Journal of Musculoskeletal Trauma

The Different Treatment Methods for Segmental Fractures of the Clavicle: Cases Report: Sung Sik Ha, Ki Do Hong, Jae Cheon Sim, Yi Rak Seo, Tae Seok Nam; J Korean Fract Soc 2017;30(3):151-155. Published online July 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.3.151

Segmental fractures of the clavicle are very rare. Therefore, to date, there has not been a clear, standardized method of management of segmental clavicle fractures. Herein, two patients with a segmental fracture are described: One patient was treated conservatively, while another patient was treated operatively. Both patients showed excellent results. We discuss the various management options with a literature review.

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Fratura segmentar da clavícula em paciente politraumatizado: Relato de caso
Carlos A. Sánchez, Pablo J. Coronel, Luisa F. García, Juan S. Afanador, Raúl Gonzalez
Revista Brasileira de Ortopedia.2024; 59(01): e139. CrossRef

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Treatment of Olecranon Fractures with Proximal Ulna Comminution Using Locking Compression Plates: Ki Do Hong, Tae Ho Kim, Jae Cheon Sim, Sung Sik Ha, Min Chul Sung, Jong Hyun Jeon; J Korean Fract Soc 2015;28(1):59-64. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.59

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the clinical results of locking compression plate (LCP) fixation for olecranon fractures with proximal ulna comminution.
MATERIALS AND METHODS
We review 10 cases of olecranon fractures with proximal ulna comminution treated with LCPs from August 2011 to August 2013. Follow-up period was from 12 months to 18 months. Mean age was 63.1 years (35-84 years). According to the Mayo classification, there were eight type IIB, and two type IIIB fractures. We used Mayo classification. Clinical evaluation was performed based on radiographic union of olecranon and measurements of range of motion at last follow-up. Disability of the arm, shoulder and hand (DASH) score and Mayo elbow performance score (MEPS) were used for evaluation of functional recovery.
RESULTS
All patients had bone union. According to the MEPS, nine of ten patients had a good or excellent outcome. The mean DASH score was 18.6. All cases started postoperative range of motion (ROM) within 14 days. Elbow ROM was more than 110degrees in all cases except one. Mean radiological bony union time was 4.2 months (2.5-6.0 months) postoperatively. Complication was hardware irritation in three patients.
CONCLUSION
Internal fixation using LCP for olecranon fractures with proximal ulna comminution can be a good treatment option which obtains good clinical results and enables early ROM.

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Treatment of Fractures of the Distal Radius Using Variable-Angle Volar Locking Plate: Jae Cheon Sim, Sung Sik Ha, Ki Do Hong, Tae Ho Kim, Min Chul Sung; J Korean Fract Soc 2015;28(1):46-52. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.46

Abstract PDF: PURPOSE
The purpose of this study is to evaluate outcome of variable-angle volar locking plate for treatment of distal radius fractures.
MATERIALS AND METHODS
We retrospectively analyzed the results in 45 cases treated by variable-angle volar locking plate. We evaluated the clinical results according to the Mayo wrist performance scoring system and radiographic results.
RESULTS
All cases had bony union. The mean Mayo wrist performance scoring system was 84.8. Between preoperative and immediate postoperative radiographic measurement, the mean radial length improved from 8.4 to 11.8 mm, radial inclination from 14.2degrees to 22.4degrees, volar tilt from -4.5degrees to 9.6degrees, and intraarticular step-off from 1.8 to 0.3 mm (p<0.05). Between immediate postoperative and latest follow-up radiographic measurements, the mean loss of radial length measured 0.8 mm, radial inclination 0.4degrees, and volar tilt 0.9degrees (p>0.05). All cases showed bone union with no evidence of malunion, nonunion, or metal failure.
CONCLUSION
Treatment of distal radius fractures using variable angle volar locking plate showed satisfactory outcomes. It is a good option to obtain stable fixation without significant loss of reduction.

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Isolated Avulsion Fracture of the Lesser Tuberosity of the Humerus: A Case Report: Tae Ho Kim, Ki Do Hong, Sung Sik Ha, Jae Chun Sim, Min Chul Sung; J Korean Fract Soc 2014;27(1):72-76. Published online January 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.1.72

Abstract PDF

Isolated avulsion of the lesser tuberosity of the humerus is a rare injury. The mechanism of injury is the avulsion of the lesser tuberosity from forced contractions of the subscapularis muscle when the arm is forced into an externally rotated position on shoulder abduction. Authors report a case for isolated avulsion of the lesser tuberosity of the humerus which was treated with open reduction and transosseous suture fixation, as well as a view of the literature.

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What are the patient-reported outcomes, functional limitations, and complications after lesser tuberosity fractures? a systematic review of 172 patients
Reinier W.A. Spek, Bram J.A. Schoolmeesters, Chantal den Haan, Ruurd L. Jaarsma, Job N. Doornberg, Michel P.J. van den Bekerom
JSES International.2021; 5(4): 754. CrossRef

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Circumferential Wiring Combined with Tension Band Wiring in the Operative Treatment of Patella Fracture: Jae Chun Sim, Sung Sik Ha, Ki Do Hong, Tae Ho Kim, Min Chul Sung; J Korean Fract Soc 2014;27(1):65-71. Published online January 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.1.65

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the radiographic and clinical results of patella fractures using a circumferential wiring combined with tension band wiring.
MATERIALS AND METHODS
Between January 2005 and June 2012, 22 (male 14, female 8) patients with patella fracture treated with circumferential wiring combined with tension band wiring were analyzed retrospectively. The mean age of patients was 51 years (range, 28 to 72 years). Controlled passive range of motion exercise was started at three weeks from the postoperative day. The patients were evaluated using radiographs, clinical examination, and Levack's scoring system.
RESULTS
All fractures healed and mean time elapsed for union was 11.5 weeks (range, 10 to 14 weeks). Complete union without displacement and full range of motion was achieved in all cases. Clinical results according to Levack's scoring system were excellent in 20 cases and good in two cases. We found broken wire in one case. In this case, results of clinical evaluation after reoperation were good.
CONCLUSION
Circumferential wiring combined with tension band wiring is appropriate for patella fractures.

