Journal of Musculoskeletal Trauma

Mechanical Properties of External Fixator according to Its Arrangement and Structure: Hong Jun Han, Byung Chang Lee, Yeung Jin Kim, Byung Soo Jin, Gun Hyee Lee; J Korean Soc Fract 2000;13(1):38-45. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.38

Abstract PDF: PURPOSE
To obtain the accurate knowledge of the fundamental mechanical properties of the external fixator affected by variations in arrangements and structures. We used newly developed external fixator, Anyfix, universal testing machine and plastic padding bone model which had similar structural properties to human tibia. The measured performance for seven different configurations of external fixators was its ability to control the motion of the bone fragment at the fracture site. Based on a unit of applied load, the corresponding displacement measured at the fracture site was used to described the stiffness of the fixation device for each load. Three stiffness moduli can be determined as axial stiffness, anterior posterior bending stiffness and lateral bending stiffness.
RESULTS
In basic configuration, all three stiffnesses for unilateral two plane external fixator showed marked increase than those for unilateral one plane model. Axial compression stiffness and bending stiffness were increased when ring component were located far from the fracture site. In modified configuration, all three stiffnesses were increased when the number of pin was increased and small sized ring was used.
CONCLUSION
The stiffness of the external fixator can be substantially increased by using unilateral two plane, locating the ring at far portion from the fracture site, using a small sized ring and increasing the number of pins.

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Brachial Plexus Injury of Whole Arm Type Developed after Surgical Treatment of Infectious Mid-Shaft Clavicular Nonunion: Byung Chang Lee, Sang Soo Kim, Hyeoung Jun Kim; J Korean Soc Fract 1998;11(1):22-27. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.22

Abstract PDF: Neurologic complications after surgical treatment of clavicular nonunion were rare, and they were usually types of incomplete paralysis of one or more branches of brachial plexus. We experienced a complete brachial plexus paralysis of whole arm type developed after compression plating and bone grafting for infectious clavicular nonunion. This 44 years old male patient, sustained infectious clavicular nonunion of mid-shaft, complains postoperatively complete paralysis of right upper extremity and severe burning pain around the clavlcle. We performed exploration after 1 day of operation. The operative findings are no gross damage of brachial plexus, direct compression with cancellous bone graft, narrowing of costoclavicular space and fibrotic adhesion with surrounding soft tissue. For decompression of brachial plexus, we perform adhesiolysis and neurolysis, and refixed the clavicle after plate bending along anterosuperior curvature and removal of inferiorly grafted bone to restore costoclavicular space. Eletrodiagnostic study in two weeks reveal severe brachial plexopathy of whole arm type. After three months of operation, he regain the nearly complete function of upper extremity and radiologic study show a evidence of bony union. The obtained results from the evaluation of this patient were as follows: 1. Direct compression by cancellous bone graft and a spike of bone is a major contributing factor. 2. Fibrous adhesion with surrounding soft tissue due to previous infection is another important factor of reducing the costoclavicular space. 3. Motor function is more profoundly affected than sensory function, and the order of motor return is radial, median, musculocutaneous, axillary and ulnar nerve. 4. When brachial plexopathy follow immediately operation of clavicle, early exploration is indicated for diagnostic and therapeutic purpose.

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Treatment of the Humeral Shaft Fracture with the Intramedullary Nail: Byung Chang Lee, Chul Hong Chun, Soo Uk Chae; J Korean Soc Fract 1998;11(1):129-135. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.129

Abstract PDF: Interlocking nailing has been increasingly used to treat humeral shaft fractures with the improvement in intramedullary device design and surgical technique. We reviewed the clinical results in twenty nine patients who had intramedullary nailing for the treatment of humeral shaft fractures from May, 1992 to July, 1995 in wonkwang university hospital. there were 8 polytrauma patients; 6 were osteoporotic elderly patients; 10 were comminuted fractures; 2 were segmental fractures; 1 was nonunion; 1 was pathologic fracture; 1 was bilateral humeral fractrure. Trueflex, Seidel and Uniflex nail were selected 13, 8 and 8 cases respectively. According to AO classification, simple, wedge and complex fractures were 14, 7 and 8 cases respectively. The result of this study were as follows : sound bony union were observed in twenty three cases, but six nonunions treated by additional operations such as bone graft, modified dual onlay bone graft or OR/IF with bone graft were occurred. Nonunion was occurred mainly in simple and wedge type of AO classification. Distraction of fracture site occurred mainly in simple type of AO classification was related with nonunion. Chronic shoulder symptoms were observed in six cases, and proximal nail protrusion and injury to rotator cuff were considered as its possible cause. Other omplications were one postoperative radial nerve palsy and metal breakage.

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Tibial Segmental Fracture Treated with Interlocking Intramedullary Nail: Churl Hong Chun, Byung Chang Lee, Gyu Taec Hwang, Soon Gu Kwon, Han Sol Lee; J Korean Soc Fract 1997;10(3):534-540. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.534

Abstract PDF

The orthopaedic surgeon experiences the difficulties of treating segmental tibial fractures by internal fixation and accompanying complications. OBJECT : The purpose of this study has been to review the useful treatment of 21 interlocking nails in the tibial segmental fracture, to investigate the union rate related to fracture types and to analyze the complications related to it. METERIAL and METHOD : Between November 1988 and August 1995, the authors treated tibial segmental fractures with interlocking intramedullary nail and analyzed 21 cases with followed up of more than 1 year. Injury mechanism were caused by traffic accident in which high velocity accounted for 17 cases. 11 cases of segmental tibial fracture were closed, and 10 cases were open. 6 cases of open fracture were open type 1, and 4 cases were open type II. We treated 21 fractures with unlearned intramedullary nail of 7 cases and limited reamed intramedullary nail of 14 cases.
RESULT
: Callus formation and consolidation were faster at the posterolateral aspect of the tibia than in anteromedial aspect. Radiologically complete union was faster in proximal portion at average 26.8 weeks than distal portion of segmental fracture at average 35.6 weeks. Complications included 2 cases of nonunion, 1 infection, 2 screw breakage and 2 ankle joint stiffness.
CONCLUSION
: We achieved excellent results using interlocking intramedullary nail by limited reaming or unlearned methoo in the tibial segmental fracture even though the injury was caused by high-velocity external force.

