Onlay patch augmentation in rotator cuff repair for moderate to large tears in elderly patients: clinical and radiologic outcomes

Background@#This study evaluated the clinical and radiologic outcomes of onlay patch augmentation in rotator cuff repair for moderate-to-large tears in elderly patients. @*Methods@#We reviewed 24 patients who underwent onlay augmentation with dermal allograft after arthroscopic rotator cuff repair from January 2017 to March 2020. Inclusion criteria were patients aged >65 years with tears >2.5 cm, who were followed for >12 months after surgery, and patients who could raise their arms above 90° preoperatively. American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, Pain visual analog scale (VAS), and VAS for satisfaction were used as clinical outcomes. For the evaluation of cuff integrity, magnetic resonance imaging scans were performed every 3 months after surgery. The results were compared before and after surgery in all patients and between the retear and intact groups. @*Results@#The average follow-up period was 16.38 months, and the mean age of patients was 71.05 years. All patients showed significant improvement in ASES score, Constant-Murley score, and pain VAS at the last evaluation. The average value of satisfaction VAS was 7.27/10. The retear rate was 25% (6/24) if Sugaya type 3 was categorized in the retear group, otherwise 16.7% (4/24), if Sugaya type 3 was categorized into the intact group. Irrespective of Sugaya type 3 being included in the retear group, there was no significant difference in outcome variables between the intact and retear groups during follow-up. @*Conclusions@#In moderate-to-large rotator cuff tear in elderly patients, onlay patch augmentation improved clinical outcomes. Retear did not adversely affect clinical outcomes.

Can manipulation under anesthesia alone provide clinical outcomes similar to arthroscopic circumferential capsular release in primary frozen shoulder (FS)?: the necessity of arthroscopic capsular release in primary FS

Background@#We evaluated the need for arthroscopic capsular release (ACR) in refractory primary frozen shoulder (FS) by comparing clinical outcomes of patients treated with ACR and manipulation under anesthesia (MUA). @*Methods@#We assessed patients with refractory primary FS, 54 patients (group A) who were treated with MUA and 22 patients (group B) who were treated with ACR. In group A, manipulation including a backside arm-curl maneuver was performed under interscalene brachial block. In group B, manipulation was performed only to release the inferior capsule before arthroscopic circumferential capsular release, which was carried out for the unreleased capsule after manipulation. Pain, range of shoulder motion, and American Shoulder and Elbow Society score were recorded at 1 week, 3 months, 6 months, and 1 year after surgery. We compared outcome variables between treatment groups and between diabetics and non-diabetics and also evaluated the numbers of patients receiving additional intra-articular steroid injection. @*Results@#Outcome variables at 3 months after surgery and improvements in outcome variables did not differ between groups. Group A showed significantly better results than group B in the evaluation of pain and range of motion at 1 week. Diabetics showed comparable outcomes to non-diabetics for most variables. Eleven patients required additional steroid injections between 8 to 16 weeks after surgery: 12.2% in group A, 18.2% in group B. Additional injections were given three times more often in diabetics compared to non-diabetics. @*Conclusions@#MUA alone can yield similar clinical outcomes to ACR in refractory FS.

Can manipulation under anesthesia alone provide clinical outcomes similar to arthroscopic circumferential capsular release in primary frozen shoulder (FS)?: the necessity of arthroscopic capsular release in primary FS

Background@#We evaluated the need for arthroscopic capsular release (ACR) in refractory primary frozen shoulder (FS) by comparing clinical outcomes of patients treated with ACR and manipulation under anesthesia (MUA). @*Methods@#We assessed patients with refractory primary FS, 54 patients (group A) who were treated with MUA and 22 patients (group B) who were treated with ACR. In group A, manipulation including a backside arm-curl maneuver was performed under interscalene brachial block. In group B, manipulation was performed only to release the inferior capsule before arthroscopic circumferential capsular release, which was carried out for the unreleased capsule after manipulation. Pain, range of shoulder motion, and American Shoulder and Elbow Society score were recorded at 1 week, 3 months, 6 months, and 1 year after surgery. We compared outcome variables between treatment groups and between diabetics and non-diabetics and also evaluated the numbers of patients receiving additional intra-articular steroid injection. @*Results@#Outcome variables at 3 months after surgery and improvements in outcome variables did not differ between groups. Group A showed significantly better results than group B in the evaluation of pain and range of motion at 1 week. Diabetics showed comparable outcomes to non-diabetics for most variables. Eleven patients required additional steroid injections between 8 to 16 weeks after surgery: 12.2% in group A, 18.2% in group B. Additional injections were given three times more often in diabetics compared to non-diabetics. @*Conclusions@#MUA alone can yield similar clinical outcomes to ACR in refractory FS.

