Journal of Musculoskeletal Trauma

The Efficacy of MRI in Tibial Plateau Fractures: Hyoun Oh Cho, Kyoung Duck Kwak, Dae Hwan Lim, Sang Min Ahn, Kyung Ku Kang; J Korean Fract Soc 2004;17(2):122-132. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.122

PURPOSE
To analysis the efficacy of MRI in assessing fracture configuration and frequency of associated soft tissue injuries in tibial plateau fractures.
MATERIALS AND METHODS
In the plain films and MRI of 47 cases with tibial plateau fractures,every fracture was classified by findings on plain film and MRI respectively according to the Schatzker system and they were compared with each other. The degree of displacement and depression of the fracture fragments were measured on plain film and MRI.
RESULTS
MRI was more accurate in determining the classification of the fracture and measuring the displacement and depression of fragments. Fracture classifications were changed in 12 cases. Especially in Schatzker VI cases, articular step off over 2 mm and articular fragments over 2X2 cm were revealed in detail by MRI. Evidence of internal derangement of the knee was found in 38 (80.8%) cases.
CONCLUSION
Most of the cases with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatment plan.

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Evaluation of the Patterns of Fractures and the Soft Tissue Injury Using MRI in Tibial Plateau Fractures
Ji-Yong Chun, Hee-Gon Park, Sung-Su Hwang
Journal of the Korean Fracture Society.2007; 20(4): 302. CrossRef

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Treatment of Severe Open Fractures of Tibial Shaft: Comparison Between Ilizarov External Fixation and Secondary Intramedullary Nailing: Hyoun Oh Cho, Kyoung Duck Kwak, Hong Joo Lee, Dae Hwan Lim, Sang Min Ahn, Jae Ho Chang, Kyung Ku Kang; J Korean Soc Fract 2002;15(2):234-242. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.234

Abstract PDF: PURPOSE
We tried to compare the results of Ilizarov external fixation cases with the cases of secondary intramedullary nailing after tempory Ilizarov fixation.
MATERIALS AND METHODS
From the January 1996 to February 2001 , 34 cases of severe open tibial shaft fracture in adults were treated with Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. According to Gustilo- Anderson classification, it consisted of type II 2 ,IIIA 7 ,IIIB 9 ,IIIC 2cases in Ilizarov group ,and type II 2, IIIA 7, IIIB 5cases in secondary intramedullary nailing group.
RESULT
There was no significant difference in the union time of Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. But the secondary nailed group had slightly better motion , less final angulation and felt more comfortable . It is the treatment preferred by patients and does not require the same high level of patient compliance as external fixation.
CONCLUSION
Secondary intramedullary nailing after temporary Ilizarov fixation is the useful method in the treatment of open fractures of tibia.

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The Neccessity of Additional Supporting Fixation for the Unstable Intertrochanteric Fractures of the Femur in the Elderly: Hyoun Oh Cho, Kyoung Duck Kwak, Soo Min Sohn, Cheol Ho Kang, Seung Il Whang, Sang Min An, Do Young Lee; J Korean Soc Fract 2001;14(1):23-29. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.23

Abstract PDF: PURPOSE
This study was designed to assess the necessity of additional supporting fixation to the traditional internal fixation for unstable intertrochanteric fractures of femur.
MATERIALS AND METHODS
Seventy two cases of unstable intertrochanteric fractures (modified Boyd-Anderson type III, IV) in the elderly were reviewed, which were internally fixed with Dynamic Hip Screw. 48 cases were treated with Dynamic Hip Screw only(Group I) and 24 cases with Dynamic Hip Screw and additional trochanteric supporting plate(Group II). In 13 cases with weak femoral cortx, we added wiring to the side plate. We measured neck-shaft angle, degrees of displacement of greater trochanteric fragment, slippage of hip screw on plain radiographs.
RESULTS
Varus change in neck-shaft angle, displacement of greater trochanteric fragment and slippage of hip screw revealed 7.3Â°, 5.4 mm, and 10.7 mm respectively in group I, while 2.1Â°, 0.1 mm and 3.8 mm respectively in group II. There were no pullout of cortical screws.
CONCLUSION
Internal fixation with additional trochanteric supporting plate to the conventional Dynamic Hip Screw was effective in unstable intertrochanteric fractures of the femur in the elderly. Added wiring to the side plate was also helpful in weak femoral cortex.

