Journal of Musculoskeletal Trauma

Operative Treatment of Traumatic Humeral Shaft Fracture: Comparision of Interlocking IM Nailing and Plate Fixation by Posterior Approach: Hyun Dae Shin, Kwang Jin Rhee, Kyung Cheon Kim, Ho Sup Song; J Korean Fract Soc 2005;18(2):93-99. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.93

PURPOSE
To compare the results and complications of interlocking IM nailing and plate fixation by posterior approach in the treatment of traumatic humeral shaft fracture MATERIALS AND METHODS: From March 1997 to March 2003, 49 patients undergone operation due to traumatic humeral shaft fracture. Follow-up was over one year. 28 patients operated with interlocking IM nailing initially and 21 operated with plate fixation by posterior approach prospectively. Statistics were compared using clinical and radiological outcomes and complications.
RESULTS
Radiologically, bone union was observed after an average of 14.3 weeks in IM nailing, and 11.7 weeks in plate fixation. So plate fixation showed earlier bone union (p=0.012). Nonunion occurred in 4 cases (14.3%) operated with IM nailing, and 1 case (4.8%), that was open shaft fracture, with plate fixation. Nonunion occurred more frequently when operated by IM nailing. 6 cases showed limitation of shoulder movement due to damage of the rotator cuff by IM nail entry site. 1 case showed radial nerve palsy, and 1 case showed axillary nerve palsy in the case of IM nailing. Also, secondary surgery due to complications was operated in 9 cases (32.1%) in IM nailing and 1 case (4.8%) in plate fixation (p=0.03).
CONCLUSION
In the case of traumatic humeral shaft fracture plate fixation by posterior approach was more useful than IM nailing in the decrease of complications and bone union. Such approach is thought to be an excellent method for anatomic reduction and nerve exploration in the case of open and comminuted fracture which accompany nerve injuries

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Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures
Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn
The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107. CrossRef
Minimally Invasive Anterior Plating of Humeral Shaft Fractures
Hyun-Joo Lee, Chang-Wug Oh, Do-Hyung Kim, Kyung-Hyun Park
Journal of the Korean Fracture Society.2011; 24(4): 341. CrossRef
Result of Interlocking Intramedullary Nailing for Humeral Shaft Fracture Evaluation of Post-operative Shoulder Function
Seung Rim Park, Tong Joo Lee, Ryuh Sub Kim, Kyoung Ho Moon, Dong Seok You
Journal of the Korean Fracture Society.2007; 20(2): 166. CrossRef

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The Fate of Large Butterfly Fragments in Femoral Shaft Comminuted Fractures Treated withClosed Interlocking Intramedullary Nailing: Keun Bae Lee, Jae Yoon Chung, Eun Sun Moon, Eun Kyoo Song, Kwang Cheul Jeong; J Korean Soc Fract 2002;15(4):504-510. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.504

Abstract PDF: PURPOSE
To evaluate the radiographic changes and union of large butterfly fragments after closed interlocking IM nailing for femoral shaft comminuted fractures.
MATERIALS AND METHODS
The objects of this study were 23 cases(15 males, 8 females) of femoral shaft comminuted fractures with butterfly fragments larger than 5cm and with the follow up period of 12 months or more from June 1995 to June 2000. We assessed the size, the degrees of displacement and angulation of the large butterfly fragments at preoperatively, one day, one month and three month postoperatively and evaluated the union at four month and six month postoperatively.
RESULTS
The size of the fragments was 8.4cm (5.0-13.0) in average. The distance between the fragment and shaft was 15.9cm preoperatively and 10.1, 7.7, 6.8cm at one day, one month and three month postoperatively. In 13 cases of angulation over 5 degrees, it changed from 19.6 degrees preoperatively to 13.9 degrees , 8.4 degrees , 5 . 9 degrees at one day, one month and three month postoperatively. There is no increase in angulation.The union was completed at 4 months in 13 cases (56.5%) and at 6 months in all except one case of delayed union, in which we did not do any further procedure until the union was achieved.
CONCLUSION
In femoral shaft comminuted fractures with displaced large butterfly fragments treated with closed interlocking IM nailing, the distance and angulation of fragments decreased gradually and even the fragments were inverted or largely displaced and angulated the fragments were united. So the caution must be given not to displace the fragments intraoperatively and to keep anatomical position of the fragments by active exercise and hydrostatic pressure of the muscles of thigh postoperatively. Then the open reduction and internal fixations of the fragments will not be necessary.

