Journal of Musculoskeletal Trauma

Proximal Tibiosbular Fracture associated with Popliteal Artery Injury: Sang Soo Kim, Hong Jun Han, Dong Churl Kim, Dae Ho Ha, Hee Jun Yoo, Suk Kyun Park; J Korean Soc Fract 1999;12(4):885-893. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.885

Abstract PDF: Injury to the popliteal artery results in amputation more frequently than any other arterial injury. The major factor in the amputated limbs was a delay in diagnosis and therapy of the arterial injury associated with blunt trauma. The proximal tibial fractures produced the highest percentage of vascular complications and indicated immediate application of therapeutic measures. The purpose of this study is to investigate the long-term results and factors that influences the results of surgical treatment in patients with combined proximal tibial fracture and popliteal artery injury. Authors reviewed the records of 24 cases treated for this injury between January 1984 and May 1997. The age of the patients ranged from 17 to 70 years(average 45 years). Nine patients presented with life threatening injuries and classical signs of acute limb ischemia. Prolonged ischemic time ranged from 3 to 6 hours 30 minutes(average 4 hours 50 minutes). The most common cause of thoses injury was traffic accident in 16 cases. Five cases had neurologic deficit ; significant soft tissue injury was present in 14 extremities. Vascular procedures included saphenous vein interposition, end-to-end anastomosis, etc. Bony procedures were accomplished by external means in 14 cases and the others treated by immediate internal fixation in 5 cases. Intraoperative fasciotomy was performed in 5 patients with lower limb ischemia. The results suggested that limb salvage was possible in 63 percent of patients with combined proximal tibial fracture and popliteal artery injuries, but a history of life-threatening condition and severe associated injury with vascular compromise was an unfavorable prognostic factor. So a well organized multidisciplinary approach is necessary to ensure life and functional limb salvage.

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The Combined Operative Treatment for Neglected Monteggia Fracture-Dislocation in Adolescent Period: Report of 2 cases: Churl Hong Chun, Sang Soo Kim, Jeong Min Yoo; J Korean Soc Fract 1998;11(4):964-969. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.964

Abstract PDF: There are various perative methods for the treatment of neglected Monteggia fracture-dislocation. ut, it is difficult to obtain good results by the onlyone operative method in the adolescent period. We reported two patients for the neglected Monteggia fracture-dislocation in adolescent period who were treated by the combined operative treatment. The combined operative method was, in regular sequence, the ulnar osteotomy, the fibrous tissus removed in the humeroradial joint, radial head reduction, Bell-Tawse annular-ligament reconstruction and fixating the radial head to the capitellum with the K-wire with neutral position. Finally, plate fixation in ulnar osteotomy site was done. After 3 weeks, we removed the K-wire and performed active ROM exercise. The clinical results were evaluated by Bruce scale at the follow-up 15 months and 53 months. The results were satisfactory without complications. So we canvass for this combined method about neglected Monteggia fracture-dislocation in adolescent period.

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Brachial Plexus Injury of Whole Arm Type Developed after Surgical Treatment of Infectious Mid-Shaft Clavicular Nonunion: Byung Chang Lee, Sang Soo Kim, Hyeoung Jun Kim; J Korean Soc Fract 1998;11(1):22-27. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.22

Abstract PDF: Neurologic complications after surgical treatment of clavicular nonunion were rare, and they were usually types of incomplete paralysis of one or more branches of brachial plexus. We experienced a complete brachial plexus paralysis of whole arm type developed after compression plating and bone grafting for infectious clavicular nonunion. This 44 years old male patient, sustained infectious clavicular nonunion of mid-shaft, complains postoperatively complete paralysis of right upper extremity and severe burning pain around the clavlcle. We performed exploration after 1 day of operation. The operative findings are no gross damage of brachial plexus, direct compression with cancellous bone graft, narrowing of costoclavicular space and fibrotic adhesion with surrounding soft tissue. For decompression of brachial plexus, we perform adhesiolysis and neurolysis, and refixed the clavicle after plate bending along anterosuperior curvature and removal of inferiorly grafted bone to restore costoclavicular space. Eletrodiagnostic study in two weeks reveal severe brachial plexopathy of whole arm type. After three months of operation, he regain the nearly complete function of upper extremity and radiologic study show a evidence of bony union. The obtained results from the evaluation of this patient were as follows: 1. Direct compression by cancellous bone graft and a spike of bone is a major contributing factor. 2. Fibrous adhesion with surrounding soft tissue due to previous infection is another important factor of reducing the costoclavicular space. 3. Motor function is more profoundly affected than sensory function, and the order of motor return is radial, median, musculocutaneous, axillary and ulnar nerve. 4. When brachial plexopathy follow immediately operation of clavicle, early exploration is indicated for diagnostic and therapeutic purpose.