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Augmentative Plate Fixation for Femoral Nonunion after Intramedullary Nailing: Hyoun Oh Cho, Kyoung Duck Kwak, Jong Jin Kim, Soo Min Sohn, Cheol Ho Kang, Hong Ju Lee; J Korean Soc Fract 2000;13(4):825-831. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.825

Abstract PDF

The purpose of this study is to evaluate the efficacy of augmentative plate fixation for the femoral nonunion after intramedullary nailing. We reviewed eleven femoral nonunion after intramedullary nailing, which were treated with augmentative plate internal fixation. All cases were initially managed with interlocking intramedullary nailing. Five were hypervascular and six were avascular. Leaving the intramedullay nail in situ, an augmentative plate fixation was applied to the fracture site to counter the rotational instability. A simultaneous bone grafting was performed in six avascular nonunion to repair the bony defect. The union time was 8.2 months in average( 7.8 months in hypervascular and 8.5 months in avascular). In conclusion, augmentative plating leaving the intramedullary nail in situ is an useful alternative for the treatment of femoral nonunion after intramedullary nailing. The technique is simple and does not require any special instruments. It facilitates an early weight bearing and gives a quick recovery from nonunion.

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The Comparison of LC-DCP versus LCP Fixation in the Plate Augmentation for the Nonunion of Femur Shaft Fractures after Intramedullary Nail Fixation
Se Dong Kim, Oog Jin Sohn, Byung Hoon Kwack
Journal of the Korean Fracture Society.2008; 21(2): 117. CrossRef

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Factors influencing the results of treatment in Lisfranc injury of the foot: Hyoun Oh Cho, Kyoung Duck Kwak, Soo Min Sohn, Woo Kun Jung, Pill Hwan Oh, Dai Hwan Lim; J Korean Soc Fract 1999;12(4):961-967. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.961

Abstract PDF: PURPOSE
: The purpose of this study is to detect the factors influencing the results of treatment for Lisfranc injuries of the foot.
MATERIALS and METHODS
: We assessed the correlation between the AOFAS Scale and each of the variables which might influence the results of treatment in 25 cases of Lisfranc injuries, using the SPSS version 7.5.
RESULTS
The mean AOFAS Scale rated 81.48 points. The degrees of initial soft tissue injury had close correlation with the AOFAS Scale; while time from injury to operation, accuracy of reduction such as the alignment of the tarsometatarsal joints, gap between the first and the second metatarsal bases, and the foot arch angles had moderate correlation with AOFAS Scale(p<0.05). The age at operation, types of fractures, joint space of the tarsometatarsal joints had little or fair degrees of correlation with the AOFAS Scale(p>0.05).
CONCLUSION
: The factorf influencing the results of treatment for Lisfranc injuries included initial deree of soft tissue injury, time form injury to operation, and variables related to the accuracy of reduction such as the alignment of tarsometatarsal joints, gap between the first and the second metatarsal bases, and the maintenance of the foot arch.

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Fracture-Separation of the Distal Humeral Epiphysis in Young Children: Hyoun Oh Cho, Kyoung Duck Kwak, Byung Yong Kim, Su Min Sohn, Pill Whan Oh; J Korean Soc Fract 1999;12(2):365-371. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.365

Abstract PDF: We have reviewed seven cases of fracture-separation of the distal humeral epiphysis, two of which were initially misdiagnosed as a fracture of the lateral condyle and one as a fracture of the supracondyle. The four cases were treated by closed reduction and cast immobilization, and three cases by open reduction and internal fixation. The one case with conservative treatment had cubitus varus, other were good result. To distinguish the fracture-separation from a fracture of lat. condyle and from a dislocated elbow is impossible using clinical signs alone. For reducing misdiagnosis, it is important to consider age and there could be need further evaluation such as arthrogram, USG, CT and MRI.

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Surgical Treatment of Acute acromioclavicular Dislocation: Hyoun Oh Cho, Kyoung Duck Kwak, Byeung Yong Kim, su Min Sohn, Jin Kyoung Moon; J Korean Soc Fract 1998;11(2):413-419. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.413

Abstract PDF: We have reviewed 40 patients of acute acromioclavicular dislocation all treated by several operative procedure from January 1990 to July 1996. After about 12 months follow up period, we analyzed the relationship between the type of operation and the clinical results. Several operative mothods were demonstrated till now, but 4 techniques or their combinations are commonly used. Those are fixation of acromioclavicular joint, fixation of coracoclavicular ligament, resection of distal end of clavicle and dynamic muscle transfer. Modified Phemister technique, modified phemister technique with coracoclavicular fixation and modified Bosworth technique were used with or without repairment of coracoclavicular ligament at our hospital. Modified Phemister technique showed less good results than those of other techniques especially when repair of the coracoclavicular ligamentwas not made, and the repair of the coracoclavicular ligaments or fixation of the coracoclavicular joint is an important factor affecting the final results.

