Correlation between Severity of Synovitis and Clinical Features in Rotator Cuff Tears

Background@#Rotator cuff tears can be asymptomatic in some cases; however, even when the tear size is small, clinical symptoms can be very severe. This suggests that symptoms of rotator cuff tears are related to factors other than the size. Although synovitis has been cited as one of the factors, there is no grading system for synovitis in rotator cuff tears. Moreover, there are few studies that evaluated the relationship between synovitis and clinical features in patients with rotator cuff tears. @*Methods@#Patients with medium-sized rotator cuff tears, who were scheduled for arthroscopic repair, were recruited for this study.The glenohumeral joint was divided into 4 quarters. Then, vascularity and hypertrophy of the joint were graded in each quarter using a modified scoring system. Clinical assessment was performed preoperatively and at 3 months and 6 months after surgery.Finally, correlation between the severity of synovitis and clinical features was analyzed. @*Results@#The intraobserver correlation coefficient was 0.815 to 0.918 and the interobserver correlation coefficient was 0.779 to 0.992 for the single measurement. Vascularity was significantly correlated with the range of motion, strength, and constant score within 6 months after surgery. Hypertrophy was correlated with the range of motion within 6 months after surgery. @*Conclusions@#Synovitis in the shoulder with rotator cuff tears can be graded by using our modified scoring system. The severity of synovitis was closely related to the clinical features after surgery. Therefore, when treating patients with rotator cuff tears, treatment of synovitis should also be considered.

Incidence and Seasonal Variation of Distal Radius Fractures in Korea: a Population-based Study

BACKGROUND: The present study aimed to investigate the incidence and seasonal variation of distal radius fractures (DRFs) in Korea. METHODS: We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service from 2011 to 2015. We used International Classification of Diseases, 10th revision codes and procedure codes to identify patients of all ages with newly diagnosed DRFs. RESULTS: An average of about 130,000 DRFs occurred annually in Korea. The incidence of DRF, by age group, was highest in the 10 to 14-year-old age group for males and the highest in the 70s age group for females, with a rapid increase of incidence after 50 years. The peak incidence of DRF occurred during winter; however, the incidence greatly varied annually when compared with that of other seasons. The incidence of DRFs during the winter season was correlated with the average temperature. CONCLUSION: The annual incidence of DRF was 130,000 in Korea. The incidence increased under an intense cold surge during winter. Active preventive measures are recommended especially in women exceeding 50 years considering the higher incidence in this age group.

The Epidemiology of Dupuytren's Disease in Korea: a Nationwide Population-based Study

BACKGROUND: To date, there have been few reports on the nationwide population-based epidemiology of Dupuytren's disease (DD). We investigated the prevalence and incidence of DD in Korea using the large dataset provided by the Korean Health Insurance Review and Assessment Service. This study is the second nationwide epidemiological study of DD after the study in Taiwan. METHODS: Records of patients diagnosed with DD between 2007 and 2014 were extracted from the large dataset by diagnostic code searching (International Classification of Disease 10th revision code M72.0) and were included in the study. We calculated the prevalence and incidence of DD based on the total population of Korea provided by the Korean Statistical Information Service. Diseases associated with DD and the trends in surgery for DD were also analyzed. RESULTS: A total 16,630 patients were diagnosed with DD during the study period. The mean annual prevalence was 32.2 per 100,000 population (41.8 per 100,000 for men; 22.5 per 100,000 for women). The mean annual incidence was 1.09 per 100,000 population (1.80 per 100,000 for men; 0.38 per 100,000 for women). The common diseases associated with DD were hypertension (30.5%), diabetes mellitus (26.7%), hyperlipidemia (20.4%), ischemic heart disease (7.9%), and cerebrovascular disease (4.6%). The mean annual proportion of the patients who had surgery for DD was 5.24% of all DD patients. CONCLUSION: The prevalence and incidence of DD in Korea were 100–1,000 times lower than those in western countries; however, it was slightly larger than that in Taiwan.