Strut Support with Tricortical Iliac Allografts in Unstable Proximal Humerus Fractures: Surgical Indication and New Definition of Poor Medial Column Support

BACKGROUND: The execution of fibular allograft augmentation in unstable proximal humerus fractures (PHFs) was technically demanding. In this study, the authors evaluated the clinical and radiographic outcomes after tricortical iliac allograft (TIA) augmentation in PHFs. METHODS: We retrospectively assessed 38 PHF patients treated with locking-plate fixation and TIA augmentation. Insertion of a TIA was indicated when an unstable PHF showed a large cavitary defect and poor medial column support after open reduction, regardless of the presence of medial cortical comminution in preoperative images. Radiographic imaging parameters (humeral head height, HHH; humeral neck-shaft angle, HNSA; head mediolateral offset, HMLO; and status of the union), Constant score, and range of motion were evaluated. Patients were grouped according to whether the medial column support after open reduction was poor or not (groups A and B, respectively); clinical outcomes were compared for all parameters. RESULTS: All fractures healed radiologically (average duration to complete union, 5.8 months). At final evaluation, the average Constant score was 73 points and the mean active forward flexion was 148°. Based on the Paavolainen assessment method, 33 patients had good results and 5 patients showed fair results. The mean loss of reduction was 1.32 mm in HHH and 5.02% in HMLO. None of the parameters evaluated showed a statistically significant difference between the two groups (poor and not poor medial column support). CONCLUSIONS: In unstable PHFs, TIA augmentation can provide good clinical and radiological results when there are poor medial column support and a large cavitary defect after open reduction.

Posterior Interosseous Nerve Palsy Caused by a Ganglion of the Arcade of Frohse

A 51-year-old male who is right-handed visited the outpatient for right fingers-drop. The patient's fingers, including thumb, were not extended on metacarpophalangeal joint. The active motion of the right wrist was available. The electromyography and nerve conduction velocity study were consistent with the posterior interosseous neuropathy. Further evaluation was done with the magnetic resonance imaging for finding the space-occupying lesion or any possible soft tissue lesion around the radial nerve pathway. On magnetic resonance imaging, the ganglion cyst, which was about 1.8 cm in diameter, was observed on the proximal part of the superficial layer of the supinator muscle (Arcade of Frohse). The surgical excision was done on the base of ganglion cyst at the base of stalk of cyst which looked to be connected with proximal radioulnar joint capsule. The palsy had completely resolved when the patient was observed on the outpatient department a month after the operation.

Advantages of Scorpion Suture Passer and 70 Degrees Arthroscope in Arthroscopic Bankart Repair: Usefulness for Inferior Labral Repair

BACKGROUND: The blunted tip of a reusable with multiple uses can cause problems with the passing procedure in arthroscopic Bankart repair. This study assessed the advantage of Scorpion with a 70° arthroscope in arthroscopic Bankart repair compared to hook typed suture passer. METHODS: Scorpion in 19 patients, the hook type suture passer (conventional group) in 18 patients were used. All patients underwent the same procedure except for the type of suture passer used. Another different point of the procedure were telescopes and the number of portals used; three arthroscopic portals (posterior, anterorsuperiorlateral, and mid-anterior) and a 30° arthroscope in the conventional group, but two portals and a 70° arthroscope as well as the 30° one in the Scorpion group. The surgery time and the surgical complications including an iatrogenic axillary nerve injury were recorded. RESULTS: The Scorpion group showed a significant decrease in surgery time compared to the conventional group. In contrast to the conventional group, Scorpion provided an easy estimation of the exit of suture passing, no iatrogenic labral injury during the passing procedure with straight movement and the sharp tip of the knife installed. Iatrogenic supraspinatus injuries could be avoided when making an accessory anteosuperiorlateral portal due to the 70° arthroscope. CONCLUSIONS: In arthroscopic Bankart repair, the use of the Scorpion suture passer and a 70° arthroscope can reduce the surgery time, avoid unnecessary supraspinatus injury, and avoid iatrogenic axillary nerve damage through the relatively easy and precise suture passing and saving of the anterosuperior portal.

