Dynamic Stabilization of the Scapula for Serratus Anterior Dysfunction: A Retrospective Study of Functional Outcome and Results

BACKGROUND: Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed by split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. METHODS: Twenty-five patients showed positive results upon long thoracic nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range, 12-120 months). Four patients had non-traumatic etiologies and 22 patients had traumatic etiologies. On follow-up assessment for functional improvement, a Constant-Murley score was used. Twenty-one patients were completely evaluated, while five patients who had less than 12 months of follow-up were excluded. RESULTS: Pain relief was achieved in 19 of the 21 patients, with 20 patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from 108degrees (range, 20degrees-165degrees) preoperatively to 151degrees (range, 125degrees-170degrees) postoperatively. The mean Constant-Murley score improved from 57.7 (range, 21-86) preoperatively to 86.9 (range, 42-98) postoperatively. A recurrence developed in one patient. Of the 21 patients, ten had excellent results, six had good results, four had fair results, and one had poor results. CONCLUSIONS: Most patients with severe symptomatic scapular winging showed functional improvement and pain relief with resolution of scapular winging.

Dynamic Stabilization of the Scapula for Serratus Anterior Dysfunction: A Retrospective Study of Functional Outcome and Results

BACKGROUND: Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed by split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. METHODS: Twenty-five patients showed positive results upon long thoracic nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range, 12-120 months). Four patients had non-traumatic etiologies and 22 patients had traumatic etiologies. On follow-up assessment for functional improvement, a Constant-Murley score was used. Twenty-one patients were completely evaluated, while five patients who had less than 12 months of follow-up were excluded. RESULTS: Pain relief was achieved in 19 of the 21 patients, with 20 patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from 108degrees (range, 20degrees-165degrees) preoperatively to 151degrees (range, 125degrees-170degrees) postoperatively. The mean Constant-Murley score improved from 57.7 (range, 21-86) preoperatively to 86.9 (range, 42-98) postoperatively. A recurrence developed in one patient. Of the 21 patients, ten had excellent results, six had good results, four had fair results, and one had poor results. CONCLUSIONS: Most patients with severe symptomatic scapular winging showed functional improvement and pain relief with resolution of scapular winging.

Structural Analysis of Proximal Humerus in Korean / 대한정형외과학회잡지

PURPOSE: Third generation shoulder arthroplasty is widely performed nowadays; however, few studies on the anatomy of the proximal humerus in the Korean population have been reported. The authors have attempted to review the anatomy of the proximal humerus. MATERIALS AND METHODS: The study sample consisted of 100 humeri of patients with a mean age of 48 years (range of 17 to 83 years) who underwent computed tomography imaging between January 2009 and October 2011 at Myongji Hospital. Diameter of the articular surface, head thickness, radius of curvature, head inclination, head to tuberosity height, bicipital groove-shaft angle, lateral angle, medial offset and posterior offset were analyzed. Results were compared depending on age and gender. RESULTS: Mean values of diameter of the articular surface was 42.70+/-3.57 mm, head thickness was 14.3+/-2.0 mm, and radius of curvature was 22.50+/-1.97 mm; these three variables showed significant sex differences. Head inclination was measured as 130.00+/-4.28 degrees, head to tuberosity height was 7.50+/-0.99 mm, bicipital groove-shaft angle was 6.60+/-0.92 degrees, and lateral angle was 163.40+/-4.05 degrees. Mean medial and posterior offset were 5.2+/-2.1 mm and 3.1+/-1.8 mm, respectively. CONCLUSION: Based on the results of this study, the measurement values of Korean humeri can be used in design of the arthroplasty prosthesis, and this will lead to more accurate anatomical reconstruction of the shoulder joint.

Intra-articular Lesions in Chronic Lateral Ankle Instability: Comparison of Arthroscopy with Magnetic Resonance Imaging Findings

