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Review Article
Updated Basic Principles of Internal Fixation of Fracture
Oog-Jin Shon, M.D., Ji-Wan Kim, M.D., Beom-Jung Kim, M.D.
Journal of the Korean Fracture Society 2013;26(1):81-91.
DOI: https://doi.org/10.12671/jkfs.2013.26.1.81
Published online: January 17, 2013

Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea.

*Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Address reprint requests to: Oog-Jin Shon, M.D. Department of Orthopedic Surgery, Yeungnam University Medical Center, 170, Hyeonchung-ro, Nam-gu, Daegu 705-717, Korea. Tel: 82-53-620-3640, Fax: 82-53-628-4020, ossoj@med.yu.ac.kr

Copyright © 2013 The Korean Fracture Society

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  • 2. Ahmad M, Nanda R, Bajwa AS, Candal-Couto J, Green S, Hui AC. Biomechanical testing of the locking compression plate: when does the distance between bone and implant significantly reduce construct stability? Injury, 2007;38:358-364.Article
  • 3. Bagby GW, Janes JM. The effect of compression on the rate of fracture healing using a special plate. Am J Surg, 1958;95:761-771.
  • 4. Baumgaertel F, Buhl M, Rahn BA. Fracture healing in biological plate osteosynthesis. Injury, 1998;29:Suppl 3. C3-C6.Article
  • 5. Cheal EJ, Mansmann KA, DiGioia AM 3rd, Hayes WC, Perren SM. Role of interfragmentary strain in fracture healing: ovine model of a healing osteotomy. J Orthop Res, 1991;9:131-142.Article
  • 6. Danis R. Théorie et pratique de l'ostéosynthése, Paris, Masson. 1949.
  • 7. Eggers GW. Internal contact splint. J Bone Joint Surg Am, 1948;30A:40-52.Article
  • 8. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma, 2004;18:488-493.
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Fig. 1
Various kinds of minimally invasive osteosynthesis (MIO).
(A) Minimally invasive plate osteosynthesis (MIPO).
(B) Minimally invasive nail osteosynthesis (MINO).
(C) Minimally invasive screw osteosynthesis (MISO).
(D) Minimally invasive external fixator osteosynthesis (MIEFO).
jkfs-26-81-g001.jpg
Fig. 2
Fracture of the distal lower leg in a 45-year-old man.
(A) Anteroposterior view of the lower leg demonstrating the distal fracture.
(B) It was treated by conventional plating of the distal fibula and locking compression plate (LCP) osteosynthesis of the distal tibia using a minimally invasive plate osteosynthesis (MIPO) technique.
(C) After implant removal 10 months after injury.
jkfs-26-81-g002.jpg
Fig. 3
Fracture of the lower leg in a 31-year-old man.
(A) Multiple injured male with open wound of both lower extremities caused by pedestrian traffic accident. Metaphyseal comminuted fracture of tibia, fibula.
(B) Because the compromised soft tissue did not allow open reduction, consolidation was attempted with the initially applied external fixator.
(C) After 2 weeks, lateral plate fixation of the distal tibia using the minimally invasive plate osteosynthesis (MIPO) technique was performed and free flap was applied.
jkfs-26-81-g003.jpg
Fig. 4
Open fracture of the lower leg in a 38-year-old man caused by a traffic accident.
(A) Metaphyseal comminuted fracture of tibia, fibula.
(B) A contaminated fracture fragment was removed, consolidation was attempted with the initially applied external fixator. An antibiotic containig cement bead was inserted in dead space.
(C) After 2 weeks, cement bead was removed, osteotomy & external fixation of distal tibial fragment was performed for bone transport and skin graft was applied.
(D) After 6 weeks, bone transport was done. External fixator was removed and fragment was fixed with previous locking compression plate (LCP).
(E) After 12 weeks, internal fixation, and bone graft was performed using autogenous iliac bone.
jkfs-26-81-g004.jpg
Fig. 5
Expert nailing system.
jkfs-26-81-g005.jpg
Fig. 6
Angular stable locking system (ASLS).
jkfs-26-81-g006.jpg
Fig. 7
Lateral entry nail of proximal femur.
(A) Spiral fracture of the femoral shaft in a 25-year-old male.
(B) Nailing was performed with A2FN (Expert Asian Femoral Nail, AO).
(C) Simple fracture of the femoral shaft in a 37-year-old female.
(D) Nailing was performed with Sirus nail (Zimmer).
jkfs-26-81-g007.jpg
Fig. 8
Collinear reduction clamp can be used for reduction.
(A) Instrument.
(B, C) Intraoperative use.
jkfs-26-81-g008.jpg
Fig. 9
Periarticular wiring can be used for reduction.
(A) Instrument.
(B) Intraoperative use.
(C) Subtrochanteric fracture of femur in a 58-year-old female.
(D) Reduction was performed using wring and nailing was done.
(E) Follow-up x-rays 6 months after surgery showed good fracture healing with callus formation.
jkfs-26-81-g009.jpg
Fig. 10
(A) Spiral fracture of shaft in a 28-year-old female.
(B) Reduction was performed with polar screw (arrow).
jkfs-26-81-g010.jpg
Fig. 11
3-dimensional C-arm.
jkfs-26-81-g011.jpg

