Journal of Musculoskeletal Trauma

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

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

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Bone Substitutes: From Basic to Current Update: Jong Seong Han, Hyung Keun Song; J Korean Fract Soc 2020;33(4):238-244. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.238

Bone substitutes are being used increasingly in bony surgery as more than two million bone grafts are performed worldwide per year. Autobone grafts represent the gold standard for bone grafting, but morbidity and limited availability are the main problems. Allobone grafts are osteoconductive, but there are still concerns regarding the infection risks, costs, and donor availability issues. As an alternative, widely used ceramic-based synthetic bone substitutes are based alternatively on calcium (hydroxyapatite, tricalcium phosphate, calcium sulfate, calcium phosphate). Ceramic-based bone substitutes are osteoconductive, but they are weaker than cortical bone and are not osteoinductive. Bone morphogenic protein, demineralized bone matrix, and platelet-rich plasma are used to obtain an osteoinductive function. Recently, cell-based and gen-based bone substitutes were developed and studied. This paper reviews the basic information and the latest concepts on bone grafts and bone substitutes.

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Tannic acid-modified magnesium oxychloride bone cement with high water resistance and osteogenic properties
Junying Chen, Yijia Guan, Yue Yang, Tingting Ma, Jinlun Feng, Wenjie Guo, Qifang Wang, Yanru Zhang, Jianguo Liao
Ceramics International.2024; 50(24): 53407. CrossRef
Surface modification of magnesium with a novel composite coating for application in bone tissue engineering
Jorgimara de O. Braga, Diogo M.M. dos Santos, Fernando Cotting, Vanessa F.C. Lins, Nádia M. Leão, Daniel C.F. Soares, Eric M. Mazzer, Manuel Houmard, Roberto B. Figueiredo, Eduardo H.M. Nunes
Surface and Coatings Technology.2022; 433: 128078. CrossRef

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

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

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Treatment of the Communited Distal Radius Fracture Using Volar Locking Plate Fixation with Allogenic Cancellous Bone Graft in the Elderly: Je Kang Hong, Chang Hyun Shin; J Korean Fract Soc 2015;28(1):8-16. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.8

Abstract PDF: PURPOSE
We studied results of the communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate in the elderly.
MATERIALS AND METHODS
We studied 29 cases of communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate from April 2009 to April 2013. Fracture was classified according to AO/OTA classification. Postoperative clinical evaluation was performed with measurement of wrist range of motion (ROM) at last follow-up, modified Mayo wrist scoring system (MMWS), and visual analogue pain scale (VAS). Radiologic evaluation was performed with measurement of radial length on immediate postoperation and last follow-up, radial inclination, volar tilt and ulnar variance checked at the last follow-up using Sarmiento criteria.
RESULTS
Using the MMWS, 13 cases were classified as 'good', 10 'fair', and 5 'normal'. The average wrist ROM was 88.5% for flexion, 92.2% for extension, 90.5% for adduction, and 94.0% for abduction. The average VAS was 1.7. On the last follow-up, average radius length, radial inclination and volar tilt did not show statistically significant improvement (p>0.05) compared to immediate post operation measurements, and according to Sarmiento criteria, 5 cases were classified as 'good', 14 'fair', and 7 'normal'.
CONCLUSION
Treatment of severe communited distal radius fracture accompanied by bone defect with volar locking plate and allogenic cancellous bone graft is a satisfying and effective treatment method in the elderly.

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

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

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Salvage Re-Fixation for the Failed Fixation of Pertrochanteric Fracture: Kyung Jae Lee, Byung Woo Min, Ki Cheor Bae, Dong Hu Kim, Kyoung Lag Lee; J Korean Fract Soc 2013;26(2):105-111. Published online April 30, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.2.105

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the clinical and radiological result in patients who got salvage re-fixation for the failed fixation of pertrochanteric fracture retrospectively.
MATERIALS AND METHODS
Between 1992 and 2009, 21 patients who could be followed-up for more than 1 year after salvage re-fixation for the failed fixation of pertrochanteric fracture were enrolled in this study. There were 16 men and 5 women. The mean age was 53 years (19-84 years) at the index surgery and the mean follow-up was 6.4 years. We evaluated the clinical and radiographic results and postoperative complications.
RESULTS
Walking ability and pain were improved in all cases and the mean leg length discrepancy was improved from 2.5 cm (0-10 cm) preoperatively to 1 cm (0-4 cm) at the latest follow-up. Nineteen patients (90.5%) out of 21 patients achieved bony union at the final evaluation and the mean union time was 4 months (3-7 months). There were 2 cases of non-union who had not received bone graft as a complication.
CONCLUSION
The clinical and radiological results of the salvage re-fixation for the failed fixation of pertrchanteric fracture were satisfactory in our study. Secure component fixation for the mechanical stability and proper bone graft for the improvement of bone biology are mandatory to improve the result.

