Clinical Results of the Arthroscopic “Multiple Pulled Suture” Technique for Large or Comminuted Bony Bankart Lesion

BACKGROUND: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. METHODS: Ten patients (mean age, 49.8 years; range, 31–79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. RESULTS: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6–10 points). CONCLUSIONS: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates.

Erratum: Comparison of the Result of the Intramedullary Nail Fixation and Plate Fixation in Humeral Shaft Fracture with Butterfly Fragments / 대한스포츠의학회지

The corresponding author of the article should be corrected as Hyeung-June Kim.

Clinical Results of the Arthroscopic “Multiple Pulled Suture” Technique for Large or Comminuted Bony Bankart Lesion

BACKGROUND: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. METHODS: Ten patients (mean age, 49.8 years; range, 31–79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. RESULTS: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6–10 points). CONCLUSIONS: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates.

Comparison of the Result of the Intramedullary Nail Fixation and Plate Fixation in Humeral Shaft Fracture with Butterfly Fragments / 대한스포츠의학회지

First aim of this study was to compare the results of the intramedullary nail fixation and plate fixation for the management of humeral shaft fracture with butterfly fragments. Second aim of this study was to appraise the necessity of anatomical reduction and fixation for butterfly fragment in humeral shaft fracture. Thirty-one patients with comminuted humeral shaft fracture were treated by reduction and internal fixation with intramedullary nail or plate. The criteria for inclusion were AO classification type B, follow-up period more than 12 months, diaphyseal fracture without involvement of joints. Eighteen patients underwent intramedullary nail fixation and 13 by plate fixation. The outcome was assessed in terms of the union rate, union time, incidence of complications, and functional outcome of shoulder joint. The union rate was 94.4% in intramedullary nail group and 100% in plate group. The average union time was found to be no significant difference between two groups (p>0.05). There was no significant difference in the American Shoulder and Elbow Surgeons' score and range of motion of shoulder and elbow joint between the two groups in last follow-up (p>0.05). The union rate and average union time and functional outcome of shoulder joint was no significant difference between the intramedullary nail fixation and plate fixation for the management of humeral shaft fracture with butterfly fragments. It is recommended to select skillful technique to avoid technical errors rather than technique to fix of butterfly fragments.

Comparison of Magnetic Resonance Imaging of Remnant Preserving versus Remnant Sacrificing Technique after Anterior Cruciate Ligament Reconstruction; Clinical Results and Second-Look Arthroscopic Findings: Pilot Study / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to clarify the difference between the remnant-preserving and remnant-sacrificing techniques in anterior cruciate ligament (ACL) reconstruction using stress test, functional score, 2nd look arthroscopy and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Among 66 patients having anatomical ACL reconstruction with the fourstrand hamstring autograft using outside-in technique (FlipCutter(R)) for the femoral tunnel from April 2012 to April 2014, 23 patients who underwent 2nd look arthroscopy and MRI were included. The remnant-preserving group included 12 patients and the remnant-sacrificing group included 11 patients. The two groups were compared and analyzed with regard to stability (Stress test using GNRB(R), pivot shift test), functional assessment (International Knee Documentation Committee [IKDC] scale, Lysholm score, one leg hoop test), and the result of second-look arthroscopy and signal to noise quotient (SNQ) ratio of the graft in MRI. RESULTS: The two groups did not differ significantly in the stability test, IKDC scale, and Lysholm test. The remnant-preserving group showed significant improvement in one leg hoop test compared with the remnant-sacrificing group (p0.05). CONCLUSION: More than 12 months after surgery, the graft of the remnant-preserving group showed lower signal intensity compared to that of the remnant-sacrificing group by MRI evaluation. The remnant preserving technique has biological difference compared with the remnant sacrificing technique in human study.

Recurred Multiple Intraarticular Synovial Hemangioma of the Knee: Case Report / 대한정형외과연구학회지

Synovial hemangioma is a rare benign intraarticular tumor. Synovial hemangioma of the knee joint has unspecific symptoms, which are pain, limitation of motion and hemarthrosis, often seen as an internal derangement of the knee. A 24-year-old woman presented with intermittent joint effusion and pain of the left knee joint and physical examination revealed slight atrophy of the quadriceps and tenderness around lateral joint line of knee. The patient was performed arthroscopic surgery due to synovial hemangioma about 17-years ago. Magnetic resonance imaging (MRI) showed the synovial hemangioma from Hoffa fat pad to anterior aspect of lateral meniscus, and thus surgical treatment was planned. Arthroscopic excision was performed and additional lesion was observed in lateral gutter, suprapatellar pouch of the knee. The biopsy confirmed the diagnosis of synovial hemangiomas. After 3 year, the patient was completely asymptomatic and showed no signs of recurrence.

