Journal of Musculoskeletal Trauma

Minimally Invasive Plate Osteosynthesis for Proximal Tibial Shaft Fracture: Young Soo Byun, Ki Chul Park, Hyun Jong Bong, Chang Hoon Lee; J Korean Fract Soc 2011;24(1):23-27. Published online January 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.1.23

PURPOSE
To report the results of patients treated by minimally invasive plate osteosynthesis (MIPO) for proximal tibial shaft fractures.
MATERIALS AND METHODS
From September 2003 to June 2008, thirty-two patients with proximal tibial shaft fractures weretreated by MIPO. There were 22 men and 10 women and mean age was 43.8 years (range; 21~72 years). Follow-up was available for all patients and the mean follow-up period was 19.5 months (range; 12~40 months). Duration of union, range of knee motion and postoperative complications were evaluated.
RESULTS
Twenty-nine patients (90.6%) healed after the MIPO technique. The mean duration of radiographic union was 18.3 weeks (range; 10~28 weeks). The mean range of knee motion was 134 degrees at the last follow-up. There were 1 non-union, 2 delayed unions, 1 superficial infection, 1 deep infection, 2 malunions with more than 5 degrees of malalignment and 14 cases of skin irritation by plate.
CONCLUSION
MIPO is an effective treatment for closed, proximal tibialshaft fractures. More aggressive treatment such as dual plating should be considered in fractures with severe comminution or bone loss.

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Medial Minimally Invasive Percutaneous Plate Osteosynthesis in Proximal Tibial Comminuted Fractures
Jae-Ang Sim, Kwang-Hui Kim, Yong-Seuk Lee, Sang-Jin Lee, Beom-Koo Lee
Journal of the Korean Orthopaedic Association.2014; 49(4): 278. CrossRef
Minimally Invasive Percutaneous Plate Stabilization Using a Medial Locking Plate for Proximal Tibial Fractures - Technical Note -
Jae Ang Sim, Beom Koo Lee, Kwang Hui Kim, Yong Seuk Lee
Journal of the Korean Fracture Society.2013; 26(4): 327. CrossRef

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Treatment of Proximal Tibia Fractures Using LCP by MIPO Technique: Sang Ho Ha, Dong Hui Kim, Jun Young Lee; J Korean Fract Soc 2010;23(1):34-41. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.34

Abstract PDF

PURPOSE
We wanted to evaluate the efficacy of MIPO (minimal invasive plate osteosynthesis) technique by LCP (locking compression plate) for treating proximal tibia fractures.
MATERIALS AND METHODS
Twenty-three patients, who had operation due to proximal tibia fracture and available for follow up for more than 1 year were included in this study. Cause of injury and accompanied injuries were checked. Operation time, period to bone union, range of joint motion and alignment were evaluated with complications.
RESULTS
Mean bone union time was 13.7 weeks (10~20). Twenty-one cases of the patients showed angulation of less than 5 degrees and 17 cases had normal range of motion. Five cases showed skin irritation by the plate and 2 cases had superficial infection.
CONCLUSION
LCP by MIPO technique for treating proximal tibia fracture showed excellent results. Delicate technique is required for the proper adjustment of LCP and the alignment of the lower leg.

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EVALUATION OF FUNCTIONAL OUTCOME OF SURGICAL TREATMENT FOR FRACTURE AROUND KNEE WITH LOCKING PLATE
VIKAS KUNTWAD, AMOL WAGH, SATYAJEET A HORE
Asian Journal of Pharmaceutical and Clinical Research.2023; : 213. CrossRef
Medial Minimally Invasive Percutaneous Plate Osteosynthesis in Proximal Tibial Comminuted Fractures
Jae-Ang Sim, Kwang-Hui Kim, Yong-Seuk Lee, Sang-Jin Lee, Beom-Koo Lee
Journal of the Korean Orthopaedic Association.2014; 49(4): 278. CrossRef
Minimally Invasive Percutaneous Plate Stabilization Using a Medial Locking Plate for Proximal Tibial Fractures - Technical Note -
Jae Ang Sim, Beom Koo Lee, Kwang Hui Kim, Yong Seuk Lee
Journal of the Korean Fracture Society.2013; 26(4): 327. CrossRef

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Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage: Seung Ryul Lee, Jae Hoon Yang, June Kyu Lee, Hyun Dae Shin, Kyung Cheon Kim, Kyu Woong Yeon, Young Mo Kim; J Korean Fract Soc 2009;22(3):152-158. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.152

Abstract PDF: PURPOSE
To find out the efficiency of two staged operation of patients with high energy proximal tibia fracture with severe soft tissue damage, the first step being external fixation, and the second, internal fixation with plates.
MATERIALS AND METHODS
The study group was the 42 patients who had followed for one year out of a group of 56, performed the first step external fixation and the second step internal fixation with plates retrospectively, from March 2003 to March 2007. The average age of the study group was 51.4, 26 men, and 16 women participating in this study. The average time of follow up was 32 months. In the final follow up, investigations of the radiological assessments and functional abilities of the bony fusion were carried out along with the complications of the soft tissue.
RESULTS
The duration after the first step external fixation until second step internal fixation to be performed was 14.9 (6~40) days in average. The final bone fusion took about 15 weeks, and according to the final follow up, the range of motion of the knee was around 110.8 degrees (6.2~117 degrees). In 31 cases, only the internal fixation was performed, while in 11 cases, soft tissue reconstruction was carried out with the internal fixations. As for the complications there were 2 cases of deep soft tissue infection, 2 cases of nonunion, 1 case of malunion and 1 case of knee joint stiffness.
CONCLUSION
In cases of proximal tibia fracture with severe soft tissue damage, external fixation was important to secure the safety of the fracture, carry forward the anatomical alignment, plan the soft tissue safety and manage the wound to decrease the number of microbial in the next operation, which is the internal fixation with plates.

