Journal of Musculoskeletal Trauma

Ultrasonographic Assessment of the Pronator Quadratus Muscle after Surgical Treatment for Distal Radius Fractures: Dong Hyuk Choi, Hyun Kyun Chung, Ji Won Lee, Cheol Hwan Kim, Yong Soo Choi; J Korean Fract Soc 2017;30(2):69-74. Published online April 30, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.2.69

Abstract PDF: PURPOSE
This study was to assess the morphological changes of the pronator quadratus (PQ) muscle using an ultrasonography in the volar locking plate fixation group and in the percutaneous K-wire fixation group for distal radius fracture, and to evaluate the impact on clinical outcomes.
MATERIALS AND METHODS
Fifty-four patients who received surgical treatment for distal radius fracture were enrolled in this study. They were divided into two groups according to treatment modality: Group 1 included 34 patients who underwent internal fixation with volar locking plate and Group 2 included 20 patients with percutaneous K-wire fixation. Thickness of the PQ muscle was measured using an ultrasonography at the final follow-up. We evaluated the outcomes using the Mayo wrist score, wrist range of motion, and grip strength at the final follow-up.
RESULTS
Compared with the uninjured side, thickness of the PQ muscle showed 31.9% of mean atrophy in Group 1 and 11.4% in Group 2. The atrophy of PQ muscle was severe in Group 1 (p=0.01). However, there was no significant difference in the mean Mayo wrist score between the two groups (83.1Â±10.9 in Group 1 and 80.2Â±8.9 in Group 2, p=0.28), except a mild limitation of pronation in Group 1.
CONCLUSION
The healed PQ muscle from fracture itself after distal radius fracture revealed a morphological atrophy. Moreover, the volar locking plate resulted in greater atrophy of the PQ muscle, but there was no specific impact on clinical outcomes.

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The Fate of Pronator Quadratus Muscle after Volar Locking Plating of Unstable Distal Radius Fractures: Chae Hyun Lim, Heun Guyn Jung, Ju Yeong Heo, Young Jae Jang, Yong Soo Choi; J Korean Fract Soc 2014;27(3):191-197. Published online July 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.3.191

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the pronator quadrates muscle in patients who underwent internal fixation with a volar locking plate for unstable distal radius fractures.
MATERIALS AND METHODS
Forty patients who underwent internal fixation with a volar locking plate for unstable distal radius fracture were enrolled. We evaluated the clinical results according to the Mayo wrist score, the wrist range of motion, and the grip strength at the last follow-up. Using ultrasonography, muscle thickness of the pronator quadrates was compared between injured and uninjured arm.
RESULTS
Bone union was achieved in all cases. The mean Mayo wrist score was 82.79 points. The grip strength of the injured arm was decreased to 89.1% of the uninjured side. The decrease of pronation range of the injured wrist motions was significant (82.3degrees, p=0.004). There was significant atrophy of the pronator quadrates muscle on the injured side (injured side: 3.19 mm, uninjured side: 4.72 mm, p=0.001); and the decrement of muscle thickness in pronator quadrates showed an association with the Mayo wrist score (r=-0.35, p=0.042).
CONCLUSION
These results suggest that continuity of the muscle is maintained after use of the volar locking plating for unstable distal radius fractures with repair of pronator quadrates; however, there is atrophy of pronator quadrates muscle and limitation of pronation in the injured wrist.

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The Results of Surgical Treatment for Nonunion of Phalanges in the Hand: Hee Dong Kim, Yoon Hong Kim, Yong Soo Choi, Heun Guyn Jung; J Korean Fract Soc 2008;21(2):140-144. Published online April 30, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.2.140

