Journal of Musculoskeletal Trauma

Chronic Osteomyelitis in Distraction Osteogenesis Area of Tibial Shaft: A Case Report: Sanguk Bae, Baekyong Song, Jin Seon Moon; J Korean Fract Soc 2014;27(4):321-326. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.321

Abstract PDF: Distraction osteogenesis with an Ilizarov external fixator is one of the most successful treatment options for large segmental bone defects after extensive debridement of chronic osteomyelitis in the tibial shaft. Its complications include skin irritation, pin tract infection, and non-union due to infection. There are few case reports on chronic osteomyelitis occurring in the distraction osteogenesis area. The authors experienced a chronic osteomyelitis in the distraction osteogenesis area of the tibial shaft and report this case with references.

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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

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 Comparison of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Proximal and Distal Tibia Fracture: Joon Soon Kang, Seung Rim Park, Sang Rim Kim, Yong Geun Park, Jae Ho Jung, Sung Wook Choi; J Korean Fract Soc 2010;23(2):172-179. Published online April 30, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.2.172

Abstract PDF

PURPOSE
To compare the efficacy of the surgical treatment through the comparison of Minimally Invasive Plate Osteosynthesis (MIPO) and Intramedullary (IM) nailing in the treatment of the tibial shaft fractures expended to metaphysis retrospectively.
MATERIALS AND METHODS
Patients with proximal or distal third fracture of tibial shaft from May 2003 to Aug. 2006 were divided into two groups depending on the surgical method. Group A consisted of 30 patients treated with IM nailing, Group B was 29 patients treated with MIPO. The clinical outcomes were evaluated retrospectively from the time for bone union and callus formation confirmed by X-ray, functional score of knee or ankle joint, and complications including nonunion, malalignment and infection.
RESULTS
Bone union was seen radiologically at a mean of 17.4 weeks in group A, and 17.0 weeks in group B. In postoperative complications, group A showed two nonunion, two delayed-union, six malalignment, and two wound infection while group B showed only one delayed-union and one wound infection.
CONCLUSION
There were no significant differences in the time for bony union and functional score between IM nailing and MIPO. Conventional IM nailing with only interlocking technique showed higher incidence of malalignment and deformity than MIPO for the treatment of the proximal or distal third fracture of the tibial shaft.

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Effect of Korean Medicine Treatments in Patients with Proximal Tibia Fracture: A Retrospective Observational Study
Jung Min Lee, Eun-Jung Lee
Journal of Korean Medicine Rehabilitation.2020; 30(3): 141. CrossRef

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Reamed versus Unreamed Interlocking Intramedullary Nailing in the Treatment of Femoral and Tibial Shaft Fracture: Sung Soo Kim, Chul Hong Kim, Myung Jin Lee, Jin Hun Kang; J Korean Fract Soc 2006;19(2):141-146. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.141

Abstract: PURPOSE
To comparative analysis of clincal difference between reamed and unreamed interlocking intramedullary nailing in the treatment of femoral and tibial shaft fractures.
MATERIALS AND METHODS
We reviewed femoral and tibial shaft fracture who were treated with reamed or unreamed nail. They were followed for a minimum of 16 months. Winquist-Hansen and Johner-Wruhs criteria were applied for the classification of the fractures. Retrospectively we evaluated the duration of operation, the amount of bleeding, the first time of callus formation, union time, the time of partial weight bearing, isthmic ratio, complications.
RESULTS
The average duration of operation for femoral fractures with reamed and unreamed nail were 104 minutes, 95 minutes, respectively. And those for tibial fractures were 96 minutes, 87 minutes, and the difference was statistically significant (p<0.05). The amount of bleeding in femoral fractures with reamed and unreamed nail were 360 ml, 223 ml, respectively. And those in tibial fractures were 280 ml, 205 ml, respectively, and the difference was statistically significant (p<0.001). The isthmic ratio in femoral fracture with reamed and unreamed nail were 105.5%, 87.0%, respectively and those in tibial fracture were 106.3%, 85.3%, respectively. There were 2 delayed unions in femoral fractures and 1 delayed union in tibial fracture with unreamed nail, and 1 metal failure in tibial fracture with unreamed nail.
CONCLUSION
Unreamed femoral intramedullary nailing involves fewer steps and less intraoperative blood loss than reamed nailing. There was no statistical difference the first time of callus formation, union time, the time of partial weight bearing. It must be consider that delayed union and metal failure in the unreamed intramedullary nailing due to high grade fracture, lower isthmic ratio, combined with multiple trauma.

