Journal of Musculoskeletal Trauma

Results of Exchange Nailing in Hypertrophic Nonunion of Femoral Shaft Fracture Treated with Nailing: Suenghwan Jo, Gwang Chul Lee, Sang Hong Lee, Jun Young Lee, Dong Hwi Kim, Sung Hae Park, Young Min Cho; J Korean Fract Soc 2019;32(2):83-88. Published online April 30, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.2.83

Abstract PDF: PURPOSE
This study examined the outcomes of exchange nailing for the hypertrophic nonunion of femoral shaft fractures treated with intramedullary nailing as well as the factors affecting the treatment outcomes.
MATERIALS AND METHODS
From January 1999 to March 2015, 35 patients, who had undergone intramedullary nailing with a femoral shaft fracture and underwent exchange nailing due to hypertrophic nonunion, were reviewed. This study investigated the time of union and complications, such as nonunion after exchange nailing, and analyzed the factors affecting the results.
RESULTS
Bone union was achieved in 31 cases (88.6%) after exchange nailing and the average bone union period was 22 weeks (14â€“44 weeks). Complications included persistent nonunion in four cases, delayed union in one case, and superficial wound infection in one case. All four cases with nonunion were related to smoking, three of them were distal shaft fractures, and one was a midshaft fracture with underlying disease.
CONCLUSION
Exchange nailing produced satisfactory results as the treatment of hypertrophic nonunion after intramedullary nailing. Smoking is considered a factor for continuing nonunion even after exchange nailing. In the case of a distal shaft, where the intramedullary fixation is relatively weak, additional efforts are needed for stability.

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Treatment for Concurrent Ipsilateral Femoral Neck and Shaft Fractures Using Reconstruction Nail with Temporary K-Wires: Sang Joon Lee, Sang Hong Lee, Sang Ho Ha, Gwang Chul Lee; J Korean Fract Soc 2015;28(1):23-29. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.23

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the results of operative treatment using a reconstruction nail after temporary K-wire fixation of the femoral neck for ipsilateral femoral neck and shaft fractures.
MATERIALS AND METHODS
A total of 11 cases were treated, which were followed-up for more than two years, between August 2007 and July 2012. The average age was 51 years (29-69 years) and men were dominant counting eight cases. All cases were operated with a reconstruction nail after temporary K-wire fixation of the femoral neck. Bone union periods, alignment, etc. were evaluated by radiological methods and accompanying damage and complications were also investigated. Functional evaluation was performed in accordance with Friedman and Wyman criteria at the last follow-up.
RESULTS
The average time for union of the femoral shaft was 22.5 weeks (12-32 weeks), and femoral neck was 13.1 weeks (8-20 weeks). There was no nonunion, and four femoral shaft fractures resulted in delayed union. There was one case of leg length discrepancy more than 2 cm long, but malalignment of more than 10 degrees was not observed. Avascular necrosis of the femoral head did not occur. Functional results were good in eight cases, fair in two cases, and poor in one case.
CONCLUSION
Treatment with reconstruction nailing after temporary K-wire fixation of the femoral neck is thought to be a good method which prevents neck displacement and has low complication rates.

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Results of Intramedullary Nailing of Femoral Shaft Fracture: Trochanteric Entry Portal (Sirus Nail) versus Piriformis Entry Portal (M/DN Nail): Sang Ho Ha, Woong Hee Kim, Gwang Chul Lee; J Korean Fract Soc 2014;27(1):50-57. Published online January 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.1.50

PURPOSE
To compare treatment results obtained using the trochanteric (Sirus nail) entry portal with those obtained using the Piriformis fossa (M/DN) entry portal during intramedullary (IM) nailing of femur shaft fractures.
MATERIALS AND METHODS
Four hundreds and thirty-two patients treated for femur shaft fracture using IM nails from February, 2001 to May, 2010 were divided into two groups. group 1 was composed of 180 patients treated through the trochanteric (Sirus nail; n=180) entry portal, while group 2 contained 170 patients treated through the piriformis fossa (M/DN nail; n=170) entry portal. We compared the clinical and radiographic findings of both groups to evaluate the treatment results.
RESULTS
Functional result, range of motion and union time (18, 20 weeks) were similar in both groups. The operation time of patients in the over-weighted group was 90 minutes in group 1 and 120 minutes in group 2 (p<0.05). Additionally, the blood loss was 280 ml in group 1 and 335 ml in group 2, and in case of over-weight patients, group 2 showed more blood loss (p<0.05). The duration of exposure to fluoroscopy differed slightly, with group 1 being less exposed than group 2; however, this difference was not significant (p>0.05). There were 18 iatrogenic fractures in group 1 and 4 in group 2 (p<0.05).
CONCLUSION
There was not much difference in complications based on clinical and radiographic findings of both groups. For groups using the trochanteric entry portal, the operation time was shorter and blood loss was lower than in groups using the piriformis entry portal. Iatrogenic fracture occurred more often in the group using the trochanteric entry portal than in the group using the piriformis entry portal.

