Journal of Musculoskeletal Trauma

Two-part and Three-part Fractures of the Proximal Humerus Treated with the Polarus Interlocking Nail: A Comparison of Fracture Types: Kyu Cheol Noh, Yung Khee Chung, Kook Jin Chung, Sung Ku Hong; J Korean Fract Soc 2006;19(2):182-187. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.182

PURPOSE
To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with the Polarus interlocking nail, comparing their fractures types.
MATERIALS AND METHODS
There were 22 patients with displaced proximal humerus fractures. There were 10 surgical neck (SN) and 1 anatomical neck (AN) two-part fractures and 10 greater tuberosity/surgical neck (GT/SN) and 1 GT/AN three-part fractures. All patients were surgically treated solely with the Polarus interlocking nail using a closed technique. Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score, which grade outcomes as excellent (>75), satisfactory (50~75), poor (<50) results. Radiographic outcome measurements included fracture alignment (neck-shaft angle), loosening of screw, fixation and hardware failure, and malunion and nonunion.
RESULTS
Overall, the average ASES score was 80.2 (range 46.0 to 98.0). There were 15/22 (68.2%) excellent, 6/22 (27.3%) satisfactory, and 1/22 (4.5%) poor results. All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. When comparing patients with two-part fractures (n=11) with patients having three-part fractures (n=11), there were statistically significant differences with ASES outcome measures (p<0.05). But, there were no statistically significant differences in age-related analysis (p>0.05).
CONCLUSION
Both displaced two-part fractures and three-part GT/SN fractures can have above satisfactory functional and radiographic outcomes with the Polarus interlocking nail using a closed technique. Even though displaced three-part GT/SN fractures in elderly osteopenic patients (>60 years), we treated successfully with the Polarus interlocking nail.

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Polarus Intramedullary Nail for Proximal Humeral and Humeral Shaft Fractures in Elderly Patients with Osteoporosis
Youn-Soo Hwang, Kwang-Yeol Kim, Hyung-Chun Kim, Su-Han Ahn, Dong-Eun Lee
Journal of the Korean Fracture Society.2013; 26(1): 14. CrossRef
Intramedullary Nailing for Complex Fractures of the Proximal and Midshaft of the Humerus
Chul-Hyun Cho, Gu-Hee Jung, Kyo-Wook Kim
Journal of the Korean Fracture Society.2011; 24(3): 237. CrossRef

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Fatigue Fracture of the Interlocking Nail in the Treatment of Femoral Shaft Fractures: Jung Ryul Kim, Jin Ho Yoon; J Korean Soc Fract 2003;16(2):163-168. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.163

Abstract PDF: PURPOSE
To analyze clinical and mechanical factors of the fatigue fracture of the intramedullary nail in the treatment of the femoral shaft fractures and to consider preventive methods of fatigue fracture.
MATERIALS AND METHODS
We reviewed 12 patients of fatigue fractures of the intramedullary and were followed for a minimum one year. The site of fatigue fracture of the intramedullary nail was at fracture site in 10 cases, just proximal to proximal locking hole in one, and the most proximal of two distal locking holes in one. We analyzed type and diameter of broken nail, time from injury to fatigue fracture, causes of metal failure, and treatment results.
RESULTS
Intramedullary nails which had fatigue fracture were reamed AO nail in four cases, Grosse-Kempf nail in four, Russel-Taylor nail in three, and long Gamma nail in one. Time to fracture of implant was average 13.6 months (range, 6~30 months). All cases were treated by intramedullary nailing, and additional autogenous bone grafting was done in three cases. At an average duration of follow-up of 7.5 months (range, 5 to 10 months), all of the fractures had healed.
CONCLUSION
To prevent fatigue fracture of intramedullary nail, closed obervation for bony union, progressive weight bearing, and augmentation with autogenous bone grafting for comminuted fracture site should be needed.

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Unreamed interlocking nailing in tibia fracture: You Sung Suh, Young Il Cho, Ho Won Jung, Yeon Il Kim; J Korean Soc Fract 2002;15(4):470-476. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.470

Abstract PDF: PURPOSE
To evaluate of clinical results and malunion according to nail insertion site and early ambulation after unreamed interlocking intramedullary nailing for the treatment of tibial fractures, MATERIALS AND METHODS: We reviewed 46 tibial fractures that were treated with unreamed static intramedullary nailing prospectively from March 1997 to May 2001. Nail insertion site and angulation of fracture site were reviewed by radiograph. All of 46 cases, ambulation was started at postoperative 2 weeks, and then clinical outcomes were reveiwed RESULTS: In all 46 cases, union was achieved at average 18.2 weeks clinically and average 19.4 weeks radiographically. There is no significant difference in angulation according to nail insertion site, i,.e. after central/medial/lateral insertion, outcome was 2 . 4 5 degrees +/-2 . 1 7 / 2 . 2 2 degrees +/-1 . 8 4 / 1 . 7 3 degrees +/-1.33(p; 0.705) in last follow up anterioposterior view, and 1.81 degrees +/-1 . 1 3 / 2 . 6 7 degrees +/-1 . 6 2 / 2 . 0 0 degrees +/-1.64(p; 0.320) in last follow up lateral view. No breakage of intramedullary nails and no stiffness on adjacent joints.
CONCLUSION
We confirmed that unreamed interlocking nailing in tibial fractures is one of the effective method for low recurrence of malunion and early ambulation

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Interlocking Intramedullary Nailing of the Proximal Humerus Fracture in Elderly Patients over 65 Years old: Hee Gon Park; J Korean Soc Fract 2002;15(3):385-390. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.385

