Journal of Musculoskeletal Trauma

Ankle Fracture Associated with Tibia Shaft Fractures: Ji Wan Kim, Hong Joon Choi, Dong Hyun Lee, Young Chang Kim; J Korean Fract Soc 2014;27(2):136-143. Published online April 30, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.2.136

PURPOSE
The purpose of this study is to evaluate the incidence of ankle injury in ipsilateral tibial shaft fractures and to assess the risk factors for ankle injury associated with tibial shaft fractures.
MATERIALS AND METHODS
Sixty patients with tibial shaft fractures were enrolled in this retrospective study. The incidence and characteristics of ankle injury were evaluated, and fracture classification, fracture site, and fracture pattern of the tibial shaft fractures were analyzed for assessment of the risk factors for ankle injury combined with tibial shaft fractures.
RESULTS
Ankle injury occurred in 20 cases (33%). There were four cases of lateral malleolar fracture, four cases of posterior malleolar fracture, two cases of distal tibiofibular ligament avulsion fracture, and 10 cases of complex injury. Fourteen cases (70%) of 20 cases of ankle injury were diagnosed from x-ray films, and the other six cases were recognized in ankle computed tomography (CT). Ankle injury occurred in 45.1% of distal tibial shaft fractures and found in 41.4% of A type, but there was no statistical significance. Ankle injury was observed in 54% of cases of spiral pattern of tibial shaft fracture and the incidence was statistically higher than 19% of cases of non-spiral pattern tibial shaft fracture.
CONCLUSION
Ankle injury was observed in 33% of tibial shaft fractures; however, only 70% could be diagnosed by x-ray. Ankle injury occurred frequently in cases of spiral pattern of tibial shaft fracture, and evaluation of ankle injury with CT is recommended in these cases.

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Usefulness of Computed Tomography on Distal Tibia Intra-Articular Fracture Associated with Spiral Tibia Shaft Fracture
Seong-Eun Byun, Sang-June Lee, Uk Kim, Young Rak Choi, Soo-Hong Han, Byong-Guk Kim
Journal of the Korean Fracture Society.2016; 29(2): 114. CrossRef

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A Comparison of Reamed and Unreamed Interlocking Intramedullary Nailing for Closed Fractures of the Tibia Shaft: Keun Bae Lee, Sung Taek Jung, Dae Chang Joo, Jae Joon Lee; J Korean Soc Fract 2000;13(3):515-521. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.515

Abstract PDF

PURPOSE
To get a reliable clinical data of interlocking IM nailing, the authors compared the results of the reamed interlocking IM nailing(Reamed) with unreamed interlocking IM nailing(Unreamed) in only closed fractures of tibial shaft. MATERIAL AND METHODS: Each Reamed(n=40) and Unreamed group(n=31) was followed by twenty-nine(13-53) months and twenty-one(13-55) months. We analyzed the results and complications of the each group.
RESULTS
The average total duration of the procedures performed without reaming was 13 minutes shorter than that of the procedures done with reaming(p>0.05). Twenty-nine fractures(73%) that were treated with reaming and eighteen(58.1%) that were treated without reaming united at postoperative 4 months. But, thirty-eight(95%) and twenty-nine(93.5%) fractures united at postoperative 6 months respectively. There was only one nonunion, which developed without reaming. Delayed union occurred after two nailing procedures with reaming and after one without reaming. Malunion occurred after one nailing with reaming and after two without reaming. There were two superficial infection, which developed after nailing with reaming.
CONCLUSION
There was no significant differences in the clinical and radiological result between reamed and unreamed nailing for the treatment of closed tibial shaft fracture. But, the bone union rate was significantly higher in reamed group than unreamed group at postoperative 4 months.