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Analysis of different entry portals for femoral nail with two different nail designs-straight nail versus lateral angulated nail - Does it make a difference?
Sanjay Yadav, Saurabh Singh, Anil Kumar Rai
Journal of Clinical Orthopaedics and Trauma.2019; 10(5): 912. CrossRef
Comparing Entry Points for Antegrade Nailing of Femoral Shaft Fractures
Ujash Sheth, Chetan Gohal, Jaskarndip Chahal, Aaron Nauth, Tim Dwyer
Orthopedics.2016;[Epub] CrossRef
The Curative Effect Comparison Between Prolonged Third Generation of Gamma Nail and Prolonged Dynamic Hip Screw Internal Fixation in Treating Femoral Intertrochanteric Fracture and the Effect on Infection
Wenye He, Wei Zhang
Cell Biochemistry and Biophysics.2015; 71(2): 695. CrossRef
Treatment of Femur Subtrochanteric Fracture Using the Intramedullary Long Nail; Comparison of Closed Reduction and Minimal Open Reduction
Sang Joon Lee, Sang Hong Lee, Sang Soo Park, Hyung Seok Park
Journal of the Korean Orthopaedic Association.2015; 50(1): 18. CrossRef
Failure to Remove a Trochanteric Entry Femoral Nail and Its Cause in Adolescent Patients: Two Cases Report
Ji-Hwan Kim, Seung-Oh Nam, Young-Soo Byun, Han-Sang Kim
Journal of the Korean Fracture Society.2015; 28(1): 71. CrossRef
Treatment of the Femoral Fracture Using Sirus® Nail: A Comparison of Complication according to the Entry Potal
Young-Yool Chung, Dong-Hyuk Choi, Dae-Hyun Yoon, Jung-Ho Lee, Ji-Hun Park
Journal of the Korean Fracture Society.2015; 28(2): 103. CrossRef
Comparison of Greater Trochanter Versus Piriformis Entry Nail for Treatment of Femur Shaft Fracture
Jong-Hee Lee, Jong-Hoon Park, Si-Yeong Park, Seong-Cheol Park, Seung-Beom Han
Journal of the Korean Fracture Society.2014; 27(4): 287. CrossRef

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The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation: Chi Hyoung Pak, Sang Hong Lee, Sang Ho Ha, Gwang Chul Lee, Kyoung Chul Song; J Korean Fract Soc 2013;26(4):284-291. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.284

Abstract PDF

PURPOSE
The purpose of this study was to analyze the results of treating subtrochanteric femoral fractures with proximal femoral nail antirotation (PFNA).
MATERIALS AND METHODS
Twenty five consecutive patients diagnosed with subtrochanteric femoral fractures underwent intramedullary fixation using PFNA and followed-up for over 12 months. According to the Seinsheimer's classification, there were 2 type IIA, 9 type IIB, 2 type IIIA, 3 type IV and 9 type V. According to the AO classification, there were 10 type A, 9 type B and 6 type C. There were 16 cases of closed reduction group and 9 cases of limited open reduction group. Retrospectively, radiological outcomes were assessed at the union period, change of neck shaft angle, tip-apex distance, Cleveland index, sliding of lag screw and complication.
RESULTS
Union was achieved in 23 of 25 cases, over an average of 17 weeks. Limb length shortening below 2 cm occurred in 7 patients. The Cleveland index was shown in 80% of 5, 6, 8 and 9 zone; the tip apex distance was 19.6 mm; the mean sliding distance was 4.4 mm; and the mean change of femur neck and shaft angle was varus 3 degree at the final follow-up. Complications included 3 cases of delayed union and 2 cases of nonunion.
CONCLUSION
With its early bony union, ambulation, rehabilitation and low complication, PFNA is a useful and reliable choice for the treatment of subtrochanteric fractures of the femur. Limited open reduction and additional fixation such as cable grip are recommended if it is difficult to obtain anatomical reduction by closed reduction.

