Journal of Musculoskeletal Trauma

Osteoporotic Hip Fracture: How We Make Better Results?: Byung-Chan Choi, Kyung-Jae Lee; J Korean Fract Soc 2024;37(1):52-59. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.52

Abstract PDF: The prevalence of osteoporosis and incidence of osteoporotic fractures is increasing gradually as life expectancy is prolonged and the aged population increases. Osteoporotic hip fractures (femoral neck fractures and femoral intertrochanteric fractures) have high mortality because the patients with these fractures are elderly and have several comorbidities. Thorough preparation and a multidisciplinary approach in the preoperative period are critical, and early surgery is recommended. There are also several principles to treat osteoporotic hip fractures and prevent fixation failures. Many studies have suggested various treatment methods for femoral neck fractures and femoral intertrochanteric fractures. Functional recovery treatment is essential based on the patient’s health and activity levels. Finally, aggressive management of osteoporosis and the prevention of falling is needed to treat osteoporotic hip fractures successfully.

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Risk Factors of Fixation Failure in Femoral Neck Fractures: Sung Hyun Yoon, Kyu Beom Kim, Hyung Jun Lee, Kyung Wook Kim; J Korean Fract Soc 2023;36(4):118-124. Published online October 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.4.118

Abstract PDF: Purpose
Internal fixation after a femoral neck fracture (FNF) is one of the conventional treatment options for the young and active elderly patients. However, fixation failure of internal fixation is a probable complication. The treatment of fixation failure after a primary internal fixation of the FNF remains a challenge.
Materials and Methods
Between July 2002 and March 2017, 83 patients who underwent internal fixation after FNF were retrospectively analyzed. Radiological assessments, including Pauwels’ angle, fracture level, reduction quality, and bone union, were measured, preoperatively and postoperatively. Moreover, intraoperative variables such as time to surgery, surgical time, and estimated blood loss were also evaluated.
Results
The patients were divided into the fixation failure and the non-failure groups. Among the 83 patients, 17 cases (20.5%) of fixation failure after the primary internal fixation of the FNF were identi-fied. When comparing the two groups according to the radiographic data, Pauwels’ angle and the reduction quality based on Garden’s angle showed significant differences (p<0.001). Moreover, when comparing the intraoperative variables, unlike the surgical time and estimated blood loss, significant differences were noted in the time interval from injury to surgery and specifically in whether the surgery was performed within 12 hours after injury (p<0.001).
Conclusion
Pauwels’ angle, reduction quality, and time to surgery are the major factors that can predict the possibility of internal fixation failure of the FNF. Early and accurate anatomical reduction is needed to decrease complications after the internal fixation of the FNF.

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Comparison of Clinical Outcomes for Femoral Neck System and Cannulated Compression Screws in the Treatment of Femoral Neck Fracture: Jae Kwang Hwang, KiWon Lee, Dong-Kyo Seo, Joo-Yul Bae, Myeong-Geun Song, Hansuk Choi; J Korean Fract Soc 2023;36(3):77-84. Published online July 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.3.77

Abstract PDF: Purpose
This study compared the clinical and radiological results of the femoral neck system (FNS) and cannulated compression screws (CCS) for the fixation of femoral neck fractures.
Materials and Methods
Patients who underwent FNS or CCS internal fixation for femoral neck fractures between January 2016 and January 2022 were analyzed retrospectively. The hip joint function using the Harris hip score (HHS) was evaluated three months and one year after surgery. The operation time, fracture healing time, and associated surgical complications in the two groups were compared and analyzed statistically.
Results
Seventy-nine patients were categorized into 38 FNS and 41 CCS groups. The FNS group had a longer operation time and higher postoperative HHS at three months (p<0.01). Femoral neck shortening was lower in the FNS group (p=0.022). There were no significant differences in the fracture healing time and other complications.
Conclusion
There were no differences in most clinical outcomes and complications between the two groups except for the three-month HHS and femoral neck shortening. This study suggests that FNS could be an alternative to CCS for treating femoral neck fractures.

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Computational Simulation of Femoral Neck System and Additional Cannulated Screws Fixation for Unstable Femoral Neck Fractures and the Biomechanical Features for Clinical Applications: Ju-Yeong Kim; J Korean Fract Soc 2023;36(1):1-9. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.1

Abstract PDF: Purpose
To identify the biomechanical features for clinical applications through a computational simulation of the fixation of the Femoral Neck System (FNS) with additional cannulated screws for a Pauwels type III femoral neck fractures.
Materials and Methods
Thirty cadaveric femurs underwent computed tomography, and the images were transferred to the Mimics^® program, resulting in three-dimensional proximal femur models. A three-dimensional scan of the FNS and 6.5 mm and 7.0 mm cannulated screws was performed to enable computerized virtual fixation of FNS with additional cannulated screws for unstable femoral neck fractures. Furthermore, the cannulated screw used for additional fixation was modeled and used as a cylinder within the Ansys program. The biomechanical characteristics of these models were investigated by applying a physiological load virtually.
Results
The maximum von Mises stress value at bone was 380.14 MPa in FNS and 297.87 MPa in FNS+7.0 mm full-thread cannulated screw. The maximum von Mises stress value at FNS was 786.83 MPa in FNS and 435.62 MPa in FNS+7.0 mm full-thread cannulated screw. The FNS group showed the highest maximum von Mises stress values at bone and FNS. For total deformation, the maximum deformation value was 10.0420 mm in FNS and 9.2769 mm in FNS+7.0 mm full-thread cannulated screws. The FNS group represented the highest maximum deformation compared to the other groups.
Conclusion
Considering the anatomical spatiality and biomechanical characteristics of the FNS in unstable femoral neck fractures, when one 7.0 mm full thread cannulated screw was also fixed to the anterosuperior portion of the FNS, significant biomechanical stability was demonstrated.