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Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture: Joon Woo Kim, Chang Wug Oh, Jong Keon Oh, Hee Soo Kyung, Woo Kie Min, Byung Chul Park, Kyung Hoon Kim, Hee Joon Kim; J Korean Fract Soc 2009;22(1):6-12. Published online January 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.1.6

Abstract PDF

PURPOSE
To assess the results of staged MIPO (Minimally Invasive Plate Osteosynthesis) for proximal tibial fractures with compromised soft tissue.
MATERIALS AND METHODS
Eighteen proximal tibial fractures (AO 41:9 cases, AO 42:9 cases) included this study. Ten were open fractures. After temporary external fixation until soft tissue healed (mean 27.3 days), MIPO was performed secondarily without bone graft. We assessed the bony union and knee function, and affecting factors of the results were investigated.
RESULTS
All fractures united at 20 weeks (range, 11~32) except 1 case. Mean range of knee flexion was 134.4degrees and mean IOWA knee score was 89.1. There were 2 superficial and 2 delayed deep infections from open fractures (grade II:1 case, grade III:3 cases), although they healed after implant removal. Open fractures seem to influence the infection rate. Otherwise, there was no related factor affecting the results.
CONCLUSION
MIPO after temporary external fixation can provide favorable results in proximal tibial fractures with soft tissue injuries, but attention of delayed infection should be paid in open fractures.

Citations

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MINIMALLY INVASIVE OSTEOSYNTHESIS WITH PLATE OR NAIL FOR META-DIAPHYSEAL TIBIAL FRACTURES - WHAT IS BETTER?
B. Makelov
Trakia Journal of Sciences.2023; 21(4): 357. CrossRef
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
Comparison of Time to Operation and Efficacies of Ultrasound-Guided Nerve Block and General Anesthesia in Emergency External Fixation of Lower Leg Fractures (AO 42, 43, 44)
Chan Kang, Sang-Bum Kim, Youn-Moo Heo, You-Gun Won, Byung-Hak Oh, June-Bum Jun, Gi-Soo Lee
The Journal of Foot and Ankle Surgery.2017; 56(5): 1019. CrossRef
Minimally Invasive Plate Osteosynthesis for Proximal Tibial Shaft Fracture
Young-Soo Byun, Ki-Chul Park, Hyun-Jong Bong, Chang-Hoon Lee
Journal of the Korean Fracture Society.2011; 24(1): 23. CrossRef
The Use of Fresh Frozen Allogenic Bone Graft in the Impacted Tibial Plateau Fractures
Yeung Jin Kim, Soo Uk Chae, Jung Hwan Yang, Ji Wan Lee, Dae Han Wi, Duk Hwa Choi
Journal of the Korean Fracture Society.2010; 23(1): 26. CrossRef
Management of Open Fracture
Gu-Hee Jung
Journal of the Korean Fracture Society.2010; 23(2): 236. CrossRef
Staged Minimally Invasive Plate Osteosynthesis of Distal Tibial Fractures
Sung-Ki Park, Chang-Wug Oh, Jong-Keon Oh, Kyung-Hoon Kim, Woo-Kie Min, Byung-Chul Park, Won-Ju Jeong, Joo-Chul Ihn
Journal of the Korean Fracture Society.2010; 23(3): 289. CrossRef
Intramedullary Nailing of Proximal Tibial Fractures
Young-Soo Byun, Dong-Ju Shin
Journal of the Korean Fracture Society.2009; 22(3): 197. CrossRef
Proximal Tibia Fracture: Plating
Ki-Chul Park
Journal of the Korean Fracture Society.2009; 22(3): 206. CrossRef

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Cause and Treatment of Extraarticular Proximal Tibial Nonunion: Sung Soo Kim, Sung Keun Shon, Kyu Yeol Lee, Chul Hong Kim, Myung Jin Lee, Min Soo Kang, Lih Wang, Im Sic Ha; J Korean Fract Soc 2008;21(4):279-285. Published online October 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.4.279

Abstract PDF: PURPOSE
To analyze the factors affecting the nonunion of extraarticular proximal tibial fracture and the outcome of nonunion treatment.
MATERIALS AND METHODS
We investigated 51 cases of extraarticular proximal tibial fractures from June 2002 to May 2006. The nonunion rate was assessed in relation to several risk factors and the treatment outcome of nonunion using plate fixation with bone graft was assessed by Klemm and BOrner functional rating system.
RESULTS
6 cases of nonunion (11.8%) was noted among 51 cases, and the risk factors examined, OTA A3 comminuted fracture was associated with a high nonunion rate with statistical significance and initial bone graft had a significant effect in bone healing. Excellent and good results were obtained in 5 cases (83.3%) and bone union was achieved in all nonunion cases.
CONCLUSION
Comminution was found to be an important factor affecting the nonunion in extraarticular proximal tibial fracture, and bone graft in primary operation could reduce the chance of nonunion. Accurate plate fixation with bone graft is a reliable option in nonunion treatment.

