Journal of Musculoskeletal Trauma

Interpositional tricortical iliac bone graft in nonunion of midshaft clavicular fractures: Eun-Seok Son, Bum-Soon Park, Chang-Jin Yon, Chul-Hyun Cho; J Musculoskelet Trauma 2025;38(1):23-31. Published online January 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00004

Abstract PDF: Background
The purpose of this study was to investigate the radiological and clinical outcomes after interpositional tricortical iliac bone graft with plate fixation for the nonunion of clavicle midshaft fractures. Methods: Between 2007 and 2020, 17 cases who were treated by interpositional tricortical iliac bone graft with plate fixation for the clavicle midshaft nonunion combined with bone defect were investigated. The mean age was 53 years (range, 22–70 years). The mean follow-up period was 102.2 months (range, 18–193 months). Serial plain radiographs were used to evaluate radiological outcomes. The University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and Quick-disabilities of the arm, shoulder, and hand (DASH) score were used to evaluate clinical outcomes. Complications were also evaluated. Results: All cases achieved complete bony union with mean healing time of 17.6 weeks (range, 14–22 weeks). The mean clavicle length difference was significantly decreased from 9.1 mm preoperatively to 2.6 mm postoperatively (P<0.001). The mean UCLA and ASES scores were significantly improved from 18.1 and 52.2 before surgery to 30.6 and 88.6 after surgery (both P<0.001), respectively. The mean final Quick-DASH score was 18.0. Three cases (17.6%) developed postoperative complications including two cases of shoulder stiffness and one case of screw irritation. Conclusions: Interpositional tricortical iliac bone graft with plate fixation for the clavicle midshaft nonunion demonstrated excellent radiological and clinical outcomes. In cases of atrophic nonunion combined with bone defect, this technique is an effective option that can provide structural support and restore clavicle length. Level of evidence: Level IV, case series.

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Effect of Additional Medial Locking Plate Fixation and Autogenous Bone Graft for Distal Femur Nonunion after Lateral Locking Plate Fixation: Ho Min Lee, Jong Pil Kim, In Hwa Baek, Han Sol Moon, Sun Kyo Nam; J Korean Fract Soc 2024;37(1):30-38. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.30

Abstract PDF: Purpose
This study examined the outcomes of additional medial locking plate fixation and autogenous bone grafting in the treatment of nonunions that occurred after initial fixation for distal femoral fractures using lateral locking plates.
Materials and Methods
The study involved eleven patients who initially underwent minimally invasive lateral locking plate fixation for distal femoral fractures between January 2008 and December 2020. The initial procedure was followed by additional medial locking plate fixation and autogenous bone grafting for clinically and radiographically confirmed nonunions, while leaving the stable lateral locking plate in situ. A clinical evaluation of the bone union time, knee joint range of motion, visual analog scale (VAS) pain scores, presence of postoperative complications, and functional evaluations using the lower extremity functional scale (LEFS) were performed.
Results
In all cases, bone union was achieved in an average of 6.1 months after the secondary surgery. The range of knee joint motion, weight-bearing ability, and VAS and LEFS scores improved at the final follow-up compared to the preoperative conditions. All patients could walk without walking assistive devices and did not experience pain at the fracture site. On the other hand, three patients complained of pain in the lateral knee joint caused by irritation by the lateral locking plate; hence, lateral hardware removal was performed. One patient complained of mild paresthesia at the anteromedial incision site. Severe complications, such as deep infection or metal failure, were not observed.
Conclusion
For nonunion with stable lateral locking plates after minimally invasive lateral locking plate fixation of distal femur fractures, additional medial locking plate fixation and autogenous bone grafting, while leaving the lateral locking plate intact, can achieve successful bone union.

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Treatment Results of Reamed Exchange Nailing in Aseptic Nonunion of Tibial Shaft Fracture: Yongjin Cho, Jun Young Lee, Jehong Ryu, Hyoung Tae Kim, Jong Jin Moon; J Korean Fract Soc 2023;36(4):125-132. Published online October 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.4.125

Abstract PDF: Purpose
Intramedullary nailing is used widely for treating tibial diaphysis fractures because of its relatively rigid internal fixation, which allows weight bearing, resulting in rapid bone healing and functional recovery. This study evaluated the results of exchange nailing in treating aseptic nonunion of tibial shaft fractures.
Materials and Methods
From November 2015 to December 2021, a retrospective study was conducted on patients who had undergone intramedullary nailing for tibial diaphysis fractures. Among them, this study focused on patients diagnosed with nonunion and who underwent exchange nailing. Twenty patients with a minimum follow-up period of at least 12 months were included in the study.
Results
The mean ages of patients were 60 years (range, 30-79 years). Of the 20 cases in which exchange nailing was performed, bone union was achieved in 18 cases (90.0%), and the mean period was 23 weeks (range, 14-46 weeks). Among the 18 cases of bone union, one case exhibited delayed union and achieved union without additional treatment after 46 weeks, while two cases of nonunion failed to achieve union and were lost to follow-up until the final assessment.
Conclusion
Reamed exchange nailing performed on aseptic nonunion after intramedullary nailing for tibial diaphysis fractures had satisfactory clinical outcomes.

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The Antibiotic Cement Coated Nail and Masquelet Technique for the Treatment of Infected Nonunion of Tibia with Bone Defect and Varus Deformity: Min Gu Jang, Jae Hwang Song, Dae Yeung Kim, Woo Jin Shin; J Korean Fract Soc 2022;35(1):26-30. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.26

Abstract PDF: Infective nonunion after fracture surgery can cause persistent pain and inflammatory exudate in patients, requiring long-term treatment. To treat infective nonunion, radical debridement of infective bone and soft tissue should be performed, followed by stable internal fixation and bone graft. Multiple treatment strategies need to be considered according to the classification of chronic osteomyelitis, size of the bone defect, degree of bone malalignment, and severity of the soft tissue injury. This paper reports a case of a patient treated with an antibiotic cement-coated nail and a Masquelet technique to treat the infected nonunion of the tibia with a bone defect and varus deformity.

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

Abstract PDF

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

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

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Treatment of Atypical Ulnar Fracture Associated with Bisphosphonate Therapy - A Case Report -: Dong-Soo Kim, Ji-Kang Park, Eui-Sung Choi, Ho-Seung Jeong, Seok-Hyun Hong, Byung-Hyun Ahn; J Korean Fract Soc 2020;33(2):101-104. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.101

Abstract PDF: Bisphosphonates can cause atypical fractures when taken for a long time. Atypical fractures appear mainly as femoral subtrochanteric or shaft fractures. On the other hand, reports of atypical fractures in the proximal ulna are relatively rare, with a high proportion of nonunion cases. This paper reports a case of nonunion after fixation for atypical fractures of the proximal ulna.

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Brachial Plexus Neuropathy after Revision of Clavicular Fracture Nonunion: A Case Report: Youngwoo Kim, Suk Kyu Choo, Neunghan Jeon; J Korean Fract Soc 2020;33(1):22-26. Published online January 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.1.22

Abstract PDF

We performed a revisionary open reduction and internal fixation for treating nonunion of the mid-shaft of the left clavicle with an autogenous cancellous bone graft. On postoperative day 4, the patient presented with neurologic deficits in the left upper extremity. We removed the implant and made a superior angulation to decompress the brachial plexus. At 6 months postoperatively, callus bridging and consolidation were visible and all hand and elbow functions were fully recovered. Our case suggests that brachial plexus neuropathy may be caused by stretching and compression after reduction and straightening of the nonunion site around adhesions or scar tissue. Therefore, care should be taken whether there are the risk factors that can cause brachial plexus neuropathy when revision surgery is performed for treating nonunion of a clavicle shaft fracture.

