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Most-read are based on citations from 2023 ~ 2025.

Review Article
Treatment of avulsion fractures around the knee
Jeong-Hyun Koh, Hyung Keun Song, Won-Tae Cho, Seungyeob Sakong, Sumin Lim
J Musculoskelet Trauma 2025;38(2):63-73.   Published online March 31, 2025
DOI: https://doi.org/10.12671/jmt.2025.00073
AbstractAbstract PDF
Avulsion fractures of the knee occur when tensile forces cause a bone fragment to separate at the site of soft tissue attachment. These injuries, which frequently affect adolescent athletes, can involve the cruciate and collateral ligaments, arcuate complex, iliotibial band, and patellar and quadriceps tendons. Radiographs aid in the initial diagnosis, while computed tomography and magnetic resonance imaging facilitate a comprehensive evaluation of injury severity and concomitant damage. Specific avulsion fracture types include: anterior cruciate ligament avulsions (tibial site, Meyers and McKeever classification), posterior cruciate ligament avulsions (tibial attachment, Griffith's classification), Segond fractures (anterolateral complex injury), iliotibial band avulsions, medial collateral ligament avulsions (reverse Segond, Stieda fractures), arcuate complex avulsions ("arcuate sign"), medial patellofemoral avulsions (patellar dislocations), and patellar/quadriceps tendon avulsions. The treatment depends on the fracture location, displacement, and associated injuries. Non-displaced fractures can be managed conservatively, while displaced fractures or those with instability require surgical reduction and fixation. Prompt recognition and appropriate intervention prevent complications such as deformity, nonunion, malunion, and residual instability. This review provides an overview of the pathogenesis, diagnosis, and management of knee avulsion fractures to guide clinical decision-making.
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Original Articles
Restoration of Lateral Tibial Plateau Widening and Articular Depression Is Necessary to Prevent Valgus Deformities after Arthroscopic Reduction and Internal Fixation in AO/OTA 41.B2 or B3 Fractures
Jun-Ho Kim, Kang-Il Kim, Sang-Hak Lee, Gwankyu Son, Myung-Seo Kim
J Korean Fract Soc 2024;37(3):125-136.   Published online July 31, 2024
DOI: https://doi.org/10.12671/jkfs.2024.37.3.125
AbstractAbstract PDF
Purpose
This study examined the factors affecting valgus deformities after arthroscopic reduction and internal fixation (ARIF) in lateral joint-depression tibial plateau fractures.
Materials and Methods
Patients with lateral joint-depression tibial plateau fractures treated with ARIF were assessed retrospectively. The radiological evaluations included the articular depression distance (ADD) and the lateral plateau widening distance (LPWD) on preoperative and postoperative computed tomography. A postoperative valgus deformity was defined as valgus malalignment (mechanical axis ≥3°) and valgus deviation (Δmechanical axis of the operated knee from the healthy knee of ≥5°). Subgroup analyses based on a postoperative valgus deformity were performed to compare the clinical outcomes, including the range of motion, patient-reported outcomes measures, and failure and osteoarthritis progression. Furthermore, factors affecting the postoperative mechanical and Δmechanical axes were assessed.
Results
Thirty-nine patients were included with a mean follow-up of 44.6 months (range, 24-106 months). Valgus malalignment and valgus deviation were observed after ARIF in 10 patients (25.6%) and five patients (12.8%), respectively. The clinical outcomes were similar in patients with and without a postoperative valgus deformity. On the other hand, lateral compartment osteoarthritis progression was significantly higher in the valgus deformity group than in the non-valgus deformity group (valgus malalignment group: 50.0% vs 6.9%, p=0.007; valgus deviation group: 60.0% vs 11.8%, p=0.032). One patient with valgus deformity underwent realignment surgery at postoperative five years. The preoperative ADD and postoperative LPWD were significantly associated with the postoperative mechanical (both, p<0.001) and Δmechanical (ADD, p=0.001; LPWD, p=0.025) axes. Moreover, the lateral meniscectomized status during ARIF was significantly associated with the Δmechanical axis (p=0.019).
Conclusion
Osteoarthritis progression was highly prevalent in patients with postoperative valgus deformity. Thus, the restoration of lateral plateau widening and articular depression and preservation of the meniscus are necessary to prevent a valgus deformity after ARIF in lateral joint-depression tibial plateau fractures.
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Does the Operator’s Experience Affect the Occurrence of Complications after Distal Radius Fracture Volar Locking Plate Fixation? A Comparative Study of the First Four Years and Thereafter
Kee-Bum Hong, Chi-Hoon Oh, Chae Kwang Lim, Sungwoo Lee, Soo-Hong Han, Jun-Ku Lee
J Musculoskelet Trauma 2024;37(4):175-183.   Published online October 25, 2024
DOI: https://doi.org/10.12671/jmt.2024.37.4.175
Correction in: J Musculoskelet Trauma 2025;38(1):40
AbstractAbstract PDF
Purpose
The management of distal radius fractures (DRFs) has evolved with the introduction of volar locking plate (VLP) fixation, offering stable fixation and better outcomes. Nevertheless, the impact of the surgeon’s experience on the complication rates in VLP fixation remains to be determined, particularly for less-experienced surgeons. This study compared the complication rates during the initial four years and subsequent two years of a hand surgeon’s practice of VLP fixation for DRFs.
