Journal of Musculoskeletal Trauma

Effect of Additional Medial Locking Plate Fixation and Autogenous Bone Graft for Distal Femur Nonunion after Lateral Locking Plate Fixation: Ho Min Lee, Jong Pil Kim, In Hwa Baek, Han Sol Moon, Sun Kyo Nam; J Korean Fract Soc 2024;37(1):30-38. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.30

Abstract PDF: Purpose
This study examined the outcomes of additional medial locking plate fixation and autogenous bone grafting in the treatment of nonunions that occurred after initial fixation for distal femoral fractures using lateral locking plates.
Materials and Methods
The study involved eleven patients who initially underwent minimally invasive lateral locking plate fixation for distal femoral fractures between January 2008 and December 2020. The initial procedure was followed by additional medial locking plate fixation and autogenous bone grafting for clinically and radiographically confirmed nonunions, while leaving the stable lateral locking plate in situ. A clinical evaluation of the bone union time, knee joint range of motion, visual analog scale (VAS) pain scores, presence of postoperative complications, and functional evaluations using the lower extremity functional scale (LEFS) were performed.
Results
In all cases, bone union was achieved in an average of 6.1 months after the secondary surgery. The range of knee joint motion, weight-bearing ability, and VAS and LEFS scores improved at the final follow-up compared to the preoperative conditions. All patients could walk without walking assistive devices and did not experience pain at the fracture site. On the other hand, three patients complained of pain in the lateral knee joint caused by irritation by the lateral locking plate; hence, lateral hardware removal was performed. One patient complained of mild paresthesia at the anteromedial incision site. Severe complications, such as deep infection or metal failure, were not observed.
Conclusion
For nonunion with stable lateral locking plates after minimally invasive lateral locking plate fixation of distal femur fractures, additional medial locking plate fixation and autogenous bone grafting, while leaving the lateral locking plate intact, can achieve successful bone union.

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Treatment of Ankle Fracture and Dislocation: Chan Kang; J Korean Fract Soc 2022;35(1):38-49. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.38

Abstract PDF: Ankle fractures are the most common type of foot and ankle fracture injury. Several types of fractures occur in the ankle structures (medial malleolus, lateral malleolus, posterior malleolus, and Chaput’s tubercle) with various mechanisms and extent of fracture force. Moreover, fractures can be accompanied by other injuries, such as distal tibiofibular syndesmotic injury, medial deltoid ligament rupture, and lateral ligament complex rupture. Ankle dislocation can be accompanied when an injury is caused by a greater fracture force. Non-surgical treatments or combined surgeries may be performed depending on the mechanism and fracture type. Generally, a stable fracture maintaining anatomical reduction is treated conservatively, but surgical treatment is performed when this is not the case. Furthermore, surgeries for stable fractures can be offered when the patients demand early weight bearing due to their occupation, age, and performance state. Restoring the ankle mortise in its anatomical shape before the injury and starting early rehabilitation for functional recovery simultaneously until a union is achieved is important. Traumatic arthritis can occur if the treatment focuses only on fractures and neglects ligament injuries, such as distal tibiofibular syndesmotic injury and medial deltoid ligament rupture. Shortening, angular deformation, and rotational deformation of the fibular promote the progression of traumatic ankle arthritis in the long term, which may further cause chronic ankle pain. An overlooked displaced posterior malleolus fracture also causes traumatic arthritis through anteroposterior instability of the ankle joint.

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Early Corrective Osteoclasis for Malunited Pediatric Medial Condylar Fracture of the Humerus: Hong Jun Jung, Ho Youn Park, Yuna Kim; J Korean Fract Soc 2022;35(1):21-25. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.21

Abstract PDF: Fractures of the medial condyle of the distal humerus in children are very rare, and the younger the age, the more difficult it is to diagnose. These fractures include an intra-articular fracture and a Salter–Harris type IV growth plate fracture. Therefore, the prognosis is poor if the fracture is neglected or misdiag-nosed because of the high incidence of complications such as nonunion, angular deformity, or joint contracture. This paper reports a case of a four-year-old child who presented with a malunion of the medial condyle of the humerus with good results after an early corrective osteoclasis.

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New Injury Mechanism and Treatment Algorithm of Posterior Elbow Dislocation: In Hyeok Rhyou; J Korean Fract Soc 2019;32(1):61-71. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.61

Abstract PDF: Although the concept of a single elbow dislocation mechanism, in which all dislocations start from the lateral side of the elbow joint and progress to the medial side, has never been able to explain the various conflicting experimental and clinical observations thus far, new studies and proposals for a valid mechanism have not been reported. The new proposal for posteromedial and posterolateral dislocation of the elbow joint according to the authors' study and the new treatment algorithm based on this new study can explain the various clinical and experimental results that have been difficult to explain, and provide a reasonable approach to the treatment of elbow dislocations.

