Journal of Musculoskeletal Trauma

Major Limb Replantation of Lower Leg Amputation with Ipsilateral Distal Femoral Comminuted Fracture in Old Age: A Case Report: Tae Young Ahn, Seung Joon Rhee, Sang Ho Kwak, Hyo Seok Jang, Sang Hyun Lee; J Korean Fract Soc 2019;32(4):227-231. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.227

Abstract PDF: The development of microsurgical techniques has also increased the success rate of replantation surgery. This paper reports the results of limb replantation performed on a lower extremity amputation that was associated with crush amputation and an ipsilateral comminuted fracture in and elderly patient. A 68-year-old female presented with a right distal tibia amputation due to a traffic accident. At that time, with a comminuted fracture in the distal femoral condyle, simple wound repair was recommended, but the caregivers strongly wanted replantation. Three years after surgery, normal walking was possible without a cane and the patient was satisfied with the function and aesthetics. What used to be contraindicated in limb replantation in the past are now indications due to the development of microsurgical techniques, surgical experience, and postoperative rehabilitation treatment. If the patient is willing to be treated, good results in contraindications can be obtained.

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Combined Ipsilateral Fracture and Dislocation of Hip, Knee and Foot Joints: A Case Report: Hyoung Soo Kim, Ju Hak Kim, Sang Joon Park, Jae Won Hyung; J Korean Fract Soc 2012;25(1):73-76. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.73

Abstract PDF: Although clinical cases of ipsilateral knee and hip joint dislocation have been reported, there are no reports of simultaneous ipsilateral hip, knee, and foot dislocations. We report here a case of a patient who had ipsilateral hip, knee, and foot joint dislocations, and review the relevant literature.

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Ipsilateral Femoral Segmental and Tibial Fractures : A Case Report: Oog Jin Sohn, Chul Hyun Park, Sang Keun Bae; J Korean Fract Soc 2009;22(3):193-196. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.193

The ipsilateral femoral segmental and tibial fractures seldom occur such as traffic accidents needed high energy mechanisms. For these fractures, surgical stabilization and early mobilization of joint produce can be the best clinical outcomes. We have experienced a case of ipsilateral femoral segmental and tibial fracture and gained good clinical results with surgical treatment. We have reported here on this case and included a review of the relevant literature.

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Clinical Outcome after Treatment of Tibia Segmental Fracture with Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis
Jun Young Lee, Hyung Seok Park, Dong Hyuk Cha
Journal of the Korean Fracture Society.2020; 33(3): 142. CrossRef

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Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture: Chang Wug Oh, Jong Keon Oh, Woo Kie Min, Shin Yoon Kim, Seung Hoon Baek, Byung Chul Park, Hyung Soo Ahn, Tae Gong Kim; J Korean Fract Soc 2007;20(2):135-140. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.135

Abstract PDF

PURPOSE
To compare retrospectively the antegrade and retrograde nailing in the management of ipsilateral femoral neck and shaft fractures.
MATERIALS AND METHODS
Thirty-two patients (thirty-three injuries) were included in this study. Mean age of patients was 38 years-old in the antegrade nailing group (16 injuries) and 44 years-old in the retrograde nailing group (17 injuries). We compared the union of fractures and complications between two groups, and investigated the influencing factors.
RESULTS
Femoral shaft fracture was united in 10 cases (63%) of antegrade group and 12 cases (71%) of retrograde group, at 28.2 and 27.3 weeks respectively. Nonunion was more prevalent in Winquist-Hansen III and IV (5 in antegrade nailing, 3 in retrograde nailing) than I and II. Femoral neck fracture was united with 1 case of nonunion in each group. Nonunion developed from Garden stage IV, but fractures of Garden stage I and II united regardless of methods.
CONCLUSION
In ipsilateral femoral neck and shaft fractures, the kinds of methods did not affect the results of shaft fractures. Minimally displaced neck fractures also were not influenced by kinds of methods, but retrograde nailing may have a benefit in fixing the displaced neck fractures

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Surgical management of bifocal femoral fractures: a systematic review and pooled analysis of treatment with a single implant versus double implants
J. D. Cnossen, Esther M. M. Van Lieshout, Michael H. J. Verhofstad
Archives of Orthopaedic and Trauma Surgery.2023; 143(10): 6229. CrossRef
Retrograde Intramedullary Nailing or the Treatment of Segmental Femoral Shaft Fracture Including Distal Part
Jong-Ho Yoon, Byung-Woo Ahn, Chong-Kwan Kim, Jin-Woo Jin, Ji-Hoon Lee, Hyun-Ku Cho, Joo-Hyun Lee
Journal of the Korean Fracture Society.2009; 22(3): 145. CrossRef
The Treatment of IM Nailing of Femoral Shaft Fracture: Piriformis Fossa versus Trochanteric Entry Portal
Hyun Kook Youn, Oog Jin Shon, Dong Sung Han
Journal of the Korean Fracture Society.2008; 21(3): 200. CrossRef