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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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Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Shaft Fracture: Jun Young Yang, Kwang Jin Rhee, June Kyue Lee, Deuk Soo Hwang, Hyun Dae Shin, Hyun Ho Lee; J Korean Soc Fract 2002;15(2):286-291. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.286

Abstract PDF

INTRODUCTION: Minimally invasive percutaneous plate osteosynthesis(MIPPO) was performed to treat distal tibial shaft fracture, and the results were compared to those of open plate fixation to find appropriate treatments MATERIALS AND METHODS: Among the patients who visited the Orthopedics Department at our hospital and were diagnosed with distal tibial shaft fracture, 12 cases that received MIPPO and 14 cases receiving open plate fixation were chosen for the study. The average age of patients were 57.8 and 50.8 years, and the male:female ratio was 1:1 in both cases. The average post-operative follow up period was 18 months and 19.5 months, and simple X-ray was done to evaluate the fracture healing.
RESULTS
The cases that received MIPPO, the operation time was 46.5 minutes and the average period of hospitalization was 25.3 days. There were no Nonunion, one case of delayed union, and one case of superficial infection. In the open plate fixation group, was 115.6 minutes and 48.3 days. Nonunion was in two cases, delayed union in two cases, superficial infection in one case, and deep infection in two cases. The nonunion cases were later given autogenous bone graft and fracture healing was attained.
CONCLUSION
By performing MIPPO quicker recovery of the patient can be made. Infection and nonunion, the most important complications due to operation, can be reduced. MIPPO thus seems to be the method leading to more close physiologic bone fusion in the treatment of distal tibial shaft fracture.

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The Comparison of Minimally Invasive Percutaneous Plate Osteosynthesis versus Open Plate Fixation in the Treatment of in the Distal Femur Fracture
Seong-Jun Ahn, Suk-Woong Kang, Bu-Hwan Kim, Moo-Ho Song, Seong-Ho Yoo, Kwan-Taek Oh
Journal of the Korean Fracture Society.2013; 26(4): 314. CrossRef

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Treatment of Severe Open Fractures of Tibial Shaft: Comparison Between Ilizarov External Fixation and Secondary Intramedullary Nailing: Hyoun Oh Cho, Kyoung Duck Kwak, Hong Joo Lee, Dae Hwan Lim, Sang Min Ahn, Jae Ho Chang, Kyung Ku Kang; J Korean Soc Fract 2002;15(2):234-242. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.234

Abstract PDF: PURPOSE
We tried to compare the results of Ilizarov external fixation cases with the cases of secondary intramedullary nailing after tempory Ilizarov fixation.
MATERIALS AND METHODS
From the January 1996 to February 2001 , 34 cases of severe open tibial shaft fracture in adults were treated with Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. According to Gustilo- Anderson classification, it consisted of type II 2 ,IIIA 7 ,IIIB 9 ,IIIC 2cases in Ilizarov group ,and type II 2, IIIA 7, IIIB 5cases in secondary intramedullary nailing group.
RESULT
There was no significant difference in the union time of Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. But the secondary nailed group had slightly better motion , less final angulation and felt more comfortable . It is the treatment preferred by patients and does not require the same high level of patient compliance as external fixation.
CONCLUSION
Secondary intramedullary nailing after temporary Ilizarov fixation is the useful method in the treatment of open fractures of tibia.

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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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Ender Nailing of Tibial Shaft Fractures: In Young Ok, Yang Guk Chung, Tec Soo Kim; J Korean Soc Fract 2000;13(1):87-95. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.87