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A Comparison according to Insertion Method for Intramedullary Nailing in Proximal Tibial Fractures: Sang Ho Moon, Byoung Ho Suh, Chung Soo Hwang, Tae Hyun Yoon; J Korean Fract Soc 2006;19(1):17-23. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.17

Abstract: PURPOSE
To compare clinical and radiological results between standard insertion method and semiextended method which was designed to improve proximal fixation and alignment in proximal tibia fracture.
MATERIALS AND METHODS
A retrospective review from May 2000 to February 2004, identified 24 extraarticular fractures in proximal tibia, initially treated with locked intramedullary nails at least 1 year follow up. There were 12 open injuries, 4 segmental, 3 butterfly fragments and 17 comminuted. Semiextended method was used in 10 fratures and standard insertion method which is cephalad to tibial tubercle in 14. Follow up clinical assessment consisted of review of associated injuries and complications and these two methods were compared by postoperative angulation and displacement in anteroposterior and lateral radiographs. Data were analysed by t-tests.
RESULTS
In semiextended group, average angulation was 2.3 degrees in coronal and 2.8 degrees in sagittal plane and average displacement was 4.5 mm in coronal and 5.3 mm in sagittal. In ordinary group, average angulation was 5.1 degrees in coronal and 7.4 degrees in sagittal plane and average displacement was 6.1 mm in coronal and 5.3 mm in sagittal. In semiextended group, there were significant reduction in coronal angulation (p=0.006) and sagittal angulation (p=0.001), but there was no significant difference in coronal (p=0.344) and sagittal (p=0.99) displacement. Both groups showed anterior, valgus angulation and posterolateral displacement in most cases. There were 14 associated injuries and one patient developed nonunion and was treated by nail exchange with autogenous bone graft.
CONCLUSION
Our retrospective analysis demonstrated that semiextended method is effective for reducing coronal and sagittal angulation, but is not helpful for reducing displacement in both planes.

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Double Plating of Proximal Tibial Fractures Using Minimally Invasive Percutaneous Osteosynthesis Technique: Chang Wug Oh, Jong Keon Oh, In Ho Jeon, Hee Soo Kyung, Il Hyung Park, Byung Chul Park, Woo Kie Min, Ji Ho Lee; J Korean Fract Soc 2005;18(3):250-255. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.250

Abstract PDF

OBJECTIVES
To evaluate the results and its efficacy of double plating for proximal tibial fractures using minimally invasive percutaneous osteosynthesis (MIPO) technique. MATERIAL & METHODS: Twenty-three fractures, followed-up more than 1 year, were included in this retrospective study. There were 18 men and 5 women, and the mean age was 53.5 years-old. According to the AO-OTA classification, five were 41A, 13 were 41C, and 5 were 42. There were four open fractures (grade I- three, grade III A-one case). The plates were fixed on the medial and lateral sides of tibia with MIPO technique. Functional and radiographic results were evaluated by the modified Rasmussen system.
RESULTS
All fractures healed without bone graft, and the mean period for fracture healing was 19.3 weeks (range, 10~32 weeks). All other patients had excellent or good clinical or radiological results, except for two patients of a fair clinical result after a combined injury. Complications included one case of shortening (1 cm) and two cases of mal-alignments (varus less than 10 degrees). There was one case of superficial infection, but no patient showed deep infection.
CONCLUSION
Double plating using MIPO technique can provide favorable results in the treatment of proximal tibial fractures.

Citations

Citations to this article as recorded by

Medial Minimally Invasive Percutaneous Plate Osteosynthesis in Proximal Tibial Comminuted Fractures
Jae-Ang Sim, Kwang-Hui Kim, Yong-Seuk Lee, Sang-Jin Lee, Beom-Koo Lee
Journal of the Korean Orthopaedic Association.2014; 49(4): 278. CrossRef
Minimally Invasive Plate Osteosynthesis for Proximal Tibial Shaft Fracture
Young-Soo Byun, Ki-Chul Park, Hyun-Jong Bong, Chang-Hoon Lee
Journal of the Korean Fracture Society.2011; 24(1): 23. CrossRef
Treatment of Proximal Tibia Fractures Using LCP by MIPO Technique
Sang-Ho Ha, Dong-Hui Kim, Jun-Young Lee
Journal of the Korean Fracture Society.2010; 23(1): 34. CrossRef
Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture
Joon-Woo Kim, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Woo-Kie Min, Byung-Chul Park, Kyung-Hoon Kim, Hee-Joon Kim
Journal of the Korean Fracture Society.2009; 22(1): 6. CrossRef

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Operative Treatment of Proximal Tibial Plateau Fractures through Lateral Submeniscal Approach: Hyug Su An, Se Ang Chang, Jun Woo Park, Jin Seok Lee, Hun Ho Bang; J Korean Fract Soc 2004;17(3):237-242. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.237

