Journal of Musculoskeletal Trauma

Assessment of Noncontiguous Posterior Malleolar Fractures in Distal One-Third Tibia Shaft Fractures with Proximal Fibula Fractures: Dae-Geun Kim, Byung Hoon Kwack; J Korean Fract Soc 2022;35(3):103-108. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.103

Abstract PDF: Purpose
Posterior malleolar fractures after intramedullary nail surgery rarely occur in distal tibia shaft fractures. The importance of preoperative ankle evaluation in preventing these fractures is also common knowledge. There are no studies in the literature on posterior malleolar fractures in distal onethird tibia shaft fractures except for distal metaphyseal tibia fractures to the best of our knowledge. The purpose of this study was to evaluate the incidence and radiological features of posterior malleolar fractures in distal one-third tibia shaft fractures with proximal fibula fractures.
Materials and Methods
Thirty-one patients diagnosed with distal one-third tibia shaft fractures with proximal fibula fractures from January 2016 to May 2021 were retrospectively reviewed. With the aid of plain radiographs and computed tomography (CT) scans, the fracture patterns of the tibia and fibula were classified according to the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification, and posterior malleolar fractures were identified. The fracture pattern was classified according to the Haraguchi classification, and the angle between the bimalleolar axis and the posterior malleolar fracture line was measured when there was a posterior malleolar fracture.
Results
Out of the 31 distal one-third tibia shaft fractures with proximal fibula fractures, 16 cases (51.6%) had noncontiguous posterior malleolar fractures that were confirmed on a CT scan, while 3 cases (18.8%) were visible on initial plain radiographs. There was no statistically significant variation seen in the presence of a posterior malleolar fracture in the tibia (p=0.15) and fibula (p=0.87) fractures. According to the Haraguchi classification, there were 15 posterolateral-oblique fractures (Type I) and 1 medial-extension fracture (Type II), and the mean angle was 24.5°.
Conclusion
Noncontiguous posterior malleolar fractures occurred in approximately half of the distal one-third tibia shaft fractures with proximal fibula fractures, and a CT scan was considered necessary to diagnose posterior malleolar fractures before surgery

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Comparison of a Novel Box-Frame External Fixator and Conventional Delta-Frame External Fixator in the Staged Treatment of Distal Tibia Fractures: Yong-Cheol Yoon, MinKyu Shin, Chang-Wug Oh, Jong-Keon Oh; J Korean Fract Soc 2020;33(3):125-133. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.125

Purpose
Distal tibia fractures with severe soft-tissue edema or intra-articular fractures are treated by staged operations using external fixators. Definitive surgery that maintains ligamentotaxis has been difficult using existing fixators. This study introduced a novel ‘box-frame’ external fixator and evaluated its clinical usefulness.
Materials and Methods
This study included 45 patients (32 males, 13 females) diagnosed with distal tibia fractures who underwent staged operations between March 2012 and March 2016, with a follow-up of at least one year. The patients were divided into two groups. In one group, fixation was performed with a box-frame external fixator (Group A). In the other group, fixation was performed with a delta-frame external fixator (Group B). The following outcomes were evaluated: the time until definitive surgery, operative time of the definitive surgery, radiation exposure time, bone union, time to achieve bone union, postsurgical complications, American Orthopaedic Foot & Ankle Society anklehindfoot score, and ankle range of motion.
Results
Compared to the delta-frame, the box-frame showed a statistically significant reduction in the mean radiation-exposure time and operative time during the definitive surgery by 58 seconds and 25 minutes, respectively. The differences in the time until definitive surgery, bone union, time to achieve bone union, postsurgical complications, and functional scores were not significant.
Conclusion
The box-frame external fixator can be a useful treatment method in the staged surgery of distal tibia fractures.

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Temporary Circular External Fixation for Spanning the Traumatized Ankle Joint
Nando Ferreira, Niel Bruwer, Adriaan Jansen van Rensburg, Ernest Muserere, Shao-Ting Jerry Tsang
JBJS Essential Surgical Techniques.2024;[Epub] CrossRef
Temporary circular external fixation for spanning the traumatised ankle joint: A cohort comparison study
William D. Harrison, Franklin Fortuin, Matthieu Durand-Hill, Etienne Joubert, Nando Ferreira
Injury.2022; 53(10): 3525. CrossRef

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The Result of Using an Additional Mini-Locking Plate for Tibial Pilon Fractures: Suenghwan Jo, Jun Young Lee, Boseon Kim, Kang Hyeon Ryu; J Korean Fract Soc 2017;30(2):75-82. Published online April 30, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.2.75

Abstract PDF: PURPOSE
We evaluated the usefulness of an additional, 2.7 mm mini-locking plate for tibial pilon fractures.
MATERIALS AND METHODS
We studied 21 patients (14 males and 7 females), who were treated with a 2.7 mm mini-locking plate via the anterolateral approach for tibial pilon fractures between September 2012 and April 2014. The mean age was 43.85 years, and the mean follow-up period was 16.6 months. The radiologic outcomes were graded by the Burwell and Charnley modified system and clinical outcomes were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score.
RESULTS
The mean union period was 14.3 weeks. At the final follow-up, radiologic results showed 16 excellent results, 4 fair results, and 1 poor result. The average VAS was 3.4 points; the average AOFAS score was 81.8 points. During the follow-up period, there were three cases of posttraumatic osteoarthritis and one case of superficial skin infection.
CONCLUSION
Additional anterolateral, 2.7 mm mini-locking plate may be a good treatment method to manage tibial pilon fractures.

