Journal of Musculoskeletal Trauma

A Biomechanical Advantage of the Lengthening with an External Fixator Over an Intramedullary Nail: An Experimental Study in Saw Bones and Cadeveric Bones: Chang Wug Oh, Poong Taek Kim, Hae Ryong Song, Jong Keon Oh, Hyung Soo Ahn, Byung Chul Park, Byung Guk Min, Sung Ki Park, Young Heon Sohn; J Korean Fract Soc 2005;18(3):335-340. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.335

Abstract PDF: PURPOSE
To know biomechanical differences in methods of limb lengthening between using monolateral external fixator and using external fixator over an intramedullary nail.
MATERIALS AND METHODS
In acryl rods, saw-bone, and cadeveric bone, we created two lengthening models of using monolateral external fixator and using external fixator over an intramedullary nail. The axial compression test was done on the site of osteotomy for lengthening. To fix the models, half pins of 5 mm in diameter and nails of 9 mm in diameter were used. Using MTS (Material Test System) machine, we evaluated the differences of axial stiffness according to the presence of an intramedullary nail or the numbers of half-pins which were fixed at each side of osteotomy.
RESULTS
Lengthening over an intramedullary nail, comparing to monolateral external fixator only, increased the axial stiffness by 1.1~1.2 times in acryl rods, 1.2~1.6 times in saw bones, and 15.6~15.9 times in cadeveric bones when the same numbers of half-pins were used. In saw bone and cadaveric bone, the group of two half pins in lengthening over an intramedullary nail was stiffer than the group of three pins in lengthening with monolateral external fixator.
CONCLUSION
In the distraction of the limb, the addition of an intramedullary nail may increase the axial stiffness of the frame of monolateral external fixator. In lengthening over an intramedullary nail, it is enough to distract the bone with fixing two half pins at each sides of osteotomy.

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Effect of Growth Hormone on Osteoblast and New Bone Formation: Hae Ryong Song, Young Jin Kang, Ki Churl Chang, Seong Chang Yeon, Ja Min Koo, Hyeon Hui Kim; J Korean Soc Fract 2003;16(3):423-431. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.423

Abstract PDF: PURPOSE
To evaluate effect of growth hormone on osteoblast and new bone formation.
MATERIALS AND METHODS
Bone defect of the tibia with preserved periosteum was made and fixed with external fixator. Intramuscular injection of growth hormone for 8 weeks in experimental group and saline in control group was performed. New bone formation at the bone defect in radiograph and bone mineral density (BMD) by quantitative computed tomography were evaluated at 8 weeks after surgery. Rat osteosarcom cells were cultured in both group to evaluate cell viability of osteoblast, alkaline phosphatase activity, and mRNA expression of osteocalcin by RT-PCR.
RESULTS
Experimental group showed more callus formation and higher BMD at the bone defect site and the distal tibia compared to control group and there was significant difference. Proliferation of osteoblast, alkaline phosphatase activity, mRNA of osteocalcin at 5 days after culture were significantly higher in experimental group than those in control group.
CONCLUSIONS
Growth hormone has positive effect on osteoblast and callus formation in vivo and vitro studies.

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Screw breakage in tibial interlocking nailing: Hyung Bin Park, Bun Jung Kang, Hae Ryong Song, Kyong Hoi Koo, Soon Taek Jeong, Se Hyun Cho; J Korean Soc Fract 2002;15(4):483-488. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.483

PURPOSE
The aims of this study were to investigate the prevalence and the causes of screw breakage in tibia nailing.
MATERIALS AND METHODS
Between 1995 and 2000, eighty-two tibial diaphyseal fractures were treated with interlocking nails. The loss of follow-up was 7 cases. We retrospectively reviewed seventy-five cases. We investigated the rate and location of metal failure and evaluated the fracture pattern, the presence of distraction after nailing and union abnormality.
RESULTS
Screw breakage was identified in seven cases (9.3%) and most frequently occurred on the second proximal locking screw. Screw breakage occurred in AO type B or C type fractures, fracture site distraction after nailing, open fracture, delayed union and nonunion.
CONCLUSION
The main cause of screw breakage is unstable bone to bone contact on the fracture site caused by comminution or distraction. The open fracture, delayed union, and nonunion also contributing factors for screw breakage. For preventing screw breakage, it is necessary to avoid fracture site distraction and delay full weight bearing in cases having unstable fracture site contact.

