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Original Articles
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
AbstractAbstract 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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Treatment of Femoral Shaft Fracture with Interlocking Humeral Nail in Older Children and Adolescent
Kun Bo Park, Hoon Park, Hyun Woo Kim, Hui Wan Park, Jae Young Roh
J Korean Fract Soc 2010;23(2):206-212.   Published online April 30, 2010
DOI: https://doi.org/10.12671/jkfs.2010.23.2.206
AbstractAbstract PDF
PURPOSE
To evaluate the results of interlocking humeral nail for femur shaft fractures through the greater trochanter in older children and adolescent.
MATERIALS AND METHODS
Eleven femoral shaft fractures in ten patients were selected. They were consisted of 9 boys and 1 girl. Two patients had osteogenesis imperfecta and one patient had a simple bone cyst as an underlying disease. 7 cases were right side and 4 cases were left side. The mean age at the time of operation was 12 years and 7 months (8 years 11 months~15 years 7 months). The mean follow-up period was 21 months and interlocking humeral nail was inserted at the greater trochanter in all patients.
RESULTS
All patients had a complete bony union without any complication such as infection, nonunion, leg length discrepancy and metal failure. Avascular necrosis of femoral head and coxa valga were not developed in all patients.
CONCLUSION
Intramedullary nailing through the greater trochanter using interlocking humeral nail is effective and safe treatment for the femoral shaft fracture in older children and adolescents.
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Interlocking Intramedullary Nailing of Forearm Shaft Fractures in Adults
Sanglim Lee, Hee Sung Lee, Yerl Bo Sung, Jae Kwang Yum
J Korean Fract Soc 2009;22(1):30-38.   Published online January 31, 2009
DOI: https://doi.org/10.12671/jkfs.2009.22.1.30
AbstractAbstract PDF
PURPOSE
To evaluate the usefulness of interlocking intramedullary nailing for operative treatment of forearm shaft fractures in adults.
MATERIALS AND METHODS
Thirteen forearm shaft fractures in 12 patients were fixated with 13 Acumed forearm intramedullary rods (ulna: 8, radius: 5). The average age was 36.7 years and mean follow-up period was 15.2 months. The union time was measured when there was no tenderness over the fracture site and the bridging callus was evident in at least two sides of the cortex. The range of motion of the joint and the rotation of the forearm was measured and the functional results were evaluated with Grace and Eversmann's rating system.
RESULTS
Radiologic union was observed at 11.8 weeks postoperatively in 11 cases out of 13. No limitation of motion was observed. Nine had excellent or good functional results. In one Galeazzi fracture, radial shaft became displaced after nailing and should be re-stabilized with plate. Proximal interlocking screws were improperly inserted in one ulnar nail. Implants were removed in 7 cases. Removal guide screw was broken while removing the intramedullary nail in one case of ulnar shaft fracture.
CONCLUSION
Interlocking intramedullay nailing might be a treatment option for the middle 1/3 shaft fractures of the adult forearm bone with favorable results.

Citations

Citations to this article as recorded by  
  • Comparison of minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) for the treatment of radial shaft fractures: a retrospective study
    Hyun-Tak Kang, Yang-Hoon Jo, Hong-Je Kang
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
  • Distal blocking screw augmentation in ulnar intramedullary nail fixation of adult forearm diaphyseal fractures
    Yong Woo Kim, Sang Ki Lee, Young Sun An
    Journal of Orthopaedic Surgery.2024;[Epub]     CrossRef
  • Comparison of Bending Strength among Plate, Steinmann Pin, and Headless Compression Screw Fixations for Proximal Ulnar Shaft Fracture in Sawbones
    Jinyoung Han, Jin Rok Oh, Jaewoong Um
    Archives of Hand and Microsurgery.2020; 25(4): 267.     CrossRef
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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
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • 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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Treatment of Forearm Shaft Fracture with Modified Interlocking Intramedullary Nail
Kwang Yul Kim, Moon Sup Lim, Shin Kwon Choi, Hyeong Jo Yoon
J Korean Fract Soc 2008;21(2):157-164.   Published online April 30, 2008
DOI: https://doi.org/10.12671/jkfs.2008.21.2.157
AbstractAbstract PDF
PURPOSE
To evaluate the result of forearm shaft fracture treated by modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA).
MATERIALS AND METHODS
15 patients with fracture of radius, ulna, radio-ulna shaft treated by modified interlocking intramedullary nail from December 2003 to February 2007 were analyzed. Modified interlocking intramedullary nail has paddle blade tip and fluted rod, so the distal screw fixation was not needed but had relatively firm fixation. It has advantages including short operation time, small operation scar. The average follow up period was 8.3 months (range, 5~15 months). We analyzed the results by average union time and the functional results according to Anderson's criteria.
RESULTS
The mean duration of union was 9.8 weeks in radius and 11.4 weeks in ulna. The average range of motion of forearm was 74.6 degree in supination and 72 degree in pronation.. Functional results assessed by Anderson were rated excellet in 12 cases, satisfactory in 3 cases. We found no complications such as delayed union, non-union, neurovascular injury and infection.
CONCLUSION
Modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA) is a viable therapeutic alternative in the management of forearm shaft fracture.

Citations

Citations to this article as recorded by  
  • Interlocking Intramedullary Nailing of Forearm Shaft Fractures in Adults
    Sanglim Lee, Hee-Sung Lee, Yerl-Bo Sung, Jae-Kwang Yum
    Journal of the Korean Fracture Society.2009; 22(1): 30.     CrossRef
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Result of Interlocking Intramedullary Nailing for Humeral Shaft Fracture Evaluation of Post-operative Shoulder Function
Seung Rim Park, Tong Joo Lee, Ryuh Sub Kim, Kyoung Ho Moon, Dong Seok You
J Korean Fract Soc 2007;20(2):166-171.   Published online April 30, 2007
DOI: https://doi.org/10.12671/jkfs.2007.20.2.166
AbstractAbstract PDF
PURPOSE
To evaluate the post-operative functional reduction of the shoulder joint and the impacting factors to post-operative shoulder joint function in interlocking IM nailing treatment of humeral shaft fracture.
MATERIALS AND METHODS
From April 1999 to August 2004, 35 patients (35 cases) whom admitted to hospital for humeral shaft fracture and treated using interlocking intramedullary nail were followed up for more than 1 year. 1 year post-operative shoulder joint function were evaluated using American Shoulder Elbow Surgery Scale (ASES). Pre-operative shoulder joint pain, radiologically degenerative change and extent of nail protrusion were evaluated, and each factor was correlated with function of the shoulder joint.
RESULTS
33 cases out of 35 cases showed union and average union period was 12 weeks. Complications consisted of 2 cases of nonunion, 1 case of infection, 1 case of loosening of distal fixing screw, 1 case of radial nerve palsy and 1 case of axillary nerve palsy. Shoulder joint function 3 months after operation : mean ASES score 78.2, 12 months after operation : mean ASES score 89.6. Pre-operative shoulder joint pain and nail protrusion showed to be statistically related to shoulder joint function.
CONCLUSION
If the operation leaves no protrusion of intramedullary nail, it can be concluded to be relatively safe and effective.

Citations

Citations to this article as recorded by  
  • Comparison of the Result of the Intramedullary Nail Fixation and Plate Fixation in Humeral Shaft Fracture with Butterfly Fragments
    Duk-Hwan Kho, Hyeung-June Kim, Byoung-Min Kim, Hyun-Ryong Hwang
    The Korean Journal of Sports Medicine.2016; 34(2): 120.     CrossRef
  • Plain Radiograph Analysis of the Distal Humerus Posterior Bowing That May Affect Interlocking Intramedullary Nailing for Humerus Shaft Fracture
    Jaekwang Yum, Kyunghwan Boo, Minkyu Sung, Jiseok Jang
    Journal of the Korean Orthopaedic Association.2015; 50(1): 31.     CrossRef
  • Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures
    Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn
    The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107.     CrossRef
  • Surgical Treatment of Pathologic Humeral Fracture
    Ho Jung Kang, Byoung Yoon Hwang, Jae Jeong Lee, Kyu Ho Shin, Soo Bong Hahn, Sung Jae Kim
    Journal of the Korean Fracture Society.2010; 23(2): 187.     CrossRef
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Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung Soo Kim, Sung Keun Sohn, Chul Hong Kim, Myung Jin Lee, Lih Wang
J Korean Fract Soc 2007;20(2):141-148.   Published online April 30, 2007
DOI: https://doi.org/10.12671/jkfs.2007.20.2.141
AbstractAbstract PDF
PURPOSE
To analyze the causes and the clinical results of treatment for the nonunion of femur shaft fractures that occurred after interlocking intramedullary nail fixation.
MATERIALS AND METHODS
We reviewed 19 cases of aseptic nonunion of femur shaft fracture in 174 patients after interlocking IM nailing from March 1999 to February 2004 and followed up for more than one year. First we investigated the factors causing nonunion. For operative options, two methods about exchange nailing and exchange nailing with bone graft were performed. Finally clinical results were analyzed with bone union rate by treatment methods and compared with the nonunion factors statistically.
RESULTS
According to the causes and types of nonunion, we performed larger IM nail change in 10 cases and IM nail change with bone graft in 9 cases. Bone union was achieved in all cases. Average bone union period were 18.5 weeks in exchange group and 16.1 weeks in exchange with bone graft group. There are significant difference between treatment methods statistically (p<0.05). Compared with the nonunion factors, initial open fracture and smoking groups showed late union rate statistically.
CONCLUSION
Based on our analysis, IM nail change is a useful method for nonunion after initial IM nailing in femoral shaft fracture, and additional bone graft that according to the radiologic pattern and stability, especially the fracture gap is also a useful option for nonunion treatment.

