Journal of Musculoskeletal Trauma

Prediction of Syndesmotic Instability according to the Lateral Malleolus Fracture Pattern in Supination-External Rotation Type Ankle Fractures: Short Oblique versus Long Oblique Fracture: Chan-Jin Park, Min-Su Lee, Keun-Bae Lee; J Korean Fract Soc 2024;37(1):39-45. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.39

Abstract PDF: Purpose
This study examined whether preoperative radiological evaluations can predict syndesmotic instability according to the lateral malleolus fracture pattern in supination-external rotation-type ankle fractures.
Materials and Methods
This study enrolled 132 patients (132 ankles) with supination-external rotation stage 3 and 4 ankle fractures. Three-dimensional computed tomography was used for the morphological classification of the lateral malleolus fractures. A long oblique fracture was defined when the posterior cortical bone height of the fracture was 4.5 cm or more from the plafond of the distal tibial articular surface. A short oblique fracture was defined when the height was less than 4.5 cm. The demographic characteristics and syndesmotic instability of the two groups were evaluated.
Results
Short oblique fractures were confirmed in 102 cases, and long oblique fractures were confirmed in 30 cases. Long oblique fractures occurred at a statistically significantly higher incidence in younger ages and among males compared to short oblique fractures. Syndesmotic instability was more common in long oblique fractures.
Conclusion
In supination-external rotation-type ankle fractures, syndesmotic instability was observed in approximately 13%. Specifically, when the fracture pattern of the lateral malleolus is long oblique, the incidence of syndesmotic instability is approximately three times higher than in short oblique fractures. Therefore, meticulous evaluations of the lateral malleolus fracture pattern and establishing an appropriate treatment plan before surgery are crucial.

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Comparison of the Size of the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures Measured Using Lateral Plain Radiography and Three-Dimensional Computed Tomography: Gun-Woo Lee, Dong-Min Jung, Woo Kyoung Kwak, Keun-Bae Lee; J Korean Fract Soc 2022;35(3):91-96. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.91

Abstract PDF: Purpose
This study aimed to evaluate and compare the accuracy of the size of the posterior malleolar fragment measured using lateral plain radiography and three-dimensional computed tomography (3DCT) in patients with ankle trimalleolar fractures.
Materials and Methods
This study enrolled 80 patients (80 ankles) with ankle trimalleolar fractures and analyzed the size of the posterior malleolar fragments using plain radiography and 3D-CT. The articular involvement of the posterior malleolar fragments was measured as a percentage of the articular surface in the sagittal length of the tibial plafond using lateral plain radiography, and the articular surface area was directly measured using 3D-CT. In addition, we classified the patients into three groups based on the morphology of the posterior malleolar fracture, according to the Haraguchi classification method, and evaluated and compared the accuracy of the size of the posterior malleolar fragments.
Results
The mean articular involvement of the posterior malleolar fragments on plain radiography was 27.6% (range, 6.0%-53.1%), which was significantly higher than the mean of 21.9% (range, 4.7%-47.1%) measured using 3D-CT (p=0.004). In the analysis, according to the fracture morphology, the mean difference between the two methods was the largest for type I fractures at 9.1% (range, 1.8%-19.5%) and the smallest for type II fractures at 1.1% (range, –7.7% to 8.8%).
Conclusion
The articular involvement of posterior malleolar fragments measured using plain radiography showed low accuracy and significantly higher values than the actual articular involvement. Therefore, careful evaluation using 3D-CT is crucial for accurate analysis and optimal treatment in patients with ankle trimalleolar fractures.