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Cortical Perforation Misidentified with Medial Condylar Fracture of Femur in Total Knee Arthroplasty: Case Report: Seung Suk Seo, Sang Won Moon; J Korean Fract Soc 2019;32(1):52-55. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.52

Abstract PDF: Intraoperative fracture in total knee arthroplasty (TKA) is a rare complication. However, when it happens, additional surgery to fix the fracture site is needed. Therefore, it is important to diagnose intraoperative fractures in TKA exactly. The authors experienced two cases of cortical perforation of medial femoral condyle misidentified as the fracture in TKA. Cortical perforation could be misdiagnosed as the fracture, which could lead to unnecessary surgery. This is the first report about cortical perforation in TKA. We report two cases of intraoperative cortical perforations and describe the radiological characteristics.

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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; J Korean Fract Soc 2016;29(3):206-212. Published online July 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.3.206

Abstract PDF

Generally, lateral plating is used for a comminuted fracture of the distal femur. However, in some cases, it has been shown that using a medial plate is necessary to achieve better outcome. Nevertheless, there are no available anatomical plates that fit either the distal medial femoral condyle or fracture fixation, except for the relatively short plate developed for distal femoral osteotomy. We found that locking compression plate-proximal lateral tibia (LCP-PLT) fits anatomically well for the contour of the ipsilateral medial femoral condyle. Moreover, LCP-PLT has less risk of breaking the thread holes since it rarely needs to be bent. We report a plastic bone model study and two cases of distal femoral fractures fixed with medial plating using LCP-PLT.

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A novel anatomical locked medial femoral condyle plate: a biomechanical study
M. A. Ozer, S. Keser, D. Barıs, O. Yazoglu
European Journal of Orthopaedic Surgery & Traumatology.2024; 34(5): 2767. CrossRef
Medial plating of distal femur: which pre-contoured angular stable plate fits best?
Shaam Achudan, Rex Premchand Antony Xavier, Sze Ern Tan
European Journal of Orthopaedic Surgery & Traumatology.2024; 34(6): 3297. CrossRef
Medial augmentation of distal femur fractures using the contralateral distal femur locking plate: A technical note
Jaime Andrés Leal
OTA International.2024;[Epub] CrossRef
The missing piece of the trauma armoury-medial femoral condyle plate
Piyush Upadhyay, Farhan Syed, Darryl N Ramoutar, Jayne Ward
Injury.2022; 53(3): 1237. CrossRef
Surgical Tips and Tricks for Distal Femur Plating
Christopher Lee, Dane Brodke, Ajay Gurbani
Journal of the American Academy of Orthopaedic Surgeons.2021;[Epub] CrossRef
Medial minimally invasive helical plate osteosynthesis of the distal femur – a new technique
G.M. Hohenberger, A.M. Schwarz, P. Grechenig, B. Clement, Mario Staresinic, Bore Bakota
Injury.2021; 52: S27. CrossRef
Feature-Based Design of Personalized Anatomical Plates for the Treatment of Femoral Fractures
Xiaozhong Chen, Zhijian Mao, Xi Jiang
IEEE Access.2021; 9: 43824. CrossRef

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Minimally Invasive Percutaneous Plate Stabilization Using a Medial Locking Plate for Proximal Tibial Fractures: Technical Note: Jae Ang Sim, Beom Koo Lee, Kwang Hui Kim, Yong Seuk Lee; J Korean Fract Soc 2013;26(4):327-332. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.327

Abstract PDF

Minimally invasive plate osteosynthesis (MIPO) is beneficial for proximal tibial fractures since these injuries are mostly caused by high energy traumas. The advantages of MIPO are minimization of soft tissue dissection and preservation of periosteal vascularization. Lateral plating has mostly developed as MIPO for proximal tibial fractures. We introduce minimal invasive percutaneous plate stabilization using a medial locking plate as alternative treatment for proximal tibial fractures.

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Effect of Korean Medicine Treatments in Patients with Proximal Tibia Fracture: A Retrospective Observational Study
Jung Min Lee, Eun-Jung Lee
Journal of Korean Medicine Rehabilitation.2020; 30(3): 141. CrossRef
Medial Minimally Invasive Percutaneous Plate Osteosynthesis in Proximal Tibial Comminuted Fractures
Jae-Ang Sim, Kwang-Hui Kim, Yong-Seuk Lee, Sang-Jin Lee, Beom-Koo Lee
Journal of the Korean Orthopaedic Association.2014; 49(4): 278. CrossRef

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Results of Treatment for Medial Condyle Fracture of the Distal Humerus in Children: Jeong Han Kang, Seung Hyeon Yang, Kuk Pil Lim, Hui Taek Kim; J Korean Fract Soc 2013;26(4):261-267. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.261