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Insufficiency Fracture of Simultaneously Bilateral Femur Neck in Patient Treated with Long-Term Bisphosphonate Treatment - A Case Report -: Seong Kee Shin, Hyung Gon Ryu, Dae Won Shin, Beom Su Han; J Korean Fract Soc 2022;35(3):109-113. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.109

Abstract PDF: Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary.

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Mortality-Related Risk Factors in Total Hip Arthroplasty for Femoral Neck Fractures in Elderly Patients: Jae Sung Suh, Hyung Gon Ryu, Young Ju Roh, Dae Won Shin; J Korean Fract Soc 2022;35(2):51-56. Published online April 30, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.2.51

Abstract PDF: Purpose
Total hip arthroplasty (THA) using dual mobility components (DMC) is a reasonable surgical option for displaced femoral neck fractures in elderly patients, resulting in lower dislocation rates and improved stability. The purpose of this study was to investigate the clinical outcomes and risk factors responsible for mortality in elderly patients who were diagnosed with a displaced femoral neck fracture and had undergone DMC-THA.
Materials and Methods
Out of 147 cases of THA from December 2018 to June 2020, a total of 79 cases were enrolled in this study, with the following characteristics: (1) Garden stage III or IV, (2) over 75 years of age, and (3) over 1 year of follow-up. All the patients received DMC-THA surgery using the anterolateral approach.
Results
The mean follow-up period was 15.0±8.43 months and a total of one dislocation case was observed. The mortality rate was 17.7% (14/79), and it was especially higher in patients with a past medical history of malignancy (odds ratio [OR]=7.18, p=0.03) or a cognitive disorder such as dementia (OR=5.48, p=0.03). Preoperative low initial hemoglobin levels (OR=0.65, p=0.04) and low UCLA (Uni-versity of California at Los Angeles) score (OR=0.47, p=0.02) were also associated with mortality.
Conclusion
When considering THA as a treatment approach in elderly patients with a displaced femoral neck fracture, a high mortality rate is expected in patients with low preoperative hemoglobin levels or a history of malignancy or cognitive disorders. Hence, thorough monitoring and management should be undertaken before and after surgery.

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Pediatric Femoral Neck Fracture: Joo Hyung Han, Hoon Park; J Korean Fract Soc 2021;34(1):34-43. Published online January 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.1.34

Abstract PDF: Pediatric femoral neck fracture is an uncommon injury with a high complication rate, regardless of the appropriate diagnosis and management. The bony anatomy and blood supply of the proximal femur in a skeletally immature patient differ from those in adult patients. Generally, these fractures result from high-energy trauma, but pathologic hip fractures also occur, usually from low-energy trauma. Pediatric femoral neck fractures are categorized using the Delbet classification system. This classification guides management and aids clinicians in determining the risk of avascular osteonecrosis. The ideal surgical treatment is determined by the fracture type and the age of the patient. Reduction, which is achieved using a closed or open procedure, combined with stable fixation and/or cast immobilization, is recommended for most of these fractures. Anatomical reduction within 24 hours from the injury may result in a good surgical outcome. Although the effects of capsular decompression after reduction and fixation have not been established, decompression is easy to perform and may reduce the risk of avascular necrosis. Despite appropriate management, osteonecrosis can occur after all types of pediatric femur neck fractures. Other complications include coxa vara, nonunion, and premature physeal arrest.

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Clinical Outcomes of Customized Staple Fixation Using K-wire in Metacarpal Base or Neck Fractures: Hong-ki Jin, Hyoung Min Kim, Yong Seung Oh, Jihoon Kim; J Korean Fract Soc 2021;34(1):23-29. Published online January 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.1.23

Abstract PDF

Purpose
This study was designed to evaluate the radiological and clinical outcomes of a new surgical technique—customized staple fixation using K-wire—in displaced metacarpal neck or base fractures. Materials and Methods: From November 2016 to May 2017, 13 unstable metacarpal neck and base fractures (10 patients) were treated with II-shaped customized K-wire staples fixation, after performing open reductions through minimal dorsal incisions. The radiological and clinical outcomes were retrospectively evaluated. Results: A mean of 2.6 staples were used for each fracture fixation. Preoperative angulation of 36.3°was reduced to 3.1° postoperatively. A week after surgery, the volar short arm splint was replaced with a dorsal splint to initiate active range of motion exercise, and the splint was subsequently removed after 3 weeks. The radiologic union was achieved at a mean of 5.1 weeks, and total active motion was recovered at a mean of 7.4 weeks. On a mean, K-wire staples were removed at 16.5 weeks after the surgery, and the mean treatment took 18.6 weeks. At the final follow-up (at mean 27.3 weeks), no significant difference was observed for total active motion of the digits and grip strength, when compared to the contralateral hand. Complete union was achieved in all fractures without deformity, or complications such as infection or nerve injury. All patients were satisfied with the cosmetic and functional outcomes. Conclusion: K-wire stapling is an effective alternative modality in treating unstable displaced metacarpal neck or base fractures. It requires minimal incision to enable open reduction. In addition, early mobilization is ensured through the rigid fixations. Moreover, it prevents postoperative joint stiffness and reduces the time needed for treatment.

