Journal of Musculoskeletal Trauma

Polarus Intramedullary Nail for Proximal Humeral and Humeral Shaft Fractures in Elderly Patients with Osteoporosis: Youn Soo Hwang, Kwang Yeol Kim, Hyung Chun Kim, Su Han Ahn, Dong Eun Lee; J Korean Fract Soc 2013;26(1):14-20. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.14

PURPOSE
To assess the effectiveness of optimal treatment of proximal humeral fractures and humeral shaft fractures in elderly patients with osteoporosis using the Polarus nail.
MATERIALS AND METHODS
Twenty-three patients with proximal humeral and humeral shaft fractures in elderly osteoporosis patients were treated using the Polarus intramedullary nail. Nine patients had proximal humeral fracture, 10 had humeral shaft fracture and 4 had the proximal humeral frac-ture extended diaphyseally. Radiological outcomes included the bone-union and the degree of re-sidual deformity. The residual deformities of the proximal humerus were assessed by the neck-shaft angle and the shaft angulation. Clinical outcome was assessed with the American Shoulder and Elbow Surgeons (ASES) score.
RESULTS
All cases had bony union and the mean union period was 16.5 weeks. The average neck/shaft alignment at the time of bone union was 135degrees and varus deformities of neck-shaft angle was not seen in all patients. Varus shaft angulation was seen in 5 patients. The mean ASES score after surgery was 86.7 points.
CONCLUSION
The Polarus intramedullary nail is effective for the treatment of proximal humeral and humeral shaft fractures in elderly patients with osteoporosis because it not only enables early postoperative mobilization, but also obtains bone-union without avascular necrosis and nonunion.

Citations

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Surgical Management of Osteoporotic Fractures: Humerus Shaft Fractures
Shankar Ramaprasad Kurpad
Indian Journal of Orthopaedics.2025;[Epub] CrossRef

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Treatment of Fractures of the Hip in Children: Do Hyun Moon, Jang Seok Choi, Jong Hun Lee; J Korean Fract Soc 2004;17(3):283-286. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.283

Abstract PDF: PURPOSE
To evaluate the result of early anatomical reduction and internal fixation of hip fracture in children.
MATERIALS AND METHODS
From January 1996 to July 2002, 21 cases (mean, 9 years) of hip fracture were available for follow-up more than 1 year. We performed early anatomical reduction and internal fixation within 24 hours as possible. Fractures were classified according to the 4 types described by Delbet. The results were analyzed according to the functional results by Ratliff and the incidence of complication.
RESULTS
There were no type I, 7 type II, 10 type III and 4 type IV fractures. Avascular necrosis of femoral head in 2 cases (type II, III). Functional result was 18 Good, 1 Fair and 2 Poor.
CONCLUSION
Fractures of the hip in children have been associated with a very high rate of serious complications, but our treatment by early anatomical reduction and interal fixation reduced rates of complication and had good functional result.

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Clinical Applications of Autologous Cultured Osteoblasts: Case Report: Seok Jung Kim, In Young Ok, Cheong Ho Chang, Young Sik Kim, Jae Deog Jang, Won Jong Bahk, Joo Hyung Lee; J Korean Fract Soc 2004;17(2):197-201. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.197

Abstract PDF: We treated 3 cases of fracture and 1 case of avascular necrosis of femoral head using autologous cultured osteoblasts injection. The stromal cells from the bone marrow were cultured to differentiate to osteoblasts for 4 weeks. The fracture sites of each patients were right ulnar shaft, left radial shaft, and left 5th metatarsal base. All of the fractures showed callus formations after 1 week of osteoblasts injection to the fracture site. After 4 weeks, callus formations were progressed. Avascular necrosis of femoral head was bilateral and both were Ficat stage II. Core decompression and allograft impaction were performed to the left, and core decompression and autologous cultured osteoblasts injection percutaneously after 4 weeks of the decompression operation were done to the right femoral head. CT images of 1 year from the operations showed trabecular bone formation and well maintained femoral head contour of the right femur, but resorption of the grafted bone for the left.