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Anterior Knee Pain after Intramedullary Nailing for Tibial Shaft Fractures
Suk-Kyu Choo, Hyoung-Keun Oh, Hyun-Woo Choi, Jae-Gwang Song
Journal of the Korean Fracture Society.2011; 24(1): 28. CrossRef

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Treatment of open Tibial Shaft Fractures with Unreamed Interlocking Intramedullary Nailing: Jeung Tak Suh, Byung Guk Park, Chong Il Yoo; J Korean Soc Fract 1999;12(3):568-576. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.568

Abstract PDF: Severe open fracture of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilization was by external fixation, but the advent of small diameter interlocking intramedullary nails has introduced a new option. From the June 1992 to December 1997, 55 cases of open tibial shaft fracture were treated with unreamed interlocking intramedullary nailing at the department of orthopedic surgery, Pusan National University Hospital. The purpose of this study is to evaluate its result and complications. Mean age was 31, mostly male. The main cause of trauma was traffic accidents(30 cases, 55%) and fracture sites consisted of mid 1/3 portion over 75%. According to the Gustilo & Anderson classification 8 type I(15%), 22 type II(40%), 15 type IIIA(27%) and 10 type IIIB(18%) were shown. Union time was 28.3 weeks on an average and union rate was 98%. There were 5 cases(9%) of delayed union, 2 cases(4%) of deep infection and 1 case(2%) of chronic osteomyelitis. In conclusion unreamed interlocking intramedullary nailing can be the first choice treatment in the treatment of open tibia shaft fractures with low postoperative infection.

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Ilizarov External Fixation for Severe Open Tibial Shaft fractures in Adults: Jeung Tak Suh, Tae Wook Nam, Chong Il Yoo; J Korean Soc Fract 1999;12(3):549-556. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.549

Abstract PDF: PURPOSE
It is to evaluate and discuss the result of severe open tibial shaft fractures treated by Ilizarov external fixation.
MATERIALS and METHODS
From the January 1992 to July 1997, 34 cases of severe open tibial shaft fracture in adults were treated with Ilizarov external fixator. 20 males and 14 females were followed for at least 1 year.
RESULTS
Fractures were evenly distributed through proximal 1/3 to distal 1/3 and its pattern was mostly comminuted one. According to Gustilo-Anderson classification, it mainly consisted of type IIIa &IIIb(28 cases: 82%). Mean bony union time was 40.2 months. There were 5 cases(15%) of delayed union, 2 cases(6%) of nonunion, 5 cases(15%) of deep infection including 3 cases(9%) of osteomyelitis, 10 cases(29%) of pin tract infection, 4 cases(12%) of malunion and 11 cases(32%) of ankle stiffness.
CONCLUSION
Conclusively, in the first place, for the successful treatment with Ilizarov external fixator, determining appropriate indications is the most important. Secondly, active reconstruction of soft tissue environment and early prophylactic bone graft, if necessary, are also essential to shorten union time. Thirdly, meticulous care of pin site and ankle motion is needed for the prevention of the two most common complications even though they are considered to be minor.

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A Treatment of Unreamed Intramedullary Nailing of Open Fracture of the Tibia: Keun Kwon Kang, Jang Jung Kim, Kun Yung Lee, Myung Kon Nam, Myung Sik Park; J Korean Soc Fract 1995;8(3):551-556. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.551

Abstract PDF: The tibial fracture was the most common fracture of the long bone fractures, especially there were many controversies in the treatment of open fracture by high energy injury. The authors analyzed retrospectively 32 patients of tibial open fracture who underwent unlearned intramedullary nailing at the Department of Orthopedic Surgery, Lee-Rha general hospital from September 1992 to August 1994 with minimal 1 year follow up. In 32 cases, the average age was 37.5 years old and the most common injury was traffic accident(25 cases,78%). Twenty seven cases were male(84.4%) and 5 cases female(15.5%). There were 17 cases of Type A fracture(53%),12 cases Type B(37.5%) and 3 cases Type C(19.5%) by A-O classification, and 11 cases were Type I open fracture(34%) by Gustilo - Anderson classification, 15 cases, Type B (47%) and 6 cases, Type III (19%). The average bone union time was 14.8 weeks except one case of infected non-union. We concluded that unlearned intramedullary nailing is recommended for the compatible treatment metnod of tibial open fractures.