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Individualized herbal prescriptions for delayed union: A case series
Jiyoon Won, Youngjin Choi, Lyang Sook Yoon, Jun-Hwan Lee, Keunsun Choi, Hyangsook Lee
EXPLORE.2023; 19(2): 260. CrossRef

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Clinical Outcomes and Radiologic Characteristics of Insufficiency Femoral Neck Fracture in Elderly Patients: Hee-Uk Ye, Kyung-Jae Lee, Byung-Woo Min, Kyung-Hwan Lim, Beom-Soo Kim, Young-Hoon Kim; J Korean Fract Soc 2021;34(1):1-7. Published online January 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.1.1

Abstract PDF: Purpose
In elderly patients, femoral neck insufficiency fractures that occur without a history of trauma are difficult to diagnose and treat, so it is emphasized that early suspicion of fractures and additional diagnostic tests are conducted. Materials and Methods: Between December 2010 to December 2019, 12 femoral neck insufficiency fractures (group 1) were evaluated by comparing them with 50 traumatic femoral neck fractures of a similar age. Along with demographic data, neck cortical thickness, shaft cortical thickness, head diameter, neck width, trochanter width, shaft width, neck-shaft angle, hip axis length, femoral neck index on the simple radiographic image were compared. Results: Seven of the 12 cases were non-displaced fractures, and it took an average of 19.2 days to diagnose the fracture after the symptoms occurred. The height was smaller than the control group at 149.1 cm in group 1 and 157.2 cm in group 2 (p<0.001). The cortical thickness of the medial femoral neck showed significant differences between the two groups: 3.16 mm in group 1 and 4.11 mm in group 2 (p=0.004). There was no statistical difference in the other measurements. Conclusion: Femoral neck insufficiency fracture often has a delayed diagnosis because of the characteristics of the fracture. The cortical thickness of the medial femoral neck in simple radiographic images can help suspect femoral insufficiency fractures in elderly patients when considered with detailed medical history taking and a physical examination.

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Rare Experience of Bilateral Femoral Neck and Shaft Fractures - A Case Report -: DaeHyun Choe, Jae-Ho Lee, Ki-Chul Park; J Korean Fract Soc 2020;33(3):154-158. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.154

Abstract PDF: Ipsilateral fractures of the femoral neck and shaft are relatively common injuries and accompany 2% to 9% of all femoral shaft fractures. On the other hand, it is extremely rare for these injuries to occur bilaterally. This paper reports the authors’ experience of a case with bilateral femoral neck and shaft fractures. The patient sustained multiple injuries, including liver laceration with hemoperitoneum, bilateral open fractures of the tibia, and bilateral femoral neck, and shaft fractures caused by a high-speed motor vehicle accident. Under the circumstances, damage-control orthopedic principles were applied, and external fixators were initially placed. After the patient’s general condition showed improvement, both femurs were fixed with a reconstruction nail. Fracture healing was achieved without complications, such as avascular necrosis of the femoral head. Despite the rare occurrence, this paper describes this case because these injuries must be managed with meticulous attention.

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Computational Simulation of Multiple Cannulated Screw Fixation for Femoral Neck Fractures and the Anatomic Features for Clinical Applications: Jin Hoon Jeong, Gu Hee Jung; J Korean Fract Soc 2018;31(2):37-44. Published online April 30, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.2.37

Abstract PDF

PURPOSE
To identify the anatomic features for clinical applications through a computational simulation of the fixation of three cannulated screws for a femoral neck fracture.
MATERIALS AND METHODS
Thirty cadaveric femurs underwent computed tomography and the images were transferred to the MimicsÂ® program, resulting in three-dimensional proximal femur models. A three-dimensional scan of the 7.0 mm cannulated screw was performed to enable computerized virtual fixation of multiple cannulated screws for femoral neck fractures. After positioning the screws definitively for cortical support, the intraosseous position of the cannulated screws was evaluated in the anteroposterior image and axial image direction.
RESULTS
Three cannulated screws located at the each ideal site showed an array of tilted triangles with anterior screw attachment and the shortest spacing between posterior and central screws. The central screw located at the lower side was placed in the mid-height of the lesser trochanter and slightly posterior, and directed toward the junction of femoral head and neck to achieve medial cortical support. All the posterior screws were limited in height by the trochanteric fossa and were located below the vastus ridge, but the anterior screws were located higher than the vastus ridge in 10 cases. To obtain the maximum spacing of the anterior and posterior screws on the axial plane, they should be positioned parallel to the cervical region nearest the cortical bone at a height not exceeding the vastus ridge.
CONCLUSION
The position of cannulated screws for cortical support were irregular triangular arrangements with the anterosuperior apex. The position of the ideal central screw in the anteroposterior view was at the mid-height of the lesser trochanter toward the junction of the femoral head and neck, and the anterior and posterior screws were parallel to the neck with a maximal spread just inferior to the vastus ridge.

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Computational Simulation of Femoral Neck System and Additional Cannulated Screws Fixation for Unstable Femoral Neck Fractures and the Biomechanical Features for Clinical Applications
Ju-Yeong Kim
Journal of the Korean Fracture Society.2023; 36(1): 1. CrossRef

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Insufficiency Fracture of the Femoral Neck after Intramedullary Nailing for the Treatment of Atypical Femoral Fracture - A Case Report -: Nam Hoon Moon, Jae Hoon Jang, Tae Hyuk Hwang, Ki Young Park; J Korean Fract Soc 2016;29(4):258-264. Published online October 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.4.258

Abstract PDF: Although several publications have reported delayed or non-union, there is a consensus that the standard treatment for atypical femoral fracture (AFF) is an intramedullary nailing. However, no case of tensile insufficiency fracture of femoral neck associated with intramedullary nailing in patients with AFF have been reported. Here, we report an 82-year-old woman with tensile type of insufficiency fracture of the femoral neck after intramedullary nailing for the treatment of AFF.

