Journal of Musculoskeletal Trauma

Risk Factors for Knee Stiffness in Distal Femoral Fractures: Dong Wook Son, Hyoung Soo Kim, Woo Young Choi; J Korean Fract Soc 2018;31(4):123-131. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.123

PURPOSE
The aims of this study were to evaluate risk factors for knee stiffness after the fixation of distal femoral fractures, and to analyze the clinical and radiologic outcomes.
MATERIALS AND METHODS
This is a retrospective case control study of 104 consecutive patients who have a distal femoral fracture and were treated with a submuscular locking plate. The case group comprised of patients with 12-month postoperative range of motion (ROM) â‰¤90Â° or a history of manipulation under anesthesia. The case group was compared with the control group of patients with a 12-month postoperative ROM >90Â°. The possible risk factors were evaluated by univariate and logistic regression analysis. The postoperative ROM and Knee Society clinical rating system was evaluated for the clinical assessment and the distal femoral angle on a whole-extremity scanogram was measured for radiologic assessments.
RESULTS
Fifty-four patients were included in the study (14 in the case group, 40 in the control group). Univariate analysis showed that comminuted fracture, intra-articular fracture, open fracture, temporary external fixation, severe osteoarthritis, and prolonged immobilization placed patients at an increased risk for knee stiffness. On the other hand, multivariate logistic regression showed that an extensor mechanism injury was the only significant predictor (p=0.001; odds ratio, 42.0; 95% confidence interval, 5.0â€“350.7). The ROM and Knee Society score were significantly lower in the case group; however, the coronal alignment was similar in the case and control group.
CONCLUSION
Various factors that delay postoperative knee motion place patients at increased risk of knee stiffness. Understanding these risk factors may help surgeons prevent postoperative knee stiffness after distal femoral fractures. In particular, extensor mechanism injury, such as patella fracture or open quadriceps injury, was found to be an independent predictable factor associated with knee stiffness.

Citations

Citations to this article as recorded by

A Comprehensive Approach to Stiffness in Total Knee Arthroplasty
Brian P. Chalmers, Linda I. Suleiman, Peter K. Sculco, Matthew P. Abdel
The Journal of Arthroplasty.2025;[Epub] CrossRef
Staged Management for Distal Femur Fractures: Impacts on Reoperation, Stiffness, and Overall Outcomes
Matthew T. Yeager, Robert W. Rutz, Alex Roszman, Gerald McGwin, James E. Darnley, Joseph P. Johnson, Clay A. Spitler
Journal of Orthopaedic Trauma.2024; 38(11): 577. CrossRef
Outcome of the Masquelet Technique for Complex Bilateral Distal Femoral Bone Defects
Ziad A Aljaafri, Abdullah Alzahrani, Ali Alshehri, Ahmed AlHussain, Faisal Alzahrani, Khalid Alsheikh
Cureus.2023;[Epub] CrossRef
Efficacy of non-operative treatment of patients with knee arthrofibrosis using high-intensity home mechanical therapy: a retrospective review of 11,000+ patients
Shaun K. Stinton, Samantha J. Beckley, Thomas P. Branch
Journal of Orthopaedic Surgery and Research.2022;[Epub] CrossRef
Distal Femoral Replacement and Extensor Mechanism Repair Reinforced With Synthetic Mesh for Distal Femur Fracture With Patellar Ligament Avulsion
Charles Powell, Kristopher Sanders, Neal Huang, Luis Felipe Colón, Colton Norton
Arthroplasty Today.2022; 16: 31. CrossRef
The fragility of statistical significance in distal femur fractures: systematic review of randomized controlled trials
Michael Megafu, Hassan Mian, Emmanuel Megafu, Sulabh Singhal, Alexander Lee, Richawna Cassie, Paul Tornetta, Robert Parisien
European Journal of Orthopaedic Surgery & Traumatology.2022; 33(6): 2411. CrossRef
Association Between Femoral “Spike” Size After Intramedullary Nailing and Subsequent Knee Motion Surgery
Michael G. Schloss, Nathan N. O'Hara, Syed M. R. Zaidi, Zachary D. Hannan, Dimitrius Marinos, Jared Atchison, Alexandra Mulliken, Jason W. Nascone, Robert V. O'Toole
Journal of Orthopaedic Trauma.2021; 35(2): 100. CrossRef
Distal Femur Replacement Versus Surgical Fixation for the Treatment of Geriatric Distal Femur Fractures: A Systematic Review
Brett P. Salazar, Aaron R. Babian, Malcolm R. DeBaun, Michael F. Githens, Gustavo A. Chavez, L. Henry Goodnough, Michael J. Gardner, Julius A. Bishop
Journal of Orthopaedic Trauma.2021; 35(1): 2. CrossRef

