Journal of Musculoskeletal Trauma

Olecranon Nonunion after Operative Treatment of Fracture: Ho Jung Kang, Ji Sup Kim, Myung Ho Shin, Il Hyun Koh, Yun Rak Choi; J Korean Fract Soc 2015;28(1):30-37. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.30

Abstract PDF: PURPOSE
Olecranon nonunion after surgical management is relatively rare, but it leads to limitation of motion of joint or instability. This retrospective study was conducted in order to analyze the cause and result of treatment.
MATERIALS AND METHODS
We analyzed 11 cases treated for nonunion of olecranon fractures. Nonunion was classified according to the spot of the lesion and the extent of articular surface damage. Evaluation was performed using Mayo elbow performance score (MEPS), Oxford elbow score (OES), Disabilities of the Arm, Shoulder and Hand (DASH) scores, and the range of motion.
RESULTS
According to the spot of the lesion and the extent of articular surface damage, nonunion was categorized as IA (2 cases), IIA (5 cases), and IIIA (4 cases). One case of IA underwent nonunion fragment excision and the remaining cases were treated by bone grafting. A plate was used in seven cases and the other three cases had both plate and tension band wiring fixation. All nonunions finally became union. The 11 patients with one year follow-up had average MEPS of 87.7 points (range: 60-100 points), average OES of 43.2, and average DASH score of 18.8 points. Complications included limitation of motion (2 cases) and ulnar nerve symptoms (3 cases).
CONCLUSION
Bone grafting and fixation by plate may be beneficial. In addition, excision can be useful in type I.

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Treatment of Non-union Distal Humerus Fractures after Operation: Hyung Sik Kim, Ki Joon Jang, Yun Rak Choi, Il Hyun Koh, Ho Jung Kang; J Korean Fract Soc 2012;25(4):310-316. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.310

PURPOSE
This study is a retrospective analysis of patients who had undergone surgical treatment for non-union of distal humerus fracture. We evaluated them in terms of causes of injury, radiologic findings, and clinical outcomes such as prognosis.
MATERIALS AND METHODS
Seven consecutive radiologic patients who were confirmed to have nonunion of a distal humerus fracture underwent reoperations. These patients had already undergone operations for distal humerus fractures. This survey was held from 2005 to 2010. The average period up to diagnosis of non-union after the first operation was 7.4 months (4 to 16 months). The mean follow-up period was 24.6 months (12 to 65 months). Each patient was graded functionally according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand Score.
RESULTS
Osteosynthesis was performed by internal fixation with plates and screws and then a bone graft for non-union of the distal humerus fracture. The average range of motion within the elbow joints was found to be a flexion contracture of 18.8 degrees (0~30 degrees) and further flexion of 120.2 degrees (102~140 degrees). Among postoperative complications, three cases of medium-degree stiffness, two cases of medial column nonunion, and one case of dissociation of the internal fixator were reported.
CONCLUSION
Stable internal fixation for maintenance reduction status is essential after accurate initial anatomical reduction. We concluded that nonunion could be prevented by additional surgical treatment such as autogenous bone graft, if it is necessary.

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Autogenous Inlay Bone Graft for Distal Humerus Nonunion with Metaphyseal Bone Defect: A Technical Note
Yong-Suk Lee, Dongmin Kim, Min-Sung Kang, Jong-Hwa Park, Sang-Uk Lee
Archives of Hand and Microsurgery.2020; 25(1): 39. CrossRef

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Surgical Treatment of Pathologic Humeral Fracture: Ho Jung Kang, Byoung Yoon Hwang, Jae Jeong Lee, Kyu Ho Shin, Soo Bong Hahn, Sung Jae Kim; J Korean Fract Soc 2010;23(2):187-193. Published online April 30, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.2.187