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Arcuate osteoplasty for brachial plexus paralysis after plate fixation of mid-clavicle fracture: a case report and literature review
Dongju Shin, Jae Hwi Han
Clinics in Shoulder and Elbow.2025; 28(3): 394. CrossRef

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Outcomes following Treatment of Geriatric Distal Femur Fractures with Analyzing Risk Factors for the Nonunion: Soo young Jeong, Jae Ho Lee, Ki Chul Park; J Korean Fract Soc 2019;32(4):188-195. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.188; Correction in: J Musculoskelet Trauma 2020;33(1):62

Abstract PDF

PURPOSE
Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (ageâ‰¥60) and to determine the risk factors related witht he occurrence of nonunion.
MATERIALS AND METHODS
This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients' underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion.
RESULTS
The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045).
CONCLUSION
The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors.

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Comparison of Clinical Outcomes for Femoral Neck System and Cannulated Compression Screws in the Treatment of Femoral Neck Fracture
Jae Kwang Hwang, KiWon Lee, Dong-Kyo Seo, Joo-Yul Bae, Myeong-Geun Song, Hansuk Choi
Journal of the Korean Fracture Society.2023; 36(3): 77. CrossRef

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Progressive Brachial Plexus Palsy after Fixation of Clavicle Shaft Nonunion: A Case Report: Hong Ki Jin, Ki Bong Park, Hyung Lae Cho, Jung Il Kang, Wan Seok Lee; J Korean Fract Soc 2019;32(2):97-101. Published online April 30, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.2.97

Abstract PDF

The brachial plexus palsy is a rare complication of a clavicle fracture, occurring in 0.5% to 9.0% of cases. This condition is caused by excessive callus formation, which can be recovered by a spur resection and surgical fixation. In contrast, only seven cases have been reported after surgical reduction and fixation. A case of progressive brachial plexus palsy was observed after fixation of the displaced nonunion of a clavicle fracture. The symptom were improved after removing the implant.

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Arcuate osteoplasty for brachial plexus paralysis after plate fixation of mid-clavicle fracture: a case report and literature review
Dongju Shin, Jae Hwi Han
Clinics in Shoulder and Elbow.2025; 28(3): 394. CrossRef

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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; J Korean Fract Soc 2019;32(2):83-88. Published online April 30, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.2.83

Abstract PDF: PURPOSE
This study examined the outcomes of exchange nailing for the hypertrophic nonunion of femoral shaft fractures treated with intramedullary nailing as well as the factors affecting the treatment outcomes.
MATERIALS AND METHODS
From January 1999 to March 2015, 35 patients, who had undergone intramedullary nailing with a femoral shaft fracture and underwent exchange nailing due to hypertrophic nonunion, were reviewed. This study investigated the time of union and complications, such as nonunion after exchange nailing, and analyzed the factors affecting the results.
RESULTS
Bone union was achieved in 31 cases (88.6%) after exchange nailing and the average bone union period was 22 weeks (14â€“44 weeks). Complications included persistent nonunion in four cases, delayed union in one case, and superficial wound infection in one case. All four cases with nonunion were related to smoking, three of them were distal shaft fractures, and one was a midshaft fracture with underlying disease.
CONCLUSION
Exchange nailing produced satisfactory results as the treatment of hypertrophic nonunion after intramedullary nailing. Smoking is considered a factor for continuing nonunion even after exchange nailing. In the case of a distal shaft, where the intramedullary fixation is relatively weak, additional efforts are needed for stability.

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Treatment Options for the Nonunions with Critical Sized Bone Loss: Jin Kak Kim, Soo Hyun Kim, Jae Woo Cho, Jong Keon Oh; J Korean Fract Soc 2017;30(2):89-101. Published online April 30, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.2.89

Abstract PDF

The management of nonunion with severe bone loss is a challenging task to both surgeons and patients. It often requires prolonged and potentially painful treatments. Moreover, it also represents serious socioeconomic issues for patients. Inadequate fracture stability, disrupted biology, such as blood supply and soft tissue, as well as severe bone loss or presence of infection are possible reasons for nonunion. Several different treatment modalities are available, including nail dynamization, plate osteosynthesis, exchange nailing, and adjuvant alternatives, such as electrical or ultrasound stimulation. Autogenous bone graft remains the standard method to reconstruct small defects. Distraction osteogenesis and induced membrane techniques are contemporary strategies of choice for the reconstruction of larger bony defects. Herein, we attempt to describe the key techniques that may be employed in treating nonunion with severe bone loss.

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Individualized herbal prescriptions for delayed union: A case series
Jiyoon Won, Youngjin Choi, Lyang Sook Yoon, Jun-Hwan Lee, Keunsun Choi, Hyangsook Lee
EXPLORE.2023; 19(2): 260. CrossRef

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Treatment Strategy of Infected Nonunion: Hyoung Keun Oh; J Korean Fract Soc 2017;30(1):52-62. Published online January 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.1.52

Abstract PDF

The management of infected nonunion is based on a detailed evaluation of patients, the involved bone and soft tissues, stability of fixation, and type of bacterial pathogens. Preoperative surgical planning and strategies for each step is mandatory for the successful treatment of infected nonunion. The radical debridement of infected tissues, including the unstable implant, is one of the most important procedures. Adequate soft tissue coverage should be considered for the appropriate management of infection; a reconstructive procedure and stable skeletal stabilization by internal or external fixation is also necessary later. A restoration of bone defects and bony union can be accomplished with bone grafting, distraction osteogenesis, vascularized fibular grafting, and induced membrane technique.

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Systematic Diagnosis and Treatment Principles for Acute Fracture-Related Infections
Jeong-Seok Choi, Jun-Hyeok Kwon, Seong-Hyun Kang, Yun-Ki Ryu, Won-Seok Choi, Jong-Keon Oh, Jae-Woo Cho
Journal of the Korean Fracture Society.2023; 36(4): 148. CrossRef
The Antibiotic Cement Coated Nail and Masquelet Technique for the Treatment of Infected Nonunion of Tibia with Bone Defect and Varus Deformity: A Case Report
Min Gu Jang, Jae Hwang Song, Dae Yeung Kim, Woo Jin Shin
Journal of the Korean Fracture Society.2022; 35(1): 26. CrossRef

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Impaired Bone Healing Metabolic and Mechanical Causes: Sam Guk Park, Oog Jin Shon; J Korean Fract Soc 2017;30(1):40-51. Published online January 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.1.40

Abstract PDF

Non-union is one of the most devastating complications after fracture fixation. It usually results in prolonged treatment duration and unpredictable results. We reviewed the literature to identify recent information regarding the following: risk factors of nonunion; mechanical risk factors, including fracture gap width and stability, osteonecrosis and healing mechanism, osteoporotic fracture and fixation method, the characteristics of fracture, soft tissue injury, local infection, and multiple fractures; as well as the metabolic risk factors, including age, comorbidities, smoking, alcoholism, and medications. The technique and devices for fracture treatment have been developed, and treatments of nonunion are evolving according to the enhancement of our understanding of nonunion. Clinicians should refer to the risk factors and advancements while developing a treatment plan.

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Evaluating the Stability of Locking Screw on Locking Compression Plate According to Various Screw Insertion Angles
Jin Woong Yi, Jong Un Kim, A. Yoon Kim, Byung Hak Oh, Ju Yong Ahn, Ki Sik Tae
International Journal of Precision Engineering and Manufacturing.2022; 23(7): 789. CrossRef
Experimental Study ofDohongsamul-tang(Taohongsiwu-tang) on Fracture Healing
Hyun Ju Ha, Min-Seok Oh
Journal of Korean Medicine Rehabilitation.2020; 30(2): 47. CrossRef
Effect of Pahyeolsandong-tang (Poxiesanteng-tang) in Tibia Fracture-induced Mice
Woo-Suk Shin, Kira Parichuk, Yun-Yeop Cha
Journal of Korean Medicine Rehabilitation.2020; 30(4): 1. CrossRef
The Clinical Effects of Complex Korean Medicine Treatment in Patient with Delayed Union of the 4th Toe Distal Phalanx Fracture
Kyungtae Park, Hee-Ra Shin, Sung-Hu An, Seung-Ryong Yeom, Young-Dal Kwon
Journal of Korean Medicine Rehabilitation.2019; 29(4): 143. CrossRef
Outcomes following Treatment of Geriatric Distal Femur Fractures with Analyzing Risk Factors for the Nonunion
Soo-young Jeong, Jae-Ho Lee, Ki-Chul Park
Journal of the Korean Fracture Society.2019; 32(4): 188. CrossRef

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Scaphoid Fractures and Nonunion: Jin Rok Oh; J Korean Fract Soc 2016;29(1):79-92. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.79

Abstract PDF: Fracture of scaphoid is relatively common, and accurate and prompt diagnosis leads to bony union with good clinical outcome. However, it can be easily missed due to vague symptomatic complaints by patients, which in turn leads to negligence of a doctor in making the diagnosis or anatomical shape of scaphoid that causes minute fracture to be ignored while viewing simple radiography. When missed, nonunion of scaphoid gradually progresses to arthritic change in the wrist. Thus when fracture of the scaphoid is suspected, further evaluation should be initiated with care, and if the diagnosis is confirmed, a proper treatment plan must be set with assessment of stability of the fracture fragment. Internal fixation is usually proposed since solid fixation of the fracture provides early return to daily activity. When nonunion of the scaphoid is present, most patients can achieve bony union with avascular bone graft and internal fixation. However, if there is sclerotic change, large bone cyst or avascular necrosis of the fracture fragment, internal fixation with bone graft that includes vascular supply should be introduced in order to achieve bony union.