Clinical and Radiographic Results of Artificial Disc Replacement Combined with Anterior Cervical Discectomy and Fusion Versus Two-Level Anterior Cervical Discectomy and Fusion in Two-Level Cervical Disc Disease

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: To compare the clinical and radiographic outcomes of a hybrid construct (HC) of cervical artificial disc replacement (CADR) combined with anterior cervical discectomy and fusion (ACDF) (group I) with 2-level ACDF (group II) in patients with 2-level cervical disc disease. SUMMARY OF LITERATURE REVIEW: ACDF is reported to potentially promote degenerative changes in the adjacent segment. CADR has been expected to reduce the risk of adjacent segment degeneration. However, its clinical course has yet to be sufficiently clarified. MATERIALS AND METHODS: Twenty-six patients underwent 2-level cervical disc surgery. Single-level CADR combined with ACDF was performed in 14 patients. Twelve patients underwent 2-level ACDF. Clinical profiles were assessed using the neck disability index (NDI) and visual analogue scale scores of arm and neck pain. Dynamic lateral cervical radiographs were obtained preoperatively and at 1, 6, 12, and 18 months postoperatively. The range of motion (ROM) of the overall cervical spine (C2-7) and the adjacent segments was measured. RESULTS: Group I showed superior NDI 18 months postoperatively (p 0.05). CONCLUSIONS: The HC group showed comparable clinical and radiographic outcomes to those of the 2-level ACDF group. HC can be used selectively in the treatment of patients with 2-level cervical disc disease.

Ulnar Nerve Injury Caused by the Incomplete Insertion of a Screw Head after Internal Fixation with Dual Locking Plates in AO/OTA Type C2 Distal Humerus Fractures

After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.

Advantages of Scorpion Suture Passer and 70 Degrees Arthroscope in Arthroscopic Bankart Repair: Usefulness for Inferior Labral Repair

BACKGROUND: The blunted tip of a reusable with multiple uses can cause problems with the passing procedure in arthroscopic Bankart repair. This study assessed the advantage of Scorpion with a 70° arthroscope in arthroscopic Bankart repair compared to hook typed suture passer. METHODS: Scorpion in 19 patients, the hook type suture passer (conventional group) in 18 patients were used. All patients underwent the same procedure except for the type of suture passer used. Another different point of the procedure were telescopes and the number of portals used; three arthroscopic portals (posterior, anterorsuperiorlateral, and mid-anterior) and a 30° arthroscope in the conventional group, but two portals and a 70° arthroscope as well as the 30° one in the Scorpion group. The surgery time and the surgical complications including an iatrogenic axillary nerve injury were recorded. RESULTS: The Scorpion group showed a significant decrease in surgery time compared to the conventional group. In contrast to the conventional group, Scorpion provided an easy estimation of the exit of suture passing, no iatrogenic labral injury during the passing procedure with straight movement and the sharp tip of the knife installed. Iatrogenic supraspinatus injuries could be avoided when making an accessory anteosuperiorlateral portal due to the 70° arthroscope. CONCLUSIONS: In arthroscopic Bankart repair, the use of the Scorpion suture passer and a 70° arthroscope can reduce the surgery time, avoid unnecessary supraspinatus injury, and avoid iatrogenic axillary nerve damage through the relatively easy and precise suture passing and saving of the anterosuperior portal.

Ulnar Nerve Injury Caused by the Incomplete Insertion of a Screw Head after Internal Fixation with Dual Locking Plates in AO/OTA Type C2 Distal Humerus Fractures

After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.

