Journal of Musculoskeletal Trauma

Comparative Study Using of Treatment with Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Interlocking Intramedullary Nailing in Distal Tibia Fractures: Chang Hwa Hong, Jong Seok Park, Sang Seon Lee, Soo Ik Awe, Woo Jong Kim, Ki Jin Jung; J Korean Fract Soc 2010;23(3):296-302. Published online July 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.3.296

Abstract PDF: PURPOSE
To compare the result of treatment between minimally invasive plate osteosynthesis (MIPO) using periarticular plate and intramedullary nailing in treatment of distal tibia fractures.
MATERIALS AND METHODS
28 cases of distal tibia fractures form Jan. 2006 to Mar. 2008 were divided into two group. Minimum follow-up was for 12 month. Group 1 consisted of 14 patients who were treated by MIPO technique and group 2 consisted of 14 patients who were treated by interlocking intramedullary nailing. The results were compared by assessing radiologic and clinical result.
RESULTS
The mean bony union time was 14 weeks (8~17) in group 1 and 15 weeks (11~20) in group 2. Operation time was 58 minutes (55~65) in group 1 and 82.7 minutes (70~100) in group 2. The average angulation in AP view was 1.5 degrees (0~2) in group 1 and 2 degrees (0~5) in group 2, in lateral view was 1.8 degrees (0~4) in group 1 and 2.3 degrees (0~12) in group 2. The average range of motion for dorsi flextion was 17.5 degrees (15~20) in group 1 and 18 degrees (16~20) in group 2, for plantar flextion was 45 degrees (42~50) in group 1 and 44 degrees (42~50) in group 2, which means that there were no severe limitation of motion in all patients, resulting in satisfactory ambulation. There was no post operative complications such as skin irritation problem caused by internal device and no implant failure and superficial wound infection.
CONCLUSION
There were no difference in bony union time, clinical result and anatomical reduction between Group 1 and Group 2 in distal tibia fractures, but operation time was shorter in MIPO than nailing.

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A Comparison between Minimally Invasive Plate Osteosynthesis & Interlocking Intramedullary Nailing in Distal Tibia Fractures: Kee Byung Lee, Si Young Song, Duek Joo Kwon, Yong Beom Lee, Nam Kyou Rhee, Jun Ha Choi; J Korean Fract Soc 2008;21(4):286-291. Published online October 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.4.286

PURPOSE
To compare the effectiveness between minimally invasive plate osteosynthesis (MIPO) and interlocking IM nailing in the treatment of distal tibia fracture without involvement of ankle joint retrospectively.
MATERIALS AND METHODS
38 patients with distal tibia fracture from Jan. 2004 to Oct. 2005 were divided into two groups. Minimum follow-up was for 12 months. Group MIPO consisted of 18 patients were treated with MIPO and group Nail consisted of 20 patients were treated with interlocking intramedullary nail. The results were compared between two groups by assessing bony union time and operation time. Clinical evaluation was evaluated by Olerud score.
RESULTS
The mean bony union time was 14.4 weeks (12~17 weeks) in group MIPO and 16.7 weeks (13~19 weeks) in group Nail (p=0.011). The mean operation time was 1.05 hours (0.6~1.6 hours) in group MIPO and 0.74 hours (0.4~1.1 hours) in group Nail (p=0.044). The Olerud score was 83.8 (75~100) in group MIPO and was 89.6 (70~100) in group Nail (p=0.075). In Complication, group MIPO showed one metal failure and two skin irritations, group Nail showed three superficial wound infections.
CONCLUSION
MIPO was the shorter bony union time and the longer operation time than the interlocking intramedullary nailing. There were no significant differences between the two groups in clinical results.

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Comparative Analysis of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Distal Tibia Fractures
Ho-Min Lee, Young-Sung Kim, Jong-Pil Kim, Phil-Hyun Chung, Suk Kang, Kaung Suk Jo
Journal of the Korean Fracture Society.2018; 31(3): 94. CrossRef
A Rehabilitation for Ankle Fracture in Korean Medicine: A Report of 4 Cases
Won-Bae Ha, Jong-Ha Lee, Yoon-Seung Lee, Dong-Chan Jo, Jin-Hyun Lee, Jung-Han Lee
Journal of Korean Medicine Rehabilitation.2017; 27(4): 171. CrossRef
Comparison of the Results between Intramedullary Nailing and Plate Fixation for Distal Tibia Fractures
Jung-Han Kim, Heui-Chul Gwak, Chang-Rack Lee, Yang-Hwan Jung
Journal of Korean Foot and Ankle Society.2015; 19(3): 86. CrossRef
Intramedullary Nailing of Distal Tibial Fractures with Percutaneous Reduction by Pointed Reduction Forceps
Jae-Kwang Hwang, Chung-Hwan Kim, Young-Joon Choi, Gi-Won Lee, Hyun-Il Lee, Tae-Kyung Kim
Journal of the Korean Fracture Society.2014; 27(2): 144. CrossRef
A Comparison of the Results between Intramedullary Nailing and Minimally Invasive Plate Osteosynthesis in Distal Tibia Fractures
Chul-Hyun Park, Chi-Bum Choi, Bum-Jin Shim, Dong-Chul Lee, Oog-Jin Shon
Journal of the Korean Orthopaedic Association.2014; 49(4): 285. CrossRef
Analysis of the Result Treated with Locking Compression Plate-Distal Tibia and Zimmer Periarticular Locking Plate in Distal Tibia Fracture
Jun-Young Lee, Sang-Ho Ha, Sung-Won Cho, Sung-Hae Park
Journal of the Korean Fracture Society.2013; 26(2): 118. CrossRef

