Journal of Musculoskeletal Trauma

Risk factors of surgical complications after use of the femoral neck system: a random forest analysis: Chul-Ho Kim, Hyun-Chul Shon, Han Soul Kim, Ji Wan Kim, Eic Ju Lim; J Musculoskelet Trauma 2025;38(3):160-167. Published online July 23, 2025; DOI: https://doi.org/10.12671/jmt.2025.00157

Abstract PDF: Background
The femoral neck system (FNS), a novel fixation device for managing femoral neck fractures (FNFs), has gained popularity in recent years. However, analyses of the surgical complications and reoperation risks associated with the use of FNS remain limited.
Methods
This retrospective observational study analyzed 57 patients who had undergone FNS fixation for FNF at two university hospitals between July 2019 and February 2024. Demographic, perioperative, and outcome variables, including age, sex, fracture classification (Garden, Pauwels, and AO), implant characteristics, tip-apex distance (TAD), neck shortening, and neck-shaft alignment, were analyzed. In addition to univariate analysis, a machine learning analysis was conducted using a random forest classifier with stratified sampling (80% training, 20% testing). The accuracy, precision, recall, F1-score, and area under the receiver’s operating curve were calculated to assess model performance.
Results
Ten patients experienced osteonecrosis of the femoral head (n=6), implant cut-out or penetration (n=3), and peri-implant fracture (n=1). Univariate analysis revealed that the TAD in the complication group was significantly shorter than that in the control group (12.1 vs. 16.7 mm; P=0.012). Additionally, neck shortening in the complication group was greater than that in the control group (4.9 vs. 2.3 mm; P=0.011). The random forest model achieved an accuracy of 83.3% and identified postoperative neck-shaft angle (NSA) as the most important predictor of complications (feature importance, 0.161), followed by bolt length (0.102) and preoperative NSA (0.094).
Conclusions
Risk factor analysis conducted using a random forest model identified postoperative NSA as the most important feature associated with postoperative complications following FNS. Therefore, care should be taken to normalize the postoperative NSA during FNF surgery. Level of Evidence: III.

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Current concepts in the management of phalangeal fractures in the hand: Hyun Tak Kang, Jun-Ku Lee; J Musculoskelet Trauma 2025;38(3):109-123. Published online July 22, 2025; DOI: https://doi.org/10.12671/jmt.2025.00136

Abstract PDF: This review focuses on the treatment of hand fractures based on the anatomical location of the fractured phalanx, excluding the thumb, and examines recent studies on the topic. The main points are as follows: in most cases of hand fractures, conservative treatment should be prioritized over surgical intervention. The three key factors in determining whether surgical treatment is necessary are (1) whether the fracture is intraarticular, (2) the stability of the fracture itself, and (3) the extent of damage to surrounding soft tissues. The primary surgical treatment is closed reduction and Kirschner-wire fixation. The risk of rotational deformity increases with fractures closer to the proximal region. Intra- articular fractures may lead to subsequent stiffness and arthritis; thus, computed tomography is recommended to assess the fracture pattern. Anatomic reduction of intraarticular fragments is required, along with correction of the inherent joint instability. No surgical method has proven to be superior; it is advantageous for the surgeon to choose a surgical approach they are familiar with and confident in, based on the specific fracture and patient factors. Complications in hand fractures are various; the most frequent is stiffness, and nonunion is uncommon. Early joint motion is crucial in minimizing the risk of stiffness.

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Computational simulation of coracoclavicular screw insertion through the superior distal clavicular plate for clinical applications in Korean cadavers: Hyung-Lae Cho, Ji Han Choi, Se-Lin Jeong, Gu-Hee Jung; J Musculoskelet Trauma 2025;38(3):143-151. Published online July 22, 2025; DOI: https://doi.org/10.12671/jmt.2025.00122

Abstract PDF: Background
The study was conducted to determine the practical area for inserting the coracoclavicular (CC) screw through the plate by analyzing three-dimensional (3D) shoulder models featuring virtually implanted, actual-size plates and screws.
Methods
Ninety cadaveric shoulders (41 males and 49 females) underwent continuous 1.0-mm slice computed tomography scans. The data were imported into image-processing software to generate a 3D shoulder model, including the scapula and clavicle. The overlapping area between the clavicle and the horizontal portion of the coracoid process (horizontal portion_CP) was analyzed in the cranial view. A curved pelvic recon plate was virtually placed on the upper surface of the distal clavicle, and an actual-size (3.5 mm) CC screw was inserted through the plate.
Results
The distal clavicle directly overlapped with the horizontal portion_CP in the vertical direction. The overlapping area was sufficient to place the 3.5 mm and 4.5 mm-sized screws. In all shoulder models, the CC screw could be inserted through the plate into the vertical direction, with an average length of 35.5 mm (range, 26.2–62.5 mm; standard deviation, 1.2 mm). In 87 models, the CC screw was inserted through the third hole from the lateral end of the plate. Two models were inserted through the second hole, and one model through the fourth hole.
Conclusions
The upper surface of the clavicle has sufficient overlapping area to place CC screws through the plate in the vertical direction in the corresponding hole. Supplemental CC screw fixation through the plate can be performed without additional or special equipment. Level of evidence: IV

