Journal of Musculoskeletal Trauma

Key Yong Kim

9 Articles

Result of Surgical Treatment of Calcaneal Fractures Using Extensile Lateral Approach: Sung Do Cho, Yong Sun Cho, Bum Soo Kim, Tae Woo Park, Gi Bong Kim, Key Yong Kim; J Korean Soc Fract 1999;12(2):320-327. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.320

Thirty-eight calcaneal fractures were treated with open reduction and internal fixation using extensile lateral approach from Jun. 1993 to Dec. 1996 and were followed more than a year. According to the Essex-Lopresti classification, there were 28 cases of joint depression type and 10 cases of tongue type. According to the Sanders classification, there were 20 cases of type II, 13 cases of type III and 5 cases of type IV. The purpose of this study is to analyze the results of surgical treatment of calcaneal fractures using extensile lateral approach and its complications. The results were as follows; 1. B.. ohler angle was improved from -2.4degrees to 20.5degrees and Gissane angle was improved from 114.5degrees to 120.4degreesafter the operation. The height of the calcaneus was improved from 75% to 95% and the width of the calcaneus was reduced from 119% to 106% of contralateral side. 2. yThe postoperative reduction status of the articular surface was analyzed by computed tomography(CT) in 18 patients and was found to be less than 2 mm of step-off in 10 cases, between 2 and 5 mm in 7 cases and more than 5 mm in 1 case. 3. Based on the assessment criteria of Salama et al., the functional results were excellent in 10 cases, good in 14 cases, fair in 10 cases, and poor in 4 cases. Unsatisfactory results were correlated with severity of articular comminution and failure to obtain accurate reduction of the articular surface. 4. Fourteen cases (36.8%), developed postoperative complications such as heel pain, causalgia and numbness, subtalar arthritis, marginal necrosis of wound, lateral subfibular impingement and heel bulging. In conclusion, Because of high incidence of postoperative complications, careful and meticulous exposure technique in doing extensile lateral approach are necessary for a satisfactory outcomes.

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Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients
Hong-Moon Sohn, Sang-Ho Ha, Sang-Hong Lee, Jun-Young Lee, Jeong-Ho Kim, Sang-Jun Lee
Journal of the Korean Fracture Society.2008; 21(3): 195. CrossRef

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A Technique for Intramedullary Nailing of Proximal Third Tibia Fractures: Jung Jae Kim, Kyung Min Noh, Woo Shin Cho, Yung Tae Kim, Key Yong Kim; J Korean Soc Fract 1998;11(2):456-463. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.456

Abstract PDF

INTRODUCTION : Recently, intramedullary nailing is the treatment of choice in the management of fractures in the tibial diaphysis. But fractures of the proximal third of the tibial shaft including segmental fractures do not appear to respond as favorably to intramedullaryu nailing as do fractures in the distal 2/3 of the tibia. One of the msot frequent complications of intramedullary nailing of proximal third tibia is fracture malalignment leading to anterior angulation, anterior displacement or valgus angulation. There are several factors combine to make these fractures difficult to reduce when nailing. 1) The pull of the patellar tendon and muscles around the proximal tibia on the shory proximal fracture fragment. 2) The traditional medial entrance point of nailing in the proximal tibia. The author`s objective is to introduce a new technique to neutralize these factors so that intramedullary nailing can be consistently used to treat poximal third ribia fractures.
MATERIALS AND METHODS
: Five of proximal third tibial shaft including one segmental fracture were treated with a new technique for intramedullary nailing of these fractures. The clinical summary was s belows. 1) Inserted two 0.125inch Steinmann pins at the proximal tibial fragment, which authors called as 'blocking pin'. These pins were crossed with 10-15degree angle at midpoint of the proximal tibia anteroposteriorly and mediolaterally. 3) Made the entrance hole using awl which was introduced just anterior to the cross point of two blocking pins. 4) The AO unreamed tibial nail was inserted anterior to two blocking pins, After then, continued the nail insertion with closed technique. 5) Performed proximal(3 screws) and distal(2 or 3 screws) locking. 6) Removed two blocking pins finally. Outcomes were evaluated immediately postoperatively and at follow-up visit by measurement of alignment in both the anteroposterior and lateral planes. All patient were evaluated clinically also.
RESULTS
: The average anterior angulation and anterior displacement immediately postoperatively were 3.0degree (range 1degree to 5degree) and 2.8mm (range 1mm to 4mm) respectively. The average coronal plane alignement was 3.2degree valgus(range 2degree to4degree valgus). There was no complication from the use of this technique either intraoperatively or postoperatively. Fracture alignment at the time of last follow-up was unchanged from immediate postoperative measurements. All 5 cases healed clinically and radiologically. In 3 casesm bone graft was performed at postoperative 6 weeks due to delayed union. The average time to radiologic healing was 21weeks(17-26 weeks).
CONCLUSIONS
: Intramedullary nailing of proximal third tibial fractures including segmental fractures is technically demending and has a problem of the high rate of malalignments. However, through a new technique above mentioned which neutralize deforming factors, reliable alignments and healing were achieved successfully in proximal third tibial fractures. The authors introduce and recommend a new technique in intramedullary nailing to treat the authors introduce and recommend a new technique in intramedullary nailing to treat the fractures of the proximal third of the tibial shaft(esp. segmental fractures).