Citations

Citations to this article as recorded by  
  • Results of Exchange Nailing in Hypertrophic Nonunion of Femoral Shaft Fracture Treated with Nailing
    Suenghwan Jo, Gwang Chul Lee, Sang Hong Lee, Jun Young Lee, Dong Hwi Kim, Sung Hae Park, Young Min Cho
    Journal of the Korean Fracture Society.2019; 32(2): 83.     CrossRef
  • Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult
    Yong-Woon Shin, Yerl-Bo Sung, Jeong Yoon Choi, Minkyu Kim
    Journal of the Korean Fracture Society.2011; 24(4): 313.     CrossRef
  • Limited Open Reduction and Intramedullary Nailing of Proximal Femoral Shaft Fracture
    Sang Ho Ha, Jun Young Lee, Sang Hong Lee, Sung Hwan Jo, Jae Cheul Yu
    Journal of the Korean Fracture Society.2009; 22(4): 225.     CrossRef
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Interlocking Intramedullary Nail in Distal Tibia Fracture
Oog Jin Shon, Sung Min Chung
J Korean Fract Soc 2007;20(1):13-18.   Published online January 31, 2007
DOI: https://doi.org/10.12671/jkfs.2007.20.1.13
AbstractAbstract PDF
PURPOSE
To evaluate the effectivity of interlocking intramedullary nailing for distal tibia fracture and prognostic factor to bone healing.
MATERIALS AND METHODS
From April 2000 to June 2005, 21 cases who had distal tibia fracture were treated by interlocking intramedullary nail were analyzed. The duration of follow-up was more than 1 year. We evaluated clinical results by IOWA ANKLE rating system and union time by simple X-ray. Furthermore, we estimated prognostic factor to union time.
RESULTS
The bone union was achieved at average 18.5 weeks. At the last follow-up, there was no non-union and infection. Average IOWA ANKLE rating score was 91.3 point. The union time was delayed in open and segmental fracture at initial fracture. And severe soft tissue injury in open fracture revealed bad result.
CONCLUSION
We concluded that interlocking intramedullary nail is effective method for treatment of the distal tibial fractures. And, adequate soft tissue management is important to bone healing and clinical outcome.

Citations

Citations to this article as recorded by  
  • 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
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Wedge Tibial Shaft Fractures Treated with Interlocking IM Nailing
Sang Jun Song, Hyung Ku Yoon, Soo Hong Han, Hyung Kun Park, In Seok Lee
J Korean Fract Soc 2006;19(3):322-328.   Published online July 31, 2006
DOI: https://doi.org/10.12671/jkfs.2006.19.3.322
AbstractAbstract
PURPOSE
To investigate the bone union time of patients treated with interlocking intramedullary nailing in wedged tibial shaft fracture and to evaluate the factors that influence this result.
MATERIALS AND METHODS
32 patients treated with interlocking intramedullary nailing for wedge tibial shaft fracture were reviewed with a follow-up period of more than 1 year. Radiographic results were assessed with diameter (%) and length (mm) of wedge fragment, pre and postoperative displacement (mm) of wedge fragment. We also checked the bone union time of the main fragment and the wedge fragment (paired t-test). We investigated the bone union time acocording to the diameter, length of wedge fragment, pre and postopertvie displacement (correlation analysis).
RESULTS
Bone union time of the main fragments averaged 15.3 weeks (6~53 weeks) and that of wedge fragment averaged 24.2 weeks (8~64 weeks) (p=0.005). There was no correspondence between wedge fragment diameter and bone union time (p=0.681), but the bone union time of wedge fragment increased in proportion to its diameter (r2=0.747, p=0.031). There was no correspondence between preoperative displacement of wedge fragment and bone union time (p=0.574), but the bone union time increased in proportion to postoperative displacement of wedge fragment (r2=0.730, p=0.001).
CONCLUSION
Wedge fragments need longer time for bone union than main fragments in interlocking intramedullary nailing for wedge tibial shaft fractures. We need to pay attention to the displacemet of fragments in treating tibial shaft fractures with large wedge fragment.
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Two-part and Three-part Fractures of the Proximal Humerus Treated with the Polarus Interlocking Nail: A Comparison of Fracture Types
Kyu Cheol Noh, Yung Khee Chung, Kook Jin Chung, Sung Ku Hong
J Korean Fract Soc 2006;19(2):182-187.   Published online April 30, 2006
DOI: https://doi.org/10.12671/jkfs.2006.19.2.182
AbstractAbstract
PURPOSE
To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with the Polarus interlocking nail, comparing their fractures types.
MATERIALS AND METHODS
There were 22 patients with displaced proximal humerus fractures. There were 10 surgical neck (SN) and 1 anatomical neck (AN) two-part fractures and 10 greater tuberosity/surgical neck (GT/SN) and 1 GT/AN three-part fractures. All patients were surgically treated solely with the Polarus interlocking nail using a closed technique. Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score, which grade outcomes as excellent (>75), satisfactory (50~75), poor (<50) results. Radiographic outcome measurements included fracture alignment (neck-shaft angle), loosening of screw, fixation and hardware failure, and malunion and nonunion.
RESULTS
Overall, the average ASES score was 80.2 (range 46.0 to 98.0). There were 15/22 (68.2%) excellent, 6/22 (27.3%) satisfactory, and 1/22 (4.5%) poor results. All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. When comparing patients with two-part fractures (n=11) with patients having three-part fractures (n=11), there were statistically significant differences with ASES outcome measures (p<0.05). But, there were no statistically significant differences in age-related analysis (p>0.05).
CONCLUSION
Both displaced two-part fractures and three-part GT/SN fractures can have above satisfactory functional and radiographic outcomes with the Polarus interlocking nail using a closed technique. Even though displaced three-part GT/SN fractures in elderly osteopenic patients (>60 years), we treated successfully with the Polarus interlocking nail.

Citations

Citations to this article as recorded by  
  • 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
    Journal of the Korean Fracture Society.2013; 26(1): 14.     CrossRef
  • Intramedullary Nailing for Complex Fractures of the Proximal and Midshaft of the Humerus
    Chul-Hyun Cho, Gu-Hee Jung, Kyo-Wook Kim
    Journal of the Korean Fracture Society.2011; 24(3): 237.     CrossRef
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Interlocking Intramedullary Nailing in the Distal Metaphyseal Fractures of the Tibia
Sang Jun Song, Duck Yun Cho, Hyung Ku Yoon, Dong Eun Shin, Jae Hwa Kim, Tae Hyung Kim
J Korean Fract Soc 2005;18(3):275-280.   Published online July 31, 2005
DOI: https://doi.org/10.12671/jkfs.2005.18.3.275
AbstractAbstract PDF
PURPOSE
To evaluate the clinical and radiographic results of interlocking intramedullary nailing for the distal metaphyseal fractures of the tibia and to identify the usefulness of the interlocking intramedullary nailing.
MATERIALS AND METHODS
Thirty four patients who underwent interlocking intramedullary nailing for distal metaphyseal fractures of the tibia were reviewed with a follow-up period of more than 2 years. Clinical result was assessed using the Olerud score and this score was marked as percentage of prefracture state. Radiographic results were assessed with varus-valgus angle, anterior-posterior angle, and bone union time. We checked the cases of complication and need for additional surgery after interlocking intramedullary nailing.
RESULTS
Clinically, Olerud score averaged 92.1% (76~100%). Radiographically, average varus-valgus angle was 1.6+/-2.9 degrees and average antero-posterior angle was 0.8+/-3.3 degrees. Bone union time averaged 18.7 weeks. As complications, there were one deep infection and two breakages of distal interlocking screw. In additional surgery, there were 1 debridement and soft tissue flap, and one dynamization of nail at postoperative 12 weeks.
CONCLUSION
Interlocking intramedullary nailing is one of safe and reliable method for distal metaphyseal fractures of the tibia, considering less soft tissue injury, possibility of early range of motion exercise, high bone union rate, and low complications rate.

Citations

Citations to this article as recorded by  
  • 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
    Journal of the Korean Fracture Society.2008; 21(4): 286.     CrossRef
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Outcomes Related to Closed Interlocking Intramedullary Nailing for Segmental Tibia Fracture
Jeung Tak Suh, Sang Jin Cheon, Young Gyun Kim, Jung Sub Lee, Choon Key Lee
J Korean Fract Soc 2005;18(3):256-263.   Published online July 31, 2005
DOI: https://doi.org/10.12671/jkfs.2005.18.3.256
AbstractAbstract PDF
PURPOSE
To evaluate the outcomes of twenty-six cases of segmental tibia fracture that were treated by closed interlocking intramedullary nailing. MATERIAL AND METHODS: All cases were followed up for at least 1 year (average 14.3 months). Clinical results were evaluated by Klemm & Borner's scale. We analyzed the average range of the motion of the ankle and knee joint, atrophy of quadriceps muscle and angular deformity at the last follow up. We evaluated complications (new fracture of the tibia, infection, compartment syndrome, nonunion, delayed union, angular deformity and pain of ankle and knee joint).
RESULTS
Results were excellent in 4 cases (15.4%), good in 18 cases (69.2%), fair in 3 cases (11.5%), and poor in 1 case (3.9%). Union was obtained in 25 cases (96.1%) over an average period of 23.3 weeks. Nine cases showed intra-operative or post-operative complications: new fracture of the proximal tibia on the posteromedial side (2 cases), local infection at an entry point (2 cases), compartment syndrome (1 case), deep infection (1 case), and delayed union (3 cases). At the last follow up, angular deformity was found in 4 cases (mean of all deformities, 6 degrees): 3 cases at the proximal fracture site (2 cases of valgus deformity: 5 and 8 degrees and 1 case of varus deformity: 7 degrees) and the other case in the distal fracture site (valgus 5 degrees). Average postoperative range of motion of the knee joint was 123.7 degrees (80~135 degrees). Knee pain or limited motion occurred in 4 cases. The average range of the motion of the ankle joint was 68.1 degrees (60~70 degrees). Limited motion occurred in 4 cases (average, 10 degrees) but no case showed ankle pain.
CONCLUSION
Closed interlocking intramedullary nailing for segmental tibia fracture often results in complications. To minimize these complications, comprehensive evaluation of the fracture, and careful surgical treatment are required.
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Operative Treatment of Traumatic Humeral Shaft Fracture: Comparision of Interlocking IM Nailing and Plate Fixation by Posterior Approach
Hyun Dae Shin, Kwang Jin Rhee, Kyung Cheon Kim, Ho Sup Song
J Korean Fract Soc 2005;18(2):93-99.   Published online April 30, 2005
DOI: https://doi.org/10.12671/jkfs.2005.18.2.93
AbstractAbstract PDF
PURPOSE
To compare the results and complications of interlocking IM nailing and plate fixation by posterior approach in the treatment of traumatic humeral shaft fracture MATERIALS AND METHODS: From March 1997 to March 2003, 49 patients undergone operation due to traumatic humeral shaft fracture. Follow-up was over one year. 28 patients operated with interlocking IM nailing initially and 21 operated with plate fixation by posterior approach prospectively. Statistics were compared using clinical and radiological outcomes and complications.
RESULTS
Radiologically, bone union was observed after an average of 14.3 weeks in IM nailing, and 11.7 weeks in plate fixation. So plate fixation showed earlier bone union (p=0.012). Nonunion occurred in 4 cases (14.3%) operated with IM nailing, and 1 case (4.8%), that was open shaft fracture, with plate fixation. Nonunion occurred more frequently when operated by IM nailing. 6 cases showed limitation of shoulder movement due to damage of the rotator cuff by IM nail entry site. 1 case showed radial nerve palsy, and 1 case showed axillary nerve palsy in the case of IM nailing. Also, secondary surgery due to complications was operated in 9 cases (32.1%) in IM nailing and 1 case (4.8%) in plate fixation (p=0.03).
CONCLUSION
In the case of traumatic humeral shaft fracture plate fixation by posterior approach was more useful than IM nailing in the decrease of complications and bone union. Such approach is thought to be an excellent method for anatomic reduction and nerve exploration in the case of open and comminuted fracture which accompany nerve injuries