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Clinical Results of Excision of Hamate Hook in the Baseball Players with Hamate Hook Nonunion: Seoung Joon Lee, Jong Soo Lee; J Korean Fract Soc 2016;29(1):12-18. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.12

Abstract PDF

PURPOSE
The purpose of this study is to report the clinical results of excision of the hamate hook in baseball players with hamate hook nonunion.
MATERIALS AND METHODS
This study included 10 baseball players treated with excision of the hamate hook. Among 10 players, there were 3 professional players and 7 amateur players. The clinical outcomes were evaluated using the visual analog scale (VAS) pain score, exercise performance score, and grip power. We also checked complications and time to return to the game.
RESULTS
At final follow-up, the average VAS score was 0.4 points and the average performance score was 9.0 points. The grip power was recovered to 96.7% of the opposite hand at final follow-up. Significant improvement in pain and grip power was observed after surgery. The average time to return to the game was 11.8 weeks. There was one case of postoperative ulnar nerve neuropathy, which was completely resolved within 12 weeks after surgery.
CONCLUSION
We think that excision of the hamate hook is an effective treatment to enable early return to the game without loss of grip strength in the baseball player with nonunion of the hamate hook.

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Isolated hook of hamate fracture in sports that require a strong grip comprehensive literature review
Heejae Kim, Bumsun Kwon, Jihyun Kim, Kiyeun Nam
Medicine.2018; 97(46): e13275. CrossRef

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Surgical Treatment of Malunion and Nonunion after Pelvic Bone Fracture: Byung Woo Min, Kyung Jae Lee; J Korean Fract Soc 2015;28(4):266-272. Published online October 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.4.266

Abstract PDF: Regardless of the efforts of several treatments after pelvic bone fracture, as many as 5% of all pelvic fractures result in malunion or nonunion of the pelvis. These complications can cause disabling symptoms, including pain, instability, and gait disturbance, which can decrease life quality of patients and increase socioeconomic problems. Therefore concerns regarding the treatment of malunion and nonunion after pelvic bone fracture are increasing. We report our experience and surgical management for pelvic malunion and nonunion.

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Infected Nonunion of Clavicle Shaft after Operation: A Case Report: Ho Su Jang, Suk Hwan Jang; J Korean Fract Soc 2015;28(1):77-81. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.77

Abstract PDF: The infected nonunion of clavicle with bone defect is an uncommon complication following clavicle shaft fracture. There were a few reports regarding treatment of the infected nonunion after clavicle fracture. We report on a case of infected clavicle nonunion successfully treated with autologous bone graft and dual plate fixation.

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Olecranon Nonunion after Operative Treatment of Fracture: Ho Jung Kang, Ji Sup Kim, Myung Ho Shin, Il Hyun Koh, Yun Rak Choi; J Korean Fract Soc 2015;28(1):30-37. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.30

Abstract PDF: PURPOSE
Olecranon nonunion after surgical management is relatively rare, but it leads to limitation of motion of joint or instability. This retrospective study was conducted in order to analyze the cause and result of treatment.
MATERIALS AND METHODS
We analyzed 11 cases treated for nonunion of olecranon fractures. Nonunion was classified according to the spot of the lesion and the extent of articular surface damage. Evaluation was performed using Mayo elbow performance score (MEPS), Oxford elbow score (OES), Disabilities of the Arm, Shoulder and Hand (DASH) scores, and the range of motion.
RESULTS
According to the spot of the lesion and the extent of articular surface damage, nonunion was categorized as IA (2 cases), IIA (5 cases), and IIIA (4 cases). One case of IA underwent nonunion fragment excision and the remaining cases were treated by bone grafting. A plate was used in seven cases and the other three cases had both plate and tension band wiring fixation. All nonunions finally became union. The 11 patients with one year follow-up had average MEPS of 87.7 points (range: 60-100 points), average OES of 43.2, and average DASH score of 18.8 points. Complications included limitation of motion (2 cases) and ulnar nerve symptoms (3 cases).
CONCLUSION
Bone grafting and fixation by plate may be beneficial. In addition, excision can be useful in type I.

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The Efficacy of Preserved Posterior Cortex in the Treatment of Infected Nonunion of the Tibia: Hyoung Min Kim, Il Jung Park, Youn Tae Roh, Byung Min Kang, Hyun Jin Lee, Jae Young Lee; J Korean Fract Soc 2014;27(4):301-307. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.301

Abstract PDF: PURPOSE
We studied the efficacy of preserved posterior cortex connecting to adjacent muscle or periosteum during wide debridement in the treatment of infected nonunion of the tibia.
MATERIALS AND METHODS
From January 2001 to May 2011, 12 cases of infected nonunion of the tibia with segmental defect larger than 4 cm after wide debridement were selected. The selected cases were categorized according to two groups; group 1 with preserved posterior cortex in the segmental defect site - six cases, group 2 without posterior cortex - six cases. The results were compared by assessing the size of bone defect, the interval between wide debridement and bone reconstruction, bony union time, complications, and clinical results.
RESULTS
The mean length of bone defect of group 1 was 7.6 cm (range 4.3-11.0 cm) and that of group 2 was 6.4 cm (range 4.0-12.0 cm). The interval between wide debridement and bone reconstruction was 10.0 weeks (range 5-18 weeks) for group 1, and 12.1 weeks (range 0-24 weeks) for group 2. The time for bony union of group 1 was 6.2 months (range 5-7 months), and that of group 2 was 10.8 months (range 7-18 months). In group 2, there were two cases of fatigue fracture and two cases of docking site nonunion after distraction osteogenesis.
CONCLUSION
The preserved posterior cortex after wide debridement of infected nonunion of the tibia helps bony union and reduces the treatment period.

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Augmentative Locking Plate Fixation for the Treatment of Femoral Nonunion after Intramedullary Nailing: Ki Chul Park, Chul Woong Kim, Kyu Tae Hwang, Ye Soo Park; J Korean Fract Soc 2013;26(4):268-274. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.268

Abstract PDF: PURPOSE
To evaluate the efficacy of the augmentative locking compression plate fixation in the treatment of femoral shaft nonunion occurring after intramedullary nailing.
MATERIALS AND METHODS
Between July 2004 and September 2012, a total of 17 patients (twelve men, five women, average age 52.5 years) who had femoral nonunions after primary intramedullary nailing for femoral shaft fractures were reviewed. The mean period of nonunion after primary nailing was 18.5 months. Leaving the nail in situ, an augmentative locking plate was applied to the nonunion site with simultaneous autogenous bone grafting, except for five hypertrophic nonunions. We followed up all patients with plain radiograph and evaluated clinical status to determine bone union.
RESULTS
All patients demonstrated evidence of fracture union with an average follow-up time of 5.0 (range 2 to 9) months. The time of operation was an average of 115 (range 45 to 160) minutes, and mean blood loss was 345.9 (range 150 to 700) ml. Two patients noted discomfort at the distal portion of plate, and one noted discomfort of donor site, but functional limitation was not observed in all patients.
CONCLUSION
Augmentative locking plate fixation for diaphyseal femoral nonunion after intramedullary nailing is a reasonable treatment option with increased stability.

