Journal of Musculoskeletal Trauma

Treatment of avulsion fractures around the knee: Jeong-Hyun Koh, Hyung Keun Song, Won-Tae Cho, Seungyeob Sakong, Sumin Lim; J Musculoskelet Trauma 2025;38(2):63-73. Published online March 31, 2025; DOI: https://doi.org/10.12671/jmt.2025.00073

Abstract PDF: Avulsion fractures of the knee occur when tensile forces cause a bone fragment to separate at the site of soft tissue attachment. These injuries, which frequently affect adolescent athletes, can involve the cruciate and collateral ligaments, arcuate complex, iliotibial band, and patellar and quadriceps tendons. Radiographs aid in the initial diagnosis, while computed tomography and magnetic resonance imaging facilitate a comprehensive evaluation of injury severity and concomitant damage. Specific avulsion fracture types include: anterior cruciate ligament avulsions (tibial site, Meyers and McKeever classification), posterior cruciate ligament avulsions (tibial attachment, Griffith's classification), Segond fractures (anterolateral complex injury), iliotibial band avulsions, medial collateral ligament avulsions (reverse Segond, Stieda fractures), arcuate complex avulsions ("arcuate sign"), medial patellofemoral avulsions (patellar dislocations), and patellar/quadriceps tendon avulsions. The treatment depends on the fracture location, displacement, and associated injuries. Non-displaced fractures can be managed conservatively, while displaced fractures or those with instability require surgical reduction and fixation. Prompt recognition and appropriate intervention prevent complications such as deformity, nonunion, malunion, and residual instability. This review provides an overview of the pathogenesis, diagnosis, and management of knee avulsion fractures to guide clinical decision-making.

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Clinical Outcomes of Triple Tension Band Wirings in Comminuted Patellar Fracture: A Comparison with Conventional Tension Band Wiring: Hyun-Cheol Oh, Han-Kook Yoon, Joong-Won Ha, Sang Hoon Park, Sungwoo Lee; J Korean Fract Soc 2024;37(2):82-86. Published online April 30, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.2.82

Abstract PDF: Purpose
This study devised triple tension band wirings (TTBW) fixation in patients with comminuted patella fractures to compare the clinical result of TTBW with that of tension band wiring (TBW).
Materials and Methods
This study was conducted on 91 patients who had undergone surgery diagnosed with acute patella fracture from January 2011 to December 2016. The study included 51 double TBW patients (Group 1) and 40 patients with TTBW (Group 2).
Results
Five out of 51 cases had a loss of reduction and fixation failure in Group 1, and no failure of fracture formation healing occurred in Group 2. Nonunion was noted in one case in Group 1 and no case in Group 2. Eight K-wire migration cases were observed in Group 1, which was not observed in Group 2. Six patients in Group 1 underwent revisional surgery. No patients in Group 2 had a reoperation. As a result of a one-year follow-up after the operation, the mean range of motion of the knee joint in groups 1 and 2 was 128.3°±11.3° and 127.9°±10.8°, respectively. The Lysholm’s scores for groups 1 and 2 were 90.8±4.2 and 90.3±3.8 points, respectively, which was not statistically significant.
Conclusion
TTBW is a helpful technique for the surgical treatment of comminuted patella fractures. The TTBW method has less reoperation due to nonunion and fixation failure. After a one-year followup, the clinical results were similar to the conventional TBW method.

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Treatment of Avulsion Fractures around the Knee: Sumin Lim; J Korean Fract Soc 2024;37(2):117-124. Published online April 30, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.2.117

Abstract PDF: Avulsion fractures are common in athletes and result from high-impact or sudden, forceful movements involving the separation of a bone fragment at the ligament or tendon attachment site. The key focus areas include the anterior and posterior cruciate ligaments, medial collateral ligament, anterolateral complex, arcuate complex, medial patellofemoral ligament, patellar tendon, and quadriceps tendon. Diagnostic approaches combine radiography with advanced imaging techniques, such as computed tomography and magnetic resonance imaging, to elucidate the extent of injury and guide treatment decisions. Treatment ranges from conservative management for non-displaced fractures to surgical intervention for displaced fractures, with strategies customized based on the specific ligament involved and the nature of the fracture.

