Journal of Musculoskeletal Trauma

In Situ Late 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; J Korean Fract Soc 2008;21(2):151-156. Published online April 30, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.2.151

Abstract PDF: PURPOSE
To evaluate the efficacy of the in situ late osteosynthesis for slightly displaced fractures of the lateral humeral condyle.
MATERIALS AND METHODS
From 2000 to 2004, 12 patients (8 boys and 4 girls) were managed with in situ late osteosynthesis for fractures of the lateral humeral condyle. The average age at the time of operation was 6 years 1 month (1 year 7 months~9 years 1 month), and the mean amount of fragment displacement was 3.3 mm (2.0~4.5 mm). The operative procedure included curettage and in situ fixation of the fragment RESULTS: Bony union was achieved in all cases after avg. 48 months (33~73 months) follow-up assessment. According to the score system of Dhillon et al, 7 patients had excellent, 3 had good, 2 had fair results. None of the patients developed avascular necrosis or premature closure of the epiphysis.
CONCLUSION
We suggest that in situ fixation is an effective method for the late treatment of slightly displaced fracture of the lateral humeral condyle.

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Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator: Suk Kyu Choo, Kyung Wook Nha, Hyoung Keun Oh, Dong Bong Lee; J Korean Fract Soc 2007;20(4):323-329. Published online October 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.4.323

Abstract PDF: PURPOSE
We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern.
MATERIALS AND METHODS
We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern.
RESULTS
Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%).
CONCLUSION
The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.

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The Usefulness of Low-Intensity Ultrasound for Nonunion and Delayed Union: Yeo Heon Yun, Jong Oh Kim, Young Do Ko, Jae Doo Yoo, Jun Mo Jung, Jong Gun Oh, Han Chen Bang, Chang Ho Choi, Myeung cheol Shin; J Korean Soc Fract 2003;16(1):104-111. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.104

Abstract PDF: PURPOSE
To evaluation of usefulness of low-intensity ultrasound for nonunion and delayed union.
MATERIALS AND METHODS
For 5 months, we treated 7 delayed union and 8 nonunion using low-intensity ultrasound. After 5 months, in checked X-ray AP and Lateral view, when cortical bridge formation was done, we through union.
RESULTS
In 7 delayed union, 5 cases-2 femur, tibia, humerus, radius were healed. In 8 nonunion, 3 femur nonunion were healed. Union rate was 71% in delayed union 37.5% in nonunion.
CONCLUSION
we thought that the low-intensity ultrasound has capacity of induction of union and was considered as the method of treatment for delayed union.

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The Effect of Dynamization in Tibia Fracture: Jin Woo Kwon, Seung Ho Shin, Won Ho Cho, Woo Se Lee, Ki Ho Sung; J Korean Soc Fract 2001;14(1):52-59. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.52

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the effect of dynamization which was done for the treatment of delayed union or persisting fracture gap after interlocking intramedullary nailing, by radiographic and physical examination.
MATERIALS AND METHODS
We analyzed 22 cases these were treated with dynamization from 247 cases of tibia shaft fracture treated initially with static interlocking intramedullary nailing from February l990 to May 2000 and were followed up more than lyear. The result of dynamization was classified as 3 groups and we divided each results 3 categories that is effective result, uncertain result and ineffective result. Group A is cases that achived ultimate union with shortening of fracture gap and was 10 cases. Group B is that achieved ultimate union but fracture gap did not reduced and was 10 cases. Group C is that showed ultimate non-union and was 2 cases.
RESULTS
The result is that dynamization was effective only 4 cases of group A. 6 cases of group A and 4 cases of group B showed instability(radiolucent halo around nail, hypertrophied callus and leg pain), and 6 cases of group B showed no shortening of fracture gap, thus these were classified as uncertain result. Group C(2 cases) showed non-union, classified as ineffective.
CONCLUSION
Dynamization caused instability in most tibia fractures except simple mid-shaft fracture. So in the comminuted fractures and distal or proximal l/3 oblique fractures, other procedures such as bone graft, refixation should be considered rather than dynamization.