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Biomechanical finite element analysis of a femoral neck system fixation construct for femur neck fractures and clinical implications: Hoon-Sang Sohn, Se-Lin Jeong, Gu-Hee Jung; J Musculoskelet Trauma 2025;38(3):133-142. Published online July 22, 2025; DOI: https://doi.org/10.12671/jmt.2025.00108

Abstract PDF: Background
This study assessed the structural/mechanical stability of fixation constructs with a femoral neck system (FNS) via finite element analysis after simulating femoral neck fractures and explored the clinical implications.
Methods
We simulated subcapital, transcervical, basicervical, and vertical fracture models using a right femur (SAWBONES) and imported the implant model of FNS to Ansys (Ansys 19.0, Ansys Inc.) to place the implant in the optimal position. The distal end of the femur model was completely fixed and was abducted 7°. The force vector was set laterally at an angle of 3° and posteriorly at an angle of 15° in the vertical ground. The analysis was conducted using Ansys software with the von Mises stress (VMS) in megapascals (MPa).
Results
The maximum VMS of the fracture site was 67.01 MPa for a subcapital, 68.56 MPa for a transcervical, 344.54 MPa for a basicervical, and 130.59 MPa for a vertical model. The maximum VMS of FNS was 840.34 MPa for a subcapital, 637.37 MPa for a transcervical, 464.07 MPa for a basicervical, and 421.01 MPa for a vertical model. The stress distribution of basicervical and vertical fractures differed significantly, and the basicervical fracture had higher VMS at the bone, implant, and fracture sites.
Conclusions
FNS fixation should be performed with consideration the osseous anchorage in the femoral head, and this technique might be appropriate for vertical fractures. Regarding the VMS at the fracture site, FNS might be applied cautiously only to basicervical fractures with anatomical reduction without a gap or comminution. Level of evidence: IV.

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Atypical femoral fractures: an update: Won-Tae Cho, Jeong-Hyun Koh, Seungyeob Sakong, Jung-Taek Kim; J Musculoskelet Trauma 2025;38(2):41-52. Published online March 28, 2025; DOI: https://doi.org/10.12671/jmt.2025.00031

Abstract PDF: This narrative review provides an up-to-date overview of atypical femoral fractures (AFFs), emphasizing diagnostic criteria, epidemiology, pathophysiology, risk factors, and evaluation with screening strategies. AFFs are rare but significant complications associated with prolonged bisphosphonate (BP) therapy for osteoporosis. Although the pathogenesis of AFFs has not been fully elucidated, its primary mechanism is thought to involve impaired bone remodeling, leading to unhealed microfractures that progress to stress fractures under repetitive loading. AFFs can occur in various regions of the femur, influenced by femoral geometry and the lower limb axis. Other risk factors include prolonged steroid use, arthroplasty, genetic predispositions, and metabolic bone disorders. The diagnosis of AFFs is based on criteria established by the American Society for Bone and Mineral Research. Key radiographic features include lateral cortical transverse fracture lines and localized cortical thickening, typically with minimal or no comminution on the medial cortex. Dual-energy X-ray absorptiometry for screening tests and magnetic resonance imaging as an advanced imaging modality enable the early detection of incomplete fractures. This multi-modal approach facilitates the prompt identification of prodromal cortical changes, reducing the risk of complete fractures in high-risk populations, particularly patients undergoing prolonged BP therapy. Level of Evidence: V

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Avulsion fractures around the hip joint and pelvis: Won-Sik Choy, Yonghan Cha, Jung-Taek Kim, Jun-Il Yoo, Jin-Woo Kim; J Musculoskelet Trauma 2025;38(2):53-62. Published online March 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00010

Abstract PDF: Avulsion fractures occur when tendons or ligaments are subjected to forces greater than they can withstand at the apophysis or enthesis, regardless of fusion status. The pelvis and hip joint are vulnerable to these injuries due to the diverse muscular structures in these structures, which serve as origins for multiple muscles leading to the lower extremities. Pelvic avulsion fractures commonly affect young athletes, but can also occur in adults. The diagnosis typically involves assessing trauma history, a clinical examination, and radiographic imaging. If the diagnosis is unclear, additional tests such as computed tomography and magnetic resonance imaging may assist in the diagnosis and provide useful information for treatment decisions. While most avulsion fractures respond well to conservative treatment, surgical intervention may be preferred in severe displacements, cases of significant retraction in active athletes, or when a faster recovery is necessary. Chronic or neglected injuries may lead to excessive osseous formation around the pelvis, causing impingement syndromes. Recognizing characteristic radiological findings based on pelvic anatomy helps to make an accurate diagnosis, as chronic injuries can mimic tumors or infectious conditions, necessitating a careful differential diagnosis.

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Easily missed nondisplaced fractures accompanying complete fractures in the lower extremity and pelvis: a narrative review: Young-Chang Park; J Musculoskelet Trauma 2025;38(1):5-12. Published online January 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00017

Abstract PDF: Nondisplaced fractures accompanying complete fractures are often difficult to detect on plain radiographs or computed tomography scans, posing a diagnostic challenge. The diagnosis of these frequently overlooked injuries can be delayed, potentially leading to suboptimal patient outcomes. This review discusses four commonly missed fracture patterns in the lower extremity and pelvis, including posterior involvement in fragility fractures of the pelvis, intertrochanteric extensions in isolated greater trochanter fractures, ipsilateral femoral neck fractures in high energy femoral shaft fractures, and posterior malleolar fractures in distal spiral tibial shaft fractures. An accurate diagnosis of these accompanying nondisplaced fractures is critical for optimizing surgical outcomes. Surgeons should incorporate thorough preoperative evaluations into their clinical practice to facilitate early detection and appropriate treatment strategies. Prompt identification and comprehensive management remain essential for improving patient outcomes.

