Journal of Musculoskeletal Trauma

Computational Simulation of Femoral Neck System and Additional Cannulated Screws Fixation for Unstable Femoral Neck Fractures and the Biomechanical Features for Clinical Applications: Ju-Yeong Kim; J Korean Fract Soc 2023;36(1):1-9. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.1

Abstract PDF: Purpose
To identify the biomechanical features for clinical applications through a computational simulation of the fixation of the Femoral Neck System (FNS) with additional cannulated screws for a Pauwels type III femoral neck fractures.
Materials and Methods
Thirty cadaveric femurs underwent computed tomography, and the images were transferred to the Mimics^® program, resulting in three-dimensional proximal femur models. A three-dimensional scan of the FNS and 6.5 mm and 7.0 mm cannulated screws was performed to enable computerized virtual fixation of FNS with additional cannulated screws for unstable femoral neck fractures. Furthermore, the cannulated screw used for additional fixation was modeled and used as a cylinder within the Ansys program. The biomechanical characteristics of these models were investigated by applying a physiological load virtually.
Results
The maximum von Mises stress value at bone was 380.14 MPa in FNS and 297.87 MPa in FNS+7.0 mm full-thread cannulated screw. The maximum von Mises stress value at FNS was 786.83 MPa in FNS and 435.62 MPa in FNS+7.0 mm full-thread cannulated screw. The FNS group showed the highest maximum von Mises stress values at bone and FNS. For total deformation, the maximum deformation value was 10.0420 mm in FNS and 9.2769 mm in FNS+7.0 mm full-thread cannulated screws. The FNS group represented the highest maximum deformation compared to the other groups.
Conclusion
Considering the anatomical spatiality and biomechanical characteristics of the FNS in unstable femoral neck fractures, when one 7.0 mm full thread cannulated screw was also fixed to the anterosuperior portion of the FNS, significant biomechanical stability was demonstrated.

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Operative Treatment of Type III Coronoid Process Fractures: In Ho Jeon, Woo Kie Min, Chang Wug Oh, Hee Soo Kyung, Byung Chul Park, Poong Taek Kim, Joo Chul Ihn, Jung Yup Lee; J Korean Fract Soc 2004;17(4):338-344. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.338

Abstract PDF: PURPOSE
To review the clinical results of eight cases of typeIII coronoid process fractures which were treated operatively.
MATERIALS AND METHODS
Eight patients with coronoid type III fracture were reviewed retrospectively. All were men with an average age of 33. There were three isolated fractures, two elbow dislocations, two radial head and neck fractures, and one medial collateral ligament rupture. Open reduction and internal fixation through anterior approach with canulated screws was used. The patients were followed up for a mean of 31 months (24 to 60).
RESULTS
Average active elbow joint motion at the most recent follow up was 105degrees. The average Mayo Elbow Performance Score was 76.9 (50 to 95). There was one excellent result, four good, two fair, and one poor.
CONCLUSION
Early open reduction and stable internal fixation provided a reliable method for the treatment of type III coronoid process fractures. Any associated ligament injuries to the elbow and fracture comminution were considered as important prognostic factors.

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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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Treatment of Type IIIB Open Tibial Shaft Fractures: Chung Nam Kang, Jong Oh Kim, Dong Wook Kim, Young Doo Koh, Jae Doo You, Jong Keon Oh, Young Seuk Kim; J Korean Soc Fract 1998;11(3):560-566. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.560

Abstract PDF

In general, severe open fractures of the tibial shaft have been treated initially with external fixation. However, despite many refinements in this technique, it has been associated with numerous complications, including problems at the sites of pins, non-union, delayed union, malunion, and infection. The purpose of this retrospective study is to analyze the results in a consecutive series of patients. There were 8 males and 2 females with an average age of the 44.9 years(range, 26-64 years). The mean follow up period was 23.2 nibtgs(range, 34-120 days). Free flap procedures were performed on all patients. The average time between removal of the fixator and intramedullary nailing was 16.5 days(range, 11-26 days). Indication of conversion to nailing was abscence of any serous discharge, reddness or local heating around pin-sites and normal renge of laboratory data. All 10 fractures had united with additional bone graft in 7 cases. The most frequent complications were delayed union in 7 cases and infection(superficial infection: 6 cases, osteomyelitis: 1 case) after IM nailing. We concluded that pin-tract infection is the major cause of infection after IM nail, but duration of external fixation and time interval(between removal of external fixator and nailing) are not isolated factors.

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Study on Instant Fish Cake Noodle Manufacturing Techniques Using Ultra-fine Powdered Kelp
Yoo-Jin Park, Se-Jong Kim, Myung-Ryun Han, Moon-Jeong Chang, Myung-Hwan Kim
Food Engineering Progress.2019; 23(3): 217. CrossRef
Treatment of Type IIIb Open Tibial Fractures
Seong Yeon Lim, Il Jae Lee, Jae Ho Joe, Hyung Keun Song
Journal of the Korean Fracture Society.2014; 27(4): 267. CrossRef

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Treatment of Open Type-III Tibial Shaft Fractures -Comparison Between Ilizarov External Fixation and Secondary Intramedullary Nailing-: Hoon Kim, Woo Dong Nam, Ki Chan Ahn, Seung Seok Seo, Young Chang Kim, Jang Seok Choi, Young Goo Lee; J Korean Soc Fract 1998;11(1):191-197. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.191

Abstract PDF: Open type III tibial shaft fractures have a high incidence of complication and a poor outcome. The most usual method of stabilization is by external fixation, but there are several complications as infection, delayed union and nonunion. We tried to compare the results of Ilizarov external fixation cases with the case of secondary intramedullary nailing after temporary Ilizarov fixation. There was no significant difference in the union time of Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. But the patients were more comfortable in the secondary intramedullary nailing. In conclusions, secondary intramedullary nailing after temporary Ilizarov fixation is the useful method in the treatment of open type III tibial shaft fractures.