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Bilateral Femoral Neck Fractures in a Young Adult: A Case Report: Eea Sub Chung, Jae Kyu Park; J Korean Fract Soc 2005;18(4):478-480. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.478

Abstract PDF: Ipsilateral femur shaft and neck fractures are occurred by high energy trauma, usually in motor vehicle accidents or fall from a height. Simultaneous Ipsilateral femur shaft and neck fractures and contralateral femur neck fracture are not yet reported in Korea. Authors report a case of simultaneous bilateral femoral neck fractures combined with a ipsilateral femoral shaft fracture in a young adult treated with anatomical reduction, internal fixation and vascularized bone graft with a review of the literature.

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Instability of Knee Associated with Ipsilateral Femoral and Tibial Shaft Fractures: Whan Yong Chung, Woo Suk Lee, Woo Sik Kim, Yong Chan Kim, Taek Soo Jeon, Sun Hong Kim, Ji Hyuk Lim, Young Su Lim; J Korean Fract Soc 2005;18(2):136-143. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.136

Abstract PDF: PURPOSE
To establish the incidence, type and significance of knee instability in patients with ipsilateral femoral and tibial shaft fracture, comparing with the patients with femoral shaft or tibial shaft fracture alone.
MATERIALS AND METHODS
Two hundreds and seventy-nine consecutive patients were retrospectively reviewed from February 2000 to April 2004. They were composed of 80 patients with femoral shaft fracture alone, 176 patients with tibial shaft fracture alone and 23 patient with ipsilateral femoral and tibial shaft fracture. We evaluate the instability of knee based on physical examinations, plain stress films and MRI. We analyze incidence and period to diagnosis of instability, period to complete bony union and Hospital for Special Surgery (HSS) knee score respectively.
RESULTS
There were 6.3% of knee instability in femoral shaft fracture alone, 9.7% in tibial shaft fracture alone and 30.4% in ipsilateral femoral and tibial shaft fracture. The average period to diagnosis of instability, average period to complete bony union and average HSS knee score were 9.2 months, 4.7 months and 65 points in femoral shaft fracture alone, 9.1 months, 4.2 months and 69 points in tibial shaft fracture alone, 8.7 months, 5.3 months (femur), 4.7 months (tibia) and 57 points in ipsilateral femoral and tibial shaft fracture respectively.
CONCLUSION
We should consider MRI to evaluate the knee instability in patient with ipsilateral femoral and tibial shaft fracture at the time of injury and make a plan early about the treatment of knee instability.

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Management of Ipsilateral Femur and Tibia Fractures, with Retrograde and Antegrade Nailings from the Knee: Chang Wug Oh, Jong Keon Oh, Woo Kie Min, In Ho Jeon, Hyung Soo Ahn, Hee Soo Kyung, Poong Taek Kim, Jung Ho Noh; J Korean Fract Soc 2005;18(2):131-135. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.131

Abstract PDF

PURPOSE
To review the results in the management of ipsilateral femur and tibia fractures, using femoral and tibial intramedullary nailings with single incision on the knee.
MATERIALS AND METHODS
We treated 19 cases of ipsilateral femur and tibia fractures (floating knee), and the retrograde femoral nailing and antegrade tibial nailing were done with single incision on the knee. Except one patient of early death, 18 patients were included in this study. The mean age of index procedure was 34.1 years, and all of them had follow-up study for a mean of 2.4 years. The mean injury severity score was 18.8, and 12 patients had other fractures in the lower extremity.
RESULTS
Primary union was achieved in all, but one patient of femur and two of tibia. The average period for union was 27.6 weeks for femur and 24.5 weeks for tibia. One femoral nonunion occurred due to the metal failure after using short nail, and two tibial nonunion were caused by the bone loss with open tibial fractures. Most patients showed no limitation in knee motion. According to Karlstrom-Olerud criteria, functional results showed 14 excellent, 3 good and 1 acceptable. The protrusion of nail tip into the knee joint made the acceptable result with moderate limitation of knee motion, but it improved after the removal of nail.
CONCLUSION
CONCLUSION: Simultaneous retrograde femoral and antegrade tibial nailing with single incision on the knee, with an appropriate technique, can achieve the satisfactory result in the management of the ipsilateral femur and tibia fractures.