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Extensive Metallosis Caused by Plate and Screw Construct for Distal Fibular Fracture - A Case Report -: Ki Tae Park, Kwang Bok Lee; J Korean Fract Soc 2013;26(2):147-150. Published online April 30, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.2.147

Abstract PDF

Metallosis has been reported in the setting of weight-bearing joint arthroplasties, like the hip and knee joints. However, the prevalence of metallosis in non-articular portions is very uncommon. We report a rare case of a patient who had metallosis secondary by fibular nonunion after fixation with plate and screw. In addition, we discuss the clinical and the operative findings, as well as the outcome of this uncommon complication.

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Plate on Plate Osteosynthesis for the Treatment of Nonhealed Periplate Fractures
Georgios Arealis, Vassilios S. Nikolaou, Andrew Lacon, Neil Ashwood, Mark Hamlet
ISRN Orthopedics.2014; 2014: 1. CrossRef

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Costoclavicular Syndrome Secondary to Nonunion of a Displaced Fracture of the Clavicle, Misdiagnosed as a Simple Muscle Strain: A Case Report: Ho Seung Jeon, Haeng Kee Noh, Seo Goo Kang, Jong Min Kim, Seung Ju Jeon; J Korean Fract Soc 2013;26(1):60-64. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.60

Abstract PDF: Thoracic outlet syndrome is a relatively common disease. However, costoclavicular syndrome as a condition secondary to nonunion of a displaced fracture of the clavicle is very rare. Most clavicular fractures in adults are united with no or minimal persistent symptoms. Also, symptomatic nonunion of a displaced fracture of the clavicle is rare. A 55-year-old male initially presented with persistent forearm pain after slip-down was initially diagnosed with simple muscle strain. However, he was given a delayed diagnosis of costoclavicular syndrome, caused by compression of the subclavian artery due to trauma in the fibrotic nonunion of the right clavicle without apparent symptoms. We obtained satisfactory results by surgical treatment. Here we report this case with a review of the literature.

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

Abstract PDF

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

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Surgical Management of Osteoporotic Fractures: Humerus Shaft Fractures
Shankar Ramaprasad Kurpad
Indian Journal of Orthopaedics.2025; 59(8): 1053. CrossRef

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Treatment of Non-union Distal Humerus Fractures after Operation: Hyung Sik Kim, Ki Joon Jang, Yun Rak Choi, Il Hyun Koh, Ho Jung Kang; J Korean Fract Soc 2012;25(4):310-316. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.310

Abstract PDF

PURPOSE
This study is a retrospective analysis of patients who had undergone surgical treatment for non-union of distal humerus fracture. We evaluated them in terms of causes of injury, radiologic findings, and clinical outcomes such as prognosis.
MATERIALS AND METHODS
Seven consecutive radiologic patients who were confirmed to have nonunion of a distal humerus fracture underwent reoperations. These patients had already undergone operations for distal humerus fractures. This survey was held from 2005 to 2010. The average period up to diagnosis of non-union after the first operation was 7.4 months (4 to 16 months). The mean follow-up period was 24.6 months (12 to 65 months). Each patient was graded functionally according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand Score.
RESULTS
Osteosynthesis was performed by internal fixation with plates and screws and then a bone graft for non-union of the distal humerus fracture. The average range of motion within the elbow joints was found to be a flexion contracture of 18.8 degrees (0~30 degrees) and further flexion of 120.2 degrees (102~140 degrees). Among postoperative complications, three cases of medium-degree stiffness, two cases of medial column nonunion, and one case of dissociation of the internal fixator were reported.
CONCLUSION
Stable internal fixation for maintenance reduction status is essential after accurate initial anatomical reduction. We concluded that nonunion could be prevented by additional surgical treatment such as autogenous bone graft, if it is necessary.

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Autogenous Inlay Bone Graft for Distal Humerus Nonunion with Metaphyseal Bone Defect: A Technical Note
Yong-Suk Lee, Dongmin Kim, Min-Sung Kang, Jong-Hwa Park, Sang-Uk Lee
Archives of Hand and Microsurgery.2020; 25(1): 39. CrossRef

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Analysis of the Factors Involved in Failed Fixation in Elderly Intertrochanteric Femoral Fracture: Joon Soon Kang, Ryuh Sup Kim, Bom Soo Kim, Young Tae Kim, Seung Hyun Hong; J Korean Fract Soc 2012;25(4):263-268. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.263

Abstract PDF: PURPOSE
To analyze the causes of internal fixation failure in elderly intertrochanteric femoral fractures.
MATERIALS AND METHODS
We retrospectively analyzed 93 intertrochanteric femoral fractures that were treated by internal fixation. The follow-up period was at least 24 months. The mean age was 73 years. We analyzed the classification of the fracture, screw position, reduction state of the fracture, and neck-shaft angle.
RESULTS
Internal fixation failure occurred in 12 cases (12.9%). The causes of internal fixation failure were one case (1.0%) of head perforation, 7 cases (7.5%) of excessive slippage of a screw, and 4 cases (4.3%) of varus deformity. Significant factors infixation failure were displacement of the posterolateral fragment more than 8 mm in anteroposterior radiograph, anterior displacement of a fragment, or more than 20-degree angulation in lateral radiography. Thirty-three cases had a screw in the middle position and 4 of these cases (12.1%) had fixation failure. Notably, 14 cases had a screw in the posteromedial position and 6 of these cases had fixation failure (42.8%).
CONCLUSION
Accurate reduction of the posteromedial fragment is essential in unstable intertrochanteric fracture and anterior displacement or angulation should be avoided to prevent fixation failure. The tip apex distance of the screw and central location of the screw in the femoral head is also an important factor.

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Treatment of Nonunion of Tibia with Extracorporeal Shock Wave Therapy: A Case Report: Seung Yong Sung, Han Kook Yoon, Jeung Yeul Jung; J Korean Fract Soc 2011;24(4):367-370. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.367

Abstract PDF: Almost tibia fractures can be surgically treated, but nonunion may occur in 10~30%, and they may accompany various complications by operation. This research was designed to review literatures and report a case of patient with nonunion of the tibia that showed good result when performing the extracorporeal shock wave therapy as a conservative treatment.

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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; J Korean Fract Soc 2011;24(4):313-320. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.313

Abstract PDF

PURPOSE
To evaluate the union time and nonunion rate after intramedullary nailing of femoral shaft fracture in adult, we would like to analysis the operation techniques, comminution, contact surface and displacement.
MATERIALS AND METHODS
We reviewed retrospectively 53 patients undergoing femoral intramedullary nailing at least 2 years postoperatively and analysised the union time and nonunion rate by operation techniques, comminution, contact surface and displacement. Patients were operated by either antegrade or retrograde intramedullary nailing.
RESULTS
There were no differences in nonunion rate, the duration of bony union between antegrade and retrograde intramedullary nail groups. Significant differences were found in the duration of bony union between the Winquist and Hansen type I, II and the type III, IV (p<0.05). There were significant differences in the duration of bony union among simple, comminuted, and segmental fracture groups (p<0.05).
CONCLUSION
The union time is affected by not operation techniques and fracture displacement, but Winquist-Hansen classification and number of fracture fragments in intramedullary nailing of adult femoral shaft fracture.