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Fracture of the Talus: Tae Jung Bang, Sun Kyu Kim, Hyung Jin Chung; J Korean Fract Soc 2016;29(3):213-220. Published online July 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.3.213

Abstract PDF: Although talus fractures are uncommon, proper management is important because they are often associated with severe complications. Talar neck and body fractures occupy most of the talar fractures. It remains controversial whether talar neck fractures require emergent or elective treatment. Elective definitive fixation, however, may reduce risks of wound complications. Many surgeons recommend dual surgical approachesâ€”anteromedial and anterolateralâ€”to allow accurate visualization and anatomic reduction. Although there are various methods of fixation, the use of plates is necessary in comminuted talar fractures. Outcomes may vary and will be dependent on the degree of the initial fracture displacement. It is necessary to restore articular congruency and axial alignment for normalizing hindfoot function. Common complications include posttraumatic arthritis, avascular necrosis, malunion, and nonunion.

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The Result of Open Reduction and Mini-Plate Fixation for Displaced Talar Neck Fracture: Woong Chae Na, Sang Hong Lee, Jun Young Lee, Sang Jun Lee, Boseon Kim; J Korean Fract Soc 2015;28(4):215-222. Published online October 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.4.215

Abstract PDF

PURPOSE
We evaluated the complications, radiological and clinical results after operative treatment using a mini-plate for fixation of displaced talar neck fractures.
MATERIALS AND METHODS
There were 20 cases of displaced talar neck fractures from May 2006 to December 2011; we performed a retrospective chart review of 15 patients treated by open reduction and internal fixation using a mini-plate who had more than 2 years of follow-up. According to Hawkin's classification, there were 7 cases of type II fractures and 8 cases of type III fractures. During postoperative 12-16 weeks we checked magnetic resonance imaging. The assessment of clinical results was based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.
RESULTS
Mean union period was 11.6 weeks (10-15 weeks). Nonunion and malunion did not occur in all cases. The mean AOFAS score was 88.2 points (80-97 points). There were 5 cases of avascular necrosis. Of these, there were 3 cases of body collapse and 4 cases of post-traumatic arthritis. In the statistical analysis, there was no correlation between the elements including gender, Hawkin's classification and union rates and clinical results.
CONCLUSION
Mini-plate fixation of a displaced talar neck fracture is thought to be a good technique, with a low rate of malunion and also showed satisfactory results in radiological and clinical assessment.

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Outcome of Type 3 Talar Neck Fractures by Means of Medial Malleolar Osteotomy and Large Distractor
Sung Hae Park, Jun Young Lee, Jung Woo Lee
Journal of the Korean Orthopaedic Association.2019; 54(1): 45. CrossRef
The Measurement of Normal Talus in Korean Cadaver
Dong-Jun Ha, Heui-Chul Gwak, Jeon-Gyo Kim, Jung-Han Kim, Chang-Rak Lee, Young-Jun Kim, Jeong-Han Lee, Byung-Ho Ha, Ui-Cheol Kim
Journal of Korean Foot and Ankle Society.2016; 20(4): 163. CrossRef

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Treatment for Concurrent Ipsilateral Femoral Neck and Shaft Fractures Using Reconstruction Nail with Temporary K-Wires: Sang Joon Lee, Sang Hong Lee, Sang Ho Ha, Gwang Chul Lee; J Korean Fract Soc 2015;28(1):23-29. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.23

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the results of operative treatment using a reconstruction nail after temporary K-wire fixation of the femoral neck for ipsilateral femoral neck and shaft fractures.
MATERIALS AND METHODS
A total of 11 cases were treated, which were followed-up for more than two years, between August 2007 and July 2012. The average age was 51 years (29-69 years) and men were dominant counting eight cases. All cases were operated with a reconstruction nail after temporary K-wire fixation of the femoral neck. Bone union periods, alignment, etc. were evaluated by radiological methods and accompanying damage and complications were also investigated. Functional evaluation was performed in accordance with Friedman and Wyman criteria at the last follow-up.
RESULTS
The average time for union of the femoral shaft was 22.5 weeks (12-32 weeks), and femoral neck was 13.1 weeks (8-20 weeks). There was no nonunion, and four femoral shaft fractures resulted in delayed union. There was one case of leg length discrepancy more than 2 cm long, but malalignment of more than 10 degrees was not observed. Avascular necrosis of the femoral head did not occur. Functional results were good in eight cases, fair in two cases, and poor in one case.
CONCLUSION
Treatment with reconstruction nailing after temporary K-wire fixation of the femoral neck is thought to be a good method which prevents neck displacement and has low complication rates.

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Treatment of 5th Metacarpal Neck Fracture Using Percutaneous Transverse Fixation with K-Wires: Jae Hak Jung, Kwan Hee Lee, Yong Ju Kim, Woo Jin Lee, Sung Hyun Choi; J Korean Fract Soc 2012;25(4):317-322. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.317

Abstract PDF: PURPOSE
To evaluate the radiologic and clinical results of percutaneous transverse fixation with K-wires for 5th metacarpal neck fracture.
MATERIALS AND METHODS
Between January 2007 and September 2010, 18 patients with a 5th metacarpal neck fracture, who underwent operative treatment, were included in this study. The surgical method was percutaneous transverse fixation using K-wires. We evaluated fracture angulation in oblique radiographs preoperatively, postoperatively, and at final follow-up, and used SPSS to perform statistical analysis. We also performed clinical evaluation using the Disabilities of the Arm, Shoulder and Hand (DASH) score.
RESULTS
All of the 18 cases were completely united, and in the oblique radiographs, the angulation was corrected from 50.69degrees to 11.68degrees. The average difference between postoperative and final follow-up angulations was 0.14degrees, which was statistically insignificant. Clinically, the DASH score was 1.030 and no complications were observed.
CONCLUSION
Percutaneous transverse fixation using K-wires could be one of the best ways to treat a 5th metacarpal neck fracture because of its simple method and low rate of complications.