Materials and Methods
The data between March 2016 and December 2022 were analyzed retrospectively under the Institutional Review Board approval. A single surgeon performed all VLP fixation surgeries after finishing regular hand surgery training, with the first four years representing the less experienced phase (Group 1) and the following two years indicating the experienced phase (Group 2). The patients’ characteristics, operation-related factors, and postoperative complications, including tendon injuries, nerve-related complications, fixation and instrument-related issues, osteosynthesis-related problems, and infections, were compared. In addition, the authors compared the data with a large multicenter study conducted by experienced hand surgeons.
Results
Three hundred and nineteen patients (321 wrists) were included. The mean age was 63.3 years, and 26.3% were male and 73.7% were female. The operation time was 53.7±14.5 minutes and 74.4±26.5 minutes in groups 1 and 2, respectively, which was statistically significantly shorter (p<0.001). The complication rates between the two groups were similar, except for the higher implant removal rates in Group 1. A comparison with a previous multicenter study revealed higher reduction losses and carpal tunnel syndrome in this study, but the overall complication rate was low.
Conclusion
In DRF management, when the operating surgeon has completed an accredited training course, VLP fixation is a good treatment method that can be performed effectively even by less experienced surgeons with low complication rates.

Citations

Citations to this article as recorded by  
  • Author correction: “Does the operator's experience affect the occurrence of complications after distal radius fracture volar locking plate fixation? A comparative study of the first four years and thereafter”
    Kee-Bum Hong, Chi-Hoon Oh, Chae Kwang Lim, Sungwoo Lee, Soo-Hong Han, Jun-Ku Lee
    Journal of Musculoskeletal Trauma.2025; 38(1): 40.     CrossRef
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Review Articles
Fragility Fractures of the Pelvis and Sacrum
Se-Won Lee, Ju-Yeong Kim
J Korean Fract Soc 2023;36(1):29-38.   Published online January 31, 2023
DOI: https://doi.org/10.12671/jkfs.2023.36.1.29
AbstractAbstract PDF
The incidence of fragility fractures of the pelvis (FFP) has increased significantly due to the aging popu-lation and improved diagnostic modalities. The evaluation and treatment of these patients differ from that of high-energy pelvic ring injuries typically seen in younger patients. Therefore, it is important to classify the FFP by patterns of the classification system to standardize optimal treatment criteria and appropriate treatment strategy. However, some cases are not classifiable according to the FFP classifi-cation. A newly proposed classification that can be verified by comparing existing FFP classifications is needed to overcome the weak points. Non-operative treatment is usually considered first and should focus on early mobilization. Operative fixation should focus on stabilizing the minimally invasive pelvic ring than the reduction of fractures to facilitate early mobilization and avoid complications that can arise from comorbidities associated with immobility.
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Avulsion fractures around the hip joint and pelvis
Won-Sik Choy, Yonghan Cha, Jung-Taek Kim, Jun-Il Yoo, Jin-Woo Kim
J Musculoskelet Trauma 2025;38(2):53-62.   Published online March 24, 2025
DOI: https://doi.org/10.12671/jmt.2025.00010
AbstractAbstract PDF
Avulsion fractures occur when tendons or ligaments are subjected to forces greater than they can withstand at the apophysis or enthesis, regardless of fusion status. The pelvis and hip joint are vulnerable to these injuries due to the diverse muscular structures in these structures, which serve as origins for multiple muscles leading to the lower extremities. Pelvic avulsion fractures commonly affect young athletes, but can also occur in adults. The diagnosis typically involves assessing trauma history, a clinical examination, and radiographic imaging. If the diagnosis is unclear, additional tests such as computed tomography and magnetic resonance imaging may assist in the diagnosis and provide useful information for treatment decisions. While most avulsion fractures respond well to conservative treatment, surgical intervention may be preferred in severe displacements, cases of significant retraction in active athletes, or when a faster recovery is necessary. Chronic or neglected injuries may lead to excessive osseous formation around the pelvis, causing impingement syndromes. Recognizing characteristic radiological findings based on pelvic anatomy helps to make an accurate diagnosis, as chronic injuries can mimic tumors or infectious conditions, necessitating a careful differential diagnosis.
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Fluid Management of Trauma Patients
Yo Huh, Jaeri Yoo
J Korean Fract Soc 2023;36(2):69-76.   Published online April 30, 2023
DOI: https://doi.org/10.12671/jkfs.2023.36.2.69
AbstractAbstract PDF
Fluid therapy is one of the fundamental treatments for the management of trauma patients. Apart from supplementary hydration, fluid therapy is also applied for resuscitation. Especially in cases of hypovolemic shock due to bleeding, fluid therapy needs to be carefully adjusted to correct the shock. The importance of fluid therapy is increasing not only in resuscitation and treatment after hospitalization but also in pre-hospital care. Fluid therapy needs to be adjusted based depending each patient’s volume status. The various classifications of fluids include crystalloid solutions, glucose solutions, and colloid solutions. Although not included as a fluid therapy, blood transfusion is increasingly gaining more importance than fluid therapy in unstable trauma patients. Early appropriate fluid therapy is crucial in the treatment of hemodynamically unstable patients such as multiple trauma and massive bleeding, whereas comprehensive fluid therapy should be applied by considering the characteristics of specific injuries such as fractures, vascular damage, and cerebral hemorrhage, as well as the age groups (children, the elderly, and pregnant women).