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Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures
Sang Soo Park, Jun-Young Lee, Sang-Ho Ha, Sung-Hae Park
Journal of the Korean Fracture Society.2013; 26(4): 275. CrossRef

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Treatment of Open Tibial Fracture with Enternal Fixator: Byung Chang Lee, Sang Soo Kim, Sang Do Cha; J Korean Soc Fract 1996;9(3):605-613. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.605

Abstract PDF: In a retrospective study from 1987 to 1993, we reviewed 191 patients with 203 open tibial fractures which were treated with external fixator and had adequate clinical and radiological follow up evaluation over 1 year. The configuration of fractures was classified using AO classification, and to extent of soft tissue damage was graded using to Gustilo classification of open fracture. There were 108 Grade I ;36 Grade II and 59 were Grade III. We used mainly unilateral two plane type(simple conventional type) and unilateral one plane type. To stabilize supplementarily large bony fragment, screw, K-wire or wire were used in 11, 41 and 6 cases respectively. 117(51.6%) open fracture wounds healed by delayed primary or secondary intentien, whereas 40(19.1%) patients received a split thickness skin graft, 31(15.3%) patients had a rotation of a myncutaneous flap, and 15(7.4%) patients received a free flap surgery for soft tissue coverage. The average time to union was 25.1 weeks. To obtain bone healing, we performed additionally bone graft in 89 cases(43.8%), fixator change only in 8 cases(3.9%), and fixator change with bone graft in 20 cases(9.9%). All cases except 28 open tibial fractures, which was performed fixator change, were treated by primary external fixation without a change of fixator. Major complications were delayed union, nonunion and pin tract infection, and superficial infection, chronic osteomyelitis, pin loosening and partial ankylosis of joint were developed. In conclusion, we think the external fixator is a routine device for open tibial fractures. The configuration of fracture and degree of soft tissue damage had influence on healing of open tibial fracrures. Supplementary fixation in combination with external fixation does not offer important advantages. We should pay attention to bone healing more than soft tissue healing in Crade I & II injury and to soft tissue healing more than bone healing in Grade III injury.

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Treatment with bone block transfer of coracoacromial ligment in acromioclayicular injury: Byung Chang Lee, Sang Soo Kim, Dae Moo Shim, Sang Do Cha; J Korean Soc Fract 1996;9(1):146-153. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.146

Abstract PDF: Several studies have shown the effectiveness of reconstruction of acromioclavicular ligament with coracoacromial ligament in treating the Grade III acromioclavicular joint injury. One of these is a bone block transfer of coracoacromial ligament into the medullary canal of the clavicle to prevent occasional pullout of the transfered ligament. Eleven cases with complete acromioclavicular dislocation(acute 3, chronic 8) were treated by this method. We modified slightly the original method described by Shoji et at. to increase the success rate. Failure of coracoclavicular reconstruction occurred in two cases. All except one patient regained nearly painlefs range of shoulder motion. One patient showed severe restriction of shoulder abduction and definite deformity. In functional evaluation by the Weitzman criteria, five were excellent, four good, one fair, and one poor. Radiologic results for restoration of coracoclavicular interval showed marked improvement but were not consistent with clinical results. Main technical problems were harvesting bone block and fixation of ligament. To obtain good osseus healing without pull out of transferred ligament, we found that preservation of bone ligament junction and careful harvest of full thickness acromiai bone block was important.

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Treatment with Unlearned Locked Intramedullary Nail for Open Tibial Fractures: Sang Soo Kim, Byung Chang Lee, Dae Moo Shim, Jae Hoon Shin; J Korean Soc Fract 1995;8(1):284-291. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.284

Abstract PDF: Open fractures of the tibia remain a formidable injury. Which the need for stabillization of open tibial fractures is accepted, the method of fracture stabilization is still controversial because of unacceptable infection rate. External fixation has been the routine and safe procedure for open tibial fractrues. However, this is not without significant complications such as pin tract infection and delayed or nonunion due to insufccient stability. We reviewed the records of 29 patients who underwent immediate unlearned locked intramedullary nailing for open tibial fractures. The average time between injury and operation was 2.4days. The classification of the open fractures was; fifteen Grade I, nine Grade II , and five Grade II a. There was no superficial infections, but one of type III a patient developed deep infection. Skin graft or rotational flap to cover the soft tissue defect were performed. All cases were treated by primary intramedullary nailing without a change of the fixator. So, we think unlearned locked intramedullary nailing is a good alternative method for the management of Grade I, II, III a open tibial fractures.

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The clavicular nonunion treated by internal fixation and bone graft: Churl Hong Chun, Sang Soo Kim, Dae Moo Shim, Byung Chang Lee, In Yong Choi; J Korean Soc Fract 1993;6(2):312-317. Published online November 30, 1993; DOI: https://doi.org/10.12671/jksf.1993.6.2.312

Abstract PDF

No abstract available.

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Intercalary Tricortical Iliac Bone Graft in the Surgical Treatment of Nonunion of Midshaft Clavicular Fractures
Chul Hyun Cho, Hyung Gyu Jang
Clinics in Shoulder and Elbow.2012; 15(1): 32. CrossRef

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