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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; J Korean Fract Soc 2016;29(2):114-120. Published online April 30, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.2.114

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the usefulness of computed tomography (CT) for spiral tibia shaft fracture by analyzing associated distal tibia intra-articular fractures diagnosed by CT only which met the indication of surgical fixation and were fixed.
MATERIALS AND METHODS
Ninety-five spiral tibia shaft fractures with preoperative ankle plain radiographs and CT were analyzed retrospectively. The incidence and type of associated distal tibia articular fractures were evaluated by reviewing ankle plain radiography and CT. The number of fractures diagnosed by CT that correspond with the indication of fixation and that were actually fixed were analyzed.
RESULTS
Among 95 spiral tibia shaft fractures, 62 cases (65.3%) were associated with distal tibia intra-articular fracture. There were 37 cases of posterior malleolar fracture, 5 cases of avulsion fracture of the distal anterior tibiofibular ligament, 5 cases of medial malleolar fracture, and 15 cases of complex fracture. Among 52 posterior malleolar fractures including complex fracture, 20 cases were diagnosed by ankle plain radiograph. Of these 20 cases, 16 posterior malleolar fractures (80.0%) met the indication of surgical fixation, and 14 cases were actually fixed with a screw. Among 32 posterior malleolar fractures diagnosed by CT only, 26 cases (81.3%) met the indication of surgical fixation and 18 cases (56.3%) were fixed by screw.
CONCLUSION
Approximately 50% of associated fractures were diagnosed by CT only and more than 80% of associated posterior malleolar fractures met the indication of surgical fixation and among these fractures, 18 cases (56.3%) were actually fixed by screw. This result suggests that CT is useful in diagnosis and treatment of distal tibia intra-articular fracture associated with spiral tibia shaft fracture.

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Treatment of Distal Tibial Spiral Fractures Combined with Posterior Malleolar Fractures
Young Sung Kim, Ho Min Lee, Jong Pil Kim, Phil Hyun Chung, Soon Young Park
Journal of the Korean Orthopaedic Association.2021; 56(4): 317. CrossRef

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Analysis of the Result Treated with Locking Compression Plate-Distal Tibia and Zimmer Periarticular Locking Plate in Distal Tibia Fracture: Jun Young Lee, Sang Ho Ha, Sung Won Cho, Sung Hae Park; J Korean Fract Soc 2013;26(2):118-125. Published online April 30, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.2.118

Abstract PDF

PURPOSE
To evaluate the clinical and radiological results of minimally invasive plate, osteosynthesis, using either a locking compression plate-distal tibia (LCP-DT) or Zimmer periarticular locking plate (ZPLP) for distal tibia fractures.
MATERIALS AND METHODS
Fifty one patients (51 cases), who underwent minimally invasive osteosynthesis using locking compression plate for distal tibia fractures between October 2008 and August 2011, were followed for more than six months. Eighteen patients were treated with LCP-DT and 33 patients with ZPLP. Time to bony union and anatomic alignment were evaluated radiologically. Clinically, American Orthopedic Foot & Ankle Society ankle-hindfoot scales (AOFAS score) and range of ankle motion were assessed and compared between two groups.
RESULTS
All patients achieved bony union at an average of 18 weeks on LCP-DT group and 16weeks on ZPLP group. The average American Orthopedic Foot & Ankle Society ankle-hindfoot scales was 83.3 points on the LCP-DT group, 84.6 points on the ZPLP group, and range of ankle motion averaged at 45 degrees, 48 degrees, respectively.
CONCLUSION
Both types of locking compression plates were effective when performing minimally invasive osteosynthesis for distal tibia fractures.

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Biomechanical analysis and clinical effects of bridge combined fixation system for femoral fractures
Da-xing Wang, Ying Xiong, Hong Deng, Fu Jia, Shao Gu, Bai-lian Liu, Qun-hui Li, Qi Pu, Zhong-zi Zhang
Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine.2014; 228(9): 899. CrossRef

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Clinical Outcomes of Locking Compression Plate Fixation through Minimally Invasive Percutaneous Plate Osteosynthesis in the Treatment of Distal Tibia Fracture: Jae Sung Yoo, Hyun Woo Park; J Korean Fract Soc 2012;25(2):117-122. Published online April 30, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.2.117

Abstract PDF

PURPOSE
To analyze the clinical results of operative treatment of distal tibia fracture with locking compression plate fixation through a minimally invasive percutaneous plate osteosynthesis technique.
MATERIALS AND METHODS
The subjects were 46 patients (conventional open surgery: 22 patients, minimally invasive percutaneous plate osteosynthesis: 24 patients) with fracture of the distal tibia who were treated with plating between November 2006 and June 2010. The time of bony union, complications, range of motion, and clinical functional outcome (according to American Orthopedic Foot and Ankle Society, AOFAS) were investigated.
RESULTS
In the minimally invasive percutaneous plate osteosynthesis group, the average union time was 14.3 weeks, postoperative range of motion was an average of 55.2, average AOFAS was 96.9, and incidence of complications was 20.8%. In the open surgery group, the average union time was 18.9 weeks, postoperative range of motion was an average of 49.1, average AOFAS was 83.8, and incidence of complications was 32.6%. There were statistically significant differences (p<0.05).
CONCLUSION
Surgical treatment with locking compression plate fixation through the minimally invasive percutaneous plate osteosynthesis technique showed favorable results regarding its union time, postoperative functional outcome, and incidence of complications. The locking compression plate fixation through minimally invasive percutaneous plate osteosynthesis technique can be an effective treatment option.