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Operative Positioning Technique for an Intertrochanteric Fracture in a Patient with an Ipsilateral Above-the-Knee Amputation - Technical Note -: Dae-Hyun Park, Yong-Uk Kwon, Dong-Seok Kim; J Korean Fract Soc 2021;34(4):137-141. Published online October 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.4.137

Abstract PDF

A 45-year-old man with a remote history of a left above-the-knee amputation presented to the emergency department with left hip pain after a mechanical fall. This case was an operative challenge because commonly used intraoperative traction methods could not be applied to a patient with an above-the-knee amputation. We describe a rarely utilized surgical technique of applying traction to an amputated extremity via a Steinmann pin during closed reduction and internal fixation of an intertrochanteric fracture.

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Periprosthetic Femur Fractures in Osseointegration Amputees
Jason Shih Hoellwarth, S. Robert Rozbruch
JBJS Case Connector.2022;[Epub] CrossRef

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Periprosthetic Fractures following Total Knee Arthroplasty: Byung Hoon Lee, Jae Ang Sim; J Korean Fract Soc 2020;33(1):52-61. Published online January 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.1.52

Abstract PDF: Recently, as the elderly population increases, the incidence of total knee arthroplasty has increased, with a concomitant increase in the frequency of periprosthetic fractures. To determine the treatment plan for fractures, the treatment method should be determined by the patient's age, osteoporosis, fixation status of the implant, and type of fracture. In recent years, operative treatment with reduction and stable fixation, rather than non-operative treatment, was used to promote early joint movement and gait. On the other hand, it is necessary to select an appropriate operative method to reduce complications of surgery, such as nonunion and infection, and expect a good prognosis. In this review, periprosthetic fractures were divided into femur, tibia, and patella fractures, and their causes, risk factors, classification, and treatment are discussed.

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Cortical Perforation Misidentified with Medial Condylar Fracture of Femur in Total Knee Arthroplasty: Case Report: Seung Suk Seo, Sang Won Moon; J Korean Fract Soc 2019;32(1):52-55. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.52

Abstract PDF: Intraoperative fracture in total knee arthroplasty (TKA) is a rare complication. However, when it happens, additional surgery to fix the fracture site is needed. Therefore, it is important to diagnose intraoperative fractures in TKA exactly. The authors experienced two cases of cortical perforation of medial femoral condyle misidentified as the fracture in TKA. Cortical perforation could be misdiagnosed as the fracture, which could lead to unnecessary surgery. This is the first report about cortical perforation in TKA. We report two cases of intraoperative cortical perforations and describe the radiological characteristics.

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Arthroscopic Assisted Intra-Articular Reduction and Internal Fixation of Tibia Plateau Fracture: Dong Hwi Kim, Gwang Chul Lee, Kwi Youn Choi, Sung Won Cho, Sang Ho Ha; J Korean Fract Soc 2013;26(3):191-198. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.191

Abstract PDF

PURPOSE
We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts.
MATERIALS AND METHODS
From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system.
RESULTS
The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases.
CONCLUSION
We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.

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Current Concepts in Management of Tibia Plateau Fracture
Sang Hak Lee, Kang-Il Kim
Journal of the Korean Fracture Society.2014; 27(3): 245. CrossRef

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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; 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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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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Risk Factors of Periprosthetic Fracture after Total Knee Arthroplasty: Ju Young Shin, Hyung Jun Kim, Seung Han Cha, Dong Heon Kim; J Korean Fract Soc 2012;25(1):1-7. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.1

Abstract PDF: PURPOSE
To evaluate the incidence rate and risk factors for periprosthetic fracture after total knee replacement (TKR).
MATERIALS AND METHODS
We carried out a retrospective case-control study of 596 patients (951 knees) who underwent TKR between 1999 and 2006 and who were followed up over 36 months. We classified patients into group I (study group) and group II (control group). We subdivided risk factors as pre-operative, intra-operative, and post-operative factors. Age, osteoporosis, revision arthroplasty, CVA, and alcohol dependence were categorized as pre-operative factors; anterior femoral notching and prosthetic types (mobile, fixed, and load-bearing) were considered intra-operative factors; and post-operative activity level was classified as a post-operative factor. We obtained information from the patients' charts, X-ray film, and telephone interviews.
RESULTS
The overall incidence rate was 2.25%; 3 patients were male, and 18 were female (14.28% and 85.72%, respectively). Old age (p<0.01, odds ratio=1.14), osteoporosis (p=0.01, odds ratio=4.74), revision arthroplasty (p=0.01, odds ratio=7.46), CVA (p=0.02, odds ratio=8.55), and alcohol dependence (p=0.03, odds ratio=44.54) were statistically significant among the pre-operative factors. Among the intra-operative factors, anterior femoral notching (p<0.01, odds ratio=11.74) was significant, and continued heavy labor (p<0.01, odds ratio=8.14) was significant among the post-operative factors.
CONCLUSION
We concluded that old age, osteoporosis, revision arthroplasty, comorbidity related with falling down, anterior femoral notching, and continued heavy labor were associated with periprosthetic fracture after TKR.