Simultaneous reconstruction of the forearm extensor compartment tendon, soft tissue, and skin

Malignant peripheral nerve sheath tumor (MPNST) is a very rare type of sarcoma, with an incidence of 0.001%. MPNST has a 5-year survival rate near 80%, so successful reconstruction techniques are important to ensure the patient's quality of life. Sarcoma of the forearm is known for its poor prognosis, which leads to wider excision, making reconstruction even more challenging due to the unique anatomical structure and delicate function of the forearm. A 44-year-old male presented with a large mass that had two aspects, measuring 9×6 cm and 7×5 cm, on the dorsal aspect of the right forearm. The extensor compartment muscles (EDM, EDC, EIP, EPB, EPL, ECRB, ECRL, APL) and invaded radius were resected with the mass. Tendon transfer of the entire extensor compartment with skin defect coverage using a 24×8 cm anterolateral thigh (ALT) perforator free flap was performed. The patient was discharged after 18 days without wound complications, and has not complained of discomfort during supination, pronation, or wrist extension/flexion through 3 years of follow-up. To our knowledge, this is the first report of successful reconstruction of the entire forearm extensor compartment with ALT free flap coverage after resection of MPNST.

National Trends in Surgery for Rotator Cuff Disease in Korea

The objective of this study was to investigate the national trends in rotator cuff surgery in Korea and analyze hospital type-specific trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2007 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes, procedure codes, and arthroscopic device code were used to identify patients who underwent surgical treatment for rotator cuff disease. A total of 383,719 cases of rotator cuff surgeries were performed from 2007 to 2015. The mean annual percentage change in the age-adjusted rate of rotator cuff surgery per population of 100,000 persons rapidly increased from 2007 to 2012 (53.3%, P < 0.001), while that between 2012 to 2015 remained steady (2.3%, P = 0.34). The proportion of arthroscopic surgery among all rotator cuff surgeries steadily rose from 89.9% in 2007 to 96.8% in 2015 (P < 0.001). In terms of hospital types, the rate of rotator cuff surgery increased to the greatest degree in hospitals with 30–100 inpatient beds, and isolated acromioplasty procedure accounted for a larger proportion of the rotator cuff surgeries in small hospitals and clinics compared to large hospitals. Overall, our findings indicate that cases of rotator cuff surgery have increased rapidly recently in Korea, of which arthroscopic surgeries account for the greatest proportion. While rotator cuff surgery is a popular procedure that is commonly performed even in small hospitals, there was a difference in the component ratio of the procedure code in accordance with hospital type.

Perilunate Injury Combined with Lunate Fracture

We present an atypical case of combined comminuted lunate fracture and the scaphoid waist fracture, chip fracture of triquetrum and pisiform. Comminuted scaphoid waist fracture was caused by forced hyperextension of the wrist, similar mechanism to stage I of progressive perilunate instability (PLI), and lunate fracture might be caused by axial compression force, does not appear on the original theory of PLI. We performed closed reduction and screw fixation for the scaphoid fracture and immobilized and mildly distracted the wrist joint with the use of a bridging external fixator to prevent further collapse of comminuted lunate by neutralizing the compression force imposed by the capitate on the lunate. We achieved excellent radiological and clinical outcomes at 29-months of follow-up. We aimed to introduce this rare injury and clinically important points in its treatment with the review of the literature.

National Surgical Trends for Distal Radius Fractures in Korea

The objective of this study was to investigate national surgical trends for distal radius fractures (DRFs) in Korea and analyze healthcare institution type-specific surgical trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2011 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes and procedure codes were used to identify patients aged ≥ 20 years with newly diagnosed DRFs. A total of 459,388 DRFs occurred from 2011 to 2015. The proportion of DRF cases treated by surgery tended to increase over time, from 32.6% in 2011 to 38.3% in 2015 (P < 0.001). Open reduction with internal fixation (ORIF) using a plate steadily gained in popularity each year, increasing from 39.2% of overall surgeries in 2011 to 60.9% in 2015. The type of surgery for DRFs differed depending on the type of healthcare institution. ORIF (91%) was the most popular procedure in tertiary hospitals, whereas percutaneous pinning (58%) was most popular in clinics. In addition, general hospitals and hospitals with 30–100 beds used external fixation more frequently than tertiary hospitals and clinics did. Overall, our findings indicate that surgical treatment of DRF, particularly ORIF, continues to increase, and that the component ratio of operation codes differed according to the healthcare institution type.

Identification of Pasteurella canis in a Soft Tissue Infection Caused by a Dog Bite: The First Report in Korea

No abstract available.