Abstract PDF

PURPOSE
Though Ender nailing in tibial shaft fractures is a good method of treatment, there were several reports about complications such as angulation or shortening. Most of those complications were associated with improper surgical technique and might be avoidable. So, we analyzed the results of tibial Ender nailing in view of the complications and their contributing factors. MATERIAL AND METHOD: Thirty-five tibial shaft fractures were treated with Ender nailing and followed up for 12 to 51 months. We evaluated the bony union, angulation, shortening, proximal migration of nail and infection, and analyzed the results in association with the type and the location of fractures, the number and the length of nails and the divergency of distal tip of nails.
RESULTS
Average bony union time was 18.5 weeks and there were 2 delayed unions, 2 nonunions, 5 angulations, 1 shortening, 3 soft tissue irritations by proximal tips of nails, 1 proximal migrations of nails and one nail breakage. Most of them were associated with technical faults such as few number, short length or insufficient divergency of nails. According to the type of fractures, the highest rate of complications was seen in segmental fractures.
CONCLUSION
Performed by proper surgical technique based on detailed fracture analysis, most of the complications of Ender nailing for tibial shaft fractures might be avoidable. Therefore, Ender nailing is one of the useful alternatives for tibial shaft fractures.

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Manoeuvring Distal Tibial Shaft Fractures with Ender’s Nailing: Case Series
Aditya Pundkar, Chandrashekar Kulkarni
Journal of Datta Meghe Institute of Medical Sciences University.2023; 18(3): 481. CrossRef

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Clamp external fixator for IIIb open tibial shaft fracture: Jeung Tak Suh, Byung Guk Park, Chong Il Yoo; J Korean Soc Fract 1999;12(3):557-567. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.557

Abstract PDF: As the saftest and simplest method of immobilization treatment, external fixation is indicated in IIIb open tibial shaft fractures with extensive damage to soft tissue and bone. This enables better wound treatment, patient transport and performace of surgical treatment such as plastic and reconstructive surgery, orthopedic surgery. From the march 1994 to september 1997 14 cases of IIIb open tibial shaft fractures were treated with clamp external fixator either Orthofix or DynaExtor. The purpose of this study is to determine indication of clamp external fixator and investigate its outcome as well as complications and solutions. 11 males and 3 females were followed for 29.3 months on an average. Fractures mainly occurred at mid 1/3 of tibial shaft and its pattern was most frequently comminuted one. Mean bony union time was 46 months. There were 1 case(7%) of delayed union, 2 cases(14%) of nonunion, 6 cases(42%) of reduction loss, 4 cases(28%) of deep infection including 2 cases(14%) of osteomyelitis, 6 cases(42%) of pin tract infection, 2 cases(14%) of malunion and 3 cases(21%) of ankle stiffness. Conclusively for the creation of a suitable environment of fracture healing and prevention of complications such as delayed union, nonunion and deep infection, thorough debridement and irrigation followed by adequate stabilization of bone, early soft tissue coverage and early prophylactic bone graft is paramount important in the treatment of IIIb open tibial shaft fracture since it is high energy trauma. In addition, initial firm fixation for the prevention of reduction loss and active and passive exercise for the prevention of ankle stiffness and pin tract infection or loosening should be taken into careful consideration.

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Treatment of Open Fractures of the Tibial Shaft by Sequential Compression technique in Ilizarov device: Suk Ku Han, In Ju Lee, Nam Yong Choi, Sung Jin Park, Gyeol Yoo, Hyo Seng Ahn; J Korean Soc Fract 1998;11(4):817-824. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.817

Abstract PDF: External skeletal fixation is used widely in the management of open or closed tibial fractures, but delayed healing is common. There is concern that this might be due not only due to the severity of injury but also to the mechanical conditions imposed at the fracture site by the fixator. Since fractures treated by external skeletal fixation can rarely be reduced to perception nor held with absolute stability, union occurs by indirect healing, which is acutely sensitive to both the charactericstics and timing of mechanical stimulation. So, the achivevment of the optimum mechanical environment is particularly important where delay in bone healing is likely. Ilizarov external fixator is useful in treating open fractures of the tibial shaft because it permits axial micromotion which enhances bridging callus formation with stable fixation as well as its complications such as infected nonunion or limb length discrepancy. The impared healing with external fixation is often caused by wrong surgical technique, such as distraction of fracture fragments by fixation device. Sequential compression at fracture site may overcome any fracture gap in external skeletal fixation and also enhance endosteal bone formation. We applied sequential compression forces at the fracture site in 18 open fractures of the tibial shaft, trated by Ilizarov external fixator with or without autogenous bone grafting. Sequential compression technique is composed of initial compression with 1 mm/wk for 4 weeks and then compression 1 mm/10 days until adequate apposition of cortex and callus formation in radiograph. We acquired successful bony union in all cases except one which had additional bone grafting in open fractures of the tibial shaft by sequential compression technique using Ilizarov device.