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Anterior Knee Pain after Intramedullary Nailing for Tibial Shaft Fractures: Suk Kyu Choo, Hyoung Keun Oh, Hyun Woo Choi, Jae Gwang Song; J Korean Fract Soc 2011;24(1):28-32. Published online January 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.1.28

Abstract PDF

PURPOSE
To analyze the possible causes and incidence of the chronic anterior knee pain follow after closed intramedullary nailing for the tibial shaft fractures, in a retrospective aspect.
MATERIALS AND METHODS
52 patients who treated with intramedullary nailing for the tibial shaft fractures from January 2001 to October 2008 were reviewed. We analyzed the relationship between knee pain and the variables (sex, age, types of fracture, protrusion extent of intramedullary nailing on proximal tibia). The aspects of pain, its onset and relieving time, and how much it influences on daily living were analyzed retrospectively. For categorical variables, group variences were estimated using Chi-square test.
RESULTS
34 patients of 52 (65%) complaint of anterior knee pain followed after intramedullary nailing, and there were no statistical differences between pain and sex/age (p>0.05). Incidence of anterior knee pain becomes higher as the severity of fracture increases, but there was no statistical difference between pain and intramedullary nailing protrusion. Pain severity was mostly not influencing on daily living, and it mostly responded to conservative treatment.
CONCLUSION
The incidence of anterior knee pain followed after intramedullary nailing was 65%, and its severity was mostly not influencing on daily living. There were no significant differences between pain and sex, age, protrusion extent of intramedullary nailing on proximal tibia, but as the severity of frature increases, the incidence of anterior knee pain became higher.

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Pain in Anterior Knee after Locked Nailing of Diaphyseal Tibia Fractures
V. V. Pisarev
Traumatology and Orthopedics of Russia.2020; 26(1): 85. CrossRef
Stress fractures of the tibia
Jung Min Park, Ki Sun Sung
Arthroscopy and Orthopedic Sports Medicine.2015; 2(2): 95. CrossRef
Tension Band Plating for a Stress Fracture of the Anterior Tibial Cortex in a Basketball Player - A Case Report -
Chul Hyun Park, Woo Chun Lee
Journal of the Korean Fracture Society.2012; 25(4): 323. CrossRef

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The Use of Fresh Frozen Allogenic Bone Graft in the Impacted Tibial Plateau Fractures: Yeung Jin Kim, Soo Uk Chae, Jung Hwan Yang, Ji Wan Lee, Dae Han Wi, Duk Hwa Choi; J Korean Fract Soc 2010;23(1):26-33. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.26

Abstract PDF

PURPOSE
To assess the behaviour of fresh frozen cancellous allograft used for supporting the reconstructed articular surface in impacted tibial plateau fractures.
MATERIALS AND METHODS
Between May 2004 and May 2008, 13 cases of impacted tibial plateau fracture were evaluated retrospectively. All fractures were treated with open reduction-internal fixation after restoration of the tibial plateau surface and insertion of fresh frozen cancellous allograft chips for subchondral support. Mean age was 46.6 (31~65) years. Average follow-up period was 36 (13~58) months. The radiological and clinical result for every patient was assessed according to the modified Rasmussen's system and Lysholm's knee score.
RESULTS
According to last follow-up weight bearing A-P X-ray, the fresh frozen cancellous allograft incorporated soundly in all cases and no complications such as joint depression, fracture reduction loss, angular deformity, and malunion were found. The mean time to complete bone union was postoperative 10+/-0.7 weeks. The mean range of motion was 135 (115~145) degrees. The mean Rasmussen's radiological score at last follow up was 15.3 (10 cases: excellent, 3 cases: good). The mean Lysholm's knee score at last follow up was 88.2+/-4.3.
CONCLUSION
We concluded that fresh frozen cancellous allograft in impacted tibial plateau fractures showed good results in terms of bone union and functional improvement and was considered to be a good structural supporter.