Abstract PDF: PURPOSE
The purpose of this study was conducted to evaluate the clinical results of proximal tibial plateau fractures treated with open reduction and internal fixation through the lateral submeniscal approach and allowed early motion of the knee and to evaluate the effectiveness of the approach.
MATERIALS AND METHODS
From January 1998 to December 2002, fifty four patients who underwent open reduction through the lateral submeniscal approach for proximal tibia plateau fracture and had a follow-up more than one year were included in this study. Clinical results were evaluated by postoperative radiographs taken at the last follow-up and Porter's assessment method.
RESULTS
Anatomical reduction was achieved under direct vision through the submeniscal approach in most of the cases in this study. The postoperative radiographs showed anatomical reduction in 32 cases (59%) and adequate reduction with displacement within 2 mm in 20 cases (37%). The clinical evaluation by Porter's assessment method revealed that 49 cases (91%) were acceptable results of excellent or good at the final follow-up CONCLUSION: This study indicates that open reduction and internal fixation through the lateral submeniscal approach can be a good option for proximal tibia plateau fractures because it allows accurate reduction of the articular fractures, which is confirmed directly during operation, identification and repair of associated soft tissue injuries are facilitated, sufficient bone graft and stable fixation of the articular fragments under direct vision allow early motion of the knee.

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Minimally Invasive Percutaneous Plate Stabilization of Proximal Tibial Fractures: Chang Wug Oh, Jong Keon Oh, In Ho Jeon, Hee Soo Kyung, Il Hyung Park, Joo Chul Ihn, Yeon Ki Woo, Ho Sung Jung; J Korean Fract Soc 2004;17(3):224-229. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.224

Abstract PDF

PURPOSE
Despite of various treatment methods, proximal tibial fractures are common injuries that may be associated with poor outcomes and high rates of complications. To improve this, percutaneous plating technique was performed in the proximal tibial fractures.
MATERIALS AND METHODS
Twenty-four proximal tibial fractures (AO 41A; 5, AO 41C; 12, AO 42; 7) were treated by percutaneous plating with either or both sides without bone graft. One was open fracture.
RESULTS
All fractures were healed. The average time for fracture healing was 16.5 weeks (range, 8~24 weeks). Complications included a 1cm shortened case and two mal-alignments; a 6 degree valgus case and 5 degree varus case. There was one case of superficial infection, which healed after plate removal. But, there was no deep infection. Results were evaluated by modified Rasmussen score system, all patients had excellent or good result.
CONCLUSION
Minimally invasive percutaneous plating technique can provide favorable results in the treatment of proximal tibial fractures.

Citations

Citations to this article as recorded by

MINIMALLY INVASIVE OSTEOSYNTHESIS WITH PLATE OR NAIL FOR META-DIAPHYSEAL TIBIAL FRACTURES - WHAT IS BETTER?
B. Makelov
Trakia Journal of Sciences.2023; 21(4): 357. CrossRef
Medial Minimally Invasive Percutaneous Plate Osteosynthesis in Proximal Tibial Comminuted Fractures
Jae-Ang Sim, Kwang-Hui Kim, Yong-Seuk Lee, Sang-Jin Lee, Beom-Koo Lee
Journal of the Korean Orthopaedic Association.2014; 49(4): 278. CrossRef
Minimally Invasive Percutaneous Plate Stabilization Using a Medial Locking Plate for Proximal Tibial Fractures - Technical Note -
Jae Ang Sim, Beom Koo Lee, Kwang Hui Kim, Yong Seuk Lee
Journal of the Korean Fracture Society.2013; 26(4): 327. CrossRef
Clinical Outcomes of Locking Compression Plate Fixation through Minimally Invasive Percutaneous Plate Osteosynthesis in the Treatment of Distal Tibia Fracture
Jae-Sung Yoo, Hyun-Woo Park
Journal of the Korean Fracture Society.2012; 25(2): 117. CrossRef
Minimally Invasive Plate Osteosynthesis for Proximal Tibial Shaft Fracture
Young-Soo Byun, Ki-Chul Park, Hyun-Jong Bong, Chang-Hoon Lee
Journal of the Korean Fracture Society.2011; 24(1): 23. CrossRef
Minimally Invasive Plate Osteosynthesis for the Upper Extremity Fracture Using a Lumbar Spreader - Surgical Technique -
Gu-Hee Jung, Chyul-Hyun Cho, Jae-Do Kim
Journal of the Korean Fracture Society.2011; 24(1): 83. CrossRef
Management of Fractures of Distal Tibia by Minimally Invasive Plate Osteosynthesis through an Anterior Approach
Gu-Hee Jung, Jae-Do Kim, Jae-Ho Jang, Sung-Keun Heo, Dong-won Lee
Journal of the Korean Orthopaedic Association.2010; 45(6): 473. CrossRef
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
Journal of the Korean Fracture Society.2010; 23(2): 172. CrossRef
Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture
Joon-Woo Kim, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Woo-Kie Min, Byung-Chul Park, Kyung-Hoon Kim, Hee-Joon Kim
Journal of the Korean Fracture Society.2009; 22(1): 6. CrossRef
Proximal Tibia Fracture: Plating
Ki-Chul Park
Journal of the Korean Fracture Society.2009; 22(3): 206. CrossRef

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Treatment of Proximal Tibial Non-union after IM Nailing in Conjunction with Anterior Buttress Plating: Han Jun Lee, Young Uk Park; J Korean Fract Soc 2004;17(2):138-141. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.138

Abstract PDF

PURPOSE
We investigated the results of autologous bone grafting and anterior buttress plating for non-union occurred in junction between metaphysis and diaphysis of tibia after intramedullary nailing technique.
MATERIALS AND METHODS
We reviewed six patients who suffered from non-union of proximal tibia for a minimum follow up of one year. The interval was 6 months in average between first and second surgery. The mean follow up period was 15 months in average. The surgical method was autologous bone grafting and anterior buttress plating without removal of previous nail.
RESULTS
In all patients, the tenderness and pain of non-union sites were passed at a postoperative one month. Radiologic bone union was achieved in all patients at 18 weeks in average, range from 11 weeks to 20 weeks. The complication was superficial infection in one patient without deleterious effect on union.
CONCLUSION
The described method in this study could be a good alternative technique for the treatment of proximal tibial non-union due to failed intramedullary nailing.