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Ipsilateral Femoral Segmental and Tibial Fractures: A Case Report
Oog Jin Sohn, Chul Hyun Park, Sang Keun Bae
Journal of the Korean Fracture Society.2009; 22(3): 193. CrossRef

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Treatment of Ipsilateral Femoral Neck and Shaft Fractures: Jung Ryul Kim, Hyung Suk Lee, Myung Sik Park, Hee Chul Yu, Doo Hyun Yang; J Korean Soc Fract 2003;16(3):327-333. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.327

Abstract PDF: PURPOSE
To analyse the result of the treatment of ipsilateral femoral neck and shaft fractures and to consider effective method of the treatment.
MATERIALS AND METHODS
Seventeen patients with ipsilateral femoral neck and shaft fractures were treated from January 1992 to January 1999 and followed up more than 2 years. Radiologic bony union between each treatment method, complication were analysed. The functional results assessed with Iowa hip rating system and Swiontkowski system.
RESULTS
In femoral neck fractures, bony union was obtained in all cases, average 12 weeks. In femoral shaft fractures, bony union was obtained in all but one case. There was no statistical association bony union time between each treatment method (p>0.05). By Iowa hip rating system, nine hips had an excellent result; eight, a good result. According to rating system of Swiontkowski, the result was excellent in nine, good in six, fair in one, and poor in one.
CONCLUSION
We concluded that early diagnosis of all injuries was needed. To avoid further vascular damage of femoral head, early anatomical reduction of the femoral neck fracture should be performed. And then, shaft fracture was fixed with implants which were most appropriate for that combination of fractures.

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Ipsilateral Femoral Neck and Shaft Fracture: Secondary Avascular Necrosis of Femoral Head: Sung Taek Jung, Keun Bae Lee, Taek Lim Yoon, Sang Don Shim, Myung Seon Kim; J Korean Soc Fract 2001;14(4):609-615. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.609

Abstract PDF: PURPOSE
To evaluate the prognostic variables that influence the incidence of complication such as avascular necrosis of femoral head, nonunion of neck after the treatment of ipsilateral femoral neck and shaft fracture by the results and long term follow up. MATERIAL AND METHODS: We studied the 18 cases of 17 patients that could be follow up over 2 years among the patients received the treatment of ipsilateral femoral neck and shaft fracture from 1987 to 1998. The average follow up duration was 54.3 months (24-120) and all patients was men. The average age was 38.2 yrs(20-60). Fifteen cases of femoral neck fracture were treated with multiple pinning and 3 cases with the compression hip screw, 12 cases of femoral shaft fracture were treated with DCP, 5 cases by interlocking IM nailing and 1 case, open fracture, by external fixator. We evaluated the bone union and complication such as avascular necrosis of femoral head and nonunion.
RESULTS
For femoral neck fracture, resection arthroplasty was performed in 1 case and nonunion in 1 case. Bone union was obtained at average 4 months in 16 cases of femoral neck fracture, at 9 months in all cases of shaft fracture. The avascular necrosis of femoral head in 5 cases included 1 case of nonunion was found at minimal 20 months to maximal 59 months follows up.
DISCUSSION
All prognostic variables of the ipsilateral femoral neck and shaft fracture, that is the Garden stage, Pauwels classification, delayed time to operation. had no statistical correlation with complication. Whenever possible the patients should be followed for a minimum 5 years to rule out avascular necrosis of femoral head.

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Difficulties in the treatment for ipsilateral concomitent femoral neck & shaft fractures: Chang Wug Oh, Shin Yoon Kim, Hee Soo Kyung, Joo Chul Ihn, Hyung Tae So, Jong Min Lee, Ho Wook Wee; J Korean Soc Fract 2001;14(2):152-158. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.152

Abstract PDF

PURPOSE
This retrospective study was performed to know the difficulties and efficient methods of treatment after several types of operations for ipsilateral femoral neck and shaft fracture.
MATERIALS AND METHODS
Thirteen cases (12 patients) with ipsilateral femoral neck and shaft fracture at the mean age of 36.6(range 21-51), have been followed up over the minimum of one year. All the patients suffered from motor vehicle accidents(11 in dash-board injury), and most of patients associated with multiple injuries including other fractures. All of femoral neck fracture were same type in basicervical area and 4 of them were missed initially. According to the classification of femoral shaft fractures, middle 1/3 fracture was most common in 10 cases and type C in 8 cases. In neck fractures, all cases were treated with multiple pinning, but in shaft fractures, 6 were treated by open plating, 5 by closed antegrade nailing, and 2 by retrograde nailing.
RESULTS
The mean union period was 12.1 weeks in neck fractures and 9.9 months in shaft fractures. In complications, there were 1 case of nonunion and 1 case of avascular necrosis in neck fractures, and 8 of delayed union, 3 of nonunion, and 2 of malunion, in shaft fractures. The methods of treatment had no influence on the results of this injury, but we had 1 failure in antegrade nailing prior to operation of neck fracture.
CONCLUSION
After operation of ipsilateral femoral neck and shaft fracture, the shaft fracture needed longer time of union and had many problems in spite of different methods. We suppose that many problems in shaft are affected not only by characteristic mechanism of injury, but also by multiple associated injury.

