Short-term Outcomes of Arthroscopic Transtendinous Repair in Partial Articular Side Tears of the Rotator Cuff

PURPOSE: This study prospectively evaluated the outcome of arthroscopic transtendinous repair as a treatment for partial articular side tears of the rotator cuff. MATERIALS AND METHODS: Fifteen patients with symptomatic, partial articular side tears of the rotator cuff underwent modified transtendinous repair. The patient's mean age was 52.5 years and the mean duration of symptoms was 33.7 weeks. The visual analogue scale (VAS), the ASES score, the active ROM of the shoulder and the patient's satisfaction were evaluated both preoperatively and postoperatively. The clinical results were analyzed using the Wilcoxon's signed rank test. RESULTS: The mean VAS was 6.6+/-1.1 before treatment and 0.4+/-0.6 at 6 month, and the ASES scores for all the patients were significantly better over the six-month period of follow-up (p<0.05). The mean active ROM in abduction was 94.3+/-22.3 before treatment, 108.7+/-16.3 at 1 month (p=0.0041) and 164.3+/-5.3 at six months (p=0.0006). In flexion, it was 105.0+/-23.8 before treatment, 119.0+/-17.4 at 1 month (p=0.0075) and 174.3+/-5.3 at six months (p=0.0006). At the final follow-up, 94% of patients were satisfied or very satisfied after operation. CONCLUSION: We experienced satisfactory clinical results after a short-term follow-up of arthroscopic transtendinous repair, and we believed this to be an effective procedure for patients with partial articular side tears of the rotator cuff.

Neglected Type IV Acromioclavicular Joint Injury: 2 Cases Report

Acromioclavicular joint injuries usually occur as a result of direct trauma to the superolateral aspect of the shoulder. Roockwood Type IV injuries are relatively uncommon, and they are easily misdiagnosed or neglected in patients who have suffered multiple traumas. Therefore, to correctly treat a patient with type IV injury, we need to take a careful physical examination and conduct proper radiologic evaluation for the acromioclavicular joint. We report here on two cases of modified Weaver-Dunn reconstruction for neglected type IV acromioclavicular joint injuries that were associated with multiple rib fractures.

Comparison of Flexible Intramedullary Nailing with External Fixation in Pediatric Femoral Shaft Fractures / 대한정형외과학회잡지

PURPOSE: This study compared the results of external fixation with those of flexible intramedullary nailing using Ender nails in pediatric femoral shaft fractures. MATERIALS AND METHODS: Twenty-eight children with pediatric femoral shaft fractures were enrolled in the study. The children's ages ranged from 6 to 11 years, and the average period of follow-up was 27.2 months. Fifteen patients underwent flexible intramedullary nailing (FIN) using Ender nails and thirteen patients underwent external fixation (EF). The outcomes were assessed based on the clinical and radiology findings. RESULTS: The healing time averaged 9.8 weeks in the FIN group and 11.2 weeks in the EF group. In the FIN group, one patient suffered pin migration. In the EF group, three patients had a pin site infection, one patient had refracture after removing the external fixator and one patient had pin breakage 8 weeks after surgery. The broken pin was removed and the condition was stabilized with internal fixation using a plate. CONCLUSION: Flexible intramedullary nailing with Ender nails is an effective treatment option for treating femoral shaft fractures in children because it has fewer complications than external fixation does.

Results of Modified Chrisman-Snook Procedure for Chronic Ankle Instability / 대한족부족관절학회지

PURPOSE: We try to retrospectively analyze the clinical results of the modified Chrisman-Snook procedure for chronic ankle instability. MATERIALS AND METHODS: From November 1997 to April 2006, thirty-one patients who underwent modified Chrisman- Snook procedure for chronic ankle instability were analyzed. All patients were male and the mean age was 31 years. The follow-up period averaged 48 months. We evaluated the clinical results measured by Hasegawa method. RESULTS: Among them, there were soldiers in 11, socker players in 6, patients who weigh more 80 kg in 5. And there were 9 patients who previously underwent modified Brostrom procedure for chronic ankle instability. The clinical results were rated as excellent in 29, fair in 2 who did not cooperate with postoperative rehabilitation program. There were complications of 2 cases of irritation of the sural nerve and recurrence respectively, 1 case of wound problem. CONCLUSION: Our results show that the modified Chrisman-Snook procedure is effective treatment method for patients with high-performance athlete/soldier or failed modified Brostrom procedure.

Avascular Necrosis of the First Metatarsal Head after Distal Chevron Osteotomy for Hallux Valgus: A Case Report / 대한족부족관절학회지

Avascular necrosis of the first metatarsal head is uncommon. It is most often seen following a distal metatarsal osteotomy for hallux valgus. Although many cases may be subclinical, it is a powerful cause of failure of bunion surgery. Avascular necrosis of the first metatarsal head results in a series of events that begins with phases of avascularity; revascularization, with or without collapse; and reossification. Collapse may result in degenerative change of the metatarsophalangeal joint. We have recently experienced a case of avascular necrosis of the first metatarsal head.