Citations

Citations to this article as recorded by  
  • Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures
    Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn
    The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107.     CrossRef
  • Minimally Invasive Anterior Plating of Humeral Shaft Fractures
    Hyun-Joo Lee, Chang-Wug Oh, Do-Hyung Kim, Kyung-Hyun Park
    Journal of the Korean Fracture Society.2011; 24(4): 341.     CrossRef
  • Result of Interlocking Intramedullary Nailing for Humeral Shaft Fracture Evaluation of Post-operative Shoulder Function
    Seung Rim Park, Tong Joo Lee, Ryuh Sub Kim, Kyoung Ho Moon, Dong Seok You
    Journal of the Korean Fracture Society.2007; 20(2): 166.     CrossRef
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Treatment of Comminuted Femoral Shaft Fracture by Interlocking Intramedullary Nailing: Comparision of results between open reduction with cerclage wiring and closed reduction
Jeung Tak Suh, Hyoung Lok Roh, Jeung Il Kim, Chong Il Yoo
J Korean Fract Soc 2005;18(1):6-11.   Published online January 31, 2005
DOI: https://doi.org/10.12671/jkfs.2005.18.1.6
AbstractAbstract PDF
PURPOSE
To compare of results between open interlocking intramedullary nailing combined with cerclage wiring and closed interlocking intramedullary nailing in treatment of femoral shaft comminuted fracture, we reviewed retrospectively 62 femoral shaft fractures.
MATERIALS AND METHODS
We reviewed retrospectively 62 femoral shaft comminuted fractures, who had been followed up for a minimum one year including Winquist-Hansen classification II, III, IV from January 1996 to December 2002. The group I include the patients who treated with closed interlocking intramedullary nailing. The group II include the patients who treated with open interlocking intramedullary nailing combined with cerclage wiring.
RESULTS
The average bone union time was 18.6 weeks in group I, 27.6 weeks in group II. The complication included 3 delayed unions, 1 nonunion and shortening of more than two centimeters in 1 patents in group I. In group II, The complication included 2 infections, 7 delayed unions and 3 nonunions.
CONCLUSION
We can use open interlocking intramedullary nailing with cerclage wiring in some femur shaft comminuted fractures, but there are many problems and complications. So we must consider it carefully before using this method.
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The Effect of Fibular Malreduction on Ankle Joint after Tibial Interlocking IM Nailing of Tibial and Fibular Fractures
Dong Eun Shin, Duck Yun Cho, Hyung Ku Yoon, Jin Soo Lee, Yoon Seok Lee, Hyoung Jun Kim
J Korean Fract Soc 2005;18(1):29-35.   Published online January 31, 2005
DOI: https://doi.org/10.12671/jkfs.2005.18.1.29
AbstractAbstract PDF
PURPOSE
To investigate the effect of fibular malreduction on ankle joint after tibia interlocking IM nailing of tibial and fibular fractures according to type of fibular fractures at preoperation.
MATERIALS AND METHODS
Thirty-nine patients who had ipsilateral tibiofibular fracture were analyzed clinically and radiographically. The talocrural angle and the distance from joint line to the tip of fibular were measured on both ankle standing AP view. The difference of angle and distance of both ankle were analyzed by paired t-test and correlation between defference and AOFAS score by Spearman correlation coefficients.
RESULTS
The difference of The talocrural angle and the distance from joint line to the tip of fibular of both ankle was statistically significant (p<0.05). The correlation between this difference and AOFAS score was statistically insignificant (p>0.05).
CONCLUSION
In tibia interlocking IM nailing of tibia and fibula fracture, malreduction of fibula could cause the change of ankle joint.

Citations

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  • The Risk Factors Associated with Nonunion after Surgical Treatment for Distal Fibular Fractures
    Jun Young Lee, Kwi Youn Choi, Sinwook Kang, Kang Yeol Ko
    Journal of Korean Foot and Ankle Society.2018; 22(3): 95.     CrossRef
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Augmentation Plate Fixation for the Management of Long-bone Nonunion after Intramedullary Nailing
Kee Haeng Lee, Hyoung Min Kim, Chan Woong Moon, Youn Soo Kim, Won Sik Nam
J Korean Fract Soc 2004;17(3):265-270.   Published online July 31, 2004
DOI: https://doi.org/10.12671/jkfs.2004.17.3.265
AbstractAbstract PDF
PURPOSE
The aims of this study were to determine the effectiveness of the treatment using augmentation plate fixation for nonunion of long bone fracture after interlocking intramedullary nailing MATERIALS AND METHODS: Thirteen patients with nonunion of the long bone fracture after interlocking intramedullary nailing who underwent augmentation plate fixation were evaluated; followed up for more than 1 years. We evaluated five patients with nonunion of the humerus, three of the tibia and five of the femur. Twelve of thirteen patients were carried out autogenous cancellous bone graft and augmentation plate fixation was performed without removal of intramedullary nail for all patients.
RESULTS
For the cause of nonunion, seven patients were by iatrogenic factors such as insecure fixaton and six patients were by fracture itself such as severe comminution and open fracture. Bone union was achieved in thirteen patients all and the average bony union time was 4.2 months (ranged from 3 to 5.5 months) for the humerus, 6.4 months (ranged from 4 to 8.5 months) for the tibia and 7.3 months (ranged from 5.5 to 9 months) for the femur. There were no complications such as reoperation, infection or plate failure.
CONCLUSION
TAugmentation plate fixation is effective treatment option for the management of long bone fracture nonunion after intramedullary nailing.

Citations

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  • Augmentation Plate Fixation for the Treatment of Femoral and Tibial Nonunion After Intramedullary Nailing
    Ali Birjandinejad, Mohammad H. Ebrahimzadeh, Hosein Ahmadzadeh-Chabock
    Orthopedics.2009; 32(6): 409.     CrossRef
  • The Comparison of LC-DCP versus LCP Fixation in the Plate Augmentation for the Nonunion of Femur Shaft Fractures after Intramedullary Nail Fixation
    Se Dong Kim, Oog Jin Sohn, Byung Hoon Kwack
    Journal of the Korean Fracture Society.2008; 21(2): 117.     CrossRef
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Treatments of the Nonunion of Femoral Shaft Fractures after Interlocking Intramedullary Nailing
Phil Hyun Chung, Chung Soo Hwang, Suk Kang, Jong Pil Kim, Jae Sang Park
J Korean Fract Soc 2004;17(2):95-102.   Published online April 30, 2004
DOI: https://doi.org/10.12671/jkfs.2004.17.2.95
AbstractAbstract PDF
PURPOSE
To investigate and analyze the clinical result in the treatment of aseptic nonunion of femoral shaft fracture after interlocking intramedullary nailing MATERIALS AND METHODS: We reviewed 23 cases of aspetic nonunion of femoral shaft fracture after interlocking intramedullary nail from March 1995 to February 2003 and follow up more than one year. 8 cases were treated by metal exchange, 3 cases by autogenous bone graft and the rest 12 cases by metal exchange and bone graft on the basis of fracture gap and type of nonunion. We evaulated nonunion type, union time and clinical result. Those patients were treated by interlocking intramedullary nail with or without bone graft. Union were accepted when the radiographic evidences showed bridging callus on both end of femoral shaft fracture with clinical evidences showing abscence of pseudomotion or pain.
RESULTS
All patients were united by one operation. Average union time were 4.8 months in metal exchange group, 3.9 months in metal exchange with autograft bone graft group, and 4.3 months in bone graft group. 15 patients (65.2%) showed hypervascular nonunion including 7 Elephant foot types (46.7%) and 8 oligotrophic types (53.5%), and 8 patients (34.8%) showed avascular nonunion according to Weber-Brunner classification CONCLUSION: Based on our analysis on clinical outcome and stability of nonunion occuring after initial interlocking intramedullary nailing in femoral shaft fracture, interlocking intramedullary nailing with bone graft made early ambulation possible and promoting returning to normal daily life much earlier, thus based on this data, we recommend interlocking intramedullary nailing for treating femoral shaft fracture along with bone graft.
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Interlocking Intramedullary Nailing for Treating Most Distal Tibial Fracture
In Heon Park, Kyung Won Song, Sung Il Shin, Jin Young Lee, Seung Yong Lee, Tae Hyoung Kim, Jeong Hun Cha
J Korean Soc Fract 2003;16(3):356-362.   Published online July 31, 2003
DOI: https://doi.org/10.12671/jksf.2003.16.3.356
AbstractAbstract PDF
PURPOSE
We analyzed the result of treatment for most distal extraarticular tibial fracture using interlocking intramedullary nail.
MATERIALS AND METHODS
From January 1999 to April 2002, 8 patients who had most distal tibial fracture were treated by interlocking intramedullary nailing. The duration of follow-up was more than 12 months. The mean age was 41.5 years old. There were 5 males and 3 females. During follow-up period, we evaluated the bone union, range of motion of knee and ankle joint and gait pattern.
RESULTS
The average distance from fracture line to ankle joint line was 1.1 cm. The bone union was achieved at average 18.6 weeks. At the last follow-up, there was no limited motion on knee. But at one case, ankle range of motion was limited from 5 degree extension to 35 degree flexion. There was no gait disturbance.
CONCLUSION
Interlocking intramedullary nailing can be recommendable and useful in the most distal tibial fractures.