The Change of the Ulnar Variance in Accordance with the Wrist Position in Ulnocarpal Impaction Syndrome

PURPOSE: We evaluated the change of the ulnar variance (UV) as forearm rotation in patients with ulnocarpal impaction syndrome (UIS). METHODS: Twenty patients who suffered from ulnar side pain of the wrist and had abnormal lesions at ulno-basal side of the lunate in the radiologic examinations were included in this study. Their UVs in six wrist position (neutral, supination, pronation, neutral and grip, supination and grip, pronation and grip) were measured by the method of perpendiculars. UVs and the maximum change of UV in patients with UIS were compared with those of control group statistically. RESULTS: There were statistically significant differences in UVs of all forearm rotation and grip status. The maximum change of UV was in supination position to pronation and grip status for all cases. The mean maximum change of UV in patients with UIS was 2.03+/-1.03 mm, and that of control group was 1.86+/-0.86 mm. But there was no significant difference between them. The ulnar shortening osteotomy was performed for thirteen UIS patients, and one patient with osteoarthritis at distal radio-ulnar joint was operated with Darrach procedure. Six patients underwent conservative treatment. CONCLUSION: There were no significant differences in the maximum change of UV as forearm rotation between UIS patients and control group.

Reproducibility of Choroidal Thickness in Normal Korean Eyes Using Two Spectral Domain Optical Coherence Tomography

PURPOSE: To investigate the reproducibility of choroidal thickness measurements in healthy Koreans using two spectral domain optical coherence tomography (SD-OCT) instruments: Zeiss Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA) and Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany). METHODS: Images were obtained in 60 eyes of 30 healthy undilated volunteers without ocular pathology in a clinical setting. The choroid was imaged in all subjects using Cirrus HD 1-line raster and Spectralis enhanced depth imaging (EDI). The choroid was measured subfoveally, 1500 microm temporal, and 1500 microm nasal to the fovea. All measurements were performed by two independent observers. One-way analysis of variance (ANOVA), Pearson correlation, and Bland-Altman analysis were used to compare measurements. RESULTS: The study group consisted of 15 males and 15 females. The mean age was 50.73 +/- 15.09 years (range, 24-75 years). There was no significant difference in the mean choroidal thickness (p > 0.05) between systems for any location. The choroidal thickness measurements using two instruments (Cirrus vs. Spectralis) were also strongly correlated (p < 0.001). CONCLUSIONS: In the present study of healthy Korean adults, good reproducibility was observed between choroidal thickness measurements of images obtained from Cirrus and Spectralis.

Patients' Compliance for the Conservative Treatment of the Elbow Epicondylitis

PURPOSE: To measure the level of compliance to conservative treatment of epicondylitis and to identify factors affecting compliance. METHODS: This study included 104 patients who were treated non-operatively for epicondylitis of the elbow from 2009 to 2011. At the time of initial visit, all patients had thorough explanation about diagnosis, cause and pathophysiology of the disease, and were recommended to wait-and-see or to have steroid injection. At minimum of 6 month's follow-up, we performed telephone survey including patient's level of perception about the disease, maintenance of initial treatment method, and final symptom relief. Statistical analysis was performed using chi-square test, Fisher's exact test and logistic regression analysis. RESULTS: Of the 104 patients, 82 (78.8%) patients maintained initial treatment methods. 23 (22.1%) remembered exact diagnosis and mechanism of the disease, 49 (47.1%) remembered cause or mechanism but not about the diagnosis, and 32 (30.8%) didn't know about the diagnosis nor mechanism. Compliances of those groups were 73.9% (17/23), 79.6% (39/49), and 81.3% (26/32), respectively, and the differences were not statistically significant (p=0.7934). Initial pain (odds ratio=0.7, p=0.0293) and the compliance (odds ratio=6.13, p=0.0015) were significant predictors of final symptom relief. CONCLUSION: There were no factors including perception level that proved to affect the compliance. Since higher compliance led to more successful outcome, further research on factors that increase compliance may be needed.

Progression of Dupuytren's Contracture after Partial Fasciectomy

PURPOSE: This study reported the clinical results of partial fasciectomy on Dupuytren's contracture and evaluated the factors associated with progression. MATERIALS AND METHODS: A retrospective analysis was performed on 32 hands in 28 patients who had subtotal fasciectomy for Dupuytren's contracture from 1992 to 2007. We evaluated complications and clinical results by Honner's classification. Through telephone interviews, we checked the progression of contracture including recurrence and extension in twenty three patients with a mean postoperative period of 5.9 years. The relationship between progression and several factors were analyzed using statistical analyses. RESULTS: Clinical results were excellent in 13 cases, good in 12, fair in 4, and poor in 3. Progression rate was 48% (11patients). It occurred at operated fingers in 3 cases, non-operated fingers in 7 cases and both in 1 case. Progression was correlated with smoking and was more common in patients with bilateral disease, but not with alcohol, age or severity. Complications occurred in 4 patients (1 complex regional pain syndrome, 1 nerve injury and 2 delayed wound healing). CONCLUSIONS: Partial fasciectomy is a suitable method for Dupuytren's contracture. Complication rate is not high if careful operation is performed. However, progression is common in patients with bilateral disease or smoking habitus.