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Postoperative Infection in the Closed Fractures of the Long Bone: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Bab Jae Lee, Il Jong Yang; J Korean Soc Fract 1997;10(4):866-871. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.866

Abstract PDF: Operative treatment for closed fractures of the long bone has many advantages including early restoration of function by stable fixation, but has untoward problems including postoperative infection. The authors reviewed 19 cases of postoperative infection for closed long bone fracture during the period from January, 1990 to December, 1995 and analyzed about clinical, radiologic, pathologic findings and found causes of infection. Most cases were associated with multiple fractures of major bones or injuries to the vital organs and delayed over 48 hours after injury to operation. Operation time was prolonged due to the simultaneous operations for multiple fractures and associated open fractures at the same time. Staphylococcus aureus was the most frequent offending organism. Irregular resorption of plate-bone interface with resultant gap between the plate and bone, on the radiographic follow up, may indicate postoperative infection.

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Ipsilateral Fractures of the Femur and Tibia: Hyoun Oh Cho, Kyeong Duck Kwak, Sung Do Cho, Cheol Soo Ryoo, Jang Ho Oh; J Korean Soc Fract 1996;9(2):416-423. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.416

Abstract PDF: Concomitant ipsilateral femoral and tibial fractures are generally caused by high energy trauma with high incidence of associated injuries and complications. Twenty-seven cases of ipsilateral fractures of the femur and tibia in 25 adults from 1990 through 1994 were reviewed and the patients were grouped according to the type of fracture and the method of treatment. Nine femoral fractures(33%) and 19 tibial fractures(70%) were open. All but one femoral fractures and 23 tibial fractures were treated operatively with plate and screws, intramedullary nail and external fixator. Local complications include 14 delayed or non-onions, 3 deep infections, 1 compartment syndrome and 2 below-the-knee amputations. Over-all, a good or excellent functional result was achieved in 20 cases(74%). More use or rigid external fixation is recommended in the management of the tibial fracture, combined with internal fixation of the femoral fracture. Examination of the ipsilateral knee suggested that with the "floating knee injuries", disruption of ligaments is a common occurance and should always by suspected.

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Treatment for the Malunion of the Distal Radius: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Cheol Soo Ryoo, Woo Keun Jung; J Korean Soc Fract 1996;9(2):290-294. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.290

Abstract PDF: Malunited fractures of the distal radius may result in adequate function of the wrist with absence of pain in elderly patients. However, posttraumatic dedormity in younger, active patients is less well toterated, especially in those engaged in heavy manual work or who require a normal range of motion of the wrist. surgical correction of the malunion of the distal radius should be considered for this group of patients. Operation for the malunited fractures of the distal radius was performed in ten cases during the periods between January, 1990 and December, 1993, who were followed for an average of 15 months.The procedures included radial osteotomy(RO) in four malunions of short duration, radial osteotomy with ulnar shortening (RO & US) in these malunions of long duration and ulnar shortening(US) in three cases. We reviewed these cases retrospectively with respect to the clinical findings(pain, grip strength, range of motion of the wrist) and radiograpic changes(volar tilt, radial articular inclination and radiul shortening). Symptoms(radioulnar or radiocarpal pain) were improved in all cases. By compairing with the opposite sides, resedual loss of grip strength was 35% in RO group, 40% in RO & US and 31% in & US group. Residual loss of motion in flexion and extension or in deviation was similar in all groups, whill loss in rotation was less in RO or RO & US group than in US group. Inclination of the radial articular surface (radial inclination and volar tilt) was restored up to the degree similar to the opposite wrist in RO or US group, while was not in US group. Radial length was restored up to the dgegrees similar to the opposite wrist in all groups. The overall results were good or very good in five among the seven cases of RO group(with or without ulnar shortening), while good only in one among the cases of US group.

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Management of Femoral Shaft Fractures in the Adolescent: Hyoun Oh Cho, Kyoung Kuck Kwak, Sung Do Cho, Cheol Soo Ryoo, Bub Jae Lee; J Korean Soc Fract 1995;8(3):521-527. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.521

Abstract PDF: Treatment of the femoral shaft fractures in adolescents with open physis is somewhat controversial. Historically, these fractures have been treated with nonoperative methods, but adolescents are less tolerant to the prolonged irnrnobilization than younger children. Futhermore, conservative treatment in this age group may be prone to result in more complications such as malunion and shortening than that in the younger age group. Therefore many authors prefer the operative method for femoral shaft fractures in the adoleseents. The authors reviewed 22 cases of adolescent femoral shaft fractures treated during the period from January, 1958 to June 1992. Seven cases were treated conseratively, eleven by open reduction and intenal fixation with DCP, and four by closed intramedullary nailing. The patients treated with traction and casting showed more often complications such as angular deformity and bone shortening than in the operative methods. In comparing with those cases of plating, the patients of intramedullary nailing had statistically significant shorter ansthesic time and less blood loss in operation. All of the fractures treated with the intramedullary nails healed without malunion or leg length discrepancy, and there was no evidence of growth plate arrest. Results of this study suggest that closed intramedullary nailing of femur fractures in aldolescents is an effective treatment option.

