Journal of Musculoskeletal Trauma

Treatment for Bone Defect of Open Tibial Fractures by Using Intramedullary Nail Fixation with Autogenous Iliac Bone Graft: Hyub Sakong, Ki Cheor Bae, Chul Hyun Cho, Kyung Jae Lee, Eun Seok Son, Du Han Kim; J Korean Fract Soc 2012;25(4):288-294. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.288

Abstract PDF: PURPOSE
This study was conducted to evaluate the results of intramedullary nail fixation with autogenous iliac bone graft for defects of bone after tibial fractures.
MATERIALS AND METHODS
Ten patients with bone defects in tibial fractures who had been treated with intramedullary nail fixation with autogenous iliac bone graft between May 2005 and September 2008 with more than 12 month follow-up were subject to study. Of the 10 patients, 8 were male and 2 were female, and the mean age was 50.2 years (29~76 years). By cause of accident, motor vehicle accidents caused 9 cases, a crush caused 1 case, and the average follow-up period was 21.9 months (12~42 months). Radiologically, we analyzed the union of the bone defect on simple x-ray and clinical evaluation was performed using the estimate method of Mekhali.
RESULTS
This study reveals that there was radiological union in all 10 cases and the mean time to union was 8.4 months (5~18 months). By clinical evaluation according to Mekhali's estimate method, 9 patients had excellent outcomes and 1 patient had limitation of motion in the ankle joint rated as a fair clinical result. None of patients developed complications post-operatively.
CONCLUSION
Our study demonstrated that the intramedullary nail fixation with autogenous iliac bone graft can be a useful operative method because it can remove external fixators early and reduce complications, and autogenous bones have exceptional osteoconduction, osteoinduction, and bone-forming ability resulting in excellent union of bones.

120 View
1 Download

Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect: Soo Kyung Lee, Jung Ryul Kim, Jong Han Lim, Jun Mo Lee; J Korean Fract Soc 2010;23(1):57-63. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.57

Abstract PDF: PURPOSE
To study clinical results and complications in the treatment of infected nonunion of the tibia according to location of nonunion and reconstruction for soft tissue defect.
MATERIALS AND METHODS
36 cases of tibia infected nonunion which were treated with the llizarov included in this study. There were proximal 1/3 in 14, middle 1/3 in 10, and distal 1/3 in 11 cases. Coverage of the soft tissue were treated with the free flap in 8 cases as classified group A and non-free flap in 17 cases classified group B. We evaluated the healing index, complications and comparing the results of each treatment by the Paley method.
RESULTS
Bone union was achieved in all cases. The proximal nonunion showed better results than those in the middle and distal area; average healing index: 35.6 days/cm (p=0.038), bone results: 92.9% (p=0.025), functional result: 90.5% (p=0.03). Group B showed significantly better results as it showed average healing index: 30.3 days/cm (p=0.015), bone results: 85.7% (p=0.025), functional results: 90.5% (p=0.015).
CONCLUSION
The nonunion of proximal 1/3 showed better results than other sites. Soft tissue reconstruction with free flap that control infection more effectively, could be improved the treatment outcomes.

88 View
0 Download

Bone Transport Over the Intramedullary Nail for Defects of Long Bone: Jae Young Roh, Chang Wug Oh, Jong Keon Oh, Hee Soo Kyung, Byung Chul Park, Woo Kie Min, Joon Woo Kim, Chang Hyun Cho; J Korean Fract Soc 2008;21(1):37-44. Published online January 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.1.37

PURPOSE
To evaluate the results of bone transport using external fixator over an intramedullary nail for defects of long bone.
MATERIALS AND METHODS
We treated 14 cases of bone defect after chronic osteomyelitis or trauma of tibia (12 cases) and femur (2 cases) using this method. The mean age of index procedure was 46.9 years, and all of them had follow-up study for a mean of 3 years. After the corticotomy and insertion of intramedullary nail, bone transport was done by external fixators. Then, the segment was moved and bone graft was done at docking site.
RESULTS
The mean transported amount was 5.8 cm, and the external fixator was removed after 141 days. The mean external fixation index was 25.6 days/cm. Primary union of distraction and docking site was achieved in all, but one had failure in union of docking site. According to the Mekhail's functional criteria, there were 5 excellent, 6 good, and 3 fair results. Among 15 complications, there were 2 major complications with residual sequelae, and they were 1 recurred osteomyelitis and 1 flexion contracture of knee.
CONCLUSION
Bone transport using external fixator over an intramedullary nail, can successfully solve defects of long bone. Since this method can remove external fixators earlier than the conventional method, it has fewer complications and makes patients to return to daily life earlier.