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Treatment of the Femoral Shaft FracturesUsing Unreamed Interlocking Intramedullary Nail: Chang Wook Oh, Joo Chul Ihn, Poong Taek Kim, Shin Yoon Kim, Hee Soo Kyung, Chung Hyun Lee; J Korean Soc Fract 2000;13(4):832-836. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.832

Abstract PDF: PURPOSE
To evaluate the usefulness of unreamed nailing inthe treatment of femoral shaft fractures.
MATERIALS AND METHODS
Between March 1996 and June 1998, unreamed nailing with closed method was done for 74 patients with 82 femoral shaft fractures. The main indications for this treatment were multiple injury or isolated femoral fracture above Winquist type II. The influence of Winquist- Hansen classification, anatomical location, and open injury over bone union and the influence of injury severity score over general complication including fat embolism were investigated.
RESULTS
Primary union occurred in 76 cases(93%) with 6 cases of nonunion and 10(12%) of delayed union, and mean time to union was 27 weeks. In open fractures, the union time was delayed(32 weeks) rather than closed fracture. In Winquist classification, there was no stastical importance on time to union, but nonunion was most common in Winquist type IV. Anatomical location has no influence on time to union. In the view point of multiple injury, the group above 18 points(31 patients) in injury severity score had none of fat embolism, but the group below 18 points(43 patients) had 2 patients.
CONCLUSION
The treatment of femoral shaft fractures by unreamed nailing had longer time to union with higher rate of delayed union, and we think that the theoretical advantage of decreasing pulmonary complications is controversial.

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Autogenous bone marrow injection for the treatment of delayed union of the long bone: Jin Hyung Sung, Jae Duk Ryu, Weon Yoo Kim, Chang Hwan Han, Eui Young Ohm, Jin Young Kim; J Korean Soc Fract 1999;12(4):1071-1076. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1071

Abstract PDF: It is known that the Salter-Harris type I and II fractures of the distal tibial epiphysis usually For resolving problems of delayed union and non-union of long bones, many efforts was made such as autogenous graft, allogenic or artificial bone graft and electrical stimulation, but there were many complications and not sufncient fracture healing process. The purpose of this study was to investigate the effect of autograft with bone marrow on the repair or bone formation of delayed union by the serial radiogram and clinical examination. We evaluated thirty nine patients which had been treated for long bone fracture, to whom bone marrow injection was made between 3 months and 13 months after adequate fixation(average.4.8months). After bone marrow injection, clinical follow up period was from 15 months to 35 months(average 26.7months). The age distribution was from 18 years to 84 years(average 42). A total of 100- 150cc of marrow was injected at the nonunion site immediately after aspiration under the C-arm. Of 39 cases, there were improved bone healing process of 30 cases(77%) by radiographically and clinically, Of 9 cases without improvement, 5 cases were due to loosening of external fixator, 2 cases was due to chronic osteomyelitis and other 2 cases was unknown origin. No serious complications were observed other than no improvement. Although percutaneous bone marrow injection does not promote healing more rapidly than would standard operative bone grafting, it has many distinct advantages over the latter. It is safe, easy, and time saving. It is economical and involves minimal trauma. It can be done under local anesthesia and avoids the risks of general anesthesia, infection and surgery. It can be done in cases which are not fit for open bone grafting because of poor condition of the skin.

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Use of Interlocking Intramedullary Nail in Treatment of Delayed Union or Nonunion of the Long Bone Fractures: Suk Kyu Choo, Byung Jik Kim, Han Suk Ko, Jeong Gook Seo, Jin Gu Kim, Jun Woo Chang; J Korean Soc Fract 1998;11(4):761-768. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.761