Citations

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  • 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
  • Interlocking Intramedullary Nail in Distal Tibia Fracture
    Oog Jin Shon, Sung Min Chung
    Journal of the Korean Fracture Society.2007; 20(1): 13.     CrossRef
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Treatment of Distal Tibial Fractures by Interlocking Intramedullary Nailing
Jung Ryul Kim, Hyung Suk Lee, Moon Ki Choi, Kwang Bok Lee, Jong Hyuk Park, Jun Mo Lee
J Korean Soc Fract 2003;16(3):348-355.   Published online July 31, 2003
DOI: https://doi.org/10.12671/jksf.2003.16.3.348
AbstractAbstract PDF
PURPOSE
To analyze the result of treatment for distal tibial fractures by interlocking intramedullary nailing.
MATERIALS AND METHODS
Eighteen patients who underwent interlocking intramedullary nailing for distal tibial fracture were followed up for more than one year. We analyzed the fracture configuration, presence of fibular fracture, angular deformity and bone union by follow-up radiograph, and complications. The functional results were assessed by Baird's ankle scoring system.
RESULTS
According to Robinson classification, there were 4 type I fractures, 12 type IIA fractures, and 2 type IIB fractures. All cases were combined with fibular fracture. The mean union period of 18 cases were 21.9 weeks. There were three complications with 3 cases of valgus deformity. In functional outcome according to Baird's ankle scoring system, 15 patients (83%) showed satisfactory results.
CONCLUSION
We concluded that interlocking intramedullary nailing is effective method for the treatment of the distal tibial fractures. However, to avoid valgus deformity of the distal tibia when combined distal fibular fracture, fibular reduction and rigid fixation should be needed.

Citations

Citations to this article as recorded by  
  • 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
  • Interlocking Intramedullary Nail in Distal Tibia Fracture
    Oog Jin Shon, Sung Min Chung
    Journal of the Korean Fracture Society.2007; 20(1): 13.     CrossRef
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Fatigue Fracture of the Interlocking Nail in the Treatment of Femoral Shaft Fractures
Jung Ryul Kim, Jin Ho Yoon
J Korean Soc Fract 2003;16(2):163-168.   Published online April 30, 2003
DOI: https://doi.org/10.12671/jksf.2003.16.2.163
AbstractAbstract PDF
PURPOSE
To analyze clinical and mechanical factors of the fatigue fracture of the intramedullary nail in the treatment of the femoral shaft fractures and to consider preventive methods of fatigue fracture.
MATERIALS AND METHODS
We reviewed 12 patients of fatigue fractures of the intramedullary and were followed for a minimum one year. The site of fatigue fracture of the intramedullary nail was at fracture site in 10 cases, just proximal to proximal locking hole in one, and the most proximal of two distal locking holes in one. We analyzed type and diameter of broken nail, time from injury to fatigue fracture, causes of metal failure, and treatment results.
RESULTS
Intramedullary nails which had fatigue fracture were reamed AO nail in four cases, Grosse-Kempf nail in four, Russel-Taylor nail in three, and long Gamma nail in one. Time to fracture of implant was average 13.6 months (range, 6~30 months). All cases were treated by intramedullary nailing, and additional autogenous bone grafting was done in three cases. At an average duration of follow-up of 7.5 months (range, 5 to 10 months), all of the fractures had healed.
CONCLUSION
To prevent fatigue fracture of intramedullary nail, closed obervation for bony union, progressive weight bearing, and augmentation with autogenous bone grafting for comminuted fracture site should be needed.
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Treatment of Femoral Shaft Nonunions with Dynamic Compression using Interlocking-Compression (IC) Nail
Youn Soo Park, Young Wan Moon, Ki Sun Sung
J Korean Soc Fract 2003;16(2):155-162.   Published online April 30, 2003
DOI: https://doi.org/10.12671/jksf.2003.16.2.155
AbstractAbstract PDF
PURPOSE
To evaluate the effectiveness of a specially designed Interlocking-Compression Nail (IC Nail(R), Osteo, Switzerland) which allows compression force across the nonunion site for the treatment of femoral shaft nonunions.
MATERIALS AND METHODS
Between Nov. 1998 and June 2002, twenty one nonunions of femoral shaft fractures in twenty patients were treated with reamed IC nails of larger diameters without bone grafting in 9 men and 11 women, 8 to 45 months after initial operations. Seventeen cases were hypervascular nonunions, 3 avascular, and 1 infected. For initial operation, 10 closed nailing, 10 open nailing and 1 plate fixation were performed. One or more additional procedures had been done in 17 cases prior to IC nailing.
RESULTS
The nonunion gap was considerably narrowed from 7.4 mm to 3.1 mm with IC nailing and bony unions were achieved in all but one case. The time for radiographic union was 4 to 15 months posteoperatively with an average of 7.4.
CONCLUSION
Reamed IC Nail(R) with a larger diameter is an effective procedure for femoral shaft fracture nonunion regardless of initial treatment modalities and even in 3 avascular nonunions, 2 have shown radiographic union without bone grafting. Additional procedures are to be considered in failed surgery of avascular nonunions.
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Minimal Open Reduction and Interlocking IM Nailing of Comminuted Humeral Shaft Fracture: Comparison between Plate Internal Fixation
Kyeong Jin Han, Soo Ik Awe, Tae Young Kim, Shin Young Khang
J Korean Soc Fract 2002;15(4):573-580.   Published online October 31, 2002
DOI: https://doi.org/10.12671/jksf.2002.15.4.573
AbstractAbstract PDF
PURPOSE
We compared the functional and radiological results after the minimal open reduction and interlocking IM nailing and LC-DCP plate internal fixation for the comminuted humeral shaft fractures.
MATERIALS AND METHODS
Fourteen plates(LC-DCP) and eighteen interlocking IM nail(AO unreamed IM nail) were applied after open reduction for 32 comminuted fractures of the humeral shaft between March 1997 and December 2001. They were followed up for a minimum 9 months after surgery and the radiological and functional results were evaluated.
RESULTS
The average fracture healing time was 13.2 weeks and union rate was 85.7% for plate internal fixation. The average fracture healing time was 12.4 weeks and union rate was 94,4% for interlocking IM nail. The average functional scores according to American Shoulder and Elbow Surgeon 's (ASES) shoulder score(Total 52 points) was 44 points for plate internal fixation and 47 points for interlocking IM nailing respectively.
CONCLUSION
Minimal open reduction and interlocking IM nailing is better method with good functional and radiological results than plate internal fixation for the comminuted humeral shaft fractures.
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The Fate of Large Butterfly Fragments in Femoral Shaft Comminuted Fractures Treated withClosed Interlocking Intramedullary Nailing
Keun Bae Lee, Jae Yoon Chung, Eun Sun Moon, Eun Kyoo Song, Kwang Cheul Jeong
J Korean Soc Fract 2002;15(4):504-510.   Published online October 31, 2002
DOI: https://doi.org/10.12671/jksf.2002.15.4.504
AbstractAbstract PDF
PURPOSE
To evaluate the radiographic changes and union of large butterfly fragments after closed interlocking IM nailing for femoral shaft comminuted fractures.
MATERIALS AND METHODS
The objects of this study were 23 cases(15 males, 8 females) of femoral shaft comminuted fractures with butterfly fragments larger than 5cm and with the follow up period of 12 months or more from June 1995 to June 2000. We assessed the size, the degrees of displacement and angulation of the large butterfly fragments at preoperatively, one day, one month and three month postoperatively and evaluated the union at four month and six month postoperatively.
RESULTS
The size of the fragments was 8.4cm (5.0-13.0) in average. The distance between the fragment and shaft was 15.9cm preoperatively and 10.1, 7.7, 6.8cm at one day, one month and three month postoperatively. In 13 cases of angulation over 5 degrees, it changed from 19.6 degrees preoperatively to 13.9 degrees , 8.4 degrees , 5 . 9 degrees at one day, one month and three month postoperatively. There is no increase in angulation.The union was completed at 4 months in 13 cases (56.5%) and at 6 months in all except one case of delayed union, in which we did not do any further procedure until the union was achieved.
CONCLUSION
In femoral shaft comminuted fractures with displaced large butterfly fragments treated with closed interlocking IM nailing, the distance and angulation of fragments decreased gradually and even the fragments were inverted or largely displaced and angulated the fragments were united. So the caution must be given not to displace the fragments intraoperatively and to keep anatomical position of the fragments by active exercise and hydrostatic pressure of the muscles of thigh postoperatively. Then the open reduction and internal fixations of the fragments will not be necessary.
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Treatment of the Nonunion of Femur Shaft Fractures after Interlocking Intramedullary Nailing
Keun Bae Lee, Eun Sun Moon, Eun Kyoo Song, Jin Choi, Sung Taek Jung
J Korean Soc Fract 2002;15(4):497-503.   Published online October 31, 2002
DOI: https://doi.org/10.12671/jksf.2002.15.4.497
AbstractAbstract PDF
PURPOSE
We analyzed the results of treatment for the nonunion of femur shaft fractures after interlocking intramedullary(IM) nail fixation. MATERIALS & METHODS: Thirty-three patients who underwent interlocking IM nailing due to femur shaft fractures from May, 1990 to July, 2000 and followed up for more than one year were evaluated retrospectively. Mean age at the time of operation was 40 years(Range, 19-68). 27 cases were men and 6 cases were women. By Weber and Brunner classification of the nonunion, hypervascular type were 10 cases(30%), avascular type 21cases(64%), mixed type 2 cases(6%). Infected type among the avascular type of nonunion were 5 cases(23%). Results were evaluated with bone union by treatment methods and complications.
RESULTS
According to the causes and types of nonunion, we performed IM nail exchange in seven cases, IM nail exchange and bone grafting in eleven cases, external fixation in five cases, compression plating and bone grafting in three cases, and only cancellous bone grafting in seven cases. Radiographical union was achieved in 19 weeks, 17 weeks, 20 weeks, 16 weeks and 15 weeks respectively. There 's no statistically significant difference between treatment methods. There are no cases of nonunion, malunion and infection.
CONCLUSION
The selection of appropriate treatment method by the cause and type of each nonunion is very important to achieve the bony union in the treatment for the nonunion of femur shaft fractures after interlocking intramedullary nailing.