Citations

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Extra-capsular proximal femoral fractures: a cohort comparison of union and complication rates after ballistic versus blunt trauma
Jordan Cook Serotte, Kevin Chen, Julia Nascimben, Jason Strelzow
European Journal of Orthopaedic Surgery & Traumatology.2025;[Epub] CrossRef
Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices
Jung-Yoon Choi, Yerl-Bo Sung, Jin-Hee Yoo, Sung-Jae Chung
Hip & Pelvis.2014; 26(2): 107. CrossRef
Augmentative Locking Plate Fixation for the Treatment of Femoral Nonunion after Intramedullary Nailing
Ki-Chul Park, Chul-Woong Kim, Kyu-Tae Hwang, Ye-Soo Park
Journal of the Korean Fracture Society.2013; 26(4): 268. CrossRef

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Autogenous Iliac Bone Grafting for the Treatment of Nonunion in the Hand Fracture: Joo Yong Kim, Young Keun Lee, Ki Chan An, Tae Woo Sung; J Korean Fract Soc 2011;24(2):163-168. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.163

Abstract PDF: PURPOSE
To evaluate autogenous iliac bone graft for nonunion after hand fracture.
MATERIALS AND METHODS
From October 2006 through September 2008, we analyzed 35 patients, 37 cases of autogenous iliac bone graft for nonunion after hand fracture that have followed up for more than 12 months. We analyzed about etiology, fracture site, initial treatment, time to bone graft, grafted bone size, grafted bone fixation method, radiologic time of bony healing and bone union rate retrospectively. Also we evaluated VAS and range of motion of each joints (MCP, PIP, DIP) at final follow-up assessment.
RESULTS
Etiology was open fracture 23 cases (62.2%), crushing injury 12 cases (32.4%), direct trauma 2 cases (5.4%). Fracture site was metacarpal bone 7 cases, proximal phalanx 17 cases, middle phalanx 8 cases, distal phalanx 5 cases. Time to bone graft was average 20.7 weeks. Grafted bone fixation method was fixation with K-wire 27 cases (73.0%), fixation with only plate 6 cases (16.2%), fixation with K-wire plus plate 2 cases (5.4%), fixation with K-wire plus cerclage wiring 2 cases (5.4%). Grafted bone size was average 0.93 cm3 and bony union time was average 11.1 weeks and we had bone union in all cases.
CONCLUSION
Autogenous iliac bone graft is the useful method in the reconstruction of non-union as complication after hand fracture.

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Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft: Eun Sun Moon, Myung Sun Kim, Il Kyu Kong, Min Sun Choi; J Korean Fract Soc 2010;23(1):69-75. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.69

Abstract PDF: PURPOSE
To evaluate the results of Acutrak-screw fixation without bone-graft for the treatment of stable scaphoid nonunion and to assess its prognostic factors.
MATERIALS AND METHODS
Fifteen patients who underwent internal fixation using Acutrak-screw without bone graft for stable scaphoid nonunion were studied. Standard radiographs and CT were analyzed for degenerative changes (presence of cystic change and periscaphoid osteoarthritis), the nonunion site using fragment ratio and union. Clinically, patients age and the interval to surgery were evaluated.
RESULTS
Mean follow-up duration was 31 months and 11 of 15 (73.3 percentages) cases healed at mean time of 12.8 weeks. Fragment ratio of nonunion site was 37.2 percentages in nonunion group and 54.2 percentages in union group (p=0.016). Presence of cystic change and periscaphoid osteoarthritis showed no singnificant statistical difference in both groups. Younger age lower than 20 years was closely related with bone union (p=0.001). But there were little correlation between bone union and interval to surgery.
CONCLUSION
Internal fixation without bone graft showed 73.3 percentages of overall union rate in the treatment of stable scaphoid nonunion. And young patients who have distally located stable scaphoid nonunion can be successfully treated with internal fixation without bone graft.

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Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect: Soo Kyung Lee, Jung Ryul Kim, Jong Han Lim, Jun Mo Lee; J Korean Fract Soc 2010;23(1):57-63. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.57

Abstract PDF: PURPOSE
To study clinical results and complications in the treatment of infected nonunion of the tibia according to location of nonunion and reconstruction for soft tissue defect.
MATERIALS AND METHODS
36 cases of tibia infected nonunion which were treated with the llizarov included in this study. There were proximal 1/3 in 14, middle 1/3 in 10, and distal 1/3 in 11 cases. Coverage of the soft tissue were treated with the free flap in 8 cases as classified group A and non-free flap in 17 cases classified group B. We evaluated the healing index, complications and comparing the results of each treatment by the Paley method.
RESULTS
Bone union was achieved in all cases. The proximal nonunion showed better results than those in the middle and distal area; average healing index: 35.6 days/cm (p=0.038), bone results: 92.9% (p=0.025), functional result: 90.5% (p=0.03). Group B showed significantly better results as it showed average healing index: 30.3 days/cm (p=0.015), bone results: 85.7% (p=0.025), functional results: 90.5% (p=0.015).
CONCLUSION
The nonunion of proximal 1/3 showed better results than other sites. Soft tissue reconstruction with free flap that control infection more effectively, could be improved the treatment outcomes.

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Cause and Treatment of Extraarticular Proximal Tibial Nonunion: Sung Soo Kim, Sung Keun Shon, Kyu Yeol Lee, Chul Hong Kim, Myung Jin Lee, Min Soo Kang, Lih Wang, Im Sic Ha; J Korean Fract Soc 2008;21(4):279-285. Published online October 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.4.279

Abstract PDF: PURPOSE
To analyze the factors affecting the nonunion of extraarticular proximal tibial fracture and the outcome of nonunion treatment.
MATERIALS AND METHODS
We investigated 51 cases of extraarticular proximal tibial fractures from June 2002 to May 2006. The nonunion rate was assessed in relation to several risk factors and the treatment outcome of nonunion using plate fixation with bone graft was assessed by Klemm and BOrner functional rating system.
RESULTS
6 cases of nonunion (11.8%) was noted among 51 cases, and the risk factors examined, OTA A3 comminuted fracture was associated with a high nonunion rate with statistical significance and initial bone graft had a significant effect in bone healing. Excellent and good results were obtained in 5 cases (83.3%) and bone union was achieved in all nonunion cases.
CONCLUSION
Comminution was found to be an important factor affecting the nonunion in extraarticular proximal tibial fracture, and bone graft in primary operation could reduce the chance of nonunion. Accurate plate fixation with bone graft is a reliable option in nonunion treatment.

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In Situ Late Metaphyseal Osteosynthesis for the Fractures of the Lateral Humeral Condyle in Children: Kun Bo Park, Seung Whan Lee, Hyun Woo Kim, Hui Wan Park, Ki Seok Lee; J Korean Fract Soc 2008;21(2):151-156. Published online April 30, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.2.151

Abstract PDF: PURPOSE
To evaluate the efficacy of the in situ late osteosynthesis for slightly displaced fractures of the lateral humeral condyle.
MATERIALS AND METHODS
From 2000 to 2004, 12 patients (8 boys and 4 girls) were managed with in situ late osteosynthesis for fractures of the lateral humeral condyle. The average age at the time of operation was 6 years 1 month (1 year 7 months~9 years 1 month), and the mean amount of fragment displacement was 3.3 mm (2.0~4.5 mm). The operative procedure included curettage and in situ fixation of the fragment RESULTS: Bony union was achieved in all cases after avg. 48 months (33~73 months) follow-up assessment. According to the score system of Dhillon et al, 7 patients had excellent, 3 had good, 2 had fair results. None of the patients developed avascular necrosis or premature closure of the epiphysis.
CONCLUSION
We suggest that in situ fixation is an effective method for the late treatment of slightly displaced fracture of the lateral humeral condyle.

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The Results of Surgical Treatment for Nonunion of Phalanges in the Hand: Hee Dong Kim, Yoon Hong Kim, Yong Soo Choi, Heun Guyn Jung; J Korean Fract Soc 2008;21(2):140-144. Published online April 30, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.2.140

Abstract PDF: PURPOSE
To evaluate the results of internal fixation and autogenous bone graft for the phalangeal nonunion in the hand.
MATERIALS AND METHODS
From Feb. 2000 until May 2006, thirteen cases that had been treated for non-union of phalanges in the hand were investigated retrospectively. Seven cases were treated with mini-plate fixation and autogenous cancellous graft and six cases with Kirschner wire fixation and autogenous cancellous graft. We analyzed bony union period radiographically and clinical results according to Belsky's score.
RESULTS
Thirteen cases obtained bony union. Seven cases of mini-plate fixation and bone graft, and six cases of K-wire fixation and bone graft achieved the bony union postoperatively on average 7.9 weeks and 6.3 weeks, respectively. Clinical results were "good" in four cases and "poor" in nine cases according to the Belsky's score. Only one of ten cases with associated injuries, such as tendon, nerve, arterial injuries and other finger fractures in the injured hand, had the good clinical result, but all three cases without associated injuries had the good one.
CONCLUSION
Internal fixation and autogenous bone graft can be a successful treatment of phalangeal nonunion. However, more careful choice of surgical treatment methods and preoperative explanation of poor post-operative results or complications should be made for phalangeal nonunion with associated injuries in the finger because of poor outcome in those cases.

