Journal of Musculoskeletal Trauma

Primary Open Reduction and Plate Fixation in Open Comminuted Intra-Articular Distal Radius Fracture: Jun-Ku Lee, Soonchul Lee, Weon Min Cho, Minkyu Kil, Soo-Hong Han; J Korean Fract Soc 2021;34(1):16-22. Published online January 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.1.16

Abstract PDF: Purpose
There are no standard surgical treatments for open distal radius fractures (DRFs), and the fracture fixator is chosen by the surgeon’s own experience. This study compared the outcomes of open reduction and volar locking plating (OR VLP) between closed and open AO-OTA type C3 DRFs. Materials and Methods: Patient data were retrospectively collected between January 2010 and December 2018. Only patients aged >18 years with AO-OTA C3 DRFs were included. After further exclusion, the patients with DRFs were divided into two groups: 13 patients with open DRFs in Group 1 and 203 patients with closed DRFs in Group 2. Data on the patient characteristics and treatment-related factors were further investigated. For the radiological evaluation, the radial height, volar height, and volar titling were measured based on the final plain radiography, and the union time was measured. The wrist range of motion (ROM), pain visual analogue scale score, and modified Mayo wrist score for function were measured at the final outpatient follow-up. Finally, the complications associated with OR VLP fixa-tion were investigated. Results: In the demographic comparison, the patients with open fractures were older (mean age, 62years) than those with closed fractures (mean age, 57 years), without a statistically significant differ-ence. The patients with open DRFs had longer antibiotic therapy and hospital stay durations. Although they presented a higher radial inclination, with statistical significance, the clinical implication was low with a mean difference of 3°. No significant differences were observed for the remaining radiological parameters, wrist ROM, and functional scores. An open DRF did not increase the complication rates,including deep infection. Conclusion: Depending on the expertise of the operating surgeon, the primary OR VLP fixation in open intra-articular comminuted DRF did not increase the incidence of deep infections and yielded similar outcomes to a closed intra-articular comminuted DRF.

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Treatment of Type IIIb Open Tibial Fractures: Seong Yeon Lim, Il Jae Lee, Jae Ho Joe, Hyung Keun Song; J Korean Fract Soc 2014;27(4):267-273. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.267

PURPOSE
The purpose of this study is to evaluate the outcome of treatment for patients with Type IIIb open tibial fractures.
MATERIALS AND METHODS
This study targeted 35 adult patients for whom follow-up was possible over one year after undergoing surgical treatment. There were 29 males and six females with an average age of 45 years.
RESULTS
Fracture location was proximal in 10 cases, midshaft in 13 cases, and the distal part of the tibia in 12 cases. An average of 10 days was observed for definitive fixation with soft tissue coverage of the injury. The mean time to radiographic union was 27 weeks. Sixteen cases (45.7%) of complications were observed. Three cases of superficial infection, two cases of deep infection, four cases of partial flap necrosis, three cases of mal-alignment, three cases of joint stiffness, and one case of hardware breakage were observed. The mean lower extremity functional scale score was 68.5 and the factors influencing the clinical results were severity of open wound (p=0.000) and occurrence of complications (p=0.000) according to results of multiple regression analysis.
CONCLUSION
In treatment of Type IIIb open tibial fractures, good clinical results can be expected provided that complications are prevented through proper reduction, firm fixation, early soft tissue reconstruction, and early rehabilitation.

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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

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Two-staged Delayed Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Open Fractures: Jung Hwan Yang, Seok Hyun Kweon, Jeung Woo Kim, Jin Young Park, Hyun Jun Kim, Chul Min Lim; J Korean Fract Soc 2008;21(1):24-30. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.24

Abstract PDF

PURPOSE
To evaluate the outcomes of distal tibial open fractures treated by two-staged delayed minimally invasive percutaneous plate osteosynthesis (MIPPO) technique.
MATERIALS AND METHODS
25 cases of distal tibial open fractures were treated with temporary ring fixation and two-staged delayed MIPPO. A mean age was 46 years old, follow-up was 23 months. The type of fracture was evaluated using the AO/OTA classification. The type of open fracture was evaluated using the Gustilo-Anderson classification that revealed 6 cases of type I, 9 cases of type II, 8 cases of type IIIA and 2 cases of type IIIB. We analyzed the radiologic results and postoperative complications. The clinical and functional result were evaluated by using Teeny and Wiss scores.
RESULTS
The average time of bone union was 18 weeks in 24 cases. There were three delayed union that achieved union twenty weeks after second operation, and 1 case underwent bone graft with additional plate fixation. 6 cases of skin necrosis were treated with skin graft, 2 cases were treated with flap. The clinical and functional assessment showed that 6 cases were excellent, 16 cases were good, 2 cases were fair, and 1 case were poor results.
CONCLUSION
Two-staged MIPPO technique for distal tibia open fractures seems to be a good procedure to obtain bone union.

