Journal of Musculoskeletal Trauma

Fractures of the Femur associated with the Hip Arthroplasty: Sung Kwan Hwang, Young Sang Lee, Jin Soo Park; J Korean Soc Fract 1999;12(4):837-843. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.837

Abstract PDF: Periprosthetic fractures as a complication of hip arthroplasty are uncommon. However, the incidence has been increafed recently especially in cementless or press-fit arthroplasties. The need to achieve a tight fit of the prosthesis in the bone when using cementless component has led to increased risk of periprosthetic fractures. We have experienced periprosthetic fractures occurred in 52 cases(51 patients) among 814 hip arthroplastic from January 1990 to December 1997. Among the 52 cases of periprosthetic fractures, 5 cases were occurred in cemented femoral stem(5 cases among the total 236 cases of cemented femoral stem : 2.1%), and 47 cases were occurred in the cementless type of femoral stem(47 cases among the total 578 cases of cementless type of femoral stem : 8.1%). There were 43 cases of intraoperative fracture and the rest was occurred postoperatively. According to the Johannson classification, type I fractures were 28 cases, type II fractures were 20 cases, and type III fractures were 4 cases. In postoperative periprosthetic fractures, according to the Vancouver classification, type A fracture was 1 case, typeB 1 fractures were 4 cases, typeB2 fractures were 2 cases, and type C fractures were 2 cases. The accurate preoperative templating and prophylactic managemnet of the risk factors are important for reducing the incidence of periprosthetic fractures.

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Proximal Humeral Fracture with Epiphyseal Plate Injury: Sung Kwan Hwang, Jin Rok Oh, Jung Ho Rah, Ki Ho Kim; J Korean Soc Fract 1997;10(4):793-800. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.793

Abstract PDF: Proximal humerus fracture with epiphyseal plate injury does not cause the growth disturbances and deformity of humerus in comparison with other fracture of epjphyseal plate. The explanation about this phenomenon is that the fracture occurs microscopically in maturing Bone near provisional calcifying zone, another explanation is that the epiphyseal plate in proximal humerus greatly contribute the longitudinal growth of humerus and has trimendous remodelling potential. In this study, we experienced the 25 cases of proximal humeral epiphyseal injury from January, 1991 to June, 1997 We analyzed the growth disturbance and deformity of the proximal humeral epiphyseal plate in regard to age, fracture type, treatment method of the 15 cases with 3 years follow-up among the 25 cases. This fracture is most common in the age of 13 to 16, 11 cases among total 15 cases(75 percent). Most common fracture type is type II by Salter-Harris classification, 14 cases among total 15 cases, 3 cases is type IV by Neer-Horowitz classification, where, manual reduction was impossible because of interposition with biceps tendon between fracture fragments. There was no impairment of motion, growth distrubance and deformity in all cases. We concluded there is no direct correlation with patient age, the degree of fracture, displacement, treatment method in view of gorwth disurbance and deformity.

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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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A treatment for the Fracture-Dislocation of the Talus: Sung Kwan Hwang, Kwang Jong Yoo; J Korean Soc Fract 1996;9(4):1016-1025. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1016

Abstract PDF: Fractures of the talus are uncommon injuries. Because of the unique blood supply and biomechanical features. the complication of the displaced fractures are frequent and long term disabilities are so severe that the importance of proper treatment is emphasized. A clinicaT evaluation of 25 patients with fracture of the talus has been made from January, 1985 to December, 1994 and followed them more than 12 months for each. The result were as follows; 1. There are 20 men and 5 women and the average age was 31.2 years. 2. The common causes of fracture were traffic accidents in 13 cases(52%) and fall from height in 9 cases(32%). 3. According to the classification by Hawkins, four of the fractures were included in type I, eight in type II, six in type III, one in type IV and six in body and process. 4. All 4 cases in type I. 1 case in type II and 4 cases in body and process fractures were treated conservatively, 7 cases in type II, 6 cases in type III, 1 case in type IV and 2 cases in body and process fractures were treated operatively. 5. According to the Hawkins criteria, final result were as follows; excellent in 10 cases, good in 7 cases, fair in 5 cases, poor in 3 cases. 6. Among the operatively treated type II, III, IV, delayed operations wrre performed in type II(2 cases). type III(3 cases). The final results of the delayed operations were good in one case, fair in one cases, poor in three cases. In conclusion, the results of the delayed operation were worse than those of the early operation, so we think that the early operation of talar fracture and dislocation will give good results.