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Cause and Treatment of Extraarticular Proximal Tibial Nonunion
Sung Soo Kim, Sung Keun Shon, Kyu Yeol Lee, Chul Hong Kim, Myung Jin Lee, Min Soo Kang, Lih Wang, Im Sic Ha
Journal of the Korean Fracture Society.2008; 21(4): 279. CrossRef

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Treatment of Comminuted Fractures of Proximal Tibia using MIPO technique: Beom Koo Lee, Hyunchul Jo, Gi Serk Eom, Jin Won Kim; J Korean Soc Fract 2002;15(2):243-250. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.243

Abstract PDF

PURPOSE
To evaluate the advantages of fixation of metaphysis by minimally invasive plate osteosynthesis(MIPO) technique for comminuted fractures of the proximal tibia. MATERIALS & METHODS: from January 1997 to February 2000, 18 cases of comminuted fracture of the proximal tibia were treated using MIPO technique. Operation time, union time, radiologic alignment, range of motion of the knee joint, functional and anatomical results according to Rassmusen's grading criteria, complications were evaluated. Minimal follow-up time was 12 months.
RESULTS
Operation time was average 51 minutes (30-80 minutes). Time to bone healing was average 10.6 weeks (9-14 weeks) There was 1 case of valgus angular deformity greater than 5 degrees. 6 cases in acceptable bony alignment less than valgus 5 degrees and 11 cases were classified into normal bony alignment. Range of motion of the knee joint was 0-140 degrees in 13 cases, 0-120 degrees in 3 cases, 0-90 degrees in 1 case, 10-90 degrees in 1 case. Rasmussen's grading criteria for functional outcome revealed there were 14 cases(77.8%) excellent results, 4 cases(22.2%) good result. and grading criteria for anatomical outcome revealed there were 7 cases(38.9%) excellent results, 11 cases(61.1%) good result.
CONCLUSION
MIPO technique for comminuted fracture of the proximal tibia seems to be a good techinque to obtain more rapid bony union with less complication.

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Treatment of Proximal Tibia Fractures Using LCP by MIPO Technique
Sang-Ho Ha, Dong-Hui Kim, Jun-Young Lee
Journal of the Korean Fracture Society.2010; 23(1): 34. CrossRef

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Treatment of nonunion of proximal tibia: Treatment using external fixator: Kuhn Sung Whang, Il Hoon Sung, Jun Sic Park; J Korean Soc Fract 2002;15(2):129-137. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.129

Abstract PDF: PURPOSE
To evaluate causes, treatment methods, outcomes and usefulness of external fixator after we have treated patients with proximal tibial nonunion successfully using external fixator.
MATERIALS AND METHODS
We treated the 10 patients with proximal tibial nonunion between December, 1991 and December, 2000. Mean follow-up period was 18.5 months. We analyzed numbers of operations, operative methods and causes of nonunion, and rated bony and functional results according to Paley's classification.
RESULTS
The causes of nonunion were infection in 6 cases, insecure fixation in 4 cases. Bony union was achieved in all 10 cases. The mean time of union was 12.9 months. Complications were developed in 8 cases. Pin site infection occurred in 7 cases, pain in 8 cases, joint stiffness in 2 cases, angular deformity in 2 cases. Functional results were excellent in one, good in four, fair in three, poor in two.
CONCLUSIONS
We concluded that external fixation method using external fixator such as Ilizarov in treating nonunion of proximal tibia was very useful because of offering advantages of bony shortening and compression, bony lengthening, bone grafting and early weight bearing in patient with infected nonunion and bone defect with many complications

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Surgical Treatment for Tibial Condyle Fracture of the Proximal Tibia: Won Tae Choi, Bo Yel Choi, Chul Hyung Lee, Eui Soon Kim, Jeong Woung Lee, Doo Hoon Sun, Myung Sang Moon; J Korean Soc Fract 2001;14(2):291-297. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.291

Abstract PDF: PURPOSE
To evaluate the results of operative treatment for tibial condyle fracture of the proximal tibia. MATERIAL AND METHODS: From March 1995 to June 1999, 15 patients with more than one year follow-up periods were treated by operative method at Sun General Hospital. 10 of them were treated by open reduction and internal fixation(plate & screw for 8, screw & K-wire for 2) and 5 of them by closed reduction and Ilizarov fixation. Preoperative prognostic factors were considered as the fracture type of Schatzker classification, associated injury, and closed or open fracture. Functional outcome was evaluated results by Blokker`s criteria.
RESULTS
According to Schatzker classification, type III were 4 cases, type IV were 6 cases, and type V were 5 cases. At last follow up, average range of motion was 115degrees (Internal fixation was 110degrees, External fixation was 130degrees) The results was according to Blokker`s criteria, 11 cases(73%) had satisfactory acceptable results, among 4 cases(27%) of non-acceptable criteria.
CONCLUSION
For treatment of tibia condyle complicated communited fracture, we are able to consider that rigid internal fixation with anatomical reduction and external fixation for early range of motion.