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Combined minimally invasive external and internal fixation in the treatment of pilon fractures
AhmedSh Rizk, MohamadS Singer, MohamadE Al-Ashhab
The Egyptian Orthopaedic Journal.2014; 49(3): 259. CrossRef
Staged Protocol in Treatment of Open Distal Tibia Fracture: Using Lateral MIPO
Oog Jin Sohn, Dong Hwa Kang
Clinics in Orthopedic Surgery.2011; 3(1): 69. CrossRef
Management of Open Fracture
Gu-Hee Jung
Journal of the Korean Fracture Society.2010; 23(2): 236. CrossRef
Staged Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures
Sung-Ki Park, Chang-Wug Oh, Jong-Keon Oh, Kyung-Hoon Kim, Woo-Kie Min, Byung-Chul Park, Won-Ju Jeong, Joo-Chul Ihn
Journal of the Korean Fracture Society.2010; 23(3): 289. CrossRef

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Interlocking Intramedullary Nail in Distal Tibia Fracture: Oog Jin Shon, Sung Min Chung; J Korean Fract Soc 2007;20(1):13-18. Published online January 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.1.13

Abstract PDF

PURPOSE
To evaluate the effectivity of interlocking intramedullary nailing for distal tibia fracture and prognostic factor to bone healing.
MATERIALS AND METHODS
From April 2000 to June 2005, 21 cases who had distal tibia fracture were treated by interlocking intramedullary nail were analyzed. The duration of follow-up was more than 1 year. We evaluated clinical results by IOWA ANKLE rating system and union time by simple X-ray. Furthermore, we estimated prognostic factor to union time.
RESULTS
The bone union was achieved at average 18.5 weeks. At the last follow-up, there was no non-union and infection. Average IOWA ANKLE rating score was 91.3 point. The union time was delayed in open and segmental fracture at initial fracture. And severe soft tissue injury in open fracture revealed bad result.
CONCLUSION
We concluded that interlocking intramedullary nail is effective method for treatment of the distal tibial fractures. And, adequate soft tissue management is important to bone healing and clinical outcome.

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Comparison of the Results between Intramedullary Nailing and Plate Fixation for Distal Tibia Fractures
Jung-Han Kim, Heui-Chul Gwak, Chang-Rack Lee, Yang-Hwan Jung
Journal of Korean Foot and Ankle Society.2015; 19(3): 86. CrossRef

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Treatment of Open Tibial Shaft Fractures using Unreamed Nailing: Jong Keon Oh, Chang Wug Oh, Kwon Jae Roh, Duk Moon Chung; J Korean Fract Soc 2005;18(1):22-28. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.22

Abstract PDF

PURPOSE
To report the results of unreamed nailing using a nail with the largest possible diameter for the management of the open tibial shaft fractures.
MATERIALS AND METHODS
Nineteen patients with open tibial shaft fractures underwent unreamed nailing with the largest possible diameter according to the isthmic diameter measured on preoperative radiography. There were 1 Grade I, 6 Grade II, 9 Grade IIIa, 3 Grade IIIb open fractures. There were 4 type A, 12 type B, 3 type C fractures according to the OTA classification. Fractures were classified as The nail was introduced after gentle passage of a 7 to 8 millimeter-hand reamer.
RESULTS
Union was obtained in all cases. However 9 (47%) fractures required an additional procedures before union. In 6 cases, dynamization was done. Two of them were required exchange nailing for nonunion, 1 of two gained bony union through additional bone graft. Three of the others had gained union through exchange nailing, bone graft, bone transport respectively. There were one rotational malunion, one superfical and one deep infection. Interlocking screw breakage developed only in one patient.
CONCLUSION
Our data indicate that unreamed nailing in the management of open tibial fractures is safe and reliable method. Using a tight fitting nail with the largest possible diameter is a safe and effective way to avoid the problems of screw breakage.

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Treatment of Type IIIb Open Tibial Fractures
Seong Yeon Lim, Il Jae Lee, Jae Ho Joe, Hyung Keun Song
Journal of the Korean Fracture Society.2014; 27(4): 267. CrossRef
Management of Open Tibial Fractures: Role of Internal Fixation
Yerl-Bo Sung
Journal of the Korean Fracture Society.2007; 20(4): 349. CrossRef

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Grade III Tibia Open Fractures Treated with Unreamed Tibial Nailing: Chang Wug Oh, Hee Soo Kyung, Do Heon Kim, Il Hyung Park, Poong Taek Kim, Joo Chul Ihn, Yeon Ki Woo, Jung Yup Lee; J Korean Fract Soc 2004;17(2):148-152. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.148

Abstract PDF

PURPOSE
This is a retrospective study to analyze the results of unreamed intramedullary nailing in grade III tibial open fracture.
MATERIALS AND METHODS
Twenty-nine Gustilo-Anderson grade III tibial open fractures fixed with unreamed tibial nail were followed more than one year. Primary union rate, union time, infection, conversion to external fixation, ankle and knee function according to different grade of open, fracture level, AO classification, and muscle flap were evaluated.
RESULTS
Primary union was achieved at sixteen fractures. There were three delayed union that achieved union twenty week after primary operation. And eight undergone secondary bone grafts which were done after inflammation sign subcided. Complications about infection were in five cases. Two cases were unable to maintain internal fixation due to deep infection, and three of superficial infection were treated with repeated debridement and antibiotics use.
CONCLUSION
In grade III tibial open fracture, unreamed nailing with early soft tissue reconstruction and early prophylactic bone graft can be a good treatment.

