Journal of Musculoskeletal Trauma

Bone Union Time of Simple Distal Femur Fractures in the Elderly according to Fracture Gap after Treated with Minimally Invasive Plate Osteosynthesis: Young Ho Cho, Sangwoo Kim, Jaewook Koo; J Korean Fract Soc 2023;36(4):133-138. Published online October 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.4.133

Abstract PDF: Purpose
This study examined the difference in bone union time according to the fracture gap after minimally invasive plate osteosynthesis (MIPO) for simple distal femoral fractures in elderly patients.
Materials and Methods
From January 2010 to December 2019, patients aged 60 years or older who underwent surgical treatment for distal femoral fractures due to a low-energy injury were investigated retrospectively. Forty patients were enrolled in the study. The patients were divided into two groups according to the fracture gap after reduction: no more than 2 mm (Group A) and more than 2 mm (Group B) in the anteroposterior and lateral plane. The demographic, operation time, presence or absence of cerclage wiring, plate screw density, plate span ratio, plate length, bone union period, non-union, and complications were evaluated.
Results
No statistical differences in operation time, cerclage wiring, plate screw density, plate span ratio, and plate length were observed between the two groups, and the bone union was achieved in all patients without complication. The bone union period was 17.24±1.48 weeks in Group A and 24.53± 5.20 weeks in Group B, which was statistically significant (p<0.001).
Conclusion
The bone union time in treating geriatric simple distal femur fractures using the MIPO tech-nique was significantly shorter in the 2 mm or less fracture gap than in the greater than 2 mm group.

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Usefulness of Reduction and Internal Fixation Using a 2.4 mm Hand Plating System in Type AO 33-A3 Distal Femur Fracture - Technical Note -: Bong-Ju Lee, Ja-Yeong Yoon, Seungha Woo; J Korean Fract Soc 2023;36(1):25-28. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.25

Abstract PDF: Open reduction in an AO 33-A3 class distal femur transverse and comminuted fracture is often difficult due to frequent reduction loss during surgery, leading to longer operative time and increased blood loss intra-operation. In this study, the authors report a case in which the use of an offset grid plate (OsteoMed, USA) using 2.4 mm HPS (hand plating system) eased the process of fracture reduction and achieved a stable internal fixation, ultimately leading to successful osteosynthesis. The authors experienced no need for temporary fixation devices such as K-wires or screws, which are otherwise required to stabilize the reduction. The fracture reduction was stable throughout the primary fixation of the fracture using a locking plate and screws. The authors report that the advantage of the HPS plate is fitting into the cortical contour and providing stable maintenance of fracture reduction intra-operation, which would be beneficial in certain distal femoral fracture patterns.

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Distal Femur Fractures Treated with Distal Femoral Locking Plate Fixation: A Retrospective Study of One Year Mortality and Risk Factors: Kwang-Hwan Jung, Yoon-Seok Youm, Seung-Hyun Jung, Jae-Min Oh, Ki Bong Park; J Korean Fract Soc 2023;36(1):10-16. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.10

Abstract PDF: Purpose
This study examined the one-year mortality after locking plate fixation for distal femur fractures and the risk factors related to death.
Materials and Methods
From July 2011 to June 2020, 128 patients who underwent locking plate fixation for distal femur fractures were analyzed retrospectively. Epidemiologic information of the patients, characteristics related to fracture and surgery, and death were investigated. The risk factors related to death were investigated using Cox analysis, and a subgroup analysis was also performed based on the age of 65 years.
Results
The one-year mortality rate after locking plate fixation for distal femur fractures was 3.9%, and the mortality rates in patients younger than 65 years and older than 65 years were 0% and 6.7%, respectively. There were no significant risk factors related to death in the total population. On the other hand, in patients aged 65 years or older, however, high-energy fracture and high comorbidity index increased the risk of death after surgery by 6.9-fold and 1.9-fold, respectively.
Conclusion
The one-year mortality rate for the total patients was 3.9%, but the mortality rate for patients over 65 years of age increased to 6.7%. High-energy fractures and high comorbidity index were risk factors related to death after surgery for distal femur fractures in patients aged 65 years or older.