A Novel Fluoroscopic View for Positioning the AO Clavicle Hook Plate Decreases Its Associated in situ Complications

BACKGROUND: The goal of this study was to evaluate whether a modified fluoroscopic technique for positioning a hook plate affected the clinical results of treating Neer type II distal clavicle fractures and Rockwood type V acromioclavicular (AC) joint separations with this device. METHODS: The study was a retrospective consecutive case series with data analysis. Sixty-four patients with a Neer type II distal clavicle fracture or a Rockwood type V AC joint injury treated between March 2009 and June 2013 were divided into 2 groups: traditional fluoroscopic technique (traditional view, 31 patients) or modified fluoroscopic technique ('hook' view, 33 patients). A visual analogue scale (VAS) score, the modified University of California-Los Angeles (UCLA) shoulder scale score, and radiographic osteolysis were the main outcome measures. RESULTS: The traditional group included a significantly larger number of patients with acromial osteolysis than the hook view group: 23 patients (74.2%) vs. 11 patients (33.3%), respectively (p=0.01). Before plate removal, the hook group reported less pain and higher UCLA shoulder scale scores than the traditional group: average VAS score, 1.55 vs. 2.26, respectively; average UCLA score, 30.88 vs. 27.06, respectively. However, there was no significant difference after plate removal. CONCLUSIONS: The hook view allows more accurate bending of the hook plate around the contour of the acromion, resulting in decreased osteolysis, decreased pain, and better function with the plate in situ.

A Novel Fluoroscopic View for Positioning the AO Clavicle Hook Plate Decreases Its Associated in situ Complications

BACKGROUND: The goal of this study was to evaluate whether a modified fluoroscopic technique for positioning a hook plate affected the clinical results of treating Neer type II distal clavicle fractures and Rockwood type V acromioclavicular (AC) joint separations with this device. METHODS: The study was a retrospective consecutive case series with data analysis. Sixty-four patients with a Neer type II distal clavicle fracture or a Rockwood type V AC joint injury treated between March 2009 and June 2013 were divided into 2 groups: traditional fluoroscopic technique (traditional view, 31 patients) or modified fluoroscopic technique ('hook' view, 33 patients). A visual analogue scale (VAS) score, the modified University of California-Los Angeles (UCLA) shoulder scale score, and radiographic osteolysis were the main outcome measures. RESULTS: The traditional group included a significantly larger number of patients with acromial osteolysis than the hook view group: 23 patients (74.2%) vs. 11 patients (33.3%), respectively (p=0.01). Before plate removal, the hook group reported less pain and higher UCLA shoulder scale scores than the traditional group: average VAS score, 1.55 vs. 2.26, respectively; average UCLA score, 30.88 vs. 27.06, respectively. However, there was no significant difference after plate removal. CONCLUSIONS: The hook view allows more accurate bending of the hook plate around the contour of the acromion, resulting in decreased osteolysis, decreased pain, and better function with the plate in situ.

Meshed Stab Incision for Severe Swelling after Foot and Ankle Injury: A Technical Report / 대한족부족관절학회지

Swelling is a body's natural reaction to foot and ankle injury to mount a healing inflammatory response. To some degree, swelling is necessary for healing and is something that cannot be avoided following injury. However, post-traumatic swelling may have an adverse effect on wound healing and surgery can often be delayed due to preoperative swelling. We report on a unique technique of making multiple meshed stab incisions around the site of injury to reduce soft tissue swelling and promote wound healing.

Acute Osteomyelitis in the Proximal Humerus Caused by Pyogenic Glenohumeral Arthritis in an Elderly Patient: A Case Report

Reports of osteomyelitis in the proximal humerus with pyogenic glenohumeral arthritis of adjacent joints mostly involve pediatric patients. Nowadays, osteomyelitis that is secondary to adjacent pyogenic glenohumeral arthritis is extremely rare, even more so in adults than in pediatrics. We report a rare case of the pyogenic glenohumeral arthritis followed by osteomyelitis of the proximal humerus in an elderly patient. Initially, we diagnosed a case of pyogenic glenohumeral arthritis only, which, despite arthroscopic synovectomy, did not resolve and severe pain continued. Subsequent radiological imaging, performed after our suspicion of a secondary involvement, allowed us to diagnose osteomyelitis combined with the pyogenic glenohumeral arthritis, which we had overlooked because of the extreme rarity of the condition in adults since the antibiotic era began.