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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; J Korean Fract Soc 2007;20(2):166-171. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.166

Abstract PDF

PURPOSE
To evaluate the post-operative functional reduction of the shoulder joint and the impacting factors to post-operative shoulder joint function in interlocking IM nailing treatment of humeral shaft fracture.
MATERIALS AND METHODS
From April 1999 to August 2004, 35 patients (35 cases) whom admitted to hospital for humeral shaft fracture and treated using interlocking intramedullary nail were followed up for more than 1 year. 1 year post-operative shoulder joint function were evaluated using American Shoulder Elbow Surgery Scale (ASES). Pre-operative shoulder joint pain, radiologically degenerative change and extent of nail protrusion were evaluated, and each factor was correlated with function of the shoulder joint.
RESULTS
33 cases out of 35 cases showed union and average union period was 12 weeks. Complications consisted of 2 cases of nonunion, 1 case of infection, 1 case of loosening of distal fixing screw, 1 case of radial nerve palsy and 1 case of axillary nerve palsy. Shoulder joint function 3 months after operation : mean ASES score 78.2, 12 months after operation : mean ASES score 89.6. Pre-operative shoulder joint pain and nail protrusion showed to be statistically related to shoulder joint function.
CONCLUSION
If the operation leaves no protrusion of intramedullary nail, it can be concluded to be relatively safe and effective.

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Comparison of the Result of the Intramedullary Nail Fixation and Plate Fixation in Humeral Shaft Fracture with Butterfly Fragments
Duk-Hwan Kho, Hyeung-June Kim, Byoung-Min Kim, Hyun-Ryong Hwang
The Korean Journal of Sports Medicine.2016; 34(2): 120. CrossRef
Plain Radiograph Analysis of the Distal Humerus Posterior Bowing That May Affect Interlocking Intramedullary Nailing for Humerus Shaft Fracture
Jaekwang Yum, Kyunghwan Boo, Minkyu Sung, Jiseok Jang
Journal of the Korean Orthopaedic Association.2015; 50(1): 31. CrossRef
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
Surgical Treatment of Pathologic Humeral Fracture
Ho Jung Kang, Byoung Yoon Hwang, Jae Jeong Lee, Kyu Ho Shin, Soo Bong Hahn, Sung Jae Kim
Journal of the Korean Fracture Society.2010; 23(2): 187. CrossRef

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Wedge Tibial Shaft Fractures Treated with Interlocking IM Nailing: Sang Jun Song, Hyung Ku Yoon, Soo Hong Han, Hyung Kun Park, In Seok Lee; J Korean Fract Soc 2006;19(3):322-328. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.322

Abstract: PURPOSE
To investigate the bone union time of patients treated with interlocking intramedullary nailing in wedged tibial shaft fracture and to evaluate the factors that influence this result.
MATERIALS AND METHODS
32 patients treated with interlocking intramedullary nailing for wedge tibial shaft fracture were reviewed with a follow-up period of more than 1 year. Radiographic results were assessed with diameter (%) and length (mm) of wedge fragment, pre and postoperative displacement (mm) of wedge fragment. We also checked the bone union time of the main fragment and the wedge fragment (paired t-test). We investigated the bone union time acocording to the diameter, length of wedge fragment, pre and postopertvie displacement (correlation analysis).
RESULTS
Bone union time of the main fragments averaged 15.3 weeks (6~53 weeks) and that of wedge fragment averaged 24.2 weeks (8~64 weeks) (p=0.005). There was no correspondence between wedge fragment diameter and bone union time (p=0.681), but the bone union time of wedge fragment increased in proportion to its diameter (r2=0.747, p=0.031). There was no correspondence between preoperative displacement of wedge fragment and bone union time (p=0.574), but the bone union time increased in proportion to postoperative displacement of wedge fragment (r2=0.730, p=0.001).
CONCLUSION
Wedge fragments need longer time for bone union than main fragments in interlocking intramedullary nailing for wedge tibial shaft fractures. We need to pay attention to the displacemet of fragments in treating tibial shaft fractures with large wedge fragment.

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Interlocking Intramedullary Nailing in the Distal Metaphyseal Fractures of the Tibia: Sang Jun Song, Duck Yun Cho, Hyung Ku Yoon, Dong Eun Shin, Jae Hwa Kim, Tae Hyung Kim; J Korean Fract Soc 2005;18(3):275-280. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.275

Abstract PDF

PURPOSE
To evaluate the clinical and radiographic results of interlocking intramedullary nailing for the distal metaphyseal fractures of the tibia and to identify the usefulness of the interlocking intramedullary nailing.
MATERIALS AND METHODS
Thirty four patients who underwent interlocking intramedullary nailing for distal metaphyseal fractures of the tibia were reviewed with a follow-up period of more than 2 years. Clinical result was assessed using the Olerud score and this score was marked as percentage of prefracture state. Radiographic results were assessed with varus-valgus angle, anterior-posterior angle, and bone union time. We checked the cases of complication and need for additional surgery after interlocking intramedullary nailing.
RESULTS
Clinically, Olerud score averaged 92.1% (76~100%). Radiographically, average varus-valgus angle was 1.6+/-2.9 degrees and average antero-posterior angle was 0.8+/-3.3 degrees. Bone union time averaged 18.7 weeks. As complications, there were one deep infection and two breakages of distal interlocking screw. In additional surgery, there were 1 debridement and soft tissue flap, and one dynamization of nail at postoperative 12 weeks.
CONCLUSION
Interlocking intramedullary nailing is one of safe and reliable method for distal metaphyseal fractures of the tibia, considering less soft tissue injury, possibility of early range of motion exercise, high bone union rate, and low complications rate.