Abstract PDF: PURPOSE
The purpose of this study is to document the result of the interlocking intramedullary nailing of the proximal humerus fracture in eldery patients over 65 years old.
MATERIALS AND METHODS
We performed a clinical and radiographic assessment after a follow up period exceeding 12months of 14cases of interlocking intramedullary nailing of proximal humerus fracture.
RESULTS
By Kronberg 's radiogrphic evaluation, 9 cases were good, 4 cases were acceptable, 1 case was poor. The average pain index was 3.2 point by Howkins guide line. All patients complained about final range of motion, especially in abduction and flexion movement.
CONCLUSION
Though the interlocking intramedullary nailing was an attractive alternative for the proximal humerus fracture stabilization for early rehabilitation in eldery patients over 65 years old, but should be consideration for postoperative shouder pain and loss of motion

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The Result of Treatment in Fracture of the Proximal Humerus: Man Je Park, Byeong Yeun Seong, Seung Ki Lee, Taek Gun Lee, Sang Yol Shin, Hyung Su Kim; J Korean Soc Fract 2002;15(2):299-306. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.299

Abstract PDF

PURPOSE
To evalute the anatomical and functional outcome after treatment for proximal humerus fracture according to surgical and conservative treatment and assess the final results according to treatment methods.
MATERIALS AND METHODS
Forty-two cases with follow-up over 12 months were divided into three groups: conservative treatment (Group 1, 20 cases), closed reduction with Rush or percutaneous pin fixation (Group 2, 11 cases), proximal intramedullary interlocking nailing(Group 3, 11 cases). The functional outcome was obtained by modified neer method using self-assessed score paper and the anatomical outcome was obtained by paavolainen method using radiologic film score. Statistics in comparing with the result of each group was analized by variance analysis using Generalized Liner Model and Fisher?s exact test.
RESULT
Anatomical reduction was best obtained in group 3 (p< 0.05) and mean duration of bone union was 10.33 weeks. Functional score was also best obtained in group 3 (p<0.05). Complication was noted in 9 cases. There was only 1 case in group 3. In studing of overall outcome, the group 3 has good result than other groups.
CONCLUSION
Proximal intramedullary interlocking nailing in displaced proximal humerus fracture can be demonstrated as better method for anatomical reduction(p<0.05) than other methods because it can make insertion of locking screw ease with multiple direction for anatomical reduction and can provides a sufficient fixation for early rehabilitation and union , while minimizing complication.

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Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?
Woo-Bin Jung, Eun-Sun Moon, Sung-Kyu Kim, David Kovacevic, Myung-Sun Kim
BMC Musculoskeletal Disorders.2013;[Epub] CrossRef
Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture
Doo-Sup Kim, Dong-Kyu Lee, Chang-Ho Yi, Jang-Hee Park, Jung-Ho Rah
Journal of the Korean Fracture Society.2011; 24(2): 144. CrossRef

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Interlocking Intramedullary Nailing of the Humerus Shaft Fractures: Ji Ho Lee, Jin Soo Park; J Korean Soc Fract 2000;13(4):982-991. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.982

Abstract PDF: PURPOSE
The purpose of this study is to document the results of the interlocking nailing of the humerus fractures which is still controversial.
MATERIALS AND METHODS
Twenty three cases of interlocking intramedullary nailing was done. 13 nails were inserted through the shoulder, 10 nails through the olecranon fossa. We used a closed technique for the 22 cases of the nailing.
RESULTS
Most patients who had antegrade nailing complained of shoulder pain. The bony union was obtained in 8 patients(61.5%) with antegrade nailing patients, somewhat high rate of nonunion compared to other methods of treatment. Criticism of the procedure is because of the trauma that can occur to the rotator cuff and possible impingement syndrome, which can occur after antegrade insertion. As for the retrograde nailing patients, the union rate was 90%, higher than that of antegrade nailing patients, but without statistical significance. Fracture propagation(3 cases), limitation in elbow extension(1 case) and rotational deformity(1 case) were occurred in retrograde nailing patients.
CONCLUSION
Though interlocking intramedullary nailing are an attractive alternative for humeral fracture stabilization because of the limited surgical exposure, there must be further considerations for the insertion site problems and improvement in bony union rate.

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Interlocking Nailing in Segmental Tibial Fractures: The Problems of the Fractures involving Proximal Portion: Ki Soo Kim, June Young Song, Kwang Soo Shon, Joon Han Kim; J Korean Soc Fract 2000;13(4):912-920. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.912

Abstract PDF: PURPOSE
To analyze the clinical features and treatment results of the tibial segmental fractures with the interlocking nailing. To compare the results between the segmental fractures with (Group I) or without (Group II) involving proximal portion of the tibia.
MATERIALS AND METHODS
We analyzed 16 patients, 16 cases of the tibial segmental fractures treated with the interlocking nailing between April 1993 and November 1998.
RESULTS
We obtained solid bone union for all cases and relatively good clinical results. The average bone union time was 20.6 weeks. The functional results were excellent in 7 cases, good in 6 cases and fair in 3 cases. There were 8 cases of malunion. The comparison between Group I and Group II revealed no remarkable differences for bone union time, functional results and complications. But the tendency of the malunion was more higher in Group I.
CONCLUSION
For segmental tibial fractures, interlocking nailing showed good clinical results. We propose that open reduction and internal fixation should be done before interlocking nailing of the fractures involving proximal portion of the tibia.