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Clinical Outcomes of the Tibia Segmental Fractures Treated by Intramedullary Nail Using Various Reduction Techniques
Oog-Jin Shon, Ji-Hoon Shin, Chul-Wung Ha
Journal of the Korean Fracture Society.2013; 26(1): 50. CrossRef

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The Effect of Safflower Seed or Matairesinol on Spontaneous Bone Formation in Surgically Induced Bone Defect in Young Rabbit: Hae Ryong Song, Do Kyung Ra, Gon Sup Kim, Ki Churl Chang, Jae Min Hwang, Seong Chan Yeon, Hyung Bin Park, Sang Won Choi; J Korean Soc Fract 2002;15(2):97-105. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.97

Abstract PDF: PURPOSE
To investigate the effect of defatted safflower seed or matairesinol on spontaneous bone formation in surgically induced bone defects in young rabbits MATERIALS AND METHODS: Bone defects(20% of original femoral length) were created at the midshaft of the femur in 52 young rabbits and stabilized with external fixation. The periosteum was preserved. Fifty-two rabbits were divided into four groups as follows; the group I fed on safflower seed powders(30%) and normal diet(70%), the group II on matairesinol (5%) and normal diet(95%), the group III on normal diet(100%) with intravenous injection of matairesinol, the group IV on normal diet(100%). Radiographs were taken weekly to evaluate the bone regeneration and union time. Biomechanical testing on the new bone formation area was performed to measure bending stiffness. The area of new bone formation was scanned by quantitative computed tomography to measure bone mineral density(BMD).
RESULT
The mean union time(weeks) was 7.2 in the group I, 8.6 in the group II, 8.8 in the group III, and 8.5 in the group IV and was significantly different between the group I and the other groups(p<0.05). The BMD and bone strength of the callus were compared between the group I and the group IV. The mean BMD was 310.45 +/-49.58 g/mm2 in the group I and 291.16 +/-55.79 g/mm2 in the group and there was significant difference(p<0.05). The mean bending stiffness was 415.33 +/-137.18 N/mm in the group I and 358.75 +/-107.32 N/mm in the group IV and there was significant difference(p<0.05).
CONCLUSION
The diet with safflower seed powder was effective for decreasing union time and increasing bone strength of the callus formed at the bone defect whereas the diet or injection with matairesinol was not effective. More experimental studies are necessary to prove the effect of matairesinol on the callus.

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Triradiate Approach in Surgical Treatment of Complex Fracture of Acetabulum: Kang Il Kim, Kyung Hoi Koo, Bun Joong Kang, Hyung Bin Park, Sun Chul Hwang, Soon Taek Jeong, Hae Ryong Song, Se Hyun Cho; J Korean Soc Fract 2001;14(4):616-622. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.616

Abstract PDF: PURPOSE
To determine the advantages of triradiate approach in complex acetabular fractures, the results were reviewed for 24 patients who had open reduction and internal fixation of complex acetabular fractures with a triradiate approach.
MATERIALS AND METHODS
Twenty four patients were followed for a mean of 3 years after the operation. All patients with complex fractures of the acetabulum were treated with open reduction and internal fixation using Y-shaped triradiate incision, osteotomy of the greater trochanter, and arthrotomy of the hip joint. In 13 patients the fracture was fixed with reconstruction plates and in I 1 patients the fracture was fixed with the plates and wires.
RESULTS
All fractures united and no patient required subsequent total hip replacement arthroplasty. Four patients had heterotopic ossification without serious limitation of motion of the hip and one patient had grade IV lesion as defined by Brooker et al, which limited motion of the hip enough to impair function. Six patients showed posttraumatic arthritis at the latest radiograph. The overall clinical result was excellent for 7 hips, good for 13, and fair for 4 as defined by d' Aubigne and Postel. The radiological result was excellent for 13 hips, and good for 6 as defined by Matta. One femoral head necrosis was observed at the latest follow-up.
CONCLUSION
A triradiate approach provides a good extra and intraarticular access to complex fracture of the acetabulum, which facilitates an accurate reduction, rigid fixation, removal of loose osteochondral fragments and management of labial injury, without increased morbidity of the hip joint.

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Two Stage Treatment of Infected Nonunion of Femur with Antibiotics Impregnated Cement Beads and External Fixator: Hyung Bin Park, Yeon Chen Jung, Hae Ryong Song; J Korean Soc Fract 2000;13(4):817-824. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.817

Abstract PDF: PURPOSE
The purpose of this study was to find out the treatment efficiency of two stage osteosynthesis with antibiotic cement beads and external skeletal fixation for infected nonunion of femur.
MATERIALS AND METHODS
In the first stage, radical debridement was performed. The soft tissue and bony defects were filled with antibiotics impregnated cement beads and the nonunion site was stabilized with external skeletal fixation. In the second stage, the debrided nonunion site was repaired with bone grafting. The intervening time between the first and second stages of treatment was 4 to 6 weeks (average 5.4 weeks). The bone defects ranged from 0.5 to 14cm, Autogeneous iliac cancellous bone grafting was performed in 17 patients and microvascularized fibular graft was performed in 5 patients.
RESULTS
The follow-up period was average 45 months (range, 27-62 months). Infection control and bone union were achieved in all 22 cases. Postoperative infection after the second-staged bone grafting occurred in one patient. This recurred case was treated with repeated two staged operation. Even though aggressive physical theraphy was done, all patients had relevant knee flexion deficits. 14 patients were achieved more than 100 degrees of knee flexion, but 8 patients had less than 80 degrees of range of motion.
CONCLUSION
We have found that two-stage treatment with antibiotic beads local therapy, external skeletal fixation, and staged bone grafting is an acceptable treatment modality for the management of infected femoral nonunion. It results in rapid recovery from osteomyelitis and a predictable recovery from nonunion.