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A Comparison between Minimally Invasive Plate Osteosynthesis & Interlocking Intramedullary Nailing in Distal Tibia Fractures
Kee-Byung Lee, Si-Young Song, Duek-Joo Kwon, Yong-Beom Lee, Nam-Kyou Rhee, Jun-Ha Choi
Journal of the Korean Fracture Society.2008; 21(4): 286. CrossRef

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Treatment of Comminuted Femoral Shaft Fracture by Interlocking Intramedullary Nailing: Comparision of results between open reduction with cerclage wiring and closed reduction: Jeung Tak Suh, Hyoung Lok Roh, Jeung Il Kim, Chong Il Yoo; J Korean Fract Soc 2005;18(1):6-11. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.6

Abstract PDF: PURPOSE
To compare of results between open interlocking intramedullary nailing combined with cerclage wiring and closed interlocking intramedullary nailing in treatment of femoral shaft comminuted fracture, we reviewed retrospectively 62 femoral shaft fractures.
MATERIALS AND METHODS
We reviewed retrospectively 62 femoral shaft comminuted fractures, who had been followed up for a minimum one year including Winquist-Hansen classification II, III, IV from January 1996 to December 2002. The group I include the patients who treated with closed interlocking intramedullary nailing. The group II include the patients who treated with open interlocking intramedullary nailing combined with cerclage wiring.
RESULTS
The average bone union time was 18.6 weeks in group I, 27.6 weeks in group II. The complication included 3 delayed unions, 1 nonunion and shortening of more than two centimeters in 1 patents in group I. In group II, The complication included 2 infections, 7 delayed unions and 3 nonunions.
CONCLUSION
We can use open interlocking intramedullary nailing with cerclage wiring in some femur shaft comminuted fractures, but there are many problems and complications. So we must consider it carefully before using this method.

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The Effect of Fibular Malreduction on Ankle Joint after Tibial Interlocking IM Nailing of Tibial and Fibular Fractures: Dong Eun Shin, Duck Yun Cho, Hyung Ku Yoon, Jin Soo Lee, Yoon Seok Lee, Hyoung Jun Kim; J Korean Fract Soc 2005;18(1):29-35. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.29

Abstract PDF

PURPOSE
To investigate the effect of fibular malreduction on ankle joint after tibia interlocking IM nailing of tibial and fibular fractures according to type of fibular fractures at preoperation.
MATERIALS AND METHODS
Thirty-nine patients who had ipsilateral tibiofibular fracture were analyzed clinically and radiographically. The talocrural angle and the distance from joint line to the tip of fibular were measured on both ankle standing AP view. The difference of angle and distance of both ankle were analyzed by paired t-test and correlation between defference and AOFAS score by Spearman correlation coefficients.
RESULTS
The difference of The talocrural angle and the distance from joint line to the tip of fibular of both ankle was statistically significant (p<0.05). The correlation between this difference and AOFAS score was statistically insignificant (p>0.05).
CONCLUSION
In tibia interlocking IM nailing of tibia and fibula fracture, malreduction of fibula could cause the change of ankle joint.

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The Risk Factors Associated with Nonunion after Surgical Treatment for Distal Fibular Fractures
Jun Young Lee, Kwi Youn Choi, Sinwook Kang, Kang Yeol Ko
Journal of Korean Foot and Ankle Society.2018; 22(3): 95. CrossRef

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Augmentation Plate Fixation for the Management of Long-bone Nonunion after Intramedullary Nailing: Kee Haeng Lee, Hyoung Min Kim, Chan Woong Moon, Youn Soo Kim, Won Sik Nam; J Korean Fract Soc 2004;17(3):265-270. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.265

Abstract PDF

PURPOSE
The aims of this study were to determine the effectiveness of the treatment using augmentation plate fixation for nonunion of long bone fracture after interlocking intramedullary nailing MATERIALS AND METHODS: Thirteen patients with nonunion of the long bone fracture after interlocking intramedullary nailing who underwent augmentation plate fixation were evaluated; followed up for more than 1 years. We evaluated five patients with nonunion of the humerus, three of the tibia and five of the femur. Twelve of thirteen patients were carried out autogenous cancellous bone graft and augmentation plate fixation was performed without removal of intramedullary nail for all patients.
RESULTS
For the cause of nonunion, seven patients were by iatrogenic factors such as insecure fixaton and six patients were by fracture itself such as severe comminution and open fracture. Bone union was achieved in thirteen patients all and the average bony union time was 4.2 months (ranged from 3 to 5.5 months) for the humerus, 6.4 months (ranged from 4 to 8.5 months) for the tibia and 7.3 months (ranged from 5.5 to 9 months) for the femur. There were no complications such as reoperation, infection or plate failure.
CONCLUSION
TAugmentation plate fixation is effective treatment option for the management of long bone fracture nonunion after intramedullary nailing.

