Latissimus Dorsi Tendon Transfer for the Treatment of Irreparable Rotator Cuff Tears

PURPOSE: Massive and irreparable rotator cuff tears present a difficult treatment problem, and if further progressed, then cuff tear arthropaty may develop. We treated seven cases of massive rotator cuff tears with latissimus dorsi tendon transfer and report their clinical results. METHODS: Seven patients of mean age of 64 years (range, 51-70 years) with irreparable massive rotator cuff tears were treated using latissimus dorsi tendon transfer. The latissimus dorsi flap was harvested through an axillary approach and reattached on the greater tuberosity, using transosseous suture with non-absorbable sutures. Outcomes were assessed clinically and radiographically after an average of 48 months (range, 28-68 months). RESULTS: The VAS pain scores improved from 6.3 to 3.3 points (p=0.019). Forward flexion increased from 62° to 105°, abduction increased from 49° to 94°, and external rotation increased from 15° to 34°. Postoperative antero-posterior radiography revealed a mean 0.1 mm depression of the humeral head, without statistical the mean American Shoulder and Elbow Surgeons score improved from 44 to 76. The acromiohumeral distance showed slight increase in amount of 0.1 mm without statistical significance. There was no complication. CONCLUSION: Latissimus dorsi transfer is a useful surgical option for treating irreparable massive rotator cuff tears.

Correction of Post Burn Extension Contracture of 4, 5th Toes Using Free Flap

Old post burn contractures on feet still remain challenging problem for reconstructive surgeon. A 43-year-old male visited Hallym University Sacred Heart Hospital with the complain of foot deformity and difficulties in shoe fitting. His right 4th and 5th toes were inverted at dorsal foot. We released the contracture of 4, 5th metatarsophalangeal joint and lengthened extensor tendon by Z-plasty, and covered the resultant defect with the anterolateral thigh flap. The flap was successful and the deformity was corrected. As there have been few reports on reconstruction of foot dorsum, especially on post burn extension contractures in the toes, we report a rare case of contracture release and coverage by free flap.

Open Reduction Through the Modified Volar Approach in Complex Dorsal Dislocations of the Metacarpophalangeal Joint

PURPOSE: To describe the surgical treatment of the complex dorsal metacarpophalangeal dislocations and its results, emphasizing on the modified volar approach with A1 pulley release. MATERIALS AND METHODS: We experienced 6 cases of dorsal dislocation of the metacarpophalangeal joint. We performed open reduction with the modified volar approach described by Eaton and Dray. Postoperatively posteroanterior and lateral radiographs of the index finger metacarpophalangeal joint and metacarpophalangeal joint range of motion was followed. RESULTS: One case with a large osteochondral fracture was operated with volar and doral approach both. Overall end results were good without any significant restriction of motion and stability of the fingers. CONCLUSION: Modified volar approach with A1 pulley release is an excellent method for complex dorsal metacarpophalangeal dislocations without osteochondral fracture.

Myositis Ossificans in the Finger: A Case Report

Myositis ossificans is a solitary benign ossifying lesion in the soft tissue. Occurring predominantly in muscles, a similar lesion may occasionally be found in subcutaneous tissues, tendons, fascia and periosteum. It is often misdiagnosed as an extraskeletal osteosarcoma because of its rapid growth. Therefore, it is sometimes called pseudomalignant myositis ossificans. Myositis ossificans rarely occurs in the distal portion of the finger. We present a case of myositis ossificans of finger and review the the clinical, radiographical, and histological presentation, as well as the appropriate therapeutic management.

Coverage of the Severely Traumatized Extremity by Emergency Free Flap: Case Report

Emergency free flap has been advocated to cover the severely injured extremity for more than two decades, due to its numerous advantages such as low incidence of flap failure and infection rate and early recovery of function. But there are very few reports about these. The authors report their experience in using the emergency free flap for reconstruction of extremities. For last 10 years, 4 patients ranging from 3 to 27 years old with severely traumatized extremities were treated with emergency free flap transfers. Three were males and the other was a female. Flap size ranged from 2x5 cm2 to 7x22 cm2. The locations of the recipient site were the dorsum of the foot, the cubital fossa, the popliteal fossa and the upper arm. The number of the donor sites used was as follows: one scapular flap, two parascapular flaps, and one radial forearm flap with the radial bone. All of the flaps survived without need of re-exploration. There was no infection or flap loss. Involved joints have recovered a normal range of motion. Therefore, we consider that the emergency free flap is a very safe and reliable method to cover the severely injured extremities.