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Outcomes of open reduction and internal fixation using 2.0/2.4 mm locking compression plate in isolated greater tuberosity fractures of humerus: Sung Choi, Dongju Shin, Sangwoo Kim, Byung Hoon Kwack; J Musculoskelet Trauma 2025;38(1):32-39. Published online January 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00005

Abstract PDF: Background
The purpose of this study was to retrospectively evaluate the radiographic and clinical results of a small single or double low-profile plate fixation of 2.0/2.4 mm locking compression plate (LCP) in treating isolated greater tuberosity (GT) fractures of the humerus. Methods: From June 2015 to October 2022, patients who underwent LCP in treating isolated GT fractures of the humerus were included in this study. The radiological and clinical results were analyzed in 15 patients who underwent open reduction and internal fixation used 2.0/2.4 mm LCP. Results: Bone union was achieved in 14 patients (93.3%) and one failed case was treated with a 2.4 mm single LCP fixation. Radiological union was achieved within 10–20 weeks. Complications occurred in two patients (13.3%), including the reduction failure and shoulder stiffness. At the final follow-up, the average clinical scores were as follows: a visual analog scale for pain of 2.1 (range, 0–5) and a University of California, Los Angeles score of 27.2 (range, 18–31). Regarding range of motion (ROM), the average active ROMs were 142° for forward flexion (range, 120°–150°), 147.1° for abduction (range, 120°– 180°), and 59.3° for external rotation (range, 45°–80°). For internal rotation, the average was observed to reach the 10th thoracic vertebra (range, 1st lumbar vertebra–7th thoracic vertebra). Conclusions: The clinical and radiologic outcomes of treating isolated GT fracture using 2.0/2.4 mm LCP were favorable, and double low-profile plate fixation may be beneficial for sufficient fracture stability if possible. Level of evidence: Level IV, case series.

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Interpositional tricortical iliac bone graft in nonunion of midshaft clavicular fractures: Eun-Seok Son, Bum-Soon Park, Chang-Jin Yon, Chul-Hyun Cho; J Musculoskelet Trauma 2025;38(1):23-31. Published online January 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00004

Abstract PDF: Background
The purpose of this study was to investigate the radiological and clinical outcomes after interpositional tricortical iliac bone graft with plate fixation for the nonunion of clavicle midshaft fractures. Methods: Between 2007 and 2020, 17 cases who were treated by interpositional tricortical iliac bone graft with plate fixation for the clavicle midshaft nonunion combined with bone defect were investigated. The mean age was 53 years (range, 22–70 years). The mean follow-up period was 102.2 months (range, 18–193 months). Serial plain radiographs were used to evaluate radiological outcomes. The University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and Quick-disabilities of the arm, shoulder, and hand (DASH) score were used to evaluate clinical outcomes. Complications were also evaluated. Results: All cases achieved complete bony union with mean healing time of 17.6 weeks (range, 14–22 weeks). The mean clavicle length difference was significantly decreased from 9.1 mm preoperatively to 2.6 mm postoperatively (P<0.001). The mean UCLA and ASES scores were significantly improved from 18.1 and 52.2 before surgery to 30.6 and 88.6 after surgery (both P<0.001), respectively. The mean final Quick-DASH score was 18.0. Three cases (17.6%) developed postoperative complications including two cases of shoulder stiffness and one case of screw irritation. Conclusions: Interpositional tricortical iliac bone graft with plate fixation for the clavicle midshaft nonunion demonstrated excellent radiological and clinical outcomes. In cases of atrophic nonunion combined with bone defect, this technique is an effective option that can provide structural support and restore clavicle length. Level of evidence: Level IV, case series.

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Analysis of Missed Fractures by Bone Scan in Elderly Hip Fracture Patients with Osteoporosis: Tae Hun Lee, Yeong Hyun Lee, Seo Won Kang; J Korean Fract Soc 2024;37(3):144-149. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.144

Abstract PDF: Purpose
The incidence of hip fractures is increasing due to an increase in elderly populations because elderly patients often have accompanying diseases, such as cognitive impairment or dementia, which may lead to missed fractures. Therefore, this study assessed the utility of bone scans in detecting missed fractures in elderly patients.
Materials and Methods
This study analyzed the data from 178 patients treated from January 2014 to March 2023. The inclusion criteria were patients who had hip fractures with osteoporosis over 70 years old. Bone scans were performed on average 10 days after injury. The rate and trend of missed fractures not detected in the initial diagnosis were determined based on sex, age, dementia status, and the presence of osteoporosis.
Results
Among the 178 hip fracture patients over 70 years old, 37 patients had a history of being diagnosed with dementia, and 141 patients had never been diagnosed. Missed fractures were confirmed in 49 cases (42 patients) (23.6%). The dementia group had 13 missed fractures, and the non-dementia group had 36 missed fractures, but there was no significant difference. Rib fractures were most common, followed by vertebral fractures.
Conclusion
Missed diagnoses of fractures were common among elderly hip fracture patients. A whole body bone scan appeared to be effective in detecting missed fractures. Therefore, identifying accompanying fractures through bone scans and delivering appropriate treatment can play an important role in postoperative rehabilitation.