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Augmentation Plate Fixation for the Treatment of Femoral and Tibial Nonunion After Intramedullary Nailing
Ali Birjandinejad, Mohammad H. Ebrahimzadeh, Hosein Ahmadzadeh-Chabock
Orthopedics.2009; 32(6): 409. CrossRef
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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Treatment of Distal Tibial Fractures by Interlocking Intramedullary Nailing: Jung Ryul Kim, Hyung Suk Lee, Moon Ki Choi, Kwang Bok Lee, Jong Hyuk Park, Jun Mo Lee; J Korean Soc Fract 2003;16(3):348-355. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.348

Abstract PDF

PURPOSE
To analyze the result of treatment for distal tibial fractures by interlocking intramedullary nailing.
MATERIALS AND METHODS
Eighteen patients who underwent interlocking intramedullary nailing for distal tibial fracture were followed up for more than one year. We analyzed the fracture configuration, presence of fibular fracture, angular deformity and bone union by follow-up radiograph, and complications. The functional results were assessed by Baird's ankle scoring system.
RESULTS
According to Robinson classification, there were 4 type I fractures, 12 type IIA fractures, and 2 type IIB fractures. All cases were combined with fibular fracture. The mean union period of 18 cases were 21.9 weeks. There were three complications with 3 cases of valgus deformity. In functional outcome according to Baird's ankle scoring system, 15 patients (83%) showed satisfactory results.
CONCLUSION
We concluded that interlocking intramedullary nailing is effective method for the treatment of the distal tibial fractures. However, to avoid valgus deformity of the distal tibia when combined distal fibular fracture, fibular reduction and rigid fixation should be needed.

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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
Interlocking Intramedullary Nail in Distal Tibia Fracture
Oog Jin Shon, Sung Min Chung
Journal of the Korean Fracture Society.2007; 20(1): 13. CrossRef

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Treatment of the Nonunion of Femur Shaft Fractures after Interlocking Intramedullary Nailing: Keun Bae Lee, Eun Sun Moon, Eun Kyoo Song, Jin Choi, Sung Taek Jung; J Korean Soc Fract 2002;15(4):497-503. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.497

Abstract PDF

PURPOSE
We analyzed the results of treatment for the nonunion of femur shaft fractures after interlocking intramedullary(IM) nail fixation. MATERIALS & METHODS: Thirty-three patients who underwent interlocking IM nailing due to femur shaft fractures from May, 1990 to July, 2000 and followed up for more than one year were evaluated retrospectively. Mean age at the time of operation was 40 years(Range, 19-68). 27 cases were men and 6 cases were women. By Weber and Brunner classification of the nonunion, hypervascular type were 10 cases(30%), avascular type 21cases(64%), mixed type 2 cases(6%). Infected type among the avascular type of nonunion were 5 cases(23%). Results were evaluated with bone union by treatment methods and complications.
RESULTS
According to the causes and types of nonunion, we performed IM nail exchange in seven cases, IM nail exchange and bone grafting in eleven cases, external fixation in five cases, compression plating and bone grafting in three cases, and only cancellous bone grafting in seven cases. Radiographical union was achieved in 19 weeks, 17 weeks, 20 weeks, 16 weeks and 15 weeks respectively. There 's no statistically significant difference between treatment methods. There are no cases of nonunion, malunion and infection.
CONCLUSION
The selection of appropriate treatment method by the cause and type of each nonunion is very important to achieve the bony union in the treatment for the nonunion of femur shaft fractures after interlocking intramedullary nailing.

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Results of Exchange Nailing in Hypertrophic Nonunion of Femoral Shaft Fracture Treated with Nailing
Suenghwan Jo, Gwang Chul Lee, Sang Hong Lee, Jun Young Lee, Dong Hwi Kim, Sung Hae Park, Young Min Cho
Journal of the Korean Fracture Society.2019; 32(2): 83. CrossRef

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Nail Breakage after Femoral Interlocking Intramedullary Nailing: Suk Kang, Phil Hyun Chung, Dong Ju Chae, Jong Pil Kim, Joon Han Kim, Sung Pock Park, Jae Sang Park; J Korean Soc Fract 2002;15(3):363-370. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.363

Abstract PDF

PURPOSE
We analyze the clinical causes and precautions of nail breakage followed by femoral intramedullary nailing MATERIALS AND METHODS: We reviewed 12 cases of nail breakage followed by the femoral intramedullary nailing from Jan. 1993 to Feb. 2001 and for each cases, we analyzed used nail diameter, patient weight and used nail, time to nail breakage and configuration of non-union. We classified fracture site at the time of trauma as proximal 1/3, middle 1/3, distal 1/3, and evaluated gap of fracture site, displacement of fragment after surgery, location and treatment of broken nail on each part, and analyzed the causes of nail breakage RESULTS: The average time of nail breakage was 8.1 months and distal 1/3 fracture were major as 6 cases. Those were mainly comminuted fracture of Winquist-Hansen type II. After surgery, gap of fracture site and displacement of fragment were mostly observed in middle 1/3 fracture and, in the part of middle 1/3, the site of nail breakage took place in fracture site. Especially in the distal 1/3 fracture, nail breakage happened usually in distal first locking screw hole. The causes of nail breakage were inadequately small diameter of nail inserted into the isthmic portion of medullary canal in proximal fracture, inaccurate reduction of fracture site in middle fracture, and the use of short length of nail and its mechanical damage caused by inaccurate insertion of distal locking screw in distal fracture.
CONCLUSION
To prevent nail breakage while femoral intramedullary nailing, in proximal fracture, adequate diameter of nail has to be inserted into the isthmic portion of medullary canal. In middle fracture, the accurate reduction of fracture site will be necessary, and the case of distal fracture, enough length of nail has to be used and especially it is important not to cause mechanical injury with the accurate insertion of distal locking screw in nail

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Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures
Bailian Liu, Ying Xiong, Hong Deng, Shao Gu, Fu Jia, Qunhui Li, Daxing Wang, Xuewen Gan, Wei Liu
Journal of Orthopaedic Surgery and Research.2014;[Epub] CrossRef
Limited Open Reduction and Intramedullary Nailing of Proximal Femoral Shaft Fracture
Sang Ho Ha, Jun Young Lee, Sang Hong Lee, Sung Hwan Jo, Jae Cheul Yu
Journal of the Korean Fracture Society.2009; 22(4): 225. CrossRef