Citations

Citations to this article as recorded by  
  • Effectiveness of the Eye Care Protocol in the Intensive Care Unit Patients: A Randomized Controlled Trial
    Kyu Won Lim, Shin Young Ha, In Soon Kang
    Journal of Korean Academy of Nursing.2024; 54(3): 432.     CrossRef
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Atypical femoral fractures: an update
Won-Tae Cho, Jeong-Hyun Koh, Seungyeob Sakong, Jung-Taek Kim
J Musculoskelet Trauma 2025;38(2):41-52.   Published online March 28, 2025
DOI: https://doi.org/10.12671/jmt.2025.00031
AbstractAbstract PDF
This narrative review provides an up-to-date overview of atypical femoral fractures (AFFs), emphasizing diagnostic criteria, epidemiology, pathophysiology, risk factors, and evaluation with screening strategies. AFFs are rare but significant complications associated with prolonged bisphosphonate (BP) therapy for osteoporosis. Although the pathogenesis of AFFs has not been fully elucidated, its primary mechanism is thought to involve impaired bone remodeling, leading to unhealed microfractures that progress to stress fractures under repetitive loading. AFFs can occur in various regions of the femur, influenced by femoral geometry and the lower limb axis. Other risk factors include prolonged steroid use, arthroplasty, genetic predispositions, and metabolic bone disorders. The diagnosis of AFFs is based on criteria established by the American Society for Bone and Mineral Research. Key radiographic features include lateral cortical transverse fracture lines and localized cortical thickening, typically with minimal or no comminution on the medial cortex. Dual-energy X-ray absorptiometry for screening tests and magnetic resonance imaging as an advanced imaging modality enable the early detection of incomplete fractures. This multi-modal approach facilitates the prompt identification of prodromal cortical changes, reducing the risk of complete fractures in high-risk populations, particularly patients undergoing prolonged BP therapy. Level of Evidence: V
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Original Articles
Acute Compartment Syndrome of Thigh: Ten-Year Experiences from a Level I Trauma Center
Hyung Keun Song, Won-Tae Cho, Wan-Sun Choi, Seung-Yeob Sakong, Sumin Im
J Musculoskelet Trauma 2024;37(4):171-174.   Published online October 25, 2024
DOI: https://doi.org/10.12671/jmt.2024.37.4.171
AbstractAbstract PDF
Purpose
To assess the demographics, injury mechanisms, treatments, and outcomes of traumatic acute compartment syndrome in the thigh.
Materials and Methods
Patients diagnosed with thigh compartment syndrome were analyzed retrospectively at the authors’ level I trauma center from March 2012 to February 2022. Data were collected from medical and radiological records, focusing on demographics, injury details, treatment timelines, and clinical outcomes.
Results
The cohort included 13 patients (11 males and 2 females) with a mean age of 46 years. Injuries primarily resulted from falls (6 patients) and vehicle accidents (5 patients). Fractures were noted in 11 patients, with seven involving the lower extremities and seven having open fractures; three of these were severe enough to be classified as Gustilo–Anderson type IIIc with associated femoral artery injuries. Time from the injury to fasciotomy ranged from within six hours to more than 24 hours. Fasciotomies were mainly single-sided (10 patients), targeting primarily the anterior compartments, and bilateral in three cases. Wound closures were performed using delayed primary closure (four patients) and partial- thickness skin grafts (five patients). Two patients died from multi-organ failure; other complications included infections (three patients), amputations (three patients), and long-term disabilities like drop foot (two patients), sensory deficits, joint stiffness (eight patients), and fracture non-unions requiring additional surgery (two patients).
Conclusion
Thigh-compartment syndrome, though infrequent, poses significant risks of mortality and chronic disability. This underscores the importance of prompt diagnosis and intervention.
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Outcomes of open reduction and internal fixation using 2.0/2.4 mm locking compression plate in isolated greater tuberosity fractures of humerus
Sung Choi, Dongju Shin, Sangwoo Kim, Byung Hoon Kwack
J Musculoskelet Trauma 2025;38(1):32-39.   Published online January 24, 2025
DOI: https://doi.org/10.12671/jmt.2025.00005
AbstractAbstract PDF
Background
The purpose of this study was to retrospectively evaluate the radiographic and clinical results of a small single or double low-profile plate fixation of 2.0/2.4 mm locking compression plate (LCP) in treating isolated greater tuberosity (GT) fractures of the humerus. Methods: From June 2015 to October 2022, patients who underwent LCP in treating isolated GT fractures of the humerus were included in this study. The radiological and clinical results were analyzed in 15 patients who underwent open reduction and internal fixation used 2.0/2.4 mm LCP. Results: Bone union was achieved in 14 patients (93.3%) and one failed case was treated with a 2.4 mm single LCP fixation. Radiological union was achieved within 10–20 weeks. Complications occurred in two patients (13.3%), including the reduction failure and shoulder stiffness. At the final follow-up, the average clinical scores were as follows: a visual analog scale for pain of 2.1 (range, 0–5) and a University of California, Los Angeles score of 27.2 (range, 18–31). Regarding range of motion (ROM), the average active ROMs were 142° for forward flexion (range, 120°–150°), 147.1° for abduction (range, 120°– 180°), and 59.3° for external rotation (range, 45°–80°). For internal rotation, the average was observed to reach the 10th thoracic vertebra (range, 1st lumbar vertebra–7th thoracic vertebra). Conclusions: The clinical and radiologic outcomes of treating isolated GT fracture using 2.0/2.4 mm LCP were favorable, and double low-profile plate fixation may be beneficial for sufficient fracture stability if possible. Level of evidence: Level IV, case series.
