Journal of Musculoskeletal Trauma

Treatment Strategy of Infected Nonunion: Hyoung Keun Oh; J Korean Fract Soc 2017;30(1):52-62. Published online January 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.1.52

The management of infected nonunion is based on a detailed evaluation of patients, the involved bone and soft tissues, stability of fixation, and type of bacterial pathogens. Preoperative surgical planning and strategies for each step is mandatory for the successful treatment of infected nonunion. The radical debridement of infected tissues, including the unstable implant, is one of the most important procedures. Adequate soft tissue coverage should be considered for the appropriate management of infection; a reconstructive procedure and stable skeletal stabilization by internal or external fixation is also necessary later. A restoration of bone defects and bony union can be accomplished with bone grafting, distraction osteogenesis, vascularized fibular grafting, and induced membrane technique.

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Systematic Diagnosis and Treatment Principles for Acute Fracture-Related Infections
Jeong-Seok Choi, Jun-Hyeok Kwon, Seong-Hyun Kang, Yun-Ki Ryu, Won-Seok Choi, Jong-Keon Oh, Jae-Woo Cho
Journal of the Korean Fracture Society.2023; 36(4): 148. CrossRef
The Antibiotic Cement Coated Nail and Masquelet Technique for the Treatment of Infected Nonunion of Tibia with Bone Defect and Varus Deformity: A Case Report
Min Gu Jang, Jae Hwang Song, Dae Yeung Kim, Woo Jin Shin
Journal of the Korean Fracture Society.2022; 35(1): 26. CrossRef

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Treatment of Wide Gap Non-Unions in Lower Extremities: Doohoon Sun, Byeong Seop Park, Taehyeon Jeon, Seung Koo Rhee; J Korean Fract Soc 2017;30(1):1-8. Published online January 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.1.1

Abstract PDF: PURPOSE
To analyze the end results of the treatment for patients with wide gap non-unions of the long bones in the lower extremities.
MATERIALS AND METHODS
A total of 62 cases of wide gap unions, with a mean age of 38 years, were included for analysis. Study cohort included six children under the age of seven years. The average size of established bone defect was 7 cm (4-23 cm). Bone defects under 7 cm were treated with plating and various bone grafts, and those over 7 cm were managed with vascularized fibular graft (VFG), distraction-osteogenesis, tibial strut, plating and etc. Two boys with a defect of the whole tibia but with an intact fibula were treated with tibialization of intact fibula and with rotation-plasty of the leg. Their end results were evaluated by the time of bony union in accordance with the treatment of defect size of the long bone as well as their age.
RESULTS
Bony unions were obtained for an average period of at least 27 months. Fifty-one cases showed an average leg-length discrepancy of 2.8 cm, and 11 cases showed no leg-length discrepancy. The VFG, distraction-osteogenesis, and tibial cortical-strut graft and plating were the most effective methods for non-unions of wide, long bone defections (>7 cm). The prognosis was more favorable in children, muscular femur, and in cases with tibial defect but intact fÃ bula.
CONCLUSION
Various bone union techniques should be considered carefully, considering the ages of patients and the size of bone defects. Due to severe physical and mental disabilities of patients during the long-treatment period, specialized orthopedic doctors for trauma and mental care were necessary.

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Delayed Operative Treatment of Long Bone Fractures in Patients with Brain Injury: Hong Moon Sohn, Sang Ho Ha, Jun Young Lee, Young Kwan Lee; J Korean Fract Soc 2006;19(2):157-162. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.157

Abstract

PURPOSE
To evaluate the postoperative progress and outcomes of bone injured patients with long bone fracture showing callus formation and deformity due to delayed surgical treatment.
MATERIALS AND METHODS
10 cases with more than 1 year follow up were chosen from 12 patients with long bone fracture whose surgical treatment was delayed due to brain injury. Exuberant callus formation and deformations were observed. Average delayed period was 6.7 weeks (4~10 weeks). Preoperative callus formation, shortening and angulation were evaluated using plain radiographs. Total operation time and transfusion amount were compared with that from operations done within 2 weeks following accident. Postoperative bone union was checked.
RESULTS
In all cases, preformed angulation and hypertrophic ossification made reduction difficult and this increased total operation time and transfusion amount but had no statistical importance. In patients with humerus and femur fractures accompanying brain injury, massive hypertrophic ossification was observed both in preoperative period and in postoperative period. Average bone union period was 13.5 weeks in humerus fractures, 17.9 weeks in femur fractures. The bone union period was shorter in subject group but had no statistical importance.
CONCLUSION
Early surgical treatment is essential to patients with long bone fracture accompanying brain injury but if early surgical treatment can not be done, proper immobilization to fracture site should be done.