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Effect of Insertion of Bone Graft Substitutes on Consolidation of Distracted Callus: Changes of Radiography & Bone Mineral Density in the Tibia of Rabbits: Chang Wug Oh, Poong Taek Kim, Byung Chul Park, Hae Ryong Song, Il Hyung Park, Jun Ho Baek, Hyung Jin Park; J Korean Soc Fract 2000;13(4):687-695. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.687

Abstract PDF: PURPOSE
This study was designed to know the effect of calcium-sulfate and xenograft on the distracted callus after lengthening.
MATERIALS AND METHODS
We had operation of subperiosteal osteotomy and external fixation on the tibial diaphysis of young New Zealand White rabbits(2.0-2.5kg); after 5 days of latency period, 7 mm(1mm/day, 2 times/day) of tibial lengthening was reached in a week. At 1 week after lengthening, the 1st experimental group of 7 rabbits received a pellet of calcium sulfate(Osteoset , Wright medical, USA) in the distraction gap, and the 2nd experimental group of 7 rabbits received 5mm2 of xenogrfat(Lubboc ) in the distraction gap. But, the control group of 7 rabbits did not receive any of above materials. We compared three groups with the changes of radiographic findings at every week and bone mineral ratio(DEXA) at every two weeks.
RESULTS
The time to complete consolidation of distraction callus of both experimental group(calcium sulfate;14 weeks, xenograft; 15.4 weeks) was shorter than that of control group(16.9 weeks) in radiographic findings. Maximum value of bone mineral ratio of distraction callus was higher and the time to reach the highest value was also shortened in the both experimental group compared to control group.
CONCLUSION
By use of bone substitutes as like calcium sulfate or xenograft in the distraction callus with external fixator, it may be possible to shorten the consolidation period and the fixator-wearing period.

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fracture and Dislocation of the Elbow Treated with Compass Elbow Hinge: Hyung Bin Park, Hae Ryong song; J Korean Soc Fract 1998;11(3):709-717. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.709

Abstract PDF: Post-traumatic elbow stiffness is a common and disastrous complication after acute elbow injury. prolonged immobilization universally leads to stiffness. Stable fixation and controlled, gradual increase in range of motion is prferred for the treatment of comminuted intraarticular fracture and acute unstable dislocation of elbow. In comminuted intraarticular fracture of elbow, the Compass Elbow Hinge provides additional stability for fixation devices used to fix intraarticular fractures and simultaneously permits measured and controlled joint mobilization. In instability after reduction of elbow dislocation, the Compass Elbow Hinge helps to protect the soft tissue from undesirable stresses during healing. The purpose of this study is to evaluate the results of the Compass Elbow Hinge in maintaining and restoring mobility in the acutely injured elbow. The authors reviewed 11 consecutive patients who had the Compass Elbow Hinge applied for acute elbow instability. The average duration of application was 7 weeks. Follow-up averaged 18 months, adn motion averaged 96 degrees in flexion/extension plane. Comcentric stability was restored in all but one case, one case of resubluxation required reconstruction of medial collateral ligament, following which, the elbow was stable. According to the Mayo elbow performance index there were 8 excellent, 2 good and 1 fair result. The Compass Elbow Hinge helps to facilitate management of complex osseo-ligamentous injuries of the elbow. It decreases the incidence of sequelae such as stiffness and instability by permitting early mobilization through a kinematically normal range of motion without jeopardizing soft tissue healing.

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Ilizarov Method for Treatment of Large Bone Defect: Hae Ryong Song, Young June Park, Ji Yeon Kim; J Korean Soc Fract 1996;9(3):794-800. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.794

Abstract PDF: Twenty eight long bone defects were treated with internal bone transport using Ilizarov method. The causes of defect were open fracture (ten cases), infected non-union(nine cases), and osteomyelitis(nine cases). The mean bone defect was 8.5cm ranging from 2.5cm to 22cm in open fracture and 5.8cm ranging from 1.8cm to 17cm in an infected nonunion, and 7.2cm ranging from 3.4cm to 12cm in osteomyelitis. Internal bone transport was performed with transverse ring system. Free latissimus dorsi muscle flap was done in three cases and rotational muscle flap in seven cases. Single level lengthening was done in 26 cases and double level lengthening in two cases. Fibular transport was done in five cases. All cases obtained bone union. The radiologic consolidation index was 89 day/cm in tibia, 71d ay/cm in femer, and 42.5 day/cm in humerus. External fixation index was 96 day/cm in tibia, 86 day/cm in femur, and 48.5 day/cm in humerus. Complications were pin tract infection(25 cases), equinus contracture of ankle(7 cases), knee flexion contracture(4 cases), delayed union(11 cases), premature consolidation(2 cases) and refracture(1 case). Ilizarov method is a useful treatment for large bone defect inopen fracture and infected nonunion. To obtain better result, careful postoperative management and intensive physiotherapy are recommended.

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