Tension Band Wiring for Distal Clavicle Fracture: Radiologic Analysis and Clinical Outcome

PURPOSE: The purpose of this study is to evaluate the radiologic and clinical outcomes after tension band wire fixation of Neer type II distal clavicle fractures. MATERIALS AND METHODS: Twenty-six patients with Neer type II distal clavicle fractures who underwent tension band wire fixation from March 2002 to May 2011 were included in the study. Fifteen cases were classified as Neer type IIa and 11 cases as type IIb. The postoperative mean follow-up period was 14.3 months. Clinical and radiologic evaluation was performed at two weeks, six weeks, three months, six months, and 12 months postoperatively. RESULTS: Bony union on X-rays was observed at an average of 11.7 weeks (range 8-20 weeks) postoperatively. The overall visual analogue scale score for pain was 1.23+/-2.75 postoperatively. The overall postoperative University of California at Los Angeles score increased to 33.5+/-2.15 from the preoperative score of 21.6+/-1.91 (p<0.05). CONCLUSION: Among various methods of treatment for Neer type II distal clavicle fracture, K-wire and tension band fixation was used and relatively satisfactory radiological and clinical results were obtained. This surgical method yields excellent clinical results, owing to its relatively easy technique, fewer complications, and allowance of early rehabilitation.

A Research on the Management of Ventilatory Insufficiency in Patients with Neuromuscular Diseases

OBJECTIVE: To investigate the real condition of pulmonary rehabilitation for patients with advanced neuromuscular diseases (NMDs) on mechanical ventilation in Korea. METHOD: In order to estimate current state of pulmonary rehabilitative management, chart review and pulmonary function evaluation were conducted in a total of 267 NMD patients who had applied mechanical home ventilator in our center from March 2001 to December 2008. RESULTS: Total 267 patients were included: 95 with Duchenne muscular dystrophy, 69 with other types of myopathy, 83 with amyotrophic lateral sclerosis (ALS), 20 with spinal muscular atrophy. Among them, 18 who were previously intubated and 17 patients who had undergone tracheostomy were switched into volume-limited non-invasive ventilation (NIV). At the time of hospital discharge, 234 patients were applied NIV successfully. Twenty other patients who once used continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) ventilators inappropriately were switched into volume-limited NIV. However, 20 patients who had successfully applied NIV first underwent tracheostomy due to exacerbation of underlying disease. CONCLUSION: Adequate pulmonary management is the only promising method to prevent lethal complications, and to prolong life span of advanced NMD patients. We assume that more NMD patients can improve their quality of life and prolong their life through proper pulmonary rehabilitation including regular pulmonary function check-ups and ventilatory state monitoring as well as early NIV application.

Clinical Usefulness of Capute Developmental Test as a Screening Test for Detecting the Language Delay

OBJECTIVE: To investigate the usefulness of Capute developmental test (Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale, CAT/CLAMS) as a screening test for detecting the language delay by evaluating the correlation with sequenced language scale for infants (SELSI). METHOD: Subjects were comprised of 101 children (18~48 months) who were referred for evaluation of language delay. Administering CAT/CLAMS, the developmental quotients (DQs) of CAT and CLAMS, including receptive language quotient (RLQ) and expressive language quotient (ELQ), were calculated. The results of RLQ, ELQ and DQs of CAT/CLAMS were compared with the receptive, expressive and total speech quotient (SQ) of SELSI. RESULTS: The correlation between CLAMS DQ and total SQ (r=0.75, p<0.01), between CLAMS RLQ and receptive SQ (r=0.76, p<0.01), and between CLAMS ELQ and expressive SQ (r=0.79, p<0.01) was statistically significant. CLAMS (DQ<70) revealed a sensitivity of 87% and a specificity of 78% for detecting language delay defined by total SQ<70. CONCLUSION: Correlation coefficient comparing CLAMS with SELSI test was significantly high in children with language delay. CLAMS DQ 70 is a reasonable screening cutoff score for detecting total SQ<70.

Comparison of Energy Expenditure and Walking Performance by Arm Cycling and Leg Cycling Exercise

OBJECTIVE: To investigate the effect of cycling ergometry and to compare energy expenditure and walking performance after arm cycling with those after leg cycling in patients with brain diseases. METHOD: Twenty-two adults with brain diseases (6 stroke, 4 traumatic brain injury, 4 brain tumor, 4 parkinsonism, 4 cerebral palsy) were recruited as subjects. They were randomly assigned to disease-matched groups; arm cycling and leg cycling (n=11 each). VO2 (L/min), VCO2 (L/min), VE (L/min), O2 rate (ml/kg, min), O2 pulse (ml/kg, bpm), O2 cost (ml/kg, m) and VO2 peak (ml/kg, min) during cycling test or walking test, and walking performance were evaluated after cycling training for 4~6 weeks. RESULTS: Arm cycling exercise did not improve any parameters such as VO2, VCO2, O2 rate and O2 cost during walking test, whereas it increased VCO2, VE and O2 pulse during cycling test. In contrast, leg cycling significantly improved walking velocity and distance, and decreased O2 cost during walking test. It also increased all parameters including VO2 peak during cycling test (p<0.05). CONCLUSION: Leg cycling exercise improved walking performance and energy efficiency of walking as well as cardiorespiratory fitness relative to arm cycling. Therefore, leg cycling promoted lower-extremity task such as walking in patients with brain diseases.

Complete Atrioventricular Block in Duchenne Muscular Dystrophy : A case report

Duchenne muscular dystrophy (DMD) is a severe X-linked recessive disorder characterized by rapid progression of muscle wasting and weakness. The disorder is caused by a mutation in the dystrophin gene on chromosome Xp21.1. DMD may be accompanied by heart failure, but conduction abnormalities are uncommon. We report a case of a 28-year- old male patient with DMD who presented with symptoms of bradycardia, chest discomfort and dyspnea. He was diagnosed as having complete atrioventricular block by electrocardiogram. Pacemaker was inserted, and subsequently symptoms and electrocardiogram findings showed improvement.

Pneumothorax Associated with Noninvasive Intermittent Positive Pressure Ventilation in Duchenne Muscular Dystrophy: A case report

Duchenne muscular dystrophy (DMD) is a severe X-linked recessive disorder characterized by rapid progression of muscle wasting and weakness. Long term noninvasive intermittent positive pressure ventilation (NIPPV) is an important treatment for neuromuscular patients with chronic respiratory failure. NIPPV is easy to administer and life-threatening complications are rare. We report two cases of pneumothorax associated with long term NIPPV in DMD. Given the increasing utilization of chronic NIPPV, we suggest that caregivers and patients must be aware of this potentially life-threatening complication.