Journal of Musculoskeletal Trauma

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

Abstract 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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Analysis of the Changes in Femoral Varus Bowing and the Factors Affecting Nonunion for the Treatment of Femoral Shaft Fractures over 60 Years Old Using Piriformis Fossa Insertion Intramedullary Nailing: Yonghan Cha, Chan Ho Park, Jun-Il Yoo, Jung-Taek Kim, WooSuk Kim, Ha-Yong Kim, Won-Sik Choy; J Korean Fract Soc 2020;33(2):65-71. Published online April 30, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.2.65

Purpose
This study examined the bony morphological changes to analyze the factors affecting bony union in the treatment of elderly femoral shaft fractures with varus bowing using piriformis fossa insertion intramedullary nailing.
Materials and Methods
This study included 26 patients over 60 years of age, who were admitted for femoral shaft fractures between January 2005 and December 2014 and treated with piriformis fossa insertion intramedullary nailing. Age, sex, height, weight, bone mineral density, injury mechanism, fracture type, diameter and length of the nail, postoperative lengthening of the femur, postoperative change in varus angle, contact between the lateral and anterior cortex, and the gap between the fracture line and the bony union were checked. The patients were divided into a varus group and nonvarus group, as well as a bone union group and nonunion group. Logistic regression analysis was performed to analyze the factors affecting nonunion.
Results
The patients were classified into 11 in the varus group and 15 in the non-varus group and 24 in the union group and 2 in the nonunion group. The varus group showed a larger increase in leg length and varus angle reduction than the non-varus group (p<0.05). The union group had more contact with the lateral cortical bone than that of the nonunion group (p<0.05). The factor affecting bone union in regression analysis was contact of the lateral cortical bone (p<0.05).
Conclusion
Treatment of a femoral shaft fracture in elderly patients with a varus deformity of the femur using piriformis fossa insertion intramedullary nail increases the length of the femur and decreases the varus deformity. For bony union, the most important thing during surgery is contact of the lateral cortical bone with the fracture site.

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Straight nail insertion through a laterally shifted entry for diaphyseal atypical femoral fractures with bowing: good indications and limitations of this technique
Seong-Eun Byun, Young-Ho Cho, Young-Kyun Lee, Jung-Wee Park, Seonguk Kim, Kyung-Hoi Koo, Young Soo Byun
International Orthopaedics.2021; 45(12): 3223. CrossRef

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Malunion: Deformity Correction of the Upper Extremity: Soo Min Cha, Hyun Dae Shin; J Korean Fract Soc 2017;30(4):209-218. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.209

Abstract PDF: Malunions after fractures are classified as shortened, angulated, torsion, or rotational deformities that is outside the acceptable range, regardless of the location, whether upper or lower extremity. The distinct feature of a malunion in the upper extremity is that it is free from weight bearing; thus, some degree of shortening is allowed compared with the contralateral normal side in long bones, such as the humerus, radius, or ulna. However, malunions associated with functional impairment, especially angulated or rotational deformities, are more likely to develop instability, degenerative lesions, or rarely, compressive neuropathy. Hence, malunions with such association may occasionally require correction.

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Clinical and Radiological Analysis of Angular Deformity of Lower Extremities: Changhoon Jeong, Jong Ho Noh; J Korean Fract Soc 2017;30(3):156-166. Published online July 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.3.156

Abstract PDF

The alignment of lower extremities is an important consideration in many clinical situations, including fracture reduction, high tibia osteotomy, total knee arthroplasty, and deformity correction. Mal-alignment of lower extremities is not only a simple cosmetic problem, but it can also produce pain, limp, and early degenerative arthritis. An assessment of lower extremity alignment, including its location and magnitude of deformity, can be achieved via mal-alignment test and mal-orientation test, using a lower extremity standing full-length radiography. Proper evaluation allows the surgeon to determine an effective treatment plan for deformity correction.