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Computed Tomography Image Analysis of the Fusion Site of Subtalar Arthrodesis for Traumatic Arthritis after a Displaced Intraarticular Calcaneal Fracture: Hong Gi Park, Jae Ang Sim, Han Soul Kim, Byung Hoon Lee; J Korean Fract Soc 2019;32(3):121-127. Published online July 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.3.121

Abstract PDF: PURPOSE
The study examined the fusion site and characteristics of the subtalar arthrodesis after intraarticular calcaneal fractures using computed tomography.
MATERIALS AND METHODS
The clinical results and computed tomographic analysis of the fusion site were reviewed in 18 patients who were followed-up for a minimum of six months after undergoing subtalar arthrodesis due to traumatic arthritis caused by an intra-articular calcaneal fracture from December 2012 to April 2017.
RESULTS
An evaluation of clinical results after subtalar arthrodesis revealed statistically significant improvements. In all cases, arthritis was found in the injured articular surface, which was displaced superolaterally from the initial primary fracture line of the calcaneus. Six months after arthrodesis, the subtalar fusion rate was 80.0% (16/20). Of these, 14 cases had a cannulated screw inserted in the uninjured site that is medial to the primary fracture line. Joint fusion was observed on the uninjured articular surface in 17 cases (85.0%).
CONCLUSION
Joint fusion was initially achieved at the uninjured posterior facet after subtalar arthrodesis due to traumatic arthritis caused by a displaced intra-articular calcaneal fracture. This suggests that meticulous surgical techniques and cannulated screw positioning at the uninjured site will promote joint fusion.

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Prediction of Concomitant Lateral Meniscus Injury with a Tibia Plateau Fracture Based on Computed Tomography Assessment: Wonchul Choi, Yunseong Choi, Go Tak Kim; J Korean Fract Soc 2018;31(4):132-138. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.132

Abstract PDF

PURPOSE
This study examined whether any fracture pattern shown in computed tomography (CT) scan is associated with the presence of lateral meniscus (LM) injury in a tibia plateau fracture.
MATERIALS AND METHODS
Fifty-three tibia plateau fractures with both preoperative CT and magnetic resonance imagings (MRI) available were reviewed. The patient demographics, including age, sex, body mass index, and energy level of injury were recorded. The fracture type according to the Schatzker classification, patterns including the lateral plateau depression (LPD), lateral plateau widening (LPW), fracture fragment location, and the number of columns involved were assessed from the CT scans. The presence of a LM injury was determined from the MRI. The differences in the factors between the patients with (Group 1) and without (Group 2) LM injuries were compared and the correlation between the factors and the presence of LM injury was analyzed.
RESULTS
The LM was injured in 23 cases (Group 1, 43.4%) and intact in 30 cases (Group 2, 56.6%). The LPD in Group 1 (average, 8.2 mm; range, 3.0â€“20.0 mm) and Group 2 (average, 3.8 mm; range, 1.4â€“12.1 mm) was significantly different (p < 0.001). The difference in LPW of Group 1 (average, 6.9 mm; range, 1.2â€“15.3 mm) and Group 2 (average, 4.8 mm; range, 1.4â€“9.4 mm) was not significant (p=0.097). The other fracture patterns or demographics were similar between in the two groups. Regression analysis revealed that an increased LPD (p=0.003, odds ratio [OR]=2.12) and LPW (p=0.048, OR=1.23) were significantly related to the presence of a LM tear.
CONCLUSION
LPD and LPW measured from the CT scans were associated with an increased risk of concomitant LM injury in tibia plateau fractures. If such fracture patterns exist, concomitant LM injury should be considered and an MRI may be beneficial for an accurate diagnosis and effective treatment.

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The value of magnetic resonance imaging in the preoperative diagnosis of tibial plateau fractures: a systematic literature review
Gregoire Thürig, Alexander Korthaus, Karl-Heinz Frosch, Matthias Krause
European Journal of Trauma and Emergency Surgery.2023; 49(2): 661. CrossRef

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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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Classification and Treatment of Unstable Intertrochanteric Fracture according to the Existence of Posterior Fragment : Preliminary Report: Lih Wang, Sung Keun Shon, Kyu Yeol Lee, Chul Hong Kim, Myung Jin Lee, Chul Won Lee, Sung Soo Kim; J Korean Fract Soc 2008;21(2):110-116. Published online April 30, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.2.110