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Outcomes following Treatment of Geriatric Distal Femur Fractures with Analyzing Risk Factors for the Nonunion: Soo young Jeong, Jae Ho Lee, Ki Chul Park; J Korean Fract Soc 2019;32(4):188-195. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.188; Correction in: J Musculoskelet Trauma 2020;33(1):62

Abstract PDF

PURPOSE
Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (ageâ‰¥60) and to determine the risk factors related witht he occurrence of nonunion.
MATERIALS AND METHODS
This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients' underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion.
RESULTS
The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045).
CONCLUSION
The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors.

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Comparison of Clinical Outcomes for Femoral Neck System and Cannulated Compression Screws in the Treatment of Femoral Neck Fracture
Jae Kwang Hwang, KiWon Lee, Dong-Kyo Seo, Joo-Yul Bae, Myeong-Geun Song, Hansuk Choi
Journal of the Korean Fracture Society.2023; 36(3): 77. CrossRef

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The Mid-Term Result after Osteosynthesis of Intra-Articular Fractures of Distal Femur: Sam Guk Park, Jeong Jae Moon, Oog Jin Shon; J Korean Fract Soc 2016;29(4):242-249. Published online October 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.4.242

Abstract PDF

PURPOSE
This study was to evaluate the radiological and clinical mid-term results and the presence of post-traumatic osteoarthritis after osteosynthesis in patients under the age of 50 years undergoing osteosynthesis for distal femur intra-articular fractures (AO/OTA 33-B & C) from high-energy trauma.
MATERIALS AND METHODS
Between January 2008 and January 2013, a total of twenty-one patients with more than three years of follow-up were enrolled. Recovery of the alignment of the lower extremity, union period, and the presence of post-traumatic osteoarthritis were confirmed by follow-up radiographs. Clinically, the range of motion, pain on fracture lesion, and Knee Society score (KSS) were evaluated.
RESULTS
The average duration of union was 18.2 weeks (10-28 weeks), and the alignment of the lower extremity was within normal range in all patients. Seven patients showed post-traumatic osteoarthritis at the final follow-up after more than three years. The presence of post-traumatic osteoarthritis was associated with the classification of fractures, coronal plane fracture, and age. The average range of motion, knee score among KSS, and function score at the last follow-up were 128.7Â°, 86.1, and 85.1, all showing a greater improvement when compared with the one-year follow-up scores.
CONCLUSION
The mid-term result was radiologically and clinically satisfactory. Furthermore, only 33.3% of patients showed a slight progress of post-traumatic osteoarthritis, which critically effects the prognosis.

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Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef

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Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture: Sung Won Cho, Sang Ho Ha, Gwang Chul Lee, Woong Hee Kim; J Korean Fract Soc 2013;26(3):205-211. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.205

Abstract PDF

PURPOSE
To analyze the clinical and radiologic results of minimally invasive plate osteosynthesis (MIPO) for distal femur fractures using a locking compression plate (LCP) and to evaluate its usefulness.
MATERIALS AND METHODS
From May 2006 to April 2011, 23 patients (24 cases) with distal femur fracture were treated by MIPO with a LCP and followed-up for at least 12 months. Mean age was 61.6 years (35-80 years). Union time and post-operative alignment were measured on radiograph, and clinical function was evaluated by range of motion (ROM), Knee Society Score and complications.
RESULTS
In 22 patients (23 cases) except for 1 case, bony union was obtained after an average of 18 weeks (12-26 weeks). The mean ROM was 124 degrees (80-135 degrees). According to the Knee Society Score, there were 12 excellent, 8 good, 1 fair and 2 poor results and the mean score was 87.5 (60-98). Postoperative complications were nonunion in 1 case, ankylosis in 1 case, malunion in 2 cases and superficial wound infection in 2 cases.
CONCLUSION
The treatment of distal femoral fracture with MIPO using a LCP was considered a useful method which can result in satisfactory clinical and radiologic outcomes if there is accurate understanding about the surgical techniques and appropriate procedures involved.