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Complication Related to Interlocking Nailing of the Tibia Fracture: Sung Kwan Hwang, Ji Man Yoo; J Korean Soc Fract 1995;8(4):823-829. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.823

Abstract PDF

PURPOSE
The study of complications after tibia fracture treated with interlocking nails of various kinds. MATERIAL & METHOD: A retrospective review of 60 cases of tibial fractures treated with interlocking nailing was under- taken to document the spectrum of complication associated with this procedure. The 60 cases of tibia fracture were followed up at least 1 year, related to clinical and radiographic union. Complications were categorized into intraoperative, early postoperative and late postoperative group.
RESULTS
1. Intraoperative complication developed in 11 cases(16.6%) : propagation of proximal tibia fracture in 5 cases(8.3%) and malalignment in 6 cases(10%), among them 3 cases(50%) occurred at proximal 1/3 facture site, 2 cases(33%) occurred at distal 1/3 site and 1 case(16%) occurred at mid 1/3 site. 2. Early post operative complication occurred in 4 cases(6.7%), lesional entry point infection in 3 cases, hematoma in 1 cases without nerve injury or compartment syndrome. 3. In late complication groups were as follows(28 cases, 47%) deep infection in 4 cases(6.6%), hard ware failure in 3 cases(5%) limb shortening more than ten in 3 cases(5%), 6 cases(10%) were angular deformity more than 5 degree and delayed union occurred in 5 cases(8.3%) which need secondary operation. 7 cases(11%) had knee pain, were rated as patellar tendinitis or implant protrusion.

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Breakage of Reamer during Tibia Intramedullary Nailing - A Case Report -
Ho Yoon Kwak, Jin Su Kim, Ki Won Young, Joo Won Joh, Sae Min Hwang
Journal of the Korean Fracture Society.2013; 26(4): 333. CrossRef

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Refracture of the Femur after Plate Removal: Sung Kwan Hwang, Jung Ho Rah, Hee Jeon Park, Yeo Seung Yoon, Jae Beom Han; J Korean Soc Fract 1995;8(4):799-806. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.799

Abstract PDF

Internal fixation with dynamic compression plate is an accepted method of treating diaphyseal fractures of the adult femur. Good results have been reported using the principles laid down by the AO group(Muller et al 1979). Refracture after secure union of a broken femur has been achieved is rare, but it is most devastating complication. There were 5 refractures out of 64 removals after fractures of the femur at the department of Orthopaedic Surgery, Yonsei University Wonju college of Medicine between January, 1988 and June, 1994. After clinical and roentgenographical analysis, following results were obtained. 1. The causes of the refracture were trivial injuries or slip down injury. 2. Among 5 cases, the average time from insertion to removal was 19.2 months, with a ranged from 16 to 28 months. 3. The internal from removal of implant to refracture was 5.6 wks, with a range from 3 to 9 weeks. 4. The incidence of refracture in out hospital(7.8%) was somewhat higher than reported incidence by others. 5. The femur plates should not be removed prior to 2 years postoperatively and its removal should be postponed, if possible. 6. It is reasonable to postpone its removal until bone strength is adequate for full activity.

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Refractures of the Upper Extremity in Children
Hui Wan Park, Ick Hwan Yang, Sun Young Joo, Kun Bo Park, Hyun Woo Kim
Yonsei Medical Journal.2007; 48(2): 255. CrossRef

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Complications in the Use of Interlocking Intramedullary Nailing for the Femoral Fractures: Sung Kwan Hwang, Jae Beum Han; J Korean Soc Fract 1995;8(1):1-12. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.1

Abstract PDF: A retrospective review was undertaken in 31 patient with femoral fracture which had complication after undergoing the closed reduction and internal fixation using interlocking intramedullay nail. The technical complexity associated with the locking nail introduces a new set of complications. This article discusses these problems and suggests means to avoid certain difficulties. The results were as follws; 1 Intraoperative complications were new fracture near the original fracture site(3 cases), Iatrogenic femur neck fracture(1 case), pudendal nerve neuropraxia(1 case). 2. Postoperative complications were delayed union(13 cases), limb shortening(4 cases), nonunion(3 cases), infection(3 cases), distal screw breakage(3 cases), nail breakage(1 case), proximal screw breakage(1 case), and angulation(1 case). 3. At final follow up, the major complications were 11 cases(13.4%) but, bone union was achived in all cases except 3 case, union rate was 96.4%. 4. Highly developed operative technique and postoperative management were necessary to diminish complications.

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Conservativ eTreated of Pelvic Ring and Acetabular Fracture: Sung Kwan Hwang, Young Sang Lee; J Korean Soc Fract 1994;7(1):12-19. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.12

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No abstract available.

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A Case Report of Korean Rehabilitation Treatment and Analysis of Conservative Treatment of Pelvic Fracture in Korea
Hyun Ju Ha, Ji Hyang Gu, Bong Seok Choi, Tae Young Oh, Eun Mi Oh, Yu-Chen Li, Min-Seok Oh
Journal of Korean Medicine Rehabilitation.2018; 28(2): 135. CrossRef

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Fractures of the carpal scaphoid: Sung Kwan Hwang, Jin Soo Park; J Korean Soc Fract 1993;6(1):65-76. Published online May 31, 1993; DOI: https://doi.org/10.12671/jksf.1993.6.1.65

Abstract PDF: No abstract available.