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Effect of Coincident Hip Fracture on Distal Radius Fracture in Patients Treated with a Volar Locking Plate: A Matched-Pair Analysis of Elderly Patients: Hyoung-Seok Jung, Min-Su Chu, Jae-Sung Lee; J Korean Fract Soc 2024;37(3):137-143. Published online July 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.3.137

Abstract PDF: Purpose
Although the incidence of simultaneous distal radius and hip fractures in older patients is minimal, patients with these coincident types of fractures exhibit unique features. This study analyzed the outcomes associated with operative treatment involving volar-locking plates in patients who sustained distal radius fractures and hip fractures and compared them with those in matched control patients who had undergone treatment for isolated distal radius fractures.
Materials and Methods
Between 2010 and 2015, 34 patients, who met the criteria for hip and distal radius fractures, were retrospectively reviewed. Thirty-four matched patients who underwent volarlocking plate fixation for isolated distal radius fractures during the same period were also reviewed. The clinical outcomes between the groups were compared using postoperative radiological parameters.
Results
The radiological assessment revealed a better radial length and inclination in the control group than in the study group at the final follow-up. In other words, patients with coincident hip fractures showed a higher tendency for loss of reduction. Despite the differences in radiological parameters, no significant differences in clinical outcomes were observed, except for grip strength.
Conclusion
Although volar-locking plating provides greater stabilization, a loss of reduction occurred in patients with coincident hip fractures.

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Comparison of the Radiological Outcomes of an Anatomical Quadrilateral Surface Plate with a Pelvic Reconstruction Plate in Acetabulum Fractures: Sung Hyun Yoon, Hee Gon Park, Dong Uk Lee; J Korean Fract Soc 2024;37(2):95-101. Published online April 30, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.2.95

Abstract PDF: Purpose
This study compared the radiological outcomes of fixation using an anatomical quadrilateral surface plate with those using a traditional pelvic reconstruction plate for fractures involving the quadrilateral surface or superomedial wall of the acetabulum.
Materials and Methods
From 2015 to 2022, 47 patients who met the inclusion and exclusion criteria were analyzed retrospectively. Internal fixation of an acetabular fracture was achieved with a pelvic reconstruction plate (n=28) or an anatomical quadrilateral surface plate (n=19). The ability to achieve immediate postoperative anatomical reduction and the long-term outcomes were assessed by confirming the arthritic changes. Immediate postoperative reduction quality and long-term radiological outcomes for post-traumatic arthritis were assessed using the Matta scoring system on standard radiographs.
Results
The assessment of immediate postoperative reduction in the pelvic reconstruction plate group was satisfactory in 16 patients (57.1%) and unsatisfactory in 12 patients (42.9%). In the anatomical quadrilateral surface plate group, the results were satisfactory in 16 patients (84.2%) and unsatisfactory in 3 patients (15.8%). When evaluating over an extended follow-up period in the pelvic reconstruction plate group, 19 patients (67.9%) demonstrated satisfactory, while 9 patients (32.1%) had unsatisfactory outcomes. In the anatomical quadrilateral surface plate group, 12 patients (63.2%) achieved satisfactory, and 7 patients (36.8%) had unsatisfactory outcomes. The immediate postoperative reduction quality was superior in the anatomical quadrilateral surface plate group (p=0.03). Comparing longterm results, the anatomical quadrilateral surface plate group did not have statistically more favorable outcomes (p=0.49).
Conclusion
In this study, the anatomical quadrilateral surface plate achieved sufficiently good radiological results without significant difference from the existing pelvic reconstruction plate. It was concluded that it is a useful option that can replace the existing metal plate in the selection of surgery for acetabular fractures.

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Treatment of Avulsion Fractures around the Knee: Sumin Lim; J Korean Fract Soc 2024;37(2):117-124. Published online April 30, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.2.117

Abstract PDF: Avulsion fractures are common in athletes and result from high-impact or sudden, forceful movements involving the separation of a bone fragment at the ligament or tendon attachment site. The key focus areas include the anterior and posterior cruciate ligaments, medial collateral ligament, anterolateral complex, arcuate complex, medial patellofemoral ligament, patellar tendon, and quadriceps tendon. Diagnostic approaches combine radiography with advanced imaging techniques, such as computed tomography and magnetic resonance imaging, to elucidate the extent of injury and guide treatment decisions. Treatment ranges from conservative management for non-displaced fractures to surgical intervention for displaced fractures, with strategies customized based on the specific ligament involved and the nature of the fracture.

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Osteoporotic Hip Fracture: How We Make Better Results?: Byung-Chan Choi, Kyung-Jae Lee; J Korean Fract Soc 2024;37(1):52-59. Published online January 31, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.1.52

Abstract PDF: The prevalence of osteoporosis and incidence of osteoporotic fractures is increasing gradually as life expectancy is prolonged and the aged population increases. Osteoporotic hip fractures (femoral neck fractures and femoral intertrochanteric fractures) have high mortality because the patients with these fractures are elderly and have several comorbidities. Thorough preparation and a multidisciplinary approach in the preoperative period are critical, and early surgery is recommended. There are also several principles to treat osteoporotic hip fractures and prevent fixation failures. Many studies have suggested various treatment methods for femoral neck fractures and femoral intertrochanteric fractures. Functional recovery treatment is essential based on the patient’s health and activity levels. Finally, aggressive management of osteoporosis and the prevention of falling is needed to treat osteoporotic hip fractures successfully.