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Minimally Invasive Plate Osteosynthesis for Fractures of Distal Tibia
Tae Hun Kim, So Hak Chung
Kosin Medical Journal.2014; 29(1): 23. CrossRef

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Minimally Invasive Osteosynthesis with Locking Compression Plate for Distal Tibia Fractures: Sung Kyu Kim, Keun Bae Lee, Keun Young Lim, Eun Sun Moon; J Korean Fract Soc 2011;24(1):33-40. Published online January 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.1.33

Abstract PDF

PURPOSE
To evaluate the outcome of minimally invasive osteosynthesis using locking compression plate for distal tibia fractures.
MATERIALS AND METHODS
Forty five patients (45 cases) who underwent minimally invasive osteosynthesis using locking compression plate for distal tibia fractures between January 2006 and June 2008, were followed for more than one year. The average duration of the follow-up was 30.5 months (12~54 months). The fracture types were as followed: 26 cases (58%) of extraarticular fractures, 19 cases (42%) of intraarticular fractures, and 16 cases (36%) of open fractures.
RESULTS
All patients achieved bone union at average of 21weeks (12~36 weeks). The average American Orthopedic Foot & Ankle Society ankle-hindfoot scales was 84.6 points (65~100 points) and range of ankle motion averaged at 46.5 degrees (20~60 degrees). Complications included 6 cases of superficial infection, 3 cases of malalignment and 5 cases of skin irritation by plate. There were no cases of deep infection, skin necrosis, shortening and metal breakage.
CONCLUSION
Minimally invasive osteosynthesis using locking compression plate for distal tibia fractures is considered to be an effective method with high healing rate, rapid functional recovery and low complication rate due to minimal disruption of bone and soft tissue biology and improved fixation strength.

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Anterolateral Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures Using an Anterolateral Locking Plate
Dongwhan Suh, Hwan Hee Lee, Young Hoon Han, Jae Jung Jeong
Journal of Korean Foot and Ankle Society.2020; 24(1): 19. CrossRef
Comparative Analysis of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Distal Tibia Fractures
Ho-Min Lee, Young-Sung Kim, Jong-Pil Kim, Phil-Hyun Chung, Suk Kang, Kaung Suk Jo
Journal of the Korean Fracture Society.2018; 31(3): 94. CrossRef
Comparison of the Results between Intramedullary Nailing and Plate Fixation for Distal Tibia Fractures
Jung-Han Kim, Heui-Chul Gwak, Chang-Rack Lee, Yang-Hwan Jung
Journal of Korean Foot and Ankle Society.2015; 19(3): 86. CrossRef
Minimally Invasive Plate Osteosynthesis for Fractures of Distal Tibia
Tae Hun Kim, So Hak Chung
Kosin Medical Journal.2014; 29(1): 23. CrossRef

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Comparative Study Using of Treatment with Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Interlocking Intramedullary Nailing in Distal Tibia Fractures: Chang Hwa Hong, Jong Seok Park, Sang Seon Lee, Soo Ik Awe, Woo Jong Kim, Ki Jin Jung; J Korean Fract Soc 2010;23(3):296-302. Published online July 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.3.296

Abstract PDF: PURPOSE
To compare the result of treatment between minimally invasive plate osteosynthesis (MIPO) using periarticular plate and intramedullary nailing in treatment of distal tibia fractures.
MATERIALS AND METHODS
28 cases of distal tibia fractures form Jan. 2006 to Mar. 2008 were divided into two group. Minimum follow-up was for 12 month. Group 1 consisted of 14 patients who were treated by MIPO technique and group 2 consisted of 14 patients who were treated by interlocking intramedullary nailing. The results were compared by assessing radiologic and clinical result.
RESULTS
The mean bony union time was 14 weeks (8~17) in group 1 and 15 weeks (11~20) in group 2. Operation time was 58 minutes (55~65) in group 1 and 82.7 minutes (70~100) in group 2. The average angulation in AP view was 1.5 degrees (0~2) in group 1 and 2 degrees (0~5) in group 2, in lateral view was 1.8 degrees (0~4) in group 1 and 2.3 degrees (0~12) in group 2. The average range of motion for dorsi flextion was 17.5 degrees (15~20) in group 1 and 18 degrees (16~20) in group 2, for plantar flextion was 45 degrees (42~50) in group 1 and 44 degrees (42~50) in group 2, which means that there were no severe limitation of motion in all patients, resulting in satisfactory ambulation. There was no post operative complications such as skin irritation problem caused by internal device and no implant failure and superficial wound infection.
CONCLUSION
There were no difference in bony union time, clinical result and anatomical reduction between Group 1 and Group 2 in distal tibia fractures, but operation time was shorter in MIPO than nailing.

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Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage: Seung Ryul Lee, Jae Hoon Yang, June Kyu Lee, Hyun Dae Shin, Kyung Cheon Kim, Kyu Woong Yeon, Young Mo Kim; J Korean Fract Soc 2009;22(3):152-158. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.152

Abstract PDF: PURPOSE
To find out the efficiency of two staged operation of patients with high energy proximal tibia fracture with severe soft tissue damage, the first step being external fixation, and the second, internal fixation with plates.
MATERIALS AND METHODS
The study group was the 42 patients who had followed for one year out of a group of 56, performed the first step external fixation and the second step internal fixation with plates retrospectively, from March 2003 to March 2007. The average age of the study group was 51.4, 26 men, and 16 women participating in this study. The average time of follow up was 32 months. In the final follow up, investigations of the radiological assessments and functional abilities of the bony fusion were carried out along with the complications of the soft tissue.
RESULTS
The duration after the first step external fixation until second step internal fixation to be performed was 14.9 (6~40) days in average. The final bone fusion took about 15 weeks, and according to the final follow up, the range of motion of the knee was around 110.8 degrees (6.2~117 degrees). In 31 cases, only the internal fixation was performed, while in 11 cases, soft tissue reconstruction was carried out with the internal fixations. As for the complications there were 2 cases of deep soft tissue infection, 2 cases of nonunion, 1 case of malunion and 1 case of knee joint stiffness.
CONCLUSION
In cases of proximal tibia fracture with severe soft tissue damage, external fixation was important to secure the safety of the fracture, carry forward the anatomical alignment, plan the soft tissue safety and manage the wound to decrease the number of microbial in the next operation, which is the internal fixation with plates.