Citations

Citations to this article as recorded by

Treatment for Bone Defect of Open Tibial Fractures by Using Intramedullary Nail Fixation with Autogenous Iliac Bone Graft
Hyub Sakong, Ki Cheor Bae, Chul Hyun Cho, Kyung Jae Lee, Eun Seok Son, Du Han Kim
Journal of the Korean Fracture Society.2012; 25(4): 288. CrossRef

194 View
3 Download
1 Crossref

Internal Bone Transport in the Management of Tibial Bone Defects: Chang Wug Oh, Woo Kie Min, Hee Soo Kyung, Il Hyung Park, In Ho Jeon, Byung Chul Park, Poong Taek Kim, Young Heon Sohn; J Korean Fract Soc 2005;18(1):36-42. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.36

Abstract PDF

PURPOSE
To retrospectively review the results of internal bone transport in the management of tibial bone defect using ilizarov fixator.
MATERIALS AND METHODS
We treated 39 cases of tibial bone defect (16 of traumatic bone loss, 23 after treatment of osteomyelitis). The mean age of index procedure was 33.8 years (range, 13~66 years), and all of them had follow-up study for a mean of 3.5 years (range, 1.6~8 years). The mean transported amount was 6.3 cm (range, 2.7~20 cm), and the external fixator was removed after 345 days (range, 120~700 days). The mean external fixation index was 60.3 days/cm (range, 13.1~121.3 days/cm).
RESULTS
Primary union of distraction and docking site was achieved in all, but two patients had failure in union of docking site. Functional results showed 6 excellent, 19 good, 10 fair, and 4 fair. The patients under age 20 showed better functional outcomes than the others. Among 73 complications (incidence, 1.87 cases/ patient), 27 of major complications with residual sequelae occurred in 20 patients. The residual sequelae were more common in the patients who had the concomitant injuries in the same leg.
CONCLUSION
Internal bone transport can solve the large amount of tibial bone defect. However, the complications are not uncommon, which might be related to the concomitant injures in the same leg.

Citations

Citations to this article as recorded by

Bone Transport Over the Intramedullary Nail for Defects of Long Bone
Jae-Young Roh, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Byung-Chul Park, Woo-Kie Min, Joon-Woo Kim, Chang-Hyun Cho
Journal of the Korean Fracture Society.2008; 21(1): 37. CrossRef
Minimally Invasive Plate Osteosynthesis to Prevent or Treat the Deformity after Distraction Osteogenesis
Chang-Wug Oh, Byung-Chul Park, Il-Hyung Park, Hee-Soo Kyung, Woo-Kie Min, Seung-Hoon Baek, Seung-Kil Baek
The Journal of the Korean Orthopaedic Association.2007; 42(6): 764. CrossRef

121 View
0 Download
2 Crossref

Effect of Growth Hormone on Osteoblast and New Bone Formation: Hae Ryong Song, Young Jin Kang, Ki Churl Chang, Seong Chang Yeon, Ja Min Koo, Hyeon Hui Kim; J Korean Soc Fract 2003;16(3):423-431. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.423

Abstract PDF: PURPOSE
To evaluate effect of growth hormone on osteoblast and new bone formation.
MATERIALS AND METHODS
Bone defect of the tibia with preserved periosteum was made and fixed with external fixator. Intramuscular injection of growth hormone for 8 weeks in experimental group and saline in control group was performed. New bone formation at the bone defect in radiograph and bone mineral density (BMD) by quantitative computed tomography were evaluated at 8 weeks after surgery. Rat osteosarcom cells were cultured in both group to evaluate cell viability of osteoblast, alkaline phosphatase activity, and mRNA expression of osteocalcin by RT-PCR.
RESULTS
Experimental group showed more callus formation and higher BMD at the bone defect site and the distal tibia compared to control group and there was significant difference. Proliferation of osteoblast, alkaline phosphatase activity, mRNA of osteocalcin at 5 days after culture were significantly higher in experimental group than those in control group.
CONCLUSIONS
Growth hormone has positive effect on osteoblast and callus formation in vivo and vitro studies.

85 View
0 Download

The Effect of Platelet-Rich Plasma (PRP) on the Healing of Allograft for the Treatment of Segmental Bone Defect of the Ulna in Rabbits: Joo Hyun Song, Jinyoung Jeong, Yong Koo Kang, Han Yong Lee, Mun Ik Son, Sang Il Seo; J Korean Soc Fract 2003;16(3):416-422. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.416

Abstract PDF

PURPOSE
The purpose of this study was to evaluate the effect of Platelet-Rich Plasma (PRP) on the healing of the allograft for the treatment of the segmental bone defect of the ulna in Rabbits.
MATERIALS AND METHODS
About 2 cm-sized segmental bone defects were created on both ulna of twenty rabbits. The rabbits were divided into two groups, even and odd number group after numbering them from 1 to 20. The segmental bone from the odd numbered animal was transplanted to the even numbered animal, and the even numbered to the odd numbered. The left side of the ulna of the animal is grafted with a segmental allograft only. The right side of the ulna was grafted with a segmental allograft and 0.7 cc of PRP. Radiographs obtained at 0, 4, 8, and 12 weeks postoperatively were graded for radiologic union.
RESULTS
The use of the combination of PRP and segmental allograft demonstrated improved healing on radiolographic study compared with that demonstrated after use of allogrft alone.
CONCLUSION
The results of the study suggests that the use of the combination of PRP and segmental allograft can be considered as an alternative method to manage the segmental defect of the long bone.

