Journal of Musculoskeletal Trauma

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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Modified Spring Plate for Treatment of Unstable Distal Clavicle Fractures: Sang Myung Lee, Il Jung Park, Hyung Min Kim, Jae Chul Park, Sung Gil Cho, Yoon Chung Kim, Seung Koo Rhee; J Korean Fract Soc 2010;23(1):64-68. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.64

Abstract PDF: PURPOSE
Unstable distal clavicle fractures should be treated surgically but may be difficult in firm fixation because of small distal fragment. Although a variety of fixation methods have been currently used, none of the methods seem to be firm fixation and little pain. We present a new technique using a spring plate which was modified from one third tubular plate and report the early results.
MATERIALS AND METHODS
Modified spring plate was made from one third tubular plate and the distal hole of the plate was cutting and sharpened by rasp. The sharp edge was bent just like an animal claw (C shape). Between May 2007 and June 2009, a total of six patients with distal clavicle fracture were treated using modified spring plate. A sling was applied in the immediate post operative period for six weeks and exercises were started immediately.
RESULTS
Union was achieved in all cases with excellent results without complication (mean Constant score, 96). All patients had returned to ordinary daily activities but mild limitation of abduction (150 degrees ) by seven weeks after surgery. After six months, the plate was removed.
CONCLUSION
The modified spring plate has provided stable fixation for unstable distal clavicle fixation without disturbance to the acromioclavicular joint, subacromial space, or rotator cuff.

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Treatment of Failed Intertrochanteric Fractures to Maintain the Reduction in Elderly Patients: Soon Yong Kwon, Hyun Woo Park, Sang Uk Lee, Soo Hwan Kang, Jae Young Kwon, Jung Hoon Do, Seung Koo Rhee; J Korean Fract Soc 2008;21(4):267-273. Published online October 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.4.267

PURPOSE
The aim of this study was to evaluate and report the new method with a cement augmented screw fixation again to treat the failed intertrochanteric fracture in elderly which were treated with ordinary compression hip screw initially.
MATERIALS AND METHODS
From Mar. 1988 to May 2007, 10 patients (mean age 69 years) with the failed intertrochanteric fracture which were treated with initial hip screw, were treated with a cement augmented compression hip screw again. The mean follow-up after surgery was over 18 months. The cause of failure, the period upto the reoperation, the neck-shaft angle after the reoperation, the position of lag screw in the femoral head, and the degree of union at last follow-up were analyzed. The change in the functional hip capacity were evaluated by the classification of Clawson.
RESULTS
Causes of failure were superior cutting-out in 6 cases, cortical anchorage failure in 3, and nonunion in one case. The period upto the reoperation was average 7.8 months. Valgus reduction of average 5.7degrees was achieved, and the positions of lag screw were postero-inferior in 6 cases, center in 3, infero-center in one case. We obtained complete union in 9 cases. The functional outcome showed moderate in 6 cases, good in 3 and poor degree in one case.
CONCLUSION
Cement augmented compression hip screw treatment will possibly reduce cutting-out of screw and bring more stability in fixation for intertrochanteric fractures in old osteoporotic patients, as well, even in failed cases treated with initial compression hip screw, but proper selection of patients is important.

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Safety and Effectiveness of the Anchor Augmentation with Bone Cement on Osteoporotic Femoral Fracture: A Systematic Reviews
So Young Kim
Journal of the Korean Fracture Society.2019; 32(2): 89. CrossRef

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Medial Transposition of Radial Nerve in Distal Humerus Shaft Fracture: A Report of Six Cases: Sang Uk Lee, Weon Yoo Kim, Soo Hwan Kang, Yong Soo Park, Seung Koo Rhee; J Korean Fract Soc 2008;21(3):240-243. Published online July 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.3.240

Abstract PDF

Sometimes serious tension occurs in the radial nerve when doing internal fixation for distal humerus shaft fracture or neurorrhaphy for radial nerve injury. Medial transposition of radial nerve on fracture site can avoid direct radial nerve injury by fracture fragment, radial nerve tension by plating for distal humerus shaft fracture, and also safe from neural tension during neurorrhaphy of damaged radial nerve. We reported here total 6 cases of backward transposition of radial nerve including 2 cases of radial nerve injury associated with humerus fracture and 4 cases of comminuted fracture of humerus shaft.