Abstract PDF: PURPOSE
We evaluated outcomes of treatment in medial condyle fracture of the distal humerus in children.
MATERIALS AND METHODS
Seven patients (4 females, 3 males) who were treated at the Pusan National University Hospital and followed-up until skeletal maturity after treatment were included. The average age at the time of fracture was 4.6 years (range, 2 to 10 years). Treatment was performed from 1 day to 6 months after the fracture: 4 patients underwent a surgical treatment for 17 days, 2 months, 2 months and 6 months after fracture, respectively. All fractures were Milch type 1. Five patients had Kilfoyle type 3, and two patients had type 2 fractures. Final outcomes were evaluated by the Mayo elbow performance score and carrying angle.
RESULTS
There were 3 excellent, 3 good and 1 fair result at the final follow-up. There was no elbow pain in any of the patients. One of the four patients who underwent a late surgical treatment received corrective osteotomy due to cubitus varus. All four patients had a limitation of elbow motion. The other three patients who had accurate diagnosis and treatment had a full range of motion.
CONCLUSION
Diagnosis of medial condyle fracture of the distal humerus based on plain radiograph is difficult in children due to its cartilaginous structures. When a patient shows pain, tenderness and swelling on the medial side of the elbow, an additional examination with magnetic resonance imaging may be required even if no fracture line is found in the radiograph. Accurate diagnosis and early treatment is important for good results.

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Ipsilateral Distal Radius and Scaphoid Fractures Associated with Posteromedial Dislocation of the Elbow Joint: A Case Report: Jin Wan Kim, Young Chul Ko, Chul Young Jung, Il Soo Eun, Young Jun Kim, Chang Kyu Kim; J Korean Fract Soc 2012;25(2):150-154. Published online April 30, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.2.150

Abstract PDF: Arm injuries occurring from high energy injuries such as falls or traffic accidents can be accompanied by wrist and elbow injuries. Monteggia fracture, Galeazzi fracture, and Essex-Lopresti fracture-dislocation are known some examples of such injuries. However, there are no reports on the dislocation of the elbow occurring from a distal radius fracture accompanied by scaphoid fracture, and there is nothing published about its prognosis. The authors report on the treatment and outcomes of a case of a 42-year-old male who had a distal radius and scaphoid fracture associated with posteromedial dislocation of the elbow on the same side of his arm along with a literature review.

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Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture: Yoon Hae Kwak, Dong Jou Shin, Kun Bo Park; J Korean Fract Soc 2010;23(1):90-96. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.90

Abstract PDF: PURPOSE
To suggest the most reliable guideline of the treatement for the supracondylar fracture in children by the comparison of the radiographic parameters between forearm supination-elbow extension and forearm pronation-elbow flexion view.
MATERIALS AND METHODS
A total of seventy-one patients were included in the study. Baumann, metaphyseal diaphyseal and medial epicondylar epiphyseal angle of normal elbow in extension and flexion view were compared. Finally, the results of Group I (operation with elbow extension view) and Group II (operation with elbow flexion view) were compared.
RESULTS
Intraobserver reproducibility and interobserver reliability were better in the Baumann angle with extension view and metaphyseal diaphyseal angle with flexion view. In extension view, Baumann and metaphyseal diaphyseal angle show negative correlation with carrying angle but in flexion view, only metaphyseal diaphyseal angle shows negative correlation. Baumann angle were greater in flexion view and medial epicondylar epiphyseal angle were greater in extension view. There was no statistical difference in the final results of Group I and II.
CONCLUSION
Baumann angle was more effective in forearm supination-elbow extension view and metaphyseal diaphyseal angle was more effective in forearm pronation-elbow flexion view. The difference between elbow extension and flexion view should be considered during operation.

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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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Medial Transposition of Radial Nerve in Distal Humerus Shaft Fracture: A Report of Six Cases: Sang Uk Lee, Weon Yoo Kim, Soo Hwan Kang, Yong Soo Park, Seung Koo Rhee; J Korean Fract Soc 2008;21(3):240-243. Published online July 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.3.240

Abstract PDF

Sometimes serious tension occurs in the radial nerve when doing internal fixation for distal humerus shaft fracture or neurorrhaphy for radial nerve injury. Medial transposition of radial nerve on fracture site can avoid direct radial nerve injury by fracture fragment, radial nerve tension by plating for distal humerus shaft fracture, and also safe from neural tension during neurorrhaphy of damaged radial nerve. We reported here total 6 cases of backward transposition of radial nerve including 2 cases of radial nerve injury associated with humerus fracture and 4 cases of comminuted fracture of humerus shaft.