Abstract PDF

PURPOSE
To evaluate and analyze the radiographic and clinical outcomes after the surgical treatments of pathologic humeral fractures.
MATERIALS AND METHODS
From October 1993 to September 2007, a retrospective investigation was conducted with a total of 13 patients who underwent operations for pathologic humeral fractures. The methods of surgical treatment were as follows-four cases of open reduction and internal fixation; eight cases of closed reduction and internal fixation with intramedullary nailing; and one of radical excision and hemiarthroplasty.
RESULTS
Of nine patients with metastatic bone lesions, three were diagnosed with primary cancer after the incidence of pathologic humeral fracture. The mean period between the diagnosis of primary cancer and pathologic fracture in the latter six cases was 36.7 (2~144) months and the mean survival period after the surgical treatments was 22.8 (12~35) weeks in all patients with bone metastasis. Fracture unions were noted in all four cases of primary humeral bone lesion but none in metastatic cases. Pain relief and functional recovery were noted in eleven patients of this study.
CONCLUSION
Satisfactory clinical outcomes with sustained pain relief and functional recovery were observed after the surgical treatments of pathologic humeral fracture. Benign bone lesions require more active and early treatments in order to facilitate the functional recovery of upper extremities and fracture union. With pathologic humeral fractures originated from metastasis, palliative treatments were preferred to fracture union method for planning long-term pain relief and functional recovery.

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The application of a dual-lead locking screw could enhance the reduction and fixation stability of the proximal humerus fractures: a biomechanical evaluation
Eunju Lee, Hyeon Jang Jeong, Yeon Soo Lee, Joo Han Oh
Frontiers in Surgery.2024;[Epub] CrossRef
Therapeutic Approach to Humeral Pathologic Fracture Caused by Benign Bone Tumor
Jeung Il Kim, Um Ji Kim, Nam Hoon Moon, Hui Taek Kim, Tae Young Ahn, In Sook Lee, You Seon Song, Kyung Un Choi
Journal of the Korean Orthopaedic Association.2016; 51(6): 509. CrossRef

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Operative Treatment of Trapezium Fractures: Ho Jung Kang, Nam Heon Seol, Man Seung Heo, Soo Bong Hahn; J Korean Fract Soc 2009;22(4):276-282. Published online October 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.4.276

Abstract PDF: PURPOSE
Fractures of trapezium are uncommon carpal bone fractures and often unrecognized lesions. We investigated about operative treatment of trapezium fracture. MATERIALS AND METHODS: Seven patients with fractures of trapezium were evaluated after surgical treatment with a mean follow up time of 18 months (12 months~3 years). Functional assessment (pain, limitation in activities of daily living, satisfaction), physical examination (range of motion, grip strength), and radiographic evaluation were performed. Traumatic arthritis and carpometacarpal joint subluxation were confirmed by radiograph. RESULTS: During study period, 122 cases were carpal bone fractures, and seven of 122 cases were fractures of trapezium. All cases were intra-articular fractures of trapezium. 1st carpometacarpal joint dislocation at 4 patients, Bennett's fracture at 1 patient, hamate hook fracture at 1 patient, and base of 4th proximal phalanx fracture at 1 patient were associated with fracture of trapezium. Open reduction and internal fixation were performed at 6 cases and 1st carpometacarpal joint arthrodesis was performed at 1 case because of neglected fracture. One of 6 cases which were performed to open reduction and internal fixation was reoperated to external fixation due to reduction loss. Clinically 6 patients revealed good results. one of 7 patients experienced limitation of thumb opposition. CONCLUSION: Based on the good results obtained with surgical intervention, we advocated open reduction and internal fixation for fractures with intraarticular depressed more than 2 mm or combined with Bennett's fracture or carpometacarpal subluxation.

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T Plate Fixation for Unstable Fracture of Distal Clavicle: Ho Jung Kang, Kwan Kyu Park, Hong Kee Yoon, Hyung Keun Song, Soo Bong Hahn; J Korean Fract Soc 2006;19(3):329-334. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.329

Abstract

PURPOSE
To review clinical and radiological results after open reduction and internal fixation with T plate for unstable distal clavicle fractures.
MATERIALS AND METHODS
From July. 1999 to December 2002, nine patients with distal clavicle Neer type II fractures were treated by open reduction and internal fixation with T plate. The bony union was confirmed by plain radiography. The clinical results were analyzed according to the classification by Kona et al.
RESULTS
Average time to fracture union was 8 weeks in all cases. The functional results were as follows: excellent in 7 cases and good in 2 cases. Screw loosening occurred in one case, but bony union was achieved.
CONCLUSION
We recommend T plate fixation as another treatment method for unstable distal clavicle fractures.