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The Results Of Femoral Shaft Fracture By Difference Of Operative Method: Ki Do Hong, Sung Sik Ha, Jae Cheon Shim; J Korean Soc Fract 2000;13(4):847-854. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.847

Abstract PDF: PURPOSE
To evaluate and compare the bone union period, complications and functional assessments between compression plate and intramedullary nailing which are operative methods of the femoral shaft fracture. MATERIAL AND METHOD: We evaluate the bone union period, complications and functional assessments of the 65 cases(63 patients). 30 cases were treated with compression plate and another 35 cases were treated with intramedullary nailing, who were diagnosed to have femoral shaft fracture. And they were treated in our hospital from January 1995 to August 1999, whose follow up was available more than 1 year.
RESULTS
Mean bone union period of compression plate fixations was 14.6 weeks and intramedullary nailing was 16.2 weeks. Complications in compression plate fixations group was deep infection in one case, metal failure in one case, refracture in one case, nonunion in one case, and there were 5 complications in intramedullary nailing fixations group which were nonunion in 2 cases, limb shortening in 2 cases and angular deformity of nail in one case. By using functional assessment according to Magerl et al16) among 30 cases of compression plate fixations, 25 were excellent, 3 were good, 2 were fair, and among 35 cases of intramedullary nailing, 29 were excellent, 4 were good, 2 were fair, so we achieved excellent results in both techniques as 83.3% and 82.9% cases each.
CONCLUSION
In operative management of femoral shaft fracture, compression plate fixations and intramedullary nailing shows average difference of 1.6weeks of bone union period, but both method didn't show significant difference in bone union period. Both methods achieved excellent results in functional assessments, so if we manage by knowing thoroughly the advantage and disadvantage of both technique, we can get a excellent results with reduced complications.

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Intramedullary Nailing of Femoral Shaft Fractures : Comparison between with and without the Fracture Table: Jung Jae Kim, Yong Gab Jeong, Kwang Hwan Jung, Soo Sung Park, Eu Gene Kim; J Korean Soc Fract 2000;13(2):320-326. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.320

Abstract PDF

PURPOSE
: To evaluate and compare the efficacy of intramedullary nailin(IMnailing) between using radiolucent plane table in lateral position and using fracture table in supine position for femoral shaft fractures.
MATERIALS AND METHODS
: Consecutive 62 cases of the fresh fractures of femoral shaft treated with intramedullary nailing were divided into 2 groups; 31 cases on the fracture tables and the other 31 cases with the lateral position on the radiolucent plane table, and we analysed the difference the length of anesthetic time, preparation and draping time, operative time, postoperative complications between the two groups.
RESULT
: There was statistically significant decrease in the length of anesthetic time, operative time in the former group, but no difference in the postoperative complication(Wilcoxon test).
CONCLUSION
: Lateral position on radiolucent plane table with the traction device for intramedullary nailing for femoral shaft fracture considered to be generally accepted not only to the limited cases which fracture tables are not available but also to general cases.