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Transhumeral Anterior Radial Nerve Transposition to Simplify Anticipated Future Humeral Reconstruction
David A. Muzykewicz, Reid A. Abrams
The Journal of Hand Surgery.2017; 42(7): 578.e1. CrossRef
Transfracture medial transposition of the radial nerve associated with plate fixation of the humerus
Ali Hassan Chamseddine, Amer Abdallah, Hadi Zein, Assad Taha
International Orthopaedics.2017; 41(7): 1463. CrossRef
Trans-fracture transposition of the radial nerve during the open approach of humeral shaft fractures
Ali H. Chamseddine, Hadi K. Zein, Abdullah A. Alasiry, Nader A. Mansour, Ali M. Bazzal
European Journal of Orthopaedic Surgery & Traumatology.2013; 23(6): 725. CrossRef
Humerus Shaft Fractures in Leisure Sport 'Flyfish Riding' - 4 Cases Report -
Bong Gun Lee, Ki Chul Park, Youn Ho Choi, Woo Sung Jung, Kyu Tae Hwang
Journal of the Korean Fracture Society.2012; 25(4): 327. CrossRef

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Lateral Approach for Internal Fixation of the Distal Humeral Shaft Fractures: Seung Koo Rhee, Joo Yup Lee, Yoo Joon Suh, Joon Ho Lee, Nong Kyoum Ahn; J Korean Fract Soc 2004;17(2):83-89. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.83

Abstract PDF

PURPOSE
To investigate the efficacy and advantages of the lateral approach for internal fixation of the distal humeral shaft fractures.
MATERIALS AND METHODS
Twelve patients with distal humeral shaft fractures who underwent open reduction and internal fixation using plate and screws by lateral approach from January, 1997 to May, 2002 were investigated. Postoperative results after a minimum 1 year follow-up were assessed using union rate, elapsed time to union, postoperative complications such as iatrogenic radial nerve palsy, range of motion of the elbow joint. Clinical outcomes were evaluated with Mayo elbow performance scoring system.
RESULTS
Union was achieved in all cases. The average time to union was 9 weeks (range, 7~12 weeks). Four cases of preoperative radial nerve palsy were revealed as contusion of the intact nerve and resolved completely by three months. The mean elbow range of motion was from 5 to 138 degrees. The average Mayo elbow performance score was 91 points; 9 cases ranked as excellent and 3 as good.
CONCLUSION
Distal humeral shaft fractures can be treated successfully through open reduction and internal fixation using plate and screws. Lateral approach is recommended to stabilize distal humeral shaft fractures without compromising the range of motion of the elbow, and to protect or explore the injured radial nerves easily

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Modified anterolateral approach for internal fixation of Holstein–Lewis humeral shaft fractures
Ho Min Lee, Young Sung Kim, Suk Kang, Min Young Lee, Jong Pil Kim
Journal of Orthopaedic Science.2018; 23(1): 137. CrossRef
Posterior Dual Plating for Distal Shaft Fractures of the Humerus
Chul-Hyun Cho, Kwang-Yeung Jeong, Beom-Soo Kim
Journal of the Korean Fracture Society.2017; 30(3): 117. CrossRef

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Treatment of Post-traumatic Dislocation of Metacarpophalangeal Joints of the Hand: Seung Koo Rhee, Seok Whan Song, Joo Yup Lee, Chang Youn Moon, Jae Chan Oh; J Korean Soc Fract 2003;16(2):253-261. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.253

Abstract PDF: PURPOSE
To analyse the obstacles to prevent the reduction for dislocation of the metacarpophalangeal (MP) joints of the hand and evaluate the relationship between the sex and dislocation type in closed reduction case.
MATERIALS AND METHODS
Total 27 cases of MP joint dislocation of the hand (11 cases of thumb, and 14 index and 2 little finger) were reviewed retrospectively. The anatomical structures to prevent the reduction were confirmed at operation and the cases which were reduced immediately were also analysed for their ages and differences of damaged structures, and finally their complications or outcome were reviewed for average 7 months after reduction.
RESULTS
In 11 cases of thumb MP joint dislocations, the complex dorsal dislocations in which the protruded metacarpal neck was caught by buttonhole of torn anterior joint capsule, volar plate and FPB were reduced by open method in 8 cases, and closed reduction was done in 2 cases but one old case required arthrodesis. In other finger MP joint dislocations, the Kaplan's concept to prevent the reduction was confirmed. But reduction of torn volar plate and incision of transverse metacarpal ligament were sufficient to reduce the dislocation with gentle longitudinal traction during the operation. In two cases of little finger MP joint dislocation, the ruptured radial collateral ligaments were noted after open reduction and it must the repaired to prevent the finger instability later. Their overall end results were good without any significant restriction of MP joints motions and finger instabilities.
CONCLUSION
One or two times of closed reduction with proper local anesthesia could be tried, but simple reducible dislocation can be converted to complex irreducible ones by the inappropriate traction method, and so proper reduction technique by closed or even in open way is important with the knowledge of anatomical obstacles to prevent the reduction of the metacarpophalangeal joints.