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Subtrochanteric Fracture Reduction during Intramedullary Nailing: Technical Note
Gyu Min Kong
Journal of the Korean Fracture Society.2019; 32(2): 107. CrossRef

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Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture: Sung Won Cho, Sang Ho Ha, Gwang Chul Lee, Woong Hee Kim; J Korean Fract Soc 2013;26(3):205-211. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.205

Abstract PDF

PURPOSE
To analyze the clinical and radiologic results of minimally invasive plate osteosynthesis (MIPO) for distal femur fractures using a locking compression plate (LCP) and to evaluate its usefulness.
MATERIALS AND METHODS
From May 2006 to April 2011, 23 patients (24 cases) with distal femur fracture were treated by MIPO with a LCP and followed-up for at least 12 months. Mean age was 61.6 years (35-80 years). Union time and post-operative alignment were measured on radiograph, and clinical function was evaluated by range of motion (ROM), Knee Society Score and complications.
RESULTS
In 22 patients (23 cases) except for 1 case, bony union was obtained after an average of 18 weeks (12-26 weeks). The mean ROM was 124 degrees (80-135 degrees). According to the Knee Society Score, there were 12 excellent, 8 good, 1 fair and 2 poor results and the mean score was 87.5 (60-98). Postoperative complications were nonunion in 1 case, ankylosis in 1 case, malunion in 2 cases and superficial wound infection in 2 cases.
CONCLUSION
The treatment of distal femoral fracture with MIPO using a LCP was considered a useful method which can result in satisfactory clinical and radiologic outcomes if there is accurate understanding about the surgical techniques and appropriate procedures involved.

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Surgical Treatment of AO/OTA 33-C Intra-Articular Distal Femoral Fractures through Parapatellar Approach
Suk Kyu Choo, Sung Tan Cho, Hyoung Keun Oh
Journal of the Korean Fracture Society.2022; 35(1): 1. CrossRef
Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef

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Arthroscopic Assisted Intra-Articular Reduction and Internal Fixation of Tibia Plateau Fracture: Dong Hwi Kim, Gwang Chul Lee, Kwi Youn Choi, Sung Won Cho, Sang Ho Ha; J Korean Fract Soc 2013;26(3):191-198. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.191

Abstract PDF

PURPOSE
We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts.
MATERIALS AND METHODS
From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system.
RESULTS
The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases.
CONCLUSION
We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.

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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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The Results of Two Stage Surgical Treatment of Pilon Fractures: Hong Moon Sohn, Jun Young Lee, Sang Ho Ha, Sang Hong Lee, Gwang Chul Lee, Kwang Hyo Seo; J Korean Fract Soc 2012;25(3):177-184. Published online July 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.3.177

Abstract PDF

PURPOSE
To report the good results of two-stage treatment in pilon fractures.
MATERIALS AND METHODS
A retrospective study of 23 patients among 30 patients with pilon fractures from March 2006 to November 2008, who underwent two-stage treatment of pilon fractures with a minimum of 24 months follow-up. The mean follow-up period was 28 months (24~41 months). In the first stage of the operation, open reduction of the articular surface and external fixation were performed after minimal incision. As the soft tissue healed, locking compression plate fixation was performed with the Minimally invasive plate osteosynthesis. Radiographic evaluation was graded by the criteria of Burwell and Charnley, and functional assessment of the ankle was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.
RESULTS
The fractures were united within 16 weeks (12~30 weeks). The radiologic results showed anatomical reduction in 18 cases and a mean AOFAS score of 81. The mean range of ankle motion was 44 degrees. There were four complications: 1 case of wound infection and 3 cases of ankle osteoarthritis.
CONCLUSION
Two-stage treatment of pilon fractures is a good treatment method because it is designed to obtain early anatomical reduction, definitive stable fixation, low rates of soft tissue complication, and good range of ankle motion.