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Surgical Treatment of AO/OTA 33-C Intra-Articular Distal Femoral Fractures through Parapatellar Approach
Suk Kyu Choo, Sung Tan Cho, Hyoung Keun Oh
Journal of the Korean Fracture Society.2022; 35(1): 1. CrossRef
Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef

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Treatment of Distal Femur Fracture with Minimally Invasive Locking Compression Plate Osteosynthesis: Ki Chul Park, Kyu Sung Chung, Joon Ki Moon; J Korean Fract Soc 2012;25(1):13-19. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.13

Abstract PDF

PURPOSE
To analyze the result of distal femur fracture treatment with minimally invasive plate osteosynthesis (MIPO) using a locking compression plate (LCP).
MATERIALS AND METHODS
From December 2004 to April 2010, 33 patients with distal femur fractures were treated by MIPO with a locking compression plate. The reduction state and bone union time was checked radiologically. The clinical outcome was evaluated by the Schatzker and Lambert criteria.
RESULTS
The mean bone union time was 16.3 weeks (10~22 weeks). There were 3 nonunions, 2 broken plates, 1 superficial infection, 7degrees of valgus angulation in 1 case, and 1.5 cm limb shortening in 1 case. Except for the 3 nonunion cases, according to the Schatzker and Lambert criteria, results were graded as excellent in 11 cases, good in 14 cases, and moderate in 5 cases.
CONCLUSION
The treatment of distal femoral fracture by MIPO with a locking compression plate resulted in good functional and radiological outcomes, but it has problems, such as broken plates and nonunion. Accurate surgical technique and appropriate treatment will be needed according to fracture type.

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Surgical Treatment of AO/OTA 33-C Intra-Articular Distal Femoral Fractures through Parapatellar Approach
Suk Kyu Choo, Sung Tan Cho, Hyoung Keun Oh
Journal of the Korean Fracture Society.2022; 35(1): 1. CrossRef
Comparing Outcomes of Retrograde Intramedullary Nail and Locking Plate Fixation in Distal Femoral Fractures
Byung-Ho Yoon, Bo Kwon Hwang, Hyoung-Keun Oh, Suk Kyu Choo, Jong Min Sohn, Yerl-Bo Sung
Journal of the Korean Fracture Society.2021; 34(4): 131. CrossRef
Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef
Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture
Sung Won Cho, Sang Ho Ha, Gwang Chul Lee, Woong Hee Kim
Journal of the Korean Fracture Society.2013; 26(3): 205. CrossRef

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Treatment of the Distal Femur Fracture with Retrograde Intramedullary Nailing: Moon Jib Yoo, Myung Ho Kim, Hee Gon Park, Woo Sup Byun, Ki Choul Kim; J Korean Fract Soc 2005;18(3):238-243. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.238

Abstract PDF

PURPOSE
To evaluate the results and complications of the retrograde intramedullary nailing for the treatment of distal femur fracture.
MATERIALS AND METHODS
Thirty three patients who received retrograde IM nailing for fractures of the distal femur between October 1998 to December 2003. Average age was 53.8+/-17 (17~86) years. The average follow up period was 19.4 (12~36) months. Clinical information included age, sex distribution, associated fracture and fracture was classified by AO classification. Functional result was evaluated by Schatzker's criteria.
RESULTS
The most common cause of injury was traffic accident (60%). The type of fracture were 6 A1 cases, 5 A2 cases, 11 A3 cases, 5 C2 cases, 6 C3 cases by AO classification. Among the 33 cases, 15 cases were excellent, 9 good, 6 fair and 1 failure according to Schatzker's criteria. Average union time was 9.7+/-3.5 months.
CONCLUSION
Treatment of distal femur fracture with retrograde intramedullary nailing was useful due to its minimal invasiveness and early range of motion, more rigid fixation.

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Retrograde Intramedullary Nailing for Periprosthetic Supracondylar Fractures of the Femur after Total Knee Arthroplasty
Hyuk-Soo Han, Kyu-Won Oh, Seung-Baik Kang
Clinics in Orthopedic Surgery.2009; 1(4): 201. CrossRef
Retrograde Nailing for Supracondylar Fracture after Total Knee Replacement: The Compatibility of Femoral Implant with Supracondylar Nail
Moon-Jib Yoo, You-Jin Kim, Jin-Won Lee
Journal of the Korean Fracture Society.2008; 21(1): 19. CrossRef
Midterm Results of Treatment with a Retrograde Nail for Periprosthetic Fractures of the Femur Following Total Knee Arthroplasty
Kyung-Taek Kim, Jin-Hun Kang, Lih Wang, Jae-Sung Hwang
Journal of the Korean Fracture Society.2007; 20(4): 309. CrossRef

