Journal of Musculoskeletal Trauma

Treatment of Infected Nonunion of Long Bone Shaft: Comparison between Fixation by Antibiotic-cement Loaded Intramedullary Nailing and Fixation by Antibiotic-cement Loaded External Monofixator: Ki Ho Nah, Seong Jin Park, Suk Ku Han, Hyun Suk Song, Nam Yong Choi; J Korean Soc Fract 2003;16(4):511-518. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.511

Abstract PDF: PURPOSE
To evaluate the surgical results between fixations by antibiotic-cement loaded intramedullary nailing and antibiotic-cement loaded external monofixator in the treatment of infected nonunion of long bone shaft with mild bone loss and shortening of less than 1 cm.
MATERIALS AND METHODS
Among the 15 cases of infected nonunion of long bone shaft, 6 cases treated with fixation by antibiotic-cement coated intramedullary nailing and 3 cases treated with fixation by intramedullary nailing along with antibiotic-cement beads insertion were divided as group I (n=9), and other 6 cases treated with fixation by external monofixator along with antibiotic-cement beads insertion were divided as group II (n=6). There was no difference between the two groups in the degree of infection in the laboratory data and clinical feature and degree of bone loss and shortening. Male was in 7 and 5 patients, average age of the patients was 34.8 (26~53) and 37.2 (20~63) years old and average follow-up period was 15.9 (12~35) and 19.3 (15~41) months in group I and II respectively.
RESULTS
Among the nine cases of group I, 3 cases were newly convereted into fixation by antibiotic-cement coated intramedullary nailing at average 9.5 weeks. Radiologic union was gained at the average of 26 weeks from the time of initial nail fixation. Infection was responsive at 6.1 weeks by laboratoey data. Knee ROM of more than 100 degrees was gained in all case and average shortening was 9.2 mm in the last follow-up. And external rotation deformity of more than 5 degrees was noted in 1 case. Among the six cases of group II, radiologic union was gained at 14 weeks in 1 case without converting to internal fixation, and the other 5 cases were converted to antibiotic cement loaded intramedullary nailing at average 12.5 weeks because of delayed uinon or angulation deformity, and radiologic union was gained at average 44 weeks from the time of fixation by external fixator. Infection was responsive at 10.2 weeks by laboratoey data. Knee ROM of more than 100degrees was gained in 5 cases, and average shortening was 11.8 mm in the last follow-up.
CONCLUSION
In the treatment of infected nonunion of long bone shaft with mild bone loss and shortening of less than 1 cm, the fixation by intramedullary nailing with the use of antibiotic-cement prefers to the fixation by external monofixator with the use of antibiotic-cement in the velocity of union, control of infection, and in the clinical aspects such as alignment, early ambulation and joint stiffness.

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Treatment of Distal Clavicle Fractures with Coracoclavicular ligament Injury: Nam Yong Choi, Suk Ku Han, Seong Jin Park, Ki Ho Na, Young Hun Kim, Hyun Seok Somg, Yong Jin Kwon; J Korean Soc Fract 2002;15(1):21-27. Published online January 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.1.21

Abstract PDF: PURPOSE
To evaluate the radiological and clinical results of the treatment of distal clavicular fractures with coracoclavicular ligament injury by coracoclavicular fixation with plating or repair of coracoclavicular ligament.
MATERIALS AND METHODS
Sixteen cases with minimum six months of follow-up were included in our study. Male was twelve and average age was 43(28-80). Ten cases of Craig type 2 were treated with coracoclavicular screw fixation with plating. Six cases of Craig type 5 were treated with coracoclavicular screw fixation with repair of coracoclavicular ligament. The radiologic assessment including coracoclavicular distance and union time and the clinical assessment including range of motion and degree of pain were evaluated.
RESULTS
Fifteen cases were united, but one case developed osteomyelitis and nonunion. Full range of motion was achieved in fifteen cases at last follow-up. Average coraco- clavicular distance compared to contralateral site in AP view was 2.1 mm increase in patients with plate fixation and 1.3 mm increase in patients with ligament repair. Average union time was 14.3 weeks and little differenece was noted between two groups(P>0.05).
CONCLUSION
Coracoclavicular screw fixation with plating or repair of coracoclavicular ligament were a useful method to treat distal clavicular fractures combined with coracoclavicular ligament injury.