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Peritalar Dislocations or Fracture-Dislocations: Seung Koo Rhee, Hwa Sung Lee, Jong Bum Park, Jin Wha Chung, Eui Yong Um, Whi Ju Whang; J Korean Soc Fract 2001;14(4):689-697. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.689

Abstract PDF: PURPOSE
To find the proper way and timing of treatment for minimizing the posttraumatic complication of peritalar dislocation or fracture-dislocation.
MATERIALS AND METHODS
We reviewed total 12 cases of peritalar dislocation or fracture-dislocation that consist of 9 cases of subtalar joint dislocations, I case of talonavicular joint dislocation and 2 cases of talar fracture-dislocations. Closed reduction was performed for subtalar dislocation without suturing the torn ligaments. The average follow up period was 25 months.
RESULTS
Of 9 subtalar dislocations, 8 cases presented acceptable results. But 1 case of a 28-year-old male patient with prolonged heavy sports activity history presented pain and mild limping. The other 3 cases of talo-navicular joint dislocation and talar fracture-dislocations presented acceptable results except one complaining of scar contracture.
CONCLUSION
Complications such as early skin necrosis or neurovascular damage could be prevented by early closed reduction for peritalar dislocations or fracture dislocations, and the repair of torn ligaments of ankle joint in peritalar dislocations did not affect the end results.

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Treatment of Clavicle Fracture : Operative vs Non-operative: Seok Whan Song, Hwa Sung Lee, Young Kyun Woo, Seung Koo Rhee, Young Yul Kim; J Korean Soc Fract 2000;13(3):544-549. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.544

Abstract PDF

INTRODUCTION: The purpose of this study was to compare the final results of the patients of the clavicle fractures, treated with the conservative or surgical techniques.
MATERIALS AND METHODS
125 patients (over 15 years old, follow-up over 6 months) were reviewed. To measure the amount of shortening of the fractured clavicle, the length of clavicle was measured from the mid-point of the medial end to the lateral. Range of motion of shoulder, evaluation of functional results and subjective satisfaction, and complications were assessed.
RESULTS
In the surgical treatment group, the period of bony union was short and the shortening of the final length of the fractured clavicle, although there was no statistical significance, was rare. Overall satisfaction for the final result and range of motion of the shoulder were not significantly different between the groups. Complication rates were higher in the conservative treatment than in the surgical.
CONCLUSIONS
In most cases of the clavicle fracture, the operative treatment is recommended to decrease the complications, to shorten the treatment period, to satisfy the patients, and probably to decrease the economical burden.

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Progressive Brachial Plexus Palsy after Fixation of Clavicle Shaft Nonunion: A Case Report
Hong-Ki Jin, Ki Bong Park, Hyung Lae Cho, Jung-Il Kang, Wan Seok Lee
Journal of the Korean Fracture Society.2019; 32(2): 97. CrossRef

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Treatment of Die-punch fractures in Unstable Distal Radius Fractures: Seung koo Rhee, Seok Whan Song, Yang Guk Chung, Wha Seong Lee, Seung Joon Ryoo; J Korean Soc Fract 1999;12(4):1012-1020. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1012

Abstract PDF: Die-punch fracture is a comminuted intra-drticular fracture on the distal radius with depressed articular fragments caused by impaction of carpal bones, mainly lunate or scaphoid. As in the other intra-articular fractures, the accurate rehtoration of congruent articular surface is necessary to get good functional results. The purpose of this study is to review the results in a series of 24 die-punch fracturef according to the type of fractures dnd the method of treatments. During the 5 year period after July, 1993, total 24 die-punch fractures in 22 patients were treated by surgery(22 cases) or closed method(2 cases) and were followed up for average 29 months. On the last follow-up examination, radiographic changes of grade 1 or 2 of post-traumatic arthritis were seen in twelve wrists and ten of them comptained of pain at wrists. Mean range of motion of wrist joints were 62 of flexion, 64 of extension, 80 of pronation, 77 of supination, 17 of radial deviation and 27 of ulnar deviation. According to the Demerit point system. total 22 of 24 cases(91.7%) showed excellent or good result and there were no poor results. From these results, we concluded the die-punch fractures are so unstable comminuted intraarticular fracture on the distal radius with displaced postero-medial fracture fragments on the radiolunate joint, that if we only reduce them anatomically, mostly by open reduction, internal fixation with or without bone grafts, then we could obtain good results.