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Transhumeral Anterior Radial Nerve Transposition to Simplify Anticipated Future Humeral Reconstruction
David A. Muzykewicz, Reid A. Abrams
The Journal of Hand Surgery.2017; 42(7): 578.e1. CrossRef
Transfracture medial transposition of the radial nerve associated with plate fixation of the humerus
Ali Hassan Chamseddine, Amer Abdallah, Hadi Zein, Assad Taha
International Orthopaedics.2017; 41(7): 1463. CrossRef
Trans-fracture transposition of the radial nerve during the open approach of humeral shaft fractures
Ali H. Chamseddine, Hadi K. Zein, Abdullah A. Alasiry, Nader A. Mansour, Ali M. Bazzal
European Journal of Orthopaedic Surgery & Traumatology.2013; 23(6): 725. CrossRef
Humerus Shaft Fractures in Leisure Sport 'Flyfish Riding' - 4 Cases Report -
Bong Gun Lee, Ki Chul Park, Youn Ho Choi, Woo Sung Jung, Kyu Tae Hwang
Journal of the Korean Fracture Society.2012; 25(4): 327. CrossRef

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The Fractures of Humerus Shaft and Medial Epicondyle by Arm Wrestling: Yeo Hun Yoon, Jong Kyung Ha, Kyung Eob Choi, Kwan Hee Lee, Sang Jin Shin; J Korean Fract Soc 2006;19(4):437-442. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.437

Abstract

PURPOSE
To evaluate the mechanism of the humeral fractures induced by arm wrestling and the clinical results of its treatment.
MATERIALS AND METHOD
We reviewed 7 humeral fractures induced by arm wrestling; 3 humeral shaft fractures, 4 humeral medial epicondyle fractures. The mechanism of the fractures and the clinical results were assessed by history and radiographs.
RESULTS
Shaft fractures were produced by twist and axial compression force. Humeral medial epicondyle fractures were the avulsion fractures by excessive contraction of flexor muscles and developed in young age. We operated 6 of them and in all cases, we could obtain fracture healings without complication.
CONCLUSION
The humeral fractures induced by arm wrestling have the differences in the ages and mechanisms as to the locations of the fractures and if the proper treatment is performed, the clinical results are satisfactory.

Citations

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Fractures of the humeral shaft caused by arm wrestling: a systematic review
Kiyohisa Ogawa, Atsushi Yoshida, Noboru Matsumura, Wataru Inokuchi
JSES Reviews, Reports, and Techniques.2022; 2(4): 505. CrossRef
Olecranon Fracture Sustained during Arm Wrestling in Middle-Aged Male
Chang-Yk Lee, Hyuk-Min Kwon, Han-Bit Kim
Journal of the Korean Orthopaedic Association.2022; 57(6): 520. CrossRef
Fracture-Separation of the Medial Humeral Epicondyle Caused by Arm Wrestling: A Systematic Review
Kiyohisa Ogawa, Atsushi Yoshida, Noboru Matsumura, Wataru Inokuchi
Orthopaedic Journal of Sports Medicine.2022;[Epub] CrossRef
Humerus Shaft Fractures Occurring in Fly Fishing Boat Riding: Injury Scene Analysis
Hongri Li, Wan Sun Choi, Bong-gun Lee, Jae-hoo Lee, Younguk Park, Doohyung Lee
The Korean Journal of Sports Medicine.2019; 37(4): 134. CrossRef
Humeral Shaft Fracture Sustained during Arm Wrestling in Young Males
Seung Rim Yi, Jieun Kwon, Ye Hyun Lee, Bo Kyu Yang, Young Joon Ahn, Se Hyuk Im, Joon Hee Cho, Sang Hoon Park
The Korean Journal of Sports Medicine.2017; 35(3): 149. CrossRef
Humerus Shaft Fractures in Leisure Sport 'Flyfish Riding' - 4 Cases Report -
Bong Gun Lee, Ki Chul Park, Youn Ho Choi, Woo Sung Jung, Kyu Tae Hwang
Journal of the Korean Fracture Society.2012; 25(4): 327. CrossRef

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Medial Plantar Nerve Injury after Screw Fixation of the Calcaneus Fracture: Bong Cheol Kwon, Yong Woon Shin, Duck Joo Kwon, Nam Kyou Rhee; J Korean Fract Soc 2006;19(2):288-290. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.288

Abstract: We present a case of medial plantar nerve injury by screw tip after open reduction and internal fixation of intraarticular calcaneus fracture. We reviewed the risk and prevention technique of medial plantar nerve injury in fixing the calcaneus fracture.