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Treatment for Concurrent Ipsilateral Femoral Neck and Shaft Fractures Using Reconstruction Nail with Temporary K-Wires
Sang-Joon Lee, Sang Hong Lee, Sang Ho Ha, Gwang-Chul Lee
Journal of the Korean Fracture Society.2015; 28(1): 23. CrossRef
Comparison of Operative Methods between Retrograde and Antegrade Nailing for Ipsilateral Femoral Shaft and Neck Fracture
Chang-Wug Oh, Jong-Keon Oh, Woo-Kie Min, Shin-Yoon Kim, Seung-Hoon Baek, Byung-Chul Park, Hyung-Soo Ahn, Tae-Gong Kim
Journal of the Korean Fracture Society.2007; 20(2): 135. CrossRef
Retrograde Intramedullary Nailing for the Treatment of Ipsilateral Femoral Shaft and Neck Fracture
Chang-Wug Oh, Jong-Keon Oh, Shin-Yoon Kim, Ki-Bong Cha, In-Ho Jeon, Byung-Chul Park, Woo-Kie Min, Tae-Gong Kim
The Journal of the Korean Orthopaedic Association.2007; 42(3): 380. CrossRef

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Treatment of Ipsilateral Femur and Tibia Fractures: Sung Keun Sohn, Kyung Taek Kim, Byeong Hwan Kim, Bum Ho Jung, Kyung Sik Hwang; J Korean Soc Fract 2000;13(4):837-846. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.837

Abstract PDF

PURPOSE
Searching for the most excellent outcome of ipsilateral fractures of femur and tibia according to the treatment methods and the combined injuries which occasionally neglected.
MATERIALS AND METHODS
We reviewed thirty cases of ipsilateral fractures of the femur and tibia, treated at the orthopaedic department of the Dong-A university hospital between February 1991 and May 1999. Children under 10 years old, treated by conservative methods were excluded in this study. Average follow-up period was 23.2 months(range, 5 to 44 months) and mean age was 34.7 years old(range, 16 to 58 years).
RESULTS
According to the measurement of the Karlstrom and Olerud, range of motion of the ipsilateral knee joint and bony union time, intramedullary nailing was the treatment of choice for both femur and tibia fracures except limited by open wound and fracture level and types(14 cases, 47%). The ipsilateral knee ligaments injury was the most common combined injury which neglected at initial trauma(8 cases, 27%).
CONCLUSION
By intramedullary nailing, the patients with ipsilateral fractures of femur and tibia could achieve early weight bearing ambulation and ipsilateral knee joint excercise, and showed the most excellent outcome. After fixation of both femur and tibia fractures, by physical examination and arthroscopic examination of ipsilateral knee joint we could detect and treat the ipsilateral knee ligaments injuries, which occasionally neglected.

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Ipsilateral Femoral Segmental and Tibial Fractures: A Case Report
Oog Jin Sohn, Chul Hyun Park, Sang Keun Bae
Journal of the Korean Fracture Society.2009; 22(3): 193. CrossRef

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Radial Head Dislocation With Ipsilateral Radial Shaft Fracture: A Case Report: Keun Woo Kim, Yong Hoon Kim, Hak Jin Min, Ui Seoung Yoon, Hee Oh Kim, Jae Hee Kim; J Korean Soc Fract 2000;13(3):570-575. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.570

Abstract PDF

Radial head dislocation with ipsilateral radial shaft fracture is one of the reportable trauma case with very low incidence. Only 4 cases of this type injury have been reported worldwide. In 3 cases of them, good results were achieved after early closed reduction of the radial head, followed by internal fixation of the radial shaft. In the a u t h o r s'case, the patient received the same method of treatment mentioned at the previous successful 3 cases. But after that, he suffered from repeated dislocations and finally nonunion of the fracture. At last, the authors could obtain bony union and stable elbow joint after radial head resection and osteosynthesis using autologous cancellous bone graft, but resulted in limitation of motion. We report the case and the experience of treatment.

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Delayed radial head dislocation after radial shaft fracture fixation: a case report and review of the literature
Jiyong Yang, Jie Zhang, Zhengzhong Yang
BMC Surgery.2022;[Epub] CrossRef

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Ipsilateral Femoral Shaft and Neck fracture: Dong Chul Lee, Yun Seok Lee, Duk Seop Shin; J Korean Soc Fract 1999;12(2):245-252. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.245