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Autograft versus allograft reconstruction of acute tibial plateau fractures: a comparative study of complications and outcome
Abolfazl Bagherifard, Hassan Ghandhari, Mahmoud Jabalameli, Mohammad Rahbar, Hosseinali Hadi, Mehdi Moayedfar, Mohammadreza Minatour Sajadi, Alireza Karimpour
European Journal of Orthopaedic Surgery & Traumatology.2017; 27(5): 665. CrossRef
Treatment of Tibial Plateau Fractures Using a Locking Plate and Minimally Invasive Percutaneous Osteosynthesis Technique
Hee-Gon Park, Dae-Hee Lee, Kyung Joon Lee
Journal of the Korean Fracture Society.2012; 25(2): 110. CrossRef

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Patient Accompanied with Simultaneous Anterior Dislocation of Hip and Anterior Dislocation of Knee : A Case Report: Hee Gon Park; J Korean Fract Soc 2009;22(3):185-188. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.185

Abstract PDF

We are reporting a case that a 61-year-old patient who had simultaneous anterior dislocation of left hip and anterior dislocation of right knee after fall from a height injury was treated by closed reduction respectively.

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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
Journal of the Korean Fracture Society.2012; 25(1): 73. CrossRef

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Retrograde Nailing for Supracondylar Fracture after Total Knee Replacement: The Compatibility of Femoral Implant with Supracondylar Nail: Moon Jib Yoo, You Jin Kim, Jin Won Lee; J Korean Fract Soc 2008;21(1):19-23. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.19

Abstract PDF: PURPOSE
Retrograde intrameullary nail is one of the treatment of periprosthetic supracondylar femoral fracture after total knee replacement (TKR), but all TKRs will not permit to insert a supracondylar nail. Therefore, we have investigated the compatibility of the TKRs with supracondylar nail.
MATERIALS AND METHODS
Using trial femoral component of the 5 used TKRs in Korea and saw bone model, we checked their compatibility and measured the dimensions of the intercondylar notches in both cruciate retaining (CR) and posterior stabilized (PS) type.
RESULTS
Although most CR prostheses had an intercondylar notch large enough to accept a supracondylar nail, in some case, this was not possible due to the notch being situated too far posteriorly. The position of the intercondylar notch is also important factor in the PS prostheses.
CONCLUSION
The notch position, rather than the notch size, was the most important factor in determining nail compatibility with femoral stem.

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Stiff Knee by Entrapment of Quadriceps Femoris Tendon at Fracture Site in Paediatric Distal Femur Shaft Fracture: Suk Kang, Jong Pil Kim, Chung Soo Hwang, Phil Hyun Chung, Young Sung Kim, Sang Ho Lee, Jin Wook Chung; J Korean Fract Soc 2007;20(4):339-344. Published online October 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.4.339

Abstract PDF: The complications following paediatric femur fracture are leg length discrepancy, angulation deformity, rotational deformity, ischemic limb. But, stiff knee is rarely expressed after trauma like paediatric femur fracture. We report a case of stiff knee due to entrapment of quadriceps femoris tendon at displaced fracture site after conservative treatment by Russel traction and hip spica cast in paediatric femur fracture. We treated successfully by resection of distal end of proximal segment of femur and release of quadriceps femoris tendon for flexion contracture of the knee.

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Midterm Results of Treatment with a Retrograde Nail for Periprosthetic Fractures of the Femur Following Total Knee Arthroplasty: Kyung Taek Kim, Jin Hun Kang, Lih Wang, Jae Sung Hwang; J Korean Fract Soc 2007;20(4):309-314. Published online October 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.4.309

Abstract PDF: PURPOSE
To analyze the midterm results of the treatment with a retrograde nail for periprosthetic fractures of the femur following total knee arthroplasty.
MATERIALS AND METHODS
Between Jan 1998 and Jan 2004, 11 cases in 11 patients were treated for the periprosthetic fractures following total knee arthroplasty. The mean follow-up was 42.0 (30~98) months and the mean age was 66.0 (57~79) years old. 2 were males and 9 patients were females. In all cases, retrograde nailing was done for the periprosthetic fractures. Postoperative range of motion, HSS knee rating score, femorotibial angle, the time required for union, complications were evaluated.
RESULTS
Postoperative range of motion was 103.6Â° degrees on an average, HSS knee rating score was 83.5 points on an average at the last follow up. The mean angulation on radiograph was valgus 6.3Â°. The mean time required for union was 4 months. One had a newly fracture line at proximal part of supracondylar fracture, but there was no significant in clinical course. There was no prostheses required revision.
CONCLUSION
It appears that retrograde nail is a reliable surgical technique for periprosthetic fractures of the femur following total knee arthroplasty with low complication rate. The midterm results in our study showed that none of the prostheses required revision.