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Salvage treatment of failed internal fixation of intertrochanteric fractures: What factors determine the failure of treatment?
Byung-Woo Min, Kyung-Jae Lee, Jong-Keon Oh, Chul-Hyun Cho, Jae-Woo Cho, Beom-Soo Kim
Injury.2020; 51(2): 367. CrossRef

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Treatment for Bone Defect of Open Tibial Fractures by Using Intramedullary Nail Fixation with Autogenous Iliac Bone Graft: Hyub Sakong, Ki Cheor Bae, Chul Hyun Cho, Kyung Jae Lee, Eun Seok Son, Du Han Kim; J Korean Fract Soc 2012;25(4):288-294. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.288

Abstract PDF: PURPOSE
This study was conducted to evaluate the results of intramedullary nail fixation with autogenous iliac bone graft for defects of bone after tibial fractures.
MATERIALS AND METHODS
Ten patients with bone defects in tibial fractures who had been treated with intramedullary nail fixation with autogenous iliac bone graft between May 2005 and September 2008 with more than 12 month follow-up were subject to study. Of the 10 patients, 8 were male and 2 were female, and the mean age was 50.2 years (29~76 years). By cause of accident, motor vehicle accidents caused 9 cases, a crush caused 1 case, and the average follow-up period was 21.9 months (12~42 months). Radiologically, we analyzed the union of the bone defect on simple x-ray and clinical evaluation was performed using the estimate method of Mekhali.
RESULTS
This study reveals that there was radiological union in all 10 cases and the mean time to union was 8.4 months (5~18 months). By clinical evaluation according to Mekhali's estimate method, 9 patients had excellent outcomes and 1 patient had limitation of motion in the ankle joint rated as a fair clinical result. None of patients developed complications post-operatively.
CONCLUSION
Our study demonstrated that the intramedullary nail fixation with autogenous iliac bone graft can be a useful operative method because it can remove external fixators early and reduce complications, and autogenous bones have exceptional osteoconduction, osteoinduction, and bone-forming ability resulting in excellent union of bones.

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

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

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Intra-articular Calcaneal Fractures Treated with Open Reduction and Internal Fixation: A Comparative Study between Groups with and without Bone Graft: Hong Moon Sohn, Sang Ho Ha, Jun Young Lee, Sung Hwan Jo, Hoon Yang; J Korean Fract Soc 2010;23(2):180-186. Published online April 30, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.2.180

Abstract PDF

PURPOSE
This study compares the clinical results of open reduction and internal fixation with and without bone graft for the treatment of intra-articular calcaneal fractures.
MATERIALS AND METHODS
Twenty-five patients who had open reduction and internal fixation for intra-articular calcaneal fractures and available for at least 1 year of follow-up were included in this study. Fifteen cases were operated with bone graft. Period to bone union and functional evaluation score were compared between both groups with analysis of complications.
RESULTS
Bone union was achieved in all cases with average bone union time of 11.6 weeks and 12.8 weeks in group with and without bone graft respectively. Creighton-Nebraska Health Foundation (CNHF) functional score was 86.5 points and 80.3 points respectively. The period to bone union and the CNHF score in the comparison of two groups were statistically insignificant. Complications were observed in four cases of group without bone graft and 5 cases of group with bone graft.
CONCLUSION
This study indicates that bone graft does not play a significant role in bone union and functional outcome when intra-articular calcaneal fractures are treated with open reduction and internal fixation.

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Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures
Chul Hyun Park, Oog Jin Shon
Journal of the Korean Fracture Society.2016; 29(3): 221. CrossRef

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

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

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The Use of Fresh Frozen Allogenic Bone Graft in the Impacted Tibial Plateau Fractures: Yeung Jin Kim, Soo Uk Chae, Jung Hwan Yang, Ji Wan Lee, Dae Han Wi, Duk Hwa Choi; J Korean Fract Soc 2010;23(1):26-33. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.26

