Journal of Musculoskeletal Trauma

Surgical Treatment for Stable 2-Part Intertrochanteric Femur Fracture Using Dynamic Hip Screw with 2-Hole Side Plate in Elderly Patients: Kyung Hoon Lee, Suk Ku Han, Seung Jae Chung, Jongho Noh, Kee Haeng Lee; J Korean Fract Soc 2016;29(3):192-199. Published online July 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.3.192

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the postoperative outcomes of elderly patients with stable 2-part intertrochanteric femur fractures surgically treated using dynamic hip screw with 2-hole side plate.
MATERIALS AND METHODS
From February 2008 to January 2014, 50 patients older than the age of 65 years, who had been followed-up for more than 6 months after the operation at The Catholic University of Korea, Bucheon St. Mary's Hospital were enrolled. A clinical evaluation of the skin incision length, operating time, and ambulatory status, using Clawson's Ambulation Capacity Classification, was performed, and a radiologic evaluation of Fogagnolo reduction quality, tip-apex distance (TAD), Cleveland index, sliding extent of lag screws, time duration till bony union, and complications was also done.
RESULTS
The mean skin incision length was 9.8 cm (range, 8-13 cm), the mean operating time was 41.4 minutes (range, 30-60 minutes), and 32 patients recovered their ambulatory function. Forty-eight patients gained bony union, and the time lapsed till union was average 10.6 weeks (range, 8-16 weeks). The evaluation of postoperative radiologic images showed the following reduction statuses by the Fogagnolo classification: 46 cases of "Good", 3 cases of "Acceptable," and 1 case of "Poor." Moreover, the mean TAD was 18.9 mm (range, 9.0-24.9 mm). While 45 cases fit into the zone 5 of the Cleveland index, other 3 were within zone 8 and the other 2 were within zone 6. The mean sliding length of the lag screws were 4.9 mm (range, 0.1-19.4 mm). There were a case of nonunion and a case of periprosthetic infection with nonunion as complications.
CONCLUSION
Using dynamic hip screws with 2-hole side plate for stable 2-part intertrochanteric femur fractures in elderly patients showed satisfactory results with respect to the recovery of ambulatory functions and bony union.

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Free Vascularized Fibular Grafts for Treatment of Infected Nonunion of the Tibia: Hyoung Min Kim, Il Jung Park, Youn Soo Kim, Kee Haeng Lee, Chan Woong Moon, In Ho Jeong, Changhoon Jeong; J Korean Fract Soc 2006;19(2):163-169. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.163

PURPOSE
To analyze the result of free vascularized fibular grafting for treatment of infected nonunion of the tibia with radical bone and soft tissue defect.
MATERIALS AND METHODS
17 patients with infected nonunion of the tibia who underwent a reconstruction using free vascularized fibular grafting were reviewed retrospectively. The mean follow-up period was 70.3 months. We analyzed the results radiographically which included the time of bone union, the amount of hypertrophy of grafted bone and complications.
RESULTS
The average length of bone defect was 8.8 cm (5~15 cm), and the average length of fibular graft was 14.1 cm (10~17.5 cm). Bony union was achieved in 11 of 17 cases and the average time of bone union was 5.2 months (4~6 months). There were 6 cases of nonunion. All nonunions developed at the proximal end of graft in patients who underwent fixation using pin and external fixator. Union was eventually achieved in all cases in 6.0 months (5~8 months) after the cancellous bone graft and plate internal fixation. Hypertrophy of grafted bones with more than 20% developed only in 4 cases out of 17. There were 3 cases of stress fracture, however there was no recurrence of infection or serious donor site morbidity.
CONCLUSION
Free vascularized fibula grafting is one of the most effective reconstruction options for the infected nonunion of the tibia with radical bone and soft tissue defect. Strong internal fixation using plate and screws is required to reduce the rate of nonunion and stress fracture of grafted fibulas.