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Simultaneous Bilateral Proximal Femoral Fracture associated with Generalized Tonic-Clonic Seizure: A Case Report: Sang Hoo Lee, Kyeong Seop Song, Seung Joo Jeon, Seong Hwan Hong; J Korean Fract Soc 2012;25(1):69-72. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.69

Abstract PDF: Simultaneous bilateral proximal femoral fractures are extremely rare, and a few have been reported in and outside the country. It may have various causes, and most cases were associated with major trauma, repetitive minor trauma, seizure, parathyroid or renal dysfunction, and anti-epileptic medications. We experienced a case of simultaneous bilateral proximal femoral fractures after generalized tonic-clonic seizure in a 70-year-old female. Herein, we report it with a review of the literature.

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Antegrade Intramedullary Prebent K-wire Fixation for the 5th Metacarpal Neck Fracture: Tae Hyung Kim, Bo Hyeon Kim, In Ho Jung, Dong Hyun Kim; J Korean Fract Soc 2011;24(1):67-72. Published online January 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.1.67

Abstract PDF

PURPOSE
To evaluate radiological and clinical results of the antegrade intramedullary prebent K-wire fixation for the 5th metacarpal neck fracture.
MATERIALS AND METHODS
Between January, 2006 and December, 2009, 31 patients with displaced neck fracture of the fifth metacarpal who received antegrade intramedullary prebent K-wire fixation were included in this study. Radiological and clinical outcome evaluations were performed.
RESULTS
All the fractures were completely united. In the oblique radiographs, the average of preoperative angulation was corrected from 38.9degrees to 4.4degrees. The average difference between postoperative and final follow-up was 1.2degrees. Clinical outcomes were satisfactory except for one patient who had sustained ulnar nerve dorsal branch injury during surgery.
CONCLUSION
Antegrade intramedullary prebent K-wire fixation may be preferentially considered as one of the best ways to fix the displaced neck fractures of the fifth metacarpal.

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Clinical Outcomes of Customized Staple Fixation Using K-wire in Metacarpal Base or Neck Fractures
Hong-ki Jin, Hyoung Min Kim, Yong Seung Oh, Jihoon Kim
Journal of the Korean Fracture Society.2021; 34(1): 23. CrossRef

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Comparison of Bone Mineral Density in Elderly Patients over 65 Years according to Presence and Types of Hip Fracture: Myung Ho Kim, Moon Jib Yoo, Joong Bae Seo, Hyun Yul Yoo, Sang Young Moon; J Korean Fract Soc 2010;23(3):263-269. Published online July 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.3.263

Abstract PDF

PURPOSE
We measured the BMD of elderly patients with osteoporotic hip fracture in order to understand the relationship between BMD of each sites and hip fracture occurrence or the types, and also to suggest a reference point for starting an osteoporosis treatment program.
MATERIALS AND METHODS
From July 2007 to February 2010, we investigated total 147 elderly osteoporotic hip fracture patients over 65 years. For control group, 80 patients who were over 65-year-old and did not have any fracture were selected. BMD was compared at each site between each groups statistically.
RESULTS
In the comparison of femur intertrochanter and neck fracture groups, BMD of femur neck and trochanter areas and L2, L3 areas were significantly less in intertrochanteric fracture group. In the analysis according to the classification of intertrochanteric fracture, BMD of intertrochanter and Ward's triangle area were significantly less in unstable fracture group than stable one. Each of the fracture threshold of intertrochanteric and neck fracture group was -1.10 and -1.36 of the T-score in proximal femur, and -1.40 and -1.40 of the T-score in lumbar vertebrae.
CONCLUSION
To examine the BMD of both proximal femur and lumbar vertebrae areas is helpful to predict the hip fracture occurrence and the type of hip fracture. And for the prevention of hip fracture in elderly patients over 65 years, we propose that the aggressive treatment of osteoporosis should be started to prevent fracture for patients with a T-score less than -1.40.

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Risk factors affecting hip fracture patterns in an elderly Korean patient population
Sug Hun Che, Myung-Rae Cho, Patrick Michael Quinn, Suk-Kyoon Song
Medicine.2023; 102(33): e34573. CrossRef
Does Fracture Severity of Intertrochanteric Fracture in Elderly Caused by Low-Energy Trauma Affected by Gluteus Muscle Volume?
Byung-Kook Kim, Suk Han Jung, Donghun Han
Hip & Pelvis.2022; 34(1): 18. CrossRef

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Internal Fixation for Femoral Neck Fracture in Patients between the Ages of Twenty and Forty Years: Ui Seoung Yoon, Jin Soo Kim, Hak Jin Min, Jae Seong Seo, Jong Pil Yoon, Joo Young Chung; J Korean Fract Soc 2010;23(1):1-5. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.1

Abstract PDF

PURPOSE
To retrospectively analysis of results of operatively treatment for femoral neck fracture occurred in twenties to thirties.
MATERIALS AND METHODS
20 patients were selected whom we were able to follow up at least 2 years after internal fixation for femoral neck fracture in twenties to thirties from 1998 to 2005. Mean age was 32.2 (21~39) and average follow up period was 26.3 (24~45) months. According to preoperative X-ray, there were 6 cases for Garden classification stage I, 10 for stage II and 4 for stage III, and 7 cases for subcapital fracture, 9 for transcervical fracture, 4 for basicervical fracture. In all cases, operations were performed within 12 hours after the injury. The operations were done after satisfying reduction with the Garden alignment index, with three cannulated screws for internal fixation. Postoperative results were analyzed by clinical symptoms and radiological examinations during follow up periods.
RESULTS
In immediately postoperative radiological examination, satisfying anatomical reduction with Garden alignment index was obtained in all cases, and unions were obtained within 4.5 months after the operation (3~6 month). Avascular necrosis of femoral head occurred in 7 cases of all patients (35.0%). The average time of occurrence of avascular necrosis of femoral head after operation was 10.7 months (9~15 months). Avascular necrosis was occutted 5 (31.3%) in fracture without displacement (Garden stage I, II), 2 (50.0%) in fracture with displacement (Garden stage III) and 4 in subcapital fracture, 3 in transcervical fracture.
CONCLUSION
The incidence of avascular necrosis of femoral head after the operation for displaced and nondisplaced femoral neck fracture between twenties and forty years was no significant difference.