Abstract PDF

PURPOSE
To predict the feature and stability of intertrochanteric fractures with posterior fragment using preoperative 3D computed tomography and to investigate the importance of the posterior fragment in treatment of unstable intertrochanteric fracture.
MATERIALS AND METHODS
15 cases of unstable fractures with posterior fragment which were treated with nail only between October 2006 to August 2007 were classified into 2 groups: study group (5 cases with cannulated screw fixation of posterior fragment) and control group (10 cases without cannulated screw fixation). The average difference of neck-shaft angle, neck screw sliding distance and the complications in the two groups were compared retrospectively after a follow up of at least 3 months.
RESULTS
The average difference of neck-shaft angle in study and control group was 3.8 and 7.5 degree (p>0.05), respectively. The average difference of neck screw sliding distance was 1.6 and 6.6 mm (p<0.05), respectively. Complication which required reoperation was not noted in study group and complications of 3 cases about neck screw lateral protrusion, proximal migration and Z-effect phenomenon were noted in control group.
CONCLUSION
The recognition and fixation of the posterior wall was found to be an important predictive factor in unstable intertrochanteric fracture treatment.

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Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures
Chetan Puram, Chetan Pradhan, Atul Patil, Vivek Sodhai, Parag Sancheti, Ashok Shyam
Injury.2017; 48: S72. CrossRef
Additional Fixations for Sliding Hip Screws in Treating Unstable Pertrochanteric Femoral Fractures (AO Type 31-A2): Short-Term Clinical Results
Su Hyun Cho, Soo Ho Lee, Hyung Lae Cho, Jung Hoei Ku, Jae Hyuk Choi, Alex J Lee
Clinics in Orthopedic Surgery.2011; 3(2): 107. CrossRef

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Comparison between X-ray and Three Dimensional Computed Tomography in Trimalleolar Ankle Fractures: Sang Jun Song, Hyung Ku Yoon, Dong Eun Shin, Soo Hong Han, Jae Hwa Kim, Hyung Kun Park, Yong Sub Han; J Korean Fract Soc 2005;18(2):160-164. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.160

Abstract PDF

PURPOSE
To evaluate the accuracy of X-ray evaluation in classification, displacement and size of posterior malleolar fragment, comparing with three dimensional computed tomography (3D CT) in trimallelar ankle fractures.
MATERIALS AND METHODS
20 cases of trimalleolar ankle fractures evaluated with preoperative 3D CT, and followed up periods were at least 2 years. All cases were classified according to the Danis-Weber and Lauge-Hansen classification. Displacement and size of posterior malleolar fragment were measured using PACS. The reliability between simple X-ray and 3D CT was evaluated in the Danis-Weber and Lauge-Hansen classification (kappa analysis). The correlation between simple X-ray and 3D CT was evaluated in displacement and size of posterior malleolar fragment (correlation analysis).
RESULTS
Degree of agreement of Danis-Weber classification in simple X-ray and 3D CT was 0.700 kappa value, and that of Lauge-Hansen was 0.605 kappa value. Measurement of simple X-ray and 3D CT about displaced status of posterior malleolar fragment showed statistically significant positive linear correlation (p= 0.000), but correlation of measurement of size in simple X-ray and CT was not statistically significant (p=0.102).
CONCLUSION
CT or operative field will be more accurate than simple X-ray to select the method of treatment and operation, especially when the displacement and size of posterior malleolar fragment are important to decide.

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Comparison of the Size of the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures Measured Using Lateral Plain Radiography and Three-Dimensional Computed Tomography
Gun-Woo Lee, Dong-Min Jung, Woo Kyoung Kwak, Keun-Bae Lee
Journal of the Korean Fracture Society.2022; 35(3): 91. CrossRef

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Postoperative Evaluation of Displaced Intra-articular Calcaneal Fractures by Computed Tomography: Woo Sik Kim, Kwang Kyoon Kim, Whan Yong Chung, Woo Suk Lee, Yong Chan Kim, Taek Soo Jeon, Dae Hwan Kim, Seong Jin Cho, Chul Mok Hwang; J Korean Fract Soc 2004;17(3):249-256. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.249