Abstract PDF

PURPOSE
To assess the behaviour of fresh frozen cancellous allograft used for supporting the reconstructed articular surface in impacted tibial plateau fractures.
MATERIALS AND METHODS
Between May 2004 and May 2008, 13 cases of impacted tibial plateau fracture were evaluated retrospectively. All fractures were treated with open reduction-internal fixation after restoration of the tibial plateau surface and insertion of fresh frozen cancellous allograft chips for subchondral support. Mean age was 46.6 (31~65) years. Average follow-up period was 36 (13~58) months. The radiological and clinical result for every patient was assessed according to the modified Rasmussen's system and Lysholm's knee score.
RESULTS
According to last follow-up weight bearing A-P X-ray, the fresh frozen cancellous allograft incorporated soundly in all cases and no complications such as joint depression, fracture reduction loss, angular deformity, and malunion were found. The mean time to complete bone union was postoperative 10+/-0.7 weeks. The mean range of motion was 135 (115~145) degrees. The mean Rasmussen's radiological score at last follow up was 15.3 (10 cases: excellent, 3 cases: good). The mean Lysholm's knee score at last follow up was 88.2+/-4.3.
CONCLUSION
We concluded that fresh frozen cancellous allograft in impacted tibial plateau fractures showed good results in terms of bone union and functional improvement and was considered to be a good structural supporter.

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Autograft versus allograft reconstruction of acute tibial plateau fractures: a comparative study of complications and outcome
Abolfazl Bagherifard, Hassan Ghandhari, Mahmoud Jabalameli, Mohammad Rahbar, Hosseinali Hadi, Mehdi Moayedfar, Mohammadreza Minatour Sajadi, Alireza Karimpour
European Journal of Orthopaedic Surgery & Traumatology.2017; 27(5): 665. CrossRef
Treatment of Tibial Plateau Fractures Using a Locking Plate and Minimally Invasive Percutaneous Osteosynthesis Technique
Hee-Gon Park, Dae-Hee Lee, Kyung Joon Lee
Journal of the Korean Fracture Society.2012; 25(2): 110. CrossRef

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

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

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

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

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

Abstract PDF

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

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

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The Results of Operative Treatment in Open Type III Tibia Fracture: Kyung Jin Song, Sung Jin Shin, Byung Yun Hwang, Myung Sik Park; J Korean Soc Fract 2003;16(2):194-200. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.194

Abstract PDF: PURPOSE
The purpose of this study was to analyze the functional outcome and propose the guidelines in the surgical treatment of open type III tibial fracture.
MATERIALS AND METHODS
We have analyzed the treatment results of 44cases; age was ranged from 15 to 76 years, and there were 35 males and 7 females. The type of fracture according to the classification by Gustilo revealed type IIIa 14 cases, type IIIb 20 cases and type IIIc in 8 cases. We analyzed functional outcome according to the classification of functional result by Tucker.
RESULTS
The average union time of type IIIa was 9.2 months, IIIb 11.0 months, and IIIc was 13.8 months. The rotational flap and free flap were done during treatment and bone lengthening especially in type IIIc. Functional results were poor especially in type IIIc.
CONCLUSION
Debridement of devitalized tissue, early soft tissue coverage and sufficient stability using intramedullary nails will be necessary in type IIIa fracture. Rigid external fixation, early soft tissue coverage by rotational muscle flap and free flap reduced infection rate with satisfactory functional outcome especially in type IIIb and IIIc fractures.

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Impacted Cancellous Allograft and Quadratus Femoris Pedicle Bone Graft of Femoral Neck Fracture Nonunion: Soo Jae Yim, Seung Han Woo; J Korean Soc Fract 2002;15(4):519-525. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.519

Abstract PDF: PURPOSE
The aim of this study was attempted to evaluate the effects of impacted cancellous allograft and quadratus femoris pedicle bone graft in the management of nonunion of femur neck fracture.
MATERIALS AND METHODS
Between March 1998 and April 1999, 5 patients, rating from 36 to 45 years of age, were treated with impacted cancellous allograft and quadratus femoris pedicle bone graft and all cases were nonunion with displaced transcervical fracture whose primary treatment had been done with closed reduction and multiple pinning. The duration of follow-up was from 36 months to 48 months and the mean follow-up period was 40 months. Clinical evaluation was done according to Lunceford functional results and radiologically bone union was evaluated by 3 monthly X-ray check.
RESULTS
After follow-up from 36 months to 48 months, all cases resulted in the bone union. Four cases, radiologically bone union was progressed during 14 weeks, and the other, obtained at 6 months. All cases, at 18 months, radiologically complete bone union was obtained. Clinical result was above fair results and no one complaints pain and instability.
CONCLUSION
For patients with nonunion of femoral neck fracture, impacted cancellous allograft and quadratus femoris pedicle bone graft was provide a good result of union.