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Management of Open Fracture
Gu-Hee Jung
Journal of the Korean Fracture Society.2010; 23(2): 236. CrossRef
Management of Open Tibial Fractures: Role of Internal Fixation
Yerl-Bo Sung
Journal of the Korean Fracture Society.2007; 20(4): 349. CrossRef

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Hybrid External Fixation and Limited Internal Fixation for Severe Open Tibial Shaft Fractures: Hong Jun Han, Soo Uk Chae, Ul Oh Jeung; J Korean Soc Fract 2003;16(1):52-58. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.52

Abstract PDF: PURPOSE
To evaluate the radiographic and clinical results of severe open tibial shaft fracture treated by hybrid external fixation and limited internal fixation.
MATERIALS AND METHODS
We reviewed 25 patients open tibial shaft fracture(> or =Gustillo classification type II) which were treated with hybrid external fixation(AnyFixR) that was invented by authors and limited internal fixation between June 1998 to June 2001. 20 males and 5 females were minimum follow up period of 12 months(12-27 months). The mean age was 45 old years(11-72 old years). The results were based on the assessment radiographical analysis with duration of bony union, delayed union including of states of nonunion and malunion, clinical analysis with pain, joint range of motion, wound infection and skin & soft tissue coverage. All fractures were classified according to the Gustilo classification, there were 6 cases of type II, 9 cases of type IIIa and 10 cases of type IIIb. The cause of injury, there were 18 cases of motor vehicle accident, 5 cases of direct trauma and 2 cases of fall from height.
RESULTS
In twenty-five cases, fifteen had union, the average time of bone union was 6.8 months and additional bone graft without change of external fixator performed in ten cases, but one case have failed and then change of intramedullary nail with bone graft. In the group of bone graft, bone union was completed at mean 8.7 months. According to the clinical analysis, no pain in the fracture site, in complications, there were 2 cases of mild joint range of motion that has acceptable result and 2 cases of wound infection were treated with effective antibiotics theraphy and wound dressing. Five cases need to coverage of the open wound, 3 cases were flap operation and each case were muscle transfer, skin graft without change of external fixator.
CONCLUSION
The use of hybrid external fixation and limited internal fixation in severe open tibial shaft fracture to be successful for the stabilization of fracture and subsequent plastic and/or orthopaedic procedure for muscle and skin coverage, bone grafting are more easily accomplished without change of external fixator.

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

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

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Treatment of Open Tibial Fracture with Repofix External Fixator: Ho Choi, Hoon Kim, Neung cheol Shin, Sang Ho Shin, Dong Soo Han; J Korean Soc Fract 2001;14(3):412-418. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.412

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the results of treatment of open tibial fracture with Repofix external fixator by clinical and radiological assessement. MATERIAL AND METHODS: 24 cases of open tibial fracture, who had been treated with Repofix external fixator from Oct. 1995 to June 1999, were evaluated about distribution of gender, age, cause of injury, fracture site and pattern, and assessed bony union time and complication.
RESULTS
The mean period of application of external fixator was 12.3 weeks and we kept PTB cast until bony union for average 11.5 weeks. According to Gustilo-Anderson's classification, the mean bony union time was 21.7 w e e k s ( type I ), 36 weeks(type II) and 39 weeks(type III), simple fracture was 22 weeks, comminuted fracture was 32 weeks(p<0.05). Complications were pin site infection(9 cases), delayed union(3 cases), nonunion(1 cases) and focal skin necrosis(1 case). There was no loss of motion about joint.
CONCLUSION
Repofix external fixator, which has the advantages of accurate reduction without extension of wound and decreases motion limitation of neighboring joint, is alternative useful appratus for open tibial fracture.

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Clinical Effectiveness of Korean Medical Rehabilitation Treatment after Patellar Fracture: A Report of 4 Cases
Ji-Hye Geum, Hyeon-Jun Woo, Jong-gyu Kim, Jung-Han Lee
Journal of Korean Medicine Rehabilitation.2020; 30(4): 203. CrossRef

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Treatment Using Unreamed Intramedullary Nailing for Open Tibial Fractures: Chang Wug Oh, Hee Soo Kyung, Joo Chul Ihn, Byung Chul Park, Hyung Jin Park; J Korean Soc Fract 2000;13(2):281-288. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.281

Abstract PDF: PURPOSE
: this paper was to evaluate the treatment results in the viewpoint of bone union, union time, and complications including infection of unreamed nailing of pen tibial fractures.
MATERIALS AND METHODS
: We reviewed 46 open tibial shaft fractures that were treated with unreamed tibial nail. AO unreamed tibial nail was inserted after reduction under image intensifier control, Considering factors were severity of open wound, type and location of fractures.
RESULTS
: Average union time of open fractures was 21.3 weeks, nonunion rate was 2/46(4%). Average union tiome were 24.1, 19.7, 24, 24, 20 weeks in open grade I , II, IIIa, IIIb, IIIc fractures. According to the type of fractures, average union time were 20.4, 23.6, 25.7 weeks and nonunion rate were 0/22, 1/18, 1/6 in type A, B, C fractures. According to the level of fractures, average union time were 24.0, 20.0, 24.1 weeks in proximal, middle, and distal fractures. There was no signficant differences in average period of radiologic union, infection rate and nonunion rate according to fracture level, open grade, but longer union time and higher nonunion rate were observed in complex and comminuted fractures(p<0.05).
CONCLUSION
: With adequate soft tissue treatment, the unreamed intramedullary nailing can be a good treatment modality for open tibial shaft fractures, even to grade IIIB.

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Treatment of the Open Tibial Fractures with Unreamed AO Intramedullary Nail: Bum Soo Kim, Sung Do Cho, Yong Sun Cho, Soon Woo Hong, Hyung Jin Cho, Ki Yong Kim; J Korean Soc Fract 2000;13(1):81-86. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.81

Abstract PDF: PURPOSE
To evaluate the results of open tibial fractures treated with unreamed AO intramedullary nail MATERIALS AND METHODS: Among the patiens of open tibial fractures who were treated with unreamed AO intramedullary nail from January 1993 to August 1998, the authors reviewed 34 patients whose follow-up was possible for more than one year. Fourteen patients were treated with AO external fixator after meticulous debridement, followed by unreamed AO intramedullary nailing, and the other 20 patients were treated with primary unreamed AO intramedullary nailing after debridement. The authors evaluated the results by the union time and the presence of complication.
RESULTS
The average union time was 26.3 weeks. There was no significant difference of union time and complications between the patients who were treated with AO exteranl fixator followed by unreamed AO intramedullary nailing and the patients who were treated primarily with debridement and unreamed AO intramedullary nailing. However there was high incidence(21%) of interlocking screw breakage.
CONCLUSION
With meticulous debridement and close observation of the wound, the open tibial fractures can be effectively treated with unreamed AO intramedullay nailing. Unreamed intramedullary nailing of open tibial fractures immediately after trauma can be recommended in selected cases.

