Functional Recovery of the Shoulder after Correcting Malrotation of the Distal Humerus: A Case Report

Although studies on malrotation of the humerus possibly leading to dysfunction of the shoulder have been reported, studies on its causes are inadequate. The authors encountered a patient complaining of malrotation accompanied by dysfunction of the shoulder which occurred during treatment of a distal humeral fracture. The patient recovered the shoulder function by only correcting malrotation of the humerus without direct treatment on the shoulder, and we report it herein with a review of the literature.

Intraobserver and interobserver reliability of radial torsion angle measurements by a new and alternative method with computed tomography

OBJECTIVE: To evaluate the intraobserver and interobserver reliability of radial torsion angle measurement using computed tomography. METHODS: Twelve pairs of cadaver radii and 116 forearms from 58 healthy volunteers were evaluated using axial computed tomography sections measured at the level of the bicipital tuberosity and the subchondral region of the radius. During digital imaging, the angle was formed by two lines, one diametrically perpendicular to the radial tubercle and the other tangential to the volar rim of the distal joint surface. Measurements were performed twice each by three observers. RESULTS: In cadaveric bones, the mean radial torsion angle was 1.48º (-6º - 9º) on the right and 1.62º (-6 º - 8º) on the left, with a mean difference between the right and left sides of 1.61º (0º - 8º). In volunteers, the mean radial torsion angle was 3.00° (-17° - 17°) on the right and 2.91° (-16°- 15°) on the left, with a mean difference between the sides of 1.58º (0º - 7º). There was no significant difference between each side. The interobserver correlation coefficient for the cadaver radii measurements was 0.88 (0.72 - 0.96) and 0.81 (0.58 - 0.93) for the right and left radius, respectively, while for the volunteers, the difference was 0.84 (0.77 - 0.90) and 0.83 (0.75 - 0.89), respectively. Intraobserver reliability was high. CONCLUSION: The described method is reproducible and applicable even when the radial tubercle has a rounded contour.

Correction in Rotational Deformity with Thoracolumbosacral Orthosis in Idiopathic Scoliosis / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: This study examined the effect of a TLSO brace treatment for the correction of axial rotational deformities in idiopathic scoliosis. SUMMARY OF THE LITERATURE REVIEW: A TLSO brace treatment is effective in correcting 2-dimensional deformities of idiopathic scoliosis but is questionable in axial rotational deformities. MATERIALS AND METHODS: Fifty three cases treated by bracing in March, 1999~February, 2005 at our department were reviewed. The posteroanterior and lateral radiographs were checked in the standing position throughout the study. The change in axial rotational deformity were analyzed using Nash & Moe method and Perdriolle's method. RESULTS: The rotational deformity had improved in 2 curves, was aggravated in 8 curves, and showed no change in 43 curves with the TLSO brace. CONCLUSIONS: The TLSO brace treatment in axial rotational deformity of idiopathic scoliosis is not effective in correcting the rotational deformity but is effective in preventing the progress of a rotational deformity.

The Shortening and Rotational Deformity after Closed Intramedullary Nailing of Femur Shaft Fracture: According to Winquist-Hansen classification

PURPOSE: This study evaluated the shortening and rotational deformity after closed intramedullary nailing of femur shaft fracture according to Winquist-Hansen classification type. MATERIALS AND METHODS: This study was based on 98 cases who received cloased intramedullary fixation about their femur shaft fractures between January 2000 and October 2005 with minimum 12 months follow up. The rotational deformity was analysed by Yang's method (45 cases) preoperatively and postoperatively, and the shortening by orthoradiogram (55 cases). Furthermore we analysed other complications, for example nonunion, infection, and metal failure. RESULTS: We found more than 15 degrees anteversion difference of both femurs in 10 cases. Among them, 9 cases were classified to type 3, 4. According to Winquist-Hansen classification, rotational deformity ranged from 3.7° (Type 1) to 8.9° (Type 4). More than 2 cm leg length discrepancy (LLD) was found in 9 cases, all of them were classified as Winquist-Hansen classification type 3, 4. In the type 1, LLD was checked as 3.2 mm and type 4, 14.2 mm. CONCLUSION: To prevent the shortening and rotational deformity after intramedullary fixation of Winquist-Hansen classification type 3, 4 femur shaft fracture, intraoperatively the exact contralateral femoral anteversion and length should be checked.

