Corrigendum: Inflammatory Cytokine Expressions of the Subacromial Bursitis and Glenohumeral Joint Synovitis in the Patients with Full Thickness Rotator Cuff Tear

This correction is being published to correct the order of the first and second authors' names in the above article.

Minimally Invasive Osteosynthesis with Locking Compression Plate for Distal Tibia Fractures

PURPOSE: To evaluate the outcome of minimally invasive osteosynthesis using locking compression plate for distal tibia fractures. MATERIALS AND METHODS: Forty five patients (45 cases) who underwent minimally invasive osteosynthesis using locking compression plate for distal tibia fractures between January 2006 and June 2008, were followed for more than one year. The average duration of the follow-up was 30.5 months (12~54 months). The fracture types were as followed: 26 cases (58%) of extraarticular fractures, 19 cases (42%) of intraarticular fractures, and 16 cases (36%) of open fractures. RESULTS: All patients achieved bone union at average of 21weeks (12~36 weeks). The average American Orthopedic Foot & Ankle Society ankle-hindfoot scales was 84.6 points (65~100 points) and range of ankle motion averaged at 46.5 degrees (20~60 degrees). Complications included 6 cases of superficial infection, 3 cases of malalignment and 5 cases of skin irritation by plate. There were no cases of deep infection, skin necrosis, shortening and metal breakage. CONCLUSION: Minimally invasive osteosynthesis using locking compression plate for distal tibia fractures is considered to be an effective method with high healing rate, rapid functional recovery and low complication rate due to minimal disruption of bone and soft tissue biology and improved fixation strength.

Treatment of the Unstable Distal Radius Fractures Using Volar Locking Plate Fixation / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate clinical and radiological results after open reduction and internal fixation of unstable distal radius fractures by using volar locking plates. MATERIALS AND METHODS: There were 73 consecutive unstable distal radius fractures treated by open reduction internal fixation using a volar locking plate. The mean age of patients was 55.5 years (range: 17-85 years): the study included 41 women and 32 men. The mean duration of follow up was 25.5 months (6.1-63.7 months). There were 18 type A, 5 type B, and 50 type C fractures by AO classification. For clinical evaluation, Green & O'Brien's modified scoring system and Demerit Point system were used. For radiological evaluation, radiographic index (radial length and radial inclination, volar tilt and ulnar variance) and Sarmiento's Criteria for Anatomic results were assessed. And, clinical results, the difference of mentioned radiographic index at preoperation, and immediate postoperative and last follow-up were compared according to AO classification and bone mineral density (BMD). RESULTS: Clinical results by the Green & O'Brien's scoring system were as follows: 46 excellent, 17 good, 9 fair, 1 poor by demonstrating more than good results in 86.3% of all cases. According to the Demerit point system, there were 50 excellent, 16 good, and 7, which showed more than good results in 90.4% of all cases. Bone union was achieved in all cases. Sarmiento Criteria showed 36 excellent, 21 good, and 16 fair. There were statistically significant improvements between preoperative and postoperative radial length, radial inclination, volar tilt and ulnar variance (p<0.05), whereas there were no statistically significant differences between those at immediate postoperative and last follow-up. There were no statistically significant differences in clinical results, measurements of radial length, radial inclination, volar tilt and ulnar variance between intragroup and intergroup, or in immediate postoperative and last follow-up according to fracture type and BMD. CONCLUSION: Volar locking plate fixation for distal radius fracture offers rigid fixation with insignificant reduction loss. It enables early rehabilitation and showed satisfactory clinical and radiological results. It is considered as an effective treatment option, regardless of fracture type and osteoporosis.

Prospective Evaluation of the Effectiveness of a Home-Based Program of Isometric Strengthening Exercises: 12-Month Follow-up

BACKGROUND: The aim of this prospective randomized clinical trial was to investigate the efficacy of a home-based program of isometric strengthening exercises for the treatment of the lateral epicondylitis (LE) of the distal humerus. We hypothesized that 1) use of isometric strengthening exercises would result in clinical benefits similar to those provided by medication and pain relief and 2) functional improvements after exercise would be time-dependent. METHODS: Patients were assigned to one of two groups: 1) an immediate physical therapy group (group I), or 2) a delayed physical therapy group (group D). Group I patients (n = 16) were instructed how to do the exercises at their first clinic visit and immediately carried out the exercise program. Group D patients (n = 15) learned and did the exercises after being on medications for 4 weeks. RESULTS: Outcomes at the 1-month clinic visit indicated that pain (measured using a visual analogue scale [VAS]) had been significantly reduced in group I compared to group D (p < 0.01). However, significant differences between groups were not found at 3-, 6-, and 12-month follow-up for either VAS scores or Mayo elbow performance scores. For modified Nirschl/Pettrone scores, a significant difference between groups was found only at the 1-month follow-up visit. By then, the number of participants who returned to all activities with no pain or occasional mild pain was six (37%) in Group I and two (13%) in Group D (p = 0.031). At the final follow-up visit, 88% of all participants performed physical activities without pain. CONCLUSIONS: Isometric strengthening exercises done early in the course of LE (within 4 weeks) provides a clinically significant improvement.