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A Comparison between Minimally Invasive Plate Osteosynthesis & Interlocking Intramedullary Nailing in Distal Tibia Fractures: Kee Byung Lee, Si Young Song, Duek Joo Kwon, Yong Beom Lee, Nam Kyou Rhee, Jun Ha Choi; J Korean Fract Soc 2008;21(4):286-291. Published online October 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.4.286

Abstract PDF

PURPOSE
To compare the effectiveness between minimally invasive plate osteosynthesis (MIPO) and interlocking IM nailing in the treatment of distal tibia fracture without involvement of ankle joint retrospectively.
MATERIALS AND METHODS
38 patients with distal tibia fracture from Jan. 2004 to Oct. 2005 were divided into two groups. Minimum follow-up was for 12 months. Group MIPO consisted of 18 patients were treated with MIPO and group Nail consisted of 20 patients were treated with interlocking intramedullary nail. The results were compared between two groups by assessing bony union time and operation time. Clinical evaluation was evaluated by Olerud score.
RESULTS
The mean bony union time was 14.4 weeks (12~17 weeks) in group MIPO and 16.7 weeks (13~19 weeks) in group Nail (p=0.011). The mean operation time was 1.05 hours (0.6~1.6 hours) in group MIPO and 0.74 hours (0.4~1.1 hours) in group Nail (p=0.044). The Olerud score was 83.8 (75~100) in group MIPO and was 89.6 (70~100) in group Nail (p=0.075). In Complication, group MIPO showed one metal failure and two skin irritations, group Nail showed three superficial wound infections.
CONCLUSION
MIPO was the shorter bony union time and the longer operation time than the interlocking intramedullary nailing. There were no significant differences between the two groups in clinical results.

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Comparative Analysis of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Distal Tibia Fractures
Ho-Min Lee, Young-Sung Kim, Jong-Pil Kim, Phil-Hyun Chung, Suk Kang, Kaung Suk Jo
Journal of the Korean Fracture Society.2018; 31(3): 94. CrossRef
A Rehabilitation for Ankle Fracture in Korean Medicine: A Report of 4 Cases
Won-Bae Ha, Jong-Ha Lee, Yoon-Seung Lee, Dong-Chan Jo, Jin-Hyun Lee, Jung-Han Lee
Journal of Korean Medicine Rehabilitation.2017; 27(4): 171. CrossRef
Comparison of the Results between Intramedullary Nailing and Plate Fixation for Distal Tibia Fractures
Jung-Han Kim, Heui-Chul Gwak, Chang-Rack Lee, Yang-Hwan Jung
Journal of Korean Foot and Ankle Society.2015; 19(3): 86. CrossRef
Intramedullary Nailing of Distal Tibial Fractures with Percutaneous Reduction by Pointed Reduction Forceps
Jae-Kwang Hwang, Chung-Hwan Kim, Young-Joon Choi, Gi-Won Lee, Hyun-Il Lee, Tae-Kyung Kim
Journal of the Korean Fracture Society.2014; 27(2): 144. CrossRef
A Comparison of the Results between Intramedullary Nailing and Minimally Invasive Plate Osteosynthesis in Distal Tibia Fractures
Chul-Hyun Park, Chi-Bum Choi, Bum-Jin Shim, Dong-Chul Lee, Oog-Jin Shon
Journal of the Korean Orthopaedic Association.2014; 49(4): 285. CrossRef
Analysis of the Result Treated with Locking Compression Plate-Distal Tibia and Zimmer Periarticular Locking Plate in Distal Tibia Fracture
Jun-Young Lee, Sang-Ho Ha, Sung-Won Cho, Sung-Hae Park
Journal of the Korean Fracture Society.2013; 26(2): 118. CrossRef

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Comparative Study of Intramedullary Nailing and Plate for Metaphyseal Fractures of the Distal Tibia: Hoon Jeong, Jae Doo Yoo, Young Do Koh, Hoon Sang Sohn; J Korean Fract Soc 2007;20(2):154-160. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.154

Abstract PDF

PURPOSE
To compare the radiological and clinical results between intramedullary nailing and plate fixation in the treatment of distal tibial fractures.
MATERIALS AND METHODS
19 cases of distal tibial metaphyseal fractures within 4 cm of the ankle joint line were enrolled. Ten patients were treated with interlocking intramedullary nail and the others with plate and screws.
RESULTS
The mean union time was 14 weeks in nailing group and 16 weeks in plate group. The average angulation in AP view was 4.1 degrees in nailing group and 3.1 degrees in plate group. The average angulation in lateral view was 1.7 degrees in nailing group and 2.7 degrees in plate group. The rotational deformity was 2.8 degrees in nailing group and 1.7 degrees in plate group in average. There was no implant failure and soft tissue problem.
CONCLUSION
There was no difference in clinical and radiological results between intramedullary nailing and plate in the treatment of the distal tibial fractures and, considering the preservation of the soft tissue, the intramedullary nails are a reliable method for managing distal metaphyseal fractures of the tibia.

