Journal of Musculoskeletal Trauma

Operative Treatment of Floating Shoulder: Ho Jung Kang, Gun Bo Park, Dong Joon Shim, Soo Bong Hahn, Eung Shick Kang; J Korean Fract Soc 2004;17(1):38-42. Published online January 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.1.38

Abstract PDF: PURPOSE
Conservative treatment of displaced ipsilateral compound fractures of clavicle and scapula neck or gleonoid cavity, causing a floating shoulder, cannot expect satisfactory results in all of them. We reviewed 9 operative cases of floating shoulders and analyzed the results with review of literature.
MATERIALS AND METHODS
Nine patients with floating shoulders were operated from July 1996 to August 2000 were reviewed. Patient's age was in average 38.3 years old. Associated injuries were 4 cases of rib fractures and 1 case of humerus shaft fracture. Other injuries included 3 hemothorax, 2 pneumothorax, 1 brachial plexus injury, and 1 ulnar nerve injury. Operation for both clavicle and scapula fracture was done in 6 cases, and surgery was done for only clavicle in 3 cases. Internal fixation for clavicle was done with 3.5 mm AO reconstruction plate in 4 cases and Dynamic Compression Plate in 5 cases.
RESULTS
Clinical results by Hardegger method showed 7 cases of excellent, 1 case of good, and 1 case of poor. Complications include 2 cases of limitation of motion of shoulder joint and one case of residual pain.
CONCLUSION
Floating Shoulder is caused by high-energy trauma, therefore initial assessment of associated injuries should be done carefully. In evaluating the articular surface of the glenoid and positions of the fracture fragment, CT evaluation is very useful in planning the surgical treatment. Clinical results after surgery can give satisfactory results.

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Double Tension Band Osteosynthesis in Supracondylar Fractures of the Humerus: Ho Jung Kang, Hong Hee Kim, Dong Joon Shim, Soo Bong Hahn, Eung Shick Kang; J Korean Soc Fract 2002;15(4):551-557. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.551

Abstract PDF: PURPOSE
This study evaluated the clinical result of supracondylar fractures of the humerus treated with double tension band osteosynthesis.
MATERIALS AND METHODS
From October 1992 to September 2001, 14 patients with supracondylar fractures of the humerus were treated by method of double tension band osteosynthesis. Eleven fractures were the results of slipped down injury and two traffic accidents and one direct trauma. All fractures were classified according to the AO fracture classification (A2; 2, A3; 1, C1; 6, C2; 3, C3; 2). There were 5 males and 9 females with average age of 51.6 years (range 15 to 88). Olecranon osteotomy was performed in 4 patients with severe comminuted fractures. Postoperative immobiliza-tions were required for an average of 20.6 days and consolidations were noted after an average of 10.1 weeks. Before operation, bone marrow density studies were performed in five fractures above 65 years. Average T-score of the patients were -3.65 on femur neck and -2.97 on lumbar spine. All patients were re-examined after an average of 16.4 months.
RESULTS
Union and consolidation was achieved in all 14 patients with no secondary displacement. In range of motion, eight patients judged their results as excellent and four as good. Ten patients had no pain and four had only occasional discomfort. Early removal of K-wires was performed in one patient because irritation of one side K-wires were develop. Sensory change of the ulnar nerve was noted in two patients. Anterior transposition of ulnar nerve was performed in one patient and the other was improved spontaneously. Skin necrosis was developed in one patient but was healed after pin removal and conservative care.
CONCLUSION
The advantages of double tension band wiring are an easier and faster procedure, less periosteal and muscle damage, and more symmetrical compression than double plating. Therefore, in the commiuted osteoporotic fracture with poor tolerance for internal fixation with the plate or the simple supracondylar fractures in young age, double tension band osteosynthesis can provide sufficient and secure stability to allow early functional exercise.