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Treatment of Type IIIB Open Tibial Shaft Fractures: Chung Nam Kang, Jong Oh Kim, Dong Wook Kim, Young Doo Koh, Jae Doo You, Jong Keon Oh, Young Seuk Kim; J Korean Soc Fract 1998;11(3):560-566. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.560

Abstract PDF

In general, severe open fractures of the tibial shaft have been treated initially with external fixation. However, despite many refinements in this technique, it has been associated with numerous complications, including problems at the sites of pins, non-union, delayed union, malunion, and infection. The purpose of this retrospective study is to analyze the results in a consecutive series of patients. There were 8 males and 2 females with an average age of the 44.9 years(range, 26-64 years). The mean follow up period was 23.2 nibtgs(range, 34-120 days). Free flap procedures were performed on all patients. The average time between removal of the fixator and intramedullary nailing was 16.5 days(range, 11-26 days). Indication of conversion to nailing was abscence of any serous discharge, reddness or local heating around pin-sites and normal renge of laboratory data. All 10 fractures had united with additional bone graft in 7 cases. The most frequent complications were delayed union in 7 cases and infection(superficial infection: 6 cases, osteomyelitis: 1 case) after IM nailing. We concluded that pin-tract infection is the major cause of infection after IM nail, but duration of external fixation and time interval(between removal of external fixator and nailing) are not isolated factors.

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Study on Instant Fish Cake Noodle Manufacturing Techniques Using Ultra-fine Powdered Kelp
Yoo-Jin Park, Se-Jong Kim, Myung-Ryun Han, Moon-Jeong Chang, Myung-Hwan Kim
Food Engineering Progress.2019; 23(3): 217. CrossRef
Treatment of Type IIIb Open Tibial Fractures
Seong Yeon Lim, Il Jae Lee, Jae Ho Joe, Hyung Keun Song
Journal of the Korean Fracture Society.2014; 27(4): 267. CrossRef

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Treatment of Open Segmental Fracture of the Tibia: Kyeong Soon Kim, Kyu Chul Shin, Dong Hyeuk Kim, Dong Heon Kim; J Korean Soc Fract 1998;11(1):205-213. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.205

Abstract PDF: Tibial segmental fractures are considered special type of lesion and pose many problems and the results often are unsatisfactory. We performed retrospective study of the 17 cases of open tibial segmental fracture which were treated from January 1990 to December 1995 and evaluated the efficacy of the external fixation and intramedullary nailing. The segmental fracture were classified according to the Melis classification and open fracture were classified according to the Gustilo-Anderson classification. After average follow-up of 16 months (range, 12 to 24 months), all of the fractures had healded except one. The results were as follows: 1. The average time of union was 22.5 weeks in the case of intramedullary nailing (Endernail; 26 weeks, Interlocking IM nailing; 21 weeks) and 31 weeks in the case of external fixation (Monofixator; 28 weeks, Ilizarov external fixator; 34 weeks). 2. Nonunion and osteomyelitis was developed in one case of Ilizarov external fixation and 5 cases of pin tract infection were also developed. Among 8 cases of external fixation group, 4 cases of delayed union and one case of malunion were developed. 3. In intramedullary nailing, delayed union was developed in 4 cases. 4. The functional results by Tile rating system were showed good in 6 cases, acceptable in 8 and poor 3. In concla\usion, intramedullary nailing provided better ressults thanexternal fixator in open segmantal tibial fractures, but we consider fixation device should be selected depending on the fracture type, degree of comminution and condition of the soft tissue.

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Treatment of Open Type-III Tibial Shaft Fractures -Comparison Between Ilizarov External Fixation and Secondary Intramedullary Nailing-: Hoon Kim, Woo Dong Nam, Ki Chan Ahn, Seung Seok Seo, Young Chang Kim, Jang Seok Choi, Young Goo Lee; J Korean Soc Fract 1998;11(1):191-197. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.191

Abstract PDF: Open type III tibial shaft fractures have a high incidence of complication and a poor outcome. The most usual method of stabilization is by external fixation, but there are several complications as infection, delayed union and nonunion. We tried to compare the results of Ilizarov external fixation cases with the case of secondary intramedullary nailing after temporary Ilizarov fixation. There was no significant difference in the union time of Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. But the patients were more comfortable in the secondary intramedullary nailing. In conclusions, secondary intramedullary nailing after temporary Ilizarov fixation is the useful method in the treatment of open type III tibial shaft fractures.

