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There is a growing interest in the factors related to insufficiency fractures. We are going to report three insufficiency fracture cases which are considered to be caused by osteoporosis, rheumatoid arthritis, steroid use and femoral shaft bowing among the patients not taking bisphosphonate. All cases are caused by low energy trauma and among these cases, one patient is being presented with a prodromal symptom and another patient complains of both prodromal symptoms and bilateral lesions.
Arthritis, Rheumatoid ; Femur ; Fractures, Stress ; Humans ; Osteoporosis ; Prodromal Symptoms

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Efficacy of Percutaneous Cerclage Wiring in Intramedullary Nailing of Subtrochanteric Femur Fracture: Technical Note.

Ki Chul PARK ; Hee Soo KIM

Journal of the Korean Fracture Society.2013;26(3):212-216. doi:10.12671/jkfs.2013.26.3.212

The subtrochanteric fractures of femur have high rates of delayed union or nonunion due to less-dense cancellous bone, insufficient cortical blood flow and high stress concentration. Anatomical reduction and rigid internal fixation are important in this region; however, an open reduction might damage the biological environment at the fracture site as well as increase the risk of nonunion. We present our experience with nine cases of subtrochanteric femur fractures surgically fixated with intramedullary nailing after percutaneous cerclage wiring through minimal incision.
Femur ; Fracture Fixation, Intramedullary ; Hip Fractures

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Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture.

Sung Won CHO ; Sang Ho HA ; Gwang Chul LEE ; Woong Hee KIM

Journal of the Korean Fracture Society.2013;26(3):205-211. doi:10.12671/jkfs.2013.26.3.205

PURPOSE: To analyze the clinical and radiologic results of minimally invasive plate osteosynthesis (MIPO) for distal femur fractures using a locking compression plate (LCP) and to evaluate its usefulness. MATERIALS AND METHODS: From May 2006 to April 2011, 23 patients (24 cases) with distal femur fracture were treated by MIPO with a LCP and followed-up for at least 12 months. Mean age was 61.6 years (35-80 years). Union time and post-operative alignment were measured on radiograph, and clinical function was evaluated by range of motion (ROM), Knee Society Score and complications. RESULTS: In 22 patients (23 cases) except for 1 case, bony union was obtained after an average of 18 weeks (12-26 weeks). The mean ROM was 124 degrees (80-135 degrees). According to the Knee Society Score, there were 12 excellent, 8 good, 1 fair and 2 poor results and the mean score was 87.5 (60-98). Postoperative complications were nonunion in 1 case, ankylosis in 1 case, malunion in 2 cases and superficial wound infection in 2 cases. CONCLUSION: The treatment of distal femoral fracture with MIPO using a LCP was considered a useful method which can result in satisfactory clinical and radiologic outcomes if there is accurate understanding about the surgical techniques and appropriate procedures involved.
Ankylosis ; Femoral Fractures ; Femur ; Humans ; Knee ; Postoperative Complications ; Range of Motion, Articular ; Wound Infection

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Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures.

Se Ang JANG ; Young Ho CHO ; Young Soo BYUN ; Ki Hong PARK ; Hyun Seong YOO ; Chul JUNG

Journal of the Korean Fracture Society.2013;26(3):199-204. doi:10.12671/jkfs.2013.26.3.199

PURPOSE: To find out the effect of early closed reduction and internal fixation (within 24 hours after admission to hospital) on the morbidity and mortality in the elderly with intertrochanteric fractures of the femur. MATERIALS AND METHODS: Retrospectively, we analyzed 99 patients with intertrochanteric fracture of the femur who underwent surgery from January, 2009 to December, 2010. We reviewed 89 of the 99 patients and checked for early complications and reviewed the mortality rates 3 months, 6 months and 1 year after surgery. There were 24 males and 65 females. The average age was 79.8 years (61-99 years). According to the American Society of Anesthesiologists classification, 25 patients were class 1, 37 patients were class 2, 26 patients were class 3, and 1 patient was class 4. All patients were operated on by one surgeon, who was skilled in inserting intramedullary nail. RESULTS: The average surgical time was 43 minutes and the average intraoperative blood loss was 165 ml. Sixteen patients experienced delirium but all of them recovered. One patient had pneumonia at one month after surgery. Pressure sores developed in one patient but improved with conservative treatment. Pulmonary thromboembolism developed in some patients one month after surgery. Three patients (3.4%) died within three months and one patient (1.1%) died between three and six months after surgery, but no patient died between six months and one year after surgery. CONCLUSION: If patients are optimized for the operation, early internal fixation of trochanteric fracture in elderly patients after arrival at the hospital should be considered to reduce early complications and mortality.
Aged ; Delirium ; Female ; Femur ; Hip Fractures ; Humans ; Male ; Operative Time ; Pneumonia ; Pressure Ulcer ; Pulmonary Embolism ; Retrospective Studies

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Arthroscopic Assisted Intra-Articular Reduction and Internal Fixation of Tibia Plateau Fracture.

Dong Hwi KIM ; Gwang Chul LEE ; Kwi Youn CHOI ; Sung Won CHO ; Sang Ho HA

Journal of the Korean Fracture Society.2013;26(3):191-198. doi:10.12671/jkfs.2013.26.3.191

PURPOSE: We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts. MATERIALS AND METHODS: From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system. RESULTS: The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases. CONCLUSION: We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.
Arthroscopy ; Depression ; Displacement (Psychology) ; Humans ; Knee Joint ; Tibia ; Tibial Fractures ; Transplants

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Intrapelvic Anterior Plate Fixation for Crescent Fracture-Dislocation of Sacroiliac Joint.