Treatment of Anchor Suture with Kirschner Wires Fixation for Chronic Perilunate Dislocation

Chronic lunate dislocations are very rare injuries comprising of less than 10% of all wrist injuries. Volar lunate dislocations account for less than 3% of perilunate dislocations. We present a case of a missed volar lunate dislocation for 6months after initial injury. He fell down and had hyperextension injury during his sports activity. When the patient visit in our hospital, neurologic symptom was developed in distribution of median nerve. Tingling sensation and radiation symptom was found in affected hand. A plain radiograph revealed a volar lunate dislocation. Nerve conduction studies confirmed compression of the median nerve at the wrist, carpal tunnel level. Operation was performed with open reduction of lunate, fixation with K-wires and anchor suture. The outcome was excellent in relieving pain, function, range of motion, grip strength. There was improvement in Mayo wrist score and disabilities of the arm, shoulder and hand score. So we report a patient and a operation technique which can be considered in similar cases.

Acute Osteomyelitis in the Proximal Humerus Caused by Pyogenic Glenohumeral Arthritis in an Elderly Patient: A Case Report

Reports of osteomyelitis in the proximal humerus with pyogenic glenohumeral arthritis of adjacent joints mostly involve pediatric patients. Nowadays, osteomyelitis that is secondary to adjacent pyogenic glenohumeral arthritis is extremely rare, even more so in adults than in pediatrics. We report a rare case of the pyogenic glenohumeral arthritis followed by osteomyelitis of the proximal humerus in an elderly patient. Initially, we diagnosed a case of pyogenic glenohumeral arthritis only, which, despite arthroscopic synovectomy, did not resolve and severe pain continued. Subsequent radiological imaging, performed after our suspicion of a secondary involvement, allowed us to diagnose osteomyelitis combined with the pyogenic glenohumeral arthritis, which we had overlooked because of the extreme rarity of the condition in adults since the antibiotic era began.

Uncommon Indications for Reverse Total Shoulder Arthroplasty

Total shoulder arthroplasty and shoulder hemiarthroplasty have been the traditional method for treating a variety of shoulder conditions, including arthritis, cuff tear arthropathy, and some fracture types. However, these procedures did not provide consistently good results for patients with torn rotator cuffs. The development of the reverse prosthesis by Grammont in the late 20th century revolutionized the treatment of the rotator-cuff-deficient shoulder with arthritis. The main indication for the reverse prosthesis remains the patient with cuff tear arthropathy who has pain and loss of motion. Because the reverse total shoulder arthroplasty produced such good results in these patients, the indications for the reverse prosthesis have expanded to include other shoulder conditions that have previously been difficult to treat successfully and predictably. This review discusses and critically reviews these newer indications for the reverse total shoulder arthroplasty.

Clinical and Radiological Results of Treatment in Bilateral Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: The purpose of this study is to find out clinical and radiological outcomes in 70 patients of both calcaneal fracture. MATERIALS AND METHODS: From March 1993 to March 2011, 70 patients underwent non-operative management or operative management at our hospital. Conservative management was performed in 15 cases of undisplaced fracture (Group A). Operative management was performed in 125 cases including 32 cases of undisplaced fracture (Group B), 60 cases of joint depression type fracture (Group C), 33 cases of tongue type fracture (Group D). Results were evaluated by VAS score, AOFAS score, circle draw test, Bohler angle (BA), Gissane angle, width & height of calcaneus. RESULTS: VAS scores were 2.0 in group A, 2.0 in group B, 2.2 in group C, 2.7 in group D. AOFAS scores were 90.4 in group A, 91.9 in group B, 72.2 in group C, 79.2 in group D. Circle draw tests were 8.4 cm in group A, 10.1 cm in group B, 7.6 cm in group C, 7.9 cm in group D. Bohler angles (BA) and Gissane angles were 19.1degrees, 96.7degrees in group A, 21.8degrees, 119.1degrees in group B, 26.3degrees, 121.2degrees in group C, 19.7degrees, 119.7degrees in group D. Calcaneal widths and heights were 39.5 mm, 31.6 mm in group A, 32.7 mm, 37.0 mm in group B, 34.4 mm, 39.2 mm in group C, 35.2 mm, 38.7 mm in group D. CONCLUSION: The main cause of bilateral calcaneal fracture is an injury from a fall, and the cases were more frequently occurred in men than women. Also the fracture in the right side tend to occur more severely compared to the left side. The surgical treatment shows better results than conservative treatment in bilateral calcaneal fracture.