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Usefulness of the Additional K-Wire Fixation and Suture for Reinforce the Treatment of Distal Clavicle Fracture Using Modified Tension Band Wiring
Seung-Bum Chae, Chang-Hyuk Choi, Dong-Young Kim
Journal of the Korean Fracture Society.2016; 29(2): 107. CrossRef
Treatment of Distal Clavicle Fracture Using Hook Plate
Su-Han Ahn, Hyeong-Jo Yoon, Kwang-Yeol Kim, Hyung-Chun Kim, In-Yeol Kim
Journal of the Korean Fracture Society.2011; 24(1): 48. CrossRef
The Surgical Outcomes of Clavicle Lateral End Fractures Fixed with the Oblique T Locking Compession Plate
Seung-Oh Nam, Young-Soo Byun, Dong-Ju Shin, Jung-Hoon Shin, Chung-Yeol Lee, Tae-Gyun Kim
Journal of the Korean Fracture Society.2011; 24(1): 41. CrossRef
Results of Hook Plate Fixation of Unstable Distal Clavicle Fractures
Hoon-Sang Sohn, Byung Chul Jo
Journal of the Korean Fracture Society.2011; 24(4): 335. CrossRef
Modified Spring Plate for Treatment of Unstable Distal Clavicle Fractures
Sang-Myung Lee, Il-Jung Park, Hyung-Min Kim, Jae-Chul Park, Sung-Gil Cho, Yoon-Chung Kim, Seung-Koo Rhee
Journal of the Korean Fracture Society.2010; 23(1): 64. CrossRef
Double Tension Band Wire Fixation for Unstable Fracture of the Distal Clavicle
Kyeong-Seop Song, Hyung-Gyu Kim, Byeong-Mun Park, Jong-Min Kim, Sung-Hoon Jung, Bong-Seok Yang
Journal of the Korean Fracture Society.2009; 22(1): 24. CrossRef

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Cannulated Screw Fixation for 4 Part Fractures of the Neck of Humerus: Ho Jung Kang, Doo Hyung Lee, Hong Kee Yoon, Soo Bong Hahn; J Korean Fract Soc 2005;18(4):432-436. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.432

Abstract PDF

PURPOSE
To analyze radiological and functional results after open reduction and internal fixation for fractures of the neck of humerus (4-part) using cannulated screws. MATERIAL AND METHODS: Between January 1997 and April 2004, 11 patients with neck of humerus fracture (4-part) were treated operatively by open reduction and internal fixation with cannulated screws. Two surgical approaches (deltopectoral for 9 cases and deltoid splitting for 2 cases) were used. The mean age was 36 years old and the mean duration of follow-up was 56 months. ASES (American Shoulder and Elbow Surgeons) score was checked to evaluate the function in shoulder joint. We used 2 cannulated screws in 2 cases, 3~4 screws in 6 cases and over 5 screws in 3 cases for fixation. In 2 cases, K-wires were used additionally and autoiliac bone graft was done in 1 cases which had poor bone mass.
RESULTS
All cases got bony union at 5.6 months on average. In functional assessment of shoulder, eight patients got excellent, one got good points. There were complications including shoulder stiffness in 2 cases, avascular necrosis of humeral head in 1 case and subacromial impingement syndrome in 1 case.
CONCLUSION
Internal fixation using cannulated screws for fractures of humerus neck (4 part) showed good bony union and functional results in patients under 50 years old who had average bone quality.

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The Surgical Outcomes for Isolated Greater Tuberosity Fracture of Proximal Humerus
Eun-Sun Moon, Myung-Sun Kim, Young-Jin Kim
Journal of the Korean Fracture Society.2007; 20(3): 239. CrossRef

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Intramedullary Nailing for the Fracture of Proximal Humerus: Ho Jung Kang, Dae Young Lee, Seung Yong Sung, Soo Bong Hahn; J Korean Fract Soc 2004;17(3):271-276. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.271

