Journal of Musculoskeletal Trauma

Original Articles

Clinical and Radiologic Analysis of Occult Osseous Lesion on Magnetic Resonance Imaging in Acute Knee Injury: Seung Key Kim, Jong Hun Lee, Nam Gee Lee, Chang Beom Park, Han Chang; J Korean Soc Fract 1997;10(4):843-850. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.843

Abstract PDF: Bone bruise or occult osseous lesion on magnetic resonance imaging was focused on the indirect sign of acute anterior cruciate ligament injury. But there were few reports which compared the location of bone bruise with the injured structure. The purposes of this study were to identify the common pattern of location of bone bruise, and to analyze the relationship between the location and injured structure or mechanism of injury. The authors reviewed 76 magnetic resonance imaging studies of the knee from March 1993 to May 1994 which show the sign of bone bruise in acute knee injury within six weeks. The mean age of the patient was 26.3 years and the main cause of injury was traffic accident. The final diagnosis was 20 cases of isolated medial collateral ligament injury, 17 cases of isolated anterior cruciate ligament injury, 16 cases of combined anterior cruciate and medial collateral ligament injury, 7 cases of meniscus injury, 6 cases of combined posterior cruciate and medial collateral ligament injury, 5 cases of isolated posterior cruciate ligament injury, 2 cases of patella dislocation, 1 case of lateral collateral ligment injury, and 2 cases of undiagnosed knee injury. In isolated MCL injuries, bone bruises were all confined to the lateral compartment. In isolated injury of ACL, the most common pattern of location of bone bruises were lateral tibial plateau and lateral femoral condyle(47.1%). In combined ACL and MCL injury, the most common pattern of location was lateral tibial plateau, only(43.8%). Bone bruise on MRI may be easy to detect during interpretation and we can obtain much information to decide the diagnosis and prognosis.

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Operative Treatment of Forearm Fractures in Children: Nam Gee Lee, Seung Ki Kim, Won Jong Bahk, Hyun Joon Song, Ban Chang; J Korean Soc Fract 1997;10(1):195-202. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.195

Abstract PDF: Management of severe diaphyseal fracture of radius and ulna in children can be a challenging problem. Reduction and maintenance of the position of two mobile parallel bones is difficult because pronating and supinating muscles produce angulatory as well as rotational forces. Open reduction and internal fixation are generally accepted for adult forearm fractures, but controversy surrounds open reduction for children. What should be done for the irreducible fracture that will result in a malunion? Several authors advocate open reduction in children over 10 years of age rather than accept poor position. And others advocate open reduction regardless of age if closed reduction is unsatisfactory. We reviewed thirteen children between 6-14 years of age, who had irreducible fractures of diaphysis of forearm both bone, and who were treated with open reduction and internal fixation with plate for mid 1/3 fractures(4 cases) and open reduction and internal fixation with K-wires for distal 1/3 fractures(9 cases). The results were as follows; 1. 2 cases(15%) had limitation of pronation within 10 comparing with uninjured side. But 11 cases(85%) had equal movements on both sides. And the range of motions of the elbow and wrist are within normal limit. 2. More than 20 angulation for mid 1/3 fracture over 10 years of age, and more than 20 angulation or 20% displacement for distal 1/3 fracture over 6 years of age, it would be better to perform a surgical treatment if nonsurgical treatment was failed. 3. Immobilization periods were 5 weeks for plate fixation group and 6.9 weeks for K-wire fixatioin group. Bone union was occurred in all cases, at 9 weeks in plate fixation group and 8 weeks in K-wire fixation group. 4. Its better to fix with plate ofr promimal 2/3 fracture and K-wire for distal 1/3 fracture in case of operation. In conclusion, our results of open reduction and internal fixation were satisfactory if adequate alignment of fractures had not been achieved or maintained.

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Lunate dislocation and perilunte dislocation with or without fracture: Won Jong Bahk, Jong Min Sohn, Nam Gee Lee, Seung Key Kim, Young Joo Park, Han Chang; J Korean Soc Fract 1996;9(1):42-49. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.42

Abstract PDF: The lnate dislocation and perilunte dislocation with or without fracture, occupying about 10% of carpal injury, might b classified as a same category of injury resulted from similar mechanim. Initial diagnosis was missed often. In case of failure of closed reduction, open reduction and internal fixation will be necessary. The authors analyzed retrospectively 15 patients with lunate dislocation and perilunate dislication without fracture(Group A)and perlunate dislication with scaphoid fracture(Group B) who were treated from 1989 to 1994 at our hespital. The follow-up periods were 7 months to 60 months with mean of 23.2 months. The results were as follows. 1.Group A were 2 cases of anterior dislication of lunate and 8 cases of perilunate dislocation Group B were 5 cases of transscaphoid perilunate fracture-dislocation. The direction of perilunar dislocation with or without scaphoid fracture was posterior in all cases. 2.The causes of injury were fall from height in 7 cases, slip in 3 cases, traffic accident in 3 cases and crushing injury in 2 cases. 3.The overall clinical results by modified Green and OBriens clinical score were excellent in 4 cases(26.7%), good in 4 cases (26.7%),fair in 4 cases(26.7)and poor in 3 cases(20%). 4.9 out of 10 cases (90%) in Group A and 3 out of 5 cases(60%) in Group B were superior to fair. Early treatment within 3 days injury was performed in 11 cases (7 in Group A,4 in Group B), The average point was 85 and 70, respectively and there was no statisticat significance between two groups(P>0.05). Treatment was delayed beyond two weeks after injury due to missed initial diagnosis and open wound in 4 cases(3 in Group A,1 in Grdup B). The final tesults were 1 case of good, 1 case of fair, 1 case of poor in Group a, and 1 case of poor in Group B. There was no statistical significance between the early treatment cases and delayed treatment cases(P>0.05). In conclusion, ounate and perilunate dislocation without scaphoid fracture can be treated by early operation to get and maintain the anatomical reduction. The authors thought that the presence of scaphoid fracture, nonanatomic reduction and delay in treatment are poor prognostic factors.

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Case Report

Selective Arterial Thrombolysis with Urokinase in Popliteal Arterial Occlusion Developed after Total Hip Replacement Arthroplasty: Seung Koo Rhee, Kee Yong Ha, Nam Gee Lee, Jong Bum Park; J Korean Soc Fract 1995;8(1):79-83. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.79

Abstract PDF: A 60 year old patient with a sudden thromboembolic occlusion of ipsilateral popliteal artery on four days after the total hip replacement (THR) were treated with high-dose urokinase by direct intraarterial selective infusion. The cause of arterial occlusion after THR was not clear, but it was thought to be caused by spontaneous thrornboembolism in an elderly patient accompanied with diffuse arteriosclerosis, and this multifocal arteriosclerosis was caused not to perform the vein graft immediately. The initial infusion therapy with 4,000 IU/min for 2 hours of urokinase was failed but the second trial with same doses of urokinase in another 2 hours was succeed with complete clot lysis. Then 500,000 IU/24 hours of urokinase was infused again, and total 1,500,000 IU/28 hours was used in this patient. But massive internal bleeding from the operation site, hip joint, for more than 1,400 co was leaked because of bleeding tendency induced by extensive use of urokinase within short duration, and minor toe amputations should be performed on 2 weeks after thrombolysis because of distal migration of small thromboembolic particles. It was suggested that the peripheral arterial occlusion resulting from thromboembolism after joint replacement, especially in an elderly patient with diffuse arteriosclerosis, could develop, and it could be successfully treated with an initially high-dose urokinase regimen if it is detected earlier, rather than vein graft or amputation.

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