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Comparison of Clinical Outcomes for Femoral Neck System and Cannulated Compression Screws in the Treatment of Femoral Neck Fracture
Jae Kwang Hwang, KiWon Lee, Dong-Kyo Seo, Joo-Yul Bae, Myeong-Geun Song, Hansuk Choi
Journal of the Korean Fracture Society.2023; 36(3): 77. CrossRef

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Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures: Tae Ho Kim, Jong Oh Kim, Sung Sik Kang; J Korean Fract Soc 2009;22(2):79-84. Published online April 30, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.2.79

Abstract PDF: PURPOSE
To evaluate the factors predicting complications after internal fixation using multiple cannulated screws in the patients with femoral neck fracture, the authors performed a comparative study of a success group and a failure group and reviewed the literature.
MATERIALS AND METHODS
Sixty-eight patients with intracapsular femoral neck fractures were treated by multiple pinning from January 2000 to July 2007 and followed up more than one year. Relationships between the complications such as failure of union, collapse of femoral head due to osteonecrosis of femoral head and several affecting factors including the degree of displacement by Garden stage, state of reduction, position of screws, patient's age, time interval from injury to operation, anatomical fracture site and two weeks postoperative (99m)Tc-MDP bone scan were analyzed.
RESULTS
Statistically significant factors were the degree of displacement by Garden stage (p<0.001), reduction state (p<0.001) and postoperative two weeks (99m)Tc-MDP bone scan (p<0.001).
CONCLUSION
An accurate anatomical reduction is needed to decrease complications with multiple cannulated screws fixation of femoral neck fracture. Displacement of fracture by Garden stage and (99m)Tc-MDP bone scan are major factors predicting complications.

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Bipolar Hemiarthroplasty for the Femoral Neck Fractures in Elderly Patients: Woong Kyo Jeong, Sang Won Park, Soon Hyuck Lee, Jong Hoon Park, Suk Ha Lee, Ji Hoon Kang, Gi Won Choi, Won Noh; J Korean Fract Soc 2008;21(1):8-12. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.8

Abstract PDF: PURPOSE
To evaluate the clinical results of bipolar hemiarthroplasty in elderly patients more than 65 years of age with a femoral neck fracture.
MATERIALS AND METHODS
Forty-six bipolar hemiarthroplasties in 43 patients more than 65 years of age which could be followed more than 3 years were included in this study. The clinical outcomes were evaluated using Harris hip score, pain score and support score. The radiological results were analyzed by femoral stem loosening and bipolar cup migration.
RESULTS
The average Harris hip score was 88.7 (62~96) points. An excellent score was recorded in 34 cases, good in 7 cases, fair in 3 cases and poor in 2 cases. The average pain score was 39.3 points and there were no pain in 20 cases, slight pain in 17 cases, mild pain in 6 cases and moderate pain in 2 cases. The average support score was 9.6 points and 32 patients could walk without the use of any assistive devices. Two cases were converted to total hip arthroplasty due to femoral stem loosening with or without bipolar cup migration.
CONCLUSION
For the early ambulation and functional recovery of elderly patients with femoral neck fracture, bipolar hemiarthroplasty was considered as one of recommendable methods.

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Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture: Chang Wug Oh, Jong Keon Oh, Woo Kie Min, Shin Yoon Kim, Seung Hoon Baek, Byung Chul Park, Hyung Soo Ahn, Tae Gong Kim; J Korean Fract Soc 2007;20(2):135-140. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.135

Abstract PDF

PURPOSE
To compare retrospectively the antegrade and retrograde nailing in the management of ipsilateral femoral neck and shaft fractures.
MATERIALS AND METHODS
Thirty-two patients (thirty-three injuries) were included in this study. Mean age of patients was 38 years-old in the antegrade nailing group (16 injuries) and 44 years-old in the retrograde nailing group (17 injuries). We compared the union of fractures and complications between two groups, and investigated the influencing factors.
RESULTS
Femoral shaft fracture was united in 10 cases (63%) of antegrade group and 12 cases (71%) of retrograde group, at 28.2 and 27.3 weeks respectively. Nonunion was more prevalent in Winquist-Hansen III and IV (5 in antegrade nailing, 3 in retrograde nailing) than I and II. Femoral neck fracture was united with 1 case of nonunion in each group. Nonunion developed from Garden stage IV, but fractures of Garden stage I and II united regardless of methods.
CONCLUSION
In ipsilateral femoral neck and shaft fractures, the kinds of methods did not affect the results of shaft fractures. Minimally displaced neck fractures also were not influenced by kinds of methods, but retrograde nailing may have a benefit in fixing the displaced neck fractures