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The Necessity of Deltoid Ligament Repair in Lateral Malleolar Fracture Combined with Medial Clear Space Widening: Bo Kyu Yang, Sung Ho Hahn, Seung Rim Yi, Young Joon Ahn, Jae Ho Yoo, Min Seok Kim, Byung June Chung; J Korean Fract Soc 2005;18(3):281-285. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.281

Abstract PDF: PURPOSE
To evaluate the necessity of deltoid ligament repair in lateral malleolar fracture associated with medial clear space widening.
MATERIALS AND METHODS
The 82 cases of 82 patients received surgical treatment for lateral malleolar fracture with medial clear space widening in our hospital from Jan. 1996 to Feb. 2002. 73 male and 9 female patients were included respectively. Average follow-up period was 13.2 month (12~50). The methods of internal fixation of lateral malleolar fracture were 66 cases by cortical screw, 16 by plate and screws, and 9 by transfixing screw.
RESULTS
Satisfactory reduction was obtained in 65 of 73 cases by only internal fixation of lateral malleolar fracture. Transfixing screw was needed in 8 cases. There was no need for repair of deltoid ligament. In clinical evaluation, no cases of limitation of movement in ankle was seen at final follow-up time. In radiologic evaluation, average medial clear space widening before operation was 5.89 mm (4.5~13 mm) and that of last follow-up time was 2.54 mm (1.5~3.5 mm). 95.2% was above good result.
CONCLUSION
In treatment of unstable lateral malleolar fracture associated with medial clear space widening due to rupture of deltoid ligament, we obtained satisfactory result by accurate anatomical reduction or internal fixation. In these cases, there were no need for repair of deltoid ligament.

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Minimally Invasive Anterior Approach in Open Reduction of Displaced Supracondylar Fractures of Humerus in Children: Chang Ryung Hur, Seung Woo Suh, Chang Ug Oh, In Jung Chae, Jun Gyu Moon, Chan Eung Park, Jae Young Hong; J Korean Fract Soc 2005;18(2):185-190. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.185

Abstract PDF

PURPOSE
To evaluate the outcomes of minimal anterior approach and thumb assisted technique, in children with Gartland type III supracondylar humerus fracture, who were operated by this technique.
MATERIALS AND METHODS
Forty two children with Gartland type III supracondylar fractures of the humerus with severe swelling were taken up for minimal open reduction and K-wire fixation. The technique used was a minimal incision in the cubital fossa and thumb assisted reduction of the fracture. Stabilization of fractures was done with 1.6 mm Kirschner wires.
RESULTS
The outcomes were excellent in 40 cases good in 2 cases. No complications including malunion or scar contracture were seen.
CONCLUSION
This technique is safe, effective and can be used for irreducible, displaced supracondylar fractures of the humerus in children

Citations

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Supracondylar Humerus Fractures: Classification Based Treatment Algorithms
Mudit Shah, Mandar Vikas Agashe
Indian Journal of Orthopaedics.2021; 55(1): 68. CrossRef
Recent Trends in Treatment of Supracondylar Fracture of Distal Humerus in Children
Soon Chul Lee, Jong Sup Shim
Journal of the Korean Fracture Society.2012; 25(1): 82. CrossRef
Treatment of displaced supracondylar fractures of the humerus in children by a pin leverage technique
H.-Y. Lee, S.-J. Kim
The Journal of Bone and Joint Surgery. British volume.2007; 89-B(5): 646. CrossRef

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Modified Tension Band Wiring using Cortical Screw for Medial Malleolar Fractures: Ho Rim Choi, Hyun Woo Doh, Byoung Heum Kim, Kyou Hyeun Kim, Jong Seok Park, Joon Min Song; J Korean Fract Soc 2004;17(4):319-322. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.319

Abstract PDF: PURPOSE
To evaluate the clinical results of modified tension band wire technique using cortical screw for treatment of displaced medial malleolar fractures of the ankle.
MATERIALS AND METHODS
From January 2001 to January 2003, 24 patients were treated by modified tension band wiring using cortical screw for medial malleolar fracture. The follow-up period was 12~35 months (average 18 months). There were 13 males and 11 females, and the mean age was 46 years. Fractures were classified by Lauge-Hansen's classification. The results were analyzed by Meyer and Kumler's criteria.
RESULTS
There were 13 cases (54%) of excellent, 9 cases (38%) of good, and one case of fair because of limitation of motion of the ankle joint and one case of poor which showed post-traumatic arthritis of the ankle.
CONCLUSION
Modified tension band wire technique using cortical screw can be an effective operative method for the treatment of displaced medial malleolar fractures of the ankle.