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Treatment of Vertebral Pseudarthrosis after Compression Fracture: Young Do Koh, Hoon Jeong; J Korean Fract Soc 2004;17(2):191-196. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.191

Abstract PDF: PURPOSE
To clarity the features of vertebral pseudarthrosis and to evaluate the efficacy of posterior instrumentation and fusion in treatment of it.
MATERIALS AND METHODS
Twelve patients with severe back pain and intravertebral pseudarthrosis showing vacuum phenomenon were treated by in situ posterior instrumentation and fusion. The kyphotic angle of pre- and post-treatment was measured on a lateral radiograph. MRI was performed in all patients. The intravertebral instability was confirmed from the dynamic lateral view. The pain level was assessed both before and after the treatment using a visual analog scale. The kyphotic angle at last follow up was also checked.
RESULTS
In eight cases, intravertebral instability was shown at the clefts in flexion-extension radiographs. MRI showed that the cleft was low intensity on the T1- weighted image and high intensity on the T2-weighted image. The pre-and postoperative mean kyphotic angles were -18.3degrees and -8.5degrees respectively. The preoperative average pain score was nine and postoperative four. At last follow up the mean kyphotic angle was -16.6degrees CONCLUSION: The cleft with intravertebral vacuum phenomenon and magnetic resonance findings of low intensity on the T1-weighted scans and high intensity on the T2-weighted scans suggests that the cleft is a pseudarthrosis associated with avascular necrosis of the vertebral body. The posterior instrumentation and fusion provides satisfactory pain relief in patient with vertebral pseudarthsosis.

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The Significance of Posterior Cortex in Complicated Femoral Neck Fractures which were Internal Fixated: You Sung Suh, Seok Bong Jung, Soo Jae Yim, Jong Seok Park, Byung Ill Lee; J Korean Soc Fract 2002;15(4):511-518. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.511

Abstract PDF: PURPOSE
When a surgeon carries out an operative treatment on a patient who has fractures of the femoral neck, he decides to do either the internal fixation for bony union or the aggressive treatment according to his experience and preparation, not according to the objective standard. The aim of this retrospective study is to prepare a guideline for the operative method.
MATERIALS AND METHODS
We analyse possible factors of the patient who has nonunion, avascular necrosis and loss of fixation after doing internal fixation in femoral neck fractures RESULTS: In this treated case of femoral neck, the appearance of complications are influenced by the maintenance of internal fixation, shape of fractures, osteoporosis, and the position of fixations; but in the complicated cases without the loss of fixation, the shape of fractures always have posterior cortical communition.
CONCLUSION
When we choose between simple fixation and aggressive treatments in cases of fractures of the femoral neck, we must treat according to the patient 's condition, displacement of the fracture, operative technique and existence of a posterior cortical comminuted fracture.

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Bone scintigraphy after multiple pinning of femoral neck fractures: Kee Haeng Lee, Youn Soo Kim, Chang Hoon Jeong, Suk Ku Han, Hyoung Min Kim, Jun Seok Kim; J Korean Soc Fract 2001;14(4):567-574. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.567

Abstract PDF: PURPOSE
To determine the value of bone scintigraphy in predicting avascular necrosis following femoral neck fracture, and to analyze of relationship between pintract sign (increased radioactivity along the pins) and avascular necrosis after multiple pinning of femoral neck fracture.
MATERIALS AND METHODS
We analyzed 20 femoral neck fractures, which were fixed with cannulated screws(14 cases) or Knowles pins(6 cases). The follow-up period was longer than 18 months, and bone scintigraphy was carried out at postoperative 3 weeks, 3 months interval to 1 year, 6 months interval to 2 years, and then every 1 year.
RESULTS
There were 14 cases with positive pin-tract sign and increased uptake of femoral head on bone scintigraphy performed at the postoperative 3 weeks, and I case with positive pin-tract sign and partially decreased uptake of femoral head. None of them developed avascular necrosis. There was I case with negative pin-tract sign and partially decreased uptake of femoral head, which showed increased uptake later and didn't develop avascular necrosis. There were 4 cases with negative pin-tract sign and generally decreased uptake of the femoral head, and all of them developed avascular necrosis.
CONCLUSION
Bone scintigraphy is a useful method predicting the avascular necrosis following femoral neck fracture, and pin-tract sign may be an early postoperative sign indicating that there is little possibility of development of avascular necrosis.