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Treatment of Tibial Shaft Fractures Using Interlocking Intramedullary Comparison of Reamed and Unlearned Methods: Woo Nam Moon; J Korean Soc Fract 1997;10(3):562-568. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.562

Abstract PDF: Sixty-four closed or Gustilo type I open fractures of the tibial shaft were treated with interlocking intramedullary nailing with(n=38) or without(n=26) reaming and were followed for an average of 13 months. The time to bony union ranged from twelve to twenty-five weeks with an average of 16.4 weeks in reamed method and from thirteen to twenty-seven weeks with an average of 15.9 weeks in unlearned method. The complications of reamed method were seen in 4 cases(11%) (two stiffness of ankle joint, one malunion and one distal screw breakage) whereas complications of unlearned method were seen in 7 cases(27%) (one stiffness of ankle joint, two malunions and four distal screw breakages). There was no significant difference in the union time of reamed and unlearned interlocking intramedullary nailing. But complications of fracture healing were less frequently seen on reamed interlocking intramedullary nailing.

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Treatment of Tibial Shaft Fractures with Ender Nailing and Postoperative Functional Bracing: Young Soo Byun, Hong Tae Kim, Won Ho Cho, Se Ang Chang, In Hak Choi, Jin Wook Jung; J Korean Soc Fract 1997;10(3):541-547. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.541

Abstract PDF: Ender nailing is an alternative method of treatment of selected unstable tibial shaft fractures. The purpose of this study is to evaluate the result of functional treatment with Ender nailing and postoperative functional bracing. We treated 31 tibial shaft fractures(16 closed, 15 open) with closed Ender nailing and postoperative functional bracing between August 1990 and September 1994 and followed up the patients from minimum 10 months to 74 months. Clinical analyses were as follows; 1. According to AO classification, 10 cases were Type A simple fractures(32%), 14 Type B wedge fractures(45%), and 7 Type C complex fractures(23%). 2. Ninety four percent of the fractures united in an average time of 17.3 weeks. The average time to union of complex fractures was longer than that of simple and wedge fractures(P<0.05). 3. There were two nonunions(6.5%), two delayed unions(6.5%), and three angulatory malunions(9.7%) between 6 and 10 , but there was no putient of significant shortening, joint stiffness, or infection. The Ender nails provide sufficient stability at the fracture site of the tibial shaft to permit carly weight-bearing in a functional brace, and this treatment provides early fracture union with less complicatioins and facilitates functional recovery.

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Extensively Comminuted Type III Open Fracture of Tibial Shaft: 4 Case Treated by Ilizarov External Fixator: Ju Hai Chang; J Korean Soc Fract 1994;7(2):480-489. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.480

Abstract PDF: It is extremely difficult to treat to the type III open fractures of the tibial shaft which have been severely comminuted and splitted in the long length. Early internal fixation with plates and screws or intramedullary nailing of type III open fracture is contraindicated because of high infection rate and circulatory compromising at the fracture site. External fixation is the method of choice for the treatment of type III open fracture of the tibia. It reduces the risk of infection and permits easy access for wound care, early mobilization of joints and weight bearing. Four type III open fractures of the tibial shaft that were very unstable had entered this hospital from November 1990 to June 1992. The patients were all young males. The causes of injury were one explosion and three motor vehicle accidents. The open fractures were three type III A and one type III B according to Gustilos classification. These fractures were stabilized with Ilizarov external fixator. Parenteral antibiotic therapy was started from the emergency room to prevent infection. Illzarov fixator was applied 17 to 63 days(av. 37 days) after injury and maintained for 6 to 12 months(av. 8 months). Subsequent autogenous bone grafting and internal fixation were done in three patients 7 to 8 months after external fixation because of delayed union. Follow-up period ranged from 1 year and 11 months to 2 years and 6 months(av. 2 years and 2 months). Solid union was obtained in all patients between 1 year 1 month and 1 year and 7 months(av, 1 year and 3 months) without active osteomyelitis. At last follow-up, there were mild limitation of ankle joint motion in all patients and tibial shortening of 18 to 34mm(av. 25 mm)on the roentgenograms of three patients. No significant working disability or malalignment of the leg was noted in all patients. The final results were very good compared to the severity of their injuries.