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The Angular Deformity of Interlocking Nailing in Tibial Fractures: Hwa Jae Jeong, Kyung Chul Kim, Jae Yeul Choi, Bon Seop Koo, Jung Hee Oh; J Korean Soc Fract 2000;13(4):905-911. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.905

Abstract PDF: PURPOSE
We studied the relationship between angular deformity and possibly contributing factors in the treatment of tibial fractures with interlocking nailing.
MATERIALS AND METHODS
Intramedullary nailing of the tibia was performed on 49 cases and were followed for the minimum of 12 months. We analyzed relationship between angular deformity and postoperative tibial alignment, operative technique and other factors.
RESULTS
Of the 49 cases, 19(38%) were angulated. Angular deformity was seen in 60%, 51.8% and 11.8% in the proximal, distal and middle third of tibial fractures respectively. With AO classification, Group A,B,C were angulated in 32.4%, 55.6%, 66.7%. In group A, 43.8% of spiral fractures, 28.6% of oblique fractures and 14.3% of transverse fractures were angulated. The cases combined with fibular fracture showed higher incidence of angular deformity than the cases with intact fibula. The opening of fracture and the nail insertion site were not significant to angular deformity.
CONCLUSION
Angular deformity of interlocking nailing in tibial fractures were more common in proximal, comminuted and spiral fractures. Precise attentions to operative technique i. e. accurate anatomical reduction and centromedullary nail orientation are recommended to prevent angular deformity. In proximal third tibial shaft fractures where muscles and patellar tendon has deforming force on fracture fragment, authors believe that use of interlocking nailing must be limited with fracture pattern.

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Treatment of Humerus Shaft Fracture with Intramedullary Nail: Dong Kyu Shin, Kwoing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Chang Hyuk Choi, Sang Bong Ko; J Korean Soc Fract 2000;13(3):562-569. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.562

Abstract PDF: PURPOSE
This study was performed to evaluate the results of treatment of the humerus shaft fracture with interlocking IM nail.
MATERIALS AND METHODS
The result of IM nailing for 29 patients with humerus shaft fracture were evaluated radiologically and clinically. We tried to compare the result of Seidel nail and that of interlocking nail.
RESULTS
The results were as follows ; 1. Nonunion rate was 50% in Seidel nail group and 27% in interlocking nail group(p=0.264). 2. Operation time was shorter in Seidel nail group(67.8min) than in interlocking nail group(115.4min)(p=0.002). 3. Fracture site distraction was present in 9 cases and resulted in nonunion in 8 cases. 4. Union time except the nonunion cases was 10.4weeks in Seidel nail group and 11.9weeks in interlocking nail group but was not considered to be significant due to many nonunion cases. 5. Proximal protrusion was present in 6 cases but resulted in shoulder LOM and pain in only 2 ). cases.
CONCLUSION
Although the operation time in Seidel nail group was shorter than in interlocking nail group, we couldn't find any other difference between the two nails. The results of treatment of humeral shaft fracture with interlocking nail was unsatisfactory in terms of union rate, complications, union time and functional result.

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A Comparison of Interlocking Nail with Wiring versus Plate Fixation in Long Oblique or Spiral Fractures of Humeral Shaft: Phil Hyun Chung, Sang Ho Moon; J Korean Soc Fract 2000;13(3):555-561. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.555

Abstract PDF: PURPOSE
To compare functional results between interlocking intramedullary nail with wiring and plate for treating long oblique or spiral diaphyseal fractures of humerus.
MATERIALS AND METHODS
From April 1996 to February 1999, 9 long oblique or spiral fractures were treated with antegrade humeral locked nails and wiring after minimal open reduction, and another 9 fractures were fixed with plate and screws. Average age of patients was 45.8 years and average follow-up was 13.5 months.
RESULTS
Nail group showed earlier clinical and radiologic union than plate and screw group. All patients with plate and screw group(plate fixation) had clinical union within 5.8+/-2.5 weeks and radiologic union within 8.5+/-2.1 weeks. But, all patients with wiring had clinical union within 2.8+/-0.6 weeks and radiologic union within 5.5 +/-1.6 weeks. At last follow-up, average range of shoulder motion in plate group was larger than nailing group, but that was stastically insignificant. Plate fixations had more complications than nailing, for example, deep infection, non-union, implant failure and radial nerve injury.
CONCLUSION
Interlocking intramedullary nail with wiring has the advantages of minimal tissue trauma and scar formation, sufficient reduction and fixation, early union and fewer complication. So it can be a worthy alternative for the treatment of long oblique or spiral fractures of humerus.

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Comparison of Intramedullary Nailing and Plate Fixation for the Treatment of Nonunion of the Long Bone Fracture on Lower Extermities: Jong Seok Park, Jae Hoon Lee, Hee Kwon, Jae Eung Yoo, Joon Min Song, Yeon Il Kim, Chang Uk Choi; J Korean Soc Fract 2000;13(2):327-333. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.327

Abstract PDF: PURPOSE
: Under the principle of rigid fixation and bone graft, we analyzed and compared the clinical results in the treatment of nonunion of long bone fractures using plate fixation and intramedullary nailing with or without bone graft.
MATERIALS AND METHODS
: We used 19 cases of plate fixation and 19cases of intramedullary nailing with or without bone graft for the treatment of the nonunion of long bone from Mar. 1994 through Feb. 1997. We analyzed and compared the clinical results of plate fixation and intramedullary nailing with bone graft in the treatment of nonunion of fracture.
RESULTS
: The mean bone union time according to nonunion type in case of plate fixation was 22.6 weeks in the hypertrophic type and 16.4 weeks in the atropic type(p<0.005). In case of intramedullary nailing was 20.4 weeks in the hypertrophic type and 15.3 weeks in the atropic type(p<0.05). According to the bone graft in case of plate fixation, 20.8 weeks in the autogenous bone graft and 19.3 weeks in the combination of autogenous bone graft and allo-bone graft(p>0.05). In case of intramedullary nailing, 16.9 weeks in the autogenous bone graft and 22.7 weeks that dosen't bone graft. According to the radioligical bone union time was 20.1 weeks in the plate fixation and 18.7 weeks in the intramedullary nailing(p>0.05).
CONCLUSION
: There was on significant difference according to the method of fixation, but the treatment of nonunion of long bone in lower extremities using intramedullary nailing will be good because of early ROM exercise and weight bearing ambulation than plate fixation. Although the type of nonunion is hypertrophic in the case of intramedullary nailing, bone graft is helpful to promote bony union.