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The Prognosis of Undisplaced Abduction Fracture of the Neck of the Femur: Young Bok Jung, Eui Chan Jang, Suk Kee Tea, Whui Jae Jin, Jung Nam Han, Jung Il Lim, Cheol Kyoung Park; J Korean Soc Fract 2001;14(2):159-165. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.159

Abstract PDF: PURPOSE
The aim of this study was to analyze frequencies, types, and treatment results of the undisplaced abduction fracture of the neck of the femur for the prediction of the prognosis. MATERIALS & METHODS: From February 1984 to February 1999, the population was selected from those who were admitted in our hospital with the diagnosis of the fracture of the neck of the femur(96 cases). Among them 34 cases of undisplaced abduction fracture who could be followed minimum 2 years were chosen. The types of initial injury, the degrees of the rotation into valgus, union and the incidences of avascular necrosis of the femur head were analyzed by plain radiographs and medical records.
RESULTS
The undisplaced abduction fracture of the neck of the femur were 34 cases(35%) of the whole 96 cases and 33 cases of them had been operated. In all the 34 cases we were able to see the bone union, however in 7 cases(20.6%) the avascular necrosis of the femur head were happened. The incidences of the avascular necrosis is related with the degrees of the rotation into valgus(p=0.004).
CONCLUSION
The undisplaced abduction fracture of the neck of the femur is known to the result in good prognosis. According to this study, not a few avascular necrosis of the femur head happened. As a results, although undisplaced abduction fracture regained to be paid intention to the incidences of the avascular necrosis and careful follow-up should be accompanied.

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Analysis and Clinical Study on Fracture Dislocation of the Talus: Ye Yeon Won, Chang Hoon Jeon, Jae In Ahn, Seung Jun Choi, Jung Mo Lee; J Korean Soc Fract 2000;13(2):382-389. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.382

Abstract PDF: PURPOSE
: Talar fractures are uncommon and so surgeon's experience in the treatment of the talar fracture is limited. This study was undertaken to evaluate the incidence, associated injuries, complications of talar fracture and results of treatment.
MATERIALS AND METHODS
: Authors experienced 15 cases of the talar fractures treated at Ajou university Hospital from 1995 to 1998 with minimal 1 year follow-up period and obtained following result.
RESULTS
: Of 15 cases, fall down injury was the most common cause of injury(11/15). 4 ipsilateral medial malleolar fractures, 2 lateral malleolar fractures and other associated injury was occured. According to the Hawkins' classification 5 cases in type I , 1 cases in typeII, 2 cases in typeIII were observed. 2 posttraumatic arthritis, 1 skin necrosis, 1 avascular necrosis, were observed as complications but nonunion was not observed.
CONCLUSIONS
: We suggest that early and accurate anatomical reduction and rigid internal fixation of the fracture dislocation of the talus canprevent complications such as acascular necrosis, posttraumatic arthritis.

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Posttraumatic avascular necrosis of talus: Soo Bong Hahn, Hong Jun Park, Kee Hong Song; J Korean Soc Fract 2000;13(2):368-374. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.368

Abstract PDF: PURPOSE
: We performed this study in order to analyze the clinical results and complications of posttraumatic avascular necrosis of talus MATERIALS AND METHODS : We performed a retrospective review of 19 patients undertaken treatment of talus fracture from September 1996 to September 1998. There were 11 males and 8 females with an a mean age of 21.4 years(range, 10-52years).
RESULTS
: In one case, there was soft tissue defect and bone maceration on dorsum of left foot due to crushing injury by traffic accident. The patient was treated with debridement and skin graft. In trauma 5 months, equinus deformity and stiffness of ankle was noted. Posttraumatic avascular necrosis of talus was noted at magnetic resonance imaging. But, there was neither collapse of talar dome nor pain. Therefore, heel cord lengthening and correction of equinus by hinged Ilizarov with distraction was done. In follow-up(1 year 3 months), avascular necrosis was improved and good ambulation without pain was possible. In another case, open reduction and internal fixation for talar neck fracture(Hawkins typeIII)was performed. In trauma 9 months, there were severe degenerative arthritis of peritalar joint, severe ankle pain, and severe avascular necrosis with collapse of talus. Therefore, dead bone resection and ankle arthrodesis with autoiliac bone graft were performed using Ilizarov external fixator. In follow-up(trauma day 1 year 11 months), good ambulation in 90degreesankle fusion state without pain was possible.
CONCLUSION
: In the treatment of talus fracture, periodic physical and radiologic examination is important for early detection of posttraumatic avascular necrosis and early management.

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Fracture-Separation of The Distal Humeral Epiphysis: Hak Yeong Jeong, Seung Wook Yang, Jae Woong Shim, Seung Joon Shin, Jeong Tae Kim; J Korean Soc Fract 1998;11(3):650-657. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.650

Abstract PDF: A fracture-separation of the distal humeral epiphysis in children is an extremely rare injury and presents problems in diagnosis, radiographic interpretation and management. From June 1992 to December 1996, Authors experienced the 5 cases of Salter - Harris type II injury of the distal humeral epiphysis at Department of Orthopedic Surgery, Pusan Maryknoll General Hospital. The patient were followed up from one year nine months to three years four months. The two cases were treated by closed reduction and percutaneous K-wire fixation and the three cases by open reduction and internal fixation with K-wires. There were 4 cases of complication seldom reported following fracture-separation of the distal humeral epiphysis. This complications consist of 4 dissolutions of trochlea, which is one, frank avascular necrosis of trochlea. In 3 cases with open reduction developed the cubitus varus & dissolution of trochlea. We speculate that this complications results from avascular necrosis of distal end of humerus. Attention to change of carrying angle and radiographic change of distal humeral end are important in detection of complication & evaluation of etiology of dissolution of distal humeral end.