Massive Rotator Cuff Tears: Arthroplasty

PURPOSE: Surgical treatment of massive rotator cuff tear is challenging and there are various surgical options. The purpose of this article is to describe arthroplasty for the treatment of massive rotator cuff tear. MATERIALS AND METHODS: We reviewed all publications that focused on and/or mentioned arthroplasty as a treatment option for massive rotator cuff tear. RESULTS: Arthroplasty can be used as primary treatment and represents a salvage option for irreparable rotator cuff tear. Hemi-arthroplasty can provide satisfactory results by Neer's limited goals criteria in patients with intact coracoacromial arch. In addition, reverse total shoulder arthroplasty can be a salvage option for pain relief and restoration of active flexion in elderly patients with pseudoparalysis. CONCLUSION: In patients with massive rotator cuff tear, proper selection of arthroplasty can provide pain relief and restoration of functional range of motion in shoulder joints.

Intraneural Ganglion of Ulnar Nerve in Proximal Forearm: Case Report

Cubital tunnel syndrome is a compressive neuropathy of the ulnar nerve posterior to the medial epicondyle of the elbow. The etiology is either idiopathic, or secondary to deformity, ectopic ossification, space occupying lesion, or osteophytes in elbow osteoarthritis. As a rare cause of cubital tunnel syndrome, we report an intraneural ganglion of ulnar nerve developed in proximal forearm with symptoms of ulnar neuropathy.

Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft

PURPOSE: To evaluate the results of Acutrak-screw fixation without bone-graft for the treatment of stable scaphoid nonunion and to assess its prognostic factors. MATERIALS AND METHODS: Fifteen patients who underwent internal fixation using Acutrak-screw without bone graft for stable scaphoid nonunion were studied. Standard radiographs and CT were analyzed for degenerative changes (presence of cystic change and periscaphoid osteoarthritis), the nonunion site using fragment ratio and union. Clinically, patients age and the interval to surgery were evaluated. RESULTS: Mean follow-up duration was 31 months and 11 of 15 (73.3 percentages) cases healed at mean time of 12.8 weeks. Fragment ratio of nonunion site was 37.2 percentages in nonunion group and 54.2 percentages in union group (p=0.016). Presence of cystic change and periscaphoid osteoarthritis showed no singnificant statistical difference in both groups. Younger age lower than 20 years was closely related with bone union (p=0.001). But there were little correlation between bone union and interval to surgery. CONCLUSION: Internal fixation without bone graft showed 73.3 percentages of overall union rate in the treatment of stable scaphoid nonunion. And young patients who have distally located stable scaphoid nonunion can be successfully treated with internal fixation without bone graft.

Bizarre Parosteal Osteochondromatous Proliferation of Middle Phalanx: A Case Report

Although bizarre parosteal osteochondromatous proliferation does not frequently occur, this calcified, osteal, chondromatous tumor has relatively high recurrence rates and presents clinical, radiological, histological features that can be classified with other lesions. And it is a benign disease that until now, there were no death or metastasis reports because of this tumor. This proliferation is hard to distinguish between other benign tumors and non-neoplastic lesions if it is occurred in small bone of hand or foot. We experienced bizarre parosteal osteochondromatous proliferation of middle phalanx of the little finger, and report this case and the review of relevant literature.

Plate Fixation of AO Type C3 Fractures of the Distal Radius

PURPOSE: To evaluate clinical and radiographic results of open reduction and internal fixation with plate in AO type C3 distal radius fracture. MATERIALS AND METHODS: We treated 18 fractures and the mean follow up was 16 months. The average age was 47.1 years old, 12 male and 6 female were included. There were 9 C3.1 fracture, 5 C3.2 and 4 C3.3. Green & O'Brien's modified clinical scoring system and Demerit Point system were applied to evaluate clinical results, for radiographic evaluation, radial length, radial inclination, volar tilt, and Sarmiento's Criteria for Anatomic results were assessed. RESULTS: Clinical results were 5 of excellent, 7 of good, and 6 of fair by Green & O'Brien's score and were 5 of excellent, 6 of good, and 7 of fair by Demerit point. There was no significant difference of radiographic results between immediate postoperation and last follow-up, and Sarmiento's Criteria showed 8 excellent, 4 good, and 6 fair. CONCLUSION: The open reduction and internal fixation with plate in AO type C3 distal radius is considered as a good treatment method that particularly benefits from fracture stable fixation without fixation loss and early rehabilitation.