Abstract PDF: The occurrence of ipsilateral hip and femoral shaft fracture is uncommon and this problematic combination occur in 2.5% to 6% of femoral fracture. This combination of fractures result from high energy trauma and occurs in young multiply injured patient. As most orthopedists attention is directed to the shaft fructure of femur, the neck fracture can be commonly missed initially. Ipsilateral femoral shaft and neck fracture has the characteristics that has multiple associated injuries and many complications, such at avascular necrosis and nonunion of the femur neck, coxa vara. We analysed the outcome of treatment to know the results of treatment and its complication in 10 patients who were treated at Orthopedic Department, Yeungnam University Hospital from May 1991 to May 1996. The results were as follows : 1. Sixty percent of femoral neck fracture was basicervical type; Ninty Percent of femoral shaft fracture occured in the middle one third and most of the fractures were comminuted. There was one open fracture of femoral shaft. 2. All of the causes of the fractures occurred in motor vehicle accident. Mean age was 40.3 years(range: 15-59 years). There were 24 associated injuries in ten patients: especially, the injuries around knee were most common(6 tibial condylar fractures, 3 patellar fractures, 1 ligament injuries). 3. The bone union was obtained at average 2.8 months after operation(2 months - 5 months) in femur neck fractures, at average 5.5 months after operation(4 months - 12 months) in femur shaft fractttres and weight hearing was permitted at average 2.3 months after operation(1.5 months - 5 months). 4. There were 3 cases of nonunion of femoral shaft fracture, but they were treated by autogenous iliac bone graft Early bone graft may be necessary in comminuted femoral shaft fracture.

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Ipsilateral Fractures of Femoral neck and Shaft: Byeong Hwan Kim, Sung Keun Sohn, Soo Jin Park; J Korean Soc Fract 1999;12(1):13-20. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.13

Abstract PDF: Ipsilateral fractures of the femoral neck and shaft are uncommon injuries with the difficulties in diagnosis and treatment. The femoral neck fracture of this injury is commonly missed on initial evaluation. The overlooked femoral neck fracture may lead to higher risk of complications such as avascular necrosis of the femoral head, nonunion and coxa vara. The authors reviewed nine cases of ipsilateral femoral neck and shaft fracture treated in our clinic from June 1990 to March 1997, and average follow-up period was 39 months(range, 16 to 97 months). The results obtained were as follows ; 1. The cause of injury was traffic accident and one femoral neck fracture was missed initially. 2. The most common site of femoral neck fracture was basicervical in 7 cases and that of shaft fractures was middle 1/3 shaft in 6 cases. 3. Two cases were treated with femoral reconstruction nail, seven with multiple neck pinning and dynamic compression plate for shaft fracture. 4. There were complication such as 2 cases of delayed union of femoral shaft, 1 case of nonunion of femoral shaft. 5. It should be treated with anatomical and rigid internal fixation in femoral neck fracture having first priority.

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Surgical Treatment of Ipsilateral Fracture of the Femur and Tibia("Floating Knee"): Eu Sub Chung, Ki Sik Hong, Seung Soo Hwang; J Korean Soc Fract 1998;11(4):825-832. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.825

Abstract PDF: Ipsilateral fractures of the femur and tibia is also called "Floating knee", It is the term applied to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur and tibia. The principles of the treatment is focussed to the rigid fixation and early restoration of the knee function. Authors reviewed 24 patient in which were treated surgical management from January 1991 to June 1998. The results were as following : 1. The patient who had both diaphyseal fractures had better clinical result than metaphyseal fractures. And the metaphyseal fractures associated with intraarticular fractures were worse than other metaphyseal fractures. 2. At the last follow up, the excellent and good results were achieved in 71% of the patients treated with internal fixation of both fractures and 60% of the patient with external fixation of the tibia, but all of the patient with wxternal fixation of the femur were poor result by Karlstrom and Olerud criteria.

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Treatment of Ipsilateral Femur and Tibia Fractures: Yong Bum Park, sang Ho Moon, Chung Su Hwang, Soon Hyun; J Korean Soc Fract 1998;11(4):754-760. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.754

Abstract PDF

Ipsilateral femur and tibia fractures - so called "floating knee" are caused by high energy trauma and frequently associated with many problems such as hemorrhagic shock, higher morbidity, delayed union, knee stiffness, etc. To get a satisfactory functional result, rigid internal fixation and early mobilization are regarded as treatment priciples at present. Authors analyzed the functional outcomes of floatinhg knee injuries according to the fracture type and methods of surgical treatments. Twenty-eight patients were diagnosed as ipsilateral femur and tibia shaft fractures and treated surgically at the Dongguk University Hospital between June 1990 and May 1996. Average age was 34.5 years, and males were predominant. Majority of cases (27 out of 28) were caused by traffic accident. According to the classification of Blake and McBryde, type I injuries were observed in 17 cases and type II in 11 cases. Average follow up period was 1.3 years. All patients were treated by surgical methods which were selected appropriately with concideration of fracture types. 14 of 17 type I injuries were treated with intramedullary nailing for both femur and tibia fractures. Among these cases, 9 were excellent and 4 were good results. But in type II injuries, only 3 of 4 cases which were fixed with intramedullary nailing for femur and plate for tibia fractures were good results. Conclusively, Intramedullar nailing is an excellent method for ipsilateral femur and tibia fracture and type II injuries which have intra-articular fracture lines meet with worse results than type I.

