Journal of Musculoskeletal Trauma

Injury Severity and Patterns of Accompanying Injury in Spinal Fracture: Hun Park, Kyung Jin Song, Kwang Bok Lee, Joo Hyun Sim; J Korean Fract Soc 2012;25(3):203-207. Published online July 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.3.203

PURPOSE
To examine the relationship between injury severity and patterns of associated injury in spinal fracture.
MATERIALS AND METHODS
From March 2004 to March 2010, a retrospective study was conducted on 291 patients who had undergone surgeries due to spinal fractures. Spinal fractures were categorized as upper cervical, lower cervical, thoracic, thoracolumbar, and lumbar region, and the severity of fracture was measured using the Abbreviated Injury Scale and Injury Severity Score (ISS). We evaluated the correlation between the fracture site and the incidence and injury severity of the associated injury, and compared the neurologic damage according to the presence/absence of the associated injury.
RESULTS
Spinal fracture occurred in the thoracic (43.5%) and lower cervical (30.0%) levels, and associated injury developed in 134 patients (47%). The area of associated injury was in the extremity (41.2%), thorax (25.5%), head, neck, and face (21.9%). Lower cervical fracture (34.5%) had a lower prevalence than thoracic (81%) and lumbar fracture (61%). The average ISS of the associated injury was 17.14 for the thoracic fracture, 12.30 for the lower cervical fracture, 8.7 for the thoracolumbar fracture and 5.69 for the lumbar fracture. Neurologic damage was highly frequent in the lower cervical fracture and included 54 patients (62.1%) and was less frequent in the upper cervical fracture, which included 7 patients (17.9%) (p=0.032).
CONCLUSION
Although the associated injury was less frequent in the lower cervical spine among the spinal fractures that underwent surgical treatment, there was a high risk of neurologic damage in the case of associated injury; therefore, there is a need to pay special attention to patients that suffer damage in this area. In addition, since the degree of the associated injury in the thoracic and lower cervical fracture is significant, an appropriate management strategy for the associated injury must be considered.

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The Clinical Effects of Complex Korean Medicine Treatment in Patients with Cervical Spine Fracture Caused by Traffic Accident: A Report of 2 Cases
Si-Hoon Han, Gi-Eon Lee, Kyeong-Sang Jo, Da-Young Byun, Min-Seok Oh
Journal of Korean Medicine Rehabilitation.2018; 28(2): 113. CrossRef
Clinical results of early stabilization of spine fractures in polytrauma patients
Ki-Chul Park, Ye-Soo Park, Wan-Sik Seo, Jun-Ki Moon, Bo-Hyun Kim
Journal of Critical Care.2014; 29(4): 694.e7. CrossRef

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Analysis for the Factors Influencing Bone Union in Segmental Tibial Shaft Fractures Treated with Interlocking Intramedullary Nailing: Kyung Jin Song, Kwang Bok Lee, Byung Yun Hwang; J Korean Fract Soc 2004;17(2):153-159. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.153

Abstract PDF

PURPOSE
To find the factors influencing bone union in segmental tibial shaft fractures treated with interlocking intramedullary nailing, and to find the special attentions during operation based on this factors.
MATERIALS AND METHODS
This retrospective study made to investigate the medical records and plain radiograms of 32 patients who treated with interlocking intramedullary nailing. We statistically analyzed the correlation between bone union time and factors influencing bone union, including fracture site, fracture pattern, Melis type, open fracture, nail diameter, reaming, postoperative gap, postoperative angulation.
RESULTS
The factors that showed the significant difference statistically were fracture site, Melis type, open fracture, postoperative gap, postoperative angulation. The factors that showed no significant difference statistically were fracture pattern, nail diameter, reaming.
CONCLUSION
We recommend that surgeons should be considered the site and type, open fracure in preoperative stage. During operation, try to reduce it accurately without angulation and gap if possible. And so, the careful planing of treament can be expected with a high rate of union and a low rate of complication.

