Journal of Musculoskeletal Trauma

Limited Open Reduction and Intramedullary Nailing of Proximal Femoral Shaft Fracture: Sang Ho Ha, Jun Young Lee, Sang Hong Lee, Sung Hwan Jo, Jae Cheul Yu; J Korean Fract Soc 2009;22(4):225-231. Published online October 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.4.225

Abstract PDF: PURPOSE
To evaluate the result of treatment of proximal femoral shaft fracture with limited open reduction and intramedullary nailing. MATERIALS AND METHODS: Fifteen patients who had limited open reduction and intramedullary nailing due to proximal femoral shaft fracture for follow-up for more than 12 months were selected between March 2001 and December 2005. The clinical and radiologic results were analyzed. Winquist-Hansen classification and OTA/AO classification were used. RESULTS: Thirteen cases achieved bone union and 2 cases showed delayed union. The mean bone union period was 21.3 weeks (14~32). There was no postoperative infection. Nonunion was observed in 2 cases of which bone union was acquired with the exchange of intramedullary nail and bone graft in one case and with the additional plate fixation and bone graft in the other case. CONCLUSION: Treating proximal femoral shaft fracture with limited open reduction and intramedullary nailing seems to be a technique to manage proximal femoral shaft fracture that has combined fracture or ipsilateral femoral fracture or is unable to acquire acceptable reduction with closed reduction.

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The Usefulness of Blocking Screw in Intramedullary Nail on Proximal Tibial Fracture: Jun Young Yang, June Kyu Lee, Young Mo Kim, Chang Hwa Hong, Kyung Cheon Kim, Sung Hwan Ahn; J Korean Fract Soc 2005;18(1):17-21. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.17

Abstract PDF: PURPOSE
To evaluate the effectiveness of a blocking screw in intramedullary nailing at the tibia proximal shaft fracture.
MATERIALS AND METHODS
63 tibia proximal shaft fractures from January 2000 to December 2002 treated with only intramedullary nailing were referred to as group I, and 8 fractures from January 2003 to December 2003 treated with both intramedullary nailing and the blocking screw were referred to as group II. Retrospective studies were done for group I and II. The incidence of nonunion and the postoperative angular alignments were compared. Malalignment was defined as an angle of 5 degrees anteroposteriorly or mediolaterally.
RESULTS
There were 7 nonunion (11%) in group I in compare with none in group II. There were 21 angular malalignments (33%) in group I and 1 in group II (12%) and most of them had valgus deformity or anterior anglulation. No complications were directly due to the use of the Blocking screw.
CONCLUSION
The technique of the blocking screw used to be one of the option for proximal tibial nailing at tibial proximal shaft fracture helps to overcome angular malalignments of bones.

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Treatment of Proximal Shaft Fracture of Tibia with Intramedullary Nail: Analysis According to AO Classification and the Poller Screw: Chang Wug Oh, Sung Jung Kim, In Ho Jeon, Hee Soo Kyung, Byung Chul Park, Joo Chul Ihn, Kyung Hoon Kim, Yun Kee Woo; J Korean Fract Soc 2004;17(2):133-137. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.133

PURPOSE
This was a retrospective study to evaluate the results of intramedullary nailing in proximal shaft fracture of tibia. We analyzed those results according to AO classification and Poller screw.
MATERIALS AND METHODS
Thirty-three proximal tibial shaft fractures (32 patients) were followed for more than one year. In AO classification, there were 6 cases of type A, 14 cases of type B, and 13 cases of type C. We used Poller screws in 14 operations. We evaluated translation, angulation and nonunion after surgeries.
RESULTS
Twenty-eight cases (85%) were united primarily, but nonunions occurred in 5 cases. Malalignment (angulation>5degree or translation>5 mm) was found in 14 cases (42%). In Poller screw used and non-used groups, the malalignment was respectively showed in 2 cases (14%) and 12 cases (63%). According to AO classification, nonunion was found in only type B with 5 cases (36%).
CONCLUSION
Intramedullary nailing of proximal shaft fracture of tibia showed relatively lower rate of primary union. Especially, when initial fractures have a butterfly fragment, it showed the higher rate of nonunion. Moreover, the malalignment rate was relatively higher, yet it is possible to reduce the rate of malalignment by using Poller screw.