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A deep learning approach for fully automated measurements of lower extremity alignment in radiographic images
Ki-Ryum Moon, Byoung-Dai Lee, Mu Sook Lee
Scientific Reports.2023;[Epub] CrossRef
Comparison of Lower-Limb Alignment in Patients with Advanced Knee Osteoarthritis: EOS Biplanar Stereoradiography versus Conventional Scanography
Hyeong-Uk Choi, Du-Han Kim, Si-Wook Lee, Byung-Chan Choi, Ki-Cheor Bae
Clinics in Orthopedic Surgery.2022; 14(3): 370. CrossRef
Prevalence of proximal tibia vara in Indonesian population with knee osteoarthritis
John Christian Parsaoran Butarbutar, Tommy Mandagi, Lasa Dhakka Siahaan, Earlene Tasya Suginawan, Elson, Irvan
Journal of Clinical Orthopaedics and Trauma.2022; 29: 101871. CrossRef
Morphometric parameters of the proximal femoral epiphysis and their effect on the hip joint
Jovan Varda, Vanja Valčić, Valentina Blagojević
Medicinski podmladak.2022; 73(2): 28. CrossRef
Factors related to femoral bowing among Korean female farmers: a cross-sectional study
Sangyoon Do, Chul Gab Lee, Dong Hwi Kim, GwangChul Lee, Kweon Young Kim, So Yeon Ryu, Hansoo Song
Annals of Occupational and Environmental Medicine.2020;[Epub] CrossRef
Effectiveness Evaluation of Scanogram Using Longbone Detector
Su-han Jang, Ji-eun Heo
Journal of Radiological Science and Technology.2020; 43(4): 235. CrossRef

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Functional Recovery of the Shoulder after Correcting Malrotation of the Distal Humerus: A Case Report: Hyunseong Yoo, Jaehui Han, Youngsoo Byun, Daegeun Jeong, Dongju Shin; J Korean Fract Soc 2016;29(1):73-78. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.73

Abstract PDF: Although studies on malrotation of the humerus possibly leading to dysfunction of the shoulder have been reported, studies on its causes are inadequate. The authors encountered a patient complaining of malrotation accompanied by dysfunction of the shoulder which occurred during treatment of a distal humeral fracture. The patient recovered the shoulder function by only correcting malrotation of the humerus without direct treatment on the shoulder, and we report it herein with a review of the literature.

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Checkrein Deformity by Incarcerated Posterior Tibial Tendon and Displaced Flexor Hallucis Longus Tendon following Ankle Dislocation: A Case Report: Su Young Bae, Hyung Jin Chung, Man Young Kim; J Korean Fract Soc 2011;24(3):271-276. Published online July 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.3.271

Abstract PDF

We report a case of 20 year-old man who had unusual equinus and checkrein deformity following dislocation of his right ankle joint. He had been treated with distal tibiofibular screw fixation and external fixation. After removal of external fixator, he had suffered from progressive deformity of foot and ankle. Widening of distal tibiofibular joint and medial clear space was found on radiograph and it was revealed that posterior tibial tendon had been dislocated and incarcerated into the distal tibiofibular joint on MRI. We corrected the deformity with excision of incarcerated posterior tibial tendon, adhesiolysis and lengthening of flexor hallucis longus tendon, reconstruction of deltoid ligament and flexor digitorum longus tendon transfer.

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Management of Checkrein Deformity
Min Gyu Kyung, Yun Jae Cho, Dong Yeon Lee
Clinics in Orthopedic Surgery.2024; 16(1): 1. CrossRef
A Neglected Extensor Hallucis Longus Tendon Rupture Caused by Arthritic Adhesion
Sung Hun Won, Sung Hwan Kim, Young Koo Lee, Dong-Il Chun, Byung-Ryul Lee, Woo-Jong Kim
Medicina.2023; 59(6): 1069. CrossRef
The Checkrein Deformity of Extensor Hallucis Longus Tendon and Extensor Retinaculum Syndrome with Deep Peroneal Nerve Entrapment after Triplane Fracture: A Case Report
Hyungon Gwak, Jungtae Ahn, Jae Hoon Lee
Journal of Korean Foot and Ankle Society.2021; 25(3): 145. CrossRef
Checkrein Deformity Due to Flexor Digitorum Longus Adhesion after Comminuted Calcaneus Fracture: A Case Report
Jin Su Kim, Han Sang Lee, Ki Won Young, Keun Woo Lee, Hun Ki Cho, Sang Young Lee
Journal of Korean Foot and Ankle Society.2015; 19(1): 35. CrossRef

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The Factors that Affect the Deformity Correction of Vertebral Body during Kyphoplasty of Osteoporotic Vertebral Compression Fracture: Young Do Koh, Jong Seok Yoon, Sung Il Kim; J Korean Fract Soc 2008;21(1):57-61. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.57

