Journal of Musculoskeletal Trauma

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; J Korean Fract Soc 2012;25(4):277-282. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.277

Abstract PDF: PURPOSE
To compare the clinical outcomes of floating knee according to the presence of knee joint injury.
MATERIALS AND METHODS
Between March 2004 and March 2009, we investigated 36 patients, who underwent surgical treatment for floating knee injuries. We classified the floating knee into two groups as type I (12 cases) has no knee joint injury and type II (24 cases) has knee joint injury. We compared two groups about combined injury (orthopedics or other part), open fracture or not, neurovascular injury,union time, range of motion, and complication rate.
RESULTS
There is statistically no significant difference between two groups as type I (6 cases, 50%) and type II (13 cases, 54.2%) in orthopedic combined injury (p=0.813), and also same as type I (3 cases, 25%) and type II (12 cases, 50%) in combined injury on the other department (p=0.151), and in floating knee with open fracture as 4 type I (33%) and 12 type II (50%) of 16 cases (44%), and Gustilo-Anderson 3 type I, 4 type II, 1 IIIA, 4 IIIB, and 4 IIIC (p=0.423). There is statistically no significant difference between two groups in neurovascular injury as 1 type I (8.3%), and 3 type II (12.5%) (p=0.708). There is a statistically significant difference between two groups in the mean bone union time as 18.2+/-5.37 weeks (12~24 weeks) for type I and 24.95+/-9.85 weeks (16~33 weeks) for type II (p=0.045), and in the mean range of knee joint motion as 133+/-12.74 degree (120~150 degree) for type I and 105+/-19.00 degree (80~135 degree) for type II (p=0.012).
CONCLUSION
Floating knee with knee joint injury is severe itself and related with severe combined injuries, subsequent range of knee joint motion limitation, the delay of union time, and high complication rate. Therefore, we should take care in surgical treatment for this trauma entity.

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Fatal Hemothorax Following Percutaneous Vertebroplasty: A Case Report: Hee Gon Park, Joo Hong Lee; J Korean Fract Soc 2007;20(2):202-205. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.202

Abstract PDF: Overall, the percutaneous vertebroplasty has low complication rate. Nevertheless, severe complications can occur. The majority of these are related to cement leakage. The cement migration through perivertebral venous system can lead to fatal complication. We present a case of death by hemothorax due to cement leakage following percutaneous vertebroplasty with literature review.

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Comminuted Pilon Fractures: Comparative Outcome Analysis according to Surgical Techniques: You Jin Kim, Hong Geun Jung, Joo Hong Lee, Woo Sup Byun, Sung Tae Lee; J Korean Fract Soc 2007;20(1):6-12. Published online January 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.1.6

PURPOSE
To evaluate the overall surgical outcome of the tibial pilon comminuted fractures and perform the comparative analysis between the limited internal fixation-external fixation group and the delayed open reduction-internal fixation (ORIF) group.
MATERIALS AND METHODS
From June 1997 to June 2004, 17 tibial pilon comminuted fractures were treated with the limited internal fixation-external fixation (6 cases) or the delayed open reduction-internal fixation (11 cases). The average age of the patients was 47.7 years (range: 41~63 years), male was fourteen patients, female was three. Follow-up period was average 33.6 months (range: 12~84 months). The clinical outcomes were evaluated by using AOFAS ankle-hindfoot score and patient satisfaction was also evaluated.
RESULTS
AOFAS score at final follow-up was 80.4 points, and 88% of the patients were satisfied with the results. AOFAS scores of the external fixation group and the delayed ORIF group were average 77.0 points and 82.2 points respectively, which did not show the statistical difference (p>0.05). Bony union was achieved at average 16.0 weeks. There were 18 complications such as skin necrosis.
CONCLUSION
We have achieved relatively encouraging functional results and high patient satisfaction for pilon comminuted fractures, without significant result difference between the two surgical techniques.