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Does a Customized 3D Printing Plate Based on Virtual Reduction Facilitate the Restoration of Original Anatomy in Fractures?
Seung-Han Shin, Moo-Sub Kim, Do-Kun Yoon, Jae-Jin Lee, Yang-Guk Chung
Journal of Personalized Medicine.2022; 12(6): 927. CrossRef
A Comparison of the Results between Intramedullary Nailing and Minimally Invasive Plate Osteosynthesis in Distal Tibia Fractures
Chul-Hyun Park, Chi-Bum Choi, Bum-Jin Shim, Dong-Chul Lee, Oog-Jin Shon
Journal of the Korean Orthopaedic Association.2014; 49(4): 285. CrossRef

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Ender Nailing of the Tibial Shaft Fractures under the Local Anesthesia: Sang Ho Ha, Jun Young Lee, Deog Yong Kim; J Korean Fract Soc 2006;19(2):147-152. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.147

Abstract: PURPOSE
To evaluate the clinical result of ender nailing under local anesthesis was done to patient with tibia shaft fracture who had high risk for general anesthesia or spinal anesthesia.
MATERIALS AND METHODS
10 cases with ender nailing procedure under local anesthesia due to high anesthetic risk were selected from total of 20 cases with tibia shaft fracture operated with ender nailing. In each patient, hepatic, diabetic, cadiopulmonary complication and thromboembolism which can be initiated or aggravated by general or spinal anesthesia, were evaluated. Radiologic and clinical evaluation were used to check bone union.
RESULTS
There were no complication of local anesthesia. Bone union were acquired in all cases with average bone union period of 18 weeks. There were no evidence of flexion deformity, limb shortening or joint contracture.
CONCLUSION
Ender nail fixations under local anesthesia enable close reduction and intramedullary nailing and is effective in patient care but has no problem with bone union. For this reason, ender nail fixation under local anesthesia seem to be effective method if general of spinal anesthesia is difficult.

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The Comparison of MIPPO vs Open Plate Fixation in the Treatment of the Distal Tibia Fracture: Seong Ho Yoo, Seong Jun Ahn, Moo Ho Song, Bu Hwan Kim, Min Soo Lee, Jong Ha Park; J Korean Fract Soc 2006;19(1):29-33. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.29

Abstract

PURPOSE
To evaluate the efficacy of the surgical treatment through the comparison of MIPPO vs open plate fixation in the treatment of the distal tibia fracture retrospectively.
MATERIALS AND METHODS
30 patients with distal tibia fracture from Jun. 2001 to Jun. 2004 were divided into two groups depending on the surgical method. Minimum follow up was 12 months. Group A consisted of 15 patients treated with MIPPO, Group B was 15 patients treated with open plate fixation. The clinical outcomes were evaluated retrospectively from operation time, rehabilitation, ROM, interval change of postoperative CRP to assess postoperative inflammatory reaction, postoperative complications and clinical result with the use of McLennan and Ungersma criteria.
RESULTS
There were no significant differences in clinical result by McLennan and Ungersma criteria in both groups. The postoperative 3 days and 7 days CRP were 4.0mg% (0.9~7.2)/0.5 mg% (0.1~1.5) in group A and 7.97mg% (2.8~14.6)/1.0mg% (0.3~1.6) in group B, shows more minimal tissue injury and early recovery in group A. Operation time in group A was shorter than group B. Normal recovery of ROM was quicker in Group A. In complications, group A showed one superficial infection and one angular deformity and group B showed one superficial infection, one infected nonunion and two ankle stiffness.
CONCLUSION
There were no significant differences in clinical result and bony union. MIPPO technique is superior to group B in view of the minimal tissue injury, complications, operation time and postoperative rehabilitation.

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Minimally Invasive Percutaneous Plate Osteosynthesis Using a Lateral Plate in Distal Tibial Fracture
Oog Jin Shon, Dae Sung Kim
Journal of the Korean Fracture Society.2010; 23(1): 42. CrossRef

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Double Plating of Proximal Tibial Fractures Using Minimally Invasive Percutaneous Osteosynthesis Technique: Chang Wug Oh, Jong Keon Oh, In Ho Jeon, Hee Soo Kyung, Il Hyung Park, Byung Chul Park, Woo Kie Min, Ji Ho Lee; J Korean Fract Soc 2005;18(3):250-255. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.250

Abstract PDF

OBJECTIVES
To evaluate the results and its efficacy of double plating for proximal tibial fractures using minimally invasive percutaneous osteosynthesis (MIPO) technique. MATERIAL & METHODS: Twenty-three fractures, followed-up more than 1 year, were included in this retrospective study. There were 18 men and 5 women, and the mean age was 53.5 years-old. According to the AO-OTA classification, five were 41A, 13 were 41C, and 5 were 42. There were four open fractures (grade I- three, grade III A-one case). The plates were fixed on the medial and lateral sides of tibia with MIPO technique. Functional and radiographic results were evaluated by the modified Rasmussen system.
RESULTS
All fractures healed without bone graft, and the mean period for fracture healing was 19.3 weeks (range, 10~32 weeks). All other patients had excellent or good clinical or radiological results, except for two patients of a fair clinical result after a combined injury. Complications included one case of shortening (1 cm) and two cases of mal-alignments (varus less than 10 degrees). There was one case of superficial infection, but no patient showed deep infection.
CONCLUSION
Double plating using MIPO technique can provide favorable results in the treatment of proximal tibial fractures.