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Alterations in Serum Levels of Receptor Activator of Nuclear Factor-κB Ligand and Osteoprotegerin in Patients with Head Injury and Fracture
Shin Young Park, Kuen Tak Suh, Chang Hoon Ryu, Seung Hun Woo, Jung Sub Lee, Seong-Gang Kim
Journal of the Korean Fracture Society.2008; 21(2): 145. CrossRef

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The Treatment of Infected Non-union of Long Bones with Plate and Screws: Han Suk Ko, Yeong Hun Kang, Deok Weon Kim, Jeong Ku Ha; J Korean Fract Soc 2006;19(1):72-77. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.72

Abstract

PURPOSE
To evaluate the usefulness of internal fixation with plate in treating infected nonunion of long bone.
MATERIALS AND METHODS
From March 1993 to February 2004, ten patients who underwent internal fixation with plate and cancellous bone graft on account of infected nonunion of long bone were retrospectively examined. The medical treatment were composed of thorough and adequate debridement of necrotic tissue, irrigation and plate fixation. Two patients were operated on with bridging plate method. Autologous cancellous bone graft was performed in 6 patients. In 2 cases, it was performed 4 weeks after internal fixation.
RESULTS
In 9 patients, radiographic union appeared on the average of 6.8months and infections were cured before union occurred.
CONCLUSION
Internal fixation with plate is a useful method for the solid fixation in the treatment of infected nonunion. The general concern was that the inserted hardware worsened the infection, which was overcomed with the operative techniques as bridging plate, debridement and cancellous bone graft.

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Treatment Strategy of Infected Nonunion
Hyoung-Keun Oh
Journal of the Korean Fracture Society.2017; 30(1): 52. CrossRef

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Two-Stage Reconstruction of Infected Nonunion of Long Bones using Antibiotics-Impregnated Cement Beads: Se Hyun Cho, Soon Taek Jeong, Hyung Bin Park, Sun Chul Hwang, Yong Chan Ha, In Hwan Hwang; J Korean Fract Soc 2004;17(4):395-400. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.395

Abstract PDF

PURPOSE
To evaluate treatment results between internal and external fixation groups in two-stage reconstruction of infected nonunion of long bones using antibiotics-impregnated cement beads.
MATERIALS AND METHODS
In the first stage, preexisting hardwares were removed and radical debridement was done. The dead space was filled with antibiotics -impregnated cement beads and the nonunion site was immobilized by external fixation, cast or skeletal traction. In the second stage, all cases were divided into two groups; the nonunion was fixed by internal fixation in group I versus external fixation in group II. The intervening period between the first and second stage was average 8.7 weeks (range, 3~23 weeks).
RESULTS
The follow-up period was average 45 months (range, 16~71 months). Infection control and bone union were achieved in all 13 cases of group I. Infection recurred in two of 28 cases in group II, one underwent above-knee amputation and the other case was lost in follow-up. The mean number of supportive operations including repeated curettage, augmentation and change of infected pins, angular correction, and soft tissue flap was average 2 and 6.2 times respectively in group I and group II. Bony union period was average 19.3 and 23.1 weeks in each group. According to Paley's classification, group I was similar to group II in bony and functional result (p>0.05).
CONCLUSION
Antibiotics-impregnated cement beads provided positive effect on infection control. Internal fixation group showed less number of additional operations and earlier bony union than external fixation group.