Assessment of the Clinical Features of Bilateral Sequential Hip Fractures in the Elderly / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the clinical features after treating of bilateral sequential hip fractures in the elderly. MATERIALS AND METHODS: We reviewed the clinical records of 21 patients who were older than 75 years and who underwent bilateral bipolar hemiarthroplasty for sequential hip fractures between March 1999 and November 2005. The minimum follow up period was 2 years. We analyzed the results by conducting radiological and clinical evaluations such as assessing the patient's walking ability, the activities of daily living, the mechanism of fracture and the associated medical conditions and arthritis. RESULTS: Walking ability was recovered by 18 cases of primary fracture and by 14 cases of sequential fracture. Return to the activities of daily living was achieved by 14 cases of primary fracture and by 14 cases of sequential fracture. The fracture mechanism was a fall/slip in 20 cases and a fall from a height in 1 case. The associated arthritis was in the spine in 14 cases, the knee in 11 cases, the shoulder in 8 cases and Hallux valgus in 5 cases, and the associated medical conditions were mainly urge incontinence in 17 cases and cardiovascular disease in 16 cases. The other previous fractures were spine compression fracture in 11 cases, ankle fracture in 6 cases, distal radius fracture in 5 cases and pelvic ramus fracture in 2 cases. CONCLUSION: Preventing recurrent falls plays a role in preventing bilateral sequential hip fractures. We think that the treatment of curable associated medical conditions and arthritis is necessary to prevent recurrent falls.

Shoulder Operation

Although shoulder pain is a very common problem and compromised shoulder movement due to pain, stiffness, or weakness can cause substantial disability, many patients fail to recognize a need for a proper treatment. The diagnosis and treatment of the shoulder should be specified for each of the disease entity. Most of shoulder pain can be managed non-operatively with a well-organized rehabilitation program. However, the surgery should always remain as an option in case of failure of conservative managements, which can be seen from a definite indication of a patient's condition. The article presents four representative disease entities other than shoulder trauma occurring in old age which doctors see most often at outpatient's clinics. Impingement syndrome, rotator cuff tear, calcifying tendonitis, and arthritis are described in this article, introducing each diseases and surgical indications and descriptions, and their results.

Bipolar Hemiarthroplasty for Femoral Basicervical Fractures in the Elderly

PURPOSE: To evaluate the results of the treatment of femoral basicervical fractures aged 75 years or older. MATERIALS AND METHODS: We reviewed the clinical records of 60 patients who were older than 75 years and who underwent bipolar hemiarthroplasty for femoral basicervical fractures using calcar replacement stem between March 1999 and November 2005. The minimum follow up period was 2 years. We analyzed the results by conducting radiological and clinical evaluations such as assessing the patient's walking ability and modified Harris hip score, the activities of daily living, the associated medical conditions and arthritis, and postoperative disgnosis. RESULTS: The mean Harris hip score were 87.2 (74~92). Walking ability was recovered in 91% (55 cases) and activity of daily living was achived in 91% (55 cases). Press-fit fixations were 56 cases and bony ingrowth fixations were 57 cases. Stress shields were 28% (17 cases). Thigh pains were 5% (3 cases) and revision rate was 3% (2/60 cases). CONCLUSION: We consider bipolar hemiarthroplasty using calcar replacement stem in femoral basicervical fractures in the Elderly with severe osteoporosis is the useful treatment in view of the stable and rigid fixation of femoral stem, early ambulation, and the low rate of complications and death, even if the operation is technically very difficult.

Risk Factors Predicting Hip Fractures in Patients Over 70 Years Old

PURPOSE: We conducted a retrospective case-control study to evaluate the factors predictive of hip fractures in elderly patients. MATERIALS AND METHODS: We studied 172 patients age 70 years or older who sustained hip fractures with minor injuries between January 2002 and January 2007. We analyzed bone mineral density, comorbidities, body mass index, and the activities of daily living (ADL) scale. One hundred eighty patients (control subjects) with no history of fracture were matched to the study subjects with respect to age and sex. RESULTS: Multivariate logistic regression showed that female sex, low bone mineral density, high ADL scale, cerebral vascular attack, and knee osteoarthritis were associated with an increased incidence of hip fracture. CONCLUSION: Female sex, low bone mineral density, and high ADL scale were related to hip fractures in the elderly. Knee osteoarthritis should be regarded as an independent risk factor for fractures because of an increased risk of falling.