BACKGROUND: Chronic lateral ankle instability often accompanies intra-articular lesions, and arthroscopy is often useful in diagnosis and treatment of intra-articular lesions. METHODS: Preoperative magnetic resonance imaging (MRI) examinations and arthroscopic findings were reviewed retrospectively and compared in 65 patients who underwent surgery for chronic lateral ankle instability from January 2006 to January 2010. MR images obtained were assessed by two radiologists, and the inter- and intra-observer reliability was calculated. American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were evaluated. RESULTS: Abnormalities of the anterior talofibular ligament (ATFL) were found in all 65 (100%) cases. In arthroscopy examinations, 33 (51%) cases had talar cartilage lesions, and 3 (5%) cases had 'tram-track' cartilage lesion. Additionally, 39 (60%) cases of synovitis, 9 (14%) cases of anterior impingement syndrome caused by osteophyte, 14 (22%) cases of impingement syndrome caused by fibrotic band and tissue were found. Sensitivity of MRI examination for each abnormality was: ATFL, 60%; osteochondral lesion of talus (OLT), 46%; syndesmosis injury, 21%; synovitis, 21%; anterior impingement syndrome caused by osteophyte, 22%. Paired intra-observer reliability was measured by a kappa statistic of 0.787 (95% confidence interval [CI], 0.641 to 0.864) for ATFL injury, 0.818 (95% CI, 0.743 to 0.908) for OLT, 0.713 (95% CI, 0.605 to 0.821) for synovitis, and 0.739 (95% CI, 0.642 to 0.817) for impingement. Paired inter-observer reliability was measured by a kappa statistic of 0.381 (95% CI, 0.241 to 0.463) for ATFL injury, 0.613 (95% CI, 0.541 to 0.721) for OLT, 0.324 (95% CI, 0.217 to 0.441) for synovitis, and 0.394 (95% CI, 0.249 to 0.471) for impingement. Mean AOFAS score increased from 64.5 to 87.92 (p < 0.001) when there was no intra-articular lesion, from 61.07 to 89.04 (p < 0.001) in patients who had one intra-articular lesion, and from 61.12 to 87.6 (p < 0.001) in patients who had more than two intra-articular lesions. CONCLUSIONS: Although intra-articular lesion in patients with chronic lateral ankle instability is usually diagnosed with MRI, its sensitivity and inter-observer reliability are low. Therefore, arthroscopic examination is strongly recommended because it improved patients' residual symptoms and significantly increased patient satisfaction.

Structural Analysis of the Coracoclavicular Ligaments in Koreans: A Cadaveric Study / 대한정형외과학회잡지

PURPOSE: Recently, the methods for reconstructing the acromion joint focused on an anatomical reconstruction. However, the reports of the anatomical method of the coraco-clavicle ligament have given different descriptions. This paper reports an anatomical study of the coraco-clavicle ligament in Koreans. MATERIALS AND METHODS: One hundred and two coraco-clavicle ligaments distracted from 6 fresh cadavers and 96 drug-administered cadavers were analyzed and calibrated. A quantitative analysis of the shape and location of the attachment site of the coracoid process and clavicle was performed, and the clinical and radiological applications were examined considering the calibrating variables. RESULTS: The conoid and trapezoid ligaments were thick and wide when measured in the middle part, and the average length up to the attachment site of the coracoid process was 11.3+/-3.6mm in men and 9.5+/-2.2mm in women. The average length of the clavicle was 158.5+/-55.7mm in men and 146.6+/-50.9mm in women. The length between the middle of the trapezoid tubercle or conoid tubercle and the lateral edge of the clavicle was 21.7+/-3.2mm and 42.8+/-3.4mm respectfully in men and 20.9+/-1.8mm and 39.9+/-3.3 respectfully in women, respectively. The angles of the conoid ligament and trapezoid ligament from the anteroposterior and lateral aspects were measured to be 25+/-8degrees and 19+/-3degrees respectfully in men and 28+/-5degrees and 17+/-3degrees degree respectfully in women. CONCLUSION: A more delicate reconstruction of the coraco-clavicle ligament is believed to be possible with regard to the mean distance from the clavicle to the conoid and trapezoid ligaments and the anticipation of a relationship between these ligaments.

The Analysis of Conservative Treatment in Midshaft Fractures of Clavicle

PURPOSE: Most clavicular fractures can be healed by conservative treatment, although there are many factors that influence healing. The aim of the present study was to analyze factors that influence (i) bone union of midshaft fractures of the clavicle treated conservatively and (ii) bone functioning, after union. The long-term goal was to determine which treatments are adequate. MATERIALS AND METHODS: We evaluated factors that have an effect on bone union and bone function after union. We evaluated age, fracture site, comminution, displacement, shortening and other factors. Among 523 clavicular midshaft fractures that presented between January 2004 and Jun 2009 at our Department of Orthopaedic Surgery, we identified 270 who had conservative treatment and 173 patients who had surgical treatment. RESULTS: The period required for bone union increased with the degree of displacement. For the group below 12 years of age, and the group without comminution, it took half the time to achieve bone union compared with the other groups. Displacement mostly occurred within 2 weeks after conservative treatment. CONCLUSION: In patients with a comminuted clavicular midshaft fracture, we might, because of expected delays in bone union, delay the start of rehabilitation until patients are more than 13 years old. Because the degree of displacement may be increased within 2 weeks during conservative treatment, we can think about surgical treatments.