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Treatment of Infected Nonunion
Sang-Ho Ha
Journal of the Korean Fracture Society.2007; 20(2): 206. CrossRef

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Treatment of Infected Nonunion of Long Bone Shaft: Comparison between Fixation by Antibiotic-cement Loaded Intramedullary Nailing and Fixation by Antibiotic-cement Loaded External Monofixator: Ki Ho Nah, Seong Jin Park, Suk Ku Han, Hyun Suk Song, Nam Yong Choi; J Korean Soc Fract 2003;16(4):511-518. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.511

Abstract PDF: PURPOSE
To evaluate the surgical results between fixations by antibiotic-cement loaded intramedullary nailing and antibiotic-cement loaded external monofixator in the treatment of infected nonunion of long bone shaft with mild bone loss and shortening of less than 1 cm.
MATERIALS AND METHODS
Among the 15 cases of infected nonunion of long bone shaft, 6 cases treated with fixation by antibiotic-cement coated intramedullary nailing and 3 cases treated with fixation by intramedullary nailing along with antibiotic-cement beads insertion were divided as group I (n=9), and other 6 cases treated with fixation by external monofixator along with antibiotic-cement beads insertion were divided as group II (n=6). There was no difference between the two groups in the degree of infection in the laboratory data and clinical feature and degree of bone loss and shortening. Male was in 7 and 5 patients, average age of the patients was 34.8 (26~53) and 37.2 (20~63) years old and average follow-up period was 15.9 (12~35) and 19.3 (15~41) months in group I and II respectively.
RESULTS
Among the nine cases of group I, 3 cases were newly convereted into fixation by antibiotic-cement coated intramedullary nailing at average 9.5 weeks. Radiologic union was gained at the average of 26 weeks from the time of initial nail fixation. Infection was responsive at 6.1 weeks by laboratoey data. Knee ROM of more than 100 degrees was gained in all case and average shortening was 9.2 mm in the last follow-up. And external rotation deformity of more than 5 degrees was noted in 1 case. Among the six cases of group II, radiologic union was gained at 14 weeks in 1 case without converting to internal fixation, and the other 5 cases were converted to antibiotic cement loaded intramedullary nailing at average 12.5 weeks because of delayed uinon or angulation deformity, and radiologic union was gained at average 44 weeks from the time of fixation by external fixator. Infection was responsive at 10.2 weeks by laboratoey data. Knee ROM of more than 100degrees was gained in 5 cases, and average shortening was 11.8 mm in the last follow-up.
CONCLUSION
In the treatment of infected nonunion of long bone shaft with mild bone loss and shortening of less than 1 cm, the fixation by intramedullary nailing with the use of antibiotic-cement prefers to the fixation by external monofixator with the use of antibiotic-cement in the velocity of union, control of infection, and in the clinical aspects such as alignment, early ambulation and joint stiffness.

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Treatment of Nonunion in the Long Bone with Low Intensity Pulsed Ultrasound (LIPUS) and LASER: In Ho Jeon, Chang Wug Oh, Sung Jung Kim, Hee Soo Kyung, Il Hyung Park, Byung Chul Park, Joo Chul Ihn, Jun Young Yeo; J Korean Soc Fract 2003;16(2):177-185. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.177

Abstract PDF: PURPOSE
Low-intensity, pulsed ultrasound (LIPUS) has demonstrated a stimulation and acceleration of the normal fracture-repair process in cellular bases as well in animal and human models. In this study, the adjunctive effect of LIPUS and LASER was investigated in established nonunion of the long bones.
MATERIALS AND METHODS
Study group consisted of eight patients to whom conventional bone graft and adjunctive LIPUS and LASER was applied. On the other hand, eight patients in the control group underwent bone graft only. Eleven men and five women were included in this study and the average age of the patients was 41.7 years (range, 19~62 years). Six of the tibias and ten of the femurs met the criteria for established nonunion. The average fracture age, the post-fracture period before the start of LIPUS/LASER treatment, was 502 days.
RESULTS
Seven of the ten nonunions who were treated by LIPUS and LASER healed completely in an average treatment time of 141 days (range, 101~202 days) and otherwise, in control group, five of the eight nonunions healed completely, in 240 days (range, 183~283 days).
CONCLUSION
This clinical study showed a positive effect of LIPUS and LASER on the rate of osseous repair, especially accelerated time to initial callus cortical bridging compared to that of conventional treatment.