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TREATMENT OF PROXIMAL TIBIA FRACTURE WITH HYBRID EXTERNAL FIXATOR: Tae Woo Park, Sung Do Cho, Youg Sun Cho, Bum Soo Kim, Sogu Lew, Su Yeon Hwang; J Korean Soc Fract 2001;14(2):285-290. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.285

Abstract PDF

PURPOSE
To evaluate the results and usefulness of hybrid external fixator in the treatment of proximal tibia fracture. MATERIAL AND METHOD: From Jan. 1997 to Jan. 2000, 19 proximal tibia fracture were treated with hybrid external fixator with or without limited internal fixation to stabilize the articular surface. All fractures were classified according to the AO classification. The results were analyzed by ROM(range of motion), bony union time, fracture reduction with MPTA(medial proximal tibial angle) and joint congruency.
RESULT
There were 1 A2, 7 A3, 1 C1, 8 C2, 2 C3 proximal tibial fractures according to the AO classification. Open fractures were 10 patients. The mean bony union time was 13 wks(range 8-36wks) and the mean length of time in the external fixator was 14wks(range 8-36wks). At last follow up, the MPTA of the proximal tibia was 87.9 degree. 2 patients developed varus(82 degree) and valgus(92 degree) deformity respectively. Complications were intermittent pin drainage in 6 patients(31.6%), deep infection in 1 patient(5.3%) and nonunion in 4 patients(21%) required bone graft and internal fixation with plate at 6 months postoperatively. Four nonunions were 3 C2 and 1 C3 according to the AO classification and three were open fracture(1 type I, 1 type IIIb, 1 type IIIc : Gustilo type) CONCLUSION: Hybrid external fixation is a good treatment option for proximal tibial fractures. However, nonunion and angular deformity would occur in severe metaphyseal comminution and soft tissue injury. Accurate fracture reduction and careful soft tissue management is prerequisite and if necessory early bone graft should be considered in such cases.

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Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage
Seung-Ryul Lee, Jae-Hoon Yang, June-Kyu Lee, Hyun-Dae Shin, Kyung-Cheon Kim, Kyu-Woong Yeon, Young-Mo Kim
Journal of the Korean Fracture Society.2009; 22(3): 152. CrossRef

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Bicondylar Tibial Plateau Fractures Treated with Hybrid-Ring External Fixator: Chang Wug Oh, Hee Soo Kyung, Joo Chul Ihn, Byung Chul Park, Young Chul Choi; J Korean Soc Fract 2000;13(4):877-883. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.877

Abstract PDF

PURPOSE
This study was designed to evaluate the indirect reduction or limited internal fixation with hybrid external fixation for bicondylar fractures of proximal tibia. MATERIALS & METHODS: Twenty-two cases (mean age; 49) proximal tibial fractures have been treated, including 7, type V and 15, type VI. After reconstruction of articular surface, the hybrid fixation was applied at the condyle and shaft with or without limited internal fixation by cannulated screw or one-third plate. We permitted early ROM exercise of knee and partial weight-bearing about 4 weeks after operation.
RESULTS
Time to union averaged 15.6 weeeks(range ; 11-20 weeks). There were 4 cases of nonunion including three cases of early bone graft for severe comminution and one infection. Functional scoring revealed 5 excellent, 12 good, 3 fair and 2 poor results. 18 out of 22 cases had good or excellent result in anatomical grading. The mean range of knee motion was 116 degrees(from 4.1 to 120 degrees). In complications, there were two cases of malunion, one deep infection, and one pin-site infection, but soft tissue compromise such as skin necrosis was not happened.
CONCLUSION
The indirect reduction or limited internal fixation with hybrid external fixation for bicondylar fractures of proximal tibia have advantages of anatomic, stable fixation, early mobilization and less soft tissue dissection, so good results of knee function can be accomplished.

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Dual Plate Fixation Compared with Hybrid External Fixator Application for Complex Tibial Plateau Fractures
Jae-Sung Lee, Yong-Beom Park, Han-Jun Lee
Journal of the Korean Fracture Society.2008; 21(2): 124. CrossRef

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Proximal Tibiosbular Fracture associated with Popliteal Artery Injury: Sang Soo Kim, Hong Jun Han, Dong Churl Kim, Dae Ho Ha, Hee Jun Yoo, Suk Kyun Park; J Korean Soc Fract 1999;12(4):885-893. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.885