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Surgical management of bifocal femoral fractures: a systematic review and pooled analysis of treatment with a single implant versus double implants
J. D. Cnossen, Esther M. M. Van Lieshout, Michael H. J. Verhofstad
Archives of Orthopaedic and Trauma Surgery.2023; 143(10): 6229. CrossRef
Retrograde Intramedullary Nailing or the Treatment of Segmental Femoral Shaft Fracture Including Distal Part
Jong-Ho Yoon, Byung-Woo Ahn, Chong-Kwan Kim, Jin-Woo Jin, Ji-Hoon Lee, Hyun-Ku Cho, Joo-Hyun Lee
Journal of the Korean Fracture Society.2009; 22(3): 145. CrossRef
The Treatment of IM Nailing of Femoral Shaft Fracture: Piriformis Fossa versus Trochanteric Entry Portal
Hyun Kook Youn, Oog Jin Shon, Dong Sung Han
Journal of the Korean Fracture Society.2008; 21(3): 200. CrossRef

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Bouquet Pin Intramedullary Nail Technique of the 5th Metacarpal Neck Fractures: Myung Ho Kim, Moon Jib Yoo, Jong Pil Kim, Ju Hong Lee, Jin Won Lee; J Korean Fract Soc 2007;20(1):64-69. Published online January 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.1.64

Abstract PDF

PURPOSE
To evaluate radiologic and clinical results of bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture.
MATERIALS AND METHODS
Between April, 2005 and February, 2006, 17 patients treated by bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture were evaluated. All patients were reviewed clinically and radiologically after operation.
RESULTS
All of 17 cases of fractures were completely united. In the anteroposterior radiographs, the average of preoperative angulation was corrected from 34.4Â° to 5.2Â°. Also, in the oblique radiographs, radiographic results of angulation correction were satisfactory which was corrected from 44.2Â° to 11.7Â°. Although, the averages of difference between postoperative and final follow-up angulations were 1.5Â° in the anteroposterior radiographs and 0.9Â° in the oblique radiographs, they were not statistically different. All patients were excellent clinically except 1 patient who has moderate joint stiffness after operation.
CONCLUSION
Selecting of appropriate patients who is indicated, bouquet pin intramedullary nail technique for the 5th metacarpal neck fracture could be a good treatment method without complications.

Citations

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Percutaneous retrograde intramedullary single wire fixation for metacarpal shaft fracture of the little finger
Soo-Hong Han, Seung-Yong Rhee, Soon-Chul Lee, Seung-Chul Han, Yoon-Sik Cha
European Journal of Orthopaedic Surgery & Traumatology.2013; 23(8): 883. CrossRef
Treatment of 5th Metacarpal Neck Fracture Using Percutaneous Transverse Fixation with K-Wires
Jae-Hak Jung, Kwan-Hee Lee, Yong-Ju Kim, Woo-Jin Lee, Sung-Hyun Choi
Journal of the Korean Fracture Society.2012; 25(4): 317. CrossRef
Antegrade Intramedullary Prebent K-wire Fixation for the 5th Metacarpal Neck Fracture
Tae-Hyung Kim, Bo Hyeon Kim, In-Ho Jung, Dong-Hyun Kim
Journal of the Korean Fracture Society.2011; 24(1): 67. CrossRef
Percutaneous Retrograde Intramedullary Pin Fixation for Isolated Metacarpal Shaft Fracture of the Little Finger
Soo Hong Han, Hyung Ku Yoon, Dong Eun Shin, Seung Chul Han, Young Woong Kim
Journal of the Korean Fracture Society.2010; 23(4): 367. CrossRef

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The Operative Treatment of Radial Head or Neck Fracture: The Sub-classification of Mason Type II Fracture: Hyun Dae Shin, Kyung Cheon Kim, Se Min Woo, Yong Bum Joo, Dong Kyu Kim; J Korean Fract Soc 2006;19(4):449-453. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.449

Abstract: PURPOSE
To evaluate the results of treatment according to the sub-classification of the Mason type II fracture.
MATERIALS AND METHODS
From 1999 to 2003, according to the sub-classification of the Mason type II fracture, 33 patients were treated with miniplate in displaced neck fracture (IIa), with compression screw in displaced head fracture (IIb), with miniplate and/or compression screw in displaced head and neck fracture (IIc), with compression screw and miniplate in comminution fracture (III) or excision of head in irreducible state. The clinical results were evaluated by An and Morrey's functional rating index.
RESULTS
Functional rate score averaged 92.7 in type IIa, 88.4 in IIb, 86.4 in IIc, 83.5 in type III with reduced fracture, 75.0 in type III with excised head, and 75.5 in type IV. Complications included heterotopic ossification (2 cases), metal loosening (1 case), malunion (1 case), partial ankylosis of elbow (3 cases), posttraumatic arthritis (1 case).
CONCLUSION
These results supported the recommendation for internal fixation with compression screw in isolated radial head fracture (IIb) and with miniplate in fracuture combined with displaced neck (IIa, IIc, indicated some III). We concluded that sub-classification is useful for dicision making in radial head or neck fracture's treatment.

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Subtrochanteric Fracture after Cannulatd Screw Fixation of Femoral Neck Fracture in a Child: A Case Report: Moo Sam Seo, Han Seong Park, Dae Won Jeong; J Korean Fract Soc 2006;19(3):392-395. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.392

Abstract: Though femoral neck fractures in adults are usually treated by fixation with multiple screws, subtrochanteric fracture at the insertion site is an uncommon complication, and in children, there has been a few reports about this complication after treatment of slipped capital femoral epiphysis. We report a subtrochanteric fracture at the insertion site of cannulated screws used in femoral neck fracture of a 9-years old boy.