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Use of Cancellous Bone Allograft in the Treatment of Long bone Fractures: Keun Bae Lee, Taek Rim Yoon, Jae Yoon Chung, Sung Taek Jung, Jae Joon Lee; J Korean Soc Fract 2001;14(4):776-782. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.776

Abstract PDF

PURPOSE
The goal of our study was to evaluate the usefulness of frozen cancellous bone allograft in the treatment of long bone fractures that had bone defect and nonunion.
MATERIALS AND METHODS
22 cases of long bone fractures(femur and tibia) with severe comminution or bone defect and nonunion were treated by operation using frozen cancellous bone allograft from March 1998 through May 2000. Thirteen were male and nine were female. The average age was 55 years old (range, 17-76 years) and the mean duration of follow-up was 20.1 months(range, 10-37 months). Eleven cases were femoral fractures, 7 cases of tibial fractures, and 4 cases of nonunion. Allografts were achieved from the patients of femoral neck fracture or osteoarthritis of the hip, and cadaveric donors. The specimens were carefully evaluated based on medical history and laboratory examination about the acute or chronic infection, and bloodtransmitted diseases. The results were evaluated by clinically, such as infection, pain at fracture site, immunological rejection and by radiologically union or resorption of allografts.
RESULTS
Radiologically, bone union was obtained in 14 cases(63.6%) at 6 months after operation, in all except two cases(90.9%) at 9 months after operation. Clinically, pain at fracture site, infection, and immunologic rejection were not observed.
CONCLUSION
In the treatment of severe comminuted fracture or nonunion of long bones, cancellous allograft transplantation after strict donor selection and appropriate screening was a good substitution for autograft avoiding of donor site morbidity or limitation in quantity.

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Influence of Process Conditions on the Quality Characteristics of Beef-Bone Broth
Byung-Su Kim, Gye-Won Kim, Jae-Yong Shim
Food Engineering Progress.2014; 18(1): 15. CrossRef

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Treatment by Composite Fixation of Fractures in Osteoporotic Patients Aged over 60Years: Keun Woo Kim, Yong Hoon Kim, Hak Jin Min, Ui Seoung Yoon, Hee Oh Kim, Young Joon Ahn, Yoon Jong Kim, Ki Chan Yoo, Sang Rim Kim; J Korean Soc Fract 2001;14(1):121-127. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.121

Abstract PDF: PURPOSE
This study summarizes the satisfactory results obtained using a composite fixation method for the surgical treatment of long bone fractures in elderly patients with osteoporosis.
MATERIALS AND METHODS
We reviewed 10 cases of long bone fractures, that were treated by composite fixation, involving patients over 60 years of age that presented with radiological osteoporosis. Composite fixation was applied incorporating, traditional plate and screw fixation in conjunction with bone graft, plate or intramedullary bone cement at four cases of humeral shaft fractures, three cases of femur supracondylar fractures, two cases of femur shaft fractures, and one case of tibia shaft fracture. Results were evaluated in methods of ambulation, range of motion, bony union and complications.
RESULTS
Satisfactory ambulation and range of motion was observed in all cases, which showed bony union without early implant failure. No re-operation were necessary due to nonunion. No medical complication was noted.
CONCLUSION
The results shows that the composite fixation method provided a stable reduction and a rigid fixation, which facilitated bony union, and allowed elderly patients with osteoporosis an early range of motion and mobility after the surgical treatment of long bone fractures.

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

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

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Autogenous bone marrow injection for the treatment of delayed union of the long bone: Jin Hyung Sung, Jae Duk Ryu, Weon Yoo Kim, Chang Hwan Han, Eui Young Ohm, Jin Young Kim; J Korean Soc Fract 1999;12(4):1071-1076. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1071