Deep Vein Thrombosis in May-Thurner Syndrome Patient after Operative Treatment of Acute Cauda Equina Syndrome: A Case Report / 대한척추외과학회지

May-Thurner syndrome, compression of the left common iliac vein by the right common iliac artery, or intimal hypertrophy of the vein resulting from chronic pulsatile force of the right common iliac artery, may results in deep vein thrombosis on the left lower extremity. A patient presented to our facility with deep vein thrombosis caused by May-Thurner syndrome, and showed post-operative fever, pain, and tenderness over the left leg, showing severe lumbar disc herniation with acute cauda equina syndrome. This syndrome should be considered as one of the causes of deep vein thrombosis in the left lower extremity.

Medial Anterior-inferior Capsular Shift in Multidirectional Shoulder Instability

Purpose: The purpose of this study was to prove the effectiveness of the open medial (glenoid-based) anteriorinferior capsular shift in patients with multidirectional shoulder instability. Materials and Methods: We reviewed 19 patients treated by medial anterior-inferior capsular shift for multidirectional shoulder instability from March, 1998 to December, 2003. 15 patients of them have experienced recurrent dislocation. 8 patients(42%) showed bilateral laxity and 11 patients(58%) generalized ligamentous laxity, and 2 patients(10.5%) voluntary subluxation. An average follow-up was 24 months (range : 9~32 months). Results: Pain improved in 18 patients of all. There was an average loss of 10 degree of external rotation, but no limitation of activity of daily living. There was no redislocation and subluxation, but two patients had some apprehension in sports activity. With Rowe score, the result was excellent or good in all patients. There were hematoma and local skin problem in 1 patient, but all had healed up. Conclusion: Medial anterior-inferior capsular shift in multidirectional shoulder instability provided satisfactory results in pain relief, patient's satisfactions and stability of glenohumeral joint. Though some of them have anterior gleniod deformities and large Hill-Sachs lesions, we could get good stabilities.

Treatment with Modified Steinmann Pins and Tension Band Wiring Technique in Proximal Humeral Comminuted Fractures with Osteoporosis

PURPOSE: To evaluate the usefulness of internal fixation with modified Steinmann pins and tension band wiring technique in comminuted proximal humeral fracture with osteoporosis and the correlations among bone mineral density, age, Neer's score and period of union. MATERIALS AND METHODS: Twelve cases of comminuted proximal humeral fracture with osteoporosis were surgically treated with modified Steinmann pins and tension band technique, and followed up for an average 20.8 months (range, 6~39 months). Average age was 73.6 years old (range, 59~85 years old). Results were assessed using Neer's evaluation criteria. RESULTS: Excellent results were noted in eight cases and satisfactory results in four cases. Radiological union was obtained in all cases. Two cases showed impingement syndrome of the proximal portions of Steinmann pins, which were managed by early removal of the metal. One case developed operative wound infection, which were managed by antibiotics therapy, irrigation and secondary closure. CONCLUSION: Internal fixation using modified Steinmann pins and tension band wiring technique for proximal humeral fracture, with osteoporosis, makes complete union of fracture, minimizes risk of complications, and enables early rehabilitation by rendering relatively rigid fixation.

Methods to Increase the Effectiveness of Trochanteric Stabilizing Plate for Unstable Femoral Intertrochanteric Fractures with Gtreater Trochanteric Fracture: Fixation of Greater Trochanter with Wire and Screw

PURPOSE: The clinical outcome is favorable for the treatment of unstable femoral intertrochanteric fractures using both dynamic hip screw (DHS) and trochanter stabilizing plate (TSP) in elderly patients. However, there are sometimes complications related to excessive sliding. Therefore, the aim of this study was to evaluate the value of additional fixation of greater trochanter using wires and screw in the unstable femoral intertrochanteric fractures with a greater trochanter fracture. MATERIALS AND METHODS: From March 2004 through December 2005, thirty-seven patients, who were more than sixty-five years of age and were diagnosed with osteoporosis, were treated with DHS and TSP in unstable femoral intertrochanteric fractures with a follow-up of more than 6 months (mean duration, 13.5 months). The patients were divided into two groups. One group (group A: 20 patients) was treated with DHS and TSP only, whereas the other (group B: 17 patients) was treated with DHS and TSP augmented by a wire and screw. The average age was 80.9 (range 68 to 89) and 83.2 years (range 72 to 91) in groups A and B, respectively. All the patients in both groups were assessed radiographically immediately after surgery and at the last follow-up. The level of sliding of the lag screw and displacement of the greater trochanter were evaluated statistically. RESULTS: Bony union was achieved in all cases except for two cases in group A. At the last follow-up, the average of lag screw sliding in groups A and B was 8.96+/-5.98mm and 4.80+/-3.68, respectively, showing a statistical difference (P value0.05). CONCLUSION: Unstable femoral intertrochanteric fractures can be treated successfully using a hip screw and TSP alone. However, the addition of wires and screws in the greater trochanter can prevent excessive sliding that occurs after displacing the greater trochanteric fragments out of the plate in the presence of a greater trochanteric fracture line or severe bone defect in the lateral aspect.

