Journal of Musculoskeletal Trauma

Two-Year Follow-Up Results after Tendon Graft and Corrective Osteotomy for the Delayed Rupture of the 2nd-5th Flexor Tendons due to a Malunion of a Distal Radius Fracture - A Case Report -: Jeung-Hwan Seo, Hyun-Gon Gwak, Jae Hoon Lee; J Korean Fract Soc 2022;35(2):63-67. Published online April 30, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.2.63

Abstract PDF: The delayed rupture of the flexor tendons is a rare complication of malunited distal radius fractures after nonoperative management. The known cause of a flexor tendon rupture is attrition between the palmarly displaced ulnar head and the involved tendons. Sharp bony spurs on the volar side of the malunited distal radius can also cause flexor tendon rupture. About 30 cases have been reported in literature. There were only four case reports about the delayed rupture of the 2nd, 3rd, 4th, and 5th flexor tendons. In this case, we experienced flexor digitorum superficialis and flexor digitorum profundus tendon ruptures of the index, middle, ring, and little fingers, after 8 months following the malunion of a distal radius fracture. At two years follow-up after tendon graft and corrective osteotomy, the range of motion and motor weakness of the 2nd, 3rd, 4th, and 5th fingers improved.

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Early Corrective Osteoclasis for Malunited Pediatric Medial Condylar Fracture of the Humerus: Hong Jun Jung, Ho Youn Park, Yuna Kim; J Korean Fract Soc 2022;35(1):21-25. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.21

Abstract PDF: Fractures of the medial condyle of the distal humerus in children are very rare, and the younger the age, the more difficult it is to diagnose. These fractures include an intra-articular fracture and a Salter–Harris type IV growth plate fracture. Therefore, the prognosis is poor if the fracture is neglected or misdiag-nosed because of the high incidence of complications such as nonunion, angular deformity, or joint contracture. This paper reports a case of a four-year-old child who presented with a malunion of the medial condyle of the humerus with good results after an early corrective osteoclasis.

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A Correction of Malunion or Deformity in the Lower Extremity: Kyeong Hyeon Park, Joon Woo Kim, Chang Wug Oh; J Korean Fract Soc 2017;30(4):219-227. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.219

Abstract PDF: The incidence of malunion in the long bone with has been reduced because of the advancements in surgical technique. However, nonunion or malunion are still observed in mechanical axis deformation of the lower limb, resulting in the overload of cartilage and instability of the joint, requiring surgical correction. Preoperative planning for malunion is very important, and accurate evaluation of the deformity is essential. Herein, we describe the indications of corrective osteotomy, choice of patients, and various surgical methods for the treatment of malunion of the long bone.

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Malunion: Deformity Correction of the Upper Extremity: Soo Min Cha, Hyun Dae Shin; J Korean Fract Soc 2017;30(4):209-218. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.209

Abstract PDF: Malunions after fractures are classified as shortened, angulated, torsion, or rotational deformities that is outside the acceptable range, regardless of the location, whether upper or lower extremity. The distinct feature of a malunion in the upper extremity is that it is free from weight bearing; thus, some degree of shortening is allowed compared with the contralateral normal side in long bones, such as the humerus, radius, or ulna. However, malunions associated with functional impairment, especially angulated or rotational deformities, are more likely to develop instability, degenerative lesions, or rarely, compressive neuropathy. Hence, malunions with such association may occasionally require correction.

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Functional Recovery of the Shoulder after Correcting Malrotation of the Distal Humerus: A Case Report: Hyunseong Yoo, Jaehui Han, Youngsoo Byun, Daegeun Jeong, Dongju Shin; J Korean Fract Soc 2016;29(1):73-78. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.73

Abstract PDF: Although studies on malrotation of the humerus possibly leading to dysfunction of the shoulder have been reported, studies on its causes are inadequate. The authors encountered a patient complaining of malrotation accompanied by dysfunction of the shoulder which occurred during treatment of a distal humeral fracture. The patient recovered the shoulder function by only correcting malrotation of the humerus without direct treatment on the shoulder, and we report it herein with a review of the literature.