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Fracture of the Medial Epicondylar Apophysis of Distal Humerus with Subluxation of the Radial Head: A Case Report: Han Yong Lee, Kee Won Rhyu, Jin Young Jeong, Joo Hyoun Song, Hae Seok Koh, Yong Koo Kang, Mun Ik Sohn; J Korean Soc Fract 2003;16(2):304-307. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.304

Abstract PDF: It has been known that fracture of medial epicondylar apophysis of distal humerus may be isolated or associated with elbow dislocations. We have experienced a case which medial epicondylar fracture of the distal humerus was associated with subluxation of the radial head. Initially, we had tried reduction of subluxated radial head by closed method, but failed. Finally open reduction had been performed. At 6 month after open reduction, clinical and radiological result were excellent. As it is difficult for those associated injuries to occur simultaneously and the similar cases never have been reported yet, we would like to present this case with a review of the literature.

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Modified Tension Band Wiring using Cortical Screw for Displaced Medial Malleolar Fractures: Jong Oh Kim, Sang Hun Ko; J Korean Soc Fract 2002;15(4):459-464. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.459

Abstract PDF: PURPOSE
To evaluate the clinical results of minimal incision and modified tension band wiring using 3.5mm cortical screw in the treatment of ankle fracture including displaced medial malleolar fractures MATERIALS AND METHODS: From March 1997 to May 2001, 77 patients were treated by modified tension band wiring using minimal incision about 4cm for medial malleolar fracture.
RESULTS
According to Lauge-Hansen classification, there were 47 supination-external rotation type fractures (61%), 14 supination -adduction type fractures (18.2%), 10 pronation-external rotation type(12.9%), 6 pronation-abduction type fracture(7.8%). The average time to union was 12.5weeks. In the functional outcome (according to Meyer and Kumler), 71 patients(92%) showed excellent results.
CONCLUSION
We concluded that modified tension band wiring using cortical screw proved effective fixation method in the treatment of the displaced medial malleolar fracture. The merits of this procedure are minimal incision about 4cm and preservation of blood supply on suprafracture area due to not injuried periosteum, stable fixation and early range of motion of joint, simple procedure and reduced surgical time.

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Operative treatment of fracture of medial epicondyle of humerus in children: Ho Jung Kang, Yong Min Cheon, Kye Wook Song, Eung Shick Kang, Hui Wan Park; J Korean Soc Fract 2001;14(4):762-768. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.762

Abstract PDF: PURPOSE
We investigated injury mechanism, clinical feature, treatment, and prognosis in fracture of medial epicondyle of humerus in children. MATERIAL AND METHOD: From April 1997 to April 2000, 10 fractures of medial epicondyle of humerus treated by operative method and followed up for minimum 12 months were analyzed retrospectively.
RESULTS
The injury mechanism includes slip down with elbow outstretched in 8 case, throwing ball in one case, arm wrestling in other one case. Ulnar nerve symptom at the distal region of fracture site was noted in one case. 2 cases had elbow dislocation at the time of trauma. Fractured fragment displaced more than 5mm in 9 cases and fractured fragment incarcerated in elbow joint in one case. Open reduction and internal fixation was done with medial approach. The mean period of cast immobilization was 6 weeks postoperatively and after removal of cast, gentle exercise of range of motion was started. After operation and postoperative follow up, in all case except one, the full range of motion of elbow joint was recovered and there were no Unar nerve symptom and valgus instability in affected elbow joint.
CONCLUSION
The indication of operation for fracture of medial epicondyle of humerus is controversial, yet. We had done open reduction and internal fixation for medial epicondyle of humerus only in case of displacement of fractured fragment more than 5mm and incarceration in elbow joint after manual reduction, ulnar nerve symptom. In 90 percents of all case, the result was satisfactory.

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Treatment of Coronal Split Fracture of the Femoral Condyle: Yong In, Seung Key Kim, Won Jong Bark, Jong Beom Park, Gun Chang, Han Chang; J Korean Soc Fract 2000;13(4):855-860. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.855

Abstract PDF: PURPOSE
To evaluate the results of treatment in 6 cases of coronal split fractures of the femoral condyle MATERIALS AND METHODS: Six cases of coronal split fractures of the femoral condyle were treated and followed up 16 to 36 months. Five cases were treated operatively. We used anteromedial approach for 3 cases, posteromedial approach for 1 case and posterolateral approach for other 1 case. Non-displaced case was treated conservatively with cast. We compared the results of each case using Letenneur assessment system.
RESULTS
All 3 cases approached anteromedially and the case approached posterolaterally showed good results. But the case approached posteromedially showed fair result with mild limitation of motion and pain. Non-displaced case treated with cast resulted in poor result with nonunion.
CONCLUSION
We propose operative treatment for coronal split fracture of the femoral condyle even though there is no displacement. Anteromedial approach and headless screw fixation could be the best method for reduction and fixation of fracture.