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Editorial
A new milestone: launching the Journal of Musculoskeletal Trauma to foster global orthopaedic trauma collaboration
Kang-il Kim
J Musculoskelet Trauma 2025;38(1):1-2.   Published online December 27, 2024
DOI: https://doi.org/10.12671/jmt.2025.00001
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Review Article
Easily missed nondisplaced fractures accompanying complete fractures in the lower extremity and pelvis: a narrative review
Young-Chang Park
J Musculoskelet Trauma 2025;38(1):5-12.   Published online January 24, 2025
DOI: https://doi.org/10.12671/jmt.2025.00017
AbstractAbstract PDF
Nondisplaced fractures accompanying complete fractures are often difficult to detect on plain radiographs or computed tomography scans, posing a diagnostic challenge. The diagnosis of these frequently overlooked injuries can be delayed, potentially leading to suboptimal patient outcomes. This review discusses four commonly missed fracture patterns in the lower extremity and pelvis, including posterior involvement in fragility fractures of the pelvis, intertrochanteric extensions in isolated greater trochanter fractures, ipsilateral femoral neck fractures in high energy femoral shaft fractures, and posterior malleolar fractures in distal spiral tibial shaft fractures. An accurate diagnosis of these accompanying nondisplaced fractures is critical for optimizing surgical outcomes. Surgeons should incorporate thorough preoperative evaluations into their clinical practice to facilitate early detection and appropriate treatment strategies. Prompt identification and comprehensive management remain essential for improving patient outcomes.
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Original Article
The clinical outcome of treating elderly distal radius fractures by long volar locking plate with the elimination of irreducible metaphyseal comminuted volar cortical fragments: a retrospective case series
Soo Min Cha
J Musculoskelet Trauma 2025;38(1):13-22.   Published online January 24, 2025
DOI: https://doi.org/10.12671/jmt.2025.00003
AbstractAbstract PDF
Background
In severe comminuted metaphyseal distal radius fracture (DRF) of elderly patients, after maintaining only radiological parameters of the radius using long volar locking plates (VLPs), we inevitably eliminated a few volar cortical fragments of metaphysis. Here, we report the final radiological and clinical outcomes of our method. Methods: For the patients who were treated between 2014 and 2018, the demographic factors, the preoperative radiologic factors, area of the eliminated volar cortical fragment, and final radiologic parameter, were evaluated. Clinical outcomes and ranges of active motion were evaluated. Results: In total, 31 patients were included. The mean patient age was 77.3 years and the mean eliminated cortical area was 3.30 cm2. At the final follow-up, the mean volar tilt, radial inclination, articular step-off, and ulnar variance were 10.35°, 20.00°, 0.58 mm, and 0.71 mm, respectively. There were no definitive correlations between bone mineral density, fragment area, the largest cortical fragment diameter ratio and differences in final and immediate postoperative measurements of these radiological parameters, respectively. Visual analog scale and disabilities of the arm, shoulder, and hand (DASH) scores were satisfactory, and the mean arcs of flexion-extension and pronation-supination were 124.35° and 133.23°. Clinical outcomes were not significantly different according to the AO system category. Conclusions: For maintenance of radiological parameters of the radius, long VLPs are useful in older patients with DRFs who exhibit volar metaphyseal comminution, despite concurrent ulnar fractures. Inevitable elimination of irreducible free comminuted cortical fragments when filling the defect does not affect final radiological and clinical outcomes. Level of evidence: Level IV, case series.
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Review Article
Avulsion Fractures around the Hip Joint and Pelvis
Ha-Yong Kim, Hajun Jang, Jung-Taek Kim, Jin-Woo Kim, Jun-Il Yoo, Won-Sik Choy, Yonghan Cha
J Korean Fract Soc 2024;37(3):150-157.   Published online July 31, 2024
DOI: https://doi.org/10.12671/jkfs.2024.37.3.150
AbstractAbstract PDF
Avulsion fractures occur when tendons or ligaments are subjected to forces greater than they can withstand at the apophysis or enthesis, regardless of the fusion status. Given the diverse muscular structures around the pelvis and hip joint, which serve as origins for multiple muscles leading to the lower extremities, these areas are vulnerable to such injuries. Pelvic avulsion fractures commonly af-fect young athletes, but they can also occur in adults. Diagnosis typically involves assessing the trauma history, clinical examination, and radiographic imaging. In cases of unclear diagnosis, additional tests, such as computed tomography or magnetic resonance imaging, may assist in treatment decisions and diagnosis. Although most avulsion fractures respond well to conservative treatment, surgical interven-tion may be preferred in severe displacements, significant retraction in active athletes, or when a faster recovery is necessary. Chronic or neglected injuries may lead to excessive osseous formation around the pelvis, causing impingement syndromes. Recognizing the characteristic radiological findings based on the pelvic anatomy aids in accurate diagnosis because chronic injuries might mimic tumors or infectious conditions, necessitating a careful differential diagnosis.
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Editorial
Introducing the Journal of Musculoskeletal Trauma
Jae Ang Sim
J Musculoskelet Trauma 2025;38(1):3-4.   Published online December 27, 2024
DOI: https://doi.org/10.12671/jmt.2025.00002
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Review Article
Crush Syndrome: Traumatic Rhabdomyolysis, Reperfusion Injury
Yong-Cheol Yoon
J Korean Fract Soc 2023;36(2):62-68.   Published online April 30, 2023
DOI: https://doi.org/10.12671/jkfs.2023.36.2.62
AbstractAbstract PDF
A crush injury causes damage to bones, muscles, blood vessels, nerves, and other tissues caused due to pressure. Crush syndrome is a reperfusion injury that occurs throughout the body after a crush injury and leads to traumatic rhabdomyolysis, in which muscle fibers are broken down. Owing to the decreased blood supply, inflammation, and changes in metabolic activity, fluids and electrolytes in the blood can move into tissues, causing hypovolemic shock. In addition, toxic substances resulting from cell destruction can circulate through the bloodstream, causing electrolyte imbalances, renal failure, arrhythmias, and cardiac arrest, with approximately 15% of patients with acute renal failure dying. The treatment for crush syndrome involves aggressive fluid therapy and correction of the electrolyte imbalances, while patients with acute renal failure may require dialysis. Surgical treatment may include debridement and irrigation of necrotic tissue, and fasciotomy is necessary to address compartment syndrome, a complication that may arise.