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Medial Minimally Invasive Percutaneous Plate Osteosynthesis in Proximal Tibial Comminuted Fractures
Jae-Ang Sim, Kwang-Hui Kim, Yong-Seuk Lee, Sang-Jin Lee, Beom-Koo Lee
Journal of the Korean Orthopaedic Association.2014; 49(4): 278. CrossRef
Minimally Invasive Plate Osteosynthesis for Proximal Tibial Shaft Fracture
Young-Soo Byun, Ki-Chul Park, Hyun-Jong Bong, Chang-Hoon Lee
Journal of the Korean Fracture Society.2011; 24(1): 23. CrossRef
Treatment of Proximal Tibia Fractures Using LCP by MIPO Technique
Sang-Ho Ha, Dong-Hui Kim, Jun-Young Lee
Journal of the Korean Fracture Society.2010; 23(1): 34. CrossRef
Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture
Joon-Woo Kim, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Woo-Kie Min, Byung-Chul Park, Kyung-Hoon Kim, Hee-Joon Kim
Journal of the Korean Fracture Society.2009; 22(1): 6. CrossRef

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Anatomical Assessment of the Proper Insertion Site for a Tibial Nailing: Soo Yong Kang, Eun Woo Lee, Ki Ser Kang, Han Jun Lee, Ho Joong Jung, Pyeong Ho Jeong; J Korean Fract Soc 2004;17(2):142-147. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.142

Abstract PDF

PURPOSE
To investigate the proper insertion site for a tibial intramedullary nail in the Korean.
MATERIALS AND METHODS
Forty volunteers without trauma below knee joint were studied to determine relationship between central axis of medullary canal and lateral tibial spine, patellar tendon and the proper insertion site, and to evaluation changes of proper insertion site during rotation of knee and effective diameter.
RESULTS
The proper insertion site located average 4.3+/-0.9 mm medial to the lateral tibial spine. The proper insertion site was in the medial 1/3 of patellar tendon in 6 knees, middle 1/3 of patellar tendon in 20 knees, and lateral 1/3 of patellar tendon in 14 knees. The proper insertion site might be changed two times in internal rotation more than in external rotation. The effective diameter was more narrow in medial slope than in lateral slope at proximal tibia.
CONCLUSION
The study indicates the ideal insertion site of tibial nail is the medial aspect of the lateral tibial spine in Korean. To reduce the mal-reduction from a improper insertion site, lateral insertion site might be safer than medial one. However, individual variations in the relationship between the patellar tendon and tibial medullary canal should be considered.

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Three-dimensional analysis of the intramedullary canal axis of tibia: clinical relevance to tibia intramedullary nailing
Sang Jun Song, B. O. Jeong
Archives of Orthopaedic and Trauma Surgery.2010; 130(7): 903. CrossRef
Three Dimensional Analysis for the Intramedullary Canal Axis of the Proximal Tibia: Clinical Relevance to Total Knee Arthroplasty
Sang Jun Song, Choong Hyeok Choi
The Journal of the Korean Orthopaedic Association.2007; 42(3): 345. CrossRef

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The Results of Operative Treatment in Open Type III Tibia Fracture: Kyung Jin Song, Sung Jin Shin, Byung Yun Hwang, Myung Sik Park; J Korean Soc Fract 2003;16(2):194-200. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.194

Abstract PDF: PURPOSE
The purpose of this study was to analyze the functional outcome and propose the guidelines in the surgical treatment of open type III tibial fracture.
MATERIALS AND METHODS
We have analyzed the treatment results of 44cases; age was ranged from 15 to 76 years, and there were 35 males and 7 females. The type of fracture according to the classification by Gustilo revealed type IIIa 14 cases, type IIIb 20 cases and type IIIc in 8 cases. We analyzed functional outcome according to the classification of functional result by Tucker.
RESULTS
The average union time of type IIIa was 9.2 months, IIIb 11.0 months, and IIIc was 13.8 months. The rotational flap and free flap were done during treatment and bone lengthening especially in type IIIc. Functional results were poor especially in type IIIc.
CONCLUSION
Debridement of devitalized tissue, early soft tissue coverage and sufficient stability using intramedullary nails will be necessary in type IIIa fracture. Rigid external fixation, early soft tissue coverage by rotational muscle flap and free flap reduced infection rate with satisfactory functional outcome especially in type IIIb and IIIc fractures.

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Screw breakage in tibial interlocking nailing: Hyung Bin Park, Bun Jung Kang, Hae Ryong Song, Kyong Hoi Koo, Soon Taek Jeong, Se Hyun Cho; J Korean Soc Fract 2002;15(4):483-488. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.483

Abstract PDF

PURPOSE
The aims of this study were to investigate the prevalence and the causes of screw breakage in tibia nailing.
MATERIALS AND METHODS
Between 1995 and 2000, eighty-two tibial diaphyseal fractures were treated with interlocking nails. The loss of follow-up was 7 cases. We retrospectively reviewed seventy-five cases. We investigated the rate and location of metal failure and evaluated the fracture pattern, the presence of distraction after nailing and union abnormality.
RESULTS
Screw breakage was identified in seven cases (9.3%) and most frequently occurred on the second proximal locking screw. Screw breakage occurred in AO type B or C type fractures, fracture site distraction after nailing, open fracture, delayed union and nonunion.
CONCLUSION
The main cause of screw breakage is unstable bone to bone contact on the fracture site caused by comminution or distraction. The open fracture, delayed union, and nonunion also contributing factors for screw breakage. For preventing screw breakage, it is necessary to avoid fracture site distraction and delay full weight bearing in cases having unstable fracture site contact.