4+5 Extensor Compartmental Vascularized Bone Graft for Stage III Kienbock's Disease : Preliminary Results

PURPOSE: The aim of this study was to evaluate the preliminary results using the 4+5 extensor compartmental vascularized bone graft for the treatment of stage III Kienbock's disease and to report the usefulness of this procedure. METHODS: A retrospective study was carried out on five patients who had undergone 4+5 extensor compartmental vascularized bone graft for stage III Kienbock's disease between Jan. 2005 and Aug. 2006. All patients were composed of two patients in stage IIIA and three patients in stage IIIB according to Lichtman classification. The radiographic findings were evaluated by carpal height ratio, Stahl's index, ulnar variance and scapholunate angle. The clinical outcome was assessed using the Mayo wrist score. RESULTS: The mean age of 43.4 years(range, 21-61) and the mean follow up of 23.6 months(range, 14-31) were presented. All patients were satisfied and the mean Mayo wrist score was 78(range, 70-85). Two patients showed further lunate collapse on follow-up radiographs. Four patients had no pain in the activity of daily living, one patient had a mild occasional pain. CONCLUSION: The 4+5 extensor compartmental vascularized bone graft for the surgical treatment of stage III Kienbock's disease is the effective treatment showing satisfactory clinical results, but a lunate collapse proceeds. Before this operation, the possibility of lunate collapse should be considered.

Results of Open Synovectomy for Rheumatoid Elbow

PURPOSE: To identify the recovery of joint movement and decrease in pain through the radiological findings after open synovectomy for the elbow with rheumatoid arthritis which was not cured by medication. MATERIALS AND METHODS: From 1997 to 2008, the research on open synovectomy for the elbow with rheumatoid arthritis was done in 19 patients with 21 cases whose average follow-up was 12 months. Despite the medical treatment, the indication of operation was towards the patients with Larsen grade I~III rheumatoid arthritis whose joint swelling and pain had not been improved. Also, the indication of operation included the patients with Larsen grade IV who rejected joint replacement or needed to postpone the operation due to young age. Main symptom was pain in all cases; Preoperative flexion contracture and flexion-extension movement on average was 29 degree and 86 degree, respectively.Postoperative radiological and physical examination were done; Visual analogue scale and Mayo elbow performance score were measured. RESULTS: Joint swelling recurred in two cases (9.5%). However, the size of swelling was mild compared to preoperative condition. Preoperative total mean flexion contracture was 29 degree (10~45 degree) and total mean flexion-extension movement was 86 degree (60~135degree). Last follow-up total mean flexion contracture was 18 degree (5~50 degree) and total mean flexion movement was 102 degree (35~150 degree). Statistically, the increase of range of joint movement was not significant. Radiologically, there were 11 cases(52.3%) showing no changes in preoperative and postoperative grade while there were 10 cases(47.6%) with increase in grade. As for VAS score, total mean preoperative score was 5 and postoperative score was 2.3(0~8) showing less pain than the past. After statistical analysis separated by Grade I, II, III and IV, last follow-up of VAS score, Mayo elbow performance score and elbow joint movement showed no statistical difference compared to Larsen grade (p=0.075). CONCLUSIONS: Open Synovectomy for elbow with rheumatoid arthritis can not stop radiological progress, and the increase in range of joint movement is not statistically meaningful. However the operation displays clinical improvement such as decrease in pain and increase in range of joint movement.

Computed Tomographic Analysis of Screw Positions in Volar Percutaneous Screw Fixation of Scaphoid Fractures

PURPOSE: We analysed the position of screws whithin the scaphoid on computed tomographic images of patients treated by volar percutaneous screw fixation for scaphoid fractures. MATERIALS AND METHODS: We reviewed 16 patients treated by volar percutaneous screw fixations for scaphoid fractures. In three (proximal, middle, distal) portions of the scaphoid, the distance from the center of the screw to the edge of the cortex and the diameter of the scaphoid were measured on the sagittal and coronal reconstructive computed tomographic images. We divided into two groups: the risk group with cortical breakage or penetration by the screw and the safe group with no cortical breakage. The position of screws was analysed and compared between two groups. RESULTS: The position of screws in the proximal scaphoid was more central than the distal scaphoid (p<0.05). The central screw placement in the distal scaphoid correlated with that in the proximal scaphoid. The average distance from the volar surface of the scaphoid tuberoisity to the entry point was 7.0 mm(5.0~8.8 mm) in risk group and 4.7 mm(1.5~7.6 mm) in safe group. It was differed significantly between risk group and safe group(p<0.05). CONCLUSION: This study suggests that volar percutaneous screw fixation for scaphoid fractures can achieve central screw placement in the proximal scaphoid. For the safe placement of the screw, a surgeon should be careful not to locate the entry point too far posteriorly on the scaphotrapezial joint.