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Surgical Treatment of Malunion and Nonunion after Pelvic Bone Fracture: Byung Woo Min, Kyung Jae Lee; J Korean Fract Soc 2015;28(4):266-272. Published online October 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.4.266

Abstract PDF: Regardless of the efforts of several treatments after pelvic bone fracture, as many as 5% of all pelvic fractures result in malunion or nonunion of the pelvis. These complications can cause disabling symptoms, including pain, instability, and gait disturbance, which can decrease life quality of patients and increase socioeconomic problems. Therefore concerns regarding the treatment of malunion and nonunion after pelvic bone fracture are increasing. We report our experience and surgical management for pelvic malunion and nonunion.

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The Clinical Results of Opening Wedge Osteotomy in the Volarly Malunited Distal Radius: Seoung Joon Lee, Jin Ho Choi; J Korean Fract Soc 2014;27(1):29-35. Published online January 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.1.29

Abstract PDF: PURPOSE
To report the clinical results of opening wedge osteotomy graft in the volarly malunited distal radius.
MATERIALS AND METHODS
Ten patients with volarly malunited distal radius fractures treated by opening wedge osteotomy were included in this study. Grip power, range of motion of the wrist, radiographic parameter and Mayo wrist scores were retrospectively evaluated.
RESULTS
At the final follow-up, the rotation of the forearm, the range of motion of wrist, and the grip power were improved. The average radial inclination improved to 22.2degrees, the average volar tilting improved to 5.6degrees, and the average ulnar variance improved to 0.8 mm. The average Mayo wrist score was improved to 85.6.
CONCLUSION
Opening wedge osteotomy for volarly malunited distal radius was considered as one of the good treatments to restore anatomy of the distal radius and distal radioulnar joint and also to improve the function of the wrist joint.

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Bilateral Malunion and Distal Radioulnar Joint Dislocation after Operative Treatment of Bilateral Galeazzi Fractures in Child: A Case Report: Sang Jin Cheon, Dong Joon Kang, Nam Hoon Moon, Seung Han Cha, He Myung Cho; J Korean Fract Soc 2009;22(4):292-296. Published online October 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.4.292

Abstract PDF: Galeazzi fractures in child is rare and seldom necessary of operative treatment because the result of conservative treatment is good. We present the patient who was a 11-year-old male and fell onto his both hands during a hundred-meter dash. His diagnosis was bilateral Galeazzi fractures and limited open reduction and internal fixation with Kirschner pins was initial treatment at local hospital. After 4 weeks postoperatively, Kirschner pins were removed and rehabilitating exercise was started. After 4 months postoperatively, he was transferred to our hospital due to malunion with severe angular deformities and distal radioulnar joint (DRUJ) dislocation. He was treated with corrective osteotomy. Thus, as in this case, we suggest more careful treatment and observation if conservative method of Galeazzi fracture in child is chosen and consider operative method as treatment according to age and pattern of fracture.

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Malunion of the Odontoid Process Developing Cervical Myelopathy: A Case Report: Teak Soo Jeon, Sang Bum Kim, Whan Yong Chung, Woo Sik Kim, Sung Hun Kim, Tae Kyun Kim; J Korean Fract Soc 2006;19(3):378-380. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.378

Abstract

Late-onset progressive myelopathy, years after odontoid fracture, is considered a rarity. Undiagnosed or untreated odontoid fractures may develop into nonunion or malunion, thereby leading to secondary delayed cervical myelopathy. We present a case of a 50-year-old man with malunion of odontoid fracture. We had a good result following one-staged posterior decompression and occipito-cervical fusion.