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Occult Fractures of the Subtalar Joint: Chong Hyuk Choi, Seong Jin Park, DJ Ogilvie Harris; J Korean Soc Fract 2000;13(4):935-940. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.935

Abstract PDF: The purpose of the current study was to investigate the results of occult fractures in the subtalar joint which were detected in delay and to find out a way of early detection. The occult osteochondral fractures of the subtalar joint are known to be associated with dislocation and to have a poor prognosis. We treated ten patients who had the occult fractures that were not associated with dislocation. Nine fractures involved posterior facet with a displaced osteochondral fracture. Seven patients lost motion in the subtalar joint completely, and arthrodesis were performed. Three subtalar joints retained some motion and were treated with physiotherapy, which improved the movement and pain. The early detection of fracture was important for the prognosis. We note the "early warning"signs of the patients who have massive swelling without definite bone injury, and who had a failure to regain the subtalar motion after immobilization. The subtalar joint should be imaged with CT or MRI. At first, aggressive physiotherapy should be considered. Arthrodesis should be considered as a final option.

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Morbidity and Mortality of Bilateral Hip Fractures in Elderly Patients: Suk Ku Han, Nam Yong Choi, Seong Jin Park, Seong Keun Lee, Chan Woong Moon; J Korean Soc Fract 2000;13(4):788-794. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.788

Abstract PDF

PURPOSE
The purpose of this study was to estimate the morbidity and mortality rate of bilateral hip fractures in elderly patients compared to that in unilateral hip fractures and to evaluate it's related risk factors.
MATERIALS AND METHODS
Twenty-two cases of bilateral hip fractures in patients who were older than 70 years with at least two year follow-up were included in our study. We analysed the risk factors of bilateral hip fractures by comparing with age, sex and diagnosis matched 22 cases of ipsilateral hip fractures including onset of secondary fracture, injury mechanism and the rate of morbidity and mortality, respectively.
RESULTS
The onset of secondary fracture and death were mostly within 1 year after operation for the first hip fracture. Comorbidity of cardiovascular, neurologic, urologic or history of previous fracture and decreased ambulation ability were related with the occurrence of bilateral hip fractures. The rate of morbidity and mortality of bilateral hip fractures were about two- fold than that of ipsilateral hip fractures. High mortality rate was noted in patients who had operation delay from injury. But no significant relationship between nutrition, body weight or bone mineral density and the development of secondary hip fractures.
CONCLUSION
To prevent the occurence of bilateral hip fractures which had more serious results than that of ipsilateral hip fractures, more aggressive rehabilitation to improve walking ability and appropriate environmental circumstances to avoid falls were important, especially in older patients.

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Assessment of the Clinical Features of Bilateral Sequential Hip Fractures in the Elderly
Duk-Hwan Kho, Ju-Yong Shin, Hyeung-June Kim, Dong-Heon Kim
The Journal of the Korean Orthopaedic Association.2009; 44(3): 369. CrossRef

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Anatomical Results According to Fracture Pattern after Surgical Treatment of Acetabular Fractures: Kyu Hyun Yang, Dae Yong Han, Seong Jin Park, Jae Min Jung; J Korean Soc Fract 2000;13(4):754-760. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.754

Abstract PDF

PURPOSE
We analyzed the anatomical results of operative treatment in acetabular fractures according to fracture pattern and surgeon's experience. MATERIAL AND METHODS: From December, 1993 to December, 1999, 100 cases of acetabular fractures operated by single surgeon were analyzed. Fracture configuration was classified by Letournel's method. The anatomical results were classified by Matt' s criteria and Claude Martimeau score.
RESULTS
There were 36 elementary fractures(anterior column type: 4 cases, posterior wall type: 29 cases, transverse type: 3 cases) and 64 complex fractures(posterior wall and posterior column type: 4 cases, anterior and posterior hemitransverse type: 8 cases, transverse and posterior wall type: 16 cases, T type: 6 cases, both column type: 30 cases). According to Matta's criteria, all elementary fractures were seen anatomic or satisfactory results however, eleven cases of combined fracture were seen unsatisfactory results. Mean Claude Martimbeau's score was 6.1 point. Elementary fracture was 7.5 point and combined fracture was 5.4 point. Both column fracture was 4.4 point and it was the lowest point among the fractures. In both column fracture, the improvement of surgeon's skill made more good anatomical results. There were four cases of infection and 2 cases of nerve injury.
CONCLUSION
In operative treatment of acetabular fractures, complexity of fracture demands more appropriate surgical approach and skillful surgeon,

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Surgical Treatment of Posterior Wall Fractures of the Acetabulum
Young-Soo Byun, Se-Ang Chang, Young-Ho Cho, Dae-Hee Hwang, Sung-Rak Lee, Sang-Hee Kim
Journal of the Korean Fracture Society.2007; 20(2): 123. CrossRef

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Segmental Breakage of Distal Interlocking Screw Complicating removal of broken nail: A Case Report: Kyu Hyun Yang, Seong Jin Park, Hyung Jung Kim; J Korean Soc Fract 2000;13(4):709-712. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.709

Abstract PDF: Metal failure (nail breakage) after locked intramedullary nailing results from delayed union or nonunion, which necessitates removal of nail and interlocking screws. Breakage of interlocking screw(s) can be associated with failure of the intramedullary nail. It usually breaks into two parts. Proximal part, which contains the screw head, can be removed by screwdriver without difficulties. Distal part can be removed from the far cortex or be left in place if it does not hinder further procedures. We experienced a case of segmental breakage of distal interlocking screw, which was associated with failure of the femoral nail and nonunion. Middle part of the broken screw obstructed the hollow of the nail and complicated the removal of the broken nail.