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Original Articles
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
AbstractAbstract 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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The Efficiency of Radiation Shielding Sheet to Reduce Radiation Exposure during C-arm Fluoroscopy
Hosang Jeon, Won Chul Shin, Hee Yun Seol, Yongkan Ki, Kyeong Baek Kim, Ki Seok Choo, Sang Don Lee, Suk-Woong Kang
J Korean Fract Soc 2023;36(4):111-117.   Published online October 31, 2023
DOI: https://doi.org/10.12671/jkfs.2023.36.4.111
AbstractAbstract PDF
Purpose
This study evaluates the radiation shielding performance of a new lead-free tungsten-based sheet to reduce the radiation exposure of operators and patients under C-arm fluoroscopy.
Materials and Methods
A non-lead radiation shielding sheet (ROO201128; Pentas, Korea) was fabri-cated using tungsten and bismuth. The dose measurements were conducted using a C-arm fluoroscopy machine at 64 kVp and 1.5 mA, assuming two possible scenarios according to the position of the sheet. In each scenario, measurements were conducted at three distances (30, 60, and 90 cm) away from the beam center and in three directions (cephal, caudal, and operator’s direction).
Results
In the area within a radius of 60 cm from the beam center, the measured doses were reduced by 66.3% on mean, and the doses measured at distances more than 60 cm were less than 0.1 mSv/h in both scenarios. The most beneficial utilization of the lead-free shielding sheet was verified during C-arm fluoroscopy by placing the sheet on the X-ray tube. The operator’s radiation exposure was reduced by 56.6% when the sheet was placed under the phantom, and by 81.0% when the sheet was placed on the X-ray tube.
Conclusion
The use of lead-free radiation shielding sheets under C-arm fluoroscopy was effective in reducing radiation exposure, and the most beneficial scenario in which the sheet can be utilized was verified when the sheet was placed on the X-ray tube.
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Effect of Coincident Hip Fracture on Distal Radius Fracture in Patients Treated with a Volar Locking Plate: A Matched-Pair Analysis of Elderly Patients
Hyoung-Seok Jung, Min-Su Chu, Jae-Sung Lee
J Korean Fract Soc 2024;37(3):137-143.   Published online July 31, 2024
DOI: https://doi.org/10.12671/jkfs.2024.37.3.137
AbstractAbstract PDF
Purpose
Although the incidence of simultaneous distal radius and hip fractures in older patients is minimal, patients with these coincident types of fractures exhibit unique features. This study analyzed the outcomes associated with operative treatment involving volar-locking plates in patients who sustained distal radius fractures and hip fractures and compared them with those in matched control patients who had undergone treatment for isolated distal radius fractures.
Materials and Methods
Between 2010 and 2015, 34 patients, who met the criteria for hip and distal radius fractures, were retrospectively reviewed. Thirty-four matched patients who underwent volarlocking plate fixation for isolated distal radius fractures during the same period were also reviewed. The clinical outcomes between the groups were compared using postoperative radiological parameters.
Results
The radiological assessment revealed a better radial length and inclination in the control group than in the study group at the final follow-up. In other words, patients with coincident hip fractures showed a higher tendency for loss of reduction. Despite the differences in radiological parameters, no significant differences in clinical outcomes were observed, except for grip strength.
Conclusion
Although volar-locking plating provides greater stabilization, a loss of reduction occurred in patients with coincident hip fractures.
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Review Articles
Avulsion Fractures in the Ankle and Foot
Gyeong Hoon Lim, Jae Won Kim, Sung Hyun Lee
J Korean Fract Soc 2024;37(2):102-116.   Published online April 30, 2024
DOI: https://doi.org/10.12671/jkfs.2024.37.2.102
AbstractAbstract PDF
An avulsion fracture occurs when a muscle-tendon unit attached to a bone produces sufficient force to tear a fragment of the bone. If not treated properly, this injury can lead to deformity, nonunion, malunion, pain, and disability. Although avulsion fractures around the foot and ankle can occur anywhere there are tendon and ligament attachments, they are common in the anterior talofibular ligament, anterior-inferior tibiotalar ligament, calcaneal tuberosity, the base of the fifth metatarsal, and navicular bone. The optimal treatment for each fracture depends on the location and severity of the fracture. Conservative treatment involves limiting weight bearing for a period, splint immobilization, and using various orthoses. Surgical treatment is usually reserved for cases of severe displacement or when nonsurgical treatment has failed. The goals of surgery include reduction of the fracture fragment, prevention of nonunion or malunion and soft tissue injury, and early return to function. The decision for each treatment modality may depend on the patient demographics or preferences and the surgeon experience. This review summarizes previous and current views on the pathogenesis, diagnosis, and treatment of common avulsion fractures to guide the treatment and diagnosis.