Comparative Study of Posterior Lumbar Interbody Fusion with Posterolateral Fusion in Degenerative Lumbar Spinal Disorders

STUDY DESIGN: A retrospective study. OBJECTIVES: The authors found that problems such as axial pain, donor site pain, loss of reduction, loosening or failure of fixation materials occurred relatively frequently after posterolateral fusion. For this, we had views on the ideas that the problems could be improved by an operation that fused vertebral bodies. Furthermore, we performed posterior lumbar interbody fusion and wanted to know the results. SUMMARY OF LITERATURE REVIEW: We performed posterior lumbar inter-body fusion as an alternative, due to complications of autoiliac bone graft that has complications, such as donor site pain. MATERIALS AND METHODS: Sixty patients with single segment degenerative lumbar disease were treated with decompression, pedicle screws fixation, and spinal fusion. The patients were followed-up for more than 2 years. Thirty patients, who had undergone posterolateral fusion with autologous iliac bone graft, were classified as the "group 1". The second 30 patients, who underwent posterior lumbar interbody fusion with cage and local bone graft, were classified as the "group 2". The operation time, blood loss, fusion rate, lumbar lordotic angle, segmental angle were compared between the 2 groups. The clinical outcomes were evaluated by Kim's functional evaluation scale. RESULTS: The operation time was shorter in group 2 (142.74 minutes vs 171.64 minutes), there was a statistical difference between the 2 groups. Intraoperative blood loss was more in group 2 (563.40 vs 551.78 mL), but total blood loss, including postoperative drained blood was less in group 2. The bony fusion rate was 90% in group 1, 97% in group 2. For the lumbar lordotic angle, the last outcome was less than the preoperative value. There was no statistical difference between the 2 groups. The segmental angle in group 1, the last outcome was less than the preoperative value. The segmental angle in group 2 was maintained the value through pre-operation to post-operation. Clinical outcomes were satisfactory in group 1 (96.67%) & in group 2 (100%). In group 1, 7 patients experienced pain at the iliac graft donor site. In group 2, there were 2 cases of retroposition of the cage. CONCLUSIONS: In the posterior lumbar interbody fusion group, operation time was shorter, total blood loss was less than in the posterolateral fusion group. Restoration and maintenance of the segmental angle in sagittal and coronal radiographs showed better outcomes, axial pain and iliac donor site pain were less. It is the authors' position that posterior lumbar interbody fusion is an alternative operation to supplement the faults of posterolateral fusion.

Comparative Study of Clinical and Radiologic Outcomes of Unstable Distal Radius Fractures in Patients 70 Years or Older: Nonoperative Versus Operative Treatment

PURPOSE: Clinical and radiologic results of operative versus nonoperative treatment were compared in patients 70 years or older who had an unstable distal radius fracture. MATERIALS AND METHODS: From March 2007 to April 2009, 49 patients who had an unstable distal radius fracture treated nonoperatively (22 patients) or operatively (27 patients) were investigated. The radiologic results between the two patient groups were compared based on bone union, dorsal tilt, radial inclination and radial shortening. The clinical results were compared based on disabilities of arm, shoulder & hand (DASH) score, the patient-rated wrist evaluation (PRWE) score, the grip strength and the motion range of the wrist joint. RESULTS: At the last follow-up examination, DASH score, PRWE score, the flexion, supination and radial deviation of wrist joint and the grip strength did not showed significant difference. Among the patients who received non-operative treatments, 18 of 22 showed radiologically recognizable deformation; average dorsal tilt of 11.9degrees, the average radial inclination of 18.9degrees, and average radial shortening of 3.8 mm. The patients who received operative treatments showed average volar tilt of 3.3degrees, radial inclination of 18.8degrees+/-3.7degrees, and radial shortening of 1.5 mm. Three patients showed radiologically recognizable deformation. CONCLUSION: Our results suggest that nonoperative treatment is initially recommended in patients with the age of 70 years or older who have an unstable distal radius fracture in terms of functional results.