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Operative treatment of fracture of medial epicondyle of humerus in children: Ho Jung Kang, Yong Min Cheon, Kye Wook Song, Eung Shick Kang, Hui Wan Park; J Korean Soc Fract 2001;14(4):762-768. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.762

Abstract PDF: PURPOSE
We investigated injury mechanism, clinical feature, treatment, and prognosis in fracture of medial epicondyle of humerus in children. MATERIAL AND METHOD: From April 1997 to April 2000, 10 fractures of medial epicondyle of humerus treated by operative method and followed up for minimum 12 months were analyzed retrospectively.
RESULTS
The injury mechanism includes slip down with elbow outstretched in 8 case, throwing ball in one case, arm wrestling in other one case. Ulnar nerve symptom at the distal region of fracture site was noted in one case. 2 cases had elbow dislocation at the time of trauma. Fractured fragment displaced more than 5mm in 9 cases and fractured fragment incarcerated in elbow joint in one case. Open reduction and internal fixation was done with medial approach. The mean period of cast immobilization was 6 weeks postoperatively and after removal of cast, gentle exercise of range of motion was started. After operation and postoperative follow up, in all case except one, the full range of motion of elbow joint was recovered and there were no Unar nerve symptom and valgus instability in affected elbow joint.
CONCLUSION
The indication of operation for fracture of medial epicondyle of humerus is controversial, yet. We had done open reduction and internal fixation for medial epicondyle of humerus only in case of displacement of fractured fragment more than 5mm and incarceration in elbow joint after manual reduction, ulnar nerve symptom. In 90 percents of all case, the result was satisfactory.

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Operative treatment of Radial neck fractures in Children: Ho Jung Kang, Jae Hoon Jun, Kye Wook Song, Soo Bong Hahn, Eung Shick Kang; J Korean Soc Fract 2001;14(4):745-752. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.745

Abstract PDF: OBJECTS: Radial neck fractures are uncommon in children, and most cases were treated by conservative treatment or manual reduction. But if proximal fragment is angulated more than 30 degrees, and displaced more than 30%, operative treatment is needed. Operative treatment is also needed in cases of closed reduction failure or in type IV of Salter-Harris classification. If open reduction is not performed, limitation of motion, altered carrying angle and radiologic change occur. We retrospectively analyzed 12 patients who had operative treatment for radial neck fractures in children.
MATERIALS AND METHODS
From April 1996 to December 1998, 12 patients with radial head fracture, were admitted to our hospital and were treated by operation. The average age of 9 years and 6 months (range 5 years 11 months to 14 years). Falling down was most common cause of injury. Seven cases were treated by open reduction and 5 cases by closed reduction. On open reduction group, 3 cases were fixed by Kirschner wire and 4 cases fixed by mini-screw. On closed reduction group, 3 cases were reduced percutaneously using steinmann pin, 1 case reduced using curet, and I case was fixed with Kirschner wire.
RESULTS
Ten cases were evaluated as good or excellent by criteria for judging results of radial neck fracture by Tibone and Stortz. Three cases had complication of heterotopic ossification, two cases had complication of limitation of motion. and one case had complication of pin loosening.
CONCLUSION
The operative treatment for radial neck fracture in children, improved the results of physical examination and roentgenographic evaluation. So operative treatment is needed for radial neck fracture in children which are more than 30 degrees angulation, more than 30% displacement and with displaced epiphyseal plate injury.

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Complications after Surgical Treatment in Fracture of The Neck of Humerus: Ho Jung Kang, Sang Jin Shin, Dae Eui Lim, Eung Shick Kang; J Korean Soc Fract 2001;14(1):91-98. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.91

Abstract PDF: PURPOSE
The causes and risk factors of complications following operative treatment of fracuture of neck of humerus were analysis. MATERIALS & METHODS: From 1995 to 1998, 32 cases of fracture of neck of humerus on which operative treatment have been taken were reviewed. The average age was 48.3 years. There were 13 cases of two part fracture, 11 cases of three part fracture and 8 cases of four part fracture, with 4 cases associated with comminution. Closed reduction and pinning was performed in 11 cases. An external fixator was applied in 1 case. Other 18 cases underwent open reduction using various fixation method including 4 K-wires, 2 cannulated screws, 5 plates, 1 Ender nail and 6 tension band wirings combined with screws each. 2 cases were underwent hemiarthroplasty.
RESULTS
Thirteen patients (41%) had postoperative complications. There were 3 nonunion, 2 pin site infection, 2 inferior subluxation of humeral head, 3 impingement syndrome, 1 hardware failure, 1 avascular necrosis of humeral head and 1 glenoid rim erosion. The incidence of postoperative complication was high in ages older than 40 years and the four part and comminuted fractures. The insufficient fixation due to osteoporosis, incomplete reduction, surgical technique and use of inappropriate implant were considered as related causative factures.
CONCLUSION
The patient's age, the quality of bone, severity of fracture and methods of fixation are all important contributing factors for postoperative complications.