Abstract PDF

PURPOSE
To evaluate the clinical and radiological result of the treatment for the fracture of proximal humerus using intramedullary nail.
MATERIALS AND METHODS
Nine cases with fractures around the shoulder joint treated with Polarus IM nail from February 1999 to June 2002 was selected. There were 1 case with segmental fracture, 2 cases with nonunion after conservative treatment, 3 cases with nonunion after IM nail, 1 case with nonunion after pinning, 1 case with metal failure after plate fixation, and 1 case with fracture combined with shoulder dislocation. Bone union was evaluated with simple radiographic findings, and functional evaluation was done using Kona evaluation method.
RESULTS
The average follow up period after the operation was 16 months and the average duration of immobilization was 2 weeks. All cases showed radiographic union and the average duration until union was 3.1 months. On the functional evaluation using Kona evaluation method, 3 cases excellent, 3 cases good, 2 cases fair, and 1 case showed poor result. The cases with poor result had combined elbow, forearm, and hand fractures at the initial injury. The complication of periprosthetic fracture caused by repeated trauma was reported in 1 case.
CONCLUSION
Polarus IM nailing can result in good clinical and functional results for the treatment of nonunion, plate failure, segmental fracture and fracture of proximal humerus with shoulder dislocation.

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Intramedullary Nailing for Complex Fractures of the Proximal and Midshaft of the Humerus
Chul-Hyun Cho, Gu-Hee Jung, Kyo-Wook Kim
Journal of the Korean Fracture Society.2011; 24(3): 237. CrossRef
Periprosthetic Fracture after Proximal Humeral Intramedullary Nail, Treated by Functional Bracing - A Case Report -
Jae-Hyuk Shin, Ho-Guen Chang, Young-Woo Kim, Nam-Kyou Rhee, Yong-Bok Park, Yong-Kuk Kim
Journal of the Korean Fracture Society.2011; 24(2): 185. CrossRef

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

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

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Differential diagnosis and its treatment of gas forming infections: Soo Bong Hahn, Ho Jung Kang, Jin Park; J Korean Soc Fract 2002;15(4):607-613. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.607

Abstract PDF

PURPOSE
To establish the guidelines for the differential diagnosis and proper initial treatment of the gas forming infections through the review of literature and our clinical experiences.
MATERIALS AND METHODS
The radiological findings, clinical course, gram stain, bacterial culture, predisposing factors and treatment of four cases of gas forming infections from January 1994 to August 2001, were retrospectively analyzed.
RESULTS
Three cases diagnosed presumptively as gas gangrene were improved through amputation or disarticulation and intravenous antibiotics. One case diagnosed presumptively as non-clostridial infection was expired due to sepsis in spite of incision, drainage and intravenous antibiotics. In the bacterial culture, two cases were non-clostridial infection, one case was not able to diagnose and one case was clostridial myonecrosis(gas gangrene) CONCLUSION: The gas forming infections are rare but life-threatening. When the proper initial treatment is delayed, the fatal complications may result. So, the presumptive diagnosis through gram stain, clinical course, radiological findings should be made as soon as possible, and according to which, the appropriate initial treatment, such as, surgical debridement, amputation, intravenous antibiotics must be started. The following treatments should be corrected by definitive diagnosis through the bacterial culture.

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Salmonella gas-forming pyomyositis in an immunocompetent patient: a case report and review
Jee Young Lee, Gyu Min Kong
Journal of International Medical Research.2025;[Epub] CrossRef
Type I, II Acute Necrotizing Fasciitis of the Low Extremity
Sang-Jun Song, In Seok Lee, Ju Hwan Chung
The Journal of the Korean Orthopaedic Association.2007; 42(5): 636. CrossRef

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

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

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

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

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

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

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

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

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

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

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

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

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Humeral Fractures Associated by Forearm Fractures: Ho Jung Kang, Kae Yong Han, Kyu Jyun Yang, Jin Oh Park; J Korean Soc Fract 1998;11(2):405-412. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.405