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Effects of Fibular Fixation for Interlocking Nailing of Distal Tibiofibular Fractures: Sang Ho Moon, Phil Hyun Chung, Chung Soo Hwang, Dong Ju Chae, Beom Kim; J Korean Soc Fract 2000;13(2):296-302. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.296

Abstract PDF: PURPOSE
: To compare redioiogic results between interlocking intramedullary nail with fibular fixation and nail only for treating distal tibiofibular diaphyseal fractures.
MATERIALS AND METHODS
: From April 1993 to February 1999, 26 distal tibiofibular fractures were antegrade nailed after anatomical reduction and fixation of fibular fractures, and another 61 fractures fixed with nails only. Average age of patients was 41.8 years. These two groups were compared by frequency of malalignment, degree of postoperative angulation, angulation according to comminution, angulation according to fracture configuration. The statistical analysis was evaluated by t-test.
RESULTS
: Fibular fixation group had no malalignment while non-fixations had angulation of 1.2+/-1.1 degree and non-fixation had 3.0+/-2.1. So fixation had lessor angulation than non-fixation significantly(p=0.004). In lateral rediographs, each had 1.3+/- 1.1, 2.8+/-2.3 degree and showed significant difference(p=0.027). In type I and II fractures of Winquist-Hansen classification, fixation group showed lesser degree of angulation in A-P plane significantly(p=0.008) but no significant difference in lateral plane. In type III and IV, no significant difference in both planes. According to configuration of fractures, transverse and spiral fractures showed no significant differences but oblique configurations had significant differences in A-P plane(p=0.002) CONCLUSION : Interlocking intramedullary nail with fibular fixation has the advantage in maintenance of alignment during insertion of nail in distal tibiofibular fractures, especially in Winquist-Hansen classification type I and II and oblique fractures in anteroposterior plane, so it can be a worthy method for the treatment of distal tibiofibular diaphyseal fractures.

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Comparative Analysis of Interlocking Nail and Anatomical Plate in the Treatment of Distal Tibial Fracture: Gun Il Im, Do Young Kim, Joo Ho Shin, Kang Seob Youn, Won Ho Cho; J Korean Soc Fract 1999;12(3):632-637. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.632

Abstract PDF

We studied 39 patients with distal tibial shaft fracture. Seventeen fractures(10 closed fractures and 7 open fractures: 5 type-I and 2 type II fractures, according to the classification of Gustilo et al.) were treated with interlocking nail, and 22 fractures(19 closed and 3 open fractures: 1 type I and 2 type II fractures) were treated with anatomical plate. The clinical results were analyzed according to treatment modality. All of the patients were followed up for more than 1 year. The average time to union was 18.1 weeks in the patients treated with interlocking nail and 23.7 weeks in the patients treated with anatomical plate. In the functional outcome(according to Klemm and Borner), twelve patients(70.6%) treated with interlocking nail showed excellent results and 10 patients(45.5%) treated with anatomical plate had excellent results. We concluded that more satisfactory results could be obtained with interlocking nail compared with anatomical plate in the treatment of the distal tibial fracture.

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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
Comparative Analysis of Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Intramedullary Nailing in Distal Tibial Metaphyseal Fractures
Gwang Chul Lee, Jun Young Lee, Sang Ho Ha, Hong Moon Sohn, Yi Kyu Park
Journal of the Korean Fracture Society.2012; 25(1): 20. CrossRef
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
Journal of the Korean Fracture Society.2010; 23(3): 296. CrossRef
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 communited & Segmental Femoral shaft Fracture by using Interlocking nailing: Comparison between Closed and Open techniques: Chang Hyuk Choi, Koing Woo Kwun, Shin Kun Kim, Sang Wook Lee, Ho Sun Chang; J Korean Soc Fract 1999;12(3):516-522. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.516

Abstract PDF: When femoral shaft fracture with severe communition and segmentation result from violent force, they are frequently associated with severe soft tissue damage. Treatment of this unstable fracture need the rigid fixation in order to prevent shorting and rotational loading. In terms of this advantages, interlocking nailing technique was widely used with open and closed methods. In the cases of fractures that having large fragments and wide displacement, closed technique has disadvantage of difficulties in anatomic reduction and its maintenance. Nineteen femoral shaft fractures had been treated by these techniques alternatively at our hospital between Feburary 1994 and Feburary 1997 and had been followed for more than 12 months. Among the 19 cases, closed techniques were 11 cases and open 8 cases. We evaluated the results of two treatment methods in terms of the bone union time, complications and functional results. Mean duration of the bone union time was 24.2 weeks in closed interlocking nailing, 24.5 weeks in open. There was no difference between the bone union time and the operation techniques(p-value>0.05). And complications were delayed union in two cases. In conclusion, in the cases of severe comminuted and segmental femoral shaft fractures especially with posteromedial fragment, open technique was more useful than closed technique, in terms of anatomic restoration and getting functional recovery afford to preinjury level of work.