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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; J Korean Fract Soc 2008;21(2):117-123. Published online April 30, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.2.117

Abstract PDF

PURPOSE
The purpose of this study was to evaluate the efficacy of the surgical treatment through the comparison of LC-DCP (Limited Contact-Dynamic Compression Plate) versus LCP (Locking Compression Plate) fixation in the plate augmentation for the nonunion of femur shaft fractures after intramedullary nail fixation.
MATERIALS AND METHODS
Twenty-four patients with the nonunion of femur shaft fractures after intramedullary nail fixation who underwent plate augmentation were evaluated from Mar. 2001 to Sept. 2005. The group with LC-DCP augmentation was done bicortical screw fixation and the group with LCP was done monocortical fixation.
RESULTS
There was one case of nail breakage in LC-DCP group, but sound bony union were achieved uneventfully in all the cases of both group. LCP fixation was slightly superior to LC-DCP fixation in view of the bony union time, operating time, postoperative Hb down, amount of postoperative transfusion, but there was no statistical difference (p>0.05). CONCLUSION: We got the satisfactory results after monocortical LCP augmentation as well as bicortical LC-DCP fixation and have concluded that monocortical LCP fixation was an effective treatment option for nonunion of femur shaft fracture occurred after Intrmedullary nail fixation.

Citations

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Delayed Union and Nonunion: Current Concepts, Prevention, and Correction: A Review
Kristin M. Bowers, David E. Anderson
Bioengineering.2024; 11(6): 525. CrossRef
RETRACTED ARTICLE: An experimental study on stress-shielding effects of locked compression plates in fixing intact dog femur
Xinwen Zhao, Wensen Jing, Zhe Yun, Xun Tong, Zhao Li, Jiajia Yu, Yaohui Zhang, Yabin Zhang, Zhixue Wang, Yanhua Wen, Heping Cai, Jun Wang, Baoan Ma, Haien Zhao
Journal of Orthopaedic Surgery and Research.2021;[Epub] CrossRef
The Treatment of IM Nailing of Femoral Shaft Fracture: Piriformis Fossa versus Trochanteric Entry Portal
Hyun Kook Youn, Oog Jin Shon, Dong Sung Han
Journal of the Korean Fracture Society.2008; 21(3): 200. CrossRef

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Nonunion with a Bony Defect of the Humerus: Treatment by Shortening: Jae Sung Lee, Soo Yong Kang, Jae Hyun Yoo; J Korean Fract Soc 2008;21(1):45-50. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.45

Abstract PDF: PURPOSE
To evaluate clinical results and advantage of interposition and shortening technique for the treatment of the humeral nonunion with bone defect.
MATERIALS AND METHODS
Eight patients with the humeral nonunion with bone defect underwent interposition of fragments and shortening had been followed-up for more than one year (mean 70 months, 16~156). There were 4 men and 4 women with a mean age of 60.5 years (range, 48 to 75 years). There included 3 proximal, 3 diaphysis and 2 distal metaphysis according to the site, mean size of the bone defect was 3.3 cm (2~5). The time to union, discrepancy of upper extremity, functional results, cosmetic satisfaction and postoperative complications were assessed.
RESULTS
All patients achieved to bone union, average union time was 10.2 weeks (range 8~14). Average limb discrepancy was 2.3 cm. All had improvement in shoulder and elbow motion after operation. Seven patients were satisfied with the cosmetic result and none had functional deficit due to limb discrepancy.
CONCLUSION
Treatment by Interposition of fragments and shortening in the intractable nonunion of humerus with a bony defect can achieve not only good functional result, shortened bone union time and improved in shoulder and elbow motion.

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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

Abstract 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.

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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
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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Testicular Necrosis after Ilioinguinal Approach for Pelvic Nonunion: A Case Report: Sang Eun Park, Young Yul Kim, Jong Hun Ji, Chang Whan Han, Weon Yoo Kim; J Korean Fract Soc 2006;19(4):490-493. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.490

Abstract

Pelvic nonunion is very difficult to treat. According to the nonunion site, anterior or posterior surgical approach should be used selectively. And if the nonunion site is located in both anterior and posterior, both anterior and posterior surgical approach should be used. We report a case of testicular necrosis after ilioinguinal approach used as a anterior approach to pelvis to treat pelvic nonunion developed as a result of unstable pelvic ring injury.

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Anatomical Study of Symphysis Pubis Using 3 Dimensional Computed Tomography in Koreans
Ji Wan Kim, Jung Min Park, Jae Suk Chang
Journal of the Korean Fracture Society.2013; 26(1): 32. CrossRef

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Free Vascularized Fibular Grafts for Treatment of Infected Nonunion of the Tibia: Hyoung Min Kim, Il Jung Park, Youn Soo Kim, Kee Haeng Lee, Chan Woong Moon, In Ho Jeong, Changhoon Jeong; J Korean Fract Soc 2006;19(2):163-169. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.163

Abstract

PURPOSE
To analyze the result of free vascularized fibular grafting for treatment of infected nonunion of the tibia with radical bone and soft tissue defect.
MATERIALS AND METHODS
17 patients with infected nonunion of the tibia who underwent a reconstruction using free vascularized fibular grafting were reviewed retrospectively. The mean follow-up period was 70.3 months. We analyzed the results radiographically which included the time of bone union, the amount of hypertrophy of grafted bone and complications.
RESULTS
The average length of bone defect was 8.8 cm (5~15 cm), and the average length of fibular graft was 14.1 cm (10~17.5 cm). Bony union was achieved in 11 of 17 cases and the average time of bone union was 5.2 months (4~6 months). There were 6 cases of nonunion. All nonunions developed at the proximal end of graft in patients who underwent fixation using pin and external fixator. Union was eventually achieved in all cases in 6.0 months (5~8 months) after the cancellous bone graft and plate internal fixation. Hypertrophy of grafted bones with more than 20% developed only in 4 cases out of 17. There were 3 cases of stress fracture, however there was no recurrence of infection or serious donor site morbidity.
CONCLUSION
Free vascularized fibula grafting is one of the most effective reconstruction options for the infected nonunion of the tibia with radical bone and soft tissue defect. Strong internal fixation using plate and screws is required to reduce the rate of nonunion and stress fracture of grafted fibulas.

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Treatment Strategy of Infected Nonunion
Hyoung-Keun Oh
Journal of the Korean Fracture Society.2017; 30(1): 52. CrossRef

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The Treatment of Infected Non-union of Long Bones with Plate and Screws: Han Suk Ko, Yeong Hun Kang, Deok Weon Kim, Jeong Ku Ha; J Korean Fract Soc 2006;19(1):72-77. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.72

Abstract

PURPOSE
To evaluate the usefulness of internal fixation with plate in treating infected nonunion of long bone.
MATERIALS AND METHODS
From March 1993 to February 2004, ten patients who underwent internal fixation with plate and cancellous bone graft on account of infected nonunion of long bone were retrospectively examined. The medical treatment were composed of thorough and adequate debridement of necrotic tissue, irrigation and plate fixation. Two patients were operated on with bridging plate method. Autologous cancellous bone graft was performed in 6 patients. In 2 cases, it was performed 4 weeks after internal fixation.
RESULTS
In 9 patients, radiographic union appeared on the average of 6.8months and infections were cured before union occurred.
CONCLUSION
Internal fixation with plate is a useful method for the solid fixation in the treatment of infected nonunion. The general concern was that the inserted hardware worsened the infection, which was overcomed with the operative techniques as bridging plate, debridement and cancellous bone graft.