Citations

Citations to this article as recorded by

Effect of Different Bone Substitutes on the Concentration of Growth Factors in Platelet-rich Plasma
Hee Soon Cho, So-Young Park, Sukyoung Kim, Sang Keun Bae, Duk Seop Shin, Myun-Whan Ahn
Journal of Biomaterials Applications.2008; 22(6): 545. CrossRef

130 View
0 Download
1 Crossref

Treatment of Large Bone Defect of Femorl Shaft with Vascularized Fibular Graft and Ender Nail: A Case Report: Song Lee, Dong Ki Ahn, Sung Wook Chun, Sun Young Chung, Hyun Soo Kim; J Korean Soc Fract 2003;16(3):340-347. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.340

Abstract PDF: Vascularized fibular graft is one of the well accepted methods in the treatment of large bone defect of femoral shaft. But bone fixation with Ender nails through the same incision of bone graft has never been reported. We performed vascularized fibular graft and bone fixation with Ender nails through single medial skin incision and permitted physiologic stress. We achieved early radiologic union and medullary widening and the patient could return to work 9 months after the accident. We would like to report such an experience of treatment with the reference of literature.

93 View
0 Download

The Effect of Safflower Seed or Matairesinol on Spontaneous Bone Formation in Surgically Induced Bone Defect in Young Rabbit: Hae Ryong Song, Do Kyung Ra, Gon Sup Kim, Ki Churl Chang, Jae Min Hwang, Seong Chan Yeon, Hyung Bin Park, Sang Won Choi; J Korean Soc Fract 2002;15(2):97-105. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.97

Abstract PDF: PURPOSE
To investigate the effect of defatted safflower seed or matairesinol on spontaneous bone formation in surgically induced bone defects in young rabbits MATERIALS AND METHODS: Bone defects(20% of original femoral length) were created at the midshaft of the femur in 52 young rabbits and stabilized with external fixation. The periosteum was preserved. Fifty-two rabbits were divided into four groups as follows; the group I fed on safflower seed powders(30%) and normal diet(70%), the group II on matairesinol (5%) and normal diet(95%), the group III on normal diet(100%) with intravenous injection of matairesinol, the group IV on normal diet(100%). Radiographs were taken weekly to evaluate the bone regeneration and union time. Biomechanical testing on the new bone formation area was performed to measure bending stiffness. The area of new bone formation was scanned by quantitative computed tomography to measure bone mineral density(BMD).
RESULT
The mean union time(weeks) was 7.2 in the group I, 8.6 in the group II, 8.8 in the group III, and 8.5 in the group IV and was significantly different between the group I and the other groups(p<0.05). The BMD and bone strength of the callus were compared between the group I and the group IV. The mean BMD was 310.45 +/-49.58 g/mm2 in the group I and 291.16 +/-55.79 g/mm2 in the group and there was significant difference(p<0.05). The mean bending stiffness was 415.33 +/-137.18 N/mm in the group I and 358.75 +/-107.32 N/mm in the group IV and there was significant difference(p<0.05).
CONCLUSION
The diet with safflower seed powder was effective for decreasing union time and increasing bone strength of the callus formed at the bone defect whereas the diet or injection with matairesinol was not effective. More experimental studies are necessary to prove the effect of matairesinol on the callus.

132 View
0 Download

Ilizarov Treatment of Nonunions with Bone Defect in the Tibia: Soo Bong Hahn, Hong Jun Park, Kee Hong Song; J Korean Soc Fract 2000;13(1):13-19. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.13

Abstract PDF: PURPOSE
To analyze the clinical results and complications of internal transport by Ilizarov for defect nonunion of tibia MATERIALS AND METHODS: We performed a retrospective review of 24 patients undertaken internal transport by Ilizarov for defect nonunion of tibia from January 1991 to December 1997. There were 21 males and 3 females with a mean age of 33.4 years(range, 17-64 years). On average, the size of bone defect measured 7.9 cm(range, 2-17 cm). Bone defects were gradually closed by progressive internal transport. After internal transport, bone grafts on 14 docking sites were performed because of delayed union. Soft tissue defects were treated with secondary closures(6 cases), skin grafts(4 cases), and flaps(4 cases).
RESULTS
According to Paley and Catagni's classification, bone results were excellent in 19 cases, good in 4 cases, and poor in 1 case. Functional results were excellent in 2 cases, good in 21 cases, and poor in 1 case. According to Paley's classification, the complications were developed as follows; Problems were pin site infections(12 cases), joint contractures(9 cases), and distraction gap delayed consolidations(3 cases). Obstacle was absent. Complication was refracture(1 case). The average distraction consolidation index was 39.4 days/cm. The average percentage transport was 139.7 %.
CONCLUSION
The application of Ilizarov to defect nonunion of the tibia is effective, but correct technique and careful follow-up is required.