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The Result of Using an Additional Mini-Locking Plate for Tibial Pilon Fractures
Suenghwan Jo, Jun Young Lee, Boseon Kim, Kang Hyeon Ryu
Journal of the Korean Fracture Society.2017; 30(2): 75. CrossRef

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Treatment of Intercondylar Fractures of Humerus with Y-plate: Jin Young Park, Joong Bae Seo, Ji Yong Chun, Myoung Ho Kim, Sang Hyuk Min, Joo Hong Lee; J Korean Fract Soc 2006;19(4):443-448. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.443

Abstract

PURPOSE
To evaluate the results of the treatment of intercondylar fractures of the humerus using Y-plate.
MATERIALS AND METHODS
The subjects were 17 patients with intercondylar fracture of humerus who were treated using the Y-plate. Nine cases were C1 type, 4 were C2 type, and the remaining 4 were C3 type. 11 subjects had accompanying fractures of another part of the body. The average age was 48.8. The average follow up period was 33 months. We used Mayo Elbow Performance Score and Risborough-Radin's rating score for each patient as the methods of rating.
RESULTS
The average range of motion of the elbow was 105 degrees (50~150 degrees). According to Cassebaum's classification for elbow range of motion, 7 cases were rated very good, 1 cases were good, 4 cases were fair, and 1 cases were poor. According to Mayo Elbow Performance Score, 7 were excellent, 7 were good, 2 fair, and 1 poor. Of the 3 patients who were fair or poor in Mayo Elbow Performance Score, 2 were type C3 fractures, and all 3 had major accompanying fractures. No significant postoperative complications developed in all cases.
CONCLUSION
The fixation with Y-plate can still be a relatively good modality of treatment for interconylar fractures of the humerus in selected cases, in spite of the known mechanical weakness of the Y-plate. The patients with severe intra-articular comminution showed relatively poor results. And we think that the age of the patient and the energy of the injury have more or less influence on the results of treatment.

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Surgical Treatment Using a Transolecranon Approach with a Dual Locking Plate for Unstable Intercondylar Fractures of the Humerus
Ji-Kang Park, Yong-Min Kim, Dong-Soo Kim, Eui-Sung Choi, Hyun-Chul Shon, Kyoung-Jin Park, Byung-Ki Cho
Journal of the Korean Fracture Society.2012; 25(2): 129. CrossRef
Operative Treatment of Distal Humeral Comminuted Fractures with Orthogonal Plating
Joong-Bae Seo, Jae-Sung Yoo
Journal of the Korean Fracture Society.2011; 24(3): 243. CrossRef
Operative Treatment of Displaced Intercondylar Fracture of the Distal Humerus with Reconstruction Plate
Ryuh Sup Kim, Tong Joo Lee, Kyoung Ho Moon, Seung Rim Park, Moon Lee
Journal of the Korean Fracture Society.2007; 20(2): 172. CrossRef

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Results of Surgical Treatment in Schatzker Type VI Tibial Plateau Fracture: Kyung Jin Song, Kwang Bok Lee, Seung Jin Moon, Joo Hong Lee; J Korean Fract Soc 2004;17(1):32-37. Published online January 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.1.32

Abstract PDF: PURPOSE
The purpose of this study was to evaluate the factors influencing the results for the treatment of the Schatzker type VI tibial plateau fractures.
MATERIALS AND METHODS
Twenty-two cases of the 21 patients in Schatzker type VI tibial plateau fractures were analyzed. Treatment results were analyzed according to the type of fracture (open vs closed), method of operative treatment, angulation more than 5 degree and status of infection. The functional results was evaluated by Hohl's functional criteria. Student t-test was used for the statistical analysis.
RESULTS
Functional outcome demonstrated 5 excellent, 8 good, 6 fair and 3 poor results. There was no significant difference in the treatment results between type of fracture, method of operative treatment and status of infection. Among 9 cases with angular deformity of more than 5 degree, 2 showed excellent or good result and 7 showed fair or poor result (p<0.05). There was no significant difference between rate of postoperative infection and the mean period of the clinical bone union (p=0.66).
CONCLUSION
Accurate anatomical reduction and rigid fixation is essential for the treatment of Schatzker type VI tibial plateau fractures for the prevention of the angular deformity. And early weight bearing exercise should be controlled for the prevention of loss of reduction and loss of alignment leading to angular deformity.