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Effect of Alternative Splinting at Extension and 90degrees Flexion on Range of Motion after Open Reduction and Internal Fixation of Distal Femur Fracture: Chong Kwan Kim, Jong Ho Yoon, Byung Woo Ahn, Chin Woo Jin, Dong Wook Kim, Young Il Kwan, Young Ho Lee; J Korean Fract Soc 2005;18(2):144-148. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.144

Abstract PDF

PURPOSE
To evaluate the usefulness of early range of motion exercise by using 90degrees knee flexion splint after open reduction and internal fixation in fracture of distal femur.
MATERIALS AND METHODS
We reviewed twenty-six cases of distal femur fractures which were treated with open reduction and internal fixation from February 2002 to November 2003. One group (group A) were treated by using 30degrees knee flexion splint, the other group (group B) were treated by using 90degrees flexion and full extension splint alternativley by post-operative 1 week. The follow up period was minimally 12 months. The range of motion and Schatzker and Lambert criteria were evaluated.
RESULTS
The mean period to gain 90degrees knee flexion was 11.4 (7~14) weeks in group A, and 6.6 (3~8) weeks in group B. Mean range of motion was 94.7degrees (average flexion contracture 9.5degrees ) in A group and 108.7degrees (average flexion contracture 6.3degrees ) in B group at 12 weeks follow-up. According to Schatzker and Lambert criteria, excellent result was achieved in 10 cases (38%), good result in 13 cases (50%), fair result in 3 cases (12%).
CONCLUSION
This study demonstrates that alternative splinting at extension and 90degrees flexion contribute to early recovery of range of motion in distal femur fractures treated with internal fixation.

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Treatment of Femur Supracondylar Fracture with Locking Compression Plate
Seong Ho Bae, Seung Han Cha, Jeung Tak Suh
Journal of the Korean Fracture Society.2010; 23(3): 282. CrossRef

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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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Femoral Neck Fracture in Bilateral Above Knee Amputee: A Case Report: Kye Young Han; J Korean Soc Fract 2003;16(1):116-119. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.116

Abstract PDF: Femoral neck fracture is a common fracture in elderly or osteoporotic women. But femoral neck fracture in previously amputed patients is rare, so the guideline of appropriate treatment is rarely discussed. Especially, femoral neck fracture in patients with above knee amputation was more rare. Hereby I report a case of femoral neck fracture occurred to 58-year-old male bilateral above knee amputee with the review of literatures.

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Knee Pain Analysis After Tibia Intramedullary Nailing: Kwang Won Lee, Jong Won Kang, Seung Hun Lee, Ha Yong Kim, Won Sik Choy; J Korean Soc Fract 2001;14(2):278-284. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.278

Abstract PDF

PURPOSE
To analyze the incidence and clinical and radiological results of anterior knee pain following tibial intramedullary nailing.
MATERIALS AND METHODS
From January 1995 to April 1999, we retrospectively analyzed in 122 patients with tibial fracture who were treated by closed intramedullary nailing. All of 125 cases analyzed the age and sex distribution, mechanism of injury, fracture morphology, relationship of nail position on radiographs to knee pain and relationship of knee pain to the incision methods of patella tendon. Anterior knee pain was assessed with a 10-point analogue scale. Statistical analysis was performed using paired T-test.
RESULTS
At a mean follow-up period of thirty-eight months(12-64 months), sixtynine( 56%) patients(70 of 125 knees) had developed anterior knee pain. Insertion of the nail through the patella tendon splitting incision was associated with a higher incidence of knee pain compared to the paratendon site of nail insertion(62% and 35% respectively). According to the radiological analysis, the mean extent of nail protrusion of 122 patients was -1.4mm and the average nail protrusion of 69 patients with knee pain was 1.3mm respectively. Nail removal resolved or improved the symptoms in 69%.
CONCLUSION
Based on these data, we would recommend a parapatella tendon incision for nail insertion, and nail removal for those patients with a painful knee after bony union.

