Journal of Musculoskeletal Trauma

Assessment of Noncontiguous Posterior Malleolar Fractures in Distal One-Third Tibia Shaft Fractures with Proximal Fibula Fractures: Dae-Geun Kim, Byung Hoon Kwack; J Korean Fract Soc 2022;35(3):103-108. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.103

Abstract PDF: Purpose
Posterior malleolar fractures after intramedullary nail surgery rarely occur in distal tibia shaft fractures. The importance of preoperative ankle evaluation in preventing these fractures is also common knowledge. There are no studies in the literature on posterior malleolar fractures in distal onethird tibia shaft fractures except for distal metaphyseal tibia fractures to the best of our knowledge. The purpose of this study was to evaluate the incidence and radiological features of posterior malleolar fractures in distal one-third tibia shaft fractures with proximal fibula fractures.
Materials and Methods
Thirty-one patients diagnosed with distal one-third tibia shaft fractures with proximal fibula fractures from January 2016 to May 2021 were retrospectively reviewed. With the aid of plain radiographs and computed tomography (CT) scans, the fracture patterns of the tibia and fibula were classified according to the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification, and posterior malleolar fractures were identified. The fracture pattern was classified according to the Haraguchi classification, and the angle between the bimalleolar axis and the posterior malleolar fracture line was measured when there was a posterior malleolar fracture.
Results
Out of the 31 distal one-third tibia shaft fractures with proximal fibula fractures, 16 cases (51.6%) had noncontiguous posterior malleolar fractures that were confirmed on a CT scan, while 3 cases (18.8%) were visible on initial plain radiographs. There was no statistically significant variation seen in the presence of a posterior malleolar fracture in the tibia (p=0.15) and fibula (p=0.87) fractures. According to the Haraguchi classification, there were 15 posterolateral-oblique fractures (Type I) and 1 medial-extension fracture (Type II), and the mean angle was 24.5°.
Conclusion
Noncontiguous posterior malleolar fractures occurred in approximately half of the distal one-third tibia shaft fractures with proximal fibula fractures, and a CT scan was considered necessary to diagnose posterior malleolar fractures before surgery

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Comparison of the Results between Plating and Intramedullary Nailing for Ipsilateral Fibular Fractures in Pilon Fractures: Yong Jin Cho, Jun Young Lee, Jae Hwan Lim, Je Hong Ryu, Jung Ho Lee; J Korean Fract Soc 2021;34(3):97-104. Published online July 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.3.97

Abstract PDF: Purpose
To compare the results between plating and intramedullary nailing for ipsilateral fibular fractures in pilon fractures.
Materials and Methods
Among 124 patients with pilon fractures from November 2008 to March 2019, 50 patients with a fibular fracture were studied retrospectively and divided into two groups: Group A using a plate and Group B using a Rush pin. The radiological tests confirmed the fracture pat-terns (Rüedi–Allgöwer classification, AO/OTA classification) and evaluated the degree of reduction of fibular and tibial fractures after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) was examined for a clinical evaluation, and the complications were checked.
Results
The two groups showed similar distributions in gender, age, injury mechanism, diabetes, smoking, mean follow-up period, Rüedi–Allgöwer classification, AO/OTA classification, and open fracture. The fibular fractures were classified as simple, wedge, multiple, and segmental, showing significant differences between the two groups (p=0.03). There was no difference in the Talocrural angle, Shenton line, and Dime sign. In the reduction of pilon fractures, the appropriate reduction was obtained in 22 cases (88.0%) for both groups. The AOFAS averaged 83.24 in Group A and 80.44 points in Group B, showing no significant difference in complications (nonunion, malunion, infection, and arthritis).
Conclusion
Regardless of how the fibular fracture was fixed, the reduction of pilon fractures in both groups showed good results. Both intramedullary nail and plate fixation could be a suitable fixation method for ipsilateral fibular fractures with a low risk of shortening in pilon fractures.

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Radiological Assessment for Morphological Diversity of Distal Fibula: Su Young Bae, Jin Hee Yoo; J Korean Fract Soc 2014;27(1):1-9. Published online January 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.1.1

Abstract PDF: PURPOSE
The purpose of this study is to determine whether the morphological consistency of distal fibula could be defined by measurement through radiological assessment as there was doubt regarding the adequacy of anatomical distal fibular plates.
MATERIALS AND METHODS
Plain radiographs and computed tomography (CT) images of 300 cases from 2009 to 2012 were reviewed. The distance from the lateral vertex to the tip of the distal fibula and to the lateral margin of the shaft was measured, respectively, in order to understand the shape of the lateral curve of the distal fibula on plain radiographs. The neutral ridge was defined as a point of the lateral ridge located in the center of the antero-posterior diameter and the distance from the tip of the distal fibula to the neutral ridge was measured for determining the shape of the ridge on CT images. The angle of the lateral and posterior surface of the fibular incisura at the level of the neutral ridge was also measured.
RESULTS
A statistically significant difference in the lateral vertex and margin of the fibular shaft on plain radiographs and distance from the tip of the distal fibula to the neutral ridge, angle of the fibular lateral surface on CT images was observed between male and female. The mean distance from the lateral vertex to the tip of distal fibula was 12.2+/-3.0 mm, to the lateral margin of the fibular shaft was 5.6+/-1.7 mm, distance from tip of the distal fibula to the neutral ridge was 54.9+/-6.4 mm, the fibular lateral surface angle was 52.2degrees+/-9.1degrees, and the fibular posterior surface angle was 32.5degrees+/-9.3degrees.
CONCLUSION
Based on the various radiologic parameters, it was concluded that there was a wide morphological diversity of shape of lateral curve and fibular ridge.