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Treatment Strategy of Infected Nonunion
Hyoung-Keun Oh
Journal of the Korean Fracture Society.2017; 30(1): 52. CrossRef

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Treatment of Subtrochanteric Fractures with Compression Hip Screw: Kee Haeng Lee, Hyoung Min Kim, Youn Soo Kim, Chang Hoon Jeong, Il Jung Park, Ill Seok Park, Chan Woong Moon; J Korean Fract Soc 2006;19(1):1-5. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.1

Abstract

PURPOSE
To evaluate the effectiveness of the compression hip screw, we reviewed the clinical results of cases of femoral subtrochanteric fracture which were treated with compression hip screw.
MATERIALS AND METHODS
From May 1997 to June 2004, 20 cases of femoral subtrochanteric fracture, which were treated with compression hip screw and followed up more than 12 months, were reviewed. By the Seinsheimer's classification, there were 1 case of type IIa, 4 cases of type IIb, 2 cases of type IIIa and IIIb, 4 cases of type IV and 7 cases of V. We analyzed the treatment results by bony union time, range of motion, ambulation status and complications.
RESULTS
All 20 cases were gained bony union without serious complications and secondary operation. The average bony union time was 19.8 weeks. 17 of 20 cases were recovered pre-injury ambulatory status level.
CONCLUSION
The compression hip screw may be effective in treatment of the femoral subtrochanteric fracture with very narrow intramedullary canal, proximal femoral deformity, comminuted fracture with large butterfly fragment, long spiral fracture with medial cortical comminution and combined intertrochanteric fracture.

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The stabilising effect by a novel cable cerclage configuration in long cephalomedullary nailing of subtrochanteric fractures with a posteromedial wedge
Pavel Mukherjee, Jan Egil Brattgjerd, Sanyalak Niratisairak, Jan Rune Nilssen, Knut Strømsøe, Harald Steen
Clinical Biomechanics.2019; 68: 1. CrossRef
Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices
Jung-Yoon Choi, Yerl-Bo Sung, Jin-Hee Yoo, Sung-Jae Chung
Hip & Pelvis.2014; 26(2): 107. CrossRef

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Augmentation Plate Fixation for the Management of Long-bone Nonunion after Intramedullary Nailing: Kee Haeng Lee, Hyoung Min Kim, Chan Woong Moon, Youn Soo Kim, Won Sik Nam; J Korean Fract Soc 2004;17(3):265-270. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.265

Abstract PDF

PURPOSE
The aims of this study were to determine the effectiveness of the treatment using augmentation plate fixation for nonunion of long bone fracture after interlocking intramedullary nailing MATERIALS AND METHODS: Thirteen patients with nonunion of the long bone fracture after interlocking intramedullary nailing who underwent augmentation plate fixation were evaluated; followed up for more than 1 years. We evaluated five patients with nonunion of the humerus, three of the tibia and five of the femur. Twelve of thirteen patients were carried out autogenous cancellous bone graft and augmentation plate fixation was performed without removal of intramedullary nail for all patients.
RESULTS
For the cause of nonunion, seven patients were by iatrogenic factors such as insecure fixaton and six patients were by fracture itself such as severe comminution and open fracture. Bone union was achieved in thirteen patients all and the average bony union time was 4.2 months (ranged from 3 to 5.5 months) for the humerus, 6.4 months (ranged from 4 to 8.5 months) for the tibia and 7.3 months (ranged from 5.5 to 9 months) for the femur. There were no complications such as reoperation, infection or plate failure.
CONCLUSION
TAugmentation plate fixation is effective treatment option for the management of long bone fracture nonunion after intramedullary nailing.

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Augmentation Plate Fixation for the Treatment of Femoral and Tibial Nonunion After Intramedullary Nailing
Ali Birjandinejad, Mohammad H. Ebrahimzadeh, Hosein Ahmadzadeh-Chabock
Orthopedics.2009; 32(6): 409. CrossRef
The Comparison of LC-DCP versus LCP Fixation in the Plate Augmentation for the Nonunion of Femur Shaft Fractures after Intramedullary Nail Fixation
Se Dong Kim, Oog Jin Sohn, Byung Hoon Kwack
Journal of the Korean Fracture Society.2008; 21(2): 117. CrossRef

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Bone scintigraphy after multiple pinning of femoral neck fractures: Kee Haeng Lee, Youn Soo Kim, Chang Hoon Jeong, Suk Ku Han, Hyoung Min Kim, Jun Seok Kim; J Korean Soc Fract 2001;14(4):567-574. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.567

