Journal of Musculoskeletal Trauma

Dong Ju Chae

12 Articles

Nail Breakage after Femoral Interlocking Intramedullary Nailing: Suk Kang, Phil Hyun Chung, Dong Ju Chae, Jong Pil Kim, Joon Han Kim, Sung Pock Park, Jae Sang Park; J Korean Soc Fract 2002;15(3):363-370. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.363

PURPOSE
We analyze the clinical causes and precautions of nail breakage followed by femoral intramedullary nailing MATERIALS AND METHODS: We reviewed 12 cases of nail breakage followed by the femoral intramedullary nailing from Jan. 1993 to Feb. 2001 and for each cases, we analyzed used nail diameter, patient weight and used nail, time to nail breakage and configuration of non-union. We classified fracture site at the time of trauma as proximal 1/3, middle 1/3, distal 1/3, and evaluated gap of fracture site, displacement of fragment after surgery, location and treatment of broken nail on each part, and analyzed the causes of nail breakage RESULTS: The average time of nail breakage was 8.1 months and distal 1/3 fracture were major as 6 cases. Those were mainly comminuted fracture of Winquist-Hansen type II. After surgery, gap of fracture site and displacement of fragment were mostly observed in middle 1/3 fracture and, in the part of middle 1/3, the site of nail breakage took place in fracture site. Especially in the distal 1/3 fracture, nail breakage happened usually in distal first locking screw hole. The causes of nail breakage were inadequately small diameter of nail inserted into the isthmic portion of medullary canal in proximal fracture, inaccurate reduction of fracture site in middle fracture, and the use of short length of nail and its mechanical damage caused by inaccurate insertion of distal locking screw in distal fracture.
CONCLUSION
To prevent nail breakage while femoral intramedullary nailing, in proximal fracture, adequate diameter of nail has to be inserted into the isthmic portion of medullary canal. In middle fracture, the accurate reduction of fracture site will be necessary, and the case of distal fracture, enough length of nail has to be used and especially it is important not to cause mechanical injury with the accurate insertion of distal locking screw in nail

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Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures
Bailian Liu, Ying Xiong, Hong Deng, Shao Gu, Fu Jia, Qunhui Li, Daxing Wang, Xuewen Gan, Wei Liu
Journal of Orthopaedic Surgery and Research.2014;[Epub] CrossRef
Limited Open Reduction and Intramedullary Nailing of Proximal Femoral Shaft Fracture
Sang Ho Ha, Jun Young Lee, Sang Hong Lee, Sung Hwan Jo, Jae Cheul Yu
Journal of the Korean Fracture Society.2009; 22(4): 225. CrossRef

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Treatment of Femoral Shaft Fracture with External Fixator in Children: Phil Hyun Chung, Suk Gang, Dong Ju Chae, Jong Pil Kim, Sung Pock Park; J Korean Soc Fract 2002;15(3):421-426. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.421

Abstract PDF: PURPOSE
Children with femoral shaft fractures in association with other injuries such as head injuries, abdominal injuries, open fractures, multiple fractures, or unstable displaced fractures require operative treatment rather than being treated in conservative methods. In this study, we compare the surgical result of femoral shaft fracture using external fixator in children, and evaluate the complications and the related factors as well as the advantage over the other management described in the literature.
MATERIALS AND METHODS
We reviewed 15 cases of femoral shaft fractures in children admitted between May, 1995 and May, 2000. The mean age was 8 years and 2months old (range: 6-12 year-old, 9 boys, 6 girls). All the evaluations were based on the postoperative radiologic studying and clinical findings. In the radiologic evaluations, bony union time, angular deformity, and leg length discrepancy in both sagittal and coronal plane were evaluated, and in the clinical evaluations, we analyzed the duration of external fixation, hospital day, range of motion in both hip and knee joint, and post-operative complications.
RESULTS
The average bony union time based on the radiologic studying was 10.9 weeks (ranging from 7 to 24 weeks). Angular deformity at the fracture site was less than 5 degrees and no rotational deformity was found in all 15 cases. The average length of overriding fracture fragment was 11.7 mm (ranging from 10 to 15 mm) and average leg length discrepancy was 2.1 mm (ranging from -3 to +10mm). Duration of external fixation averaged 12.1 weeks (ranging from 9 to 24 weeks) and average hospital day was 29.4 day (ranging from 21 to 48 day). None of the patient had limitation in hip or knee joint movement. There were 1 case of refracture (case of pathologic fracture) and 4 cases of pin tract infection(superficial infection).
CONCLUSION
At our institution, we observed average overgrowth of 2.1 mm and no severe complications excepts in 1 case of refracture due to pathologic fracture. Thus we concluded that closed reduction and external fixation is effective in treating open, or unstable displaced fracture of femoral shaft with other associated injuries in pediatric population, and it is also believed to be effective means in treating closed femoral fractures.