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The Effect of Dynamization in Tibia Fracture: Jin Woo Kwon, Seung Ho Shin, Won Ho Cho, Woo Se Lee, Ki Ho Sung; J Korean Soc Fract 2001;14(1):52-59. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.52

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the effect of dynamization which was done for the treatment of delayed union or persisting fracture gap after interlocking intramedullary nailing, by radiographic and physical examination.
MATERIALS AND METHODS
We analyzed 22 cases these were treated with dynamization from 247 cases of tibia shaft fracture treated initially with static interlocking intramedullary nailing from February l990 to May 2000 and were followed up more than lyear. The result of dynamization was classified as 3 groups and we divided each results 3 categories that is effective result, uncertain result and ineffective result. Group A is cases that achived ultimate union with shortening of fracture gap and was 10 cases. Group B is that achieved ultimate union but fracture gap did not reduced and was 10 cases. Group C is that showed ultimate non-union and was 2 cases.
RESULTS
The result is that dynamization was effective only 4 cases of group A. 6 cases of group A and 4 cases of group B showed instability(radiolucent halo around nail, hypertrophied callus and leg pain), and 6 cases of group B showed no shortening of fracture gap, thus these were classified as uncertain result. Group C(2 cases) showed non-union, classified as ineffective.
CONCLUSION
Dynamization caused instability in most tibia fractures except simple mid-shaft fracture. So in the comminuted fractures and distal or proximal l/3 oblique fractures, other procedures such as bone graft, refixation should be considered rather than dynamization.

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Treatment of open Tibial Shaft Fractures with Unreamed Interlocking Intramedullary Nailing: Jeung Tak Suh, Byung Guk Park, Chong Il Yoo; J Korean Soc Fract 1999;12(3):568-576. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.568

Abstract PDF: Severe open fracture of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilization was by external fixation, but the advent of small diameter interlocking intramedullary nails has introduced a new option. From the June 1992 to December 1997, 55 cases of open tibial shaft fracture were treated with unreamed interlocking intramedullary nailing at the department of orthopedic surgery, Pusan National University Hospital. The purpose of this study is to evaluate its result and complications. Mean age was 31, mostly male. The main cause of trauma was traffic accidents(30 cases, 55%) and fracture sites consisted of mid 1/3 portion over 75%. According to the Gustilo & Anderson classification 8 type I(15%), 22 type II(40%), 15 type IIIA(27%) and 10 type IIIB(18%) were shown. Union time was 28.3 weeks on an average and union rate was 98%. There were 5 cases(9%) of delayed union, 2 cases(4%) of deep infection and 1 case(2%) of chronic osteomyelitis. In conclusion unreamed interlocking intramedullary nailing can be the first choice treatment in the treatment of open tibia shaft fractures with low postoperative infection.

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Interlocking Intramedullary Nailing for the Treatment of Segmental Tibial Shaft Fractures: Kyung Jin Song, Young Keun Lee, Jeong Yeul Kim, Byung Yun Hwang; J Korean Soc Fract 1999;12(1):69-75. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.69

Abstract PDF: The treatment of segmental tibial shaft fractures poses many problems because of the serious damage to the surrounding soft tissue that usually occurs from the high-energy trauma, and the results are often unsatisfactory following lots of complications like non-union, delayed union, malunion, and infection We studied to evaluate the treatement results of interlocking intramedullary nailing for the segmental tibial shaft fractures. Twenty-two cases of segmental tibial shaft fractures were reviewed and we analyzed the results of surgical treatement in the viewpoint of bony union times, complication and its final outcome. The range of follow-up was 12 months to 68 months with mean 38 months follow-up. Most of the patients were between forty and sixty years, and average age was 47 years. Associated injury was incurred in nineteen cases with various musculoskeletal symptoms and signs. According to Meils classification, 8 were Type I, 1 was Type II and 3 were Type IV of the 12 closed fractures. Of the 10 open fractures, 4 were Type, 2 were Type II, 3 were Type IV, and 1 demonstrated multisegmental fractures. All of the closed fractures were united well except only one infected nonunion. The average time to union was 21.6 weeks with range from 16 to 26 weeks. The healing was tlowest in Type IV and fastest in Type I fractures. There was no significant difference in the healing time between the distal and proximal fractures. Of the 10 open fractures, each one of open type I fracture and open type II fractures did not united because of infected nonunion. The average time to union was 26.4 weeks with range from 16 to 38 weeks for the remaining 8 open fractures. The healing was slowest in Type IV and fastest in Type I fractures. There were 3 cases of infected nonunion, 1 case of delayed union of the proximal fracture and 1 case of valgus deformity of distal fracture. The infection was controlled and bone union obtained with removal of the nail and reaming, curettage and antibiotic bead wire, and plating with bone graft. We recommand that wherever poslible, interlocking intramedullary nailing can be used for the closed or open type I and II segmental tibial shaft fractures. And a high rate of union and a low rate of complication can be expected with this treatment modality.