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Fracture-Related Complication: Fat Embolism Syndrome: Beom-Soo Kim; J Korean Fract Soc 2023;36(3):95-102. Published online July 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.3.95

Abstract PDF: Fat embolization is a common occurrence after trauma or during orthopedic procedures involving intramedullary manipulation. Although uncommon, fat embolism syndrome (FES) with respiratory failure, neurologic dysfunction, and petechial rash can be fatal to patients. Two theories are proposed for the manifestation of FES: in the mechanical theory, FES occurs when fat tissue in the bone marrow enters the bloodstream and mechanically blocks it; the biochemical theory proposes that FES occurs due to an inflammatory reaction caused by free fatty acids. There are currently no clear diagnostic criteria for FES, and symptoms and signs are typically nonspecific. For the treatment of FES, conservative and supportive management is performed for the specific symptoms, and close monitoring of the respiratory and neurologic systems is required in high-risk groups. Early fracture fixation of long bones helps prevent and reduce the severity of fat embolism.

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Outcomes of Minimally Invasive Surgery in Intra-Articular Calcaneal Fractures: Sanders Type III, Joint Depressive Type Calcaneal Fracture: Je Hong Ryu, Jun Young Lee, Kang Yeol Ko, Sung Min Jo, Hyoung Tae Kim; J Korean Fract Soc 2023;36(3):85-94. Published online July 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.3.85

Abstract PDF: Purpose
To evaluate the radiologic and clinical outcomes of a minimally invasive technique using the tarsal sinus approach in the management of Sanders type III, joint depressive type calcaneal fractures.
Materials and Methods
Between July 2011 and September 2019, data of 29 patients who underwent a minimally invasive procedure with the sinus tarsi approach for Sanders type III joint depressive intra-articular calcaneal fractures, and were followed up for more than 1 year were analyzed. We evaluated the radiologic outcomes by assessing the radiologic parameters (Böhler angle, Gissane angle, calca-neal length, calcaneal height, calcaneal width). We also evaluated the clinical outcomes based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the complications associated with the technique.
Results
The radiological results showed an improvement in the Böhler angle from 2.5° to 18.6° and the Gissane angle from 132.4° to 119.1° after the operation. The mean AOFAS score during the clini-cal evaluation was 79.5. We observed 13 cases of posttraumatic arthritis, 1 case of subtalar arthrodesis, and no case of wound complication.
Conclusion
Minimally invasive technique for Sanders type III joint depressive calcaneal fractures resulted in relatively satisfactory radiologic and clinical outcomes. Open reduction and internal fixation through the sinus tarsi approach reduce complications including wound problems. This approach offers satisfactory results without long-term complications.

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Hip Fractures in the Elderly: Perioperative Management and Prevention of Medical Complications: Keong-Hwan Kim; J Korean Fract Soc 2023;36(1):39-44. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.39

Abstract PDF

Elderly patients with hip fractures are at an increased risk of developing medical complications with higher mortality rates. Most patients require surgical treatment, and an early surgical intervention can reduce complications and lower mortality risk. A restrictive red blood cell transfusion strategy is usually applied, and the amount of transfusion can be reduced through medications such as tranexamic acid. Delirium can be prevented using non-pharmacological methods. In addition, it is necessary to prevent venous thromboembolism through mechanical or chemical prophylaxis. A multidisciplinary approach using the ERAS (Enhanced Recovery After Surgery) protocol and orthogeriatric care can help to reduce medical complications and mortality.

Citations

Citations to this article as recorded by

Treatment of Incompletely Displaced Femoral Neck Fractures Using Trochanteric Fixation Nail-Advanced in Patients Older Than 50 Years of Age
Jee Young Lee, Gyu Min Kong
Journal of Orthopaedic Trauma.2025; 39(7): 352. CrossRef

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Fragility Fractures of the Pelvis and Sacrum: Se-Won Lee, Ju-Yeong Kim; J Korean Fract Soc 2023;36(1):29-38. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.29

Abstract PDF: The incidence of fragility fractures of the pelvis (FFP) has increased significantly due to the aging popu-lation and improved diagnostic modalities. The evaluation and treatment of these patients differ from that of high-energy pelvic ring injuries typically seen in younger patients. Therefore, it is important to classify the FFP by patterns of the classification system to standardize optimal treatment criteria and appropriate treatment strategy. However, some cases are not classifiable according to the FFP classifi-cation. A newly proposed classification that can be verified by comparing existing FFP classifications is needed to overcome the weak points. Non-operative treatment is usually considered first and should focus on early mobilization. Operative fixation should focus on stabilizing the minimally invasive pelvic ring than the reduction of fractures to facilitate early mobilization and avoid complications that can arise from comorbidities associated with immobility.