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Analysis of Risk Factors for the Posterolateral Articular Depression and Status of Posterolateral Fragment in Lateral Condylar and Bicondylar Tibial Plateau Fractures with Joint Depression: Jung Yun Choi, Yong Woon Shin, Beom Jung Lee; J Korean Fract Soc 2013;26(4):241-247. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.241

Abstract PDF

PURPOSE
To evaluate risk factors of posterolateral articular depression and characteristics of the posterolateral fragment in lateral condylar and bicondylar tibial plateau fractures with joint depression.
MATERIALS AND METHODS
We reviewed 48 patients of Schatzker type II and type V (type II 34, type V 14) and evaluated risk factors of posterolateral articular depression according to the posterolateral fragment, fibular fracture, and Schatzker classification. We evaluated the position of articular depression and anterolateral fracture line of the posterolateral fragment and measured anterior to posterior lengths of the posterolateral fragment.
RESULTS
Posterolateral articular depression was found in 20 of 34 cases (59%) with coexisting posterolateral fragment and in 16 of 21 cases (76%) with coexisting fibular fracture. There was a significant difference in the occurrence of posterolateral articular depression with the existence of the posterolateral fragment and fibular fracture (p<0.001). Multivariate regression analysis revealed that fibular fracture increased the occurrence of posterolateral articular depression (odds ratio 24.5, 95% confidence interval 2.2-267.2). Fifty-seven percentage of the anterolateral fracture line of the posterolateral fragment existed posterior to the anterior margin of the fibular head.
CONCLUSION
This study showed that fibular fracture affects posterolateral articular depression in Schatzker type II and V tibial plateau fractures. Selecting a fixation device and performing fracture reduction requires a careful consideration since the anterolateral fracture line of the posterolateral fragment exists posterior to the anterior margin of the fibular head.

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Current Concepts in Management of Tibia Plateau Fracture
Sang Hak Lee, Kang-Il Kim
Journal of the Korean Fracture Society.2014; 27(3): 245. CrossRef

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Extensive Metallosis Caused by Plate and Screw Construct for Distal Fibular Fracture - A Case Report -: Ki Tae Park, Kwang Bok Lee; J Korean Fract Soc 2013;26(2):147-150. Published online April 30, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.2.147

Abstract PDF

Metallosis has been reported in the setting of weight-bearing joint arthroplasties, like the hip and knee joints. However, the prevalence of metallosis in non-articular portions is very uncommon. We report a rare case of a patient who had metallosis secondary by fibular nonunion after fixation with plate and screw. In addition, we discuss the clinical and the operative findings, as well as the outcome of this uncommon complication.

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Plate on Plate Osteosynthesis for the Treatment of Nonhealed Periplate Fractures
Georgios Arealis, Vassilios S. Nikolaou, Andrew Lacon, Neil Ashwood, Mark Hamlet
ISRN Orthopedics.2014; 2014: 1. CrossRef

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Surgical Management of Comminuted Avulsion Fracture of the Proximal Fibula with Lateral Collateral Ligament Injury: Technical Note: Jong Min Kim, Byeong Mun Park, Sang Hoo Lee, Seung Ju Jeon, Jun Beum Shin, Kyeong Seop Song; J Korean Fract Soc 2013;26(1):77-80. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.77

Abstract PDF

Anteromedial force to the knee in an extended position can cause an avulsion fracture of the proximal fibula with combined injuries to the posterolateral ligaments. Avulsion fractures of the proximal fibula are rare and current management of these fractures is based on few descriptions in literature. Various surgical methods of fixation for these fractures have been reported, but there is still no standard treatment modality. Anatomic reduction of these fractures is technically difficult, and failure of reduction may cause posterolateral instability, secondary arthritis and other complications. We present our experience with two such cases of comminuted avulsion fractures of the proximal fibular with posterolateral ligament ruptures surgically fixated with a locking compression hook plate and non absorbable sutures.

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Treatment of Avulsion Fractures around the Knee
Sumin Lim
Journal of the Korean Fracture Society.2024; 37(2): 117. CrossRef

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Nonunion of Humeral Intercondylar Comminuted Fracture Treated with Fibular Graft: A Case Report: Jin Rok Oh, Chang Ho Lee, Ki Yeon Kwon, Hoi Jeong Chung; J Korean Fract Soc 2010;23(1):118-121. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.118

Abstract PDF

Nonunion of comminuted distal humeral fracture is troublesome problem to orthopedic surgeon. We report a case of 59 years old woman, who suffered nonunion of comminuted distal humeral fracture previously treated by open reduction and internal fixation with plate and screws concomitantly autoiliac bone graft. We reconstructed humeral condyle with fibular inlay graft inside cortical shell of intercondylar bone fragment and obtained excellent result in radiological and functional outcome.