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The Usefulness of Poller Screw with Antegrade Nailing in the Initial Treatment of Infraisthmal Femur Shaft Fracture: Jeong Hyun Yoo, Hyoung Soo Kim, Chang Geun Kim, Ho Il Kwak, Sang Heon Song; J Korean Fract Soc 2015;28(4):230-236. Published online October 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.4.230

Abstract PDF: PURPOSE
The purpose of this study was to evaluate the radiologic and clinical outcomes after intramedullary nailing with Poller screw insertion at initial stage in infraisthmal femur shaft fractures.
MATERIALS AND METHODS
Seven consecutive patients (7 femurs) treated with antegrade intramedullary nailing with Poller screw insertion for the infraisthmal femur shaft fracture were reviewed retrospectively. There were 4 male and 3 female patients. Mean age was 46.1 years (20-72 years). Operative time including Poller screw insertion, time for union, malalignment, and range of motion were evaluated.
RESULTS
All 7 cases had primarily healed successfully. Mean time for radiologic union was 19.1 weeks (16-24 weeks) postoperatively. One case had 5 degree valgus malalignment. One case of 15 mm shortening was reported and he required shoe lift orthosis. All cases had a full range of motion in hip and knee joint.
CONCLUSION
Antegrade intramedullary nailing with Poller screw insertion is useful in the initial treatment of infraisthmal femur shaft fracture, because it could provide additional stability. An additional 20 minutes were required but a Poller screw should be considered according to the anatomic location of a femur shaft fracture.

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Combined Ipsilateral Fracture and Dislocation of Hip, Knee and Foot Joints: A Case Report: Hyoung Soo Kim, Ju Hak Kim, Sang Joon Park, Jae Won Hyung; J Korean Fract Soc 2012;25(1):73-76. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.73

Abstract PDF: Although clinical cases of ipsilateral knee and hip joint dislocation have been reported, there are no reports of simultaneous ipsilateral hip, knee, and foot dislocations. We report here a case of a patient who had ipsilateral hip, knee, and foot joint dislocations, and review the relevant literature.

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Avulsion Fracture of The Medial Meniscus: A Case Report: Hyoung Soo Kim, Seung Rim Park, Joon Soon Kang, Woo Hyeong Lee, Kil Seok Ko; J Korean Soc Fract 2000;13(1):109-112. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.109

Abstract PDF: Post-traumatic meniscal ossicle due to avulsion fracture of medial meniscus was very rare. They were often associated with meniscal tear, but caused symptoms without a tear, by mass effect from protruding meniscal contour. so it had to be differential diagnosised with free loose body in the knee joint. We experienced a symptomatic meniscal ossicle due to post-traumatic avulsion fracture of the posterior horn of medial meniscus, and managed with open reduction, internal fixation with screw and washer after arthroscopic examination. We report a rare case of meniscal ossicle in detail with literature

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Radiologic Follow-up Results of Distraction After Treatment of Distal Radius Fractures using External Fixator: Jong Oh Kim, Dong Wook Kim, Young Do Koh, Jae Doo Yoo, Kyoung Soo Kim; J Korean Soc Fract 1999;12(4):988-994. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.988

Abstract PDF: External fixation for severe fractures of the distal radius is accepted treatment offering the potential advantages of controlled distraction, accurate positioning of fracture fragments, and avoidance of extensive open procedures. One of the limitation of external fixation for distal radius fractures is excessive distraction, which affect the outcome. This study was conducted to evaluate the changes of the distraction of the intercarpal and radiocarpal joint, developed after treatment of distal radius fractures with external fixator. Restrospective study was done for 28 paitents, who were evaluated by chart review, questionnaire, radiograph, and physical examination. The carpal height ratio, radial inclination, velar tilt, radial length were measured in the postoperative and follow-up radiographs. The carpal height ratio was used to quantify the distraction. Functional evaluation was performed with Demerit-Point system described by Garthland and Werley. Five fractures had an excellent results, 16 had a good results, 4 had a fair results, and 3 had poor results. After union, average radial inclination was 21.3 degree, average dorsal angulation was -0.5 degree, and radial shortening was 1mm. Increased carpal height ratio of the 9 cases did not decrease to less than 0.56 at one year after operation. The over-distraction of intercarpal and radiocarpal joint developed after external fixation of the distal radius fracture, did not have decreased in the one year follow-up radiographs after operation. The over- distraction should be avoided intraoperativly.