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

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

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Treatment of Scaphoid Fractures and Nonunions: Wan-Sun Choi; J Korean Fract Soc 2022;35(4):182-189. Published online October 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.4.182

Abstract PDF: A scaphoid fracture is one of the most common types of wrist fractures, and if treatment is delayed, there is a high possibility of nonunion due to anatomical factors such as limited blood supply to the injured bone. Therefore, it is important to suspect a scaphoid fracture based on the mechanism of wrist injury and physical examination of the patient. A computed tomography scan or magnetic resonance imaging can also aid early diagnosis of the fracture. Stable acute fractures can be treated conservatively, but unstable fractures require surgical treatment, and percutaneous screw fixation is usually performed. Nonunions require bone grafts and are treated with non-vascularized bone grafts and screw fixation. However, if the nonunion is located at the proximal pole, a vascularized bone graft may be considered because there is a possibility of avascular necrosis. Pedicled vascularized and free vascularized medial femoral condyle bone grafts are mainly used in such cases. The treatment of a proximal pole nonunion with impaired blood flow remains controversial. There are conflicting opinions on whether a nonvascularized bone graft is sufficient or whether a vascularized bone graft is necessary.

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Comparison of the Clinical and Radiological Outcomes of TFNA (Trochanteric Fixation Nail-Advanced) and PFNA-II (Proximal Femoral Nail Antirotation-II) Treatment in Elderly Patients with Intertrochanteric Fractures: Min Sung Kwon, Young Bok Kim, Gyu Min Kong; J Korean Fract Soc 2022;35(4):162-168. Published online October 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.4.162

Abstract PDF

Purpose
Trochanteric fixation nail advanced (TFNA) was modified to compensate for the shortcomings of proximal femoral nail antirotation-II (PFNA-II). The clinical and radiological outcomes of surgeries us-ing the PFNA-II and TFNA for femoral intertrochanteric fractures were compared.
Materials and Methods
Eighty-two patients who underwent surgeries using PFNA-II or TFNA were analyzed. Only those who were followed up for more than a year were enrolled. Bone union, shortening of the femoral neck, and the tip–apex distance of the intramedullary nail were compared in the radiological findings. Clinical outcomes, including the frequency of complications and gait ability (Koval score), were also assessed.
Results
The mean follow-up periods were 22 and 19 months for the PFNA-II and TFNA groups, re-spectively. In the PFNA-II group, two cases of femoral head cut-out and one case of varus collapse were observed. In the TFNA group, only one case of femoral head cut-out was observed; however, there was no significant difference in the frequency of complications between the two groups (p=0.37). Ad-ditionally, both the shortening of the femoral neck and the decrease in gait ability after surgery showed relative improvement in the TFNA group compared to the PFNA-II group; however, there was no sig-nificant difference between the two groups.
Conclusion
The use of both TFNA and PFNA-II was associated with satisfactory outcomes. In patients who underwent surgeries using TFNA, the recovery of gait ability, frequency of complications, and short-ening of the femoral neck were not significantly different from PFNA-II, suggesting that both are suitable instrument choices for intertrochanteric fracture treatment. However, the clinical significance must be further assessed using a larger group of patients over a longer follow-up period in future studies.

Citations

Citations to this article as recorded by

Treatment of Incompletely Displaced Femoral Neck Fractures Using Trochanteric Fixation Nail-Advanced in Patients Older Than 50 Years of Age
Jee Young Lee, Gyu Min Kong
Journal of Orthopaedic Trauma.2025; 39(7): 352. CrossRef
Clinical and Radiological Outcomes of Unstable Intertrochanteric Fractures Treated with Trochanteric Fixation Nail-Advanced and Proximal Femoral Nail Antirotation-II: Correlation between Lateral Sliding of the Helical Blade and Lateral Trochanteric Pain
Sung Yoon Jung, Myoung Jin Lee, Lih Wang, Hyeon Jun Kim, Dong Hoon Sung, Jun Ha Park
Journal of the Korean Orthopaedic Association.2024; 59(3): 208. CrossRef

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Benefits of a Demineralized Bone Matrix in Osteoporotic Intertrochanteric Femoral Fracture Patients: Se Jin Kim, Hong-Man Cho, Myung Cheol Jung; J Korean Fract Soc 2022;35(4):151-161. Published online October 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.4.151

Abstract PDF: Purpose
Osteoporosis causes various fixation failures in patients with intertrochanteric fractures. This study aimed to investigate the effect of a demineralized bone matrix (DBM) for cancellous or cortical bone defects on internal fixation in older osteoporotic patients with intertrochanteric fractures.
Materials and Methods
Among patients with intertrochanteric fractures who underwent surgical treatment from January 2016 to December 2021 at a facility, 171 patients were AO/OTA type 31-A1 and type 2 fractures which are considered relatively stable. The patients were grouped based on DBM use (Group A: DBM use, Group B: DBM non-use), and their clinical and radiology results were analyzed retrospectively. The patients were then subdivided into Group A-a and -b after removing factors that could cause treatment failures, such as the reduction status and location of the helical blade, and then further subdivided (Group A-a-1/2/3/4 and Group B-b-1/2/3/4) according to cancellous or cortical bone defects that could accompany intertrochanteric fractures. The time to full weight-bearing (FWB) and Harris hip score (HSS) 3 months after surgery in these subgroups were investigated.
Results
There was no significant difference in the clinical radiology results and complications between Group A and Group B. However, the time to FWB (p<0.001) and HSS (p=0.029) were significantly superior in Group A. In Group A-a with DBM use, after removing the risk factors for intertrochanteric fracture failure, the time to FWB (p=0.055) was close to the significance level, and HSS (p=0.036) was significantly superior. In Group A-a-1 (cancellous defect only) and Group A-a-3 (cancellous and cortical defect), the time to FWB (p=0.088, 0.052) was close to the significance level, and the HSS (p=0.039, 0.018) was significantly superior when DBM was used.
Conclusion
In patients with intertrochanteric fractures of AO/OTA type 31-A2.3 or less, if stable reduction and firm fixation are achieved, selective DBM use may help early recovery after surgery.