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Treatment of Type III Open Tibial Fractures with Repofix External Fixator: Chang Hoon Jeon, Ye Yeon Won; J Korean Soc Fract 1995;8(4):855-863. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.855

Abstract PDF: We reviewed 18 patients with type III open tibial fracture from February 1992 to June 1995 (mean follow-up period 56.7 weeks) treated with Repofix external fixator. There were 16 men and 2 women. According to the Gustilos classification, there were type IIIa in 11 cases and type IIIb in 7 cases. Mean period of removal of external fixator was 19.3 weeks and after removal of external fixator, cast immobillization was performed in 4 cases. Among them, bony unions were noted in 15 cases and there were nonunion in 2 cases and malunion in 1 case. The causes of nonunion were failure of accurate reduction in 1 cases and severe initial comminuted fracture in 1 case. Complications were nerve injury, pin site infection and ring-type osteomyelitis. After removal of external fixator, nerve injuries were recovered and pin site infections except 1 case were healed. Ring-type osteomylitis was occurred in 1 case after removal of external fixator and osteomyelitis was dured after curettage. When type III open tibial fractures were treated with Repofix external fixator, there were advantages of 1) early weight bearing, 2) sagittal and coronal reduction of fracture and 3) correction of rotation. With advantages, this external fixator was appropriate for the treatment of type III open tibial fractures.

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Extensively Comminuted Type III Open Fracture of Tibial Shaft: 4 Case Treated by Ilizarov External Fixator: Ju Hai Chang; J Korean Soc Fract 1994;7(2):480-489. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.480

Abstract PDF: It is extremely difficult to treat to the type III open fractures of the tibial shaft which have been severely comminuted and splitted in the long length. Early internal fixation with plates and screws or intramedullary nailing of type III open fracture is contraindicated because of high infection rate and circulatory compromising at the fracture site. External fixation is the method of choice for the treatment of type III open fracture of the tibia. It reduces the risk of infection and permits easy access for wound care, early mobilization of joints and weight bearing. Four type III open fractures of the tibial shaft that were very unstable had entered this hospital from November 1990 to June 1992. The patients were all young males. The causes of injury were one explosion and three motor vehicle accidents. The open fractures were three type III A and one type III B according to Gustilos classification. These fractures were stabilized with Ilizarov external fixator. Parenteral antibiotic therapy was started from the emergency room to prevent infection. Illzarov fixator was applied 17 to 63 days(av. 37 days) after injury and maintained for 6 to 12 months(av. 8 months). Subsequent autogenous bone grafting and internal fixation were done in three patients 7 to 8 months after external fixation because of delayed union. Follow-up period ranged from 1 year and 11 months to 2 years and 6 months(av. 2 years and 2 months). Solid union was obtained in all patients between 1 year 1 month and 1 year and 7 months(av, 1 year and 3 months) without active osteomyelitis. At last follow-up, there were mild limitation of ankle joint motion in all patients and tibial shortening of 18 to 34mm(av. 25 mm)on the roentgenograms of three patients. No significant working disability or malalignment of the leg was noted in all patients. The final results were very good compared to the severity of their injuries.

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The Treatment of Type III Open Tibia Fractures with Ender Nails: Preliminary Report: Sang Ho Ha, Sang Hong Lee, Dong Min Shin, Jin Seok Park; J Korean Soc Fract 1989;2(2):219-228. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.219

Abstract PDF: Type III open tibial fracture is difficult to treat beacause of frequent complications, and recently external fixation have been used successfully. Intramedullary nailing with flexible nails is now routinely performed in Type I and II open tibial fractures. Thirteen cases of Type III open tibial fractures teated with Ender nails from January 1 983 to December 1988 were identified and retrospectively reviewed. The results were as follows; 1. The patients were predominantly more common in male and the average age was 41 years, and most common cause was traffic accident. 2. According to the Gustilo and Andersons classification, Type III-A was 7 cases, TypeIII-B was 5 cases, and Type III-C was 1 case. All 13 cases were combined fibular fracture. 3. All 13 cases were used two Ender nails, nailing methods were two antegrade insertioni (7 cases), two retrograde insertion (3 cases), and one antegrade & retrograde insertion (3 cases). 8 cases were operated within one day of accident, 7 cases were used other combined metals, and 5 cases were treated with Rush pinning of fibular fracture. 4. Among the secondary additional operation required after Ender nailing, bone operation were 7 cases, soft tissue operation were 5 cases, and delayed amputation were 2 cases. 5. Among II cases except amputation, controversial complications were nonunion (6 cases), chronic osteomyelitis (1 case), delayed union (1 case). 6. A retrospective evaluation of 13 cases treated Ender nailing revealed that Ender nailing was simple, effective method in some selected cases of Type III open tibia fractures.

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