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The Radiologic Evaluation of Treatment Outcome in Intra-articular Calcaneal Fracture by Open Reduction without Bone Graft: Kwang Soon Song, Si Hyun Jeon, Jae Hong Chun; J Korean Soc Fract 2002;15(2):226-233. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.226

Abstract PDF

PURPOSE
The purpose of this study was to investigate the efficacy of bone graft use in the treatment of displaced intra-articular calcaneal fractures.
MATERIALS AND METHODS
We analysed retrospectively 40 displaced intra-articular calcaneal fractures, which had undergone open reduction and internal fixation without bone graft from June 1989 to July 1998. Radiological assessments were made from the lateral view of the affected calcaneus, recording the Bohler angle, the Gissane angle and ratio of height/width of the calcaneus. Matching criteria included Essex-Lopresti classification, method of fixation, age, and sex.
RESULT
The mean preoperative Bohler angle was -7 degrees(standard deviation [S D ] 1 8 degrees), postoperative Bohler angle was 21 degrees(SD 7 degrees), last follow-up Bohler angle was 1 9 degrees(SD 7 degrees). Bohler angle increased a mean 28 degrees(maximum 70 degrees, minimum 2 degrees). The preoperative Gissane angle was 104 degrees(SD 17.87 degrees), postoperative Gissane angle was 1 0 6 . 2 degrees(SD 10.07 degrees), last follow-up Gissane angle was 104.48 degrees(SD 10.1 degrees). The preoperative ratio of height/width of the calcaneus was 0.568(SD 0.076), postoperative ratio was 0.637(SD 0.037), last follow-up ratio was 0.648(SD 0.038). There was no significant differences in fracture pattern, method of fixation, age, and sex(P>0.05).
CONCLUSION
The result of this study showed that there was no significant change in serial radiologic evaluation. Bone graft was not served to the effectiveness or security in the treatment of displaced intra-articular calcaneal fractures.

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Open Reduction and Internal Fixation with AO Calcaneal Plate for Displaced Intra-articular Calcaneal Fracture
Myung Jin Lee, Sung Keun Sohn, Kyu Yeol Lee, Sung Soo Kim, Min Soo Kang, Hyeon Jun Kim, Sang Kyu Sun
Journal of the Korean Fracture Society.2010; 23(3): 303. CrossRef

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Treatment of Humeral Shaft Nonunion after Primary Internal Fixation: Jong Oh Kim, Yeo Hon Yun, Dong Wook Kim, Young Do Ko, Jae Doo Yoo, Jin Won Jung; J Korean Soc Fract 2001;14(2):236-244. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.236

Abstract PDF: PURPOSE
To evaluate the methods of treatment to obtain rigid fixation for nonunion of humerus shaft fractures developed after operative treatment.
MATERIALS AND METHODS
From January 1993 to January 2000, twenty-one patients of nonunion of humerus shaft after primary internal fixation were reviewed and the results were analyzed. Three cases who have loss of follow-up were excluded.
RESULTS
In twenty-one cases, nineteen had union but, two cases have failed. In the group of compression plate fixation and bone graft, bone union was completed at mean 4.4 months, in the group of IM nailing and bone graft at 4.9 months, in case of bone graft only with state of IM nailing at 5.5 months. Mean time until bone union was 4.6 months.
CONCLUSION
Distraction should be avoided during IM nailing at primary internal fixation. Secondly, To obtain rigid fixation in nonunion of humerus shaft after primary internal fixation, use larger and more broad plate, dual plate or IM nail.

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Operative Treatment with the Reconstruction Plate for the Displaced Clavicle Shaft Fracture of Adults: Ig Gon Kim, Jae Hyek Kim, Ryong Hwang, Young Ill Hong; J Korean Soc Fract 2000;13(4):941-947. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.941

Abstract PDF

PURPOSE
The purpose of this study was to know the usefulness of bony union and faster recovery of shoulder motions by the open reduction and internal fixation with the reconstruction plate for the displaced clavicle shaft fracture of adults. MATERIAL AND METHOD: From January 1993 to December 1997, for 5 years, we analyzed 28 cases which underwent for a year of displaced clavicular shaft fracture over 11mm after open reduction and internal fixation with the reconstruction plate and supplementary iliac bone graft.
RESULT
At all 28 cases, there were united without delayed union for average 7.2 weeks after operation. Motion of the shoulder joint were returned to normal within 1.8 weeks except two cases who had combined humerus fracture and partial gastrectomy for peptic ulcer.
CONCLUSION
It seems that operative treatment with the reconstruction plate and supplementary bone graft for the displaced clavicle shaft fracture of adults showed effective union and faster recovery of shoulder motions.