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Interlocking Intramedullary Nailing with Transfixing Serew for Femur Shaft Fracture: Sung Kwan Hwang, Woo Yong Yi; J Korean Soc Fract 1992;5(2):289-299. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.289

Abstract PDF: Despite advances in fracture management. the long bone fracture have high rate of morbidity. Recently interlocking intramedullary nailing have gained increasing attention and accepta- nce as a treatment modality for femoral shaft fracture. Early proper fixation of long bone fractures is needed for early mobiliaation of the patient to facilitate pulmonary care and to prevent secondary complications due to prolonged bed rest and traction We treated twenty-eight patients of femur shaft fracture using interlocking intramedullary nails and transfixing screws. All twenty-eight fractures were nailed in static fashion initially. Twelve patients were randomly chosen and they were changed from statlc fixation to dynamic fixation at average 16 weeks after surgory. The purpose of this study was to compare the bone healing rates, clinical results, and postoperative complication between the static fixation group and dynamiaation group. The results were as follows ; 1. According to Winqulst-Hansen classification : 9 cases were type I : 7 cases, type II : 6 cases, type III : 4 cases, type IV and : 2 cases, type V. 2. All sixteen fractures, treated by static fixation achieved bony union(mean union time : 21 weeks). 3. Of twelve fractures with dynamization, eleven fractures were united (mean union time, 19 weeks). 4. Postoperative complications were limb shortening (4 cases : mean 0.7cm), nail breakage (1 case) and nonunion(1 case). We consider interlocking intramedullary nailing is the treatment of choice for closed or open femoral shaft fractures and dynamization is not an essential procedure for fracture healing.

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Treatment of hip fracture in elderly over sixty a comparison studybetween the internal fixation and arthroplasty: Sung Kwan Hwang, Yong Seok Choi; J Korean Soc Fract 1992;5(1):121-128. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.121

Abstract PDF: No abstract available.

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Pitfalls and Complications in the Use of Interlocking Intramedullary Nailing for the Femoral Fractures: Sung Kwan Hwang, Jong Seon Yoon; J Korean Soc Fract 1990;3(1):71-78. Published online May 31, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.1.71

Abstract PDF: The introduction of percutaneously inserted transfixing interlocking screws increase the stabization potential of the intramedullary nail. The use of interlocking system extend the indications for closed intramedullary nailing. However, the added technical complexity, related with the locking screws, introduces a new errors and pitfalls. Among 32 patients who had closed interlocking I.M. nailing for 32 femoral fractures, 7 patients showed intra-or-postoperative complications. Six patients had intraoperative complication : four patients(new fracture near the fracture site) ; one patient(femur neck fracture), and one patient(failure of distal locking). Two patients experienced postoperative complication :one deep infection and another, proximal migration of nail. All 7 patients had pitfalls and complications related with operative techniques for interlocking I.M nailing. After careful analysis of the pitfalls and complications, following suggestions were considered. 1. To reduce the new fracture near the fracture site, insert the nail through an entry portal of trochanteric fossa centered over the axis of the femoral medullary canal. 3. Avoid repeated awling and placing the entry portal too far medially, which can result in iatorogenic fracture of the femur neck. 4. After distal screw insertion, the correct position of the screw in the screw hole should be confirmed on AP and lateral view. 5. Adequate preoperative and postoperative use of antibiotics were seriously considered in case of open fractures.

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Complication Folloing Operative Treatment in Complete Acromioclavicular Joint Dislocation: Sung Kwan Hwang, Jae In Ahn, Heui Jeon Park, Zi Hoan Cha; J Korean Soc Fract 1988;1(1):64-70. Published online November 30, 1988; DOI: https://doi.org/10.12671/jksf.1988.1.1.64

Abstract PDF: The conservative treatment such as plinting, bandaging and harnessing in the partial disrupton of the acromioclavicular joint(Grade II or less) has been successuful, but many surgeons prefer to operative treaments for complete A-C dislocation(Grade III). Though more than 55 operative methods of treatment were reported in the literature, they could be divided into four categories: 1) acromioclar reduction and acromioclavicular fixation, 2) acromicoclavicular reduction, coracoclavicular ligament repair, and coracoclavicular fixation, 3) distal clavicle excision, and 4) muscle transfers. Among numerous operative methods, we used Weaver-Dunn technic, A-O tension Band technic, and Modified bosworth technic in total 28 cases of complete A-C dislocation from March 1984 to June 1988 at the Yonsei University Wonju College of Medicine, Wonju Christian Hospital. In most cases, excellent or good results were obtained, but we stillfound swveral postperative complications. We experienced neither deep wound infection nor osteomyelitis. All 6 cases had fixation-related complications. After close examination of operation notes and X-rays, following suggestions were considered. 1. Reduce every A-C joint anatomically before inserting K-wires through A-C joints. 2. Start shoulder motion several days after operation to provide enough time form healing of deltoid and trapezius muscles. 3. Surgenous play a major role to prevent commplications such as malposition of fixatives and incomplete A-C joint reduction

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