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Surgical Treatment of Distal Radius Fractures and Treatment of Common Accompanying Lesions: Joo-Hak Kim; J Korean Fract Soc 2022;35(3):120-127. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.120

Abstract PDF: There have been major advances in the treatment of distal radius fractures over the past 20 years. Specifically, the development of the volar locking plate in 2001 and the subsequent improvements in its design and performance have enabled the treatment of distal radius fractures that were previously considered difficult to treat. The volar plate is used for fractures and shows good results with anatomical reduction and firm fixation. However, when trying to apply it to more complex fractures, there are still difficulties related to the unique anatomical structure of the distal radius, and there are also several factors that can impair joint function and cause pain after surgery. In this review, the factors to be considered to ensure better outcomes during ORIF (open reduction and internal fixation), and external fixation in the treatment of distal radial fractures are described. The review also details the common accompanying injuries and management methods.

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Current Treatment of Calcaneal Fractures and Dislocation: Dae Jin Nam, Sung Hyun Lee; J Korean Fract Soc 2022;35(2):74-82. Published online April 30, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.2.74

Abstract PDF: Calcaneal fractures are the most common fractures occurring in the tarsal bone. In the past, surgical treatments were not preferred because they were accompanied by severe comminution and soft tissue complications. In recent years, there have been great advancements in the treatment of calcaneal fractures owing to the development of new surgical techniques and instruments. However, a standard treatment method has not yet been established. In this review article, we summarize the latest information on the indications and treatment methods of calcaneal fractures.

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Posterior Anti-Glide Plating for Supination External Rotation Type Lateral Malleolar Fractures: Clinical Comparison of Locking versus Non-Locking One-Third Semi-Tubular Plate Fixation: Jun Young Lee, Yong Jin Cho, Dong Hyuk Cha, Hyun Bai Choi, Jung Ho Lee; J Korean Fract Soc 2022;35(2):57-62. Published online April 30, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.2.57

Abstract PDF: Purpose
The purpose of this study was to evaluate and compare the clinical and radiological outcomes between locking plates and non-locking plates using posterior anti-glide plating for supination external rotation type lateral malleolar fractures.
Materials and Methods
A total of 50 patients who underwent internal fixation of posterior anti-glide plating due to lateral malleolar fractures, classified as supination-external rotation (SER) as per the Lauge-Hansen classification system, at our hospital from January 2017 to November 2018 were retro-spectively evaluated. Patients were divided into two groups: 1/3 semi-tubular locking plate (24 patients) and 1/3 semi-tubular non-locking plate (26 patients). A radiographic assessment was performed after surgery to evaluate the time of bone union. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score was measured after the surgery to evaluate the clinical outcomes.
Results
The two groups showed similar distributions in sex, age, height, body mass index, fracture pattern, and mean follow-up period. Complete bone union was obtained in all cases and the mean bone union time was 13.00±3.38 weeks in Group 1 and 12.92±3.26 weeks in Group 2 (p=0.87). The mean AOFAS score at 24 weeks was 95.66±2.86 in Group 1 and 95.84±2.79 in Group 2 (p=0.82). The mean AOFAS score at 48 weeks was 97.25±3.54 in Group 1 and 96.57±3.07 in Group 2 (p=0.47). Two cases of complications were observed in the non-locking plate group.
Conclusion
For the treatment of Lauge-Hansen SER type lateral malleolar fracture, internal fixation us-ing locking 1/3 semi-tubular plate and non-locking 1/3 semi-tubular plate are both favorable fixation methods.

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Mortality-Related Risk Factors in Total Hip Arthroplasty for Femoral Neck Fractures in Elderly Patients: Jae Sung Suh, Hyung Gon Ryu, Young Ju Roh, Dae Won Shin; J Korean Fract Soc 2022;35(2):51-56. Published online April 30, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.2.51

Abstract PDF: Purpose
Total hip arthroplasty (THA) using dual mobility components (DMC) is a reasonable surgical option for displaced femoral neck fractures in elderly patients, resulting in lower dislocation rates and improved stability. The purpose of this study was to investigate the clinical outcomes and risk factors responsible for mortality in elderly patients who were diagnosed with a displaced femoral neck fracture and had undergone DMC-THA.
Materials and Methods
Out of 147 cases of THA from December 2018 to June 2020, a total of 79 cases were enrolled in this study, with the following characteristics: (1) Garden stage III or IV, (2) over 75 years of age, and (3) over 1 year of follow-up. All the patients received DMC-THA surgery using the anterolateral approach.
Results
The mean follow-up period was 15.0±8.43 months and a total of one dislocation case was observed. The mortality rate was 17.7% (14/79), and it was especially higher in patients with a past medical history of malignancy (odds ratio [OR]=7.18, p=0.03) or a cognitive disorder such as dementia (OR=5.48, p=0.03). Preoperative low initial hemoglobin levels (OR=0.65, p=0.04) and low UCLA (Uni-versity of California at Los Angeles) score (OR=0.47, p=0.02) were also associated with mortality.
Conclusion
When considering THA as a treatment approach in elderly patients with a displaced femoral neck fracture, a high mortality rate is expected in patients with low preoperative hemoglobin levels or a history of malignancy or cognitive disorders. Hence, thorough monitoring and management should be undertaken before and after surgery.