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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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Treatment with an Interlocking Nail for Ipsilateral Fracture of the Femur and Tibia: Sang Soo Kim, Churl Hong Chun, Dong Churl Kim, Sang Hoon Cha; J Korean Soc Fract 1996;9(3):541-546. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.541

Abstract PDF: Concomitant ipsilateral femoral and tibial fractures present a challenging therapeutic problem. They are generally caused by high-energy trauma, primarily motor-vehicle accidents, and the associated injuries frequently develop. Also the complications much as delayed union, non-union, malunion and stiffness of the knee are more prevalent in patients with this combination of fractures than in patients with an isolated femoral or tibial fractures. The interlocking nail system has many advantages about among the many treatment methods of isolated long bone fractures, but the surgical technique is very difficult at the concomitant ipsilateral femoral and tibial fractures. The purpose of this study has been to review the surgical technique and to grasp an easy reduction method at that fractures. We routinely perform the interlocking nail for the ipsilateral femoral and tibial fractures in order to promote early motion of the knee in 14 patients from 1989 to 1995. Local complications included 1 case of femoral metal failure, and 2 cases of nonunion treated by bone graft. At the last follow up examination, at an average of 13 months after injury, the mean range of motion of the knee was 130 degrees. Over-all, a good or excellent functional result was achieved in about 93% of the patients according to the criteria suggested by Karlstr m and Olerud. In conclusion, the best results were achieved when both fractures were stabilized surgically with the interlocking nail system.

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T-Plate Fixation of Unstable Fractures of the Distal Radins: Churl Hong Chun, Sang Soo Kim, Hak Sun Kim, Jeong Hyu Lee; J Korean Soc Fract 1996;9(2):295-302. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.295

Abstract PDF: In the treatment of Unstable fractures of the Distal Radius, selecting a right method of treatment that can give the best result is very difficult. Many complications can be developed if improper mothods are chosen o treat these fractures. We analyzed 25 patients with unstable fractures of the distal raduis, being treated with open reduction and internal fixation with T-plate from May 1986 to December in 1994 and, being followed for more than 12 months. The results were as follows; 1. In twenty-five patients, 17 cases were Cellosfractures, 2 cases Smith fractures and 6 cases Bartons fractures. 2. In follow-up roentgenogram, the mean values of the radial length, radial deviation, volar tilt and step-off are 18.8 mm,20.3 ,8 ,0.2mm respectively. 3. Recovery of wrist function was correlated with the degree of correction of volar tilt angle in the postoperative roentgenogram . 4. In 25 patients treated with open reduction and internal fixation using the T-plate, satisfactory result was obtained in 88% (22 cases) of patients, We concluded that this is the effective method for treating unstable fractures of the distal radius because this method permits early motion of the wrist by firm and stable fixation.

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Treatment with bone block transfer of coracoacromial ligment in acromioclayicular injury: Byung Chang Lee, Sang Soo Kim, Dae Moo Shim, Sang Do Cha; J Korean Soc Fract 1996;9(1):146-153. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.146

Abstract PDF: Several studies have shown the effectiveness of reconstruction of acromioclavicular ligament with coracoacromial ligament in treating the Grade III acromioclavicular joint injury. One of these is a bone block transfer of coracoacromial ligament into the medullary canal of the clavicle to prevent occasional pullout of the transfered ligament. Eleven cases with complete acromioclavicular dislocation(acute 3, chronic 8) were treated by this method. We modified slightly the original method described by Shoji et at. to increase the success rate. Failure of coracoclavicular reconstruction occurred in two cases. All except one patient regained nearly painlefs range of shoulder motion. One patient showed severe restriction of shoulder abduction and definite deformity. In functional evaluation by the Weitzman criteria, five were excellent, four good, one fair, and one poor. Radiologic results for restoration of coracoclavicular interval showed marked improvement but were not consistent with clinical results. Main technical problems were harvesting bone block and fixation of ligament. To obtain good osseus healing without pull out of transferred ligament, we found that preservation of bone ligament junction and careful harvest of full thickness acromiai bone block was important.

