Journal of Musculoskeletal Trauma

Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures: Sang Woo Kim, Chae Chil Lee, Sang Hun Ko, Il Yeong Hwang, Min Seok Kim, Woo Young Jin; J Korean Fract Soc 2019;32(1):1-5. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.1

PURPOSE
This paper suggests the use of distraction dynamic external fixators (DDEF) for the treatment of proximal middle phalanx fractures.
MATERIALS AND METHODS
Seven patients, who were diagnosed with comminuted intra-articular fractures at the base of the middle phalanx from February 2014 to November 2016, were enrolled in this study (volar aspect 6 cases, dorsal aspect 1 case). They underwent a closed reduction under a C-arm image intensifier, and DDEF was applied with general anesthesia. Range of motion (ROM) exercise was encouraged after 3 to 5 days postoperatively, and DDEF was removed after 5 weeks. Subluxation, angulation and displacement were evaluated 6 weeks postoperatively.
RESULTS
The patients who were treated with DDEF showed a normal proximal interphalangeal joint ROM (100Â°), and there was no subluxation or displacement on the X-ray film 6 weeks postoperatively. In addition, there were no signs of infection, such as local heat, redness, and pus-like discharge.
CONCLUSION
DDEF helps maintain the reduction and reducing forces through the ligamentotaxis. The joint stiffness is reduced, which it makes early return to daily life easier.

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Treatment of Neglected Proximal Interphalangeal Fracture Dislocation Using a Traction Device: A Case Report
Yongun Cho, Jai Hyung Park, Se-Jin Park, Ingyu Lee, Eugene Kim
Journal of the Korean Fracture Society.2019; 32(4): 222. CrossRef

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Chronic Osteomyelitis in Distraction Osteogenesis Area of Tibial Shaft: A Case Report: Sanguk Bae, Baekyong Song, Jin Seon Moon; J Korean Fract Soc 2014;27(4):321-326. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.321

Abstract PDF: Distraction osteogenesis with an Ilizarov external fixator is one of the most successful treatment options for large segmental bone defects after extensive debridement of chronic osteomyelitis in the tibial shaft. Its complications include skin irritation, pin tract infection, and non-union due to infection. There are few case reports on chronic osteomyelitis occurring in the distraction osteogenesis area. The authors experienced a chronic osteomyelitis in the distraction osteogenesis area of the tibial shaft and report this case with references.

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Subtalar Distraction Arthrodesis for Calcaneal Malunion: Hyung Jin Chung, Jae Kwang Yum, Kook Jin Chung, Jae Min Jeon; J Korean Fract Soc 2006;19(1):34-40. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.34

Abstract

PURPOSE
To evaluate the results and efficacy of the subtalar distraction arthrodesis on patients with complications due to malunion after intra-articular calcaneal fracture.
MATERIALS AND METHODS
From October 2001 to September 2004, we operated on 10 patients (14 cases). There were 9 male patients and one female; their mean age was 41 years old. Ten cases among them were operated initially. The mean period between initial injury and arthrodesis was 18 months. The mean follow up period was 16 months. During the operation, we used extensile lateral approach and arthrodesis was performed using tricortical bone block and cannulated screws. The ankle-hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT of the both feet were examined for union and various parameters.
RESULTS
Thriteen cases achieved radiologic bone union. The mean ankle-hindfoot scale (maximum: 94 points) increased from 52.4 points preoperatively to points 77.2 at the final follow-up. The radiologic analysis of the pre and postoperative standing lateral radiograph showed mean increase of 6.9 mm in talo-calcaneal height, 5.2 degrees in talocalcaneal angle, 4.3 degrees in talar declination angle and average decrease of 4.5 degrees in talo-first metatarsal angle.
CONCLUSION
The short term result of the subtalar distraction arthrodesis using tricortical bone block was promising, but longer follow-up will be needed.