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Tardy Ulnar Nerve Palsy Caused by Post-Traumatic Elbow deformities: Seung koo Rhee, seok Whan Song, Hwa Sung Lee, Ho Tae Kim; J Korean Soc Fract 1998;11(2):420-426. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.420

Abstract PDF: Thirty-five patients with tardy ulnar nerve palsy caused by cubitus valgus (33 cases0 and varus (2 cases) deformities were retrospectively studied. All patients had a history of old fracture on the distal humerus during childhood. The mean interval between the previous fractures and the onset of ulnar neuropathy was 19 years. The severity of nerve palsy was classified as McGowan's grade I in 24 patients, grade II in 8 patients, and grade III in 3 patients. The mean carrying angle was average 29 degrees in 33 cases with cubitus valgus and it was decreased to average 11 degrees postoperatively, but the angle was average -23 degrees preoperatively in 2 cases with cubitus varus and it was corrected to average 9 degrees postoperatively. the cause of palsy was analysed by mechanical stetching in 11 cases, compression by a fibrous band between the two heads of flexor carpi ulnaris in 8 cases, and diffuse fibrous adhesion around the ulnar tunnel in 5 cases. All patients was treated with supracondylar closing wedge osteotomy accompanied with anterior ulnar nerve transposition in 13 patients, corrective osteotomy only in 12 patients, and anterior ulnar nerve transposition only in 10 patients. Their end results were analysed as good in 24 cases, fair in 8 cases, and poor in 3 cases within average 6 months after the operations (4 to 13 months). The poor results was obtained in 3 cases out of 9 cases with corrective osteotomy group (33.3%). Conclusively, a tardy ulnar nerve palsy caused by post-traumatic elbow deformities should be corredcted with anterior ulnar nerve transposition with or without corrective closing wedge osteotomy but not by corrective osteotomy only, because of compressive neuropathy by diffuse fibrous adhesion or bands of two heads of FCU around the ulnar tunnel in elbow.

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Delayed Management of Supracondylar and Intercondylar Fracture of the Femur Using the Composite Graft(Autograft+Processing Allograft): Young Kyun Woo, Seung Koo Rhee, Soen Yong Kwon, Hwa Sung Lee, Joo Yup Lee; J Korean Soc Fract 1996;9(4):951-957. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.951

Abstract PDF: There are many difficuties and problems to get anatomical reduction and rigid internal fixation in treatment of supracondylar and intercondylar fracture of the fumur. Authors reviewed and clinically analysed 7 patients w.ith svpracondylar and intercondylar fracture of the femur treated by delayed reconstruction from August 1993 to Decfmber 1995. Of 1 cases, there were 5 cases of open and 2 cases of closed fracture. According to AO classification, 7 cases were classified as followed; A3 type-l case, C2 type-4 cases, and C3 type-2 cases. They underwent surgical treatment at average 35 days after injury(range from 25 days to 58 days). Main causes of delay in surgical treatment were poor preoperative condition associated with mulliple injuries in 3 cases, wound problems at the site of open fracture in 3 cases and the combined state in 1 case. For internal fixation of fractures, a supracondylar nail in 4 cases and a dynamic condylar screw in 3 cases were used, and the bony defective area of fracture site in all 1 cases was replaced by the composite graft made of the autogenous cancellous bone and the processing allograft(Tutoplast). The period of follow up was from 8 months to 30 months(average time 14.8 months). There were no infection or allograft-rejection postoperatively. Clinical union was achieved from 6 months to 10 months in 6 cases, and nonunion associated with incomplete incorporation of graft bone was developed in 1 case. In 6 cases of clinical union, clinical assessment estimated by Schatzker and Lamberts criteria was fair in 1 case and failure in 5 cases, and change of tibiofemoral alignment occurred in 2 cases. The above poor clinical results could be considered to be derived from the delayed operative intervention resulting in joint stiffness due to soft tissue contracture, arthritis and large bony defect. In conclusion, even if it showed poor clinical results, the composite graft made of the autogenous cancellous bone and the pmcessing allograft could serve as a possible alternative for restoration of large bony defect in delayed management of supracondylar and intercondylar fracture of the fumur.