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Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures
Sang Soo Park, Jun-Young Lee, Sang-Ho Ha, Sung-Hae Park
Journal of the Korean Fracture Society.2013; 26(4): 275. CrossRef

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Results of Surgical Treatment in Schatzker Type VI Tibial Plateau Fracture: Kyung Jin Song, Kwang Bok Lee, Seung Jin Moon, Joo Hong Lee; J Korean Fract Soc 2004;17(1):32-37. Published online January 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.1.32

Abstract PDF: PURPOSE
The purpose of this study was to evaluate the factors influencing the results for the treatment of the Schatzker type VI tibial plateau fractures.
MATERIALS AND METHODS
Twenty-two cases of the 21 patients in Schatzker type VI tibial plateau fractures were analyzed. Treatment results were analyzed according to the type of fracture (open vs closed), method of operative treatment, angulation more than 5 degree and status of infection. The functional results was evaluated by Hohl's functional criteria. Student t-test was used for the statistical analysis.
RESULTS
Functional outcome demonstrated 5 excellent, 8 good, 6 fair and 3 poor results. There was no significant difference in the treatment results between type of fracture, method of operative treatment and status of infection. Among 9 cases with angular deformity of more than 5 degree, 2 showed excellent or good result and 7 showed fair or poor result (p<0.05). There was no significant difference between rate of postoperative infection and the mean period of the clinical bone union (p=0.66).
CONCLUSION
Accurate anatomical reduction and rigid fixation is essential for the treatment of Schatzker type VI tibial plateau fractures for the prevention of the angular deformity. And early weight bearing exercise should be controlled for the prevention of loss of reduction and loss of alignment leading to angular deformity.

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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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The Results of Operative Treatment in Open Type III Tibia Fracture: Kyung Jin Song, Sung Jin Shin, Byung Yun Hwang, Myung Sik Park; J Korean Soc Fract 2003;16(2):194-200. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.194

Abstract PDF: PURPOSE
The purpose of this study was to analyze the functional outcome and propose the guidelines in the surgical treatment of open type III tibial fracture.
MATERIALS AND METHODS
We have analyzed the treatment results of 44cases; age was ranged from 15 to 76 years, and there were 35 males and 7 females. The type of fracture according to the classification by Gustilo revealed type IIIa 14 cases, type IIIb 20 cases and type IIIc in 8 cases. We analyzed functional outcome according to the classification of functional result by Tucker.
RESULTS
The average union time of type IIIa was 9.2 months, IIIb 11.0 months, and IIIc was 13.8 months. The rotational flap and free flap were done during treatment and bone lengthening especially in type IIIc. Functional results were poor especially in type IIIc.
CONCLUSION
Debridement of devitalized tissue, early soft tissue coverage and sufficient stability using intramedullary nails will be necessary in type IIIa fracture. Rigid external fixation, early soft tissue coverage by rotational muscle flap and free flap reduced infection rate with satisfactory functional outcome especially in type IIIb and IIIc fractures.

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Management of Both Tibia Fracture: Kyung Jin Song, Sang Hun Song, Jong Hyuk Park; J Korean Soc Fract 2003;16(2):186-193. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.186

Abstract PDF: PURPOSE
The purpose of this study was to analyze the associated injury, difficulties in management and complications with surgery, and to suggest the guideline according to the severity and type of injury in the management of both tibia fractures. MATERIAL AND METHOD: We analyzed 12 patients, 8 men and 4 women and their age was 43.4 years old in average. The cause of injury was traffic accident in 10, autobike in 1 and farm machine injury in 1 case. There were both open tibia fracture in 6, one side open fracture in 2 and both closed fracture in 4 cases. We analyzed the average interval from injury to operation, duration of hospitalization, duration of both side bone union and complications.
RESULTS
In both open tibia fracture, the average interval from injury to operation was 12.5 days, average duration of hospitalization was 3.2 months, and average duration of bone union was 14.5 months. In one side open fracture, the average interval to operation was 25 days, average duration of hospitalization was 3.75 months, and average duration of bone union was 8.7 months. In both closed fracture, the average interval to operation was 15 days, average duration of hospitalization was 1.92 months, and average duration of bone union was 4.8 months.
CONCLUSION
Both tibia fractures were caused by high energy and also associated with multiple injury, and fracture stability and soft tissue damage should be evaluated thoroughly before surgery. Anatomical reduction and rigid fixation should be necessary to reduce the post-surgical complications.