Citations

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  • Results of Exchange Nailing in Hypertrophic Nonunion of Femoral Shaft Fracture Treated with Nailing
    Suenghwan Jo, Gwang Chul Lee, Sang Hong Lee, Jun Young Lee, Dong Hwi Kim, Sung Hae Park, Young Min Cho
    Journal of the Korean Fracture Society.2019; 32(2): 83.     CrossRef
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Unreamed interlocking nailing in tibia fracture
You Sung Suh, Young Il Cho, Ho Won Jung, Yeon Il Kim
J Korean Soc Fract 2002;15(4):470-476.   Published online October 31, 2002
DOI: https://doi.org/10.12671/jksf.2002.15.4.470
AbstractAbstract PDF
PURPOSE
To evaluate of clinical results and malunion according to nail insertion site and early ambulation after unreamed interlocking intramedullary nailing for the treatment of tibial fractures, MATERIALS AND METHODS: We reviewed 46 tibial fractures that were treated with unreamed static intramedullary nailing prospectively from March 1997 to May 2001. Nail insertion site and angulation of fracture site were reviewed by radiograph. All of 46 cases, ambulation was started at postoperative 2 weeks, and then clinical outcomes were reveiwed RESULTS: In all 46 cases, union was achieved at average 18.2 weeks clinically and average 19.4 weeks radiographically. There is no significant difference in angulation according to nail insertion site, i,.e. after central/medial/lateral insertion, outcome was 2 . 4 5 degrees +/-2 . 1 7 / 2 . 2 2 degrees +/-1 . 8 4 / 1 . 7 3 degrees +/-1.33(p; 0.705) in last follow up anterioposterior view, and 1.81 degrees +/-1 . 1 3 / 2 . 6 7 degrees +/-1 . 6 2 / 2 . 0 0 degrees +/-1.64(p; 0.320) in last follow up lateral view. No breakage of intramedullary nails and no stiffness on adjacent joints.
CONCLUSION
We confirmed that unreamed interlocking nailing in tibial fractures is one of the effective method for low recurrence of malunion and early ambulation
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Interlocking Intramedullary Nailing of the Proximal Humerus Fracture in Elderly Patients over 65 Years old
Hee Gon Park
J Korean Soc Fract 2002;15(3):385-390.   Published online July 31, 2002
DOI: https://doi.org/10.12671/jksf.2002.15.3.385
AbstractAbstract PDF
PURPOSE
The purpose of this study is to document the result of the interlocking intramedullary nailing of the proximal humerus fracture in eldery patients over 65 years old.
MATERIALS AND METHODS
We performed a clinical and radiographic assessment after a follow up period exceeding 12months of 14cases of interlocking intramedullary nailing of proximal humerus fracture.
RESULTS
By Kronberg 's radiogrphic evaluation, 9 cases were good, 4 cases were acceptable, 1 case was poor. The average pain index was 3.2 point by Howkins guide line. All patients complained about final range of motion, especially in abduction and flexion movement.
CONCLUSION
Though the interlocking intramedullary nailing was an attractive alternative for the proximal humerus fracture stabilization for early rehabilitation in eldery patients over 65 years old, but should be consideration for postoperative shouder pain and loss of motion
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Nail Breakage after Femoral Interlocking Intramedullary Nailing
Suk Kang, Phil Hyun Chung, Dong Ju Chae, Jong Pil Kim, Joon Han Kim, Sung Pock Park, Jae Sang Park
J Korean Soc Fract 2002;15(3):363-370.   Published online July 31, 2002
DOI: https://doi.org/10.12671/jksf.2002.15.3.363
AbstractAbstract PDF
PURPOSE
We analyze the clinical causes and precautions of nail breakage followed by femoral intramedullary nailing MATERIALS AND METHODS: We reviewed 12 cases of nail breakage followed by the femoral intramedullary nailing from Jan. 1993 to Feb. 2001 and for each cases, we analyzed used nail diameter, patient weight and used nail, time to nail breakage and configuration of non-union. We classified fracture site at the time of trauma as proximal 1/3, middle 1/3, distal 1/3, and evaluated gap of fracture site, displacement of fragment after surgery, location and treatment of broken nail on each part, and analyzed the causes of nail breakage RESULTS: The average time of nail breakage was 8.1 months and distal 1/3 fracture were major as 6 cases. Those were mainly comminuted fracture of Winquist-Hansen type II. After surgery, gap of fracture site and displacement of fragment were mostly observed in middle 1/3 fracture and, in the part of middle 1/3, the site of nail breakage took place in fracture site. Especially in the distal 1/3 fracture, nail breakage happened usually in distal first locking screw hole. The causes of nail breakage were inadequately small diameter of nail inserted into the isthmic portion of medullary canal in proximal fracture, inaccurate reduction of fracture site in middle fracture, and the use of short length of nail and its mechanical damage caused by inaccurate insertion of distal locking screw in distal fracture.
CONCLUSION
To prevent nail breakage while femoral intramedullary nailing, in proximal fracture, adequate diameter of nail has to be inserted into the isthmic portion of medullary canal. In middle fracture, the accurate reduction of fracture site will be necessary, and the case of distal fracture, enough length of nail has to be used and especially it is important not to cause mechanical injury with the accurate insertion of distal locking screw in nail

Citations

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  • Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures
    Bailian Liu, Ying Xiong, Hong Deng, Shao Gu, Fu Jia, Qunhui Li, Daxing Wang, Xuewen Gan, Wei Liu
    Journal of Orthopaedic Surgery and Research.2014;[Epub]     CrossRef
  • Limited Open Reduction and Intramedullary Nailing of Proximal Femoral Shaft Fracture
    Sang Ho Ha, Jun Young Lee, Sang Hong Lee, Sung Hwan Jo, Jae Cheul Yu
    Journal of the Korean Fracture Society.2009; 22(4): 225.     CrossRef
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The Result of Treatment in Fracture of the Proximal Humerus
Man Je Park, Byeong Yeun Seong, Seung Ki Lee, Taek Gun Lee, Sang Yol Shin, Hyung Su Kim
J Korean Soc Fract 2002;15(2):299-306.   Published online April 30, 2002
DOI: https://doi.org/10.12671/jksf.2002.15.2.299
AbstractAbstract PDF
PURPOSE
To evalute the anatomical and functional outcome after treatment for proximal humerus fracture according to surgical and conservative treatment and assess the final results according to treatment methods.
MATERIALS AND METHODS
Forty-two cases with follow-up over 12 months were divided into three groups: conservative treatment (Group 1, 20 cases), closed reduction with Rush or percutaneous pin fixation (Group 2, 11 cases), proximal intramedullary interlocking nailing(Group 3, 11 cases). The functional outcome was obtained by modified neer method using self-assessed score paper and the anatomical outcome was obtained by paavolainen method using radiologic film score. Statistics in comparing with the result of each group was analized by variance analysis using Generalized Liner Model and Fisher?s exact test.
RESULT
Anatomical reduction was best obtained in group 3 (p< 0.05) and mean duration of bone union was 10.33 weeks. Functional score was also best obtained in group 3 (p<0.05). Complication was noted in 9 cases. There was only 1 case in group 3. In studing of overall outcome, the group 3 has good result than other groups.
CONCLUSION
Proximal intramedullary interlocking nailing in displaced proximal humerus fracture can be demonstrated as better method for anatomical reduction(p<0.05) than other methods because it can make insertion of locking screw ease with multiple direction for anatomical reduction and can provides a sufficient fixation for early rehabilitation and union , while minimizing complication.

Citations

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  • Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?
    Woo-Bin Jung, Eun-Sun Moon, Sung-Kyu Kim, David Kovacevic, Myung-Sun Kim
    BMC Musculoskeletal Disorders.2013;[Epub]     CrossRef
  • Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture
    Doo-Sup Kim, Dong-Kyu Lee, Chang-Ho Yi, Jang-Hee Park, Jung-Ho Rah
    Journal of the Korean Fracture Society.2011; 24(2): 144.     CrossRef
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Comparative Analysis of Interlocking IM Nailing and LC-DCP fixation in the Treatment of Distal Tibial Fracture
Hwa Yeop Na, Young Jun Park, Sang Hoon Ko, Wahn Sub Choe, Young Sang Lee, Kyung Dong Yoon
J Korean Soc Fract 2002;15(2):152-158.   Published online April 30, 2002
DOI: https://doi.org/10.12671/jksf.2002.15.2.152
AbstractAbstract PDF
PURPOSE
To compare the clinical results between interlocking IM nailing and LC-DCP fixation in the treatment of distal tibial shaft fracture.
MATERIALS AND METHODS
From August 1998 to August 2001, 23 patients were treated by interlocking IM nail and 15 patients were treated by LC-DCP for distal tibial shaft fracture.
RESULTS
Accoding to Robinson classification, there were 12 type 1 fractures (52.1%) and 11 type 2a fractures (47.8%) in the interlocking IM nailing group, and 4 type 1 fractures (26.7%), 8 type 2a fractures (53.4%) and 3 type 2c fractures (20.07%) in the LC-DCP fixation group. The average time to bony union was 16 weeks in the patients treated with interlocking IM nail and 12 weeks in the patients treated with LC-DCP. In the functional outcome (according to Klemm and Borner), 18 patients treated (78.2%) with interlocking IM nail showed satisfactory results and 13 patients (86.6%) treated with LC-DCP had satisfactory results.
CONCLUSION
We concluded that more satisfactory results could be obtained with LC-DCP fixation compared with interlocking IM nailing in the treatment of the distal tibial fracture.