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Mid-Term Follow Up Results of Subtalar Distraction Arthrodesis Using a Double Bone-Block for Calcaneal Malunion
Hyung-Jin Chung, Su-Young Bae, Ji-Woong Choo
Yonsei Medical Journal.2014; 55(4): 1087. CrossRef

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Short Segment Fixation of Flexion-Distraction Injuries in Thoracolumbar Spines: Young Do Koh, Jeong Joon Lee, Jong Kyong Ha; J Korean Fract Soc 2005;18(4):452-458. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.452

Abstract PDF: PURPOSE
To evaluate the efficacy of short segment fixation in flexion-distraction injuries of thoracolumbar junction.
MATERIALS AND METHODS
Twenty-five patients with a flexion-distraction injury in thoracolumbar junction confirmed by radiogram or MRI and stabilized with a short construct spanning short segment were included in this study. We investigated the location of fractures, type of fractures, anterior or posterior vertebral body height, and preoperative and postoperative kyphotic angle of injuried motion-segments on radiologic examinations and clinical outcome on the Oswestry score.
RESULTS
A significant correction of deformity was achieved, from a mean preoperative kyphosis of 17.3 degrees to a mean postoperative kyphosis of 8.4 degrees. The loss of correction were minimal. The mean Oswestry score was 6.9, with 84% of patients having minimal disability (<20%) and no correlation with age, sex, the location of fractures, type of fractures, change of kyphotic angle.
CONCLUSION
This study demonstrates the efficacy of posterior open reduction and short segment fixation of flexion-distraction injuries.

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Fracture of Vertebral Body in Flexion-Distraction Injury of Thoracolumbar Spine: Young Do Koh, Jong Oh Kim, Yeo Hon Yun, Jae Doo Yoo, Jun Mo Jung; J Korean Soc Fract 2003;16(2):262-269. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.262

Abstract PDF

PURPOSE
To evaluate the configuration of vertebral body fractures in flexion-distraction injuries of thoracolumbar spine.
MATERIALS AND METHODS
We investigated the location of fractures, anterior or posterior vertebral body height, kyphotic angle of injured segments, canal encroachment and severity of comminution on radiologic examinations of 21 cases.
RESULTS
There were 11 compression fractures and 9 burst fractures. 85% of fractures were located in the inferior vertebrae of injured segments. Anterior vertebral height decreased by 27% on average with decrease of 18% in compression fractures and 40% in burst fractures. Posterior height decreased by 1% on average with increase of 1% in compression fractures and decrease of 4% in burst fractures. The average kyphotic angle of injured segments was 19.5 degrees with 15.4degrees in compression fractures and 26.8 degrees in burst fractures. The canal encroachment in 9 burst fractures was 27% on average, and the comminution of vertebral body was mild in 74%.
CONCLUSION
The fracture of vertebral body in flexion-distraction injuries of thoracolumbar spine was very common, and located on the inferior vertebrae of injured segment. The decrease of vertebral height, canal encroachment and severity of comminution was relatively less than the estimated from mechanism of injury, with offset effect of distraction force.

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Differences in Thoracolumbar Burst Fractures by Falls from Height with Associated Foot and Ankle Fractures
Chung-Shik Shin, Eea-Sub Chung, Chang-Eon Yu, Byeong-Yeol Choi
Journal of Korean Society of Spine Surgery.2012; 19(2): 47. CrossRef

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The Effect of Low Intensity Ultrasound on Distraction Osteogenesis in the Rabbit Femur: Hyung Bin Park, Hae Ryoung Song, Kyung Hoi Koo, Soon Taek Jeong, Bun Jung Kang, Se Hyun Cho; J Korean Soc Fract 2002;15(2):159-165. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.159

Abstract PDF: PURPOSE
The effects of ultrasound on mechanical properties of the callus in distraction osteogenesis was assessed in this study. MATERIAL AND METHOD: Forty mature New Zealand white rabbits were divided into two groups (ultrasound group and control group). A midshaft femoral osteotomy was made and fixed with a small external fixator. After a latent period of a week, lengthening was performed at the rate of 1mm a day for 2 weeks. Low intensity ultrasound (EXOGEN inc, Piscataway, NJ U.S.A) was applied to the operated limb for 20 minutes a day in the ultrasound group, while the control group waited for natural maturation of the callus. The bone mineral density and mechanical properties such as ultimate load, ultimate stress, deflection at ultimate load, ultimate stiffness and energy absorption at ultimate load were measured and analyzed.
RESULT
The bone mineral density, the area of the callus, ultimate load, ultimate stress and energy absorption at ultimate load were not significantly different between the two groups (p>0.05). The ultimate stiffness in the ultrasound group was significantly higher than those of the control group (p<0.01). The deflection at ultimate load in the ultrasound group was significantly lower than those of the control group (p<0.01).
CONCLUSION
The low density ultrasound has a positive effect on the mechanical properties of the distracted callus in the rabbit femoral model in terms of the ultimate stiffness and the deflection at ultimate load.