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Open Source-Based Surgical Navigation for Fracture Reduction of Lower Limb
Sanghyun Joung, Jaeyeong Park, Chul-Woo Park, Chang-Wug Oh, Il Hyung Park
Transactions of the Korean Society of Mechanical Engineers A.2014; 38(5): 497. CrossRef

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The Problems of Locked Intramedullary Nailing in the Proximal Shaft Fractures of the Tibia: Jin Woo Kwon, Kyoung Tae Sohn, Seung Ho Shin, Jae Il Kim; J Korean Soc Fract 1999;12(1):76-82. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.76

Abstract PDF: Proximal shaft fractures of the tibia have a high incidence of complication and often result in poor outcomes. Plate fixation and locked intramedullary nailing are the most common methods of treatment, but now the latter is more popular because of soft tissue problem, osteomyelitis etc.. The purpose of this study is to evaluate the results of locked intramedullary nailing in the treatment of proximal shaft fractures of the tibia and to draw a conclusion that what type of fracture patterns are the appropriate indication of nailing. We analyzed 18 proximal shaft fractures of the tibia which were treated by locked intramedullary nailing from October 1991 to March 1997 and followed more than 12 months. The results were as follows ; The complications were occurred in 12 cases(66.6%); 4 cases of delayed or non-union, 8 of angular deformity, 1 of leg length discrepancy. Delayed or non-unions were caused by fracture site comminution and bone defect. 5 anterior angular deformities were due to the pulling of the knee extensor mechanism and 3 valgus deformities were due to medially located entry portal. In conclusion, since locked intramedullary nailing in proximal tibial fractures causes a high incidence of complications, it is recommended in transverse or undisplaced fractures. And plate fixation and bone graft will be recommended in comminuted or displaced oblique fractures, if soft tissue condition is permitted.

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Surgical Management of the Proximal Tibial Shaft Fractures - A Comparison of Plate Fixation and Interlocking Intramedullary Nailing -: Ki Soo Kim, Yong Soo Choi, Chul Hun Choi, Jin Ho Yang; J Korean Soc Fract 1997;10(4):872-878. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.872

Abstract PDF: The treatment of proximal tibial shaft fractures is an area of great controversy. The purpose of this study was to make the comparison between the results of the plate fixation and those of the interlocking nailing, and to identify the effects of the location of the nail bend on the reduction of the proximal tibial shaft fractures. From June 1991 to May 1995, we performed the plate fixation in 12 cases and interlocking nailing in 16 cases for the proximal tibial shaft fracture. We subdivided the interlocking nailing group into two groups: Group A had the fractures within the posterior bending length of the nail in 8 cases, Group B had the fractures over the posterior bending length of the nail in 8 cases. The results were as follows; The most common type of fractures was the Winquist-Han son type III, 9 cases(75%), in the plate fixation group, and the segmental fracture, 10 cases(62.5%), in the interlocking nailing group. In the plate fixation group, autogenous bone graft were used in 7 cases (58.3%), primary in 5 cases and secondary in 2 cases. The interlocking nailing group had a tendency to cause the surgical problems during the nailing such as angular deformity in 3 cases, displacement of the fracture in 2 cases, extension of the fracture in one case, need an open reduction in one case and unstable fixation in one case. The surgical problems were associatied with the incorrect entry point and the fractures within the posterior bending length of the nail (Group A). Clinically excellent and good results, according to Klemm and Borner criteria, were obtained in 12 cases(100%) of the plate fixation group and 13 cases(81.3%) of the interlocking nailing group. the fair results were associtated with the angular deformity in the Group A. In conclusion, the preoperative planing must carefully consider such as the type of fracture, technical familarity, and understanding of the implants and instrumentations ofr the successful treatment of the proximal tibial shaft fractures. The plate fixation is preferable method for the fractures within the posterior bending length of the nail(Group A).

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