Citations

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  • 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
  • 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
    Journal of the Korean Fracture Society.2010; 23(3): 296.     CrossRef
  • 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
    Journal of the Korean Fracture Society.2008; 21(4): 286.     CrossRef
  • 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
    Journal of the Korean Fracture Society.2007; 20(2): 154.     CrossRef
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The Efficacy of Dynamization of Static Interlocking Intramedullary Nailing as A Trial Leading to Bony Union of Femur Shaft Fracture
Byung Soon Kim, Duck Yeon Cho, Hyung Ku Yoon, Soo Hong Han, Jin Yong Kim, Yong Wook Kim
J Korean Soc Fract 2002;15(2):138-145.   Published online April 30, 2002
DOI: https://doi.org/10.12671/jksf.2002.15.2.138
AbstractAbstract PDF
PURPOSE
To evaluate the efficacy of dynamization of static interlocking intramedullary nailing as a trial leading to bony union of femur shaft fracture, delayed union of femur shaft fracture underwent dynamization were investigated. MATERIALS & METHODS: Between april 1995 and December 2000, 162 patients were treated static interlocking intramedullary nailing, 14 patients were selected who had underwent dynamization. The average age was 39 years old (range 24 to 61), they were 11 men and 3 women. The type of fractures were two communited, seven segmental and five simple fractures. Dynamization were done by removal of proximal or distal interlocking screw. We defined complete bony union as radiological and clinical bony union. Also we measured leg length discrepancy and angulation by radiologic parameters.
RESULTS
Of the 14 patients who showed delayed union, 7 patients were noted successful bony union by dynamization, and of the 7 patients who failed union by dynamization, 6 patients were noted bony union by supportive operative treatments(bone graft : 4 patients, nail exchanging : 1 patient, both method 1 patient). One patient was seen nonunion state because of patient's refusal of treatment. 7 patients who were noted successful bony union by dynamization had 2 degrees~6 degrees(average 4.14 degrees) varus-valgus angulation and 4 degrees~9 degrees(average 6 degrees) AP angulation, and 3 of the 7 patients showed leg length discrepancy(LLD) greater than 2 cm. The other 7 patients had 2 degrees~5 degrees(average 3.57 degrees) varus-valgus angulation and 3 degrees~7 degrees(average 5 degrees) AP angulation, and 2 of the 7 patients showed LLD greater than 2cm. Of the 14 patients, 5 patients showed limping.
CONCLUSION
Dynamization of intramedullary nainling is a simple and valuable method for improving bony union of femur shaft fracture in the case of delayed union. But if the delayed unions are seen due to large bone defect, supportive operative treatments (bone graft, nail exchanging etc.) to avoid significant complica-tion(shortening and angulation) is needed.
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The Comparison of the Using of Plate Fixation and Interlocldng IM Nailing in Humeral Shaft Fracture
Myung Hwan Son, Byung Chul Kim, Nam Wook Kang, Min Yong Kim
J Korean Soc Fract 2001;14(4):720-725.   Published online October 31, 2001
DOI: https://doi.org/10.12671/jksf.2001.14.4.720
AbstractAbstract PDF
PURPOSE
This study was to evaluate the results and the usefulness of the plate fixation and the interlocking IM nailing for the humeral shaft fractures.
MATERIALS AND METHODS
We have reviewed thirty cases of humeral shaft fractures, which were treated with plate fixation in seventeen cases and interlocking IM nailing in thirteen cases in period of February 1993 to May 1999. The Russel-Taylor nails were used in all cases for interlocking IM nailing. The clinical and the radiological results were evaluated after operation.
RESULTS
The average union time was 14.5 weeks for the plate fixation and 15.2 weeks for the interlocking IM nail respectively. There were two cases of wound infection and one case of radial nerve injury for the plate fixation, and two cases of rotator cuff injury on the shoulder were found after the interlocking IM nailing.
CONCLUSION
Interlocking IM nailing is a relatively simple procedure with low rate of infection and radial nerve injury, but rotator cuff injury is a considerable problem after operation.
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Comparison between Ender Nail and Interlocking Nail in The Treatment of Infra-isthmic Tibial Shaft Fracture
Seung Wook Yang, Moo Ho Song, Hyung Taek Park, Sun Jin Choi
J Korean Soc Fract 2001;14(4):651-659.   Published online October 31, 2001
DOI: https://doi.org/10.12671/jksf.2001.14.4.651
AbstractAbstract PDF
PURPOSE
To compare the clinical results between Ender nail and interlocking nail in the treatment of infra-isthmic tibial shaft fracture.
MATERIALS AND METHODS
The authors analyzed 44 cases of infra-isthmic tibial shaft fracture treated with Ender nail(23 cases) as a group 1 or interlocking nail(21 cases) as a group 2 from 1994 to 1998. Fracture type was divided by AO classification, and measured the fracture level, the time of bone union and angular deformity was checked with roentgenograms. The functional results were compared using the criteria by Klemm and Borner.
RESULTS
Distal end of fracture line from ankle joint shows no difference between two groups(P>0.05). Mean operation time was 96 minutes in group 1 and 140 minutes in group 2(P<0.05). Mean intraoperative blood loss was 103cc in group 1 and 254cc in group 2(P<0.05). Mean bone union time was 19.26 weeks in group 1 and 24.81 weeks in group 2. There was no significant difference between two groups in the angulation(P>0.05) and the functional results by Klemm and Borner.
CONCLUSION
Ender nail is a good method of treatment in infra-isthmic tibial fracture when isthmic portion of tibia is too narrow, or insertion of distal interlocking screws were too difficult to insert because of the severe soft tissue injury. The stability of fixation can be strengthened with a three point fixation as fanning of the nails in the distal fragments using more than 3 nails selecting a 1cm longer nail than the ordinary nail length for diaphyseal fracture.
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Usefulness of Interlocking Compression Nail in Treatment of Femoral Shaft Stable Fracture
Keun Bae Lee, Sung Taek Jung, Eun Sun Moon, Eun Kyoo Song, Kwang Cheul Jeong
J Korean Soc Fract 2001;14(4):601-608.   Published online October 31, 2001
DOI: https://doi.org/10.12671/jksf.2001.14.4.601
AbstractAbstract PDF
PURPOSE
The goal of our study was to evaluate the usefulness and results of the Interlocking Compression Nail in femoral shaft stable fractures.
MATERIALS AND METHODS
The 87 patients, 88 cases, who were underwent internal fixations with interlocking compression nail for the stable fracture of the femoral shaft were evaluated. The majority of the causes of injury was traffic accident and the majority of location of the fractures was middle one thirds. The classification of the fracture using Winquist-Hansen classification showed that grade 0 were 23 cases(26.1%), grade 1, 47 cases(53.4%) and grade 2, 18 cases(20.5%). We used ICnail(Osteo, Switzerland) that can actively compress the fracture gap, maximum 10mm.
RESULTS
We used active compression in 63 cases(71.6%) and the mean length of compression was 2.3mm(range 1-5mm). The bone union was seen in 63 cases(71.6%) at postoperative 4 months and in 87 cases(98.9%) at postoperative 6 months. There was one case of delayed union, but there were no nonunion, infection, leg length discrepancy, and angular or rotational deformity, disturbing the daily activity.
CONCLUSION
The interlocking compression nail can reduce the fracture gap easily and effectively using compression screw by active interfragmentary compression. Thereby promote fracture healing and postoperative stability at the fracture site can be obtained, so early weight bearing is possible. Especially, this is recommendable useful method for femoral shaft stable fracture.
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Surgical Treatment for Nonunion of Femoral Shaft Fractures
Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suk Ha Lee, Young Bae Kim, Jong Ro Yoon, Eui Sang Seol, Kwang Yeol Park, Dae Woong Kang
J Korean Soc Fract 2001;14(3):364-370.   Published online July 31, 2001
DOI: https://doi.org/10.12671/jksf.2001.14.3.364
AbstractAbstract PDF
PURPOSE
The purpose of this study is to analyze the clinical and radiological result of surgical treatment for femoral shaft nonunion.
MATERIALS AND METHODS
From January 1993 to December 1999, 21 cases of femoral shaft nonunion were treated surgically and followed for an average of 15 months. We analyzed initial cause of injuries, classification of fractures, and cause of nonunion in clinically and radiologically. The authors analyzed the average time to union and results after surgical treatment by rigid internal fixation with interlocking intramedullary nail and autogenous bone graft.
RESULTS
The mean duration of bony union was 22 weeks and bony union achieved in 18 cases(85.7%) of 21 cases. The complications were shortening of leg length and limping gait in 2 cases, partial limitation of knee joint in 2 cases, superficial infection in 2 cases.
CONCLUSION
Rigid internal fixation with interlocking intrameduallary nail and bone graft is useful method of treatment for femoral shaft nonunion according to cause and type of nonunion.
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The Effect of Dynamization in Tibia Fracture
Jin Woo Kwon, Seung Ho Shin, Won Ho Cho, Woo Se Lee, Ki Ho Sung
J Korean Soc Fract 2001;14(1):52-59.   Published online January 31, 2001
DOI: https://doi.org/10.12671/jksf.2001.14.1.52
AbstractAbstract PDF
PURPOSE
The purpose of this study is to evaluate the effect of dynamization which was done for the treatment of delayed union or persisting fracture gap after interlocking intramedullary nailing, by radiographic and physical examination.
MATERIALS AND METHODS
We analyzed 22 cases these were treated with dynamization from 247 cases of tibia shaft fracture treated initially with static interlocking intramedullary nailing from February l990 to May 2000 and were followed up more than lyear. The result of dynamization was classified as 3 groups and we divided each results 3 categories that is effective result, uncertain result and ineffective result. Group A is cases that achived ultimate union with shortening of fracture gap and was 10 cases. Group B is that achieved ultimate union but fracture gap did not reduced and was 10 cases. Group C is that showed ultimate non-union and was 2 cases.
RESULTS
The result is that dynamization was effective only 4 cases of group A. 6 cases of group A and 4 cases of group B showed instability(radiolucent halo around nail, hypertrophied callus and leg pain), and 6 cases of group B showed no shortening of fracture gap, thus these were classified as uncertain result. Group C(2 cases) showed non-union, classified as ineffective.
CONCLUSION
Dynamization caused instability in most tibia fractures except simple mid-shaft fracture. So in the comminuted fractures and distal or proximal l/3 oblique fractures, other procedures such as bone graft, refixation should be considered rather than dynamization.
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Interlocking Intramedullary Nailing of the Humerus Shaft Fractures
Ji Ho Lee, Jin Soo Park
J Korean Soc Fract 2000;13(4):982-991.   Published online October 31, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.4.982
AbstractAbstract PDF
PURPOSE
The purpose of this study is to document the results of the interlocking nailing of the humerus fractures which is still controversial.
MATERIALS AND METHODS
Twenty three cases of interlocking intramedullary nailing was done. 13 nails were inserted through the shoulder, 10 nails through the olecranon fossa. We used a closed technique for the 22 cases of the nailing.
RESULTS
Most patients who had antegrade nailing complained of shoulder pain. The bony union was obtained in 8 patients(61.5%) with antegrade nailing patients, somewhat high rate of nonunion compared to other methods of treatment. Criticism of the procedure is because of the trauma that can occur to the rotator cuff and possible impingement syndrome, which can occur after antegrade insertion. As for the retrograde nailing patients, the union rate was 90%, higher than that of antegrade nailing patients, but without statistical significance. Fracture propagation(3 cases), limitation in elbow extension(1 case) and rotational deformity(1 case) were occurred in retrograde nailing patients.
CONCLUSION
Though interlocking intramedullary nailing are an attractive alternative for humeral fracture stabilization because of the limited surgical exposure, there must be further considerations for the insertion site problems and improvement in bony union rate.
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Interlocking Nailing in Segmental Tibial Fractures: The Problems of the Fractures involving Proximal Portion
Ki Soo Kim, June Young Song, Kwang Soo Shon, Joon Han Kim
J Korean Soc Fract 2000;13(4):912-920.   Published online October 31, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.4.912
AbstractAbstract PDF
PURPOSE
To analyze the clinical features and treatment results of the tibial segmental fractures with the interlocking nailing. To compare the results between the segmental fractures with (Group I) or without (Group II) involving proximal portion of the tibia.
MATERIALS AND METHODS
We analyzed 16 patients, 16 cases of the tibial segmental fractures treated with the interlocking nailing between April 1993 and November 1998.
RESULTS
We obtained solid bone union for all cases and relatively good clinical results. The average bone union time was 20.6 weeks. The functional results were excellent in 7 cases, good in 6 cases and fair in 3 cases. There were 8 cases of malunion. The comparison between Group I and Group II revealed no remarkable differences for bone union time, functional results and complications. But the tendency of the malunion was more higher in Group I.
CONCLUSION
For segmental tibial fractures, interlocking nailing showed good clinical results. We propose that open reduction and internal fixation should be done before interlocking nailing of the fractures involving proximal portion of the tibia.
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The Angular Deformity of Interlocking Nailing in Tibial Fractures
Hwa Jae Jeong, Kyung Chul Kim, Jae Yeul Choi, Bon Seop Koo, Jung Hee Oh
J Korean Soc Fract 2000;13(4):905-911.   Published online October 31, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.4.905
AbstractAbstract PDF
PURPOSE
We studied the relationship between angular deformity and possibly contributing factors in the treatment of tibial fractures with interlocking nailing.
MATERIALS AND METHODS
Intramedullary nailing of the tibia was performed on 49 cases and were followed for the minimum of 12 months. We analyzed relationship between angular deformity and postoperative tibial alignment, operative technique and other factors.
RESULTS
Of the 49 cases, 19(38%) were angulated. Angular deformity was seen in 60%, 51.8% and 11.8% in the proximal, distal and middle third of tibial fractures respectively. With AO classification, Group A,B,C were angulated in 32.4%, 55.6%, 66.7%. In group A, 43.8% of spiral fractures, 28.6% of oblique fractures and 14.3% of transverse fractures were angulated. The cases combined with fibular fracture showed higher incidence of angular deformity than the cases with intact fibula. The opening of fracture and the nail insertion site were not significant to angular deformity.
CONCLUSION