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Assessments of Reduction for Supracondylar Humerus fractures in Children: Comparison of Clinical carrying angle, Baumanns angle and Metaphyseal-diaphyseal angle: Seung Rim Park, Hyoung Soo Kim, Joon Soon Kang, Woo Hyeong Lee, Seong Hwan Kim; J Korean Soc Fract 1999;12(3):660-666. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.660

Abstract PDF

PURPOSE
The object of this retrospective study is to verify Baumanns angle as assessment methods of reduction for supracondylar fracture of the humerus in children and to confirm what is the more accurate assessment methods of supracondylar fracture of the humerus between Baumanns and metaphyseal-diaplyseal angle.
MATERIALS AND METHODS
34 cases of more than 1 years follow up after closed reduction and pinning were reviewed. Simple linear regression has been used for statistical analysis and Pearsons correlation coefficient(rho) has been used for comparison of Baumanns angle and metaphy seal-diaphyseat angle.
RESULTS
The results form simple linear regression, about a 10 change in Baumanns angle contributes to a change in the carrying angle of approximately 3.7 on the uninjured(=-0.372, r=-0.750, P<0.001) and injured( =-0.365, r=-0.759, P<0.001) arms. In comparison of Baumanns angle and metaphyseal-diaphyseal angle to predict final carrying angle, the correlation coefficient between Baumanns angle and carrying angle(r=-0.759) was higher than that between metaphyseal-diaphyseal angle and carying angle(r=-0.495) with statistical significant using Fishers rho(P<0.05).
CONCLUSION
The Baumannss angle after reduction can be reliably used to predict accurately the final carrying angle and is more accurate than the metaphyseal-diaphyseal angle to predict the final carrying angle.

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Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture
Yoon Hae Kwak, Dong Jou Shin, Kun Bo Park
Journal of the Korean Fracture Society.2010; 23(1): 90. CrossRef

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Results and Problems of open Intramedullary Nailing of Femoral Shaft Fracture: Chung Nam Kang, Jong Oh Kim, Dong Wook Kim, Young Do Koh, Jae Doo You, Kyoung Soo Kim; J Korean Soc Fract 1999;12(1):28-34. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.28

Abstract PDF: The intramedullary nailing is one of the most available methods in treatment of femoral shaft fracture. The closed intramedullary nailing is known to be the best method of treatment of femur shaft fracture, but it is not always available in cases of deficit of equipment, severe associated injury, and some fracture pattern. The open intramedullary nailing has advantage of easily obtaining anatomical reduction but it increases the risk of infection, the incidence of delayed union and additional operations inevitably. We reviewed 33 cases of open intramedullary nailing in femur shaft fracture from September 1994 to September 1997. The results were as follows : 1. The average union time was 27.3 weeks. 2. Location of fractures was middle one-thirds in most cases, and Winquist-Hansen classification type II was the most common. 3. The complication included 8 delayed unions, 3 nonunions, 2 infections, shortening of more than two centimeters in 3 patients. 4. In 4 cases, we did open intramedullary nailing with bone graft initially, but all of them has complication as delayed union and nonunion. We can use open intramedullary nailing method in some femur shaft fractures, but there are many problems and complications. So we must consider it carefully before using this method.

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Treatments of Intraarticular Calcaneal Fracture: Based on CT Classification and Comparison of Treatments: Seung Rim Park, Hyoung Soo Kim, Joon Soon Kang, Woo Hyeong Lee, Ju Sik Park; J Korean Soc Fract 1999;12(1):103-112. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.103