Abstract PDF

PURPOSE
The purpose of the present study was to define the factors that affect the treatment and clinical result of displaced calcaneal fracture with use of the pre- operative and final follow-up computed tomography scanning.
MATERIALS AND METHODS
Present study included the 17 patients(18 feet) whom we performed surgery for displaced intra-articular calcaneal fracture at our institution between March 2000 and March 2002 and had a minimum follow-up of 12 months. For all patients, the Bohler's angle and posterior facet incongruity were measured with computed tomography pre- and post-operatively. The Creighton-Nebraska Health Foundation Assessment Scale for Fractures of the Calcaneus (CN scale) was used to evaluate the clinical results.
RESULTS
Of all eighteen fractures, the clinical results were excellent in three (16.6%), good in six (33.3%), fair in six (33.3%), and poor in three (16.6%). The Bohler's angle averaged 21degrees, 15degrees, 27degrees, 25degrees at final follow-up in each above clinical result group. The step-off averaged 1.0, 1.6, 3.9 and 6.0 mm and the average range of motion of the subtalar joint at final follow-up were 85, 76, 60 and 45% of normal. CT evaluation showed intra-articular screws in the posterior subtalar joint in three (16.6%) of the eighteen fractures but their average clinical result was good (80.3 points).
CONCLUSION
The restoration of the congruity and range of motion of posterior subtalar joint are considered important factor that affect clinical result.

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Correlation Analysis of Reduction for Intra-Articular Calcaneal Fracture and Clinical Outcomes Using Postoperative Computed Tomography
Joon-Sang Eom, Young-Deuk Joo, Seong-Jun Kim, Min-Ho Shin, Dong-Oh Lee, Hong-Geun Jung
Journal of Korean Foot and Ankle Society.2014; 18(4): 165. CrossRef

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Prediction of Peroneal Tenosynovitis in the Intraarticular Calcaneal Fractures Using Computed Tomography: Jeung Tak Suh, Ju Young Jung, Hui Tak Kim, Chong Il Yoo, Seong Ho Hwang, Heung Tae Chung; J Korean Soc Fract 2000;13(3):537-543. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.537

Abstract PDF: PURPOSE
The purpose of the current study is that CT can predict peroneal tenosynovitis in the intraarticular calcaneal fracture.
MATERIALS AND METHOD
Sixty five calcaneal fractures in 55 patients were evaluated with CT scan. The follow-up period after operation was averaged 19 months (ranging from 4 to 79 months). A classification for peroneal tendon injury was developed, based on CT scan.
RESULTS
Of the 65 intraarticular calcaneal fractures, the incidence of peroneal tenosynovitis were 14 cases(26%)[open reduction and internal fixation group 7/43(16%), Essex-Lopresti group 7/22(32%)]. According to the author's classification, the incidence of peroneal tenosynovitis among open reduction and internal fixation subgroup was followed ; type I was none(0/4), type II 11%(2/19), type III 20%(3/15) and type IV 40%(2/5) respectively(p=0.074). The incidence of peroneal tenosynovitis among Essex-Lopresti subgroup was followed ; type I was none(0/4), type II 16%(1/6), type III 33%(3/9) and type IV 100%(3/3) respectively(p=0.009).
CONCLUSION
CT can be used to evaluate the status of the peroneal tendon as well as to predict the development of peroneal tenosynovitis. The open reduction and internal fixation in type III and IV is preferable to achieve a alignment of peroneal tendon and a accurate reduction of subtalar joint.

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Three-Dimensional Computed Tomography of Acetabular Fractures: Poong Taek Kim, Joo Chul Ihn, Chang Wug Oh, Seung Hoon Oh; J Korean Soc Fract 2000;13(1):46-51. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.46

Abstract PDF: PURPOSE
In the evaluation of acetebular fractures, conventional radiography is limited by distortion, magnification, and overlap of fracture fragments. Computed tomography(CT) has already been shown to be superior in this field. The purpose of this paper was to use 3D reformations for classification of acetabular fractures and planning of operation.
MATERIALS AND METHODS
From July 1994 to December 1998, we reviewed 40 acetabular fractures. We evaluated fractures as plain X-ray(inlet & outlet view, AP view, obturator foramen & illiac wing view), axial CT with 3 mm slices, and 3D reformations. We classified fractures by classification of Letournel.
RESULTS
32 cases of 40 cases were displaced fractures, We recognized fracture easily in 3D reformations. 12 cases were posteior wall fracture. 9 cases were both column frctures. We interpretated both column fractures difficultly in plain X-ray, but we had many informations about rotation & displacement of fracture fragment by 3D reformations. Undisplaced fracture was 8 cases. We interpretated undisplaced fracture difficultly in 3D reformations and distinguished difficultly from normall 3D reformations.
CONCLUSION
3D reformations were useful for analysis of complex displaced fracture but not useful for analysis of undisplaced fracture. Acetabular internal oblique view was useful for analysis of quadrilateral space & posterior wall fractures. Acetabular external view was useful for decision of surgical approach.