Abstract PDF: PURPOSE
To determine the value of bone scintigraphy in predicting avascular necrosis following femoral neck fracture, and to analyze of relationship between pintract sign (increased radioactivity along the pins) and avascular necrosis after multiple pinning of femoral neck fracture.
MATERIALS AND METHODS
We analyzed 20 femoral neck fractures, which were fixed with cannulated screws(14 cases) or Knowles pins(6 cases). The follow-up period was longer than 18 months, and bone scintigraphy was carried out at postoperative 3 weeks, 3 months interval to 1 year, 6 months interval to 2 years, and then every 1 year.
RESULTS
There were 14 cases with positive pin-tract sign and increased uptake of femoral head on bone scintigraphy performed at the postoperative 3 weeks, and I case with positive pin-tract sign and partially decreased uptake of femoral head. None of them developed avascular necrosis. There was I case with negative pin-tract sign and partially decreased uptake of femoral head, which showed increased uptake later and didn't develop avascular necrosis. There were 4 cases with negative pin-tract sign and generally decreased uptake of the femoral head, and all of them developed avascular necrosis.
CONCLUSION
Bone scintigraphy is a useful method predicting the avascular necrosis following femoral neck fracture, and pin-tract sign may be an early postoperative sign indicating that there is little possibility of development of avascular necrosis.

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Operative Treatment of Fracture of the Body of the Scapula: Moon Gu Choi, Hyoung Min Kim, Youn Soo Kim, Kee Haeng Lee, Chang Hoon Chung, Kwang Yeol Lee; J Korean Soc Fract 1999;12(3):698-703. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.698

Abstract PDF: PURPOSE
Although fracture of the body of the scapula have been treated successfully by conservative treatment but residual deformity was high and related to the residual symptom. Authors had done open reduction and internal fixation with wiring in the case of severe displacement of the fracture fragment of the body of scapula and analyzed that results. MATERIAL AND METHODS: Authors treated 18 cases of fracture of the body of the scapula in 17 patients from October, 1985 to June, 1996. Conservatively treated group was 12 cases which has less than 2cm displacement and operatively treated group was 6 cases which has more than 2cm displacement of the fracture fragment. Internal fixation was done with wiring. All cases was followed up average 1 year 9 months(from 13 months to 8 year 8 months) and evaluated by McGinnis assessment system.
RESULTS
All cases united within ten weeks. Five cases in the operatively treated six cases got anatomic reduction and stable fixation with wiring and had no operation related complication. Operatively treated group has average 2.83 associated injury and conservatively treated group has average 1.87 Neurovascular complication compromised the results.
CONCLUSION
Operative treatment of the fracture of the scapular body can reduce the residual deformity and residual symptom in the severely displaced case and facilitate early rehabilitation.

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Operative Treatment of the Condylnr Fractures of the Femur: Moon Gu Choi, Youn Soo Kim, Kee Haeng Lee, Chang Hoon Chung, Hyoung Min Kim, Joong Hyuk Kwon; J Korean Soc Fract 1999;12(3):523-528. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.523

Abstract PDF: PURPOSE
To evaluate the results of the the condylar fracture of the femur treated by open reduction and cancellous screw fixation. METERIALS AND METHODS: From April, 1994 to October, 1998, 9 cases of the condylar fracture of the femur were open reduced and internally fixed with cancellous screw. According to AO classification, B2 type, B3 type and C2 type were all three cases each. All intraarticular fragment of the 9 cases were fixed with cancellous screws fixation after open reduction. Additionally 2 cases were fixed with dynamic condylar screw and 1 case was fixed with supracondylar nail. Authors followed up from shortest one year one month to longist three year four month(average 2 years) and evaluated them by using the method of Schatzker and Lamberts.
RESULTS
Seven of 9 cases had reduced anatomically, and remained 2 case which were delayed to operation cannot reduced anatomically. In all case stable fixation of the intraarticular fragment was obtained by cancellous screw fixation without perioperative complication. Schatzker and Lamberts assesment shows excellent in four, good in one, fair in three and failure in one case. CONCLUSTION: In case of the condylar fracture of the femur, early and relatively simple screw fixation can obtain anotomical reduction and prevent complication caused by incongruent joint surface.