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The results of Operative Treatment in the Proximal Tibial Plateau Fracture: Kyung Jin Song, Keun Ho Yang, Joo Hong Lee; J Korean Soc Fract 2002;15(4):489-496. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.489

Abstract PDF: INTRODUCTION: The purpose of this study was to analyze the results, prognosis and complications in the treatment of proximal tibia plateau fractures, and to suggest the guideline for the proper management in the difficult cases of tibial plateau fractures.
MATERIALS AND METHODS
We have analyzed 27 cases, which surgically treated during recent five years with average 36.6 months follow-up. Patients ranged in age from 24 to 83 years at the time of hospitalization, consisting of 19 males(70.4%) and 8 females(29.6%). The type of fracture by Schatzker classification revealed in type I 3 cases(11.1%), type II 1 case(3.7%), type III 0 case(0%), type IV 3 cases(11.1%), type V 1 case(3.7%) and type VI 19 cases(70.4%). The associated injury occurred in 22 cases(81.5%), most of them were ipsilateral fibular, ipsilateral femoral and radioulnar fractures. The results were evaluated by Blokker 's criteria.
RESULTS
Screw fixation was done in 4 cases(18%) and plate fixation in 23 cases(85.2%), and bone grafting was done in 10 cases(37.0%). There were 10 postoperative complications with 3 cases of knee ankyosis, 3 cases of angular deformity, 3 cases of infection, and 1 case of traumatic arthritis. According to Blokker 's criteria, 22 cases(81.5%) had satisfactory results.
CONCLUSIONS
Accurate anatomical reduction and rigid internal fixation of the proximal tibial plateau fracture enabled early motion and normalization of injured soft tissues, and also provided functional improvement of the knee.

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Open Reduction using Lateral Approach in Displaced Intra-articular Fracture of Calcaneus: Kyung Jin Song, Keun Ho Yang, Joo Hong Lee; J Korean Soc Fract 2002;15(4):446-454. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.446

Abstract PDF: PURPOSE
This study was designed to investigate the usefulness of lateral approach for accurate reduction and rigid internal fixation in comminuted intra-articular fractures of calcaneus.
MATERIALS AND METHOD
Twenty patients(21 cases) who had intra-articular fracture of calcaneus and underwent an open reduction and internal fixation using lateral approach were enrolled. Using Essex-Lopresti classification, all cases were intra-articular fracture, which joint depression type was 17 cases and 4 of severe comminuted tongue type. We compared the preoperative and postoperative change of B o h l e r 's angle and clinical results were analyzed using Paley and Halls evaluation protocol and scoring system.
RESULTS
The average B ohler 's angle was restored from 2.8 to 25.1 after operations and clinical results classified 4 well, 12 good, 4 fair, 1 poor cases. Postoperative complications were 2 cases of wound dehiscence, 1 of infection and one had sural nerve injury. Late complications included 3 cases of limitation of motion of ankle that disturb usual activity, 3 of sustained pain and 2 of traumatic arthritis and 2 cases had 2 complications at the same patients.
CONCLUSION
The lateral approach is valuable for the comminuted intra-articular fractures of calcaneus that enables accurate anatomical reduction and rigid internal fixation by providing direct exposure of subtalar joint, and also with little morbidity of neurovascular injury.