Citations

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Surgical Management of Type II Odontoid Fractures in a Resource-Limited Setting: A Case Series
Ntsambi Glennie, Israël A Maoneo, Kisubi Michel, Chérubin Tshiunza, Antoine Beltchika
Cureus.2024;[Epub] CrossRef

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Attritional Flexor Tendon Ruptures after Malunited Distal Radial Fracture: A Case Report: Jin Ho Cho, Hyoung Keun Oh; J Korean Fract Soc 2006;19(1):93-95. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.93

Abstract: Ruptures of extensor pollicis longus tendon after distal radial fractures are well-known. However, delayed flexor tendon rupture of finger as a complication of the fracture are less common. We report the case of delayed rupture of flexor digitorum profundus tendon to middle and ring fingers and flexor digitorum superficialis to ring finger in 72 year old female patient. She was treated by free tendon graft with palmaris longus tendon. After 1 year follow-up, range of motion and flexion power were recovered to nearly normal.

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Subtalar Distraction Arthrodesis for Calcaneal Malunion: Hyung Jin Chung, Jae Kwang Yum, Kook Jin Chung, Jae Min Jeon; J Korean Fract Soc 2006;19(1):34-40. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.34

Abstract

PURPOSE
To evaluate the results and efficacy of the subtalar distraction arthrodesis on patients with complications due to malunion after intra-articular calcaneal fracture.
MATERIALS AND METHODS
From October 2001 to September 2004, we operated on 10 patients (14 cases). There were 9 male patients and one female; their mean age was 41 years old. Ten cases among them were operated initially. The mean period between initial injury and arthrodesis was 18 months. The mean follow up period was 16 months. During the operation, we used extensile lateral approach and arthrodesis was performed using tricortical bone block and cannulated screws. The ankle-hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT of the both feet were examined for union and various parameters.
RESULTS
Thriteen cases achieved radiologic bone union. The mean ankle-hindfoot scale (maximum: 94 points) increased from 52.4 points preoperatively to points 77.2 at the final follow-up. The radiologic analysis of the pre and postoperative standing lateral radiograph showed mean increase of 6.9 mm in talo-calcaneal height, 5.2 degrees in talocalcaneal angle, 4.3 degrees in talar declination angle and average decrease of 4.5 degrees in talo-first metatarsal angle.
CONCLUSION
The short term result of the subtalar distraction arthrodesis using tricortical bone block was promising, but longer follow-up will be needed.

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Mid-Term Follow Up Results of Subtalar Distraction Arthrodesis Using a Double Bone-Block for Calcaneal Malunion
Hyung-Jin Chung, Su-Young Bae, Ji-Woong Choo
Yonsei Medical Journal.2014; 55(4): 1087. CrossRef

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A Slipped Capital Femoral Epiphysis following Ipsilateral Femoral Subtrochanteric fracture: A Case Report: In Young OK, Yang Soo Kim, Yong jin Kwon; J Korean Soc Fract 2002;15(4):526-530. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.526

Abstract PDF

It was known that the etiologies of slipped capital femoral epiphysis(SCFE) were trauma, hormonal or endocrine disorder, genetic factor, radiation, renal osteodystrophy which render the epiphyseal plate susceptible to displacement. We report the case of a 6 year old boy who had SCFE following malunion of the ipsilateral subtrochanteric fracture. The alteration of shear force on epiphyseal plate can be one of the contributing factors in SCFE.

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Delayed slipped capital femoral epiphysis after orif for subtrochanteric femur fracture
Zied Mansi, Mohsen Chamakh, Ltifi Atef, Wajdi Chermiti, Haggui Ali, Gazzah Wael
International Journal of Surgery Case Reports.2024; 118: 109593. CrossRef
Slipped capital femoral epiphysis following a delbet type 3 intertrochanteric fracture fixation
Babak Mirzashahi, Mohammad Moshirfar, Alireza Moharrami
Archives of Trauma Research.2022; 11(2): 97. CrossRef

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Unreamed interlocking nailing in tibia fracture: You Sung Suh, Young Il Cho, Ho Won Jung, Yeon Il Kim; J Korean Soc Fract 2002;15(4):470-476. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.470