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Plate augmentation for the nonunion of femur shaft fractures after interlocking intramedullary nail fixation: Ki Soo Kim, Ju O Kim, Hyun Guyn Jung, Byoung Oh Jung; J Korean Soc Fract 1999;12(1):21-27. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.21

Abstract PDF

Ten patients with nonunions of femoral shaft fractures were treated with plate augmentations and bone grafts. The patients sustained comminuted femoral shaft fractures and were fixed with interlocking intramedullary nails. Eight of the ten patients were inserted by closed technique and two were open. We followed the patients and waited for average 11.6 months, and during that periods, six of the ten patients received several procedures to facilitate union. But nails alone could not provide enough stability for the fracture unions. We exposed the nonunion sites, left the nails in situ, and applied additional plates with bone grafts. All nonunions were vascular and hypermobile, which could be corrected after plate applications. The patients were followed for at least 1 year(average 2.7 years), and all achieved radiologic solid unions after 7.7 months(average). No complications were noted. We believe that we can apply additional plates without removing previously inserted intramedullary nails for the hypermobile femoral shaft nonunions.

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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
Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef

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A Comparison of Using Closed Interlocking Nailing versus Plate Fixation in Humeral Shaft Comminuted Fractures: Dong Gyu Lee, Woo Dong Nam, Jang Seok Choi; J Korean Soc Fract 1999;12(1):126-134. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.126

Abstract PDF: The purpose of this paper is to compare the results, complication, advantages and disadvantages of treatment with closed interlocking intramedullary nail with those with plate in humeral shaft comminuted fractures. The authors have reviwed 25 cases of humeral shaft comminuted fractures, which were treated with closed interlocking intramedullary nail in 14 cases and plate in 11 cases, from November 1992 to May 1996. The results were as follows: 1. The average time of operation in closed interlocking nailing was 72 minutes and that of plate fixation was 104 minutes. 2. The average time for bone union was 14.7 weeks in closed interlocking nailing and 14.9 weeks in plate fixation. 3. The complications of closed interlocking nailing were 2 cases of delayed union, 1 case of nonunion, 1 case of postoperative radial nerve palsy and 3 cases of pain and stiffness of shoulder. 4. The complications of plate fixation were 1 case of delayed union, 2 cases of nonunion, 1 case of postoperative radial nerve palsy, 1 case of stiffness of shoulder. 5. Excellent and good functional results rated by Stewart and Hundley were 12(85%) cases in closed interlocking nailing and 8(73%) cases in plate fixation. We concluded that closed interlocking nailing is one of the better useful method of treatment in humeral shaft comminuted fractures but, the procedures should be performed exactly.

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Use of Interlocking Intramedullary Nail in Treatment of Delayed Union or Nonunion of the Long Bone Fractures: Suk Kyu Choo, Byung Jik Kim, Han Suk Ko, Jeong Gook Seo, Jin Gu Kim, Jun Woo Chang; J Korean Soc Fract 1998;11(4):761-768. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.761

Abstract PDF

Of the several nonoperative and operative options described for the treatment of delayed union and nonunion of the long bone, interlocking nailing with reaming offect of internal splint, autogenous bone graft and early return to a normal way of life. The purpose of this study is to evaluate the usefulness and complication of intramedullary(IM) naling with reaming by retrospective method. We treated 34 patients with delayed union or nonunion of the tibia, femur, and humerus by interlocking nailing with reaming between January 1992 and December 1996. The results were as follows ; 1. Of the 34 cases, there were 13 tibia fracture, 17 femur fracture, 4 humerus fracture. Half of them were ununited and another half were delayed in fracture healing. 2. Previous methods of treatment were conservative treatment in 2 cases, external fixator in 2, plate & screws fixation in 8, Ender nail in 2, Kuntscher nail in 2 and interlocking nail in 7 among 24 cases of cloed fracture and external fixator in 8 and interlocking nail in 2 among 10 cases of open fracture. 3. Twenty-five patients were treated with closed nailing and 9 were treated with open nailing. Iliac bone graft was performed at 3 cases and fibulotomy was performed at 1 case. 4. Union was obtained in 33 cases and 1 case needed additional bone grafting to achieve union. 5. Postoperative complications were one nonunion, two evtry site pain, one screw breakage, one heterotopic ossification, and one postoperative infection. Interlocking nailing with reaming was associated with a high union rate(97%) in our eries. The authors believe that IM nailing with reaming is a useful option for treatment of delayed or nonunion of the long bone fracture.

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Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef

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Treatment of the Femoral Shaft Fractures using Unreamed Interlocking Intramedullary Nail: Sung Taek Jung, Eun Sun Moon, Moon Lee; J Korean Soc Fract 1998;11(2):471-476. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.471

Abstract PDF: The current trend in the use of the unreamed intramedullary nail to avoid the increased damage to the intramedullary blood supply may be theoretically attractive for femoral shaft fracture stabilization but little clinical and radiological attention was reported. We have evaluated the results of treatment of femoral shaft fracture with unreamed interlocking intramedullary nail. Thirty-eight femoral fractures have been followed for more than twelve months were included in this study. Most of the fractures were the result of moderate to high-energy trauma. Thirty-three cases were fresh closed fracture and five were open fractures. Winquist-Hansen type I fracture (16 cases) were most common and healing period was shorter than other type. Healing occurred in 35 cases and mean healing period was 18.7 weeks with a range of 11 to 32 weeks. Postoperative complications were delayed union in 3 cases. We concluded that unreamed interlocking nailing for femoral shaft fracture seems to be a useful method with low complication rate.