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Treatment of Comminuted Fractures of Femur & Tibia with Ilizarov Apparatus: Soo Bong Hahn, Hong Jun Park, Hui Wan Park, Sung Hun Kim; J Korean Soc Fract 2000;13(1):20-29. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.20

Abstract PDF: PURPOSE
To evaluate the effectiveness of Ilizarov external fixator for the treatment of unstable closed or open comminuted femoral and tibial fractures, especially those with severe soft tissue injury by clinical and radiological analysis.
MATERIALS AND METHODS
Fifty six consecutive femoral or tibial fractures were treated using Ilizarov external fixator between May 1991 and August 1998 and followed up for minimum 12 months upto 36 months with the average of 16 months. All of them consisted of comminuted or segmental fractures. And thirty five cases of them were open fractures. There were nine Type I, seventeen Type II, five Type IIIA, and four Type IIIB fractures. Primary closure was performed for Type I and II fractures. Split-thickness skin graft (5 cases) and free vascularized flap (3 cases) were used for severe soft tissue defects.
RESULTS
All fractures healed within the average of 7.7 months (from minimum 3 months to maximum 24 months). Bone grafts were performed in 39 cases. Bony union was obtained in all the cases with Ilizarov method. The most common complication, the adjacent joint contracture was developed in 21 cases (37.5%). Pin site infection in 12 cases (21.4%), delayed union in 3 cases (5.4%), angulation deformity in 2 cases (3.6%) were developed.
CONCLUSION
The Ilizarov external fixation technique is one of the effective methods in the management of unstable closed or open comminuted femoral or tibial fractures.

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Treatment of open Tibial Shaft Fractures with Unreamed Interlocking Intramedullary Nailing: Jeung Tak Suh, Byung Guk Park, Chong Il Yoo; J Korean Soc Fract 1999;12(3):568-576. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.568

Abstract PDF: Severe open fracture of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilization was by external fixation, but the advent of small diameter interlocking intramedullary nails has introduced a new option. From the June 1992 to December 1997, 55 cases of open tibial shaft fracture were treated with unreamed interlocking intramedullary nailing at the department of orthopedic surgery, Pusan National University Hospital. The purpose of this study is to evaluate its result and complications. Mean age was 31, mostly male. The main cause of trauma was traffic accidents(30 cases, 55%) and fracture sites consisted of mid 1/3 portion over 75%. According to the Gustilo & Anderson classification 8 type I(15%), 22 type II(40%), 15 type IIIA(27%) and 10 type IIIB(18%) were shown. Union time was 28.3 weeks on an average and union rate was 98%. There were 5 cases(9%) of delayed union, 2 cases(4%) of deep infection and 1 case(2%) of chronic osteomyelitis. In conclusion unreamed interlocking intramedullary nailing can be the first choice treatment in the treatment of open tibia shaft fractures with low postoperative infection.

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Clamp external fixator for IIIb open tibial shaft fracture: Jeung Tak Suh, Byung Guk Park, Chong Il Yoo; J Korean Soc Fract 1999;12(3):557-567. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.557

Abstract PDF: As the saftest and simplest method of immobilization treatment, external fixation is indicated in IIIb open tibial shaft fractures with extensive damage to soft tissue and bone. This enables better wound treatment, patient transport and performace of surgical treatment such as plastic and reconstructive surgery, orthopedic surgery. From the march 1994 to september 1997 14 cases of IIIb open tibial shaft fractures were treated with clamp external fixator either Orthofix or DynaExtor. The purpose of this study is to determine indication of clamp external fixator and investigate its outcome as well as complications and solutions. 11 males and 3 females were followed for 29.3 months on an average. Fractures mainly occurred at mid 1/3 of tibial shaft and its pattern was most frequently comminuted one. Mean bony union time was 46 months. There were 1 case(7%) of delayed union, 2 cases(14%) of nonunion, 6 cases(42%) of reduction loss, 4 cases(28%) of deep infection including 2 cases(14%) of osteomyelitis, 6 cases(42%) of pin tract infection, 2 cases(14%) of malunion and 3 cases(21%) of ankle stiffness. Conclusively for the creation of a suitable environment of fracture healing and prevention of complications such as delayed union, nonunion and deep infection, thorough debridement and irrigation followed by adequate stabilization of bone, early soft tissue coverage and early prophylactic bone graft is paramount important in the treatment of IIIb open tibial shaft fracture since it is high energy trauma. In addition, initial firm fixation for the prevention of reduction loss and active and passive exercise for the prevention of ankle stiffness and pin tract infection or loosening should be taken into careful consideration.