Nailbed Repair using 2-octyl Cyanoacrylate (Dermabond(R))

PURPOSE: Nailbed repair using fine 6-0 or 7-0 absorbable sutures can be technically demanding and time-consuming. We describe a simpler method of nailbed repair using 2-octyl cyanoacrylate (Dermabond(R)) topical adhesive. MATERIALS AND METHODS: Fifteen consecutive patients with nailbed injuries not involving the germinal matrix were repaired with Dermabond(R). There were 7 simple lacerations, 4 stellate lacerations and 4 severe crush injury according to Zook's classification. The appearance of the nail at twelve months was graded according to ridging, splitting, deformity, and sheen of the nail. RESULTS: Nailbed repairs using Dermabond(R) took on average 3.2 minutes to complete. Six patients had excellent aesthetic results, Eight had good results, and one patient with a crush injury had a fair result. There were no complications. CONCLUSION: Dermabond(R) is a useful tool for rapidly repairing acute nailbed injuries. The outcome of repairing injuries not involving the germinal matrix is similar to that expected for suture repairs of similar injuries.

Is the Distant Pedicled Flap Still Useful in Reconstruction of the Injured Hand?

INTRODUCTION: The purpose of this study is to evaluate the necessity of distant pedicled flap in the treatment of soft tissue defects in the hand. MATERIALS AND METHODS: Distant pedicled flap was performed in the 25 hands of 25 patients from 2000 to 2004. There were 20 males and 5 females and mean age was 34 years. The surgery was done for electrical burns in 13 patients, flame burns in 8 patients and crushing injuies in 4 patients. RESULTS: We have performed 25 distant pedicled flaps for the coverage of soft tissue defects in the hands when local and free flaps were unavailable. Soft tissue coverages by distant pedicled flap were completely successful in all the 25 hands. No complication such as total flap loss, marginal flap loss and infection occurred. CONCLUSION: Distant pedicled flaps were very useful alternative method in the treatment of soft tissue defect in the hand.

Free Fillet Flap of the Forearm Amputee for Coverage of the Contralateral below Elbow Amputee and Restoration of the Flexion of the Elbow

Free vascularized tissue transfer to preserve upper extremity amputation level is uncommon but very useful procedure. To cover the below-elbow amputee stump and restore the function of the elbow, we have used a free flap as a spare part concept from the contralateral hand which was so severely damaged that amputation was inevitable.

Localized Pigmented Villonodular Synovitis with Recurrent Subluxation of the Patella: A Case Report / 대한정형외과학회잡지

Pigmented villonodular synovitis is a slow, usually monoarticular, progressive proliferative disorder of uncertain etiology involving joint tissue, tendon sheath, and bursae. Pigmented villonodular synovitis has been divided in two forms-diffuse and localized. Localized pigmented villonodular synovitis of the knee joint can present with symptoms of pain, locking and instability. We report a case of a patient who presented with symptoms of recurrent subluxation of patella due to a localized pigmented villonodular synovitis occurring in the medial patellofemoral joint.

Radiographic Comparison of Stable Burst Fractures with Compression Fractures in Thoracolumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study was designed to evaluate the radiographic diagnostic method to detect any abnormal findings and differentiate stable burst fractures with compression fractures at thoracolumbar spine. OBJECTIVES: To evaluate diagnostic sensitivity of radiographic analysis and confirm the effectiveness of the radiographic diagnostic methods to differentiate stable burst fractures with pure compression fractures. SUMMARY OF BACKGROUND DATA: A data showed that the diagnostic sensitivity using radiographic analysis was 83%. The greater sensitivity was obtained at high posterior superior vertebral angle and PSVA/PIVA > 1.3. MATERIALS AND METHODS: Thirty-one patients with thoracolumbar spine fractures were evaluate to differentiate stable burst fractures with pure compression fractures. All patients were taken X-ray and CT. The PSVA(Posterior superior vertebral angle), PIVA(Posterior inferior vertebral angle), PSVA/PIVA were checked using lateral plain radiographs during follow-up period, and the final data was analysed using radiological & statistical methods. RESULTS: Middle column failure of stable burst fractures was greatly observed at high PSVA(especially >100degree) and high PSVA/PIVA ratio(> 1.3). CONCLUSION: The radiographic analysis using PSVA(Posterior superior vertebral angle), PIVA(Posterior inferior vertebral angle), PSVA/PIVA might be the one of useful methods to differentiate stable burst fractures with pure compression fractures at thoracolumbar spine during follow-up period.