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Treatment of the Femoral Shaft Fracture by Interlocking Intramedullary Nailing: Sung Joon Im, Sung Jin Kim, Dae Sang Yoo, Ho Sik Sung; J Korean Soc Fract 1998;11(1):181-190. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.181

Abstract PDF: Femoral shaft fractures result from high energy trauma such as traffic accident or falls, and it is frequently accompanied by multiple fractures and several other organ injuries. Intramedullary nail is the effective device available for patient with appropriate fracture of the femoral shaft, and it may also prevent several complications, such as infections and delayed union that can be caused by periosteum and soft tissue injury. Rigid internal fixaton of the femoral shaft fracture with interlocking intramedullary nails presents a significant advance in the management of unst-able fractures and provides longitudinal and rotational stability as well as early joint motion and weight bearing. This procedure has been used with wide popularity because it is possible simultaneously to preserve the range of motion and to obtain the bone union. The purpose of this sutdy is to evaluate the differences of the functional results and duration of the bone union based on Winquist-Hansen classification. Also we analyzed the causes of the complications and results of the treatment. Forty one cases of the femoral shaft fractures were treated with interlocking intramedullary nailing during the period from January 1993 to June 1995 over 12 months follow up. The results were as follows: 1. Among 41 cases of the femoral shaft fractures, static nailings were used in 34 cases and 7 cases with dynamic nailings, then bone union was achieved at 18 weeks for static mode and 15 weeks for dynamic mode respectively. 2. Intraoperative complications were new fractures near the original fracture site(2 cases) and femur neck(1 case). 3. Postoperative complications were delayed union(4 cases), metal failre(1 case), limb shortening(1 case) and distal screw breakage(1 case). 4. Delayed union developed in 4 cases with static mode, but bone union was achieved at average of 22 weeks after changing to dynamic mode at 15 weeks. 5. Functional results were assessed by Karlstrom and Olerud criteria and 80% of the patients were in excellent and goood results.

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Seidel Interlocking Intramedullary Nailing for Humerus Fractures: Woo Nam Moon, Jae Yong Ahn; J Korean Soc Fract 1998;11(1):16-21. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.16

Abstract PDF: From retrospective review of 26 humerus fractures treated by Seidel interlocking intramedullary nailing, 17 complications in nine patients(35%) were occurred: two delayed unions, three malunions, two infections, one distraction of fracture gap, two additional fragmentations, two failures in proximal interlocking screw insertion, three distal locking mechanism failures and two proximal protrusions of nail. Functional assessment was carried out an all patients at a mean follow up 13 months(9-23 months). The results were ten excellent, twelve good, two fair and two poor. These results show that there are considerable problems at present in the use of the seidel interlocking nail.

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Surgical Management of the Proximal Tibial Shaft Fractures - A Comparison of Plate Fixation and Interlocking Intramedullary Nailing -: Ki Soo Kim, Yong Soo Choi, Chul Hun Choi, Jin Ho Yang; J Korean Soc Fract 1997;10(4):872-878. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.872

Abstract PDF: The treatment of proximal tibial shaft fractures is an area of great controversy. The purpose of this study was to make the comparison between the results of the plate fixation and those of the interlocking nailing, and to identify the effects of the location of the nail bend on the reduction of the proximal tibial shaft fractures. From June 1991 to May 1995, we performed the plate fixation in 12 cases and interlocking nailing in 16 cases for the proximal tibial shaft fracture. We subdivided the interlocking nailing group into two groups: Group A had the fractures within the posterior bending length of the nail in 8 cases, Group B had the fractures over the posterior bending length of the nail in 8 cases. The results were as follows; The most common type of fractures was the Winquist-Han son type III, 9 cases(75%), in the plate fixation group, and the segmental fracture, 10 cases(62.5%), in the interlocking nailing group. In the plate fixation group, autogenous bone graft were used in 7 cases (58.3%), primary in 5 cases and secondary in 2 cases. The interlocking nailing group had a tendency to cause the surgical problems during the nailing such as angular deformity in 3 cases, displacement of the fracture in 2 cases, extension of the fracture in one case, need an open reduction in one case and unstable fixation in one case. The surgical problems were associatied with the incorrect entry point and the fractures within the posterior bending length of the nail (Group A). Clinically excellent and good results, according to Klemm and Borner criteria, were obtained in 12 cases(100%) of the plate fixation group and 13 cases(81.3%) of the interlocking nailing group. the fair results were associtated with the angular deformity in the Group A. In conclusion, the preoperative planing must carefully consider such as the type of fracture, technical familarity, and understanding of the implants and instrumentations ofr the successful treatment of the proximal tibial shaft fractures. The plate fixation is preferable method for the fractures within the posterior bending length of the nail(Group A).

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Treatment of Subtochanteric Fractures of the Femur by Interlocking Nailing: Do Hyun Moon, Bum Gu Lee, Jin Hong Ko, Young Kab Shin; J Korean Soc Fract 1997;10(3):548-555. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.548

Abstract PDF: Subtrochanteric fracture of the femur are difficult to treat successfully. Although performing operative treatment, the incidence of mechanical complication is higher than other sites of long bones. During the period of January. 1990 to June. 1995, twe nty-four cases of subtrochanteric fracture of femur were treated by Interlocking intramedullary nail at the Department of Orthopedic Surgery, Gil Hospital, Incheon, and the results were obtained as follows : 1. Associated injuries, which were common in lower limb(7 cases), pelvic bone(3 cases) and upper limb(4 cases) made a fracture more difficult to treat. 2. Fieldings type III(12 cases) fracture and Seinsheimers type II(18 cases) fracture and Russel-T aylors Type I A(19 cases) fracture and Winqist-Hansen Type II(13 cases) fracture were most common. 3. The average union time was 19.3 weeks. 4. The complications were three cases. : delayed union(1 case), infection(1 cases), angular deformity(1 case). 5. Interlocking nail is one of the good implant for rigid fixation of subtrochanteric fracture, especially mechanical characteristics of interlocking nail have eliminated the requirement of surgically reconstituting the medial femoral cortex.