Figure & Data

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    • A Review of Domestic and International Clinical Research Trends on Pharmacopuncture Treatment for Fractures
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      Journal of Physiology & Pathology in Korean Medicine.2023; 37(6): 185.     CrossRef
    • Comparison of Greater Trochanter Versus Piriformis Entry Nail for Treatment of Femur Shaft Fracture
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      Updated Basic Principles of Internal Fixation of Fracture
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    Updated Basic Principles of Internal Fixation of Fracture
    Image Image Image Image Image Image Image Image Image Image Image
    Fig. 1 Various kinds of minimally invasive osteosynthesis (MIO). (A) Minimally invasive plate osteosynthesis (MIPO). (B) Minimally invasive nail osteosynthesis (MINO). (C) Minimally invasive screw osteosynthesis (MISO). (D) Minimally invasive external fixator osteosynthesis (MIEFO).
    Fig. 2 Fracture of the distal lower leg in a 45-year-old man. (A) Anteroposterior view of the lower leg demonstrating the distal fracture. (B) It was treated by conventional plating of the distal fibula and locking compression plate (LCP) osteosynthesis of the distal tibia using a minimally invasive plate osteosynthesis (MIPO) technique. (C) After implant removal 10 months after injury.
    Fig. 3 Fracture of the lower leg in a 31-year-old man. (A) Multiple injured male with open wound of both lower extremities caused by pedestrian traffic accident. Metaphyseal comminuted fracture of tibia, fibula. (B) Because the compromised soft tissue did not allow open reduction, consolidation was attempted with the initially applied external fixator. (C) After 2 weeks, lateral plate fixation of the distal tibia using the minimally invasive plate osteosynthesis (MIPO) technique was performed and free flap was applied.
    Fig. 4 Open fracture of the lower leg in a 38-year-old man caused by a traffic accident. (A) Metaphyseal comminuted fracture of tibia, fibula. (B) A contaminated fracture fragment was removed, consolidation was attempted with the initially applied external fixator. An antibiotic containig cement bead was inserted in dead space. (C) After 2 weeks, cement bead was removed, osteotomy & external fixation of distal tibial fragment was performed for bone transport and skin graft was applied. (D) After 6 weeks, bone transport was done. External fixator was removed and fragment was fixed with previous locking compression plate (LCP). (E) After 12 weeks, internal fixation, and bone graft was performed using autogenous iliac bone.
    Fig. 5 Expert nailing system.
    Fig. 6 Angular stable locking system (ASLS).
    Fig. 7 Lateral entry nail of proximal femur. (A) Spiral fracture of the femoral shaft in a 25-year-old male. (B) Nailing was performed with A2FN (Expert Asian Femoral Nail, AO). (C) Simple fracture of the femoral shaft in a 37-year-old female. (D) Nailing was performed with Sirus nail (Zimmer).
    Fig. 8 Collinear reduction clamp can be used for reduction. (A) Instrument. (B, C) Intraoperative use.
    Fig. 9 Periarticular wiring can be used for reduction. (A) Instrument. (B) Intraoperative use. (C) Subtrochanteric fracture of femur in a 58-year-old female. (D) Reduction was performed using wring and nailing was done. (E) Follow-up x-rays 6 months after surgery showed good fracture healing with callus formation.
    Fig. 10 (A) Spiral fracture of shaft in a 28-year-old female. (B) Reduction was performed with polar screw (arrow).
    Fig. 11 3-dimensional C-arm.
    Updated Basic Principles of Internal Fixation of Fracture

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