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Update 1 of: Destruction and Detection of Chemical Warfare Agents
Yoon Jeong Jang, Kibong Kim, Olga G. Tsay, David A. Atwood, David G. Churchill
Chemical Reviews.2015; 115(24): PR1. CrossRef

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Posterior Plating in Distal Fibular Fracture: Choong Hyeok Choi, Young A Cho, Jae Hoon Kim, Il Hoon Sung; J Korean Fract Soc 2007;20(2):161-165. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.161

Abstract PDF

PURPOSE
To report the technical experience of posterior plating for the distal fibular fracture.
MATERIALS AND METHODS
20 Weber type-B fibular fractures were included in this study, which were treated with the posterior plating. 1/3 semitubular plate was used and orientation of all screws were intended to be perpendicular to the plate as possible. Fixation stability and maintenance of reduction after plating was assessed manually in the operating field. Clinical results were evaluated at least 1 year after operation, using American Orthopaedic Foot and Ankle Society (AFOAS) Ankle-Hindfoot score.
RESULTS
5 cases were firmly stabilized without using any lag screw or fixation of distal fragment. For improving stability or achieving proper reduction, a lag screw was placed posteroanteriorly through the plate in 14 cases. Anteroposterior interfragmentary fixation in 1 case before plating, and contouring of the plate in 3 cases were needed in cases of which the posterior plating impeded reduction of distal fibular fracture. In all cases, fracture was stabilized without fixation through the most distal hole. There were no major postoperative complications. AFOAS score was 95.5Â±5.2.
CONCLUSION
The posterior plating technique for distal fibular fracture is regarded as a recommendable option. Additional fixation with interfragmentary screw or contouring of the plate, however, would be needed in some cases to achieve anatomical reduction or sufficient stability.

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A Specialized Fibular Locking Plate for Lateral Malleolar Fractures
Eui Dong Yeo, Hak Jun Kim, Woo In Cho, Young Koo Lee
The Journal of Foot and Ankle Surgery.2015; 54(6): 1067. CrossRef

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Free Vascularized Fibular Grafts for Treatment of Infected Nonunion of the Tibia: Hyoung Min Kim, Il Jung Park, Youn Soo Kim, Kee Haeng Lee, Chan Woong Moon, In Ho Jeong, Changhoon Jeong; J Korean Fract Soc 2006;19(2):163-169. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.163

Abstract

PURPOSE
To analyze the result of free vascularized fibular grafting for treatment of infected nonunion of the tibia with radical bone and soft tissue defect.
MATERIALS AND METHODS
17 patients with infected nonunion of the tibia who underwent a reconstruction using free vascularized fibular grafting were reviewed retrospectively. The mean follow-up period was 70.3 months. We analyzed the results radiographically which included the time of bone union, the amount of hypertrophy of grafted bone and complications.
RESULTS
The average length of bone defect was 8.8 cm (5~15 cm), and the average length of fibular graft was 14.1 cm (10~17.5 cm). Bony union was achieved in 11 of 17 cases and the average time of bone union was 5.2 months (4~6 months). There were 6 cases of nonunion. All nonunions developed at the proximal end of graft in patients who underwent fixation using pin and external fixator. Union was eventually achieved in all cases in 6.0 months (5~8 months) after the cancellous bone graft and plate internal fixation. Hypertrophy of grafted bones with more than 20% developed only in 4 cases out of 17. There were 3 cases of stress fracture, however there was no recurrence of infection or serious donor site morbidity.
CONCLUSION
Free vascularized fibula grafting is one of the most effective reconstruction options for the infected nonunion of the tibia with radical bone and soft tissue defect. Strong internal fixation using plate and screws is required to reduce the rate of nonunion and stress fracture of grafted fibulas.

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Treatment Strategy of Infected Nonunion
Hyoung-Keun Oh
Journal of the Korean Fracture Society.2017; 30(1): 52. CrossRef

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Relationship of Tibial Nonunion with Fibular Nonunion in the Tibio-fibular Shaft Fracture: Sang Bong Ko; J Korean Fract Soc 2006;19(2):153-156. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.153

Abstract

PURPOSE
The purpose of this study is to know the relationship of tibial nonunion with fibular nonunion in the tibio-fibular shaft fracture.
MATERIALS AND METHODS
From March 1998 to February 2004, 98 tibio-fibular shaft fractures which did not involve adjacent joints and were followed up at least 1 year were selected. The characteristics of patients and tibia shaft fracture were analyzed statistically to know the above relationship.
RESULTS
The patient's factor and tibia shaft fracture factor were not significant statistically. In patients with the fibular union, there was 1 case (1/68) of tibia nonunion, but in patients with the fibular nonunion, there were 6 cases (6/30) of tibia nonunion. So fibular nonunion was significant statistically associated with tibia nonunion (p=0.003).
CONCLUSION
Fibular nonunion was presumed to have a higher risk of tibia nonunion.

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The Risk Factors Associated with Nonunion after Surgical Treatment for Distal Fibular Fractures
Jun Young Lee, Kwi Youn Choi, Sinwook Kang, Kang Yeol Ko
Journal of Korean Foot and Ankle Society.2018; 22(3): 95. CrossRef

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Inlay Fibular Autograft and Helical LCP Fixation for a Segmental Comminuted Fracture of the Osteoporotic Proximal Humerus: A Case Report: Young Soo Byun, Dong Ju Shin, Se Ang Chang, Do Yop Kwon; J Korean Fract Soc 2006;19(1):100-103. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.100

Abstract

Unstable fractures of the proximal humerus should be treated with precise reduction and stable fixation, and early joint motion should be permitted. But stable fixation of the proximal humerus is frequently difficult to obtain in older patients due to osteoporosis and fracture comminution. We treated one case of a segmental comminuted fracture of the proximal humerus with severe osteoporosis with a method of inlay fibular autograft and fixation with a helical locking compression plate (LCP). Stable fixation was obtained, so early motion of the shoulder joint was permitted. The fracture was healed in 12 weeks after the operation without loss of fixation and there were no problems at the donor site of the fibula. Functional recovery of the shoulder was satisfactory. The result of Neer's functional score was 87 points (satisfactory) and Constant score was 83 points.