Abstract PDF: It is known that the Salter-Harris type I and II fractures of the distal tibial epiphysis usually For resolving problems of delayed union and non-union of long bones, many efforts was made such as autogenous graft, allogenic or artificial bone graft and electrical stimulation, but there were many complications and not sufncient fracture healing process. The purpose of this study was to investigate the effect of autograft with bone marrow on the repair or bone formation of delayed union by the serial radiogram and clinical examination. We evaluated thirty nine patients which had been treated for long bone fracture, to whom bone marrow injection was made between 3 months and 13 months after adequate fixation(average.4.8months). After bone marrow injection, clinical follow up period was from 15 months to 35 months(average 26.7months). The age distribution was from 18 years to 84 years(average 42). A total of 100- 150cc of marrow was injected at the nonunion site immediately after aspiration under the C-arm. Of 39 cases, there were improved bone healing process of 30 cases(77%) by radiographically and clinically, Of 9 cases without improvement, 5 cases were due to loosening of external fixator, 2 cases was due to chronic osteomyelitis and other 2 cases was unknown origin. No serious complications were observed other than no improvement. Although percutaneous bone marrow injection does not promote healing more rapidly than would standard operative bone grafting, it has many distinct advantages over the latter. It is safe, easy, and time saving. It is economical and involves minimal trauma. It can be done under local anesthesia and avoids the risks of general anesthesia, infection and surgery. It can be done in cases which are not fit for open bone grafting because of poor condition of the skin.

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New Bone formation in Vascularized Periosteal Flap over the Bone Defect of the Shaft of the Radius in Rabbit. : Early Radiological, Histological and Immunohistochemical Study of Osteogenesis: Jae Kwang Yum, Young Bok Jung, Mi Kyung Kim, Ho Rim Choi, Tae Yeul Yoo, Jung Nam Han; J Korean Soc Fract 1999;12(4):1003-1011. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1003

Abstract PDF: Vascularized periosteal flap(VPF) it thought to enable formation of new bone and promote union in bone defect without risk of complications in donor site. Studiol about the VPF thus far have been centered on the long term result than early change after YPF. The purpose of this study was to elucidate the process of new bone formation in early stage after YPF by radiological, histological, electron microscopical and immunohistochemical studies. In experimental group, segmental resection of bone including the periosteum was performed in fifty-six radii of immature New Zealand white rabbits preserving the periosteal circulation from median artery which is the main source of blood supply to the periosteum. In order to simulate the transplantation of VPF, the vascular pedicle of median artery and veins was dissected from adjacent soft tissue and the periosteum was longitudinally incised to remove the bone tissue in the periosteum. Thereafter the vascularized periosteum was repaired. From the first to fourteenth day after the simulated VPF, the findings in the VPFs were observed by radiological, light microscopical, scanning electron microscopical methods and activity of osteocalcin was measured by immunohistochemical method. In control group, the bone tissue and periosteum were completely removed from the mid-shaft of seven radii, thereafter the radiological findings were observed at 1, 2, 3, 4, 8, 12, 16th week and light microscopical findings were observed at 8, 16th week after operation. From the results of this study, it is concluded that YPF is vigorously and uniformly osteogenic in its early stage. It it thought that this study could serve as a basic data for the future experimental studiol about VPF in animals and clinical application.

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

Abstract PDF

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

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

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Traumatic Refracture : Report of 3 cases: Byung Ill Lee, Young Hoon Cho, Jae Eung Yoo, Soo Kyun Rah; J Korean Soc Fract 1997;10(4):940-944. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.940

Abstract PDF: Traumatic refracture refers to a recurrence of a fracture by a major trauma, after it had gained complete union from an earlier rracture through internal fixation. We report 3 cases of our experience in this relatively rare injury of long bone.

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Postoperative Infection in the Closed Fractures of the Long Bone: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Bab Jae Lee, Il Jong Yang; J Korean Soc Fract 1997;10(4):866-871. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.866

Abstract PDF: Operative treatment for closed fractures of the long bone has many advantages including early restoration of function by stable fixation, but has untoward problems including postoperative infection. The authors reviewed 19 cases of postoperative infection for closed long bone fracture during the period from January, 1990 to December, 1995 and analyzed about clinical, radiologic, pathologic findings and found causes of infection. Most cases were associated with multiple fractures of major bones or injuries to the vital organs and delayed over 48 hours after injury to operation. Operation time was prolonged due to the simultaneous operations for multiple fractures and associated open fractures at the same time. Staphylococcus aureus was the most frequent offending organism. Irregular resorption of plate-bone interface with resultant gap between the plate and bone, on the radiographic follow up, may indicate postoperative infection.