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Metal Failure after Internal Fixation in the Treatment of Femur Mid-shaft Fractures: Kyung Jin Song, Jang Yeub Jeon, Jin Ho Yoon, Myung Sik Park, Byung Yeon Hwang; J Korean Soc Fract 2002;15(3):349-355. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.349

Abstract PDF: PURPOSE
To evaluate the causative factors of metal failure after internal fixation, and to suggest more rational treatment guideline that can prevent metal failure in the mid-shaft femur fractures.
MATERIALS AND METHODS
A retrospective review of 17 cases, who were treated with internal fixation for the femur mid-shaft fracture was analyzed. We evaluated the cause of injury, fracture type and site, associated injury, used instruments, duration to metal failure, and complications.
RESULTS
The metal failure occurred on average 14.8 months after internal fixation. As extrinsic factors, early exercise and weight-bearing in 7 cases, slip down during ambulation in 4 cases, improper physical therapy in 3 cases and unknown cause in 3 cases were related to metal failure. Most metal failure were occurred at the initial fracture site in 12 cases. Other metal failure site were empty holes in 1 case and proximal area of fracture site in 1 case, and screw breakage in 3 cases.
CONCLUSION
Accurate preoperative evaluation of fracture site, fracture type and proper selection of instrument, and precise surgical technique will be essential for the prevention of metal failure.

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Operative Treatment of Open Tibial Fracture: Kyung Jin Song, Sun Woong Jang; J Korean Soc Fract 2002;15(1):45-51. Published online January 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.1.45

Abstract PDF: PURPOSE
The purpose of the present study was to clarify the contributing factors, such as the method of fracture stabilization, type of internal fixation and the deep infection rate(DIR) in the treatment of open tibial fractures. MATERIAL AND METHODS: We made a retrospective study of these 87 open tibial fractures treated with various fixation method. Patients were divided into immediate internal fixation(IIF) group, delayed internal fixation(DIF) group and external fixation(EF) groups. Fixation methods, deep infection rate related with fixation devices and time to bone union were compared and anaylzed according to the Gustilo`s classification.
RESULTS
The mean time to union in open type I, II, IIIa, IIIb, and IIIc was 5.7 months, 8.6 months, 7.1 months, 9.7 months, and 18.0 month respectively. The mean time to union in group IIF, DIF1, DIF2 and EF was 7.2 months, 8.1 months 5.5 months, and 10.7 months and 13.1 months. The mean time to union of group using a interlocking IM nailing, plate and screws, and external fixator was 6.3 month, 6.9 months, and 10.6 months. SUMMARY: We concluded that there is an advantage of immediate internal fixation over external fixation in the prevention of infection and promotion of fracture healing in the treatment of open tibia fractures. Immediate internal fixation could be recommended for type I, II, IIIa and some cases of IIIb open tibia fracture.

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Limb Salvage versus Early Amputation according to Mangled Extremity Severity Score in Treatment of the Lower Extremity Open Fractures associated with Severe Soft Tissue Injury: Kyung Jin Song, Yong Min Kim, Kyung Rae Lee; J Korean Soc Fract 2002;15(1):28-35. Published online January 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.1.28

Abstract PDF: PURPOSE
To evaluate the availability of the mangled extremity severity score(MESS) in deciding the early treatment modality for the patients with open lower extremity fractures and severe soft tissue injury.
MATERIALS AND METHODS
Analyzed 27 patients for the lower extremity open fractures with extensive soft tissue injury. A comparative study using a MESS, a cause of injury, vascular injury and a fracture pattern, average hospital stay and average hospital charges were analyzed, and daily living ability and subjective self-evaluation were assessed.
RESULTS
There was statistically significant correlation applying MESS to patient group that had been operated by early amputation because of severe soft tissue and vascular injury. But there was no significant difference in the subjective self-assessment score, admission period and total cost during admission between each treatment method.
CONCLUSION
MESS can be used as an objective assessment criteria in deciding the proper treatment modality for the cases of lower limbs fracture with extensive soft tissues and vascular injury.