Kwang Jun OH ; Jin Ho CHOI

Journal of the Korean Fracture Society.2013;26(3):184-190. doi:10.12671/jkfs.2013.26.3.184

PURPOSE: To evaluate the radiological and clinical outcomes of intrapelvic anterior plate fixations for Day Classification Type II crescent fracture-dislocations of sacroiliac joints. MATERIALS AND METHODS: Ten patients who had undertaken the surgical treatment for the sacroiliac joint from 2006 to 2012 were enrolled in this study. All cases fell into Type II by Day Classification for sacroiliac joint injuries. For surgical treatments, the plate fixation through the intra-pelvic anterior approach was first performed for all cases and anterior ring fixation was performed in 4 cases with more severely displaced anterior pelvic ring injuries. Then, radiological and clinical evaluation was implemented. RESULTS: The bone union was observed from all patients whom performed the surgical fixation. In the radiological results, 9 cases with the anatomic and nearly-anatomic reductions were observed. Out of the 10 cases which performed the rotational displacement analysis, there were 3 excellent cases, 6 good cases and 1 fair case. The 10 cases that performed the deformity index and vertical displacement analysis, less variations were observed in the anterior ring fixations after intra-pelvic anterior plate fixation group. According to the clinical results, 4 excellent cases, 3 good cases, and 3 moderate cases were observed. CONCLUSION: In the Type II crescent fracture-dislocation of sacroiliac joint, the intrapelvic anterior plate fixation achieved satisfactory anatomical reductions, radiological stabilities and clinical results.
Congenital Abnormalities ; Displacement (Psychology) ; Humans ; Sacroiliac Joint

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Treatment of Unstable Sacral Fractures Related to Spino-Pelvic Dissociations.

Hong Sik KIM ; Jung Hwan LEE ; Ki Chul PARK ; Ye Soo PARK

Journal of the Korean Fracture Society.2013;26(3):178-183. doi:10.12671/jkfs.2013.26.3.178

PURPOSE: To evaluate the outcomes of surgical treatment modality in unstable sacral fractures combined with spinal and pelvic ring injury depending on the presence of spino-pelvic dissociations. MATERIALS AND METHODS: The subjects were 16 patients, with unstable sacral fractures combined with spinal and pelvic ring injuries, were operated from July 2004 to January 2011. The patients were divided into 2 groups depending on the presence of spino-pelvic dissociations: those with dissociations were group 1, and those without dissociations were group 2. Group 1 was treated with spino-pelvic fixations using iliac screw, while group 2 was treated with percutaneous iliosacral screw fixations. The availability of the radiological bony union with its application periods, and clinical results using visual analogue scale (VAS) and oswestry disability index (ODI) were evaluated, retrospectively. RESULTS: Out of 16 patients, 8 patients in group 1 were treated with spino-pelvic fixation using iliac screw, and 8 patients in group 2 were treated with percutaneous iliosacral screw fixation. The mean bony union period was 17.4 weeks in group 1, and 19.6 weeks in group 2. The Mean VAS and ODI scores on the last follow-up were 2.5 points and 15.6 points in group 1, 2 points and 18.8 points in group 2, respectively. Both groups had favorable clinical results at the last follow-up. CONCLUSION: For surgical treatments of unstable sacral fractures, spino-pelvic fixation using iliac screws is advised for cases with combined spino-pelvic dissociation, while percutaneous iliosacral screw fixation is advised for cases without combined dissociation.
Dissociative Disorders ; Follow-Up Studies ; Humans

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The Character of Reverse Obliquity Intertrochanteric Fractures in Elderly Patients.

Ji Wan KIM ; Jae Suk CHANG ; Jung Hwan SUNG ; Jung Jae KIM

Journal of the Korean Fracture Society.2013;26(3):173-177. doi:10.12671/jkfs.2013.26.3.173

PURPOSE: To discriminate the characteristics between reverse obliquity fractures in the elderly and that of young adults using three-dimensional computed tomography (3D CT). MATERIALS AND METHODS: Eighteen patients who had reverse obliquity intertrochanteric fractures were enrolled from January 2007 to March 2012. The fracture pattern was analyzed using the 3D CT. The area showing low density (bone defect) of trochanter and femoral neck region was measured. Patients were divided into two groups: Group I, less than 65 years old and Group 2, 65 years and over. RESULTS: In all 9 cases of group 1, the proximal fragment had a 'V' shape with an average of 5.6 cm below the vastus ridge; however, the fracture of 8 cases (88.97%) in group 2 had a 'Lambda' shape of the distal fragment at the level of vastus ridge and an additional fracture line extending to the greater trochanter tip. The bone defect volume of the trochanter and femoral neck region was larger significantly in group 2 than in group 1. CONCLUSION: Reverse obliquity intertrochanteric fracture in the elderly demonstrated a pattern of bursting fracture with 4 parts, which had different patterns from that of young patients. We believe that the larger volume of bone defects resulted in the difference of fracture patterns between the two groups.
Aged ; Femur ; Femur Neck ; Hip Fractures ; Humans ; Young Adult

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