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Vascularized Fibular Graft in the Treatment of Chronic Osteomyelitis of Long Tubular Bone: Kwang Suk Lee, Sang Won Park, Kyung Jo Woo, Jong Won Kim; J Korean Soc Fract 1997;10(2):365-370. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.365

Abstract PDF: Previous management of chronic osteomyelitis has included antibiotic therapy, radical debridement, skin-grafting, distant cross-leg flaps, and local muscle flaps. Each of these modalities of treatment has limitations. However, over the last 20 years, vascularized fibular bone grafts have proved to be a valuable method of reconstruction of skeletal defects in the extremities following both infected and uninfected skeletal nonunions unresponsive to conventional methodology. We evaluated the efficacy of vascularized fibular graft in the treatment of chronic osteomyelitis of long bone. From August 1988 to June 1995, fourteen cases of chronic osteomyelitis of long bone which were followed for an average of 3 years duration were treated by vascularized fibular graft at the Department of Orthopaedic Surgery, Korea University Hospital. The results were as follows; 1. Even if the long tubular bone infection was uncontrolled, vascularized fibular graft could be performed and it was highly resistent to local infection. 2. Twelve cases (85.7%) out of a fourteen cases had primarily obtained bony union. 3. Free vascularized fibular graft is significant and reliable porcedure of bone grafting for the treatment of chronic osteomyelitis of long tubular bones.

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Treatment of Long Bone Fracture Using LC-DCP: Byoung Ho Lee, Sang Ho Ha, Seung Kim; J Korean Soc Fract 1997;10(1):37-43. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.37

Abstract PDF: LC-DCP is the latest plate and screw system developed by AO-ASIF group. There are many merits of LC-DCP with its unique contour and material. : Reduction of surface contact between plate and bone result in preserved vascularization and then improved bone consolidation. Compression can be achieved in either longitudinal direction and a lag screw can be inserted at greater inclination. In addition, pure titanium as an LC-DCP material display optimal biocompatibility and reduce the spread of bacteria and increase resistance against infection. Between June 1994 and September 1995, 39 patients with 40 long bone fractures were treated using LC-DCP.(24 femur, 13 humerus, 3 tibia) Follow-up averaged 12 months : Bone union was achieved in 32 cases(80%) The complications were 7 cases of metal failure, 7 cases of limited joint motion, 2 cases of nonunion,2 cases of delayed union and 2 cases of deep infection.

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Ilizarov Method for Treatment of Large Bone Defect: Hae Ryong Song, Young June Park, Ji Yeon Kim; J Korean Soc Fract 1996;9(3):794-800. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.794

Abstract PDF: Twenty eight long bone defects were treated with internal bone transport using Ilizarov method. The causes of defect were open fracture (ten cases), infected non-union(nine cases), and osteomyelitis(nine cases). The mean bone defect was 8.5cm ranging from 2.5cm to 22cm in open fracture and 5.8cm ranging from 1.8cm to 17cm in an infected nonunion, and 7.2cm ranging from 3.4cm to 12cm in osteomyelitis. Internal bone transport was performed with transverse ring system. Free latissimus dorsi muscle flap was done in three cases and rotational muscle flap in seven cases. Single level lengthening was done in 26 cases and double level lengthening in two cases. Fibular transport was done in five cases. All cases obtained bone union. The radiologic consolidation index was 89 day/cm in tibia, 71d ay/cm in femer, and 42.5 day/cm in humerus. External fixation index was 96 day/cm in tibia, 86 day/cm in femur, and 48.5 day/cm in humerus. Complications were pin tract infection(25 cases), equinus contracture of ankle(7 cases), knee flexion contracture(4 cases), delayed union(11 cases), premature consolidation(2 cases) and refracture(1 case). Ilizarov method is a useful treatment for large bone defect inopen fracture and infected nonunion. To obtain better result, careful postoperative management and intensive physiotherapy are recommended.