Abstract PDF: PURPOSE
To evaluate of clinical results and malunion according to nail insertion site and early ambulation after unreamed interlocking intramedullary nailing for the treatment of tibial fractures, MATERIALS AND METHODS: We reviewed 46 tibial fractures that were treated with unreamed static intramedullary nailing prospectively from March 1997 to May 2001. Nail insertion site and angulation of fracture site were reviewed by radiograph. All of 46 cases, ambulation was started at postoperative 2 weeks, and then clinical outcomes were reveiwed RESULTS: In all 46 cases, union was achieved at average 18.2 weeks clinically and average 19.4 weeks radiographically. There is no significant difference in angulation according to nail insertion site, i,.e. after central/medial/lateral insertion, outcome was 2 . 4 5 degrees +/-2 . 1 7 / 2 . 2 2 degrees +/-1 . 8 4 / 1 . 7 3 degrees +/-1.33(p; 0.705) in last follow up anterioposterior view, and 1.81 degrees +/-1 . 1 3 / 2 . 6 7 degrees +/-1 . 6 2 / 2 . 0 0 degrees +/-1.64(p; 0.320) in last follow up lateral view. No breakage of intramedullary nails and no stiffness on adjacent joints.
CONCLUSION
We confirmed that unreamed interlocking nailing in tibial fractures is one of the effective method for low recurrence of malunion and early ambulation

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Treatments of the Malunited Tibial Shaft Fracture: Taik Seon Kim, Jae Ik Shim, Sung Jong Lee, Suk Ha Lee, Yeon Sik Yu, Young Bae Kim, Kwang Yeol Park; J Korean Soc Fract 2000;13(4):897-904. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.897

Abstract PDF: PURPOSE
The malunited diaphyseal tibia fractures result in tibial shortening, angular deformities, gait disturbance, development of joint pain, etc. The authors analyzed the results of treatment consist of corrective osteotomy for diaphyseal malunion with internal or external fixation.
MATERIALS AND METHODS
The authors reviewed 18 cases of tibial diaphyseal malunion treated in Korea Veterans Hospital between January 1992 and December 1998. Mean follow-up period was 4.2 years. The preoperative deformities were varus, anterior or posterior bowing and shortening. The preoperative symptoms were knee joint pain, ankle joint pain, and gait disturbance. Corrective osteotomy was done on the site of malunion in all cases. Fixation were done with IM nailings(13 cases), plates(3 cases) and Ilizarov external fixator. We analyzed the unions radiologically and the knee pains with HSS score.
RESULTS
All malunions were successfully corrected. Mean duration of union was 4.5 month. In the coronal plane, preoperative varus deformity(mean 16.5degrees varus) was corrected to 3degrees of valgus. In the saggital plane, anterior and posterior bowing was corrected to neutral. In 15 cases of the patient with knee joint pain, the mean HSS score was improved from 69 preopertively to 82 postoperatively.
CONCLUSION
The correction of tibia diaphyseal malunion had good results by osteotomy at the malunited site and firm internal or external fixation. And it also improved knee joint pain significantly.

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Attritional Rupture of the Flexor Tendons after Malunion of Distal Radial Fracture : Report of One Case: Jae Do Kang, Kwang Yul Kim, Sang Hun Ko, Hyung Chun Kim, Kyeong Chil Jung, Moon Sub Yim; J Korean Soc Fract 1997;10(4):929-933. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.929

Abstract PDF: There are a few of reports of delayed rupture of flexor tendon around the wrist and hand by attrition. Only 4 cases of delayed flexor tendon rupture of finger except rupture of flexor pollicis longus after Cellos fracture were reported until now. Several causes of the delayed rupture of the tendon around the wrist and hand were reported by many authors. Cellos fracture is one of the cause of the attritional rupture. But the frequency of the attritonal rupture of the flexor tendon was only one-third of the extensor tendons. Furthermore, flexor tendons of the finger were less commonly affected than that of the thumb by their anatomical features. We would like to report a very rare case of delayed rupture of flexor digitorum profundus on 73 year old male patient by attrition on the bony spur which was formed by malunion of distal radial fracture about 10 years ago. They were treated by direct repair for ring finger and free tendon graft with flexor digitorum sublimis of middle finger for little finger. After 1 year follow up, range of motion and flexion power were recovered to nearly normal.