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Operative Treatment of the Capitellar Fracture of the Humerus: Ho Jung Kang, Sang Jin Shin, Hyoung Sik Kim, Eung Shick Kang; J Korean Soc Fract 2000;13(3):584-590. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.584

Abstract PDF: PURPOSE
The capitellar fractures of the humerus are rare. Furthermore, the treatment of the fracture has been controversial. This study presents the experience in the operative treatment of capitellar fractures of the humerus.
MATERIALS AND METHODS
Eleven patients with an average age of 41.0 years (range, 15-76 years) were included in this study. The average length of follow-up was 13.6 months (range, 12-17 months). Type I fracture was noticed in ten patients and type III in one patient. Herbert screws, Kirschner wires, cancellous screw and miniscrew were used for internal fixation. The postoperative immobilization period averaged 6.7 days (range, 3-10 days).
RESULTS
Flexion of the elbow averaged 135 degrees (range, 100-150 degrees), with an average flexion contracture of 17 degrees (range, 5-45 degrees). Supination averaged 83 degrees (range, 20-90 degrees) and pronation averaged 87 degrees (range, 80-90 degrees). Seven patients had an excellent functional results, two good and two fair according to Broberg and Morrey elbow-rating scale. The complications included loosening of Kirschner's wires in two patients, osteochondral loose body in one, nonunion and heterotopic ossification in one and severe limitation of motion in one.
CONCLUSION
The early motion of the elbow joint after anatomical reduction and internal fixation for the displaced capitellar fracture is an effective treatment in restoring normal elbow function.

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Operative Treatment of Radial Head Fracture of Mason type III: Ho Jung Kang, Moon Soo Park, Sang Jin Shin, Eung Shick Kang, Byeong Mun Park; J Korean Soc Fract 1999;12(3):732-740. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.732

Abstract PDF: The treatment of choice for Mason type III radial head fracture was total excision. But, open reduction and internal fixation of fractures of the radial head has become a commonplace as the result of both improvements in the techniques and implants for the fixation of small articular fragments as well as increasing recognition of the important role that the radial head plays in the stability of the forearm and elbow, particularly in the face of acute combined osseous and ligamentous injury. To date, reports of radial head fixation have made little mention on Mason type III fracture. From January 1993 to September 1997, 10 patients with fracture of radial head(Mason type III) were treated at Yong-dong Severance Hospital, Yonsei University College of Medicine. There were 6 males and 4 females with average age of 30 years(range 16 to 47). All of the fractures were comminuted and Mason type III. Seven fractures were the results of falling down and two slipping down and one pedestrian injury. Six fractures(60%) were evaluated as good or excellent by Bruces criteria. The heterotopic ossification was complicated in two cases. The nonunion of radial head fracture occured in two cases. The radial nerve palsy occured in one case. The partial ankylosis of elbow developed in three cases. Kirschners wires migrated in four cases. Open reduction and internal fixation increased the range of motion and decreased the subjective pain and did not cause any proximal migration of radius, impingement of ulnar carpal and radiocapitellar joint and could be a good treatment modality. The further evaluation should be directed to camparison between the open reduction and internal fixation and prosthetic replacement after total excision of radial head.