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Efficacy of Integrated Korean Medicine Treatment Including Motion-Style Acupuncture Treatment for L1 Burst Fracture and Bilateral Femoral Condyle, Proximal Tibial, and Proximal Fibular Comminuted Fractures: A Case Report
Da Dam Kim, Seong Hyeon Jeon, Woo Young Kim
Journal of Acupuncture Research.2024;[Epub] CrossRef
Comparison of Floating Knee according to Presence of Knee Joint Injury
Eau-Sup Chung, Jong Hyuk Park, Hee Rack Choi, Joo Hong Lee, Kwang-Bok Lee
Journal of the Korean Fracture Society.2012; 25(4): 277. CrossRef

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Ipsilateral Fracture of the Femoral Neck and Shaft: Chong Kwan Kim, Jeong Hwan Kim, Dae Young Kim; J Korean Soc Fract 1998;11(4):738-744. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.738

Abstract PDF: Ipsilateral femoral neck and shaft fractures are uncommon and have difficulty in diagnosis. The injury results from high energy trauma. From January, 1990 to March, 1995, 10 cases of ipsilateral femur neck and shaft fractures had been treated. Follow up period varied from 10 months to 3 years (average 1 year 10 month). The purpose of this study is to evaluate the fracture pattern of neck, complications due to delayed operation, and efficient methods of fixation. The neck fractures were minimally displaced or not displaced in 8 cases. The femur shaft fractures were usually comminuted and located at midshaft. The timing of operation was often determined by the patient's status as a multiple trauma victim, but a delay of days to cases, diagnosis was delayed, but there was no complication, like as avascular necrosis and nonunion. There was one case of nonunion of femur shaft, and which was treated with bone graft. We could not find the difference in complication rate among the fixation methods. Anatomic reduction and stable fixation seem to be more important than the method of fixation and timing of operation.

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Analysis of the Operative Treatment of Ipsilateral diaphyseal Fractures of the Humerus and Forearm: Jung Ryul Kim, Kyung Jin Song, Sung Jin Kim, Jun Mo Lee, Byung Yun Hwang; J Korean Soc Fract 1998;11(1):34-40. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.34

Abstract PDF

Twenty-six adults who had concomitant ipsilateral shaft fracture of the humerus and forearm were managed with operative treatment. The mean age was 41 years (range 20 to 55 years), and the mean follow-up was 3.3 years (range 1.5 to 6 years). We reviewed initial soft tissue injury, presence of open fracture, and evaluted radiologic bone union. The functional outcome assessed with rating system of Lange and Foster, which is based on terms of fracture healing and functional restoration of the upper extremity. Overall rate of union for the humerus was 88.4 per cent, for the radius was 82.6 per cent and for the ulna 84.2 percent. We found no difference in average time to union between the treatment group with regard to open reduction and plate fixation or intramedullary nailing in the humerus and forearm bones (P>0.1, Wilcoxon signed rank test). But radiologic evaluation revealed a significant correlation between presence of open fracture and average time to union. The functional result was good in 12 cases (46%), fair in 6 cases(23%), and poor in 8 cases (31 %) according to Lange and Foster criteria. There were four nonunions of the humerus, three of the radius, and three of the ulna. Infection occurred three patients. Other complications were high radial nerve palsy in one case and above elbow amputation in one case. The results following injury were affected both by the severity of the initial trauma and by the treatment given. Best chance for a functional outcome will result from stable fixation of both the humeral and the forearm components.

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Classic Floating Elbow in Adults: A Case Series
Chul-Hyun Cho, Kyung-Keun Min
Clinics in Shoulder and Elbow.2015; 18(1): 8. CrossRef

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The Treatment and Complications of Ipsilateral Fracture of the Femur and tibia: Kyu Min Kong, Ki Chan Ahn, Sung Seok Seo, Young Chang Kim, Jang Seok Choi, Young Goo Lee; J Korean Soc Fract 1997;10(3):556-561. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.556

Abstract PDF: Ipsilateral fracture of the femur and tibia is difficult to treat because it is often comminuted and combined with severe soft tissue injury. And The result of treatment is poor in most cases. The thirty-four cases were treated at Pusan Paik Hospital from March, 1992 to February, 1995. The result were as follows; 1. The bony union time was shorter in the intramedullary nailing than other methods. 2. There were less complications in the group of used intramedullary nailing than other methods. 3. The intramedullary nailing was relatively good treatment method for ipsilateral fracture of the femur and tibia.

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A Traumatic Anterior Hip Dislocation Associated Ipsilateral Femoral Shaft Segmental Fracture : Case Report: Chang Soo Kang, Young Rae Cho; J Korean Soc Fract 1997;10(3):516-521. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.516

Abstract PDF: Traumatic hip dislocation associated with ipsilateral femur shaft fracture is a very rare injury and often results from high velocity injury such as traffic accidents or fall from a height. This combined injury was first documented by Sir Ashley Cooper in 1823. Wiltberger, Mitchell and Hedrick estimated its incidence at one out of 100,000 cases of fractured femoral shaft. Until 1978 there have been only 3 cases were reported of anterior hip dislocation with ipsilateral femoral shaft fracture in the literature. We have recently had the opportunity to manage the patient with anterior hip dislocation with ipsilateral femoral shaft segmental fracture and contralateral acetabular fracture.