Distribution of Glomus Tumors in Fingers

PURPOSE: Glomus tumor has known as smaller than 1 cm, hard to palpate, therefore patients often suffer from chronic pain. Based on our experiences about glomus tumors, we would like to evaluate their distributions. MATERIALS AND METHODS: This study includes 24 cases that underwent surgery for clinically diagnosed glomus tumor from January, 2001 to May, 2009. Clinical symptoms were firstly evaluated and ultrasonography in 8 cases and Magnetic Resonance Imaging (MRI) in 5 cases were performed for more accurate diagnosis and localization. Complete resection with biopsy was done in all cases. RESULTS: According to pathologic findings, 20 out of 24 cases were reported as glomus tumor, and the other 4 cases were 2 fibrous tumor with chronic inflammation, 1 hemangioma, and 1 neuroma. Twenty glomus tumors at dorsal side under the nail were distributed to proximal radial in 11 cases, proximal ulnar in 6 cases, distal radial in 2 cases and distal ulnar in 1 case. Tumors were more frequently found at proximal in 17 cases(85%) and at radial side in 13 cases(65%). CONCLUSIONS: Glomus tumors tend to occur under nail of proximal and radial part. We think that accurate diagnosis and location of glomus tumors are needed to complete surgical resection.

The Radiologic and Clinical Changes after Open Complete Repair of Massive Rotator Cuff Tears

PURPOSE: This study evaluated the preoperative and postoperative radiologic findings of patients with complete repairs after massive rotator cuff tears along with the incidence of re-tear and the clinical outcomes. MATERIALS AND METHODS: This study evaluated 33 cases who had open complete repairs for massive rotator cuff tears and these patients were followed up for more than 24 months. The clinical evaluation was performed according to the shoulder joint function test of the American Shoulder and Elbow Surgeons (ASES), and the degree of arthritis related to the massive rotator cuff tears was evaluated using the Hamada classification. RESULTS: The ASES scores improved from 37.6 preoperatively to 85.6 postoperatively. The mean preoperative acromio-humeral interval (AHI) score was 6.5 mm, which increased to 9.3 mm immediately after surgery, and there was a decreased to 6.5 mm noted at the last follow up. The lower radiology stages of arthritis according to the classification showed better preoperative and postoperative results. CONCLUSION: An open complete repair as the surgical treatment for a massive rotator cuff tear showed satisfactory results for pain relief and an improvement in the shoulder joint function though re-tear after surgery.

New Fibular Strut Graft Technique to Minimize Donor Site Complications / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of a periosteal sleeve preserced fibular strut graft for the minimization of donor site complications. MATERIALS AND METHODS: Between September 1998 and March 2005, 20 patients who were followed for more than 12 months after the fibular sturt graft for a bone defect using a periosteal sleeve preservation technique were evaluated. The mean age was 13.3 years (range, 2-29 years) and the mean follow-up period was 16.2 months (range, 12-36 months). RESULTS: The mean time for the union of the primary disease was 3.3 months (range, 2-6 months) and for regeneration of the donor site was 9.1 weeks (range, 4-12 weeks) in 13 cases. Partial regeneration developed in 6 cases and there was no regeneration in 1 case. There were 2 cases of donor site complications. CONCLUSION: The new fibular strut graft technique is very effective method for reconstruction of a bone defect with a minimization of the donor site complications particularly in children.

The Surgical Outcomes for Isolated Greater Tuberosity Fracture of Proximal Humerus

PURPOSE: To evaluate the adequate surgical methods and postoperative rehabilitation by analyzing the outcome of surgical treatment for isolated greater tuberosity fracture of proximal humerus. MATERIALS AND METHODS: Ten patients who allowed at least 1 year follow up after the surgical treatment of isolated greater tuberosity fractures were evaluated. Their mean age was 52.3 years (range, 28~67) and mean follow up duration was 23.8 months (range, 12~36). We choosed the different approaches and fixation methods according to size, location and presence of comminution of the fragment, and combined injury. The rehabilitation programs were indivisualized and we evaluated the clinical outcomes using UCLA and Constant scoring system. RESULTS: According to the UCLA scoring system, 5 cases were excellent, 3 cases were satisfactory, and 2 cases were unsatisfactory. By the Constant scoring system, 8 cases were excellent and 2 cases were good. The average bony union time was 7.6 weeks (range, 6~8) except the 2 cases of revision surgery. Two cases were operated using cannulated screws alone, 3 cases using only nonabsorbable sutures and 5 cases using cannulated screws and nonabsorbable sutures. One out of two revision cases was developed from the negligence of preoperative shoulder anterior dislocation with rupture of subscapularis, and the other was caused by improper immobilization of the fracture site postoperatively. CONCLUSION: Not only the adequate surgical approaches and the fixation methods according to the size and comminution of fragment, but also the identification of combined injuries were very important in the surgical treatment for the isolated greater tuberosity fracture. And we considered that the adequate postoperative rehabilitation and proper protection based on the intraoperative fixation stability play an important role for the better clinical and radiological outcomes.