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Ilizarov External Fixation for Severe Open Tibial Shaft fractures in Adults: Jeung Tak Suh, Tae Wook Nam, Chong Il Yoo; J Korean Soc Fract 1999;12(3):549-556. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.549

Abstract PDF: PURPOSE
It is to evaluate and discuss the result of severe open tibial shaft fractures treated by Ilizarov external fixation.
MATERIALS and METHODS
From the January 1992 to July 1997, 34 cases of severe open tibial shaft fracture in adults were treated with Ilizarov external fixator. 20 males and 14 females were followed for at least 1 year.
RESULTS
Fractures were evenly distributed through proximal 1/3 to distal 1/3 and its pattern was mostly comminuted one. According to Gustilo-Anderson classification, it mainly consisted of type IIIa &IIIb(28 cases: 82%). Mean bony union time was 40.2 months. There were 5 cases(15%) of delayed union, 2 cases(6%) of nonunion, 5 cases(15%) of deep infection including 3 cases(9%) of osteomyelitis, 10 cases(29%) of pin tract infection, 4 cases(12%) of malunion and 11 cases(32%) of ankle stiffness.
CONCLUSION
Conclusively, in the first place, for the successful treatment with Ilizarov external fixator, determining appropriate indications is the most important. Secondly, active reconstruction of soft tissue environment and early prophylactic bone graft, if necessary, are also essential to shorten union time. Thirdly, meticulous care of pin site and ankle motion is needed for the prevention of the two most common complications even though they are considered to be minor.

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Treatment Using Unreamed Intramedullary Nailing for Open Tibial Fractures: In Heon Park, Ki Byung Lee, Kyung Won Song, Jin Young Lee, Seung Yong Lee; J Korean Soc Fract 1997;10(4):886-891. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.886

Abstract PDF: Intramedullary nailing has become the most popular fixation method in the treatment of the tibial shaft fractures because it affords most rigid fixation of fracture via closed method which makes early rehabilitation possible. Unlearned interlocking nails offer the advantages of loss damage to the intramedullary blood supply, so infectious rate was lower in open fractures compared with reamed nails. We have analyzed 34 cases of 30 patients who performed unlearned interlocking intramedullary nail for open tibial fractures. The results were as follows : 1. The classification of the open fracture was 12 cases Gustilo-Anderson Type I, 20 cases Type II, 2 case Type III. 2. Bony union occured an average of 18 weeks postoperatively. 3. The complication were 4 cases of nonunion, 1 case of deep infection, and 1 case of screw loosening. In conclusion, unlearned intramedullary nailing is a good alternative method for the management of Type I, II open tibial fracture.

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Delayed Intramedullary Nailing after Failed External fixation for Open Tibial Fractures: Jin Hong Ko, Bum Gu Lee, Do Hyun Moon, Hong Gi Park, Cheol Won Park; J Korean Soc Fract 1997;10(3):694-701. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.694

Abstract PDF: Recently, extemal fxation and unreamed intramedullary nailing are largely used for operative treatment for open long bone fractures. Extemal fixation, especially in cases of unstable fractures, blamed for complications, for example, malunion, delayed union, loss of reduction, refracture, pin tract infection. In addition, there are some problems such as long hospital stay and delayed returning to work. Some surgeons tried to treat such problems by secondary intramedullary nailing, but they came to different retults. The purpose of the current study is to evaluate our experience with secondary intramedullary nailing after failed external fixation of 4 cases of open Grade II, 8 cases of open Grade III a, and 4 cases of open Grade III b tibial fractures. The results are as follows ; 1. The external fixation had been maintained for 123 days in average. 2. The mean interval between removal of the external fixation and intramedullary nailing was 16 days except 5 immediate operation. 3. Reamed intramedullary nailing with static interlocking were done in all 16 cases. 4. In 12 cases of 16, bone union was obtained without complications, and the mean union time after intramedullary nailing was 21.7 weeks radiollogically. 5. Deep infections developed in 2 cases, which had in fracture site, and local infections in 2 cases, which had been in previous pin site of external fixator. In conclusion, delayed intramedullary nailing was a method for treatment of problematic external fixation, such as delayed union, nonunion, loss of fixation, and pin site infection, for open fractures of the tibia.

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Disseminated Intravascular Coagulation Following Septic Shock in Multiple Open Fractures : a Case Report: Tai Seung Kim, Jae Lim Cho, Choong Hyeok Choi, Sung Hee Oh, Do Hyeung Kim, Kuhn Sung Whang; J Korean Soc Fract 1997;10(3):583-587. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.583

Abstract PDF: Disseminated intravascular coagulation is known to be a syndrome which can evoke compound derangement in the cascade mechanism of normal hemostasis, which causes depletion of coagulation factors, secondary fibrinolysis, and eventually massive and uncontrollable bleeding. Even though there still are not absolute criteria for diagnosis, some laboratory findings - platelet count, plasma fibrinogen, fibrinogen degradation product, plasma protamine test, etc - can suggest the possibility to diaglose. The basic principle in management is to eliminate the triggering mechanism as soon as possible and to cure the initial disease entities. In orthopedic point of view, disseminated intravascular coagulation can occur in the case of malignancy, massive trauma, infection, sepsis and so on. Authors report a case of disseminated intravascular coagulation occured in a 12 year 2 month old male patient who visited Hanyang university hospital in septic condition after emergency operations following multiple open fractures on his left femur. tibia and fibula in a motor-cycle accident.