The Comparison of Two Different Fixation Materials In Modified Weaver-Dunn Operation / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the usefulness and difference of fixation persistence with two different fixation materials (Mersilene tape and Dall-Miles cable) in modified Weaver-Dunn operation. MATERIALS AND METHODS: Twenty-five cases of acute acromioclavicular dislocation were surgically treated with modified Weaver-Dunn operation, and followed for an average about 15.8 months. For the fixation material, Dall-Miles cable were used in 10 cases, Mersilene tape in 15 cases. Radiological and clinical evaluation were done in all cases. For clinical evaluation, UCLA shoulder function test and ASES score were used. RESULTS: Excellent results were noted in group with Mersilene tape 6 cases and Dall-Miles cable 4 cases, good in 8 cases and 6 cases, and fair in 1 case only Mersilene tape in UCLA shoulder function test. The difference of coracoclavicular distance between injury side and normal side were analysed in radiologically at before, after and 3 months after operation. Results are as follows; 11.2 mm, -0.5 mm, 0.5 mm, 0.8 mm in group with Mersilene tape, 10.3 mm, -0.5 mm, 1.4 mm, 1.7 mm in Dall-Miles cable. CONCLUSION: Two different fixation material used in the fixation of modified Weaver-Dunn operation have enough fixation power for clinical outcome. But Mersilene tape was better than Dall-Miles cable in the persistency of fixation and handling.

Treatment of Proximal Humeral Fractures using Modified Steinmann Pins and Tension Band Wiring / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evalulate the usefulness of internal fixation with two modified Steinmann pins and tension band wiring in displaced proximal humeral fracture. MATERIALS AND METHODS: Thirteen cases of displaced proximal humeral fracture were surgically treated with modified Steinmann pins and tension band wiring and followed for an average 24.9 (6-39) months. Male to female ratio was 6 to 7. Average age was 58.1 (39-81) years. Results were assessed using Neer's evaluation criteria. RESULTS: Excellent results were noted in 9 cases and satisfactory results in 4 cases. All cases obtained radiological union. There was no complication such as avascular necrosis of humeral head or metal failure. Two cases showed impingement syndrome of the proximal portions of Steinmann pins, which were managed by early removal of the metal after union. CONCLUSIONS: Internal fixation using modified Steinmann pins and tension band wiring for proximal humeral fracture minimizes perioperative soft tissue damage, has a low risk of complications, and enables early rehabilitation by rendering relatively rigid fixation.

An Immunoelectron Microscopic Study on Localization of Fibronectin by 17-beta Estradiol Effects in Rat Tibia / 대한정형외과연구학회지

Fibronectin(FN) is a multifunctional glycoprotein with ARG-GLY-ASP(RGD) sequences that has been known as an important constituent of extracellular matrix in bone. 17-beta estradiol, bone active hormone has been reported to stimulate the in vitro production of several extracellular matrix proteins. Though it is known that estrogen withdrawal causes a significant diminition in PTH induced FN production, the hormonal regulation of FN production in bone has not been thoroughly studied. Especially the study using immunoelectron microscopy about FN production is rare. So, the author undertook tile present study to pursue the effect of estrogen on the distribution of fibronectin in the process of bone matrix formation with immunoelectron microscopy. Four to five weeks old female Sprague-Dawley rats, weighing about 150 gm, were used as experimental animals. It was grouped as ovariectomy group, sham operation group, ovarectomy with estrogen injection group, and normal control group. Each group was sacrificed at 1 week, 3 weeks and 5 weeks postoperatively. Ovaries were removed under the pentobarbital anesthesia, and for the estrogen injection group, 0.25 mg/kg of 17-beta estradiol was injected subcutaneously after oophorectomy. Immunoelectromicroscopic findings were as follows. 1 At the one week after operation, the distributions of gold particles, show the fibronectin reaction in osteoid, are similar in the control group, sham operation group, and ovariectomy with estrogen injection group at intermediate reactions, but it is severely decreased in the ovariectomy group as a weak reaction. 2. At there weeks after operation, the distributions of gold particle are similar in the control group, sham operation group and ovariectomy with estrogen injection group as intermediate reactions, but it is also decreased in the ovariectomy group as a weak reaction. 3 At the five weeks after operation, all the groups have similar distributions of gold particles as intermediate reaction. It is suggested that the estrogen secreted in ovary, partially effects on the fibronectin formation in the matrix of developing bone, and other factors stimulate and compensate the fibronectin formation with removal of ovaries.

A clinical study of the pelvic bone fracture / 대한정형외과학회잡지

No abstract available.