of implant was average 13.6 months (range, 6~30 months). All cases were treated by intramedullary nailing, and additional autogenous bone grafting was done in three cases. At an average duration of follow-up of 7.5 months (range, 5 to 10 months), all of the fractures had healed.
CONCLUSION
To prevent fatigue fracture of intramedullary nail, closed obervation for bony union, progressive weight bearing, and augmentation with autogenous bone grafting for comminuted fracture site should be needed.

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Treatment of Infected Nonunion of the Tibia by Ilizarov External Fixator: Jung Ryul Kim, Keun Ho Yang, Byung Yun Hwang; J Korean Soc Fract 2000;13(4):921-927. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.921

Abstract PDF: PURPOSE
To analyze the clinical results and complications of the Ilizarov technique in the treatment of the tibial nonunion.
MATERIALS AND METHODS
Twenty-seven patients who had infected nonunion of the tibia were managed with Ilizarov external fixator form January 1992 to January 1997. Types of nonunion were classified according to Paley and status of infection were divided into AO classification. We evaluated clinical outcomes and complications which were assessed with rating system of Paley.
RESULTS
All cases obtained bony union. The mean time to union was 11.5 months. On average, healing index was 51.4 days/cm(range 28-72 days/cm) and percentage of increment was 18.5 %(range, 13-31.5 %). According to Paley criteria, bone results were good to excellent in 22 cases(81.5 %), and functional results were good to excellent in 24 cases(88.9 %). Total thirty five complications were occurred, which were classified by Paley criteria, problems in 15 cases, obstacles in 17 cases, and complication in 3 case.
CONCLUSION
Ilizarov technique is a useful method in management of the tibial nonunion, but we have to consider the complications and endeavor to reduce them.

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Treatment of Infected Nonunion of the Femur: Jung Ryul Kim, Byung Yun Hwang; J Korean Soc Fract 1999;12(4):851-857. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.851

Abstract PDF: The pupose of this study was to analyze influences on the bony union, to evaluate results and to consider effective methods of the treatment of infected nonunited fracture of the femur Seventeen patients who had infected nonunited fracture of the femur were managed from January 1989 to January 1996. We reviewed the results according to the method of treatment. Fixation were judged to be unstable in all of patients who had undergone primary internal fixation so that we treated them with radical debridement of soft tissue and necrotic bone. The bacterial cultures usually revealed a mixed infection and the organisms cultured from the infected fracture site were, in order of frequency , Staphylococcus aureus, Escherichia coli, Streptococcus, Pseudomonas, and Enterococcus. At the time of final evaluation, functional results according to criteria of Sanders-Swiontkowski-Helfet were excellent in three, good in five, fair in four, and poor in five. The average motion of the knee joint ranged from 6.7(0-20) of extension to 75.5(50-130) of flexion. The five patients had shortening of affected limb (mean 1.8+/-.2cm). Effective treatment of the infected non-union should be achieved not only bony union but also bacteriological and clinical remission of infection with subsequent closure of the wound and physical rehabilitation of the patient. Rigid internal fixation at the site of non-union can provide fracture healing as well as eradicate infection by improving the biologic environment.

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Treatment of Supracondylar Fractures of the Humerus in Children by Open Reduction: Jung Ryul Kim, Jun Mo Lee, Joo Hong Lee, Pil Soo Sin; J Korean Soc Fract 1999;12(4):1040-1045. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1040

Abstract PDF: PURPOSE
To analyze the results of open reduction in displaced supracondylar fractures of the humerus in children, and to propose guidelines for an open approach to supracondylar fractures.
MATERIALS AND METHODS
Twenty-six children(average age 6.7 years), who had open reduction of severely displaced supracondylar fractures were reviewes retrospectively over a 2- year period(1993 to 1997). Elbow range of motion, carrying angle, and radiographic measurement of the Baumann angle were assessed, then each distal humerus were compared to uninjured side.
RESULTS
At follow-up, the Baumann angle and carrying angle differed by an average of 2 degrees and 4 degrees respectively compared with the unaffected arm. Range of motion was satisfactory in 96% of patientl, and there wah no significant cubitus varus.
CONCLUSIONS
Open reduction of severely displaced supracondylar fractures is a safe and effective procedure, for which orthopedists should lower their threshold, given certain appropriate indicators.

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Results of Treatment for Fractures of the Talar Neck: Kyung Jin Song, Jung Ryul Kim, Moon Kyu Kim, Byung Yun Hwang; J Korean Soc Fract 1999;12(2):435-439. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.435

Abstract PDF: The purpose of this investigation was to evaluate the clinical results and to suggest appropriate treatment modality in the treatment of the fracture of talar neck. Twelve patients who had the fracture of talar neck were managed from October 1988 to April 1996 and followed more than 24 months. We reviewed the results according to the method of treatment, and complications following surgery. Three were treated with closed reduction and casting, one with closed reduction and K-wire fixation, eight were treated with open reduction and internal fixation. The functional result was excellent in 58.3 % and good in 33.3 % according to Hawkins criteria. Overall, there were three complications, one with skin necrosis on the incision site and the other two with subtalar arthritis. The treatment results were affected by the severity of trauma at the time of injury. Anatomical reduction by closed or open method, and stabilization with cast or rigid internal fixation could facilitate early mobilization and minimize postoperative complications in the treatment of talar neck fractures.