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Patellar fracture fixation using cannulated screws and Fiber Wire tension band
Elsayed M Bayomy, Mohamed Y Shaheen
Egyptian Orthopaedic Journal.2023; 58(1): 15. CrossRef

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Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail: Jae Cheon Sim, Tae Ho Kim, Ki Do Hong, Sung Sik Ha, Jong Seong Lee; J Korean Fract Soc 2013;26(1):37-43. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.37

Abstract PDF

PURPOSE
To compare the result between the third generation gamma nail (gamma 3 nail) and proximal femoral nail anti-rotation (PFNA) in the treatment of unstable intertrochanteric fractures.
MATERIALS AND METHODS
Between March 2009 and June 2011, 47 consecutive patients with unstable intertrochanteric femoral fractures were treated with gamma 3 nail or PFNA. We reviewed 24 cases of gamma 3 nail and 23 cases of PFNA. Retrospectively, we evaluated the mean operation time, amount of bleeding, average union period, reduction status, change of neck shaft angle, Tip-apex distance, Cleveland index, sliding of lag screw and complication on set of telephone interview and outpatient. We also evaluated the postoperative capability of function and mobility, using 'Modified Koval index'.
RESULTS
There were no significant differences between the groups, which were treated with gamma 3 nail and PFNA. In addition, they did not show statistical difference. We experienced 2 cases of complication (gamma 3 nail 1 case, PFNA 1 case), which were cut-out of the femoral head.
CONCLUSION
The gamma 3 nail and PFNA were seen with good results in the treatment of unstable intertrochanteric fracture.

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Comparative analysis of operation time and intraoperative fluoroscopy time in intramedullary and extramedullary fixation of trochanteric fractures
Milan Mitkovic, Sasa Milenkovic, Ivan Micic, Predrag Stojiljkovic, Igor Kostic, Milorad Mitkovic
Vojnosanitetski pregled.2022; 79(2): 177. CrossRef
Does the Helical Blade Lead to Higher Rates of Fixation Failure as Compared to Lag Screw in the Cephalomedullary Nailing Treatment of Hip Fractures? A Systematic Review and Meta-Analysis
Chul-Ho Kim, Han Soul Kim, Yong-Chan Kim, Dou Hyun Moon
Journal of Orthopaedic Trauma.2021; 35(8): 401. CrossRef
The Curative Effect Comparison Between Prolonged Third Generation of Gamma Nail and Prolonged Dynamic Hip Screw Internal Fixation in Treating Femoral Intertrochanteric Fracture and the Effect on Infection
Wenye He, Wei Zhang
Cell Biochemistry and Biophysics.2015; 71(2): 695. CrossRef
Accuracy of the Lesser Trochanter for Guiding Lag Screw Insertion in Hip Fracture Management
Jianlin Xiao, Zhongli Gao, Yanguo Qin, Xuezhou Li, Ao Wang, Lanyu Zhu, Jincheng Wang
Orthopedics.2014;[Epub] CrossRef

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Surgical Techniques for Percutaneous Reduction by Towel Clips and Percutaneous Intramedullary Fixation with Steinmann Pins for Clavicle Shaft Fractures: Ki Do Hong, Jae Chun Sim, Sung Sik Ha, Tae Ho Kim, Jong Hyun Kim, Jong Seong Lee; J Korean Fract Soc 2012;25(1):31-37. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.31

Abstract PDF

PURPOSE
To report the clinical results of surgical treatment of clavicle shaft fracture by percutaneous reduction with towel clips and percutaneous intramedullary pin fixation.
MATERIALS AND METHODS
This study reviewed the results of 80 cases of clavicle shaft fracture treated by percutaneous reduction with towel clips and percutaneous intramedullary pin fixation with Steinmann pins from January 2002 to August 2010, after follow-up for 12 months or more. We evaluated the clinical results, such as union time and complications.
RESULTS
Bone union was evident in all cases and the mean time for bone union to appear on radiological findings was 10.3 weeks. Using Kang's criteria, 78 of the 80 patients (97.5%) showed good results and there were no severe complications.
CONCLUSION
Percutaneous reduction with towel clips and the percutaneous intramedullary pin fixation method showed good results for treating clavicle shaft fracture.

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Additional fixation using a metal plate with bioresorbable screws and wires for robinson type 2B clavicle fracture
Woo Jin shin, Young Woo Chung, Seon Do Kim, Ki-Yong An
Clinics in Shoulder and Elbow.2020; 23(4): 205. CrossRef
A Comparison between Minimally Invasive Percutaneous Plate Osteosynthesis and Plate Fixation in the Treatment of Clavicle Midshaft Fracture
Seong-Ho Yoo, Suk-Woong Kang, Bu-Hwan Kim, Moo-Ho Song, Yeong-Joon Kim, Gyu-Taek Park, Chang-Hun Kwack
Journal of the Korean Orthopaedic Association.2017; 52(1): 1. CrossRef

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Comparison of Operative Management in Distal Radius Fractures Using 3.5 mm Versus 2.4 mm Volar Locking Compression Plates: Sung Sik Ha, Tae Ho Kim, Ki Do Hong, Jae Chun Sim, Jong Hyun Kim; J Korean Fract Soc 2011;24(2):156-162. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.156

Abstract PDF

PURPOSE
To evaluate clinical and radiological results using 3.5 mm & 2.4 mm volar locking compression plate (LCP) in distal radius fractures.
MATERIALS AND METHODS
This study reviewed the results of 115 cases of distal radius fractures treated with 3.5 mm volar LCP (73 cases) & 2.4 mm volar LCP (42 cases) from September 2003 to June 2009. The radiographic results were evaluated by radiographic assessment, and the clinical results were evaluated by Knirk and Jupiter's criteria, Modified Mayo wrist scoring system and DASH score.
RESULTS
Radiological evaluation of the radial length, radial inclination, volar tilt and intraarticular step off were improved both 3.5 mm volar LCP and 2.4 mm volar LCP. Nine cases of arthritis occured in 3.5 mm volar LCP and 7 cases in 2.4 mm volar by using the Knirk and Jupiter's criteria. The mean score evaluated by Modified Mayo was 86.7 in 3.5 mm volar LCP and 84.8 in 2.4 mm volar LCP. DASH score was 11.2 point in 3.5 mm volar LCP, 10.9 point in 2.4 mm volar LCP. All cases showed bone union showing no evidence of malunion, nounion, nor metal failure.
CONCLUSION
Distal radius fractures treated with 3.5 mm volar LCP and 2.4 mm volar LCP show satisfying radiological and clinical outcome.