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Does cerclage wiring interfere with fracture healing of osteosynthesis in comminuted midshaft clavicle fractures? A multicenter study
Hyo Jin Lee, Yong Bok Park, Chang Heon Shim, Young Min Noh
Orthopaedics & Traumatology: Surgery & Research.2021; 107(8): 103091. CrossRef
Anatomical Reduction of All Fracture Fragments and Fixation Using Inter-Fragmentary Screw and Plate in Comminuted and Displaced Clavicle Mid-Shaft Fracture
Kyoung Hwan Koh, Min Soo Shon, Seung Won Lee, Jong Ho Kim, Jae Chul Yoo
Journal of the Korean Fracture Society.2012; 25(4): 300. CrossRef
Does Interfragmentary Cerclage Wire Fixation in Clavicle Shaft Fracture Interfere the Fracture Healing?
Jae-Kwang Yum, Yong-Woon Shin, Hee-Sung Lee, Jae-Gu Park
Journal of the Korean Fracture Society.2011; 24(2): 138. CrossRef

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Comparison of Intramedullary Nailing and Plate Fixation for the Treatment of Nonunion of the Long Bone Fracture on Lower Extermities: Jong Seok Park, Jae Hoon Lee, Hee Kwon, Jae Eung Yoo, Joon Min Song, Yeon Il Kim, Chang Uk Choi; J Korean Soc Fract 2000;13(2):327-333. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.327

Abstract PDF: PURPOSE
: Under the principle of rigid fixation and bone graft, we analyzed and compared the clinical results in the treatment of nonunion of long bone fractures using plate fixation and intramedullary nailing with or without bone graft.
MATERIALS AND METHODS
: We used 19 cases of plate fixation and 19cases of intramedullary nailing with or without bone graft for the treatment of the nonunion of long bone from Mar. 1994 through Feb. 1997. We analyzed and compared the clinical results of plate fixation and intramedullary nailing with bone graft in the treatment of nonunion of fracture.
RESULTS
: The mean bone union time according to nonunion type in case of plate fixation was 22.6 weeks in the hypertrophic type and 16.4 weeks in the atropic type(p<0.005). In case of intramedullary nailing was 20.4 weeks in the hypertrophic type and 15.3 weeks in the atropic type(p<0.05). According to the bone graft in case of plate fixation, 20.8 weeks in the autogenous bone graft and 19.3 weeks in the combination of autogenous bone graft and allo-bone graft(p>0.05). In case of intramedullary nailing, 16.9 weeks in the autogenous bone graft and 22.7 weeks that dosen't bone graft. According to the radioligical bone union time was 20.1 weeks in the plate fixation and 18.7 weeks in the intramedullary nailing(p>0.05).
CONCLUSION
: There was on significant difference according to the method of fixation, but the treatment of nonunion of long bone in lower extremities using intramedullary nailing will be good because of early ROM exercise and weight bearing ambulation than plate fixation. Although the type of nonunion is hypertrophic in the case of intramedullary nailing, bone graft is helpful to promote bony union.

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Nonunion of the Clavicular Fracture: Sang Eun Lee, Il Hyun Nam, Sang Soo Lee, Dong Hee Lee, Keum Joo Lee; J Korean Soc Fract 1999;12(3):741-748. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.741

Abstract PDF

We analysed 20 cases of clavicular nonunions, treated by internal fixation with plate and bone graft at the Pohang St. Marrys Hospital between 1993 and 1997. Among them, sixteen patients had been treated with conservative method and four with surgery initially. Radiologically, seventeen nonunions were atrophic and three hypertrophic. Interposition of the injured soft tissue, inadequate reduction and insecure fixation were etiologic factors of nonunion in this study. The complete unionswere achieved in eighteen by plating with iliac bone graft and in two by intramedullary fixation with S-pin or Rush-pin each The average time for union was 14.2 weeks. The average length of follow-up was 16.5 months. The complications were limitation of motion in three patients and brachial plexus injury in one. Associated symptoms of the nonunion including pain disappeared in all patients. In this study, we discuss the cause and treatment of clavicular nonunion with specific attention to the rigid internal fixation and the outcome of treatment. We concluded that symptomatic nonunion of the clavicle could be treated by operation, and rigid internal fixation with plate and bone grafts are thought to be a reliable treatment for the nonunion of the clavicle.