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A Clinical Study of rmmediate Internal Fixation(within 24 Hrs) in Open Fractures of The Long Bones: Yoon Sik Kim, Jae Eung Yoo, Chi Soo Sohn, Jong Seouk Park, Hee Kwon, Joon Min Song, Soo Kyun Rah; J Korean Soc Fract 1996;9(3):593-604. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.593

Abstract PDF: The major goals in the treatment of open fractures of the long bones are to prevent infection, avoid malunion or nonunion, achieve bone union, and restore limb and patient function as soon and as fully as possible. The treatment modalities adopted in open fractures still remains controversial, especially in Gustilo-Anderson Type III. It has been the fear of infection that has lead to the traditionally accepted opinion that immediate internal fixation of open fractures is contraindicated but, nowadays, it is no longer tabooed. Owing to the early meticulous wound debridment and irrigation, and the use of bactericidal antibiotics, the infection rate reduced remarkably. Fifty-five cases of open long bone fractures treated by immediate internal fixation within 24 hours from inury were reviewed, which were treated at the Department of Orthopedic Surgery, Soonchunhyang University hospital for nine and half years from June, 1985 to January, 1995. The results were as follow: 1, There were 20 Type II , 19 Type III A, 10 Type IIIB and 5 Type IIIC open fractures treated by immediate internal fixation within 24 hours following to Gustilo-Andersons classification. 2. The most common causes of open fractures were traffic accident(84%). 3. The associated injuries of the patients treated by immediate infernal fixation were in sequence.:26 multitraumatized patient, 5 arterial injuries, 5 musculotendinous injuries, 3 major joint dislocations and so forth. 4. Normal bony union was achieved in 41 patients(73.2%), Delayed bony union was in 7 patient(12.5%) and nonunion in 8 patients(14.5%). 5. Primary wound healing was achieved in 40 patients(71.4%), superficial to moderate infection were in 5 patients(9%), deep to osteomyelitis in 11 patients(19.6%). 6. According to the subtypes of open fractures, deep to osteomyelitis were 80% in Type IIIC, 30% in Type IIIB, 10.6% in Type IIIA and 10% in Type II.

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The Treatment of Infected Fracture of Long Bones: Hak Yeong Jeong, Seung Wook Yang, Young Cheol Shin, Jae Woong Shim; J Korean Soc Fract 1995;8(3):678-687. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.678

Abstract PDF: The increase in incidence and severity of open injury to bone and surrounding soft tisseues from vehicular and industrial accidents, and the aggressive surgical approach of open reduction and internal fixation of closed fractures contribute to a definite rise in acute wound infection in fracture management. The main objectives are twofold in the treatment of infected fractures, the first to diagnose infection early and the second to treat it effectively and to prevent it from spreading into bone. To solve these problems, we used some principles of treatment, those are meticulous debridement of infected tissue, management of soft tissue and bony defect and maintenance of fracture stability. From Jan. 1988 to Dec. 1993, we treated 23 infected fractures of long bone and the result were as follows. 1. The infected fractures were femur in 9 and tibia in 14 cases. 2. There were 14 open fractures and 9 closed fractures. 3. In closed fracture, the first infection sign was developed average 7.8 days after open reduction, and average 9 days after trauma in open fracture. 4. The most common causative organism was staphylococcus aureus. 5. Infection was controlled from 3 months to a year and 8 months. 6. The number of soft tissue and bone debridement was one to four times. 7. Bony union was achieved from 6 months to 2 years in tibia and 6 months to 2 years and 1 month in femur.

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Treatment of the Long Bone fractures Assuiated with Vascular Injuries: Myun Whan Ahn, Yong Seok Choi, Jong Chal Ahn; J Korean Soc Fract 1994;7(1):113-121. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.113

Abstract PDF: Vascular injuries combined with long bone fractures have been infrequent and difficult to manage. Despite of recent advancement in the vacular repalr and fixation of fracutres, it is not easy to save the limb. In order to identify the factor associated with amputation or salvage of the affected limb, a retrospective study of 14 patients whose injured vessels were repaired primarily at the time of bone fixation was perfomed. The ischemic time, the degree of soft tissue or bone injury and the method of treatment were evaluated with relation to the limb salvage, 4(28.6%) of that 14 long bone fractures needed secondary amputation due to a vascular insufficiency. In 3 of 4 fractures, in which vascular repair were delayed over 24 hours, afftected limbs were amputated later. Thus, the ischemnic time was determined as an important factor for limb salvage after the vascular injury associated with the long bone fracture(p<0.05). However, the dogree of the soft tissue of bone injury and the method of treatment were not correlated with the limb salvage.