The Results of the Surgical Treatment using Posterior Spinal instrumentation for Tuberculous Spondylitis / 대한척추외과학회지

STUDY DESIGN: Twenty-nine patients with spinal tuberculousis were evaluated according to the surgical treatment methods using posterior spinal instrumentation and conventional anterior excision and interbody fusion methods without posterior spinal instrumentation. OBJECTIVE: To confirm the effectiveness of the surgical treatment methods using posterior spinal instrumentation (combined with anterior radical excision and anterior interbody fusion ) in tuberculous spondylitis. SUMMARY OF BACKGROUND DATA: Relatively good results(maintaining corrected kyphotic angle , short fusion time, rapid rehabilitation etc.)were obtained in posterior spinal instrumetnation group, especially at thoracic and thoracolumbar spine, but no specific benefits of posterior instrumentation at low lumbar spine during follow-up period. METHODS: Twenty-nine patients with tuberculous spondylitis were divided into two groups depending on their use of posterior spinal instrument in surgical treatment methods ; one group consisted of 18 cases which were treated by anterior radical excision of involved body and anterior interbody fusion with posterior spinal instrumentation(Group I), and the other groups consisted of 11 cases which were treated by anterior radical excision of involved body and anterior interbody fusion(Group II). Change of corrected kyphotic angle according to the level of lesion, number of involved body and complications were measured using pre-, post-operative, and follow-up radiographs and chart review. RESULTS: Comparing the two groups, relatively short fusion time, less kyphotic angle loss, and low complication rates were obtained in posterior spinal instrumentation group(Group I) during the follow up period, especilally, at thoracic and thoracolumbar spine. However, there were no significant postoperative and follow-up results in both groups at low lumbar spine. CONCLUSIONS: Tuberculous spondylitis can be treated, and correction can be maintained with anterior radical excision of involved body and anterior interbody fusion with posterior spinal instrumentation during follow up period.

Reconstruction of ankle using free vascularized flap from amputated hand: A case report / 대한정형외과학회잡지

It is indispensable to cover the skin defect when bone or tendon is exposed. In case of inevitable amputation of an extremity, it is possible to harvest a free flap from the amputed limb for providing coverage of the other wound. This technique allows immediate wound coverage without the morbidity of an additional donor site. We experienced an electrical burn case with inevitahle wrist disarticulation and successfully treated soft tissue defect of ankle using free vascularized flap.

Extensor Mechanism Injuries of the Finger / 대한정형외과학회잡지

Injuries to the extensor mechanism include a wide range of injuries from minor one to massive defect. And the methods of treatment must be individualized according to the anatomical site, extent and chronicity of injuries. The extensor mechanism is a triangular thin sheet like structure, the function of which cannot be explained completely by the Tubiana's church-steeple like diagram. Authors think that the extensor mechanism should be repaired or reconstructed as a triangular sheet. The tension of the repaired or reconstructed tendon was estimated as good when the neutral extensions were obtained in all the MP, PIP and DIP joints after the completion of sutures. Also authors think that stable sutures are mandatory for the early rehabilitation postopoeratively. Seventy-five patients have been treated by the authors from 1982 to 1994. According to zonal classification, forty-two patients were injured in Zone I. 5 in Zone II, 21 in Zone III, 5 in Zone IV and 2 patients were unclassified due to massive defects of the extensor mechanism. Mostly bony mallet injuries were treated by open reduction and K-wire fixation. Acute tendinous mallet injuries were treated by conservative splinting and old injuries were treated by anatomical plication of the terminal extensor tendon. Old buttonhole deformities were generally treated by the central tendon plication. Massive defects were managed by skin coverage and reconstruction of the extensor mechanism by using a tendon graft which was tailored like a triangular thin sheet. With author's treatment principles, excellent or good results were obtained in about 87%. Consequently, authors emphasize that an anatomical repair or reconstruction is a keystone in the treatment of injuries to the extensor mechanism.

Internal Fixation of Capitellar Fractures Using Herbert Screws: A Report of Three Cases / 대한정형외과학회잡지

Capitellar fracture was first described by Hahn in 1853. It is rare, espically in children, and has been occurred 0.5% to 1% of incidence of all elbow injuries. Factures of the capitellum can involve a significant portion of the articular surfaces. It is desirable to reduce and internally fix the capitellar fragment, if possible, because this restores the artucular surface and augment joint stability. Three patients with displaced fractures of the capitellum(capitulum humeri) were treated by open reduction and internal fixation using Herbert screws, which stabilized the joint, allowed anatomical reduction, and gave rigid fixation. Postoperatively, early motion of the joint was allowed. All fractures were united without evidence of avascular necrosis and final follow-up was excellent.

Clinical investigations of treatment for infected nonunion in long bone with papineau's cancellous bone graft / 대한정형외과학회잡지

No abstract available.

A clinical study on the femoral fracture occurred on the total hip replacement / 대한정형외과학회잡지

No abstract available.

Clinical investigations of effective percutaneous automateddiscectomy / 대한정형외과학회잡지

No abstract available.