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Meniscal Incision to Approach for Lateral Tibial Plateau Fractures: Moon Gu Choi, Kee Haeng Lee, Chang Hoon Chung, Hyoung Min Kim, Hyun Jun Song; J Korean Soc Fract 1997;10(1):53-58. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.53

Abstract PDF: Exposure to the posterolateral comer of the tibial condyle was difficult due to narrow joint space and meniscus. From 1995. 1. to 1996. 4., the authors operatively reduced and internally fixed 9 cases of lateral tibial plateau fractures using lateral meniscal incision with minimal detatchment and retraction to improve visualization posterior aspect of articular cartilage Eight of the 9 cases were studied with three dimentional computerised tomogram and 1 case with roentgenographic tomogram to evaluate the shape, site and degree of comminution of the fracture fragments. ROM exercise was started at 4 weeks postopratively, manipulation under anesthesia were done in 3 cases at 12 weeks postoperatively. The follow up period was 13 months(from 8M to 1yr 11M). The results were obtained as follows, 1. Seven cases were split depression type, one was pure depression type and one was bicondylar type. 2. Articular depression were posterolateral aspect in 8 cases, and lateral aspect in one case. The degree of depression was average 15mm(range from 6mm to 22mm). 3. Six of the 9 cases had peripheral tear of the lateral meniscus. 4. Second look arthroscopy shows that the incision site of the meniscus were thinned but completely healed in 3 cases. 5. The ROM of the knee joint were 0 - over 135 in seven cases, 0 - 90 in one case, 30 - 60 in one case. This meniscal incision approach was one of the effective methods that provides exposure of the entire articula surface of the lateral tibial condyle easily to allow accureate eduction.

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Causes and Treament of Nonunion of the Femur Shaft: Moon Gu Choi, Hyoung Min Kim, Youn Soo Kim, Kee Haeng Lee, Hong Hua Song, Young Joo Park; J Korean Soc Fract 1996;9(1):81-87. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.81

Abstract PDF: The causes of nonunion of the femur shaft could be divided as fracture itself and iatrogenic. And also the methods of treatment are controversial. From Dec. 1988 to Jan. 1995. We analyzed 21 cases of nonunion of the femur shaft. The period of follow up was from 1 year to 4 year 7 month (average time 2 years). The causes of the nonunion were fracture itself in 1 case, inadequate fixation in 17 cases, and early weight bearing in 3 cases. Seventeen of 21 were plate fixation cases and 4 or 21 were intramedullary-nailing cases. Metallic failures were seen in 15 cases. Cancellous bone graft was done in all cases. Cancellous bone graft only without other additional fixation were done in two cases, plate fixation were done in 8 cases, and intramedullary nailing were done in 11 cases. Additional narrow plate fixations were done in 9 cases, which 3 cases were done with plate fixation and 6 cases were done with intramedullary nailing. Partial weight bearing were done 2.5 months in which case cancellous bone graft only, plate fixation and intramedullary nailing cases, were done 2 months in the case of narrow additional plate with intramedullary nailing. Authors concluded that stable internal fixation was very important and additional narrow plate fixation was good alternative method in the treatment of nonunion of the femur shaft.

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Inferior Subluxation of the Humeral Head After Trauma to the Shoulder: In Kim, Seung Koo Rhee, Yang Kim, Kee Haeng Lee; J Korean Soc Fract 1990;3(1):110-118. Published online May 31, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.1.110

Abstract PDF: Since 1980, we have treated twelve patients who had antero-inferior subluxation of humeral head after acute trauma to the shoulder or to the proximal part of the humerus, of both. the diagnosis of subluxation was based on clinical and radiographic examination. To evaluate the rdiological features, and also to clarify the mechanism as well as the treatment for this subluxation, we have been analysed and the following results were obtained. 1. The careful radiographic interpretation, especially standing neutral shoulder AP and lateral films, was quite important to find the hidden soft tissue injuries which it could be caused the subluxation of humeral head after acute trauma to the shoulder. 2. The incidences of subluxation was 24.5%, 12 cases out of the total 49 cases. 3. The subluxation was frequently frequently developed in adduction type of fracture, avulsion fracture of the greater tuberosity and in women with over the 40 of their ages. 4. Intial subluxation of humeral head after trauma might be caused by the rupture of capsule of rotator cuff, and late subluxation may be developed by the loss of damaged muscle tone or direct muscle damage due to intial or sugical trauma. 5. Except the results of the nerve damage after trauma or surgery, the subluxation could be recovered by average 22 day after the first recognition of subluxation with hte vigorous isometric biceps setting exercise immediately after trauma. 6. Isometric biceps seetting exercise was the most important basic step for the every injuries aroud the shoulder joint.

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