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Bone Union Rates in Open Phalangeal Fracture of Hand: S W Suh, S H Lee, J G Oh, D Park, K S Kim, C J Kim; J Korean Soc Fract 1996;9(3):782-787. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.782

Abstract PDF: This review was undertaken to analyze the rate of bone union according to accuracy of reduction, methods of fixation, timimg of wound closure and to determine if immediate wound closure increases the infection rate. The materials used in this study included 49 cases of open digital fractures of hand which had been treated at Ansan Hospital, Korea University, College of Medicine from January, 1988 to May, 1995. Of the 38 patients, male were 34(89.5%) and female were 4(10.5%). The average age at operation was 31.9(ranging from 18 to 56 years). On terms of sites of injury within digits, proximal phalanx injured in 18 cases, mid-phalanx16 cases, distal phalanx 20 cases. As a fixatives, K-wire was used in 36 cases(73.5%), mini-plate 8 cases(16.3%), splint immobilization in 5 cases(10.2%). Average time to bone union for K-wire fixation was 12.8 weeks, miniplate was 13.6 weeks, splint immobilization 13.2 weeks. On terms of accuracy of reduction, width of gap between fragments were measured, cases with width of gap less than 2mm were 28 cases(57.6%), cases more than 2mm were 21 cases(42.4%). Bone union periods according to the accuracy of reduction are as follows: cases with width of gap less than 2mm was 11.4 weeks, more than 2mm-15.7 weeks, apposition more than 2/3-12.6 weeks, less than 2/3-16 weeks. Degree of soft tissue injuries was classified based on modified Gustillo-Andersons classification. One case belonged to type I injury, 15 cases to type II and 33 cases to type III. Bone union periods for type I, II was 12.9 weeks in average, and 13.8 weeks for type III.

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Treatment of Open Tibial Fracture with Enternal Fixator: Byung Chang Lee, Sang Soo Kim, Sang Do Cha; J Korean Soc Fract 1996;9(3):605-613. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.605

Abstract PDF: In a retrospective study from 1987 to 1993, we reviewed 191 patients with 203 open tibial fractures which were treated with external fixator and had adequate clinical and radiological follow up evaluation over 1 year. The configuration of fractures was classified using AO classification, and to extent of soft tissue damage was graded using to Gustilo classification of open fracture. There were 108 Grade I ;36 Grade II and 59 were Grade III. We used mainly unilateral two plane type(simple conventional type) and unilateral one plane type. To stabilize supplementarily large bony fragment, screw, K-wire or wire were used in 11, 41 and 6 cases respectively. 117(51.6%) open fracture wounds healed by delayed primary or secondary intentien, whereas 40(19.1%) patients received a split thickness skin graft, 31(15.3%) patients had a rotation of a myncutaneous flap, and 15(7.4%) patients received a free flap surgery for soft tissue coverage. The average time to union was 25.1 weeks. To obtain bone healing, we performed additionally bone graft in 89 cases(43.8%), fixator change only in 8 cases(3.9%), and fixator change with bone graft in 20 cases(9.9%). All cases except 28 open tibial fractures, which was performed fixator change, were treated by primary external fixation without a change of fixator. Major complications were delayed union, nonunion and pin tract infection, and superficial infection, chronic osteomyelitis, pin loosening and partial ankylosis of joint were developed. In conclusion, we think the external fixator is a routine device for open tibial fractures. The configuration of fracture and degree of soft tissue damage had influence on healing of open tibial fracrures. Supplementary fixation in combination with external fixation does not offer important advantages. We should pay attention to bone healing more than soft tissue healing in Crade I & II injury and to soft tissue healing more than bone healing in Grade III injury.

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A Clinical Study of rmmediate Internal Fixation(within 24 Hrs) in Open Fractures of The Long Bones: Yoon Sik Kim, Jae Eung Yoo, Chi Soo Sohn, Jong Seouk Park, Hee Kwon, Joon Min Song, Soo Kyun Rah; J Korean Soc Fract 1996;9(3):593-604. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.593

Abstract PDF: The major goals in the treatment of open fractures of the long bones are to prevent infection, avoid malunion or nonunion, achieve bone union, and restore limb and patient function as soon and as fully as possible. The treatment modalities adopted in open fractures still remains controversial, especially in Gustilo-Anderson Type III. It has been the fear of infection that has lead to the traditionally accepted opinion that immediate internal fixation of open fractures is contraindicated but, nowadays, it is no longer tabooed. Owing to the early meticulous wound debridment and irrigation, and the use of bactericidal antibiotics, the infection rate reduced remarkably. Fifty-five cases of open long bone fractures treated by immediate internal fixation within 24 hours from inury were reviewed, which were treated at the Department of Orthopedic Surgery, Soonchunhyang University hospital for nine and half years from June, 1985 to January, 1995. The results were as follow: 1, There were 20 Type II , 19 Type III A, 10 Type IIIB and 5 Type IIIC open fractures treated by immediate internal fixation within 24 hours following to Gustilo-Andersons classification. 2. The most common causes of open fractures were traffic accident(84%). 3. The associated injuries of the patients treated by immediate infernal fixation were in sequence.:26 multitraumatized patient, 5 arterial injuries, 5 musculotendinous injuries, 3 major joint dislocations and so forth. 4. Normal bony union was achieved in 41 patients(73.2%), Delayed bony union was in 7 patient(12.5%) and nonunion in 8 patients(14.5%). 5. Primary wound healing was achieved in 40 patients(71.4%), superficial to moderate infection were in 5 patients(9%), deep to osteomyelitis in 11 patients(19.6%). 6. According to the subtypes of open fractures, deep to osteomyelitis were 80% in Type IIIC, 30% in Type IIIB, 10.6% in Type IIIA and 10% in Type II.