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Analysis of Affecting Factors of Fixation Failure of Femoral Neck Fractures Using Internal Fixation: Soo Jae Yim, Seung Han Woo, Min Young Kim, Jong Seok Park, Eung Ha Kim, Yoo Sung Seo, Byung Il Lee; J Korean Fract Soc 2006;19(3):297-302. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.297

Abstract

PURPOSE
To evaluate the factors which influence on the fixation failure after internal fixation using multiple cannulated screws in the patients with femoral neck fracture.
MATERIALS AND METHODS
Ninty-six patients (male: 63, female: 33) who underwent closed reduction and internal fixation of femoral neck fracture between Feb. 1994 and Jun. 2002 with use of multiple cannulated screws. The mean age was 68 years (17~90) and mean follow-up period was average 50 months (36 months~6 years). The fixation failure was defined by change in fracture position above 10 mm, change in each screws position above 5%, backing above 20 mm, or perforation of the head, respectively. They were evaluated with the age, gender, fracture type, accuracy of reduction, placement of screws, posterior comminution and also studied the risk factors which influenced nonunion and the development of avascular necrosis.
RESULTS
Twenty-four patients out of 96 patients had radiographic signs of fixation failure. The incidence of nonunion in the fixation failure group was 41% (10/24) and AVN was 33% (8/24). There were statistically significant correlations between fixation failure and nonunion and that posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion.
CONCLUSION
In case of femoral neck fracture of internal fixation using multiple cannulated screws, posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion and fixation failure.

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Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures
Joon Soon Kang, Kyoung Ho Moon, Joong Sup Shin, Eun Ho Shin, Chi Hoon Ahn, Geon Hong Choi
Clinics in Orthopedic Surgery.2016; 8(2): 146. CrossRef
Internal Fixation for Femoral Neck Fracture in Patients between the Ages of Twenty and Forty Years
Ui-Seoung Yoon, Jin-Soo Kim, Hak-Jin Min, Jae-Seong Seo, Jong-Pil Yoon, Joo-Young Chung
Journal of the Korean Fracture Society.2010; 23(1): 1. CrossRef
Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures
Tae-Ho Kim, Jong-Oh Kim, Sung-Sik Kang
Journal of the Korean Fracture Society.2009; 22(2): 79. CrossRef

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The Reliability of Proximal Femoral Shaft Fracture Classification: Sang Wook Lee, Sang Bong Ko, Myung Rae Cho, Ho Hyoung Lee; J Korean Fract Soc 2006;19(1):6-10. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.6

Abstract: PURPOSE
The Garden classification by which femur neck fracture is classified and the Boyd-Griffin classification by which trochanteric fracture is classified are studied on the reproducibility, repeatability, interobserver's and intraobserver's reliability and then reliability.
MATERIALS AND METHODS
56 cases in femoral neck fracture and 60 cases in trochanteric fracture who were operated from May 1999 to December 2003 were classified by three observers who are hip surgeon, orthopaedic surgeon and senior residentship doctors three times. Femur neck fracture was classified by Garden's method which used commonly and trochanteric fracture was classified by Boyd-Griffin method which is classified by the pattern of fracture and degree of comminution. We got the interobserver's and intraobserver's Kappa score using the Stata 7.0 statistically. The statistical analysis was made by Stata 7.0.
RESULTS
Garden classification in femur neck fracture showed moderate agreement in intraobserver reliability and fair agreement in interobserver reliability. Boyd-Griffin classification in trochanteric fracture showed substantial agreement in intraobserver reliability and moderate agreement in interobserver reliability.
CONCLUSION
Boyd-Griffin classification showed over moderate agreement but Garden classification showed fair agreement, so using Garden classification in femur neck fracture has some problem in reliability and application.

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Bilateral Femoral Neck Fractures in a Young Adult: A Case Report: Eea Sub Chung, Jae Kyu Park; J Korean Fract Soc 2005;18(4):478-480. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.478

Abstract PDF: Ipsilateral femur shaft and neck fractures are occurred by high energy trauma, usually in motor vehicle accidents or fall from a height. Simultaneous Ipsilateral femur shaft and neck fractures and contralateral femur neck fracture are not yet reported in Korea. Authors report a case of simultaneous bilateral femoral neck fractures combined with a ipsilateral femoral shaft fracture in a young adult treated with anatomical reduction, internal fixation and vascularized bone graft with a review of the literature.

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Cannulated Screw Fixation for 4 Part Fractures of the Neck of Humerus: Ho Jung Kang, Doo Hyung Lee, Hong Kee Yoon, Soo Bong Hahn; J Korean Fract Soc 2005;18(4):432-436. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.432

Abstract PDF

PURPOSE
To analyze radiological and functional results after open reduction and internal fixation for fractures of the neck of humerus (4-part) using cannulated screws. MATERIAL AND METHODS: Between January 1997 and April 2004, 11 patients with neck of humerus fracture (4-part) were treated operatively by open reduction and internal fixation with cannulated screws. Two surgical approaches (deltopectoral for 9 cases and deltoid splitting for 2 cases) were used. The mean age was 36 years old and the mean duration of follow-up was 56 months. ASES (American Shoulder and Elbow Surgeons) score was checked to evaluate the function in shoulder joint. We used 2 cannulated screws in 2 cases, 3~4 screws in 6 cases and over 5 screws in 3 cases for fixation. In 2 cases, K-wires were used additionally and autoiliac bone graft was done in 1 cases which had poor bone mass.
RESULTS
All cases got bony union at 5.6 months on average. In functional assessment of shoulder, eight patients got excellent, one got good points. There were complications including shoulder stiffness in 2 cases, avascular necrosis of humeral head in 1 case and subacromial impingement syndrome in 1 case.
CONCLUSION
Internal fixation using cannulated screws for fractures of humerus neck (4 part) showed good bony union and functional results in patients under 50 years old who had average bone quality.

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The Surgical Outcomes for Isolated Greater Tuberosity Fracture of Proximal Humerus
Eun-Sun Moon, Myung-Sun Kim, Young-Jin Kim
Journal of the Korean Fracture Society.2007; 20(3): 239. CrossRef

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