Abstract PDF: PURPOSE
To evaluate the results of internal fixation and autogenous bone graft for the phalangeal nonunion in the hand.
MATERIALS AND METHODS
From Feb. 2000 until May 2006, thirteen cases that had been treated for non-union of phalanges in the hand were investigated retrospectively. Seven cases were treated with mini-plate fixation and autogenous cancellous graft and six cases with Kirschner wire fixation and autogenous cancellous graft. We analyzed bony union period radiographically and clinical results according to Belsky's score.
RESULTS
Thirteen cases obtained bony union. Seven cases of mini-plate fixation and bone graft, and six cases of K-wire fixation and bone graft achieved the bony union postoperatively on average 7.9 weeks and 6.3 weeks, respectively. Clinical results were "good" in four cases and "poor" in nine cases according to the Belsky's score. Only one of ten cases with associated injuries, such as tendon, nerve, arterial injuries and other finger fractures in the injured hand, had the good clinical result, but all three cases without associated injuries had the good one.
CONCLUSION
Internal fixation and autogenous bone graft can be a successful treatment of phalangeal nonunion. However, more careful choice of surgical treatment methods and preoperative explanation of poor post-operative results or complications should be made for phalangeal nonunion with associated injuries in the finger because of poor outcome in those cases.

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Radiologic Reduction Loss after Surgical Treatment of Distal Radius Fracture: Heun Guyn Jung, Jin Bae Choi, Seung Yong Seo, Yong Soo Choi; J Korean Fract Soc 2006;19(4):454-459. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.454

Abstract: PURPOSE
To compare and analyse radiologic reduction loss between fixation with K-wire only group and fixation with K-wire and external fixator group for surgical treatment of distal radial fracture.
MATERIALS AND METHOD
We analysed 60 patients who received the operative treatment with K-wire fixation only or K-wire and external fixator and also were in regular follow up at least one year. We compared radiologic reduction loss of radial length, radial inclination and volar tilt between immediate post-operative radiograph and latest follow up radiograph according to operative methods, fracture patterns and age groups.
RESULTS
Reduction loss of volar tilt was greater in fixation with K-wire only group than fixation with K-wire and external fixator group (p<0.05). Reduction losses of radial length and radial inclination were more in intra-articular subgroup than extra-articular subgroup in fixation with K-wire only group (p<0.05). No significant difference of reduction loss was noted between intra-articular and extra-articular subgroups in fixation with K-wire and external fixator group.
CONCLUSION
More radiologic reduction loss can be expected in fixation with K-wire only group for intra-articular distal radius fracture compared with extra-articular distal radius fracture. Additional external fixation should be added in intra-articular distal radius fracture to reduce radiologic reduction loss.

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Operative treatment of displaced intraarticular fractures of the calcaneus: Ki Soo Kim, Yong Soo Choi, seung Chae Han, Kwang Soo Shon; J Korean Soc Fract 1998;11(4):894-899. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.894

Abstract PDF

As technology in imaging has improved, we have learned more of the anatomical features of these fractures, and onw several objective studies in the literature with sufficient follow up recommend surgical treatment for some displaced intraarticular fractures of the calcaneu. The purpose of this study is to report the results of the open reduction with rigid internal fixation for displaced intraarticular fractures of the calcaneus. from March 1994 to December 1996, the author managed twenty-nine displaced intraarticular fractures of the calcaneus in twenty-three patients with open reduction via extended lateral approach and internal fixation using the plate. The fractures were classified according to Essex-Lopresti with the lateral radiograph and according to Sanders with the computed tomograph. Clinical results were assessed the pain, activity, return to work, range of motion, change in shoe size and swelling from creighton-Nebraska health foundation assessment. Among the 29 cases, satisfactory results were obtained in 24 cases(82.9%). We assessed the radioolgic objective parameters such as Bohler angle, crucial angle, height and width of the calcaneus, and the arthritis of the subtalar joint. Radiologically, we showed satisfactory restoration of the calcaneal morphology and severe subtalar arthritis in 4 cases. We found the negative correation between the clinical results and the radiological subtalar arthritis(P=0.038). In managing displaced intraarticular fractures of the calcaneus, open reduction via extended lateral approach and rigid internal fixation seemed to be useful method.