Abstract PDF: The treatment modality of the displaced intraarticular calcaneal fractures is still controversial. The objectives of this study are to classify intraarticular fractures based on computed tomography and to compare the treatment results according to the classification and to consider the influence of Bohler angle to the prognosis of this injuries. From October 1989 to March 1997, 62 fractures(58 patients) who had been treated after calcaneal CT(computed tomography) were selected. The interval between the trauma and the last follw-up was mean 3.3 years(1.1-5.2 years). They had been treated with one of the three methods, that is, open reduction and internal fixation(OR/IF), Essex Lopresti or simple cast immobilization. The fracture was classified as type I(non-displced), type I(two part or split), type III(three part or split depression), type IV (four part or highly comminuted) based on CT according to Sanders et. al. The calcaneal scoring system proposed by Kerr et. al. was applied to the assessment of the treatment results, which may be more appropriate for non-parametric statistical test. The type I fractures had been treated only with cast immoobilization with or without manual reduction and all of the 4 cases(100%) have shown favorable(excellent or good) results. The OR/IF group(favorable results for 15 of 18 cases(83.3%) in type II and for 11 of 13(84.6%) in type III) have shown better results than those of other two group(P<0.05). The results between other two groups, that is, Essex-Lopresti operation group(favorable results for 4 of 8 cases(50%) in type II and for 1 of 3(33.3%) in type III)and cast immobization(2 of 5 cases(40%) in type II and for 0 of 2(O%) in type III) have made no significant differences(p>0.5). In type IV, there were no significant differences among the results of the three methods(p>0.1) and worse results than type II, III (p <0.05) probably due to difficulty in reduction of highly comminuted articular facets. The Bohler angle has given no significant influence to the final results(p>0.1). In conclusion, OR/IF has shown better results than closed modalities in the treatment of displaced intraarticular calcaneal fractures and may be the primary choice of treatment for these fractures. We have used Kruskal-Wallis H test and its approximation to chi-square distribution for comparison of three groups and Mann-Whitney U test and its approximation to normal distribution for two groups and have been aided by the computer program, SPSS in statistical calculations. The p-value was 0.05.

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The Treatment of Comminuted Fractures of Distal Humerus with Rigid Internal Fixation and Early Motion: Seung Rim Park, Hyoung Soo Kim, Joon Soon Kang, Woo Hyeong Lee, Joo Hyung Lee, Seung Jun Park; J Korean Soc Fract 1998;11(1):28-33. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.28

Abstract PDF

Comminuted fractures of distal humerus are difficult fracures to treat because of their rarity and associated significant comminution. The results of managing theses fractures non-operatively are limited by failure to get anantomical reduction and early mobilization, which often results in painful stiff elbow and/or pseudoarthrosis. The goals of open reduction are to preserve articular surface and restore elbow function. Hence an operative management with anatomical reduction of fragments becomes the treatment of choice for these fractures. Authors analyzed 17 patients, with 30 months follow-up on an average, who were treated with open reduction and rigid internal fixation followed early mobilization during the period from jan. 1991 to Dec. 1996. Following results were obtained. 1. According to the Muller's classification, type A was 4 cases(23.5%), type B was 4 (23.5%), and type C was 9(53%) 2. Excellent or good results were obtained in 12 cases(71%) by the criteria of Aitken and Rorabeck. 3. There were limitation of full extension over 5degreein all cases and no other severe complications causing disability of elbow.

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Treatment for the Supracondylar Fractures of the Distal Humerus with Cannulated Screw
Jin Soo Park, Young Khee Chung, Jung Han Yoo, Kyu Cheol Noh, Kook Jin Chung, Dong Nyoung Lee
Journal of the Korean Fracture Society.2007; 20(1): 58. CrossRef

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Surgical Treatment of Acromioclayicular Joint Dislocation with Coracoclavicular Ligament Reconstruction using Coracoacromial Ligament: Seung Rim Park, Hyoung Soo Kim, Joon Soon Kang, Woo Hyung Lee, Joo Hyung Lee, Min Seon Rim; J Korean Soc Fract 1997;10(4):949-955. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.949

Abstract PDF: Several treatment methods for complete acromioclavicular(AC) joint dislocation have been recommended. This study was performed to evaluate the results of the injuries that had been treated operatively with Bosworth technique combined with coracoclavicular ligament reconstruction using coiacoacromial ligament. Between September 1992 and October 1995, 19 cases were treated with this method. We made an assessment of the results suggested by Taft. Subjectively, fifteen patients had no pain or stiffness. 17 patients had normal strength and full range of motion objectively. On the roentgenographic bases, 16 cases showed normal findings and one showed the subluxation of the AC joint. The overall Taft score was 10.8 points and 84 % of the patients showed good or excellent results. The advantages of this method include anatomical reduction of the AC joint and early motion of shoulder. Ligament reconstruction enables early removal of the lag screw which precludes joint stiffness and metal problems. We conluded that this method was a good surgical method for complete AC joint dislocation.