Angular deformity of interlocking nailing in tibial fractures were more common in proximal, comminuted and spiral fractures. Precise attentions to operative technique i. e. accurate anatomical reduction and centromedullary nail orientation are recommended to prevent angular deformity. In proximal third tibial shaft fractures where muscles and patellar tendon has deforming force on fracture fragment, authors believe that use of interlocking nailing must be limited with fracture pattern.
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Case Report
Segmental Breakage of Distal Interlocking Screw Complicating removal of broken nail: A Case Report
Kyu Hyun Yang, Seong Jin Park, Hyung Jung Kim
J Korean Soc Fract 2000;13(4):709-712.   Published online October 31, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.4.709
AbstractAbstract PDF
Metal failure (nail breakage) after locked intramedullary nailing results from delayed union or nonunion, which necessitates removal of nail and interlocking screws. Breakage of interlocking screw(s) can be associated with failure of the intramedullary nail. It usually breaks into two parts. Proximal part, which contains the screw head, can be removed by screwdriver without difficulties. Distal part can be removed from the far cortex or be left in place if it does not hinder further procedures. We experienced a case of segmental breakage of distal interlocking screw, which was associated with failure of the femoral nail and nonunion. Middle part of the broken screw obstructed the hollow of the nail and complicated the removal of the broken nail.
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Original Articles
Treatment of Humerus Shaft Fracture with Intramedullary Nail
Dong Kyu Shin, Kwoing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Chang Hyuk Choi, Sang Bong Ko
J Korean Soc Fract 2000;13(3):562-569.   Published online July 31, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.3.562
AbstractAbstract PDF
PURPOSE
This study was performed to evaluate the results of treatment of the humerus shaft fracture with interlocking IM nail.
MATERIALS AND METHODS
The result of IM nailing for 29 patients with humerus shaft fracture were evaluated radiologically and clinically. We tried to compare the result of Seidel nail and that of interlocking nail.
RESULTS
The results were as follows ; 1. Nonunion rate was 50% in Seidel nail group and 27% in interlocking nail group(p=0.264). 2. Operation time was shorter in Seidel nail group(67.8min) than in interlocking nail group(115.4min)(p=0.002). 3. Fracture site distraction was present in 9 cases and resulted in nonunion in 8 cases. 4. Union time except the nonunion cases was 10.4weeks in Seidel nail group and 11.9weeks in interlocking nail group but was not considered to be significant due to many nonunion cases. 5. Proximal protrusion was present in 6 cases but resulted in shoulder LOM and pain in only 2 ). cases.
CONCLUSION
Although the operation time in Seidel nail group was shorter than in interlocking nail group, we couldn't find any other difference between the two nails. The results of treatment of humeral shaft fracture with interlocking nail was unsatisfactory in terms of union rate, complications, union time and functional result.
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A Comparison of Interlocking Nail with Wiring versus Plate Fixation in Long Oblique or Spiral Fractures of Humeral Shaft
Phil Hyun Chung, Sang Ho Moon
J Korean Soc Fract 2000;13(3):555-561.   Published online July 31, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.3.555
AbstractAbstract PDF
PURPOSE
To compare functional results between interlocking intramedullary nail with wiring and plate for treating long oblique or spiral diaphyseal fractures of humerus.
MATERIALS AND METHODS
From April 1996 to February 1999, 9 long oblique or spiral fractures were treated with antegrade humeral locked nails and wiring after minimal open reduction, and another 9 fractures were fixed with plate and screws. Average age of patients was 45.8 years and average follow-up was 13.5 months.
RESULTS
Nail group showed earlier clinical and radiologic union than plate and screw group. All patients with plate and screw group(plate fixation) had clinical union within 5.8+/-2.5 weeks and radiologic union within 8.5+/-2.1 weeks. But, all patients with wiring had clinical union within 2.8+/-0.6 weeks and radiologic union within 5.5 +/-1.6 weeks. At last follow-up, average range of shoulder motion in plate group was larger than nailing group, but that was stastically insignificant. Plate fixations had more complications than nailing, for example, deep infection, non-union, implant failure and radial nerve injury.
CONCLUSION
Interlocking intramedullary nail with wiring has the advantages of minimal tissue trauma and scar formation, sufficient reduction and fixation, early union and fewer complication. So it can be a worthy alternative for the treatment of long oblique or spiral fractures of humerus.
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Breakage of Interlocking Screw after Intramedullary Nailing of Femoral Shaft Fracture
Gun Il Im, Cheol Won Hyun, Joo Ho Shin, Do Young Kim, Won Ho Cho
J Korean Soc Fract 2000;13(3):463-469.   Published online July 31, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.3.463
AbstractAbstract PDF
PURPOSE
We analysed risk factors for failure of interlocking screws after femoral intramedullary nailing, and introduce tips for removing broken screw.
MATERIALS AND METHODS
Seventy-two closed femoral shaft fractures were treated with interlocking nail. We compared 7 patients in whom interlocking screw breakage occurred (Group I) with 65 patients without breakage of interlocking screw (Group II). Analytic parameters were age, weight, level of fracture, degree of comminution, nail diameter. We used Mann-Whitney U test & Chi-sqare test for statistical analysis.
RESULT
Upper one of distal interlocking screws was broken in 6 patients, both of distal screws were broken in one patient. All of the patients with broken screws had associated delayed union. The mean age of patients were 20 years in group I, 31 years in group II. The mean weight were 69.6 Kg in group I, 62.02kg in group II. Three patients had fractures in proximal half and four patients had fractures in distal half in group I. In group II, there were 25 proximal fractures and 40 distal fractures. There were 2 type I, 2 type II, 1 type III, 2 type IV fractures in group I, and 16 type I, 31 type II, 17 type III, 1 type IV fractures according to Winquist and Hansen classification. Nail diameters were 10mm in 4 patients, 11mm in 2 patients, 12mm in 1 patient for group I and 10mm in 8 patients, 11mm in 13 patients, 12mm in 25 patients, 13mm in 13 patients, and 14mm in 6 patients for group II. Age, weight, degree of comminution, nail diameter had statistically significant relation to the breakage of interlocking screw(p<0.05), but the level of fracture didn't(p>0.05). Broken screws were easily removed by advancing screw to medial compartment with S-pin and making short medial incision.
CONCLUSION
It is suggested from our study that combination of parameters may have contributed to the failure of interlocking screw ; narrower diameter nail for comminuted fracture in young, active patients with more body weight. Inserting two screws have advantage over one screw.
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Comparison of Intramedullary Nailing and Plate Fixation for the Treatment of Nonunion of the Long Bone Fracture on Lower Extermities
Jong Seok Park, Jae Hoon Lee, Hee Kwon, Jae Eung Yoo, Joon Min Song, Yeon Il Kim, Chang Uk Choi
J Korean Soc Fract 2000;13(2):327-333.   Published online April 30, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.2.327
AbstractAbstract PDF
PURPOSE
: Under the principle of rigid fixation and bone graft, we analyzed and compared the clinical results in the treatment of nonunion of long bone fractures using plate fixation and intramedullary nailing with or without bone graft.
MATERIALS AND METHODS
: We used 19 cases of plate fixation and 19cases of intramedullary nailing with or without bone graft for the treatment of the nonunion of long bone from Mar. 1994 through Feb. 1997. We analyzed and compared the clinical results of plate fixation and intramedullary nailing with bone graft in the treatment of nonunion of fracture.
RESULTS
: The mean bone union time according to nonunion type in case of plate fixation was 22.6 weeks in the hypertrophic type and 16.4 weeks in the atropic type(p<0.005). In case of intramedullary nailing was 20.4 weeks in the hypertrophic type and 15.3 weeks in the atropic type(p<0.05). According to the bone graft in case of plate fixation, 20.8 weeks in the autogenous bone graft and 19.3 weeks in the combination of autogenous bone graft and allo-bone graft(p>0.05). In case of intramedullary nailing, 16.9 weeks in the autogenous bone graft and 22.7 weeks that dosen't bone graft. According to the radioligical bone union time was 20.1 weeks in the plate fixation and 18.7 weeks in the intramedullary nailing(p>0.05).
CONCLUSION
: There was on significant difference according to the method of fixation, but the treatment of nonunion of long bone in lower extremities using intramedullary nailing will be good because of early ROM exercise and weight bearing ambulation than plate fixation. Although the type of nonunion is hypertrophic in the case of intramedullary nailing, bone graft is helpful to promote bony union.
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Effects of Fibular Fixation for Interlocking Nailing of Distal Tibiofibular Fractures
Sang Ho Moon, Phil Hyun Chung, Chung Soo Hwang, Dong Ju Chae, Beom Kim
J Korean Soc Fract 2000;13(2):296-302.   Published online April 30, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.2.296
AbstractAbstract PDF
PURPOSE
: To compare redioiogic results between interlocking intramedullary nail with fibular fixation and nail only for treating distal tibiofibular diaphyseal fractures.
MATERIALS AND METHODS
: From April 1993 to February 1999, 26 distal tibiofibular fractures were antegrade nailed after anatomical reduction and fixation of fibular fractures, and another 61 fractures fixed with nails only. Average age of patients was 41.8 years. These two groups were compared by frequency of malalignment, degree of postoperative angulation, angulation according to comminution, angulation according to fracture configuration. The statistical analysis was evaluated by t-test.
RESULTS
: Fibular fixation group had no malalignment while non-fixations had angulation of 1.2+/-1.1 degree and non-fixation had 3.0+/-2.1. So fixation had lessor angulation than non-fixation significantly(p=0.004). In lateral rediographs, each had 1.3+/- 1.1, 2.8+/-2.3 degree and showed significant difference(p=0.027). In type I and II fractures of Winquist-Hansen classification, fixation group showed lesser degree of angulation in A-P plane significantly(p=0.008) but no significant difference in lateral plane. In type III and IV, no significant difference in both planes. According to configuration of fractures, transverse and spiral fractures showed no significant differences but oblique configurations had significant differences in A-P plane(p=0.002) CONCLUSION : Interlocking intramedullary nail with fibular fixation has the advantage in maintenance of alignment during insertion of nail in distal tibiofibular fractures, especially in Winquist-Hansen classification type I and II and oblique fractures in anteroposterior plane, so it can be a worthy method for the treatment of distal tibiofibular diaphyseal fractures.
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Malalignment of Tibial Fracture Following Interlocking Intramedullary Nailing
Seung Wook Yang, Hyung Taek Park, Kuen Tak Suh
J Korean Soc Fract 2000;13(2):236-243.   Published online April 30, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.2.236
AbstractAbstract PDF
PURPOSE
: The purpose of this study was to evaluate the incidence and the factors that influence on malalignment following interlocking nailing for tibial fracture.
MATERIALS AND METHODS
: The authors analysed 59 patients, 60 cases tibial fracture treated with interlocking intramedullary nailing from 1993 to 1997 about nail insertion site, nail entrance angle and fracture type with roentegenogram. Malalignment was defined as 5 degree or more angular deformity in varus-valgus, 10 degree or more angular deformity in anterior-posterior plane.
RESULTS
: Malalignment was found in 15 cases out of 60(25%). We found malalaignment in 7 cases out of 11(64%)in proximal fracture, 6 cases out of 29(21%) in middle fracture, 2 cases out of 20(10%) in distal fracture(p<0.001). Correlation between nail insertion site or medial entrance angle and angular deformity was higher in proximal fractures. In midshaft wedge fractures, direction of main fragment influenced on the axial alignment.
CONCLUSION
: Centromedullary nail orientation is required to prevent malalignment after interlocking intramedullary nailing. Precise selection of nail insertion site and nail entrance angle under the C-arm control in proximal tibial fracture is necessary. Fracture type and fragment direction must be considered during tibial nailing in comminuted tibial fracture.
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Interlocking Compression Nails for the Treatment of Acute Tibial Shaft Fractures
Sang Wook Bae, Ho Yoon Kwak
J Korean Soc Fract 2000;13(1):74-80.   Published online January 31, 2000
DOI: https://doi.org/10.12671/jksf.2000.13.1.74
AbstractAbstract PDF
PURPOSE
To evaluate the differences between interlocking compression nail and ordinary compression nail in the treatement of acute tibial shaft fractures ,ATERIALS AND METHODS: From March, 1995 to November, 1998, 67 patients were treated with intramedullary nail for the acute tibial shaft fractures. Among them, 27 cases treated with interlocking compression nails and 22 cases, with ordinary interlocking nails were analyzed in terms of average union time, complications and functional results.
RESULTS
One tibial shaft treated with interlocking compression nail failed to unite. Average union time was 14.4 weeks in the group treated with interlocking compression nails, 14.2 weeks, with ordinary interlocking nails. Functional results were graded as excellent and good in 85% in the group treated with interlocking compression nails, 90%, with ordinary compression nails.
CONCLUSION
There was no difference in the treatment results between the groups treated with interlocking compression nails and ordinary interlocking nails.
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Comparative Analysis of Interlocking Nail and Anatomical Plate in the Treatment of Distal Tibial Fracture
Gun Il Im, Do Young Kim, Joo Ho Shin, Kang Seob Youn, Won Ho Cho
J Korean Soc Fract 1999;12(3):632-637.   Published online July 31, 1999
DOI: https://doi.org/10.12671/jksf.1999.12.3.632
AbstractAbstract PDF
We studied 39 patients with distal tibial shaft fracture. Seventeen fractures(10 closed fractures and 7 open fractures: 5 type-I and 2 type II fractures, according to the classification of Gustilo et al.) were treated with interlocking nail, and 22 fractures(19 closed and 3 open fractures: 1 type I and 2 type II fractures) were treated with anatomical plate. The clinical results were analyzed according to treatment modality. All of the patients were followed up for more than 1 year. The average time to union was 18.1 weeks in the patients treated with interlocking nail and 23.7 weeks in the patients treated with anatomical plate. In the functional outcome(according to Klemm and Borner), twelve patients(70.6%) treated with interlocking nail showed excellent results and 10 patients(45.5%) treated with anatomical plate had excellent results. We concluded that more satisfactory results could be obtained with interlocking nail compared with anatomical plate in the treatment of the distal tibial fracture.