Abstract PDF: PURPOSE
To study which factors affect the deformity correction of vertebral body during kyphoplasty procedure.
MATERIALS AND METHODS
25 osteoporotic vertebral compression fractures were treated with balloon kyphoplasty from October 2006 to May 2007. Lateral radiographs were taken at 5 different stages with preoperative lateral decubitus position, after placing the patient in prone position on an operation table, after inflating balloon, after deflation and removal of the balloon, after inserting the cement. Then we analyzed the compression ratios and kyphotic angles of the vertebral bodies in each stage.
RESULTS
Placing the patient in prone position showed significant postural reduction in kyphotic angle and restorement of the anterior and middle body height. The inflation of the balloon demonstrated significant reduction of kyphotic angle and restorement of the anterior and middle body height. After the deflation, anterior and middle body height has decreased significantly. After the deflation, the kyphotic angle and the anterior and middle body heights were not restored signigicantly compared with those of initial prone position.
CONCLUSION
Vertebral height and kyphotic angle were partially recovered by inflating the balloon, but the correction was lost after deflating the balloon. Statistically, the body deformity was not restored significantly after deflating the balloon compared with that of intraoperative prone position. Therefore, we concluded that, in kyphoplasty of osteoporotic compression fractures, the postural reduction is the most important factor in deformity correction of fractured vertebral bodies.

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The Shortening and Rotational Deformity after Closed Intramedullary Nailing of Femur Shaft Fracture: According to Winquist-Hansen classification: Dong Eun Shin, Dong Hoon Lee, Chang Soo Ahn, Ki Shik Nam; J Korean Fract Soc 2007;20(4):297-301. Published online October 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.4.297

Abstract PDF

PURPOSE
This study evaluated the shortening and rotational deformity after closed intramedullary nailing of femur shaft fracture according to Winquist-Hansen classification type.
MATERIALS AND METHODS
This study was based on 98 cases who received cloased intramedullary fixation about their femur shaft fractures between January 2000 and October 2005 with minimum 12 months follow up. The rotational deformity was analysed by Yang's method (45 cases) preoperatively and postoperatively, and the shortening by orthoradiogram (55 cases). Furthermore we analysed other complications, for example nonunion, infection, and metal failure.
RESULTS
We found more than 15 degrees anteversion difference of both femurs in 10 cases. Among them, 9 cases were classified to type 3, 4. According to Winquist-Hansen classification, rotational deformity ranged from 3.7Â° (Type 1) to 8.9Â° (Type 4). More than 2 cm leg length discrepancy (LLD) was found in 9 cases, all of them were classified as Winquist-Hansen classification type 3, 4. In the type 1, LLD was checked as 3.2 mm and type 4, 14.2 mm.
CONCLUSION
To prevent the shortening and rotational deformity after intramedullary fixation of Winquist-Hansen classification type 3, 4 femur shaft fracture, intraoperatively the exact contralateral femoral anteversion and length should be checked.

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The Fate of Butterfly Fragments in Extremity Shaft Comminuted Fractures Treated with Closed Interlocking Intramedullary Nailing
Ki-Chan An, Yoon-Jun Kim, Jang-Suk Choi, Seung Suk Seo, Hi-Chul Gwak, Dae-Won Jung, Dong-Woo Jeong
Journal of the Korean Fracture Society.2012; 25(1): 46. CrossRef
Limited Open Reduction and Intramedullary Nailing of Proximal Femoral Shaft Fracture
Sang Ho Ha, Jun Young Lee, Sang Hong Lee, Sung Hwan Jo, Jae Cheul Yu
Journal of the Korean Fracture Society.2009; 22(4): 225. CrossRef

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The Angulation as to the Location of the Lag Screw of Compression Hip Screw in the Intertrochanteric Fracture of the Hip: Sang Won Park, Kwang Jun Oh, Seung Yong Wang; J Korean Soc Fract 2002;15(1):15-20. Published online January 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.1.15