100 View
0 Download

Ilizarov Method for Treatment of Tibia Nonunion Associated with Bone Defects: Sung Taek Jung, Keun Bae Lee, Eun Kyoo Song, Sung Nam Jung; J Korean Soc Fract 1999;12(4):932-939. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.932

Abstract PDF: PURPOSE
: This study was to evaluate the results and complications in gap nonunions of the tibia treated by Ilizarov method MATERIALS and METHODS : We reviewed 30 patients of tibial nonunions(23 atrophic, 7 hypertrophic) with bone loss(1-l3cm, mean 4.6cm) who were treated by Ilizarov technique. The causes of bone defect were open fracture with bone loss(15 cases) and infected nonunions(15 cases). Bone defects were closed by Ilizarov bone transport technique.
RESULTS
All patients had satisfactory union. The mean distraction-consolidation index (distraction-consolidation time/ distraction gap) was 1.3 months/cm. The younger patients and metaphyseal lengthening healed faster than the older patients and diaphyseal lengthening. Even though, we met with the numerous complicationt such as pain around the pin site, pin site infection and delayed union, we could successfully treat most of them.
CONCLUSION
: The application of Ilizarov techniques to nonunions of the tibia with bone defect was very effective, but correct technique and careful follow-up examination was required to avoid complications.

39 View
0 Download

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

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

74 View
0 Download

Treatment of Infected Nonunion with Bone Defect with Ilizarov Lenthening apparatus: Joo Chul Ihn, Byung Chul Park, Il Hyung Park, Hee Soo Kyung, Chang Wug Oh, Jin Hum Cho; J Korean Soc Fract 1998;11(1):91-99. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.91

Abstract PDF: From June 1993 to May 1997, 12 patients aged from 13 to 41 years were treated for infected nonunion with bone defect by the Ilizarov technique. Of 12 cases, 9 cases were tibia and 3 cases were femur. The cuases of nonunion were open comminuted fractures with initial bone loss and bone defect after removal of sequestrum. Infection was managed by radical resection of the infected necrotic bone and insertion of antibiotics mixed cement beads. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length inequality was achieved by means of external lenghthening technique. Corticotomies were performed at the proximal level(7), at the distal level(5). The average optained length averaged 4.8cm in length and healing index averaged 67.4days/cm According to paley and Catagni's callification bony and functional results were either excellent or good execpt I case (nonunion, poor bony result). The complications (devided by paley to 3 categories: problems, obstacles, complications) were pin tract infecton(8), pain(5), mild flexion contracture of joint(1), delayed consolidation(3), soft tissue impingement(2), joint stiffness(3) and nonunion(1). We concluded that Ilizarov techinque was very effective for treatment of infected nonunion with bone defect and soft tissue defect.

93 View
0 Download

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

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

70 View
0 Download

Treatment of Bone Loss by Local Bone Transportation: A report 3 eases: Sung Joon Kim, Kuhn Sung Whang, Hyun Kee Chung, Ye So Park; J Korean Soc Fract 1992;5(2):410-416. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.410

Abstract PDF: We experienced the local bone transportation in 3 cases. with a dynamic axial fixator, which had been effected the large bone defects because of the loss of the bony segment or infected non-union. The 2 patients showed the large femoral bone defect after motorcycle accident and the other patient. The tibial infected nonunion with large bone defect. The two femoral bone defects were treated by callotasis, and the tibial bone defect by chondrodiatasis. The size of bony defects were 12.Ocm and 6.5cm and the amount of bony transportation were 10.Ocm, 9.4cm and 5.9cm in orthoroentgenogram. These local bone transportations induced excellent osteogenesls and it filled up the defects We suggest that local bone transportation might be one of the best ways for the treatment of the large bone defects.

81 View
0 Download

Treatment of the defect nonunion of the tibia by Ilizarov internal transfer technique report of one case: Kyu Hyun Yang, Jun Seop Jahng, Hui Wan Park, Jin Woo Lee; J Korean Soc Fract 1991;4(1):106-111. Published online May 31, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.1.106

Abstract PDF: No abstract available.

121 View
0 Download

Search