Journal of Musculoskeletal Trauma

Triplane Fracture Management: Prediction of Periosteal Entrapment and the Need for Open Reduction by Measurements of the Physeal Fracture Gap in Preoperative Computed Tomography Scans: Dae Hee Lee, Joo Han Kwon, Jae Uk Jung; J Korean Fract Soc 2024;37(1):1-7. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.1

Abstract PDF: Purpose
This study measured the physeal fracture gap on preoperative ankle computed tomography (CT) to predict the periosteal entrapment that requires an open reduction in distal tibia triplane fractures.
Materials and Methods
This study retrospectively reviewed patients who had undergone internal fixation for a triplane fracture from April 2004 to September 2022. The demographic data, including age,body mass index, and past medical history, were analyzed. In the radiographic evaluations, ankle CT and ankle simple radiographs, including anteroposterior (AP), lateral, and mortise views, were taken preoperatively. Postoperatively, simple ankle radiographs were obtained periodically, including AP, mortise, and lateral views. The physeal fracture gap was measured on ankle CT, and the larger gap between the coronal and sagittal view of CT was selected. The residual physeal gap <2 mm was considered an adequate reduction.
Results
Of 17 cases, three demonstrated successful reduction using closed reduction techniques. Periosteal entrapment was observed in 14 cases open reduction cases. In all three closed reduction cases, the physeal gap estimated on preoperative ankle CT was under 3 mm with a mean gap of 2.4±0.2 mm (range, 2.1-2.5 mm). In the remaining 14 open reduction cases, the measured physeal gap was over 3 mm, averaging 5.0±2.7 mm (range, 3.1-12.2 mm). There was a significant difference in the preoperative physeal gap between the two groups (p<0.01). Overall, good reduction was achieved in all 17 cases; the postoperative physeal gap was under 2 mm with a mean of 1.0±0.5 mm (closed reduction group, 0.5±0.2 mm; open reduction group, 1.1±0.5 mm).
Conclusion
Open reduction is strongly recommended for triplane fractures with a physeal fracture gap of 3 mm or more in preoperative ankle CT, suggesting the possibility of an entrapped periosteum in the fracture gap.

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Ankle Fractures in Children: Classification and Treatment: Ha-Yong Kim, Yong-Han Cha, Woo-Suk Kim, Won-Sik Choy; J Korean Fract Soc 2021;34(2):87-95. Published online April 30, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.2.87

Abstract PDF: Pediatric ankle fractures are defined as damage to the metaphysis, epiphyseal plate, and epiphysis of the distal tibia and fibula. Although the injury mechanism could be similar, the fracture patterns and treatment of pediatric ankle fractures are different from those of adults. In children, growth plate injuries are more common with a force that would cause sprains in adults because the ligaments are stronger than the growth plate cartilage in children. In the adolescent period, unique fractures, called “transitional fractures”, occur while the physis is closed. For a diagnosis, plain images of the anteroposterior, lateral, and mortise views are essential. Stress radiographs, ultrasound, and magnetic resonance imaging can be used for suspected ligament injuries. The treatment goal is to restore the articular congruity, normal bony alignment, and preserve the epiphyseal plate to ensure normal growth. Pediatric ankle fractures frequently lead to premature physeal arrest, angular deformities, malunion, and posttraumatic arthritis even after anatomic reduction. Treating surgeons should follow-up children for a sufficient time and explain to the caregiver the possible complications before treatment.

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Pediatric around Elbow Fracture: Taehun Kim, Jaeho Cho, Seungmin Chung; J Korean Fract Soc 2021;34(1):44-49. Published online January 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.1.44

Abstract PDF: This study assessed the current concepts of pediatric elbow fractures. PubMed and Embase databases were searched for publications in English on elbow fractures. Papers believed to yield significant findings to this area were included in this review. The supracondyle of humerus, lateral condyle of the humerus, proximal radius, and proximal ulna fractures were included. Sixteen papers and textbooks were selected. Pediatric elbow fractures should be evaluated for combined injuries. Treatment should be done accurately for each fracture for the further growth of children.