The Amount and Related Factors of Reduction Loss in Distal Radius Fracture after Treatment by Kapandji Technique

PURPOSE: To evaluate the amount and related factors of reduction loss in distal radius fracture after treatment by Kapandji technique. MATERIALS AND METHODS: From September 2004 to May 2006, 44 cases (43 patients) of distal radius fractures were treated by Kapandji technique. Fracture were classified with AO classification and volar tilt, radial inclination, and radial length were measured in preoperative, immediate, postoperative radiographs. Also the amount and related risk factors of reduction loss were analyzed. In addition, the radiological results at last follow up were evaluated using modified Lidstrom scoring system. RESULTS: There was significantly more reduction loss of volar tilt in the patients with AO type C comparing with other fracture types, but the patients who were treated using three k-wire fixations including intrafocal K-wires showed significantly more reduction loss of volar tilt also. Overall radiological results at last follow up showed that excellent was 50% in cases with dorsal comminution, but, the other cases 90%. In addition, excellent was 70% in type A cases, but, in type C 44%. CONCLUSION: Kapandji technique percutaneous pinning is the one of effective treatment options for distal radius fracture. But, type of fracture, total number of K-wires, and presence of dorsal cortical comminution showed the significant relation with postoperative reduction loss of volar tilt and overall radiological results at last follow up.

Winged Scapula Caused by Rhomboideus and Trapezius Muscles Rupture Associated with Repetitive Minor Trauma: A Case Report

We experienced a rare case of winged scapula that was caused by the rupture of the rhomboideus major and the lower trapezius muscles without any nerve injury in a 12 yr old female after she had carried a heavy backpack. Electrodiagnostic study revealed that the onset latencies, amplitudes and conduction velocities were normal in the long thoracic nerve, the spinal accessory nerve and the dorsal scapular nerve. The needle EMG findings were normal as well. An explorative operation was performed and the rupture of the rhomboideus major and lower trapezius muscles was detected. Direct surgical repair of the ruptured muscle was carried out and the deformity was corrected. The anatomical and functional restoration was satisfactorily accomplished.

Negative Pressure Wound Therapy for Traumatic Soft Tissue Defects

PURPOSE: To evaluate the negative pressure wound therapy for traumatic soft tissue defects by vacuum-assised closure (V.A.C.(R)). MATERIALS AND METHODS: 33 patients with traumatic soft tissue defects were treated by using V.A.C.(R) which removes edema fluid, eliminates an extrinsic cause of microcirculatory embarrassment and may directly stimulate cellular proliferation of reparative granulation tissue. We removed all necrotic tissue prior to application of the V.A.C.(R). The foam dressing was placed into direct contact with wound and was changed every 48~72 hours. The setting for vacuum pump was continuous pressure of 100 to 125 mm Hg. C-reactive protein was checked to evaluate wound infection. We measured wound size and total duration of treatment. RESULTS: Mean duration of treatment was 25.2 days and mean decrease of wound size was 31.9%. The concentration of CRP after V.A.C.(R) therapy reduced by day 8 below 1.0 mg/dl and gradually decreased to normal level by day 10. All patients showed hastened wound healing by rapid formation of granulation tissue. CONCLUSION: Negative pressure wound therapy is useful in patients with traumatic soft tissue defects, which reduces treatment duration and cost by rapid wound healing and effective infection control.