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The PFNA Nail for Pertrochanteric Fracture of the Femur without Fracture Table
Jeoung Ho Kim, Sang Hong Lee, Kwang Chul Lee, Sung Won Cho
Journal of the Korean Fracture Society.2011; 24(3): 217. CrossRef

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The Problems of Locked Intramedullary Nailing in the Proximal Shaft Fractures of the Tibia: Jin Woo Kwon, Kyoung Tae Sohn, Seung Ho Shin, Jae Il Kim; J Korean Soc Fract 1999;12(1):76-82. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.76

Abstract PDF: Proximal shaft fractures of the tibia have a high incidence of complication and often result in poor outcomes. Plate fixation and locked intramedullary nailing are the most common methods of treatment, but now the latter is more popular because of soft tissue problem, osteomyelitis etc.. The purpose of this study is to evaluate the results of locked intramedullary nailing in the treatment of proximal shaft fractures of the tibia and to draw a conclusion that what type of fracture patterns are the appropriate indication of nailing. We analyzed 18 proximal shaft fractures of the tibia which were treated by locked intramedullary nailing from October 1991 to March 1997 and followed more than 12 months. The results were as follows ; The complications were occurred in 12 cases(66.6%); 4 cases of delayed or non-union, 8 of angular deformity, 1 of leg length discrepancy. Delayed or non-unions were caused by fracture site comminution and bone defect. 5 anterior angular deformities were due to the pulling of the knee extensor mechanism and 3 valgus deformities were due to medially located entry portal. In conclusion, since locked intramedullary nailing in proximal tibial fractures causes a high incidence of complications, it is recommended in transverse or undisplaced fractures. And plate fixation and bone graft will be recommended in comminuted or displaced oblique fractures, if soft tissue condition is permitted.

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Consumptive Coagulopathy Secondary to a Traumatic False Aneurysm of Deep Femoral Artery: Duke Whan Chung, Hwi Joong Yoon, Chang Moo Yim, Young Soo Chun, Hyun Ju Park; J Korean Soc Fract 1998;11(1):85-90. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.85

Abstract PDF: A case of consumptive coagulopathy due to pseudoaneurysm, which occured as a complication of intramedullary nailing, was rarely reported. Pseudoaneurysm of peripheral artery is presented with pulsating mass and may show extrinsic indentations of the adjacent bone. The coagulopathy and bleeding responded to surgical elimination of the fistula and aneurysm. Diffuse intravascular coagulopathy or consumptive coagulopathy is infrequently associated with pseudoaneurysm of deep femoral artery. Laceration of major arteries are more common in open than in closed fractures. They usually occur only when a major artery is in close proximity to bone as complications to frractures. Diffuse intravascular coagulopathy or consumptive coagulopathy is characterized clinically by excessive bleeding, ecchymosis and petechiae and by laboratory evidence of a disease in the numbers of platelets and amount of fibrinogen and an increase of fibrin degradation products with prolonged prothrombin and partial thromboplastin times. When the two coexist, they create a difficult clinical problem that reuires optimal medical and surgical treatments. If the appropriate treatment was delayed, serious complication such as sepsis or death could be occured. Prompt recongnition through appropriate laboratory tests and early surgical intervention was indicated essentially. We are reporting one case of coagulopathy associated with pseudoaneurysm of deep femoral artery that presented to the broad clinical picture.

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A Prospective Study of Fractures of the Tibial Shaft Treated with Intramedullary Interlocking Nail : Comparing One versus Two Distal Screws: Eun Woo Lee, Ki Ser Kang, Soo Yong Kang, Eui Chan Jang, Jin Woo Lee; J Korean Soc Fract 1997;10(2):303-308. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.303

Abstract PDF: In non-randomized prospective study, 67 tibial fractures were treated with intramedullary inter-locking nail. Patients were divided into 2 groups based on the number of distal locking screw. Group I was consisted of 33 fractures treated with one distal locking screw Group II was consisted of 34 fractures treated with two distal locking screws. The patients were followed up for an average of 12 months. There was no statistically significant difference between group I and II with regard to total operation time, fracture union time. However fluoroscopic time was significantly longer at group II than group I. Serial radiographs of patients in both group were analyzed for change of hardware and fracture healing postoperatively. No significant difference was found between two groups in fracture union time, hardware failure and complications in proximal and middle tibial fracture. But the angulation and locking screw breakage were significant in group I in distal tibia fracture. We concluded that fracture of the proximal and middle third of the tibia that require interlocking nail can be successfully treated with a single distal locking screw. However, in fractures of the distal one third, two distal locking screws should be required to prevent of angular deformity in sagittal plane and for stablefixaton. The use of a single distal locking screw reduces operation time, radiation exposure, local soft tissue discomfort and cost without compromizing fracture union.