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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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Concomitant Ipsilateral Femoral Neck and Shaft Fractures: Kuen Tak Suh, Sang Jin Cheon, Chong Il Yoo; J Korean Soc Fract 1996;9(2):458-465. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.458

Abstract PDF: Concomitant ipsilateral fractures of the femoral neck and shaft are rare, and present diagnostic difficulties and complex choices as to treatment. At the Department of Orthopedic surgery, Pusan National University Hospital, from April 1987 to June 1998, 18 cases of the concomitant ipsilateral fractures of the femoral neck and shaft had been treeated and followed up for 48.7 months in average (ranging from 12 months to 89 months). Initially one case of the femoral neck fracture was missed, which was a non-displaced fracture. Femoral reck fractures were treated with multiple screws or pins in all cases except two cases treated with recon struction nail. For the femoral shaft fractures, plate and screws were applied in 12 cases, Ender nails in three cases, reconstruction nail in two cases and skeletal traction in one case. Nonunion of femoral shaft fracture was developed in one case treated with skeletal fraction, metal loosening in one case treated with Ender nails, and limited motion of the knee in three cases which had knee injuries. But in our cases, avascular necrosis of femoral head and nonunion of the femoral neck and metal failure were not developed. The key factors of successful treatment for concomitant ipsilateral fractures of the femoral neck and shaft seemed to be careful evaluation of the associated hip injures in felnoral shaft fracture and early anatomical reduction and rigid fixation of fractures with early motion of joints.

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

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

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Treatment of the Ipsilateral fracture of Femur and Tibia in Children: Jong Seok Park, Yoon Sik Kim, Hee Kwon, Jun Min Song, Soo Kyun Rah, Chang Uk Choi; J Korean Soc Fract 1996;9(1):129-136. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.129

Abstract PDF: Sixteen cases of fracture of the femur and tibia on the same leg in children below 16 year age were treated in Soonchunyang Univ. Hospital during the period 1988-1993. We studied all of these patients, classified by LettsNew classification of pediatric floating knee, retrospectively with analysis of treatment and results. The results were as follows; 1. Among the 16 cases,14 cases were male(88%), and 10 cases(63%) were at their first decade and 6 cases(37%) were at second decades. 2. The main cause of injury was traffic accident;15 cases(94%). 3. The most common concomitant injury was fracture in other site;5 cases(31%). 4. Among the 9 cases of conservative treatment, limping and leg length inequality were occurred in 6 cases(61%), and malunion in 5 cases(56fo). 5. Among the 7 cases of operative treatment, limping was occurred in 1 cases(14%), leg length inequality was in 2 cases(29%), and malunion in 3 cases(43%). 6. Among the 10 cases at first decade, limping was occurred in the 6 cases(75%) out of 8 cases of conservative treatment, but it was not occurred in 2 cases of operative treatment. According to the results, we suggest that at least one fracture should be rigidly fixed in all cases.

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Treatment of Ipsilateral Fracture of the Femur and Tibia: Dong Heon Kim, Kyu Cheol Shin, Bo Hyeon Kim; J Korean Soc Fract 1995;8(3):620-627. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.620

Abstract PDF: The floating knee describes the fail knee joint segment resulting from fractures of the shafts or adjacent metaphyses of the ipsilateral femu. and tibia. It usually is associated with majo. soft tissue damages, open fractures, and other site injuries. The methods of treatment have been controversal. The key point of the treatment is focussed to the early restoration of the knee function. The floating knee in 24 patients were treated by surgical management from March 1988 to December 1994. The results were follows: 1. Average bone union time in femur was 20 weeks and in tibia was 18 weeks. Difference of the result of the treatment between the interlocking nail and Ender nail was not significant. 2. At the last follow up, the excellent and good results were 83% by Karlstrom and Olerud criteria, and the first group using the intrarneduallary nail achieved best result. 3. The most common complication was loss of the range of motion of the knee and loss of the range of motion of the knee was 0 to 45 degrees(the average 1 degrees).

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Treatment of Ipsilateral Fracture of the Femur and Tibia("Floating Knee"): Soo Bong Hahn, Gang Hee Koh; J Korean Soc Fract 1995;8(3):488-496. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.488

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 local trauma to the soft tissue is often extensive. We retrospectively reviewed 48 cases of the ipsilateral fracture of femur and tibia from March 1983 to March 1993 and analyzed the clinical and functional results. The results were as follows. 1. The most common site of fracture was middle one-third and the most common type of the fracture was comminuted in both femur and tibia. 2. The most common associated injury was concomitant fracture and dislocation of other sites(28 cases) and fat embolism was developed in 4 cases and compartment syndrome was developed in 3 cases. 3. Satisfactory reults were achieved in 72% of the patients treated with internal fixation of both fracture, 63% of the patient with internal fixation for the femur and 43% of the patients managed conseuatively.