Abstract PDF: Injury to the popliteal artery results in amputation more frequently than any other arterial injury. The major factor in the amputated limbs was a delay in diagnosis and therapy of the arterial injury associated with blunt trauma. The proximal tibial fractures produced the highest percentage of vascular complications and indicated immediate application of therapeutic measures. The purpose of this study is to investigate the long-term results and factors that influences the results of surgical treatment in patients with combined proximal tibial fracture and popliteal artery injury. Authors reviewed the records of 24 cases treated for this injury between January 1984 and May 1997. The age of the patients ranged from 17 to 70 years(average 45 years). Nine patients presented with life threatening injuries and classical signs of acute limb ischemia. Prolonged ischemic time ranged from 3 to 6 hours 30 minutes(average 4 hours 50 minutes). The most common cause of thoses injury was traffic accident in 16 cases. Five cases had neurologic deficit ; significant soft tissue injury was present in 14 extremities. Vascular procedures included saphenous vein interposition, end-to-end anastomosis, etc. Bony procedures were accomplished by external means in 14 cases and the others treated by immediate internal fixation in 5 cases. Intraoperative fasciotomy was performed in 5 patients with lower limb ischemia. The results suggested that limb salvage was possible in 63 percent of patients with combined proximal tibial fracture and popliteal artery injuries, but a history of life-threatening condition and severe associated injury with vascular compromise was an unfavorable prognostic factor. So a well organized multidisciplinary approach is necessary to ensure life and functional limb salvage.

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Periosteal Impingement in Salter-Harris Type II Injury of proximal Tibial Epiphysis: Sang ho Mmn, Phil Hyun Chung; J Korean Soc Fract 1999;12(4):1046-1050. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1046

Abstract PDF: Despite the frequent exposure of the knee in children to violent trauma, the incidence of fracture of the proximal tibial epiphysis is extremely low, accounting for about 0.5 per cent of all epiphyseal injuries. This is due to its freedom from collateral ligament attachments and therefore the frequent varus and valgus stresses to the knee are transmitted not to the epiphysis but rather to the metaphysis distal to it. Closed reduction and external immobilization is adequate treatment for most type - I or 3 fractures. Patients with displaced type - III or IV fractures undergo open reduction and internal fixation when there was significant displacement of the fragments or incongruity of the joint. The authors reviewed a case of Salter-Harris type II injury of proximal tibial epiphysis which required open reduction and internal fixation because it had the insertion spread of the periosteum into the separation site.

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Treatment of conuninuted Segmental Fracture of the Proximal Tibial Shaft with Retrograde Ender Nails: Jung Geun Choi, Geun Sun Choi, Soo Jae Yim, Syung Ryul Yoon; J Korean Soc Fract 1999;12(3):543-548. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.543

Abstract PDF: PURPOSE
To present the result of retrograde Ender pinning technique for treatment of comminuted segmental fracture of the proximal tibial shaft.
MATERIALS and METHODS
From 1994 to 1998, we treated twenty-one cases of the comminuted segmental proximal tibial shaft fracture with the retrograde Ender pinning technique. We have followed up the clinical results.
RESULTS
The clinical bone union time was average eleven weeks, and the radiologic bone union time was average nineteen weeks.
CONCLUSIONS
In the treatment of comminuted segmental proximal tibial shaft fracture, the retrograde Ender pinning technique is useful. The method improves fixation of the proximal fragment, is simple and effective, provides good fixation of the tibia in patients in whom stabilization of several fractures is required, and can be used for fixation of tibial shaft fracture with soft tissue damage.

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The Treatment of the Proximal Tibia Fracture -Comparison of the Variable Method of Fixation-: Dong Heon Kim, Kyu cheol Shin, Kyeong Soon Kim, Byeong Chun Chang, Dae Sul Kang; J Korean Soc Fract 1998;11(2):442-448. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.442

Abstract PDF: The treatment of proximal tibial fracture is an area of great controversy. Because open and comminuted fractures are common, selection of fixation method of the proximal tibial fracture is more difficult than any other fractures. Many authors reported high rate of malunion and loss of reduction. The purpose of this study is to compare the results of the proximal tibial fractures depending on the fixation method. We evaluated the records of 35 patients (36 fractures) who had been treated with intramedullary nailing, plate and screws and external fixation from January 1989 to January 1996. The mean period of follow-up was 12months. Of the 36 fractures, 8 fractures were with intramedullary nailing, 12 fractures with plate and screws, 16 fractures with external fixator. In intramedullary nailing groupp, the average time of bony union was nineteen weeks (16-27), in plate and screws fixation group twenty three weeks (18-31) and in external fixation group 22 weeks (19-29). The complications of intramedullary nailing group were 3 nonunions, 1 delayed union, 1 varus deformity, 2 anterior angulations and 2 cases of deep wound infection. The complications of plate and screws group were 1 nonunion, 3 delayed union, 1 deep wound infection, 2 superficial infections and in most fractures partial stiffiness of knee joint. The complications of external fixator group were 1 nonunion, 1 delayed union, 1 deep wound infection, 6 pin tract infections and 3 cases of knee joint stiffness. In our cases, if there is open wound higher than Gustilo grade III-B and severe comminuted fracture initially, the external fixation is more preferred for wound management and also more advantageous method for the patients who got a multiple trauma in abdomen, chest and head injuries. In closed fractures and Gustilo grade I, II open fractures, intramedullary nailing is considered to be more preferable method. But the anatomy of proximal tibia made nailing these fractures technically difficult. In conclusion, we consider each method of fixation is useful fixation method of the proximal tibial fractures, but each method should be selected advertently depending on the severity of soft tissue injury and the degree of comminution of the fractures.