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Fracture-Related Complication: Fat Embolism Syndrome
Beom-Soo Kim
J Korean Fract Soc 2023;36(3):95-102.   Published online July 31, 2023
DOI: https://doi.org/10.12671/jkfs.2023.36.3.95
AbstractAbstract PDF
Fat embolization is a common occurrence after trauma or during orthopedic procedures involving intramedullary manipulation. Although uncommon, fat embolism syndrome (FES) with respiratory failure, neurologic dysfunction, and petechial rash can be fatal to patients. Two theories are proposed for the manifestation of FES: in the mechanical theory, FES occurs when fat tissue in the bone marrow enters the bloodstream and mechanically blocks it; the biochemical theory proposes that FES occurs due to an inflammatory reaction caused by free fatty acids. There are currently no clear diagnostic criteria for FES, and symptoms and signs are typically nonspecific. For the treatment of FES, conservative and supportive management is performed for the specific symptoms, and close monitoring of the respiratory and neurologic systems is required in high-risk groups. Early fracture fixation of long bones helps prevent and reduce the severity of fat embolism.
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Original Articles
Computational Simulation of Femoral Neck System and Additional Cannulated Screws Fixation for Unstable Femoral Neck Fractures and the Biomechanical Features for Clinical Applications
Ju-Yeong Kim
J Korean Fract Soc 2023;36(1):1-9.   Published online January 31, 2023
DOI: https://doi.org/10.12671/jkfs.2023.36.1.1
AbstractAbstract PDF
Purpose
To identify the biomechanical features for clinical applications through a computational simulation of the fixation of the Femoral Neck System (FNS) with additional cannulated screws for a Pauwels type III femoral neck fractures.
Materials and Methods
Thirty cadaveric femurs underwent computed tomography, and the images were transferred to the Mimics ® program, resulting in three-dimensional proximal femur models. A three-dimensional scan of the FNS and 6.5 mm and 7.0 mm cannulated screws was performed to enable computerized virtual fixation of FNS with additional cannulated screws for unstable femoral neck fractures. Furthermore, the cannulated screw used for additional fixation was modeled and used as a cylinder within the Ansys program. The biomechanical characteristics of these models were investigated by applying a physiological load virtually.
Results
The maximum von Mises stress value at bone was 380.14 MPa in FNS and 297.87 MPa in FNS+7.0 mm full-thread cannulated screw. The maximum von Mises stress value at FNS was 786.83 MPa in FNS and 435.62 MPa in FNS+7.0 mm full-thread cannulated screw. The FNS group showed the highest maximum von Mises stress values at bone and FNS. For total deformation, the maximum deformation value was 10.0420 mm in FNS and 9.2769 mm in FNS+7.0 mm full-thread cannulated screws. The FNS group represented the highest maximum deformation compared to the other groups.
Conclusion
Considering the anatomical spatiality and biomechanical characteristics of the FNS in unstable femoral neck fractures, when one 7.0 mm full thread cannulated screw was also fixed to the anterosuperior portion of the FNS, significant biomechanical stability was demonstrated.
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Biomechanical Investigation to Establish Stable Fixation Strategies for Distal Tibial Fractures in Various Situations: Finite Element Analysis Studies
Sung Hun Yang, Jun Young Lee, Gu-Hee Jung, Hyoung Tae Kim, Ba Woo Ko
J Korean Fract Soc 2024;37(2):71-81.   Published online April 30, 2024
DOI: https://doi.org/10.12671/jkfs.2024.37.2.71
AbstractAbstract PDF
Purpose
This study examined the structural and mechanical stability as well as the clinical significance of various fixation constructs for distal tibial fractures using finite element analysis.
Materials and Methods
Fracture models with 20 mm and 120 mm defects were produced, and implants of an intramedullary nail and anatomical plate model were applied. An axial load of 800 N with 60% distribution in the medial compartment and 40% in the lateral compartment was applied and analyzed using Ansys ® software.
Results
In the intramedullary nail model, the maximum von Mises stress occurred at the primary lag screw hole and adjacent medial cortex, while in the plate model, it occurred at the locking holes around the fracture. The maximum shear stress on the bone and metal implant in the fracture model with a 20 mm defect was highest in the plate assembly model, and in the fracture model with a 120 mm defect, it was highest in the two-lag screw assembly model.
Conclusion
Based on an analysis of the maximum shear stress distribution, securing the fixation strength of the primary lag screw hole is crucial, and the assembly model of the intramedullary nail with two lag screws and a blocking screw applied was the model that best withstood the optimal load. Securing the locking hole directly above the fracture is believed to provide the maximum fixation strength because the maximum pressure in the plate model is concentrated in the proximal locking hole and the surrounding cortex.
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Comparison of Results between Minimally Invasive Plate Fixation and Antegrade Intramedullary Nailing of Recon-Type in Low-Energy Injury Distal Femoral Shaft Fractures
Hong Moon Sohn, Gwangchul Lee, Ba Rom Kim, Jung Soo Oh
J Korean Fract Soc 2024;37(2):87-94.   Published online April 30, 2024
DOI: https://doi.org/10.12671/jkfs.2024.37.2.87
AbstractAbstract PDF
Purpose
This study compared the outcomes of minimally invasive plate osteosynthesis and antegrade intramedullary nailing for low-energy fracture of the distal femoral shaft.
Materials and Methods
A study was conducted on 30 patients who underwent surgery for low-energy fractures of the distal femoral shaft between January 2016 and April 2022. The study compared 15patients who underwent minimally invasive plate osteosynthesis (Group P) with 15 patients who underwent recon-type antegrade intramedullary nailing (Group N). We evaluated intraoperative blood loss, operative time, C-arm exposure time, bone density, final union status, anatomical reduction, and clinical evaluation. The complications were also examined, and statistical analysis was conducted to compare the two groups.
Results
The blood loss, surgery time, and C-arm time were similar in the two groups. The radiographic assessments and clinical evaluations were also similar in the two groups. The clinical results showed no difference between the groups. Group N had one case of nonunion and one case of delayed union, while Group P had one case of nonunion and one case of peri-prosthetic fracture.