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Treatment Strategy of Infected Nonunion
Hyoung-Keun Oh
Journal of the Korean Fracture Society.2017; 30(1): 52. CrossRef

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The Operative Treatment of Mid-Shaft Clavicular Nonunions: Intramedullary Fixation with Threaded Steinmann Pin and Bone Grafting: Jeong Ro Yoon, Hak Jun Kim, Taik Seon Kim, Haeng Kee Noh; J Korean Fract Soc 2005;18(4):415-420. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.415

Abstract PDF: PURPOSE
To evaluate the clinical and radiological results of the treatment of mid-shaft clavicular nonunions using intramedullary fixation with threaded Steinmann pin and bone grafting. MATERIAL AND METHODS: In 16 patients treated with intramedullary fixation of threaded Steinmann pin and autogenous iliac bone grafting for the mid-shaft clavicular nonunions, 10 patients with follow-up over 1 year were investigated. All patients (10 clavicle fractures) underwent conservative treatment initially. The average age of patients was 56 years old (range, 18~70 years old). Eight cases were atrophic nonunions, two hypertrophic. A clinical assessment was evaluated postoperatively after 5 months according to the evaluation method of Kona et al.
RESULTS
According to the evaluation method of Kona et al, four cases achieved excellent results, five cases good, and one case achieved a fair result. The average period until bony union was 9 weeks (range, 7~12.5 weeks) without infection, pin migration or breakage. One case showed skin irritation by lateral margin of Steinmann pin, which was subsided by pin removal after bony union.
CONCLUSION
We obtained satisfactory results and have concluded that intramedullary fixation with threaded Steinmann pin and bone grafting could appropriately treat nonunions of the mid-clavicular fracture occurred after conservative treatment, because it minimizes soft tissue injury, gets relatively stable fixation and early ROM, predicts early bone union, facilitates pin removal under local anesthesia.

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Radical Necrotic Bone Resection and Ilizarov Technique for Infected Nonunion of the Tibia: Keun Bae Lee, Byung Soo Kim, Sung Taek Jung, Eun Kyoo Song, Kyung Do Kang; J Korean Fract Soc 2005;18(4):405-409. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.405

Abstract PDF: PURPOSE
To evaluate the clinical results of radical necrotic bone resection and distraction osteogenesis for the treatment of infected nonunion of tibia using the Ilizarov technique.
MATERIALS AND METHODS
32 patients who were followed up at least 1 year after the treatment of infected nonunion of tibia from March 1995 to March 2001 were evaluated. Their mean age was 43 years and mean duration of follow-up was 37 months. The results were divided into bone results and functional results and analyzed by grading to excellent, good, fair, and poor.
RESULTS
The average amount of bone lengthening was 5.3 cm (range, 2~10 cm) and the average healing index was 61.5 days/cm (range, 52.7~70.4 days/cm). Bony union was obtained at average 10.3 months in all cases. The bone result was excellent in 9 cases, good 18, and fair 5. The functional result was excellent in 8 cases, good 16, fair 7, and poor 1 case.
CONCLUSION
Ilizarov technique is an effective method in the treatment of infected nonunion of tibia for early range of motion exercise, weight bearing and correction of limb shortening.

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Treatment of Scaphoid Nonunions with Autogenous Cancellous Bone Grafting Combined with Threaded K-wire Fixation: Yong Ho Kang, Hyung Gyu Kim, Seung Ju Jeon, Nam Heun Kim; J Korean Fract Soc 2005;18(3):317-324. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.317

Abstract PDF: PURPOSE
To evaluate the results of surgical treatment of autogenous cancellous bone grafting combined with threaded K-wire fixation for scaphoid nonunions.
MATERIALS AND METHODS
We retrospectively reviewed the 13 patients with scaphoid nonunion, which was follow up at least 12 months from March 1999 to June 2003. According to the Mayo classification, two cases were type P (proximal third), eight cases were type W (waist) and three cases were type D (distal third). According to the Russe classification, eight cases showed horizontal oblique type, another two cases were transverse, and last three belonged to vertical oblique type. We assessed the radiologic bony union, correction of humpback deformity and lateral intrascaphoid angle and degenerative change of radioscaphoid joint, clinical results were evaluated using assessment of Maudsley.
RESULTS
Radiologic union was obtained in all cases, mean time of union was 15.4 weeks (13~17.4 weeks), and there was no radiological evidence of postoperative humpback deformity, intercarpal instability, proximal osteonecrosis and degenerative changes. According to assessment of Maudsley, there were 7 excellent cases, 4 good cases, 1 fair case and 1 poor case among these 13 cases. The final clinical results were 11 excellent cases, 2 good case in the aspect of wrist pain and tenderness. All range of motion was satisfactory to patients except 4 cases (3 fair, 1 poor) and every patients could return to work except 1 poor case.
CONCLUSION
The surgical treatment using a autogenous cancellous bone grafting combined with threaded K-wire fixation for scaphoid nonunion was a relatively straightforward technique, which provides simplicity, and high union rate.

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Nonunion of the Humerus Shaft: Tae Seok Nam, Ji Won Choi, Ju Hyun Kim, Soung Yon Kim, Jung Jae Kim, Jae Myeung Chun; J Korean Fract Soc 2005;18(3):294-298. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.294

Abstract PDF

PURPOSE
To evaluate the cause and treatment results of nonunion of humerus shaft fractures.
MATERIALS AND METHODS
39 cases were treated for humerus shaft nonunion between February 1990 and May 2002. The presence of open wounds, initial treatment modality after injury, treatment method for the nonunion and time to union were studied using medical records. The fracture type and appropriateness and problems of the initial surgical treatment were reviewed. Also, Pain and functional recovery in daily living were evaluated in the outpatient clinic, after surgery for nonunion.
RESULTS
Amongst the 30 cases, transverse fracture was the most common with 19cases. Most of 29 cases, initially surgically treated, revealed incorrect selection of the internal fixator or technical errors. For surgical treatment of nonunion, open reduction and internal fixation with cancellous bone graft was performed, most commonly, in 36 cases (92.3%). All cases showed clinical and radiographic union at an average of 13.3 weeks. More than 90% of the patients replied minimal pain and excellent functional recovery of daily living at final follow-up.
CONCLUSION
If treated with surgery by correct selection of internal fixation methods and accurate technical skills, nonunion incidence can be reduced.

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Comparing the Use of Single and Double Interlocking Distal Screws on a Polarus Intramedullary Nail for Humeral Shaft Fractures
Hee Seok Yang, Jeong Woo Kim, Hong Je Kang, Jung Hyun Park, Yong Chan Lee, Kwang Mee Kim
Clinics in Shoulder and Elbow.2015; 18(2): 91. 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
The Fate of Butterfly Fragments in Extremity Shaft Comminuted Fractures Treated with Closed Interlocking Intramedullary Nailing
Ki-Chan An, Yoon-Jun Kim, Jang-Suk Choi, Seung Suk Seo, Hi-Chul Gwak, Dae-Won Jung, Dong-Woo Jeong
Journal of the Korean Fracture Society.2012; 25(1): 46. CrossRef

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Two-Stage Reconstruction of Infected Nonunion of Long Bones using Antibiotics-Impregnated Cement Beads: Se Hyun Cho, Soon Taek Jeong, Hyung Bin Park, Sun Chul Hwang, Yong Chan Ha, In Hwan Hwang; J Korean Fract Soc 2004;17(4):395-400. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.395

Abstract PDF

PURPOSE
To evaluate treatment results between internal and external fixation groups in two-stage reconstruction of infected nonunion of long bones using antibiotics-impregnated cement beads.
MATERIALS AND METHODS
In the first stage, preexisting hardwares were removed and radical debridement was done. The dead space was filled with antibiotics -impregnated cement beads and the nonunion site was immobilized by external fixation, cast or skeletal traction. In the second stage, all cases were divided into two groups; the nonunion was fixed by internal fixation in group I versus external fixation in group II. The intervening period between the first and second stage was average 8.7 weeks (range, 3~23 weeks).
RESULTS
The follow-up period was average 45 months (range, 16~71 months). Infection control and bone union were achieved in all 13 cases of group I. Infection recurred in two of 28 cases in group II, one underwent above-knee amputation and the other case was lost in follow-up. The mean number of supportive operations including repeated curettage, augmentation and change of infected pins, angular correction, and soft tissue flap was average 2 and 6.2 times respectively in group I and group II. Bony union period was average 19.3 and 23.1 weeks in each group. According to Paley's classification, group I was similar to group II in bony and functional result (p>0.05).
CONCLUSION
Antibiotics-impregnated cement beads provided positive effect on infection control. Internal fixation group showed less number of additional operations and earlier bony union than external fixation group.