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Alteration of the Patella Tendon Length after Intramedullary Nail in Tibial Shaft Fractures
Dong-Eun Shin, Ki-Shik Nam, Jin-Young Bang, Ji-Hoon Chang
Journal of the Korean Fracture Society.2012; 25(4): 283. CrossRef
Anterior Knee Pain after Intramedullary Nailing for Tibial Shaft Fractures
Suk-Kyu Choo, Hyoung-Keun Oh, Hyun-Woo Choi, Jae-Gwang Song
Journal of the Korean Fracture Society.2011; 24(1): 28. CrossRef

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Popliteal Artery Injury Associated with Fracture and/or Dislocation of the Knee: Jun Young Yang, Kwang Jin Rhee, June Kyu Lee, Deuk Soo Hwang, Ki Yong Byun, Taek Soo Jeon; J Korean Soc Fract 2000;13(3):494-500. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.494

Abstract PDF: PURPOSE
To compare the outcome in patients who have popliteal artery injury associated with fracture and/or dislocation around the knee according to treatment option.
MATERIALS AND METHODS
We have reviewed fourteen cases of popliteal artery injury patients associated with fracture and/or dislocation injury around the knee who had visited at Chungnam National University Hospital from April 1997 to July 1999.
RESULTS
Combined skeletal injuries included fracture of distal femur, fracture of proximal tibia, and dislocation of the knee. Internal or external fixation was applied for skeletal injuries. We repaired the injured popliteal artery using end-to-end anastomosis (3 cases), interposed saphenous vein graft (9 cases), prosthetic vein graft (1 case), or thrombectomy alone (1 case). The amputation rate was 21 % (3 out of 14 patients). In limb salvage cases, we evaluated the function of knee joint, and the results were as follows : good 5 cases, fair 3 cases, and poor 3 cases.
CONCLUSION
Early diagnosis and prompt management for injuries of the popliteal artery is the most important factor to save the limb. Also, complete resection of all injured portion of vessel and reconstruction of patency through interposed saphenous vein graft are most useful method.

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Delayed Diagnosed Thrombosis Associated with Closed Fractures Around the Knee: Byung Moon Park, Hyung Koo Yoon, Kwang Pyo Jeon, Kyung Hoom Kang, Jin Il Kim, Dong Soo Kim, Yong Jae Lee; J Korean Soc Fract 2000;13(2):289-295. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.289

Abstract PDF: PURPOSE
: The goal of this study is to decrease the chance of the lower limb loss resulting from the delayed diagnosis of arterial thrombosis after first operation in a patient of the closed fractures around the knee by early diagnosis and proper management via studying several prognostic factors.
MATERIALS AND METHODS
: We have reviewed 8 cases of delayed diagnosed arterial thrombosis patient who was follow up for 1 year or more March 1987 to February 1997, retrospectively. We have followed ip the clinical results.
RESULTS
: The amputation rate was 50%(4/8), and among associated injuries, tibial or peroneal nerve palsy was combined in 75%(6/8). The time interval from initial trauma to diagnosis was significantly different between amputation group(77hours) and non amputation group(34.25hours). Better results were obtained in cases who had early diagnosis and treated with end to end anastomosis than vein graft.
CONCLUSION
: It is very important that the vascular status should be assessed not only at the first examination but also repeatedly over the ensuing hours and days with caution, even though there was absence of ischemic sign.

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Knee Fractures and Ligament Injuries Associated with Ipsilateral Femoral Shaft Fractures: Mechanism of Injury, Site of th Knee Fracture and Ligament Injury: Dong Ju Chae, Phyl Hyun Chung, Won Suk Chae; J Korean Soc Fract 2000;13(2):230-235. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.230