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Treatment of Intertrochanteric Fractures of Femur Using Intramedullary Hip-Screw: Phil Hyun Chung, Chung Soo Hwang, Suk Gang, Dong Ju Chae, Jong Pil Kim, Joon Han Kim; J Korean Soc Fract 2001;14(4):575-583. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.575

Abstract PDF: PURPOSE
We analyze the results of the treatment of intertrochanteric fractures by using intramedullary hip screw.
MATERIALS AND METHODS
We reviewed 34 patients of intertrochanteric fracture who were treated by using of intramedullary hip screw from March 1998 to February 2000, and we classified the fractures by Evans system. 26 cases were treated by closed reduction and internal fixation; 8 cases were by open reduction and internal fixation. We analyzed fracture figure and stability, amount of sliding of lag screw, the change of femur neck-shaft angle, postoperative activity and postoperative complication RESULTS: Bony union was obtained in average 14.3 weeks. Gap of fracture site was formed in 2 cases and crack on entry area of nail was formed in 1 case. Postoperative wound infection occurred in laces and delayed union occurred in 1 case. The change of femur neck-shaft angle showed an average decrease 1.7 degree in stable fractures, 3.5 degree in unstable fractures. Lag screw was sided an average 1.0 mm in stable fractures, 2.6 mm in unstable fractures. Postoperative mobility were analyzed by score of Parker and Palmer, and showing from 7.6 score pretrauma to 3.37 score postoperation in 1 month, 5.0 score postoperation in 3 months, 7.48 score postoperation in 6 months and 7.5 score postoperation in one year.
CONCLUSION
Intramedullary hip screw in intertrochanteric fractures reduced the collapse by processing union of fracture site due to the less decreases of femur neck shaft angle and the shortening by sliding of lag screw

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Knee Fractures and Ligament Injuries Associated with Ipsilateral Femoral Shaft Fractures: Mechanism of Injury, Site of th Knee Fracture and Ligament Injury: Dong Ju Chae, Phyl Hyun Chung, Won Suk Chae; J Korean Soc Fract 2000;13(2):230-235. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.230

Abstract PDF: PURPOSE
: To establish the incidence and type of knee fractures, injury of knee ligament associated with ipsilateral femoral shaft fractures. What is the most common mechanism of these combined injuries? MATERIALS AND METHODS : From March 1995 to February 1999, evaluation of one hundred and twenty consecutive patients with fracture of the femoral shaft showed fractures and injuries of the ligaments of the ipsilateral knee in thirty-five(29%) of them. Of those thirty-five, nineteen patients had injured their knees and femoral shaft fractures by the dashboard injury. Twelve injuries were caused in a motor cycle accident, and two patients occurred in pedestrians struck by cars. Two injuries were caused by falls.
RESULTS
: There were twenty fractures of th knee and fifteen injuries of the ligament. Seventeen of the twenty fractures were in the patella, two in the bicondyle of the proximal tibia and one in the lateral condyle of the proximal tibia. Eleven of seventeen fractures of the patella were open fractures. Of fifteen injuries of the ligament, there were six posterior cruciate ligament tears (including 2 partial tears and 1 avulsion fracture), three posterior cruciate ligament tears with medial or lateral collateral ligament disruption , three anterior cruciate ligament tears(2 tibial spine fractures and 1 partial tear), two lateral collateral ligament disruptions and one medial collateral ligament tear. The locations of femoral shaft fracture were proximal in four patients, middle in thirty, and distal in one patient.
CONCLUSION
: We conclude that there is a high incidence of ipsilateral fracture of the patella and posterior cruciate ligament tears in patients with femoral shaft fractures. The dashboard injury is the most common mechanism of the ipsilateral knee fractures and ligament tears with femoral shaft fractures.

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Effects of Fibular Fixation for Interlocking Nailing of Distal Tibiofibular Fractures: Sang Ho Moon, Phil Hyun Chung, Chung Soo Hwang, Dong Ju Chae, Beom Kim; J Korean Soc Fract 2000;13(2):296-302. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.296