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Reconstruction of Medial Collateral Ligament in Old Posterior Dislocation of the Elbow: Sang Soo Lee, Ho Yeun Hwang, Dong Hee Lee, Il Hyun Nam, Sang Un Lee; J Korean Soc Fract 2000;13(3):576-583. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.576

Abstract PDF: PURPOSE
To evaluate and analyse the operative results of reconstruction of medial collateral ligament(MCL) in old posterior dislocation of the elbow.
MATERIALS AND METHODS
Nine patients (from 1989 to 1999) with old posterior dislocation of the elbow treated by operation were reviewed. We analysed the pattern of dislocation, associated injury, method of operation, complication and functional results. All patients were treated with open reduction. Reconstruction of MCL was undertaken in three patients of nine.
RESULTS
All nine patients who had underwent open reduction were improved in the flexion-extension motion of elbow. Three patients of nine underwent reconstructive surgery of MCL were much improved in the flexion-extension motion. But there is no differences in improving the pronation-supination motion between of them(P>0.05, ttest).
CONCLUSION
Precise understanding of MCL anatomy and appropriate intraoperative technique are mandatory. We achieved much more range of motion in the cases of reconstruction and early motion rather than those of immobilization for 3 weeks with K-wire. We believe reconstruction of MCL is a useful addition to treatment options for old elbow dislocation of elbow.

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PROPER SCREW LENGTH FOR FIXATION OF THE MEDIAL MALLEOLAR FRACTURE OF ANKLE: Dong Bae Shin, Soo Hong Han, Seung Soo Jeon; J Korean Soc Fract 2000;13(3):522-528. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.522

Abstract PDF: PURPOSE
There is rare report about screw length in ankle fracture in spite of the anatomical characteristic that distal densest area can give enough purchase of screw threads for fixation of medial malleolar fragment. Purpose of the current study is to evaluate the results of screw fixation and to estimate proper screw length in medial malleolar fracture.
MATERIALS AND METHODS
Authors retrospectively reviewed 136 cases of medial malleolar fracture which had been performed from Janurary 1985 to December 1997. The patients were divided into 3 groups according to screw length ; under 34mm screw length (9 cases), between 35mm and 45mm (76 cases), over 46mm (50 cases). Each group was evaluated bone union time, clinical outcomes and radiological results by Meyer and Kumler.
RESULTS
Good and excellent results were achieved 121 cases (89%) on clinical result and 125 cases (91.9%) on radiological result by Meyer criteria. There were no statistical differences between three group, but the 35mm-45mm screw length group showed slightly faster union tendency.
CONCLUSION
In the treatment of medial malleolar fracture, around 40mm length screw is sufficient for fixation and it doesn,t need to use the screw over 45mm length for more rigid fixation.

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HERBERT SCREW FIXATION FOR NON-COMMINUTED CLOSED MEDIAL MALLEOLAR FRACTURE: Dong Man Park, Yong Jin Kim, Jea Won Chang, Jin Cheul Park; J Korean Soc Fract 1999;12(3):638-644. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.638

Abstract PDF: It is known that the Salter-Harris type I and II fractures of the distal tibial epiphysis usually Non-comminuted closed displaced medial malleolar fracture has been treated by open reduction and internal fixation. Since fracture fragment of medial malleolar is usually thiner and smaller than that of lateral malleolar, it is more difficult to fix firmly than that of lateral malleolar. In the treatment of medial malleolar fracture, although various fixation methods in the treatment of medial malleolar fracture have been reported, several complications have been reported. And then authors have been tried to find fixation methods and firm fixation material for medial malleolar fracture to minimize complications. The purpose of this paper is to compare operation time, duration of bone union, the presence of complication, and results by Meyer and Kumler criteria between Herbert and malleolar screw and to introduce percutaneous Herbert screw fixation technique. Since March 1996, forty-four patients had undergone surgical intervention for medial malleolar fractures. Twenty-three Herbert screw and twenty-one malleolar screws were used. The results were as follows; The operation time was shorter in Herbert screw fixation group. There were no complications such as pain and tenderness due to hardware protrusion and metal lossening in Herbert screw fixation group. We come to the coonclusion that the Herbert screw fixation method was a little better than the malleolar screw fixation method according to comparison by Meyer and Kumler ctireria. We concluded that Herbert screw fixation was a better method for non-comminuted closed displaced medial malleolar fracture to obtain early union and to prevent postoperative complications.

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Percutaneous Fixation in Medial Malleolar Fracture: Phil Hyun Chung, Chung Soo Hwang, Suk Kang, Ki Se Nam, Ho Kyun Bae; J Korean Soc Fract 1999;12(2):314-320. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.314

Abstract PDF: Fracture of the ankle is one of the most common fractures. Usually medial malleolar fractures, when non-displaced or minimally displaced, have been treated by closed reduction and cast immobilization for long period, so stiffness and osteoporosis of ankle were frequently inevitable. We investigated the result of percutaneous pinning or screw fixation and early mobilization in the treatment of medial malleolar fracture of the ankle. With clinical and radiological data, authors analysed 17 patients(17 ankles) who were treated with closed reduction and percutaneous pinning or screw fixation between August 1991 and May 1997. and following results were obtained. One case of pin site infection was noted and no nonunion or loss of fixation was identified and average duration of bone union was 12 weeks. According to Burwell's protocol, the good result are 16 cases, the fair is 1 case and the poor result is not observed. From the viewpoint of rehabilitation, authors consider percutaneuos pinning is an excellent plan of treatment of medial malleolar fractures, when non-displaced or minimally displaced.