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Fatigue Fracture of the Interlocking Nail in the Treatment of the Distal Part of the femoral Shaft Fractures: Won Sik Choy, Hwan Jung Kim, Kwag Won Lee, Young Sik Min, Ha Yong Kim, Moon Ho Shon; J Korean Soc Fract 1997;10(3):522-528. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.522

Abstract PDF: Closed intramedullary nailing with or without interlocking screws has been a widely accepted method for the fixation of fractures of the femoral shaft. The design of the interlocking nail introduces the potiential for high stress concentrations at the proximal and distal holes. The authors experienced six cases of metal failure of the interlocking nail in the treatment of fractures of the distal part of the femoral shaft from February 1992 to March 1995. The predisposing factors to fatigue fracture of the interlocking nail were studied. In all patients, the fracture of femur was five centimeters or less from the more proximal of the two distal screw-holes. The risk of fatigue failure may be minimized by using nails that have a larger diameter, by using nails long enough to be driven down to the subchondral area of the knee joint and by avoiding early weight-bearing.

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Treatment of the Femur Shaft Fractures using Interlocking Nail: Jong Keon Oh, Soon Hyuck Lee, Seung Woo Suh, Young Soo Byun; J Korean Soc Fract 1997;10(2):289-294. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.289

Abstract PDF: A series of forty patients who had forty femoral shaft fractures that were treated with static interlocking nailing were analyzed to determine the incidence of union of the fracture without planed conversion from static to dynamic intramedullary fixation as a technique to stimulate healing of the fracture. All of the forty cases were nailed using closed method under the guide of a image intensifier. The time to full weight was individualized for each patient and depend on the degree of comminution, the postoperative cortical contact between the major fragments, the presence of bridging callus as seen on follow up x-rays, and the patients mobility according to the associated injuries. Healing occurred in thirty nine(97%) of the forty fractures of the femoral shaft that had been treated with static interlocking nailing without dynamizaton. Only one patient needed conversion from static to dynamic interlocking fixation to promote fracture healing. This patient had a delayed union after closed interlocking nailing of Gustilo type I open midshaft fracture associated with Winquist type II comminution. We concluded that static interlocking nailing for femoral shaft fractures does not seem to inhibit the fracture healing process, and that conversion to dynamic intramedullary fixation is needed only for exceptional cases of delayed union.

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Angulation Deformity Following Interlocking Nailing for Treaeent of Tibia Fracture: Hong Jun Han, Jae Hoon Shin, Jeong Hyu Lee; J Korean Soc Fract 1996;9(4):1002-1008. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1002

Abstract PDF: Intramedullary nailing is often the treatment of choice in the management of fractures in the tibial diaphysis. With the advent of interlocking nailing, the indication for nailing have expanded, recently. One of the most frequent but little discussed complication of tibial nailing is fracture malalignment leading to angular or rotational deformities. This retrospective study was undertaken to access the incidence of aneular malalignment after interlocking nailing for 210 tibiae(208 patients). The results obtained were as follows; 1. The incidence of angular malalignment was 12.4% 2. The incidence of angular malalignment was 15.8% in proximal one third, 4.1% in middle one third,20.7% in distal one third fractures. 3. The most frequent deformity was valgus angulation in distal one third fractures. 4. Angular deformity was developed more frequently in cases of unlearned nailing(18.9%) than reamed nailing(8.4%). 5. Angular deformity was developed more frequently in cases of double level fracture(22.2%) than single level fracture(11.5%).

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Treatment with an Interlocking Nail for Ipsilateral Fracture of the Femur and Tibia: Sang Soo Kim, Churl Hong Chun, Dong Churl Kim, Sang Hoon Cha; J Korean Soc Fract 1996;9(3):541-546. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.541

Abstract PDF: Concomitant ipsilateral femoral and tibial fractures present a challenging therapeutic problem. They are generally caused by high-energy trauma, primarily motor-vehicle accidents, and the associated injuries frequently develop. Also the complications much as delayed union, non-union, malunion and stiffness of the knee are more prevalent in patients with this combination of fractures than in patients with an isolated femoral or tibial fractures. The interlocking nail system has many advantages about among the many treatment methods of isolated long bone fractures, but the surgical technique is very difficult at the concomitant ipsilateral femoral and tibial fractures. The purpose of this study has been to review the surgical technique and to grasp an easy reduction method at that fractures. We routinely perform the interlocking nail for the ipsilateral femoral and tibial fractures in order to promote early motion of the knee in 14 patients from 1989 to 1995. Local complications included 1 case of femoral metal failure, and 2 cases of nonunion treated by bone graft. At the last follow up examination, at an average of 13 months after injury, the mean range of motion of the knee was 130 degrees. Over-all, a good or excellent functional result was achieved in about 93% of the patients according to the criteria suggested by Karlstr m and Olerud. In conclusion, the best results were achieved when both fractures were stabilized surgically with the interlocking nail system.