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Closed Interlocked Nailing in Comminuted Femoral Shaft Fractures: Jung Jae Kim, Chang Won Lee, Key Yong Kim; J Korean Soc Fract 1997;10(1):8-15. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.8

Abstract PDF: Intramedullary nailing is one of the most popular method of treatment in femoral shaft fractures,which provides relatively stable fixation and preservation of blood supply and early mobilization. But whether open reduction, cerclage wiring and/or bone graft is necessary for the displaced comminuted fragment is still a subject of controversy. To clarify such debate we compared the results of IM nailing between simple, minimal displaced fractures and displaced, comminuted ones treated with closed method. We analyzed 36 cases of the fresh closed fractures of femoral shaft treated by closed intramedullary nailing from December 1992 to January 1996. There were 24 cases of minimal displaced fractures and 12 cases of displaced ones more than 1 cm during operation. The average follow-up period was 12 months(5-48 months). Clinical and radiological fracture union occurred in 97% of cases(35/36). Radiological callus was noticed just around 3 weeks postoperatively in both groups and the average time to radiological union was 23 weeks in minimal displaced group and 24.8 weeks in displaced one. Because there was no significant difference in bone healing time, closed interlocking intramedullary nailing is thought to be also the good method of treatment in femoral fractures regardless of fracture pattern or displacement of fragments.

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Problems and complication after Interlocking Intramedullar Nailing for Femoral Shaft Fracture: In Suk Oh, Do Hyun Moon, Jin Hong Ko, Ki Dong Kang, Si Hwan Kim; J Korean Soc Fract 1996;9(3):547-556. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.547

Abstract PDF

Fracture of the femoral shaft, is among most common fractures in orthopaedics, with its aspect becomming more complex. Since the introduction of Kuncher Nail, closed rodding techinque and locking nail system were followed with additional feature of preventing shortening and rotation as well as allowing early weight bearing and joint motion. With their wide application, we met many problems during the operative procedure due to delicient concept and technique. We have checked the possible problems during and after the procedure of interlocking nailing for the femoral fractures in 65 cases. 1. With poor selection of implant, long, short and small nail were used in 5, 3 & 2 cases, respectively. 2. In the process of operation, inlet error, angular & rotational deformity, femoral neck fracture, failure (or loossening) of distal screws were 2,10, 1, and 4 cases, respectively. 3. A New fragment was made in 7 cases(11%) durinbg surgery, especially medial side and distal to the fracture line. 4. Post-operative deep infection were developed in 2 cases. 5. Post-operative metal failure and delayed(or non) union was 1 and 7(11%) cases, delayed union (or nonunion) occured in 3 cases(20%) after open reduction while following closed reduction in 4 cases(8%).

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Iatrogenic Femur Proximal Shaft Fracture during Nailing Using Lateral Entry Portal on Femur Shaft Fracture
Hong Moon Sohn, Gwang Chul Lee, Chae Won Lim
Journal of the Korean Orthopaedic Association.2014; 49(4): 272. CrossRef

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Treatment of Nonunion of the Tibia Fracture: Dong Heon Kim, Kyu Cheol Shin, Hee Cheol Park, Ju Yong Shin; J Korean Soc Fract 1996;9(1):112-118. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.112