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The Treatment of Nonunion of Femoral Fractures with an Interlocking Nailing: Churl Hong Chun, Sang Soo Kim, Dong Churl Kim, Hee Jun Yoo; J Korean Soc Fract 1995;8(3):497-504. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.497

Abstract PDF

Nonunion of femoral fractures has continued to challenge orthopaedic surgeons. Interlocking nailing with reaming offers the advantages of stable fixation. adequate alignment, minimum shortening, good rotational control, early weight bearing without external support and high union rate. Between August 1988 and March 1993, 20 patients with nonunion of the femoral fractures were treated by an interlocking nailing with reaming. The types of primary treatment prior to nonunion were plate fixation in 10 patients, conventional intramedullary nailing in 9 patients and external fixation in 1 patient. The purpose of this study was to evaluate the causes of nonunion and analyze the results with interlocking nailing in the management of nonunion of femoral fractures. The radiological examination revealed that formation of the bridge callus took a mean of 3.5 months for the patients who received the plate and screw fixation. On the other hand. it took a mean of 2.4 months for the patients who were treated with conventional intramedullary nailing. When the two groups of patients were combined, it took a mean of 3.2 months. All patients were obtained the complete union in a mean time of 10.4 months after an interlocking nailing. Complications were 1 breakage of distal target screws. 1 pain near the entry of nail and 1 delayed union. Limb shortening was measured by roentgenoscanography and occurred in all patients but not clinically significant.

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Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef

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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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The clavicular nonunion treated by internal fixation and bone graft: Churl Hong Chun, Sang Soo Kim, Dae Moo Shim, Byung Chang Lee, In Yong Choi; J Korean Soc Fract 1993;6(2):312-317. Published online November 30, 1993; DOI: https://doi.org/10.12671/jksf.1993.6.2.312

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Intercalary Tricortical Iliac Bone Graft in the Surgical Treatment of Nonunion of Midshaft Clavicular Fractures
Chul Hyun Cho, Hyung Gyu Jang
Clinics in Shoulder and Elbow.2012; 15(1): 32. CrossRef

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Idiopathic Fever following Childrens femur Fractures: Hong Jun Han, Hyun Lee, Sang Soo Kim; J Korean Soc Fract 1990;3(2):280-283. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.280

Abstract PDF: Not infrequently, Orthopaedic surgeons notice that fever following childrens femur fractures does not coincide with the laboratory findings. The authors agree that knowledge of the frequency, time of onset, duration, and magnitude would be helpful in accessing the significance of fever in the postinjury period. The authors reviewed 65 childrens femur fractures without infection under the 15 years old from March 1984 to December 1989 and following observations were made. 1. Fever developed in 32 patients(49%), but only in 7 patients(11%) significant fever elevation was found. 2. The mean onset of fever was 4 days after trauma, and the mean duration was 3 days. 3. The rate of fever occurrence increased In accordance with age. 4. Fever was least common in patients having oblique fracture. 5. Associated injuries were found more commonly in the febrile group.

