• Clinics in Shoulder and Elbow
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• v.14 no.1
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• pp.59-66
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• 2011

Purpose: We wanted to evaluate the clinical and radiological outcomes and the prognosis of various surgical treatments for the distal clavicle fracture with an acromioclavicular joint injury. Materials and Methods: A retrospective study of 21 patients with a minimum of 12 months follow up was done. We classified acromioclavicular (AC) injury into type I (only intra-articular fracture (IAF), 5 cases), type II (IAF with widening of the AC joint > 7 mm, 9 cases) and type III (IAF with AC joint superior subluxation > 50%, 7 cases). The distal clavicle fractures were fixed using plate (9 cases), mini screws (1 case), K wire and tension band wiring (10 cases) and transarticular pinning (1 case). Acromioclavicular or coracoacromial ligament reconstruction was not done in all the cases. Results: In 20 of 21 cases, bone union was achieved at an average of 8.4 weeks. Traumatic arthritis (5 cases), AC joint widening (4 cases) and AC joint subluxation (2 cases) were noted at the last follow up. The average UCLA score was 32.6 in the type I AC joint injuries, 34 in type II and 34.1 in type III. There was no relationship between the clinical outcomes and the preoperative AC joint injury pattern, postoperative traumatic arthritis, AC joint widening or AC joint subluxation (p>0.05). Conclusion: Satisfactory results were achieved by acute reduction and firm fixation of the distal clavicle fracture with AC joint injury. There was no relationship between the pattern of AC joint injury, the residual radiologic findings and the functional outcome.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.3 no.1
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• pp.26-31
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• 2010

Purpose: The purpose of this study is to evaluate the clinical usefulness of ultrasound in treatment of patella fracture. Material and Methods: Twenty cases of twenty patients with patella fracture radiographically from March, 2006 to September, 2009 were involved in this study, there were 8 males and 12 females, there were 13 right knees, 7 left knees, the average age was 43 years (range, 14~72 years). We decided the methods of treatment by using the ultrasound in conjunction with Drayer's test that examining the intactness of patella retinaculum. There were 10 transverse, 8 vertical and 2 comminuted fractures, we examined the patella retinaculum by using the ultrasound and performed Drayer's test. Results: In 12 cases of intact retinaculum, Drayer's test was negative and we allowed patients ambulation without surgical fixation especially. In 4 cases of completely ruptured retinaculum, Drayer's test was positive and we treated the patella fractures by the use of ORIF (open reduction and internal fixation) method, in 2 cases of partially ruptured retinaculum, Drayer's test was negative but displacement of fractures were more than 2 mm, we treated the patella fractures by the use of CRIF (closed reduction and internal fixation) method and obtained clinically satisfactory results. Conclusion: In conjunction with radiographs and Drayer's test, an ultrasound would be one of the useful diagnostic modality for determining treatment method of the patella fracture.

• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.135-140
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• 2013

We report a case of recurrent shoulder dislocation and combined proximal humerus fracture in neurofibromatosis type I. A twenty-year-old male patient with known neurofibromatosis type I presented with right shoulder dislocation and proximal humerus fracture following a minor trauma. His injured arm also had large plexiform neurofibromas on the elbow, and the dislocation of the shoulder joint was proven to be recurrent. Bony deformation of the humerus and scapula were revealed on X-ray and computed tomography, as well as multiple neurofibromatic changes of the deltoid and periscapular muscles were noted on magnetic resonance imaging. Open reduction and capsular reconstruction were performed and humeral fracture was stabilized with a reconstruction plate. Satisfactory union and functional result were achieved and the dislocation did not recur until the 7-month followup after the procedure. Recurrent shoulder dislocation and combined proximal humerus fracture in neurofibromatosis type I are rare complications. However, it should still be considered in the orthopaedic evaluation process of the diseases.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.92-98
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• 2007