Abstract PDF: PURPOSE
: To compare redioiogic results between interlocking intramedullary nail with fibular fixation and nail only for treating distal tibiofibular diaphyseal fractures.
MATERIALS AND METHODS
: From April 1993 to February 1999, 26 distal tibiofibular fractures were antegrade nailed after anatomical reduction and fixation of fibular fractures, and another 61 fractures fixed with nails only. Average age of patients was 41.8 years. These two groups were compared by frequency of malalignment, degree of postoperative angulation, angulation according to comminution, angulation according to fracture configuration. The statistical analysis was evaluated by t-test.
RESULTS
: Fibular fixation group had no malalignment while non-fixations had angulation of 1.2+/-1.1 degree and non-fixation had 3.0+/-2.1. So fixation had lessor angulation than non-fixation significantly(p=0.004). In lateral rediographs, each had 1.3+/- 1.1, 2.8+/-2.3 degree and showed significant difference(p=0.027). In type I and II fractures of Winquist-Hansen classification, fixation group showed lesser degree of angulation in A-P plane significantly(p=0.008) but no significant difference in lateral plane. In type III and IV, no significant difference in both planes. According to configuration of fractures, transverse and spiral fractures showed no significant differences but oblique configurations had significant differences in A-P plane(p=0.002) CONCLUSION : Interlocking intramedullary nail with fibular fixation has the advantage in maintenance of alignment during insertion of nail in distal tibiofibular fractures, especially in Winquist-Hansen classification type I and II and oblique fractures in anteroposterior plane, so it can be a worthy method for the treatment of distal tibiofibular diaphyseal fractures.

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Bilateral Floating Knees Treated by 4 Intramedullary Nails: A Case Report: Phil Hyun Chung, Dong Ju Chae, Sang ho Moon, Ho Gyoon Bae; J Korean Soc Fract 1999;12(2):267-271. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.267

Abstract PDF: The treatment of simultaneous ipsilateral femoral and tibial fractures is a challenging therapeutic problem. Unfortunately, despites a number of reports on these fractures, guidelines for treatment have not been well established. Because the knee joint is isolated partially or completely, the term "floating knee"is used. But most of these injuries are ipsilateral and few bilateral cases were reported in the literatures. The authors reviewed a case of bilateral floating knee treated by 4 intramedullary nails without having any prolonged healing time or limited range of motion in both knee joint postoperatively.

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Treatments of Tibial Condylar Fractures: Yong Bum Park, Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Dong Ju Chae, Han Chul Kim, Sang ho Moon, Seung Hun Lee, Tae Young Kim, Sun Hyun Yun; J Korean Soc Fract 1998;11(4):790-797. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.790

Abstract PDF: The tibial condylar fractures are characterized by intra-articular extension of fracture line and associated soft tissue injuries, and could affect knee alignment, stability, adn range of motion after treatments. Therefore, anatomical reduction and rigid internal fixation is mandatory to get satisfactory results. But this method of treatment can not be always possible due to technical dimend of surgical sklls and high risk of postoperative infection. The authors analyzed 43 cases of tibial condylar fractures, which were treated at the orthopaedic department of the Dongguk University Hospital from March 1990 to May 1996. Males were 34, and females were 9. Average age of patients was 41.4 years, and average follow up period was 18 months. The most common causes of injuries were traffic accidents (36 cases), and most common type of fracture was Schatzker type I. associated soft tissue injuries were observed in 21 cases. Treatment methods were chosen by degree of displacement of fracture fragment and associated soft tissue injuries. Conservative treatments were done in 23 cases and operative treatments in 20 cases. Satisfactory results were obtained in overall 32 cases(74%) regardless of the methods of treatment. Unsatisfactory results were observed in patients who had associated soft injuries and significant displacement of fracture. Conclusively, satisfactory results could be obtained in patients with tibial condylar fractures by appropriate selection of treatments according to displacement of fracture and associated soft tissue injuries.

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Malailgnment Following Intramedullary Nailing of Tibial Shaft Fracture - s comparison between medial parapatellar approachand patellar tendon spltting approach -: Dong Ju Chae, Phil Hyun Chung, Tae Young Kim; J Korean Soc Fract 1998;11(4):849-857. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.849

Abstract PDF: Intramedullary nailing is often the treatment of choice in the management of fractures in the tibial diaphysis. One of the most frequent complications of tibial nailing is fracture malalignment leading to angulatory or rotational deformities. Access to the proximal tibia for intramedullary nailing of the tibial shaft fractures may be via a patallar tendon splitting or paratendinous exposure. Although the tendon splitting approach is more direct, the incidence of knee pain is significantly higher when this technique is used. In addition, several cases of heterotopic ossification have been reported following tendon splitting approaches. For these reasons an incision medial to the tendon is generally chosen. We reviewed 140 cases(131 patients) of tibial shaft fractures who were treated by use of the intramedullary nailing from 1994 to 1997 and made a comparison between the medial parapatellar approach and the patellar tendon splitting approach about degree of malalignment. We have noticed that there was significant difference in the number of tibias that were malaligned after tibial nailing with the medial parapatellar access and the tendon splitting approach. With the medial parapatellar approach, malalignment was seen in 13/42 tibiae(31.0%) of the fractures of tibial shaft, 11/12 tibiae of the proximal third fractures and 2/10 tibiae of the distal third fractures respectively. With the patellar tendon splitting approach, malalignment was seen in 8/98 tibiae(8.2%) of the fractures of the tibial shaft, 4/15 tibiae of the proximal third fractures, 1/45 of the middle third fractures and 3/38 tibiae of the distal third fractures respectively. We conclude that the tendon splitting approach may be better for intramedullary nailing of the proximal fractures of the tibia and the medial parapatellar approach may be chosen for the treatment of the middle and distal shaft fractures of the tibia.