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Comparative Study between Compression Plate with Screw Fixation and Interlocking Intramedullary Nailing of Tibial Shaft Fractures in Adult: Sang Won Park, Jong Hoon Park; J Korean Soc Fract 1995;8(1):278-283. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.278

Abstract PDF: Various methods have been used in the treatment of tibial shaft fractures in adults. In recent years, generally accepted two surgical methods are compression plate with screw fixation and intramedullary nailing. The authors reviewed 73 cases of tibial shaft fractures, treated by operation in Department of Orthopedic Surgery, Korea University Hospital from June 1986 to April 1993 and minimum follow up period was one year. All cases were devided into 2 Groups, open reduction with compression plate fixation(35 cases) and closed reduction with interlocking intramedullary nailing(38 cases), and the two-groups were compared with each other. The results were as follows: 1. The average time of clinical and radiological union were 17.5 weeks & 26.3 weeks in the compression plate group and 12.3 weeks & 18.5 weeks in the interlocking intramedullary nailing group respectively. 2. Bony union rate was not influenced by the level of the tibial fracture. It was delayed especially in the comminuted fracture. 3. Two cases of delayed union, one case of superficial infection and two cases of limited range of motion occured in the compression plate group. Two cases of delayed union and one case of infection combined limited hee motion occured in the interlocking intramedullary nailing group. 4. According to our clinical study, interlocking intramedullary nailling is regarded as a better method for the management of comminuted tibial shaft fracture than compression plaate and screw fixation.

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Treatment of Tibial Shaft Fractures by Intramedullary Nailing: Sung Kon Kim, Sung Woo Suh, Hyung Suk Kim; J Korean Soc Fract 1994;7(2):431-437. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.431

Abstract PDF: From March, 1989 to Sept. 1992, total of 31 cases of tibial shaft fracture have been admitted treated with intramedullary nailing at the Department of Orthopaedic Surgery, Ansan Hospital, Korea University. Among them, 13 cases which had been followed-up than 2years were analyzed and the results were as follows; 1. Among the 13 patients, 9 of them(69.2%) were male, the rest of 4(30.8%)were female. 2. Eight cases out of 13 were open fractures with Gustilo type I-4 cases, type II-2 cases, type III-2 cases and the remaining 5 were closed type. 3. Treatment offered were either interlocking intramedullary nailing(10 cases, 76.9%) or insertion of flexble nails(3 cases, 23.1%). 4. There were no cases with non-union and the average period of bone union was 21.6 weeks. 5. Delayed union and superficial infection occured in each three cases as a complication. 6. Intramedullary nailing could be used carefully in tibial shaft fracture even in the communicated & open fractures.

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Treatment of the Tibia Shaft Fractures with Unreamed Intramedullary Interlocking Nail: Ki Chan Ahh, Seung Seok Seo, Hyun Duek Yoo, Jang Seok Choi; J Korean Soc Fract 1994;7(1):95-104. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.95

Abstract PDF: In general, blood supply of the long bones contributes three ways-nutrient, metaphyseal and periosteal vessels. Its vascular damage is caused by major trauma or extensive soft tissue det-achment. When the diaphysis of long bone is reamed, endosteal blood supply is eliminated. In our hospital, 23 selected cases of the diaphyseal fracture of tibla have been treated by manipulative reduction, unlearning of the medullary canal and fixation of fracture fragments with an Interlocking intramedullary nail for preserration its vascularity as possible. We analized the patients from Jan. 1992 to May 1993, who were followed up for a mean 12 months. Most of cases were acute, 18 of these cases were open fracture and main cause of the injury was traffic accidents. Overall, 90% of the patients were judged to have good or excellent result based on both clinical and radiological parameters, and the average bony union time was 17 weeks. The complications were mainly infection(3 cases), loosening or breakage of the locking screws(3 cases) and delayed union(1 case). The merits of unlearned interlocking nailing were relatively easy procedure, short operation time, decreased complcations, rigid fixation and early rehabilitation. We concluded that unlearned intramedullary interlocking nailing is a useful method to treat the tibia shaft fractures, especially open type.

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