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Interlocking Intramedullary Nailing for the Treatment of Segmental Fractures of the Femur: Kyung Jin Song, Hwang Jik Kim, Jeong Yul Kim, Joo Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1998;11(3):522-527. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.522

Abstract PDF: Segmental femoral fractures are unusual injury caused by a severe force and associated with marked demage to the soft tissue, especially the quardriceps muscle. Intramedullary nailing is the most common treatment modality for the segmental femur fractures with high union rate and few complications. The purpose of this study is to evaluate the results of surgical treatment with interlocking intramedullary nailing for the segmental femoral fractures. We analyzed 23 consecutive segmental femoral fractures with static interlocking nail from May, 1989 to Feburary, 1997. Major associated injuries were sustained in 18 cases. There were 19 closed and 4 open fractures. Eighteen cases(78.3%) were done by closed technique and 5 cases(21.7%) were done by open technique. All fractures united at an average of 25.9 fractures. There were 3 malunion, 1 shortening(18mm) and stiffness of knee, 1 delayed union, and 1 limited motion of the knee. delayed union was treated by dynamization and autogenous bone graft, and additional intervention for union was unnecessary for the other problems. Although interlocking intramedullary nailing for the segmental femoral fracture is a techniqually demanding procedure, we recommand that it is the treatment of choice for closed and open(open type I) segmental fractures of the femur.

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The Effect of Dynamization After Static Intelocking Intramedullary Nailing: Kyoo Seog shin, Jong Soon Kim, Kong Wha Lee, Jin Hwan Seo; J Korean Soc Fract 1998;11(2):262-268. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.262

Abstract PDF: We had investigated the effect of dynamization in static interlocking intramedullary nailing for the long bone fracture of the femur and tibia treated in Bongseng Memorial Hospital for last 3 years (from Jan. 1994 to Jan. 1997) Total 62 patients (37 tibia, 28 femur) were treated, 35 cases were reamed at operaion and 27 cases not reamed. following results were obtained; 1. In all except 24 fractures, the static interlocking intramedullary nail was preserved without dynamization and got to mean union time of 17.2 weeks (femur) and 6.4 weeks (tibia). 2. The 24 patients (14 femur, 10 tibia) did not show callus formation and complained of vague pain in fracture site at 20 weeks after static mode. In those cases, we tried dynamization as a initial treatment modality. 3. The success rate after dynamization was about 87%. 4. The interval between nailing and dynamization did not affect the success rate. 5. Dynamization could be done day surgery.

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The Clinical Results of Unreamed Interlocking Intramedullary Nailing for Tibial Fractures: Young Ho Kwon, Hyun Mok Yang; J Korean Soc Fract 1997;10(3):569-574. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.569

Abstract PDF: Recently interlocking intramedullary nailing is used widely for the management of tibial shaft fractures. We evaluated any differences in healing time and complications associated with reamed and unlearned tibial interlocking intramedullary nailing. Between January 1991 and February 1996 we performed a retrospective trial on 62 patients with tibial shaft fractures comparing the reamed with unlearned interlocking nailing. The mean time to union for patients with unlearned intramedullary nail was 18.5 weeks(13 to 32 weeks) which was significantly less(P<0.05) than the 21.7 weeks(16 to 36 weeks) for reamed group. The complications of the reamed interlocking intramedullary nailing were three delayed unions (9.3%), three superficial infections(9.3%), and two cases of knee joint or ankle joint LOM(6.2%). The complications of the unlearned interlocking intramedullary nailing were four delayed unions(13.9%), three angular deformities(10.3%), three screw breakages(10.3%), and one superficial infection(3.4%). Unlearned interlocking intramedullary nailing is better for the tibial shaft comminuted fractures with small diameter, unstable tibial isthmus fractures, pelytraurnatized patient and some type of open fractures.

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Treatment of Distal Tibial Fractures by Interlocking Intramedullary Nailing: Bu Hwan Kim, Joung In Yim, Hee Yeong Chung, Jung Ju Kim; J Korean Soc Fract 1997;10(2):316-323. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.316

Abstract PDF: Intramedullary rigid nailing has been used to treat diaphyseal fracture of tibia, but with improvement of practical technical ideas, especially development of interlocking transverse screw, the indication of intramedullary nailing for tibial fracture became expanded to the fractures occurred 3cm proximal to the ankle joint. We treated 34 distal tibial fractures from Mar. 1992 to Feb. 1995 and followed up at least more than one year. The results of treatment were as follows ; 1. Time for union was 11.3 weeks in closed fracture group and 19 weeks in open group. 2. According to the functional classification of Klemm and Borner, excellent and good results were obtained in 30 cases(94.1%). 3. Complications developed in 7 cases which include ankle motion limitation, angular deformity, delayed union.

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Nonunion after Interlocking Intramedullay Nailing in Tibia Segmental Fractures: Jin Hong Rhee, Jeong Woung Lee, Jae Yong Cho, Sang Won Bae, Seog Hyun Yoon, Ju Youn Lee; J Korean Soc Fract 1997;10(2):309-315. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.309

Abstract PDF

Tibial segmetnal fracture, usually caused by strong external force has recently been increased in frequency because of increased traffic accident. This type of fracture has been well known to be very difficult to manage on reduction and maintenance of reduction, and also that it has high rate of complications such as delayed union, nonunion, infection and etc., because of high incidence of open fracture and association with other injury. For the management of this type fracture there are various methods from conservative care to operative treatment such as internal or external fixation. We analyzed nonunion of 8 cases who underwent interlocking intramedullary nailing for tibia segmental fracture. The results were as follows ; 1. Interlocking intramedullary nailing for the treatment of tibia segmental fractures were done in 29 cases(76.31%) out of total 38 tibia segmental fractures. 2. Nonunion occurred in 8 out of 29 cases(27.6%). 3. Nonunion occurred at the distal fracture site in 7 cases and both proximal and distal fracture site in 1 case. 4. Nonunion occurred in 4 cases of open fractures, 3 cases of closed fractures with compartment syndrome. 5. Nonunion occurred in 5 cases of Melis type IV, fracture, 2 cases of type I and 1 case of type II fracture. Although the interlocking intramedullary nailing is thought to be good method for the tibia segmental fracture, our study showed relatively high rate of nonunion especially, at the distal fracture site, in case of open fracture, associated with compartment syndrome and Melis Type IV fracture. On the basis of this study we recommend that closer attention should be paid to the method of treatment, fracture type, severity of comminution, open or closed fracture, degree of soft tissue injury, and fracture site.