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The Pattern of Occurrence of Fractures in Children and Adolescents and Its Managements Based on the Database of the Health Insurance Review and Assessment Service: Yong Wook Kwon, Soon Hyuck Lee, Hyun Woo Kim, Jin Ho Hwang; J Korean Fract Soc 2014;27(4):308-314. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.308

Abstract PDF

PURPOSE
The purpose of this article is to report on the pattern of medical process and relative frequencies of fractures in children and adolescents.
MATERIALS AND METHODS
The authors retrospectively analyzed the database of the health insurance review and assessment service regarding children and adolescents under 20 years old treated from 2008 to 2010. Newly registered numbers of fractures in children and adolescents according to sex, month, institution, and anatomical location were also reviewed.
RESULTS
A total of 1,893,416 fractures occurred during three years; approximately 630,000 cases were treated during one year (approximately 562 cases among 10,000 people during one year). During one year, the most fractures occurred in June and the least in February. Senior general hospital consisted of 5.72%, 12.30% in general hospital, 19.28% in hospital, and 62.70% in clinics. Among the fracture sites, 0.05% were cervical fractures, 0.91% in sternum and thoracic vertebra, 1.35% in lumbar vertebra and pelvis, 12.79% in shoulder and upper extremities, 26.87% in lower extremities, 38.10% in wrist and hand, 1.01% in femur, 10.40% in lower extremities including ankle, and 8.52% in foot excluding ankle. The maximal incidence was age 14 years in male and 12 years in female.
CONCLUSION
The authors reviewed the pattern of medical process and relative frequencies of fractures in children and adolescents.

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Analysis of Computed Tomography Scans for Radiation Safety Management in the Republic of Korea
Min Young Lee, Ji Woo Kim, Ga Eun Oh, Geon Woo Son, Kwang Pyo Kim
Journal of Radiation Protection and Research.2024; 49(3): 141. CrossRef

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Fracture-Dislocation of S1 in 3-Year-Old Boy: A Case Report: Sang Bong Ko, Sang Wook Lee; J Korean Fract Soc 2010;23(2):232-235. Published online April 30, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.2.232

Abstract PDF: Fracture-dislocation of the sacrum that has not yet fully developed is common in the distal sacrococcygeal joint of children, but this injury is rarely seen in 1st Sacrum. Most of these patients have a severe neurological deficit, so this injury generally requires surgical decompression. We managed a three year old patient who had a S1 fracture-dislocation without a neurological deficit, and the patient was treated with simple skin traction and bed rest without surgery. The child had a satisfactory result, so we report on this case with reviewing the relevant literatures.

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Pediatric Forearm Bone Fractures Treated with Flexible Intramedullary Nail: Suk Kyu Choo, Jin Hwan Kim, Hyung Keun Oh, Dong Hyun Kim; J Korean Fract Soc 2007;20(2):190-195. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.190

Abstract PDF: PURPOSE
To determine the usefulness of flexible intramedullary fixation in pediatric forearm diaphyseal fractures.
MATERIALS AND METHODS
We reviewed 22 cases of forearm diaphyseal fractures treated with flexible intramedullary nail and K-wire. The radiographic assessment was based on the time to union, maintenance of reduction and angular deformity. The functional outcome was assessed with the range of motion and complications at last follow up.
RESULTS
Average length of follow up was 13.9 months with mean age of 10.8 years and the time to union was 5.2 weeks. There were no angular deformity and fuctional results were excellent in all cases. There were 5 cases of soft tissue irritation of nail insertion site as post operative complication which was resolved after nail removal.
CONCLUSION
Flexible intramedullary for pediatric forearm bone fractures is an effective and safe method which gives a good functional outcome.

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Percutaneous Transphyseal Intramedullary K-wire Fixation for the Diaphyseal Forearm Fractures in Children: Jung Hoei Ku, Young Chul Go, Man Jun Park; J Korean Fract Soc 2006;19(3):374-377. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.374

Abstract: PURPOSE
Although the standard treatment of diaphyseal forearm fractures in children is conservative treatment with closed reduction and cast immobilization, unstable or irreducible fractures are usually needed by surgical intervention. The aim of this article is to determine the efficacy of the percutaneous transphyseal intramedullary K-wires fixation for the forearm diaphyseal fractures in children.
MATERIALS AND METHODS
In this retrospective study, we reviewed 18 cases of forearm diaphyseal fractures in children, which were treated with percutaneous transphyseal intramedullary nailing using K-wires from January 2001 to December 2004. We analyzed the period for radiologic bone union and the complications until the last follow-up.
RESULTS
The average period of follow-up was 15 months with mean age of 7.8 years. The average time to bone union was 6.2 weeks and nonunion, malunion, radio-ulnar synostosis and refracture were not found, just 2 local pin site infections were seen but healed by conservative treatment. Postoperative scar was small and the complications until the last follow-up were not found.
CONCLUSION
In the operative treatment of the forearm diaphyseal fractures in children, we think percutaneous transphyseal intramedullary K-wire fixation is one of the effective methods because of the minimal invasiveness, simplicity and easiness in removal.