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The Effect of fibular fractures in the healing of tibial shaft fractures treated with an interlocking nail: Ki Soo Kim, Yong Soo Choi, Jong Jun Park, Sun Young Chung; J Korean Soc Fract 1996;9(2):449-457. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.449

Abstract PDF: The effect of fibular fractures in the healing of tibial shaft fractures has controversial results. Its results are the greater part of the data for the conservative treatment of tibial shaft fractures. Recently closed interlocking nailing has been the most efficient treatment for displaced fractures of the tibial shaft. The purpose of this study was to evaluate the effect of fibular fractures in the healing of tibial shaft fractures treated with an interlocking nail and to determine whether the fibular fracture had a relation with other prognostic factors. From Mar. 1992 to Feb. 1995. the authors performed interlocking nailing for displaced fractures of the tibial shaft in 111 patients. We reviewed 98 patients with a minimal ten month follow up period. We divided the fractures into three groups; the intact fibula group which consisted of 15 patients had tibial shaft fractures with intact fibula, the same level fracture group had tibiofibular fractures at the same level in 56 patients and the different level fracture group had tibiofibular at different level in 27 patients. The results were as follows: 1. Clinically excellent and good results, according to Klemm and Horner criteria. were in 15 patients(100%) of the intact fibula group,49 patients(87.4%) in the same level fracture group and 21 patients(92.5%) in the different leyel fracture group. 2. Radiologically bone healing was obtained in 15 patients(100%) with a mean union time of 13.3 weeks in the intact fibula group, 42 patients(75.O%) with a mean union time of 17.9 weekf in the same level fracture goup and 2,1 patients(85.2%) with a mean union time of 15.3 weeks in the different level fracture group. 3. The same level fracture group had a tendency to cause a bending force while the different level fracture group tended to treat a torsional force. We found that the bending fractures had the worst prognosis. These results suggest that the treatment of tibial shaft fractures with an intact fibula by using an interlocking nail prevents significant complications and allows early weight bearing, thus permiiting early mobilization of the traumatized patient. The level of the fibular fracture associated with the tibial fracture may be a useful prognostic factors in the healing of tibial shaft fractures.

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A Treatment of Unreamed Intramedullary Nailing of Open Fracture of the Tibia: Keun Kwon Kang, Jang Jung Kim, Kun Yung Lee, Myung Kon Nam, Myung Sik Park; J Korean Soc Fract 1995;8(3):551-556. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.551

Abstract PDF: The tibial fracture was the most common fracture of the long bone fractures, especially there were many controversies in the treatment of open fracture by high energy injury. The authors analyzed retrospectively 32 patients of tibial open fracture who underwent unlearned intramedullary nailing at the Department of Orthopedic Surgery, Lee-Rha general hospital from September 1992 to August 1994 with minimal 1 year follow up. In 32 cases, the average age was 37.5 years old and the most common injury was traffic accident(25 cases,78%). Twenty seven cases were male(84.4%) and 5 cases female(15.5%). There were 17 cases of Type A fracture(53%),12 cases Type B(37.5%) and 3 cases Type C(19.5%) by A-O classification, and 11 cases were Type I open fracture(34%) by Gustilo - Anderson classification, 15 cases, Type B (47%) and 6 cases, Type III (19%). The average bone union time was 14.8 weeks except one case of infected non-union. We concluded that unlearned intramedullary nailing is recommended for the compatible treatment metnod of tibial open fractures.

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Interlocking Nailing for Tibial Fractures: Ick Hwan Yang, Kyu Hyun Yang, Dae Yong Han, Hui Wan Park, Hyun Cheol Oh; J Korean Soc Fract 1995;8(3):538-543. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.538

Abstract PDF: Nawadays, tibial fractures are not uncommon and those treatment methods are varied also. Recently interlocking nailing for tibial fracture is widely used. Between March 1992 and February 1994, 20 tibial fractures were treated with interlocking nail in 18 patients over 12 months follow up. The results were as follows: 1. Seventeen cases(85.0%) were able to perform active ROM exercise of knee and ankle within 1 week. Partial weight bearing for dynamic interlocking nailing, was allowed in 2.6 weeks(mean). For static interlocking nailing, weight bearing was allowed in 6.7 weeks. 2. The average operation time was 42 minutes, blood loss within 100ml. The fracture sites were not exposed. 3. Union without complications was achieved in 19 cases(95.0%) in average 12.8 weeks. One case needed a secondary operation later with Ilizarov external flxator due to reduction failure. 4. There was no nonunion or reduction loss after weitht bearing. 5. Complications were reduction failure, supeficial infections, and screw breakages. In conclusion, interlocking nailing for tibial fractures was gained good results with low complications and early weight bearing, leads to excellent results.

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The Treatment of Nonunion of Femoral Fractures with an Interlocking Nailing: Churl Hong Chun, Sang Soo Kim, Dong Churl Kim, Hee Jun Yoo; J Korean Soc Fract 1995;8(3):497-504. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.497

Abstract PDF

Nonunion of femoral fractures has continued to challenge orthopaedic surgeons. Interlocking nailing with reaming offers the advantages of stable fixation. adequate alignment, minimum shortening, good rotational control, early weight bearing without external support and high union rate. Between August 1988 and March 1993, 20 patients with nonunion of the femoral fractures were treated by an interlocking nailing with reaming. The types of primary treatment prior to nonunion were plate fixation in 10 patients, conventional intramedullary nailing in 9 patients and external fixation in 1 patient. The purpose of this study was to evaluate the causes of nonunion and analyze the results with interlocking nailing in the management of nonunion of femoral fractures. The radiological examination revealed that formation of the bridge callus took a mean of 3.5 months for the patients who received the plate and screw fixation. On the other hand. it took a mean of 2.4 months for the patients who were treated with conventional intramedullary nailing. When the two groups of patients were combined, it took a mean of 3.2 months. All patients were obtained the complete union in a mean time of 10.4 months after an interlocking nailing. Complications were 1 breakage of distal target screws. 1 pain near the entry of nail and 1 delayed union. Limb shortening was measured by roentgenoscanography and occurred in all patients but not clinically significant.

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Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef

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