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Treatment of Infected Nonunion
Sang-Ho Ha
Journal of the Korean Fracture Society.2007; 20(2): 206. 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

Abstract 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.

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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

Abstract 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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The Clinical Results in Compression Plate Fixation with Autogenous Cancellous Bone Graft for Humerus Diaphyseal Nonunion: Kwang Hyun Lee, Seong pil Lee, Hyung Jong Kim, Bong Geun Lee, Joo Hak Kim; J Korean Fract Soc 2004;17(2):90-94. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.90

Abstract PDF: PURPOSE
A The purpose of this retrospective study was to evaluate the results of compression plating and autogenous iliac bone graft in the management of humeral diaphyseal nonunion.
MATERIALS AND METHODS
Twenty patients who underwent the surgical treatments between May. 1998 and May. 2002 were included in this study. Nine of them are males and the others are females. The average age of them, when they was on operation, was 45 years. The symptoms lasted 23 months on average. They have been followed up for 33 months at an average. Treatment of nonunion consisted of resecting the atrophic nonunion, shortening the bone, apposing bleeding diaphyseal surface. Rigid fixation was then achieved using a compression plate and autogenous bone graft.
RESULTS
Solid bony union was achieved in all patients. In one patient, the bone was not healed at the first operation of plating and autogenous bone graft, but achieved union after the use of intramedullary nailing. In another patient, because of infected nonunion, we achieved union after several surgical debridement and stabilization by internal fixation.
CONCLUSION
This study documents that compression plate fixation with autogenous cancellous bone graft is a viable option with predictable and satisfactory results for humerus diaphyseal nonunion.

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Treatment for Intractable Infected Nonunion of Lower Extremity in Elderly People using External Fixator: Seung Jun Park, Jong Sup Shim, Sung Kee Shin; J Korean Fract Soc 2004;17(2):177-183. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.177

Abstract PDF

PURPOSE
To introduce and report the results of treatment of old patients' infected nonunion using external fixator.
MATERIALS AND METHODS
Nine patients more than 60 years old were included in the study. Four cases had combined medical problems of diabetes, hypertension, and vascular disorder. We used Ilizarov fixator in eight cases and uni-lateral external fixator in one. All patients were treated with debridement, broad sequestrectomy, segmental resection, bone graft and compression of fracture site about 1~1.5 cm. We evaluated the final results by functional result and complication according to the criteria of Paley.
RESULTS
Average length discrepancy was 1.7 cm before operation by initial bone loss and final follow-up shortening was average 2.6 cm. Mean duration of fixtor removal was 5.2 months. We acquired bony union lastly in 8 cases. Final functional result was 3 excellent, 2 good, 2 fair and 2 poor. Among them, 2 good, 1 fair and 1 poor cases had medical problem.
CONCLUSION
In old patients, compression of nonunion site and early joint motion using external fixator seemed to be very useful in the treatment of intractable infected nonunion of lower extremity and in minimizing duration of treatment.

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Manufacturing Techniques of Ancient Forged High-tin Bronze Wares from Archaeological Sites in Bagan, Myanmar
Jae Sung Lee, Yee Yee Win, Bonnie Lee, Jae Eun Yu
Journal of Conservation Science.2023; 39(5): 673. CrossRef
Treatment of Infected Nonunion
Sang-Ho Ha
Journal of the Korean Fracture Society.2007; 20(2): 206. CrossRef

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Treatment of Infected Nonunion of Long Bone Shaft: Comparison between Fixation by Antibiotic-cement Loaded Intramedullary Nailing and Fixation by Antibiotic-cement Loaded External Monofixator: Ki Ho Nah, Seong Jin Park, Suk Ku Han, Hyun Suk Song, Nam Yong Choi; J Korean Soc Fract 2003;16(4):511-518. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.511

Abstract PDF: PURPOSE
To evaluate the surgical results between fixations by antibiotic-cement loaded intramedullary nailing and antibiotic-cement loaded external monofixator in the treatment of infected nonunion of long bone shaft with mild bone loss and shortening of less than 1 cm.
MATERIALS AND METHODS
Among the 15 cases of infected nonunion of long bone shaft, 6 cases treated with fixation by antibiotic-cement coated intramedullary nailing and 3 cases treated with fixation by intramedullary nailing along with antibiotic-cement beads insertion were divided as group I (n=9), and other 6 cases treated with fixation by external monofixator along with antibiotic-cement beads insertion were divided as group II (n=6). There was no difference between the two groups in the degree of infection in the laboratory data and clinical feature and degree of bone loss and shortening. Male was in 7 and 5 patients, average age of the patients was 34.8 (26~53) and 37.2 (20~63) years old and average follow-up period was 15.9 (12~35) and 19.3 (15~41) months in group I and II respectively.
RESULTS
Among the nine cases of group I, 3 cases were newly convereted into fixation by antibiotic-cement coated intramedullary nailing at average 9.5 weeks. Radiologic union was gained at the average of 26 weeks from the time of initial nail fixation. Infection was responsive at 6.1 weeks by laboratoey data. Knee ROM of more than 100 degrees was gained in all case and average shortening was 9.2 mm in the last follow-up. And external rotation deformity of more than 5 degrees was noted in 1 case. Among the six cases of group II, radiologic union was gained at 14 weeks in 1 case without converting to internal fixation, and the other 5 cases were converted to antibiotic cement loaded intramedullary nailing at average 12.5 weeks because of delayed uinon or angulation deformity, and radiologic union was gained at average 44 weeks from the time of fixation by external fixator. Infection was responsive at 10.2 weeks by laboratoey data. Knee ROM of more than 100degrees was gained in 5 cases, and average shortening was 11.8 mm in the last follow-up.
CONCLUSION
In the treatment of infected nonunion of long bone shaft with mild bone loss and shortening of less than 1 cm, the fixation by intramedullary nailing with the use of antibiotic-cement prefers to the fixation by external monofixator with the use of antibiotic-cement in the velocity of union, control of infection, and in the clinical aspects such as alignment, early ambulation and joint stiffness.

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Surgical Treatment for the Non-union of the Lateral Humeral Condyle Fracture using Closing Wedge Osteotomy and Bone Graft: Sang Ho Ha, Hong Moon Sohn, Jun Young Lee, Sun Jong Oh; J Korean Soc Fract 2003;16(3):379-384. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.379

Abstract PDF

PURPOSE
To evaluate the clinical results of the surgical treatment for established nonunion of lateral humeral condyle fracture using closing wedge osteotomy and bone graft.
MATERIALS AND METHODS
Six patients diagnosed as symptomatic established nonunion of lateral humeral condyle fracture and cubitus valgus deformity were reviewed retrospectively. The average age was 23 years old and mean follow up period was 32 months. We investigate the changes of the symptoms and radiographic findings, and determine the results by Oppenheim's criteria.
RESULTS
According to Oppenheim's criteria, 3 patients showed excellent, 2 good, 1 poor. Carrying angle is improved to 10.2 degrees and range of motion was decreased by mean 9 degrees. All of the patients' muscle weakness and pain were improved, and was achieved solid union at the last follow up.
CONCLUSION
In the treatment of symptomatic established lateral humeral fracture and cubitus valgus deformity, better functional and cosmetic results are anticipated by a closing wedge osteotomy and bone graft.

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In SituLate Metaphyseal Osteosynthesis for the Fractures of the Lateral Humeral Condyle in Children
Kun Bo Park, Seung Whan Lee, Hyun Woo Kim, Hui Wan Park, Ki Seok Lee
Journal of the Korean Fracture Society.2008; 21(2): 151. CrossRef

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