Abstract PDF

Of the several nonoperative and operative options described for the treatment of delayed union and nonunion of the long bone, interlocking nailing with reaming offect of internal splint, autogenous bone graft and early return to a normal way of life. The purpose of this study is to evaluate the usefulness and complication of intramedullary(IM) naling with reaming by retrospective method. We treated 34 patients with delayed union or nonunion of the tibia, femur, and humerus by interlocking nailing with reaming between January 1992 and December 1996. The results were as follows ; 1. Of the 34 cases, there were 13 tibia fracture, 17 femur fracture, 4 humerus fracture. Half of them were ununited and another half were delayed in fracture healing. 2. Previous methods of treatment were conservative treatment in 2 cases, external fixator in 2, plate & screws fixation in 8, Ender nail in 2, Kuntscher nail in 2 and interlocking nail in 7 among 24 cases of cloed fracture and external fixator in 8 and interlocking nail in 2 among 10 cases of open fracture. 3. Twenty-five patients were treated with closed nailing and 9 were treated with open nailing. Iliac bone graft was performed at 3 cases and fibulotomy was performed at 1 case. 4. Union was obtained in 33 cases and 1 case needed additional bone grafting to achieve union. 5. Postoperative complications were one nonunion, two evtry site pain, one screw breakage, one heterotopic ossification, and one postoperative infection. Interlocking nailing with reaming was associated with a high union rate(97%) in our eries. The authors believe that IM nailing with reaming is a useful option for treatment of delayed or nonunion of the long bone fracture.

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Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef

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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 Effect of Dynamization After Static Intelocking Intramedullary Nailing: Kyoo Seog shin, Jong Soon Kim, Kong Wha Lee, Jin Hwan Seo; J Korean Soc Fract 1998;11(2):262-268. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.262

Abstract PDF: We had investigated the effect of dynamization in static interlocking intramedullary nailing for the long bone fracture of the femur and tibia treated in Bongseng Memorial Hospital for last 3 years (from Jan. 1994 to Jan. 1997) Total 62 patients (37 tibia, 28 femur) were treated, 35 cases were reamed at operaion and 27 cases not reamed. following results were obtained; 1. In all except 24 fractures, the static interlocking intramedullary nail was preserved without dynamization and got to mean union time of 17.2 weeks (femur) and 6.4 weeks (tibia). 2. The 24 patients (14 femur, 10 tibia) did not show callus formation and complained of vague pain in fracture site at 20 weeks after static mode. In those cases, we tried dynamization as a initial treatment modality. 3. The success rate after dynamization was about 87%. 4. The interval between nailing and dynamization did not affect the success rate. 5. Dynamization could be done day surgery.

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Treatment of Extra-articular Proximal Tibial Fracture: Ki Hong Choi, Chung Nam Kang, Jin Man Wang, Kwon Jae Roh, Sang Kyum Lee; J Korean Soc Fract 1990;3(2):223-231. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.223

Abstract PDF: The management of extra-articular proximal tibial fracture remains controversy. Many reporters recognized that the proximal tibial facture are best treated by closed reduction and long leg cast, however delayed union with this method have frequently been documented in spite of anatomical characteristics of proximal tibia. Thirty patients of the fracture of extra-articular Froximal tibia were treated and managed at the Department of Orthopaedic Surgery, Ewha University Hospital from January, 1583 to December 1989. The following results were obtained: 1. According to Gerard classification, anterior long oblique & posterior long oblique fracture were 18 cases(60%) and 8 cases(27%) respectively. Delayed union developed in 9 cases(50%) of 18 cases anterior long oblique fracture and 2 cases(25%) of 8 cases posterior long oblique fracture. 2. All cases of deleyed union of tibia developed through or below the tuberosity. 3. Among 30 cases, the fractures were managed with closed method at 23 cases, open method at 7 cases, internal fixation at 12 cases without delayed union and external fixator at 10 cases. The all cases using external fixator resulted in delayed union. 4. Among 30 cases, 16 cases(53%) were open fracture, and the most common type was type IIIb. Delayed union developed in 8 cases(50%) of 9 cases(56%) type IIIb. 5. The 24 cases (80%) of fibular fracture were concurred with proximal tibial fracture, and delayed union developed in 10 cases (42% ) of 24 cases fibular fracture and one case of 6. cases without fibular fracture. In conclusion, many delayed unions were frequent. In our experience, in case of GradeIII open comminuted fractures, we used external fixation methods mostly, so delayed unions were developed. But after management of soft tissue injury, healing time were short with bone graft as soon as possible, We consider that in cases in which internal fixation was possible according to soft tissue injury, delated unions are prevented by internal fixation using plate and screws or retrograde flexible nails.

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