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Treatment of Fractures of the Distal Radius Using Variable-Angle Volar Locking Plate
Jae-Cheon Sim, Sung-Sik Ha, Ki-Do Hong, Tae-Ho Kim, Min-Chul Sung
Journal of the Korean Fracture Society.2015; 28(1): 46. CrossRef
Functional Outcomes of Percutaneous K-Wire Fixation for Distal Radius Fractures with or without Osteoporosis
Ki-Chan An, Gyu-Min Kong, Jang-Seok Choi, Hi-Chul Gwak, Joo-Yong Kim, Sung-Yub Jin
Journal of the Korean Fracture Society.2013; 26(4): 248. CrossRef

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Operative Treatment with Gamma 3 Nail in Femur Intertrochanteric Fracture: Ki Do Hong, Jae Chun Sim, Sung Sik Ha, Tae Ho Kim, Yoon Ho Choi, Jong Hyun Kim; J Korean Fract Soc 2011;24(1):7-15. Published online January 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.1.7

Abstract PDF

PURPOSE
To evaluate clinical and radiological results of surgical treatment of femur intertrochantenric fracture using Gamma 3 nail.
MATERIALS AND METHODS
With clinical study, 22 patients who were treated surgically by Gamma 3 nail were retrospectively evaluated. By postoperative radiograph and last follow up radiograph we measured Tip-apex distance, Cleveland index, Neck-shaft angle change Lag screw slippage and Union time. And By medical record review, the clinical results were evaluated with the operation time, intraperative estimated blood loss, amount of transfusion, change of mobility and complication.
RESULTS
The mean change of femur neck shaft angle was 5.18 degrees. The mean lag screw sliding was 5.43 mm. The mean bone union time was 11.8 weeks. From all of these examples shows bone union. The mean operative time was 41 min, blood loss was 161 ml and the transfusion amount was 0.3 pint. In Ceder et al mobility score, it showed 0.2 point decreased and in Jensen social function score, it showed 0.6 point increased. Comparing the results before and after operation, the results were satisfactory.
CONCLUSION
Using the Gamma 3 nail, the treatment of fermur intertrochanteric fractures showed good results both radiologically and clinically.

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Changes in Tip-Apex Distance by Position and Film Distance Measured by Picture Archiving and Communication System (PACS)
Kyu Yeol Lee, Sung Soo Kim, Hyeon Jun Kim, Dong Ho Ha, Hyung Min Yoon, Hyun Su Do
Hip & Pelvis.2015; 27(1): 36. CrossRef
Results of Asian Type Gamma 3 Nail in Treatment of Trochanteric Fractures
Bing Zhe Huang, Yong Wook Park, Jin Su Park, Kyu Cheol Noh, Soung Yon Kim, Kook Jin Chung, Hong Kyun Kim, Hyong Nyun Kim, Yong Hyun Yoon, Ji Hyo Hwang
Journal of the Korean Fracture Society.2014; 27(3): 213. CrossRef
Treatment of Unstable Pertrochanteric Fractures with a Long Intramedullary Nail
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Dae Jung Huh
Hip & Pelvis.2013; 25(1): 51. CrossRef
Comparative Study of Intertrochanteric Fracture Treated with the Proximal Femoral Nail Anti-Rotation and the Third Generation of Gamma Nail
Jae-Cheon Sim, Tae-Ho Kim, Ki-Do Hong, Sung-Sik Ha, Jong-Seong Lee
Journal of the Korean Fracture Society.2013; 26(1): 37. CrossRef

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The Surgical Treatment of Distal Femur Medial Condyle Fracture Using Lateral Anatomical Plate of Opposite Side through Medial Approach: Sung Sik Ha, Jae Chun Sim, Ki Do Hong, Jae Young Kim, Kwang Hee Park, Yoon Ho Choi; J Korean Fract Soc 2009;22(4):246-251. Published online October 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.4.246

Abstract PDF

PURPOSE
To evaluate clinical and radiological results of surgical treatment of distal femur medial condyle fracture using lateral anatomical plate of opposite side through medial approach. MATERIALS AND METHODS: This study reviewed the results of 9 cases of distal femur medial condyle fracture treated with lateral anatomical plate of opposite side through medial approach from December 2005 to June 2007, after a follow up of more than 12 months. There were 2 males and 7 females with a mean age of 63.1 (57~72) years. The clinical results were evaluated using the Schatzker's criteria, and the radiographic results were evaluated using the bone union time. RESULTS: Using the Schatzker's criteria, 7 cases of the 9 patients (78%) showed exellent results. The mean time for bone union was 13.4 (11~15) weeks. There were 3 cases of pain on full weight bearing same as previous operative state by degenerative osteoarthritis. There weren't complications as joint stiffness, infection, varus & rotational deformity, malunion, nonunion, and metal failure. CONCLUSION: Plate fixation using medial approach provides the proper anatomical reduction and stronger fixation, and outcome good results.