The Changes in the Dimensions of Neural Foramen After Anterior Interbody Fusion in the Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: A prospective radiological assessment was performed using computerized tomography measurements. OBJECTIVES: The aim of this study was to assess the changes in the dimensions of the neural foramen after anterior interbody fusion with posterior fixation in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Anterior lumbar interbody fusion distracts the height and width of the neural foramen. MATERIALS AND METHODS: Anterior interboody fusion with posterior fixation was performed in twenty-five patients. The sagittal parameters were the height and area of the neural foramen. The fused lumbar segments was imaged in the direct sagittal projections in a CT (SOMATOM Senstaion; SIMENS, Germany) and 1-mm slice thickness before surgery and after solid fusion. Computer digitation was used for the measurements independently by three different observers. Statistical analysis was performed using a Wilcoxon signed test and a paired T-test to determine the correlation between the measurements, and Pearson correlation to determine the level of interobserver and intraobserver agreement. RESULTS: After anterior interbody fusion and posterior fixation, the height and the area of the neural foramen had increased significantly by 15.5+/-14.0%(p.0.001) and 23.2+/-17.7%(p.0.001). There was a significant confidence in interobserver (0.9466~0.9996) and intraobserver(0.8896~0.9991) agreement. CONCLUSIONS: Anterior interbody fusion significantly increased the changes in the dimensions of the neural foramen. Anterior distraction and decompression with anterior interbody fusion increased the area of the neural foramen This study shows that anterior interbody fusion can be used to decompress the neural foramen in the spondylolisthesis.

Results of Operative Treatment for Large Osteochondral Lesion of Medial Talar Dome / 대한족부족관절학회지

PURPOSE: The purpose of this study is to assess the results of the autologous osteochondral grafting harvested from medial side of talus for relatively large osteochondral lesion of the medial talar dome. MATERIALS AND METHODS: From October 2004 to September 2005, 12 patients with osteochondral lesion measured more than 10 mm in axial MRI who were followed up more than 1 year after operation were analyzed. We evaluated postoperative symptoms by Mann and Reynolds scale, morbidity of donor site, and compared the range of both ankle motion. We also evaluated the union at the medial malleolar osteotomy site, trabecular connection between the grafted osteochondral mass and talus, irregularity of the articular surface in lesion. RESULTS: Clinical results were rated as excellent in 4, good in 7, fair in 1. The mean angle of the total range of motion in affected ankle was decreased by 3 degrees compared to that in unaffected ankle. We did not observe abnormal findings at donor site. The osteotomized bone was united at mean 9 weeks (range, 8-12 weeks). We observed trabecular connection between grafted osteochondral mass and talus at mean 14 weeks (range, 12-16 weeks). We also observed irregular articular surface in osteochondral lesions in 6, smooth articular surface in 6. CONCLUSION: The local autologous osteochondral graft for relatively large osteochondral lesion of the medial talar dome is useful operative method with advantages of wide operative field, low morbidity of donor site, and high satisfaction rate.

Results of Early Primary Repair for Acute Severe Ankle Sprains / 대한족부족관절학회지

PURPOSE: The purpose of this study is to assess the clinical and radiological results of the early primary repair for acute ankle sprains. MATERIALS AND METHODS: From October 2002 to September 2005, nine patients with acute ankle sprain were analyzed. Among them, eight patients took the inversion stress X-ray at local clinics, and the mean talar tilting angle was 28 degrees. We observed avulsion fragment near lateral malleolus in the other. The average age at the time of operation was 24 years and average follow-up period was 29 months. We evaluated postoperative symptoms by Hasegawa's clinical rating system, postoperative complications, and compared the talar tilting angle and anterior draw distance between both ankles at the final follow-up X-rays. RESULTS: Anterior talofibular ligament was ruptured at fibula in 4, at midsubstance in 3, at talus in 1 and at fibula and midsubstance simultaneously in 1. Calcaneofibular ligament was ruptured at fibula in 3 including a case of avulsion fracture, at midsubstance in 2, and at calcaneus in 4. And posterior talofibular ligament was ruptured at midsubstance in 2. Clinical results were rated as excellent in all. We did not find major postoperative complications except for one sural nerve irritation. Both (injured ankle/uninjured ankle) talar tilting angle averaged 6.8/8.2 degrees and anterior draw distance averaged 2.9/3.7 mm at final follow-up X-rays. CONCLUSION: Early primary repair is recommended for treating acute severe ankle sprains and in case found avulsion fracture in X-ray taken after ankle sprain.

Treatment of Rotator Cuff Tear Arthropathy with Prosthetic Replacement of Humeral Head / 대한정형외과학회잡지

PURPOSE: To assess the effectiveness of a prosthetic replacement of the humeral head in rotator cuff tear arthropathy patients. MATERIALS AND METHODS: 11 patients underwent a prosthetic replacement of the humeral head for rotator cuff tear arthropathy between 1997 and 2003. The average age was 69 years and 9 out of the 11 patients were women. The average follow-up was 44 months. The level of pain, daily activities, range of motion and patient's satisfaction were assessed both preoperatively and postoperatively. RESULTS: The mean pain score decreased from 9.0 preoperatively to 2.2 postoperatively. The mean active forward elevation increased from 40o to 82o and the mean external rotation increased from 8.2o to 30o. The mean ASES score improved from 22 to 72. Nine patients were satisfied with the surgical outcome, particularly in terms of pain relief and the improvement in their daily activities. CONCLUSION: A prosthetic replacement of the humeral head is an effective treatment option for pain relief as well as for improving the functional activity in rotator cuff tear arthropathy.