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Current Concepts in Management of Pilon Fracture
Jun-Young Lee, Sang-Joon Lee
Journal of the Korean Fracture Society.2014; 27(2): 173. CrossRef

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Comparative Analysis of Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Intramedullary Nailing in Distal Tibial Metaphyseal Fractures: Gwang Chul Lee, Jun Young Lee, Sang Ho Ha, Hong Moon Sohn, Yi Kyu Park; J Korean Fract Soc 2012;25(1):20-25. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.20

Abstract PDF

PURPOSE
To compare results between minimally invasive plate osteosynthesis using a periarticular plate and intramedullary nailing in distal tibial metaphyseal fractures in two treatment groups.
MATERIALS AND METHODS
Sixty-one cases of distal tibial metaphyseal fractures from December 2008 to December 2009 were evaluated. The minimal follow-up period was 12 months. Thirty patients treated by minimally invasive plate osteosynthesis using a periarticular plate were Group A; 31 patients treated by intramedullary nailing were Group B. We compared and analyzed the results of each group by radiological and clinical assessments.
RESULTS
The mean bony union time was 16.4 weeks in Group A and 17.2 weeks in Group B. The mean operation time was 45 minutes in Group A and 48 minutes in Group B. The mean radiation exposure times were 4.2 minutes and 4.8 minutes, respectively. VAS scores were 0.7 points and 0.5 points in each respective group. In Group A, the VAS score was 1.7 points when we applied pressure on the skin around the plate. The mean Olerud and Molander Ankle Score was 87.4 points and 86.3 points, respectively. A superficial wound infection occurred in 1 case in each group, and angular deformities more than 5 degrees occurred in 2 Group B cases.
CONCLUSION
No significant differences in results were observed between the two groups. However, a higher incidence of angular deformity was seen in the intramedullary nailing group. Therefore, we must be careful during surgery.

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Comparative Analysis of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Distal Tibia Fractures
Ho-Min Lee, Young-Sung Kim, Jong-Pil Kim, Phil-Hyun Chung, Suk Kang, Kaung Suk Jo
Journal of the Korean Fracture Society.2018; 31(3): 94. CrossRef
A Comparison of the Results between Intramedullary Nailing and Minimally Invasive Plate Osteosynthesis in Distal Tibia Fractures
Chul-Hyun Park, Chi-Bum Choi, Bum-Jin Shim, Dong-Chul Lee, Oog-Jin Shon
Journal of the Korean Orthopaedic Association.2014; 49(4): 285. CrossRef

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Treatment of the Trimalleolar Fracture Using Posterolateral Approach: Minimum 2-year Follow Up Results: Gwang Chul Lee, Jun Young Lee, Sang Ho Ha, Jae Won You, Sang Hong Lee, Hong Moon Sohn, Ki Young Nam, Kwang Hyo Seo; J Korean Fract Soc 2011;24(4):328-334. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.328

Abstract PDF

PURPOSE
To analyze the long term follow up results of treatment with posterolateral approach and to investigate its usefulness in the patients of trimalleolar fracture with posterior fragment which is above 25% of articular involvement.
MATERIALS AND METHODS
There were 34 cases of trimalleolar fracture in our hospital from May 2004 to April 2008. We investigated 20 patients who underwent operation with the posterolateral approach and over-2 years follow up cases. The mean follow up period was 34 (24~58) months. Preoperative posterior malleolar fragment involved above 25% of articular surface in all cases and displaced more than 2 mm in 11 cases. We analyzed the radiologic type of posterior malleolar fragments and evaluated the function and pain through AOFAS score and complications.
RESULTS
All cases showed primary union at mean 13.1 weeks. The complications are that partial ankylosis result of soft tissue contracture is seen in 2 cases (10%) and post-traumatic arthritis is seen in 1 cases (5%) and 17 cases (85%) of all patients are showed excellent AOFAS score.
CONCLUSION
The posterolateral approach is a valuable method because that it enables us to easily reduction and internal fixation of the posterior malleolus and lateral malleolus at one time and the results are satisfied for a long time follow up.

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Outcomes of Immediate Operative Treatment of Ankle Trimalleolar Open Fractures
Jun-Young Lee, Yong-Jin Cho, Sin-Wook Kang, Yung-Min Cho, Hyun-Bai Choi
Journal of Korean Foot and Ankle Society.2020; 24(1): 25. CrossRef

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