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Clinical Outcomes of the Tibia Segmental Fractures Treated by Intramedullary Nail Using Various Reduction Techniques
Oog-Jin Shon, Ji-Hoon Shin, Chul-Wung Ha
Journal of the Korean Fracture Society.2013; 26(1): 50. CrossRef

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Operative Treatment of Open Tibial Fracture: Kyung Jin Song, Sun Woong Jang; J Korean Soc Fract 2002;15(1):45-51. Published online January 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.1.45

Abstract PDF: PURPOSE
The purpose of the present study was to clarify the contributing factors, such as the method of fracture stabilization, type of internal fixation and the deep infection rate(DIR) in the treatment of open tibial fractures. MATERIAL AND METHODS: We made a retrospective study of these 87 open tibial fractures treated with various fixation method. Patients were divided into immediate internal fixation(IIF) group, delayed internal fixation(DIF) group and external fixation(EF) groups. Fixation methods, deep infection rate related with fixation devices and time to bone union were compared and anaylzed according to the Gustilo`s classification.
RESULTS
The mean time to union in open type I, II, IIIa, IIIb, and IIIc was 5.7 months, 8.6 months, 7.1 months, 9.7 months, and 18.0 month respectively. The mean time to union in group IIF, DIF1, DIF2 and EF was 7.2 months, 8.1 months 5.5 months, and 10.7 months and 13.1 months. The mean time to union of group using a interlocking IM nailing, plate and screws, and external fixator was 6.3 month, 6.9 months, and 10.6 months. SUMMARY: We concluded that there is an advantage of immediate internal fixation over external fixation in the prevention of infection and promotion of fracture healing in the treatment of open tibia fractures. Immediate internal fixation could be recommended for type I, II, IIIa and some cases of IIIb open tibia fracture.

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Treatment of Ipsilateral Femur and Tibia Fractures: Sung Keun Sohn, Kyung Taek Kim, Byeong Hwan Kim, Bum Ho Jung, Kyung Sik Hwang; J Korean Soc Fract 2000;13(4):837-846. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.837

Abstract PDF

PURPOSE
Searching for the most excellent outcome of ipsilateral fractures of femur and tibia according to the treatment methods and the combined injuries which occasionally neglected.
MATERIALS AND METHODS
We reviewed thirty cases of ipsilateral fractures of the femur and tibia, treated at the orthopaedic department of the Dong-A university hospital between February 1991 and May 1999. Children under 10 years old, treated by conservative methods were excluded in this study. Average follow-up period was 23.2 months(range, 5 to 44 months) and mean age was 34.7 years old(range, 16 to 58 years).
RESULTS
According to the measurement of the Karlstrom and Olerud, range of motion of the ipsilateral knee joint and bony union time, intramedullary nailing was the treatment of choice for both femur and tibia fracures except limited by open wound and fracture level and types(14 cases, 47%). The ipsilateral knee ligaments injury was the most common combined injury which neglected at initial trauma(8 cases, 27%).
CONCLUSION
By intramedullary nailing, the patients with ipsilateral fractures of femur and tibia could achieve early weight bearing ambulation and ipsilateral knee joint excercise, and showed the most excellent outcome. After fixation of both femur and tibia fractures, by physical examination and arthroscopic examination of ipsilateral knee joint we could detect and treat the ipsilateral knee ligaments injuries, which occasionally neglected.

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Ipsilateral Femoral Segmental and Tibial Fractures: A Case Report
Oog Jin Sohn, Chul Hyun Park, Sang Keun Bae
Journal of the Korean Fracture Society.2009; 22(3): 193. CrossRef

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Treatment of Tibial Defect by Fibular Transposition using Ilizarov: Chung Soo Han, Yong Girl Rhee, Chang Hyun Cho, Moo Song Park, Dong Jun Shin; J Korean Soc Fract 1999;12(4):943-947. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.943

Abstract: Treatment of large segmental defect of tibia is difficult because of associated infection, shortening of limb, nonunion and soft tissue reconstruction. There has been a few options for the reconstruction of segmental tibial defect including vascularized or nonvascularized fibular graft, vascularized iliac bone graft, compression-distraction osteosynthesis and allograft. Tibialization of the ipsilateral fibula for 5 patients who had large tibial defect was successfully achieved by fibular transposition using Ilizarov apparatus at our hosipital . The average defect of tibia was 10.4cm in length. The average time of Ilizarov fixation was 10.3 months. Although one patient required bone grafts, most of them achieved good bony union. The clinical and radiological features and their results were also addressed. Fibular transposition using Ilizarov may be a satisfactory method of treatment for the large segmental tibial defect associated with severe soft tissue injury or vascular compromise.

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Reamed versus Unreamed Intramedullary Nailing after External Fixator Application in the Treatment of Open Tibial-Shaft Fracture: Dong Bae Shin, Joon Cheol Choi, Young Soo Lee, Yong Jeng Kim, Soo Hong Han, Dong Eun Shin, Yeun Ho Lee; J Korean Soc Fract 1999;12(2):272-276. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.272

Abstract PDF: The authers reviewed 15 patients of open fracture of the tibial shaft who were treated by external fixation followed by intramedullary nailing. These fractures comprised two Type-I, two Type-II, four Type-IIIa, and seven Type-IIIb injuries. Ten patients were treated with unreamed intramedullary nailing and 5 patients were treated with reamed intramedullary nailing. The results were analyzed as followings: 1. All fractures had union at 5.2 months after intramedullary nailing and 4 true osteomyelitis were developed. 2. All osteomyelitis were developed for the patients who were treated with reamed intramedullary nailing. 3. There was no osteomyelitis who were treated with unreamed intramedullary nailing. 4. Delayed conversion to intramedullary nailing after control of pin tract infection had no effect for prevention of osteomyelitis.