Abstract PDF: PURPOSE
: To establish the incidence and type of knee fractures, injury of knee ligament associated with ipsilateral femoral shaft fractures. What is the most common mechanism of these combined injuries? MATERIALS AND METHODS : From March 1995 to February 1999, evaluation of one hundred and twenty consecutive patients with fracture of the femoral shaft showed fractures and injuries of the ligaments of the ipsilateral knee in thirty-five(29%) of them. Of those thirty-five, nineteen patients had injured their knees and femoral shaft fractures by the dashboard injury. Twelve injuries were caused in a motor cycle accident, and two patients occurred in pedestrians struck by cars. Two injuries were caused by falls.
RESULTS
: There were twenty fractures of th knee and fifteen injuries of the ligament. Seventeen of the twenty fractures were in the patella, two in the bicondyle of the proximal tibia and one in the lateral condyle of the proximal tibia. Eleven of seventeen fractures of the patella were open fractures. Of fifteen injuries of the ligament, there were six posterior cruciate ligament tears (including 2 partial tears and 1 avulsion fracture), three posterior cruciate ligament tears with medial or lateral collateral ligament disruption , three anterior cruciate ligament tears(2 tibial spine fractures and 1 partial tear), two lateral collateral ligament disruptions and one medial collateral ligament tear. The locations of femoral shaft fracture were proximal in four patients, middle in thirty, and distal in one patient.
CONCLUSION
: We conclude that there is a high incidence of ipsilateral fracture of the patella and posterior cruciate ligament tears in patients with femoral shaft fractures. The dashboard injury is the most common mechanism of the ipsilateral knee fractures and ligament tears with femoral shaft fractures.

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Results of Judet Quadricepsplasty in Knee Stiffness: Kuhn Sung Whang, Ki Chul Park, Kyung Sik Kim; J Korean Soc Fract 2000;13(1):96-102. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.96

Abstract PDF

PURPOSE
: We performed this study to evaluate the proper indication and complication of the Judet quadricepsplasty in the stiff knee.
MATERIALS AND METHODS
: Authors analyzed 15 cases in 14 patients treated by Judet quadricepsplasty from July 1990 to may 1998. There were 9 male and 5 female with an average age of 32.0 years. The average follow-up was 3 years 7 months. Causes of stiff knee sere femoral distal fracture in 7 cases, femoral midshaft fracture in 5 cases, tuberculosis osteomyelitis in 3 cases. The average interval between injury and quadricepsplasty was 1 year 10 months. We check the preoperative and last follow up range of motion in involved knee, and check the postoperative and last follow up extension lag and complication.
RESULTS
: By the Judet' classification, last follow up results were shown to be 5 cases in excellent, 5 cases in good, 5 cases in poor. Complications were patella fracture in 3 cases, infection in 1 case, femoral artery rupture in 1 case, and these 5 cases were shown to be poor results. Three patella fractures were arisen at the insertion of Quadriceps muscle. Infection was secondary type by the hematoma results from inappropriate hemostasis. Femoral artery rupture was arisen by the severe fibrosis at the surrounding arteries and tissues results from chronic infection due to long term application of Ilizarov apparatus. In the excellent and good results, average preoperative range of motion were 36.0 degrees, average last follow up range of motion were 96..5 degrees, average flexion gain were 60.5 degrees. Postperative extension lag were 16.5 degrees in 7 cases(70%), but last follow up extension lag were 8.7 degrees in 4 cases(40%).
CONCLUSION
: Judet quadricepsplasty was excellent method to solve the extra-articular stiff knee in the proper indication. Inappropriate indication were thought to severe intra-articular adhesion, severe osteoporosis of patella, severe fibrosis in the medial aspect of distal thigh. Postoperative early ROM exercise using CPM were thought to improve the range of motion of involved knee.

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A Modified Thompson Quadricepsplasty for Extension Contracture Resulting From Femoral and Periarticular Knee Fractures
Mohammad H. Ebbrahimzadeh, Ali Birjandi-Nejad, Said Ghorbani, Mohammad Reza Khorasani
Journal of Trauma: Injury, Infection & Critical Care.2010; 68(6): 1471. CrossRef

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Osteochondral Avulsion Fracture in Patella after Treatment of Abscess around Knee: A Case report: Keun Soo Lee, Geon Woo Lee, Sang Ho Song, Hyun Seo; J Korean Soc Fract 1999;12(2):290-293. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.290

Abstract PDF: Osteochondral avulsion fracture of patella has been rarely reported. We experienced one case of osteochondral avulsion fracture which was developed after abscess around knee. The patient was a 16year old with the history of abscess. The presenting symptom was knee pain and loss of extension power. Radiologic and operative findings suggested that osteochondral avulsion fracture of the patella, was caused by minor trauma near the insertion site of quadriceps tendon. In usual case of quadriceps tendon rupture, the rupture occurred at the musculotendinous junction, caused by sudden contracture of the muscle without trauma history. This case was treated successfully with tension band wiring technique. Differential diagnosis between osteochondral avulsion fracture and osteomyelitis of patella was emphasized.