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Medial Plating of Distal Femoral Fracture with Locking Compression Plate-Proximal Lateral Tibia: Cases' Report
Se-Ang Jang, Young-Soo Byun, In-Ho Han, Dongju Shin
Journal of the Korean Fracture Society.2016; 29(3): 206. CrossRef

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Operative Treatment with ITST in Femur Trochanteric Fracture: Ki Do Hong, Jae Chun Sim, Sung Sik Ha, Jae Young Kim, Jung Ho Kang, Kwang Hee Park; J Korean Fract Soc 2008;21(4):274-278. Published online October 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.4.274

Abstract PDF

PURPOSE
To evaluate the clinical and radiographic results of treatment of trochanteric fracture with ITST (Intertrochanteric/ Subtrochanteric) nail.
MATERIALS AND METHODS
We reviewed the results of 40 cases of trochanteric fracture treated with ITST from January 2006 to May 2007, which could be followed up for more than 12 months. The cases include 13 males and 27 females, and the mean age is 75.6 years old. The clinical results were evaluated by Ceder mobility assessment, and the radiographic results were evaluated by the change of femoral neck-shaft angle and sliding of lag screw.
RESULTS
The mean bone union time is 13.5 weeks. Thirty four cases (85%) were recovered to pre-injury state of walking ability. The change of neck-shaft angle was an average of 5.21degrees and the sliding distance of lag screw was an average of 5.78 mm. Complications were occurred in 4 patients (10%).
CONCLUSION
The ITST nail were seen good results in treatment of trochanteric fracture and has relatively less complications than other internal fixator.

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Treatment of the Intertrochanteric Femoral Fracture with Proximal Femoral Nail: Nailing Using the Provisional K-wire Fixation
Gu-Hee Jung
Journal of the Korean Fracture Society.2011; 24(3): 223. CrossRef

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Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann Pin: Sung Sik Ha, Jae Chun Sim, Ki Do Hong, Jae Young Kim, Jung Ho Kang, Kwang Hee Park; J Korean Fract Soc 2007;20(3):233-238. Published online July 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.3.233

Abstract PDF

PURPOSE
To evaluate the results between open reduction and internal fixation with the plate and percutaneous reduction by towel clip and intramedullary fixation with Steinmann pin for clavicle shaft fractures in adult.
MATERIALS AND METHODS
We have studied the results in 33 cases with the plate, 35 cases with the Steinmann pin among total 68 cases of clavicle shaft fracture. The patients were followed up over a period of at least 12 months. The final postoperative outcome was analyzed with the clinical outcomes using Kang's criteria, radiological union time and operation time.
RESULTS
The clinical outcome that was good or excellent according to the Kang's criteria showed a distribution of 88% in the group using the plate with 29 cases out of total 33 cases, 91% in the group using the Steinmann pin with 32 cases out of total 35 cases. The mean radiological union time was 8.9 weeks in the group using the plate, 9.1 weeks in the group using Steinmann pin. The mean operation time was 72 minutes in the group using the plate, whereas was 18 minutes in the group using Steinmann pin.
CONCLUSION
In the treatment of adult clavicle shaft fracture, two groups did not show a significant statistical difference in clinical and radiological outcomes. However, the operation time and postoperative functional recovery was significantly shorter and faster in the group using Steinmann pin. Additionally economic and cosmetic aspect was more satisfactory in the group using Steinmann pin.

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Anatomical Reduction of All Fracture Fragments and Fixation Using Inter-Fragmentary Screw and Plate in Comminuted and Displaced Clavicle Mid-Shaft Fracture
Kyoung Hwan Koh, Min Soo Shon, Seung Won Lee, Jong Ho Kim, Jae Chul Yoo
Journal of the Korean Fracture Society.2012; 25(4): 300. CrossRef
Does Interfragmentary Cerclage Wire Fixation in Clavicle Shaft Fracture Interfere the Fracture Healing?
Jae-Kwang Yum, Yong-Woon Shin, Hee-Sung Lee, Jae-Gu Park
Journal of the Korean Fracture Society.2011; 24(2): 138. CrossRef

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Lateral Plate Fixation of Distal Tibial Metaphyseal Fracture Using Minimally Invasive Plate Osteosynthesis Technique: Ki Do Hong, Sung Sik Ha, Nam Sik Chung, Jae Cheon Sim, Sang Cheon Ahn; J Korean Fract Soc 2006;19(1):24-28. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.24

Abstract

PURPOSE
To evaluate the efficiency of lateral plate fixation using minimally invasive plate osteosynthesis (MIPO) technique as a treatment of distal tibial metaphyseal fracture.
MATERIALS AND METHODS
Among the patient who were treated from March, 2002 to September, 2004, the cases of twenty patients with distal tibial metaphyseal fracture treated by lateral plate fixation using MIPO technique who were able to be followed up for at least one-year period were reviewed in this study. According to AO/OTA classification, five were type A1, twelve cases were type A2 and other three cases were type A3, and among them two cases were open fracture type I according to the Gustillo-Anderson classification. Radiologic studies and clinical assessment described by Daniel et al and complication following the treatment were evaluated.
RESULTS
At a mean of 16.4 weeks (range 11 to 23), all fractures united without secondary procedures. According to clinical assessment, all cases had good and excellent result, and there were no complications.
CONCLUSION
The lateral plate fixation using MIPO technique of distal tibial metaphyseal fracture is an efficient method of treatment with high functional recovery rate which minimize soft tissue damage, decreases the risk of infection and incidence of nonunion at the same time as the classic MIPO technique does, and it is a useful alternative method when there is a anteromedial soft tissue damage.