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Flexible Intramedullary Nail Fixation of Pediatric Femoral Shaft Fracture: Suk Kyu Choo, Byung Jik Kim, Hyun Wook Chung; J Korean Fract Soc 2005;18(1):60-64. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.60

Abstract PDF: PURPOSE
To traditional treatment of pediatric femoral shaft fracture has been a traction and spica cast application. But flexible intramedullary nail fixation has been introduced as an alternative to other treatment modalities. With this in mind, we analyzed the clinical and radiologic results of flexible intramedullary nail fixation of pediatric femoral shaft fractures.
MATERIALS AND METHODS
We analyzed 12 patients (13 cases) who were treated with flexible intramedullary nail and followed up for at least 6 months at the department of Orthopedic Surgery, Inje University Ilsan Paik Hospital since May, 2002.
RESULTS
In all 12 patients (13 cases) involving 1 case with reoperation because of reduction failure, average duration of bone union was 12.6 weeks. There were no considerable complications except mild post-op knee pain and limitation of motion.
CONCLUSION
In spite of relatively short term study, a flexible intramedullary nail fixation seems to be a useful method without serious complications on pediatric femoral shaft fracture. However, in big or older pediatric patients, interlocking intramedullary nail fixation may be a better choice rather than a flexible nail fixation because of it's insufficient stability.

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The Correlation between Surgical Timing and Perioperative Complications in the Treatment of Displaced Supracondylar Humeral Fractures of Children: Soo Hong Han, Duck Yun Cho, Hyung Ku Yoon, Byung Soon Kim, Jae Hwa Kim, Hyung Kun Park, Se Hyen Kim; J Korean Soc Fract 2003;16(2):278-283. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.278

Abstract PDF: PURPOSE
Even though emergent percutaneous pinning after closed reduction is the popularized treatment of the displaced type II and type III pediatric supracondylar fractures of the humerus, the timing of pinning still presents controversy. The purpose of this study is to suggest an appropriate surgical time without significant perioperative complications.
MATERIALS AND METHODS
From April 1995 to January 2002, 179 consecutive patients who had undergone surgical treatment were selected. They were divided to 5 groups [A group: 8 hours or less following injury (24 cases), B group: from 9 to 16 hours (63 cases), C group: from17 hours to 24 hours (63 cases), D group: from 25 hours to 48 hours (18 cases), and E group: from 49 hours to 72 hours (11 cases)] and reviewed retrospectively to analyze perioperative complications and operation time.
RESULTS
There was no significant difference between each group with respect to surgical wound infection, iatrogenic ulnar nerve injury, VIC, operation time and the necessity of reoperation (p>0.05).
CONCLUSION
Within the parameters outlined in our study, we could not find the any meaningful correlation between surgical timing and occurrence of perioperative complications and also, we think that the timing of percutaneous pinning can be delayed to the time when a surgeon considers it appropriate.

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Treatment of the Children's Femur Shaft Fracture by Early Spica Cast: Kwang Hoon Chung, Jong Sup Shim, Ki Sun Sung, Seung Jun Park; J Korean Soc Fract 2003;16(2):270-277. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.270

Abstract PDF

PURPOSE
To investigate the proper indication, technical point and complication of the early hip spica cast.
MATERIALS AND METHODS
Thirty-one children with thirty-two fractures more than 2-year follow up were included. The patient's average age and weight were 5 year 2 months and 19.1 Kg respectively. Spica cast was applied as follow. First short leg cast was applied, and then patient was placed on the spica cast table. During the cast incorporation, the hip and knee flexed sufficiently to maintain length and alignment of the fracture, and popliteal fossa was well molded and padded. The meticulous valgus molding of the fracture site was also needed.
RESULTS
Average bayonet overriding of the fracture was initially 1.1 cm, however it increased to 1.5 cm during cast immobilization. In the 9 patients (28.1%), cast wedging correction were needed to 3 to 14 days after initial cast immobilization and the cause of correction was related to patients weight. At the final follow up, there was no serious functional or cosmetic complications.
CONCLUSION
For the successful treatment, the proper patients selection, meticulous cast application and careful radiographic assessment after cast application were needed.