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Treatments of Intraarticular Calcaneal Fracture: Based on CT Classification and Comparison of Treatments: Seung Rim Park, Hyoung Soo Kim, Joon Soon Kang, Woo Hyeong Lee, Ju Sik Park; J Korean Soc Fract 1999;12(1):103-112. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.103

Abstract PDF: The treatment modality of the displaced intraarticular calcaneal fractures is still controversial. The objectives of this study are to classify intraarticular fractures based on computed tomography and to compare the treatment results according to the classification and to consider the influence of Bohler angle to the prognosis of this injuries. From October 1989 to March 1997, 62 fractures(58 patients) who had been treated after calcaneal CT(computed tomography) were selected. The interval between the trauma and the last follw-up was mean 3.3 years(1.1-5.2 years). They had been treated with one of the three methods, that is, open reduction and internal fixation(OR/IF), Essex Lopresti or simple cast immobilization. The fracture was classified as type I(non-displced), type I(two part or split), type III(three part or split depression), type IV (four part or highly comminuted) based on CT according to Sanders et. al. The calcaneal scoring system proposed by Kerr et. al. was applied to the assessment of the treatment results, which may be more appropriate for non-parametric statistical test. The type I fractures had been treated only with cast immoobilization with or without manual reduction and all of the 4 cases(100%) have shown favorable(excellent or good) results. The OR/IF group(favorable results for 15 of 18 cases(83.3%) in type II and for 11 of 13(84.6%) in type III) have shown better results than those of other two group(P<0.05). The results between other two groups, that is, Essex-Lopresti operation group(favorable results for 4 of 8 cases(50%) in type II and for 1 of 3(33.3%) in type III)and cast immobization(2 of 5 cases(40%) in type II and for 0 of 2(O%) in type III) have made no significant differences(p>0.5). In type IV, there were no significant differences among the results of the three methods(p>0.1) and worse results than type II, III (p <0.05) probably due to difficulty in reduction of highly comminuted articular facets. The Bohler angle has given no significant influence to the final results(p>0.1). In conclusion, OR/IF has shown better results than closed modalities in the treatment of displaced intraarticular calcaneal fractures and may be the primary choice of treatment for these fractures. We have used Kruskal-Wallis H test and its approximation to chi-square distribution for comparison of three groups and Mann-Whitney U test and its approximation to normal distribution for two groups and have been aided by the computer program, SPSS in statistical calculations. The p-value was 0.05.

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CT Classification and Surgical Treatment of Intra-Articular Fracture of the Calcaneus: Gi Sik Hong, Eu Seup Chung, Seong Ku Chee; J Korean Soc Fract 1997;10(1):91-98. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.91

Abstract PDF: Computed tomography was used in the evaluation of intra-articular fractures of the calcaneus to develop and reasonable treatment program and predict prognosis. Seventeen fractures of the calcaneus in the sixteen patients were shown to involve the posterior facet and classified by the images of coronal CT scan; Type I(non-displaced), Type II(displaced) and Type III(comminuted). There were one Type I, ten Type II, and six type III fractures. All of which were treated with open reduction and internal fixation, with or without bone graft. The length of follow-up period ranged from thirteen to fourty-five months(mean : 24 months). The results were graded by a predetermined point system. The one type I had an excellent result. Of the ten type 2 fractures ; three had excellent result, four good result, two fair result, and one poor result. Ofthe six type 3 fracture, one had good result, three fair result, two poor result. On the basis a our study, we believed that open reduction and internal fixation was a good method of treatment for the displaced or mildly comminuted intraarticular fracture of the calcaneus

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