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Operative Treatment of the Malunited Phalangeal Neck Fractures: Ho Jung Kang, Young Gon Koh, Joong Won Ha, Eung Shick Kang; J Korean Soc Fract 1997;10(3):658-664. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.658

Abstract PDF: It is generally accepted that malunited phalangeal neck fracture in hands not only limits range of motion but also accelerates the onset of degenerative changes, with increasing pain and stiffness of the affected joint. When displaced or rotated phalangeal neck fracture presents within the first or second weeks, properly performed closed or open reduction with percutaneous pinning or internal fixation is excellent options with predictable results. Malaligned fractures that present later frequently cannot be readily reduced. Once fully united, treatment options have included corrective osteotomy if function is significantly impaired or if appearance is objectionable. We have followed 9 patients, who had operations for malunited phalangeal neck fractures. The average length of follow up was 27 months. The interval between injury and operation ranged from 4 weeks to 6 years, with a mean of 21 months. Sites of operation include thumbs(3 cases), 2nd fingers(1 case), 3rd fingers(2 cases), 4th fingers(2 cases) and 5th finger(1 case). For those cases with less than 8 weeks elapsed since the injury, osteoclasis of the fracture with fixation using K-wire or pull-out was carried out. For those cases with more than 8 weeks elapsed, realignment osteotomy followed by fixation with K-wire or miniscrew was used. Parameters for the evaluation of result include range of motion to within 10 degree of full range in each joint, deviation of the fingers during active maximum flexion and extension, the minimum distance between the tip of the finger pulp and the palm, full bony union, relief of pain and the subjective cosmetlc result. Excellent and good results were noticed in 7 cases. The best results can be achieved only with near-anatomic restoration of the joint surface and early active motion exercise. In conclusion, with careful patient selection and close attention to operative detail, operative treatment of malunited phalangeal neck fracture can be effective.

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Open Reduction & Internal Fixation for The Nonunion of Scaphoid Fracture: Eung Shick Kang, Ho Jeong Kang, Keun Soo Lee; J Korean Soc Fract 1996;9(1):8-14. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.8

Abstract PDF

Scaphoid fracture is the most common carpal bone fracture and at least 5% of acute fractures of the scaphoid fail to unite after conservative treatment. The failures have been attributed to delay in beginning treatment, inadequate immobilization, displacement of fragments, instability due to ligamentous injury, and inadequate blood supply of the proximal fragment. Previously, some authors reported several kinds of treatment mordality for nonunion of scaphoid. Of all the techniques that have been introduced, we have used open reduction and internal fixation (O/R & I/F) with autogenous iliac bone graft(AIBG). We reviewed the 10 cases of patients who underwent O/R & IT with K-wire or Herbert screw and A1BG from Jan 1985 to Aug 1994. The results were as follow 1.Among 10 cases, 9 cases were male and 1 case was female, and all cases were right hand, and most common age group was twenties (70%). 2.The most common cause of injury was falling with outstretched hand in 8 cases. 3.In the previous treatment, 8 cases had non-specific treatment and 2 cases had cast immobilization. 4.In the operation method, open reduction and internal fixation (O/R & IT) with K-wire combined with autogenous iliac bone graft (AIBG) for 8 cases, and O/R & I/F with Herbert screw combined with AIBG for I case and O/R & I/F with Herbert screw without bone graft for 1 case. 5-After operation, average duration of cast immobilization was 2.8 months (2.5months-3months). 6.All patients had a bony union with average duration 6.2 months (3months- 10months).

Citations

Citations to this article as recorded by

Volar Percutaneous Cannulated Screw Fixation for Subacute Scaphoid Wasit Fracture
Jae Kwang Kim, Jong Oh Kim, Seung Yup Lee, Nam Hoon Do
Journal of the Korean Fracture Society.2009; 22(2): 104. CrossRef

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Treatment of the distal radius fractures with open reduction and internal fixation: Eung Shick Kang, Kyoo Ho Shin, Sang Wook Lee; J Korean Soc Fract 1995;8(2):413-418. Published online April 30, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.2.413

Abstract PDF: Treatment of displaced or comminuted intra-articular fractures of distal radius is often difficult and demanding. Emphasis has been on achieving and maintaining an anatomical reduction of the fragments by open reduction and internal fixation. We analyzed twenty nve cases of intra-articular fracture of distal radius treated with open reduction and internal fixation from January 1989 to December 1993 by the method of Gartland and Werley (clinical) and Lidstrom(radiologic) The results of this study were as follows. 1. 84% of the patients had satisfactory results on the basis of the subjective criteria of minimal deformity, absence of pain, and good strength. 2. 88% of the patients had satisfactory results on the basis of radiologic and clinical evaluation. 3. When the intra-articular step-off exceeded 2mm, the results were only fair. 4. If one cannot achieve and maintain a articular step-off of 2mm or less, open reduction of the fracture should be considered.