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The effects of the fibular stabilization in the treatment of distal tibio-fibula fracture: Kyung Jin Song, Gyu Hyung Kim, Myung Sik Park, Byung Yun Hwang; J Korean Soc Fract 2001;14(4):660-667. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.660

Abstract PDF: PURPOSE
The purpose of this study was to analyze the effect of fibula stabilization on reduction and union time of tibial fracture, and change in ankle mortise in the treatment of distal tibiofibular fracture.
MATERIALS AND METHODS
We reviewed 23 cases with distal tibiofibula fracture; 10 cases were stabilized and 13 cases were not stabilized for the fibula fracture with reduction and stabilization for the tibia fracture. We analyzed the initial and last follow-up radiograph, and clinical functional outcome.
RESULTS
There were significant differences in the tibiofibular clear space and tibiofibular overlap between two groups and there were somewhat significant differences in the union time of the tibial fracture and ROM of ankle and pain of fracture site or ankle between two groups. But there were no significant differences in talo-crural angle and gap of tibial fracture site between two groups. Moreover, such factors as initial displacement, soft tissue damage, comminution of fracture were affected the union time and prognosis of a tibial fractures.
CONCLUSION
Fibular stabilization group was effective in the maintenance of ankle mortise but there was no difference in the functional outcome. Analysis for much more cases and long term follow-up will be necessary for the precise evaluation of the treatment results.

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Surgical Treatment of the Bimalleolar Ankle Fractures: Kyung Jin Song, Keun Ho Yang, Kyung Rae Lee, Ju Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1999;12(4):956-960. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.956

Abstract PDF

We designed this study to evaluate the functional outcome and to suggest the guidelines in the treatment of bilnalleolar ankle fractures with clinical and radiological analysis after operative treatment. We analyzed 35 patients with bimalleolar fractures among 90 ankle fractures and followed up for more than 1 year. All 36 fractures were classified according to Lauge-Hansen system and the Meyer criteria was used for the clinical and radiological assessment. Seventeen cases(47%) were supination-external rotation(47%), 9 cases(21%) were supination- adduction: 6 cases(17%) were pronation-abduction and 4 cases(11%) were pronation-external rotation type. Satisfactory results was obtained in 32 cases(89%) according to the criteria of Meyer in the viewpoint of clinical and radiological analysis. Satisfactory results could be obtained with early anatomical reduction and rigid internal fixation for the treatment of bimalleolar ankle fractures. Distal tibiofibular syndesmosis disruption could be spontaneously reduced without trans-syndesmotic screw fixation by early open reduction and rigid internal fixation for the bimalleolar ankle fractures. Early and more accurate anatomical reduction can reduce the post-traumatic arthritis in cases with moderate talar displacement and open fractures.

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MANAGEMENT OF FRACTURES AROUND ANKLE JOINT
Pagidimarri Manasa, Devarasetty Shanmukha Sreenivas, B. Someswara Reddy
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2021; : 14. CrossRef

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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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Interlocking Intramedullary Nailing for the Treatment of Segmental Tibial Shaft Fractures: Kyung Jin Song, Young Keun Lee, Jeong Yeul Kim, Byung Yun Hwang; J Korean Soc Fract 1999;12(1):69-75. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.69

