Journal of Musculoskeletal Trauma

Avulsion fractures around the hip joint and pelvis: Won-Sik Choy, Yonghan Cha, Jung-Taek Kim, Jun-Il Yoo, Jin-Woo Kim; Received December 18, 2024 Accepted January 22, 2025 Published online March 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00010 [Epub ahead of print]

Abstract PDF: Avulsion fractures occur when tendons or ligaments are subjected to forces greater than they can withstand at the apophysis or enthesis, regardless of fusion status. The pelvis and hip joint are vulnerable to these injuries due to the diverse muscular structures in these structures, which serve as origins for multiple muscles leading to the lower extremities. Pelvic avulsion fractures commonly affect young athletes, but can also occur in adults. The diagnosis typically involves assessing trauma history, a clinical examination, and radiographic imaging. If the diagnosis is unclear, additional tests such as computed tomography and magnetic resonance imaging may assist in the diagnosis and provide useful information for treatment decisions. While most avulsion fractures respond well to conservative treatment, surgical intervention may be preferred in severe displacements, cases of significant retraction in active athletes, or when a faster recovery is necessary. Chronic or neglected injuries may lead to excessive osseous formation around the pelvis, causing impingement syndromes. Recognizing characteristic radiological findings based on pelvic anatomy helps to make an accurate diagnosis, as chronic injuries can mimic tumors or infectious conditions, necessitating a careful differential diagnosis.

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Avulsion Fractures around the Hip Joint and Pelvis: Ha-Yong Kim, Hajun Jang, Jung-Taek Kim, Jin-Woo Kim, Jun-Il Yoo, Won-Sik Choy, Yonghan Cha; J Korean Fract Soc 2024;37(3):150-157. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.150

Abstract PDF: Avulsion fractures occur when tendons or ligaments are subjected to forces greater than they can withstand at the apophysis or enthesis, regardless of the fusion status. Given the diverse muscular structures around the pelvis and hip joint, which serve as origins for multiple muscles leading to the lower extremities, these areas are vulnerable to such injuries. Pelvic avulsion fractures commonly af-fect young athletes, but they can also occur in adults. Diagnosis typically involves assessing the trauma history, clinical examination, and radiographic imaging. In cases of unclear diagnosis, additional tests, such as computed tomography or magnetic resonance imaging, may assist in treatment decisions and diagnosis. Although most avulsion fractures respond well to conservative treatment, surgical interven-tion may be preferred in severe displacements, significant retraction in active athletes, or when a faster recovery is necessary. Chronic or neglected injuries may lead to excessive osseous formation around the pelvis, causing impingement syndromes. Recognizing the characteristic radiological findings based on the pelvic anatomy aids in accurate diagnosis because chronic injuries might mimic tumors or infectious conditions, necessitating a careful differential diagnosis.

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Ankle Fractures in Children: Classification and Treatment: Ha-Yong Kim, Yong-Han Cha, Woo-Suk Kim, Won-Sik Choy; J Korean Fract Soc 2021;34(2):87-95. Published online April 30, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.2.87

Abstract PDF: Pediatric ankle fractures are defined as damage to the metaphysis, epiphyseal plate, and epiphysis of the distal tibia and fibula. Although the injury mechanism could be similar, the fracture patterns and treatment of pediatric ankle fractures are different from those of adults. In children, growth plate injuries are more common with a force that would cause sprains in adults because the ligaments are stronger than the growth plate cartilage in children. In the adolescent period, unique fractures, called “transitional fractures”, occur while the physis is closed. For a diagnosis, plain images of the anteroposterior, lateral, and mortise views are essential. Stress radiographs, ultrasound, and magnetic resonance imaging can be used for suspected ligament injuries. The treatment goal is to restore the articular congruity, normal bony alignment, and preserve the epiphyseal plate to ensure normal growth. Pediatric ankle fractures frequently lead to premature physeal arrest, angular deformities, malunion, and posttraumatic arthritis even after anatomic reduction. Treating surgeons should follow-up children for a sufficient time and explain to the caregiver the possible complications before treatment.

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Analysis of the Changes in Femoral Varus Bowing and the Factors Affecting Nonunion for the Treatment of Femoral Shaft Fractures over 60 Years Old Using Piriformis Fossa Insertion Intramedullary Nailing: Yonghan Cha, Chan Ho Park, Jun-Il Yoo, Jung-Taek Kim, WooSuk Kim, Ha-Yong Kim, Won-Sik Choy; J Korean Fract Soc 2020;33(2):65-71. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.65

Abstract PDF

Purpose
This study examined the bony morphological changes to analyze the factors affecting bony union in the treatment of elderly femoral shaft fractures with varus bowing using piriformis fossa insertion intramedullary nailing.
Materials and Methods
This study included 26 patients over 60 years of age, who were admitted for femoral shaft fractures between January 2005 and December 2014 and treated with piriformis fossa insertion intramedullary nailing. Age, sex, height, weight, bone mineral density, injury mechanism, fracture type, diameter and length of the nail, postoperative lengthening of the femur, postoperative change in varus angle, contact between the lateral and anterior cortex, and the gap between the fracture line and the bony union were checked. The patients were divided into a varus group and nonvarus group, as well as a bone union group and nonunion group. Logistic regression analysis was performed to analyze the factors affecting nonunion.
Results
The patients were classified into 11 in the varus group and 15 in the non-varus group and 24 in the union group and 2 in the nonunion group. The varus group showed a larger increase in leg length and varus angle reduction than the non-varus group (p<0.05). The union group had more contact with the lateral cortical bone than that of the nonunion group (p<0.05). The factor affecting bone union in regression analysis was contact of the lateral cortical bone (p<0.05).
Conclusion
Treatment of a femoral shaft fracture in elderly patients with a varus deformity of the femur using piriformis fossa insertion intramedullary nail increases the length of the femur and decreases the varus deformity. For bony union, the most important thing during surgery is contact of the lateral cortical bone with the fracture site.

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Straight nail insertion through a laterally shifted entry for diaphyseal atypical femoral fractures with bowing: good indications and limitations of this technique
Seong-Eun Byun, Young-Ho Cho, Young-Kyun Lee, Jung-Wee Park, Seonguk Kim, Kyung-Hoi Koo, Young Soo Byun
International Orthopaedics.2021; 45(12): 3223. CrossRef

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