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Fracture & Dislocation of Tarso-metatarsal Joint: Eung Shick Kang, Ho Jung Kang, Ick Hwan Yang, Dong Wha Lee; J Korean Soc Fract 1992;5(2):212-218. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.212

Abstract PDF: The fracture and dislocation of tarso-metatarsal joint is rare injury, but if it occurs, as-sociated soft tissue injury is so severe according to its cause of injury. We reviewed 19 patients of fracture and dislocation of tarso-metatarsal joint who were treated in patient service, during the perlod, from April, 1981 to March, 1991 at our hospital. The results were as follows; 1. Fifteen patients (75%) among the 19 patients were injured due to traffic accident and the associated injury was so severe. 2. Nine cases were treated with percutaneous pinning, closed redoclion with cast immobilization in 2 cases and open reduction with multiple pinning in 8 cases. Three cases needed free vasculariaed flap for its extensive soft tissue injury and, one case was taken below knee amputation for its associatrd severe injury. 3. Anatomical reduction was achieved in 15 cases and iss results were as follows: good in 4 cases. fair in 10 cases and poor in one case Anatomical reduction was not achieved in 3 cases and the results were as follows : fair in one case and poor in 2 cases. 4. Eight cases which were treated with open reduction with multiple pinning had the results as follows: good in one. fair in 6 cases and the remaining one case had taken below knee amputation Seven cases which were treated with closed reductlon and cast immobiliza- cases and poor in 3 cases. 5. The patients who were achieved anatomical reduction had better results than who were not achieved anatomical reduction, Buy the results of all patients were not so satisractory. That is because of the point that the Lisfranc joint injury had associated with severe soft tissue injuries. We concluded that early and active intervention and anatomical reduction should be achieved for the better results.

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A Clinical Study of complicated Fractures in the Hand: Eung Shick Kang, Hyung Kon Kim; J Korean Soc Fract 1988;1(1):24-35. Published online November 30, 1988; DOI: https://doi.org/10.12671/jksf.1988.1.1.24

Abstract PDF: Fractures of the metacarpals and phalanges are the most common fractures in the skeletal system. Because these fractures are so common, they are considered as minor injuries frequently and treated in improper methods in many cases. As a result, complications such as malunion, stiffness, nonunion, traumatic arthritis, and infection may develop and cause severe functional disability and economic loss. The authers reviewed 138 cases of fractures of the hand and 20 complicated cases which were admitted and treated in the department of orthopedic surgery, Severance hospital from 1983 to 1987. 1. Fractures occured more commonly in man(81.9%) than woman, and more commonly in the second decade(32.6%). 2. The most common cause was the machinary injury(42.8%), the traffic accident was the second(34.8%). 3. Open fractures occured in 57 cases(41.3%), and the cases with multiple fractures were 54(39.1%). 4. The most frequently fractured bone was the metacarpal(44.6%), especially metcarpal neck, then the proximal phalanx(33.0%), middle phalanx(12.7%), distal phalanx(9.7%) in decreasing frequency. 5. The most frequent associated injuries were dislocation and subluxation(45.8%), tendon injury was the second(28.8%). 6. Complications were found in 20 cases(14.5%), and malunion and stiffness occured most frequently. 7. The incidence of malunion was 7.5% of all fractures. Malunion occured most frequently in metacarpal fractures(10.9%) and angulatory deformity was most common(55.0%). 8. Stiffness occured in 12 cases(8.7%). The most common sites were distal and proximal interphalangeal joints(33.3%, respectively). 9. Traumatic arthritis occured in 8 cases, which were all intraarticular fractures. The metacarpophallangeal joint was the most common site(50.0%). 10. Nonunion occured in 3.0% of the all fractures and was most common in proxiaml phalangeal fractures(4.5%). The bone graft and internal fixation were carried out in 2 cases, and the results were good. 11. Infection occured in 6 cases(4.3%) and confined to pin tract and soft tissue. They were treated well with conservative treatment.

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