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Treatment using Intramedullary Fixation for Open Tibial Diaphyseal Fractures: Young Goo Lee, Jnng Seok Choi, Young Chang Kim, Hyun Duck Yoo, Seung Seok Seo, Sang Hun Ha; J Korean Soc Fract 1996;9(3):583-592. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.583

Abstract PDF: This fractures of tibial shaft are common and open injuries are frequently accompanied due to its anatomical characteristics. External fixation was widely used for treatment of open fractures of tibia, but recently internal fixation combined with appropriate debridement and antibiotics has been reported, with more comfortness and less secondary operations. We analysed 33 cases of open tibial diaphyseal fractures treated using intramedullary fixation devices. The results were as follows. 1. The methods of fixation were Ender nail, 15 cases, and interlocking nail, 18 cases. And 17 cases out of 18 interlocking nail were unlearned one. 2. The Ender nail was used in 5 cases for open type I fracture, 7 type II, 2 type III-a and 1 type III-b, And the interlocking nail was used in 9 cases for type 1, 7 type II, 1 type IIIa and 1 type III-b. The average operation time was 55 minutes for Ender nail, while 14 minutes for interlocking nail. 3. The Ender nailing group has 6 complications;one case superficial infection, one deep infection, one delayed union, one nonunion and two angulation deformities. The interlocking nailing group has also 6 complications;one case superficial infection, two deep infections, one delayed union, one nonunion and one peroneal nerve palsy. 4. The average union period was 18.4 weeks in Ender nail and 19.1 weeks in interlocking nail.

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Treatment of Type III Open Tibial Fractures with Repofix External Fixator: Chang Hoon Jeon, Ye Yeon Won; J Korean Soc Fract 1995;8(4):855-863. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.855

Abstract PDF: We reviewed 18 patients with type III open tibial fracture from February 1992 to June 1995 (mean follow-up period 56.7 weeks) treated with Repofix external fixator. There were 16 men and 2 women. According to the Gustilos classification, there were type IIIa in 11 cases and type IIIb in 7 cases. Mean period of removal of external fixator was 19.3 weeks and after removal of external fixator, cast immobillization was performed in 4 cases. Among them, bony unions were noted in 15 cases and there were nonunion in 2 cases and malunion in 1 case. The causes of nonunion were failure of accurate reduction in 1 cases and severe initial comminuted fracture in 1 case. Complications were nerve injury, pin site infection and ring-type osteomyelitis. After removal of external fixator, nerve injuries were recovered and pin site infections except 1 case were healed. Ring-type osteomylitis was occurred in 1 case after removal of external fixator and osteomyelitis was dured after curettage. When type III open tibial fractures were treated with Repofix external fixator, there were advantages of 1) early weight bearing, 2) sagittal and coronal reduction of fracture and 3) correction of rotation. With advantages, this external fixator was appropriate for the treatment of type III open tibial fractures.

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Treatment of Open Fracture of Tibial Shaft with Non-reamed Interlocking Nailing: Byung Woo Min, Kwang Soon Song, Chearl Hyung Kang, Ki Weon Park; J Korean Soc Fract 1995;8(4):841-847. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.841

Abstract PDF: Intramedullary nailing for the treatment of a fractured tibia has proven its value not only through rigid fixation but also early joint motion and weight bearing which promote more rapid bony union and functional recovery. Recently reaming intramedullary nailing technique leaves the problems of destroying the endosteal blood supply, which associated with delayed union and postoperative infection. The purpose of this study is to evaluate the results and the complications of nonreamed interlocking intramedullary nailing in the treatment of open tibial fractures. The authors reviewed 20 cases of open fractures of tibial shaft that were treated with nonreamed interlocking intramedullary nailing from May 1993 to July 1994 The follow up period ranged from 12 to 26 months. The results were summariBed as follows. 1. The average period of radiologic union was obtatined in 21.2 weeks. 2. Complications include 1 case of delayed union and 1 case of postoperative infection in Type III open tibial fracture. Locking screw broke in 1 case of Type I open tibial fracture. 3. According to the criteria of functional results by Klemm and Borner, 18 cases(90%) showed excellent results.

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A Treatment of Unreamed Intramedullary Nailing of Open Fracture of the Tibia: Keun Kwon Kang, Jang Jung Kim, Kun Yung Lee, Myung Kon Nam, Myung Sik Park; J Korean Soc Fract 1995;8(3):551-556. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.551

Abstract PDF: The tibial fracture was the most common fracture of the long bone fractures, especially there were many controversies in the treatment of open fracture by high energy injury. The authors analyzed retrospectively 32 patients of tibial open fracture who underwent unlearned intramedullary nailing at the Department of Orthopedic Surgery, Lee-Rha general hospital from September 1992 to August 1994 with minimal 1 year follow up. In 32 cases, the average age was 37.5 years old and the most common injury was traffic accident(25 cases,78%). Twenty seven cases were male(84.4%) and 5 cases female(15.5%). There were 17 cases of Type A fracture(53%),12 cases Type B(37.5%) and 3 cases Type C(19.5%) by A-O classification, and 11 cases were Type I open fracture(34%) by Gustilo - Anderson classification, 15 cases, Type B (47%) and 6 cases, Type III (19%). The average bone union time was 14.8 weeks except one case of infected non-union. We concluded that unlearned intramedullary nailing is recommended for the compatible treatment metnod of tibial open fractures.

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Treatment with Unlearned Locked Intramedullary Nail for Open Tibial Fractures: Sang Soo Kim, Byung Chang Lee, Dae Moo Shim, Jae Hoon Shin; J Korean Soc Fract 1995;8(1):284-291. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.284

Abstract PDF: Open fractures of the tibia remain a formidable injury. Which the need for stabillization of open tibial fractures is accepted, the method of fracture stabilization is still controversial because of unacceptable infection rate. External fixation has been the routine and safe procedure for open tibial fractrues. However, this is not without significant complications such as pin tract infection and delayed or nonunion due to insufccient stability. We reviewed the records of 29 patients who underwent immediate unlearned locked intramedullary nailing for open tibial fractures. The average time between injury and operation was 2.4days. The classification of the open fractures was; fifteen Grade I, nine Grade II , and five Grade II a. There was no superficial infections, but one of type III a patient developed deep infection. Skin graft or rotational flap to cover the soft tissue defect were performed. All cases were treated by primary intramedullary nailing without a change of the fixator. So, we think unlearned locked intramedullary nailing is a good alternative method for the management of Grade I, II, III a open tibial fractures.