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Helical Plating for Fractures of the Proximal Humeral Shaft
Young-Soo Byun, Dong-Ju Shin, Young-Bo Park, Min-Guek Kim, Toe-Hoe Gu, Jae-Hwi Han
Journal of the Korean Orthopaedic Association.2017; 52(3): 232. CrossRef
Allogeneic Inlay Cortical Strut Grafts for Large Cysts or Post-curettage Cavitary Bony Defects
Yang-Guk Chung, Yong-Koo Kang, Chol-Jin Kim, An-Hi Lee, Jeong-Mi Park, Won-Jong Bahk, Hyun-Ho Yoo
The Journal of the Korean Bone and Joint Tumor Society.2011; 17(2): 73. CrossRef
Minimally Invasive Plate Osteosynthesis, MIPO
Young-Soo Byun
Journal of the Korean Fracture Society.2007; 20(1): 99. CrossRef

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The Effect of Fibular Malreduction on Ankle Joint after Tibial Interlocking IM Nailing of Tibial and Fibular Fractures: Dong Eun Shin, Duck Yun Cho, Hyung Ku Yoon, Jin Soo Lee, Yoon Seok Lee, Hyoung Jun Kim; J Korean Fract Soc 2005;18(1):29-35. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.29

Abstract PDF

PURPOSE
To investigate the effect of fibular malreduction on ankle joint after tibia interlocking IM nailing of tibial and fibular fractures according to type of fibular fractures at preoperation.
MATERIALS AND METHODS
Thirty-nine patients who had ipsilateral tibiofibular fracture were analyzed clinically and radiographically. The talocrural angle and the distance from joint line to the tip of fibular were measured on both ankle standing AP view. The difference of angle and distance of both ankle were analyzed by paired t-test and correlation between defference and AOFAS score by Spearman correlation coefficients.
RESULTS
The difference of The talocrural angle and the distance from joint line to the tip of fibular of both ankle was statistically significant (p<0.05). The correlation between this difference and AOFAS score was statistically insignificant (p>0.05).
CONCLUSION
In tibia interlocking IM nailing of tibia and fibula fracture, malreduction of fibula could cause the change of ankle joint.

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The Risk Factors Associated with Nonunion after Surgical Treatment for Distal Fibular Fractures
Jun Young Lee, Kwi Youn Choi, Sinwook Kang, Kang Yeol Ko
Journal of Korean Foot and Ankle Society.2018; 22(3): 95. CrossRef

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Treatment of Large Bone Defect of Femorl Shaft with Vascularized Fibular Graft and Ender Nail: A Case Report: Song Lee, Dong Ki Ahn, Sung Wook Chun, Sun Young Chung, Hyun Soo Kim; J Korean Soc Fract 2003;16(3):340-347. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.340

Abstract PDF: Vascularized fibular graft is one of the well accepted methods in the treatment of large bone defect of femoral shaft. But bone fixation with Ender nails through the same incision of bone graft has never been reported. We performed vascularized fibular graft and bone fixation with Ender nails through single medial skin incision and permitted physiologic stress. We achieved early radiologic union and medullary widening and the patient could return to work 9 months after the accident. We would like to report such an experience of treatment with the reference of literature.

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Radiological Assessment for Distal Fibular Length: Il Hoon Sung, Jong Min Lee; J Korean Soc Fract 2003;16(2):208-214. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.208

Abstract PDF: PURPOSE
This study was performed to reevaluate the radiological parameters for assessing the length of the distal fibula in the mortise view of the ankle and to introduce a more reliable method to lessen measurement error.
MATERIALS AND METHODS
Mortise view radiographs of 36 normal ankles from 18 healthy volunteers were obtained. The talocrural angle and bimalleolar angle were measured two times and compared bilaterally by two independent observers. Also, The lateral malleolar angle, newly devised in our department was measured and compared bilaterally.
RESULTS
The average of the talocrural angle, bimalleolar angle, and lateral malleolar angle was 78.4 degrees (range 74 to 83), 78.3 degrees (range 73 to 86), and 36.7 degrees (range 30 to 41), respectively. The difference of the talocrural angle, bimalleolar angle, and lateral malleolar angle between right and left was 2.1 degrees, 3.0 degrees, and 1.2 degrees (95% confidence limit), respectively. Intraobsever difference of the talocrural angle, bimalleolar angle, and lateral malleolar angle was 1.5 degrees, 1.6 degrees, and 0.4 degrees, respectively. Interobsever difference of the talocrural angle, bimalleolar angle, and lateral malleolar angle was 1.3 degrees, 2.4 degrees, and 1.0 degrees, respectively.
CONCLUSION
When using various measurement methods to judge the length of the distal fibula, the measurement error should be considered. The proposed method, lateral malleolar angle, would be a good method for assessing the length of distal fibula in the mortise view of ankle.