Citations

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    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
  • Comparative Analysis of Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Intramedullary Nailing in Distal Tibial Metaphyseal Fractures
    Gwang Chul Lee, Jun Young Lee, Sang Ho Ha, Hong Moon Sohn, Yi Kyu Park
    Journal of the Korean Fracture Society.2012; 25(1): 20.     CrossRef
  • 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
    Journal of the Korean Fracture Society.2010; 23(3): 296.     CrossRef
  • A Comparison between Minimally Invasive Plate Osteosynthesis & Interlocking Intramedullary Nailing in Distal Tibia Fractures
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    Journal of the Korean Fracture Society.2008; 21(4): 286.     CrossRef
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Treatment of open Tibial Shaft Fractures with Unreamed Interlocking Intramedullary Nailing
Jeung Tak Suh, Byung Guk Park, Chong Il Yoo
J Korean Soc Fract 1999;12(3):568-576.   Published online July 31, 1999
DOI: https://doi.org/10.12671/jksf.1999.12.3.568
AbstractAbstract PDF
Severe open fracture of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilization was by external fixation, but the advent of small diameter interlocking intramedullary nails has introduced a new option. From the June 1992 to December 1997, 55 cases of open tibial shaft fracture were treated with unreamed interlocking intramedullary nailing at the department of orthopedic surgery, Pusan National University Hospital. The purpose of this study is to evaluate its result and complications. Mean age was 31, mostly male. The main cause of trauma was traffic accidents(30 cases, 55%) and fracture sites consisted of mid 1/3 portion over 75%. According to the Gustilo & Anderson classification 8 type I(15%), 22 type II(40%), 15 type IIIA(27%) and 10 type IIIB(18%) were shown. Union time was 28.3 weeks on an average and union rate was 98%. There were 5 cases(9%) of delayed union, 2 cases(4%) of deep infection and 1 case(2%) of chronic osteomyelitis. In conclusion unreamed interlocking intramedullary nailing can be the first choice treatment in the treatment of open tibia shaft fractures with low postoperative infection.
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Case Report
Intraoperative Fracture of the Tibia Associated with Removal of the Interlocking Intramedullary Nail: Report of 5 cases
Chan Hoon Yoo, Young Soo Byun, Hong Tae Kim, Hyun Min Kim, Yeon Min Park, Soo Yeol Jeon
J Korean Soc Fract 1999;12(3):538-542.   Published online July 31, 1999
DOI: https://doi.org/10.12671/jksf.1999.12.3.538
AbstractAbstract PDF
We have experienced five cases of intraoperative fracture of the tibia assoicated with removal of ACE interlocking tibial nail. All fractures occured in young patients whose ages ranged from eighteen to twenty-nine years(mean, 24 years). We think the main reason of the fracture was characteristic design of ACE nail such as prominent distal angulation and posterior longitudinal slot. The other factors were age of the patient, material of the nail and timing of removal of the nail. In conclusion, we advise caution in the removal of the ACE reamed interlocking intramedullary tibial nail in young patient.

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  • Failure to Remove a Trochanteric Entry Femoral Nail and Its Cause in Adolescent Patients: Two Cases Report
    Ji-Hwan Kim, Seung-Oh Nam, Young-Soo Byun, Han-Sang Kim
    Journal of the Korean Fracture Society.2015; 28(1): 71.     CrossRef
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Original Article
Treatment of communited & Segmental Femoral shaft Fracture by using Interlocking nailing: Comparison between Closed and Open techniques
Chang Hyuk Choi, Koing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Ho Sun Chang
J Korean Soc Fract 1999;12(3):516-522.   Published online July 31, 1999
DOI: https://doi.org/10.12671/jksf.1999.12.3.516
AbstractAbstract PDF
When femoral shaft fracture with severe communition and segmentation result from violent force, they are frequently associated with severe soft tissue damage. Treatment of this unstable fracture need the rigid fixation in order to prevent shorting and rotational loading. In terms of this advantages, interlocking nailing technique was widely used with open and closed methods. In the cases of fractures that having large fragments and wide displacement, closed technique has disadvantage of difficulties in anatomic reduction and its maintenance. Nineteen femoral shaft fractures had been treated by these techniques alternatively at our hospital between Feburary 1994 and Feburary 1997 and had been followed for more than 12 months. Among the 19 cases, closed techniques were 11 cases and open 8 cases. We evaluated the results of two treatment methods in terms of the bone union time, complications and functional results. Mean duration of the bone union time was 24.2 weeks in closed interlocking nailing, 24.5 weeks in open. There was no difference between the bone union time and the operation techniques(p-value>0.05). And complications were delayed union in two cases. In conclusion, in the cases of severe comminuted and segmental femoral shaft fractures especially with posteromedial fragment, open technique was more useful than closed technique, in terms of anatomic restoration and getting functional recovery afford to preinjury level of work.
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J Musculoskelet Trauma : Journal of Musculoskeletal Trauma
© The Korean Orthopaedic Trauma Association.
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