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Clinical analysis on 9 cases of tibial shaft nonunion: J C Inh, P T Kim, B C Park, S Y Kim, J H Park; J Korean Soc Fract 1994;7(1):151-160. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.151

Abstract PDF: It is often difficult to achieve bony union in the cases of nonunion of the fractured tibia. The frequency of nonunion of tibial shaft is increasing due to an increment of open, commi noted fractures, associated soft tissue injuries and association of visceral ruptures, and so its treatments give orthopedic surgeons a rather difficult obstacles. 9 cases of nonunion of tibial shaft were treated from Jan., 1988 to Dec., 1992 and the average folllow up period was 11.6 months with minimal 9 months and maximum 17 months, and the results were as follows: 1. Of the 9 patients, there were 7 male and 2 female patients. 2. The cause of the fractures was traffic accident, all of 9. 3. Of the 9 cases, there were 6 open and 3 closed fractures. 4. The shape of fractures consisted of 3 comminuted, 3 segmental, 2 oblique, 1 transverse. 5. At the time of initial treatemt, 5 were treated operatively, 4 were treated conseuatively 6. Of the 3 associated injuries, there was 1 pelvic bone fracture, 1 multiple rib fracture with pneumo-hemothorax, 1 head injury. 7. Average period from injury to diagnosis as nonunion was 9.3 months. 8. Of the probable causes of nonunion, 5 cases were caused by inadeauate or inappropriate immobilization, 2 by bone defect, 1 by infection, 1 by implant failure. 9. The average time required for union was 6.4 months in hypertrophic nonunion and 8.8 months in atrophic nonunion.

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Clinical Study of Tibial Shaft Fractures: Soo Kil Kim, Keung Bae Rhee, Sae Jung Oh, Kye Seok Yang; J Korean Soc Fract 1989;2(1):71-81. Published online June 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.1.71

Abstract PDF: The tibia has poor soft tissue coverage and poor blood supply in anatomy, but it is the most commonly fractured bone of all the long bones, therefore tibial fractures are much controversy concerning the method of treatment because of frequent complications. The 63 adult patients(67 fractures) with fractures of the shaft of the tibia were treated at the Department of Orthopaedic Surgery, Choong Ang Gil Hospital during the 4 years from Jan. 1984 to Dec. 1987. by the group, the 24 cases(25 fractures) were treated with conservative methods, the 21 cases(23 fractures) were treated with self compression plate & screw fixation and the 18 cases(19 fractures) were treated with Ender nailing. The results obtained were as follows; 1. The average time of bone union was the 17.7 weeks.;the 14.1 weeks in the Ender nailing, the 17.5 weeks in conservative treatment methods, the 21.2 weeks in the compression plate & screws fixation. While hte rate of bone union was the 91.0%.;the 96.0% in conservative treatment method, the 86.9% in the compression plate & srews fixation, the 89.5 in the Ender nailing. 2. In the average time of bone union among the various levels of fractures, middle one third(16.7 weeks) healed more rapidly than the proximal one third(18.4 weeks) and distal one third(18.3 weeks). 3. As to the types and natures of fracture, average time of bone union was longer in open fractures(19.9 weeks) and comminuted fractures(20.6 weeks) than closed fractures(17.0 weeks) and simple fractures(15.5 weeks). 4. By the modified Ellis classification of tibial fractures, average time of bone union was the 16.2 weeks in minor severity, the 18.3 weeks in moderate severity, and the 20.1 weeks in major severity. Therefore the higher the severity, the longer the average time of bone union and the higher the complication. 5. In an intact fibula, tibial fractures healed more rapidly and the complications ocurred in the concomitant fibular fractures. 6. The complication of the tibial fractures were 28 cases, and most important complication were impairment of joint function, malunion and common peroneal nerve injury in conservative method, nonunion and infection in the compression plate and screws fixation, and delayed union in the Ender nailing.

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