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Measurement of Angulation after Treatment of Fractures of the Tibia: Comparison of Conventional Methods and New Method Using Mechanical Axis: Chul Yong Chung, Chan Young Son, Sun Bon Koo, Sang Eun Kim; J Korean Soc Fract 1998;11(4):912-917. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.912

Abstract PDF: The importance of residual angular deformity after tibial fracture is still uncertain. but it is generally assumed that osteoarthritis of the ankle and the knee will result when the deformity is severe. Therefore accurate measurement of the alignment of the tibia is important clinically and in research. We compared the results of conventional methods (method 1,2) of measuring the angulation deformity after a fracture of the shaft of the tibia, with a new method using mechanical axis reported by Milner11) (method 3). Sixty-seven patients of tibial fractures with angulation deformity treated at sei Gang General Hospital from January 1995 to December 1996 were evaluated. Samples of 20 sets of standard AP and lateral radiographs of both tibia were measured. The results obtained were as follows. 1. The difference between the angles obtained by Milner's new method (method 3) and conventional methods (method 1,2) was significant in all planes. 2. Both the mean intra-& interobserver difference were minimal in new method, compared with conventional methods, t all planes. 3. There is no statistically significant difference using by paired T-test between angles obtained by new method and conventional methods (p>0.05). From these results, an angulation of measuring the new method was accurate and has good inter- and intraoesrver reliability.

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Angulation Deformity Following Interlocking Nailing for Treaeent of Tibia Fracture: Hong Jun Han, Jae Hoon Shin, Jeong Hyu Lee; J Korean Soc Fract 1996;9(4):1002-1008. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1002

Abstract PDF: Intramedullary nailing is often the treatment of choice in the management of fractures in the tibial diaphysis. With the advent of interlocking nailing, the indication for nailing have expanded, recently. One of the most frequent but little discussed complication of tibial nailing is fracture malalignment leading to angular or rotational deformities. This retrospective study was undertaken to access the incidence of aneular malalignment after interlocking nailing for 210 tibiae(208 patients). The results obtained were as follows; 1. The incidence of angular malalignment was 12.4% 2. The incidence of angular malalignment was 15.8% in proximal one third, 4.1% in middle one third,20.7% in distal one third fractures. 3. The most frequent deformity was valgus angulation in distal one third fractures. 4. Angular deformity was developed more frequently in cases of unlearned nailing(18.9%) than reamed nailing(8.4%). 5. Angular deformity was developed more frequently in cases of double level fracture(22.2%) than single level fracture(11.5%).

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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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Surgical Treatment of Open Tibia Fractures: Intramedullary nailing versus external fixation: Hag Ji Kim, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 1995;8(3):544-550. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.544

Abstract PDF: There is still controversies in the method of surgical treatment for open tibia shaft fractures according to there degree of comminution and extent of soft tissue injury. It is generally accepted as open fracture type I, II can be treated with intramedullary nailing but there are so many suggestions for the type III fractures until now. We tried to evaluate the treatment result for the open tibia shaft fracture treated with intramedullary nailing or external fixatives with respect to seven parameters. time to union, tibial alignment, total number of operations, range of motion of the knee and ankle, pain, presence of infection, and complications. We retrospectively analyzed surgically treated sixty-sever tibia(sixty-six patients), forty-one tibia with extrernal fixatives and twenty-six tibia with intramedullaty nailing, at the Chonbuk University Hospital from January 1988 to December 1993 with mean follow up 32 months. Traffic accident was the most common cause of fracture. In Gustilos classification, 21 were in type I, 18 were in type II and 28 were in type III. Intramedullary nailing should be a safe alternative to extemal fixation for type I, II and III-A open fractures. External fixatives could be used temporarily or permanently for the type III-B and III-C fractures.

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Comparison of Crosse-Kempfs versus Brookers Interlocked Nailing for the Tibial Fracture: Jae Won You, Byoung Bo Lee, Jin Suk Park; J Korean Soc Fract 1994;7(2):490-500. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.490

Abstract PDF: Recently, Intramedullary nailing has become the most common method treating tibial fractures. Various patterns of intramedullary nails are now being developed and using. The purpose of this study is to compare the clinical results, merits and defects of Blocker interlocked nails with Grosse-Kempf(G-K) interlocked nails and to recommend the appropriate nail according to the type and location of the tibial fracture. The authors analysed 62 cases(G-K nail, 34cases; Brooker nail, 28 cases) of tibial fractures which were treated at Chosun university hospital and Sun Cheon hospital between 1991 and 1993. The results were as follows; 1. The average operation time was 62 minutes for G-K interlocked nailing and 35 minutes for Brooker interlocked nailing. 2. In segmental fractures involving the proximal shaft or in proximal shaft fractures, all cases treated with a C-K nail had good results, but 3 of the 8 cases treated with Blocker nail showed angular deformity. 3. In distal shaft fractures, especially fractures with poor soft tissue coverage or within 6cm of the distal tibial end, it was difficult to insert the two distal locking screws of the G-K nail. 4. The complications associated with G-K nails were deep infection(2 cases), nonunion(1 case), loosening and breakage of locking screw(3 cases), and limitation of knee motion(3 cases). The Complications associated with Brooker nails were deep infection(1 case), uonunion(1 case), loosening and breakage of locking screw(2 cases), limitation of knee motion(2 cases), and angular deformity(3 cases). 5. According to Klemm and Boner criteria for functional result, 88% of G-K nail and 89% of Brooker nail fell into good or excellent categories. In conclusion, we recommend G-K nailing in segmental fractures involving the proximal shaft or proximal shaft fractures and the Brooker nailing in distal shaft fractures.

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Clinical study of may anatomical bone plate in distal tibial fractures: Seung Gyun Cha, Won Seuk Lee, Oue Joong Kim, Jin Hak Kim; J Korean Soc Fract 1991;4(1):94-99. Published online May 31, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.1.94

Abstract PDF: No abstract available.

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