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Costoclavicular Syndrome: A Case Report
Sung Keun Sohn, Sung Soo Kim, Chang Geun Song, Jong Ill Kwak
Journal of the Korean Fracture Society.2007; 20(1): 86. CrossRef

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Operative Treaeent of Hohl II, III Plateau Fracture by Small Incision and Bone Window: Jin Woo Kwon, Kyoung Tae Sohn, Sung Ho Shin, Woo Se Lee, Won Ho Jo, Jae Il Kim; J Korean Soc Fract 1999;12(3):593-600. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.593

Abstract PDF: Severely depressed plateau fractures, especially Hohl I, III, can not be reduced by ligamentotaxis and require elevation through a cortical window, bone grafting, and fixation with either cancellous screws or a buttress plate. But traditional long lateral parapatellar incision and plate fixation method caused frequent wound dehiscence and deep infection. Thus to reduce the soft tissue problem we treated Hohl II, III plateau fractures by small anterolateral L-shaped incision, submeniscal exposure, reduction of depressed plateau and bone graft through bone window, and then cancellous screws fixation beneath the subchondral bone of elevated plateau. We anayzes 22 cases with Hohl II, III plateau fractures, which were treated by these method from February 1990 to December 1997 and followed more than 1 year. Males were 17, and females were 5. Average age of patients was 44.7 years. The most common cause of injury was traffic accidents(17 cases), and fracture type according to the Hohl classification was 14 cases of type II, 8 of type III. The associated injuries were 18 cases of meniscus tear, 13 of ligament injury(6 ACL, 7 MCL). The clinical results by Blokkers criteria were satisfactory 19 cases(86.3%) and unsatisfactory 3 cases(13.7%). We concluded that this method has following advantages; relatively firm fracture fixation, short operation time, low soft tissue problem.

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ankle and Tibitalocalcaneal Arthrodesis using Lateral Malleolus as Bone Graft: Yung Khee Chung, Jung Han Uoo, Yong Wook Park, Kang Il Lee; J Korean Soc Fract 1998;11(4):918-923. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.918

Abstract PDF: A variety of surgical approaches and bone grafting techniques for ankle and tibiotalocalcaneal arthrodesis have been described. Wed used transfibular approach and lateral malleolus was used for bone graft. This permitted excellent visualization of the ankle and subtalar joint so that the fusion can readily be achieved under th direct visualization. And also we didn't need to prepare the additional bone graft from another site. Ten ankle fusions and two tibiotalocalcaneal fusions were carried out and reviewed. The average age of the patients was 43 years(range, 27 - 58 years). The average follow-up was 27.8 months(range, 24 - 34 months). We evaluated the clinical and radiological results, and complications. All cases were satisfied and fused. But we experienced one minor complication that was posteroplantar heel pain caused by prominence of cannulated screw head. So, we suggest that this procedure has benefit for ankle or tibiotalocalcaneal fusion.

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Operative Treatiment with Open Reduction and Heterogenous bone graft to the Acute Displaced Intra-articular Calcaneus Fractures: Moon Jib Yoo, Suk Joo Lyu, Sung Churl Lee, Hong Geun Jung, Soon Haeng Kwon, Jeong Wan Kim, Myung Ho Kim; J Korean Soc Fract 1998;11(3):611-616. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.611

Abstract PDF: The calcaneus is the most frequently fractured tarsal bone. Although there were many reports of treatment using variable methods, but no definite general agreement to the treatment method of the intra-articular calcaneus fracture. From May. 1995 to Apr. 1997, 14 displaced intra-articular fractures of the calcaneus in 12 patients underwent open reduction and heterogenous bone graft (Lubboc, TRANSPHYTO S.A., France) at the Dept. of Orthopaedic Surgery, Dankook University Hospital The fractures were 13 joint depression type and 1 tongue type fractures according to the classification of Essex-Lopresti. The average follow-up was 20 months and clinical assessment underwent by Clinical Assessment Rating system of Hutchinson and Huebner; we got a satisfactory results for the treatment of displaced intra-articular calcaneus fracture by open reduction and heterogenous bone graft. We didn't need harvesting autograft by use of heterogenous bone graft into bone defect site instead of autograft. Our purpose of using heterogenous bone were filling of defect and internal fixation. We used minimal skin incision and minimal internal fixation device, so reduced complications such as wound edge necrosis and peroneal entrapment caused by entensile appraoch. There were no posterior facet depression and decreased B hler angle for 1 year follow up.