Abstract PDF: Nonunion after tibia fracture is a relatively common problem. The cases of nonunion have been known open and comunited fracture, extensive soft tissue injury, interposition of the soft tissue, distarbance of the blood supply and inadequate fixation. A number of methods stimulating union have born described. These include fibular osteotomy followed by weight-bearing in a cast, autogenous boone graft with or without additional stabilization, internal or external fixation with compression, open or closed IM nailing and even electromagetic stimulation. In this paper we carried out retrospective study of the 24 nonunion of the tibia fracture which were treated at the Department of Orthopeadic Surgery, Kon-Kuk University Hospital from March 1990 to March 1995. The results were as follows: 1. Among 24 cases of monunions, 16cases(66.6%) were communited fractures and 18cases(75%) were open fractures. 2. Hypervascular nonunion were 12cases and avascular nonunion were 12cases. Previous methods of treatinent were conservative treatment in 6cases of closed fracture and were treated with Ender nailing, multiple K-wire fixation, Ilizarolr external fixation, monofixator external fixation in 1 Bcases of open fractures. 3. The average duration from injury to dignosis of nonunion was 7 months tweets.(Range 5 months to 24months) 4. Tibial nonunion were treated with plate and screw with bone graft(Bcases), Interlocking IM nail ing(14cases), and nizarov external fixation with bone graft(teases). 5. The average time of union was 23weeks in all patients: 24 weeks in the case of plate and screw with bone graft. 20 weeks in the case of interlocking IM nailing. 28 weeks in the case Ilizarov external fixation with bone graft. 6. The main complications were joint stiffness due to long-term cast irnrnobiliBation in the case of plate and screw with bone graft, LROM of joint contracture and external pin site in the case of Ilizarov external fixation with bone graft, deep infection Icase and knee joint pain teases due to proximal nail protrusion in the case of Interlocking IM nailing.

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A Clinical Comparison between DCP Fixation and Brooker-Wills IM Nailing in the Treatment of Tibial Shaft Fracture: Hyung Seok Kim, Ki Do Hong, Sung Sik Ha, Young Ki Ko, Dong Seok Kang, Jae Hyun Lim; J Korean Soc Fract 1994;7(2):284-292. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.284

Abstract PDF: The tibia is the most commonly fractured bone in the long bones. There are many controversy concerning the method of treatments because of many complications, such as non-union, delayed union and infection. We comparatively analyzed 21 cases of Brooker-Wills IM nailing and 35 cases of DCP fixation in the treatment of tibial shaft fractures from Jan. 1988 to Dec. 1992. The results were as follow: 1. The averge bone union time was 12.1 weeks in Brooker-Wills IM nailing group and 13.9 weeks in DCP fixation group. There were significant different between two groups of the bone union time especially, the age from 20s to 40s and type B fracture in according to A-O classification but no different of the bone union time in open fractures. 2. There was more complications in DCP fixation than in Blocker IM nailing to treat the tibia shaft fractures. 3. In according to the above results to treat the tibia shaft fracture, we meet the conclusion that it will be a benifit to treat the tibia shaft fracture with IM nails than with DCP fixation especilly, young ages and type B fractures in A-O classification. Also we need further study for advantage between the IM nails which flexible and hard one, reamed and unlearned one.

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Delayed Femoral Neck Fracture in Interlocking Intramedullary Nailed Femur: A case report: Sung Man Rowe, Eun Sun Moon, Eun Kyoo Song, Sung Taek Jung; J Korean Soc Fract 1989;2(2):269-273. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.269

Abstract PDF: We report an uncommon complication following interlocking intramedullary nailing of the femur: delayed femoral neck fracture after 5 months of unevenful postoperative course. He was a 47-year-old laborer with good quality of bone, nevertheless he sustained femoral neck fracture after minor fall on the ground. We thought that loss of bone elasticity caused by interlocked nail in the whole femoral shaft including intertrochanteric portion made stress concentration on the femoral neck to develop a fracture with minor magnitude of traumatic force.

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