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External monofixator in open tibia fractures: Soon Hyuck Lee, Seung Woo Suh, Young Soo Byun, Yoon Sung Chung; J Korean Soc Fract 1994;7(2):571-579. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.571

Abstract PDF: Tibia fracture is often accompanied by soft tissue injury. There is controversy about the treatment of open tibia fractures, but the extemal fixator is most widely used as a initial treatment. Especially in open tibia fractures treated by extemal fixator, early secondary conversion to internal fixation device are suggested by some authors, but without risks of complication. In contrast others suggest that bone union problems are not due to external fixator itself and different types of bone union are observed according to the stability of fracture site. The purpose of this study is to assess the clinical results with its affecting factors and to observe the morphological pattern of union in tibial open fractures treated by external fixator without significant soft tissue problems. Authors analyzed 16 cases with tibial open fracture managed by external fixator in Ansan hospital, College of medicine, Korea University from May, 1988 to Sept., 1993 with follow-up period more than 11 months. 1. The tibial open fractures are mainly occurred in young active age group(20-50 yrs). 2. The union rate in accurate reduction and stable fixation cases was 90%, in contrast non-union rate in unstable fixation was 50%, and these non-union cases were managed by additional procedure(intramedullary nailing or autogenous bone graft). 3. In stable fuation, mode of fracture healing was mainly primary osteonal bone healing mechanism. 4. External fixator could be used in open tibial fracture with accurate reduction and stable fixation not as a temporary fixation but as a treatment modality.

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Department of Orthopedic Surgery, Kwang Ju Christian Hospital: Ki Soo Kim, Seung Hee Ko, Chang Moon Suh, Yong Soo Choi, Kyung Ho Kim, Dong Myung Lee, Yang Min Jung; J Korean Soc Fract 1994;7(2):553-561. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.553

Abstract PDF: The tibia, which is covered by subcutaneous tissue anteromdially, frequently sustain open comminuted fracture by trauma. The open fractures have higher risks of infection, nonunion, delayed union and joint stiffness. The authors reviewed 54 cases of open tibial fracture, treated at Kwang Ju Christian Hospital from January 1989 to December 1992. The results were as follows : 1. The most common cause of injury was traffic accident(41 case) and the average age of the patients was 32 years. 2. The radiographic union was obtained at 16.1 weeks in type I open fracture, 18.3 weeks in type III, 20.1 weeks in type IIIa,28.0 weeks in type IIIb, and 34.7 weeks in type IIIc open fracture. 3. The secondary operation was required frequently to obtain bone union in open type II, III fracture.

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Extensively Comminuted Type III Open Fracture of Tibial Shaft: 4 Case Treated by Ilizarov External Fixator: Ju Hai Chang; J Korean Soc Fract 1994;7(2):480-489. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.480

Abstract PDF: It is extremely difficult to treat to the type III open fractures of the tibial shaft which have been severely comminuted and splitted in the long length. Early internal fixation with plates and screws or intramedullary nailing of type III open fracture is contraindicated because of high infection rate and circulatory compromising at the fracture site. External fixation is the method of choice for the treatment of type III open fracture of the tibia. It reduces the risk of infection and permits easy access for wound care, early mobilization of joints and weight bearing. Four type III open fractures of the tibial shaft that were very unstable had entered this hospital from November 1990 to June 1992. The patients were all young males. The causes of injury were one explosion and three motor vehicle accidents. The open fractures were three type III A and one type III B according to Gustilos classification. These fractures were stabilized with Ilizarov external fixator. Parenteral antibiotic therapy was started from the emergency room to prevent infection. Illzarov fixator was applied 17 to 63 days(av. 37 days) after injury and maintained for 6 to 12 months(av. 8 months). Subsequent autogenous bone grafting and internal fixation were done in three patients 7 to 8 months after external fixation because of delayed union. Follow-up period ranged from 1 year and 11 months to 2 years and 6 months(av. 2 years and 2 months). Solid union was obtained in all patients between 1 year 1 month and 1 year and 7 months(av, 1 year and 3 months) without active osteomyelitis. At last follow-up, there were mild limitation of ankle joint motion in all patients and tibial shortening of 18 to 34mm(av. 25 mm)on the roentgenograms of three patients. No significant working disability or malalignment of the leg was noted in all patients. The final results were very good compared to the severity of their injuries.

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Clinical study for use of monofixateur of open tibia fracutres: Seung Gyun Cha, Dong Chul Oh, Won Suk Lee, Ouc Jung Kim, Jin Yong Jung; J Korean Soc Fract 1990;3(2):262-267. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.262

Abstract PDF: Open fracture is common in the tibia than any other long bones. Because of its precarious blood supply, delayed union, nonunion and infection are frequent complications. Many external fixation device has been useful for the management of unstable, comminuted open tibia fracture for its several advantages. Among the 20 cases of open tibia fracture treated with monofixateur device from May 1987 to April 1989, the following results were obtained. 1. By Gustilo et al. Type I, II and III fractures were seen in 2 patients (10%), 16 pateints (80%) and 2 patients (10%) respectively. 2. The average fixation time was 18 weeks and full weight bearing was performed at 31 weeks.

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