Journal of Musculoskeletal Trauma

Original Articles

Surgical Treatment of Type II distal clavicle end Fracture: Phil Hyun Chung, Suk Kang, Dong Joo Chae, Jong Pil Kim, Sang Ho Lee; J Korean Soc Fract 2002;15(2):106-113. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.106

Abstract PDF: PURPOSE
Many authors have supported open reduction and internal fixation of type II distal clavicle fractures because of high rates of nonunion and delayed union after conservative treatment. Authors analyzed thirty-nine cases of type II distal clavicle fractures which had been treated operatively and reviewed the result of operative treatment retrospectively.
MATERIALS AND METHODS
We evaluated 39 unstable distal 1/3 clavicular fractures with operative treatment from May 1992 to December 1999 and followed up for at least 1 year. According to the classification of Rockwood, type IIa was 28cases and IIb was 11 cases. We treated all the cases by open reduction, such as transacromial pin fixation in 27 cases, and plate and screws with or without bone graft in 12 cases. The operative method was chosen in operative field.
RESULT
We analyzed the results in term of the time to radiologic union, functional evaluation, and complications. Average time to union was 8.5 weeks in the cases of transacromial pin fixation and 12.7 weeks in the cases using plate and screws with or without bone graft. Functional results was evaluated by classification of functional results by Kona et al. In cases of transacromial pin fixation, excellent result was 13 cases and good was 14 cases. In cases of plate and screws, excellent result was 4 cases, good 6 cases, fair 1 case, and poor was 1 case. The complications of transacromial pin fixation were 4 cases of pin site infection and 1 case of pin migration. But, neither nonunion nor deep infection was appeared. The complication of plate and screws was 2 cases of metal failure in which were fixated by only two cortical screws on distal fragment.
CONCLUSION
We concluded that minimal open reduction and transacromial pin fixation is thought to be good method in treatment of distal 1/3 clavicular fracture in regard to the time to union, functional results, and complications.

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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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Intra-Articular Fractures of the Calcaneus: Open reduction and internal fixation via extended lateral transcalcaneal approach: Chung Soo Hwang, Phil Hyun Chung, Suk Kang, Yong Min Kim, Hyung Ho Oh, Dong Joo Chae, Min Hyo Park, Jee Hong Kim, Yun Chul Cho; J Korean Soc Fract 1996;9(3):733-741. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.733

Abstract PDF: Fractures with displaced articular facet of subtalar joint occupies 60-75% of whole calcaneal fractures. Nowadays, general principle of treatment for displaced intraarticular fracture has become anatomical reduction of joint surface and rigid fixation of the fracture. However, it had been difficult to apply this principle in cases of calcaneus due to various obstacles such as anatomical characteristics, therefore outcomes were not satisfactory in many cases. Extended lateral approach, which was designed by Letournel and Benirschke, contributed greatly in overcoming those obstacles. From August 1992 to April 1994, the author managed fifteen displaced intraarticular fractures of the calcaneus in fourteen patients with open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate. The fractures were examined preoperatively with Brodens view and classified according to Eastwood(1992) with 2-plane CT. All the fractures united within postoperative 20 weeks(average 10.9 weeks). Final results were assessed by the clinical criteria for calcaneal fracture designed in Greighton Nebraska Health Foundation. Among the 15 cases, excellent results were obtained in eight cases, good in six, fair in one. There were no remarkable complications at the latest follow-up. In managing displaced intraarticular fractures of calcaneus, open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate seemed to be very useful and harmless method.

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