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Minimally Invasive Plate Osteosynthesis for Fractures of Distal Tibia
Tae Hun Kim, So Hak Chung
Kosin Medical Journal.2014; 29(1): 23. CrossRef
Staged Protocol in Treatment of Open Distal Tibia Fracture: Using Lateral MIPO
Oog Jin Sohn, Dong Hwa Kang
Clinics in Orthopedic Surgery.2011; 3(1): 69. CrossRef
Minimally Invasive Percutaneous Plate Osteosynthesis Using a Lateral Plate in Distal Tibial Fracture
Oog Jin Shon, Dae Sung Kim
Journal of the Korean Fracture Society.2010; 23(1): 42. CrossRef

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Treatment of Fractures of the Distal Radius using Locking Compression Plate: Jae Cheon Sim, Nam Sik Chung, Ki Do Hong, Sung Sik Ha, Ji Hoon Kang; J Korean Fract Soc 2005;18(2):100-104. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.100

Abstract PDF

PURPOSE
To evaluate the usefulness of locking compression plate (LCP) and volar plating through anterior approach for distal radius fracture.
MATERIALS AND METHODS
We retrospectively analysed that 15 distal radius fracture, which would not be reduced by closed reduction or too comminuated to maintain reduction or articular surface inconguency, were treated by open reduction through anterior approach and volar plating using LCP. The results were evaluated by preoperative and postoperative radiographs. Functional results were analysed using the Modified Mayo Wrist Scoring System.
RESULTS
All cases achieved anatomical articular surface reduction postoperatively. In terms of radiologic analysis, mean radial length (9.0 mm vs. 11.8 mm), radial inclination (14.7degrees vs. 20.9degrees ), volar tilt (-6.3degrees vs. 8.3degrees ) and articular step-off (1.4 mm vs. 0.3 mm) were improved. The average Modified Wrist Score was 89. Nonunion or malunion was not occurred.
CONCLUSION
Open reduction through anterior approach and volar plating using LCP is a useful method that provides excellent results with few complications in the treatment of fracture of the distal radius.

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Periprosthetic Fracture after Locked Plating in the Osteoporotic Long Bone Fracture
Ki-Chul Park, Hong-Sik Kim, Jeong-Han Oh
Journal of the Korean Orthopaedic Association.2012; 47(3): 222. CrossRef
2.4 mm Volar Locking Compression Plate for Treatment of Unstable Distal Radius Fractures
Sung-Jin Kim, Chul-Hyun Cho
Journal of the Korean Fracture Society.2011; 24(2): 151. CrossRef
Treatment of Femur Supracondylar Fracture with Locking Compression Plate
Seong Ho Bae, Seung Han Cha, Jeung Tak Suh
Journal of the Korean Fracture Society.2010; 23(3): 282. CrossRef
Comparison of Outcomes for Unstable Distal Radius Intraarticular Fractures - T-locking Compression Plate versus External Fixator -
Chul-Hyun Cho, Su-Won Jung, Sung-Won Sohn, Chul Hyung Kang, Ki-Cheor Bae, Kyung-Jae Lee
Journal of the Korean Fracture Society.2008; 21(1): 51. CrossRef
Basic Principle of the Locking Compression Plate
Keun Bae Lee
Journal of the Korean Fracture Society.2008; 21(3): 261. CrossRef
Volar T-Locking Compression Plate for Treatment of Unstable Distal Radius Fractures
Chul Hyun Cho, Ki Choer Bae, Doo Hyun Kwon
Journal of the Korean Fracture Society.2008; 21(3): 220. CrossRef

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Intramedullary Fixation of Clavicle Fracture Percutaneously Reduced By Towel Clip: Ki Do Hong, Sung Sik Ha, Nam Sik Chung, Jae Cheon Sim, Gyoung Ho Kim; J Korean Fract Soc 2004;17(4):328-332. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.328

Abstract PDF

PURPOSE
To investigate the utility of surgical treatment of clavicle shaft fracture using a percutaneous towel clip reduction and intramedullary fixation.
MATERIALS AND METHODS
This study was conducted for total 16 cases of patients who had no neurovascular injury and a few comminuted bone fragment among patients with clavicle shaft fracture from January 2002 to July 2003. The method of operation was percutaneous towel clip reduction and intramedullary fixation. The clinical and radiological results were evaluated.
RESULTS
Radiologically, 15 cases showed bone unions and the average time was 9.1 weeks. According to Kang's criteria clinically, there were 14 cases which were more than an excellence. One case substituted open reduction and nailing fixation due to a medial migration of K-wire and re- displacement of fracture even in 1 week. However, there wasn't any other major complication.
CONCLUSION
Due to its having no additional injury to soft tissues, no scar formations, and its short operation time, percutaneous towel clip reduction and intramedullary fixation will be very useful as one of the treatments of clavicular shaft fracture if it follows correct surgical indications.

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Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann
Sung-Sik Ha, Jae-Chun Sim, Ki-Do Hong, Jae-Young Kim, Jung-Ho Kang, Kwang-Hee Park
Journal of the Korean Fracture Society.2007; 20(3): 233. CrossRef

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Nancy Nail Fixation for Femur Shaft Fracture in Children: Ki Do Hong, Sung Sik Ha, Nam Sik Chung, Jae Cheon Sim, Jae Young Kim; J Korean Soc Fract 2003;16(4):592-599. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.592

Abstract PDF

PURPOSE
To investigate, the radiologically, the duration of bone union, angular formation, leg length discrepancy, other complications and mean hospital stay after Nancy nail fixation has been performed in children with femoral shaft fracture, and also to inquire into the clinical validity of such procedure. MATERIAL AND METHOD: Included in this study were 12 patients who had been treated with the Nancy nail fixation for the femoral shaft fracture and then followed up for a year or more. The age distribution ranged from 4 to 12 years with mean age 7.2 years. After the fracture was reduced under an imaging intensifier, 2 or 3 Nancy nails were pinned onto the medial and lateral femur distally.
RESULTS
The average duration for complete union was 9.9 weeks. Any angular formation over 5 degrees was notfound. Leg length discrepancy ranged from 2 mm shortening to 12 mm overgrowth with a mean value of 2.8 cm. In one case, with overgrowth over 10 mm or more, there was no gait disturbance. In all cases, There was neither infection, delayed union, nor any motion disturbance. A nail was moved distally in one case and skin irritation was evident in another case. The mean hospital stay was 17.3 days.
CONCLUSION
Nancy nail fixation in pediatric femoral shaft fracture relatively has less complications and is a safe surgical procedure. In addition, it helps in reducing hospital stay.