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The results of Operative Treatment in the Proximal Tibial Plateau Fracture: Kyung Jin Song, Keun Ho Yang, Joo Hong Lee; J Korean Soc Fract 2002;15(4):489-496. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.489

Abstract PDF: INTRODUCTION: The purpose of this study was to analyze the results, prognosis and complications in the treatment of proximal tibia plateau fractures, and to suggest the guideline for the proper management in the difficult cases of tibial plateau fractures.
MATERIALS AND METHODS
We have analyzed 27 cases, which surgically treated during recent five years with average 36.6 months follow-up. Patients ranged in age from 24 to 83 years at the time of hospitalization, consisting of 19 males(70.4%) and 8 females(29.6%). The type of fracture by Schatzker classification revealed in type I 3 cases(11.1%), type II 1 case(3.7%), type III 0 case(0%), type IV 3 cases(11.1%), type V 1 case(3.7%) and type VI 19 cases(70.4%). The associated injury occurred in 22 cases(81.5%), most of them were ipsilateral fibular, ipsilateral femoral and radioulnar fractures. The results were evaluated by Blokker 's criteria.
RESULTS
Screw fixation was done in 4 cases(18%) and plate fixation in 23 cases(85.2%), and bone grafting was done in 10 cases(37.0%). There were 10 postoperative complications with 3 cases of knee ankyosis, 3 cases of angular deformity, 3 cases of infection, and 1 case of traumatic arthritis. According to Blokker 's criteria, 22 cases(81.5%) had satisfactory results.
CONCLUSIONS
Accurate anatomical reduction and rigid internal fixation of the proximal tibial plateau fracture enabled early motion and normalization of injured soft tissues, and also provided functional improvement of the knee.

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Open Reduction using Lateral Approach in Displaced Intra-articular Fracture of Calcaneus: Kyung Jin Song, Keun Ho Yang, Joo Hong Lee; J Korean Soc Fract 2002;15(4):446-454. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.446

Abstract PDF: PURPOSE
This study was designed to investigate the usefulness of lateral approach for accurate reduction and rigid internal fixation in comminuted intra-articular fractures of calcaneus.
MATERIALS AND METHOD
Twenty patients(21 cases) who had intra-articular fracture of calcaneus and underwent an open reduction and internal fixation using lateral approach were enrolled. Using Essex-Lopresti classification, all cases were intra-articular fracture, which joint depression type was 17 cases and 4 of severe comminuted tongue type. We compared the preoperative and postoperative change of B o h l e r 's angle and clinical results were analyzed using Paley and Halls evaluation protocol and scoring system.
RESULTS
The average B ohler 's angle was restored from 2.8 to 25.1 after operations and clinical results classified 4 well, 12 good, 4 fair, 1 poor cases. Postoperative complications were 2 cases of wound dehiscence, 1 of infection and one had sural nerve injury. Late complications included 3 cases of limitation of motion of ankle that disturb usual activity, 3 of sustained pain and 2 of traumatic arthritis and 2 cases had 2 complications at the same patients.
CONCLUSION
The lateral approach is valuable for the comminuted intra-articular fractures of calcaneus that enables accurate anatomical reduction and rigid internal fixation by providing direct exposure of subtalar joint, and also with little morbidity of neurovascular injury.

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Treatment of Supracondylar Fractures of the Humerus in Children by Open Reduction: Jung Ryul Kim, Jun Mo Lee, Joo Hong Lee, Pil Soo Sin; J Korean Soc Fract 1999;12(4):1040-1045. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1040

Abstract PDF: PURPOSE
To analyze the results of open reduction in displaced supracondylar fractures of the humerus in children, and to propose guidelines for an open approach to supracondylar fractures.
MATERIALS AND METHODS
Twenty-six children(average age 6.7 years), who had open reduction of severely displaced supracondylar fractures were reviewes retrospectively over a 2- year period(1993 to 1997). Elbow range of motion, carrying angle, and radiographic measurement of the Baumann angle were assessed, then each distal humerus were compared to uninjured side.
RESULTS
At follow-up, the Baumann angle and carrying angle differed by an average of 2 degrees and 4 degrees respectively compared with the unaffected arm. Range of motion was satisfactory in 96% of patientl, and there wah no significant cubitus varus.
CONCLUSIONS
Open reduction of severely displaced supracondylar fractures is a safe and effective procedure, for which orthopedists should lower their threshold, given certain appropriate indicators.