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Importance of maintenance medial buttress in treatment of supra-condylar and inter-condylar(T-condylar) fracture of the femur: Seung Ho Yune, Kwang Jin Rhee, Chan Hee Park, Ki Yong Byun, Sang Yong Lee, Seung Kwon Rho; J Korean Soc Fract 1996;9(1):50-58. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.50

Abstract PDF

Recently, treatment of supracondylar and intercondylar(T-condylar) fracture of the femur has been changed from conservative treatment to do open reduction and internal fixation. Principles of anatomical reduction, rigid internal fixation and early knee joint exercise are recommended, but there are many difficulties and problems to get anatomial reduction and rigid internal fixation. we observed 3 cases of malunion & nonunion that were treated by ORIF. In these cases, there is a failure in restoring medial buttress of distal femur due to inadequate reduction and internal fixation. Dynamic condylar screw(DCS) or blade plate were usually used through lateral approach and laterally applying method can not always restore the medial buttress of the fracture site. In these cases, early exercise and early weight bearing have to be postponed,and the results were poor. So we want to emphasize the principles in open reduction and internal fixation of the supra-and inter-condylar fracture fo the femur. To get anatomecal reduction is very important, but if is not possible in severely comminuted fractures, we have to try to maintain medial buttress by another methods such as double plating(to add a medial auxiliary buttress plate to lateral internal fixation) or auxiliary external fixations instead of medial anatomical contact.

Citations

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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
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
Journal of the Korean Fracture Society.2009; 22(4): 246. CrossRef

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Treatment of the Posterior Lip Fracture of Distal Tibia Using Posteromedial Apprroach: Chung Nam Kang, Jong oh Kim, Seok Beom Lee, Oh Yong Kang, Min Soo Shin; J Korean Soc Fract 1995;8(3):594-599. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.594

Abstract PDF

The primary goal of treatment of the posterior lip fracture is to effect the returning of normal function that is accomplished by the early institution of motion. A variety of both open and closed treatment have been recommended, but many authors have advocated internal fixation of large fragments that compromise 25 per cent or more of the articular surface on the lateral radiography Open reduction with internal fixation of the posterior lip fragment has been associated with technical problems. VisualiBation of the articular surface is obscure by overhanging of the posterior tibial margin and talus. And than efforts at open reduction of posterior lip fragments are frequently unsuccessful. We used the posteromedial approach to this lesion. The results obtained from this study were as follows; 1. Of the 17 cases, male was 9 cases(53%), female was 8 cases(47%) the most common victim was twentieth and thirtieth decades. 2. The mean afticular surface involvement of the posterior lip fragments in the sagittal plane were 28 percent. 3. The location of posterior lip fragment was central(2 cases), posteromedial(6 cases), posterolateral(9 cases). 4. The posteromedial approach affords the most predictable way to cary out an absolutely anatomic reduction of posterior lip fractures and a low complication rate.

Citations

Citations to this article as recorded by

Treatment of the Posterior Malleolar Fracture Using Posterior Approach
Hyun Wook Chung, Dong Hwan Kim, Si Hoon Yoo, Jin Soo Suh
Journal of the Korean Fracture Society.2010; 23(1): 50. CrossRef
Radiologic Analysis and Treatment of Posterior Malleolar Fractures of the Ankle
Jae Sung Lee, Soo Yong Kang, Han Jun Lee, Young Bong Ko
Journal of the Korean Fracture Society.2009; 22(2): 98. CrossRef

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Tension Band Wiring with Anchoring Screw in Medial Malleolar Fracture: Young Won Rho, Taik Keun Ahn, Jong Oh Kim, Taik Seon Kim, Jai Ik Shim; J Korean Soc Fract 1990;3(2):247-251. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.247

Abstract PDF: Since development of sports and leisure, ankle fracture occurs frequently. The goal of treatment of ankle fracture is anatomic restoration of ankle joint. With introduction of tension band wiring technique by A-O group, this technique was used popularly. The authors reported 15 cases of medial malleolar fracture in which patients were treated by tension band wiring with anchoring of screw instead of primary osseous tunnel, from September 1987 to August 1989. The advantage of modified tension band wiring technique is shortening of operative time and simplicity of technique.

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