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Correlation Analysis of Reduction for Intra-Articular Calcaneal Fracture and Clinical Outcomes Using Postoperative Computed Tomography
Joon-Sang Eom, Young-Deuk Joo, Seong-Jun Kim, Min-Ho Shin, Dong-Oh Lee, Hong-Geun Jung
Journal of Korean Foot and Ankle Society.2014; 18(4): 165. CrossRef

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Surgical Management of the Proximal Tibial Shaft Fractures - A Comparison of Plate Fixation and Interlocking Intramedullary Nailing -: Ki Soo Kim, Yong Soo Choi, Chul Hun Choi, Jin Ho Yang; J Korean Soc Fract 1997;10(4):872-878. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.872

Abstract PDF: The treatment of proximal tibial shaft fractures is an area of great controversy. The purpose of this study was to make the comparison between the results of the plate fixation and those of the interlocking nailing, and to identify the effects of the location of the nail bend on the reduction of the proximal tibial shaft fractures. From June 1991 to May 1995, we performed the plate fixation in 12 cases and interlocking nailing in 16 cases for the proximal tibial shaft fracture. We subdivided the interlocking nailing group into two groups: Group A had the fractures within the posterior bending length of the nail in 8 cases, Group B had the fractures over the posterior bending length of the nail in 8 cases. The results were as follows; The most common type of fractures was the Winquist-Han son type III, 9 cases(75%), in the plate fixation group, and the segmental fracture, 10 cases(62.5%), in the interlocking nailing group. In the plate fixation group, autogenous bone graft were used in 7 cases (58.3%), primary in 5 cases and secondary in 2 cases. The interlocking nailing group had a tendency to cause the surgical problems during the nailing such as angular deformity in 3 cases, displacement of the fracture in 2 cases, extension of the fracture in one case, need an open reduction in one case and unstable fixation in one case. The surgical problems were associatied with the incorrect entry point and the fractures within the posterior bending length of the nail (Group A). Clinically excellent and good results, according to Klemm and Borner criteria, were obtained in 12 cases(100%) of the plate fixation group and 13 cases(81.3%) of the interlocking nailing group. the fair results were associtated with the angular deformity in the Group A. In conclusion, the preoperative planing must carefully consider such as the type of fracture, technical familarity, and understanding of the implants and instrumentations ofr the successful treatment of the proximal tibial shaft fractures. The plate fixation is preferable method for the fractures within the posterior bending length of the nail(Group A).

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The Effect of fibular fractures in the healing of tibial shaft fractures treated with an interlocking nail: Ki Soo Kim, Yong Soo Choi, Jong Jun Park, Sun Young Chung; J Korean Soc Fract 1996;9(2):449-457. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.449

Abstract PDF: The effect of fibular fractures in the healing of tibial shaft fractures has controversial results. Its results are the greater part of the data for the conservative treatment of tibial shaft fractures. Recently closed interlocking nailing has been the most efficient treatment for displaced fractures of the tibial shaft. The purpose of this study was to evaluate the effect of fibular fractures in the healing of tibial shaft fractures treated with an interlocking nail and to determine whether the fibular fracture had a relation with other prognostic factors. From Mar. 1992 to Feb. 1995. the authors performed interlocking nailing for displaced fractures of the tibial shaft in 111 patients. We reviewed 98 patients with a minimal ten month follow up period. We divided the fractures into three groups; the intact fibula group which consisted of 15 patients had tibial shaft fractures with intact fibula, the same level fracture group had tibiofibular fractures at the same level in 56 patients and the different level fracture group had tibiofibular at different level in 27 patients. The results were as follows: 1. Clinically excellent and good results, according to Klemm and Horner criteria. were in 15 patients(100%) of the intact fibula group,49 patients(87.4%) in the same level fracture group and 21 patients(92.5%) in the different leyel fracture group. 2. Radiologically bone healing was obtained in 15 patients(100%) with a mean union time of 13.3 weeks in the intact fibula group, 42 patients(75.O%) with a mean union time of 17.9 weekf in the same level fracture goup and 2,1 patients(85.2%) with a mean union time of 15.3 weeks in the different level fracture group. 3. The same level fracture group had a tendency to cause a bending force while the different level fracture group tended to treat a torsional force. We found that the bending fractures had the worst prognosis. These results suggest that the treatment of tibial shaft fractures with an intact fibula by using an interlocking nail prevents significant complications and allows early weight bearing, thus permiiting early mobilization of the traumatized patient. The level of the fibular fracture associated with the tibial fracture may be a useful prognostic factors in the healing of tibial shaft fractures.