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A Comparison of Treatment between Plate Fixation and Antegrade Intramedullary Fixation of the Humeral Shaft Fractures: Jung Ryul Kim, Joo Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1999;12(1):119-125. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.119

Abstract PDF: We compared the clinical and radiographic outcomes between plate fixation and antegrade interlocking intramedullary fixation for humeral shaft fractures requiring operative intervention. Through retrospective, radomized comparative study, a total sixty adult patients have been reviewed. Thirty patients were treated with plate fixation, thirty another patients were treated with antegrade interlocking intramedullary fixation. Average follow-up time was two year and five months(range, one to four years). Average time to union was 10.8 weeks in plate fixation group and 16.9 weeks in intramedullary fixation group. Overall rate of union was 100% in plate fixation group and 90 % in intramedullary fixation group. According to Stewart and Hundleys functional assessment system, excellent or good results were obtained 29 cases(97%) in plate fixation group, 24 cases(80%) in interlocking intramedullary fixation group. In the plate group, only one fracture had deep infection but in the nail group, nine fractures had complications : three with nonunion, three with shoulder pain and limited ROM, two with intraoperative comminution and one with postoperative radial nerve palsy. There were some technical problems in antegrade intramedullay nailing such as difficulty proximal locking, failed expanlion of distal locking, iatrogenic fracture and distraction between fracture fragment. We concluded that the results after plate fixation have been shown to be preferable with respect to clinical and functional outcomes. In our study, the majority of circumstance requiring internal fixation, plate fixation is proferred and antegrade intramedullary fixation must be used in inevitable situation such as multiple trauma patients, fracture with overlying burns, patients with osteoporotic bone, pathologic fractures and segmental tractures.

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

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

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Analysis of Metal Failures for the femur Shaft Fractures: Kyung Jin Song, Hwang Jik Kim, Jeong Ryul Kim, Joo Hong Lee, Byung Yun Hwang; J Korean Soc Fract 1998;11(3):501-508. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.501

Abstract PDF: The purpose of this investigation was to analyze the causes of the metal failures, and to suggest reasonable methods that can prevent metallic failures in the treamtnet of femur shaft fractures. There were 27 metal failures in 25 patient who underwent internal fixation for the femur shaft fracture between May of 1990 and May of 1996. We analyzed the causes of injury, fracture site, associated injury and used implants for the femur shaft fractures. And also analyzed the interval since operation to metal failure, method of treatment, and complications following surgery for the metallic failures. There were 13 stainless steel DCP(dynamic compression plate), 4 titanium LC(low contact)-DCP, 7 interlocking IM(intramedullary) nails, 2 Dutscher nails, and 1 anatomical plate. The metal failure occurred on average 6.1 months after internal fixation. Eight stainless steel DCP, 4 LC0DCP and 1 anatomical plate failed at the empty hole located at the fracture site. With interlocking IM nail, 4 cases of failure occurred at the proximal 1/3 of femur and other 3 cases showed failure on distal interlocking hole in distal femoral shaft fractures. All failures developed at the fracture site in kuntscher nail. For the treatment of metal failures, we used stainless steel DCP in 12 cases, interlocking IM nail in 7 cases, Kuntcher nail in 2 cases, Ender nail in 1 case, dual plate in 1 case, and external fixation in 2 cases. Autogenous cancellous iliac bone graft applied in 20 cases for the augmentation of frcture site or to fill the defect area. There were 2 cases of re-failure, 2 chronic osteomyelitis, 1 fracture site infection, 2 delayed union and knee joint ankylosis in 1 case. Accurate preoperative evaluation of fracture site, fracture pattern and proper implant selection will be essential for the prevention of metal failures. Minimal soft tissue dissection, anatomical reduction and rigid internal fixation will be necessary for the satisfactory outcome in the treatment of femur shaft fractures. Augmentation with autogenous cancellous bone graft should be followed after internal fixation for the comminuted fractures or bony defect over the fracture site. Postoperative rehabilitation program should be individualized according to the preoperative fracture pattern, used implant, and fracture stability.

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Unusual Isolated lateroplantar Dislocation of the First Tarsometatarsal Joint: A case Report: Joo Hong Lee, Jae Hoon Lee, Hak Ji Kim, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 1996;9(2):349-353. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.349

Abstract PDF: Dislocation and fracture-dislocation fo the Tarsometatarsal joint were rare injuries, but an increase of motor vehicle accidents, industrial and athletic injuries seems to be responsible for an incresing incidence of these injuries. Because of the basic inherent stabilith of the bony architecture and the structures on the sole of the foot including the plantar fascia, the intrinsic foot muscles, peroneus, tibialis posterior tendon and the stronger plantar pligaments most dislocations occur in dorsal and lateral direction. We report a case of 32 year-old male patient who had an isolated fracture and disloction of the first Tarsometatarsal joint with laterai and plantarward displacement. This developed by in-car accident and which did not fit to any proposed classification systems. The diagnosis was delayed because of the combined injuries, but with open reduction and internal fixation with 2 smooth K-wires, satisfactory results could at 12 moonths follow-up study.

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