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A Comparison of Treatment between Plate Fixation and Antegrade Intramedullary Fixation of the Humeral Shaft Fractures: Jung Ryul Kim, Joo Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1999;12(1):119-125. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.119

Abstract PDF: We compared the clinical and radiographic outcomes between plate fixation and antegrade interlocking intramedullary fixation for humeral shaft fractures requiring operative intervention. Through retrospective, radomized comparative study, a total sixty adult patients have been reviewed. Thirty patients were treated with plate fixation, thirty another patients were treated with antegrade interlocking intramedullary fixation. Average follow-up time was two year and five months(range, one to four years). Average time to union was 10.8 weeks in plate fixation group and 16.9 weeks in intramedullary fixation group. Overall rate of union was 100% in plate fixation group and 90 % in intramedullary fixation group. According to Stewart and Hundleys functional assessment system, excellent or good results were obtained 29 cases(97%) in plate fixation group, 24 cases(80%) in interlocking intramedullary fixation group. In the plate group, only one fracture had deep infection but in the nail group, nine fractures had complications : three with nonunion, three with shoulder pain and limited ROM, two with intraoperative comminution and one with postoperative radial nerve palsy. There were some technical problems in antegrade intramedullay nailing such as difficulty proximal locking, failed expanlion of distal locking, iatrogenic fracture and distraction between fracture fragment. We concluded that the results after plate fixation have been shown to be preferable with respect to clinical and functional outcomes. In our study, the majority of circumstance requiring internal fixation, plate fixation is proferred and antegrade intramedullary fixation must be used in inevitable situation such as multiple trauma patients, fracture with overlying burns, patients with osteoporotic bone, pathologic fractures and segmental tractures.

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Analysis of the Operative Treatment of Ipsilateral diaphyseal Fractures of the Humerus and Forearm: Jung Ryul Kim, Kyung Jin Song, Sung Jin Kim, Jun Mo Lee, Byung Yun Hwang; J Korean Soc Fract 1998;11(1):34-40. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.34

Abstract PDF

Twenty-six adults who had concomitant ipsilateral shaft fracture of the humerus and forearm were managed with operative treatment. The mean age was 41 years (range 20 to 55 years), and the mean follow-up was 3.3 years (range 1.5 to 6 years). We reviewed initial soft tissue injury, presence of open fracture, and evaluted radiologic bone union. The functional outcome assessed with rating system of Lange and Foster, which is based on terms of fracture healing and functional restoration of the upper extremity. Overall rate of union for the humerus was 88.4 per cent, for the radius was 82.6 per cent and for the ulna 84.2 percent. We found no difference in average time to union between the treatment group with regard to open reduction and plate fixation or intramedullary nailing in the humerus and forearm bones (P>0.1, Wilcoxon signed rank test). But radiologic evaluation revealed a significant correlation between presence of open fracture and average time to union. The functional result was good in 12 cases (46%), fair in 6 cases(23%), and poor in 8 cases (31 %) according to Lange and Foster criteria. There were four nonunions of the humerus, three of the radius, and three of the ulna. Infection occurred three patients. Other complications were high radial nerve palsy in one case and above elbow amputation in one case. The results following injury were affected both by the severity of the initial trauma and by the treatment given. Best chance for a functional outcome will result from stable fixation of both the humeral and the forearm components.

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Classic Floating Elbow in Adults: A Case Series
Chul-Hyun Cho, Kyung-Keun Min
Clinics in Shoulder and Elbow.2015; 18(1): 8. CrossRef

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Functional Outcome after Operative Treatment of the Fractures of the Forearm Both Bones: Jung Ryul Kim, Kyung Jin Song, Joo Won Jung, Jun Mo Lee, Byung Yun Hwang; J Korean Soc Fract 1997;10(4):934-939. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.934

Abstract PDF

Twenty-seven adults who had a closed fracture of both bones of the forearm were managed with plate in twenty-four radial and twenty-three ulnar fracture. and with intramedullary nailing in three radial and four ulnar fractures. And were followed for a mean three years and two months(range, one year to six years). Standard anterioposterior and lateral radiographs were made of both forearms, and evaluated bone union that was qualified by measurement of the amount and location of the maximum radial bow in the relation to the contralateral normal ram. The functional outcome was assessed with rating system of Anderson, which is based on union of the fracture and rotation to the forearm, also with measurement of grip strength. Overall rate of union for the radius was 92.5 per cent and for the ulna 96.2 per cent. Average time to union was 10.4 weeks in the radius and 10.3 weeks in the ulna. Twenty-three patients(84%) had an excellent, good, or acceptible functional results, according to the criteria of Anderson. At follow-up, the mean and standard error for motion of the elbow from 64.0+/-4.1 of pronation to 74.3+/-4.2 supination. Seventeen patients(63%) had a grip strength that was more than 80 per cent of that of the contralateral side. Mean maximal radial bow was 15.1+/-0.4 millimeter and mean location of radial bow was 61.2+/-1.1 per cent in the normal arm. There was good or excellent rotation of the forearm, the rotation was close to where it was in the normal extremity. When five radial and three ulnar transverse fractures which were treated with less than five-hole plate, radiographic union was delayed(mean 13.3 weeks) and less satisfactory restoration of the function were obtained. However eleven radial and nine ulnar transverse fractures which were treated with more than six-hole plate were all united(mean 10.2 weeks) and acceptible restoration of the function were obtained Overall, there were three nonunions(two radial and one ulnar fracture), and one infection. Restoration of the normal radial bow was related to functional outcome. A good functional result was associated with restoration of the normal amount and location of the radial bow. Plating with more than six cortex secured by screws on each side of the fracture, provided a successful method for obtaining union and optimum function after fractures of the foream.

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Treatment of Forearm Shaft Fracture with Modified Interlocking Intramedullary Nail
Kwang-Yul Kim, Moon-Sup Lim, Shin-Kwon Choi, Hyeong-Jo Yoon
Journal of the Korean Fracture Society.2008; 21(2): 157. CrossRef

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