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Interlocking Intramedullary Nailing of the Femoral Shaft Fracture: A Comparison between Gross-Kempf Nail and Interlocking Compression Nail: Ki Soo Kim, Yong Soo Choi, Chae In Lim, Yang Min Chung; J Korean Soc Fract 1995;8(4):767-776. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.767

Abstract PDF: Various designs of interlocking intramedullary nailing systems allowing closed nailing techniques have been used in the treatment of femoral shaft fractures, but there are little objective data available to compare their performance. The authors reviewed 58 patients of femoral shaft fractures which were treated at Kwang ju christian hospital from April 1992 to June 1994. The Gross-Kempf nail was used in 39 patients and the Interlocking compression nail was used in 19 patients. The purpose of this study is to determine if there are any significant difference in the application, ease of use or clinical outcome. The average follow up period up period was 21.5 months (range 12 to 31 months) and the results were as follows. 1. Two nails have similar indication for use, but G-K nail was more satisfactory for proximal fractures of the femur and I-C nail was used as a compression nail with application of one proximal interlocking screw in oval hole in simple stabilizable fractures(Winquist Hansen type I and / or type II). 2. In the G-K naiBing group, the partially threaded screw of distal locking gaining purchase in only one cortex comes loose more often and backs out more frequently. In the I-C nailing group, the fully threaded screw of distal locking is able to fail of screw because of smaller core diameter of the screw. Successful distal locking is not only dependent upon strength of transverse screw, but also upon achieving cortical fixations with threads. 3. Complications seemed to be failure of operative principle and postoperative care rather than any intrinsic problems with the nail themselves.

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Department of Orthopedic Surgery, Kwang Ju Christian Hospital: Ki Soo Kim, Seung Hee Ko, Chang Moon Suh, Yong Soo Choi, Kyung Ho Kim, Dong Myung Lee, Yang Min Jung; J Korean Soc Fract 1994;7(2):553-561. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.553

Abstract PDF: The tibia, which is covered by subcutaneous tissue anteromdially, frequently sustain open comminuted fracture by trauma. The open fractures have higher risks of infection, nonunion, delayed union and joint stiffness. The authors reviewed 54 cases of open tibial fracture, treated at Kwang Ju Christian Hospital from January 1989 to December 1992. The results were as follows : 1. The most common cause of injury was traffic accident(41 case) and the average age of the patients was 32 years. 2. The radiographic union was obtained at 16.1 weeks in type I open fracture, 18.3 weeks in type III, 20.1 weeks in type IIIa,28.0 weeks in type IIIb, and 34.7 weeks in type IIIc open fracture. 3. The secondary operation was required frequently to obtain bone union in open type II, III fracture.

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Treatment of Intertrochanterie fracture of the Femur with Ender Nails in the Elderly Patients: Seong Taek Kim, Ki Soo Kim, Yeub Kim, Seung Hee Koh, Yong Soo Choi, Sang Tae Park; J Korean Soc Fract 1992;5(2):300-308. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.300

Abstract PDF: The incidence of intertrochanteric fracture of the femur in the elderly patient has been increased progresslvely due to the prolongation of Korean average life span and improvement of the medical survice. The mortality. however, in these elderly patients is relatively high. Rigid internal fixation of intertrochanteric fracture with early mobilization of the patient has in recent years reduced the mortality and morbidity. From September 1984 to August 1991, the authors had treated with Ender nails for 126 cases of intertrochanteric fracture. From 109 cases followed more than six months, the clincal results were as follows. 1. The average age was 74.8 years. 2. 73 cases (67%) were unstable fractures and 36 cases (33%) were stable fractures by Evans classification. The most common type was type 3 (35.8%) by the Tronzo classification, A2 type(55.1%) by the AO classification. 3. The main indication were stable fracture, unstable fracture over 70 years old, high anesthe tic resk, severe osteoporosis and wound at greater trochanter. 4. Intraoperatlve complications were experienced in 37 cases(33.9%). The improper entry hole site was most common. 5. Postoperative complications occured in 57 cases(52.3%) and more frequently in unstable fractures(57.5%). The most common complication was knee joint pain in 45 cases (41.3%) 6. Recently, patients who had Ender nails with Knowles pins showed good results in the presence of severe osteoporosis or unstable fracture.

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