Abstract PDF: The treatment of segmental tibial shaft fractures poses many problems because of the serious damage to the surrounding soft tissue that usually occurs from the high-energy trauma, and the results are often unsatisfactory following lots of complications like non-union, delayed union, malunion, and infection We studied to evaluate the treatement results of interlocking intramedullary nailing for the segmental tibial shaft fractures. Twenty-two cases of segmental tibial shaft fractures were reviewed and we analyzed the results of surgical treatement in the viewpoint of bony union times, complication and its final outcome. The range of follow-up was 12 months to 68 months with mean 38 months follow-up. Most of the patients were between forty and sixty years, and average age was 47 years. Associated injury was incurred in nineteen cases with various musculoskeletal symptoms and signs. According to Meils classification, 8 were Type I, 1 was Type II and 3 were Type IV of the 12 closed fractures. Of the 10 open fractures, 4 were Type, 2 were Type II, 3 were Type IV, and 1 demonstrated multisegmental fractures. All of the closed fractures were united well except only one infected nonunion. The average time to union was 21.6 weeks with range from 16 to 26 weeks. The healing was tlowest in Type IV and fastest in Type I fractures. There was no significant difference in the healing time between the distal and proximal fractures. Of the 10 open fractures, each one of open type I fracture and open type II fractures did not united because of infected nonunion. The average time to union was 26.4 weeks with range from 16 to 38 weeks for the remaining 8 open fractures. The healing was slowest in Type IV and fastest in Type I fractures. There were 3 cases of infected nonunion, 1 case of delayed union of the proximal fracture and 1 case of valgus deformity of distal fracture. The infection was controlled and bone union obtained with removal of the nail and reaming, curettage and antibiotic bead wire, and plating with bone graft. We recommand that wherever poslible, interlocking intramedullary nailing can be used for the closed or open type I and II segmental tibial shaft fractures. And a high rate of union and a low rate of complication can be expected with this treatment modality.

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Interlocking Intramedullary Nailing for the Treatment of Segmental Fractures of the Femur: Kyung Jin Song, Hwang Jik Kim, Jeong Yul Kim, Joo Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1998;11(3):522-527. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.522

Abstract PDF: Segmental femoral fractures are unusual injury caused by a severe force and associated with marked demage to the soft tissue, especially the quardriceps muscle. Intramedullary nailing is the most common treatment modality for the segmental femur fractures with high union rate and few complications. The purpose of this study is to evaluate the results of surgical treatment with interlocking intramedullary nailing for the segmental femoral fractures. We analyzed 23 consecutive segmental femoral fractures with static interlocking nail from May, 1989 to Feburary, 1997. Major associated injuries were sustained in 18 cases. There were 19 closed and 4 open fractures. Eighteen cases(78.3%) were done by closed technique and 5 cases(21.7%) were done by open technique. All fractures united at an average of 25.9 fractures. There were 3 malunion, 1 shortening(18mm) and stiffness of knee, 1 delayed union, and 1 limited motion of the knee. delayed union was treated by dynamization and autogenous bone graft, and additional intervention for union was unnecessary for the other problems. Although interlocking intramedullary nailing for the segmental femoral fracture is a techniqually demanding procedure, we recommand that it is the treatment of choice for closed and open(open type I) segmental fractures of the femur.

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Analysis of Metal Failures for the femur Shaft Fractures: Kyung Jin Song, Hwang Jik Kim, Jeong Ryul Kim, Joo Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1998;11(3):501-508. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.501

Abstract PDF: The purpose of this investigation was to analyze the causes of the metal failures, and to suggest reasonable methods that can prevent metallic failures in the treamtnet of femur shaft fractures. There were 27 metal failures in 25 patient who underwent internal fixation for the femur shaft fracture between May of 1990 and May of 1996. We analyzed the causes of injury, fracture site, associated injury and used implants for the femur shaft fractures. And also analyzed the interval since operation to metal failure, method of treatment, and complications following surgery for the metallic failures. There were 13 stainless steel DCP(dynamic compression plate), 4 titanium LC(low contact)-DCP, 7 interlocking IM(intramedullary) nails, 2 Dutscher nails, and 1 anatomical plate. The metal failure occurred on average 6.1 months after internal fixation. Eight stainless steel DCP, 4 LC0DCP and 1 anatomical plate failed at the empty hole located at the fracture site. With interlocking IM nail, 4 cases of failure occurred at the proximal 1/3 of femur and other 3 cases showed failure on distal interlocking hole in distal femoral shaft fractures. All failures developed at the fracture site in kuntscher nail. For the treatment of metal failures, we used stainless steel DCP in 12 cases, interlocking IM nail in 7 cases, Kuntcher nail in 2 cases, Ender nail in 1 case, dual plate in 1 case, and external fixation in 2 cases. Autogenous cancellous iliac bone graft applied in 20 cases for the augmentation of frcture site or to fill the defect area. There were 2 cases of re-failure, 2 chronic osteomyelitis, 1 fracture site infection, 2 delayed union and knee joint ankylosis in 1 case. Accurate preoperative evaluation of fracture site, fracture pattern and proper implant selection will be essential for the prevention of metal failures. Minimal soft tissue dissection, anatomical reduction and rigid internal fixation will be necessary for the satisfactory outcome in the treatment of femur shaft fractures. Augmentation with autogenous cancellous bone graft should be followed after internal fixation for the comminuted fractures or bony defect over the fracture site. Postoperative rehabilitation program should be individualized according to the preoperative fracture pattern, used implant, and fracture stability.