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Injuries of the Knee Associated with Fractures of the Tibial Shaft: Kwang Won Lee, In Sung Hwang, Seung Hun Lee, Tae Gyoo Ahn, Ha Yong Kim, Whoan Jeang Kim, Won Sik Choy; J Korean Soc Fract 1999;12(2):277-283. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.277

Abstract PDF: Two hundred and seventeen consecutive patients with two hundred and twenty five diaphyseal tibia fractures were retrospectively reviewed to evaluate the frequencies, types and the results of treatments for the associated ipsilateral knee ligaments and menisci injuries from May 1993 to Feb 1997 at Eulji Medical College Hospital. Average follow-up period was 41 months(20~65 months). Thirteen patients with knee injuries(5.8%) were diagnosed by stress X-ray & MRI evaluation and confirmed by arthroscopic examination. Eleven patients(84.6%) were diagnosed as having a ligament or meniscus injury at the time of initial management. The posterior cruciate ligament(PCL) was injured in eight patients(50%); the anterior cruciate ligament(ACL), in three; the medial collateral ligament, in three; the lateral collateral ligament, in two: the medial meniscus, in two; and the lateral meniscus, in two. There was no relationship between specific ligament damage and the cause of the injury or level of fracture. Collateral ligament injuries, two ACL, and four PCL injuries were treated conservatively and one PCL injuries were treated with pull-out suture technique and another four PCL injuries were treated with reconstruction using bone-patella tendon-bone. One ACL injury was treated with reconstruction using semitendinosus tendon. As evaluated by the method of HSS knee score, there were seven(53.9%) excellent, four(30.8%) good, and two fair(15.3%). On the basis of the results of this study, we believe that, after stabilization of a fracture of the tibial shaft, it is essential to examine the knee throughly to identify any associated ligamentous injuries.

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Bilateral Floating Knees Treated by 4 Intramedullary Nails: A Case Report: Phil Hyun Chung, Dong Ju Chae, Sang ho Moon, Ho Gyoon Bae; J Korean Soc Fract 1999;12(2):267-271. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.267

Abstract PDF: The treatment of simultaneous ipsilateral femoral and tibial fractures is a challenging therapeutic problem. Unfortunately, despites a number of reports on these fractures, guidelines for treatment have not been well established. Because the knee joint is isolated partially or completely, the term "floating knee"is used. But most of these injuries are ipsilateral and few bilateral cases were reported in the literatures. The authors reviewed a case of bilateral floating knee treated by 4 intramedullary nails without having any prolonged healing time or limited range of motion in both knee joint postoperatively.

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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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Clinical and Radiologic Analysis of Occult Osseous Lesion on Magnetic Resonance Imaging in Acute Knee Injury: Seung Key Kim, Jong Hun Lee, Nam Gee Lee, Chang Beom Park, Han Chang; J Korean Soc Fract 1997;10(4):843-850. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.843

Abstract PDF: Bone bruise or occult osseous lesion on magnetic resonance imaging was focused on the indirect sign of acute anterior cruciate ligament injury. But there were few reports which compared the location of bone bruise with the injured structure. The purposes of this study were to identify the common pattern of location of bone bruise, and to analyze the relationship between the location and injured structure or mechanism of injury. The authors reviewed 76 magnetic resonance imaging studies of the knee from March 1993 to May 1994 which show the sign of bone bruise in acute knee injury within six weeks. The mean age of the patient was 26.3 years and the main cause of injury was traffic accident. The final diagnosis was 20 cases of isolated medial collateral ligament injury, 17 cases of isolated anterior cruciate ligament injury, 16 cases of combined anterior cruciate and medial collateral ligament injury, 7 cases of meniscus injury, 6 cases of combined posterior cruciate and medial collateral ligament injury, 5 cases of isolated posterior cruciate ligament injury, 2 cases of patella dislocation, 1 case of lateral collateral ligment injury, and 2 cases of undiagnosed knee injury. In isolated MCL injuries, bone bruises were all confined to the lateral compartment. In isolated injury of ACL, the most common pattern of location of bone bruises were lateral tibial plateau and lateral femoral condyle(47.1%). In combined ACL and MCL injury, the most common pattern of location was lateral tibial plateau, only(43.8%). Bone bruise on MRI may be easy to detect during interpretation and we can obtain much information to decide the diagnosis and prognosis.

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