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Result of Fibular Fixation Using Screw in Ankle Fracture: Chung Soo Han, Yang Sun Im, Sun Teak Cheong; J Korean Soc Fract 2002;15(4):477-482. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.477

Abstract PDF

PURPOSE
To compare the use of screw only fixation with lateral one-third tubular plate fixation of non-comminuted oblique fracture of the lateral malleous and report the advantages of screw only fixation MATERIALS AND METHODS: From January 1996 to January 2000, we had operated 44 cases of non-comminuted oblique fractures of the lateral malleous (Denis-Weber type B, Lange-Hausen classification supination-external rotation injury). All cases had a follow-up period of over 6 months. There were 21 cases of cortical or bone screw fixation (group I) and 23 cases of one third tubular plate fixation (group II). Radiologic and clinical outcome parameters were used to compare group I with group II.
RESULTS
There were no significant difference in bone union rate and period between group I and group II (group I : 92 days, group II : 89 days). All cases of both groups recovered a complete range of motion after cast off. There was 1 case superficial infection in group II.
CONCLUSION
The radiologic and clinical results and complications between screw only fixation and one-third tubular plate fixation at non-comminuted lateral fibular fracture have no difference. The advantage of screw only fixation at non-comminuted lateral malleolar fracture is a small incision, short operation time and decreased patient 's complaints as compared with a similar group of patients treated by fixation with a lateral one third tubular plate fixaiton.

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A Rehabilitation for Ankle Fracture in Korean Medicine: A Report of 4 Cases
Won-Bae Ha, Jong-Ha Lee, Yoon-Seung Lee, Dong-Chan Jo, Jin-Hyun Lee, Jung-Han Lee
Journal of Korean Medicine Rehabilitation.2017; 27(4): 171. CrossRef

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Treatement of Diastasis of the Distal Tibiofibular Syndesmosis: Woo Chun Lee, Han Suk Ko, Cheol Lee, Ki Heon Nam, Kang Hoon Ko, Jong Deuk Rha; J Korean Soc Fract 2001;14(4):677-684. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.677

Abstract PDF: PURPOSE
To investigate the indication of transfixation of distal tibiofibular syndesmosis.
MATERIALS AND METHODS
Twenty-two patients were surgically treated for diastasis of the distal tibiofibular syndesmosis and followed for more than one year. The decision to transfix the syndesmosis was made according to the result of intraoperative stress test.
RESULTS
In patients with bimalleolar fracture, good or excellent clinical results were obtained in all patients, and no widening of the medial clear space and I mm or no widening of the tibiofibular clear space was observed. In patients with deltoid ligament tear, good or excellent results were obtained in five patients, and the medial clear space was widened more than 1mm in three patients and tibiofibular clear space was widened 2mm or more in four patients.
CONCLUSION
We believe that transyndesmotic fixation is not required if anatomical bimalleolar fracture fixation is achieved, and in patients who have deltoid ligament rupture, it may be better to transfix the syndesmosis regardless of the level of fibular fracture.

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The effects of the fibular stabilization in the treatment of distal tibio-fibula fracture: Kyung Jin Song, Gyu Hyung Kim, Myung Sik Park, Byung Yun Hwang; J Korean Soc Fract 2001;14(4):660-667. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.660

Abstract PDF: PURPOSE
The purpose of this study was to analyze the effect of fibula stabilization on reduction and union time of tibial fracture, and change in ankle mortise in the treatment of distal tibiofibular fracture.
MATERIALS AND METHODS
We reviewed 23 cases with distal tibiofibula fracture; 10 cases were stabilized and 13 cases were not stabilized for the fibula fracture with reduction and stabilization for the tibia fracture. We analyzed the initial and last follow-up radiograph, and clinical functional outcome.
RESULTS
There were significant differences in the tibiofibular clear space and tibiofibular overlap between two groups and there were somewhat significant differences in the union time of the tibial fracture and ROM of ankle and pain of fracture site or ankle between two groups. But there were no significant differences in talo-crural angle and gap of tibial fracture site between two groups. Moreover, such factors as initial displacement, soft tissue damage, comminution of fracture were affected the union time and prognosis of a tibial fractures.
CONCLUSION
Fibular stabilization group was effective in the maintenance of ankle mortise but there was no difference in the functional outcome. Analysis for much more cases and long term follow-up will be necessary for the precise evaluation of the treatment results.

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The Posterior Plate for Distal Fibular Fixation: Beak Yong Song, Ho Yoon Kwak, Sang Wook Bae, Kyung Tai Lee, Nam Hong Choi, Jin Young Kim, Ho Jun Kim; J Korean Soc Fract 2001;14(1):79-84. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.79

Abstract PDF: PURPOSE
To evaluate the clinical results between the posterior and lateral plate for distal fibular fixation in the bimalleolar, trimalleolar fracture and isolated lateral malleolar fractures with more than 3 mm of displacement.
MATERIALS AND METHODS
We reviewed 69 cases treated by open reduction and internal fixation with the posterior or lateral plate for distal fibular fractures in the bimalleolar, trimalleolar fractures and isolated lateral malleolar fractures with more than 3mm of displacement. The follow up period was more than 12 months.
RESULTS
In the posterior plate group, radiographically there were no intraarticular screw, loss of fixation, nonunion and malunion, but 2 cases of distal tibiofibular synostosis were developed. In physical examination, there were no wound complication, palpable screws, peroneal tendinitis and limitation of motion, but 2 patients who had distal tibiofibular synostosis complained of mild discomfort after walking.
CONCLUSION
The posterior plate for distal fibular fixation is thought to be a favorable method and can be recommended as the fixation modality of choice regardless of level of fracture, because of increased biomechanical stability and few complication.