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The Gamma Mail for Subtrochanteric Fractures of the Femur: Suk Kang, Jung Soo Hwang, Phil Hyun Chung, Dong Ju Chae, Yong Bum Park, Han Chul Kim, Kyu Hwang Um, Jeong Yong Hong; J Korean Soc Fract 1998;11(1):159-167. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.159

Abstract PDF: The aubtrochanteric area is cortical bone which has a decreased blood supply and a serious communition after trauma. Large biomechanical stresses in the subtrochanteric area can lead to failure of fixation devices. Many fixation devices have been used to treat the fractures of subtochanter of the femur. The Gamma nail was introduced for the treatment of peritrochanteric fractures with the theoretical advantage of a load-shearing femoral component. We reviewed 15 patients of subtrochanteric fractures who were treated by use of the Gamma nail at Dongguk university hospital since March 1993. Results showed satisfactory fracture union with little loss of position, even in comminuted fractures. The patients had shorter convalescence and earlier weight bearing. Perioperative complications were few. We conclude that Gamma nail is effective in achieving good stabilization of the unstable fractures of the subtrochanteric region and is an advance in the treatment of subtrochanteric fractures of the femur.

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Osteofibrous Dysplasia of The Femoral Shaft: Chung Soo Hwang, Phil Hyun Chung, Dong Ju Chae, Jung Yong Hong, Seung Hun Lee; J Korean Soc Fract 1997;10(4):761-765. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.761

Abstract PDF: Osteofibrous dysplasia is a rare benign fibrosseous lesion that occurs predominantly in children. It is almost always occurs in the tibia, occasionally in both tibia and fibula or only in the fibula. It is distinguished from fibrous dysplasia by the osteoblastic rimming of the bony trabeculae and the presence of lamellar bone and radiographically by its cortical location rather than medullary location. We are now reporting a case of an eleven-year-old male patient who had a osteofibrous dysplasia of the femoral shaft with pathological fracture.

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Flexion type, Supracondylar Fractures of the Humerus in Children: Phil Hyun Chung, Suk Kang, Hyung Ho Oh, Dong Ju Chae, Dae Jin Kim; J Korean Soc Fract 1996;9(4):1104-1110. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1104

Abstract PDF: The flexion type, supracondylar fracture of the humerus is a rare injury of the elbow in children. It is known as difficult fracture to achieve and maintain reduction and is associated with relative high incidence of complications such as ulnar nerve injury, varus deformity and limited range of motion of the elbow. We have experienced 6 cases of flexion type sapracondylar fracture of the humerus in children. We performed closed reduction and percutaneous piniiing in type II fracture and in type III fracture, open reduction and internal fixation was performed because closed reduction was failed. The resuli were generally excellent. Full range of motion of the elbow and under 5 degree varus or valgus deformity resulted in. We become to believe that the aggressive approaches-even open reduction in type III fracture-provide good results and decrease the complications mentioned previously.

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Failure after Operative Fixation of Fracture in Rigid Cerebral Palsy: Report of 2 Cases: Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Yong Min Kim, Hyung Ho Oh, Dong Ju Chae, Seung Hoon Lee; J Korean Soc Fract 1996;9(1):229-234. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.229

Abstract PDF: In the management of fractures in patients with cererbral palsy, pre-existing contracture of joint and muscles, difficulty in maintenance of reduction partly because of involuntary motion of muscles are obstacles to the orthopaedic surgeons. Furthermore, disuse osteopenia in long term bed-ridden patients may be a Predisposing factor of refracture. Failures such as refracture were reported to occur 19 times more in cerebral palsy patients. Those failures usually result in malunion, which may be a cause of severely deformed extremities. Among various types of cerebral palsy, rigid type is rare and involuntary muscle contraction is rigid. Therefore, fractures in these patients may be more difficult to manage and be accompanied by more complications, such as refracture compared even to spastic type. We experienced fractures in two patients with rigid cerebral palsy. An 11 year-old boy(proximal femoral shaft fracture) and a 45 year-old man(humerus shaft fracture) were treated with open reduction and internal fixation using plate and screws. Initial fixation was thought to be enoughly stable, but within 3 weeks postoperatively, maintenance of reduction in both fractures failed eventually. Because of the rarity of cases and difficulty in maintenance of reduction, we report these two cases after reviewing of the literatures.

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