Abstract PDF: We reviewed fractured patients in Yongdong Severance Hospital for 10 years(1987-96), and collected 42 fractured patients who had concomittent ipsilateral humeral fractures and forearm fractures. The causes of injury were falling down in 21, slipping down in 2, motor vehicle accident in 15, machinery injuries in 2, crushing injury in 1 and ski injury in 1. among them 13 patients were under 15 years old. Nine cases of supracondylar fractures, three cases of lateral condylar fractures and one case of proximal humeral fractures were included. Patterns of combined forearm fractures were diverse. Twenty-three cases were occurred in the age between 16 and 59 years. Fracture patterns were very complicated in both humerus and forearm in this age. Most common humeral fracture was midshaft fracture and forearm was both forearm bone fracture. The fractures were resulted from relatively more severe traumatic event in this age than other ages. Number of patients over 60 years was six. four of them had proximal humeral fractures, one of them distal humeral fracture and one of them humeral medial comdylar fracture. Forearm fracture patterns were various but the olecranon fracture was the most common forearm fracture(4/6) in the aged. We treated fractures by many combinations of operative and conservative means. Generally K-wires were applied to the children when internal fixation was indicated. The shaft of long bones were fixated usually by dynamic compression plate and comminuted articular fractures by Egyre plate or K-wires. The average follow up period was 15 months(5-35 months). 17 complications were resulted. There were 4 nonunions, 3 elbow ankylosises, 1 Volkmann's ischemic contracture, 7 nerve paralysises(4 ulna nerve, 3 radial nerve) and 2 infections.

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

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

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Fractures at the Base of the Fifth Metacarpal: Ho Jung Kang, Han Sik Kim, Dong Eun Shin, Eung Shik Kang; J Korean Soc Fract 1997;10(3):645-650. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.645

Abstract PDF: The treatment of 16 intraarticular fractures at the base of the fifth metacarpal was studied. Intraarticular fractures at the base of the fifth metacarpal resembled Bennetts and Rolandos fractures in their pattern and in their tendency to instability. The problem was usually not the reduction, but rather maintaining the reduction. A force hitting the head of the fifth metacarpal along the longitudinal axis of the metacarpal was the most common cause of injury, Five fractures were immobilized in a plaster cast after closed reduction. Six fractures were treated by closed reduction and percutaneous pinning, 4 by open reduction and pinning. 1 by open reduction and plating. At follow up after median 14.8 months, the result of 11 cases was satisfactory. Two cases nonoperated showed decreased grip power, limited motion, radiographical signs of osteoarthritis, and pain. Three cases operated showed decreased grip power. We concluded that restoration of articular surface and internal fixation againt the muscular pull was mandatory for a satisfactory outcome.

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A Clinical Study of Ankle Diastasis with Fracture of flbula: Koon Soon Kang, Jun Seop Jahng, Hui Wan Park, Ho Jung Kang, Young Chul Cho; J Korean Soc Fract 1994;7(2):388-396. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.388

Abstract PDF: Ankle joint is important as a weight-bearing joint and ankle diastasis requires accurate diagnosis and treatment. The authors analysed 82 cases of ankle diastasis with fibular fracture during the year 1986 through 1992 at YoungDong Severance Hospital. The results obtained are as follows. 1. The most common cause of injury was slip down, and traffic accident and fall down in order. 2. By Weber classification, 42 cases were type BS(+) and 40 cases were type C. By Lauge-Hansen classification, supination-external rotation was most common (35 cases). 3. Open reduction was done in all cases for fracture of fibula. 45 cases of ankle diastasis were treated with one transfixation screw and 37 cases without transfixation after confirmation by Cotton test. 4. The result according to Cottons criteria, 39 cases(86.7%) were were good or fair in transfixation group, and 34 cases(91.9%) in nontransfixation group. In conclusion, the transfixation screw was not necessary in cases of ankle diastasis which was considered as stable by Cotton test after internal fixation for the fracture of fibula.