Abstract PDF: PURPOSE
The purpose of this study was to evaluate the change of the angulation deformity according to apposition of medial cortex and sliding mechanism as to the location of the lag screw in the intertrochanteric fracture of the Korean femur which neck-shaft angle is relatively small .
MATERIALS AND METHODS
We selected the patients those angulation of femur neck-shaft was within 5 degree in comparison with normal side, and displacement of fracture fragment was within 4mm on the immediate post-operative radiograph. According to Evans classification, all patients were type I fracture. We classified the patients in two groups -stable medial cortex apposition(Group I) was 13 cases, and unstable no apposition(Group II) was 16 cases.
RESULTS
In the Group I, the varus-valgus angulation was average 3.3 degrees when lag screw was positioned at the middle of the femur neck, average 3.6 degrees when lag screw was positioned at the inferior to the femur neck. In the Group II, the varus-valgus angulation was average 6.1 degrees when lag screw was middle of the femur neck, average 1.5 degrees when lag screw was inferior to the femur neck.
CONCLUSION
There is no difference in angulation deformity when the lag screw is inferior or middle of femur neck if medial cortex is contacted, but the angulation deformity is less when the lag screw is inferior to femur neck if medial cortex is not contacted, in intertrochanteric fracture.

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Torsional Deformity Following Intramedullary Nailing for Treatment of the Tibia Fractures: Ju O Kim, Sung Jun Lee, Yeub Kim, Hae Ryong Huh; J Korean Soc Fract 2000;13(4):928-934. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.928

Abstract PDF: PURPOSE
To determine the incidence and extent of torsional mal-alignment in patients with tibial shaft fractures treated with closed antegrade intramedullary(IM) nailing.
MATERIALS AND METHODS
We measured torsion using CT scanning in 35 patients. Affected tibiae were compared with the normal tibiae.
RESULTS
A torsional difference of 8degrees or more found in 22 cases(63%) as compared with the uninjured side. Only 7 of these cases could be clinically detected and only two patients noted the problem.
CONCLUSION
Torsional mal-alignment occurs in a significant number of tibial fractures treated by closed IM nailing in spited of careful attention to detail. We recommend that torsional mal-alignment be considered as a likely cause for less than optimal result after treatment of the tibial fractures by closed IM nailing and to investigate this further by performing CT scans.

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The Angular Deformity of Interlocking Nailing in Tibial Fractures: Hwa Jae Jeong, Kyung Chul Kim, Jae Yeul Choi, Bon Seop Koo, Jung Hee Oh; J Korean Soc Fract 2000;13(4):905-911. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.905

Abstract PDF: PURPOSE
We studied the relationship between angular deformity and possibly contributing factors in the treatment of tibial fractures with interlocking nailing.
MATERIALS AND METHODS
Intramedullary nailing of the tibia was performed on 49 cases and were followed for the minimum of 12 months. We analyzed relationship between angular deformity and postoperative tibial alignment, operative technique and other factors.
RESULTS
Of the 49 cases, 19(38%) were angulated. Angular deformity was seen in 60%, 51.8% and 11.8% in the proximal, distal and middle third of tibial fractures respectively. With AO classification, Group A,B,C were angulated in 32.4%, 55.6%, 66.7%. In group A, 43.8% of spiral fractures, 28.6% of oblique fractures and 14.3% of transverse fractures were angulated. The cases combined with fibular fracture showed higher incidence of angular deformity than the cases with intact fibula. The opening of fracture and the nail insertion site were not significant to angular deformity.
CONCLUSION
Angular deformity of interlocking nailing in tibial fractures were more common in proximal, comminuted and spiral fractures. Precise attentions to operative technique i. e. accurate anatomical reduction and centromedullary nail orientation are recommended to prevent angular deformity. In proximal third tibial shaft fractures where muscles and patellar tendon has deforming force on fracture fragment, authors believe that use of interlocking nailing must be limited with fracture pattern.

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Remodelling of Angular DeforMity after Femoral Shaft Fractures in Children: Young Bae Pyo, Sang Ho Ha, Hong Moon Sohn; J Korean Soc Fract 1998;11(1):116-122. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.116

Abstract PDF: The common sequelae after femoral shaft fractures in children are leg-length discrepancy, angular deformity and rotational deformity. Overgrowth after the conservative management of fractures has been clearly defined, and it has been reported that rotational deformities can remodel. The importance of angular deformity after fracture is less clear although it has been reported as many as 40% of cases. So, authors reviewed 15 children (16 cases) with unilaterral femoral shaft fractures who had more than 10 degrees angular deformity after conservative treatment and observed the remodelling of deformity both at the fracture site and the physes. after average follow up of 34 months, the results were as follows 1. The average correction was 84% of the initial angular deformity; the physes contributed more than the fracture site. 2. The anterior angulation remodelled better than the varus angulation. 3. Younger children remodelled better and the magnitude of the angulation influenced the degree of remodelling.

