Treatment Results for Unstable Distal Clavicle Fractures Using Hybrid Fixations with Finger Trap Wire and Plate / 대한정형외과학회잡지

Purpose@#This study assessed the results of surgical treatment for Neer type-II and type-V unstable distal clavicle fractures via hybrid fixation with a locking compression plate and finger trap wire. @*Materials and Methods@#From September 2016 to April 2018, 15 patients treated for Neer type-II and type-V unstable distal clavicle fractures using hybrid fixation were analyzed retrospectively. The clinical results were analyzed based on the radiological healing time, range of motion of the shoulder joint, American Shoulder and Elbow Society (ASES) score, and the University of California at Los Angeles (UCLA) shoulder score. @*Results@#The range of motion of the shoulder joint completely recovered to the normal range within 9.2 weeks on average (6−24 weeks). Furthermore, the follow-up of the clinical trial showed excellent results, including an ASES score of 98.5±2.3 and an UCLA score of 34.2±1.3. In addition, fracture union was successfully achieved in all cases, and was identified during week 15 on average. @*Conclusion@#For the treatment of unstable distal clavicle fractures, hybrid fixation is a useful surgical method with excellent clinical outcomes through rapid recovery of the range of motion of the shoulder joint after surgery.

Effect of Steroid Treatment in Myasthenia Gravis

Twenty-one myasthenic patients were treated with high-dose daily prednisone regimen at Seoul National University Hospital from May 1983 to January 1985. Observations in relation to dosage, drug schedule, clinical responses, and sideeffects led us to following conclusions concerning the management of myasthenia gravis with steroid. In addition, factors influencing the result were considered. 1) Among 21 patients, twenty(95%) showed clinical improvement of variable degrees. 2) Significant improvement could be expected especially in male patients, in older patients, and in those with duration of myasthenia gravis less than 6 months prior to treatment. Performance of thymectomy or thymothymectomy, thymic pathology, and clinical grade at the time of therapy were not considered to affect the outcome. 3) Ten cases (48%) suffered from initial exacerbations, most of which occurred within the first four days of treatment. Steroid-induced crises developed in four cases with preexisting brittle or severe generalized myasthenia. 4) Period taken to show the initial response and the maximum improvement varied widely but majority of them occurred within 15 days and 70 days respectively. 5) Off-day weakness during the alternate-day schedule required special cautions and, if persitent, immediate return to daily schedule was desirable. 6) Thymectomy prior to steroid treatment was not always necessary but, when both regimens were scheduled together, preparation therapy with steroid thought to be more favorable. 7) Aside from initial exacerbations side-effects during the treatment were not remarkable, all of which disappeared with reduction of dosage.

A Clinical Study on Guillain-Barr'e Syndrome

Authors reviewed clinical recordings of 102 patients who were diagnosed as Guillain-Barre syndrome from 1979 to 1983 at Seoul National University Hospital. Among them, eighty-five cases were selected for the clinical study of Guillain-Barre syndrome through application of strict diagnostic criteria. And the following results were obtained. 1) There was a male preponderance (2.5:1) and an apparent predilection for the first and the second decades in this series. 2) Seasonal predilection was in summer and fall over five years. As judged from the uneven monthly incidence rate in each year, some epidemic tendency is likely to be in Guillain-Barre syndrome. 3) Sixty cases (71%) of this series had a history of antecedental events. The onset of neuritic symptoms occurred within one week from the preceding events in twenty-nine cases and one to two weeks in twenty cases. 4) The neuritic symptoms started from lower limbs in fifty cases (59%), upper limbs in eighteen (21%), cranial nerve distribution in six (7%) and developed nearly simultaneously in eleven (13%). 5) Most of the disabilities of the patients were devided into flaccid paralysis of limbs, cranial nerve dysfunction, autonomic dysfunction, respiratory difficulty and sensory abnormalities (paresthesia and myalgia). Autonomic dysfunction was observed in nine cases (11%), respiratory difficulty in thirty-one (37%), sensory abnormality in thirty-two (38%), and cranial nerve dysfunction in forty-seven (55%). 6) Authors devided the crainal nerve dysfunction into facial diplegia which was the most frequent form, bulbar palsy the next, masticatory muscle weakness the third, and ocular paresis the least. 7) There were two cases of Fisher syndrome (2.4%), three cases of polyneuritis cranialis (3.5%), and two cases of recurrence (2.4%) in this series. 8) Two cases (2.4%) died of respiratroy and bulbar dysfunction. Five cases (6%) had residual disability in motor function till six months follow-up.