Citations

Citations to this article as recorded by

Funciones entre dendroides (abanicos) que (no) preservan (no)contractibilidad
José G. Anaya, Félix Capulín, Mónica Sánchez Garrido
Revista Integración.2021;[Epub] CrossRef
Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures
Sang Soo Park, Jun-Young Lee, Sang-Ho Ha, Sung-Hae Park
Journal of the Korean Fracture Society.2013; 26(4): 275. CrossRef

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Problems of Interlocking Intramedullary Nailing for Fracture Treatment: Bu Hwan Kim, Jong In In, Yi Chul Kim; J Korean Soc Fract 1997;10(1):142-149. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.142

Abstract PDF: With the introduction of image intensifier in orthopaedic surgery, interlocked intramedullary nailing is one of the most prevailing method in the treatment of long bone fracture especially in femur and tibia. Advantages of this method are rigid fixation of fracture fragment resistant to rotational force, low infection rate, possible early post-operative motion and weight bearing and bone graft effect by medullar reaming procedure. But we had encountered variable complications during and after operation of 63 cases in 59 patients who had undergone interlocking nailing for femur or tibia fractures from Mar 1990 to Feb 1992 at Dae Dong General Hospital. The results were as follows : 1. Delayed union and nonunion developed in nine cases and infection was noted in nine cases, seven of them were superficial infections. 2. Operative complication were encountered with four cases of new fracture, three cases of angolation deformity, four cases of shortening. 3. Four cases of nail profusion was developed because of inadequate implant length. Postoperative metallic failure was found in three cases. 4. Sufficient preoperative planning and skillful technique can decrease the complications.

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Interlocking Intramedullary Nailing in the Treatment of the Tibial Shaft Fractures: Comparative Study between Reamed and Unreamed Nailing: Jae Hoon Lee, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 1996;9(4):993-1001. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.993

Abstract PDF: Interlocking intramedullary nailing has been popularized by its many advantages in the fracture treatment of long bone compared with the other fixatives. The purpose of this paper was to evaluate the treatment results in the viewpoint of bone union, complication and functional outcomes of the interlocking intramedullary nailing between reamed and unlearned technique in the treatment of tibial shaft fractures. We reviewed 64 tibial shaft fracture that were treated at our hospital from May 1990 to February 1995 with interlorking intramedullary nailing that composed 36 reamed, and 28 unlearned cases. These included 33 open fractures and 34 closed fractures. There was no significant di florences in average prriod of radiologic union, complications and in the functional outcomes between the two treatment grovps(P<0.05). Unlearned interlocking intramedullary nailing in the tibial shaft fractures must be a goof treatment modality by its simplicity, shorter operation time, less probability in pulmonary and throrrlboembolic complications and less comprormised medullary blood supply, especially in patients with multiple trauma or open fractures.

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Treatment with Unleamed Interlocking Intramedullary Nail for Tibial Shaft Fracture: Hyung Ku Yoon, Kwang Pyo Jeon, Dae Eun Jung, Ho Seung Jeon, Man Je Park; J Korean Soc Fract 1996;9(2):466-474. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.466

Abstract PDF: Recently intramedullary nailing has become the most common method treating tibial fractures. Reamed intramedullaiy nailing technique leaves the problem of destorying the endosteal blood supply, which associated with delayed union and postoperative infection. Recent reports have shown excellent rate of union and low rate of intection with unlearned interlocking intramedullary nail. Author reviewed 58 cases of tibia shaft fractures that were treated with unrealned interlocking nail from Feb. 1992 to Feb. 1994. 1. Furty nine fractures were closed and 9 were open (Gustilo-Andersonl;3,II;5, IIIa;1). Thrity one fractures involved the distal portion, 19 fractures the middle portion, 6 fractures tile proximal portion and 2 fractures were segmental. 2. Thirty six cases were male and 22 were female. The most common age was 3rd decade (25.8%). 3. The most common caute was traffic accident. 4. Average interval from injury to operation were 5.7 days in close fracture and 11.3 days in open fracture. 5. The mean duration of bone union were 15.7 weeks in closed fracture and 19.5 wreks in open fracture. 6. Complications include 1 case of delayed union, 1 case of joint stiffness and 1 case of screw failure. 7. According to the functional results by Klemm and Borner, 42 cases were excellent, 15 cases were good and 1 was fair.

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Treatment of femoral Shaft Fractures with Static Interlocking Intramedullary Nailing: Choong Hee Won, Seung Baik Kang, Kun Shin, Kyung Chul Jeon, Jin Sun Yoe, Kwan Hwan Jang; J Korean Soc Fract 1995;8(3):533-537. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.533

Abstract PDF

We managed thirty-five patients who had a fracture of the femoral shaft with interlocking fixation and twenty-five of thirty-five patients healed without conversion to dynamic intramedullary fixation and followed more than a year. The results of treatment of fractures of the femoral shaft with static interlocking nailing were reviewed. The average duration of follow-up was sixteen months(range, twelve to twenty-four months). Radiographic consolidation was seen in all fractures at a median of sixteen weeks(range, eight to twenty weeks). There were no non-unions. We concluded that routine conversion of static interlocking to dynamic interlocking is not necessary in the intramedullary nailing of the femur shaft fractures.