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Comparison of Flexible Intramedullary Nailing with External Fixation in Pediatric Femoral Shaft Fractures
Do-Young Kim, Sung-Ryong Shin, Un-Seob Jeong, Yong-Wook Park, Sang-Soo Lee, Keun-Min Park
The Journal of the Korean Orthopaedic Association.2008; 43(1): 30. CrossRef

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Complications after treatment of tibial Non fracture: Ki Do Hong, Sung Sik Ha, Hyun Jong Cha; J Korean Soc Fract 2001;14(4):668-676. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.668

Abstract PDF: PURPOSE
Aim of this study was to find the treatment and preventive method of the complication occurred after treatment of tibial pilon fracture. MATERIAL AND METHODS: 10 cases of complication, which has required the unplanned operative treatment among 25 cases of tibial pilon fracture from 1994 to 1999 were analyzed rertrospectively according to the Ruedi-Allgower classification, open or closed fracture, isolated or polytrauma , type of complication, type of procedure, primary or delayed wound closure.
RESULTS
There were 1 type I, 3 type II, and 6 type III Ruedi-Allgower fracture type, 3 open fracture, 7 isolated and 3 polytrauma. 6 required plastic surgery procedure such as pedicle flap or full thickness skin graft and 7 required orthpaedic procedure such as osteotomy, cancellous bone graft, metal removal and currettage, debridement of ankle.
CONCLUSION
The complications after treatment of tibial pilon fracture are classified to intraoperative, early and late postoperative complication. Intraoperative complication include penetration of the joint by screw and inadequate reconstitution of the articular surface which can be avoided by taking intraoperative roetgenograms, early complication include wound necrosis which can be minimized by good soft tissue technique, late complication include nonunion, joint stiffness and posttraumatic arthritis can be treated by osteotomy, cancellous bone graft and anatomic reduction with early motion.

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The Results Of Femoral Shaft Fracture By Difference Of Operative Method: Ki Do Hong, Sung Sik Ha, Jae Cheon Shim; J Korean Soc Fract 2000;13(4):847-854. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.847

Abstract PDF: PURPOSE
To evaluate and compare the bone union period, complications and functional assessments between compression plate and intramedullary nailing which are operative methods of the femoral shaft fracture. MATERIAL AND METHOD: We evaluate the bone union period, complications and functional assessments of the 65 cases(63 patients). 30 cases were treated with compression plate and another 35 cases were treated with intramedullary nailing, who were diagnosed to have femoral shaft fracture. And they were treated in our hospital from January 1995 to August 1999, whose follow up was available more than 1 year.
RESULTS
Mean bone union period of compression plate fixations was 14.6 weeks and intramedullary nailing was 16.2 weeks. Complications in compression plate fixations group was deep infection in one case, metal failure in one case, refracture in one case, nonunion in one case, and there were 5 complications in intramedullary nailing fixations group which were nonunion in 2 cases, limb shortening in 2 cases and angular deformity of nail in one case. By using functional assessment according to Magerl et al16) among 30 cases of compression plate fixations, 25 were excellent, 3 were good, 2 were fair, and among 35 cases of intramedullary nailing, 29 were excellent, 4 were good, 2 were fair, so we achieved excellent results in both techniques as 83.3% and 82.9% cases each.
CONCLUSION
In operative management of femoral shaft fracture, compression plate fixations and intramedullary nailing shows average difference of 1.6weeks of bone union period, but both method didn't show significant difference in bone union period. Both methods achieved excellent results in functional assessments, so if we manage by knowing thoroughly the advantage and disadvantage of both technique, we can get a excellent results with reduced complications.

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The Result Of Surgical Treatment Of The Femur Unstable Intertrochanteric Fracture Using Compression Hip Screw: Analysis Of Effect Of Degree Of Force On Trauma And Degree Of Osteoporosis: Ki Do Hong, Sung Sik Ha, Sang Weon Park; J Korean Soc Fract 2000;13(4):795-803. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.795

Abstract PDF: PURPOSE
To analyise the effect of degree of force on trauma and degree of osteoporosis in femoral unstable intertrochanteric fracture's result of treatment using compression hip screw.
MATERIALS AND METHODS
From January 1993 to December 1997, 55 patients who were operated with compression hip screw and followed up for more than 1 year were devided into high and low energy injured group by the mechanism of the trauma and also devided low(gradeIV,V,VI) and high grade osteoporosis group(gradeI,II,III) by Singh's index. We analize and compare the result of treatment in each groups.
RESULTS
The averrage rate of mechanincal complication was 24%. The mechanical complication rate of the high grade osteoporosis group(34%) was higher than low grade osteoporosis group(9%)(p<0.05). The average subsidence of compression screw was 9.9mm and it shows significant difference between low(7.8mm ) and high grade osteoporosis group(11.5mm )(p<0.05). The average increased varus deformity of neckshaft angel during follow up was 3.8degrees and it shows singnificant defference between high energy injuried group(4.6degrees ) and low energy injuried group(2.7degrees)(p<0.05). No difference was seen in each groups for time of bone union(p>0.05). In view of functional recovery by Clawson's method, no difference between pre-injury and postoperative state was seen in 7 cases(22%) in high grade osteoporosis group and 13 cases(57%) in low grade osteoporosis group, thus worse functional recovery was seen in high grade osteoporosis group.
CONCLUSIONS
We observed higher mechanical complication rate, more compression screw subsidence and worse functional recovery in high grade osteoporosis group and more varus deformity in high energy injured group. Thus we need more attension to treatment and follow up in high energy injured, severe osteoporotic unstable intertrochanteric fracture.

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A Treatment of Carpal Scaphoid Fracture: Ki Do Hong, Sung Sik Ha, Sang Weon Park; J Korean Soc Fract 2000;13(4):1003-1010. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.1003

Abstract PDF: PURPOSE
To analyze the clinical result of treatment of scaphoid fractures MATERIALS AND METHODS: From January 1994 to December 1998, we reviewed 25 carpal scaphoid fractures. Conservative treatment was performed in non-displaced, acute fractures and operative treatment was performed in others.
RESULT
Bony union takes average 13.6weeks of all cases and no statistical difference was seen between conservative treatment group(average : 12.7weeks) and operative treatment group(average : 14.1weeks). The complications were seen in 6 cases(24%), which were non-union in one case among the conservative treatment group, and non-union in one case, osteoarthritis in 3 cases and reflex sympathetic dystrophy in one case among the operative treatment group. Satisfactory results were 17(68%) of 25 cases by Maudsley's method. No statistical difference was seen between conservative treatment group(satisfactory results:78%) and operative treatment group(satisfactory results:63%)(p>0.05), but statistical difference was seen between acute fracture group(satisfactory result:81%) and others(satisfactory results:44%)(p<0.05).
CONCLUSION
More satisfactory result was seen in acute fracture group than in subacute and old fracture group, therefore we think early diagnosis has important role in result of treatment of scaphoid fracture. Also we think conservative treatment is preferable to non-displaced, acute fracture and operative treatment is preferable to others.