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Clinical Analysis of Avascular Necrosis of the Femoral Head following femoral Neck Fracture: You Sung Suh, Kyung Dae Min, Byung Joon Shin, Byung Ill Lee, Yeon Ill Kim, Soo Kyun Rah, Chang Uk Choi; J Korean Soc Fract 1998;11(2):304-312. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.304

Abstract PDF: Post-traumatic avascular necrosis is a notorious complication of intracapsular fractures of the femoral neck, whether or not the fracture unites. The incidence of avascular necrosis of the femoral head following femoral neck fractures has been reported variably ranged from 7% to 84%. The purposes of this study are to analysis the clinical features of avascular necrosis of the femoral head following femoral neck fractures and to define causative factors of posttraumatic avascular necrosis. From May 1986 to May 1995, sixty-eight patients with intracapsular femoral neck fracture were operated on osteosynthesis in soonchunhyang University Hospital; we analysed retrospectively with follow-up more than two years, post-traumatic avascular necrosis(AVN) was developed in 13 patients(AVN group) and united forty-six patients were included non-avascular necrosis group, nine patients were excluded due to nonunion. Comparative study was performed between these two groups. The results were as follows: 1. The avascular necrosis of the femoral head following femoral neck fractures treated with osteosynthesis was noted in 13 cases (19%) 2. The eleven cases of 13 cases showed segmental collapse of the femoral head within 2 years. 3. Among the causative factors, age and sex, delay before operation and fixation device have no statistical significance(p>0.05) but type of fracture, initial displacement and quality of reduction showed to be statistical correlation(p<0.05). In conclusion, adequate reuction and internal fixation for the femoral neck fracture may essential to minimize avascular necrosis following osteosynthesis.

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Avascular Necrosis After the Fracture of the Neck of the Talus: Chang Ju Lee, Won Ho Cho, Ho Guen Chang, Byung Il Min; J Korean Soc Fract 1989;2(2):194-201. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.194

Abstract PDF: Avascular necrosis was a frequent complication of the fracture of the neck of the talus. Hawkins described a subchondral radiolucency visible in the body of the talus six to eight weeks after fracture. This sign has proved to be a useful objective prognostic sign; the presence of this sign would not undergo avscular necrosis. In eleven patients, serial roetgenograms were examined for this phenomenon. The results were as follows: 1. Six fractures that had the Hawkins sign did not undergo avascular necrosis. 2. Also, we experienced two cases of partial Hawkins sign which developed the partial avascular necrosis.

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Fracture of the Neck of the Talus: Ik Dong Kim, Poong Taek Kim, Byung Chul Park, Young Wook Choi, Young Gu Lyu, Sung Ho Kim; J Korean Soc Fract 1989;2(2):179-188. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.179

Abstract PDF: We Clinically analysed 10 cases of fractures of the neck of the talus which had been treated at the Department of Orthopedic Surgery, Kyungbook Nantional University Hospital from 1984 to 1988 and the following results were obtained. 1. Of the 10 cases, Hawkiins type I was 2 cases, type II, 4 cases and type III, 4 cases. 2. Avascular necrosis was developed in 7 cases. 1 of type I, 3 of type II and 3 of type III. 3. In all 6 cases with comminution at subtalar and medial aspect of talus, avascular necrosis was developed. 4. Hawkins sign was evident in the plane roentgenogram from 5th weeks to 12th weeks(mean at 8th weeks) and we could diagnose the avascular necrosis of talar body at 9.3th weeks. 5. Bone scan was not a helpful diagnostic tool for the confirmation of the avascular necrosis of the talar body. 6. Absolute non-weight bearing is mandatory until solid union is obtained and partial weight bearing with PTB brace is advisable after emergence of the sign of revasculariztion on the plane roetgenogram. 7. Of the 10 cases of the fracture of the neck of the talus, satisfactory results were obtained in 7 cases and of the 7 cases with avascular necrosis, relatively good results were in 5 cases.

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