Contributing Factors of Radial Nerve Palsy Associated with Humeral Shaft Fracture

PURPOSE: To analyze related factors of radial nerve palsy in patients with humeral shaft fractures. MATERIALS AND METHODS: We reviewed 107 paients with humeral shaft fracture between January 2000 and June 2007. Thirteen patients had radial nerve palsy after trauma and 9 patients after the operation. We analyzed contributing factors of radial nerve palsy associated with humeral shaft fracture including the cause of trauma, location and pattern of fracture, surgical approach and tourniquet application in cases of plate fixation, the exploration for the nerve and the time for operation. RESULTS: The difference in the incidences of radial nerve palsy after trauma and operation was not significant according to the location and pattern of fracture. The tendency of higher rate of radial nerve palsy after trauma in oblique or comminuted fractures, and after operation in spiral fractures was observed. The operation using intramedullary nailing and radial nerve exploration significantly reduced the incidence of radial nerve palsy after operation (p=0.01 and p=0.02). Posterior approach in open reduction and plate fixation showed a tendency of lower incidence of radial nerve palsy after operation (p=0.78). In logistic regression analysis, radial nerve exploration was the only significant factor that reduced the possibility of radial nerve palsy after operation (17.27: odds ratio, p=0.02). CONCLUSION: In humeral shaft fractures, we should take into consideration whether intramedullary nailing is possible or not. In cases of anterior or anterolateral approach of open reduction and plate fixation, radial nerve should be carefully inspected. In most cases, we recommend radial nerve exploration in order to minimize the possibility of radial nerve palsy after operation.

Volar Plating of Distal Radius Fractures

Volar plating seems to indicate that many surgeons believe it leads to superior results, and is attractive because of the ease of the operative approach and the soft tissue sleeve to protect digital and wrist tendons. And also it have a locking mechanism to produce the fixed angle device with a low profile and may be thought to be a new era in the surgical treatment of dorsally displaced distal radius fractures even in the face of comminuted or osteoporotic bone. Locked volar plating allows direct fracture reduction, stable fixation and provides stability enough to allow early mobilization and function. The results with volar locking or fixed angle fixation for the general treatment of unstable distal radius fractures in elderly patients has been favorable. Volar plating has fewer complications than external fixation and dorsal plating and allow for earlier return to function. The current indications, technical aspects, clinical results, and complications of the volar plating are being reviewed.

Factors and Surgical Pitfalls Causing Nonunion

No abstract available.

Arthroscopically Assisted En Bloc Resection of the Distal Clavicle in the Acromioclavicular Joint Lesion / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of arthroscopically assisted operation of the acromioclavicluar joint lesion with the rotator cuff lesion. MATERIALS AND METHODS: We evaluated the clinical results in eighteen consecutive patients with osteoarthritis of the acromioclavicular joint and rotator cuff lesion, who were treated arthroscopically assisted en bloc resection of the distal clavicle and arthroscopic acromioplasty. The average age of the patients at the time of operation was fifty six years. The average duration of follow-up was one year and ten months. The UCLA shoulder rating scale was used to evaluate the clinical results. RESULTS: Pain score was improved from 2.1+/-1.1 preoperatively to 9.2+/-1.0 postoperatively. Function score was improved from 4.2+/-1.7 to 9.4+/-0.9, active forward flexion score, from 3.7+/-0.5 to 5 and strength score, from 4.0+/-0.9 to 4.9+/-0.2. On follow-up radiographic examination, there was no specific complication, including heterotopic ossification, remnant bony fragment of distal clavicle, and superior migration of the clavicle. CONCLUSION: It is considered that arthroscopically assisted en bloc resection of the distal clavicle and acromioplasty is recommendable method for symptomatic acromioclavicular joint lesion and rotator cuff lesion, which could get the satisfactory clinical results.

Chronic Finger Tip Pain / 대한류마티스학회지

No abstract available.