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Stiff Knee by Entrapment of Quadriceps Femoris Tendon at Fracture Site in Paediatric Distal Femur Shaft Fracture
Suk Kang, Jong Pil Kim, Chung Soo Hwang, Phil Hyun Chung, Young Sung Kim, Sang Ho Lee, Jin Wook Chung
Journal of the Korean Fracture Society.2007; 20(4): 339. CrossRef

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Retrograde Flexible Intramedullary Nailing of Pediatric Femur Fractures: Chang Wug Oh, Byung Chul Park, Hyung Jin Park; J Korean Soc Fract 2001;14(2):272-277. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.272

Abstract PDF

PURPOSE
This study was designed to evaluate the clinical effectiveness including bone union, leg length discrepancy, after retrograde flexible intramedullary nailing for pediatric femoral fractures. MATERIAL AND METHOD: Nineteen cases (18 patients) with femur fracture at the age of 4 to 10 years (mean age 6.7) have been followed up over the minimum of one year. Under imaging intensifier, the fracture was temporarily reduced with manual traction, and 1 or 2 flexible nails were inserted at medial and lateral side of distal femur above the distal epiphysis. After two weeks of immobilization with long leg splint, joint motion was permitted. At 6-8 weeks, partial weight bearing was permitted, and at 10- 12 weeks, full weight bearing was permitted.
RESULTS
Time to radiologic union averaged 10.9 weeks. Limb length discrepancy ranged from 7mm of shortening to 6mm of overgrowth(mean ; 1.1mm of overgrowth), but there was no severe limb length discrepancy over 10mm. As another complications, there were one case of limited motion of knee joint and one case of broken nail.
CONCLUSION
We found that retrograde flexible intramedullary nailing is a safe, effective treatment for acute femoral shaft fractures in skeletally immature patients.

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Treatment of Femoral Shaft Fracture with Interlocking Humeral Nail in Older Children and Adolescent
Kun-Bo Park, Hoon Park, Hyun-Woo Kim, Hui-Wan Park, Jae Young Roh
Journal of the Korean Fracture Society.2010; 23(2): 206. CrossRef

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Treatment of Pediatric Femoral Fractures Using External Fixator: Sung Kwan Hwang, Seung Tae Jeong; J Korean Soc Fract 1997;10(1):25-30. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.25

Abstract PDF: Seven patients with femur fractures were treated with external fixators. The average age at fracture was 8 years 4 months ranging from 6 years to 10 years. Of 7 fractures, 5 were closed fractures and 2 were open fractures. The average time to healing of fractures was 7.3 weeks(ranging from 4 to 20 weeks). Duration of extemal Dxation averaged 12 weeks. There were 2 cases of pin tract infection; none resulted in osteomyelitis. Of all cases, angulation at the fracture site was less than 5 degrees. Two patients had leg length discrepancy less than 10mm. Conclusion ; External fxation is a well-proven technique for managing femoral fractures in the child with multiple injuries. It is also an effective means of treating isolated femoral fractures in the podiatric population.

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Treatment of the Pediatric Ankle Fracture: Kyung Chul Kim, Jae Yeul Choi, Joon Sik Kim, Young Soo Jhe, Beoung Chul Yun; J Korean Soc Fract 1996;9(2):341-348. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.341

Abstract PDF

The objectives of this study is to evaluate the incidence and the complicated results of pediatric ankle fracture. The injuries of the ankle in children occur mostly at physis rather than ligamentous structure, and the injuries of the physis may result in arrest of the growth of physis and these may lead to angular deformity, joint incongruity, and growth disturbance, which are frequently reported in the literatures. Accurate treatment under the clear understanding of mechanism of injury in very important for preventing this complications. We reviewed 17 cases of pediatric ankle fracture, from June 1990 to June 1994 and followed up for more than 1 year at department of orthopaedic surgery Kangbuk Samsung Hospital. We could obtain results as follows; 1. The mean age was 1 1 years old, and predominant in male. 2. Sports injury was the most common cause. 3. According to modified Dias and Tachdjan classification, supination inversion type was the most common and according to Salter Harris classification, type II was. 4. Eight cases were treated by closed reduction and immobilizatior in a plaster cast, and other nine by open reduction and internal fixation, among them, three cases had complications, such as angular deformity, Joint incongruity, and premature closure of physis.

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Interposition of Periosteum in Distal Tibial Physeal Fractures of Children
Phil Hyun Chung, Suk Kang, Jong Pil Kim, Young Sung Kim, Jae Woo Cho
Journal of the Korean Fracture Society.2011; 24(1): 73. CrossRef

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