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Arthroscopic Assisted Management For the Fracture Of the Tibial Intercondylar eminence Using Tension Band Technique: Seung Rim Park, Hyoung Soo Kim, Joon Soon Kang, Woo Hyung Lee, Sung Eyu Lee, Hyun Yang Chun; J Korean Soc Fract 1997;10(1):67-72. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.67

Abstract PDF: Avulsion fracture of the intercondylar eminence of the tibia(Type III as classified By Meyers and Mckeever) can be managed by arthroscopic reduction and fixation. Recently, the different arthroscopic suturing techniques, fixation with K-wire, screw and staple fixation have been employed to treat this injuries, however, most of these techniques are complicated and they do not always achieve stable fixation enough to facilitate early rehabilitation and restore stability to the knee through a full range of motion so far. A new technique for treatment of the tibial spine fracture arthroscopically, using the tension band method is presented. The advantage of this method include : 1. to be technically less demanding. 2. to allow for stable fixation even thin or comminuted fragments. 3. to present simple and safe removal of internal fixation. 4. to facilitate early rehabilitation.

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Overgrowth and Remodelling after Femoral Shaft Fractures in Children: Seung Rim Park, Hyoung Soo Kim, Joon Soon Kang, Woo Hyeong Lee, Hyun Yang Chun; J Korean Soc Fract 1997;10(1):226-232. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.226

Abstract PDF: Fifty-two femoral shaft fractures in children, treated conservatively, were studied clinically and radiographically to access the overgrowth and it is related factors. Among them, we reviewed fourteen children(16 cases), who had angular deformities over 10 after union for the spontaneous correction of the angular deformity. They had an average follow-up of 40.5 months and 32.4 months. The results were as follows : 1. The average of the overgrowth was 9.9mm. 2. The overgrowth was influenced by the age, but was not promoted by other factors. 3. The average overgrowth of the age group between 4 and 9 was 10.8 +/- 2.7mm. 4. The average correction was 78% of the initial angular deformity, 77% had occurred at the physes and 23% at the fracture site. 5. There was no close relation between the remodelling rate and degrees of initial deformity.

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Operative treatment of the Unstable Pelvic Bone Fracture: Byung Woo Min, Kwang Soon Song, Chul Hyung Kang, Young Soo Kim; J Korean Soc Fract 1996;9(3):518-524. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.518

Abstract PDF

Unstable pelvic bone fracture caused by high-energy trauma that can result in life-threatening situations in which intrapelvic hemorrhage and neurovascular injury. Long-term complications are frequently present, such as leg length discrepancy, gait disturbance and chronic low-back pain. Recently it is principle that it is mandatory to restore the anatomy of pelvic ring structure and to fixistably by means of internal fixation or extemal fixation for successful outcome after unstable pelvicring injury. 26 cases of unstable pelvic bone fracture were treated operatively at the authors hospital between 1992 and 1994. We analyse the clinical and the radiological result. The following results were obtained. 1. The incidence of the unstable pelvic bone fracture was 26 cases(18.4%) of all pelvic bone fractures(141 cases). 2. By the classification of modified Tile, type B1 were 8 cases, type B2(3 cases). type C1(7 cases) and type C3(8 cases). 3. Associated organ injury were found most commonly in the acetabular fracture(8 cases), and other extremity fracture(8 cases), genitourinary system(6 cases) and hemopenitoneum(4 cases). 4. The specific fracture pattern was classified according to various anatomical locations such as transsymphysis(7 cases), transpubic(7 cases), combination of the trassymphysis and traspubic(1 cases), trassacroiliac(7 cases), transiliac(9 cases), transsacral(1 case) and sacroiliac fracture dis location(1 case). 5. According to the fracture location, following methods of stabilization were applied. For the ante rior portion of pelvic ring, plates(13 cases), external fixators(3 cases) and wirings(3 cases) were used. For the posterior portion of pelvic ring, plates(9 cases), percutaneous iliosacral screws(3 cases) and lag screw(1 case) were used. 6. The results revealed as excellent in 20 cases, good in 5 case and fair in 1 case. 7. Postoperative complications were fixation failure(2 cases), metal failure(1 case) and nerve injury(1 case).

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Surgical Treatment of Malunion and Nonunion after Pelvic Bone Fracture
Byung-Woo Min, Kyung-Jae Lee
Journal of the Korean Fracture Society.2015; 28(4): 266. CrossRef
Clinical Results of Surgical Treatment of Acetabular Fractures according to Quality of Reduction
Sang-Hong Lee, Min-Kyu Shin, Sueng-Hwan Jo
The Journal of the Korean Orthopaedic Association.2007; 42(2): 153. CrossRef

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