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A comparative study of the Brooker-Wills and Russell-Taylor Nailing for fractures of the tibial shaft: Hyung Seok Kim, Ki Do Hong, Sung Sik Ha, Young Wha Lee; J Korean Soc Fract 1999;12(4):909-915. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.909

Abstract PDF: The efficacy of intramedullary nailing in treating patients who have fractures of the tibial shaft has been well estabilished. Forty-five fractures of the shaft of the tibia(forty-five patients) were randomized to treat with interlocking nail with either the Blocker-Wills nail(nineteen fractures) or the Russell-Taylor nail(twenty-six fractures), who were treated at Department of Orthopaedic Surgery, Seoul Adventist Hospital from January, 1993 to December, 1997. Forty-five patients had acute traumatic fractures of the shaft of tibia with no other significant injuries, patients with other injuries which would intefere with functional evaluation were excluded, We analyzed the result of treatment clinically and radilogically. The results obtained were as follows ; 1. The average operating time was 114.7 minutes in Blocker-Wills nailing and 141.7 minutes in Russell-Taylor nailing. 2. The average time to fracture union healing was 16.7 weeks for Brooker-Wills nailing and 18.6 weeks for Russell-Taylor nailing. 3. The complications including delayed union and superficial infection were greater in Russell-Taylor ndiling than in Blocker-Wills nailing. 4. In functional results accourding to Klemm and Bormer were above good in 16 cases(84.2%) of Brooker-Wills group, and 22 cases(84.6%) in Russell-Taylor nailing group.

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AClinical study of the Lateral Humeral Condyle Fractures in children: Hyung Seok Kim, Ki Do Hong, Sung Sik Ha, Beom soo Kim; J Korean Soc Fract 1998;11(4):994-1000. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.994

Abstract PDF

Fracture of the lateral humeral condyle is a relatively common injury in children. It is an itraarticular fracture involving the growth plate so, the treatment should be done very carefully to reduce aditional damage and complication. The authors analyzed 34 fractures of the lateral humeral condyle in children who were treated from Mar. 1993 to Feb. 1998, to know the releationship between the factors affecting the development of complications and the results. The results were summerized as follows ; 1. There were 1 case (2.9 %) of Milch type I and 33 cases (97.1 %) of Milch ype II, and according to Jakob' stage, 9 case (26.5 %) of stage I, 19 cases (55.9 %) of stage II, and 6 cases (17.6 %) of stage III. 2. They were treated with cast immobilization in 5 cases (14.7 %), with closed rduction and percutaneous K-wire pinning in 8 cases (23.5%), and with open reduction and K-wire fixation in 21 cases (61.8%). 3. According to the criteria of Hardacre, the result of 5 cases of cast immobilization were excellent, 8 cases of closed reduction and percutaneous K-wire pinning were 3 excellent, 4 good, 1 poor, and 22 cases of open reduction and K-wire fixation were 19 excellent, 2 good, so there were 22 cases (64.7%) excellent, 11 cases (32.4%) good, and 1 case (2.9%)poor. 4. The complications were 11 cases (32.4%) of bony spur, 6 cases (17.6%) of overgrowth of the lateral condylar or capitellum, 1 case (2.9%) of premature epiphyseal fusion, and 2 cases (5.9%) of pinning site infection.

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Synthesis and Characterization of Large NaX Zeolite Crystals by Continuous Crystallization
Hae Jin Lee, Hyung Mi Lim, Ik Jin Kim
Materials Science Forum.2005; 492-493: 731. CrossRef

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A Clinical study of the Tibial Plateau Fracture: Hyung Seok Kim, Ki do Hong, Sung Sik Ha, Beom Soo Kim; J Korean Soc Fract 1998;11(3):597-604. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.597

Abstract PDF

The tibial plateau fracture often produce some disabilities of the knee joint because it is the intraarticular fracture and often associated with soft tissue, ligament and meniscal injury. The authors analyzed 42 cases of the Tibial Plateau fractures, which were treated at the department of orthopaedic surgery, Seoul Adventist Hospital from 1992 to 1997, to know the releationship between the type of fracture, the methods of treatment, and the results. The results were summerized as follows; 1. The most common fracture type by Schatzker classification was type I(18 case 42.9%). 2. Sixteen cases among of 42 cases were treated with conservative treatment, and 26 cases were treated with operative method 3. The clinical result according to Blokker method, acceptable were 34 cases (81.0%) and unacceptable were 8 cases (19.0%) 4. The complications were limitation of range of motion(4 case), peroneal nerve palsy(2 case), posttraumatic arthritis(1 case), wound infection(1 case).