Introduction: The treatment of proximal humeral fracture is traditionally determined by Neer's classification system. The severely displaced three-part or four-part fracture is an indication for primary hemiarthroplasty. The current authors report the clinical results of 10 patients who received hemiarthroplasty for proximal comminuted fractures. The minimum follow-up period was 12 months. Materials and Methods: The current authors studied 10 patients who, between July 1999 and March 2005, each received hemiarthroplasty for a proximal humeral fracture of one shoulder. According to Neer's classification system, 5 of the patients had three-part fractures, and 5 of the patients had 4-part fractures. The mean interval between trauma and hemiarthroplasty was 6.1 days. The mean age of the 6 female and 4 male patients was 67.4 years(range: 56 to 76). Shoulder function was evaluated using the Constant score, the Simple Shoulder Test, and the modified UCLA score. Results: The mean Constant score was 51.4(range: 34 to 60). The mean modified SST score was 7.8 out of 12 tasks. Excluding the one patient who had also sustained an axillary artery rupture and a brachial plexus injury after the initial trauma, the mean Constant score for the remaining 9 patients was 53.5(range: 44 to 60), and the mean SST score was 7.2 tasks. The modified UCLA score averages for pain, function, and active forward flexion and strength were, respectively, 8.2($6{\sim}10$), 6.6($2{\sim}8$), and 6.9($4{\sim}8$). The total UCLA score was an average of 21.7($12{\sim}26$). Patients' the modified UCLA ratings were as follows: Excellent: 3, Good: 6, and Poor: 1. The patient with the poor outcome was the one who had also sustained the neurovascular injury. Patient's subjective satisfaction rating were as follows: Excellent: 2, Good: 7, and Poor: 1. Conclusion: Based on short term follow-up results, this study indicates that hemiarthroplasty is the treatment of choice for proximal humeral fractures on which it would be difficult to perform open reduction and internal fixation. Hemiarthroplasty is a useful treatment modality to prevent shoulder stiffness and to allow daily living tasks in elderly patients. However, restoration of muscle power and range of joint motion were not recovered satisfactorily.

• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.107-114
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• 2013

Purpose: This study is designed to evaluate the clinical and radiographical results for the displacement of fracture fragments after interlocking intramedullary nailing in humeral shaft fractures. Materials and Methods: We retrospectively reviewed the results of 8 cases of humeral shaft fractures that have displacements of over 10 mm and under 20 mm after interlocking intramedullary nailing between July 2004 and August 2011. The mean age was 54.1 years (range, 43 to 70 years) and there were 3 male and 5 female patients. Radiographically, the time to bony union, change of displacement and angulation of the fracture site, and degree of improvement of these two factors were measured. Clinically, the range of motion of shoulder and elbow joints, postoperative pain and complications were evaluated. Results: All cases showed complete bony union in last follow-up. The mean time to bony union was 16.1 weeks. At the last follow-up, almost all cases had normal range of motion of shoulder and elbow joints. But, one case had stiffness of shoulder joint. Therefore, arthroscopic capsular release and manipulation was performed. One case had transient shoulder pain and the other case had transient elbow pain. In the two cases, pull-out of proximal interlocking screw were noted, but they finally had bony union. Conclusion: Although considerable displacement of fracture fragments after interlocking intramedullary nailing in humeral shaft fractures was present, we had excellent radiographical and clinical outcomes. Therefore, an additional procedure, such as open reduction or another fixation for the fracture site, was not necessary.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.220-226
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• 2007

Purpose: The distal clavicle has a biomechanical structure different from that of the proximal or middle 1/3 clavicle, and delayed union or nonunion occurs frequently in a distal clavicle fracture. The authors obtained favorable results from an open reduction and bone grafting of the distal clavicle nonunion. We report the results together with review of the relevant literature. Materials and Methods: The subjects were 8 patients(average age, 38.9) who had undergone surgery for distal clavicle nonunion from August 2003 to May 2006. Nonunion occurred after surgical treatment in 4 cases, and after conservative treatment in the other 4. In all cases, the patients complained of pain. Results: The mean follow-up duration was 14 months, and radiological union was observed in 8 weeks on average. In all cases, the range of shoulder joint motion was normal at the end of the follow-up observation. In the functional evaluation, 7 cases showed excellent results and 1 case showed good results. Conclusion: Surgical treatment is a safe and reliable treatment for distal clavicle fracture nonunion because it can achieve early rehabilitation and union.

• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.143-147
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• 2012

A triple disruption of the SSSC, an extremely rare injury, has been reported by only a few authors. We present a patient who had sustained a triple disruption of the SSSC: coracoid and scapular spine fractures, and an acromioclavicular joint separation. Treatment consisted of an anatomical restoration of the SSSC, with maintenance of the acromiohumeral and coracohumeral distances; this was achieved by open reduction and internal fixation of the fractures and of the separation. Six months after surgery, the injured shoulder was asymptomatic, with full range of motion. Five years after surgery, at the final follow-up, the function of the SSSC had been restored to the patient's complete satisfaction.

• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.230-235
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• 1998

Fractures of the scapula are relatively uncommon injuries and treatment in the vast majority of cases remains nonsurgical and the results have been quite satisfactory. But the scapular fracture itself may be neglected because of its high incidence of many kinds of associated injuries so its delayed treatment sometimes gives bad and unpredictable results. Although open reduction and internal fixation has been accepted as the treatment of choice for displaced intra-articular fractures in many anatomical regions, there has been no definite treatment principles of surgical indications and approaches in the glenohumeral joint. At our institution, II displaced intra-articular fractures of the glenohumeral joint were treated with open reduction and internal fixation from March 1993 to February 1997. This paper reports the results of treating 11 displaced intra­articular fractures of the glenoid by open reduction and internal fixation. There were 10 men and one woman and the fractures were classified according to Ideberg : Type Ⅰa(4), Type Ⅱ(3), Type Ⅲ(1), Type IV(1), Type Va(1), and Type Vc(1).

• Journal of the Korean Arthroscopy Society
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• v.6 no.1
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• pp.31-36
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• 2002

Objective : The purpose of this study was to evaluate the clinical and radiological results after treatment of old ACL(anterior cruciate ligament) avulsion fracture of tibia. Materials and Method : 11 cases who were followed up at least 2 years after treatment in chronic ACL avulsion fracture of tibia were included in this study. The average age of patients was 26(9-66) years and the mean period of follow up was 53(24-131) months. After evaluation of the lesion and treatment of associated lesion under arthroscope, open reduction and internal fixation or fragment removal was performed. Pull-out suture was performed in 8 cases, screw fixation in 2 cases. Results : The Lysholm knee score was 64.3 in average preoperatively and improved to 96.2 average at follow up. On the Lachman test, there were mild(+) instabilities in 7 cases, moderate(++) in 4 cases. On the postoperative Lachman test, there were no instabilities in 9 cases, mild(+) instabilities in only 2 cases. According to Meyers and Mckeever's evaluation protocol, 9 cases $(81.8\%)$ were excellent, 2 case $(18.2\%)$, good. On preoperative instrumented anterior laxity test with $Telos^{\circledR}$, side to side difference in 201b was 7.8(10-4) min in average and 2.1(6-0) mm in average at follow-up. Conclusion : In chronic ACL avulsion fracture, it is thought that combination of arthroscopic evaluation of associated injury and open reduction and fixation and fragment removal can bring about satisfactory results.

• Clinics in Shoulder and Elbow
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• v.9 no.2
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• pp.189-195
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• 2006

Purpose: To analyze the result of the accurate open reduction of acromioclavicular (AC) joint and pin fixation, coracoclavicular (CC) screw fixation without CC ligament repair for AC joint injuries. Materials and Methods: Between January 2000 and December 2003, seventeen cases with at least one year follow-up among twenty-one cases underwent operation for AC-CC ligament injuries. A transverse incision approximately 5 cm in length was made over the clavicle, and the AC joint was reduced accurately. Under the image intensifier, a cannulated screw and washer were inserted for the CC ligament. Two Steinman pins were inserted for the AC joint and the AC ligament was repaired with nonabsorbable suture. Gentle passive range of motion was begun postoperative 2 weeks. The pins were removed at $6{\sim}8$ weeks and the screw was removed at $10{\sim}12$ weeks. The results were evaluated by a distance between AC and CC joints on plain films and ASES score at last follow-up. Results: At the last follow-up, there was no limitation of motion and average ASES score was 96($86{\sim}100$ points). There was no failure showing over 5 mm difference of distance compared to opposite side on the plain films. Seven cases had the skin damages and local infection due to pin migration and three cases showed the loosening of CC screw. Conclusion: We could have satisfactory results by accurate reduction of AC joint and simple pins and screw fixation for AC-CC ligament injuries.