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The Treatment of Danis-Weber Type B Fractures of the Distal Fibula by Multiple Kirschner Wires Fixation: Ho Yoon Kwak, Baik Young Song, Sang Wook Bae, Nam Hong Choi, Jin Young Kim; J Korean Soc Fract 2000;13(3):529-536. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.529

Abstract PDF

PURPOSE
To evaluate the accuracy of reduction and stability of fixation according to different methods of internal fixation for the Danis-Weber classification type B fractures of the distal fibula. MATERIAL AND METHODS: Seventy-three cases with follow up of average 13 months were divided into three groups: plate fixation(Group I, 36), more than two lag screws fixation (Group II, 13) and multiple K wires fixation with less than one lag screw(Group III, 24). We measured the bimalleolar angle and axial displacement of the fracture ends for radiographic evaluation, and used the Meyer's classification for clinical evaluation.
RESULTS
There was significant difference of postoperative fibular shortening between group I(0.44mm) and III(0.17mm) on the anteroposterior view(p=0.003), but no difference of it on the lateral view. The changes of bimalleolar angle and the increment of fibular shortening showed no significant difference among three groups.
CONCLUSION
Multiple K wires fixation combined with less than one lag screw for Danis-Weber type B fractures of distal fibula demonstrated that it provides accurate reduction and stable internal fixation.

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Posterior Plating in Distal Fibular Fracture
Choong-Hyeok Choi, Young-A Cho, Jae-Hoon Kim, Il-Hoon Sung
Journal of the Korean Fracture Society.2007; 20(2): 161. CrossRef

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Effects of Fibular Fixation for Interlocking Nailing of Distal Tibiofibular Fractures: Sang Ho Moon, Phil Hyun Chung, Chung Soo Hwang, Dong Ju Chae, Beom Kim; J Korean Soc Fract 2000;13(2):296-302. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.296

Abstract PDF: PURPOSE
: To compare redioiogic results between interlocking intramedullary nail with fibular fixation and nail only for treating distal tibiofibular diaphyseal fractures.
MATERIALS AND METHODS
: From April 1993 to February 1999, 26 distal tibiofibular fractures were antegrade nailed after anatomical reduction and fixation of fibular fractures, and another 61 fractures fixed with nails only. Average age of patients was 41.8 years. These two groups were compared by frequency of malalignment, degree of postoperative angulation, angulation according to comminution, angulation according to fracture configuration. The statistical analysis was evaluated by t-test.
RESULTS
: Fibular fixation group had no malalignment while non-fixations had angulation of 1.2+/-1.1 degree and non-fixation had 3.0+/-2.1. So fixation had lessor angulation than non-fixation significantly(p=0.004). In lateral rediographs, each had 1.3+/- 1.1, 2.8+/-2.3 degree and showed significant difference(p=0.027). In type I and II fractures of Winquist-Hansen classification, fixation group showed lesser degree of angulation in A-P plane significantly(p=0.008) but no significant difference in lateral plane. In type III and IV, no significant difference in both planes. According to configuration of fractures, transverse and spiral fractures showed no significant differences but oblique configurations had significant differences in A-P plane(p=0.002) CONCLUSION : Interlocking intramedullary nail with fibular fixation has the advantage in maintenance of alignment during insertion of nail in distal tibiofibular fractures, especially in Winquist-Hansen classification type I and II and oblique fractures in anteroposterior plane, so it can be a worthy method for the treatment of distal tibiofibular diaphyseal fractures.

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Treatment of Tibial Defect by Fibular Transposition using Ilizarov: Chung Soo Han, Yong Girl Rhee, Chang Hyun Cho, Moo Song Park, Dong Jun Shin; J Korean Soc Fract 1999;12(4):943-947. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.943

Abstract: Treatment of large segmental defect of tibia is difficult because of associated infection, shortening of limb, nonunion and soft tissue reconstruction. There has been a few options for the reconstruction of segmental tibial defect including vascularized or nonvascularized fibular graft, vascularized iliac bone graft, compression-distraction osteosynthesis and allograft. Tibialization of the ipsilateral fibula for 5 patients who had large tibial defect was successfully achieved by fibular transposition using Ilizarov apparatus at our hosipital . The average defect of tibia was 10.4cm in length. The average time of Ilizarov fixation was 10.3 months. Although one patient required bone grafts, most of them achieved good bony union. The clinical and radiological features and their results were also addressed. Fibular transposition using Ilizarov may be a satisfactory method of treatment for the large segmental tibial defect associated with severe soft tissue injury or vascular compromise.

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Surgical Treatment of Avulsion Fracture of the Fibular Head Associated with Lateral Instability of the Knee: Min Young Chung, Won Suck Lee, Soo Myung Lee, Won Cheul Song, Chang Woo Kim, Kwang Min Jung; J Korean Soc Fract 1997;10(3):597-603. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.597

Abstract PDF

Though avulsion fracture of the fibular head rarely occurs, it frequently associates with lateral compartment injury of the knee which resulls in lateral instability. Some authors preferred to internally fixing avulsion fracture of the fibular head to prevent and restore lateral instability of the knee. Our purpose was to suggest that lateral instability of the knee be restored by internal fixation of the fibular head in these cases. We reviewed 6 cases of avulsion fracture of the fibular head associated with lateral instability of the knee which were treated surgically from January, 1993 to December, 1994 with average 2-year-over follow-up. We evaluated each cases using the Knee Ligament Standard Evaluation Form proposed by International Knee Documentation Committee. The results were as follows. The average displacement of the fibular head was 8.4mm. The activity level and overall grade were A(normal) in 4 cases, B(nearly normal) in 1 case, D(severe abnormal) in 1 case. Lateral instability of the knee was satisfactorily restored by internal fixation of the fibular head and repair of ligamentous injuries in cases of avulsion fracture of the fibular head associated with lateral instability of the knee.