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Angulation Deformity Following Interlocking Nailing for Treaeent of Tibia Fracture: Hong Jun Han, Jae Hoon Shin, Jeong Hyu Lee; J Korean Soc Fract 1996;9(4):1002-1008. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1002

Abstract PDF: Intramedullary nailing is often the treatment of choice in the management of fractures in the tibial diaphysis. With the advent of interlocking nailing, the indication for nailing have expanded, recently. One of the most frequent but little discussed complication of tibial nailing is fracture malalignment leading to angular or rotational deformities. This retrospective study was undertaken to access the incidence of aneular malalignment after interlocking nailing for 210 tibiae(208 patients). The results obtained were as follows; 1. The incidence of angular malalignment was 12.4% 2. The incidence of angular malalignment was 15.8% in proximal one third, 4.1% in middle one third,20.7% in distal one third fractures. 3. The most frequent deformity was valgus angulation in distal one third fractures. 4. Angular deformity was developed more frequently in cases of unlearned nailing(18.9%) than reamed nailing(8.4%). 5. Angular deformity was developed more frequently in cases of double level fracture(22.2%) than single level fracture(11.5%).

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Supracondylar Closing Wedge Osteotomy for Posttraumatic Angular Deformity of Distal Humerus: Methods for Reducing Secondary Deformity: Sung Soo Kim, Sung Keun Sohn, Chul Hong Kim; J Korean Soc Fract 1996;9(3):706-714. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.706

Abstract PDF: The angular deformity of distal humerus is one of the most frequent complication of supracondylar fracture in growing children. The deformity rarely limits function, but corrected by patients request due to cosmetic problem. Many orthopedic surgeons have suggested various operation methods but with high incidence of complications related to these operations, also we often experience secondary deformity after inaccurate osteotomy. Therefore to identify desirable operative method to reduce secondary deformity, a retrospective study of 17 patients operated with angular deformity following distal humerus fracture was carried out in which replanning with isosceles triangle method was done in all cases. The following results were obtained. 1. The complications were two cases of metal failure and one of non union. 2. The basic requirement of closing wedge osteotomy without secondary deformity was that:the center line of isosceles triangle whose apex angle should be identical to the deformity angle and be placed on the concave apex of deformity, should overlap the transverse bisector of hurnerusforearm axes. In inevitable cases, the disparity should be minimized to alleviate secondary deformity. 3. The translation was calculated by the equation of T=Dxsin Î±(T:translation, D:proximal or distal migration of the point of contact of humerus-forearm axes, Î±:angle of the deformity). In conclusion, we think that the deformity may be corrected safely and easily using minute preoperative planning with application of above principle.

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Supracondylar Osteotomy for Cubitus Vnrus Deformity by Using Plate in Adults: Hyun Ki Yoon, Sung Seok Soe, Young Ku Lee; J Korean Soc Fract 1992;5(2):319-324. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.319

Abstract PDF: Cubitus varus deformity is the most common complication of supracondylar fractures of the humerus in children. For the correction of this deformity, three basic types of osteotomies were known. Among them, the lateral closing wedge osteotomy is the easiest, safest and the most stable method. After osteotomy, the methods of fixation are plate fixation, crossed kirschner wires, staple, and French techniques. Between 1987 and 1991, 15 corrective supracondylar osteotomy of the humerus in adults were perromed at department of orthopaedic surgery inje University, Paik hoshpital Pusan, Korea. All were fixed with plate and screws. From this small series of retrospective study, the authors concluded that plate fixation is good method for the prevention of complication after osteotomy and results are satisfactory.

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Application of the Ilizarow technique to the complications of tibial open fracture report of two cases: Eun Kyoo Song, Ju Chull Jeung, Sung Man Rowe, Hyung Soon Kim; J Korean Soc Fract 1991;4(2):332-339. Published online November 30, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.2.332

Abstract PDF: No abstract available.

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