The Treatment of Unstable Proximal Humerus Fracture Using Locking Plate

PURPOSE: The purpose of this study was to determine the results of internal fixation with locking plate system for the unstable proximal humerus fracture. MATERIALS AND METHODS: Sixteen cases of unstable proximal humerus fracture were treated using locking plate system between September 2004 and June 2005. Average age of the patients was 55.6 years (range, 22 to 78), male was four patients, female was twelve. The clinical outcomes were evaluated by using Neer's evaluation criteria and Constant socring system. We analyzed the radiological results by bony union time and Paavolainen method. All data was analyzed statistically. RESULTS: According to Neer's evaluation ciriteria, eleven cases (69%) showed excellent or satisfactory results and according to Constant scoring system, twelve cases (75%) showed excellent or good result. Twelve cases (75%) showed good results by Paavolainen method. In all cases, bony union was obtained in average 12.8 weeks after operation. There were two complications; one screw irritation and one screw loosing. CONCLUSION: The patients treated using locking proximal humerus plate could exercise earlier due to good initial stability. And the clinical and radiological results were relatively good. The treatment of unstable proximal humerus fracture with locking plate system was considered as a good method.

Pathoanatomical Factors Responsible for Femoral Shortening in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to determine the relative contributions made by pathoanatomical factors responsible for femoral shortening in Legg-Calve-Perthes disease (LCPD), and to devise a method of reducing the amount of residual shortening based on a better understanding of its pathoanatomy and developmental pattern in LCPD. MATERIALS AND METHODS: We measured shortening of three anatomical components, namely, the femoral epiphysis, neck, and diaphysis on the teleoroentgenograms of 106 LCPD patients, comprised of 35 children with active disease, 24 in the healing stage, and 47 at skeletal maturity. RESULTS: The proportional contributions made by these 3 anatomical components to residual shortening at skeletal maturity were; 20% by the epiphysis (epiphyseal flattening), 53% by the neck (physeal growth retardation), and 27% by the diaphysis (underuse atrophy). These contributions differed according to disease stage and shortening severity. Mean diaphyseal shortening was 3.9 mm at skeletal maturity, but this increased to 5.8 mm when only patients with severe shortening (20 mm or more) were included. CONCLUSION: Our findings suggest that diaphyseal shortening is likely to be minimized by the implementation of limb exercise programs.

Brachymetatarsia of the First Metatarsal treated by Callotasis / 대한족부족관절학회지

PURPOSE: To analyze the outcome of metatarsal lengthening of first brachymetatarsia by callotasis using an external fixator. MATERIALS AND METHODS: Between January 1998 and February 2004, 10 patients (17 cases) were reviewed. The mean age at operation was 17.3 years. Seven patients had bilateral first brachymetatarsia and eight patients had combined 4th brachymetatarsia. The operations were performed with a monoexternal fixator, and distraction was started at a rate of 0.75 mm/day after 7 days. The radiographic results were evaluated by lengthening amount and percentage, fixation time, and healing index. Complications and AOFAS score were evaluated. RESULTS: The average lengthening amount was 17.7 mm and the average lengthening percentage was 43.4%. The external fixation time was 107 days and average healing index was 69.8 days/cm. The evaluation according to AOFAS score was excellent in 12 cases and good in 5 cases. Complications were 4 cases of hallux valgus, 4 of metatarsophalangeal joint stiffness, 3 of medial angular deformity, 3 of pes cavus, 2 of pin breakage, 2 of pin site infection, and 1 of skin hyperpigmentation. CONCLUSION: Callotasis for 1st brachymetatarsia is a very useful treatment method with high patient satisfaction, excellent healing rate and early ambulation without bone graft. Nevertheless, great care must be taken to minimize the various possible complications.

Brachymetatarsia of the First Metatarsal treated by Callotasis / 대한족부족관절학회지

PURPOSE: To analyze the outcome of metatarsal lengthening of first brachymetatarsia by callotasis using an external fixator. MATERIALS AND METHODS: Between January 1998 and February 2004, 10 patients (17 cases) were reviewed. The mean age at operation was 17.3 years. Seven patients had bilateral first brachymetatarsia and eight patients had combined 4th brachymetatarsia. The operations were performed with a monoexternal fixator, and distraction was started at a rate of 0.75 mm/day after 7 days. The radiographic results were evaluated by lengthening amount and percentage, fixation time, and healing index. Complications and AOFAS score were evaluated. RESULTS: The average lengthening amount was 17.7 mm and the average lengthening percentage was 43.4%. The external fixation time was 107 days and average healing index was 69.8 days/cm. The evaluation according to AOFAS score was excellent in 12 cases and good in 5 cases. Complications were 4 cases of hallux valgus, 4 of metatarsophalangeal joint stiffness, 3 of medial angular deformity, 3 of pes cavus, 2 of pin breakage, 2 of pin site infection, and 1 of skin hyperpigmentation. CONCLUSION: Callotasis for 1st brachymetatarsia is a very useful treatment method with high patient satisfaction, excellent healing rate and early ambulation without bone graft. Nevertheless, great care must be taken to minimize the various possible complications.