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Treatments of the delayed Union or Nonunion of Tibial Shaft Fracture Fixed with Interlocking IM nail: Yong Bum Park, chung Soo Hwang, Phil Hyun Chung, Suk Kang, Dong Joo Chae, Han Chul Kim, Sang Ho Moon, Jong Phil Kim, Dae Jin Kim; J Korean Soc Fract 1998;11(3):552-559. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.552

Abstract PDF: Interlocking intramedullary nailing has been the first choice treatment of most tibial shaft fractures because its rigidity of fixation allows early ROM and weight bearing. Although most interlocking nailing procedures are performed with closed reduction that preserve periosteal blood supply, delayed union or nonunion is often occurs. so secondary procedures, such as bone graft, dynamization, nail exchange, are necessary to achieve fracture healing. We analyzed 25 cases of delayed union or nonunion from 432 tibial shaft fractures fixed initially with static interlocking intramedullary nailing since January 1990 till January 1996. Overall incidence of delayed union or nonunion is 5.8%(25/432). Secondary procedures included mainly iliac bone graft or dynamization. Average time to achieve bone union after secondary procedure is 6.1 months. The more distracted or displaced fracture ends after interlocking nailing or the more comminuted fracture fragments led to the more delayed bone union. Careful attention to minimize distraction or displacement during interlocking nailing is necesary to decrease the incidence of delayed union or nonunion. And appropriate procedures should be performed when delayed union or nonunion is predicted, which result in success in most cases.

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The Treatment of Infected Nonunion of Femur after Open Reduction and Internal Fixation: Hee Soo kyung, Joo Chul Ihn, Byung Chul Park, Yong Goo Kim; J Korean Soc Fract 1998;11(3):540-545. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.540

Abstract PDF: Infected nonunion developed after open reduction and internal fixation is one of the serious complications among the treatments of fracture of long bone. It is very difficult to eliminate the infection, to correct the deformity and defect at the same time obtaining union. All six cases were male, the average of age was 34 years old from 21 to 49. Five cases were closed fracture and one was open fracture. For the primary internal implant, five cases were plate and one was intramedullary nail. About the 6 cases of infected nonunion of femur from June, 1994 to October, 1996, we performed the following procedure : after removal of internal fixation, extensive debridememt, complete sequestrectomy, firm fixation with Ilizarov external fixator, compression at fracture site and early autogenous cancellous bone graft. We obtained following results : 1. The average duration of infection was 7.8 months, average duration of bone union was 5.8 months. Average duration of follow-up was 17.5 months. 2. The average shortening of leg was 1.4cm. 3. According to classification of Paley and Catagni, the bone results were excellent in all cases, functional results were excellent in 4 cases and fair in 2 cases. 4. In conclusion, firm fixation with Ilizarov fixator, sequestrectomy, early autogenous cancellous bone graft and compression is one of the good treatment modalities of infected nonunion of the femur.

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Surgical Treatment of Intra-articular Fracture of the Os Calcis: Soo Kil Kim, Young Gyu Kim, Bum Gu Lee, Jin Hong Ko, Su Chan Lee, Young Kim; J Korean Soc Fract 1996;9(2):354-365. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.354

Abstract PDF: Intra-articular fractures involving the posterior facet of the subtalar joint are associated with significant and prolonged disability. But, the treatment of choice for displaced intra-articular calcaneal fractures remains controversial. We treated 30 displaced intra-articular fractures of the calcaneus by open 1eduction and internal fixation through the lateral approach with autogenous bone graft at the Department of Orthopaedic Surgery, Choong-ang Gil and Dong Inchon Gil Ceneral Hospital from January 1990 to October 1994 The clinical and radiographic analyses were as follows. 1. Of 26 patients, 20 patients were male and 6 patients were female. 2. The main cause fractures of calcaneus was a fall from a height in 23 cases(88%) and most of associ ated fractures were spine injury in 6 patients. 3. Fracture was classified according to Essex-Lopresti classification. 13 cases were tongue type, 17 cases were joint depression type. 4. Alt Open reduction and internal fixation through the laterl approach with bone graft was performed in joint depression type and tongue type. 5. The preoperative ayerage Bohlers angle was - 5. The postoperative avereage Bohlers angle was -24, Which was increased significantly. 6. Complications were 12 cases ; included heel pad pain in 8 caLes, osteomyelitis and superficial wound infection in 2 cases, transient sensory hypesthesia on the lateral side of the foot in 2 cases. 7. Based on assessement of Salama, the results were excellent in 5 cases, good in 1 Teases, fair in 6 cases, poor in 2 cases.