Conclusion
Antegrade intramedullary nailing of the recon-type demonstrated comparable results to minimally invasive plate osteosynthesis. Hence, antegrade intramedullary nailing of the recon-type, which enhances stability by fixing the entire femur and providing additional fixation in the distal portion, is deemed appropriate for treating distal femoral shaft fractures.
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Comparison of outcomes of reinforced tension band wiring and precontoured plate and screw fixation in the management of Mayo type IIIB olecranon fractures
Hyun Goo Kang, Tong Joo Lee, Samuel Jaeyoon Won
J Musculoskelet Trauma 2025;38(2):96-101.   Published online February 28, 2025
DOI: https://doi.org/10.12671/jmt.2025.00059
AbstractAbstract PDF
Background
Mayo type IIIB olecranon fractures are characterized by significant displacement and comminution, presenting a challenge in selecting the appropriate fixation technique. This study compared the clinical and radiographic outcomes, complications, and reoperation rates of reinforced tension band wiring (TBW) and precontoured plate and screw fixation (PF) in the surgical treatment of Mayo type IIIB olecranon fractures.
Methods
This retrospective review analyzed 24 patients diagnosed with Mayo type IIIB olecranon fractures, who were treated between 2005 and 2023. Of these, 11 patients underwent reinforced TBW, and 13 received precontoured PF. Clinical outcomes were assessed using Disabilities of the Arm, Shoulder, and Hand (DASH) scores and the Mayo Elbow Performance Score (MEPS). Radiographic outcomes focused on fracture union. Operative times, complication rates, and reoperation rates were compared between the groups.
Results
Both the reinforced TBW and PF groups achieved satisfactory clinical outcomes, with no significant between-group differences in DASH and MEPS scores (P>0.05). Radiographic union was achieved in all patients. The reinforced TBW group demonstrated a significantly shorter operative time than the PF group (93.6±7.4 min vs. 132.3±13.7 min; P<0.001). Complication rates were similar between the two groups (reinforced TBW, 38.4%; PF, 36.3%), but hardware-related irritation occurred more frequently in the reinforced TBW group. Reoperations were required in 15.8% of the reinforced TBW group due to hardware irritation, whereas no reoperations were necessary in the PF group.
Conclusions
Reinforced TBW and PF are both effective surgical options for managing Mayo type IIIB olecranon fractures, yielding comparable clinical and radiographic outcomes. While reinforced TBW offers shorter operative times and lower costs, PF is associated with fewer hardware-related complications. Further prospective studies are needed to optimize treatment strategies for these complex fractures. Level of Evidence: Level III.
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Review Articles
Hip Fractures in the Elderly: Perioperative Management and Prevention of Medical Complications
Keong-Hwan Kim
J Korean Fract Soc 2023;36(1):39-44.   Published online January 31, 2023
DOI: https://doi.org/10.12671/jkfs.2023.36.1.39
AbstractAbstract PDF
Elderly patients with hip fractures are at an increased risk of developing medical complications with higher mortality rates. Most patients require surgical treatment, and an early surgical intervention can reduce complications and lower mortality risk. A restrictive red blood cell transfusion strategy is usually applied, and the amount of transfusion can be reduced through medications such as tranexamic acid. Delirium can be prevented using non-pharmacological methods. In addition, it is necessary to prevent venous thromboembolism through mechanical or chemical prophylaxis. A multidisciplinary approach using the ERAS (Enhanced Recovery After Surgery) protocol and orthogeriatric care can help to reduce medical complications and mortality.
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Checkrein Deformity after Fracture
Jungtae Ahn, Gu-Hee Jung
J Korean Fract Soc 2024;37(1):60-68.   Published online January 31, 2024
DOI: https://doi.org/10.12671/jkfs.2024.37.1.60
AbstractAbstract PDF
Checkrein deformity has dynamic characteristics in which the degree of extension contracture of the metatarsophalangeal joint and flexion contracture of the interphalangeal joint change according to the movement of the ankle joint. Although the primary lesion is the flexor hallucis longus, several clinical features exist because of the accessory connection with the flexor tendon of other toes. After a physical diagnosis, a radiological examination should be performed to determine the cause and location of adhesion. Moreover, it is vital to determine if it is direct adhesion to the tendon tissue or muscle contracture due to ischemic muscle damage. Although there are no clear guidelines for surgical treatment, it can be divided broadly into two methods: soft tissue release and Z-plasty performed through direct access to the lesion site or indirect access through the tarsal tunnel or medial midfoot approach. Direct tendon tissue release surgery should be attempted if the tendon tissue is locally attached to the fracture callus or specific soft tissue. On the other hand, operation on the lesion site should be performed first if the checkrein deformity occurred due to an implant or bone fragments, followed by release surgery. If muscle contracture and movement are limited due to ischemic damage, surgery should be performed to remove adhesions and additional tendon connections around the flexor hallucis longus and digitorum longus by approaching through the tarsal canal and the medial side of the midfoot. The fixed contractures of the metatarsophalangeal and interphalangeal joints should be addressed if the limitations of tendon excursion are identified despite the release techniques.