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Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult
Yong-Woon Shin, Yerl-Bo Sung, Jeong Yoon Choi, Minkyu Kim
Journal of the Korean Fracture Society.2011; 24(4): 313. CrossRef

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Problems and Complications after Interlocking Intramedullary Nailing for Femoral Fracture: Young Bae Pyo, Sang Hong Lee, Young Hyun Jeon; J Korean Soc Fract 1995;8(3):505-512. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.505

Abstract PDF: Interlocking nailing is the best method available in treatment of femoral shaft fracture dui to its many advantages compared with other method. However, we have encountered many problems during the operative procedure and postoperative periods due to technical complexities. After we have evaluated problems during and after the procedure of interlocking nailing for the femoral fractures in 56 cases, we suggest the means to avoid these errors and complications. 1. Among the 54 patients,39 complications and technical errors have been reported in 19 patients. 2. Intraoperative complications and technical errors were encountered in ; 9 cases of improper portal of entry, 3 cases of new fragmentation,3 cases of angulation,2 cases of new fracture line,2 cases of failure of distal locking screw insertion,2 cases of distraction of fracture site, 1 case of proximal protrusion of nail and 1 case of rotation of nail. 3. Postoperative complications were encountered ,6 cases of delayed union,2 cases of nonunion,2 cases of limb shortening,2 cases of deep infection,2 cases of loosening of distal locking screw, 1 case of breakage of distal locking screw and 1 case of failure of nail.

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Comparative Study between Compression Plate with Screw Fixation and Interlocking Intramedullary Nailing of Tibial Shaft Fractures in Adult: Sang Won Park, Jong Hoon Park; J Korean Soc Fract 1995;8(1):278-283. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.278

Abstract PDF: Various methods have been used in the treatment of tibial shaft fractures in adults. In recent years, generally accepted two surgical methods are compression plate with screw fixation and intramedullary nailing. The authors reviewed 73 cases of tibial shaft fractures, treated by operation in Department of Orthopedic Surgery, Korea University Hospital from June 1986 to April 1993 and minimum follow up period was one year. All cases were devided into 2 Groups, open reduction with compression plate fixation(35 cases) and closed reduction with interlocking intramedullary nailing(38 cases), and the two-groups were compared with each other. The results were as follows: 1. The average time of clinical and radiological union were 17.5 weeks & 26.3 weeks in the compression plate group and 12.3 weeks & 18.5 weeks in the interlocking intramedullary nailing group respectively. 2. Bony union rate was not influenced by the level of the tibial fracture. It was delayed especially in the comminuted fracture. 3. Two cases of delayed union, one case of superficial infection and two cases of limited range of motion occured in the compression plate group. Two cases of delayed union and one case of infection combined limited hee motion occured in the interlocking intramedullary nailing group. 4. According to our clinical study, interlocking intramedullary nailling is regarded as a better method for the management of comminuted tibial shaft fracture than compression plaate and screw fixation.

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Treatment of Unstable Tibial Fracture Using Interlocking Intramedullary Nailing: In Suk Oh, Do Hyun Moon, Jin Hong Ko, Su Chan Lee, Yeoung Hun Jang; J Korean Soc Fract 1995;8(1):269-277. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.269

Abstract PDF: With increasing industrial and traffic accident, tibia fractures by high energy has been increased and their treatment is difficult. There are many controversy concerning the method of treatment, because of many complications, such as malunion, delayed union, nonunion, infection and joint contracture. The use of an intramedullary nail with interlocking bolts, either closed or open thchnique has became an attractive alternative method of treatment for unstable fracture of tibia. From Januaiy, 1987 to December,1992 we treated 63 fractures of the tibia by minipulative reduction and fixation of the fracture fragments with rigid intramedullary nail at Department of Ouhopaedic Surgery Choong-ang Gil Hospital. The following result was obtained. 1) The average time from injury to operation is in closed and open fracture, 6 and 21 days respectively. 2) Of 63 fractures, 60 fractures united and the union rate was 95.2% 3) The average time of bone union was the 19.3 wks : the 17.8 wks in closed fracture ; the 21.6 wks in open fracture ; the 22.3 wks in Non-union. 4) Regardless of amount of comminution, we treated tibial fractures extending from 3 CM distal to the tibial tuberosity to 5 CM above the ankle joint. 5) Static and dynamic interlocking nailing were done 44 and 19 cases respectively. 6) We permitted weight bearing within 2 weeks in butterfly or oblique fracture within 6 weeks in communited or segmental fracture. 7) According to the functional classification of Klemm and 3,orner, among 63 cases, 35 were excellent,20 good,5 fEir and 3 poor.

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Clinical Results of the Delayed & Non-union of the Long Bones with Interlocking Intramedullary Nailing: Han Suk Go, Yoon Seong Yoon, Eung Sun Ahl; J Korean Soc Fract 1994;7(1):167-173. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.167

Abstract PDF: Delayed & non-union are common complications of the fracture of long bones. Many kinds of treatment modalities for delayed & non-union have been reported, but rigid fixation and bone graft have been the most common accepted method. The interlocking Intramedullary nailing technique has advantages which the rigid internal fixation and bone grafting effect of reaming debris. We treated nine cases of delayed & non-union of femur and tibia at the Department of Orthopedic Surgery, Seoul Paik Hospital from Jan. 1990 to Octo. 1992 and results were as follows. 1. Nine cases of the delayed & non-union were consisted by 7 cases of femur and 2 cases of tibia. 2. Causes of delayed & non-union were failure of implants in 4 cases, inadequate and inappropriate immobilization in 3 cases, and persistent gap in 2 cases. 3. Union was achieved in 7 cases and union rate is 77.8%.

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