Relationship between rotatioanal deformity and operational correction rate in scoliosis / 上海第二医科大学学报

Objective To study the relationship between rotational deformity and operational correction rate in scoliosis. MethodsFrom January 2005 to December 2006,44 cases of adolescent idiopathic scoliosis with operational correction were reviewed.Before operation,all the patients were performed MRI scan of the whole spine and the rotation angle of superior and inferior endplate of nine vertebraes with the center of apical vertebrae were measured so that the mechanical torsion angle of vertebrae and disc were calculated,and the rotation compliance of the spine was obtained.In addition,preoperative plain,lateral and bending film of thoracic-lumbar vertebrae were taken to measure the Cobb angle,and the items above were compared with those of post-operation to calculate the scoliosis flexibility and correction rate.Correlation analysis was conducted between the rotation compliance,flexibility and operational correction rate in scoliosis.Results There were significant differences in the mean coronal and sagittal Cobb angle before and after the operation(P

Changes in Vertebral Rotation Following Segmental Pedicle Screw Instrumentation and Rod Derotation in Idiopathic Thoracic Scoliosis : Part I - CT Evaluation / 대한정형외과학회잡지

The employment of segmental pedicle screw instrumentation has greatly enhanced the correction of scoliotic deformity. However there is still much controversy on the ability of the system to correct the rotational deformity. This prospective study with 12 idiopathic throacic scoliosis patients subjected to segmental pedicle screw instrumentation was performed to determine the effect of the system on the rotational deformity of idiopathic throacic scoliosis. In addition to the standing films to measure the magnitude of scoliotic curvatures, preand postoperative CT were utilized for the measurement and comparison of angle of rotation relative to the sagittal plane(RAsag.), relative rotation with reference to the upper and lower end vertebrae(RAend), relative rotation with reference to the sacrum(RAsac.), frontal translation(TF) and sagittal translation(TS) for the apical vertebrae. Despite the high correction rate obtained in the frontal plane(average 71.1%) and normalization of sagittal contour, the rotational corrections were statistically insignificant in all parameters and showed no significant correlation to the correction of the curvatures nor horizontal plane displacement as represented by the frontal and sagittal displacement. In conclusions, the segmental pedicle screw instrumentation with rod derotation does not produce significant derotation by itself.

Clinical Studies of Corrective Osteotomy for Various Angular Deformities of Tibia / 대한정형외과학회잡지

Since 1856, Mayer13) coined the term “osteotomy” for a tibial resection for an angular deformity, various shapes and designs of osteotomies in long bone or pelvis have been popularized to treat the malunion, osteoarthritis of hip and knee, bow leg, L.C.P., or C.D.H. etc. The purpose of corrective osteotomy for tibia is so different from that of upper extremity because it must be restored the weight bearing alignment, and equalize or minimize the leg length discrepancy. We respectively reviewed 14 cases with various angular deformities on tibia who were treated at Dept. of Orthopaedic Surgery, Catholic Medical College from Jan. 1976 to Dec. 1984. The results obtained were as follows: 1. Causes of angular or rotational deformities of tibia were malunion in 11, bow leg in 2 and partial closure of distal tibial epiphysis in l. 2. Ten cases of tibial deformities exceeded over the 10° of medial or lateral angulation and 15° of anterior or posterior bowing were corrected for normal weight-bearing alignment in lower leg. And a rotational deformity may be so disabling to walk as to require surgery. So four cases of tibial angular deformities combined with more than 20° of external rotation and 5° of internal rotation were corrected for normal good looking walks. 3. The maximum length that can be gained by an opening wedge osteotomy was near the point of maximum angluation, but it could be changed by the cause of deformity and patient's age. We've done 4 cases of opening and 10 cases of closing wedge osteotomy. 4. Angular deformity in one plane due to fracture in children under 10 years of age may be corrected spontaneously by growth, but deformities due to bow leg or epiphyseal injury cann't be expected any spontaneous correction of deformity by growth. So three cases of tibial deformities due to bow leg or epiphyseal injury in children were corrected in earlier after recognition of that deformities because of possible damage to articular cartilage and the combined rotational deformities. 5. A slight deformity if the angulation involves near a joint, knee or ankle could be seriously disabling and so must be correctcd earlier. 6. Functional results of the corrective wedge osteotomy in angular and rotational deformities of tibia were excellent, good, fair in 4, 7 and 3, respectively.