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Avulsion Fractures of around the Hand
Dong Whan Kim, Jung Il Lee
J Korean Fract Soc 2024;37(3):158-168.   Published online July 31, 2024
DOI: https://doi.org/10.12671/jkfs.2024.37.3.158
AbstractAbstract PDF
An avulsion fracture occurs when soft tissues, including the tendons and ligaments, are forcibly detached from the main bone by an external force. The hand contains numerous anatomical structures, such as ligaments, tendons, and volar plates, which are essential for maintaining multidirectional motion and joint stability. Excessive force applied in a specific direction can damage these structures, leading to avulsion fractures around the joint. These fractures can result in severe complications if left untreated or improperly managed, including joint deformity, contracture, nonunion or malunion of the fracture, secondary osteoarthritis, and limited range of motion. Therefore, an accurate examination, diagnosis, and appropriate treatment are crucial for preventing these adverse outcomes. An avulsion fracture can be managed conservatively when the avulsed fragment does not compromise joint stability or motion. Nevertheless, surgical intervention is required to stabilize the fragment if it affects joint stability or motion. The use of internal fixation has become more prevalent because of recent advances in small implants for fixation.
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Original Articles
Bone Union Time of Simple Distal Femur Fractures in the Elderly according to Fracture Gap after Treated with Minimally Invasive Plate Osteosynthesis
Young Ho Cho, Sangwoo Kim, Jaewook Koo
J Korean Fract Soc 2023;36(4):133-138.   Published online October 31, 2023
DOI: https://doi.org/10.12671/jkfs.2023.36.4.133
AbstractAbstract PDF
Purpose
This study examined the difference in bone union time according to the fracture gap after minimally invasive plate osteosynthesis (MIPO) for simple distal femoral fractures in elderly patients.
Materials and Methods
From January 2010 to December 2019, patients aged 60 years or older who underwent surgical treatment for distal femoral fractures due to a low-energy injury were investigated retrospectively. Forty patients were enrolled in the study. The patients were divided into two groups according to the fracture gap after reduction: no more than 2 mm (Group A) and more than 2 mm (Group B) in the anteroposterior and lateral plane. The demographic, operation time, presence or absence of cerclage wiring, plate screw density, plate span ratio, plate length, bone union period, non-union, and complications were evaluated.
Results
No statistical differences in operation time, cerclage wiring, plate screw density, plate span ratio, and plate length were observed between the two groups, and the bone union was achieved in all patients without complication. The bone union period was 17.24±1.48 weeks in Group A and 24.53± 5.20 weeks in Group B, which was statistically significant (p<0.001).
Conclusion
The bone union time in treating geriatric simple distal femur fractures using the MIPO tech-nique was significantly shorter in the 2 mm or less fracture gap than in the greater than 2 mm group.
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Analysis of Missed Fractures by Bone Scan in Elderly Hip Fracture Patients with Osteoporosis
Tae Hun Lee, Yeong Hyun Lee, Seo Won Kang
J Korean Fract Soc 2024;37(3):144-149.   Published online July 31, 2024
DOI: https://doi.org/10.12671/jkfs.2024.37.3.144
AbstractAbstract PDF
Purpose
The incidence of hip fractures is increasing due to an increase in elderly populations because elderly patients often have accompanying diseases, such as cognitive impairment or dementia, which may lead to missed fractures. Therefore, this study assessed the utility of bone scans in detecting missed fractures in elderly patients.
Materials and Methods
This study analyzed the data from 178 patients treated from January 2014 to March 2023. The inclusion criteria were patients who had hip fractures with osteoporosis over 70 years old. Bone scans were performed on average 10 days after injury. The rate and trend of missed fractures not detected in the initial diagnosis were determined based on sex, age, dementia status, and the presence of osteoporosis.
Results
Among the 178 hip fracture patients over 70 years old, 37 patients had a history of being diagnosed with dementia, and 141 patients had never been diagnosed. Missed fractures were confirmed in 49 cases (42 patients) (23.6%). The dementia group had 13 missed fractures, and the non-dementia group had 36 missed fractures, but there was no significant difference. Rib fractures were most common, followed by vertebral fractures.
Conclusion
Missed diagnoses of fractures were common among elderly hip fracture patients. A whole body bone scan appeared to be effective in detecting missed fractures. Therefore, identifying accompanying fractures through bone scans and delivering appropriate treatment can play an important role in postoperative rehabilitation.
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Prediction of Syndesmotic Instability according to the Lateral Malleolus Fracture Pattern in Supination-External Rotation Type Ankle Fractures: Short Oblique versus Long Oblique Fracture
Chan-Jin Park, Min-Su Lee, Keun-Bae Lee
J Korean Fract Soc 2024;37(1):39-45.   Published online January 31, 2024
DOI: https://doi.org/10.12671/jkfs.2024.37.1.39
AbstractAbstract PDF
Purpose
This study examined whether preoperative radiological evaluations can predict syndesmotic instability according to the lateral malleolus fracture pattern in supination-external rotation-type ankle fractures.
Materials and Methods
This study enrolled 132 patients (132 ankles) with supination-external rotation stage 3 and 4 ankle fractures. Three-dimensional computed tomography was used for the morphological classification of the lateral malleolus fractures. A long oblique fracture was defined when the posterior cortical bone height of the fracture was 4.5 cm or more from the plafond of the distal tibial articular surface. A short oblique fracture was defined when the height was less than 4.5 cm. The demographic characteristics and syndesmotic instability of the two groups were evaluated.
Results
Short oblique fractures were confirmed in 102 cases, and long oblique fractures were confirmed in 30 cases. Long oblique fractures occurred at a statistically significantly higher incidence in younger ages and among males compared to short oblique fractures. Syndesmotic instability was more common in long oblique fractures.
Conclusion
In supination-external rotation-type ankle fractures, syndesmotic instability was observed in approximately 13%. Specifically, when the fracture pattern of the lateral malleolus is long oblique, the incidence of syndesmotic instability is approximately three times higher than in short oblique fractures. Therefore, meticulous evaluations of the lateral malleolus fracture pattern and establishing an appropriate treatment plan before surgery are crucial.
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