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Proximal Row Carpectomy for Disease of the Proximal Carpal Bone: Seung Koo Rhee, Hyoung Min Kim, Soon Young Kwon, Hwa Sung Lee, Hang Kyu Lee; J Korean Soc Fract 1996;9(2):311-318. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.311

Abstract PDF: The management of pain, stiffness and weakness of the wrist following unsuccessful conservative treatment of fractures of the scaphoid or of Kienbocks disease and so on is a difficult problem. Despite the recommendation by Cotton in 1924 and subsequently by others that the proximal row of carpal bones should be removed in the presence of disease, arthrodesis or various stabilizing procedures continue to be recommended. But, although a radiocarpal fusion, when successful, leads to a painless, stable wrist, the loss of the normal motion of the wrist inevitably results in some loss of function of the hand. The purpose of this study is to evaluate the efficacy of the proximal-row carpectomy. Since 1987, five patients were studied following proximal-row carpectomy. The lesions for which the operation was done included two Kienbocks disease, one crushing injury, one transscaphoid volar lunar dislocation, and one scapholunate dissociation. Their end results after average 74 months of follow-up showed less pain than before operation and a reasonable range of flexion/extension which varied between 65% and 85% of normal, the average being 74%, Postoperative grip strength was from 70 to 90% fo normal, the average being 78%. In conclusion, excision of the proximal row of tile carpus is a useful procedure, with a limited application in patients with Kienbocks disease, dislocation of the lunate bone, scapholunate dissociation and similar injuries which do not respond to conservative management.

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Selective Arterial Thrombolysis with Urokinase in Popliteal Arterial Occlusion Developed after Total Hip Replacement Arthroplasty: Seung Koo Rhee, Kee Yong Ha, Nam Gee Lee, Jong Bum Park; J Korean Soc Fract 1995;8(1):79-83. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.79

Abstract PDF: A 60 year old patient with a sudden thromboembolic occlusion of ipsilateral popliteal artery on four days after the total hip replacement (THR) were treated with high-dose urokinase by direct intraarterial selective infusion. The cause of arterial occlusion after THR was not clear, but it was thought to be caused by spontaneous thrornboembolism in an elderly patient accompanied with diffuse arteriosclerosis, and this multifocal arteriosclerosis was caused not to perform the vein graft immediately. The initial infusion therapy with 4,000 IU/min for 2 hours of urokinase was failed but the second trial with same doses of urokinase in another 2 hours was succeed with complete clot lysis. Then 500,000 IU/24 hours of urokinase was infused again, and total 1,500,000 IU/28 hours was used in this patient. But massive internal bleeding from the operation site, hip joint, for more than 1,400 co was leaked because of bleeding tendency induced by extensive use of urokinase within short duration, and minor toe amputations should be performed on 2 weeks after thrombolysis because of distal migration of small thromboembolic particles. It was suggested that the peripheral arterial occlusion resulting from thromboembolism after joint replacement, especially in an elderly patient with diffuse arteriosclerosis, could develop, and it could be successfully treated with an initially high-dose urokinase regimen if it is detected earlier, rather than vein graft or amputation.

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Clinical analysis in radial styloid process fracture: Seung Koo Rhee, Whan Keun Yoo, In Seol Chung; J Korean Soc Fract 1993;6(1):100-106. Published online May 31, 1993; DOI: https://doi.org/10.12671/jksf.1993.6.1.100

Abstract PDF: No abstract available.

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Inferior Subluxation of the Humeral Head After Trauma to the Shoulder: In Kim, Seung Koo Rhee, Yang Kim, Kee Haeng Lee; J Korean Soc Fract 1990;3(1):110-118. Published online May 31, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.1.110

Abstract PDF: Since 1980, we have treated twelve patients who had antero-inferior subluxation of humeral head after acute trauma to the shoulder or to the proximal part of the humerus, of both. the diagnosis of subluxation was based on clinical and radiographic examination. To evaluate the rdiological features, and also to clarify the mechanism as well as the treatment for this subluxation, we have been analysed and the following results were obtained. 1. The careful radiographic interpretation, especially standing neutral shoulder AP and lateral films, was quite important to find the hidden soft tissue injuries which it could be caused the subluxation of humeral head after acute trauma to the shoulder. 2. The incidences of subluxation was 24.5%, 12 cases out of the total 49 cases. 3. The subluxation was frequently frequently developed in adduction type of fracture, avulsion fracture of the greater tuberosity and in women with over the 40 of their ages. 4. Intial subluxation of humeral head after trauma might be caused by the rupture of capsule of rotator cuff, and late subluxation may be developed by the loss of damaged muscle tone or direct muscle damage due to intial or sugical trauma. 5. Except the results of the nerve damage after trauma or surgery, the subluxation could be recovered by average 22 day after the first recognition of subluxation with hte vigorous isometric biceps setting exercise immediately after trauma. 6. Isometric biceps seetting exercise was the most important basic step for the every injuries aroud the shoulder joint.

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