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Recurrent Treatment Failure in Vancouver Classification Type C Periprosthetic Fractures around a Well Fixed Short Femoral Stem: Byeong Yeol Choi, Hong-Man Cho, Jiyeon Park; J Korean Fract Soc 2022;35(1):16-20. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.16

Abstract PDF: A short femoral stem (type 1 cementless stem) is being increasingly used to perform total hip arthroplasty; however, various types of intra- or postoperative periprosthetic fractures have been reported in recent times. A 66-year-old woman with a history of bilateral total hip arthroplasties using a type 1B femoral stem was admitted 2 months post-operation for a Vancouver type C periprosthetic fracture. She underwent open reduction and internal fixation; however, we observed recurrent non-union and plate breakage at the same site. In this case report, we discuss the factors associated with treatment failure in patients with a Vancouver type C periprosthetic fracture following type 1 femoral stem im-plantation.

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Comparing Outcomes of Retrograde Intramedullary Nail and Locking Plate Fixation in Distal Femoral Fractures: Byung-Ho Yoon, Bo Kwon Hwang, Hyoung-Keun Oh, Suk Kyu Choo, Jong Min Sohn, Yerl-Bo Sung; J Korean Fract Soc 2021;34(4):131-136. Published online October 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.4.131

Abstract PDF: Purpose
We compared the radiological and clinical results of fixation for distal femoral fracture (DFF) using a locking compression plate (LCP) or a retrograde intramedullary nail (RIN).
Materials and Methods
From October 2003 to February 2020, 52 cases of DFF with a minimum 1-year follow-up (with a mean follow-up of 19.1 months) were included: 31 were treated with LCP and 21 with RIN. The operation time, blood loss, and hospitalization period were compared, and the incidence of postoperative nonunion, malunion, delayed union and metal failure and other post-operative complications were evaluated and compared.
Results
There was no significant difference in the operating time between the two groups, but the mean blood loss was significantly higher in the LCP group (LCP 683.5 ml vs RIN; 134.9 ml; p=0.015). In 49 out of 52 cases, bone union was achieved without additional surgery in an average of 6.8 months, and a complete union was achieved after additional surgery in three cases of nonunion (LCP 2 cases vs RIN 1 case; p=0.065). One case of malunion and superficial infection was confirmed in each group.
Conclusion
Internal fixation using LCP and RIN give good outcomes with a low complication rate and can therefore be considered useful surgical treatments for DFF.

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Helical Blade Locking Sleeve Disassembly Following Failed Femur Intertrochanter Fracture: Soon Ho Huh, Hong-Man Cho, Ji-Yeon Park; J Korean Fract Soc 2021;34(3):112-116. Published online July 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.3.112

Abstract PDF: A helical blade type of hip screw is used widely for the operative management of femoral trochanteric fractures. A 73-year-old female patient was admitted for femoral trochanteric fracture AO/OTA type 31A2.2. A helical blade locking sleeve dissembled 18 weeks after surgery did not achieve accurate reduction. The patient underwent bipolar hip hemiarthroplasty because the fracture reduction was lost, and it was impossible to remove the remaining helical blade without bone loss. The authors report this case of a rare complication of helical blade.

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Clinical and Radiologic Outcome of Intertrochanteric Fracture Treatment Using TFNA (Trochanteric Fixation Nail-Advanced): Hyeon Joon Lee, Hyun Bai Choi, Ba Rom Kim, Seung Hwan Jo, Sang Hong Lee; J Korean Fract Soc 2021;34(3):105-111. Published online July 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.3.105

Abstract PDF

Purpose
This study evaluated the clinical and radiological outcomes of TFNA (Trochanteric Fixation NailAdvanced; Depuy Synthes) for the treatment of proximal femur fractures.
Materials and Methods
This was a retrospective study of 64 patients diagnosed with a proximal femur fracture from January 2019 to November 2019. The patient’s demographic data, preoperatively and postoperatively Koval grade, modified Harris hip score, EQ-5D (Euro-Qol-5 Dimension), sliding and advancement of the blade, radiologic outcome, and complications were investigated.
Results
Fifty patients were available for evaluation at one year postoperatively. The patients reported the following: the Koval grade decreased after surgery; the modified Harris hip score decreased from 78.56±8.88 to 72.74±6.59 (p=0.149); the mean EQ-5D decreased from 0.75±0.09 to 0.72±0.06 (p=0.000). Satisfactory reduction was achieved on a postoperative radiographic examination in 47 patients in six months. Complications occurred in seven cases.
Conclusion
TFNA is considered an appropriate implant for treating intertrochanteric fractures of the femur with a minimum follow-up of one year.

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GS Hip Nail versus Affixus Hip Fracture Nail for the Intramedullary Nailing of Intertrochanteric Fractures
Seungcheol Kwon, Minjae Lee, Heeyeon Lee, Jihyo Hwang
Journal of Clinical Medicine.2023; 12(21): 6720. CrossRef
Comparison of the Clinical and Radiological Outcomes of TFNA (Trochanteric Fixation Nail-Advanced) and PFNA-II (Proximal Femoral Nail Antirotation-II) Treatment in Elderly Patients with Intertrochanteric Fractures
Min Sung Kwon, Young Bok Kim, Gyu Min Kong
Journal of the Korean Fracture Society.2022; 35(4): 162. CrossRef

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