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Establishment of Classification of Tibial Plateau Fracture Associated with Proximal Fibular Fracture
Zhan‐le Zheng, Yi‐yang Yu, Heng‐rui Chang, Huan Liu, Hui‐lin Zhou, Ying‐ze Zhang
Orthopaedic Surgery.2019; 11(1): 97. CrossRef

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Ankle Arthrodesis by Internal Fixation with Cancellous Screws and Fibula Strut Graft: Report of Two Cases: Jin Man Wang, Kwon Jae Roh, Yeo Hon Yun, Dong Jun Kim, Joo Seok Eom; J Korean Soc Fract 1997;10(3):480-484. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.480

Abstract PDF: We present two cases of ankle arthrodesis in which tibiotalar fixation was achieved by two cancellous-bone screws across the ankle joint and a lateral fibular strut graft fixed with a proximal and a distal screw. This operation is a technique described by Thordarson and his associates, who performed only an in vitro biomechanical study using fresh-frozen cadaver. Through the recent clinical trial, we could get excellent results in both of our cases. We feel the fibular strut graft provides additional stability to tibiotalar internal fixation. This technique may have a special value for those cases with poor bone quality or osteoporosis.

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Vascularized Fibular Graft in the Treatment of Chronic Osteomyelitis of Long Tubular Bone: Kwang Suk Lee, Sang Won Park, Kyung Jo Woo, Jong Won Kim; J Korean Soc Fract 1997;10(2):365-370. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.365

Abstract PDF: Previous management of chronic osteomyelitis has included antibiotic therapy, radical debridement, skin-grafting, distant cross-leg flaps, and local muscle flaps. Each of these modalities of treatment has limitations. However, over the last 20 years, vascularized fibular bone grafts have proved to be a valuable method of reconstruction of skeletal defects in the extremities following both infected and uninfected skeletal nonunions unresponsive to conventional methodology. We evaluated the efficacy of vascularized fibular graft in the treatment of chronic osteomyelitis of long bone. From August 1988 to June 1995, fourteen cases of chronic osteomyelitis of long bone which were followed for an average of 3 years duration were treated by vascularized fibular graft at the Department of Orthopaedic Surgery, Korea University Hospital. The results were as follows; 1. Even if the long tubular bone infection was uncontrolled, vascularized fibular graft could be performed and it was highly resistent to local infection. 2. Twelve cases (85.7%) out of a fourteen cases had primarily obtained bony union. 3. Free vascularized fibular graft is significant and reliable porcedure of bone grafting for the treatment of chronic osteomyelitis of long tubular bones.

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The Effect of fibular fractures in the healing of tibial shaft fractures treated with an interlocking nail: Ki Soo Kim, Yong Soo Choi, Jong Jun Park, Sun Young Chung; J Korean Soc Fract 1996;9(2):449-457. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.449

Abstract PDF: The effect of fibular fractures in the healing of tibial shaft fractures has controversial results. Its results are the greater part of the data for the conservative treatment of tibial shaft fractures. Recently closed interlocking nailing has been the most efficient treatment for displaced fractures of the tibial shaft. The purpose of this study was to evaluate the effect of fibular fractures in the healing of tibial shaft fractures treated with an interlocking nail and to determine whether the fibular fracture had a relation with other prognostic factors. From Mar. 1992 to Feb. 1995. the authors performed interlocking nailing for displaced fractures of the tibial shaft in 111 patients. We reviewed 98 patients with a minimal ten month follow up period. We divided the fractures into three groups; the intact fibula group which consisted of 15 patients had tibial shaft fractures with intact fibula, the same level fracture group had tibiofibular fractures at the same level in 56 patients and the different level fracture group had tibiofibular at different level in 27 patients. The results were as follows: 1. Clinically excellent and good results, according to Klemm and Horner criteria. were in 15 patients(100%) of the intact fibula group,49 patients(87.4%) in the same level fracture group and 21 patients(92.5%) in the different leyel fracture group. 2. Radiologically bone healing was obtained in 15 patients(100%) with a mean union time of 13.3 weeks in the intact fibula group, 42 patients(75.O%) with a mean union time of 17.9 weekf in the same level fracture goup and 2,1 patients(85.2%) with a mean union time of 15.3 weeks in the different level fracture group. 3. The same level fracture group had a tendency to cause a bending force while the different level fracture group tended to treat a torsional force. We found that the bending fractures had the worst prognosis. These results suggest that the treatment of tibial shaft fractures with an intact fibula by using an interlocking nail prevents significant complications and allows early weight bearing, thus permiiting early mobilization of the traumatized patient. The level of the fibular fracture associated with the tibial fracture may be a useful prognostic factors in the healing of tibial shaft fractures.

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Ipsilateral Momentary Fibular Transfer in an Large Tibia Defect Using Ring Fixator: A Case Report: Hak Sun Kim, Churl Hong Chun, Hye Jung Kim; J Korean Soc Fract 1996;9(1):220-224. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.220

Abstract PDF: Massive segmental bony defect in open tibial fractures are generally treated with conventional bone grafting, free vascularized fibular graft or ring fixator technique. There are corcumstance when conventional bone graft is not adequate. A vascularized fibular graft may be superior to conventional graft, but it is with ring fixator is alternative method. The procedure can be accomplished by transferring the osteotomized part of the fibula to the tibia by means of olive wires. There was a 20-year-old male patient with Gustilo type IIIc open tibial fracture. Soft tissue defect was severe and femoral angiogram was perfomed. Only tibialis posterior artery was patent and peroneal artery was partially damaged. Latissmus dorsi flap was performed for covering soft tissue defect. Since the only patent tibialis posterior artery was already used for latissmus dorsi flap, it was difficult to perform vascularized fibular graft. Also it was technically difficult for us to accomplish a gradual transport using ring fixator because the distal tibia was lost. Thus, the fibular transfer was performed immediately after the ring fixator was applied. Good bony union and fibular hypertophy were obtained even though these two procedure had been done simultaneously.