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Fractures of the Middle Third of the Tibia Treated with a Functional Brace
Augusto Sarmiento, Loren L. Latta
Clinical Orthopaedics & Related Research.2008; 466(12): 3108. CrossRef

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Surgical Treatment of the Pilon Fractures: Jung Jae Kim, Jong Hi Park, Woo Shin Cho, Key Yong Kim; J Korean Soc Fract 1997;10(3):492-500. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.492

Abstract PDF: The intraarticular fractures of the distal tibia. so-called pilon fractures have been difficult in management due to the severe comminution of articular surface and frequent soft tissue problems. So there have been many controversies in the method of treatment. Although historically the results of various type of treatment of these fractures have been less than optimal, there has been a recent trend that suggests success in the majority of cases through operative treatment following the principles outlined by the AO/ASIF group. Among the patients of pilon fracture admitted to our hospital from October 1989 to August 1995 who were treated by open reduction and internal fixation, 32 patients(34 cases) were included who could be follow up for more than 2 years. According to AO/ASIF classification, type B1 5 cases, type B2 7 cases, type B3 5 cases, type C1 3 cases, type C2 4 cases, type C3 10 cases. The authors analyaed the clinical and radiological results of tibial pilon fractures exclusively treated by internal fixation. The results as follow : 1. Among 34 cases, 12 cases(35.3%) were not associated with of fibula fracture. There was no stastical relationship between the severity of pilon fracture and the presence of flbula fracture. 2. Good results in fracture reduction was obtained at 26 cases(76.5%) and good functional reults was obtained at 26 cases(76.5%). 3. The most commom postoperative complication was infection combined with skin problem(6 cases), which were treated by antibiotics and flap surgery. 4. Anatomical reduction and stable internal fixation of articular surface, careful manipulation of soft tissues and early range of motion exercise yielded good results of surgical treatment of pilon fracture.

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Closed Interlocked Nailing in Comminuted Femoral Shaft Fractures: Jung Jae Kim, Chang Won Lee, Key Yong Kim; J Korean Soc Fract 1997;10(1):8-15. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.8

Abstract PDF: Intramedullary nailing is one of the most popular method of treatment in femoral shaft fractures,which provides relatively stable fixation and preservation of blood supply and early mobilization. But whether open reduction, cerclage wiring and/or bone graft is necessary for the displaced comminuted fragment is still a subject of controversy. To clarify such debate we compared the results of IM nailing between simple, minimal displaced fractures and displaced, comminuted ones treated with closed method. We analyzed 36 cases of the fresh closed fractures of femoral shaft treated by closed intramedullary nailing from December 1992 to January 1996. There were 24 cases of minimal displaced fractures and 12 cases of displaced ones more than 1 cm during operation. The average follow-up period was 12 months(5-48 months). Clinical and radiological fracture union occurred in 97% of cases(35/36). Radiological callus was noticed just around 3 weeks postoperatively in both groups and the average time to radiological union was 23 weeks in minimal displaced group and 24.8 weeks in displaced one. Because there was no significant difference in bone healing time, closed interlocking intramedullary nailing is thought to be also the good method of treatment in femoral fractures regardless of fracture pattern or displacement of fragments.