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Treatment of Distal Femoral Shaft and Supracondylar Fracture with aRetrograde Intramedullary Nailing: Sang Hong Lee, Jun Young Lee, Sang Ho Ha, Hong Moon Sohn, Kwang Chul Lee; J Korean Fract Soc 2004;17(2):103-109. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.103

Abstract PDF

PURPOSE
Retrograde intramedullary nailing has been recommended as one of the treatment options for the distal femoral fracture, particularly in patients who are obese, are pregnant, has sustained ipsilateral femoral neck fracture, have multiple injuries. However there are some disadvantage such as post-arthrotomy infection, knee joint stiffness. This paper is to evaluate the result and complication of treatment of distal femoral fracture with a retrograde intramedullary nailing.
MATERIALS AND METHODS
We reviewed 13 cases (distal femoral shaft fracture: 6 cases, supracondylar fracture: 7 cases) of the distal femoral fracture who had been treated with retrograde intramedullary nailing and follow up for more than 12 months from January 1999 to December 2001. The rate of bony union, range of motion of the knee, complications were evaluated.
RESULTS
The mean duration of bony union was 20 weeks (range, 16~25 weeks). A case of delayed union was developed. In 4 cases of 13 cases showed posterior angulation below 6 degree, which did not need further treatment. According to Saunder's criteria, excellent result was achieved in 8 patients, good result in 5 patients, respectively.
CONCLUSION
This study showed good clinical and radiological results of union with retrograde intramedullary nailing at the distal femoral fracture and ipsilateral multiple fracture

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Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult
Yong-Woon Shin, Yerl-Bo Sung, Jeong Yoon Choi, Minkyu Kim
Journal of the Korean Fracture Society.2011; 24(4): 313. CrossRef
Axial Malalignment after Minimally Invasive Plate Osteosynthesis in Distal Femur Fractures with Metaphyseal Comminution
Jae-Ho Jang, Gu-Hee Jung, Jae-Do Kim, Cheung-Kue Kim
Journal of the Korean Orthopaedic Association.2011; 46(4): 326. CrossRef

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Clinical Result of Surgical Treatment in Distal Femur Fractures using Dynamic Compression Screw and Blade Plate: Seung Baik Kang, Joong Hee Won, Bong Soon Chang, Eui Seong Choi, Jin Seon Yoo, Hee Joong Kim; J Korean Soc Fract 1996;9(3):557-566. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.557

Abstract PDF: The fracture of distal femur, which include the supracondylar region, intercondylar region and knee joint, have many problems by nature. It is almost all comminuted fracture and has a some difficulty in approach. Early attempts at internal fixation frequently gave unacceptably high rates of malunion, nonunion, and infection. Traditionally, nonsurgical treatment has been favored. Over the past 15 years, improved and meticulous techniques of internal fixation has been shown to yield good to excellent results. Also a number of excellent devices are now available. We reviewed the patients who were admitted for fractures of the distal femur and were treated by the surgical treatments at department of Orthopaedic Surgery, Chungbuk National University Hospital from July 1993 through Augrst 1994. Fourteen cases were followed for more than one year. An average age at operation was 54 years (range, 18-74 years). The analysis group consisted of 9 males and 5 females. The cause of injuries were motor cycle injury in 8 cases, in-car accident in 2 cases, pedestrian injury in 2 cases and fall down in 2 cases. According to the classifications of AO, 4 cases were type Al, 2 were type A2, 2 were type A3, Cl was 1 case, C2 were 2 cases and C3 were 3 cases. Open fractures were 2 cases. Blade plate was used in 10 cases and DCS(dynamic compression screw) in 4 cases. With serial follow-up X-ray, ROM of knee and Neers scoring system, evaluation was performed. Excellent or good results were obtained in 13 cases (93%). Deep infection was developed in one case. At last follow-up, ROM was satisfactory. Blad plate was very useful for severe osteoporotic patient. For comminuted, displaced intra-articular fractures such as Type C, extensile surgical approach was most useful.

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