Citations

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Comparison of Floating Knee according to Presence of Knee Joint Injury
Eau-Sup Chung, Jong Hyuk Park, Hee Rack Choi, Joo Hong Lee, Kwang-Bok Lee
Journal of the Korean Fracture Society.2012; 25(4): 277. CrossRef

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Femoral Shaft Fracture Associated with Ipsilateral Femoral Neck or Intertrochanteric Fracture: Kyoo Ho Shin, Yun Pei Kung, Jun Seop Jahng; J Korean Soc Fract 1995;8(3):480-487. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.480

Abstract PDF: The segmental fracture of the femur usually was caused by severe force and often accompanied with marked damage of the soft tissue and associated fractures of the other bones. Treatment of the segmental fracture is almost always required operation, and the interest lies in deciding on what operating methods to use and the technical difficulty involed with each method. From Jan. 1986 to Dec. 1993, 29 patients were treated for femoral neck or intertrochanteric fractures which accompanied with ipsilateral femoral shaft fractures at Severance Hospital, Yonsei University College of Medicine, 16 cases were intracapsular (femoral neck) and 13 cases were extracapsular (intertrochanter) hip fractures. We analysed the union time and complications of the 21 cases which were followed over one year. The following results were obtained: 1. For the group of ipsilateral femoral neck and shaft fracture, the knee injury was the most common associated injury (66.7%). 2. For the group of ipsilateral intertrochanter and femoral shaft fracture, the knee injury was not so frequent than the previous group (11.1 to). 3. The ipsilateral femoral neck and shaft fracture was induced by a longitudinal force, which was parallel with femoral shaft and through the knee, and accompanied with a lateral force. But the ipsilateral intertrochanter and femoral shaft fracture may be induced by a different mechanism, a direct transverse force towards the proximal femur. In conclusion. the ipsilateral intertrochanteric and femoral shaft fracture should be distinguished from the ipsilateral femoral neck and shaft fracture, because of the associated injury pattern and different mechanism of the injury.

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Surgical Treatment of Concomitant Ipsilateral Humerus and Forearm Fractures: Jeung Tak Suh, Sung Hun Kim, Chong Il Yoo; J Korean Soc Fract 1994;7(2):316-321. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.316

Abstract PDF: The term "floating elbow" refers to concomitant ipsilateral humeral and forearm bone fractures. This type of fractures is relatively rare and has few guidelines for treatment. Author reviewed 14 cases of these fractures which were treated by open reduction and rigid internal fixation in Pusan National University Hospital from January 1983 to January 1993. In follow up study, Author obtained that good results in 10 cases(71%) of patient, and fair results in 3 cases of patient. Author advocate the patient with concomitant ipsilateral humerus and forearm bone fractures should requires open reduction and stable internal fixation of the both humerus and forearm bone, as soon as possible.

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Ipsilateral Fractures of the Hip Joint and Femoral Shaft: Sang Won Park, Soon Hyuck Lee, Jung Ho Park, Hong Kun Lee; J Korean Soc Fract 1990;3(1):88-95. Published online May 31, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.1.88

Abstract PDF: Ipsilateral fractures of the hip joint and femoral shaft, which generally occur by severe trauma, are frequently associated with multiple fractures and other injuries. Initially overlocked femur neck fracture may lead unpredicted complications, and femoral shaft fractures, usually comminuted, could be complicated with malunion, infection, limb shortening and limited ROM of knee joing. It is difficult to determine the type of fixation device and priority of fracture in treatment according to the variation of the site and pattern of fracture. Eleven pateints with ipsilateral fractures of hip joint and femoral shaft were treated at Korea university Haehwa hospital from Jan. 1984 to Oct. 1988. Among them, nine pateints were followed up more than twelve months. There were eight male and one female. The ages ranged from twenty-two to fifty-three years, the average being 37.6 years. Seven cases caused by traffic accident and fall down trauma in two cases. 1. The levels of hip joint fractures were 6 femoral neck, 1 basal neck-intertrochanteric, and 2 intertrochanteric region. 2. The levels of femoral shaft fractures were 3 proximal one-third and 6 middle one-third. 3. Eight fractures of the femoral shaft except one were comminuted or segmented. 4. Six patients has other fractures or organ injuries. 5. All nine pateints had operation. In six patients with femoral neck and shaft fractures, the femoral shaft fractures were first reduced and fixed, and femoral neck fractures were stabilized later, In three pateints with femoral shaft and basal neck or intertrochanteric fractures, both fractures reduced and fixed simultaneously. 6. Several devices were used according to the site and patterns of fractures. 7. There were complications in three cases:one coxa vara, limb shortening, and infection, knee joint sitffness, and avascular necrosis in one case.

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