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Operative Treatment of Proximal Humeral Fracture using Inlay Graft of Fibular Allograft Combined with Plating: Duck Yun Cho, Eun Sung Koh, Myong Hyoung Lee; J Korean Soc Fract 1995;8(1):84-92. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.84

Abstract PDF

Fracture of the proximal humerus occurs more frequently in older individuals who may have advancing osteoporosis, causing the bone to weaken, even with minimal force. And, most proximal humeral fractures respond satisfactory to conservative treatment. But, operative treatment is reconmended in the case that poor results are anticipated by the severe displacement and comminution. In older patient with proximal humerus fracture, there was some problem such as osteoporosis, absorption of cancellous bone, cystic formation, and weakness of the mechanical support, and it has difficulties in rigid fixation and early ROM. Four cases of displaced fracture of the proximal humerus in older patients over 50-year-old Treated by using plate & inlay fibular allograft from Apr. 1991 to Dec. 1993 were analized clinically and radiologically. The following results were obtained. 1. The results of these patients were rated by the Neers functional criteria. Of four cases, three cases had excellent results, one case had satisfactory. 2. There was no allograft related complications, such as infection & graft rejection. So, in treatment of proximal humerus fracture at old individuals, open reduction and internal fixation with plating and inlay graft using fibular allograft was very useful method, and it resulted in rigid fixation, early ROM. and good functional result.

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Allogeneic Inlay Cortical Strut Grafts for Large Cysts or Post-curettage Cavitary Bony Defects
Yang-Guk Chung, Yong-Koo Kang, Chol-Jin Kim, An-Hi Lee, Jeong-Mi Park, Won-Jong Bahk, Hyun-Ho Yoo
The Journal of the Korean Bone and Joint Tumor Society.2011; 17(2): 73. CrossRef

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The effects of the flbular stabilization in the treatment of tibio-fibula shaft fracture: Dong Bae Shin, Young Kyu Lee, Jang Yeob Ahn, Byung Kuk Cho, Dae Ug Hur; J Korean Soc Fract 1994;7(2):634-641. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.634

Abstract PDF: Many authors have been discussed effects of fibular stabilization in the healing of the tibiofibular shaft fracture. A-0 group recommand fixation of the fibular shaft fracture in treatment of tibio-fibula shaft fracture with rationale of more stability of tibial fracture site and anatomical restoration of tibio-fibula relationship and so better effect on ankle motion. The purpose of this study is to indentify the effect of fibula stabilazation on reduction state of tibial fracture site, change in ankle mortise and healing period of tibial fracture site. Authors performed fibula stabilization with 1/3 plate and screws in 8 cases of tibio-fibula shaft fracture and compare with 40 cases of tibio-fibula fracture without fibula stabilization in point of above mentioned three effects. The results were as follows. 1. O/R & I/F of the fibular fracture, had no effect on the reduction state of the tibial shaft fracture site but it was somewhat helpful to restoration of the ankle mortise owing to the restoration of the fibular length. 2. There were no significant differences in the weight bearing time and the union time of the tibial fracture between two groups. 3. We experienced 2 cases of implant failure on the fibular fixation site, due to shortening of the tibial fracture site and overloading of the fibular fixation site. In these 2 cases, ankle pain was debeloped before the implant-failure. From the above result, we suggest that fibula stabilization have no benefit in treatment of tibio-fibular shaft fracture.

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A Clinieal Study of the Tibial Pilon Fractures: Cheol Kwak, Sung Seok Soe, Hyun Duk Yoo, Young Chang Kim, Jang Seok Choi, Young Ku Lee; J Korean Soc Fract 1992;5(2):260-267. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.260

Abstract PDF: Intraarticular fractures of the distal tibia, the so-called pilon tibial fracture, usually resultfrom a torsional injury, a motor vehicle accident, or a fall from a height. The management of these fractures has been notoriously difficult due to the comminution of the distal tibia, articular incongruity, and asscociat ed soft-tissue trauma. The best results of treatment reported for this fracture, have followed early open reduction and rigid internal fixation to restore length, recon struction of the plafond, primary cancellous bone-grafting, butress plate on tibia, early motion and prolonged non weight-bearing. The purpose of this study was to examine the experience of the Pusan Paik Hospital between 1986 and 1991 as it relates to the treatment of 20 pilon fractures and to correlates the Clinical fesults with fracture type. They were followed post-operatively for an average of 22.3 months. The results were as follows 1. The most frequent type of the fraEture was type III according to Ruedl and Allgowe Classification. 2. Open reduction and internal fixation in cases type II & III has showed better resulis than those treated conservatively. 3. The fibula fracture fixed internally with a plate first often makes re construction of the distal tlbia easier. 4. The most often complication was the ankle joint pain.

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Anterior transposition of vascularized fibula for the segmentaldefects of both tibias report of one case: Kwang Suk Lee, Jong Woong Park; J Korean Soc Fract 1992;5(1):150-156. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.150

Abstract PDF: No abstract available.

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