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Scaphoid nonunion Ireated by Bone Graft and Internal Fixation: Jae Sung Seo, Myun Whan Ahn, Woo Seok Jang; J Korean Soc Fract 1996;9(2):257-263. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.257

Abstract PDF: There is difficuity in the treatment of scaphoid nonunion, because of it is not easy to diagnosis scaphoid fracture after affecting the damage, and also of inadequate treatment. We have performed wedge bone Graft and internal fixation in treatment of 52scaphoid nonunions from April, 1986 to June, 1994. We got result as below by analysis of 27 cases which could follow up more than one year. 1. The most frequent age of fracture is the 3rd decade and the fracthre is more frequent in men (26 cases)than in woman (1 case). 2. The X-ray fingings of nonunion are bony sclerosis (13 cases), cystic change(3 cases), and absorption of fracture line (11 cases). 3. The mean period of bony union is 14.7 weeks. 4. In 8 cases there has been dorsal intercalated segmental instability(DISI) on preoperative X-ray finding and which is corrected after operation. 5. In evaluatory system by Herbert and Fischer about degree of patients satisfaction, the grade 0 is 15 cases, grade 1 is 11 cases and grade 2 is 1 case, in clinical results, grade 0 is 15 cases, grade lis 9 cases and grade 2 is 3 cases, in radiographic result, grade 0 is 22 cases, grade 1 is 4 cases, grado 2 is 1 case.

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The Result of Osteosynthesis of Scaphoid with Matti-Russe Technique and Herbert Screw: Duck Yun Cho, Young Gil Hahm, Myoung Hyoung Lee; J Korean Soc Fract 1996;9(1):24-32. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.24

Abstract PDF: Fracture of scaphoid are second most common fractures of wrist, and about 1/6 of these fractures proceed to nonunion. The most widely used surgical procedure of scaphoid nonunion has been Matti-Russe procedures,and Hebert screw is a recently introduced fixation device as a means of rigid internal fixation promoting union and decreasing immobilization time. Authors have managed 15 cases of scaphoid nonunion with Mtti-Russe bone grafting technique and herbert screw, and accomplished satisfactory results: The union rate Was 96.6%, the average time to union was 17.1 weeks, and according to Maudsleys assessment criteria, we obtained 7 cases of excellnt, 6 good, and 2 fair results. Despite of its technical demand and lack of the number and study material, Matti-Russe bone grafting technique with Herbert screw fixation seems efficient and reliable method of treatment.

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Surgical Treatment of Scaphoid Nonunion: Jae Ik Thim, Taek Sun Kim, Sung Jong Lee, Suk Ha Lee, Chang Moo Yoo, Kil Joo Han; J Korean Soc Fract 1996;9(1):15-23. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.15

Abstract PDF

The scaphoid fracture is the most common fracture of the carpal bone in young men and has high incidence of nonunion. Many methods of treatment for nonunion of the carpal scaphoid have been described; bone grafting, screw fixation, pulsed electromagnetic field and cast, percutaneous pinning and Herbert screw fixation. Two of the commonest methods of treatment are Matti-Russe procedure and Herbert screw fixation and this paper compares these two surgical treatments. At the Department of Orthopaedic Surgery, Korea Veterans Hospital, from October 1988 to October 1994, 11 cases of the scaphoid nonunion had been treated by Matti-Russe procedure only (4 cases), Matti-Russe procedure with K-wire (2 cases) and Bone graft with Herbert screw fixation (5 cases) and followed up more than 1 year. The results were as follows; 1. Among 11 cases, 10 cases were male and 1 case was female and the range of age was 19-46 years (Mean 26.2 years). 2. The sites of fracture were confined to the waist in 9 cases (82%) and prox 1/3 in 2 cases (18%). 3. The treatment methods were Matti-Russe only in 4 cases, Matti-Russe procedure with K-wire in 2 cases and Bone graft with Herbert screw fixation in 5 cases. 4. Postoperative cast immobilization was done for 16.5 weeks in the cases treated by Matti-Russe procedure and for 4 weeks in the cases treated by Bone graft with Herbert screw fixation. 5. The union rate was 91 % after postoperative 4 months (Mean 4.1 months). 6. The results of treatment were excellent in 7 cases (64%), good in 3 cases (27%) and fair in 1 case(9%). Therefore the Matti-Russe procedure and Bone graft with Herbert Screw fixation are good procedures in the treatment of scaphoid nonunion. But, Bone graft with Herbert screw fixation is more useful in young men because of short periods of immobilization and early returning to work.

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Volar Percutaneous Cannulated Screw Fixation for Subacute Scaphoid Wasit Fracture
Jae Kwang Kim, Jong Oh Kim, Seung Yup Lee, Nam Hoon Do
Journal of the Korean Fracture Society.2009; 22(2): 104. CrossRef

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