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Operative Treatment of the Malunited Phalangeal Neck Fractures: Ho Jung Kang, Young Gon Koh, Joong Won Ha, Eung Shick Kang; J Korean Soc Fract 1997;10(3):658-664. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.658

Abstract PDF: It is generally accepted that malunited phalangeal neck fracture in hands not only limits range of motion but also accelerates the onset of degenerative changes, with increasing pain and stiffness of the affected joint. When displaced or rotated phalangeal neck fracture presents within the first or second weeks, properly performed closed or open reduction with percutaneous pinning or internal fixation is excellent options with predictable results. Malaligned fractures that present later frequently cannot be readily reduced. Once fully united, treatment options have included corrective osteotomy if function is significantly impaired or if appearance is objectionable. We have followed 9 patients, who had operations for malunited phalangeal neck fractures. The average length of follow up was 27 months. The interval between injury and operation ranged from 4 weeks to 6 years, with a mean of 21 months. Sites of operation include thumbs(3 cases), 2nd fingers(1 case), 3rd fingers(2 cases), 4th fingers(2 cases) and 5th finger(1 case). For those cases with less than 8 weeks elapsed since the injury, osteoclasis of the fracture with fixation using K-wire or pull-out was carried out. For those cases with more than 8 weeks elapsed, realignment osteotomy followed by fixation with K-wire or miniscrew was used. Parameters for the evaluation of result include range of motion to within 10 degree of full range in each joint, deviation of the fingers during active maximum flexion and extension, the minimum distance between the tip of the finger pulp and the palm, full bony union, relief of pain and the subjective cosmetlc result. Excellent and good results were noticed in 7 cases. The best results can be achieved only with near-anatomic restoration of the joint surface and early active motion exercise. In conclusion, with careful patient selection and close attention to operative detail, operative treatment of malunited phalangeal neck fracture can be effective.

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Treatment for the Malunion of the Distal Radius: Hyoun Oh Cho, Kyoung Duck Kwak, Sung Do Cho, Cheol Soo Ryoo, Woo Keun Jung; J Korean Soc Fract 1996;9(2):290-294. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.290

Abstract PDF: Malunited fractures of the distal radius may result in adequate function of the wrist with absence of pain in elderly patients. However, posttraumatic dedormity in younger, active patients is less well toterated, especially in those engaged in heavy manual work or who require a normal range of motion of the wrist. surgical correction of the malunion of the distal radius should be considered for this group of patients. Operation for the malunited fractures of the distal radius was performed in ten cases during the periods between January, 1990 and December, 1993, who were followed for an average of 15 months.The procedures included radial osteotomy(RO) in four malunions of short duration, radial osteotomy with ulnar shortening (RO & US) in these malunions of long duration and ulnar shortening(US) in three cases. We reviewed these cases retrospectively with respect to the clinical findings(pain, grip strength, range of motion of the wrist) and radiograpic changes(volar tilt, radial articular inclination and radiul shortening). Symptoms(radioulnar or radiocarpal pain) were improved in all cases. By compairing with the opposite sides, resedual loss of grip strength was 35% in RO group, 40% in RO & US and 31% in & US group. Residual loss of motion in flexion and extension or in deviation was similar in all groups, whill loss in rotation was less in RO or RO & US group than in US group. Inclination of the radial articular surface (radial inclination and volar tilt) was restored up to the degree similar to the opposite wrist in RO or US group, while was not in US group. Radial length was restored up to the dgegrees similar to the opposite wrist in all groups. The overall results were good or very good in five among the seven cases of RO group(with or without ulnar shortening), while good only in one among the cases of US group.

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