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Treatment of Commiuted Fractures of the Proximal Tibia Using Ilizarov External Fixator: Jae Ik Lee, Myung Hwan Son, Jae Hong Park, Kang Hoon Kim; J Korean Soc Fract 1998;11(1):198-204. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.198

Abstract PDF: Twenty one comminuted fractures of the proximal tibia in 21 patients were treated with Ilizarov external fixator from May 1990 to May 1996 in Pusan City Medical Center. The average duration of external fixation was 17weeks, and all of the fractures healed without bone graft. The mean time to union was 18weeks in closed comminuted fractures, and 21 weeks in Gustilo type I, II open fractures. The complications with this technique were pin tract infection 3 cases, pin loosening 6 cases, septic arthritis 1 case, post-traumatic osteoathritis 1 case, and joint ankylosis 1 case. The average duration of follow up was 18 months. The range of knee motion of 19 cases of the the 21 patients was at least 115-degrees arc. Post-operative immediate exercise was possible, and partial weight bearing with crutch was also possible after post-operative 4 weeks. We concluded that Ilizarov external fixation is a satisfactory technique for the treatment of selected comminuted fractures of the proximal tibia.

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Management of Unstable Proximal Tibial Fractures Using the Ilizarov: Hong Gee Park, Beom Goo Lee, Soo Chan Lee, Do Hyun Moon, Jin Hong Ko, Ki Dong Kang, Hyun Park; J Korean Soc Fract 1997;10(2):332-337. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.332

Abstract PDF: We reviewed fifteen cases of unstable tibial fractures treated with Ilizarov method from May 1995 to May 1996. We attained satisfactory bony union in all cases without bone graft(Average time 19 weeks). There were numbers of complications, such as pin tract infection, angular deformity and joint ankylosis but its were soluble and careful management & numbers of minor surgery were needed to prevent & solve such complications. Post-op immediate weight bearing and ROM exercise were possible and showed no difficulty in getting mainteance of reduction & fracture healing, and serious joint ankylosis waa not developed. In conclusions, Ilizarov method is an excellent treatment in getting reduction, maintenance of reduction, early ambulation and fracture healing in the cases of unstable tibia fractures.

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Extra-articulaf Fracture of Proximal Tibia: Heui Jeon Park, Jae In Ahn; J Korean Soc Fract 1990;3(2):232-237. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.232

Abstract PDF

Twenty-nine cases of the proximal tibial metaphyseal fractures(extra-articular) treated at the Department of Orthopaedics, Wonju Christian Hospital from January 1982 to December 1989 were studied in clinical and radiological aspects. The results were as follows: 1. The main cause of the fractures was the traffic accident, 19 cases (65.6%). 2. The most common type of the fractures was transverse fracture, 18 cases (62%). 3. The average time required for fracture union was 18 weeks in the conservative treatment group, 16 weeks in the surgical treatment group. 4. In the union time of the fracture, operative treatment was shorter than closed treatment. 5. The incidence of complication was relatively high in conservative treated group, 7 cases (21%).

Citations

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The microstructure analysis of cerium-modified barium titanate having core-shell structured grains
Y. Park, H.G. Kim
Ceramics International.1997; 23(4): 329. CrossRef
The effect of grain size on dielectric behavior of BaTiO3 based X7R materials
Y. Park, Y.H. Kim, H.G. Kim
Materials Letters.1996; 28(1-3): 101. CrossRef
Effect of external pressure on the dielectric temperature characteristics of cerium-modified barium titanate based ceramic
Yung Park, Yoonho Kim
Materials Research Bulletin.1996; 31(12): 1479. CrossRef

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Treatment of Extra-articular Proximal Tibial Fracture: Ki Hong Choi, Chung Nam Kang, Jin Man Wang, Kwon Jae Roh, Sang Kyum Lee; J Korean Soc Fract 1990;3(2):223-231. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.223

Abstract PDF: The management of extra-articular proximal tibial fracture remains controversy. Many reporters recognized that the proximal tibial facture are best treated by closed reduction and long leg cast, however delayed union with this method have frequently been documented in spite of anatomical characteristics of proximal tibia. Thirty patients of the fracture of extra-articular Froximal tibia were treated and managed at the Department of Orthopaedic Surgery, Ewha University Hospital from January, 1583 to December 1989. The following results were obtained: 1. According to Gerard classification, anterior long oblique & posterior long oblique fracture were 18 cases(60%) and 8 cases(27%) respectively. Delayed union developed in 9 cases(50%) of 18 cases anterior long oblique fracture and 2 cases(25%) of 8 cases posterior long oblique fracture. 2. All cases of deleyed union of tibia developed through or below the tuberosity. 3. Among 30 cases, the fractures were managed with closed method at 23 cases, open method at 7 cases, internal fixation at 12 cases without delayed union and external fixator at 10 cases. The all cases using external fixator resulted in delayed union. 4. Among 30 cases, 16 cases(53%) were open fracture, and the most common type was type IIIb. Delayed union developed in 8 cases(50%) of 9 cases(56%) type IIIb. 5. The 24 cases (80%) of fibular fracture were concurred with proximal tibial fracture, and delayed union developed in 10 cases (42% ) of 24 cases fibular fracture and one case of 6. cases without fibular fracture. In conclusion, many delayed unions were frequent. In our experience, in case of GradeIII open comminuted fractures, we used external fixation methods mostly, so delayed unions were developed. But after management of soft tissue injury, healing time were short with bone graft as soon as possible, We consider that in cases in which internal fixation was possible according to soft tissue injury, delated unions are prevented by internal fixation using plate and screws or retrograde flexible nails.

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