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The Treatment of Infected Large Defect of the Long Bone - Allograft Transplantation and Ilizarov Technique: Duck Yun Cho, Sung Bum Yang, Kwang Chang; J Korean Soc Fract 1992;5(2):400-409. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.400

Abstract PDF: Infected large defect of the long bone have had many obstacles in treatment. It is usually very difficult to obtain union and to correct coexisting infection, deformity, & leg length discrepancy, Allograft transplantation have been traditionally used to treat infected large defect of the long bone. And Ilizarov technique has recently gained popularity as a multifactorial approach to the management of infected large defect of the long bone. We performed allograft transplantation in 5 cases and Ilizarov technique in 6 cases with infected large defect of the long bone at National Medical Center from 1987 through 1991. The results were as follows; 1. In the cases of allograft transplantaton, the average size of the bone defect was 9.6cm (range from 6cm to 3cm) and the average length of leg length discrepancy was 2.4cm (range from 0cm to 4cm). 2. In the six cases of Ilizarov technique, the average size of the bone defect was 2.5cm(range from 0.5cm to 4.5cm) and the average length of leg length discrepancy was 3.7cm(range from 0cm to 7cm). 3. In the cases of allograft transplantation, the bone union was achieved in two cases. Two cases have been followed up for 19 and 26 months each and they showed complete bone union in the proximal side of host-graft junction, but not complete union in the distal side. In one case, developed the osteolysis of the grafted bone due to the infection. After operation, the average length of leg length discrepancy was 1.4cm(range from 0 cm to 2cm). 4. In the cases of Ilizarov technique, bone union was achieved in three cases. One case have been followed up for 15 menths and showed incomplete bone union. In two cases, additional operation was performed due to the nonunion and the fracture between the junction of the proximal bone fragment and the transportated bone fragment in each. So we report our results of diferent two methods of treatment even if limited cases and experiences.

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Free Fibular Graft to the Segmental Dedect of Long Bone: Yung Khee Chung, Jung Han Yoo, Yong Han Woo; J Korean Soc Fract 1989;2(2):281-287. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.281

Abstract PDF: Since the documentation of bone graft techniques by Walther in 1820, it has been used widely for the treatment of nonunion, and bone defect due to osteomyelitis, neoplasm, or trauma, and ofr arthrodesis. But many problems are still remained in the treatment of the extensive bone defect. Therefore, varous techniques have evolved to conventional autogenous graft, fresh allograft bone trandsplantation, or free vascularized bone graft. According to Dell P.C. et al, the vascularized grafts were transiently stronger than the conventional nonvascularized ones at six weeks postoperatively because of the differences in the repari mechanisms but thereafter there were no appreciable differences. Therefore, except an inadequate soft tissue bed such as in a chronically infected nonunion, a congenital pseudarthosis, and a previously irradiated or heavily scrred soft tissue bed, we expect good result with conventional nonvascularized fibular graft when there is a segmental bone defect less than 12cm, and/or inadequate fascilities for the microvascular surgery. The four patients with the segmental defect of long bone were treated with conventional nonvascularized fibular graft at Kang Nam Sacred Heart Hospital between July 1980 and October 1988, and are reported with reviews of literatures.

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Treatment of Intractable Nonunion of the Long Bone with the Invasive Electrical Stimulation: Myung Chul Yoo, Dae Kyung Bae, Yong Girl Rhee, Deok Ho Ahn, Goong Hee Cho; J Korean Soc Fract 1989;2(1):82-90. Published online June 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.1.82

Abstract PDF: Nonunion of the long bone is one of the difficult porbloems in orthopaedic surgery. We studied the effect of the electrical stimulation. From July, 1980 to August, 1988, 30 nonunions of the long bones were treated with the invasive type electrical stimulator. The range of follow-up period was from 3 months to 7 years(average, 25 months). The results were as foloowings: 1. The good bony union has occurred in 26 cases(86.7%). 2. The previous infection was in 11 cases and its union rate was 100% 3. The average duration of bone union in over-all cases was 5. months and in previous infeted cases, was 5.5 months. 4. The average duration of bone union in open fracture was 5.5 months and in closed fracture, was 5 months. 5. The invasive electrical stimulation was a good technique to treat the intractable nonunion as the result of long bone fracture.

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