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Effect of Insertion of Bone Graft Substitutes on Consolidation of Distracted Callus: Changes of Radiography & Bone Mineral Density in the Tibia of Rabbits: Chang Wug Oh, Poong Taek Kim, Byung Chul Park, Hae Ryong Song, Il Hyung Park, Jun Ho Baek, Hyung Jin Park; J Korean Soc Fract 2000;13(4):687-695. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.687

Abstract PDF: PURPOSE
This study was designed to know the effect of calcium-sulfate and xenograft on the distracted callus after lengthening.
MATERIALS AND METHODS
We had operation of subperiosteal osteotomy and external fixation on the tibial diaphysis of young New Zealand White rabbits(2.0-2.5kg); after 5 days of latency period, 7 mm(1mm/day, 2 times/day) of tibial lengthening was reached in a week. At 1 week after lengthening, the 1st experimental group of 7 rabbits received a pellet of calcium sulfate(Osteoset , Wright medical, USA) in the distraction gap, and the 2nd experimental group of 7 rabbits received 5mm2 of xenogrfat(Lubboc ) in the distraction gap. But, the control group of 7 rabbits did not receive any of above materials. We compared three groups with the changes of radiographic findings at every week and bone mineral ratio(DEXA) at every two weeks.
RESULTS
The time to complete consolidation of distraction callus of both experimental group(calcium sulfate;14 weeks, xenograft; 15.4 weeks) was shorter than that of control group(16.9 weeks) in radiographic findings. Maximum value of bone mineral ratio of distraction callus was higher and the time to reach the highest value was also shortened in the both experimental group compared to control group.
CONCLUSION
By use of bone substitutes as like calcium sulfate or xenograft in the distraction callus with external fixator, it may be possible to shorten the consolidation period and the fixator-wearing period.

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Radiologic Follow-up Results of Distraction After Treatment of Distal Radius Fractures using External Fixator: Jong Oh Kim, Dong Wook Kim, Young Do Koh, Jae Doo Yoo, Kyoung Soo Kim; J Korean Soc Fract 1999;12(4):988-994. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.988

Abstract PDF: External fixation for severe fractures of the distal radius is accepted treatment offering the potential advantages of controlled distraction, accurate positioning of fracture fragments, and avoidance of extensive open procedures. One of the limitation of external fixation for distal radius fractures is excessive distraction, which affect the outcome. This study was conducted to evaluate the changes of the distraction of the intercarpal and radiocarpal joint, developed after treatment of distal radius fractures with external fixator. Restrospective study was done for 28 paitents, who were evaluated by chart review, questionnaire, radiograph, and physical examination. The carpal height ratio, radial inclination, velar tilt, radial length were measured in the postoperative and follow-up radiographs. The carpal height ratio was used to quantify the distraction. Functional evaluation was performed with Demerit-Point system described by Garthland and Werley. Five fractures had an excellent results, 16 had a good results, 4 had a fair results, and 3 had poor results. After union, average radial inclination was 21.3 degree, average dorsal angulation was -0.5 degree, and radial shortening was 1mm. Increased carpal height ratio of the 9 cases did not decrease to less than 0.56 at one year after operation. The over-distraction of intercarpal and radiocarpal joint developed after external fixation of the distal radius fracture, did not have decreased in the one year follow-up radiographs after operation. The over- distraction should be avoided intraoperativly.

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Distal Radius Fracture treated with Distraction Plate Technique: Ho Jung Kang, Dae Yong Han, Tae Yong Koo; J Korean Soc Fract 1994;7(2):308-315. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.308

Abstract PDF: The comminuted intraarticular fracture of the distal radius requires early, accurate reduction of the articular surfaces and sustained restoration of anatomic position. The most commonly employed methods are pins and plaster, external fixation, percutaneous pinning and open reduction and internal fixation. There are pitfalls, advantages and disadvantages inherent in each method. Open reduction and internal fixation has been condemned for some time without any controlled series documention its ineffectiveness. Anatomic open reduction and internal fixation with early mobilization, however, are recommanded for nearly every other intraarticular fracture. Two cases of displaced intraarticular fracture of distal radius was managed with distraction plating technique. We will present these cases in detail.

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