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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

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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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Interlocking Intramedullary Nailing in the Treatment of the Tibial Shaft Fractures: Comparative Study between Reamed and Unreamed Nailing: Jae Hoon Lee, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 1996;9(4):993-1001. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.993

Abstract PDF: Interlocking intramedullary nailing has been popularized by its many advantages in the fracture treatment of long bone compared with the other fixatives. The purpose of this paper was to evaluate the treatment results in the viewpoint of bone union, complication and functional outcomes of the interlocking intramedullary nailing between reamed and unlearned technique in the treatment of tibial shaft fractures. We reviewed 64 tibial shaft fracture that were treated at our hospital from May 1990 to February 1995 with interlorking intramedullary nailing that composed 36 reamed, and 28 unlearned cases. These included 33 open fractures and 34 closed fractures. There was no significant di florences in average prriod of radiologic union, complications and in the functional outcomes between the two treatment grovps(P<0.05). Unlearned interlocking intramedullary nailing in the tibial shaft fractures must be a goof treatment modality by its simplicity, shorter operation time, less probability in pulmonary and throrrlboembolic complications and less comprormised medullary blood supply, especially in patients with multiple trauma or open fractures.

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Unusual Isolated lateroplantar Dislocation of the First Tarsometatarsal Joint: A case Report: Joo Hong Lee, Jae Hoon Lee, Hak Ji Kim, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 1996;9(2):349-353. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.349

Abstract PDF: Dislocation and fracture-dislocation fo the Tarsometatarsal joint were rare injuries, but an increase of motor vehicle accidents, industrial and athletic injuries seems to be responsible for an incresing incidence of these injuries. Because of the basic inherent stabilith of the bony architecture and the structures on the sole of the foot including the plantar fascia, the intrinsic foot muscles, peroneus, tibialis posterior tendon and the stronger plantar pligaments most dislocations occur in dorsal and lateral direction. We report a case of 32 year-old male patient who had an isolated fracture and disloction of the first Tarsometatarsal joint with laterai and plantarward displacement. This developed by in-car accident and which did not fit to any proposed classification systems. The diagnosis was delayed because of the combined injuries, but with open reduction and internal fixation with 2 smooth K-wires, satisfactory results could at 12 moonths follow-up study.

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Clinical Evaluation for the Tibial Pilon Fractures: Kyung Jin Song, Joo Won Jung, Joo Bong Lee, Myung Sik Park, Byung Yun Bwang; J Korean Soc Fract 1996;9(1):200-204. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.200