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Intramedullary Nailing in Distal Tibial Fracture: Kyu Hyun Yang, Dae Yong Han, Seong Jin Park, Hwan Wook Yoo, Ki Won Yang; J Korean Soc Fract 1999;12(4):901-908. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.901

Abstract PDF: PURPOSE
: We evaluated the efficacy of intramedullary nailing in distal tibial fractures. Material and Method : Twenty-six patients with distal tibial fracture were treated with intramedullary nailing between Jan. 1996 and May 1998. Operation was done on the fracture table under skeletal traction. We evaluated the causes of trauma, type of fracture, location of fracture, time to union, malunion, nonunion, range of motion of knee and ankle, and degree of pain.
RESULTS
: There were 4 cases of open fracture and 4 cases of closed soft tissue injury at fracture site. The time to fracture union was 19 weeks on average. One case(3.8%) did not heal by 10 months and was classified as nonunion. The union rate was 96.2 % and the complication rate was 7.7%(one case of nonunion and one case of malunion). There was no infection and soft tissue disruption. The range of motion of knee was reduced in 1 case(3.8%) and 2 patients(7.7%) complained of mild pain at the knee joint. The range of motion of the ankle joint was reduced in 4 cases(15.5%), averaging 15.5 degrees in dorsiflexion and 9 cases(34.6%), averaging 21 degress in plantarflexion. Two patients complained of mild pain at the ankle joint.
CONCLUSION
: We had relatively good clinical and radiological results and concluded that closed intramedullary nailing is a safe and effective method of managing distal tibial fracture.

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Surgical Treatment of Stenosing Synovitis and Dislocation of Peroneal Tendon as a Complication of Calcaneal Fracture: Seong Jin Park, Suk Whan Song, Nam Yong Choi, Byung Lae Jo, In Ju Lee; J Korean Soc Fract 1997;10(1):99-103. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.99

Abstract PDF: Malunion of calcaneal fracture results in most of long-term complications such as pain and limitation of motion at hindfoot. Though it is reported that patients symptoms continue to improve during following years, some patients are disabled espicially due to pain. Among the source of pain following malunited calcaneal fracture, traumatic arthritis of subtalar joint, peroneal tendinitis with or without dislocation of tendons, compression neuropathy, and other sequelae were believed to be responsible. The authors report the result of surgical treatment of 9 patients with malunited calcaneal fracture, who had stenosing tenosynovitis(3 cases), and recurrent dislocation of peroneal tendon(6cases). key words; peroneal tendon, stenosing tendinitis, dislocation, malunion, calcaneus Excision of bone mass from the lateral wall of calcaneus and adhesiolysis relieved symptoms of stenosing synovitis. Zoellner and Clancy technique of deepening peroneal tendon groove and reconstruction of peroneal retinaculum using periosteal flap were supplemented for dislocation of peroneal tendon. Among nine patients, four needed subtalar arthrodesis. The results were favorable.

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Treatment of Tibial Shaft Fracture Using Intramedullary Nail: Dae Young Han, Kyu Hyun Yang, Young Chul Cho, Myung Koo Kim, Seong Jin Park; J Korean Soc Fract 1995;8(3):566-571. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.566

Abstract PDF: In the treatment of tibial shaft fracture with intramedullary nail. reaming effectively lengthens the isthmus of the tibia and there by extends the number of fractures amenable to this technique. Reming process, however, destroys the endosteal blood supply, may impair bony union and provecate infection in open fracture. Eighty-eight cases of tibial shaft fractures treated with reamed nail(56 cases) and unlearned nail(32 cases) from January 1991 to August 1994 at Yonsei Medical Center were analyzed. Average follow-up period was 7.3 months.
Results
were as follows 1. In closed fractures, there was no difference in union time between reamed and unlearned group, and low energy injury group had shorter union time than high energy injury group. 2. In open fractures, unlearned group had shorter union time than reamed group. 3. Unlearned group had less complications such as infection and delayed union, and had more cases of interlocking screw breakage(3 cases) which did not dusturb the bony union. In conclusion, unlearned tibial nailing was useful method to treat not only open fracture but also closed fracture.

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The role of lateral malleolus in normal growth and biomechanics of ankle clinical long term study in growing children: In Rhee Kim, Yong Sik Kim, Soon Yong Kwon, Kee Won Ryu, Seong Jin Park, Ko Seung; J Korean Soc Fract 1992;5(1):138-149. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.138

Abstract PDF: No abstract available.

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