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Change in Carrying Angle after Supraeondylar Fracture of the Humerus in Children: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Byoung Yong Kim; J Korean Soc Fract 1994;7(1):65-71. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.65

Abstract PDF

Supracondylar fracture of the humerus is the most common fracture about the elbow in children. Due to the thinners in this region, it is difficult to reduce the displaced fracture and to maintain the reduction. The purpose of this study is to review the change in carrying angle after this fracture with references to the level and type of the fracture and method of treatment. The authors reviewed 90 cases of supracondylar fracture in children. Ten cases were treated conservatively, sixty eight by percutaneous pinning and twelve by open reduction with regard to the level of the fractures, sixty nine cases(78.9%) revealed fracture through the olecranon fossa. And the less the age of the patient, the more distal was the level of the fracture. change in carrying angle was more common in fractures through the olecranon fossa, in cases of type 4 fractures and in cases of percutaneous pinning. About one third of the cases with fish-tail sign or medial impaction on postoperative roentgenogram showed change in carrying angle of more than 6 degrees. cases with change in carrying angle or more than 6 degrees revealed insufficient redutlon or inadequate fixation. In cases of open reducton the results were good or excellent in all.

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Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture
Yoon Hae Kwak, Dong Jou Shin, Kun Bo Park
Journal of the Korean Fracture Society.2010; 23(1): 90. CrossRef

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Angular Changes after Operative Treatment for the Supracondylar fractures of the Femur: Hyoun Oh Cho, Kyoung Duek Kwak, Sung Do Cho, Cheol Soo Ryoo, Bub Jae Lee; J Korean Soc Fract 1994;7(1):174-180. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.174

Abstract PDF: A fractures of the distal femur is an extremely complex fracture with which to deal. Poor bone stock, proximity to the knee joint, and a truncated shape make this area of the femur less suitable for internal fixation than other areas. Ideal care still somewhat controversial. Major complications include nonunion, delayed union, infection, loss of fixation, Joint stiffness and angular deformity, etc. The authors reviewed postoperative tiblo-femoral angular changes from the twenty six cases of supracondylar and intercondylar fractures of the femur treated operatively from January, 1988 to December, 1991. Fractures of a single condyle were excluded. The fractures were fixed internally with dynamic condylar screw(DCS) in nine cases, anatomic plate in nine, dynamic compression plate(DCP) in six and others in two. During the periods of follow up there noted varus change of 3.7 degrees in average. We reviewed retrospectively these postoperative varus or valgus angular changes with reference to the degree of injury, type of fracture, time elapsed from injury to operation, kind of internal fixation device, initial bone graft and postoperative brace supplement. Less angular changes in the tiblo-femoral angle with better results were noted in cases with lower energy injuries, AO type Al, A2 or Cl fractures, operation within 1 week of injury, internal fixation with DCS, initial bone graft and postoperative corrective brace supplement.

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Clinical study of angular deformity after treatment of fracture of proximal tibia: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Jung Hwan Suh, Jong Dae Baek; J Korean Soc Fract 1993;6(2):241-246. Published online November 30, 1993; DOI: https://doi.org/10.12671/jksf.1993.6.2.241

Abstract PDF: No abstract available.

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Treatment of unstable distal radius fracture: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Ang Hyoung Sohn; J Korean Soc Fract 1993;6(1):92-99. Published online May 31, 1993; DOI: https://doi.org/10.12671/jksf.1993.6.1.92

Abstract PDF: No abstract available.

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A comparison of operative methods for displaced proximal humeral fractures: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Jung Hwan Suh, Ang Hyoun Son; J Korean Soc Fract 1992;5(1):57-64. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.57

Abstract PDF: No abstract available.

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Pain relief by postoperative infusional continuous regional analges ia: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Sang Ryoul Lee; J Korean Soc Fract 1992;5(1):161-167. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.161

Abstract PDF: No abstract available.

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Trochanteric fractures of the femur pitfalls of the treatment withdynamic hip screw in elderly patients: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Ang Hyoun Son; J Korean Soc Fract 1992;5(1):111-120. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.111

Abstract PDF: No abstract available.

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