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Treatment for the tibial Pilon fractures involving ankle joint must be the most challenging one in the long bone fractures following lots of complications. We analyzed fourteen patients those who underwent surgical treatment for distal tibia fracture extending through the tibial plafond into the ankle joint. Under the Ruedi and Allgower classification two were in type I, two were in type II and ten were in type III. The Mean follow-uP Period was four years ranging from two to seven years. The purpose of this paper is to evaluate the treatment results of tibia Pilon fractures and analyBe the causes of complications. In surgical treatment method, we tried early open reduction and rigid internal fixation as far aas possible in the closed pilon fracture. We assessed the function under the objective and sutjective criteria of Ovadia and Beals. Two out of two in type I, one out of two in type II and four out of ten in type III Pilon fractures obtained good functional outcome. There were 3 wound infections, 1 malunion with reflex sympathetic dystrophy and 2 traumatic osteoarthritis as a complication. Type I and type II Pilon fractures proved to be amenable to open reduction, restoration of anatomic position, and stable internal fixation with early joint exercise. Nonanatomic reduction, unstable fixation, infection, and secondary arthrosis were associated in type III Pilon fractures with poor functional outcome after surgical treatment.

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Comminuted Pilon Fractures: Comparative Outcome Analysis according to Surgical Techniques
You-Jin Kim, Hong-Geun Jung, Joo-Hong Lee, Woo-Sup Byun, Sung-Tae Lee
Journal of the Korean Fracture Society.2007; 20(1): 6. CrossRef

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Surgical Treatment of Open Tibia Fractures: Intramedullary nailing versus external fixation: Hag Ji Kim, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 1995;8(3):544-550. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.544

Abstract PDF: There is still controversies in the method of surgical treatment for open tibia shaft fractures according to there degree of comminution and extent of soft tissue injury. It is generally accepted as open fracture type I, II can be treated with intramedullary nailing but there are so many suggestions for the type III fractures until now. We tried to evaluate the treatment result for the open tibia shaft fracture treated with intramedullary nailing or external fixatives with respect to seven parameters. time to union, tibial alignment, total number of operations, range of motion of the knee and ankle, pain, presence of infection, and complications. We retrospectively analyzed surgically treated sixty-sever tibia(sixty-six patients), forty-one tibia with extrernal fixatives and twenty-six tibia with intramedullaty nailing, at the Chonbuk University Hospital from January 1988 to December 1993 with mean follow up 32 months. Traffic accident was the most common cause of fracture. In Gustilos classification, 21 were in type I, 18 were in type II and 28 were in type III. Intramedullary nailing should be a safe alternative to extemal fixation for type I, II and III-A open fractures. External fixatives could be used temporarily or permanently for the type III-B and III-C fractures.

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Evaluation of Treatment for Clavicle fracture: Comparision between Conservative Versus Operative Treatment: Kyung Jin Song, Ki Young Chang, Byung Yun Hwang; J Korean Soc Fract 1995;8(1):181-187. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.181

Abstract PDF: There is still controversies in the treatment of clavicle fracture between conservative versus operative treatment. We reviewed one hundred thirth-six patients(141 cases) treated conservatively and operatively since February 1981 to September 1993 at Chonbuk National University Hospital. The mean follow-up was forth-six months ranging from six months to twelve years. Fifty cases treated surgically and ninty-one cases treated conservatively. In the surgical treatment group, mostly treated with intramedullary nailling with K-wires or Steinmann pin and plating with screws, with or without bone graft. We tried to evaluate the result of treatment between these two treatment groups in the viewpoint of criteria of pain, deformity, limitation of motion, subjective symptoms and disturbance of daily activities and also in the viewpoint of complications like nonunion, malunion, motion limitaion, infection and metal failures. The most common complication of the conservative treatment was malunion and nonunion was the most common complication in the operative treatment. Satisfactory results obtained in 89% of operative treatment group in the functional group and 88% of operative treatment group in the functional evaluation scale. Each clavicle fracture should be treated according to their degree of comminution, site of fracture, neurovascular injury, associated injury and doctors experience as which cases can promptly be treated either conservatively or operatively. But we would like insist of surgical treatment for the cases necessitating surgery for the provention of nonunion, malunion and joint stiffness what are common complications in the conservative treatment of clavicle fractures.

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