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Surgical Treatment of Calcaneal Fractures: Koon Soon Kang, Jun Seop Jahng, Bui Wan Park, Ho Jung Kang, Dong Eun Shin; J Korean Soc Fract 1994;7(2):379-387. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.379

Abstract PDF: The Os Calcis is the largest bone of the tarsal bones. The incidence of fracture of the calcaneus is more frequent than that of any other tarsal bones. Farctures involving subtalar joint can usually cause serious and persistent disabilities and badly influence the patients psychologically, socially and economically. But, there was no standardized treatment method for these fractures. The purpose of this article is to describe the surgical technique and the results obtained in 33 consecutive cases of calcaneal fractures involving the subtalar joint. The results were as follows, 1. Of 33 patients, 24 patients were male and 9 patients were female. 2. The main cause of fracture of calcaneus was a fall from a height in 79% of cases. Most of the associated fractures were the spinal and tibial fractures. 3. Of these intra-articular fractures, 19 fractures were joint depression type and 14 cases were tongue type by Essex-Lopresti classification. 4. Open reduction and internal fixation was performed in 18 cases of joint depression type and 6 cases of tongue type, and closed reduction and axial pinning was performed in 8 cases of tongue type and 1 case of joint depression type. 5. After average twenty-two months follow-up, the over all results of open reduction and internal fixation were excellent and good in 71%, and that of closed reduction and axial pinning were excellent and good in 67% by Salama creteria. 6. Complications included four superficial wound infection and one subluxation of peroneal tendon.

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Distal Radius Fracture treated with Distraction Plate Technique: Ho Jung Kang, Dae Yong Han, Tae Yong Koo; J Korean Soc Fract 1994;7(2):308-315. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.308

Abstract PDF: The comminuted intraarticular fracture of the distal radius requires early, accurate reduction of the articular surfaces and sustained restoration of anatomic position. The most commonly employed methods are pins and plaster, external fixation, percutaneous pinning and open reduction and internal fixation. There are pitfalls, advantages and disadvantages inherent in each method. Open reduction and internal fixation has been condemned for some time without any controlled series documention its ineffectiveness. Anatomic open reduction and internal fixation with early mobilization, however, are recommanded for nearly every other intraarticular fracture. Two cases of displaced intraarticular fracture of distal radius was managed with distraction plating technique. We will present these cases in detail.

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Ipsilateral Fracture of the Femoral Neck and Shaft: Ho Jung Kang, Dae Yong Han, Dong Eun Shin; J Korean Soc Fract 1994;7(2):246-255. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.246

Abstract PDF: Ipsilateral fractures of the femoral neck and shaft are relatively uncommon infuries and usually the result of high-energy trauma in young adults. Frequently, the severe trauma responsible for this injury combination is also productive of associated injuries indeed life threatening. Several unique features of this injury have been recognized, including the high incidence of associated knee injuries, particulary fractures of the patella. This is thought to be due to a mechanism of injury in which the femur is longitudinally loaded at the flexed knee while positioned in neutral abduction. Also, this combination of injuries pose a difficult problem in management. The authors reviewed 14 cases of ipsilateral fracture of the femoral neck and shaft for the evaluation of the associated injury and method of ueatment from October 1986 to Febraury 1991 and the average follow-up period was 1.8 years. The results were as follows. 1. The site of the femoral neck and shaft fracture were mainly, basicervical and midshaft. 2. In two cases, the femoral neck fracture was not diagnosed initially. 3. Most of the associated fractures were patella and tibial fractures and PCL ruptures. 4. Complications Included three stiffness of the knee, two delayed union of the femoral shaft, one superficial wound infection and one delayed union with coxa vara deformity of the femoral neck.

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Avulsion Fractures of the Tibial Tuberosity: Three Cases Reports: Ho Jung Kang, Koon Soon Kang, Jun Seop Jahng, Young June Park; J Korean Soc Fract 1992;5(2):372-377. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.372

Abstract PDF: The talus is a important bone because it supports and distributes the body forces above it. Avulslon Fractures of the tibial tubercle prior to epiphyseal closure are uncommon. Fractures that are seen most frequently in adolescents. Watson-Jones classified these injuries into three types. The authors treated three cases of the tuberosity fractures. Two adolescent boys were treated with open reduction and screw fixation and K-wire fixation. One adult man was treated with open reduction and circumferential wire fixation. The Osgood-schlatter disease was diagnosed in two patients. There were small flecks of calcification 3 to 4cm proximal to the tubercle in the two adolescent cases. Functional motion was started within six weaks after operation. No early complications occurred, and no later defermities. such as genu recurvatum as reported by Blount, were detected. All patients returned to normal activity in one year after an operation.

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

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

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