Operative Treatment for Extensor Carpi Ulnaris Tendon Dislocation / 대한정형외과학회잡지

PURPOSE: Extensor carpi ulnaris (ECU) subluxation has a low incidence rate, to date, there has only been a few studies evaluating the operative treatment for type of injury. The purpose of this study was to retrospectively analyze 11 patients with ECU subluxation who underwent operative treatment. MATERIALS AND METHODS: Between March 2005 and February 2015, 11 patients received operative treatment. Magnetic resonance imaging and dynamic ultrasound were used to make the diagnosis. ECU subluxation patterns were classified by the Inoue's classification system. There were two cases of type A, one case of type B, five cases of type C, and three cases unfit for Inoue's classification. We also found two cases of radial subluxation and one case of ulnar locked subluxation. In type A and B cases, ECU tendons were relocated then sheaths repair was performed, and the extensor retinaculum reconstruction was performed. In type C cases, the fibro-osseous sheaths were fixed. In the three unclassified cases, extensor retinaculum reconstruction was performed. In all cases, fibro-osseous sheaths were fixed using the anchor suture technique. We compared the clinical results based on the following: motion range of the wrist joint; grip strength; visual analogue scale (VAS) score; quick disabilities of the arm, shoulder and hand (Q-DASH) score; and Mayo wrist score. RESULTS: The median age of patients at the time of the operation was 32 years, and the average follow-up period was 11.2 months. There were five cases of triangular fibrocartilage complex tear, two cases of distal radioulnar joint instability, three cases of ECU split tear as accompanying injury. There were significant differences in the clinical results. The average motion range of the wrist increased compared with the preoperative value (84.7% to 92.4% compared to contralateral normal side). The postoperative VAS score, Q-DASH score and Mayo wrist score showed better results compared with the respective preoperative values (6.0 to 1.1, 40.9 to 12.4, 75.9 to 86.4). CONCLUSION: ECU subluxation is a rare occurrence. Dynamic ultrasound is useful in diagnosing ECU tendon subluxation. Satisfactory results can be obtained with the use of a proper technique, which depends on the type of subluxation.

Effect of Axial loading on Lumbar spine MRI: Comparative Study of Effect between a Patient Group with Claudication and a Patient Group without Claudication

STUDY DESIGN: This study intended to find out differences of effects by axial loading in MRI examination in a patient group with neurologic claudication and a group without neurologic claudication. OBJECTIVES: It was intended to understand in which group the effects of axial loading can be expected when taking MRI on the lumbar spine. SUMMARY OF THE LITERATURE REVIEW: The study of Willen and Danielson found spinal canal stenosis, which cannot be found by existing methods comparing an MRI taken in bended posture of lumbar without axial loading implementation by MRI taken with axial loading implementation. Hiwatashi et al. also reported that there was a change of treatment direction by laminectomy after axial loading in patients who were intended to take a conservational treatment before the axial loading. MATERIALS AND METHODS: A total of 39 patients and 54 intervertebral discs were compared. The distances from a sagittal plane before and after intervertebral discs were compared by measuring a sectional area of dura mater in a horizontal plane image and two groups were compared by existence of patients' neurologic claudication. RESULTS: The AP diameter before and after a intervertebral discs increased into 41.98 mm from 41.1 mm on the average and the sectional area of dura mater showed 137.47mm2 before loading and 119.86mm2 after loading on the average. There was not a significant difference in the distances before and after axial loading implementation, but a significant difference was found in the sectional area of dura mater. CONCLUSION: Axial loading would contribute to diagnose spinal disease, and especially, spinal canal stenosis in a patient group with claudication.

Comparative Study of Clinical and Radiologic Outcomes of Unstable Distal Radius Fractures in Patients 70 Years or Older: Nonoperative Versus Operative Treatment

PURPOSE: Clinical and radiologic results of operative versus nonoperative treatment were compared in patients 70 years or older who had an unstable distal radius fracture. MATERIALS AND METHODS: From March 2007 to April 2009, 49 patients who had an unstable distal radius fracture treated nonoperatively (22 patients) or operatively (27 patients) were investigated. The radiologic results between the two patient groups were compared based on bone union, dorsal tilt, radial inclination and radial shortening. The clinical results were compared based on disabilities of arm, shoulder & hand (DASH) score, the patient-rated wrist evaluation (PRWE) score, the grip strength and the motion range of the wrist joint. RESULTS: At the last follow-up examination, DASH score, PRWE score, the flexion, supination and radial deviation of wrist joint and the grip strength did not showed significant difference. Among the patients who received non-operative treatments, 18 of 22 showed radiologically recognizable deformation; average dorsal tilt of 11.9degrees, the average radial inclination of 18.9degrees, and average radial shortening of 3.8 mm. The patients who received operative treatments showed average volar tilt of 3.3degrees, radial inclination of 18.8degrees+/-3.7degrees, and radial shortening of 1.5 mm. Three patients showed radiologically recognizable deformation. CONCLUSION: Our results suggest that nonoperative treatment is initially recommended in patients with the age of 70 years or older who have an unstable distal radius fracture in terms of functional results.

Minimally Invasive Reduction and Pin Fixation Treatment for Displaced Intraarticular Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: To evaluate the clinical efficacy of the minimally invasive posterior approach for the surgical treatment of intraarticular fracture of calcaneus. MATERIALS AND METHODS: From March 2006 to October 2008, we studied retrospectively 45 patients, 56 cases who were treated with minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and AOFAS score, circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared Bohler angle and Gissane angle. RESULTS: By Creighton-Nebraska score, Sanders type 1 was 81, type 2 was 75, type 3 was 69, type 4 was 61. By AOFAS score, Sanders type 1 was 88, type 2 was 82, type 3 was 78, type 4 was 63. And by circle draw test, type 1 was 8.8 cm, type 2 was 8.5 cm, type 3 was 8 cm, type 4 was 6.6 cm. Preoperative Bohler angle and Gissane angle were 7.2degrees, 98degrees, and it increased to 21.2degrees, 116degrees after postoperative 1 year. CONCLUSION: Minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture was considered to be an effective treatment modality.