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Impaction and Tension-Band Wiring Technique in Proximal Humerus Fractures Accompanying Severe Comminution of Surgical Neck: Sung Il Bin, Sung Jin Cho, Key Yong Kim; J Korean Soc Fract 1996;9(4):1054-1060. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1054

Abstract PDF: Proximal humerus frartures occur most commonly in elderly people, especially with osteoporotic bone. But recently these fractures are also common in younger people due to the increased incidence of trafnc accidents or sports injuries. It is reported that displacement of major fracture fragments can be observed in about 20 percents of proximal humerus fractures and they need some form of surgical treatment. But when there is a sevfre comminution in the area of surgical neck which precludes anatomical reduction, it is almost impossible to obtain rigid fixation and to start an early motion. We reported ten cases of unstable proximal humerus fractures with severe comminution of surgical neck which preclude anatomical reduction and stable rxation and require impaction of the shaft fragment into the head and fixation with multiple pins and tension band wiring. After an arevage follow-up period of 30 months, we obtained the following results: 1. Nine cases out of 10 showed satisfactory results, excellent in 2 cases and good in 7 cases. But there was 1 case in poor. 2. In complications, 2 cases showed transient postoperative subluxation and 3 case showed moderate joint stiffness. But there was no avascular necrosis of humeral head.

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Classification of Femoral Neck Fractures: Soo Ho Lee, Ewy Ryong Chung, Hyung Sun Ahn, Jae Suk Chang, Key Yong Kim; J Korean Soc Fract 1996;9(1):88-96. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.88

Abstract PDF: The authors have reviewed 45 cases of femoral neck fractures from January 1991 to September 1994 with special reference to fracture classification. Follow-up periods for these cases were more than 1 year for all of these cases. The results were as follows: 1. AO classification of femoral neck fractures is better than Garden's classification in its simplicity and less inter-observer variations. 2. AO classification of femoral neck fractures is better than Garden's classification in predicting healing complications of internal fixation of femoral neck fractures. 3. Another factors predicting healing complications are the accuracy of reduction and the postoperative bone scintigraphy. With the above results, we concluded that AO classification of femoral neck fractures seems to be useful in clinical application to femoral neck fractures together with Garden's classification.

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Operative Treatment of Three Part Fraetures of the Proximal Humerus Following AO/ASIF Principle: Key Yong Kim, Choon Sung Lee, Sung Il Bin; J Korean Soc Fract 1992;5(2):342-347. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.342

Abstract PDF: The three part fractures of proximal humerus are not uncommon and the management is still under debate. For the good functional result, rigid internal or external fixation and early ROM exercise is mandatory. From Oct, 1989 to Oct, 1991, the results of treatment of 13 cases of proximal humerus 3-part fractures exclusively treated by internal fixation following the principles of the AO/ASIF group were analyzed at the Department of Orthopedic Surgery, Asan Medical Center. The results were as follows ; 1. The major cause of injury was traffic accident(9 out of 13 cases). 2. The associated injuries were brachlal plexopathy(1), rib fractures(1) and femur fractures (1). 3. The types of fractures were type B(7 cases), and type C(6 cases) according to AO/ASIF classification. 4. Open reduction and internal fixation was performed with T plate and tension band wiring, if necessary. 5. The excellent results were 4 cases and satisfactory results were 5 cases according to Neer criterla.

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Operative treatment of the tibial pilon fractures following AO/ASIFprinciple: Key Yong Kim, Sung Il Bin, Won Hyeok Oh; J Korean Soc Fract 1992;5(1):129-137. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.129

Abstract PDF: No abstract available.

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A Clinical Study of tibial Pilon Fractures: Key Yong Kim, Duck Yun Cho, Jai Gon Seo, Sung Bum Yang, Kyu Jung Cho; J Korean Soc Fract 1989;2(2):211-218. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.211

Abstract PDF: The tibial pilon fracture is one of the most difficult fracuture to treat because of severe metaphyseal bone defect, comminution of the articular surface, disruption of ankle mortise and accompanying soft tissues injury resulting from axial compression and rotational forces. The recent concept of management of tibial pilon fracture is to open and provide anatomical reduction with stable internal fixation, early joint motion and considerably delayed weight bearing. We reviewed 16 cases of tibial pilon fracture experienced from June 1985 to December 1 988 and the result were as follows; Tibial pilon fracture comprises 8.7% of all ankle fractures(183 cases) during the period and prevalent in male. According to the classification by Ruedi and Allgoewer, 2 cases of typeI, 9 cases of type II and 5 cases of type III. 3 cses treated conservatively and 13 cases operatively. Better results were obtaiined in latter group, and in typeI and type II than III. The important factors influencing the clinical result were the type of fracture and accuracy of reduction including maintainace of fibular length.

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