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Change of Patellar Length after Internal Fixation of the Patellar Fracture: Min Jong Lee, Sang Soo Kim, Kyung Youl Jhon; J Korean Soc Fract 1989;2(2):234-245. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.234

Abstract PDF: As fracture of the patella may casue loss of continuity of the extensor mechanism and incongruity of the patellofemoral joint, the aim of treatment is to restore function and strength of the knee and to minimize posttraumatic osteoathritis by closed or open methods. To know which method is adequate to fixation of the patellar fractures, the authors reviewed 35 cases of the patellar fractures, which were treated with K-wire fixation, circumferential wiring, modified tension band wiring or combined circumferential wiring with modified tension band wiring, with radiological change of patellar length after exercise, and obtained the following results: 1. Postoperative lengthening of the patea occurred in 17 out of 35 cases(49%) and the range was 1.3 to 8.0mm, mean 3.1mm 2. Patellar lenthening occurred in cases with K-wire fixation or cirumferential wiring more than modified thension band or combined circumferential wiring with modified tension band fixation. 3. Modified tension band added to circumferential wiring may be obtained more rigid fixation in comminuted fracture, especially.

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Analysis of Results of External Fixation in the Tibial Shaft Fracture: Sang Soo Kim, Dae Moo Shim, Min Jong Lee, Yong Suk Shim; J Korean Soc Fract 1989;2(1):60-70. Published online June 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.1.60

Abstract PDF: The fracture of the tibia shaft is difficult to treat because of high tendency of open fracture and complications such as osteomyelitis, soft tissue defect, delayed union and non-union. To evaluate that external fixation alone can be a final solution on treatment of the tibial fractures of the change of treament mode after external fixation, We studied 50 cases of fractures of the tibia shaft which were treated with external fixation between January 198 4 and June 1988. The results were as follows. 1. Among causes of injury, the traffic accidents were the most common. 2. Among the type of fractures, comminuted fractures were 26 cases(41%) and open fractures 47 cases(92%). By classification of Gustilo and Anderson most cases were open type III(60%). 3. The 4 cases(8%) were treated with external fixation alone and the time to union ave-raged 5.2 months. 4. For the 15 cases(30%), external fixators were removed, then applied cast and the time to union averaged 5.3 months. The 12 cases(24%) were treated with bone grafting and cast after removal of external fixator and the time to union averaged 6.8 months. 5. Among the secondary additional operatioin required after external fixation, bone operations were 34 cases, soft tissue operations 13 cases and comosite operations 3 cases. The bone 5 cases(39%) out of 13 cases of soft tissue operation. 6. The duration of external fixation was 22 days to 248 days, mean 101.6 days. 7. A retrospective evaluation of 50 cases treated external fixation revealed that external fixation was simple, safe and dffective method in the initial stage of fracture treatment but could not be a final Solution.

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The Calcaneal Trabecular Pattern as an Index of Osteoporosis and the Role of Osteoporosis in Ankle Joint Fractures: Ju O Kim, Hong Jun Han, Young Suk Kim, Sang Soo Kim; J Korean Soc Fract 1989;2(1):101-106. Published online June 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.1.101

Abstract PDF: To provide another effective method of surveying osteoporosis, authors introduced the calcaneal trabecular pattern as an index of osteoporosis. We reviewed the roentgenograms of 144 patients with ankle or hip joint fracture. The trabecular pattern in the cacaneum(expressed as the calcaneal index) and that in the upper end of the femur(Singhs index) were well correlated, and both indices have a inverse correlation with age. The calcaneal index did not reveal any correlation with the type of ankle joint fractures, but it was estimated to provide useful information for ankle joint fractures in selection of treatment mode including fixation method and prediction of the prognosis.

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Treatment of difficult Nonunion by Modified Dual Onlay graft: Sang Soo Kim, Ju O Kim, Dae Moo Shim, Bong Joo Park, Young Jin Choe; J Korean Soc Fract 1988;1(1):86-90. Published online November 30, 1988; DOI: https://doi.org/10.12671/jksf.1988.1.1.86

Abstract PDF: For the difficult nonunion, such as large bone defect, severe osteoporosis, nonunion with repeated operations, or nonunion at the metaphyses, authors performed modified dual onlay bone graft. One side was appied wiht plate for the stabilization of the nonunion site and the other side with cortical bone from tibia for the osteogenecity. We performed this operation in five cases and all of them had good results. This method is believed to be superior in its stronger stabilization and less donor site problem, however, with sufficient osteogenecity, to the original dual onlay graft. Moreover, even to the metaphyseal area, plate can be contoured to the bone shape, which makes this operation applicable to all areas of bone.

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