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Coating and Intergrowth of NaX Molecular Sieve Films on Porous Ceramic Paper for Membranes
Ik Jin Kim, Hae Jin Lee
Key Engineering Materials.2007; 280-283: 891. CrossRef
Effects of Seeding on Large Crystal Growth of NaX Zeolite by Continuous Crystallisation
Ik Jin Kim, Hae Jin Lee, Panagiotis Tsiakaras
Key Engineering Materials.2007; 280-283: 861. CrossRef

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Treatment of Supracondylar Fractures of the Humerus in Children: Hyung Seok Kim, Ki Do Hong, Sung Sik Ha, Eu Suk Lew, Tae Hoon Kim; J Korean Soc Fract 1997;10(4):964-971. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.964

Abstract PDF: Supracondylar fracture of the humerus is the most common elbow fracture in children. It can be complicated by Volkmanns ischemic contracture, nerve injury, deformity of elbow, joint stiffness, and myositis ossificans, etc. even after the treatment. Various methods of treating displaced supracondylar rracture have been described, and the indications for open reduction and internal fixation are relatively established well. The surgeon, however, might be in trouble with making decision for closed reduction, whether to maintain by casting or by percutaneous pinning. From fan. 1990 to May 1990, 117 patients of supracondylar tracture had been treated in Seoul Adventist Hospital, and 82 patients of them were challenged initially by closed reduction and casting. Among them, 51 cases have been followed more than 1 year, and they are reviewed. 1. The average age was 7.2 years, and the patient population consisted of 33 boys and 18 girls. 2. 3 cases of nerve injuries, 2 cases of ipsilateral forearm bone fractures, 2 cases of impending Volkmanns ischemic contracture and 1 case of cerebral contusion were associated with supracondylar fracture. 3. Fracture pattern were classified as flexion type of 1 case and extension type of 50 cases. According to Gartland classification, type II was 16 cases(31.4%), type III-A was 27(52.9%) and III-B was 7(13.7%). Of all, 28 cases(54.9%) were comminuted and 23 were non-comminuted. On the other hand, 14 cases(27.5%) were oblique fracture and 37(72.5%) were transverse one, classified by pattern of fracture line. 4. Success rate of closed reduction and casting were 56.3% in Garland type II, 33.3% in type III-A, 42.9% in type III-B. In comminuted fracture, it was 21.4% and 65.2% in non-comminuted one. Success rate was 7.1% in oblique fracture, and 54.1% in transverse one. This suggests that comminuted fracture or oblique fracture should not be tried by closed reduction and casting but by percutaneous pinning. 87.5% of non-comminuted and transverse fractures were treated successfully by initial closed reduction and casting, and it also suggests that closed reduction and casting should be done only in this case selectively. 5. By Flynns criteria the results were excellent in 9 cases, good in 8, fair in 3 and poor in 1 with casting. Percutaneous pinning resulted in 15 excellent, 10 good, and 1 fair cases. Open reduction and internal fixation resulted in 2 excellent and 2 good cases.

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Modified tension band wiring and Circumferential wiring in the operative treatment of patella fracture: Hyung Seok Kim, Ki Do Hong, Sung Sik Ha, Young Keun Park, Nam Sik Chung; J Korean Soc Fract 1994;7(2):522-529. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.522

Abstract PDF: The patella, the largest human sesamoid bone, lies within and is important functional component of the knee extensor mechanism, So the treatment of patellar fracture is considered very important. In this series, we experiened 24 cases of ptellar fractures treated with modified tension band wiring and circumferential wiring from Jan. 1987 to Dec. 1992 at the department of orthopaedic surgery, Seoul Adventist Hospital. The Results were as follows; 1. The mean fracture healing peroid was 9.6 weeks in cases of modified tension band wiring and 12.4 weeks in circumferential wiring. 2. circumferential wiring is a good method for severe comminuted, small fragmented fracture and modified tension band wiring is for displaced transeverse fracture and large fragmented comminuted feacture.

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A Clinical Comparison between DCP Fixation and Brooker-Wills IM Nailing in the Treatment of Tibial Shaft Fracture: Hyung Seok Kim, Ki Do Hong, Sung Sik Ha, Young Ki Ko, Dong Seok Kang, Jae Hyun Lim; J Korean Soc Fract 1994;7(2):284-292. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.284

Abstract PDF: The tibia is the most commonly fractured bone in the long bones. There are many controversy concerning the method of treatments because of many complications, such as non-union, delayed union and infection. We comparatively analyzed 21 cases of Brooker-Wills IM nailing and 35 cases of DCP fixation in the treatment of tibial shaft fractures from Jan. 1988 to Dec. 1992. The results were as follow: 1. The averge bone union time was 12.1 weeks in Brooker-Wills IM nailing group and 13.9 weeks in DCP fixation group. There were significant different between two groups of the bone union time especially, the age from 20s to 40s and type B fracture in according to A-O classification but no different of the bone union time in open fractures. 2. There was more complications in DCP fixation than in Blocker IM nailing to treat the tibia shaft fractures. 3. In according to the above results to treat the tibia shaft fracture, we meet the conclusion that it will be a benifit to treat the tibia shaft fracture with IM nails than with DCP fixation especilly, young ages and type B fractures in A-O classification. Also we need further study for advantage between the IM nails which flexible and hard one, reamed and unlearned one.

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A Clinical Study of the Tibia Plateau Fracture: Hyung Seok Kim, Ki Do Hong, Sung Sik Ha, Dong Seok Kang, Jae Hyun Lim; J Korean Soc Fract 1994;7(1):105-112. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.105

Abstract PDF: The tibia plateau fractures are more common and severe than past decade because of increased traffic accident and industrial injury recently There are many argument about treatment of tibla plateau fractures, but the main goal of treatment Is to achived a stable, well-a-ligned, movable joint with minimum surface irregularities and with adequate soft tissue healing. The authors analyzed the 38 cases of the tibia plateau fractures treated at the Department of Orthopedic Surgery, Seoul Adventist Hospital from 1987 to 1992, to know the relationship between the type of fracture, treatment, and the results. The fallowing results were obtained. 1. The incidence Is more frequent in male and fifth decade was the most popular. 2. The most common cause of injury was traffic accident. 3. The most affrected site was left(26 cases) and lateral condyle(25 cases). 4. The most common fracture type acording to the Hohls classification were undisplaced and communited type of fractures. 5. 14 cases were treated with conservative method and 24 cases were treated with surgical method and 75% of patient which were treated with conservative, 86% of patient which were treated with surgical method, obtained satisfactory result according to Brokkers evaluation 6. The factors of poor results were as follow, communited fracture in Hohls classification, associated with severe other part of fracture, with severe soft tissue injury, or with ligament and meniscal injury.

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